Neurodesarrollo a los 2 años en cardiopatía congénita: utilidad pronóstica de los marcadores de daño cerebral / Neurodevelopmental outcomes in congenital heart disease: Usefulness of biomarkers of brain injury

Introducción: En la actualidad, las alteraciones del neurodesarrollo son la complicación más frecuente en los pacientes con cardiopatía congénita (CC) en edad escolar. Analizamos la incidencia de eventos neurológicos agudos (ENA) en pacientes con CC sometidos a cirugía cardiaca y la utilidad de los neuromarcadores para predecir el neurodesarrollo. Métodos: Estudio prospectivo observacional en recién nacidos (RN) con CC diagnosticada prenatalmente, y sometidos a cirugía el primer año de vida. Se evaluaron: 1) biomarcadores sanguíneos de lesión cerebral (S100B, enolasa neuronal específica) en sangre de cordón y periquirúrgicos; 2) datos clínicos y analíticos perinatales y periquirúrgicos; 3) tratamientos y complicaciones, y 4) neurodesarrollo (escala de Bayley III) a los 2 años. Resultados: Se incluyeron 84 RN con CC de diagnóstico fetal, confirmada posnatalmente, sometidos a cirugía cardiaca en el primer año de vida. Diecisiete pacientes tenían corazón univentricular, 20 pacientes obstrucción izquierda y 10 síndromes genéticos. Fallecieron en el periodo posquirúrgico 5 pacientes (5,9%) y 9 pacientes presentaron ENA (10,7%). Las puntuaciones medias en el test de Bayley III fueron normales, pero el 31% tuvieron alteración cognitiva, motora o en el lenguaje. Los pacientes con síndromes genéticos, ENA y CC univentriculares tuvieron peor neurodesarrollo. La elevación de S100B en el postoperatorio inmediato se correlacionó con peores puntuaciones. Conclusiones: Los pacientes con CC sometidos a cirugía tienen mayor riesgo de sufrir alteraciones del neurodesarrollo. Los pacientes con síndromes genéticos o corazones univentriculares presentan peores resultados. Presentar ENA posquirúrgico puede contribuir a peores resultados. Niveles de S100B elevados en el postoperatorio se correlacionan con peores resultados en los test de neurodesarrollo a los 2 años...(AU)

Introduction: At present, neurodevelopmental abnormalities are the most frequent type of complication in school-aged children with congenital heart disease (CHD). We analysed the incidence of acute neurologic events (ANEs) in patients with operated CHD and the usefulness of neuromarkers for the prediction of neurodevelopment outcomes. Methods: Prospective observational study in infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. We assessed the following variables: (1) serum biomarkers of brain injury (S100B, neuron-specific enolase) in cord blood and preoperative blood samples; (2) clinical and laboratory data from the immediate postnatal and perioperative periods; (3) treatments and complications; (4) neurodevelopment (Bayley-III scale) at age 2 years. Results: The study included 84 infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. Seventeen had univentricular heart, 20 left ventricular outflow obstruction and 10 genetic syndromes. The postoperative mortality was 5.9% (5/84) and 10.7% (9/84) patients experienced ANEs. The mean overall Bayley-III scores were within the normal range, but 31% of patients had abnormal scores in the cognitive, motor or language domains. Patients with genetic syndromes, ANEs and univentricular heart had poorer neurodevelopmental outcomes. Elevation of S100B in the immediate postoperative period was associated with poorer scores. Conclusions: Children with a history of cardiac surgery for CHD in the first year of life are at risk of adverse neurodevelopmental outcomes. Patients with genetic syndromes, ANEs or univentricular heart had poorer outcomes. Postoperative ANEs may contribute to poorer outcomes. Elevation of S100B levels in the postoperative period was associated with poorer neurodevelopmental outcomes at 2 years...(AU)

Neurodevelopmental outcomes in congenital heart disease: Usefulness of biomarkers of brain injury.

