Maternal-Fetal Immunologic Response to SARS-CoV-2 Infection in a Symptomatic Vulnerable Population: A Prospective Cohort.

BACKGROUND: Coronavirus disease 2019 (COVID-19) disproportionally affects pregnant women and their newborn; however, little is known about variables that modulate maternal-fetal immune response to infection. METHODS: We prospectively studied socioeconomic, biologic, and clinical factors affecting humoral immunity in 87 unvaccinated pregnant women hospitalized in Buenos Aires for symptoms consistent with COVID-19. RESULTS: The number of days between symptom onset and childbirth predicted maternal and newborn virus spike protein receptor binding domain (RBD)-specific immunoglobulin G (IgG). These findings suggest newborns may benefit less when mothers deliver soon after COVID-19 infection. Similarly, a longer time between symptom onset and birth predicted higher in utero transfer of maternal IgG and its concentration in cord blood. Older gestational age at birth was associated with lower maternal to cord blood IgG ratio. Of women with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 87% developed RBD-specific IgA responses in breast milk within 96 hours of childbirth. IgA was not significantly associated with time from infection but correlated with maternal serum IgG and placental transfer. CONCLUSIONS: These results demonstrate the combined role of biologic, clinical, and socioeconomic variables associated with maternal RBD-specific antibodies and supports early vaccination strategies for COVID-19 in socioeconomically vulnerable pregnant women. CLINICAL TRIALS REGISTRATION: NCT04362956.

The discovery BPD (D-BPD) program: study protocol of a prospective translational multicenter collaborative study to investigate determinants of chronic lung disease in very low birth weight infants.

BACKGROUND: Premature birth is a growing and serious public health problem affecting more than one of every ten infants worldwide. Bronchopulmonary dysplasia (BPD) is the most common neonatal morbidity associated with prematurity and infants with BPD suffer from increased incidence of respiratory infections, asthma, other forms of chronic lung illness, and death (Day and Ryan, Pediatr Res 81: 210-213, 2017; Isayama et la., JAMA Pediatr 171:271-279, 2017). BPD is now understood as a longitudinal disease process influenced by the intrauterine environment during gestation and modulated by gene-environment interactions throughout the neonatal and early childhood periods. Despite of this concept, there remains a paucity of multidisciplinary team-based approaches dedicated to the comprehensive study of this complex disease. METHODS: The Discovery BPD (D-BPD) Program involves a cohort of infants < 1,250 g at birth prospectively followed until 6 years of age. The program integrates analysis of detailed clinical data by machine learning, genetic susceptibility and molecular translation studies. DISCUSSION: The current gap in understanding BPD as a complex multi-trait spectrum of different disease endotypes will be addressed by a bedside-to-bench and bench-to-bedside approach in the D-BPD program. The D-BPD will provide enhanced understanding of mechanisms, evolution and consequences of lung diseases in preterm infants. The D-BPD program represents a unique opportunity to combine the expertise of biologists, neonatologists, pulmonologists, geneticists and biostatisticians to examine the disease process from multiple perspectives with a singular goal of improving outcomes of premature infants. TRIAL REGISTRATION: Does not apply for this study.

Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial.

BACKGROUND: Delayed cord clamping allows for the passage of blood from the placenta to the baby and reduces the risk of iron deficiency in infancy. To hold the infant for more than 1 min at the level of the vagina (as is presently recommended), on the assumption that gravity affects the volume of placental transfusion, is cumbersome, might result in low compliance, and interferes with immediate contact of the infant with the mother. We aimed to assess whether gravity affects the volume of placental transfusion METHODS: We did a multicentre non-inferiority trial at three university-affiliated hospitals in Argentina. We obtained informed consent from healthy mothers with normal term pregnancies admitted early in labour. Vigorous babies born vaginally were randomly assigned in a 1:1 ratio by computer-generated blocks and sequentially numbered sealed opaque envelopes to be held for 2 min before clamping the umbilical cord, at the level of the vagina (introitus group) or on the mother's abdomen or chest (abdomen group). Newborn babies were weighed immediately after birth and after cord clamping. The primary outcome was the difference in weight (as a proxy of placental transfusion volume). The prespecified non-inferiority margin was 18 g (20%). We used t test and χ(2) test for group comparison, and used a multivariable linear regression analysis to control for covariables. This trial is registered with ClinicalTrials.gov, number NCT01497353. FINDINGS: Between Aug 1, 2011, and Aug 31, 2012, we allocated 274 newborn babies to the introitus group and 272 to the abdomen group. 77 newborn babies in the introitus group and 78 in the abdomen group were ineligible after randomisation (eg, caesarean section, forceps delivery, short umbilical cord or nuchal cord). Mean weight change was 56 g (SD 47, 95% CI 50-63) for 197 babies in the introitus group compared with 53 g (45, 46-59) for 194 babies in the abdomen group, supporting non-inferiority of the two approaches (difference 3 g, 95% CI -5.8 to 12.8; p=0.45). We did not note any serious adverse events during the study. INTERPRETATION: Position of the newborn baby before cord clamping does not seem to affect volume of placental transfusion. Mothers could safely be allowed to hold their baby on their abdomen or chest. This change in practice might increase obstetric compliance with the procedure, enhance maternal-infant bonding, and decrease iron deficiency in infancy. FUNDING: Foundation for Maternal and Child Health (FUNDASAMIN).

