Predicting the optimal depth of ultrasound-guided right internal jugular vein central venous catheters in neonates.

BACKGROUND: Poor positioning of a central venous catheter (CVC) can cause severe complications. The objective is to create a formula that predicts the optimal insertion depth of a real time ultrasound-guided CVC in the right internal jugular vein (RIJV) in newborns. METHODS: Between 2015 and 2017, 91 newborns that required a CVC were included in a prospective observational study. Variables such as gestational age, gender, weight, height, and neck length were studied. On the chest x-ray, the distance between the insertion site on the skin and the catheter tip was measured. RESULTS: Of the patients included, 50 (54.9%) were males and 40 (44.4%) females; 64 (70.3%) were preterm. Mean gestational age was 33.44 (25 to 41) weeks, weight 2020 (580 to 3980) g, and height 43.04 (26 to 53) cm. Variables were correlated with catheter length and an algorithm was modeled for the introduction method, in which the highest corrected determination coefficient was obtained for weight (R2 = 0.723). CONCLUSION: This study demonstrated that the weight of the newborn was the most significant individual predictor of optimal insertion depth of a CVC in the RIJV. The formula Y = 2.6 + 0.7 (weight in kg) that we suggest is practical and reproducible. LEVEL OF EVIDENCE: Level IV.

Differences in omentin-1 levels in term newborns according to birth weight.

BACKGROUND: Adipokines are produced by adipose tissue and are involved in metabolic processes. Omentin-1 is an adipokine that has been shown in vitro to possibly be involved in insulin sensitivity modulation. The prenatal stage is a crucial period for development of metabolic diseases in the long term, therefore, small (SGA) and large (LGA) for gestational age newborns have an increased risk of type 2 diabetes and metabolic syndrome later in life. AIMS: To evaluate the differences in omentin-1 concentrations in umbilical cord blood from healthy term newborns according to birth weight and explore the association between omentin-1 and anthropometry, glucose, insulin and insulin sensitivity. STUDY DESIGN: This was a secondary analysis of stored umbilical cord blood of term newborns. SUBJECTS: Newborns classified according to birth weight as SGA (n = 30), adequate for gestational age (AGA) (n = 12) and LGA (n = 34). OUTCOME MEASURES: An analysis of omentin-1, glucose and insulin were performed. RESULTS: Differences were found in serum omentin-1 levels (ng/mL) between SGA 328.17 ±â€¯108.04, AGA 253.05 ±â€¯98.25 and LGA 250.91 ±â€¯100.48 (p = 0.009). In the linear regression analysis, the independent variables HOMA-IR, QUICK-I and FGIR were predictors of serum omentin-1 levels (r = 0.175, p = 0.003). CONCLUSIONS: Omentin-1 cord blood levels have a differentiated behavior according to weight for gestational age with LGA newborns having lower levels and SGA newborns higher levels. HOMA-IR, QUICK-I and FGIR weakly predicted omentin-1 in cord blood, suggesting that omentin-1 possibly has an implication in insulin sensitivity since birth.

Vitamin D deficiency in Mexican mothers and their newborns. / Deficiencia de vitamina D en madres y neonatos mexicanos.

Objective: The purpose of this study is to establish the prevalence of vitamin D deficiency and their newborns and analyze the risk factors related to this deficiency. Methods: This is an observational, transversal, and prospective study. It included 191 puerperal women and their full-term newborns. Serum 25 hydroxyvitamin D values were analyzes by enzyme immunoassay. Results: 61% of the puerperal presented deficiency and 26% insufficiency of vitamin D. In the newborn group 98% showed deficiency and 66% of them presented severe deficiency. There is a positive correlation between the values of vitamin D in mothers and their newborns (r2 = 0.173 ng/ml; p = 0.017). The lowest levels were in autumn. (15.75 ng/mL mothers, 6 ng/mL newborns). There was no correlation between vitamin D levels in mothers and their dietary intake, maternal skin type, sun time exposure and prenatal body mass index. Conclusions: This is the first study that shows the existence of a high deficiency of vitamin D in Mexican mothers and their newborns.

Congenital lateral abdominal wall hernia.

