Cost-utility analysis of Palivizumab for Respiratory Syncytial Virus infection prophylaxis in preterm infants: update based on the clinical evidence in Spain.

BACKGROUND: This study aimed at estimating the efficiency of palivizumab in the prevention of Respiratory Syncytial Virus (RSV) infection and its sequelae in preterm infants (32day 1-35day 0weeks of gestational age -wGA-) in Spain. METHODS: A decision-tree model was developed to compare health benefits (Quality Adjusted Life Years-QALYs) and costs of palivizumab versus a non-prophylaxis strategy over 6 years. A hypothetical cohort of 1,000 preterm infants, 32day 1-35day 0 wGA (4.356 kg average weight) at the beginning of the prophylaxis (15 mg/kg of palivizumab; 3.88 average number of injections per RSV season) was analysed. The model considered the most recent evidence from Spanish observational and epidemiological studies on RSV infection: the FLIP II study provided hospital admission and Intensive Care Unit (ICU) admission rates; in-hospital mortality rate was drawn from an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. Quality of life baseline value, number of hospitalized infants and the presence of recurrent wheezing over time were granted to estimate QALYs. National Health Service and societal perspective (included also recurrent wheezing indirect cost) were analysed. Total costs (€, 2016) included pharmaceutical and administration costs, hospitalization costs and recurrent wheezing management annual costs. A discount rate of 3.0% was applied annually for both costs and health outcomes. RESULTS: Over 6 years, the base case analysis showed that palivizumab was associated to an increase of 0.0731 QALYs compared to non-prophylaxis. Total costs were estimated in €2,110.71 (palivizumab) and €671.68 (non-prophylaxis) from the National Health System (NHS) perspective, resulting in an incremental cost utility ratio (ICUR) of €19,697.69/QALYs gained (prophylaxis vs non-prophylaxis). Results derived from the risk-factors population subgroups analysed were in line with the total population results. From the societal perspective, the incremental cost associated to palivizumab decreased to an €1,253.14 (ICUR = €17,153.16€/QALYs gained for palivizumab vs non-prophylaxis). One-way and probabilistic sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm infants 32day 1-35day 0 wGA in Spain.

Los errores de tratamiento en una unidad neonatal, uno de los principales acontecimientos adversos / Medication errors in a neonatal unit: One of the main adverse events

INTRODUCCIÓN: Las unidades neonatales son uno de los ámbitos hospitalarios más expuestos a la comisión de errores de tratamiento. El error de medicación (EM) se define como el incidente, evitable, secundario a la utilización inapropiada de medicamentos, que causa o puede causar daño al paciente. El objetivo de este trabajo es dar a conocer la incidencia de EM (incluida la alimentación) notificados en nuestra unidad neonatal así como sus características y posibles factores causales. Así mismo se expone una relación de las estrategias llevadas a cabo para su prevención. MATERIAL Y MÉTODOS: Se analizan los EM declarados en un servicio de neonatología. RESULTADOS: Durante un período de 7 años, en el servicio de neonatología se han notificado 511 EM. La incidencia en la unidad de críticos fue de 32,2 por 1.000 días de hospitalización o 0,2 por paciente, de los cuales 0,22 por 1.000 días tuvieron repercusión grave; el 39,5% fueron errores de prescripción, el 68,1% de administración y el 0,6% reacciones adversas a medicamentos. El 65,4% fue producido por fármacos. Se interceptó el 17%. El 89,4% no tuvo repercusión sobre el paciente; el 0,6% causó secuelas permanentes o muerte. Los profesionales de enfermería declararon el 65,4% de los EM. El factor causal más frecuentemente implicado fue la distracción (59%). Se realizaron medidas correctoras simples (alertas), intermedias (protocolos, sesiones clínicas, cursos) y complejas (análisis causales, monografía). CONCLUSIONES: Es imprescindible conocer la propia realidad para poder establecer medidas preventivas y, junto al trabajo en equipo y las buenas prácticas, promover un clima de seguridad

