El Servicio de neonatología en el Hospital Universitario La Paz en el año 2012 / Neonatology Department in the Hospital Universitario La Paz in the year 2012

En relación con el estado actual del Servicio de neonatología (SN), tras señalar la misión y visión del mismo, se concreta la información estructural y cartera de servicios. A continuación se describen la actividad asistencial en el paciente ingresado y en consulta de seguimiento, la actividad docente de pregrado, médicos residentes y formación continuada y las estrategias de mejora de la calidad del SN en el seno de redes nacionales e internacionales. Por último, se destacan objetivos asistenciales y de investigación actuales del SN. Repetidas veces se hace alusión a participación de la familia en todas las actividades del SN del H. Materno Infantil La Paz (AU)

The current situation, objectives and level of care provided by the Neonatal Unit of La Paz Children´s Hospital are specified. Data ate reported of clinical activity in inpatient care and follow-up programs for high risk patients. Undergraduate teaching, pediatrics residency programs, continued quality improvement and education strategies with participation in specific national and global neonatal databases are described. Future clinical and research objectives are highlighted. Family centered and parental involvement in care is considered a major aim in all activities in the neonatal unit (AU)

Efectividad de palivizumab en la prevención de la infección por el virus respiratorio sincitial en prematuros de 32' a 35º semanas de gestación en España / Effectiveness of palivizumab to prevent hospitalization for respiratory syncytial virus infection in preterm infants 32' to 35º weeks’ gestation in Spain

Objetivo: Se pretende evaluar la efectividad de palivizumab para prevenir ingresos por el virus respiratorio sincitial (VRS) cuando es administrado a ex prematuros de 321 a 350 semanas de gestación, con menos de 6 meses de edad al inicio de la estación VRS y que presenten alguna de las combinaciones de factores de riesgo de ingreso por VRS. Pacientes y métodos: Se ha utilizado la base de datos del estudio FLIP-2, excluyendo los niños sin ningún factor de riesgo. Se estudió a 627 niños tratados con palivizumab y 4.092 que no lo recibieron. Las agrupaciones de factores de riesgo combinaron dos «factores mayores» (edad cronológica inferior a 10 semanas al inicio de la estación o haber nacido en las 10primeras semanas de la estación; hermano mayor que fuera a la escuela o asistencia a la guardería) y dos «factores menores» (gestante fumadora; sexo varón). Se han calculado los diferentes riesgos absoluto y relativo y el número de pacientes que es necesario tratar (NNT) para cada combinación de factores de riesgo. Resultados: En cada combinación se encuentra un menor peso y una menor edad gestacional altamente significativos (p <0,001) en los niños tratados con palivizumab. En la combinación«2 factores mayores» se encuentra el menor NNT (13,5), y si se añade la combinación «1 factor mayor + 2 factores menores», el NNT alcanza un valor de 15,1. La combinación que sólo exige la presencia de un factor mayor o menor corresponde al estudio global. Ingresaron 186 (4,55%) no tratados con palivizumab y 9 (1,44%) de los tratados (p <0,001; NNT= 32,2). Conclusiones: En los ex prematuros de 321 a 350 semanas, con una edad cronológica inferior a 10 semanas al inicio de la estación VRS o que hayan nacido en las 10 primeras semanas de la estación, y con un hermano mayor que vaya a la escuela o asista a la guardería, para prevenir un ingreso VRS habría que administrar palivizumab a 14 de ellos (AU)

Objective: The objective of the study was to evaluate effectiveness of palivizumab to prevent respiratory syncytial virus (RSV) infection when administered to former preterm infants321 to 350 weeks’ gestation aged less than 6 months at the beginning of RSV season using any of the possible combinations of known risk factors for RSV hospitalization. Patients and methods: Data were retrieved from the FLIP-2study database. Infants without risk factors were excluded. The database included 627 infants who received palivizumab and 4,092 who did not. Seven accumulative subgroups were established according to the combinations of risk factors combining two “major factors” (chronological age less than10 weeks at the beginning of RSV season or being born during the first10 weeks of the season; school-age siblings or daycare attendance)and two “minor factors” (mother smoking during pregnancy; male gender). Absolute risk, relative risk, and number needed to treat (NNT) were obtained for each subgroup. Results: In each subgroup, birth weight and gestational age were significantly lower in palivizumab treated infants. The combination “2 major factors” showed a NNT of [13.5], and when merged with “1 major factor or 2 minor factors” the NNT reached 15.1. Combination requesting only one risk factor either major or minor corresponded by design to the global study.186 patients of the treated group (4.55%) and 9 patients of the non-treated group (1.44%) were admitted to the hospital, of the treated (p <0.001; NNT of 32.2).Conclusion: In former preterm infants 321 to 350 weeks’ gestation with chronological age less than10 weeks at the beginning of RSV season (or being born during the first 10 weeks of the season) and with school-age siblings or daycare attendance,14 should be treated with palivizumab to prevent one RSV hospitalization (AU)

