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Resumen Introduccion En 2017 se realizo una encuesta a nivel mundial sobre el cumplimiento de las practicas que promueve la Neo-IHAN (Iniciativa para la Humanizacion de la Asistencia al Nacimiento y la Lactancia en las unidades neonatales). Objetivo Presentar los resultados de las unidades espanolas que participaron en la encuesta mundial y compararlos con los obtenidos internacionalmente. Material y metodos Estudio transversal mediante una encuesta sobre el cumplimiento de los requisitos de la Neo-IHAN («Tres principios basicos», «Diez pasos adaptados a unidades neonatales» y el «cumplimiento del Codigo internacional de comercializacion de sucedaneos de leche materna»). El cumplimiento se calculo como la media en cada indicador y una puntuacion media final para cada unidad neonatal. Para las puntuaciones parciales y finales de cada pais y a nivel internacional se utilizo la mediana. Las puntuaciones van de 0 a 100. Resultados La tasa de respuesta en Espana fue del 90% de las unidades de nivel 2 y 3. El rango de la media para las unidades neonatales fue de 37 a 99, sin diferencias segun el nivel asistencial. La puntuacion global de Espana (72) esta por debajo de la mediana internacional (77), asi como en 8 de los 14 requisitos de la Neo-IHAN. Las unidades neonatales de hospitales con maternidades acreditadas IHAN obtuvieron una puntuacion media final significativamente mayor, asi como en 9 de los 14 requisitos frente a las no acreditadas. Conclusiones Los resultados, tanto internacionales como nacionales, indican una mejora de las practicas de la lactancia materna en las unidades neonatales. Los beneficios de la acreditacion IHAN de las maternidades alcanzan a las unidades neonatales. Espana tiene varios puntos clave por debajo de la puntuacion internacional.

Several studies have been conducted to investigate the feasibility of customized nasal masks produced by three-dimensional (3D) facial imaging and printing for continuous positive airway pressure in adults and in premature mannequin. In ad­dition to replicating the entire process, we applied the customized nasal mask to a premature patient who weighed less than 1,000 g. Facial scanning was performed. The study masks were manufactured using stereolithography with a 3D printer mod­el Form3BL (FormLABS). Elastic 50 resin was used as the material. We verified the feasibility of the correct transmission of non-invasive ventilation and found that the mask improved the respiratory parameters and reduced the need for supplemental oxygen. The fraction of inspired oxygen (FiO2) was lowered from 45%, which was the requirement when the traditional mask is used, to almost 21% when the nasal mask was applied to the premature patient, who was either in incubator or in kangaroo position. In view of these results, a clinical trial is being launched to evaluate the safe­ty and efficacy of 3D-printed masks in extremely low birth weight (ELBW) infants. 3D printing provides an alternative for obtaining customized masks that may be more suitable for non-invasive ventilation in ELBW infants than traditional masks.

Two important topics about children and adolescents in our primary care activity are presented in this update document: tobacco smoking prevention in adolescence and prophylaxis with vitamin K to prevent the hemorrhagic disease of the newborn.

Introduction: Early skin-to-skin contact (ESSC) is associated with rare, sudden, unexpected postnatal collapse episodes. Placing the newborn in ESSC closer to an upright position may reduce the risk of airway obstruction and improve respiratory mechanics. This study assessed whether a greater inclination of the mother’s bed during ESSC would reduce the proportion of healthy term newborns (HTNs) who experienced episodes of pulse oximeter saturation (SpO2) Methods: We conducted a multicenter randomized controlled trial comparing the effect of the mother’s bed incline, 45° versus 15°, on desaturation in HTNs during ESSC. Before delivery on 1,271 dyads, randomization was conducted, and stringent criteria to select healthy mothers and term newborns were monitored until after birth. Preductal SpO2 was continuously monitored between 10 min and 2 h after birth. The primary outcome was the occurrence of at least one episode of SpO2 Results: 254 (20%) mother-infant dyads were eligible for analysis (45°, n = 126; 15°, n = 128). Overall, 57% (95% confidence interval [CI]: 51%–63%) of newborns showed episodes of SpO2 2 Conclusions: We did not show that a high mother bed inclination during ESSC led to significantly fewer HTNs who experienced episodes of SpO2

