[Neonatal viral meningitis. The importance of the polymerase chain reaction in their diagnosis]. / Meningitis viricas neonatales. Importancia de la reaccion en cadena de la polimerasa en su diagnostico.

INTRODUCTION: The different types of viral meningitis constitute a condition that is relatively frequent in newborn infants, although in many cases they are underdiagnosed due to the absence of pleocytosis in the cerebrospinal fluid (CSF). AIMS: To describe the clinical features and laboratory findings of newborn infants with viral meningitis and to highlight the importance of the polymerase chain reaction (PCR) in the CSF to diagnose this condition. PATIENTS AND METHODS: A retrospective review of the medical records of newborn infants hospitalised in the neonatology section who had been diagnosed with viral meningitis between May 2014 and May 2017. RESULTS: Altogether 17 cases of viral meningitis were registered (15 caused by enterovirus and two due to parechovirus), which accounts for 14.8% of all newborns hospitalised owing to febrile symptoms. All of them had fever (100%), and other notable symptoms were irritability (76%) and rejection of feeding (65%). Normal cellularity was found in the CSF without high protein levels in 88% of them, and without hypoglycorrhachia in all of them (100%), which meant that many of these children had previously been left with a diagnosis of a febrile syndrome with no focus. These data stress the need to perform the PCR in the CSF of newborn infants who have a fever without a focus, due to the normal status of the results of the complementary tests in most cases. Subsequent neurological follow-up was performed in 64.7% of the children in the neurology service, without any neurological sequelae being found, except in one case. CONCLUSIONS: Multiple PCR in the CSF has become an essential diagnostic technique in cases of newborn infants with a suspected infection, and replaces viral culture as the reference test due its being quicker and more sensitive.

TITLE: Meningitis viricas neonatales. Importancia de la reaccion en cadena de la polimerasa en su diagnostico.Introduccion. Las meningitis viricas representan una entidad relativamente frecuente en los recien nacidos, aunque en muchos casos infradiagnosticadas, ante la ausencia de pleocitosis en el liquido cefalorraquideo (LCR). Objetivos. Describir las caracteristicas clinicas y los hallazgos de laboratorio de neonatos con meningitis viricas y destacar la importancia de la reaccion en cadena de la polimerasa (PCR) en el LCR para diagnosticar esta patologia. Pacientes y metodos. Revision retrospectiva de historias clinicas de neonatos ingresados en la seccion de neonatologia diagnosticados de meningitis virica entre mayo de 2014 y mayo de 2017. Resultados. Se registraron 17 casos de meningitis virica (15 causadas por enterovirus y dos por parechovirus), que constituyen el 14,8% de los neonatos ingresados por sindrome febril. Todos manifestaron fiebre (100%), y otros sintomas destacados fueron irritabilidad (76%) y rechazo de la ingesta (65%). El 88% curso con celularidad normal en el LCR y sin hiperproteinorraquia, y el 100%, sin hipoglucorraquia, por lo que previamente muchos de estos niños quedaban con el diagnostico de sindrome febril sin foco. Estos datos resaltan la necesidad de realizar la PCR en el LCR a neonatos con fiebre sin foco, debido a la normalidad de las pruebas complementarias en la mayoria de los casos. El 64,7% de los niños recibio seguimiento neurologico posterior en consulta de neurologia, sin objetivarse secuelas neurologicas, salvo en uno de ellos. Conclusiones. La PCR multiple en el LCR se ha convertido en una tecnica diagnostica imprescindible en el recien nacido con sospecha de infeccion y sustituye al cultivo viral como prueba de referencia por su mayor rapidez y sensibilidad.

[Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option?]. / Enterocolitis necrotizante y perforaciones intestinales en prematuros de muy bajo peso. Cuá1 es la mejor opción quirúrgica?

