Browsing by Author "Toso, Alberto"

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    Antenatal exposure to magnesium sulfate and neonatal outcomes in very low birth weight infants: a multicenter study
    (2024) Vaz Ferreira, Catalina; Caro, Jose; Villarroel del Pino, Luis A.; Muñoz, Sergio; Álvarez, Patricia; Flores, Gerardo; Herrera, Tamara; Toso, Alberto; Toso Milos, Paulina Alejandra; Tapia Illanes, José Luis; NEOCOSUR Neonatal Network
    Objective: To explore the association between antenatal magnesium sulfate (MgSO4), mortality and incidence of intraventricular hemorrhage (IVH) in very low birth weight (VLBW) infants. Study design: Retrospective, cohort study of infants <32 weeks’ GA born at centers of NEOCOSUR Network between January 2015 and December 2020. Subjects were categorized as exposed vs non-exposed to antenatal MgSO4. Primary outcomes were death, incidence of severe IVH (Grade III-IV) and severe IVH/death. Secondary outcomes included relevant morbidities. Results: 7418 VLBW infants were eligible. Antenatal MgSO4 was associated with a significantly decreased death rate after admission (aOR 0.67 [95% CI, 0.49–0.94]) and severe IVH/ death (aOR 0.68 [95% CI, 0.50–0.93]). No significant reduction in severe IVH was observed (aOR 1.11 [95% CI, 0.72–1.71]). No differences between groups were observed in rates of morbidities. Conclusion: Antenatal MgSO4 was associated with a decreased death rate after admission and in severe IVH/ death.
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    Congenital diaphragmatic hernia: phosphodiesterase-5 and Arginase inhibitors prevent pulmonary vascular hypoplasia in rat lungs
    (2022) Toso, Alberto; Aranguiz, Óscar; Cespedes, Carlos; Navarrete, Orieta; Hernández, Cherie; Vio, Carlos P.; Luco Illanes, Matías Fernando; Casanello Toledo, Paola Cecilia; Kattan Said, Alberto Javier
    Background Severe pulmonary hypoplasia related to congenital diaphragmatic hernia (CDH) continues to be a potentially fatal condition despite advanced postnatal management strategies. Objective To evaluate the effect of the antenatal sildenafil and 2(S)-amino-6-boronohexanoic acid (ABH-Arginase inhibitor) on lung volume, pulmonary vascular development, and nitric oxide (NO) synthesis in a Nitrofen-induced CDH rat model. Methods Nitrofen-induced CDH rat model was used. Nitrofen was administrated on embryonic day(E) 9,5. At E14, five intervention groups were treated separately: Nitrofen, Nitrofen+Sildenafil, Nitrofen+ABH, Nitrofen+Sildenafil+ABH and Control. At term, offspring's lungs were weighed, some paraffin-embedded for histology, others snap-frozen to analyze eNOS, Arginase I-II expression, and activity. Results In CDH-bearing offsprings, ABH or Sildenafil+ABH preserved the total lung/body-weight index (p < 0.001), preventing pulmonary vascular smooth muscle cell hyperproliferation and improving lung morphometry. Sildenafil+ABH increased 1.7-fold the lung nitrite levels (p < 0.01) without changes in eNOS expression. Sildenafil and ABH improved the number of pulmonary vessels. Conclusion These results suggest that in this CDH rat model, the basal activity of Arginase participates in the lung volume and, together with phosphodiesterase-5, regulates NOS activity in the term fetal lung. The combined treatment (Sildenafil+ABH) could revert some of the pulmonary features in CDH by improving the local NO synthesis and preventing smooth muscle cell hyperproliferation. Impact This study presents Arginase inhibition as a new therapeutic target and the importance of the combined antenatal treatment to improve pulmonary vascular development in a congenital diaphragmatic hernia (CDH) rat model. This study shows that the action of an Arginase inhibitor (ABH) enhances the effects already described for sildenafil in this model. These results reinforce the importance of prenatal treatments' synergy in recovering the hypoplastic lung in the Nitrofen-induced CDH rat model.
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    Estrategias de prevención de infecciones tardías en unidades de cuidados intensivos neonatales
    (2019) Toso, Alberto
    Introducción: la sepsis tardía (ST) sigue siendo un problema relevante en las unidades de cuidados intensivos de neonatología (UCIN), especialmente en recién nacidos (RN) menores de 1500 g o RN de muy bajo peso al nacer (RNMBPN). Método: se realizó una búsqueda de la mejor evidencia disponible respecto a las estrategias de prevención de infecciones en unidades de cuidados intensivos neonatales. Resultados: se han descrito diversas estrategias para intentar disminuir su incidencia, entre estas se incluye el uso de vacunas en el embarazo, profilaxis con fluconazol y uso de probióticos. Han demostrado utilidad otras medidas destinadas a reducir y racionalizar el uso de antibióticos, la creación de equipos especializados y la incorporación de bundles a la práctica clínica. Conclusiones: Este artículo resume la evidencia actualmente disponible y proporciona herramientas que pueden ser utilizadas en la práctica cotidiana dentro de las UCIN.