Background Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Up to 15%-20% of infected newborns will develop long-term sequelae such as hearing loss and neurologic abnormalities. The aim of this study was to investigate the prevalence of congenital CMV infection (cCMV) and associated clinical abnormalities in Spain. Methods A prospective screening for cCMV by viral load in saliva was performed. Saliva samples were obtained within the first 72 hours of life in a maternity ward in Madrid (Spain), during a 1-year period. All positive screening tests were confirmed with viral load in urine. Clinical, laboratory, auditory, visual and cerebral imaging assessments were performed in all children with cCMV. Results Of the 4097 neonates born during the study period, 3190 (78%) were included. CMV viral load in saliva was detectable in 24/3190 (0.75%) children, and congenital infection was confirmed in 15/3190 (0.47%, CI 95%: 0.29%-0.77%). Positive predictive value was 62.5% (CI 95%: 46.5%-76.1%). Two infants presented symptoms at birth. Eight (53.3%) children showed abnormalities in magnetic resonance imaging; most of them isolated white matter abnormalities. Newborns with abnormalities in magnetic resonance imaging showed higher viral loads in blood and saliva (P = 0.04). Conclusions One in 200 neonates born in our hospital presented a cCMV infection. CMV viral load in saliva has been shown to be a simple and highly accepted screening method but should be confirmed by CMV detection in urine. In spite of the fact that half of infected children had abnormalities in cerebral imaging, diagnosis during the neonatal period would have been impossible without a screening program in most cases.

BackgroundDuring early skin-to-skin contact (ESSC), alterations in peripheral oxygen saturation (SpO2) and heart rate (HR) have been frequently observed.ObjectivesThis study aimed to determine the incidence of cardiorespiratory events (CREs) during ESSC in healthy term newborns (HTNs) and estimate the association of maternal and neonatal prognostic factors with the risk of CREs.MethodsA pooled analysis of the cohort from a clinical trial involving healthy mother–child dyads during ESSC was performed. Pulse oximetry was employed to continuously monitor SpO2 and HR within 2 h after birth. The individual and combined prognostic relevance of the demographic and clinical characteristics of dyads for the occurrence of a CRE (SpO2 180 bpm) was analyzed through logistic regression models.ResultsOf the 254 children assessed, 169 [66.5%; 95% confidence interval (95% CI), 60.5–72.5%] had at least one CRE. The characteristics that increased the risk of CRE were maternal age ≥35 years (odds ratio, 2.21; 95% CI, 1.19–4.09), primiparity (1.96; 1.03–3.72), gestational body mass index (BMI) >25 kg/m2 (1.92; 1.05–3.53), and birth time between 09:00 p.m. and 08:59 a.m. (2.47; 1.02–5.97).ConclusionCREs were more frequent in HTNs born during nighttime and in HTNs born to first-time mothers, mothers ≥35 years, and mothers with a gestational BMI >25 kg/m2. These predictor variables can be determined during childbirth. Identification of neonates at higher risk of developing CREs would allow for closer surveillance during ESSC.

In utero transmission of severe acute respiratory syndrome coronavirus 2 infection is a point of debate. We report a case of severe acute respiratory syndrome coronavirus 2 vertical transmission from asymptomatic mother, with molecular detection in mother's blood at delivery and neonatal nasopharyngeal swabs at 5 and 28 hours of life and later IgG seroconversion. The newborn was asymptomatic.

AIM To assess, at national level, the implementation of eight principles for infant- and family-centred developmental care (IFCDC) in neonatal units. A European expert group established eight 'Principles of care' in 2018 that define neurodevelopmental and family-centred care. METHODS The implementation of each principle was assessed by a survey sent to level-III Spanish units. A principle was considered to be implemented if all answers to the principle-associated questions were positive. RESULTS The response rate was 84.5% (65/77). No unit had implemented eight principles. Principle 1 (free parental access) was implemented in 21.5% of the centres; Principle 2 (psychological support) 40%; Principle 3 (pain management) 7.7%; Principle 4 (environmental influences) 29%; Principle 5 (postural support) 84.6%; Principle 6 (kangaroo-care) 67.7%; Principle 7 (breastfeeding) 23% and Principle 8 (sleep protection) in 46%. In units attending ≥50 very low birth weight (VLBW) infants, four or more principles had been implemented in 31% vs 13%

Appropriate decontamination of breast pump milk collection kits (BPKs) is critical to obtain safe milk for infants and to avoid discarding donor human milk (DHM).To evaluate two strategies for BPK decontamination by assessing microbial cultures and the proportion of discarded DHM, according to the criteria of the National Institute for Health and Care Excellence for pre-pasteurization cultures.Prospective comparative study, allocation ratio 1:1, microbiologist-blind.47 new donors in a human milk bank in Madrid.Study group (N=21): BPKs washed with water and detergent after each use and further steam decontamination within a microwavable bag. Control group (N=26): washing, rinsing and drying only. Five samples: first sample by hand expression and four samples (one per week) collected using the same pump and method.Primary: proportion of DHM discarded due to contamination. Secondary: comparison of the microbiota between samples obtained by hand expression and breast pump in both groups.In total, 217 milk samples were collected: 47 by hand expression and 170 by pump expression (78 from study group). Steam decontamination of BPKs using a microwavable bag after washing resulted in a lower proportion of discarded DHM samples (1.3% vs 18.5%, P0.001) and samples contaminated with Enterobacteriaceae (1.3% vs 22.8%, P0.001) and Candida spp. (1.3% vs 14.1%, P0.05) compared with samples collected with BPKs that were washed but not steam decontaminated. There were no differences in bacterial contamination between samples obtained using steam decontaminated BPKs and those obtained by hand expression.Steam decontamination of BPKs using a microwavable bag after washing decreases the amount of discarded DHM and the number of samples with potentially pathogenic bacteria.

