Cuidados centrados en el desarrollo. Situación en las unidades de neonatología de España / Developmental centered care. Situation in Spanish neonatal units

INTRODUCCIÓN: Los cuidados centrados en el desarrollo (CCD) tienen por objeto favorecer el desarrollo neurosensorial y emocional del niño. En España tenemos información de la aplicación de los CCD desde 1999, pero no se conoce el grado de implantación actual. OBJETIVOS: Describir el grado de implantación de los CCD en las unidades neonatales públicas que atendieron a más de 50 recién nacidos con peso menor a 1.500g en el año 2012. Comparación con los datos previos publicados en 2006. MATERIAL Y MÉTODOS: Se realizó un estudio transversal observacional descriptivo incluyendo las unidades neonatales españolas seleccionadas. Se envió un cuestionario con 7 preguntas formuladas de igual manera que en el cuestionario del 2006 para la comparación. RESULTADOS: Se envió la encuesta a 27 unidades. La tasa de respuesta del 2012 fue del 81% vs. el 96% en 2006. Respecto a medidas de control del ruido, en 2012 fue el 73% vs. el 11% en el 2006 (p < 0,01). El uso de sacarosa fue el 50% en 2012 frente al 46% en 2006 (p = 0,6). La entrada libre de padres en 2012 fue el 82% vs. el 11% en 2006 (p < 0,01). El Método Canguro, en el 2012, se realizó sin limitaciones en un 82% frente al 31% en el 2006 (p < 0,01). CONCLUSIONES: La implantación de los CCD en España ha mejorado. Todavía hay un margen de mejora en áreas como el uso de sacarosa o el control del ruido, pero hay que resaltar el cambio tan positivo que se ha producido en relación con la entrada de padres

INTRODUCTION: Developmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown. Objetive: To determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006. MATERIAL AND METHODS: A descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire. RESULTS: The survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<0.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=0.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<0.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<0.01). CONCLUSIONS: The implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits

[Developmental centered care. Situation in Spanish neonatal units]. / Cuidados centrados en el desarrollo. Situación en las unidades de neonatología de España.

INTRODUCTION: Developmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown. OBJETIVE: To determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006. MATERIAL AND METHODS: A descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire. RESULTS: The survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<.01). CONCLUSIONS: The implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits.

[Neonatal outcome of triplets]. / Evolución neonatal de los recién nacidos trillizos (desde el nacimiento hasta el alta hospitalaria).

OBJECTIVE: To determine the neonatal morbidity and mortality in triplets. METHOD: Retrospective study of 189 triplets born between January'98 and December'04. RESULTS: Mean maternal age was 33 years. Of the pregnancies, 71.4 % were achieved using fertilization techniques, 84 % received antenatal steroids and 96.8 % of births were by caesarean section. The mean gestational age was 32 weeks (246-355), with a mean birth weight of 1,500 g (450-2,650). There 53.4 % were female neonates. Cardiopulmonary resuscitation (CPR) at birth was not required by 82 %, 13.5 % required bag-mask ventilation and 4.9 % required advanced CPR. Low/moderate respiratory distress syndrome was observed in 27 % of the infants (oxygen/CPAP), and 19 % required mechanical ventilation and surfactant. 12 % showed patent ductus arteriosus was seen in 12 %, necrotizing enterocolitis in 4.2 %, sepsis (vertical and nosocomial), 17 %, grade III retinopathy in 1.1 % and 7.4 % had bronchopulmonary dysplasia. Grade III/IV intraventricular haemorrhage was present in 4.2 %, and 3.2 % periventricular leukomalacia. Survival rate at discharge from hospital was 95.2 %. Of those, 10 % showed risk of serious sequelae defined as: grade III-IV intraventricular haemorrhage, periventricular leukomalacia, grade III retinopathy and bronchopulmonary dysplasia. There were no major complications in 64.5 % of the children. Despite a prematurity rate of 100 %, this large series of triplets shows an excellent survival and a relatively low serious associated morbidity. It is also important to point out the intensive perinatological follow-up to which these pregnancies are subject.