Comparison of devices for newborn ventilation in the delivery room.

OBJECTIVE: To evaluate the effectiveness and safety of a T-piece resuscitator compared with a self-inflating bag for providing mask ventilation to newborns at birth. STUDY DESIGN: Newborns at ≥26 weeks gestational age receiving positive-pressure ventilation at birth were included in this multicenter cluster-randomized 2-period crossover trial. Positive-pressure ventilation was provided with either a self-inflating bag (self-inflating bag group) with or without a positive end-expiratory pressure valve or a T-piece with a positive end-expiratory pressure valve (T-piece group). Delivery room management followed American Academy of Pediatrics and International Liaison Committee on Resuscitation guidelines. The primary outcome was the proportion of newborns with heart rate (HR)≥100 bpm at 2 minutes after birth. RESULTS: A total of 1027 newborns were included. There was no statistically significant difference in the incidence of HR≥100 bpm at 2 minutes after birth between the T-piece and self-inflating bag groups: 94% (479 of 511) and 90% (466 of 516), respectively (OR, 0.65; 95% CI, 0.41-1.05; P=.08). A total of 86 newborns (17%) in the T-piece group and 134 newborns (26%) in the self-inflating bag group were intubated in the delivery room (OR, 0.58; 95% CI, 0.4-0.8; P=.002). The mean±SD maximum positive inspiratory pressure was 26±2 cm H2O in the T-piece group vs 28±5 cm H2O in the self-inflating bag group (P<.001). Air leaks, use of drugs/chest compressions, mortality, and days on mechanical ventilation did not differ significantly between groups. CONCLUSION: There was no difference between the T-piece resuscitator and a self-inflating bag in achieving an HR of ≥100 bpm at 2 minutes in newborns≥26 weeks gestational age resuscitated at birth. However, use of the T-piece decreased the intubation rate and the maximum pressures applied.

Postpartum use of oxytocin and volume of placental transfusion: a randomised controlled trial.

OBJECTIVE: To assess whether oxytocin administered before clamping the umbilical cord modifies the volume of placental transfusion. DESIGN: Randomised controlled trial. METHODS: Mothers of term infants born vigorous by vaginal delivery with informed consent provided in early labour were randomly assigned to oxytocin (10 IU) given intravenously within 15 s of birth (group 1) or after clamping the umbilical cord 3 min after delivery (group 2). Soon after birth, all infants were weighed using a 1 g precision scale and subsequently placed on the mother's abdomen or chest. At 3 min, in both groups, the cord was clamped and cut, and the weight was again obtained. The primary outcome (volume of placental transfusion) was estimated by the difference in weights. RESULTS: 144 patients were included. There were no differences in the primary outcome: infants in group 1 (n=70) gained a mean weight of 85.9 g (SD 48.3), and in group 2 (n=74) 86.7 g (SD 49.6) (p=0.92). No differences were found in secondary outcomes, including newborns' haematocrit and bilirubin concentrations and severe maternal postpartum haemorrhage. On the advice of the Data and Safety Monitoring Committee, the trial was stopped due to futility at 25% of the planned sample size. CONCLUSIONS: When umbilical cord clamping is delayed for 3 min, term newborn infants born vigorous receive a clinically significant placental transfusion which is not modified by the administration of intravenous oxytocin immediately after birth. TRIAL REGISTRATION NUMBER: NCT02618499.

