[A bioethics curriculum for the pediatric residency program: experience of a university hospital]. / La bioética en el programa de formación de residentes de pediatría.

BACKGROUND: Pediatric education should be fully committed to being humanistically as well as scientifically responsive to the needs of the times. Although interest in bioethical issues in clinical practice has increased, ethical problem solving is not usually taught in residency training programs. OBJECTIVE: To describe the implementation of a bioethics training program in our department of pediatrics. METHODS: We designed a program that took into account the difficulties that such a program might face: time constraints, inadequate training in ethics among medical staff and, sometimes, residents' attitudes towards a formal program. RESULTS: Throughout the last four years, six to seven ethics sessions per year were scheduled. The contents included traditional topics in medical ethics (i.e. treatment refusal in adolescents or clinical trials involving minors) as well as issues that confront residents during their training (informed consent, confidentiality, etc.). These ethics sessions were based on clinical cases and were integrated into the existing meetings timetable (daily meetings from Monday to Thursday between October and June) and were prepared by the residents themselves. CONCLUSIONS: The implementation of a bioethics component, using a modified case-based approach, in our pediatric residency program was satisfactory.

[Outcome of newborn with birth weight less than or equal to 1500g and gestational age less than or equal to 32 weeks, during the 2 first years of age corrected: comparison of two time periods]. / Seguimiento de recién nacidos de peso menor o igual a 1.500g y edad gestacional menor o igual a 32 semanas durante los 2 primeros años de edad corregida: comparación de 2 periodos de tiempo.

INTRODUCTION: Advances in perinatal care have resulted in increased survival rates for extremely low birth weight children, but it is fundamental to know if these improved survival rates have been accompanied by increased impairment rates. OBJECTIVE: To compare, over two different time periods, the survival and disability rates at 2 years of corrected age, among newborns < or =32 weeks and weighed < or = 1500 g at birth. METHODOLOGY: Follow-up study that included 963 children born in the hospital between 1991 and 2004 who met the study criteria. Neonatal morbidity, mortality and disability to 2 years of corrected age in 2 time periods 1991-1998 (period I) and 1999-2004 (period II) have been evaluated and analysed by subgroups of weight (weight < 1000 g and 1000-1500 g). RESULTS: Mortality decreased significantly during the second period, both for children with birth weight <1000 g (32% vs 44%) as for those with birth weight between 1000 and 1500 g ( 3,6% vs 9%). Analysing all children < or = 1500 g, an increase in the survivors without disability was observed in the second period (69% vs 60%, p=0.003); but by subgroups this increase only was significant in children with birth weight 1000-1500 g (67% vs 82%). CONCLUSIONS: In our study, globally analysing all children with birth weight < or = 1500 g, it can be seen that there has been an increase in survival without an increase in the frequency of disabilities. Analysing by weight subgroups, survival has increased in both groups, but disability has decreased only in the birth weight 1000-1500 g subgroup.

Fetal anaemia due to pyruvate kinase deficiency.

Pyruvate kinase deficiency was diagnosed in an infant by umbilical vessel sampling at 30 weeks' gestation. Although three previous hydropic siblings had been stillborn or died in the neonatal period, this infant survived with transfusion dependent haemolytic anaemia. Prompt fetal diagnosis of pyruvate kinase deficiency is feasible and allows better management of hydrops fetalis due to this disorder.

[Early discharge of low-birth-weight neonates. 5-year experience]. / Alta precoz en recién nacidos de bajo peso. Experiencia de 5 años.

The object of this study was to determine whether the hospital stay could be reduced in low birth weight infants without any risk. A prospective, controlled and randomized study has been made with 80 newborn infants with birth weights < or = 2.000 gm. The infants of the experimental group (n = 40) were discharged with weights < or = 2.000 gm and the control group (n = 40) were discharged with weights > or = 2.000 gm. Both groups showed similar social, economic, perinatal and postnatal conditions. We have found significant advantages in the experimental group such as: reducing the period of hospitalization (p = 0.005), greater weight increase (p < 0.001), a longer breast feeding period (p = 0.02) and a 29% reduction in expenditures. The follow-up shows that there are no significant differences between the groups regarding morbidity, mortality, growth or psychomotor development. We conclude that there are no disadvantages, but considerable advantages, in early discharge of low birth weight infants.

[Meckel syndrome (author's transl)]. / Síndrome de Meckel. (Disencefalia esplacnoquística) A propósito de cuatro casos.

Authors study four cases, two siblings in two different families, with several anomalies allowing to consider them as examples of the Meckel-Grüber syndrome. A review of the recent literature about this entity is made, as well as a comparative study of the anomalie present in the published cases.

