X Carbonell Estrany

Publications (30)28.24 Total impact

• Article: [Erythropoietin treatment for late anaemia after haemolytic disease of the newborn].

  E Alvarez Domínguez, J M Pérez Fernández, J Figueras Aloy, X Carbonell Estrany
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  ABSTRACT: After several years of erythropoietin (EPO) use in the prophylaxis of anaemia of prematurity, it also began to be administered to treat post-haemolytic disease anaemia of the newborn in order to avoid blood transfusions. To show the results obtained with EPO treatment in post-haemolytic disease anemia of the newborn. Observational study in 13 newborns with late anaemia due to an hemolytic disease caused by Rh isoimmunization (9 cases), AB0 isoimmunization (2 cases), glucose-6-P-dehydrogenase deficiency (1 case) or idiopathic (1 case). The newborns began EPO treatment when they reached the haematocrit level for a blood transfusion. EPO treatment was started at 26±7 days of life (15-46), with a haematocrit value of 21.7±3% (18-27) and a reticulocyte count of 3.8±2.2%. Blood transfusion was not necessary in 11 newborns (haematocrit of 30.7±4.4% and reticulocytes of 5.9±1.4%), and only 2 newborns were admitted for a blood transfusion (haematocrit 18±4.4% and reticulocytes 0.6%). Significant increases in haemoglobin and reticulocyte figures were seen after EPO treatment. EPO administration proved useful to avoid blood transfusion in 84% of treated newborns. No adverse events were detected which could be attributed to this treatment,.
  Anales de Pediatría 10/2010; 73(6):334-9. · 0.77 Impact Factor
• Article: [Recommendations for the use of palivizumab in the prevention of respiratory syncytial virus infection in late preterm infants (32(1) to 35(0) weeks of gestation)].

  J Figueras Aloy, X Carbonell Estrany
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  ABSTRACT: Late preterm infants (32(1) to 35(0) weeks gestation) aged less than 6 months at start of RSV station or discharged during this time may benefit from RSV monoclonal antibodies (palivizumab) administration to decrease the rates of RSV hospitalization. The Spanish Society of Neonatology considers, based on FLIP2 results in Spain, that palivizumab prophylaxis is strongly recommended if the "2 major risk factors" are present (chronological age less than 10 weeks at start of RSV season or being born during its first 10 weeks; sibling of school age or attending day-care assistance). Palivizumab is also recommended when "1 major risk factor and the 2 minor risk factors" are present. Minor risk factors are: mother smoking during pregnancy and being a male.
  Anales de Pediatría 08/2010; 73(2):98.e1-4. · 0.77 Impact Factor
• Source

  Available from: Ignacio Méndez

  Article: [Quality of life of preterm infants and admissions due to respiratory infections].

  I Méndez Rubio, P Lázaro de Mercado, X Carbonell Estrany, J Figueras Aloy
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  ABSTRACT: Study of the association between lower respiratory tract infection hospitalisations and health related quality of life (HRQoL) in preterm infants of 32-35 weeks of gestational age. Survey study nested into a prospective follow-up cohort study of preterm infants (FLIP-2). During the last FLIP-2 visit, 216 preterm-parent pairs were interviewed. The structured questionnaire included measures of HRQoL (QUALIN modified scale for the infant, and SF-12 for the parent, and Visual scales for both), caregiver overload (Zarit modified scale and indirect measurements). From October 2006 to March 2007 (RSV season), there were 71 respiratory hospitalisations (33%). Triplets and infants living in homes with >5 inhabitants were most likely to be hospitalised. Parents of hospitalised children were most likely, to have more and longer times off work for child care (47% vs. 18%), to have higher overload, and to obtain lower values in the physical dimension of SF-12. Multiple regression model associated infant HRQoL with higher gestational age, having 0-3 year-old siblings, being recommended palivizumab and had received it, lower caregiver overload, higher caregiver mental HRQoL and no absence from work for child care. Although respiratory hospitalisations were not associated with infant HRQoL, caregivers' HRQoL and overload were. Preterm infant HRQoL is associated with their caregivers' HRQoL and overload, and with receiving RSV prophylaxis when their risk profile recommends it.
  Anales de Pediatría 12/2009; 73(3):121-31. · 0.77 Impact Factor
• Article: Attempt to normalize simulated exhaled nitric oxide according to ventilatory settings.