Evolución neonatal de los recién nacidos trillizos (desde el nacimiento hasta el alta hospitalaria) / Neonatal outcome of triplets

Objetivo: Determinar la morbilidad y la mortalidad neonatales de los trillizos. Método: Estudio retrospectivo de 189 trillizos nacidos entre enero de 1998 y diciembre de 2004. Resultados: La edad media materna fue de 33 años. El 71,4 % de las gestaciones se obtuvieron mediante técnicas de reproducción asistida. El 84 % recibió corticoides prenatales. El 96,8 % nació mediante cesárea. La edad gestacional media fue de 32 semanas (246-355), con peso medio de 1.500 g (450-2.650). El 53,4 % fueron niñas. El 82 % no necesitó reanimación al nacer, el 13,5 % requirió reanimación con bolsa autoinflable y el 4,9 %, reanimación avanzada. El 27 % de los neonatos presentaron síndrome de distrés respiratorio leve/moderado (oxígeno/CPAP) y el 19 %, grave (ventilación mecánica/agente tensiactivo). El 12 % presentó ductus arterioso persistente; el 4,2 %, enterocolitis; el 17 %, sepsis (vertical y nosocomial); el 1,1 %, retinopatía de grado III, y el 7,4 %, displasia broncopulmonar. El 4,2 % presentó hemorragia intraventricular (HIV) grado III-IV, y el 3,2 %, leucomalacia periventricular. La supervivencia al recibir el alta fue del 95,2 %, el 10 % mostraron signos de riesgo de secuelas graves, definidas como: HIV grado III-IV, leucomalacia periventricular, retinopatía grado III y displasia broncopulmonar. El 64,5 % de los neonatos no presentaron ninguna complicación destacable durante su ingreso. Aunque la incidencia de prematuridad es del 100 %, esta serie larga de trillizos muestra una excelente supervivencia y una morbilidad grave asociada relativamente baja. Destaca el elevado control perinatológico de estas gestaciones (AU)

Objective: To determine the neonatal morbidity and mortality in triplets. Method: Retrospective study of 189 triplets born between January'98 and December'04. Results: Mean maternal age was 33 years. Of the pregnancies, 71.4 % were achieved using fertilization techniques, 84 % received antenatal steroids and 96.8 % of births were by caesarean section. The mean gestational age was 32 weeks (246-355), with a mean birth weight of 1,500 g (450-2,650). There 53.4 % were female neonates. Cardiopulmonary resuscitation (CPR) at birth was not required by 82 %, 13.5 % required bag-mask ventilation and 4.9 % required advanced CPR. Low/moderate respiratory distress syndrome was observed in 27 % of the infants (oxygen/CPAP), and 19 % required mechanical ventilation and surfactant. 12 % showed patent ductus arteriosus was seen in 12 %, necrotizing enterocolitis in 4.2 %, sepsis (vertical and nosocomial), 17 %, grade III retinopathy in 1.1 % and 7.4 % had bronchopulmonary dysplasia. Grade III/IV intraventricular haemorrhage was present in 4.2 %, and 3.2 % periventricular leukomalacia. Survival rate at discharge from hospital was 95.2 %. Of those, 10 % showed risk of serious sequelae defined as: grade III-IV intraventricular haemorrhage, periventricular leukomalacia, grade III retinopathy and bronchopulmonary dysplasia. There were no major complications in 64.5 % of the children. Despite a prematurity rate of 100 %, this large series of triplets shows an excellent survival and a relatively low serious associated morbidity. It is also important to point out the intensive perinatological follow-up to which these pregnancies are subject (AU)

[Review of standards and recommendations for the design of a neonatology unit]. / Revisión de los estándares y recomendaciones para el diseño de una unidad de neonatología.

