Intoxicaciones agudas atendidas en un servicio de urgencias. De la prepandemia a la nueva normalidad / Acute poisoning among patients attended to in an emergency department: From the pre-pandemic period to the new normality

Fundamentos La pandemia por COVID-19 ha provocado cambios globales que afectan a la vida diaria de la población mundial, con un impacto directo sobre la salud física y mental de los individuos, así como en sus hábitos sociales y recreativos. Métodos Análisis retrospectivo de aspectos demográficos y clínicos de los pacientes atendidos por intoxicaciones agudas en un servicio de urgencias hospitalario durante 3 períodos distintos: prepandemia (2019), tras el confinamiento domiciliario (2020) y en el período pospandémico (2021), analizando en cada uno los meses de junio y julio. Resultados Se incluyeron 1.182 intoxicaciones agudas. En relación con la etapa prepandémica, el número de intoxicados disminuyó durante el confinamiento (2019: 1,9 vs. 2020: 1,5%; p<0,01), incrementándose la ratio varón/mujer (2,0 vs. 1,4; p=0,02) y la edad media (2019: 31,4 vs. 2020: 41,3; p<0,001), tendencia que se mantuvo en el año 2021 (38,3). La intoxicación con motivación suicida también aumentó en dicho período (2019: 8,71 vs. 2020: 21,0%; p<0,01), mientras que las lúdicas decrecieron (2019: 76,1 vs. 2020: 62,0%; p<0,01), con un aumento no significativo en el último año 2021 (69,0%; p=0,07). Conclusiones La pandemia por COVID-19 ha generado cambios clínicos y epidemiológicos en las intoxicaciones agudas atendidas en un servicio de urgencias hospitalario durante las distintas fases de la pandemia (AU)

Background The COVID-19 pandemic has caused global changes that affect the daily life of the world's population, with a direct impact on individuals’ physical and mental health as well as on their social and recreational habits. Methods This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department (ED) at three different periods of time: pre-pandemic (2019), after strict lockdown of the population in Spain (2020), and post-pandemic (2021). We analyzed 2 months (June and July) in each period. Results A total of 1,182 cases of acute poisoning were included. Compared to the pre-pandemic period, during lockdown, the number of patients with acute poisoning decreased (2019: 1.9% vs. 2020: 1.5%; p<.01); the ratio of men to women increased (2.0 vs. 1.4; p=.02); and the mean age of patients increased (2019: 31.4 vs. 2020: 41.3; p<.001), a trend which continued in 2021 (38.3). Poisoning with suicidal intention also increased during the pandemic (2019: 8.71% vs. 2020: 21.0%; p<.01) whereas poisonings with a recreational intention declined (2019: 76.1% vs. 2020: 62.0%; p<.01) with a non-significant increase in 2021 (69.0%, p=.07). Conclusion The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic (AU)

Acute poisoning among patients attended to in an emergency department: from the pre-pandemic period to the new normality.

BACKGROUND: The COVID-19 pandemic has caused global changes that affect the daily life of the world's population, with a direct impact on individuals' physical and mental health as well as on their social and recreational habits. METHODS: This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department (ED) at three different periods of time: pre-pandemic (2019), after strict lockdown of the population in Spain (2020), and post-pandemic (2021). We analyzed 2 months (June and July) in each period. RESULTS: A total of 1,182 cases of acute poisoning were included. Compared to the pre-pandemic period, during lockdown, the number of patients with acute poisoning decreased (2019: 1.9% vs. 2020: 1.5%; p < 0.01); the ratio of men to women increased (2.0 vs. 1.4; p = 0.02); and the mean age of patients increased (2019: 31.4 vs. 2020: 41.3; p < 0.001), a trend which continued in 2021 (38.3). Poisoning with suicidal intention also increased during the pandemic (2019: 8.71% vs. 2020: 21.0%; p < 0.01) whereas poisonings with a recreational intention declined (2019: 76.1% vs. 2020: 62.0%; p < 0.01) with a non-significant increase in 2021 (69.0%, p = 0.07). CONCLUSION: The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic.

