Efectos de la suplementación con cinc en el primer año de vida / Effects of supplementation with zinc in the first year of life

El cinc es un nutriente esencial por su papel fundamental en muchos aspectos del metabolismo celular. Se revisa en este artículo el papel del cinc en la incidencia de enfermedades infecciosas, la mortalidad, el crecimiento y el neurodesarrollo, haciendo especial hincapié en los ensayos publicados de suplementación con cinc (Zn) en lactantes. Se han revisado ensayos clínicos de suplementación randomizados y controlados, doble ciego, publicados e indexados en las bases de datos Medline, Embase y Cochrane. Se han seleccionado aquellos ensayos realizados en menores de 1 año en los que un grupo experimental recibe suplementos de Zn y un grupo control no, aceptándose la administración conjunta de otros micronutrientes (minerales y vitaminas) si existe un grupo control en el que la no administración de suplementos de Zn es la única diferencia con el experimental. Se consideraron los ensayos de una duración de al menos 2 semanas y con visitas domiciliarias por lo menos cada 4 semanas en el caso de estudiarse la morbilidad. El suplemento con cinc disminuye la incidencia de diarrea y neumonía y la duración de la diarrea si se administra durante su curso. En países en vías de desarrollo la suplementación con cinc mejora el crecimiento. En recién nacidos pretérmino existe una relación entre ingesta de cinc y crecimiento. La relación entre la ingesta de cinc y el neurodesarrollo precisa de más investigación (AU)

Zinc is a essential nutrient because of its major role in many aspects of cellular metabolism. In this article the role of zinc in the incidence of infectious diseases, mortality, growth and neurodevelopment is revised, emphasizing the clinical trials on supplementation with zinc in infants. We revised randomized controlled double-blind clinical trials of zinc supplementation, published and indexed in Medline, Embase and Cochrane databases. We selected those trials with children less of one year of life, in which an experimental group receives zinc supplementation and the control group does not; simultaneous administration of other micronutrients (vitamins and minerals) was accepted if there was a control group in which the only difference with respect to the experimental group was the no administration of supplemental zinc. We considered the trials with duration of almost 2 weeds and with home visits at least monthly in the case of morbidity studies. The zinc supplementation decreases the incidence of diarrhea and pneumonia and the duration of diarrhea if it is given during its cause. In developing countries, zinc supplementation improves growth. In preterm infants there is a relation between intake of zinc and growth. The relation between intake of zinc and neurodevelopment needs further investigation (AU)

Prevención de la ferropenia durante el primer año de vida / No disponible

La ferropenia continúa siendo un problema frecuente entre los lactantes españoles, con potenciales efectos negativos sobre su neurodesarrollo. La mayoría de organizaciones no recomiendan la suplementación universal con hierro en los lactantes nacidos a término sanos de países desarrollados, aunque puede considerarse justificada en aquellos casos en que no puede asegurarse la ingesta recomendada por medio de la dieta. Debe promoverse la ingesta de carne y pescado, evitar el consumo excesivo de zumos y, sobre todo la introducción de la leche de vaca en el primer año de vida. En los niños con lactancia artificial o mixta se recomienda utilizar fórmulas suplementadas. Los lactantes nacidos pretérmino o con bajo peso para su edad gestacional alimentados al pecho deben recibir suplementos que aporten un mínimo de 2 mg por kg de peso y día de hierro elemental. La fórmula para prematuros debe estar suplementada con un contenido en hierro igual o superior a 12 mg/L. Durante el tratamiento con eritropoyetina deben aportarse un mínimo de 6 mg/kg/día de hierro oral lo antes posible. La administración parenteral de hierro continúa planteando controversia (AU)

Iron deficiency is common in spanish infants, with potential negative effects on neurodevelopment. Most medical organizations do not recommend universal iron supplements in tem infants born in developed countries. Preventive measures include encouraging a diversified diet rich in sources of iron and avoiding excessive juice intake. In infants, the introduction of cow´s milk in the first year of life is the greatest dietary risk factor for the development of iron deficiency and iron deficiency anemia. Iron supplements can be used in those infants in which a diversified diet that is rich in sources of iron is not consumed. Formula-fed-infants should consume iron-containing infant formula. Premature and low-birth weight infants should receive iron supplements of at least 2 mg/kg/day during the first months of life. Premature infant formula should contain at least 12 mg/L of iron. Erythropoietin-treated premature infants should receive iron oral supplements of at least 6 mg/kg/day as soon as possible. Intravenous iron administration remains controversial (AU)

[Multiple type I pseudohypoaldosteronism: neonatal management and outcome]. / Seudohipoaldosteronismo tipo I múltiple: presentación y seguimiento.

