Valoración clínica del estado nutricional fetal al nacer mediante el Clinical Assessment of Nutritional Status score / Assessment of foetal nutrition status at birth using the CANS score

INTRODUCCIÓN: La malnutrición fetal (MF) traduce una pérdida o fallo de adquisición intrauterina de la cantidad adecuada de grasa y masa muscular, asociando connotaciones pronósticas a corto y largo plazo. Siendo el diagnóstico de MF esencialmente clínico, el objetivo de este trabajo es detectar la incidencia MF mediante el Clinical Assessment of Nutritional Status score(CANS score), y comparar los resultados con los parámetros antropométricos clásicos. PACIENTES Y MÉTODOS: Estudio retrospectivo poblacional de recién nacidos a término entre 2003 y 2014 (n = 14.477). Se clasificaron en recién nacidos de peso adecuado, pequeño y grande para la edad gestacional. Se realizó el CANS score y se calculó el índice ponderal (IP) a todos los recién nacidos incluidos, considerándose MF los puntos de corte: CANS score < 25 e IP < 2,2 g/cm3. RESULTADOS: Mediante el CANS score el 7,6% (n = 1.101) de la población presentó MF, el 50,3% (n = 538) de los recién nacidos de peso pequeño para la edad gestacional, el 76,2% (n = 193) del subgrupo < p3 y el 4,67% (n = 559) de los recién nacidos de peso adecuado para la edad gestacional. El CANS score fue < 25 en el 7,26% (n = 1.043) de los recién nacidos con IP ≥ 2,2 g/cm3 (n = 14.356), y el CANS score fue > 24 en el 49% con IP < 2,2 g/cm 3 (n = 109). CONCLUSIONES: Es conveniente identificar todos aquellos recién nacidos con MF por los riesgos que pueden presentar a corto y largo plazo. La valoración mediante CANS score permite una mejor identificación del estado nutricional de los recién nacidos que empleando únicamente las curvas de peso según la edad gestacional

INTRODUCTION: Foetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study is to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. PATIENTS AND METHODS: Retrospective population of term infants was studied between 2003 and 2014 (n=14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score <25 and PI < 2.2 g/cm3. RESULTS: Using the CANS score, 7.6% (n 1,101) of the population showed FM, 50.3% (n = 538) of SGA, 76.2% (n = 193) subgroup = 559) of AGA. The CANS score was < 25 in 7.26% (n = 1,043) of newborns with PI ≥ 2.2 g/cm3 (n = 14.356), and the CANS score was > 24 in 49% with PI < 2.2 g/cm3 (n = 109). CONCLUSIONS: It is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term. CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age

Riesgo de déficits en el desarrollo en los prematuros tardíos: evaluación a los 48 meses mediante el Ages & Stages Questionnaires(R) / Development deficit risks in the late premature newborn: Evaluation at 48 months using the Ages & Stages Questionnaires(R)

INTRODUCCIÓN: La ausencia de protocolos específicos de seguimiento dificulta el conocimiento de la repercusión de la prematuridad tardía en el desarrollo psicomotor. El objetivo es evaluarlo a los 4 años y compararlo con los nacidos a término (AT). Población y método: Estudio de cohortes retrospectivo de 90 prematuros tardíos (PT) y 89 AT sanos, a los 48 meses, evaluados mediante el Ages & Stages Questionnaires(R) (ASQ-3). Las variables continuas se describen mediante media±DE comparadas con el test de la t de Student para muestras independientes; las variables categóricas, mediante frecuencias y proporciones, comparadas con el test de independencia de la chi al cuadrado. Se determinó un punto de corte para la puntuación total del ASQ-3 capaz de discriminar el riesgo de déficit del desarrollo mediante un análisis ROC. Una selección step-wise para el modelo de regresión logística determinó los factores de riesgo asociados. RESULTADOS: Las puntuaciones medias de cada dominio y de la puntuación global del ASQ-3 no mostraron diferencias entre ambos grupos. Sin embargo, al analizar la densidad de probabilidades para la puntuación global del ASQ-3 ≤ 251 puntos, 15 PT (16,6%) y 4 AT (4,5%) mostraban riesgo de déficit psicomotor, y la prematuridad tardía y la ausencia de lactancia materna resultaron factores asociados significativamente. CONCLUSIONES: Hubo una mayor prevalencia de riesgo de déficit en el desarrollo en los PT, lo que justifica considerar esta población de riesgo y establecer programas de seguimiento eficientes. Debe seguirse investigando si este riesgo corresponde a toda la población o si existen factores biológicos o antecedentes perinatales que los hacen más vulnerables

