Lactancia materna en España y factores relacionados con su instauración y mantenimiento: estudio LAyDI (PAPenRed) / Breastfeeding in Spain and the factors related to its establishment and maintenance: LAyDI Study (PAPenRed)

Objetivo: Conocer estadísticas reales sobre lactancia materna en España, así como factores socioculturales y perinatales que afectan a su inicio y mantenimiento. Diseño: Estudio prospectivo, multicéntrico, longitudinal, de ámbito nacional (estudio LAyDI). Sitio: Consulta de pediatras de atención primaria. Participantes: Cohorte de recién nacidos entre abril de 2017 y marzo de 2018 en España que se siguieron hasta los dos años en ocho visitas. Medidas principales: Se analizaron las tasas de los diferentes tipos de lactancia en cada visita y también se analizaron variables relacionadas con la gestación, el parto, el período neonatal, sociales, económicas y biológicas. Resultados: Muestra inicial de 1.946 (50,1% varones). El 90,7% decidieron iniciar lactancia materna al nacimiento. La cifra de lactancia materna exclusiva (LME) fue del 66,4% a los 15días y del 35,2% a los 6meses. Cualquier tipo de lactancia materna (lactancia materna total [LMT]) a los 6meses fue del 61,7%. La supervivencia de LMT presentó una mediana de 6,0meses (IC95%: 6,0-6,1). Variables relacionadas con LME a los 15días: hijos previos, nivel de educación de madre, ausencia de enfermedad durante el embarazo, no separación madre e hijo al nacer, no utilización de chupete, no existencia de problemas en pezones, y momento de decisión tipo lactancia. Variables relacionadas con mayor duración LMT son: la relación mayor de 5años de los padres, no usar de chupete, colecho al mes de vida, decidir lactancia materna antes del embarazo, recibir información sobre lactancia durante el embarazo y utilizar apoyo de asociaciones. Conclusiones: El abandono temprano de la lactancia materna es un problema importante en las sociedades occidentales. Existen factores sobre los que se puede actuar para mejorar resultados.(AU)

Objective: To find out actual statistics on breastfeeding in Spain, as well as sociocultural and perinatal factors that affect its initiation and maintenance. Design: Prospective, multicentre, longitudinal, nationwide study (XXX study). Site: Primary care paediatricians’ office. Participants: Cohort of newborns born between April 2017 and March 2018 in Spain who were followed up to two years of age in 8 visits. Main measures: Rates of different types of breastfeeding were analysed at each visit and variables related to gestation, delivery, neonatal period, social, economic and biological variables were also analysed. Results: Initial sample of 1946 (50.1% male). 90.7% decided to initiate breastfeeding at birth. Exclusive breastfeeding (EBF) was 66.4% at 15days and 35.2% at 6months. Any type of breastfeeding (total breastfeeding [TBF]) at 6months was 61.7%. Median survival from TBF was 6.0months (95%CI: 6.0-6.1). Variables related to EBF at 15days: previous children, mother's level of education, absence of illness during pregnancy, no separation of mother and child at birth, no dummy use, no nipple problems, and time of decision to breastfeed. Variables related to longer duration of TBF: relationship of parents older than 5years, no dummy use, co-sleeping at one month of life, deciding to breastfeed before pregnancy, receiving information on breastfeeding during pregnancy and using support from associations. Conclusions: Early abandonment of breastfeeding is a major problem in Western societies. There are factors that can be worked on to improve outcomes.(AU)

[Breastfeeding in Spain and the factors related to its establishment and maintenance: LAyDI Study (PAPenRed)]. / Lactancia materna en España y factores relacionados con su instauración y mantenimiento: estudio LAyDI (PAPenRed).

