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IntroductionWhile non-invasive positive-pressure ventilation (NIPPV) is increasingly used as a mode of respiratory support for preterm infants, it remains unclear whether this technique translates into improved respiratory outcomes. We assessed the association between NIPPV use and bronchopulmonary dysplasia (BPD)-free survival in never intubated very preterm infants. MethodsThis multicenter cohort study analyzed data from the Spanish Neonatal Network SEN1500 corresponding to preterm infants born at

OBJECTIVES: To describe neonatal and maternal characteristics of the largest prospective cohort of newborns from mothers with coronavirus disease 2019 (COVID-19), the data of which were prospectively collected from the nationwide registry of the Spanish Society of Neonatology. METHODS: Between March 8, 2020, and May 26, 2020, the data of 503 neonates born to 497 mothers diagnosed with COVID-19 during pregnancy or at the time of delivery were collected by 79 hospitals throughout Spain. RESULTS: Maternal symptoms were similar to that of the general population, with 5% of severe forms. In 45.8% of asymptomatic women at the time of delivery, severe acute respiratory syndrome coronavirus 2 infection was detected because of recommendations established in Spain to perform COVID-19 screening in all women admitted to the hospital for labor. The rate of preterm deliveries was 15.7% and of cesarean deliveries, 33%. The most common diagnostic test was detection of viral RNA by polymerase chain reaction of nasopharyngeal swabs at a median age of 3 hours after delivery (1-12 hours). Almost one-half of neonates were left skin-to-skin after delivery, and delayed clamping of umbilical cords was performed in 43% of neonates. Also, 62.3% of asymptomatic neonates were managed with rooming-in. Maternal milk was received by 76.5% of neonates, 204 of them as exclusive breastfeeding. CONCLUSIONS: The current study indicates that there is no need for separation of mothers from neonates, allowing delayed cord clamping and skin-to-skin contact along with maintenance of breastfeeding in a high percentage of newborns from mothers with COVID-19.

Objectives: Most studies of inhaled nitric oxide (iNO) for prevention of bronchopulmonary dysplasia (BPD) in premature infants have focused on short-term mortality and morbidity. Our aim was to determine the long-term effects of iNO. Methods: A 7-year follow-up was undertaken of infants entered into a multicenter, double-blind, randomized, placebo-controlled trial of iNO for prevention of BPD in premature infants born between 24 and 28 weeks plus six days of gestation. At 7 years, survival and hospital admissions since the 2-year follow-up, home oxygen therapy in the past year, therapies used in the previous month and growth assessments were determined. Questionnaires were used to compare general health, well-being, and quality of life. Results: A total of 305 children were assessed. No deaths were reported. Rates of hospitalization for respiratory problems (6.6 vs. 10.5%, iNO and placebo group, respectively) and use of respiratory medications (6.6 vs. 9.2%) were similar. Two patients who received iNO and one who received placebo had received home oxygen therapy. There were no significant differences in any questionnaire-documented health outcomes. Conclusions: iNO for prevention of BPD in very premature infants with respiratory distress did not result in long-term benefits or adverse long-term sequelae. In the light of current evidence, routine use of iNO cannot be recommended for prevention of BPD in preterm infants.

Las recomendaciones incluidas en este documento señalan las indicaciones actuales del tratamiento con óxido nítrico inhalado (ONi) en el recién nacido, diferenciando claramente las apoyadas en evidencia científica de las que todavía no lo están, como su uso en prematuros. Tras comentar la metodología, dosificación y efectos secundarios, se insiste en las causas de falta de respuesta al ONi. : The recommendations in this document describe the current indications for inhaled nitric oxide (iNO) treatment in the newborn and clearly distinguish between those supported by scientific evidence and those for which evidence is still lacking, such as its use in preterm infants. The methodology for iNO administration, its dosage and the main secondary effects are discussed, and the reasons for lack of response to this treatment are analyzed.

