Cribado de la infección por citomegalovirus en recién nacidos de muy bajo peso / Screening for cytomegalovirus infection in very low birth weight infants

Introducción: El citomegalovirus (CMV) es el principal agente causante de infecciones de transmisión vertical, congénitas o adquiridas. El objetivo es conocer la relevancia clínica de dicha infección en prematuros extremos. Pacientes y método: Se incluye a los prematuros de edad gestacional ≤ 31 semanas y peso de nacimiento ≤ 1.500 g atendidos entre marzo del 2006 y diciembre del 2010, a los que se aplicó el protocolo de cribado de la infección por CMV. Se determinó la serología para CMV a sus madres. Cuando la serología era positiva, se congelaba la leche a –20 °C durante 72 h a partir de los 7 días. A las 5 semanas se determinaba el ADN para CMV en orina. Si era positivo se investigaba ADN-CMV en leche materna y en la muestra de sangre seca del cribado metabólico. Resultados: Se estudió a 342 prematuros extremos con 53 (15,5%) infecciones: 8 (2,3%) congénitas, 35 (10,2%) adquiridas y 10 (2,9%) en las que no se pudo precisar su tipo. Una IgM+ en la madre se halló en 2 infecciones congénitas y 2 adquiridas. Los neonatos con citomegalovirosis congénita presentaron un menor peso de nacimiento, más retraso de crecimiento intrauterino, trombopenia, transfusiones de plaquetas, sepsis precoz (incluyendo las clínicas) y alteraciones en la ecografía cerebral. Entre los que presentaron una infección adquirida fueron más frecuentes las sepsis tardías. Conclusiones: Las infecciones por CMV, tanto congénitas como adquiridas, son frecuentes en los prematuros extremos y el protocolo presentado permite diagnosticarlas y probablemente prevenir algunas formas adquiridas al seleccionar a las pacientes a quienes congelar la leche (AU)

Introduction: Cytomegalovirus (CMV) is the most common congenital and acquired vertically transmitted viral infection in humans. The aim of the study is to determine the clinical relevance of this infection in very low birth weight (VLBW) infants in our area. Patients and method: Preterm infants (gestational age ≤ 31 weeks) with a birth weight ≤ 1500 g treated between March 2006 and December 2010 were included. They underwent the screening protocol for diagnosing CMV infection. CMV serology was performed on the mothers. When it was positive, their breast milk was frozen at –20 °C for 72 hours from the 7th day of birth. At 5 weeks, the urine of the newborn was tested for CMV-DNA. In case of a positive result, CMV-DNA was performed in breast milk and in the dry blood sample from metabolic screening. Results: A total of 342 preterm infants were studied, with 53 (15.5%) infected by CMV: 8 (2.3%) with congenital infection, 35 (10.2%) with acquired infection, and 10 (2.9%) in which it was impossible to determine precisely. IgM-CMV + in the mother was found in two congenital infections and two acquired infections. Newborns affected by congenital CMV infection showed a lower birth weight, more intrauterine growth restriction, thrombopenia, need for platelet transfusions, early sepsis (including clinical sepsis), and cerebral ultrasound anomalies. Late sepsis was more frequent in cases of acquired CMV infection. Conclusions: Congenital or acquired CMV infections are frequent in VLBW infants, and our protocol enables them to be diagnosed and probably prevents some acquired CMV infections by selecting which patients should freeze the breast milk (AU)

[Screening for cytomegalovirus infection in very low birth weight infants]. / Cribado de la infección por citomegalovirus en recién nacidos de muy bajo peso.

