Prediction of retinopathy of prematurity using the screening algorithm WINROP in a Mexican population of preterm infants.

OBJECTIVE: To retrospectively validate the WINROP (weight, insulin-like growth factor I, neonatal, retinopathy of prematurity [ROP]) algorithm in identification of type 1 ROP in a Mexican population of preterm infants. METHODS: In infants admitted to the neonatal intensive care unit at Hospital Civil de Guadalajara from 2005 to 2010, weight measurements had been recorded once weekly for 192 very preterm infants (gestational age [GA] <32 weeks) and for 160 moderately preterm infants (GA ≥32 weeks). Repeated eye examinations had been performed and maximal ROP stage had been recorded. Data are part of a case-control database for severe ROP risk factors. RESULTS: Type 1 ROP was found in 51.0% of very preterm and 35.6% of moderately preterm infants. The WINROP algorithm correctly identified type 1 ROP in 84.7% of very preterm infants but in only 5.3% of moderately preterm infants. For infants with GA less than 32 weeks, the specificity was 26.6%, and for those with GA 32 weeks or more, it was 88.3%. CONCLUSIONS: In this Mexican population of preterm infants, WINROP detected type 1 ROP early in 84.7% of very preterm infants and correctly identified 26.6% of infants who did not develop type 1 ROP. Uncertainties in dating of pregnancies and differences in postnatal conditions may be factors explaining the different outcomes of WINROP in this population.

[Risk factors associated to neonatal cross-infection]. / Factores de riesgo asociados a sepsis neonatal nosocomial.

BACKGROUND: Late-onset sepsis (occurring after 3 days of age) either cross-infection (CI) or perinatal is the first cause of morbidity and mortality in neonatal intensive care units (NICU) around the world. Our objective was to determine the current incidence of CI risk factors in neonates admitted to the NICU of the Hospital Civil de Guadalajara during a 9-month period. METHODS: A case-control study with 114 newborns; 38 with CI and 76 controls. Odds ratio with 95 % confidence interval were calculated. RESULTS: Associated risk factors were total parenteral nutrition (OR = 16.54, CI = 6.30-43.39, p < 0.001); weight < 1000 g (OR = 7.33, CI = 2.15-25.01, p < 0.001); intravascular catheter (OR = 6.79, CI = 2.68-17.00, p < 0.001); gestational age < 30 weeks (OR = 4.54, CI = 1.61-12.81, p < 0.003); intratracheal intubation and mechanical ventilation with (OR = 6.98, CI = 2.94-16.5, p < 0.001). CONCLUSIONS: Total parenteral nutrition and weight < 1000 g showed the greatest association with cross-infection; in this study, male gender was not a risk factor.

[Hyaline membrane disease: mortality and maternal and neonatal risk factors]. / Enfermedad de membrana hialina: mortalidad y factores de riesgo maternos y neonatales.

OBJECTIVE: To identify maternal and neonatal risk factors associated with hyaline membrane disease and its mortality. PATIENTS AND METHOD: A case-control study with 41 newborns with hyaline membrane disease and 123 controls was made between September 2001 and February 2002 in the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. The diagnosis of hyaline membrane disease was done with clinical and radiographic data. Maternal risk factors were obtained by direct interview with the mother; the newborn data were obtained of the clinical files. The association was measured with the odds ratios (OR) and the confidence interval of 95%. RESULTS: The frequency of hyaline membrane disease was of 6.8 per 1,000 live births. Mortality rate was of 2.8 per 1,000 live births. There were 17 deaths (41%). The risk factors associated with hyaline membrane were: illness during the first and second trimester of pregnancy, (OR: 3.28 [1.16-9.31]; OR: 8.88 [3.56-22.50], respectively), Apgar score lower than seven at the first minute (OR: 18.57 [4.50-88.67]), and masculine gender (OR: 2.58 [1.15-5.83]). CONCLUSIONS: Frequency and mortality were similar to the reported by other studies made in population samples. The exposure to illnesses during pregnancy and the low Apgar score were associated with the increased frequency of hyaline membrane disease.

[Transient tachypnea of the newborn, obstetric and neonatal risk factors]. / Taquipnea transitoria del recién nacido, factores de riesgo obstétricos y neonatales.

