Hematoma espontáneo del cordón umbilical / Spontaneous haematoma of the umbilical cord

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[Comparison of two gentamicin dosing schedules in the newborn]. / Comparación de dos pautas de dosificación de gentamicina en el recién nacido.

INTRODUCTION: Gentamicin is widely used in full-term neonates as empirical therapy for early-onset suspected or proven sepsis. Several dosing schedules for gentamicin have been recommended for this neonatal population. OBJECTIVE: To compare gentamicin serum levels, efficacy and toxicity of two dosing schedules in term and preterm newborns. MATERIAL AND METHODS: The study included 200 newborns who were started on gentamicin therapy. Group A (N=100) was prescribed a multiple-daily dosing regimen and Group B (N=100) on a once-daily dosing regimen. Newborns in Group A received gentamicin at 2.5-3.5 mg/kg/dose q12-18 h depending on postnatal age and serum creatinine levels, and newborns in Group B received 4-5 mg/kg/dose q24-48 h depending on postconceptional and postnatal age. All peak and trough serum drug levels, demographic data, and markers of potential nephrotoxicity and ototoxicity were compared. RESULTS: Peak serum gentamicin levels were significantly higher (8.2+/-0.22 microg/ml vs. 5.9+/-0.13 microg/ml; p

Comparación de dos pautas de dosificación de gentamicina en el recién nacido / Comparison of two gentamicin dosing schedules in the newborn

Introducción: La gentamicina es uno de los antibióticos más utilizado en el tratamiento de las infecciones bacterianas graves del recién nacido y diferentes pautas de dosificación de gentamicina han sido recomendadas en este grupo poblacional. Objetivo: Comparar las concentraciones séricas, la eficacia y la toxicidad de dos pautas de dosificación de gentamicina en recién nacidos a término y pretérmino. Material y métodos: Se evaluó prospectivamente a 200 recién nacidos que recibieron tratamiento con gentamicina. En el grupo A (n = 100) se administró según una pauta de múltiples dosis diarias (2,5-3,5 mg/kg/dosis cada 12-18 h), dependiendo de la edad posnatal y las concentraciones séricas de creatinina. En el grupo B (n = 100) se administró en pauta de única dosis diaria (4-5 mg/kg/dosis cada 24-48 h), según la edad posnatal y posconcepcional. Entre ambos grupos se compararon las concentraciones pico y valle séricas de gentamicina, los datos generales y la prevalencia de nefrotoxicidad y ototoxicidad. Resultados: Las concentraciones pico de gentamicina fueron significativamente superiores (8,2 ± 0,22 μg/ml frente a 5,9 ± 0,13 μg/ml; p £ 0,001) y las concentraciones valle fueron significativamente inferiores (0,9 ± 0,06 μg/ml frente a 1,7 ± 0,08 μg/ml; p £ 0,001) en el grupo B. No hubo diferencias significativas entre ambos grupos respecto a la eficacia clínica, o a la prevalencia de nefrotoxicidad u ototoxicidad. Conclusiones: La pauta de gentamicina en única dosis diaria es efectiva, segura y disminuye el riesgo de concentraciones séricas fuera de rango terapéutico en recién nacidos pretérmino y a término (AU)

Introduction: Gentamicin is widely used in full-term neonates as empirical therapy for early-onset suspected or proven sepsis. Several dosing schedules for gentamicin have been recommended for this neonatal population. Objective: To compare gentamicin serum levels, efficacy and toxicity of two dosing schedules in term and preterm newborns. Material and methods: The study included 200 newborns who were started on gentamicin therapy. Group A (N = 100) was prescribed a multiple-daily dosing regimen and Group B (N = 100) on a once-daily dosing regimen. Newborns in Group A received gentamicin at 2.5-3.5 mg/kg/dose q12-18 h depending on postnatal age and serum creatinine levels, and newborns in Group B received 4-5 mg/kg/dose q24-48 h depending on postconceptional and postnatal age. All peak and trough serum drug levels, demographic data, and markers of potential nephrotoxicity and ototoxicity were compared. Results: Peak serum gentamicin levels were significantly higher (8.2 ± 0.22 μg/ml vs. 5.9 ± 0.13 μg/ml; p £ 0.001) and trough levels were significantly lower (0.9 ± 0.06 μg/ml vs. 1.7 ± 0.08 μg/ml; p £ 0.001) in Group B than in Group A. There was no significant difference between the groups either in the clinical failure rate or in the nephrotoxicity or ototoxicity outcomes. Conclusions: Once-daily dosing regimen of gentamicin in preterm and term newborns is safe and effective, with a reduced risk of serum drug concentrations falling outside the therapeutic range (AU)

Muerte perinatal en una gestación múltiple asociada a corangiosis placentaria / Perinatal death in a multiple pregnancy associated with placental chorangiosis

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[Use of somatostatin in five neonates with chylothorax]. / Tratamiento con somatostatina en cinco recién nacidos con quilotórax de diferentes etiologías.

