Valoración clínica del estado nutricional fetal al nacer mediante el Clinical Assessment of Nutritional Status score / Assessment of foetal nutrition status at birth using the CANS score

INTRODUCCIÓN: La malnutrición fetal (MF) traduce una pérdida o fallo de adquisición intrauterina de la cantidad adecuada de grasa y masa muscular, asociando connotaciones pronósticas a corto y largo plazo. Siendo el diagnóstico de MF esencialmente clínico, el objetivo de este trabajo es detectar la incidencia MF mediante el Clinical Assessment of Nutritional Status score(CANS score), y comparar los resultados con los parámetros antropométricos clásicos. PACIENTES Y MÉTODOS: Estudio retrospectivo poblacional de recién nacidos a término entre 2003 y 2014 (n = 14.477). Se clasificaron en recién nacidos de peso adecuado, pequeño y grande para la edad gestacional. Se realizó el CANS score y se calculó el índice ponderal (IP) a todos los recién nacidos incluidos, considerándose MF los puntos de corte: CANS score < 25 e IP < 2,2 g/cm3. RESULTADOS: Mediante el CANS score el 7,6% (n = 1.101) de la población presentó MF, el 50,3% (n = 538) de los recién nacidos de peso pequeño para la edad gestacional, el 76,2% (n = 193) del subgrupo < p3 y el 4,67% (n = 559) de los recién nacidos de peso adecuado para la edad gestacional. El CANS score fue < 25 en el 7,26% (n = 1.043) de los recién nacidos con IP ≥ 2,2 g/cm3 (n = 14.356), y el CANS score fue > 24 en el 49% con IP < 2,2 g/cm 3 (n = 109). CONCLUSIONES: Es conveniente identificar todos aquellos recién nacidos con MF por los riesgos que pueden presentar a corto y largo plazo. La valoración mediante CANS score permite una mejor identificación del estado nutricional de los recién nacidos que empleando únicamente las curvas de peso según la edad gestacional

INTRODUCTION: Foetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study is to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. PATIENTS AND METHODS: Retrospective population of term infants was studied between 2003 and 2014 (n=14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score <25 and PI < 2.2 g/cm3. RESULTS: Using the CANS score, 7.6% (n 1,101) of the population showed FM, 50.3% (n = 538) of SGA, 76.2% (n = 193) subgroup = 559) of AGA. The CANS score was < 25 in 7.26% (n = 1,043) of newborns with PI ≥ 2.2 g/cm3 (n = 14.356), and the CANS score was > 24 in 49% with PI < 2.2 g/cm3 (n = 109). CONCLUSIONS: It is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term. CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age

Riesgo de déficits en el desarrollo en los prematuros tardíos: evaluación a los 48 meses mediante el Ages & Stages Questionnaires(R) / Development deficit risks in the late premature newborn: Evaluation at 48 months using the Ages & Stages Questionnaires(R)

INTRODUCCIÓN: La ausencia de protocolos específicos de seguimiento dificulta el conocimiento de la repercusión de la prematuridad tardía en el desarrollo psicomotor. El objetivo es evaluarlo a los 4 años y compararlo con los nacidos a término (AT). Población y método: Estudio de cohortes retrospectivo de 90 prematuros tardíos (PT) y 89 AT sanos, a los 48 meses, evaluados mediante el Ages & Stages Questionnaires(R) (ASQ-3). Las variables continuas se describen mediante media±DE comparadas con el test de la t de Student para muestras independientes; las variables categóricas, mediante frecuencias y proporciones, comparadas con el test de independencia de la chi al cuadrado. Se determinó un punto de corte para la puntuación total del ASQ-3 capaz de discriminar el riesgo de déficit del desarrollo mediante un análisis ROC. Una selección step-wise para el modelo de regresión logística determinó los factores de riesgo asociados. RESULTADOS: Las puntuaciones medias de cada dominio y de la puntuación global del ASQ-3 no mostraron diferencias entre ambos grupos. Sin embargo, al analizar la densidad de probabilidades para la puntuación global del ASQ-3 ≤ 251 puntos, 15 PT (16,6%) y 4 AT (4,5%) mostraban riesgo de déficit psicomotor, y la prematuridad tardía y la ausencia de lactancia materna resultaron factores asociados significativamente. CONCLUSIONES: Hubo una mayor prevalencia de riesgo de déficit en el desarrollo en los PT, lo que justifica considerar esta población de riesgo y establecer programas de seguimiento eficientes. Debe seguirse investigando si este riesgo corresponde a toda la población o si existen factores biológicos o antecedentes perinatales que los hacen más vulnerables

