Antibiotic use in infants at risk of early-onset sepsis: results from a unicentric retrospective cohort study.

BACKGROUND: Antibiotic use for early-onset sepsis represents a high percentage of antibiotic consumption in the neonatal setting. Measures to assess infants at risk of early-onset sepsis are needed to optimize antibiotic use. Our primary objective was to assess the impact of a departmental guideline on antibiotic use among term infants with suspected EOS not confirmed, in our neonatal unit. METHODS: Retrospective cohort study, to compare antibiotic use in term infants during a baseline period of January to December 2018, and a postintervention period from October 2019, to September 2020, respectively. The primary outcome was antibiotic use measured by days of therapy, the antibiotic spectrum index, the antibiotic use rate, and the length of therapy. RESULTS: We included 71 infants in the baseline period and 66 infants in the postintervention period. Compared to those in the baseline period, there was a significant reduction in overall antibiotic measures in the postintervention period, (P < 0.001). The total days of therapy/1000 patient-days decreased from 63/1000 patient-days during the baseline period to 25.8/1000 patient-days in the postintervention period, representing a relative reduction of 59%. The antibiotic use rate decreased by more than half of the infants, from 3.2% during the baseline period to 1.3% in the postintervention period. CONCLUSIONS: The use of a departmental guideline to assess infants at risk of early-onset sepsis based on their clinical condition and prompt discontinuation of antibiotics, is a simple and low-cost measure that contributed to an important decrease in antibiotic use.

Dosis de radiación por radiografías y factores asociados en neonatos de la Unidad de Recién Nacidos del Hospital Universitario San Ignacio, Bogotá, Colombia / X-ray radiation dose and associated factors in neonates from the newborn unit of Hospital Universitario San Ignacio, Bogotá, Colombia

Introducción. Las radiografías continúan usándose ampliamente, subestimando los riesgos. Esto sucede, especialmente, en las unidades de cuidado neonatal, lo que implica que los neonatos reciben una dosis de radiación ionizante mayor que los adultos. Objetivo. Cuantificar las dosis de radiación recibidas al tomar radiografías y evaluar los posibles factores asociados con el aumento de la dosis. Materiales y métodos. Se llevó a cabo un estudio observacional de 160 neonatos de la Unidad de Recién Nacidos del Hospital Universitario San Ignacio, Bogotá, Colombia. Se consideró como variable dependiente la dosis de entrada en piel por cada radiografía. Se hizo la caracterización de los pacientes, seguida de un análisis multivariado con regresión lineal múltiple para identificar factores asociados. Resultados. Se analizaron 160 pacientes y 492 radiografías en total. Entre los hallazgos más frecuentes, se encuentran: pacientes de sexo masculino (n=87; 54,4 %), nacimiento por cesárea (n=122; 76,3 %) e indicación de toma de radiografías por dificultad respiratoria (n=123; 24,9 %). El 1,8 % (n=9) de los pacientes no tenían una indicación para la toma de la radiografía. La radiografía más frecuente fue la de tórax (n=322; 65,4 %). La mayoría de las radiografías se tomaron con el equipo computarizado (n=352; 71,5 %) y no con el digital (n=140, 28,4 %). La mediana de la dosis de entrada en piel con el equipo computarizado fue de 0,112 mGy (0,022; 0,134 mGy) y, con el equipo digital, de 0,020 mGy (0,019, 0,022 mGy). Conclusiones. Se cuantificaron las dosis de radiación absorbida en neonatos, general y específica, con el equipo computarizado y el digital. Se identificaron mayores dosis con el equipo computarizado. Se reconoció la interacción entre el equipo computarizado con menores edades gestacionales corregidas como principal factor para el aumento de la dosis. Además, se reconoció la relación entre el equipo computarizado y una menor edad gestacional corregida, como principal factor para una mayor dosis.

