Association between early echocardiography screening of low systemic blood flow and intraventricular hemorrhage in preterm infants: a multicenter cohort study.

OBJECTIVE: To determine whether early echocardiography screening of low systemic blood flow reduces intraventricular hemorrhage in preterm infants. STUDY DESIGN: Prospective multicenter study in preterm infants below 33 weeks of gestational age at nine neonatal units. Five units performed early echocardiography screening for low systemic blood flow and guided clinical management (exposure group) and 4 units did not (control group). Our main outcome was ≥grade II intraventricular hemorrhage or death within the first 7 days of life. The main analysis used the inverse probability of treatment weighting. RESULTS: Three hundred and thirty-two preterm infants (131 in the exposure group and 201 in the control group) were included. Exposure to early echocardiography screening was associated with a significant reduction in ≥grade II intraventricular hemorrhage or early death [odds ratio 0.285 (95% CI: 0.133-0.611); p = 0.001]. CONCLUSIONS: Early echocardiography screening for low systemic blood flow may reduce the incidence of intraventricular hemorrhage in preterm infants.

Rabdomiólisis aguda en edad pediátrica

La rabdomiólisis es un síndrome caracterizado por la destrucción del músculo esquelético y liberación de elementos intracelulares a la circulación. La triada clásica de dolor muscular, debilidad y orina oscura no es muy común en la edad pediátrica, prevaleciendo una sintomatología más atípica cuanto menor sea la edad del afectado. La etiología puede ser adquirida o hereditaria, siendo las causas más frecuentes las infecciones, miopatías y el ejercicio físico. La severidad de la enfermedad es muy variable, desde una elevación aislada de las enzimas musculares hasta una patología más grave con alteraciones hidroelectrolíticas e insuficiencia renal. A continuación, se describen tres casos clínicos en los que tener un alto índice de sospecha resultó esencial para poder iniciar un tratamiento precoz con hidratación intravenosa y así garantizar una evolución favorable hasta la recuperación. (provisto por Infomedic International)

Rhabdomyolysis is a syndrome characterized by the destruction of skeletal muscle and release of intracellular elements into the circulation. The classic triad of muscle pain, weakness and dark urine is not very common in pediatric age, with more atypical symptomatology prevailing the younger the age of the affected person. The etiology can be acquired or hereditary, the most frequent causes being infections, myopathies and physical exercise. The severity of the disease is very variable, from an isolated elevation of muscle enzymes to a more severe pathology with hydroelectrolytic alterations and renal failure. Three clinical cases are described below in which a high index of suspicion was essential to initiate early treatment with intravenous hydration and thus guarantee a favorable evolution until recovery. (provided by Infomedic International)