[Acute poisoning among patients attended to in an emergency department: From the pre-pandemic period to the new normality]. / Intoxicaciones agudas atendidas en un servicio de urgencias. De la prepandemia a la nueva normalidad.

Background: The COVID-19 pandemic has caused global changes that affect the daily life of the world's population, with a direct impact on individuals' physical and mental health as well as on their social and recreational habits. Methods: This study aimed to retrospectively analyze the demographic and clinical characteristics of patients attended to for acute poisoning in a hospital emergency department (ED) at three different periods of time: pre-pandemic (2019), after strict lockdown of the population in Spain (2020), and post-pandemic (2021). We analyzed 2 months (June and July) in each period. Results: A total of 1,182 cases of acute poisoning were included. Compared to the pre-pandemic period, during lockdown, the number of patients with acute poisoning decreased (2019: 1.9% vs. 2020: 1.5%; p<.01); the ratio of men to women increased (2.0 vs. 1.4; p=.02); and the mean age of patients increased (2019: 31.4 vs. 2020: 41.3; p<.001), a trend which continued in 2021 (38.3). Poisoning with suicidal intention also increased during the pandemic (2019: 8.71% vs. 2020: 21.0%; p<.01) whereas poisonings with a recreational intention declined (2019: 76.1% vs. 2020: 62.0%; p<.01) with a non-significant increase in 2021 (69.0%, p=.07). Conclusion: The COVID-19 pandemic generated clinical and epidemiological changes in the acute poisonings attended to in a hospital emergency department during the various phases of the pandemic.

Intoxicaciones en la tercera edad / Poisoning among the elderly

Objetivos Las intoxicaciones siguen siendo un problema de salud pública importante. En el presente estudio evaluamos la epidemiología de las intoxicaciones en la tercera edad. Métodos Estudio de cohorte retrospectivo realizado entre 2011 y 2019 en un hospital universitario. Analizamos variables demográficas, tipo de tóxico involucrado, naturaleza suicida o accidental de la intoxicación y la probabilidad de ingreso o muerte en el hospital. Resultados Un total de 880 (6,1%) de las 14.300 intoxicaciones atendidas en el mismo período sucedieron en mayores de 65 años. El grupo más numeroso fueron individuos entre 65-69 años (39%), seguidos por el grupo de 70-75 años (20%), siendo varones el 57%. En el 88% de los casos participó un único tóxico, por orden de frecuencia alcohol (51,6%), fármacos (29,5%) y productos domésticos o industriales (12,8%). Las intoxicaciones por alcohol predominaron en hombres hasta los 75 años y por encima de esta edad predominó la intoxicación farmacológica o suicida, principalmente en mujeres. Ingresaron un total de 145 (16%) sujetos, siendo los fármacos más frecuentemente implicados digoxina y benzodiacepinas. La probabilidad de ingreso se asoció con la intoxicación por metformina, digoxina, litio o la edad del paciente (OR por año = 1,03; IC 95%: 1,0-1,06). Fallecieron 19 pacientes (2,16%), principalmente por ingestas cáusticas suicidas (OR = 5,7: IC 95%: 1,4-23,6) o por fármacos, relacionados directamente con la metformina (OR = 10,1; IC 95%: 2,4-42,4). Conclusiones La prevalencia de intoxicaciones en la tercera edad no es despreciable, y los médicos deben sospecharlas ante situaciones clínicas complejas (AU)