INTRODUCTION: Lack of specific monitoring protocols hinders the knowledge of the impact of late prematurity on delayed psychomotor development. The objective of this study is to evaluate this at 48 months and compare it with those born at term. Population and methods: A retrospective cohort study was conducted on 90 late preterm (PT) and 89 term (AT) healthy children at 48 months, assessed by the Ages & Stages Questionnaires(R) (ASQ-3). Continuous variables described using mean and standard deviation compared with the t Student t test for independent samples. The categorical variables were described as frequencies and proportions, compared with the Chi-square test of independence. A cut-off was determined for the total score of ASQ-3 able to discriminate the risk of developmental deficit by a ROC analysis. A step-wise logistic regression model identified the associated risk factors. RESULTS: The mean scores for each domain and overall ASQ-3 score showed no differences between groups. However, when analyzing the probability density for the ASQ-3 total score of ≤251 points, 15 PT (16.6%) and 4 AT (4.5%) showed risk of psychomotor deficits, and late prematurity and lack of breastfeeding were significantly associated factors. CONCLUSIONS: There is an increased prevalence of risk of development deficit in the PT, which justifies considering this population at risk and establishing effective monitoring programs. It should be further investigated whether this risk corresponds to the entire population, or if there are biological factors or perinatal history that makes them more vulnerable

[Assessment of foetal nutrition status at birth using the CANS score]. / Valoración clínica del estado nutricional fetal al nacer mediante el Clinical Assessment of Nutritional Status score.

INTRODUCTION: Foetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study is to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. PATIENTS AND METHODS: Retrospective population of term infants was studied between 2003 and 2014 (n=14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score <25 and PI <2.2g/cm(3). RESULTS: Using the CANS score, 7.6% (n 1,101) of the population showed FM, 50.3% (n=538) of SGA, 76.2% (n=193) subgroup 24 in 49% with PI <2.2g/cm(3) (n=109) CONCLUSIONS: It is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term. CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age.

[Development deficit risks in the late premature newborn: Evaluation at 48 months using the Ages & Stages Questionnaires®]. / Riesgo de déficits en el desarrollo en los prematuros tardíos: evaluación a los 48 meses mediante el Ages & Stages Questionnaires®.

INTRODUCTION: Lack of specific monitoring protocols hinders the knowledge of the impact of late prematurity on delayed psychomotor development. The objective of this study is to evaluate this at 48 months and compare it with those born at term. POPULATION AND METHODS: A retrospective cohort study was conducted on 90 late preterm (PT) and 89 term (AT) healthy children at 48 months, assessed by the Ages & Stages Questionnaires® (ASQ-3). Continuous variables described using mean and standard deviation compared with the t Student t test for independent samples. The categorical variables were described as frequencies and proportions, compared with the Chi-square test of independence. A cut-off was determined for the total score of ASQ-3 able to discriminate the risk of developmental deficit by a ROC analysis. A step-wise logistic regression model identified the associated risk factors. RESULTS: The mean scores for each domain and overall ASQ-3 score showed no differences between groups. However, when analyzing the probability density for the ASQ-3 total score of ≤251 points, 15 PT (16.6%) and 4 AT (4.5%) showed risk of psychomotor deficits, and late prematurity and lack of breastfeeding were significantly associated factors. CONCLUSIONS: There is an increased prevalence of risk of development deficit in the PT, which justifies considering this population at risk and establishing effective monitoring programs. It should be further investigated whether this risk corresponds to the entire population, or if there are biological factors or perinatal history that makes them more vulnerable.

Morbilidad neonatal en los recién nacidos a término precoz / Neonatal morbidity in early-term newborns

INTRODUCCIÓN: En las últimas décadas ha aumentado de forma significativa el nacimiento de niños de 37 y 38 semanas de gestación, período denominado a término precoz, paralelamente al aumento de partos inducidos y el incremento en la tasa de cesáreas. Pacientes y método: Estudio retrospectivo poblacional de cohortes, en el que se incluyó a los nacidos entre las 37 y 41 semanas de gestación en el período 1992-2011 (n=35.539). Esta población se dividió en 2 cohortes, los recién nacidos a término precoz (RNTP), de 37-38 semanas (n=11.318), y los recién nacidos a término completo (RNTC), de 39-41 semanas (n=24.221). Se analizan la tasa de cesárea, el ingreso en unidad neonatal, la morbilidad respiratoria, la apnea y la necesidad de asistencia respiratoria, hiperbilirrubinemia que requiere fototerapia, hipoglucemia, convulsiones, encefalopatía hipóxico-isquémica, necesidad de nutrición parenteral y sepsis precoz. RESULTADOS: Se observa un aumento progresivo del número de cesáreas a lo largo del período estudiado (del 30,9% al 40,3%). En los RNTP la tasa de cesárea fue superior que en los RNTC (38,3% vs. 31,3%; p < 0,0001). En la comparación de ambos grupos, se encontraron diferencias significativas en la tasa de ingreso en unidad neonatal, 9,1% vs. 3,5% (p < 0,0001); la morbilidad respiratoria (membrana hialina 0,14% vs. 0,007%; [p < 0,0001]; la taquipnea transitoria, 1,71% vs. 0,45% [p < 0,0001], la ventilación mecánica, 0,2% vs. 0,07% [p < 0,009]; la presión positiva continua en la vía respiratoria, 0,11% vs. 0,01% [p < 0,0001]); la fototerapia, 0,29% vs. 0,07% (p < 0,0001); la hipoglucemia, 0,54% vs. 0,11% (p < 0,0001), y la nutrición parenteral, 0,16% vs. 0,04% (p < 0,0001). No se encontraron diferencias significativas en la tasa de sepsis precoz, neumotórax, síndromes aspirativos, convulsiones y encefalopatía hipóxico-isquémica. CONCLUSIONES: En nuestro medio, existe un número importante de RNTP, que presentan una morbilidad significativamente superior a los recién nacidos catalogados de RNTC. Tras individualizar cada caso, es aconsejable no finalizar un embarazo antes de las 39 semanas de gestación, salvo por condicionamientos maternos, placentarios o fetales que indiquen que continuar el embarazo comporte un mayor riesgo para el feto y/o la madre

