Recomendaciones de seguimiento del prematuro tardío / Follow-up recommendations for the late preterm infant

La población de prematuros tardíos (PT), aquellos nacidos entre las 340 y 366 semanas de gestación, representa el 70-74% de todos los prematuros, y no está incluida de forma específica en la mayoría de los protocolos de seguimiento para niños prematuros. Durante muchos años los PT han sido manejados como si de recién nacidos a término se tratasen, lo que ha llevado al desconocimiento de su evolución a medio y largo plazo. A la morbilidad neonatal se añade una mayor incidencia de afección posnatal, con una tasa de reingresos hospitalarios por malnutrición, hiperbilirrubinemia y problemas respiratorios superior a los nacidos a término. La inmadurez cerebral puede ser el principal responsable de los déficits observados en el neurodesarrollo a largo plazo en esta población y aumentar su vulnerabilidad. Se describen retrasos o discapacidades en la etapa preescolar, parálisis cerebral, retraso mental, discapacidad intelectual, esquizofrenia, trastornos del desarrollo psicológico, la conducta y la emoción. El grupo SEN34-36 de la Sociedad Española de Neonatología, en colaboración con la Asociación Española de Pediatría de Atención Primaria, han desarrollado estas recomendaciones de seguimiento con el objetivo principal de disminuir el impacto de la prematuridad en el desarrollo de los PT. Los objetivos secundarios del documento son sensibilizar a neonatólogos y pediatras de los posibles riesgos de secuelas de los PT, determinar y unificar las evaluaciones y/o intervenciones que deberían realizarse, ofrecer herramientas de seguimiento clínico para detectar de manera precoz los déficits en el desarrollo y coordinar la atención de todos los profesionales implicados

The population of late preterm infants (PT), those born between 34 + 0 and 36 + 6 weeks of gestation, accounts for 70-74% of all premature infants, and is not specifically included in most of the follow-up protocols for preterm infants. For many years, PTs have been handled as if they were term newborns, which has led to a limited knowledge of their outcome in the medium and long term. Their neonatal morbidity is associated with a higher incidence of postnatal complications, with an increased rate of hospital re-admissions due to malnutrition, hyperbilirubinaemia, and respiratory problems, when compared to term infants. Cerebral immaturity may be the main cause of the deficits observed in the long-term neurodevelopment of this population, making them more vulnerable. Several issues have been described, such as delays or disabilities in the pre-school stage, cerebral palsy, mental retardation, intellectual disability, schizophrenia, and psychological development of behavioural and emotional disorders. The SEN34-36 Group of the Spanish Society of Neonatology, in collaboration with the Spanish Association of Primary Care Paediatrics, have developed these follow-up recommendations with the main objective of reducing the impact of prematurity on PT development. The secondary objectives of the document are to make neonatologists and paediatricians aware of the risks of sequelae of PTs, to determine and unify the evaluations and / or interventions that should be carried out, to offer clinical follow-up tools for the early detection of developmental delays, and to coordinate the care by all the professionals involved

[Follow-up recommendations for the late preterm infant]. / Recomendaciones de seguimiento del prematuro tardío.

The population of late preterm infants (PT), those born between 34+0 and 36+6 weeks of gestation, accounts for 70-74% of all premature infants, and is not specifically included in most of the follow-up protocols for preterm infants. For many years, PTs have been handled as if they were term newborns, which has led to a limited knowledge of their outcome in the medium and long term. Their neonatal morbidity is associated with a higher incidence of postnatal complications, with an increased rate of hospital re-admissions due to malnutrition, hyperbilirubinaemia, and respiratory problems, when compared to term infants. Cerebral immaturity may be the main cause of the deficits observed in the long-term neurodevelopment of this population, making them more vulnerable. Several issues have been described, such as delays or disabilities in the pre-school stage, cerebral palsy, mental retardation, intellectual disability, schizophrenia, and psychological development of behavioural and emotional disorders. The SEN34-36 Group of the Spanish Society of Neonatology, in collaboration with the Spanish Association of Primary Care Paediatrics, have developed these follow-up recommendations with the main objective of reducing the impact of prematurity on PT development. The secondary objectives of the document are to make neonatologists and paediatricians aware of the risks of sequelae of PTs, to determine and unify the evaluations and / or interventions that should be carried out, to offer clinical follow-up tools for the early detection of developmental delays, and to coordinate the care by all the professionals involved.

