Human Milk Feeding Is Associated with Decreased Incidence of Moderate-Severe Bronchopulmonary Dysplasia in Extremely Preterm Infants.

BACKGROUND: An increased rate of bronchopulmonary dysplasia (BPD) is reported in extremely preterm infants. A potential role of human milk feeding in protecting against this condition has been suggested. METHODS: A retrospective descriptive study was conducted based on data about morbidity in the population of infants born between 22+0 and 26+6 weeks of gestation, included in the Spanish network SEN1500 during the period 2004-2019 and discharged alive. The primary outcome was moderate-severe BPD. Associated conditions were studied, including human milk feeding at discharge. The temporal trends of BPD and human milk feeding rates at discharge were also studied. RESULTS: In the study population of 4341 infants, the rate of moderate-severe BPD was 43.7% and it increased to >50% in the last three years. The factors significantly associated with a higher risk of moderate-severe BPD were birth weight, male sex, high-frequency oscillatory ventilation, duration of invasive mechanical ventilation, inhaled nitric oxide, patent ductus arteriosus, and late-onset sepsis. Exclusive human milk feeding and any amount of human milk at discharge were associated with a lower incidence of moderate-severe BPD (OR 0.752, 95% CI 0.629-0.901 and OR 0.714, 95% CI 0.602-0.847, respectively). During the study period, the proportion of infants with moderate-severe BPD fed any amount of human milk at discharge increased more than twofold. And the proportion of infants with moderate-severe BPD who were exclusively fed human milk at discharge increased at the same rate. CONCLUSIONS: Our work shows an inverse relationship between human milk feeding at discharge from the neonatal unit and the occurrence of BPD.

Documento del Grupo de Estudios Neonatales sobre el acompañamiento de padres y madres a recién nacidos en las Unidades de Cuidados Intensivos Neonatales y Maternidades durante la pandemia por SARS-CoV-2 / Document of the Neonatal Study Group on the accompaniment of parents of newborns in Neonatal Intensive Care Units and Maternity Units during the SARS-CoV-2 pandemic

El documento partede una reflexión sobre la política de restricción de visitas de los padres en las unidades neonatales y del acompañamientoen las plantas de maternidad que se aplicó en los hospitales en las primeras fases de la pandemia. Casi un año tras suinicio, un grupo de neonatólogos con espíritu autocrítico trabajamos de forma conjunta, en el marco del Grup d’EstudisNeonatals, con la voluntad de analizar los posibles efectos adversos de las medidas sobre aspectos fundamentales comoson el neurodesarrollo del recién nacido, la lactancia materna y la salud psicológica de los progenitores. Y, finalmente,desde el conocimiento y recursos que teníamos en ese momento, elaborar nuevas recomendaciones.(AU)

The document is based on a reflection on the policy ofrestricting parental visits in neonatal units and the accompanying in maternity wards that was applied in hospitals inthe early phases of the pandemic. Almost a year after its beginning, a group of neonatologists with a self-critical spiritworked together, within the framework of the Grup d’Estudis Neonatals, with the aim of analyzing the possible adverseeffects of the measures on fundamental aspects such as the neurodevelopment of the newborn, breastfeeding andthe psychological health of the parents. And, finally, from the knowledge and resources we had at that time, to developnew recommendations.(AU)

El document parteix d’una reflexiósobre la política de restricció de visites dels pares a les unitats neonatals i de l’acompanyament a les plantes dematernitat que es va aplicar als hospitals a les primeres fases de la pandèmia. Gairebé un any després del seu inici,un grup de neonatòlegs amb esperit autocrític treballem conjuntament, en el marc del Grup d’Estudis Neonatals,amb la voluntat d’analitzar els possibles efectes adversos de les mesures sobre aspectes fonamentals com sónel neurodesenvolupament del nounat, la lactància materna i la salut psicològica dels progenitors. I, finalment, desdel coneixement i recursos que teníem en aquell moment, elaborar noves recomanacions.(AU)

Active approach in delivery room and survival of infants born between 22 and 26 gestational weeks are increasing in Spain.

