[A protocol for prognostic evaluation of newborns with necrotizing enterocolitis]. / Protocolo para valoración pronóstica en recién nacidos con enterocolitis necrótica.

A modified Vásquez-Estévez protocol for prognostic appraisal of newborns with necrotizing enterocolitis was retrospectively applied to 23 confirmed cases from year 1987 throughout 1989 in general metropolitan hospital at Santiago, Chile. Cases were classified as low (0-12 points) or high (13-30) risk according to its corresponding score. Case fatality rates ranged from 7.1% to 77.7% in low and high risk groups, respectively. Sensibility was 87.5%, specificity 86.6% and efficiency 86.6%. Instrument application was easy. It concluded that this is a valuable tool for the prognostic evaluation of necrotizing enterocolitis. A wider and deeper prospective application would allow to measure more exactly its usefulness in other settings.

[Newborn infants of diabetic mothers]. / Recién nacido hijo de madre diabética.

Some features as well as pathological findings in 63 infants born to diabetic mothers (IDM) under control in a diabetes unit of a general hospital at metropolitan Santiago, Chile, from 1985 through 1988 are presented. Out of 63 newborns, 22 came from mothers with pregestational diabetes mellitus (PGDM) and 41 were born to mothers with gestational diabetes mellitus (GDM). Significant differences were detected among PGDM and GDM groups of newborns in the following features: mean gestational age (GE) premature (54.5% vs. 26.8% 37 weeks GE or less), jaundice (40.9% vs. 17.1%) and congenital malformations (18.2% vs. 0%). No significant differences were found in fetal distress, hypoglycemia, respiratory distress syndrome and birth trauma although as a whole these last were more frequently recorded among infant born to insulin dependent diabetic mothers. It is concluded that in spite of an appropriate control, morbidity remains higher in IDM, particularly in IDM PGDM.

[Adrenal hemorrhage in newborn infants]. / Hemorragia suprarrenal en el recién nacido.

A retrospective clinical description of 7 newborn infants with adrenal haemorrhage. All patients were born at term by vaginal delivery. Their birth weights ranged between 2,550 and 3,950, and only one was small for gestational age. Two patients had Apgar scores less than 6 at one minute and both were born by forceps delivery. The first symptom of adrenal haemorrhage was an abdominal mass. Diagnosis was confirmed by ultrasonography demonstrating a right adrenal echogenic mass which displaced the Kidney which disappeared along a few and all patients survived.

[Neonatal necrotizing enterocolitis]. / Enterocolitis necrotizante en el período neonatal.

Necrotizing enterocolitis (NEC) is an extremely severe clinical entity in whose pathogenesis at least two of the following factors are involved: intestinal ischaemia, pathogenic bacterial colonization and excessive substrate in the intestinal contents. Common risk factors are prematurity, rapid increase of feeding volume, polycythemia and perinatal asphyxia. Clinical features are abdominal distention, gastric retention, bloody stools and intestinal wall pneumatosis; while its complications are bowel perforation, peritonitis and shock. Early diagnosis allows prompt medical treatment based upon intestinal rest, no oral feeding, parenteral hydration and nutrition, nasogastric intubation, broad spectrum antibiotics and close surveillance. Surgery is kept to treat complications. Prevention includes feeding with human milk in prematures with slow increase of partial and total volumes, early initial fastening in cases of asphyxia and careful and close surveillance of high-risk newborns.