[Neonatal conjunctivitis caused by Chlamydia trachomatis]. / Conjuntivitis neonatal por Chlamydia trachomatis.

32 newborns with neonatal Chlamydia trachomatis conjunctivitis were reported. Diagnosis was carried out through immunofluorescent monoclonal antibody of conjunctiva scraping staining; 37 conjunctiva samples were taken from same number of newborn patients not responds to topical antibiotic treatment. The sample came out from two different third level institutions with maternal facilities and attending more than five thousand deliveries per year each one of them. Were studied incidence and clinical picture from neonatal C. trachomatis conjunctivitis. Positive immunofluorescent and conjunctive culture of secretion to C. trachomatis in the sample were 86 per cent (32 out of 37). 19 of the newborns acquired Staphylococcus associated to C. trachomatis (59%): nine with S. aureus in six Staphylococcus negative coagulase was isolated and four with the latest two. Out of 32 patients who demonstrated positive cultures to C. trachomatis (86%), 22(69%) were males and ten (31%) were females. Significant proportion of newborns were identified as small for gestational age. 18 of them were born by natural way and 14 by cesarean section. In 16/32 (50%) had interstitial pneumonia by Chlamydia. The main clinical findings were stated as: conjunctiva exudate in different stages including purulent secretion and oedema or inflammation of the ophthalmic conjunctiva. Those newborns where topical therapy did not irradiate the organism and demonstrated clinical picture persistence or relapse and diagnosis of C. trachomatis infection, systemic treatment with erythromycin and topic tetracycline were installed, disappearing all symptoms. Maternal history related to neonatal disease were mainly: endocervical infection, miscarriages and or preterm delivery.

[The effect of phenobarbital on the severity of intraventricular hemorrhage]. / Efecto del fenobarbital sobre la gravedad de la hemorragia intraventricular.

During an eight-months period, we studied every newborns under 34 gestation weeks who needed mechanical ventilation (MV) from the moment they were born and whom had an ultrasonogram without intraventricular hemorrhage in the first six hours after birth. Patient were separated in two groups: the first, a group of 30 patients received phenobarbital 20 mg/kg IV in the first 6 hours of life and then 2.5 mg/kg, I.V., every 12 hours for the next five days. Blood levels were measured 24 and 96 hours after the initial dose was given. The second group of 30 patients was not treated with phenobarbital. In both groups a brain ultrasonogram was made every 48 hours until 15 days of life. There were no difference in weight, gestational age, Apgar score, way of birth, initial diagnosis, incidence of pneumothorax, mortality and days with MV between the two groups. During the first three days were measured blood glucose, blood pressure, mean airway pressure, PCO2, PO2 and found no significant difference between both groups. The blood pH showed statistically significant difference, with better values at 48-72 hours in the group treated with phenobarbital. The global incidence of intraventricular hemorrhage was 16 (53%) in the group treated and 14 (46%) in the not treated, this difference was not statistically significant. The degree of hemorrhage, found was: I and II degree, eleven (69%) in the treated group and four (28%), in the control group; III and IV degree five (31%), in the treated group and ten (71%), in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Child of insulin-dependent diabetic mother: neonatal impact]. / Hijo de madre diabética insulino-dependiente: repercusiones neonatales.

Pregnancy and diabetes mellitus have been associated to a high incidence of neonatal morbidity and mortality. The purpose of the present study was to determinate the incidence of macrosomia, congenital malformations and their effect in the neonatal period. We review 42 live infants of insulin dependent diabetic mothers (IDDM) in a third level center. The variables analyzed were: severity of maternal diabetes, sex, weight, gestational age, trophism, Apgar score at one minute, mode of delivery, presence of congenital malformations, morbidity and mortality. The population was divided in three groups: 1. Neonates with appropriate for gestational age (AGA), 2. Large for gestational age (LGA), and 3. Small for gestational age (SGA). According to trophism, 27 (64%) were AGA, eleven (26%) were LGA and four (9%) were SGA. About morbidity, hypoglycemia was more frequent in the LGA. The group of SGA had lower Apgar score at one minute compared with the AGA. There were congenital malformations in seven neonates and being more frequent in the SGA group. The proportion of major malformation was of 4.7%. Fetal hyperinsulinemia is responsible for the morbidity of IDDM, being necessary adequate metabolic control of the mothers before pregnancy and the management of diabetes and pregnancy should be done in a center with experience.

