[Vertical transmission of human immunodeficiency virus: six years of development 1987-1992)]. / Transmisión vertical del virus de la inmunodeficiencia humana: seis años de evolución (1987-1992).

BACKGROUND: According to World Health Organization estimates, from the beginning of the epidemics to the end of 1994, the number of children infected by human immunodeficiency virus (HIV) was 1.5 million. This paper describes the evolution of some clinical and epidemiologic characteristics of vertically transmitted HIV infection. PATIENTS AND METHODS: All children born to HIV-infected mothers who delivered at a university hospital in Barcelona, Spain, between 1987 and 1992, were included in the study. Rates of HIV vertical transmission, HIV infection incidence and mortality due to HIV were estimated, and trends for the study period analyzed. Odds ratios were used to assess associations between variables. RESULTS: 192 newborns were identified and allocated, with respect to the year of birth, in three cohorts of 71, 58 and 63 children. Overall HIV vertical transmission rate was 16.5% and did not differ between cohorts. Infection incidence density rates increased over time (0.2, 4.9 and 8.1 cases/100 child-years, respectively; p = 0.016), while incubation periods decreased significantly (248, 103 and 114 days; p = 0.0004). There were no changes in mortality density rates (2.2 deaths/100 child-years). Regarding mothers' characteristics, a significant temporal trend (p < 0.001) for being older at delivery, belonging to the heterosexual transmission group and having symptomatic infection was observed over time. CONCLUSIONS: Certain clinical and epidemiologic aspects of HIV vertical transmission have changed over time, however the number of new cases has remained fairly constant. In our setting, both early diagnosis and clinical management of these children have improved, but primary prevention for HIV vertical transmission has not been effective. Better counselling for HIV-infected women of childbearing age is needed.

[Retinopathy of prematurity: casuistics between 1996 and 2001]. / Retinopatía del prematuro. Casuística de los años 1995-2001.

BACKGROUND: Retinopathy of prematurity (ROP) is a cause of neurosensorial morbidity. OBJECTIVES: To study the incidence, associated risks factors, treatment, and outcome of ROP in premature infants born at less than 32 weeks in our hospital. METHODS: We performed a descriptive study of patients born between the January 1, 1995, and December 31, 2001, in Sant Joan de Déu Hospital in Barcelona (Spain) at <= 32 weeks of gestation who survived until their first month of life. An ocular evaluation was performed between weeks 4 and 6 of life and was repeated every 1-2 weeks until retinal vascularization was complete. Ocular sequelae and visual function were evaluated. Bivariate comparison of groups with and without ROP was performed. RESULTS: Of the 324 patients evaluated, 74 presented ROP (22.8 %), of which 63 patients (21.7 %) were classified as stage 1 or 2 and 11 (3.7 %) as stage 3. An inverse correlation between the incidence of retinopathy and weight and gestational age was found. Threshold disease (3 plus) was detected in 9 patients (16 eyes; 3.1 % of the study sample and 12.1 % of the neonates with retinopathy). All of these neonates were treated with laser therapy. Ocular sequelae were mild in 2.7 % of the patients, moderate in 0.6 % and severe in 0.6 %. The visual function (n 236) of infants with ROP (n 74) was altered in 4 patients (1.7 %). Of these, alterations were severe in 2 patients (0.8 %). Bivariate analysis revealed significant differences (p < 0.001) in low birth weight, gestational age, days of oxygen therapy, days of mechanical ventilation, days of antibiotic therapy, and number of blood transfusions. CONCLUSIONS: In this study the incidence of ROP was similar to that in other centers. Development of ROP was strongly associated with its various risk factors. Severe stages were not seen above 30 weeks of gestational age. The results of laser therapy were optimal, with fewer alterations in ocular examination and visual function than those estimated in patients without treatment.

[Neurological follow-up of very low birth weight newborns at the age of two years (1998-1999)]. / Seguimiento neurológico de recién nacidos menores de 1.500 gramos a los dos años de edad.

