Comparison of two methods for cleaning breast pump milk collection kits in human milk banks.

BACKGROUND: Appropriate decontamination of breast pump milk collection kits (BPKs) is critical to obtain safe milk for infants and to avoid discarding donor human milk (DHM). AIM: To evaluate two strategies for BPK decontamination by assessing microbial cultures and the proportion of discarded DHM, according to the criteria of the National Institute for Health and Care Excellence for pre-pasteurization cultures. METHODS: Prospective comparative study, allocation ratio 1:1, microbiologist-blind. PARTICIPANTS: 47 new donors in a human milk bank in Madrid. INTERVENTIONS: Study group (N=21): BPKs washed with water and detergent after each use and further steam decontamination within a microwavable bag. Control group (N=26): washing, rinsing and drying only. Five samples: first sample by hand expression and four samples (one per week) collected using the same pump and method. OUTCOMES: Primary: proportion of DHM discarded due to contamination. Secondary: comparison of the microbiota between samples obtained by hand expression and breast pump in both groups. FINDINGS: In total, 217 milk samples were collected: 47 by hand expression and 170 by pump expression (78 from study group). Steam decontamination of BPKs using a microwavable bag after washing resulted in a lower proportion of discarded DHM samples (1.3% vs 18.5%, P<0.001) and samples contaminated with Enterobacteriaceae (1.3% vs 22.8%, P<0.001) and Candida spp. (1.3% vs 14.1%, P<0.05) compared with samples collected with BPKs that were washed but not steam decontaminated. There were no differences in bacterial contamination between samples obtained using steam decontaminated BPKs and those obtained by hand expression. CONCLUSIONS: Steam decontamination of BPKs using a microwavable bag after washing decreases the amount of discarded DHM and the number of samples with potentially pathogenic bacteria.

Association between maltreatment and polydrug use among adolescents.

Different studies have related sexual and physical abuse during childhood and adolescence to the development of substance abuse disorders. Nevertheless, we are not aware of the role that other more common maltreatment types, such as neglect, will play among the most risky pattern of consumption: the polydrug use. A clinical sample of 655 adolescents, divided into two groups: polydrug users and non-polydrug users, were assessed on their pattern of drug consumption, history of childhood maltreatment, current psychopathology and their family history of alcoholism. Polydrug users had a greater prevalence of all types of maltreatment, although the most associated to this group were sexual abuse and emotional neglect. Other relevant variables to adolescent consumption were: the diagnosis of depressive disorder, the presence of anxiety traits and the family history of alcohol dependence. Polydrug users have higher risks of having had problems during infancy and adolescence, such as maltreatment and other psychopathological conditions, with the addition of family history of alcoholism. Accordingly, practitioners should take into account that those variables may influence polydrug abuse because it is the most risky pattern for subsequent dependence of substances, and they should always be considered during treatment.

Estudio comparativo de RetCam II frente a oftalmoscopia binocular en el cribado de la retinopatía de la prematuridad / Comparative study of RetCamRetCam II vs. binocular ophthalmoscopy in a screening program for retinopathy of prematurity

OBJETIVO: Conocer el grado la utilidad de la RetCam como alternativa a la oftalmoscopia binocular (BIO) en el cribado de la retinopatía de la prematuridad (ROP). MÉTODOS: Estudio observacional prospectivo comparativo. Se realizaron un total de 169 exámenes con RetCam II en 83 niños prematuros participantes en un programa de cribado de la ROP, exámenes que fueron almacenados en un archivo para análisis posterior. Un oftalmólogo altamente cualificado evaluó el fondo usando el oftalmoscopio binocular indirecto. El examinador evaluó posteriormente las fotografías en busca de la presencia o ausencia de ROP, la zona y el grado de la enfermedad, y la presencia o ausencia de enfermedad plus. Estos datos fueron comparados con los resultados de oftalmoscopio binocular indirecto para determinar la sensibilidad, especificidad y los valores predictivos positivo (VPP) y negativo (VPN) del método. RESULTADOS: Fue detectada ROP con oftalmoscopio binocular indirecto (BIO) en 108 ojos; en la exploración con RetCam se detectó ROP en 74 ojos. De los 306 ojos examinados con RetCam, se hallaron falsos negativos en 34 ojos y ningún falso positivo. La sensibilidad de RetCam fue de 0,68 y la especificidad del 0,99. El VPP fue de 0,93 y el VPN fue de 0,85. Treinta y cuatro casos de ROP no fueron diagnosticados por la RetCam. Todos estos casos fueron en la zona III o la zona II anterior, todas en grado leve y con mejoría espontánea. Ningún caso de ROP umbral se perdió. CONCLUSIÓN: Aunque el oftalmoscopio binocular indirecto continúa siendo el método gold standard para el diagnóstico de la ROP, la RetCam ofrece una alternativa al oftalmoscopio binocular indirecto para el cribado de la ROP

