Correction: Prediction of mortality in very low birth weight neonates in Spain.

[This corrects the article DOI: 10.1371/journal.pone.0235794.].

Early Physiotherapy Intervention Program for Preterm Infants and Parents: A Randomized, Single-Blind Clinical Trial.

BACKGROUND: The early developmental interventions might be designed with a preventative approach to improving the development of at-risk preterm infants. The present study aimed to evaluate the effectiveness of an early physiotherapy intervention on preterm infants' motor and global development, and on parents' stress index. METHODS: 48 infants were enrolled and randomized into two groups. Infants allocated to the intervention group received an early physiotherapy intervention, based on parental education sessions and tactile and kinesthetic stimulation during the NICU period, as well as a home-based activity program. The intervention commenced after 32 weeks post-menstrual age and ended at 2 months corrected age. Infants allocated to the control group received the usual care based on the NIDCAP-care. RESULTS: No differences were found between groups on the Alberta Infant Motor Scale at 2- or 8-months corrected age. Infants in the intervention group showed more optimal fine motor, problem-solving, personal-social, and communication development at 1 month corrected age. CONCLUSIONS: The results showed no effect on the early physiotherapy intervention. Results might be related to the dose or intensity of the intervention, but also to the poor parental compliance. CLINICALTRIALS: gov NCT03313427.

Prediction of mortality in very low birth weight neonates in Spain.

OBJECTIVE: Predictive models for preterm infant mortality have been developed internationally, albeit not valid for all populations. This study aimed to develop and validate different mortality predictive models, using Spanish data, to be applicable to centers with similar morbidity and mortality. METHODS: Infants born alive, admitted to NICU (BW<1500 g or GA<30 w), and registered in the SEN1500 database, were included. There were two time periods; development of the predictive models (2009-2012) and validation (2013-2015). Three models were produced; prenatal (1), first 24 hours of life (2), and whilst admitted (3). For the statistical analysis, hospital mortality was the dependent variable. Significant variables were used in multivariable regression models. Specificity, sensitivity, accuracy, and area under the curve (AUC), for all models, were calculated. RESULTS: Out of 14953 included newborns, 2015 died; 373 (18.5%) in their first 24 hours, 1315 (65.3%) during the first month, and 327 (16.2%) thereafter, before discharge. In the development stage, mortality prediction AUC was 0.834 (95% CI: 0.822-0.846) (p<0.001) in model 1 and 0.872 (95% CI: 0.860-0.884) (p<0.001) in model 2. Model 3's AUC was 0.989 (95% CI: 0.983-0.996) (p<0.001) and 0.942 (95% CI: 0.929-0.956) (p<0.001) during the 0-30 and >30 days of life, respectively. During validation, models 1 and 2 showed moderate concordance, whilst that of model 3 was good. CONCLUSION: Using dynamic models to predict individual mortality can improve outcome estimations. Development of models in the prenatal period, first 24 hours, and during hospital admission, cover key stages of mortality prediction in preterm infants.

Predicción de mortalidad en recién nacidos prematuros. Revisión sistemática actualizada / Prediction of mortality in premature neonates. An updated systematic review