OBJECTIVE: To find out actual statistics on breastfeeding in Spain, as well as sociocultural and perinatal factors that affect its initiation and maintenance. DESIGN: Prospective, multicentre, longitudinal, nationwide study (XXX study). SITE: Primary care paediatricians' office. PARTICIPANTS: Cohort of newborns born between April 2017 and March 2018 in Spain who were followed up to two years of age in 8 visits. MAIN MEASURES: Rates of different types of breastfeeding were analysed at each visit and variables related to gestation, delivery, neonatal period, social, economic and biological variables were also analysed. RESULTS: Initial sample of 1946 (50.1% male). 90.7% decided to initiate breastfeeding at birth. Exclusive breastfeeding (EBF) was 66.4% at 15days and 35.2% at 6months. Any type of breastfeeding (total breastfeeding [TBF]) at 6months was 61.7%. Median survival from TBF was 6.0months (95%CI: 6.0-6.1). Variables related to EBF at 15days: previous children, mother's level of education, absence of illness during pregnancy, no separation of mother and child at birth, no dummy use, no nipple problems, and time of decision to breastfeed. Variables related to longer duration of TBF: relationship of parents older than 5years, no dummy use, co-sleeping at one month of life, deciding to breastfeed before pregnancy, receiving information on breastfeeding during pregnancy and using support from associations. CONCLUSIONS: Early abandonment of breastfeeding is a major problem in Western societies. There are factors that can be worked on to improve outcomes.

Evaluación del sistema parasimpático durante procedimientos dolorosos en neonatología / Parasympathetic evaluation for procedural pain assessment in neonatology

Introducción: El monitor NIPE (Newborn Infant Parasympathetic Evaluation) es una herramienta rápida, continua y objetiva de evaluación del disconfort neonatal. Los objetivos fueron describir los cambios del NIPE tras una extracción sanguínea y los factores implicados en su variación. Material y métodos: Estudio observacional analítico con recogida de datos prospectiva. Se incluyeron los recién nacidos ingresados en cuidados intensivos entre junio y diciembre de 2021 a quienes se les realizó extracción sanguínea. Se recogieron variables demográficas, las relacionadas con la realización del procedimiento, la puntuación NIPE, la frecuencia cardiaca previa y en los minutos 1, 2, 3, 4, 5, 10 y 15 posteriores. Resultados: Se incluyeron 86 registros de 49 pacientes. Durante los primeros cuatro minutos tras el procedimiento hubo un descenso significativo en la puntuación NIPE, siendo el descenso máximo de un 22,8% respecto al valor basal, produciéndose el nadir a los 2,79 minutos. El mayor descenso del NIPE ocurrió en pacientes prematuros, varones, con menor Apgar a los cinco minutos, en procedimientos ya realizados previamente, tras cesárea y en horario matutino. No hubo diferencias con la realización en canguro. La correlación entre NIPE y frecuencia cardíaca fue débil. Conclusiones:Tras un procedimiento doloroso, como una extracción sanguínea, el monitor NIPE mostró un descenso significativo los primeros cuatro minutos, agudizándose el descenso con la prematuridad, la reiteración de procedimientos o el nacimiento tras cesárea. El monitor NIPE puede ayudar a identificar eficazmente a aquellos neonatos que sufren dolor agudo tras un procedimiento, complementándose con las escalas de valoración clínica. (AU)

Introduction: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. Material and methods: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15min after the procedure. Results: The study included 86 records for 49 patients. In the first 4min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. Conclusions: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales. (AU)

Parasympathetic evaluation for procedural pain assessment in neonatology.

INTRODUCTION: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. MATERIAL AND METHODS: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15 min after the procedure. RESULTS: The study included 86 records for 49 patients. In the first 4 min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79 min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. CONCLUSIONS: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4 min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales.

Rituximab treatment in pediatric patients with steroid-dependent nephrotic syndrome: A tertiary hospital.

