Hipotonía neonatal: ¿entraña un diagnóstico difícil? / Neonatal hypotonia: is it a diagnostic challenge?

Introducción. La hipotonía constituye un signo habitual de enfermedad en el neonato. Ahora bien, se trata de un signo inespecífico: puede ser la manifestación inicial de una enfermedad neurológica o multisistémica. Objetivos. Estudiar las principales causas de la hipotonía neonatal y evaluar la exactitud diagnóstica de la anamnesis y la exploración física en el neonato hipotónico. Pacientes y métodos. Estudio retrospectivo de 22 años con recién nacidos afectados por hipotonía e ingresados en la unidad de cuidados intensivos neonatales. A partir de la anamnesis y de los datos recabados durante la exploración física, se hizo una clasificación inicial en condiciones de enmascaramiento del tipo de hipotonía: central, periférica o indeterminada. Resultados. El número de pacientes estudiados ascendió a 91. De ellos, 42 (46,2%) presentaban antecedentes de alteraciones prenatales: polihidramnios (28,6%), retraso del crecimiento intrauterino (21,4%) y presentación de nalgas (19%). Cincuenta y tres (58,2%) habían precisado reanimación al nacer. Los principales síntomas asociados consistieron en disnea (65,9%), dificultades de alimentación (36,5%) y escasez de movimientos espontáneos (22,4%). El diagnóstico definitivo se obtuvo en 64 neonatos (70,3%): el 81,3% mostraba hipotonía central, y el 18,7%, hipotonía periférica. El valor predictivo positivo de la clasificación inicial alcanzó el 97,9% en la hipotonía central y el 66,7% en la hipotonía periférica. La tasa de mortalidad fue del 8,8%, y resultó superior en el grupo de hipotonía periférica (58,3% frente a 1,3%). Conclusiones. La hipotonía neonatal aparece vinculada con una larga lista de trastornos. Una anamnesis minuciosa y una valoración neurológica cuidadosa brindan un alto valor predictivo diagnóstico que debe orientar el estudio etiológico

Introduction. Hypotonia is a frequent sign of disease in newborns. However, it's a nonspecific clinical finding: may be the presentation form of a systemic or neurological disease. Aims. To study the main causes of neonatal hypotonia as well as to evaluate the diagnostic accuracy of the anamnesis and physical examination of the hypotonic newborn. Patients and methods. A 22-year retrospective study of hypotonic neonates admitted to the Neonatal Intensive Care Unit was conducted. It was performed an initial blind classification of hypotonia’s type (central-CH, peripheral-PH or undetermined hypotonia) based on the clinical history and the recorded data of physical examination. Results. 91 infants were included. 42 (46.2%) had prenatal history abnormalities: polyhydramnios (28.6%), intrauterine growth restriction (21.4%) and pelvic presentation (19.0%). 53 (58.2%) required resuscitation at birth. The main associated symptoms were respiratory distress (65.9%), feeding difficulties (36.5%) and decreased spontaneous movements (22.4%). The final diagnosis was reached in 64 newborns (70.3%): 81.3% with CH, 18.7% with PH. The positive predictive value of the initial classification was 97.9% in CH and 66.7% in PH group. The mortality rate was 8.8% and it was higher in PH group (58.3% vs 1.3%). Conclusions. Neonatal hypotonia can be associated to an extensive list of disorders. A detailed clinical history associated to a careful neurological evaluation present a high diagnostic predictive value that should guide the etiological investigation

Syphilis in Pregnancy and Congenital Syphilis: Reality in a Portuguese Central University Hospital.

Purpose To evaluate maternal-fetal surveillance and follow-up of infants at risk for congenital syphilis (CS). Methods Retrospective cohort study in a Portuguese Tertiary Referral Hospital. The main inclusion criterion was a positive syphilis serology. The study included all pregnant women that delivered in our hospital between January 2004 and December 2013. The neonates were classified according to their probability of infection based on the Centers for Disease Control and Prevention guidelines. Results Among the 27 pregnancies at risk for CS, 48.2% (n = 13) of the women had a diagnosis during the 1st trimester, and the median gestational age at the end of the treatment was 28 weeks. Inadequate treatment was noted in 44.4% (n = 12) of the women. Adverse pregnancy outcomes were observed in 30.8% of the cases (n = 8), 5 of which had been adequately treated. We found 2 (7.7%) cases with "proven or highly probable CS," 10 (38.5%) with "possible CS," 12 (46.1%) with "less likely CS," and 2 (7.7%) with "unlikely CS." Among the infants, the treatment was successful, except for 1 neurosyphilis case. Conclusion This study highlights many of the difficulties/concerns encountered in the maternal-neonatal management of syphilis. We highlight the importance of assuring the early detection of the infection as a way of guaranteeing the timely treatment, as well as a good compliance to the treatment and follow-up through a more efficient pregnant women surveillance network.