OBJECTIVE: To determine the performance of RetCam vs. binocular ophthalmoscopy (BIO) in a screening program for retinopathy of prematurity (ROP). METHODS: Observational comparative study with prospective data collection. Examinations with RetCam (n = 169) were performed on 83 infants included in a screening program for ROP and stored for analysis at a later stage. An experienced ophthalmologist examined the ocular fundus with binocular indirect ophthalmoscopy (BIO). The RetCam images were assessed for the presence of ROP, zone, grade, and presence of plus disease. RetCam and BIO data were compared by visually to estimate sensitivity, specificity, positive (VPP) and negative (VPN) predictive values. RESULTS: ROP disease was detected in 108 eyes with BIO, and in 74 with RetCam. Out of 306 eyes examined with RetCam, false negative results were found in 34 eyes, with no false positives. Sensitivity of RetCam exam vs. BIO was 0.68, and specificity was 0.99. Positive predictive value was 0.93 and negative predictive value was 0.85. All 34 ROP cases not detected with RetCam were in zone III or outer zone II. They were all mild and regressed spontaneously. No threshold ROP was missed with RetCam. CONCLUSION: Binocular indirect ophthalmoscopy is the reference method for the diagnosis of ROP. RetCam may be used as an alternative for ROP screening

Comparative study of RetCamRetCam II vs. binocular ophthalmoscopy in a screening program for retinopathy of prematurity.

OBJECTIVE: To determine the performance of RetCam vs. binocular ophthalmoscopy (BIO) in a screening program for retinopathy of prematurity (ROP). METHODS: Observational comparative study with prospective data collection. Examinations with RetCam (n=169) were performed on 83 infants included in a screening program for ROP and stored for analysis at a later stage. An experienced ophthalmologist examined the ocular fundus with binocular indirect ophthalmoscopy (BIO). The RetCam images were assessed for the presence of ROP, zone, grade, and presence of plus disease. RetCam and BIO data were compared by visually to estimate sensitivity, specificity, positive (VPP) and negative (VPN) predictive values. RESULTS: ROP disease was detected in 108 eyes with BIO, and in 74 with RetCam. Out of 306 eyes examined with RetCam, false negative results were found in 34 eyes, with no false positives. Sensitivity of RetCam exam vs. BIO was 0.68, and specificity was 0.99. Positive predictive value was 0.93 and negative predictive value was 0.85. All 34 ROP cases not detected with RetCam were in zone III or outer zone II. They were all mild and regressed spontaneously. No threshold ROP was missed with RetCam. CONCLUSION: Binocular indirect ophthalmoscopy is the reference method for the diagnosis of ROP. RetCam may be used as an alternative for ROP screening.

Cuidados centrados en el desarrollo. Situación en las unidades de neonatología de España / Developmental centered care. Situation in Spanish neonatal units

INTRODUCCIÓN: Los cuidados centrados en el desarrollo (CCD) tienen por objeto favorecer el desarrollo neurosensorial y emocional del niño. En España tenemos información de la aplicación de los CCD desde 1999, pero no se conoce el grado de implantación actual. OBJETIVOS: Describir el grado de implantación de los CCD en las unidades neonatales públicas que atendieron a más de 50 recién nacidos con peso menor a 1.500g en el año 2012. Comparación con los datos previos publicados en 2006. MATERIAL Y MÉTODOS: Se realizó un estudio transversal observacional descriptivo incluyendo las unidades neonatales españolas seleccionadas. Se envió un cuestionario con 7 preguntas formuladas de igual manera que en el cuestionario del 2006 para la comparación. RESULTADOS: Se envió la encuesta a 27 unidades. La tasa de respuesta del 2012 fue del 81% vs. el 96% en 2006. Respecto a medidas de control del ruido, en 2012 fue el 73% vs. el 11% en el 2006 (p < 0,01). El uso de sacarosa fue el 50% en 2012 frente al 46% en 2006 (p = 0,6). La entrada libre de padres en 2012 fue el 82% vs. el 11% en 2006 (p < 0,01). El Método Canguro, en el 2012, se realizó sin limitaciones en un 82% frente al 31% en el 2006 (p < 0,01). CONCLUSIONES: La implantación de los CCD en España ha mejorado. Todavía hay un margen de mejora en áreas como el uso de sacarosa o el control del ruido, pero hay que resaltar el cambio tan positivo que se ha producido en relación con la entrada de padres

INTRODUCTION: Developmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown. Objetive: To determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006. MATERIAL AND METHODS: A descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire. RESULTS: The survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<0.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=0.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<0.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<0.01). CONCLUSIONS: The implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits

[Developmental centered care. Situation in Spanish neonatal units]. / Cuidados centrados en el desarrollo. Situación en las unidades de neonatología de España.