Resumen: Introducción: Los trastornos del comportamiento y del aprendizaje se describen con frecuencia en

Introduction: Behavioural disorders and learning disabilities are often recognised in

Background Although the positive effects of good clinical quality standards in perinatal care and breastfeeding support for women, newborns and families have been already demonstrated, many of these practices were disrupted during the COVID-19 pandemic. The objective of this study was to analyse the impact of the COVID-19 pandemic on perinatal care and breastfeeding support practices offered by the Spanish maternity hospitals committed to the UNICEF Baby-friendly Hospital Initiative (BFHI), to women with and without COVID-19. Methods Implementation of perinatal practices was assessed by a cross-sectional survey conducted in May 2020 using an online questionnaire. Comparison with pre-pandemic situation and level of commitment to BFHI practices was performed. Results Response rate was 50% (58/116). Mothers with COVID-19 suffered greater restrictions in the practices compared to women without COVID-19, with lower rates of companion of choice during labour (84% vs 100%; p = 0.003), skin-to-skin contact (32% vs 52%; p = 0.04), rooming-in (74% vs 98%; p p = 0.006), and breastfeeding support (78% vs 94%; p = 0.02). Practices were significantly less prevalent in COVID-19 mothers compared to pre-pandemic situation. A lower accompaniment rate was observed in non-COVID-19 group during delivery (24% vs 47.9%; p p = 0.01) and rooming-in (83.9% vs 57.9%; p Conclusion All mothers suffered restrictions in perinatal care during the COVID-19 pandemic. Women with COVID-19 infection suffered more restrictions in perinatal practices than women without infection. The degree of commitment to WHO-UNICEF perinatal quality standards, integrated into the BFHI, was associated with maintenance of good clinical practices.

This article belongs to the Special Issue Pediatric Nutrition for a Healthy Life., Holder pasteurization (HoP; 62.5 °C, 30 min) is commonly used to ensure the microbiological safety of donor human milk (DHM) but diminishes its nutritional properties. A high-temperature short-time (HTST) system was designed as an alternative for human milk banks. The objective of this study was to evaluate the effect of this HTST system on different nutrients and the bile salt stimulated lipase (BSSL) activity of DHM. DHM was processed in the HTST system and by standard HoP. Macronutrients were measured with a mid-infrared analyzer. Lactose, glucose, myo-inositol, vitamins and lipids were assayed using chromatographic techniques. BSSL activity was determined using a kit. The duration of HTST treatment had a greater influence on the nutrient composition of DHM than did the tested temperature. The lactose concentration and the percentage of phospholipids and PUFAs were higher in HTST-treated than in raw DHM, while the fat concentration and the percentage of monoacylglycerides and SFAs were lower. Other nutrients did not change after HTST processing. The retained BSSL activity was higher after short HTST treatment than that following HoP. Overall, HTST treatment resulted in better preservation of the nutritional quality of DHM than HoP because relevant thermosensitive components (phospholipids, PUFAs, and BSSL) were less affected., This research was funded by grants from the Spanish Research Projects in Health funded by ISCIII-the state plan for scientific and technical research and innovation and European Regional Development Fund (ERDF) (ref. PI12/02128 and PI15/00995) and by ALG2016-75476-R project from the Ministerio de Economía, Industria y Competitividad (Spain). Moreover, this work has received a grant from the Hero Institute for Infant Nutrition (Alcantarilla, Murcia, España; 2012). Additionally, this study was supported by RETICS “Maternal and Child Health and Development Network” (SAMID Network), funded by the PN I+D+i 2008-2011 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion and the ERDF (ref. RD12/0026).