What is the value of neonatal autopsy? Pathological and clinical correlation in 135 cases. / ¿Cuál es el valor de la autopsia neonatal? Correlación anatomoclínica en 135 casos.

INTRODUCTION: Neonatal autopsy is a valuable, critical diagnostic method to provide genetic counseling for future pregnancies. POPULATION AND METHODS: Retrospective study including all neonatal autopsies performed on deceased neonates at Clínica y Maternidad Suizo Argentina between January 1998 and December 2006. The rate of autopsies was established; the diagnosis indicated in the medical record was compared to autopsy findings. RESULTS: Out of 227 deceased infants, 135 autopsies were performed (rate: 59.5%). Concordance was complete in 25% of autopsies. New information was found in 26%, which had significant implications for genetic counseling. CONCLUSIONS: The rate of autopsies was 59.5%. Pathological and clinical correlation and unsuspected findings with implications for genetic counseling demonstrate the relevance of performing neonatal autopsies systematically.

INTRODUCCIÓN: La autopsia neonatal es un valioso método diagnóstico y esencial para el asesoramiento familiar sobre futuros embarazos. POBLACIÓN Y MÉTODOS: Estudio retrospectivo que incluyó todas las autopsias de neonatos fallecidos en la Clínica y Maternidad Suizo Argentina desde enero de 1998 a diciembre de 2006. Se determinó la tasa de autopsias y se compararon los diagnósticos obtenidos de las historias clínicas con los resultados de estas. RESULTADOS: Sobre el total de 227 niños fallecidos,se realizaron 135 autopsias (tasa de 59,5%). En el 25%,la concordancia fue completa. En el 26%, se halló nueva información con significativa implicancia para el asesoramiento genético. CONCLUSIONES: La tasa de autopsias fue del 59,5%. La correlación anatomoclínica y sus insospechados hallazgos con implicancia para el asesoramiento genético muestran la importancia de la práctica sistemática de la autopsia neonatal.

Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial.

BACKGROUND: Meconium aspiration syndrome (MAS) is a life-threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Although anecdotal data concerning the efficacy of intrapartum oropharyngeal and nasopharyngeal suctioning of MSAF are conflicting, the procedure is widely used. We aimed to assess the effectiveness of intrapartum suctioning for the prevention of MAS. METHODS: We designed a randomised controlled trial in 11 hospitals in Argentina and one in the USA. 2514 patients with MSAF of any consistency, gestational age at least 37 weeks, and cephalic presentation were randomly assigned to suctioning of the oropharynx and nasopharynx (including the hypopharynx) before delivery of the shoulders (n=1263), or no suctioning before delivery (n=1251). Postnatal delivery-room management followed Neonatal Resuscitation Program guidelines. The primary outcome was incidence of MAS. Clinicians diagnosing the syndrome and designating other study outcomes were masked to group assignment. An informed consent waiver was used. Analysis was by intention to treat. FINDINGS: 18 infants in the suction group and 15 in the no suction group did not meet entry criteria after random assignment. 87 in the suction group were not suctioned, and 26 in the no suction group were suctioned. No significant difference between treatment groups was seen in the incidence of MAS (52 [4%] suction vs 47 [4%] no suction; relative risk 0.9, 95% CI 0.6-1.3), need for mechanical ventilation for MAS (24 [2%] vs 18 [1%]; 0.8, 0.4-1.4), mortality (9 [1%] vs 4 [0.3%]; 0.4, 0.1-1.5), or in the duration of ventilation, oxygen treatment, and hospital care. INTERPRETATION: Routine intrapartum oropharyngeal and nasopharyngeal suctioning of term-gestation infants born through MSAF does not prevent MAS. Consideration should be given to revision of present recommendations.

