Gut microbiota in preterm infants receiving breast milk or mixed feeding.

BACKGROUND: Preterm birth is the leading cause of mortality in newborns, with very-low-birth-weight infants usually experiencing several complications. Breast milk is considered the gold standard of nutrition, especially for preterm infants with delayed gut colonization, because it contains beneficial microorganisms, such as Lactobacilli and Bifidobacteria. AIM: To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less. METHODS: An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less, born at the University Hospital Dr. José Eleuterio González at Monterrey, Mexico. A total of 40 preterm neonates were classified into breast milk feeding (BM) and mixed feeding (MF) groups (21 in the BM group and 19 in the MF group), from October 2017 to June 2019. Fecal samples were collected before they were introduced to any feeding type. After full enteral feeding was achieved, the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing. Numerical variables were compared using Student's t-test or using the Mann-Whitney U test for nonparametric variables. Dominance, evenness, equitability, Margalef's index, Fisher's alpha, Chao-1 index, and Shannon's diversity index were also calculated. RESULTS: No significant differences were observed at the genus level between the groups. Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group (P < 0.011). In addition, higher counts of Gammaproteobacteria were detected in the final than in the initial sample (P = 0.040). According to the Margalef index, Fisher's alpha, and Chao-1 index, a decrease in species richness from the initial to the final sample, regardless of the feeding type, was observed (P < 0.050). The four predominant phyla were Bacteroidetes, Actinobacteria, Firmicutes, and Proteobacteria, with Proteobacteria being the most abundant. However, no significant differences were observed between the initial and final samples at the phylum level. CONCLUSION: Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria, contributing to the literature of the gut microbiota structure of very low-birth-weight, preterm.

Annular pancreas as a cause of neonatal duodenal obstruction, a case report.

The annular pancreas (AP) is an uncommon congenital anomaly, characterised by a circumferential envelope in the second portion of the duodenum. In recent years, some genetic component has been found in the etiology. A newborn full-term male, weighing at 1910 g at birth, had a history of intrauterine growth restriction and diagnosis of tetralogy of Fallot, Down syndrome and congenital hypothyroidism. Duodenal membrane is suspected after persistent postprandial vomiting and abdominal distension; his abdomen was distended, hyperresonant and soft. The gastroduodenal series showed data compatible with a duodenal membrane so exploratory laparotomy was performed, finding the pancreas completely wrapping the second portion of the duodenum, so a diamond-shaped-duodenoduodenostomy anastomosis was performed. The AP should be considered, especially in male neonates with postprandial vomiting, abdominal distension, who show some other congenital anomaly, and in the abdominal X-ray, the sign of the double bubble is observed.

Subaortic left brachiocephalic vein and real-time ultrasound-guided puncture.

We describe a subaortic left brachiocephalic vein, a congenital anomaly that can be suspected during the rapid central vein assessment before central venous catheterization. Since the vein descends vertically/obliquely rapidly from its origin, we suggest that the puncture should be made at a greater angle (50°-60°) than what is usually used to puncture this vein (20°-30°). Failure to identify this anomaly may cause a failed puncture or complications from the puncture of adjacent blood vessels.

Entorno alimentario y su relación con obesidad en una población del noreste de México.

No disponible.

Surgical management of palatal teratoma (epignathus) with the use of virtual reconstruction and 3D models: a case report and literature review.

Epignathus is a rare congenital orofacial teratoma that arises from the sphenoid region of the palate or the pharynx. It occurs in approximately 1:35,000 to 1:200,000 live births representing 2% to 9% of all teratomas. We present the case of a newborn of 39.4 weeks of gestation with a tumor that occupied the entire oral cavity. The patient was delivered by cesarean section. Oral resection was managed by pediatric surgery. Plastic surgery used virtual 3-dimensional models to establish the extension, and depth of the tumor. Bloc resection and reconstruction of the epignathus were performed. The mass was diagnosed as a mature teratoma associated with cleft lip and palate, nasoethmoidal meningocele that conditions hypertelorism, and a pseudomacrostoma. Tridimensional technology was applied to plan the surgical intervention. It contributed to a better understanding of the relationships between the tumor and the adjacent structures. This optimized the surgical approach and outcome.

Pectus up: la nueva técnica de tracción para pectus excavatum. Primera cirugía en el noreste de México.

