Modelling the seasonal impacts of a wastewater treatment plant on water quality in a Mediterranean stream using microbial indicators.

Faecal pollution modelling is a valuable tool to evaluate and improve water management strategies, especially in a context of water scarcity. The reduction dynamics of five faecal indicator organisms (E. coli, spores of sulphite-reducing clostridia, somatic coliphages, GA17 bacteriophages and a human-specific Bifidobacterium molecular marker) were assessed in an intermittent Mediterranean stream affected by a wastewater treatment plant (WWTP). Using Bayesian inverse modelling, the decay rates of each indicator were correlated with two environmental drivers (temperature and streamflow downstream of the WWTP) and the generated model was used to evaluate the self-depuration distance (SDD) of the stream. A consistent increase of 1-2 log10 in the concentration of all indicators was detected after the discharge of the WWTP effluent. The decay rates showed seasonal variation, reaching a maximum in the dry season, when SDDs were also shorter and the stream had a higher capacity to self-depurate. High seasonality was observed for all faecal indicators except for the spores of sulphite-reducing clostridia. The maximum SDD ranged from 3 km for the spores of sulphite-reducing clostridia during the dry season and 15 km for the human-specific Bifidobacterium molecular marker during the wet season. The SDD provides a single standardized metric that integrates and compares different contamination indicators. It could be extended to other Mediterranean drainage basins and has the potential to integrate changes in land use and catchment water balance, a feature that will be especially useful in the transient climate conditions expected in the coming years.

Blastocyst vs cleavage-stage embryo transfer: systematic review and meta-analysis of reproductive outcomes.

OBJECTIVES: Blastocyst transfer in assisted reproduction techniques could be advantageous because the timing of exposure of the embryo to the uterine environment is more analogous to a natural cycle and permits embryo self-selection after activation of the embryonic genome on day 3. Conversely, the in-vitro environment is likely to be inferior to that in vivo, and in-vitro culture beyond embryonic genomic activation could potentially harm the embryo. Our objective was to identify, appraise and summarize the available evidence comparing the effectiveness of blastocyst vs cleavage-stage embryo transfer. METHODS: This was a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the transfer of blastocysts (days 5-6) with the transfer of cleavage-stage embryos (days 2-3) in women undergoing in-vitro fertilization or intracytoplasmic sperm injection. The last electronic searches were run on 1 August 2016. Abstracts and studies with a mean difference between the two study groups of > 0.5 for the number of embryos transferred were excluded. RESULTS: We screened 1187 records and assessed 33 potentially eligible studies. Twelve studies were included, comprising a total of 1200 women undergoing blastocyst transfer and 1218 undergoing cleavage-stage embryo transfer. We observed low-quality evidence of no significant difference of blastocyst transfer on live birth/ongoing pregnancy (relative risk (RR), 1.11 (95% CI, 0.92-1.35), 10 RCTs, 1940 women, I2 = 54%), clinical pregnancy (RR, 1.10 (95% CI, 0.93-1.31), 12 RCTs, 2418 women, I2 = 64%), cumulative pregnancy (RR, 0.89 (95% CI, 0.67-1.16), four RCTs, 524 women, I2 = 63%) and miscarriage (RR, 1.08 (95% CI, 0.74-1.56), 10 RCTs, 763 pregnancies, I2 = 0%). There was moderate-quality evidence of a decrease in the number of women with surplus embryos after the blastocyst-stage embryo transfer (RR, 0.78 (95% CI, 0.66-0.91)). Overall, the quality of the evidence was limited by the quality of the included studies and by unexplained inconsistency across studies. CONCLUSIONS: Current evidence shows no superiority of blastocyst compared with cleavage-stage embryo transfer in clinical practice. As the quality of the evidence for the primary outcomes is low, additional well-designed RCTs are still needed before robust conclusions can be drawn. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Obstetrical and perinatal outcomes following blastocyst transfer compared to cleavage transfer: a systematic review and meta-analysis.

