[Neonatal and perinatal mortality in hospitals of the Basque Country-Navarre Neonatal Study Group (GEN-VN) during the period 2000-2006]. / Evolución de la mortalidad neonatal y perinatal en los hospitales del Grupo de Estudios Neonatales Vasco-Navarro (GEN-VN) en el periodo 2000-2006.

BACKGROUND: In 2000, the Basque-Navarre Neonatal Study Group (GEN-VN) was created with a clear objective of studying the perinatal and neonatal health outcomes in newborns. OBJECTIVE: The aim of this investigation is to present the trends of neonatal and perinatal mortality and their causes in the hospitals of the Basque-Navarre Neonatal Study Group from 2000 to 2006. PATIENTS AND METHOD: A descriptive study was carried out on the 157,623 births in the participating hospitals of the Basque-Navarre Neonatal Study Group, from 2000 to 2006. During this period, of the total births, 156.904 were born alive, there were 719 foetal deaths and 363 newborns died within the first 28 days of life. Perinatal and neonatal mortality was analysed, raw and stratified by gestational age and birth weight. RESULTS: The Basque -Navarre Neonatal Study Group collects from 80.5% to 96.8% of all the births reported by the authorities. There is a decreasing trend in foetal and perinatal mortality rates from 2000 to 2006. However, neonatal mortality rates shows a stable trend when compared with the descense in the last years of the 20th century. The most frequent causes of death are respiratory, infections and the congenital anomalies. CONCLUSIONS: Collecting regional data improves the quality of neonatal and perinatal mortality studies. Very low birth weight and very low gestational age newborns require special quality of care due their high mortality (54.8% of neonatal mortality in 2006), therefore further studies are required on the impact of these newborns on neonatal mortality in our hospitals.

Evolución de la mortalidad neonatal y perinatal en los hospitales del Grupo de Estudios Neonatales Vasco-Navarro (GEN-VN) en el periodo 2000–2006 / Neonatal and perinatal mortality in hospitals of the Basque Country-Navarre Neonatal Study Group (GEN-VN) during the period 2000–2006

Introducción: el Grupo de Estudios Neonatales Vasco-Navarro (GEN-VN) se creó en el año 2000 para estudiar y contribuir a mejorar los resultados de la asistencia de los recién nacidos de Navarra y el País Vasco. Objetivo: presentar la evolución de las tasas de mortalidad perinatal y neonatal de los hospitales participantes en el GEN-VN en el periodo de 2000 a 2006 y analizar sus causas. Pacientes y método: estudio descriptivo con base poblacional de los 157.623 nacimientos de los hospitales del GEN-VN en un periodo de 7 años (2000-2006). De ellos, 156.904 nacieron vivos y hubo 719 muertes fetales y 363 muertes neonatales. Se analizó la mortalidad perinatal y neonatal, bruta y específica por grupos de peso y edad gestacional. Resultados: el GEN-VN recogió entre un 80,5 y un 96,8% del total de nacimientos que declararon las administraciones de Navarra y País Vasco. Las tasas de mortalidades fetal y perinatal mostraron una tendencia decreciente, mientras que la mortalidad neonatal está estabilizada por encima del 2‰, en comparación con el descenso observado durante los últimos años del siglo xx. Las causas más frecuentes de mortalidad fueron las infecciones, la insuficiencia respiratoria y las anomalías congénitas. Conclusiones: la recogida regional de datos aumenta la calidad de los estudios de mortalidad perinatal y neonatal, al tener una base poblacional. Los recién nacidos de muy bajo peso y muy baja edad gestacional requieren una atención especializada debido a la alta mortalidad, que representa el 54,8% de la mortalidad neonatal (año 2006) (AU)