INTRODUCTION: At present, neurodevelopmental abnormalities are the most frequent type of complication in school-aged children with congenital heart disease (CHD). We analysed the incidence of acute neurologic events (ANEs) in patients with operated CHD and the usefulness of neuromarkers for the prediction of neurodevelopment outcomes. METHODS: Prospective observational study in infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. We assessed the following variables: (1) serum biomarkers of brain injury (S100B, neuron-specific enolase) in cord blood and preoperative blood samples; (2) clinical and laboratory data from the immediate postnatal and perioperative periods; (3) treatments and complications; (4) neurodevelopment (Bayley-III scale) at age 2 years. RESULTS: the study included 84 infants with a prenatal diagnosis of CHD who underwent cardiac surgery in the first year of life. Seventeen had univentricular heart, 20 left ventricular outflow obstruction and 10 genetic syndromes. The postoperative mortality was 5.9% (5/84) and 10.7% (9/84) patients experienced ANEs. The mean overall Bayley-III scores were within the normal range, but 31% of patients had abnormal scores in the cognitive, motor or language domains. Patients with genetic syndromes, ANEs and univentricular heart had poorer neurodevelopmental outcomes. Elevation of S100B in the immediate postoperative period was associated with poorer scores. CONCLUSIONS: children with a history of cardiac surgery for CHD in the first year of life are at risk of adverse neurodevelopmental outcomes. Patients with genetic syndromes, ANEs or univentricular heart had poorer outcomes. Postoperative ANEs may contribute to poorer outcomes. Elevation of S100B levels in the postoperative period was associated with poorer neurodevelopmental outcomes at 2 years. Studies with larger samples and longer follow-ups are needed to define the role of these biomarkers of brain injury in the prediction of neurodevelopmental outcomes in patients who undergo surgery for management of CHD.

Neuron-specific enolase kinetics: an additional tool for neurological prognostication after cardiac arrest.

INTRODUCTION AND OBJECTIVES: To analyze neuron-specific enolase (NSE) kinetics as a prognostic biomarker of neurological outcome in cardiac arrest survivors treated with targeted temperature management. METHODS: We performed a retrospective analysis of patients resuscitated from in- or out-of-hospital cardiac arrest admitted from September 2006 to May 2018 in a single tertiary care center and cooled to 32°C to 34°C for 24 hours. Blood samples for measurement of NSE values were drawn at hospital admission and at 24, 48, and 72hours after return of spontaneous circulation (ROSC). Neurological outcome was evaluated by means of the Cerebral Performance Category (CPC) score at 3 months and was characterized as good (CPC 1-2) or poor (CPC 3-5). RESULTS: Of 451 patients, 320 fulfilled the inclusion criteria and were analyzed (80.3% male, mean age 61±14.1 years). Among these, 174 patients (54.4%) survived with good neurological status. Poor outcome patients had higher median NSE values at hospital admission and at 24, 48 and 72 hours after ROSC. At 48 and 72 hours after ROSC, NSE predicted poor neurological outcome with areas under the receiver-operating characteristic curves of 0.85 (95%CI, 0.81-0.90) and 0.88 (95%CI, 0.83-0.93), respectively. In addition, delta NSE values between 72hours after ROSC and hospital admission predicted poor neurological outcome with an area under the receiver-operating characteristic curve of 0.90 (95%CI, 0.85-0.95) and was an independent predictor of unfavorable outcome on multivariate analysis (P <.001). CONCLUSIONS: In cardiac arrest survivors treated with targeted temperature management, delta NSE values between 72 hours after ROSC and hospital admission strongly predicted poor neurological outcome.

