Dorotea Blanco - Academia.edu (original) (raw)
Papers by Dorotea Blanco
<p>Likelihood ratios and post-test probability of abnormal aEEG and adverse neurological ou... more <p>Likelihood ratios and post-test probability of abnormal aEEG and adverse neurological outcome, patients not treated with hypothermia according to hours of life.</p
European Neuropsychopharmacology, Oct 1, 2022
<p>ROC curves for different hours of life.</p
<p>Characteristics of included articles with hypothermia treatment.</p
Neurología, 2020
INTRODUCTION More than a decade has passed since therapeutic hypothermia (TH) was introduced in S... more INTRODUCTION More than a decade has passed since therapeutic hypothermia (TH) was introduced in Spain; this is the only neuroprotective intervention that has become standard practice in the treatment of perinatal hypoxic-ischaemic encephalopathy (HIE). This article aims to provide a current picture of the technique and to address the controversies surrounding its use. DEVELOPMENT In the last 10 years, TH has been successfully implemented in the vast majority of tertiary hospitals in Spain, and more than 85% of newborns with moderate or severe HIE currently receive the treatment. The factors that can improve the efficacy of TH include early treatment onset (first 6hours of life) and the control of comorbid factors associated with perinatal asphyxia. In patients with moderate HIE, treatment onset after 6hours seems to have some neuroprotective efficacy. TH duration longer than 72hours or deeper hypothermia do not offer greater neuroprotective efficacy, but instead increase the risk of adverse effects. Unclarified aspects are the sedation of patients during TH, the application of the treatment in infants with mild HIE, and its application in other scenarios. Prognostic information and time frame are one of the most challenging aspects. CONCLUSIONS TH is universal in countries with sufficient economic resources, although certain unresolved controversies remain. While the treatment is widespread in Spain, there is a need for cooling devices for the transfer of these patients and their centralisation.
<p>QUADAS 2 assessment of included papers.</p
<p>Pooled sensitivity and specificity, diagnostic odds ratio and likelihood ratios with con... more <p>Pooled sensitivity and specificity, diagnostic odds ratio and likelihood ratios with confidence intervals for abnormal aEEG and death or moderate/severe disability, patients receiving and not receiving TH.</p
<p>Characteristics of included articles with no hypothermia treatment.</p
Neurología (English Edition), 2022
INTRODUCTION More than a decade has passed since therapeutic hypothermia (TH) was introduced in S... more INTRODUCTION More than a decade has passed since therapeutic hypothermia (TH) was introduced in Spain; this is the only neuroprotective intervention that has become standard practice in the treatment of perinatal hypoxic-ischaemic encephalopathy (HIE). This article aims to provide a current picture of the technique and to address the controversies surrounding its use. DEVELOPMENT In the last 10 years, TH has been successfully implemented in the vast majority of tertiary hospitals in Spain, and more than 85% of newborns with moderate or severe HIE currently receive the treatment. The factors that can improve the efficacy of TH include early treatment onset (first 6 h of life) and the control of comorbid factors associated with perinatal asphyxia. In patients with moderate HIE, treatment onset after 6 h seems to have some neuroprotective efficacy. TH duration longer than 72 h or deeper hypothermia do not offer greater neuroprotective efficacy, but instead increase the risk of adverse effects. Controversy persists around the sedation of patients during TH, the application of the treatment in infants with mild HIE, and its application in other scenarios. Prognostic information and time frame are one of the most challenging aspects. CONCLUSIONS TH is universal in countries with sufficient economic resources, although certain unresolved controversies remain. While the treatment is widespread in Spain, there is a need for devices for the transfer of these patients and their centralisation.
Antioxidants & Redox Signaling, 2021
The pathogenesis and progression of Hypoxic-Ischemic Encephalopathy (HIE), a major cause of sever... more The pathogenesis and progression of Hypoxic-Ischemic Encephalopathy (HIE), a major cause of severe neurological disability and mortality in the perinatal period, is shaped by the interplay of multiple processes including inflammation, oxidative stress, and excitotoxicity. We conducted a longitudinal study determining biomarkers of oxidative stress and inflammation in non-invasive urine samples of newborns with moderate/severe HIE (N=51) employing Liquid Chromatography-Mass Spectrometry. We noted that levels of several biomarkers of oxidative stress increased over time demonstrating the ongoing propagation of oxidative injury. Prostaglandins, in contrast, showed a decreasing trend in their concentration profiles over time, which probably reflects their mediation on pathogenic mechanisms, including the inflammatory response. Statistically significant differences in the levels oxidative stress of neonates with distinct brain lesion patterns, as detected with Magnetic Resonance Imaging (MRI), were observed, revealing an increase of lipid peroxidation biomarkers in newborns with cerebral lesions (MRI score 1) as compared to scores 0 and 2. Moreover, a gender-dependent study showed no statistically significant differences in biomarker concentrations between male and female infants. Our observation leads to the hypothesis that the monitoring of non-invasive lipid peroxidation biomarkers could aid diagnosis and predicting of long-term outcomes as complementary tool to standard explorations.