INTRODUCTION: In the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate. PATIENTS AND METHOD: Retrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n=35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n=11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n=24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed. RESULTS: There was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<0.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<0.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<0.0001], transient tachypnea 1.71% vs 0.45% [P<0.0001], mechanical ventilation 0.2% vs 0.07% [P<0.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<0.0001), hypoglycemia 0.54% vs 0.11% (P<0.0001), parenteral nutrition 0.16% vs 0.04% (P<0.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy. CONCLUSIONS: In our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating that continuing the pregnancy may increase the risk for the fetus and/or the mother

[Neonatal morbidity in early-term newborns]. / Morbilidad neonatal en los recién nacidos a término precoz.

INTRODUCTION: In the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate. PATIENTS AND METHOD: Retrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n=35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n=11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n=24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed. RESULTS: There was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<.0001], transient tachypnea 1.71% vs 0.45% [P<.0001], mechanical ventilation 0.2% vs 0.07% [P<.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<.0001), hypoglycemia 0.54% vs 0.11% (P<.0001), parenteral nutrition 0.16% vs 0.04% (P<.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy. CONCLUSIONS: In our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating that continuing the pregnancy may increase the risk for the fetus and/or the mother.

Prematuros tardíos: una población de riesgo infravalorada / Late preterm infants: A population at underestimated risk

Introducción y objetivo: La tasa de prematuridad ha experimentado un incremento progresivo en los últimos años, a costa casi exclusivamente de los prematuros tardíos (34 a 36 semanas). Es una población que, si bien con menor riesgo que los prematuros de menor edad gestacional, tiene una tasa de morbimortalidad significativamente mayor que los recién nacidos a término. Sin embargo, hay una cierta infravaloración respecto a su evolución a corto y a largo plazo. El objetivo de este trabajo es revisar la incidencia de prematuridad en este centro y analizar la morbimortalidad en los prematuros tardíos comparada con los recién nacidos a término. Población y métodos: Revisión retrospectiva de los recién nacidos en el hospital desde el 1 de enero de 1992 hasta el 31 de diciembre de 2008. Entre las 340/7 y las 366/7 semanas de gestación formaron el grupo de prematuros tardíos (n=2.003), y los de 37 a 42 semanas cumplidas de gestación conformaron el grupo de recién nacidos a término (n=32.015). Se formaron 2 subgrupos según 2 períodos de tiempo (de 1992 a 1998 y de 2000 a 2008). Se analizaron las tasas de morbimortalidad, para cada uno de los grupos y subgrupos, y se compararon, así como la morbilidad semana a semana desde la semana 34 a la semana 42. Resultados: Durante el período estudiado, la tasa de prematuridad aumentó del 3,9 al 9,8%, a expensas exclusivamente de los prematuros tardíos (el 79% del total).La tasa de mortalidad en los prematuros tardíos fue del 5% comparada con el 1,1% en los a término (p<0,0001; odds ratio de 4,71; intervalo de confianza del 95%: 2,3 a 9,5). La incidencia de ingreso en la Unidad de Neonatología, tasa de cesáreas, gemelaridad, trastornos respiratorios, necesidad de asistencia respiratoria en forma de presión positiva continua en la vía respiratoria nasal o ventilación mecánica, incidencia de apneas, ictericia que precisó fototerapia, hipoglucemia y necesidad de nutrición parenteral fueron significativamente superiores (p<0,0001) en el grupo de pretérminos tardíos comparado con los recién nacidos a término. La tasa de morbilidad fue descendente a medida que aumentaba la edad gestacional, con el valor más bajo a partir de las 39 semanas. Conclusiones: La morbimortalidad en los prematuros tardíos es significativamente superior a la de los recién nacidos a término. Es necesario revisar las pautas ante estos prematuros nacidos cerca de término, buscar las posibles causas de su prematuridad, intentar reducir su incidencia y elaborar un cuidadoso protocolo de atención y vigilancia para minimizar la morbimortalidad asociada. Sería aconsejable establecer un seguimiento a largo plazo, a fin de conocer cuáles son las consecuencias sobre su desarrollo psicomotor. El colectivo obstétrico debe sensibilizarse del verdadero riesgo del nacimiento en estas edades gestacionales cercanas a término (AU)