INTRODUCTION: Developmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown. OBJETIVE: To determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006. MATERIAL AND METHODS: A descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire. RESULTS: The survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<.01). CONCLUSIONS: The implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits.

Alopecia femenina y sistemas de integración capilar: estudio de la repercusión psicológica / Alopecia female hair integration system: a study of the psychological impact

Fundamento: Es sabido que la alopecia femenina provoca una intensa repercusión en el psiquismo. Sin embargo, no existen estudios que calibren los cambios que puedan producirse en el mismo, cuando el aspecto de la paciente mejora gracias a la implantación de un Sistema de Integración Capilar. Un Sistema de Integración Capilar (SIC) es una prótesis parcial de cabello, de carácter semipermanente, personalizada, hecha a mano con pelos naturales de iguales características de color, grosor y textura al cabello del paciente, que se ajusta a la porción del cuero cabelludo carente de pelo y que se integra, sin intervención quirúrgica, cabello a cabello ocultando las zonas afectadas y creando una apariencia homogénea. El objetivo de este trabajo es conocer en qué medida la implantación del SIC mejora el estado psicológico de las pacientes que sufren alopecia de diferentes tipos. Material y método: Se estudió en 24 mujeres con alopecia moderada-grave de diferentes tipos que acudieron de forma sucesiva al Instituto Médico Dermatológico (IMD) de Madrid (España) entre febrero y julio de 2011 para ser tratadas con SIC. Se completó el cuestionario Hospital Anxiety and Depression Scale (HADS) antes y 3 meses después de la implantación del SIC. Se comparó la evolución en el tiempo de los cuadros de ansiedad y depresión a través del test de McNemar como herramienta estadística. Resultados: Ansiedad: al inicio del estudio el 83,33% de las pacientes mostraban diferentes niveles de ansiedad. A los 3 meses de la (AU)

Rationale: It is well know that female alopecia has a severe psychological impact. However, there are no studies assessing the psychological changes that may occur when the patient’s image improves due to the implementation of a Hair Integration System (HIS). A HIS is a partial, personalized, semipermanent hair prosthesis made of natural hair with the same characteristics of color, thickness, and texture than the patient’s hair and that is adjusted to the portion of the scalp lacking the hair and that is integrated hair by hair without any surgical intervention, covering the areas affected and yielding a homogenous appearance. The aim of this work was to know to what extent the implantation of HIS improves the psychological status of patients suffering from different types of alopecia. Material and methods: We studied 24 women with severe to moderate alopecia of different types consecutively consulting to the Instituto Médico Dermatológico (IMD) of Madrid (Spain) between February and July of 2011 to be treated by HIS. The patients completed the Hospital Anxiety and Depression Scale (HADS) before and 3 months after the implantation of HIS. The time course of anxiety and depression disorders was compared by using the McNemar test. Results: Anxiety: at the study beginning, 83.33% of the patients showed different anxiety levels. Three months after the implantation of HIS, 74.99%of the patients showed a statistically significant improvement (p value < 0.01) in the anxiety status. Depression: at the study beginning, 66.67% of the patients showed depression signs. Three months after, the signs of depression were no longer existent in 100% of the patients. Conclusions: this study confirms that alopecia disorders have a negative psychological impact (anxiety, depression) in women. HIS is an efficacious tool for the cosmetic treatment of alopecia, with almost immediate positive psychological effects (AU)

Estudio de los niveles de ansiedad en los profesionales de una unidad neonatal / Study of anxiety levels in neonatal unit staff

Introducción: Los profesionales que trabajan en unidades neonatales intervienen cotidianamente en situaciones de estrés generadas por las condiciones de trabajo y la naturaleza de las tareas. En consecuencia pueden presentar niveles elevados de ansiedad, entendida como una respuesta emocional que engloba aspectos cognitivos, fisiológicos y motores. Objetivos: Evaluar el nivel de ansiedad y la influencia de variables sociodemográficas en los profesionales de una unidad de cuidados intensivos neonatales. Método: Estudio prospectivo transversal. A todos los médicos, enfermeros/as y auxiliares se les entregó dos cuestionarios autoadministrados en situación basal para valorar ansiedad rasgo y ansiedad estado (IDDA-EA Inventario Diferencial de Adjetivos para el Estudio del Estado de Ánimo; STAI, Cuestionario de Ansiedad Estado-Rasgo).Resultados: Hubo una tasa de respuesta del 88,5%. El 36% puntuaron entre los centiles 30 y 70 en ansiedad estado, por encima del centil 70 el 11,8% y por debajo del centil 30 el 51%. No se encuentran diferencias significativas en relación al estamento ni a la edad. Tampoco hubo diferencias significativas entre ansiedad estado y rasgo. En función del género se obtiene una diferencia estadísticamente significativa de 8 puntos mayor para las mujeres. Conclusiones: Para la mayoría de los profesionales las situaciones cotidianas en las que se ven involucrados no suscitan cargas de ansiedad significativas ya que la mitad de los profesionales tienen unos niveles inferiores a la media de la población. Se perciben competentes y capaces de enfrentarse a sus tareas. Tienen un alto grado de interés y de atención en la actividad que desarrollan(AU)

