Background: Necrotizing enterocolitis (NEC) is a highly painful intestinal complication in preterm infants that requires adequate pain management to prevent short- and long-term effects of neonatal pain. There is a lack of international guidelines for pain management in NEC patients. Therefore, this study aims to describe current pain management for NEC patients in European neonatal intensive care units (NICUs). Methods: An online survey was designed and conducted to assess current practices in pain management for NEC patients in European NICUs. The survey was distributed via neonatal societies, digital platforms, and professional contacts. Results: Out of the 259 responding unique European NICUs from 36 countries, 61% had a standard protocol for analgesic therapy, 73% assessed pain during NEC, and 92% treated NEC patients with intravenous analgosedatives. There was strong heterogeneity in the used pain scales and initial analgesic therapy, which mainly included acetaminophen (70%), fentanyl (56%), and/or morphine (49%). A third of NICU representatives considered their pain assessment adequate, and half considered their analgesic therapy adequate for NEC patients.Conclusions: Various pain scales and analgesics are used to treat NEC patients in European NICUs. Our results provide the first step towards an international guideline to improve pain management for NEC patients. Impact: This study provides an overview of current pain management practices for infants with necrotizing enterocolitis (NEC) in European neonatal intensive care units.Choice of pain assessment tools, analgosedatives, and dosages vary considerably among NICUs and countries.A third of NICU representatives were satisfied with their current pain assessment practices and half of NICU representatives with their analgesic therapy practices in NEC patients in their NICU.The results of this survey may provide a first step towards developing a European pain management consensus guideline for patients with NEC.

Necrotizing enterocolitis (NEC) is a devastating gut disease in preterm neonates. In NEC animal models, mesenchymal stromal cells (MSCs) administration has reduced the incidence and severity of NEC. We developed and characterized a novel mouse model of NEC to evaluate the effect of human bone marrow-derived MSCs (hBM-MSCs) in tissue regeneration and epithelial gut repair. NEC was induced in C57BL/6 mouse pups at postnatal days (PND) 3-6 by (A) gavage feeding term infant formula, (B) hypoxia/hypothermia, and (C) lipopolysaccharide. Intraperitoneal injections of PBS or two hBM-MSCs doses (0.5 x 10(6) or 1 x 10(6)) were given on PND2. At PND 6, we harvested intestine samples from all groups. The NEC group showed an incidence of NEC of 50% compared with controls (p < 0.001). Severity of bowel damage was reduced by hBM-MSCs compared to the PBS-treated NEC group in a concentration-dependent manner, with hBM-MSCs (1 x 10(6)) inducing a NEC incidence reduction of up to 0% (p < 0.001). We showed that hBM-MSCs enhanced intestinal cell survival, preserving intestinal barrier integrity and decreasing mucosal inflammation and apoptosis. In conclusion, we established a novel NEC animal model and demonstrated that hBM-MSCs administration reduced the NEC incidence and severity in a concentration-dependent manner, enhancing intestinal barrier integrity.

Bronchiolitis in children is associated with significant rates of morbidity and mortality. Many studies have been performed using samples from hospitalized bronchiolitis patients, but little is known about the immunological responses from infants suffering from mild/moderate bronchiolitis that do not require hospitalization. We have studied a collection of nasal lavage fluid (NLF) samples from outpatient bronchiolitis children as a novel strategy to unravel local humoral and cellular responses, which are not fully characterized. The children were age-stratified in three groups, two of them (GI under 2-months, GII between 2-4 months) presenting a first episode of bronchiolitis, and GIII (between 4 months and 2 years) with recurrent respiratory infections. Here we show that elevated levels of pro-inflammatory cytokines (IL1 beta, IL6, TNF alpha, IL18, IL23), regulatory cytokines (IL10, IL17A) and IFN gamma were found in the three bronchiolitis cohorts. However, little or no change was observed for IL33 and MCP1, at difference to previous results from bronchiolitis hospitalized patients. Furthermore, our results show a tendency to IL1 beta, IL6, IL18 and TNF alpha increased levels in children with mild pattern of symptom severity and in those in which non RSV respiratory virus were detected compared to RSV+ samples. By contrast, no such differences were found based on gender distribution. Bronchiolitis NLFs contained more IgM, IgG1, IgG3 IgG4 and IgA than NLF from their age-matched healthy controls. NLF from bronchiolitis children predominantly contained neutrophils, and also low frequency of monocytes and few CD4(+) and CD8(+) T cells. NLF from infants older than 4-months contained more intermediate monocytes and B cell subsets, including naive and memory cells. BCR repertoire analysis of NLF samples showed a biased VH1 usage in IgM repertoires, with low levels of somatic hypermutation. Strikingly, algorithmic studies of the mutation profiles, denoted antigenic selection on IgA-NLF repertoires. Our results support the use of NLF samples to analyze immune responses and may have therapeutic implications.

Introducción Las redes sociales tienen un creciente potencial como herramienta educativa universitaria, pero existe poca evidencia sobre cuáles son las preferencias de los alumnos, y en qué condiciones prefieren utilizarlas. El objetivo de nuestro estudio ha sido identificar esas preferencias para favorecer un uso dirigido por el profesorado de Ciencias de la Salud. Métodos Hemos investigado las redes sociales preferidas de los alumnos del último curso del Grado de Medicina a través de un cuestionario online. Se ha realizado un análisis descriptivo de sus respuestas, y de relación estadística entre las mismas a través del cálculo de la chi-cuadrado. Resultados Han participado en el estudio un total de 147 alumnos, de una muestra de 220. Más del 80% consideraban que las redes sociales son una herramienta docente útil, y mostraban un interés moderado-máximo hacia el aprendizaje vehiculado a través de las mismas. De entre las redes sociales, las preferidas fueron Instagram y YouTube. Una mayoría desean recibir las «píldoras educativas» con una frecuencia moderada, y con contenido mixto (texto, imágenes, cuestionarios¿). Conclusión El uso de las redes sociales como herramienta docente suscita interés entre los alumnos, que se decantan por redes de contenido visual. Esta conectividad profesor-alumno podría favorecer el refuerzo de conceptos docentes y la comunicación bidireccional.

