[Neurological follow-up of very low birth weight newborns at the age of two years (1998-1999)]. / Seguimiento neurológico de recién nacidos menores de 1.500 gramos a los dos años de edad.

BACKGROUND: Because of improved obstetric and neonatal care, there is growing interest in the later outcome of very low birth weight newborns. OBJECTIVES: The aim of this study was to evaluate the survival rate of very low birth weight newborns and to identify disabilities at the age of 2 years. MATERIAL AND METHODS: An observational, follow-up study was performed of neonates with a birth weight of under 1,500 grams born between 1998 and 1999. The follow-up program included pediatric, maturative, neurological, psychological, ophthalmological, and audiological evaluation. Neurosensorial disabilities were classified as mild, moderate, or severe. RESULTS: One hundred thirty-six very low birth weight newborns were admitted. The survival rate was 77.9 % and 83.9 % completed the follow-up to the age of 2 years. The neurosensorial disability rate was 20.2 %; disability was severe in 9 %, moderate in 1.1 %, and mild in 10.1 %. In patients lost to follow-up, birth weight was higher, gestational age was older, and sonographic findings were more frequently normal. CONCLUSION: Survival in very low birth weight newborns has increased with improved neonatal care. The presence of sequelae was similar to that found in other follow-up studies. A substantial number of patients were lost to follow up, which influenced the disability rates.

Seguimiento neurológico de recién nacidos menores de 1.500 gramos a los dos años de edad / Neurological follw-up of very low birth weight newborns at the age of two years (1998-1999)

Antecedentes: Existe un interés creciente en el seguimiento de los recién nacidos de muy bajo peso al nacimiento con la mejoría de la asistencia obstétrica y neonatal. Objetivos: Evaluar las cifras de supervivencia de los recién nacidos de muy bajo peso, junto con la proporción y los tipos de secuelas que se observan a los 2 años de edad. Material y métodos Estudio observacional de seguimiento de los recién nacidos de menos de 1.500 g nacidos entre los años 1998-1999. Se evalúan los datos obtenidos en el programa de seguimiento compuesto por visitas a pediatría, maduración, neurología, psicología y oftalmología; y la realización de potenciales evocados visuales y auditivos. Las secuelas obtenidas se clasifican en leves, moderadas o graves. Resultados: Ingresan un total de 136 recién nacidos de muy bajo peso. La supervivencia es del 77,9 por ciento. Completaron el seguimiento hasta los 2 años un 83,9 por ciento de los supervivientes. La aparición de secuelas se observa en el 20,2 por ciento de los niños, de las cuales el 9 por ciento son graves, el 1,1 por ciento moderadas y el 10,1 por ciento leves. Los pacientes perdidos en el seguimiento presentan mayor peso al nacimiento, mayor edad gestacional y mayor normalidad ecográfica que los pacientes seguidos. Conclusión: Se obtiene un incremento en la supervivencia de los recién nacidos de muy bajo peso con la mejoría de los cuidados neonatales. La presencia de secuelas es similar a la obtenida en otros estudios de seguimiento. Se considera relevante la muestra de pacientes perdidos y su influencia en los porcentajes de secuelas obtenidas (AU)

[Retinopathy of prematurity: casuistics between 1996 and 2001]. / Retinopatía del prematuro. Casuística de los años 1995-2001.

