In memoriam del profesor Dr. Angel Nogales Espert (Valencia 1941-Madrid 2012) / In memoriam of profesor Dr. Angel Nogales Espert (Valencia 1941-Madrid 2012)

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Rendimiento neuropsicológico en niños pretérmino con muy bajo peso en el nacimiento / Neuropsychologycal (performance, efficiency, production) in preterm infants with very low birth weight

Introducción: El objetivo principal de este trabajo es conocerlas características neuropsicológicas de un grupo de niños prematuros y con bajo peso al nacimiento, teniendo en cuenta su heterogeneidad y sus rasgos comunes, la gravedad de los síntomas y la necesidad de recibir cuidados específicos. Pacientes y métodos: El grupo estaba formado por 73 sujetos en total, 33 niños y 40 niñas. El número de sujetos en el grupo de bajo peso (GBP) fue de 23 y el del grupo control (GC) de 50. La media de edad en el momento de la recogida de datos fue de 32,65 meses en el GBP y de 31,9 meses para el GC. El estatus socioeconómico de ambos grupos era de tipo medio. Los estadísticos descriptivos de ambos grupos son: «semanas de gestación» con grupo pretérmino (<32 semanas) y grupo control (>37 semanas) y, «peso al nacimiento» con grupo de bajo peso (<1.500 g) y grupo control (>2.500 g). Se evaluó a los participantes mediante una batería de pruebas neuropsicológicas creada específicamente para este estudio. Resultados: El GC obtuvo mejores resultados en casi todas las funciones, pero no todas resultaron estadísticamente significativas, sólo «articulación, lenguaje expresivo y reconocimiento de figuras». Por el contrario, el GBP obtuvo resultados estadísticamente significativos en «reconocimiento de colores». Conclusiones: Se postula la necesidad de realizar un diagnóstico neuropsicológico precoz en los niños de bajo peso al nacer por pertenecer a una población de alto riesgo(AU)

Introduction: The primary target of this work is to know the neuropsychological characteristics of one premature children and with low weight in the birth group, considering it's heterogeneity, common characteristics, the gravity of the symptoms and the necessity to receive specific cares. Patients and methods: The total group is formed by 73 subjects, 33 males and 40 females. The number of subjects of low weight group (LWG) are 23 and the subjects of control group (CG) 50. The average ages at the time of the sample were of 32.65 months, GBP and of 31.9 months GC. The socioeconomic status of both groups were average type. Statistical descriptive of both groups are "weeks of gestation" with the group preterm (<32 weeks) and the control group (>37 weeks) and "weight in the birth", the group of very low weight (<1,500 g) and the control group (>2,500 g). The subjects are evaluated through a neuropsychological battery of tests created for this study. Results: The LWG obtains better results in almost functions but not all are statistically significant, only "articulation, expressive language and recognition of figures". In the other way, the CG obtains statistically significant results in "recognition of colors". Conclusions: We postulate the necessity to realise a precocious neuropsychologycal diagnostic in the children with low weight birth because they belong to a high-risk group(AU)

Cierre intrauterino del conducto arterial en probable relación con la ingesta materna de metamizol durante el tercer trimestre de gestación / Intrauterine closure of the ductus probably associated with the taking of metamizole during the third trimester

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[Reduced postnatal growth in very low birth weight newborns with GE < or = 32 weeks in Spain]. / Restricción posnatal del crecimiento en recién nacidos españoles de muy bajo peso con edad gestacional menor o igual a 32 semanas.

