Right ventricle speckle tracking in bronchopulmonary dysplasia: one-year follow-up.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is still a major concern in preterm infants and adequate screening methods for secondary right ventricle (RV) failure are needed. Early detection could be aided by taking measurements of RV deformation using speckle tracking echocardiography. A prospective longitudinal study was carried out over 28 months at a tertiary care pediatric cardiology center. Preterm infants < 32 weeks gestational age (GA) were eligible for the study. Enrolled patients were separated in two groups: NO-BPD or BPD. At three timepoints over the first year of life, echocardiogram measurements were performed. Right ventricle strain was studied using speckle tracking analysis and compared to conventional function parameters. RESULTS: Fifty patients were enrolled in the study, 22 in the NO-BPD group and 28 in the BPD group. RV strain showed no statistical differences between groups. However, the BPD group showed worse RV function than the NO-BPD group, using speckle tracking analysis and other conventional parameters. During the study follow-up, an improvement trend is shown in RV strain. CONCLUSIONS: RV longitudinal strain and strain rate derived by speckle tracking is feasible in preterm infants. Although there seems to be a good correlation between RV strain and BPD severity, the results of this study were not conclusive. More studies should be carried out to investigate the optimum echocardiographic screening model of RV dysfunction in BPD patients.

Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late preterm and term infants.

INTRODUCTION AND OBJECTIVE: Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. METHODS: A prospective cohort study in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. SAMPLE SIZE: 207, 59 neonates developed hypoglycemia. RESULTS: Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. CONCLUSIONS: Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.

Estudio prospectivo de factores perinatales asociados a hipoglucemia precoz en el neonato prematuro tardío y a término / Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late-preterm and term infants

Introducción y objetivos: La hipoglucemia neonatal ofrece múltiples controversias. El objetivo del estudio es valorar los principales factores y circunstancias ambientales implicadas en el desarrollo de la hipoglucemia neonatal precoz. Métodos: Estudio analítico prospectivo de una cohorte de recién nacidos entre 34 + 1 y 40 + 6 semanas de edad gestacional. Se realizó una determinación de glucemia capilar a las dos, cuatro y ocho horas de vida. Tamaño muestral: 207; 59 neonatos desarrollaron hipoglucemia. Resultados: renatalmente, los factores con mayor influencia fueron la diabetes gestacional con mal control glucémico, gemelaridad y edad gestacional. La presencia de líquido amniótico meconial y el nacimiento por cesárea programada se asociaron a mayor probabilidad de hipoglucemia. Postnatalmente, el contacto precoz piel con piel, la succión al pecho, la iluminación tenue y la normotermia fueron factores protectores. El modelo predictivo que combinó tipo de iluminación, temperatura corporal y cifra de exceso de bases clasificó correctamente al 98% de los casos de hipoglucemia grave, con un R2 de Nagelkerke de 0,645 y especificidad del 99,5%. Conclusiones: Los factores postnatales ambientales parecen estar relacionados de forma directa en el desarrollo de la hipoglucemia precoz, por lo que el apoyo a la unión maternofilial y a la lactancia materna es fundamental. Nuestros resultados permiten una mejor identificación de los neonatos que no son subsidiarios de realizar controles de glucemia por tener poco riesgo de desarrollarla. (AU)

Introduction and objective: Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. Methods: A prospective cohort study, in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. Sample size: 207; 59 neonates developed hypoglycemia. Results: Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. Conclusions: Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal–child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.(AU)

[Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late-preterm and term infants]. / Estudio prospectivo de factores perinatales asociados a hipoglucemia precoz en el neonato prematuro tardío y a término.

INTRODUCTION AND OBJECTIVE: Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. METHODS: A prospective cohort study, in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. SAMPLE SIZE: 207; 59 neonates developed hypoglycemia. RESULTS: Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. CONCLUSIONS: Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.

Encuesta sobre detección de hipoglucemia y uso de glucómetros portátiles: ¿qué glucómetro es el más usado en las unidades neonatales españolas? / Survey on hypoglycaemia diagnosis and glucometer use - which is the most widely used glucometer in Spanish neonatology units?