Background: In 2000, the Basque-Navarre Neonatal Study Group (GEN-VN) was created with a clear objective of studying the perinatal and neonatal health outcomes in newborns. Objective: The aim of this investigation is to present the trends of neonatal and perinatal mortality and their causes in the hospitals of the Basque-Navarre Neonatal Study Group from 2000 to 2006. Patients and method: A descriptive study was carried out on the 157,623 births in the participating hospitals of the Basque-Navarre Neonatal Study Group, from 2000 to 2006. During this period, of the total births, 156.904 were born alive, there were 719 foetal deaths and 363 newborns died within the first 28 days of life. Perinatal and neonatal mortality was analysed, raw and stratified by gestational age and birth weight. Results: The Basque -Navarre Neonatal Study Group collects from 80.5% to 96.8% of all the births reported by the authorities. There is a decreasing trend in foetal and perinatal mortality rates from 2000 to 2006. However, neonatal mortality rates shows a stable trend when compared with the descense in the last years of the 20th century. The most frequent causes of death are respiratory, infections and the congenital anomalies. Conclusions: Collecting regional data improves the quality of neonatal and perinatal mortality studies. Very low birth weight and very low gestational age newborns require special quality of care due their high mortality (54.8% of neonatal mortality in 2006), therefore further studies are required on the impact of these newborns on neonatal mortality in our hospitals (AU)

Limitaciones de la procalcitonina como marcador único de sepsis neonatal de origen nosocomial / Limitations of procalcitonin as single marker of nosocomial neonatal sepsis

Introducción: Recientemente se ha sugerido que la procalcitonina (PCT) tiene capacidad discriminativa en el diagnóstico de sepsis neonatal. El objetivo de este estudio prospectivo multicéntrico es evaluar la utilidad de la PCT como marcador de sepsis neonatal de origen nosocomial. Pacientes y métodos: Se incluyeron 100 neonatos con sospecha de sepsis nosocomial de entre 4 y 28 días de vida ingresados en los servicios de neonatología de 13 hospitales de tercer nivel de España durante un período de 1 año. Se midió la concentración de PCT mediante análisis inmunoluminométrico. Se calculó la eficacia diagnóstica de la PCT en el momento de la sospecha de infección, a las 12-24 h y a las 36-48 h. Resultados: Se diagnosticaron 61 casos de sepsis nosocomial. Las concentraciones de PCT fueron superiores en los casos de sepsis nosocomial frente a los neonatos con sospecha de sepsis no confirmada. Los neonatos con sepsis por estafilococos coagulasa-negativos mostraron niveles de PCT más bajos que aquellos con sepsis nosocomial por otros agentes. Los puntos de corte óptimo para la PCT de acuerdo con las curvas ROC fueron 0,59 ng/mL en el momento de la sospecha de infección (sensibilidad 81,4%, especificidad 80,6%), 1,34 ng/mLa las 12-24 h (sensibilidad 73,7%, especificidad 80,6%) y 0,69 ng/mL a las 36-48 h (sensibilidad 86,5%, especificidad 72,7%) para el diagnóstico de sepsis de origen nosocomial. Conclusiones: La PCT mostró una moderada capacidad diagnóstica para la sepsis neonatal de origen nosocomial desde el momento de la sospecha de infección. Aunque por sí sola no sería suficientemente fiable, podría ser útil como parte de un chequeo de sepsis más completo (AU)

Background: It has recently been suggested that serum procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin. Methods: One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acutecare teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12-24 h and 36-48 h after the onset of symptoms was calculated. Results: The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12–24 h and 36- 48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0,59 ng/mL at the time of suspicion of sepsis (sensitivity 81,4%, specificity 80,6%); 1,34 ng/mL within 12-24 h of birth (sensitivity 73,7%, specificity 80,6%), and 0,69 ng/mL within 36-48 h of birth (sensitivity 86,5%, specificity 72,7%). Conclusions: Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of sepsis, but would be useful as part of a full sepsis evaluation (AU)

[Postnatal growth up to 2 years of corrected age in a cohort of very low birth weight infants]. / Crecimiento posnatal hasta los dos años de edad corregida de una cohorte de recién nacidos de muy bajo peso de nacimiento.

