[Neonatal complications associated to HELLP syndrome]. / Complicaciones neonatales del síndrome HELLP.

INTRODUCTION: HELLP syndrome is a variant of pregnancy-induced hypertension that is associated with significant maternal and perinatal morbidity and mortality. The aim of our study was to investigate the neonatal complications associated to this syndrome. PATIENTS AND METHOD: A retrospective observational study was carried out on all newborns of mothers with HELLP syndrome in Virgen del Rocio hospital from 1995 to 2005. There were 120 newborns of 99 mothers with HELLP syndrome. Gestational age, birth weight, length, skull perimeter, number of hospital admissions and mortality were analyzed. The birth weight, length and skull perimeter were compared with a healthy population of the same gestational age using Lubchenco charts. The statistical relationships were determined between the mothers' platelet counts and the birth weight and perinatal mortality. RESULTS: A total of 80% of pregnancies were preterm delivery with a mean gestational age of 33 weeks. Mean birth weight was 1,834g, length 41cm and skull perimeter 29cm. A third of newborns had fetal growth restriction. 61% of newborns needed admitting to hospital due to prematurity and low birth weight. There were 24 perinatal deaths. We did not find any correlation between the number of platelets of the mother and birth weight or perinatal mortality. CONCLUSIONS: HELLP syndrome is an uncommon but potentially serious complication of pregnancy which is associated with an increased risk of adverse maternal and fetal outcome.

[Acute renal failure after intake of mushrooms]. / Insuficiencia renal aguda tras consumo de setas.

The picking and consumption of wild mushrooms is a frequent practice in our region and may lead to accidental poisoning when confused with edible mushrooms. We describe the case of a 9-year-old boy who, following the ingestion of a poisonous mushroom, presented with uncontrollable vomiting and subsequent hepatic, haematological and renal failure some hours later. The patient required haemodialysis. The clinical course, laboratory findings and renal histology, which showed tubular necrosis with basal membrane preserved and lymphocytic interstitial infiltrate, confirmed the diagnosis of a severe mixed syndrome. The patient evolved favourably after the poisoning, recovering renal and liver function. In any case of acute renal failure of unknown cause in children, it would be necessary to rule out ingestion of mushrooms, since the patient could benefit from early treatment with haemoperfusion and thus prevent the deterioration of the renal function and other organs. In our patient, haemoperfusion was not carried out due to the lengthy period of latency since the ingestion of the toxic substance until diagnosis.

[Short-term complications of late preterm infants]. / Complicaciones a corto plazo de los recién nacidos pretérmino tardíos.

INTRODUCTION: Late preterm infants, born at 34-36(+6) weeks gestation, are physiologically more immature than term infants. As a consequence, they have an increased risk of morbidity and mortality. Since health outcomes in prematurity may change depending on local factors we have proposed determine the short-term medical problems of these infants in our hospital. PATIENTS AND METHODS: A retrospective observational study was carried out on all newborn ≥ 34 weeks gestation admitted to Virgen del Rocio hospital from May 2005 to December 2008. We divided this cohort into late preterm (34-36(+6) weeks, n=769) and term (37-41(+6) weeks, n=1460) groups. We compared mortality and morbidity data between the 2 groups. RESULTS: Late preterm group was associated with assisted reproduction, twin pregnancy, caesarean delivery and preeclampsia during pregnancy. The risk of hospitalization was six times greater in these infants and neonatal intensive care admissions were twice as common. The hospital stay was double in this group. Neonatal respiratory morbidity and jaundice were greater in the preterm group. The use of surfactant, oxygen and respiratory support (CPAP and CMV) was also higher. There were no significant differences in hypoglycaemia and neonatal mortality between both groups. CONCLUSIONS: Late preterm infants represent a well-defined risk group for developing complications and should be available the necessary resources should be made available for their special care.