BACKGROUND: Corticosteroids have had a central role in the treatment of nephrotic syndrome. The management of these patients who become dependent to steroids is complex, involving different immunosuppressive drugs patterns. The monoclonal antibody anti CD20, Rituximab, is likely to have beneficial effects in cases of steroid-dependent nephrotic syndrome patients with no easy resolution, even when we cannot make a statement about the specific role in the impact. We bring our personal experience in pediatric patients treated with this medication during the last years, to provide a thorough overview and useful information about the role of Rituximab in this pathology. METHODS: Retrospective study in patients with steroid-dependent idiopathic nephrotic syndrome controlled in the division of Pediatric Nephrology of a Spanish tertiary hospital in those patients who had received at least one treatment cycle of Rituximab, at any moment along the evolution of the disease. RESULTS: The study involved 8 patients. All of them previously received immunosuppressive therapy. The Rituximab were administered as an intravenous infusion, in a dose of 375 mg/m2, and all doses were administered in a period during which the disease was in remission. The depletion of lymphocytes B (CD19, 0%) were confirmed after the first dose of Rituximab except for one, with a lymphocyte count of 1%. The period of depletion lasts 10,3 months (median; range 6,5-16 months), and only one of the patients registered a relapse of the disease in this period. A reduction of relapses suffered by patients has been shown after the treatment began (3,6 relapses/year in the previous year to the start of the treatment versus 0,1 relapses/year during the first year post-rituximab). The relapse-free survival in the first year reached 83,3% in patients who suffered more than one relapse (75% of patients), and without a relapse after the treatment began in 2 cases. One or more drugs could be removed in 87,5% of patients after the first cycle of rituximab. After the rituximab treatment, we reached a 96,5% decrease in the corticosteroids doses administered (28,5 mg/m2/day during the 3 months pre-treatment versus 1 mg/m2/day in the last 3 months of patient monitoring). Not a significant observed adverse effect attributed to the drug after the post-rituximab monitoring period (median 46,5 months, range 5-97 months). CONCLUSION: The favorable results reported after rituximab treatment in our patients seems to confirm the effectiveness of this drug in the steroid-dependent nephrotic syndrome, making that therapeutic option into consideration and legitimating the use of the drug in complex cases involving pediatric patients. Even so, it seems recommendable to design pertinent studies to clarify, among others, the optimum regimen of the treatment (dose, interval and cycles), clinical repercussion and potential adverse effects in long terms.

Tratamiento con rituximab en pacientes pediátricos con síndrome nefrótico córtico-dependiente. Experiencia en un hospital terciario / Rituximab treatment in pediatric patients with steroid-dependent nephrotic syndrome: a tertiary hospital

Introducción: La corticoterapia continúa siendo la piedra angular en el tratamiento del síndrome nefrótico. El manejo de los pacientes que desarrollan dependencia a esteroides es complejo, implicando distintas pautas de fármacos inmunosupresores. El rituximab, anticuerpo monoclonal anti-CD20, parece tener efectos beneficiosos en pacientes con síndrome nefrótico córtico-dependiente de difícil manejo clínico, si bien aún no está bien definido su papel en esta entidad. Con el fin de aportar información útil sobre el papel del rituximab en esta patología, presentamos nuestra experiencia personal en pacientes pediátricos tratados con este fármaco en los últimos años. Materiales y métodos: Estudio retrospectivo en pacientes con síndrome nefrótico idiopático córtico-dependiente controlados en la Sección de Nefrología Pediátrica de un hospital terciario español, y que habían recibido, al menos, un ciclo de tratamiento con rituximab durante cualquier momento de la evolución de la enfermedad. (AU)

Background: Corticosteroids have had a central role in the treatment of nephrotic syndrome. The management of these patients who become dependent to steroids is complex, involving different immunosuppressive drugs patterns. The monoclonal antibody anti CD20, Rituximab, is likely to have beneficial effects in cases of steroid-dependent nephrotic syndrome patients with no easy resolution, even when we cannot make a statement about the specific role in the impact. We bring our personal experience in pediatric patients treated with this medication during the last years, to provide a thorough overview and useful information about the role of Rituximab in this pathology. Methods: Retrospective study in patients with steroid-dependent idiopathic nephrotic syndrome controlled in the division of Pediatric Nephrology of a spanish tertiary hospital in those patients who had received at least one treatment cycle of Rituximab, at any moment along the evolution of the disease. (AU)

Antibiotherapy at birth in very low birth weight infants before and after the use of interleukin 6 as an infectious biomarker in a tertiary level unit.

BACKGROUND: Neonatal sepsis is a condition with high mortality and morbidity that contributes to high rates of antibiotic therapy at birth. In addition, very low birth weight newborns (VLBWN) are particularly vulnerable. Interleukin 6 (IL-6) seems to be an early and effective marker that could help a better selection of patients to be treated. This study aimed to evaluate the use of antibiotics in the first 72 hours of life in VLBW infants before and after using IL-6 as an infection marker. Also, we wanted to analyze the differences in morbidity and mortality during admission and other factors associated with the decision to start antibiotic treatment. METHODS: We conducted a cohort retrospective study. We included VLBWN born in our hospital or admitted before 72 hours of life in two two-year periods (2007-2008 and 2011-2012). RESULTS: Antibiotics use during the first 72 hours of life was analyzed as the primary variable, which was reduced by 20% on the second period (p = 0.002). Regarding the analysis of secondary variables, we found no significant differences in mortality during hospital admission and the incidence of nosocomial sepsis, enterocolitis, or invasive fungal infection. The multivariate analysis indicated extreme prematurity and the study group as the most strongly related factors to the start of antibiotic therapy. CONCLUSIONS: IL-6 was a useful marker of infection to reduce the use of antibiotic therapy in VLBW infants without increasing mortality.

