[Periventricular leukomalacia prevalence in premature newborn]. / Prevalencia de leucomalacia periventricular en neonatos prematuros.

BACKGROUND: the periventricular leukomalacia (PLM) is considered a lesion of the central nervous system secondary to a hypoxic-ischemic insult, and affects more to premature than term neonates. However, the reported rates in the literature are between 2 % to 25 % in premature neonates. The objective was to determine the prevalence of PLM in premature neonates. METHODS: a two year prospective screening program with transfontanel ultrasound in premature neonates weighing < 2000 g was carried out at 4 weeks of age. RESULTS: from 38 355 consecutive deliveries 562 were premature neonates weighted = 2000 g who fulfilled inclusion criteria and all were studied with transfontanel ultrasonography; we found 36 (6.34 %) premature neonates with PLM. Of the 346 neonates weighing = 1500 g, 26 (7.5 %) had a positive examination for PLM. In the 1501 g to 2000 g group, 10 of 216 (4.6 %) had PLM. The PLM prevalence was higher in male (2:1). Neurological exam was normal at the time of study. CONCLUSIONS: the PLM was present in 6.3 % of premature neonates weighing < 2000 g with 2 affected males for each female.

[A 35 year period review of the perinatal mortality in a gynecology-obstetric unit]. / Mortalidad fetal, neonatal y perinatal en un hospital de ginecoobstetricia. Revisión de 35 años.

OBJECTIVE: To estimate the perinatal mortality rates over a 35 year period in neonates 22 weeks' gestation or above 500 g at birth until seven days postdelivery. METHODS: Data was obtained from medical records and the fetal death (FD) and neonatal death (ND) certificates. RESULTS: There were 889 282 deliveries (D) with 10,178 FD (11.2/1000 D) and 10,126 ND [11.3/1000 live newborns (LNB) with a significant reduction from 1972 to 2006 of 57 % in fetal mortality rate (p <0.0001) and 18.8 % in neonatal mortality rate (p <0.01). We registered 8081/10,126 (79.84 %) neonates who died from 0 to 6 days (9.2/1000 LNB). The overall perinatal mortality rate was 20.5/1000 D, with a 48.4 % significant reduction from 1972 to 2006 (p < 0.0001), 27.8/1000 ND, a 13.5/1000 ND respectively. We observed 4161 immature neonates (0.47 %); 55,340 premature newborns (6.2 %) and 9055 twin pregnancies (1 %). CONCLUSIONS: The fetal, neonatal and perinatal mortality rates were below the national media and presented a significant decrease from 1972 to 2006, more accentuated in fetal mortality rate (57 %) and perinatal mortality rate (48.4 %).

[Normal parameters of ear acoustic emissions in neonates]. / Parámetros de normalidad de las otoemisiones acústicas en neonatos.

INTRODUCTION: The ear acoustic emissions (EAE) are produced from pure low intensity tones coming from the cochlea in response to a stimulus. Hypocusia in the neonate may be detected by universal hearing screening programs using EAE that have a sensitivity of 91% and specificity of 85%. OBJECTIVE: To define the normal limits we measured the EAE in a group of healthy newborns and calculated the media and standard deviation (SD). PATIENTS AND METHODS: We enrolled 280 healthy neonates, previous external ear evaluation for permeability and we measured the EAE at 7 to 30 days of life at 2000, 2500, 3187, 4000, 5062 y 6375 Hz, using a 55-65 dB stimulus for each frequency band. RESULTS: In each frequency band evaluated we calculated the media: 10.76, 9.16, 9.46, 7.89, 4.83, 2 dB SPL, and minus two SD: 0.54, -0.33, 0.06, -2.04, -4.37, -7.43 dB SPL, that we considered the lower limit of normality for both ears in each frequency band tested. There were no significant differences between measurements in both ears (p>0.05). CONCLUSIONS: The EAE measurement is an easy, and low cost test that can be used to make the universal hearing screening accessible. These results support the normal levels of EAE and the Corti organ function in healthy newborns.

