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Infants might be exposed to pain during their admissions in the neonatal intensive care unit [NICU], both from their underlying conditions and several invasive procedures required during their stay. Considering the particularities of this population, recognition and adequate management of pain continues to be a challenge for neonatologists and investigators. Diverse therapies are available for treatment, including non-pharmacological pain management measures and pharmacological agents (sucrose, opioids, midazolam, acetaminophen, topical agents…) and research continues. In recent years one of the most promising drugs for analgesia has been dexmedetomidine, an alpha-2 adrenergic receptor agonist. It has shown a promising efficacy and safety profile as it produces anxiolysis, sedation and analgesia without respiratory depression. Moreover, studies have shown a neuroprotective role in animal models which could be beneficial to neonatal population, especially in preterm newborns. Side effects of this therapy are mainly cardiovascular, but in most studies published, those were not severe and did not require specific therapeutic measures for their resolution. The main objective of this article is to summarize the existing literature on neonatal pain management strategies available and review the efficacy of dexmedetomidine as a new therapy with increasing use in the NICU.

The prevalence of postnatal growth faltering (PGF) in preterm infants with very low birth weight (VLBW) (n = 112; and 2013–2017, n = 92) were compared. Results. In the second five-year period, a decrease in prevalence of PGF was observed (36.6% vs. 22.8%, p = 0.033), an increase in growth rate in the first 28 days (5.22 (4.35–6.09) g/kg/day vs. 11.38 (10.61–12.15) g/kg/day, p < 0.0001) and an increase in height standard deviation (SD) at 2 years (−1.12 (−1.35–−0.91) vs. −0.74 (−0.99–−0.49) p = 0.023). Probability of short stature at 2 years was directly related to daily weight gain in the first 28 days. Conclusions: when comparing two five-year periods in the last two decades, growth in VLBW preterm infants has improved, both during neonatal period and at two years of age.

Background: Controversy between short-term neonatal growth of very low birth-weight preterm (VLBW) and neurodevelopment may be affected by criteria changes of extrauterine growth restriction (EUGR). Objective: to determine if new EUGR criteria imply modifications in the relationship between old criteria and results of neuropsychological tests in preterm children. Patients and methods: 87 VLBW at 5–7 years of age were studied. Neuropsychological assessment included RIST test (Reynolds Intellectual Sctreening Test) and NEPSY-II (NE neuro, PSY psycolgy assessment) tests. The relationships between these tests and the different growth parameters were analyzed. Results: RIST index was correlated with z-score Fenton’s weight (p = 0.004) and length (p = 0.003) and with z-score IGW-21’s (INTERGRWTH-21 Project) weight (p = 0.004) and length (p = 0.003) at neonatal discharge, but not with z-score difference between birth and neonatal discharge in weight, length, and HC for both. We did not find a statistically significant correlation between Fenton or IGW-21 z-scores and scalar data of NEPSY-II subtasks. Conclusion: In our series, neonatal growth influence on neuropsychological tests at the beginning of primary school does not seem robust, except for RIST test. New EUGR criteria do not improve the predictive ability of the old ones.

Resumen: La prevalencia de la hipertensión arterial ha aumentado considerablemente en la edad pediátrica como consecuencia principal de su detección en niños mayores y adolescentes, en quienes predomina la causa esencial (primaria). En otras etapas de la edad pediátrica la HTA es menos frecuente, en especial en lactantes. En este grupo la hipertensión arterial obedece casi siempre a causas secundarias, en ocasiones potencialmente graves, por lo que resulta imprescindible detectarla, llevar a cabo un proceso diagnóstico etiológico adecuado y proporcionar al paciente un adecuado tratamiento, que suele requerir de un profesional especializado. A las dificultades técnicas propias de la medición de la presión arterial en los lactantes se añade la ausencia de recomendaciones específicas relacionadas con su identificación sistemática y de valores de normalidad bien establecidos en este rango de edad, por lo que su manejo constituye un reto diagnóstico y terapéutico para el profesional. A través de la exposición de 3 casos de hipertensión detectada en la etapa de lactante, se pretende sensibilizar al pediatra sobre esta enfermedad, así como proporcionar información sobre su orientación diagnóstica y terapéutica, incidiendo asimismo en las medidas farmacológicas. Abstract: Arterial Hypertension prevalence (HTN) has significantly increased in paediatric patients, mainly in older children and teenagers. In these subjects the most common type is essential or primary HTN. However, in infants HTN prevalence is significantly lower and is almost always due to secondary causes, which can be potentially severe. Hence the importance of its detection, in order to establish an etiological diagnosis and provide an appropriate treatment, which usually requires a specialist physician. In addition to the technical difficulties of blood pressure measurement in infants, the lack of recommendations to perform a systematic screening in this age range and the absence of well-established normal values turns infancy-onset HTN into a diagnostic and therapeutic challenge for the physician. By means of the exposition of three infancy-onset HTN cases, the aim is to increase the paediatrician's awareness of this pathology and also to provide information about its diagnostic and therapeutic approach, dealing also with pharmacological measures of treatment.

