Efectividad de palivizumab en la prevención de la infección por el virus respiratorio sincitial en prematuros de 32' a 35º semanas de gestación en España / Effectiveness of palivizumab to prevent hospitalization for respiratory syncytial virus infection in preterm infants 32' to 35º weeks’ gestation in Spain

Objetivo: Se pretende evaluar la efectividad de palivizumab para prevenir ingresos por el virus respiratorio sincitial (VRS) cuando es administrado a ex prematuros de 321 a 350 semanas de gestación, con menos de 6 meses de edad al inicio de la estación VRS y que presenten alguna de las combinaciones de factores de riesgo de ingreso por VRS. Pacientes y métodos: Se ha utilizado la base de datos del estudio FLIP-2, excluyendo los niños sin ningún factor de riesgo. Se estudió a 627 niños tratados con palivizumab y 4.092 que no lo recibieron. Las agrupaciones de factores de riesgo combinaron dos «factores mayores» (edad cronológica inferior a 10 semanas al inicio de la estación o haber nacido en las 10primeras semanas de la estación; hermano mayor que fuera a la escuela o asistencia a la guardería) y dos «factores menores» (gestante fumadora; sexo varón). Se han calculado los diferentes riesgos absoluto y relativo y el número de pacientes que es necesario tratar (NNT) para cada combinación de factores de riesgo. Resultados: En cada combinación se encuentra un menor peso y una menor edad gestacional altamente significativos (p <0,001) en los niños tratados con palivizumab. En la combinación«2 factores mayores» se encuentra el menor NNT (13,5), y si se añade la combinación «1 factor mayor + 2 factores menores», el NNT alcanza un valor de 15,1. La combinación que sólo exige la presencia de un factor mayor o menor corresponde al estudio global. Ingresaron 186 (4,55%) no tratados con palivizumab y 9 (1,44%) de los tratados (p <0,001; NNT= 32,2). Conclusiones: En los ex prematuros de 321 a 350 semanas, con una edad cronológica inferior a 10 semanas al inicio de la estación VRS o que hayan nacido en las 10 primeras semanas de la estación, y con un hermano mayor que vaya a la escuela o asista a la guardería, para prevenir un ingreso VRS habría que administrar palivizumab a 14 de ellos (AU)

Objective: The objective of the study was to evaluate effectiveness of palivizumab to prevent respiratory syncytial virus (RSV) infection when administered to former preterm infants321 to 350 weeks’ gestation aged less than 6 months at the beginning of RSV season using any of the possible combinations of known risk factors for RSV hospitalization. Patients and methods: Data were retrieved from the FLIP-2study database. Infants without risk factors were excluded. The database included 627 infants who received palivizumab and 4,092 who did not. Seven accumulative subgroups were established according to the combinations of risk factors combining two “major factors” (chronological age less than10 weeks at the beginning of RSV season or being born during the first10 weeks of the season; school-age siblings or daycare attendance)and two “minor factors” (mother smoking during pregnancy; male gender). Absolute risk, relative risk, and number needed to treat (NNT) were obtained for each subgroup. Results: In each subgroup, birth weight and gestational age were significantly lower in palivizumab treated infants. The combination “2 major factors” showed a NNT of [13.5], and when merged with “1 major factor or 2 minor factors” the NNT reached 15.1. Combination requesting only one risk factor either major or minor corresponded by design to the global study.186 patients of the treated group (4.55%) and 9 patients of the non-treated group (1.44%) were admitted to the hospital, of the treated (p <0.001; NNT of 32.2).Conclusion: In former preterm infants 321 to 350 weeks’ gestation with chronological age less than10 weeks at the beginning of RSV season (or being born during the first 10 weeks of the season) and with school-age siblings or daycare attendance,14 should be treated with palivizumab to prevent one RSV hospitalization (AU)

Utilidad predictiva de ingreso por infección por virus respiratorio sincitial de diferentes asociaciones de factores de riesgo en prematuros de 32 a 35 semanas de gestación en España / Usefulness of different risk factor associations in predicting admissions due to respiratory syncytial virus in premature newborns of 32 to 35 weeks gestation in Spain