INTRODUCTION: Neonatal units are one of the hospital areas most exposed to the committing of treatment errors. A medication error (ME) is defined as the avoidable incident secondary to drug misuse that causes or may cause harm to the patient. The aim of this paper is to present the incidence of ME (including feeding) reported in our neonatal unit and its characteristics and possible causal factors. A list of the strategies implemented for prevention is presented. MATERIAL AND METHODS: An analysis was performed on the ME declared in a neonatal unit. RESULTS: A total of 511 MEs have been reported over a period of seven years in the neonatal unit. The incidence in the critical care unit was 32.2 per 1000 hospital days or 20 per 100 patients, of which 0.22 per 1000 days had serious repercussions. The ME reported were, 39.5% prescribing errors, 68.1% administration errors, 0.6% were adverse drug reactions. Around two-thirds (65.4%) were produced by drugs, with 17% being intercepted. The large majority (89.4%) had no impact on the patient, but 0.6% caused permanent damage or death. Nurses reported 65.4% of MEs. The most commonly implicated causal factor was distraction (59%). Simple corrective action (alerts), and intermediate (protocols, clinical sessions and courses) and complex actions (causal analysis, monograph) were performed. CONCLUSIONS: It is essential to determine the current state of ME, in order to establish preventive measures and, together with teamwork and good practices, promote a climate of safety

[Medication errors in a neonatal unit: One of the main adverse events]. / Los errores de tratamiento en una unidad neonatal, uno de los principales acontecimientos adversos.

INTRODUCTION: Neonatal units are one of the hospital areas most exposed to the committing of treatment errors. A medication error (ME) is defined as the avoidable incident secondary to drug misuse that causes or may cause harm to the patient. The aim of this paper is to present the incidence of ME (including feeding) reported in our neonatal unit and its characteristics and possible causal factors. A list of the strategies implemented for prevention is presented. MATERIAL AND METHODS: An analysis was performed on the ME declared in a neonatal unit. RESULTS: A total of 511 MEs have been reported over a period of seven years in the neonatal unit. The incidence in the critical care unit was 32.2 per 1000 hospital days or 20 per 100 patients, of which 0.22 per 1000 days had serious repercussions. The ME reported were, 39.5% prescribing errors, 68.1% administration errors, 0.6% were adverse drug reactions. Around two-thirds (65.4%) were produced by drugs, with 17% being intercepted. The large majority (89.4%) had no impact on the patient, but 0.6% caused permanent damage or death. Nurses reported 65.4% of MEs. The most commonly implicated causal factor was distraction (59%). Simple corrective action (alerts), and intermediate (protocols, clinical sessions and courses) and complex actions (causal analysis, monograph) were performed. CONCLUSIONS: It is essential to determine the current state of ME, in order to establish preventive measures and, together with teamwork and good practices, promote a climate of safety.

Caminando hacia una cultura de seguridad en la unidad neonatal: experiencia de 6 años / Towards a safety culture in the neonatal unit: Six years experience

INTRODUCCIÓN: La cultura de seguridad es el esfuerzo colectivo de una institución para encaminar la totalidad de los recursos hacia el objetivo de la seguridad. MATERIAL Y MÉTODOS: Se analizan 6 años de experiencia de la Comisión de la Seguridad del paciente neonatal. Se creó un buzón para la declaración de acontecimientos adversos y se diseñaron medidas para su corrección, así como información del trabajo realizado y su valoración. RESULTADOS: Durante 6 años se han recibido 1.287 notificaciones de acontecimientos adversos de las cuales 600 (50,8%) ocurrieron en la UCI neonatal. Quince (1,2%) graves contribuyeron a la muerte del paciente; 1.282 (99,6%) acontecimientos adversos se consideraron evitables. Se adoptaron medidas correctoras simples (notificación, alertas, etc.) en 559 (43,4%), medidas intermedias (protocolos, boletín, etc.) en 692 (53,8%) y medidas más complejas (análisis causa-raíz, libretos, formación continuada, trabajos prospectivos, etc.) en 66 (5,1%). Respecto al trabajo sobre las infecciones relacionadas con la asistencia sanitaria, se demostró cómo las estrategias de prevención (lavado de manos, inserción y mantenimiento de vías) repercuten directamente en su disminución. Se realizaron 2 encuestas, obteniendo un grado de satisfacción de la comisión de 7,5/10. Con la versión española del Hospital Survey on Patient Safety Culture se obtuvo un grado de cultura de seguridad de 7,26 sobre 10. CONCLUSIONES: Se ha iniciado un camino hacia la cultura de seguridad. La declaración de los acontecimientos adversos es un elemento clave para obtener información sobre el tipo, la etiología y la evolución, y decidir posibles estrategias de prevención