El pectus excavatum es la deformidad de la caja torácica frecuente, siendo el sexo masculino el mayormente afectado. Presentamos el caso de un varón de 16 años con pectus excavatum e índice de Haller de 4, a quien se somete a cirugía de pectus up con sistema de tracción esternal externa y fijación con tornillos. Se obtuvo una muy buena respuesta funcional y estética en su posoperatorio. La cirugía de pectus up como método poco invasivo da buenos resultados posoperatorios.The pectus excavatum is the most frequent deformity of the rib cage, with the male sex being the most affected. We present the case of a 16-year-old male with the presence of pectus excavatum with a Haller's index of 4 who undergoes pectus up surgery with an external sternal traction system and screw fixation. A very good functional and aesthetic response was obtained. The pectus up surgery as a less invasive technique has good postoperative results.

Acquisition of skin characteristics by Monte Carlo modeling and evolutionary setting of parameters.

BACKGROUND: In this paper, we present the intelligent system to characterize optically human skin; our proposal is a non-invasive way to obtain some parameters of the skin such as the concentration of hemoglobin, water percentages, and thickness of the layers of the skin. MATERIAL AND METHODS: To achieve the objective of this work, we used an experimental technique called diffuse reflectance spectrophotometry and numerical calculations, such as the Monte Carlo method and the evolutionary algorithm Evonorm. RESULTS: Five case studies were performed. In the first two cases with the Monte Carlo method, a simulated diffuse reflectance was obtained with proposed parameters in order to compare the parameters obtained by the evolutionary algorithm and the proposed parameters. In the rest of the cases, an experimental diffuse reflectance obtained from volunteers was used. CONCLUSIONS: Numerical modeling was presented to non-invasively detect some parameters of the skin such as hemoglobin concentration, water percentages, and the thickness of the epidermis, dermis, and hypodermis. It was proposed to use evolutionary algorithms for being robust methods for the optimization of complex problems with a reasonable computational cost.

Predicting the optimal depth of ultrasound-guided right internal jugular vein central venous catheters in neonates.

BACKGROUND: Poor positioning of a central venous catheter (CVC) can cause severe complications. The objective is to create a formula that predicts the optimal insertion depth of a real time ultrasound-guided CVC in the right internal jugular vein (RIJV) in newborns. METHODS: Between 2015 and 2017, 91 newborns that required a CVC were included in a prospective observational study. Variables such as gestational age, gender, weight, height, and neck length were studied. On the chest x-ray, the distance between the insertion site on the skin and the catheter tip was measured. RESULTS: Of the patients included, 50 (54.9%) were males and 40 (44.4%) females; 64 (70.3%) were preterm. Mean gestational age was 33.44 (25 to 41) weeks, weight 2020 (580 to 3980) g, and height 43.04 (26 to 53) cm. Variables were correlated with catheter length and an algorithm was modeled for the introduction method, in which the highest corrected determination coefficient was obtained for weight (R2 = 0.723). CONCLUSION: This study demonstrated that the weight of the newborn was the most significant individual predictor of optimal insertion depth of a CVC in the RIJV. The formula Y = 2.6 + 0.7 (weight in kg) that we suggest is practical and reproducible. LEVEL OF EVIDENCE: Level IV.

Vaspin, a Compensatory Mechanism Against High Glucose Levels Since Birth?

Objective: Hormones produced by fat tissue, adipokines, produced during intrauterine life have recently been implicated in fetal growth. Vaspin is an adipokine expressed in visceral adipose tissue and has insulin-sensitizing effects. Elevated serum vaspin concentrations are associated with alterations in insulin sensitivity. We aimed to determine if vaspin concentrations in cord blood from healthy, term newborns differ among those born small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). A secondary objective was to determine whether an association existed between vaspin and anthropometric measurements, glucose and insulin levels in the newborn. Methods: The study population included healthy term newborns, 30 subjects in the SGA, 12 in the AGA, and 34 in the LGA group. Anthropometry was documented in all subjects. Blood was taken from the umbilical cord vein from each child for later analysis for vaspin, insulin and glucose concentrations. Results: Cord blood vaspin, insulin and glucose concentrations were not different between the three study groups. A negative correlation between vaspin and glucose concentrations was demonstrated in the whole cohort (r=-0.364, p=0.001). This correlation was also observed in the LGA group (r=-0.482, p=0.004). Glucose concentrations significantly predicted vaspin concentrations (r2=0.132, p=0.001). Conclusion: We found a negative association between glucose and vaspin concentrations in umbilical cord blood. In addition there was a predictive association between blood glucose and resulting vaspin concentration, suggesting that vaspin can be used as a predictor of alterations in the insulin-glucose metabolism from birth.

