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Introduction: Introduction: the stability of total parenteral nutrition admixtures for neonates (TPNAn) has been questioned in relation to the interaction between calcium and fish oil emulsions. Aim: the aim of this study was to check the stability (particle size < 1 µm) of different individualized TPNAn prepared with fish-oil emulsion and containing calcium at concentrations ranging from 10 to 20 mmol/L. Methods: admixtures analyzed: twelve different formulations with SMOFlipid® 20 % (conserved for 24 h and for 96 h), three formulations with Lipoplus® 20 % (conserved for 96 h) and three formulations with SMOFlipid® 20 % with Multi-12K1® Pediatric (conserved for 96 h). Two bags were compounded for each formulation and conservation period. Measurements on each admixture bag: particle standardized diameter by laser diffraction technique and pH by a calibrated pH-meter. Data analysis with mixed linear regression models. Results: maximum particle size was < 0.8 µm for all investigated admixtures. Lipid concentration of 5 g/L and sodium and potassium concentration of 100 mmol/L slightly increased the proportion of particles > 0.6 µm. Ninety six hours storage also increased the percentage of particles > 0.6 µm (+0.143 ± 0.07; p = 0.038) but did not influence other parameters. No association with calcium composition was observed. Amino acid content was inversely correlated with pH (-0.83; p < 0.0001). Conclusions: the studied individualized parenteral nutrition admixtures for newborns that contain fish oil emulsions and meet cation requirements are stable for at least 96 hours.

Background: Early hypophosphatemia is common in premature infants ≤1250 g. The aim of this study was to assess the frequency and severity of hypophosphatemia after sodium glycerophosphate supplementation from first day of life in parenteral nutrition and to address the safety of this practice., Methods: Prospective cohort study of infants ≤1250 g birth weight born in a tertiary-care level neonatal intensive care unit and supplied with sodium glycerophosphate from the first day of life. Primary outcome was the presence of hypophosphatemia (<4 mg/dL) on the first week. Data were compared with our 2014 prospective subcohort of infants ≤1250 g receiving phosphate after 48 hours of life and morbidity with that of our 2016 retrospective cohort of ≤1250 g., Results: Fifty-four neonates were included. The frequency of hypophosphatemia was 29.6%. Only 1 patient presented hypophosphatemia <2 mg/dL. Mild hypokalemia was found in 8 patients (50%). No cases of hypernatremia were observed. Patients with hypophosphatemia had significantly lower gestational age (27.4 vs 28.8 weeks, P = .032) and lower z-score birth weight (-1.68 vs -0.47; P = .001). When compared with the 2014 subcohort, we found a lower frequency of hypophosphatemia (29.6% vs 69.2%; P = .008) and a lower rate of samples with hypophosphatemia (20.4% vs 51.4%; P = .0002) and critical hypophosphatemia (0.68% vs 11.4%, P = .0005). No differences were found in morbidity or mortality., Conclusions: Sodium glycerophosphate supplementation in parenteral nutrition from the first day of life significantly decreased the frequency of hypophosphatemia. No adverse events were reported., (© 2018 American Society for Parenteral and Enteral Nutrition.)

Objective: To determine the frequency and magnitude of neonatal hypophosphataemia (<4mg/dL) in a neonatal Intensive Care Unit and to describe risk groups., Patients and Methods: Retrospective study of hospitalised newborns over a 44 month period (phase 1). Retrospective study of <1,500g/<32 weeks of gestation newborns over a 6 month period (phase 2). Prospective study of <1,500g or 1,550-2,000g, and intrauterine growth restriction (IUGR) newborns. Measurements were made on the 1st, 3rd, 7th, and 14th days of life (phase 3)., Results: Phase 1: 34 (2.4%) of 1,394 patients had a diagnosis of hypophosphataemia, 76% of them ≤32 weeks of gestation and <1500 grams, and 24% >32 weeks with weight

