Impact of neonatal morbidity on the risk of developmental delay in late preterm infants.

BACKGROUND: Late preterm infants (LPI) have a higher risk of developmental delay (DD) than term-born infants. The association of perinatal complications with specific morbidity is not clear. AIM: (1) To compare the risk of DD at 4years of age between LPI who have presence or absence of any morbidity associated with the prematurity at birth, called complicated (cLPI) or uncomplicated (uLPI), and term-born infants, (2) to determine maternal and perinatal factors associated with risk of DD, and (3) to analyze, in LPI, the association between perinatal morbidity and risk of DD. METHODS: A retrospective cohort study including 163 LPI - 47 cLPI and 116 uLPI - and 158 term-born infants (Terms) was conducted. Parents completed the Ages & Stages Questionnaires®3rd Spanish version (ASQ3). Risk of DD was defined as the presence of any ASQ3 domain scoring below the mean minus 2 SD. Association between risk of DD and maternal and perinatal factors was analysed using a multivariate logistic model. Incidence of risk of DD was analysed according to specific morbidity. RESULTS: Compared to Terms, cLPI have a higher risk of DD in the communication domain. Respiratory pathology was associated with a higher risk in the communication domain. Caesarean delivery was the only maternal perinatal risk factor for DD, especially in gross motor domain. CONCLUSIONS: At the age of 4years cLPI, especially those with respiratory morbidity, had a higher risk of communication delay. Caesarean delivery was the only perinatal risk factor associated with risk of DD.

Valors de tensió arterial en nadons sans / Valores de tensión arterial en recién nacidos sanos / Blood pressure values in healthy newborns

Fonament: escassetat d'estudis sobre el valor de la tensió arterial en nounats sans. Objectiu: determinar els valors de tensió arterial en el pe-ríode neonatal immediat en nounats sans. Mètode: cohort de 4.496 nadons de 36 a 41 setmanes de gestació, entre gener de 2007 i desembre de 2010, sense malformacions congènites. Mesura de la tensió arterial sistòlica, diastòlica i mitjana per mètode oscil•lomètric al moment de l'ingrés a la sala de nadons, als 30-60 minuts de vida. Registre dels resultats en una base de dades amb els valors de pes en néixer i edat gestacional. Resultats: els valors de tensió arterial varien amb l'edat gestacional, amb increments significatius des de les 36 fins a les 41 setmanes, així com amb el pes en néixer. Conclusions.: és important establir patrons estàndard de tensió arterial en el període neonatal amb la finalitat de detectar anormalitats. L'edat i el pes en néixer influeixen en els resultats. La metodologia hi té un paper essencia

Fundamento. Escasez de estudios sobre el valor de la tensión arterial en recién nacidos sanos. Objetivo. Determinar los valores de tensión arterial en el período neonatal inmediato en recién nacidos sanos. Método. Cohorte de 4.496 recién nacidos de 36 a 41 semanas de gestación entre enero de 2007 y diciembre de 2010 sin malformaciones congénitas. Medición de la tensión arterial sistólica, diastólica y media por método oscilométrico a su ingreso en la nursería, a los 30-60 minutos de vida. Registro de los resultados en una base de datos junto a los valores de peso al nacer y edad gestacional. Resultados. Los valores de tensión arterial varían con la edad gestacional, con incrementos significativos desde las 36 a las 41 semanas, así como con el peso al nacer. Conclusiones. Es importante establecer patrones estándar de tensión arterial en el período neonatal. La edad y el peso al nacer influyen en los resultados. La metodología juega un papel esencial (AU)

Background. There is a paucity of studies on blood pressure values in healthy newborns. Objective. To determine the values of blood pressure in the immediate neonatal period in healthy newborns. Methods. A cohort of 4,496 newborn infants of 36 to 41 weeks of gestational age born between January 2007 and December 2010 were included in the study. Newborns with congenital malformations were excluded. Measurement of arterial blood pressure, including systolic, diastolic, and median, was performed using an oscillometric method at the time of admission to the nursery, which was within 30 to 60 minutes of life. The results were recorded in a database, along with the birth weight and gestational age. Results. The blood pressure values vary with gestational age, with significant increases from 36 to 41 weeks, and with birth weight. Conclusions. It is important to define the normal blood pressure patterns in the neonatal period. Gestational age, birth weight, and the method used may influence blood pressure readings (AU)

Increase in invasive nonvaccine pneumococcal serotypes at two hospitals in Barcelona: was replacement disease to blame?