AIM: To analyze postnatal growth restriction in a cohort of very low birth weight (VLBW) infants with gestational age < or = 32 weeks in 55 Spanish neonatal units (SEN 1500 Network) during 2002 and 2003. METHODS: Weight, length and head circumference were recorded at birth, and at discharge. Weight was also recorded at 28 days postnatal, and 36 weeks of postmenstrual age. Growth restriction was measured as the shift in weight z score from birth to 28th day. RESULTS: The study included 2317 VLBW infants. Weight z score at birth, 28 days, 36 weeks of postmenstrual age and discharge were: -0.66 +/- 1.3, -2.54 +/- 1.35, -3.12 +/- 1.7, -1.56 +/- 1.1, respectively. Length z score at birth and at discharge were: -0.88 +/- 1.8, and -1.97 +/- 1.56. Head circumference z score at birth and at discharge: -0.83 +/- 1.87, and -0.60 +/- 1.96. Prenatal steroids, gestational age, place of birth, type of hospital, CRIB score, symptomatic patent ductus arteriosus and late-onset bacterial sepsis were related with the shift in weight z score at 28 days (multiple linear regression), but explained very little (14 %) of his change. Weight and length at discharge were under the 10th percentile in 77 % and 80 % of the infants, respectively. CONCLUSIONS: VLBW infants < or = 32 GA suffer postnatal growth restriction with respect to intrauterine growth pattern, which is more relevant in the first 28 days of life, in patients with more severe illnesses, and differs among neonatal units. Perinatal and neonatal items evaluated are poorly related with restriction.

[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.

Restricción posnatal del crecimiento en recién nacidos españoles de muy bajo peso con edad gestacional menor o igual a 32 semanas / Reduced postnatal growth in very low birth weight newborns with GE <= 32weeks in Spain

Objetivo: Analizar la restricción posnatal del crecimiento en una cohorte de recién nacidos de muy bajo peso (RNMBP) y de no más de 32 semanas de gestación de 55 unidades de neonatología españolas (SEN 1500). Métodos: Se estudiaron peso, longitud y perímetro craneal al nacer y en el momento del alta. El peso se registró también a los 28 días de vida y 36 semanas de edad posmenstrual. Se analizó la relación entre restricción de crecimiento y datos perinatales y neonatales. Resultados: Se incluyeron 2.317 niños. La puntuación Z de peso al nacer, a los 28 días, a las 36 semanas de edad posmenstrual y al alta fue, respectivamente, ­0,66 ± 1,3, ­2,54 ± 1,35, ­3,12 ± 1,7, ­1,56 ± 1,1. La puntuación Z de longitud al nacer y al alta fue ­0,88 ± 1,8 y ­1,97 ± 1,56, respectivamente; la puntuación Z del perímetro craneal al nacer fue ­0,83 ± 1,87 y en el momento del alta ­0,60 ± 1,96. Los factores relacionados con el grado de restricción de peso a los 28 días fueron: corticoides prenatales, edad gestacional, lugar de nacimiento, tipo de hospital, puntuación CRIB, ductus arterioso persistente sintomático y sepsis tardía. Estos factores sólo explicaron el 14 % de la variabilidad del grado de restricción. El peso y la longitud al alta fueron inferiores a P10 en el 77 % y el 80 % de los RNMBP, respectivamente. Conclusiones: Los RNMBP de no más de 32 semanas de gestación durante su estancia en las unidades de neonatología sufren una "restricción de crecimiento" respecto al patrón intrauterino. Esta restricción ocurre sobre todo en los primeros 28 días de vida y es diferente en distintas unidades españolas. Las variables estudiadas explican en escasa medida este fenómeno (AU)

Aim: To analyze postnatal growth restriction in a cohort of very low birth weight (VLBW) infants with gestational age <= 32 weeks in 55 Spanish neonatal units (SEN 1500 Network) during 2002 and 2003. Methods: Weight, length and head circumference were recorded at birth, and at discharge. Weight was also recorded at 28 days postnatal, and 36 weeks of postmenstrual age. Growth restriction was measured as the shift in weight z score from birth to 28th day. Results: The study included 2317 VLBW infants. Weight z score at birth, 28 days, 36 weeks of postmenstrual age and discharge were: ­0.66 ± 1.3, ­2.54 ± 1.35, ­3.12 ± 1.7, ­1.56 ± 1.1, respectively. Length z score at birth and at discharge were: ­0.88 ± 1.8, and ­1.97 ± 1.56. Head circumference z score at birth and at discharge: ­0.83 ± 1.87, and ­0.60 ± 1.96. Prenatal steroids, gestational age, place of birth, type of hospital, CRIB score, symptomatic patent ductus arteriosus and late-onset bacterial sepsis were related with the shift in weight z score at 28 days (multiple linear regression), but explained very little (14 %) of his change. Weight and length at discharge were under the 10th percentile in 77 % and 80 % of the infants, respectively. Conclusions: VLBW infants <= 32 GA suffer postnatal growth restriction with respect to intrauterine growth pattern, which is more relevant in the first 28 days of life, in patients with more severe illnesses, and differs among neonatal units. Perinatal and neonatal items evaluated are poorly related with restriction (AU)

