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UAW, Upper airways; ROS, Reactive oxygen species.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cláudio D'Elia, David Gozal, Oliviero Bruni, Ekaterini Goudouris, Miguel Meira e Cruz" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Cláudio" "apellidos" => "D'Elia" ] 1 => array:2 [ "nombre" => "David" "apellidos" => "Gozal" ] 2 => array:2 [ "nombre" => "Oliviero" "apellidos" => "Bruni" ] 3 => array:2 [ "nombre" => "Ekaterini" "apellidos" => "Goudouris" ] 4 => array:2 [ "nombre" => "Miguel" "apellidos" => "Meira e Cruz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755721001765?idApp=UINPBA000049" "url" => "/00217557/0000009800000005/v1_202209230625/S0021755721001765/v1_202209230625/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0021755722000754" "issn" => "00217557" "doi" => "10.1016/j.jped.2022.05.002" "estado" => "S300" "fechaPublicacion" => "2022-09-01" "aid" => "1088" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "J Pediatr (Rio J). 2022;98:439-41" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Is there an “acceptable” percentage of using infant formula during hospital stays?" 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Corso, Cláudia R. Hentges, Rita C. Silveira, Raquel C. Rivero, Bruna S. Rojas, Tatiana S. Tellechea, Renato S. Procianoy" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Camila" "apellidos" => "Penso" ] 1 => array:2 [ "nombre" => "Andréa L." "apellidos" => "Corso" ] 2 => array:2 [ "nombre" => "Cláudia R." "apellidos" => "Hentges" ] 3 => array:2 [ "nombre" => "Rita C." "apellidos" => "Silveira" ] 4 => array:2 [ "nombre" => "Raquel C." "apellidos" => "Rivero" ] 5 => array:2 [ "nombre" => "Bruna S." "apellidos" => "Rojas" ] 6 => array:2 [ "nombre" => "Tatiana S." "apellidos" => "Tellechea" ] 7 => array:2 [ "nombre" => "Renato S." "apellidos" => "Procianoy" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755722000225?idApp=UINPBA000049" "url" => "/00217557/0000009800000005/v1_202209230625/S0021755722000225/v1_202209230625/en/main.assets" ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Autopsy in a neonatal intensive care unit: do we still need it in 2022?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "442" "paginaFinal" => "443" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Floris Groenendaal, Peter G.J. Nikkels" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Floris" "apellidos" => "Groenendaal" "email" => array:1 [ 0 => "F.Groenendaal@umcutrecht.nl" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] 1 => array:3 [ "nombre" => "Peter G.J." "apellidos" => "Nikkels" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Department of Pathology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands" "etiqueta" => "b" "identificador" => "aff0002" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0001" class="elsevierStylePara elsevierViewall">In a recent paper, Penso et al. described postmortem findings of infants who died while being admitted to a large neonatal intensive care unit in the southern part of Brazil.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a></p><p id="para0002" class="elsevierStylePara elsevierViewall">While rates of autopsy in high-income countries appeared to be declining in particular following the discussion on retained tissue after pediatric autopsy in the United Kingdom,<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> the authors have been able to stabilize and even increase the rate of neonatal autopsies.</p><p id="para0003" class="elsevierStylePara elsevierViewall">In addition, the suggestion that improved non-invasive diagnostics such as postmortem MRI could replace autopsies has influenced the discussion on the value of autopsies. Although the postmortem MRI added valuable information to the autopsy, the current opinion is that it cannot fully replace autopsies.<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> In practice, tissue or organs that have been retained for further examinations such as the heart or brain is sometimes collected by the parents at a later stage to be buried.</p><p id="para0004" class="elsevierStylePara elsevierViewall">Penso and co-authors have demonstrated that in more than one-third of cases additional findings were obtained from neonatal autopsies, which contributed to subsequent genetic counseling or would have changed patient management if the knowledge had been present antemortem.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a></p><p id="para0005" class="elsevierStylePara elsevierViewall">Their findings are highly relevant and the authors must be applauded for performing this thorough study. Interestingly, the findings are not very dissimilar from a recent study in a level III NICU in a high-income country. In 24% of the patients, the autopsy revealed major additional findings (Goldman<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> class I or class II), most frequently in the circulatory system.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> Differences between this study and the study by Penso might be explained by the postnatal age at death. When infants die at a later time point after birth, there are more opportunities for advanced diagnostic procedures.</p><p id="para0006" class="elsevierStylePara elsevierViewall">In neonatal intensive care, the questions from clinicians and parents that can be answered by autopsy are reaching far beyond establishing the cause of death. In most neonates who pass away while being admitted to a NICU the cause of death is known, and in many high-income countries death follows redirection of care.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">However, neonatal autopsies also answer questions that are extremely relevant for improving neonatal care, such as disclosing diseases or malformations of the infant that otherwise would have stayed undetected.