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INTRODUCTION: Donor milk is the second best alternative for a newborn after the mother's own milk, especially when the baby is a premature or a sick child since this milk has the advantage of protecting against necrotizing enterocolitis. There are currently 13 milk banks in Spain, however this is not sufficient to supply all Spanish neonatal units with donor milk. In order to bring donor milk to the babies in Neonatal Unit of the Regional University Hospital of Malaga, a Satellite Centre (CS) was created in 2012, depending on the Milk Bank of Virgen de las Nieves Hospital in Granada. AIM: Assessing the efficiency of a SC compared to an independent milk bank. METHOD: A study of cost minimization is used for the analysis. The cost of the implementation of the SC is calculated and compared to the cost of the implementation of the Milk Bank of Virgen de las Nieves of Granada. Additionally, the maintenance cost per year of the 2 models is compared, taking into account the running phase from June, 2012 through August 2015 in the SC. RESULTS: A SC implies savings of 88,852 Euro in equipment, and 24,572 Euro per year in maintenance compared to an independent milk bank. CONCLUSIONS: The efficiency of the SC is due to a better use of resources. A distribution network model of donor human milk, consisting of milk banks and SC, makes it possible to equally supply human milk to premature infants with a reduced cost.

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En el presente artículo, vamos a desarrollar la función que desempeña nuestra Unidad en los aspectos asistencial, docente, formativo e investigador, dentro del Sistema Sanitario Público de Andalucía y con unos valores y una misión perfectamente establecidos, que describiremos en el mismo. Haremos mención, asimismo, de la cartera de servicios que la Unidad ofrece dentro de los hospitales a los que pertenece, la población de referencia y los niveles asistenciales en los que se encuadran las dos Unidades en los Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, que conforman la Unidad de Gestión Clínica Intercentros (UGCI) desde 2005. Dentro de nuestra filosofía de prestación de cuidados, desde hace años, somos una unidad de puertas abiertas, que persigue la implicación de la familia en los cuidados del recién nacido ingresado y el control del microambiente que rodea al mismo, con monitorización del ruido, la intensidad lumínica, las medidas de contención, etc. E integrándose todo esto en los Cuidados Centrados en el Desarrollo y la Familia (AU)

In this article, I am going to develop the role played by our Unit in the care, teaching, training and researcher aspects within the Public Health System of Andalusia and with some values as well as a perfectly established mission, which I will describe in it. I will also refer to the List of Services offered by the Unit within the hospitals they belong to, the reference population and the care levels in which the two Units in the Regional University Hospitals and Virgen de la Victoria de Malaga fit into, which have made up the lntercenter Clinical Management Unit (UGCI) since 2005. Within our care giving philosophy, we have had Open Doors Unit for years. This unit pursues involvement of the family in the care of hospitalized newborn and control of the micro-environment surrounding it, with monitoring of noise, light intensity, contention measures, etc., all of this being integrated in Cares Focused on Development and the Family (AU)

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La displasia broncopulmonar sigue siendo la secuela más frecuente relacionada con los recién nacidos de muy bajo peso al nacer y especialmente con aquellos con pesos extremadamente bajos. Pese a los avances en la prevención y los cuidados de la insuficiencia respiratoria asociada a la prematuridad, no ha ocurrido un descenso en su incidencia en esta población, aunque sí hemos asistido en los últimos años a un cambio en su expresión clínica y en su gravedad. Existen, sin embargo, diferencias aún importantes entre los distintos centros en cuanto a la frecuencia de su presentación, probablemente debido a la aplicación de un diagnóstico clínico no homogéneo. En este artículo, la Comisión de Estándares de la Sociedad Española de Neonatología quiere revisar los criterios diagnósticos de la displasia broncopulmonar para reducir, en la medida de lo posible, la variabilidad intercentro de la misma (AU)

Bronchopulmonary dysplasia is the most common sequelae related to very low birth weight infants, mostly with those of extremely low birth weight. Even with advances in prevention and treatment of respiratory distress syndrome associated with prematurity, there is still no decrease in the incidence in this population, although a change in its clinical expression and severity has been observed. There are, however, differences in its frequency between health centres, probably due to a non-homogeneously used clinical definition. In this article, the Committee of Standards of the Spanish Society of Neonatology wishes to review the current diagnosis criteria of bronchopulmonary dysplasia to reduce, as much as possible, these intercentre differences (AU)

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Las gestaciones que conllevan algún riesgo materno y/o fetal no siempre son diagnosticadas en un centro especializado en la atención neonatal, por lo que el transporte posnatal es una parte esencial dentro de la estructura de los servicios sanitarios perinatales. El objetivo del transporte neonatal es trasladar al recién nacido a un centro especializado que disponga de la infraestructura y la experiencia necesarias para su asesoramiento y tratamiento. El transporte ideal del recién nacido es el que se realiza in utero. Desafortunadamente, no todos los problemas pueden detectarse a tiempo para el traslado materno y hasta un 30-50% de ellos pueden presentarse durante el parto o en el periodo neonatal inmediato. Por ello es necesario disponer de conocimientos y medios para la reanimación y la estabilización del recién nacido en el momento del parto y de un sistema de transporte neonatal especializado que permita trasladar a los pacientes con el mismo nivel de cuidados que recibiría en el hospital receptor sin que suponga en ningún caso un deterioro de su salud o un riesgo elevado para ella. La Sociedad Española de Neonatología, a través de su Comisión de Estándares, ha querido revisar y actualizar en este documento las recomendaciones para el transporte intraútero, las indicaciones para el traslado neonatal, la organización y la logística necesarias para realizarlo (personal, comunicación, documentación, medio de transporte y equipamiento), la estabilización previa al mismo, el manejo durante el traslado y el ingreso en el hospital receptor (AU)

