Respuesta a «Ingeniería de materiales, mechanical power, ventilación protectora y una de paracaídas» / Reply to «Materials engineering, mechanical power, protective ventilation and a parachute»

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Implicaciones clínicas de la teoría reológica en la prevención de la lesión pulmonar inducida por el ventilador. ¿Es la potencia mecánica la solución? / Clinical implications of the rheological theory in the prevention of ventilator-induced lung injury. Is mechanical power the solution?

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Stress, strain y potencia mecánica. ¿Es la ingeniería de materiales la respuesta para prevenir la lesión inducida por el ventilador? / Stress, strain and mechanical power: Is material science the answer to prevent ventilator induced lung injury?

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Recomendaciones para la asistencia respiratoria en el recién nacido (III). Surfactante y óxido nítrico / Recommendations for respiratory support in the newborn (III). Surfactant and nitric oxide

Las recomendaciones incluidas en este documento forman parte de una revisión actualizada de la asistencia respiratoria en el recién nacido. Están estructuradas en 12 módulos y en este trabajo se presenta el módulo 7. El contenido de cada módulo es el resultado del consenso de los miembros del Grupo Respiratorio y Surfactante de la Sociedad Española de Neonatología. Representan una síntesis de los trabajos publicados y de la experiencia clínica de cada uno de los miembros del grupo (AU)

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group (AU)

[Recommendations for respiratory support in the newborn (iii). Surfactant and nitric oxide]. / Recomendaciones para la asistencia respiratoria en el recién nacido (iii). Surfactante y óxido nítrico.

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group.

Estudio retrospectivo de factores de riesgo de transmisión vertical de infección por virus hepatitis C / Retrospective study of risk factors of vertical transmission of hepatitis C virus

Introducción: A pesar de la baja prevalencia infantil de infección por virus hepatitis C (VHC) y su leve clínica inicial, la infección crónica puede evolucionar a cirrosis y/o hepatocarcinoma. Es fundamental controlar su transmisión vertical. Los últimos estudios describen hasta 50% de transmisiones intraútero. Material y métodos: Estudiamos retrospectivamente 17 casos de infección por VHC en 8 años, analizando los factores de riesgo de transmisión vertical, para aplicar prevención primaria. Resultados: Solo la adicción a drogas vía parenteral muestra riesgo significativo, sin ser la coinfección VIH factor de confusión. La carga viral, la coinfección por VIH, la disfunción hepática y el tiempo de evolución de infección no muestran mayor riesgo. La cesárea, la amniocentesis y la monitorización interna pueden ser factores de riesgo (sin significación estadística), pero no las horas de amniorrexis. La lactancia materna muestra protección. Conclusiones: Pese a la importancia frecuentemente atribuida, el efecto de la carga viral sobre el riesgo de transmisión no está claramente establecido: la ausencia de viremia no descarta el riesgo de transmisión, ya que la detección de ARN viral puede ser intermitente, y por tanto, los datos al respecto deben interpretarse con cautela. La inmunosupresión secundaria a la coinfección por VIH supone mayor riesgo de transmisión, pero dicho efecto disminuye al mejorar la capacidad inmune gracias al tratamiento antirretroviral. Respecto a las características del parto, el tiempo transcurrido tras la rotura de membranas no ha mostrado ser factor de riesgo; y se desestima la cesárea como forma óptima y electiva de finalizar la gestación de estas mujeres. La lactancia materna, lejos de suponer mayor riesgo de transmisión, puede ser protectora. La escasa carga viral en la leche, su inactivación por el pH ácido gástrico y sus beneficios inmunológicos justificarían este resultado. Dadas las limitaciones de los estudios retrospectivos, es necesario plantear análisis prospectivos para conocer mejor el papel de los posibles factores de riesgo y establecer pautas claras de prevención; de momento, es fundamental el control evolutivo de todos los hijos de madres con infección por el VHC (AU)

Introduction: Despite the low prevalence of paediatric HCV infection and its initial mild clinical expressiveness, chronic infection could progress into cirrhosis and/or hepatocarcinoma. It is essential to control vertical transmission. Recent studies show that up to 50% of transmissions occur within the uterus. Material y methods: A retrospective study was conducted on 17 cases of (Hepatitis C virus) HCV infection registered over a period of 8 years. Vertical transmission risk factors were analysed, in order to introduce primary prevention. Results: Only parenteral drug addiction significantly increased the rate of HCV transmission; HIV co-infection was not a confounding factor. HCV viremia, HIV co-infection, liver dysfunction and/or duration of the infection did not appear to affect the rate of transmission. Caesarean section, amniocentesis and internal monitoring may be risk factors (not statistically significant), but not prolonged vaginal delivery after amniotic membrane rupture. Breastfeeding showed protection. Conclusions: The effect of viremia on the risk of transmission is not clearly established, despite the importance usually attributed. Lack of viremia does not discount the risk of transmission, due to viral RNA detection can be intermittent, so it should be interpreted cautiously. Immunosuppression secondary to HIV co-infection implies a higher risk of transmission, but this effect decreases by improving immune competence by antiretroviral treatment. With regard to the birth characteristics, time after the rupture of membranes has not shown being a risk factor; being the caesarean not advisable as a good alternative to finish the pregnancy. Breastfeeding does not increase the risk, even it can be protective. This results would be justified by the low viral content of milk, its inactivation by gastric pH and its immunological benefits. Given that retrospective studies results are limited, prospective studies need to be carried out in order to improve the understanding of the role of possible risk factors and to provide a clear preventive guidelines. At the moment it is essential to control all the children born of mothers with HCV infection (AU)