OBJECTIVE: To study postnatal somatic growth up to 2 years of corrected postnatal age (CPA) in a cohort of very low birth weight infants (VLBWI) in our unit, according to their intrauterine growth status at birth. PATIENTS AND METHODS: We performed an observational follow-up study of postnatal growth in a cohort of VLBWI (birth weight < 1,500 g) attended from January 1, 1994 to December 31, 1999. Weight, length, and head circumference were assessed at birth and again at 2 years CPA. Infants were classified as small-for-gestational age (SGA) if weight was below 2 standard deviations (SD) of the reference population mean. RESULTS: The cohort consisted of 260 VLBWI (18.5% SGA). Mean gestational age (SD) was 29 (2.7) weeks, weight was 1,150 (223) g, length was 37.4 (2.7) cm, and head circumference was 27 (1.8) cm. At birth Z-scores were -0.82, -0.92 and -0.8 for weight, length and head circumference. The corresponding mean Z scores at 2 years' CPA were -1.44, -1.49 and -0.31. At 2 years' CPA, more SGA infants still had a weight below the 3rd percentile than those with normal birthweight (26% vs. 16%). SGA infants had a higher daily weight increase during their hospital stay (27.5 vs. 21.2 g/day, p > 0.5). Gender did not significantly influence the growth pattern. CONCLUSIONS: Weight showed the lowest postnatal increase, particularly in infants < 1,000 g. Head circumference showed the greatest catch-up growth pattern, almost reaching the mean for the general population by 2 years' CPA. Growth retardation in SGA continued up to 2 years' CPA.

Crecimiento posnatal hasta los dos años de edad corregida de una cohorte de recién nacidos de muy bajo peso de nacimiento / Postnatal growth up to 2 years of corrected age in a cohort of very low birth weight infants

Objetivo: Analizar la evolución del crecimiento somático posnatal hasta los 2 años de edad corregida, de una cohorte de recién nacidos de muy bajo peso (RNMBP) asistidos en nuestra unidad, según el patrón de crecimiento intrauterino al nacimiento. Pacientes y métodos: Estudio observacional de seguimiento de una cohorte de RNMBP (peso natal < 1.500 g), asistidos entre enero de 1994 y diciembre de 1999. Se valoró el peso, la longitud y el perímetro craneal al nacer y a los 2 años de edad corregida. Los neonatos fueron clasificados como de bajo peso para la gestación (BPG) si el peso estaba por debajo de dos desviaciones estándar (DE) de la media. Resultados: La cohorte consta de 260 RNMBP (18,5 % de BPG) las medias (DE) de la edad gestacional, peso natal, longitud y perímetro craneal fueron de 29 (2,7) semanas, 1.150 (223) g, 37,4 (2,7) cm y 27 (1,8) cm, respectivamente. Las puntuaciones medias del índice Z al nacer para estos parámetros fueron de –0,82, –0,92 y –0,8. A los 2 años de edad corregida, las puntuaciones medias del índice Z para peso, longitud y perímetro craneal fueron de –1,44, –1,49 y –0,31.A los 2 años de edad corregida, el 26 % de los BPG tenían aún un peso inferior al percentil 3, frente al 16 % en los de peso apropiado para la gestación (PAG). El grupo de BPG tuvo un mayor crecimiento en peso durante su estancia en la unidad (27,5 g/día para los BPG frente a 21,2 g/día en los PAG). No se detectaron diferencias significativas con relación al sexo. Conclusiones: El peso fue el parámetro con peor evolución, sobre todo en los de menos de 1.000 g, y el perímetro craneal el más recuperado a los 2 años de edad corregida, acercándose a la media de la población normal. La desventaja de crecimiento de la población con BPG en relación con los de PAG persiste a los 2 años de edad corregida (AU)

