Infecciones del tracto urinario en neonatos sin explicación. Hiperbilirrubinemia: Prevalencia y predictivo factores de riesgo / Urinary tract infections in unexplained neonatal hyperbilirubinemia: Prevalence and predictive risk factors

Introduction: Urinary tract infections (UTIs) are widespread clinical disorder among early neonates. Neonates with UTIs were susceptible to higher rates of morbidity and mortality, particularly when presented with hyperbilirubinemia. Early diagnosis may help in complete recoveryrather than being threatened in terms of complications. The study aimed at determining the prevalence and predictive risk factors of UTIs in neonates with an unexplained hyperbilirubinemia. Method: A cross-sectional study was carried out in the NICU of Aswan University Hospital, Egypt from August 2018 to February 2019. The study was conducted on 140 newborns who were diagnosed with indirect hyperbilirubinemia in the first 4 weeks of life after exclusion of unrelated criteria. Demographic and clinical data were collected by an interview questionnaire. Biochemical markers including bilirubin level, CBC, urine analysis and urine cultures and sensitivity were determined. Results: The prevalence rate of UTIs in the studied newborns was 25%. Escherichia -coli was the dominant organism isolated. Amikacin was the most common antibiotic sensitive to the isolates. There was a significant difference between the UTI positive and negative neonates in the univariate analysis regarding some studied variables. While, an increase in the number of WBCs in the blood (OR = 6.90, P = 0.001), small for gestational age (OR = 4.07, P = 0.021), prolonged phototherapy (OR = 3.50, P = 0.034), and presence of maternal complications (OR = 2.92, P = 0.001) were statistically associated with a positive urine culture in multivariate analysis. Conclusions and recommendations: The prevalence rate of UTIs was 25%. The study indicated the importance of routine screening of UTI (urine culture) as part of the clinical assessment of unexplained hyperbilirubinemia in neonates with an increase in the number of WBCs in their blood, small for gestational age, prolonged duration of phototherapy, and neonates born from mothers who had a history of obstetric complications

Hiperbilirrubinemias hereditarias: un diagnóstico diferencial a considerar en ictericia / Hereditary hiperbilirrubinemias: a differential diagnosis to considerer in icterus

Las hiperbilirrubinemias hereditarias (HBH) son patologías originadas por defectos en las enzimas y proteínas que participan del metabolismo de la bilirrubina. El clearence de bilirrubina incluye captación y almacenamiento en hepatocitos, conjugación, excreción hacia la bilis y recaptura de su forma conjugada por hepatocitos. Las HBH varían de acuerdo a su patogenia, presentación clínica, niveles de bilirrubinemia y tratamientos disponibles. En general son poco frecuentes, a excepción del Síndrome de Gilbert. Están las que son de predominio indirecto, como el Síndrome de Gilbert y el de Crigler-Najjar, y las de predominio directo, como el Síndrome de Dubin-Johnson y el de Rotor. En general no requieren tratamiento específico y tienen curso benigno, a excepción del Síndrome de Crigler-Najjar para el cual existen medidas terapéuticas específicas a considerar, teniendo un pronóstico reservado para algunas de sus formas de presentación. Es importante el conocimiento de estos síndromes dado el alto índice de sospecha requerido para su diagnóstico y para su diferenciación de otras patologías hepatobiliares de mayor riesgo y severidad.

Hereditary hiperbilirrubinemias (HBH) are pathologies originated from the defect of the enzymes and proteins involved in the metabolism of bilirubin. The bilirubin clearance includes uptake and storage in hepatocytes, conjugation, excretion into bile and recapture of its conjugated form by hepatocytes. HBH vary according to their pathogenesis, clinical presentation, levels of bilirubin and available treatments. Generally they are infrequent, except for Gilbert Syndrome. There are those with indirect bilirubin predominance, such as Gilbert and Crigler-Najjar syndromes, and those with direct bilirubin predominance, including Dubin-Johnson and Rotor syndromes. In general, they do not require specific treatment and have a benign course, with the exception of the Crigler-Najjar Syndrome, for which there are specific therapeutic measures to consider, as well as a reserved prognosis for some of their forms of presentation. The knowledge of these syndromes is important 2 given the high index of suspicion required for its diagnosis and for its differentiation from other hepatobiliary pathologies of greater risk and severity.

