Very low birth weight infants typically sit unsupported and walk later than term infants. Tables describing reference values for milestones acquisition for different categories of infants (gestational age, birth weight and other determinants) may contribute to inform the decision making process on access to available resources.

Aim: To describe variations in practice between follow-up programmes for very preterm children born at less than 32 weeks' gestation or with very low birth weight of less than 1,500 g. Methods:A survey on follow-up practices was electronically distributed to level II and III units among hospitals of the Spanish National Health Service in 2016. The survey included 70 questions covering issues such as follow-up organisation and resources, routine assessments, relationships with other services and families, information management and training.Results: The response rate was 91.5% (141/154). Among respondents, 70.9% (100/ 141) reported that they do provide follow-up and 42% do so up to six years of age. Routine neurological and ophthalmological follow-up is not performed in 60% and 37% of hospitals, respectively, and a second hearing assessment is not given in 62%. Just 38% of units have psychologist. In 41% of hospitals, training in follow-up skills is not included in Paediatric Residency training programme.Conclusion: Although Spain has a nationwide health system that provides universal health coverage, we found that follow-up care for children born very preterm/very low birth weight is not equitable. Nearly half of paediatric residents receive no training in follow-up for this high-risk population.1042

Background. Random safety audits (RSAs) are a safety tool but have not been widely used in hospitals. Objectives. To determine the frequency of proper use of equipment safety mechanisms in relation to monitoring and mechanical ventilation by performing RSAs. The study also determined whether factors related to the patient, time period, or characteristics of the area of admission influenced how the device safety systems were used. Methods. A prospective observational study was conducted in a level III-C Neonatal Intensive Care Unit (NICU) during 2012. 87 days were randomly selected. Appropriate overall use was defined when all evaluated variables were correctly programmed in the audited device. Results. A total of 383 monitor and ventilator audits were performed. The Kappa coefficient of interobserver agreement was 0.93. The rate of appropriate overall use of the monitors and respiratory support equipment was 33.68%. Significant differences were found with improved usage during weekends, OR 1.85 (1.12–3.06, p = 0.01), and during the late shift (3 pm to 10 pm), OR 1.59 (1.03–2.4, p = 0.03). Conclusions. Equipment safety systems of monitors and ventilators are not properly used. To improve patient safety, we should identify which alarms are really needed and where the difficulties lie for the correct alarm programming.

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Aim Validated a model that used bronchopulmonary dysplasia (BPD), brain injuries measured using ultrasound and retinopathy of prematurity (ROP) to predict late death or disability in premature infants at seven years of age. Methods A retrospective study was performed at the 12 de Octubre Hospital neonatal unit in Madrid. A logistic model was applied to estimate the independent prognostic contribution of each morbidity, and the effect that the combination of morbidities had on the seven‐year outcomes. The analysis was performed on the total cohort from 1991 to 2008 and on two subcohorts from 1991 to 1998 and 1999 to 2008. Results A total of 1001 children were included with a mean birth weight of 922 ± 208 g. Severe ROP was strongly associated with poor neurodevelopment, with an odds ratio (OR) 3.17 and 95% confidence interval (CI) of 1.56–6.50, and so was BPD (OR 1.52, 95% CI: 1.03–2.2). The combination of two neonatal morbidities increased the risk of a poor outcome (OR 4.44, 95% CI: 1.51–7.86). The model behaved differently in the two subcohorts. Conclusion The prognostic model predicted a poor outcome at seven years of age when the subjects had at least two of the three morbidities.

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Background: From clinical point of view it is important to detect all seizure activity in neonates. The cerebral function monitor (CFM) processes the electro encephalogram (EEG) into an amplitudeintegrated EEG (aEEG) signal that is relatively easy to read and interpret compared to the classical EEG. So far seizures were defined based on the visual interpretation of a typical pattern.Objective: The objective of this study is to create a program for automatic detection of seizures in neonatal aEEG signals, based on a quantitative analysis. Seizures of a length of more than 60 seconds are included.Method: Since high cerebral activity corresponds with high amplitude in the aEEG signal, the program detects rises in amplitude of the lower margin, compared to the background signal. The lower margin is defined as a threshold value, where 95% of the aEEG samples are above this threshold. If this lower margin for a segment is significantly higher than the mean lower margin of the 6 minutes prior to the segment, and if this difference in height continues for at least 60 seconds, this pattern is marked as a seizure. Muscle artefacts are detected based on the frequency content of the EEG signal. Other artefacts are detected using the amplitudes of aEEG, EEG and impedance of the electrodes. Three signals were used to train the program.Results: Three CFM recordings of 9 hours from full-term newborns with different background patterns were used to evaluate the program. The signals were annotated by an expert in neonatal neurophysiology, who found in total 95 seizures. The program detected 101 patterns as seizures, with a sensitivity of 98% (93 true positives) and a positive predictive value of 92% (8 false positives).Conclusion: This study indicates that it is possible to automatically detect seizures of more than 60 seconds, using CFM recordings. Objective: Evaluation of DC in Spanish neonatal units through consideration of some aspects of the care provided to very low birth weight infants and their families. EVALUATION OF DEVELOPMENTAL CENTERED CARE IN SPANISH NEONATAL UNITSMethods: The study centers on Spanish hospitals caring for children under 1500g. In a telephone questionnaire, we performed a transversal study by asking 25 questions releated to DC.Results: Of the 100 hospitals taking care of children under 1500g, 83 of them, representative of all the regions, responded to the questionnaire. Of these, 31% had noise pollution controls, 72% controlled light intensity, 75% bound the infants and 29% used sacarose as an analgesic, 10% allowed unrestricted parental visits. In 22% Kangaroo care is openly used. 63% of the centers admitted difficulties with regards to introducing changes in the DC. There are not differences in the implementation of the DC between big and small hospitals.Conclusions: In practically all centers some type of DC activity occurs although in certain areas such as unrestricted parental visits, the rate of implementation is low. Clinical protocols based on available evidence and supported by wide staff co...