Retinal ganglion cell complex thickness at school-age, prematurity and neonatal stressors.

PURPOSE: To investigate the association between the ganglion cell complex (GCC) thickness at early school-age and prematurity and other neonatal factors. METHODS: Cross-sectional study. The sample included very preterm children with gestational age (GA) below 32 weeks or birthweight below 1500 g enrolled in a follow-up program (n = 101) and a comparison group of term-born children (n = 49). Ganglion cell complex (GCC) thickness was measured at 4-8 years using high-quality optical coherence tomography (OCT) images. Data on neonatal and postnatal features were extracted from clinical records; analyses included mixed linear models. RESULTS: Ganglion cell layer (GCL) and retinal nerve fiber layer (mRNFL) were thicker in term than in preterm born children (2.9 µm and 2.4 µm respectively, p < 0.001). Within the preterm group, lower GA was associated with a decrease in total GCL (0.7 µm per week, p < 0.001). Being small for GA was associated with further thinning in both layers (1.4 and 2.8 µm). Postnatal corticosteroids therapy and severe brain lesion were associated with thinning in the total GCL of 6 µm (p < 0.001) and 4.1 µm (p = 0.002), respectively, and shock was associated with thinning in total mRNFL of 6 µm (p < 0.001). CONCLUSIONS: Lower GA or birthweight are associated with thinning of GCC layers. When performing an OCT examination at school-age and a decrease in GCC thickness is observed, it may be relevant to ask about a history of prematurity, and further enquire about neonatal shock, postnatal corticosteroids therapy or severe brain lesion that are related to additional decrease in GCC thickness.

Uso del Strength and Difficulties Questionnaire en prematuros para su evaluación psicosocial y cribado del trastorno por déficit de atención e hiperactividad / The use of strength and difficulties questionnaire in psychosocial evaluation and attention deficit hyperactivity disorder screening in preterm infants

Introducción: Los trastornos del comportamiento y del aprendizaje se describen con frecuencia en < 1.500 g o < 32 semanas (RNMBP/MP). Se dispone de muy poca información en población española. Objetivo: Identificar los problemas psicosociales de los RNMBP/MP mediante la aplicación del test Strength and Difficulties Questionnaire (SDQ) a los 6 años y comparar los resultados con los de una población de referencia. Establecer los puntos de corte para el uso del SDQ como cribado del trastorno por déficit de atención e hiperactividad (TDAH) en RNMBP/MP. Participantes y métodos: Estudio prospectivo observacional en RNMBP/MP evaluados a los 6 años con SDQ. Se recogen variables perinatales, neurodesarrollo y diagnóstico de TDAH mediante DSM-5. Resultados: Se incluyeron 214 niños con el total de las valoraciones. Comparados con la población de referencia obtuvieron puntuaciones significativamente mayores en síntomas emocionales, relaciones con compañeros y en el total del test. La escala de hiperactividad y la puntuación total se identifican como buenos predictores del diagnóstico de TDAH, con un área bajo la curva ROC de 0,83 y 0,87, respectivamente. Las puntuaciones que consiguen una adecuada sensibilidad para el cribado de TDAH son ≥ 6 para la escala de hiperactividad y ≥ 13 para la puntuación total del test, y una puntuación combinada ≥ 5 en hiperactividad junto con un total ≥ 12. Conclusiones: Los RNMBP/MP presentan más frecuentemente problemas emocionales y de relación que sus compañeros nacidos a término. El test SDQ podría utilizarse como una prueba de cribado para el TDAH

Introduction: Behavioural disorders and learning disabilities are often recognised in < 1,500g or < 32 weeks very low birth weight (VLBW) infants. There is very limited data in the Spanish population. Objective: To determine the presence of psychosocial disorders in preterm infants at 6 years of age, as assessed by the strength and difficulties (SDQ) questionnaire, in comparison to a reference population. To set a cut-off value to use SDQ as a screening tool for attention deficit hyperactivity disorder (ADHD) in the preterm child. Participants and methods: A prospective observational study was conducted on premature children assessed at 6 years of age using the SDQ. Perinatal variables, neurodevelopment, and diagnosis of ADHD, according to the DSM-5, were collected. Results: A total of 214 children who met all the requirements, were included. When compared with the reference population they had significantly higher scores in emotional symptoms, in peer relationships, and in the total score of the test. The hyperactivity scale and the total test score are good predictors of a diagnosis of ADHD, with an area under the ROC curve of 0.83 (95% CI: 0.76-0.90) for hyperactivity, and 0.87 (95% CI: 0.80-0.93) for the total score. The scores for hyperactivity and the total test, from which the screening for ADHD could be considered positive would be ≥ 6 and ≥ 13 respectively, and a combination of hyperactivity ≥ 5 and total score ≥ 12. Conclusions: Preterm children are at higher risk of emotional and peer relationship problems than those born full term. The SDQ test could be used for ADHD screening

[The use of strength and difficulties questionnaire in psychosocial evaluation and attention deficit hyperactivity disorder screening in preterm infants]. / Uso del Strength and Difficulties Questionnaire en prematuros para su evaluación psicosocial y cribado del trastorno por déficit de atención e hiperactividad.