To determine the association between intrahospital growth rate (GR) and breast milk fortification and somatometry, and risk for death after discharge or severe disability at 2 years of corrected age (CA).Retrospective analysis of GR and subsequent course. Infants born in the 1990-2015 period with a birth weight1500 g were included. Infants with diseases affecting growth were excluded. An overall cohort and 2 sub-cohorts were studied: infants born in the 1990-2001 period (without fortification) and 2002-2015 period (with fortification). The GR was estimated and deemed adequate if12 g/kg/day.A total of 1194 patients were recruited. An adequate GR was associated with a higher median weight at 2 years of CA in the overall cohort (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0.02). The 2002-2015 cohort reached a higher mean height (86.42 ± 4.03 cm versus 85.56 ± 4.01, p = 0.02). More preterm infants caught-up growth at 2 years of CA in the overall cohort with an adequate GR (62.50 % versus 34.69 %, p0.02). No differences were observed in the risk for death after discharge or severe disability at 2 years of CA with an adequate GR (OR: 0.79; 95 % confidence interval: 0.47-1.12).An adequate GR was associated with improved growth, but not with a lower risk for death after discharge or severe disability. The cohort with fortified breast milk reached a higher mean height at 2 years of CA.Objetivo. Determinar la asociación de la velocidad de crecimiento (VC) intrahospitalaria y la fortificación de leche humana con la somatometría y el riesgo de muerte tras el alta o discapacidad grave a los 2 años de edad corregida (EC). Población y método. Análisis retrospectivo de la VC y evolución posterior. Se incluyeron los recién nacidos del período 1990-2015, con peso al nacer1500 g. Se excluyeron neonatos con patología que afectaba al crecimiento. Se estudió una cohorte global y dos subcohortes: los nacidos en 1990-2001 (sin fortificación) y los nacidos en 2002-2015 (fortificada). La VC se calculó según la fórmula de Fenton y se consideró adecuada si resultó12 g/kg/día. Resultados. Se reclutaron 1194 pacientes. La VC adecuada se asoció a mayor mediana de peso a los 2 años de EC en la cohorte global (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0,02. La cohorte 2002-2015 alcanzó mayor talla media (86,42 ± 4,03 cm versus 85,56 ± 4,01, p = 0,02) y mayor porcentaje de prematuros que alcanzaron un crecimiento compensatorio (catch-up) a los 2 años de EC en la cohorte global con VC adecuada (62,50 % versus 34,69 %, p0,02). No se encontraron diferencias en el riesgo de muerte tras el alta o discapacidad grave a los 2 años de EC con VC adecuada (OR: 0,79; IC95 %: 0,47-1,12) ni al considerarse el análisis por subcohortes. Conclusiones. Una VC adecuada se asoció con mejor crecimiento, pero no con menor riesgo de muerte tras el alta o discapacidad grave. La cohorte fortificada alcanzó mayor talla media a los 2 años de EC.

Preconception and prenatal exposure to environmental contaminants may affect future health. Pregnancy and early life are critical sensitive windows of susceptibility. The aim of this review was to summarize current evidence on the toxic effects of environment exposure during pregnancy, the neonatal period, and childhood. Alcohol use is related to foetal alcohol spectrum disorders, foetal alcohol syndrome being its most extreme form. Smoking is associated with placental abnormalities, preterm birth, stillbirth, or impaired growth and development, as well as with intellectual impairment, obesity, and cardiovascular diseases later in life. Negative birth outcomes have been linked to the use of drugs of abuse. Pregnant and lactating women are exposed to endocrine-disrupting chemicals and heavy metals present in foodstuffs, which may alter hormones in the body. Prenatal exposure to these compounds has been associated with pre-eclampsia and intrauterine growth restriction, preterm birth, and thyroid function. Metals can accumulate in the placenta, causing foetal growth restriction. Evidence on the effects of air pollutants on pregnancy is constantly growing, for example, preterm birth, foetal growth restriction, increased uterine vascular resistance, impaired placental vascularization, increased gestational diabetes, and reduced telomere length. The advantages of breastfeeding outweigh any risks from contaminants. However, it is important to assess health outcomes of toxic exposures via breastfeeding. Initial studies suggest an association between pre-eclampsia and environmental noise, particularly with early-onset pre-eclampsia. There is rising evidence of the negative effects of environmental contaminants following exposure during pregnancy and breastfeeding, which should be considered a major public health issue.

AIM: To describe variations in practice between follow-up programmes for very preterm children born at less than 32weeks' gestation or with very low birth weight of less than 1,500g. METHODS: A survey on follow-up practices was electronically distributed to level II and III units among hospitals of the Spanish National Health Service in 2016. The survey included 70 questions covering issues such as follow-up organisation and resources, routine assessments, relationships with other services and families, information management and training. RESULTS: The response rate was 91.5% (141/154). Among respondents, 70.9% (100/141) reported that they do provide follow-up and 42% do so up to six years of age. Routine neurological and ophthalmological follow-up is not performed in 60% and 37% of hospitals, respectively, and a second hearing assessment is not given in 62%. Just 38% of units have psychologist. In 41% of hospitals, training in follow-up skills is not included in Paediatric Residency training programme. CONCLUSION: Although Spain has a nationwide health system that provides universal health coverage, we found that follow-up care for children born very preterm/very low birth weight is not equitable. Nearly half of paediatric residents receive no training in follow-up for this high-risk population.