Introducción: Se pretende evaluar los valores predictivos de ingreso por el virus respiratorio sincitial (VRS) de diferentes asociaciones de factores de riesgo en prematuros españoles de 32 a 35 semanas de gestación atendidos en 2 estaciones de VRS consecutivas. Pacientes y métodos: Se utilizó la base de datos del estudio FLIP-2. Se excluyó a los niños que recibieron palivizumab profiláctico. Se estudiaron 193 ingresos de VRS positivo y 4.568 niños no ingresados. Los factores de riesgo analizados fueron la edad cronológica inferior a 10 semanas al inicio de la estación o haber nacido en las 10 primeras semanas de la estación, hermano mayor que fuera a la escuela o asistiera a la guardería, madre fumadora durante la gestación, sexo varón, lactancia materna ausente durante 2 meses o menos, 4 o más adultos en casa, sibilancias en padres o hermanos, ser pequeño para la edad gestacional y 2 o más fumadores en casa. Resultados: El modelo de regresión logística incluyó los 4 primeros factores citados como variables independientemente significativas, con un coeficiente de determinación de 0,062 y un área bajo la curva de 0,687 (p<0,001). Los valores predictivos de ingreso de VRS positivo para un niño con los 4 factores de riesgo fueron los siguientes: el 6,2% de sensibilidad, el 98,6% de especificidad, el 16,2% de valor predictivo positivo, el 96,1% de valor predictivo negativo, el 94,9% de exactitud, un cociente de probabilidad positivo (CP+) de 4,581 y un cociente de probabilidad negativo de 0,951. El CP+ para un niño con los 2 factores mayores de riesgo es de 2,657. Conclusiones: La utilidad predictiva de ingreso de VRS positivo según la presencia de diferentes factores de riesgo en prematuros españoles de 32 a 35 semanas de gestación es escasa, aunque similar a otros modelos existentes (AU)

Aim: The aim of the study was to evaluate the risk factor associations for respiratory syncytial virus (RSV) hospitalization in preterm infants from 32 to 35 weeks gestation, treated during two consecutive RSV seasons in Spain. Patients and methods: A database (FLIP-2) was used after excluding the infants who received prophylactic palivizumab. A total of 193 RSV+ admissions and 4568 non-hospitalized children were studied. The risk factors analyzed were: chronological age <=10 weeks at start of RSV season or to be born during the first 10 weeks of the season; school-age siblings or daycare attendance; mother smoking during pregnancy; male gender; breastfeeding <=2 months; >=4 adults at home; history of wheezing; small for gestational age; >=2 smokers at home. Results: Logistic regression model included the first four previously mentioned risk factors as independently significant variables, with R2 of 0.062 and area under curve of 0.687 (P<0.001). Predictive values for a child with the four risk factors were: sensitivity 6.2%, specificity 98.6%, predictive positive value 16.2%, negative predictive value 96.1%, accuracy 94.9%, positive likelihood ratio 4.581, and negative likelihood ratio 0.951. Positive likelihood ratio for a child with the two major risk factors is 2.657. Conclusions: Usefulness of different risk factor associations to predict hospitalization for respiratory syncytial virus infection in preterm infants 32 to 35 weeks gestation in Spain is low, although similar to other models (AU)

[Usefulness of different risk factor associations in predicting admissions due to respiratory syncytial virus in premature newborns of 32 to 35 weeks gestation in Spain]. / Utilidad predictiva de ingreso por infección por virus respiratorio sincitial de diferentes asociaciones de factores de riesgo en prematuros de 32 a 35 semanas de gestación en España.

AIM: The aim of the study was to evaluate the risk factor associations for respiratory syncytial virus (RSV) hospitalization in preterm infants from 32 to 35 weeks gestation, treated during two consecutive RSV seasons in Spain. PATIENTS AND METHODS: A database (FLIP-2) was used after excluding the infants who received prophylactic palivizumab. A total of 193 RSV+ admissions and 4568 non-hospitalized children were studied. The risk factors analyzed were: chronological age <=10 weeks at start of RSV season or to be born during the first 10 weeks of the season; school-age siblings or daycare attendance; mother smoking during pregnancy; male gender; breastfeeding <=2 months; >=4 adults at home; history of wheezing; small for gestational age; >=2 smokers at home. RESULTS: Logistic regression model included the first four previously mentioned risk factors as independently significant variables, with R(2) of 0.062 and area under curve of 0.687 (P<0.001). Predictive values for a child with the four risk factors were: sensitivity 6.2%, specificity 98.6%, predictive positive value 16.2%, negative predictive value 96.1%, accuracy 94.9%, positive likelihood ratio 4.581, and negative likelihood ratio 0.951. Positive likelihood ratio for a child with the two major risk factors is 2.657. CONCLUSIONS: Usefulness of different risk factor associations to predict hospitalization for respiratory syncytial virus infection in preterm infants 32 to 35 weeks gestation in Spain is low, although similar to other models.

Alimentación del prematuro: requerimientos nutricionales / Feeding the premature baby: nutritional requirements

Los aportes nutricionales para corregir la restricción del crecimiento de los RNPT y alcanzar la apropiada ganancia del peso, serían casi dos veces las de los RN a término. Sin embargo, las estrategias nutricionales deben estar equilibradas con las preocupaciones sobre el que la nutrición agresiva puede ocasionar intolerancia digestiva o enterocolitis necrotizante, y que ese exceso de algunos nutrientes puede tener efectos tóxicos. La nutrición parenteral va a ser necesaria para el gran prematuro, cuya inmadurez o condición médica desaconseja la alimentación enteral completa (AU)

