RESUMO
ROP screening is carried out at all the Spanish hospitals, but there is little agreement on the criteria used for its screening and other aspects related to its practice. Our aim is to report on recommendations for prevention, screening, treatment and follow-up of the retinopathy of prematurity in Spain. Prevention strategies and recommendations for screening, exploration and treatment of ROP, as well as of the organisation of the services to carry out it are reviewed. The most recent bibliography on the basis of the scientific evidence is considered, taking as reference, the guidelines published by the American Academy of Pediatrics (AAP) in 2006 and the recommendations updated in 2007 in the United Kingdom. The recommended prevention strategies are based on the best neonatal practice. The standards, as far as the screening is concerned, are established by birth weight (< or =1,500 g), gestational age (< or =32 weeks) and unstable neonatal clinical course. Indirect ophthalmoscopy is the standard technique for exploration and laser therapy the treatment of choice.
Assuntos
Triagem Neonatal , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/terapia , Humanos , Recém-Nascido , Retinopatia da Prematuridade/prevenção & controleRESUMO
INTRODUCTION: Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. OBJECTIVES: To test the introduction of the ECTS in pediatrics and modify the teaching methodology. STUDY DESIGN: The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. RESULTS: Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. CONCLUSIONS: Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated.
Assuntos
Educação Médica/normas , Cooperação Internacional , Pediatria/educação , Desenvolvimento de Programas , Ensino/métodos , Ensino/normas , Logro , Currículo/normas , Europa (Continente)Assuntos
Confusão/etiologia , Intoxicação/complicações , Adolescente , Confusão/diagnóstico , Feminino , HumanosRESUMO
OBJECTIVE: To evaluate the influence of intrauterine growth on neonatal morbidity and mortality in live neonates born in a regional tertiary care center. PATIENTS AND METHODS: A retrospective cohort study was performed. Data from 12,311 live neonates (LN) born in our hospital (from January 1999 to December 2003) were reviewed to analyze neonatal morbidity and mortality according to whether the LN were appropriate (AGA), small (SGA) or large (LGA) for gestational age. The variables collected from birth to hospital discharge were: gestational abnormalities, gender, delivery type, Apgar score, respiratory distress, presentation of obstetric trauma (including cephalohematomas), hypoglycemia, hypocalcemia, hyperbilirubinemia, congenital malformations, heart disease, and type of hospital discharge. Differences were examined among groups. We used the chi-squared test to compare the frequency of these variables in each group. RESULTS: Data from 12,311 LN were entered into the database; 11,182 (90.8%) were AGA, 743 (6.1%) were LGA and 386 (3.1%) were SGA. There were 52.58% boys and 47.42% girls, and 5.5% of LN had macrosomia (birth weight > 4,000 g). A total of 0.39% of LN died before hospital discharge. Among LN, there were 1,215 preterm infants, representing 9.89% of all LN and 2.63% died (SGA 25% and AGA 75%). There was a prevalence of boys in the LGA group and of girls in the SGA group (p = 0.000). The presence of maternal diabetes (pregestational or gestational) was significantly higher (p = 0.000) in the LGA group. Maternal hypertension, smoking and drug addiction were significantly higher in the SGA group. The finding of obstetric trauma was significantly higher in the LGA group (p = 0.000). The proportion of congenital malformations, hypocalcemia and hypoglycemia was higher in the SGA group than in the AGA and LGA groups (p = 0.000). Neonatal mortality was significantly higher (p = 0.000) in the SGA group and preterm infants. CONCLUSIONS: Neonates with deviations in the pattern of intra-uterine growth had worse outcome. Prognosis was worse in SGA neonates, followed by LGA neonates, than in AGA neonates.
Assuntos
Desenvolvimento Fetal , Doenças do Recém-Nascido/epidemiologia , Estudos de Coortes , Humanos , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Estudos RetrospectivosRESUMO
The outcome of 45 neonates with EEG-confirmed seizures (ESz) was analyzed with regard to treatment. ESz persisted in 17 of 32 neonates receiving phenobarbital/phenytoin (13 had a poor outcome, 4 died). In contrast, ESz were rapidly controlled in 13 of 13 nonresponders to phenobarbital/phenytoin treated with midazolam (4 had poor outcome, 2 died). Nonresponders to phenobarbital/phenytoin had a significantly worse outcome than responders did. Midazolam effectively controlled ESz in nonresponders to phenobarbital/phenytoin and correlated with significantly improved long-term neurodevelopment.