Introduction: The professionals who routinely work in neonatal units become under stress due to the working conditions and the nature of the tasks carried out. As a consequence of this, they may have high levels of anxiety. Anxiety is defined as an emotional response or response patterns that include cognitive, physiological and behavioural aspects. Methods: A prospective cross-sectional study was conducted on all neonatologist, nurses and care assistants who were given two self-administered questionnaires under baseline conditions, to assess Sate Anxiety and Trait Anxiety. (IDDA-EA; STAI, State-Trait Anxiety Inventory).Results: The response rate was 88.5%, and 36% scored between 30 and 70 percentiles on State Anxiety, with 11.8% above the 70 percentile and 51% below the 30 percentile. There were no significant differences in relation to occupation or age. There were also no significant differences between State and Trait Anxiety. Regarding gender, it has obtained A statistically significant difference of 8 points higher was obtained for women. Conclusions: For the majority professionals everyday situations in which are involved do not significantly raise the burden of anxiety, as half of them have levels below the average. They perceive themselves as competent and able to cope with their tasks. They have a high degree of interest and attention in the activities performed(AU)

[Study of anxiety levels in neonatal unit staff]. / Estudio de los niveles de ansiedad en los profesionales de una unidad neonatal.

INTRODUCTION: The professionals who routinely work in neonatal units become under stress due to the working conditions and the nature of the tasks carried out. As a consequence of this, they may have high levels of anxiety. Anxiety is defined as an emotional response or response patterns that include cognitive, physiological and behavioural aspects. METHODS: A prospective cross-sectional study was conducted on all neonatologist, nurses and care assistants who were given two self-administered questionnaires under baseline conditions, to assess Sate Anxiety and Trait Anxiety. (IDDA-EA; STAI, State-Trait Anxiety Inventory). RESULTS: The response rate was 88.5%, and 36% scored between 30 and 70 percentiles on State Anxiety, with 11.8% above the 70 percentile and 51% below the 30 percentile. There were no significant differences in relation to occupation or age. There were also no significant differences between State and Trait Anxiety. Regarding gender, it has obtained A statistically significant difference of 8 points higher was obtained for women. CONCLUSIONS: For the majority professionals everyday situations in which are involved do not significantly raise the burden of anxiety, as half of them have levels below the average. They perceive themselves as competent and able to cope with their tasks. They have a high degree of interest and attention in the activities performed.

Prospective study in critically ill non-neutropenic patients: diagnostic potential of (1,3)-ß-D-glucan assay and circulating galactomannan for the diagnosis of invasive fungal disease.

Diagnosis of invasive fungal disease (IFD) in patients under intensive care is challenging. Circulating biomarkers, (1,3)-ß-D-glucan (BG) and galactomannan (GM), were prospectively assessed in 98 critically ill patients at risk of IFD. There were 11 cases of invasive aspergillosis (IA; 4 proven and 7 probable), 9 cases of proven invasive candidiasis (IC), 1 case of mixed proven IC and probable IA, 1 case of proven zygomycosis, and 1 case of mixed mycelial proven IFD. In all IA cases there was no significant difference when the area under the receiver operating characteristic curve (AUC) of GM (0.873 [95%CI, 0.75-0.99]) and BG (0.856 [95% CI, 0.71-0.99]) were compared (p = 0.871). The AUC for BG in IC and for the rest of the IFD cases was 0.605 (95% CI, 0.39-0.82) and 0.768 (95% CI, 0.63-0.90) respectively. Positive BG (40%) predated blood culture (n = 3) and abdominal pus (n = 1) a mean of 3.25 days before Candida was grown. In patients with IFD caused by molds, BG appeared a mean of 5.65 days before culture results. For the diagnosis of patients at risk of IC, BG has shown a high NPV (94.5%), with positive results also predating blood cultures in 30% of patients. In conclusion, early BG results permit a timely initiation of antifungal therapy in patients at risk of IFD.

Comparative study of the Weil osteotomy with and without fixation.

