Lung Microbiota and Ventilator-Associated Pneumonia in the Neonatal Period.

The lung microbiota is a complex community of microorganisms that colonize the respiratory tract of individuals from, or even before, birth. Although the lungs were traditionally believed to be sterile, recent research has shown that there is a diversity of bacterial species in the respiratory system. Knowledge about the lung microbiota in newborns and its relationship with bacterial infections is of vital importance to understand the pathogenesis of respiratory diseases in neonatal patients undergoing mechanical ventilation. In this article, the current evidence on the composition of the lung microbiota in newborns will be reviewed, as well as the risks that an altered microbiota can impose on premature newborns. Although advances in neonatal intensive care units have significantly improved the survival rate of preterm infants, the diagnosis and treatment of ventilator-associated pneumonia has not progressed in recent decades. Avoiding dysbiosis caused by inappropriate use of antibiotics around birth, as well as avoiding intubation of patients or promoting early removal of endotracheal tubes, are among the most important preventive measures for ventilator-associated pneumonia. The potential benefit of probiotics and prebiotics in preventing infectious, allergic or metabolic complications in the short or long term is not clearly established and constitutes a very important field of research in perinatal medicine.

Improved efficiency in the management of newborns with infectious risk factors by the sepsis risk calculator and clinical observation.

OBJECTIVE: To evaluate the efficiency of the sepsis risk calculator and the serial clinical observation in the management of late preterm and term newborns with infectious risk factors. METHOD: Single-center, observational, two-phase cohort study comparing the rates of neonates born ≥35 weeks' gestation, ≥2000 g birthweight, and without major congenital anomalies, who were screened and/or received antibiotics for early-onset neonatal sepsis risk at our center during two periods, before (January/2018-June/2019) and after (July/2019-December/2020) the implementation of the sepsis risk calculator. RESULTS: A total of 1796 (Period 1) and 1867 (Period 2) patients with infectious risk factors were included. During the second period, tests to rule out sepsis were reduced by 34.0 % (RR, 95 %CI): 0.66 (0.61, 0.71), blood cultures by 13.1 %: 0.87 (0.77, 0.98), hospital admissions by 13.5 %: 0.86 (0.76, 0.98) and antibiotic administration by 45.9 %: 0.54 (0.47, 0.63). Three cases of early-onset neonatal sepsis occurred in the first period and two in the second. Clinical serial evaluation would have detected all true cases. CONCLUSIONS: The implementation of a sepsis risk calculator in the management of newborns ≥35 weeks GA, ≥2000 g birthweight, without major congenital anomalies, with infectious risk factors is safe and adequate to reduce laboratory tests, blood cultures, hospital admissions, and antibiotics administration. Serial clinical observation, in addition, could be instrumental to achieve or even improve this goal.

Morbidity and Mortality of Very-Low-Birthweight Twin Infants according to Their Sex and the Sex of the Co-Twin: A Retrospective Cohort Study.

INTRODUCTION: The concept of male disadvantage regarding the prognosis of premature newborns was introduced more than half a century ago, and it has been corroborated over time. However, the influence of the sex of one twin on the outcomes of the other has yielded contradictory results. OBJECTIVE: The aim of the study was to determine if, in twin pregnancies of VLBW infants, the outcomes of one twin are modified by the sex of the co-twin. METHODS: A multicentre retrospective study of a cohort of infants admitted to the collaborating units of the Spanish SEN1500 neonatal network was conducted. Liveborn VLBW twin infants, from 23+0 to 31+6 weeks of gestational age (GA), admitted from 2011 to 2020 were included. Outborn patients, infants with major congenital anomalies, and cases with only one twin admitted were excluded. The main outcomes were survival until first hospital discharge, survival without moderate or severe bronchopulmonary dysplasia (BPD), survival without major brain damage (MBD), and survival without major morbidity. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated. RESULTS: 2,111 twin pairs were included. Male infants exhibited worse outcomes than females (IRR; 95% CI) regarding survival (0.96; 0.94, 0.98), survival without moderate or severe BPD (0.89; 0.86, 0.93), survival without MBD (0.94; 0.91, 0.97), and survival without major morbidity (0.87; 0.81, 0.93). Differences disappeared when the co-twin was a female infant: survival (1.00; 0.97, 1.03), survival without moderate or severe BPD (0.96; 0.91, 1.01), survival without MBD (0.99; 0.95, 1.04), and survival without major morbidity (0.94; 0.85, 1.03). Results for female infants did not change significantly with co-twin sex. CONCLUSIONS: Among VLBW twins from 23+0 to 31+6 weeks of GA, male infants have higher risk of morbidity and mortality overall. In cases of pregnancies with different-sex foetuses, males seem to improve their results, while these do not change for females. The underlying mechanism of this influence deserves further investigation.