Congenital abdominal wall defects that are located outside of the anterior wall are extremely rare and difficult to classify because there are no well accepted guidelines. There are two regions outside of the anterior wall: the flank or lateral wall; and the lumbar region. We report the case of a patient with an oval 3 cm-diameter hernia defect located above the anterior axillary line, which affects all layers of the muscular wall. An anorectal malformation consisting of a recto-vestibular fistula was also identified, and chest X-ray showed dextrocardia. The suggested treatment is repair of the defect before 1 year of age. Given that the anomalies described may accompany lateral abdominal wall hernia, it is important to diagnose and treat the associated defects.

Efficacy and safety of ultrasound-guided internal jugular vein catheterization in low birth weight newborn.

BACKGROUND: Central venous catheterization is not the first choice of vascular access in neonates. Success depends on the size of the vessel and the skill of the health professional performing the procedure. The internal jugular vein provides a predictable path for central venous cannulation, although it is more difficult to cannulate infants than adults and even more difficult in smaller newborns. METHODS: We conducted a prospective study in 100 newborns, in which a 4 Fr ultrasound-guided central venous catheter was placed in the right internal jugular vein (RIJV). The study population was low birth weight (LBW) newborns <2500g, very low birth weight (VLBW) newborns <1500g and extremely low birth weight (ELBW) newborns <1000g. RESULTS: There were 53% female patients, mean gestational age was 31weeks, mean weight 1352g and the CVC was placed at a mean of 12days of extrauterine life. Birth weight distribution was 39% LBW; 33% VLBW and 28% ELBW. A mean of two (1-8) attempts were necessary with a procedure duration of 16.8 (10-40) minutes. Success of RIJV catheterization was 94%. One attempt was necessary in 50% and up to 5 attempts in 95.7%. Success by weight was VLBW, 97.2%; ELBW, 92.9%; LBW, 91.7%. A venous hematoma occurred in 5% of cases. CONCLUSIONS: Ultrasound-guided RIJV cannulation with real-time visualization to gain access to the central venous circulation in low birth weight newborns is effective and safe.

Adding Multiple Adipokines into the Model do not Improve Weight Gain Prediction by Leptin Levels in Newborns.

OBJECTIVE: Most adipose tissue programming is realized in early life. Also, the postnatal three months, rather than the later phases of infancy, may be more relevant in the development of an adverse cardiometabolic risk profile. The adipokines phenotype, as a predictor of early-life weight gain, has been recently explored in cord blood. To determine whether in addition to leptin levels in cord samples, adiponectin, interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), resistin, plasminogen activator inhibitor-1 (PAI-1), and tumor necrosis factor alpha (TNF-α) levels improve weight gain prediction during the first three months of life. METHODS: Adiponectin, IL-6, MCP-1, leptin, resistin, PAI-1, and TNF-α were measured by multiplex immunoassay in a subsample of 86 healthy term newborns. RESULTS: Leptin levels significantly predicted weight gain at 3 months of follow-up (r2=0.09, p=0.006). In the multivariate analysis, including additional adipokines in the model, stepwise or all at once, did not increase the prediction of weight gain after the first three months of life. CONCLUSION: Adding adiponectin, IL-6, MCP-1, resistin, PAI-1, and TNF-α to the prediction model of weight gain in healthy newborns did not prove to be useful. It is probable that their relative contribution to weight gain is not important. Only leptin was relevant as a predictor of weight gain at the 3-month endpoint.

Leptin, IL-6 and TNF-α levels in umbilical cord blood of healthy term newborns in relation to mode of delivery.

In the development of the foetal immune system, cytokines play an important role in its function. Therefore, we sought to determine whether the mode of delivery affects the expression of leptin, IL-6 and TNF-α in umbilical cord blood in healthy term newborns. We collected 125 samples of umbilical cord blood to analyse leptin, IL-6 y TNF-α levels with multiplex immunoassay (MIA). The samples were classified according to mode of delivery: vaginal delivery (VD) and caesarean section (CS). Leptin and IL-6 had higher concentrations in umbilical cord blood in VD than in CS: 42.55 ng/ml (11.92-104.28) versus 35.20 ng/ml (3.26-9326.76), p = 0.039; 9.32 pg/ml (1.13-2020.31) versus 3.81 pg/ml (0.52-834.69) p < 0.001, respectively. Also, a weak correlation between TNF-α and IL-6 was found (r = 0.238, p = 0.007). The most important finding in our study was the differential concentrations of leptin and IL-6 according to mode of delivery.