[Subependymal/intraventricular hemorrhage in preterm newborn infants. Neurodevelopmental course during the first year of life]. / Hemorragia subependimaria/intraventricular en neonatos pretérmino. Evolución del neurodesarrollo durante el primer año de vida.

Subependymal/intraventricular hemorrhage (SE/IVH) is the most frequently encountered type of hemorrhage in the neonatal period. Premature infants often develop SE/IVH which remains is one of most serious neonatal events. We studied a group of 96 premature newborn infants: half of which were diagnosed with SE/IVH. We evaluated the babies at six and 12 months of age which++ a battery of neurobehavioral exams, including neurological, psychological, motor an audiological test. In 52 of infants with SE/IVH showed some type of neurobehavioral abnormality, compared with 13% of non-SE/IVH infants. In 56% of SE/IVH infants had neurological abnormalities at 12 months (P < 0.0001) difference with non-SE/IVH), predominantly in areas of muscle tone and reflex. Motor abnormalities were encountered in 42% of SE/IVH children, and in 4% of non-SE/IVH children at 12 months. Psychometric abnormalities at 12 months were noted in 53% of the SE/IVH group. Hypocusis were noted in 38% of the SE/IVH group and in 15% of the non-SE/IVH group.

[Nosocomial infection in newborn infants on mechanical ventilation]. / Infección nosocomial en recién nacidos con ventilación mecánica.

During a two-year period (1988-1989), were studied newborns treated with intermittent mandatory ventilation (IMV). The goal was to know incidence of infections in these patients and characteristics of these process. Of 187, 40 (21.3%) were infected. For these neonates the mean gestational age was 33 +/- 3 weeks and average for birth weight was 1755 +/- 644 g. In 32 the infecting agent was isolated, being the most common coagulase negative Staphylococcus, it was found in 18 (45%), Klebsiella sp in 7 (17%), Escherichia coli in 1 and Candida albicans in 1. In the remaining 8 (20%) with negative cultures, postmortem confirmation was made in 5 and in 3 by clinical, radiologic or hematologic evidence. Of the 17 positive blood cultures and 3 spinal fluid culture, the same bacteria grew as in the bronchial aspirate. Were found, thrombocytopenia in 22 (55%) and leucocytosis in 19 (47%) as the most common blood changes. Pneumonia was the most common form of infection; it was found in 30 (75%); 22 of 40 died (55%). We concluded that 21.3% of neonates under IMV without infections, may get infected later in the hospital. S. epidermidis is the etiologic agent that predominates through the whole year, except during epidemics caused by others agents.

[Nosocomial infection in the neonatal period at a third level care center]. / Infección nosocomial en la etapa neonatal en un centro de tercer nivel de atención.

Results are presented on epidemiologic surveillance of nosocomial infection of all neonates attended at the Instituto Nacional de Perinatologia throughout 1988-1990, reporting rates of 2.1, 2.9 and 5.5 per 100 discharge for each of the years studied. Data are presented in full by service, showing rates of 4.7, 9.5 and 23.0 per 100 discharge in Neonatal Intensive Care Unit (NICU) and 1.5, 3.2 and 6.7 per 100 discharge for Neonatal Intermediate Care (NIC) for the same three years. With respect to type of infection, septicemia, pneumonia and conjunctivitis come as the most frequent causes of infection and Staphylococcus sp coagulase negative (30%), Staphylococcus aureus (27%) and Escherichia coli (7%) as the prevailing microorganisms in nosocomial infection.

[The perinatal aspects of surviving low-birth weight neonates]. / Aspectos perinatales de neonatos sobrevivientes de bajo peso.

