Cribado universal de infección por citomegalovirus en prematuros de menos de 1.500g / Universal cytomegalovirus infection screening in premature newborns less than 1500g

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Correlation between histological signs of placental underperfusion and perinatal morbidity in late-onset small-for-gestational-age fetuses.

OBJECTIVE: To investigate whether signs of placental underperfusion (PUP), defined as any maternal and/or fetal vascular pathology, confer an increased risk of neonatal morbidity in late-onset small-for-gestational-age (SGA) fetuses with normal umbilical artery (UA) Doppler indices. METHODS: A cohort of 126 SGA singleton fetuses with normal UA Doppler indices that were delivered after 34 weeks' gestation was studied. For each case, the placenta was evaluated histologically for signs of PUP using a hierarchical and standardized classification system. Neonatal morbidity was assessed according to the score calculated from the morbidity assessment index for newborns (MAIN), a validated outcome scale. The independent association between PUP and neonatal morbidity was evaluated using multivariable median regression analysis. RESULTS: In 84 (66.7%) placentae, 97 placental histological findings that qualified as signs of PUP were observed. These PUP cases had a significantly higher incidence of emergency Cesarean section for non-reassuring fetal status (44.1% vs 21.4%, respectively; P = 0.013) and neonatal metabolic acidosis at birth (33.3% vs 14.3%, respectively; P = 0.023), than did those without PUP. The median MAIN score differed significantly between those with PUP and those without (89 vs 0, respectively; P = 0.025). This difference remained significant after adjustment for potential confounders. The proportion of cases with scores indicative of mild to severe morbidity was also significantly higher in the PUP group (31% vs 14.3%, respectively; P = 0.043). CONCLUSION: In late-onset SGA fetuses with normal UA Doppler indices, signs of PUP imply a higher neonatal morbidity. These findings allow the phenotypic profiling of fetal growth restriction among the general population of late-onset SGA.

Quantitative ultrasound texture analysis of fetal lungs to predict neonatal respiratory morbidity.

OBJECTIVE: To develop and evaluate the performance of a novel method for predicting neonatal respiratory morbidity based on quantitative analysis of the fetal lung by ultrasound. METHODS: More than 13,000 non-clinical images and 900 fetal lung images were used to develop a computerized method based on texture analysis and machine learning algorithms, trained to predict neonatal respiratory morbidity risk on fetal lung ultrasound images. The method, termed 'quantitative ultrasound fetal lung maturity analysis' (quantusFLM™), was then validated blindly in 144 neonates, delivered at 28 + 0 to 39 + 0 weeks' gestation. Lung ultrasound images in DICOM format were obtained within 48 h of delivery and the ability of the software to predict neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, was determined. RESULTS: Mean (SD) gestational age at delivery was 36 + 1 (3 + 3) weeks. Among the 144 neonates, there were 29 (20.1%) cases of neonatal respiratory morbidity. Quantitative texture analysis predicted neonatal respiratory morbidity with a sensitivity, specificity, positive predictive value and negative predictive value of 86.2%, 87.0%, 62.5% and 96.2%, respectively. CONCLUSIONS: Quantitative ultrasound fetal lung maturity analysis predicted neonatal respiratory morbidity with an accuracy comparable to that of current tests using amniotic fluid.

Cribado universal de infección por citomegalovirus en prematuros de menos de 1.500 g / Universal cytomegalovirus infection screening in premature newborns less than 1500 g