[Hearing screening and diagnosis of hearing loss: high risk versus low risk neonates]. / Tamizaje y confirmación diagnóstica de hipoacusia. Neonatos de alto riesgo versus población abierta.

INTRODUCTION: congenital hearing loss is a serious health problem affecting 1 to 3 out of 1000 neonates, and is the most common cause of neurosensorial defect; hearing screening helps to identifying early permanent childhood hearing loss (HL). OBJECTIVE: to establish the percentage of hearing loss in newborns with and without risk factors through hearing screening. MATERIAL AND METHODS: by using a cross-sectional design, a group of neonates with risk factors and a group without risk factors were included in a two-stage hearing screening program. The otoacoustic emissions (OAEs) procedure was done in the first stage and the automated auditory brain stem response (AABR) procedure in the second stage. The latter was performed only in children with abnormal results in the OAE procedure. RESULTS: 518 newborns were included in the hearing screening procedures; 220 neonates with risk factors and 298 without risk factors. 35 had + OAE test and the ABBR procedure helped to confirm that 30 neonates had hearing loss, 26 had bilateral HL; 10 had asymmetric HL; 4 had unilateral HL and 5 were false positives. The AABR procedure ascertained 17 HL cases with a threshold > 40 dB (86 per 100,000), 11 cases (55 per 100,000) in the risk group and 6 (30 per 100,000) in the non-risk group (p < 0.05). The main risk factors were prematurity, craniofacial anomalies, mechanical ventilation, prescription of amikacin and cytomegalovirus infection. CONCLUSIONS: the two-stage hearing screening program ascertained that 5.7 % had HL. AABR (threshold > 40 dB) confirmed 17 (86 per 100,000) neonates with HL, which was more frequent in the risk group (5 %) than in the non-risk group (2 %; p < 0.05).

[Hypoglycemia in the newborns of women with diabetes mellitus]. / Hipoglucemia neonatal en hijos de madres con diabetes mellitus.

Neonatal hypoglycemia is a frequent event in the first hours of life of newborns from mothers with diabetes mellitus. We studied a group of diabetic mothers newborns during the first day of life, taking venous blood samples at < 6 h, 6-12 h and 12-24 h of life for glucose analysis (n = 85), defining hypoglycaemia as a glucose level < 35 mg/dL. Calcium serum levels were also determined in the first venous sample in 19 neonates and 7 mEq/L was the criteria for hypocalcemia. The mothers age (mean +/- standard deviation) was 30.5 +/- 5.5 years (range 16-41 years), 43 (50.6%) of them with gestational diabetes, 40 (47.1%) with type 2 diabetes and 2 (2.4%) with type 1 diabetes. Pregnancies ended by caesarean section in 78 (91.8%) and by partum in seven (8.2%) women. There were 20 (23.5%) preterm newborns. In relation to neonates weight, 27 (31.7%) were macrosomic and 7 (8.2%) were premature, two of them with very low weight. A total of 55 (64.77%) newborns had hypoglycaemia, but only one of them had a convulsive episode, the rest were asymptomatic. In relation to the newborns weight, 18 (66.6%) of the macrosomic, 33 (64.7%) of the normal weight and four (57.1%) of the premature groups had hypoglycaemia. The comparisons between the newborns weight groups showed non significant differences, but the prevalence of neonatal hypoglycaemia was significantly higher in the group of gestational diabetes than in the type 2 diabetes group (p < 0.05). Calcium analysis also disclosed asymptomatic hypocalcemia in five (7.25%) newborns. These results show an elevated prevalence of asymptomatic neonatal hypoglycaemia in the offspring of women with diabetes mellitus in their early hours of life, and stress the importance of systematic glucose monitoring and early treatment in the first hours of life of these neonates.