Introducción: la implementación de la telemedicina es cada vez mayor; sin embargo, no existen estudios controlados en nuestro medio que demuestren su efecto en Atención Primaria (AP). Nuestro objetivo es analizar si la implementación de prácticas tecnológicas puede ir encaminada al asesoramiento de las familias. Materiales y métodos: estudio piloto de intervención, prospectivo, controlado no aleatorizado, muestreo consecutivo, con seguimiento longitudinal de seis meses, realizado en un centro de AP pediátrica. Seguimiento a través de web, redes sociales y telemedicina, entre las revisiones del niño sano, 1-2, 2-4 y 4-6 meses. Charlas grupales por telemedicina: vacunas, lactancia materna e introducción alimentos. El grupo control recibió el seguimiento habitual de AP. Resultados: la distribución sociodemográfica, revisiones presenciales del niño sano, detección de patologías fueron homogéneas en los dos grupos. En el grupo de intervención, se objetivó una disminución de la frecuentación de visita pediátrica/enfermería (p

Los prematuros de 35 semanas o menos de gestación, con o sin enfermedad pulmonar crónica (EPC), y los lactantes con cardiopatía congénita grave tienen un mayor riesgo de infección y hospitalización por el virus respiratorio sincitial (VRS). Las medidas higiénicas y los anticuerpos monoclonales para el VRS son eficaces en la disminución de la hospitalización en estos pacientes. Su utilización: a) es muy recomendable en prematros de 28 semanas o menos de gestación al nacer, o nacidos entre las 29-32 semanas con menos de 6 meses al inicio de la estación del VRS o dados de alta durante la misma, o niños afectados de EPC en tratamiento en los últimos 6 meses, o de cardiopatía congénita grave. Los dos últimos grupos pueden recibir la profilaxis durante dos estaciones del VRS. b) Es recommendable en prematuros 32-35 semanas de gestación menores de 6 meses que presenten dos o más factores de riesgo: edad cronológica inferior a 10 semanas al comienzo de la estación VRS, lactancia materna de 2 meses o menos (por indicación médica), tener al menos un hermano de menos de 14 años, asistencia a guardería, antecedentes familiars de sibilancias, 4 personas o más adultas en el hogar o malformaciones de vías aéreas o enfermedad neuromuscular. : Premature babies ≤ 35 weeks gestation, with or without chronic lung disease (CLD), and infants affected by severe congenital heart disease should be considered high risk population for RSV infection and hospitalization. Hygienic measures and RSV monoclonal antibodies (palivizumab) have been found useful in decreasing rates of RSV hospitalization in these patients. Guidelines for their administration include: a) strongly recommended use in premature babies ≤ 28 weeks gestation, or born between 29-32 weeks gestation and less than 6 months at start of RSV station or discharged along it, or affected by CLD in treatment during last 6 months or by severe congenital heart disease. Last two groups could be prophylaxed for two RSV seasons. b) Recommended use among premature babies between 32-35 weeks gestation and less than 6 months of age and presenting two or more risk factors:chronologic age < 10 weeks at start of RSV station, breastfeeding ≤ 2 months (physician prescription), sibling < 14 years old, day-care assistance, family history of wheezing, ≥ 4 adults at home, airways malformation or neuromuscular disease.

Background: Bronchiolitis caused by the respiratory syncytial virus (RSV) and its related complications are common in infants born prematurely, with severe congenital heart disease, or bronchopulmonary dysplasia, as well as in immunosuppressed infants. There is a rich literature on the different aspects of RSV infection with a focus, for the most part, on specific risk populations. However, there is a need for a systematic global analysis of the impact of RSV infection in terms of use of resources and health impact on both children and adults. With this aim, we performed a systematic search of scientific evidence on the social, economic, and health impact of RSV infection. Methods: A systematic search of the following databases was performed: MEDLINE, EMBASE, Spanish Medical Index, MEDES-MEDicina in Spanish, Cochrane Plus Library, and Google without time limits. We selected 421 abstracts based on the 6,598 articles identified. From these abstracts, 4 RSV experts selected the most relevant articles. They selected 65 articles. After reading the full articles, 23 of their references were also selected. Finally, one more article found through a literature information alert system was included. Results: The information collected was summarized and organized into the following topics: 1. Impact on health (infections and respiratory complications, mid-to long-term lung function decline, recurrent wheezing, asthma, other complications such as otitis and rhino-conjunctivitis, and mortality; 2. Impact on resources (visits to primary care and specialists offices, emergency room visits, hospital admissions, ICU admissions, diagnostic tests, and treatments); 3. Impact on costs (direct and indirect costs); 4. Impact on quality of life; and 5. Strategies to reduce the impact (interventions on social and hygienic factors and prophylactic treatments). Conclusions: We concluded that 1. The health impact of RSV infection is relevant and goes beyond the acute episode phase; 2. The health impact of RSV infection on children is much better documented than the impact on adults; 3. Further research is needed on mid-and long-term impact of RSV infection on the adult population, especially those at high-risk; 4. There is a need for interventions aimed at reducing the impact of RSV infection by targeting health education, information, and prophylaxis in high-risk populations.