SEN1500: diseño y desarrollo del registro de niños de menos de 1.500 g al nacer en España / SEN1500: Design and implementation of a registry of infants weighing less than 1.500 g at birth in Spain

Objetivo: Diseño y desarrollo de un registro de niños de menos de 1.500 g al nacer en España. Material y métodos: Estudio de cohortes prospectivo multicéntrico. Se incluyen todos los recién nacidos vivos de peso inferior a 1.500 g al nacer en las unidades neonatales (UN) que voluntariamente se integren en el proyecto. Resultados: En los primeros 4 años de funcionamiento del registro han participado en el estudio 65 UN diferentes. El total de niños seleccionados entre 2002 y 2005 es de 9.637. Conclusiones: La misión de las bases de datos de los niños de muy bajo peso al nacer es intentar mejorar la calidad y la seguridad de los cuidados médicos que se proporcionan a los recién nacidos y a su familia. Su desarrollo posibilita la coordinación de programas de educación sanitaria y formación de profesionales médicos y de enfermería, de líneas de investigación y de proyectos de mejora (AU)

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 (AU)

[T lymphocyte immunophenotype as a diagnostic marker of late-onset neonatal sepsis]. / Inmunofenotipificación de linfocitos T como marcador diagnóstico de sepsis neonatal tardía.

BACKGROUND: Given the high risks associated with neonatal sepsis, there is a need for a diagnostic marker that would predict the disease before the results of blood or cerebrospinal fluid cultures are available. We evaluated changes in the CD4+ T lymphocyte immunophenotype in neonates with late-onset sepsis to try to improve the test combinations currently used (C reactive protein, immature:total neutrophil ratio, leukocytosis). PATIENTS AND METHODS: We performed a prospective cohort study in 24 neonates with late-onset sepsis and 48 non-infected controls with a gestational age of 37 weeks or less. CD4+ T lymphocyte subpopulations in peripheral blood samples were identified by labeling with monoclonal antibodies and quantified by flow cytometry. Diagnostic performance curves were constructed by logistic regression. RESULTS: As a marker of late-onset neonatal sepsis, a percentage of CD4+/CD45RO+/CD45RA- T lymphocytes of >3.5% showed a sensitivity of 94.1%, specificity of 69.2%, positive predictive value of 80.0%, negative predictive value of 90.0%, and odds ratio of 36.0 (p<0.001). When we combined this marker with a C-reactive protein level of >10.0 mg/L, the specificity of this combination of tests increased to 94.7% and the positive predictive value to 85.7%. CONCLUSIONS: A percentage of CD4+/CD45RO+/CD45RA- T lymphocytes of >3.5% is an effective indicator of late-onset neonatal sepsis in preterm infants. If this marker is combined with a C-reactive protein level of >10.0 mg/l, its diagnostic performance is improved.

