Burden of respiratory syncytial virus hospitalisation among infants born at 32-35 weeks' gestational age in the Northern Hemisphere: pooled analysis of seven studies.

To provide comprehensive information on the epidemiology and burden of respiratory syncytial virus hospitalisation (RSVH) in preterm infants, a pooled analysis was undertaken of seven multicentre, prospective, observational studies from across the Northern Hemisphere (2000-2014). Data from all 320-356 weeks' gestational age (wGA) infants without comorbidity were analysed. RSVH occurred in 534/14 504 (3.7%) infants; equating to a rate of 5.65 per 100 patient-seasons, with the rate in individual wGA groups dependent upon exposure time (P = 0.032). Most RSVHs (60.1%) occurred in December-January. Median age at RSVH was 88 days (interquartile range (IQR): 54-159). Respiratory support was required by 82.0% of infants: oxygen in 70.4% (median 4 (IQR: 2-6) days); non-invasive ventilation in 19.3% (median 3 (IQR: 2-5) days); and mechanical ventilation in 10.2% (median 5 (IQR: 3-7) days). Intensive care unit admission was required by 17.9% of infants (median 6 days (IQR: 2-8) days). Median overall hospital length of stay (LOS) was 5 (IQR: 3-8) days. Hospital resource use was similar across wGA groups except for overall LOS, which was shortest in those born 35 wGA (median 3 vs. 4-6 days for 32-34 wGA; P < 0.001). Strategies to reduce the burden of RSVH in otherwise healthy 32-35 wGA infants are indicated.

Cost-utility analysis of Palivizumab for Respiratory Syncytial Virus infection prophylaxis in preterm infants: update based on the clinical evidence in Spain.

BACKGROUND: This study aimed at estimating the efficiency of palivizumab in the prevention of Respiratory Syncytial Virus (RSV) infection and its sequelae in preterm infants (32day 1-35day 0weeks of gestational age -wGA-) in Spain. METHODS: A decision-tree model was developed to compare health benefits (Quality Adjusted Life Years-QALYs) and costs of palivizumab versus a non-prophylaxis strategy over 6 years. A hypothetical cohort of 1,000 preterm infants, 32day 1-35day 0 wGA (4.356 kg average weight) at the beginning of the prophylaxis (15 mg/kg of palivizumab; 3.88 average number of injections per RSV season) was analysed. The model considered the most recent evidence from Spanish observational and epidemiological studies on RSV infection: the FLIP II study provided hospital admission and Intensive Care Unit (ICU) admission rates; in-hospital mortality rate was drawn from an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. Quality of life baseline value, number of hospitalized infants and the presence of recurrent wheezing over time were granted to estimate QALYs. National Health Service and societal perspective (included also recurrent wheezing indirect cost) were analysed. Total costs (€, 2016) included pharmaceutical and administration costs, hospitalization costs and recurrent wheezing management annual costs. A discount rate of 3.0% was applied annually for both costs and health outcomes. RESULTS: Over 6 years, the base case analysis showed that palivizumab was associated to an increase of 0.0731 QALYs compared to non-prophylaxis. Total costs were estimated in €2,110.71 (palivizumab) and €671.68 (non-prophylaxis) from the National Health System (NHS) perspective, resulting in an incremental cost utility ratio (ICUR) of €19,697.69/QALYs gained (prophylaxis vs non-prophylaxis). Results derived from the risk-factors population subgroups analysed were in line with the total population results. From the societal perspective, the incremental cost associated to palivizumab decreased to an €1,253.14 (ICUR = €17,153.16€/QALYs gained for palivizumab vs non-prophylaxis). One-way and probabilistic sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm infants 32day 1-35day 0 wGA in Spain.

