Morbimortalidad en recién nacidos con una edad gestacional igual o inferior a 26 semanas: estudio de los límites de viabilidad en nuestro medio / Morbidity and mortality in newborns with gestational age of 26 or less: study of the limits of viability in our setting

Introducción: La toma de decisiones acerca de los cuidados perinatales en fetos y recién nacidos (RN) al límite de la viabilidad continúa siendo un problema clínico y ético de la máxima envergadura para obstetras y neonatólogos. La inclusión de los padres en el proceso de toma de decisiones exige que la información proporcionada esté basada en los mejores datos disponibles. El objetivo de nuestro estudio fue conocer las tasas específicas de supervivencia al alta y de supervivencia sin morbilidad mayor, por edad gestacional (EG), en RN ≤26 semanas. Pacientes y métodos: Durante el periodo 2004-2010 se recogieron datos de todos los RN vivos (RNV) intramuros, de ≤26 semanas de EG. Se estudiaron los datos demográficos, de intervenciones y los resultados en morbimortalidad específica por EG. Resultados: Se incluyeron 137 RNV con una EG ≤26 semanas, de los que 8 fallecieron en la sala de partos. Entre los 129 ingresados en la unidad de cuidados intensivos neonatales, la supervivencia se incrementó progresivamente en función de la EG desde el 30,4% a las 24 semanas hasta el 64,7% a las 26 semanas. Asimismo, la supervivencia sin morbilidad mayor se incrementó desde el 4,3 al 25,9% en dichas EG. La mediana (rango intercuartílico) de la estancia hospitalaria en los supervivientes fue de 90 (76,5-113) días, y en los que fallecieron de 8 (3-21,5) días. Conclusiones: La supervivencia y la supervivencia sin morbilidad mayor aumentan significativamente con la EG en RN al límite de la viabilidad. Estos resultados, específicos por EG, aportan una información relevante para la toma de decisiones asistenciales e indican el potencial impacto en la gestión de recursos sanitarios (AU)

Introduction: Decision-making about perinatal care in fetuses and newborns at the limit of viability remains an important clinical and ethical problem for obstetricians and neonatologists. The inclusion of parents in the decision-making process requires that the information provided be based on the best available data. The aim of our study was to determine the specific rates, by GA, of survival and survival without major morbidity at hospital discharge in infants of ≤26 weeks of gestational age (GA). Patients and methods: During the period 2004-2010, data were collected from all live inborn infants ≤26 weeks GA, who did not die in the delivery room, and that were admitted for intensive care. We studied demographics data, interventions and morbidity and mortality by GA. Results: We included 137 live born infants ≤26 weeks GA, of which 8 died in delivery room. Among the 129 admitted to NICU, survival increased progressively as a function of the GA, from 30.4% at 24 weeks to 64.7% at 26 weeks. Likewise, survival without major morbidity increased from 4.3 to 25.9% in these GA. The average length of stay at discharge in survivors decreased significantly with increasing GA, with a median (IQR) of 90 (76.5-113) days. In non-survivors, the median (IQR) at death was 8 (3-21.5) days. Conclusions: Survival and survival without major morbidity increase significantly with increasing GA in infants at the limit of viability. These results, specific by GA, provide relevant information for health care decision-making, and highlight the potential impact on the management of health resources (AU)

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"

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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

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

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.

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

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.

[Effect of hygiene interventions on the thermal stability of extremely low-birth-weight newborns in the first two weeks of life]. / Repercusión del aseo en la estabilidad térmica del recién nacido de extremado bajo peso durante las primeras dos semanas de vida.

