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Abstract Objective: Among the mechanisms proposed for the development of bronchopulmonary dysplasia is the increase in the pulmonary inflammatory process and oxidative stress. Thus, the control of this process may result in improvements in bronchopulmonary dysplasia-related outcomes. This study aims to analyze the current scientific evidence regarding the use of budesonide, a potent anti-inflammatory drug, associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia. Methods: A systematic review of the literature was performed on the Embase and MEDLINE platforms, and studies that compared budesonide with pulmonary surfactant versus pulmonary surfactant for treating respiratory distress syndrome were included. The primary outcome was a reduction in bronchopulmonary dysplasia or death. Results: Four randomized clinical trials and two observational studies were included in this systematic review. Three of the randomized clinical trials found a reduction in bronchopulmonary dysplasia or death in the use of budesonide with the surfactant, all the other studies (1 clinical trial and 2 observational studies) found no statistical differences between the groups for the primary outcomes. The three main studies showed a reduction in the primary outcome; however, all studies showed great heterogeneity regarding the type of surfactant (poractant or beractant) and the method of administration. Conclusion: Robust clinical studies, in a heterogeneous population, using porcine surfactant associated with budesonide, with administration by a minimally invasive technique are necessary for there to be a recommendation based on scientific evidence for its widespread use.

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OBJECTIVE: Among the mechanisms proposed for the development of bronchopulmonary dysplasia is the increase in the pulmonary inflammatory process and oxidative stress. Thus, the control of this process may result in improvements in bronchopulmonary dysplasia-related outcomes. This study aims to analyze the current scientific evidence regarding the use of budesonide, a potent anti-inflammatory drug, associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia. METHODS: A systematic review of the literature was performed on the Embase and MEDLINE platforms, and studies that compared budesonide with pulmonary surfactant versus pulmonary surfactant for treating respiratory distress syndrome were included. The primary outcome was a reduction in bronchopulmonary dysplasia or death. RESULTS: Four randomized clinical trials and two observational studies were included in this systematic review. Three of the randomized clinical trials found a reduction in bronchopulmonary dysplasia or death in the use of budesonide with the surfactant, all the other studies (1 clinical trial and 2 observational studies) found no statistical differences between the groups for the primary outcomes. The three main studies showed a reduction in the primary outcome; however, all studies showed great heterogeneity regarding the type of surfactant (poractant or beractant) and the method of administration. CONCLUSION: Robust clinical studies, in a heterogeneous population, using porcine surfactant associated with budesonide, with administration by a minimally invasive technique are necessary for there to be a recommendation based on scientific evidence for its widespread use.

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El proceso de respiración y el intercambio gaseoso requiere la interacción de variadas fuerzas en los distintos tejidos y órganos involucrados. La tensión superficial a nivel alveolar provocaría colapso de dichas estructuras de no ser por las características del surfactante que lo recubre. Revisaremos en este articulo la fisiología involucrada en su estructura física, producción y efectos pulmonares.

The process of breathing and gas exchange requires the interaction of various forces in the different tissues and organs involved. The surface tension at the alveolus would cause collapse of these structures without of the surfactant that covers it. We will review in this article the physiology involved in its physical structure, production, and pulmonary effects.

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Abstract Objective To compare the effects of expectant versus interventionist care in the management of pregnant women with severe preeclampsia remote from term. Data sources An electronic search was conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILACS, for its Spanish acronym), World Health Organization's International Clinical Trials Registry Platform (WHO-ICTRP), and Open- Grey databases. The International Federation of Gynecology and Obstetrics (FIGO, for its French acronym), Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG), and Colombian Journal of Obstetrics and Gynecology (CJOG) websites were searched for conference proceedings, without language restrictions, up to March 25, 2020. Selection of studies Randomized clinical trials (RCTs), and non-randomized controlled studies (NRSs) were included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of the evidence. Data collection Studies were independently assessed for inclusion criteria, data extraction, and risk of bias. Disagreements were resolved by consensus. Data synthesis Four RCTs and six NRS were included. Low-quality evidence from the RCTs showed that expectant care may result in a lower incidence of appearance, pulse, grimace, activity, and respiration (Apgar) scores<7 at 5 minutes (risk ratio [RR]: 0.48; 95% confidence interval [95%CI]: 0.23%to 0.99) and a higher average birth weight (mean difference [MD]: 254.7 g; 95%CI: 98.5 g to 410.9 g). Very low quality evidence from the NRSs suggested that expectant care might decrease the rates of neonatal death (RR: 0.42; 95%CI 0.22 to 0.80), hyalinemembrane disease (RR: 0.59; 95%CI: 0.40 to 0.87), and admission to neonatal care (RR: 0.73; 95%CI: 0.54 to 0.99). Nomaternal or fetal differences were found for other perinatal outcomes. Conclusion Compared with interventionist management, expectant care may improve neonatal outcomes without increasing maternal morbidity and mortality.

Resumo Objetivo Comparar os efeitos dos cuidados expectantes versus intervencionistas no manejo de gestantes com pré-eclâmpsia grave distante do termo. Fontes de dados Foi realizada uma busca eletrônica no Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS, para o espanhol) acrônimo), Plataforma Internacional de Registro de Ensaios Clínicos da Organização Mundial da Saúde (OMS-ICTRP) e bancos de dados OpenGrey. Foram pesquisados os sites da Federação Internacional de Ginecologia e Obstetrícia (FIGO, por sua sigla em francês), do Royal College of Obstetricians e Ginecologistas (RCOG), do American College of Obstetricians e Ginecologistas (ACOG) e do Colombian Journal of Obstetrics and Gynecology (CJOG) procedimentos da conferência, sem restrições de idioma, até 25 de março de 2020. Seleção de estudos Ensaios clínicos randomizados (RCTs) e estudos controlados não randomizados (NRSs) foram incluídos. A abordagem de Classificação de Recomendações, Avaliação, Desenvolvimento e Avaliação (GRADE) foi usada para avaliar a qualidade da evidência. Coleta de dados Os estudos foram avaliados de forma independente quanto aos critérios de inclusão, extração de dados e risco de viés. As discordâncias foram resolvidas por consenso. Síntese de dados Quatro RCTs e seis NRS foram incluídos. Evidências de baixa qualidade dos ECRs mostraram que o cuidado expectante pode resultar em uma incidência menor de pontuações de aparência, pulso, careta, atividade e respiração (Apgar) <7 em 5 minutos (razão de risco [RR]: 0,48; intervalo de confiança de 95% [IC 95%]: 0,23% a 0,99) e um peso médio ao nascer superior (diferença média [MD]: 254,7 g; IC 95%: 98,5 ga 410,9 g). Evidências de qualidade muito baixa dos NRSs sugeriram que os cuidados expectantes podem diminuir as taxas de morte neonatal (RR: 0,42; IC de 95% 0,22 a 0,80), doença da membrana hialina (RR: 0,59; IC de 95%: 0,40 a 0,87) e admissão à assistência neonatal (RR: 0,73; IC 95%: 0,54 a 0,99). Nenhuma diferença materna ou fetal foi encontrada para outros resultados perinatais. Conclusão Em comparação com o manejo intervencionista, o cuidado expectante pode melhorar os resultados neonatais sem aumentar a morbidade e mortalidade materna.