Actualización de las recomendaciones de la Sociedad Española de Neonatología para la utilización del palivizumab como profilaxis de las infecciones graves por el virus respiratorio sincitial / Update of recommendations on the use of palivizumab as prophylaxis in RSV infections

El Comité de Estándares de la Sociedad Española de Neonatología (SENeo) considera que el nuevo documento de la Academia Americana de Pediatría respecto a las recomendaciones del palivizumab para prevenir las infecciones graves por el virus respiratorio sincitial (VRS) no aporta nuevas evidencias científicas que justifiquen la modificación de las recomendaciones actuales de la SENeo. No obstante, se proponen unos ajustes en los criterios de las recomendaciones vigentes para reducir el coste del fármaco mediante su administración correcta y juiciosa

The Standards Committee of the Spanish Neonatology Society (SENeo) considers that the new document from the American Academy of Pediatrics, including recommendations for palivizumab use to prevent serious infections produced by the Respiratory Syncytial Virus (RSV), provides no new scientific evidence which would justify the modification of the current recommendations of the SENeo. However, some adjustments to the criteria of the existing recommendations are proposed to reduce the cost of the drug by its correct and judicious management

[Update of recommendations on the use of palivizumab as prophylaxis in RSV infections]. / Actualización de las recomendaciones de la Sociedad Española de Neonatología para la utilización del palivizumab como profilaxis de las infecciones graves por el virus respiratorio sincitial.

The Standards Committee of the Spanish Neonatology Society (SENeo) considers that the new document from the American Academy of Pediatrics, including recommendations for palivizumab use to prevent serious infections produced by the Respiratory Syncytial Virus (RSV), provides no new scientific evidence which would justify the modification of the current recommendations of the SENeo. However, some adjustments to the criteria of the existing recommendations are proposed to reduce the cost of the drug by its correct and judicious management.

Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference.

Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.

Evolución del peso del prematuro con alta precoz y atención domiciliaria de enfermería / Influence of in-home nursing care on the weight of the early discharged preterm newborn

INTRODUCCIÓN: La atención domiciliaria de enfermería (ADE) del recién nacido prematuro próximo al alta en su propio domicilio en lugar del hospital normaliza la situación familiar, favorece la lactancia materna y el desarrollo del recién nacido y permite la reorganización de los recursos sanitarios. El propósito del presente trabajo es demostrar que el prematuro sometido al programa de ADE experimenta un aumento de peso superior en el domicilio respecto al hospital y no incrementa su morbilidad. Pacientes y metodología: Estudio comparativo de 65 casos y 65 controles (apareados por peso, edad y sexo), prematuros, de procedencia interna y con peso al alta inferior a 2.100 g. La ADE fue administrada por un pediatra neonatólogo y 2 enfermeras especializadas en neonatología dependientes de los servicios hospitalarios, que realizaron visitas seriadas a domicilio. El aumento de peso se calculó por g/día y g/kg/día, comparando la semana previa al inicio del estudio con la primera semana del estudio. RESULTADOS: Los grupos fueron comparables. El aumento de peso en el grupo con ADE fue de 38 g/día, significativamente superior al del grupo control (31 g/día). Las variables independientes predictoras del «aumento en g/kg/día durante el estudio» fueron la ADE, el sexo varón, tomar menos lactancia materna y no haber padecido una hemorragia peri-intraventricular. La morbilidad neonatal fue similar. CONCLUSIONES: La ADE implicó un mayor aumento de peso del recién nacido en casa que durante su permanencia en el hospital, y no aumentó la morbilidad neonatal

INTRODUCTION: In-Home nursing care of the preterm newborn helps to bring the family situation to normal, promotes breastfeeding and development of the newborn, and enables the reorganization of health care resources. The purpose of this paper is to demonstrate that in-home nursing care of the preterm newborn leads to an increase in weight and a similar morbidity. Patients and methodology: A total of 65 cases and 65 controls (matched by weight, age and sex) were studied, all of them preterm newborns born in hospital and weighing less than 2100 g at discharge. In-home nursing care was carried out by a pediatrician neonatologist, as well as two nurses specialized in neonatology who made several visits to the home. Weight gain was calculated as g/day and g/Kg/day, comparing the first week of the study with the week prior to the beginning of the study. RESULTS: The groups were comparable. Weight gain in the group with home nursing care was 38 g per day, significantly higher than the weight gain in the control group (31 g/day). The independent predictive variables of the increase in g/Kg/day during the study were in-home nursing care, male gender, breastfeeding less, and not having suffered from a peri-intraventricular hemorrhage. Neonatal morbidity was similar in both groups. CONCLUSIONS: In-home care was associated with a greater weight gain of the newborn at home than during their stay in the hospital, and can be considered safe because neonatal morbidity was not increased

[Influence of in-home nursing care on the weight of the early discharged preterm newborn]. / Evolución del peso del prematuro con alta precoz y atención domiciliaria de enfermería.