INTRODUCCIÓN: La prematuridad extrema se asocia a altas tasas de mortalidad. Para profesionales y familias, es prioritario establecer de forma individualizada las probabilidades de muerte en diferentes momentos. El objetivo de este estudio es efectuar una revisión sistemática de modelos predictivos de mortalidad en prematuros publicados recientemente. MÉTODOS: Doble búsqueda de artículos publicados en PubMed sobre modelos predictivos de muerte en prematuros. Población estudiada: prematuros con edad gestacional ≤ 30 semanas o peso al nacer ≤ 1.500 g. Inclusión: trabajos publicados con nuevos modelos desde junio del 2010 hasta julio del 2019, tras revisión sistemática de Medlock (2011). Se valoran: población, características de modelos, variables utilizadas, medidas de funcionamiento y validación. RESULTADOS: De 7.744 referencias (primera búsqueda) y 1.435 (segunda búsqueda), se seleccionaron 31 trabajos, incluyéndose al final 8 nuevos modelos. Cinco modelos (62,5%) se desarrollaron en América del Norte y 2 (25%) en Europa. Un modelo secuencial (Ambalavanan) permite realizar predicciones de muerte al nacer, 7, 28 días de vida y 36 semanas posmenstruales. Análisis de regresión logística múltiple en el 87,5% de modelos. La discriminación poblacional se midió por odds ratio (75%) y área bajo la curva (50%). La «validación» se ha realizado en 5 modelos (interna). Tres modelos disponen de acceso online. No hay modelos predictivos validados en España. CONCLUSIONES: La toma de decisiones basada en modelos predictivos permite una mayor individualización de la atención dada a un niño prematuro y una mejor utilización de recursos. Es necesario desarrollar modelos de predicción de mortalidad en prematuros de España

INTRODUCTION: Extreme prematurity is associated with high mortality rates. The probability of death at different points in time is a priority for professionals and parents, and needs to be established on an individual basis. The aim of this study is to carry out a systematic review of predictive models of mortality in premature infants that have been published recently. METHODS: A double search was performed for article published in PubMed on models predicting mortality in premature neonates. The population studied were premature neonates with a gestational age of ≤ 30 weeks and / or a weight at birth of ≤ 1500g. Works published with new models from June 2010 to July 2019 after a systematic review by Medlock (2011) were included. An assessment was made of the population, characteristics of the model, variables used, measurements of functioning, and validation. RESULTS: Of the 7744 references (1st search) and 1435 (2nd search) found, 31 works were selected, with 8 new models finally being included. Five models (62.5%) were developed in North America and 2 (25%) in Europe. A sequential model (Ambalavanan) enables predictions of mortality to be made at birth, 7, 28 days of life, and 36 weeks post-menstrual. A multiple logistic regression analysis was performed on 87.5% of the models. The population discrimination was measured using Odds Ratio (75%) and the area under the curve (50%). "Internal Validation" had been carried out on 5 models. Three models can be accessed on-line. There are no predictive models validated in Spain. CONCLUSIONS: The making of decisions based on predictive models can lead to the care given to the premature infant being more individualised and with a better use of resources. Predictive models of mortality in premature neonates in Spain need to be developed

Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants / Desfechos clínicos após tratamento mais conservador da persistência do canal arterial em prematuros

Abstract Objective: Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation. Method: Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009-2011), patients who failed medical treatment underwent surgical closure; in second period (2012-2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival-without-morbidity were compared. Results: This study included 188 patients (27 ± 2 weeks, 973 ± 272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85.7% P1 versus 56% P2, p < 0.001) and surgical closure (34.5% P1 versus 16.1% P2, p < 0.001) were observed. No differences were found in chronic lung disease (28.8% versus 13.9%, p = 0.056), severe retinopathy of prematurity (7.5% versus 11.8%, p = 0.403), necrotizing enterocolitis (15.5% versus 6.9%, p = 0.071), severe intraventricular hemorrhage (25.4% versus 18.4%, p = 0.264), mortality (17.5% versus 15.2%, p = 0.690) or survival-without-morbidity adjusted OR = 1.10 (95% CI: 0.55-2.22); p = 0.783. In P2, 24.5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (n = 82) showed significant differences: lower incidence of chronic lung disease (50% versus 19.6%, p = 0.019) and more survival-without-morbidity (20% versus 45.6%, p = 0.028) were found. Conclusion: A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival-without-morbidity. However, two-thirds of preterm infants under 26 weeks are still treated.

