Follow-up of infants born to mothers with autoinmune thyroid disease. What should not be screened? / Seguimiento del hijo de madre con patología tiroidea autoinmune. ¿Qué no debemos cribar?

INTRODUCTION: Thyroid dysfunction is a common problem in pregnant women. It is usually of an autoimmune origin, with Hashimotós thyroiditis and Graves disease being the most common conditions. Although hormonal changes and transplacental antibody transfer may occur, specific neonatal screening has not been shown to be useful. PATIENTS AND METHOD: A prospective study of newborns of women with autoimmune thyroid disease born at a level III university hospital (November 2013-December 2016). Neonates were selected during their stay at the maternity. Babies with perinatal asphyxia were excluded. Data were collected from the clinical histories of mothers and newborns. RESULTS: A total of 191 neonates were included. Ninety percent of mothers had been diagnosed with autoimmune hypothyroidism. Only 5.8% of newborns had some laboratory disorder, consisting of slightly increased thyroid-stimulating hormone levels, which returned to normal at the age of one month and did not correlate to thyroid peroxidase antibody levels. Transient hyperthyrotropinemia was diagnosed in one newborn and required thyroxin treatment during the first year of life. Among newborns from mothers with Graves disease, 36.8% had some abnormal laboratory value during the first 7 days of life, but there were no cases of hyperthyroidism and only one of transient hyperthyrotropinemia. CONCLUSIONS: Experience at our hospital in screening of newborns from hypothyroid mothers reveals a high number of laboratory controls with a poor diagnostic yield. No relationship was found between thyroid peroxidase antibody levels and thyroid dysfunction. We support the recommendations to continue testing serum thyroid-stimulating hormone and FT4 levels at 48h of life in newborns of mothers with autoimmune hypothyroidism.

[Arteriovenous malformations of the vein of Galen]. / Malformación arteriovenosa de la vena de Galeno.

Vein of Galen arteriovenous malformations encompass a diverse group of vascular anomalies that share a common feature: dilatation of the vein of Galen. Although clinical presentations are highly variable, depending on age of presentation, signs and symptoms overlap between age groups. The association of heart failure and cranial bruit constitutes the most striking clinical presentation in neonates. However, less severe and fulminant modes of presentation are frequent in older infants, children, and adults. Treatment approaches consist of symptomatic treatment of heart failure on the one hand and of surgery or endovascular treatment on the other. The results of the latter have improved in recent years, opening up a broad spectrum of new possibilities. We present the case of an asymptomatic 15-day-old neonate who presented an arteriovenous malformation of the vein of Galen and who was treated with endovascular occlusion of the arterial afferents. An excellent result was obtained with no evidence of neurological abnormalities.

Malformación arteriovenosa de la vena de Galeno / Arteriovenous malformations of the vein of Galen

Las malformaciones arteriovenosas de la vena de Galeno engloban un grupo diverso de anomalías vasculares que comparten un rasgo común: la dilatación de la vena de Galeno. Las manifestaciones clínicas son muy variables, dependiendo de la edad de presentación, aunque los signos y síntomas se superponen entre los distintos grupos de edad. La asociación de insuficiencia cardíaca y soplo craneal produce la manifestación clínica más llamativa en los recién nacidos. Sin embargo, son más frecuentes presentaciones menos graves y repentinas, tanto en lactantes de mayor edad como en escolares y adultos. La terapia consistirá, por un lado, en el tratamiento sintomático de la insuficiencia cardíaca y, por otro, en el tratamiento directo sobre la lesión mediante cirugía o acceso intravascular. Este último tipo de tratamiento ha mejorado los resultados, abriendo nuevas y amplias posibilidades. Se presenta el caso de un paciente de 15 días de vida, asintomático, con una malformación arteriovenosa de la vena de Galeno, al que se le realizó una oclusión intravascular de las aferencias arteriales, en la que se obtuvo un resultado excelente sin secuelas neurológicas (AU)