Enfermedades frecuentes del tiroides en la infancia / No disponible

La aparición de alteraciones de la función tiroidea en los niños es muy frecuente. Parece que hay datos suficientes para asegurar que el seguimiento de las hormonas tiroideas, al menos durante la infancia, es muy útil para evitar posibles problemas a largo plazo. Por tanto, cualquier beneficio potencial sería mayor que los posibles efectos dañinos. En los controles de salud de los niños, siempre debe investigarse la presencia de signos de sospecha de disfunción endocrinológica. En esta especialidad tan vinculada a los procesos de crecimiento y desarrollo, donde los signos de casi todas sus patologías son muy discretos en su comienzo, debe agudizarse al máximo la observación, ya que es importante el diagnóstico precoz para que los tratamientos resulten eficaces y puedan evitar las secuelas de la enfermedad. Solo si se investiga, la mayoría de las enfermedades endocrinológicas pueden ser descubiertas tempranamente. Únicamente el pediatra puede contribuir al diagnóstico precoz. La interpretación de normalidad/anormalidad del proceso de crecimiento y desarrollo del niño, es una herramienta de gran utilidad durante la infancia. En la etapa de estudio, así como en la de tratamiento, una vez confirmada la enfermedad, el pediatra debe integrar el equipo ampliado de atención del niño. El pediatra por su parte, en estrecha comunicación con el grupo especializado, conducirá a la familia y al paciente en su nueva condición de enfermo crónico(AU)

The appearance of alterations of the thyroid function in children is very frequent. It seems that there are sufficient data to assure that the control of thyroid function during childhood is at least very useful in order to avoid possible problems in the long-term development. Therefore, any potential benefit would be greater than the possible harmful effects. In the controls of the well child, the signs of suspicion of endocrinologic disfunción must be investigated always. In the processes of growth and development, where the signs of almost all their impairments are very discreet in their beginning, the observation must become thorough since early diagnosis is important for the treatments to be effective and to be able to avoid the sequels of the disease. Pediatricians have an important contribution to the early diagnosis. The interpretation of normality/abnormality of the process of growth and development of the infant, is a very useful tool during childhood. In the stage of study as well as in the treatment, pediatricians must integrate the extended team of childcare. Pediatricians will lead the family and the patient in its new condition of chronic patient(AU)

Utilidad predictiva de ingreso por infección por virus respiratorio sincitial de diferentes asociaciones de factores de riesgo en prematuros de 32 a 35 semanas de gestación en España / Usefulness of different risk factor associations in predicting admissions due to respiratory syncytial virus in premature newborns of 32 to 35 weeks gestation in Spain

Introducción: Se pretende evaluar los valores predictivos de ingreso por el virus respiratorio sincitial (VRS) de diferentes asociaciones de factores de riesgo en prematuros españoles de 32 a 35 semanas de gestación atendidos en 2 estaciones de VRS consecutivas. Pacientes y métodos: Se utilizó la base de datos del estudio FLIP-2. Se excluyó a los niños que recibieron palivizumab profiláctico. Se estudiaron 193 ingresos de VRS positivo y 4.568 niños no ingresados. Los factores de riesgo analizados fueron la edad cronológica inferior a 10 semanas al inicio de la estación o haber nacido en las 10 primeras semanas de la estación, hermano mayor que fuera a la escuela o asistiera a la guardería, madre fumadora durante la gestación, sexo varón, lactancia materna ausente durante 2 meses o menos, 4 o más adultos en casa, sibilancias en padres o hermanos, ser pequeño para la edad gestacional y 2 o más fumadores en casa. Resultados: El modelo de regresión logística incluyó los 4 primeros factores citados como variables independientemente significativas, con un coeficiente de determinación de 0,062 y un área bajo la curva de 0,687 (p<0,001). Los valores predictivos de ingreso de VRS positivo para un niño con los 4 factores de riesgo fueron los siguientes: el 6,2% de sensibilidad, el 98,6% de especificidad, el 16,2% de valor predictivo positivo, el 96,1% de valor predictivo negativo, el 94,9% de exactitud, un cociente de probabilidad positivo (CP+) de 4,581 y un cociente de probabilidad negativo de 0,951. El CP+ para un niño con los 2 factores mayores de riesgo es de 2,657. Conclusiones: La utilidad predictiva de ingreso de VRS positivo según la presencia de diferentes factores de riesgo en prematuros españoles de 32 a 35 semanas de gestación es escasa, aunque similar a otros modelos existentes (AU)