Objective: To study postnatal somatic growth up to 2 years of corrected postnatal age (CPA) in a cohort of very low birth weight infants (VLBWI) in our unit, according to their intrauterine growth status at birth. Patients and methods: We performed an observational follow-up study of postnatal growth in a cohort of VLBWI (birth weight 0.5). Gender did not significantly influence the growth pattern. Conclusions: Weight showed the lowest postnatal increase, particularly in infants 0.5). Gender did not significantly influence the growth pattern. Conclusions: Weight showed the lowest postnatal increase, particularly in infants < 1,000 g. Head circumference showed the greatest catch-up growth pattern, almost reaching the mean for the general population by 2 years’ CPA. Growth retardation in SGA continued up to 2 years’ CPA (AU)

Parotiditis aguda supurativa neonatal / Neonatal acute suppurative parotitis

La parotiditis aguda supurativa es una enfermedad muy infrecuente en el período neonatal. En la literatura especializada se han publicado aproximadamente 100 casos. La deshidratación y la prematuridad son dos importantes factores que predisponen a su desarrollo. El diagnóstico es fundamentalmente clínico, y son útiles el recuento leucocitario y la ecografía parotídea. Staphylococcus aureus es el agente etiológico aislado con más frecuencia. El tratamiento inicial consiste en antibioticoterapia intravenosa empírica antiestafilocócica durante 7-10 días. El pronóstico es bueno. La enfermedad cursa sin recurrencias.Se describen los casos de 2 recién nacidos de 12 días de vida que presentaron fiebre, tumefacción parotídea unilateral, con eritema, calor y dolor, y secreción purulenta por el conducto de Stenon. Se hace una revisión de la literatura (AU)

[Neonatal acute suppurative parotitis]. / Parotiditis aguda supurativa neonatal.

Acute suppurative parotitis is highly uncommon in neonates. Approximately 100 cases have been reported in the literature. Dehydration and prematurity are important predisposing factors. Diagnosis is based on clinical signs. White blood cell count and parotid ultrasonography are useful. The most commonly isolated causative organism is Staphylococcus aureus. Initial treatment consists of antistaphylococcal empiric antimicrobial therapy for 7-10 days. The prognosis is good. The illness is not usually associated with recurrences. We describe two 12-day-old newborn infants who presented with fever, unilateral swelling of the parotid region with erythema, warmness and pain, and purulent discharge from Stensen's duct. We also provide a literature review.

[Morbidity and mortality of very-low-birth-weight infants as an indicator of the quality of perinatal care]. / Morbimortalidad en recién nacidos de muy bajo peso en el control de la calidad de la asistencia perinatal.

OBJECTIVE: To compare the clinical outcomes of a cohort of very low birth weight (VLBW) infants who received healthcare in our unit from 1994-2000 with all the variables included in the Vermont-Oxford Network (VON) database. METHODS: A historical cohort of 417 VLBW live infants born in our center from 1994-2000 was evaluated. The 80 variables of the VON already prospectively included in the unit's database were used and a further 20 variables were added through retrospective review of medical records. The rates of perinatal risk factors, interventions, and causes of morbidity were analyzed and the periods 1994-1997 and 1998-2000 were compared. We also compared these rates with those reported by the VON. RESULTS: Comparison of the results in both periods showed an increase in the percentage of multiple pregnancies and prenatal corticosteroid exposure, as well as in the early use of surfactant and continuous positive pressure. The incidence of intraventricular hemorrhage decreased, but no differences were observed in other outcomes. Our rates of Cesarean sections and multiple births, as well as the use of prenatal steroids, were higher than those of the VON. The outcomes of infants receiving healthcare in our unit were similar to those of the VON but mortality in infants weighing < 800 g was slightly higher, coinciding with higher rates of late sepsis. CONCLUSION: Morbidity rates in VLWB infants receiving care in our unit decreased during the period studied and compared favorably with those reported by the VON. Alltogether, our results indicate that the quality of care in our perinatal center is good. General use of this methodology would permit comparison of outcomes and quality of care across regions and nations, as well as across Europe, in a recently established network (EuroNeoNet.com).

