Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer.

OBJECTIVE: Determine the suitability of transcutaneous bilirubin (TCB) as a tool to assess the effectiveness of phototherapy on patched skin. STUDY DESIGN: A prospective observational study was conducted. We covered a fragment of skin (sternum) with a photo-opaque patch. Several simultaneous TCB and TSB measurements were performed with the JM-105 bilirubinometer. Bland and Altman test evaluated the agreement between bilirubin levels. RESULT: A total of 217 patients were studied, 48.8% were preterm. The mean difference between TSB and TCB before the start of treatment was 1.07 mg/dL. During phototherapy, differences on covered skin were 0.52, 0.27, and 0.39 mg/dL at 24, 48, and 72 h of therapy respectively. The best correlation was observed at 48 h in preterm infants. CONCLUSION: The measurement of TCB on patched skin (PTCB) is useful for monitoring the response to phototherapy in term and preterm infants. We use a patch with a removable flap that eases successive measures without disturbing the patients.

Prenatal Therapy with Magnesium Sulfate and Its Correlation with Neonatal Serum Magnesium Concentration.

INTRODUCTION: Antenatal magnesium sulfate (MgSO4) administration has shown to be effective in minimizing cerebral palsy and severe motor dysfunction at the age of 2 years. The aim of this study is to determine the relationship between the magnesium dose delivered to the mother and the magnesium concentration in the neonates. MATERIALS AND METHODS: A prospective cohort study was conducted on neonates of less than 32 weeks' gestation admitted to the neonatal intensive care unit of University Hospital Complex of Vigo from December 2012 to July 2015. Comparative analysis of magnesium levels between the groups of neonates exposed to MgSO4 and the control group. RESULTS: A total of 118 neonates were included in the study. The mothers of 62 of them had received MgSO4 as a neuroprotective agent. There was a significant correlation between the full dose of MgSO4 received by the mother and the levels of magnesium in the neonate in the first 24 hours of life (r2 = 0.397; p < 0.001). CONCLUSION: The MgSO4 dose received by the mother has a linear relationship with the magnesium levels obtained in neonates.

[Appendicitis versus nonspecific acute abdominal pain: diagnostic accuracy of ultrasound]. / Apendicitis versus dolor abdominal agudo inespecífico: rendimiento diagnóstico de la ecografía.

PURPOUSE: The aim of this study is to assess the diagnostic accuracy of ultrasound to differentiate appendicitis from nonspecific acute abdominal pain, that is the most common process requiring differential diagnosis in clinical practice. MATERIAL AND METHODS: Patients admitted for suspicion of appendicitis were prospectively evaluated in our hospital during two years (2013-2014). Cases of nonspecific acute abdominal pain and appendicitis assessed by ultrasound were enrolled in the study. The different variables collected were statistically analyzed by descriptive, univariate and diagnostic accuracy studies. RESULTS: A total of 275 patients were studied, 143 cases of nonspecific acute abdominal pain and 132 cases of appendicitis. Ultrasound sensitivity and specificity to differentiate appendicitis were 94.7% and 87.4% respectively, with a 12.6% rate of false positives and a 5.3% rate of false negatives. The rate of false negatives in perforated group was 17.4% and analysis according to Pediatric Appendicitis Score risk groups showed a 12.2% rate of false positives in low-risk group and a 6.3% rate of false negatives in high-risk group. CONCLUSIONS: The use of ultrasound in low clinical probability cases of appendicitis could rise unnecessary surgery rate, due to the significant number of false positives in this group of patients. In high probability clinical cases, ultrasound does not contribute too much to diagnosis and it could be a confusion factor by the significant number of false negative associated to perforated appendicitis.