INTRODUCTION: In-Home nursing care of the preterm newborn helps to bring the family situation to normal, promotes breastfeeding and development of the newborn, and enables the reorganization of health care resources. The purpose of this paper is to demonstrate that in-home nursing care of the preterm newborn leads to an increase in weight and a similar morbidity. PATIENTS AND METHODOLOGY: A total of 65 cases and 65 controls (matched by weight, age and sex) were studied, all of them preterm newborns born in hospital and weighing less than 2100 g at discharge. In-home nursing care was carried out by a pediatrician neonatologist, as well as two nurses specialized in neonatology who made several visits to the home. Weight gain was calculated as g/day and g/Kg/day, comparing the first week of the study with the week prior to the beginning of the study. RESULTS: The groups were comparable. Weight gain in the group with home nursing care was 38 g per day, significantly higher than the weight gain in the control group (31 g/day). The independent predictive variables of the increase in g/Kg/day during the study were in-home nursing care, male gender, breastfeeding less, and not having suffered from a peri-intraventricular hemorrhage. Neonatal morbidity was similar in both groups. CONCLUSIONS: In-home care was associated with a greater weight gain of the newborn at home than during their stay in the hospital, and can be considered safe because neonatal morbidity was not increased.

High risk for RSV bronchiolitis in late preterms and selected infants affected by rare disorders: a dilemma of specific prevention.

Respiratory syncytial virus (RSV) is the most frequent aetiologic agent that causes bronchiolitis and lower respiratory tract infection in infants. These infections may be severe and even life-threatening in selected high-risk populations. Traditional, well-established, high-risk populations are preterm infants with or without chronic lung disease and children with congenital heart disease. For these children, RSV prophylaxis using palivizumab, a monoclonal anti-RSV humanised antibody against the F-protein of RSV, has proven safe and efficacious in preventing RSV-related hospitalisation. Recently, a number of rare medical conditions have been associated with the risk of severe RSV infections. Evidence of safety and efficacy of RSV prophylaxis in these populations is lacking. Given the low incidence of these conditions, randomised trials are not feasible. A practical, opinion-based approach to this dilemma is offered in this paper. It is proposed that these rare disorders may qualify for RSV prophylaxis if the association between a specific condition and the risk of severe RSV infection is confirmed in at least 3 independent publications, of which at least 1 includes a prospective cohort study. To facilitate pharmaco-economic analyses, at least one of the three studies must also report on the absolute risk of severe RSV infection in the specified illness. The authors believe that qualification criteria will enable caregivers to target RSV prophylaxis more effectively in children with rare conditions and the proposed approach provides direction for future epidemiological studies on the risk of severe RSV infection in children with these uncommon, medical illnesses.

Tratamiento con eritropoyetina para la anemia tardía tras enfermedad hemolítica del recién nacido / Erythropoietin treatment for late anaemia after haemolytic disease of the newborn

Introducción: Tras varios años de empleo de eritropoyetina (EPO) en la profilaxis de la anemia del prematuro se empezó a utilizarla en algunos recién nacidos (RN) para tratar la anemia neonatal tardía posthemólisis y evitar la transfusión de hematíes. Objetivo: Mostrar los resultados del tratamiento con EPO en la anemia neonatal tardía posthemólisis. Pacientes y métodos: Estudio observacional en 13 RN con anemia tardía secundaria a enfermedad hemolítica por isoinmunización Rh (9 casos), ABO (2 casos), déficit de glucosa-6-P-deshidrogenasa (1 caso) e idiopática (1 caso). Los neonatos iniciaron el tratamiento con EPO cuando se encontraron en indicación de transfusión o próximo a ella. Resultados: Se empezó el tratamiento con EPO a la edad de 26±7 días (15–46), con un valor de hematocrito de 21,7±3% (18–27) y un recuento reticulocitario del 3,8±2,2%. En 11 niños se pudo evitar la transfusión (alcanzaron un hematocrito de 30,7±4,4% y reticulocitos del 5,9±1,4%) y sólo 2 debieron ingresar a tal efecto (con hematocrito 18±1,4% y reticulocitos del 0,6%). Tras la EPO se encuentra un aumento significativo de la hemoglobina (Hb) y de los reticulocitos. Conclusiones: La EPO se ha mostrado útil para evitar la transfusión de hematíes en el 84% de los niños tratados. No se han observado efectos secundarios atribuibles a su uso (AU)