Necrotizing enterocolitis (NEC) and isolated intestinal perforation (IP) are common diseases in very low birth weight infants (VLBW) and require surgery in 20-40% of cases. We have performed a retrospective review of VLBW infants with NEC or IP who underwent a surgical procedure between 2000 and 2010, either initial laparotomy (group 1), peritoneal drain placement and subsequent laparotomy (group 2) or peritoneal drainage (group 3). Of 487 VLBW infants admitted to our hospital in the last ten years, 80 patients had NEC or IP, out of these, 31% (n=25) were treated surgically. The study population consisted of 14 girls and 11 boys with a mean gestational age of 26+3 weeks and mean birth weight of 801.4 g (range 460 to 1490 g). Pneumoperitoneum was seen in 48% of cases (n=12). Twelve patients underwent initial laparotomy, 10 patients were treated with peritoneal drainage and subsequent laparotomy and in 3 patients a peritoneal drainage was placed. Mean time between drainage and laparotomy was 69.6 hours. Sixty-eight percent of patients had NEC and thirty-two percent were IP. Survival rate was higher in the group who underwent initial laparotomy (p = 0.001) with an overall mortality of 32% (8 deaths). Optimal surgical procedure must be decided upon clinical condition of individual patients. We consider that initial laparotomy should be the treatment option in VLBW infants with intestinal perforation due to NEC or IP.

Incremento de la incidencia de los derrames pleurales en el Área de Salud de Albacete: Revisión de 12 años / Increase in the incidence of pleural effusion in the Health Care Area of Albacete: A 12 year review

Introducción. En los últimos años se ha constatado un aumento en la incidencia de derrames pleurales (DP) para-neumónicos. El objetivo del estudio es conocer las características epidemiológicas, clínicas y microbiológicas de los derrames, su incidencia y los cambios producidos desde la introducción de la vacuna antineumocócica. Material y métodos. Estudio retrospectivo y descriptivo de pacientes ingresados por DP en el Servicio de Pediatría del Complejo Hospitalario Universitario de Albacete desde enero de 1996 hasta diciembre de 2007. Resultados. Grupo de estudio: 71 pacientes. La incidencia anual de DP ha aumentado desde el año 2000, con una incidencia máxima de 24 caos por 100.000 niños menores de 14 años del Área de Albacete. El 72,4% de los niños no habían recibido la vacuna antineumocócica. Se practicó 23 (32,3%). Se identificó el microorganismo responsable en 19 casos (26,7%). 13 fueron por Neumococo (18,5%). El 57% de los neumococos fueron sensibles a penicilina. 15 casos (21,1%) precisaron tubo de drenaje pleural y un 22,5% (16 casos) toracoscopia. Conclusiones. Desde el año 2000 observamos un aumento de la incidencia global de los DP y de los derrames por Neumococo. Las características clínicas de nuestros pacientes son similares a las descritas en otras publicaciones. La rentabilidad de los cultivos y la resistencia de Neumococo a la penicilina han sido bajas (AU)

Introduction. An increased incidence of parapneumonic pleural effusions has recently been reported. The aim of this study is to identify the epidemiological, clinical and microbiological characteristics of this illness, to determine the impact of the antipneumococcal vaccine and any changes occurred since its introduction. Material and methods. Retrospective analysis of patients hospitalized due to a pleural effusion in the Department of Paediatrics of the Universitary Hospital of Albacete form January 1996 to December 2007. Results. Study group: 71 patients. The anual incidence of pleural effusions has increased since 2000, with a peak incidence of 24 cases per 100,000 children under 14 years old in the Area of Albacete. 72,4% of children had not received the pneumococcal vaccine. Thoracocentesis was performed in 56,3%. 23 cases fulfilled criteria for empyema (32.3%). The involved microorganism was isolated in 19 case (26.7%), 13 were Pneumococcus (18.5%). 57% of Pneumococci were sensitive to Penicilli. 15 children (21.1%) needed a pleural tube, 16 (22.5%) a thoracoscopy. Conclusins. We observed and increase in the overall incidence of pleural effusions since 200, most of them due to Pneumococcus. The clinical features of our patients are similar to others reported in the literature. The sensitivity of microbiological cultures is low as well as the Pneumococcus resitance to penicillin (AU)