BACKGROUND: Retinopathy of prematurity (ROP) is a cause of neurosensorial morbidity. OBJECTIVES: To study the incidence, associated risks factors, treatment, and outcome of ROP in premature infants born at less than 32 weeks in our hospital. METHODS: We performed a descriptive study of patients born between the January 1, 1995, and December 31, 2001, in Sant Joan de Déu Hospital in Barcelona (Spain) at <= 32 weeks of gestation who survived until their first month of life. An ocular evaluation was performed between weeks 4 and 6 of life and was repeated every 1-2 weeks until retinal vascularization was complete. Ocular sequelae and visual function were evaluated. Bivariate comparison of groups with and without ROP was performed. RESULTS: Of the 324 patients evaluated, 74 presented ROP (22.8 %), of which 63 patients (21.7 %) were classified as stage 1 or 2 and 11 (3.7 %) as stage 3. An inverse correlation between the incidence of retinopathy and weight and gestational age was found. Threshold disease (3 plus) was detected in 9 patients (16 eyes; 3.1 % of the study sample and 12.1 % of the neonates with retinopathy). All of these neonates were treated with laser therapy. Ocular sequelae were mild in 2.7 % of the patients, moderate in 0.6 % and severe in 0.6 %. The visual function (n 236) of infants with ROP (n 74) was altered in 4 patients (1.7 %). Of these, alterations were severe in 2 patients (0.8 %). Bivariate analysis revealed significant differences (p < 0.001) in low birth weight, gestational age, days of oxygen therapy, days of mechanical ventilation, days of antibiotic therapy, and number of blood transfusions. CONCLUSIONS: In this study the incidence of ROP was similar to that in other centers. Development of ROP was strongly associated with its various risk factors. Severe stages were not seen above 30 weeks of gestational age. The results of laser therapy were optimal, with fewer alterations in ocular examination and visual function than those estimated in patients without treatment.

Retinopatía del prematuro. Casuística de los años 1995-2001 / Retinopathy of prematurity: casuistics between 1996 and 2001

Antecedentes: La retinopatía del prematuro (ROP) es una causa de morbilidad neurosensorial. Objetivos Estudiar la incidencia, factores de riesgo asociados, tratamiento y evolución de la retinopatía de la prematuridad en recién nacidos pretérmino menores de 32 semanas procedentes de nuestro hospital. Métodos: Pacientes nacidos entre 1 de enero de 1995 y 31 de diciembre de 2001 en el Hospital Sant Joan de Déu (Barcelona) con 32 semanas de edad gestacional, que han sobrevivido hasta el mes de vida. Se les realizó fondo de ojo entre las 4 y 6 semanas de vida, continuando con el examen cada 1-2 semanas, hasta su completa vascularización. Seguimiento evolutivo de las secuelas del fondo de ojo y función visual. Estudio descriptivo con comparación bivariable entre los grupos con y sin ROP. Resultados: De los 324 casos estudiados, 74 presentaron ROP (22,8 por ciento), de los cuales se clasificaron de estadios 1 y 2 a 63 pacientes (21,7 por ciento) y de estadio 3 a 11 (3,7 por ciento). Se evidenció una correlación inversa entre la incidencia de retinopatía y el peso o la edad gestacional. El estadio umbral (3 plus) se detectó en 9 casos (16 ojos) (3,1 por ciento de la muestra de estudio y 12,1 por ciento de los recién nacidos afectados de retinopatía) que se trataron con fotocoagulación con láser. Las secuelas del fondo de ojo fueron leves en el 2,7 por ciento de pacientes, moderadas en el 0,6 por ciento y graves en el 0,6 por ciento. La función visual (n 236) de los recién nacidos con ROP (n 74) se encontró alterada en 4 pacientes (1,7 por ciento de los explorados) de los cuales fue grave en 2 (0,8 por ciento). En el análisis bivariante, el bajo peso al nacer, la edad gestacional, días de oxigenoterapia y ventilación mecánica, días de antibiótico, número de transfusiones de sangre mostraron diferencias significativas (p < 0,001). Conclusiones: En este estudio la incidencia de ROP es similar a la de otros centros y se ve una fuerte asociación a distintos factores de riesgo para su aparición. No se observan estadios graves a partir de las 30 semanas. Los resultados de la fotocoagulación con láser son óptimos, con disminución de las secuelas en el fondo de ojo y en la función visual las estimadas sin tratamiento (AU)

Síndrome de Beckwith-Wiedemann. Aportación de cinco casos y revisión de la literatura / Beckwith-Wiedemann syndrome: a report

Presentamos nuestra experiencia con el síndrome de Beckwith-Wiedemann (SBW), aportando cinco casos, cuyo diagnóstico y seguimiento se llevó a cabo en nuestro centro y que se registraron desde el año 1987 hasta 1998. Todos ellos son hijos de padres sanos no consanguíneos. Presentan un desarrollo psicomotor normal, y la edad media de seguimiento ha sido de 5,2 años (rango: 20 meses-10 años). Todos ellos, menos uno, cumplen al menos 3 criterios mayores: patología onfalica, macroglosia, hipoglucemia neonatal y gigantismo pre y/o posnatal y alguno de los diferentes criterios menores descritos en este síndrome. Los cinco pacientes sobreviven en la actualidad. El caso 5 es una forma incompleta de la enfermedad, pero que presenta la característica del desarrollo de un tumor de Wilms a lo largo de su evolución (AU)

[Congenital diaphragmatic hernia: evaluation of two ways of management]. / Hernia diafragmática congénita: análisis de dos formas de tratamiento.