Introduction: After several years of erythropoietin (EPO) use in the prophylaxis of anaemia of prematurity, it also began to be administered to treat post-haemolytic disease anaemia of the newborn in order to avoid blood transfusions. Objective: To show the results obtained with EPO treatment in post-haemolytic disease anemia of the newborn. Patients and methods: Observational study in 13 newborns with late anaemia due to an hemolytic disease caused by Rh isoimmunization (9 cases), AB0 isoimmunization (2 cases), glucose-6-P-dehydrogenase deficiency (1 case) or idiopathic (1 case). The newborns began EPO treatment when they reached the haematocrit level for a blood transfusion. Results: EPO treatment was started at 26±7 days of life (15–46), with a haematocrit value of 21.7±3% (18–27) and a reticulocyte count of 3.8±2.2%. Blood transfusion was not necessary in 11 newborns (haematocrit of 30.7±4.4% and reticulocytes of 5.9±1.4%), and only 2 newborns were admitted for a blood transfusion (haematocrit 18±4.4% and reticulocytes 0.6%). Significant increases in haemoglobin and reticulocyte figures were seen after EPO treatment. Conclusions: EPO administration proved useful to avoid blood transfusion in 84% of treated newborns. No adverse events were detected which could be attributed to this treatment (AU)

[Erythropoietin treatment for late anaemia after haemolytic disease of the newborn]. / Tratamiento con eritropoyetina para la anemia tardía tras enfermedad hemolítica del recién nacido.

INTRODUCTION: After several years of erythropoietin (EPO) use in the prophylaxis of anaemia of prematurity, it also began to be administered to treat post-haemolytic disease anaemia of the newborn in order to avoid blood transfusions. OBJECTIVE: To show the results obtained with EPO treatment in post-haemolytic disease anemia of the newborn. PATIENTS AND METHODS: Observational study in 13 newborns with late anaemia due to an hemolytic disease caused by Rh isoimmunization (9 cases), AB0 isoimmunization (2 cases), glucose-6-P-dehydrogenase deficiency (1 case) or idiopathic (1 case). The newborns began EPO treatment when they reached the haematocrit level for a blood transfusion. RESULTS: EPO treatment was started at 26±7 days of life (15-46), with a haematocrit value of 21.7±3% (18-27) and a reticulocyte count of 3.8±2.2%. Blood transfusion was not necessary in 11 newborns (haematocrit of 30.7±4.4% and reticulocytes of 5.9±1.4%), and only 2 newborns were admitted for a blood transfusion (haematocrit 18±4.4% and reticulocytes 0.6%). Significant increases in haemoglobin and reticulocyte figures were seen after EPO treatment. CONCLUSIONS: EPO administration proved useful to avoid blood transfusion in 84% of treated newborns. No adverse events were detected which could be attributed to this treatment,.

Calidad de vida en lactantes nacidos prematuros según ingresos por infección respiratoria / Quality of life of preterm infants and admissions due to respiratory infections

Introducción: Estudio de la calidad de vida relacionada con la salud (CVRS) en lactantes nacidos prematuros de 32–35 semanas de gestación según su ingreso por infección respiratoria del tracto inferior. Métodos: Estudio transversal anidado en el estudio FLIP-2 sobre 216 progenitores/prematuros de 32–35 semanas, seleccionados concurrentemente en la entrevista final del estudio FLIP-2. Se midió la CVRS del prematuro con la escala QUALIN modificada, la del progenitor se midió con el cuestionario SF-12 y con escalas visuales. Se valoró la sobrecarga del cuidador con escalas directas (Zarit modificada) y medidas indirectas. Se hizo un estudio descriptivo y de asociación multivariante. Resultados: El 33% (71 niños) ingresó por causa respiratoria. Ingresaron significativamente más los nacidos en partos triples y los residentes en hogares con más de 5 habitantes. El 47% de los progenitores de los pacientes ingresados causó baja laboral para atender al niño, frente al 18% del otro grupo. Los padres de los pacientes ingresados tienen mayor sobrecarga y menor puntuación en el componente físico del cuestionario SF-12. El modelo multivariante asocia a la CVRS del prematuro con mayor edad gestacional, tener hermanos de 0–3 años, recibir profilaxis del virus respiratorio sincitial (VRS) cuando está recomendada por tener factores de riesgo, menor sobrecarga del cuidador, mayor CVRS del cuidador en la escala mental del cuestionario SF-12 y no haber perdido jornadas laborales. Conclusiones: Haber ingresado por infección respiratoria no se asocia a diferente CVRS en los prematuros, aunque sí a diferente CVRS y sobrecarga en los cuidadores. La CVRS en los lactantes está asociada a la de sus cuidadores y a su sobrecarga, y a recibir profilaxis del VRS cuando la presencia de factores de riesgo la haría recomendable (AU)

