Word recognition and phonological representation in very low birth weight preterms.

BACKGROUND: Several studies have shown impaired neurocognitive development in infants born very preterm. Language is one of the areas that may be affected. Early lexical development measurements have revealed possible delays associated with low gestational age, but no studies have analyzed lexical processing using real-time measures in this at-risk population. AIMS: To explore the effects of preterm birth on the robustness of phonological representations and lexical processing speed. SUBJECTS AND METHODS: Eighteen two-year-old VLBW healthy preterms (≤32weeks of gestation; ≤1500g) and a matched group of at term infants, equivalent in age, gender, SES, linguistic environment and expressive lexicon were compared in a 'looking-while-listening' task, using correctly pronounced and mispronounced known words involving a vowel change. Percentage of target fixation, longest look duration, shift rate and orientation latency measures were used to analyze possible between-group differences in phonological representation and familiar word recognition processes. RESULTS: Based on the percentage of fixation time measure both groups succeeded at word recognition and responded similarly to mispronunciations. However, preterms significantly differed from full-terms in processing speed measures, showing longer look duration, lower shift rate and slower orientation latencies to target from distracter. CONCLUSIONS: Preterm birth negatively affects lexical processing speed. Birth weight and gestational age are two critical variables in these results. Slower language processing in preterms can compromise the acquisition of more complex lexical and grammatical representations later in development and may underlie poor language outcomes frequently observed in children born very prematurely.

Abandonos en el seguimiento de recién nacidos de muy bajo peso antes de los 2 años / Follow-up programme dropouts in very low weight newborns before two years of age

Introducción: El aumento en la supervivencia de recién nacidos de muy bajo peso (RNMBP) y su morbilidad neuroevolutiva obliga a implementar programas de seguimiento, cuyo abandono limita la consecución de los objetivos asistenciales y la validez de los estudios. Objetivos: De los RNMBP asistidos entre 2002-2005 en nuestra unidad neonatal y perdidos en seguimiento antes de 2 años, se pretende conocer su neurodesarrollo, morbilidad post-alta y situación sociocultural y compararlos con los seguidos. Pacientes: Se asiste a 318 RNMBP, de los cuales 53 (16,6%) fallecen. A los 2 años completan el seguimiento 215 (grupo S) y 50 lo abandonan (grupo A).Métodos: Revisión de historias y bases de datos. Entrevista telefónica sistematizada a padres que abandonan seguimiento. Resultados: Se entrevista a 30 casos (grupo R) del grupo perdido. De ellos, 6 pacientes ingresan por patología respiratoria; el 26,7% (8 casos) presenta secuelas neuroevolutivas (1 grave; 1moderada; 6 leves) frente al 14% en el grupo S (p < 0,05). El grupo R, comparado con el grupo S, presenta una mayor tasa de inmigración (14 vs 40%), menor nivel de estudios parental y mayor distancia casa-hospital (p < 0,05). En el grupo R, el 57% tiene nivel socioeconómico bajo. Conclusiones: La entrevista telefónica ha permitido conocer la situación clínica del 60% de RNMBP perdidos en seguimiento. Hay una mayor tasa de secuelas en el grupo perdido, aunque en su mayoría son leves. Una serie de factores sociales, económicos y culturales desfavorableshan podido influir en el abandono. Conviene elaborar estrategias para evitar en lo posible pérdidas en el seguimiento (AU)

Introduction: The increase in survival rates of very low weight newborns (VLWN) and their neurodevelopmental morbidity has led to the implementation of follow-up programmes. The withdrawal from follow up limits the achievement of care goals and the validity of studies in this field. Goals: To assess the neurodevelopmental status, morbidity, social and economical data in the VLWN seen in our Neonatal Care Unit between 2002 and 2005 and lost in the follow up programme before the age of two, and compare these findings with the group who completed follow up. Patients: A total of 318 VLWN were included, of 53 had died. At the age of two, 215 had completed the monitoring visits (group S) and 50 had quit (group A).Methods: Using the SEN 1500 data base, and telephone interview of those parents who quit the programme. Results: A total of 30 cases were interviewed (Group R). Six patients had e been admitted to hospital due to respiratory illness; 26.7% had neurodevelopmental impairment (1 case, severe;1 case, moderate; 6 cases, mild) compared to 14% in group S (P < 0.05). In group R, compared with group S, included more immigrants (40 vs. 14%), parental education level was lower and distance between home and hospital was greater (P < 0.05). In group R, 57% of families had a low socioeconomic standard. Conclusions: The telephone interview allowed the clinical status of 60% of VLWN lost to follow up to be determined. Sequelae rate, mainly mild, was higher in the lost-to follow-up group. Some unfavourable social, economical and cultural factors could have influenced the interruption. It is advisable to develop strategies to prevent loss in the follow up (AU)

[Follow-up programme dropouts in very low weight newborns before two years of age]. / Abandonos en el seguimiento de recién nacidos de muy bajo peso antes de los 2 años.