[Evaluation of strategies aimed at reducing the level of noise in different areas of neonatal care in a tertiary hospital]. / Evaluación de las estrategias enfocadas a disminuir el nivel de ruido en las diferentes áreas de atención neonatal en un hospital de tercer nivel.

OBJECTIVE: To determine the noise levels of different areas responsible for newborn care, develop intervention strategies to decrease the noise, and evaluate its effectiveness. METHODS: Prospective, observational and longitudinal study carried out using a sonometer, measuring sound levels for three weeks in the neonatal intensive care unit (NICU), neonatal intermediate care unit (UCIREN), delivery (TOCO QX) and nursery (CUNERO) units. We implemented an intervention program and subsequent measurements were performed under the same initial conditions. RESULTS: When comparing the decibel levels in different areas during the three weeks, pre- and post-intervention, we found at the neonatal intensive care unit 59.9±4.8 vs. 56.4±4.7 dB (p<0.001), neonatal intermediate care unit 55.3±3.9 vs. 51.3±4.4 dB (p<0.001), delivery unit 57.3±4.6 vs. 57.3±5.5 dB (NS), and nursery unit 57.6±5.8 vs. 53.9±5.8 dB (p<0.001). CONCLUSIONS: There was a significant reduction in noise levels of 3.5 dB at the NICU, 4 dB at UCIREN and 3.7 dB at TOCO QX, so the intervention program was effective in these areas; however, the decibel levels registered continue above those recommended by international standards.

A new positive-pressure device for nasal foreign body removal.

OBJECTIVES: Nasal foreign bodies (FBs) are common causes of pediatric emergency consultations. The different methods for removing nasal FBs have varying levels of efficacy. The aim of this study was to evaluate the safety and efficacy of a new device for nasal FB removal in children. METHODS: A nasal occlusion device that uses modulated positive pressure to remove FBs was evaluated in a series of 18 patients ranging in age from 1 to 8 years diagnosed with a nasal FB during a period of 7 months. RESULTS: The device successfully removed FBs in 17 (94.4%) of the 18 patients. In 12 of the cases (66.7%), the FB was removed during the first attempt. None of the patients had complications or sequelae at the time of removal or at the follow-up visit. CONCLUSIONS: The nasal occlusion device used in this study was found to be a promising, safe, effective, and easy to use tool for FB removal in a pediatric emergency room setting.

Vascular assessment of the right internal jugular vein in low birth weight newborns.

OBJECTIVE: To determine the dimensions and depth of the right internal jugular vein (RIJV) in low birth weight newborns by ultrasound and assess the differences in weight and determine the relationship of the vein with the carotid artery. METHOD: We performed a vascular assessment of the RIJV in 100 low birth weight newborns. The subjects were divided into three groups, low birth weight (LBW) newborns, <2500 g; very low birth weight (VLBW) newborns, <1500 g; and extremely low birth weight (ELBW) newborns <1000 g. RESULTS: Of the newborns, 39% had LBW, 33% had VLBW, and 28% had ELBW. The medians were gestational age 31 weeks, weight 1300 g, anteroposterior diameter of the RIJV 2.2 mm, and the distance from the skin-RIJV 3.6 mm. In LBW newborns, the median anteroposterior diameter of RIJV was 2.7 mm; in LBW newborns 2.2; in ELBW newborns 1.9 (p < 0.001); the median distance from skin to RIJV for LBW newborns was 4.1 mm; for VLBW newborns, 3.6 and for ELBW newborns 2.9 (p < 0.01); differences that were statistically significant. CONCLUSIONS: In low birth weight newborns, the diameter and depth of the RIJV is directly proportional to the weight of the subjects studied.

[Risk factors associated with intrauterine growth restriction in newborns attended in a university hospital]. / Crecimiento intrauterino. (corrected) Factores para su restricción.