During pregnancy, it is not always possible to identify maternal or foetal risk factors. Infants requiring specialised medical care are not always born in centres providing intensive care and will need to be transferred to a referral centre where intensive care can be provided. Therefore Neonatal Transport needs to be considered as part of the organisation of perinatal health care. The aim of Neonatal Transport is to transfer a newborn infant requiring intensive care to a centre where specialised resources and experience can be provided for the appropriate assessment and continuing treatment of a sick newborn infant. Intrauterine transfer is the ideal mode of transport when the birth of an infant with risk factors is diagnosed. Unfortunately, not all problems can be detected in advance with enough time to safely transfer a pregnant woman. Around 30- 50% of risk factors will be diagnosed during labour or soon after birth. Therefore, it is important to have the knowledge and resources to resuscitate and stabilise a newborn infant, as well as a specialised neonatal transport system. With this specialised transport it is possible to transfer newly born infants with the same level of care that they would receive if they had been born in a referral hospital, without increasing their risks or affecting the wellbeing of the newborn. The Standards Committee of the Spanish Society of Neonatology reviewed and updated recommendations for intrauterine transport and indications for neonatal transfer. They also reviewed organisational and logistic factors involved with performing neonatal transport. The Committee review included the type of personnel who should be involved; communication between referral and receiving hospitals; documentation; mode of transport; equipment to stabilise newly born infants; management during transfer, and admission at the referral hospital (AU)

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En el año 2004 fue elaborado por el Comité de Estándares y la Junta Directiva de la Sociedad Española de Neonatología (SEN) un primer documento sobre niveles asistenciales y recomendaciones de mínimos para la atención neonatal, a partir del cual se pudo definir el nivel asistencial de cada centro en nuestro país, así como los requerimientos técnico-sanitarios según niveles. La presente revisión pretende tener en cuenta los cambios experimentados en la asistencia neonatal en los últimos años y optimizar la localización de recursos. Las unidades que proporcionan asistencia a los recién nacidos deben estar organizadas dentro de un sistema de regionalización de los cuidados perinatales. Las características funcionales de cada nivel asistencial deben ser definidas de forma uniforme y clara, y esto incluye requerimientos de equipamiento, instalaciones, personal, servicios de apoyo, formación y organización de servicios (incluyendo el transporte) necesarios para cubrir las prestaciones de cada nivel de cuidados (AU)

A policy statement on the levels of care and minimum recommendations for neonatal healthcare was first proposed by the Standards Committee and the Board of the Spanish Society of Neonatology in 2004. This allowed us to define the level of care of each center in our country, as well as the health and technical requirements by levels of care to be defined. This review takes into account changes in neonatal care in the last few years and to optimize the location of resources. Facilities that provide care for newborn infants should be organized within a regionalized system of perinatal care. The functional capabilities of each level of care should be defined clearly and uniformly, including requirements for equipment, facilities, personnel, ancillary services, training, and the organization of services (including transport) needed to cover each level of care (AU)

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Bronchopulmonary dysplasia is the most common sequelae related to very low birth weight infants, mostly with those of extremely low birth weight. Even with advances in prevention and treatment of respiratory distress syndrome associated with prematurity, there is still no decrease in the incidence in this population, although a change in its clinical expression and severity has been observed. There are, however, differences in its frequency between health centres, probably due to a non-homogeneously used clinical definition. In this article, the Committee of Standards of the Spanish Society of Neonatology wishes to review the current diagnosis criteria of bronchopulmonary dysplasia to reduce, as much as possible, these inter-centre differences.

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During pregnancy, it is not always possible to identify maternal or foetal risk factors. Infants requiring specialised medical care are not always born in centres providing intensive care and will need to be transferred to a referral centre where intensive care can be provided. Therefore Neonatal Transport needs to be considered as part of the organisation of perinatal health care. The aim of Neonatal Transport is to transfer a newborn infant requiring intensive care to a centre where specialised resources and experience can be provided for the appropriate assessment and continuing treatment of a sick newborn infant. Intrauterine transfer is the ideal mode of transport when the birth of an infant with risk factors is diagnosed. Unfortunately, not all problems can be detected in advance with enough time to safely transfer a pregnant woman. Around 30- 50% of risk factors will be diagnosed during labour or soon after birth. Therefore, it is important to have the knowledge and resources to resuscitate and stabilise a newborn infant, as well as a specialised neonatal transport system. With this specialised transport it is possible to transfer newly born infants with the same level of care that they would receive if they had been born in a referral hospital, without increasing their risks or affecting the wellbeing of the newborn. The Standards Committee of the Spanish Society of Neonatology reviewed and updated recommendations for intrauterine transport and indications for neonatal transfer. They also reviewed organisational and logistic factors involved with performing neonatal transport. The Committee review included the type of personnel who should be involved; communication between referral and receiving hospitals; documentation; mode of transport; equipment to stabilise newly born infants; management during transfer, and admission at the referral hospital.

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A policy statement on the levels of care and minimum recommendations for neonatal healthcare was first proposed by the Standards Committee and the Board of the Spanish Society of Neonatology in 2004. This allowed us to define the level of care of each center in our country, as well as the health and technical requirements by levels of care to be defined. This review takes into account changes in neonatal care in the last few years and to optimize the location of resources. Facilities that provide care for newborn infants should be organized within a regionalized system of perinatal care. The functional capabilities of each level of care should be defined clearly and uniformly, including requirements for equipment, facilities, personnel, ancillary services, training, and the organization of services (including transport) needed to cover each level of care.

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