Follow-up of infants born to mothers with autoinmune thyroid disease. What should not be screened? / Seguimiento del hijo de madre con patología tiroidea autoinmune. ¿Qué no debemos cribar?

INTRODUCTION: Thyroid dysfunction is a common problem in pregnant women. It is usually of an autoimmune origin, with Hashimotós thyroiditis and Graves disease being the most common conditions. Although hormonal changes and transplacental antibody transfer may occur, specific neonatal screening has not been shown to be useful. PATIENTS AND METHOD: A prospective study of newborns of women with autoimmune thyroid disease born at a level III university hospital (November 2013-December 2016). Neonates were selected during their stay at the maternity. Babies with perinatal asphyxia were excluded. Data were collected from the clinical histories of mothers and newborns. RESULTS: A total of 191 neonates were included. Ninety percent of mothers had been diagnosed with autoimmune hypothyroidism. Only 5.8% of newborns had some laboratory disorder, consisting of slightly increased thyroid-stimulating hormone levels, which returned to normal at the age of one month and did not correlate to thyroid peroxidase antibody levels. Transient hyperthyrotropinemia was diagnosed in one newborn and required thyroxin treatment during the first year of life. Among newborns from mothers with Graves disease, 36.8% had some abnormal laboratory value during the first 7 days of life, but there were no cases of hyperthyroidism and only one of transient hyperthyrotropinemia. CONCLUSIONS: Experience at our hospital in screening of newborns from hypothyroid mothers reveals a high number of laboratory controls with a poor diagnostic yield. No relationship was found between thyroid peroxidase antibody levels and thyroid dysfunction. We support the recommendations to continue testing serum thyroid-stimulating hormone and FT4 levels at 48h of life in newborns of mothers with autoimmune hypothyroidism.

Age of sitting unsupported and independent walking in very low birth weight preterm infants with normal motor development at 2 years.

AIMS: The aims of this study is to (i) determine the age of sitting unsupported and independent walking in preterm infants with birth weight under 1500 g (very low birth weight, VLBW); (ii) estimate differences between VLBW children and a reference population and (iii) estimate the association between clinical characteristics and late age at sitting and walking. METHODS: A longitudinal study was conducted of a cohort of 876 children with VLBW. The World Health Organization (WHO) motor development study population was used as a reference. Ages for both skills were established by interview with parents. Means were compared with t-test, ANOVA and Bonferroni adjustment where appropriate. RESULTS: The inclusion criteria were complied with 694 patients; 50% of VLBW sat at 7 m corrected age (CA) and walked at 13 m CA. Both motor skills were acquired later (7.3 +/- 1.5 and 13.6 +/- 2.8 m) compared with the control group (6 +/- 1.1 and 12.1 +/- 1.8 m). Weight or head circumference at birth below the 10th percentile or the presence of bronchopulmonary dysplasia were associated with delayed acquisition of both skills. CONCLUSION: Very low birth weight infants typically sit unsupported and walk later than term infants. Tables describing reference values for milestones acquisition for different categories of infants (gestational age, birth weight and other determinants) may contribute to inform the decision making process on access to available resources.

[Retinopathy of prematurity screening in Spanish neonatal units]. / Cribado de la retinopatía de la prematuridad en las unidades neonatales españolas.

INTRODUCTION: A wide variety of retinopathy of prematurity (ROP) screening criteria exists in the different hospitals. In 1988, the benefits of cryotherapy treatment in severe ROP cases were demonstrated, and since then, some scientific societies have made recommendations on the screening and treatment of ROP. Within the Spanish scientific community, there are no specific recommendations on screening, diagnosis or treatment. OBJECTIVES: To describe the criteria used in the screening of retinopathy in premature newborns by those Spanish hospitals caring for babies with birth weights below 1,500 g. MATERIAL AND METHOD: A cross-sectional study was performed based on a 50 question questionnaire on screening criteria and other related issues. This questionnaire was sent to those public and private neonatal units in Spain caring for babies with birth weights below 1,500 grams. The questionnaire was sent and returned between January 2002 and May 2003. RESULTS: Units in all of the 17 autonomous communities and both autonomous cities in territorial Spain (Ceuta and Melilla) responded. There was a 90% response rate. All the participating hospitals perform ROP screening. Only 62.9% of the hospitals follow a written protocol on screening. A large majority of hospitals (79.8%) perform a retinal eye examination on all newborns below 1500 g at birth. Half of the hospitals included in the study, 51.6%, determine the cut-off point for performing the screening at 32 weeks of gestational age. Around 73% of the hospitals include the administering of oxygen supplements to premature babies as part of the criteria for screening, regardless of the babies' weight and gestational age. Weight, gestational age and oxygen are the only criteria used in 51% of the units. That all hospitals in Spain should establish some screening criteria was suggested by 90% of the responses. Only 10% use analgesia or sedation, other than topical, when examining the retina. CONCLUSIONS: Even though all the hospitals participating in the study screen for ROP, there is little agreement on which criteria should be followed when screening and on other aspects related to its practice.

