[Prenatal corticosteroid and early surfactant therapy in infants born at < or = 30 weeks gestation]. / Tratamiento con corticoides prenatales y surfactante precoz en recién nacidos de igual o menos de 30 semanas de gestación.

BACKGROUND: Prenatal corticosteroid (PNC) exposure and postnatal surfactant therapy improve outcome in very low birth weight infants (VLBWI). However, the efficacy of PNC in the prevention of chronic lung disease is debated. OBJECTIVE: To study the effects of PNC exposure on outcome in VLBWI born at < or = 30 weeks' gestation. PATIENTS AND METHODS: We performed a multicenter, longitudinal study. The Spanish Surfactant Group database (n 5 1,275) was searched and 211 VLBWI born at < or = 30 weeks who received early surfactant therapy (< or = 30 min) were identified. Perinatal events, neonatal management and rates of mortality and complications were evaluated. Data on the subgroup of infants who received PNC (157, 74.4 %) were compared with data on 54 infants who did not receive this therapy. RESULTS: Mean (+/- SD) birth weight and gestational age were 944 (226) g and 27 (1.8) weeks. Surfactant was given at 16 +/- 13 min (61 % < or = 15 min). A total of 124 infants (58.8 %) developed respiratory distress syndrome. No differences were found in birth weight, gestational age, or Apgar score at 1 and 5 min. However the age at first surfactant dose was lower in infants exposed to PNC. PNC-exposed infants required fewer doses of surfactant, were extubated earlier (58.9 vs. 161 h) and needed a lower FiO2 at 48 h (0.28 vs. 0.35). Moreover, neonatal mortality (15.9 vs. 27.8 %), the incidence of intraventricular hemorrhage (25.2 vs. 50 %), ductus arteriosus (40.3 vs. 63.5 %) and necrotizing enterocolitis (9 vs. 19.2 %) were lower in infants receiving PNC. However, the incidence of chronic lung disease was similar in both groups. CONCLUSIONS: PNC exposure of VLBWI born at < or = 30 weeks receiving early surfactant therapy reduced mortality and the incidence of certain complications but did not decrease the incidence of chronic lung disease.

[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)

[The Europe against immature lung (EURAIL) project. Strategies for the prevention and treatment of lung immaturity in neonates]. / Proyecto EURAIL. Estrategias de prevención y tratamiento contra la inmadurez pulmonar en España.

OBJECTIVE: To determine clinical practice variability in the prevention and postnatal treatment of lung immaturity in Spain. PATIENTS AND METHODS: Cross-sectional study within a larger study in 13 European countries. Data were obtained from the medical records of all very low birth weight (VLBW) infants born in participating centers, without other instrumentation. RESULTS: A questionnaire was sent to 213 centers. Seventy-two (34 %) responded, with 162,157 births (40 % of total births in 1999). Eight percent of infants were of low birth weight, 1.2 % (2,015) of very low birth weight and 0.45 % were of extremely low birth weight. A total of 52.2 % of VLBW infants received at least one dose of prenatal steroids, 28.8 % received a full course and 9.3 % received more than one cycle. All centres used surfactant and 76.8 % had a written protocol. Forty-one percent of VLBW infants were intubated, 47.6 % required mechanical ventilation for more than 6 hours, and 5 % underwent continuous positive airway pressure. A total of 80.4 % used postnatal steroids, half of them for chronic lung disease prevention, and 83.4 % used steroids to treat this disease. Steroids were most frequently indicated at 7-14 days of life for 3-9 days. The most important causes of neonatal morbidity were chronic lung disease in 14 %, ductus arteriosus in 16.7 %, intraventricular hemorrhage in 8.5 %, and necrotizing enterocolitis in 7.3 %. CONCLUSIONS: Prenatal exposure to steroids was low. Repeat cycles and postnatal steroid use to prevent chronic lung disease was high. Recent scientific evidence on the use of pre- and postnatal steroids should be more widely disseminated.

Proyecto EURAIL. Estrategias de prevención y tratamiento contra la inmadurez pulmonar en España / The Europe against immature lung (EURAIL) project. Strategies for the prevention and treatment of lung immaturity in neonates

Objetivo: Conocer la variabilidad de la práctica clínica habitual en la prevención y el tratamiento de la inmadurez pulmonar. Pacientes y métodos Estudio transversal dentro de un estudio en 13 países europeos. De todos los neonatos de muy bajo peso nacidos en los centros colaboradores se recogieron datos de las historias clínicas sin ningún tipo de instrumentación adicional. Resultados La encuesta fue remitida a 213 centros, de los cuales contestaron 72 (34 per cent), con un total de 162.157 nacimientos (40 per cent del total en 1999). El 8 per cent de los recién nacidos eran de bajo peso, el 1,2 per cent de muy bajo peso (2.015) y el 0,45 per cent de extremado bajo peso. El 52,5 per cent de los de muy bajo peso recibieron al menos una dosis de corticoides prenatales, el 28,8 per cent, un ciclo completo, y el 9,3 per cent, más de un ciclo. Todos los centros utilizan algún preparado surfactante, y cuentan con un protocolo escrito el 76,8 per cent. El 41 per cent de los recién nacidos de muy bajo peso fueron intubados al nacer, el 47,6 per cent precisaron ventilación mecánica durante más de 6 h y el 5 per cent presión positiva continua. El 80,4 per cent de centros usaban corticoides posnatales, la mitad para la prevención de enfermedad pulmonar crónica (EPC) y el 83,4 per cent como de terapéutica. La pauta más habitual era indicarlos a los 7-14 días de vida, durante 3-9 días. Entre la morbilidad neonatal destaca la EPC (14 per cent), conducto arterioso sintomático (16,7 per cent), hemorragia intraventricular (8,5 per cent) y enterocolitis necrosante (7,3 per cent). Conclusiones: La tasa de exposición a corticoides prenatales fue baja y la práctica de repetir los ciclos y el empleo de corticoides posnatales para prevenir la EPC elevadas. Sigue siendo preciso difundir la reciente evidencia científica sobre el uso de corticoides prenatales y posnatales (AU)