Nacer pequeño para la edad gestacional puede depender de la curva de crecimiento utilizada / To born small for gestational age may depend on the growth curve used

Introducción y objetivo: Los estándares poblacionales de crecimiento intrauterino son necesarios para evaluar si el recién nacido (RN) ha crecido bien, si su estado nutricional es adecuado y para identificar grupos de riesgo como los pequeños para su edad gestacional (PEG). Se analizan las diferencias entre las curvas de crecimiento intrauterino utilizadas habitualmente en nuestro medio y el número de RN que cada una de ellas identifica como PEG. Material y métodos: Estudio transversal en 4.486 RN caucásicos (2.361 niños y 2.125 niñas), con una edad gestacional entre 35 y 41 semanas. La valoración antropométrica del RN (peso y longitud) se realizó siguiendo la metodología estándar. Se comparó el porcentaje de RN que quedaba con un peso y una longitud por debajo del percentil10 (P10) para su edad gestacional a partir de cuatro curvas de crecimiento intrauterino (Olsen et al. 2010, Lubchenco et al. 1966, Delgado et al. 1996, Carrascosa et al. 2008), siendo diagnosticado de PEG. Resultados: El peso y longitud de los niños eran significativamente mayores que los de las niñas en todas las edades estudiadas. Los valores para el P10 en cada edad gestacional son globalmente similares entre las curvas analizadas y superponibles a los de nuestra población, con la clara excepción de la gráfica de Lubchenco et al. cuyos valores para el P10 son de hasta 300 g. menos en los RN de mayor edad gestacional. Las gráficas de Lubchenco et al. identifican un menor número de PEG que las otras. El porcentaje de niños PEG de nuestra muestra osciló entre un 1,7% y 14% en dependencia del estándar, sexo y edad gestacional considerados. Conclusión: El número de niños clasificados como PEG(..) (AU)

Introduction and objective: Population standards of intrauterine growth are necessary to evaluate if the newborn has grown well, if their nutritional conditions are appropriate and to identify groups at risk as those small for gestational age (SGA). Differences in the number of SGA newborns identified, depending on the standard applied, have been analyzed in this study. Material and methods: Cross-sectional study conducted in 4,486 Caucasian newborns (2,361 boys and 2,125 girls),born between 35 and 41 weeks. Weight and length valuation was performed following the standard methodology. Percentage of children under the 10th percentile for weight and length was calculated depending on the standard used (Olsen et al. 2010, Lubchenco et al. 1966, Delgado et al. 1996, Carrascosa et al. 2008), being diagnosed of SGA. Results: Weight and length were significantly higher in boys than in girls at all ages. 10th percentile values defined for every gestational age are globally similar among the different standards and our population, with the clear exception of Lubchenco curves whose 10th percentile values are even 300 g. lower for the newborns at the highest gestational ages. Lubchenco charts do not fit the pattern of intrauterine growth of our population and identify a smaller number of SGA. The percentage of SGA of our sample ranged between 1.7% and 14% in depending on the standard, sex and gestational age considered. Conclusion: The number of children classified as SGA is different according to each standard used. Lubchenco charts identify a smaller number of SGA than the others. The rest of curves show similar values and seem to be well adapted for our population. The correct identification of SGA will allow a better assessment of short and long-term risks of these newborns (AU)

[To born small for gestational age may depend on the growth curve used]. / Nacer pequeño para la edad gestacional puede depender de la curva de crecimiento utilizada.