INTRODUCCIÓN Y OBJETIVOS: la hipoglucemia neonatal sigue ofreciendo múltiples controversias. El objetivo del estudio es presentar la situación actual en torno a la forma de detección de la hipoglucemia neonatal y conocer el glucómetro portátil más utilizado en las unidades neonatales españolas en la actualidad. MÉTODOS: se elaboró un cuestionario "online" sobre el uso de glucómetros en neonatos y los dispositivos más utilizados, que fue enviado a los integrantes de la Sociedad Española de Neonatología. Participaron 75 centros. RESULTADOS: los glucómetros portátiles siguen teniendo un uso generalizado en la población neonatal. Más del 75 % de las unidades realizan un despistaje de la hipoglucemia neonatal en circunstancias clínicas concretas; el 13 % de los centros lo continúan realizando a todos los recién nacidos en las unidades neonatales. A mayor nivel asistencial, mayor es el porcentaje de detección de la hipoglucemia por otros sistemas de análisis (como gasometrías capilares): chi2, p = 0,019. Se usan múltiples modelos de glucómetro actualmente, encontrándose diferencias según el nivel asistencial (chi2, p = 0,01), siendo los modelos de la firma Nova Biomedical, Abbott y Roche Diagnostics los más usados. CONCLUSIONES: se observa que existen diferencias en la realización del despistaje de la hipoglucemia neonatal, por lo que es de gran importancia consensuar los procedimientos y acotar la población neonatal de mayor riesgo, para disminuir la variabilidad en la práctica clínica y mejorar la calidad de la asistencia neonatal

INTRODUCTION AND OBJECTIVE: neonatal hypoglycemia persistently offers multiple diagnostic controversies. This study aims to present the current situation regarding neonatal hypoglycaemia detection, and to gain insight into the most widely used portable glucometers in neonatal units today. METHODS: an online questionnaire was prepared and sent to the members of the Spanish Society of Neonatology; a total of 75 hospitals participated. RESULTS: portable glucometers continue to be widely used in the neonatal population. More than 75 % of units perform neonatal hypoglycemia screening in specific clinical circumstances, and 13 % of units continue to perform protocolized screening on all newborns at neonatal units. The higher the level of care, the higher the percentage of hypoglycaemia detection by other tests (such as blood gas analysis): chi2, p = 0.019. Multiple models of portable glucometers are currently used, with differences according to level of care (chi2, p = 0.01). Nova Biomedical, Abbott, and Roche Diagnostics models are most commonly used. CONCLUSIONS: differences in the performance of neonatal hypoglycaemia screening are observed, so standardised procedures and limiting the neonatal population at risk are important to reduce variability in clinical practice, and to improve the quality of neonatal care

[Survey on hypoglycaemia diagnosis and glucometer use-which is the most widely used glucometer in Spanish neonatology units?] / Encuesta sobre detección de hipoglucemia y uso de glucómetros portátiles: ¿qué glucómetro es el más usado en las unidades neonatales españolas?

INTRODUCTION: Introduction and objective: neonatal hypoglycemia persistently offers multiple diagnostic controversies. This study aims to present the current situation regarding neonatal hypoglycaemia detection, and to gain insiht into the most widely used portable glucometers in neonatal units today. Methods: an online questionnaire was prepared and sent to the members of the Spanish Society of Neonatology; a total of 75 hospitals participated. Results: portable glucometers continue to be widely used in the neonatal population. More than 75 % of units perform neonatal hypoglycemia screening in specific clinical circumstances, and 13 % of units continue to perform protocolized screening on all newborns at neonatal units. The higher the level of care, the higher the percentage of hypoglycaemia detection by other tests (such as blood gas analysis): chi2, p = 0.019. Multiple models of portable glucometers are currently used, with differences according to level of care (chi2, p = 0.01). Nova Biomedical, Abbott, and Roche Diagnostics models are most commonly used. Conclusions: differences in the performance of neonatal hypoglycaemia screening are observed, so standardised procedures and limiting the neonatal population at risk are important to reduce variability in clinical practice, and to improve the quality of neonatal care.