Morbimortalidad en recién nacidos de muy bajo peso en el control de la calidad de la asistencia perinatal / Morbidity and mortality ofvery-low-birth-weight infants as an indicator ofthe quality of perinatal care

Objetivo. Comparar los resultados de una cohorte de recién nacidos de muy bajo peso natal (RNMBP) asistidos en nuestra unidad de 1994 a 2000, con referencia al conjunto de todas las variables incluidas en la base de datos de la Red Vermont-Oxford Network (VON).Métodos. Se seleccionaron los 417 RNMBP nacidos vivos en el centro en los años 1994-2000. A las 80 variables de la VON ya incluidas en la base de datos de la unidad de modo prospectivo, se añadieron otras 20, mediante revisión retrospectiva de las historias clínicas. Se analizaron las tasas de los principales antecedentes, intervenciones y causas de morbilidad, comparando los dos períodos, 1994-1997 y 1998-2000, así como con los resultados referenciados por la VON. Resultados. La comparación entre ambos períodos mostró un aumento de embarazos múltiples y del uso de corticoides prenatales, así como de la aplicación de surfactante precoz y presión positiva continua. La tasa de hemorragia intraventricular descendió de manera significativa, sin que se observaran diferencias en otras tasas analizadas. Al comparar nuestros datos con VON, se observó que la tasa de cesáreas, embarazos múltiples y uso de corticoides prenatales fueron más elevadas. Si bien los resultados fueron similares a los de la VON, se detectó un cierto exceso de mortalidad en < 800 g, coincidente con tasas más elevadas de sepsis tardías. Conclusión. Las tasas de morbilidad neonatal disminuyeron durante el período estudiado, comparando favorablemente con las de la VON. En su conjunto, los resultados evidencian una notable calidad de la asistencia perinatal prestada. La generalización de esta metodología, permitiría comparaciones entre diferentes Unidades, a nivel regional, nacional o Europeo, en una red de unidades recientementecreada (EuroNeoNet.com) (AU)

[Severe malformations associated with congenital diaphragmatic hernia: conditioning factors for mortality]. / Malformaciones mayores asociadas a la hernia diafragmática congénita: condicionantes de la mortalidad.

We have retrospectively reviewed the clinical records of 42 newborns with congenital diaphragmatic hernia (CDH) treated in our Neonatal Unit between January 1974 and December 1991. In 20 of the children, the CDH was associated with other malformations, which were major in 11 cases (26.2%). The malformations which occurred most frequently were cardiovascular, followed by chromosomal anomalies and those affecting the central nervous system (CNS). All of the newborns with major malformations are included in the high risk group or those with early diagnosis. Overall mortality was 57.1%. Nine out of the 11 cases with major malformations died (81.8%).

[Acute renal failure in perinatal asphyxia]. / Insuficiencia renal aguda en la asfixia perinatal.

Patients with perinatal asphyxia from a total population of 15,216 births were studied prospectively. A total of 76 newborn infants achieved the criteria for inclusion. These were distributed in three populations: 53 (73%) without acute renal failure (ARF); 17 (22%) with ARF of prerenal type; 6, (8%) with ARF of renal type. Incidence of several perinatal factors were compared (gestational age, birth weight, meconial amniotic fluid, cord and/or placental disturbances, type of delivery, APGAR Score, and resuscitation). Authors observed that in the group of preterm infants, ARF is present, always was of renal type. In the population with ARF of renal type perinatal asphyxia was clinically worse: greatest frequency of meconial amniotic fluid (p less than 0,025) and worse response to resuscitation with a lower increment in the APGAR Score between one and five minutes (p less than 0.005).