Influencia de la oxitocina administrada durante el parto en el mantenimiento de la lactancia materna. Estudio preliminar / Influence of oxytocin administered during labor in maintaining. breastfeeding. Preliminary study

Introducción: El uso de la oxitocina (Oxt) durante el parto está tan generalizado que hay una tendencia a asumir que sus efectos son bien conocidos. El objetivo del presente estudio es determinar si la Oxt administrada durante el parto posee alguna influencia sobre el mantenimiento de la lactancia materna exclusiva (LME). Pacientes y métodos: Este trabajo forma parte de un estudio cuyo objetivo principal es valorar la influencia de la Oxt administrada durante el parto en los reflejos neonatales primitivos. Se trata de un estudio descriptivo observacional realizado en 20 díadas madre-hijo. Se incluyeron madres primigestas que no habían presentado complicaciones durante el embarazo y habían tenido un recién nacido a término sano fruto de un parto vaginal inducido o estimulado con Oxt. Se realizó una llamada telefónica a los 3 meses. Resultados: Las dosis de Oxt que recibieron durante el parto las madres que no mantenían LME al cabo de 1 y 3 meses fueron superiores a las que mantenían LME (p <0,05). Conclusión: La Oxt administrada durante el parto puede influir de forma negativa en el mantenimiento de la LME(AU)

Introduction: Synthetic oxytocin (Oxt) is the most commonly used drug to induce or augment labour contractions. The objective of the study is to evaluate the effect of Oxt used during labour on exclusive breastfeeding. Patients and methods: This job is part of an observational descriptive study which primary objective is to investigate the effect of intrapartum oxytocin administration on primitive neonatal reflexes. Twenty women with their first term pregnancies were studied. Inclusion criteria were: healthy primiparae with a single gestation at term and vaginal delivery induced or augmented with Oxt. Three months following the birth all mothers were contacted by telephone to assess feeding. Results: Women breastfeeding exclusively had received a significantly lower average dose of Oxt than those women who were not exclusively breastfeeding at 1 and 3 months postpartum (p<0.05). Conclusion: Synthetic Oxt used during labour may have negative influence on breastfeeding(AU)

Edades de sedestación y marcha en recién nacidos pretérmino menores de 1. 500 gr con displasia broncopulmonar / Ages of sitting up and walking in preterm newborns less than 1, 500 G with bronchopulmonary dysplasia

Introducción: La incidencia de secuelas neurológicas en los recién nacidos pretérmino (RNPT) con displasia broncopulmonar (DBP) es considerablemente mayor que la de aquellos que no la presentan. Conocer la cronología de adquisición de los hitos motores puede servir para proporcionar mejor información a los padres acerca de la posible existencia de un retraso en el desarrollo. El objetivo del presente estudio es estimar la influencia que tiene la DBP sobre las edades de adquisición de la sedestación y la marcha en los RNPT<1.500g con exploración neurológica normal a los 2 años. Pacientes y métodos: Estudio longitudinal con una cohorte de 885 RNPT con peso al nacimiento inferior a 1.500g, ingresados en el Hospital 12 de Octubre entre enero de 1991 y diciembre de 2003. Las edades a las que se alcanzaban los hitos motores evaluados se establecían mediante entrevista con los padres. La comparación de medias se realizó mediante la t de Student y el test de Bonferroni. Resultados: Los pacientes con DBP alcanzaron la sedestación a los 7,8±2m vs 7,1±1,3 m en los RNPT sin DBP y la marcha a los 14,5±3,8m vs 13,4±2,5m (p<0,001). Los pacientes con DBP tenían mayor riesgo de adquirir ambos hitos motores por encima del p90 (OR=2,6 (1,6-4,1) para la sedestación y OR=2,8 (1,6-4,8) para la marcha), efecto que se mantuvo tras ajustar por edad gestacional y peso al nacimiento. Conclusión: La DBP, en el grupo de RNPT<1.500g con exploración neurológica normal a los 2 años, implica un retraso en la adquisición de la sedestación y la marcha (AU)