INTRODUCTION AND OBJECTIVE: Population standards of intrauterine growth are necessary to evaluate if the newborn has grown well, if their nutritional conditions are appropriate and to identify groups at risk as those small for gestational age (SGA). Differences in the number of SGA newborns identified, depending on the standard applied, have been analyzed in this study. MATERIAL AND METHODS: Cross-sectional study conducted in 4,486 Caucasian newborns (2,361 boys and 2,125 girls), born between 35 and 41 weeks. Weight and length valuation was performed following the standard methodology. Percentage of children under the 10(th) percentile for weight and length was calculated depending on the standard used (Olsen et al. 2010, Lubchenco et al. 1966, Delgado et al. 1996, Carrascosa et al. 2008), being diagnosed of SGA. RESULTS: Weight and length were significantly higher in boys than in girls at all ages. 10(th) percentile values defined for every gestational age are globally similar among the different standards and our population, with the clear exception of Lubchenco curves whose 10(th) percentile values are even 300 g. lower for the newborns at the highest gestational ages. Lubchenco charts do not fit the pattern of intrauterine growth of our population and identify a smaller number of SGA. The percentage of SGA of our sample ranged between 1.7% and 14% in depending on the standard, sex and gestational age considered. CONCLUSION: The number of children classified as SGA is different according to each standard used. Lubchenco charts identify a smaller number of SGA than the others. The rest of curves show similar values and seem to be well adapted for our population. The correct identification of SGA will allow a better assessment of short and long-term risks of these newborns.

Parálisis branquial obstétrica en nuestro Servicio: Revisión de 10 años / Obstetric brachial paralysis in our Department: A 10 years review

Introducción. La parálisis branquial obstétrica es una entidad relativamente frecuente, originada en el período neonatal. Objetivo. Determinar la incidencia y pronóstico de la parálisis obstétrica del plexo branquial y analizar factores de riesgo asociados. Material y métodos. Estudio retrospectivo descriptivo, de todos aquellos niños nacidos en nuestro centro y diagnosticados de parálisis braquial en los últimos 10 años, valorando variables perinatales y evolución de los mismos. Resultados. Se diagnosticaron 23 parálisis braquiales (1/1.000 recién nacidos), 13 varones (56,5%) y 10 mujeres 843,5%). Todos los partos fueron a término con una incidencia de distocia de hombros del 69,5% y un peso medio al nacimiento de 3.937 g (3.390-5.110 g). La parálisis fue más frecuente en el lado derecho (65,2%), con afectación de raíces superiores en todos los casos. El 74% de los niños se recuperó en los primeros 6 meses de vida, precisando fisioterapia un 57,1%; solo en dos casos se llevaron a cabo otras pautas terapéuticas. A pesar del tratamiento, un 17% de los niños presentaron secuelas permanentes. Conclusiones. La parálisis branquial obstétrica sigue siendo un problema frecuente en nuestro medio; habitualmente, se afectan las raíces superiores, suele ser unilateral con predominio del lado derecho y puede originar secuelas permanentes (AU)

Introduction. The obstetrical brachial palsy is a relatively frequent entity with origin in the neonatal period. Objective. To determine the incidence and prognosis of obstetric brachial plexus injuries and analyze associated risk factors. Material and methods. Retrospective descriptive study, of all those children born in our center and diagnosed of brachial palsy, in the last 10 years, valuing perinatal variables and evolution of the same ones. Results. Obstetrical brachial palsy was diagnosed in 23 children’s 81/1000 newborn), 12 males 856.5&) and 10 females (43.5%). All the patients were born full term with an incident of distocia of shoulders of 69.5% and an average weight to the birth of 3937 g (3390-5110 g). The palsy was more frequent in the right side (65.2%), mainly of upper roots in all the cases. 74% of the children recovered in the first 6 months of life, needing physical therapy 57,1%, only in two cases other treatments were carried out. In spite of the treatment, 17% of the children presented permanent sequels. Conclusions. The obstetrical brachial palsy continues being a frequent problem in our environment, usually affecting upper roots, unilaterally, with predominance of the right side and can originate permanent sequels (AU)

Flúter auricular en un recién nacido pretérmino / Atrial flutter in preterm newborn

Se comunica un caso de flúter auricular en un recién nacido pretérmino con insuficiencia cardiaca, mala respuesta farmacológica y recuperación del ritmo normal tras una cardioversión eléctrica (AU)