¿Cuál es el valor de la autopsia neonatal? Correlación anatomoclínica en 135 casos / What is the value of neonatal autopsy? Pathological and clinical correlation in 135 cases

Introducción. La autopsia neonatal es un valioso método diagnóstico y esencial para el asesoramiento familiar sobre futuros embarazos. Población y métodos. Estudio retrospectivo que incluyó todas las autopsias de neonatos fallecidos en la Clínica y Maternidad Suizo Argentina desde enero de 1998 a diciembre de 2006. Se determinó la tasa de autopsias y se compararon los diagnósticos obtenidos de las historias clínicas con los resultados de estas. Resultados. Sobre el total de 227 niños fallecidos,se realizaron 135 autopsias (tasa de 59,5%). En el 25%,la concordancia fue completa. En el 26%, se halló nueva información con significativa implicancia para el asesoramiento genético. Conclusiones. La tasa de autopsias fue del 59,5%. La correlación anatomoclínica y sus insospechados hallazgos con implicancia para el asesoramiento genético muestran la importancia de la práctica sistemática de la autopsia neonatal.

Introduction. Neonatal autopsy is a valuable, critical diagnostic method to provide genetic counseling for future pregnancies. Population and methods. Retrospective study including all neonatal autopsies performed on deceased neonates at Clínica y Maternidad Suizo Argentina between January 1998 and December 2006. The rate of autopsies was established; the diagnosis indicated in the medical record was compared to autopsy findings. Results. Out of 227 deceased infants, 135 autopsies were performed (rate: 59.5%). Concordance was complete in 25% of autopsies. New information was found in 26%, which had significant implications for genetic counseling. Conclusions. The rate of autopsies was 59.5%. Pathological and clinical correlation and unsuspected findings with implications for genetic counseling demonstrate the relevance of performing neonatal autopsies systematically.

[Newborn ventilation: comparison between a T-piece resuscitator and self-infating bags in a neonatal preterm simulator]. / Ventilación del recién nacido: comparación entre un reanimador con pieza en T y bolsas autoinflables en un simulador de neonato prematuro.

INTRODUCTION: Although the provision of effective assisted ventilation is the most effective intervention in delivery room resuscitation of depressed newborn infants, there is still limited evidence about which is the optimal device to deliver positive pressure ventilation (PPV). OBJECTIVE: To compare the accuracy of pressures and ventilation rate (VR) delivered to a neonatal simulator with three devices: 240 ml and 450 ml self-infating bags (SIB) and a T-piece resuscitator, and to evaluate the variability in terms of providers' experience. MATERIAL AND METHODS: 76 health care providers divided in two groups according to experience were asked to provide positive pressure ventilation to a neonatal simulator through a facial mask or an endotracheal tube with three ventilating devices: a T-piece resuscitator, a 240 ml and a 450 ml self-infating bags. Participants used each combination of device and interface randomly on 2 consecutive occasions. Mean and maximum PIP and respiratory rate were recorded. Statistical analyses were performed using two-factor analysis of variance for repeated measures. RESULT: SIB 240 and 450 were similar in the mean target peak inspiratory pressure (PIP) but both were significantly different (p < 0.001) from T-piece, although all values were close to the target. Mean VR was over the target for all the devices (p < 0.001). The highest difference found was 7 ± 1.7 breaths/minute with the 240 ml bag when compared with the T-piece using a mask. Experienced operators were closer than novice operators to target VR, regardless of the device or interface. CONCLUSION: The accuracy for the devices was comparable in the variables measured regardless operator´s experience. Overall, the T-piece provided lower PIP while both SIB, higher than the target. The VR was over the target for all the devices. Both SIB and novice participants were associated with higher VR. The intraoperator consistency was comparable in the variables measured with all devices.

[Delivery room practices in infants born through meconium stained amniotic fluid: a national survey]. / Prácticas en la asistencia de niños nacidos con líquido amniótico meconial en la sala de partos: una encuesta nacional.