BACKGROUND: Weil osteotomy is a technique widely used in patients with metatarsalgia which shortens the metatarsal and reduces the load under the metatarsal head. METHODS: The aim of this paper is to compare the results of the Weil osteotomy with and without any fixation system. We present a retrospective study of 92 patients (97 feet) who underwent treatment for metatarsalgia between 1999 and 2005. One hundred and six osteotomies were vixed using a screw amd no fixation was used in 92. The mean follow-up was 51.2 and 46.6 months respectively. RESULTS: All the patients were evaluated following the AOFAS LMIS scale, obtaining a mean score of 69.8 points (ranged 15-100) and 75.3 points (from 47 to 100) in each group (P=0.11). CONCLUSIONS: The results of fixed and unfixed Weil osteotomies were not significantly different. Our study could not find a significant relationship between metatarsal shortening and main complications (recurrent metatarsalgia, transfer metatarsalgia and stiffness of the metatarsophalangeal joint).

Edades de sedestación y marcha en recién nacidos pretérmino menores de 1. 500 gr con displasia broncopulmonar / Ages of sitting up and walking in preterm newborns less than 1, 500 G with bronchopulmonary dysplasia

Introducción: La incidencia de secuelas neurológicas en los recién nacidos pretérmino (RNPT) con displasia broncopulmonar (DBP) es considerablemente mayor que la de aquellos que no la presentan. Conocer la cronología de adquisición de los hitos motores puede servir para proporcionar mejor información a los padres acerca de la posible existencia de un retraso en el desarrollo. El objetivo del presente estudio es estimar la influencia que tiene la DBP sobre las edades de adquisición de la sedestación y la marcha en los RNPT<1.500g con exploración neurológica normal a los 2 años. Pacientes y métodos: Estudio longitudinal con una cohorte de 885 RNPT con peso al nacimiento inferior a 1.500g, ingresados en el Hospital 12 de Octubre entre enero de 1991 y diciembre de 2003. Las edades a las que se alcanzaban los hitos motores evaluados se establecían mediante entrevista con los padres. La comparación de medias se realizó mediante la t de Student y el test de Bonferroni. Resultados: Los pacientes con DBP alcanzaron la sedestación a los 7,8±2m vs 7,1±1,3 m en los RNPT sin DBP y la marcha a los 14,5±3,8m vs 13,4±2,5m (p<0,001). Los pacientes con DBP tenían mayor riesgo de adquirir ambos hitos motores por encima del p90 (OR=2,6 (1,6-4,1) para la sedestación y OR=2,8 (1,6-4,8) para la marcha), efecto que se mantuvo tras ajustar por edad gestacional y peso al nacimiento. Conclusión: La DBP, en el grupo de RNPT<1.500g con exploración neurológica normal a los 2 años, implica un retraso en la adquisición de la sedestación y la marcha (AU)

Introduction: Adverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age. Patients and methods: A longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital “12 de Octubre” between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate. Results: Both motor skills were acquired later in the group with BPD (7.8±2m vs. 7.1±1.3m for sitting unsupported and 14.5±3.8m vs. 13.4±2.5m for walking) (P<.001). BPD was associated with delayed acquisition (above p90) of these skills, OR=2.6 (1.6-4.1) for sitting and OR=2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight. Conclusión: BPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years (AU)

[Ages of sitting up and walking in preterm newborns less than 1,500 G with bronchopulmonary dysplasia]. / Edades de sedestación y marcha en recién nacidos pretérmino menores de 1. 500 gr con displasia broncopulmonar.

INTRODUCTION: Adverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age. PATIENTS AND METHODS: A longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital "12 de Octubre" between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate. RESULTS: Both motor skills were acquired later in the group with BPD (7.8±2m vs. 7.1±1.3m for sitting unsupported and 14.5±3.8m vs. 13.4±2.5m for walking) (P<.001). BPD was associated with delayed acquisition (above p90) of these skills, OR=2.6 (1.6-4.1) for sitting and OR=2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight. CONCLUSION: BPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years.

[Congenital cataracts: complications and functional results according to different surgical techniques]. / Cataratas congénitas: complicaciones y resultados funcionales según diferentes técnicas quirúrgicas.