Introduction. Radiographs are still widely used, underestimating the risks. This situation is frequent in neonatal care units, generating radiation doses than in adults. Objective. To quantify the received radiation doses when performing radiographs on neonates and the possible factors associated with higher doses. Materials and methods. We performed an observational study of 160 neonates from the newborn unit of the Hospital Universitario San Ignacio, Bogotá, Colombia. We considered the input dose of each radiograph as the dependent variable. Patients were characterized and a multivariate analysis with multiple linear regression was performed to identify associated factors. Results. We analyzed 160 newborns and 492 radiographs. The most frequent findings were male patients (n=87, 54.4%), cesarean delivery (n=122, 76.3%), and radiograph indication for respiratory distress (n=123, 24.9%). One-point eight percent of the patients (n=9) did not have radiograph indication. The most frequently taken radiograph was chest (322, 65.4%). Most radiographs were taken with a computerized equipment (n=352, 71.5%), compared to a digital one (n=140, 28.4%). The median input dose with computerized equipment was 0.112 mGy (0.022, 0.134 mGy), and with the digital equipment was 0.020 mGy (0.019, 0.022 mGy). Conclusions. The general and specific absorbed radiation doses were measured in neonates with a computerized and a digital equipment. We identified higher doses with the computerized equipment. In addition, it was recognized the correlation between computerized radiography equipment with lower corrected gestational ages as the main factor for dose increase.

Associations of Dietary Intake and Nutrient Status with Micronutrient and Lipid Composition in Breast Milk of Donor Women.

The influence of the diet and nutritional status of milk donors on the nutritional composition of donor human milk (DHM) is unknown. The present study aimed to determine the nutritional profile of DHM and the associations between donors' dietary intake and nutritional status and the micronutrient and lipid composition in DHM. For this purpose, 113 donors completed a food frequency questionnaire, provided a five-day weighed dietary record, and collected milk for five consecutive days. Nutrient determinations in donors' erythrocytes, plasma, urine, and milk were performed. Multiple linear regressions were conducted for the evaluation of the associations. We highlight the following results: DHM docosahexaenoic acid (DHA) was positively associated with donors' plasma DHA content and donors' DHA intake (R2 0.45, p < 0.001). For every 1 g/day DHA intake, an increase of 0.38% in DHA content and 0.78% in total omega-3 content was observed in DHM (R2 0.29, p < 0.001). DHM saturated fatty acids were positively associated with erythrocyte dimethyl acetals, plasma stearic acid, trans fatty acids intake, and breastfeeding duration and negatively associated with erythrocyte margaroleic acid (R2 0.34, p < 0.01). DHM cholecalciferol was associated with plasma cholecalciferol levels and dairy intake (R2 0.57, p < 0.01). Other weaker associations were found for free thiamin, free riboflavin, pyridoxal, dehydroascorbic acid, and the lipid profile in DHM. In conclusion, the diet and nutritional status of donors influence the fatty acid profile and micronutrient content of DHM.

Follow-up of Kangaroo Mother Care programmes in the last 28 years: results from a cohort of 57 154 low-birth-weight infants in Colombia.

BACKGROUND: Kangaroo Mother Care (KMC) is an evidence-based intervention focused on premature and low-birth-weight (LBW) infants. In different healthcare systems, outpatient KMC programmes (KMCPs) have been pioneers in the follow-up of these high-risk newborns.Here, we describe an overview analysis performed in an unprecedented data set comprising Colombian infants and spanning 28 years. METHODS: Cohort study of 57 154 infants discharged home in kangaroo position (KP) for follow-up in four KMCPs between 1993 and 2021. RESULTS: At birth and at hospital discharge to a KMCP, median gestational age and weight were 34.5 and 36 weeks, 2000 g and 2200 g, respectively. Chronological age at admission was 8 days. Over time, anthropometric measures at birth and somatic growth during follow-up improved; on the other hand, percentages of mechanical ventilation, intraventricular haemorrhage and need for intensive care decreased as neuropsychomotor, sensory disorders and bronchopulmonary dysplasia incidence at 40 weeks. Risk of cerebral palsy and teenage mothers' frequency was higher in the poorest population. Early home discharge in KP in less than 72 hours was possible in 19% of the cohort. During the COVID-19 pandemic, we observed a more than twofold increase in exclusive breast feeding at 6 months and a reduction in readmission rates. CONCLUSION: This study provides a general overview of KMCPs follow-up during the last 28 years within the Colombian healthcare system. These descriptive analyses have allowed us to structure KMC as an evidence-based method. KMCPs allow close monitoring with regular feedback about preterm or LBW infants' perinatal care, quality of care over time and health status during their first year of life. Monitoring these outcomes is challenging but guarantees access to high-risk infants' care with equity.

