[Usefulness of different risk factor associations in predicting admissions due to respiratory syncytial virus in premature newborns of 32 to 35 weeks gestation in Spain]. / Utilidad predictiva de ingreso por infección por virus respiratorio sincitial de diferentes asociaciones de factores de riesgo en prematuros de 32 a 35 semanas de gestación en España.

AIM: The aim of the study was to evaluate the risk factor associations for respiratory syncytial virus (RSV) hospitalization in preterm infants from 32 to 35 weeks gestation, treated during two consecutive RSV seasons in Spain. PATIENTS AND METHODS: A database (FLIP-2) was used after excluding the infants who received prophylactic palivizumab. A total of 193 RSV+ admissions and 4568 non-hospitalized children were studied. The risk factors analyzed were: chronological age <=10 weeks at start of RSV season or to be born during the first 10 weeks of the season; school-age siblings or daycare attendance; mother smoking during pregnancy; male gender; breastfeeding <=2 months; >=4 adults at home; history of wheezing; small for gestational age; >=2 smokers at home. RESULTS: Logistic regression model included the first four previously mentioned risk factors as independently significant variables, with R(2) of 0.062 and area under curve of 0.687 (P<0.001). Predictive values for a child with the four risk factors were: sensitivity 6.2%, specificity 98.6%, predictive positive value 16.2%, negative predictive value 96.1%, accuracy 94.9%, positive likelihood ratio 4.581, and negative likelihood ratio 0.951. Positive likelihood ratio for a child with the two major risk factors is 2.657. CONCLUSIONS: Usefulness of different risk factor associations to predict hospitalization for respiratory syncytial virus infection in preterm infants 32 to 35 weeks gestation in Spain is low, although similar to other models.

[Quality control of nosocomial infection in PICU]. / Control de calidad en la infección nosocomial en la UCIP.

INTRODUCTION: Nosocomial infection represents a problem of public health given his high morbidity and mortality, and the cost that it causes to the sanitary system. OBJECTIVE: To analyze the nosocomial infection related to the principal invasive techniques realized in the paediatric intensive care unit of our hospital. MATERIAL AND METHODS: We prospectively analyzed the epidemiological information (days of hospitalization, days of placement of devices, intravascular and closed drainage system, and mechanical ventilation) and the incidence of nosocomial infections (bacteriemias, pneumonias, urinary tract infections) in the patients admitted during the years 2000-2004. RESULTS: There was analyzed a total of 302 patients finding an accumulated incidence of nosocomial infection of 9.76 %. The microorganisms isolated with major frequency were the gramnegative stain (46.60 %), followed by Candida sp. (33.30 %) and grampositive cocci (20.01 %). The predominant location of infection was the bacteriemia, with an incidence of 4.09 % (2.99 % of primary bacteraemia Vs 1.10 % of catheter related infection). The mean rate of incidence of bacteriemias associated to intravasculares devices (BADV) was 8.92 (NNISS 7.3 ) with mean rate of utilization of the device of 0.65 (> Pc90 of the NNISS). The pneumonia associated with mechanical ventilation (NAVM) presented a mean rate of incidence of 1.80 departing from a mean rate of utilization of 0.27 (< Pc25 of the NNISS). The urinary infection associated with the closed drainage system presented an average rate of effect of 2.63 , with a mean rate of utilization of the closed drainage system of 0.37 (Pc75). CONCLUSIONS: Nosocomial infection represents an important problem in PICU. These data allow us the knowledge of the incidence of nosocomial infection in our PICU and target the strategies for reducing morbidity and mortality.

[SEN1500: design and implementation of a registry of infants weighing less than 1,500 g at birth in Spain]. / SEN1500: diseño y desarrollo del registro de niños de menos de 1.500 g al nacer en España.