UNLABELLED: Based on the results of two large RCTs, guidelines from NRP/AAP, ILCOR, ACOG, and from Argentinean scientific societies for intrapartum and postpartum management of pregnancies with Meconium Stained Amniotic Fluid (MSAF) have radically changed. However, there are no data as to current delivery room management of infants born through MSAF. OBJECTIVES: 1) To assess current delivery room approaches in infants born through MSAF in Argentina; 2) To evaluate the adherence to NRP/AAP recommendations among different centers. DESIGN/METHODS: A 20-question anonymous web-mail based survey was sent to 121 institutions with > or = 500 births a year. RESULTS: The response rate was 63% representing 182,540 deliveries/year (26% of the total number of births in the country). Among the surveyed institutions, 24% were located in the city of Buenos Aires and 72% were public hospitals. Although no longer recommended, the following procedures are frequently performed: 1) Oro-nasopharingeal suctioning of meconiumstained infants before the delivery of the shoulders: sometimes, 50% of centers; always, 7 %. 2) Routine tracheal suctioning in vigorous infants, 30%. 3) Glottis exposure under laryngoscopy, 13 % for thin-consistency MSAF and 43% for thick-consistency MSAF. On the contrary, and although strongly recommended, only 69% of depressed infants have tracheal suctioning before ventilation. Up to 7% of centers perform other non recommended procedures such as chest compression and pressure over the larynx, to avoid breathing, and gastric lavage. CONCLUSIONS: In spite of not being currently recommended, intrapartum suction and postnatal intubation and suction of vigorous infants with MSAF are commonly performed in Argentina while in depressed newborns the latter procedure is not always carried out. Our study confirms the frequent gaps observed between scientific evidence, guidelines and clinical practice.

What (not) to do at and after delivery? Prevention and management of meconium aspiration syndrome.

Meconium aspiration syndrome (MAS) is a life-threatening disorder in newborn infants. Universal intrapartum suction of infants with meconium stained amniotic fluid (MSAF) and postnatal suction of vigorous infants have been used in an attempt to decrease the incidence and severity of the disease by clearing the airway. Both procedures have been proven fruitless when challenged through randomised control trials (RCTs). Endotracheal intubation and suctioning are currently recommended only for non-vigorous infants. Respiratory failure in infants with MAS is frequently treated initially with conventional or synchronized mechanical ventilation. Surfactant administration and high-frequency ventilation (HFV) are commonly used as rescue therapy for severe cases. Nitric oxide (NO) is added when severe pulmonary hypertension is demonstrated. ECMO is an option when other treatments have failed. In the pathophysiology of severe MAS, asphyxia and pulmonary hypertension are considered to be more important than the obstruction of the airways and/or damage to the lung produced by meconium.

Perinatal testicular torsion: a unique strategy.

BACKGROUND/PURPOSE: Perinatal testicular torsion (PTT) is defined as testicular torsion occurring prenatally or within the first 30 days of life. The aim of this study was to evaluate the data obtained from patients with PTT and propose principles of management based on clinical, surgical, and histologic findings. METHODS: A retrospective analysis of 27 boys seen between 1990 and 2005 with surgically documented PTT was conducted. Patients were divided into 2 groups: A, prenatal testicular torsion; B, postnatal testicular torsion. The presence of acute scrotal inflammatory signs defined the urgency to operate. RESULTS: There were 4 clinical pictures in group A: A1, patients with a nubbin testis (n = 3); A2, patients with a small and hard testis (n = 12); A3, patients with a normal-sized and hard testis (n = 8); and A4, patients with an acute scrotum (n = 2). Group B (n = 2) presented no sign after birth and later developed an acute scrotum. Surgical exploration and histologic examination showed clear signs of a long-standing testicular torsion in groups A1, A2, and A3 or a recent-onset testicular torsion in groups A4 and B. Only one testis could be salvaged (group B). CONCLUSIONS: Clinical signs correlated very well with surgical and histologic findings and can define the need and the urgency to operate. Although testicular salvage rate is very low, the affected side always should be explored to confirm the diagnosis and to fix or remove the affected testicle. The contralateral scrotum also should be explored because of the risk of asynchronous contralateral testicular torsion.

Ventilación del recién nacido: comparación entre un reanimador con pieza en t y bolsas autoinflables en un simulador de neonato prematuro / Newborn ventilation: comparison between a T-piece resuscitator and self-inflating bags in a neonatal preterm simulator