AIM: To describe the trends in the delivery room approach and survival of extremely premature infants over the past two decades. METHODS: Time-series analysis of infants included in the Spanish SEN1500 network from 2004 to 2019. Patients born from 22 + 0 to 26 + 6 weeks were included. The primary outcome was an active approach in the delivery room. Survival and temporal trends were also studied. RESULTS: The study population included 8284 patients. At 22 and 23 weeks, an active approach was followed in 41.4% and 80.8%. A temporal trend toward a more active approach was observed at 23 weeks. Antenatal steroids were administered in 19.6% and 58.1% at 22 and 23 weeks. From 24 weeks, an active approach was applied in nearly all cases throughout the period, and more than 80% of patients received antenatal steroids. The rates of survival after an active approach were 8.7%, 21.6%, 40.6%, 59.9%, and 74.7% at 22, 23, 24, 25, and 26 weeks and significantly increased over the period, except for infants born at 22 weeks. CONCLUSION: Active management and survival of infants born from 23 weeks increased over the period, but the frequency of antenatal steroid administration was lower than the intention to resuscitate.

Changes in perinatal management and outcomes in infants born at 23 weeks of gestational age during the last decade in Spain.

INTRODUCTION: The 2021-updated guidelines of the Spanish Society of Neonatology Guidelines have moved the zone of parental discretion to 23 + 0-23 + 6 weeks. The objective of this study was to describe the changes in perinatal management at this gestational age along the last decade and to determine if a more active perinatal management has contributed to improved outcomes. METHODS: Retrospective analysis of prospectively collected data from the 23-week infants included in the Spanish SEN 1500 neonatal network during the period 2010-2019. The main study outcomes were survival at discharge and survival without major morbidity of actively managed infants. Two periods were compared: 2010-2014 (Period 1) and 2015-2019 (Period 2). NICUs were classified into low activity NICUs (less than 50 admissions of very low birth weight infants per year) and high activity NICUs (50 or more admissions). RESULTS: A total of 381 infants were included, 182 in Period 1 and 199 in Period 2. In Period 2 an increase in the use of intrapartum magnesium sulfate (21.5% vs 39.9%, p .002), antenatal steroids (56.6% vs 69.3%, p .011) and active neonatal approach in delivery room (76.9% vs 86.9%, p .011) were observed.The clinical outcomes of the actively managed 313 infants were similar in both periods, except for less arterial hypotension in Period 2. Survival was 27.1% in Period 1 and 25% in Period 2 (p .068) and survival without major morbidity was 2.1% and 2.3% respectively (p .914). No difference was found between low and high activity NICUs. CONCLUSION: A change to a more active intention to treat infants born at 23 weeks is taking place in Spain. But the survival rate of the actively-managed infants has remained stable around 25-30% during the study period. A multidisciplinary effort is needed to improve outcomes in this population.

Risk factors for postpartum depression in mothers of newborns admitted to neonatal intensive care unit.

BACKGROUND: There is a lack of information on how maternal stress coping styles during admission of the newborn to the neonatal intensive care unit (NICU) influences the onset of the postpartum depression (PPD). We examined potential risk factors for the emergence of the PPD in mothers whose infants were admitted to the NICU. METHODS: A cross-sectional study was conducted on 401 mothers, 125 were mothers whose infants were admitted to the NICU and 276 mothers without NICU care. Newborn illness severity information score was taken throughout NICU admission via the Clinical Risk Index for Babies (CRIB). Six weeks after giving birth, participants from both groups individually completed the Edinburg Postnatal Depression Scale (EPDS), the Postpartum Bonding Questionnaire (PBQ) and the Coping Strategies Inventory (CSI) using an online platform. RESULTS: No differences were found regarding PPD and bonding in either groups. Multivariate analysis provided a final model in which cognitive restructuring, problem avoidance, severity of neonatal health problems during the first 12 hours of life, and problem solving were the best predictors of postpartum depression explaining, 43.7% of the variance in the NICU group. CONCLUSION: It is necessary to obtain early detailed information on coping styles in the NICU environment to prevent the possible onset of PPD.