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into 12 modules, and in this work module 8 is presented. Each module is the result of a consensus process amongst all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, as well as the clinical experience of each one of the members of the group., (Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: This study analysed the changes in growth velocity (GV) of preterm infants weighing <1500 g based on different nutritional practices over a 24-year period., Methods: A retrospective study with prospectively collected data was performed in a level three Spanish neonatal intensive care unit. Data on birthweight, gestational age (GA) and GV were collected from 1990 to 2013 and breastfeeding data were gathered from 2000. A generalised linear model corrected by GA and small for gestational age was applied. Multiple mean comparisons between the levels of the variables of interest were performed using the Tukey test., Results: We included 1651 children in the study. The average GA in 1990-1991 was 30.48 ± 2.89 and the average GA in 2012-2013 was 28.79 ± 2.58 (p < 0.01). Significant differences were found when we compared the adjusted GV between the first and last study periods. The most important differences appeared between 1990 and 2013, when the GV increased by 3.27 ± 0.5 g/kg/day (p < 0.01). The breastfeeding rate in 2000-2001 was 47.95% and in 2012-2013 it was 73.58% (p = 0.0002)., Conclusion: Introducing nutritional practices such as the increased use of breastmilk and the breastfeeding rate improved GV over the study period., (©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group., (Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Random safety audits (RSAs) are a safety tool but have not been widely used in hospitals., Objectives: To determine the frequency of proper use of equipment safety mechanisms in relation to monitoring and mechanical ventilation by performing RSAs. The study also determined whether factors related to the patient, time period, or characteristics of the area of admission influenced how the device safety systems were used., Methods: A prospective observational study was conducted in a level III-C Neonatal Intensive Care Unit (NICU) during 2012. 87 days were randomly selected. Appropriate overall use was defined when all evaluated variables were correctly programmed in the audited device., Results: A total of 383 monitor and ventilator audits were performed. The Kappa coefficient of interobserver agreement was 0.93. The rate of appropriate overall use of the monitors and respiratory support equipment was 33.68%. Significant differences were found with improved usage during weekends, OR 1.85 (1.12-3.06, p = 0.01), and during the late shift (3 pm to 10 pm), OR 1.59 (1.03-2.4, p = 0.03)., Conclusions: Equipment safety systems of monitors and ventilators are not properly used. To improve patient safety, we should identify which alarms are really needed and where the difficulties lie for the correct alarm programming.

Introduction: The benefits of donor human milk compared with artificial formulas have been well demonstrated; nevertheless the impact in the clinical practice of opening a human milk bank within a neonatal unit has not yet been studied. The main aim of this study was to analyze the impact on the clinical practice of opening a human milk bank in a neonatal unit to provide donor human milk for preterm infants ≤ 32 weeks of gestational age., Methods: A before and after study was designed, with the intervention being the opening a human milk bank. Preterm infants ≤ 32 weeks of gestational age born in the Hospital 12 Octubre from July to December 2005 and January to June 2008 (firsts 6 months after opening the human milk bank) were included., Results: After opening the human milk bank, enteral feedings were started 31h before (P<.001), 100ml/kg/day were achieved 59.5h before (P<.001) and 150 ml/kg/day 52 h before (P=.002). Enteral feedings were never started LM with artificial formula, the exposure to formula in the first 15 days of life was reduced from 50% to 16.6%, and it's consumption during the first 28 days of life was significantly reduced. There was a higher consumption of own mother's milk during the hospital stay, and a higher rate of exclusive breastfeeding at hospital discharge (54% vs 40%)., Conclusions: The availability of donor human milk has led to quicker progression with enteral feedings and earlier withdrawal of parenteral nutrition. It has reduced the exposure to artificial formulas, and has also increased the intake of own mother's milk during the hospital stay and the rate of exclusive breastfeeding at hospital discharge., (Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Introduction: Early administration of nutrients in adequate amounts is of vital importance to preterm infants because it decreases the time needed to reach the expected weight and tolerate enteral nutrition as well as reducing their hospital stay. The main objective of this study was to analyze the prescription of parenteral nutrition (PN) in patients weighing less than 1,500 g at birth in their first 7 days of life during the years 2006-2010 in our hospital and the adequacy of those requirements to the recommendations., Materials and Methods: Amino acids, glucose, lipids (g/ kg/day) and calories (kcal/kg/day) prescribed in the PN of the first week of life were collected., Results: We studied 1899 parenteral nutrition prescriptions from 2006 to 2010 corresponding to the first week of life of 360 patients weighing less than 1,500 g. The caloric content increased from an average of 41.83 kcal/kg/day (1.89 g/kg/ day of amino acids and 0.69 g/kg/day lipids) on the first day of life to 80.61 kcal/kg/day (3.2 g/kg/day of amino acids and 2.4 g/kg/day of lipids) on the seventh day. About 70% of prescriptions for the children who had PN on the first day of life contained lipids. But when all children who had PN on the fourth day were considered, only 17% of these patients had lipid intake on the first day of life. No prescription exceeded 120 kcal/kg/day. Only 17.9% on the sixth day and 25.5% on the seventh day received more than 90 kcal/kg/day. In our hospital PN is not prepared on Sundays and holidays. 30.1% and 56.9% of children born on weekdays received PN the first and second day versus 11.6% and 38.8% of those born on a holiday or the day before holiday., Conclusions: A high percentage of premature babies do not get the recommended amounts of nutrients in their first week of life in our hospital.

