Variabilidad en la ratio enfermera-paciente en las unidades de cuidados intensivos neonatales y cuidados intermedios / Variability in the nurse-patient ratio in neonatal intensive care units and intermediate care units

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Percentiles de carnitina y acilcarnitinas en muestras de cribado neonatal de prematuros de muy bajo peso / Carnitine and acylcarnitine percentiles in very low birth weight premature newborn screening samples

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Cierre parcial del ductus arterioso intraútero asociado a consumo materno de flavonoides / Partial closure of the intrauterine arteriosus ductus resulting from a maternal consumption of flavonoids

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Corticoides antenatales y prevención del distrés respiratorio del recién nacido prematuro: utilidad de la terapia de rescate / Ante-natal corticosteroids and prevention of respiratory distress in the premature newborn: Usefulness of rescue treatment

Aunque se conoce la efectividad de la corticoterapia materna para la maduración pulmonar fetal en prematuros, no hay seguridad acerca del tiempo en que el tratamiento continúa siendo efectivo. Realizamos un estudio descriptivo y longitudinal, para relacionar el tiempo transcurrido desde la administración de glucocorticoides maternos, y la necesidad o no de surfactante, y a partir de qué punto se debería considerar la repetición de las dosis de corticoides maternos. Se incluyeron 91 prematuros de ≤32 semanas y/o ≤1.500g (límite 34+6 semanas) cuyas madres habían recibido una pauta completa de corticoides. En los pacientes de 27-34+6 semanas, comprobamos que a mayor tiempo transcurrido entre el parto y la administración de corticoides, mayor probabilidad de necesitar tratamiento con surfactante (p=0,027). La curva ROC calculada determinó un punto de corte de 8 días a partir del cual debería valorarse el repetir la dosis de corticoide

The effectiveness of antenatal corticosteroid therapy for foetal lung maturation in pre-term infants is well known, but there is uncertainty about the time that the treatment remains effective. A descriptive, longitudinal study was conducted to determine whether the need for surfactant administration was determined by the time-lapse between corticosteroids administration and delivery, and when repeating the doses of maternal corticosteroids should be considered. A total of 91 premature infants ≤32 weeks and/or ≤1,500 g (limit 34+6 weeks) whose mothers had received a complete course of corticosteroids were included. In patients at 27-34+6 weeks, we found that the longer the time elapsed between delivery and administration of corticosteroids, most likely were the babies to require treatment with surfactant (P=.027). The resulting ROC curve determined an 8-days cut-off after which repeating a dose of corticosteroids should be assessed

Prenatal alcohol exposure and its repercussion on newborns.

BACKGROUND: Alcohol consumption during pregnancy, even when moderate, implies a risk of impaired neurodevelopment, physical impairments and malformations. Its early identification is essential for establishing preventive measures to diminish disabilities among newborns. METHODS: To determine the frequency of consumption of substance use in pregnant women, we have used the techniques of gas chromatography/mass spectrometry and liquid chromatography/tandem mass spectrometry to detect drugs and markers of chronic consumption of alcohol in meconium. We performed a prospective study during a period of 10 months among 110 infants in our hospital, assessing anthropometry, neuromuscular development and determination of toxic substances in urine and meconium. Furthermore, meconium analysis identified fatty acid ethyl esters (FAEEs) and ethyl glucuronide (Etg). We also conducted a survey regarding the obstetric history, toxic habits, and employment status of the mothers. RESULTS: According to early detection markers analyzed in meconium (FAEE >1000 ng/g and/or Etg >50 ng/g meconium), 34.65% of pregnant women consumed alcohol during pregnancy, and 17% were positive for both markers. Within the positive cases, 50% of those exceeding a FAEE's value of 5000 ng/g in meconium had low birth-weight children. Only 5/110 mothers (4.5%) admitted to occasional alcohol consumption during pregnancy. Nobody admitted to frequent intake. The cocaine test was positive in three cases; two of them were positive for alcohol as well. CONCLUSION: As expected, many screening devices do not accurately capture use during pregnancy and supplemental methods such as meconium analysis of biomarkers of chronic alcohol consumption may be warranted.