Assuntos
Epilepsia Neonatal Benigna/tratamento farmacológico , Midazolam/administração & dosagem , Fenobarbital/administração & dosagem , Convulsões/tratamento farmacológico , Fatores Etários , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Encéfalo/efeitos dos fármacos , Encéfalo/crescimento & desenvolvimento , Encéfalo/fisiopatologia , Relação Dose-Resposta a Droga , Resistência a Medicamentos/fisiologia , Eletroencefalografia , Epilepsia Neonatal Benigna/diagnóstico , Epilepsia Neonatal Benigna/fisiopatologia , Moduladores GABAérgicos/administração & dosagem , Moduladores GABAérgicos/efeitos adversos , Moduladores GABAérgicos/uso terapêutico , Humanos , Recém-Nascido , Midazolam/efeitos adversos , Midazolam/uso terapêutico , Fenobarbital/efeitos adversos , Fenobarbital/uso terapêutico , Estudos Retrospectivos , Convulsões/diagnóstico , Convulsões/fisiopatologia , Resultado do TratamentoRESUMO
INTRODUCTION: Neonatal convulsions continues being motive for multiple controversies: the diagnosis only by clinical approaches, the necessity to confirm with EEG record and their treatment and control. OBJECTIVE: To establish the incidence of type of clinical neonatal seizures and the correspondence of these to the EEG trace background and the EEG epileptic activity, the underlying etiology, the response to antiepileptic treatment, and their prognosis. PATIENTS AND METHODS: Retrospective study of admitted newborns with the diagnosis of neonatal seizures in our hospital, during the period included between January 1993 and October 2001. Some of variables collected were: birth and gestational age, Apgar, clinical pattern, duration of the convulsions, critical and intercritical EEG traced, EEG background, etiological diagnosis, treatment used and response of the same, evolution and neurological state at hospital discharge and at one year of age (corrected age in preterm infants). RESULTS: 74 children were admitted with neonatal convulsion diagnosis, of these only 56 EEG convulsions were confirmed (42% presented subtle seizures, 33.9% tonic, 64.3% clonic multifocal, 10.7% clonic focal, and 16.1% myoclonic multifocal). 55.4% of the infants had 2 or more types of clinical convulsions, 25% of all had an epileptic state, and 42.9% had at some time of the EEG record, electroclinical dissociation. The more frequent critical EEGs abnormalities was multifocal discharges (64.3%), and together with the focal discharges of low frequency had significant (p<0.01) worse pharmacological control, and also unfavourable outcome. The infants having had EEGs background moderately and markedly abnormal showed unfavourable outcome in 72.2% and 100% respectively, while it was only in 15.4% of the infants who had EEGs background normal or lightly abnormal. With the antiepileptic treatment the clinical control of the convulsions was obtained in more than 80% of the cases, while control of the electrical convulsions was only in 62.5%. There was a higher significant association between favourable response to treatment and normal neurological examination at hospital discharge and at 1 year of age. CONCLUSIONS: The necessity to confirm by means of EEG record the neonatal clinical convulsions, before and after having established the anticonvulsant treatment, due to the control of electrical convulsions improves their neurological outcome.
Assuntos
Eletroencefalografia , Espasmos Infantis/fisiopatologia , Anticonvulsivantes/uso terapêutico , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Prognóstico , Estudos Retrospectivos , Espasmos Infantis/diagnóstico , Espasmos Infantis/tratamento farmacológico , Espasmos Infantis/etiologia , Resultado do TratamentoRESUMO
OBJECTIVE: The aims of this study were to evaluate the relationship between pediatric health care visits and immunization coverage. PATIENTS AND METHODS: The study was made in a rural health care center. All of the children between 3 months and 14 years old were included. The data were obtained directly from their clinical histories. The quality of the health care visits was evaluated according to the fulfillment of A.E.P. patterns of health care. RESULTS: We observed that 87% of infants, 74% of preschool children and 74% of school children were correctly vaccinated. We observed a significantly lower (p < 0.05) coverage of the MMR vaccine in respect to the first three doses of DPT and OPV vaccines; and the coverage of OPV and DT at 6 years old was even lower. The quality of health care visits was good in 67% of infants, 10% of preschool children and 12% of school children. There was a relationship between incomplete vaccinations and missed visits (p < 0.001) and also with low quality health care visits (p < 0.001). CONCLUSIONS: We conclude that there is a significant relationship between missed visits and low quality health care visits with delayed immunization.