OBJECTIVE: To design and implement a registry of infants weighing less than 1,500 g at birth in Spain. MATERIAL AND METHODS: Prospective, cohort, multicenter study. All live born infants weighing less than 1,500 g in several voluntarily participating neonatal units in public and private hospitals were included. RESULTS: In the first 4 years of the registry (2002 to 2005), 9,638 very-low-birth-weight infants were born in the 65 neonatal units that have so far joined the program. CONCLUSIONS: The goal of very-low-birth-weight infant databases is to try to improve the quality and safety of the medical care given to these newborns and their families. This type of program helps to coordinate and promote several areas, including those of health education, training of medical staff, research and development, surveillance and quality improvement.

[Lung function and exposure to tobacco smoke among adolescents]. / Función pulmonar y exposición al humo del tabaco en adolescentes.

OBJECTIVE: To study lung function in adolescents in relation to smoking (active and passive smokers) and to investigate the repercussion on spirometric parameters. PATIENTS AND METHOD: We studied 301 healthy adolescents with no history of bronchial asthma or colds in the month prior to the study. A questionnaire on tobacco exposure was administered and spirometry (Datospir-92) was performed. RESULTS: There were 165 boys (54.5%) and 136 girls (45.5%) aged between 14 and 20 years old (16.40+/-1.32). A total of 27.2% were non-smokers and were not exposed to tobacco smoke (NS), 31.3% were passive smokers, with household exposure of 10 cigarettes per day during at least the previous year (PS), and 41.5% were current smokers who had been smoking>or=10 cigarettes/day for at least 1 year (CS). Significant differences were found between age and smoking habits (p=0.0001) and between smoking habits and female sex (girls CS: 33.9% vs boys CS: 21.8 %) (p=0.007). A significant association was found between smoking (NS, PS and CS) and spirometric parameters (ANOVA): forced vital capacity (FVC) (p=0.001), forced expiratory volume in 1 second (FEV1) (p=0.0001), FEV1/FVC (p=0.004), peak expiratory flow (PEF) (p=0.0001), midexpiratory flow at 25% of forced vital capacity (MEF25%) (p=0.01), MEF50% (p=0.0001) and MEF25-75% (p=0.0001); CS in relation to NS was as follows: FEV1, PEF, MEF50%, MEF25-50% (p=0.0001) and FVC, FEV1/FVC, MEF25% (p=0.01); CS in relation to PS: FEV1/ FVC (p=0.02), PEF (p=0.004), MEF50% and MEF25-75% (p=0.003), PS in relation to NS: FVC and FEV1 (p=0.02). Significant differences in FVC, FEV1 and MEF25-75% were found in female CS in comparison with boys. CONCLUSIONS: The CS group showed a significant decrease in spirometric parameters in relation to the NS group. The airway was affected sooner in the female group of smokers than in the male group, even though the intensity and time of exposure were the same in both groups.

[Review of standards and recommendations for the design of a neonatology unit]. / Revisión de los estándares y recomendaciones para el diseño de una unidad de neonatología.

Standards for the design of a neonatology unit are reviewed. The process should begin with a planning team to outline the desired objectives to be achieved, followed by the intervention of a team of architects. Medical considerations, standards and recommendations, as well as architectural considerations (adequate privacy and intimacy, need for social support and communication, flexibility and accessibility) should be taken into account. From the architectural point of view, the greatest problem is the space available; furthermore, if the aim is to personalize the unit for the newborn and family, the need for space will be even greater. The following aspects should be analyzed and integrated into the design of the unit: standards and recommendations regarding space, the site of the unit, area of direct neonatal care, electrical installation, equipment, lighting and noise levels, nursing staff, communication systems, maintenance and refurbishment.

[Neonatal neoplasms: a single-centre experience]. / Neoplasias neonatales: experiencia de un centro.

INTRODUCTION: Malignant tumors are uncommon in the neonatal period and benign tumors may have malignant potential. OBJECTIVES: To describe the neoplasms diagnosed and treated in newborns (

[The efficiency (cost-effectiveness) of palivizumab as prophylaxis against respiratory syncytial virus infection in premature infants with a gestational age of 32-35 weeks in Spain]. / La eficiencia (coste-efectividad) de palivizumab como profilaxis para la infección por virus respiratorio sincitial en prematuros de 32-35 semanas en España.