Utilidad de la distracción mandibular en la secuencia de Pierre Robin en el período neonatal / Usefulness of mandibular distraction in the Pierre Robin sequence in neonates

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Fallo hepático agudo neonatal: presentación de 2 casos y revisión de la bibliografía / Acute neonatal liver failure: two case studies and literature review

El fallo hepático agudo neonatal es una entidad poco frecuente, con una mortalidad muy elevada. La sospecha de fallo hepático ante situaciones de mal estado general y disfunción hepática, hipoglucemia recurrente o persistente y clínica de sepsis es fundamental para establecer un tratamiento precoz y efectivo. Existen pruebas de primera y segunda línea para poder orientar un diagnóstico etiológico, a la vez que se instauran medidas generales que permitan su estabilización, antes de considerar otras medidas terapéuticas, como el trasplante hepático. Presentamos el inicio y la evolución de 2 casos de fallo hepático neonatal diagnosticados de hemocromatosis y linfohistiocitosis hemofagocítica familiar (AU)

Acute neonatal liver failure is a rare entity with a high mortality rate. In order to establish an early and effective treatment, a high index of suspicion in newborns with a poor general condition and hepatic dysfunction, recurrent or persistent hypoglycaemia and signs and symptoms of sepsis, is critical. There are first- and second-line test to establish the aetiology, parallel to the implementation of general stabilization measures, and prior to the consideration of other therapeutic options such as liver transplantation. We present the onset and the outcome of two patients affected from acute neonatal liver failure that were diagnosed of hemochromatosis and hemophagocytic lymphohistiocytosis, respectively (AU)

[Ante-natal corticosteroids and prevention of respiratory distress in the premature newborn: usefulness of rescue treatment]. / Corticoides antenatales y prevención del distrés respiratorio del recién nacido prematuro: utilidad de la terapia de rescate.

The effectiveness of antenatal corticosteroid therapy for foetal lung maturation in pre-term infants is well known, but there is uncertainty about the time that the treatment remains effective. A descriptive, longitudinal study was conducted to determine whether the need for surfactant administration was determined by the time-lapse between corticosteroids administration and delivery, and when repeating the doses of maternal corticosteroids should be considered. A total of 91 premature infants ≤32 weeks and/or ≤1,500 g (limit 34+6 weeks) whose mothers had received a complete course of corticosteroids were included. In patients at 27-34+6 weeks, we found that the longer the time elapsed between delivery and administration of corticosteroids, most likely were the babies to require treatment with surfactant (P=.027). The resulting ROC curve determined an 8-days cut-off after which repeating a dose of corticosteroids should be assessed.

Meduloblastoma congénito gigante de presentación y localización atípicas / Congenital giant medulloblastoma with atypical presentation and location

El meduloblastoma congénito es uno de los tumores intracraneales más frecuentes en la edad pediátrica; sin embargo, su presentación es poco frecuente antes de los 2 meses de vida. Presentamos el caso deun recién nacido con un meduloblastoma congénito gigante, con sintomatología en el periodo neonatal inmediato y de localización atípica. Este tipo de tumor debe ser tenido en consideración al realizar el diagnóstico diferencial de la hidrocefalia congénita (AU)

Congenital medulloblastoma is one of the most frequent pediatric intracranial tumors, however, it is unusual its presentation before the two months of life. We are presenting the case of a new-born infant with a giant congenital medulloblastoma, with symptoms in the immediate neonatal period and atypical location. This kind of tumor must be taken on account when making a differential diagnosis of congenital ventricular hydrocephalus (AU)

¿Mejora el aporte proteico precoz el crecimiento extrauterino en recién nacidos pretérmino de bajo peso? / Does early parenteral protein intake improve extrauterine growth in low birth weight preterms?

Introducción: El retraso de crecimiento postnatal es frecuente en los recién nacidos pretérmino (RNPT) de bajo peso. La administración precoz de proteínas en su nutrición parece mejorar el crecimiento extrauterino y las comorbilidades asociadas. Evaluamos el impacto sobre el crecimiento posnatal de un nuevo protocolo de nutrición parenteral con aporte precoz de aminoácidos en recién nacidos < 1.500g. Material y métodos: Estudio observacional de casos-controles sobre una muestra de 58 RNPT < 1.500g. El grupo de casos lo formaron 29 RNPT que recibieron al menos 1,5g/kg/día de aminoácidos vía parenteral en las primeras 24h de vida, con aumentos diarios hasta alcanzar al menos 3,5g/kg/día al 3.°-4.° día, comparándose con un grupo control de 29 RNPT en los que el aporte de aminoácidos se inició el 2.°-3.° día de vida a 1g/kg/día, con incrementos menores diariamente. Valoramos la evolución somatométrica de ambos en el primer mes de vida. Resultados: No había diferencias en las características basales (sexo, edad gestacional, parámetros somatométricos) entre ambos grupos. Los RNPT que recibieron proteínas a dosis mayores y más precozmente tuvieron una ganancia de peso significativamente mayor que el grupo control (423±138g vs. 315±142g; p=0,005), presentando también una mayor velocidad de ganancia ponderal diaria (19,4±3,3 vs. 16,5±4,8; p=0,010) y una recuperación más precoz del peso al nacimiento (11,5±3,3 días vs. 14,5±4,5 días; p=0,045). No se observó mayor incidencia de complicaciones. Conclusiones: El aporte precoz de aminoácidos a dosis más altas mejora la ganancia ponderal en RNPT sin observarse un riesgo añadido para el paciente(AU)

