Hipoglucemia neonatal en hijos de madres con diabetes mellitus gestacional. Comparación de la incidencia según el tratamiento materno / Neonatal hypoglycemia in infants born to mothers with gestational diabetes mellitus. Comparison of its incidence based on maternal treatment

Introducción. La hipoglucemia neonatal es una complicación de la diabetes mellitus gestacional Son pocos los estudios que avalan la pesquisa sistemática en este grupo poblacional durante las primeras horas de vida. Objetivos. Evaluar la asociación entre tratamiento materno recibido (dieta versus insulina) y el desarrollo de hipoglucemia, e identificar los factores de riesgo asociados. Población y métodos. Estudio observacional, analítico y retrospectivo realizado en en las sedes de Buenos AIres y San Justo de un hospital general de tercer nivel entre el 1 de enero de 2017 y el 31 de diciembre de 2018. Se estimó la incidencia de hipoglucemia (≤47 mg/dl) en recién nacidos según el manejo de la diabetes materna y se realizó un análisis multivariable para evaluar factores asociados. Resultados. Se incluyeron 195 pacientes. No se encontró diferencia estadística en la incidencia de hipoglucemia según el tratamiento materno recibido (45,3 % versus 39,7 %; p = 0,45) ni se identificaron factores de riesgo asociados. Modificando el valor de corte a ≤40 mg/dl, tampoco se encontraron diferencias en la incidencia (23,4 % versus 19 %, p = 0,48); no obstante, los pacientes hipoglucémicos presentaron un hematocrito significativamente mayor y una menor prevalencia de lactancia exclusiva al egreso. El análisis multivariable mostró una asociación independiente entre alto peso al nacer con hipoglucemia que requiere corrección. Conclusiones. La incidencia de hipoglucemia neonatal en la población estudiada no presentó diferencia según el tratamiento materno recibido. El estudio realizado fundamenta el control de la glucemia en estos niños en la práctica diaria.

Introduction. Neonatal hypoglycemia is a complication of gestational diabetes mellitus. Few studies have been conducted to support a systematic screening in the first hours of life of this population group. Objectives. To assess the association between the treatment administered to the mother (diet vs. insulin) and the development of hypoglycemia, and to identify associated risk factors. Population and methods. Observational, analytical, and retrospective study carried out at the Buenos Aires and San Justo maternal centers of a general, tertiary care hospital between 01-01-2017 and 12-31-2018. The incidence of neonatal hypoglycemia (≤ 47 mg/dL) based on the management of maternal diabetes was estimated and a multivariate analysis was done to assess related factors. Results. A total of 195 patients were included. No statistical difference was found in the incidence of hypoglycemia based on the treatment administered to the mother (45.3% vs. 39.7%; p = 0.45) and no associated risk factors were identified. Once the cutoff point was changed to ≤ 40 mg/dL, no differences were found in the incidence either (23.4% versus 19%, p = 0.48); however, patients with hypoglycemia had a significantly higher hematocrit level and a lower prevalence of exclusive breastfeeding upon discharge. Multivariate analysis showed an independent association between a high birth weight and hypoglycemia, requiring correction. Conclusions. The incidence of neonatal hypoglycemia in the studied population did not vary based on the treatment received by the mother. This study supports the control of glycemia in these infants in daily practice.

Estado nutricional de la mujer embarazada y su relación con las complicaciones de la gestación y el recién nacido / Nutrition status of pregnant women and its relationship with complications of pregnancy and the newborn

RESUMEN: El estado nutricional materno determina las condiciones de salud y nutricionales del recién nacido, así como las complicaciones durante el embarazo y el parto. Se realizó el estudio en 894 mujeres que tuvieron su parto en los Hospitales de la ciudad de Loja Ecuador durante el periodo enero - junio del 2019. Se determinó la antropometría de la madre y de su hijo, así como se tomó datos de complicaciones durante el embarazo y el parto, de su historia clínica. Además, se efectuó la correlación entre el estado nutricional pre-gestacional de la madre con el recién nacido, de igual forma con el estado de salud de la madre. El objetivo de este trabajo fue determinar el estado nutricional pre-gestacional y su relación con la condición de salud y nutricional del niño. El IMC pre-gestacional reportó 47,3 % de sobrepeso y obesidad y 2,6 % de bajo peso. En un porcentaje mayor al 10 % las madres con sobrepeso y obesidad tuvieron hijos grandes para la edad gestacional, de igual forma las madres con bajo peso tuvieron el 26,1 % recién nacidos pequeños. Las principales complicaciones de las madres relacionadas con sobrepeso y obesidad fueron: diabetes gestacional, hemorragia postparto y pre-eclampsia durante el embrazo. Importante señalar la alta frecuencia de infecciones de las vías urinarias 53,9 % (478); y vaginitis 22,3 % (199); aunque estas no están directamente relacionadas con procesos metabólicos como etiología, más si están favorecidos por ellos. Durante el parto la complicación más frecuente fue el parto distócico con un 8,9 % (77), además del total de partos el 41,8 % (374) terminaron en cesárea, de estos el 51, 6 % (193) corresponden a sobrepeso y obesidad. Las complicaciones del recién nacido fueron: Síndrome de dificultad respiratoria aguda, asfixia neonatal e hipoglicemia. En conclusión, el estado nutricional pre-gestacional de la madre está relacionado directamente con el estado de salud y nutricional del recién nacido.

