Growth of Very Low Birth Weight Infants Who Received a Liquid Human Milk Fortifier: A Randomized, Controlled Multicenter Trial.

OBJECTIVES: To evaluate growth (weight, length, head circumference, and knee-heel length [KHL]) in very low birth weight (VLBW) infants (500-1500 g) who received human milk with a liquid fortifier (LHMF) with high protein and fatty acid content versus a traditional powder fortifier (PHMF) for 45 days or until discharge. METHODS: This was a multicenter, randomized, controlled trial. An intention-to-treat analysis was performed to determine adverse events and withdrawal causes. We also performed an efficacy analysis involving the infants who completed at least 2 weeks of study. RESULTS: Of the 158 infants enrolled in the study, 146 completed at least 2 weeks, and 125 completed the entire study. The biodemographic characteristics were similar between groups, with no differences in increments of weight (22.9 vs 22.7 g kg-1 day-1), length (1.03 vs 1.09 cm/week), head circumference (0.91 vs 0.90 cm/week), or KHL (3.6 vs 3.3 mm/week). The KHL increment was greater in infants weighing >1 kg receiving LHMF (3.7 vs 3.2 mm/week, P = 0.027). Although there were no significant differences in serious adverse events, the incidence difference of the composite outcome death/necrotizing enterocolitis between groups warrants attention (1.3% with LHMF and 8.1% with PHMF). CONCLUSION: There were no differences in the overall growth between VLBW infants receiving either fortifier.

[Prevalence of chromosomal aberrations at birth in the Clinical Hospital of Universidad de Chile, 1990-2001]. / Prevalencia al nacimiento de aberraciones cromosómicas en el Hospital Clínico de la Universidad de Chile. Período 1990-2001.

BACKGROUND: A cytogenetical study should be performed to every newborn with malformations. If a chromosomal aberration is found, parents must be studied to give an adequate genetic advise. AIM: To study the frequency of chromosomal aberrations in newborns with malformations. PATIENTS AND METHODS: In the Clinical Hospital of the University of Chile all malformations in newborns are registered, as part of the Collaborative Latin American Study of Congenital Malformations (ECLAMC). The frequency of chromosomal aberrations, determined by cytogenetical studies, was determined in newborns with malformations. RESULTS: In the study period, there were 32,214 births. Of these, 2,268 live newborns and 43 stillbirths had malformations. Ninety nine children with malformations had chromosomal aberrations (4.3%). Trisomy 21 was the most common aberration with a rate of 23/10,000 births, followed by trisomy 18 with a rate of 4/10,000 and trisomy 18 with a rate of 1.2/10,000. Ninety four percent of these children were born alive and 16.1% died before discharge from the hospital. The masculinity indexes for Down syndrome and for trisomy 18 were 0.38 and 0.61 respectively. CONCLUSIONS: A higher frequency of female gender for trisomy 21 and male gender for trisomy 18 has not been reported previously.

[Congenital malformations of the digestive system. Maternity Clinical Hospital at the University of Chile. 1991-2001]. / Malformaciones congénitas del sistema digestivo. Maternidad Hospital Clínico de la Universidad de Chile. Período 1991-2001.

BACKGROUND: There were 26,617 births attended at the University of Chile Clinical Hospital, of which 0.63% were stillborn. A frequency of malformations of 7.2 per born alive and of 22.1 per stillborn was detected in this population. AIM: To report the frequency of digestive system congenital malformations in this population. MATERIAL AND METHODS: Analysis of data from the births that occurred at the University of Chile Hospital, that was gathered using codified form for the Latin American Collaborative Study for Congenital Malformations. RESULTS: Ninety seven digestive congenital malformations were detected, with a rate of 26.4 per 10,000 born alive and 12.2 per 10,000 stillborn. Diaphragmatic hernia was the most frequent malformation found, followed by imperforated anus, onphalocele and esophageal atresia. There was a secular increase in the frequency of these malformations. CONCLUSIONS: The frequency of digestive system malformations is higher than in the rest of hospitals participating in the Latin American Collaborative Study for Congenital Malformations.

[The Apgar Score. Is it still valid after a half century?]. / Test de Apgar. Después de medio siglo. Sigue vigente?

In 1952, Virginia Apgar MD, proposed to assess the clinical condition of newborns, during the first minutes of life and to evaluate anesthetic and obstetrical practices. She proposed five objectives and easily measured clinical signs: cardiac frequency, respiratory effort, muscle tone, irritability and color. The test was later named "Apgar Score Test". Since then, all newborns are evaluated using Apgar score. This article reviews the uses and abuses of Apgar test. It has been used to assess asphyxia, predict neurological damage, to identify newborns that require reanimation and as a survival predictor. It is concluded that Apgar score is useful to know the vitality of a newborn during his first minutes of life. It is a background, that along with acid base state and evolution, allows the diagnosis of asphyxia and predicts survival. Therefore, after half a century of use, it still remains useful.

[Survival, viability and prognosis of premature infant]. / Sobrevida, viabilidad y pronóstico del prematuro.

An heterogeneous group of newborns with different gestational ages, birth weight, nutritional status and different risks of morbidity and mortality are classified as premature. Therefore the definition of premature children subgroups is mandatory. Very low weight premature babies are those with a birth weight of less than 1500 g. In Chile, they correspond to 0.9% of newborns and they contribute to neonatal mortality with 50 to 70% and to infantile mortality, with 25 to 30%. Survival of extremely premature babies has improved significantly in the last decades, due to a better perinatal care, the appearance of neonatal intensive care units, the routine use of mechanical ventilation, the perinatal use of steroids and the introduction of exogenous surfactant. However, survival varies considerably according to the place of birth, birth weight and gestational age and may be associated with different degrees of physical and mental disability. The imminent birth of a child in the limit of viability will require complex and difficult ethical decisions. There is consensus that the limit of viability is 23 weeks and that it fluctuates between 24 and 26 weeks in different parts of the world.