[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.

Efectos a corto plazo de la musicoterapia sobre las variables fisiológicas en recién nacidos prematuros ingresados en una Unidad de Cuidados Intensivos Neonatales / Short term effects of music therapy on the physiological variables in premature newborns admitted to a Neonatal Intensive Care Unit

Resultados de un estudio prospectivo realizado en una Unidad de Cuidados Intensivos Neonatales de nivel III, en el que se valoró la influencia de la música en vivo, a corto plazo, sobre ciertas variables fisiológicas en recién nacidos prematuros. La exposición musical consistió en 3 sesiones semanales de improvisación de música en vivo con un violonchelo durante el periodo en el que los pacientes recibían alimentación enteral. Los resultados, estadísticamente significativos, muestran una disminución de la frecuencia cardiaca y respiratoria y una elevación de los valores de saturación de oxígeno cuando los recién nacidos prematuros fueron estimulados con la música

The present investigation consists of an empirical study in which it is assessed the influence, in the short term, of live music on certain physiological variables of premature babies. The objective was to analyze the study variables in preterm infants admitted without musical exposure and with musical exposition. To carry out this research, we worked in the Level III Neonatal Intensive Care Unit, with a sample of 29 premature babies and their parents. The musical exhibition consisted of 3 weekly sessions of improvisation of live music with a cello while they were being fed. The results indicate that, when the premature children were are stimulated with music, heart rate and respiratory frequency variables decreased and the oxygen saturation increased with statistically significant values

[Study of anxiety levels in neonatal unit staff]. / Estudio de los niveles de ansiedad en los profesionales de una unidad neonatal.

INTRODUCTION: The professionals who routinely work in neonatal units become under stress due to the working conditions and the nature of the tasks carried out. As a consequence of this, they may have high levels of anxiety. Anxiety is defined as an emotional response or response patterns that include cognitive, physiological and behavioural aspects. METHODS: A prospective cross-sectional study was conducted on all neonatologist, nurses and care assistants who were given two self-administered questionnaires under baseline conditions, to assess Sate Anxiety and Trait Anxiety. (IDDA-EA; STAI, State-Trait Anxiety Inventory). RESULTS: The response rate was 88.5%, and 36% scored between 30 and 70 percentiles on State Anxiety, with 11.8% above the 70 percentile and 51% below the 30 percentile. There were no significant differences in relation to occupation or age. There were also no significant differences between State and Trait Anxiety. Regarding gender, it has obtained A statistically significant difference of 8 points higher was obtained for women. CONCLUSIONS: For the majority professionals everyday situations in which are involved do not significantly raise the burden of anxiety, as half of them have levels below the average. They perceive themselves as competent and able to cope with their tasks. They have a high degree of interest and attention in the activities performed.

Beneficios de la lactancia materna. Papel de los Bancos de Leche / Benefits of breastfeeding. Role of Milk Banks

No disponible

Seguimiento del hijo de madre con patología tiroidea autoinmune. ¿Qué no debemos cribar? / Follow-up of infants born to mothers with autoinmune thyroid disease. What should not be screened?

