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)

La ventilación asistida ajustada neuralmente incrementa la variabilidad respiración a respiración y mejora la sincronización paciente-ventilador / Neurally adjusted ventilatory assist increases respiratory variability and improves patient-ventilator synchronisation

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El paracetamol podría ser útil en el tratamiento del ductus arterioso persistente en el recién nacido de muy bajo peso / Paracetamol could be useful in the treatment of patent ductus arteriosus in the very-low-birth-weight infant

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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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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'

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La ventilación ajustada neuralmente es eficaz en el destete y la extubación del recién nacido prematuro / Successful weaning and extubation in the premature newborn using neurally adjusted ventilatory assist

La asistencia respiratoria al recién nacido prematuro puede asociarse a complicaciones locales y sistémicas producto del traumatismo mecánico a los tejidos y la respuesta inflamatoria que en ellos se desencadena. Un objetivo fundamental, por tanto, es reducir su duración y efectos adversos. La ventilación ajustada neuralmente (NAVA), al mejorar la sincronización entre paciente y máquina, y optimizar los volúmenes de gas entregados a las necesidades de aquel, podría ser una herramienta fundamental en la consecución de dicho objetivo. Presentamos 2 casos de pacientes prematuros con síndrome de distrés respiratorio grave que pudieron ser satisfactoriamente destetados y extubados con esta modalidad asistencial. Nuevos estudios son necesarios para evaluar si los beneficios inmediatos se reflejan en mejores resultados a largo plazo

Invasive and non-invasive ventilation of the preterm newborn may be associated with local and systemic complications due to mechanical trauma to lung tissues and their inflammatory response. A key objective of any type of mechanical ventilation, therefore, is to reduce its duration and the side effects related to it. Neurally Adjusted Ventilatory Assist (NAVA) may improve synchronization between patient and ventilator and optimize the gas volume delivered to the lungs, according to the patient needs, eventually reducing volu- and biotrauma. Two preterm babies with severe respiratory distress syndrome are presented, who were successfully weaned and extubated with the help of this ventilatory system. Further studies are needed to assess whether short-term benefits are reflected in better outcomes in the long run

[Successful weaning and extubation in the premature newborn using neurally adjusted ventilatory assist]. / La ventilación ajustada neuralmente es eficaz en el destete y la extubación del recién nacido prematuro.

Invasive and non-invasive ventilation of the preterm newborn may be associated with local and systemic complications due to mechanical trauma to lung tissues and their inflammatory response. A key objective of any type of mechanical ventilation, therefore, is to reduce its duration and the side effects related to it. Neurally Adjusted Ventilatory Assist (NAVA) may improve synchronization between patient and ventilator and optimize the gas volume delivered to the lungs, according to the patient needs, eventually reducing volu- and biotrauma. Two preterm babies with severe respiratory distress syndrome are presented, who were successfully weaned and extubated with the help of this ventilatory system. Further studies are needed to assess whether short-term benefits are reflected in better outcomes in the long run.

Desacuerdos en la relación clínica y proceso de toma de decisiones / Disagreements in the clinical relationship and the decision-making process

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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

Influencia de la edad gestacional, el tipo de parto y la reanimación en el riesgo de neumotórax en neonatos mayores de 37 semanas / Influence of gestational age, type of delivery, and resuscitation, on the incidence of pneumothorax in term neonates

INTRODUCCIÓN: La cesárea electiva antes de las 39 semanas de edad gestacional (EG) se ha asociado a un incremento en la incidencia de distrés respiratorio iatrogénico y de neumotórax en el recién nacido a término (RNT), probablemente en relación con una mayor morbilidad respiratoria y necesidad de reanimación. Estos aspectos no han sido evaluados sistemáticamente en nuestro medio. OBJETIVO: Conocer si la EG, el tipo de parto y la intensidad de la reanimación cardiopulmonar (RCP) se asocian con un incremento en la incidencia de neumotórax en el RNT. PACIENTES Y MÉTODOS: Se estudiaron todos los RNT (≥ 37 semanas de EG) nacidos en nuestra maternidad durante el periodo 2006-2010, según el tipo de parto (vaginal, cesárea o fórceps) y su indicación en el caso de las cesáreas. Se consideró RCP avanzada la aplicación de presión positiva con mascarilla, intubación, o necesidad de compresiones torácicas y/o medicación. El diagnóstico de neumotórax fue clínico y radiológico. RESULTADOS: Se incluyeron un total de 32.238 RNT. Tipo de parto: vaginal 76,1%, cesárea 12,4% y fórceps 11,5%. La incidencia de neumotórax fue del 0,316%, siendo significativamente mayor en las cesáreas (0,85%) que en los fórceps (0,59%) o nacimientos vaginales (0,19%) (p < 0,001); en ≥ 40 semanas de EG (0,37%) frente a ≤ 39 semanas de EG (0,24%) (p = 0,033) y en RCP avanzada (4,29%) frente a RCP básica (0,18%) (p < 0,001). CONCLUSIONES: La EG ≥ 40 semanas, el parto mediante cesárea o fórceps y la RCP avanzada se asociaron significativamente a una mayor incidencia de neumotórax en el RNT. En nuestra población no se observó un aumento en la incidencia de neumotórax tras cesárea electiva en menores de 39 semanas de EG