SUMMARY: The maternal nutritional status determines the health and nutritional conditions of the newborn, as well as complications during pregnancy and childbirth. The study was carried out in 894 women who had their delivery in the Hospitals of the city of Loja Ecuador during the period January - June 2019. The anthropometry of the mother and her child was determined, as well as data on complications during pregnancy and delivery, from their clinical history. In addition, the correlation was made between the pre-gestational nutritional status of the mother with the newborn, in the same way with the health status of the mother. The objective of this work was to determine the pre-gestational nutritional status and its relationship with the health and nutritional condition of the child. The pre-gestational BMI reported 47.3 % overweight and obesity and 2.6 % underweight. In a percentage higher than 10 %, mothers with overweight and obesity had large children for gestational age, in the same way, mothers with low weight had 26.1 % small newborns. The main complications of the mothers related to overweight and obesity were: gestational diabe- tes, postpartum hemorrhage and pre-eclampsia during pregnancy. It is important to note the high frequency of urinary tract infections 53.9% (478); and vaginitis 22.3% (199; although these are not directly related to metabolic processes such as etiology, more if they are favored by them. During delivery, the most frequent complication was dystocic delivery with 8.9 % (77), in addition to the total deliveries 42.5 % (374) that ended in cesarean section, of which 51.6 % (193) correspond to overweight and obesity. The complications of the newborn were: Acute respiratory distress syndrome, neonatal asphyxia and hypoglycemia. In conclusion, the pre-gestational nutritional status of the mother is directly related to the health and nutritional status of the newborn.

Effect of Obesity on Gestational and Perinatal Outcomes / Efeito da obesidade sobre os resultados gestacionais e perinatais

Abstract Purpose To assess the impact of pre-pregnancy obesity (body mass index [BMI] ≥30 kg/m2) on the gestational and perinatal outcomes. Methods Retrospective cohort study of 731 pregnant women with a BMI ≥30 kg/m2 at the first prenatal care visit, comparing them with 3,161 women with a BMI between 18.5 kg/m2 and 24.9 kg/m2. Maternal and neonatal variables were assessed. Statistical analyses reporting the demographic features of the pregnant women (obese and normal) were performed with descriptive statistics followed by two-sided independent Student's t tests for the continuous variables, and the chi-squared (χ2) test, or Fisher's exact test, for the categorical variables. We performed a multiple linear regression analysis of newborn body weight based on the mother's BMI, adjusted by maternal age, hyperglycemic disorders, hypertensive disorders, and cesarean deliveries to analyze the relationships among these variables. All analyses were performed with the R (R Foundation for Statistical Computing, Vienna, Austria) for Windows software, version 3.1.0. A value of p < 0.05 was considered statistically significant. Results Obesity was associated with older age [OR 9.8 (7.8-12.2); p < 0.01], hyperglycemic disorders [OR 6.5 (4.8-8.9); p < 0.01], hypertensive disorders [OR 7.6 (6.1-9.5); p < 0.01], caesarean deliveries [OR 2.5 (2.1-3.0); p < 0.01], fetal macrosomia [OR 2.9 (2.3-3.6); p < 0.01] and umbilical cord pH [OR 2.1 (1.4-2.9); p < 0.01). Conversely, no association was observed with the duration of labor, bleeding during labor, Apgar scores at 1 and 5 minutes after birth, gestational age, stillbirth and early neonatal mortality, congenital malformations, and maternal and fetal injury. Conclusion We observed that pre-pregnancy obesity was associated with maternal age, hyperglycemic disorders, hypertension syndrome, cesarean deliveries, fetal macrosomia, and fetal acidosis.

Resumo Objetivo Avaliar o impacto da obesidade pré-gestacional (índice de massa corpórea [IMC] ≥30 kg/m2) sobre os resultados gestacionais e perinatais. Métodos Estudo transversal retrospectivo, com 731 gestantes que apresentaram IMC ≥ 30 kg/m2 na primeira consulta de pré-natal, comparando-as a 3.161 gestantes com IMC entre 18,5 kg/m2 e 24,9 kg/m2. Foram avaliadas variáveis maternas e neonatais. A análise estatística baseou-se nas características demográficas das gestantes (obesas e com peso normal), e foi realizada com estatísticas descritivas seguidas de testes t de Student independentes bicaudais para variáveis contínuas, e teste de qui-quadrado (χ2) ou exato de Fisher para as variáveis categóricas. Foi realizada uma regressão linear múltipla do peso do recém-nascido sobre o IMC materno, ajustado por idade materna, síndromes hiperglicêmicas, síndromes hipertensivas hipertensivas e operações cesarianas, a fim de analisar a relação entre essas variáveis. Todas as análises foram realizadas com o uso de R (R Foundation for Statistical Computing, Viena, Áustria) para Windows, versão 3.1.0. Um valor de p < 0,05 foi considerado estatisticamente significante. Resultados A obesidade associou-se à idade materna [OR 9,8 (7,8-12,2); p < 0,01], distúrbios hiperglicêmicos [OR 6.5 (4,8-8,9); p < 0,01], distúrbios hipertensivos (RP: 7,6 [6,1-9,5]; p < 0,01), maior taxa de operação cesariana [OR 2,5 (2,1-3,0); p < 0,01], macrossomia fetal [OR 2,9 (2,3-3,6); p < 0,01] e baixo pH na artéria umbilical [OR 2,1 (1,4-2,9); p < 0,01]. Não foi observada associação com tempo de trabalho de parto, sangramento durante o trabalho de parto, índice de Apgar no 1° e 5° minutos, idade gestacional, natimortalidade e mortalidade neonatal precoce, malformações congênitas e tocotraumatismo materno e fetal. Conclusões O estudo mostrou que a obesidade pré-gestacional associou-se com idade materna mais elevada, distúrbios hiperglicêmicos e hipertensivos, taxas mais altas de operação cesariana, macrossomia e acidose fetal.

