[Factors related to respiratory complications in very low birth weight infants with respiratory distress syndrome]. / Factores en la morbilidad respiratoria de los recién nacidos de muy bajo peso con membrana hialina.

INTRODUCTION: Very low birth weight (VLBW) infants, with a birth weight below 1500 g and a structurally immature lung, are at high risk for developing bronchopulmonary dysplasia. This risk is even higher if respiratory distress syndrome is present. Other acute lung diseases, such as air leak and pulmonary hemorrhage, can also be present. The aim of this study was to analyze the statistical relevance of several neonatal factors in the development of pulmonary complications in a sample of VLBW infants with respiratory distress syndrome. PATIENTS AND METHODS: A total of 209 VLBW infants with respiratory distress syndrome were studied. The variables analyzed were delivery date, respiratory distress syndrome grade, sex, birth weight, gestational age, referral (from within the hospital or elsewhere), prenatal corticosteroid administration, type of gestation, type of delivery, amniorrhexis time, Apgar test at 1 and 5 minutes, surfactant administration, hours of life at which the first dose of surfactant was administered, and early sepsis. A multiple logistic regression analysis was developed using Hosmer-Lemeshow methodology. RESULTS: In the multivariate analysis, air leak was related to respiratory distress syndrome grade and surfactant administration. Pulmonary hemorrhage was related to lower birth weight and absence of prenatal corticosteroid administration. Bronchopulmonary dysplasia was related to single pregnancies, absence of prenatal corticosteroid administration, lower birth weight, lower Apgar score at 1 minute, and higher respiratory distress syndrome grade. CONCLUSIONS: Respiratory morbidity in VLBW infants with respiratory distress syndrome could be influenced by several interrelated intrinsic and extrinsic variables.

[Evoked potentials in a population of children below 1,500 grams at birth: a description and probabilities]. / Potenciales evocados en una población de niños menores de 1.500 gramos: descripción y probabilidades.

INTRODUCTION: Bioelectrical behaviour was studied in a group of low birth weight children. AIM: To evaluate whether the characteristics of the waves of the brain potentials in these children, who weighed less than 1500 g at birth and experienced anomalous circumstances and events during their perinatal period, would help reach an early diagnosis of the possible developmental disorders they might suffer later on in life. SUBJECTS AND METHODS: Both visual and auditory cerebral evoked potentials were recorded in a group of children born underweight and the results were compared with the findings from another group of healthy children who were born in normal physiological conditions and were apparently free of any kind of pathology. RESULTS: In the waves and locations that were examined, the problem group displayed latencies that were longer than those of the control group; in contrast, no statistically significant differences were found in the amplitude, regardless of the location. Low gestational age and lower weight made latencies longer, but no relationship was found between latencies and the other perinatal features that were studied. CONCLUSIONS: Children with low weight at birth have slower wave latencies than normal children. This slowing, which is inversely proportional to the weight and weeks of gestation, is considered to be an anomalous sign that could be related to brain immaturity, delayed development or to disorders affecting myelination. Moreover, the amplitude, which has received far less attention from researchers, is usually shorter in these processes, although in our study we found no differences with the group of healthy children--only very slightly in the P300, in the weeks and the weight, and the N100 only in one location with respect to weight. Since these children usually have developmental disorders, the use of evoked potentials could be a very useful tool in their detection and ensuing therapy.

Factores de riesgo en la mortalidad de los recién nacidos de muy bajo peso con membrana hialina / Risk factors for mortality in very low birth weight infants with respiratory distress syndrome

Introducción: La expectativa de vivir de los recién nacidos de muy bajo peso (RNMBP) ha mejorado en los últimos años. Cuando estos pacientes presentan, además, enfermedad de membrana hialina (EMH), es difícil conocer con seguridad cuáles son los factores que más influyen en su mortalidad. Este trabajo tiene el objetivo de averiguar, dentro de un conjunto de variables, las más influyentes en la mortalidad desde una perspectiva multifactorial. Pacientes y métodos Se tomó una muestra de 209 RNMBP con EMH nacidos en un período amplio, 15 años y 7 meses. Se consideraron las variables: "fecha de parto", "grado de enfermedad de membrana hialina", "sexo", "peso al nacimiento", "semanas de gestación", "procedencia", "administración de corticoides prenatales", "tipo de gestación", "tipo de parto", "momento de la amniorrexis", "puntuación del test de Apgar al minuto y a los 5 min", "administración de surfactante", "horas de vida en la administración de la primera dosis de surfactante" y "sepsis precoz". Siguiendo la metodología de selección de variables de Hosmer-Lemeshow se realizó un análisis de regresión logística múltiple. Resultados: Resultaron significativas las variables peso al nacimiento; test de Apgar, 5; corticoides prenatales, grado de membrana hialina y tratamiento con agente tensioactivo, quedando la importancia del resto de las variables diluida en ellas. Conclusiones: El incremento de peso y el test de Apgar a los 5 min, la administración de agente tensioactivo y corticoides, así como un grado bajo de membrana hialina hacen que la mortalidad disminuya. El modelo de regresión logística encontrado cuantifica cómo actúan estos factores y permite estimar la probabilidad de fallecer para un nuevo RNMBP con EMH

