Inferring phenomenological models of first passage processes.

Biochemical processes in cells are governed by complex networks of many chemical species interacting stochastically in diverse ways and on different time scales. Constructing microscopically accurate models of such networks is often infeasible. Instead, here we propose a systematic framework for building phenomenological models of such networks from experimental data, focusing on accurately approximating the time it takes to complete the process, the First Passage (FP) time. Our phenomenological models are mixtures of Gamma distributions, which have a natural biophysical interpretation. The complexity of the models is adapted automatically to account for the amount of available data and its temporal resolution. The framework can be used for predicting behavior of FP systems under varying external conditions. To demonstrate the utility of the approach, we build models for the distribution of inter-spike intervals of a morphologically complex neuron, a Purkinje cell, from experimental and simulated data. We demonstrate that the developed models can not only fit the data, but also make nontrivial predictions. We demonstrate that our coarse-grained models provide constraints on more mechanistically accurate models of the involved phenomena.

Infants' object interactions are long and complex during everyday joint engagement.

As infants interact with the object world, they generate rich information about object properties and functions. Much of infant learning unfolds in the presence of caregivers, who talk about and act on the objects of infant play. Does mother joint engagement correspond to real-time changes in the complexity and duration of infant object interactions? We observed 38 mothers and their first-born infants (cross-sectional, 13, 18, and 23 months) during 2 h of everyday activity as infants freely navigated their home environments. Behavioral coding explored thousands of infant object interactions within and outside mother joint engagement. Object interactions involving exclusively simple play were shorter than complex play bouts. Critically, mothers' multimodal input (i.e., touching/gesturing toward and talking about the focal object) corresponded with more complex and longer play bouts than when mothers provided no input. Bouts involving complex play and multimodal input lasted 7.5 times longer than simple play bouts absent mother input. Moreover, "action-orienting talk" (e.g., "Twist it", "Feed dolly"), rather than talk per se, corresponded with longer bout duration and complexity. Notably, the association between joint engagement and play duration was not a function of mothers having more time to join. Analyses that eliminated short infant bouts and considered the timing of mothers' behaviors confirmed that mother input "extended" the duration of play bouts. As infants actively explore their environments, their object interactions change moment to moment in the presence of mothers' multimodal engagement.

Joint engagement in the home environment is frequent, multimodal, timely, and structured.

Infants develop in a social context, surrounded by knowledgeable caregivers who scaffold learning through shared engagement with objects. However, researchers have typically examined joint engagement in structured tasks, where caregivers sit near infants and display frequent, prompt, and multimodal behaviors around the objects of infant action. Which features of joint engagement generalize to the real-world? Despite the importance of joint engagement for infant learning, critical assumptions around joint engagement in everyday interaction remain unexamined. We investigated behavioral and temporal features of joint engagement in the home environment, where objects for play abound and dyad proximity fluctuates. Infant manual actions, mother manual and verbal behaviors, and dyad proximity were coded frame-by-frame from 2-h naturalistic recordings of 13- to 23-month-old infants and their mothers (N = 38). Infants experienced rich, highly structured, multimodal mother input around the objects of their actions. Specifically, joint engagement occurred within seconds of infant action and was amplified in the context of interpersonal proximity. Findings validate laboratory-based research on characteristics of joint engagement while highlighting unique properties around the role of mother-infant proximity and temporal structuring of caregiver input over extended time frames. Implications for the social contexts that support infant learning and development are discussed.

Towards a dynamic clamp for neurochemical modalities.

The classic dynamic clamp technique uses a real-time electrical interface between living cells and neural simulations in order to investigate hypotheses about neural function and structure. One of the acknowledged drawbacks of that technique is the limited control of the cells' chemical microenvironment. In this manuscript, we use a novel combination of nanosensor and microfluidic technology and microfluidic and neural simulations to add sensing and control of chemical concentrations to the dynamic clamp technique. Specifically, we use a microfluidic lab-on-a-chip to generate distinct chemical concentration gradients (ions or neuromodulators), to register the concentrations with embedded nanosensors and use the processed signals as an input to simulations of a neural cell. The ultimate goal of this project is to close the loop and provide sensor signals to the microfluidic lab-on-a-chip to mimic the interaction of the simulated cell with other cells in its chemical environment.