Incidence of local complications and risk factors associated with peripheral intravenous catheter in neonates / Incidencia de complicaciones locales y factores de riesgo asociados con el catéter intravenoso periférico en neonatos / Incidência de complicações locais e fatores de risco associados ao cateter intravenoso periférico em neonatos

Abstract OBJECTIVE To evaluate the incidence of complications related to the use of peripheral intravenous catheter in neonates and identify the associated risk factors. METHOD Prospective cohort study conducted in a Neonatal Intensive Care Unit. Participants were the hospitalized neonates undergoing peripheral intravenous puncture in the period from February to June 2013. RESULTS The incidence of complications was 63.15%, being infiltration/extravasation (69.89%), phlebitis (17.84%) and obstruction (12.27%). The risk factors were the presence of infection (p = 0.0192) and weight at the puncture day (p = 0.0093), type of intermittent infusion associated with continuous infusion (p <0.0001), endotracheal intubation (p = 0.0008), infusion of basic plan (p = 0.0027), total parenteral nutrition (P = 0.0002), blood transfusion associated with other infusions (p = 0.0003) and other drugs (p = 0.0004). Higher risk of developing complications in the first 48 hours after puncture. CONCLUSION A high rate of complications related to the use of peripheral intravenous catheter, and risk factors associated with infection, weight, drugs and infused solutions, and type of infusion.

Resumen OBJETIVO Evaluar la incidencia de complicaciones relacionadas con el uso del catéter intravenoso periférico en neonatos e identificar factores de riesgo asociados. MÉTODO Cohorte prospectiva, realizada en Unidad de Cuidados Intensivos Neonatal. Los participantes fueron los neonatos hospitalizados sometidos a la punción intravenosa periférica, en el período de febrero a junio de 2013. RESULTADOS La incidencia de complicaciones fue del 63,15%, siendo infiltración/fuga (69,89%), flebitis (17,84%) y obstrucción (12,27%). Los factores de riesgo fueron: presencia de infección (p=0,0192) y peso el día de la punción (p=0,0093), tipo de infusión intermitente asociada con la continua (p<0,0001), intubación orotraqueal (p=0,0008), infusión de plano básico (p=0,0027), nutrición parenteral total (p=0,0002), hemotransfusión asociada con otras infusiones (p=0,0003) y otros fármacos (p=0,0004). Mayor riesgo de desarrollar complicación las primeras 48 horas post punción. CONCLUSIÓN Un índice elevado de complicaciones relacionadas con el uso del catéter intravenoso periférico y factores de riesgo asociados con la infección, peso, drogas y soluciones infundidas y tipo de infusión.

Resumo OBJETIVO Avaliar a incidência de complicações relacionadas ao uso do cateter intravenoso periférico em neonatos e identificar fatores de risco associados. MÉTODO Coorte prospectiva, realizada em Unidade de Terapia Intensiva Neonatal. Os participantes foram os neonatos internados submetidos à punção intravenosa periférica, no período de fevereiro a junho de 2013. RESULTADOS A incidência de complicações foi de 63,15%, sendo infiltração/extravasamento (69,89%), flebite (17,84%) e obstrução (12,27%). Os fatores de risco foram: presença de infecção (p=0,0192) e peso no dia da punção (p=0,0093), tipo de infusão intermitente associada à contínua (p<0,0001), intubação orotraqueal (p=0,0008), infusão de plano básico (p=0,0027), nutrição parenteral total (p=0,0002), hemotransfusão associada a outras infusões (p=0,0003) e outros medicamentos (p=0,0004). Maior risco de desenvolver complicação nas primeiras 48 horas pós-punção. CONCLUSÃO Uma taxa elevada de complicações relacionadas ao uso do cateter intravenoso periférico e fatores de risco associados à infecção, peso, drogas e soluções infundidas e tipo de infusão.

