Síndrome alcoholic fetal / Fetal alcohol syndrome

Sustancias, tanto farmacológicas como medioambientales pueden originar malformaciones o síndromes fetales. En la presente revisión nos interesan los efectos del alcohol sobre el feto. El alcohol es una bebida cada vez de mayor consumo y con inicio precoz, como se puede comprobar en las estadísticas actuales que señalan este inicio entre los 13 y 14 años, siendo su distribución equitativa entre hombre y mujeres. Esta peculiaridad unida al aumento de embarazos entre los adolescentes motiva que actualmente se aprecie un aumento de frecuencia del síndrome alcohólico fetal, tanto a esta edad como en madres de edad avanzada (AU)

Both pharmacological as well as environmental substances may cause malformations or fetal syndromes. We have studied the effects of alcohol on the fetus in the present review. Alcohol is an increasingly consumed drink whose consumption is also beginning an at increasingly earlier age, as can be verified in the current statistics that show this initiation between 13 and 14 years, its distribution being the same between men and women. This characteristic, together with the increase of pregnancies among adolescent, is why an increase in the frequency of fetal alcohol syndrome is currently seen both at this age and in elderly mothers (AU)

Cerebelitis aguda e hidrocefalia secundaria / Acute cerebellitis and secondary hydrocephalus

No disponible

[Neurological follow-up of very low birth weight newborns at the age of two years (1998-1999)]. / Seguimiento neurológico de recién nacidos menores de 1.500 gramos a los dos años de edad.

BACKGROUND: Because of improved obstetric and neonatal care, there is growing interest in the later outcome of very low birth weight newborns. OBJECTIVES: The aim of this study was to evaluate the survival rate of very low birth weight newborns and to identify disabilities at the age of 2 years. MATERIAL AND METHODS: An observational, follow-up study was performed of neonates with a birth weight of under 1,500 grams born between 1998 and 1999. The follow-up program included pediatric, maturative, neurological, psychological, ophthalmological, and audiological evaluation. Neurosensorial disabilities were classified as mild, moderate, or severe. RESULTS: One hundred thirty-six very low birth weight newborns were admitted. The survival rate was 77.9 % and 83.9 % completed the follow-up to the age of 2 years. The neurosensorial disability rate was 20.2 %; disability was severe in 9 %, moderate in 1.1 %, and mild in 10.1 %. In patients lost to follow-up, birth weight was higher, gestational age was older, and sonographic findings were more frequently normal. CONCLUSION: Survival in very low birth weight newborns has increased with improved neonatal care. The presence of sequelae was similar to that found in other follow-up studies. A substantial number of patients were lost to follow up, which influenced the disability rates.

Seguimiento neurológico de recién nacidos menores de 1.500 gramos a los dos años de edad / Neurological follw-up of very low birth weight newborns at the age of two years (1998-1999)

Antecedentes: Existe un interés creciente en el seguimiento de los recién nacidos de muy bajo peso al nacimiento con la mejoría de la asistencia obstétrica y neonatal. Objetivos: Evaluar las cifras de supervivencia de los recién nacidos de muy bajo peso, junto con la proporción y los tipos de secuelas que se observan a los 2 años de edad. Material y métodos Estudio observacional de seguimiento de los recién nacidos de menos de 1.500 g nacidos entre los años 1998-1999. Se evalúan los datos obtenidos en el programa de seguimiento compuesto por visitas a pediatría, maduración, neurología, psicología y oftalmología; y la realización de potenciales evocados visuales y auditivos. Las secuelas obtenidas se clasifican en leves, moderadas o graves. Resultados: Ingresan un total de 136 recién nacidos de muy bajo peso. La supervivencia es del 77,9 por ciento. Completaron el seguimiento hasta los 2 años un 83,9 por ciento de los supervivientes. La aparición de secuelas se observa en el 20,2 por ciento de los niños, de las cuales el 9 por ciento son graves, el 1,1 por ciento moderadas y el 10,1 por ciento leves. Los pacientes perdidos en el seguimiento presentan mayor peso al nacimiento, mayor edad gestacional y mayor normalidad ecográfica que los pacientes seguidos. Conclusión: Se obtiene un incremento en la supervivencia de los recién nacidos de muy bajo peso con la mejoría de los cuidados neonatales. La presencia de secuelas es similar a la obtenida en otros estudios de seguimiento. Se considera relevante la muestra de pacientes perdidos y su influencia en los porcentajes de secuelas obtenidas (AU)

[Retinopathy of prematurity: casuistics between 1996 and 2001]. / Retinopatía del prematuro. Casuística de los años 1995-2001.