OBJETIVO: El objetivo del estudio es evaluar el rendimiento diagnóstico de la ecografía para diferenciar la apendicitis del dolor abdominal agudo inespecífico, principal proceso con el que requiere diagnóstico diferencial en la práctica clínica. MATERIAL Y METODOS: Se evaluaron los pacientes atendidos por sospecha de apendicitis en nuestro centro durante 2 años (2013-2014), incorporando al estudio los casos de dolor abdominal agudo inespecífico y apendicitis en los que se realizó ecografía. Las diferentes variables recogidas se analizaron estadísticamente de manera descriptiva, univariante y con estudios de rendimiento diagnóstico. RESULTADOS: Se estudiaron 275 casos; 143 casos de dolor abdominal agudo inespecífico y 132 casos de apendicitis. La sensibilidad y especificidad de la ecografía para diferenciar apendicitis fue del 94,7% y 87,4%, respectivamente, con un porcentaje de falsos positivos del 12,6% y de falsos negativos del 5,3%. El porcentaje de falsos negativos en el grupo de apendicitis perforada alcanzó el 17,4% y el análisis según los grupos de riesgo establecidos por el Pediatric Appendicitis Score mostró un porcentaje de falsos positivos del 12,2% en el grupo de bajo riesgo y de falsos negativos del 6,3% en el grupo de alto riesgo. CONCLUSIONES: El uso de la ecografía en casos de baja probabilidad clínica de apendicitis podría incrementar la tasa de cirugía innecesaria, debido al significativo número de falsos positivos en este grupo de pacientes. En casos de alta probabilidad clínica de apendicitis, la ecografía aporta poco al diagnóstico, e incluso podría ser un factor de confusión por el significativo número de falsos negativos asociados a la apendicitis perforada.

[Recommendations for respiratory support in the newborn (iii). Surfactant and nitric oxide]. / Recomendaciones para la asistencia respiratoria en el recién nacido (iii). Surfactante y óxido nítrico.

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group.

[Universal cytomegalovirus infection screening in premature newborns less than 1500 g]. / Cribado universal de infección por citomegalovirus en prematuros de menos de 1.500 g.

INTRODUCTION: Cytomegalovirus (CMV) infection is endemic, and children who attend day care are the most important source of infection. OBJECTIVE: To establish recommendations based on the medical evidence on the vertical transmission of cytomegalovirus in preterm infants weighing less than 1500g at birth. BACKGROUND: Infection in pregnant women may be primary or secondary. Although there is fetal infection, 85% of newborn infants are asymptomatic. Symptoms of infection include low birth weight, hepatosplenomegaly, thrombocytopenia, microcephaly and neurological disorders. The prognosis of symptomatic children is very poor, with high mortality and neurological disorders. The virus can be reactivated during breast feeding, and early infection is possible through breast milk, probably with little impact in term infants, although the long-term neurological outcome worsens in preterm infants. The diagnostic method of choice is the identification of CMV in urine; the determination in the first two weeks of life suggests congenital infection; later it can be acquired at birth or through breast milk or contaminated blood transfusion. CONCLUSION AND RECOMMENDATION: Determine viral DNA at 4-6 weeks of life by protease chain reaction. If it is positive, monitoring of samples from the first days of life and breast milk are mandatory. This should allow the newborn to be classified into three states: "Without CMV infection", "Congenital CMV infection", "Acquired CMV infection".

Displasia broncopulmonar: definiciones y clasificación / Bronchopulmonary dysplasia: definitions and classifications

La displasia broncopulmonar sigue siendo la secuela más frecuente relacionada con los recién nacidos de muy bajo peso al nacer y especialmente con aquellos con pesos extremadamente bajos. Pese a los avances en la prevención y los cuidados de la insuficiencia respiratoria asociada a la prematuridad, no ha ocurrido un descenso en su incidencia en esta población, aunque sí hemos asistido en los últimos años a un cambio en su expresión clínica y en su gravedad. Existen, sin embargo, diferencias aún importantes entre los distintos centros en cuanto a la frecuencia de su presentación, probablemente debido a la aplicación de un diagnóstico clínico no homogéneo. En este artículo, la Comisión de Estándares de la Sociedad Española de Neonatología quiere revisar los criterios diagnósticos de la displasia broncopulmonar para reducir, en la medida de lo posible, la variabilidad intercentro de la misma (AU)