INTRODUCCIÓN: Introducción y objetivos: la hipoglucemia neonatal sigue ofreciendo múltiples controversias. El objetivo del estudio es presentar la situación actual en torno a la forma de detección de la hipoglucemia neonatal y conocer el glucómetro portátil más utilizado en las unidades neonatales españolas en la actualidad. Métodos: se elaboró un cuestionario "online" sobre el uso de glucómetros en neonatos y los dispositivos más utilizados, que fue enviado a los integrantes de la Sociedad Española de Neonatología. Participaron 75 centros. Resultados: los glucómetros portátiles siguen teniendo un uso generalizado en la población neonatal. Más del 75 % de las unidades realizan un despistaje de la hipoglucemia neonatal en circunstancias clínicas concretas; el 13 % de los centros lo continúan realizando a todos los recién nacidos en las unidades neonatales. A mayor nivel asistencial, mayor es el porcentaje de detección de la hipoglucemia por otros sistemas de análisis (como gasometrías capilares): chi2, p = 0,019. Se usan múltiples modelos de glucómetro actualmente, encontrándose diferencias según el nivel asistencial (chi2, p = 0,01), siendo los modelos de la firma Nova Biomedical, Abbott y Roche Diagnostics los más usados. Conclusiones: se observa que existen diferencias en la realización del despistaje de la hipoglucemia neonatal, por lo que es de gran importancia consensuar los procedimientos y acotar la población neonatal de mayor riesgo, para disminuir la variabilidad en la práctica clínica y mejorar la calidad de la asistencia neonatal.

Recomendaciones de la Sociedad Española de Neonatología para la utilización de palivizumab como profilaxis de las infecciones graves por el virus respiratorio sincitial en lactantes de alto riesgo, actualización / An update of the recommendations of the Spanish Neonatology Society for the use of palivizumab as prophylaxis for severe infections due to syncytial respiratory virus in high risk infants

No disponible

Recomendaciones para el cuidado del cordón umbilical en el recién nacido / Recommendations for the care of the umbilical cord in the newborn

El cuidado del cordón umbilical hasta su desprendimiento continúa siendo motivo de controversia en la actualidad. La Organización Mundial de la Salud recomienda en su última revisión realizar la cura en seco en países con cuidados obstétricos adecuados y una tasa baja de mortalidad neonatal. Por otro lado, en los últimos años han surgido nuevos estudios y revisiones que atribuyen un beneficio a aplicar clorhexidina tópica en el muñón. El presente documento analiza la evidencia disponible y concluye en la conveniencia de continuar recomendando la cura en seco en los nacimientos de nuestro entorno

The care of the umbilical cord until its detachment still remains controversial. The latest updated recommendations by the World Health Organisation advocate dry cord care in those countries with adequate obstetric care and low neonatal mortality rate. In recent years, new studies and reviews attribute some benefit to applying chlorhexidine on the umbilical stump. An analysis is presented here of the available evidence and results in the advisability of still recommending the dry cord care in the newborns in our setting

[Recommendations for the care of the umbilical cord in the newborn]. / Recomendaciones para el cuidado del cordón umbilical en el recién nacido.

The care of the umbilical cord until its detachment still remains controversial. The latest updated recommendations by the World Health Organisation advocate dry cord care in those countries with adequate obstetric care and low neonatal mortality rate. In recent years, new studies and reviews attribute some benefit to applying chlorhexidine on the umbilical stump. An analysis is presented here of the available evidence and results in the advisability of still recommending the dry cord care in the newborns in our setting.

Propéptido natriurético cerebral como marcador de evolución digestiva en el recién nacido prematuro / Brain natriuretic peptide as a marker of digestive evolution in the premature newborn

Antecedentes y objetivo: el ductus arterioso persistente hemodinámicamente significativo (DAP-HS) se asocia a mayor riesgo de enterocolitis necrotizante (ECN) y peor tolerancia enteral en los recién nacidos prematuros (RNPT). Se ha demostrado asociación entre el propéptido natriurético cerebral (proBNP) y el DAP-HS. Nuestro objetivo fue analizar la relación entre los niveles de proBNP y la tolerancia enteral, el riesgo de ECN y la ganancia ponderal en el RNPT. Material y métodos: estudio retrospectivo observacional, que incluyó a RNPT menores de 32 semanas de gestación y/o 1.500 g, con estudio ecocardiográfico y determinación de niveles de proBNP a las 48-72 horas de vida. Resultados: de 117 pacientes incluidos, el 65,8% tuvo un DAPHS y el 9,4% presentó ECN confirmada. El DAP-HS se asoció a mayor duración de la nutrición parenteral (p < 0,001), a ECN confirmada (p = 0,006) y a peor ganancia ponderal durante el ingreso (p < 0,001). Los valores de proBNP se relacionaron con la ECN (no ECN 12.189,5 pg/ml, rango 654-247.986; ECN 41.445 pg/ml, rango 15.275-166.172; p < 0,001), sin encontrar asociación con el resto de variables de evolución digestiva. En el análisis multivariante de regresión logística, las variables relacionadas de forma independiente con el desarrollo de ECN fueron la edad gestacional y el proBNP superior a 22.400 pg/ml (OR 13,386; IC 95% 1,541-116,262; p = 0,019). Conclusiones: el proBNP podría ser un marcador precoz de patología digestiva grave en el RNPT. Los niveles elevados podrían relacionarse con mayor riesgo de ECN en los neonatos más inmaduros