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    Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate
    (ELSEVIER, 2023) Carvajal, Jorge; Casanello, Paola; Toso, Alberto; Farias, Marcelo; Carrasco-Negue, Karina; Araujo, Kenny; Valero, Paola; Fuenzalida, Javiera; Solari, Caterina; Sobrevia, Luis
    The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non -viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.
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    Mechanical ventilation and survival without major morbidities in Very-Low-Birth-Weight Infants: a multicenter study
    (2023) Toso, Alberto; Kuzmanic, Daniela; Domínguez, Angélica; González, Álvaro; Herbozo, Cecilia; Brener Dik, Pablo Hernán; Ahumada, Luis Alberto; Méndez, Álvaro; Aburto, Claudia; Tapia Illanes, José Luis
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    Mortality in very low birth weight (VLBW) infants in South American NEOCOSUR Neonatal Network: timing and causes
    (2022) Toso, Alberto; Vaz Ferreira, C.; Herrera, T.; Villarroel del Pino, Luis A.; Brusadin, M.; Escalante Rivas, María José; Masoli, Daniela; D'Apremont, Ivonne; Tapia Illanes, José Luis; Mariani, G.
    Sociedad Argentina de Pediatría.INTRODUCTION: Mortality in very low birth weight infants (VLBWIs) has remained at ~26% in the past 16 years in the NEOCOSUR Neonatal Network. OBJECTIVE: Mortality in very low birth weight infants (VLBWIs) has remained at ~26% in the past 16 years in the NEOCOSUR Neonatal Network. POPULATION AND METHODS: Observational, multicenter cohort study; retrospective analysis of data collected prospectively. Newborn infants born between 24 and 31+6 weeks of gestation age with a birth weight between 500 and 1500 g in the 26 sites of the NEOCOSUR Neonatal Network were included. The causes of death were analyzed depending on whether they occurred in the delivery room (DR) or in the neonatal intensive care unit (NICU). The postnatal age at time of death was determined using the KaplanMeier test. RESULTS: Observational, multicenter cohort study; retrospective analysis of data collected prospectively. Newborn infants born between 24 and 31+6 weeks of gestation age with a birth weight between 500 and 1500 g in the 26 sites of the NEOCOSUR Neonatal Network were included. The causes of death were analyzed depending on whether they occurred in the delivery room (DR) or in the neonatal intensive care unit (NICU). The postnatal age at time of death was determined using the KaplanMeier test. CONCLUSIONS: Important differences were observed in the causes of death of VLBWIs depending on their occurrence in the DR or the NICU. Infectious and respiratory conditions were the most relevant factors following admission to the NICU.Introducción. La mortalidad de los recién nacidos de muy bajo peso de nacimiento (RNMBPN) se ha mantenido en ~26 % en los últimos 16 años en la Red Neonatal NEOCOSUR. Objetivo. Determinar la causa de muerte de los RNMBPN y su temporalidad en el período 20072016 en la Red Neonatal NEOCOSUR. Población y métodos. Estudio observacional de cohorte multicéntrica; análisis retrospectivo de datos obtenidos prospectivamente. Se incluyeron recién nacidos entre 24 y 31+6 semanas de edad gestacional y peso de nacimiento de 500-1500 g, en 26 centros de la Red Neonatal NEOCOSUR. Las causas de muerte se analizaron según ocurriera en sala de partos (SP) o durante la estadía en la unidad de cuidados intensivos neonatales (UCIN). La edad posnatal de muerte se determinó a través de análisis de Kaplan-Meier. Resultados. Se incluyeron un total de 11753 RNMBPN con una mortalidad global del 25,6 %. Las causas de muerte predominantes en SP fueron malformaciones congénitas (43,3 %), enfermedades respiratorias (14,3 %) y prematuridad (11,4 %). Las causas de muerte predominantes en UCIN fueron las respiratorias (24,2 %) e infecciosas (24,1 %). La edad promedio de muerte fue de 10,2 días y mediana de 4 días. El 10,2 % de las muertes ocurrieron en SP; el 21,5 %, durante el primer día; el 52 % ocurrió en los primeros 4 días y el 63,8 %, durante la primera semana de vida. , A través de los años, la mortalidad de los recién nacidos de muy bajo peso de nacimiento (RNMBPN) se ha mantenido estable, en torno al 26 % en la Red Neonatal NEOCOSUR.1 Esta mortalidad es mayor que la reportada por otras redes neonatales de países desarrollados. Así, los datos de la Red Suiza dan cuenta de una mortalidad de solo un 11 % entre los años 2012 a 2014 para el mismo grupo de recién nacidos.2 La red internacional iNEO, que agrupa 10 redes a lo largo del mundo, describe una mortalidad global del 9,1 % en RNMBPN de entre 24 a 32 semanas de edad gestacional entre los años 2007 y 2015.3 Por otra parte, la Red Neonatal Brasilera informa una mortalidad de 30 % en RNMBPN.4 f. Red Neonatal del Cono Sur (www. neocosur.org). Correspondencia: Alberto Toso: aatoso@ uc.cl Financiamiento: Ninguno. Conflicto de intereses: Ninguno que declarar. Recibido: 12-8-2021 Aceptado: 12-1-2022 Conclusiones. Se encuentran importantes diferencias en las causas de muerte de RNMBPN según ocurra en SP o en UCIN. Las infecciosas y respiratorias son las más relevantes luego del ingreso a la unidad de cuidados intensivos.