BACKGROUND: Retinopathy of prematurity (ROP) is a cause of neurosensorial morbidity. OBJECTIVES: To study the incidence, associated risks factors, treatment, and outcome of ROP in premature infants born at less than 32 weeks in our hospital. METHODS: We performed a descriptive study of patients born between the January 1, 1995, and December 31, 2001, in Sant Joan de Déu Hospital in Barcelona (Spain) at <= 32 weeks of gestation who survived until their first month of life. An ocular evaluation was performed between weeks 4 and 6 of life and was repeated every 1-2 weeks until retinal vascularization was complete. Ocular sequelae and visual function were evaluated. Bivariate comparison of groups with and without ROP was performed. RESULTS: Of the 324 patients evaluated, 74 presented ROP (22.8 %), of which 63 patients (21.7 %) were classified as stage 1 or 2 and 11 (3.7 %) as stage 3. An inverse correlation between the incidence of retinopathy and weight and gestational age was found. Threshold disease (3 plus) was detected in 9 patients (16 eyes; 3.1 % of the study sample and 12.1 % of the neonates with retinopathy). All of these neonates were treated with laser therapy. Ocular sequelae were mild in 2.7 % of the patients, moderate in 0.6 % and severe in 0.6 %. The visual function (n 236) of infants with ROP (n 74) was altered in 4 patients (1.7 %). Of these, alterations were severe in 2 patients (0.8 %). Bivariate analysis revealed significant differences (p < 0.001) in low birth weight, gestational age, days of oxygen therapy, days of mechanical ventilation, days of antibiotic therapy, and number of blood transfusions. CONCLUSIONS: In this study the incidence of ROP was similar to that in other centers. Development of ROP was strongly associated with its various risk factors. Severe stages were not seen above 30 weeks of gestational age. The results of laser therapy were optimal, with fewer alterations in ocular examination and visual function than those estimated in patients without treatment.

Retinopatía del prematuro. Casuística de los años 1995-2001 / Retinopathy of prematurity: casuistics between 1996 and 2001

Antecedentes: La retinopatía del prematuro (ROP) es una causa de morbilidad neurosensorial. Objetivos Estudiar la incidencia, factores de riesgo asociados, tratamiento y evolución de la retinopatía de la prematuridad en recién nacidos pretérmino menores de 32 semanas procedentes de nuestro hospital. Métodos: Pacientes nacidos entre 1 de enero de 1995 y 31 de diciembre de 2001 en el Hospital Sant Joan de Déu (Barcelona) con 32 semanas de edad gestacional, que han sobrevivido hasta el mes de vida. Se les realizó fondo de ojo entre las 4 y 6 semanas de vida, continuando con el examen cada 1-2 semanas, hasta su completa vascularización. Seguimiento evolutivo de las secuelas del fondo de ojo y función visual. Estudio descriptivo con comparación bivariable entre los grupos con y sin ROP. Resultados: De los 324 casos estudiados, 74 presentaron ROP (22,8 por ciento), de los cuales se clasificaron de estadios 1 y 2 a 63 pacientes (21,7 por ciento) y de estadio 3 a 11 (3,7 por ciento). Se evidenció una correlación inversa entre la incidencia de retinopatía y el peso o la edad gestacional. El estadio umbral (3 plus) se detectó en 9 casos (16 ojos) (3,1 por ciento de la muestra de estudio y 12,1 por ciento de los recién nacidos afectados de retinopatía) que se trataron con fotocoagulación con láser. Las secuelas del fondo de ojo fueron leves en el 2,7 por ciento de pacientes, moderadas en el 0,6 por ciento y graves en el 0,6 por ciento. La función visual (n 236) de los recién nacidos con ROP (n 74) se encontró alterada en 4 pacientes (1,7 por ciento de los explorados) de los cuales fue grave en 2 (0,8 por ciento). En el análisis bivariante, el bajo peso al nacer, la edad gestacional, días de oxigenoterapia y ventilación mecánica, días de antibiótico, número de transfusiones de sangre mostraron diferencias significativas (p < 0,001). Conclusiones: En este estudio la incidencia de ROP es similar a la de otros centros y se ve una fuerte asociación a distintos factores de riesgo para su aparición. No se observan estadios graves a partir de las 30 semanas. Los resultados de la fotocoagulación con láser son óptimos, con disminución de las secuelas en el fondo de ojo y en la función visual las estimadas sin tratamiento (AU)

Bronquiolitis aguda: influencia de la clínica en la respuesta al salbutamol y la duración de la estancia hospitalaria. Estudio prospectivo de 98 pacientes / Acute bronchiolitis: clinical influence on salbutamol response and hospital stay time. A prospective study of 98 patients