Introducción: La patología tiroidea es un problema frecuente en las mujeres embarazadas. Su etiología suele ser autoinmune siendo la tiroiditis de Hashimoto y la enfermedad de Graves las entidades principales. A pesar de las posibles alteraciones hormonales y del paso transplacentario de anticuerpos estimulantes, la realización de un cribado neonatal específico no ha demostrado su utilidad en el neonato. Pacientes y métodos: Estudio prospectivo (noviembre de 2013-diciembre de 2016) de los hijos de madre con patología tiroidea autoinmune nacidos en un hospital universitario nivel III. Los recién nacidos se seleccionaron en maternidad. Se excluyeron los casos de asfixia perinatal. Los datos se recogieron de las historias clínicas de madres y recién nacidos. Resultados: Se incluyeron 191 recién nacidos. El 90% de las madres estaban diagnosticadas de hipotiroidismo autoinmune, de cuyos hijos solo un 5,8% tuvo alguna alteración analítica tratándose de leves ascensos de tirotropina, con normalización al mes de vida, no correlacionándose con los niveles de anti-TPO. Se diagnosticó una hipertirotropinemia transitoria que precisó tratamiento durante el primer año de vida. El 36,8% de los hijos de madre con Graves tuvo algún control analítico alterado en los primeros 7 días de vida, no diagnosticándose ningún caso de hipertiroidismo y solo una hipertirotropinemia transitoria. Conclusiones: La experiencia de nuestro centro en el manejo del cribado neonatal tiroideo muestra un elevado número de controles analíticos con un escaso rendimiento diagnóstico. No encontramos relación entre niveles de anticuerpos anti-TPO y disfunción tiroidea. Apoyamos las recomendaciones de mantener el cribado neonatal universal como única exploración en los hijos de madre hipotiroidea

Introduction: Thyroid dysfunction is a common problem in pregnant women. It is usually of an autoimmune origin, with Hashimotós thyroiditis and Graveś disease being the most common conditions. Although hormonal changes and transplacental antibody transfer may occur, specific neonatal screening has not been shown to be useful. Patients and method: A prospective study of newborns of women with autoimmune thyroid disease born at a level III university hospital (November 2013-December 2016). Neonates were selected during their stay at the maternity. Babies with perinatal asphyxia were excluded. Data were collected from the clinical histories of mothers and newborns. Results: A total of 191 neonates were included. Ninety percent of mothers had been diagnosed with autoimmune hypothyroidism. Only 5.8% of newborns had some laboratory disorder, consisting of slightly increased thyroid-stimulating hormone levels, which returned to normal at the age of one month and did not correlate to thyroid peroxidase antibody levels. Transient hyperthyrotropinemia was diagnosed in one newborn and required thyroxin treatment during the first year of life. Among newborns from mothers with Graveś disease, 36.8% had some abnormal laboratory value during the first 7 days of life, but there were no cases of hyperthyroidism and only one of transient hyperthyrotropinemia. Conclusions: Experience at our hospital in screening of newborns from hypothyroid mothers reveals a high number of laboratory controls with a poor diagnostic yield. No relationship was found between thyroid peroxidase antibody levels and thyroid dysfunction. We support the recommendations to continue testing serum thyroid-stimulating hormone and FT4 levels at 48h of life in newborns of mothers with autoimmune hypothyroidism

Seguimiento del prematuro/gran prematuro / Follow up of the premature/very premature in Primary Care

Dado que la prematuridad es uno de los principales problemas sanitarios de los países desarrollados, este taller tiene como objetivo dotar al equipo de Atención Primaria de los conocimientos y herramientas necesarias, para hacerse cargo de forma conjunta y coordinada con el equipo hospitalario, de los programas de seguimiento de los niños con una edad gestacional menor de 32 semanas o con un peso al nacimiento inferior a 1.500 g. Para ello, el pediatra de Atención Primaria debe conocer cómo es el desarrollo habitual de estos niños, las características de su evolución, las variantes que presentan con respecto a la normalidad, los problemas que pueden aparecer y los signos de alarma que pueden ayudar a identificarlos con precocidad. Hay que asegurarse de que estos niños estén en un programa de seguimiento –que de forma ideal debería extenderse hasta la adolescencia– y acudan a los controles; también se debe prestar apoyo a la familia y evitar repeticiones innecesarias de pruebas. En los programas de seguimiento se realizan múltiples cribados y recomendaciones con objeto de mejorar en lo posible la evolución a medio y largo plazo de los niños. Recomendamos la lectura del texto completo del “Programa de actividades preventivas y de promoción de la salud para niños prematuros con una edad gestacional menor de 32 semanas o un peso inferior a 1.500 g. Del alta hospitalaria a los 7 años” de C. Pallás Alonso para PrevInfad, en el que está basado este taller y texto. Disponible en www.aepap.org/previnfad/pdfs/previnfad_menor32-1500.pdf (AU)

