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Biomedical subjects

C R Pallás Alonso

Publications and source records attributed to C R Pallás Alonso.

16 recordsLinked to original sources
PubMed2006

[Developmental centered care. Evaluation of Spanish neonatal units].

INTRODUCTION: Developmental and family centered care (DC) is a framework that aims to enhance the neurodevelopment of the infant. Over the last few years Spanish neonatal units have been working toward introducing this type of care. OBJECTIVE: To evaluate DC in Spanish neonatal units by assessing certain features of the care provided to very low birth weight infants and their families. MATERIAL AND METHOD: Spanish hospitals attending infants under 1,500 g were identified. A cross sectional study was performed using a telephone questionnaire with 25 DC-related items. RESULTS: Of the 100 hospitals attending infants under 1,500 g, 83 hospitals from all the Autonomous Communities in Spain participated in the survey. Of these, 31 % had noise pollution controls, 72 % controlled light intensity, 75 % bound the infants, and 29 % used saccharose as an analgesic. Ten percent allowed unrestricted parental visits. Twenty-two percent used kangaroo care without restriction. Sixty-three percent of the units reported difficulties when introducing DC-related changes. CONCLUSIONS: Practically all neonatal units have some type of DC activity, although in certain areas, such as unrestricted parental visits, the rate of implementation is low.

Cross-Sectional Studies↗
PubMed2006

[Assessment of the new Ballard score to estimate gestational age].

BACKGROUND AND OBJECTIVES: The New Ballard Score (NBS) is commonly used to estimate gestational age (GA) in the newborn. The aims of this study were: a) to determine the reliability of the NBS; b) to estimate the agreement between two methods of GA assessment, NBS and ultrasonography (US) or last menstrual period (LMP); c) to estimate the agreement between NBS and US/LMP in distinct subgroups of neonates. PATIENTS AND METHODS: We performed a prospective, blind study. NBS was performed in neonates born in Hospital 12 Octubre, Madrid before the age of 48 hours. The level of agreement was estimated with two analytical parameters: the intraclass correlation coefficient (ICC) and the mean differences method (MD). RESULTS: Inter-observer agreement was very good (ICC > 0.8). Agreement between US/LMP and NBS was good (ICC = 0.6-0.8). In infants with lower weight or GA, and in those whose mothers had received prenatal corticosteroid therapy, NBS tended to overestimate GA compared with US/LMP (MD = 1.2-2.9). CONCLUSIONS: The agreement between two observers in NBS assessment was very good. The agreement between NBS and US/LMP was good, but differences of more than 2 weeks in GA were frequent. In very preterm newborns and in infants whose mothers had received prenatal corticosteroid therapy, NBS tends to overestimate GA.

Anthropometry↗
PubMed2006

[The use of the continuous positive airway pressure for early stabilization in very low birthweight infants].

BACKGROUND: The introduction of continuous positive airway pressure (CPAP) in neonatal units provides a new strategy in the management of infants weighing less than 1500 g, and especially in those weighing less than 1000 g, allowing a reduction in the use of surfactant without negatively affecting prognosis. OBJECTIVES: To compare the rate of surfactant use in very low birthweight (VLBW) infants before and after the introduction of CPAP for early stabilization. To compare the frequency of pneumothorax, bronchopulmonary dysplasia (BPD), mortality, severe brain injury, length of hospital stay, and days of intubation in both groups of VLBW infants. METHODS: We performed a before-after study comparing VLBW infants born in a tertiary care hospital in two periods: group 1 consisted of 78 VLBW infants born in 2001 and group 2 consisted of 80 VLBW infants born from June 2003 to February 2004. Group 1 received conventional management (intubation and administration of surfactant in the delivery room). In group 2, CPAP was introduced for early stabilization. RESULTS: The mean weight was 1059+/-309 g in group 1 and 1127+/-295 g in group 2 (p = 0.15). The mean gestational age was 29 +/- 3.3 weeks in group 1 and 29 +/- 2.8 weeks in group 2 (p = 1). Fifty-four percent of the neonates in group 1 were intubated in the delivery room versus 31 % of those in group 2 (p = 0.004). Surfactant was used in 68 % of neonates in group 1 versus 49 % of those in group 2 (RR = 1.34 [1.06-1.83]). The mean number of days of intubation was 4 +/- 11 in group 1 versus 2.7 6 5.8 in group 2 (p 5 0.15). Bronchopulmonary dysplasia at a corrected age of 36 weeks occurred in 19 % of neonates in group 1 and in 14.5 % of those in group 2 (RR = 1.34 [0.63-2.84]). The mean number of days on oxygen was 34 6 47 and 21 6 25 respectively (p = 0.04). Necrotizing enterocolitis occurred in 3.8 % of neonates in group 1 and in 8.7 % of those in group 2 (RR= 0.43 [0.11-1.63]). The mortality rate and frequency of pneumothorax were similar in both groups. In the subgroup of VLWB infants with a gestation age of < 28 weeks, no differences were found between the two periods. CONCLUSIONS: The use of CPAP for early stabilization of VLBW infants is not associated with an increase in neonatal morbidity. This therapy allows the use of surfactant to be decreased, and even allows the number of days on oxygen to be reduced, without adverse effects. However, data on long-term follow-up are not yet available.