</p><p id="para0008" class="elsevierStylePara elsevierViewall">Infants in the study by Penso et al died at a median age of 1 day, so these infants may not have lived long enough to undergo relevant postnatal examinations such as cardiac ultrasonography. However, the results of the autopsies may serve as a guide for the development of obstetric diagnostics including fetal ultrasonography in that particular area of the country.</p><p id="para0009" class="elsevierStylePara elsevierViewall">In other settings, postmortem findings may support or contradict radiological or microbiological test results and therefore serve to improve clinical care.</p><p id="para0010" class="elsevierStylePara elsevierViewall">In addition to providing information for parents and medical staff, autopsies may also provide scientific data. A few decades ago, the authors published discordance of congenital malformations in genotypically identical twins with trisomy 18. These findings suggested that nongenetic factors played an important role in the etiology of congenital malformations in these twins.<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Some parents give permission for an autopsy to “help other parents” and to “advance medical knowledge”.<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">Although the report of Penso et al is important, a few aspects have not been addressed in much detail. Consent to perform an autopsy was obtained by 19.1%. The authors do not provide the backgrounds of the parents who did not give permission, and what potential bias this could create. The attitude of doctors and nurses toward autopsies, the duration of admission to the NICU, the religion of the parents, or financial aspects could all influence the rate of consent for autopsy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0012" class="elsevierStylePara elsevierViewall">Informing the parents of the deceased infant by means of written or digital information can assist in obtaining permission for an autopsy.</p><p id="para0013" class="elsevierStylePara elsevierViewall">It is important that the parents receive information that they understand and from a person they trust.<a class="elsevierStyleCrossRefs" href="#bib0008"><span class="elsevierStyleSup">8,11</span></a> In most settings, the neonatologist will provide the information obtained to the parents, but in adults, direct communication between pathologists and family has been shown to be very effective.<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> Most studies indicate that the number of parents who regret <span class="elsevierStyleItalic"><span class="elsevierStyleUnderline">not</span></span> giving consent is much larger than the percentage of parents who did give consent for autopsy.<a class="elsevierStyleCrossRefs" href="#bib0008"><span class="elsevierStyleSup">8,11</span></a> This is also shown in autopsies of stillborn infants.<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a></p><p id="para0014" class="elsevierStylePara elsevierViewall">Medical and nursing staff is much more positive towards autopsies and therefore ask permission when the results of autopsies are discussed in regular audits.</p><p id="para0015" class="elsevierStylePara elsevierViewall">The value of autopsies has been summarized by Burton and Underwood in 2007, and is still relevant.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a></p><p id="para0016" class="elsevierStylePara elsevierViewall">Finally, the medical community must continue to convince governments and insurers that autopsies are part of routine medical care and that adequate funding for autopsies is mandatory. In some countries like the Netherlands, medical insurance stops when a person dies and the costs of autopsies must be covered by the hospital. Needless to say that this will limit autopsy rates, in particular for people who died at home.</p><p id="para0017" class="elsevierStylePara elsevierViewall">Optimal neonatal care in the 21<span class="elsevierStyleSup">st</span> century still needs autopsies. As Rankin et al. state: “Every family should be offered the opportunity for a postmortem examination” after the death of their newborn baby.<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> The paper by Penso et al. provides an excellent example of this policy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-05-06" "fechaAceptado" => "2022-05-06" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="notep9001">See paper by Penso et al. in pages 471–6.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autopsy in a Neonatal Intensive Care Unit: pathological and clinical agreement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C Penso" 1 => "AL Corso" 2 => "CR Hentges" 3 => "RC Silveira" 4 => "RC Rivero" 5 => "BS Rojas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr (Rio J)" "fecha" => "2022" "volumen" => "98" "paginaInicial" => "471" "paginaFinal" => "476" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foetal and neonatal autopsy rates and use of tissue for research: the influence of 'organ retention' controversy and new consent process" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "TY Khong" 1 => "AR. 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Year/Month | Html | Total | |
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2024 November | 7 | 0 | 7 |
2024 October | 18 | 28 | 46 |
2024 September | 33 | 29 | 62 |
2024 August | 40 | 37 | 77 |
2024 July | 48 | 39 | 87 |
2024 June | 21 | 22 | 43 |
2024 May | 24 | 19 | 43 |
2024 April | 31 | 21 | 52 |
2024 March | 24 | 18 | 42 |
2024 February | 28 | 20 | 48 |
2024 January | 31 | 25 | 56 |
2023 December | 40 | 17 | 57 |
2023 November | 34 | 39 | 73 |
2023 October | 37 | 42 | 79 |
2023 September | 35 | 42 | 77 |
2023 August | 23 | 12 | 35 |
2023 July | 27 | 18 | 45 |
2023 June | 14 | 11 | 25 |
2023 May | 27 | 18 | 45 |
2023 April | 35 | 9 | 44 |
2023 March | 49 | 21 | 70 |
2023 February | 45 | 26 | 71 |
2023 January | 27 | 25 | 52 |
2022 December | 80 | 41 | 121 |
2022 November | 53 | 32 | 85 |
2022 October | 157 | 69 | 226 |
2022 September | 59 | 44 | 103 |
2022 August | 33 | 32 | 65 |
2022 July | 44 | 37 | 81 |
2022 June | 72 | 46 | 118 |