Tumor de Askin / Askins tumor

Resumen El tumor de Askin es una rara neoplasia de la pared torácica que pertenece al grupo de tumores neuroectodérmicos primitivos que incluyen desde el sarcoma de Ewing hasta el neuroepitelioma. Su principal característica es el dolor. Los tumores neuroectodérmicos primitivos (PNET) derivan de células pluripotenciales neuroectodérmicas de la cresta neural y pertenecen al grupo de tumores de células pequeñas redondas y azules que se caracterizan por un comportamiento agresivo, con manifestaciones clínicas diversas que dependen de su localización anatómica. La localización más común es la toracopulmonar, seguida por el área pélvica. Las metástasis normalmente afectan a los pulmones, huesos, hígado y cerebro. Su diagnóstico se basa en estudios imagenológicos y se confirma con el estudio de histopatología en biopsia o en la resección quirúrgica.

Abstract The Askin's tumor is a rare neoplasm of the chest wall that belongs to the group of primitive neuroectodermal tumors (PNETs), which are derivatives from neuroectodermal pluripotent neural crest cells. The range of this type of tumors covers from Ewing's sarcoma to the neuroepithelioma and they belong to the group of small round blue cells tumors which are characterized for having an aggressive behavior with diverse clinical manifestations depending on their anatomical location. The most common location for the Askin's tumor is the thoracopulmonary area followed by the pelvic area and in the case of metastases the lungs, bones, liver and brain are the most affected parts. In order to identify this disease, the diagnosis of this type of tumor consists on image studies and the confirmation is made through a hispathology biopsy or surgical resection.

[Polymetastatic highly aggressive Small Cell Undifferentiated Neuroendocrine Carcinoma of Ascending Colon]. / Carcinoma neuroendocrino indiferenciado polimetástatico altamente agresivo de células pequeñas de colon ascendente.

Neuroendocrine carcinoma (NEC) of the colon is a rare and very aggressive tumor with poor prognosis. The current case report presents a 53-year-old male with a 6 cm × 10 cm ascending colon carcinoma, causing large intestine obstruction, with simultaneous multiple hepatic metastases and peritoneal carcinomatosis. Surgical resection of the primary tumor was performed, because of the bowel obstruction, to ameliorate the symptoms before the onset of chemotherapy. Histopathology revealed that the tumor was a small-cell undifferentiated NEC. During the post0operative period, the patient presented pulmonary metastases, and on the 36th post-operative day, death occurred due to respiratory failure.

El carcinoma neuroendocrino del colon es un tumor raro y muy agresivo, con mal pronóstico. Se presenta el caso de un hombre de 53 años con un carcinoma de colon ascendente de 6 × 10 cm que causa obstrucción del intestino grueso, con metástasis hepáticas múltiples simultáneas y carcinomatosis peritoneal. Se realizó la resección quirúrgica del tumor primario, debido a la obstrucción intestinal, para mejorar los síntomas antes del inicio de la quimioterapia. La histopatología reveló que el tumor era un carcinoma neuroendocrino indiferenciado de células pequeñas. Durante el posoperatorio, el paciente presentó metástasis pulmonares y el día 36 posoperatorio se produjo la muerte por insuficiencia respiratoria.

Marcadores moleculares de la asfixia perinatal / Molecular markers of perinatal asphyxia

Introducción: la asfixia perinatal es un problema de salud que puede acarrear alteraciones del neurodesarrollo en los recién nacidos. Las determinaciones en suero de enolasa específica de neurona, lactato deshidrogenasa y aspartato amino transferasa han sido utilizadas como marcadores de asfixia perinatal. Objetivos: evaluar el valor de las determinaciones en suero de lactato deshidrogenasa, aspartato amino transferasa y enolasa específica de neurona como marcadores moleculares de la asfixia perinatal. Métodos: se realizó un estudio observacional descriptivo de corte transversal. Se trabajó con una muestra intencional de 41 recién nacidos asfícticos, clasificados con distintos grados de encefalopatía hipóxico-isquémica según los criterios de Sarnat. Se tomaron muestras de suero al momento del nacimiento y a las 72 horas siguientes. Las determinaciones en suero de enolasa específica de neurona se realizaron por ELISA. Se cuantificó lactato deshidrogenasa y aspartato amino transferasa por espectrofotometría. Resultados: todos los pacientes presentaron valores elevados en suero, de los tres analitos, a las 24 y 72 horas de nacidos. Los valores enzimáticos no variaron significativamente entre las 24 y 72 horas de nacidos sin tomar en cuenta el grado de encefalopatía hipóxico-isquémica. Existe correlación positiva entre los valores enzimáticos a las 24 y a las 72 horas de enolasa específica de neurona y lactato deshidrogenasa. No fue posible diferenciar el grado de encefalopatía hipóxico-isquémica a través de los niveles en suero de estas enzimas. Conclusiones: los valores de estas determinaciones enzimáticas contribuyen a describir desde el punto de vista bioquímico el cuadro del neonato con asfixia perinatal(AU)