Aim: The aim of the study was to evaluate the risk factor associations for respiratory syncytial virus (RSV) hospitalization in preterm infants from 32 to 35 weeks gestation, treated during two consecutive RSV seasons in Spain. Patients and methods: A database (FLIP-2) was used after excluding the infants who received prophylactic palivizumab. A total of 193 RSV+ admissions and 4568 non-hospitalized children were studied. The risk factors analyzed were: chronological age <=10 weeks at start of RSV season or to be born during the first 10 weeks of the season; school-age siblings or daycare attendance; mother smoking during pregnancy; male gender; breastfeeding <=2 months; >=4 adults at home; history of wheezing; small for gestational age; >=2 smokers at home. Results: Logistic regression model included the first four previously mentioned risk factors as independently significant variables, with R2 of 0.062 and area under curve of 0.687 (P<0.001). Predictive values for a child with the four risk factors were: sensitivity 6.2%, specificity 98.6%, predictive positive value 16.2%, negative predictive value 96.1%, accuracy 94.9%, positive likelihood ratio 4.581, and negative likelihood ratio 0.951. Positive likelihood ratio for a child with the two major risk factors is 2.657. Conclusions: Usefulness of different risk factor associations to predict hospitalization for respiratory syncytial virus infection in preterm infants 32 to 35 weeks gestation in Spain is low, although similar to other models (AU)

[Usefulness of different risk factor associations in predicting admissions due to respiratory syncytial virus in premature newborns of 32 to 35 weeks gestation in Spain]. / Utilidad predictiva de ingreso por infección por virus respiratorio sincitial de diferentes asociaciones de factores de riesgo en prematuros de 32 a 35 semanas de gestación en España.

AIM: The aim of the study was to evaluate the risk factor associations for respiratory syncytial virus (RSV) hospitalization in preterm infants from 32 to 35 weeks gestation, treated during two consecutive RSV seasons in Spain. PATIENTS AND METHODS: A database (FLIP-2) was used after excluding the infants who received prophylactic palivizumab. A total of 193 RSV+ admissions and 4568 non-hospitalized children were studied. The risk factors analyzed were: chronological age <=10 weeks at start of RSV season or to be born during the first 10 weeks of the season; school-age siblings or daycare attendance; mother smoking during pregnancy; male gender; breastfeeding <=2 months; >=4 adults at home; history of wheezing; small for gestational age; >=2 smokers at home. RESULTS: Logistic regression model included the first four previously mentioned risk factors as independently significant variables, with R(2) of 0.062 and area under curve of 0.687 (P<0.001). Predictive values for a child with the four risk factors were: sensitivity 6.2%, specificity 98.6%, predictive positive value 16.2%, negative predictive value 96.1%, accuracy 94.9%, positive likelihood ratio 4.581, and negative likelihood ratio 0.951. Positive likelihood ratio for a child with the two major risk factors is 2.657. CONCLUSIONS: Usefulness of different risk factor associations to predict hospitalization for respiratory syncytial virus infection in preterm infants 32 to 35 weeks gestation in Spain is low, although similar to other models.

Situación actual del cuidado neonatal. Estrategias de mejora en nuestro medio / Current situation of neonatal care. Strategies for improvement in our setting

En la búsqueda de la mejora de la calidad de la neonatología es obligado el trabajo en equipo de médicos y enfermeras de neonatología y de las diferentes especialidades médicas y quirúrgicas que, como consultores, colaboran en la atención del neonato enfermo. En este contexto es imprescindible la participación de la gerencia y dirección médica hospitalaria en la planificación y control de los resultados, para actuar como transmisor y dinamizador ante los responsables sanitarios de la comunidad. En la Comunidad de Madrid está funcionando desde 2007 un programa del transporte neonatal bien organizado realizado por un equipo de neonatologos entrenados. En la actualidad se dispone de soportes eficientes para la mejora de la calidad a nivel hospitalario (comisión central de calidad), comunitario, nacional e internacional. El trabajo en redes neonatales nacionales (SEN 1500) e internacionales (Vermont Oxford Network, EuroNeoNet) ha sido incorporado por los servicios de neonatología de nuestra país (AU)

In the search to improve the quality of neonatology, team work of neonatology doctors and nurses and the different medical and surgical specialties who, as consultants, collaborate in the care of the neonatal patient, is mandatory. In this context, participation of the hospital management and medical administration in planning and control of the results to act in a transmitter and energizing role in regards to the health care responsible persons of the community is essential. In The Madrid Community, a well-organized neonatal transportation program performed by a skilled neonatologist team has been functioning since 2007. Currently, there are efficient supports for the improvement of the quality on the community, national and international hospital levels (central quality committee). Work in national neonatal (SEN 1500) and international networks (Vermont Oxford Network, EuroNeoNet) has been incorporated by the neonatology services of our country (AU)

[SEN1500: design and implementation of a registry of infants weighing less than 1,500 g at birth in Spain]. / SEN1500: diseño y desarrollo del registro de niños de menos de 1.500 g al nacer en España.