Inmunofenotipificación de linfocitos T como marcador diagnóstico de sepsis neonatal tardía / T lymphocyte immunophenotype as a diagnostic marker of late-onset neonatal sepsis

Introducción Dada la elevada morbimortalidad asociada con la sepsis neonatal, es necesario un marcador diagnóstico que prediga la enfermedad antes de obtener el resultado del cultivo de sangre y/o líquido cefalorraquídeo. Se evaluaron los cambios en el inmunofenotipaje de los linfocitos T CD4+ en neonatos con sepsis de comienzo tardío con el fin de mejorar los resultados obtenidos con los test diagnósticos empleados actualmente (proteína C reactiva, índice neutrófilos inmaduros/neutrófilos totales, leucocitosis). Pacientes y métodos Un estudio de cohortes prospectivo se llevó a cabo en 24 neonatos con sepsis de comienzo tardío y 48 recién nacidos controles no infectados, de edad gestacional igual o inferior a 37 semanas. Se identificaron las subpoblaciones de linfocitos T CD4+ en sangre periférica mediante tinción con anticuerpos monoclonales y cuantificación por citometría de flujo. Se construyeron curvas de rendimiento diagnóstico mediante regresión logística. Resultados Como marcador de sepsis neonatal de comienzo tardío, un porcentaje de linfocitos T CD4+/CD45RO+/CD45RA­ > 3,5 % muestra una sensibilidad del 94,1 %, una especificidad del 69,2 %, un valor predictivo positivo del 80,0 %, valor predictivo negativo del 90,0 %, y una odds ratio de 36,0 (p 10,0 mg/l, la especificidad de esta combinación de marcadores aumenta al 94,7 % y el valor predictivo positivo, al 85,7 %. Conclusiones Un porcentaje de linfocitos T CD4+/CD45RO+/CD45RA­ > 3,5 % es un buen indicador de sepsis neonatal de comienzo tardío en neonatos pretérmino. Y si se combina con una proteína C reactiva > 10,0 mg/l el rendimiento diagnóstico mejora

Background Given the high risks associated with neonatal sepsis, there is a need for a diagnostic marker that would predict the disease before the results of blood or cerebrospinal fluid cultures are available. We evaluated changes in the CD4+ T lymphocyte immunophenotype in neonates with late-onset sepsis to try to improve the test combinations currently used (C reactive protein, immature:total neutrophil ratio, leukocytosis). Patients and methods We performed a prospective cohort study in 24 neonates with late-onset sepsis and 48 non-infected controls with a gestational age of 37 weeks or less. CD4+ T lymphocyte subpopulations in peripheral blood samples were identified by labeling with monoclonal antibodies and quantified by flow cytometry. Diagnostic performance curves were constructed by logistic regression. Results As a marker of late-onset neonatal sepsis, a percentage of CD4+/CD45RO+/CD45RA­ T lymphocytes of > 3.5 % showed a sensitivity of 94.1 %, specificity of 69.2 %, positive predictive value of 80.0 %, negative predictive value of 90.0 %, and odds ratio of 36.0 (p 10.0 mg/L, the specificity of this combination of tests increased to 94.7 % and the positive predictive value to 85.7 %. Conclusions A percentage of CD4+/CD45RO+/CD45RA­ T lymphocytes of > 3.5 % is an effective indicator of late-onset neonatal sepsis in preterm infants. If this marker is combined with a C-reactive protein level of > 10.0 mg/l, its diagnostic performance is improved

Limitaciones de la procalcitonina como marcador único de sepsis neonatal de origen nosocomial / Limitations of procalcitonin as single marker of nosocomial neonatal sepsis