OBJECTIVES: To evaluate the efficiency (cost-effectiveness) of palivizumab in preventing severe respiratory syncytial virus (RSV) infection in premature infants with a gestational age of 32-35 weeks (GA 32-35) and two or more risk factors (RF) in Spain. DESIGN: decision tree model using data from the scientific literature and the FLIP I and FLIP II studies (cohort of 326 infants with GA 32-35 and two or more RF who received palivizumab) sponsored by the Spanish Society of Neonatology. Main effectiveness measure: quality-adjusted life years (QALY) gained. PERSPECTIVES: the national health service (NHS), which includes direct costs (administration of palivizumab and hospital admissions), and the societal perspective, which also includes indirect costs (the child's future lost productivity). Discount: 3 % annually for effectiveness and indirect costs. Sensitivity analysis: construction of 37 scenarios modifying variables related to effectiveness and costs. RESULTS: Prophylaxis with palivizumab in premature infants with GA 32-35 and two or more RF produced an incremental cost-effectiveness ratio (ICER) of 13,849 euro/QALY from the NHS perspective, and an ICER of 4,605 euro/QALY from the societal perspective. In the sensitivity analysis, from the NHS perspective the ICER ranged from 5,351 euro/QALY (most favorable scenario) to 23,276 euro/QALY (least favorable scenario). CONCLUSIONS: Palivizumab is a cost-effective therapy as prophylaxis against RSV in infants with GA 32-35 and two or more RF. Its use is efficient from the NHS perspective, since the cost of a QALY, even in the least favorable scenarios, is lower than the threshold of 30,000 Euro/QALY considered socially acceptable in Spain.

[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.

[Respiratory disease in young people and smoking]. / Patología respiratoria en los jóvenes y hábito tabáquico.

OBJECTIVE: To assess the prevalence of respiratory disease among adolescents and young adults and to determine whether disease is more common among smokers. POPULATION AND METHOD: Four hundred twenty subjects (45.3% female and 54.7% male) between 14 and 21 years of age were studied. The subjects were enrolled in public and private schools in Tenerife (Spain). Each subject filled in an epidemiological questionnaire as recommended by the American Thoracic Society (ATS). RESULTS: We found that 26.5% were habitual smokers, 11.0% were occasional smokers, 3.6% were ex-smokers and 45.6% were passive smokers. Only 13.4% reported not being exposed to tobacco smoke. Respiratory diseases included recurrent upper respiratory tract infections (14.1%), lower respiratory tract infections (16%), allergy (32.5%) and asthma (10.5%), bronchospasm with exercise (25.8%) and chronic coughing (8.6%). The incidences of the following diseases were higher in young smokers: upper respiratory tract infections (p = 0.001), lower respiratory tract infections (p = 0.004), bronchospasm with exercise (p = 0.02) and chronic cough (p = 0.0001). Young smokers also lost more school days per year due to respiratory disease (p = 0.01). The rate of lower respiratory tract infections per year was higher among young smokers than among those who were unexposed (p = 0.004). CONCLUSION: Smoking, which leads to a higher incidence of respiratory disease, has a negative impact on adolescents.

[Bilirubin-albumin binding in term newborns on total parenteral nutrition]. / Unión bilirrubina-albúmina en recién nacidos a término sometidos a nutrición parenteral total.

We evaluate the influence of plasma lipid levels supplied in parenteral nutrition, on the bilirubin-albumin binding of 12 term newborns with severe pathologies. As controls we selected 2 groups of an equal number o newborns who were receiving maternal or artificial lactation. The reserved albumin binding capacity decreased in newborns subjected to parenteral nutrition (52.3 versus 72.9/73.5). This decrease correlated positively with greater concentrations of free fatty acids (r = 0.9234, p < 0.001), cholesterol (r = 0.9049, p < 0.001), and triglycerides (r = 0.8802, p < 0.001). The clear influence of the studied lipid parameters on the bilirubin albumin binding, invites us to consider the systematic use of heparin for the mobilization of lipoprotein-lipase from the vascular endothelium and to promote a better management of lipids in term newborns, especially if there is an important hyperbilirubinemia.