Standards for the design of a neonatology unit are reviewed. The process should begin with a planning team to outline the desired objectives to be achieved, followed by the intervention of a team of architects. Medical considerations, standards and recommendations, as well as architectural considerations (adequate privacy and intimacy, need for social support and communication, flexibility and accessibility) should be taken into account. From the architectural point of view, the greatest problem is the space available; furthermore, if the aim is to personalize the unit for the newborn and family, the need for space will be even greater. The following aspects should be analyzed and integrated into the design of the unit: standards and recommendations regarding space, the site of the unit, area of direct neonatal care, electrical installation, equipment, lighting and noise levels, nursing staff, communication systems, maintenance and refurbishment.

Revisión de los estándares y recomendaciones para el diseño de una unidad de neonatología / Review of standards and recommendations for the design of a neonatology unit

Se revisan los estándares para el diseño de una unidad de neonatología. El proceso debe iniciarse con un equipo de planificación que debe indicar los objetivos que se desean conseguir, para que posteriormente intervenga el equipo de arquitectos. Se deben tener en cuenta las aportaciones médicas, los estándares y recomendaciones, y las aportaciones arquitectónicas (adecuada privacidad e intimidad, necesidad de apoyo social y comunicación, flexibilidad y accesibilidad). Desde el punto de vista arquitectónico, el mayor problema es el del espacio disponible, y debemos tener en cuenta que si queremos personalizar el entorno del cuidado para el recién nacido y su familia e introducir los cuidados centrados en la familia, las necesidades de espacio serán aún mayores. Se analizan los estándares y recomendaciones relativos al espacio, ubicación de la unidad, área de atención directa al neonato, instalación eléctrica, iluminación y nivel de ruido, equipamiento, personal de enfermería, sistemas de comunicaciones, mantenimiento y renovación

Standards for the design of a neonatology unit are reviewed. The process should begin with a planning team to outline the desired objectives to be achieved, followed by the intervention of a team of architects. Medical considerations, standards and recommendations, as well as architectural considerations (adequate privacy and intimacy, need for social support and communication, flexibility and accessibility) should be taken into account. From the architectural point of view, the greatest problem is the space available; furthermore, if the aim is to personalize the unit for the newborn and family, the need for space will be even greater. The following aspects should be analyzed and integrated into the design of the unit: standards and recommendations regarding space, the site of the unit, area of direct neonatal care, electrical installation, equipment, lighting and noise levels, nursing staff, communication systems, maintenance and refurbishment

[Long-term cognitive dysfunctions related to prematurity]. / Disfunciones cognitivas a largo plazo relacionadas con la prematuridad.

INTRODUCTION: Little is understood about the effects of prematurity on long-term cognitive functioning. No detailed studies have been carried out in a Spanish population to investigate the cognitive performance of adolescents who were born preterm. AIMS: To utilise the Wechsler intelligence scales to examine the performance of a broad sample of adolescents who were born preterm, to describe the clinical significance of this performance and to analyse the discriminatory powers of the different subtests. SUBJECTS AND METHODS: The intelligence quotients of 62 preterm subjects and 62 controls were evaluated by administering the full Wechsler intelligence scales. A number of specific neuropsychological functions were also assessed. RESULTS: Significant differences were observed in the overall, verbal and manipulative intelligence quotients, as well as in most of the subtests, although less than 30% of the preterm subjects displayed any alterations in their performance. The subtests that were most sensitive to the poor performance of the preterm subjects were vocabulary, coding and picture arrangement. The significant differences in learning, memory, cognitive flexibility and verbal fluency were not upheld on controlling for general cognitive performance. CONCLUSIONS: Adolescents with a history of prematurity as a group offer low performance on the Wechsler intelligence scale, although most of them achieve scores within the range of what can be considered to be normal. The different subtests that make up this scale do not exhibit the same degree of sensitivity when evaluating the possible difficulties preterm adolescents have in cognitive performance.