Síndrome de artrogriposis, disfunción tubular renal y colestasis: causa de colestasis neonatal. A propósito de un caso / Arthrogryposis-renal tubular dysfunction-cholestasis syndrome: a cause of neonatal cholestasis. Case report

El síndrome de artrogriposis, disfunción tubular renal y colestasis es un trastorno fatal infrecuente que compromete múltiples aparatos y sistemas de órganos. Es un trastorno autosómico recesivo hereditario, causado por defectos en los genes VPS33B y VIPAR. Los tres signos primordiales de este síndrome son la artrogriposis, la disfunción tubular renal y la colestasis. Otros compromisos orgánicos a veces asociados con este síndrome son ictiosis, malformación del sistema nervioso central, anomalías trombocíticas, defectos cardíacos congénitos y grave retraso del crecimiento. Las manifestaciones clínicas, la biopsia de un órgano y los análisis de mutaciones pueden ayudar con el diagnóstico, pero no existe un tratamiento curativo; solamente puede instaurarse un tratamiento sintomático. Varios síntomas de esta afección usualmente se manifiestan en el período neonatal: artrogriposis, colestasis neonatal, lesiones cutáneas, entre otros. En general, la supervivencia se prolonga hasta el primer año de vida. Presentamos el caso de una recién nacida con una rápida evolución y desenlace fatal.

Arthrogryposis-renal dysfunction-cholestasis syndrome is a rare lethal disorder that involves multipl organ system. It is inherited autosomal recessive and caused by defects in the VPS33B and VIPAR genes. Three cardinal findings of this syndrome are arthrogryposis, renal tubular dysfunction and cholestasis.The other organ involvements including ichthyosis, central nervous system malformation, platelet anomalies, congenital heart defects and severe failure to thrive are sometimes associated with this syndrome. Clinical findings, organ biopsy and mutational analysis can help for diagnosing but there is no curative treatment except supportive care. Several symptoms of this condition are already usually present in the neonatal period: arthrogryposis, neonatal cholestasis, skin lesions, among others. Usually survival is until the first year of life. We present a newborn whose evolution was rapidly fatal.

Intimate Partner Violence Against Pregnant Women: Study About The Repercussions On The Obstetric And Neonatal Results / Violencia Del Compañero Íntimo Contra Las Mujeres Embarazadas: Estudio Sobre El Impacto En Los Resultados Obstétricos Y Neonatales / Violência do parceiro íntimo contra a gestante: estudo sobre as repercussões nos resultados obstétricos e neonatais

This observational, descriptive and analytic study aimed to identify the prevalence of IPV cases among pregnant women and classify them according to the type and frequency; identify the obstetric and neonatal results and their associations with the intimate partner violence (IPV) occurrence in the current pregnancy. It was developed with 232 pregnant women who had prenatal care at a public maternity hospital. Data were collected via structured interview and in the patients’ charts and analyzed through the statistic software SAS® 9.0. Among the participants, 15.5% suffered IPV during pregnancy, among that 14.7% suffered psychological violence, 5.2% physical violence and 0.4% sexual violence. Women who did not desire the pregnancy had more chances of suffering IPV (p<0.00; OR=4.32 and 95% CI [1.77 – 10.54]). With regards to the obstetric and neonatal repercussions, there was no statistical association between the variables investigated. Thus, for the study participants there were no negative obstetric and neonatal repercussions related to IPV during pregnancy.

Este estudio tuvo como objetivos describir el proceso de traducción y adaptación cultural del instrumento Perceived Stigmatization Questionnaire (PSQ) y analizar la consistencia interna de los ítems en la etapa del pre-test. El PSQ fue desarrollado para la evaluación de la percepción de los comportamientos estigmatizantes de víctimas de quemaduras. El proceso de adaptación fue realizado de agosto del 2012 a febrero del 2013, incluyendo las etapas preconizadas en la literatura. Como parte de ese proceso, fue realizado el pre-test con 30 adultos víctimas de quemaduras. Todos los participantes de esa etapa informaron comprender los ítems del instrumento y la escala de respuesta. No hubo sugerencias o cambios en la versión probada. El valor del alfa de Cronbach en el pre-test fue de 0,87. La contribución del estudio está en la descripción de la operacionalización de cada una de las etapas de ese proceso metodológico y demuestra la consistencia interna de los ítems en el pre-test.


Este estudo observacional, descritivo e analítico que objetivou identificar a prevalência de violência por parceiro íntimo (VPI) entre gestantes e classificá-la quanto ao tipo e frequência; identificar resultados obstétricos e neonatais e suas associações com a ocorrência da VPI na gestação atual. Foi desenvolvido com 232 gestantes que realizaram acompanhamento pré-natal em uma maternidade pública. Os dados foram coletados por entrevista estruturada e nos prontuários e analisados com o programa SAS® 9.0. Entre as participantes, 15,5% sofreram VPI durante a gestação, sendo que 14,7% sofreram violência psicológica, 5,2%, violência física e 0,4%, violência sexual. As mulheres que não desejaram a gestação tiveram maior chance de sofrer VPI (p<0,00; OR= 4,32 e IC 95% [1,77 – 10,54]). Com relação às repercussões obstétricas e neonatais, não houve associação estatisticamente significativa entre as variáveis investigadas. Conclui-se que para as participantes do estudo, não houve repercussões obstétricas e neonatais negativas relacionadas à VPI na gestação.
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Bilateral absence of fifth ray in feet, cleft palate, malformed ears, and corneal opacity in a patient with Miller syndrome

