[Age for sitting and walking in children born weighing less than 1,500 g and normal motor development at two years of age]. / Edad de sedestación y marcha en niños con peso al nacer menor de 1.500 g y desarrollo motor normal a los dos años.

OBJECTIVE: To estimate the corrected age (CA) of acquisition of sitting and walking in very low birth weight infants with normal motor outcome at 2 years of age and to determine whether transient hypertonia is associated with a delay in the acquisition of sitting and walking. METHODS: Follow-up study of very low birth weight infants (under 1500 g) admitted to the Neonatology Department of the Hospital 12 de Octubre from January 1991 to December 1996. At 2 years of age, 260 infants had normal motor outcome and 36% of these had been diagnosed with transient hypertonia. The age at which sitting and walking were attained was recorded by interview with the parents and was confirmed by examination. RESULTS: The mean CA at which sitting was attained was 7.2 +/- 1.4 months. Ninety percent of the infants had acquired sitting at a CA of 9 months. Mean age at which walking was attained was 13.4 +/- 2.8 months. Ninety percent could walk at 16 months. Infants with and without transient hypertonia acquired sitting and walking at the same age. CONCLUSIONS: Ninety percent of very low birth weight infants attained sitting at a CA of 9 months and walking at a CA of 16 months. Transient hypertonia did not modify the pattern of sitting and walking and it could be considered a variation of normality within the development of very premature infants.

[Cerebral palsy and age of sitting and walking in children weighing less than 1,500 g at birth]. / Parálisis cerebral y edad de sedestación y marcha en niños con peso al nacer menor de 1.500 g.

OBJECTIVE: To describe the corrected age (CA) of acquisition for sitting and walking in very low birth weight infants with cerebral palsy and to estimate the probability of walking as a function of age of acquisition of sitting and type of cerebral palsy. METHODS: Follow up study of very low birth weight infants (under 1500 g) admitted to the Neonatology Department of the Hospital 12 de Octubre in Spain between January 1991 and December 1996. At a corrected age of 2 years, 11.5% (34 children) were diagnosed with cerebral palsy. Ages of attainment of sitting and walking were established by interview with the parents and were confirmed by examination. Age of attainment of sitting and type of cerebral palsy were investigated as possible predictors of ambulatory status. RESULTS: Sitting was attained by 73% of the children. The probability of attainment of sitting at 9 months was 21% and at 18 months it was 68%. Only one child achieved sitting after 18 months. Fifty-three percent of the children became ambulatory. The probability of becoming ambulatory was 24% at 18 months and 47% at 30 months. If sitting was attained before 12 months of age the probability of becoming ambulatory was 47% at 18 months and 76% at 30 months. All children with spastic hemiplegia, 66% of those with diplegia and only 8% of those with quadriplegia became ambulatory. CONCLUSIONS: Sitting by the age of 12 months was directly related to achieving ambulation. Irrespective of the type of cerebral palsy, all children with hemiplegia and more than 60% of those with diplegia ambulated while children with quadriplegia were much less likely to ambulate.

[Survival at discharge of newborn infants weighing less than 1000 g (1991-1997). When are they too small?]. / Supervivencia al alta de los recién nacidos con un peso menor de 1.000 g (1991-1997). Cuándo son demasiado pequeños?

OBJECTIVE: To describe survival rates at discharge in liveborn infants with birth-weight under 1000 g by birth-weight and gestational age categories in a third level spanish hospital in order to improve health care planning and parental counselling about the threshold of viability. STUDY DESIGN: A follow-up study of 178 infants with birth-weight under 1000 g born alive between 1991 at 1997. Six newborns with lethal malformations were not included. RESULTS: Overall survival at discharge was 54%. During the study period survival rate improved in the birth-weight group 750-999 g. In the group below 750 g survival rate was lower and improved more slowly. Survival rate for infants below 750 g and 26 weeks was extremely low. Over 749 g and 25 weeks survival was over 50%. CONCLUSIONS: Survival rate showed an improving trend during the study period. In the last years of the study period survival in infants with birth-weight over 749 g was above 85%. For infants under 750 g and 26 weeks was extremely low. Family and medical decision making about active treatment of these newborns should be an individualized process.