The nutritional to correct growth restriction in post-term newborn (PTNB) and to reach the appropriate weight gain would be twice that of the full-term NB. However, the nutritional strategies should be balanced with the concerns that aggressive nutrition could lead to digestive intolerance or necrotizing enterocolitis and that this excess of some nutrient may have toxic effects. Parenteral nutrition will be necessary for the large premature, whose immaturity or medical condition recommends against complete enteral feeding (AU)

Análisis del programa de detección precoz de la hipoacusia neonatal en nuestro centro / Analysis of the program of early detection of neonatal hearing loss in our hospital

Objetivos: Conocer los resultados del programa de detección precoz de hipoacusia en recién nacidos (RN) de nuestro hospital durante 2001 y 2004. Pacientes y métodos: Se realizaron otoemisiones acústicas (OEA) a 2.461 (2001) y 2.549 RN (2004); si éstas eran negativas, se repetían antes de un mes. Los RN con la segunda otoemisión negativa eran remitidos al servicio de otorrinolaringología (ORL), completándose su valoración mediante potenciales auditivos troncoencefálicos. Resultados: El 10% (n= 260) y el 5% (n= 145), respectivamente, no pasaron la primera OEA. Continuaron esta primera fase 234 (2001) y 144 (2004), y no pasaron la segunda OEA el 16% (n= 37) y el 24% (n= 35), generándose una remisión al servicio de ORL del 1,51 y el 1,37% cada año; 29 niños no completaron la fase diagnóstica. De los 72 RN con sospecha de hipoacusia, el 59,72% (n= 43) completó el programa, el 30,23%había estado ingresado, el 23,25% presentaba factores de riesgo y el 48,83% tenía OEA negativas bilaterales. En el servicio de ORL se confirmó la hipoacusia en 23 RN (53,48%): en un 57,14% era neurosensorial (un 62% en RN varones sin factores de riesgo; un 75% bilaterales y un 50% profundas) y en un 42,16% era de transmisión. Conclusiones: Nuestra incidencia global de hipoacusia neurosensorial y de transmisión es de 4,54/1.000 RN, y para la neurosensorial profunda de 1,87/1.000 RN. El 71% de los hipoacúsicos eran RN sanos y sin factores de riesgo, predominando los varones. La capacidad de detección de las OEA fue significativamente mayor en 2004; las remisiones a ORL fueron adecuadas, las pérdidas de seguimiento en la primera fase escasas, pero elevadas en la de confirmación (AU)

Objectives: To examine the results of the program of early detection of hearing loss in newborn infants (NB) in our hospital during 2001 and 2004.Patients and methods: Otoacoustic emissions (OAE) were evaluated in 2,461 (2001) and 2,549 NB (2004) and, if the results were negative, the evaluation was repeated before one month had elapsed. The NB with a second negative OAE test were sent to the otorhinolaryngology service (ORL), where their evaluation was completed, including assessment of the auditory brainstem response (ABR). Results: The first OAE test was negative in 260 (10%) and145 (5%) NB, respectively. In all, 234 (2001) and 144 (2004) continued this first stage; 37 (16%) and 35 (24%) NB, respectively, failed to pass the second OAE test, and 1.51% and 1.37%in each year were referred to ORL, whereas 29 children did not complete the diagnostic phase. Of the 72 NB with suspected auditory dysfunction, 59.72% (n= 43) completed the program, 30.23% had been admitted to the hospital, 23.25% had risk factors and 48.83% had bilateral negative results on OAE testing. The ORL service confirmed hearing loss in 23 NB (53.48%): sensorineural in 57.14% (62% were boys with no risk factors, and it was bilateral in 75% and profound in 50%) and conductive in 42.16%. Conclusions: Our overall incidence of sensorineural and conductive hearing loss was 4.54/1,000 NB, and that of deep sensorineural hearing loss was only 1.87/1,000 NB. In all, 71% of the infants with hearing loss were normal and had no risk factors ,and there was a male predominance. The capacity for detection of OAE was significantly greater in 2004; the referrals to ORL were appropriate, the rate of loss to follow-up was low in the first stage and elevated in the confirmation stage (AU)

[Quality control of nosocomial infection in PICU]. / Control de calidad en la infección nosocomial en la UCIP.