Miller syndrome is one of the acrofacial dysostosis syndromes, which are characterized by malformations of the craniofacial region and limbs. A 26 month old male child, the product of healthy nonconsanguineous parents has many typical features of Miller syndrome. He has cleft lip and palate, malar hypoplasia, left crumpled cup shaped ear, and prominent nose together with the absence of the fifth ray in feet [postaxial] and fixation of interphalangeal joints of both thumbs [preaxial]. However the limb affection is bilateral and symmetrical against what is usually reported [bilateral with more affection of one side] and the micrognathia is very mild. Our patient has also bilateral corneal opacities as well as underdeveloped external genitals. There is phenotypic variability in Miller syndrome, and our patient may represent a new distinct subgroup in postaxial acrofacial dysostosis

Impacto de la altura en el embarazo y en el producto de la gestación / Impact of high altitude on pregnancy and newborn parameters

Esta revisión describe los procesos asociados con mantener un embarazo en mujeres nacidas al nivel del mar que cursan su embarazo en la altura; en aquellas que viajan intermitentemente, o las que nacen y residen en la altura. La literatura examinada demuestra que la frecuencia de malformaciones congénitas es elevada en la altura; que las tasas de mortalidad fetal tardía, nacidos pequeños para su edad gestacional, y preeclampsia se encuentran incrementadas en la altura, asociadas a valores altos de hemoglobina materna (>14,5 g/dL). En conclusión, el embarazo en una mujer expuesta de forma aguda, intermitente o permanente a las grandes alturas, genera mayores riesgos en comparación con un embarazo desarrollado a nivel del mar.

This review describes adverse outcomes in pregnancy after brief, intermittent, or permanent residence at high altitudes. Review of literature shows that congenital malformations rates are higher at high altitudes. Additionally, rates of stillbirths, small size for gestational age, and preeclampsia are increased in populations living at high altitudes and are associated with high maternal hemoglobin levels (>14.5 g/dl). In conclusion, a pregnant woman exposed briefly, intermittently, or permanently to high altitudes results in increased risk of adverse outcomes when compared to pregnancies observed at sea level.

Eventos adversos em Unidade de Terapia Intensiva Neonatal / Adverse events in a Neonatal Intensive Care Unit / Eventos adversos en Unidad de Cuidados Intensivos Neonatales

Estudo observacional, prospectivo, para determinar a incidência de eventos adversos (EAs) em Unidade de Terapia Intensiva Neonatal (UTIN). Utilizou-se um "instrumento" específico, adaptado do modelo americano utilizado pela Rede Vermont-Oxford. Dos 218 recém-nascidos, 183 (84%) apresentaram EAs, correspondendo a 2,6 EA/paciente. Distúrbios da termorregulação (29%), distúrbios da glicemia (17,1%) e Infecção Relacionada à Assistência à Saúde (IRAS) de origem hospitalar (13,5%) foram os mais frequentes. Alguns EAs apresentaram associação com peso de nascimento (p < 0,05). O percentual de IRAS e a extubação não programada foi diretamente proporcional ao tempo de internamento. A incidência de EAs em UTIN é elevada entre os recém-nascidos de muito baixo peso. A qualidade da assistência torna-se primordial na elaboração das estratégias preventivas.

This was a prospective, observational study conducted in a neonatal intensive care unit to determine the incidence of adverse events. A specific trigger tool instrument was used, based on the one from Vermont-Oxford Network. A total of 218 neonates were followed and AEs were detected in 183 (84%) of them, with a rate of 2,6 AE/patient. Thermoregulation disorders (29%), disorders of glycemic control (17,1%) and nosocomial infections (13,5%) were the most frequent. Some AE were associated with birth weight (p<0.05). The accidental extubations and nosocomial infections were associated with hospital days. The incidence of AEs is high, especially among neonates with very low birth weight. Best practices regarding preventive strategies are necessary to improve quality of health care for these infants.

Estudio observacional, prospectivo para determinar la incidencia de eventos adversos (EAs) en la Unidad Neonatal de Cuidados Intensivos (UNCI). Fue utilizado un instrumento específico adaptado del modelo americano Vermont-Oxford. De los 218 recién nacidos, el 84% presentaron EA, lo que corresponde a 2,6 EA / paciente. Trastornos de la termorregulación (29%), trastornos de la glicemia (17,1%) e infección relacionada con el cuidado de la salud (IRCS) nosocomiales (13,5%) fueron los más frecuentes. Algunos presentaron asociación con el peso al nacer (p<0,05). El porcentaje de IRCS y la extubación no programada fue directamente proporcional a la duración de la estancia hospitalaria. La incidencia de EAs en la UNCI es alta entre los recién nacidos de muy bajo peso al nacer. La calidad de la asistencia es fundamental en el desarrollo de estrategias de prevención.

