[Retinopathy of prematurity. Prevention, screening and treatment guidelines]. / Retinopatía de la prematuridad. Recomendaciones para la prevención, el cribado y el tratamiento.

ROP screening is carried out at all the Spanish hospitals, but there is little agreement on the criteria used for its screening and other aspects related to its practice. Our aim is to report on recommendations for prevention, screening, treatment and follow-up of the retinopathy of prematurity in Spain. Prevention strategies and recommendations for screening, exploration and treatment of ROP, as well as of the organisation of the services to carry out it are reviewed. The most recent bibliography on the basis of the scientific evidence is considered, taking as reference, the guidelines published by the American Academy of Pediatrics (AAP) in 2006 and the recommendations updated in 2007 in the United Kingdom. The recommended prevention strategies are based on the best neonatal practice. The standards, as far as the screening is concerned, are established by birth weight (< or =1,500 g), gestational age (< or =32 weeks) and unstable neonatal clinical course. Indirect ophthalmoscopy is the standard technique for exploration and laser therapy the treatment of choice.

[Study of the introduction of the European Credit Transfer System (ECTS) in pediatrics and modification of the teaching methodology]. / Estudio sobre la introducción del Sistema de Transferencia de Créditos Europeo en Pediatría y modificaciones de la metodología docente.

INTRODUCTION: Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. OBJECTIVES: To test the introduction of the ECTS in pediatrics and modify the teaching methodology. STUDY DESIGN: The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. RESULTS: Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. CONCLUSIONS: Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated.

Estudio sobre la introducción del Sistema de Transferencia de Créditos Europeo en Pediatría y modificaciones de la metodología docente / Study of the introduction of the european credit transfer system (ECTS) in pediatrics and modification of the teaching methodology

Introducción Las Facultades Médicas españolas han comenzado el nuevo proceso de reforma curricular en el marco del proceso de implantación del Espacio Europeo de Educación Superior y deben incorporar el Sistema de Transferencia de Créditos Europeo (ECTS) a los nuevos planes del estudio antes de 2010. Objetivos El objetivo del trabajo fue experimentar la introducción de los créditos ECTS en la asignatura de Pediatría y modificar la metodología docente. Diseño del estudio Adaptación del programa teórico y práctico, estableciendo unos objetivos docentes y un sistema de evaluación. Se realizaron encuestas a los alumnos al inicio del segundo cuatrimestre del curso 2004-2005, antes de realizar el examen teórico de la asignatura y al finalizar el curso académico, utilizando para las respuestas una escala de tipo Likert con 5 grados. Se comparó la priorización de las competencias genéricas y específicas de los alumnos con la de los profesionales médicos en la encuesta de la Conferencia Nacional de Decanos (CND). Para el análisis de los resultados se aplicaron pruebas no paramétricas. Resultados Los 15 créditos actuales se transformaron en 11 ECTS, con 297 h de trabajo para los alumnos. Se redujo el programa teórico de 80 a 52 lecciones. Los alumnos prepararon y presentaron 14 casos clínicos, bajo la supervisión de sus tutores. Los profesores consideraron que el aprendizaje teórico había sido similar al de cursos anteriores (66,6 %) y había sido mejor el práctico (73,3 %). Los alumnos opinaron que el proyecto debía continuar (73,2 %), pero el 98,8 % consideraron que la carga de trabajo había sido excesiva. Los alumnos apreciaron de forma estadísticamente significativa que mejoró la docencia práctica y su capacidad para preparar y presentar casos clínicos. El rendimiento académico de los alumnos fue significativamente mejor que el de los alumnos del curso anterior. Los estudiantes estuvieron de acuerdo con la prioridad de competencias de la CND para 9/9 de las generales y 4/17 de las específicas. La estimación de horas de trabajo de los alumnos fue mayor por los alumnos que por los profesores. El 73,3 % de los alumnos contestaron que el proyecto debía mejorarse, reduciendo la carga de trabajo de los alumnos y mejorando el sistema de evaluación. Conclusiones La introducción de los ECTS mejoró el rendimiento académico, la formación práctica y el autoaprendizaje de los alumnos. La experiencia fue satisfactoria para profesores y alumnos. La estimación de la carga de trabajo de los alumnos fue subestimada

Introduction Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. Objectives To test the introduction of the ECTS in pediatrics and modify the teaching methodology. Study design The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. Results Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. Conclusions Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated

[Neonatal morbidity and mortality according to intrauterine growth pattern]. / Morbilidad y mortalidad de los recién nacidos según el patrón de crecimiento intrauterino.

