Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn.

OBJECTIVE: To estimate the influence of skin-to-skin care on the thermal regulation of the infant and the rate of breastfeeding at different points of time. We also aim to establish whether skin-to-skin contact reduces maternal pain during episiotomy repair and decreases the time to expel the placenta. METHODS: A randomized control study was performed with 137 patients in each branch of the study. Differences between the study groups were analysed with the unpaired t-test, Fisher test or chi-square test as appropriate. RESULTS: Greater thermal stability in the skin-to-skin care group was found where an average temperature rise of 0.07°C was observed. Mothers in the skin-to-skin care group exclusively breastfed more frequently at discharge. Mean time to expel the placenta was lesser in the skin-to-skin care group. CONCLUSION: This study shows that skin-to-skin care implies better thermal regulation and a better proportion of exclusive breastfeeding at hospital discharge.

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.

[Evaluation of pain in a neonatal intensive care unit during endocrine-metabolic tests]. / Valoración del dolor en la unidad de cuidados intensivos neonatales durante la extracción de las pruebas endocrinometabólicas.

OBJECTIVES: To determine whether the pain suffered during the endocrine metabolic test can be lowered by adding skin to skin care to the use of sucrose. To establish factors that may modify the feeling of pain and evaluate the parents opinion during the extraction. PATIENTS AND METHODS: Controlled clinical trial. Two groups: group 1 (n= 27), skin to skin and sucrose, and group 2 (n=27), sucrose. The pain was measured with the Neonatal Infant Pain Scale (NIPS) during the endocrine metabolic test. Patients on mechanical ventilation, with HIV III or IV and those who had been given sedative analgesics in the previous 24 hours were excluded. RESULTS: The average gestational age in group 1 was 35.1 +/- 3.5 weeks and 35.4 +/- 3.2 weeks for group 2. The NIPS in group 1 was 2.51 +/- 1.42 and 2.81 +/- 2.11 (NS) in group 2. On only one occasion was severe pain noticed (group 2). There was a tendency towards a higher NIPS with a higher gestational age (r=0.19) and a lower number of previous capillary (r= -0.06) and venous (r= -0.11) extractions. Group 1 parents thought that this practice contributed to decreasing their children's irritability and increased their trust in the care team. CONCLUSION: By adding skin to skin care to the sucrose during the endocrine metabolic test does not relieve the pain feeling. Parents in the skin to skin group thought that this practice contributed to decreasing their children's irritability and increased their trust in the care team.

[Assessment of the new Ballard score to estimate gestational age]. / Valoración del test de Ballard en la determinación de la edad gestacional.

BACKGROUND AND OBJECTIVES: The New Ballard Score (NBS) is commonly used to estimate gestational age (GA) in the newborn. The aims of this study were: a) to determine the reliability of the NBS; b) to estimate the agreement between two methods of GA assessment, NBS and ultrasonography (US) or last menstrual period (LMP); c) to estimate the agreement between NBS and US/LMP in distinct subgroups of neonates. PATIENTS AND METHODS: We performed a prospective, blind study. NBS was performed in neonates born in Hospital 12 Octubre, Madrid before the age of 48 hours. The level of agreement was estimated with two analytical parameters: the intraclass correlation coefficient (ICC) and the mean differences method (MD). RESULTS: Inter-observer agreement was very good (ICC > 0.8). Agreement between US/LMP and NBS was good (ICC = 0.6-0.8). In infants with lower weight or GA, and in those whose mothers had received prenatal corticosteroid therapy, NBS tended to overestimate GA compared with US/LMP (MD = 1.2-2.9). CONCLUSIONS: The agreement between two observers in NBS assessment was very good. The agreement between NBS and US/LMP was good, but differences of more than 2 weeks in GA were frequent. In very preterm newborns and in infants whose mothers had received prenatal corticosteroid therapy, NBS tends to overestimate GA.