OBJECTIVE: To design and implement a registry of infants weighing less than 1,500 g at birth in Spain. MATERIAL AND METHODS: Prospective, cohort, multicenter study. All live born infants weighing less than 1,500 g in several voluntarily participating neonatal units in public and private hospitals were included. RESULTS: In the first 4 years of the registry (2002 to 2005), 9,638 very-low-birth-weight infants were born in the 65 neonatal units that have so far joined the program. CONCLUSIONS: The goal of very-low-birth-weight infant databases is to try to improve the quality and safety of the medical care given to these newborns and their families. This type of program helps to coordinate and promote several areas, including those of health education, training of medical staff, research and development, surveillance and quality improvement.

SEN1500: diseño y desarrollo del registro de niños de menos de 1.500 g al nacer en España / SEN1500: Design and implementation of a registry of infants weighing less than 1.500 g at birth in Spain

Objetivo: Diseño y desarrollo de un registro de niños de menos de 1.500 g al nacer en España. Material y métodos: Estudio de cohortes prospectivo multicéntrico. Se incluyen todos los recién nacidos vivos de peso inferior a 1.500 g al nacer en las unidades neonatales (UN) que voluntariamente se integren en el proyecto. Resultados: En los primeros 4 años de funcionamiento del registro han participado en el estudio 65 UN diferentes. El total de niños seleccionados entre 2002 y 2005 es de 9.637. Conclusiones: La misión de las bases de datos de los niños de muy bajo peso al nacer es intentar mejorar la calidad y la seguridad de los cuidados médicos que se proporcionan a los recién nacidos y a su familia. Su desarrollo posibilita la coordinación de programas de educación sanitaria y formación de profesionales médicos y de enfermería, de líneas de investigación y de proyectos de mejora (AU)

Objective: To design and implement a registry of infants weighing less than 1,500 g at birth in Spain. Material and methods: Prospective, cohort, multicenter study. All live born infants weighing less than 1,500 g in several voluntarily participating neonatal units in public and private hospitals were included. Results: In the first 4 years of the registry (2002 to 2005), 9,638 very-low-birth-weight infants were born in the 65 neonatal units that have so far joined the program. Conclusions: The goal of very-low-birth-weight infant databases is to try to improve the quality and safety of the medical care given to these newborns and their families. This type of program helps to coordinate and promote several areas, including those of health education, training of medical staff, research and development, surveillance and quality improvement (AU)

Deficiencia de yodo y prematuridad / Iodine deficiency and prematurity

El yodo es un oligoelemento esencial para la síntesis de hormonas tiroideas. La deficiencia de este oligoelemento es especialmente preocupante en el recién nacido, que debe sintetizar suficientes hormonas tiroideas para hacer frente a sus necesidades hormonales, ya que los preparados para alimentación de neonatos a término y prematuros no siempre contienen el yodo necesario. En el mundo, la mayor causa dehipotiroxinemia es la deficiencia de yodo, la cual está reconocida como la causa más importante de retraso mental y parálisis cerebral prevenible (AU)

Iodine is a trace element essential for the synthesis of thyroid hormones. Iodine deficiency is especially worrying inneonates, who must synthesize sufficient thyroid hormones to meet their hormonal requirements, since formula preparations for premature and term infants do not always contain adequate iodine. Worldwide, the main cause of hypothyroxinemia is iodine deficiency, which in turn is the main preventable cause of mental retardation and cerebral palsy(AU)

Efectos de la suplementación con cinc en el primer año de vida / Effects of supplementation with zinc in the first year of life