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 (

Entre enero de 2016 y diciembre de 2017 se han actualizado las siguientes recomendaciones para la infancia y la adolescencia: - Protocolo de seguimiento para el recién nacido con un peso menor de 1.500 g o con menos de 32 semanas de gestación (< 1.500 < 32). - Vacunas en la infancia y adolescencia. - Cribado de alteraciones visuales en la infancia. - Cribado de la hipoacusia en la infancia. - Detección precoz de los trastornos del desarrollo. - Manual de trabajo. Salvo que se indique lo contrario, el grado de evidencia y la fuerza de la recomendación se expresan de acuerdo con la metodología publicada por el USPSTF en 2012 [disponible en: http://www.uspreventiveservicestaskforce.org/uspstf/ grades.htm]. Los últimos documentos actualizados se han realizado con metodología GRADE [disponible en: www.gradeworkinggroup. org]...

Objective: To determine the frequency and magnitude of neonatal hypophosphataemia (32 weeks with weight 32 semanas con peso

Resumen: Objetivo: Conocer la frecuencia y la magnitud de la hipofosforemia neonatal ( 32 semanas con peso 32 weeks with weight

Resumen: Introducción: Las auditorías en tiempo real son una herramienta de seguridad que apenas se ha aplicado anteriormente en el ámbito hospitalario. El objetivo del estudio fue determinar mediante auditorías si la información y el material necesario para la reanimación estaban disponibles para cada paciente de cuidados intensivos y si factores relacionados con el paciente, el momento o su ubicación en la unidad influyen en el cumplimiento de las recomendaciones. Material y métodos: Estudio observacional prospectivo realizado durante el año 2012 en una unidad neonatal nivel III-C. Dentro de un estudio más amplio de auditorías de recursos tecnológicos y procedimientos se incluyó la evaluación de la información escrita sobre el tubo endotraqueal, mascarilla y ambú de cada paciente y los laringoscopios del carro de parada. Dos veces por semana al azar se seleccionaba qué procedimiento o recurso se iba a evaluar. Se definió la variable uso global adecuado cuando todos los ítems evaluados eran correctos en el mismo procedimiento. Resultados: Se realizaron 17 auditorías que incluyeron 296 valoraciones. El coeficiente kappa interobservador fue 0,93. La frecuencia de uso global adecuado de la información y el material de reanimación fue de 62,50% (185/296). La mascarilla y ambú preparado en cada paciente fue la variable mejor cumplimentada (97,3%; p = 0,001). El uso global adecuado fue mejor en días festivos que en laborables (73,97 vs. 58,74%; p = 0,01) y el resto del año frente al verano (66,06 vs. 52%; p = 0,02). Conclusiones: Solo en el 62,5% de los casos toda la información y el material necesario para atender una situación crítica de forma urgente estaba fácilmente disponible. Gracias a las auditorías se identificaron oportunidades de mejora. Abstract: Background: Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. Material and methods:: Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. Results: A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P=.001). Significant differences were found with improved usage during weekends versus working-day (73.97 vs. 58.74%, P=.01), and the rest of the year versus 3rd quarter (66.06 vs. 52%, P=.02). Conclusions: Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits.

Background: Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. Material and methods: Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. Results: A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P = .001). Significant differences were found with improved usage during weekends vs. working-day (73.97 vs. 58.74%, P = .01), and the rest of the year vs. 3rd quarter (66.06 vs. 52%, P = .02). Conclusions: Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits. Resumen: Introducción: Las auditorías en tiempo real son una herramienta de seguridad que apenas se ha aplicado anteriormente en el ámbito hospitalario. El objetivo del estudio fue determinar mediante auditorías si la información y el material necesario para la reanimación estaban disponibles para cada paciente de cuidados intensivos y si factores relacionados con el paciente, el momento o su ubicación en la unidad influyen en el cumplimiento de las recomendaciones. Material y métodos: Estudio observacional prospectivo realizado durante el año 2012 en una unidad neonatal nivel III-C. Dentro de un estudio más amplio de auditorías de recursos tecnológicos y procedimientos se incluyó la evaluación de la información escrita sobre el tubo endotraqueal, mascarilla y ambú de cada paciente y los laringoscopios del carro de parada. Dos veces por semana al azar se seleccionaba qué procedimiento o recurso se iba a evaluar. Se definió la variable uso global adecuado cuando todos los ítems evaluados eran correctos en el mismo procedimiento. Resultados: Se realizaron 17 auditorías que incluyeron 296 valoraciones. El coeficiente kappa interobservador fue 0,93. La frecuencia de uso global adecuado de la información y el material de reanimación fue de 62,50% (185/296). La mascarilla y ambú preparado en cada paciente fue la variable mejor cumplimentada (97,3%; p = 0,001). El uso global adecuado fue mejor en días festivos que en laborables (73,97 vs. 58,74%; p = 0,01) y el resto del año frente al verano (66,06 vs. 52%; p = 0,02). Conclusiones: Solo en el 62,5% de los casos toda la información y el material necesario para atender una situación crítica de forma urgente estaba fácilmente disponible. Gracias a las auditorías se identificaron oportunidades de mejora.