STUDY QUESTION: Is blastocyst transfer safe when compared to cleavage stage embryo transfer regarding obstetric and perinatal outcomes? SUMMARY ANSWER: The clinical equipoise between blastocyst and cleavage stage embryo transfer remains as the evidence associating blastocyst transfer with some adverse perinatal outcomes is of low/very low quality. WHAT IS KNOWN ALREADY: Extended embryo culture to the blastocyst stage provides some theoretical advantages and disadvantages. While it permits embryo self-selection, it also exposes those embryos to possible harm due to the in vitro environment. Both effectiveness and safety should be weighed to permit evidence-based decisions in clinical practice. STUDY DESIGN, SIZE, DURATION: This is a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies reporting perinatal outcomes for singletons comparing the deliveries resulting from blastocyst and cleavage stage embryo transfer. Observational studies were included because the primary outcomes, perinatal mortality and birth defects, are rare and require a large number of participants (>50 000) to be properly assessed. The last electronic searches were last run on 11 March 2016. PARTICIPANTS/MATERIALS, SETTING, METHOD: There were 12 observational studies encompassing 195 325 singleton pregnancies included in the study. No RCT reported the studied outcomes. The quality of the included studies was evaluated according to the Newcastle-Ottawa Scale and the quality of the evidence was evaluated according to GRADE criteria. MAIN RESULTS AND THE ROLE OF CHANCE: Blastocyst stage transfer was associated with increased risks of preterm birth (<37 weeks), very preterm birth (<32 weeks), large for gestational age and perinatal mortality, although the latter was only identified from one study. Conversely, blastocyst stage transfer was associated with a decrease in the risks of small for gestational age and vanishing twins, although the latter was reported by only one study. LIMITATIONS, REASONS FOR CAUTION: The observational nature of the included studies and some inconsistency and imprecision in the analysis contributed to decreasing our confidence in the estimates. WIDER IMPLICATIONS OF THE FINDINGS: Due to the overall low quality of available evidence, the clinical equipoise between cleavage stage and blastocyst transfer remains. More large well-conducted studies are needed to clarify the potential risks and benefits of blastocyst transfer. As this review was initiated to support global recommendations on best practice, and in light of the challenges in lower resource settings to offer extended culture to blastocyst stage, it is critical to take into consideration these obstetric and neonatal outcomes in order to ensure any recommendation will not result in the overburdening of existing maternal and child health care systems and services. STUDY FUNDING/COMPETING INTERESTS: No external funding was either sought or obtained for this study. The authors have no competing interests to declare. PROSPERO REGISTRATION NUMBER: CRD42015023910.

Prospective multicenter cohort study of estrogen and insulin-like growth factor system in BRCA mutation carriers.

PURPOSE: Major clinical characteristics of BRCA1/2-related cancers include association with estrogen and metabolic consequences. We aimed to evaluate serum estradiol (E2) and insulin-like growth factor 1 (IGF-1) levels as a marker of insulin resistance in BRCA1/2 mutation carriers and high-risk, BRCA-negative controls. METHODS: Eligible cancer-free women (age 18-42 with regular menstrual cycles) who had been screened for BRCA1/2 mutations between 2005 and 2013 completed a questionnaire and underwent a single blood draw. E2 was measured with radioimmunoassay, and IGF-1 was measured with enzyme-linked immunosorbent assay. RESULTS: Eighty-six women participated (44 carriers and 42 non-carriers) in this study. BRCA mutation carriers were significantly younger than non-carriers (p = 0.0002). Age-adjusted basal (menstrual cycle days 2-5) serum E2 level was not significantly different between BRCA mutation carriers and non-carriers (30.4 vs. 24.7 pg/mL, p = 0.07). BRCA mutation carriers have significantly lower age-adjusted serum IGF-1 levels compared to non-carriers (89.7 vs. 112.6 ng/mL, p < 0.001). In women with BRCA mutations, the risk of having low serum IGF-1 level (IGF-1: ≤85 ng/mL) was 10.7 times as great as that of women without BRCA mutations (95 % CI 2.5, 46.2). There was a significant inverse association between basal E2 and IGF-1 levels in BRCA mutation carriers after adjusting age and BMI (p = 0.03). CONCLUSIONS: IGF-1 level is significantly lower in cancer-free BRCA mutation carriers versus BRCA-negative controls, and there is a potential association between E2 and IGF-1 in cancer-free BRCA mutation carriers. Our findings may instigate future studies evaluating the role of both E2 and IGF-1 in BRCA mutation carriers.