Introduction: Adverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age. Patients and methods: A longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital “12 de Octubre” between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate. Results: Both motor skills were acquired later in the group with BPD (7.8±2m vs. 7.1±1.3m for sitting unsupported and 14.5±3.8m vs. 13.4±2.5m for walking) (P<.001). BPD was associated with delayed acquisition (above p90) of these skills, OR=2.6 (1.6-4.1) for sitting and OR=2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight. Conclusión: BPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years (AU)

[Ages of sitting up and walking in preterm newborns less than 1,500 G with bronchopulmonary dysplasia]. / Edades de sedestación y marcha en recién nacidos pretérmino menores de 1. 500 gr con displasia broncopulmonar.

INTRODUCTION: Adverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age. PATIENTS AND METHODS: A longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital "12 de Octubre" between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate. RESULTS: Both motor skills were acquired later in the group with BPD (7.8±2m vs. 7.1±1.3m for sitting unsupported and 14.5±3.8m vs. 13.4±2.5m for walking) (P<.001). BPD was associated with delayed acquisition (above p90) of these skills, OR=2.6 (1.6-4.1) for sitting and OR=2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight. CONCLUSION: BPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years.

Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn.

OBJECTIVE: To estimate the influence of skin-to-skin care on the thermal regulation of the infant and the rate of breastfeeding at different points of time. We also aim to establish whether skin-to-skin contact reduces maternal pain during episiotomy repair and decreases the time to expel the placenta. METHODS: A randomized control study was performed with 137 patients in each branch of the study. Differences between the study groups were analysed with the unpaired t-test, Fisher test or chi-square test as appropriate. RESULTS: Greater thermal stability in the skin-to-skin care group was found where an average temperature rise of 0.07°C was observed. Mothers in the skin-to-skin care group exclusively breastfed more frequently at discharge. Mean time to expel the placenta was lesser in the skin-to-skin care group. CONCLUSION: This study shows that skin-to-skin care implies better thermal regulation and a better proportion of exclusive breastfeeding at hospital discharge.

Age of sitting unsupported and independent walking in very low birth weight preterm infants with normal motor development at 2 years.

AIMS: The aims of this study is to (i) determine the age of sitting unsupported and independent walking in preterm infants with birth weight under 1500 g (very low birth weight, VLBW); (ii) estimate differences between VLBW children and a reference population and (iii) estimate the association between clinical characteristics and late age at sitting and walking. METHODS: A longitudinal study was conducted of a cohort of 876 children with VLBW. The World Health Organization (WHO) motor development study population was used as a reference. Ages for both skills were established by interview with parents. Means were compared with t-test, ANOVA and Bonferroni adjustment where appropriate. RESULTS: The inclusion criteria were complied with 694 patients; 50% of VLBW sat at 7 m corrected age (CA) and walked at 13 m CA. Both motor skills were acquired later (7.3 +/- 1.5 and 13.6 +/- 2.8 m) compared with the control group (6 +/- 1.1 and 12.1 +/- 1.8 m). Weight or head circumference at birth below the 10th percentile or the presence of bronchopulmonary dysplasia were associated with delayed acquisition of both skills. CONCLUSION: Very low birth weight infants typically sit unsupported and walk later than term infants. Tables describing reference values for milestones acquisition for different categories of infants (gestational age, birth weight and other determinants) may contribute to inform the decision making process on access to available resources.

[Evaluation of pain in a neonatal intensive care unit during endocrine-metabolic tests]. / Valoración del dolor en la unidad de cuidados intensivos neonatales durante la extracción de las pruebas endocrinometabólicas.