Birth order and morbidity and mortality to hospital discharge among inborn very low-birthweight, very preterm twin infants admitted to neonatal intensive care: a retrospective cohort study.

OBJECTIVE: To know the association of birth order with the risk of morbidity and mortality in very low-birthweight (VLBW) twin infants less than 32 weeks' gestational age (GA). DESIGN: Retrospective cohort study. SETTING: Infants admitted to the collaborating centres of the Spanish SEN1500 neonatal network. PATIENTS: Liveborn VLBW twin infants, with GA from 23+0 weeks to 31+6 weeks, without congenital anomalies, admitted from 2011 to 2020. Outborn patients were excluded. MAIN OUTCOME MEASURES: Respiratory distress syndrome (RDS), patent ductus arteriosus, bronchopulmonary dysplasia (BPD), necrotising enterocolitis, major brain damage (MBD), late-onset neonatal sepsis, severe retinopathy of prematurity, survival and survival without morbidity. Crude and adjusted incidence rate ratios were calculated. RESULTS: Among 2111 twin pairs included, the second twin had higher risk (adjusted risk ratio (aRR) of RDS (aRR 1.08, 95% CI 1.03 to 1.12) and need for surfactant (aRR1.10, 95% CI 1.05 to 1.16). No other significant differences were found, neither in survival (aRR 1.01, 95% CI 0.99 to 1.03) nor in survival without BPD (aRR 1.02, 95% CI 0.99 to 1.05), survival without MBD (aRR 1.02, 95% CI 0.99 to 1.06) nor in survival without major morbidity (aRR 0.97, 95% CI 0.92 to 1.03). However, second twins born by caesarean section (C-section) after a vaginally delivered first twin had less overall survival and survival without MBD. CONCLUSION: In modern perinatology, second twins are still more unstable immediately after birth and require more resuscitation. After admission to the neonatal intensive care unit, they are at increased risk of RDS, but not other conditions, except for second twins delivered by C-section after a first twin delivered vaginally, who have decreased overall survival and survival without major brain injury.

Effects of public health measures during the SARS-CoV-2 pandemic on the winter respiratory syncytial virus epidemic: An interrupted time series analysis.

BACKGROUND: Public health measures (PHM) designed to contain the spread of COVID-19 pandemic have influenced the epidemiological characteristics of other viral infections. Its impact on acute RSV bronchiolitis in infants of ≤24 months old has not been systematically studied in our setting. OBJECTIVES: To describe the monthly pattern of visits to the Paediatric Emergency Department (PED) of patients 0 to 14 years of age, the rate of patients diagnosed with RSV acute bronchiolitis per thousand inhabitants of 0 to 24 months, and the rate of them requiring hospital admission during the winter 2020-2021, in the context of local and national COVID-19 restrictions and compare them to the four previous seasons. METHODS: Interrupted time series analysis of patients assisted in the PED and diagnosed with or admitted for RSV acute bronchiolitis in a tertiary University Hospital from January 2016 to February 2020 (pre-intervention period) and from March 2020 to June 2021 (post-intervention period). INTERVENTION: Preventive PHM implemented by the Spanish government weighted by the Containment and Health Index of the Oxford COVID-19 Government Response Tracker. RESULTS: The intervention was followed by an immediate reduction of the rate of visits to the PED of -19.5 (95% confidence interval [CI] -24.0, -14.9) per thousand, and the rate of diagnoses and admissions for RSV acute bronchiolitis of -44.3 (95% CI -73.8, -14.8) and -1.4 (95% CI -2.7, -0.1) per thousand, respectively, with a delayed rebound. CONCLUSIONS: After the implementation of PHM to prevent the spread of SARS-CoV-2 infection, an immediate and important decline in the visits to the PED was observed, with an upward change thereafter. There was also an initial reduction in the diagnoses of and admissions by RSV acute bronchiolitis. An upward trend was observed six to nine months after the usual time of the winter RSV epidemic, coinciding with the relaxation of the preventive PHM.