Neonatal unplanned extubations: an unsolved safety issue / Extubaciones neonatales no programadas: un problema de seguridad no resuelto

Abstract Background: Unplanned extubations are safety events relatively frequent in the neonatal intensive care units (NICU). This study aimed to describe the frequency and characteristics of unplanned extubations in a NICU. Methods: We conducted a retrospective observational study of unplanned extubations in the NICU of a tertiary regional referral hospital. We reviewed medical records for data collection and performed the statistical analysis, comparing the cases of unplanned extubations with those in which it did not occur among all the cases that received intubation and invasive neonatal mechanical ventilation. Results: A total of 958 newborns were admitted to the NICU, of which 174 required assistance with invasive mechanical ventilation (18.1%) and 28 experienced unplanned extubations (16.1%): 25 patients with one episode, one with two episodes, and two with three episodes. The rate was 2.93 unplanned extubations for every 100 days of invasive mechanical ventilation in 5 years, with a significant decrease in the last three years (p = 0.0158). We found a statistically significant correlation between a weight < 1500 g and unplanned extubation in the multivariate analysis, although sedation appears to affect its interaction. Conclusions: Unplanned extubations are a relatively frequent problem, although with a tendency to decrease in recent years. The weight of the patients at birth and sedation during ventilation are important factors in this safety problem.

Resumen Introducción: La extubación no programada es un evento de seguridad relativamente frecuente en las unidades de cuidados intensivos neonatales (UCIN). El objetivo de este estudio fue conocer la frecuencia y las características de las extubaciones no programadas en una UCIN. Métodos: Se realizó un estudio observacional retrospectivo de las extubaciones no programadas en la UCIN de un hospital regional de referencia de tercer nivel. Se revisaron las historias clínicas y se realizó el análisis estadístico de los datos, comparando los casos de extubación no programada con aquellos en los que no sucedió entre todos los pacientes que recibieron intubación y ventilación mecánica invasiva neonatal. Resultados: Ingresaron en la UCIN 958 neonatos, de los cuales 174 precisaron asistencia con ventilación mecánica invasiva (18.1%) y 28 tuvieron una extubación no programada (16.1%). De estos, 25 presentaron un episodio, uno presentó dos episodios y dos presentaron tres episodios de extubación no programada. La tasa fue de 2.93 extubaciones no programadas por cada 100 días de ventilación mecánica invasiva en 5 años, con una importante disminución en los últimos 3 años (p = 0.0158). El peso < 1500 g se relacionó con las extubaciones no programadas de forma estadísticamente significativa en el análisis multivariante, aunque la sedación aparece como un factor modificador de efecto a través de su interacción. Conclusiones: Las extubaciones no programadas son un problema relativamente frecuente, aunque con tendencia a disminuir en los últimos años. El peso de los pacientes al nacimiento y la sedación son factores importantes en este problema de seguridad.

Neonatal unplanned extubations: an unsolved safety issue.

BACKGROUND: Unplanned extubations are safety events relatively frequent in the neonatal intensive care units (NICU). This study aimed to describe the frequency and characteristics of unplanned extubations in a NICU. METHODS: We conducted a retrospective observational study of unplanned extubations in the NICU of a tertiary regional referral hospital. We reviewed medical records for data collection and performed the statistical analysis, comparing the cases of unplanned extubations with those in which it did not occur among all the cases that received intubation and invasive neonatal mechanical ventilation. RESULTS: A total of 958 newborns were admitted to the NICU, of which 174 required assistance with invasive mechanical ventilation (18.1%) and 28 experienced unplanned extubations (16.1%): 25 patients with one episode, one with two episodes, and two with three episodes. The rate was 2.93 unplanned extubations for every 100 days of invasive mechanical ventilation in 5 years, with a significant decrease in the last three years (p = 0.0158). We found a statistically significant correlation between a weight < 1500 g and unplanned extubation in the multivariate analysis, although sedation appears to affect its interaction. CONCLUSIONS: Unplanned extubations are a relatively frequent problem, although with a tendency to decrease in recent years. The weight of the patients at birth and sedation during ventilation are important factors in this safety problem.