INTRODUCTION: A safety culture is the collective effort of an institution to direct its resources toward the goal of safety. MATERIAL AND METHODS: An analysis is performed on the six years of experience of the Committee on the Safety of Neonatal Patient. A mailbox was created for the declaration of adverse events, and measures for their correction were devised, such as case studies, continuous education, prevention of nocosomial infections, as well as information on the work done and its assessment. RESULTS: A total of 1287 reports of adverse events were received during the six years, of which 600 (50.8%) occurred in the neonatal ICU, with 15 (1.2%) contributing to death, and 1282 (99.6%) considered preventable. Simple corrective measures (notification, security alerts, etc.) were applied in 559 (43.4%), intermediate measures (protocols, monthly newsletter, etc.) in 692 (53.8%), and more complex measures (causal analysis, scripts, continuous education seminars, prospective studies, etc.) in 66 (5.1%). As regards nosocomial infections, the prevention strategies implemented (hand washing, insertion and maintenance of catheters) directly affected their improvement. Two surveys were conducted to determine the level of satisfaction with the Committee on the Safety of Neonatal Patient. A rating 7.5/10 was obtained in the local survey, while using the Spanish version of the Hospital Survey on Patient Safety Culture the rate was 7.26/10. CONCLUSIONS: A path to a culture of safety has been successfully started and carried out. Reporting the adverse events is the key to obtaining information on their nature, etiology and evolution, and to undertake possible prevention strategies

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

No disponible

Actualización de las recomendaciones de la Sociedad Española de Neonatología para la utilización del palivizumab como profilaxis de las infecciones graves por el virus respiratorio sincitial / Update of recommendations on the use of palivizumab as prophylaxis in RSV infections

El Comité de Estándares de la Sociedad Española de Neonatología (SENeo) considera que el nuevo documento de la Academia Americana de Pediatría respecto a las recomendaciones del palivizumab para prevenir las infecciones graves por el virus respiratorio sincitial (VRS) no aporta nuevas evidencias científicas que justifiquen la modificación de las recomendaciones actuales de la SENeo. No obstante, se proponen unos ajustes en los criterios de las recomendaciones vigentes para reducir el coste del fármaco mediante su administración correcta y juiciosa

The Standards Committee of the Spanish Neonatology Society (SENeo) considers that the new document from the American Academy of Pediatrics, including recommendations for palivizumab use to prevent serious infections produced by the Respiratory Syncytial Virus (RSV), provides no new scientific evidence which would justify the modification of the current recommendations of the SENeo. However, some adjustments to the criteria of the existing recommendations are proposed to reduce the cost of the drug by its correct and judicious management

[Towards a safety culture in the neonatal unit: Six years experience]. / Caminando hacia una cultura de seguridad en la unidad neonatal: experiencia de 6 años.

INTRODUCTION: A safety culture is the collective effort of an institution to direct its resources toward the goal of safety. MATERIAL AND METHODS: An analysis is performed on the six years of experience of the Committee on the Safety of Neonatal Patient. A mailbox was created for the declaration of adverse events, and measures for their correction were devised, such as case studies, continuous education, prevention of nosocomial infections, as well as information on the work done and its assessment. RESULTS: A total of 1287 reports of adverse events were received during the six years, of which 600 (50.8%) occurred in the neonatal ICU, with 15 (1.2%) contributing to death, and 1282 (99.6%) considered preventable. Simple corrective measures (notification, security alerts, etc.) were applied in 559 (43.4%), intermediate measures (protocols, monthly newsletter, etc.) in 692 (53.8%), and more complex measures (causal analysis, scripts, continuous education seminars, prospective studies, etc.) in 66 (5.1%). As regards nosocomial infections, the prevention strategies implemented (hand washing, insertion and maintenance of catheters) directly affected their improvement. Two surveys were conducted to determine the level of satisfaction with the Committee on the Safety of Neonatal Patient. A rating 7.5/10 was obtained in the local survey, while using the Spanish version of the Hospital Survey on Patient Safety Culture the rate was 7.26/10. CONCLUSIONS: A path to a culture of safety has been successfully started and carried out. Reporting the adverse events is the key to obtaining information on their nature, etiology and evolution, and to undertake possible prevention strategies.