INTRODUCCIÓN: La infección por citomegalovirus es una infección endémica y los niños que acuden a guardería constituyen el foco de infección más importante para las gestantes. OBJETIVO: Establecer una recomendación para el diagnóstico basada en la evidencia médica sobre la infección de trasmisión vertical por citomegalovirus en prematuros menores de 1.500g al nacer. ANTECEDENTES: La infección en la gestante puede ser primaria o secundaria. Aunque exista infección fetal, el 85% de los recién nacidos serán asintomáticos. Los síntomas de infección son: bajo peso al nacer, hepatoesplenomegalia, trombocitopenia, microcefalia y trastornos neurológicos. El pronóstico de los niños sintomáticos suele ser grave, con elevada mortalidad y secuelas neurológicas. El virus se puede reactivar durante la lactancia y es posible la infección precoz a través de la leche materna, probablemente con poca repercusión en niños a término, aunque en prematuros puede afectar al neurodesarrollo a largo plazo. El método diagnóstico de elección es la identificación del citomegalovirus en orina; la determinación en las 2 primeras semanas de vida indica infección congénita. Un diagnóstico posterior sugiere que puede haber sido adquirida en el parto o a través de la leche materna o transfusión de sangre contaminada. Conclusión y recomendación: Determinar el ADN viral por reacción en cadena de la polimerasa a las 4-6 semanas de vida. En caso positivo, investigar en muestras obtenidas los primeros días de vida y en leche materna. Ello debe permitir clasificar al recién nacido en 3 estados: «no infectado», «infección congénita» e «infección adquirida»

INTRODUCTION: Cytomegalovirus (CMV) infection is endemic, and children who attend day care are the most important source of infection. OBJECTIVE: To establish recommendations based on the medical evidence on the vertical transmission of cytomegalovirus in preterm infants weighing less than 1500g at birth. BACKGROUND: Infection in pregnant women may be primary or secondary. Although there is fetal infection, 85% of newborn infants are asymptomatic. Symptoms of infection include low birth weight, hepatosplenomegaly, thrombocytopenia, microcephaly and neurological disorders. The prognosis of symptomatic children is very poor, with high mortality and neurological disorders. The virus can be reactivated during breast feeding, and early infection is possible through breast milk, probably with little impact in term infants, although the long-term neurological outcome worsens in preterm infants. The diagnostic method of choice is the identification of CMV in urine; the determination in the first two weeks of life suggests congenital infection; later it can be acquired at birth or through breast milk or contaminated blood transfusion. Conclusion and recommendation: Determine viral DNA at 4-6 weeks of life by protease chain reaction. If it is positive, monitoring of samples from the first days of life and breast milk are mandatory. This should allow the newborn to be classified into three states: «Without CMV infection», «Congenital CMV infection», «Acquired CMV infection»

[Universal cytomegalovirus infection screening in premature newborns less than 1500 g]. / Cribado universal de infección por citomegalovirus en prematuros de menos de 1.500 g.

INTRODUCTION: Cytomegalovirus (CMV) infection is endemic, and children who attend day care are the most important source of infection. OBJECTIVE: To establish recommendations based on the medical evidence on the vertical transmission of cytomegalovirus in preterm infants weighing less than 1500g at birth. BACKGROUND: Infection in pregnant women may be primary or secondary. Although there is fetal infection, 85% of newborn infants are asymptomatic. Symptoms of infection include low birth weight, hepatosplenomegaly, thrombocytopenia, microcephaly and neurological disorders. The prognosis of symptomatic children is very poor, with high mortality and neurological disorders. The virus can be reactivated during breast feeding, and early infection is possible through breast milk, probably with little impact in term infants, although the long-term neurological outcome worsens in preterm infants. The diagnostic method of choice is the identification of CMV in urine; the determination in the first two weeks of life suggests congenital infection; later it can be acquired at birth or through breast milk or contaminated blood transfusion. CONCLUSION AND RECOMMENDATION: Determine viral DNA at 4-6 weeks of life by protease chain reaction. If it is positive, monitoring of samples from the first days of life and breast milk are mandatory. This should allow the newborn to be classified into three states: "Without CMV infection", "Congenital CMV infection", "Acquired CMV infection".