We describe an atrial flutter in preterm newborn with heart failure, resistant to pharmacological treatment and recovery of the normal heart rhythm after electrical cardioversion (AU)

Desarrollo neurológico en prematuros de muy bajo peso tras ser dados de alta en la Unidad Neonatal / Neurodevelopmental outcome of very low Barth weight infants alter discharge from the intensive care unit

Objetivo. Determinar la relación entre factores de riesgo perinatal, incluyendo la hemorragia intraventricular (HIV), y el desarrollo neurológico tras tres años de seguimiento en los niños con muy bajo peso al nacer dados de alta en nuestra Unidad Neonatal. Material y método. Estudio retrospectivo de 70 recién nacidos con un peso≤ 1,500 g dados de alta entre los años 2002 y 2005. Se realizó seguimiento del desarrollo psicomotor hasta los tres años y se comparó la presencia o no de secuelas con los distintos factores de riesgo perinatales. Resultados. De los 70 niños, 45 fueron seguidos hasta los tres años (peso medio 1.191 g) y el 46,4% (21) tenían antecedente de HIV. La presencia de secuelas (26,6%) se relacionó con el antecedente de corioamnionitis materna (p<0,01) y con una puntuación baja en el test de Apgar (p<0,05), pero no con otros factores de riesgo. Comentarios. Nuestros resultados sugieren que la corioamnionitis y una puntuación baja en el test de Apgar asocian significativamente alteraciones en el desarrollo psicomotor a los tres años de edad. La existencia de otras patologías o tratamientos más agresivos asocian un retraso transitorio que no se relaciona con alteración en el desarrollo psicomotor a largo plazo (AU)

To evaluate the relationship between risk perinatal factors included intraventricular hemorrhage and neurodevelopment outcome after three years of very low birth weight after discharge form the intensive care unit. Material and methods. A retrospective study was undertaken of 70 preterm babies discharge form the intensive care unit between 2002-05 weighting less than 1.500 g. They were followed-up with a neurological evaluation for three years. The presence of neurological sequelae and risk perinatal factors were compared. Results: Seventy patient followed-up during three years (mean weight 1.191 g), 46,6% (21) of these presented intraventricular haemorrhage. A significant association between neurological sequelae and maternal chorioamnionitis (p<0,01) a low Apgar score (p<0,05) was found, but not in relation to other risk factors. Conclusions. The results suggest that preterm infants exposed to maternal chorioamnionitis or low Apgar score are at a higher risk of poor neurological outcome at the age of three years. Other pathology or aggressive treatments associate a transitory delay that does not relate to alteration in the psychomotor long-term development (AU)

Pénfigo sifilítico: ¿pasado, presente o futuro? / The past, present, and future of pemphigus syphiliticus

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[Anthropometric and nutritional study of full-term newborns. Evaluation of the submandibular adipose skinfold]. / Estudio antropométrico nutricional en recién nacidos a término. Valoración del pliegue adiposo submandibular.

OBJECTIVE: We performed an anthropometric study in a series of normal full-term newborns to evaluate the discriminatory capabilities of the submandibular skinfold compared to other anthropometric parameters. MATERIAL AND METHODS: We studied 794 consecutive Caucasian newborns, 377 males and 471 females, with a mean gestational age of 39.5 +/- 0.9 weeks and adequate weights for age. Anthropometric variables analyzed included weight, length, left arm circumference and bicipital, tricipital, subscapular, suprailiac and submandibular skinfolds. Statistical analysis was performed by using the Student's t-test to evaluate differences between the different parameters and by Pearson's test to look for correlations among them. RESULTS: The weight and lengths of male newborns were significantly higher than those of female newborns (p < 0.005) These parameters showed differences with other series of newborns studied. Measurements of the tricipital, subscapular and suprailiac skinfolds were significantly different between males and females (p < 0.005); however, bicipital and submandibular skinfolds were not. The submandibular skinfold measurement highly correlated with the other skinfold measurements, especially with the bicipital measurement, in both males (0.536; p < 0.0001) and females (0.578; p < 0.001). Submandibular skinfold measurements also correlated with weight and arm circumference in both sexes. CONCLUSIONS: Some somatometric measurements in normal term newborns differ significantly between the sexes, especially weight, length and tricipital, subscapular and suprailiac skinfolds. The submandibular skinfold correlates well with weight, arm circumference and the four routinely measured skinfolds. This finding suggests that measurement of the submandibular skinfold should be included in the evaluation of the newborn's nutritional status.