Objetivo Avaliar a vigilância materno-fetal e o acompanhamento de crianças em risco de sífilis congênita (SC). Métodos Estudo de coorte retrospetivo desenvolvido num hospital terciário de referência, cujo principal critério de inclusão foi a presença de serologia positiva para sífilis. O estudo incluiu todas as grávidas admitidas no nosso Hospital entre janeiro de 2004 e dezembro de 2013. Os recém-nascidos foram classificados de acordo com a probabilidade de infeção, com base nas recomendações do Centers for Disease Control and Prevention. Resultados Entre as 27 gravidezes em risco de SC, 48,2% (n = 13) tiveram diagnóstico durante o 1° trimestre; a idade gestacional média no final do tratamento foi de 28 semanas. Em 44,4% (n = 12) das mulheres, o tratamento foi considerado inadequado. Em 30,8% dos casos (n = 8) houve algum evento adverso da gravidez, dos quais 5 foram adequadamente tratados. Em dois dos casos (7,7%) a SC foi provada ou considerada como altamente provável, 10 (38,5%) com SC provável, 12 (46,1%) com SC pouco provável, e 2 (7,7%) com SC improvável. Nos lactentes, o tratamento foi bem sucedido, com exceção de um caso de neurossífilis. Conclusão Este estudo visa realçar muitas das dificuldades/preocupações encontradas na vigilância materno-neonatal dos casos com diagnóstico de sífilis. ublinhamos, não só, a importância de se assegurar a deteção precoce de infeção como forma de se garantir o tratamento atempado, mas também, uma adequada adesão à vigilância/tratamento, através de uma rede mais eficiente entre as diferentes instituições envolvidas no acompanhamento das grávidas.

Syphilis in Pregnancy and Congenital Syphilis: Reality in a Portuguese Central University Hospital / Sífilis na gravidez e sífilis congênita: realidade de um hospital universitário central português

Abstract Purpose To evaluate maternal-fetal surveillance and follow-up of infants at risk for congenital syphilis (CS). Methods Retrospective cohort study in a Portuguese Tertiary Referral Hospital. The main inclusion criterion was a positive syphilis serology. The study included all pregnant women that delivered in our hospital between January 2004 and December 2013. The neonates were classified according to their probability of infection based on the Centers for Disease Control and Prevention guidelines. Results Among the 27 pregnancies at risk for CS, 48.2% (n = 13) of the women had a diagnosis during the 1st trimester, and the median gestational age at the end of the treatment was 28 weeks. Inadequate treatment was noted in 44.4% (n = 12) of the women. Adverse pregnancy outcomes were observed in 30.8% of the cases (n = 8), 5 of which had been adequately treated. We found 2 (7.7%) cases with "proven or highly probable CS," 10 (38.5%) with "possible CS," 12 (46.1%) with "less likely CS," and 2 (7.7%) with "unlikely CS."Among the infants, the treatment was successful, except for 1 neurosyphilis case. Conclusion This study highlights many of the difficulties/concerns encountered in the maternal-neonatal management of syphilis. We highlight the importance of assuring the early detection of the infection as a way of guaranteeing the timely treatment, as well as a good compliance to the treatment and follow-up through a more efficient pregnant women surveillance network.

Resumo Objetivo Avaliar a vigilância materno-fetal e o acompanhamento de crianças em risco de sífilis congênita (SC). Métodos Estudo de coorte retrospetivo desenvolvido num hospital terciário de referência, cujo principal critério de inclusão foi a presença de serologia positiva para sífilis. O estudo incluiu todas as grávidas admitidas no nosso Hospital entre janeiro de 2004 e dezembro de 2013. Os recém-nascidos foram classificados de acordo com a probabilidade de infeção, com base nas recomendações do Centers for Disease Control and Prevention. Resultados Entre as 27 gravidezes em risco de SC, 48,2% (n = 13) tiveram diagnóstico durante o 1° trimestre; a idade gestacional média no final do tratamento foi de 28 semanas. Em 44,4% (n = 12) das mulheres, o tratamento foi considerado inadequado. Em 30,8% dos casos (n = 8) houve algum evento adverso da gravidez, dos quais 5 foram adequadamente tratados. Em dois dos casos (7,7%) a SC foi provada ou considerada como altamente provável, 10 (38,5%) com SC provável, 12 (46,1%) com SC pouco provável, e 2 (7,7%) com SC improvável. Nos lactentes, o tratamento foi bem sucedido, com exceção de um caso de neurossífilis. Conclusão Este estudo visa realçar muitas das dificuldades/preocupações encontradas na vigilância materno-neonatal dos casos com diagnóstico de sífilis. ublinhamos, não só, a importância de se assegurar a deteção precoce de infeção como forma de se garantir o tratamento atempado, mas também, uma adequada adesão à vigilância/ tratamento, através de uma rede mais eficiente entre as diferentes instituições envolvidas no acompanhamento das grávidas.

Isolated suppurative submandibular sialadenitis in a preterm neonate.

Neonatal isolated suppurative submandibular sialadenitis (NISSS) is rare, with only 21 cases described in the English literature. All cases, with the exception of one, were caused by Staphylococcus aureus. In this case report, we describe a preterm neonate with NISSS due to infection by S aureus and Klebsiella pneumonia presenting on day 11 of life with submandibular swelling and low-grade fever. Possible contributors for the development of the infection include prematurity, neutropenia, prolonged orogastric feed and bacterial virulence. Antibiotic treatment was effective. To the best of our knowledge, this is the first case report of NISSS caused by a mixed flora.