Introduction: perinatal asphyxia is a health problem which may cause neurodevelopmental alterations in newborns. Serum determinations of neuron-specific enolase, lactate dehydrogenase, and aspartate aminotransferase have been used as markers of perinatal asphyxia. Objectives: evaluate the value of serum determinations of lactate dehydrogenase, aspartate aminotransferase and neuron-specific enolase as molecular markers of perinatal asphyxia. Methods: a cross-sectional observational descriptive study was conducted of 41 asphyxiated newborns classified as different grades of hypoxic-ischemic encephalopathy according to Sarnat's scale. Serum samples were taken at birth and 72 hours later. Serum determinations of neuron-specific enolase were obtained by ELISA. Lactate dehydrogenase and aspartate aminotransferase were quantified by espectrophotometry. Results: all the patients had high serum values of the three analytes 24 and 72 hours after birth. Enzyme values did not vary significantly from 24 to 72 hours after birth, not considering the grade of hypoxic-ischemic encephalopathy. A positive correlation was found between enzyme values for neuron-specific enolase and lactate dehydrogenase at 24 and 72 hours. It was not possible to differentiate the grade of hypoxic-ischemic encephalopathy via the serum levels of these enzymes. Conclusions: the values of these enzyme determinations contribute to describe the status of neonates with perinatal asphyxia from a biochemical point of view(AU)

Marcadores moleculares de la asfixia perinatal / Molecular markers of perinatal asphyxia

Introducción: la asfixia perinatal es un problema de salud que puede acarrear alteraciones del neurodesarrollo en los recién nacidos. Las determinaciones en suero de enolasa específica de neurona, lactato deshidrogenasa y aspartato amino transferasa han sido utilizadas como marcadores de asfixia perinatal. Objetivos: evaluar el valor de las determinaciones en suero de lactato deshidrogenasa, aspartato amino transferasa y enolasa específica de neurona como marcadores moleculares de la asfixia perinatal. Métodos: se realizó un estudio observacional descriptivo de corte transversal. Se trabajó con una muestra intencional de 41 recién nacidos asfícticos, clasificados con distintos grados de encefalopatía hipóxico-isquémica según los criterios de Sarnat. Se tomaron muestras de suero al momento del nacimiento y a las 72 horas siguientes. Las determinaciones en suero de enolasa específica de neurona se realizaron por ELISA. Se cuantificó lactato deshidrogenasa y aspartato amino transferasa por espectrofotometría. Resultados: todos los pacientes presentaron valores elevados en suero, de los tres analitos, a las 24 y 72 horas de nacidos. Los valores enzimáticos no variaron significativamente entre las 24 y 72 horas de nacidos sin tomar en cuenta el grado de encefalopatía hipóxico-isquémica. Existe correlación positiva entre los valores enzimáticos a las 24 y a las 72 horas de enolasa específica de neurona y lactato deshidrogenasa. No fue posible diferenciar el grado de encefalopatía hipóxico-isquémica a través de los niveles en suero de estas enzimas. Conclusiones: los valores de estas determinaciones enzimáticas contribuyen a describir desde el punto de vista bioquímico el cuadro del neonato con asfixia perinatal(AU)