Given that prematurity is one of the principal health problems in developed countries, the aim of this workshop is to provide the Primary Care team with the knowledge and the tools necessary to be able to be responsible, jointly and coordinating with the Hospital team, for follow up programs of children with a gestational age of less than 32 weeks or with a birth weight of less than 1500 g. To do this, the Primary Care paediatrician must know what is the usual development in these children, the characteristics of their progress, the variations within normal that can be seen, the problems that can occur, and the alarm signs that may help to identify them early. You must ensure that these children are in a follow up program – which ideally is extended until adolescence – and that they attend reviews. Support must also be provided for the family and avoid repeating unnecessary tests. Multiple screening and recommendations are included in follow up programs, with the purpose of improving the progress of the children in the medium to long term. We recommend reading the complete text of the “Preventive Activities Program and health promotion for premature children with a gestational age of less than 32 weeks or a birth weight of less than 1500 g. From hospital discharge to 7 years old" by C. Pallás Alonso for PrevInfad, on which this workshop and text is based. (Available at: www.aepap.org/previnfad/pdfs/previnfad_menor32-1500.pdf (AU)

Estudio de los niveles de ansiedad en los profesionales de una unidad neonatal / Study of anxiety levels in neonatal unit staff

Introducción: Los profesionales que trabajan en unidades neonatales intervienen cotidianamente en situaciones de estrés generadas por las condiciones de trabajo y la naturaleza de las tareas. En consecuencia pueden presentar niveles elevados de ansiedad, entendida como una respuesta emocional que engloba aspectos cognitivos, fisiológicos y motores. Objetivos: Evaluar el nivel de ansiedad y la influencia de variables sociodemográficas en los profesionales de una unidad de cuidados intensivos neonatales. Método: Estudio prospectivo transversal. A todos los médicos, enfermeros/as y auxiliares se les entregó dos cuestionarios autoadministrados en situación basal para valorar ansiedad rasgo y ansiedad estado (IDDA-EA Inventario Diferencial de Adjetivos para el Estudio del Estado de Ánimo; STAI, Cuestionario de Ansiedad Estado-Rasgo).Resultados: Hubo una tasa de respuesta del 88,5%. El 36% puntuaron entre los centiles 30 y 70 en ansiedad estado, por encima del centil 70 el 11,8% y por debajo del centil 30 el 51%. No se encuentran diferencias significativas en relación al estamento ni a la edad. Tampoco hubo diferencias significativas entre ansiedad estado y rasgo. En función del género se obtiene una diferencia estadísticamente significativa de 8 puntos mayor para las mujeres. Conclusiones: Para la mayoría de los profesionales las situaciones cotidianas en las que se ven involucrados no suscitan cargas de ansiedad significativas ya que la mitad de los profesionales tienen unos niveles inferiores a la media de la población. Se perciben competentes y capaces de enfrentarse a sus tareas. Tienen un alto grado de interés y de atención en la actividad que desarrollan(AU)

Introduction: The professionals who routinely work in neonatal units become under stress due to the working conditions and the nature of the tasks carried out. As a consequence of this, they may have high levels of anxiety. Anxiety is defined as an emotional response or response patterns that include cognitive, physiological and behavioural aspects. Methods: A prospective cross-sectional study was conducted on all neonatologist, nurses and care assistants who were given two self-administered questionnaires under baseline conditions, to assess Sate Anxiety and Trait Anxiety. (IDDA-EA; STAI, State-Trait Anxiety Inventory).Results: The response rate was 88.5%, and 36% scored between 30 and 70 percentiles on State Anxiety, with 11.8% above the 70 percentile and 51% below the 30 percentile. There were no significant differences in relation to occupation or age. There were also no significant differences between State and Trait Anxiety. Regarding gender, it has obtained A statistically significant difference of 8 points higher was obtained for women. Conclusions: For the majority professionals everyday situations in which are involved do not significantly raise the burden of anxiety, as half of them have levels below the average. They perceive themselves as competent and able to cope with their tasks. They have a high degree of interest and attention in the activities performed(AU)