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RESUMEN Fundamento: la neumonía por COVID-19 es una enfermedad recién conocida que se ha extendido de manera rápida por todo el mundo. Los fundamentos patogénicos y los cambios histopatológicos que provoca el COVID-19 no se comprenden en su totalidad, lo cual atenta contra la identificación clínica adecuada de los pacientes y la implementación de estrategias terapéuticos eficaces. Objetivo: describir los hallazgos histopatológicos hallados en autopsia de casos confirmados de COVID-19. Métodos: la evidencia se recopiló mediante una búsqueda en PubMed de publicaciones en idioma inglés, utilizando las palabras claves: coronavirus, COVID-19, autopsy y síndrome de dificultad respiratoria aguda en varias combinaciones en el año 2020. Solo se hallaron cinco artículos con información sobre los resultados de las autopsias de casos confirmados con COVID-19. Resultados: desde el inicio de la pandemia en diciembre de 2019 se han publicado siete informes de autopsias de casos confirmados con COVID-19, recogidos en cuatro artículos. Todas las autopsias han coincidido en el principal hallazgo: daño alveolar difuso con formación de membrana hialina, lo cual se correlaciona con las manifestaciones clínicas del síndrome de dificultad respiratoria aguda. Conclusiones: el COVID-19 produce principalmente daño alveolar, el cual consiste en edema pulmonar con formación de membrana hialina que se expresa clínicamente como un síndrome de dificultad respiratoria aguda.

ABSTRACT Background: COVID-19 pneumonia is a recently recognized disease that has spread rapidly throughout the world. The pathogenic foundations and histopathological changes caused by COVID-19 are not fully understood, which undermines the proper clinical identification of patients and the implementation of effective therapeutic strategies. Objective: to describe the histopathological findings found at autopsy of confirmed cases of COVID-19. Methods: evidence was collected by searching PubMed for English language publications, using the keywords: coronavirus, COVID-19, autopsy and acute respiratory distress syndrome in various combinations in 2020. Only five articles were found with information on the autopsy results of confirmed cases with COVID-19. Results: since the start of the pandemic in December 2019, seven autopsy reports of confirmed cases with COVID-19 have been published, collected in 4 articles. All autopsies have agreed on the main finding: diffuse alveolar damage with hyaline membrane formation, which correlates with the clinical manifestations of acute respiratory distress syndrome. Conclusions: COVID-19 mainly produces alveolar damage, which consists of pulmonary edema with hyaline membrane formation, which is clinically expressed as an acute respiratory distress syndrome.

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La enfermedad de membrana hialina se debe a la deficiencia de surfactante en los pulmones de los recién nacidos especialmente los menores de 37 semanas de gestación. El manejo materno con corticoides prenatales en este grupo, disminuye la morbimortalidad asociada a esta patología neonatal. Se analiza desde el punto de la evidencia actualmente existente la administración de surfactante a estos prematuros y se revisa el tipo de surfactante a administrar, cuando es el mejor momento para administrarlo, la dosis y la forma de administrarlo.

Hyaline membrane disease is due to surfactant deficiency in the lungs of newborns, especially those younger than 37 weeks gestation. Maternal management with prenatal corticosteroids in this group reduces the morbidity and mortality associated with this neonatal pathology. The administration of surfactant to these preterm infants is analyzed from the point of the currently existing evidence and the type of surfactant to be administered is reviewed, when is the best time to administer it, the dose and the form of administration.

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Abstract Objective: The stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome. Method: This study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours. Results: The sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8 -22) stable microbubbles/mm2; control group = 100 (48 -230) microbubbles/mm2 (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85 -0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm2, the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively. Conclusion: The study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.

Resumo Objetivo: O teste das microbolhas estáveis no aspirado gástrico e no líquido amniótico foi usado no diagnóstico da síndrome do desconforto respiratório do recém-nascido. Contudo, nenhum estudo fez esse teste nos aspirados bucais de neonatos prematuros. O objetivo deste estudo foi avaliar o desempenho do teste das microbolhas estáveis em aspirados bucais de recém-nascidos prematuros para prever síndrome do desconforto respiratório. Método: Este estudo incluiu neonatos com idade gestacional < 34 semanas. Os fluidos orais foram obtidos imediatamente após o nascimento e os fluidos gástricos foram coletados nos primeiros 30 minutos de vida. As amostras foram congeladas e testadas em 72 horas. Resultados: A amostra foi composta de aspirados pareados de 64 recém-nascidos, divididos em dois grupos: grupo de síndrome do desconforto respiratório (n = 21) e grupo de controle (n = 43). A mediana (intervalo interquartil) da contagem das microbolhas estáveis nas amostras de fluido oral dos neonatos com síndrome do desconforto respiratório foi significativamente menor que a dos neonatos que não desenvolveram sintomas respiratórios: grupo de síndrome do desconforto respiratório = 12 (8-22) microbolhas estáveis/mm2; grupo de controle = 100 (48-230) microbolhas/mm2 (p < 0,001). A correlação entre a contagem das microbolhas nos aspirados gástricos e bucais foi 0,90 (intervalo de confiança de 95% = 0,85-0,95; p < 0,001). Considerando um ponto de corte de 25 microbolhas/mm2, a sensibilidade e a especificidade do teste das microbolhas estáveis foram 81,4% e 85,7%, respectivamente. Conclusão: O estudo sugere que o teste das microbolhas estáveis feito no aspirado bucal é uma opção confiável ao fluido gástrico para a predição da síndrome do desconforto respiratório do recém-nascido.