BACKGROUND: The addition of somatostatin to the conventional treatment of neonatal chylothorax has been described in isolated cases. OBJECTIVE: To describe the results obtained in a series of five patients with neonatal chylothorax treated with somatostatin. PATIENTS: Five neonates (gestational age range: 29-39 weeks) diagnosed with chylothorax of various etiologies were included. Chylothorax was congenital in two neonates, secondary to congenital diaphragmatic hernia repair in two neonates and secondary to thrombosis in the superior vein cava in one neonate. All the neonates were started on conservative therapy and intravenous somatostatin in distinct doses ranging from a bolus of 2 microg/kg/12 h to continuous perfusion at 10 microg/kg/h. RESULTS: In all patients the chylous drainage was stopped. No adverse effects were observed. CONCLUSIONS: Somatostatin can be a safe and effective option in the treatment of both primary and secondary neonatal chylothorax refractory to conservative treatment.

Tratamiento con somastotina en cinco recién nacidos con quilotórax de diferentes etiologías / Use of somatostatin in five neonates with chylothorax

Antecedentes. En pacientes aislados se ha descrito el uso de la somatostatina como una opción terapéutica adicional al tratamiento convencional del quilotórax neonatal. Objetivo. Describir nuestros resultados en una serie de 5 pacientes con quilotórax neonatal tratados con somatostatina. Pacientes. Se incluyeron 5 recién nacidos (29-39 semanas de edad gestacional) diagnosticados de quilotórax de diferentes etiologías: dos congénitos, dos secundarios a cirugía reparadora de hernias diafragmáticas congénitas, y uno secundario a trombosis venosa de la vena cava. Tras la confirmación diagnóstica se inició en todos los niños tratamiento conservador y somatostatina intravenosa en diferentes pautas, desde bolos de 2 μg/kg/12 h, hasta perfusión continua de 10 μg/kg/h. Resultados. En todos los pacientes se logró el cese del drenaje linfático y no se observaron efectos secundarios. Conclusiones. La somatostatina puede ser una opción terapéutica eficaz y segura en el tratamiento del quilotórax, tanto primario como secundario, refractario al tratamiento conservador

Background. The addition of somatostatin to the conventional treatment of neonatal chylothorax has been described in isolated cases. Objective. To describe the results obtained in a series of five patients with neonatal chylothorax treated with somatostatin. Patients. Five neonates (gestational age range: 29-39 weeks) diagnosed with chylothorax of various etiologies were included. Chylothorax was congenital in two neonates, secondary to congenital diaphragmatic hernia repair in two neonates and secondary to thrombosis in the superior vein cava in one neonate. All the neonates were started on conservative therapy and intravenous somatostatin in distinct doses ranging from a bolus of 2 μg/kg/12 h to continuous perfusion at 10 μg/kg/h. Results. In all patients the chylous drainage was stopped. No adverse effects were observed. Conclusions. Somatostatin can be a safe and effective option in the treatment of both primary and secondary neonatal chylothorax refractory to conservative treatment

Low prevalence of complications of delayed herniotomy in the extremely premature infant.

AIM: To study the relationship between the delay of herniotomy in the extremely premature infant and the rate of complications in comparison with full-term children. METHODS: A follow-up study of three groups of neonates operated on for inguinal hernia was performed. The groups were defined as: a) the short-waiting group (SWG): prematures (mean gestational age: 32.56 +/- 0.62; n = 9) operated on within 2 wk of diagnosis (median: 5 d); b) the long-waiting group (LWG): prematures (mean gestational age: 28.38 +/- 1; n = 21) operated on after more than 2 wk (median: 39 d); and c) control group of full-term children (FTG); (mean gestational age: 38.18 +/- 0.29; median of timing: 3 d; n = 11). Several variables (gestational age, weight at birth and at surgery, side of the inguinal herrnia, timing, duration of surgery, type of anaesthesia, length of hospitalization), as well as the occurrence of apnoea, incarceration and testicular atrophy were compared between groups. RESULTS: Timing was the only variable that was different between the LWG and the other two groups (p < 0.001, ANOVA). Seven preoperative episodes of incarceration occurred: one in the SWG, two in the LWG and four in the FTG (p = 0.138, chi2). In the follow-up study two testicular atrophies, related to previous episodes of incarceration, were found: one in the FTG and the other in the SWG (p = 0.221, chi2). CONCLUSION: The deferral of herniotomy in the extremely premature infant, until the child is ready to be discharged from the neonatal unit, does not seem to increase the risk of incarceration episodes or testicular atrophy.

Histiocitosis sinusal con linfadenopatía masiva y manifestaciones extraganglionares / Sinus histiocytosis with massive lymphadenopathy (SHML) with extranodal manifestations in an 8-year-old boy

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