El colecho favorece la práctica de la lactancia materna y no aumenta el riesgo de muerte súbita del lactante. Dormir con los padres / Bed-sharing favours the practice of breastfeeding and does not increase the risk of sudden infant death syndrome. Sleeping with parents

La práctica de los padres de dormir junto a sus hijos ha sido una constante en la humanidad. Con el aumento en la prevalencia y duración de la lactancia materna, se ha observado paralelamente un aumento de esa práctica, que posiblemente se dé con más frecuencia que la reconocida en las encuestas. Los estudios han demostrado interrelación y mutua potenciación entre lactancia materna y colecho. Las asociaciones y organizaciones pediátricas recomiendan evitar el colecho, por relacionarlo con la muerte súbita del lactante. Se basan, sin embargo, en estudios en su mayoría no controlados, bajo la influencia de factores de riesgo no tenidos en cuenta. Los autores, tras una revisión exhaustiva sobre colecho, lactancia y muerte súbita del lactante, encuentran el colecho como una práctica beneficiosa para la lactancia y concluyen que, bien practicado, evitando factores de riesgo, no guarda relación con la muerte súbita del lactante (AU)

The practice of bed-sharing by parents and their offspring has been a common behaviour among humans. In parallel with the increase of breastfeeding rates, a higher frequency of bed-sharing has been observed worldwide. And, it is probable that it occurs more frequently than what appears reflected in surveys. There seems to be an interrelated and mutually enhanced effect between breastfeeding and bed-sharing. Pediatric associations and health organizations have warned against the practice of bed-sharing based on studies that describe a link between this practice and Sudden Infant Death Syndrome (SIDS). However, many were non-controlled studies that did not include other potentially risky circumstances. After a thoroughly review of the available literature, the authors have found the practice of bed-sharing to be of benefit on the basis of a warm and close-up infant care approach and calls for recognition and avoidance of risky situations that could represent a threat for infant life (AU)

Uso del chupete y lactancia materna / Use of pacifiers and breastfeeding

El uso del chupete se encuentra muy arraigado en las sociedades desarrolladas, ya que calma el llanto del bebé, ayuda a conciliar el sueño, y reduce el estrés y el dolor en procedimientos desagradables. Su uso se ha relacionado con una menor duración y exclusividad de la lactancia materna, aumento de otitis media, problemas dentales y riesgo de accidentes. Además, estudios recientes relacionan su uso, particularmente durante el sueño, con disminución del riesgo de muerte súbita del lactante. Otros beneficios demostrados son su efecto analgésico y el estímulo de la succión no nutritiva en niños pretérmino y a término. El debate sobre su utilización o no es actualmente motivo de controversia, pero es importante que los profesionales de la salud y los padres conozcan los riesgos y beneficios que conlleva el uso del chupete. Dada la controversia actual, el Comité de Lactancia Materna de la Asociación Española de Pediatría ha realizado, a la luz de las pruebas disponibles actualmente, una revisión del tema en relación con la lactancia materna (AU)

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant is sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breast feeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant (AU)

[Use of pacifiers and breastfeeding]. / Uso del chupete y lactancia materna.

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant́s sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breastfeeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant.

El método de la madre canguro / Kangaroo mother care

Desde hace tiempo, las unidades de neonatología están tratando de introducir los cuidados centrados en el desarrollo, que pretenden mejorar el desarrollo del prematuro a través de intervenciones especiales, entendiendo al recién nacido y a su familia como una unidad. En estos cuidados se incluye el método de la madre canguro (MMC), que se define como el contacto piel con piel entre la madre y el niño prematuro de la forma más precoz, continua y prolongada posible con lactancia materna, para que ambos se beneficien de sus ventajas. El MMC debería ofrecerse a todos los niños prematuros o recién nacidos a término enfermos como una alternativa al cuidado en la incubadora, dado que es efectivo para el control de la temperatura, reduce el riesgo de infecciones y de episodios de apnea, favorece la lactancia materna, permite y fortalece la vinculación madre/padre-hijo, devuelve a los padres el protagonismo del cuidado de sus hijos y reduce la estancia hospitalaria

Developmental care was introduced in many neonatal care units some time ago. The aim of this initiative is to improve preterm outcomes through comprehensive interventions that consider the newborn infant and his or her family as a closed unit. Kangaroo mother care, which is included among these interventions, is defined as mother and infant skin-to-skin contact as early as possible, as continuously as possible and as long as possible, together with breastfeeding, which will benefit both mother and infant. Kangaroo mother care should be offered to all preterm or sick newborns as an alternative to care in an incubator as it is effective in terms of temperature control, reduces the risk of infections and episodes of apnea, favors breastfeeding, enables and strengthens mother/fatherinfant bonding, restores the predominant role of the family in infant care and reduces hospital stays

Colitis eosinofílica y lactancia materna / Eosinophilic colitis and breast feeding

No disponible

Efficacy of bronchodilators administered by nebulizers versus spacer devices in infants with acute wheezing.