OBJECTIVE: To evaluate the influence of intrauterine growth on neonatal morbidity and mortality in live neonates born in a regional tertiary care center. PATIENTS AND METHODS: A retrospective cohort study was performed. Data from 12,311 live neonates (LN) born in our hospital (from January 1999 to December 2003) were reviewed to analyze neonatal morbidity and mortality according to whether the LN were appropriate (AGA), small (SGA) or large (LGA) for gestational age. The variables collected from birth to hospital discharge were: gestational abnormalities, gender, delivery type, Apgar score, respiratory distress, presentation of obstetric trauma (including cephalohematomas), hypoglycemia, hypocalcemia, hyperbilirubinemia, congenital malformations, heart disease, and type of hospital discharge. Differences were examined among groups. We used the chi-squared test to compare the frequency of these variables in each group. RESULTS: Data from 12,311 LN were entered into the database; 11,182 (90.8%) were AGA, 743 (6.1%) were LGA and 386 (3.1%) were SGA. There were 52.58% boys and 47.42% girls, and 5.5% of LN had macrosomia (birth weight > 4,000 g). A total of 0.39% of LN died before hospital discharge. Among LN, there were 1,215 preterm infants, representing 9.89% of all LN and 2.63% died (SGA 25% and AGA 75%). There was a prevalence of boys in the LGA group and of girls in the SGA group (p = 0.000). The presence of maternal diabetes (pregestational or gestational) was significantly higher (p = 0.000) in the LGA group. Maternal hypertension, smoking and drug addiction were significantly higher in the SGA group. The finding of obstetric trauma was significantly higher in the LGA group (p = 0.000). The proportion of congenital malformations, hypocalcemia and hypoglycemia was higher in the SGA group than in the AGA and LGA groups (p = 0.000). Neonatal mortality was significantly higher (p = 0.000) in the SGA group and preterm infants. CONCLUSIONS: Neonates with deviations in the pattern of intra-uterine growth had worse outcome. Prognosis was worse in SGA neonates, followed by LGA neonates, than in AGA neonates.

Morbilidad y mortalidad de los recién nacidos según el patrón de crecimiento intrauterino / Neonatal morbidity and mortality according to intrauterine growth pattern