INTRODUCTION: The increase in survival rates of very low weight newborns (VLWN) and their neurodevelopmental morbidity has led to the implementation of follow-up programmes. The withdrawal from follow up limits the achievement of care goals and the validity of studies in this field. GOALS: To assess the neurodevelopmental status, morbidity, social and economical data in the VLWN seen in our Neonatal Care Unit between 2002 and 2005 and lost in the follow up programme before the age of two, and compare these findings with the group who completed follow up. PATIENTS: A total of 318 VLWN were included, of 53 had died. At the age of two, 215 had completed the monitoring visits (group S) and 50 had quit (group A). METHODS: Using the SEN 1500 data base, and telephone interview of those parents who quit the programme. RESULTS: A total of 30 cases were interviewed (Group R). Six patients had been admitted to hospital due to respiratory illness; 26.7% had neurodevelopmental impairment (1 case, severe; 1 case, moderate; 6 cases, mild) compared to 14% in group S (P<.05). In group R, compared with group S, included more immigrants (40 vs. 14%), parental education level was lower and distance between home and hospital was greater (P<.05). In group R, 57% of families had a low socioeconomic standard. CONCLUSIONS: The telephone interview allowed the clinical status of 60% of VLWN lost to follow up to be determined. Sequelae rate, mainly mild, was higher in the lost-to- follow-up group. Some unfavourable social, economical and cultural factors could have influenced the interruption. It is advisable to develop strategies to prevent loss in the follow up.

Algoritmo para la asignación etiológica de la prematuridad / Algorithm for an etiological classification of prematurity

Ante la dificultad para clasificar etiológicamente la prematuridad, en la práctica se ha impuesto una división en 3 subtipos según la presentación clínica: prematuridad médicamente indicada, rotura prematura de membranas (RPM) y espontánea o idiopática. Sin embargo, esta categorización es discutible, resulta poco precisa y admite criterios diversos a la hora de su aplicación. Objetivo: Elaborar una clasificación causal de la prematuridad y diseñar un sistema que facilite la asignación de cada caso concreto en el período perinatal. Métodos: Revisión sistematizada de la literatura médica, técnica cualitativa de consenso mediante grupo nominal, y cuantitativa, mediante estudio piloto con la versión inicial del algoritmo. Resultados: Se elaboró una clasificación que estableció una división general entre causa «próxima principal» y «causas asociadas», lo que permitió incluir concausas e, incluso, factores de riesgo más remotos. La causa principal incluyó 7 grandes categorías: inflamatorias (RPM y afines), vasculares (restricción del crecimiento intrauterino y afines), maternas locales, maternas generales, enfermedad fetal, pérdida de bienestar fetal e idiopáticas. La prematuridad de causa electiva o «por indicación médica» se estableció como categoría previa e independiente y, por tanto, compatible con las otras causas consideradas. Para facilitar el establecimiento de la causa principal, se diseñó un algoritmo con formato de diagrama de flujo unidireccional. Conclusiones: Se propone una clasificación pragmática de la prematuridad que facilite un cierto grado de precisión y la concordancia entre los clínicos (AU)

Due to the difficulty in classifying the etiology of preterm birth, it has been dicided into three subtypes according to its clinical presentation: medically indicated, ruptured membranes, and spontaneous or idiopathic. Nevertheless, this classification is controversial, imprecise and can result in multiple interpretations when applied. Objective: To design an etiologically based classification of preterm birth, and to design a system to easily assign each case during the perinatal period. Methods: Review of literature, qualitative analysis using consensus methods through nominal group technique, and quantitative analysis of a pilot study using a first version of the algorithm. Results: A classification is made to establish a general division between the “primary cause” and “associated causes” of preterm birth, that allows remote causes or risk factors to be included. The primary cause includes seven categories: inflammatory (ruptured membranes and related); vascular (intrauterine growth restriction and related); maternal–local; maternal–systemic; fetal pathology; fetal distress; idiopathic. The medically indicated preterm birth is defined as a previous or independent category and so is compatible with the other, previously mentioned causes. An algorithm was designed to make it easier to classify the primary cause of preterm birth usinf a flowchart. Conclusions: A pragmatic classification of preterm birth is proposed that may help to achieve better precision and agreement between clinicians (AU)

[Algorithm for an etiological classification of prematurity]. / Algoritmo para la asignación etiológica de la prematuridad.