INTRODUCTION: Behavioural disorders and learning disabilities are often recognised in<1,500g or<32 weeks very low birth weight (VLBW) infants. There is very limited data in the Spanish population. OBJECTIVE: To determine the presence of psychosocial disorders in preterm infants at 6 years of age, as assessed by the strength and difficulties (SDQ) questionnaire, in comparison to a reference population. To set a cut-off value to use SDQ as a screening tool for attention deficit hyperactivity disorder (ADHD) in the preterm child. PARTICIPANTS AND METHODS: A prospective observational study was conducted on premature children assessed at 6 years of age using the SDQ. Perinatal variables, neurodevelopment, and diagnosis of ADHD, according to the DSM-5, were collected. RESULTS: A total of 214 children who met all the requirements, were included. When compared with the reference population they had significantly higher scores in emotional symptoms, in peer relationships, and in the total score of the test. The hyperactivity scale and the total test score are good predictors of a diagnosis of ADHD, with an area under the ROC curve of 0.83 (95% CI: 0.76-0.90) for hyperactivity, and 0.87 (95% CI: 0.80-0.93) for the total score. The scores for hyperactivity and the total test, from which the screening for ADHD could be considered positive would be≥6 and≥13 respectively, and a combination of hyperactivity≥5 and total score≥12. CONCLUSIONS: Preterm children are at higher risk of emotional and peer relationship problems than those born full term. The SDQ test could be used for ADHD screening.

Model that predicted death or disabilities in premature infants was valid at seven years of age.

AIM: Validated a model that used bronchopulmonary dysplasia (BPD), brain injuries measured using ultrasound and retinopathy of prematurity (ROP) to predict late death or disability in premature infants at seven years of age. METHODS: A retrospective study was performed at the 12 de Octubre Hospital neonatal unit in Madrid. A logistic model was applied to estimate the independent prognostic contribution of each morbidity, and the effect that the combination of morbidities had on the seven-year outcomes. The analysis was performed on the total cohort from 1991 to 2008 and on two subcohorts from 1991 to 1998 and 1999 to 2008. RESULTS: A total of 1001 children were included with a mean birth weight of 922 ± 208 g. Severe ROP was strongly associated with poor neurodevelopment, with an odds ratio (OR) 3.17 and 95% confidence interval (CI) of 1.56-6.50, and so was BPD (OR 1.52, 95% CI: 1.03-2.2). The combination of two neonatal morbidities increased the risk of a poor outcome (OR 4.44, 95% CI: 1.51-7.86). The model behaved differently in the two subcohorts. CONCLUSION: The prognostic model predicted a poor outcome at seven years of age when the subjects had at least two of the three morbidities.

Developmental Outcomes, Attachment and Parenting: Study of a Sample of Spanish Premature Children.

The aim of this study is to provide an overview of the development of premature children, including attachment, child psychological adjustment and parental variables. 130 children < 1,500 g or < 32 weeks at birth from two public hospitals, assessed at two years corrected age, together with their parents. Parental socio-demographic data was collected. Infant development, attachment and child psychological adjustment were evaluated, as was parental stress. The percentage of preterm children with developmental delays ranged from 5% to 21%. Girls tend to show higher levels of development than boys with effect sizes ranging from small, η2p = .02, to medium, η2p = .07. Secure attachment was the most frequent pattern in the sample. No significant differences, p < .05, between preterm children and the normative population were found on children´s behavioral problems and maternal stress levels. Despite the fact prematurity is considered to be a risk factor for a child´s development, a significant proportion of these children do not show problems in terms of developmental levels, attachment pattern and maternal stress. However, socio-emotional and affective domains, as well as psychological support programs for parenthood, should be followed up from a multidisciplinary perspective.