Disfunciones cognitivas a largo plazo relacionadas con la prematuridad / Long-term cognitive dysfunctions related to prematurity

Introducción. Los efectos de la prematuridad sobre el funcionamiento cognitivo a largo plazo son poco conocidos. En población española no existe un estudio detallado del rendimiento cognitivo de los adolescentes nacidos prematuros. Objetivo. Explorar el rendimiento en las escalas de inteligencia de Wechsler en una amplia muestra de adolescentes con antecedentes de prematuridad, describir la significación clínica de este rendimiento y analizar la capacidad discriminativa de los distintos subtests. Pacientes y métodos. Se evaluó el coeficiente de inteligencia de 62 sujetos pretérmino y 62 controles a través de la administración completa de las escalas de inteligencia Wechsler. Además, se evaluaron diversas funciones neuropsicológicas específicas. Resultados. Se observaron diferencias significativas en los cocientes de inteligencia total, verbal y manipulativo, así como en la mayoría de subtests, aunque menos del 30% de los sujetos prematuros presentaron un rendimiento alterado. Los subtests más sensibles al bajo rendimiento de los prematuros fueron: vocabulario, claves e historietas. Las diferencias significativas en aprendizaje, memoria, flexibilidad cognitiva y fluidez verbal, no se mantuvieron al controlar por el rendimiento cognitivo general. Conclusiones. Los adolescentes con antecedentes de prematuridad como grupo presentan un bajo rendimiento en la escala de inteligencia de Wechsler, aunque la mayoría de ellos obtienen puntuaciones dentro del intervalo de la normalidad. Los distintos subtests que componen esta escala no presentan el mismo grado de sensibilidad al evaluar las posibles dificultades de rendimiento cognitivo de los adolescentes pretérmino

Introduction. Little is understood about the effects of prematurity on long-term cognitive functioning. No detailed studies have been carried out in a Spanish population to investigate the cognitive performance of adolescents who were born preterm. Aims. To utilise the Wechsler intelligence scales to examine the performance of a broad sample of adolescents who were born preterm, to describe the clinical significance of this performance and to analyse the discriminatory powers of the different subtests. Subjects and methods. The intelligence quotients of 62 preterm subjects and 62 controls were evaluated by administering the full Wechsler intelligence scales. A number of specific neuropsychological functions were also assessed. Results. Significant differences were observed in the overall, verbal and manipulative intelligence quotients, as well as in most of the subtests, although less than 30% of the preterm subjects displayed any alterations in their performance. The subtests that were most sensitive to the poor performance of the preterm subjects were vocabulary, coding and picture arrangement. The significant differences in learning, memory, cognitive flexibility and verbal fluency were not upheld on controlling for general cognitive performance. Conclusions. Adolescents with a history of prematurity as a group offer low performance on the Wechsler intelligence scale, although most of them achieve scores within the range of what can be considered to be normal. The different subtests that make up this scale do not exhibit the same degree of sensitivity when evaluating the possible difficulties preterm adolescents have in cognitive performance

[Developmental centered care. Evaluation of Spanish neonatal units]. / Cuidados centrados en el desarrollo. Situación en las unidades de neonatología de España.

INTRODUCTION: Developmental and family centered care (DC) is a framework that aims to enhance the neurodevelopment of the infant. Over the last few years Spanish neonatal units have been working toward introducing this type of care. OBJECTIVE: To evaluate DC in Spanish neonatal units by assessing certain features of the care provided to very low birth weight infants and their families. MATERIAL AND METHOD: Spanish hospitals attending infants under 1,500 g were identified. A cross sectional study was performed using a telephone questionnaire with 25 DC-related items. RESULTS: Of the 100 hospitals attending infants under 1,500 g, 83 hospitals from all the Autonomous Communities in Spain participated in the survey. Of these, 31 % had noise pollution controls, 72 % controlled light intensity, 75 % bound the infants, and 29 % used saccharose as an analgesic. Ten percent allowed unrestricted parental visits. Twenty-two percent used kangaroo care without restriction. Sixty-three percent of the units reported difficulties when introducing DC-related changes. CONCLUSIONS: Practically all neonatal units have some type of DC activity, although in certain areas, such as unrestricted parental visits, the rate of implementation is low.