El cinc es un nutriente esencial por su papel fundamental en muchos aspectos del metabolismo celular. Se revisa en este artículo el papel del cinc en la incidencia de enfermedades infecciosas, la mortalidad, el crecimiento y el neurodesarrollo, haciendo especial hincapié en los ensayos publicados de suplementación con cinc (Zn) en lactantes. Se han revisado ensayos clínicos de suplementación randomizados y controlados, doble ciego, publicados e indexados en las bases de datos Medline, Embase y Cochrane. Se han seleccionado aquellos ensayos realizados en menores de 1 año en los que un grupo experimental recibe suplementos de Zn y un grupo control no, aceptándose la administración conjunta de otros micronutrientes (minerales y vitaminas) si existe un grupo control en el que la no administración de suplementos de Zn es la única diferencia con el experimental. Se consideraron los ensayos de una duración de al menos 2 semanas y con visitas domiciliarias por lo menos cada 4 semanas en el caso de estudiarse la morbilidad. El suplemento con cinc disminuye la incidencia de diarrea y neumonía y la duración de la diarrea si se administra durante su curso. En países en vías de desarrollo la suplementación con cinc mejora el crecimiento. En recién nacidos pretérmino existe una relación entre ingesta de cinc y crecimiento. La relación entre la ingesta de cinc y el neurodesarrollo precisa de más investigación (AU)

Zinc is a essential nutrient because of its major role in many aspects of cellular metabolism. In this article the role of zinc in the incidence of infectious diseases, mortality, growth and neurodevelopment is revised, emphasizing the clinical trials on supplementation with zinc in infants. We revised randomized controlled double-blind clinical trials of zinc supplementation, published and indexed in Medline, Embase and Cochrane databases. We selected those trials with children less of one year of life, in which an experimental group receives zinc supplementation and the control group does not; simultaneous administration of other micronutrients (vitamins and minerals) was accepted if there was a control group in which the only difference with respect to the experimental group was the no administration of supplemental zinc. We considered the trials with duration of almost 2 weeds and with home visits at least monthly in the case of morbidity studies. The zinc supplementation decreases the incidence of diarrhea and pneumonia and the duration of diarrhea if it is given during its cause. In developing countries, zinc supplementation improves growth. In preterm infants there is a relation between intake of zinc and growth. The relation between intake of zinc and neurodevelopment needs further investigation (AU)

[Abdominal vascular malformations and Down syndrome]. / Malformaciones vasculares abdominales y síndrome de Down.

Malformations of the abdominal venous system are rare vascular disorders. These entities are associated with other malformations and with chromosomal anomalies such as trisomy 21. Abdominal venous malformations are probably the most frequent congenital vascular malformations in Down syndrome. Prenatal diagnosis allows the early follow-up and treatment of complications. We present a case of Down syndrome associated with an abdominal venous malformation diagnosed at the first trimester of pregnancy.

Malformaciones vasculares abdominales y síndrome de Down / Abdominal vascular malformations and Down syndrome

Las malformaciones del sistema venoso abdominal son alteraciones vasculares raras. Se asocian a otras malformaciones y, ocasionalmente, se han descrito asociadas a alteraciones cromosómicas como la trisomía 21. Son probablemente las malformaciones congénitas vasculares más frecuentes en el síndrome de Down. El diagnóstico prenatal permite un seguimiento precoz y un tratamiento temprano de las complicaciones. Presentamos un caso de síndrome de Down con una malformación venosa abdominal asociada, diagnosticada en el primer trimestre de gestación

Malformations of the abdominal venous system are rare vascular disorders. These entities are associated with other malformations and with chromosomal anomalies such as trisomy 21. Abdominal venous malformations are probably the most frequent congenital vascular malformations in Down syndrome. Prenatal diagnosis allows the early follow-up and treatment of complications. We present a case of Down syndrome associated with an abdominal venous malformation diagnosed at the first trimester of pregnancy

Prevención de la ferropenia durante el primer año de vida / No disponible

La ferropenia continúa siendo un problema frecuente entre los lactantes españoles, con potenciales efectos negativos sobre su neurodesarrollo. La mayoría de organizaciones no recomiendan la suplementación universal con hierro en los lactantes nacidos a término sanos de países desarrollados, aunque puede considerarse justificada en aquellos casos en que no puede asegurarse la ingesta recomendada por medio de la dieta. Debe promoverse la ingesta de carne y pescado, evitar el consumo excesivo de zumos y, sobre todo la introducción de la leche de vaca en el primer año de vida. En los niños con lactancia artificial o mixta se recomienda utilizar fórmulas suplementadas. Los lactantes nacidos pretérmino o con bajo peso para su edad gestacional alimentados al pecho deben recibir suplementos que aporten un mínimo de 2 mg por kg de peso y día de hierro elemental. La fórmula para prematuros debe estar suplementada con un contenido en hierro igual o superior a 12 mg/L. Durante el tratamiento con eritropoyetina deben aportarse un mínimo de 6 mg/kg/día de hierro oral lo antes posible. La administración parenteral de hierro continúa planteando controversia (AU)

