Cerebral rScO2 Measured by Near-Infrared Spectroscopy (NIRS) During Therapeutic Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy: A Systematic Review.

INTRODUCTION: Perinatal asphyxia, a leading cause of neonatal mortality and neurological sequelae, necessitates early detection of pathophysiological neurologic changes during hypoxic-ischaemic encephalopathy (HIE). This study aimed to review published data on rScO2 monitoring during hypothermia treatment in neonates with perinatal asphyxia to predict short- and long-term neurological injury. METHODS: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study identification was performed through a search between November and December 2021 in the electronic databases PubMed, Embase, Lilacs, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). The main outcome was short-term (Changes in brain magnetic resonating imaging) and long-term (In neurodevelopment) neurological injury. The study protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews) with CRD42023395438. RESULTS: 380 articles were collected from databases in the initial search. Finally, 15 articles were selected for extraction and analysis of the information. An increase in rScO2 measured by NIRS (Near-infrared spectroscopy) at different moments of treatment predicts neurological injury. However, there exists a wide variability in the methods and outcomes of the studies. CONCLUSION: High rScO2 values were found to predict negative outcomes, with substantial discord among studies. NIRS is proposed as a real-time bedside tool for predicting brain injury in neonates with moderate to severe HIE.

Short-term neurological injury in newborns infants with overcooling in passive hypothermia and transferred to reference hospital in Colombia.

AIM: The aim of the study was to determine whether overcooling (temperature <33°C) during passive hypothermia when transporting neonates with perinatal asphyxia increased the risk of short-term neurological injury. METHODS: A retrospective observational study was performed. Newborns transferred to the LaCardio neonatal unit between January 2021 and April 2022 with moderate and severe perinatal asphyxia and who received passive hypothermia during transport were included. A temperature of <33°C was considered overcooling. A composite outcome of neurological injury was defined by the presence of abnormalities on brain magnetic resonance imaging, video telemetry, seizure before discharge or both. RESULTS: The study included 101 newborns. A total of 18 neonates had a temperature <33°C after transportation. Neurological injuries were present in 21.8% of the temperature <33°C group and 78.2% of the temperature ≥33°C group. Temperature <33°C at the end of transport (aOR 9.2, 95% CI 1.1-77.3) were associated with neurological injury before discharge from the unit. CONCLUSION: During transportation, overcooling in neonates with asphyxia increases the risk of neurological injury before discharge from the neonatal unit. It is important to qualify the transport team with adequate training and equipment for therapeutic hypothermia.

Tumor neuroectodérmico primitivo periférico extraesquelético/sarcoma de Ewing metastásico en un neonato / Metastatic primitive extraskeletal peripheral neurectodermal tumor/ewing sarcoma in a neonate / Tumor neuroectodérmico primitivo periférico extra esquelético/sarcoma de ewing apresentado em neonato

El tumor neuroectodérmico primitivo periférico/sarcoma de Ewing, descrito a comienzos del siglo XX, es un tumor muy maligno poco frecuente de gran mortalidad, cuya causa es la translocación t(11;22)(q24;q12) en células derivadas de la cuarta hojilla embrionaria o células de la cresta neural que, por su posibilidad de diferenciación en linajes mesenquimales craneocefálicos, fácilmente se convierte en metastásico. Se encuentra bajo la denominación de enfer- medades raras debido a su baja frecuencia de aparición. A nivel mundial se han referenciado, menos de 20 casos con afectación periférica extraósea congénita y este es el primero en reportarse en Colombia. En el presente caso se describe la lesión tumoral extraesquelética con metástasis a pulmón y a cerebro, en un neonato de sexo femenino, fruto de un embarazo único, prematuro, sin reporte de exposición a factores de riesgo medioam- bientales, que fue remitida con la lesión tumoral al segundo día de vida, por dificultad respiratoria grave progresiva a falla respiratoria. La bebé fue atendida en la unidad neonatal de la Fundación Cardioinfantil de Bogotá.

A female premature infant with no history of exposure, who on presented a peripheral primitive neuroectodermal tumor/extraosseous Ewing sarcoma with metastases to lungs and brain which rapidly invaded the airways. The knowledge of this exotic neoplasm could support the diagnosis and management of newborns with this rare tumor associated with respiratory failure and high mortality. This is the first newborn report of pPNET/Ewing sarcoma in South America, of which fewer than twenty cases have been published. Primitive neuroectodermal tumors or Ewing Sarcoma (PNET/ES) are an aggressive, rare and lethal tumor family of small blue cells with a varied histological morphology that affect the nervous system, skeleton, soft tissues, skin, or parenchymal organs. They are prevalent in the second decade of life, more frequent in whites, male/female 1.3-1.5:1, 85% are caused by nonrandom translocation t(11;22)(q24;q12) limited to the tumor, and therefore non-heritable, with chimeric EWS/FLI1 fusion and a positive CD99 immuno- phenotype. The reporting of this rare tumor associated with neonatal respiratory failure could facilitate its diag- nosis and early treatment.