Introduction: perinatal asphyxia is a health problem which may cause neurodevelopmental alterations in newborns. Serum determinations of neuron-specific enolase, lactate dehydrogenase, and aspartate aminotransferase have been used as markers of perinatal asphyxia. Objectives: evaluate the value of serum determinations of lactate dehydrogenase, aspartate aminotransferase and neuron-specific enolase as molecular markers of perinatal asphyxia. Methods: a cross-sectional observational descriptive study was conducted of 41 asphyxiated newborns classified as different grades of hypoxic-ischemic encephalopathy according to Sarnat's scale. Serum samples were taken at birth and 72 hours later. Serum determinations of neuron-specific enolase were obtained by ELISA. Lactate dehydrogenase and aspartate aminotransferase were quantified by espectrophotometry. Results: all the patients had high serum values of the three analytes 24 and 72 hours after birth. Enzyme values did not vary significantly from 24 to 72 hours after birth, not considering the grade of hypoxic-ischemic encephalopathy. A positive correlation was found between enzyme values for neuron-specific enolase and lactate dehydrogenase at 24 and 72 hours. It was not possible to differentiate the grade of hypoxic-ischemic encephalopathy via the serum levels of these enzymes. Conclusions: the values of these enzyme determinations contribute to describe the status of neonates with perinatal asphyxia from a biochemical point of view(AU)

[An experimental model of mass-type brain damage in the rat: expression of brain damage based on neurospecific enolase and protein S100B]. / Modelo experimental de lesión cerebral tipo masa en rata: expresión del daño cerebral mediante enolasa neuroespecífica y proteína S100B.

OBJECTIVE: To determine whether a model of transient mass-type brain damage (MTBD) in the rat produces early release of neurospecific enolase (NSE) and protein S100B in peripheral blood, as an expression of the induced brain injury. DESIGN: An experimental study with a control group. SETTING: Experimental operating room of the Institute of Biomedicine (IBiS) of Virgen del Rocío University Hospital (Seville, Spain). PARTICIPANTS: Fourteen adult Wistar rats. INTERVENTIONS: Blood was sampled at baseline, followed by: MTBD group, a trephine perforation was used to insert and inflate the balloon of a catheter at a rate of 500 µl/20 sec, followed by 4 blood extractions every 20 min. Control group, the same procedure as before was carried out, though without trephine perforation. PRIMARY STUDY VARIABLES: Weight, early mortality, serum NSE and S100B concentration. RESULTS: Differences in NSE and S100B concentration were observed over time within the MTBD group (P<.001), though not so in the control group. With the exception of the baseline determination, differences were observed between the two groups in terms of the mean NSE and S100B values. Following MTBD, NSE and S100B progressively increased at all measurement timepoints, with r=0.765; P=.001 and r=0.628; P=.001, respectively. In contrast, the control group showed no such correlation for either biomarker. CONCLUSIONS: Serum NSE and S100B concentrations offer an early indication of brain injury affecting the gray and white matter in an experimental model of mass-type MTBD in the rat.

Tumor neuroendocrino de la mama: a propósito de un caso / Neuroendocrine tumor of the breast: a purpose of a case

Los tumores neuroendocrinos en la glándula mamaria, representan menos del 2 por ciento de las lesiones malignas que se presentan en la mama, un 30 por ciento pueden ser metastásicos, principalmente de tumores carcinoides intestinales. Se presenta el caso de una paciente femenina 64 años con el antecedente de carcinoma de mama izquierda pT1N1Mo Estadio II A, se le practicó en el año 2000 cirugía preservadora, recibió tratamiento sistémico y radioterapia, presentando recaída local, histológicamente y por inmuhistoquímica, como tumor neuroendocrino, en mayo de 2008 se le realiza mastectomía simple izquierda. Actualmente viva y sin enfermedad. Los tumores neuroendocrinos pueden presentarse en localizaciones extra intestinales. El diagnóstico debe realizarse por histología y confirmado con técnicas de inmunohistoquímica, son tumores de baja agresividad biológica, no se presentan síntomas sistémicos por liberación de hormonas como en otras localizaciones, y el tratamiento debe basarse en el estadio clínico de la enfermedad al momento del diagnóstico.