Bronchopulmonary dysplasia is the most common sequelae related to very low birth weight infants, mostly with those of extremely low birth weight. Even with advances in prevention and treatment of respiratory distress syndrome associated with prematurity, there is still no decrease in the incidence in this population, although a change in its clinical expression and severity has been observed. There are, however, differences in its frequency between health centres, probably due to a non-homogeneously used clinical definition. In this article, the Committee of Standards of the Spanish Society of Neonatology wishes to review the current diagnosis criteria of bronchopulmonary dysplasia to reduce, as much as possible, these intercentre differences (AU)

Recomendaciones sobre transporte neonatal / Recommendations for neonatal transport

Las gestaciones que conllevan algún riesgo materno y/o fetal no siempre son diagnosticadas en un centro especializado en la atención neonatal, por lo que el transporte posnatal es una parte esencial dentro de la estructura de los servicios sanitarios perinatales. El objetivo del transporte neonatal es trasladar al recién nacido a un centro especializado que disponga de la infraestructura y la experiencia necesarias para su asesoramiento y tratamiento. El transporte ideal del recién nacido es el que se realiza in utero. Desafortunadamente, no todos los problemas pueden detectarse a tiempo para el traslado materno y hasta un 30-50% de ellos pueden presentarse durante el parto o en el periodo neonatal inmediato. Por ello es necesario disponer de conocimientos y medios para la reanimación y la estabilización del recién nacido en el momento del parto y de un sistema de transporte neonatal especializado que permita trasladar a los pacientes con el mismo nivel de cuidados que recibiría en el hospital receptor sin que suponga en ningún caso un deterioro de su salud o un riesgo elevado para ella. La Sociedad Española de Neonatología, a través de su Comisión de Estándares, ha querido revisar y actualizar en este documento las recomendaciones para el transporte intraútero, las indicaciones para el traslado neonatal, la organización y la logística necesarias para realizarlo (personal, comunicación, documentación, medio de transporte y equipamiento), la estabilización previa al mismo, el manejo durante el traslado y el ingreso en el hospital receptor (AU)

During pregnancy, it is not always possible to identify maternal or foetal risk factors. Infants requiring specialised medical care are not always born in centres providing intensive care and will need to be transferred to a referral centre where intensive care can be provided. Therefore Neonatal Transport needs to be considered as part of the organisation of perinatal health care. The aim of Neonatal Transport is to transfer a newborn infant requiring intensive care to a centre where specialised resources and experience can be provided for the appropriate assessment and continuing treatment of a sick newborn infant. Intrauterine transfer is the ideal mode of transport when the birth of an infant with risk factors is diagnosed. Unfortunately, not all problems can be detected in advance with enough time to safely transfer a pregnant woman. Around 30- 50% of risk factors will be diagnosed during labour or soon after birth. Therefore, it is important to have the knowledge and resources to resuscitate and stabilise a newborn infant, as well as a specialised neonatal transport system. With this specialised transport it is possible to transfer newly born infants with the same level of care that they would receive if they had been born in a referral hospital, without increasing their risks or affecting the wellbeing of the newborn. The Standards Committee of the Spanish Society of Neonatology reviewed and updated recommendations for intrauterine transport and indications for neonatal transfer. They also reviewed organisational and logistic factors involved with performing neonatal transport. The Committee review included the type of personnel who should be involved; communication between referral and receiving hospitals; documentation; mode of transport; equipment to stabilise newly born infants; management during transfer, and admission at the referral hospital (AU)

Niveles asistenciales y recomendaciones de mínimos para la atención neonatal / Health care levels and minimum recommendations for neonatal care