INTRODUCTION: Lack of specific monitoring protocols hinders the knowledge of the impact of late prematurity on delayed psychomotor development. The objective of this study is to evaluate this at 48 months and compare it with those born at term. Population and methods: A retrospective cohort study was conducted on 90 late preterm (PT) and 89 term (AT) healthy children at 48 months, assessed by the Ages & Stages Questionnaires(R) (ASQ-3). Continuous variables described using mean and standard deviation compared with the t Student t test for independent samples. The categorical variables were described as frequencies and proportions, compared with the Chi-square test of independence. A cut-off was determined for the total score of ASQ-3 able to discriminate the risk of developmental deficit by a ROC analysis. A step-wise logistic regression model identified the associated risk factors. RESULTS: The mean scores for each domain and overall ASQ-3 score showed no differences between groups. However, when analyzing the probability density for the ASQ-3 total score of ≤251 points, 15 PT (16.6%) and 4 AT (4.5%) showed risk of psychomotor deficits, and late prematurity and lack of breastfeeding were significantly associated factors. CONCLUSIONS: There is an increased prevalence of risk of development deficit in the PT, which justifies considering this population at risk and establishing effective monitoring programs. It should be further investigated whether this risk corresponds to the entire population, or if there are biological factors or perinatal history that makes them more vulnerable

[Assessment of foetal nutrition status at birth using the CANS score]. / Valoración clínica del estado nutricional fetal al nacer mediante el Clinical Assessment of Nutritional Status score.

INTRODUCTION: Foetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study is to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. PATIENTS AND METHODS: Retrospective population of term infants was studied between 2003 and 2014 (n=14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score <25 and PI <2.2g/cm(3). RESULTS: Using the CANS score, 7.6% (n 1,101) of the population showed FM, 50.3% (n=538) of SGA, 76.2% (n=193) subgroup 24 in 49% with PI <2.2g/cm(3) (n=109) CONCLUSIONS: It is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term. CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age.

[Development deficit risks in the late premature newborn: Evaluation at 48 months using the Ages & Stages Questionnaires®]. / Riesgo de déficits en el desarrollo en los prematuros tardíos: evaluación a los 48 meses mediante el Ages & Stages Questionnaires®.

INTRODUCTION: Lack of specific monitoring protocols hinders the knowledge of the impact of late prematurity on delayed psychomotor development. The objective of this study is to evaluate this at 48 months and compare it with those born at term. POPULATION AND METHODS: A retrospective cohort study was conducted on 90 late preterm (PT) and 89 term (AT) healthy children at 48 months, assessed by the Ages & Stages Questionnaires® (ASQ-3). Continuous variables described using mean and standard deviation compared with the t Student t test for independent samples. The categorical variables were described as frequencies and proportions, compared with the Chi-square test of independence. A cut-off was determined for the total score of ASQ-3 able to discriminate the risk of developmental deficit by a ROC analysis. A step-wise logistic regression model identified the associated risk factors. RESULTS: The mean scores for each domain and overall ASQ-3 score showed no differences between groups. However, when analyzing the probability density for the ASQ-3 total score of ≤251 points, 15 PT (16.6%) and 4 AT (4.5%) showed risk of psychomotor deficits, and late prematurity and lack of breastfeeding were significantly associated factors. CONCLUSIONS: There is an increased prevalence of risk of development deficit in the PT, which justifies considering this population at risk and establishing effective monitoring programs. It should be further investigated whether this risk corresponds to the entire population, or if there are biological factors or perinatal history that makes them more vulnerable.

Morbilidad neonatal en los recién nacidos a término precoz / Neonatal morbidity in early-term newborns