Recomendaciones para la informatización de los servicios de neonatología / Recommendations for the computerisation of neonatology services

El objetivo es proporcionar el marco para la recopilación de datos en el área de la salud de los recién nacidos que permitan la armonización de la asistencia sea cual sea su lugar de nacimiento. Para ello es necesario conocer la población atendida y la mayor dificultad es la ausencia de un sistema de recopilación de datos y de unos estándares asistenciales para todas las condiciones del recién nacido. Es imprescindible disponer de un registro único en el que se recojan los principales datos perinatales y neonatales de todos los recién nacidos. La Sociedad Española de Neonatología (SEN) debe ser el depositario y responsable de la base de datos, que debe cumplir todas las exigencias legales de privacidad y confidencialidad. A nivel de cada centro es posible conocer el peso relativo de la afección atendida por grupos de diagnósticos relacionados (DRG) y los resultados desde el aspecto de calidad asistencial. Mediante análisis comparativos (estudios de benchmarking,...) es posible establecer las pautas de diagnóstico y tratamiento.Es necesario conocer la población de recién nacidos atendida y definir criterios de diagnóstico y tratamiento para mejorar la calidad asistencial. La SEN desea dirigirse a los responsables asistenciales de los centros hospitalarios para pedirles su apoyo y colaboración en la puesta en marcha de estas recomendaciones (AU)

The aim is to provide a framework for data collection in the health area of newborn infants allowing harmonization of their care. This requires knowing the population served, and the greatest difficulty is the absence of a data collection system and standards of care for all conditions of the newborn infant. It is essential to have a single record with the main perinatal and neonatal data of all newborn infants. The Spanish Society of Neonatology (SEN) should be responsible for the database, which must meet all legal requirements of privacy and confidentiality. It is possible to determine the relative weight of the pathology treated using Diagnostic Related Groups (DRG) and the results from a quality care perspective. Guidelines for diagnosis and treatment may be established by comparative analysis (benchmarking studies…).Conclusion and Recommendation. It is necessary to know the newborn population served, and define criteria for diagnosis and treatment to improve quality of care. The SEN wishes to address those responsible for the care in hospitals, and to ask for their support and cooperation in the implementation of these recommendations(AU)

Neurodevelopmental outcome of full-term small-for-gestational-age infants with normal placental function.

OBJECTIVE: To evaluate the 2-year neurodevelopmental outcome of full-term, small-for-gestational-age (SGA) newborns with normal placental function, according to current criteria based on umbilical artery Doppler findings. METHODS: A cohort of consecutive full-term, SGA newborns with normal prenatal umbilical artery Doppler was compared with a group of full-term, appropriate-for-gestational-age (AGA) infants sampled from our general neonatal population. Neurodevelopmental outcome was evaluated at 24 months' corrected age using the Bayley Scales of Infant and Toddler Development, 3(rd) Edition (Bayley-III), which evaluates cognitive, language, motor, social-emotional and adaptive competencies. The effect of the study group on each domain was adjusted with MANCOVA and logistic regression for gestational age at delivery, socioeconomic status, gender, tobacco smoking and breastfeeding. RESULTS: A total of 223 infants (112 SGA and 111 AGA) were included. The groups differed significantly with respect to socioeconomic status and gestational age at delivery. All studied neurodevelopmental domains were poorer in the SGA group, reaching significance for the cognitive (92.9 vs 100.2, adjusted P = 0.027), language (94.7 vs 101, adjusted P = 0.025), motor (94.2 vs 100, adjusted P = 0.027) and adaptive (89.2 vs 96.5, adjusted P = 0.012) scores. Likewise, the SGA group had a higher risk of low scores in language (odds ratio (OR) = 2.63; adjusted P = 0.045) and adaptive (OR = 2.72; adjusted P = 0.009) domains. CONCLUSIONS: Compared with normal-sized babies, full-term SGA infants, without placental insufficiency defined according to currently used criteria, have lower 2-year neurodevelopmental scores. These data challenge the concept that SGA fetuses with normal umbilical artery Doppler are 'constitutionally small' but otherwise completely normal.

[Recommendations for the computerisation of neonatology services]. / Recomendaciones para la informatización de los servicios de neonatología.

The aim is to provide a framework for data collection in the health area of newborn infants allowing harmonization of their care. This requires knowing the population served, and the greatest difficulty is the absence of a data collection system and standards of care for all conditions of the newborn infant. It is essential to have a single record with the main perinatal and neonatal data of all newborn infants. The Spanish Society of Neonatology (SEN) should be responsible for the database, which must meet all legal requirements of privacy and confidentiality. It is possible to determine the relative weight of the pathology treated using Diagnostic Related Groups (DRG) and the results from a quality care perspective. Guidelines for diagnosis and treatment may be established by comparative analysis (benchmarking studies…). Conclusion and Recommendation. It is necessary to know the newborn population served, and define criteria for diagnosis and treatment to improve quality of care. The SEN wishes to address those responsible for the care in hospitals, and to ask for their support and cooperation in the implementation of these recommendations.

Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age pregnancies with normal fetal and maternal Doppler indices.

OBJECTIVE: To evaluate the risk of adverse perinatal outcome according to estimated fetal weight (EFW) in a cohort of term small-for-gestational-age (SGA) pregnancies with normal umbilical, fetal middle cerebral and maternal uterine artery Doppler indices. METHODS: A cohort of 132 term SGA fetuses with normal umbilical artery pulsatility index (PI), mean uterine artery PI and cerebroplacental ratio was compared to a control group of 132 appropriate-for-gestational-age babies, matched by gestational age at delivery. The capacity of the EFW percentile to predict Cesarean delivery, Cesarean delivery for non-reassuring fetal status (NRFS), neonatal acidosis and days of neonatal hospitalization was analyzed. RESULTS: As a whole, SGA fetuses with normal Doppler findings did not show a statistically significant difference for intrapartum Cesarean delivery (22.0 vs. 15.9%; P = 0.21) and neonatal acidosis (3.3 vs. 1.5%; P = 0.30), but had significantly higher risk for Cesarean delivery for NRFS (15.9 vs. 5.3%; P < 0.01) and longer neonatal hospitalization (1.39 vs. 0.87 days; P < 0.05) than did controls. SGA fetuses with EFW < 3(rd) centile had a significantly higher incidence of intrapartum Cesarean delivery (30.0 vs. 15.3%; P = 0.04), Cesarean delivery for NRFS (25.0 vs. 8.3%; P < 0.01) and longer neonatal hospitalization (2.0 vs. 0.9 days; P < 0.01) than those with EFW ≥ 3(rd) centile. SGA cases with EFW ≥ 3(rd) centile had perinatal outcomes similar to those of controls with normal EFW. CONCLUSION: Among SGA fetuses with normal placental and cerebral Doppler ultrasound findings, EFW < 3(rd) centile discriminates between those with a higher risk for adverse perinatal outcome and those with outcomes similar to those of normally grown fetuses.

Increased nuchal translucency and normal karyotype: perinatal and pediatric outcomes at 2 years of age.

OBJECTIVE: To assess the perinatal and pediatric outcomes up to 2 years of age in singleton karyotypically normal fetuses with increased nuchal translucency (NT) above the 99(th) percentile. METHODS: Singleton fetuses with NT above the 99(th) percentile and normal karyotype scanned in our center from 2002 to 2006 were included. Work-up included first- and second-trimester anomaly scan, first- and second-trimester fetal echocardiography, and in selected cases infection screening and genetic testing. Among survivors, a pediatric follow-up up to 2 years of age was undertaken. RESULTS: During this 4-year period, 171 singleton fetuses with NT above the 99(th) percentile and normal karyotype were included in the study. There were seven spontaneous fetal losses, 38 terminations of pregnancy and two postnatal deaths. Among the 124 (72.5%) survivors, 12 (9.7%) were born with structural abnormalities. Neurodevelopmental follow-up was completed in 108 (87.1%) of the 124 survivors and four (3.7%) showed moderate to severe impairment. Overall, a structural abnormality or genetic syndrome was diagnosed in 50 fetuses/newborns. Prenatal diagnosis was achieved for 83.8% (31/37) of the structural abnormalities and 69.2% (9/13) of the genetic syndromes. Interestingly, a single umbilical artery was found in six fetuses with no structural defects at birth, five of which had a long-term favorable outcome (4.5%), and in one 22q11 microdeletion syndrome was diagnosed at 2 years of age. CONCLUSION: Singleton fetuses with an increased NT above the 99(th) percentile and normal karyotype showed a 63% intact survival. Long-term neurodevelopmental outcome among survivors did not appear to differ from that reported for the general population.

Obstetrical and neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitors: the relevance of dose.

