We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
The term neural tube defects (NTDs) or spina bifida refers to a diverse group of congenital malformations of the central nervous system that primarily affect the spinal cord and vertebral column. In the most severe cases, such as myelomeningocele and meningocele, there is a failure of the vertebral column to close, allowing the spinal cord to protrude externally (open defects). Milder forms, such as lipomas or lipomyelomeningocele, present as a soft mass covered by skin, a hairy lumbar patch, or may go unnoticed (closed defects). The most severe defects can be associated with other brain malformations, such as Chiari II malformation.
The cause of neural tube defects (NTDs) is unknown, but current evidence suggests that genetic predisposition combines with external factors. Some of these factors are recognized (such as valproic acid or methotrexate), but in most cases, they are related to a deficiency or interference in folic acid metabolism.
Administration of folic acid to women before conception has reduced the incidence of the malformation.
Prenatal diagnosis is usually performed via ultrasound. Since 2011, our hospital has applied an ultrasound-based technique, developed by rehabilitation doctors and obstetricians, that allows prenatal determination of the type and motor level of the fetus with spina bifida. This enables an individualized and reliable prognosis of the child’s motor and functional abilities.
Patients with myelomeningocele:
Patients with lipomas or lipomyelomeningocele:
The treatment of choice for open defects is prenatal surgical closure between 24–26 weeks of gestation, aiming to minimize sequelae from the malformation.
From birth, a child with spina bifida must be monitored in a specialized unit that guarantees their lifelong care and therapeutic needs. The multidisciplinary team should include obstetricians, pediatricians, neurosurgeons, urologists, orthopedic surgeons, pediatric surgeons, rehabilitation doctors, physiotherapists, occupational therapists, nurses, and orthotic technicians.
Treatment must be individualized, as different types of neural tube defects lead to different sequelae.
Basic objectives of NTD treatment:
The Spina Bifida Unit at our hospital has existed since the 1970s. It is the only unit in the area that can provide continuous care from birth throughout life, with the same team of professionals.
The rehabilitation doctor coordinates the unit, integrating the various therapeutic proposals to ensure they are realistic and achievable. This approach prevents unfeasible recommendations that could cause disappointment for families and suffering for the patient.
There are two key aspects in the prevention, detection, and treatment of cognitive-behavioral disorders: the observation made by parents and the observation made by the child’s pediatrician. This highlights the importance of routine pediatric visits.
During the first year of life, stimulation through play and singing is essential. The brain’s plasticity for learning during this period is greater than at any other stage of life, and brain weight grows exponentially. Stimuli are crucial; both smiling and passive movement of the limbs naturally occur through play.
Observing the child is also important to identify which areas need additional support, such as teaching them to roll over, crawl, or walk. In case of doubt or if a significant abnormality is detected, a multidisciplinary approach is needed to establish an early diagnosis and the most appropriate treatment.
It is essential in child development—especially during the first year of life—to provide stimulation through play and singing. The brain’s plasticity for learning during the first year is greater than at any other stage of life, and the brain’s weight increases exponentially. Stimuli are essential; both smiling and passive limb movements naturally occur through play.
Observing the child is also important to identify which areas need more support: teaching them to roll over, crawl, or walk. In case of doubt or if a significant abnormality is detected, a multidisciplinary approach will be necessary to establish the diagnosis and provide appropriate therapy as early as possible.
The treatment of cognitive-behavioral disorders depends on the specific condition detected.
In the case of genetic disorders, a specific treatment is often not possible, but early analysis and detection are always necessary.
In the case of metabolic disorders, there are specific diets or medications aimed at fully or partially correcting the detected metabolic disorder.
Human genome ultra-sequencing currently allows the detection of hundreds of genetic alterations from a small blood sample, from which genetic information is extracted. There are databases in all developed countries that, working in a network, share information to group sporadic cases from around the world, enabling joint research into how these alterations affect a person’s behavior or learning.
Likewise, the biochemical study of the body’s metabolic pathways is becoming increasingly comprehensive, allowing the design of specific drugs for each situation.
A new treatment approach, currently under development, is the shift from pills to cells as therapy—working directly on the affected cell to modify its behavior. This approach is still very preliminary, but it is a field that will undoubtedly see significant development in the future.
The neurosensory development of children is a complex process that begins during intrauterine life and continues from the neonatal stage throughout childhood and into adolescence. All disorders or dysfunctions related to learning or behavior are grouped under cognitive-behavioral disorders.
Learning is a constant part of human behavior throughout life, but the quantity and quality of knowledge acquired during the first year of life is far greater—or at least comparable—to that acquired over the rest of a lifetime. The human brain increases in weight by one gram per day during the first year, followed by the formation of neuronal connections and networks that enable social smiling at one month of age, recognition of unfamiliar people at seven months, and learning to refuse to release objects around one year of age. In parallel, motor development progresses, allowing children to walk between 12 and 16 months. As development continues, cognitive (learning) and behavioral (approach–avoidance) growth intertwine, along with social interactions with parents and siblings. Many times, it is the parents—and sometimes pediatricians—who first notice that a child seems “different” or shows behaviors that draw attention.
The spectrum of cognitive-behavioral disorders is very broad, as are their symptoms. In general, symptoms include not achieving cognitive or behavioral milestones within the age range considered normal. For example, not exhibiting a social smile by the second month of life or not recognizing strangers by twelve months. Cognitive-behavioral disorders often form part of a broader condition, frequently with a genetic basis that may also affect other organs.