Introduction: In the last few years the life expectancy of very low birth weight (VLBW) infants has improved. When these patients have respiratory distress syndrome, it is difficult to know with any certainty which factors have the greatest influence on mortality. The aim of this study was to determine which variables, among a series, have the greatest influence on mortality from a multivariate perspective. Patients and methods: A sample of 209 VLBW infants born over a long period (15 years and 7 months) was studied. The following variables were analyzed: date of birth, degree of respiratory distress syndrome, sex, birth weight, weeks of gestation, born within or elsewhere, prenatal corticoid administration, type of gestation, type of delivery, amniorrhexis time, Apgar test at 1 and 5 minutes, surfactant administration, hours of life at which the first dose of surfactant was administered, and early sepsis. A multiple logistic regression analysis was developed using Hosmer-Lemeshow methodology. Results: The following variables were identified as significant: birth weight, Apgar test at 5 minutes, prenatal corticoids, degree of respiratory distress syndrome, and surfactant administration. The remaining variables were less important in the multivariate analysis. Conclusions: Higher birth weight and Apgar score at 5 minutes, prenatal corticoid and surfactant administration, and a lower degree of respiratory distress syndrome reduce mortality. The logistic regression model used quantifies how these factors behave and allows the probability of mortality in VLBW infants with respiratory distress syndrome to be estimated

[Risk factors for mortality in very low birth weight infants with respiratory distress syndrome]. / Factores de riesgo en la mortalidad de los recién nacidos de muy bajo peso con membrana hialina.

INTRODUCTION: In the last few years the life expectancy of very low birth weight (VLBW) infants has improved. When these patients have respiratory distress syndrome, it is difficult to know with any certainty which factors have the greatest influence on mortality. The aim of this study was to determine which variables, among a series, have the greatest influence on mortality from a multivariate perspective. PATIENTS AND METHODS: A sample of 209 VLBW infants born over a long period (15 years and 7 months) was studied. The following variables were analyzed: date of birth, degree of respiratory distress syndrome, sex, birth weight, weeks of gestation, born within or elsewhere, prenatal corticoid administration, type of gestation, type of delivery, amniorrhexis time, Apgar test at 1 and 5 minutes, surfactant administration, hours of life at which the first dose of surfactant was administered, and early sepsis. A multiple logistic regression analysis was developed using Hosmer-Lemeshow methodology. RESULTS: The following variables were identified as significant: birth weight, Apgar test at 5 minutes, prenatal corticoids, degree of respiratory distress syndrome, and surfactant administration. The remaining variables were less important in the multivariate analysis. CONCLUSIONS: Higher birth weight and Apgar score at 5 minutes, prenatal corticoid and surfactant administration, and a lower degree of respiratory distress syndrome reduce mortality. The logistic regression model used quantifies how these factors behave and allows the probability of mortality in VLBW infants with respiratory distress syndrome to be estimated.

[A study of evoked potentials in the brains of very low birth weight infants]. / Estudio de potenciales evocados cerebrales en niños de muy bajo peso al nacimiento.

INTRODUCTION: This work studies the behaviour of the N200 and P300 waves of the brain evoked potentials (BEP) in a group of very low birth weight infants and results are compared with a second group of children whose weight was normal at birth. AIMS: The objective of this study was to determine whether the N200 and, more especially, the P300 waves in children under the age of 3 could be used to assess the development and prognosis of their disorders. PATIENTS AND METHODS: BEP were performed in very low birth weight infants (taken as the test group) and in others whose weight at birth was normal (control group); the difference in ages when the potentials were recorded was not statistically significant. RESULTS: The EEG index was evaluated for both the test and the control group, and a difference was found with a significance of p < 0.001. Latency, in milliseconds, of the N200 wave and the P300 wave was recorded at the same sites for the test and control groups and showed differences with a significance of p < 0.001. CONCLUSIONS: The findings from the EEG and the latencies of the N200 and P300 waves in the BEP of very low birth weight infants are pathological and are linked to immaturity of the brain, which is characteristic of this population. This tool could help to detect developmental disorders and to facilitate a better approach to attending these children.

[Ellis van Creveld syndrome]. / Síndrome de Ellis van Creveld.

The last two cases of Ellis van Creveld syndrome diagnosed in the Neonatology Service of our department are presented and the clinical and radiological features described. One of the children, the boy, was suffering from ocular malformations which are not common in this syndrome. Both have heart malformations which are frequent in this syndrome. Paradoxically the boy, who was quite below the third percentile in height, has less alterations in the long bones than did the baby girl, who was within the normal height range. Attention is called to the lack of adipose panniculus in the boy, but the girl's weight is within the normal limits. Both died because of the heart anomalities with accompanying respiratory distress.