[Bilirubin-albumin binding in term newborns on total parenteral nutrition]. / Unión bilirrubina-albúmina en recién nacidos a término sometidos a nutrición parenteral total.

We evaluate the influence of plasma lipid levels supplied in parenteral nutrition, on the bilirubin-albumin binding of 12 term newborns with severe pathologies. As controls we selected 2 groups of an equal number o newborns who were receiving maternal or artificial lactation. The reserved albumin binding capacity decreased in newborns subjected to parenteral nutrition (52.3 versus 72.9/73.5). This decrease correlated positively with greater concentrations of free fatty acids (r = 0.9234, p < 0.001), cholesterol (r = 0.9049, p < 0.001), and triglycerides (r = 0.8802, p < 0.001). The clear influence of the studied lipid parameters on the bilirubin albumin binding, invites us to consider the systematic use of heparin for the mobilization of lipoprotein-lipase from the vascular endothelium and to promote a better management of lipids in term newborns, especially if there is an important hyperbilirubinemia.

[Hypercapnia induced reversible opening of the blood-brain barrier in experimental hyperbilirubinemia]. / Apertura reversible de la barrera hematoencefálica inducida por hipercapnia en hiperbilirrubinemia experimental.

OBJECTIVE: The incidence of bilirubin encephalopathy in extremely ill neonates with low serum bilirubin is stimulating interest in factors that can modify the blood-brain barrier permeability and allow the passage of bilirubin-albumin macrocomplexes, which may be produced by hypercapnia. MATERIALS AND METHODS: Without modifying the normal bilirubin-albumin affinity, we increased cerebral flow by two levels of hypercapnia (PCO2 67.1 and 101.9 mmHg), acquired by inhalation of CO2 enriched air (5 and 15%) and a decrease in pH (7.00 and 6.93). RESULTS: We demonstrate an increment in cerebral bilirubin deposition (control 2.43 +/- 0.54 mg/g versus 3.29 +/- 0.43 and 3.28 +/- 1.07, F = 4.80, p < 0.05) and I125 albumin (control 26.1 +/- 95.8 micrograms/g versus 364.4 +/- 156.1 and 430.8 +/- 122.4, F03.34, p < 0.05).

[High frequency oscillatory ventilation in the preterm newborn infants with respiratory distress syndrome]. / Ventilación de alta frecuencia de casos rescatados en recién nacidos pretérminos con síndrome de distrés respiratorio.

OBJECTIVE: The objective of this study was to evaluate the efficiency and response of gas exchange by the use of high frequency respiratory modalities in cases rescued after failure of conventional mechanical ventilation. PATIENTS AND METHODS: A retrospective study of twelve premature infants that required high frequency ventilation (HFV) as rescue therapy for treatment of respiratory distress syndrome (RDS) because of failure of conventional mechanical ventilation (CNV) were studied. The mean weight and gestational age were 1,041 gr (500-1,730) and 28 weeks (26-34), respectively. Fifty percent of the infants weighed less than 1,000 grams. Two different respiratory apparatus were used. Five infants were treated using Infant Star and seven with Babylog 8000. The variables were analyzed by comparison of the means with significance taken as p < 0.05. RESULTS: High frequency ventilation was initiated at 24 hours of life (2-86) and the mean duration was 33 hours (1-133). We saw a significant improvement in oxygenation after starting HFV and during the first and second controls after HFV initiation. PaO2 increased from 59 mmHg to 87 (HFV-initial), 119 mmHg (HFV-first control) and 98 mmHg (HFV second control; p < 0.05). Likewise, a/AO2 increased from 0.087 to 0.13 (HFV-initial), 0.19 (HFV-first control) and and 0.18 (HFV-second control; p < 0.05). The oxygenation index (OI) decreased from 23 to 16 (HFV-initial p < 0.05) and to 11 during the first and second controls (p < 0.01). Despite the improvement in oxygenation, there were no differences in mean airway pressure levels. We did not see any change in PaCO2 levels. The mortality rate was 58%, with a mean age at death of 82 hours of life (6-264). CONCLUSIONS: High frequency ventilation might be used as a rescue therapy for treatment of respiratory distress syndrome since there is an improvement in oxygenation.

[Postnatal growth in very low birth weight infants: assessment with a new somatometric index]. / Crecimiento postnatal de los recién nacidos de muy bajo peso: valoración mediante un nuevo índice somatométrico.