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RESUMEN Introducción: El estándar para inducción de madurez pulmonar en fetos con riesgo de nacer prematuramente es la administración de 12 mg de betametasona acetato/fosfato por dos veces espaciada cada 24 horas. El uso establecido en algunos hospitales públicos en Chile es con dos dosis de 12 mg betametasona fosfato aunque no existen estudios publicados sólo con betametasona fosfato sobre la incidencia de Síndrome de Distress Respiratorio (SDR). Objetivo: Evaluar efecto de betametasona en su forma fosfato como tratamiento antenatal para inducción de madurez fetal pulmonar en la incidencia SDR debido a membrana hialina en prematuros menores de 34 semanas de edad gestacional. Comparar el efecto de betametasona fosfato con el efecto publicado de betametasona acetato/fosfato. Material y método: Análisis de incidencia de SDR en prematuros nacidos en Hospital Padre Hurtado entre 24+0 y 34+0 semanas que recibieron betametasona fosfato para madurez pulmonar y aquellos que no la recibieron. Resultados: De 1.265 neonatos estudiados, 722 completaron dos dosis (57,5%); 436 sólo una dosis (34,5%) y 107 (8,5%) no recibieron corticoides antenatales. La incidencia de SDR debido a membrana hialina en el grupo con dos dosis fue 8,7%, una dosis 25,3% y 32,7% en los no tratados (p<0,001). Para SDR severo las incidencias fueron 6,7%, 12,6% y 16,8% respectivamente (p<0,001). Conclusiones: Inducción de madurez fetal pulmonar con betametasona fosfato en dos dosis de 12 mg IM separadas por 24 horas otorga una reducción significativa de incidencia de SDR semejante a la publicada con betametasona acetato/fosfato en iguales dosis.

ABSTRACT The standard for induction of lung maturity in fetuses at risk of being born prematurely is the administration of 12 mg of betamethasone acetate/phosphate two doses separated by 24 hours. The established use in some public hospitals in Chile is with two doses of 12 mg betamethasone phosphate although there are no studies published with betamethasone phosphate alone on the incidence of respiratory distress syndrome (RDS). Objective: To evaluate the effect of betamethasone in its phosphate form as antenatal treatment for the induction of fetal lung maturity in the incidence of RDS due to hyaline membrane in preterm infants less than 34 weeks of gestational age. To compare the effect of betamethasone phosphate with the published effect of betamethasone acetate/phosphate. Material and method: Analysis of the incidence of RDS in preterm infants born at Hospital Padre Hurtado between 24 + 0 and 34 + 0 weeks who received betamethasone phosphate for lung maturity and those who did not receive it. Results: Of 1,265 infants studied, 722 completed two doses (57.5%); 436 only one dose (34.5%) and 107 (8.5%) did not receive antenatal corticosteroids. The incidence of RDS due to hyaline membrane in the group with two doses was 8.7%, one dose 25.3% and 32.7% in the untreated ones (p <0.001). For severe RDS, incidences were 6.7%, 12.6% and 16.8% respectively (p <0.001). Conclusions: Induction of fetal lung maturity with betamethasone phosphate in two doses of 12 mg IM separated by 24 hours gives a significant reduction in the incidence of RDS similar to that published with betamethasone acetate/phosphate in equal doses.

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OBJECTIVE: The stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome. METHOD: This study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours. RESULTS: The sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n=21) and control group (n=43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group=12 (8-22) stable microbubbles/mm2; control group=100 (48-230)microbubbles/mm2 (p<0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval=0.85-0.95; p<0.001). Considering a cut-off point of 25microbubbles/mm2, the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively. CONCLUSION: The study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.

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INTRODUCCIÓN: Múltiples factores influyen en el riesgo de morbimortalidad del prematuro con restricción del crecimiento intrauterino (RCIU). La comparación de gemelos con crecimiento intrauterino discordante permite evaluar su efecto, excluyendo factores maternos y manejo prenatal. Nuestro objetivo fue evaluar el efecto de la RCIU sobre la morbilidad aguda, crónica y mortalidad, en parejas de recién nacidos gemelares prematuros extremos. PACIENTES Y MÉTODO: Gemelos menores de 1500 g y 30 semanas de gestación, de la Red Neocosur. Se realizaron análisis separados de pares de gemelos concordantes, discordantes leves y severos, evaluando el efecto de la RCIU sobre morbi-mortalidad. Se realizó análisis multivariado para establecer magnitud del efecto. RESULTADOS: 459 pares de gemelos, 227 concordantes, 110 discordantes leves y 122 severos. Entre los concordantes solo hubo diferencia en uso de oxígeno a las 36 semanas. En discordantes leves, el menor tuvo menos enfermedad de membrana hialina y requirió menos dosis de surfactante, pero tuvo un mayor riesgo de Displasia broncopulmonar (DBP) o muerte. En discordantes severos, el menor presentó mayor mortalidad, sepsis, utilización y permanencia en ventilación mecánica, pese a menor frecuencia de enfermedad de membrana hialina. En regresión múltiple, el riesgo combinado de DBP o muerte fue mayor en gemelo menor y discordante severo. CONCLUSIÓN: En gemelos discordantes, la patología respiratoria aguda fue más frecuente en el gemelo mayor, aunque el riesgo de DBP o muerte fue mayor en el gemelo con RCIU.