  J Figueras-Aloy, R Berrueco, M D Salvia-Roiges, J M Rodríguez-Miguélez, X Miracle-Echegoyen, F Botet-Mussons, A Mur-Sierra, O Vall, X Carbonell-Estrany
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  ABSTRACT: Simulated exhaled nitric oxide (eNO) depends on ventilatory settings used in different experimental conditions. To normalize the simulated minute exhaled nitric oxide according to different ventilatory settings. Different ventilatory settings influence the concentrations of exhaled nitric oxide and these results can be normalized. METHODOLOGY AND STUDY DESIGN: We used a rubber lung model (50 ml) with an orifice through which a 3 mm endotracheal tube was introduced. The NO, which simulated that of endogenous production, was delivered through the base of the lung using a unidirectional rotameter and obtaining a concentration of around 25 ppb. The sample of gas was recorded through a 6 F arterial catheter introduced into the endotracheal tube to its tip. The ventilator used was a Babylog 8000. Air delivered was compressed and filtered and had an NO content of under 0.3 ppb. The NO level assessed was the plateau value given by the software of the Sievers NOA apparatus. Each experiment involved sampling during 1 min, three times. Normalization was done using a multiple cubic regression formula. An increase in respiratory frequency or in peak of inspiratory pressure were accompanied by a decrease in eNO (ppb). Minute volume was adjusted for the percentage of leakage given by the ventilator. Normalization was obtained analyzing 518 respirations with different ventilatory settings. The coefficient of variation fell from 15.5% to 0.27%. Validation of the normalization formula was performed in other three groups (320, 372, and 372 respirations) with different simulated NO concentrations (25, 16, and 50 ppb), resulting in reduction of the coefficient of variation from 42.7% to 9.3%, from 42.3% to 10.6% and from 45.2% to 9.6%, respectively. Normalization of simulated minute eNO according to ventilatory settings is possible using the equipment and experimental set-up reported. Extrapolation to patients is not possible without constraints.
  Pediatric Pulmonology 12/2008; 43(12):1167-74. · 2.53 Impact Factor
• Source

  Available from: umcutrecht.nl

  Article: Clinical relevance of prevention of respiratory syncytial virus lower respiratory tract infection in preterm infants born between 33 and 35 weeks gestational age.

  X Carbonell-Estrany, L Bont, G Doering, J-B Gouyon, M Lanari
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  ABSTRACT: Premature infants are vulnerable to severe respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) resulting in hospitalisation and the potential for longer-term respiratory morbidity. Whilst the severity and consequence of RSV LRTI are generally accepted and recognised in infants born <or=32 weeks gestational age (GA), there is less acknowledgment of the potential consequences in infants born 33-35 weeks GA. However, there is a growing body of evidence suggesting that infants born between 33 and 35 weeks GA may be equally at risk for RSV LRTI as infants born <32 weeks GA. Interrupted lung development and an immature immune system have been linked with an increased susceptibility for RSV LRTI, along with other environmental, social, and physiological risk factors. Currently, the only effective method of preventing RSV LRTI is prophylaxis with palivizumab. Often with limited healthcare resources, identifying infants at greatest risk of RSV LRTI who would potentially benefit most from prophylaxis is highly desirable, particularly in the 33-35-week GA group. The purpose of this article is to examine the causes and consequences of RSV LRTI in infants born 33-35 weeks GA, and look at the potential for using risk factors to identify high risk infants and, thereby, optimise prophylaxis. The causes and consequences of RSV LRTI in infants born 33-35 weeks GAA were determined via literature review. A number of underlying risk factors that significantly increase the risk of severe RSV LRTI and subsequent hospitalisation in this group of infants have been identified, most notably from the FLIP and PICNIC studies. A European predictive model based on the risk factors in the FLIP study has recently been developed and validated, which will aid identification of infants born between 33 and 35 weeks GA with the highest risk of RSV hospitalisation. Implementation of this model and prophylaxis of infants born between 33 and 35 weeks GA should be a national or regional decision, taken in perspective of other public health needs.
  European Journal of Clinical Microbiology 10/2008; 27(10):891-9. · 2.86 Impact Factor
• Article: Probable early-onset group B streptococcal neonatal sepsis: a serious clinical condition related to intrauterine infection.