Theophylline impact on weaning in oxygen-dependent infants followed in an outpatient Kangaroo Program.

Background: Theophylline was an orally administered xanthine used for treatment of apnea of prematurity and Bronchopulmonary Dysplasia in ambulatory follow-up of Low-Birth-Weight infants (LBWI) with oxygen-dependency in the outpatient Kangaroo Mother Care Program (KMCP). Theophylline's main metabolic product is caffeine; therefore, it was an alternative due to the frequent lack of ambulatory oral caffeine in low and middle-income countries. Objective: To assess the effectiveness of oral theophylline in decreasing days with oxygen and to describe frequency of adverse related events. Methods: Quasi-experiment before and after withdrawal of theophylline given systematically to LBWI with ambulatory oxygen in two KMCPs. Results: 729 patients were recruited; period 1: 319 infants when theophylline was given routinely and period 2: 410 infants when theophylline was no longer used. The theophylline cohort had less gestational age, less weight at birth, more days in Neonatal Intensive Care Unit, more days of oxygen-dependency at KMCP admission, and more frequencies of Intrauterine Growth Restriction and apneas. After adjusting with propensity score matching, multiple linear regression showed that nutrition was associated with days of oxygen-dependency, but theophylline treatment not. No differences were found in frequencies of readmissions up to 40 weeks, intraventricular hemorrhage or neurodevelopmental problems. Participants in period 2 had more tachycardia episodes. Conclusions: We did not find association between oral theophylline treatment and the reduction of days with ambulatory oxygen. For the current management of oxygen-dependency in LBW infants, the importance of nutrition based on exclusive breast feeding whenever possible, is the challenge.

Factors Associated with Neonatal Arterial Hypertension: Case and Control Study.

Background. Neonatal high blood pressure has been diagnosed more frequently in recent years, and its impact extends to adulthood. However, the knowledge gaps on associated factors, diagnosis, and treatment are challenging for medical personnel. The incidence of this condition varies depending on neonatal conditions. Patients in the Newborn Unit are at increased risk of developing high blood pressure. The persistence of this condition beyond the neonatal stage increases the risk of cardiovascular disease and chronic kidney disease in childhood and adulthood. Methodology. A case-control study was carried out. It included hospitalized patients with neonatal hypertension as cases. Three controls were randomly selected for each case and matched by gestational age. The variables were analyzed based on their nature. Multivariate analysis was performed using a multivariate conditional regression model to identify variables associated with the outcome. Finally, the model was adjusted for possible confounders. Results. 37 cases were obtained and matched with 111 controls. In the univariate analysis, heart disease (OR 2.86; 95% CI 1.22-6.71), kidney disease (OR 7.24; 95% CI 1.92-28.28), bronchopulmonary dysplasia (OR 6.62; 95% CI 1.42-50.82) and major surgical procedures (OR 3.71; 95% CI 1.64-8.39) had an association with neonatal arterial hypertension. Only the latter maintained this finding in the multivariate analysis (adjusted OR 2.88; 95% CI 1.14-7.30). A significant association of two or more comorbidities with neonatal arterial hypertension was also found (OR 3.81; 95% CI 1.53-9.49). Conclusions. The study analyzed the factors related to high blood pressure in hospitalized neonates, finding relevant associations in the said population. The importance of meticulous neonatal care and monitoring of risk factors such as birth weight and major surgeries is highlighted.

Within arms reach: Physical proximity shapes mother-infant language exchanges in real-time.