Complicaciones a corto plazo de los recién nacidos pretérmino tardíos / Short-term complications of late preterm infants

Introducción: Los recién nacidos pretérmino tardíos, entre las 34-36+6 semanas de edad gestacional son fisiológicamente más inmaduros que los recién nacidos a término y, por tanto, tienen mayor riesgo de morbi-mortalidad. Dado que los resultados de salud en la prematuridad pueden variar en función de factores locales nos hemos propuesto conocer en nuestro medio las complicaciones que presentan a corto plazo estos recién nacidos. Pacientes y métodos: Estudio observacional retrospectivo de los recién nacidos ≥ 34 semanas de edad gestacional ingresados en el Hospital Virgen del Rocío desde Mayo de 2005 hasta diciembre de 2008. Dividimos la población en dos grupos: pretérmino tardío (34-36+6 semanas de edad gestacional, n = 769) y a término (37-41+6 semanas de edad gestacional, n = 1.460) comparando la mortalidad y la morbilidad a corto plazo entre los dos grupos. Resultados: La prematuridad tardía se asoció con la reproducción asistida, la gestación gemelar, la preclampsia materna y el parto por cesárea. El riesgo de ingreso hospitalario fueseis veces mayor en estos recién nacidos, siendo cerca de dos veces mayor la necesidad de ingreso en la unidad de cuidados intensivos neonatal. El tiempo de estancia hospitalaria fue el doble en este grupo. En cuanto a los motivos de ingresos, se evidenció una mayor incidencia de distrés respiratorio e ictericia. La necesidad de surfactante, oxigenoterapia y soporte respiratorio (presión positiva continua en la vía aérea y ventilación mecánica convencional) fue igualmente mayor. No hubo diferencias significativas entre ambos grupos en relación con la presencia de hipoglucemia que precisara ingreso ni en cuanto a la mortalidad neonatal. Conclusiones: Los recién nacidos pretérmino tardíos de nuestro medio representan un colectivo bien definido de riesgo de presentar complicaciones por lo que deben disponerse los recursos necesarios para su atención diferenciada (AU)

Introduction: Late preterm infants, born at 34-36+6 weeks gestation, are physiologically more immature than term infants. As a consequence, they have an increased risk of morbidity and mortality. Since health outcomes in prematurity may change depending on local factors we have proposed determine the short-term medical problems of these infants in our hospital. Patients and methods: A retrospective observational study was carried out on all newborn ≥ 34 weeks gestation admitted to Virgen del Rocio hospital from May 2005 to December 2008. We divided this cohort into late preterm (34-36+6 weeks, n = 769) and term (37-41+6 weeks, n = 1460) groups. We compared mortality and morbidity data between the 2 groups. Results: Late preterm group was associated with assisted reproduction, twin pregnancy, caesarean delivery and preeclampsia during pregnancy. The risk of hospitalization was six times greater in these infants and neonatal intensive care admissions were twice as common. The hospital stay was double in this group. Neonatal respiratory morbidity and jaundice were greater in the preterm group. The use of surfactant, oxygen and respiratory support (CPAP and CMV ) was also higher. There were no significant differences in hypoglycaemia and neonatal mortality between both groups. Conclusions: Late preterm infants represent a well-defined risk group for developing complications and should be available the necessary resources should be made available for their special care (AU)

Complicaciones neonatales del síndrome HELLP / Neonatal complications associated to HELLP syndrome

Introducción: el síndrome HELLP es un trastorno hipertensivo de la gestación que se asocia a un incremento de la morbilidad y mortalidad materna y perinatal. El objetivo de nuestro estudio es conocer las complicaciones neonatales de este síndrome. Pacientes y método: estudio retrospectivo observacional de los recién nacidos de madres con síndrome HELLP asistidas en el Hospital Virgen del Rocío entre 1995 y 2005. Se estudió a 120 recién nacidos de 99 madres con síndrome HELLP. Se analizaron la edad gestacional, el peso, la longitud, el perímetro craneal, el porcentaje de ingreso y la mortalidad. El peso, la longitud y el perímetro craneal se compararon con los de una población sana de la misma edad gestacional utilizando las gráficas de Lubchenco. Se determinó si había asociación estadística entre el número de plaquetas de la madre y el peso y la mortalidad perinatal. Resultados: el 80% de los partos fueron prematuros, con una media de 33±4 (intervalo intercuartílico, 24-41) semanas de gestación. El peso medio de los recién nacidos fue de 1.834±810 g; la longitud media, 41±6cm y el perímetro craneal, 29±3cm. Un tercio de los neonatos presentaban retraso del crecimiento intrauterino. El 61% de los pacientes precisó ingreso hospitalario, y los motivos más frecuentes fueron la prematuridad y el bajo peso al nacer. Hubo 24 muertes perinatales. En nuestra muestra no se evidenció correlación significativa entre el número de plaquetas de la madre y el peso o la mortalidad del recién nacido. Conclusiones: este síndrome es una complicación rara pero potencialmente grave del embarazo que conlleva un riesgo de problemas maternos y fetales aumentado (AU)