INTRODUCTION: Multiple factors influence the risk of morbidity and mortality of premature infants with intrauterine growth restriction (IUGR). The comparison of twins with different intrauterine growth allows evaluating the effect of the restriction, excluding maternal factors and prenatal mana gement. Our objective was to assess the effect of IUGR on acute and chronic morbidity, and mortality of extreme preterm twins. PATIENTS AND METHOD: Twins weighing less than 1500 grams and gesta tion equal to or less than 30 weeks, of the Neocosur Network. Separate analyses were performed on concordant twin pairs, and on mild and severe discordant twins, evaluating the effect of IUGR on morbidity and mortality. A multivariate analysis was performed in order to establish the impact of this effect. RESULTS: 459 twin pairs, 227 concordant twins, 110 of mild discordance, and 122 of severe discordance. Among the concordant ones, there was only a difference in oxygen uptake at 36 weeks. In those of mild discordance, the smaller twin presented a lower frequency of hyaline membrane disease and required fewer doses of surfactant, but had a higher risk of bronchopulmonary dysplasia (BPD) or death. In severe discordant twins, the smaller one presented higher mortality, sepsis, use and permanence in mechanical ventilation, despite the lower frequency of hyaline membrane disease. In multiple regression analysis, the combined risk of BPD or death was higher in the smaller twin and of severe discordance. CONCLUSION: In discordant twins, the acute respiratory pathology was more frequent in the larger one, although the risk of BPD or death was higher in the one with IUGR.

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Resumen OBJETIVO: Comparar las complicaciones perinatales en pacientes con eclampsia, síndrome HELLP y su asociación. MATERIALES Y MÉTODOS: Estudio transversal y comparativo efectuado en mujeres con eclampsia, síndrome HELLP, o ambos, y sus neonatos atendidas en el Hospital Regional Docente de Cajamarca, Perú, entre el 1 de enero y el 31 de diciembre de 2015. La información se procesó con el programa Epi Info versión 7. Se usó la ANOVA y χ2 no paramétrica con Kruskal-Wallis para comparar grupos, y se consideró significativo un valor de p < 0.05. RESULTADOS: Se registraron 3411 nacimientos; 71 pacientes tuvieron eclampsia o síndrome HELLP. Las complicaciones perinatales de prematurez, menor peso y talla al nacer y Apgar más bajo fueron significativamente mayores en mujeres con síndrome HELLP que con eclampsia. En cuanto a prematurez hubo 30 (66.6%) casos de madres con síndrome HELLP, 14 (70%) con eclampsia asociada con síndrome HELLP y ninguno con eclampsia (p = 0.01). El peso promedio al nacimiento fue 2133.5 ± 66.7 g en síndrome HELLP y 3083.1 ± 67.8 g en eclampsia (p = 0.001). Hubo Apgar más bajo al minuto y a los cinco minutos en la combinación eclampsia y síndrome HELLP que en solo eclampsia (p = 0.002). No hubo diferencias significativas en la mortalidad, restricción del crecimiento fetal, asfixia neonatal, taquipnea transitoria, enfermedad de membranas hialinas, enterocolitis necrotizante, policitemia, ictericia patológica o sepsis. La tasa de cesáreas en síndrome HELLP fue 41 (91.1%) y en eclampsia 4 (66.6%) (p = 0.03). CONCLUSIONES: Las complicaciones perinatales son mayores pacientes con síndrome HELLP que con eclampsia.

Abstract OBJECTIVES: To compare perinatal complications in patients with eclampsia, HELLP syndrome and association. MATERIALS AND METHODS: a cross-sectional, comparative study conducted in women with eclampsia and / or HELLP syndrome and their perinates in Hospital Regional Docente de Cajamarca , Peru. Data obtained from 01/01/2015 to 12/31/15. Information processing was carried out with the Epi Info program version 7. The ANOVA and non-parametric χ2 with Kruskal-Wallis were used to compare groups, and a value of P <0.05 was considered significant. RESULTS: 71 women had eclampsia and / or HELLP syndrome of 3411 births. Perinatal complications such as prematurity, lower weight and height at birth and lower Apgar were significantly higher in HELLP syndrome than in eclampsia. Regarding prematurity, there were 30 (66.6%) in HELLP syndrome, 14 (70%) in eclampsia associated with HELLP syndrome and none in eclampsia (p = 0.01). Birth weight was 2133.5 ± 66.7 g in HELLP syndrome and 3083.1 ± 67.8 g in eclampsia (p = 0.001). Apgar was lower at minute and at 5 minutes in the combination eclampsia and HELLP syndrome than in eclampsia alone (p = 0.002). There were no significant differences in mortality, IUGR, neonatal asphyxia, transient tachypnea, hyaline membrane disease, necrotizing enterocolitis, polycythemia, pathological jaundice or sepsis. The rate of cesareans in HELLP syndrome was 41 (91.1%) and in eclampsia 4 (66.6%) (p = 0.03). CONCLUSIONS: Perinatal complications are greater in HELLP syndrome than in eclampsia.

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RESUMEN Introducción: la enfermedad de membrana hialina, es una patología que afecta a prematuros, principalmente los menores de 30 semanas. Existen en el momento actual varios tipos de surfactantes para el tratamiento de esta entidad, los cuales han mostrado eficacia similar, pero algunos resultan ser más costo-efectivos que otros. Objetivo: evaluar la efectividad de Alveofact® versus Curosurf®, en neonatos prematuros ≤ 32 semanas, con enfermedad de membrana hialina, efectos colaterales de la administración, complicaciones neonatales y comparar los costos de su administración. Materiales y método: estudio de cohorte retrospectiva, en 136 neonatos prematuros, ≥ 24 semanas y ≥ 500g de peso al nacer; 64 de ellos fueron tratados con Alveofact® y 72 con Curosurf®. La exposición consistió en la administración de una dosis de Alveofact® (bovactant) 100mg/Kg y Curosurf® (poractant alfa) 200mg/Kg inicialmente, y como segunda dosis se suministró 100mg/Kg para cada uno. Posteriormente, se evaluó tiempo de ventilación mecánica, de oxigenoterapia, estancia, necesidad de segunda dosis, efectos colaterales por la administración y complicaciones; adicionalmente, mortalidad y displasia broncopulmonar. El análisis estadístico se realizó con Stata® 11.0, empleando Chi2 o Prueba exacta de Fisher, prueba t-test no pareado o Wilcoxon rank-sum. Resultados: no se hallaron diferencias significativas para tiempo de ventilación mecánica, oxigenoterapia, segunda dosis, estancia y complicaciones entre Alveofact® y Curosurf®. Adicionalmente, la displasia broncopulmonar se presentó en el 22,8% y la mortalidad en el 30,1%, sin diferencia significativa entre los dos surfactantes. Conclusiones: los resultados de esta investigación muestran que ambos surfactantes son igual de efectivos, pero el Curosurf® resulta más costoso. MÉD.UIS. 2016;29(3):13-25.