BACKGROUND: Elective caesarean section before 39 weeks gestational age (GA) has been associated with a higher incidence of iatrogenic respiratory distress and pneumothorax in term newborn babies, probably because of a higher respiratory morbidity and the need for resuscitation. These factors have not been systematically evaluated in our patients. OBJECTIVE: To determine whether the gestational age, type of delivery, and intensity of resuscitation, are associated with an increase in the incidence of pneumothorax in term neonates. PATIENTS AND METHODS: Full term neonates (≥37 weeks GA) born in our maternity unit from January 2006 to December 2010 were studied, along with the type of delivery (vaginal, forceps or caesarean section). Advanced cardiopulmonary resuscitation (CPR) was defined as the need of bag and mask intermittent ventilation, intubation, chest compression, and/or administration of medication. The diagnosis of pneumothorax was clinical and radiological in all cases. RESULTS: A total of 32,238 full term newborns were included. Type of delivery: vaginal 76.1%, C-section 12.4%, and forceps 11.5%. The incidence of pneumothorax was 0.316%. It was significantly higher in C-section (0.85%), than in forceps (0.59%), or non-instrumental vaginal deliveries (0.19%) (P < 0.001), and in infants ≥40 weeks GA (0.37%) compared to ≤39 weeks GA (0.24%) (P = 0.033), and in advanced CPR (4.29%) compared to basic CPR (0.18%) (P < 0.001). CONCLUSIONS: A GA≥40 weeks, C-section, or forceps delivery, and advanced CPR immediately after birth were significantly associated with a higher incidence of pneumothorax in full term newborn babies. In our population, we did not observe an increase in pneumothorax among neonates born by elective C-section before 39 weeks of gestation

Factores de riesgo de hipotermia al ingreso en el recién nacido de muy bajo peso y morbimortalidad asociada / Hypothermia risk factors in the very low weight newborn and associated morbidity and mortality in a neonatal care unit

INTRODUCCIÓN: El enfriamiento del recién nacido tras el parto puede interferir con la adaptación posnatal debido a posibles efectos metabólicos y hemodinámicos. Los factores relacionados con el mismo, así como su relación con la morbimortalidad neonatal no han sido estudiados de forma sistemática en nuestro medio. OBJETIVOS: Analizar la temperatura al ingreso en la Unidad de Cuidados Intensivos Neonatales (UCIN) de los recién nacidos de muy bajo peso (RNMBP) y/o < 30 semanas de edad gestacional (EG), e identificar las variables perinatales que se asocian con una reducción de la misma, y su relación con la morbimortalidad neonatal. PACIENTES Y MÉTODOS: Se incluyeron 635 RNMBP y/o menores de 30 semanas de EG nacidos en nuestra maternidad desde enero de 2006 a noviembre de 2012. Se llevó a cabo un análisis multivariante entre las variables perinatales y la temperatura al ingreso, y una remisión logística entre esta y las variables de morbimortalidad para establecer asociaciones independientes. RESULTADOS: El peso al nacimiento (PRN) y la EG (media ± DE) fueron 1.137,6 ± 257,6 g y 29,5 ± 2,8 semanas, respectivamente. La temperatura media al ingreso: 35,8 ± 0,6 ° C (rango: 33,0-37,8 °C); temperatura inferior de 36 °C: 44,4%. Las variables perinatales asociadas de forma independiente con la temperatura fueron la corioamnionitis, el PRN, el parto vaginal frente a cesárea y la reanimación cardiopulmonar (RCP) avanzada. Una menor temperatura al ingreso se asoció a un incremento en el riesgo de hemorragia intracraneal (HIV-MG) grados 3 y 4 (OR: 0,377; IC 95%: 0,221-0,643; p < 0,001) y de mortalidad (OR: 0,329; IC 95%: 0,208-0,519; p = 0,012). CONCLUSIONES: La proporción de RNMBP y/o < 30 semanas de EG que ingresan con hipotermia es elevada en nuestro medio. El PRN, el parto vaginal y la RCP avanzada fueron las principales variables relacionadas con la hipotermia, y esta se asoció con un mayor riesgo de HIV-MG y de mortalidad