Objetivo: Analizar la influencia del patrón de crecimiento intrauterino sobre la morbilidad y mortalidad de los recién nacidos vivos en un hospital regional terciario. Pacientes y métodos: Se revisaron de forma retrospectiva, mediante un estudio de cohortes, a 12.311 recién nacidos vivos nacidos en nuestro hospital (entre enero de 1999 y diciembre de 2003), para analizar la morbilidad y la mortalidad neonatal, según fueran adecuados (AEG), pequeños (PEG) o grandes (GEG) para la edad gestacional. Las variables recogidas desde su nacimiento hasta el momento de su alta hospitalaria fueron: patología gestacional, sexo, tipo de parto, valoración de Apgar, existencia de dificultad respiratoria, traumatismo obstétrico (incluyendo cefalohematoma), malformaciones congénitas, hipoglucemia, hipocalcemia, hiperbilirrubinemia, cardiopatía y el tipo de alta hospitalaria. La incidencia de estas variables en los tres grupos se comparó aplicando el test de la ji cuadrado (χ 2). Resultados: De los 12.311 recién nacidos vivos recogidos en la base de datos, el 90,8 % (n = 11.182) fueron AEG, el 6,1 % (n = 743) GEG y el 3,1 % (n = 386) fueron PEG. El 52,58 % era niños y el 47,42 % niñas. Fueron macrosómicos (peso al nacer ≥ 4.000 g) el 5,5 % de los recién nacidos. Fallecieron el 0,39 % de los recién nacidos vivos. Del total de recién nacidos vivos 1.215 fueron pretérmino, lo que supone el 9,89 % del total y fallecieron el 2,63 % (PEG el 25 % y AEG el 75 %). Existió un predominio de niños en el grupo de GEG y de niñas en el grupo de PEG (p 5 0,000). La existencia de diabetes materna (pregestacional o gestacional) fue significativamente más alta (p 5 0,000) en el grupo de GEG y los antecedentes de hipertensión materna, madre fumadora o drogadicta en el grupo de PEG (p = 0,000). La existencia de trauma obstétrico fue significativamente mayor en los GEG (p = 0,000). La tasa de malformaciones congénitas, hipocalcemia e hipoglucemia (p 5 0,000) fue más elevada en los PEG respecto a los otros grupos. La mortalidad neonatal fue significativamente mayor en los PEG y en los prematuros (p = 0,000). Conclusiones: Existe una peor evolución de los recién nacidos que presentan una desviación del patrón de crecimiento intrauterino, teniendo un peor pronóstico los PEG y en menor cuantía los GEG, respecto a los AEG

Objective: To evaluate the influence of intrauterine growth on neonatal morbidity and mortality in live neonates born in a regional tertiary care center. Patients and methods: A retrospective cohort study was performed. Data from 12,311 live neonates (LN) born in our hospital (from January 1999 to December 2003) were reviewed to analyze neonatal morbidity and mortality according to whether the LN were appropriate (AGA), small (SGA) or large (LGA) for gestational age. The variables collected from birth to hospital discharge were: gestational abnormalities, gender, delivery type, Apgar score, respiratory distress, presentation of obstetric trauma (including cephalohematomas), hypoglycemia, hypocalcemia, hyperbilirubinemia, congenital malformations, heart disease, and type of hospital discharge. Differences were examined among groups. We used the chi-squared test to compare the frequency of these variables in each group. Results: Data from 12,311 LN were entered into the database; 11,182 (90.8 %) were AGA, 743 (6.1 %) were LGA and 386 (3.1 %) were SGA. There were 52.58 % boys and 47.42 % girls, and 5.5 % of LN had macrosomia (birth weight > 4,000 g). A total of 0.39 % of LN died before hospital discharge. Among LN, there were 1,215 preterm infants, representing 9.89 % of all LN and 2.63 % died (SGA 25 % and AGA 75 %). There was a prevalence of boys in the LGA group and of girls in the SGA group (p = 0.000). The presence of maternal diabetes (pregestational or gestational) was significantly higher (p = 0.000) in the LGA group. Maternal hypertension, smoking and drug addiction were significantly higher in the SGA group. The finding of obstetric trauma was significantly higher in the LGA group (p = 0.000). The proportion of congenital malformations, hypocalcemia and hypoglycemia was higher in the SGA group than in the AGA and LGA groups (p = 0.000). Neonatal mortality was significantly higher (p = 0.000) in the SGA group and preterm infants. Conclusions: Neonates with deviations in the pattern of intra-uterine growth had worse outcome. Prognosis was worse in SGA neonates, followed by LGA neonates, than in AGA neonates

Midazolam in neonatal seizures with no response to phenobarbital.

The outcome of 45 neonates with EEG-confirmed seizures (ESz) was analyzed with regard to treatment. ESz persisted in 17 of 32 neonates receiving phenobarbital/phenytoin (13 had a poor outcome, 4 died). In contrast, ESz were rapidly controlled in 13 of 13 nonresponders to phenobarbital/phenytoin treated with midazolam (4 had poor outcome, 2 died). Nonresponders to phenobarbital/phenytoin had a significantly worse outcome than responders did. Midazolam effectively controlled ESz in nonresponders to phenobarbital/phenytoin and correlated with significantly improved long-term neurodevelopment.

