Smoking influence on early and late fetal growth.

OBJECTIVES: Smoking during pregnancy is a leading and modifiable risk factor for fetal growth restriction (FGR) and low birthweight (<10th centile). We studied the effects of smoking in the development of early and late FGR or low birthweight, as well as in uteroplacental and fetoplacental hemodynamics of growth-restricted fetuses. METHODS: Retrospective cohort study of 5,537 consecutive singleton pregnancies delivered at ≤34 + 0 ("early delivery" group, n=95) and >34 + 0 ("late delivery" group, n=5,442) weeks of gestation. Each group was divided into smokers and non-smokers. Prenatal diagnosis of FGR was based on customized fetal growth standards and fetal Doppler, and postnatal birthweight was assessed using the Olsen newborn chart. RESULTS: There were 15/95 (15.8%) and 602/5,442 (11.1%) smokers in the early and late delivery groups, respectively. In early deliveries, FGR was diagnosed in 3/15 (20%) of smokers and in 20/80 (25%) of non-smokers (p=0.68). We also found no differences in birthweights and hemodynamics. In late deliveres, FGR was detected in 30/602 (5%) smokers and 64/4,840 (1.3%) non-smokers (p<0.001). Birthweights <3rd centile and <10th centile were more common in smokers vs. non-smokers: 38/602 (6.3%) vs. 87/4,840 (1.8%) and 89/602 (14.8%) vs. 288/4,840 (6%), respectively (all p<0.01). Fetal Doppler of late FGR showed slightly higher umbilical artery resistances in smokers. CONCLUSIONS: Smoking in pregnancy is associated with FGR, low birthweight and higher umbilical artery Doppler resistances after 34 weeks of gestation, but we could not confirm this association in earlier deliveries.

Obstetric and pediatric growth charts for the detection of fetal growth restriction and neonatal adverse outcomes in preterm newborns before 34 weeks of gestation.

INTRODUCTION: Identification of fetal growth-restricted (FGR) infants depends on the fetal or newborn charts used to identify them. We aimed to compare the prenatal and postnatal diagnosis of FGR and their ability to predict adverse perinatal outcomes. METHODS: Observational retrospective cohort study of 95 consecutive mother-infant pairs with preterm birth between 24 and 34 weeks (study period: January 2014 to December 2015). Prenatal sonographic diagnosis of FGR, based on customized fetal growth standards and fetal Doppler, was compared with the postnatal diagnosis of FGR based on a birthweight < 3rd percentile according to newborn charts (International Newborn size references for the Intergrowth twenty-first century program, and Olsen's charts). Neonatal mortality and adverse neonatal outcomes were compared among groups. RESULTS: In 23/95 (24%) cases a prenatal diagnosis of early FGR was made. Postnatal FGR was confirmed in 11/23 (48%) cases using Olsen's charts and 8/23 (35%) using Intergrowth 21st charts. One postnatal FGR case was missed by prenatal ultrasound. Bronchopulmonary dysplasia, sepsis and hypoglycemia were more frequent in pre- and postnatal FGR versus non-FGR. After adjusting for gestational age and sex, only an increased relative risk of hypoglycemia (2.0, 95%CI 1.0-2.8) was observed in infants with pre- and postnatal FGR diagnosis. Nonsignificant differences on neonatal outcomes were identified between prenatal FGR cases with normal birthweight and the non-FGR group. CONCLUSION: Only prenatal FGR cases in which a birthweight below the third percentile is confirmed by means of postnatal charts (Olsen or Intergrowth standard) are at higher risk of adverse postnatal outcome.

Obstetric and pediatric growth charts for the detection of late-onset fetal growth restriction and neonatal adverse outcomes.