Resumo Objetivo O tratamento da persistência do canal arterial ainda é controverso. Nosso objetivo foi descrever o impacto de uma abordagem mais conservadora em nossas taxas de tratamento e nos principais desfechos da prematuridade, especialmente em prematuros com < 26 semanas de gestação. Método Revisão de prontuários de lactentes com ≤ 30 semanas e persistência do canal arterial entre 2009-2016 em dois centros. Em 2011, mudamos o manejo da persistência do canal arterial: no primeiro período (2009-2011), os pacientes que não apresentaram sucesso com o tratamento clínico foram submetidos a fechamento cirúrgico; no segundo período (2012-2016), apenas aqueles com comprometimento cardiopulmonar foram submetidos ao fechamento cirúrgico. Comparamos o tratamento clínico, fechamento cirúrgico, mortalidade e sobrevida sem morbidade. Resultados Foram incluídos 188 pacientes (27 ± 2 semanas, 973 ± 272 gramas); 63 em P1 e 125 em P2. Em P2, foram observadas taxas significativamente mais baixas de tratamento clínico (85,7% no P1 versus 56% no P2, p < 0,001) e fechamento cirúrgico (34,5% no P1 versus 16,1% no P2, p < 0,001). Não foram encontradas diferenças em relação à doença pulmonar crônica (28,8% versus 13,9%, p = 0,056), retinopatia grave da prematuridade (7,5% versus 11,8%, p = 0,403), enterocolite necrosante (15,5% versus 6,9%, p = 0,071), hemorragia intraventricular grave (25,4% versus 18,4%, p = 0,264), mortalidade (17,5% versus 15,2%, p = 0,690) ou OR ajustado pela sobrevida sem morbidade = 1,10 (IC95%: 0,55-2,22); p = 0,783. Em P2, 24,5% dos pacientes receberam alta com persistência do canal arterial. O subgrupo nascido entre 23 a 26 semanas (n = 82) apresentou diferenças significativas, foram encontradas menor incidência de doença pulmonar crônica (50% versus 19,6%, p = 0,019) e maior sobrevida sem morbidade (20% versus 45,6%, p = 0,028). Conclusão Uma abordagem conservadora em prematuros com persistência do canal arterial pode evitar tratamentos clínicos e cirúrgicos, sem um impacto significativo na sobrevida sem morbidade. No entanto, dois terços dos prematuros com menos de 26 semanas ainda são tratados.

[Prediction of mortality in premature neonates. An updated systematic review]. / Predicción de mortalidad en recién nacidos prematuros. Revisión sistemática actualizada.

INTRODUCTION: Extreme prematurity is associated with high mortality rates. The probability of death at different points in time is a priority for professionals and parents, and needs to be established on an individual basis. The aim of this study is to carry out a systematic review of predictive models of mortality in premature infants that have been published recently. METHODS: A double search was performed for article published in PubMed on models predicting mortality in premature neonates. The population studied were premature neonates with a gestational age of ≤30 weeks and / or a weight at birth of ≤1500g. Works published with new models from June 2010 to July 2019 after a systematic review by Medlock (2011) were included. An assessment was made of the population, characteristics of the model, variables used, measurements of functioning, and validation. RESULTS: Of the 7744 references (1st search) and 1435 (2nd search) found, 31 works were selected, with 8 new models finally being included. Five models (62.5%) were developed in North America and 2 (25%) in Europe. A sequential model (Ambalavanan) enables predictions of mortality to be made at birth, 7, 28 days of life, and 36 weeks post-menstrual. A multiple logistic regression analysis was performed on 87.5% of the models. The population discrimination was measured using Odds Ratio (75%) and the area under the curve (50%). "Internal Validation" had been carried out on 5 models. Three models can be accessed on-line. There are no predictive models validated in Spain. CONCLUSIONS: The making of decisions based on predictive models can lead to the care given to the premature infant being more individualised and with a better use of resources. Predictive models of mortality in premature neonates in Spain need to be developed.

Survey of neonatal resuscitation practices showed post-training improvements but need to reinforce preterm management, monitoring and adrenaline use.