  X Carbonell-Estrany, J Figueras-Aloy, S Salcedo-Abizanda, M de la Rosa-Fraile
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  ABSTRACT: The estimated incidence of true early-onset group B streptococcal (GBS) neonatal infection is based on positive GBS blood or cerebrospinal fluid (CSF) culture results, but the real burden of disease is underestimated owing to the high incidence of culture-negative sepsis possibly because of antibiotic administration to the mother. To examine the rate of probable early-onset GBS neonatal sepsis and to assess its impact on total GBS neonatal disease. A multicentre longitudinal prospective surveillance of 107,021 deliveries. The rates of culture-proven and probable early-onset GBS sepsis were 0.39 and 0.47 per 1000 live births, respectively. Of great concern was the finding of three deaths related to the infection in the group with probable early-onset GBS sepsis. The use of chemoprophylaxis in GBS-colonised pregnant women, especially when it is incomplete, may not be sufficient to prevent clinical neonatal infection, but may inhibit the growth of GBS in blood and CSF cultures. In assessing the effectiveness of GBS prophylaxis, it is advisable to consider the incidence of culture-positive and probable culture-negative GBS neonatal infection.
  Archives of Disease in Childhood - Fetal and Neonatal Edition 04/2008; 93(2):F85-9. · 3.05 Impact Factor
• Article: [Prevention of adverse effects related to ophthalmological examination in premature infants].

  S Herrero-Pérez, M D Salvia-Roges, M Rodríguez-Miguélez, J Figueras-Aloy, X Carbonell-Estrany
  Anales de Pediatría 03/2004; 60(2):193. · 0.77 Impact Factor
• Article: Efficacy of three treatment schedules in severe meconium aspiration syndrome.

  M D Salvia-Roigés, X Carbonell-Estrany, J Figueras-Aloy, J M Rodríguez-Miguélez
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  ABSTRACT: To compare three different schedules in severe meconium aspiration syndrome (MAS) treatment: standard, bronchoalveolar lavage (BAL) with diluted surfactant, and diluted surfactant BAL plus a single early dexamethasone dose. Twenty-four full-term newborns with severe MAS (needing mechanical ventilation and with oxygenation index > or = 15) were divided into three groups: group I (historical control group; n = 6) treated with standard therapy; group II (n = 7) treated in the first hours of life with one BAL using diluted surfactant (beractant 5 mg/mL) in a volume of 15 mL/kg in four aliquots; and group III (n = 11) treated with one diluted surfactant BAL and a previous single dose of intravenous dexamethasone (0.5 mg/kg). At 12 h, groups II and III showed a significant improvement in oxygenation index (OI) compared with group I (14.7% and 27.0% vs -19.6% respectively; p = 0.012). Group III also showed a significantly lower OI than group I at 24 h (63.6% vs -27.9%) and at 48 h (87.1% vs 49.6%). Group III, in comparison to group I, showed a lower FiO2 requirement at 12 h (0.66 vs 1), at 24 h (0.4 vs 0.87) and at 48 h (0.35 vs 0.67), and a decrease in the number of days of inhaled nitric oxide administration, mechanical ventilation, oxygen therapy and hospitalisation period. All patients from groups II and III survived and none developed pneumothorax or respiratory infections. Diluted surfactant BAL in the first hours of life combined with an intravenous single dose of dexamethasone may be an effective treatment for severe MAS.
  Acta Paediatrica 01/2004; 93(1):60-5. · 2.07 Impact Factor
• Article: Plasma nitrite/nitrate and endothelin-1 concentrations in neonatal sepsis.