INTRODUCTION: Nosocomial infection represents a problem of public health given his high morbidity and mortality, and the cost that it causes to the sanitary system. OBJECTIVE: To analyze the nosocomial infection related to the principal invasive techniques realized in the paediatric intensive care unit of our hospital. MATERIAL AND METHODS: We prospectively analyzed the epidemiological information (days of hospitalization, days of placement of devices, intravascular and closed drainage system, and mechanical ventilation) and the incidence of nosocomial infections (bacteriemias, pneumonias, urinary tract infections) in the patients admitted during the years 2000-2004. RESULTS: There was analyzed a total of 302 patients finding an accumulated incidence of nosocomial infection of 9.76 %. The microorganisms isolated with major frequency were the gramnegative stain (46.60 %), followed by Candida sp. (33.30 %) and grampositive cocci (20.01 %). The predominant location of infection was the bacteriemia, with an incidence of 4.09 % (2.99 % of primary bacteraemia Vs 1.10 % of catheter related infection). The mean rate of incidence of bacteriemias associated to intravasculares devices (BADV) was 8.92 (NNISS 7.3 ) with mean rate of utilization of the device of 0.65 (> Pc90 of the NNISS). The pneumonia associated with mechanical ventilation (NAVM) presented a mean rate of incidence of 1.80 departing from a mean rate of utilization of 0.27 (< Pc25 of the NNISS). The urinary infection associated with the closed drainage system presented an average rate of effect of 2.63 , with a mean rate of utilization of the closed drainage system of 0.37 (Pc75). CONCLUSIONS: Nosocomial infection represents an important problem in PICU. These data allow us the knowledge of the incidence of nosocomial infection in our PICU and target the strategies for reducing morbidity and mortality.

Control de calidad en la infección nosocomial en la UCIP / Quality control of nosocomial infection in PICU

Introducción: La infección nosocomial representa un problema de salud dada su elevada morbimortalidad y el incremento de costes que ocasiona al sistema sanitario. Objetivo: Analizar la infección nosocomial relacionada con las principales técnicas invasivas realizadas en la unidad de cuidados intensivos pediátricos de nuestro hospital. Material y métodos: Recogida prospectiva de datos epidemiológicos (número de días de ingreso, de colocación de dispositivos, intravasculares y sondaje urinario cerrado y ventilación mecánica) y aparición de infecciones nosocomiales (bacteriemias, neumonías, infecciones de orina) en los pacientes ingresados durante los años 2000-2004. Resultados: Se analizaron un total de 302 pacientes y se encontró una incidencia acumulada de infección nosocomial del 9,76 %. Los microorganismos aislados con mayor frecuencia fueron los gramnegativos (46,60 %), seguidos de Candida sp. (33,30 %) y cocos grampositivos (20,01 %). Su localización predominante fue la bacteriemia, con una incidencia acumulada parcial del 4,09 %, predominando las primarias frente a las relacionadas a dispositivo intravascular (el 2,99 frente al 1,10 %). La tasa media de incidencia de bacteriemias asociadas con dispositivos intravasculares (BADV) fue del 8,92 ‰ (National Nosocomial Infectious Surveillance System [NNISS] 7,3 ‰) con una tasa media de utilización del dispositivo de 0,65 (> Pc90 del NNISS). La neumonía asociada a ventilación mecánica (NAVM) presentó una tasa media de incidencia del 1,80 ‰ partiendo de una tasa media de utilización del 0,27 (< Pc25 del NISS). La infección urinaria asociada con el sondaje urinario cerrado presentó una tasa media de incidencia del 2,63 ‰, con una tasa media de utilización del sondaje del 0,37 (Pc75). Conclusiones: La infección nosocomial representa un problema importante en las UCIP. Los datos obtenidos de este estudio nos permiten conocer la incidencia de la infección nosocomial en nuestra unidad de cuidados intensivos pediátricos (UCIP) y dirigir las estrategias de mejora para disminuir la mortalidad y morbilidad (AU)

Introduction: Nosocomial infection represents a problem of public health given his high morbidity and mortality, and the cost that it causes to the sanitary system. Objective: To analyze the nosocomial infection related to the principal invasive techniques realized in the paediatric intensive care unit of our hospital. Material and methods: We prospectively analyzed the epidemiological information (days of hospitalization, days of placement of devices, intravascular and closed drainage system, and mechanical ventilation) and the incidence of nosocomial infections (bacteriemias, pneumonias, urinary tract infections) in the patients admitted during the years 2000-2004. Results: There was analyzed a total of 302 patients finding an accumulated incidence of nosocomial infection of 9.76 %. The microorganisms isolated with major frequency were the gramnegative stain (46.60 %), followed by Candida sp. (33.30 %) and grampositive cocci (20.01 %). The predominant location of infection was the bacteriemia, with an incidence of 4.09 % (2.99 % of primary bacteraemia Vs 1.10 % of catheter related infection). The mean rate of incidence of bacteriemias associated to intravasculares devices (BADV) was 8.92 ‰ (NNISS 7.3 ‰) with mean rate of utilization of the device of 0.65 (> Pc90 of the NNISS). The pneumonia associated with mechanical ventilation (NAVM) presented a mean rate of incidence of 1.80 ‰ departing from a mean rate of utilization of 0.27 (< Pc25 of the NNISS). The urinary infection associated with the closed drainage system presented an average rate of effect of 2.63 ‰, with a mean rate of utilization of the closed drainage system of 0.37 (Pc75). Conclusions: Nosocomial infection represents an important problem in PICU. These data allow us the knowledge of the incidence of nosocomial infection in our PICU and target the strategies for reducing morbidity and mortality (AU)

Universidades, hospitales y necesidad de pediatras, ¿hay soluciones? / Universities, Hospitals and paediatric needs. Are there solutions?