Pleiotropic role of the RNA chaperone protein Hfq in the human pathogen Clostridium difficile.

Clostridium difficile is an emergent human pathogen and the most common cause of nosocomial diarrhea. Our recent data strongly suggest the importance of RNA-based mechanisms for the control of gene expression in C. difficile. In an effort to understand the function of the RNA chaperone protein Hfq, we constructed and characterized an Hfq-depleted strain in C. difficile. Hfq depletion led to a growth defect, morphological changes, an increased sensitivity to stresses, and a better ability to sporulate and to form biofilms. The transcriptome analysis revealed pleiotropic effects of Hfq depletion on gene expression in C. difficile, including genes encoding proteins involved in sporulation, stress response, metabolic pathways, cell wall-associated proteins, transporters, and transcriptional regulators and genes of unknown function. Remarkably, a great number of genes of the regulon dependent on sporulation-specific sigma factor, SigK, were upregulated in the Hfq-depleted strain. The altered accumulation of several sRNAs and interaction of Hfq with selected sRNAs suggest potential involvement of Hfq in these regulatory RNA functions. Altogether, these results suggest the pleiotropic role of Hfq protein in C. difficile physiology, including processes important for the C. difficile infection cycle, and expand our knowledge of Hfq-dependent regulation in Gram-positive bacteria.

Hormone variations associated with quantitative fat measures in the menopausal transition.

OBJECTIVE: Reproductive hormone levels are associated with body size, and the association between estradiol and body size varies over the menopausal transition. This study aims to delineate these relationships using quantitative measures of visceral and subcutaneous fat. METHODS: Early follicular hormones (follicle stimulating hormone (FSH), estradiol, luteinizing hormone, dehydroepiandrosterone sulfate, testosterone) and T-1 weighted abdominal MRI images were obtained in a cross-sectional assessment of 77 women in the Penn Ovarian Aging Study. Fat volume (cm(3)) was quantified using validated software (Amira) and divided into tertiles of visceral and subcutaneous fat volume for analysis. Multivariable linear regression models compared hormone values between tertiles adjusting for race, age, and menopausal status. RESULTS: In adjusted models, estradiol was positively associated with visceral fat tertiles (geometric mean (GM) estradiol (pg/ml): Low 13.0, Mid 17.5, High 26.7, p = 0.006) while FSH was inversely associated with visceral fat tertiles (GM FSH (mIU/ml): Low 42.8, Mid 43.2, High 30.8, p = 0.03). The association of estradiol with visceral and subcutaneous fat tertiles varied by menopausal status (p < 0.001). In the early transition, estradiol was similar across tertiles of fat; postmenopause, estradiol was positively associated with visceral fat. Other hormones were not associated with fat measures. CONCLUSIONS: Estradiol was associated with quantitative measures of visceral fat and varies by menopausal status. This finding suggests that visceral fat may be an important mediator in hormone changes over the menopausal transition.

From the closet to the shore: Fashion waste pollution on Colombian Central Caribbean beaches.