The incidence of cognitive-behavioral disorders is estimated to be between 1% and 3% of all children.
Parents are often the first to notice atypical signs in development or behavior, sometimes by comparing with siblings. During routine visits, the pediatrician evaluates age-appropriate developmental skills. If further assessment is needed, pediatric neurologists and geneticists can provide a more precise diagnosis. Diagnostic tests for these disorders always include a physical examination, genetic analysis, and laboratory tests that evaluate for metabolic diseases. Neuroimaging studies may also be helpful.
Treatment depends on the cause of the cognitive-behavioral developmental disorder. If the cause is metabolic, effective and sometimes curative treatments may exist. If the cause is genetic, it is possible to predict the course of the condition and recommend supportive educational strategies, although fully effective treatments are not yet available.
The physical examination helps determine whether the child is reaching developmental milestones appropriate for their age.
Genetic tests detect whether there is an alteration in the patient’s genes that could explain the observed anomaly.
Laboratory tests—typically using blood or urine—help confirm or rule out abnormalities in the body’s normal metabolic pathways.
Pediatric neurological examination, imaging studies, metabolic laboratory tests, genetic studies based on sequencing or ultra-sequencing, and evaluation by Child Psychiatry (Pediatric Psychiatry).
If there is a family history of cognitive-behavioral disorders, genetic counseling prior to pregnancy may be useful. The neurosensory development of children is a complex process that begins during intrauterine life and continues from the neonatal stage through childhood and adolescence. Adequate monitoring during pregnancy and childbirth is also essential to help prevent these types of disorders.
One in eight women develops breast cancer, with the peak incidence at age 50. It is important to note that only about 5 % of breast cancers are hereditary, and 1 % of men can also be affected.
Localized breast cancer, meaning the tumor is confined to the breast and there are no metastases, has a five-year survival rate of 90 %, meaning that 90 women out of 100 will still be alive five years after being diagnosed with breast cancer. Breast cancer mortality has decreased significantly over the past three decades due to the implementation of mammographic screening and advances in treatments.
Breast cancer is an uncontrolled growth of breast cells resulting from abnormal changes in the genes that regulate cell growth and maintain healthy cells.
Breast cancer often appears without any noticeable changes in the breast and may be detected only through screening mammography. When symptoms do occur, the most common is the presence of a lump in the breast, usually found through self-examination. Less common symptoms include a lump in the armpit, changes in breast size or shape, changes in skin texture or color—such as breast swelling or skin irritation known as “peau d’orange”—local pain, and nipple inversion or discharge.
It is important to note that benign breast conditions can cause these same symptoms, so it is essential to consult a primary care physician or gynecologist to rule out breast cancer.
When breast cancer is suspected, a mammogram and ultrasound should be performed, with the latter helping to distinguish whether the lesion is solid or cystic. A core needle biopsy of the lesion is essential to confirm or rule out breast cancer and to provide the necessary information to classify the type of breast cancer.
After confirming a breast cancer diagnosis, in some cases, a staging study is required, which may include a bone scan and a thoracoabdominal CT scan to rule out metastasis to organs such as bone, lung, or liver.
Breast cancers are classified as ductal or lobular, with ductal being the most common (80%) and originating in the milk ducts.
Based on biological behavior, breast cancers are categorized into subtypes according to the expression of hormone receptors and the HER2 protein. The main groups are:
Luminal (80%, hormone receptor–positive)
HER2-positive (20%, with HER2 expression/amplification)
Triple-negative (20%, lacking hormone receptors and HER2 expression)
According to tumor spread, breast cancer is staged from I to IV, with stage IV being the most advanced. Staging is based on three main variables: T (tumor size), N (degree of axillary lymph node involvement), and M (presence of metastasis).
Treatment for early-stage breast cancer, meaning cancer localized to the breast or lymph nodes without organ metastasis, includes a combination of surgery, radiotherapy, chemotherapy, biological therapies, and hormone therapy. The choice of treatment depends on tumor biology and disease stage (TNM classification).
In some cases, when the benefit of chemotherapy for preventing recurrence is uncertain, genomic platforms such as Oncotype DX can be used. This test analyzes 21 genes in the removed tumor tissue and provides a score from 0 to 100, with higher scores indicating tumors that are more likely to benefit from chemotherapy.
Lifestyle habits that help reduce the risk of breast cancer include:
The acceptance of these terms implies that you give your consent to the processing of your personal data for the provision of the services you request through this portal and, if applicable, to carry out the necessary procedures with the administrations or public entities involved in the processing. You may exercise the mentioned rights by writing to web@vallhebron.cat, clearly indicating in the subject line “Exercise of LOPD rights”. Responsible entity: Vall d’Hebron University Hospital (Catalan Institute of Health). Purpose: Subscription to the Vall d’Hebron Barcelona Hospital Campus newsletter, where you will receive news, activities, and relevant information. Legal basis: Consent of the data subject. Data sharing: If applicable, with VHIR. No other data transfers are foreseen. No international transfer of personal data is foreseen. Rights: Access, rectification, deletion, and data portability, as well as restriction and objection to its processing. The user may revoke their consent at any time. Source: The data subject. Additional information: Additional information can be found at https://hospital.vallhebron.com/es/politica-de-proteccion-de-datos.