Objectives Poisonings continue to be an important public health problem. Herein, we analyzed the epidemiology of poisonings in elderly individuals. Methods Retrospective cohort study conducted between 2011 and 2019 in a university hospital. We analyzed demographic variables, type of poison involved, suicidal or accidental nature of the poisoning, and the probability of admission, or death to the hospital. Results A total of 880 (6.1%) of the 14,300 poisonings treated in the same period occurred in people over 65 years of age. The most numerous group were individuals between 65-69 years-old (39%), followed by the group of 70-75 years-old (20%), being men 57%. In 88% of the cases a single poison participated, being by frequency alcohol (51.6%), drugs (29.5%), and household or industrial products (12.8%). Alcohol intoxication predominated in men up to 75 years of age, and above this age drug or suicidal intoxication predominated, mainly in women. A total of 145 (16%) subjects were hospitalized, the drugs most frequently implicated being digoxin and benzodiazepines. The probability of hospital admission was associated with intoxication by metformin, digoxin, lithium or with the age of the patient (OR per year = 1.03; 95% CI: 1.0-1.06). A total of 19 patients died (2.16%), mainly due to suicidal caustic ingestion (OR = 5.7: 95% CI: 1.4-23.6) or by drugs, directly related to metformin (OR = 10.1; 95% CI: 2.4-42.4). Conclusions The prevalence of poisoning in the elderly is not negligible, and physicians should have a high index of suspicion in a complex situation (AU)

Poisoning among the elderly.

OBJECTIVES: Poisonings continue to be an important public health problem. Herein, we analyzed the epidemiology of poisonings in elderly individuals. METHODS: Retrospective cohort study conducted between 2011 and 2019 in a university hospital. We analyzed demographic variables, type of poison involved, suicidal or accidental nature of the poisoning, and the probability of admission, or death to the hospital. RESULTS: A total of 880 (6.1%) of the 14,300 poisonings treated in the same period occurred in people over 65 years of age. The most numerous group were individuals between 65-69 years-old (39%), followed by the group of 70-75 years-old (20%), being men 57%. In 88% of the cases a single poison participated, being by frequency alcohol (51.6%), drugs (29.5%), and household or industrial products (12.8%). Alcohol intoxication predominated in men up to 75 years of age, and above this age drug or suicidal intoxication predominated, mainly in women. A total of 145 (16%) subjects were hospitalized, the drugs most frequently implicated being digoxin and benzodiazepines. The probability of hospital admission was associated with intoxication by metformin, digoxin, lithium or with the age of the patient (OR per year = 1.03; 95% CI: 1.0-1.06). A total of 19 patients died (2.16%), mainly due to suicidal caustic ingestion (OR = 5.7: 95% CI: 1.4-23.6) or by drugs, directly related to metformin (OR = 10.1; 95% CI: 2.4-42.4). CONCLUSIONS: The prevalence of poisoning in the elderly is not negligible, and physicians should have a high index of suspicion in a complex situation.

Poisoning among the elderly. / Intoxicaciones en la tercera edad.

OBJECTIVES: Poisonings continue to be an important public health problem. Herein, we analyzed the epidemiology of poisonings in elderly individuals. METHODS: Retrospective cohort study conducted between 2011 and 2019 in a university hospital. We analyzed demographic variables, type of poison involved, suicidal or accidental nature of the poisoning, and the probability of admission, or death to the hospital. RESULTS: A total of 880 (6.1%) of the 14,300 poisonings treated in the same period occurred in people over 65 years of age. The most numerous group were individuals between 65-69 years-old (39%), followed by the group of 70-75 years-old (20%), being men 57%. In 88% of the cases a single poison participated, being by frequency alcohol (51.6%), drugs (29.5%), and household or industrial products (12.8%). Alcohol intoxication predominated in men up to 75 years of age, and above this age drug or suicidal intoxication predominated, mainly in women. A total of 145 (16%) subjects were hospitalized, the drugs most frequently implicated being digoxin and benzodiazepines. The probability of hospital admission was associated with intoxication by metformin, digoxin, lithium or with the age of the patient (OR per year = 1.03; 95% CI: 1.0-1.06). A total of 19 patients died (2.16%), mainly due to suicidal caustic ingestion (OR = 5.7: 95% CI: 1.4-23.6) or by drugs, directly related to metformin (OR = 10.1; 95% CI: 2.4-42.4). CONCLUSIONS: The prevalence of poisoning in the elderly is not negligible, and physicians should have a high index of suspicion in a complex situation.

