Prevalencia y duración de la lactancia materna en el medio rural / Prevalence and nutritional of maternal breastfeeding in the rural setting

Introducción y objetivos. A pesar del reconocimiento generalizado de los beneficios de la lactancia materna para la madre y el recién nacido en la mayoría de países no se alcanzan los niveles deseados El objetivo de este trabajo es evaluar la prevalencia, duración y motivos de abandono de la lactancia materna en un medio rural. Métodos. Se realizó un estudio prospectivo observacional durante un año de todos los recién nacidos en el hospital comarcal de Alcañiz, que se complementó con una encuesta sobre las características de la lactancia durante los primeros meses para rellenar y entregar por el pediatra o médico de familia de Atención Primaria. Resultados. Durante el periodo a estudio hubo 456 recién nacidos. Iniciaron lactancia materna el 96,9% de los neonatos, el 26.5% recibieron suplementos (por indicación médica o por petición de los padres). Al alta, el 84,7% se fueron con lactancia materna exclusiva. La duración media de la lactancia materna fue de cuatro meses y medio con una media de inicio de lactancia artificial a los dos meses y medio. El motivo más frecuente de abandono fue la decisión materna (44,5%). Conclusiones. Tenemos resultados muy positivos en cuanto al inicio de la lactancia materna, pero debemos seguir trabajando en la formación de los profesionales sanitarios y en la información a los padres para el mantenimiento de esta y en las causas de abandono, siendo estas la mayor parte de las veces modificables (AU)

Introduction and objectives. Despite of the knowledge of the benefits of breastfeeding for the mother and newborn, in most countries the desired levels are not reached. The objective of this study is to evaluate the prevalence, duration and reasons for abandoning breastfeeding in a rural setting. Methods. A prospective observational study was conducted for one year of all newborns in the hospital of Alcañiz, which was complemented by a survey on the characteristics of breastfeeding during the first months to be filled in and delivered by the paediatrician of primary care. Results. During the study period there were 456 new-borns. 96.99% of newborns started breastfeeding, 26.5 received supplements (either by medical indication or at the request of the parents). At discharge, 84.7% went on exclusive breastfeeding. The mean duration of breastfeeding was four and a half months with a mean of initiation of artificial breastfeeding at two and a half months. The most frequent reason for abandonment was the internal decision (44.5%). Conclusions. We have very positive results looking the initiation of breastfeeding, but we must continue working in the training of health professionals and in the information given to parents for promote the maintenance of this and decrease the reasons of abandonment, most of times modifiable (AU)

Síndrome Cri du Chat: a propósito de un caso. Características clínicas y evolutivas / Cri du Chat Syndrome: a case report. Clinical and evolutive characteristics

El síndrome Cri du Chat tiene una incidencia de 1/15.000—1/50.000 y es debido a una delección del cromosoma 5p. Los individuos afectos presentan un fenotipo especial, discapacidad intelectual, retraso del lenguaje junto con un llanto agudo característico en las primeras tapas de su vida, si bien, hay una variabilidad clínica según la extensión y localización de la delección. Es muy portante iniciar una terapia rehabilitadora precozmente ara mejorar sus capacidades de aprendizaje y comunicación y así mejorar su calidad de vida. Se presenta el caso 6 un lactante con sospecha clínica del síndrome al nacimiento confirmándose en el estudio genético. Se describen los aspectos clínicos y evolutivos más característicos del síndrome (AU)

The Cri du Chat syndrome has an incidence of 1/15,000 - 1/50,000 and is caused by a deletion of the chromosome 5p. Affected individuals have a special phenotype, intellectual disability, language delay and a characteristic acute cry in the early stages of their life, although there is a clinical variability according to the extent and location of the deletion. It is very important to begin rehabilitation therapy early to improve learning and communication skills and thus improve quality of life. We report the case of an infant with clinical suspicion of the syndrome at birth that was confirmed by genetic testing. We describe the most characteristic clinical and evolutionary aspects of the syndrome (AU)

Luxación congénita de rodilla: a propósito de 2 casos / Congenital dislocation of the knee: Report of 2 cases

La luxación congénita de rodilla (LCR) es una patología muy poco frecuente cuyo diagnóstico se realiza al nacimiento por los hallazgos clínicos, confirmándose radiológicamente. Se ha relacionado con diversas etiologías, desde malas posiciones fetales intraútero hasta trastornos genéticos. El pronóstico dependerá del inicio precoz del tratamiento y de la asociación de otras anomalías congénitas. Presentamos 2 nuevos casos de LCR observados en nuestro hospital en el período de un mes, diagnosticados en los primeros momentos tras el nacimiento, ambos con buena evolución clínica

