Maternal vaccination against COVID-19 and neonatal outcomes during Omicron: INTERCOVID-2022 study.

BACKGROUND: In early 2023, when Omicron was the variant of concern, we showed that vaccinating pregnant women decreased the risk for severe COVID-19-related complications and maternal morbidity and mortality. OBJECTIVE: This study aimed to analyze the impact of COVID-19 during pregnancy on newborns and the effects of maternal COVID-19 vaccination on neonatal outcomes when Omicron was the variant of concern. STUDY DESIGN: INTERCOVID-2022 was a large, prospective, observational study, conducted in 40 hospitals across 18 countries, from November 27, 2021 (the day after the World Health Organization declared Omicron the variant of concern) to June 30, 2022, to assess the effect of COVID-19 in pregnancy on maternal and neonatal outcomes and to assess vaccine effectiveness. Women diagnosed with laboratory-confirmed COVID-19 during pregnancy were compared with 2 nondiagnosed, unmatched women recruited concomitantly and consecutively during pregnancy or at delivery. Mother-newborn dyads were followed until hospital discharge. The primary outcomes were a neonatal positive test for COVID-19, severe neonatal morbidity index, severe perinatal morbidity and mortality index, preterm birth, neonatal death, referral to neonatal intensive care unit, and diseases during the neonatal period. Vaccine effectiveness was estimated with adjustment for maternal risk profile. RESULTS: We enrolled 4707 neonates born to 1577 (33.5%) mothers diagnosed with COVID-19 and 3130 (66.5%) nondiagnosed mothers. Among the diagnosed mothers, 642 (40.7%) were not vaccinated, 147 (9.3%) were partially vaccinated, 551 (34.9%) were completely vaccinated, and 237 (15.0%) also had a booster vaccine. Neonates of booster-vaccinated mothers had less than half (relative risk, 0.46; 95% confidence interval, 0.23-0.91) the risk of being diagnosed with COVID-19 when compared with those of unvaccinated mothers; they also had the lowest rates of preterm birth, medically indicated preterm birth, respiratory distress syndrome, and number of days in the neonatal intensive care unit. Newborns of unvaccinated mothers had double the risk for neonatal death (relative risk, 2.06; 95% confidence interval, 1.06-4.00) when compared with those of nondiagnosed mothers. Vaccination was not associated with any congenital malformations. Although all vaccines provided protection against neonatal test positivity, newborns of booster-vaccinated mothers had the highest vaccine effectiveness (64%; 95% confidence interval, 10%-86%). Vaccine effectiveness was not as high for messenger RNA vaccines only. Vaccine effectiveness against moderate or severe neonatal outcomes was much lower, namely 13% in the booster-vaccinated group (all vaccines) and 25% and 28% in the completely and booster-vaccinated groups, respectively (messenger RNA vaccines only). Vaccines were fairly effective in protecting neonates when given to pregnant women ≤100 days (14 weeks) before birth; thereafter, the risk increased and was much higher after 200 days (29 weeks). Finally, none of the neonatal practices studied, including skin-to-skin contact and direct breastfeeding, increased the risk for infecting newborns. CONCLUSION: When Omicron was the variant of concern, newborns of unvaccinated mothers had an increased risk for neonatal death. Neonates of vaccinated mothers had a decreased risk for preterm birth and adverse neonatal outcomes. Because the protective effect of COVID-19 vaccination decreases with time, to ensure that newborns are maximally protected against COVID-19, mothers should receive a vaccine or booster dose no more than 14 weeks before the expected date of delivery.

Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study.

BACKGROUND: In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. METHODS: INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. FINDINGS: We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0-38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03-1·31]) and SPMMI (RR 1·21 [95% CI 1·00-1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88-1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12-1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84-3·43]), perinatal complications (RR 1·84 [95% CI 1·02-3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67-20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02-4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44-41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22-65) and 76% (47-89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48-87) and 91% (65-98) after a booster dose. INTERPRETATION: COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority. FUNDING: None.