Iron deficiency is common in spanish infants, with potential negative effects on neurodevelopment. Most medical organizations do not recommend universal iron supplements in tem infants born in developed countries. Preventive measures include encouraging a diversified diet rich in sources of iron and avoiding excessive juice intake. In infants, the introduction of cow´s milk in the first year of life is the greatest dietary risk factor for the development of iron deficiency and iron deficiency anemia. Iron supplements can be used in those infants in which a diversified diet that is rich in sources of iron is not consumed. Formula-fed-infants should consume iron-containing infant formula. Premature and low-birth weight infants should receive iron supplements of at least 2 mg/kg/day during the first months of life. Premature infant formula should contain at least 12 mg/L of iron. Erythropoietin-treated premature infants should receive iron oral supplements of at least 6 mg/kg/day as soon as possible. Intravenous iron administration remains controversial (AU)

[Effect of hygiene interventions on the thermal stability of extremely low-birth-weight newborns in the first two weeks of life]. / Repercusión del aseo en la estabilidad térmica del recién nacido de extremado bajo peso durante las primeras dos semanas de vida.

INTRODUCTION: A prospective study was performed of a cohort of extremely low-birth-weight (ELBW) premature neonates (birth weight 500 to 1,000 g) consecutively admitted to the neonatal intensive care unit. The aim of this study was to examine the thermal changes that occur during all the hygiene-related interventions in ELBW infants in the first 2 weeks of life. PATIENTS AND METHODS: The study was carried out for 10 consecutive months in the Neonatology Service of La Paz University Hospital. We studied all consecutively admitted ELBW infants who satisfied the following criteria: a) adequate weight for gestational age; b) survival for at least 1 week, and c) no major congenital malformations or dysmorphic features. The infants included in the study were managed according to a standard care protocol for maintaining thermal stability and preventing cold-induced stress. Central temperature (Tc) was measured in the axilla and peripheral temperature (Tp) was measured on the sole of the foot. Both temperatures were continuously monitored for a) a period of scheduled non-handling--baseline period--and b) during and after a series of "hygiene interventions". In each of these periods, Tc and Tp were continuously monitored and recorded at 10 min intervals for the first 30 minutes and then at 30 min intervals until completing a 180 min period. RESULTS: Although incubator temperature was raised by a mean of 3 degrees C during hygiene interventions, hygiene was accompanied by a change in body temperature that remained fairly constant throughout the study period; Tc and Tp decreased by a mean of 1 degrees C with respect to baseline temperature. A fall in axillary temperature to less than 36.5 degrees C was observed in 87.4 % of recordings and a fall to less than 36 degrees C was observed in 45.5 %; axillary temperature remained below 36.5 degrees C for a mean duration of almost 1 hour. The differential temperature (Td 5 Tc - Tp), an indicator of thermal stress, was more than 1 degrees C for a mean duration of more than 80 min and > 2 degrees C for more than 20 minutes in both the first and second weeks of life. CONCLUSIONS: During hygiene interventions, ELBW infants experienced a sharp fall in central and peripheral body temperature. After hygiene interventions, these neonates had a Td suggestive of prolonged thermal stress, despite the use of standardized care protocols designed to avoid or minimize the potential effects of hygiene interventions on neonatal temperature.

Repercusión del aseo en la estabilidad térmica del recién nacido de extremado bajo peso durante las primeras dos semanas de vida / Effect of hygiene interventions on the thermal stability of extremely low-birth-weight newborns in the first two weeks of life

El objetivo del estudio fue examinar los cambios térmicos que tienen lugar durante un conjunto de acciones agrupadas en relación con el aseo corporal en los RNEBP durante las primeras 2 semanas de vida. Pacientes y métodos. El estudio se realizó durante 10 meses consecutivos en el Servicio de Neonatología del Hospital Universitario La Paz. Se estudiaron todos los RNEBP ingresados consecutivamente que cumplieron los siguientes criterios: a) peso adecuado a la edad gestacional; b) sobrevivir al menos una semana, y c) no presentar malformaciones congénitas mayores o rasgos dismórficos. Los niños incluidos en el estudio fueron manejados según los protocolos de cuidado estándar dirigidos a mantener la estabilidad térmica y evitar el estrés por frío. La temperatura central (Tc) se midió en el hueco axilar y la periférica (Tp) en la planta de un pie. Ambas temperaturas se monitorizaron de forma continua durante: a) un período de no manipulación programada (período basal), y b) durante y después de un conjunto de intervenciones agrupadas que denominamos "aseo". Durante ambos períodos se monitorizaron de forma continua la Tc y la Tp, registrándose a intervalos de 10 min durante los primeros 30 min y posteriormente cada 30 min hasta completar un período de registro de 180 min. Resultados. A pesar que durante el aseo la temperatura de la incubadora se incrementó casi 3 °C por término medio, el aseo conllevó un patrón de cambio en la temperatura corporal similar durante todo el período de estudio; la Tc y la Tp descendieron aproximadamente 1 °C por término medio respecto a la temperatura basal. Se observó una caída de la temperatura axilar por debajo de 36,5 °C en el 87,4 % de los registros y por debajo de 36 °C en el 45,5 % y la temperatura axilar permaneció inferior a 36,5 °C durante prácticamente una hora por término medio. Además, la temperatura diferencial (Td 5 Tc ­ Tp), un indicador de estrés térmico, fue superior a 1 °C durante más de 80 min y a 2 °C durante más de 20 min por término medio, tanto en la primera como en la segunda semana de vida. Conclusiones. Durante el aseo de los RNEBP tiene lugar un marcado descenso de la temperatura corporal, tanto central como periférica. Tras el aseo, estos recién nacidos presentan una Td indicativa de estrés térmico, durante períodos prolongados. Estos cambios térmicos tienen lugar aun siguiendo protocolos de aseo estandarizados dirigidos a evitar o aminorar la potencial repercusión de este en la temperatura del recién nacido

