Browsing by Author "Fabres Biggs, Jorge Guillermo Eduardo"

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    Factors associated with survival and survival without major morbidity in very preterm infants in two neonatal networks: SEN1500 and NEOCOSUR
    (S. Karger A.G., 2021) García-Muñoz Rodrigo, Fermín; Fabres Biggs, Jorge Guillermo Eduardo; Tapia Illanes, José Luis; D'apremont Ormeño, Ivonne; San Feliciano, Laura; Zozaya Nieto, Carlos; Figueras Aloy, Josep; Mariani, Gonzalo; Musante, Gabriel; Silvera, Fernando; Zegarra, Jaime; Vento, Máximo
    Introduction: Very low-birth weight (VLBW) infants represent a high-risk population for morbidity and mortality in the neonatal period. Variability in practices and outcomes between centers has been acknowledged. Multicenter benchmarking studies are useful to detect areas of improvement and constitute an interesting research tool. Objectives: The aim of the study was to determine the perinatal variables and interventions associated with survival and survival without major morbidity in VLBW infants and compare the performance of 2 large networks. Methods: This is a prospective study analyzing data collected in 2 databases, the Spanish SEN1500 and the South American NEOCOSUR networks, from January 2013 to December 2016. Inborn patients, from 24(0) to 30(6) weeks of gestational age (GA) were included. Hazard ratios for survival and survival without major morbidity until the first hospital discharge or transfer to another facility were studied by using Cox proportional hazards regression. Results: A total of 10,565 patients, 6,120 (57.9%) from SEN1500 and 4,445 (42.1%) from NEOCOSUR, respectively, were included. In addition to GA, birth weight, small for gestational age (SGA), female sex, and multiple gestation, less invasive resuscitation, and the network of origin were significant independent factors influencing survival (aHR [SEN1500 vs. NEOCOSUR]: 1.20 [95% CI: 1.15-1.26] and survival without major morbidity: 1.34 [95% CI: 1.26-1.43]). Great variability in outcomes between centers was also found within each network. Conclusions: After adjusting for covariates, GA, birth weight, SGA, female sex, multiple gestation, less invasive resuscitation, and the network of origin showed an independent effect on outcomes. Determining the causes of these differences deserves further study.
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    The unfinished work of neonatal very low birthweight infants quality improvement: Improving outcomes at a continental level in South America
    (2021) Tapia Illanes, José Luis; Toso, Alberto; Vaz Ferreira, C.; Fabres Biggs, Jorge Guillermo Eduardo; Musante, G.; Mariani, G.; Herrera, T., I; D'Apremont, Ivonne
    Neonatal mortality rate varies between 4.2 and 18.6 per thousand by country in South America. There is little information regarding the outcomes of very low birth weight infants in the region and mortality rates are extremely variable ranging from 6% to over 50%. This group may represent up to 50-70% of the neonatal mortality and approximately 25-30% of infant mortality. Some initiatives, like the NEOCOSUR Network, have systematically collected and analyzed epidemiological information on VLBW infants' outcomes in the region. Over a 16-year period, survival without major morbidity improved from 37 to 44%. However, mortality has remained almost unchanged at approximately 27%, despite an increase in the implementation of the best available evidence in perinatal practices over time. Implementing quality improvement initiatives in the continent is particularly challenging but represents a great opportunity considering that there is a wide margin for progress in both care and outcomes.
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    Vernix caseosa reveals mechanistic clues linking maternal obesity to atopic dermatitis pathogenesis
    (2023) Arenas Cabalín, Carolina Andrea; Dibarrart Duhalde, Marisol; Núñez Rosales, Juan José; Faunes Pérez, Miriam Elizabeth; Avaca Bengochea, Mónica; Ávalos Odano, Patricia De Las Mercedes; Fabres Biggs, Jorge Guillermo Eduardo; Álvarez Figueroa, María Javiera; Vera Kellet, Cristián Andrés; Silva Valenzuela, Sergio; Sáez Steeger, Claudia; Borzutzky Schachter, Arturo José
    Background Maternal overweight and obesity have been associated with an increased risk of atopic dermatitis (AD) in the offspring, but the underlying mechanisms are unclear. Vernix caseosa (VC) is a proteolipid material covering the fetus produced during skin development. However, whether maternal prepregnancy weight excess influences fetal skin development is unknown. Characterizing the VC of newborns from mothers with prepregnancy overweight and obesity might reveal AD-prone alterations during fetal skin development.ObjectiveWe sought to explore AD biomarkers and staphylococcal loads in VC from the offspring of mothers who were overweight/obese (O/O) before pregnancy versus in those from offspring of normal weight mothers.MethodsThe VC of newborns of 14 O/O and 12 normal weight mothers were collected immediately after birth. Biomarkers were determined by ELISA and staphylococcal species by quantitative PCR.ResultsThe VC from the O/O group showed decreased expression of skin barrier proteins (filaggrin and loricrin) and increased levels of proinflammatory biomarkers (IgA, thymic stromal lymphopoietin [TSLP], S100A8, IL-25, and IL-33). No differences in concentrations of antimicrobial peptides and enzymes were detected. The VC from the O/O group had a lower Staphylococcus epidermidis and Staphylococcus hominis commensal bacterial load, whereas Staphylococcus aureus bacterial load was not significantly different between the 2 groups. Maternal body mass index was negatively correlated with VC filaggrin expression and S epidermidis load and was positively associated with TSLP concentration. One-year follow-up established that the offspring of O/O mothers had a higher incidence of AD that was specifically linked with decreased VC filaggrin expression and lower S epidermidis load.ConclusionsVC from neonates of mothers with prepregnancy overweight and obesity exhibit skin barrier molecular alterations and staphylococcal dysbiosis that suggest early mechanistic clues to this population’s increased risk of AD.