Aim This study analysed the changes in growth velocity (GV) of preterm infants weighing

Pregnancy induces a number of immunological, hormonal, and metabolic changes that are necessary for the mother to adapt her body to this new physiological situation. The microbiome of the mother, the placenta and the fetus influence the fetus growth and undoubtedly plays a major role in the adequate development of the newborn infant. Hence, the microbiome modulates the inflammatory mechanisms related to physiological and pathological processes that are involved in the perinatal progress through di erent mechanisms. The present review summarizes the actual knowledge related to physiological changes in the microbiota occurring in the mother, the fetus, and the child, both during neonatal period and beyond. In addition, we approach some specific pathological situations during the perinatal periods, as well as the influence of the type of delivery and feeding., This research was funded by the PN I+D+I 2008–2011 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), RETICS Maternal and Child Health and Development Network, SAMID Network, Ref. RD16/0022/0015. Anna Parra-Llorca acknowledges Rio Hortega grant CM18/00165 from the Instituto de Investigación en Salud Carlos III (Ministry of Science, Universities and Innovation; Kingdom of Spain); Talía Sainz is funded by The Instituto de Salud Carlos III- Spanish Ministry of Science and Innovation cofounded by FEDER (EU). (Grant nº JR16/00021); Cristina Calvo is a member of the IdiPAZ Research Institute, Madrid. Spain. Translational Research Network for Pediatric Infectious Diseases (RITIP), Madrid, Spain. TEDDY Network Member (European Network of Excellence for Pediatric Clinical Research, Bari, Italy)

Resumen: En este documento de actualización presentamos cuatro temas trascendentes para la infancia y la adolescencia en nuestra actividad de atención primaria: el apoyo a la lactancia materna, la promoción de la actividad física, la prevención de lesiones infantiles por accidente de tráfico y el cribado de depresión mayor. Abstract: Four important topics about children and adolescents in our Primary Care activity are presented in this update document: support for breastfeeding, promotion of physical activity, prevention of child injuries due to traffic accidents, and screening for major depression

Objective This study aimed to assess the applicability of the insertion of small diameter catheters through the femoral vein in extremely low-birth-weight (ELBW) infants.Study Design All femoral small diameter catheters (Silastic or femoral arterial catheter [FAC]) inserted in ELBW infants in a tertiary level neonatal intensive care unit were retrospectively reviewed. Success rate, dwelling time, and percutaneously inserted central venous catheter–related complications were recorded.Results Thirteen small diameter catheters were inserted in seven ELBW infants. Mean gestational age at birth was 25+3 weeks (standard deviation [SD] ± 2.12) and mean birth weight was 686 g (SD ± 204.9). Mean weight at the first time of insertion was 1,044 g (SD ± 376.3). In two occasions, a FAC was used instead of a Silastic. In most cases (11/13, 84.6%), the patient was intubated prior to the procedure. The mean dwelling time was 16.7 days (SD ± 9.8). Most of the inserted small diameter catheters were removed electively (8/12, 66.7%), except for one episode of clinical sepsis from coagulase-negative Staphylococcus and three cases of accidental line extravasation. No other complications were reported. The success rate was 92.3%.Conclusion Femoral venous catheterization using small diameter catheters in ELBW infants may be promising when other routes have been exhausted. Our results support that it is a feasible technique that can be performed at the bedside with successful results when conducted by experienced personnel.