AIM: Neonatal resuscitation surveys have showed practice variations between countries, centres and levels of care. We evaluated delivery room practices after a nationwide neonatal resuscitation training programme focused on nontertiary centres. METHODS: A 2012 survey sent to all Spanish hospitals handling deliveries covered staff availability and training, equipment and practices in the delivery room and during transfers to neonatal intensive care units. The results from 98 centres that had completed a previous survey in 2007 were analysed by levels of care. Pearson's chi-square test was used to compare the proportions. RESULTS: The following had significantly improved in 2012 compared to 2007: the availability of T-piece resuscitators (71.4% vs. 41.8%), plastic wraps (69.4% vs. 31.6%), gas blenders (79.6% vs. 40.8%), pulse oximetry (92.9% vs. 61.2%), use of continuous positive airway pressure (82.7% vs. 43.9%) (all p < 0.01), the availability of instructors (55.6% vs. 83.3%, p < 0.05) and neonatal resuscitation courses (40.8% vs. 79.6%, p < 0.05) in nontertiary centres. In 2012, the use of exhaled carbon dioxide detectors was <7% and endotracheal administration of adrenaline was >90%. CONCLUSION: Neonatal resuscitation equipment and practices improved over time, but several aspects needed to be reinforced in training programmes, namely preterm infants' management, monitoring and adrenaline administration.

Survival and Neurodevelopmental Outcomes of Preterms Resuscitated With Different Oxygen Fractions.

BACKGROUND AND OBJECTIVES: Stabilization of preterm infants after birth frequently requires oxygen supplementation. At present the optimal initial oxygen inspiratory fraction (Fio2) for preterm stabilization after birth is still under debate. We aimed to compare neurodevelopmental outcomes of extremely preterm infants at 24 months corrected age randomly assigned to be stabilized after birth with an initial Fio2 of 0.3 versus 0.6 to 0.65 in 3 academic centers from Spain and the Netherlands. METHODS: Randomized, controlled, double-blinded, multicenter, international clinical trial enrolling preterm infants <32 weeks' gestation assigned to an initial Fio2 of 0.3 (Lowox group) or 0.6 to 0.65 (Hiox group). During stabilization, arterial pulse oxygen saturation and heart rate were continuously monitored and Fio2 was individually titrated to keep infants within recommended ranges. At 24 months, blinded researchers used the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) to assess visual acuity, neurosensory deafness, and language skills. RESULTS: A total of 253 infants were recruited and 206 (81.4%) completed follow-up. No differences in perinatal characteristics, oxidative stress, or morbidities during the neonatal period were assessed. Mortality at hospital discharge or when follow-up was completed didn't show differences between the groups. No differences regarding Bayley-III scale scores (motor, cognitive, and language composites), neurosensorial handicaps, cerebral palsy, or language skills between groups were found. CONCLUSIONS: The use of an initial lower (0.3) or higher (0.6-0.65) Fio2 during stabilization of extremely preterm infants in the delivery room does not influence survival or neurodevelopmental outcomes at 24 months.

Lung Ultrasound as a Predictor of Mechanical Ventilation in Neonates Older than 32 Weeks.

