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(1) Background: The relationship between enteral nutrition and neonatal necrotizing enterocolitis (NEC) among premature neonates is still unclear. The present work was designed to assess the relationship between NEC and feeding strategies compared to control infants. (2) Methods: A retrospective case-control study of premature infants (<35 weeks' gestation) with or without NEC that examined feeding practices and clinical characteristics at birth and 3, 7, and 14-day hospitalization, with a longitudinal and cross-sectional analysis. (3) Results: A total of 100 newborns with NEC diagnosis and 92 neonates without the disease with similar demographic and clinical characteristics were included. The median day of NEC diagnosis was 15 days (Interquartile Range (IQR) 5-25 days). A significantly higher number of neonates that were fasting on days 7 and 14 developed NEC (p < 0.05). In the longitudinal analysis, generalized linear and mixed models were fit to evaluate NEC association with feeding strategies and showed that exclusive mother's own milk (MM) and fortified human milk (FHM) across time were significantly less likely associated with NEC (p < 0.001) and that enteral fasting was positively related with NEC. In the cross-sectional analysis, a binary logistic regression model was fit and predicted 80.7% of NEC cases. MM was also found to correlate with a reduced risk for NEC (OR 0.148, 95% CI 0.044-0.05, p = 0.02), and in particular, on day 14, several factors were related to a decreased odd for NEC, including birth weight, antenatal steroids, and the use of FHM (p < 0.001). (4) Conclusions: MM and FHM were associated with less NEC compared to fasting on days 7 and 14. Feeding practices in Neonatal Intensive Care Units (NICUs) should promote exclusive MM across the two-week critical period as a potential guideline to improve NEC outcome.

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Cow's milk allergy (CMA) is an immune-based disease that has become an increasing problem. The diagnosis and management of CMA varies from one clinical setting to another and represents a challenge in pediatric practice. In addition, because nonallergic food reactions can be confused with CMA symptoms, there is an overdiagnosis of the disease. In response to these situations, pediatric specialties from recognized institutions throughout Latin America decided to develop a clinical guideline for diagnosis and management of cow's milk allergy. These guidelines include definitions, epidemiology, pathophysiology overview, clinical and evidencebased recommendations for the diagnosis and treatment of CMA. They also include prevention and prognosis sections and identify gaps in the current knowledge to be addressed through future research.

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Introducción: La pérdida de peso en los primeros cinco a siete días de vida y el crecimiento en los prematuros depende de muchos factores. Existe una asociación inversa entre la edad gestacional y la pérdida de peso corporal en la primera semana de vida: a menor edad gestacional y menor peso al nacimiento es más difícil lograr una velocidad de crecimiento adecuada. Los objetivos de este estudio fueron determinar la pérdida de peso corporal en recién nacidos ≤ 1,500 g, calcular la velocidad de crecimiento absoluta (g/día) y relativa (g/kg/día), y correlacionar la pérdida ponderal porcentual con la edad gestacional. Material y métodos: Estudio observacional, longitudinal y retrospectivo de recién nacidos ≤ de 1,500 g. Las variables de estudio fueron edad gestacional, peso, talla y perímetro cefálico al nacer, con seguimiento de peso diario, talla y perímetro cefálico semanal. Se calculó la pérdida ponderal máxima, la velocidad de crecimiento y se correlacionó la pérdida ponderal máxima con la edad gestacional. Resultados: Se analizaron 101 casos, con edad gestacional promedio de 30.2 ± 2.3, peso al nacer de 1,190.7 g ± 204.5, 42 neonatos (41.6%) fueron con peso bajo para la edad gestacional y 59 (58.4%) con peso adecuado para la edad gestacional. El porcentaje máximo de pérdida de peso fue de 8.6 ± 4.5%, la recuperación del peso se presentó en el día 10.9 ± 5.2; la velocidad de crecimiento fue de 19.3 ± 5.4 g/día y 16.9 ± 5.4 g/kg/día; a menor edad gestacional hay mayor pérdida ponderal máxima con una correlación negativa baja y significativa (r = -0.422, p < 0.0001). Conclusiones: La velocidad de crecimiento absoluta (g/d) y relativa (g/kg/d) son útiles en la valoración nutricia diaria de todo recién nacido prematuro, permite detectar patrones de crecimiento subóptimos y realizar de manera oportuna intervenciones nutricionales para mejorar la velocidad de crecimiento. La pérdida ponderal en recién nacidos prematuros tiene una asociación significativa negativa, inversa con la edad gestacional.