OBJECTIVES: Late-onset fetal growth restriction (FGR) has heterogeneous prenatal and postnatal diagnostic criteria. We compared the prenatal and postnatal diagnosis of late-onset FGR and their ability to predict adverse perinatal outcomes. METHODS: Retrospective cohort study of 5442 consecutive singleton pregnancies that delivered beyond 34 + 0 weeks. Prenatal diagnosis of FGR was based on customized fetal growth standards and fetal Doppler while postnatal diagnosis was based on a birthweight <3rd percentile according to newborn charts (Olsen's charts and Intergrowth 21st century programme). Perinatal outcomes were analyzed depending on whether the diagnosis was prenatal, postnatal or both. RESULTS: A total of 94 out of 5442 (1.7%) were diagnosed as late-onset FGR prenatally. Olsen's chart and Intergrowth 21st chart detected that 125/5442 (2.3%) and 106/5442 (2.0%) of infants had a birthweight <3rd percentile, respectively. These charts identified 35/94 (37.2%) and 40/94 (42.6%) of the newborns with a prenatal diagnosis of late-onset FGR. Prenatally diagnosed late-onset FGR infants were at a higher risk for hypoglycemia, jaundice and polycythemia. Both prenatally and postnatally diagnosed as late-onset FGR had a higher risk for respiratory distress syndrome when compared to non-FGR. The higher risks for intensive care admission and composite adverse outcomes were observed in those with a prenatal diagnosis of late-onset FGR that was confirmed after birth. CONCLUSIONS: Current definitions of pre- and postnatal late-onset FGR do not match in more than half of cases. Infants with a prenatal or postnatal diagnosis of this condition have an increased risk of neonatal morbidity even if these diagnoses are not coincident.

Necessary resources and barriers perceived by professionals in the implementation of the NIDCAP.

BACKGROUND: The implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) requires a significant effort from all professionals involved. AIM: To determine the necessary requirements and barriers perceived by health professionals in the implementation of the NIDCAP. STUDY DESIGN: A questionnaire covering requirements and obstacles perceived in the implementation of the NIDCAP was developed and validated in two Spanish level III neonatal intensive care units. The questionnaire was answered by 305 health professionals (response rate of 85%). RESULTS: The requirements identified in the questionnaire were considered by most respondents as necessary to implementing the NIDCAP, especially more time, education, and staff. Nurses, compared to doctors, thought that more staff was necessary (93% vs. 74%; p < .01). The main obstacle identified in the survey was lack of coordination among different professionals (77%), followed by noise level in the unit (35%). Doctors, in comparison to nurses, considered noise level (61% vs. 23%; p < .01) and nursing staff (56% vs. 29%; p = .05) the most relevant obstacles to NIDCAP implementation. The more experienced professionals perceived their own colleagues as an obstacle, particularly among nursing staff. CONCLUSIONS: The implementation of the NIDCAP requires a series of conditions that confirm it is not a trivial process but rather a somewhat laborious one. The lack of coordination among different professionals is often considered the main obstacle.

Staff perceptions on Newborn Individualized Developmental Care and Assessment Program (NIDCAP) during its implementation in two Spanish neonatal units.

BACKGROUND: The implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) requires great effort. Few studies evaluating staff perception of NIDCAP exist, especially in Southern Europe, and these few studies usually have a low representation of the medical staff. AIMS: Exploration of staff perception (neonatologists, nurses and nursing assistants) of NIDCAP during its implementation and their attitude towards it and intention to put it into practice. STUDY DESIGN: This study is a descriptive survey measuring staff perceptions of NIDCAP and its effects on their work in two Spanish neonatal level III intensive care units (NICUs). Validated questionnaires were distributed to neonatologists, nurses and nursing assistants of which 305 were completed (response rate: 85%). RESULT: Virtually all the items which assess the infant's well being and the parents' role received a positive evaluation. However, three items got slightly negative evaluations: NIDCAP was more time consuming and nurses' working conditions and lighting in the unit were less optimal than in earlier practices. The professionals also had a positive attitude and a willingness to use the NIDCAP. Neonatologists perceived NIDCAP more positively than the nursing staff with statistically significant differences. CONCLUSION: The neonatal unit staff in two Spanish NICUs perceived NIDCAP positively. This assessment is more positive for neonatologists than for nurses.

Heating-induced bacteriological and biochemical modifications in human donor milk after holder pasteurisation.