INTRODUCTION: A prospective study was performed of a cohort of extremely low-birth-weight (ELBW) premature neonates (birth weight 500 to 1,000 g) consecutively admitted to the neonatal intensive care unit. The aim of this study was to examine the thermal changes that occur during all the hygiene-related interventions in ELBW infants in the first 2 weeks of life. PATIENTS AND METHODS: The study was carried out for 10 consecutive months in the Neonatology Service of La Paz University Hospital. We studied all consecutively admitted ELBW infants who satisfied the following criteria: a) adequate weight for gestational age; b) survival for at least 1 week, and c) no major congenital malformations or dysmorphic features. The infants included in the study were managed according to a standard care protocol for maintaining thermal stability and preventing cold-induced stress. Central temperature (Tc) was measured in the axilla and peripheral temperature (Tp) was measured on the sole of the foot. Both temperatures were continuously monitored for a) a period of scheduled non-handling--baseline period--and b) during and after a series of "hygiene interventions". In each of these periods, Tc and Tp were continuously monitored and recorded at 10 min intervals for the first 30 minutes and then at 30 min intervals until completing a 180 min period. RESULTS: Although incubator temperature was raised by a mean of 3 degrees C during hygiene interventions, hygiene was accompanied by a change in body temperature that remained fairly constant throughout the study period; Tc and Tp decreased by a mean of 1 degrees C with respect to baseline temperature. A fall in axillary temperature to less than 36.5 degrees C was observed in 87.4 % of recordings and a fall to less than 36 degrees C was observed in 45.5 %; axillary temperature remained below 36.5 degrees C for a mean duration of almost 1 hour. The differential temperature (Td 5 Tc - Tp), an indicator of thermal stress, was more than 1 degrees C for a mean duration of more than 80 min and > 2 degrees C for more than 20 minutes in both the first and second weeks of life. CONCLUSIONS: During hygiene interventions, ELBW infants experienced a sharp fall in central and peripheral body temperature. After hygiene interventions, these neonates had a Td suggestive of prolonged thermal stress, despite the use of standardized care protocols designed to avoid or minimize the potential effects of hygiene interventions on neonatal temperature.

Estado fetal no tranquilizador, asfixia perinatal y encefalopatía neonatal / Nonreassuring fetal status, perinatal asphyxia and neonatal encephalopathy

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Repercusión del aseo en la estabilidad térmica del recién nacido de extremado bajo peso durante las primeras dos semanas de vida / Effect of hygiene interventions on the thermal stability of extremely low-birth-weight newborns in the first two weeks of life

El objetivo del estudio fue examinar los cambios térmicos que tienen lugar durante un conjunto de acciones agrupadas en relación con el aseo corporal en los RNEBP durante las primeras 2 semanas de vida. Pacientes y métodos. El estudio se realizó durante 10 meses consecutivos en el Servicio de Neonatología del Hospital Universitario La Paz. Se estudiaron todos los RNEBP ingresados consecutivamente que cumplieron los siguientes criterios: a) peso adecuado a la edad gestacional; b) sobrevivir al menos una semana, y c) no presentar malformaciones congénitas mayores o rasgos dismórficos. Los niños incluidos en el estudio fueron manejados según los protocolos de cuidado estándar dirigidos a mantener la estabilidad térmica y evitar el estrés por frío. La temperatura central (Tc) se midió en el hueco axilar y la periférica (Tp) en la planta de un pie. Ambas temperaturas se monitorizaron de forma continua durante: a) un período de no manipulación programada (período basal), y b) durante y después de un conjunto de intervenciones agrupadas que denominamos "aseo". Durante ambos períodos se monitorizaron de forma continua la Tc y la Tp, registrándose a intervalos de 10 min durante los primeros 30 min y posteriormente cada 30 min hasta completar un período de registro de 180 min. Resultados. A pesar que durante el aseo la temperatura de la incubadora se incrementó casi 3 °C por término medio, el aseo conllevó un patrón de cambio en la temperatura corporal similar durante todo el período de estudio; la Tc y la Tp descendieron aproximadamente 1 °C por término medio respecto a la temperatura basal. Se observó una caída de la temperatura axilar por debajo de 36,5 °C en el 87,4 % de los registros y por debajo de 36 °C en el 45,5 % y la temperatura axilar permaneció inferior a 36,5 °C durante prácticamente una hora por término medio. Además, la temperatura diferencial (Td 5 Tc ­ Tp), un indicador de estrés térmico, fue superior a 1 °C durante más de 80 min y a 2 °C durante más de 20 min por término medio, tanto en la primera como en la segunda semana de vida. Conclusiones. Durante el aseo de los RNEBP tiene lugar un marcado descenso de la temperatura corporal, tanto central como periférica. Tras el aseo, estos recién nacidos presentan una Td indicativa de estrés térmico, durante períodos prolongados. Estos cambios térmicos tienen lugar aun siguiendo protocolos de aseo estandarizados dirigidos a evitar o aminorar la potencial repercusión de este en la temperatura del recién nacido