OBJECTIVE: The aim of this study was to analyze the treatment and evolution of congenital diaphragmatic hernia in the last 16 years, distinguishing two ways of management, and to look for parameters that can predict the evolution. MATERIALS AND METHODS: Between 1978 and 1994, 29 cases of congenital diaphragmatic hernia were treated in our NICU. During the first period (1978-1988) 17 cases (group 1) were treated after birth as a surgical emergency. In the second period (1989-1994), preoperative stabilization was performed before surgery (12 cases, group 2). Two cases of group 2 were excluded because of the association of other malformations that were the cause of death. RESULTS: Both groups were similar in gestational age, birth weight and Apgar score at 5 minutes. Overall mortality was 48.1% (47.0% in group 1 and 50.0% in group 2). No infants with PaCO2 greater than 40 mmHg and OI greater than 40 or VEI over 1,000 survived. CONCLUSION: Despite preoperative stabilization, there is no difference in the mortality rate of the two groups. With congenital diaphragmatic hernia, as with other entities of low incidence, collaborative studies are needed to obtain enough cases to analyze the results more precisely.

[Risk and outcome factors in necrotizing enterocolitis]. / Factores de riesgo y pronósticos en la enterocolitis necrotizante.

OBJECTIVE: The objective of this study was to identify risk and outcome factors in necrotizing enterocolitis (NEC). PATIENTS AND METHODS: We have studied 72 cases of NEC collected from 1987 until 1994 in the three hospitals of the integrated Unit. A case-control study matched for gestational age and center was performed for 26 risk factors. Conditional logistic regression was used in significant bivariate variables. The 18 outcome factors had the same statical treatment, but without the paired design. RESULTS: Serous infections previous to NEC, apnea and feeding increments greater than 20 cc/kg/day have been identified as risk factors for preterm babies (p < 0.05). Severe acidosis and pneumoperitoneum have been found significant outcome variables, but with very low discriminatory capacity. CONCLUSIONS: It has been found difficult to identify risk factors for NEC besides the gestational age. Outcome factors have very low sensitivity. Preventive treatment should be directed to decrease the effect of the inflammatory mediators in the gastrointestinal tract.

[Elastase-alpha 1-antiprotease in neonatal sepsis]. / Elastasa-alpha 1-antiproteasa en la sepsis neonatal.

Elastase-alpha 1-proteinase inhibitor complex (E-alpha 1-PI) was evaluated in 682 blood samples from 516 newborn infants. They were divided into three groups: control (group 1; n = 99), non-infectious (group 2; n = 338) and infectious (group 3; n = 82). The plasma values of E-alpha 1-PI complex (median; minimum-maximum, in microgram/L) were 180; 46-296 in group 1, 337; 40-2524 in group 2 and 954.5; 183-8160 in group 3. Significant differences were found between the groups (p < 0.001). E-alpha 1-PI complex in blood showed a sensitivity of 75%, specificity of 81.9%, positive predictive value of 30.6% and negative predictive value of 96.8% for the diagnosis of neonatal infection.

[Attitude towards parents after the death of their newborn infant in a neonatal unit]. / Atención a los padres de recién nacidos fallecidos en neustra unidad neonatal.

We have analyzed the neonatology team's actions, as well as the parent's reactions, after the death of a newborn baby in the Intensive Care Unit. A questionnaire was drawn-up and sent to 180 parents of decreased newborn babies in order to get to know their opinions about certain aspects related to their experience in the hospital. Only 49 out of the 180 (27.2%) questionnaires were sent back. From their answers, we would like to stress their positive opinion regarding both the medical care (95%) and the information that they received (93%). The suggestion that the hospital should have a trained team of trained professionals available to provide psychological support in such situations was made in 95.9% of the questionnaires. This analysis has justified changes in our team's procedure when confronted with newborn deaths.