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[SEN1500: design and implementation of a registry of infants weighing less than 1,500 g at birth in Spain]. / SEN1500: diseño y desarrollo del registro de niños de menos de 1.500 g al nacer en España.

OBJECTIVE: To design and implement a registry of infants weighing less than 1,500 g at birth in Spain. MATERIAL AND METHODS: Prospective, cohort, multicenter study. All live born infants weighing less than 1,500 g in several voluntarily participating neonatal units in public and private hospitals were included. RESULTS: In the first 4 years of the registry (2002 to 2005), 9,638 very-low-birth-weight infants were born in the 65 neonatal units that have so far joined the program. CONCLUSIONS: The goal of very-low-birth-weight infant databases is to try to improve the quality and safety of the medical care given to these newborns and their families. This type of program helps to coordinate and promote several areas, including those of health education, training of medical staff, research and development, surveillance and quality improvement.

SEN1500: diseño y desarrollo del registro de niños de menos de 1.500 g al nacer en España / SEN1500: Design and implementation of a registry of infants weighing less than 1.500 g at birth in Spain

Objetivo: Diseño y desarrollo de un registro de niños de menos de 1.500 g al nacer en España. Material y métodos: Estudio de cohortes prospectivo multicéntrico. Se incluyen todos los recién nacidos vivos de peso inferior a 1.500 g al nacer en las unidades neonatales (UN) que voluntariamente se integren en el proyecto. Resultados: En los primeros 4 años de funcionamiento del registro han participado en el estudio 65 UN diferentes. El total de niños seleccionados entre 2002 y 2005 es de 9.637. Conclusiones: La misión de las bases de datos de los niños de muy bajo peso al nacer es intentar mejorar la calidad y la seguridad de los cuidados médicos que se proporcionan a los recién nacidos y a su familia. Su desarrollo posibilita la coordinación de programas de educación sanitaria y formación de profesionales médicos y de enfermería, de líneas de investigación y de proyectos de mejora (AU)

Objective: To design and implement a registry of infants weighing less than 1,500 g at birth in Spain. Material and methods: Prospective, cohort, multicenter study. All live born infants weighing less than 1,500 g in several voluntarily participating neonatal units in public and private hospitals were included. Results: In the first 4 years of the registry (2002 to 2005), 9,638 very-low-birth-weight infants were born in the 65 neonatal units that have so far joined the program. Conclusions: The goal of very-low-birth-weight infant databases is to try to improve the quality and safety of the medical care given to these newborns and their families. This type of program helps to coordinate and promote several areas, including those of health education, training of medical staff, research and development, surveillance and quality improvement (AU)

[Lung function and exposure to tobacco smoke among adolescents]. / Función pulmonar y exposición al humo del tabaco en adolescentes.

OBJECTIVE: To study lung function in adolescents in relation to smoking (active and passive smokers) and to investigate the repercussion on spirometric parameters. PATIENTS AND METHOD: We studied 301 healthy adolescents with no history of bronchial asthma or colds in the month prior to the study. A questionnaire on tobacco exposure was administered and spirometry (Datospir-92) was performed. RESULTS: There were 165 boys (54.5%) and 136 girls (45.5%) aged between 14 and 20 years old (16.40+/-1.32). A total of 27.2% were non-smokers and were not exposed to tobacco smoke (NS), 31.3% were passive smokers, with household exposure of 10 cigarettes per day during at least the previous year (PS), and 41.5% were current smokers who had been smoking>or=10 cigarettes/day for at least 1 year (CS). Significant differences were found between age and smoking habits (p=0.0001) and between smoking habits and female sex (girls CS: 33.9% vs boys CS: 21.8 %) (p=0.007). A significant association was found between smoking (NS, PS and CS) and spirometric parameters (ANOVA): forced vital capacity (FVC) (p=0.001), forced expiratory volume in 1 second (FEV1) (p=0.0001), FEV1/FVC (p=0.004), peak expiratory flow (PEF) (p=0.0001), midexpiratory flow at 25% of forced vital capacity (MEF25%) (p=0.01), MEF50% (p=0.0001) and MEF25-75% (p=0.0001); CS in relation to NS was as follows: FEV1, PEF, MEF50%, MEF25-50% (p=0.0001) and FVC, FEV1/FVC, MEF25% (p=0.01); CS in relation to PS: FEV1/ FVC (p=0.02), PEF (p=0.004), MEF50% and MEF25-75% (p=0.003), PS in relation to NS: FVC and FEV1 (p=0.02). Significant differences in FVC, FEV1 and MEF25-75% were found in female CS in comparison with boys. CONCLUSIONS: The CS group showed a significant decrease in spirometric parameters in relation to the NS group. The airway was affected sooner in the female group of smokers than in the male group, even though the intensity and time of exposure were the same in both groups.