Introduction. A prospective study was performed of a cohort of extremely low-birth-weight (ELBW) premature neonates (birth weight 500 to 1,000 g) consecutively admitted to the neonatal intensive care unit. The aim of this study was to examine the thermal changes that occur during all the hygiene-related interventions in ELBW infants in the first 2 weeks of life. Patients and methods. The study was carried out for 10 consecutive months in the Neonatology Service of La Paz University Hospital. We studied all consecutively admitted ELBW infants who satisfied the following criteria: a) adequate weight for gestational age; b) survival for at least 1 week, and c) no major congenital malformations or dysmorphic features. The infants included in the study were managed according to a standard care protocol for maintaining thermal stability and preventing cold-induced stress. Central temperature (Tc) was measured in the axilla and peripheral temperature (Tp) was measured on the sole of the foot. Both temperatures were continuously monitored for a) a period of scheduled non-handling ­baseline period­ and b) during and after a series of "hygiene interventions". In each of these periods, Tc and Tp were continuously monitored and recorded at 10 min intervals for the first 30 minutes and then at 30 min intervals until completing a 180 min period. Results. Although incubator temperature was raised by a mean of 3 °C during hygiene interventions, hygiene was accompanied by a change in body temperature that remained fairly constant throughout the study period; Tc and Tp decreased by a mean of 1 °C with respect to baseline temperature. A fall in axillary temperature to less than 36.5 °C was observed in 87.4 % of recordings and a fall to less than 36 °C was observed in 45.5 %; axillary temperature remained below 36.5 °C for a mean duration of almost 1 hour. The differential temperature (Td 5 Tc ­ Tp), an indicator of thermal stress, was more than 1 °C for a mean duration of more than 80 min and > 2 °C for more than 20 minutes in both the first and second weeks of life. Conclusions. During hygiene interventions, ELBW infants experienced a sharp fall in central and peripheral body temperature. After hygiene interventions, these neonates had a Td suggestive of prolonged thermal stress, despite the use of standardized care protocols designed to avoid or minimize the potential effects of hygiene interventions on neonatal temperature

[The skin as an expression of neurological alterations in the neonate]. / La piel como expresión de alteraciones neurológicas en el recién nacido.

The skin is involved in many different genetic syndromes and diseases with multiple organ involvement. Neurodevelopmental disorders appear in many of these entities and knowledge of these cutaneous alterations may provide clues to their diagnosis. Recognizing these skin disorders in the newborn allows early identification of neonates with a biological risk of epilepsy and motor and/or cognitive disorders and enables them to be followed up. This helps to plan the management of these patients and, in many entities, to predict their natural history and provide genetic counseling to the family. This review examines the cutaneous signs that may provide important clues in the neonate that help to identify entities that carry a risk of neurodevelopmental disorders in the neonate.

La piel como expresión de alteraciones neurológicas en el recién nacido / The skin as an expression of neurological alterations in the neonate

La alteración de la piel forma parte de diferentes síndromes genéticos y de enfermedades con afectación multiorgánica. Muchas de estas entidades cursan con alteración del neurodesarrollo y la piel constituye una importante pista para el diagnóstico de estas entidades nosológicas. El reconocimiento en el recién nacido de los trastornos cutáneos asociados a alteraciones del SNC permite: a) identificar precozmente una población de recién nacidos con riesgo biológico de epilepsia y de trastorno motor y/o cognitivo; b) incluir a estos recién nacidos en programas de seguimiento, formular planes de tratamiento y/o intervenciones terapéuticas, y c) en muchas entidades predecir la historia natural del trastorno y aportar consejo genético a la familia. Esta revisión examina los signos cutáneos que pueden aportar importantes pistas en el recién nacido para el reconocimiento de entidades con riesgo de trastorno del desarrollo neuroevolutivo en el neonato

The skin is involved in many different genetic syndromes and diseases with multiple organ involvement. Neurodevelopmental disorders appear in many of these entities and knowledge of these cutaneus alterations may provide clues to their diagnosis. Recognizing these skin disorders in the newborn allows early identification of neonates with a biological risk of epilepsy and motor and/or cognitive disorders and enables them to be followed up. This helps to plan the management of these patients and, in many entities, to predict their natural history and provide genetic counseling to the family. This review examines the cutaneus signs that may provide important clues in the neonate that help to identify entities that carry a risk of neurodevelopmental disorders in the neonate

[Morbidity at 2 years in infants with a birth weight of < 1,500 g]. / Morbilidad a los dos años de edad en niños con un peso al nacimiento menor de 1.500 g.