PURPOSE: To evaluate visual results, refractive error and complications in a series of congenital cataracts treated with different surgical techniques. METHODS: Retrospective review of 51 eyes with congenital cataracts which were surgically treated between 1989 and 2005. Eleven were unilateral cataracts and 40 were bilateral cataracts. Thirty-three eyes were treated with a primary intraocular lens (IOL) and 18 were aphakic eyes. RESULTS: The best outcomes were observed in bilateral cataracts and in those that received early primary IOL. Three eyes achieved 0.8-1, two eyes achieved 0.6-0.7. All of them were eyes with primary IOL. Seventeen percent of unilateral cataracts and 23.8% of bilateral cataracts achieved 0.4 or better. The most serious complication was visual axis opacification (VAO), 27 of 51 eyes developed VAO. Fifty percent of eyes with primary IOL and 63% of aphakic eyes developed VAO. The VAO developed sooner in the IOL group (6.5 months on average). There was a high myopic shift in 3 eyes. There was a significantly greater myopic shift in the unilateral cases. CONCLUSIONS: The best acuities were achieved in the eyes which had been treated with early primary IOL, but they had a higher rate of complications (VAO), thus requiring reoperation. Final refraction in the unilateral group was significantly more myopic than in the bilateral group.

Cataratas congénitas: complicaciones y resultados funcionales según diferentes técnicas quirúrgicas / Congenital cataracts: complications and functional results according to different surgical techniques

Objetivo: Evaluar los resultados funcionales, el error refractivo y las complicaciones de unaserie de cataratas congénitas que fueron intervenidas mediante diferentes técnicas.Métodos: Se realizó un análisis retrospectivo de 51 ojos con cataratas congénitas que fueronintervenidas quirúrgicamente entre 1989 y 2005. Once cataratas eran unilaterales y 40 eranbilaterales. En 33 ojos se empleó lente intraocular primaria (LIO) mientras que en 18 no seempleó LIO.Resultados: Los mejores resultados funcionales se observaron en cataratas bilaterales intervenidasquirúrgicamente empleando LIO primaria de forma precoz. Tan sólo 3 ojos consiguieronagudeza visual (AV) de 0,8-1, dos ojos 0,6-0,7. Todos ellos fueron ojos con LIO primaria.El 17% de las cataratas unilaterales y el 23,8% de las bilaterales consiguieron AV de0,4 o mejor. La complicación más importante fue la opacificación del eje visual (OEV) queocurrió en 27 de los 51 ojos. El 50% de los ojos con LIO primaria y el 63% de los ojos afáquicosdesarrollaron OEV. La OEV se desarrolló antes en el grupo de LIO primaria (con unamedia de 6,5 meses de edad). Tan sólo se observó un error miópico alto en 3 ojos. Se observóun error miópico significativamente mayor en las cataratas unilaterales.Conclusiones: Los mejores resultados funcionales se consiguieron en ojos intervenidos conLIO primaria de forma precoz, sin embargo estas cataratas presentaron una tasa mayor deOEV que requirieron tratamiento quirúrgico. La refracción final en el grupo de cataratasunilaterales fue significativamente más miópica que en el grupo de cataratas bilaterales(AU)

Purpose: To evaluate visual results, refractive error and complications in a series ofcongenital cataracts treated with different surgical techniques.Methods: Retrospective review of 51 eyes with congenital cataracts which were surgicallytreated between 1989 and 2005. Eleven were unilateral cataracts and 40 were bilateralcataracts. Thirty-three eyes were treated with a primary intraocular lens (IOL) and 18 wereaphakic eyes.Results: The best outcomes were observed in bilateral cataracts and in those that receivedearly primary IOL. Three eyes achieved 0.8-1, two eyes achieved 0.6-0.7. All of them wereeyes with primary IOL. Seventeen percent of unilateral cataracts and 23.8% of bilateralcataracts achieved 0.4 or better. The most serious complication was visual axis opacification(VAO), 27 of 51 eyes developed VAO. Fifty percent of eyes with primary IOL and 63% ofaphakic eyes developed VAO. The VAO developed sooner in the IOL group (6.5 months onaverage). There was a high myopic shift in 3 eyes. There was a significantly greater myopicshift in the unilateral cases.Conclusions: The best acuities were achieved in the eyes which had been treated with earlyprimary IOL, but they had a higher rate of complications (VAO), thus requiring reoperation.Final refraction in the unilateral group was significantly more myopic than in the bilateralgroup(AU)

Age of sitting unsupported and independent walking in very low birth weight preterm infants with normal motor development at 2 years.

AIMS: The aims of this study is to (i) determine the age of sitting unsupported and independent walking in preterm infants with birth weight under 1500 g (very low birth weight, VLBW); (ii) estimate differences between VLBW children and a reference population and (iii) estimate the association between clinical characteristics and late age at sitting and walking. METHODS: A longitudinal study was conducted of a cohort of 876 children with VLBW. The World Health Organization (WHO) motor development study population was used as a reference. Ages for both skills were established by interview with parents. Means were compared with t-test, ANOVA and Bonferroni adjustment where appropriate. RESULTS: The inclusion criteria were complied with 694 patients; 50% of VLBW sat at 7 m corrected age (CA) and walked at 13 m CA. Both motor skills were acquired later (7.3 +/- 1.5 and 13.6 +/- 2.8 m) compared with the control group (6 +/- 1.1 and 12.1 +/- 1.8 m). Weight or head circumference at birth below the 10th percentile or the presence of bronchopulmonary dysplasia were associated with delayed acquisition of both skills. CONCLUSION: Very low birth weight infants typically sit unsupported and walk later than term infants. Tables describing reference values for milestones acquisition for different categories of infants (gestational age, birth weight and other determinants) may contribute to inform the decision making process on access to available resources.