La Neonatología, primera Área de Capacitación Específica de la Pediatría en Espana / Neonatology, the First Specific Training Area of Paediatrics in Spain

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Atención del parto en el agua. Consenso de la Sociedad Española de Neonatología y de la Sección de Medicina Perinatal de la Sociedad Española de Obstetricia y Ginecología / Underwater delivery. Consensus of the Spanish Neonatology Society and the Perinatal Section of the Spanish Obstetrics and Gynecology Society

La atención del trabajo de parto en el agua como alternativa al parto tradicional es una práctica que se ha incrementado en muchos países. Se ha constatado que esta modalidad de parto es un método eficaz para disminuir el dolor y acortar el tiempo de dilatación. La American Academy of Pediatrics y The American College of Obstetricians and Gynecologists han publicado un informe clínico en el cual señalan los potenciales beneficios maternos durante la primera parte del parto pero ponen en entredicho la realización de esta técnica durante el expulsivo y el nacimiento del recién nacido. En este informe, la Sociedad Española de Neonatología y la Sociedad Española de Obstetricia y Ginecología analizan la evidencia científica disponible en la actualidad sobre la realización del parto bajo agua y el impacto que puede tener esta práctica en la madre y sobre todo en la salud del recién nacido

Immersion in water during labor and delivery as an alternative to traditional delivery is a practice that has increased in many countries. This technique is effective in reducinge pain and duration of labor. The American Academy of Pediatrics and The American College of Obstetricians and Gynecologists have published a clinical report which indicates the potential maternal benefits during the first stage of labor but, questions the performance ofthis technique during delivery and birth of the newborn. In this report, the Spanish Society of Neonatology and the Spanish Society of Obstetrics and Gynecology analyze the current scientific evidence on water immersion delivery, and the impact this practice could have in the mother and especially in the wellbeing of newborn

Fe de errores de "Morbimortalidad en recién nacidos al límite de la viabilidad en España: estudio de base poblacional" / Erratum of "Morbidity and mortality in newborns at the limit of viability in Spain: A population-based study"

No disponible

Fe de errores de 'Nuevas curvas poblacionales de crecimiento en recién nacidos extremadamente prematuros españoles' / Erratum of 'New population curves in spanish extremely preterm neonates'

No disponible

[Underwater delivery. Consensus of the Spanish Neonatology Society and the Perinatal Section of the Spanish Obstetrics and Gynecology Society]. / Atención del parto en el agua. Consenso de la Sociedad Española de Neonatología y de la Sección de Medicina Perinatal de la Sociedad Española de Obstetricia y Ginecología.

Immersion in water during labor and delivery as an alternative to traditional delivery is a practice that has increased in many countries. This technique is effective in reducing pain and duration of labor. The American Academy of Pediatrics and The American College of Obstetricians and Gynecologists have published a clinical report which indicates the potential maternal benefits during the first stage of labor but, questions the performance of this technique during delivery and birth of the newborn. In this report, the Spanish Society of Neonatology and the Spanish Society of Obstetrics and Gynecology analyze the current scientific evidence on water immersion delivery, and the impact this practice could have in the mother and especially in the wellbeing of newborn.

[Update of recommendations on the use of palivizumab as prophylaxis in RSV infections]. / Actualización de las recomendaciones de la Sociedad Española de Neonatología para la utilización del palivizumab como profilaxis de las infecciones graves por el virus respiratorio sincitial.

The Standards Committee of the Spanish Neonatology Society (SENeo) considers that the new document from the American Academy of Pediatrics, including recommendations for palivizumab use to prevent serious infections produced by the Respiratory Syncytial Virus (RSV), provides no new scientific evidence which would justify the modification of the current recommendations of the SENeo. However, some adjustments to the criteria of the existing recommendations are proposed to reduce the cost of the drug by its correct and judicious management.