Introduction: Weight loss in the first five to seven days of life and growth in preterm infants depends on many factors. In the first week of life, there is an inverse association between gestational age and loss of body weight; with very low birth weight and low gestational age is more difficult to achieve adequate growth velocity. The objectives were to determine the loss of body weight in infants less than 1,500 g calculate, the absolute growth velocity (g/day) and relative (g/kg/day), and correlate the percentage weight loss and gestational age. Methods: Observational, longitudinal and retrospective study of preterm neonates ≤ 1,500 g. The variables analyzed were at birth: weight, gestational age, length, and cephalic circumference, then monitoring the weight per day, and length and cephalic circumference, per week. It was calculated maximum weight loss and growth velocity. For maximum weight loss and gestational age, Pearson correlation was used. Results: Cases of 101 infants, with birth weight 1,190.7 ± 204.5 g and gestational age of 30.2 ± 2.3 were analyzed, 42 neonates (41.6%) had low birth weight for gestational age and 59 (58.4%) adequate weight for gestational age; the maximum average of weight loss was 8.6% ± 4.5; loss was presented in day 4.2 ± 1.7 and weight regain was presented on day 10.9 ± 5.2. Growth velocity was 19.3 ± 5.4 g/day and 16.9 ± 5.4 g/kg/day, an inverse negative correlation was observed between weight loss and gestational age (r = -0.422, p < 0.0001). Conclusions: The absolute growth velocity (g/day) and relative (g/kg/day) are useful in assess the nutritional condition in premature infants, and gives the opportunity to clinicians detect suboptimal growth velocity patterns and make adequate interventions. An inverse negative correlation was observed between weight loss and gestational age.

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La historia del control térmico neonatal data de finales del siglo XIX con la observación de Pierre Budin en el Hospital de Maternidad de París; Budin reportó una disminución en la mortalidad del 66 al 38% en recién nacidos con peso ≤ 2,000 gramos, posterior a la introducción de medidas de control térmico. Con el número creciente de prematuros de muy bajo peso que se atienden hoy en día en las Unidades de Cuidado Intensivo Neonatal es esencial que pediatras, neonatólogos y todo el personal involucrado en la atención entiendan la transición y la adaptación fisiológica que estos niños deben hacer, con la finalidad de proporcionarles un ambiente térmico óptimo con la tecnología que está disponible en la actualidad. La revisión concluye con la evaluación de la información disponible en estudios clínicos, mediante niveles de evidencia y grados de recomendación de acuerdo al sistema GRADE.

The history of neonatal thermal control dates from the late XIX century, with the observation of Pierre Budin in Paris Maternity Hospital, reporting a decrease in mortality from 66 to 38% in infants weighing ≤ 2,000 grams, after the introduction of thermal control measures. With the growing number of very low birth weight infants who are seen today in the Neonatal Intensive Care Units, it is essential that pediatricians, neonatologists and all staff involved in the care, understand the transition and physiological adaptation children should do, with the aim of providing a optimal thermal environment thermal environment with currently available technology. The review concludes with an evaluation of available information on clinical studies, using levels of evidence and grades of recommendation, according to the GRADE system.

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Introducción. Las escalas de riesgo son herramientas para cuantificar el riesgo inicial y facilitar y validar la comparación de resultados entre hospitales. Pueden ser de mucha utilidad para evaluar la calidad y los costos de los cuidados proporcionados y establecer un patrón aceptable de funcionamiento en las Unidades de Cuidado Intensivo Neonatal. El objetivo de este trabajo fue conocer los factores de riesgo para la mortalidad neonatal en menores de 1500 g utilizando la escala CRIB II. Métodos. Se realizó un estudio de casos y controles durante el período 2007-2009. Se analizaron las variables que contempla el CRIB II por medio del cálculo de promedios y desviaciones estándar, además de la razón de momios con el intervalo de confanza al 95% y las curvas ROC para puntos de corte de sensibilidad y especifcidad. Resultados. Se analizaron 52 casos (fallecidos) y 52 controles (sobrevivientes). La edad promedio fue 28.5 semanas de gestación y el peso promedio 865 g. Los factores de riesgo para el aumento de la mortalidad fueron: sexo masculino, Apgar bajo al minuto, Apgar bajo a los 5 minutos, temperatura <36 °C, hemorragia intraventricular y ventilación de alta frecuencia. La prematurez extrema fue la causa base más frecuente de mortalidad (90%). La hemorragia intraventricular fue la causa directa más frecuente (40.3%) seguida de choque séptico (19.2%), fuga aérea (11.5%), enfermedad de membrana hialina (9.6%), hemorragia pulmonar (9.6%) y enterocolitis (3.8%). Conclusiones. La escala predictiva CRIB II es de utilidad para el pronóstico de la mortalidad neonatal.