Estudio de la calidad de las prescripciones médicas en un servicio de urgencias pediátricas / Study on the quality of the medical prescriptions in a Pediatrics Emergency Service

Antecedentes: En los últimos años se han publicado algunos trabajos sobre el error médico. Los servicios de urgencias pediátricas (SUP) son especialmente susceptibles al error de prescripción, pero se han escrito pocos artículos específicos al respecto. Objetivos: Determinar la frecuencia y las variables asociadas con las desviaciones de la buena práctica médica en las prescripciones médicas en nuestro SUP. Métodos: Estudio retrospectivo observacional. Revisamos las prescripciones realizadas en 58 días elegidos de forma aleatoria (entre julio de 2003 y marzo de 2004). De cada una de ellas evaluamos la legibilidad, el cálculo de dosis, las unidades, el intervalo y la alergia medicamentosa. Recogimos el día de la semana, el turno y el grado de formación del médico responsable. Resultados: Durante los 58 días revisados se realizaron3.143 prescripciones. Detectamos una o más desviaciones de la buena práctica médica en 1.348 (43%). Ninguna de ellas fue clasificada como grave. La variable donde más desviaciones detectamos fue en la legibilidad, seguida del cálculo de la dosis. En el 11%, al menos uno de los elementos se consideró ilegible. Se encontraron diferencias estadísticamente significativas al analizar las variables correspondientes al día de la semana (fin de semana frente a lunes-viernes; p= 0,0036) y el grado de formación (residente frente a adjunto; p <0,0001). Conclusiones: Los errores en la prescripción médica son frecuentes en nuestro SUP; ninguno de ellos es grave, pero sí limitan el buen cumplimiento del tratamiento. Se pueden identificar circunstancias que hacen más frecuentes las desviaciones y, de esta forma, diseñar intervenciones para mejorar la calidad asistencial (AU)

Background: Several papers related to the medical mistakes have been published over the past years. The Pediatrics Emergency Services are specially susceptible as regards to the prescription mistake but there are few specific articles. Objectives: To determine the frequency and variables associated to the deviations of good medical practice in medical prescriptions in our Pediatrics Emergency Service. Methods: Retrospective observational study. We revised the prescriptions done during fifty eight days on a random basis(from July 2003 to March 2004). From every prescription: legibility, dose assessment, units, intervals and drug allergies were evaluated. The day of the week, shift and level of training of the prescribing physician were documented. Results: During the revised 58 day, 3,143 prescriptions were made. One or more deviations to the good medical practice were detected in 1,348 (43%) of the prescriptions. None of the mistakes were classified as severe. The variable where more deviations were detected was the legibility and dosage assessment. In 11% at least one of the elements were considered illegible. Statistical significant differences were found when analyzing the day of the week variables (week-end vs. Monday-Friday, p= 0.0036) and to the level of training (resident vs. pediatricians, p <0.0001). Conclusions: Medical prescription mistakes are very common in our Pediatrics Emergency Service. None of them were severe but limited the good compliance of the treatment. Some characteristics that make deviations more frequent can be identified in order to design interventions to improve the quality (AU)

Revisión de los parámetros hematológicos y bioquímicos para identificar la ferropenia / Review of haematology and biochemistry parameters to identify iron deficiency

Introducción: La ferropenia es una de las deficiencias nutricionales más frecuentes en la primera infancia. En las últimas décadas se han incorporado nuevas técnicas para el diagnóstico de la ferropenia a los clásicos marcadores bioquímicos; sin embargo, no se conoce bien qué parámetros deberían incluirse en un panel para identificar el déficit de hierro y la anemia ferropénica. Los objetivos de este estudio fueron los siguientes: a) determinar los valores de los parámetros hematológicos eritrocíticos y del contenido de hemoglobina eritrocitaria (CHr), así como de ferritina, de sideremia, de saturación de transferrina, de transferrina y de capacidad total de fijación de hierro, con objeto de analizar su relevancia en la identificación de la ferropenia en la muestra, y b) determinar qué parámetros hematológicos y bioquímicos son predictores independientes de ferropenia en la muestra estudiada. Pacientes y métodos: La muestra procedía de una población urbana con una edad comprendida entre los 6 meses y los 14 años, de ambos sexos. El protocolo de estudio incluía un cuestionario y la realización de una analítica que constaba de hemograma con CHr y bioquímica del metabolismo férrico. Resultados: Se incluyó a 237 niños. El análisis de regresión logística identificó al CHr y al hierro como los únicos parámetros independientemente asociados al diagnóstico de ferropenia (p<0,05); la reducción relativa del riesgo fue más significativa para el parámetro CHr. Conclusiones: Este estudio apoya que un panel basado exclusivamente en parámetros hematológicos, con la inclusión del CHr, es una alternativa válida al panel conjunto hematológico y bioquímico tradicionalmente empleado para identificar el déficit de hierro y la anemia ferropénica en la infancia (AU)

