[Morbidity at 2 years in infants with a birth weight of < 1,500 g]. / Morbilidad a los dos años de edad en niños con un peso al nacimiento menor de 1.500 g.

OBJECTIVES: To determine morbidity at 2 years' corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid. PATIENTS AND METHODS: An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87%) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient. RESULTS: Among the patients initially included in the study, 87% completed the follow-up; 17.1% had one or more major sequela. We found one case (0.4%) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9% had a development quotient below 85 and 18% had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of 2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings. CONCLUSIONS: Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years' corrected age.

Morbilidad a los dos años de edad en niños con un peso al nacimiento menor de 1.500 g / Morbidity at 2 years in infants with a birth weight of < 1.500 g

Objetivos: Conocer la morbilidad a los 2 años de edad corregida de una cohorte de recién nacidos con un peso inferior a1.500 g durante los años 1999-2000 en un hospital terciario de la Comunidad de Madrid. Pacientes y métodos: Estudio observacional de seguimiento longitudinal de una cohorte de 213 pacientes con peso inferior a 1.500 g al nacimiento. De éstos, 188 (87 %) finalizaron el seguimiento completo a los 2 años. Se estudiaron de forma prospectiva las diferentes morbilidades neurosensoriales, prestando especial atención a las morbilidades mayores: oftalmológicas, auditivas, motoras y bajo cociente de desarrollo (CD). Resultados: Completaron el seguimiento el 87 % de los pacientes incluidos inicialmente en el estudio; el 17,1 % presentaron una o más secuelas mayores. Encontramos un caso (0,4%) de sordera neurosensorial bilateral y un caso de ceguera bilateral; el 5,8 % (11/188) de los niños presentaron alguna forma de parálisis cerebral y un 14,9 % tuvieron un CD < 85 a los 2 años de edad. El 18 % no había alcanzado el percentil 3 (P3) de peso a los 2 años de seguimiento. Hallamos, como factores de mal pronóstico neurológico la microcefalia a los 2 años de edad y la aparición de lesiones de sustancia blanca (incluyendo la hiperecogenicidad periventricular persistente y ventriculomegalia de bordes irregulares) como alteraciones ecográficas. Conclusiones: Menos de una quinta parte de los recién nacidos de muy bajo peso (RNMBP) presentan alguna secuela grave a los 2 años de seguimiento. Encontramos como factores de mal pronóstico neurológico la microcefalia a los 2 años de edad corregida y la presencia de alteración de la sustancia blanca en los hallazgos ecográficos. Nos preocupan los datos de crecimiento y desarrollo, puesto que el 18 % de los pacientes no han alcanzado el P3 de peso a los 2 años de edad corregida (AU)

Objectives: To determine morbidity at 2 years’ corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid. Patients and methods: An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87 %) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient. Results: Among the patients initially included in the study, 87%completed the follow-up; 17.1 % had one or more major sequela. We found one case (0.4 %) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9%had a development quotient below 85 and 18 % had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings. Conclusions: Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years’ corrected age (AU)

[Ability of neonatal head circumference to predict long-term neurodevelopmental outcome]. / Utilidad del perímetro cefálico en el recién nacido para anticipar problemas en el neurodesarrollo.

AIM: We review the ability of head circumference (HC) at birth and head growth during the neonatal period to predict neurodevelopmental outcome, putting emphasis on new knowledge in this area. DEVELOPMENT: During infancy HC correlates closely with intracranial volume and constitutes an accurate predictor of cerebral volume. Both an abnormal head size at birth and an abnormal head growth during the neonatal period, can express brain damage or the presence of entities that involve varied degrees of neurological dysfunction in childhood. In general, the influence of head size or growth abnormalities on neurodevelopment is more related to the underlying etiology and/or the presence of structural diseases of the brain than with the HC alteration itself. HC evaluation is of particular interest in sick neonates, specially very low birth weight infants, regardless of whether they are normal or small for gestational age, and both during admission an during the first months of life. In these patients, HC catch-up within the first months of life represents a favorable neurodevelopmental prognostic factor. CONCLUSION: HC measuring and head growth evaluation constitute the most simple, inexpensive and quick available tools to assess the development of the central nervous system and identify neonates at risk of neurodevelopmental disorders.

Utilidad del perímetro cefálico en el recién nacido para anticipar problemas en el neurodesarrollo / Ability of neonatal head circumference to predict long-term neurodevelopmental outcome