OBJECTIVE: The purpose of this study was to evaluate the effects of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) on obstetrical and neonatal outcomes. METHOD: A case-control study was conducted to compare perinatal outcomes among pregnant women with affective disorder (DSM-IV criteria) and who received SSRIs during pregnancy with those of women without an active psychiatric disorder during pregnancy who were non-exposed to antidepressants during pregnancy. Each case was matched to two controls for maternal age (± 2 years) and parity. RESULTS: A total of 252 women were enrolled in the study, 84 exposed and 168 non-exposed. Demographic and clinical characteristics did not differ significantly between the groups. The rates of prelabor rupture of membranes, induction of labor and cesarean delivery were slightly higher but not statistically significant in the exposed group. The mean gestational age at birth was 38.8 (± 1.86) weeks for the exposed group and 39.4 (± 1.52) weeks for the non-exposed group (p=.005). Rates for preterm birth were higher in the exposed group (OR=3.44, 95% CI=1.30-9.11). After stratification for dose, it was found that exposure to a high-dose was associated with lower gestational age (p=.009) and higher rates of prematurity (OR=5.07, 95% CI=1.34-19.23). The differences remained significant after controlling for maternal status and the length of exposure. CONCLUSION: Women treated with SSRIs during pregnancy, mainly at high-dose, had an increased risk of preterm birth compared to healthy women of similar age and parity who were not exposed to SSRI during pregnancy.

Neurobehavioral outcomes in preterm, growth-restricted infants with and without prenatal advanced signs of brain-sparing.

OBJECTIVE: To evaluate the neurobehavioral outcomes of preterm infants with intrauterine growth restriction (IUGR), with and without prenatal advanced brain-sparing. METHODS: A cohort of IUGR infants (birth weight < 10(th) percentile with abnormal umbilical artery Doppler) born before 34 weeks of gestation was compared with a control group of appropriate-for-gestational age infants matched for gestational age at delivery. MCA pulsatility index was determined in all cases within 72 hours before delivery. Neonatal neurobehavior was evaluated at 40 weeks' ( ± 1) corrected age using the Neonatal Behavioral Assessment Scale. The effect of abnormal MCA pulsatility index (< 5(th) percentile) on each neurobehavioral area was adjusted for maternal smoking status and socioeconomic level, mode of delivery, gestational age at delivery, pre-eclampsia, newborn illness severity score and infant sex by multiple linear and logistic regression. RESULTS: A total of 126 preterm newborns (64 controls and 62 IUGR) were included. Among IUGR fetuses, the proportion of abnormal MCA Doppler parameters was 53%. Compared with appropriate-for-gestational age infants, newborns in the IUGR subgroup with abnormal MCA Doppler had significantly lower neurobehavioral scores in the areas of habituation, motor system, social-interactive and attention. Similarly, the proportion of infants with abnormal neurobehavioral scores was significantly higher in the IUGR subgroup with abnormal MCA Doppler parameters in the areas of habituation, social-interactive, motor system and attention. CONCLUSION: Abnormal MCA Doppler findings are predictive of neurobehavioral impairment among preterm newborns with IUGR, which suggests that this reflects an advanced stage of brain injury with a higher risk of abnormal neurological maturation.

Gastroenteritis vírica en niños hospitalizados. Estudio prospectivo multicéntrico / Viral gastroenteritis in hospitalized children. A multicentre prospective study