Evolución del peso del prematuro con alta precoz y atención domiciliaria de enfermería / Influence of in-home nursing care on the weight of the early discharged preterm newborn

INTRODUCCIÓN: La atención domiciliaria de enfermería (ADE) del recién nacido prematuro próximo al alta en su propio domicilio en lugar del hospital normaliza la situación familiar, favorece la lactancia materna y el desarrollo del recién nacido y permite la reorganización de los recursos sanitarios. El propósito del presente trabajo es demostrar que el prematuro sometido al programa de ADE experimenta un aumento de peso superior en el domicilio respecto al hospital y no incrementa su morbilidad. Pacientes y metodología: Estudio comparativo de 65 casos y 65 controles (apareados por peso, edad y sexo), prematuros, de procedencia interna y con peso al alta inferior a 2.100 g. La ADE fue administrada por un pediatra neonatólogo y 2 enfermeras especializadas en neonatología dependientes de los servicios hospitalarios, que realizaron visitas seriadas a domicilio. El aumento de peso se calculó por g/día y g/kg/día, comparando la semana previa al inicio del estudio con la primera semana del estudio. RESULTADOS: Los grupos fueron comparables. El aumento de peso en el grupo con ADE fue de 38 g/día, significativamente superior al del grupo control (31 g/día). Las variables independientes predictoras del «aumento en g/kg/día durante el estudio» fueron la ADE, el sexo varón, tomar menos lactancia materna y no haber padecido una hemorragia peri-intraventricular. La morbilidad neonatal fue similar. CONCLUSIONES: La ADE implicó un mayor aumento de peso del recién nacido en casa que durante su permanencia en el hospital, y no aumentó la morbilidad neonatal

INTRODUCTION: In-Home nursing care of the preterm newborn helps to bring the family situation to normal, promotes breastfeeding and development of the newborn, and enables the reorganization of health care resources. The purpose of this paper is to demonstrate that in-home nursing care of the preterm newborn leads to an increase in weight and a similar morbidity. Patients and methodology: A total of 65 cases and 65 controls (matched by weight, age and sex) were studied, all of them preterm newborns born in hospital and weighing less than 2100 g at discharge. In-home nursing care was carried out by a pediatrician neonatologist, as well as two nurses specialized in neonatology who made several visits to the home. Weight gain was calculated as g/day and g/Kg/day, comparing the first week of the study with the week prior to the beginning of the study. RESULTS: The groups were comparable. Weight gain in the group with home nursing care was 38 g per day, significantly higher than the weight gain in the control group (31 g/day). The independent predictive variables of the increase in g/Kg/day during the study were in-home nursing care, male gender, breastfeeding less, and not having suffered from a peri-intraventricular hemorrhage. Neonatal morbidity was similar in both groups. CONCLUSIONS: In-home care was associated with a greater weight gain of the newborn at home than during their stay in the hospital, and can be considered safe because neonatal morbidity was not increased

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

INTRODUCCIÓN: La infección por citomegalovirus es una infección endémica y los niños que acuden a guardería constituyen el foco de infección más importante para las gestantes. OBJETIVO: Establecer una recomendación para el diagnóstico basada en la evidencia médica sobre la infección de trasmisión vertical por citomegalovirus en prematuros menores de 1.500g al nacer. ANTECEDENTES: La infección en la gestante puede ser primaria o secundaria. Aunque exista infección fetal, el 85% de los recién nacidos serán asintomáticos. Los síntomas de infección son: bajo peso al nacer, hepatoesplenomegalia, trombocitopenia, microcefalia y trastornos neurológicos. El pronóstico de los niños sintomáticos suele ser grave, con elevada mortalidad y secuelas neurológicas. El virus se puede reactivar durante la lactancia y es posible la infección precoz a través de la leche materna, probablemente con poca repercusión en niños a término, aunque en prematuros puede afectar al neurodesarrollo a largo plazo. El método diagnóstico de elección es la identificación del citomegalovirus en orina; la determinación en las 2 primeras semanas de vida indica infección congénita. Un diagnóstico posterior sugiere que puede haber sido adquirida en el parto o a través de la leche materna o transfusión de sangre contaminada. Conclusión y recomendación: Determinar el ADN viral por reacción en cadena de la polimerasa a las 4-6 semanas de vida. En caso positivo, investigar en muestras obtenidas los primeros días de vida y en leche materna. Ello debe permitir clasificar al recién nacido en 3 estados: «no infectado», «infección congénita» e «infección adquirida»