Perspectivas y valoración de la lactancia en los padres varones de una maternidad privada de la Ciudad Autónoma de Buenos Aires. Investigación cualitativa / Fathers' perspectives and assessment of breastfeeding at a private maternity center in the City of Buenos Aires. A qualitative study

Introducción. En los últimos años, creció la evidencia sobre la efectividad de la inclusión de los padres o las parejas en las intervenciones que promueven la lactancia para mejorar las tasas de iniciación, duración y exclusividad. Objetivos. Identificar perspectivas y valoraciones sobre la lactancia en las parejas de las personas que amamantan, y generar información que permita la creación de intervenciones apropiadas que favorezcan la incorporación de los padres en los espacios de cuidado y en el sostén de la lactancia. Materiales y métodos. Estudio cualitativo, con diseño de teoría fundamentada. Se realizaron 4 grupos de enfoque con padres. Los datos fueron procesados definiendo unidades de análisis por flujo libre, codificadas en dos planos, una codificación abierta, en categorías que emergieron y la agrupación de las categorías en cinco temas principales. Resultados. Participaron 16 padres. Se identificaron 5 temas principales: conocimiento de los padres sobre la lactancia, sentimientos frente a la lactancia, participación de la pareja en la lactancia, construcción de la idea de paternidad, lactancia en la sociedad. La lactancia recibió una valoración positiva. Si bien se consensuó una responsabilidad familiar compartida en su sostén, no se identificaron acciones suficientes de coparticipación. Los participantes manifestaron el deseo de ejercer una paternidad más comprometida, sin embargo, relataron que los entornos laborales no acompañan estas transformaciones. Conclusión. Se evidenciaron valoraciones positivas hacia la lactancia, conocimientos adecuados y preocupación por las dificultades. Se asumió una responsabilidad compartida en su sostén, pero faltaron en los relatos la mención de acciones concretas de coparticipación.

Introduction. The evidence about the effectiveness of fathers' or partners' involvement in breastfeeding interventions to promote initiation, duration, and exclusiveness rates has increased in recent years. Objectives. To identify the perspectives and assessments of breastfeeding among partners of breastfeeding women and develop information to create adequate interventions that favor the inclusion of fathers in care spaces and in the support of breastfeeding. Materials and methods. Qualitative study with a grounded theory design. Four focus groups were held with fathers. Data were processed defining free flow analysis units, coded in 2 levels, an open code, with emerging categories, and such categories grouped into 5 main topics. Results. A total of 16 fathers participated. Five main topics were identified: fathers' knowledge about breastfeeding, feelings towards breastfeeding, partner's involvement in breastfeeding, development of the concept of fatherhood, breastfeeding in society. Breastfeeding was positively assessed. Although breastfeeding support was considered a shared family responsibility, there were not enough co-participation actions identified. Participants expressed their desire to play a more involved fatherhood role; however, they stated that these transformations are not supported at workplaces. Conclusion. The evidence showed a positive assessment of breastfeeding, adequate knowledge, and concern about difficulties. Breastfeeding support was considered a shared responsibility, but not enough specific co-participation actions were mentioned.

Fathers' perspectives and assessment of breastfeeding at a private maternity center in the City of Buenos Aires. A qualitative study. / Perspectivas y valoración de la lactancia en los padres varones de una maternidad privada de la Ciudad Autónoma de Buenos Aires. Investigación cualitativa.

INTRODUCTION: Introduction. The evidence about the effectiveness of fathers' or partners' involvement in breastfeeding interventions to promote initiation, duration, and exclusiveness rates has increased in recent years. OBJECTIVES: To identify the perspectives and assessments of breastfeeding among partners of breastfeeding women and develop information to create adequate interventions that favor the inclusion of fathers in care spaces and in the support of breastfeeding. MATERIAL AND METHODS: Qualitative study with a grounded theory design. Four focus groups were held with fathers. Data were processed defining free flow analysis units, coded in 2 levels, an open code, with emerging categories, and such categories grouped into 5 main topics. RESULTS: A total of 16 fathers participated. Five main topics were identified: fathers' knowledge about breastfeeding, feelings towards breastfeeding, partner's involvement in breastfeeding, development of the concept of fatherhood, breastfeeding in society. Breastfeeding was positively assessed. Although breastfeeding support was considered a shared family responsibility, there were not enough co-participation actions identified. Participants expressed their desire to play a more involved fatherhood role; however, they stated that these transformations are not supported at workplaces. CONCLUSIONS: The evidence showed a positive assessment of breastfeeding, adequate knowledge, and concern about difficulties. Breastfeeding support was considered a shared responsibility, but not enough specific coparticipation actions were mentioned.