Introduction: Study of the association between lower respiratory tract infection hospitalisations and health related quality of life (HRQoL) in preterm infants of 32–35 weeks of gestational age. Methods: Survey study nested into a prospective follow-up cohort study of preterm infants (FLIP-2). During the last FLIP-2 visit, 216 preterm-parent pairs were interviewed. The structured questionnaire included measures of HRQoL (QUALIN modified scale for the infant, and SF-12 for the parent, and Visual scales for both), caregiver overload (Zarit modified scale and indirect measurements). Results: From October 2006 to March 2007 (RSV season), there were 71 respiratory hospitalisations (33%). Triplets and infants living in homes with >5 inhabitants were most likely to be hospitalised. Parents of hospitalised children were most likely, to have more and longer times off work for child care (47% vs. 18%), to have higher overload, and to obtain lower values in the physical dimension of SF-12. Multiple regression model associated infant HRQoL with higher gestational age, having 0–3 year-old siblings, being recommended palivizumab and had received it, lower caregiver overload, higher caregiver mental HRQoL and no absence from work for child care. Conclusions: Although respiratory hospitalisations were not associated with infant HRQoL, caregivers' HRQoL and overload were. Preterm infant HRQoL is associated with their caregivers' HRQoL and overload, and with receiving RSV prophylaxis when their risk profile recommends it (AU)

Recomendaciones de uso de palivizumab para la prevención de la infección por virus respiratorio sincitial en prematuros de 321 a 350 semanas de gestación / Recommendations for the use of palivizumab in the prevention of respiratory syncytial virus infection in late preterm infants (321 to 350 weeks of gestation)

Los prematuros entre 321–350 semanas de gestación menores de 6 meses al inicio de la estación VRS o dados de alta durante la misma pueden beneficiarse de medidas higiénicas y de anticuerpos monoclonales para el virus respiratorio sincitial (Palivizumab) a fin de disminuir su hospitalización por esta infección. La Sociedad Española de Neonatología considera que, de acuerdo con la evidencia científica actual y en especial tras los resultados del estudio FLIP2 en población española, la profilaxis con palivizumab en prematuros de 321 a 350 semanas es muy recomendable cuando estén presentes los 2 factores de riesgo mayores (edad cronológica inferior a 10 semanas al comienzo de la estación o nacer en las 10 primeras semanas de la misma; tener al menos un hermano en edad escolar o de guardería o acudir a la misma). También se considera recomendable la profilaxis con palivizumab cuando estén presentes un factor mayor y 2 factores menores (antecedente de tabaquismo materno durante la gestación; sexo varón) (AU)

Late preterm infants (321 to 350 weeks gestation) aged less than 6 months at start of RSV station or discharged during this time may benefit from RSV monoclonal antibodies (palivizumab) administration to decrease the rates of RSV hospitalization. The Spanish Society of Neonatology considers, based on FLIP2 results in Spain, that palivizumab prophylaxis is strongly recommended if the “2 major risk factors” are present (chronological age less than 10 weeks at start of RSV season or being born during its first 10 weeks; sibling of school age or attending day-care assistance). Palivizumab is also recommended when “1 major risk factor and the 2 minor risk factors” are present. Minor risk factors are: mother smoking during pregnancy and being a male (AU)

[Recommendations for the use of palivizumab in the prevention of respiratory syncytial virus infection in late preterm infants (32(1) to 35(0) weeks of gestation)]. / Recomendaciones de uso de palivizumab para la prevención de la infección por virus respiratorio sincitial en prematuros de 32(1) a 35(0) semanas de gestación.