UNLABELLED: The etiology of preterm birth is difficult to classify. It is usually divided into three clinical types according to its clinical presentation: medically indicated; caused by ruptured membranes; and spontaneous or idiopathic. However, this classification is controversial, imprecise and can result in multiple interpretations when applied. OBJECTIVE: To design an etiologically based classification of preterm birth, and to design a system to easily assign each case during the perinatal period. METHODS: Review of literature, qualitative analysis using consensus methods through nominal group technique, and quantitative analysis of a pilot study using a first version of the algorithm. RESULTS: A classification is made to establish a general division between the "primary cause" and "associated causes" of preterm birth, that allows remote causes or risk factors to be included. The primary cause includes seven categories: inflammatory (ruptured membranes and related); vascular (intrauterine growth restriction and related); maternal-local; maternal-systemic; fetal pathology; fetal distress; idiopathic. The medically indicated preterm birth is defined as a previous or independent category and so is compatible with the other, previously mentioned causes . An algorithm was designed to make it easier to classify the primary cause of preterm birth using a flowchart. CONCLUSIONS: A pragmatic classification of preterm birth is proposed that may help to achieve better precision and agreement between clinicians.

Cauterization of meso-ovarian vessels, a new model of intrauterine growth restriction in rats.

Intrauterine growth restriction (IUGR) remains an important cause of perinatal morbidity and mortality. Both IUGR and low birth weight have been identified as risk factors for increased incidence of cardiovascular disease, dyslipemia, and other diseases in the adulthood. Several animal models have been developed to study the underlying mechanisms of IUGR and its later consequences, with utero-placental ischemia by uterine artery ligation (UAL) being the most frequently used in rats. The relevance of this model lies in the fact that it induces altered placental perfusion, the main cause of IUGR in humans in Western countries. However, there is also controversy over the grade and homogeneity of IUGR obtained. In this study, we propose a new animal model of IUGR related to placental ischemia through the cauterization of meso-ovarian vessels. We aimed to test the feasibility of meso-ovarian vessel cauterization (CMO), and to compare it with uterine artery ligation (UAL). The CMO group had similar incidence of perinatal mortality, percentage of IUGR, and evolution of body weight during early extrauterine life to the UAL group, indicating that both methods are similarly efficient for inducing IUGR. Moreover, both of them affect the ratio of fetal to placental weight, and the weight of vital organs, supporting the hypothesis of a fetal compensatory response or "brain- and heart-sparing effect". Both operative models suffer approximately 50% perinatal mortality, implying that they are both more efficient in the production of IUGR when C-section is performed. On the other hand, CMO was significantly faster to perform than UAL and seemed to produce a more uniform ischemia throughout the uterus than the UAL method, resulting in a more homogeneous group of IUGR pups.

Catalunya pionera en cirurgia fetal / No disponible

No disponible

Rehospitalization because of respiratory syncytial virus infection in premature infants younger than 33 weeks of gestation: a prospective study. IRIS Study Group.

OBJECTIVE: To collect data on hospitalization for respiratory syncytial virus (RSV) infections and presumptive risk factors for rehospitalization among premature infants in Spain. DESIGN: Observational, prospective, longitudinal, multicenter study. SETTING: Fourteen Spanish neonatal units with an annual birth cohort of 57,000 infants. PATIENTS: All children (n = 680) born < or =32 weeks of gestational age between April 1, 1998, and March 31, 1999, and discharged from the hospital before March 31, 1999, were included in the study. A total of 96 were excluded because of administration of prophylactic treatment (n = 55) or were lost to follow-up (n = 41). Five children died during the study period, but death was related to RSV in only 1 case. METHODS AND MAIN OUTCOME MEASURES: Neonatal and demographic data were recorded at the initial visit. Infants were prospectively followed at monthly intervals up to March 31, 1999. In patients rehospitalized for respiratory disorders, further data about RSV status and morbidity were collected. A comparison was made between children rehospitalized for RSV infection and those who were not. The influence of factors on the probability of rehospitalization for RSV infection was assessed by logistic regression analysis. RESULTS: Of the 584 evaluable patients 118 (20.2%) were rehospitalized for respiratory disease during the study period. The causative pathogen was identified in 89 (75.4%) hospital admissions. Of these 59 (66.3%) were a result of RSV infection in 53 children; 6 were reinfections. In a logistic regression model significant independent prognostic variables included: lower risk of RSV hospitalization with increase gestational age [odds ratio (OR), 0.85; 95% confidence interval (CI), 0.72 to 0.99; P < 0.047]; higher risk with chronic lung disease (OR = 3.1; 95% CI 1.22 to 7.91; P < 0.016); and living with school age siblings (OR = 1.86; 95% CI 1.01 to 3.4; P < 0.048). CONCLUSION: This large descriptive study has enabled us to define the influence of specific risk factors that increase the risk of rehospitalization for RSV infection in preterm infants. Such studies help to define the appropriate role of available prophylactic interventions and establish treatment guidelines.