Neuroendocrines in the mammary gland tumors represent less than 2 percent of malignant injuries, which 30 percent can be source metastatic, mainly tumors intestinal carcinoid. The clinical of a female patient case 64 years old are presented with the antecedent of pT1N1Mo Stadium II A left breast carcinoma who was practiced in the year 2000 sparing surgery, received systemic therapy and radiotherapy, featuring local relapse, histological and inmuhistochemestry, as neuroendocrines, practicing it in May of 2008 mastectomy left, currently living and without disease tumor. Neuroendocrines tumors can occur in extra intestinal in lung, uterine and less common in the mammary gland neck locations. The diagnosis must be made by histology and confirmed with Immunohistochemistry techniques, are tumors of low biological aggression, not have systemic symptoms by release of hormones as in other locations, and treatment must be based on the clinical stage of the disease at the time of diagnosis.

Enolasa específica de neurona en dos recién nacidos con depresión ligera al nacer / Neuron- specific Enolase in two newborns presenting with moderate depression at birth

La enolasa específica de neurona es una isoenzima que se vierte al torrente sanguíneo después de un episodio de daño neuronal. En los procesos de hipoxia neonatal estos valores enzimáticos en suero suelen estar alterados. El objetivo del presente artículo fue estudiar la enolasa específica de neurona en suero de 2 recién nacidos con Apgar bajo y determinar si, en el seguimiento durante un año, dichos pacientes presentaban trastornos del desarrollo psicomotor. MÉTODOS. Se tomaron muestras de suero al momento del nacimiento y a las 72 h siguientes. Se determinaron los niveles de enolasa específica de neurona por un método inmunoenzimá tico de tipo ELISA. Cada muestra fue evaluada por el método de reacción en cadena de la polimerasa para citomegalovirus, en el Instituto de Inmunología de Wuersburg (Alemania). También se cuantificaron anticuerpos contra citomegalovirus de clase IgM e IgG, en el Laboratorio de Neuroquímica de la Universidad Georg August de Goettingen (Alemania). Se recogieron los datos clínicos de interés de cada recién nacido y al a±o se citaron a estos pacientes y se les realizó un examen físico para evaluar su neurodesarrollo. RESULTADOS. Las cifras de enolasa estuvieron incrementadas tanto al nacimiento como a las 72 h, con anticuerpos anticitomegalovirus de clase IgG que fueron transferidos de la madre a través de la placenta. No se encontró presencia de este virus en el momento del nacimiento. En el examen físico y neurológico realizado al año se constató que los niños evolucionaban satisfactoriamente hasta esa fecha. CONCLUSIONES. Se recomienda extender el estudio hasta los 3 años de vida y aumentar el número de pacientes estudiados, con énfasis en aquellos casos cuyo Apgar es menor de 5 a los 5 min del nacimiento(AU)