This paper examines the environmental effects of fashion waste on the central Caribbean coast of Colombia, highlighting significant ecological issues in coastal areas. A survey of 27 beaches found 503 items of fashion waste, mainly shoes and sandals, with an average density of 0.93 items/m2. The distribution of this type of waste varies notably across different beach types, with exposed, rural, and remote beaches showing higher accumulation, indicating a relationship between beach characteristics and waste concentration. Primary sources of this waste include riverine transport, coastal tourism, and poorly managed sewage systems, impacting urban, rural, and village beaches differently. The study reveals that longshore currents and oceanic movements, significantly influence the transport and fate of this waste, with exposed beaches accumulating more fashion waste than sheltered ones. The presence of driftwood also plays a vital role in trapping fashion waste along coastlines. The findings highlight the need for effective management strategies to mitigate the impact of fashion waste, providing crucial insights for local and national coastal managers and implications for managing fashion waste in the Southern Caribbean and similar regions worldwide.

Analysis and classification of tea varieties using high-performance liquid chromatography and global retention models.

As a result of their metabolic processes, medicinal plants produce bioactive molecules with significant implications for human health, used directly for treatment or for pharmaceutical development. Chromatographic fingerprints with solvent gradients authenticate and categorise medicinal plants by capturing chemical diversity. This work focuses on optimising tea sample analysis in HPLC, using a model-based approach without requiring standards. Predicting the gradient profile effects on full signals was the basis to identify optimal separation conditions. Global models characterised retention and bandwidth for 14 peaks in the chromatograms across varied elution conditions, facilitating resolution optimisation of 63 peaks, covering 99.95 % of total peak area. The identified optimal gradient was applied to classify 40 samples representing six tea varieties. Matrices of baseline-corrected signals, elution bands, and band ratios, were evaluated to select the best dataset. Principal Component Analysis (PCA), k-means clustering, and Partial Least Squares-Discriminant Analysis (PLS-DA) assessed classification feasibility. Classification limitations were found reasonable due to tea processing complexities, involving drying and fermentation influenced by environmental conditions.

Geographical heterogeneity and dominant polymer types in microplastic contamination of lentic ecosystems: implications for methodological standardization and future research.

This study examines the prevalence and distribution of microplastic polymer types in lentic ecosystems, revealing significant heterogeneity across different geographical regions and ecosystems. The most dominant type of microplastic observed was polyethylene (PE), followed by polypropylene (PP) and polystyrene (PS), which aligns with global production rates. North America, Asia, and Europe were identified as the regions with the highest microplastic contamination, with the United States, China, Italy, and Spain being the most affected countries. The physical characteristics of each ecosystem, such as wind speed, depth, and eutrophication, alongside seasonal variations, and anthropogenic activities, contributed to the observed heterogeneity in microplastics concentrations. The study highlights the need for further research on microplastics in lentic ecosystems, considering their unique physical characteristics and anthropogenic influences. A significant lack of methodological standardization in microplastics research was identified, leading to underestimation of microplastics prevalence and high heterogeneity in meta-analyses.

[Alpha-Lactalbumin as an ingredient of infant formula]. / Alpha-Lactoalbúmina como ingrediente de fórmulas infantiles.

Alpha-Lactalbumin is the main whey protein in human milk rising 2,44 g/L in mature milk. It has a key function in the synthesis of lactose from glucose and galactose in the mammary gland although this compound has also other beneficial effects on the infant health due to the high proportion of essential aminoacids (tryptophan and cysteine). It seems also to increase iron absorption in the digestive track, and in in vitro experiments, linked to oleic acid (HAMLET complex), has shown anticarcinogenic effects against cellular tumor such as human papilloma. In addition, this complex has been reported to exhibit antimicrobial properties against Streptococcus pneumoniae, Haemophilus influenzae, enteropathogenic strains of Escherichia coli and Salmonella thypimurium. However, the in vivo synthesis of HAMLET complex during milk digestion has not been proved yet. Infant formula have been improved considerably during the last decades not only adapting nutrient concentrations to infants requirements but also by the addition of new bioactive ingredients such as alpha-lactalbumin, to have the same functional effect as in breast fed babies.

