Teratoma cervical congénito: reporte de casos / Congenital cervical teratoma: case report

Los teratomas cervicales son tumoraciones infrecuentes y su ubicación a este nivel solo se presenta en el 6 % de todos los tumores de este tipo. Su pronóstico depende del tamaño, localización, tasa de crecimiento, compromiso en la vía aérea, y el manejo adecuado de la lesión. En la literatura se encuentran pocos reportes de casos, dado que dicha enfermedad es poco común. En la Fundación Valle del Lili, en el año anterior, se recibieron varios recién nacidos con masas en el cuello de los cuales dos correspondieron a teratomas congénitos. En el presente reporte se describen dos recién nacidos con grandes masas en cuello, sin diagnóstico prenatal, una de ellas con compromiso hasta región del lóbulo temporal, y en ambos casos con marcado compromiso de la vía aérea y lesiones de rápido crecimiento. El manejo inicial fue la resección quirúrgica con participación del grupo interdisciplinario de la Unidad de Neonatología. El estudio anatomopatológico reportó un teratoma benigno en el primer caso y en el segundo un teratoma inmaduro. Se resalta el manejo interdisciplinario y se incluyen los estudios de imágenes, resultados histopatológicos y se realiza revisión amplia de la literatura existente.

Cervical teratomas are rare tumors in newborns, usually represent close 6% of all of them. Pronostic depend of extension, localization of the mass, optim treatment, rate of growth and level of airway compromise. There are few reports of cases because of low frecuency of presentation. Last year in the Valle del Lili Foundation we admited some newborns with cervical tumors, two of them with congenital teratomas. We present two neonates patients with giant neck masses present at birth, without prenatal diagnosis, one with compromise until temporal lobe and both with severe airway compromise. Initial management was surgical excision with pediatric surgeon, neurosurgeon and interdisciplinary group of specialists of the neonatal intensive care unit. Histopathology study of the lesion reported benign teratoma in the first case and immature teratoma in the second one. We recognize interdisciplinary management and included imagenology histopathology studies and literature review is done.

Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial.

BACKGROUND: Chronic lung disease is one of the most frequent and serious complications of premature birth. Because mechanical ventilation is a major risk factor for chronic lung disease, the early application of nasal continuous positive airway pressure has been used as a strategy for avoiding mechanical ventilation in premature infants. Surfactant therapy improves the short-term respiratory status of premature infants, but its use is traditionally limited to infants being mechanically ventilated. Administration of very early surfactant during a brief period of intubation to infants treated with nasal continuous positive airway pressure may improve their outcome and further decrease the need for mechanical ventilation. OBJECTIVE: Our goal was to determine if very early surfactant therapy without mandatory ventilation improves outcome and decreases the need for mechanical ventilation when used in very premature infants treated with nasal continuous positive airway pressure soon after birth. DESIGN/METHODS: Eight centers in Colombia participated in this randomized, controlled trial. Infants born between 27 and 31 weeks' gestation with evidence of respiratory distress and treated with supplemental oxygen in the delivery room were randomly assigned within the first hour of life to intubation, very early surfactant, extubation, and nasal continuous positive airway pressure (treatment group) or nasal continuous airway pressure alone (control group). The primary outcome was the need for subsequent mechanical ventilation using predefined criteria. RESULTS: From January 1, 2004, to December 31, 2006, 279 infants were randomly assigned, 141 to the treatment group and 138 to the control group. The need for mechanical ventilation was lower in the treatment group (26%) compared with the control group (39%). Air-leak syndrome occurred less frequently in the treatment group (2%) compared with the control group (9%). The percentage of patients receiving surfactant after the first hour of life was also significantly less in the treatment group (12%) compared with the control group (26%). The incidence of chronic lung disease (oxygen treatment at 36 weeks' postmenstrual age) was 49% in the treatment group compared with 59% in the control group. All other outcomes, including mortality, intraventricular hemorrhage, and periventricular leukomalacia were similar between the groups. CONCLUSIONS: In premature infants treated with nasal continuous positive airway pressure early after birth, the addition of very early surfactant therapy without mandatory ventilation decreased the need for subsequent mechanical ventilation, decreased the incidence of air-leak syndrome, and seemed to be safe. Reduction in the need for mechanical ventilation is an important outcome when medical resources are limited and may result in less chronic lung disease in both developed and developing countries.