BACKGROUND: intrauterine growth restriction (IUGR) is related with neonatal morbidity and mortality. The detection and prenatal monitoring are necessary for an early intervention. The objective was to establish the prevalence and risk factors associated with intrauterine growth restriction in the university hospital Dr. José Eleuterio González. METHODS: we performed an observational, cross-sectional study, during the period from May 2009 to April 2010. The sample was divided into two groups, asymmetrical and symmetrical IUGR. RESULTS: the global prevalence of IUGR was 13.5 %. We included 464 patients, 324 (70 %) with asymmetric IUGR and 140 (30 %) with symmetric IUGR. The maternal variables were not statistically significant (p = ns) between groups. We found a mean weight at birth higher (2548 ± 437.33) in the symmetric IUGR group (p < 0.01), as well as a higher vaginal delivery rate (p < 0.05) as compared with the asymmetrical IUGR group. The overall mortality rate was higher in the asymmetric IUGR group (p < 0.01). CONCLUSIONS: prevalence of IUGR in our population is higher than that reported in the literature; there were more preterm infants and higher mortality in the asymmetric group.

[Incidence and risk factors associated with in-hospital neonatal sepsis]. / Sepsis neonatal intrahospitalaria. Incidencia y factores de riesgo.

BACKGROUND: inhospital neonatal sepsis (IHNS) is a clinical syndrome characterized by an inflammatory reaction with local or systemic signs of infection, accompanied by the causal agent in the first month of life. The objective was to know the incidence and risk factors associated with IHNS. METHODS: during 2006 and 2007 a total of 49 patients in the case group and 50 patients in the control group were included in the study. A serie of qualitative variables comparing the two groups to determine their association were analyzed. RESULTS: We found an incidence of IHNS in our hospital of 3.7 %. The most frequently observed risk factors were: birth weight between 1501-2500 g, in the hypotrophic group, the use of central vascular access, ranitidine, steroids, parenteral nutrition, endotracheal intubation, orogastric catheter, vesical catheter, and also the presence of cardiopathy or hyaline membrane disease (HDM). The mortality rate was 24.4 %. CONCLUSIONS: the incidence of IHNS was less than reported in the literature. The number of deaths associated with IHNS was low.

Enfermedad vascular obstructiva neonatal / Occlusive vascular disease (neonatal stroke)

Introducción. La enfermedad vascular obstructiva neonatal puede ocurrir tanto en el feto como en el recién nacido. En el 50 por ciento de los casos la arteria cerebral media del lado izquierdo es la más afectada. La incidencia anual se reporta en 2.5 por cada 100,000 niños. Caso clínico. Lactante masculino de 3 meses de edad, producto de la primera gesta, de término, nació mediante cesárea con líquido amniótico claro, aparentemente sin datos de asfixia, ictericia o cianosis. Cursó asintomático hasta los 3 meses, cuando presentó crisis convulsivas localizadas a hemicuerpo derecho motivo por el cual es estudiado. Como hallazgo se encontró en el estudio de imagen un infarto antiguo a nivel del hemisferio izquierdo, en territorio de la arteria cerebral media con oclusión en su nacimiento. Conclusión. La incidencia de enfermedad vascular obstructiva en neonatos es más común de lo que se reporta, debido a su difícil reconocimiento al examen clínico. Los antecedentes perinatales y postnatales son importantes para la sospecha clínica y el estudio completo por medio de los diferentes métodos diagnósticos de gabinete; siendo la angiorresonancia la que ofrece una evaluación no invasiva del parénquima y de la vasculatura cerebral con mayor beneficio que la utilización de la angiografía

Experiencia clínica con la ventilación de alta frecuencia de flujo interrumpido en un hospital privado / The clinical expriencie with the high frequency ventilation of interrupted flow

Objetivo: Se documenta la experiencia clínica obtenida con la ventilación de alta frecuencia de flujo interrumpido, en una unidad de cuidados intensivos neonatales. Material y métodos: Se incluyeron para estudio a 19 niños que ameritaron cambio de ventilación mandatoria intermitente a ventilación de alta frecuencia de flujo interrumpido a criterios clínicos y gasométricos, así como la frecuencia de complicaciones observadas en los niños. Resultados: Los neonatos tenían problemas pulmonares. El diagnóstico principal para decidir el cambio a la VAFFI fue la hipertensión pulmonar persistente. Hubo una diferencia significativa entre la predicción de muerte y la que ocurrió (P < 0.05). Los neonatos mostraron mejoría significativa (P < 0.05) en la PaO2 y la PaCO2. Conclusiones: La VAFFI es útil en pacientes hipoxémicos, particularmente eliminando CO2. Disminuye el riesgo de muerte y complicaciones entre los pacientes que la reciben, de acuerdo a los criterios clínicos que se adoptaron en ese estudio