En el año 2004 fue elaborado por el Comité de Estándares y la Junta Directiva de la Sociedad Española de Neonatología (SEN) un primer documento sobre niveles asistenciales y recomendaciones de mínimos para la atención neonatal, a partir del cual se pudo definir el nivel asistencial de cada centro en nuestro país, así como los requerimientos técnico-sanitarios según niveles. La presente revisión pretende tener en cuenta los cambios experimentados en la asistencia neonatal en los últimos años y optimizar la localización de recursos. Las unidades que proporcionan asistencia a los recién nacidos deben estar organizadas dentro de un sistema de regionalización de los cuidados perinatales. Las características funcionales de cada nivel asistencial deben ser definidas de forma uniforme y clara, y esto incluye requerimientos de equipamiento, instalaciones, personal, servicios de apoyo, formación y organización de servicios (incluyendo el transporte) necesarios para cubrir las prestaciones de cada nivel de cuidados (AU)

A policy statement on the levels of care and minimum recommendations for neonatal healthcare was first proposed by the Standards Committee and the Board of the Spanish Society of Neonatology in 2004. This allowed us to define the level of care of each center in our country, as well as the health and technical requirements by levels of care to be defined. This review takes into account changes in neonatal care in the last few years and to optimize the location of resources. Facilities that provide care for newborn infants should be organized within a regionalized system of perinatal care. The functional capabilities of each level of care should be defined clearly and uniformly, including requirements for equipment, facilities, personnel, ancillary services, training, and the organization of services (including transport) needed to cover each level of care (AU)

Recomendaciones para la informatización de los servicios de neonatología / Recommendations for the computerisation of neonatology services

El objetivo es proporcionar el marco para la recopilación de datos en el área de la salud de los recién nacidos que permitan la armonización de la asistencia sea cual sea su lugar de nacimiento. Para ello es necesario conocer la población atendida y la mayor dificultad es la ausencia de un sistema de recopilación de datos y de unos estándares asistenciales para todas las condiciones del recién nacido. Es imprescindible disponer de un registro único en el que se recojan los principales datos perinatales y neonatales de todos los recién nacidos. La Sociedad Española de Neonatología (SEN) debe ser el depositario y responsable de la base de datos, que debe cumplir todas las exigencias legales de privacidad y confidencialidad. A nivel de cada centro es posible conocer el peso relativo de la afección atendida por grupos de diagnósticos relacionados (DRG) y los resultados desde el aspecto de calidad asistencial. Mediante análisis comparativos (estudios de benchmarking,...) es posible establecer las pautas de diagnóstico y tratamiento.Es necesario conocer la población de recién nacidos atendida y definir criterios de diagnóstico y tratamiento para mejorar la calidad asistencial. La SEN desea dirigirse a los responsables asistenciales de los centros hospitalarios para pedirles su apoyo y colaboración en la puesta en marcha de estas recomendaciones (AU)

The aim is to provide a framework for data collection in the health area of newborn infants allowing harmonization of their care. This requires knowing the population served, and the greatest difficulty is the absence of a data collection system and standards of care for all conditions of the newborn infant. It is essential to have a single record with the main perinatal and neonatal data of all newborn infants. The Spanish Society of Neonatology (SEN) should be responsible for the database, which must meet all legal requirements of privacy and confidentiality. It is possible to determine the relative weight of the pathology treated using Diagnostic Related Groups (DRG) and the results from a quality care perspective. Guidelines for diagnosis and treatment may be established by comparative analysis (benchmarking studies…).Conclusion and Recommendation. It is necessary to know the newborn population served, and define criteria for diagnosis and treatment to improve quality of care. The SEN wishes to address those responsible for the care in hospitals, and to ask for their support and cooperation in the implementation of these recommendations(AU)

[Bronchopulmonary dysplasia: definitions and classifications]. / Displasia broncopulmonar: definiciones y clasificación.