[Neonatal convulsions: influence of the electroencephalographic pattern and the response to treatment on the outcome]. / Convulsiones neonatales: influencia del patrón electroencefalográfico en su evolución y en la respuesta al tratamiento.

INTRODUCTION: Neonatal convulsions continues being motive for multiple controversies: the diagnosis only by clinical approaches, the necessity to confirm with EEG record and their treatment and control. OBJECTIVE: To establish the incidence of type of clinical neonatal seizures and the correspondence of these to the EEG trace background and the EEG epileptic activity, the underlying etiology, the response to antiepileptic treatment, and their prognosis. PATIENTS AND METHODS: Retrospective study of admitted newborns with the diagnosis of neonatal seizures in our hospital, during the period included between January 1993 and October 2001. Some of variables collected were: birth and gestational age, Apgar, clinical pattern, duration of the convulsions, critical and intercritical EEG traced, EEG background, etiological diagnosis, treatment used and response of the same, evolution and neurological state at hospital discharge and at one year of age (corrected age in preterm infants). RESULTS: 74 children were admitted with neonatal convulsion diagnosis, of these only 56 EEG convulsions were confirmed (42% presented subtle seizures, 33.9% tonic, 64.3% clonic multifocal, 10.7% clonic focal, and 16.1% myoclonic multifocal). 55.4% of the infants had 2 or more types of clinical convulsions, 25% of all had an epileptic state, and 42.9% had at some time of the EEG record, electroclinical dissociation. The more frequent critical EEGs abnormalities was multifocal discharges (64.3%), and together with the focal discharges of low frequency had significant (p<0.01) worse pharmacological control, and also unfavourable outcome. The infants having had EEGs background moderately and markedly abnormal showed unfavourable outcome in 72.2% and 100% respectively, while it was only in 15.4% of the infants who had EEGs background normal or lightly abnormal. With the antiepileptic treatment the clinical control of the convulsions was obtained in more than 80% of the cases, while control of the electrical convulsions was only in 62.5%. There was a higher significant association between favourable response to treatment and normal neurological examination at hospital discharge and at 1 year of age. CONCLUSIONS: The necessity to confirm by means of EEG record the neonatal clinical convulsions, before and after having established the anticonvulsant treatment, due to the control of electrical convulsions improves their neurological outcome.

Convulsiones neonatales: influencia del patrón electroencefalográfico en su evolución y en la respuesta al tratamiento / Neonatal convulsions: influence of the electroencephalographic pattern and the response to treatment on the outcome

Introducción. Existen controversias sobre las convulsiones neonatales (CNN): fiabilidad del diagnóstico únicamente por criterios clínicos, necesidad de la confirmación electroencefalográfica y tratamiento. Objetivo. Estudiar la incidencia de los tipos clínicos de CNN y su correspondencia con el trazado electroencefalográfico de fondo y la actividad convulsiva del EEG, la respuesta al tratamiento anticonvulsivo y su pronóstico. Pacientes y métodos. Estudio retrospectivo de los casos ingresados con el diagnóstico de CNN en nuestro hospital, entre enero de 1993 y octubre de 2001. Se registraron las siguientes variables: patrón clínico, duración de las convulsiones, trazado electroencefalográfico crítico e intercrítico, trazado electroencefalográfico de fondo, diagnóstico etiológico, tratamiento y respuesta al mismo, y estado neurológico al alta y después del año de edad (edad corregida para los pretérmino). Resultados. De un total de 74 niños, en sólo 56 se confirmaron convulsiones electroencefalográficamente, y, de ellas, un 42 por ciento correspondió a convulsiones sutiles, 33,9 por ciento tónicas, 64,3 por ciento clónicas multifocales, 10,7 por ciento clónicas focales y 16,1 por ciento mioclónicas multifocales. El 55,4 por ciento presentó dos o más tipos clínicos de convulsiones, el 25 por ciento desarrolló un estado epiléptico, y el 42,9 por ciento mostró disociación electroclínica. Las anomalías electroencefalográficas críticas más frecuentes fueron las descargas multifocales (64,3 por ciento), que, junto con las descargas focales de baja frecuencia, eran las de peor control farmacológico y peor pronóstico. El trazado electroencefalográfico de fondo moderada y marcadamente anormal fue un indicador de mala evolución. Con tratamiento se consiguió el control clínico en más del 80 por ciento de los casos, y el control electroencefalográfico en sólo el 62,5 por ciento. Hubo una asociación significativa ( p < 0,01) entre la respuesta favorable al tratamiento y la exploración neurológica normal al alta de la unidad neonatal y después del año de edad. Conclusiones. Se deben monitorizar las CNN mediante EEG, antes y después de instaurado el tratamiento anticonvulsionante, ya que con el control de las convulsiones electroencefalográficas se mejora el pronóstico neurológico de estos niños (AU)