[Utility of congenital hypothyroidism screening in neonates for monitoring iodine deficit disorders in the Canary Islands (Spain)]. / Utilidad del programa de cribado neonatal del hipotiroidismo congénito para la valoración de la deficiencia de yodo en Canarias.

BACKGROUND: Newborns in European cities where iodine intake is low have been demonstrated to present high frequencies of transitory hypothyroidism. Because the neonatal period is critical for cerebral development, this is a cause for concern. Published studies (WHO/UNICEF/ICCIDD) indicate that neonates with a thyroid-stimulating hormone (TSH) concentration of more than 5 mU/ml revealed by screening for congenital hypothyroidism present mild iodine deficiency. OBJECTIVE: To analyze the utility of TSH values as an indicator of the prevalence of iodine deficiency in the general population. MATERIAL AND METHODS: We prospectively evaluated 19 809 neonates, corresponding to all the neonates screened from May 2001 to April 2002 in the Canary Islands.TSH determination in whole blood dried on filter paper was performed using immunofluorescence (Delphia) in the Center for the Detection of Metabolic Disorders in the Canary Islands. The percentage of neonates in each island with TSH values of > 5 mU/l was calculated. Samples of cord blood were not used. RESULTS: A total of 19 809 infants were analyzed. Of these 1800 had values of TSH > 5 mU/L, representing 9.08 % of neonates. The mean age at blood extraction was 4.31 6 3.78 days (range: 0.5-40). The percentage of neonates with values of THS > 5 mU/L in each island was 13.1 % in Gran Canaria, 5.1 % in Lanzarote, 7.3 % in Fuerteventura, 6.0 % in Tenerife, 6.2 % in La Palma, 6.6 % in Gomera and 10.1 % in Hierro. In 77.5 % of neonates in Gran Canaria blood was extracted for screening within the first 72 hours of life and 15.2 % of these neonates had TSH concentrations of > 5 mU/L. In 22.5 % of neonates blood was extracted on the third day of life or later and 7.9 % of these neonates had TSH values of > 5 mU/L. CONCLUSIONS: In the Canary Islands, the percentage of neonates with iodine deficiency, according to elevated TSH levels detected screening for congenital hyperthyroidism, was small. The validity of TSH level as an indicator of the prevalence of iodine deficiency in the general population is influenced by the days of life at which the blood sample is taken.

[Neonatal convulsions: influence of the electroencephalographic pattern and the response to treatment on the outcome]. / Convulsiones neonatales: influencia del patrón electroencefalográfico en su evolución y en la respuesta al tratamiento.

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.

Midazolam in neonatal seizures with no response to phenobarbital.

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.

[Vertically transmitted bacteremias: to treat or not to treat?]. / Bacteriemias verticales: ¿tratar o no tratar?

OBJECTIVE: To analyze the incidence, etiology and management of infants born in 1977 with vertically transmitted bacteremia or suspected early neonatal sepsis. PATIENTS AND METHODS: The total number of newborn infants in this period was 2,365. We revised the clinical histories of the infants diagnosed with bacteremia and classified them into two groups: a) those with vertically transmitted bacteremias, according to the recommendations of the Castrillo Group, and b) those with suspected early onset neonatal sepsis in whom blood culture was positive and analytical data suggested bacterial infection but who showed no clinical symptoms of vertically transmitted sepsis. Birthweight, sex, gestational age, risk factors for neonatal infection, clinical signs and laboratory tests suggestive of bacterial infection and microbiological agents were analyzed. The clinical and analytical evolution of the treated and untreated newborn infants was studied. RESULTS: The newborn infants were diagnosed with vertically transmitted bacteremia (an incidence of 4.2x1,000 live newborn infants) and 17 were diagnosed with suspected early onset neonatal sepsis (7.8x1,000 live newborns). All the infants had risk factors for neonatal sepsis. The most common of them was prolonged membrane rupture (>- 18 hours) due to which sepsis screening was carried out (hemogram, C-reactive protein at 12 and 36-48 hours of life, and blood culture). In both groups the most commonly isolated microorganism was group B streptococcus, which was found in 30% of vertically transmitted bacteremias and in 41.2% of suspected early onset neonatal sepsis. All the newborn infants with suspected sepsis and two with vertically transmitted bacteremia were treated without incident. The remaining eight infants with untreated vertically transmitted bacteremia were followed-up clinically ana analytically for one year, and remained asymptomatic. CONCLUSIONS: The most common microorganism in vertically transmitted bacteremia and suspected early onset neonatal sepsis was group B streptococcus. None of the untreated infants developed late sepsis or meningitis. Our findings suggest that non-treatment of asymptomatic infants with vertically transmitted bacteremias is appropriate as long and close clinical surveillance is maintained.

