[Psychomotor development in late premature newborns at five years. Comparison with term newborns using the ASQ3®]. / Desarrollo psicomotor en prematuros tardíos a los cinco años de edad: comparación con recién nacidos a término mediante ASQ3®.

INTRODUCTION: Late prematures (LP) belong to a subgroup of many premature babies with a risk of delayed psychomotor development (PMD). Many subtle changes pass unnoticed if adequate assessment tools are not used. The Ages & Stages Questionnaires 3® (ASQ3®) for parents appears simple and useful for the detection of risk of impairment of PMD, and is recommended by scientific societies that study LP. OBJECTIVES: To evaluate the risk of impaired PMD in LP at 5years-old, and compare them with term newborns (TNB) using the ASQ3. PATIENTS AND METHODS: Data were collected on the LP born in a third level hospital in 2010, as well as 2TNB of the same gender for each LP. The prenatal and postnatal morbidity variables were compared. At 5years, their families (excluding those with other neurological risks) were asked to complete the ASQ3. The cut-off point was determined for the total score of the ASQ3 that would discriminate the risk of PMD impairment using ROC analysis. The cut-off point to determine a change in each domain was obtained according to the ASQ3 manual. RESULTS: The ASQ3 was completed for 88 (47%) and 131 (35%) TNB. All the overall mean scores and those for domains were lower in LP, with no significant differences found between the two groups. A risk of PMD impairment (≤253 points) was observed in 7LP compared to 4TNB, with no significant difference. More maternal, foetal, and neonatal illnesses were observed in 195LP than in the 390TNB. In the univariate analysis, male gender and restricted uterine growth (RUG) were factors associated with a risk of PMD impairment and only RUG in the multivariate analysis. CONCLUSION: The risk of PMD impairment between LP and TNB at 5years appears not to be shown, with no significant differences between both, and with the values obtained in the ASQ3 being slightly lower in the LP. Male gender and RUG negatively influence this risk.

Influencia externa en los partos: efecto lunar gravitacional y meteorológico / External influences on birth deliveries: Lunar gravitational and meteorological effects

OBJETIVO: Investigar la influencia externa tanto lunar como climatológica en la frecuencia de partos. Incluye fuerza gravitacional lunar mediante apogeo y perigeo lunar apenas investigado. MATERIAL Y MÉTODOS: Estudio retrospectivo mediante revisión de historias clínicas de todos los partos únicos de inicio espontáneo durante un periodo de 4 años (2015-2018). Se analiza estadísticamente la relación de los partos mediante coeficiente de nacimientos con variables cualitativas lunares (4 fases clásicas, apogeo-perigeo lunar y superlunas) y variables cuantitativas atmosféricas (presiones atmosféricas medias, temperatura media y velocidad media del viento). RESULTADOS: No se encontró relación entre las variables estudiadas y el coeficiente de nacimientos. Se encontró periodicidad de partos con más nacimientos en los meses de mayo y junio. CONCLUSIÓN: Pese al mito existente de la influencia meteorológica y, sobre todo, lunar en los partos, no se encuentra razón estadística que lo apoye. Además de las fases clásicas, la fuerza gravitacional lunar tampoco parece desencadenar el parto

OBJECTIVE: To investigate the influence of external factors such as lunar and meteorological effects on the frequency of birth deliveries. It includes the lunar gravitational force using the scarcely investigated lunar apogee and perigee (furthest and closest distance to earth, respectively). MATERIAL AND METHODS: A retrospective study was conducted by reviewing the medical records of all spontaneous single deliveries during a 4 year period (2015-2018). A statistical analysis was performed on the relationship of the deliveries using birth rates with qualitative lunar variables (four classic phases, lunar apogee- perigee, and super moons) and quantitative atmospheric variables (mean atmospheric pressures, mean temperature, and mean wind velocity). RESULTS: No relationship was found between the variables studied and the birth rate. There were periods with more births in the months of May and June. CONCLUSION: Despite the myth on the meteorological, and in particular, the lunar influence on birth deliveries, no statistical association was found to support this. Furthermore, the classic moon phases and the lunar gravitational force do not seem to trigger birth delivery either

Adherencia a las recomendaciones de la Guía RECORD en los pacientes con diabetes mellitus tipo 1 menores de 18 años / Adherence to the RECORD Guidelines in patients with type 1 diabetes aged under 18

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Hipoglucemia secundaria a hiperinsulinismo en un paciente con síndrome de QT largo congénito / Hipoglycemia secondary to hyperinsulinism in a patient with congenital long QT syndrome

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[External influences on birth deliveries: Lunar gravitational and meteorological effects]. / Influencia externa en los partos: efecto lunar gravitacional y meteorológico.