Enfermedad periodontal como factor de riesgo para presentar resultados perinatales adversos / Periodontal disease as a risk factor for the adverse perinatal outcomes

Objetivo: Determinar si la enfermedad periodontal (EP) es un factor de riesgo que pudiera ejercer alguna influencia en la presentación de resultados perinatales adversos en la población general. Método: Estudio prospectivo de cohorte, en el cual se incluyeron 282 pacientes que acudieron al Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo León, México, para atención del parto. Se realizó examen dental clasificándolas como sanas o enfermas. Para el análisis estadístico se utilizó estadística descriptiva, medidas de tendencia central y de dispersión, X² y riesgo relativo (RR) para establecer asociación entre la enfermedad periodontal y las variables de estudio. Resultados: La incidencia de EP fue de 15 por ciento. La edad promedio de 22,1 años. El RR para parto prematuro fue 0,67 (IC 95 por ciento 0,19-2,33; p=0,81), preeclampsia 1,17 (IC 95 por ciento 0,45-3,02; p=0,35), ruptura prematura de membranas 0,842 (IC 95 por ciento 0,80-0,88; p=0,76), bajo peso al nacer 0,85 (IC 95 por ciento 0,33-2,51; p=0,71). Conclusión: En nuestro estudio no encontramos asociación entre pacientes con enfermedad periodontal y resultados perinatales adversos.

Objective: To determine the relationship between maternal periodontal disease and the development of adverse perinatal outcomes. Methods: A prospective cohort study was performed; 282 patients were included, who were assisted for their birth delivery at the Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo León, Mexico. A dental examination was done classifying them as healthy or sick. A descriptive and statistic study was done looking for the association between periodontal disease and the variables of the study were compared using X² and relative risk. Results: The incidence of periondontal disease was 15 percent. The average age was 22.1 years. The risk ratio for preterm delivery was 0.67 (CI 95 percent 0.19-2.33; p=0.81), preeclampisa 1.17 (CI 95 percent 0.45-3.02; p=0.35), premature rupture of membranes 0.842 (CI 95 percent 0.80-0.88; p=0.76), low birthweight 0.85 (CI 95 percent 0.33-2.51; p=0.71). Conclusion: No significant association was seen between periodontal disease and the adverse perinatal outcomes.

Antibiotic sensitivity pattern of causative organisms of neonatal septicemia in an urban hospital of Bangladesh.

Background: The information of the sensitivity pattern of the causative organisms is very important for effective control of septicemia in neonates. OBJECTIVE: To determine the proportion and profile of pathogenic bacteria in the blood cultures of the neonates with clinically suspected septicemia and their susceptibility pattern to antimicrobial agents for developing a unified antibiotic treatment protocol. Materials and Methods: A cross-sectional retrospective study was conducted over a period of 3 year and 4 months (39 months). The study included 1000 patients admitted in the selected hospital in Bangladesh. Blood samples for culture were taken aseptically before starting antibiotic therapy. Microorganisms were isolated and identified by standard microbiological processes which include colony morphology, Gram stain, and biochemical profiles. Antimicrobial sensitivity patterns were performed by Kirby-Bauer's disc diffusion method against imipenem, ciprofloxacin, ceftazidime, chloramphenicol, netilmicin, gentamicin, ceftriaxone, aztreonam, cefotaxime, cephalexin, and ampicillin. Results: Among the patients, 633 (63.3%) were males and 367 (36.7%) were females. Blood cultures were found positive in 194 (19.4%) neonates. The organisms isolated were Pseudomonas spp. (31.4%), Klebsiella pneumoniae (23.2%), Staphylococcus aureus (12.4%), Escherichia coli (7.2%), Acinatobactor (5.7%), Gram-negative Bacilli (4.1%), Flavobacterium spp. (3.6%), Serratia spp. (5.7%), Citrobacter fruendi (3.1%), Streptococcus species (2.6%), and Enterobacter spp. (1.0%). A majority of the bacterial isolates in neonatal sepsis were found sensitive to imipenem (91.8%) and ciprofloxacin (57.2%) and resistant to commonly used antibiotics, eg. ampicillin (96.4%) and cephalexin (89.2%). Conclusion : The problem can be mitigated by careful selection and prudent use of available antibiotics.

Intoxicación neonatal por sulfato de magnesio: caso clínico / Magnesium neonatal intoxication: a case review

Magnesium Sulfate is currently the treatment of choice for severe preeclampsia and eclampsia. Since it crosses the placenta, magnesium can reach high levels in fetal plasma, occasionally reaching levels higher than maternal plasma. Objective: To analyze a 35 weeks gestational age newborn, who presented hypermagnesemia due to maternal treatment with magnesium sulfate (in routine dosage) indicated for severe preeclampsia. Clinical Case: The mother was infused with MgS04 for 17 hours until pregnancy was interrupted because of fetal monitoring. The baby weighed 2,620 grams, was depressed, hypotonic, cyanotic and without respiratory effort and only partially responded to initial resuscitation with positive pressure ventilation. The infant was admitted to the Neonatal Intensive Care Unit for monitoring, support and management. High levels of plasma MgS04 were found (4.7 mg/dl), compatible with the diagnosis of hypermagnesemia. Symptoms and signs slowly disappeared, and the child was discharged after 10 days of hospitalization. Conclusion: We present the clinical case of a newborn with a history of maternal use of magnesium sulfate, who presented hypermagnesemia characterized by neonatal depression, hypotonia, central apnea with oxygen requirement and who progressively normalized in a 10 day period.