Late preterm infants (32(1) to 35(0) weeks gestation) aged less than 6 months at start of RSV station or discharged during this time may benefit from RSV monoclonal antibodies (palivizumab) administration to decrease the rates of RSV hospitalization. The Spanish Society of Neonatology considers, based on FLIP2 results in Spain, that palivizumab prophylaxis is strongly recommended if the "2 major risk factors" are present (chronological age less than 10 weeks at start of RSV season or being born during its first 10 weeks; sibling of school age or attending day-care assistance). Palivizumab is also recommended when "1 major risk factor and the 2 minor risk factors" are present. Minor risk factors are: mother smoking during pregnancy and being a male.

Efectividad de palivizumab en la prevención de la infección por el virus respiratorio sincitial en prematuros de 32' a 35º semanas de gestación en España / Effectiveness of palivizumab to prevent hospitalization for respiratory syncytial virus infection in preterm infants 32' to 35º weeks’ gestation in Spain

Objetivo: Se pretende evaluar la efectividad de palivizumab para prevenir ingresos por el virus respiratorio sincitial (VRS) cuando es administrado a ex prematuros de 321 a 350 semanas de gestación, con menos de 6 meses de edad al inicio de la estación VRS y que presenten alguna de las combinaciones de factores de riesgo de ingreso por VRS. Pacientes y métodos: Se ha utilizado la base de datos del estudio FLIP-2, excluyendo los niños sin ningún factor de riesgo. Se estudió a 627 niños tratados con palivizumab y 4.092 que no lo recibieron. Las agrupaciones de factores de riesgo combinaron dos «factores mayores» (edad cronológica inferior a 10 semanas al inicio de la estación o haber nacido en las 10primeras semanas de la estación; hermano mayor que fuera a la escuela o asistencia a la guardería) y dos «factores menores» (gestante fumadora; sexo varón). Se han calculado los diferentes riesgos absoluto y relativo y el número de pacientes que es necesario tratar (NNT) para cada combinación de factores de riesgo. Resultados: En cada combinación se encuentra un menor peso y una menor edad gestacional altamente significativos (p <0,001) en los niños tratados con palivizumab. En la combinación«2 factores mayores» se encuentra el menor NNT (13,5), y si se añade la combinación «1 factor mayor + 2 factores menores», el NNT alcanza un valor de 15,1. La combinación que sólo exige la presencia de un factor mayor o menor corresponde al estudio global. Ingresaron 186 (4,55%) no tratados con palivizumab y 9 (1,44%) de los tratados (p <0,001; NNT= 32,2). Conclusiones: En los ex prematuros de 321 a 350 semanas, con una edad cronológica inferior a 10 semanas al inicio de la estación VRS o que hayan nacido en las 10 primeras semanas de la estación, y con un hermano mayor que vaya a la escuela o asista a la guardería, para prevenir un ingreso VRS habría que administrar palivizumab a 14 de ellos (AU)

Objective: The objective of the study was to evaluate effectiveness of palivizumab to prevent respiratory syncytial virus (RSV) infection when administered to former preterm infants321 to 350 weeks’ gestation aged less than 6 months at the beginning of RSV season using any of the possible combinations of known risk factors for RSV hospitalization. Patients and methods: Data were retrieved from the FLIP-2study database. Infants without risk factors were excluded. The database included 627 infants who received palivizumab and 4,092 who did not. Seven accumulative subgroups were established according to the combinations of risk factors combining two “major factors” (chronological age less than10 weeks at the beginning of RSV season or being born during the first10 weeks of the season; school-age siblings or daycare attendance)and two “minor factors” (mother smoking during pregnancy; male gender). Absolute risk, relative risk, and number needed to treat (NNT) were obtained for each subgroup. Results: In each subgroup, birth weight and gestational age were significantly lower in palivizumab treated infants. The combination “2 major factors” showed a NNT of [13.5], and when merged with “1 major factor or 2 minor factors” the NNT reached 15.1. Combination requesting only one risk factor either major or minor corresponded by design to the global study.186 patients of the treated group (4.55%) and 9 patients of the non-treated group (1.44%) were admitted to the hospital, of the treated (p <0.001; NNT of 32.2).Conclusion: In former preterm infants 321 to 350 weeks’ gestation with chronological age less than10 weeks at the beginning of RSV season (or being born during the first 10 weeks of the season) and with school-age siblings or daycare attendance,14 should be treated with palivizumab to prevent one RSV hospitalization (AU)

[Quality of life of preterm infants and admissions due to respiratory infections]. / Calidad de vida en lactantes nacidos prematuros según ingresos por infección respiratoria.