  J Figueras-Aloy, L Gómez, J M Rodríguez-Miguélez, Y Jordán, M D Salvia, W Jiménez, X Carbonell-Estrany
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  ABSTRACT: To determine the changes in plasma nitrite/nitrate (NOx) and endothelin-1 (ET-1) concentrations during neonatal sepsis. In a prospective study, 60 consecutive newborns meeting the criteria for sepsis and without receiving exogenous nitric oxide (25 haemoculture-positive [HC+] and 35 haemoculture-negative [HC-]) were compared with 68 healthy newborns (46 full-term and 22 preterm). NOx and ET-1 concentrations were measured in each newborn within 48 h of diagnosis of sepsis and then every third day up to three determinations. SNAP-II and SNAPPE-II severity scores were performed at the moment of highest clinical severity. At the beginning of the sepsis period, controls and septicaemic newborns had similar NOx and ET-1 levels, with the exception of infants with severe HC+ sepsis. Throughout the sepsis period, NOx increased in moderate HC+ sepsis and decreased in HC--sepsis, reaching a significant difference at the end of the study period (59.9 +/- 72.7 vs 33.9 15.3 micromol/L; p = 0.036). Meanwhile, ET-1 in newborns with severe HC+ sepsis remained higher than that in the moderate HC+ sepsis group and HC--group, reaching significant differences in all the periods. The highest ET-1 value was positively correlated with SNAP-II and SNAPPE-II scores. NOx concentrations increased throughout the neonatal HC+ sepsis period, reaching significant differences after 7-9 d. The highest ET-1 levels in neonatal HC+ sepsis emerged before the NOx peak, at 3-5 d, and later decreased. Only newborns with severe HC+ sepsis presented a significant increase in ET-1 concentrations from the beginning of the septicaemic process.
  Acta Paediatrica 06/2003; 92(5):582-7. · 2.07 Impact Factor
• Article: [Guidelines for respiratory syncytial virus prophylaxis. An update].

  X Carbonell-Estrany, J Quero Jiménez
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  ABSTRACT: 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.
  Anales espanoles de pediatria 05/2002; 56(4):334-6.
• Article: Anaemia of prematurity: treatment with erythropoietin.

  X Carbonell-Estrany, J Figueras-Aloy
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  ABSTRACT: Anemia of prematurity is a hyporegenerative anemia usually appearing after the second week, reaching highest intensity in the second month of life. It's normocytic and normochromic with low reticulocyte count. It has been attributed to EPO deficiency. The low EPO levels detected in premature infants and the proper response to synthetic erythropoietin suggested that EPO administration in premature of < or =32 weeks gestational age could be of benefit trying to maintain or increase the hematocrit levels. Protocols of EPO administration to premature babies should always be considered as EPO+Fe, keeping ferritin levels over 100 ng/ml. Failures to EPO+Fe treatment in very small premature babies, measured as no decrease in the need of blood transfusions, may be due to the amount of blood looses that should be restricted.
  Early Human Development 12/2001; 65 Suppl:S63-7. · 2.05 Impact Factor
• Article: Hospitalization rates for respiratory syncytial virus infection in premature infants born during two consecutive seasons.