Background and objective: There has been a gradual rise in prematurity rates recent years, almost exclusively at the expense of the late preterm (34 to 36 weeks). This population, although with less risk than smaller preterm gestational age, has a morbidity rate significantly higher than term infants. However, there is some underestimation regarding developments in the short and long term. The aim of this study was to look at the incidence of prematurity in our institution and to analyze morbidity and mortality in late preterm compared with term infants. Subjects and methods: We performed a retrospective review of newborns in our Hospital from January 1992 until December 31, 2008. Late preterm group was defined as between 340/7 and 366/7 weeks gestation (N=2003) and term infants from 37 to 42 weeks gestation (N=32015). We formed 2 subgroups according two time periods (1992–1998 and 2000–2008). The morbidity and mortality for each of the groups and subgroups, and the morbidity from week 34 to 42, were analysed and compared. Results: During the period studied, the prematurity rate increased from 3.9% to 9.8%, exclusively at the expense of the late preterm (79%). The rate of mortality in late preterm was 5 ‰ compared to 1.1 ‰ in the term (P <0.0001, OR 4.71, 95% CI 2.3–9.5). The incidence of admission to the Neonatal Unit, Cesarean rate, twin, respiratory disorders, need for respiratory support in the form of nasal CPAP or mechanical ventilation, incidence of apnea, jaundice requiring phototherapy, hypoglycaemia and need for parenteral nutrition were significantly higher (P<0.0001) in the late preterm group compared with term infants. The morbidity rate decreased significantly as gestational age increased, with the lowest value from 39 weeks. Conclusions: Morbidity and mortality in late preterm infants is significantly higher than in term infants. The guidelines for these near term premature babies need to be reviewed, looking for possible causes of prematurity, and trying to reduce their impact, as well as developing a protocol for their care and close monitoring to minimize the associated morbidity. There should be long-term monitoring to find out the consequences on their psychomotor development. The obstetrics group should be made aware of the true risks of births in the near-term gestational ages (AU)

[Late preterm infants: A population at underestimated risk]. / Prematuros tardíos: una población de riesgo infravalorada.

BACKGROUND AND OBJECTIVE: There has been a gradual rise in prematurity rates recent years, almost exclusively at the expense of the late preterm (34 to 36 weeks). This population, although with less risk than smaller preterm gestational age, has a morbidity rate significantly higher than term infants. However, there is some underestimation regarding developments in the short and long term. The aim of this study was to look at the incidence of prematurity in our institution and to analyze morbidity and mortality in late preterm compared with term infants SUBJECTS AND METHODS: We performed a retrospective review of newborns in our Hospital from January 1992 until December 31, 2008. Late preterm group was defined as between 34(0/7) and 36(6/7) weeks gestation (N=2003) and term infants from 37 to 42 weeks gestation (N=32015). We formed 2 subgroups according two time periods (1992-1998 and 2000-2008). The morbidity and mortality for each of the groups and subgroups, and the morbidity from week 34 to 42, were analysed and compared. RESULTS: During the period studied, the prematurity rate increased from 3.9% to 9.8%, exclusively at the expense of the late preterm (79%). The rate of mortality in late preterm was 5 per thousand compared to 1.1 per thousand in the term (P <0.0001, OR 4.71, 95% CI 2.3-9.5). The incidence of admission to the Neonatal Unit, Cesarean rate, twin, respiratory disorders, need for respiratory support in the form of nasal CPAP or mechanical ventilation, incidence of apnea, jaundice requiring phototherapy, hypoglycaemia and need for parenteral nutrition were significantly higher (P<0.0001) in the late preterm group compared with term infants. The morbidity rate decreased significantly as gestational age increased, with the lowest value from 39 weeks. CONCLUSIONS: Morbidity and mortality in late preterm infants is significantly higher than in term infants. The guidelines for these near term premature babies need to be reviewed, looking for possible causes of prematurity, and trying to reduce their impact, as well as developing a protocol for their care and close monitoring to minimize the associated morbidity. There should be long-term monitoring to find out the consequences on their psychomotor development. The obstetrics group should be made aware of the true risks of births in the near-term gestational ages.

[Influence of socioeconomic factors on weight, length and head circumference measurements in newborns from 35 to 42 weeks gestational age]. / Influencia de los factores socioeconómicos en el peso, la longitud y el perímetro occipitofrontal de los recién nacidos entre 35 y 42 semanas de gestación.