[Outcome at 3 years of age in a low birth weight cohort]. / Evolución a los 3 años de edad de una cohorte de recién nacidos de muy bajo peso.

OBJECTIVE: The objective of this study was to establish the outcome at 3 years of age for very low birth weight newborns admitted to the Hospital 12 de Octubre from January 1991 to December 1993. PATIENTS AND METHODS: A follow-up study was performed. The pediatric assessment included a neurological, psychological, visual and audiological evaluation. At the end of the follow-up, children were blindly assessed to determine the rate of neurosensory disability. The severity of the neurosensory disability was graded as severe, moderate or mild by a functional classification. The rates of cerebral palsy, blindness and deafness were reported. RESULTS: Two hundred fifty-three infants between 500 and 1,499 g were admitted to the Hospital 12 de Octubre of which 182 survived. Of these, 137 (75% of the survivors) were assessed at 3 years of age. The children who dropped out during the follow-up period had similar characteristics to those with a complete follow-up program except that the drop-out child was more likely to belong to a disadvantaged family. The rate of neurosensory disability was 28.5% (39/137), 16% were mild, 5% moderate and 7% severe. The rate of cerebral palsy was 13% (18/137), blindness 1.4% and deafness 0.7%. CONCLUSIONS: Children from more disadvantaged families are less likely to continue in follow-up programs and this supposes a bias in the follow-up program. At 3 years, neurosensory disability was diagnosed in 1 out of every 4 children and cerebral palsy in 1 out of 8 children.

[Periventricular leukomalacia and persistent hyperechogenicity: relationship between ultrasound findings and sequelae]. / Leucomalacia periventricular e hiperecogenicidad persistente: relación entre hallazgos ecográficos y secuelas.

OBJECTIVES: The objective of this study was to know the incidence of periventricular leukomalacia and persistent periventricular echodensities in neonates with a birth weight < 1,500 g and to correlate cranial ultrasound findings with the developmental outcome of these babies at 18 months of corrected age. PATIENTS AND METHODS: We performed a cohort study of 319 newborns weighing 1500 g or less who were admitted to the Neonatal Intensive Care Unit of "12 de Octubre" Hospital between July 1990 and April 1994. Scans were performed while they were hospitalized and 183 surviving infants were followed up to 18 months of corrected age. Relative risks (rr) and 95% confidence intervals (95% CI) were calculated for sequelae according to neonatal cranial ultrasound abnormalities. Ninety-six infants with normal scans were considered as the control group. Persistent periventricular echodensities were classified as mild, moderate or severe. RESULTS: The incidence of periventricular leukomalacia was 3% (10/319) and of persistent periventricular echodensites was 11.2% (36/319). The percentage of sequelae was 5% for control infants, 15.6% (rr = 3, CI 95% = 0.94-8.8) for persistent periventricular echodensities, independent of its severity, 50% (rr = 9.7, CI 95% = 2.6-35) for moderate persistent periventricular echodensities and 78% (rr = 15.6, CI 95% = 6-38) for periventricular leukomalacia. CONCLUSIONS: Periventricular leukomalacia multiplies the number of sequelae by 15. Persistent periventricular echodensities, independent of its severity, does not multiply the number of sequelae significantly. However, moderate persistent periventricular echodensities multiply the number of sequelae by 9.

[Spontaneous chylothorax: seven cases of prenatal diagnosis]. / Quilotórax espontáneo: siete casos de diagnóstico prenatal.

Authors present 7 cases of spontaneous congenital chylothorax, all of them diagnosed antepartum echographycally. Six of them needed cardiopulmonary resucitation but none presented fetal anoxia. Three cases had associated malformations. Treatment included thoracocenthesis, pleural drainage, assisted ventilation and appropriate nutrition. Pleural effusion lasted from 14 days to 6 months. Complications were: pneumothorax, metabolic acidosis and bacterial infections. Three patients died by respiratory failure. Pulmonary hypoplasia was present in two of them, and suspected in the third one. Survivors are free of symptoms.