The prognostic value of the neutrophil-to-lymphocyte ratio in patients with testicular cancer.

OBJECTIVES: To evaluate the potential prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in testicular cancer. MATERIALS AND METHODS: 80 patients with testicular cancer treated at our institution from 2005 to 2018 were retrospectively reviewed. Age, tumor markers, stage and histotype at final pathology, eventual medical treatment, tumor recurrence and follow-up data were extracted. The NLR was retrospectively calculated from blood tests. Data were analyzed by medians comparison, linear correlation, univariate and multivariate Cox regression and survival curve analysis. RESULTS: Population's median age was 33 years and median follow-up was 40.5 months. Overall, the median NLR was significantly reduced after orchiectomy (2.2 [1.55-3.09] vs. 1.77 [1.34-2.46], M-W P<0.001). Post-orchiectomy NLR was higher in patients who had disease recurrence (2.51;IQ 1.84-3.74 vs 1.59; IQ 1.10-2.24; M-W P=0.001), regardless of disease's stage: HR=1,85 (95%CI 0,99-3,46) and HR=1,91 (95%CI 0,96-3,78) for stage disease I or stage II, respectively. After stratification of patients by post-orchiectomy NLR (optimal cut-off: 2.255), patients with lower NLR had significantly longer recurrence-free survival (107.7 months [95%CI 97,7-119,2] vs. 57.65 months [95%CI 48,2-81,1], P<0.001). Univariable and multivariable Cox proportional hazard analyses, showed post-orchiectomy NLR, histotype at final pathology and disseminated disease at diagnosis as predictors of recurrence. CONCLUSION: NLR is a simple and wildly available biomarker. Higher post-orchiectomy NLR was found independently correlated to higher risk of recurrence, regardless of disease stage, which could potentially lead to a worse prognosis.

Occupational exposure to endocrine-disrupting chemicals and other parental risk factors in hypospadias and cryptorchidism development: a case-control study.

AIM OF THE STUDY: Endocrine-disrupting chemicals (EDCs) are exogenous agents that are capable of altering the endocrine system functions, including the regulation of developmental processes. The aim of this study was to investigate the association between EDC exposure and other parental factors in the etiology of hypospadias and cryptorchidism. METHODS: A case-control study was conducted. Cases (n = 210) were infants aged between 6 months and 14 years diagnosed with hypospadias or cryptorchidism who attended the authors' hospital over a period of 18 months, and controls (n = 210) were infants within the same range of age and without any urological disorders who attended the outpatient clinic of the same hospital during the same time period. Their selection was independent of exposures. Data on parental occupational exposure to EDCs and other sociodemographic variables were collected through face-to-face interviews and systematically for both cases and controls. Crude and adjusted odds ratios (ORs) were estimated to control for confounding with their 95% confidence interval (CI) by means of logistic regressions. Specifically, three final models of a dichotomous outcome were constructed: one for cryptorchidism, one for hypospadias, and the third considering both malformations together. The Hosmer-Lemeshow test was used to assess the goodness of fit of the models. Their discriminatory accuracy (DA) was ascertained by estimating their areas under the receiver operating characteristic curves area under the curve (AUC) along with their 95% CI. RESULTS: Associations were found between advanced maternal age (OR adjusted = 1.82; 95% CI: 1.14-2.92), mother's consumption of anti-abortives (OR = 5.40; 95% CI: 1.40-38.5) and other drugs (OR = 2.02; 95% CI: 1.31-3.16) during pregnancy, maternal and paternal occupational exposure to EDCs (OR = 4.08; 95% CI: 2.03-8.96 and OR = 3.90; 95% CI: 2.41-6.48, respectively), fathers smoking (OR = 2.0; 95% CI: 1.33-2.99), and fathers with urological disorders (OR = 2.31; 95% CI: 1.15-4.90). Maternal and paternal high educational level could be protective of cryptorchidism (OR = 0.47; 95% CI: 0.28-0.76 and OR = 0.63; 95% CI: 0.42-0.93, respectively). The DA of the models for the whole sample (AUC = 0.75; 95% CI: 0.70-0.79) for cryptorchidism (AUC = 0.76; 95% CI: 0.71-0.82) and for hypospadias (AUC = 0.75; 95% CI: 0.69-0.81) was moderately high. CONCLUSIONS: Advanced age, some parental occupational exposure to EDCs, some drug consumption, smoking, and the father's history of urological disorders may increase risk and predict the developments of these malformations. Studies with higher samples sizes are needed to assess associations between individual EDC occupational exposures and drugs and these malformations.

