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INTRODUCTION: Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. OBJECTIVES: To test the introduction of the ECTS in pediatrics and modify the teaching methodology. STUDY DESIGN: The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. RESULTS: Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. CONCLUSIONS: Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated.

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Introducción Las Facultades Médicas españolas han comenzado el nuevo proceso de reforma curricular en el marco del proceso de implantación del Espacio Europeo de Educación Superior y deben incorporar el Sistema de Transferencia de Créditos Europeo (ECTS) a los nuevos planes del estudio antes de 2010. Objetivos El objetivo del trabajo fue experimentar la introducción de los créditos ECTS en la asignatura de Pediatría y modificar la metodología docente. Diseño del estudio Adaptación del programa teórico y práctico, estableciendo unos objetivos docentes y un sistema de evaluación. Se realizaron encuestas a los alumnos al inicio del segundo cuatrimestre del curso 2004-2005, antes de realizar el examen teórico de la asignatura y al finalizar el curso académico, utilizando para las respuestas una escala de tipo Likert con 5 grados. Se comparó la priorización de las competencias genéricas y específicas de los alumnos con la de los profesionales médicos en la encuesta de la Conferencia Nacional de Decanos (CND). Para el análisis de los resultados se aplicaron pruebas no paramétricas. Resultados Los 15 créditos actuales se transformaron en 11 ECTS, con 297 h de trabajo para los alumnos. Se redujo el programa teórico de 80 a 52 lecciones. Los alumnos prepararon y presentaron 14 casos clínicos, bajo la supervisión de sus tutores. Los profesores consideraron que el aprendizaje teórico había sido similar al de cursos anteriores (66,6 %) y había sido mejor el práctico (73,3 %). Los alumnos opinaron que el proyecto debía continuar (73,2 %), pero el 98,8 % consideraron que la carga de trabajo había sido excesiva. Los alumnos apreciaron de forma estadísticamente significativa que mejoró la docencia práctica y su capacidad para preparar y presentar casos clínicos. El rendimiento académico de los alumnos fue significativamente mejor que el de los alumnos del curso anterior. Los estudiantes estuvieron de acuerdo con la prioridad de competencias de la CND para 9/9 de las generales y 4/17 de las específicas. La estimación de horas de trabajo de los alumnos fue mayor por los alumnos que por los profesores. El 73,3 % de los alumnos contestaron que el proyecto debía mejorarse, reduciendo la carga de trabajo de los alumnos y mejorando el sistema de evaluación. Conclusiones La introducción de los ECTS mejoró el rendimiento académico, la formación práctica y el autoaprendizaje de los alumnos. La experiencia fue satisfactoria para profesores y alumnos. La estimación de la carga de trabajo de los alumnos fue subestimada

Introduction Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. Objectives To test the introduction of the ECTS in pediatrics and modify the teaching methodology. Study design The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. Results Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. Conclusions Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated

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OBJECTIVE: To evaluate the influence of intrauterine growth on neonatal morbidity and mortality in live neonates born in a regional tertiary care center. PATIENTS AND METHODS: A retrospective cohort study was performed. Data from 12,311 live neonates (LN) born in our hospital (from January 1999 to December 2003) were reviewed to analyze neonatal morbidity and mortality according to whether the LN were appropriate (AGA), small (SGA) or large (LGA) for gestational age. The variables collected from birth to hospital discharge were: gestational abnormalities, gender, delivery type, Apgar score, respiratory distress, presentation of obstetric trauma (including cephalohematomas), hypoglycemia, hypocalcemia, hyperbilirubinemia, congenital malformations, heart disease, and type of hospital discharge. Differences were examined among groups. We used the chi-squared test to compare the frequency of these variables in each group. RESULTS: Data from 12,311 LN were entered into the database; 11,182 (90.8%) were AGA, 743 (6.1%) were LGA and 386 (3.1%) were SGA. There were 52.58% boys and 47.42% girls, and 5.5% of LN had macrosomia (birth weight > 4,000 g). A total of 0.39% of LN died before hospital discharge. Among LN, there were 1,215 preterm infants, representing 9.89% of all LN and 2.63% died (SGA 25% and AGA 75%). There was a prevalence of boys in the LGA group and of girls in the SGA group (p = 0.000). The presence of maternal diabetes (pregestational or gestational) was significantly higher (p = 0.000) in the LGA group. Maternal hypertension, smoking and drug addiction were significantly higher in the SGA group. The finding of obstetric trauma was significantly higher in the LGA group (p = 0.000). The proportion of congenital malformations, hypocalcemia and hypoglycemia was higher in the SGA group than in the AGA and LGA groups (p = 0.000). Neonatal mortality was significantly higher (p = 0.000) in the SGA group and preterm infants. CONCLUSIONS: Neonates with deviations in the pattern of intra-uterine growth had worse outcome. Prognosis was worse in SGA neonates, followed by LGA neonates, than in AGA neonates.

