Evaluación del sistema parasimpático durante procedimientos dolorosos en neonatología / Parasympathetic evaluation for procedural pain assessment in neonatology

Introducción: El monitor NIPE (Newborn Infant Parasympathetic Evaluation) es una herramienta rápida, continua y objetiva de evaluación del disconfort neonatal. Los objetivos fueron describir los cambios del NIPE tras una extracción sanguínea y los factores implicados en su variación. Material y métodos: Estudio observacional analítico con recogida de datos prospectiva. Se incluyeron los recién nacidos ingresados en cuidados intensivos entre junio y diciembre de 2021 a quienes se les realizó extracción sanguínea. Se recogieron variables demográficas, las relacionadas con la realización del procedimiento, la puntuación NIPE, la frecuencia cardiaca previa y en los minutos 1, 2, 3, 4, 5, 10 y 15 posteriores. Resultados: Se incluyeron 86 registros de 49 pacientes. Durante los primeros cuatro minutos tras el procedimiento hubo un descenso significativo en la puntuación NIPE, siendo el descenso máximo de un 22,8% respecto al valor basal, produciéndose el nadir a los 2,79 minutos. El mayor descenso del NIPE ocurrió en pacientes prematuros, varones, con menor Apgar a los cinco minutos, en procedimientos ya realizados previamente, tras cesárea y en horario matutino. No hubo diferencias con la realización en canguro. La correlación entre NIPE y frecuencia cardíaca fue débil. Conclusiones:Tras un procedimiento doloroso, como una extracción sanguínea, el monitor NIPE mostró un descenso significativo los primeros cuatro minutos, agudizándose el descenso con la prematuridad, la reiteración de procedimientos o el nacimiento tras cesárea. El monitor NIPE puede ayudar a identificar eficazmente a aquellos neonatos que sufren dolor agudo tras un procedimiento, complementándose con las escalas de valoración clínica. (AU)

Introduction: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. Material and methods: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15min after the procedure. Results: The study included 86 records for 49 patients. In the first 4min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. Conclusions: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales. (AU)

Parasympathetic evaluation for procedural pain assessment in neonatology.

INTRODUCTION: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. MATERIAL AND METHODS: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15 min after the procedure. RESULTS: The study included 86 records for 49 patients. In the first 4 min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79 min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. CONCLUSIONS: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4 min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales.

Displasia evolutiva de caderas: más allá del cribado. La exploración, nuestra asignatura pendiente / Develomental dysplasia of the hip: beyond the screening. Physical exam is our pending subject

Introducción: La displasia del desarrollo de la cadera se trata de una patología relativamente frecuente y es una causa importante de discapacidad si no se trata de la forma adecuada. Existen una serie de factores de riesgo que aumentan la probabilidad de presentar una displasia de caderas, pero la mayoría de los afectados no los presentan. Por ello, la exploración física es fundamental para su diagnóstico. No obstante, el número de ecografías solicitadas parece ser muy superior al que sería necesario, según los hallazgos clínicos.Material y métodos: Estudio observacional descriptivo retrospectivo de los recién nacidos pertenecientes al área de referencia de un hospital terciario. Se recogieron las ecografías de caderas realizadas en nuestro centro durante el periodo de estudio, así como los diagnósticos de displasia durante dicho periodo para comprobar la frecuencia de presentación de los factores de riesgo y los hallazgos clínicos, además del número de ecografías solicitadas en este periodo y su rendimiento.Resultados: Se incluyeron un total de 456 recién nacidos a los que se realizaron un total de 530 ecografías de caderas. Tres de las 12 displasias detectadas en este tiempo presentaban factores de riesgo, el resto de los pacientes fue diagnosticado por la clínica.Conclusiones: Los protocolos de screening son implementados de forma adecuada en nuestro medio, aunque sin la exploración física detallada no sería posible la detección precoz de la displasia, evitando con ello secuelas a largo plazo. No obstante, el número de ecografías de caderas solicitadas es muy superior al que se esperaría, dado el bajo porcentaje de displasias halladas. (AU)