Background and objective: hemodynamically significant patent ductus arteriosus (HS-PDA) is associated with an increased risk of necrotizing enterocolitis (NEC) and worse enteral tolerance in preterm newborns (PN). An association has been demonstrated between brain natriuretic propeptide (proBNP) and HS-PDA. Our objective was to analyze the relationship between proBNP levels and enteral tolerance, NEC risk and weight gain in PN. Material and methods: a retrospective study was performed in neonates born before 32 weeks' gestation or with birth weight below 1500 grams, in whom proBNP determination and echocardiography were performed at 48 to 72 h of life. Results: 117 patients were included. 65.8% had a HS-PDA and 9.4% had an outcome of NEC. HS-PDA was associated with longer duration of parenteral nutrition (p < 0.001), a confirmed NEC (p = 0.006) and worse weight gain during admission (p < 0.001). ProBNP levels were associated to NEC (no NEC 12189.5 pg / mL, range 654-247986; NEC 41445 pg/mL, range 15275-166172, p < 0.001). No association was found with the rest of gastrointestinal outcomes. Multivariate logistic regression analysis showed a significant association of NEC with gestational age and proBNP above 22,400 pg/mL (OR 13,386, 95% CI 1,541-116,262, p = 0.019). Conclusions: proBNP could be an early marker of severe digestive pathology in PN. Increased proBNP levels could be associated with a significant increased risk of NEC in very immature newborns

[Brain natriuretic peptide as a marker of digestive evolution in the premature newborn]. / Propéptido natriurético cerebral como marcador de evolución digestiva en el recién nacido prematuro.

INTRODUCTION: Background and objective: hemodynamically significant patent ductus arteriosus (HS-PDA) is associated with an increased risk of necrotizing enterocolitis (NEC) and worse enteral tolerance in preterm newborns (PN). An association has been demonstrated between brain natriuretic propeptide (proBNP) and HS-PDA. Our objective was to analyze the relationship between proBNP levels and enteral tolerance, NEC risk and weight gain in PN. Material and methods: a retrospective study was performed in neonates born before 32 weeks' gestation or with birth weight below 1500 grams, in whom proBNP determination and echocardiography were performed at 48 to 72 h of life. Results: 117 patients were included. 65.8% had a HS-PDA and 9.4% had an outcome of NEC. HS-PDA was associated with longer duration of parenteral nutrition (p < 0.001), a confirmed NEC (p = 0.006) and worse weight gain during admission (p < 0.001). ProBNP levels were associated to NEC (no NEC 12189.5 pg / mL, range 654-247986; NEC 41445 pg/mL, range 15275-166172, p < 0.001). No association was found with the rest of gastrointestinal outcomes. Multivariate logistic regression analysis showed a significant association of NEC with gestational age and proBNP above 22,400 pg/mL (OR 13,386, 95% CI 1,541-116,262, p = 0.019). Conclusions: proBNP could be an early marker of severe digestive pathology in PN. Increased proBNP levels could be associated with a significant increased risk of NEC in very immature newborns.