[Review of standards and recommendations for the design of a neonatology unit]. / Revisión de los estándares y recomendaciones para el diseño de una unidad de neonatología.

Standards for the design of a neonatology unit are reviewed. The process should begin with a planning team to outline the desired objectives to be achieved, followed by the intervention of a team of architects. Medical considerations, standards and recommendations, as well as architectural considerations (adequate privacy and intimacy, need for social support and communication, flexibility and accessibility) should be taken into account. From the architectural point of view, the greatest problem is the space available; furthermore, if the aim is to personalize the unit for the newborn and family, the need for space will be even greater. The following aspects should be analyzed and integrated into the design of the unit: standards and recommendations regarding space, the site of the unit, area of direct neonatal care, electrical installation, equipment, lighting and noise levels, nursing staff, communication systems, maintenance and refurbishment.

Función pulmonar y exposición al humo del tabaco en adolescentes / Lung function and exposure to tobacco smoke among adolescents

Objetivo Estudiar la función pulmonar de adolescentes y relacionarlo con hábito tabáquico (HT) en fumadores activos y pasivos. Investigar la repercusión sobre los parámetros espirométricos. Pacientes y método Un total de 301 adolescentes sanos, no diagnosticados de asma bronquial y sin presentar episodios catarrales en el mes previo. Encuesta de exposición al tabaco y espirometría basal (Datospir-92). Resultados Un total de 165 varones (54,5 %) y 136 mujeres (45,5 %) de las siguientes edades: 14-20 años (16,40 ± 1,32). Distribución: 27,2 %, no fumadores, no expuestos al humo del tabaco (NE); 31,3 %, fumadores pasivos, expuestos en su domicilio a más de 10 cigarrillos/día al menos durante el último año (FP); 41,5 %, fumadores habituales que fumaban 10 o más cigarrillos al día al menos durante un año (FH). Existen diferencias significativas entre edad y HT (p = 0,0001), entre HT y sexo femenino (mujeres FH: 33,9 %; varones FH: 21,8 %) p = 0,007. Obtuvimos relación entre HT (NE, FP y FH) y parámetros espirométricos (ANOVA): capacidad vital forzada (FVC) (p = 0,001), volumen espiratorio forzado en el primer segundo (FEV1) (p = 0,0001), FEV1/FVC (p = 0,004), pico máximo de flujo espiratorio (PEF) (p = 0,0001), MEF25 % (flujo espiratorio máximo cuando queda en el pulmón el 25 % de la FVC) (p = 0,01), MEF50 % (p = 0,0001) y MEF25-75 % (p = 0,0001). El FH en relación con NE: FEV1, PEF, MEF50 %, MEF25-75 % (p = 0,0001), FVC, FEV1/FVC, MEF25 % (p = 0,01). El FH en relación con FP: FEV1/FVC (p = 0,02), PEF (p = 0,004), MEF50 %, MEF25-75 % (p = 0,003). El FP en relación con NE: FVC, FEV1 (p = 0,02). Las mujeres FH presentan diferencias significativas en: FVC, FEV1 y MEF25-75 %, con respecto a los varones. Conclusiones Los adolescentes FH presentan un descenso significativo de los parámetros espirométricos en relación con los NE. Las mujeres fumadoras, con la misma intensidad y tiempo de exposición que los varones, tienen afectada su vía aérea más precozmente

Objective To study lung function in adolescents in relation to smoking (active and passive smokers) and to investigate the repercussion on spirometric parameters. Patients and method We studied 301 healthy adolescents with no history of bronchial asthma or colds in the month prior to the study. A questionnaire on tobacco exposure was administered and spirometry (Datospir-92) was performed. Results There were 165 boys (54.5 %) and 136 girls (45.5 %) aged between 14 and 20 years old (16.40 ± 1.32). A total of 27.2 % were non-smokers and were not exposed to tobacco smoke (NS), 31.3 % were passive smokers, with household exposure of 10 cigarettes per day during at least the previous year (PS), and 41.5 % were current smokers who had been smoking >= 10 cigarettes/day for at least 1 year (CS). Significant differences were found between age and smoking habits (p = 0.0001) and between smoking habits and female sex (girls CS: 33.9 % vs boys CS: 21.8 %) (p = 0.007). A significant association was found between smoking (NS, PS and CS) and spirometric parameters (ANOVA): forced vital capacity (FVC) (p = 0.001), forced expiratory volume in 1 second (FEV1) (p = 0.0001), FEV1/FVC (p = 0.004), peak expiratory flow (PEF) (p = 0.0001), midexpiratory flow at 25 % of forced vital capacity (MEF25 %) (p = 0.01), MEF50 % (p = 0.0001) and MEF25-75 % (p = 0.0001); CS in relation to NS was as follows: FEV1, PEF, MEF50 %, MEF25-50 % (p = 0.0001) and FVC, FEV1/FVC, MEF25 % (p = 0.01); CS in relation to PS: FEV1/ FVC (p = 0.02), PEF (p = 0.004), MEF50 % and MEF25-75 % (p = 0.003), PS in relation to NS: FVC and FEV1 (p =0.02). Significant differences in FVC, FEV1 and MEF25-75 % were found in female CS in comparison with boys. Conclusions The CS group showed a significant decrease in spirometric parameters in relation to the NS group. The airway was affected sooner in the female group of smokers than in the male group, even though the intensity and time of exposure were the same in both groups