INTRODUCTION: Study of the association between lower respiratory tract infection hospitalisations and health related quality of life (HRQoL) in preterm infants of 32-35 weeks of gestational age. METHODS: Survey study nested into a prospective follow-up cohort study of preterm infants (FLIP-2). During the last FLIP-2 visit, 216 preterm-parent pairs were interviewed. The structured questionnaire included measures of HRQoL (QUALIN modified scale for the infant, and SF-12 for the parent, and Visual scales for both), caregiver overload (Zarit modified scale and indirect measurements). RESULTS: From October 2006 to March 2007 (RSV season), there were 71 respiratory hospitalisations (33%). Triplets and infants living in homes with >5 inhabitants were most likely to be hospitalised. Parents of hospitalised children were most likely, to have more and longer times off work for child care (47% vs. 18%), to have higher overload, and to obtain lower values in the physical dimension of SF-12. Multiple regression model associated infant HRQoL with higher gestational age, having 0-3 year-old siblings, being recommended palivizumab and had received it, lower caregiver overload, higher caregiver mental HRQoL and no absence from work for child care. CONCLUSIONS: Although respiratory hospitalisations were not associated with infant HRQoL, caregivers' HRQoL and overload were. Preterm infant HRQoL is associated with their caregivers' HRQoL and overload, and with receiving RSV prophylaxis when their risk profile recommends it.

Attempt to normalize simulated exhaled nitric oxide according to ventilatory settings.

BACKGROUND: Simulated exhaled nitric oxide (eNO) depends on ventilatory settings used in different experimental conditions. OBJECTIVES: To normalize the simulated minute exhaled nitric oxide according to different ventilatory settings. WORKING HYPOTHESIS: Different ventilatory settings influence the concentrations of exhaled nitric oxide and these results can be normalized. METHODOLOGY AND STUDY DESIGN: We used a rubber lung model (50 ml) with an orifice through which a 3 mm endotracheal tube was introduced. The NO, which simulated that of endogenous production, was delivered through the base of the lung using a unidirectional rotameter and obtaining a concentration of around 25 ppb. The sample of gas was recorded through a 6 F arterial catheter introduced into the endotracheal tube to its tip. The ventilator used was a Babylog 8000. Air delivered was compressed and filtered and had an NO content of under 0.3 ppb. The NO level assessed was the plateau value given by the software of the Sievers NOA apparatus. Each experiment involved sampling during 1 min, three times. Normalization was done using a multiple cubic regression formula. RESULTS: An increase in respiratory frequency or in peak of inspiratory pressure were accompanied by a decrease in eNO (ppb). Minute volume was adjusted for the percentage of leakage given by the ventilator. Normalization was obtained analyzing 518 respirations with different ventilatory settings. The coefficient of variation fell from 15.5% to 0.27%. Validation of the normalization formula was performed in other three groups (320, 372, and 372 respirations) with different simulated NO concentrations (25, 16, and 50 ppb), resulting in reduction of the coefficient of variation from 42.7% to 9.3%, from 42.3% to 10.6% and from 45.2% to 9.6%, respectively. CONCLUSIONS: Normalization of simulated minute eNO according to ventilatory settings is possible using the equipment and experimental set-up reported. Extrapolation to patients is not possible without constraints.

Clinical relevance of prevention of respiratory syncytial virus lower respiratory tract infection in preterm infants born between 33 and 35 weeks gestational age.

Premature infants are vulnerable to severe respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) resulting in hospitalisation and the potential for longer-term respiratory morbidity. Whilst the severity and consequence of RSV LRTI are generally accepted and recognised in infants born

Probable early-onset group B streptococcal neonatal sepsis: a serious clinical condition related to intrauterine infection.