[Tanatophoric dwarfism. A case report (author's transl)]. / Nanismo tanatóforo. Presentación de un caso

A new case of atipic chondrodystrophies classified as tanatophoric dwarfism, with pathologic studies is presented. At the same time a revision of the most important works of literature is made. Genetic, clinic and pathologic aspects of the picture have being studied, presenting the differential diagnosis with other osteochondrodysplasias of the newborn.

[Loss to follow-up and cerebral palsy]. / Abandonos en el seguimiento de recién nacidos de muy bajo peso y frecuencia de parálisis cerebral.

BACKGROUND: The longer follow-up programs last, the greater the loss to follow-up. These losses to follow-up may undermine the completion of health care goals and the validity of study results. OBJECTIVES: 1) To compare neonatal characteristics in children easily followed-up and in those lost to follow-up. 2) To trace and assess children lost to follow-up. 3) To estimate the occurrence of cerebral palsy in children easily followed-up and in those lost to follow-up. METHODS: From 1991 to 1997, 601 neonates with a birth weight under 1,500 g were admitted to the Neonatology Department. At discharge, 447 infants were included in the follow-up program. Moderate-to-severe cerebral palsy was assessed when the children were aged 2 years. A specific search strategy was implemented to find those children lost to follow-up. Data on the development of those traced were updated through a standardized telephone questionnaire. RESULTS: Twenty percent of the children were lost to follow-up before the age of 2 years. Fifty-seven percent of those not available at this age were assessed by telephone interview. No differences were found in the neonatal characteristics of infants easily followed-up and those lost to follow-up except in situations of critical social disadvantage: 10 % in followed-up infants, 41 % in infants lost to follow-up. Disabling cerebral palsy was observed in 7 % of children easily followed-up and in 23 % of those lost and traced (relative risk: 3.1, 1.5-5.5). CONCLUSIONS: The risk of having disabling cerebral palsy is three times higher in children lost to follow-up than in those easily followed-up. Dismissing this source of bias may underestimate disability rates when assessing health care programs or when interpreting study results.

[Cerebral palsy and age of sitting and walking in children weighing less than 1,500 g at birth]. / Parálisis cerebral y edad de sedestación y marcha en niños con peso al nacer menor de 1.500 g.

OBJECTIVE: To describe the corrected age (CA) of acquisition for sitting and walking in very low birth weight infants with cerebral palsy and to estimate the probability of walking as a function of age of acquisition of sitting and type of cerebral palsy. METHODS: Follow up study of very low birth weight infants (under 1500 g) admitted to the Neonatology Department of the Hospital 12 de Octubre in Spain between January 1991 and December 1996. At a corrected age of 2 years, 11.5% (34 children) were diagnosed with cerebral palsy. Ages of attainment of sitting and walking were established by interview with the parents and were confirmed by examination. Age of attainment of sitting and type of cerebral palsy were investigated as possible predictors of ambulatory status. RESULTS: Sitting was attained by 73% of the children. The probability of attainment of sitting at 9 months was 21% and at 18 months it was 68%. Only one child achieved sitting after 18 months. Fifty-three percent of the children became ambulatory. The probability of becoming ambulatory was 24% at 18 months and 47% at 30 months. If sitting was attained before 12 months of age the probability of becoming ambulatory was 47% at 18 months and 76% at 30 months. All children with spastic hemiplegia, 66% of those with diplegia and only 8% of those with quadriplegia became ambulatory. CONCLUSIONS: Sitting by the age of 12 months was directly related to achieving ambulation. Irrespective of the type of cerebral palsy, all children with hemiplegia and more than 60% of those with diplegia ambulated while children with quadriplegia were much less likely to ambulate.

[Survival at discharge of newborn infants weighing less than 1000 g (1991-1997). When are they too small?]. / Supervivencia al alta de los recién nacidos con un peso menor de 1.000 g (1991-1997). Cuándo son demasiado pequeños?

OBJECTIVE: To describe survival rates at discharge in liveborn infants with birth-weight under 1000 g by birth-weight and gestational age categories in a third level spanish hospital in order to improve health care planning and parental counselling about the threshold of viability. STUDY DESIGN: A follow-up study of 178 infants with birth-weight under 1000 g born alive between 1991 at 1997. Six newborns with lethal malformations were not included. RESULTS: Overall survival at discharge was 54%. During the study period survival rate improved in the birth-weight group 750-999 g. In the group below 750 g survival rate was lower and improved more slowly. Survival rate for infants below 750 g and 26 weeks was extremely low. Over 749 g and 25 weeks survival was over 50%. CONCLUSIONS: Survival rate showed an improving trend during the study period. In the last years of the study period survival in infants with birth-weight over 749 g was above 85%. For infants under 750 g and 26 weeks was extremely low. Family and medical decision making about active treatment of these newborns should be an individualized process.