[Prognostic factors related to mortality in newborns with jejunoileal atresia]. / Factores pronóstico para mortalidad en neonatos con atresia intestinal yeyuno-ileal.

BACKGROUND: Jejuno-ileal atresia is one of the main causes of intestinal obstruction in neonates. The origin is vascular accidents in the fetal intestine. It is an entity that requires early and specialist management. OBJECTIVE: to know the factors related to mortality in neonates with jejunoileal atresia. METHODS: Case-control nested in a cohort design, comparative study during ten years, between deceased and survivors analyzing factors related to mortality before surgery and during surgery and in the postoperative course. RESULTS: We analyzed 70 patients in 10 years, there were 10 deaths (14.2%). No one had a prenatal diagnosis. Factors related to mortality were: intestinal perforation with a relative risk (RR) of 4.4, peritonitis (RR: 5.6), the need of stomas (RR: 4.9), the presence of sepsis (RR: 4.6) and when the residual small bowel length was below 1 meter (RR: 7.4). CONCLUSION: The delay in diagnosis causes late intervention and increased mortality delayed diagnosis promotes late transport of the neonate and enhances mortality, factors associated with mortality related to intestinal perforation. It is necessary to spread this disease in the medical community to improve prenatal and postnatal diagnosis.

Anomalias congénitas en población de bajo riesgo: screening con ultrasonido prenatal en un sistema público de salud / Congenital anomalies in low risk population: screening with prenatal ultrasound in a public health system

Conocer la prevalencia de anomalías congénitas, y la capacidad diagnóstica del ultrasonido en el segundo trimestre (18 a 28 semanas). Se evalúa la información sobre 41.294 partos (1995-1997), en el área sur-oriente de salud pública en Santiago, Chile. La prevalencia de anomalías congénitas mayores que son hospitalizadas en dicho período fue de 1,15 por ciento (475/41340). En el grupo estudiado, el 77 por ciento tuvo un examen de ultrasonido durante el trimestre medio. La sensibilidad del ultrasonido fue del 50 por ciento. La sensibilidad por sistemas fue de: 78,9 por ciento en genito-urinarias; 76,8 por ciento en anomalías del sistema nervioso central; 55,2 por ciento en gastro-intestinales; 56,6 por ciento en músculo-esqueléticas; 49 por ciento en trisomías (13, 18, 21); 44 por ciento en síndromes malformativos ; 36,2 por ciento para las anomalías cardiovasculares; 20 por ciento en faciales; y 28 por ciento para otras malformaciones. La mortalidad perinatal ampliada fue de 12,17/1000 (503/41340); el 24,1 por ciento de ésta (121/503) se asoció a anomalías congénitas. La evaluación con ultrasonido en el trimestre medio detecta una proporción significativa de las anomalías congénitas. Es importante aumentar la cobertura del examen de ultrasonido en el trimestre medio y mejorar la calidad del estudio ultrasonográfico cardiovascular y facial

[Polyhydramnios and its relationship with congenital malformations: ultrasonographic diagnosis]. / Polihidramnios y su relación con malformaciones congénitas: diagnóstico ultrasonográfico.

We analyzed the occurrence of polyhydramnios during pregnancy and to indicate the association with congenital abnormalities of the product and maternal alterations. A retrospective descriptive and transversal study was performed which included 6087 pregnant patients who were submitted to ultrasonographic studies from January 1, 1991 to December 31, 1993. The final sample consisted of 72 patients with criteria of polyhydramnios and who had a complete, clinical history, specific data concerning the reproductive history and maternal risk factors associated with polyhydramnios and fetal malformations was compiled. The occurrence of polyhydramnios during pregnancy was 1.1% and the association with congenital malformations was 13.8%, being the majority neural tube defects. The maternal alterations were related in 13.7% to polyhydramnios, being primary cause gestational diabetes. Anencephalia presented a significant statistics (p < 0.05). The occurrence of polyhydramnios is low in obstetric patients. Neural tube defects such as anencephalia are the primary fetal defects. Gestational diabetes and multiple gestations are the more significant maternal alterations.

Perinatal factors associated with neural tube defects (anencephaly [correction of anancephaly], spina bifida and encephalocele)

The objective of the present study was to determine the presence of risk factors for the occurrence of neural tube defects. Data for 33,535 births which occurred at Hospital do Servidor Público Estadual de Säo Paulo from July 1973 to December 1986 were collected in a prospective manner as recommended by Estudo Colaborativo Latino-Americano de Malformaçöes Congênitas (ECLAMC, Collaborative Latin American Study on Congenital Malformations). Twenty-six cases of neural tube defects were detected (0.77/1000 births). Of these, 11 were cases of spina bifida (0.39/1000 births), 9 of anencephaly (0.27/1000 births) and 6 of encephalocele (0.18/1000 births). We observed a higher frequency of polyhydramnios, premature labor, Apgar scores of less than 7 at the first and fifth minutes, low birth weight and intrauterine growth retardation

Perinatal factors associated with neural tube defects (anencephaly [correction of anancephaly], spina bifida and encephalocele).

The objective of the present study was to determine the presence of risk factors for the occurrence of neural tube defects. Data for 33,535 births which occurred at Hospital do Servidor Público Estadual de São Paulo from July 1973 to December 1986 were collected in a prospective manner as recommended by "Estudo Colaborativo Latino-Americano de Malformações Congênitas" (ECLAMC, Collaborative Latin American Study on Congenital Malformations). Twenty-six cases of neural tube defects were detected (0.77/1000 births). Of these, 11 were cases of spina bifida (0.39/1000 births), 9 of anencephaly (0.27/1000 births) and 6 of encephalocele (0.18/1000 births). We observed a higher frequency of polyhydramnios, premature labor, Apgar scores of less than 7 at the first and fifth minutes, low birth weight and intrauterine growth retardation.