Introduction: Advances in perinatal care have resulted in increased survival rates for extremely low birth weight children, but it is fundamental to know if these improved survival rates have been accompanied by increased impairment rates., Objective: To compare, over two different time periods, the survival and disability rates at 2 years of corrected age, among newborns < or =32 weeks and weighed < or = 1500 g at birth., Methodology: Follow-up study that included 963 children born in the hospital between 1991 and 2004 who met the study criteria. Neonatal morbidity, mortality and disability to 2 years of corrected age in 2 time periods 1991-1998 (period I) and 1999-2004 (period II) have been evaluated and analysed by subgroups of weight (weight < 1000 g and 1000-1500 g)., Results: Mortality decreased significantly during the second period, both for children with birth weight <1000 g (32% vs 44%) as for those with birth weight between 1000 and 1500 g ( 3,6% vs 9%). Analysing all children < or = 1500 g, an increase in the survivors without disability was observed in the second period (69% vs 60%, p=0.003); but by subgroups this increase only was significant in children with birth weight 1000-1500 g (67% vs 82%)., Conclusions: In our study, globally analysing all children with birth weight < or = 1500 g, it can be seen that there has been an increase in survival without an increase in the frequency of disabilities. Analysing by weight subgroups, survival has increased in both groups, but disability has decreased only in the birth weight 1000-1500 g subgroup., (Copyright 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Objectives: To describe the morbidity and mortality associated with congenital gastrointestinal obstruction, assess the usefulness of prenatal diagnosis, and analyze the results in relation to the site of obstruction., Patients and Methods: We performed a retrospective case series study of 148 patients in a 13-year period (1990-2003). Sites of obstruction was classified into three groups: I) gastric, duodenal or jejunal; II) ileal or colonic; III) anorectal., Results: There were 65 patients in group I, 38 in group II and 45 in group III. Surgery was performed in 137 patients. Trisomy was diagnosed in 15 patients, polymalformation syndrome in 16 patients, and cystic fibrosis in seven patients. More than one site of intestinal obstruction was found in 22 patients (15 %). Morbidity consisted of nosocomial sepsis in 32 %, necrotizing enterocolitis in 7 %, and short gut in 3.4 %. Prematurity (48 %) was associated with higher morbidity and mortality. Overall mortality was 14.2 %, mainly associated with other malformations and extraintestinal problems. When patients with other extraintestinal malformations were excluded, the highest mortality was found in group II (OR: 12.19; CI: 2.4-76.2). The overall sensitivity of prenatal diagnosis was 0.44 and the mean gestational age at diagnosis was 31.6 weeks (SD 5.2). According to the site of obstruction, sensitivity was 0.77 in group I, 0.39 in group II and 0.04 in group III. Prenatal diagnosis did not alter prognosis., Conclusions: Morbidity and mortality were strongly influenced by extraintestinal problems. The most severe intestinal complications were midgut volvulus and necrotizing enterocolitis. Prenatal diagnosis was late and showed good sensitivity only in group I.