INTRODUCTION: Cytomegalovirus (CMV) is the most common congenital and acquired vertically transmitted viral infection in humans. The aim of the study is to determine the clinical relevance of this infection in very low birth weight (VLBW) infants in our area. PATIENTS AND METHOD: Preterm infants (gestational age ≤ 31 weeks) with a birth weight ≤ 1500g treated between March 2006 and December 2010 were included. They underwent the screening protocol for diagnosing CMV infection. CMV serology was performed on the mothers. When it was positive, their breast milk was frozen at -20°C for 72hours from the 7th day of birth. At 5 weeks, the urine of the newborn was tested for CMV-DNA. In case of a positive result, CMV-DNA was performed in breast milk and in the dry blood sample from metabolic screening. RESULTS: A total of 342 preterm infants were studied, with 53 (15.5%) infected by CMV: 8 (2.3%) with congenital infection, 35 (10.2%) with acquired infection, and 10 (2.9%) in which it was impossible to determine precisely. IgM-CMV+in the mother was found in two congenital infections and two acquired infections. Newborns affected by congenital CMV infection showed a lower birth weight, more intrauterine growth restriction, thrombopenia, need for platelet transfusions, early sepsis (including clinical sepsis), and cerebral ultrasound anomalies. Late sepsis was more frequent in cases of acquired CMV infection. CONCLUSIONS: Congenital or acquired CMV infections are frequent in VLBW infants, and our protocol enables them to be diagnosed and probably prevents some acquired CMV infections by selecting which patients should freeze the breast milk.

Administración precoz de eritropoyetina en el prematuro extremo, ¿factor de riesgo de la retinopatía del prematuro? / Early administration of erythropoietin in the extreme premature, a risk factor for retinopathy of prematurity?

Introducción: La eritropoyetina (EPO) estimula la angiogénesis y podría favorecer la retinopatía del prematuro (ROP). El objetivo fue determinar si la EPO más hierro (Fe) administrada a partir del quinto día de vida era un factor de riesgo independiente para el desarrollo de ROP y su gravedad. Pacientes y métodos: 718 prematuros supervivientes con peso al nacer (PN) ≤1.500g o edad gestacional (EG) ≤32 semanas (y 6 días), ingresados entre 2001 y 2008. Los objetivos de SaO2 durante estos años fueron mantenerla entre el 88 y el 93%. El tratamiento con EPO se inició a los 5–7 días de vida, a 250UI/kg/3 veces a la semana vía subcutánea, asociada a Fe 5–6mg/kg/día, hasta las 34 semanas de edad corregida o el alta. Resultados: 493 prematuros (68,7%) no presentaron ROP, 139 (19,4%) tuvieron una ROP grado 1, 50 (7,0%) una grado 2 y 36 (5,0%) una grado 3. 27 precisaron láser. Una mayor gravedad de la ROP se asoció con menor PN y EG, más patología neonatal y mayor agresividad terapéutica (duración de la oxigenoterapia o ventiloterapia, número de transfusiones de hematíes). Los factores de riesgo asociados de manera independiente y significativa con la presencia de cualquier estadio de ROP fueron: menor PN, ausencia de cesárea, administración de EPO y necesidad de transfusión de hematíes. La administración de EPO aumentó 2,4 veces el riesgo de ROP, pero la influencia de la EPO sólo se observó en la aparición de ROP grado 1 (odds ratio: 5,50). Conclusiones: La administración de EPO+Fe se asocia y quizás favorece la aparición de ROP grado 1 (AU)

Introduction: Erythropoietin (EPO) stimulates angiogenesis and may favour the appearance of retinopathy of prematurity (ROP). The objective was to determine if EPO+Fe administered from the 5th day of life could be an independent risk factor for ROP appearance and its severity. Patients and method: The study included 718 preterm newborns with a birth weight ≤1,500g or a gestational age ≤32 weeks (and 6 days), admitted between 2001 and 2008. During these years, the target SaO2 was between 88% and 93%. EPO treatment began at 5–7 days of life, with a dose of 250 UI/Kg, 3 times a week, subcutaneously, together with Fe, 5–6mg/kg/day, both until 34 weeks of corrected age or discharge. Results: A total of 493 preterms (68.7%) did not have ROP, 139 (19.4%) had a grade 1 ROP, 50 (7.0%) a grade 2 ROP and 36 (5.0%) a grade 3 ROP. Laser therapy was required by 27 severe ROP was associated with lower birth weight and gestational age, more neonatal morbidity and a more aggressive treatment (duration of oxygen supplements or mechanical ventilation, number of blood transfusions). Risk factors independently and significantly associated with any ROP grade were: lower birth weight, no caesarean section, EPO administration and need for blood transfusion. EPO administration increased the risk of ROP by 2.4, but this only happened in case of grade 1 ROP (OR: 5.50). Conclusions: EPO+Fe administration is associated and perhaps stimulates the appearance of grade 1 ROP (AU)