Introduction. A prospective study was performed of a cohort of extremely low-birth-weight (ELBW) premature neonates (birth weight 500 to 1,000 g) consecutively admitted to the neonatal intensive care unit. The aim of this study was to examine the thermal changes that occur during all the hygiene-related interventions in ELBW infants in the first 2 weeks of life. Patients and methods. The study was carried out for 10 consecutive months in the Neonatology Service of La Paz University Hospital. We studied all consecutively admitted ELBW infants who satisfied the following criteria: a) adequate weight for gestational age; b) survival for at least 1 week, and c) no major congenital malformations or dysmorphic features. The infants included in the study were managed according to a standard care protocol for maintaining thermal stability and preventing cold-induced stress. Central temperature (Tc) was measured in the axilla and peripheral temperature (Tp) was measured on the sole of the foot. Both temperatures were continuously monitored for a) a period of scheduled non-handling ­baseline period­ and b) during and after a series of "hygiene interventions". In each of these periods, Tc and Tp were continuously monitored and recorded at 10 min intervals for the first 30 minutes and then at 30 min intervals until completing a 180 min period. Results. Although incubator temperature was raised by a mean of 3 °C during hygiene interventions, hygiene was accompanied by a change in body temperature that remained fairly constant throughout the study period; Tc and Tp decreased by a mean of 1 °C with respect to baseline temperature. A fall in axillary temperature to less than 36.5 °C was observed in 87.4 % of recordings and a fall to less than 36 °C was observed in 45.5 %; axillary temperature remained below 36.5 °C for a mean duration of almost 1 hour. The differential temperature (Td 5 Tc ­ Tp), an indicator of thermal stress, was more than 1 °C for a mean duration of more than 80 min and > 2 °C for more than 20 minutes in both the first and second weeks of life. Conclusions. During hygiene interventions, ELBW infants experienced a sharp fall in central and peripheral body temperature. After hygiene interventions, these neonates had a Td suggestive of prolonged thermal stress, despite the use of standardized care protocols designed to avoid or minimize the potential effects of hygiene interventions on neonatal temperature

[The skin as an expression of neurological alterations in the neonate]. / La piel como expresión de alteraciones neurológicas en el recién nacido.

The skin is involved in many different genetic syndromes and diseases with multiple organ involvement. Neurodevelopmental disorders appear in many of these entities and knowledge of these cutaneous alterations may provide clues to their diagnosis. Recognizing these skin disorders in the newborn allows early identification of neonates with a biological risk of epilepsy and motor and/or cognitive disorders and enables them to be followed up. This helps to plan the management of these patients and, in many entities, to predict their natural history and provide genetic counseling to the family. This review examines the cutaneous signs that may provide important clues in the neonate that help to identify entities that carry a risk of neurodevelopmental disorders in the neonate.