Acompanyament parental als nounats de les unitats neonatals i plantes de maternitat durant la pandèmia per SARS-CoV-2 / Acompañamiento parental a recién nacidos en las unidades neonatales y plantas de maternidad en relación A lA pandemia por sars-coV-2 / Policies on parental Access restriction in neonatal units And maternity wards during the sars-cov-2 pandemic

Fonament: Des de l’inici de la pandèmia per SARS-CoV-2,la majoria d’unitats neonatals d’arreu del món han aplicatprotocols de restricció de la presència de mares i pares,amb l’objectiu de protegir el personal sanitari i els nounats.Objectiu. Avaluar els efectes col·laterals derivats de la pocapresència de mares i pares al costat dels seus nadons a lesunitats neonatals, i els relacionats amb les restriccions ales plantes de maternitat. Mètode: Revisió de la literatura. S’ha consultat Pubmed iGoogle Scholar utilitzant com a paraules clau ‘SARS-CoV-2’i ‘covid-19’ combinades amb ‘neonatal’, ‘NICU’ i ‘parents’,‘family centered care’ i ‘neurodevelopmental care’. S’hanconsultat dominis en què es recullen resums actualitzatsde l’evidència científica disponible sobre la pandèmia perSARS-CoV-2: www.dontforgetthebubles.com i el web de laSocietat Espanyola de Neonatologia (www.seneo.es). Laveu de les famílies s’ha cercat mitjançant les pàgines deles associacions que els representen i a les xarxes socials.Resultats. El model de cures centrades en el desenvolupa-ment i la família, que ha demostrat efectes positius sobre lasalut dels nadons ingressats i el neurodesenvolupament delsprematurs, es veu amenaçat si es limita la presència paren-tal. La restricció també ha demostrat tenir efectes adversossobre la lactància materna i la salut psicològica dels pares imares. Les dades disponibles fins ara posen de manifest uncomportament benigne de la infecció covid-19 en nadons.Conclusions: En un moment crucial per a la implantació delmodel de cures centrades en el desenvolupament a les uni-tats neonatals catalanes, i amb les dades disponibles, ésimprescindible redissenyar les polítiques d’acompanyamentparental als nadons ingressats.(AU)

Fundamento: Desde el inicio de la pandemia por SARS-CoV-2, lamayoría de unidades neonatales de todo el mundo han aplicadoprotocolos de restricción de la presencia parental, con el objetivode proteger al personal sanitario y a los propios recién nacidos. Objetivo: Evaluar los efectos colaterales derivados de la menor pre-sencia de los padres junto a sus bebés en las unidades neonatales,y los relacionados con las restricciones en las plantas de maternidad.Método: Revisión de la literatura. Se ha realizado búsqueda enPubmed i Google Scholar utilizando como palabras clave ‘SARS-CoV-2’ y ‘covid-19’ en combinación con ‘neonatal’, ‘NICU’ y ‘pa-rents’, ‘family centered care’ y ‘neurodevelopmental care’. Se hanconsultado dominios donde se recogen resúmenes actualizados dela evidencia científica disponible sobre la pandemia por SARS-CoV-2: www.dontforgetthebubles.com y la web de la Sociedad Es-pañola de Neonatología (www.seneo.es). La opinión de las familiasse ha buscado en las páginas web de las asociaciones que las re-presentan y en las redes sociales. Resultados: El modelo de cuidados centrados en el desarrollo y lafamilia, que ha demostrado efectos positivos sobre la salud de losrecién nacidos ingresados y el neurodesarrollo de los prematuros,se ve amenazado si se limita la presencia parental. La restriccióntambién ha demostrado tener efectos adversos sobre la lactanciamaterna y la salud psicológica de los progenitores. Los datos dis-ponibles hasta ahora ponen de manifiesto un comportamiento be-nigno de la infección por covid-19 en recién nacidos. Conclusiones: En un momento crucial para la implantación del mo-delo de cuidados centrados en el desarrollo en las unidades neo-natales catalanas, y con los datos disponibles, es imprescindiblerediseñar las políticas de acompañamiento de los padres a sushijos recién nacidos ingresados.(AU)