BACKGROUND: The prognosis of neonatal respiratory distress may be difficult to estimate at admission. Lung ultrasound is a useful diagnostic tool that is quick, requires little training, and is radiation free. OBJECTIVE: This study aims to analyze whether early lung ultrasound can predict respiratory failure. METHODS: From January to December 2014, lung ultrasound was performed on neonates admitted with breathing difficulties if they were older than 32 weeks and not intubated. A neonatologist, not aware of the patient's clinical condition, analyzed the stored ultrasound images. The findings were classified into the following 2 groups according to the potential risk of a bad respiratory outcome: low risk (normal or transient tachypnea of the newborn) or high risk (respiratory distress syndrome, meconium aspiration syndrome, pneumothorax, or pneumonia). A second investigator made the same classification after reading the chest X-rays. Respiratory failure was defined as a need for mechanical ventilation during the first day of life. RESULTS: In total, 105 neonates were recruited (64.8% in the low-risk sonography group and 35.2% in the high-risk sonography group). Of those, 20% needed intubation, and this was more frequent in the high-risk group (relative risk = 17.5; 95% CI 4.3-70.9, p < 0.01). As predictors of respiratory failure, lung ultrasound and chest X-ray showed a high index of agreement (κ coefficient = 0.91; 95% CI 0.83-1, p < 0.01) and good accuracy (ultrasound: 95% sensitivity, 82.5% specificity, and a negative predictive value of 98.5%). CONCLUSIONS: Early lung ultrasound is a useful tool to determine which neonates admitted with respiratory distress will require mechanical ventilation. It may help the clinician to carrying out appropriate transfers.

Changes in Parenteral Nutrition During the First Week of Life Influence Early but Not Late Postnatal Growth in Very Low-Birth-Weight Infants.

BACKGROUND AND AIMS: Postnatal growth restriction remains a serious problem in very low-birth-weight infants. Enhanced parenteral supply of nutrients as soon as possible after birth is one of the strategies addressed to avoid extrauterine growth restriction. We aimed to analyze changes in growth patterns and in clinical outcomes in our unit after a change in our parenteral nutrition (PN) protocol. METHODS: We collected data from 2 time periods, comprising the 2 years before (period I) and the 2 years after (period II) the change of protocol. We included 142 very low-birth-weight infants ≤32 weeks of gestation with a birth weight ≤1500 g. Data regarding nutrition intakes (parenteral and enteral) in the first week of life, growth during admission, and clinical outcomes were retrieved from clinical charts. RESULTS: Babies in period II received a higher nutrition supply during the first week of life, but no further differences were found after this period. Weight at 14 days of life was significantly higher in period II but not at day 28 of life or discharge. CONCLUSIONS: In our population, an enhanced PN regimen for very low-birth-weight infants led to a better growth at 14 days of life. However, this positive effect had disappeared at day 28 of life. Strategies to improve nutrient supply once the preterm baby is stable and on full enteral feeds should be implemented and analyzed.

[Hypotonia in the neonatal period: 12 years' experience]. / Hipotonía en el período neonatal: 12 años de experiencia.

INTRODUCTION: Hypotonia is one of the most frequent signs of neurological pathology in newborn infants. AIMS: To determine, in a 12-year retrospective study, the relative frequency of neurological pathologies that can be accompanied by hypotonia during the neonatal period and to describe the neurological development after two years' follow-up. PATIENTS AND METHODS: We conducted a systematic review of the newborn infants with hypotonia due to an identifiable cause who were admitted to the neonatal unit of the Hospital Sant Joan de Deu between January 1996 and December 2008. Information collected referred to family history, data related with the pregnancy and childbirth, clinical features and complementary tests. RESULTS. A total of 73 hypotonic newborn infants were identified, 21 (28.7%) of whom met eligibility criteria. The majority, 81% (n = 17), were classified as central hypotonias and the remaining 19% (n = 4) were graded as peripheral hypotonias. In the first group, 47% (n = 8) presented chromosomal disorders, 29.4% (n = 5) had metabolic diseases and 23.5% (n = 4) displayed malformations of the central nervous system. CONCLUSIONS: The central causes of hypotonia continue to be the most prevalent in the neonatal period and, within these, chromosomal disorders are the most frequent. Peripheral causes are less common and have a more severe prognosis. Advances in molecular genetics have allowed many neuromuscular diseases to be diagnosed both genetically and at the molecular level. The diversity and complexity of the pathologies justifies a multidisciplinary approach being taken to treat these newborn infants.