Background: Fetoscopic laser photocoagulation can directly injure fetal skin and may at birth resemble aplasia cutis congenita (ACC). Case report: A twin monochorionic pregnancy was complicated by twin-to-twin transfusion syndrome requiring in utero laser photocoagulation, resulting in the death of one twin. After birth, the viable baby presented skin lesions in both legs that were congruent with laser-induced burns. Conclusions: Laser-induced burns present as asymmetric superficial non-necrotic or ulcerated lesions, with a geographic outline, which turn into scars with no retraction or contractures and no changes in pain perception or motor limitations over time. ACC lesions are bilateral and symmetric, with a regular outline, an ulcerated or necrotic appearance, a higher degree of skin involvement affecting all skin layers and, over time, they turn into scars with retraction and contractures. These differential features may help clinicians in a challenging approach to the diagnosis of congenital skin defects.

Angle of inclination; Apparent life-threatening events; Bradycardia Angle d'inclinació; Esdeveniments que aparenten amenaçar la vida; Bradicàrdia Ángulo de inclinación; Acontecimientos que aparentan amenazar la vida; Bradicardia BACKGROUND: Early mother-child skin-to-skin contact (SSC) in the first 2 h postpartum is highly beneficial for both mother and child. However, cases have been reported of newborns who have experienced apparently life-threatening events (ALTEs) or sudden death during this procedure. The causes of these events are unknown. Newborn's prone position could influence the onset of these events but there is very little evidence to support any recommendation. We hypothesize that newborns' breathing obstruction episodes increase as mothers lie more horizontally. The main objective of this study is to compare the occurrence of desaturation and bradycardia episodes as a function of mother's bed incline. The study is designed as a randomized, controlled, assessor blind, multicenter, superiority trial with two parallel groups and 1:1 allocation ratio. METHODS: The study participants will be full-term healthy mother-newborn dyads from ten hospitals in Spain. Participants will be randomly assigned to one of two study arms defined by mother's bed inclination (45° or 15°). The planned sample size is 5866. Centralized permuted blocks randomization and assessor blinding will be implemented. The newborns will be monitored remotely with pulse oximetry, from 10 min to 2 h after delivery. We established SO2 and heart rate (HR) limit alarms, as well as an action protocol in the event of alarm activation. The primary outcome is the number of healthy newborns who undergo episodes of SO2 ≤ 90%. Secondary outcomes are the mean SO2 level, the number of newborns who experience episodes of SO2 ≤ 85%, the time to SSC discontinuation due to abnormal SO2 or HR, and episodes of HR 180 bpm. Subgroups and pooled analysis will be performed to identify if breast-feeding and mother and child positions favor the occurrence of desaturation or bradycardia episodes. DISCUSSION: A simple intervention such as modifying mother's bed angle of inclination while in SSC with her child during the first 2 h postpartum could favor newborn's hemodynamic and respiratory stabilization and thus contribute to reducing the onset of ALTEs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02585492 . Registered on 22nd October 2015. PROTOCOL VERSION: 2 (30th June 2015).

Prematurity carries a high risk of mortality and sequelae, altering the bonding process and leading to repercussions in terms of attachment.To assess the type of attachment in children under 32weeks' gestational age (GA) or below 1500g, in hospitals where development-centred care has been implemented and to study the association between various types of attachment and certain neonatal and family characteristics.Children1500g or32weeks GA who were born or admitted before 48h of life to one of two hospitals in Madrid between January and December 2012 were candidates for the study. The type of attachment was assessed through the strange situation procedure (SSP). Attachment was classified according to three types: secure (B), avoidant (A), or resistant/ambivalent (C). Insecure attachment was considered to be A+C. Children were assessed at a corrected age of 2years using the Bayley III Scales and SSP. Data on the characteristics of the parents and children were collected.A total of 59% (117/199) of the children1500g or32weeks GA born in 2012 in the two study hospitals were able to be evaluated. Secure attachment was found in 64% (75/117), avoidant attachment in 12.8% (15/117), and resistant/ambivalent in 23.1% (27/117). The children with secure attachment had a score of 107.6±16 in the cognitive area of the Bayley's Scale versus 98.8±18.8 in those with insecure attachment (p 0.007). Frequency of secure attachment at ≤26weeks GA was 23% (3/13) versus 69% (72/104) in children26weeks GA (p 0.003).Nearly two-thirds of the children studied presented secure attachment, which was associated with better cognitive development. The frequency of secure attachment is lower in the children born more preterm.