Continuous Positive Airway Pressure↗
PubMed2004

[Characteristics of immigrant women and their neonates].

BACKGROUND: Immigrant status is frequently assumed to constitute a health risk because migration is inevitably associated with a period of significant adjustment and stress. OBJECTIVE: To compare the social characteristics and perinatal outcomes of mothers who deliver in a third level hospital in Spain according to their socioeconomic level of the country of origin. METHODS: From December 2000 to March 2001, women who delivered were selected according to the socioeconomic status of their birth country. All women from low and middle income countries (immigrant mothers) and a sample (1:2) of those from high income countries (mainly Spanish-born mothers) completed a questionnaire on antenatal care, demographic and social characteristics, and country of birth and were followed-up to monitor neonatal clinical features. RESULTS: During the three months of the study, 203/1352 (15 %, CI 13.2-17.1) of the delivering mothers were immigrants. Most were from Central and South America (56 %, CI 49-62). Prenatal care was appropriate in most of the women (in 92.1 % of immigrant mothers and in 96.8 % of Spanish mothers, p 5 0.01). The proportions of premature births, low birth weight and very-low birth weight showed no statistically significant differences between immigrant and Spanish mothers (15 vs. 10.6, 6.4 vs. 9.4, and 2.1 vs. 1.5, respectively, p > 0.05 in all comparisons). Perinatal complications, including an Apgar score < or = 6, and the need for admission to the neonatal unit or to the intensive or intermediate care units, were not more frequent in the newborns of immigrant mothers. Immigrant women had less social or family support after delivery and maternity leave was much less frequent (62 % vs. 90 %, p < 0.001). CONCLUSIONS: Most of the immigrant women had healthy pregnancies and healthy birth outcomes. Perinatal complications do not seem to be more frequent among immigrant women. Differences were found in social support. To improve the health of these children, social support to immigrant women and their children should be intensified.

Adult↗
PubMed2002

[Loss to follow-up and cerebral palsy].

BACKGROUND: The longer follow-up programs last, the greater the loss to follow-up. These losses to follow-up may undermine the completion of health care goals and the validity of study results. OBJECTIVES: 1) To compare neonatal characteristics in children easily followed-up and in those lost to follow-up. 2) To trace and assess children lost to follow-up. 3) To estimate the occurrence of cerebral palsy in children easily followed-up and in those lost to follow-up. METHODS: From 1991 to 1997, 601 neonates with a birth weight under 1,500 g were admitted to the Neonatology Department. At discharge, 447 infants were included in the follow-up program. Moderate-to-severe cerebral palsy was assessed when the children were aged 2 years. A specific search strategy was implemented to find those children lost to follow-up. Data on the development of those traced were updated through a standardized telephone questionnaire. RESULTS: Twenty percent of the children were lost to follow-up before the age of 2 years. Fifty-seven percent of those not available at this age were assessed by telephone interview. No differences were found in the neonatal characteristics of infants easily followed-up and those lost to follow-up except in situations of critical social disadvantage: 10 % in followed-up infants, 41 % in infants lost to follow-up. Disabling cerebral palsy was observed in 7 % of children easily followed-up and in 23 % of those lost and traced (relative risk: 3.1, 1.5-5.5). CONCLUSIONS: The risk of having disabling cerebral palsy is three times higher in children lost to follow-up than in those easily followed-up. Dismissing this source of bias may underestimate disability rates when assessing health care programs or when interpreting study results.

Cerebral Palsy↗
PubMed2000

[Age for sitting and walking in children born weighing less than 1,500 g and normal motor development at two years of age].

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

Age Factors↗
PubMed2000

[Cerebral palsy and age of sitting and walking in children weighing less than 1,500 g at birth].

OBJECTIVE: To describe the corrected age (CA) of acquisition for sitting and walking in very low birth weight infants with cerebral palsy and to estimate the probability of walking as a function of age of acquisition of sitting and type of cerebral palsy. METHODS: Follow up study of very low birth weight infants (under 1500 g) admitted to the Neonatology Department of the Hospital 12 de Octubre in Spain between January 1991 and December 1996. At a corrected age of 2 years, 11.5% (34 children) were diagnosed with cerebral palsy. Ages of attainment of sitting and walking were established by interview with the parents and were confirmed by examination. Age of attainment of sitting and type of cerebral palsy were investigated as possible predictors of ambulatory status. RESULTS: Sitting was attained by 73% of the children. The probability of attainment of sitting at 9 months was 21% and at 18 months it was 68%. Only one child achieved sitting after 18 months. Fifty-three percent of the children became ambulatory. The probability of becoming ambulatory was 24% at 18 months and 47% at 30 months. If sitting was attained before 12 months of age the probability of becoming ambulatory was 47% at 18 months and 76% at 30 months. All children with spastic hemiplegia, 66% of those with diplegia and only 8% of those with quadriplegia became ambulatory. CONCLUSIONS: Sitting by the age of 12 months was directly related to achieving ambulation. Irrespective of the type of cerebral palsy, all children with hemiplegia and more than 60% of those with diplegia ambulated while children with quadriplegia were much less likely to ambulate.