Objective: To identify the determinants associated with uremia elevation in the first days of life in extremely premature infants., Methods: We performed a prospective cohort study in a cohort of neonates born at less than 30 weeks of gestation., Results: Forty-eight preterm infants were included, of which 10 died. The mean fluid administration was 55, 72, 88 and 124 mL/kg on the first, second, third and seventh days of life. Amino acid doses were low in the first two days of life and were unrelated to uremia elevation. Thirty-one percent of the infants presented hypernatremia. Uremia was measured in 31 infants between the fifth and tenth days of life and 12 infants (38.7 %) had uremia values of 100 mg/dL or higher, without creatinine elevation. All of these infants were born at less than 27 weeks of gestation, weighed less than 850 grams at birth, and showed greater weight loss (19.2 % vs. 13.8 %; p 5 0.037) and higher natremia (150.2 mEq/L vs. 146.6 mEq/L; p 5 0.023). The use of furosemide increased the risk of elevated uremia (relative risk: 2.54; 95 % confidence interval: 1.05 6.14)., Conclusions: Total uremia of 100 mg/dL or higher was associated with dehydration, greater weight loss, higher natremia, furosemide use, lower gestational age, and lower birth weight.

Objective: To estimate the corrected age (CA) of acquisition of sitting and walking in very low birth weight infants with normal motor outcome at 2 years of age and to determine whether transient hypertonia is associated with a delay in the acquisition of sitting and walking., Methods: Follow-up study of very low birth weight infants (under 1500 g) admitted to the Neonatology Department of the Hospital 12 de Octubre from January 1991 to December 1996. At 2 years of age, 260 infants had normal motor outcome and 36% of these had been diagnosed with transient hypertonia. The age at which sitting and walking were attained was recorded by interview with the parents and was confirmed by examination., Results: The mean CA at which sitting was attained was 7.2 +/- 1.4 months. Ninety percent of the infants had acquired sitting at a CA of 9 months. Mean age at which walking was attained was 13.4 +/- 2.8 months. Ninety percent could walk at 16 months. Infants with and without transient hypertonia acquired sitting and walking at the same age., Conclusions: Ninety percent of very low birth weight infants attained sitting at a CA of 9 months and walking at a CA of 16 months. Transient hypertonia did not modify the pattern of sitting and walking and it could be considered a variation of normality within the development of very premature infants.

Objective: To describe survival rates at discharge in liveborn infants with birth-weight under 1000 g by birth-weight and gestational age categories in a third level spanish hospital in order to improve health care planning and parental counselling about the threshold of viability., Study Design: A follow-up study of 178 infants with birth-weight under 1000 g born alive between 1991 at 1997. Six newborns with lethal malformations were not included., Results: Overall survival at discharge was 54%. During the study period survival rate improved in the birth-weight group 750-999 g. In the group below 750 g survival rate was lower and improved more slowly. Survival rate for infants below 750 g and 26 weeks was extremely low. Over 749 g and 25 weeks survival was over 50%., Conclusions: Survival rate showed an improving trend during the study period. In the last years of the study period survival in infants with birth-weight over 749 g was above 85%. For infants under 750 g and 26 weeks was extremely low. Family and medical decision making about active treatment of these newborns should be an individualized process.

Objective: The objective of this study was to analyze the weight, length and head circumference development in prematurely born babies who weighed less than 1,500 grams and who were included in the follow-up program of our neonatal unit., Patients and Methods: Review of data of the cohort included in the follow-up program between May 1990 and September 1995 was carried out. The weight and length were measured from 3 months of corrected age to 4 years of age. The head circumference was measured until 2 years of age., Results: We recruited 259 premature newborns (136 boys and 123 girls). The median gestational age was 30 weeks (23 to 36) and the median weight was 1,150 g (500 to 1,499 g). Twenty-seven percent were underweight for their gestational age (LWGA). The proportion of cases with weight below the 3rd percentile in the follow-up was stable around 25% in the group of adequate weight for gestational age. (AWGA). At 3 months of corrected age this proportion was 70% in the LWGA group, but there was a trend towards catch-up at 2 years of age. The worst results were obtained in the group that weighed less than 750 g at birth. The head circumference was better preserved than longitudinal growth and thus better than weight. All cases of head circumference below the 3rd percentile in the follow-up occurs in the LWGA group., Conclusions: Weight was the parameter with the worst evolution during follow-up, especially in the group that weighed less than 750 g at birth. The group of LWGA tended to catch-up at 2 years of age.