BACKGROUND: Because of improved obstetric and neonatal care, there is growing interest in the later outcome of very low birth weight newborns. OBJECTIVES: The aim of this study was to evaluate the survival rate of very low birth weight newborns and to identify disabilities at the age of 2 years. MATERIAL AND METHODS: An observational, follow-up study was performed of neonates with a birth weight of under 1,500 grams born between 1998 and 1999. The follow-up program included pediatric, maturative, neurological, psychological, ophthalmological, and audiological evaluation. Neurosensorial disabilities were classified as mild, moderate, or severe. RESULTS: One hundred thirty-six very low birth weight newborns were admitted. The survival rate was 77.9 % and 83.9 % completed the follow-up to the age of 2 years. The neurosensorial disability rate was 20.2 %; disability was severe in 9 %, moderate in 1.1 %, and mild in 10.1 %. In patients lost to follow-up, birth weight was higher, gestational age was older, and sonographic findings were more frequently normal. CONCLUSION: Survival in very low birth weight newborns has increased with improved neonatal care. The presence of sequelae was similar to that found in other follow-up studies. A substantial number of patients were lost to follow up, which influenced the disability rates.

[Infections by group D streptococci (author's transl)]. / Infecciones por estreptococo D.

A study of the pediatric infections due to group D streptococci, based on the causist of the Pediatric Department of the School of Medicine at Barcelona is performed. It comprises 20 cases of newborn sepsis (one of them with meningitis), and nine urinary infections in children of several ages. The isolated straws, that pertained all to "enterococcus", revealed greatest sensibility in decreasing order to ampicillin, carbenicillin, chloramphenicol, furantoin and gentamicin. In neonatal sepsis the beginning was precocious in 50% of the cases, the frequency of newborns with low birth weight was high (35%), and the course was favourable in 95%; the only case that died was affected of meningitis with pyocephalia. Urinary infections prevailed in the first year of life (44%), but all the affected were older than a month of life. There were characterized by little accused symptomatology, and quickly favourable course of the infection, through adequate antibiotic treatment. Nevertheless, the long term prognosis is darkened by severe renal and urinary malformations that were appreciated in 55% of the patients.

[Pattern of survival and sequelae in very low birth weight infants]. / Evolución de la supervivencia y secuelas del recién nacido de muy bajo peso.

The survival and sequelae of the very low birth weight (VLBW) newborns are reported. Two time-periods have been compared (1980-84 vs 1985-88) as well as two weight groups. (Lower than 1,000 vs 1,000-1,499). A total number of 205 VLBW were admitted, and 74 died. Only 72 were used to study morbidity and sequelae with a minimum follow-up of 12 months after correcting age. Those with a weight lower than 1,000 g have a greater motor impairment, (45.5 vs 16.4%), cognitive deficiency (55.5 vs 14.8%), myopia (27.3 vs 3.3%), neurosensorial deafness (27.3 vs 0%), and overall sequelae. During the period 1985-88, survival was 77.9% of the VLBW have any sequelae (12.5% major sequelae and 15.3% minor sequelae). A 36.4% of the newborns with a weight under 1,000 g have major sequelae comparing with the 8.2% in the others. Growth delay is closely related to neurologic sequelae.

[Incidence and mortality of bronchopulmonary dysplasia]. / Incidencia y mortalidad de la displasia broncopulmonar.

In this paper an attempt is made to analyze the variations in the incidence and severity of bronchopulmonary dysplasia (BPD) in our environment. A review has been made of the clinical records of premature infants with a diagnosis of BPD from 1979 to 1989, both inclusive. The existence of BPD was accepted when, after assisted ventilation with intermittent positive pressure for a minimum of 72 hours, there were respiratory difficulties, a compatible radiography of the thorax and requirements of over 0.21 FiO2 on the 28th day of life. Between 1985 and 1989, the incidence of BPD was similar to that of the five previous years (38.3% versus 42.3%), but mortality decreased (21.7% versus 36.3%). Other epidemiological data worth noting are the appearance of BPD in 2.6 per 1000 live newborns, 9.6 per 1000 newborns kept in hospital and 15.9% of premature infants treated with ventilation. BPD was found in 73% of newborns weighing less than 1.000 g, 41% weighing between 1000 and 1.499 g and only 16% of those weighing over 1,499 g. BPD was found in all newborns of less than 28 weeks, in 38% of those between 28 and 30 weeks and only in 4% of those aged more than 30 weeks. BPD appeared specially after hyalline membrane disease (30.7%).