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm.

AIM: The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood. METHOD: Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20-year-old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure. RESULTS: The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct relationship between brain volumes and duration of KMC, after controlling for potential confounders. CONCLUSION: Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.

Randomized Clinical Trial of Metoclopramide as Prophylaxis of Gastroesophageal Reflux Disease in Preterm Infants.

BACKGROUND: Gastroesophageal reflux (GER) is more frequent in premature infants. Metoclopramide was introduced routinely in premature babies followed in ambulatory care by the Colombian Kangaroo Mother Care program (KMCP), based on a 2004 Cochrane review. AIM: Because of the recent controversy on the use of metoclopramide in children, this study was conducted to evaluate the effectiveness and safety of metoclopramide given as GER disease (GERD) prophylaxis. METHODS: A randomized clinical trial was conducted between April 2017 and January 2019 in 466 premature infants discharged home and followed at a KMCP. Double-blind allocation to metoclopramide versus placebo was performed, 0.2 mg/kg three times daily, administered 15 min before feeding, up to term. Exclusion criteria were oxygen dependency, any perinatal neurological problem or parent's participation refusal. The incidence of GERD symptoms and adverse events that could be associated with the use of metoclopramide were recorded by parents weekly (e.g., emesis, cyanosis or apnea, post-prandial crying episodes, extrapyramidal symptoms, tremor, and drowsiness). RESULTS: A total of 466 subjects were recruited, most of them late preterm. The groups' baseline characteristics were similar. Median duration of the intervention was approximately 3 weeks, at which time most patients were at term. In the longitudinal mixed effects analysis, we did not find clinically significant differences in GERD-related symptoms between groups, either in minor or severe side effects. CONCLUSION: Results show absence of effectiveness in the systematic use of metoclopramide as prophylaxis of GERD symptoms in premature infants. Additionally, no adverse effects attributable to the drug were found. ClinicalTrials.gov: NCT02907632; September 20, 2016. Retrospectively registered.

Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants.

BACKGROUND: In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care Program (KMCP) with ambulatory oxygen, strict follow-up, and oxygen weaning protocols. OBJECTIVES: (1) To describe growth, morbimortality, and oxygen monitoring up to 6 months in OD preterm infants. (2) To explore associations between oxygen weaning, perinatal history, Hb levels, transfusions, feeding patterns, and growth. METHODS: A prospective cohort study. Descriptive and multivariate analysis. RESULTS: Recruited patients were 407 with 33 weeks median gestational age (GA). Mothers presented infections >28%, pre-eclampsia in 22%, and 80% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age, and hospital stay were 36 weeks, 21 and 17 days, respectively; 56.8% of patients had neonatal sepsis and 67.8% were admitted to the neonatal intensive care unit. At oxygen weaning, patients had a median of 54 days with oxygen, median weight 3240 g and GA 41 weeks. Median follow-up oxygen saturation was 94% with 1/64-1/2 L/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 67% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement while invasive ventilation and transfusions had the opposite effect (R2 = .49). CONCLUSIONS: In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding, and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.

Systematic review and meta-analysis suggest that the duration of Kangaroo mother care has a direct impact on neonatal growth.

AIM: A 2016 Cochrane review showed that Kangaroo mother care (KMC) had a moderate impact on preterm growth, with high heterogeneity among studies. This systematic review and meta-analysis considered new evidence on KMC, particularly the duration. METHOD: Databases were searched for papers published in English, French, Spanish and Portuguese up to 2017. Randomised controlled trials (RCT) of preterm or low birth weight infants were included if they compared growth between KMC and conventional care. Anthropometric measures were related to duration. RESULTS: We identified 1368 papers, and 13 RCTs covering 743 KMC infants and 718 controls met the selection criteria. Infants held in KMC for at least 6 h/d gained more weight than the controls, with a mean difference of 8.99 g/d (95% confidence interval 8.14-9.84, I2  = 0%). This difference persisted between 2 and 6 h/d and disappeared with 2 hours or less. When we used g/kg/d, the weight gain was higher when the duration was at least 8 h/d. Only babies who received 6 h/d gained more length and head circumference. CONCLUSIONS: The effect of the KMC on growth was directly related to the duration.