OBJECTIVE: We have studied the postnatal growth of very low birth weight infants by using a differential index in reference to intrauterine growth evaluated by means of Lubchenko and Usher graphs. PATIENTS AND METHODS: We analyzed the postnatal growth between birth and hospital discharge of 194 infants with birth weights less than 1500 g. No selection was made according to pathology and those newborns who died are treated as missing values. The differential index was calculated as the percentage deviation of the studied parameter and its 10th percentile and the range between the 10th and 90th percentiles. RESULTS: The weight differential index decreased between birth and hospital discharge (20.8 +/- 33.3 versus -10.03 +/- 30.6, t = 16.97, p < 0.001), as well as that of the height differential index (30.9 +/- 39.1 versus -10.05 +/- 44.35, t = 5.65, p < 0.001), with that of cephalic growth being unchanged (23.2 +/- 43.2 versus 40.4 +/- 35.4, t = -2.29, p = NS). Newborns included in the early discharge program had a worse differential index at the final discharge than at early discharge (-19.1 +/- 27.9 versus -9.8 +/- 22.2, t = -6.1, p < 0.001). Height and cephalic growth was better at the final hospital discharge (-6.6 +/- 46.1 versus 22.7 +/- 26.1, t = -2.8, p < 0.05; 28.8 +/- 37.7 versus 50.1 +/- 27.5, t = -3.48, p < 0.01).

[Prognostic value of the electroencephalogram in hypoxic ischemic encephalopathy]. / Valor pronóstico del electroencefalograma en la encefalopatía hipóxico-isquémica (EHI).

In order to check the prognostic implications of EEG tracings in hypoxic-ischemic encephalopathy (HIE), we carried out prospective EEG recordings in 116 newborn babies (65 term and 51 premature) admitted to our neonatal intensive care unit as a result of perinatal asphyxia. Forty term neonates were found to have critical and/or intercritical epileptiform EEG alterations; the developmental results of 23 of these cases (57.5%) were adverse and were favorable in 17 cases (42.5%). Given that unfavorable results occurred in only 4 of the other 25 term neonates, the epileptiform EEG alterations were statistically significant for adverse developmental results (p < 0.005). Of the premature neonates, 29 were found to have critical and/or intercritical epileptiform EEG alterations. The developmental results were adverse in 19 of these children (65.5%) and favorable in 10 cases (34.8%). The statistical evaluation in this case showed a barely significant difference (p < 0.005) between epileptiform EEG alterations and poor developmental outcome when uncorrected age was used, and no statistically significant difference when corrected age was used. Thus, we conclude that although epileptiform EEG anomalies may serve as markers for neurological development impairments, they must be considered in conjunction with the background EEG tracing.

[Ganglio-thalamic encephalomalacia. Ultrasonic diagnosis]. / Encefalomalacia gangliotalámica. Diagnóstico sonográfico.

We have performed serial trans-fontanelle sonography on 69 newborns with perinatal asphyxia. Ten neonates presented high ultrasonic density in the thalamus and the basal ganglia. These images were preceded, in eight of them, by diffuse echoes for all of the CNS, corresponding to cerebral edema. The most significant clinical findings were convulsions and important depression of conscience level and muscular tone. Eight of ten newborns presented major abnormalities in the electroencephalogram (severe depression of background). Since its coexistence with other parenchymal lesions and poor neurologic development, we consider the ganglio-thalamic ultrasonic densities to be a sign of severe ischemic hypoxic cerebral damage.

[Acute monocytic leukemia as secondary neoplasia in a girl with acute lymphocytic leukemia]. / Leucemia monocítica aguda (LMA-M5) como segunda neoplasia en una niña con LLA-L1.

The presence of second malignancies in children suffering from acute lymphoblastic leukemia (ALL) is becoming increasingly frequent. Nevertheless, the appearance of M5 type acute myeloid leukemia (AML) in patients being treated for ALL is very rare. We report the presence of AML-M5 as a second malignancy in a girl diagnosed of ALL-L1 56 months before. The clinical course of this rare association is discussed.

[Extrinsic allergic alveolitis: apropos of a case in a child]. / Alveolitis alérgica extrínseca: a propósito de un caso en edad pediátrica.

We present a young male (12 years) with low grade fever, weight loose, anorexia and progressive dyspnea. The clinical, roentgenological and pulmonary function pictures are close with interstitial pneumonitis. The patient had a pigeon loft on his house, thus we tried confirmed the diagnosis of extrinsic allergic alveolitis: pigeon breeder's lung. We believed at any patient age the pigeon breeder's lung must be considered in the differential diagnosis of interstitial pneumonitis. A good anamnesis will avoid unnecessary complementary test.