Introduction: There has been a continuous improvement in the methods to detect iron deficiency, a common condition in children, in the last decades or so, but it is still difficult to establish which parameters should be included in a diagnostic panel for iron deficiency and iron deficiency anaemia. The objectives of this study were to evaluate the diagnostic efficiency of commonly used haematological and biochemical markers, as well as the reticulocyte haemoglobin content (CHr) in the diagnosis of iron deficiency with or without anaemia. Study design: A descriptive cross-sectional study was carried out on an urban population of both sexes aged 6 months to 14 years. A complete blood cell count with CHr was obtained. Biochemical markers of iron metabolism, transferrin saturation, serum iron, ferritin and total iron binding capacity were also measured. Results: Samples were obtained for 237 children. A multiple stepwise logistic regression analysis identified CHr and iron serum as the only parameters independently associated to iron deficiency (P<0.05). CHr was the strongest predictor of iron deficiency and iron deficiency anaemia. Conclusions: Our study indicates that the measurement of CHr may be a reliable method to assess deficiencies in tissue iron supply. CHr together with a complete blood count may provide an alternative to the traditional biochemical panel for the diagnosis of iron deficiency in children (AU)

Contenido de hemoglobina reticulocitaria para el diagnóstico de la ferropenia / Reticulocyte haemoglobin content in the diagnosis of iron deficiency

Introducción: El reconocimiento del déficit de hierro es crucial para administrar un tratamiento precoz que prevenga las complicaciones multisistémicas de la anemia ferropénica. El parámetro contenido de hemoglobina reticulocitaria (CHr) ha demostrado mayor efectividad que los índices convencionales para detectar el déficit de hierro antes de su progresión a anemia en determinadas poblaciones. Los objetivos de este estudio fueron valorar la utilidad del CHr para el diagnóstico del déficit de hierro y de la anemia ferropénica en España y determinar el valor del CHr con mejor rendimiento para el diagnóstico de ferropenia. Pacientes y métodos: La muestra procedía de una población urbana de ambos sexos con una edad comprendida entre los 6 meses y los 14 años. El protocolo de estudio incluía un cuestionario y la realización de una analítica que constaba de hemograma con CHr y bioquímica del metabolismo férrico. Resultados: Se incluyeron 237 niños. La cifra del CHr correspondiente a 25pg mostró la mejor combinación de sensibilidad (90,7%) y especificidad (80,1%). En los grupos con déficit de hierro y con anemia ferropénica la media del CHr se situó por debajo de 25pg, mientras que en aquéllos con anemia no ferropénica y normal la media fue igual o superior a este valor. Conclusiones: El CHr es un parámetro hematológico útil para diagnosticar la ferropenia en la población infantil. La cifra de 25pg demostró ser el punto de corte más adecuado para identificar el déficit de hierro acompañado o no de anemia por su elevado rendimiento diagnóstico (AU)

Introduction: The detection of iron deficiency is essential in order to start early treatment to prevent long-term systemic complications of iron deficiency anaemia. Reticulocyte haemoglobin content (CHr) has been shown to be a helpful indicator for detecting iron deficiency before the development of anaemia. The objectives of this study were to evaluate the efficiency of CHr in the assessment of iron deficiency with or without anaemia and to determine the cut-off value with the best diagnostic yield. Study design: A descriptive cross-sectional study was carried out on an urban population of both sexes aged 6 months to 14 years. The study protocol included a questionnaire and taking a venous blood sample for a complete blood cell count with CHr and biochemical indicators of iron status. Results: Samples were obtained for 237 children. A CHr cut-off value of 25pg had an overall sensitivity of 90.7% and specificity of 80.1% for the diagnosis of iron deficiency with or without anaemia. The value of CHr was below 25pg in the diagnostic groups with iron deficiency and iron deficiency anaemia, and above this value in the diagnostic groups with non-iron deficient anaemia or normal. Conclusions: CHr is a useful hematological marker to identify iron deficiency and iron deficiency anaemia in childhood. A CHr value of 25pg showed the best performance to identify iron deficiency with or without anaemia (AU)