Litter in coastal and marine environments.

Litter is one of the most pervasive and fastest-growing anthropogenic alterations of the World's coasts and oceans. Along with climate change, litter has been identified as one of humankind's most critical environmental problems that demand urgent solutions. Litter magnitudes and distribution, and the related detrimental environmental effects, have been documented in all existing coastal and marine environments (e.g., beaches, dunes, abyssal plains and submarine canyons, among others). Litter's presence is now so ubiquitous in the environment that it serves as a geological indicator of the Anthropocene. As part of the solution to this out-of-hand problem, Marine Pollution Bulletin has produced this Special Issue entitled "Litter in Coastal and Marine Environments". This collection of 37 papers provides a focal point for such related current studies and, in part, seeks to discuss implementing specific management strategies under different scenarios. No single solution exists to cope with the litter issue. However, legally binding global governance that will effectively limit and control the magnitude of litter pollution is greatly needed. The topical range of this collection of papers includes case studies focussing on litter types (mainly dominated by plastics), sources, impacts and solutions.

Artificial structures as biological "influencers": Hydrozoa and Anthozoa diversity in a Colombian Caribbean Marina.

The Puerto Velero Marina, located on the central Caribbean coast of Colombia, is an example of an artificial structure that serves as a substrate for a vulnerable community such as cnidarians (Hydrozoa and Anthozoa). This study provides the first assessment of corals and other cnidarians inhabiting artificial marine habitats in a marginal environment of the Caribbean of Colombia. The Puerto Velero Marina was built into a 7 km2 sand spit generated by sedimentation at the mouth of the Magdalena River. In this study were recorded 14 cnidarian species, among which were found 48 small colonies of scleractinian corals such as Porites, Siderastrea, Phyllangia, and Astrangia. This initial biodiversity assessment of the artificial structure provides a baseline that highlights the importance of further monitoring programs to identify non-native species that could reach this kind of hard structures.

Microplastics pollution on Colombian Central Caribbean beaches.

The growing literature on microplastics (MPs) in coastal and marine environs reflects the seriousness of this pollutant category. Diverse litter studies on Colombia's Central Caribbean Coast have not presented detailed study of MPs' typology, magnitude or distribution. This baseline study presents for first time the MPs problem on 23 beaches in 75 km coastal reach between Punta Roca and Galerazamba, on the central Colombian Caribbean Coast. The Microplastics Pollution Index (MPPI) and Coefficient of Microplastic Impact (CMPI) were developed and applied along with the Environmental Status Index (ESI) and their integration through sector analysis, and mapping using Agglomerative Hierarchical Clustering and Multidimensional Scaling, and Principal Components Analysis. Microplastics abundances (densities) ranged from 2457 to 557 MPs/kg, similar to other global beaches and bays. The MPs Index for the 23 beaches classified 8 beaches as "Moderate," 10 beaches as "High" and 5 as "Very High." Microplastic fibers were the dominant typology at 83% of the combined beaches total (ranging from Moderate to Very High for individual beaches).

Plastic pollution on the Colombian central Caribbean beaches.

Along 24 beaches of the Central Caribbean Coast of Colombia, plastic items were collected and grouped into 43 different typologies. The average plastic abundance was 4.54 items/m2 being eight typologies responsible for 82% of all plastic collected. The application of the Clean Coast Index (CCI) and the Plastic Abundance Index (PAI) allows categorization of the study area as "Extremely Dirty" coastal strip with a "Very High Abundance" of plastics. Beaches were statistically grouped into three specific types: moderate, bad and extremely bad environmental conditions. The typology and magnitudes of plastics found in the study area suggest a combination of sources that primarily include dumping and direct activities on the beach. Plastic medical and sanitary waste, ocean/waterway items, and plastic items related to smoking-related activities also were observed.

The invasive species Perna viridis (Linnaeus, 1758 - Bivalvia: Mytilidae) on artificial substrates: A baseline assessment for the Colombian Caribbean Sea.