Objetivos: investigar factores clínicos que influyen en la respuesta favorable al salbutamol de ciertos pacientes con bronquiolitis aguda leve y moderada y su relación con la duración de la estancia hospitalaria. Material y método: estudio prospectivo abierto, durante tres estaciones epidémicas (1998-2001) de bronquiolitis. Se incluyen pacientes, previamente sanos, ingresados con bronquiolitis. Todos se someten a una dosis de prueba de salbutamol nebulizado. Los que tienen respuesta favorable, con mejoría de su score clínico de puntuación en uno o más puntos a los 30 minutos de la prueba, siguen recibiendo dosis similares (0,2 mg/kg de peso) cada 4-6 horas durante su ingreso. Se agrupan los pacientes atendiendo a la auscultación de sibilancias o sólo estertores. Cada grupo se subdivide en dos subgrupos por la presencia de infiltrado/atelectasia en la radiografía de tórax o no. Resultados: el total de pacientes estudiados fue 98 con edad media de 2,5 ñ 2,28 meses. Los pacientes con sibilancias fueron 44 (13 con infiltrado/atelectasia y 31 sin afectación parenquimatosa). Los que tenían estertores finos fueron 54 pacientes (29 con infiltrado/atelectasia y 25 sin). 84 pacientes (85,7 por ciento) tenían el virus respiratorio sincitial positivo en moco. (AU)

[Long-term effect of angiotensin-converting inhibitors in children with proteinuria]. / Efecto a largo plazo de los inhibidores de la enzima conversora de la angiotensina en niños con proteinuria.

BACKGROUND: Prolonged proteinuria is a risk factor for renal damage. Angiotensin-converting enzyme (ACE) inhibitors can reduce proteinuria in adults with different types of nephropathy. PATIENTS AND METHODS: We evaluated treatment with low doses of ACE inhibitors (captopril and enalapril) in nine children with proteinuria due to chronic glomerular nephropathy. The patients' diagnoses were Henoch-Schönlein nephropathy, Berger's disease, Alport's disease, and chronic glomerulonephritis (GN) (membranous GN, focal and segmental GN, and membranoproliferative GN). None of the patients were receiving concomitant treatment. Those who had received corticoids, immunosuppressive or hypotensive drugs during the previous 3 months were excluded. The medication was administered over a prolonged period (mean 26.6 6.36 months). RESULTS: Proteinuria was initially in the nephrotic range (M = 55.34 10.44 mg/m2/h). In all patients concentrations fell significantly after 6 months and at the end of the treatment(p = 0.01 and p = 0.05). No adverse reactions to the medication were observed. The decrease in glomerular filtration rate was not significant. No significant changes in arterial pressure were found during treatment. CONCLUSIONS: ACE inhibitors could be an effective alternative for reducing proteinuria in children with prolonged nephropathy. These inhibitors do not produce the adverse effects associated with other drugs and can therefore be used for long periods.

Efecto a largo plazo de los inhibidores de la enzima conversora de la angiotensina en niños con proteinuria / Long-term effect of angiotensin-converting enzyme inhibitors in children with proteinuria

Antecedentes: La proteinuria por sí misma representa un riesgo de lesión renal cuando se mantiene elevada de forma persistente a lo largo del tiempo. Los inhibidores de la enzima conversora de la angiotensina (IECA) pueden reducir la proteinuria en adultos con diversas nefropatías. Pacientes y métodos: Se ha evaluado el efecto del tratamiento con dosis bajas de IECA (captopril y enalapril) en 9 niños con proteinuria afectados de nefropatía glomerular crónica. Los diagnósticos de los pacientes eran: nefropatía de Schönlein-Henoch, enfermedad de Berger, enfermedad de Alport y glomerulonefritis crónica (membranosa, focal y segmentaria y mesangiocapilar). En ningún caso debían recibir tratamiento concomitante, y se excluyeron aquellos que hubieran recibido corticoides, inmunosupresores o hipotensores en los últimos 3 meses. La medicación se administró durante un período de tiempo prolongado (tiempo medio 26,6 6,36 meses). Resultados: La proteinuria que era inicialmente de rango nefrótico (mujeres 55,34 10,44 mg/m2/h) descendió en todos los casos de forma significativa a los 6 meses y al final del tratamiento (p < 0,01 y p < 0,05). No se han observado reacciones adversas a la medicación. El descenso en las cifras de filtrado glomerular no fue significativo. Tampoco se modificó de forma significativa la presión arterial durante el tratamiento. Conclusiones: Los IECA pueden ser una alternativa eficaz en la reducción de la proteinuria en niños con nefropatías de larga evolución, sin los efectos secundarios de otros fármacos, por lo que pueden utilizarse durante tiempo prolongado (AU)

[Vertical transmission of human immunodeficiency virus: six years of development 1987-1992)]. / Transmisión vertical del virus de la inmunodeficiencia humana: seis años de evolución (1987-1992).