Bronchopulmonary dysplasia is the most common sequelae related to very low birth weight infants, mostly with those of extremely low birth weight. Even with advances in prevention and treatment of respiratory distress syndrome associated with prematurity, there is still no decrease in the incidence in this population, although a change in its clinical expression and severity has been observed. There are, however, differences in its frequency between health centres, probably due to a non-homogeneously used clinical definition. In this article, the Committee of Standards of the Spanish Society of Neonatology wishes to review the current diagnosis criteria of bronchopulmonary dysplasia to reduce, as much as possible, these inter-centre differences.

[Recommendations for neonatal transport]. / Recomendaciones sobre transporte neonatal.

During pregnancy, it is not always possible to identify maternal or foetal risk factors. Infants requiring specialised medical care are not always born in centres providing intensive care and will need to be transferred to a referral centre where intensive care can be provided. Therefore Neonatal Transport needs to be considered as part of the organisation of perinatal health care. The aim of Neonatal Transport is to transfer a newborn infant requiring intensive care to a centre where specialised resources and experience can be provided for the appropriate assessment and continuing treatment of a sick newborn infant. Intrauterine transfer is the ideal mode of transport when the birth of an infant with risk factors is diagnosed. Unfortunately, not all problems can be detected in advance with enough time to safely transfer a pregnant woman. Around 30- 50% of risk factors will be diagnosed during labour or soon after birth. Therefore, it is important to have the knowledge and resources to resuscitate and stabilise a newborn infant, as well as a specialised neonatal transport system. With this specialised transport it is possible to transfer newly born infants with the same level of care that they would receive if they had been born in a referral hospital, without increasing their risks or affecting the wellbeing of the newborn. The Standards Committee of the Spanish Society of Neonatology reviewed and updated recommendations for intrauterine transport and indications for neonatal transfer. They also reviewed organisational and logistic factors involved with performing neonatal transport. The Committee review included the type of personnel who should be involved; communication between referral and receiving hospitals; documentation; mode of transport; equipment to stabilise newly born infants; management during transfer, and admission at the referral hospital.

[Health care levels and minimum recommendations for neonatal care]. / Niveles asistenciales y recomendaciones de mínimos para la atención neonatal.

A policy statement on the levels of care and minimum recommendations for neonatal healthcare was first proposed by the Standards Committee and the Board of the Spanish Society of Neonatology in 2004. This allowed us to define the level of care of each center in our country, as well as the health and technical requirements by levels of care to be defined. This review takes into account changes in neonatal care in the last few years and to optimize the location of resources. Facilities that provide care for newborn infants should be organized within a regionalized system of perinatal care. The functional capabilities of each level of care should be defined clearly and uniformly, including requirements for equipment, facilities, personnel, ancillary services, training, and the organization of services (including transport) needed to cover each level of care.

[Recommendations for the computerisation of neonatology services]. / Recomendaciones para la informatización de los servicios de neonatología.

The aim is to provide a framework for data collection in the health area of newborn infants allowing harmonization of their care. This requires knowing the population served, and the greatest difficulty is the absence of a data collection system and standards of care for all conditions of the newborn infant. It is essential to have a single record with the main perinatal and neonatal data of all newborn infants. The Spanish Society of Neonatology (SEN) should be responsible for the database, which must meet all legal requirements of privacy and confidentiality. It is possible to determine the relative weight of the pathology treated using Diagnostic Related Groups (DRG) and the results from a quality care perspective. Guidelines for diagnosis and treatment may be established by comparative analysis (benchmarking studies…). Conclusion and Recommendation. It is necessary to know the newborn population served, and define criteria for diagnosis and treatment to improve quality of care. The SEN wishes to address those responsible for the care in hospitals, and to ask for their support and cooperation in the implementation of these recommendations.