We analyzed prenatal history of 277 live low birth weight infants (less than 2,500 g). We tried to determine some perinatal factors that may be associated with good prognosis in this group of babies. The variables analyzed were: maternal age, number of prenatal visits, complication of pregnancy, mode of delivery, birth weight, sex, gestational age. Apgar score at 1 minute and the neonatal morbidity. The population was divided in 3 groups: 1. Less than 1,000 g, (3).2. 1,000-1,499 g, (37) and 3. 1,500-2,499 g (237). Each group was also divided in appropriate for gestational age (AGA) and small for gestational age (SGA). We found that morbidity and the risk of death, is less in the SGA compared with AGA, associated with better prenatal care, higher birth weight and gestational age.

[The determination of pulmonary phospholipids in the gastric contents for an assessment of the respiratory distress syndrome]. / Determinación de los fosfolípidos pulmonares en contenido gástrico para evaluación del síndrome de dificultad respiratoria.

Since hyaline membrane disease (HMD) is an important cause of mortality and morbidity in preterm newborns, we decided to evaluate the utility of pulmonary phospholipid (PP) determination in gastric aspirate for confirmatory diagnosis. For that purpose we studied 31 preterm and 30 term babies and compared the results between them and PP in gastric aspirate and amniotic fluid from their mothers. All the term newborns were normal, with mean weight of 3,221, and 39 weeks of gestational age; the results of phosphatidyl inositol (PI) and phosphatidyl glycerol (PG) were positive. The premature babies had a mean weight of 2,424 g and 35 weeks of gestational age. Thirteen had respiratory distress, 4 transient tachypnea and 9 HMD. In this group the babies with PI present and PG absent developed respiratory distress without HMD. The test had sensibility of 69% and specificity of 100%, and in patients without PG and PI the sensibility and specificity was 100%. We concluded that this test has enough sensibility and specificity for the confirmation of HMD in gastric aspirate when the PI and PG are not present.

[Alterations in neuro-development in the 1st year of life in newborn infants weighing 2000 grams or less at birth]. / Alteraciones del neurodesarrollo en el primer año de vida en neonatos que pesaron 2.000 gramos o menos al nacer.

The infants with low weight at birth have great chance of exhibiting early death or neurodevelopmental sequelae. We prospectively evaluated the neurological and psychological development during the first year of life in 118 infants who weighted less than 2,000 g at birth. All patients were examined with the Amiel Tison and Grenier test (neurologic evaluation), Gesell test (psychological) and Brunette-Lezine test (Psychomotor scale). Mean gestational age was 33 weeks (SD = 3.1) and birth mean weight was 1495 g (SD = 291). Seventy per cent were delivered by cesarean section. Neurological abnormalities were found in 20 infants (alteration of muscular tone in all and motor deficit in 50%). Twenty five per cent had abnormal Gesell test and 17% psychomotor retardation (13% mild and 4% severe).

[Indomethacin in the prevention of subependymal-intraventricular hemorrhage in preterm newborns with conventional mechanical ventilation]. / Indometacina en la prevención de la hemorragia subependimaria-intraventricular del recién nacido pretérmino con ventilación mecánica convencional.

The results of a double blind study to evaluate the efficiency of prophylactic endovenous indomethacin versus placebo for prevention of intraventricular hemorrhage (IVH) in newborn infants between 28 to 36 weeks of age who were intubated at the delivery room and required mechanical ventilation in NICU are presented. Fourty six patients required mechanical ventilation, but 14 neonates had IVH evaluated by ultrasound when were admitted to the Unit. At least 32 infants were studied, 16 for each group. There were no differences between the groups in weight, gestational age, sex and delivery way. The mobility was the same in relation to hialine membrane disease, sepsis, pneumonie and pneumotorax. The placebo group had more frequency of PDA and mortality (P < 0.5). There were no differences in mean airway pressure and arterial gases, also in glucose, platelets and urinary volume. The indomethacin group had mayor urinary density and FeNa but the results were always in normal ranges. The IVH was the same in both groups. We concluded that the indomethacin at the levels used did not produced alterations, and if the IVH is not prevented, were observed lesser severity of the same and the frequency of PDA and mortality are lesser. But still is necessary more number of cases for best conclusions.