Objective: To evaluate the side effects of the limitation of parentspresence with their babies in neonatal units and those related torestrictions on maternity wards access. Method: Literature review. A search using ‘SARS-CoV-2’ and ‘CO-VID-19’ as keywords combined to ‘neonatal’, ‘NICU’, ‘parents’,‘family centered care’ and ‘neurodevelopmental care’. Consulta-tion of websites containing updated and summarized scientific li-terature about the pandemic and its consequences in newbornshas also been performed: www.dontforgetthebubles.com andwww.seneo.es. The voice of the families has been mainly obtainedthrough the websites of their associations and the social networks. Results. The family-centered care model has shown positive effectson the health of sick newborns and on premature infants’ neuro-development. This model of care is under threat if parental accessis limited. It has been shown that these restrictions have also ad-verse effects on breastfeeding and on caregivers’ psychologicalwellbeing. Data from different neonatal series report a benigncourse of COVID-19 infection in neonates and preterm babies. Conclusions: At a crucial moment for the implementation of thedevelopmental centered care model in Catalan neonatal units, andwith the available data, it is essential to redesign the policies regar-ding parents who accompany their babies admitted to the units.(AU)

A Breast Milk Pump at the Bedside: A Project to Increase Milk Production in Mothers of Very Low Birth Weight Infants.

The amount of milk production in mothers of babies admitted to the neonatal intensive care unit (NICU) is mostly determined by some actions focused on the first hours and days after birth. Working for an improvement in our previous results in terms of maternal expressed breast milk (MEBM) production, we designed a pilot project and a small observational study. After increasing the number of breast milk pumps to allow full-time availability and implementing educational strategies and updated information for parents, the volume of MEBM production by day 14 after birth was doubled and increased to >500 mL per day. The rate of exclusive breastfeeding at discharge improved from 26.67% to 76.19%. The cost of the use of donor milk per patient decreased by 15.7%. This study is an example of a cost-beneficial quality improvement strategy. It demonstrates the importance of an optimal supply of breast milk pumps in NICU and educational interventions focused on enhancing MEBM production.

Breastfeeding Disparities between Multiples and Singletons by NICU Discharge.

Multiple pregnancy increases the risk of a range of adverse perinatal outcomes, including breastfeeding failure. However, studies on predictive factors of breastfeeding duration in preterm twin infants have a conflicting result. The purpose of this observational study was to compare feeding practices, at hospital discharge, of twin and singleton very low birth weight infants. The study is part of a prospective survey of a national Spanish cohort of very low birth weight infants (SEN1500) that includes 62 neonatal units. The study population comprised all infants registered in the network from 2002 to 2013. They were grouped into singletons and multiples. The explanatory variables were first analyzed using univariate models; subsequently, significant variables were analyzed simultaneously in a multiple stepwise backward model. During the twelve-year period, 32,770 very low birth weight infants were included in the database, of which 26.957 were discharged alive and included in this analysis. Nine thousand seven hundred and fifty-eight neonates were multiples, and 17,199 were singletons. At discharge, 31% of singleton infants were being exclusively breastfed, 43% were bottle-fed, and 26% were fed a combination of both. In comparison, at discharge, only 24% of multiple infants were exclusively breastfed, 43% were bottle-fed, and 33% were fed a combination of both (p < 0.001). On multivariable analysis, twin pregnancy had a statistically significant, but small effect, on cessation of breastfeeding before discharge (OR 1.10; 95% CI: 1.02, 1.19). Risks of early in-hospital breastfeeding cessation were also independently associated with multiple mother-infant stress factors, such as sepsis, intraventricular hemorrhage, retinopathy, necrotizing enterocolitis, intubation, and use of inotropes. Instead, antibiotic treatment at delivery, In vitro fertilization and prenatal steroids were associated with a decreased risk for shorter in-hospital breastfeeding duration. Multiple pregnancy, even in the absence of pathological conditions associated to very low birth weight twin infants, may be an impeding factor for in-hospital breastfeeding.