Effectiveness and Safety of Fast Enteral Advancement in Preterm Infants Between 1000 and 2000 g of Birth Weight.

BACKGROUND: The advancement of enteral nutrition in premature infants is still controversial. Clinicians must provide adequate caloric intake but avoiding feeding intolerance and necrotizing enterocolitis (NEC). The aim of this study was to establish the safety and effectiveness of fast enteral advancement by comparing it with traditional advancement. METHODS: This is a controlled randomized clinical trial. Feeding was advanced at 30 mL/kg/d vs 20 mL/kg/d in premature infants under 34 weeks between 1000 and 1499g birth weight, and at 40 mL/kg/d vs 20 mL/kg/day in those weighing 1500-1999 g. Outcomes included time to reach total enteral nutrition, days of parenteral nutrition (PN) and/or intravenous fluid (IVF), days to recover birth weight, episodes of feeding intolerance, growth and weight gain at 40 weeks, sepsis, hypoglycemia, hyperbilirubinemia, NEC, and mortality. Student t-test or Mann-Whitney U test, Fisher test or χ2 test, and multiple linear regression were used. RESULTS: Differences were found in days to reach total enteral nutrition (slow: 7 [IQR(interquartile range), 6-9], fast: 4 [IQR, 4-6]; P < .001) and days of IVF or PN (slow: 6 [IQR, 4-8], fast: 3 [IQR, 3-5]; P < .001). Fast advancement decreases time to total enteral nutrition by 3 days and PN and/or IVF by up to 5 days. There were no differences in other outcomes. CONCLUSIONS: Fast enteral advancement decreases the days to reach total enteral nutrition and the days of PN and/or IVF without causing greater feeding intolerance. Additional studies are required for more evidence.

Systematic review and meta-analysis suggest that Kangaroo position protects against apnoea of prematurity.

AIM: The aim of this study was to determine whether the Kangaroo position decreased apnoea events in preterm newborns compared with conventional care in incubator. METHODS: We conducted a systematic review of clinical trials published in English, French, Spanish and Portuguese. A comprehensive literature search was realised until 2017. The main outcome was apnoea events. Data were extracted and combined in a fixed-effects model. The quality of the evidence was assessed according to the GRADE framework (grading the quality of evidence and the strength of recommendations). RESULTS: Four original clinical trials were selected. These trials were conducted in India and Nepal, between 2005 and 2016. The systematic review comprised 416 preterm newborns. Three studies were randomised controlled trials and one was quasi-experimental. Meta-analysis showed a statistically significant reduction in apnoea episodes (relative risk [RR] 0.41; 95% confidence interval [CI] 0.22, 0.78). The result remained significant when only the three clinical trials were analysed (RR 0.43; 95% CI 0.23, 0.83). Quality analysis indicated moderate quality because of lack of an appropriate method of randomisation in one study. CONCLUSION: The Kangaroo position could have protective effect against apnoea events in preterm infants, decreasing the associated risk of death or long-term disability.

[The Kangaroo Mother Care Program of Yopal, Colombia: an opportunity to keep track of preterm infants]. / El Programa Madre Canguro de Yopal, Colombia: una oportunidad de seguimiento del niño prematuro.