Introduction. Neonatal convulsions continues being motive for multiple controversies: the diagnosis only by clinical approaches, the necessity to confirm with EEG record and their treatment and control. Objective. To establish the incidence of type of clinical neonatal seizures and the correspondence of these to the EEG trace background and the EEG epileptic activity, the underlying etiology, the response to antiepileptic treatment, and their prognosis. Patients and methods. Retrospective study of admitted newborns with the diagnosis of neonatal seizures in our hospital, during the period included between January 1993 and October 2001. Some of variables collected were: birth and gestational age, Apgar, clinical pattern, duration of the convulsions, critical and intercritical EEG traced, EEG background, etiological diagnosis, treatment used and response of the same, evolution and neurological state at hospital discharge and at one year of age (corrected age in preterm infants). Results. 74 children were admitted with neonatal convulsion diagnosis, of these only 56 EEG convulsions were confirmed (42% presented subtle seizures, 33.9% tonic, 64.3% clonic multifocal, 10.7% clonic focal, and 16.1% myoclonic multifocal). 55.4% of the infants had 2 or more types of clinical convulsions, 25% of all had an epileptic state, and 42.9% had at some time of the EEG record, electroclinical dissociation. The more frequent critical EEGs abnormalities was multifocal discharges (64.3%), and together with the focal discharges of low frequency had significant (p < 0.01) worse pharmacological control, and also unfavourable outcome. The infants having had EEGs background moderately and markedly abnormal showed unfavourable outcome in 72.2% and 100% respectively, while it was only in 15.4% of the infants who had EEGs background normal or lightly abnormal. With the antiepileptic treatment the clinical control of the convulsions was obtained in more than 80% of the cases, while control of the electrical convulsions was only in 62.5%. There was a higher significant association between favourable response to treatment and normal neurological examination at hospital discharge and at 1 year of age. Conclusions. The necessity to confirm by means of EEG record the neonatal clinical convulsions, before and after having established the anticonvulsivant treatment, due to the control of electrical convulsions improves their neurological outcome (AU)

[Is there a relationship between vaccination coverage and pediatric health care?]. / Están la cobertura vacunal y los exámenes de supervisión pediátrica de la salud íntimamente relacionados?

OBJECTIVE: The aims of this study were to evaluate the relationship between pediatric health care visits and immunization coverage. PATIENTS AND METHODS: The study was made in a rural health care center. All of the children between 3 months and 14 years old were included. The data were obtained directly from their clinical histories. The quality of the health care visits was evaluated according to the fulfillment of A.E.P. patterns of health care. RESULTS: We observed that 87% of infants, 74% of preschool children and 74% of school children were correctly vaccinated. We observed a significantly lower (p < 0.05) coverage of the MMR vaccine in respect to the first three doses of DPT and OPV vaccines; and the coverage of OPV and DT at 6 years old was even lower. The quality of health care visits was good in 67% of infants, 10% of preschool children and 12% of school children. There was a relationship between incomplete vaccinations and missed visits (p < 0.001) and also with low quality health care visits (p < 0.001). CONCLUSIONS: We conclude that there is a significant relationship between missed visits and low quality health care visits with delayed immunization.