Esferocitosis hereditaria: Revisión. Parte I. Historia, demografía, etiopatogenia y diagnóstico / Hereditary spherocytosis. Review. Part I. History, demographics, pathogenesis, and diagnosis

La esferocitosis hereditaria es la anemia hereditaria más frecuente en nuestro país luego de la talasemia menor. En este artículo, se revisan aspectos históricos, demográficos, genéticos y etiopatogénicos de la enfermedad, y se describen las pruebas de laboratorio para su diagnóstico. Se remarca el comportamiento de la enfermedad en nuestra población y se detallan las deficiencias proteicas predominantes en nuestro país. Se enfatiza sobre las nuevas técnicas de laboratorio actualmente disponibles, con alta sensibilidad y especificidad, que permiten realizar un diagnóstico más temprano con volúmenes de muestra mucho menores que los necesarios para las pruebas convencionales.

Hereditary spherocytosis is the most frequent hereditary anemia excluding beta thalassemia in Argentina. Historical, demographic, genetic and pathogenic aspects of the disease are reviewed, and confirmatory laboratory tests are described. Special characteristics on the outcome of the disease in our population and prevalent protein deficiencies in our country are described. Emphasis is given on new available laboratory tests, which allow an earlier diagnosis using volume of blood samples significantly smaller than required for conventional tests.

Egreso precoz del recién nacido: [revisión] / Early newborn discharge: [review]

El egreso precoz del recién nacido, definido como el alta de las 48 horas del nacimiento, se ha convertido en una práctica clínica rutinaria, motivada en parte por la presión familiar de convertir el acto de nacer en un acontecimiento natural, y fomentada por la escasez de camas maternas en los institutos públicos de salud. A pesar de su frecuente aplicación, no existen estudios bien diseñados que demuestren la seguridad del egreso precoz cuando se emplea de manera colectiva. Aunque ofrece beneficios biológicos y sociales, el alta temprana puede ser un procedimiento riesgoso, debido a situaciones no detectadas que pueden amenazar el bienestar del neonato en el ambiente del hogar, cuando el niño no está siendo supervisado por personal de salud. Las complicaciones neonatales asociadas al egreso precoz son más frecuentes cuando el alta no se complementa con una visita temprana programada a las 48 horas del alta, y cuando se aplica de manera masiva, sin individualizar las necesidades particulares de cada pareja madre-niño. La condición neonatal más importante relacionada al alta precoz es la hiperbilirrubinemia excesiva, especialmente en el neonato prematuro tardío. La Academia Americana de Pediatría ha establecido un conjunto de criterios mínimos a cumplir para que el neonato se vaya al hogar antes de 48 horas, el seguimiento de los cuales es variable entre los pediatras. Estas normas son dificiles de cumplir en los hospitales públicos venezolanos, debido a la alta densidad de nacimientos y a características demográficas particulares. Es factible que se requiera la formulación de requisitos propios de egreso que se puedan aplicar en grupos bien seleccionados de nuestra población.

Early newborn discharge has progressively become a common clinical practice in many institutions, due to the mothers' wish to demedicalize the childbirth process and to the scarcity of maternal beds in public hospitals. Although early discharge provides social and biological benefits, its collective application may be associated with risks for the mother and the newborn, since immediate postnatal recovery has shifted from the hospital to the home, where the infant is not being supervised by health professionals. These risks are more relevant when short stays are not complemented with a follow-up visit within 48 hours, and when early discharge is massively applied without consideration for particular needs of mothers and infants. The most common neonatal complication seen after early newborn discharge is extreme hyperbilirubinemia, most notorious in late preterm infants. A list of minimal criteria for early discharge has been published by the American Academy of Pediatrics. The compliance with these guidelines is highly variable among pediatricians, and its suitability in our maternity wards is not warranted. Formulation of particular criteria adjusted to the demographic and behavioral characteristics of our perinatal population seems mandatory.

Essential fatty acid status in infants and children with chronic liver disease

The relationship between essential fatty acid [EFA] status and degree of hyperbilirubinaemia and oxidant stress in infants and children with chronic liver diseases was evaluated. Thirty patients with chronic cholestasis and 30 with liver cirrhosis were examined; 30 healthy subjects served as controls. Patient groups had significant decreases in EFAs and significant elevation of total bilirubin. Levels of thiobarbituric acid reactive substances were significantly raised and were significantly inversely correlated to decreased EFA levels. There were also significant decreases in retinol, alpha-tocopherol and alpha-tocopherol/total lipids ratio, which had significant positive correlations with decreased EFA levels. Infants and children with chronic liver diseases have a high risk of EFA deficiency correlated with progressive elevation of serum bilirubin and progressive deterioration of oxidant status