During everyday interactions, mothers and infants achieve behavioral synchrony at multiple levels. The ebb-and-flow of mother-infant physical proximity may be a central type of synchrony that establishes a common ground for infant-mother interaction. However, the role of proximity in language exchanges is relatively unstudied, perhaps because structured tasks-the common setup for observing infant-caregiver interactions-establish proximity by design. We videorecorded 100 mothers (U.S. Hispanic N = 50, U.S. Non-Hispanic N = 50) and their 13- to 23-month-old infants during natural activity at home (1-to-2 h per dyad), transcribed mother and infant speech, and coded proximity continuously (i.e., infants and mother within arms reach). In both samples, dyads entered proximity in a bursty temporal pattern, with bouts of proximity interspersed with bouts of physical distance. As hypothesized, Non-Hispanic and Hispanic mothers produced more words and a greater variety of words when within arms reach than out of arms reach. Similarly, infants produced more utterances that contained words when close to mother than when not. However, infants babbled equally often regardless of proximity, generating abundant opportunities to play with sounds. Physical proximity expands opportunities for language exchanges and infants' communicative word use, although babies accumulate massive practice babbling even when caregivers are not proximal.

A framework for studying behavioral evolution by reconstructing ancestral repertoires.

Although different animal species often exhibit extensive variation in many behaviors, typically scientists examine one or a small number of behaviors in any single study. Here, we propose a new framework to simultaneously study the evolution of many behaviors. We measured the behavioral repertoire of individuals from six species of fruit flies using unsupervised techniques and identified all stereotyped movements exhibited by each species. We then fit a Generalized Linear Mixed Model to estimate the intra- and inter-species behavioral covariances, and, by using the known phylogenetic relationships among species, we estimated the (unobserved) behaviors exhibited by ancestral species. We found that much of intra-specific behavioral variation has a similar covariance structure to previously described long-time scale variation in an individual's behavior, suggesting that much of the measured variation between individuals of a single species in our assay reflects differences in the status of neural networks, rather than genetic or developmental differences between individuals. We then propose a method to identify groups of behaviors that appear to have evolved in a correlated manner, illustrating how sets of behaviors, rather than individual behaviors, likely evolved. Our approach provides a new framework for identifying co-evolving behaviors and may provide new opportunities to study the mechanistic basis of behavioral evolution.

Emphysematous gastritis as a manifestation of non-occlusive mesenteric ischemia after coartectomy / Gastritis enfisematosa como manifestación de isquemia mesentérica no oclusiva tras coartectomía

Major interventions in cardiovascular surgery of patients with aortic pathology can result in the compromise of perfusion of organs distant from the surgery site, the gastrointestinal tract being one of the most sensitive to hemodynamic changes, especially in extreme age groups with a high risk of morbidity and mortality. The case of a young infant is reported, with a history of Turner syndrome, who is led to correction of aortic coarctation plus arch hypoplasia, presenting as a postoperative complication a picture of emphysematous gastritis with systemic compromise, a process that was favored by low cardiac output post-pump and the presence of early urosepsis, all of which was interpreted as part of the spectrum of non-occlusive mesenteric ischemia syndrome. Its early diagnosis made possible a prompt intervention consisting of parenteral nutritional support, acid brake, broad-spectrum antibiotic therapy and strict radiological follow-up, achieving complete resolution of her symptoms, without short-term complications. This case demonstrated that the identification of risk factors for splanchnic ischemia, a high clinical suspicion and careful medical management, allowed a favorable outcome for a disease with a high mortality rate and very few cases reported in the pediatric population.

Las intervenciones mayores en cirugía cardiovascular de pacientes con patología aórtica pueden traer como consecuencia el compromiso de la perfusión de órganos distantes al sitio de la cirugía, siendo el tracto gastrointestinal uno de los más sensibles a los cambios hemodinámicos, en especial en grupos extremos de edad con un alto riesgo de morbimortalidad. Se reporta el caso de una lactante con antecedente de síndrome de Turner, quien es llevada a corrección de coartación de aorta más hipoplasia del arco, presentando como complicación posoperatoria un cuadro de gastritis enfisematosa con compromiso sistémico, proceso que fue favorecido por bajo gasto cardiaco posterior a bomba y presencia de urosepsis temprana, todo lo cual fue interpretado como parte del espectro del síndrome de isquemia mesentérica no oclusiva. Su diagnóstico precoz hizo posible una pronta intervención, consistente en soporte nutricional parenteral, freno ácido, antibioticoterapia de amplio espectro y seguimiento radiológico estricto, logrando la resolución completa de su sintomatología, sin complicaciones a corto plazo. Este caso demuestra que la identificación de factores de riesgo de isquemia esplácnica, una alta sospecha clínica y un cuidadoso manejo médico permiten un desenlace favorable para una patología con una alta tasa de mortalidad y muy pocos casos reportados en población pediátrica.