Introduction: HELLP syndrome is a variant of pregnancy-induced hypertension that is associated with significant maternal and perinatal morbidity and mortality. The aim of our study was to investigate the neonatal complications associated to this syndrome. Patients and method: A retrospective observational study was carried out on all newborns of mothers with HELLP syndrome in Virgen del Rocio hospital from 1995 to 2005. There were 120 newborns of 99 mothers with HELLP syndrome. Gestational age, birth weight, length, skull perimeter, number of hospital admissions and mortality were analyzed. The birth weight, length and skull perimeter were compared with a healthy population of the same gestational age using Lubchenco charts. The statistical relationships were determined between the mothers’ platelet counts and the birth weight and perinatal mortality. Results: A total of 80% of pregnancies were preterm delivery with a mean gestational age of 33 weeks. Mean birth weight was 1,834g, length 41cm and skull perimeter 29cm. A third of newborns had fetal growth restriction. 61% of newborns needed admitting to hospital due to prematurity and low birth weight. There were 24 perinatal deaths. We did not find any correlation between the number of platelets of the mother and birth weight or perinatal mortality. Conclusions: HELLP syndrome is an uncommon but potentially serious complication of pregnancy which is associated with an increased risk of adverse maternal and fetal outcome (AU)

Insuficiencia renal aguda tras consumo de setas / No disponible

La recolección y consumo de setas silvestres es una práctica frecuente en nuestro medio y puede dar lugar a intoxicaciones accidentales al ser confundidas con hongos comestibles. Describimos el caso de un niño de 9 años que tras la ingesta de un hongo tóxico comienza horas después con vómitos incoercibles y posterior afectación hepática, hematológica y renal, precisando hemodiálisis. El curso clínico, los hallazgos de laboratorio y la histología renal, donde se evidencia necrosis tubular con membrana basal conservada e infiltrado linfocitario intersticial, confirman el diagnóstico de un síndrome mixto grave. La evolución de la intoxicación fue favorable, recuperándose la función renal y hepática. Ante cualquier caso de insuficiencia renal aguda no filiada en niños, habría que descartarla exposición a tóxicos, ya que podría beneficiarse de un tratamiento precoz con hemoperfusión y así evitar el agravamiento de la función renal y resto de órganos. En nuestro paciente la hemoperfusión no fue realizada por el largo período de latencia que había ocurrido desde la ingesta del tóxico hasta su diagnóstico (AU)

The picking and consumption of wild mushrooms is a frequent practice in our region and may lead to accidental poisoning when confused with edible mushrooms. We describe the case of a 9-year-old boy who, following the ingestion of a poisonous mushroom, presented with uncontrollable vomiting and subsequent hepatic, haematological and renal failure some hours later. The patient required haemodialysis. The clinical course, laboratory findings and renal histology, which showed tubular necrosis with basal membrane preserved and lymphocytic interstitial infiltrate, confirmed the diagnosis of a severe mixed syndrome. The patient evolved favourably after the poisoning, recovering renal and liver function. In any case of acute renal failure of unknown cause in children, it would be necessary to rule out ingestion of mushrooms, since the patient could benefit from early treatment with haemoperfusion and thus prevent the deterioration of the renalfunction and other organs. In our patient, haemoperfusion was not carried out due to the lengthy period of latency since the ingestion of the toxic substance until diagnosis (AU)