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Epidemiological studies performed by the IRIS study group in the last two respiratory syncytial virus (RSV) seasons found that the hospitalization rates for RSV in premature infants born before or in week 32 of gestation were 13.4 % and 13.1 %, respectively. Of these, 18 % and 25 % of the infants were admitted to the intensive care unit. Currently available information demonstrates the efficacy of RSV monoclonal antibodies (palivizumab) and the absence of major adverse effects. To date, there are no data that indicate the need to modify the guidelines for RSV prophylaxis in premature infants published in 2000.

Premature babies < = 35 weeks gestation, with or without chronic lung disease (CLD), should be considered high risk population for RSV infection and rehospitalization. RSV monoclonal antibodies (palivizumab) have been found useful in decreasing rates of RSV hospitalization in this patients. Guidelines for their administration include: 1. Recommend their use in premature born between 29-32 weeks gestation without CLD and less than 6 months at entry of RSV station. 2. Strongly recommend their use in premature babies < = 28 weeks gestation or affected with CLD in treatment during last 6 months. These patients should be prophylaxed for two RSV seasons. 3. Prophylaxis among premature babies between 32-35 weeks gestation is not recommended on routine bases. Each case has to be individually analyzed considering risk factors.

Objective: The care of very sick babies requires the use of invasive catheters in the neonatal intensive care unit. Our objective was to review the invasive catheters placed (umbilical and epicutaneous) between 1994 and 1998 and describe the guidelines used to take care of the intravenous lines., Patients and Methods: Two periods were compared (January 1994 until June 1997 and July 1997 until September 1998) and characteristics of the patient and catheter were analyzed. During the first period, sepsis related to the catheter was diagnosed according to clinical and analytical criteria and required a positive blood culture. The same criteria were required in the second period, but coincidence of the organisms in the peripheral and catheter blood culture was also needed., Results: A total of 1,285 central catheters were studied in 958 newborn admissions. Umbilical catheter were used in 6% of the cases and epicutaneous in 23%, most of which were in the upper extremities. The most frequent reason to remove the catheter was the end of the indication. The incidence of catheter related sepsis in the first period was 1% and during the second period 6%. Strict diagnostic criteria used in the second period were more predictive for sepsis. If premature babies were considered alone, the incidence increased to 14%. The most frequent organism isolated was Staphylococcus epidermidis., Conclusions: To decrease the incidence of sepsis related to catheters, a strict protocol for placement and maintenance must be followed.

Objective: Our objective was to analyze the utility of treatment with erythropoietin (EPO) plus iron in decreasing the need of late transfusions and reaching hematocrit > or = 32% in preterm infants of < or = 32 weeks of gestation., Patients and Methods: Between March 1996 and October 1998, preterm infants of one unit were considered as the control group, while another group in another unit in the same hospital were treated with EPO (250 U/Kg, 3 times a week, subcutaneously) from day 7 of life until 37 weeks 37 post-conception. Oral iron was added to treatment one week later (5 mg/Kg, and increased in order to keep ferritin levels > 100 ng/ml). More strict transfusion criteria were established. Weights were stratified in < 1,000 g, 1,000-1,249 g and > or = 1,250 g., Results: Blood losses during the first 2 weeks were higher in the control group and that was probably the reason for the increased number of transfusions during the first 10 days of life. Late transfusions decreased in the EPO treated group (p < 0.0003). This was significant after the 3rd week and in the 1,000-1,249 g weight group. The EPO-treated group showed lower hematocrit < or = 32% (p < 0.001). When EPO-treated infants were separately analyzed it was clear that late transfusions were more frequent in infants that were smaller, more immature and sicker and with higher blood losses. The reticulocyte count increase was similar in both groups of late transfused vs. Not transfused EPO-treated infants, being higher at 4 weeks after EPO was started (30/1000). EPO and ferritin values were always higher in late transfused EPO-treated infants than in non-transfused infants., Conclusions: The EPO plus iron treated group of preterm infants had a 40% decrease in the need for late transfusions in comparison with the control group. The best results were obtained in the 1000-1249 g group of preterm infants.