Background: The Baby-Friendly Hospital Initiative (BFHI) has a positive effect on breastfeeding in maternity wards; however, few studies have examined to what degree it affects care in neonatal intensive care units (NICUs). Recently, the BFHI has been adapted to the NICUs (Neo-BFHI). Objective: This study aimed to compare breastfeeding support in Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited (group 1) with NICUs in hospitals that have not yet begun this initiative (group 2). Methods: A validated questionnaire on breastfeeding support was distributed to level II and III NICUs in Spanish public hospitals. A univariate analysis and an analysis adjusted for the number of beds in NICUs were conducted. The results of the analysis of 36 breastfeeding support measures are presented in accordance with the Ten Steps to Successful Breastfeeding adapted to NICUs. Results: Of the 141 participating NICUs, 129 (91%) responded to the questionnaire: 38 NICUs from group 1 and 91 NICUs from group 2. Group 1 had implemented a higher number of breastfeeding support measures than group 2. There were significant differences in 18 measures related to steps 2, 4, 5, 7, and 8 of the Neo-BFHI. In addition, a comparison of NICUs in hospitals with full accreditation (7 of 129) with those in group 2 revealed significant differences in 7 measures pertaining to steps 2, 5, 8, and 9. Conclusion: The Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited have better implementation of practices to promote and support breastfeeding.

Resumen: Introducción: Actualmente no existe una política unificada de cómo promocionar la lactancia materna en la unidad neonatal ni sobre la práctica de nutrición enteral con leche materna (LM) en los prematuros. Nuestro objetivo fue describir las medidas de apoyo a la lactancia y la utilización de LM en grandes prematuros de los hospitales públicos españoles. Método: Se distribuyó un cuestionario sobre prácticas de alimentación enteral. Se analizaron los datos de las unidades que atendían a menores de 32 semanas o 1.500 g. Se realizó un análisis univariante comparando las unidades de nivel ii y iii. Resultados: La tasa de respuesta fue del 91%. Un total de 93 unidades atienden a menores de 32 semanas o de 1.500 g (17 de nivel ii y 76 de nivel iii). El 49% registra la tasa de lactancia al alta. En el 75% (70/93) existe una guía de manejo de LM (nivel iii 81 vs. nivel ii 47%; p = 0,002). El 25% dispone de leche donada. El 46% inicia alimentación trófica en las primeras 6 h. En el 89% el volumen máximo de LM administrado es ≥180 ml/kg/día (nivel iii 93 vs. nivel ii70%; p = 0,017). Se fortifica en el 96% de las unidades y el 92% la inicia a partir de un volumen determinado de leche. Para modificar la cantidad de fortificante, el 59% utiliza la curva de peso y el 36% criterios analíticos. El 9% emplea fortificante proteico puro. Conclusiones: Existe una gran variabilidad en las medidas de apoyo a la lactancia y en las prácticas de alimentación enteral de los grandes prematuros en las unidades españolas. Abstract: Introduction: There is currently no unified policy on either breastfeeding support or enteral nutrition practices, as regards human milk (HM) in pre-term newborns. The aim of this study was to describe breastfeeding support measures, as well as the use of HM in very preterm infants in Spanish public hospitals. Method: A questionnaire on enteral feeding practices was distributed. Data were analysed from units caring for newborns less than 32 weeks or 1,500 g. A univariate analysis was performed comparing level ii and iii care units. Results: There was a 91% response rate. A total of 93 units cared for infants less than 32 weeks or 1,500 g (17 level ii and 76 level iii), and 49% of the units recorded the breastfeeding rate on discharge. Around 75% (70/93) had a guideline on managing HM (level iii 81 vs. level ii 47%, P=.002), and 25% had access to donor human milk. Just under half (46%) started trophic feeding in the first 6 h. Target enteral feeding volume in stable preterm infants was ≥ 180 ml/kg/day in 89% of the units (level iii 93% vs. level ii 70%, P =.017). HM fortifier was used in 96% of the units. In 92%, it was added when the required enteral volume was tolerated. In 59% of the units, adjustments in the quantity of fortifier were made according to weight, and in 36%, it depended on analytical criteria. Some units (9%) used pure protein fortifier. Conclusions: There is a marked variability in breastfeeding support measures and in feeding practices of preterm infants in Spanish neonatal units.

Compare the oral colonization profile of premature infants admitted at NICU before and after doing oral care routine with sterile water versus no intervention.It was a randomized clinical trial composed of 37 premature infants admitted at the Neonatal Intensive Care Unit (NICU) with a birth weight (BW)1500 g. They were distributed in two groups: the study group (SG) with 15 patients who received an oral hygiene with sterile water; and a control group (CG) (no intervention) formed by 22 patients. Primary outcome was oral colonization profile before and after doing oral care.In the study group, the number of patients colonized by the Gram-positive bacteria at the beginning of the study was 53% versus 40% at the end (p=0.10). For Gram negative, 40% at the study's beginning versus 60% at the end (p=0.18). In the control group, the number of colonized patients for the Gram-positive bacteria at the onset of the study was 54.5% versus 32% patients at the end (p=0.24). For Gram negative, 32% patients at the start of the study versus 77% at the end (p = 0.003).There is a significant increase of the Gram-negative flora in those patients without oral care.