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»

Nuevas curvas poblacionales de crecimiento en recién nacidos extremadamente prematuros españoles / New population curves in spanish extremely preterm neonates

INTRODUCCIÓN: La mayoría de los datos antropométricos de referencia utilizados en nuestro país proceden de estudios llevados a cabo fuera del mismo hace muchos años, o bien están basados en datos de un único o pocos centros. Además, el número de recién nacidos extremadamente prematuros (RNEP) incluidos ha sido muy escaso. OBJETIVOS: Desarrollar unas tablas y gráficas de referencia poblacionales en nuestro país para el peso, la longitud y el perímetro craneal (PC), por edad gestacional y sexo, en RNEP de raza blanca procedentes de gestaciones únicas. PACIENTES Y MÉTODOS: Se incluyeron de todos los recién nacidos ≤ 28 semanas de EG, registrados sobre la base de los datos SEN1500 durante 10 años (2002-2011). La EG se estimó basándose en la ecografía fetal precoz o la fecha de la última regla. Los datos se analizaron mediante el paquete estadístico SPSS 20 y se crearon tablas percentiladas de referencia independientes para varones y mujeres, utilizando el método LMS de Cole y Green. RESULTADOS: Se presentan las primeras tablas y gráficas percentiladas con base poblacional en nuestro país de peso, longitud y PC en RNEP, incluyendo recién nacidos al límite de viabilidad. Se objetiva un dimorfismo sexual desde las 23 semanas de gestación. CONCLUSIONES: Estas nuevas referencias, específicas por sexo y de base poblacional, pueden ser útiles para mejorar la evaluación del crecimiento del prematuro extremo en nuestro país, así como para el desarrollo de estudios epidemiológicos, o evaluación de tendencias temporales y de intervenciones clínicas o de salud pública dirigidas a la optimización del crecimiento fetal. Un dimorfismo sexual es evidente desde etapas muy tempranas de la gestación

INTRODUCTION: Most anthropometric reference data for extremely preterm infants used in Spain are outdated and based on non-Spanish populations, or are derived from small hospital-based samples that failed to include neonates of borderline viability. OBJECTIVES: To develop gender-specific, population-based curves for birth weight, length, and head circumference in extremely preterm Caucasian infants, using a large contemporary sample size of Spanish singletons. PATIENTS AND METHODS: Anthropometric data from neonates ≤ 28 weeks of gestational age were collected between January 2002 and December 2010 using the Spanish database SEN1500. Gestational age was estimated according to obstetric data (early pregnancy ultrasound). The data were analyzed with the SPSS.20 package, and centile tables were created for males and females using the Cole and Green LMS method. RESULTS: This study presents the first population-based growth curves for extremely preterm infants, including those of borderline viability, in Spain. A sexual dimorphism is evident for all of the studied parameters, starting at early gestation. CONCLUSIONS: These new gender-specific and population-based data could be useful for the improvement of growth assessments of extremely preterm infants in our country, for the development of epidemiological studies, for the evaluation of temporal trends, and for clinical or public health interventions seeking to optimize fetal growth

Morbimortalidad en recién nacidos al límite de la viabilidad en España: estudio de base poblacional / Morbidity and mortality in newborns at the limit of viability in Spain: A population-based study

