ABSTRACT
Resumen Las cardiopatías congénitas (CC) tienen una incidencia aproximada de 5-10 CC por cada 1.000 recién nacidos vivos, 1/3 requieren intervención antes del primer mes de vida. Uno de cada 10 RN con CC muere antes del primer año de vida sin diagnóstico o con diagnóstico tardío de CC, y de estos, el 25% muere durante la primera semana. Se han realizado estudios utilizando la saturometría pre y posductal resultando como screening positivo la saturación por debajo de 96%, con resultados muy satisfactorios. La ecocardiografía Doppler color es el estudio que permite con mayor sensibilidad y especificidad para descartar la presencia de una enfermedad cardíaca en la etapa neonatal. Objetivos: diagnosticar en forma temprana las cardiopatías asintomáticas en la etapa neonatal que nazcan en nuestro sanatorio, centro de tercer nivel y referente nacional en Cardiología Pediátrica. Población y método: ingresaron al estudio todos los recién nacidos cuyo parto o cesárea se haya realizado en el Sanatorio Americano desde junio de 2008 hasta julio de 2011 inclusive, que no tuviesen indicación formal de Ecocardiograma por otra causa (soplo, prematuridad, cianosis, saturometría patológica, etcétera) y que hayan aceptado el estudio mediante firma del consentimiento. Resultados: el número de pacientes ingresados al estudio fue de 307. Se encontraron nueve pacientes con ductus arterioso permeable (2,7% del total) y 3 pacientes con comunicación interauricular tipo ostium secundum (1% del total). Total de cardiopatías encontradas 12, (3,7% del total). Conclusiones: la posibilidad de utilizar este screening en instituciones como la nuestra es posible debido a la presencia permanente de los técnicos y el correcto equipamiento. La aceptación por parte de padres y pediatras tratantes fue excelente.
Summary Congenital heart diseases (CHD) have an incidence rate of approximately 5-10 CC per 1000 live newborns, 1/3 need surgery before the first month of life. One in every 10 newborns with CHD dies before the 1st year of life without diagnosis or with delayed diagnosis of CHD, and 25% of these die during the first week. There have been studies using pre and postductal oximetry measurements, resulting in positive screening saturation below 96%, with very satisfactory results. Colour Doppler echocardiography is the study that allows greater sensitivity and specificity and the one that rules out the presence of a heart condition in the neonatal stage. Objective: to check the high sensitivity and specificity of the study in our midst. To avoid a neonatal discharge without diagnosis of CHD in our sanatorium, third level facility and benchmark national in pediatric cardiology. Population and method: newborns whose birth or caesarean section had been done in Sanatorio Americano from June 2008 until July 2011 were admitted to the study and those who had no formal indication of echocardiography by another cause. (blow, prematurity, cyanosis, etc.) and also those that have accepted the study by signature of consent. Results: the number of patients admitted to the study was 307. 9 patients were found with patent ductus arteriosus (2.7% of the total) and 3 patients with atrial septal defect type ostium secundum, (1% of the total). Heart disease found (3.7% of the total), 12 total. Conclusions: approval rates among parents and treating pediatricians were excellent.
ABSTRACT
Objective To assess the application value of serum procalcitonin(PCT)for the differentiation between the neonates with or without septicemia.Methods PCT,C-reactive protein(CRP),blood and blood culture tests were done in 75 cases of neonatal septicemia as the therapy group,and 74 neonates without the signs of infection as the control group after the admission of our hospital One week later,the therapy group also re-examined the PTC and CRP tests.Furthermore,the results were analyzed.Results The levels of CRP(23.26±5.68)mg/L and PCT(7.61±4.53)ng/L in therapy group were dramatically reduced compared with(4.09±1.09)mg/L,(1.95±0.25)ng/L in therapy group,and(6.42±4.54)mg/L,(0.45±0.16)ng/L in the control group before therapy,the t values are 28.71,12.97 and 19.97,14.08 respectively,and p value are both less than 0.01.The positive rates of PTC,CRP and blood culture were 82.7％,48.0％ 28.0％ before the admition to hospital.The differences of PTC and CRP,PTC and blood culture had statistical significances(x2=5.64,P＜0.05;x2=10.40,P＜0.01).If 2.5 μg/L of PCT and 8mg/L of CRP would be regarded as cutoff point in our study,the sensitivity and specificity of PCT or CRP for diagnosis of neonatal septicemia was 82.7％ and 80.3％,48.7％ and 78.4％.Conclusion Our data suggested that the serum PTC is a valuable marker for the early diagnosis of neonatal septicemia.
ABSTRACT
Objective To investigate the urodynamic pattern in infants with no apparent lower urinary tract symptoms. Methods Video cystometry with simultaneous perineal EMG recording was performed in 14 infants (10 male and 4 female,age 2 d to 2.5 months) with congenital renal pelvis dilatation who were screened for potential bladder dysfunction and VUR.No abnormal lower urinary tract was observed at examination. Results The post-voiding residual urine volume was (1.2?0.8)ml.The maximum bladder capacity was (33?24)ml,with voiding efficiency being 0.87?0.17.Detrusor instability occurred in 21%(3/14) of the subjects. The intermittent voiding pattern was observed in 64% (9/14) of the subjects and characterized by one or repeated increase in sphincter activity with simultaneous rise in voiding detrusor pressure curve. The maximum voiding detrusor pressure was (74?24)cmH 2O.The peak voiding detrusor pressure induced by dyssynergia could rise up to more than 100 cmH 2O. Conclusions In infants with no apparent lower urinary tract symptoms,bladder instability is uncommon,but the capacity is lower than the expected normal range.The high voiding pressure is induced by detrusor-sphincter dyssynergia.