Multimodal parent behaviors within joint attention support sustained attention in infants.

Parents support and scaffold more mature behaviors in their infants. Recent research suggests that parent-infant joint visual attention may scaffold the development of sustained attention by extending the duration of an infant's attention to an object. The open question concerns the parent behaviors that occur within joint-attention episodes and support infant sustained attention to an object. In the study, parent-infant dyads played with objects on a tabletop while their eye-gaze was recorded with head-mounted eye-trackers. Parent hand contact with the objects as well as speech were coded and analyzed to identify the presence of parent touch and talk during bouts of infant visual attention. This study, consistent with prior research, showed that joint attention is associated with longer infant visual attention. The relevant parent behaviors considered, parent talk and touch, not only were highly likely to occur when both the parent and infant visually attended to the same object, but were also associated with infant attention to an object that was longer than infant attention that did not include these parent behaviors. Parent talk was the most potent behavior that coincided with longer infant looks. In sum, joint attention extends infant attention and joint attention involves more than mutual coordination of eye-gaze, it involves multimodal parent behaviors coordinated with the infant's visual attention. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Gaze in Action: Head-mounted Eye Tracking of Children's Dynamic Visual Attention During Naturalistic Behavior.

Young children's visual environments are dynamic, changing moment-by-moment as children physically and visually explore spaces and objects and interact with people around them. Head-mounted eye tracking offers a unique opportunity to capture children's dynamic egocentric views and how they allocate visual attention within those views. This protocol provides guiding principles and practical recommendations for researchers using head-mounted eye trackers in both laboratory and more naturalistic settings. Head-mounted eye tracking complements other experimental methods by enhancing opportunities for data collection in more ecologically valid contexts through increased portability and freedom of head and body movements compared to screen-based eye tracking. This protocol can also be integrated with other technologies, such as motion tracking and heart-rate monitoring, to provide a high-density multimodal dataset for examining natural behavior, learning, and development than previously possible. This paper illustrates the types of data generated from head-mounted eye tracking in a study designed to investigate visual attention in one natural context for toddlers: free-flowing toy play with a parent. Successful use of this protocol will allow researchers to collect data that can be used to answer questions not only about visual attention, but also about a broad range of other perceptual, cognitive, and social skills and their development.

Gastritis enfisematosa como manifestación de isquemia mesentérica no oclusiva tras coartectomía / Emphysematous gastritis as a manifestation of non-occlusive mesenteric ischemia after coartectomy

Resumen Las intervenciones mayores en cirugía cardiovascular de pacientes con patología aórtica pueden traer como consecuencia el compromiso de la perfusión de órganos distantes al sitio de la cirugía, siendo el tracto gastrointestinal uno de los más sensibles a los cambios hemodinámicos, en especial en grupos extremos de edad con un alto riesgo de morbimortalidad. Se reporta el caso de una lactante con antecedente de síndrome de Turner, quien es llevada a corrección de coartación de aorta más hipoplasia del arco, presentando como complicación posoperatoria un cuadro de gastritis enfisematosa con compromiso sistémico, proceso que fue favorecido por bajo gasto cardiaco posterior a bomba y presencia de urosepsis temprana, todo lo cual fue interpretado como parte del espectro del síndrome de isquemia mesentérica no oclusiva. Su diagnóstico precoz hizo posible una pronta intervención, consistente en soporte nutricional parenteral, freno ácido, antibioticoterapia de amplio espectro y seguimiento radiológico estricto, logrando la resolución completa de su sintomatología, sin complicaciones a corto plazo. Este caso demuestra que la identificación de factores de riesgo de isquemia esplácnica, una alta sospecha clínica y un cuidadoso manejo médico permiten un desenlace favorable para una patología con una alta tasa de mortalidad y muy pocos casos reportados en población pediátrica.