Morbidity and mortality of very low birth weight multiples compared with singletons.

BACKGROUND: Previous studies comparing the neonatal outcome of very low birth weight (VLBW) multiples and singletons have suggested a worse outcome for multiples at gestational ages on the limits of viability. OBJECTIVES: The objective of this study is to determine the neonatal mortality and morbidity of VLBW multiples compared to singletons. METHODS: This is a retrospective study including all infants registered in the Spanish network for infants under 1500 g (SEN1500), over a 12-year period (from 2002 to 2013). Mortality and major morbidities were compared between singletons and multiples. RESULTS: About 32,770 infants were included: 21,123 singletons (64.5%) and 11,647 multiples (35.5%), with a mean gestational age of 29.5 weeks (22-38), and mean birth weight of 1115 g (340-1500). When adjusted by other perinatal factors, multiple pregnancy has a significantly higher risk of mortality than singleton pregnancy (odds ratio (OR) 1.15; IC 95% 1.05-1.26, p = .002), but not a higher risk of major morbidity or composite adverse outcome. In the subgroup of infants born before 26 weeks, multiples showed a higher risk of mortality (63.9% versus 51%, OR 1.7; 95% CI 1.47-1.96) and a higher risk of composite adverse outcome (88.9% versus 81.5%, OR 1.82, 95% CI 1.28-2.24). CONCLUSIONS: In preterm infants born with less than 1500 g, multiple pregnancy is a prognostic factor that can slightly increase mortality. Extremely preterm infants born before 26 weeks have a greater risk of mortality and major morbidity if they come from a multiple pregnancy.

Fatal alloimmune thrombocytopenia due to anti-HLA alloimmunization in a twin pregnancy: A very infrequent complication of assisted reproduction.

The most frequently involved antigen in severe fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the human platelet antigen 1a. Platelets express the HLA-A and B antigens on their membrane and some studies report that maternal anti-HLA class I antibody can also cause FNAIT. We report here a very unusual case of a first twin pregnancy produced in vitro by oocyte and semen donation where the mother developed markedly elevated HLA antibodies, in the absence of anti-platelet or anti-neutrophil antibodies, that provoked in one of the twins a profound thrombocytopenia and intracranial hemorrhage and a mild thrombocytopenia and neutropenia in the second twin lasting until the fourth month of life. In addition, anti-D alloimmunization provoked hemolytic disease of the newborn with intrauterus anemia detected in the first twin and post-natal anemia in the second twin that required red blood cell transfusion and phototherapy. We hypothesize that the complete HLA-incompatible twin pregnancy due to the oocyte donation might have contributed to the severity of the clinical manifestations.

Hiperinsulinisme en una unitat neonatal / Hiperinsulinismo en una unidad neonatal / Hyperinsulinism in a newborn unit

Introducció: lhiperinsulinisme (HI) és la causa més freqüent dhipoglucèmia neonatal mantinguda. Es pot dividir en transitori o secundari i persistent o congènit. Es presenta una revisió del tema, a partir de quatre casos diagnosticats a la nostra unitat durant set anys. Observació clínica: dels quatre casos, tres són transitoris o secundaris i un persistent. Els factors predisposants dels transitoris són la pèrdua del benestar fetal i la diabetis gestacional. El persistent, amb una ressonància magnètica (RM) cranial i un estudi genètic normals, no va respondre al tractament amb diazòxid (DI) i va millorar amb dextrinomaltosa i alimentació contínua. Cap cas va presentar seqüeles neurològiques. Comentaris: els nostres casos compleixen els criteris diag-nòstics dHI. La incidència dHI al nostre centre és d1/4.500 nascuts vius i la dHI persistent d1/20.000 nascuts vius en set anys. LHI transitori o secundari es relaciona amb lasfíxia neonatal, el retard del creixement intrauterí i la diabetis gestacional. Els casos descrits presen-ten pèrdua del benestar fetal i diabetis. El tractament inicial és laportació de glucosa. Després, el fàrmac de primera línia és el DI. LHI persistent acostuma a no respondre al tractament i pot ser focal o difús, el primer dels quals es pot beneficiar de cirurgia. El màxim objectiu és la prevenció de seqüeles neurològiques. És fonamental el maneig conjunt amb un especialista endocrinòleg