Introducción. En los últimos años, creció la evidencia sobre la efectividad de la inclusión de los padres o las parejas en las intervenciones que promueven la lactancia para mejorar las tasas de iniciación, duración y exclusividad. Objetivos. Identificar perspectivas y valoraciones sobre la lactancia en las parejas de las personas que amamantan, y generar información que permita la creación de intervenciones apropiadas que favorezcan la incorporación de los padres en los espacios de cuidado y en el sostén de la lactancia. Materiales y métodos. Estudio cualitativo, con diseño de teoría fundamentada. Se realizaron 4 grupos de enfoque con padres. Los datos fueron procesados definiendo unidades de análisis por flujo libre, codificadas en dos planos, una codificación abierta, en categorías que emergieron y la agrupación de las categorías en cinco temas principales. Resultados. Participaron 16 padres. Se identificaron 5 temas principales: conocimiento de los padres sobre la lactancia, sentimientos frente a la lactancia, participación de la pareja en la lactancia, construcción de la idea de paternidad, lactancia en la sociedad. La lactancia recibió una valoración positiva. Si bien se consensuó una responsabilidad familiar compartida en su sostén, no se identificaron acciones suficientes de coparticipación. Los participantes manifestaron el deseo de ejercer una paternidad más comprometida, sin embargo, relataron que los entornos laborales no acompañan estas transformaciones. Conclusión. Se evidenciaron valoraciones positivas hacia la lactancia, conocimientos adecuados y preocupación por las dificultades. Se asumió una responsabilidad compartida en su sostén, pero faltaron en los relatos la mención de acciones concretas de coparticipación.

Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study.

BACKGROUND: The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed. OBJECTIVE: To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission. STUDY DESIGN: In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices. RESULTS: A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2-9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. CONCLUSION: In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study.

BACKGROUND: It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. OBJECTIVE: This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. STUDY DESIGN: This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. RESULTS: We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32-2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25-2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17-3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99-2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99-5.49) and 6.26 (95% confidence interval, 4.35-9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63-2.86; risk ratio, 2.53; 95% confidence interval, 1.44-4.45; and risk ratio, 2.84; 95% confidence interval, 1.67-4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32-2.35), 2.07 (95% confidence interval, 1.20-3.57), and 2.77 (95% confidence interval, 1.66-4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. CONCLUSION: COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.

[Prenatal and postnatal nutrition: long term impact on health]. / Nutrición pre y posnatal: impacto a largo plazo en la salud.

Nutrition in early stages of life is one of the most influential environmental factors for the good development of organs and systems and the wellbeing of the child. Epigenetic mechanisms can explain how prenatal and postnatal nutrition affects genes expression with the subsequent risk of immune and metabolic diseases. The objective of this paper is to update the knowledge of the role the nutritional status and dietary practices of pregnant women and the child's feeding patterns over the first year of life have in the risk of future diseases.

[Prebiotics in infant health]. / Prebióticos en salud infantil.

The composition of human milk is the main base for the development of infant formulas concerning its macronutrients and micronutrients contents and bioactive compounds. Technological advances in the composition of human milk have identified a great number of bioactive compounds such as prebiotics which are responsible for immunological protection and the prevention of different pathologies. In order to achieve similar benefits, they are part of the contents of infant formulas.

Prebióticos en salud infantil / Prebiotics in infant health

La composición de la leche materna es la base principal para el desarrollo de fórmulas infantiles en cuanto a su contenido de macronutrientes, micronutrientes y compuestos bioactivos. Los avances tecnológicos en el conocimiento de la composición de la leche materna han permitido identificar un gran número de componentes bioactivos, como los prebióticos, responsables de la protección inmunológica y de la prevención de diferentes patologías, lo cual ha llevado a su incorporación en las fórmulas infantiles para lograr beneficios similares.

Prebióticos en salud infantil / Prebiotics in infant health

La composición de la leche materna es la base principal para el desarrollo de fórmulas infantiles en cuanto a su contenido de macronutrientes, micronutrientes y compuestos bioactivos. Los avances tecnológicos en el conocimiento de la composición de la leche materna han permitido identificar un gran número de componentes bioactivos, como los prebióticos, responsables de la protección inmunológica y de la prevención de diferentes patologías, lo cual ha llevado a su incorporación en las fórmulas infantiles para lograr beneficios similares.(AU)

Perinatal testicular torsion: a unique strategy.