OBJECTIVE: To investigate the influence of external factors such as lunar and meteorological effects on the frequency of birth deliveries. It includes the lunar gravitational force using the scarcely investigated lunar apogee and perigee (furthest and closest distance to earth, respectively). MATERIAL AND METHODS: A retrospective study was conducted by reviewing the medical records of all spontaneous single deliveries during a 4 year period (2015-2018). A statistical analysis was performed on the relationship of the deliveries using birth rates with qualitative lunar variables (four classic phases, lunar apogee- perigee, and super moons) and quantitative atmospheric variables (mean atmospheric pressures, mean temperature, and mean wind velocity). RESULTS: No relationship was found between the variables studied and the birth rate. There were periods with more births in the months of May and June. CONCLUSION: Despite the myth on the meteorological, and in particular, the lunar influence on birth deliveries, no statistical association was found to support this. Furthermore, the classic moon phases and the lunar gravitational force do not seem to trigger birth delivery either.

Tumefacción en región malar en un neonato / Swelling in the malar region in a neonate

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Transient phenylketonuria in premature infants.

Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine (phe) metabolism caused by a deficiency in the enzyme phenylalanine hydroxylase that converts phe into tyrosine. If left untreated, PKU results in increased phe concentrations in the blood and in the brain, which cause severe intellectual disability, epilepsy, and behavioral problems. These disorders can be prevented if a diet low in phe is introduced. This report focuses on a preterm newborn (gestational age 29 wk) with adequate weight (1290 g) and no family history of PKU. His parents had not received metabolic neonatal screening. A blood sample at 16 d of age and a weight of 1430 g showed phe 420 µmol/L, compatible with mild PKU. Mixed feeding was initiated with a formula free of phe (X-Phe), and breastfeeding was fortified with a contribution of 3.5 g/kg daily (2.5 g X-Phe and 1 g of high-value biological proteins). The next measurements of amino acid levels in the blood and urine were normal, and the progenitors study for PKU was negative. Normal feeding was reintroduced with normal neurologic and metabolic later evolution. The disorders of the metabolism of phe, in most cases, are due to a genetic condition. However, there are infrequent cases of transient hyperphenylalaninemia secondary to delayed maturation of the hydroxylation enzyme system. They are especially significant in premature infants. Although these forms have not been shown to cause sequelae, in view of high levels of phe in the blood, phe consumption must be restricted.

Desarrollo psicomotor en pacientes con cardiopatía congénita grave / Psychomotor development in patients with severe congenital heart disease

Objetivo. Analizar los hitos motores alcanzados en los dos primeros años de vida en pacientes con cardiopatía congénita grave. Pacientes y métodos. De 89 pacientes con cardiopatía congénita grave, 19 fueron excluidos por antecedentes de prematuridad o cromosomopatía, cuatro por antecedente de ictus isquémico y dos por ausencia de historia clínica. Se obtuvieron resultados del test de Denver (TD) a los 2, 6, 12, 15 y 18 meses, y resultados en los campos motor, del lenguaje y de interacción social. Resultados. El 59,4% fueron varones, y el 40,6%, mujeres. La edad media de los pacientes sometidos a oxigenación con membrana extracorpórea con TD patológico a los 18 meses fue de 3 meses, frente a 11,88 meses de los que presentaban un TD normal. El TD a los 2 meses resultó normal en el 98,4% de los pacientes, en el 87,5% a los 6 y 12 meses, en el 81,3% a los 15 meses, y en el 85% a los 18 meses. Dos de los pacientes con alteración en el neurodesarrollo normalizaron el TD antes de los 24 meses. El campo del neurodesarrollo más afectado fue el del lenguaje (15,6%), seguido del motor (10,9%) y de la interacción social (8%). Conclusiones. El retraso en el desarrollo psicomotor, especialmente en el área del lenguaje, es más frecuente en pacientes con cardiopatías congénitas graves, y la presencia de cianosis y la necesidad de circulación con membrana extracorpórea son las variables que más se asocian con este tipo de patología

Aim. Retrospective analysis of the neurodevelopment in the first two years of life in patients with severe congenital heart disease. Patients and methods. Out of 89 patients with severe congenital heart disease 19 were excluded due to a history of prematurity and/or chromosomopathy, four due to a history of ischemic stroke and two due to lack of medical history. Denver Test (DT) results at 2, 6, 12, 15 and 18 months, and results in motor, language and social interaction fields were achieved. Results. 59.4% were male and 40.6% female. The mean age of patients undergoing extracorporeal membrane oxygenation with pathological DT at 18 months was 3 months, compared to 11.88 months in those with normal DT. DT at 2 months was normal in 98.4% of patients, 87.5% at 6 and 12 months, 81.3% at 15 months and 85% at 18 months. Two patients with abnormal neurodevelopment normalized the DT before 24 months. The field of neurodevelopment most affected was language (15.6%), followed by motor (10.9%) and social interaction (8%). Conclusions. Psychomotor development delay, especially in the area of language, is more frequent in patients with severe congenital heart disease. The presence of cyanosis and the need for extracorporeal membrane oxygenation were the variables that are most associated with this type of pathology