Tratamiento con eritropoyetina para la anemia tardía tras enfermedad hemolítica del recién nacido / Erythropoietin treatment for late anaemia after haemolytic disease of the newborn

Introducción: Tras varios años de empleo de eritropoyetina (EPO) en la profilaxis de la anemia del prematuro se empezó a utilizarla en algunos recién nacidos (RN) para tratar la anemia neonatal tardía posthemólisis y evitar la transfusión de hematíes. Objetivo: Mostrar los resultados del tratamiento con EPO en la anemia neonatal tardía posthemólisis. Pacientes y métodos: Estudio observacional en 13 RN con anemia tardía secundaria a enfermedad hemolítica por isoinmunización Rh (9 casos), ABO (2 casos), déficit de glucosa-6-P-deshidrogenasa (1 caso) e idiopática (1 caso). Los neonatos iniciaron el tratamiento con EPO cuando se encontraron en indicación de transfusión o próximo a ella. Resultados: Se empezó el tratamiento con EPO a la edad de 26±7 días (15–46), con un valor de hematocrito de 21,7±3% (18–27) y un recuento reticulocitario del 3,8±2,2%. En 11 niños se pudo evitar la transfusión (alcanzaron un hematocrito de 30,7±4,4% y reticulocitos del 5,9±1,4%) y sólo 2 debieron ingresar a tal efecto (con hematocrito 18±1,4% y reticulocitos del 0,6%). Tras la EPO se encuentra un aumento significativo de la hemoglobina (Hb) y de los reticulocitos. Conclusiones: La EPO se ha mostrado útil para evitar la transfusión de hematíes en el 84% de los niños tratados. No se han observado efectos secundarios atribuibles a su uso (AU)

Introduction: After several years of erythropoietin (EPO) use in the prophylaxis of anaemia of prematurity, it also began to be administered to treat post-haemolytic disease anaemia of the newborn in order to avoid blood transfusions. Objective: To show the results obtained with EPO treatment in post-haemolytic disease anemia of the newborn. Patients and methods: Observational study in 13 newborns with late anaemia due to an hemolytic disease caused by Rh isoimmunization (9 cases), AB0 isoimmunization (2 cases), glucose-6-P-dehydrogenase deficiency (1 case) or idiopathic (1 case). The newborns began EPO treatment when they reached the haematocrit level for a blood transfusion. Results: EPO treatment was started at 26±7 days of life (15–46), with a haematocrit value of 21.7±3% (18–27) and a reticulocyte count of 3.8±2.2%. Blood transfusion was not necessary in 11 newborns (haematocrit of 30.7±4.4% and reticulocytes of 5.9±1.4%), and only 2 newborns were admitted for a blood transfusion (haematocrit 18±4.4% and reticulocytes 0.6%). Significant increases in haemoglobin and reticulocyte figures were seen after EPO treatment. Conclusions: EPO administration proved useful to avoid blood transfusion in 84% of treated newborns. No adverse events were detected which could be attributed to this treatment (AU)

[Erythropoietin treatment for late anaemia after haemolytic disease of the newborn]. / Tratamiento con eritropoyetina para la anemia tardía tras enfermedad hemolítica del recién nacido.

INTRODUCTION: After several years of erythropoietin (EPO) use in the prophylaxis of anaemia of prematurity, it also began to be administered to treat post-haemolytic disease anaemia of the newborn in order to avoid blood transfusions. OBJECTIVE: To show the results obtained with EPO treatment in post-haemolytic disease anemia of the newborn. PATIENTS AND METHODS: Observational study in 13 newborns with late anaemia due to an hemolytic disease caused by Rh isoimmunization (9 cases), AB0 isoimmunization (2 cases), glucose-6-P-dehydrogenase deficiency (1 case) or idiopathic (1 case). The newborns began EPO treatment when they reached the haematocrit level for a blood transfusion. RESULTS: EPO treatment was started at 26±7 days of life (15-46), with a haematocrit value of 21.7±3% (18-27) and a reticulocyte count of 3.8±2.2%. Blood transfusion was not necessary in 11 newborns (haematocrit of 30.7±4.4% and reticulocytes of 5.9±1.4%), and only 2 newborns were admitted for a blood transfusion (haematocrit 18±4.4% and reticulocytes 0.6%). Significant increases in haemoglobin and reticulocyte figures were seen after EPO treatment. CONCLUSIONS: EPO administration proved useful to avoid blood transfusion in 84% of treated newborns. No adverse events were detected which could be attributed to this treatment,.