El Sulfato de Magnesio es actualmente el medicamento de elección para el tratamiento de la embarazada con preeclampsia severa y eclampsia. Dado que atraviesa la placenta, alcanza elevados niveles en el plasma fetal, pudiendo en ocasiones superar la concentración plasmática materna. Objetivo: Analizar la evolución de un neonato de 36 semanas de edad gestacional que cursó con cuadro de hipermagnesemia secundario a tratamiento materno con sulfato de magnesio en dosis habituales, indicado como terapia de una preeclampsia severa. Caso clínico: Madre recibe infusión de MgS04 por un total de 17 hrs antes de decidirse la interrupción del embarazo por vía alta debido a un registro sospechoso. Se obtuvo recién nacido de 2 620 gramos, deprimido, sin esfuerzo respiratorio, hipotónico y cianótico, que respondió parcialmente a la reanimación inicial con ventilación a presión positiva. Se decidió ingreso a Cuidados Intensivos de la Unidad de Neonatología para monitorización, soporte y manejo. Se detectaron niveles plasmáticos elevados de MgS04 de 4,7 mg/dL compatibles con el diagnóstico de Hipermagnesemia. La signología fue disminuyendo progresivamente, decidiéndose el alta luego de 10 días de hospitalización. Conclusión: Se presenta caso clínico de un recién nacido, con antecedente de sulfato de magnesio administrado a la madre y que evoluciona con un cuadro de hipermagnesemia caracterizado por depresión neonatal, apneas centrales, requerimientos de oxígeno e hipotonía, los cuales van normalizándose progresivamente en el curso de 10 días.

Evaluating and managing neonatal acute renal failure in a resource-poor setting.

Acute renal failure (ARF) is encountered in neonatal care where it may be associated with significant morbidities. Pre-renal failure, which is due to impaired renal tissue perfusion, is the commonest type of ARF. It is amenable to treatment with excellent prognosis following prompt diagnosis and timely institution of appropriate intervention. Unfortunately, ARF in the newborn is usually asymptomatic and it is only suspected when a newborn infant has not been observed to pass urine over several hours or when serum Creatinine is observed to be elevated or rising. In resource-poor settings, it is often difficult to conduct detailed evaluation of suspected cases of newborn ARF due to lack of appropriate equipments and infrastructure. Similarly, therapeutic facilities are sparse and there is heavy reliance on conservative management of cases. Such difficulties encountered in the evaluation and management of newborns with ARF in most parts of the developing world, like Nigeria, where diagnostic and therapeutic facilities are limited are highlighted.

Complicações maternas e ocorrências neonatais associadas às gestações múltiplas resultantes de técnicas de reprodução assistida / Maternal complications and neonatal events associated to multiple pregnancies resulting from assisted reproduction techniques / Complicaciones maternas e eventos neonatales asociados con gestaciones múltiples resultantes de técnicas de reproducción asistida

A gestação múltipla é a mais freqüente e a mais séria complicação iatrogênica das técnicas de reprodução assistida. O objetivo do estudo foi conhecer as complicações maternas e as ocorrências neonatais associadas às gestações múltiplas resultantes de reprodução assistida em um centro de referência na área de reprodução assistida. Trata-se de uma pesquisa observacional, transversal, descritiva e retrospectiva que foi realizada no Hospital e Maternidade Santa Joana, centro de referência na área de reprodução humana localizado no município de São Paulo, Brasil. A população estudada foi constituída por 131 prontuários de gestantes internadas com patologias clínicas e trabalho de parto, advindas de gestações múltiplas resultantes de técnicas de reprodução assistida. As complicações maternas predominantes foram: o trabalho de parto prematuro (65,5%), a amniorrexe prematura (42%). As ocorrências neonatais mais freqüentes foram as doenças respiratórias (65,1%), a icterícia (38,4%), os distúrbios metabólicos (13%) e as doenças neurológicas (9%).

Multiple pregnancy is the most frequent and serious iatrogenic complication of the assisted reproduction techniques. The purpose of this study was to know the maternal complications and neonatal events associated to multiple pregnancies, resulting from assisted reproduction in a reference center in the field of assisted reproduction. This was an observational, cross-section, descriptive and retrospective study performed at Hospital e Maternidade Santa Joana, a reference center in the area of human reproduction in the city of São Paulo, Brazil. The studied population consisted of 131 medical records of pregnant women admitted with clinical pathologies and in labor, resulting from multiple pregnancies resulting from assisted reproduction techniques. The predominant maternal complications were: premature labor (65.5%) and premature amniorrhexis (42%), The most frequent neonatal occurrences were respiratory diseases (65.1%), jaundice (38.4%), metabolic disorders (13%) and neurological diseases (9%).

La gestación múltiple es la más frecuente y corresponde a la más seria complicación iatrogénica de las técnicas de reproducción asistida. El objetivo del estudio fue conocer las complicaciones maternas y los eventos neonatales asociados a las gestaciones múltiples resultantes de la reproducción asistida en un centro de referencia en el área de reproducción asistida. Se trata de una investigación observacional, transversal, descriptiva y retrospectiva que fue realizada en el Hospital y Maternidad Santa Joana, centro de referencia en el área de reproducción humana, localizado en el municipio de São Paulo, Brasil. La población estudiada fue constituida por 131 registros de gestantes internadas con patologías clínicas y trabajo de parto, provenientes de gestaciones múltiplas resultantes de técnicas de reproducción asistida. Las complicaciones maternas predominantes fueron: el trabajo de parto prematuro (65,5%) y la ruptura prematura del saco amniótico (42%). Los eventos neonatales más frecuentes fueron las enfermedades respiratorias (65,1%), la ictericia (38,4%), los disturbios metabólicos (13%) y las enfermedades neurológicas (9%).