Cribado de la retinopatía de la prematuridad en las unidades neonatales españolas / Retinopathy of prematurity screening in spanish neonatal units

Introducción: Existe gran variación en los criterios de cribado de retinopatía de la prematuridad (ROP) entre los diferentes hospitales. Desde que en 1988 se demostró el beneficio del tratamiento con crioterapia de los casos de ROP grave, algunas sociedades científicas han realizado recomendaciones para el cribado y el tratamiento de la ROP. No existen recomendaciones específicas de cribado, diagnóstico o tratamiento por parte de las sociedades científicas españolas. Objetivos: Describir qué criterios se están utilizando para el cribado de la ROP en los diferentes centros españoles que atienden a niños con peso de nacimiento inferior a 1.500 g. Material y método: Se trata de un estudio transversal; se elaboró un cuestionario con 50 preguntas sobre los criterios de cribado y otras cuestiones relacionadas. Este cuestionario se envió a los centros neonatales públicos y privados de España que atendían a niños con peso al nacer inferior a 1.500 g. El período de envío y recepción fue el comprendido entre enero de 2002 y mayo de 2003. Resultados: Se obtuvieron respuestas de las 17 comunidades autónomas y de las dos ciudades autónomas del territorio español. La tasa de respuesta fue del 90 %. En todos los centros participantes se realiza el cribado de la ROP. Sólo dispone de un protocolo de cribado por escrito el 62,9 % de los centros. El 79,8 % realiza la exploración de fondo de ojo a todos los recién nacidos con un peso inferior a 1.500 g al nacer. La mitad de los centros incluidos, el 51,6 %, establece el punto de corte para realizar el cribado en las 32 semanas de edad gestacional. El 73 % de los centros considera la administración de suplementos de oxígeno en los niños prematuros como criterio de cribado independiente del peso y la edad gestacional. El 51 % no usa otros criterios diferentes al peso, edad gestacional y administración de oxígeno. El 90 % piensa que deberían establecerse los mismos criterios de cribado en todos los centros de España. Sólo el 10 % usa analgesia o sedación, además de la tópica, para la exploración del fondo de ojo. Conclusiones: Aunque en todos los centros españoles participantes en el estudio se realiza el cribado para la ROP, existe poco acuerdo en los criterios utilizados para el cribado y en otros aspectos relacionados con su práctica (AU)

Introduction: A wide variety of retinopathy of prematurity (ROP) screening criteria exists in the different hospitals. In 1988, the benefits of cryotherapy treatment in severe ROP cases were demonstrated, and since then, some scientific societies have made recommendations on the screening and treatment of ROP. Within the Spanish scientific community, there are no specific recommendations on screening, diagnosis or treatment. Objectives: To describe the criteria used in the screening of retinopathy in premature newborns by those Spanish hospitals caring for babies with birth weights below 1,500 g. Material and method: A cross-sectional study was performed based on a 50 question questionnaire on screening criteria and other related issues. This questionnaire was sent to those public and private neonatal units in Spain caring for babies with birth weights below 1,500 grams. The questionnaire was sent and returned between January 2002 and May 2003. Results: Units in all of the 17 autonomous communities and both autonomous cities in territorial Spain (Ceuta and Melilla) responded. There was a 90 % response rate. All the participating hospitals perform ROP screening. Only 62.9 % of the hospitals follow a written protocol on screening. A large majority of hospitals (79.8 %) perform a retinal eye examination on all newborns below 1500 g at birth. Half of the hospitals included in the study, 51.6 %, determine the cut-off point for performing the screening at 32 weeks of gestational age. Around 73 % of the hospitals include the administering of oxygen supplements to premature babies as part of the criteria for screening, regardless of the babies’ weight and gestational age. Weight, gestational age and oxygen are the only criteria used in 51 % of the units. That all hospitals in Spain should establish some screening criteria was suggested by 90 % of the responses. Only 10 % use analgesia or sedation, other than topical, when examining the retina. Conclusions: Even though all the hospitals participating in the study screen for ROP, there is little agreement on which criteria should be followed when screening and on other aspects related to its practice (AU)

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