Resumen: El objetivo es proporcionar el marco para la recopilación de datos en el área de la salud de los recién nacidos que permitan la armonización de la asistencia sea cual sea su lugar de nacimiento. Para ello es necesario conocer la población atendida y la mayor dificultad es la ausencia de un sistema de recopilación de datos y de unos estándares asistenciales para todas las condiciones del recién nacido. Es imprescindible disponer de un registro único en el que se recojan los principales datos perinatales y neonatales de todos los recién nacidos. La Sociedad Española de Neonatología (SEN) debe ser el depositario y responsable de la base de datos, que debe cumplir todas las exigencias legales de privacidad y confidencialidad. A nivel de cada centro es posible conocer el peso relativo de la afección atendida por grupos de diagnósticos relacionados (DRG) y los resultados desde el aspecto de calidad asistencial. Mediante análisis comparativos (estudios de benchmarking,…) es posible establecer las pautas de diagnóstico y tratamiento.Es necesario conocer la población de recién nacidos atendida y definir criterios de diagnóstico y tratamiento para mejorar la calidad asistencial. La SEN desea dirigirse a los responsables asistenciales de los centros hospitalarios para pedirles su apoyo y colaboración en la puesta en marcha de estas recomendaciones. Abstract: The aim is to provide a framework for data collection in the health area of newborn infants allowing harmonization of their care. This requires knowing the population served, and the greatest difficulty is the absence of a data collection system and standards of care for all conditions of the newborn infant. It is essential to have a single record with the main perinatal and neonatal data of all newborn infants. The Spanish Society of Neonatology (SEN) should be responsible for the database, which must meet all legal requirements of privacy and confidentiality. It is possible to determine the relative weight of the pathology treated using Diagnostic Related Groups (DRG) and the results from a quality care perspective. Guidelines for diagnosis and treatment may be established by comparative analysis (benchmarking studies…).Conclusion and Recommendation. It is necessary to know the newborn population served, and define criteria for diagnosis and treatment to improve quality of care. The SEN wishes to address those responsible for the care in hospitals, and to ask for their support and cooperation in the implementation of these recommendations.

Introduction of advanced therapeutic modalities for diaphragmatic congenital hernia (CDH) has allowed to reach considerable improvements in survival rate. Nevertheless, there are few studies which analyze the clinical evolution of the long-term survivors. The aim of this work is to analyze the outcomes of the patients with CDH in our hospital.Fifty-five neonates with CDH were treated in our center between 1998 and 2005. We included in the study those patients that were alive at the moment of first hospital discharge (72%; n=40 patients). ECMO therapy was needed in 6 of them during neonatal treatment. A descriptive transverse review of the clinical record as well as a telephonic interview to the parents was performed for the respiratory, cardiological, digestive and neurological conditions, following standard diagnostic studies in every case. The mean age of the children in the moment of the study was 4.2 years (1-9).The 8.3% of the children needed domiciliary oxygen therapy during a maximum of 3 months in all the cases. 22% of the cases suffered from respiratory problems, being bronchiolitis and pneumonia the most frequent diagnoses. Only a patient developed asthma. The gastroesophageal reflux is the most frequent long-term condition (47%), but only 8.3% needs surgical treatment. Regarding to cardiological problems, 14% developed pulmonary hypertension, being slight - moderate in all the cases but in one case who was the only deceased of the series. Regarding to neurological problems only 1 patient developed serious alterations (brain paralysis), having suffered a hemorrhage parenquimatosa during the treatment with ECMO. No other patient presents motor, visual nor auditory alterations in the development, last mild alteration in language (4 patients). Differences do not exist with the group of patients that did not need ECMO during the treatment in cardiological and digestive complications, being higher percentage with respiratory problems.In our sample only 2 patients present serious sequels (5%). Of this preliminary study we can conclude that the comorbility in the CDH is very low having these patient a good development and good quality of life.