OBJECTIVES: The objectives of the present study were to enumerate and characterize the pathogenic potential of the Bacillus population that may survive holder pasteurisation of human milk and to evaluate the nutritional damage of this treatment using the furosine and lactulose indexes. MATERIALS AND METHODS: Milk samples from 21 donors were heated at 62.5°C for 30 minutes. Bacterial counts, lactose, glucose, myoinositol, lactulose, and furosine were determined before and after the heat treatment. Some B cereus isolates that survived after pasteurisation were evaluated for toxigenic potential. RESULTS: Nonpasteurised milk samples showed bacterial growth in most of the agar media tested. Bacterial survival after pasteurisation was observed in only 3 samples and, in these cases, the microorganisms isolated belonged to the species B cereus. Furosine could not be detected in any of the samples, whereas changes in lactose, glucose, and myoinositol concentrations after holder pasteurisation were not relevant. Lactulose was below the detection limit of the analytical method in nonpasteurised samples, whereas it was found at low levels in 62% of the samples after holder pasteurisation. The lactation period influenced myoinositol content because its concentration was significantly higher in transition milk than in mature or late lactation milk samples. CONCLUSIONS: Holder pasteurisation led to the destruction of bacteria present initially in donor milk samples, except for some B cereus that did not display a high virulence potential and did not modify significantly the concentration of the compounds analyzed in the present study.

Simultaneous analysis of frequently used licit and illicit psychoactive drugs in breast milk by liquid chromatography tandem mass spectrometry.

A liquid chromatography tandem mass spectrometry (LC-MS-MS) method for the quantification of frequently used licit (caffeine, nicotine and cotinine) and illicit drugs (opiates, cocaine, cannabinoids and amphetamines) in breast milk was developed and fully validated. Chromatography was performed on a reverse-phase column using a gradient of 2mM ammonium acetate, pH 6.6, and methyl alcohol as mobile phase at a flow rate of 0.35 mL/min. Separated analytes were quantified by electrospray ionization tandem mass spectrometry in positive ion mode using multiple reaction monitoring. Milk samples were kept at -20 °C until analysis and the compounds under investigation were extracted from the matrix by Bond Elut Certify cartridges. The concentration range covered was LOQ to 1000 ng/mL for all the investigated drugs. Intra- and inter-assay imprecision was less than 20%, analytical recovery ranged between 51.6% and 86.5%, matrix effect between 71.1% and 116.6% and process efficiency between 46.8% and 84.0%. Analytes were stable after three freeze-thaw cycles, after 6 months at -20 °C and after the pasteurization process (differences to the initial concentration always lower than 10%). matrix effect ranged from 77.6% to 116.6%, recovery from 51.6% to 86.5%, and process efficiency from 46.8% to 79.0%. This LC-MS-MS assay was applied to screen samples from the largest Spanish milk bank and samples coming from drug addicted mothers. The developed method provided adequate sensitivity and performance characteristics to prove the presence of only caffeine in a small percentage of samples from milk donating nursing mothers and the presence or absence of most commonly used illicit drugs in breast milk from addicted lactating mothers.

Diferencias conductuales según género en convivencia escolar / Behavioral gender differences in school relationships

Los adolescentes asumen diferentes roles sociales mediados por el género que influyen el desarrollo de su identidad y cómo se manifiesta la violencia escolar. El objetivo de este trabajo es estudiar las diferencias conductuales en el acoso escolar según el género. La muestra (N= 641) tiene una edad entre12 y 16 años. Se estudiaron variables personales mediante autoinformes, y variables relacionales con medidas sociométricas. Los resultados indican mayor incidencia de acoso, rechazo entre iguales e inadaptación escolar entre los chicos. Ellas refieren más agresiones relacionales, aceptación y habilidades sociales, pero también mayor inadaptación personal. Las víctimas femeninas son las más rechazadas. Las diferencias de género parecen más relevantes en las variables relacionales, sugiriendo la importancia del contexto relacional en el acoso (AU)

Adolescents take on different social roles mediated by gender, which affect the development of their identity and the expression of school violence. The purpose of this work is to study the behavioral differences in bullying depending on gender. The sample (N= 641) is aged between 12 and 16 years old. Personal variables are assessed byself-reports, and relational variables by sociometric measures. Results indicate a large incidence of bullying, peer rejection, and school maladjustment among boys. Girls report more relational aggressions, acceptance and social skills, but also higher personal maladjustment. Female victims are rejected the most. Gender differences seem more relevant in relational variables, suggesting the special importance of the relational context in bullying (AU)

[Behavioral gender differences in school relationships]. / Diferencias conductuales según género en convivencia escolar.