[Rituximab treatment in pediatric patients with steroid-dependent nephrotic syndrome: a tertiary hospital]. / Tratamiento con rituximab en pacientes pediátricos con síndrome nefrótico córtico-dependiente. Experiencia en un hospital terciario.

BACKGROUND: Corticosteroids have had a central role in the treatment of nephrotic syndrome. The management of these patients who become dependent to steroids is complex, involving different immunosuppressive drugs patterns. The monoclonal antibody anti CD20, Rituximab, is likely to have beneficial effects in cases of steroid-dependent nephrotic syndrome patients with no easy resolution, even when we cannot make a statement about the specific role in the impact. We bring our personal experience in pediatric patients treated with this medication during the last years, to provide a thorough overview and useful information about the role of Rituximab in this pathology. METHODS: Retrospective study in patients with steroid-dependent idiopathic nephrotic syndrome controlled in the division of Pediatric Nephrology of a spanish tertiary hospital in those patients who had received at least one treatment cycle of Rituximab, at any moment along the evolution of the disease. RESULTS: The study involved 8 patients. All of them previously received immunosuppressive therapy. The Rituximab were administered as an intravenous infusion, in a dose of 375 mg/m2, and all doses were administered in a period during which the disease was in remission. The depletion of lymphocytes B (CD 19%) were confirmed after the first dose of Rituximab except for one, with a lymphocyte count of 1%. The period of depletion lasts 10.3 months (median; range 6.5-16 months), and only one of the patients registered a relapse of the disease in this period. A reduction of relapses suffered by patients has been shown after the treatment began (3.6 relapses/year in the previous year to the start of the treatment vs. 0.1 relapses/year during the first year post-rituximab). The relapse-free survival in the first year reached 83.3% in patients who suffered more than one relapse (75% of patients), and without a relapse after the treatment began in 2 cases. One or more drugs could be removed in 87.5% of patients after the first cycle of rituximab. After the rituximab treatment, we reached a 96.5% decrease in the corticosteroids doses administered (28.5 mg/m2/day during the 3 months pre-treatment vs. 1 mg/m2/day in the last 3 months of patient monitoring). Not a significant observed adverse effect attributed to the drug after the post-rituximab monitoring period (median 46.5 months, range 5-97 months). CONCLUSION: The favorable results reported after rituximab treatment in our patients seems to confirm the effectiveness of this drug in the steroid-dependent nephrotic syndrome, making that therapeutic option into consideration and legitimating the use of the drug in complex cases involving pediatric patients. Even so, it seems recommendable to design pertinent studies to clarify, among others, the optimum regimen of the treatment (dose, interval and cycles), clinical repercussion and potential adverse effects in long terms.

Composición nutricional de la leche materna donada según el periodo de lactancia / Nutritional composition of donor human milk according to lactation period

INTRODUCCIÓN: cuando no se dispone de leche materna propia, la leche materna donada es la mejor alternativa para asegurar los requerimientos nutricionales de los recién nacidos prematuros o enfermos. OBJETIVOS: conocer el contenido de macronutrientes de la leche materna donada y cómo varían estos en los distintos periodos de la lactancia. MATERIAL Y MÉTODOS: se analizó de forma retrospectiva la composición nutricional de 822,423 litros de leche materna donada, procedentes de 160 donantes del banco de leche materna de un hospital de tercer nivel entre el 1 de febrero de 2017 y el 31 de diciembre de 2019. RESULTADOS: el contenido en lípidos y carbohidratos se mantiene constante a lo largo de la lactancia; sin embargo, el contenido proteico disminuye inicialmente para luego volver a aumentar a partir del segundo año de lactancia. CONCLUSIONES: los bancos de leche materna deben conocer las variaciones del contenido en macronutrientes de la leche donada para optimizar la nutrición del recién nacido prematuro