Introduction: Developmental dysplasia of the hip is a common cause of disability among children. Early detection leads to better prognosis. There are some risk factors that increase the possibility of developing a dysplasia. But not every child with developmental dysplasia has them. This means that physical examination is still very useful to detect them. However, based on clinical findings, the amount of requested ultrasound seems higher than it would be necessary. Methods: Retrospective cohort study of infants born in a single tertiary care centre. Babies in which hip ultrasound was performed were included. During the period of study, patients with diagnosis of developmental hip dysplasia were also included, as well as the amount of ultrasounds requested during this period, and their efficiency. Results: Out of the 456 new-borns included, 530 hip ultrasounds were performed. Just 3 of the total 12 dysplasias had risk factors. The others were diagnosed through clinical examination. Conclusions: Screening protocols are useful to detect hip dysplasia but clinical examination is very important to detect those cases without risk factors. However, the number of tests is higher than expected according to the diagnosed dysplasias. (AU)

Developmental dysplasia of the hip: Beyond the screening. Physical exam is our pending subject.

INTRODUCTION: Developmental dysplasia of the hip is a common cause of disability among children. Early detection leads to better prognosis. There are some risk factors that increase the possibility of developing a dysplasia. But not every child with developmental dysplasia has them. This means that physical examination is still very useful to detect them. However, based on clinical findings, the amount of requested ultrasound seems higher than it would be necessary. METHODS: Retrospective cohort study of infants born in a single tertiary care centre. Babies in which hip ultrasound was performed were included. During the period of study, patients with diagnosis of developmental hip dysplasia were also included, as well as the amount of ultrasounds requested during this period, and their efficiency. RESULTS: Out of the 456 newborns included, 530 hip ultrasounds were performed. Just 3 of the total 12 dysplasias had risk factors. The others were diagnosed through clinical examination. CONCLUSIONS: Screening protocols are useful to detect hip dysplasia but clinical examination is very important to detect those cases without risk factors. However, the number of tests is higher than expected according to the diagnosed dysplasias.

[Develomental dysplasia of the hip: beyond the screening. Physical exam is our pending subject]. / Displasia evolutiva de caderas: más allá del cribado. La exploración, nuestra asignatura pendiente.

INTRODUCTION: Developmental dysplasia of the hip is a common cause of disability among children. Early detection leads to better prognosis. There are some risk factors that increase the possibility of developing a dysplasia. But not every child with developmental dysplasia has them. This means that physical examination is still very useful to detect them. However, based on clinical findings, the amount of requested ultrasound seems higher than it would be necessary. METHODS: Retrospective cohort study of infants born in a single tertiary care centre. Babies in which hip ultrasound was performed were included. During the period of study, patients with diagnosis of developmental hip dysplasia were also included, as well as the amount of ultrasounds requested during this period, and their efficiency. RESULTS: Out of the 456 new-borns included, 530 hip ultrasounds were performed. Just 3 of the total 12 dysplasias had risk factors. The others were diagnosed through clinical examination. CONCLUSIONS: Screening protocols are useful to detect hip dysplasia but clinical examination is very important to detect those cases without risk factors. However, the number of tests is higher than expected according to the diagnosed dysplasias.

Uso del Strength and Difficulties Questionnaire en prematuros para su evaluación psicosocial y cribado del trastorno por déficit de atención e hiperactividad / The use of strength and difficulties questionnaire in psychosocial evaluation and attention deficit hyperactivity disorder screening in preterm infants