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica, 1999
The attendance respiratory extracorporeal (AREC) is an oxygenation form for membrane extracorpore... more The attendance respiratory extracorporeal (AREC) is an oxygenation form for membrane extracorporeal with flow tidal and veno-venous cannula described by Chevalier et al. in 1990. We present our clinical experience so much with AREC in system veno-venous flow tidal as veno-arterial. From october of 1997 until the present time we have treated three patients by means AREC, in two patients with veno-venous system and in one veno-arterial. In all the cases bomb Collin-Cardio has been used with bladder for flow tidal and membrane of oxygenation of 0.8 m2, being inserted a system of alternative clamp of the branches of the circuit. The system AREC has been used in two patients with congenial diaphragmatic hernia, right in a case and left in the other one. The gestational age was of 38 and 36 weeks with a weight of 3,200 and 2,900 grams. Both patients were remitted from other centers by failure of the conventional treatment. In both cases the indication of AREC was the sharp deterioration o...
Biological Trace Element Research, 1997
The objective of this study was to determine the effect of systemic MgSO4 infusion on subendocard... more The objective of this study was to determine the effect of systemic MgSO4 infusion on subendocardial and subepicardial perfusion. Seventeen spontaneously breathing piglets were examined. Myocardial perfusion was measured using radiolabeled microspheres at baseline, 30 and 60 min after either MgSO4 (80 mg/kg) or saline infusion. Blood pressure, heart rate, and cardiac output were also measured at these time intervals. Comparison of the magnesiuminduced changes in systemic blood pressure and on subendocardial and subepicardial perfusion at 30 and 60 min with values obtained with saline solution at 30 and 60 min, yielded no statistically significant difference (Tables 1-3). The ratio of subendocardial/subepicardial blood flow and subendocardial and subepicardial coronary vascular resistance at 30 and 60 min revealed no statistically significant differences between the magnesium and the control group (Table 3). There were no statistically significant difference in cardiac output and heart rate during any of the measured periods (Table 2). Our results suggest that the administration of MgSO4 does not alter the ratio of subendocardial/subepicardial blood flow and the ratio of subendocardial/subepicardial coronary vascular resistance.
... EXTRACORPOREA (ECMO). Manuel Sánchez Luna , Juan Vázquez Estévez, Dorotea Blanco Bravo ... Ru... more ... EXTRACORPOREA (ECMO). Manuel Sánchez Luna , Juan Vázquez Estévez, Dorotea Blanco Bravo ... Rubén Greco Martínez, Enrique Maroto Departamento de Pediatría ... modificado posteriormente por JY Chevalier en Francia el cual lo denominó AREC ...
Anales de Pediatría, 2011
La encefalopatía hipóxico-isquémica perinatal es uno de los acontecimientos más dramáticos e ines... more La encefalopatía hipóxico-isquémica perinatal es uno de los acontecimientos más dramáticos e inesperados que pueden afectar a un recién nacido y su familia. La primera esperanza de poder ayudar a estos niños surgió hace más de 20 años con el descubrimiento de la naturaleza evolutiva del daño cerebral en las primeras horas tras el insulto hipóxico-isquémico, capaz de delimitar un tiempo de «ventana terapéutica». Tras este hallazgo, la «vieja idea» del tratamiento con hipotermia inició el paso de los estudios experimentales a los ensayos clínicos, para muchos, de «dudosa validez ética». Los resultados de los primeros ensayos clínicos con hipotermia, cambiaron radicalmente el sentido de la duda: si inicialmente era éticamente cuestionable someter al grupo de tratamiento a un terapia potencialmente muy peligrosa (afectación de la síntesis de surfactante, hipertensión pulmonar, arritmias, coagulopatía, etc.), ahora lo era el iniciar nuevos ensayos que mantuviesen en normotermia al grupo ...
This brief report describes how Spain has improved the follow-up care of very low birth weight an... more This brief report describes how Spain has improved the follow-up care of very low birth weight and very preterm infants by implementing recommendations by the Spanish Neonatal Society and the Spanish Association of Paediatric Primary Care. It compares five key areas covered by national surveys carried out in 2016 and 2019, before and after the 2017 guidelines were implemented.