[Brachial measurements as nutritional indicators in health term newborns]. / Medidas braquiales en recién nacidos término sanos como índices nutricionales.

OBJECTIVE: Our objective was to study the correlations between weight and length and weight index and brachial areas in healthy term newborns as indicators of nutritional status. PATIENTS AND METHODS: We studied 794 consecutive Caucasian newborns, 377 male and 417 females, with gestational ages of 39 +/- 09 weeks and adequate weights. We measured weight, length, weight/length index, body mass index and weight index. Measurements of the arm perimeter and tricipital skinfold were used to calculate the fatty, lean and total areas by two different methods. Mean, standard deviation and percentiles were utilized in the measurements. The Student's t-test was used to calculate differences and Pearson's test for correlations. RESULTS: We found that weight, length and weight/length indexes were higher in males than in females, except for the weight index. Brachial areas and parameter were higher in females, except for the lean area. We did not find significant differences between gender in brachial measurements calculated by the different methods. Among the males, we found a high degree of correlation between weight and the weight/length index (r = 0.963; p < 0.0001), and weight and total body area (r = 0.649; p < 0.0001). Similar data were obtained among females, where in addition a high correlation was found between the fat percentage and the body mass index (BMI, r = 0.223; p < 0.0001), as well as between brachial areas and BMI in both genders (p < 0.0001). CONCLUSIONS: In normal newborns, the brachial areas, taken as indicators of body composition, are statistically significantly correlated with the anthropometric parameters widely used to measure the nutritional status of newborns.

[An experimental study on the effects of maternal hyperphenylalaninemia on the central nervous system and behavior of offspring rats]. / Estudio experimental sobre los efectos de la hiperfenilalaninemia materna en el sistema nervioso central y la conducta de ratas hijas.

OBJECTIVE: This work attempts to study the cerebral alterations in rat offspring of hyperphenylalaninemic mothers, as well as the possibility of preventing them by means of administration of dietetic supplements of valine, leucine and isoleucine during the pregnancy. PATIENTS AND METHODS: An experimental study in two consecutive pregnancies of 18 Wistar rats was carried out. The first pregnancy serves as the control group. In the second pregnancy, an experimental hyperphenylalaninemia was provoked by means of injection of phenylalanine and chlorophenylalanine (phenylalanine-hydroxylase inhibitor). In half of the mothers during the second pregnancy the diet was supplemented with branched-chain amino acids. In the offspring rats, a histological cerebral study was performed (conventional electron microscopy and study of synaptosomes). A behavioral study (T-water maze) was also performed at birth and on the 35th and 65th days of life. RESULTS: The offspring of the group submitted to hyperphenylalaninemia were microcephalic (p = 0.0003) and had fewer synaptosomes that had a larger surface area (p = 0.0081 in newborn rats, p = 0.0028 on the 35th day of life) and of a more immature aspect (less vesicular content). In addition, alteration in the myelinization were detected. In the behavior test (65th day of life), the offspring of the mothers with hyperphenylalaninemia make significantly more mistakes (p = 0.0167) and they needed more time for their resolution (p = 0.059). None of these alterations could be prevented by the administration of supplements of branched-chain amino acids to the mother. These supplements resulted in a higher fertility rate, but this action results in affected young rats, so their administration seems to be counter-productive.