Trombosis intracardiaca neonatal ligada a catéter: utilidad del activador tisular del plasminógeno recombinante / Neonatal intracardiac thrombosis related to catheter: use of recombinat tissue plasminogen activator

La utilización de catéteres venosos centrales en las unidades de cuidados intensivos neonatales es una práctica habitual no exenta de complicaciones. Dentro de dichas complicaciones, las más frecuentes son las de tipo infeccioso, aunque no podemos desdeñar las de tipo mecánico y trombótico. La incidencia de trombosis ligada al catéter es variable, y la actitud que cabe tomar ante dicho cuadro sigue siendo controvertida en el periodo neonatal. Presentamos el caso de un recién nacido a término que, debido a su patología de base, precisó un acceso venoso central mediante canalización umbilical. Al tercer día de vida se detectó por ecocardiografía la existencia de un trombointra auricular derecho, que se resolvió mediante tratamiento fibrinolítico local con activador tisular del plasminógeno recombinante, administrado a través de catéter silástico central, sin observarse complicaciones mayores(AU)

The use of central venous catheters in the intensive neonatal care units is a common practice not without complications, being infections its most common type, although mechanic and thrombotic ones are also common. The incidence of thrombosis related to catheter varies, and the attitude in the neonatal period remains controversial. We are discussing a case of a term new born suffering from a previous pathology, and central venous access via umbilical pipe was required. On its third day of life, the newborn was detected a right a trial thrombus by means of echocardiography, that was resolved with local thrombolytic therapy with r TPA, administered through central silastic catheter with no further complications observed(AU)

Hipermetioninemia en el recién nacido pretérmino. Estudio de los factores predisponentes / Hypermethioninemia in the preterm newborn. Predisposing factors

Introducción: El exceso de metionina puede ser causa de alteraciones del sistema nervioso central, tales como edema cerebral difuso y trastornos de la mielinización. Pacientes y método: Estudio ambispectivo observacional durante un período de 15 meses de los recién nacidos prematuros ingresados en nuestro hospital que presentaron hipermetioninemia en las pruebas de cribado neonatal por espectrometría de masas en tándem. Seguimiento evolutivo de estos neonatos hasta el año de edad con valoración de sus niveles de metionina en relación con la alimentación, parámetros somatométricos y desarrollo neurológico. Resultados: De una población de estudio de 187 neonatos pretérmino, 16 de ellos presentaron hipermetioninemia aislada. El peso y la alimentación de estos recién nacidos con una fórmula de inicio especial enriquecida en metionina está relacionada con el aumento del número de casos de hipermetioninemia aislada transitoria (el 62,6% recibieron un aporte de metionina superior a 97mg/kg/día), además se halló una correlación estadísticamente significativa entre los días que los pacientes recibían esa fórmula y el tiempo que tardaron en normalizarse las cifras de metionina en plasma (r: 0,791; p: 0,000). No observamos correlación entre las cifras máximas de metionina alcanzadas en plasma y la puntuación obtenida en el test de Brunet Lézine a los 6 meses de edad corregida. Conclusiones: Este estudio pone de relevancia la importancia del suplemento de aminoácidos, concretamente de metionina, en las leches de fórmula de los recién nacidos prematuros por la trascendencia que pueden suponer para su desarrollo neurológico (AU)

Introduction: Excess methionine can cause central nervous system disorders such as diffuse cerebral edema and disorders of myelin. Patients and method: A retrospective and prospective (ambispective) observational study in preterm newborns admitted to our hospital over a period of 15 months and who had hypermethioninemia in neonatal screening tests by tandem mass spectrometry. The progress of these infants was monitored during the first year of life, assessing their methionine levels, diet, somatometric parameters and neurodevelopment. Results: From a study population of 187 preterm infants, 16 of them showed isolated hypermethioninemia. Weight and feeding the babies with a special formula enriched with methionine is related to an increased number of cases of transient isolated hypermethioninemia (62.6% received a higher contribution of methionine than 97mg/kg/day). We also found a statistically significant correlation between the days that patients received the formula and the time it takes to normalize the levels of methionine in plasma (R 0.791, p=0.000). There was no correlation between the methionine peak reached in plasma and the score on the Brunet Lézine test, at the corrected age of 6 months. Conclusions: This study highlights the importance amino acid supplements, particularly methionine, in premature infants’ formulas due to the impact they may have on neurological development (AU)

[Hypermethioninemia in the preterm newborn. Predisposing factors]. / Hipermetioninemia en el recién nacido pretérmino. Estudio de los factores predisponentes.