[Survival of very low birth weight newborns (less than 1,500 grams) in relation to conventional mechanical ventilation]. / Sobrevida en recién nacidos de muy bajo peso al nacer (menores de 1.500 gramos) con relación a la ventilación mecánica convencional.

One hundred and five very low birth weight neonates, selected through convenience sampling during 1989, were subdivided into those who received mechanical ventilation (MCV) and those who did not receive mechanical ventilation (W/O MCV) and later analyzed. The maternal morbidity in both groups were very similar; 66 of the cases were placed in group MCV and 39 in the W/O MCV. There were differences in birth weight, gestational age, severe asphyxia and hospital stay in the patients with MCV. The neonatal morbidity (SDR, intraventricular hemorrhaging, bronchopulmonary dysplasia, etc.) was more frequently seen in this group. The global mortality was 47%, all of the cases were from the ventilated group. The ventilated patients who died were in the hospital a lesser number of days and had a lesser frequency of prenatal control. We conclude that low weight neonates who require mechanical respiratory assistance have a greater risk of morbidity and mortality. The lesser weight and gestational age, the greater the risk. A group of neonates will have a lesser capacity to synthesize phospholipids and therefore a greater risk of dying. Physicians should be more attentive to the complications related to ventilated low-weight premature neonates.

[Growth curves for premature infants during the 1st year of life]. / Curvas de crecimiento del neonato pretérmino durante el primer año de vida.

A 107 newborn premature children were anthropometrically evaluated during the first 12 months of their lives at the Growth Clinic of the National Institute of Perinatology in Mexico City. The study was longitudinal and included variables such as weight, height, cephalic, thoracic, abdominal and bronchial perimeters. The data are show in percentiles of 10, 50 and 90 for each variable. A symmetrical logarithmic behavior throughout the entire curve was seen with each of the six indicators evaluated, whose greatest percentage increase within the growth rate was generally seen during the first semester, decreasing during the second. It was seen that once the child reaches one, the premature infant reaches the full-term child (50 percentile) in weight, height and cephalic perimeter. In addition, the average speed of growth was four times greater for weight, two times greater for height and similar for the cephalic perimeter of the premature child with respect to the full-term infant. We conclude that it is useful to count on specific growth curves for premature children since their speed and rhythm of growth are different than for the full-term child during the first year of life.

[A follow-up during the first year of life of newborn infants with very low weight at birth]. / Seguimiento durante el primer año de vida, de neonatos con muy bajo peso al nacer.

Groups of low-weight neonates, especially those under 1,500 g, discharged from the Intensive Care Unit, have a greater frequency of having psychoneurologic, audiologic, language and ophthalmologic scars in comparison with those neonates who suffered no complications. These frequencies vary considerably depending on different authors, the type of sequela and the duration of the follow-up. It is difficult to identify early on, which of these children will be affected in his later development. The currently used prognostic indexes have shown the importance of combining the child's psychoneurologic and biologic evolution as well as his surrounding environmental factors. Thirty-eight newborns were studied. Each weighted 1,500 g or less and were discharged from the Neonatal Intensive Care Unit. All of the patients were subsequently evaluated by specialists in Neurology, Psychology, Social Communication, Neuromotor Rehabilitation and Ophthalmology at 3, 6, 9 and 12 months of age (37 weeks) and included in a study conducted by the Program for Pediatric Follow-up at the National Institute of Perinatology. In general, the number of abnormalities found in each of the specialties during the first months of life was notorious, which later decreased as the child got older. For example, Neurology found abnormalities at 3 months in a proportion of 0.61 and at 12 months, it decreased to 0.19 (P less than 0.001). During neuromotor stimulation something similar was seen at three months a proportion of 0.39 abnormalities were recorded while at 12 months this decreased to 0.18. The human communication tests showed a proportion of 0.32 at 3 months and 0.10 at 12 months (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[The neurological and psychomotor evolution at 2 years of age of newborn infants who underwent assisted ventilation]. / Evolución neurológica y psicomotora a los dos años de vida de recién nacidos que fueron sometidos a ventilación asistida.

