Influencia del pH de cordón umbilical en el resultado del cribado auditivo con otoemisiones en recién nacidos sanos / Influence of umbilical cord pH on the outcome of hearing screening with otoacoustic emissions in healthy newborns

Objetivo Es conocido el efecto de la hipoxia sobre el funcionamiento de las células ciliadas externas de la cóclea, que son las responsables de la respuesta a las otoemisiones utilizadas en el cribado auditivo neonatal. El objetivo de este estudio es conocer la influencia de variaciones leves o moderadas del pH de cordón umbilical al nacer en el resultado del cribado auditivo con otoemisiones en recién nacidos sanos sin factores de riesgo auditivo. Resultados La muestra está compuesta de 4.536 niños sanos. Los resultados no muestran diferencias significativas en el resultado del cribado auditivo entre el grupo de pH asfíctico (<7,20) y normal. Tampoco se detecta una cifra de pH inferior a 7,20 en la muestra que se relacione con alteración en el cribado. Desglosando en subgrupos con factores conocidos de variación en el resultado del cribado, como es el género o la lactancia, tampoco se detectan diferencias significativas de respuesta. El Apgar ≤ 7 sí se relaciona significativamente con un pH<7,20. Conclusiones En conclusión, las situaciones de asfixia leve-moderada asociadas al parto de recién nacidos sanos sin factores de riesgo auditivo no alteran el resultado del cribado con otoemisiones. (AU)

Objective The effect of hypoxia on the functioning of the outer hair cells of the cochlea, which are responsible for the response to otoemissions used in neonatal hearing screening, is well known. The aim of this study is to determine the influence of mild to moderate variations in umbilical cord pH at birth on the outcome of hearing screening with otoemissions in healthy newborns without hearing risk factors. Results The sample is composed of 4536 healthy infants. The results show no significant differences in the hearing screening outcome between the asphyctic (<7.20) and normal pH group. Nor is a figure below 7.20 detected in the sample that is related to an alteration in the screening. When broken down into subgroups with known factors of variation in the screening result, such as gender or lactation, no significant differences in response were detected. Apgar ≤ 7 is significantly related to pH<7.20. Conclusions In conclusion, mild-moderate asphyxia associated with delivery of healthy newborns, without auditory risk factors, does not alter the outcome of otoemission screening. (AU)

Influence of umbilical cord pH on the outcome of hearing screening with otoacoustic emissions in healthy newborns.

The effect of hypoxia on the functioning of the outer hair cells of the cochlea, which are responsible for the response to otoemissions used in neonatal hearing screening, is well known. The aim of this study is to determine the influence of mild to moderate variations in umbilical cord pH at birth on the outcome of hearing screening with otoemissions in healthy newborns without hearing risk factors. The sample is composed of 4536 healthy infants. The results show no significant differences in the hearing screening outcome between the asphyctic (<7.20) and normal pH group. Nor is a figure below 7.20 detected in the sample that is related to an alteration in the screening. When broken down into subgroups with known factors of variation in the screening result, such as gender or lactation, no significant differences in response were detected. Apgar ≤7 is significantly related to pH<7.20. In conclusion, mild-moderate asphyxia associated with delivery of healthy newborns, without auditory risk factors, does not alter the outcome of otoemission screening.

Maternal factors associated with smoking during gestation and consequences in newborns: Results of an 18-year study.

BACKGROUND: Tobacco use is one of the most important causes of obstetric and perinatal pathologies. Its frequency during pregnancy is high and could be related to various socioeconomic and cultural characteristics of the mothers. AIM: The aim of this study is to determine the trend and prevalence of smoking in pregnant mothers in our area over the years and the socio-cultural or obstetric factors associated with smoking as well as the repercussions on the newborns related to its consumption. METHODS: Retrospective study of 18,959 mothers of healthy newborns in the maternity ward of the regional hospital during the years 2002-2019. The variable under study was maternal smoking during pregnancy compared with various maternal, obstetric, and perinatal factors. RESULTS: A mean percentage of 20.4% of the mothers smoked, with significantly decreasing percentages over the years. There was a significant association between smoking and mothers' age, origin, level of education, the occurrence of previous abortions, parity, type of breastfeeding at discharge, type of delivery, low birth weight, and need for neonatal resuscitation. CONCLUSIONS: This defines a profile of pregnant smokers on whom it is important to act: young, Spanish, with a low level of education, multiparous, and with previous miscarriages. Its repercussions are also evident with a lower birth weight in newborns. Knowledge of these factors will make it possible to design more effective intervention strategies to reduce smoking during pregnancy. RELEVANCE FOR PATIENTS: Any effort that reduces smoking habits can improve the health status of mothers and newborns and the first step is to know who are risk pregnants.