Assuntos
Serviços de Saúde/economia , Visita a Consultório Médico , Pediatria/economia , Vacinação/economia , Adolescente , Criança , Pré-Escolar , Promoção da Saúde , Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , População Rural , EspanhaRESUMO
In order to check the prognostic implications of EEG tracings in hypoxic-ischemic encephalopathy (HIE), we carried out prospective EEG recordings in 116 newborn babies (65 term and 51 premature) admitted to our neonatal intensive care unit as a result of perinatal asphyxia. Forty term neonates were found to have critical and/or intercritical epileptiform EEG alterations; the developmental results of 23 of these cases (57.5%) were adverse and were favorable in 17 cases (42.5%). Given that unfavorable results occurred in only 4 of the other 25 term neonates, the epileptiform EEG alterations were statistically significant for adverse developmental results (p < 0.005). Of the premature neonates, 29 were found to have critical and/or intercritical epileptiform EEG alterations. The developmental results were adverse in 19 of these children (65.5%) and favorable in 10 cases (34.8%). The statistical evaluation in this case showed a barely significant difference (p < 0.005) between epileptiform EEG alterations and poor developmental outcome when uncorrected age was used, and no statistically significant difference when corrected age was used. Thus, we conclude that although epileptiform EEG anomalies may serve as markers for neurological development impairments, they must be considered in conjunction with the background EEG tracing.
Assuntos
Asfixia Neonatal/diagnóstico , Isquemia Encefálica/diagnóstico , Eletroencefalografia , Epilepsia/diagnóstico , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Prognóstico , Estudos ProspectivosRESUMO
We have performed a prospective study in 65 asphyxiated term newborns to evaluate the prognostic value of three different methods: 1) Neurological examination, 2) Electroencephalographic tracings (EEGs) and 3) Transfontanellar sonography, carried out periodically from birth until discharged from the neonatal unit. The neurological status of surviving infants was assessed at one year of age. We found a statistically significant (p < 0.0001) association between the neurological examination, electroencephalographic tracings and transfontanellar sonography during the neonatal period and the neurological development. The prognostic value, as a function of sensibility, specificity and predictive value of the three methods was very high. No differences were found among them, although the EEGs and neurological examinations showed the highest predictive values.
Assuntos
Asfixia Neonatal/diagnóstico , Asfixia Neonatal/etiologia , Ecoencefalografia , Eletroencefalografia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Exame Neurológico , Valor Preditivo dos Testes , Prognóstico , Estudos ProspectivosRESUMO
We have performed serial trans-fontanelle sonography on 69 newborns with perinatal asphyxia. Ten neonates presented high ultrasonic density in the thalamus and the basal ganglia. These images were preceded, in eight of them, by diffuse echoes for all of the CNS, corresponding to cerebral edema. The most significant clinical findings were convulsions and important depression of conscience level and muscular tone. Eight of ten newborns presented major abnormalities in the electroencephalogram (severe depression of background). Since its coexistence with other parenchymal lesions and poor neurologic development, we consider the ganglio-thalamic ultrasonic densities to be a sign of severe ischemic hypoxic cerebral damage.
Assuntos
Doenças dos Gânglios da Base/diagnóstico , Encefalomalacia/diagnóstico , Doenças Talâmicas/diagnóstico , Ultrassonografia , Humanos , Recém-Nascido , Leucomalácia Periventricular/diagnósticoRESUMO
Authors studied in a total of 189 newborns, incidence of minor and variant malformation normalities, excluding craniofacial ones (already analyzed in a previous paper). After grouping the results in different corporal zones where these could be found, they find a greater incidence, in the cutaneous system and less in other corporeal areas. Since results differ mainly from those which already exist, therefore, they think that new studies are necessary in distinct geographic areas due to variation o their incidence in them.
Assuntos
Anormalidades Congênitas , Anormalidades Congênitas/classificação , Anormalidades Congênitas/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , EspanhaRESUMO
Authors have studied the presence of minor variant malformations of craniofacial normalities in 189 newborns. Results were grouped according to different anatomical areas where they settled. They have found a greater expressiveness of minor anomalies and, above all, in the auricular external car and, in minor proportion, in the nose and ocular orbs. Results are similar in some cases with the scarce preexistent data, but they differ meaningly with others; maybe that this is produced by the own distinct geographic areas variations.