ABSTRACT Introduction: hyaline membrane disease, is a condition that affects preterm infants, especially those under 30 weeks. There are at present various types of surfactants for the treatment of this entity, which have shown similar efficacy, but some turn out to be more cost-effective than others. Objective: to evaluate the effectiveness of Alveofact® versus Curosurf® in preterm infants ≤32 weeks with hyaline membrane disease, side effects of administration, neonatal complications and to compare the costs of administration of the two surfactants. Materials and method: retrospective cohort study in 136 preterm infants ≥ 24 weeks and ≥ 500 g birth weight; 64 of them were treated with Alveofact ® and 72 with Curosurf ®. The exposure was the administration of a first dose of Alveofact ® (bovactant) 100mg/Kg and Curosurf ® (poractant alpha) 200mg/Kg and 100mg/Kg second dose for each group. Duration of mechanical ventilation, oxygen therapy, stay, need for second dose, side effects and complications administration were evaluated; additionally, mortality and bronchopulmonary dysplasia. Statistical analysis was performed with Stata ® 11.0 using Chi2 or Fisher exact test, t-test or unpaired Wilcoxon rank-sum. Results: no significant differences in duration of mechanical ventilation, oxygen therapy, second dose, stay and complications between Alveofact ® and Curosurf ® were found. The bronchopulmonary dysplasia occurred in 22.8% and 30.1% mortality, with no significant difference between the two surfactants. Conclusions: the results of this research show that both surfactants are equally effective, but Curosurf ® is more expensive. MÉD.UIS.2016;29(3):13-25.

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Introdução: O objetivo do estudo foi determinar a prevalência da Doença da Membrana Hialina (DMH) em prematuros de baixo peso e suas principais complicações. Métodos: Foi realizado um estudo descritivo do tipo série de casos. A população em estudo foram 34 prematuros com peso inferior a 1500 gramas e/ou idade gestacional inferior a 32 semanas nascidos no período de julho de 2010 a julho de 2011 no Hospital Universitário de Canoas/RS. Resultados: Pré-eclâmpsia e trabalho de parto prematuro foram as causas mais frequentes de parto pré-termo. DMH ocorreu em todos os recém-nascidos com peso inferior a 1000 gramas. Em prematuros com peso ao nascer entre 1001 e 1250 gramas e 1251 e 1499 gramas, a prevalência da DMH foi de 71,4% e 44,4%, respectivamente. A complicação da DMH mais frequente foi a persistência do canal arterial. Conclusões: A prevalência da DMH encontrada foi de 100% nos prematuros com peso até 1000 gramas e de 71,4% nos RNs com peso entre 1001g e 1250g. Nos prematuros com peso de 1251g a 1499g, a prevalência foi de 44,4% (AU)

Introduction: The aim of the study was to determine the prevalence of hyaline membrane disease (HMD) in preterm, low birth weight infants and its major complications. Methods: A descriptive study of the case series was conducted. The study population were 34 preterm infants weighing less than 1500 grams and/or gestational age less than 32 weeks born from July 2010 to July 2011 at the University Hospital of Canoas, RS. Results: Pre-eclampsia and preterm labor were the most frequent causes of preterm birth. HMD occurred in all newborns weighing less than 1000 grams. In premature infants with birth weights between 1001 and 1250 grams and 1251 grams and 1499, the prevalence of DMH was 71.4% and 44.4%, respectively. The most frequent complication of DMH was the persistent ductus arteriosus. Conclusions: The prevalence of DMH was 100% in preterm infants weighing up to 1000 grams and 71.4% in newborns weighing between 1001g to 1250g. In premature infants weighing 1251g to 1499g, the prevalence was 44.4% (AU)

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A Síndrome do Desconforto Respiratório (SDR), também conhecida como Doença da Membrana Hialina, é uma das principais causas de morbidade e mortalidade neonatal. O principal fator associado à SDR é a produção insuficiente de surfactante pulmonar, o que geralmente está associada à prematuridade. Alguns protocolos internacionais recomendam que a confirmação da maturidade pulmonar fetal seja realizada em partos eletivos antes de 39 semanas de gestação. Diversos são os métodos capazes de avaliar a maturidade pulmonar fetal, como a Relação Lecitina/Esfingomielina,a Pesquisa de Corpos Lamelares, a Relação Surfactante/Albumina, o percentual deFosfatidilglicerol, o Índice de Estabilidade da Espuma e o Shake Test ou Teste de Clements. Este estudo visa apresentar os principais métodos disponíveis e as recomendações atuais sobre quando realizar a avaliação da maturidade pulmonar fetal.(AU)

The Respiratory Distress Syndrome (RDS), also known as hyaline membrane disease, is a major cause of neonatal morbidity and mortality. The main factor associated with RDS is the insufficient production of pulmonary surfactant, which is usually associated with prematurity. Some international guidelines recommend that the confirmation of fetal lung maturity is performed in elective deliveries before 39 weeks of gestation. There are several methods to assess fetal lung maturity, such as the Lecithin/Sphingomyelin ratio, the Lamellar Body Count, the Surfactant/Albumin ratio, the percentage of phosphatidylglycerol, the Foam Stability Index and the Shake Test or Clements test. This study aims to present the main available methods and current recommendations on when to conduct the evaluation of fetal lung maturity.(AU)