INTRODUCTION: when own mother's breast milk is unavailable, donor human milk is the best option to guarantee the nutritional requirements of preterm or ill newborns. OBJECTIVES: to analyze the macronutrient composition of donor breast milk and its evolution over lactation periods. MATERIAL AND METHODS: we retrospectively analyzed the nutritional composition of 822.423 L of donor breast milk from 160 donors at the human milk bank of a third-level hospital between February 1, 2017 and December 31, 2019. RESULTS: lipid and carbohydrate composition remains constant throughout lactation. However, protein content decreases initially to increase again starting in the second year of lactation. CONCLUSIONS: donor human milk banks should be aware of the variations in macronutrient composition donor human milk shows in order to optimize nutrition for preterm newborns

[Nutritional composition of donor human milk according to lactation period]. / Composición nutricional de la leche materna donada según el periodo de lactancia.

INTRODUCTION: Introduction: when own mother´s breast milk is unavailable, donor human milk is the best option to guarantee the nutritional requirements of preterm or ill newborns. Objectives: to analyze the macronutrient composition of donor breast milk and its evolution over lactation periods. Material and methods: we retrospectively analyzed the nutritional composition of 822.423 L of donor breast milk from 160 donors at the human milk bank of a third-level hospital between February 1, 2017 and December 31, 2019. Results: lipid and carbohydrate composition remains constant throughout lactation. However, protein content decreases initially to increase again starting in the second year of lactation. Conclusions: donor human milk banks should be aware of the variations in macronutrient composition donor human milk shows in order to optimize nutrition for preterm newborns.

INTRODUCCIÓN: Introducción: cuando no se dispone de leche materna propia, la leche materna donada es la mejor alternativa para asegurar los requerimientos nutricionales de los recién nacidos prematuros o enfermos. Objetivos: conocer el contenido de macronutrientes de la leche materna donada y cómo varían estos en los distintos periodos de la lactancia. Material y métodos: se analizó de forma retrospectiva la composición nutricional de 822,423 litros de leche materna donada, procedentes de 160 donantes del banco de leche materna de un hospital de tercer nivel entre el 1 de febrero de 2017 y el 31 de diciembre de 2019. Resultados: el contenido en lípidos y carbohidratos se mantiene constante a lo largo de la lactancia; sin embargo, el contenido proteico disminuye inicialmente para luego volver a aumentar a partir del segundo año de lactancia. Conclusiones: los bancos de leche materna deben conocer las variaciones del contenido en macronutrientes de la leche donada para optimizar la nutrición del recién nacido prematuro.

Positive Response to One-Year Treatment With Burosumab in Pediatric Patients With X-Linked Hypophosphatemia.

X-linked hypophosphatemia (XLH) causes significant burden in pediatric patients in spite of maintained treatment with phosphate supplements and vitamin D derivatives. Administration of burosumab has shown promising results in clinical trial but studies assessing its effect in the everyday practice are missing. With this aim, we analyzed the response to one-year treatment with burosumab, injected subcutaneously at 0.8 mg/kg every 2 weeks, in five children (three females) aged from 6 to 16 years, with genetically confirmed XLH. Patients were being treated with phosphate and vitamin D analogs until the beginning of burosumab treatment. In all children, burosumab administration led to normalization of serum phosphate in association with marked increase of tubular reabsorption of phosphate and reduction of elevated serum alkaline phosphatase levels. Baseline height of patients, from -3.56 to -0.46 SD, increased in the three prepubertal children (+0.84, +0.89, and +0.16 SD) during burosumab treatment. Growth improvement was associated with reduction in body mass index (-1.75, -1.47, and -0.17 SD, respectively), suggesting a salutary effect of burosumab on physical activity and body composition. Burosumab was well-tolerated, mild local pain at the injection site and transient and mild headache following the initial doses of burosumab being the only reported undesirable side effects. No patient exhibited hyperphosphatemia, progression of nephrocalcinosis, worsening of metabolic control or developed hyperparathyroidism. Mild elevation of serum PTH present at the beginning of treatment in one patient 4 was not modified by burosumab administration. These results indicate that in the clinical setting, beyond the strict conditions and follow-up of clinical trials, burosumab treatment for 1 year exerts positive effects in pediatric patients with XLH without major adverse events.