Adolescents take on different social roles mediated by gender, which affect the development of their identity and the expression of school violence. The purpose of this work is to study the behavioral differences in bullying depending on gender. The sample (N=641) is aged between 12 and 16 years old. Personal variables are assessed by self-reports, and relational variables by sociometric measures. Results indicate a large incidence of bullying, peer rejection, and school maladjustment among boys. Girls report more relational aggressions, acceptance and social skills, but also higher personal maladjustment. Female victims are rejected the most. Gender differences seem more relevant in relational variables, suggesting the special importance of the relational context in bullying.

Improving the quality of medical prescriptions in neonatal units.

BACKGROUND: Pediatric units, especially neonatal units, are highly vulnerable to error generally and to medication error in particular. Potential failures are distributed across the entire medication process, occurring mostly at the time of medication prescription and during preparation for drug administration. OBJECTIVE: To estimate the prevalence of violations of good prescribing practice before and after the implementation of several measures aimed at improving the quality of the medical prescription. METHODS: Before and after evaluation study with prospective data collection in a third level neonatal unit. 6,320 handwritten medical prescriptions for neonates admitted in the first study period and 1,435 in the second period were analyzed. Training on good prescribing practice and the implementation of a pocket PC-based automatic dosage calculation system were the interventions. The main outcome measure was the proportion of prescriptions with violations of good prescribing practice: incorrect dose, units, dose interval, route of administration or legibility. RESULTS: Incorrect prescriptions decreased from 39.5% before the intervention to 11.9% after, with an adjusted prevalence ratio of 0.29 (0.25-0.34). The number of wrongly specified items on a single prescription decreased from 11.1% of the prescriptions with two or more wrongly specified items in the first period to 1.3% in the second period, with a prevalence ratio of 0.09 (0.05-0.14). CONCLUSIONS: Violations of good prescribing practice are common in neonatal units. A simple intervention should improve the quality of handwritten medical prescriptions for newborns admitted to intensive care settings.

Screening for retinopathy of prematurity: is it painful?

BACKGROUND: Screening programmes for retinopathy of prematurity have shown to reduce unfavourable visual outcome and to be cost-effective. Following present recommendations, almost 1% of all newborn babies should therefore be screened and undergo at least one ophthalmologic examination. This is a skilled procedure that requires drug instillation and manipulation of the ocular globe with scleral indentation. The objective of this study is to describe the side effects of this ophthalmic exam with special focus on the occurrence of pain. METHODS: This was an observational study with a before-after analysis where all neonates undergoing an ophthalmologic exam during a 4-month period in a third level hospital were included. CRIES pain score was determined before the exam, 5 min after and 24 h after the screening manoeuvre. Blood pressure and pulse rate were determined in addition to the mentioned measurements 30 min after the ophthalmologic examination. Minimum oxygen saturation, apnoeas, gastrointestinal side effects (like vomiting and gastric aspirates), the need for respiratory assistance or for intensive care unit admission were recorded within 24 h before and after the procedure. RESULTS: 27 preterm neonates underwent an ophthalmologic examination and were included in the study. CRIES pain score was significantly higher 5 min after and 24 h after the screening procedure than before. This difference was also observed after stratification for birth weight and gestational age. No other study variable modified this time effect. No significant changes in blood pressure and pulse rate were shown after the ophthalmic exam. Vomiting was present in 4% of the newborns, gastric aspirates in 22% and apnoeas in 41% after the examination. Ten percent of the explored preterm babies needed increased respiratory assistance and 4% had to be transferred from the intermediate care unit to the intensive care because of severe apnoeas. COMMENTS: An increase in pain score was shown after retinopathy of prematurity screening examination. Physiologic variable changes do not last long enough to evaluate the impact of certain procedures. Multivariate pain scores (like CRIES) should be used in everyday practice. It seems that the ophthalmologic examination in preterm babies might be painful and further studies should identify the best strategy to prevent pain during the retinopathy of prematurity screening manoeuvre.