Introducción: Recientemente se ha sugerido que la procalcitonina (PCT) tiene capacidad discriminativa en el diagnóstico de sepsis neonatal. El objetivo de este estudio prospectivo multicéntrico es evaluar la utilidad de la PCT como marcador de sepsis neonatal de origen nosocomial. Pacientes y métodos: Se incluyeron 100 neonatos con sospecha de sepsis nosocomial de entre 4 y 28 días de vida ingresados en los servicios de neonatología de 13 hospitales de tercer nivel de España durante un período de 1 año. Se midió la concentración de PCT mediante análisis inmunoluminométrico. Se calculó la eficacia diagnóstica de la PCT en el momento de la sospecha de infección, a las 12-24 h y a las 36-48 h. Resultados: Se diagnosticaron 61 casos de sepsis nosocomial. Las concentraciones de PCT fueron superiores en los casos de sepsis nosocomial frente a los neonatos con sospecha de sepsis no confirmada. Los neonatos con sepsis por estafilococos coagulasa-negativos mostraron niveles de PCT más bajos que aquellos con sepsis nosocomial por otros agentes. Los puntos de corte óptimo para la PCT de acuerdo con las curvas ROC fueron 0,59 ng/mL en el momento de la sospecha de infección (sensibilidad 81,4%, especificidad 80,6%), 1,34 ng/mLa las 12-24 h (sensibilidad 73,7%, especificidad 80,6%) y 0,69 ng/mL a las 36-48 h (sensibilidad 86,5%, especificidad 72,7%) para el diagnóstico de sepsis de origen nosocomial. Conclusiones: La PCT mostró una moderada capacidad diagnóstica para la sepsis neonatal de origen nosocomial desde el momento de la sospecha de infección. Aunque por sí sola no sería suficientemente fiable, podría ser útil como parte de un chequeo de sepsis más completo (AU)

Background: It has recently been suggested that serum procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin. Methods: One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acutecare teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12-24 h and 36-48 h after the onset of symptoms was calculated. Results: The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12–24 h and 36- 48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0,59 ng/mL at the time of suspicion of sepsis (sensitivity 81,4%, specificity 80,6%); 1,34 ng/mL within 12-24 h of birth (sensitivity 73,7%, specificity 80,6%), and 0,69 ng/mL within 36-48 h of birth (sensitivity 86,5%, specificity 72,7%). Conclusions: Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of sepsis, but would be useful as part of a full sepsis evaluation (AU)

La perinatología del recién nacido hijo de inmigrantes en el Hospital Clínico San Carlos de Madrid / Perinatology of newborns of immigrants parents at Hospital Clínioc San Carlos in Madrid, Spain

Objetivo: Conocer algunos de los aspectos perinatales de los recién nacidos hijos de inmigrantes, en el Hospital Clínico« San Carlos» de Madrid, con el fin de profundizar en el fenómeno migratorio. Material y métodos: Se analizan comparativamente los aspectos perinatales de 2.759 hijos de inmigrantes con los de 3.990 hijos de españoles, nacidos en el hospital en los últimos tres años. Se analizan: el orden de nacimiento, el curso y control del embarazo, el tiempo de ingreso y de rotura de la bolsa anteparto, el tipo de parto y la anestesia empleada. Resultados: De los inmigrantes nacidos en este hospital, más del 53% son primogénitos, y un 34% nacidos en segundo lugar. Casi el 10% de las inmigrantes no controlan el embarazo. El tiempo medio de ingreso anteparto es de 30 a 36 horas y el de rotura de bolsa de 5 horas. El porcentaje medio de cesáreas de estos tres últimos años ha sido de un 18%. Conclusiones: El porcentaje de recién nacidos hijos de inmigrantes va en aumento, y en este hospital se acerca actualmente al 50% de los recién nacidos. Cuanto mejor conozcamosto dos los aspectos relacionados con la inmigración, mejor podremos atender a estos pacientes en todos los aspectos, incluido el sanitario

Objective: To identify certain perinatal features of the newborn of immigrant parents at Hospital Clínico «San Carlos» (HCSC)in arder to acquire deeper knowledge about the immigration phenomenon in Spain. Material and methods: We studied certain perinatal characteristics of 2.759 newborns of immigrant parents as compared with 3,990 Spanish children, all of them born at HCSC in the last threey ears. We analyzed: birth order, course and health care monitoring during pregnancy, length of hospital stay, length of time between sac rupture and delivery, type of birth and type of anesthesia used. Results: More than 53% of the newborns were first born infants and 34% were second-born. Nearly 10% of the immigrant mothers underwent no monitoring during pregnancy. The average duration of the predelivery hospital stay was 30 to 36 hours, and the average length of time between sac rupture and delivery was 5 hours. Eighteen percent of the births were cesarean. Conclusions: The number of newborns of immigrant parents is increasing, currently accounting for almost 50% of the births at HCSC. The more we know about every factor related to this phenomenon, the better we will be able to assist the immigrant population

[A combined neonatal hearing screening protocol]. / Protocolo combinado de cribado auditivo neonatal.