Introducción: El objetivo de este estudio fue determinar prospectivamente la etiología vírica de la gastroenteritis aguda (GEA) en lactantes hospitalizados, así como describir las características clínicas de los principales virus. Pacientes y métodos: Desde octubre de 2006 hasta marzo de2007, se realizó el seguimiento de todos los niños de 1-23 meses de edad hospitalizados en tres hospitales, desde el momento de la admisión hasta las 72 horas tras el alta, para detectarla presencia de GEA. Se analizó una muestra de heces de los niños con GEA para la detección de rotavirus, calicivirus (norovirus y sapovirus), astrovirus y adenovirus mediante transcripción inversa y reacción en cadena de la polimerasa. Resultados: De un total de 1.576 pacientes hospitalizados, se pudo realizar el seguimiento de 1.300 (82,5%), que han constituido nuestra cohorte de estudio. Un total de 242 niños tuvieron GEA (un 18,6% de la cohorte), obteniéndose muestra de heces de 217 (89,7%). En 91 casos (42%) se detectaron rotavirus, en 72 norovirus (33,2%), en 7 astrovirus (3,2%) y en2 adenovirus; no se detectó sapovirus en ningún caso. Trece niños (6%) presentaron infecciones mixtas por dos o más virus, y 32 (14,7%) resultaron negativos para todos los virus analizados. En los casos de GEA por norovirus se observa menor apatía y pérdida de peso que en los casos de rotavirus, pero mayorporcentaje de heces con sangre.Conclusiones: Los virus son una causa frecuente de GEA enlos niños menores de 2 años hospitalizados; el principal virus hallado es el rotavirus, seguido del norovirus. Debido a las escasas diferencias clínicas observadas entre rotavirus y norovirus, es necesaria su determinación analítica para su diferenciación (AU)

Introduction: The objective of this study was to determine prospectively the viral etiology of acute gastroenteritis (AGE) in hospitalized weaning babies and describe the clinical characteristics of the principal virus detected. Patients and methods: All children aged 1 to 23 months admitted to 3 hospitals during October 2006-March 2007 were followed for the presence of AGE from the time of hospital admission until 72 hours after hospital discharge. A stool sample of children with AGE was tested for calicivirus (norovirus and sapovirus), rotavirus, adenovirus and astrovirus by RT-PCR. Results: Of the 1,576 hospitalized children, 1,300 (82.5%)were fully monitored being our study cohort. A total of 242children had AGE (18.6% of the cohort) and stool samples from217 children were obtained (89.7%). In 91 cases (42%) were positive to rotavirus, 72 (33.2%) to norovirus, 7 (3.2%) to astrovirus, and in 2 to adenovirus, not detecting sapovirus in any case, 13 children (6%) showed mixed infections by two or more viruses and 32 (14.7%) cases were negative for the analyzed virus. Norovirus AGE have less apathy and weight loss than thecases of rotavirus but a higher percentage of stools with blood. Conclusions: The viruses are a frequent cause of AGE among the hospitalized children of less than 2 years of age being rotavirus the principal virus found followed by norovirus. Few clinical differences were observed between rotavirus and norovirus and analytical determination is necessary for their differentiation (AU)

Prevalence and perinatal outcome of dichorionic and monochorionic twins with nuchal translucency above the 99(th) percentile and normal karyotype.

OBJECTIVE: To evaluate the prevalence of and perinatal outcome associated with increased nuchal translucency thickness (NT) > 99(th) percentile in dichorionic and monochorionic twins with normal karyotype. METHODS: Two hundred and six consecutive twin pregnancies (166 dichorionic and 40 monochorionic) underwent an NT scan during a 4-year period. In those with NT > 99(th) percentile and normal karyotype, we performed first- and second-trimester anomaly scans, fetal echocardiography at 14-16 and 20-22 weeks, maternal serology and, in monochorionic pregnancies, serial ultrasound examinations every other week. Perinatal outcome was recorded. RESULTS: There were 10 (4.95%) pregnancies in which one of the fetuses had NT > 99(th) percentile and normal karyotype, including five fetuses (1.5%) in dichorionic and five (6.25%) in monochorionic pregnancies. During the same period the prevalence of NT > 99(th) percentile and normal karyotype in singleton pregnancies studied in our center was 2.6%. Among the 10 twins affected, six (60%) were diagnosed with structural abnormalities (three dichorionic and three monochorionic), and two intrauterine fetal demises occurred (one dichorionic and one monochorionic). Thus, the perinatal outcome was normal in only two of the pregnancies, one dichorionic and one monochorionic. CONCLUSIONS: The prevalence of NT > 99(th) percentile in dichorionic twins with a normal karyotype is similar to that in singletons. In monochorionic twins we confirmed previous studies reporting an increased prevalence compared with singletons. NT > 99(th) percentile with a normal karyotype in twins was associated with a high rate of fetal abnormalities and/or fetal demise (overall 80%) irrespective of chorionicity.