BACKGROUND/PURPOSE: Perinatal testicular torsion (PTT) is defined as testicular torsion occurring prenatally or within the first 30 days of life. The aim of this study was to evaluate the data obtained from patients with PTT and propose principles of management based on clinical, surgical, and histologic findings. METHODS: A retrospective analysis of 27 boys seen between 1990 and 2005 with surgically documented PTT was conducted. Patients were divided into 2 groups: A, prenatal testicular torsion; B, postnatal testicular torsion. The presence of acute scrotal inflammatory signs defined the urgency to operate. RESULTS: There were 4 clinical pictures in group A: A1, patients with a nubbin testis (n = 3); A2, patients with a small and hard testis (n = 12); A3, patients with a normal-sized and hard testis (n = 8); and A4, patients with an acute scrotum (n = 2). Group B (n = 2) presented no sign after birth and later developed an acute scrotum. Surgical exploration and histologic examination showed clear signs of a long-standing testicular torsion in groups A1, A2, and A3 or a recent-onset testicular torsion in groups A4 and B. Only one testis could be salvaged (group B). CONCLUSIONS: Clinical signs correlated very well with surgical and histologic findings and can define the need and the urgency to operate. Although testicular salvage rate is very low, the affected side always should be explored to confirm the diagnosis and to fix or remove the affected testicle. The contralateral scrotum also should be explored because of the risk of asynchronous contralateral testicular torsion.

Surfactante pulmonar exógeno en el tratamiento de la enfermedad de membrana hialina severa: efectos agudos / Exogenus surfactant for the treatment of severe hyaline menbrana disease

Con el objetivo de valorar los efectos del tratamiento como rescate de un surfactante natural modificado producido en la República Argentina,entre el 1-8-1990 y el 31-7-1991,40 recíen nacidos prematuros(RNPret)con diagnóstico de EMH severa y en asistencia respiratoria mecánica(ARM)recibieron por instilación endotraqueal una dosis de 90 mg/Kg en las primeras 24 horas de vida,repitiéndose hasta 3 dosis adicionales dentro de las 48 horas según requerimientos de ARM y oxígeno.De 17 RNPret con pn menor a 1.00 g fallecieron 10(59 por ciento)de causas asociadas a la EMH y otros 5 de causas no relacionadas.De los 23 RNPret con PN superior a 1.000 g la sobrevida fue del 100 por ciento.Siete pacientes(17,5 por ciento) presentaron una o más formas de escape de aire extraalveolar(4 neumotórax y 4 enfisemas intersticiales pulmonares)Tres RNPret,todos con PN inferior a 1.200 g,desarrollaron displasia broncopulmonar.Si bien fue un estudio no controlado,comprobamos que la administración de este surfactante tuvo efectos inmediatos beneficiosos que hacen suponer se debieron al tratamiento instaurado.No se observaron efectos perjudiciales atribuibles al tratamiento

Surfactante pulmonar exógeno en el tratamiento de la enfermedad de membrana hialina severa: efectos agudos / Exogenus surfactant for the treatment of severe hyaline menbrana disease

Con el objetivo de valorar los efectos del tratamiento como rescate de un surfactante natural modificado producido en la República Argentina,entre el 1-8-1990 y el 31-7-1991,40 recíen nacidos prematuros(RNPret)con diagnóstico de EMH severa y en asistencia respiratoria mecánica(ARM)recibieron por instilación endotraqueal una dosis de 90 mg/Kg en las primeras 24 horas de vida,repitiéndose hasta 3 dosis adicionales dentro de las 48 horas según requerimientos de ARM y oxígeno.De 17 RNPret con pn menor a 1.00 g fallecieron 10(59 por ciento)de causas asociadas a la EMH y otros 5 de causas no relacionadas.De los 23 RNPret con PN superior a 1.000 g la sobrevida fue del 100 por ciento.Siete pacientes(17,5 por ciento) presentaron una o más formas de escape de aire extraalveolar(4 neumotórax y 4 enfisemas intersticiales pulmonares)Tres RNPret,todos con PN inferior a 1.200 g,desarrollaron displasia broncopulmonar.Si bien fue un estudio no controlado,comprobamos que la administración de este surfactante tuvo efectos inmediatos beneficiosos que hacen suponer se debieron al tratamiento instaurado.No se observaron efectos perjudiciales atribuibles al tratamiento