La piel como expresión de alteraciones neurológicas en el recién nacido / The skin as an expression of neurological alterations in the neonate

La alteración de la piel forma parte de diferentes síndromes genéticos y de enfermedades con afectación multiorgánica. Muchas de estas entidades cursan con alteración del neurodesarrollo y la piel constituye una importante pista para el diagnóstico de estas entidades nosológicas. El reconocimiento en el recién nacido de los trastornos cutáneos asociados a alteraciones del SNC permite: a) identificar precozmente una población de recién nacidos con riesgo biológico de epilepsia y de trastorno motor y/o cognitivo; b) incluir a estos recién nacidos en programas de seguimiento, formular planes de tratamiento y/o intervenciones terapéuticas, y c) en muchas entidades predecir la historia natural del trastorno y aportar consejo genético a la familia. Esta revisión examina los signos cutáneos que pueden aportar importantes pistas en el recién nacido para el reconocimiento de entidades con riesgo de trastorno del desarrollo neuroevolutivo en el neonato

The skin is involved in many different genetic syndromes and diseases with multiple organ involvement. Neurodevelopmental disorders appear in many of these entities and knowledge of these cutaneus alterations may provide clues to their diagnosis. Recognizing these skin disorders in the newborn allows early identification of neonates with a biological risk of epilepsy and motor and/or cognitive disorders and enables them to be followed up. This helps to plan the management of these patients and, in many entities, to predict their natural history and provide genetic counseling to the family. This review examines the cutaneus signs that may provide important clues in the neonate that help to identify entities that carry a risk of neurodevelopmental disorders in the neonate

[Morbidity at 2 years in infants with a birth weight of < 1,500 g]. / Morbilidad a los dos años de edad en niños con un peso al nacimiento menor de 1.500 g.

OBJECTIVES: To determine morbidity at 2 years' corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid. PATIENTS AND METHODS: An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87%) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient. RESULTS: Among the patients initially included in the study, 87% completed the follow-up; 17.1% had one or more major sequela. We found one case (0.4%) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9% had a development quotient below 85 and 18% had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of 2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings. CONCLUSIONS: Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years' corrected age.

Morbilidad a los dos años de edad en niños con un peso al nacimiento menor de 1.500 g / Morbidity at 2 years in infants with a birth weight of < 1.500 g

Objetivos: Conocer la morbilidad a los 2 años de edad corregida de una cohorte de recién nacidos con un peso inferior a1.500 g durante los años 1999-2000 en un hospital terciario de la Comunidad de Madrid. Pacientes y métodos: Estudio observacional de seguimiento longitudinal de una cohorte de 213 pacientes con peso inferior a 1.500 g al nacimiento. De éstos, 188 (87 %) finalizaron el seguimiento completo a los 2 años. Se estudiaron de forma prospectiva las diferentes morbilidades neurosensoriales, prestando especial atención a las morbilidades mayores: oftalmológicas, auditivas, motoras y bajo cociente de desarrollo (CD). Resultados: Completaron el seguimiento el 87 % de los pacientes incluidos inicialmente en el estudio; el 17,1 % presentaron una o más secuelas mayores. Encontramos un caso (0,4%) de sordera neurosensorial bilateral y un caso de ceguera bilateral; el 5,8 % (11/188) de los niños presentaron alguna forma de parálisis cerebral y un 14,9 % tuvieron un CD < 85 a los 2 años de edad. El 18 % no había alcanzado el percentil 3 (P3) de peso a los 2 años de seguimiento. Hallamos, como factores de mal pronóstico neurológico la microcefalia a los 2 años de edad y la aparición de lesiones de sustancia blanca (incluyendo la hiperecogenicidad periventricular persistente y ventriculomegalia de bordes irregulares) como alteraciones ecográficas. Conclusiones: Menos de una quinta parte de los recién nacidos de muy bajo peso (RNMBP) presentan alguna secuela grave a los 2 años de seguimiento. Encontramos como factores de mal pronóstico neurológico la microcefalia a los 2 años de edad corregida y la presencia de alteración de la sustancia blanca en los hallazgos ecográficos. Nos preocupan los datos de crecimiento y desarrollo, puesto que el 18 % de los pacientes no han alcanzado el P3 de peso a los 2 años de edad corregida (AU)

Objectives: To determine morbidity at 2 years’ corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid. Patients and methods: An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87 %) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient. Results: Among the patients initially included in the study, 87%completed the follow-up; 17.1 % had one or more major sequela. We found one case (0.4 %) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9%had a development quotient below 85 and 18 % had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings. Conclusions: Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years’ corrected age (AU)

[Guidelines for respiratory syncytial virus prophylaxis. An update]. / Recomendaciones para la prevención de la infección por virus respiratorio sincitial: revisión.

Epidemiological studies performed by the IRIS study group in the last two respiratory syncytial virus (RSV) seasons found that the hospitalization rates for RSV in premature infants born before or in week 32 of gestation were 13.4 % and 13.1 %, respectively. Of these, 18 % and 25 % of the infants were admitted to the intensive care unit. Currently available information demonstrates the efficacy of RSV monoclonal antibodies (palivizumab) and the absence of major adverse effects. To date, there are no data that indicate the need to modify the guidelines for RSV prophylaxis in premature infants published in 2000.