Abstract Major interventions in cardiovascular surgery of patients with aortic pathology can result in the compromise of perfusion of organs distant from the surgery site, the gastrointestinal tract being one of the most sensitive to hemodynamic changes, especially in extreme age groups with a high risk of morbidity and mortality. The case of a young infant is reported, with a history of Turner syndrome, who is led to correction of aortic coarctation plus arch hypoplasia, presenting as a postoperative complication a picture of emphysematous gastritis with systemic compromise, a process that was favored by low cardiac output post-pump and the presence of early urosepsis, all of which was interpreted as part of the spectrum of non-occlusive mesenteric ischemia syndrome. Its early diagnosis made possible a prompt intervention consisting of parenteral nutritional support, acid brake, broad-spectrum antibiotic therapy and strict radiological follow-up, achieving complete resolution of her symptoms, without short-term complications. This case demonstrated that the identification of risk factors for splanchnic ischemia, a high clinical suspicion and careful medical management, allowed a favorable outcome for a disease with a high mortality rate and very few cases reported in the pediatric population.

Caso Clínico: Coartación de Aorta Torácica / Case Report: Thoracic Aortic Coarctation

INTRODUCCIÓN: Las enfermedades cardíacas congénitas son relativamente frecuentes, afectando a 8 de cada 1000 recién nacidos en Ecuador. El 30% de niños que tienen anormalidades genéticas son portadores de cardiopatías congénitas que aparecen en las primeras semanas del embarazo, destacándose como causas principales los factores genéticos, infecciosos y químicos. La importancia de presentar el tema radica en el hecho de ser el primer lactante intervenido por cardiopatía congénita en el hospital “José CarrascoArteaga”, con la participación multidisciplinaria de especialistas en el tema. CASO CLÍNICO: El presente caso trata sobre un paciente lactante de 7 meses de edad, con antecedentes de distrés respiratorio luego del nacimiento; a la exploración física lossignos que más se destacaron fueron la presencia de un soplo holosistólico en barra en todos los focos de auscultación, la disminución de pulsos femorales y tensión arterial baja en miembros inferiores. EVOLUCIÓN: Se realizaron estudios complementarios concluyéndose el diagnóstico decoartación de aorta torácica descendente, se inició tratamiento a base de betabloqueantes durante cuatro meses y se decidió tratamiento quirúrgico mediante coartectomía deaorta con anastomosis término-terminal, el paciente evolucionó favorablemente despuésdel procedimiento. CONCLUSIÓN: El presente caso demuestra la necesidad de una sospecha clínica paradeterminar el diagnóstico de enfermedades congénitas graves, resalta el procedimiento diagnóstico con el apoyo de los métodos complementarios y respalda la evidencia disponible en cuanto al tratamiento de la patología con el procedimiento quirúrgico adecuado, el mismo que fue seleccionado de acuerdo a la condición clínica del paciente, con buenosresultado(AU)

BACKGROUND: Congenital cardiac diseases are relatively frequent, affecting 8 of 1000 newborns in Ecuador. 30% of children with congenital abnormalities have also any congenital cardiopathy which appear at early pregnancy stages; genetic, infectious and chemical factorsoutstand as main causes of this. Importance of this topic lies in the fact of the first surgical treatment performed in a patient diagnosed with a congenital cardiopathy by a multidisciplinaryparticipation of specialists at “José Carrasco Arteaga” hospital.CASE REPORT: This case is about a 7-months old nursing infant who had precedents of respiratory distress after birth; bar holosystolic murmur at every auscultation foci, femoral pulses decrease and low arterial tension in lower limbs were outstanding findings in physical examination. EVOLUTION: Complementary studies were performed, a descendant thoracic aortic coarctation diagnosis was concluded, a betablocker based therapy was used during 4 months and surgical treatment by aortic coarctectomy with end-to-end anastomosis was decided, the patient had a favourably evolution after procedure. CONCLUSION: This case demonstrates the need of clinic suspicion to determine the diagnosisof severe congenital diseases, it highlights the diagnostic process with complementary studies and supports available evidence about the treatment of this pathology with the appropriatetreatment, which was selected according to patient’s condition and had good results(AU)