Programa para el fomento de apego a los neonatos prematuros, desarrollado en padres de recién nacidos hospitalizados / The stimulation in utero with the participation of the parents on the delivery and early relationship, when the newborn requiers hospitalization

Introducción: la interacción del binomio madre-hijo es fomentado con la ®estimulación in útero¼, con la participación de los padres en el parto y la convivencia temprana, lo cual es frustrado cuando se requiere hospitalización. Material y métodos: es un estudio prospectivo que consistió en su primera fase en detección y seguimiento de la embarazada de alto riesgo en la consulta de control prenatal, y en la segunda fase, al requerir el recién nacido hospitalización, en evaluación de la actitud de los padres hacia su hijo ante una situación desconocida e inesperada; se impartió un programa de entrenamiento sobre apego para los padres y se realizó una valoración pre y post programa. Los resultados se confrontaron estadísticamente con la prueba de t de ®studen¼ de dos colas. Resultados: se encuestó a 48 embarazadas para conocer las experiencias respecto de su futuro hijo. Cuarenta y seis (96 por ciento) de las embarazadas establecieron estimulación con su hijo al hablarle y acariciar su vientre. Durante la hospitalización se estudió a 24 padres de éstos recién nacidos y encontramos significancia estadística al confrontar los puntajes pre y post programa (P < 0.001). Conclusiones: es necesario formar grupos multidisciplinarios en el manejo del recién nacido críticamente enfermo y enfocar las medidas terapéuticas hacia la interacción padre-hijos como punto angular para el desarrollo y madurez familiar así como del individuo

Comparación de la ventilación de alta frecuencia de flujo interrumpido versus ventilación de alta frecuencia de presión positiva en recién nacidos con diagnóstico de hipertensión pulmonar persistente / Comparison between interrupted flow high frequency ventilation and positive pressure high frequency ventilation in persistent pulmonary hypertension of the newborn

Introducción. La hipertensión pulmonar persistente (HPP) del recién nacido es un síndrome que se caracteriza por el aumento de la resistencia vascular pulmonar y grave hipoxemia. Está asociado a: asfixia perinatal, aspiración de meconio, enfermedad pulmonar grave, hernia diafragmática y sepsis. En su manejo se han utilizado vasodilatadores, ventilación mecánica convencional con alcalosis, ventilación de alta frecuencia y oxigenación de membrana extracorpórea. Material y métodos. Estudio prospectivo; se compararon 2 grupos, uno formado por neonatos manejados con ventilación de alta frecuencia de presión positiva (VAFPP) y posteriormente con ventilación de alta frecuencia de flujo interrumpido (VAFFI) (este grupo se le conoció como VAFPP-VAFFI), el otro grupo manejado con VAFPP solamente (VAFPP-S). La comparación de las variables fueron hechas en fases: Primera fase: se analizaron variables generales. Segunda fase: se confrontaron variables gasométricas y ventilatorias estando ambos grupos en VAFPP. Tercera fase: se confrontaron variables gasométricas y ventilatorias únicamente del grupo VAFPP-VAFFI antes y durante la ventilación de flujo interrumpido. Cuarta fase: se compararon variables entre los sobrevivientes. Resultados. El grupo de VAFPP-VAFFI fue de 17 pacientes y el de VAFPP-S de 14. Primera fase: no hubo diferencia estadística al comparar: peso, edad gestacional, sexo, vía de nacimiento, calificación de Apgar y trofismo. Segunda fase: al comparar las variables de esta fase no se encontró diferencia estadística en ambos grupos. Tercera fase: se comparó al grupo VAFPP-VAFFI antes y durante el manejo con flujo interrumpido, encontrando mejoría gasométrica (P<0.001), disminución en el gradiente alvolo-arterial y en el índice de oxigenación (P<0.001). Al comparar los parámetros ventilatorios se encontró que durante la VAFFI se disminuyeron: presión inspiratoria pico (P<0.001), ciclados por minuto (P<0.001) y presión media de la vía aérea (P<0.001). Cuarta fase: el grupo VAFPP-VAFFI tuvo menos displasia broncopulmonar (P<0.05), ventilación en VAFPP (P<0.001) y defunciones (P<0.01) en comparación a VAFPP-S. Conclusiones. De acuerdo a los resultados la VAFFI es útil como rescate en recién nacidos de término con HPP que no responden a la VAFPP y en los cuales se han agotado los parámetros del ventilador convencional continuando en hipoxia e hipercapnea con una mortalidad esperada mayor del 90 por ciento utilizando el gradiente alveolo-arterial...