OBJECTIVE: In Colombia, the incidence of prematurity and low birth weight (LBW) is 12.8%. To describe a standardized follow-up until 12 months of 1138 premature and/or LBW included in the Yopal KMCP (2014 -2015). MATERIALS AND METHODS: Prospective cohort. RESULTS: the patients are from the subsidized health care system (Colombia government), 58.2% live in the city and 24.6% at more than two hours from the city; 80.6% of parents are stable couples and 78.9% are employed; 69% of mothers started prenatal control from the first trimester. The most frequent obstetric pathologies were urinary tract infection and pre-eclampsia; 97% of deliveries were in the hospital; 55% by caesarean section. Majority of infants were late preterm; 13.3% passed through the Neonatal Intensive Care Unit (NICU) with 27% ventilated and 5.9% oxygen-dependent at discharge. At 6 months more than 50% had exclusive breastfeeding. Ophthalmology screening was performed in 54% (4.6% retinopathy), optometry in 72% and audiology in 70% (4.7% with hearing deficit). At 12 months 4.4% had abnormal neurological exam and 95% complete vaccines schedule. Lost to follow up was 35% and mortality 0.4%. CONCLUSION: It is important to implement KMCP in intermediate and isolated cities to ensure a high-risk follow-up for all LBW and / or premature babies, to detect somatic, sensory or neuro-psychomotor development anomalies and to perform timely interventions.

OBJETIVO: En Colombia, la incidencia de prematurez y bajo peso al nacer (BPN) es del 12,8%. El objetivo del estudio fue describir el seguimiento estandarizado hasta 12 meses de 1 138 prematuros y/o BPN, atendidos en el Programa Madre Canguro (PMC) de Yopal durante 2014 y 2015. MATERIALES Y MÉTODOS: Estudio de cohorte prospectiva. RESULTADOS: Los pacientes eran del sistema subsidiado. El 58,2% vivía en la ciudad y 24,6% a más de dos horas de la ciudad. El 80,6% de los padres eran parejas estables y 78,9% tenía empleo. El 69% de las madres inició control prenatal desde el primer trimestre. Las patologías obstétricas más frecuentes fueron la infección urinaria y la pre-eclampsia. El 47% de los partos fueron intrahospitalarios, 55% por cesárea. La mayoría eran prematuros tardíos. El 13,3% pasaron por cuidados intensivos con 27% ventilados y 5,9% oxígeno-dependientes al egreso. A los seis meses, más del 50% tenía lactancia materna exclusiva. Se realizó tamizado de oftalmología en 54% (4,6% retinopatía), de optometría en 72% y de audiología en 70% (4,7% con déficit de audición). A los 12 meses 4,4% tenían examen neurológico anormal y 95% vacunas completas. La deserción fue de 35% y la mortalidad de 0,4%. CONCLUSIONES: Es importante implementar PMC en las ciudades intermedias de Colombia que manejan BPN y/o prematuros para asegurar un seguimiento de alto riesgo que detecte anomalías del desarrollo somático, sensorial o neuro-psicomotor y realizar intervenciones oportunas.

El Programa Madre Canguro de Yopal, Colombia: una oportunidad de seguimiento del niño prematuro / The Kangaroo Mother Care Program of Yopal, Colombia: an opportunity to keep track of preterm infants

RESUMEN Objetivo En Colombia, la incidencia de prematurez y bajo peso al nacer (BPN) es del 12,8%. El objetivo del estudio fue describir el seguimiento estandarizado hasta 12 meses de 1 138 prematuros y/o BPN, atendidos en el Programa Madre Canguro (PMC) de Yopal durante 2014 y 2015. Materiales y Métodos Estudio de cohorte prospectiva. Resultados Los pacientes eran del sistema subsidiado. El 58,2% vivía en la ciudad y 24,6% a más de dos horas de la ciudad. El 80,6% de los padres eran parejas estables y 78,9% tenía empleo. El 69% de las madres inició control prenatal desde el primer trimestre. Las patologías obstétricas más frecuentes fueron la infección urinaria y la pre-eclampsia. El 47% de los partos fueron intrahospitalarios, 55% por cesárea. La mayoría eran prematuros tardíos. El 13,3% pasaron por cuidados intensivos con 27% ventilados y 5,9% oxígeno-dependientes al egreso. A los seis meses, más del 50% tenía lactancia materna exclusiva. Se realizó tamizado de oftalmología en 54% (4,6% retinopatía), de optometría en 72% y de audiología en 70% (4,7% con déficit de audición). A los 12 meses 4,4% tenían examen neurológico anormal y 95% vacunas completas. La deserción fue de 35% y la mortalidad de 0,4%. Conclusiones Es importante implementar PMC en las ciudades intermedias de Colombia que manejan BPN y/o prematuros para asegurar un seguimiento de alto riesgo que detecte anomalías del desarrollo somático, sensorial o neuro-psicomotor y realizar intervenciones oportunas.(AU)