Adherence to Mediterranean diet is not associated with birthweight - Results form a sample of Canarian pregnant women / La adherencia a la dieta mediterránea no se asocia al peso al nacer: resultados de una muestra de mujeres canarias embarazadas

Background: the prevalence of overweight and obesity showed and increasing trend over the past few years. The burden of this epidemic represents a public health issue worldwide. Spain, and especially the Canary Islands, are not exempt. Pregnancy is a situation of weight gain, and the amount of such increase during gestation can affect the health status of both the mother and her baby. Thus, an optimal dietary style becomes of importance. Aim: given the benefits of the Mediterranean diet (MD) on various health outcomes, we aimed to study the adherence to this dietary pattern in a sample of Canarian pregnant women, and to investigate its association with their newborn's weight. Methods: adherence to MD as well as clinical history and anthropometrics were assessed in a sample of pregnant women followed at a Canarian hospital. Similarly, their newborn characteristics were studied. Results: our findings showed an overall low adherence to MD, with no association between this trend and birthweight. Conclusions: in conclusion, specific tools should be tailored to the target population to assess adherence to MD, and further efforts should be made to promote a healthy eating pattern and lifestyle among the pregnant population

Introducción: la prevalencia del sobrepeso y la obesidad presentó una tendencia al alza en los últimos años. La carga de esta epidemia supone un problema de salud pública en todo el mundo. España, y especialmente las Islas Canarias, no es una excepción. El embarazo es una situación en la que se gana peso y la cantidad de peso que se gana durante la gestación puede afectar al estado de salud tanto de la madre como del niño. Por tanto, adquiere importancia seguir un tipo de dieta óptimo. Objetivo: dados los beneficios de la dieta mediterránea (DM) sobre varios resultados de salud, nos propusimos estudiar la adherencia a este patrón dietético en una muestra de embarazadas canarias e investigar su asociación con el peso neonatal. Métodos: la adherencia a la DM, al igual que la historia clínica y la antropometría, se evaluó en una muestra de mujeres embarazadas seguidas en un hospital canario. También se estudiaron las características de los neonatos. Resultados: nuestros hallazgos mostraron una adherencia general baja a la DM, sin ninguna asociación entre esta tendencia y el peso al nacer. Conclusiones: en conclusión, se deben adaptar a la población objeto de este estudio herramientas específicas que sirvan para evaluar la adherencia a la DM, y se deben realizar nuevos esfuerzos para fomentar un patrón alimenticio y un estilo de vida saludables entre la población gestante

Adherence to Mediterranean diet is not associated with birthweight - Results form a sample of Canarian pregnant women.

INTRODUCTION: Background: the prevalence of overweight and obesity showed and increasing trend over the past few years. The burden of this epidemic represents a public health issue worldwide. Spain, and especially the Canary Islands, are not exempt. Pregnancy is a situation of weight gain, and the amount of such increase during gestation can affect the health status of both the mother and her baby. Thus, an optimal dietary style becomes of importance. Aim: given the benefits of the Mediterranean diet (MD) on various health outcomes, we aimed to study the adherence to this dietary pattern in a sample of Canarian pregnant women, and to investigate its association with their newborn's weight. Methods: adherence to MD as well as clinical history and anthropometrics were assessed in a sample of pregnant women followed at a Canarian hospital. Similarly, their newborn characteristics were studied. Results: our findings showed an overall low adherence to MD, with no association between this trend and birthweight. Conclusions: in conclusion, specific tools should be tailored to the target population to assess adherence to MD, and further efforts should be made to promote a healthy eating pattern and lifestyle among the pregnant population.

INTRODUCCIÓN: Introducción: la prevalencia del sobrepeso y la obesidad presentó una tendencia al alza en los últimos años. La carga de esta epidemia supone un problema de salud pública en todo el mundo. España, y especialmente las Islas Canarias, no es una excepción. El embarazo es una situación en la que se gana peso y la cantidad de peso que se gana durante la gestación puede afectar al estado de salud tanto de la madre como del niño. Por tanto, adquiere importancia seguir un tipo de dieta óptimo. Objetivo: dados los beneficios de la dieta mediterránea (DM) sobre varios resultados de salud, nos propusimos estudiar la adherencia a este patrón dietético en una muestra de embarazadas canarias e investigar su asociación con el peso neonatal. Métodos: la adherencia a la DM, al igual que la historia clínica y la antropometría, se evaluó en una muestra de mujeres embarazadas seguidas en un hospital canario. También se estudiaron las características de los neonatos. Resultados: nuestros hallazgos mostraron una adherencia general baja a la DM, sin ninguna asociación entre esta tendencia y el peso al nacer. Conclusiones: en conclusión, se deben adaptar a la población objeto de este estudio herramientas específicas que sirvan para evaluar la adherencia a la DM, y se deben realizar nuevos esfuerzos para fomentar un patrón alimenticio y un estilo de vida saludables entre la población gestante.