OBJECTIVE: To identify the obstetrics and neonatal risk factors associated with transient tachypnea of the newborn. PATIENTS AND METHODS: Case-control study of 110 neonates with transient tachypnea and 110 newborns controls, between May and October 2000, in the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. The diagnosis of transient tachypnea was done by clinical and radiology data and exclusion of the other causes of respiratory distress. The exposure was documented by a direct interview to the mother and clinical information of the clinical expedient. The association was measured with the odds ratios and confidence interval of 95%. RESULTS: The frequency of transient tachypnea was of 2 percent newborn alive. The risk factors that were associated with transient tachypnea was: low Apgar score at minute (OR: 33.74, CI 95%: 4.73-681.52), premature rupture of amniotic membranes (OR: 3.65, CI 95%: 1.53-8.90), cesarean section (OR: 2.01, CI 95%: 1.14-3.57) and masculine gender (OR: 2.02, CI 95%: 1.14-3.60). It was more frequent in the cases the antecedent of diabetes mellitus and bronchial asthma. CONCLUSIONS: The results suggest that it's necessary to improve the obstetrics surveillance to diminish the frequency of low Apgar score and risk factors associated with transient tachypnea of the newborn.

Etiología de sepsis neonatal y sensibilidad a los antibióticos en el Nuevo Hospital Civil de Guadalajara / Ethiology of neonatal sepsis and sensitivity to antibiotics in the New Civil Hospital of Guadalajara

Objetivo: Identificar las bacterias causantes de sepsis neonatal y sus patrones de sensibilidad a diversos antibióticos en el Nuevo Hospital Civil de Guadalajara. Material y métodos: El estudio se realizó en la unidad de cuidados intensivos neonatales de un hospital de segundo nivel de atención en guadalajara, Jalisco, México. Se analizaron 74 neonatos con sospecha clínica y/o paraclínica de sepsis, bajo un diseño prospectivo, transversal, observacional y comparativo. Se consideró como infectados a los neonatos que en dos hemocultivos tomados de sitios diferentes de venopunción, tuvieron el mismo aislamiento. Los antibiogramas se realizaron por el método de kirby-Bauer, con los puntos recomendados por la NCCLS. Resultados: Hubo 41 (55.4 por ciento) pacientes con hemocultivos positivos. De los aislamientos, 30 (73 por ciento) correspondieron a K. pneumoniae y 8 (19 por ciento) a S. epidermidis. Todas las cepas de K. pneumoniae fueron resistentes a ampicilina, pero 93 por ciento fueron sensibles a los aminoglucósidos y las cefalosporinas de tercera generación probados. Todas las cepas de estafilococos fueron sensibles a vancomicina y sólo dos fueron resistentes a dicloxacilina. Conclusiones: El 98 por ciento de las cepas de K. pneumoniae presentó el mismo patrón de sensibilidad a los antibióticos, lo que sugiere una transmisión horizontal intrahospitalaria. La gran mayoría de los aislamientos fueron sensibles a los antimicrobianos de uso común, por lo que sugerimos que el tratamiento empírico inicial debe incluir a aminoglucósidos como gentamicina o amikacina, asociados a dicloxacilina o en casos específicos vancomicina y dejar como alternativa el uso de cefalosporinas de tercera generación.

Ictiosis vulgar congénita en una paciente con trisomía 18 / Congenital ichthyosis vulgaris in a patient with trisomy 18

Introducción. Presentamos una recién nacida con trisomía 18 que presentó además ictiosis vulgar de inusual inicio congénito. Caso Clínico. La propósita nació de embarazo de pretérmino, con bajo peso; tuvo exposición prenatal a fármacos anestésicos, analgésicos, antibióticos y antiácidos. Presentó dificultad para la alimentación, además de dismorfia craneofacial, cardiopatía congénita, anomalías contracturales, de genitales y dermatoglíficas. El estudio cromosómico resultó con un complemento 47,XIX, + 18. En las extremidades inferiores, sobre las superficies extensoras, mostró dermatosis compatible con ictiosis vulgar en el estudio clínico e histopatológico. Falleció a los 37 días de vida por múltiples fallas orgánicas. Conclusión. A la trisomía 18 regular la relacionamos con edad materna avanzada. A la ictiosis la consideramos una mutación fresca autosómica dominante. Incluimos el diagnóstico diferencial de la ictiosis vulgar autosómica dominante y ligada al cromosoma X. La confluencia de ambos eventos en una misma paciente (P= 1:2'000,000) constituye una nueva asociación no descrita previamente