This baseline paper shows the Indo-Pacific mussel Perna viridis (Asian green mussel) inhabiting on floating plastic substrates in the Atlantico Department, as well as rafting on marine debris found at the Via Parque Isla de Salamanca (Magdalena). Both observations are the northernmost record of the species found in the Colombian Caribbean Sea. The above finding opens a new door that suggests that larval dispersion alone may not be the only process responsible for the presence of this invasive suspension-feeder bivalve because this species needs specific vectors for its dispersal. Some organisms such Perna viridis can persist in the marine environment, but they do not necessarily have a rafting capability that allows them to move over long distances. Floating structures as well as marine debris can serve as optimal substrates in the marine environment, contributing to an increase in the problems of non-native species on sites with a high degree of susceptibility to species invasion.

The impact of anthropogenic litter on Colombia's central Caribbean beaches.

A total of 7563 anthropogenic litter (AL) items, grouped into twelve different typologies, were collected along 25 beaches located on the central Caribbean coast of Colombia. The average AL abundance was 6.05 items/m2, plastic items being the most common reaching a total percentage of 88.9% with an average density of 5.38 items/m2. Application of 3 evaluation indices, based on the AL data, placed most of the beaches into the status of unacceptable conditions of cleanness (Dirty to Extremely Dirty), and into mediocre to unsatisfactory environmental status. Hazardous anthropogenic litter (HAL), occurred in considerable amounts with hazardous items reaching a high of 7% (502 items of 7563 total items collected), and an average of 0.40 items/m2. Beaches were statistically grouped into four specific types that ranged from beaches in good environmental conditions (Group A) to beaches in extremely adverse environmental conditions (Group D). The typology and magnitudes of AL found along the study area suggest a combination of sources that are associated with the multiple usages developed along this region's coast. Anthropogenic litter is mainly related to land-based sources, and these generating source activities can be found in nearby basins and/or on the same beaches where the litter remains. This paper proposes four key actions to specifically reduce AL, as well as an 8-step agenda to address solutions to the broader management of litter problems.

[Epidemiology, clinical results and success rate in hip preservation surgery in avascular osteonecrosis of the femoral head]. / Epidemiología, resultados clínicos y tasa de éxito en cirugía preservadora de cadera en la necrosis avascular de cabeza femoral.

INTRODUCTION: Avascular osteonecrosis of the femoral head (ONFH) is a frequent pathology with an insidious and asymptomatic presentation in early stages, so the diagnosis is often made in advanced stages, where the only effective solution is total hip arthroplasty (THA). Diagnosis in early stages will allow the use of therapeutic options that avoid or delay ATC. Our objective is to evaluate the demographic, clinical results and the success rate in our center of patients diagnosed with ONFH and who have been subsidiary of hip preservation surgery. MATERIAL AND METHODS: Unicentric, prospective, uncontrolled clinical study of patients diagnosed with ONFH between January 2012 and September 2017 with a Steinberg IIIA stage. The surgical technique used is decompressive forage, associated with bone allograft and bone marrow aspiration. RESULTS: 26 hips were operated on with our surgical technique. The success rate obtained is 61.54%, since 10 cases have required THA during the study (38.46%). CONCLUSIONS: The therapeutic success in ONFH is directly related to the degree of the disease, which is why early diagnosis is important. The decompressive forage with bone allograft that associates bone marrow aspiration is an option to be taken into account, since in early stages it shows a high success rate.