[Family impact of rotavirus gastroenteritis in children under two years]. / Impacto familiar de la gastroenteritis por rotavirus en menores de dos años.

INTRODUCTION: Acute gastroenteritis (AGE) in infants has a significant impact on the quality of life of their parents. MATERIAL AND METHODS: Cross-sectional study on the sociological family impact related to rotavirus AGE in children under 2 years. The study was carried out in 25 hospitals and 5 primary care centres in Spain. Sociodemographic, epidemiological and clinical data were recorded, as well as the symptomatology of AGE and its severity measured by the Clark scale. Stool samples were tested to determine rotavirus positive (RV+) or negative (RV-). The parents were asked to complete a a family impact questionnaire. RESULTS: Stool specimens were tested in 1087 AGE cases (584 RV+ vs 503 RV-). The 99.5 % of parents whose children were RV+ reported more worries vs. the 97.7 % of RV-, and RV+ had a higher importance score (p < 0.05). A higher percentage of RV+ parents and those with a high importance score reported more time dedicated to dehydration treatment (p < 0.05). The 82.5 % vs. 73.9 % had disruption of their household tasks, with more importance scores (p < 0.05). RV+ had a higher percentage and importance score than RV- ones in all aspects of their child's AGE symptoms, except loss of appetite. CONCLUSION: AGE produces important dysfunctional experiences in daily family life. According to parental perceptions, RV+ produces greater worries and dysfunctions in child behaviour.

[Survey on scientific research activity in Spanish neonatal divisions between 2000 and 2004]. / Encuesta sobre la actividad investigadora en los servicios de neonatología en España en el período 2000-2004.

Research is an essential activity in neonatology. Following the recommendation of the Spanish Neonatal Society (SEN), a questionnaire on the state of research activity was sent to all Spanish neonatal divisions belonging to all public and private institutions with structured neonatal activity. The following items were included: (i) clinical level of the units; (ii) academic degrees and professional qualifications of the staff members; (iii) characteristics of the scientific activity performed, and (iv) financial and technical aid supporting research. Of a total of 115 eligible hospitals, 86 hospitals (74.8 %), including most of the referral centers, participated in the survey. Notable among the positive results were the findings that a significant number of neonatologists have doctoral degrees (17.4 %), are active members of the SEN (74.9 %), and wish to participate in scientific research (100 %). In addition, the presence of epidemiologists (100 %), research support units (85 %) and ethical committees (93 %) in the hospitals is widespread. Negative aspects include the lack of a specific budget to initiate research (74 %), lack of protected time even with research grants (86 %), and lack of interrelation with other groups of basic or clinical researchers (43 %). Analysis of scientific production revealed that most of the abstracts presented are restricted to Spanish national meetings, and only a small number of consolidated groups publish regularly in peer-reviewed international journals with impact factor. Measures that could help to improve the current situation are the formation of multi-hospital groups, participation in comprehensive databases (SEN 1500), and joint meetings for basic and clinical scientists, among others. The results of this survey were presented at the Congress of Perinatal Medicine held in Las Palmas (November, 2005).

Encuesta sobre la actividad investigadora en los servicios de neonatología en España en el período 2000-2004 / Survey on scientific research activity in Spanish Neonatal Divisions between 2000 and 2004