OBJECTIVES: To determine morbidity at 2 years' corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid. PATIENTS AND METHODS: An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87%) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient. RESULTS: Among the patients initially included in the study, 87% completed the follow-up; 17.1% had one or more major sequela. We found one case (0.4%) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9% had a development quotient below 85 and 18% had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of 2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings. CONCLUSIONS: Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years' corrected age.

Morbilidad a los dos años de edad en niños con un peso al nacimiento menor de 1.500 g / Morbidity at 2 years in infants with a birth weight of < 1.500 g

Objetivos: Conocer la morbilidad a los 2 años de edad corregida de una cohorte de recién nacidos con un peso inferior a1.500 g durante los años 1999-2000 en un hospital terciario de la Comunidad de Madrid. Pacientes y métodos: Estudio observacional de seguimiento longitudinal de una cohorte de 213 pacientes con peso inferior a 1.500 g al nacimiento. De éstos, 188 (87 %) finalizaron el seguimiento completo a los 2 años. Se estudiaron de forma prospectiva las diferentes morbilidades neurosensoriales, prestando especial atención a las morbilidades mayores: oftalmológicas, auditivas, motoras y bajo cociente de desarrollo (CD). Resultados: Completaron el seguimiento el 87 % de los pacientes incluidos inicialmente en el estudio; el 17,1 % presentaron una o más secuelas mayores. Encontramos un caso (0,4%) de sordera neurosensorial bilateral y un caso de ceguera bilateral; el 5,8 % (11/188) de los niños presentaron alguna forma de parálisis cerebral y un 14,9 % tuvieron un CD < 85 a los 2 años de edad. El 18 % no había alcanzado el percentil 3 (P3) de peso a los 2 años de seguimiento. Hallamos, como factores de mal pronóstico neurológico la microcefalia a los 2 años de edad y la aparición de lesiones de sustancia blanca (incluyendo la hiperecogenicidad periventricular persistente y ventriculomegalia de bordes irregulares) como alteraciones ecográficas. Conclusiones: Menos de una quinta parte de los recién nacidos de muy bajo peso (RNMBP) presentan alguna secuela grave a los 2 años de seguimiento. Encontramos como factores de mal pronóstico neurológico la microcefalia a los 2 años de edad corregida y la presencia de alteración de la sustancia blanca en los hallazgos ecográficos. Nos preocupan los datos de crecimiento y desarrollo, puesto que el 18 % de los pacientes no han alcanzado el P3 de peso a los 2 años de edad corregida (AU)

Objectives: To determine morbidity at 2 years’ corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid. Patients and methods: An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87 %) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient. Results: Among the patients initially included in the study, 87%completed the follow-up; 17.1 % had one or more major sequela. We found one case (0.4 %) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9%had a development quotient below 85 and 18 % had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings. Conclusions: Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years’ corrected age (AU)

Daño de la sustancia blanca en el recién nacido prematuro y morbilidad neurológica: algo más que una interrupción de fibras / Injury to the white matter in the premature newborn and neurological morbidity; something more than an interruption of fibers

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Diagnóstico de miastenia grave neonatal transitoria a la cabecera del paciente / Bedside diagnosis of transiest neonatal myasthenia gravis

El diagnóstico de miastenia grave en el periodo neonatal es un hecho infrecuente. Los antecedentes familiares y el examen clínico deben orientar a la realización de un test farmacológico anticolinesterasa, mediante el cual se consiguen cambios en la expresión facial y la conducta motora del paciente que permiten establecer finalmente el diagnóstico. Este tipo de iconografía no es frecuente en la bibliografía (AU)