Cuidados centrados en el desarrollo. Situación en las unidades de neonatología de España / Developmental centered care. Evaluation of Spanish neonatal units

Introducción: Los cuidados centrados en el desarrollo (CCD) y en la familia pretenden mejorar el desarrollo del niño. En los últimos años los servicios de neonatología españoles están intentando introducir este tipo de cuidados. Objetivo: Conocer la situación actual de los CCD en las unidades neonatales españolas valorando diversos aspectos de los cuidados que se proporcionan a los recién nacidos de muy bajo peso y sus familias. Material y método: Se identificaron los hospitales españoles que atienden a niños con peso menor de 1.500 g. Se realizó un estudio transversal por medio de un cuestionario telefónico con 25 preguntas en relación con los CCD. Resultados: De los 100 hospitales que atienden niños con peso menor de 1.500 g se pasó el cuestionario a 83 centros de todas las comunidades autónomas. El 31 % disponían de medidas para controlar el ruido, el 72 % controlaban la intensidad lumínica, el 75 % utilizan nidos para el mantenimiento de la flexión y el 29 % utiliza la sacarosa como analgésico. El 10 % de los centros refieren entrada libre de los padres. En el 22 % se realiza el método canguro sin restricción. En el 63 % de los centros se reconocen dificultades para introducir cambios en relación con los CCD. Conclusiones: En prácticamente todos los centros se realiza alguna actividad en relación con los CCD aunque para ciertos aspectos, como la entrada libre de los padres, existe una tasa de implantación muy baja

Introduction: Developmental and family centered care (DC) is a framework that aims to enhance the neurodevelopment of the infant. Over the last few years Spanish neonatal units have been working toward introducing this type of care. Objective: To evaluate DC in Spanish neonatal units by assessing certain features of the care provided to very low birth weight infants and their families. Material and method: Spanish hospitals attending infants under 1,500 g were identified. A cross sectional study was performed using a telephone questionnaire with 25 DC-related items. Results: Of the 100 hospitals attending infants under 1,500 g, 83 hospitals from all the Autonomous Communities in Spain participated in the survey. Of these, 31 % had noise pollution controls, 72 % controlled light intensity, 75 % bound the infants, and 29 % used saccharose as an analgesic. Ten percent allowed unrestricted parental visits. Twenty-two percent used kangaroo care without restriction. Sixty-three percent of the units reported difficulties when introducing DC-related changes. Conclusions: Practically all neonatal units have some type of DC activity, although in certain areas, such as unrestricted parental visits, the rate of implementation is low

[Retinopathy of prematurity: incidence, severity and outcome]. / Retinopatía del prematuro: incidencia, gravedad y evolución.

OBJECTIVE: The aim of this study was to evaluate the incidence, severity and outcome of retinopathy of prematurity (ROP) in neonates with birth weights of less than 1,501 g in our environment. METHODS: A prospective study of infants with birth weights of less than 1,501 g was performed from January 1999 to June 2000. One hundred seventy-eight infants were enrolled in the study. Mean gestational age was 29.8 2.9 weeks and mean birth weight was 1,095 261.5 g. RESULTS: Overall, 52 infants (29.2 %) developed ROP, of which 10 (5.6 %) presented threshold ROP requiring treatment. None of the infants with a gestational age of more than 30 weeks and a birth weight of more than 1,250 g presented severe retinopathy. CONCLUSIONS: The incidence found in the present study is similar to that of other studies. Immaturity is the most significant risk factors for the development of ROP. The results of our study led us to change our screening program to detect all threshold ROP.