Relación entre la percepción del consumo oral de líquidos y el volumen urinario en población sana / Oral fluid intake perception and urine volume in a healthy population

Introducción: el volumen urinario bajo (< 1 ml/kg/h) es el factor etiológico más frecuente en la litiasis renal. Frecuentemente, se asume que los niños que refieren beber mucho tienen una diuresis protectora. En este estudio analizamos el hábito de consumo de líquidos en niños sanos y su relación con el volumen urinario. Metodología: se estudiaron 84 niños, de 5 a 17 años. Se registró la percepción de consumo habitual de líquidos como: "poco", "normal" o "mucho" y los tipos de bebida habitual. Se cuantificó el volumen en orina de 24 h y se relacionó con la percepción de la ingesta de líquidos. Resultados: la ingesta habitual de líquidos fue calificada como "poca" en el 23% de los casos, "normal" en un 56% y "mucha" en un 21%. El 39% de los niños (33/84) presentó una diuresis > 1 ml/kg/h que, por grupos, supone el 38,9% de los que refirieron una ingesta escasa, el 63% de los de consumo "normal" y el 73,7% de los que refirieron ingesta elevada. El 56% de los niños de los grupos de ingesta "normal" y "elevada" mostraron una diuresis < 1 ml/kg/h. Conclusiones: la mayoría de niños mostraron una diuresis por debajo del límite recomendado, incluso entre los que refieren una ingesta "normal" o "elevada" de líquidos. Estos hallazgos hacen visible la necesidad de promover estrategias encaminadas a aumentar el consumo de agua en la población (AU)

Introduction: a low urine volume is a main etiological factor for renal lithiasis (< 1 ml/kg/h). It is commonly assumed that children who report a high fluid intake have a protective urine volume. The purpose of the present study is to assess the habit of fluid intake in healthy schoolchildren and to evaluate its relation with the urinary volume. Methods: eighty-four healthy schoolchildren (5-17 years) were asked to categorize their usual fluid intake amount by choosing one of the three options: "low", "normal" or "high" fluid intake. The usual consumed types of beverage were also recorded. Twenty-four-hour urine volume was measured in each child. The results of the questionnaire were compared to that from the urine samples. Results: a "low" fluid intake was referred by 23% of children, a "normal" fluid intake by 57% and a "high" fluid intake by 21%. Diuresis values > 1 ml/kg/h were observed in 39% of children (that is: 38.9% of the "low intake" group, 63% of the "normal intake" group and 73.7% of the "high intake" group). Among "normal" and "high" intake groups, a urinary output < 1 ml/kg/h was found in 56% of children. Conclusions: a majority of the studied children did not reach the minimum recommended diuresis to prevent urinary lithiasis, even among children who report a high intake of fluids. Strategies aimed at increasing water intake by children population should be highly encouraged (AU)

Rebound growth after hemiepiphysiodesis: An animal-based experimental study of incidence and chronology.