INTRODUCCIÓN: La asistencia perinatal a recién nacidos (RN) extremadamente inmaduros constituye un problema clínico y ético de gran trascendencia para profesionales y familias, y hace necesaria una información actualizada de la máxima calidad acerca de las posibilidades de supervivencia del niño. El objetivo de este estudio fue conocer las tasas específicas de supervivencia al alta hospitalaria y de supervivencia sin morbilidad mayor conocida en RN con una edad gestacional (EG) ≤ 26 semanas en España. PACIENTES Y MÉTODOS: Se incluyeron los RN vivos de ≤ 26 semanas que ingresaron en los centros colaboradores de la red SEN1500 (2004-2010). Se excluyeron los nacidos extramuros, los fallecidos en el paritorio y los que tenían malformaciones incompatibles con la vida. RESULTADOS: En total 3.236 pacientes fueron incluidos. La supervivencia específica por EG fue de 12,5, 13,1, 36,9, 55,7 y 71,9% a las 22, 23, 24, 25 y 26 semanas de EG, respectivamente. La supervivencia sin hemorragia intracraneal grave, leucomalacia periventricular, displasia broncopulmonar y/o retinopatía de la prematuridad fue del 1,5, 9,5, 19,0 y 29,9% a las 23, 24, 25 y 26 semanas, respectivamente. CONCLUSIONES: La supervivencia sin morbilidad mayor en menores de 23 semanas de EG es excepcional, y en RN de 23 y 24 semanas, muy baja. Los RN ≥ 25 semanas de EG tienen posibilidades razonables de supervivencia y, en ausencia de malformaciones mayores u otras complicaciones relevantes, se les debería ofrecer reanimación activa y cuidados intensivos. Es fundamental la actualización continua de los datos propios de cada centro y su comparación con los resultados poblacionales de referencia

INTRODUCTION: Perinatal care in extremely immature newborns is a clinical and ethical problem of great importance for professionals and families, and requires that the available information on the chances of child survival is of the highest quality. The aim of this study was to determine the specific rates of survival at hospital discharge, and survival without major morbidity in newborns with a gestation age (GA) ≤26 weeks in Spain. PATIENTS AND METHODS: We included live newborns≤26 weeks admitted to the collaborating centers of the SEN1500 network (2004-2010). Out born patients, infants who died in delivery room, and those with congenital anomalies incompatible with life were excluded. RESULTS: A total of 3,236 patients were included. GA specific survival was 12.5, 13.1, 36.9,55.7, and 71.9% at 22, 23, 24, 25, and 26 weeks of GA, respectively. Survival without severe intracranial hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, and/or retinopathy of prematurity was 1.5, 9.5, 19.0, and 29.9% at 23, 24, 25 and 26 weeks GA, respectively .CONCLUSIONS: Survival without major morbidity in infants less than 23 weeks GA is exceptional, and scarce in newborns with 23 and 24 weeks GA. Infants ≥25 weeks GA have reasonable chances of survival and, in the absence of major malformations or other relevant complications, should be offered active resuscitation and intensive care. The continuous updating of the results of individual centers is of utmost importance, as well as their comparison with the reference population-based results

[Influence of in-home nursing care on the weight of the early discharged preterm newborn]. / Evolución del peso del prematuro con alta precoz y atención domiciliaria de enfermería.

INTRODUCTION: In-Home nursing care of the preterm newborn helps to bring the family situation to normal, promotes breastfeeding and development of the newborn, and enables the reorganization of health care resources. The purpose of this paper is to demonstrate that in-home nursing care of the preterm newborn leads to an increase in weight and a similar morbidity. PATIENTS AND METHODOLOGY: A total of 65 cases and 65 controls (matched by weight, age and sex) were studied, all of them preterm newborns born in hospital and weighing less than 2100 g at discharge. In-home nursing care was carried out by a pediatrician neonatologist, as well as two nurses specialized in neonatology who made several visits to the home. Weight gain was calculated as g/day and g/Kg/day, comparing the first week of the study with the week prior to the beginning of the study. RESULTS: The groups were comparable. Weight gain in the group with home nursing care was 38 g per day, significantly higher than the weight gain in the control group (31 g/day). The independent predictive variables of the increase in g/Kg/day during the study were in-home nursing care, male gender, breastfeeding less, and not having suffered from a peri-intraventricular hemorrhage. Neonatal morbidity was similar in both groups. CONCLUSIONS: In-home care was associated with a greater weight gain of the newborn at home than during their stay in the hospital, and can be considered safe because neonatal morbidity was not increased.