[Validation of perinatal causes of death in death certificates]. / Validación de las causas de muerte perinatal de los boletines estadísticos de defunción.

OBJECTIVE: The objective of this study was to assess the validity of perinatal causes of death in death certificates and the influence of some variables related to perinatal mortality. PATIENTS AND METHODS: All perinatal deaths having occurred in Barcelona in 1994 and reported in death certificates were included. Additional sources of information were certificates of abortions and also other documents such as autopsy reports and medical records, that served as references to determine the most reliable or standard cause of death (SBC) The SBC was determined by a group of experts. The validity was assessed by comparing the cause of death as stated in the death certificate (BC) and the SBC, calculating the general agreement, the detection rate (DR) or sensitivity and the confirmation rate (CR) or positive predictive value. The chi-square test was used to compare proportions. RESULTS: In 166 (91.2%) of the 182 cases, the BC and SBC were assigned to the same group of the International Classification of Diseases. For congenital defects, the DR was 85.7 (95% CI: 75.1-96.3) and the CR was 81.8 (95% CI: 70.4-93.2). For problems in the perinatal period the DR was 95.6 (95% CI: 92.1-99.1) and the CR was 94.9 (95% CI: 91.2-98.6). Both were considered reliable causes. These rates were similar for the different categories of other variables (birth weight, gestational age, vital status, sex, hospital of birth, autopsy and mother's age). Nevertheless, in the study of detailed causes (3 digits of the International Classification of Diseases) the general agreement was much lower (40.1%). Except for the congenital defects of the nervous system, the remaining causes of death had a low validity. CONCLUSIONS: This study shows the low validity of detailed causes of perinatal death reported in death certificates. It is necessary to improve the completion and coding of death certificates following the WHO recommendations.

Schinzel-Giedion syndrome: report of two sibs.

We report on two further cases, a sister and a brother, with Schinzel-Giedion syndrome. Both presented the following manifestations: "coarse face" with midface retraction, agenesis of corpus callosum, bilateral hydronephrosis, and typical skeletal anomalies. Patient 1 had a malignant sacrococcygeal teratoma. This is the third case of malignancy in this syndrome. Patient 2 died shortly after birth.

[Neurological development of very low birth weight infants (<1,501 gr) at two ears of age]. / Evolución neurológica a los dos años de edad en una población de recién nacidos de muy bajo peso (< 1.501 g).

The aim of this study is to analyse different aspects of the psychomotor development, during the first two years of the life, of 56 very low birth weight newborns (less of 1.501 g) that had completed a follow-up program. Of the results we have got, the most important are the following: 4 observations (7%) presented severe sequelae motor disability in a tetraparesis with sensorial defects in 3 of them and behavior disturbance (psychosis) with visual defect in the rest. Three observations (5.3%) presented moderate sequelae: all of them with motor disability (hemi- or tetraparesis) and cognitive deficiency. Me have to point out that in the two groups described above, the pathological signs were detected before the age of 6 months. Nine observations (16%) presented mild sequelae dominating language delayed (7% of whole sample) and transient abnormalities in 7 of them (12.5%). In the subgroup of small for gestational age newborns (21 observations), 28.5% presented mild sequelae, 14% transient abnormalities and no one presented severe or moderate sequelae. Although a long term follow-up is necessary in order to detect learning, cognitive, or behavior disturbances, that can just become evident later, we think that the attention of the deviations of the normality during the two first years of the life, would warn about possible future disturbances.

[Cerebral gigantism: report on two familial cases (author's transl)]. / Gigantisme cérébral: deux cas familiaux.

Two cases of cerebral gigantism occurring in related boys (cousins of 3rd degree) are discussed. It is difficult to argue from these cases in favour of a precise type of hereditary transmission. The hypothesis of a dominant trait with weak penetrance cannot be excluded. A genetic heterogeneity of the Sotos syndrome is very likely.