Rebound growth after hemiepiphysiodesis may be a normal event, but little is known about its causes, incidence or factors related to its intensity. The aim of this study was to evaluate rebound growth under controlled experimental conditions. A total of 22 six-week-old rabbits underwent a medial proximal tibial hemiepiphysiodesis using a two-hole plate and screws. Temporal growth plate arrest was maintained for three weeks, and animals were killed at intervals ranging between three days and three weeks after removal of the device. The radiological angulation of the proximal tibia was studied at weekly intervals during and after hemiepiphysiodesis. A histological study of the retrieved proximal physis of the tibia was performed. The mean angulation achieved at three weeks was 34.7° (standard deviation (sd) 3.4), and this remained unchanged for the study period of up to two weeks. By three weeks after removal of the implant the mean angulation had dropped to 28.2° (sd 1.8) (p < 0.001). Histologically, widening of the medial side was noted during the first two weeks. By three weeks this widening had substantially disappeared and the normal columnar structure was virtually re-established. In our rabbit model, rebound was an event of variable incidence and intensity and, when present, did not appear immediately after restoration of growth, but took some time to appear.

Prevalencia de la lactancia materna en el sector de salud del Hospital «Son LLàtzer» de Palma de Mallorca / Prevalence of breastfeeding in the health sector Hospital Son Llàtzer (Palma de Mallorca)

Objetivo: Conocer la incidencia y la prevalencia de la lactancia materna (LM) en los 6 primeros meses de vida, y relacionarla con las variables que predisponen al inicio de la lactancia y su mantenimiento, las dificultades más frecuentes y los motivos de abandono y/o la introducción temprana de otros alimentos. Se pretende comparar las prácticas hospitalarias recomendadas por la Organización Mundial de la Salud y la prevalencia de lactancia materna al inicio. Material y método: Estudio descriptivo transversal con recogida de datos retrospectivos, mediante encuesta telefónica a madres de bebés de 15, 30, 90 y 180 días, y los registros de enfermería de la maternidad sobre alimentación de los recién nacidos. Resultados: La prevalencia de la decisión de lactancia materna en el momento del parto es del 81,2%, y al alta del hospital del 76%. Va descendiendo progresivamente, y a los 15 días de vida es del 73,6%, al mes del 72,5%, a los 3 meses del 56,9%, y a los 6 meses del 37,8%. Las madres que han hecho «piel con piel» después del parto y han iniciado la lactancia precoz en la primera hora tienen una mayor prevalencia de lactancia materna completa frente a lactancia parcial a los 15 días (un 86,6 y un 86,3%, frente un 56,3 y un 55%, respectivamente). La asociación desaparece a partir del primer mes, y tampoco se observa ninguna relación entre la práctica de «piel con piel» y la lactancia materna en la primera hora, con el abandono precoz de la lactancia. La edad de la madre no se asocia al tipo de la lactancia, según los datos obtenidos. El 79,3% de las madres con estudios universitarios mantiene la lactancia hasta los 3 meses, frente al 62,2% de las madres con otros estudios; a los 6 meses, todas lo hacen de forma similar. Los momentos críticos de abandono se presentan alrededor del primer mes, y entre el cuarto y quinto mes de vida. Los motivos de lactancia parcial durante el primer mes son principalmente (75,64%) el llanto, el hambre, la poca ganancia de peso y la leche insuficiente. Los motivos de lactancia parcial entre los 3 y 6 meses son la recomendación profesional (60,6%), motivos de trabajo o estudios (18,2%), y leche insuficiente, llanto o hambre (18,2%). Conclusiones: Las tasas de lactancia materna en el sector de salud del Hospital «Son Llàtzer» son similares a las obtenidas en otros estudios y a las de la Encuesta Nacional de Salud de 2006. Las prácticas hospitalarias adecuadas mejoran la prevalencia de la lactancia al inicio; después son muchos los factores que intervienen. Para mejorar la prevalencia de la lactancia los meses posteriores, se debe mejorar la atención sanitaria tras la hospitalización y las medidas institucionales que la protejan (AU)