Objective: Nowadays economical criteria lead to early maternal hospital discharge, even before 48 hours after labor, producing an increase in neonatal readmissions for hyperbilirubinemia. We tried to predict the healthy term newborns that may develop a significant hyperbilirubinemia (> or = 17 mg/dl in the first 4 days of life)., Methods: Bilirubin in umbilical cord blood, transcutaneous measurements of bilirubin at 24, 48 and between 60 and 96 hours of life and bilirubin in blood obtained from heel-sticks at 96 hours was analyzed in 610 newborns. Moreover, serum bilirubin was determined at the same time-points in 169 newborns submitted to blood extractions for different reasons. The transcutaneous bilirubinometer used was a Minolta/Air-Shields JM-102., Results: A significant hyperbilirubinemia was present in 2.95% of the newborns. The correlation between serum and transcutaneous bilirubin was high (r = 0.92; p < 0.0001). Umbilical cord blood bilirubin with a cut-off point of 2.2 mg/dl was not an useful predictor of neonatal jaundice. At 24 and 48 hours of life serum bilirubin levels > or = 6 mg/dl and > or = 9 mg/dl, respectively, predicted a subsequent hyperbilirubinemia with a sensitivity of 100% at both time-points, specificity of 47.5% and 64.3%, positive predictive value of 7.3% and 16.4%, respectively, and a negative predictive value of 100% for both. Transcutaneous measurement at 48 hours with a cut-off point of 13 (equivalent to a bilirubinemia of 9 mg/dl) predicts hyperbilirubinemia with a sensitivity of 94.4%, specificity of 51.7%, positive predictive value of 6.0% and negative predictive value of 99.6%., Conclusions: If the newborn presents a bilirubinemia > or = 6 mg/dl at 24 hours and > or = 9 mg/dl or a transcutaneous measurement > or = 13 at 48 hours a new bilirubin measurement must be performed between 48 and 72 hours of life.

Objectives: The objectives of this study were to determine the characteristics of early onset neonatal sepsis (EONS) due to group B streptococci (GBS) in our population and to evaluate the efficacy of a prevention program in our hospital during a 4 year period., Material and Methods: We revised all cases of EONS due to GBS between 1985 and 1994 and studied pregnant women colonized by GBS and their infants between 1991 and 1994., Results: In ten years, we diagnosed 45 cases of EONS due to GBS, 30 born in our hospital and 15 born in other hospitals. Sixty-two percent of the patients presented some risk factor (gestation < 37 weeks, rupture of membranes > 18 hours or intrapartum fever > or = 37.8 degrees C. Between 1991 and 1994, 93% of pregnant women colonized by GBS received antibiotic prophylaxis, 14.7% of these women had some risk factor for infection. Two infants from mothers colonized had EONS due to GBS. One mother did not receive antibiotic prophylaxis and the other presented intrapartum fever. In another 5 cases observed during this period, the vaginal culture of the mother was negative for GBS. The incidence of EONS due to GBS during these 4 years was 0.82 cases per 1,000 live births., Conclusion: We consider it necessary to use antibiotic prophylaxis in all pregnant carriers of GBS, as well as the administration of antibiotics to pregnant women with a rupture of membranes < 34 weeks of gestation and the practice of an intrapartum culture for the detection of GBS in pregnant women without previous cultures and premature rupture of the membranes.

Objective: The objective of this study was to identify risk and outcome factors in necrotizing enterocolitis (NEC)., Patients and Methods: We have studied 72 cases of NEC collected from 1987 until 1994 in the three hospitals of the integrated Unit. A case-control study matched for gestational age and center was performed for 26 risk factors. Conditional logistic regression was used in significant bivariate variables. The 18 outcome factors had the same statical treatment, but without the paired design., Results: Serous infections previous to NEC, apnea and feeding increments greater than 20 cc/kg/day have been identified as risk factors for preterm babies (p < 0.05). Severe acidosis and pneumoperitoneum have been found significant outcome variables, but with very low discriminatory capacity., Conclusions: It has been found difficult to identify risk factors for NEC besides the gestational age. Outcome factors have very low sensitivity. Preventive treatment should be directed to decrease the effect of the inflammatory mediators in the gastrointestinal tract.

Three cases of serious infections due to Candida parapsilosis in infants are reported. Two patients are children exposed to abdominal surgery, parenteral nutrition and antibiotic treatment, who developed catheter-associated sepsis with successful response to change of catheter and intravenous amphotericin B, despite one of the patients showed a relapse some weeks after. Third patient, a hydrocephalic child with external ventricular shunt, developed cerebrospinal fluid infection without response to antifungal treatment and died. Sepsis and meningitis due to Candida parapsilosis can be observed in infants with some risk factors, as use of intravascular or intraventricular catheters. Change of the catheter and treatment with amphotericin B are indicated in these infections.

Among 1,049 admissions in the newborn department, during 18 months, authors found 148 positive blood cultures to staphylococci epidermidis (EPN). Recovery of EPN from blood should not be dismissed as a contaminant. 11 newborn were considered to have septicemia by EPN, that means 1.04% of all admissions and 5.6% of babies admitted in intensive care. They find that catheters (100%), assisted ventilation (45.4%) and previous surgery (36.3%) are significant predisposing risk factors. Clinical and laboratory pattern was not different of other sepsis except its late onset. Two patient died. Vancomycin is considered the drug of choice.

We have performed 113 percutaneous catheterization in 87 newborn babies, locating them centrally in 60 cases (53%). In 69 (61%) cases the duration of catheter was as long as desired. Average duration was 14.65 days. No important complications were detected. We think that this in a useful technique that allows a long term circulatory access, even central venous lines. Aseptic procedure is mandatory as well as X-ray control of the distal tip of the catheter.