[Early administration of erythropoietin in the extreme premature, a risk factor for retinopathy of prematurity?]. / Administración precoz de eritropoyetina en el prematuro extremo, ¿factor de riesgo de la retinopatía del prematuro?

INTRODUCTION: Erythropoietin (EPO) stimulates angiogenesis and may favour the appearance of retinopathy of prematurity (ROP). The objective was to determine if EPO+Fe administered from the 5th day of life could be an independent risk factor for ROP appearance and its severity. PATIENTS AND METHOD: The study included 718 preterm newborns with a birth weight ≤1,500g or a gestational age ≤32 weeks (and 6 days), admitted between 2001 and 2008. During these years, the target SaO2 was between 88% and 93%. EPO treatment began at 5-7 days of life, with a dose of 250 UI/Kg, 3 times a week, subcutaneously, together with Fe, 5-6mg/kg/day, both until 34 weeks of corrected age or discharge. RESULTS: A total of 493 preterms (68.7%) did not have ROP, 139 (19.4%) had a grade 1 ROP, 50 (7.0%) a grade 2 ROP and 36 (5.0%) a grade 3 ROP. Laser therapy was required by 27 severe ROP was associated with lower birth weight and gestational age, more neonatal morbidity and a more aggressive treatment (duration of oxygen supplements or mechanical ventilation, number of blood transfusions). Risk factors independently and significantly associated with any ROP grade were: lower birth weight, no caesarean section, EPO administration and need for blood transfusion. EPO administration increased the risk of ROP by 2.4, but this only happened in case of grade 1 ROP (OR: 5.50). CONCLUSIONS: EPO+Fe administration is associated and perhaps stimulates the appearance of grade 1 ROP.

Afectación sistémica en prematuros tras administración intranasal de un colirio de tetrizolina / Systemic involvement in premature infants after intranasal administration of tetryzoline drops

No disponible

[Early onset of neonatal sepsis due to Streptococcus agalactiae: study of ten years (1985-1994) and the utility of intrapartum prophylaxis]. / Sepsis neonatal precoz por Streptococcus agalactiae: estudio de diez años (1985-1994) y eficacia de la profilaxis intraparto.

OBJECTIVES: The objectives of this study were to determine the characteristics of early onset neonatal sepsis (EONS) due to group B streptococci (GBS) in our population and to evaluate the efficacy of a prevention program in our hospital during a 4 year period. MATERIAL AND METHODS: We revised all cases of EONS due to GBS between 1985 and 1994 and studied pregnant women colonized by GBS and their infants between 1991 and 1994. RESULTS: In ten years, we diagnosed 45 cases of EONS due to GBS, 30 born in our hospital and 15 born in other hospitals. Sixty-two percent of the patients presented some risk factor (gestation < 37 weeks, rupture of membranes > 18 hours or intrapartum fever > or = 37.8 degrees C. Between 1991 and 1994, 93% of pregnant women colonized by GBS received antibiotic prophylaxis, 14.7% of these women had some risk factor for infection. Two infants from mothers colonized had EONS due to GBS. One mother did not receive antibiotic prophylaxis and the other presented intrapartum fever. In another 5 cases observed during this period, the vaginal culture of the mother was negative for GBS. The incidence of EONS due to GBS during these 4 years was 0.82 cases per 1,000 live births. CONCLUSION: We consider it necessary to use antibiotic prophylaxis in all pregnant carriers of GBS, as well as the administration of antibiotics to pregnant women with a rupture of membranes < 34 weeks of gestation and the practice of an intrapartum culture for the detection of GBS in pregnant women without previous cultures and premature rupture of the membranes.