BACKGROUND AND OBJECTIVE: gestational age and anthropometric measurements, i.e. weight, length and head circumference at birth, have all been used as predictors of neonatal morbidity-mortality and adult morbidity. Differences in ethnic or socioeconomic background of newborn cohorts, as well as methodological differences between studies limit the validity and application of current anthropometric curves across different populations. Thus, we conducted a study to obtain local reference data in a Hospital that had a medium-high socio-economic class population, probably different to others recently published in our geographic area, and to compare them. PATIENTS AND METHOD: Weight, length and head circumference at birth were retrospectively analysed in 31,397 live Caucasian neonates born at 23-42 weeks in SCIAS-Hospital de Barcelona between 1992 and 2006. Only single gestations were selected and no other exclusion by materno-fetal or neonatal pathology criteria were applied. Percentile values, mean and standard deviation for each anthropometric measurement were calculated according to gestational age and gender. They were compared with the results from recent publications of our geographic area. RESULTS: Males were found to have significantly higher weight, length and head circumference values than females from 36 weeks. There was a trend towards higher values in our population when compared with others in our geographic area. CONCLUSIONS: The influence of socioeconomic factors on fetal growth seems evident. Nevertheless, it is difficult to assume that the observed differences must be exclusively due to the population characteristics or the different methodologies in the selection of the sample. Thus, it is desirable to have anthropometric reference curves obtained from populations of surrounding areas, with epidemiological methodologies that might be more appropriate in identifying valid outcome predictors, and enable us to compare with others groups according to racial, socioeconomic and disease factors.

Influencia de los factores socioeconómicos en el peso, la longitud y el perímetro occipitofrontal de los recién nacidos entre 35 y 42 semanas de gestación / Influence of socioeconomic factors on weight, length and head circumference measurements in newborns from 35 to 42 weeks gestational age

Introducción y objetivo: la clasificación del recién nacido según peso, longitud y perímetro occipitofrontal al nacer en relación con la edad gestacional se ha utilizado como indicador de morbimortalidad neonatal, así como factor pronóstico de enfermedades de la edad adulta. Las diferentes poblaciones analizadas y metodologías en la recogida de datos hacen que los resultados sean dispares entre publicaciones. El objetivo es establecer los valores antropométricos de referencia para nuestro hospital, que atiende a una población caracterizada por un nivel socioeconómico medio-alto, distinta, probablemente, de otras publicadas recientemente en nuestro entorno, y compararlas. Pacientes y método: análisis del peso, la longitud y el perímetro occipitofrontal al nacimiento de 31.397 recién nacidos vivos consecutivos en SCIAS-Hospital de Barcelona, de 1992 a 2006, con edades gestacionales entre 23 y 42 semanas. Se seleccionaron las gestaciones únicas y se separaron según sexo. Todos ellos de raza caucásica. No hubo exclusiones por enfermedad materna, fetal o neonatal. Se obtuvieron los valores en percentiles, media y desviación estandar, y se compararon según sexo. Se realizaron curvas según la edad gestacional a partir de las 35 semanas. Se compararon con los resultados de publicaciones recientes referidas a poblaciones de nuestro entorno geográfico. Resultados: se aprecian diferencias significativas en el peso, la longitud y el perímetro occipitofrontal al nacer según sexo a partir de las 36 semanas, con valores más altos en los varones. Se observa una tendencia a valores más altos en nuestra población al compararlos con otras de nuestro entorno geográfico. Conclusiones: la influencia del factor socioeconómico sobre el crecimiento fetal parece evidente. Sin embargo, es difícil asegurar que las diferencias observadas sean debidas, exclusivamente, a las características poblacionales o a las diferentes metodologías en la selección de la muestra. Es recomendable disponer de valores antropométricos poblacionales de referencia de la zona geográfica a la que pertenecemos, obtenidos a partir de metodologías epidemiológicas, para clasificar al recién nacido de forma adecuada y poder establecer comparaciones con sectores poblacionales diferenciados según factores raciales, socioeconómicos o por enfermedades (AU)

Background and objective: gestational age and anthropometric measurements, i.e. weight, length and head circumference at birth, have all been used as predictors of neonatal morbidity-mortality and adult morbidity. Differences in ethnic or socioeconomic background of newborn cohorts, as well as methodological differences between studies limit the validity and application of current anthropometric curves across different populations. Thus, we conducted a study to obtain local reference data in a Hospital that had a medium-high socio-economic class population, probably different to others recently published in our geographic area, and to compare them. Patients and method: Weight, length and head circumference at birth were retrospectively analysed in 31,397 live Caucasian neonates born at 23–42 weeks in SCIAS-Hospital de Barcelona between 1992 and 2006. Only single gestations were selected and no other exclusion by materno-fetal or neonatal pathology criteria were applied. Percentile values, mean and standard deviation for each anthropometric measurement were calculated according to gestational age and gender. They were compared with the results from recent publications of our geographic area. Results: Males were found to have significantly higher weight, length and head circumference values than females from 36 weeks. There was a trend towards higher values in our population when compared with others in our geographic area. Conclusions: The influence of socioeconomic factors on fetal growth seems evident. Nevertheless, it is difficult to assume that the observed differences must be exclusively due to the population characteristics or the different methodologies in the selection of the sample. Thus, it is desirable to have anthropometric reference curves obtained from populations of surrounding areas, with epidemiological methodologies that might be more appropriate in identifying valid outcome predictors, and enable us to compare with others groups according to racial, socioeconomic and disease factors (AU)

[Cord blood levels of interleukin 6 in preterm infants as an early marker of neonatal morbidity]. / Determinación de interleucina 6 en sangre de cordón en prematuros, como indicador precoz de morbilidad neonatal.