Revisión de los estándares y recomendaciones para el diseño de una unidad de neonatología / Review of standards and recommendations for the design of a neonatology unit

Se revisan los estándares para el diseño de una unidad de neonatología. El proceso debe iniciarse con un equipo de planificación que debe indicar los objetivos que se desean conseguir, para que posteriormente intervenga el equipo de arquitectos. Se deben tener en cuenta las aportaciones médicas, los estándares y recomendaciones, y las aportaciones arquitectónicas (adecuada privacidad e intimidad, necesidad de apoyo social y comunicación, flexibilidad y accesibilidad). Desde el punto de vista arquitectónico, el mayor problema es el del espacio disponible, y debemos tener en cuenta que si queremos personalizar el entorno del cuidado para el recién nacido y su familia e introducir los cuidados centrados en la familia, las necesidades de espacio serán aún mayores. Se analizan los estándares y recomendaciones relativos al espacio, ubicación de la unidad, área de atención directa al neonato, instalación eléctrica, iluminación y nivel de ruido, equipamiento, personal de enfermería, sistemas de comunicaciones, mantenimiento y renovación

Standards for the design of a neonatology unit are reviewed. The process should begin with a planning team to outline the desired objectives to be achieved, followed by the intervention of a team of architects. Medical considerations, standards and recommendations, as well as architectural considerations (adequate privacy and intimacy, need for social support and communication, flexibility and accessibility) should be taken into account. From the architectural point of view, the greatest problem is the space available; furthermore, if the aim is to personalize the unit for the newborn and family, the need for space will be even greater. The following aspects should be analyzed and integrated into the design of the unit: standards and recommendations regarding space, the site of the unit, area of direct neonatal care, electrical installation, equipment, lighting and noise levels, nursing staff, communication systems, maintenance and refurbishment

[Neonatal neoplasms: a single-centre experience]. / Neoplasias neonatales: experiencia de un centro.

INTRODUCTION: Malignant tumors are uncommon in the neonatal period and benign tumors may have malignant potential. OBJECTIVES: To describe the neoplasms diagnosed and treated in newborns (

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

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

Neoplasias neonatales: experiencia de un centro / Neonatal neoplasms: a single-centre experience

Introducción Los tumores malignos en el período neonatal son poco frecuentes y los benignos pueden tener un potencial de malignización. Objetivos Revisar las neoplasias diagnosticadas y tratadas en recién nacidos (≤ 28 días de vida) en el Hospital Universitario de Canarias, su asociación con anomalías congénitas y valorar el diagnóstico prenatal. Pacientes y métodos Se revisaron de forma retrospectiva las historias clínicas de las neoplasias diagnosticadas durante la época neonatal en los últimos 25 años en nuestro centro. Se analizaron las siguientes variables: el porcentaje de neoplasias neonatales sobre el total de las registradas en niños menores de 14 años y su incidencia, sexo, año de diagnóstico, edad al diagnóstico clínico y si se había hecho diagnóstico prenatal, tipo de tumor (diagnóstico histológico), asociación a síndromes u otras malformaciones congénitas, tratamiento recibido y evolución posterior. Resultados Del total de 260 tumores diagnosticados en nuestra unidad desde 1980, 16 (6,1 %) han sido en la etapa neonatal, con una incidencia de 276,5 casos por 10 6 recién nacidos vivos. El 43,8 % eran varones y el 56,2 % mujeres, con una edad media al diagnóstico de 5,5 días de vida (límites entre 1 a 28 días). El diagnóstico fue prenatal en 5 neonatos (31,2 %), de los cuales hasta un 60 % se hizo en los últimos 7 años. Otros 5 recién nacidos fueron diagnosticados en la primera exploración neonatal. Los diagnósticos histopatológicos fueron: neuroblastoma (n = 5; 31,2 %), teratoma/tumor de células germinales (n = 4; 25 %), sarcoma de partes blandas (1 fibrosarcoma de muslo y 2 hemangiopericitomas, de espalda y cardíaco; 18,8 %), un nefroma mesoblástico, un caso de tumor cerebral (ependimoblastoma), un melanoma (asociado a un nevo melanocítico congénito gigante), y una leucemia aguda (asociada a síndrome de Down). El tratamiento recibido fue: sólo cirugía (n = 10; 62,5 %), cirugía más quimioterapia (n =5; 31,2 %) y uno sin tratamiento. La supervivencia global actuarial es del 87,5 %. De los supervivientes hasta un 33,3 % presentan algún tipo de secuela. Conclusiones Las neoplasias más frecuentemente diagnosticadas en el período neonatal fueron tumores sólidos como el neuroblastoma y teratomas/tumores de células germinales. El 12,5 % estuvieron asociadas con síndromes u anomalías congénitas. En los últimos 7 años se observa un avance en su diagnóstico prenatal. La mayoría respondieron a la terapia instaurada, principalmente cirugía, con un buen pronóstico a largo plazo