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Objetivo: Analizar la influencia del patrón de crecimiento intrauterino sobre la morbilidad y mortalidad de los recién nacidos vivos en un hospital regional terciario. Pacientes y métodos: Se revisaron de forma retrospectiva, mediante un estudio de cohortes, a 12.311 recién nacidos vivos nacidos en nuestro hospital (entre enero de 1999 y diciembre de 2003), para analizar la morbilidad y la mortalidad neonatal, según fueran adecuados (AEG), pequeños (PEG) o grandes (GEG) para la edad gestacional. Las variables recogidas desde su nacimiento hasta el momento de su alta hospitalaria fueron: patología gestacional, sexo, tipo de parto, valoración de Apgar, existencia de dificultad respiratoria, traumatismo obstétrico (incluyendo cefalohematoma), malformaciones congénitas, hipoglucemia, hipocalcemia, hiperbilirrubinemia, cardiopatía y el tipo de alta hospitalaria. La incidencia de estas variables en los tres grupos se comparó aplicando el test de la ji cuadrado (χ 2). Resultados: De los 12.311 recién nacidos vivos recogidos en la base de datos, el 90,8 % (n = 11.182) fueron AEG, el 6,1 % (n = 743) GEG y el 3,1 % (n = 386) fueron PEG. El 52,58 % era niños y el 47,42 % niñas. Fueron macrosómicos (peso al nacer ≥ 4.000 g) el 5,5 % de los recién nacidos. Fallecieron el 0,39 % de los recién nacidos vivos. Del total de recién nacidos vivos 1.215 fueron pretérmino, lo que supone el 9,89 % del total y fallecieron el 2,63 % (PEG el 25 % y AEG el 75 %). Existió un predominio de niños en el grupo de GEG y de niñas en el grupo de PEG (p 5 0,000). La existencia de diabetes materna (pregestacional o gestacional) fue significativamente más alta (p 5 0,000) en el grupo de GEG y los antecedentes de hipertensión materna, madre fumadora o drogadicta en el grupo de PEG (p = 0,000). La existencia de trauma obstétrico fue significativamente mayor en los GEG (p = 0,000). La tasa de malformaciones congénitas, hipocalcemia e hipoglucemia (p 5 0,000) fue más elevada en los PEG respecto a los otros grupos. La mortalidad neonatal fue significativamente mayor en los PEG y en los prematuros (p = 0,000). Conclusiones: Existe una peor evolución de los recién nacidos que presentan una desviación del patrón de crecimiento intrauterino, teniendo un peor pronóstico los PEG y en menor cuantía los GEG, respecto a los AEG

Objective: To evaluate the influence of intrauterine growth on neonatal morbidity and mortality in live neonates born in a regional tertiary care center. Patients and methods: A retrospective cohort study was performed. Data from 12,311 live neonates (LN) born in our hospital (from January 1999 to December 2003) were reviewed to analyze neonatal morbidity and mortality according to whether the LN were appropriate (AGA), small (SGA) or large (LGA) for gestational age. The variables collected from birth to hospital discharge were: gestational abnormalities, gender, delivery type, Apgar score, respiratory distress, presentation of obstetric trauma (including cephalohematomas), hypoglycemia, hypocalcemia, hyperbilirubinemia, congenital malformations, heart disease, and type of hospital discharge. Differences were examined among groups. We used the chi-squared test to compare the frequency of these variables in each group. Results: Data from 12,311 LN were entered into the database; 11,182 (90.8 %) were AGA, 743 (6.1 %) were LGA and 386 (3.1 %) were SGA. There were 52.58 % boys and 47.42 % girls, and 5.5 % of LN had macrosomia (birth weight > 4,000 g). A total of 0.39 % of LN died before hospital discharge. Among LN, there were 1,215 preterm infants, representing 9.89 % of all LN and 2.63 % died (SGA 25 % and AGA 75 %). There was a prevalence of boys in the LGA group and of girls in the SGA group (p = 0.000). The presence of maternal diabetes (pregestational or gestational) was significantly higher (p = 0.000) in the LGA group. Maternal hypertension, smoking and drug addiction were significantly higher in the SGA group. The finding of obstetric trauma was significantly higher in the LGA group (p = 0.000). The proportion of congenital malformations, hypocalcemia and hypoglycemia was higher in the SGA group than in the AGA and LGA groups (p = 0.000). Neonatal mortality was significantly higher (p = 0.000) in the SGA group and preterm infants. Conclusions: Neonates with deviations in the pattern of intra-uterine growth had worse outcome. Prognosis was worse in SGA neonates, followed by LGA neonates, than in AGA neonates

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OBJECTIVE: At present, growth regulating factors in the transition from fetal to postnatal life remain unknown. The purpose of this study was to analyze the influence of GH and nutrition on neonatal growth. PATIENTS AND METHODS: Serum and 24-hour urine GH levels, various anthopometric variables and daily energy and nutrient intake were measured in appropriate (AGA), large (LGA) and small for gestational age (SGA) newborn infants. These variables were measured at 1 (n = 98), 3 (n = 41) and 5 weeks of postnatal age (n = 8). RESULTS: The highest GH levels at the 1st week of postnatal life were obtained in preterm SGA infants (GHs: 61.4 +/- 20.0 microUI/m; GHu: 18.6 +/- 10.3 ng/kg/24 h). GH levels decreased in preterm infants, so that differences between groups failed to be significant at the third and fifth weeks of postnatal life. Urinary GH excretion did not show significant variations in the control group during the study (1st wk 3.0 +/- 3.5; 3rd wk 2.3 +/- 2.7; 5th wk 3.2 +/- 4.7 ng/kg/24 h). Daily protein intake had a direct relationship with both triceps skinfold and weight and head perimeter increase. SGA preterm infants showed a higher fat increase compared to AGA preterm infants. Serum and urinary GH levels were not related to the anthopometric variables studied. CONCLUSIONS: There are differences in GH secretion and body composition between SGA and AGA preterm infants. GH probably does not contribute to neonatal growth.

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