Aplasia cutis congética y feto papiráceo / Congenital aplasia cutis and papiraceus fetus

La aplasia cutis congénita es definida como ausencia congénita de piel y anexos cutáneos. Afecta en un 80 por ciento el cuero cabelludo y en un 20 por ciento extremidades, tronco y nuca. Caso clínico. Se trata de un recién nacido masculino de 2,040 gramos de peso Apgar 9-9, 40 semanas por Capurro, producto de tercera gesta de madre de 33 años y padre de 35 años, no consanguíneos, ambos sanos; presenta áreas desprovistas de piel en ambos flancos de aproximadamente 12 x 10 centímetros, además de región superoexterna de ambos muslos y áreas ya cicatrizadas en rodillas, siendo todas simétricas; la placenta fue monocoriónica, biamniótica de aspecto normal con presencia de feto papiráceo el cual se observó completamante atrófico de 5.5 centímetros de longitud. Discusión. Requiere tratamiento inmediato para evitar sobreinfección bacteriana en las áreas afectadas, su pronóstico es favorable

Predicción de madurez pulmonar fetal mediante el conteo de cuerpos gemerales en líquido amniótico / Prediction of fetal lung maturity through lamellar body count in amniotic fluid

Introducción. La enfermedad de membrana hialina (EMH) es causa común de morbilidad y mortalidad neonatal, los exámenes para madurez pulmonar juegan un importante papel para establecer el manejo obstétrico y neonatal. El conteo de cuerpos lamelares (CCL) en líquido amniótico es un nuevo estudio que permite conocer la madurez fetal pulmonar. Material y métodos. Estudio prospectivo realizado con el objetivo de correlacionar el CCL en líquido amniótico con la presencia de EMH. Se analizaron las muestras de líquido amniótico de recién nacidos prematuros y de término obtenidos por cesárea. Las variables analizadas fueron: edad gestacional (semanas), peso (g), CCL/µL, presencia o ausencia de EMH con un conteo menor o mayor de 30,000/µL, determinándose: sensibilidad, especificidad, valor de predicción positiva (VVP) y valor de predicción negativa (VPN). Resultados. La edad gestacional en recién nacidos prematuros fue de 33ñ2.4 semanas y de 39ñ0.6 semanas en los de término (p<0.001); el peso fue de 1,963ñ746 y 3,180ñ400g respectivamente (P<0.001), el CCL para los prematuros fue de 86,931ñ104,676/µL y de 103,086ñ44,346/µL para los de término (no significativo). De toda la muestra se encontró 4 niños con EMH y CCL menor de 30,000/µL, determinando una sensibilidad del 80 por ciento, especificidad 100 por ciento, VPP cien por ciento y VPN 97.56. De las madres que recibieron esteroides prenatales ningún niño prematuro desarrolló EMH, en cambio de 10 madres que no los recibieron 6 niños la presentaron (P<0.5). Conclusión. Se recomienda el CCL como examen para determinar madurez pulmonar fetal, que no es afectado por contaminación de sangre y/o meconio y es de realización rápida (menos de 5 minutos); posible de hacer en todo hospital del país que tenga aparato de conteo de células sanguíneas, haciéndolo por el canal de plaquetas. No es costoso (cuesta menos que una biometría hemática completa), y es confiable para descartar EMH si el conteo es mayor de 30,000/µL

Peritonitis meconial in utero: presentación de un caso y revisión de la literatura / Meconium peritonitis in utero: a Case report review of literature

Introducción. La peritonitis meconial se presenta en el recién nacido de término, siendo compicación rara en el prematuro. Ocurre después de una perforación in utero. Ocasionalmente se sella y no está asociada a obstrucción intestinal. Caso clínico. Se presenta un neonato con peritonitis meconial, sin datos de obstrucción intestinal. El diagnóstico fue un hallazgo por radiografía toracoabdominal, corroborado con ultrasonido abdominal por la presencia de calcificaciones. Conclusiones. Se hace una revisión de la literatura, consideraciones clínicas y tratamiento de la peritonitis meconial