OBJECTIVES: To determine whether the pain suffered during the endocrine metabolic test can be lowered by adding skin to skin care to the use of sucrose. To establish factors that may modify the feeling of pain and evaluate the parents opinion during the extraction. PATIENTS AND METHODS: Controlled clinical trial. Two groups: group 1 (n= 27), skin to skin and sucrose, and group 2 (n=27), sucrose. The pain was measured with the Neonatal Infant Pain Scale (NIPS) during the endocrine metabolic test. Patients on mechanical ventilation, with HIV III or IV and those who had been given sedative analgesics in the previous 24 hours were excluded. RESULTS: The average gestational age in group 1 was 35.1 +/- 3.5 weeks and 35.4 +/- 3.2 weeks for group 2. The NIPS in group 1 was 2.51 +/- 1.42 and 2.81 +/- 2.11 (NS) in group 2. On only one occasion was severe pain noticed (group 2). There was a tendency towards a higher NIPS with a higher gestational age (r=0.19) and a lower number of previous capillary (r= -0.06) and venous (r= -0.11) extractions. Group 1 parents thought that this practice contributed to decreasing their children's irritability and increased their trust in the care team. CONCLUSION: By adding skin to skin care to the sucrose during the endocrine metabolic test does not relieve the pain feeling. Parents in the skin to skin group thought that this practice contributed to decreasing their children's irritability and increased their trust in the care team.

Valoración del dolor en la unidad de cuidados intensivos neonatales durante la extracción de las pruebas endocrinometabólicas / Evaluation of pain in a neonatal intensive care unit during endocrine-metabolic tests

Objetivos: Determinar si el dolor ocasionado durante la realización de las pruebas endocrinometabólicas puede disminuirse realizando cuidado piel con piel, además de con el uso de sacarosa. Establecer factores que puedan modificar la sensación dolorosa y valorar la opinión de los padres durante la extracción. Pacientes y métodos: Se trata de un ensayo clínico controlado, con dos grupos: grupo 1 (n=27): con cuidado piel con piel y sacarosa, y grupo 2 (n=27): con sacarosa. Se valoró el dolor mediante la escala Neonatal Infant Pain Scale (NIPS) durante la extracción. Se excluyeron los pacientes con ventilación mecánica, con hemorragia intraventricular (HIV) de grados III o IV, o que hubieran recibido analgésicos-sedantes en las 24 h previas. Resultados: La edad gestacional media en el grupo 1 fue 35,1 ± 3,5 semanas y en el grupo 2 de 35,4 ± 3,2 semanas. El NIPS en el grupo 1 fue 2,51 ± 1,42 y en el grupo 2, 2,81 ± 2,11 (NS). En una ocasión se apreció dolor intenso (grupo 2). Se observó una tendencia a obtener un mayor valor del NIPS a mayor edad gestacional (r=0,19) y a menor número de extracciones capilares (r= -0,06) y venosas previas (r =-0,11). Los padres de los niños del grupo 1 refirieron que creían contribuir a una menor irritabilidad de sus hijos y que aumentaba su confianza con el personal asistencial. Conclusión: Añadir el contacto piel con piel a la administración de sacarosa durante la extracción de las pruebas endocrinometabólicas no disminuye la sensación dolorosa medida mediante la puntuación NIPS. Los padres que realizaron el contacto piel con piel valoraron de forma muy positiva su implicación en el procedimiento, creyendo contribuir a una menor irritabilidad de sus hijos, además de tener una sensación de mayor confianza respecto al personal asistencial (AU)

Objectives: To determine whether the pain suffered during the endocrine metabolic test can be lowered by adding skin to skin care to the use of sucrose. To establish factors that may modify the feeling of pain and evaluate the parents opinion during the extraction. Patients and methods: Controlled clinical trial. Two groups: group 1 (n= 27), skin to skin and sucrose, and group 2 (n=27), sucrose. The pain was measured with the Neonatal Infant Pain Scale (NIPS) during the endocrine metabolic test. Patients on mechanical ventilation, with HIV III or IV and those who had been given sedative analgesics in the previous 24 hours were excluded. Results: The average gestational age in group 1 was 35.1 ± 3.5 weeks and 35.4 ± 3.2 weeks for group 2. The NIPS in group 1 was 2.51 ± 1.42 and 2.81 ± 2.11 (NS) in group 2. On only one occasion was severe pain noticed (group 2). There was a tendency towards a higher NIPS with a higher gestational age (r=0.19) and a lower number of previous capillary (r= -0.06) and venous (r= -0.11) extractions. Group 1 parents thought that this practice contributed to decreasing their children's irritability and increased their trust in the care team. Conclusion: By adding skin to skin care to the sucrose during the endocrine metabolic test does not relieve the pain feeling. Parents in the skin to skin group thought that this practice contributed to decreasing their children's irritability and increased their trust in the care team (AU)