Objective: To know the incidence and importance of breastfeeding during the first six months of life, and to relate it to the variables that predispose to the beginning of breastfeeding and maintenance, the most frequent difficulties and the motives for abandoning it and/or introducing other kind of food early. We aim to compare hospital practice recommended by the World Health Organization and the importance of breastfeeding at the beginning. Material and method: Transversal descriptive study with retrospective data gathering, telephonically surveying to mothers of babies 15, 30, 90 and 180 days old and maternity infirmary registries about newborns feeding. Results: 81.2% decide to breastfeed at the moment of birth, 76% after hospital leave. It descends progressively 73.6% after 15 days of life, 72.5% after one month, 56.9% after three months, 37.8% after 6 months. Mothers that hare "touched skin to skin" right after birth and hare initiated breastfeeding during the first hour hare a higher prevalence of full breastfeeding against partial breastfeeding after 15 days is a 86.6 and a 86.3%, against 56.3 and 55%, respectively. The association disappears after the first month, and there is no direct relation between the practice of getting in contact of "skin with skin" during de first hour and the early cessation of breastfeeding. The age of the mother is not associated with the type of lactation according to the gathered data. 79.3% of women who are university students keep on breastfeeding for 3 months, compared to 62.2% in other studies, after 6 months they all do it in a similar way. The critical moments of abandonment are around first month, and between the 4th and 5th month of life. The reasons for partial breastfeeding during the first month are primarily 75.64% crying, hunger, puts on little weight, insufficient milk. The reasons for partial breastfeeding between 3 and 6 months is a 60.6% professional recommendation, a 18.2% because of working or studying and 18.2% insufficient milk, crying or hunger. Conclusions: Rates of breastfeeding in the Hospital Son Llàtzer health sector are similar to those obtained in other studies and those of the 2006 National Health Survey. Appropriate hospital practices improve the prevalence of breastfeeding in the beginning, after that there are a lot of other factors involved. To improve the prevalence of breastfeeding during the subsequent months, health care and measures that protect it should be improved (AU)

[Developmental outcome of extremely low birth weight infants (<1,000 g) during the first three years of life]. / Seguimiento de recién nacidos de peso menor o igual a 1.000 g durante los tres primeros años de vida.

INTRODUCTION: Obstetrics and Perinatal Care has improved in the last few years. As a result there has been a significant increase in preterm babies and longer survival. The risk of abnormalities in their development is high; they need follow up, prompt action and prevention from the neonatal period. MATERIAL AND METHODS: We evaluated 116 preterm babies, birth weight less than or equal to 1,000 grams, admitted to our Unit over 5 years. Seventy five neonates survived after the neonatal period (64.7 %). We studied the development during the first three years of life. RESULTS: The number of admissions of extremely low birth weigh infants has increased by 100 % in the last five years and the survival has increased by 15 %. Failure to thrive was the most frequent problem; in the first 2 years of life neonatal growth retardation was present in more than 50 % of cases (58 % 1st year, 57 % 2nd year, 40 % 3rd year). Catch-up growth occurred except in infants who had intrauterine growth retardation. Motor function disorders were the most serious; minor alterations in this system were the most frequent but usually did not compromise the life of the patient. Cerebral palsy was present in 14 % in the 1st year of life, 17,4 % 2nd year and 19 % 3rd year. Retinopathy of prematurity was very high in our group (74 %), but ophthalmic sequela were infrequent (3.2 % 1st year, 3.9 % 2nd year, and 3.4 % 3rd year); similarly with hearing function (deafness 2.0 %). Only some mild or moderate language development delay was present and psychomotor development was normal in the majority of cases and those who were retarded improved with time. CONCLUSIONS: Nowadays there is a significant increase in the incidence and survival of extremely low birth weigh infants. They have a higher risk of abnormal development. The most frequent problem is failure to thrive and the most serious is cerebral palsy. Major ophthalmic and hearing sequela are rare. Psychomotor and language development is normal in the majority of these patients.