Neuron-specific Enolase of is an isoenzyme present in blood stream after a neuronal damage episode. In processes of neonatal hypoxia, these enzymatic values in serum may be altered. The aim of present paper was to study Enolase specific of neuron in the serum of two newborns with low Apgar score and to determine if, during a one year follow-up, such patients presented disorders of psychomotor development. METHODS: We took serum samples at birth and at 72 hours. Levels of Enolase specific of neuron by immunoenzymatic method type ELISA were determined. Each sample was assessed by polymerase chain reaction (PCR) to cytomegalovirus in Wuersburg Institute of Immunology (Germany). Also, we quantified antibodies to IgM and IgG cytomegalovirus in Neurochemistry Institute of Georg August of Goettingen University (Germany). Interesting clinical data of each newborn were collected and after a year, all these patients were cited for a physical examination to evaluate tits neurodevelopment. RESULTS: Enolase figures were increased both at birth and at 72 hours, with IgG anticytomegalovirus antibodies from mother through placenta. At birth there was not presence of this virus. At physical and neurological examination performed at 1 year it was possible to confirm that children evolved adequately until now. CONCLUSIONS: Study must to be prolonged until 3 years of life, and to increase number of study patients, emphasizing on those with an Apgar score lower than 5 at 5 minutes post-birth(AU)

Enolasa específica de neurona en dos recién nacidos con depresión ligera al nacer / Neuron- specific enolase in two newborns presenting with moderate depression at birth

La enolasa específica de neurona es una isoenzima que se vierte al torrente sanguíneo después de un episodio de daño neuronal. En los procesos de hipoxia neonatal estos valores enzimáticos en suero suelen estar alterados. El objetivo del presente artículo fue estudiar la enolasa específica de neurona en suero de 2 recién nacidos con Apgar bajo y determinar si, en el seguimiento durante un año, dichos pacientes presentaban trastornos del desarrollo psicomotor. MÉTODOS. Se tomaron muestras de suero al momento del nacimiento y a las 72 h siguientes. Se determinaron los niveles de enolasa específica de neurona por un método inmunoenzimá tico de tipo ELISA. Cada muestra fue evaluada por el método de reacción en cadena de la polimerasa para citomegalovirus, en el Instituto de Inmunología de Wuersburg (Alemania). También se cuantificaron anticuerpos contra citomegalovirus de clase IgM e IgG, en el Laboratorio de Neuroquímica de la Universidad Georg August de Goettingen (Alemania). Se recogieron los datos clínicos de interés de cada recién nacido y al a±o se citaron a estos pacientes y se les realizó un examen físico para evaluar su neurodesarrollo. RESULTADOS. Las cifras de enolasa estuvieron incrementadas tanto al nacimiento como a las 72 h, con anticuerpos anticitomegalovirus de clase IgG que fueron transferidos de la madre a través de la placenta. No se encontró presencia de este virus en el momento del nacimiento. En el examen físico y neurológico realizado al año se constató que los niños evolucionaban satisfactoriamente hasta esa fecha. CONCLUSIONES. Se recomienda extender el estudio hasta los 3 años de vida y aumentar el número de pacientes estudiados, con énfasis en aquellos casos cuyo Apgar es menor de 5 a los 5 min del nacimiento.

Neuron-specific Enolase of is an isoenzyme present in blood stream after a neuronal damage episode. In processes of neonatal hypoxia, these enzymatic values in serum may be altered. The aim of present paper was to study Enolase specific of neuron in the serum of two newborns with low Apgar score and to determine if, during a one year follow-up, such patients presented disorders of psychomotor development. METHODS: We took serum samples at birth and at 72 hours. Levels of Enolase specific of neuron by immunoenzymatic method type ELISA were determined. Each sample was assessed by polymerase chain reaction (PCR) to cytomegalovirus in Wuersburg Institute of Immunology (Germany). Also, we quantified antibodies to IgM and IgG cytomegalovirus in Neurochemistry Institute of Georg August of Goettingen University (Germany). Interesting clinical data of each newborn were collected and after a year, all these patients were cited for a physical examination to evaluate tits neurodevelopment. RESULTS: Enolase figures were increased both at birth and at 72 hours, with IgG anticytomegalovirus antibodies from mother through placenta. At birth there was not presence of this virus. At physical and neurological examination performed at 1 year it was possible to confirm that children evolved adequately until now. CONCLUSIONS: Study must to be prolonged until 3 years of life, and to increase number of study patients, emphasizing on those with an Apgar score lower than 5 at 5 minutes post-birth.