It is important to evaluate the development of neonates submitted to assisted ventilation since it is one of the most commonly used procedures in patients with respiratory failure. A group of 50 neonates who had been submitted to assisted ventilation were studied and compared to another group of 50 children with the same inclusion criteria, except for the fact that they had not needed ventilation. They were each evaluated since birth and thereafter every two months during their first year of life and every three months in the second year. The Amiel Tison Neurological Assessment was used to evaluate the children during the first year while the Mayo Clinic General Neurological Exploration adapted for nursing children was applied during the following year. In assessing psychomotor development, the Brunette Lezine Scale, standardized for Mexican children, was used. For practical purposes, a sample of the results obtained during the second year are presented while some pertinent variables are commented on. For those included in the ventilated group, results show a higher frequency of hyaline membrane disease (27 cases), intraventricular hemorrhage (19), pneumonia (18), and arterious duct persistence (13). The control group showed the following frequencies, respectively: 0, 4, 5, and 4 cases. The ventilation group was found to have a statistically significant higher relative risk rate (P less than 0.05) and a higher risk for neurologic sequelae (P less than 0.001) when compared to the control group. Asphyxia and hemorrhaging were factors associated and present in the ventilated group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Post-dosage loading concentrations of theophylline and pharmacokinetic study after the fifth maintenance dosage in premature newborns with apnea]. / Concentraciones de teofilina postdosis de impregnación y estudio farmacocinético en la quinta dosis de mantenimiento en recién nacidos pretérmino con apneas.

From a group of 50 premature newborns with central and mixed apnea, 34 received a loading dose of 4.3 mg/kg intravenous theophylline (group I) and 16 received 6 mg/kg orally (group II); the maintenance dose was 0.86 and 1 mg/kg every eight hours, respectively. Mean maximum serum concentrations after the loading dose were 5.8 +/- 2.3 mcg/mL in 25 newborns from group I, and 6.6 +/- 1,3 mcg/mL in 8 newborns from group II (P less than 0.20). Mean maximum concentration after the fifth maintenance dose was 7.5 +/- 1.7 mcg/mL in 26 newborns from group I, and 5.8 +/- 1.4 mcg/mL in 16 newborns from group II (P = 0.001); mean minimum concentration was 5.3 +/- 1.6 mcg/mL and 4.5 +/- 1.4 mcg/mL, respectively (P greater than 0.10). Mean clearance was 30.21 +/- 11.03 and 27.1 +/- 7.7 mL/kg/h; mean apparent distribution volume was 0.5 +/- 0.25 and 0.76 +/- 0.32 L/kg; elimination rate constant was 0.049 +/- 0.04 and 0.040 +/- 0.03/h-1 for both groups respectively, with significant differences between groups only in the apparent distribution volume (P less than 0.001). Half-life time (T1/2) was from four to 118 hours. The study population was divided into three groups according to half-life time: those with a half-life time of lesser than 20 hours (47.6%); an intermediate half-life time of from 20 to 30 hours (23.8%); and a long half-life time of more than 31 hours (28.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Morbidity and mortality in low birth weight infants]. / Morbilidad y mortalidad en neonatos de bajo peso al nacer.

The results in morbidity and mortality between 415 newborn infants with birth weight under 2,500 g are presented; the patients with great congenital malformations were not included. The population was divided in three categories 1,500-2,499 g, 1,000-1,499 g and less than 1,000 g and each categorie was divided in small for gestational age (SGE) and appropriate for gestational age (AGE). The mortality rate was very high in the extreme low birth weight. 67% of the population were AGE y 33% for SGE. The intrahospitalary morbidity was different between each group, being the SGE with less morbidity and less length of hospitalization, with no relation to birth weight. In our study there was no differences between perinatal asphyxia and birth weight, probably because the SGE babies born in better conditions than the other group.

[Neonatal systemic infection caused by Listeria monocytogenes]. / Infección sistémica neonatal por Listeria monocytogenes.