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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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    Utilidad del tromboelastograma en pediatría: correlación con pruebas habituales de la coagulación
    (2019) Sepúlveda Varela, Pablo Andrés; Salgado, Andrea P.; Barriga Gonzaga, José Eduardo; Toso, Alberto; Rojas B., Felipe; Aguirre Rioseco, Noemí Doris; Zúñiga Contreras, Pamela Alejandra
    Los exámenes habituales de coagulación evalúan distintos elementos de la hemostasia en forma parcial, y no traducen las interacciones celulares, lo que es especialmente sensible en pacientes críticos.Las técnicas viscoelásticas, como el tromboelastograma (TEG) muestran el proceso de coagulacióncompleto, y están siendo evaluadas como exámenes de la coagulación global. Objetivo: determinarla correlación de los exámenes habituales de coagulación con los valores del TEG, en niños atendidosen una unidad de cuidados intensivos (UCI). Pacientes y Método: Se revisaron 238 TEG de pacientes<18 años, con evidencia de alteración de coagulación clínica y/o de laboratorio, hospitalizados en UCI. Se correlacionaron los valores de los parámetros del TEG con cada uno de los valores de los exámenes habituales de coagulación. Los exámenes se obtuvieron según protocolo, utilizando una muestra de sangre de 4,5 ml para TEG con equipo TEG® 5000 Thrombelastograph Hemostasis System, mediante un transductor electromagnético que permite la medición de la resistencia durante la formación y lisis del coágulo. El recuento de plaquetas se obtuvo utilizando método automatizado o microscopía con contraste de fase; el fibrinógeno, tiempo de protrombina y de tromboplastina parcial activada por métodos nefelométricos. Resultados: 201 TEGs correspondientes a 59 pacientes.Se evidenció una correlación moderada a baja en todos los parámetros medidos. No se encontró correlación entre porcentaje de lisis del coágulo, ni firmeza del coágulo. Conclusiones: Existe una baja correlación entre la información entregada por TEG y los exámenes de coagulación habituales, esto sugiere que el TEG aporta información diferente acerca del estado de coagulación de los pacientes críticos evaluados.
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    Vasopressin as adjunctive therapy in pulmonary hypertension associated with refractory systemic hypotension in term newborns
    (2022) Santelices Ruíz, Felipe; Masoli, Daniela; Kattan Said, Alberto Javier; Toso, Alberto; Luco Illanes, Matías Fernando
    Abstract Objective. The aim of our study is to describe the effects of vasopressin on term infants with persistent pulmonary hypertension under a standardized protocol. Study Design: In 2019, we designed a standardized protocol for the management of refractory hypotension in the context of pulmonary hypertension, which included the use of vasopressin. This is a retrospective cohort study to evaluate the clinical, laboratory, and echocardiographic outcomes of patients who required vasopressin in the context of this new protocol in a referral level IV neonatal intensive care unit. Results: We included 48 neonates with a median gestational age of 37 weeks in a period of 30 months (December 2019 to May 2022). Congenital diaphragmatic hernia was the main cause of persistent pulmonary hypertension in this cohort (82%). All patients were on mechanical ventilation and receiving inhaled nitric oxide. In our cohort at 4 hours after initiation of vasopressin, blood pressure, serum pH, and urinary output increased significantly. The vasoactive inotropic score, lactate and oxygenation index decreased. Echocardiographic follow-up also showed a decrease in the relative pressure of the right ventricle and an improvement in the cardiac output of both ventricles. There were no episodes of severe hyponatremia (<120 mmol/L). Discussion: This study showed that the use of vasopressin in neonates with persistent pulmonary hypertension and refractory systemic hypotension was associated with a rapid and significant improvement in oxygenation and hemodynamic markers of perfusion, including blood pressure. This association was early during the first hours of treatment and vasopressin was safely withdrawn after a median of 3 days of treatment.