[Multicystic encephalomalacia in twin pregnancies]. / Encefalomalacia multiquística en gestaciones gemelares.

Multicystic encephalomalacia (ME) is a rare entity in the pediatric age. In ME brain tissue in substituted by cavities of variable size. ME has different etiologies being asphyxia and circulatory alterations the most important factors. In monozygotic twins there is an increased incidence of structural anomalies than dizygotic twins. We present four twin patients with ME. Three of them had a prenatal dead sibling. The fourth pair of twins had a twin-twin transfusion. We want to stress the utility of brain echography in early diagnosis of ME.

[Outbreak of respiratory syncytial virus in a neonatal unit]. / Brote de infección por virus respiratorio sincitial en una unidad neonatal.

Described is an outbreak of nosocomial RSV infection, following the admission of a 20-day-old and 11-day-old newborn with lower respiratory infections, diagnosed as being caused by RSV through detection of viral antigens by direct FAT (fluorescent antibody test) of nasopharyngeal samples. Later on, 5 of the other 20 newborn in patients in the same care unit also showed positive results in direct FAT, for RSV. The clinical manifestations of these patients were mild even in those cases with underlying PHT and cardiac disease and consisted of: cough (5/5), nasal discharge (3/5), poor feeding (1/5), sneezing (1/5), distress (1/5) and irritability (1/5). The rapid diagnosis of RSV though the direct FAT enables us to establish hygienic restrictions and patients isolation to keep the virus from spreading.

[Sudden infant death syndrome (SIDS): identification of infants at risk and their home monitoring. Apropos of 25 cases]. / El síndrome de la muerte súbita del lactante (SMSL): identificación de lactantes de riesgo y su monitorización domiciliaria. A propósito de 25 casos.

The SIDS problem is an important medicosocial question therefore it is necessary to identify the high risk infants in order to try to avoid it. We discuss our two years experience in a Home Apnea Monitoring Program. This article includes the first 25 children on home monitoring: 13 infants. 4 preterms and 8 SIDS siblings. We explain the apnea presentation form, the differential diagnosis methods and the diagnosis protocol for the different high risk groups. We speak about the different information obtained through the Pneumocardiogram (PNG), pH metric, the polysomnogram (PSG).... and the indications for Home Apnea Monitoring and the family role in this program. At the end we indicate that it is necessary to have more information and investigation about SIDS in our country.

[Intraventricular hemorrhage in healthy newborn infants at term]. / Hemorragia intraventricular en el recién nacido a término sano.

Cases of intraventricular haemorrhage in full term newborn reported in the literature are scarce and etiopathological factors responsive remain unclear. Authors report a series of four full term infants weighting normal for their gestational age, who developed intraventricular hemorrhage, without any previous etiological factor. Seizures were the onset in all the newborns and, two of them prothrombin test was decreased. Diagnosis was confirmed by cranial ultrasonographic and CT scan after Papilla's classification. Haemorrhage was grade IV in two cases, grade III in another and grade I in the last case. One of the patients died in neonatal period, and the three others developed hydrocephalus. Two of them required ventriculo peritoneal shunt. Follow-up was carried from 14 months to 4 years. Authors found that infants who developed widespread haemorrhage had a poor neurologic outcome.

[Persistent tubular Nephrogram in a newborn (author's transl)]. / Nefrograma tubular persistent en el recién nacido. A propoósito de un caso.

The case presented is that of a newborn with palpable renal masses and oliguria that lasted for the first five days of live. The pyelography that was perfomed showed a prolonged tubular nephrogram and a light increase in kidney size. The good general state, normal test results, a kidney biopsy which failed to show any histological changes and its favorable development, suggested a diagnosis of transitory tubular obstruction caused by protein casts. It is suggested the diagnosis of the Tamm Horsfall proteinuria in the light of the works published in which similar case histories and urograms were cited. These works proved the presence of Tamm Horsfall mucoprotein by the use of specific immunofluorescence tests.