BACKGROUND: According to World Health Organization estimates, from the beginning of the epidemics to the end of 1994, the number of children infected by human immunodeficiency virus (HIV) was 1.5 million. This paper describes the evolution of some clinical and epidemiologic characteristics of vertically transmitted HIV infection. PATIENTS AND METHODS: All children born to HIV-infected mothers who delivered at a university hospital in Barcelona, Spain, between 1987 and 1992, were included in the study. Rates of HIV vertical transmission, HIV infection incidence and mortality due to HIV were estimated, and trends for the study period analyzed. Odds ratios were used to assess associations between variables. RESULTS: 192 newborns were identified and allocated, with respect to the year of birth, in three cohorts of 71, 58 and 63 children. Overall HIV vertical transmission rate was 16.5% and did not differ between cohorts. Infection incidence density rates increased over time (0.2, 4.9 and 8.1 cases/100 child-years, respectively; p = 0.016), while incubation periods decreased significantly (248, 103 and 114 days; p = 0.0004). There were no changes in mortality density rates (2.2 deaths/100 child-years). Regarding mothers' characteristics, a significant temporal trend (p < 0.001) for being older at delivery, belonging to the heterosexual transmission group and having symptomatic infection was observed over time. CONCLUSIONS: Certain clinical and epidemiologic aspects of HIV vertical transmission have changed over time, however the number of new cases has remained fairly constant. In our setting, both early diagnosis and clinical management of these children have improved, but primary prevention for HIV vertical transmission has not been effective. Better counselling for HIV-infected women of childbearing age is needed.

[Features in human immunodeficiency virus type 1 in the neonatal period]. / Manifestaciones de la infección por el virus de la inmunodeficiencia humana tipo 1 en el período neonatal.

UNLABELLED: Different patterns of disease expression have been found in pediatric HIV1 infection. The precise timing of vertical transmission of HIV1 cannot be pinpointed. Some studies suggests that a substantial proportion of infants are infected during gestation are likely to have more extensive infection and thus more accelerated disease that infants who become infected during labor or delivery. PATIENTS: We examined the clinical manifestations and laboratory findings in seven newborns with HIV1 infection. RESULTS: In all patients, have been bound clinical or laboratory features at birth. Five newborn was prematurely (71.4%). The most common clinical findings in this group was: hepatomegaly (6/7), failure to drive (6/7), esplenomegaly (5/7) and limphadenopaties (5/7). The laboratory findings was: trombopeny and cellular immunosuppression (5/7). The HIV1 infection was determined by detection of p24 antigen, chain reaction polymerase or viral cocultive in blood in the first day of live. The mortality in this group was the 70% in the first year of life. COMMENTS: This results suggest that the timing of HIV1 infection was intrauter. This group has an accelerated disease course, developing manifestations of AIDS in first month of life and dying earlier. Although, a variety of maternal and fetal factors may contributed to the intrauter infection, for example the characteristics of the mother's infection, immune status, level of HIV1-neutralizing antibody, p24 antigaenemia prematurity and others.

[Guillain-Barre syndrome: a study of 13 children]. / Síndrome de Guillain-Barré. Análisis de 13 casos pediátricos.

A group of 13 children, aged 2 to 14 years, and diagnosed with Guillain-Barré syndrome has been analyzed. Clinical features and outcome were retrospectively studied. In 75% of the patients there was an infectious illness previous to the neurologic symptoms and in four children the etiologic agent was demonstrated. Motor deficits affecting the limbs and muscle stretch reflexes were absent in all thirteen patients. Cranial nerve involvement showed-up in 46%. Meningitic symptoms occurred in 62% of the cases. One of the children developed the Fisher syndrome variant. Two patients required assisted ventilation. Three children showed associated immunologic abnormalities, with one of the patients having a selective IgA deficiency, another child showing an increment in IgE and the other Kawasaki syndrome. We have not demonstrated differences in the outcome between the patients with corticoid treatment.

[Neurologic evolution of premature infants following assisted ventilation, with and without bronchopulmonary dysplasia]. / Evolución neurológica del recién nacido pretérmino ventilado con y sin displasia broncopulmonar.

The aim of this work was to evaluate the influence of bronchopulmonary dysplasia on the neurological outcome of the preterm infant requiring assisted ventilation. Thirty-nine preterm infants requiring ventilation support during 72 hours or more were classified into two groups according to the presence or absence of bronchopulmonary dysplasia (BPD). In the BPD group (n = 11), only the incidence of mild cognitive deficits was significantly higher (36.4 % vs 0 %). Our results suggest that the neurological outcome of the infants with BPD is more closely associated with other neonatal events (intraventricular hemorrhage, periventricular leukomalacia, neonatal seizures, longer ventilation support, maximum serum bilirubin levels, low Apgar score at 10 minutes and poor intake of amino acids) than with the presence of BPD. The data of this study suggest that indomethacin reduces the risk of neurological deficits.