Introducción: Los trastornos del comportamiento y del aprendizaje se describen con frecuencia en < 1.500 g o < 32 semanas (RNMBP/MP). Se dispone de muy poca información en población española. Objetivo: Identificar los problemas psicosociales de los RNMBP/MP mediante la aplicación del test Strength and Difficulties Questionnaire (SDQ) a los 6 años y comparar los resultados con los de una población de referencia. Establecer los puntos de corte para el uso del SDQ como cribado del trastorno por déficit de atención e hiperactividad (TDAH) en RNMBP/MP. Participantes y métodos: Estudio prospectivo observacional en RNMBP/MP evaluados a los 6 años con SDQ. Se recogen variables perinatales, neurodesarrollo y diagnóstico de TDAH mediante DSM-5. Resultados: Se incluyeron 214 niños con el total de las valoraciones. Comparados con la población de referencia obtuvieron puntuaciones significativamente mayores en síntomas emocionales, relaciones con compañeros y en el total del test. La escala de hiperactividad y la puntuación total se identifican como buenos predictores del diagnóstico de TDAH, con un área bajo la curva ROC de 0,83 y 0,87, respectivamente. Las puntuaciones que consiguen una adecuada sensibilidad para el cribado de TDAH son ≥ 6 para la escala de hiperactividad y ≥ 13 para la puntuación total del test, y una puntuación combinada ≥ 5 en hiperactividad junto con un total ≥ 12. Conclusiones: Los RNMBP/MP presentan más frecuentemente problemas emocionales y de relación que sus compañeros nacidos a término. El test SDQ podría utilizarse como una prueba de cribado para el TDAH

Introduction: Behavioural disorders and learning disabilities are often recognised in < 1,500g or < 32 weeks very low birth weight (VLBW) infants. There is very limited data in the Spanish population. Objective: To determine the presence of psychosocial disorders in preterm infants at 6 years of age, as assessed by the strength and difficulties (SDQ) questionnaire, in comparison to a reference population. To set a cut-off value to use SDQ as a screening tool for attention deficit hyperactivity disorder (ADHD) in the preterm child. Participants and methods: A prospective observational study was conducted on premature children assessed at 6 years of age using the SDQ. Perinatal variables, neurodevelopment, and diagnosis of ADHD, according to the DSM-5, were collected. Results: A total of 214 children who met all the requirements, were included. When compared with the reference population they had significantly higher scores in emotional symptoms, in peer relationships, and in the total score of the test. The hyperactivity scale and the total test score are good predictors of a diagnosis of ADHD, with an area under the ROC curve of 0.83 (95% CI: 0.76-0.90) for hyperactivity, and 0.87 (95% CI: 0.80-0.93) for the total score. The scores for hyperactivity and the total test, from which the screening for ADHD could be considered positive would be ≥ 6 and ≥ 13 respectively, and a combination of hyperactivity ≥ 5 and total score ≥ 12. Conclusions: Preterm children are at higher risk of emotional and peer relationship problems than those born full term. The SDQ test could be used for ADHD screening

Análogos de prostaglandinas I2 (epoprostenol y treprostinil) para el tratamiento de la hipertensión pulmonar refractaria secundaria a displasia broncopulmonar en un lactante / Prostaglandin 12 analogs (epoprostenol and treprostinil) as a treatment for refractory bronchopulmonary dysplasia-induced pulmonary hypertension in an infant

La hipertensión pulmonar es una complicación frecuente de la displasia broncopulmonar. A pesar de su alta incidencia, existen pocos tratamientos disponibles. El epoprostenol y el treprostinil son análogos de las prostaglandinas I2, que activan la adenilato ciclasa e incrementan el adenosín monofosfato cíclico en las células de la musculatura lisa de la arteria pulmonar y pueden resultar eficaces en el tratamiento de estos pacientes. Se presenta el caso de un prematuro de extremado bajo peso con hipertensión pulmonar secundaria a displasia broncopulmonar grave, no respondedora a óxido nítrico inhalado y sildenafilo, que fue tratado con análogos de prostaglandinas I2. En nuestro paciente, este tratamiento evidenció mejoría clínica y ecocardiográfica significativa tras varias semanas de tratamiento.

Pulmonary hypertension is a common complication of bronchopulmonary dysplasia, with a high mortality rate. Despite the high incidence of pulmonary hypertension, there are few available treatments. Epoprostenol and treprostinil are prostaglandin I2 analogs that activate adenylate cyclase and increase cyclic adenosine monophosphate in the pulmonary arterial smooth muscle cells. Therefore, they may be an effective treatment for these patients. We report the use of prostaglandin I2 analogs in an extremely low birth weight preterm baby with severe bronchopulmonary dysplasia associated with pulmonary hypertension non-responding to inhaled nitric oxide and sildenafil. In our patient this treatment resulted in remarkable clinical and echocardiographic improvement, evident after a few weeks of treatment.