[Prognostic value of the electroencephalogram in hypoxic ischemic encephalopathy]. / Valor pronóstico del electroencefalograma en la encefalopatía hipóxico-isquémica (EHI).

In order to check the prognostic implications of EEG tracings in hypoxic-ischemic encephalopathy (HIE), we carried out prospective EEG recordings in 116 newborn babies (65 term and 51 premature) admitted to our neonatal intensive care unit as a result of perinatal asphyxia. Forty term neonates were found to have critical and/or intercritical epileptiform EEG alterations; the developmental results of 23 of these cases (57.5%) were adverse and were favorable in 17 cases (42.5%). Given that unfavorable results occurred in only 4 of the other 25 term neonates, the epileptiform EEG alterations were statistically significant for adverse developmental results (p < 0.005). Of the premature neonates, 29 were found to have critical and/or intercritical epileptiform EEG alterations. The developmental results were adverse in 19 of these children (65.5%) and favorable in 10 cases (34.8%). The statistical evaluation in this case showed a barely significant difference (p < 0.005) between epileptiform EEG alterations and poor developmental outcome when uncorrected age was used, and no statistically significant difference when corrected age was used. Thus, we conclude that although epileptiform EEG anomalies may serve as markers for neurological development impairments, they must be considered in conjunction with the background EEG tracing.

[Prognosis of perinatal asphyxia in full-term neonates]. / Pronóstico de la asfixia perinatal en el recién nacido a término.

We have performed a prospective study in 65 asphyxiated term newborns to evaluate the prognostic value of three different methods: 1) Neurological examination, 2) Electroencephalographic tracings (EEGs) and 3) Transfontanellar sonography, carried out periodically from birth until discharged from the neonatal unit. The neurological status of surviving infants was assessed at one year of age. We found a statistically significant (p < 0.0001) association between the neurological examination, electroencephalographic tracings and transfontanellar sonography during the neonatal period and the neurological development. The prognostic value, as a function of sensibility, specificity and predictive value of the three methods was very high. No differences were found among them, although the EEGs and neurological examinations showed the highest predictive values.

[Ganglio-thalamic encephalomalacia. Ultrasonic diagnosis]. / Encefalomalacia gangliotalámica. Diagnóstico sonográfico.

We have performed serial trans-fontanelle sonography on 69 newborns with perinatal asphyxia. Ten neonates presented high ultrasonic density in the thalamus and the basal ganglia. These images were preceded, in eight of them, by diffuse echoes for all of the CNS, corresponding to cerebral edema. The most significant clinical findings were convulsions and important depression of conscience level and muscular tone. Eight of ten newborns presented major abnormalities in the electroencephalogram (severe depression of background). Since its coexistence with other parenchymal lesions and poor neurologic development, we consider the ganglio-thalamic ultrasonic densities to be a sign of severe ischemic hypoxic cerebral damage.

[Minor malformations and variations from normality at birth. II: Minor body anomalies excluding craniofacial anomalies]. / Malformaciones menores y variantes de la normalidad al nacimiento. II: Anomalías menores corporales con exclusión de las craneofaciales.

Authors studied in a total of 189 newborns, incidence of minor and variant malformation normalities, excluding craniofacial ones (already analyzed in a previous paper). After grouping the results in different corporal zones where these could be found, they find a greater incidence, in the cutaneous system and less in other corporeal areas. Since results differ mainly from those which already exist, therefore, they think that new studies are necessary in distinct geographic areas due to variation o their incidence in them.

[Minor malformations and variants of normality at birth. I: Minor craniofacial anomalies]. / Malformaciones menores y variantes de la normalidad al nacimiento. I: Anomalías menores craneofaciales.

Authors have studied the presence of minor variant malformations of craniofacial normalities in 189 newborns. Results were grouped according to different anatomical areas where they settled. They have found a greater expressiveness of minor anomalies and, above all, in the auricular external car and, in minor proportion, in the nose and ocular orbs. Results are similar in some cases with the scarce preexistent data, but they differ meaningly with others; maybe that this is produced by the own distinct geographic areas variations.