Age Factors↗
PubMed2000

[Survival at discharge of newborn infants weighing less than 1000 g (1991-1997). When are they too small?].

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

Cohort Studies↗
PubMed1998

[Outcome at 3 years of age in a low birth weight cohort].

OBJECTIVE: The objective of this study was to establish the outcome at 3 years of age for very low birth weight newborns admitted to the Hospital 12 de Octubre from January 1991 to December 1993. PATIENTS AND METHODS: A follow-up study was performed. The pediatric assessment included a neurological, psychological, visual and audiological evaluation. At the end of the follow-up, children were blindly assessed to determine the rate of neurosensory disability. The severity of the neurosensory disability was graded as severe, moderate or mild by a functional classification. The rates of cerebral palsy, blindness and deafness were reported. RESULTS: Two hundred fifty-three infants between 500 and 1,499 g were admitted to the Hospital 12 de Octubre of which 182 survived. Of these, 137 (75% of the survivors) were assessed at 3 years of age. The children who dropped out during the follow-up period had similar characteristics to those with a complete follow-up program except that the drop-out child was more likely to belong to a disadvantaged family. The rate of neurosensory disability was 28.5% (39/137), 16% were mild, 5% moderate and 7% severe. The rate of cerebral palsy was 13% (18/137), blindness 1.4% and deafness 0.7%. CONCLUSIONS: Children from more disadvantaged families are less likely to continue in follow-up programs and this supposes a bias in the follow-up program. At 3 years, neurosensory disability was diagnosed in 1 out of every 4 children and cerebral palsy in 1 out of 8 children.

Child, Preschool↗
PubMed1998

[Changes in weight, length and head circumference in premature newborn babies weighing less than 1,500 grams at birth].

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

Anthropometry↗
PubMed1997

[Neonatal meningitis: study of 56 cases].

OBJECTIVE: The objective of this study was to know the most common organisms causing neonatal meningitis in a defined region of southern Madrid, the developmental outcome of these babies and the risk factors associated with the prognosis. PATIENTS AND METHODS: This was an observational study of 56 cases of meningitis diagnosed in our Neonatal Service between 1988 and 1994. In order to study the handicaps of these babies, only those who were born before May 1993 were considered so that they had a corrected age of at least 2 years when the neurological evaluations were done. RESULTS: The most common causative organisms were group B Streptococcus (27%), E. coli (11%) and enteroviruses (9%). In the premature infants the leading organisms were E. coli and Candida albicans. The age at diagnosis was 8 +/- 6 days in the group of preterm infants (p = 0.002). The mortality was associated with the prematurity (risk ratio: 17.8), the isolation of a gram-negative organism in the cerebral fluid (RR: 3.3) and the presence of abnormal findings in cerebral ultrasound studies (RR: 12.7). Sequelae were associated with the presence of abnormal findings in cerebral ultrasound studies (RR: 24.7) or in the neurologic examination (R: 7) and with the presence of previous cerebral lesions (RR: 5.7). CONCLUSIONS: Neonatal ultrasound examination, as well as the gestational age, the causative organisms, the presence of a previous cerebral lesion and the neurological examination, seem to be very important in predicting the prognosis of these babies.

Female↗
PubMed1997

[Periventricular leukomalacia and persistent hyperechogenicity: relationship between ultrasound findings and sequelae].

OBJECTIVES: The objective of this study was to know the incidence of periventricular leukomalacia and persistent periventricular echodensities in neonates with a birth weight < 1,500 g and to correlate cranial ultrasound findings with the developmental outcome of these babies at 18 months of corrected age. PATIENTS AND METHODS: We performed a cohort study of 319 newborns weighing 1500 g or less who were admitted to the Neonatal Intensive Care Unit of "12 de Octubre" Hospital between July 1990 and April 1994. Scans were performed while they were hospitalized and 183 surviving infants were followed up to 18 months of corrected age. Relative risks (rr) and 95% confidence intervals (95% CI) were calculated for sequelae according to neonatal cranial ultrasound abnormalities. Ninety-six infants with normal scans were considered as the control group. Persistent periventricular echodensities were classified as mild, moderate or severe. RESULTS: The incidence of periventricular leukomalacia was 3% (10/319) and of persistent periventricular echodensites was 11.2% (36/319). The percentage of sequelae was 5% for control infants, 15.6% (rr = 3, CI 95% = 0.94-8.8) for persistent periventricular echodensities, independent of its severity, 50% (rr = 9.7, CI 95% = 2.6-35) for moderate persistent periventricular echodensities and 78% (rr = 15.6, CI 95% = 6-38) for periventricular leukomalacia. CONCLUSIONS: Periventricular leukomalacia multiplies the number of sequelae by 15. Persistent periventricular echodensities, independent of its severity, does not multiply the number of sequelae significantly. However, moderate persistent periventricular echodensities multiply the number of sequelae by 9.

Echoencephalography↗