Profile of sodium phenylbutyrate granules for the treatment of urea-cycle disorders: patient perspectives.

Urea-cycle disorders are a group of rare hereditary metabolic diseases characterized by deficiencies of one of the enzymes and transporters involved in the urea cycle, which is necessary for the removal of nitrogen produced from protein breakdown. These hereditary metabolic diseases are characterized by hyperammonemia and life-threatening hyperammonemic crises. Pharmacological treatment of urea-cycle disorders involves alternative nitrogen-scavenging pathways. Sodium benzoate combines with glycine and phenylacetate/phenylbutyrate with glutamine, forming, respectively, hippuric acid and phenylacetylglutamine, which are eliminated in the urine. Among the ammonia-scavenging drugs, sodium phenylbutyrate is a well-known long-term treatment of urea-cycle disorders. It has been used since 1987 as an investigational new drug, and was approved for marketing in the US in 1996 and the EU in 1999. However, sodium phenylbutyrate has an aversive odor and taste, which may compromise patients' compliance, and many patients have reported difficulty in taking this drug. Sodium phenylbutyrate granules are a new tasteless and odor-free formulation of sodium phenylbutyrate, which is indicated in the treatment of urea-cycle disorders. This recently developed taste-masked formulation of sodium phenylbutyrate granules was designed to overcome the considerable issues that taste has on adherence to therapy. Several studies have reported the clinical experience of patients with urea-cycle disorders treated with this new tasteless formulation of sodium phenylbutyrate. Analysis of the data indicated that this taste-masked formulation of sodium phenylbutyrate granules improved quality of life for urea-cycle disorder patients. Furthermore, a postmarketing report on the use of the product has confirmed the previous observations of improved compliance, efficacy, and safety with this taste-masked formulation of sodium phenylbutyrate.

Finalización electiva versus manejo expectante en el control de la gestación prolongada: estudio prospectivo de 200 gestantes / Elective termination versus expectant management in prolonged pregnancy: a prospective study of 200 pregnant women

Objetivo. Comparar la finalización electiva de la gestación prolongada versus el manejo expectante, en gestaciones de bajo riesgo obstétrico. Material y método. Ensayo clínico controlado y aleatorizado entre actuaciones activas y expectantes, sobre una muestra de 200 mujeres con gestación prolongada de bajo riesgo obstétrico entre febrero de 2003 y junio de 2005 en el Hospital Universitario Materno-Infantil de Canarias. Resultados. El grupo estudio está formado por 200 pacientes - 102 del grupo activa y 98 del grupo expectante -. No se encontraron diferencias epidemiológicas entre ambos grupos. El parto no fue inducido en un porcentaje de gestantes significativamente superior en el grupo activa frente al grupo expectante (51% vs 35,7%, p=0,02; OR 0,53 [CI 95% 0,3-0,94]), es decir, el número de inducciones es significativamente superior en el grupo de manejo expectante. Una tasa significativamente menor de gestantes del grupo activa presentó líquido amniótico meconial durante la dilatación (15,7% vs 28,6% p=0,02; OR 0,47 [IC 95% 0,23-0,93]). No existen diferencias significativas con relación al tipo de parto, no obstante el porcentaje de intervención cesárea fue marcadamente inferior en el grupo activa frente al grupo expectante ([12,7% vs 18,4%, p=0,3; OR 0,65 [IC 95% 0.3-1.41]). Los resultados perinatales no muestran diferencias significativas entre ambos grupos. Conclusiones. La finalización electiva en el semana 42, en gestaciones de bajo riesgo obstétrico con condiciones cervicales desfavorables, parece reducir la tasa de cesáreas sin comprometer los resultados perinatales (AU)