Hipotonía en el período neonatal: 12 años de experiencia / Hypotonia in the neonatal period: 12 years' experience

Introducción. La hipotonía es uno de los signos más frecuentes de patología neurológica en el neonato. Objetivos. Determinar, en un estudio retrospectivo a 12 años, la frecuencia relativa de patologías neurológicas que pueden cursar con hipotonía durante el período neonatal y describir la evolución neurológica a los dos años de seguimiento. Pacientes y métodos. Revisión sistemática de los recién nacidos hipotónicos sin causa identificable que ingresaron en la unidad neonatal del Hospital Sant Joan de Déu de enero de 1996 a diciembre de 2008. Se han recogido antecedentes familiares, datos relacionados con el embarazo y parto, características clínicas y pruebas complementarias. Resultados. Se identificaron 73 recién nacidos hipotónicos, de los cuales 21 (28,7%) cumplieron los criterios de inclusión. El 81% (n = 17) se clasificó como hipotonías centrales y el 19% (n = 4) como hipotonías periféricas. En el primer grupo, el 47% (n = 8) presentó alteraciones cromosómicas; el 29,4% (n = 5), enfermedades metabólicas, y el 23,5% (n = 4), malformaciones del sistema nervioso central. Conclusiones. Las causas centrales de hipotonía siguen siendo las más prevalentes en el período neonatal y, dentro de éstas, las cromosomopatías. Las causas periféricas son menos frecuentes y de pronóstico más grave. Los avances en genética molecular han permitido el diagnóstico genético y molecular de numerosas enfermedades neuromusculares. La diversidad y complejidad de patologías justifica el abordaje multidisciplinar de estos recién nacidos (AU)

Introduction. Hypotonia is one of the most frequent signs of neurological pathology in newborn infants. Aims. To determine, in a 12-year retrospective study, the relative frequency of neurological pathologies that can be accompanied by hypotonia during the neonatal period and to describe the neurological development after two years’ follow-up. Patients and methods. We conducted a systematic review of the newborn infants with hypotonia due to an identifiable cause who were admitted to the neonatal unit of the Hospital Sant Joan de Déu between January 1996 and December 2008. Information collected referred to family history, data related with the pregnancy and childbirth, clinical features and complementary tests. Results. A total of 73 hypotonic newborn infants were identified, 21 (28.7%) of whom met eligibility criteria. The majority, 81% (n = 17), were classified as central hypotonias and the remaining 19% (n = 4) were graded as peripheral hypotonias. In the first group, 47% (n = 8) presented chromosomal disorders, 29.4% (n = 5) had metabolic diseases and 23.5% (n = 4) displayed malformations of the central nervous system. Conclusions. The central causes of hypotonia continue to be the most prevalent in the neonatal period and, within these, chromosomal disorders are the most frequent. Peripheral causes are less common and have a more severe prognosis. Advances in molecular genetics have allowed many neuromuscular diseases to be diagnosed both genetically and at the molecular level. The diversity and complexity of the pathologies justifies a multidisciplinary approach being taken to treat these newborn infants (AU)

Desarrollo léxico en el prematuro: medidas del vocabulario expresivo en el segundo año de vida / Lexical development in preterms: expressive vocabulary measures in the second year of life