INTRODUCTION: Excess methionine can cause central nervous system disorders such as diffuse cerebral edema and disorders of myelin. PATIENTS AND METHOD: A retrospective and prospective (ambispective) observational study in preterm newborns admitted to our hospital over a period of 15 months and who had hypermethioninemia in neonatal screening tests by tandem mass spectrometry. The progress of these infants was monitored during the first year of life, assessing their methionine levels, diet, somatometric parameters and neurodevelopment. RESULTS: From a study population of 187 preterm infants, 16 of them showed isolated hypermethioninemia. Weight and feeding the babies with a special formula enriched with methionine is related to an increased number of cases of transient isolated hypermethioninemia (62.6% received a higher contribution of methionine than 97mg/kg/day). We also found a statistically significant correlation between the days that patients received the formula and the time it takes to normalize the levels of methionine in plasma (R 0.791, p=0.000). There was no correlation between the methionine peak reached in plasma and the score on the Brunet Lézine test, at the corrected age of 6 months. CONCLUSIONS: This study highlights the importance amino acid supplements, particularly methionine, in premature infants' formulas due to the impact they may have on neurological development.

Serum levels of IGF1 are a useful predictor of retinopathy of prematurity.

OBJECTIVE: To ascertain whether insulin-like growth factor 1 (IGF1) is associated with retinopathy of prematurity (ROP) and is a useful predictor of the disease. Although its aetiopathogenesis is multifactorial, development of the disease appears to be related to a deficiency in IGF1, a hormone that acts together with vascular endothelial growth factor in the normal angiogenesis in the retina. DESIGN: Prospective study for a 30-month period. PARTICIPANTS: A total of 74 premature newborn babies, of less than 1500 g and/or 32 weeks' gestational age or less. TESTING: To determine the development and severity of ROP. MAIN OUTCOME MEASURES: Serum levels of IGF1 were measured once a week from birth until 40 weeks corrected gestational age in each subject. RESULTS: Of our subjects, 32.4% developed some form of ROP, and all those ROP patients had the following characteristics at birth (median +/- standard deviation scores): low weight (1098 +/- 188 vs. 1393 +/- 285 g), short length (36.74 +/- 1.77 vs. 38.89 +/- 3.08 cm), small cranial perimeter (26.03 +/- 1.74 vs. 27.93 +/- 1.81 cm) and young gestational age (29.7 +/- 1.78 vs. 31.3 +/- 1.79 weeks) (p < 0.05). Other factors previously associated with ROP that were also observed with statistically significant frequency in our ROP patients were bronchopulmonary dysplasia, intracranial haemorrhage, the need for erythrocyte transfusion or treatment with erythropoietin and sepsis (all p < 0.05). Levels of IGF1 at the 3rd week post-partum, independent of gestational age at birth, were clearly lower in the group who developed ROP (29.13 vs. 43.16 ng/mL, p < 0.05). A value of 30 ng/mL of IGF1 in the third week post-partum was found to have a 90% sensitivity in the diagnosis of ROP. A rapid rise in IGF1 levels between the 3rd and 5th weeks appeared to be related to the development of a higher stage of ROP. CONCLUSION: Determination of IGF1 serum levels in the 3rd week post-partum, independent of gestational age at birth, provides a sufficient and reliable prognostic tool and allows the identification of a group of patients at high risk of developing the disease.

Hiperamoniemia. Tratamiento de urgencia y en fase aguda de un paciente con citrulinemia / Hyperammonaemia. Treatment in the emergency and acute phase of a patient with citrullinaemia

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