Anales De Pediatria, 2011
Standardisation of hypothermia as a treatment for perinatal hypoxic-ischaemic encephalopathy is s... more Standardisation of hypothermia as a treatment for perinatal hypoxic-ischaemic encephalopathy is supported by current scientific evidence. The following document was prepared by the authors on request of the Spanish Society of Neonatology and is intended to be a guide for the proper implementation of this therapy.We discuss the difficulties that may arise when moving from the strict framework of clinical
<p>Likelihood ratios and post-test probability of abnormal aEEG and adverse neurological ou... more <p>Likelihood ratios and post-test probability of abnormal aEEG and adverse neurological outcome, patients not treated with hypothermia according to hours of life.</p
European Neuropsychopharmacology, Oct 1, 2022
<p>ROC curves for different hours of life.</p
<p>Characteristics of included articles with hypothermia treatment.</p
Neurología, 2020
INTRODUCTION More than a decade has passed since therapeutic hypothermia (TH) was introduced in S... more INTRODUCTION More than a decade has passed since therapeutic hypothermia (TH) was introduced in Spain; this is the only neuroprotective intervention that has become standard practice in the treatment of perinatal hypoxic-ischaemic encephalopathy (HIE). This article aims to provide a current picture of the technique and to address the controversies surrounding its use. DEVELOPMENT In the last 10 years, TH has been successfully implemented in the vast majority of tertiary hospitals in Spain, and more than 85% of newborns with moderate or severe HIE currently receive the treatment. The factors that can improve the efficacy of TH include early treatment onset (first 6hours of life) and the control of comorbid factors associated with perinatal asphyxia. In patients with moderate HIE, treatment onset after 6hours seems to have some neuroprotective efficacy. TH duration longer than 72hours or deeper hypothermia do not offer greater neuroprotective efficacy, but instead increase the risk of adverse effects. Unclarified aspects are the sedation of patients during TH, the application of the treatment in infants with mild HIE, and its application in other scenarios. Prognostic information and time frame are one of the most challenging aspects. CONCLUSIONS TH is universal in countries with sufficient economic resources, although certain unresolved controversies remain. While the treatment is widespread in Spain, there is a need for cooling devices for the transfer of these patients and their centralisation.
<p>QUADAS 2 assessment of included papers.</p
<p>Pooled sensitivity and specificity, diagnostic odds ratio and likelihood ratios with con... more <p>Pooled sensitivity and specificity, diagnostic odds ratio and likelihood ratios with confidence intervals for abnormal aEEG and death or moderate/severe disability, patients receiving and not receiving TH.</p
<p>Characteristics of included articles with no hypothermia treatment.</p
Neurología (English Edition), 2022
INTRODUCTION More than a decade has passed since therapeutic hypothermia (TH) was introduced in S... more INTRODUCTION More than a decade has passed since therapeutic hypothermia (TH) was introduced in Spain; this is the only neuroprotective intervention that has become standard practice in the treatment of perinatal hypoxic-ischaemic encephalopathy (HIE). This article aims to provide a current picture of the technique and to address the controversies surrounding its use. DEVELOPMENT In the last 10 years, TH has been successfully implemented in the vast majority of tertiary hospitals in Spain, and more than 85% of newborns with moderate or severe HIE currently receive the treatment. The factors that can improve the efficacy of TH include early treatment onset (first 6 h of life) and the control of comorbid factors associated with perinatal asphyxia. In patients with moderate HIE, treatment onset after 6 h seems to have some neuroprotective efficacy. TH duration longer than 72 h or deeper hypothermia do not offer greater neuroprotective efficacy, but instead increase the risk of adverse effects. Controversy persists around the sedation of patients during TH, the application of the treatment in infants with mild HIE, and its application in other scenarios. Prognostic information and time frame are one of the most challenging aspects. CONCLUSIONS TH is universal in countries with sufficient economic resources, although certain unresolved controversies remain. While the treatment is widespread in Spain, there is a need for devices for the transfer of these patients and their centralisation.
Antioxidants & Redox Signaling, 2021
The pathogenesis and progression of Hypoxic-Ischemic Encephalopathy (HIE), a major cause of sever... more The pathogenesis and progression of Hypoxic-Ischemic Encephalopathy (HIE), a major cause of severe neurological disability and mortality in the perinatal period, is shaped by the interplay of multiple processes including inflammation, oxidative stress, and excitotoxicity. We conducted a longitudinal study determining biomarkers of oxidative stress and inflammation in non-invasive urine samples of newborns with moderate/severe HIE (N=51) employing Liquid Chromatography-Mass Spectrometry. We noted that levels of several biomarkers of oxidative stress increased over time demonstrating the ongoing propagation of oxidative injury. Prostaglandins, in contrast, showed a decreasing trend in their concentration profiles over time, which probably reflects their mediation on pathogenic mechanisms, including the inflammatory response. Statistically significant differences in the levels oxidative stress of neonates with distinct brain lesion patterns, as detected with Magnetic Resonance Imaging (MRI), were observed, revealing an increase of lipid peroxidation biomarkers in newborns with cerebral lesions (MRI score 1) as compared to scores 0 and 2. Moreover, a gender-dependent study showed no statistically significant differences in biomarker concentrations between male and female infants. Our observation leads to the hypothesis that the monitoring of non-invasive lipid peroxidation biomarkers could aid diagnosis and predicting of long-term outcomes as complementary tool to standard explorations.
