[Unusual Organophosphate Poisoning: Transplacental Route]. / Intoxicación inusual por organofosforados: Vía transplacentaria.

INTRODUCTION: Accidental or intentional intoxication by organophosphates, which are toxic substances that inhibit acetylcholinesterase, constitutes a serious public health problem worldwide, with a greater impact in developing countries. Chronic intoxication during pregnancy with alterations in neurodevelopment and fetal growth has been described. OBJECTIVE: To describe an unusual case of transplacentally acquired organophosphorus poisoning, highlighting the clinical presentation, the management with atropine, and the neurological outcome. CLINICAL CASE: 36-weeks premature newborn, whose mother presented acute intentional organophosphorus poisoning 17 hours before birth. The patient was born by emergency C-section, without respiratory distress, with bradycardia, hypotonia, miosis, and bron- chorrhea, as well as clinical signs and laboratory evidence of acute poisoning, with severe metabolic acidosis, and decreased cholinesterase activity. She required advanced resuscitation, management in the Neonatal Intensive Care Unit with invasive ventilation, inotropes, and repeated doses of atropine. She evolved with left hemiparesis and convulsive syndrome that was treated with phenobarbital. She was discharged at 34 days of life with her mother, under custody and supervision of social and family welfare. Treatment and follow-up were suspended until her first year of life when her custody was transferred to an aunt. In neurological control at 18 months, she presented persistence of hemiparesis and speech-language delay, without new seizures. CONCLUSIONS: Organophosphorus poisoning is very rare in the neonatal period and due to the absence of guidelines for the management of this type of patients its treatment is challenging and must be individualized, multidisciplinary, evaluating the risk and benefit of each intervention.

Factores predisponentes para ictericia neonatal en los pacientes egresados de la UCI neonatal, Hospital Infantil los Ángeles de Pasto / Predisposing factors for neonatal jaundice in patients discharged from neonatal ICU, in los Ángeles children's Hospital in Pasto

Resumen Introducción: La ictericia neonatal es una de las condiciones más frecuentes en los recién nacidos, a pesar de ser benigna, un tratamiento inadecuado puede llegar a ser nocivo para el paciente. Objetivo: Determinar los factores predisponentes de ictericia neonatal en los pacientes egresados de la UCI neonatal del Hospital Infantil Los Ángeles de la ciudad de Pasto (Nariño) en el periodo enero de 2007 - agosto de 2011. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo y cuantitativo. Se estudiaron 608 historias clínicas de neonatos egresados con diagnóstico de ictericia neonatal; las variables estudiadas se analizaron con el complemento de Excel, XLSTAT-Pro 7.5.2. Resultados: Los principales factores predisponentes encontrados en la población, fueron la lactancia materna exclusiva y el género masculino en un 87%, y 57,40% respectivamente, además 90,79% fueron recién nacidos a término, 92,93% tuvieron peso adecuado para la edad gestacional y 54,93% presentaron ictericia neonatal entre los 2 y 7 días de vida extrauterina. Conclusiones: La ictericia neonatal está asociada a factores maternos y neonatales, tanto modificables como no modificables, que pueden ser abordados con estrategias adecuadas para reducir la carga de enfermedad.

Abstract Introduction: Neonatal jaundice is one of the most common conditions in newborns; however, improper treatment can be harmful to the patient, despite being benign. Objective: To determine the predisposing factors of neonatal jaundice in patients discharged from the neonatal ICU of Los Angeles children's Hospital in the city of Pasto (Nariño) between January 2007and August 2011. Materials and methods: An observational, descriptive, retrospective and quantitative study was conducted. 608 clinical histories of discharged infants diagnosed with neonatal jaundice were studied. The variables studied were analyzed with the complement of Excel, XLSTAT-Pro 7.5.2. Results: The main predisposing factors found in the population were exclusive breastfeeding and male gender in 87%, and 57.40% respectively; besides, 90.79% were newborns at term, 92.93% had adequate weight for their gestational age and 54.93% presented neonatal jaundice between 2 and 7 days of extrauterine life. Conclusions: Neonatal jaundice is associated with both modifiable and non-modifiable maternal and neonatal factors that can be addressed with appropriate strategies to reduce the burden of disease.