[Dietary calcium deprivation in the pregnant rat: evaluation of the repercussions on the maternal and fetal skeleton]. / Deprivación del calcio dietario a la rata gestante: valoración de la repercusión en el esqueleto materno y fetal.

Authors have studied: calcemia, bone ashes calcium content and bone turnover by histofluorescence in 44 Wistar female adult rats. Control group (A) received for 21 days (equivalent to pregnancy) a normocalcemic diet, and group B an hypocalcemic diet. Both received demethyl-chlortetracycline intra-peritoneally at the beginning and end of the experience. Fetuses were fully calcinated and ash weight and calcium content determined. Group B shows a significative decrease in calcemia (F = 284.66, p less than 0.01), bone ash calcium content (F = 47.2, p less than 0.01) and an increase in endosteal bone resorption (F = 32.89, p less than 0.01), while bone formation including synthesis of bone matrix and calcium deposition is diminished (total bone formation, F = 20.0, p less than 0.01). No significative differences have been found among rats of the same group for the fact of being pregnant. No differences have been detected among fetuses of both groups. Fetuses seem to act as parasites and authors support a possible explanation for neonatal hypocalcemia.

[Transcutaneous bilirubinometry: correlation of the reading site obtained with spectrophotometry and diazoreaction technique]. / Bilirrubinometría transcutánea: correlación del área de medida con la espectrofotometría y colorimetría por diazorreacción.

During the last ten years, the clinical use of a non-invasive method for the measurement of bilirubin became available as an alternative for classical routine procedures. Values obtained with a Minolta bilirubinometer from different reading sites were correlated with those obtained by using an optic bilirubinometer (American Diagnostics) and a dimethyl-sulfoxide mediated diazoreaction. The antero-external face of the thigh revealed the highest correlation coefficients with the two serum techniques (r = 0.925, p < 0.001) and was more efficient when the newborn was under phototherapy (r = 0.811, p < 0.01).

[Metabolic control, C peptide and lipids in insulin-dependent diabetes mellitus]. / Control metabólico, péptido C y lípidos en la diabetes mellitus insulin-dependiente.

Total cholesterol, HDL cholesterol, triglyceride, glycohaemoglobine and plasma glycoprotein levels were measured in 67 diabetic children and 40 nondiabetic ones. A dynamic study on C peptide secretion was also made in 28 diabetic patients. It was checked the fact that diabetic children showed normal whole cholesterol (172.1 +/- 32.1 mg/dl), HDL cholesterol (48.1 +/- 18.8 mg/dl) and triglyceride (58.3 +/- 26.8 mg/dl) levels, demonstrating no relationship with sex, age, length of diabetes, nor with the degree of metabolic control of disease, classified taking into account several clinical and biochemical indicators. C peptide concentration was found to be within normal levels in the whole group of patients under clinical remission phase of diabetes and also in 75% of children during the first 6 months of disease development. C peptide levels were higher in male than female diabetic children, showing an inverse relationship with duration of disease (r = -0.577, p less than 0.001) and with daily insulin requirements (r = -0.532, p less than 0.005). Discriminant analysis and multiple regression analysis results showed that the patients with a higher risk of bad control of diabetes were the older, those with a larger duration of disease, specially female, those with no remission phase of diabetes during clinical course of disease, and those showing bad motivation in relation to treatment.