Administrar ventilación asistida adecuada es la intervención más eficaz durante la reanimación de los recién nacidos en sala de partos. La evidencia sobre cuál es el dispositivo óptimo para suministrar ventilación con presión positiva (VPP) luego del nacimiento es aún limitada. Objetivo. Comparar la precisión en la administración de presión positiva y frecuencia respiratoria en un modelo de reanimación neonatal, con bolsas autoinflables (BAI) de 240 ml y 450 mly un reanimador con pieza en T y evaluar la variabilidad según la experiencia del operador.Población y métodos. 76 profesionales divididos en dos grupos, de acuerdo a su experiencia, realizaron VPP a un simulador neonatal empleando los tres dispositivos de ventilación, con máscara facial y tubo endotraqueal. Utilizaron aleatoriamente cada combinación de dispositivo y la interfaz en dos oportunidades consecutivas. Se realizó análisis de varianza a dos factores paramediciones repetidas.Resultados. Las BAI 240 y 450 fueron similares en la media de la presión inspiratoria máxima (PIM), pero ambas fueron significativamente diferentes(p menor 0,001) con respecto al reanimador con pieza en T, aunque los valores se acercaron a lo solicitado. La frecuencia respiratoria media sobrepasó la indicada con todos los dispositivos (p menor 0,001). Los operadores experimentados, independientemente del dispositivo y de la interfaz utilizados, estuvieron más cerca que los principiantes de la frecuencia respiratoria solicitada. Conclusión. Tanto la pieza en T como las BAI administraron PIM cercanas a las indicadas, independientemente de la experiencia del operador,y con las bolsas se observaron valores superiores.Las BAI y los operadores principiantes se asociaron con una mayor FR. La consistencia intraoperador fue equiparable en las variablesmedidas con todos los dispositivos.

Prácticas en la asistencia de niños nacidos con líquido amniótico meconial en la sala de partos: una encuesta nacional / Delivery room practices in infants born through meconium stained amniotic fluid: a national survery

Las guías de las sociedades científcas internacionales para asistencia intraparto y posparto de nacimiento con líquido amniótico meconial (LAM) cambiaron radicalmente en los últimos años en base a dos grandes estudios aleatorizados. En la Argentina no hay información acerca de las prácticas que se realizan en estos nacimientos. Objetivos: 1) Conocer qué prácticas se utilizan en la recepción de recién nacidos con antecedente de LAM. 2) Evaluar el grado de adherencia a las recomendaciones actuales. Material y métodos- Encuesta anónima vía internet a centros del país con mayor o igual 500 nacimientos anuales. Se contactaron 121 instituciones. Resultados: Respondieron 76/121 (63 por ciento) correspondientes a 182540 nacimientos anuales (26 por ciento del total de la Argentina). De las respuestas, 24 por ciento fueron de la Ciudad de Buenos Aires y 72 por ciento de hospitales públicos. Se realizan frecuentemente los siguientes procedimientos no recomendados: 1) aspiración orofaríngea y nasofaríngea antes del desprendimiento de los hombros: en el 50 por ciento a veces y en el 7 por ciento siempre; 2) Aspiración endotraqueal de rutina en niños vigorosos, 30 por ciento de los centros; 3) laringoscopia de rutina para visualizar las cuerdas vocales en el 13 por ciento de LAM fluido y 31 por ciento de LAM espeso. Por el contrario, y a pesar de ser una recomendación formal, la aspiración endotraqueal de niños deprimidos antes de comenzar con la ventilación se realiza sólo en el 69 por ciento de los casos. Un 7 por ciento de los centros encuestados, realiza otros procedimientos no recomendados, como comprensión torácica y presión sobre la laringe para evitar que el niño respire y también el lavado gástrico. Conclusiones: La aspiración orofaríngea y nasofaríngea antes del desprendimiento de los hombros y la intubación y aspiración posnatal de niños vigorosos con LAM se realizan frecuentemente en la Argentina.

Torsión testicular bilateral y sincrónica en un recién nacido. Caso clínico / Bilateral and synchronous testicular torsion in a newborn. Case report

La torsión testicular perinatal, definida como aquella ocurrida entre el período prenatal y el período postnatal hasta el mes de nacimiento, es una entidad rara que, en general, afecta uno de los testículos. Como la mayoría de los casos ocurre durante el período prenatal, la tasa de pérdida testicular es muy alta.La torsión testicular bilateral, ya sea sincrónica o asincrónica, es mucho más rara. La existencia de torsión testicular unilateral debe alertar al equipo médico neonatal sobre la posibilidad cierta de torsión contralateral.Presentamos un recién nacido con torsión testicular bilateral (compromiso de pared escrotal bilateral, con testículos duros,adheridos a cubiertas escrotales, sin hidrocele ni signos inflamatorios agudos, ecografía y eco-doppler característicos, y necrosis isquémica con pérdida de ambos testículos durante la exploración quirúrgica). Proponemos pautas de manejo de la torsión testicular.