Análisis crítico de una década de cribado neonatal de hipoacusia en un hospital comarcal / Results from ten years newborn hearing screening in a secondary hospital

INTRODUCCIÓN: Se evalúa el protocolo de cribado de hipoacusia neonatal en un hospital comarcal. PACIENTES: Análisis en 14.247 recién nacidos en la maternidad del centro desde el año 2002 al 2013 inclusive. MÉTODOS: Protocolo con registro de otoemisiones bilaterales (registro inicial y repetición si falla, al mes de vida) y potenciales auditivos (confirmación). RESULTADOS: Se realizó la prueba antes del alta a 14.015 neonatos (98,3% de la muestra) cumpliendo así los objetivos de cobertura del cribado. En el primer paso resultaron normales el 93,7%, lo que implica una adecuada tasa de paso y no obliga a excesivas repeticiones. La segunda determinación obtiene también buenos resultados, puesto que el 88,9% de los que acuden resultan normales, dejando solo un 0,63% del grupo inicial para valorar con potenciales. Un 10,6% no acude a la cita, lo que constituye el principal problema detectado. En los remitidos a potenciales esta pérdida es mayor, con un 29,5%, a pesar de que la rentabilidad en aquellos pacientes que se exploran con esta técnica es muy alta dado que el 69,4% de ellos presenta unos potenciales alterados. Esta cifra de alterados representa el 0,31% del total de recién nacidos estudiados, cifra similar a la incidencia de sordera congénita. Teniendo en cuenta las pérdidas en seguimiento referidas la incidencia real podría ser mayor. CONCLUSIONES: El programa es muy útil pero necesita un control estricto del seguimiento para evitar pérdidas de pacientes. Para ello es fundamental tener una base de datos dedicada y un coordinador del programa

INTRODUCTION: A critical analysis is performed on the results of a newborn hearing screening program in a regional hospital. PATIENTS: Screening results from 14,247 newborns in our maternity ward from 2002 to 2013. METHODS: Two step recordings of bilateral otoacoustic emissions (initial and repeat, if failed, at about one month of life). Assessment by clinical brainstem responses. RESULTS: The first step was performed on 14,015 newborns (98.3% of the total) reaching the screening objective. The first step pass figures were 93.7%, which implies a good pass rate with a few patients to repeat. The second step is also good because it has a pass rate of 88.9% of newborns examined (only 0.63% of initial group needed brainstem responses assessment), but 10.6% were lost to follow up, and that is a major problem. In newborns, scheduled for brainstem responses, the loss to follow-up is worse, with a figure of 29.5%, despite the high accuracy of this test given that 69.4% of those assessed showed hearing loss. This figure represents a 0.31% of the initial group, and is a similar to that published for congenital hearing loss. Including patients that were lost to follow up this figure could be greater. CONCLUSION: Newborn hearing screening is useful but needs stronger control to avoid the follow up loss. In order to achieve this, it is crucial to have a good database and a screening coordinator

[Results from ten years newborn hearing screening in a secondary hospital]. / Análisis crítico de una década de cribado neonatal de hipoacusia en un hospital comarcal.

INTRODUCTION: A critical analysis is performed on the results of a newborn hearing screening program in a regional hospital. PATIENTS: Screening results from 14,247 newborns in our maternity ward from 2002 to 2013. METHODS: Two step recordings of bilateral otoacoustic emissions (initial and repeat, if failed, at about one month of life). Assessment by clinical brainstem responses. RESULTS: The first step was performed on 14,015 newborns (98.3% of the total) reaching the screening objective. The first step pass figures were 93.7%, which implies a good pass rate with a few patients to repeat. The second step is also good because it has a pass rate of 88.9% of newborns examined (only 0.63% of initial group needed brainstem responses assessment), but 10.6% were lost to follow up, and that is a major problem. In newborns, scheduled for brainstem responses, the loss to follow-up is worse, with a figure of 29.5%, despite the high accuracy of this test given that 69.4% of those assessed showed hearing loss. This figure represents a 0.31% of the initial group, and is a similar to that published for congenital hearing loss. Including patients that were lost to follow up this figure could be greater. CONCLUSION: Newborn hearing screening is useful but needs stronger control to avoid the follow up loss. In order to achieve this, it is crucial to have a good database and a screening coordinator.

[Epidemiological surveillance of vertically-transmitted Chagas disease at three maternity hospitals in the Valencian Community]. / Vigilancia epidemiológica de la transmisión vertical de la enfermedad de Chagas en tres maternidades de la Comunidad Valenciana.