INTRODUCCIÓN: En las últimas décadas ha aumentado de forma significativa el nacimiento de niños de 37 y 38 semanas de gestación, período denominado a término precoz, paralelamente al aumento de partos inducidos y el incremento en la tasa de cesáreas. Pacientes y método: Estudio retrospectivo poblacional de cohortes, en el que se incluyó a los nacidos entre las 37 y 41 semanas de gestación en el período 1992-2011 (n=35.539). Esta población se dividió en 2 cohortes, los recién nacidos a término precoz (RNTP), de 37-38 semanas (n=11.318), y los recién nacidos a término completo (RNTC), de 39-41 semanas (n=24.221). Se analizan la tasa de cesárea, el ingreso en unidad neonatal, la morbilidad respiratoria, la apnea y la necesidad de asistencia respiratoria, hiperbilirrubinemia que requiere fototerapia, hipoglucemia, convulsiones, encefalopatía hipóxico-isquémica, necesidad de nutrición parenteral y sepsis precoz. RESULTADOS: Se observa un aumento progresivo del número de cesáreas a lo largo del período estudiado (del 30,9% al 40,3%). En los RNTP la tasa de cesárea fue superior que en los RNTC (38,3% vs. 31,3%; p < 0,0001). En la comparación de ambos grupos, se encontraron diferencias significativas en la tasa de ingreso en unidad neonatal, 9,1% vs. 3,5% (p < 0,0001); la morbilidad respiratoria (membrana hialina 0,14% vs. 0,007%; [p < 0,0001]; la taquipnea transitoria, 1,71% vs. 0,45% [p < 0,0001], la ventilación mecánica, 0,2% vs. 0,07% [p < 0,009]; la presión positiva continua en la vía respiratoria, 0,11% vs. 0,01% [p < 0,0001]); la fototerapia, 0,29% vs. 0,07% (p < 0,0001); la hipoglucemia, 0,54% vs. 0,11% (p < 0,0001), y la nutrición parenteral, 0,16% vs. 0,04% (p < 0,0001). No se encontraron diferencias significativas en la tasa de sepsis precoz, neumotórax, síndromes aspirativos, convulsiones y encefalopatía hipóxico-isquémica. CONCLUSIONES: En nuestro medio, existe un número importante de RNTP, que presentan una morbilidad significativamente superior a los recién nacidos catalogados de RNTC. Tras individualizar cada caso, es aconsejable no finalizar un embarazo antes de las 39 semanas de gestación, salvo por condicionamientos maternos, placentarios o fetales que indiquen que continuar el embarazo comporte un mayor riesgo para el feto y/o la madre

INTRODUCTION: In the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate. PATIENTS AND METHOD: Retrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n=35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n=11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n=24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed. RESULTS: There was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<0.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<0.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<0.0001], transient tachypnea 1.71% vs 0.45% [P<0.0001], mechanical ventilation 0.2% vs 0.07% [P<0.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<0.0001), hypoglycemia 0.54% vs 0.11% (P<0.0001), parenteral nutrition 0.16% vs 0.04% (P<0.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy. CONCLUSIONS: In our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating that continuing the pregnancy may increase the risk for the fetus and/or the mother

[Neonatal morbidity in early-term newborns]. / Morbilidad neonatal en los recién nacidos a término precoz.

INTRODUCTION: In the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate. PATIENTS AND METHOD: Retrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n=35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n=11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n=24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed. RESULTS: There was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<.0001], transient tachypnea 1.71% vs 0.45% [P<.0001], mechanical ventilation 0.2% vs 0.07% [P<.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<.0001), hypoglycemia 0.54% vs 0.11% (P<.0001), parenteral nutrition 0.16% vs 0.04% (P<.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy. CONCLUSIONS: In our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating that continuing the pregnancy may increase the risk for the fetus and/or the mother.

Adams-Oliver syndrome with unusual central nervous system alterations.

The association of aplasia cutis congenita of the scalp with distal malformations of the limbs is known as Adams-Oliver syndrome. Other reported associations include palatine or auricular malformations, cardiovascular alterations, and spina bifida. Multiple hereditary patterns have been described for this condition, and sporadic cases have also been reported. We report an infant with Adams-Oliver syndrome associated with intracranial calcifications in whom no evidence of intrauterine infection could be demonstrated.

Perinatal hypoxic-ischaemic syndrome. Diagnostic and prognostic value of computed tomography.

Sixty-two full-term neonates with hypoxic-ischaemic encephalopathy were studied. Computed tomography (CT) was performed during the first week of life and the clinical and radiologic findings were correlated. In 57 cases (92%) CT was abnormal. Subarachnoid haemorrhage (SAH) was present in 53 cases, oedema in 23 cases and other lesions in 7 cases. Twenty-two cases had associated SAH and oedema. It was concluded that SAH and/or oedema has a good prognosis. When neurologic involvement is severe and CT shows signs of necrosis, the prognosis is less favourable.