Management of neonatal sepsis and the use of antimicrobials have an important impact on morbidity and mortality. However, there is no recent background on which antibiotic regimens are used in different European neonatal intensive care units (NICUs). Our study aimed to describe the use of antibiotics and other aspects of early- and late-onset sepsis (EOS and LOS, respectively) management by European NICUs. We conducted an online survey among NICUs throughout Europe to collect information about antibiotic stewardship, antibiotic regimens, and general aspects of managing neonatal infections. NICUs from up to 38 European countries responded, with 271 valid responses. Most units had written clinical guidelines for EOS (92.2%) and LOS (81.1%) management. For EOS, ampicillin, penicillin, gentamicin, and amikacin were the most commonly used antibiotics. Analysis of the combinations of EOS regimens showed that the most frequently used was ampicillin plus gentamicin (54.6%). For LOS, the most frequently used antibiotics were vancomycin (52.4%), gentamicin (33.9%), cefotaxime (28%), and meropenem (15.5%). Other aspects of the general management of sepsis have also been analyzed. The management of neonatal sepsis in European NICUs is diverse. There was high self-reported adherence to the local clinical guidelines. There was homogeneity in the combination of antibiotics in EOS but less in LOS.

Hemorrhage of the adrenal glands in the neonatal period happens secondarily to birth trauma and to changes in venous pressure. Neonatal jaundice has as an infrequent etiology the presence of an adrenal gland hematoma. Symptomatic cases are rare, and if they manifest, it is usually as prolonged jaundice. We present the case of a neonate who was admitted at 20 hours of life due to isoimmune jaundice. Due to an increase in conjugated bilirubin, anabdominal ultrasound was requested at 10 days of life, which showed a non-vascularized right adrenal mass, 50 x 21 mm, with cystic images inside, compatible with bleeding of the right adrenal gland. Serial ultrasound showed a progressive resolution until its disappearance, keeping the baby asymptomatic and without jaundice. In cases of prolonged jaundice in the neonatal period, the possibility of significant adrenal hemorrhage must be assessed.

Introducción: La representación del menor en los anuncios de publicidad es un tema pocoinvestigado y reflejado en la bibliografía, tanto de la pediatría social como de la comunicaciónaudiovisual. El objetivo del presente estudio es describir cómo se representa al menor en lapublicidad que se vehiculiza a través de Internet, y si esa representación es adecuada o no.Material y métodos: Se analizaron todos los anuncios en los que aparecían menores a lo largode 2 meses, visualizando, 3 días por semana, las páginas web más visitadas en Espa¿na. Lavaloración de cómo se representaba al menor se realizó con una herramienta de evaluación,elaborada por los autores, basada en la legislación europea y espa¿nola, que mostró una altaconcordancia interevaluador. Se realizó un análisis descriptivo de las variables categóricas y seestableció la relación de interdependencia entre las mismas a través de la prueba Chi-cuadrado.Resultados: Se identificaron 173 anuncios donde apareció al menos un menor, que es general-mente representado solo (63,5%), en un entorno natural (36,9%) y con edad escolar (44,5%). Laspáginas web de «prensa general» son las que más frecuentemente muestran anuncios donde serepresentan menores, a través del uso de banners (82%). En la mayor parte de los casos el usoinadecuado de la figura del menor tiene lugar mediante la representación táctica del mismo, yno meramente estratégica.Conclusiones: El uso de la imagen del menor en la publicidad que se vehiculiza a través

Aim The aim of our review was to describe the clinical response to inhaled nitric oxide (iNO) in a series of preterm babies in respiratory failure during uplift transfers to a neonatal intensive care unit. Methods We performed a retrospective review of critical newborns with gestational age <34(+0) weeks transferred from January 2013 to December 2018. Data were extracted from our Clinical Information System for transport. The primary measure of this review was to assess whether a significant improvement in the oxygenation saturation index (OSI) occurred following the use of iNO. Results Thirty preterm babies <34(+0) weeks were included in our review. OSI, as a measure of oxygenation, did not statistically improve as an immediate response to iNO from referral to receiving hospital (17.1 vs 16.4; P = .7). We found that pH (7.15 vs 7.29; P = .004) and pCO2 (8.1 vs 6.3; P = .05) significantly improved probably based on ventilation management. Conclusion Following the recommendations of the American Academy of Paediatrics and other organizations, iNO should not routinely be used during the neonatal transfer of preterm babies <34(+0) in respiratory failure. We need to conduct further studies to establish which selected preterm patients would benefit from being treated with iNO.

Resumen Objetivos: establecer el impacto de las artes marciales en el desarrollo de habilidades motoras, específicamente sobre la propiocepción, en jóvenes afectados por síndrome de Down. Diseño: en este estudio participan 7 adolescentes en los que se evalúa secuencialmente el control postural antes, durante y después de 2 años de entrenamiento de karate. Se adaptaron tres pruebas (prueba de sentadillas, del flamenco y de velocidad del movimiento del brazo) para realizar un análisis de la propiocepción. Resultados: concluimos que la incorporación del karate en la rutina deportiva de jóvenes afectados por síndrome de Down conlleva una mejora en su equilibrio y coordinación general.