Comparación del incremento del perímetro abdominal con la prueba de hidrógeno espirado como predictor clínico de intolerancia a la lactosa / Comparison of an increased waist circumference with a positive hydrogen breath test as a clinical predictor of lactose intolerance

Introducción. La intolerancia a la lactosa es una afección frecuente en pediatría, cuyo diagnóstico erróneo conlleva morbilidad. El objetivo primario del estudio fue evaluar la utilidad del incremento del perímetro abdominal durante la prueba de hidrógeno espirado como predictor de intolerancia a la lactosa. El objetivo secundario fue analizar la influencia del índice de masa corporal, de la medida de la cintura y de la edad en la distensión abdominal de pacientes intolerantes a la lactosa. Población y métodos. Se incluyó a 138 sujetos de entre 3 y 15 años de edad a los cuales se les realizaron mediciones seriadas del perímetro abdominal y determinaciones de hidrógeno espirado cada 30 minutos por 3 horas, durante la prueba de hidrógeno espirado. Resultados. Del total de la muestra, 35 (25,4%) resultaron intolerantes a la lactosa. El incremento de 0,85 cm en el perímetro abdominal comparado con el perímetro abdominal basal tiene sensibilidad del 88% y especificidad del 85% para predecir intolerancia a la lactosa (OR 42,14; IC 95%: 13,08-135,75; p <0,001). El índice de masa corporal y la medida de la cintura no afectaron la distensibilidad del abdomen (p= NS); sin embargo, la edad modificó el momento de la distensión. Conclusiones. El incremento del perímetro abdominal de 0,85 cm en relación con el perímetro abdominal basal durante la prueba de hidrógeno espirado es un parámetro útil para diagnosticar la intolerancia a la lactosa en pediatría. Las variaciones en relación con el índice de masa corporal y la cintura no modificaron la utilidad del incremento del perímetro abdominal a diferencia de la edad.

Introduction. Lactose intolerance is a common disease in pediatrics, and its wrong diagnosis will lead to morbidity. The primary objective of this study was to assess the usefulness of an increased waist circumference during the hydrogen breath test as a predictor of lactose intolerance. The secondary objective was to analyze the impact of body mass index, waist circumference measurement, and age on the abdominal distension of patients with lactose intolerance. Population and methods. A total of 138 subjects aged 3 to 15 years were included. They underwent serial measurements of the waist circumference and hydrogen levels in the breath every 30 minutes over 3 hours during the hydrogen breath test. Results. Out of the entire sample, 35 (25.4%) patients had lactose intolerance. An increase of 0.85 cm in waist circumference compared to the baseline waist circumference results in a sensitivity of 88% and a specificity of 85% to predict lactose intolerance (odds ratio: 42.14, 95% confidence interval: 13.08-135.75, p < 0.001). The body mass index and waist circumference measurement did not affect abdominal distension (p= not significant); however, age modified the time of distension. Conclusions. A 0.85 cm increase in waist circumference compared to the baseline waist circumference during the hydrogen breath test is a useful parameter for the diagnosis of lactose intolerance in pediatrics. Variations in relation to body mass index and waist circumference did not affect the usefulness of an increased waist circumference, unlike age.

Comparison of an increased waist circumference with a positive hydrogen breath test as a clinical predictor of lactose intolerance. / Comparación del incremento del perímetro abdominal con la prueba de hidrógeno espirado como predictor clínico de intolerancia a la lactosa.

INTRODUCTION: Lactose intolerance is a common disease in pediatrics, and its wrong diagnosis will lead to morbidity. The primary objective of this study was to assess the usefulness of an increased waist circumference during the hydrogen breath test as a predictor of lactose intolerance. The secondary objective was to analyze the impact of body mass index, waist circumference measurement, and age on the abdominal distension of patients with lactose intolerance. POPULATION AND METHODS: A total of 138 subjects aged 3 to 15 years were included. They underwent serial measurements of the waist circumference and hydrogen levels in the breath every 30 minutes over 3 hours during the hydrogen breath test. RESULTS: Out of the entire sample, 35 (25.4%) patients had lactose intolerance. An increase of 0.85 cm in waist circumference compared to the baseline waist circumference results in a sensitivity of 88% and a specificity of 85% to predict lactose intolerance (odds ratio: 42.14, 95% confidence interval: 13.08-135.75, p ≤ 0.001). The body mass index and waist circumference measurement did not affect abdominal distension (p= not significant); however, age modified the time of distension. CONCLUSIONS: A 0.85 cm increase in waist circumference compared to the baseline waist circumference during the hydrogen breath test is a useful parameter for the diagnosis of lactose intolerance in pediatrics. Variations in relation to body mass index and waist circumference did not affect the usefulness of an increased waist circumference, unlike age.

La intolerancia a la lactosa es una afección frecuente en pediatría, cuyo diagnóstico erróneo conlleva morbilidad. El objetivo primario del estudio fue evaluar la utilidad del incremento del perímetro abdominal durante la prueba de hidrógeno espirado como predictor de intolerancia a la lactosa. El objetivo secundario fue analizar la influencia del índice de masa corporal, de la medida de la cintura y de la edad en la distensión abdominal de pacientes intolerantes a la lactosa.