To determine if the needs of cardiopulmonary support of neonates with congenital diaphragmatic hernia (CDH) they can be indicators for the election of the most suitable moment to the surgery.We treated 16 consecutive neonates with congenital diaphragmatic hernia (CDH) from 2004 to 2005. Mean birth weight was 2900.63 +/- 531.51 g. Patients was divided in 2 groups. Group A: newborns without adrenaline nor noradrenaline like vasoactive drugs and conventional respiratory assistant; the surgery was performed during the first 48 hours of life. Group B: newborns with adrenaline or noradrenaline like vasoactive drugs, high-frequency oscillatory ventilation or extracorporeal membrane oxygenation; surgery was delayed (10.66 +/- 8.26 days).Four neonates died during the first 24 hours of life without surgical treatment not fulfilling criteria of support ECMO. Five patients were operated during the first 48 hours, fulfilling all of them the clinical criteria of the group A. Mortality does not exist in this group. Seven patients were operated late fulfilling the criteria of the group B. They all needed VAFO. Two patients of this group needed support ECMO. The survival rate in this group was 83.3%.In our opinion, the patients with CDH that need initially high cardiopulmonary support, VAFO and/or ECMO would be necessary a time of wait to realize the surgery. In those patients who don't need this level of treatment the delay would not justify itself in the surgical intervention.

The mortality rate of infants with congenital diaphragmatic hernia (CDH) remains high, despite clinical improvements. Many attempts have been made to find accurate and reliable predictors of outcome. Deadspace (Vd/Vt) and dynamic compliance (DC) measured by single breath CO2 analysis may be useful to evaluate pulmonary function and perfusion. In the present study we analyse both parameters in patients with CDH. Nine patients with CDH were included for Vd/Vt and DC study. Measurements of arterial blood gases (pH, PO2, pCO2) were obtained, oxygenation index and alveolo-arterial difference calculated at diagnosis, preoperatively and postoperatively. Vd/Vt and DC were measured at the same moments by analysis of the CO2 espirogram. Statistical analysis was performed using Fisher exact test, ANOVA and Mann Whitney and Chi-square. The Vd/Vt was significant lower for the group of patients who survived (0.39 +/- 0.07 vs 0.64 +/- 0.14, p = 0.038). DC was significantly higher in the survivors group (1.39 +/- 0.30 vs 0.5 +/- 0.07, p = 0.011). The analysis of the evolutive Vd/Vt and DC (initial and preoperative) showed significant differences within both groups. Respiratory deadspace can be easily quantified in neonates with congenital diaphragmatic hernia providing an important insight regarding the efficiency of the airway-alveolus and its relationship to pulmonary blood flow. Vd/Vt and DC measurement constitute a reliable method to predict outcome in patients with CDH.

OBJECTIVE: The aim of this study was to evaluate the results of high frequency ventilation (HFV) used as a rescue strategy in newborn infants with severe lung disease who either failed conventional mechanical ventilation (CMV) or had an air block. PATIENTS AND METHODS: From April 1995 to June 1998, 241 infants with severe lung disease and managed according to a common protocol of HFV used as a rescue strategy were prospectively evaluated in the nine participating level III Spanish Neonatal Intensive Care Units. The most frequent diagnoses were respiratory distress syndrome (119), meconium aspiration (24), pneumonia (19) and congenital diaphragm hernia (18). RESULTS: Mean +/- SD gestational age and birth weight were 32.0 +/- 5.5 weeks and 1,187 +/- 1,071 g, respectively. All babies were previously manages with CMV for a mean of 59 hours. HFV was started at a mean postnatal age of 82 hrs, with a mean oxygenation index (OI) of 28.3 +/- 15.3 and an a/A DO2 of 0.10 +/- 0.08. Initial mean HFV settings were: mean airway pressure 12.8 +/- 3.4 mbar, frequency 8.3 +/- 1.4 Hz, amplitude 53 +/- 20 percent, tidal volume 2.2 +/- 0.7 ml/kg and FiO2 0.88 +/- 0.2. At two hours of HFV there was a significant increase in the mean PaO2 (from 48 to 80 mmHg), with a concomitant decrease in FiO2 (from 0.88 to 0.79), PaCO2 (from 60 to 46 mmHg) and OI (from 28 to 18). Mean a/A DO2 increased from 0.10 to 0.19; these changes remained similar thereafter. HFV was suspended after a mean of 95 hrs because of improvement in 70%, death in 19% and failure to improve the clinical condition in the remaining 19%. Intrahospital death rate was 32%. The following complications were observed: pneumothorax (10%), interstitial emphysema (4%), intraventricular hemorrhage grades III and IV (14.5%) and bronchopulmonary dysplasia (35%). CONCLUSIONS: HFV is an effective rescue strategy that improves pulmonary gas exchange within two hours of its initiation.