The aim of this study was to compare the response of infants with acute wheezing to treatments with inhaled terbutaline when administered by nebulizer or by metered-dose inhaler and spacer device (MDI-spacer). Thirty-four infants between the ages of 1 and 24 months who were seen in our emergency department for acute wheezing were studied in a double-blind, randomized trial. The participants received two treatments of terbutaline at 20-min intervals, either by a nebulizer (2 mg/dose in 2.8 mL of 0.9% saline solution) or by an MDI-spacer device (0.5 mg/dose). The outcome measure was a clinical score, based on respiratory rate, degree of wheezing, retractions, degree of cyanosis, color, and pulse oximetry data measured before treatment, 20 min after the first treatment, and again 20 min after the second treatment. There was no difference in the rate of improvement in the clinical score between infants who received terbutaline by nebulizer and those who received it by MDI-spacer. We conclude that MDI-spacers and nebulizers are equally effective means of delivering beta-2 agonists to infants and small children with acute wheezing.

[Kangaroo method in delivery room for full-term babies]. / Método canguro en sala de partos en recién nacidos a término.

OBJECTIVE: Our objective was to determine the tolerance to kangaroo care in the delivery room. PATIENTS AND METHODS: We have studied 651 normal full term newborn infants delivered in our hospital during an 8 month period. Immediately after birth, the newborn infants were dried and placed in skin-to-skin contact between their mother's breasts. They remained in kangaroo care in the delivery room, during transportation to the post-partum area and in their room as long as two hours. The kangaroo care duration, the infant's post-kangaroo care axillary temperature, the mother's and infant's attitudes and the type of newborn feeding were recorded. RESULTS: Of the patients studied, 533 (82%) were put in skin-to-skin contact and the kangaroo care lasted 49 +/- 23 min (mean +/- SD). Eighty-percent of the mothers had decided previously to breastfeed their child. The post-kangaroo care axillary temperature was > or = 36 degrees C in 96% of the newborns and it was proportional to the kangaroo care duration (r = 0.31, p < 0.0001; IC 95%; beta = 0.0038-0.0068). During kangaroo care, most of the mothers looked at their child and were happy, although 21% felt tired. Almost all infants (98.5%) stayed awake. The newborn infants who spontaneously did the first breastfeeding during the skin-to-skin contact remained more time in kangaroo care (60 +/- 22 vs 36 +/- 17 minutes; p < 0.0001). If the infant remained more than 50 minutes in kangaroo care, he had nearly 8 times more probability of breastfeeding spontaneously (odds ratio = 7.73; IC 95%: OR = 4.02-15.1). CONCLUSIONS: We recommend kangaroo care in the delivery room as a safe and well tolerated method for mothers and newborn infants which contributes to their well-being. In order to improve breastfeeding and the newborn's temperature, we recommend that the infant remains more than 50 minutes in kangaroo care.

["Kangaroo method" in the care of premature infants admitted to a neonatal intensive care unit]. / Método canguro en recién nacidos prematuros ingresados en una Unidad de Cuidados Intensivos Neonatal.

OBJECTIVE: More and progressively smaller preterm infants are taken out of the incubator and placed skin-to-skin (kangaroo care) on their mother's chest to promote bonding and breastfeeding. The aim of our study was to know the tolerance to kangaroo care and its security for preterm infants and their mothers, as well as its relationship to breastfeeding. PATIENTS AND METHODS: We studied 445 sessions of 38 stable preterm newborns in our Neonatal Intensive Care Unit (NICU). Their mean birth weight was 1,452 +/- 415 g and gestational age 31.5 +/- 2 weeks (mean +/- SD). The preterm infants, dressed in a diaper and cotton cap, were placed in skin-to-skin contact between their mother's breasts in an upright position and covered with a towel. The kangaroo care duration, temperature, heart rate, respiratory rate, StcO2, and the mother and infant behavioral responses were recorded. During kangaroo care, the preterm infants were nourished by their mother's milk directly by breastfeeding or by intermittent tube feeding, depending on their sucking reflex. The kangaroo care lasted 30-90 minutes, one to eight times a day depending on the availability of the mother. RESULTS: During the kangaroo care, body temperatures, heart rate, respiratory rate and StcO2 remained stable. In the majority of cases, In the majority of cases, the preterm infants showed conduct patterns that indicated good tolerance toward this method, including open hand, sleeping, alert tranquility and even smiles. The breastfeeding sessions were longer than normal because the premature infants alternated short periods of sucking with longer sleep periods. Mothers participated actively looking, talking, touching, smiling and even playing with their preterm infants. CONCLUSIONS: Kangaroo care is a safe and well-accepted method for preterm infants admitted to a NICU and their mothers. Intermittent kangaroo care does not allow for breastfeeding by demand, therefore with the smallest preterm infants, we are obligated to supplement feeding with the mother's milk by tube gavage.