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Introducción: según la Organización Mundial de la Salud, aproximadamente el 40 % de los partos prematuros están precedidos de ruptura prematura de membranas. Objetivo: identificar la morbilidad y mortalidad neonatal de las pacientes que presentaron rotura prematura de membranas pretérmino entre las 28,0 y 32,6 sem en el Hospital Ginecoobstétrico "Ramón González Coro". Métodos: se realizó un estudio descriptivo retrospectivo de 45 gestantes con rotura prematura de membranas pretérmino, entre las 28,0 y 32,6 sem de edad gestacional, que ingresaron en el Hospital Ginecobstétrico Ramón González Coro, entre enero de 2006 y diciembre de 2008. Se utilizó el porcentaje, las frecuencias, datos de contingencia y medias. La información fue procesada en el paquete estadístico SPSS 11.5. Resultados: el 48,9 % pesó menos de 1 500 g; el 22,0 % presentó síndrome de distrés respiratorio y enfermedad de membrana hialina; el 60,0 % de los que continuaron con una conducta expectante por más de 8 días luego de culminado el tratamiento antimicrobiano tuvieron sepsis neonatal; el 50,0 % presentó enfermedad de membrana hialina luego de 8 días de administrados los inductores de la madurez pulmonar fetal; todos los fallecidos pesaron menos de 1 500 g. Conclusiones: aproximadamente la mitad de los recién nacidos tuvo un peso inferior a los 1 500 g. La enfermedad de membrana hialina y la sepsis neonatal fueron las complicaciones más frecuentes. Predominó la enfermedad de membrana hialina en los que concluyeron la terapia esteroidea por más de 8 días. La mortalidad neonatal fue significativa en los recién nacidos con peso inferior a 1 500 g.

Introduction: according to the World Health Organization, approximately 40 % of preterm births are preceded by premature rupture of membranes. Objective: to identify neonatal morbidity and mortality in patients who had premature rupture of membranes between 28.0 and 32.6 weeks at Ramón González Coro Maternity Hospital. Methods: a retrospective study was conducted in 45 pregnant women with preterm premature rupture of membranes between 28.0 and 32.6 wk gestational age, they were admitted to Ramón González Coro Maternity Hospital, from January 2006 to December 2008. Percentage, frequencies, and average data contingency were estimated. The information was processed using SPSS 11.5. Results: 48.9 % weighed less than 1 500 g, 22.0 % had respiratory distress syndrome and hyaline membrane disease, 60.0 % of those who continued with watchful approach for more than 8 days after completed antimicrobial treatment, had neonatal sepsis, 50.0 % had hyaline membrane disease after 8 days receiving inducers of fetal lung maturity, all dead cases weighed less than 1 500 g. Conclusions: about half of these infants weighing less than 1 500 g. Hyaline membrane disease and neonatal sepsis were the most common complications. Hyaline membrane disease was predominant in those who completed steroid therapy for more than eight days. Neonatal mortality was significant in infants weighing less than 1 500 g.

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Introducción: La enfermedad de membrana hialina es causa importante de mortalidad neonatal. El objetivo de esta investigación fue evaluar la eficacia de tres tipos de surfactante exógeno en prematuros. Pacientes y Método: Estudio de cohorte retrospectiva, en 93 neonatos prematuros, > 24 semanas y > 500 g de peso al nacer, 31 para cada surfactante. La exposición fue la administración de 1ª dosis bovactant (Alveofact®) 50 mg/kg, beractant (Survanta®) 100 mg/kg inicial, y poractant alfa (Curosurf®) 200 mg/kg. Las variables en estudio incluyeron tiempo de ventilación mecánica, tiempo de oxigenoterapia, estancia hospitalaria, necesidad de segunda dosis de surfactante, eventos adversos por la administración del surfactante y complicaciones por prematuridad. Además, se evaluó mortalidad, displasia broncopulmonar (DBP) y mortalidad o DBP. Análisis estadístico mediante Stata® 11.0, empleando X² o Prueba Exacta de Fisher para variables cualitativas y Pruebas ANOVA o Kruskal-Wallis para cuantitativas y riesgo relativo para las asociaciones, todas con su intervalo de confianza de 95%. Resultados: No hubo diferencias para sexo, peso y edad gestacional al nacer entre los 3 grupos. No se hallaron diferencias estadísticamente significativas para tiempo de ventilación mecánica, tiempo de oxigenoterapia, administración de una segunda dosis de surfactante, estancia hospitalaria y complicaciones entre los 3 grupos. Los eventos adversos por administración de surfactante se presentaron para beractant y poractant alfa. Ocurrieron 30 (32,3 por ciento) muertes, 8 (25,8 por ciento) para bovactant, 10 (32,3 por ciento) beractant y 12 (38,7 por ciento) poractant alfa (p > 0,05). La mortalidad y/o DBP ocurrió en 10 (32,2 por ciento) neonatos con bovactant, 10 (32,2 por ciento) con beractant y 14 (45,2 por ciento) con poractant alfa (p > 0,05). Conclusiones: Los resultados primarios y secundarios entre los tres surfactantes evaluados fueron muy similares...

Introduction: Hyaline membrane disease is an important cause of neonatal mortality. The objective of this research is to evaluate the efficacy of three different exogenous surfactants in premature infants. Patients and Method: A retrospective cohort analysis in 93 preterm infants > 24 weeks and birth weight > 500 g was performed, 31 infants for each surfactant. Exposure consisted of the 1st dose of bovactant (Alveofact®) 50 mg/kg, beractant (Survanta®) 100 mg/kg initially, and poractant alfa (Curosurf®) 200 mg/kg. The variables included duration of mechanical ventilation, duration of oxygen therapy, hospital stay, need for second dose of surfactant, adverse events surfactant administration and prematurity complications. Mortality and bronchopulmonary dysplasia (BPD) were evaluated. Statistical analysis was performed using Stata® 11.0, X² or Fisher exact test for qualitative variables and ALNOVA or Kruskal-Wallis tests for quantitative and association relative risk, all with 95 percent confidence level. Results: There were no gender, weight and gestational age differences at birth among the three groups. No statistically significant differences were found regarding duration of mechanical ventilation, duration of oxygen therapy, administration of a second dose of surfactant, hospital stay and complications among the three groups. Adverse events related to surfactant administration occurred for beractant and poractant alpha. There were 30 (32.3 percent) deaths, 8 (25.8 percent) associated to bovactant, 10 (32.3%) to beractant and 12 (38.7 percent) to poractant alpha (p > 0.05). Mortality and/or BDP occurred in 10 (32.2 percent) infants who received bovactant, 10 (32.2 percent) beractant and 14 (45.2 percent) with poractant alpha (p > 0.05). Conclusions: The primary and secondary outcomes among the three surfactants tested were similar, taking into account the limitations of the work.