Hipoglucemia neonatal en hijos de madres con diabetes mellitus / Hypoglycemia in the newborns of women with diabetes mellitus

Neonatal hypoglycemia is a frequent event in the first hours of life of newborns from mothers with diabetes mellitus. We studied a group of diabetic mothers newborns during the first day of life, taking venous blood samples at < 6 h, 6-12 h and 12-24 h of life for glucose analysis (n = 85), defining hypoglycaemia as a glucose level < 35 mg/dL. Calcium serum levels were also determined in the first venous sample in 19 neonates and 7 mEq/L was the criteria for hypocalcemia. The mothers age (mean ± standard deviation) was 30.5 ± 5.5 years (range 16-41 years), 43 (50.6%) of them with gestational diabetes, 40 (47.1%) with type 2 diabetes and 2 (2.4%) with type 1 diabetes. Pregnancies ended by caesarean section in 78 (91.8%) and by partum in seven (8.2%) women. There were 20 (23.5%) preterm newborns. In relation to neonates weight, 27 (31.7%) were macrosomic and 7 (8.2%) were premature, two of them with very low weight. A total of 55 (64.7%) newborns had hypoglycaemia, but only one of them had a convulsive episode, the rest were asymptomatic. In relation to the newborns weight, 18 (66.6%) of the macrosomic, 33 (64.7%) of the normal weight and four (57.1%) of the premature groups had hypoglycaemia. The comparisons between the newborns weight groups showed non significant differences, but the prevalence of neonatal hypoglycaemia was significantly higher in the group of gestational diabetes than in the type 2 diabetes group (p < 0.05). Calcium analysis also disclosed asymptomatic hypocalcemia in five (7.25%) newborns. These results show an elevated prevalence of asymptomatic neonatal hypoglycaemia in the offspring of women with diabetes mellitus in their early hours of life, and stress the importance of systematic glucose monitoring and early treatment in the first hours of life of these neonates.

La hipoglucemia neonatal es un evento frecuente en las primeras horas de vida del recién nacido (RN) de madres que padecen diabetes mellitus (DM). Para conocer su prevalencia estudiamos los hijos de mujeres con DM y embarazo (n = 85) y cuyos nacimientos ocurrieron en el periodo de reclutamiento de cuatro meses. A estos neonatos se les determinaron las concentraciones de glucosa en sangre venosa realizando una toma en las primeras seis horas, la segunda toma entre las seis y las doce horas y una tercera toma entre las 12-24 horas de vida, usando como criterio de hipoglucemia el propuesto por Cornblath para RN con factores de riesgo para hipoglucemia neonatal (glucosa < 35 mg/dL). Además, en 19 de estos niños se determinó la concentración de calcio en suero en la primera muestra de sangre venosa, tomando como criterio de hipocalcemia < 7 mEq/L. La edad de las madres fue de 30.5 + 5.5 años (media ± DE) de 30.5 ± 5.5 años, con una banda de variación de 16-41 años, 43 (50.6%) padecían DM gestacional, 40 (47.1%) DM tipo 2 y dos DM tipo 1 (2.4%). Setenta y ocho embarazos (91.8%) terminaron por cesárea y siete (8.2%) por parto, obteniéndose 85 RN vivos, de los cuales 20 (23.5%) fueron pretérmino y 65 (76.5%) de término. De acuerdo con el peso al nacer, hubo 27 (31.7%) RN macrosómicos y siete (8.2%) prematuros. Un total de 55 (64.7%) neonatos presentaron hipoglucemia, uno de los cuales desarrolló un episodio convulsivo, el resto no tuvo signos clínicos. La hipoglucemia ocurrió en 18 (66.6%) de los macrosómicos, 33 (64.7%) de los neonatos de peso normal y en cuatro (57.1%) de los prematuros. La comparación de la prevalencia de hipoglucemia por grupos de peso neonatal no mostró diferencias significativas entre los tres grupos, pero la comparación de la prevalencia de hipoglucemia con relación a la variante del tipo de diabetes materna mostró una mayor prevalencia en los hijos de mujeres con diabetes gestacional (p < 0.05). Hubo además cinco niños (7.25%) que presentaron hipocalcemia asintomática. Estos resultados muestran la alta prevalencia de hipoglucemia neonatal asintomática y la necesidad de establecer una vigilancia activa de la glucemia durante las primeras horas de vida en los RN de madres que padecen DM.