[Factors related to the normalization of weight of premature infants]. / Factores relacionados con la normalización del peso en el prematuro.

A total of 136 newborns, visited during the period 1980-88, have been studied to evaluate the main factors related to the normalization of weight in preterm babies. They were classified in those who did not achieve a normal weight, those whose normalization was long-lasting (after 40 weeks of postconceptional age), and those with early normalization (before 40 weeks of postconceptional age). Mean-time of the follow-up was 25.7 months, and 96 children achieved a normal weight (70.6%), 104 a normal length (78.8%), and 111 a normal head circumference (86.7%). Preterm babies with a weight under 1,500 g normalize their weight later than those with a greater weight (31 vs 18.5 months p = 0.010). Preterm newborns with early weight normalization had lower morbidity, greater body size at birth and earlier caloric intake. The opposite situation happened in the other two groups. Those without a normalization in the weight have a greater frequency of neurologic sequelae.

[Pathogenic factors in bronchopulmonary dysplasia]. / Factores patogénicos de la displasia broncopulmonar.

This paper analyses the main pathogenic and prognostic factors of BPD. A study was made of 60 premature babies who were ventilated for a period of more than 72 hours. The control group consisted of the 37 premature babies who did not develop BPD and the study group of the remaining 23 who, 28 days after birth, showed respiratory difficulties, a compatible radiography of the thorax and FiO2 requirements above 0.21. The severity of the BDP in the neonatal period was quantified by means of the clinical and radiological criteria of Toce and a special scale was applied to its evolutive aspects.

[Long-term effect of angiotensin-converting inhibitors in children with proteinuria]. / Efecto a largo plazo de los inhibidores de la enzima conversora de la angiotensina en niños con proteinuria.

BACKGROUND: Prolonged proteinuria is a risk factor for renal damage. Angiotensin-converting enzyme (ACE) inhibitors can reduce proteinuria in adults with different types of nephropathy. PATIENTS AND METHODS: We evaluated treatment with low doses of ACE inhibitors (captopril and enalapril) in nine children with proteinuria due to chronic glomerular nephropathy. The patients' diagnoses were Henoch-Schönlein nephropathy, Berger's disease, Alport's disease, and chronic glomerulonephritis (GN) (membranous GN, focal and segmental GN, and membranoproliferative GN). None of the patients were receiving concomitant treatment. Those who had received corticoids, immunosuppressive or hypotensive drugs during the previous 3 months were excluded. The medication was administered over a prolonged period (mean 26.6 6.36 months). RESULTS: Proteinuria was initially in the nephrotic range (M = 55.34 10.44 mg/m2/h). In all patients concentrations fell significantly after 6 months and at the end of the treatment(p = 0.01 and p = 0.05). No adverse reactions to the medication were observed. The decrease in glomerular filtration rate was not significant. No significant changes in arterial pressure were found during treatment. CONCLUSIONS: ACE inhibitors could be an effective alternative for reducing proteinuria in children with prolonged nephropathy. These inhibitors do not produce the adverse effects associated with other drugs and can therefore be used for long periods.

[Etiopathogenic factors in neonatal necrotizing enterocolitis]. / Factores etiopatogénicos de la enterocolitis necrotizante neonatal.

Necrotizing enterocolitis is the most common digestive emergency in neonatal units. Several factors are involved in their pathogenesis: intestinal ischemia, bacterial colonization and feeding. To analyse these factors, 25 cases of NEC are compared to a control group of 48 newborns. Results showed an incidence of NEC about 1.6 0/00 live newborns, without a greater mortality in respect to other pathologic newborns. Ischemic factors influence significatively in appearance of ECN (p less than 0.001). None of them received maternal feeding. By this reason it seems to be a protective factor against bottle feeding (p less than 0.05). Enteral feeding its main influence upon mature newborns. No common bacterial findings have been found, but 68% of children developed clinical findings compatible with sepsis. Severity of abdominal sings in clinical examination in the acute phase of NEC is positively correlated with the presence of complications. Individual considerations are needed in sight to the different severity and prognosis of NEC.

[Pathology of the very low birthweight neonate]. / Patología del niño de peso muy bajo al nacimiento.