Objetivo. Se revisa el valor del perímetro cefálico (PC) al nacimiento y del crecimiento cefálico en el neonato para predecir el desarrollo neurológico ulterior y se enfatiza en los nuevos conocimientos en esta área. Desarrollo. Durante la infancia, el PC se correlaciona estrechamente con el volumen intracraneal y predice certeramente el volumen cerebral. La alteración del tamaño cefálico en el momento del nacimiento, así como del crecimiento de éste durante el período neonatal, puede expresar la existencia de algún daño cerebral y, en otras ocasiones, señalar la presencia de entidades que conllevan diversos grados de disfunción neurológica en la niñez. En general, la trascendencia neuroevolutiva de las alteraciones en el tamaño y el crecimiento de la cabeza, se relaciona más con la etiología subyacente o la presencia de patología estructural del cerebro que con la alteración del PC per se. La vigilancia del crecimiento cefálico es de gran utilidad en los neonatos enfermos, particularmente en los recién nacidos pretérmino < 1.500 g, independientemente de que sean de peso adecuado o de bajo peso a la edad gestacional, tanto durante su ingreso hospitalario como durante los primeros meses de vida. En estos pacientes, la recuperación del crecimiento cefálico a los percentiles de crecimiento constitucional en los primeros meses de vida es un factor pronóstico neuroevolutivo favorable. Conclusión. La medición del PC y la vigilancia del crecimiento cefálico constituyen los métodos más sencillos, baratos, rápidos y disponibles que contribuyen a evaluar la normalidad del desarrollo del sistema nervioso central y a reconocer a los neonatos en riesgo de trastornos del neurodesarrollo (AU)

Aim. We review the ability of head circumference (HC) at birth and head growth during the neonatal period to predict neurodevelopmental outcome, putting emphasis on new knowledge in this area. Development. During infancy HC correlates closely with intracranial volume and constitutes an accurate predictor of cerebral volume. Both an abnormal head size at birth and an abnormal head growth during the neonatal period, can express brain damage or the presence of entities that involve varied degrees of neurological dysfunction in childhood. In general, the influence of head size or growth abnormalities on neurodevelopment is more related to the underlying etiology and/or the presence of structural diseases of the brain than with the HC alteration itself. HC evaluation is of particular interest in sick neonates, specially very low birth weight infants, regardless of whether they are normal or small for gestational age, and both during admission an during the first months of life. In these patients, HC catch-up within the first months of life represents a favorable neurodevelopmental prognostic factor. Conclusion. HC measuring and head growth evaluation constitute the most simple, inexpensive and quick available tools to assess the development of the central nervous system and identify neonates at risk of neurodevelopmental disorders. (AU)

Profilaxis con palivizumab frente al virus respiratorio sincitial: ¿es necesario revisar sus indicaciones? / Palivizumab prophylaxis against respiratory syncytial virus. Should its indications be reviewed?

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Síndrome displasia coriorretiniana, microcefalia y retraso mental con linfedema / Chorioretinal dysplasia-microcephaly-mental retardation syndrome

No disponible

Seguimiento de niños de alto riesgo biológico / Follow up of children with biological high risk

No disponible

[Multiple type I pseudohypoaldosteronism: neonatal management and outcome]. / Seudohipoaldosteronismo tipo I múltiple: presentación y seguimiento.

UNLABELLED: Multiple type I pseudohypoaldosteronism (PHA-I) is an autosomal recessive condition with multiple target-organ unresponsiveness to aldosterone, manifested early after birth with severe salt-wasting and hyperkalemia. Case 1. Female infant born at term after an uneventful pregnancy. One female sibling died in the first week of life with hyperkalemia. The diagnosis of multiple PHA-I resulted from a picture of dehydratation, hyperkalemia and hyponatremia with increased plasma renin activity (PRA), plasma aldosterone and sweat electrolytes. The treatment consisted of salt and sodium bicarbonate supplements, restricted potassium intake, cation exchange resins and high fluid intake. During first year she was hospitalized for severe salt-losing crises. At 7 years of age, she needs salt and sodium bicarbonate supplements and cation exchange resins. She has a normal growth and neurodevelopment. Case 2. Seven-day female newborn with consanguinity in maternal family. Pregnancy and delivery were uncomplicated. On admission she was severely dehydrated with hyponatremia, hyperkalemia, metabolic acidosis and elevated PRA, plasma aldosterone and sweat electrolytes. She remained hospitalized for six months and she was dependent on high amounts of salt and sodium bicarbonate supplements, fluid intake and cation exchange resins. Growth and neurodevelopment are normal. CONCLUSIONS: Multiple PHA-I may be suspected in a newborn with salt-loss and hyperkalemia without glucocorticoid defect. The frequent episodes of dehydratation during the first year of life require long hospitalization. The improvement with age make possible an ambulatory control after the first year of life.

[Staphylococcus coagulase negative infection in neonates caused by intravascular catheters. Prospective study]. / Sepsis por staphylococcus coagulasa negativo en recién nacidos portadores de catéteres intravasculares. Estudio prospectivo.

We present a prospective study about 100 intravascular catheters inserted into 88 newborns. 35 positive blood cultures were obtained; 19 with clinical signs of sepsis and 16 in asymptomatic newborns. Coagulase-negative Staphylococci were the most common isolated organisms -84.2% in the symptomatic cases, 100% in the asymptomatic ones. A comparative study was realized between cases of catheter-related sepsis with positive blood culture of coagulase-negative Staphylococcus (n = 14) versus asymptomatic cases with positive blood culture (n = 16). Risk factors in the appearance of symptoms are: prematurity, newborns old age when catheters are inserted and days of catheter placement.