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica, 1999
The attendance respiratory extracorporeal (AREC) is an oxygenation form for membrane extracorpore... more The attendance respiratory extracorporeal (AREC) is an oxygenation form for membrane extracorporeal with flow tidal and veno-venous cannula described by Chevalier et al. in 1990. We present our clinical experience so much with AREC in system veno-venous flow tidal as veno-arterial. From october of 1997 until the present time we have treated three patients by means AREC, in two patients with veno-venous system and in one veno-arterial. In all the cases bomb Collin-Cardio has been used with bladder for flow tidal and membrane of oxygenation of 0.8 m2, being inserted a system of alternative clamp of the branches of the circuit. The system AREC has been used in two patients with congenial diaphragmatic hernia, right in a case and left in the other one. The gestational age was of 38 and 36 weeks with a weight of 3,200 and 2,900 grams. Both patients were remitted from other centers by failure of the conventional treatment. In both cases the indication of AREC was the sharp deterioration o...
Biological Trace Element Research, 1997
The objective of this study was to determine the effect of systemic MgSO4 infusion on subendocard... more The objective of this study was to determine the effect of systemic MgSO4 infusion on subendocardial and subepicardial perfusion. Seventeen spontaneously breathing piglets were examined. Myocardial perfusion was measured using radiolabeled microspheres at baseline, 30 and 60 min after either MgSO4 (80 mg/kg) or saline infusion. Blood pressure, heart rate, and cardiac output were also measured at these time intervals. Comparison of the magnesiuminduced changes in systemic blood pressure and on subendocardial and subepicardial perfusion at 30 and 60 min with values obtained with saline solution at 30 and 60 min, yielded no statistically significant difference (Tables 1-3). The ratio of subendocardial/subepicardial blood flow and subendocardial and subepicardial coronary vascular resistance at 30 and 60 min revealed no statistically significant differences between the magnesium and the control group (Table 3). There were no statistically significant difference in cardiac output and heart rate during any of the measured periods (Table 2). Our results suggest that the administration of MgSO4 does not alter the ratio of subendocardial/subepicardial blood flow and the ratio of subendocardial/subepicardial coronary vascular resistance.
... EXTRACORPOREA (ECMO). Manuel Sánchez Luna , Juan Vázquez Estévez, Dorotea Blanco Bravo ... Ru... more ... EXTRACORPOREA (ECMO). Manuel Sánchez Luna , Juan Vázquez Estévez, Dorotea Blanco Bravo ... Rubén Greco Martínez, Enrique Maroto Departamento de Pediatría ... modificado posteriormente por JY Chevalier en Francia el cual lo denominó AREC ...
Anales de Pediatría, 2011
La encefalopatía hipóxico-isquémica perinatal es uno de los acontecimientos más dramáticos e ines... more La encefalopatía hipóxico-isquémica perinatal es uno de los acontecimientos más dramáticos e inesperados que pueden afectar a un recién nacido y su familia. La primera esperanza de poder ayudar a estos niños surgió hace más de 20 años con el descubrimiento de la naturaleza evolutiva del daño cerebral en las primeras horas tras el insulto hipóxico-isquémico, capaz de delimitar un tiempo de «ventana terapéutica». Tras este hallazgo, la «vieja idea» del tratamiento con hipotermia inició el paso de los estudios experimentales a los ensayos clínicos, para muchos, de «dudosa validez ética». Los resultados de los primeros ensayos clínicos con hipotermia, cambiaron radicalmente el sentido de la duda: si inicialmente era éticamente cuestionable someter al grupo de tratamiento a un terapia potencialmente muy peligrosa (afectación de la síntesis de surfactante, hipertensión pulmonar, arritmias, coagulopatía, etc.), ahora lo era el iniciar nuevos ensayos que mantuviesen en normotermia al grupo ...
This brief report describes how Spain has improved the follow-up care of very low birth weight an... more This brief report describes how Spain has improved the follow-up care of very low birth weight and very preterm infants by implementing recommendations by the Spanish Neonatal Society and the Spanish Association of Paediatric Primary Care. It compares five key areas covered by national surveys carried out in 2016 and 2019, before and after the 2017 guidelines were implemented.
Anales De Pediatria, 2011
Standardisation of hypothermia as a treatment for perinatal hypoxic-ischaemic encephalopathy is s... more Standardisation of hypothermia as a treatment for perinatal hypoxic-ischaemic encephalopathy is supported by current scientific evidence. The following document was prepared by the authors on request of the Spanish Society of Neonatology and is intended to be a guide for the proper implementation of this therapy.We discuss the difficulties that may arise when moving from the strict framework of clinical