Objective. To compare elective termination versus expectant management in low-risk prolonged pregnancy. Material and method. We performed a controlled randomized clinical trial comparing the results of active and expectant approaches in the management of low-risk prolonged pregnancy in a sample of 200 women between February 2003 and June 2005 at the Maternity Ward of the Canary Islands University Hospital. Results. The study group consisted of 200 patients. There were 102 in the active management group and 98 in the expectant management group. No between-group epidemiologic differences were found. Labor was not induced in a significantly higher proportion of patients in the active than in the expectant group [51% vs 35.7%, p=0.02; OR 0.53 (95% CI 0.3-0.94)] i.e. the induction rate was significantly higher in the expectant group. The proportion of patients with meconium-stained amniotic fluid during labor was significantly lower in the active management group [15.7% vs 28.6% p=0.02; OR 0.47 (95% CI 0.23-0.93)]. No significant differences were found in the type of delivery, although the proportion of cesarean sections was noticeably lower in the active management than in the expectant management group [(12.7% vs 18.4%, p=0.3; OR 0.65 (95% CI 0.3-1.41)]. No significant differences were found in perinatal outcomes between the two groups. Conclusions. Elective termination of low-risk pregnancies with unfavorable cervical findings at week 42 seems to reduce the rate of cesarean section without impairing perinatal outcome (AU)

Características epidemiológicas de la sífilis congénita en Gran Canaria. ¿Es necesario el cribado? / Epidemiological characteristics of congenital syphilis in Gran Canaria (Spain). Is screening necessary?

Objetivos: Establecer la incidencia, en nuestro medio, de gestaciones y recién nacidos con infección luética. Dilucidar las características sociales y epidemiológicas de las embarazadas con diagnóstico de sífilis e identificar los factores de riesgo para padecer sífilis congénita en Gran Canaria. Método: Se ha utilizado un diseño de casos y controles durante un período de 6 años (desde el 1 de enero de 1994 al 31 de diciembre de 1999). El estudio ha sido conducido utilizando controles (binomio madre e hijo) para valorar las diferencias en las características socioculturales, sanitarias, cuidado prenatal, abuso de sustancias tóxicas antes y durante la gestación, complicaciones del embarazo y del parto. Para la comparación de variables se han utilizado las siguientes pruebas estadísticas: t de Student o test de Wilcoxon, χ2 o test exacto de Fisher. La evolución de las tasas de sífilis en las mujeres embarazadas y de sífilis congénita se ha analizado mediante un modelo de regresión de Poisson. Resultados: La incidencia de mujeres que presentaron sífilis durante el embarazo permaneció estable. En un 98% de las madres del grupo control, el embarazo fue adecuadamente controlado, pero lo fue sólo en un 66% de las madres que presentaron sífilis durante el embarazo (p < 0,0001). El consumo de drogas y el antecedente de enfermedad de transmisión sexual previa fueron factores asociados con la infección. Las mujeres con sífilis durante el embarazo tuvieron embarazos más cortos, una semana menos por término medio que las madres del grupo control, y mostraron una mayor tasa de prematuridad. Conclusiones: La incidencia de sífilis en nuestro medio es particularmente elevada, de 3,38 casos por 1.000 habitantes. Entre las características maternas, los principales factores independientes de riesgo de padecer sífilis durante la gestación fueron el abuso en el consumo de drogas durante el embarazo y el antecedente de enfermedad de transmisión sexual previa

Objectives: To determine the incidence of syphilis infection in pregnant women and neonates and to identify the social and epidemiological characteristics of pregnant women with a diagnosis of syphilis, as well as the risk factors for congenital syphilis in Gran Canaria. Method: A case-control study was performed over a 6-year period (January 1, 1994 to December 31, 1999). The study was performed using controls (mother-child pairs) to evaluate differences in sociocultural and health characteristics, prenatal care, toxic substance abuse before and during pregnancy, pregnancy complications, and delivery. For the comparison of variables, Student's t-test or Wilcoxon's test and the chi-square test or Fisher's exact test were used. The evolution of syphilis rates in pregnant women and of congenital syphilis was analyzed through a Poisson regression model. Results: The incidence of women with syphilis during pregnancy was stable. Prenatal care was adequate in 98% of the women in the control group and in only 66% of mothers with syphilis during pregnancy (p < 0.0001). Factors associated with infection were drug abuse and having a history of prior sexually transmitted diseases. Pregnant women with syphilis had shorter pregnancies (1 week less, on average) than women in the control group and a higher rate of prematurity. Conclusions: The incidence of syphilis in our environment is particularly high: 3.38 cases per thousand inhabitants. Among maternal characteristics, the main independent risk factors for syphilis infection during pregnancy were drug abuse during pregnancy and having a history of prior sexually transmitted diseases