INTRODUCTION: The prematurity rate in our country is 8-9 %. Despite the decrease in neonatal mortality during the last decade, there is still a high incidence of neonatal morbidity and its subsequent sequelae. It is well known that the fetal inflammatory response plays an important role in the presence of neonatal morbidity. The aim of this study is to determine if interleukin 6 (IL-6) measurements in cord blood are a useful parameter to recognize those preterms with higher probability of suffering neonatal morbidity. PATIENTS AND METHOD: Descriptive and prospective study in newborns with gestational ages (GA) < or = 34 weeks. We determined IL-6 levels in cord blood; white cell count and C reactive protein (CRP) levels at 0, 12, 24 and 72 hours of life, and blood culture at admission. Clinical data was also collected, including perinatology factors, symptomatology on admission and subsequent evolution until discharge or death. RESULTS: We included 99 newborns with a GA between 23 and 34 weeks and birth weights between 480 and 2,855 g. Levels of IL-6 > 10 pg/ml show a significant correlation between maternal fever and/or chorioamnionitis (P = 0.005), a weak but significant correlation (P = 0.05, r = 0.3) between increased levels of CRP at 24 hours of life and Critical Risk Index for Babies (CRIB) score > or = 4 (P < 0.003, r = 0.2) and a significant correlation (P = 0.04) with the presence of periventricular leukomalacia (PVL) and with length of hospital stay (P = 0.0015). Patients with a lower GA show a trend to have higher levels of IL-6. CONCLUSIONS: IL-6 could be a useful and early marker of neonatal morbidity. Its rapid ability to predict neonatal morbidity gives it an advantage over other classical blood markers.

Determinación de interleucina 6 en sangre de cordón en prematuros, como indicador precoz de morbilidad neonatal / Cord blood levels of interleukin 6 in preterm infants as an early marker of neonatal morbidity

Introducción: La incidencia de prematuridad en nuestro país es aproximadamente del 8-9 %. A pesar del descenso de la mortalidad en este grupo de pacientes durante las últimas décadas, la morbilidad en el período neonatal y las secuelas posteriores siguen siendo elevadas. Se sabe que la respuesta inflamatoria fetal tiene un papel importante en la presencia de morbilidad neonatal. El objetivo de este estudio es determinar si la interleucina 6 (IL-6) en sangre de cordón es un parámetro útil para identificar a los prematuros que tienen mayor probabilidad de presentar morbilidad neonatal. Pacientes y método: Estudio descriptivo, prospectivo en recién nacidos con edad gestacional (EG) de hasta 34 semanas. Se determina IL-6 en sangre de cordón; recuento leucocitario y proteína C reactiva (PCR) a las 0, 12, 24 y 72 h de vida, y hemocultivo al ingresar. Se recogen factores perinatológicos, clínica en el momento del ingreso y evolución posterior hasta el alta o fallecimiento. Resultados: Se incluyen 99 recién nacidos con EG entre 23 y 34 semanas y peso al nacer entre 480 y 2.855 g. Los valores de IL-6 > 10 pg/ml muestran una correlación significativa con el antecedente de fiebre y/o corioamnionitis materna (p = 0,005), correlación débil pero significativa (p = 0,05; r = 0,3) con valores elevados de PCR a las 24 h de vida y con valores de la puntuación del índice de riesgo clínico para niños (CRIB) ≥ 4 (p = 0,003; r = 0,2) y correlación significativa (p = 0,04) con la presencia de leucomalacia periventricular (LPV) y con los días de ingreso (p = 0,015). En los pacientes con menor EG se observa una tendencia a mostrar valores de IL-6 más elevados. Conclusiones La IL-6 puede ser un marcador útil y precoz de morbilidad neonatal. Su precocidad para predecir morbilidad supone una ventaja frente a los marcadores analíticos clásicos (AU)