[Prostaglandin 12 analogs (epoprostenol and treprostinil) as a treatment for refractory bronchopulmonary dysplasia-induced pulmonary hypertension in an infant]. / Análogos de prostaglandinas I2 (epoprostenol y treprostinil) para el tratamiento de la hipertensión pulmonar refractaria secundaria a displasia broncopulmonar en un lactante.

Pulmonary hypertension is a common complication of bronchopulmonary dysplasia, with a high mortality rate. Despite the high incidence of pulmonary hypertension, there are few available treatments. Epoprostenol and treprostinil are prostaglandin I2 analogs that activate adenylate cyclase and increase cyclic adenosine monophosphate in the pulmonary arterial smooth muscle cells. Therefore, they may be an effective treatment for these patients. We report the use of prostaglandin I2 analogs in an extremely low birth weight preterm baby with severe bronchopulmonary dysplasia associated with pulmonary hypertension non-responding to inhaled nitric oxide and sildenafil. In our patient this treatment resulted in remarkable clinical and echocardiographic improvement, evident after a few weeks of treatment.

La hipertensión pulmonar es una complicación frecuente de la displasia broncopulmonar. A pesar de su alta incidencia, existen pocos tratamientos disponibles. El epoprostenol y el treprostinil son análogos de las prostaglandinas I2, que activan la adenilato ciclasa e incrementan el adenosín monofosfato cíclico en las células de la musculatura lisa de la arteria pulmonar y pueden resultar eficaces en el tratamiento de estos pacientes. Se presenta el caso de un prematuro de extremado bajo peso con hipertensión pulmonar secundaria a displasia broncopulmonar grave, no respondedora a óxido nítrico inhalado y sildenafilo, que fue tratado con análogos de prostaglandinas I2. En nuestro paciente, este tratamiento evidenció mejoría clínica y ecocardiográfica significativa tras varias semanas de tratamiento.

[The use of strength and difficulties questionnaire in psychosocial evaluation and attention deficit hyperactivity disorder screening in preterm infants]. / Uso del Strength and Difficulties Questionnaire en prematuros para su evaluación psicosocial y cribado del trastorno por déficit de atención e hiperactividad.

INTRODUCTION: Behavioural disorders and learning disabilities are often recognised in<1,500g or<32 weeks very low birth weight (VLBW) infants. There is very limited data in the Spanish population. OBJECTIVE: To determine the presence of psychosocial disorders in preterm infants at 6 years of age, as assessed by the strength and difficulties (SDQ) questionnaire, in comparison to a reference population. To set a cut-off value to use SDQ as a screening tool for attention deficit hyperactivity disorder (ADHD) in the preterm child. PARTICIPANTS AND METHODS: A prospective observational study was conducted on premature children assessed at 6 years of age using the SDQ. Perinatal variables, neurodevelopment, and diagnosis of ADHD, according to the DSM-5, were collected. RESULTS: A total of 214 children who met all the requirements, were included. When compared with the reference population they had significantly higher scores in emotional symptoms, in peer relationships, and in the total score of the test. The hyperactivity scale and the total test score are good predictors of a diagnosis of ADHD, with an area under the ROC curve of 0.83 (95% CI: 0.76-0.90) for hyperactivity, and 0.87 (95% CI: 0.80-0.93) for the total score. The scores for hyperactivity and the total test, from which the screening for ADHD could be considered positive would be≥6 and≥13 respectively, and a combination of hyperactivity≥5 and total score≥12. CONCLUSIONS: Preterm children are at higher risk of emotional and peer relationship problems than those born full term. The SDQ test could be used for ADHD screening.

Secondary asplenia as a complication of severe Meningococcal Sepsis.

We report the case of an 11-month-old infant who had a medical history of meningococcal septicaemia 6 months prior to this admission and presented to hospital with an episode of fever due to Streptococcus pneumoniae bacteraemia. During this second admission, an abdominal ultrasound scan revealed secondary asplenia.

Hipotensión intracraneal idiopática asociada a disrafismo espinal oculto / Idiopathic intracranial hypotension associated with occult spinal dysraphism

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