ABSTRACT Objective In Colombia, the incidence of prematurity and low birth weight (LBW) is 12.8%. To describe a standardized follow-up until 12 months of 1138 premature and/or LBW included in the Yopal KMCP (2014 -2015). Materials and Methods Prospective cohort. Results: the patients are from the subsidized health care system (Colombia government), 58.2% live in the city and 24.6% at more than two hours from the city; 80.6% of parents are stable couples and 78.9% are employed; 69% of mothers started prenatal control from the first trimester. The most frequent obstetric pathologies were urinary tract infection and pre-eclampsia; 97% of deliveries were in the hospital; 55% by caesarean section. Majority of infants were late preterm; 13.3% passed through the Neonatal Intensive Care Unit (NICU) with 27% ventilated and 5.9% oxygen-dependent at discharge. At 6 months more than 50% had exclusive breastfeeding. Ophthalmology screening was performed in 54% (4.6% retinopathy), optometry in 72% and audiology in 70% (4.7% with hearing deficit). At 12 months 4.4% had abnormal neurological exam and 95% complete vaccines schedule. Lost to follow up was 35% and mortality 0.4%. Conclusion It is important to implement KMCP in intermediate and isolated cities to ensure a high-risk follow-up for all LBW and / or premature babies, to detect somatic, sensory or neuro-psychomotor development anomalies and to perform timely interventions.(AU)

Caracterización de recién nacidos a término con diagnóstico de intolerancia a la vía oral en su primera semana de vida / Characterization of term new-born with diagnosis of feeding intolerance in first week of life

Introducción: El diagnóstico de intolerancia a la vía oral en los recién nacidos atérmino no se basa en la definición operativa. No hay estudios sobre factores de riesgo.Objetivo: Caracterizar a recién nacidos a término hospitalizados con diagnóstico deintolerancia a la vía oral. Analizar la calidad sobre este diagnóstico y establecer suincidencia real. Diseño y metodología: Cohorte retrospectiva entre 2011 y 2013. Seanalizaron variables prenatales, intraparto y postparto y si el diagnóstico cumplía conlos criterios de la definición. Resultados: El 11,3 % de los pacientes tenía intoleranciaa la vía oral, y solo el 33 % cumplía con la definición operativa. La incidencia anualestimada estuvo entre el 3,5 % y el 4,4 %. En la caracterización de la población, lasvariables más frecuentes fueron: consumo de fórmula láctea (88 %), antecedentematerno de anestesia regional (69 %), ictericia (61 %), sexo masculino (58 %), partopor cesárea (57 %) e hipoglucemia (53 %). Conclusiones: La incidencia real es similara otros países; el 66 % de los pacientes no cumplía con la definición operativa. Serequieren estudios analíticos que exploren la relación causal con las variables másfrecuentes.

Introduction : The diagnosis of feeding intolerance in at term newborns is not based on the operational definition. There are not studies on risk factors. Objective: To characterize term newborns hospitalized with a diagnosis of feeding intolerance. To develop a quality analysis about diagnostic and to establish real incidence. Design and Methods: Retrospective cohort between 2011 and 2013. Prenatal, intrapartum, and postpartum variables were analyzed as well as if the diagnosis met the criteria for the operational definition. Results: 11.3% of patients showed feeding intolerant, only 33% met the operational definition. The annual incidence was between 3.5% and 4.4%. In the characterization of the population, the most common variables were: consumption of artificial feeding (88%), maternal history of regional anesthesia (69%), jaundice (61%), male sex (58%), cesarean delivery (57 %), and hypoglycemia (53%). Conclusions: The incidence was similar to the one in other countries. 66% of patients did not meet the operational definition. Analytical depth studies exploring causal relationship are required.