[Congenital cytomegalovirus infection in the infants of HIV-infected mothers]. / Infección congénita por citomegalovirus en hijos de madres infectadas por el VIH.

BACKGROUND: Cytomegalovirus (CMV) is the most common congenital viral infection, mainly in the infants of HIV-infected women. The aim of this study was to evaluate the prevalence of congenital CMV infection in infants born to HIV-infected women in our hospital, the possible influence of maternal antiretroviral therapy, the relationship between vertical HIV transmission and congenital CMV infection, and the clinical outcome of these infants. PATIENTS AND METHODS: Between 1987 and 2003, we performed a prospective, cohort study of all the infants born to HIV-infected mothers, in whom CMV was cultured in urine in the neonatal period. Congenital CMV infection was defined as a CMV positive urine culture obtained in the first 3 weeks of life. RESULTS: A total of 257 patients were included in the study, with positive CMV urine culture in 12 (4.6 %). Before 1997 the prevalence was 9.2 % vs 1.34 % in the second period (p < 0.01). In infants born to HIV-infected women without zidovudine therapy the prevalence was 6.3 % compared with 3.1 % in the group with zidovudine therapy (p > 0.05). Vertical HIV transmission was observed in 23 infants, of which six (26 %) had congenital CMV coinfection. Only six infants (2.5 %) without HIV-infection had congenital CMV infection (p < 0.01). The outcome of congenital CMV infection was good in all infants. CONCLUSIONS: Congenital CMV infection is more frequent in infants born to HIV-infected women. The prevalence was higher in the first study period and in infants with vertical HIV transmission. All infants with congenital CMV infection had a favorable outcome.

[Respiratory infection due to Chlamydia trachomatis in infants. Clinical presentation and outcome in 18 patients]. / Infección respiratoria por Chlamydia trachomatis en lactantes. Presentación clínica y evolución de 18 casos.

BACKGROUND: Among other diseases, Chlamydia trachomatis causes epididymitis and prostatitis in men and urethritis, cervicitis and pelvic inflammatory disease in women. In children, it most usually causes conjunctivitis and is also responsible for lower respiratory tract disease, occasionally requiring hospital admission. OBJECTIVE: To draw attention to this disease, which is usually overlooked and which can be potentially serious. METHODS: We retrospectively reviewed the medical records of infants aged less than 6 months with symptoms of lower respiratory tract disease in whom C. trachomatis antigen was detected by enzyme immunoassay. RESULTS: We identified 18 patients with C. trachomatis between 1993 and 2002. Of these, 17 patients required hospital admission and five required monitoring in the pediatric intensive care unit. The mean length of hospital stay was 9.6 days. Three patients were immigrants. The mean age at admission was 6.6 weeks. Apnea occurred in five infants. Chest x-ray showed interstitial infiltrates in five infants. Sixteen patients were treated with erythromycin and all made a complete recovery. CONCLUSIONS: Although lower respiratory tract disease caused by C. trachomatis is usually managed on an outpatient basis, it sometimes requires hospital admission or even management in the intensive care unit. Therefore, C. trachomatis infection should be ruled out in infants aged less than 6 months with clinical symptoms of lower respiratory tract disease for which no other pathogen can be found.

[Ages of sitting up and walking in preterm newborns less than 1,500 G with bronchopulmonary dysplasia]. / Edades de sedestación y marcha en recién nacidos pretérmino menores de 1. 500 gr con displasia broncopulmonar.

INTRODUCTION: Adverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age. PATIENTS AND METHODS: A longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital "12 de Octubre" between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate. RESULTS: Both motor skills were acquired later in the group with BPD (7.8±2m vs. 7.1±1.3m for sitting unsupported and 14.5±3.8m vs. 13.4±2.5m for walking) (P<.001). BPD was associated with delayed acquisition (above p90) of these skills, OR=2.6 (1.6-4.1) for sitting and OR=2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight. CONCLUSION: BPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years.