[Assessment of the new Ballard score to estimate gestational age]. / Valoración del test de Ballard en la determinación de la edad gestacional.

BACKGROUND AND OBJECTIVES: The New Ballard Score (NBS) is commonly used to estimate gestational age (GA) in the newborn. The aims of this study were: a) to determine the reliability of the NBS; b) to estimate the agreement between two methods of GA assessment, NBS and ultrasonography (US) or last menstrual period (LMP); c) to estimate the agreement between NBS and US/LMP in distinct subgroups of neonates. PATIENTS AND METHODS: We performed a prospective, blind study. NBS was performed in neonates born in Hospital 12 Octubre, Madrid before the age of 48 hours. The level of agreement was estimated with two analytical parameters: the intraclass correlation coefficient (ICC) and the mean differences method (MD). RESULTS: Inter-observer agreement was very good (ICC > 0.8). Agreement between US/LMP and NBS was good (ICC = 0.6-0.8). In infants with lower weight or GA, and in those whose mothers had received prenatal corticosteroid therapy, NBS tended to overestimate GA compared with US/LMP (MD = 1.2-2.9). CONCLUSIONS: The agreement between two observers in NBS assessment was very good. The agreement between NBS and US/LMP was good, but differences of more than 2 weeks in GA were frequent. In very preterm newborns and in infants whose mothers had received prenatal corticosteroid therapy, NBS tends to overestimate GA.

[Congenital cytomegalovirus infection in the infants of HIV-infected mothers]. / Infección congénita por citomegalovirus en hijos de madres infectadas por el VIH.

BACKGROUND: Cytomegalovirus (CMV) is the most common congenital viral infection, mainly in the infants of HIV-infected women. The aim of this study was to evaluate the prevalence of congenital CMV infection in infants born to HIV-infected women in our hospital, the possible influence of maternal antiretroviral therapy, the relationship between vertical HIV transmission and congenital CMV infection, and the clinical outcome of these infants. PATIENTS AND METHODS: Between 1987 and 2003, we performed a prospective, cohort study of all the infants born to HIV-infected mothers, in whom CMV was cultured in urine in the neonatal period. Congenital CMV infection was defined as a CMV positive urine culture obtained in the first 3 weeks of life. RESULTS: A total of 257 patients were included in the study, with positive CMV urine culture in 12 (4.6 %). Before 1997 the prevalence was 9.2 % vs 1.34 % in the second period (p < 0.01). In infants born to HIV-infected women without zidovudine therapy the prevalence was 6.3 % compared with 3.1 % in the group with zidovudine therapy (p > 0.05). Vertical HIV transmission was observed in 23 infants, of which six (26 %) had congenital CMV coinfection. Only six infants (2.5 %) without HIV-infection had congenital CMV infection (p < 0.01). The outcome of congenital CMV infection was good in all infants. CONCLUSIONS: Congenital CMV infection is more frequent in infants born to HIV-infected women. The prevalence was higher in the first study period and in infants with vertical HIV transmission. All infants with congenital CMV infection had a favorable outcome.