Introduction: Extrauterine growth restriction affects most premature newborns. Early and higher parenteral protein intake seems to improve postnatal growth and associated comorbidities. We evaluate the impact of a new parenteral nutrition protocol based on early amino acid administration on postnatal growth in premature infants with a birth weight < 1,500 grams. Material and methods: A case-control study in 58 premature newborns with a birth weight < 1,500 grams. In the case group we included 29 preterm neonates who received at least 1.5g/kg/day parenteral amino acid during the first 24hours after birth, reaching a maximum dose of 3.5g/kg/day on the 3rd-4th day after birth. The control group was formed by 29 preterm neonates for whom protein support began on the 2nd-3rd day after birth with a dose of 1g/kg/day with lower daily increases than the case group. Growth rates and complications were followed until 28 days of life or discharge from NICU. Results: There were no differences between groups in baseline characteristics. Premature newborns who received higher and earlier doses of proteins had a greater weight gain than the control group, and this difference was statistically significant (423±138g vs. 315±142g; P=.005). In addition, they had a higher daily weight gain rate (19.4±3.3 vs. 16.5±4.8; P=.010) and they regained birth weight earlier (11.5±3.3 days vs. 14.5±4.5 days; P=.045). A higher incidence of complications was not observed. Conclusions: Early and higher amino acid administration improves growth rate in premature neonates with no apparent increase in risks for the patient(AU)

Trombosis intracardiaca neonatal ligada a catéter: utilidad del activador tisular del plasminógeno recombinante / Neonatal intracardiac thrombosis related to catheter: use of recombinat tissue plasminogen activator

La utilización de catéteres venosos centrales en las unidades de cuidados intensivos neonatales es una práctica habitual no exenta de complicaciones. Dentro de dichas complicaciones, las más frecuentes son las de tipo infeccioso, aunque no podemos desdeñar las de tipo mecánico y trombótico. La incidencia de trombosis ligada al catéter es variable, y la actitud que cabe tomar ante dicho cuadro sigue siendo controvertida en el periodo neonatal. Presentamos el caso de un recién nacido a término que, debido a su patología de base, precisó un acceso venoso central mediante canalización umbilical. Al tercer día de vida se detectó por ecocardiografía la existencia de un trombointra auricular derecho, que se resolvió mediante tratamiento fibrinolítico local con activador tisular del plasminógeno recombinante, administrado a través de catéter silástico central, sin observarse complicaciones mayores(AU)

The use of central venous catheters in the intensive neonatal care units is a common practice not without complications, being infections its most common type, although mechanic and thrombotic ones are also common. The incidence of thrombosis related to catheter varies, and the attitude in the neonatal period remains controversial. We are discussing a case of a term new born suffering from a previous pathology, and central venous access via umbilical pipe was required. On its third day of life, the newborn was detected a right a trial thrombus by means of echocardiography, that was resolved with local thrombolytic therapy with r TPA, administered through central silastic catheter with no further complications observed(AU)

Long-term pharmacological management of phenylketonuria, including patients below the age of 4 years.

BH4 therapy is an advancement in the treatment of phenylketonuria, reducing blood phenylalanine (phe) levels and increasing tolerance to natural proteins of responding patients. We report the results of 16 patients undergoing long-term BH4 treatment. Responding patients to BH4 was usually based on 24-h loading tests; a ≥30% decrease in blood phe was considered a positive response. Weekly loading made it possible to identify an additional "slow responder." The 16 responders constitute 24.6% of patients who completed the trial (87.5% of responders in mild hyperphenylalaninemia, 38.1% in mild PKU, and 2.8% in classical PKU).Mean dose of BH4 used was 9.75 ± 0.9 mg/kg per day, during a mean of 62 months. Age at treatment start was below 4 years in seven patients; five of which begun treatment during their first month since birth. All but one patient showed good treatment compliance; six continue on BH4 monotherapy without dietary phe restriction; six showed an increase in phe tolerance of 24-55%; and in the five patients who received treatment since the neonatal period an increase in phe tolerance following the phase of maximum growth has persisted. None of the patients showed side effects except one whom vomiting at the beginning of the treatment.Testing at the time of diagnosis in the neonatal period is very appropriate, and if there is a positive response, the patient can be treated with BH4 from onset with the advantage of being able to continue breast-feeding.