Protocolo de seguimiento para el recién nacido menor de 1.500 g o menor de 32 semanas de edad gestación / Follow-up protocol for newborns of birthweight less than 1500 g or less than 32 weeks gestation

La mortalidad de los niños nacidos con peso menor de 1.500 g o con una edad gestacional menor de 32 semanas (<1.500 < 32) ha disminuido significativamente en las últimas décadas. Dado el mayor riesgo de discapacidad de estos niños, el seguimiento tras el alta hospitalaria se considera muy necesario. En este documento, el Grupo de Seguimiento de la Sociedad Española de Neonatología, en colaboración con la Asociación Española de Pediatría de Atención Primaria, propone un protocolo de seguimiento específico para los < 1.500 < 32, cuyo objetivo es estandarizar las actividades y evaluaciones según los criterios de buena práctica

The mortality of children with a birthweight of less than 1500 g or with a gestational age of less than 32 weeks (<1500 < 32) has decreased significantly in the last 20 years or so. Given the higher risk of disability in these children, follow-up after hospital discharge is considered essential. In this document, the Follow-Up Group of the Spanish Society of Neonatology, in collaboration with the Spanish Society of Paediatric Primary Care, propose a follow-up protocol specific for the < 1500 < 32, which has as its aim to standardise the activities and evaluations according to good practice criteria

[Follow-up protocol for newborns of birthweight less than 1500 g or less than 32 weeks gestation]. / Protocolo de seguimiento para el recién nacido menor de 1.500 g o menor de 32 semanas de edad gestación.

The mortality of children with a birthweight of less than 1500g or with a gestational age of less than 32 weeks (<1500<32) has decreased significantly in the last 20 years or so. Given the higher risk of disability in these children, follow-up after hospital discharge is considered essential. In this document, the Follow-Up Group of the Spanish Society of Neonatology, in collaboration with the Spanish Society of Paediatric Primary Care, propose a follow-up protocol specific for the<1500<32, which has as its aim to standardise the activities and evaluations according to good practice criteria.

Developmental outcomes, attachment and parenting: study of a sample of Spanish premature children

The aim of this study is to provide an overview of the development of premature children, including attachment, child psychological adjustment and parental variables. 130 children < 1,500 g or < 32 weeks at birth from two public hospitals, assessed at two years corrected age, together with their parents. Parental socio-demographic data was collected. Infant development, attachment and child psychological adjustment were evaluated, as was parental stress. The percentage of preterm children with developmental delays ranged from 5% to 21%. Girls tend to show higher levels of development than boys with effect sizes ranging from small, η2p = .02, to medium, η2p = .07. Secure attachment was the most frequent pattern in the sample. No significant differences, p < .05, between preterm children and the normative population were found on children's behavioral problems and maternal stress levels. Despite the fact prematurity is considered to be a risk factor for a child's development, a significant proportion of these children do not show problems in terms of developmental levels, attachment pattern and maternal stress. However, socio-emotional and affective domains, as well as psychological support programs for parenthood, should be followed up from a multidisciplinary perspective

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Improving nutritional practices in premature infants can increase their growth velocity and the breastfeeding rates.

AIM: This study analysed the changes in growth velocity (GV) of preterm infants weighing <1500 g based on different nutritional practices over a 24-year period. METHODS: A retrospective study with prospectively collected data was performed in a level three Spanish neonatal intensive care unit. Data on birthweight, gestational age (GA) and GV were collected from 1990 to 2013 and breastfeeding data were gathered from 2000. A generalised linear model corrected by GA and small for gestational age was applied. Multiple mean comparisons between the levels of the variables of interest were performed using the Tukey test. RESULTS: We included 1651 children in the study. The average GA in 1990-1991 was 30.48 ± 2.89 and the average GA in 2012-2013 was 28.79 ± 2.58 (p < 0.01). Significant differences were found when we compared the adjusted GV between the first and last study periods. The most important differences appeared between 1990 and 2013, when the GV increased by 3.27 ± 0.5 g/kg/day (p < 0.01). The breastfeeding rate in 2000-2001 was 47.95% and in 2012-2013 it was 73.58% (p = 0.0002). CONCLUSION: Introducing nutritional practices such as the increased use of breastmilk and the breastfeeding rate improved GV over the study period.

Juvenile granulosa cell tumor of the testis: case report and review of literature.

Juvenile granulosa cell tumor of the testis is an infrequent tumor of the gonadal stroma characteristic of the pediatric age. It usually appears as a scrotal mass and less frequently as an abdominal or inguinal mass. It may be associated with ambiguous genitalia and/or abnormal sex chromosomes. The recommended treatment is orchiectomy alone because local recurrence or metastasis have never been observed. We describe a patient with a juvenile granulosa cell tumor of the testis and review the literature.