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Introducción: el parto pretérmino de un recién nacido con peso menor de 1 500 g, constituye uno de los problemas más importantes para la salud materno-infantil, ya que en este grupo de pacientes se concentra la mayor parte de la morbilidad y mortalidad perinatal. Objetivo: identificar eventos perinatales en partos pretérmino con recién nacidos menores de 1 500 g. Métodos: se realizó un estudio descriptivo de 80 gestantes con edad gestacional entre 28,0 y 36,6 sem que presentaron partos pretérmino con recién nacidos menores de 1 500 g pertenecientes al Hospital Ginecobstétrico "Ramón González Coro", desde enero de 2008 a diciembre de 2010. El análisis descriptivo de los datos se realizó mediante distribuciones de frecuencias absolutas y relativas. Se utilizó la prueba Chi Cuadrado (X²) con un 95 % de confiabilidad. Resultados: el 75 % presentó factores de riesgo. Predominaron los trastornos hipertensivos del embarazo, el asma bronquial y la anemia con un 48,8 %, 7,5 % y 6,3 % respectivamente. El 45 % de los partos fue secundario a una rotura prematura de membranas pretérmino. El bajo peso al nacer predominó en el 56,3 % del total. El 29,8 % presentó restricción del crecimiento fetal y el 28,6 % enfermedad de membrana hialina. Conclusiones: las tres cuartas partes presentaron factores de riesgo. Predominó la hipertensión arterial y la preeclampsia como factores de riesgo principales. La causa más frecuente de parto pretérmino fue la rotura prematura de membranas. La restricción del crecimiento intrauterino y la enfermedad de membrana hialina fueron las complicaciones más frecuentes.

Introduction: preterm delivery of an infant weighing less than 1 500 g is one of the most important health problems for a mother and her child, as perinatal morbidity and mortality are concentrated in this patient population. Objective: to identify perinatal events in preterm birth infants weighing less than 1 500 g. Methods: a descriptive study was carried out to identify perinatal events in 80 pregnant women with gestational age between 28.6-36.6 weeks. These patients had preterm birth infants weighing less than 1 500 grams. They were all attended at Ramón González Coro OB/GYN Hospital, from January 2008 to December 2010. This descriptive data analysis used distributions of absolute and relative frequencies. The chi-square test (X²) was used, showing 95 % confidence. Results: 75 % had risk factors. Pregnancy hypertensive disorders (48.8 %), asthma (7.5 %), and anemia (6.3 %) were predominant. 45 % of births occurred after premature rupture of membranes. Low birth weight prevailed in 56.3 % of the total. 29.8 % had fetal growth restriction and 28.6% had hyaline membrane disease. Conclusions: risk factors were present in three quarters of the patients. Hypertension and pre-eclampsia predominated as major risk factors. The most common cause of preterm birth was premature rupture of membranes. Intrauterine growth restriction and hyaline membrane disease were the most frequent complications.

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Comparar la incidencia de la enfermedad de membrana hialina del recién nacido de pacientes preeclámpticas con embarazadas normotensas sanas. Se realizó un estudio de cohortes en todas las pacientes con embarazos simples entre 24 y 36 más 5 semanas de gestación con fetos vivos en el período de enero de 1999 a septiembre de 2008. El diagnóstico de la enfermedad de membrana hialina se realizó por los criterios clínicos y radiológicos. Servicio de Ginecología y Obstetricia. Hospital Central “Dr. Urquinaona”. Maracaibo. Estado Zulia. El número de recién nacidos con diagnóstico de enfermedad de membrana hialina durante el período de estudio fue de 2 491 casos, representando un 7,73 por ciento de los recién nacidos vivos. Se encontraron 56 casos (11,24 por ciento) de la enfermedad de membrana hialina en los recién nacidos de los casos de pacientes preeclámpticas y 206 recién nacidos (10,33 por ciento) entre las pacientes controles (OR 1,098; IC 95 por ciento 0,803 - 1,502). Al seleccionar los recién nacidos con edad gestacional menor de 32 semanas, se encontró en las pacientes preeclámpticas un total de 92 recién nacidos de los cuales 28 de ellos (30,43 por ciento) desarrollaron enfermedad de membrana hialina, mientras que en el grupo de los controles se encontraron 261 recién nacidos de los cuales 70 (26,81 por ciento) desarrollaron la enfermedad (OR 1,194; IC 95 por ciento 0,708 - 2,012). No existe diferencia en la incidencia de la enfermedad de membrana hialina de recién nacido de pacientes preeclámpticas comparado con embarazadas normotensas

To compare the incidence of hyaline membrane disease in newborns of preeclamptic patients with normotensive pregnant patients. A cohort study was done with all patients with single pregnancies between 24 + 0 and 36 + 5 weeks of gestation with live fetuses in the period January 1999 to September 2008. Diagnosis of hyaline membrane disease was done over clinical criteria. Servicio de Ginecologia y Obstetricia. Hospital Central “Dr. Urquinaona”. Maracaibo. Estado Zulia. The number of newborn with diagnosis of hyaline membrane disease during the period was of 2 491 cases, representing 7.73 percent of all live newborns. There were 56 cases (11.45 percent) of hyaline membrane disease in newborn of cases and 206 newborns (10.33 percent) between control patients (OR 1.098; 95 percent IC 0.803 - 1.502). When newborn less than 32 weeks were selected, in preeclamptic patients, there were 92 newborns of whom 28 (30.43 percent) developed hyaline membrane disease, while in control group there were found 70 of 261 newborns who developed disease (OR 1.194; 95 percent IC 0.708 - 2.012). There is not difference in the incidence of hyaline membrane disease in newborn of preeclamptic patients compared with normotensive pregnant patients