Retinopatía del prematuro: incidencia, gravedad y evolución / Retinopathy of prematurity: incidence, severity and outcome

Objetivo: Determinar la incidencia, gravedad y evolución de la retinopatía del prematuro en recién nacidos con peso inferior a 1.501 g en nuestro medio. Métodos Se ha efectuado un estudio prospectivo de los recién nacidos de peso inferior a 1.501 g entre enero de 1999 y junio de 2000. Se han incluido en el estudio 178 pacientes con una edad gestacional media de 29,8 2,9 semanas y peso medio de 1.095 261,5 g. Resultados Desarrollaron retinopatía el 29,2 per cent de los recién nacidos, de los cuales 5,6 per cent presentaron una retinopatía en estadio umbral y precisaron tratamiento. Ningún paciente de más de 30 semanas o más de 1.250 g presentó una retinopatía grave. Conclusiones La incidencia es similar a la publicada en la literatura, y la inmadurez es el principal factor de riesgo de desarrollar la retinopatía. Los resultados del estudio nos ha hecho variar el programa de cribado para detectar todos los prematuros con retinopatía del prematuro en estadio umbral (AU)

[Continuous arteriovenous hemofiltration in the newborn infant]. / Hemofiltración arterio-venosa continua en el recién nacido.

OBJECTIVE: We present 12 newborns with acute renal failure (ARF) of different etiologies that were treated with continuous arterio-venous hemofiltration (CAVH). PATIENTS AND METHODS: Gestational age and birth weight ranged from 26-42 weeks and 700-4, 700 grams, respectively. The umbilical artery and vein were most frequently used as vascular accesses. Two types of filters were used: Gambro FH 22 and Amicon Minifilter. RESULTS: Treatment lasted from 8 to 120 hours. We obtained an ultrafiltration median of 25 ml/h ranging from 10.75 mL/h to 82.8 mL/h (4.1-31.8 mL/k/h). The volume balance was negative in all patients. Treatment was well tolerated. Complications included hypotension when the system was started and hypoglycemia. CAVH was stopped because of normalization of renal function in 6 cases and death in the other 6. In the latter, cardiac malformation was the cause of death in 3 cases and multiple organ failure in the other 3. CONCLUSIONS: CAVH is useful is the treatment of ARF in the oligoanuric newborn.

[Transposition of the great arteries and pulmonary hypertension: inhaled nitric oxide as a therapy and early surgical correction]. / Transposición de grandes arterias e hipertensión pulmonar: tratamiento con óxido nítrico inhalado y corrección anatómica precoz.

OBJECTIVE: The objective of this study is to present our preliminary experience with pulmonary hypertension inhaled nitric oxide therapy with two newborns presenting with transposition of the great arteries, as well as the usefulness of the Doppler in pulmonary hypertension diagnosis. PATIENTS AND METHODS: Revision of the variations of the hypoxic parameters according to the therapy and revision of the diagnostic procedures in both cases was carried out. RESULTS: Nitric oxide therapy was followed by an evident improvement of the hypoxia and the patient's hemodynamic stabilization, which allowed surgical correction in optimal conditions. The ductal flow pattern allowed recognition of the presence of pulmonary hypertension. CONCLUSIONS: Inhaled nitric oxide must be taken into account as a very useful option in the treatment of this kind of patient and the Doppler examination allows the evaluation of the presence of pulmonary hypertensions.

[Umbilical colonization in normal newborns. A comparative study of 4 methods for umbilical antisepsis]. / Colonización umbilical en recién nacidos normales. Estudio comparativo de cuatro métodos de antisepsia umbilical.

We report the results of a prospective study in which the effectiveness of 70% alcohol (A), mercurochrome (M), a solution of alcohol and mercurochrome (AM) and 1% chlorhexidine (C) as umbilical antiseptics was tested on 311 normal newborn infants. Similar results were obtained by using A, M, or AM; however, when C was used umbilical colonization was significantly reduced as compared to when the other three antiseptic agents were used. The umbilical cords that had been scrubbed with A, M or AM were detached by the 8th day after birth, whereas those treated with C took 14 days to fall off. The use of chlorhexidine resulted in a marked increase in pure cultures positive for Gram negative bacteria (Proteus spp. and Pseudomonas spp.) which was not the case with the other three antiseptics tested.