Seguimiento de recién nacidos de peso menor o igual a 1.000 g durante los tres primeros años de vida / Developmental outcome of extremely low birth weight infants (<1.000 g) during the first three years of life

Introducción: Debido a los avances en obstetricia y neonatología nos encontramos actualmente con un aumento importante de recién nacidos prematuros y una mayor supervivencia de éstos. Son niños con mayor riesgo de alteraciones en su desarrollo, por lo que es necesario un seguimiento y una actuación precoces, además de una prevención desde el período neonatal. Material y métodos. Se evalúan 116 prematuros de peso menor o igual a 1.000 g que ingresaron en nuestra unidad durante 5 años. Sobrevivieron al período neonatal 75 (64,7 %) y se hizo un seguimiento de su desarrollo durante los primeros 3 años de vida. Resultados: En esos 5 años aumentó el 100 % el número de ingresos de recién nacidos de bajo peso extremado y la supervivencia subió el 15 %. La secuela más frecuente fue el retraso ponderal; más de la mitad no seguían una curva normal en sus primeros 2 años de vida (el 58 % el primer año, el 57 % el segundo año y el 40 % el tercer año) aunque tendían progresivamente a la normalidad, salvo aquéllos nacidos con retraso del crecimiento intrauterino, que tuvieron peor pronóstico. En cuanto al desarrollo neurológico, las secuelas motoras fueron las más graves; lo más frecuente fueron mínimas alteraciones en la motricidad que no comprometían la vida normal del niño, pero el 14 % presentaba signos de parálisis cerebral el primer año de vida, el 17,4 % el segundo año y el 19 % el tercer año. Aunque el porcentaje de retinopatía de la prematuridad en nuestro grupo fue alto (74 %), las secuelas oftalmológicas fueron escasas (el 3,2 % el primer año, el 3,9 el segundo año y el 2,4 % el tercer año), así como las auditivas (sordera, 2,0 %). El desarrollo del lenguaje y el psicomotor fue normal en la mayoría de los niños y los que presentaron algún retraso fue leve o moderado. Conclusiones: Nos encontramos ante un aumento importante de la incidencia y supervivencia de recién nacidos de bajo peso extremo, con mayor riesgo de presentar secuelas en su desarrollo. La más frecuente es el retraso en la curva ponderal y la más grave, la parálisis cerebral; las alteraciones oftalmológicas y auditivas graves son poco frecuentes y el desarrollo psicomotor y del lenguaje es normal en la mayoría de estos niños (AU)

Introduction: Obstetrics and Perinatal Care has improved in the last few years. As a result there has been a significant increase in preterm babies and longer survival. The risk of abnormalities in their development is high; they need follow up, prompt action and prevention from the neonatal period. Material and methods: We evaluated 116 preterm babies, birth weight less than or equal to 1,000 grams, admitted to our Unit over 5 years. Seventy five neonates survived after the neonatal period (64.7 %). We studied the development during the first three years of life. Results: The number of admissions of extremely low birth weigh infants has increased by 100 % in the last five years and the survival has increased by 15 %. Failure to thrive was the most frequent problem; in the first 2 years of life neonatal growth retardation was present in more than 50 % of cases (58 % 1st year, 57 % 2nd year, 40 % 3rd year). Catch-up growth occurred except in infants who had intrauterine growth retardation. Motor function disorders were the most serious; minor alterations in this system were the most frequent but usually did not compromise the life of the patient. Cerebral palsy was present in 14 % in the 1st year of life, 17,4 % 2nd year and 19 % 3rd year. Retinopathy of prematurity was very high in our group (74 %), but ophthalmic sequela were infrequent (3.2 % 1st year, 3.9 % 2nd year, and 3.4 % 3rd year); similarly with hearing function (deafness 2.0 %). Only some mild or moderate language development delay was present and psychomotor development was normal in the majority of cases and those who were retarded improved with time. Conclusions: Nowadays there is a significant increase in the incidence and survival of extremely low birth weigh infants. They have a higher risk of abnormal development. The most frequent problem is failure to thrive and the most serious is cerebral palsy. Major ophthalmic and hearing sequela are rare. Psychomotor and language development is normal in the majority of these patients (AU)