Estudio poblacional de los prematuros en el Hospital Universitario de Guadalajara años 2010 / Population study of premature infants in the University Hospital of Guadalajara year 2010

En las unidades de neonatología llama poderosamente la atención el aumento de hijos de padres inmigrantes y el incremento del número de prematuros tardíos. Actualmente, uno de cada cinco nacimientos en España se puede atribuir a la población inmigrante. El 69% de las mujeres inmigrantes tiene entre 15 y 49 años, comparado con el 48% de las españolas. Mientras que la tasa de prematuridad se mantiene constante en un 7-8% , los prematuros tardíos se han incrementado un 13% desde el 2001 suponiendo los prematuros tardíos un 75% de todos ellos. La prematuridad es la principal causa de muerte en el primer mes de vida y la segunda causa de morbilidad fetal o neonatal tras las malformaciones congénitas. La tasa de morbimortalidad en esta población es más baja de la de prematuros de EG más baja, pero mayor que en los recién nacidos a término, presentando sobre todo alta tasa de mal adaptación pulmonar, membrana hialiina, apneas, inestabilidad térmica, hipoglucemia, hipocalcemia, anemia, ictericia, problemas neurológicos (el volumen cerebral en la semana 34ª es el 65% del término). La razón por la que han aumentado en número no es bien conocida. Una hipótesis sería el aumento en las técnicas de reproducción asistida, que generarían un incremento en el número de embarazos múltiples. La segunda hipótesis son los avances en la práctica obstétrica que han llevado a un incremento en el número de intervenciones médicas y quirúrgicas durante el embarazo (AU)

One out of five births actually in Spain is due to foreign parents, which is higher tan the proportion of immigrants in the whole population. This can be explained by a higher fecundity rate and because this population is younger than Spanish (69% of immigrants women have an age between 15 and 49, compare to 48% of Spanish women). The number of preterm births has increased too in the last years up to 7-8%, specially late preterm infants, (define by birth at 34 0/7 through 36 6/7 weeks gestation), which have increased a 13% from 2001. The characteristics of late-preterm infants predispose them to a higher risk of morbidity and mortality than term infant greater risk of respiratory distress, apnea, hypoglycemia, temperature instability, anemia, jaundice, feeding difficulties, cerebral palsy and neurodevelopmental handicaps. The reason for the increase in late-preterm births during the last decade is not well understood. One hypothesis is that it may be attributable to increased use of reproductive technologies, and an increase in multifetal pregnancies. An-other hypothesis is that advances is obstetric practice have led to an increase in surveillance and medical interventions during pregnancy (AU)

[Factors associated to admission to Intensive Care in patients hospitalized due to pandemic Influenza A/H1N1 2009]. / Factores asociados a ingreso en unidad de cuidados intensivos en pacientes hospitalizados por Influenza pandémica A/H1N1 2009.

OBJECTIVE: The present study explores the possible factors related to severe cases of pandemic flu. DESIGN: A retrospective cohort study was conducted in patients hospitalized with Influenza A/H1N1 2009 during the pandemic period. SETTING: Ramon y Cajal University Hospital (Madrid, Spain). PATIENTS: All hospitalized patients with positive RT-PCR (real-time polymerase chain reaction) for Influenza A/H1N1 2009 virus. MAIN VARIABLES: The main variables collected were: history of risk factors for severe Influenza, history of immunization, clinical presentation, laboratory tests, chest X-ray report, administration of antiviral treatment, and hospital stay. RESULTS: The median age of the 100 cases was 38 years (range 4 months to 80 years). Seventy-seven percent of the patients had at least one risk factor. Asthma was the most common factor among patients younger than 18 years, versus smoking in the older subjects. Antiviral therapy was initiated a median time of three days (range 0 to 18 days) after the onset of illness. Nineteen percent of the patients were admitted to Intensive Care, and 2% died. Metabolic disease and abnormal chest X-ray findings were factors associated to admission to the ICU. CONCLUSION: As in other studies, abnormal chest X-ray findings upon admission and metabolic disease were related to poor outcomes of 2009 pandemic Influenza A (H1N1) infection in our patients.