Background. Clinical Risk Index for Babies (CRIB) II score as well as other scoring systems was developed during the last decade in neonatal intensive care units in order to predict morbidity and mortality risk. Today, risk-adjusted severity of illness is frequently used in clinical research and quality assessments. The objective was to evaluate the clinical risk index in very low birth weight newborns with the CRIB II score in a tertiary hospital during 2007-2009. Methods. We performed a case-control study in 52 patients who died (cases) and 52 survivors (controls). Descriptive statistical analysis was performed by obtaining mean and standard deviation. We also performed odds ratio with 95% confdence interval and ROC curves in order to obtain cutoff points for sensitivity and specifcity. Results. Mean gestational age was 28.5 weeks. Average weight was 865 g. Factors associated with increased risk of mortality were male gender, low Apgar score, temperature <36°C, intraventricular hemorrhage and high frequency ventilation. The most frequent cause of mortality (90%) was extreme prematurity. Intraventricular hemorrhage was the most common direct cause (40.3%) followed by septic shock (19.2%), air leak (11.5%), hyaline membrane disease (9.6%) pulmonary hemorrhage (9.6%) and enterocolitis (3.8%). Conclusions. The CRIB II scale is a useful tool for predicting neonatal mortality.

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Introducción. La mortalidad neonatal es un indicador sensible y específico que nos permite conocer el estado de salud de un país y plantear estrategias para mejorarlo. Resulta de una cadena compleja de determinantes como los biológicos, los socioeconómicos y los de salud. El objetivo de este trabajo fue conocer la tasa de mortalidad neonatal general, por peso y edad gestacional, en un instituto de tercer nivel de atención durante 2007 y 2008. Métodos. Se analizaron todos los casos provenientes del comité de mortalidad perinatal y neonatal, de 2007 y 2008, desde 22 semanas de gestación en adelante. El análisis estadístico se realizó mediante medidas de tendencia central y dispersión para las variables cuantitativas y para las variables cualitativas frecuencia, porcentaje, χ² y razón de momios con nivel de significación estadística < 0.05. Resultados. La tasa de mortalidad para el año 2007 fue de 17.7 × 1000 nacidos vivos y para el 2008 de 19.7 × 1000 nacidos vivos. En relación con el peso y con la edad gestacional no se encontró aumento de riesgo al comparar los resultados de ambos años. Las malformaciones ocuparon el mayor porcentaje entre las causas de defunción. Conclusiones. Las tasas de mortalidad en 2007 y 2008 fueron de 17.7 y 19.7 × 1000 nacidos vivos, respectivamente. Las principales causas de defunción fueron las malformaciones cardiacas.

Background. Mortality is a sensitive and specific indicator for determining the health status of a country in order to implement improvement strategies. It is the result of biological, social, economic and health factors. The aim of this study was to determine neonatal general mortality and its relationship with weight and gestational age at a third-level health institution from 2007 to 2008. Methods. We analyzed all patients >22 weeks of gestational age from the perinatal mortality service. Statistical analysis was done using measures of central tendency and dispersion for quantitative variables and χ2, percentage and frequency for qualitative variables; odds ratios were calculated with significance level <0.05. Results. The mortality rate for 2007 was 17.7 per 1000 live births, and for 2008 it was 19.7 per 1000 live births. When we compared both years, we did not find an increased risk for weight and gestational age. Malformations occupied the largest causes of death. Conclusions. For years 2007 and 2008, mortality rates were 17.7 and 19.7 per 1000 live births, respectively, and the main cause of deaths were cardiac malformations.

