M. Iriondo

Impact of histological chorioamnionitis, funisitis and clinical chorioamnionitis on neurodevelopmental outcome of preterm infants

BACKGROUND The role of chorioamnionitis in neurodevelopment of preterm infants is not fully understood. AIM To examine the association between different indicators of intrauterine inflammation (clinical chorioamnionitis, histological chorioamnionitis and funisitis) and neurodevelopmental impairment in very preterm infants. METHODS Preterm infants with a birth weight of <1500 g or a gestational age of <32 weeks were included. Follow-up evaluation up to 2 years of age consisted of neurological examination, neurodevelopmental assessment and visual and audiologic tests. Outcome data were compared between the chorioamnionitis and the control groups, controlling for gestational age, birth weight and Apgar score at 5 min. RESULTS One hundred seventy-seven patients comprised the study population (mean gestational age 29±2 weeks, mean birth weight 1167±344 g). Histological chorioamnionitis was present in 49% of placentas, whereas funisitis was observed in 25%. In 57% cases clinical maternal chorioamnionitis was suspected. Follow-up was available for 130 (82%) patients. Infants with funisitis, compared with controls, had a significantly higher incidence of moderate to severe disability (18% vs 5%, OR 4.07; 95% CI 1.10-15.09). CONCLUSION The results of this study suggest that, unlike a broad definition of histological chorioamnionitis including inflammation of maternal or fetal placental tissues, funisitis may entail a higher risk of moderate to severe disability at 2 years of age in preterm infants.

Encuesta española de reanimación neonatal 5 años después. ¿Vamos mejorando?

INTRODUCTION An analysis is presented of delivery room (DR) neonatal resuscitation practices in Spanish hospitals. METHODS A questionnaire was sent by e-mail to all hospitals attending deliveries in Spain. RESULTS A total of 180 questionnaires were sent, of which 155 were fully completed (86%). Less than half (71, 46%) were level i or ii hospitals, while 84 were level iii hospital (54%). In almost three-quarters (74.2%) of the centres, parents and medical staff were involved in the decision on whether to start resuscitation or withdraw it. A qualified resuscitation team (at least two members) was available in 80% of the participant centres (63.9% level i-ii, and 94.0% level iii, P<.001). Neonatal resuscitation courses were held in 90.3% of the centres. The availability of gas blenders, pulse oximeters, manual ventilators, and plastic wraps was higher in level iii hospitals. Plastic wraps for pre-term hypothermia prevention were used in 63.9% of the centres (40.8% level i-iiand 83.3% level iii, P<.001). Term newborn resuscitation was started on room air in 89.7% of the centres. A manual ventilator (T-piece) was the device used in most cases when ventilation was required (42.3% level i-iiand 78.6% level iii, P<.001). Early CPAP in preterm infants was applied in 91.7% of the tertiary hospitals. In last 5 years some practices have improved, such neonatal resuscitation training, pulse oximeter use, or early CPAP support. CONCLUSIONS There is an improvement in some practices of neonatal resuscitation. Significant differences have been found as regards the equipment or practices in the DR, when comparing hospitals of different levels of care.

Abandonos en el seguimiento de recién nacidos de muy bajo peso antes de los 2 años

INTRODUCTION The increase in survival rates of very low weight newborns (VLWN) and their neurodevelopmental morbidity has led to the implementation of follow-up programmes. The withdrawal from follow up limits the achievement of care goals and the validity of studies in this field. GOALS To assess the neurodevelopmental status, morbidity, social and economical data in the VLWN seen in our Neonatal Care Unit between 2002 and 2005 and lost in the follow up programme before the age of two, and compare these findings with the group who completed follow up. PATIENTS A total of 318 VLWN were included, of 53 had died. At the age of two, 215 had completed the monitoring visits (group S) and 50 had quit (group A). METHODS Using the SEN 1500 data base, and telephone interview of those parents who quit the programme. RESULTS A total of 30 cases were interviewed (Group R). Six patients had been admitted to hospital due to respiratory illness; 26.7% had neurodevelopmental impairment (1 case, severe; 1 case, moderate; 6 cases, mild) compared to 14% in group S (P<.05). In group R, compared with group S, included more immigrants (40 vs. 14%), parental education level was lower and distance between home and hospital was greater (P<.05). In group R, 57% of families had a low socioeconomic standard. CONCLUSIONS The telephone interview allowed the clinical status of 60% of VLWN lost to follow up to be determined. Sequelae rate, mainly mild, was higher in the lost-to- follow-up group. Some unfavourable social, economical and cultural factors could have influenced the interruption. It is advisable to develop strategies to prevent loss in the follow up.

Rethinking Classification of Prematurity: A New Clinical Algorithm That Improves Etiologic Assignment of Preterm Births

Background: There is a need for a better etiologic classification of preterm births and for tools to help to determine the possible etiologies of these births. Objective: Having previously developed the Barcelona Etiology of Prematurity (BEP) algorithm, based on a new classification for preterm births, we sought to validate this algorithm in clinical studies whereby doctors retrospectively assigned the etiology of preterm birth according to principal cause and associated causes. Method: In phase 1 of the study, 91 preterm neonates consecutively admitted to a tertiary hospital were etiologically classified by doctors using the BEP algorithm. In phase 2, another 29 cases, representing the full spectrum of standard clinical scenarios, were classified by 20 doctors randomly divided into two groups of 10: one group used the algorithm and the other did not. Results: In phase 1, the doctors were able to assign the etiology of all 91 clinical cases using the BEP algorithm, showing a 95.6% level of agreement with the etiologies set by the authors. In phase 2, for the 572 total evaluations, the group that used the BEP algorithm had significantly fewer errors in assigning the principal cause of prematurity than the group that did not use the algorithm (4.51 vs. 16.20%, respectively; p < 0.0001), and also demonstrated a higher level of correlation in assigning the associated causes. Conclusions: The proposed classification may be used to retrospectively categorize the etiology of preterm births, and the BEP algorithm facilitates this task enabling greater accuracy and precision in clinical data.