O tumor neuroectodérmico primitivo periférico extra esquelético /Sarcoma de Ewing, descrito a inicios do século XX, é um tumor raro e maligno que apre-senta alto grau de mortalidade devido à translocação t(11;22)(q24;q12) em células derivadas da quarta hojilla embrionária ou crista neural que por possibilidade de diferenciação de linagens mesenquimales cráneocefá-lico, pode virar facilmente em metastasico.Trata-se de uma doença rara, debido à baixa frequência de aparição. Mundialmente tem se referenciado apro-ximadamente 15 eventos com afetação periférica extraóssea congênita e este é o primeiro caso reportado na Colômbia. No artigo se descreve a lesão tumoral extraesquelética com metastasis no pulmão e cérebro apresentado em neonato feminino produto de gravidez única pre-térmo sem reporte de exposição a fatores de risco medioambientais. O bebe foi remitido com lesão tumoral no segundo dia de ida, por ter apresentado difi-culdade respiratória progressiva grave e insuficiência ventilatória, foi atendida na unidade neonatal da Funda-cion Cardioinfantil (FCI-IC), na cidade de Bogotá.

Comportamiento epidemiológico de la sepsis nosocomial en la Unidad de Recién Nacidos de la Fundación Cardioinfantil / Nosocomial Infections at the Neonatal Intensive Care Unit of Fundación Cardioinfantil in Bogotá

Objetivo. Se realizó un estudio retrospectivo que describe las características demográficas, la etiología, los factores asociados, la mortalidad, la sensibilidad y la resistencia de los microorganismos a los antibióticos usados en sepsis nosocomial. Diseño del estudio. Se realizó la recolección de datos desde el 2004 hasta el primer trimestre del 2006. Se definió infección nosocomial probada como la infección diagnosticada después de 72 horas de hospitalización y que recibe manejo antibiótico mayor a 3 días. Resultados. Se revisaron 60 historias clínicas, en las cuales los gérmenes Gram negativos fueron los principales causantes de sepsis nosocomial, tanto intra como extrainstitucional; de ellos la k. pneumoniae fue el germen más frecuentemente encontrado. Conclusiones. Los gérmenes Gram negativos son los microorganismos predominantemente causantes de sepsis nosocomial en la Unidad de Recién Nacidos (URN) de la Fundación Cardioinfantil (FCI).

Objective. To describe the demographic characteristics, etiologic agents, some associated factors and, the resistance pattern of the microorganisms in neonates identified with nosocomial infections at the Neonatal Intensive Care Unit of Fundación Cardioinfantil in Bogotá. Study design. This retrospective study was developed from 2004 to the first trimester of 2006. Nosocomial infection was defined as the infection diagnosed after 72 hours of hospital admission in a neonate who received antimicrobial therapy during more than three days. Results. Sixty clinical medical charts were reviewed. Gram-negative organisms were the most frequent agents (71.2%) causing nosocomial infections acquired within or outside of the institution. Klebsiella pneumoniae was the agent most frequently identified with 65% of resistance to third generation cephalosporin. Conclusion. Gram-negative are the predominant etiologic agents responsible of nosocomial infections in neonates admitted to the Fundación Cardioinfantil.

Factores predictores de neumonía en niños menores de cuatro años / Predictive factors of pneumonia in children under 4 years old

Se estudiaron 23 pacientes menores de cuatro años referidos al Hospital Santa Clara con IRA Neumonía, para evaluar la frecuencia respiratoria y saturación de oxígeno al ingreso y egreso. Así mismo se tomaron 43 niños como control para medir iguales variables y obtener valores normales a la altura de Bogotá. Se encontró que la frecuencia respiratoria se mueve más rápido hacia lo anormal, pero la saturación de oxígeno es la que primero se recupera a lo normal. Se obtuvieron valores para saturación de oxígeno y frecuencia respiratoria similares a los establecidos a nivel del mar

Evaluación del efecto antinflamatorio de ketoconazol crema / Anti-inflamatory action of ketoconazole cream: an evaluation

Se informa la experiencia clínica comparativa doble ciego entre Ketoconazol crema al 2 por ciento e hidrocortisona crema al 1 por ciento para determinar objetivamente el potencial antinflamatorio de Ketoconazol en un padecimiento inflamatorio no micótico. Los resultados muestran la esperada eficacia de hidrocortisona y un efecto similar de Ketoconazol, comprobado estadísticamente, lo que reafirma su capacidad antinflamatoria. Este descubrimiento aumenta la confianza en el uso de Ketoconazol tópico para casos padecimientos micóticos cutáneos inflamatorios.