BACKGROUND: The estimated incidence of true early-onset group B streptococcal (GBS) neonatal infection is based on positive GBS blood or cerebrospinal fluid (CSF) culture results, but the real burden of disease is underestimated owing to the high incidence of culture-negative sepsis possibly because of antibiotic administration to the mother. OBJECTIVE: To examine the rate of probable early-onset GBS neonatal sepsis and to assess its impact on total GBS neonatal disease. DESIGN: A multicentre longitudinal prospective surveillance of 107,021 deliveries. RESULTS: The rates of culture-proven and probable early-onset GBS sepsis were 0.39 and 0.47 per 1000 live births, respectively. Of great concern was the finding of three deaths related to the infection in the group with probable early-onset GBS sepsis. CONCLUSIONS: The use of chemoprophylaxis in GBS-colonised pregnant women, especially when it is incomplete, may not be sufficient to prevent clinical neonatal infection, but may inhibit the growth of GBS in blood and CSF cultures. In assessing the effectiveness of GBS prophylaxis, it is advisable to consider the incidence of culture-positive and probable culture-negative GBS neonatal infection.

Repercusión fetal y neonatal del shock anafiláctico materno / Impact of maternal anaphylactic shock on the fetus and the newborn

Ante un shock en una embarazada (de causa hemorrágica, séptica, anafiláctica u otra) se debe tener en cuenta que hay dos pacientes vulnerables: la madre y el feto. La mejoría de la madre puede ser conseguida con la administración de inotrópicos, los cuales pueden dañar el feto al disminuir la circulación placentaria. La lesión fetal dependerá de la causa, la intensidad y la duración del shock, así como de la maduración del feto y de los fármacos empleados en su tratamiento. El factor más importante en el tratamiento del shock de la gestante será el rápido restablecimiento de la presión arterial en la madre sin reducir la perfusión placentaria. La lesión fetal puede pasar desapercibida inicialmente, por lo que será imprescindible efectuar un seguimiento clínico y de neuroimagen tanto del feto como del posterior recién nacido

Shock (hemorrhagic, septic, anaphylactic or of some other etiology) during pregnancy involves two vulnerable patients: the mother and the fetus. The recovery of the mother can be achieved with the administration of inotropic agents, but these drugs can harm the fetus by reducing the placental circulation. The extent of the damage depends on the cause, the severity and the duration of the shock, as well as the maturity of the fetus and the drugs employed to treat the mother. The most important factor in the treatment of shock in the pregnant woman is the rapid restoration of her arterial pressure without reducing the placental perfusion. Since the fetal lesion may initially go undetected, prenatal and postnatal clinical follow-up and neuroimaging are indispensable

Efficacy of three treatment schedules in severe meconium aspiration syndrome.

AIM: To compare three different schedules in severe meconium aspiration syndrome (MAS) treatment: standard, bronchoalveolar lavage (BAL) with diluted surfactant, and diluted surfactant BAL plus a single early dexamethasone dose. METHODS: Twenty-four full-term newborns with severe MAS (needing mechanical ventilation and with oxygenation index > or = 15) were divided into three groups: group I (historical control group; n = 6) treated with standard therapy; group II (n = 7) treated in the first hours of life with one BAL using diluted surfactant (beractant 5 mg/mL) in a volume of 15 mL/kg in four aliquots; and group III (n = 11) treated with one diluted surfactant BAL and a previous single dose of intravenous dexamethasone (0.5 mg/kg). RESULTS: At 12 h, groups II and III showed a significant improvement in oxygenation index (OI) compared with group I (14.7% and 27.0% vs -19.6% respectively; p = 0.012). Group III also showed a significantly lower OI than group I at 24 h (63.6% vs -27.9%) and at 48 h (87.1% vs 49.6%). Group III, in comparison to group I, showed a lower FiO2 requirement at 12 h (0.66 vs 1), at 24 h (0.4 vs 0.87) and at 48 h (0.35 vs 0.67), and a decrease in the number of days of inhaled nitric oxide administration, mechanical ventilation, oxygen therapy and hospitalisation period. All patients from groups II and III survived and none developed pneumothorax or respiratory infections. CONCLUSION: Diluted surfactant BAL in the first hours of life combined with an intravenous single dose of dexamethasone may be an effective treatment for severe MAS.