Congenital lateral abdominal wall hernia.

Congenital abdominal wall defects that are located outside of the anterior wall are extremely rare and difficult to classify because there are no well accepted guidelines. There are two regions outside of the anterior wall: the flank or lateral wall; and the lumbar region. We report the case of a patient with an oval 3 cm-diameter hernia defect located above the anterior axillary line, which affects all layers of the muscular wall. An anorectal malformation consisting of a recto-vestibular fistula was also identified, and chest X-ray showed dextrocardia. The suggested treatment is repair of the defect before 1 year of age. Given that the anomalies described may accompany lateral abdominal wall hernia, it is important to diagnose and treat the associated defects.

Efficacy and safety of ultrasound-guided internal jugular vein catheterization in low birth weight newborn.

BACKGROUND: Central venous catheterization is not the first choice of vascular access in neonates. Success depends on the size of the vessel and the skill of the health professional performing the procedure. The internal jugular vein provides a predictable path for central venous cannulation, although it is more difficult to cannulate infants than adults and even more difficult in smaller newborns. METHODS: We conducted a prospective study in 100 newborns, in which a 4 Fr ultrasound-guided central venous catheter was placed in the right internal jugular vein (RIJV). The study population was low birth weight (LBW) newborns <2500g, very low birth weight (VLBW) newborns <1500g and extremely low birth weight (ELBW) newborns <1000g. RESULTS: There were 53% female patients, mean gestational age was 31weeks, mean weight 1352g and the CVC was placed at a mean of 12days of extrauterine life. Birth weight distribution was 39% LBW; 33% VLBW and 28% ELBW. A mean of two (1-8) attempts were necessary with a procedure duration of 16.8 (10-40) minutes. Success of RIJV catheterization was 94%. One attempt was necessary in 50% and up to 5 attempts in 95.7%. Success by weight was VLBW, 97.2%; ELBW, 92.9%; LBW, 91.7%. A venous hematoma occurred in 5% of cases. CONCLUSIONS: Ultrasound-guided RIJV cannulation with real-time visualization to gain access to the central venous circulation in low birth weight newborns is effective and safe.

Adding Multiple Adipokines into the Model do not Improve Weight Gain Prediction by Leptin Levels in Newborns.

OBJECTIVE: Most adipose tissue programming is realized in early life. Also, the postnatal three months, rather than the later phases of infancy, may be more relevant in the development of an adverse cardiometabolic risk profile. The adipokines phenotype, as a predictor of early-life weight gain, has been recently explored in cord blood. To determine whether in addition to leptin levels in cord samples, adiponectin, interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), resistin, plasminogen activator inhibitor-1 (PAI-1), and tumor necrosis factor alpha (TNF-α) levels improve weight gain prediction during the first three months of life. METHODS: Adiponectin, IL-6, MCP-1, leptin, resistin, PAI-1, and TNF-α were measured by multiplex immunoassay in a subsample of 86 healthy term newborns. RESULTS: Leptin levels significantly predicted weight gain at 3 months of follow-up (r2=0.09, p=0.006). In the multivariate analysis, including additional adipokines in the model, stepwise or all at once, did not increase the prediction of weight gain after the first three months of life. CONCLUSION: Adding adiponectin, IL-6, MCP-1, resistin, PAI-1, and TNF-α to the prediction model of weight gain in healthy newborns did not prove to be useful. It is probable that their relative contribution to weight gain is not important. Only leptin was relevant as a predictor of weight gain at the 3-month endpoint.

Leptin, IL-6 and TNF-α levels in umbilical cord blood of healthy term newborns in relation to mode of delivery.

In the development of the foetal immune system, cytokines play an important role in its function. Therefore, we sought to determine whether the mode of delivery affects the expression of leptin, IL-6 and TNF-α in umbilical cord blood in healthy term newborns. We collected 125 samples of umbilical cord blood to analyse leptin, IL-6 y TNF-α levels with multiplex immunoassay (MIA). The samples were classified according to mode of delivery: vaginal delivery (VD) and caesarean section (CS). Leptin and IL-6 had higher concentrations in umbilical cord blood in VD than in CS: 42.55 ng/ml (11.92-104.28) versus 35.20 ng/ml (3.26-9326.76), p = 0.039; 9.32 pg/ml (1.13-2020.31) versus 3.81 pg/ml (0.52-834.69) p < 0.001, respectively. Also, a weak correlation between TNF-α and IL-6 was found (r = 0.238, p = 0.007). The most important finding in our study was the differential concentrations of leptin and IL-6 according to mode of delivery.