INTRODUCCIÓN: Antecedentes y objetivo: el ductus arterioso persistente hemodinámicamente significativo (DAP-HS) se asocia a mayor riesgo de enterocolitis necrotizante (ECN) y peor tolerancia enteral en los recién nacidos prematuros (RNPT). Se ha demostrado asociación entre el propéptido natriurético cerebral (proBNP) y el DAP-HS. Nuestro objetivo fue analizar la relación entre los niveles de proBNP y la tolerancia enteral, el riesgo de ECN y la ganancia ponderal en el RNPT. Material y métodos: estudio retrospectivo observacional, que incluyó a RNPT menores de 32 semanas de gestación y/o 1.500 g, con estudio ecocardiográfico y determinación de niveles de proBNP a las 48-72 horas de vida. Resultados: de 117 pacientes incluidos, el 65,8% tuvo un DAPHS y el 9,4% presentó ECN confirmada. El DAP-HS se asoció a mayor duración de la nutrición parenteral (p < 0,001), a ECN confirmada (p = 0,006) y a peor ganancia ponderal durante el ingreso (p < 0,001). Los valores de proBNP se relacionaron con la ECN (no ECN 12.189,5 pg/ml, rango 654-247.986; ECN 41.445 pg/ml, rango 15.275-166.172; p < 0,001), sin encontrar asociación con el resto de variables de evolución digestiva. En el análisis multivariante de regresión logística, las variables relacionadas de forma independiente con el desarrollo de ECN fueron la edad gestacional y el proBNP superior a 22.400 pg/ml (OR 13,386; IC 95% 1,541-116,262; p = 0,019). Conclusiones: el proBNP podría ser un marcador precoz de patología digestiva grave en el RNPT. Los niveles elevados podrían relacionarse con mayor riesgo de ECN en los neonatos más inmaduros.

Evolución cardiológica postnatal y factores asociados a la agenesia de ductus venoso de diagnóstico prenatal / Postnatal cardiac outcomes associated with the prenatal diagnosis of absence of ductus venosus

Resumen Introducción: la agenesia del ductus venoso es una anomalía infrecuente con pronóstico variable. Puede ir de hallazgo aislado a producir muerte fetal. Así mismo, puede asociarse a otras anomalías y síndromes genéticos. Material y métodos: estudio descriptivo de 12 niños con diagnóstico prenatal de agenesia del ductus venoso. Se evaluó lugar de drenaje de vena umbilical, variables perinatales, obstétricas, otras anomalías asociadas y evolución. Resultados: el 75% (9/12) presentaba drenaje extrahepático de vena umbilical; de ellos, el 44,4% (4/9) presentó insuficiencia cardiaca fetal. Al nacimiento, un 50% (6/12) asociaba anomalías cardiacas estructurales y un 41,6% (5/12) precisaron tratamiento médico. El 25% (3/12) asociaba síndromes genéticos. 25% (3/12) de niños fallecieron (100% con cardiopatía), y un tercio de los supervivientes (3/9) presentó anomalías estructurales cardiacas. El 50% (6/12) de madres tenían antecedente de aborto o muerte fetal intraútero previa, 25% (3/12) de embarazos fueron producto de reproducción asistida y 25% (3/12) de gestaciones múltiples. Conclusiones: se halló una incidencia elevada de defectos estructurales cardiacos en niños con agenesia del ductus venoso. Son más usuales si el drenaje es extrahepático y en ellos hay mayor frecuencia de anomalías genéticas y mortalidad. Un porcentaje importante de pacientes precisan tratamiento perinatal; la evolución es satisfactoria en los supervivientes.

Abstract Introduction: The absence of ductus venosus is an uncommon condition with a variable prognosis, which can vary from an isolated finding to causing foetal death. Furthermore, it can also be associated with other genetic anomalies and syndromes. Material and method: A descriptive study was conducted on 12 children with a prenatal diagnosis of absence of ductus venosus. An evaluation was made of the umbilical vein drainage site, perinatal and obstetric variables, other associated anomalies, and the outcomes. Results: Extra-hepatic drainage of the umbilical vein was observed in 75% (9/12) of cases, of which 44.4% (4/9) had foetal heart failure. At birth, 50% (6/12) were associated with cardiac structure anomalies, and 41.6% (5/12) required medical treatment. Genetic syndromes were detected in 25% (3/12) of cases. There were 25% (3/12) deaths (100% with heart disease), and one-third (3/9) of the survivors had cardiac structure anomalies. A history of abortion or previous intrauterine death was recorded in 50% (6/12) of the mothers, and in 25% (3/12) the pregnancies were the result of assisted reproduction, and 25% (3/12) multiple gestations. Conclusions: An elevated incidence of cardiac structure defects is found in children with absence of ductus venosus. They are more common if the drainage is extrahepatic, and within those, there is a higher frequency of genetic anomalies and death. A significant percentage of patients require perinatal treatment: The outcome is satisfactory in the survivors.