[Retrospective study of risk factors of vertical transmission of hepatitis C virus]. / Estudio retrospectivo de factores de riesgo de transmisión vertical de infección por virus hepatitis C.

INTRODUCTION: Despite the low prevalence of paediatric HCV infection and its initial mild clinical expressiveness, chronic infection could progress into cirrhosis and/or hepatocarcinoma. It is essential to control vertical transmission. Recent studies show that up to 50% of transmissions occur within the uterus. MATERIAL AND METHODS: [corrected] A retrospective study was conducted on 17 cases of (Hepatitis C virus) HCV infection registered over a period of 8 years. Vertical transmission risk factors were analysed, in order to introduce primary prevention. RESULTS: Only parenteral drug addiction significantly increased the rate of HCV transmission; HIV co-infection was not a confounding factor. HCV viremia, HIV co-infection, liver dysfunction and/or duration of the infection did not appear to affect the rate of transmission. Caesarean section, amniocentesis and internal monitoring may be risk factors (not statistically significant), but not prolonged vaginal delivery after amniotic membrane rupture. Breastfeeding showed protection. CONCLUSIONS: The effect of viremia on the risk of transmission is not clearly established, despite the importance usually attributed. Lack of viremia does not discount the risk of transmission, due to viral RNA detection can be intermittent, so it should be interpreted cautiously. Immunosuppression secondary to HIV co-infection implies a higher risk of transmission, but this effect decreases by improving immune competence by antiretroviral treatment. With regard to the birth characteristics, time after the rupture of membranes has not shown being a risk factor; being the caesarean not advisable as a good alternative to finish the pregnancy. Breastfeeding does not increase the risk, even it can be protective. This results would be justified by the low viral content of milk, its inactivation by gastric pH and its immunological benefits. Given that retrospective studies results are limited, prospective studies need to be carried out in order to improve the understanding of the role of possible risk factors and to provide a clear preventive guidelines. At the moment it is essential to control all the children born of mothers with HCV infection.

Miopatía nemalínica: forma infrecuente de hipotonía neonatal / Nemaline myopathy: an uncommon form of neonatal hypotonia

La hipotonía neonatal constituye un reto diagnóstico, debido a la gran variedad de etiologías y de exploraciones complementarias necesarias para llegar a su diagnóstico. Clínicamente, se pueden agrupar en hipotonías paralíticas y no paralíticas; entre estas últimas encontramos el grupo de las miopatías congénitas, al que pertenece la miopatía nemalínica (MN).La MN es una enfermedad congénita no progresiva de la musculatura esquelética caracterizada por la presencia de bastoncillos o cuerpos nemalínicos en las fibras musculares. Presentamos el caso clínico de un recién nacido prematuro con sospecha de enfermedad neuromuscular, en el que se iniciaron estudios para un diagnóstico etiológico, que fueron normales. La biopsia muscular mostró los cuerpos nemalínicos característicos de la MN. La evolución clínica no fue satisfactoria; se realizó una traqueotomía a los 3 meses de vida y en la actualidad, a los 11 meses de vida, precisa ventilación domiciliaria con presión positiva continua en la vía respiratoria. El diagnóstico de MN requiere un alto índice de sospecha y la biopsia muscular como confirmación. En la actualidad no puede ofrecerse consejo genético en los casos esporádicos (AU)

Neonatal hypotonia constitutes a diagnostic challenge due to the wide variety of etiologies and the broad array of supplementary tests necessary to arrive at the correct diagnosis. Clinically, we can differentiate between paralyzing and non paralyzinghypotonia. Congenital myopathies, including nemaline myopathy, belong to the latter group. Nemaline myopathy is a non progressive congenital disorder of skeletal muscle, characterized by the presence of rod-like structures, or nemaline bodies, in muscle fibers. We report the case of a premature infant who was assessed on the suspicion of neuromuscular disease. The results of the initial diagnostic studies were normal, but muscle biopsy eventually revealed the rod-like structures characteristic of nemaline myopathy. The clinical course was unsatisfactory and, after undergoing tracheotomy at the age of three months, at the time of writing, he was ten months old and required home continuous positive airway pressure (CPAP) ventilation. The diagnosis of nemaline myopathy requires a high index of suspicion and the performance of a muscle biopsy. At the present time, genetic counseling cannot be provided in sporadic cases (AU)