Introducción. El hiperinsulinismo (HI) es la causa más frecuente de hipoglucemia neonatal mantenida. Se puede dividir en transitorio o secundario y persistente o congénito. Se presenta una revisión del tema, a partir de cuatro casos diagnosticados en nuestra unidad durante siete años. Observación clínica. De los cuatro casos, tres son transitorios o secundarios y uno persistente. Los factores predisponentes de los transitorios son la pérdida del bienestar fetal y la diabetes gestacional. El persistente, con una resonancia magnética (RM) craneal y un estudio genético normales, no respondió al diazóxido (DI) y mejoró con dextrinomaltosa y alimentación continua. Ningún caso presentó secuelas neurológicas. Comentarios. Nuestros casos cumplen los criterios diagnósticos de HI. La incidencia de HI en nuestro centro es de 1/4.500 nacidos vivos y la de HI persistente de 1/20.000 nacidos vivos en siete años. El HI transitorio o secundario se relaciona con la asfixia neonatal, el retraso del crecimiento intrauterino y la diabetes gestacional. Los casos descritos presentan pérdida del bienestar fetal y diabetes. El tratamiento inicial es el aporte de glucosa. Después, el fármaco de primera linea es el DI. El HI persistente acostumbra a no responder al tratamiento y puede ser focal o difuso, el primero de los cuales puede beneficiarse de cirugía. El máximo objetivo es la prevención de secuelas neurológicas. Es fundamental el manejo conjunto con un especialista endocrinólogo (AU)

Introduction. Hyperinsulinism (HI) is the most frequent cause of sustained neonatal hypoglycemia; it can be transient (secondary) or persistent (congenital). We describe four cases of neonatal HI seen in a neonatal unit over a seven-year period. Clinical observation. Three of the four cases were transient or secondary, and the other was persistent. Loss of fetal wellbeing and gestational diabetes were the predisposing factors in the three transient cases. The case of persistent HI had normal brain magnetic resonance imaging and genetics; it did not respond to treatment wth diazoxide (DI) but improved with continuous feeding and dextrinomaltose. All four cases recovered with no neurological sequelae. Comments. Our fours cases met the diagnosis criteria for HI. Over the seven-year period, the overall incidence of HI was 1 in 4,500 live births, while the incidence of persistent HI was 1 in 20,000 live births. Transient or secondary HI is related to birth asphyxia, intrauterine growth retardation, and gestational diabetes. The initial treatment of HI is with glucose and DI. Persistent or congenital HI seldom responds to treatment and it can be the result of focal or diffuse pancreatic disease, the first of which anomalies could benefit from surgery. Prevention of neurological sequelae is the main objective of the treatment. A multidisciplinary management with endocrinology is recommended (AU)

Hospital outcomes of extremely low birth weight infants after introduction of donor milk to supplement mother's milk.

AIM: This study evaluated the impact of an exclusive human milk diet to nourish extremely low birth weight infants in the neonatal intensive care unit. MATERIALS AND METHODS: This multicenter pre-post retrospective study included all inborn infants <1,000 g admitted to four Level IV neonatal intensive care units either before or after implementing a donor human milk policy. The feeding protocol was unchanged in both periods. Collected data included maternal/infant demographics, infant clinical data, and enteral intake as mother's own milk, donor milk, and formula. RESULTS: Two hundred one infants were enrolled. Infant growth and other clinical outcomes were similar in both groups. Exposure to mother's own milk at discharge was not different. Median time in oxygen and duration of mechanical ventilation were significantly higher among formula-fed infants (63 versus 192 hours [p=0.046] and 24 versus 60 hours [p=0.016], respectively). CONCLUSIONS: Our results add evidence supporting the safety of donor milk. This study also found an association between exposure to formula in preterm infants and the requirement for respiratory support, a finding that warrants further investigation.