  X Carbonell-Estrany, J Quero
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  ABSTRACT: To collect data on hospitalization rates for respiratory syncytial virus (RSV) illness during the season of 1999 to 2000 in nonprophylaxed premature infants < or = 32 weeks gestational age (GA) in Spain and compare this with previously published data collected in the season of 1998 to 1999. Children born at < or = 32 weeks GA between April 1, 1999, and April 31, 2000, and discharged from the hospital before April 31, 2000, were included. Neonatal and demographic data were obtained at the initial visit. Study subjects were followed at monthly intervals throughout the respiratory season. RSV status and morbidity data were collected on patients rehospitalized for respiratory illness. The 999 evaluable patients in the 2000 season were comparable to the 1999 sample, except for higher rates of family allergy history and number of multiple deliveries and a lower rate of neonatal morbidity. The hospitalization rate for RSV illness was 13.4% in the 1999 season and 13.1% in the 2000 season; 10 (8%) were RSV reinfections in the 2000 season. Significant independent prognostic variables for high risk of RSV hospital admission included: lower gestational age; chronologic age < 3 months at onset of the RSV season; living with school age siblings; and exposure to tobacco smoke. Hospitalization rates for RSV disease in nonprophylaxed preterm infants < or = 32 weeks GA were high in Spain and comparable during two consecutive RSV seasons (13%). Readmission for a second RSV infection was also common.
  The Pediatric Infectious Disease Journal 09/2001; 20(9):874-9. · 3.58 Impact Factor
• Article: Early administration of the second dose of surfactant (beractant) in the treatment of severe hyaline membrane disease.

  J Figueras-Aloy, J Quero, X Carbonell-Estrany, G Ginovart, J Pérez-Rodríguez, F Raspall, J M Rodríquez Miguélez, M D Salvía
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  ABSTRACT: The aim of this study was to demonstrate that administration of the second dose of beractant 2 h after the first one is more effective than 6 h after the initial dose. The inclusion criteria for the recruitment of newborn infants were: age < or = 8 h, birthweight 600-2000 g, gestational age 23-36 wk, need for mechanical ventilation with inspiratory oxygen fraction (FiO2) > or = 0.4 and mean airway pressure (MAP) > or = 7 cmH2O to obtain arterial oxygen tension (PaO2) values between 70 and 80 mmHg, and thoracic X-ray compatible with hyaline membrane disease (HMD). Newborns with major congenital malformations, hydrops fetalis or severe pulmonary hypoplasia, or being treated with high-frequency oscillatory ventilation were excluded. In total, 57 premature newborns were studied, 20 of them below 1000 g, who received 100 mg kg-1 of beractant in 2 aliquots and showed an inadequate response, i.e. after 2 h of the first dose the newborn still needed a FiO2 > or = 0.4 and a MAP > or = 7 cmH2O to achieve a PaO2 > 70 mmHg. The second dose was randomly administered 2 or 6 h from the first one. CONCLUSION: The 2 study groups were comparable except for a higher need of dopamine and seroalbumin in 2-h group. Evolution and complications were similar. Twelve hours after the first dose, the percentage improvement in the arteriolar/alveolar ratio (a/ADO2) in the 2-h group was similar to that in the 6-h group. However, in newborns below 1000 g, 12 h after the first dose the a/ADO2 percentage improvement in the 2-h group was greater than in 6-h group (median of 103.6% vs 16.3%; p = 0.035). In premature infants below 1000 g, it seems reasonable to advance the second dose of beractant if needed.
  Acta Paediatrica 04/2001; 90(3):296-301. · 2.07 Impact Factor
• Article: Rehospitalization because of respiratory syncytial virus infection in premature infants younger than 33 weeks of gestation: a prospective study. IRIS Study Group.