Calidad del seguimiento clínico y neurológico en una cohorte de recién nacidos muy prematuros, 2002-2012 / Quality of clinical and neurologic monitoring in a cohort of extremely premature infants, 2002-2012

Objetivo Explorar el curso clínico de una cohorte de recién-nacidos <1000 gr o <29 semanas de edad gestacional al nacer, luego del alta del Programa Madre Canguro (PMC). Método Encuesta telefónica a padres de una cohorte retrospectiva de 569 prematuros manejados en tres PMC entre 2002 y 2012. Resultados Se contactó 65,4 % de la cohorte a una mediana de edad de 4 años. Un total de 34 pacientes (6 %) fallecieron, 65 % en los primeros 6 meses de vida. Se rehospitalizaron 63 %, 32 % presentaban antecedente de hemorragia intraventricular, 30 % tenían Enfermedad Pulmonar Crónica, 5,2 % parálisis cerebral o retardo mental y 2,7 % convulsiones. Un 72 % se controlaron por Pediatra, 65 % necesitaron terapia física y 39 % terapia del lenguaje. El 7 % repitió años escolares y 9 % de los mayores de 4 años no había iniciado escritura. Un 4 % de los que ya escribían, presentaba dificultades. Un 81 % de los mayores de 6 años presentaba dificultad para vestirse y 55 % no practicaba ningún deporte. Discusión Los prematuros extremamente inmaduros o de bajo peso tienen una tasa elevada de secuelas respiratorias y neurológicas que impactan su calidad de vida y la de su familia. Es importante continuar con un seguimiento estricto después de 12 meses para detectar y manejar a tiempo las alteraciones del desarrollo neuro-psicomotor.(AU)

Objective To explore the clinical course of a cohort of newborns <1000 gr or <29 weeks of gestational age at birth after discharge from the Kangaroo Mother Care Program (KMC). Method Telephone surveys with parents of a cohort of 569 premature babies treated in 3 KMC programs between 2002 and 2012. Results The study contacted 65.4 % of the cohort, averaging 4 years old. 34 patients (6 %) passed away, 65 % during the first 6 months of life. 63 % were re-hospitalized, 32 % presented antecedents of intraventricular hemorrhage, 30 % had chronic lung disease, 5.2 % had cerebral palsy or mental retardation, and 2.7 % had convulsions. 72 % were monitored by a pediatrician, 65 % needed physical therapy, and 39 % needed speech therapy. 7 % repeated years in school and 9% of those over 4 years old had not begun to write. 4 % of those who could write had difficulties. 81 % of those over 6 years old had difficulties dressing themselves; 55 % did not practice sports. Discussion Extremely premature or low birth weight premature babies have a higher level of respiratory and neurological consequences that affect their quality of life and that of their family. It is important to strictly monitor their health after 12 months in order to promptly detect and manage neuro-psychomotor and sensorial development disorders.(AU)

[Quality of clinical and neurologic monitoring in a cohort of extremely premature infants, 2002-2012]. / Calidad del seguimiento clínico y neurológico en una cohorte de recién nacidos muy prematuros, 2002-2012.

Objective To explore the clinical course of a cohort of newborns <1000 gr or <29 weeks of gestational age at birth after discharge from the Kangaroo Mother Care Program (KMC). Method Telephone surveys with parents of a cohort of 569 premature babies treated in 3 KMC programs between 2002 and 2012. Results The study contacted 65.4 % of the cohort, averaging 4 years old. 34 patients (6 %) passed away, 65 % during the first 6 months of life. 63 % were re-hospitalized, 32 % presented antecedents of intraventricular hemorrhage, 30 % had chronic lung disease, 5.2 % had cerebral palsy or mental retardation, and 2.7 % had convulsions. 72 % were monitored by a pediatrician, 65 % needed physical therapy, and 39 % needed speech therapy. 7 % repeated years in school and 9% of those over 4 years old had not begun to write. 4 % of those who could write had difficulties. 81 % of those over 6 years old had difficulties dressing themselves; 55 % did not practice sports. Discussion Extremely premature or low birth weight premature babies have a higher level of respiratory and neurological consequences that affect their quality of life and that of their family. It is important to strictly monitor their health after 12 months in order to promptly detect and manage neuro-psychomotor and sensorial development disorders.