Patologías maternas, su efecto sobre el feto y el recién nacido / Maternal diseases, their effect on the fetus and newborn

Este artículo pretende describir las patologías maternas que con frecuencia afectan al feto y al recién nacido. Se revisarán las patologías propias del embarazo, aquellas exacerbadas por éste, y enfermedades que por su fisiopatología, tienen un comportamiento interesante en el feto y el recién nacido. No es el objetivo de este artículo describir todas las patologías maternas que pueden afectar al feto y recién nacido, sino solamente las más frecuentes y relevantes. Es interesante destacar que muchas de las enfermedades a las cuales nos vamos a referir, pueden afectar al feto y al recién nacido, tanto en su crecimiento, como en la aparición de malformaciones, así como aumentando el riesgo de secuelas y mortalidad en éstos. Aquí radica la importancia de establecer un adecuado diagnóstico y manejo en los periodos previos al embarazo y prenatal con el fin de evitar estos riesgos.

The present artide will describe some of the maternal diseases that affects the newborn and the fetus, the diseases that were revised, are those that are present only during pregnancy, those exacerbated by pregnancy, and those that theír physiopathology is interestíng in how it's present in the fetus and newborn. It's not the objective of this artide to descríbe in extensive all of the disease that are related to pregnancy and affects the fetus and newborn. It's interesting to note that most of the maternal diseases that are treated in this artide, could affect the fetus and newborn, restricting their growth, increasing the risk of malformations, sequels and death. This is why it's important to realize an adequate diagnosis and management, previous to and during the pregnancy.

Síndrome hipotónico del recién nacido / Hypotonic syndrome in the newborn

Background: The Newborn Hypotonic Syndrome (NHS) is a clinical entity that presents up to 28 days after birth. The main symptom is a significant decrease in muscular tone, but its severity is determined by the lack of muscular strength. NHS is a relatively frequent entity, so it becomes an important diagnosis problem. There is few information in literature regarding its incidence. Method: Retrospective study performed between May 2000 - April 2006, including patients with diagnosis of NHS in a Neonatal Intesive Care Unit. Results: 2 158 newborns, of which 113 (5.2 percent) had NHS. 83 percent of cases were attributed to central causes, such as hipoxic-isquemic encephalopathy (49 percent) and genetic disorders (15 percent). 17 percent of cases corresponded to peripheral causes, including hypermagnesemia (68 percent) and myopathic diseases (21 percent). Conclusions: 1) NHS is a relatively frequent clinical entity; 2) Central causes are the most prevalent; 3) It is possible to study the etiology of NHS with a systematic approach.

Introducción: El síndrome hipotónico del recién nacido (SHRN) es un cuadro clínico que se presenta hasta los 28 días de vida extrauterina. Su síntoma definitorio es la disminución significativa en tono muscular, pero su gravedad se relaciona a asociación a falta de fuerzas. Es un cuadro aparentemente poco frecuente en este grupo etáreo, pero que plantea un problema diagnóstico importante. Existe escasa información en la literatura respecto a su frecuencia real. Objetivo: Evaluar la incidencia de SHRN, su etiología y aprobación diagnóstica. Método: Estudio retrospectivo con revisión de fichas clínicas, desde mayo 2000 a abril 2006, incluyendo pacientes ingresados con diagnóstico de SHRN a unidad de intermedio-intensivo de servicio de recién-nacidos de un hospital universitario (SRNU). Resultados: El número total de RN ingresados a SRNU fue 2158, en 5,2 por ciento (113) el motivo de ingreso, principal o secundario, correspondió a SHRN. Del total de SHRN, 83 por ciento correspondió a causas centrales, destacando encefalopatía hipóxico-isquemica (ehi) (49 por ciento) y genetopatía (15 por ciento). Las causas periféricas correspondieron a 17 por ciento, destacando hipermagnesemia (68 por ciento) y miopatías (21 por ciento). Conclusiones: Con los datos obtenidos, es posible concluir para este estudio: 1) El SHRN es una entidad clínica relativamente frecuente; 2) Las causas centrales son las más frecuentes; 3) Es posible estudio escalonado orientado a encontrar etiología específica del SHRN.

Management of infants with intra-uterine growth restriction.

Intra-uterine growth restriction (IUGR) contributes to almost two-thirds of LBW infants born in India. Poor nutritional status and frequent pregnancies are common pre-disposing conditions in addition to obstetric and medical problems during pregnancy. Growth restriction may be symmetrical or asymmetrical depending on the time of insult during pregnancy. The pathological insult in an asymmetrical IUGR occurs during the later part of the pregnancy and has a brain-sparing effect. Common morbidities are more frequent in < 3rd percentile group as compared to 3rd-10th percentile group. Guidelines for management of IUGR neonates in these two groups have been provided in the protocol.