Hiperinsuflación pulmonary en un recién nacido / Lung overinflation in a newborn

El enfisema lobar congénito (ELC) es una patología malformativa pulmonar que consiste en la insuflación excesiva de uno o más lóbulos pulmonares. Generalmente, se manifiesta en el período neonatal como distrés respiratorio progresivo con necesidades de oxígeno. A la exploración puede detectarse hipoventilación marcada del lóbulo afecto, por lo que puede confundirse con neumotórax. Es importante conocer esta patología malformativa y saber que la existencia de radiografías iníciales normales no descartan el diagnóstico. Un diagnóstico correcto vita el uso de drenaje pleural, cuya colocación agravaría el compromiso respiratorio que ya presenta el paciente (AU)

Congenital lobar emphysema is a congenital pulmonary malformation due to a excessive insuflation or one or more lungs lobes. Generally, it presented in a newborn as respiratory distress with oxygen necessity. It can be detected as marked hypoventilation of the affected lobe, leading to the mistaken diagnosis of pneumothorax. It´s highly important to know this malformative disease. The fact of having a previous normal X-ray of the patient never rules our the diagnosis. A correct diagnosis would avoid a thoracic drainage with might worsen the respiratory distress (AU)

Síndrome de Walker-Warburg en gemelos de etnia gitana / No disponible

No disponible

Síndrome de Lemierre / Lemierre's syndrome

No disponible

Quilotórax bilateral secundario a fractura vertebral / Bilateral chylothorax secondary to vertebral fracture

No disponible

Artritis por Candida albicans en una lactante con antecedentes de candidiasis sistémica en período neonatal / Candida albicans arthritis in a healthy infant previously treated for systemic candidiasis during the newborn period

La artritis fúngica en pacientes pediátricos es rara y en la mayor parte de las ocasiones es secundaria a una diseminación hematógena concomitante o producida poco tiempo antes. Presentamos un caso de artritis de rodilla por Candida albicans en una lactante sana de tres meses de edad diagnosticada dos meses después de una candidiasis hematógena, en principio, correctamente tratada con anfotericina B. Se revisan los tratamientos de la candidiasis hematógena y de la artritis por Candida (AU)

[Oxygen transport and consumption and oxygen saturation in the right atrium in an experimental model of neonatal septic shock]. / Transporte y consumo de oxígeno y saturación de oxígeno en aurícula derecha en un modelo experimental de shock séptico neonatal.

UNLABELLED: Mixed venous oxygen saturation monitoring is useful to know about the balance of oxygen supply and consumption in patient with shock as well as a form of assessing the effects of different therapeutic maneuvers. Because of newborn peculiarities this measurement is difficult and therefore, the monitoring of the shock state is limited. OBJECTIVES: To investigate the validity of central venous oxygen saturation at right atria as a reflection of mixed venous oxygen saturation in an experimental model of neonatal sepsis. METHODS: In six newborn piglets septic shock was induced by 180 minutes continuous infusion of Group B Streptococcus. Blood samples were obtained from aortic and pulmonary arteries and from right atrium at baseline and at 30-minutes intervals after the bacterial infusion was begun. Changes in arterial pressures, vascular resistances, cardiac index, oxygen delivery and consumption and the oxygen extraction index were also analyzed. RESULTS: Group B Streptococcus infusion induced significant decreases versus baseline situation of both, oxygen delivery and oxygen tissular extraction index, without changes in oxygen consumption, at 30 minutes of bacterial infusion, with a significant correlation between mixed venous and central venous oxygen saturations. Mixed venous oxygen saturation significantly correlates with right atrium oxygen saturation, r2 = 0,88, along all the period of study. CONCLUSIONS: Mixed venous oxygen saturation is a useful measurement of the oxygen delivery and consumption state in the critically ill newborn infant, and central venous oxygen saturation at the right atrium can be a sure, efficient and easy alternative for the neonatal patient.