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Introducción. La prevalencia de colestasis neonatal varía del 7-57%. Parte del manejo incluye al ácido ursodesoxicólico (UDCA) y al fenobarbital, ambos con débil sustento en la literatura. El objetivo de este trabajo es comparar la efectividad del UDCA vs fenobarbital en la reducción de las cifras de bilirrubina directa, en recién nacidos prematuros con colestasis, con peso entre 1 000-2 000 g. Métodos. Se realizó un ensayo clínico aleatorizado cruzado en 18 pacientes. Cada individuo recibió al azar una de las dos intervenciones: UDCA (10 mg/kg/día c/12 h) o fenobarbital (a 3 mg/kg/día c/24 h) durante un período inicial de 7 días. Después de 7 días de lavado, se les asignó el tratamiento contrario. En total se realizaron 36 tratamientos. Se midieron bilirrubinas y pruebas de función hepática al inicio y final de cada tratamiento. El análisis se realizó por medio de medidas de tendencia central y de dispersión, de acuerdo al tipo de variable. Para la comprobación de hipótesis se realizó t pareada. Resultados. En el grupo que recibió UDCA a 10 mg/kg/día c/12 h por 7 días, disminuyeron las cifras de bilirrubina directa en 2.7 mg/dL (P<0.01). Conclusiones. Se recomienda el uso de UDCA a dosis de 10 mg/kg/día c/12 h por vía enteral como coadyuvante para el tratamiento de colestasis neonatal.

Background. The prevalence of neonatal cholestasis varies from 7-57%. Part of the treatment includes ursodeoxycholic acid (UDCA) and phenobarbital, both with little supporting evidence in the literature. We undertook this study to compare the effectiveness of phenobarbital vs. UDCA in reducing the direct serum bilirubin levels in patients with cholestasis and weighing from 1 000 to 2 000 g. Methods. Using a cross-randomized clinical trial, 18 patients were included with 36 treatments. Each subject randomly received one of the two interventions: UDCA (10 mg/kg/day) every 12 h or phenobarbital (3 mg/kg/day, every 24 h for 7 days) continuing with 7 days of wash-out to return to their initial state, and to subsequently receive the other treatment. At the beginning and at the end of the administration of each medication, bilirubin concentrations and hepatic test functions were measured. Central tendency and dispersion measurements were applied according to the type of variable. For hypothesis confirmation, paired t-test was carried out. Results. The obtained results indicate that with UDCA at a dose of 10 mg/kg/day every 12 h for 7 days, serum bilirubin levels decreased to 2.7 mg/dL (p <0.01). Phenobarbital had no effect in reducing bilirubin concentration. Conclusion. Use of UDCA is recommended at a dose of 10 mg/kg/dose every 12 h (PO) as a coadjuvant in the treatment of neonatal cholestasis.

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BACKGROUND: Infants from neonatal intensive care units (NICU) are at high risk for sensorineural hearing loss (SNHL); however, risk factors may change from NICU to NICU and from country to country. Our objective was to describe the main causes associated with SNHL in infants from a tertiary level NICU in Mexico City and to show the associated audiometric profiles. METHODS: We performed a comparison of follow-up of infants from NICU with SNHL and a control group with the same history but with normal hearing. Infants were examined at birth by brainstem auditory evoked potentials (BAEP) and followed by audiometric tests. Hearing loss was associated with clinical variables. RESULTS: SNHL group had 146 children and the control group had 272 children. Mean weight at birth in the SNHL group was 1530+/-581 g and in the control group, 1723+/-805 g (p<0.01). Days spent at the NICU and under mechanical ventilation were higher in the SNHL group (p<0.001). In addition, serum bilirubin levels were higher in the SNHL group than in the control group (p<0.001). Blood exchange, intraventricular hemorrhage, and neonatal meningitis comprised the main SNHL-associated variables. Use of prenatal steroids and pulmonary surfactant demonstrates protection against SNHL. Audiometric profiles disclosed mainly severe SNHL. CONCLUSIONS: Low birth weight, longer stay in NICU and under mechanical ventilation, higher serum bilirubin levels, prevalence of blood exchange, intraventricular hemorrhage, and meningitis in high-risk newborns were the main risk factors associated with SNHL and merit hearing screening and early intervention in high-risk infants.