INTRODUCTION AND AIM: Immigration to Spain of Latin Americans with Chagas disease in its indeterminate phase could result in vertical transmission of the disease or transmission by transfusion or organ transplantation. To ascertain the magnitude of this problem, we investigated the prevalence of bearers among women who gave birth in 3 state maternity hospitals in the Valencian Community and the incidence of vertical transmission. PATIENTS AND METHODS: An immunoprecipitation test to detect anti-Trypanosoma cruzi antibodies was carried out on 624 pregnant Latin American women. In positive cases, indirect immunofluorescence and PCR analysis were performed on mothers. In addition, a microhematocrit and PCR analysis were performed on the newborns of these mothers, and immune precipitation was carried out from age 7 months. Chagas-positive mothers were referred for outpatient care at the hospital internal medicine departments. Percentage of positive serology was calculated for the total number of patients and by country of origin. RESULTS: A total of 29 women (4.8%; 95% CI, 3.1-6.3) were Chagas-positive; all were asymptomatic and PCR-negative. None of their children were positive to the tests performed. Bolivian women were the most frequently affected: 24 out of 137 (17.5%; 95% CI, 11.2-23.9) DISCUSSION: The high prevalence of Chagas disease in the Latin American immigrant population has raised awareness of this disease among professionals involved in the study and treatment of this illness. Further epidemiological studies are needed to establish the feasibility of universal detection programs in this population.

Vigilancia epidemiológica de la transmisión vertical de la enfermedad de Chagas en tres maternidades de la Comunidad Valenciana / Epidemiological surveillance of vertically-transmitted Chagas disease at three maternity hospitals in the Valencian Community

INTRODUCCIÓN Y OBJETIVO. La inmigración a nuestro país de poblaciones latinoamericanas afectadas de enfermedad de Chagas en fase indeterminada abre la posibilidad de transmisión vertical y por transfusión o trasplante de órganos afectados por esta enfermedad. Para averiguar la magnitud del problema, hemos investigado la prevalencia de portadoras entre las mujeres que dan a luz en tres maternidades públicas de la Comunidad Valenciana y la tasa de transmisión vertical. PACIENTES Y MÉTODOS. A un total de 624 mujeres latinoamericanas embarazadas se les practicó una prueba de inmunoprecipitación para detectar anticuerposanti-Trypanosoma cruzi. A las madres positivas se les realizó inmunofluorescencia indirecta y reacción en cadena de la polimerasa (PCR), y a sus hijos, microhematocrito yPCR en el período neonatal e inmunoprecipitación a partir de los 7 meses de vida. Se remitieron las madres seropositivas a la consulta de medicina interna. Se calculó el porcentaje de serología positiva total y por países. RESULTADOS. Un total de 29 mujeres (4,8 %; intervalo dec onfianza [IC] del 95 %: 3,1-6,3) eran seropositivas, todas asintomáticas y con PCR negativa. Ninguno de sus hijosresultó positivo en las pruebas realizadas. Las mujeres bolivianas fueron las más frecuentemente afectadas:24 de 137 (17,5 %; IC 95 %: 11,2 a 23,9).DISCUSIÓN. La elevada prevalencia de enfermedad de Chagas en la población inmigrante latinoamericana obliga a sensibilizar a los profesionales implicados en el conocimiento de esta enfermedad. Se necesitan más estudios epidemiológicos para poder establecer la conveniencia de programas de detección universal para este colectivo (AU)

INTRODUCTION AND AIM. Immigration to Spain of Latin Americans with Chagas disease in its indeterminate phase could result in vertical transmission of the disease or transmission by transfusion or organ transplantation. To ascertain the magnitude of this problem, we investigated the prevalence of bearers among women who gave birth in 3 state maternity hospitals in the Valencian Communityand the incidence of vertical transmission. PATIENTS AND METHODS. An immunoprecipitation test to detect anti-Trypanosoma cruzi antibodies was carried out on 624 pregnant Latin American women. In positive cases, indirect immunofluorescence and PCR analysis were performed on mothers. In addition, a microhematocrit and PCR analysis were performed on the new-borns of these mothers, and immune precipitation was carried out from age 7 months. Chagas-positive mothers were referred for outpatient care at the hospital internal medicine departments. Percentage of positive serology was calculated for the total number of patients and by country of origin. RESULTS. A total of 29 women (4.8 %; 95 % CI, 3.1-6.3)were Chagas-positive; all were asymptomatic and PCR-negative. None of their children were positive to the tests performed. Bolivian women were the most frequently affected: 24 out of 137 (17.5 %;95 % CI, 11.2-23.9)DISCUSSION. The high prevalence of Chagas disease in the Latin American immigrant population has raised awareness of this disease among professionals involved in the study and treatment of this illness. Further epidemiological studies are needed to establish the feasibility of universal detection programs in this population (AU)