Listeria monocytogenes is a gram positive cocco-bacillus which causes perinatal infections and also attacks immunocompromised hosts. Little is known about it in our medium. As part of a prospective study on neonatal systemic infections, its participation at the National Institute of Perinatology was researched. During a period of 18 months, 9,283 live newborns were observed, 141 of them were diagnosed with neonatal septicemia. During this period seven neonates had systemic infections due to Listeria monocytogenes: three had septicemia (two of these with meningitis) and all seven cases had pneumonia. The gestational age of the neonates was 26.1 to 41 weeks (X + DS = 35 + 4.3), with a weight of 830 g to 2,975 g (X + DS 1,958 + 773), four out of seven weighed less than 2,000 grams. The most frequent clinical manifestation was respiratory related causing a need for a differential diagnosis with hyaline membrane disease, transitory tachypnea and meconium swallowing at birth. All of the strains isolated were found to be susceptible to ampicillin, penicillin, gentamicin and amikacin; requiring high CMI levels of cephalosporins.

[The Apgar score as a predictor of neurologic sequellae]. / El puntaje de Apgar como predictor de secuelas neurológicas.

65 newborns with Apgar score less than 7 were studied. Initially 2 groups were formed. Group 1 with severe asphyxia Apgar 0-3 and group 2 with moderate asphyxia Apgar 4-7. Each group was divided according to Apgar score at 5 minutes; with good recuperation Apgar greater than or equal to 6 and bad recuperation Apgar less than 6. So four subgroups were formed. All patients were evaluated with Amiel Tison neurological examination at 12 months old. Of the 65 newborns, 52 (80%) had a normal neurologic examination, and only 12 (20%) were not normal. There were not significant statistic differences neither between the moderate and severely asphyxiated groups nor between the four subgroups at 5 minutes and their neurological examination. We conclude that the Apgar score at 5 minutes is not a good predictive of neurological sequelae, because there is a myriad of factors difficult to investigate in relation to the etiology of neurologic sequelae. We stress the importance of reviewing the original idea about the Apgar score as a useful method (instrument) to evaluate the hemodynamic and homeostatic conditions of the newborns.

[Neurologic follow-up of polycythemic newborn infants]. / Seguimiento neurológico de neonatos policitémicos.

Seventy five newborn infants with neonatal polycythemia diagnosis (venous hematocrit levels greater than 65% were studied). They were born in the Instituto Nacional de Perinatologia and follow through their first year of life searching for neurologic findings. The more frequent signs related to polycythemia in this group were: presence of plethora, respiratory distress, cyanosis and tremors; the associated findings were hypoglycemia, hyperbilirubinemia, necrotizing enterocolitis and meconium aspiratum. Sixty eight of the seventy five neonates developed symptomatology and seven didn't. The eight neonates who developed neurologic transient impairments belonged to the symptomatic group in a 0.11 proportion. We concluded that the number of babies with neurologic findings in our sample was small in comparison with other reference studies; we also found that the exchange transfusion is not a preventive measure for neurologic sequel, but it is useful to diminish the symptomatology caused by polycythemia; besides we don't recommend this procedure in asymptomatic babies because the complication risks as the enterocolitis. We propose a simple treatment scheme.

[Comparison of computed tomography and ultrasonic studies of the brain in newborns and infants. Correlation in 40 cases]. / Comparación de la tomografía computada de cerebro con el estudio por ultrasonido en recién nacidos y lactantes. Correlación de 40 casos.

We correlate the cases of forty neonates and nursing infants whose brains were studied using ultrasound and CT scan. The indications for the aforementioned studies were: 15 cases of dysmorphism, 16 cases with significant neurological signs and 9 cases of preterm neonates with body weight less than 1,500 g. The results of the correlations were as follows: 24 cases demonstrated similar images (60%), 14 cases showed a better resolution of the images by ultrasound (35%), better resolution of the images by CT scan in 2.5% and non-coincidental images in one case (2.5%). We conclude that in the specialty of neonatology, using ultrasound has more advantages than the CT scan method.