Valor del examen de la placenta. A propósito de un caso de meningitis neonatal / The importance of placental examinational. Apropos of a case of neonatal meningitis

No disponible

No disponible

[Randomized multi-center trial of the administration of erythropoietin in anemia of prematurity]. / Estudio multicéntrico aleatorizado de administración de eritropoyetina en la anemia de la prematuridad.

OBJECTIVES: The purpose of this study was to test the therapeutic effect of human recombinant erythropoietin (rH-EPO) on anemia of prematurity. MATERIAL AND METHODS: Fifty-eight preterm infants less than 34 weeks of gestational age from three different hospitals were studied. Transfusional policies were similar in all three centers. Infants with ABO or Rh incompatibility were excluded. At 28 days after birth, 28 infants (48.3%) had hemoglobin levels under 10.5 g/dL and were randomized to receive rH-EPO or standard care. Those infants ascribed to the treatment group received 200 U/kg of body weight of rH-EPO subcutaneously once a day, three days a week for 4 weeks together with oral supplements of ferrous sulfate at a dosage of 4 mg/kg/day. Both groups received daily doses of 50 micrograms of folic acid and 5U of vitamin E per os. Erythropoietin and ferritin were determined at randomization and at 60 days of age. Hemoglobin, reticulocytes, leucocytes, granulocytes and platelets were measured once a week, from the beginning of the treatment until 60 days of age. RESULTS: At randomization into treatments, there were no significant differences between the groups with respect to weight, gestational age, hemoglobin (9.42 +/- 0.73 vs 9.26 +/- 0.68 g/dL), reticulocytes (61.7 +/- 32.2 vs 68.0 +/- 61.0 x 10(9)/L), ferritin, EPO1 leucocytes or platelets. At 60 days of age, the treatment group showed higher hemoglobin values (10.5 +/- 1.73 vs 9.1 +/- 1.0 g/dL, p < 0.05). There were no significant differences between reticulocyte counts (176.4 +/- 91.1 vs 112.6 +/- 85.0 x 10(9)/L), granulocytes (2,351 +/- 868 vs 2,075 +/- 856 x 10(9)/L), platelets (400 +/- 138 vs 316 +/- 164 x 10(9)/L) or ferritin (209 +/- 177 vs 393 +/- 328 micrograms/mL). Of the infants in the nontreated group, 13.3% received blood transfusions between 30 and 60 days of age, while only 6.7% of the treatment group did (p = 0.31). DISCUSSION: We have been able to find 11 controlled studies in the medical literature which deal with the clinical usage of rH-EPO in newborns. Six use the hormone in an early phase and 5 in a posterior one. Our study should be included in the later and, as happens in most of them, demonstrates the efficacy of rH-EPO in the treatment of late anemia of the preterm newborn as shown by an increment in the hemoglobin levels and a trend towards the diminution in the use of blood transfusions. We have not observed substantial adverse effects.

[Value of the Coombs test in ABO incompatibility]. / Valor del test de Coombs en la incompatibilidad ABO.

We studied the ABO haemolytic disease of the newborn in our neonatal unit to consider their serological aspects and clinical importance. 21% of all pregnancies were ABO incompatibles. The direct antiglobulin test was positive in 46 (11.3%) of them. The Elution was positive in all the newborns with direct antiglobulin test positive (Cd+). The anti-A o anti-B antibodies concentration in mothers was higher than 1/128 in 38 (84%). The C3d complement fraction was activated in two newborns. The infants Cd+ were born to group O mothers in all cases, and nobody was premature. Twelve (26%) of Cd+ presented jaundice which need phototherapy, and one moreover exchange transfusion. The direct antiglobulin test is very useful for detect the liable newborns of serious jaundice; therefore, we thing that is suitable to make this test in infants born to group O mothers. The newborns Cd+ did not have significant anemia at first three months of life.

[Metastatic neuroblastomas: factors influencing survival]. / Neuroblastomas metastáticos: factores que influyen en la supervivencia.

Sixty-two patients with metastatic neuroblastoma admitted to the Hospital Infantil "Valle de Hebrón" de Barcelona during the period of October 1966-March 1985 are reviewed. The survival rate was 16% with an overall cure rate of 9.6%. The age, sex, site of primary tumor, site of metastases, and urinary catecholamine excretion were not independent prognostic factors. Patients with initial stage I, II or III and late evolution to stage IV had a worse prognostic (survival rate 13%, p less than or equal to 0.05). We compare five treatment protocols. We obtain a better response by a multichemotherapy made of cyclophosphamide, vincristine, adriamycin, DTIC combined in a sequential order with cis-platin and VM-26. The median survival for this group was 19.9 months and the survival rate 57.1% (p less than 0.001).