AIM: To describe an increase in the incidence of invasive pneumococcal disease (IPD) caused by serotypes not contained in the heptavalent pneumococcal conjugate vaccine (PCV7) in children in two hospitals in Barcelona with different vaccine uptake. METHODS: Cumulative incidences of IPD, vaccine and nonvaccine serotypes (NVSTs), and main clinical presentations before (1998-2001) and after vaccine introduction (2005-2008) were compared. RESULTS: The incidence of IPD in children aged <2 years at Hospital Germans Trias i Pujol covering a population in which PCV7 was not widely used showed a nonsignificant increase from 29.9 to 58.8 per 100,000 child-years between both periods. Following vaccine introduction, there was a 2.5-fold increase in IPD caused by NVSTs in children aged <5 years. Analysis of trends in the almost fully vaccinated population of Hospital de Barcelona revealed a nonsignificant reduction in IPD incidence in children aged <2 years from 63.1 to 26.0 per 100,000 child-years. NVSTs in children aged <5 years showed a nonsignificant 1.7-fold increase in the vaccine period at this centre. CONCLUSIONS: The paradoxical increase in invasive infections caused by NVSTs in these populations with different vaccine use suggests that these changes were not driven only by PCV7.

TRPC6 mutational analysis in a large cohort of patients with focal segmental glomerulosclerosis.

BACKGROUND: Mutations in the TRPC6 gene have been reported in six families with adult-onset (17-57 years) autosomal dominant focal segmental glomerulosclerosis (FSGS). Electrophysiology studies confirmed augmented calcium influx only in three of these six TRPC6 mutations. To date, the role of TRPC6 in childhood and adulthood non-familial forms is unknown. METHODS: TRPC6 mutation analysis was performed by direct sequencing in 130 Spanish patients from 115 unrelated families with FSGS. An in silico scoring matrix was developed to evaluate the pathogenicity of amino acid substitutions, by using the bio-physical and bio-chemical differences between wild-type and mutant amino acid, the evolutionary conservation of the amino acid residue in orthologues, homologues and defined domains, with the addition of contextual information. RESULTS: Three new missense substitutions were identified in two clinically non-familial cases and in one familial case. The analysis by means of this scoring system allowed us to classify these variants as likely pathogenic mutations. One of them was detected in a female patient with unusual clinical features: mesangial proliferative FSGS in childhood (7 years) and partial response to immunosupressive therapy (CsA + MMF). Asymptomatic carriers of this likely mutation were found within her family. CONCLUSIONS: We describe for the first time TRPC6 mutations in children and adults with non-familial FSGS. It seems that TRPC6 is a gene with a very variable penetrance that may contribute to glomerular diseases in a multi-hit setting.

Sobredistensió vesical: importància de la reeducació de l’hàbit miccional en el tractament / Importance of bladder training in the management

Introducció. El tractament quirúrgic exclusiu de la sobredistensió vesical pot no ésser suficient. Observació clínica. Cas d’un nen de 6 anys afectat d’una megabufeta urinària amb ureterohidronefrosi bilateral i reflux bilateral massiu, tractat quirúrgicament i amb reeducació miccional. Comentari. A més de la correcció quirúrgica, la reeducació de l’hàbit miccional és fonamental per al tractament de la sobredistensió vesical (AU)

We present and discuss the case of a 6 yo boy with a large bladder and bilateral ureterohydronephrosis with massive bilateral reflux (megacystis-megaureter syndrome), who underwent surgical repair and voiding rehabili- Sobredistensió vesical: importància de la reeducació de l’hàbit miccional en el tractament Joan Rodó 1, Pere Sala 2, Clara Vila 2, María Elizari 2, Xavier Demestre 2, Frederic Raspall 2 1 Servei de Cirurgia. Hospital Sant Joan de Déu. Barcelona 2 Servei de Pediatria. SCIAS. Hospital de Barcelona. Barcelona tation. The importance of bladder training and voiding rehabilitation is discussed (AU)

Enhanced culture detection of Kingella kingae, a pathogen of increasing clinical importance in pediatrics.

Osteoarticular infection and occult bacteremia are the 2 invasive infectious pathologies most frequently associated in childhood with Kingella kingae. We report a series of 11 patients in whom osteomyelitis predominates over septic arthritis, which is the reverse of other series, probably as a consequence of inoculation of samples during surgery on agar media, used in combination with or as an alternative to inoculation into blood culture bottles. Although K. kingae infections usually follow a benign clinical course, we noted 2 patients with mild orthopedic sequelae.