INTRODUCCIÓN: La necrosis avascular de cabeza femoral (NACF) es una patología frecuente que en sus inicios es asintomática y se manifiesta de forma insidiosa, por lo que a menudo el diagnóstico se realiza en estadios avanzados, donde la única solución eficaz es la artroplastía total de cadera (ATC). El diagnóstico en fases precoces permitirá utilizar opciones terapéuticas que eviten o retrasen la ATC. Nuestro objetivo es valorar los resultados demográficos, clínicos y la tasa de éxito en nuestro centro de pacientes con diagnóstico de NACF y que han sido subsidiarios de cirugía de preservación de cadera. MATERIAL Y MÉTODOS: Estudio clínico unicéntrico, prospectivo, no controlado de pacientes con diagnóstico de NACF entre Enero de 2012 y Septiembre de 2017 con un estadio Steinberg IIIA. La técnica quirúrgica utilizada es el forage descompresivo, asociado a relleno con aloinjerto y aspirado de médula ósea. RESULTADOS: Se intervinieron 26 caderas con nuestra técnica quirúrgica. La tasa de éxito obtenida es de 61.54%, ya que 10 casos han precisado ATC durante el estudio (38.46%). CONCLUSIÓN: El éxito terapéutico en la NACF está directamente relacionado con el grado de la enfermedad, por lo que es importante el diagnóstico precoz. El forage descompresivo con relleno de aloinjerto que asocia aspirado de médula ósea es una opción a tener en cuenta, ya que en estadios iniciales muestra una elevada tasa de éxito.

[Unusual evolution of reactive arthritis after endovesical immunotherapy with BCG].

Intravesical instillation of BCG (Bacille Calmette-Guerin) is a therapy prepared with weakened strains of Mycobacterium bovis and is an effective complementary treatment for high-risk (non-musculoinfiltrating or non-invasive) bladder cancer. Although its safety for clinical use is high, endovesical immunotherapy is not without complications. Arthralgia and arthritis are infrequent, but potentially severe, complications, the early diagnosis of which can allow adequate medical treatment and avoid chronification of the pathology. This case shows the therapeutic management of hip osteoarthritis in a 59-year-old woman, a rare and serious complication, secondary to a rare pathology such as reactive arthritis due to BCG instillation.

[Respiratory care in neonatal intensive care units. Situation in the year 2005]. / Asistencia respiratoria en las unidades de cuidados intensivos neonatales en España: situación en 2005.

AIM: To learn the characteristic of the neonatal intensive care units (NICUs) that offer neonatal respiratory assistance in Spain. MATERIAL AND METHOD: A structured survey was developed and sent to all Spanish neonatal units to learn about the respiratory care offered in 2005. RESULTS: A total of 96 Units answered the survey, with an estimated representatively of 63%, with a range from 3 to 92%, depending on the geographical area. Level IIIc Units were in the upper range. Answer the survey 26 units type IIb (27%), 16 IIIa (17%), 40 IIIb (42%) and 14 IIIc (14%). The total number of level III NICU beds was 541 (1.2 beds per 1000 livebirths; range, 0.7-1.7). The mean number of beds per NICU was 4.1 in level IIIa Units, 2.8 in those IIIb and 14.6 in type IIIc NICUs. In level III NICUs, the bed per physician ratio was 2.4 and that of beds per registered nurse was 2.8 (2.2 in level IIIc NICUs). There were a total 13,219 admissions, 54% of those needed mechanical ventilation (36% in IIIa and 65% in level IIIc NICUs). Oxygen blenders for resuscitation at birth were available in 42% of level IIIb and IIIc NICUs. NICUs had one neonatal ventilator per bed, and 63% of units had high frequency ventilation available. All units had nasal-CPAP systems, 25% of level IIIa Units, 58% IIIb and 64% of those type IIIc had systems for nasal ventilation. All level IIIc and 93% of level IIIb NICUs were able to provide inhaled nitric oxygen therapy. Four NICUS offered ECMO. CONCLUSIONS: The mean number of NICU beds per 1000 livebirths is within the lower limits of those been recommended, and there were wide variations among different geographical areas. A 54% of those babies admitted to NICUs required mechanical ventilation. The mean number of NICU beds per registered nurse was 2.8. There was an adequate number of neonatal ventilators (one per bed) and 63% were able to provide HFV. All NICUs hand n-CPAP systems.