86 very low birthweight infants who has been hospitalized between February 1980 and February 1987 and discharged were analysed. 15 of these newborns weighed less than 1,000 g (group 1) and 71 weighed between 1,000 and 1,499 g (group 2). We compared the maternal records, both groups. In group 1, early neonatal depression was more frequent, as well as seizures, infectious complications, patency of the ductus, and chronic respiratory complications.

[Guillain-Barre syndrome: a study of 13 children]. / Síndrome de Guillain-Barré. Análisis de 13 casos pediátricos.

A group of 13 children, aged 2 to 14 years, and diagnosed with Guillain-Barré syndrome has been analyzed. Clinical features and outcome were retrospectively studied. In 75% of the patients there was an infectious illness previous to the neurologic symptoms and in four children the etiologic agent was demonstrated. Motor deficits affecting the limbs and muscle stretch reflexes were absent in all thirteen patients. Cranial nerve involvement showed-up in 46%. Meningitic symptoms occurred in 62% of the cases. One of the children developed the Fisher syndrome variant. Two patients required assisted ventilation. Three children showed associated immunologic abnormalities, with one of the patients having a selective IgA deficiency, another child showing an increment in IgE and the other Kawasaki syndrome. We have not demonstrated differences in the outcome between the patients with corticoid treatment.

[Neurologic evolution of premature infants following assisted ventilation, with and without bronchopulmonary dysplasia]. / Evolución neurológica del recién nacido pretérmino ventilado con y sin displasia broncopulmonar.

The aim of this work was to evaluate the influence of bronchopulmonary dysplasia on the neurological outcome of the preterm infant requiring assisted ventilation. Thirty-nine preterm infants requiring ventilation support during 72 hours or more were classified into two groups according to the presence or absence of bronchopulmonary dysplasia (BPD). In the BPD group (n = 11), only the incidence of mild cognitive deficits was significantly higher (36.4 % vs 0 %). Our results suggest that the neurological outcome of the infants with BPD is more closely associated with other neonatal events (intraventricular hemorrhage, periventricular leukomalacia, neonatal seizures, longer ventilation support, maximum serum bilirubin levels, low Apgar score at 10 minutes and poor intake of amino acids) than with the presence of BPD. The data of this study suggest that indomethacin reduces the risk of neurological deficits.

[Features in human immunodeficiency virus type 1 in the neonatal period]. / Manifestaciones de la infección por el virus de la inmunodeficiencia humana tipo 1 en el período neonatal.

UNLABELLED: Different patterns of disease expression have been found in pediatric HIV1 infection. The precise timing of vertical transmission of HIV1 cannot be pinpointed. Some studies suggests that a substantial proportion of infants are infected during gestation are likely to have more extensive infection and thus more accelerated disease that infants who become infected during labor or delivery. PATIENTS: We examined the clinical manifestations and laboratory findings in seven newborns with HIV1 infection. RESULTS: In all patients, have been bound clinical or laboratory features at birth. Five newborn was prematurely (71.4%). The most common clinical findings in this group was: hepatomegaly (6/7), failure to drive (6/7), esplenomegaly (5/7) and limphadenopaties (5/7). The laboratory findings was: trombopeny and cellular immunosuppression (5/7). The HIV1 infection was determined by detection of p24 antigen, chain reaction polymerase or viral cocultive in blood in the first day of live. The mortality in this group was the 70% in the first year of life. COMMENTS: This results suggest that the timing of HIV1 infection was intrauter. This group has an accelerated disease course, developing manifestations of AIDS in first month of life and dying earlier. Although, a variety of maternal and fetal factors may contributed to the intrauter infection, for example the characteristics of the mother's infection, immune status, level of HIV1-neutralizing antibody, p24 antigaenemia prematurity and others.

[Prognostic factors of neurosensory sequelae in extremely premature infants]. / Factores pronósticos de las secuelas neurosensoriales en el prematuro extremo.