[Pulmonary complications during parenteral feeding via percutaneous silicon catheters]. / Complicaciones pulmonares durante la nutrición parenteral con catéteres siliconados percutáneos.

Percutaneous fine bore silicone central catheters are frequently used in sick full term newborns and in low birth weight premature infants; although their use has some risks. We report two cases of pleural effusion in two prematures of 34 and 33 weeks gestation and birth weight of 1,510 and 1,650 g, respectively; and one case neumonitis in a newborn of a 38 weeks gestation and 2,730 g birth weight. All of them have in common same initial clinical sign: increase mucus secretion of the upper airway a few hours after the beginning of parenteral nutrition using the type of catheter mentioned with the tip abnormally located in pulmonary artery. These complications are probably related to endothelial injury of very slow flow vessels due to the high osmolarity and low pH of the parenteral solutions used; which probably, in turn, produce thrombosis and vascular perforation, and/or extravasation. We suggest to suspect a pulmonary artery abnormally located catheter in patients receiving parenteral nutrition who increase upper airway mucus secretion. The rapid correction of the position would prevent major complications.

[Occult bacteremia at a pediatric emergency clinic]. / Bacteriemia oculta en un servicio de urgencias pediátricas.

In order to known the incidence of unsuspected bacteremia in our area and to determine the usefulness of the laboratory tests to identify children with such pathology, a prospective study was designed including 61 infants between 3 and 24 months of age admitted to our emergency room with fever of 39 degrees centigrade or more, without apparent focality or respiratory symptoms. All underwent blood culture, complete blood count and C-reactive protein plasma levels determination. No positive blood cultures were obtained. The relation bands/total neutrophils greater than 0.15 with leucocytosis or neutrophilia was not found in any child, and leucopenia was found in only one. We conclude that occult bacteremia is not present in our milieu amongst children who fit into the risk factor criteria defined by TEELE et al. and that it might be convenient to include a fever of less than 24 hours as a risk factor in order to exclude many children with fever and a clear focality.

[Monitoring theophylline in premature newborn infants]. / Monitorización de la teofilina en el recién nacido prematuro.

In order to defined the PO theophylline dose which produced effective theophylline concentrations between 4-10 micrograms/ml in prematures babies, we analized the theophylline pharmacokinetic of 6 adequate weight for gestational age female prematures, aged 31-34 gestational weeks, to which we administered PO 5 mg/kg of theophylline as the attack dose, following by a PO maintained dose of 2.5 mg/kg/12 h. In steady-state we did the pharmacokinetic studies after the administration of one dose. We found that only maintenance doses of 2.5 mg/kg/12 h produced therapeutic theophylline concentrations. Considering the pharmacokinetic data, we conclude that PO maintenance dose of 3 mg/kg/12 h of theophylline will be necessary to reach effective theophylline concentration.

[Pharmacokinetics of theophylline in children with acute asthmatic crisis]. / Farmacocinética de la teofilina en niños con crisis asmática aguda.

In order to defined the theophylline dose which produce effective theophylline concentrations with less number of plasmatic controls, we analyzed the theophylline pharmacokinetics of 18 boys and girls between 3-12 year olds of Tarragona, to which we administered 6 mg/kg/6 h of aminophylline by IV intermittent infusion (30 min), following by rapid-release PO aminophylline at the same dose and intervals. In steady-state we did the pharmacokinetic studies at 1 h, 4 h and 6 h after the administration of one dose. The maintenance dose obtained was administered PO as slow-release theophylline, with later controls of theophylline concentration. We found that maintenance dose of 24.1 +/- 4.7 mg/kg/day (mean +/- SD) allowed theophylline concentration between therapeutic levels in the population studied.