Tronco Arterioso Común. Una Década de Experiencia en el Instituto Nacional de Cardiología “Ignacio Chávez”, México DF / COMMON ARTERIAL TRUNK. A DECADE OF EXPERIENCE AT THE NATIONAL INSTITUTE OF CARDIOLOGY OF MEXICO

INTRODUCCIÓN: El objetivo del presente trabajo fue realizar una descripción de la incidencia y manejo de la patología denominada tronco arterioso común en un centro de Cardiología de México.MÉTODOS: El presente es un estudio descriptivo, retrospectivo de prevalencia. Se revisaron expedientes de pacientes tratados en el servicio de Cirugía Cardiovascular del Instituto Nacional de Cardiología “Ignacio Chávez” de México desde enero del 2000 hasta diciembre del 2010. Se incluyeron al estudio los pacientes con diagnóstico de Tronco Arterioso Común. Las variables estudiadas fueron descriptivas de la población, características clínicas, el método de diagnóstico, los factores de riesgo de morbilidad y mortalidad, los injertos utilizados y la evolución postquirúrgica.RESULTADOS: Se analizaron 44 casos, la edad promedio 13 meses, 22 mujeres (50%), NYHA clase I, 26 casos (59%), NYHA clase II 18 casos (41%). El síntoma más frecuente fue disnea en 41 pacientes (93%). 4 pacientes (9%) tenían una deleción del cromosoma 22. Por ecocardiografía se diagnosticó la variante tipo I del tronco arterioso en 42 casos (96%). El número de valvas fue de 3 en 31 casos (71%), 7 pacientes (16%) presentaron tronco arterioso complejo con otras cardiopatías asociadas. El diagnóstico preoperatorio fue el mismo que con los hallazgos quirúrgicos en un 77% de los casos.CONCLUSIÓN: El promedio de edad a la los niños fueron operado fue mayor a 1 año. La mortalidad perioperatoria fue del 9% y la mortalidad global fue del 13.5%, las patología asociadas a tronco arterioso fueron la comunicación interauricular 11% y la persistencia de conducto arterioso 5%. La estenosis del injerto fue la complicación más frecuente en el post-operatorio tardío en un 22%.(AU)

BACKGROUND: The objective of this study was to conduct an overview of the incidence and management of the condition called Common Arterial Trunk in the Cardiology Center of Mexico. METHODS: This is a descriptive retrospective study of prevalence. Records of patients treated at the Department of Cardiovascular Surgery at the National Institute of Cardiology of Mexico from January 2000 through December 2010 were reviewed. The study included patients diagnosed with Common Arterial Trunk. The variables studied were descriptive of the population, clinical features, the method of diagnosis, risk factors for morbidity and mortality, the grafts used and post-operative evolution.RESULTS: Forty-four (44) cases were analyzed, over an average of 13 months, 22 women (50%), NYHA class I, 26 cases (59%), NYHA class II, 18 cases (41%). The most common symptom was dyspnea in 41 patients (93%). Four patients (9%) had a deletion of chromosome 22 by echocardiography variant type I Common Arterial Trunk in 42 cases (96%) was diagnosed. The number of valves was 3 in 31 cases (71%); seven patients (16%) had Common Arterial Trunk with other complex congenital heart defects. The pre-operative diagnosis was the same as with surgical findings in 77% of the cases. CONCLUSIONS: The average age of the children that was operated on was older than 1 year. Peri-operative mortality was 9% and the overall mortality was 13.5%, the pathology associated with Trunk Arteriosus was interauericular communication 11% and patent ductus arteriosus by 5%. Graft stenosis was the most frequent complication in the late post-operative at 22%. (AU)