Introduction: The prematurity rate in our country is 8-9 %. Despite the decrease in neonatal mortality during the last decade, there is still a high incidence of neonatal morbidity and its subsequent sequelae. It is well known that the fetal inflammatory response plays an important role in the presence of neonatal morbidity. The aim of this study is to determine if interleukin 6 (IL-6) measurements in cord blood are a useful parameter to recognize those preterms with higher probability of suffering neonatal morbidity. Patients and method: Descriptive and prospective study in newborns with gestational ages (GA) ≤ 34 weeks. We determined IL-6 levels in cord blood; white cell count and C reactive protein (CRP) levels at 0, 12, 24 and 72 hours of life, and blood culture at admission. Clinical data was also collected, including perinatology factors, symptomatology on admission and subsequent evolution until discharge or death. Results: We included 99 newborns with a GA between 23 and 34 weeks and birth weights between 480 and 2,855 g. Levels of IL-6 > 10 pg/ml show a significant correlation between maternal fever and/or chorioamnionitis (P = 0.005), a weak but significant correlation (P = 0.05, r = 0.3) between increased levels of CRP at 24 hours of life and Critical Risk Index for Babies (CRIB) score ≥ 4 (P < 0.003, r = 0.2) and a significant correlation (P = 0.04) with the presence of periventricular leukomalacia (PVL) and with length of hospital stay (P = 0.0015). Patients with a lower GA show a trend to have higher levels of IL-6. Conclusions IL-6 could be a useful and early marker of neonatal morbidity. Its rapid ability to predict neonatal morbidity gives it an advantage over other classical blood markers (AU)

[Neonatal withdrawal syndrome to selective serotonin reuptake inhibitors: case report and literature review]. / Síndrome de abstinencia neonatal a inhibidores selectivos de la recaptación de serotonina: a propósito de un caso y revisión de la bibliografía.

INTRODUCTION: The treatment with selective serotonin reuptake inhibitors (SSRIs) is widely prescribed in pregnant women. Its gestational use is not associated with an increased risk of major foetal anomalies when used in their recommended doses. A SSRI-related neonatal syndrome has been described secondary to withdrawal in infants exposed to these drugs during the last trimester of pregnancy. However, little is known about neonatal psychopharmacology. CASE REPORT: An infant whose mother received treatment with paroxetine (20 mg/kg/day) during the third trimester was born prematurely and presented withdrawal symptoms within few days after birth. Symptoms were irritability with constant crying, shivering, increased muscle tone, coreiform movements and feeding problems. Only supportive care was needed and symptoms disappeared by two weeks of age. CONCLUSIONS: In utero exposure to SSRIs during the last trimester through delivery may result in a self-limited neonatal behavioural syndrome that can be managed with supportive care. Its increasing incidence in neonates may be due to a greater frequency of its gestational use. All these neonates should be followed-up closely looking forward withdrawal symptoms in the first days of life. We need a better understanding of SSRIs effects and pharmacokinetics, and further research should focus on whether it is safe to use SSRIs during the last trimester.

Síndrome de abstinencia neonatal a inhibidores selectivos de la recaptación de serotonina: a propósito de un caso y revisión de la bibliografía / Neonatal withdrawal syndrome to selective serotonine reuptake inhibitors: case report and literature review

Introducción. El tratamiento con inhibidores selectivosde la recaptación de serotonina (ISRS) en mujeres gestantes es cadavez más frecuente. Su uso durante la gestación, en las dosis recomendadas,no tiene efectos teratogénicos. Se ha descrito un síndromeneonatal asociado a los ISRS por abstinencia en recién nacidosde madres expuestas a estos fármacos durante el último trimestrede gestación. Sin embargo, se conoce muy poco su farmacocinéticaen el neonato. Caso clínico. Varón prematuro cuya madrehabía recibido tratamiento con paroxetina (20 mg/kg/día) duranteel tercer trimestre de gestación que nació prematuro y presentó alos pocos días de vida síntomas compatibles con un síndrome deabstinencia. Dichos síntomas consistían en irritabilidad con llantoconstante, temblores, aumento del tono muscular, movimientos coreiformesy problemas para la alimentación. Los síntomas desparecierona las dos semanas de vida, únicamente con tratamiento desoporte. Conclusiones. La exposición intrauterina a los ISRS duranteel tercer trimestre de gestación puede ser la causa de un síndromede abstinencia neonatal, generalmente autolimitado y quesólo requiere tratamiento de soporte. La creciente incidencia de estesíndrome neonatal puede deberse al uso cada vez más frecuentede estos fármacos en mujeres gestantes. Todos estos neonatos de riesgotendrían que ser objeto de un seguimiento durante los primerosdías de vida. Se precisa conocer mejor los efectos y la farmacocinéticade los ISRS en la época neonatal y son necesarios más estudiospara determinar si el uso de los ISRS durante el último trimestrede la gestación es seguro

Introduction. The treatment with selective serotonine reuptake inhibitors (SSRIs) is widely prescribed in pregnantwomen. Its gestational use is not associated with an increased risk of major foetal anomalies when used in their recommendeddoses. A SSRI-related neonatal syndrome has been described secondary to withdrawal in infants exposed to these drugsduring the last trimester of pregnancy. However, little is known about neonatal psychopharmacology. Case report. An infantwhose mother received treatment with paroxetine (20 mg/kg/day) during the third trimester was born prematurely andpresented withdrawal symptoms within few days after birth. Symptoms were irritability with constant crying, shivering,increased muscle tone, coreiform movements and feeding problems. Only supportive care was needed and symptomsdisappeared by two weeks of age. Conclusions. In utero exposure to SSRIs during the last trimester through delivery mayresult in a self-limited neonatal behavioural syndrome that can be managed with supportive care. Its increasing incidence inneonates may be due to a greater frequency of its gestational use. All these neonates should be followed-up closely lookingforward withdrawal symptoms in the first days of life. We need a better understanding of SSRIs effects and pharmacokinetics,and further research should focus on whether it is safe to use SSRIs during the last trimester