Infección congénita por citomegalovirus en hijos de madres infectadas por el VIH / Congenital cytomegalovirus infection in the infants of HIV-infected mothers

Introducción: El citomegalovirus (CMV) es la causa más frecuente de infección viral congénita, y es más prevalente en la población infectada por el virus de la inmunodeficiencia humana (VIH). El objetivo del estudio es determinar la prevalencia de CMV congénito en hijos de madres infectadas por el VIH de nuestro hospital, la posible influencia del tratamiento materno, la asociación entre la transmisión vertical del VIH y la infección congénita por CMV, así como la evolución de éstos. Pacientes y métodos: Estudio de cohortes prospectivo desde 1987 a 2003, de todos los hijos de madre seropositiva en quienes se realizó cultivo de CMV en orina en el período neonatal. Se ha definido CMV congénito a la positividad del CMV en orina obtenida antes de la tercera semana de vida. Resultados: De los 257 pacientes incluidos en el estudio se aisló CMV en orina en 12 (4,6 %). Antes de 1997 la prevalencia fue del 9,2 % frente al 1,34 % en el período posterior (p 0,05). Presentaron transmisión vertical del VIH 23 niños, seis de ellos (26 %) presentaron CMV congénito frente al 2,5 % de aquellos en los que no hubo transmisión vertical del VIH (p < 0,01). La evolución de todos los casos de CMV congénito fue favorable. Conclusión: La prevalencia del CMV congénito en hijos de madres VIH parece su mayor que en la población general. La prevalencia es mayor en el primer período del estudio y en los que presentaban transmisión vertical del VIH. En todos los casos de infección congénita por CMV la evolución fue favorable

Background: Cytomegalovirus (CMV) is the most common congenital viral infection, mainly in the infants of HIV-infected women. The aim of this study was to evaluate the prevalence of congenital CMV infection in infants born to HIV-infected women in our hospital, the possible influence of maternal antiretroviral therapy, the relationship between vertical HIV transmission and congenital CMV infection, and the clinical outcome of these infants. Patients and methods: Between 1987 and 2003, we performed a prospective, cohort study of all the infants born to HIV-infected mothers, in whom CMV was cultured in urine in the neonatal period. Congenital CMV infection was defined as a CMV positive urine culture obtained in the first 3 weeks of life. Results: A total of 257 patients were included in the study, with positive CMV urine culture in 12 (4.6%). Before 1997 the prevalence was 9.2 % vs 1.34 % in the second period (p 0.05). Vertical HIV transmission was observed in 23 infants, of which six (26 %) had congenital CMV coinfection. Only six infants (2.5 %) without HIV-infection had congenital CMV infection (p < 0.01). The outcome of congenital CMV infection was good in all infants. Conclusions: Congenital CMV infection is more frequent in infants born to HIV-infected women. The prevalence was higher in the first study period and in infants with vertical HIV transmission. All infants with congenital CMV infection had a favorable outcome

[Respiratory infection due to Chlamydia trachomatis in infants. Clinical presentation and outcome in 18 patients]. / Infección respiratoria por Chlamydia trachomatis en lactantes. Presentación clínica y evolución de 18 casos.

BACKGROUND: Among other diseases, Chlamydia trachomatis causes epididymitis and prostatitis in men and urethritis, cervicitis and pelvic inflammatory disease in women. In children, it most usually causes conjunctivitis and is also responsible for lower respiratory tract disease, occasionally requiring hospital admission. OBJECTIVE: To draw attention to this disease, which is usually overlooked and which can be potentially serious. METHODS: We retrospectively reviewed the medical records of infants aged less than 6 months with symptoms of lower respiratory tract disease in whom C. trachomatis antigen was detected by enzyme immunoassay. RESULTS: We identified 18 patients with C. trachomatis between 1993 and 2002. Of these, 17 patients required hospital admission and five required monitoring in the pediatric intensive care unit. The mean length of hospital stay was 9.6 days. Three patients were immigrants. The mean age at admission was 6.6 weeks. Apnea occurred in five infants. Chest x-ray showed interstitial infiltrates in five infants. Sixteen patients were treated with erythromycin and all made a complete recovery. CONCLUSIONS: Although lower respiratory tract disease caused by C. trachomatis is usually managed on an outpatient basis, it sometimes requires hospital admission or even management in the intensive care unit. Therefore, C. trachomatis infection should be ruled out in infants aged less than 6 months with clinical symptoms of lower respiratory tract disease for which no other pathogen can be found.