Objective: The objective of this study was to determine the incidence of surgical wound infection and the impact of this on the implementation of an antibiotic protocol according to the type of surgery and the prevailing endogenous flora in our neonatology unit., Patients and Methods: Patients' charts were retrospectively reviewed in order to assess the effectiveness of a protocol of surgical prophylaxis, comparing the incidence of postsurgical wound infection in two periods of time. Surgical interventions were classified according to the period of the study in which they were performed, before (period A) and after (period B) the protocol was undertaken. In addition, if the antibiotics administered fit or not those indicated in the protocol, it was classified as correct or not., Results: A total of 31 (37%) of the interventions were performed in period A, whereas 53 (63%) were carried out in period B. No statistically significant differences were found between periods with regard to the proportion of infections 925.8% vs 15%). When prophylactic antibiotics were administered correctly, infection occurred in 10.2%, as compared to 31.4% when they did not fit the protocol (p < 0.05). The duration of the antibiotics was longer in period A, in infected wounds and when prophylaxis was not correct., Conclusions: The correct adjustment to the protocol significantly decreases the incidence of wound infections, as well as the duration of antibiotic use. An appropriate policy of antibiotic prophylaxis in surgery is advantageous in terms of economic cost and might prevent antibiotic resistance and avoid unnecessary toxicity.

Objective: The aim of this study was to compare the efficacy of medical advice and cognitive-behavioral group therapy in the treatment of primary obesity in children and adolescents 7 to 15 years old., Patients and Methods: From five primary care centers 353 subjects (176 boys and 177 girls) were recruited and assigned to three groups. These groups were: medical advice (Group 1), cognitive-behavioral group therapy (Group 2) and those that rejected all treatments (Group 3). Forty variables were controlled and studied for association with prognosis., Results: A significant, but modest decrease in relative body mass index was noted in groups 1 and 2 in the first 6 months, but at two years no differences between the three groups were detected., Conclusions: It is concluded that cognitive-behavioral group therapy is not more effective than medical advice in our population and neither had a significant effect at two years when compared to no treatment.

A study was performed to determine, in our population, the relationship between transcutaneous, visual and serum bilirubin values. This was done in attempts to reduce the number of serum bilirubin determinations to be performed in the future. We did a correlation coefficient between serum bilirubin and five measurements of transcutaneous bilirubin levels in a group of 60 term newborns and 60 preterm newborns, obtaining a value of 0.84 in both groups. The results were also considered from an analytical point of view where the ability of the test to predict an alteration in serum bilirubin levels, for example > or = 12 mg/dl in preterm and > or = 13 mg/dl in term newborns, was assessed. For values of 18 in preterm and 17 in term infants, the transcutaneous method was found to be both sensitive and specific. If Kramer's test is also evaluated the results improve.

Authors described a new case of Coffin Lowry syndrome which presents a severe form, typical of males. Slight degree of affection in the mother and sister supports hypothesis of X-linked dominant trait. Authors want to underline normal appearance of the newborn period and progressive appearance of both neurological alterations and typical face of this condition. They have observed repetitive pneumonia probably produced by alimentary aspiration.

Authors present 7 cases of spontaneous congenital chylothorax, all of them diagnosed antepartum echographycally. Six of them needed cardiopulmonary resucitation but none presented fetal anoxia. Three cases had associated malformations. Treatment included thoracocenthesis, pleural drainage, assisted ventilation and appropriate nutrition. Pleural effusion lasted from 14 days to 6 months. Complications were: pneumothorax, metabolic acidosis and bacterial infections. Three patients died by respiratory failure. Pulmonary hypoplasia was present in two of them, and suspected in the third one. Survivors are free of symptoms.