Cribado de cardiopatías congénitas críticas en el periodo neonatal. Recomendación de la Sociedad Española de Neonatología / Pulse oximetry screening of critical congenital heart defects in the neonatal period. The Spanish National Neonatal Society recommendation

Debido a su gravedad y a las consecuencias de un diagnóstico tardío, los defectos cardíacos congénitos críticos (DCCC) representan un reto, por lo que es necesario su diagnóstico muy precoz, idealmente antes del comienzo de los síntomas clínicos, que normalmente preceden al colapso circulatorio o muerte del recién nacido. Por ello es importante su diagnóstico prenatal y posnatal muy precoz; sin embargo, tanto el diagnóstico por ecocardiografía fetal como la exploración física del recién nacido pueden ser insuficientes para diagnosticar un número importante de estos DCCC. El cribado de DCCC mediante el uso de pulsioximetría ha demostrado ser un método eficaz, no invasivo y de bajo coste, además de bien tolerado, para detectar a recién nacidos asintomáticos y afectos de DCCC en las primeras horas después del nacimiento. La Sociedad Española de Neonatología, a través de su Comisión de Estándares, hace una recomendación, basada en la evidencia actual, para la implementación en nuestro medio de la pulsioximetría como cribado neonatal de DCCC, y poder ofrecer a estos recién nacidos el mejor tratamiento posible en cada caso (AU)

Due to its severity, as well as the consequences of a late diagnosis, critical congenital heart defects (CCHD) represent a challenging situation, making an early diagnosis necessary and ideally before symptoms appear when circulatory collapse or death of the newborn can occur. Due to this, a prenatal and very early postnatal diagnosis is very important. Prenatal ultrasound screening and physical examination of the newborn can miss a considerable number of CCHD cases. Pulse oximetry screening has been demonstrated to be an effective, non-invasive, inexpensive, and well accepted tool in the early diagnosis of CCHD. The Spanish National Society of Neonatology, through its Standards Committee, and based on the current evidence, recommend the implementation of pulse oximetry screening of CCHD in Spain, and then to offer the best therapy possible to these newborn infants (AU)

[Pulse oximetry screening of critical congenital heart defects in the neonatal period. The Spanish National Neonatal Society recommendation]. / Cribado de cardiopatías congénitas críticas en el periodo neonatal. Recomendación de la Sociedad Española de Neonatología.

Due to its severity, as well as the consequences of a late diagnosis, critical congenital heart defects (CCHD) represent a challenging situation, making an early diagnosis necessary and ideally before symptoms appear when circulatory collapse or death of the newborn can occur. Due to this, a prenatal and very early postnatal diagnosis is very important. Prenatal ultrasound screening and physical examination of the newborn can miss a considerable number of CCHD cases. Pulse oximetry screening has been demonstrated to be an effective, non-invasive, inexpensive, and well accepted tool in the early diagnosis of CCHD. The Spanish National Society of Neonatology, through its Standards Committee, and based on the current evidence, recommend the implementation of pulse oximetry screening of CCHD in Spain, and then to offer the best therapy possible to these newborn infants.

Recomendaciones para la prevención, la detección y el manejo de la hiperbilirrubinemia en los recién nacidos con 35 o más semanas de edad gestacional / Guidelines for prevention, detection and management of hyperbilirubinaemia in newborns of 35 or more weeks of gestation

La hiperbilirrubinemia representa la causa más común de reingreso hospitalario en la primera semana de vida. Su detección continúa siendo un desafío, debido especialmente al alta precoz que puede asociarse con un retraso en el diagnóstico. La identificación de los niños con riesgo de desarrollar hiperbilirrubinemia significativa es una de las principales prioridades de la sanidad pública. En este documento, se presenta un enfoque para el manejo de la ictericia del recién nacido, según recomendaciones basadas en la evidencia médica y en la opinión del Comité de Estándares de la Sociedad Española de Neonatología (AU)

Hyperbilirubinaemia is one of the most frequent causes of hospital readmission during the first week of life. Its detection is still a big challenge, mainly due to the early discharge from the hospital that can be associated with a delay of the diagnosis. The identification of those newborns at risk of developing significant hyperbilirubinaemia is one of the main priorities in the public health care system. An approach to the management of newborn jaundice is presented in this article, following the recommendations based on the medical evidence and on the opinion of the Standards Committee of the Spanish Society of Neonatology (AU)

Recomendaciones para la identificación inequívoca del recién nacido / Recommendations for the unequivocal identification of the newborn