Evolució postnatal dels infants nascuts després d'una seroconversió materna a Toxoplasma gondiidurant lagestació / Evolución postnatal de los neonatos nacidos después de una seroconversión materna a toxoplasma gondii durante la gestación / Postnatal evolutionof children born after a maternal toxoplasma gondii seroconversion during pregnancy

Fonament: la toxoplasmosi congènita és transmissible alfetus, habitualment assimptomàtica i només detectableper serologies. L'eficàcia del tractament fetal i postnatal éscontrovertida. Objectiu: explorar l'evolució postnatal dels fills de mares infectades per Toxoplasma gondiidurant la gestació. Mètode: l'estudi és retrospectiu. Inclou tots els nadonsnascuts vius, entre gener del 1999 i desembre del 2011, de mares seroconvertides a T. gondiidurant la gestació. Esdescriuen la confirmació d'infecció congènita en cada cas,el tractament rebut i el seguiment posterior. Resultats: s'inclouen 29 nadons nascuts vius, en 26 delsquals es va realitzar la reacció en cadena de la polimerasaen líquid amniòtic (PCR-LA) a T. gondii. En dos casos varesultar positiva i es va iniciar tractament. Dels 24 casosamb PCR-LA negativa, tres es van diagnosticar d'infeccióen el seguiment postnatal. Dels tres casos en què no es varealitzar la PCR-LA, un va ser una seroconversió molt tardana. En els altres dos, les serologies es van negativitzar alcap de 6 mesos. El total d'infants amb infecció congènitaconfirmada és de 6/29 (20,69%). Conclusions: el tractament prenatal no exclou la infecció fetal. Destaca l'absència de símptomes en néixer i de lesionsal sistema nerviós i a la retina en tots els infectats. La incidència d'infecció congènita és similar a la d'altres sèries. Una PCR-LA negativa no la descarta, només l'absènciad'IgG en sang als 12 mesos n'exclou el diagnòstic. Cal fercontrols oftalmològics i del neurodesenvolupament. Malgratun tractament correcte, hi ha risc de lesions retinianes finsa la vida adulta

Fundamento. La toxoplasmosis congénita es transmisible al feto, habitualmente asimptomática y sólo detectable por serología. La eficacia del tratamiento fetal y postnatal es controvertida. Evolució postnatal dels infants nascuts després d’una seroconversió materna a Toxoplasma gondii durant la gestació Eva Capdevila, Roser Porta, Josep Maria Cubells, Xavier Viñallonga, Mariona Roger, Vicente Molina Unitat Neonatal. Institut Universitari Dexeus. Barcelona Objectivo. Explorar la evolución postnatal de los hijos de madres infectadas por Toxoplasma gondii durante la gestación. Método. El estudio es retrospectivo. Incluye a todos los recién nacidos vivos, entre enero del 1999 y diciembre del 2011, de madres seroconvertidas a T. gondii durante la gestación. Se describen la confirmación de infección congénita en cada caso, el tratamiento recibido y el seguimiento posterior. Resultados. Se incluyen 29 niños nacidos vivos, en 26 de los cuales se realizó la reacción en cadena de la polimerasa en líquido amniótico (PCR-LA) a T. gondii. En dos casos resultó positiva y se les inició tratamiento. De los 24 casos con PCR-LA negativa, tres se diagnosticaron de infección en el seguimiento postnatal. De los tres casos en los que no se realizó PCR-LA, uno fue una seroconversión muy tardía. En los otros dos las serologías se negativizaron a los 6 meses. El total de niños con infección congénita confirmada es de 6/29 (20,69%). Conclusiones. El tratamiento prenatal no excluye la infección fetal. Destaca la ausencia de síntomas al nacer y de lesiones en sistema nervioso y retina en todos los infectados. La incidencia de infección congénita es similar a la de otras series. Una PCR-LA negativa no la descarta, sólo la ausencia de IgG en sangre a los 12 meses excluirá el diagnóstico. Se deben realizar controles oftalmológicos y del neurodesarrollo. A pesar de un tratamiento correcto existe riesgo de lesiones retinianas hasta la vida adulta (AU)