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Introducción: uno de los desafíos más importantes en el campo de la neonatología ha sido el tratamiento integral al recién nacido muy pequeño, así como el lograr disminuir las elevadas tasas de morbilidad y mortalidad en estos con edad gestacional extremadamente baja. Métodos: se realizó un estudio descriptivo observacional de corte transversal, en el que se incluyeron 139 neonatos con peso al nacer menor de 1 500 g y menos de 37 semanas de edad gestacional, en el período de 2003-2007, en el Hospital Ginecoobstétrico "Dr. Eusebio Hernández". Las variables de estudio fueron: edad gestacional, peso al nacer, sexo, modo de nacimiento, puntaje de Apgar, evaluación nutricional, morbilidad y causa de muerte. Se presentaron los resultados mediante tasas y porcentajes principalmente. Resultados: la incidencia hallada fue del 0,66 % en el período de estudio. Más de la mitad de los pacientes nacieron mediante cesárea (57,6 %) y el 73,3 % obtuvo una puntuación de Apgar normal. La incidencia de recién nacidos con peso inferior a los 1 000 g fue de 11,5 %. Más de ¾ del universo se clasificó con crecimiento intrauterino restringido. La primera causa de morbilidad fue la sepsis de comienzo tardío, seguido por la enfermedad de la membrana hialina. El 100 % de los pacientes inmaduros no sobrevivió (menos de 28 semanas), mientras que el 37,5 % de los extremadamente pequeños al nacer (menos de 1 000 g) fueron egresados vivos. La entidad que más muertes causó fue la sepsis (34,2 %), principalmente, la sepsis de comienzo tardío, con un índice de letalidad 1,5 mayor que la sepsis congénita. Conclusiones: la incidencia de los neonatos de muy bajo peso fue inferior a lo referido en reportes internacionales. La sepsis y la enfermedad de la membrana hialina constituyeron las principales causas de morbilidad y mortalidad. Los neonatos minúsculos y los inmaduros conformaron el grupo de mayor aporte a la mortalidad.

Introduction: one of the more significant challenges in the field of the neonatology has been the integral treatment to a very small newborn as well as to achieve decrease the high rates of morbility and mortality in newborns with a very low gestational age. Methods: an observational and descriptive and cross-sectional study was conducted in 139 neonates weighing under 1 500 g and with less than 37 weeks of gestational age, over 2003-2007 in the "Dr. Eusebio Hernandez" Gynecology and Obstetric Hospital. The study variables were: gestational age, birth weight, sex, birth route, Apgar score, nutritional assessment, morbility and cause of death. Authors showed the results mainly by means of rates and percentages. Results: the incidence found was of the 0, 66 % during study period. More than a half of patients born by cesarean section (57.6 %) and the 73.3 % had a normal Apgar score. The newborn incidence weighing under 1 000 g was of 11.5 %. More than the three quarter of universe was diagnosed with a restricted intrauterine growth. The first cause of morbility was the late onset sepsis, followed by the hyaline membrane disease. The 100% of immature patients dyed (less than 28 weeks), whereas the 37.5 % of the very small at birth (less than 1 000 g) were alive at discharge. The entity that more deaths provoked was the sepsis (34.2 %), mainly, the late onset sepsis, with a lethality rate 1,5 higher than the congenital sepsis. Conclusions: the incidence of neonates with very low weight was lower than mentioned in the international reports. Sepsis and hyaline membrane disease were the major causes of morbility and mortality. The very little neonates and those immature were included the group with more cases of mortality.

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Introduction: It is thought that intrauterine growth restriction induces respiratory maturation. The information varies if the studies consider analysis based on birth weight or gestational age. Objective: The goal of this study is to compare the incidence and evolution of hyaline membrane disease (HMD) between small and adequate premature babies under 35 weeks of gestational age (< 35 wGA) based on data in the literature. Patients and Methods: Two databases were created and analyzed: a) 2 022 newborns < 35 wGA admitted to the Service, whose incidence of HMD was calculated, and b) 733 newborns < 35 wGA with HMD and treated with surfactant, to describe the evolution. Results: Analysis of GA group shows a higher incidence of HMD (35.2 percent) among small for GA, and less (29.1 percent) among those who are not small for GA (p: 0.026). If a subset is formed for the newborns < 1 500 g in birth weight, those small for gestational age have a lower incidence (47.5 percent) than those adequate for GA (60.7 percent). Logistic regression analysis for discharge with oxygen of newborns with HMD shows association with lower z score for birth weight, corticosteroid use and oxygen dependence at 36 weeks. Conclusions: Preterm newborns small for GA show a higher incidence of HMD and oxygen dependence when comparing for GA.

Introducción: Tradicionalmente se ha considerado que la restricción de crecimiento intrauterina produce maduración respiratoria, pero la información es diferente según si los estudios consideran el análisis por grupos de peso de nacimiento o edad gestacional. Objetivo: El objetivo de este análisis fue comparar la incidencia y evolución de membrana hialina, de los prematuros menores de 35 semanas de edad gestacional según fueran pequeños o no para edad gestacional. Pacientes y Método: Se analizaron dos bases de datos: 2 022 menores de 35 semanas hospitalizados en el Servicio para determinar incidencia de membrana hialina y 733 menores de 35 semanas tratados con surfactante con diagnóstico de membrana hialina para comparar evolución de ésta. Resultados: El análisis por grupos de edad gestacional muestra una incidencia de membrana hialina mayor, de 35,2 por ciento, en los pequeños para la edad gestacional, y de 29,1 por ciento en los no pequeños (p: 0,026). Si se analiza sólo menores de 1 500 gramos de peso de nacimiento, el grupo pequeño tiene una incidencia menor, de 47,5 por ciento, y los no pequeños de 60,7 por ciento. El análisis de regresión logística para alta con oxígeno de los que tuvieron membrana hialina, muestra asociación con menor puntaje z de peso de nacimiento, uso de corticoides y dependencia de oxígeno a las 36 semanas. Conclusiones: El recién nacido pretérmino pequeño para edad gestacional tiene mayor incidencia de membrana hialina y evoluciona con mayor dependencia de oxígeno al comparar por edad gestacional.

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