La investigación es una actividad fundamental en la neonatología. A propuesta de la Sociedad Española de Neonatología (SEN) se ha realizado una encuesta para conocer el estado de la investigación en los centros públicos y privados con una actividad neonatal estructurada. Se han incluido los siguientes apartados: a) nivel asistencial del centro hospitalario; b) nivel profesional del personal adscrito; c) características de la producción científica realizada, y d) estructura de apoyo a la investigación. De un total de 115 hospitales posibles han participado 86 (74,8 %), y destaca la participación de los grandes hospitales de referencia. Entre los resultados positivos obtenidos llama la atención un porcentaje significativo de neonatólogos con el grado de doctor (17,4 %), una elevada afiliación a la SEN (74,7 %), un deseo unánime realizar investigación (100 %) y la existencia generalizada de epidemiólogos (100 %), unidades de apoyo (85 %) y comités de ética en los hospitales (100 %). Los aspectos negativos son la escasez de medios económicos para el inicio de una primera investigación (74 %), la ausencia de tiempo protegido aun con proyectos concedidos (86 %) y la falta de relación con otros grupos de investigadores básicos o clínicos (43 %). En relación con la producción científica, la mayor parte de las comunicaciones y artículos se restringen al ámbito nacional, y sólo pequeños grupos consolidados publican asiduamente en revistas de impacto internacionales. La formación de grupos multihospitalarios, la existencia de bases de datos (SEN 1500) y reuniones mixtas básicas y clínicas y otras medidas que se sugieren pueden ayudar a mejorar la situación de la investigación en el ámbito de la neonatología. Los resultados de esta encuesta fueron presentados en el Congreso de Medicina Perinatal celebrado en Las Palmas (noviembre de 2005)

Research is an essential activity in neonatology. Following the recommendation of the Spanish Neonatal Society (SEN), a questionnaire on the state of research activity was sent to all Spanish neonatal divisions belonging to all public and private institutions with structured neonatal activity. The following items were included: (i) clinical level of the units; (ii) academic degrees and professional qualifications of the staff members; (iii) characteristics of the scientific activity performed, and (iv) financial and technical aid supporting research. Of a total of 115 eligible hospitals, 86 hospitals (74.8 %), including most of the referral centers, participated in the survey. Notable among the positive results were the findings that a significant number of neonatologists have doctoral degrees (17.4 %), are active members of the SEN (74.9 %), and wish to participate in scientific research (100 %). In addition, the presence of epidemiologists (100 %), research support units (85 %) and ethical committees (93 %) in the hospitals is widespread. Negative aspects include the lack of a specific budget to initiate research (74 %), lack of protected time even with research grants (86 %), and lack of interrelation with other groups of basic or clinical researchers (43 %). Analysis of scientific production revealed that most of the abstracts presented are restricted to Spanish national meetings, and only a small number of consolidated groups publish regularly in peer-reviewed international journals with impact factor. Measures that could help to improve the current situation are the formation of multi-hospital groups, participation in comprehensive databases (SEN 1500), and joint meetings for basic and clinical scientists, among others. The results of this survey were presented at the Congress of Perinatal Medicine held in Las Palmas (November, 2005)

Endocarditis neumocócica: revisión a propósito de un caso y nueva pauta de tratamiento asociada a fosfomicina / Pneumococcal endocarditis: report of a case involving a novel treatment with association of fosfomycin and a review of the literature

Se presenta un interesante caso de endocarditis bacteriana en un varón de 12 años de edad, que asociaba como patología de base una comunicación interventricular membranosa, que presentó buena respuesta al tratamiento asociado con penicilina en altas dosis, gentamicina y fosfomicina. Se adjunta una revisión bibliográfica acerca de los distintos tratamientos antibióticos descritos, incluidas las pautas menos habituales. Se incluye en la discusión una extensa explicación de la asociación al tratamiento antibiótico de fosfomicina

The authors present an interesting case of bacterial endocarditis in a 12 year-old boy, the underlying cause of which was a membranous ventricular septal defect. The infection responded well to treatment with high-dose penicillin, in combination with gentamycin and fosfomycin. A review of the literature dealing with the different types of antibiotic therapy, including less conventional approaches, is provided, and the reasons for administering combination treatment involving fosfomycin are explained in detail

Memory performance in a sample of very low birth weight adolescents.

Prematurely born participants with very low birth weight (VLBW) are at high risk of brain injury in the perinatal period and of later cognitive impairment. Studies of long-term memory sequelae in VLBW participants are scarce and focus on verbal and visual memory assessed by standard clinical memory tests. There is even less research into everyday memory, and the results obtained are contradictory. This study explores long-term memory deficits in VLBW adolescents using 2 standard clinical memory tests and 1 everyday memory test. Results show impairment only in everyday memory. These memory deficits are not specific; they are related to an impaired general cognitive performance. Unlike birth weight, gestational age is a good predictor of intelligence.