Background. Toxoplasmosis can be transmitted to the fetus. Congenital toxoplasmosis is usually asymptomatic and can only be detected by serology. The efficacy of fetal and postnatal treatment has not been well established. Objective. To describe the postnatal outcome of children born to mothers infected with Toxoplasma gondii during pregnancy. Method. Retrospective study including all children born to mothers who seroconverted to T. gondii during pregnancy between January 1999 and December 2011. Confirmation of congenital infection, indication of treatment, and ophthalmological and neurological follow-up are described. Results. Twenty-nine children were evaluated. In 26 cases polymerase chain reaction to T. gondii in amniotic fluid (PCR-AF) was performed. The test was positive in 2 cases, and treatment was started. Of the 24 cases with negative PCR-AF, 3 were diagnosed with infection with positive serology during postnatal follow-up. In 1 of the 3 cases that did not have PCR-AF done, a very late seroconversion was seen. Serologies in the other 2 cases were negative at 6 months. In total, 6 children (20.7%) had a congenital infection confirmed. Conclusions. Prenatal treatment does not avoid fetal infection. The absence of symptoms in all newborns and the lack of neurological and ophthalmological damage is highlighted. The incidence of congenital infection after maternal seroconversion is similar to other studies. A negative PCR-AF does not rule out infection; only negative serology at 12 months will exclude it. Ophthalmological and neurological evaluations are mandatory. Even with the early initiation of therapy, there is a risk of retinal damage until adult age (AU)

Està augmentant la incidència d’infecció perinatal per Listeria monocytogenes? / No disponible

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Brote nosocomial por Listeria monocytogenes en una Unidad de Neonatos / Nosocomial outbreak due to Listeria monocytogenes in a neonatal unit

Introducción Se describe la investigación de un brote por Listeria monocytogenes en una Unidad de Neonatos. Métodos Se realizó una encuesta epidemiológica, recogida de muestras ambientales y estudio de epidemiología molecular. Resultados Se trata de un brote nosocomial de infección por L. monocytogenes, confirmado por epidemiología molecular, en una Unidad de Neonatos que afectó a tres niños. La cadena de transmisión no pudo ser confirmada, pero se sospecha una transmisión cruzada vehiculizada por las manos del personal. Conclusión La estricta adherencia a las medidas de prevención estándar es necesaria para evitar estos brotes nosocomiales (AU)

Introduction Description of an outbreak of Listeria monocytogenes in a neonatal intensive care unit. Methods A questionnaire, environmental investigation and molecular study were performed. Results We identified a nosocomial outbreak of L. monocytogenes, confirmed by the genetic study, in a neonatal intensive care unit. Three infants were affected. Although the transmission mechanism could not be elucidated, cross-infection was strongly suggested. Conclusion Adherence to universal hygiene standards is necessary to avoid nosocomial outbreaks (AU)

[Nosocomial outbreak due to Listeria monocytogenes in a neonatal unit]. / Brote nosocomial por Listeria monocytogenes en una Unidad de Neonatos.

INTRODUCTION: Description of an outbreak of Listeria monocytogenes in a neonatal intensive care unit. METHODS: A questionnaire, environmental investigation and molecular study were performed. RESULTS: We identified a nosocomial outbreak of L. monocytogenes, confirmed by the genetic study, in a neonatal intensive care unit. Three infants were affected. Although the transmission mechanism could not be elucidated, cross-infection was strongly suggested. CONCLUSION: Adherence to universal hygiene standards is necessary to avoid nosocomial outbreaks.