Inicio del Hospital Infantil Cruces antes de la incorporación al sistema MIR. A modo de reportaje / Initiation of the Hospital Infamil Cruces before incorporation into the MIR (Spanish Medieal Residency) system. As a report

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[Postnatal growth up to 2 years of corrected age in a cohort of very low birth weight infants]. / Crecimiento posnatal hasta los dos años de edad corregida de una cohorte de recién nacidos de muy bajo peso de nacimiento.

OBJECTIVE: To study postnatal somatic growth up to 2 years of corrected postnatal age (CPA) in a cohort of very low birth weight infants (VLBWI) in our unit, according to their intrauterine growth status at birth. PATIENTS AND METHODS: We performed an observational follow-up study of postnatal growth in a cohort of VLBWI (birth weight < 1,500 g) attended from January 1, 1994 to December 31, 1999. Weight, length, and head circumference were assessed at birth and again at 2 years CPA. Infants were classified as small-for-gestational age (SGA) if weight was below 2 standard deviations (SD) of the reference population mean. RESULTS: The cohort consisted of 260 VLBWI (18.5% SGA). Mean gestational age (SD) was 29 (2.7) weeks, weight was 1,150 (223) g, length was 37.4 (2.7) cm, and head circumference was 27 (1.8) cm. At birth Z-scores were -0.82, -0.92 and -0.8 for weight, length and head circumference. The corresponding mean Z scores at 2 years' CPA were -1.44, -1.49 and -0.31. At 2 years' CPA, more SGA infants still had a weight below the 3rd percentile than those with normal birthweight (26% vs. 16%). SGA infants had a higher daily weight increase during their hospital stay (27.5 vs. 21.2 g/day, p > 0.5). Gender did not significantly influence the growth pattern. CONCLUSIONS: Weight showed the lowest postnatal increase, particularly in infants < 1,000 g. Head circumference showed the greatest catch-up growth pattern, almost reaching the mean for the general population by 2 years' CPA. Growth retardation in SGA continued up to 2 years' CPA.

Crecimiento posnatal hasta los dos años de edad corregida de una cohorte de recién nacidos de muy bajo peso de nacimiento / Postnatal growth up to 2 years of corrected age in a cohort of very low birth weight infants

Objetivo: Analizar la evolución del crecimiento somático posnatal hasta los 2 años de edad corregida, de una cohorte de recién nacidos de muy bajo peso (RNMBP) asistidos en nuestra unidad, según el patrón de crecimiento intrauterino al nacimiento. Pacientes y métodos: Estudio observacional de seguimiento de una cohorte de RNMBP (peso natal < 1.500 g), asistidos entre enero de 1994 y diciembre de 1999. Se valoró el peso, la longitud y el perímetro craneal al nacer y a los 2 años de edad corregida. Los neonatos fueron clasificados como de bajo peso para la gestación (BPG) si el peso estaba por debajo de dos desviaciones estándar (DE) de la media. Resultados: La cohorte consta de 260 RNMBP (18,5 % de BPG) las medias (DE) de la edad gestacional, peso natal, longitud y perímetro craneal fueron de 29 (2,7) semanas, 1.150 (223) g, 37,4 (2,7) cm y 27 (1,8) cm, respectivamente. Las puntuaciones medias del índice Z al nacer para estos parámetros fueron de –0,82, –0,92 y –0,8. A los 2 años de edad corregida, las puntuaciones medias del índice Z para peso, longitud y perímetro craneal fueron de –1,44, –1,49 y –0,31.A los 2 años de edad corregida, el 26 % de los BPG tenían aún un peso inferior al percentil 3, frente al 16 % en los de peso apropiado para la gestación (PAG). El grupo de BPG tuvo un mayor crecimiento en peso durante su estancia en la unidad (27,5 g/día para los BPG frente a 21,2 g/día en los PAG). No se detectaron diferencias significativas con relación al sexo. Conclusiones: El peso fue el parámetro con peor evolución, sobre todo en los de menos de 1.000 g, y el perímetro craneal el más recuperado a los 2 años de edad corregida, acercándose a la media de la población normal. La desventaja de crecimiento de la población con BPG en relación con los de PAG persiste a los 2 años de edad corregida (AU)

Objective: To study postnatal somatic growth up to 2 years of corrected postnatal age (CPA) in a cohort of very low birth weight infants (VLBWI) in our unit, according to their intrauterine growth status at birth. Patients and methods: We performed an observational follow-up study of postnatal growth in a cohort of VLBWI (birth weight 0.5). Gender did not significantly influence the growth pattern. Conclusions: Weight showed the lowest postnatal increase, particularly in infants 0.5). Gender did not significantly influence the growth pattern. Conclusions: Weight showed the lowest postnatal increase, particularly in infants < 1,000 g. Head circumference showed the greatest catch-up growth pattern, almost reaching the mean for the general population by 2 years’ CPA. Growth retardation in SGA continued up to 2 years’ CPA (AU)

[Supplementation of maternal milk with calcium and phosphorus for the feeding of premature neonates weighing 1500 g or less. How long should it be continued?]. / Suplementación con calcio y fósforo de la leche materna para la alimentación de recién nacidos pretérmino, de peso less than or equal to 1.500 g. Hasta cuando proseguir?

Feeding four preterm infants weighing less than or equal to 1,500 g with human milk supplemented with calcium (160-200 mg/kg/day) and phosphorus (80-200 mg/kg/day) until term postmenstrual age was reached, and suitable levels of plasma calcium, phosphorus and alkaline phosphatase and urinary excretion index of calcium and phosphorus were attained. When such a supplementation was suppressed at 38-40 weeks of postmenstrual age a rapid onset of biochemical disturbances was observed: a rise of plasma calcium (p less than 0.025) and alkaline phosphatase (p less than 0.0025) with a decrease of plasma phosphorus (p less than 0.005) and of urinary phosphate excretion (p less than 0.002). Reincorporation to former supplemented regime results in quick recovery of these parameters. Authors can assert that the necessity of calcium and phosphorus supplementation of human milk for less than or equal to 1.500 g preterm infant feeding exceeds the term postmenstrual age if suitable calcium and phosphorus levels are to be obtained.

[Acute renal failure in perinatal asphyxia]. / Insuficiencia renal aguda en la asfixia perinatal.

Patients with perinatal asphyxia from a total population of 15,216 births were studied prospectively. A total of 76 newborn infants achieved the criteria for inclusion. These were distributed in three populations: 53 (73%) without acute renal failure (ARF); 17 (22%) with ARF of prerenal type; 6, (8%) with ARF of renal type. Incidence of several perinatal factors were compared (gestational age, birth weight, meconial amniotic fluid, cord and/or placental disturbances, type of delivery, APGAR Score, and resuscitation). Authors observed that in the group of preterm infants, ARF is present, always was of renal type. In the population with ARF of renal type perinatal asphyxia was clinically worse: greatest frequency of meconial amniotic fluid (p less than 0,025) and worse response to resuscitation with a lower increment in the APGAR Score between one and five minutes (p less than 0.005).