[Recommendations on making decisions and end of life care in neonatology]. / Recomendaciones sobre toma de decisiones y cuidados al final de la vida en neonatología.

Healthcare-professionals who work in neonatal units believe that a very important part of their work is the care of sick newborns, and their families if the neonate has an incurable disease or will die. The effort is focused on preventing disproportionate and unnecessary treatments that result in pain and discomfort, and also separate the child from his family. These situations usually occur when the infant has a terminal illness, extreme immaturity with complications, or severe birth defects. In this paper, the Ethics Working Group of the Spanish Society of Neonatology reflects on decision making at this time of life. The ethical aspects are reviewed, including, limiting treatment, the basis of decision-making process (that should include adequate information), the relationship of trust, and deliberation between parents and professionals to make the right decision. It highlights the importance of caring for the family in a complex situation and of great suffering, when faced with the recommendation of professionals to limit treatment because their child suffers from a disease with a poor prognosis. The care of the sick neonate care at the end of life, and their families requires a considerable effort, dedication and training of all health personnel. The repeated experience of being close to suffering and death can adversely affect the professionals involved. Finally, there is mention of the legal aspects of limiting treatment, how to perform and document decision process, the withdrawal of life support, assessment of symptoms and pain control and sedation.

Rotavirus: vieja enfermedad, nuevas vacunas / No disponible

El rotavirus es la causa más importante de diarrea en la infancia. En países en vías de desarrollo presenta una gran morbimortalidad, siendo responsable de casi 500.000 muertes en niños menores de 5 años cada año. Por otro lado, en Europa y Norteamérica cerca de la tercera parte de todos los ingresos hospitalarios por gastroenteritis se deben a este microorganismo. La infección por rotavirus afecta prácticamente a la totalidad de los niños hasta los 5 años de edad, aunque las formas graves de la enfermedad ocurren sobre todo entre los 3 meses y los 3 años. El virus aparece en altas concentraciones en las heces de los niños enfermos y tiene una gran capacidad de transmisión entre individuos. La carga de la enfermedad y el costo social y económico son muy elevados, alcanzando los 1.600 euros por cada ingreso. En 2006 se han comercializado en nuestro país dos nuevas vacunas orales. Ambas demuestran un muy buen perfil de seguridad y una elevada eficacia en la prevención de enfermedad grave, deshidratación y hospitalizaciones por gastroenteritis en población infantil

Rotavirus is a major cause of diarrhoea in childhood. It shows an enormous morbidity and mortality in developing countries, being responsible for approximately half a million deaths per year among children aged less than five years. In the other hand in Europe and United States of America nearly one third of admissions by gastroenteritis are due to this microorganism. Rotavirus infects almost all infants by the age of five years, although severe disease appears almost always in children of three to thirty-six months. Rotavirus appears in high concentrations in the stools of infected children having an increasing capacity of transmission person to person. Burden of the disease and its social and economic cost are extremely high reaching one thousand and six hundred euros by each hospitalization. Two new oral vaccines have been commercialized in our country last year. Both of them report an excellent profile of security and a high efficacy in the prevention of severe disease, dehydration and admissions to hospital because of gastroenteritis in the childhood population (AU)

[Making ethical decision of limiting vital support to critical newborns]. / Toma de decisiones éticas y limitación del soporte vital en recién nacidos críticos.

OBJECTIVE: To know the cause of death and the criteria used in the vital support limitation decisions in the critical newborn who eventually died. PATIENTS AND METHODS: A retrospective review of the medical records for all newborns who died in the NICU between 1987-1994 was performed. The following actions were defined: total vital support, do not resuscitate order (DNR), vital support withdrawal (VSW). RESULTS: The mortality rate in the NICU was 7.3% (55/753), with a neonatal mortality rate of 2.98 per thousand live births. Medical records of 53 patients were reviewed. In 67.9% of the patients (36/53; p < 0.001) the therapeutical effort was limited. The most frequent way of action was the VSW (35.8%) and the support most frequently interrupted was mechanical ventilation (89%). DNR was established in 32%. Only 42% of the parents were involved in the decision making process to limit support. In three patients (6%), there was evidence of disagreement between the medical team and the family and the parents of two opting for a more aggressive care. In the three cases, the family determined the course of action. In general, the decision of support limitation was justified based on "bad prognosis". Retrospectively, the criteria were: not viable (11%), eminent death (14%), no response to treatment (22%) and quality of life judgments (53%). CONCLUSIONS: It is very frequent to take decisions on vital support limitation in neonates when they are in a critical situation. We consider that the individual evaluation of each patient's prognosis, combined with standards of ethical criteria, the "child's best interest" and the "potential for relation", pondered in a rational way, constitute an adequate guideline for making conflictive ethical decisions together with the child's parents.

[The long-term efficacy of a recombinant hepatitis B vaccine in newborns]. / Eficacia a largo plazo de la vacuna recombinante de hepatitis B en recién nacidos.

A prospective evaluation of the immunogenicity, protective efficacy and safety of the recombinant hepatitis B vaccine associated to the immunoglobulin (IG) in newborns with high risk of infection by the hepatitis B virus was carried out. Two groups of newborns were used. The first group was formed by children with HBsAG carrier mothers (56 children) and the second group consisted of newborns of mothers negative for HBsAG, but having a high risk of infection (21 children). Within the first few hours of life, all of the newborns received a dose (20 mcg) or recombinant vaccine and 0.5 ml of IG. New doses of vaccine were administered at one and six months of life. At eight months of age, the anti-HBs seroconversion rate in children belonging to groups 1 and 2 was 100%, with an elevated anti-HBs titer and with no detected cases of positive HBsAG. On a long term basis (39 +/- 5 months), only 5.6% of the children present an anti-HBs titer < 10 mUI/ml. The recombinant hepatitis B vaccine associated to IG is immunogenic and provides efficient protection in newborns. Important side effects were not observed.

[Neonatal listeriosis: third Spanish series on 45 observations (author's transl)]. / Listeriosis neonatal. Tercera serie española a propósito de 45 casos.

During the period January'69-June'81, 45 cases of listeriosis in neonatal period were observed. 37 of them had an early onset (82%) while other eight had late infection disease (18%). Incidence was 1/6,346 newborns with most frequent presentation in spring. No epidemic forms or asymptomatic carriers were discovered. Perinatal, clinical, analytical, radiological, bacteriologic and pathological data are shown, emphasizing differences between the two clinical forms. Overall mortality of 43%, although brought to zero in the last six years, together with the same percentage of neurological sequela in the late form, urges for better knowledge of epidemiology and preventive measures, as well as a closer obstetric-neonatal relationship.