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BACKGROUND: Extremely low birth weight (ELBW) has been associated with poor cognitive development in children. We performed this research to establish the association between ELBW and the influence of biological and socioeconomic factors in the intelligence quotient (IQ) score in school-age children. METHODS: This study comprised 184 children with mean and standard deviation of 6.9 +/- 0.8 years of age. The children were divided into four groups based on their birth weight as follows: group A (n = 25), < or =1000 g; group B (n = 52), 1001-1500 g; group C (n = 66), 1501-2500 g; and group D (n = 41), > or =2501 g. The Stanford-Binet after the Terman-Merril Intelligence Scale was used to determine IQ scores. RESULTS: Mean and standard deviation (SD) of IQ values were 95.3 +/- 11.3 for group A, 103.1 +/- 14.4 for group B, 105.1 +/- 12.3 for group C, and 106.8 +/- 11.7 for group D (p = 0.003). Frequencies of children with scores below normal distribution were the following: 28% in group A; 10% in group B; 15% in group C, and 5% in group D (chi(2) = 0.04). Bronchopulmonary dysplasia and parental education were associated with lower IQ scores (p <0.05). CONCLUSIONS: IQ scores of children born with ELBW were significantly lower when compared to children born with a higher birth weight. Additional studies are important to determine whether these neurodevelopmental delays persist into adulthood, and whether there are additional factors associated with catch-up and recovery.

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Antecedentes: Los esteroides prenatales han sido utilizados para reducir la frecuencia de complicaciones respiratorias neonatales. Anualmente se informan 13 millones de nacimientos prematuros en el mundo, el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes informa el 19.7%. Objetivo: El objetivo del presente trabajo fue conocer el riesgo de utilizar uno o más esquemas de esteroides antenatales en amenaza de parto prematuro. Material y Métodos: Se trata de un estudio retrospectivo en un hospital de tercer nivel, del primero de enero del 2002 al 31 de diciembre del 2003, se incluyeron neonatos prematuros entre la semana 26 a 32 de gestación, cuyas madres recibieron uno o más esquemas de esteroides antenatales, dos dosis de 12 mg de betametasona intramuscular con intervalo de 24 horas o cuatro dosis de 6 mg de dexametasona intramuscular. Resultados: Se revisaron 108 expedientes que cumplieron con los criterios de inclusión, se dividieron en dos: grupo I, 69 neonatos con un solo esquema y grupo II con 39, con dos o más esquemas. La edad gestacional fue significativamente menor para el grupo I con 28 semanas (p = 0.001). La ruptura prematura de membranas de más de 24 horas tuvo mayor frecuencia en el grupo I: 65% de los neonatos de este grupo necesitaron intubación endotraqueal durante la reanimación al nacimiento, contra el 59% del grupo II. Aumentó el riesgo para septicemia en el grupo I. La principal causa de muerte en ambos grupos fue el choque séptico. El riesgo de muerte fue mayor para el grupo I, OR 3.57; IC 95%: 1.2 - 11.36. Conclusión: No se pudo demostrar que la utilización de más de un esquema de maduración pulmonar sea perjudicial para el neonato.

Introduction: Prenatal steroids have been used to reduce the frequency of neonatal respiratory complications. 13 million of preterm births are reported annually. Nineteen point seven percent of the births at The National Institute of Perinatology in Mexico City are preterm. We want to know the risks of antenatal corticosteroid therapy in pregnant women with preterm labor. Material and Methods: We conducted a retrospective study in a third level hospital between January first 2002 and December 31 2003. Neonates with gestational ages between 26 and 32 weeks whose mothers received one or more antenatal corticosteroids therapy schemes (2 doses of 12 mg of intramuscular betametasone with 24 hour interval or 4 doses or 6 mg of intramuscular dexamethasone) were included. Results: One hundred and eight clinical records were reviewed and divided into two different groups: Group I (n = 69) who received one antenatal steroid scheme and Group II (n = 39) with 2 or more antenatal steroids therapy schemes. Men gestational age was significantly lower, 28 weeks, in group I (p = 0.001). Premature rupture of membranes of 24 hour of duration or more was more frequent in group I and 65% of the neonates in this group required endotracheal intubation during neonatal reanimation and 59% of the neonates in group II. Required this maneuver. There was an increased risk of septicemia and death in group I. The principal cause of death in both groups was septic shock. The risk of death was higher in group I; OR 3.57 IC 95% 1.2,11.36. Conclusion: According to this results we were no able te demonstrate that more than one maturation treatment schedule were benefitial in any way to the neonates.