Primer Cierre Quirúrgico del Conducto Arterioso en el Hospital “José Carrasco Arteaga” / FIRST SURGICAL CLOSURE OF DUCTUS ARTERIOSUS IN “JOSÉ CARRASCO ARTEAGA” HOSPITAL

INTRODUCCIÓN:Cuando el conducto arterioso es suficientemente amplio, el shunt aortopulmonar puede ser hemodinámicamente significativo, siendo en estas circunstancias necesario su cierre mediante la administración de inhibidores de la ciclooxigenasa, como la Indometacina o Ibuprofeno, cuando no se consigue éxito el paso a seguir es el cierre quirúrgico.CASO CLÍNICO: Se trata de un recién nacido pequeño para la edad gestacional de 35 Semanas de gestación, quien fue transferido al Hospital “José Carrasco Arteaga” con requerimientos de oxígeno, intolerancia oral, taquicardia, presión arterial diferencial, precordio hiperdinámico, pulsos saltones, soplo sistólico en región infraclavicular izquierda y borde paraesternal superior izquierdo con thrill. Recibió tratamiento con restricción de líquidos, apoyo inotrópico y diuréticos por sospecha de Ductus Arterioso Permeable (DAP) e insuficiencia cardíaca.EVOLUCIÓN: El paciente a las 8 horas de hospitalización presentó hemorragia pulmonar, aumentaron los requerimientos de oxígeno y el ecocardiograma confirmó el diagnóstico de DAP, por lo que se adicionó al tratamiento farmacológico el esquema de ibuprofeno, sin respuesta. Con la indicación de cirugía para cierre de DAP se realizó el tratamiento como el primer caso de un paciente pretérmino con cierre del conducto arterioso con clip de titanio por toracotomía. Sin complicaciones.CONCLUSIÓN: La sospecha clínica de conducto arterioso persistente hace que se plantee los exámenes de laboratorios necesarios para confirmar su diagnóstico y en ello juega un papel importante la ecocardiografía, y una vez hecho el diagnóstico el inicio precoz del tratamiento farmacológico ya sea con indometacina no ibuprofeno dependiendo de la disponibilidad institucional garantiza el cierre, por lo tanto evitar todas las complicaciones que trae consigo dicha patología. Además debe ir encaminado a dar un soporte médico adecuado al recién nacido pretérmino.(AU)

BACKGROUND: When the ductus arteriosus islarge enough, the aortopulmonary shunt can be hemodynamically significant, making it necessary in these circumstances for closure by administration of cyclooxygenase inhibitors such as indomethacin or ibuprofen, when that is not successful, the next step is to close surgically.CASE REPORT: This is a newborn small for gestational age of 35 weeks gestation, which was transferred to the “José Carrasco Arteaga” Hospital with oxygen requirements, oral intolerance, tachycardia, pulse pressure, hyperdynamic precordium, bounding pulses, systolic murmur in the left infraclavicular region and left upper parasternal border with thrill. It was treated with fluids restriction, diuretics and inotropic support for suspected patent ductus arteriosus (PDA) and heart failure.EVOLUTION: The patient at eight hours of hospitalization showed pulmonary hemorrhage, increased oxygen requirements and an echocardiogram confirmed the diagnosis of DAP, which was added to drug treatment scheme ibuprofen unanswered. The surgical indication for PDA closure treatment was performed as the first case of a patient with premature closure of the ductus arteriosus with titanium clip thoracotomy. Without complications.CONCLUSION: The clinical suspicion of patent ductus arteriosus makes necessary, the laboratory tests to confirm the diagnosis and echocardiography plays an important role, and once the diagnosis is made, early initiation of drug treatment with either indomethacin or ibuprofen depending on the institutional availability, ensures closure thus avoiding all the complications that come with this disease. Also the duty should be aiming to give the appropriate medical support to pre-term infants. Had it failed, as previously described, the surgical closure by thoracotomy and use of clips improves the outcome of that procedure.(AU)