Arterial Hypertension prevalence (HTN) has significantly increased in paediatric patients, mainly in older children and teenagers. In these subjects the most common type is essential or primary HTN. However, in infants HTN prevalence is significantly lower and is almost always due to secondary causes, which can be potentially severe. Hence the importance of its detection, in order to establish an etiological diagnosis and provide an appropriate treatment, which usually requires a specialist physician. In addition to the technical difficulties of blood pressure measurement in infants, the lack of recommendations to perform a systematic screening in this age range and the absence of well-established normal values turns infancy-onset HTN into a diagnostic and therapeutic challenge for the physician. By means of the exposition of three infancy-onset HTN cases, the aim is to increase the paediatrician’s awareness of this pathology and also to provide information about its diagnostic and therapeutic approach, dealing also with pharmacological measures of treatment. Resumen: La prevalencia de la hipertensión arterial (HTA) ha aumentado considerablemente en la edad pediátrica como consecuencia principal de su detección en niños mayores y adolescentes, en quienes predomina la causa esencial (primaria). En otras etapas de la edad pediátrica la HTA es menos frecuente, en especial en lactantes. En este grupo la HTA obedece casi siempre a causas secundarias, en ocasiones potencialmente graves, por lo que resulta imprescindible detectarla, llevar a cabo un proceso diagnóstico etiológico adecuado y proporcionarle un adecuado tratamiento, que suele requerir de un profesional especializado. A las dificultades técnicas propias de la medición de la presión arterial en los lactantes se añade la ausencia de recomendaciones específicas relacionadas con su identificación sistemática y de valores de normalidad bien establecidos en este rango de edad, por lo que su manejo constituye un reto diagnóstico y terapéutico para el profesional. A través de la exposición de 3 casos de hipertensión detectada en etapa de lactante, se pretende sensibilizar al pediatra sobre esta patología, así como proporcionar información sobre su orientación diagnóstica y terapéutica, incidiendo asimismo en las medidas farmacológicas.

Background and objectives: Variable diagnostic criteria and growth charts have been used for extrauterine growth restriction (EUGR). The objective was to assess the prevalence and concordance of EUGR in extremely-low-birthweight (ELBW) infants with the most frequent diagnostic criteria and growth charts. Materials and methods: An observational, retrospective and multicenter study was conducted from 2011 to 2020 including ELBW infants from the Spanish SEN1500 Network. EUGR prevalence was calculated at discharge using different definitions: cross-sectional (anthropometry less than the 10th centile), longitudinal (decrease of more than 1 SD from birth to discharge), “true” cross-sectional and “true” longitudinal (using the criteria previously described, excluding infants small for gestational age at birth). Concordance among Fenton, Olsen and INTERGROWTH-21st was assessed with Fleiss’ Kappa coefficient. Results: The prevalence of EUGR was variable with the different definitions and growth references studied in the 7914 ELBW infants included. Overall, it was higher with Fenton for all the EUGR criteria studied by weight and length. The agreement among growth charts was substantial (κ > 0.6) for all the definitions except for longitudinal EUGR by weight (moderate, κ = 0.578). Conclusions: The prevalence of EUGR was variable in our cohort with the different diagnostic criteria and growth charts. The agreement among charts was good for all the definitions of EUGR except longitudinal EUGR by weight.