Modern neonatal intensive care has led to a rise in the survival rate of very low birthweight infants (VLBW), but at the same time is a greater number of neurosensorial sequelae. In this study, 50 VLBW (weight less than 1,500 g) babies followed up for at least 12 months are analysed. 18% showed major sequelae (40% of those weighing less than 1,000 g, 12.5% of those weighing 1,000 g or more). The prognostic factors which were most important in the prediction of sequelae were: low birthweight, major irregularities in the EEG, the presence of sepsis, and prolonged ventilotherapy or antibiotherapy.

[Prognosis factors in hypoxico-ischemic encephalopathy in full term infants]. / Factores pronósticos en la encefalopatía hipoxicoisquémica del recién nacido a término.

This study analyzes 61 full-term neonates affected by hypoxic-ischemic encephalopathy, who were followed for a minimum of 15 months to determine the factors related to the later appearance of neurological sequels. No severe sequels have been detected, while 8.2% showed moderate sequels and 4.9% slight sequels. The degree of cerebral suffering and the intensity of convulsions influence both the appearance of sequels and their severity, contrary to the scores of the Apgar tests after one minute or 5 minutes and the birth weight. By applying the formula (Sequel Rate = 0.2143* Cerebral suffering + 0.3228* Convulsions - 0.2276* EEG RN - 0.0851), if the "sequel rate" is equal to or lower than 0.55, the probability of later sequels is null, whereas a value in excess of this figure indicates a 57.1% probability of their arising.

[Congenital syphilis and syphilitic mothers. Survey of the past 10 years]. / Sífilis congénita versus de madre luética. Revisión de los últimos 10 años.

Two hundred and sixty-two newborn infants, born to mothers with a positive syphilis serology, have been studied. Twenty-six newborn infants had congenital syphilis and two hundred and thirty-six were considered as newborn infants from syphilitic mothers. This study has demonstrated that the newborn infants with congenital syphilis have been born to mothers with greatest risk factors. Newborn infants with congenital syphilis born to mothers on treatment during the pregnancy had a milder case of congenital syphilis than newborn infants born to mothers without treatment during the pregnancy. A diagnostic test for the treatment in these newborns has been proposed; if the test score is less than 5, we are dealing with a child of a syphilitic mother that does not need treatment and if the test results are higher than 5 we can confirm the diagnosis of congenital syphilis and immediate treatment must be started.

[Newborn infant of drug-addicted mother: maternal, perinatal, neonatal aspects, and neonatal abstinence syndrome]. / Recién nacido de madre adicta a las drogas: aspectos maternos, perinatológicos, neonatales y síndrome de abstinencia.

Maternal drug addiction has increased in an alarming way over the last ten years. Therefore, the withdrawal syndrome in the newborn has also increased. 53% of the newborns (of chemical dependent mother) studied from 1985 to 1989 in HCP have presented this syndrome. We have analysed: perinatal, neonatal and maternal factors, and their clinical features and treatment: There is a great incidence of perinatal asphyxia, acidosis, premature rupture of the fetal membranes, etc. The newborns are usually premature or of low birth weight for their gestational age. They present diverse pathology: syphilis, HBsAg +, HIV +, gonorrhea, congenital malformations, etc. The mothers are often prostitutes, belong to a low socioeconomic status, have had previous abortions and have had no control of the actual pregnancy, etc. The syndrome of abstinence presents with: jitteriness, sweating, high-pitched or continuous crying, vomits, diarrhea, and even seizures. The neurological and digestive manifestations are the most difficult to treat. The treatment consists of general measures (little stimulation dim light, etc.), phenobarbital, and chlorpromazine.

[Newborn infants of diabetic mothers. Clinical study in the period 1980-1985]. / Recién nacido de madre diabética. Estudio clínico del período 1980-1985.

An statistical analysis is reported on specific problems of the infant of diabetic mother during the period 1980-1985, with a total of 287 newborns. Complications in this sample are exposed, and significant differences demonstrated in gestational age, fetal distress, hypocalcemia, polycythemia, jaundice, respiratory distress syndrome and associated problems according to clinical type of diabetes mellitus. High percentage of congenital malformations is pointed-out with a predominance of cardiac septal defects. Diabetological control was closer in insulin-dependent group, therefore, its effect has been studied separately. A lower rate of hypoglycemia was found in those under control, while infant of insulin-dependent diabetic mother showed a better compliance between weight and gestational age and a lower rate of respiratory distress syndrome.