INTRODUCTION: Heat loss in the newborn after delivery could interfere with post-natal adaptation due to metabolic and hemodynamic instability. Associated perinatal factors and their relationship with morbidity and mortality during the neonatal period have not been systematically studied in our unit. OBJECTIVES: To determine the temperature of very low birth weight (VLBW) infants on admission to our NICU, and to determine the associated perinatal variables, and the association of temperature with morbidity and mortality. PATIENTS AND METHODS: Infants born in our maternity from January 2006 to November 2012, with birth weights (BW) 401 g to 1,499 g and/or less than 30 weeks gestational age, were included. A multivariate analysis was performed using the perinatal variables and the temperature on admission, as well as a logistic regression between these and the morbidity-mortality variables, in order to detect any independent associations. RESULTS: A total of 635 infants were included, with a mean (±SD) birth weight and gestational age of 1,137.6±257.6 g, and 29.5±2.0 weeks, respectively. The mean admission temperature was 35.8±0.6 ◦C (range: 33.0-37.8 ◦C). The proportion of infants with a temperature <36 ◦C was 44.4%. Independently associated perinatal variables were chorioamnionitis, birth weight, vaginal delivery, and advanced cardiopulmonary resuscitation (CPR). Admission hypothermia was associated with severe intraventricular haemorrhage (IVH) (grades 3 and 4) (OR: 0.377; 95% CI: 0.221-0.643; P<0.001), and mortality (OR: 0.329; 95% CI: 0.208-0.519; P=0.012). CONCLUSIONS: Hypothermia on admission is frequent among our VLBW infants. Birth weight, vaginal delivery, and advanced CPR were the principal variables associated with hypothermia. A low temperature on admission was related to an increased risk of IVH and mortality

[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.

[Influence of gestational age, type of delivery, and resuscitation, on the incidence of pneumothorax in term neonates]. / Influencia de la edad gestacional, el tipo de parto y la reanimación en el riesgo de neumotórax en neonatos mayores de 37 semanas.

BACKGROUND: Elective caesarean section before 39 weeks gestational age (GA) has been associated with a higher incidence of iatrogenic respiratory distress and pneumothorax in term newborn babies, probably because of a higher respiratory morbidity and the need for resuscitation. These factors have not been systematically evaluated in our patients. OBJECTIVE: To determine whether the gestational age, type of delivery, and intensity of resuscitation, are associated with an increase in the incidence of pneumothorax in term neonates. PATIENTS AND METHODS: Full term neonates (≥ 37 weeks GA) born in our maternity unit from January 2006 to December 2010 were studied, along with the type of delivery (vaginal, forceps or caesarean section). Advanced cardiopulmonary resuscitation (CPR) was defined as the need of bag and mask intermittent ventilation, intubation, chest compression, and/or administration of medication. The diagnosis of pneumothorax was clinical and radiological in all cases. RESULTS: A total of 32,238 full term newborns were included. Type of delivery: vaginal 76.1%, C-section 12.4%, and forceps 11.5%. The incidence of pneumothorax was 0.316%. It was significantly higher in C-section (0.85%), than in forceps (0.59%), or non-instrumental vaginal deliveries (0.19%) (P<.001), and in infants ≥ 40 weeks GA (0.37%) compared to ≤ 39 weeks GA (0.24%) (P=.033), and in advanced CPR (4.29%) compared to basic CPR (0.18%) (P<.001). CONCLUSIONS: A GA ≥ 40 weeks, C-section, or forceps delivery, and advanced CPR immediately after birth were significantly associated with a higher incidence of pneumothorax in full term newborn babies. In our population, we did not observe an increase in pneumothorax among neonates born by elective C-section before 39 weeks of gestation.

[Hypothermia risk factors in the very low weight newborn and associated morbidity and mortality in a neonatal care unit]. / Factores de riesgo de hipotermia al ingreso en el recién nacido de muy bajo peso y morbimortalidad asociada.

INTRODUCTION: Heat loss in the newborn after delivery could interfere with post-natal adaptation due to metabolic and hemodynamic instability. Associated perinatal factors and their relationship with morbidity and mortality during the neonatal period have not been systematically studied in our unit. OBJECTIVES: To determine the temperature of very low birth weight (VLBW) infants on admission to our NICU, and to determine the associated perinatal variables, and the association of temperature with morbidity and mortality. PATIENTS AND METHODS: Infants born in our maternity from January 2006 to November 2012, with birth weights (BW) 401 g to 1,499 g and/or less than 30 weeks gestational age, were included. A multivariate analysis was performed using the perinatal variables and the temperature on admission, as well as a logistic regression between these and the morbidity-mortality variables, in order to detect any independent associations. RESULTS: A total of 635 infants were included, with a mean (± SD) birth weight and gestational age of 1,137.6 ± 257.6g, and 29.5 ± 2.0 weeks, respectively. The mean admission temperature was 35.8 ± 0.6°C (range: 33.0-37.8°C). The proportion of infants with a temperature < 36°C was 44.4%. Independently associated perinatal variables were chorioamnionitis, birth weight, vaginal delivery, and advanced cardiopulmonary resuscitation (CPR). Admission hypothermia was associated with severe intraventricular haemorrhage (IVH) (grades 3 and 4) (OR: 0.377; 95% CI: 0.221-0.643; P<.001), and mortality (OR: 0.329; 95% CI: 0.208-0.519; P=.012). CONCLUSIONS: Hypothermia on admission is frequent among our VLBW infants. Birth weight, vaginal delivery, and advanced CPR were the principal variables associated with hypothermia. A low temperature on admission was related to an increased risk of IVH and mortality.

[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.

Errores conceptuales como origen de conflictos éticos en el establecimiento de niveles asistenciales en una paciente con trisomía 18 / Conceptual errors as the origin of ethical conflicts in the establishment of care levels in a patient with trisomy 18

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