Recomendaciones de seguimiento del prematuro tardío / Recommendations for the follow-up of the late preterm infant

La prematuridad continúa siendo la primera causa de morbimortalidad neonatal e infantil y constituye uno de los problemas de salud más importantes, sobre todo en la sociedad industrializada. La población de prematuros tardíos, que incluye a los niños nacidos entre las 340 y 366 semanas de edad gestacional, representa el 70-74% de todos los prematuros. Los prematuros tardíos presentan mayor incidencia de patología comparados con los recién nacidos a término y no solo en el periodo neonatal sino también durante la infancia, con unas mayores tasas de rehospitalización y consulta a los servicios de urgencias, un mayor riesgo de infecciones, de fallo de medro, de problemas respiratorios y de trastornos del neurodesarrollo. Nuestro objetivo debe ser poder realizar diagnósticos e intervenciones precoces, principalmente a nivel del neurodesarrollo, que multiplicarán la probabilidad de buena evolución. En esta línea, desde el grupo de trabajo SEN34-36 de la Sociedad Española de Neonatología, en colaboración con la Asociación Española de Pediatría de Atención Primaria, se ha desarrollado este documento de Recomendaciones de seguimiento del prematuro tardío, con el objetivo de sensibilizar a pediatras y neonatólogos de las patologías en las que los prematuros tardíos presentan mayor riesgo y sobre las que debemos focalizar nuestra atención, facilitando una guía de trabajo a los profesionales implicados en el seguimiento de este grupo de prematuros

Prematurity continues to be the leading cause of neonatal and infant morbidity and mortality and stands as one of the most important health problems, especially in industrialized countries. Late preterm infants are those born between 34 and 36 weeks of gestational age and represent 70-74% of all premature births. Late preterm infants show a higher incidence of pathology compared to term infant and not only in the neonatal period but also during childhood, with higher rates of hospital readmissions and visits to emergency services, an increased risk of infections, of failure to thrive, respiratory problems and neurodevelopmental disorders. Our objective will be to anticipate diagnoses and apply early interventions, mainly at the level of neurodevelopment, which will increase the likelihood of better outcomes. In this line, from the working group SEN34-36 of the Spanish Society of Neonatology and in collaboration with the Spanish Association of Pediatrics of Primary Care, this document of Recommendations for the follow-up of the late preterm infant has been edited in order to raise awareness among pediatricians and neonatologists about the most common pathologies in these babies, and on which we must focus our attention, thereby providing a working guide to the professionals involved in the follow-up of this group of premature infants

Anemia y enfermedad celiaca en una paciente con síndrome de Down / Anaemia and celiac disease in a patient with Down syndrome

Las personas con síndrome de Down (SD) tienen más probabilidades de presentar enfermedad celiaca (EC) que la población general. Se presenta un caso de EC que se manifiesta con anemia importante, en una chica adolescente con SD. Paciente de sexo femenino de 13 años de edad, con SD, que ingresa por anemia acompañada de astenia, anorexia y alteración del ritmo intestinal de unas 4 semanas de evolución. Tiene antecedentes de menstruaciones abundantes y algún vómito antes del inicio de la enfermedad actual. Al constatarse la palidez cutánea sele practica analítica y ésta indica una importante anemia, con cifra de hemoglobina de 4,7 g/dL, por lo que la paciente es derivada al hospital. La exploración física muestra una frecuencia cardiaca de 106xminuto,tensión arterial de 112/48 mmHg, palidez cutánea y de mucosas y soplo sistólico. La anemia es normocítica hipocroma y con ferropenia. Los estudios de imagen descartan patología hemorrágica gastrointestinal. El estudio de médula ósea también es normal. Se inicia tratamiento con sulfato ferroso por vía oral. Un mes después, la paciente vuelve a ingresar por dolor abdominal, vómitos y diarrea. Durante el ingreso se practican determinación de anticuerpos antiendomisio y antitransglutaminasa tisular, que resultan positivos. La biopsia intestinal confirma EC. Se instaura una dieta sin gluten y se mantiene el tratamiento con hierro, tras lo cual sigue una evolución favorable y recuperación dela anemia. Hay autores e instituciones que recomiendan la práctica de cribado de EC en personas asintomáticas con SD. En cualquier caso, en las que presentan sintomatología gastrointestinal o de otros tipos –como puede ser una anemia no explicable por otros motivos–, debe descartarse la posibilidad de EC (AU)

Down syndrome (DS) is associated with an increase drisk of celiac disease (CD) than that found ingeneral population. An adolescent girl with DS and CD presenting with severe anaemia is reported. A 13 year-old girl was admitted to hospital for anaemia and a 4 week-history of asthenia, anorexia, and disturbed bowel habit. Her past medical history was remarkable for hypermenorrhea and occasional vomiting. Heart rate was 106xminute and blood pressure112/48 mmHg. On physical exam she was pale and a systolic murmur was heard. Blood tests depicted a severe hypochromic normocytic anaemia with haemoglobin values of 4,7 g/dL Gastrointestinal bleeding was ruled out on the basis of several image studies and a bone marrow study was also normal. Iron supplement with ferrous sulphate was prescribed. A month later she was readmitted to hospital for abdominal pain, vomiting and diarrhoea. Serum endomysium antibodies and tissue transglutaminase antibodies were found to be positive and an intestinal biopsy confirmed the diagnosis of CD. She was started on a gluten-free diet and the iron supplement was maintained. She subsequently followed a favourable clinical course with cessation of gastrointestinal symptoms and correction of the manaemia. Several authors have suggested that people with DS should be routinely screened for CD even if they area symptomatic. Moreover, the existence of CD should be specially considered in people with DS who present with gastrointestinal symptoms or anaemia of unclear etiologies (AU)