La identificación del recién nacido es un derecho reconocido, tanto a nivel internacional como nacional, y la correcta identificación del paciente constituye una prioridad dentro de las políticas de mejora de la seguridad de la asistencia sanitaria. En este documento el Comité de Estándares de la Sociedad Española de Neonatología recoge las recomendaciones para garantizar la identificación inequívoca del recién nacido durante su estancia hospitalaria. La combinación del codificador neonatal (pulsera de la madre y pulsera del recién nacido y pinza de cordón con un mismo número y con un código de barras idéntico y exclusivo para cada recién nacido), junto con la recogida de una muestra de sangre materna y otra de sangre del cordón umbilical (para análisis de ADN en caso exclusivamente de duda de identidad) es actualmente el método más fiable de identificación del recién nacido (AU)

Newborn identification is a legal right recognised by international and national laws. Moreover, improving the accuracy of correct patient identification is an important goal of patient safety solutions programs. In this article, the Standards Committee of the Spanish Society of Neonatology establishes recommendations to ensure correct identification of the newborn whilst in hospital. Currently, the most reliable method of identification of the newborn is the combination of identification cord clamp and bracelets (mother bracelet, newborn bracelet and cord clamp with the same number and identical and exclusive barcode system for each newborn) and the collection of maternal and umbilical cord blood samples (for DNA testing only for identification purposes) (AU)

[Risk factors and biochemical markers in metabolic bone disease of premature newborns]. / Factores de riesgo y marcadores bioquímicos de la enfermedad metabólica ósea del recién nacido prematuro.

BACKGROUND: Metabolic bone disease (MBD) of prematurity is a complication of multifactorial aetiology, which has been increasing, due to progressive decrease in mortality of preterm newborns. The aim of the study was to analyze risk factors of severe MBD and its analytical markers. PATIENTS AND METHOD: Retrospective study involving preterm infants less than 32 weeks gestational age and/or weight less tan 1,500 g born between january 2012 and december 2014. Comparison was made according to the presence of severe MBD. RESULTS: 139 patients were recruited. Mean value of 25(OH)D3 was 70.68 ± 25.20 nmol/L, being higher in patients born in spring-summer than in autumn-winter (80.94 ± 25.33 vs 61.13 ± 21.07; p = 0.000). Levels of 25(OH)D3 were similar in patients with severe MBD compared with the rest of patients (65.61 ± 26.49 vs 72.07 ± 24.89, P = 0.283). Higher levels of alkaline phosphatase (AP, IU/L ) (1314.19 ± 506.67 vs 476.56 ± 188.85; p = 0.000) were found in these patients. Cutoff point of AP 796.5 IU/L (S 95.2%, specificity 92.4%) was calculated by ROC curve. The risk factors most associated to severe EMO were restricted fetal growth, birth weight, duration of ventilation therapy and parenteral nutrition. CONCLUSIONS: AP levels were the best marker of severe MBD development. EMO risk increases with the number of risk factors and lower levels of 25(OH)D3. Levels of 25(OH)D3 higher than 70nmol/L appear to protect from the development of severe MBD, even in patients with multiple risk factors.

Criterios de alta hospitalaria para el recién nacido de muy bajo peso al nacimiento / Hospital discharge criteria for very low birth weight newborns

Los criterios de alta del recién nacido pretérmino se basan principalmente en los denominados criterios fisiológicos (termorregulación, estabilidad respiratoria y la capacidad para realizar alimentación oral), sin que podamos olvidar la importancia de la adquisición de competencias por parte de los padres para el cuidado de sus hijos y la necesidad de una adecuada planificación del alta como pilares de un alta con plenas garantías. En este documento del Comité de Estándares de la Sociedad Española de Neonatología se revisan los criterios de alta del recién nacido pretérmino con objeto de que pueda ser útil como guía en la planificación del alta y para unificar criterios entre las distintas Unidades de Neonatología (AU)

Hospital discharge criteria for the pre-term newborn are mainly based on physiological competences (thermoregulation, respiratory stability, and feeding skills), although family support and ability to care for the baby, as well as a well-planned discharge are also cornerstones to ensure a successful discharge. In this article, the Committee of Standards of the Spanish Society of Neonatology reviews the current hospital discharge criteria in order for it to be useful as a clinical guide in Spanish neonatal units (AU)