Introduction Malignant tumors are uncommon in the neonatal period and benign tumors may have malignant potential. Objectives To describe the neoplasms diagnosed and treated in newborns (≤ 28 days of life) in the Hospital Universitario de Canarias and their association with congenital abnormalities and to evaluate prenatal diagnosis of these tumors. Patients and methods The medical records of patients with neoplasms diagnosed during the neonatal period in the previous 25 years in our hospital were retrospectively reviewed. The variables analyzed were the percentage of neonatal neoplasms among the total number of cancer cases in children aged less than 14 years, their incidence among all the newborns in our hospital, sex, year of diagnosis, age at clinical diagnosis, the presence or absence of prenatal diagnosis, type of tumor (histologic diagnosis), association with syndromes or other congenital anomalies, treatment, and long-term outcome. Results Of 260 neoplasms diagnosed in our unit from 1980, 16 (6.1 %) were diagnosed in the neonatal period. The incidence of neonatal neoplasms was estimated to be 276.5 per million live births. Males accounted for 43.8 % and females for 56.2 %, with a mean age at diagnosis of 5.5 days (range 1-28 days). Five neonates (31.2 %) had a prenatal diagnosis, 60 % of which were made in the last 7 years of the study period. A further five newborns were diagnosed at the initial neonatal examination. Histologic diagnoses were neuroblastoma (n = 5; 31.2 %), teratoma/ germ cell tumor (n = 4; 25 %), soft tissue sarcoma (one fibrosarcoma of the thigh and two hemangiopericytoma of the back and heart; 18.8 %), and one case each of mesoblastic nephroma, cerebral tumor (ependymoblastoma), melanoma (associated with giant congenital melanocytic nevi), and acute leukemia (associated with Down syndrome). Treatment consisted of surgery alone (n = 10; 62.5 %) and surgery plus chemotherapy (n = 5; 31.2 %); one patient received no treatment. The overall actuarial survival rate was 87.5 %. Sequelae were observed in 33.3 % of survivors. Conclusions The neoplasms most frequently diagnosed in the neonatal period were solid tumors, mainly neuroblastoma and teratomas/germ cell tumors; 12.5 % were associated with syndromes or congenital anomalies. In the last 7 years, the prenatal diagnosis of these entities has improved. Most of the neoplasms responded to therapy, mainly surgery, and long-term outcome was favorable

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

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

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

[The efficiency (cost-effectiveness) of palivizumab as prophylaxis against respiratory syncytial virus infection in premature infants with a gestational age of 32-35 weeks in Spain]. / La eficiencia (coste-efectividad) de palivizumab como profilaxis para la infección por virus respiratorio sincitial en prematuros de 32-35 semanas en España.

OBJECTIVES: To evaluate the efficiency (cost-effectiveness) of palivizumab in preventing severe respiratory syncytial virus (RSV) infection in premature infants with a gestational age of 32-35 weeks (GA 32-35) and two or more risk factors (RF) in Spain. DESIGN: decision tree model using data from the scientific literature and the FLIP I and FLIP II studies (cohort of 326 infants with GA 32-35 and two or more RF who received palivizumab) sponsored by the Spanish Society of Neonatology. Main effectiveness measure: quality-adjusted life years (QALY) gained. PERSPECTIVES: the national health service (NHS), which includes direct costs (administration of palivizumab and hospital admissions), and the societal perspective, which also includes indirect costs (the child's future lost productivity). Discount: 3 % annually for effectiveness and indirect costs. Sensitivity analysis: construction of 37 scenarios modifying variables related to effectiveness and costs. RESULTS: Prophylaxis with palivizumab in premature infants with GA 32-35 and two or more RF produced an incremental cost-effectiveness ratio (ICER) of 13,849 euro/QALY from the NHS perspective, and an ICER of 4,605 euro/QALY from the societal perspective. In the sensitivity analysis, from the NHS perspective the ICER ranged from 5,351 euro/QALY (most favorable scenario) to 23,276 euro/QALY (least favorable scenario). CONCLUSIONS: Palivizumab is a cost-effective therapy as prophylaxis against RSV in infants with GA 32-35 and two or more RF. Its use is efficient from the NHS perspective, since the cost of a QALY, even in the least favorable scenarios, is lower than the threshold of 30,000 Euro/QALY considered socially acceptable in Spain.