OBJECTIVE: To analyze a neonatal hearing screening protocol with transient evoked otoacoustic emissions (OAE) and auditory brainstem response (ABR). PATIENTS AND METHODS: We studied 1,532 newborns with a protocol using transient evoked otoacoustic emissions and auditory brainstem response. We also evaluated auditory development until twelve months of age with quarterly questionnaires. RESULTS: A total of 1,485 (97 %) newborns had normal OAE, 185 (12 %) were referred for ABR exploration and only 11 (0.7 %) were referred to the otorhinolaryngology service for auditory study and diagnosis. Four neonates had auditory disjunction. No false negatives were detected in the follow-up. CONCLUSIONS: This hearing screening protocol with OEA and ABR is useful for detecting hearing loss in neonates. The prevalence of hearing loss in this study was 2.6 % of live newborns.

Protocolo combinado de cribado auditivo neonatal / A combined neonatal hearing screening protocol

Objetivo: El objetivo de este estudio es analizar un protocolo de cribado auditivo neonatal en el que se combina el uso de otoemisiones acústicas (OEA) evocadas y potenciales evocados auditivos de tronco cerebral (PEATC). Pacientes y métodos. Se estudiaron 1.532 recién nacidos con un protocolo en el que se realizaron OEA y PEATC. Además, se realizó una evaluación del desarrollo auditivo hasta los 12 meses de edad mediante unos cuestionarios trimestrales. Resultados: Superaron las OEA 1.485 niños (97%), a 185 bebés (12%) fue necesario realizarles PEATC y sólo 11 niños (0,7%) precisaron ser remitidos al servicio de otorrinolaringología para completar el estudio y realizar el diagnóstico definitivo. En 4 niños se detectó enfermedad auditiva. En este estudio no se detectó ningún falso negativo durante el seguimiento. Conclusiones: Este protocolo de estudio en el que se usa OEA y PEATC de forma combinada, demuestra ser útil para la detección de la hipoacusia en recién nacidos. La prevalencia de la hipoacusia detectada en este estudio fue de 2,6 recién nacidos vivos (AU)

[Auditory neuropathy]. / Neuropatía auditiva.

INTRODUCTION: Auditory neuropathy is a type of neurosensorial hypoacusis that produces significant impairment in language comprehension. Etiologically, this neuropathy has been related to perinatal hypoxia, hyperbilirubinemia, metabolic disorders and degenerative entities that affect the auditory pathway. PATIENTS AND METHODS: We report five children with this disorder. Two of the children were referred for otorhinolaryngeal assessment after failing the neonatal hearing screening and one was referred because of a history of perinatal hypoxia. The two eldest children were referred because of schooling problems and language impairment. In all the children, auditory brainstem response, otoacoustic emissions, tympanometry stapedius reflex were examined and liminal and condition-orientation reflex audiometry were performed. After diagnosis, the children were followed-up for 3 consecutive years. RESULTS: In all five children, tympanogram and otoacoustic emissions were normal. The stapedius reflex and auditory brainstem responses with 80-90 dli stimuli were absent. Medium latency and conical and cognitive potentials were normal in the only child (aged 9 years) in whom they could be performed. In two children (aged 7 and 9 years), verbal discrimination was within the normal range for theft age. In all the children, audiometry revealed bilateral mild-to-moderate hypacusla, which did not change during follow up. CONCLUSIONS: Auditory neuropathy can be detected by the combined use of neonatal hearing screening techniques, auditory brainstem responses and otoacoustic emissions. Interest in the early identification and diagnosis of this disorder Is due to the clear benefit to language development secondary to the early treatment and rehabilitation of these children.