UNLABELLED: Multiple type I pseudohypoaldosteronism (PHA-I) is an autosomal recessive condition with multiple target-organ unresponsiveness to aldosterone, manifested early after birth with severe salt-wasting and hyperkalemia. Case 1. Female infant born at term after an uneventful pregnancy. One female sibling died in the first week of life with hyperkalemia. The diagnosis of multiple PHA-I resulted from a picture of dehydratation, hyperkalemia and hyponatremia with increased plasma renin activity (PRA), plasma aldosterone and sweat electrolytes. The treatment consisted of salt and sodium bicarbonate supplements, restricted potassium intake, cation exchange resins and high fluid intake. During first year she was hospitalized for severe salt-losing crises. At 7 years of age, she needs salt and sodium bicarbonate supplements and cation exchange resins. She has a normal growth and neurodevelopment. Case 2. Seven-day female newborn with consanguinity in maternal family. Pregnancy and delivery were uncomplicated. On admission she was severely dehydrated with hyponatremia, hyperkalemia, metabolic acidosis and elevated PRA, plasma aldosterone and sweat electrolytes. She remained hospitalized for six months and she was dependent on high amounts of salt and sodium bicarbonate supplements, fluid intake and cation exchange resins. Growth and neurodevelopment are normal. CONCLUSIONS: Multiple PHA-I may be suspected in a newborn with salt-loss and hyperkalemia without glucocorticoid defect. The frequent episodes of dehydratation during the first year of life require long hospitalization. The improvement with age make possible an ambulatory control after the first year of life.

[Adenosine triphosphate (ATP) in the management of paroxysmal supraventricular tachycardia: experience in the neonatal period]. / Manejo del adenosín trifosfato (ATP) en la taquicardia paroxística supraventricular: experiencia en el período neonatal.

INTRODUCTION AND OBJECTIVE: The management of supraventricular tachycardia (SVT) in infants is somewhat controversial since numerous methods of treatment are effective. Regardless of the treatment chosen, it is important to quickly stop the tachycardia in neonates with SVT because they may suddenly become hemodynamically unstable. METHODS: Seventeen episodes of SVT treated with intravenous ATP are studied in 3 newborns (two were preterm infants: 30 and 34 weeks of pregnancy). Ages at presentation ranged from 2 to 27 days. RESULTS: ATP is effective in all episodes of SVT, with a mean intravenous doses between 0.10 and 0.50 mg/kg/dose. All patients showed short sinus arrest after ATP. No adverse side effects or hemodynamics changes occurred after ATP administration. CONCLUSIONS: ATP is a safe and reliable antiarrhythmic in neonatal period, including prematurity. We reviewed the experience in ATP management of SVT, mainly in pediatric population.

[Lumbosacral agenesis. Presentation of one case. Literature review and embriological considerations (author's transl)]. / Agenesia lumbosacra. Presentación de un caso. Revisión de la literatura y consideraciones embriológicas.

A case of a complete lumbosacral agenesis is presented, whose etiological factors are unknown. Clinically, motor deficit corresponded to the agenesis level, but the sensibility and the autonomous nervous system functions, which were conserved, partially, in lower levels than the normal ones in the agenesis. The case report is completed with electromiography, mielography, rectal biopsy, urography, cistography, opaque enema and inborn infection study. There are three facts: a partially conserved sensibility in the lower extremities, normal bladder function and above all, the presence of nervous parasympatics normal fibers in rectum wall, in contrast with the serious motor alteration just in the same medullar levels. Explanation of these facts suggest origin of an embryological source. It is assumed that the noxa must have acted between the third and the fourth weeks of pregnancy at a caudal cordomesoblast level, supposing that it did not affect neural crest.