Cribratge neonatal de la hipoacusia / Cribado neonatal de la hipoacusia / Newborn hearing screening

Objectiu. Avaluació d’un mètode senzill per al cribratge neonatal universal de la hipoacúsia. Mètode. Estudi prospectiu amb otoemissions acústiques evocades (OAE) dels infants nascuts a l’Hospital de Barcelona l’any 2001. Es van fer entre els 3 i els 5 dies de vida en els nadons a terme sans, i abans de l’alta en els prematurs i els ingressats per patologia. En cas d’absència de resposta, unilateral o bilateral, es va fer control a les 2-3 setmanes i als 2 mesos amb OAE. En cas de persistir absents, es va fer control per otorinolaringòleg (ORL) i potencials evocats auditius de tronc cerebral (PEATC). Resultats. Es van fer OAE al 97% dels 2.027 nadons nascuts l’any 2001. En 11 (0.5%) les OAE persistien absents bilaterals en el control als 2 mesos, i després de la revisió per ORL es va diagnosticar hipoacúsia en 3 (1.5‰ dels nascuts vius). Els altres 8 (4‰), s’han de considerar com a falsos positius. En 22 nens amb resposta unilateral absent no es va aconseguir control. Conclusions. Les OAE són un mètode senzill i útil per al diagnòstic precoç de la hipoacúsia neonatal. S’ha de minimitzar el nombre de falsos positius. S’ha de transmetre als pediatres el benefici dels controls, abans dels 3 mesos, amb OAE dels infants amb absència de resposta unilateral o bilateral, i amb PEATC en cas de persistir absents (AU)

Objetivo. Evaluación de un método sencillo para el cribado neonatal universal de la hipoacusia. Método. Estudio prospectivo con otoemisiones acústicas evocadas (OAE) de los recién nacidos del Hospital de Barcelona en el año 2001. Realizadas a los 3-5 días de vida en los nacidos a término sanos, y antes del alta en los prematuros y en los ingresados por patología. En caso de ausencia de respuesta, unilateral o bilateral, control a las 2-3 semanas y a los 2 meses con OAE. En caso de persistir ausentes, control por otorinolaringólogo (ORL) i potenciales evocados auditivos de tronco cerebral (PEATC). Resultados. Se realizaron OAE al 97% de los 2027 nacidos en el año 2001. En 11 (0.5%) las OAE persistían ausentes bilateralmente en el control a los 2 meses y, después de la revisión por ORL, en 3 (1.5‰) se diagnosticó hipoacusia. Los 8 restantes (4‰) deben considerarse como falsos positivos. En 22 niños con respuesta unilateral ausente, no se consiguió control. Conclusiones. Las OAE constituyen un método sencillo y útil para el diagnóstico precoz de la hipoacusia neonatal. Debe minimizarse el número de falsos positivos. Debe transmitirse a los pediatras el beneficio de los controles con OAE, antes de los 3 meses, de los niños con ausencia de respuesta unilateral o bilateral, y con PEATC en caso de persistir ausentes (AU)

Objective. Evaluation of an easy-to-use test for universal newborn hearing screening Method. Prospective study using evoked otoacoustic emissions (EOAE) in newborns at Hospital de Barcelona during 2001. EOAE were performed on the 2nd or 3rd days of life in normal term newborns, and before discharge from the neonatal unit in premature infants and in term infants with perinatal complications. A repeat EOAE test was performed at 2-3 weeks and at 2 months in those infants with unilateral or bilateral absence of response. Those cases that failed the second test underwent brain auditory evoked potential (BAEP) as diagnostic procedure and were referred to otolaryngology for evaluation. Results. EOAE were performed in 97% of 2027 newborns. In 11 of them (0.5%), EOAE showed bilateral hearing loss at 2 months of age. After examination by otolaryngology and after undergoing BAEP, 3 infants (0.15%) were diagnosed with hearing loss. The other 8 infants (0.4%) were considered false positives. In 22 infants with unilateral absence of response, a follow-up test was not performed. Conclusions. EOAE are an easy and useful method for early diagnosis of neonatal hearing loss. False positives must be minimized. Pediatricians must be aware of the need to perform follow-up EOAE before 3 months of age to all infants with unilateral or bilateral absence of response (AU)

Outbreaks of influenza A virus infection in neonatal intensive care units.

BACKGROUND: Outbreaks of nosocomial influenza virus infections have been described rarely during childhood and even less so in the neonatal period. METHODS: We report 30 neonates admitted to 2 neonatal intensive care units with nosocomial influenza A virus infection, which occurred in 2 outbreaks during 1999. Risk factors for infection were evaluated, and control measures were adopted. Virus was detected by indirect immunofluorescence antibody screen. Any infant with nasopharyngeal aspirate positive for influenza A virus was considered infected. RESULTS: Of 95 infants screened 30 were positive for influenza A virus (31.5%). Mean birth weight was 1622 g, and mean gestational age was 31 weeks in the infected group. In the noninfected group mean birth weight was 2594 g and mean gestational age was 36.4 weeks. Low birth weight, short gestational age, twin pregnancy and mechanical ventilation were identified as risk factors for infection. Clinical symptoms were seen in 22, and 8 were asymptomatic. Clinical features were predominantly respiratory and digestive. The outcome was favorable in all cases. CONCLUSIONS: Infection by influenza virus has to be considered as a possible cause of nosocomial infection in the neonatal period. Control measures and prevention are important.