Comparison between one and three doses a week of recombinant erythropoietin in very low birth weight infants.

OBJECTIVE: To compare transfusion requirements and erythropoietic response in preterms between schedules of rEPO administration once or three times per week, using the same weekly dose. STUDY DESIGN: Prospective, randomized trial including infants weighing <1500 g at birth and/or were 32 weeks' gestation: Group 1 (60 infants) received subcutaneous rEPO at 250 units kg(-1) per dose, three times weekly for 6 weeks; Group 2 (59 infants), at 750 units kg(-1) per dose, once weekly for 6 weeks. Efficacy was evaluated based on the transfusion requirement, hemoglobin changes, reticulocyte counts, serum transferrin receptor (sTfR) and serum ferritin. The frequency of adverse effects was registered in both groups. RESULT: A total of 13 infants were transfused in each group (relative risk: 0.98; 95% confidence interval: 0.4 to 2.3). Phlebotomy loss and red blood cell transfusion volumes received were similar in both groups. Hemoglobin levels were lower at end of study in Group 2 (10.6±1.5 g dl(-1) versus 11.5±1.4 g dl(-1); P<0.003). At end of study, reticulocyte counts and sTfR values increased and serum ferritin values decreased, without significant differences between the two groups. Incidence of complications was similar in both groups. CONCLUSION: The once-weekly rEPO schedule for very low birth weight infants proved as effective as the three-times-weekly schedule, in relation to erythropoietic stimulus and transfusion requirement.

Melatonin levels during the first week of life and their relation with the antioxidant response in the perinatal period.

AIM: Melatonin is a potent free radical scavenger and an indirect antioxidant. Knowledge about the behavior of melatonin secretion in the early neonatal period, which may relate to its properties at a vital stage during very high antioxidant demands, is limited. PATIENTS AND METHODS: We studied 35 newborns admitted to the Neonatal Unit with respiratory distress syndrome (RDS) and with no signs of sepsis, severe anemia, hemodynamic compromise or malformation. The gestational age of the newborns was 26-40 weeks (mean value 32.5 weeks) and the weight at birth was 870-4,400 g (mean value 1,800 g). They were classified into two groups: 1,500 g birthweight. In all cases, at 09:00 h on their 1st, 3rd and 7th days of life, serum melatonin was measured by RIA. The clinical history was recorded and treatment and follow-up were performed according to established neonatology practice, and the resultant data recorded. Informed consent from the parents or guardians was obtained in accordance with the Declaration of Helsinki. Statistical analysis was carried out using ANOVA-II (factor I: day of sample; factor II: birthweight). RESULTS: There were significant increases in melatonin levels with increasing birthweight (p = 0.017), but no changes by day of sample. Although in both study groups melatonin levels increased during the first few days this was not statistically significant. CONCLUSIONS: In newborns of low birthweight, we report high melatonin concentrations in the morning and during the first week of life. These increase with maturation, and at full-term were similar to nocturnal levels during the acrophase of pineal gland secretion in toddlers and schoolage children, when pineal gland secretion is maximal and takes place reflecting environmental variations. In the early neonatal period these high levels of melatonin seem to derive from extrapineal sources, which mature to provide antioxidant protection in accordance with other elements of the antioxidant network to compensate for the high levels of oxidative stress that are present in the perinatal period.

[Parent's perception of vaccination]. / Percepción de la vacunación por parte de los padres.

OBJECTIVE: The purpose of this study was to analyze the attitude and grade of knowledge of the parents of children concerning the vaccination of their children, as well as to know their opinion about a program destine to diminish their anxiety. PATIENTS AND METHODS: The subjects of the study were parents of children of our county that began their immunizations in 1994. The method utilized was realization of a survey with closed questions. The statistical analysis was carried out by means of the R-SIGMA program. RESULTS: There were 115 surveys registered. Of these 71% has adequate knowledge of the illness against which their child had been vaccinated. Anxiety and fear was seen in 60% before beginning the vaccination process, descending to 30% once the process of immunization began. Only 54.5% perceived the vaccination as inoffensive and 66% considered that the illness against which their child was being protected were very grave. The principal secondary effect seen in the children was fever (70.4%). Forty-one percent of those surveyed considered that the illness of the vaccination program were typical of a low socioeconomic class. Only 7% gave an opinion that the vaccine should be voluntary and in 100% of the cases was it considered that it was an advance in medicine. Only 25% of the population surveyed had access to previous information and their attitude was reinforced positively. The data most valued by those surveyed, referring to the vaccination program, was the informative interview previous to the program and the presence of the pediatrician. CONCLUSIONS: The vaccine is considered as something dangerous, but necessary. Better education of the parents, on the part of the sanitary authorities and those responsible of ordering and administering vaccines, would result in a modification in the attitude of the population in regards to vaccinations.

[Acute acalculous cholecystitis secondary to immersion asphyxia. Implications in organ donation]. / Colecistitis aguda acalculosa secundaria a asfixia por inmersion. Implicaciones en la donacion de organos.

A case of acute acalculous cholecystitis in a two year-old girl that undergone drowning in sweet water is reported. Cerebral death was diagnosed and the organs donation was authorized. A biliary peritonitis secondary to gallbladder perforation was met during organs extraction. The liver was rejected.

[Peptic ulcer in children]. / Ulcera péptica en niños.

Gastric and duodenal ulcers diagnosed by endoscopic examination are evaluated. Fasting and after lunch test serum gastrin levels were elevated. Other endoscopic findings were found in 42% of patients. Last histological examination revealed that gastritis and gastroduodenitis may coexist. With endoscopic examination incidence of peptic ulcus has increased in the pediatric age.

[Letterer-Siwe in an eighteen-month child (author's transl)]. / Un caso de enfermedad de Letterer-Siwe.

A case of Letterer-Siwe revealing the clinical variability of this illness is described. A one and a half year old child with osteoporosis and osteolysis of the sphenoid bone at the level of the sella turcica and eczematous lesions in the retroauricular and cranial region is presented. Cortical steroid and orally administered Methotrexate have been used. Progress is good and possibility of radiating the sphenoid bone lesion with a small field not affecting the hypophysis is considered.