  X Carbonell-Estrany, J Quero, G Bustos, A Cotero, E Doménech, J Figueras-Aloy, J M Fraga, L G García, A García-Alix, M G Del Río, X Krauel, J B Sastre, E Narbona, V Roqués, S S Hernández, M Zapatero
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  ABSTRACT: To collect data on hospitalization for respiratory syncytial virus (RSV) infections and presumptive risk factors for rehospitalization among premature infants in Spain. Observational, prospective, longitudinal, multicenter study. Fourteen Spanish neonatal units with an annual birth cohort of 57,000 infants. All children (n = 680) born < or =32 weeks of gestational age between April 1, 1998, and March 31, 1999, and discharged from the hospital before March 31, 1999, were included in the study. A total of 96 were excluded because of administration of prophylactic treatment (n = 55) or were lost to follow-up (n = 41). Five children died during the study period, but death was related to RSV in only 1 case. Neonatal and demographic data were recorded at the initial visit. Infants were prospectively followed at monthly intervals up to March 31, 1999. In patients rehospitalized for respiratory disorders, further data about RSV status and morbidity were collected. A comparison was made between children rehospitalized for RSV infection and those who were not. The influence of factors on the probability of rehospitalization for RSV infection was assessed by logistic regression analysis. Of the 584 evaluable patients 118 (20.2%) were rehospitalized for respiratory disease during the study period. The causative pathogen was identified in 89 (75.4%) hospital admissions. Of these 59 (66.3%) were a result of RSV infection in 53 children; 6 were reinfections. In a logistic regression model significant independent prognostic variables included: lower risk of RSV hospitalization with increase gestational age [odds ratio (OR), 0.85; 95% confidence interval (CI), 0.72 to 0.99; P < 0.047]; higher risk with chronic lung disease (OR = 3.1; 95% CI 1.22 to 7.91; P < 0.016); and living with school age siblings (OR = 1.86; 95% CI 1.01 to 3.4; P < 0.048). This large descriptive study has enabled us to define the influence of specific risk factors that increase the risk of rehospitalization for RSV infection in preterm infants. Such studies help to define the appropriate role of available prophylactic interventions and establish treatment guidelines.
  The Pediatric Infectious Disease Journal 08/2000; 19(7):592-7. · 3.58 Impact Factor
• Article: [Recommendations for the prevention of respiratory syncytial virus infections. Standards Committee of the Spanish Society of Neonatology. Board of Directors of the Spanish Society of Neonatology].

  X Carbonell Estrany, J Quero Jiménez
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  ABSTRACT: 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.
  Anales espanoles de pediatria 05/2000; 52(4):372-4.
• Article: [Invasive catheters in neonates].

  C Sánchez García-Vao, X Carbonell Estrany, M T Esqué Ruiz, M Barjau Capdevila, J Mingueza Ortega, L Giraldó Lozano
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  ABSTRACT: 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. 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. 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. To decrease the incidence of sepsis related to catheters, a strict protocol for placement and maintenance must be followed.
  Anales espanoles de pediatria 11/1999; 51(4):382-8.
• Article: [Usefulness of erythropoietin in the treatment of anemia of prematurity. Influence of birth weight].

  X Carbonell Estrany, J Figueras Aloy, J M Pérez Fernández, A Fernández López, G González Luis, M D Salvía Roiges
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  ABSTRACT: 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. 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. 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. 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.
  Anales espanoles de pediatria 09/1999; 51(3):281-6.
• Article: [Hyperbilirubinemia in full-term newborns. Predictive factors].

  X Carbonell Estrany, F Botet Mussons, J Figueras Aloy, A Riu Godó
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  ABSTRACT: 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). 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. 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%. 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.
  Anales espanoles de pediatria 04/1999; 50(4):389-92.
• Article: [Blood extractions, transfusion policy and erythropoietin in the newborn].

  J Figueras Aloy, X Carbonell Estrany
  Anales espanoles de pediatria 08/1998; 49(1):46-8.
• Article: [Early onset of neonatal sepsis due to Streptococcus agalactiae: study of ten years (1985-1994) and the utility of intrapartum prophylaxis].

  J Bosch Mestres, A Palou Chárlez, L Serra Azuara, E Alvarez Domínguez, M C Ricart Costa, R Ros Vallverdú, X Carbonell Estrany
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  ABSTRACT: 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. 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. 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. 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.
  Anales espanoles de pediatria 04/1997; 46(3):272-6.