Síndrome del pulmón seco en el recién nacido / Dry lung syndrome in a neonate

No disponible

[Topiramate and pregnancy. Neonate with bone anomalies]. / Topiramato y embarazo. Recién nacido con anomalías óseas.

Topiramate is a new generation, antiepileptic drug used for the treatment of persistent partial crises. To date no specific teratogenic effects have been reported in humans, but they have appeared in experimental animals. We present the case of a neonate whose mother suffered from partial epilepsy, which was treated with topiramate throughout pregnancy at doses of 300 mg per day. When the child was born agenesis of the right thumb, hypoplasia of the left thumb, and syndactylia of the second and third toes of the foot with agnesis of some phalanges, and hypoplasia of the right orbicular muscle in the mouth were observed. No etiologic cause was found. We discuss whether there could have been a causal relationship with topiramate monotherapy.

Topiramato y embarazo. Recién nacido con anomalías óseas / Topiramate and pregnancy. Neonate with bone anomalies

El topiramato es un fármaco antiepiléptico de nueva generación utilizado entre otras indicaciones para tratamiento de las crisis parciales rebeldes a otros anticomiciales. Hasta la fecha no se han descrito efectos teratogénicos organoespecíficos en seres humanos, pero sí en animales de experimentación. Se presenta el caso de un recién nacido de madre con una epilepsia parcial tratada durante toda la gestación con topiramato en dosis de 300 mg al día. Al nacer se comprobó agenesia del dedo pulgar derecho, hipoplasia del pulgar izquierdo, sindactilia del segundo y tercer dedos de los pies y agenesia de algunas falanges, hipoplasia del músculo orbicular derecho de la boca. No se encontró ninguna causa etiológica y se especula si la monoterapia con topiramato pudiera tener relación causal

Topiramate is a new generation, antiepileptic drug used for the treatment of persistent partial crises. To date no specific teratogenic effects have been reported in humans, but they have appeared in experimental animals. We present the case of a neonate whose mother suffered from partial epilepsy, which was treated with topiramate throughout pregnancy at doses of 300 mg per day. When the child was born agenesis of the right thumb, hypoplasia of the left thumb, and syndactylia of the second and third toes of the foot with agnesis of some phalanges, and hypoplasia of the right orbicular muscle in the mouth were observed. No etiologic cause was found. We discuss whether there could have been a causal relationship with topiramate monotherapy

[Autoimmune hemolytic anemia with complement-positive direct antiglobulin test]. / Anemia hemolítica autoinmune con prueba de antiglobulina positiva a complemento.

Autoimmune hemolytic anemia (AIHI) is an infrequent disease in the pediatric age group. Its diagnosis is given by the direct antiglobulin test (DAT) or Coombs' test, which determines which type of globulin (IgG or complement) is the cause of the hemolysis. The type of globulin involved determines the etiology of AIHI, which is usually confirmed by positive results of other laboratory investigations such as cold agglutinin determination or the Donath-Landsteiner test. We present three cases of AIHI. DAT was positive to complement with diverse etiology: warm antibody with IgG-negative DAT, cold agglutinins associated with infectious mononucleosis, and Doth-Landsteiner antibodies. In all patients, empirical treatment with corticosteroids was initiated. The treatment was withdrawn or continued, depending on the final etiology of AIHI.

Anemia hemolítica autoinmune con prueba de antiglobulina positiva a complemento / Autoimnune hemolytic anemia with complement-positive direct antiglobulin test

La anemia hemolítica autoinmune (AHAI) es una enfermedad poco frecuente en la edad pediátrica. Su diagnóstico se establece mediante la prueba de antiglobulina directa (PAD) o test de Coombs que determina qué tipo de globulina (IgG o complemento) es la causante de la hemólisis. Dependiendo del tipo de globulina que resulte, ésta orienta la etiología de la AHAI, que se suele confirmar a través de la positividad de otras pruebas de laboratorio, como la determinación de crioaglutininas o la prueba de Donath-Landsteiner. Se presentan 3 casos de anemia hemolítica autoinmune con PAD positiva a complemento con etiología diferente: por anticuerpos calientes con PAD negativa a IgG, por crioaglutininas asociadas a mononucleosis infecciosa y por anticuerpos de Donath-Landsteiner. En todos los casos se inició tratamiento empírico con corticoides que se suspendió o continuó según la etiología final de la AHAI. (AU)