Diversos trabajos previos han mostrado que el desarrollo léxico y gramatical puede estar comprometido en niños nacidos muy prematuramente, aunque los resultados de distintas investigaciones no siempre resultan coincidentes. Se presentan aquí los resultados de una muestra de niños sanos, nacidos muy prematuramente ≤ 32 semanas gestación y ≤ 1.500 g de peso al nacer), en los que se obtuvieron medidas del vocabulario expresivo a los 12, 18 y 24 meses (edad corregida por gestación) mediante el Inventario de Desarrollo Comunicativo MacArthur. Los datos de esta muestra se comparan con los obtenidos por tres grupos independientes de nacidos a término, procedentes del mismo hospital y comparables en lengua familiar y estatus socioeconómico. Los resultados muestran diferencias significativas en el vocabulario total expresivo alcanzado a los 18 y los 24 meses, pero no así en el primer nivel de edad analizado. En la composición del vocabulario, distinguiendo entre rutinas, nombres, predicados y palabras gramaticales, observamos diferencias significativas en todas las categorías a los 18 meses, aunque a los 24 meses sólo se mantienen las diferencias relativas a rutinas y nombres. En un segundo análisis de los datos, dividiendo la muestra según el sexo, se comprueba que, tanto a los 18 como a los 24 meses, las diferencias significativas entre prematuros y controles se sitúan exclusivamente en la muestra de niños y se manifestaban en todas las categorías analizadas. En conjunto, estos resultados apuntan a un ritmo inicial de crecimiento léxico (expresivo) más lento en el prematuro, sólo aparente a partir de los 18 meses y con mayor incidencia en la población masculina. Se discute el valor de estos datos en relación con el desarrollo lingüístico posterior en esta población de riesgo (AU)

Previous research has shown that lexical and grammatical development may be compromised in very preterm infants, although results from different studies are not always coincident. Expressive lexicon measures were obtained in a sample of healthy very preterm infants (≤ 32 gestation weeks and birth weight ≤ 1500 g), using the MacArthur Communicative Development Inventory at 12, 18 and 24 months of age (corrected for gestation). Data from this sample were compared with results from three independent groups of full term infants born in the same hospital and with comparable language background and socioeconomic status. Significant differences were found in total number of words produced at 18 and 24 months of age, but not at the first age level under analysis. Regarding vocabulary composition, significant differences were observed in all categories under study (social words, nouns, predicates and function words) at 18 months of age, but at 24 months significant differences were restricted to the categories of social words and nouns. Further analysis of the data by gender revealed that differences between full term and preterm infants reached significance in the male subgroup, both at 18 and 24 months of age and for all lexical categories. Taken together these results suggest an initially slower expressive lexicon development in the population of infants born preterm, but differences are only evident from age 18 months and with a higher incidence in the male subgroup. The paper discusses the predictive value of these data for later language outcomes in this at risk population (AU)

A prospective incidence study of nosocomial infections in a neonatal care unit.

BACKGROUND: Health care improvements and technical advances for diagnostic and therapeutic management in the neonatal care unit (NCU) have made possible the increasing survival of neonates with severe pathologic conditions. However, nosocomial infections (NI) still represent an important cause of morbidity and mortality in this population. OBJECTIVE: To describe the epidemiologic profile of NI in the NCU. METHODS: A prospective surveillance study was performed in the NCU at a university hospital in Barcelona during 6 months. Two hundred sixty-eight neonates were admitted during the study period. Centers for Disease Control and Prevention criteria were used as standard definitions for NI. Data including risk factors associated with NI were recorded. RESULTS: Sixty-five neonates had a total of 88 NI. The incidence rate of NI was 1.6 per 100 patient-days. The accumulative rate of NI was 32.7 per 100 admissions. Bacteremia (28.4%), conjunctivitis (19.5%), respiratory infection (10.2%), and urinary tract infection (7.9%) were the most common episodes observed. Gram-positive bacteria were the most commonly isolated germs (76.4%), with coagulase-negative Staphylococcus (72.5%) being the main pathogen. Intrinsic risk factors related to NI were low birth weight (<1000 g) and urinary catheter and peripheral venous catheter (P<.01). CONCLUSIONS: NI represent an important and frequent problem in neonates. Knowledge of the incidence of NI allows the targeting and implementation of preventive strategies for reducing morbidity and mortality related to NI in an NCU.

Geomorfología de la cuenca inferior del río Salado como base para la investigación hidrológica

Explica que para el estudio integral de la cuenca del río Salado en la provincia de Santa Fe, se confeccionó el mapa geomorfológico orientado hacia el comportamiento hidrológico del sistema. Identifica y analiza los elementos morfológicos de mayor incidencia en el funcionamiento hídrico