Congenital dislocation of the knee is a rare disease. The diagnosis is made at birth by clinical findings, and confirmed radiologically. It has been associated with various etiologies from intrauterine fetal malpositions to genetic disorders. The prognosis depends on early treatment and whether there are other congenital anomalies. We report two new cases of congenital dislocation of the knee, observed in our hospital during the period of a month, diagnosed immediately after birth, and both with a good clinical outcome

[Congenital dislocation of the knee: report of 2 cases]. / Luxación congénita de rodilla: a propósito de 2 casos.

Congenital dislocation of the knee is a rare disease. The diagnosis is made at birth by clinical findings, and confirmed radiologically. It has been associated with various etiologies from intrauterine fetal malpositions to genetic disorders. The prognosis depends on early treatment and whether there are other congenital anomalies. We report two new cases of congenital dislocation of the knee, observed in our hospital during the period of a month, diagnosed immediately after birth, and both with a good clinical outcome.

[Lumbar puncture and early neuroimaging in complex febrile seizures. Report of a case of shaken infant syndrome]. / Punción lumbar y neuroimagen precoz en las crisis febriles complejas. A proposito de un caso de síndrome de lactante sacudido.

INTRODUCTION: Febrile convulsions are one of the most frequent pathologies seen in paediatric emergencies. The diagnosis of febrile seizures is clinico evolutionary and is easily established once the acute process is overcome and a normal state is restored in the child. The differential diagnosis is established with the processes that associate fever and convulsions in children between the ages of 1 month and 6 years, many of which require specific treatment. Certain complementary examinations, essentially a blood test, lumbar puncture and neuroimaging, are needed to identify them. Shaken infant syndrome is a form of physical abuse which includes the presence of intracranial traumatic injury, retinal haemorrhage and, in general, the absence of other physical signs of traumatic injury in the child. CASE REPORT: An 8 month old infant who presented a convulsive seizure on the left side of the body which coincided with an axillary temperature of 38 C that remitted with intravenous diazepam 40 minutes after onset. An early cranial computerised tomography (CT) scan led to a diagnosis of shaken infant syndrome. DISCUSSION: This case constitutes an argument in favour of performing an early cranial CT scan in complex febrile convulsions and in prolonged or partial non provoked seizures. We highlight the risks involved in performing a lumbar puncture in the absence of suspected non complicated acute bacterial meningitis. The diagnostic usefulness of an early CT scan in diagnosing such an important problem as shaken infant syndrome must also be noted, due to the risk of repetition and its high morbidity and mortality rates.

[Inhaled nitric oxide in the treatment of persistent pulmonary hypertension in a newborn]. / Oxido nítrico inhalado en el tratamiento de la hipertensión pulmonar persistente del RN.

OBJECTIVE: Our aim was to assess from a clinical and analytical point of view the response to inhaled nitric oxide in patients with persistent pulmonary hypertension of the newborn (PPHN). PATIENTS AND METHODS: A retrospective study was analyzed in ten patients with PPHN who received inhaled nitric oxide. The ventilatory and gasometric data were reviewed before treatment, during the first hours and afterwards, in all patients, in the surviving group and in the most common associated disease group (intrauterine pneumonia). The parameters analyzed to assess the response to NO treatment were the oxygenation index (IO) and the PaO2 increase. Statistical analysis was performed by using a comparison of means. RESULTS: The mean oxygenation index before starting the treatment with inhaled NO was 39 +/- 7.3 in the total group and 38.4 +/- 8.8 in the surviving patients. At 2.9 +/- 1.1 hours after treatment a mild improvement was observed in the total group and it was more evident in the surviving group (32.4 +/- 15.2 and 26.4 +/- 7.8, respectively; p < 0.05). After treatment was discontinued, the IO was 24.7 +/- 21.9 (p < 0.05) and 12.8 +/- 7.5 (p < 0.001). The PaO2 increment in both groups was 51.2 +/- 55.5% and 66.8% +/- 28.1%. The patients with intrauterine pneumonia showed the highest PaO2 increase after treatment was discontinued (78.3% +/- 41.9%). CONCLUSIONS: Early treatment with inhaled NO in term newborns with PPHN produced a sustained improvement in oxygenation. This treatment might reduce the number of patients who need extracorporal membrane oxygenation.