[Study of the introduction of the European Credit Transfer System (ECTS) in pediatrics and modification of the teaching methodology]. / Estudio sobre la introducción del Sistema de Transferencia de Créditos Europeo en Pediatría y modificaciones de la metodología docente.

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.

[Neonatal morbidity and mortality according to intrauterine growth pattern]. / Morbilidad y mortalidad de los recién nacidos según el patrón de crecimiento intrauterino.

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.

[Influence of growth hormone (GH) and nutrition on neonatal growth]. / Influencia de la GH y de la nutrición sobre el crecimiento en el periodo neonatal.

OBJECTIVE: At present, growth regulating factors in the transition from fetal to postnatal life remain unknown. The purpose of this study was to analyze the influence of GH and nutrition on neonatal growth. PATIENTS AND METHODS: Serum and 24-hour urine GH levels, various anthopometric variables and daily energy and nutrient intake were measured in appropriate (AGA), large (LGA) and small for gestational age (SGA) newborn infants. These variables were measured at 1 (n = 98), 3 (n = 41) and 5 weeks of postnatal age (n = 8). RESULTS: The highest GH levels at the 1st week of postnatal life were obtained in preterm SGA infants (GHs: 61.4 +/- 20.0 microUI/m; GHu: 18.6 +/- 10.3 ng/kg/24 h). GH levels decreased in preterm infants, so that differences between groups failed to be significant at the third and fifth weeks of postnatal life. Urinary GH excretion did not show significant variations in the control group during the study (1st wk 3.0 +/- 3.5; 3rd wk 2.3 +/- 2.7; 5th wk 3.2 +/- 4.7 ng/kg/24 h). Daily protein intake had a direct relationship with both triceps skinfold and weight and head perimeter increase. SGA preterm infants showed a higher fat increase compared to AGA preterm infants. Serum and urinary GH levels were not related to the anthopometric variables studied. CONCLUSIONS: There are differences in GH secretion and body composition between SGA and AGA preterm infants. GH probably does not contribute to neonatal growth.