[Influence of socioeconomic factors on weight, length and head circumference measurements in newborns from 35 to 42 weeks gestational age]. / Influencia de los factores socioeconómicos en el peso, la longitud y el perímetro occipitofrontal de los recién nacidos entre 35 y 42 semanas de gestación.

BACKGROUND AND OBJECTIVE: gestational age and anthropometric measurements, i.e. weight, length and head circumference at birth, have all been used as predictors of neonatal morbidity-mortality and adult morbidity. Differences in ethnic or socioeconomic background of newborn cohorts, as well as methodological differences between studies limit the validity and application of current anthropometric curves across different populations. Thus, we conducted a study to obtain local reference data in a Hospital that had a medium-high socio-economic class population, probably different to others recently published in our geographic area, and to compare them. PATIENTS AND METHOD: Weight, length and head circumference at birth were retrospectively analysed in 31,397 live Caucasian neonates born at 23-42 weeks in SCIAS-Hospital de Barcelona between 1992 and 2006. Only single gestations were selected and no other exclusion by materno-fetal or neonatal pathology criteria were applied. Percentile values, mean and standard deviation for each anthropometric measurement were calculated according to gestational age and gender. They were compared with the results from recent publications of our geographic area. RESULTS: Males were found to have significantly higher weight, length and head circumference values than females from 36 weeks. There was a trend towards higher values in our population when compared with others in our geographic area. CONCLUSIONS: The influence of socioeconomic factors on fetal growth seems evident. Nevertheless, it is difficult to assume that the observed differences must be exclusively due to the population characteristics or the different methodologies in the selection of the sample. Thus, it is desirable to have anthropometric reference curves obtained from populations of surrounding areas, with epidemiological methodologies that might be more appropriate in identifying valid outcome predictors, and enable us to compare with others groups according to racial, socioeconomic and disease factors.

[Cord blood levels of interleukin 6 in preterm infants as an early marker of neonatal morbidity]. / Determinación de interleucina 6 en sangre de cordón en prematuros, como indicador precoz de morbilidad neonatal.

INTRODUCTION: The prematurity rate in our country is 8-9 %. Despite the decrease in neonatal mortality during the last decade, there is still a high incidence of neonatal morbidity and its subsequent sequelae. It is well known that the fetal inflammatory response plays an important role in the presence of neonatal morbidity. The aim of this study is to determine if interleukin 6 (IL-6) measurements in cord blood are a useful parameter to recognize those preterms with higher probability of suffering neonatal morbidity. PATIENTS AND METHOD: Descriptive and prospective study in newborns with gestational ages (GA) < or = 34 weeks. We determined IL-6 levels in cord blood; white cell count and C reactive protein (CRP) levels at 0, 12, 24 and 72 hours of life, and blood culture at admission. Clinical data was also collected, including perinatology factors, symptomatology on admission and subsequent evolution until discharge or death. RESULTS: We included 99 newborns with a GA between 23 and 34 weeks and birth weights between 480 and 2,855 g. Levels of IL-6 > 10 pg/ml show a significant correlation between maternal fever and/or chorioamnionitis (P = 0.005), a weak but significant correlation (P = 0.05, r = 0.3) between increased levels of CRP at 24 hours of life and Critical Risk Index for Babies (CRIB) score > or = 4 (P < 0.003, r = 0.2) and a significant correlation (P = 0.04) with the presence of periventricular leukomalacia (PVL) and with length of hospital stay (P = 0.0015). Patients with a lower GA show a trend to have higher levels of IL-6. CONCLUSIONS: IL-6 could be a useful and early marker of neonatal morbidity. Its rapid ability to predict neonatal morbidity gives it an advantage over other classical blood markers.

[Neonatal withdrawal syndrome to selective serotonin reuptake inhibitors: case report and literature review]. / Síndrome de abstinencia neonatal a inhibidores selectivos de la recaptación de serotonina: a propósito de un caso y revisión de la bibliografía.

INTRODUCTION: The treatment with selective serotonin reuptake inhibitors (SSRIs) is widely prescribed in pregnant women. Its gestational use is not associated with an increased risk of major foetal anomalies when used in their recommended doses. A SSRI-related neonatal syndrome has been described secondary to withdrawal in infants exposed to these drugs during the last trimester of pregnancy. However, little is known about neonatal psychopharmacology. CASE REPORT: An infant whose mother received treatment with paroxetine (20 mg/kg/day) during the third trimester was born prematurely and presented withdrawal symptoms within few days after birth. Symptoms were irritability with constant crying, shivering, increased muscle tone, coreiform movements and feeding problems. Only supportive care was needed and symptoms disappeared by two weeks of age. CONCLUSIONS: In utero exposure to SSRIs during the last trimester through delivery may result in a self-limited neonatal behavioural syndrome that can be managed with supportive care. Its increasing incidence in neonates may be due to a greater frequency of its gestational use. All these neonates should be followed-up closely looking forward withdrawal symptoms in the first days of life. We need a better understanding of SSRIs effects and pharmacokinetics, and further research should focus on whether it is safe to use SSRIs during the last trimester.

[Topiramate and pregnancy. Neonate with bone anomalies]. / Topiramato y embarazo. Recién nacido con anomalías óseas.

Topiramate is a new generation, antiepileptic drug used for the treatment of persistent partial crises. To date no specific teratogenic effects have been reported in humans, but they have appeared in experimental animals. We present the case of a neonate whose mother suffered from partial epilepsy, which was treated with topiramate throughout pregnancy at doses of 300 mg per day. When the child was born agenesis of the right thumb, hypoplasia of the left thumb, and syndactylia of the second and third toes of the foot with agnesis of some phalanges, and hypoplasia of the right orbicular muscle in the mouth were observed. No etiologic cause was found. We discuss whether there could have been a causal relationship with topiramate monotherapy.

[External tutor of ePTFE in tracheal stenosis. Clinical application]. / Tutor externo de ePTFE en estenosis traqueal. Aplicación clínica.

Acquired tracheal stenosis in children can be either to direct cervicothoracic trauma or to post-intubation. Resection and end-to-end anastomosis continues to be the treatment of choice. The high rate of restenosis is directly related to anastomotic tension in resections of more than 2 cm. We report a case of a 7 year old child who suffered severe injury caused by car crash and intubation at the scene of the accident, with subsequent development of a cervical tracheal stenosis which required preoperative iterative laser sessions and balloon dilatation on 3 occasions, without result. Resection and primary anastomosis with an external stent of ePTFE was performed. The patient was treated successfully and was extubated promptly. Post-operative endoscopic studies and magnetic resonance imaging showed widely patent tracheal lumina with no stenosis. Three years post-operatively, the child is asymptomatic and participates in competitive sport activities. We can conclude that the model described above was clinically effective in the prevention of post-anastomotic tracheal stenosis in the child.