Impacto de la edad, las comorbilidades y las complicaciones en pacientes con COVID-19 con síndrome de dificultad respiratoria aguda en la ventilación mecánica invasiva. Estudio multicéntrico observacional / Impact of Age, Comorbidities and Complications in COVID-19 Patients with Acute Respiratory Distress Syndrome on Invasive Mechanical Ventilation. An Observational Multicenter Study

Objetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA) y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza-mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en 5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante el segundo semestre de 2020.Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR, que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el se-gundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más fre-cuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y las alteraciones de parámetros clínicos y de laboratorio registrados.Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001). Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad. Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60 años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.

Objectives: Millions of patients with COVID-19 were admitted to intensive care world-wide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comor-bidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization.Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020.Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who devel-oped ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hyper-tension) and the complications of shock, acute renal failure (AKI) and pneumonia as-sociated with mechanical ventilation (VAP), on the one hand, and the alterations of re-corded clinical and laboratory parameters, were analyzed.Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hyper-tension and diabetes, and complications of ARF and shock were significantly associat-ed with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality.Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis

Retinopatía de la prematuridad agresiva posterior / Aggressive Posterior Retinopathy of Prematurity

Introducción: La retinopatía del prematuro es una enfermedad ocular provocada por una alteración en la vasculogénesis de la retina, que lleva a la pérdida parcial o total de la visión. Objetivo: Presentar el primer caso, en la provincia de Santa Clara, de retinopatía de la prematuridad agresiva posterior y el tratamiento realizado. Presentación del caso: Niña prematura con más de 5 factores de riesgo al nacer que presentó retinopatía de la prematuridad agresiva posterior y se le realizó tratamiento con bevacizumab intravítreo. Conclusiones: La evolución de la niña en un período de un 1 año resultó satisfactoria con regresión total de la enfermedad. El tratamiento establecido constituye un método alternativo con buenos resultados en algunas condiciones específicas como la retinopatía del prematuro agresiva posterior(AU)

Introduction: Retinopathy of prematurity is an ocular disease caused by an alteration in retinal vasculogenesis, leading to partial or total loss of sight. Objective: To present the first case, in the province of Santa Clara, of aggressive posterior retinopathy of prematurity and the treatment performed. Case presentation: Premature girl with more than 5 risk factors at birth who presented aggressive posterior retinopathy of prematurity and was treated with intravitreal bevacizumab. Conclusions: The evolution of the girl in a period of 1 year was satisfactory with total regression of the disease. The established treatment constitutes an alternative method with good results in some specific conditions such as aggressive posterior retinopathy of prematurity(AU)

Evaluación de la salud sexual, mental y sueño en hombres chilenos posterior a infección por SARS-CoV-2 / Sexual, physical, mental and sleep sequelae four months after SARS-CoV-2 disease

BACKGROUND: Long term sequelae can be observed after SARS-CoV2. AIM: To describe the sexual, physical, mental and sleep sequelae four months after SARS-CoV2 diagnosis. PATIENTS AND METHODS: Patients recovering from SARS-CoV2 with different degrees of disease severity were consecutively included and separated in two study groups, namely Group 1 including patients that had an acute respiratory distress syndrome (ARDS) and Group 2 including those with mild or moderate COVID-19. Handgrip strength, respiratory polygraphy (RP), Quality of life using the SF-12 questionnaire, and the international index of erectile (IIEF-5) function were assessed. RESULTS: Twenty patients who had ARDS, and 10 without ARDS were included. Erectile dysfunction was observed in 77 and 10% of patients with and without ARDS, respectively (p < 0.01). The figures for sleep obstructive apnea were 82 and 40% respectively (p = 0.02) and for the physical domain SF-12 score were 39.2 and 47.9 points respectively (p = 0.01). No differences in muscle strength were observed. After a multivariable analysis, previous ARDS due to COVID-19 was independently associated with erectile dysfunction, with an odds ratio of 30.6 (95% confidence intervals, 3.08300.3, p = 0.003). CONCLUSIONS: Among men with ARDS due to COVID-19, the prevalence of erectile dysfunction was high and independently associated with a severe disease four months after discharge.

Enfisema pulmonar congênito: relato de caso / Congenital pulmonary enphysema: case report

Introdução: O enfisema pulmonar congênito (EPC) é uma doença rara, possuindo uma incidência de 1:20-30 mil nascimentos, é mais comum no sexo masculino do que no feminino, em uma razão de 3:1 e sua etiologia permanece desconhecida. Um terço dos casos são sintomáticos ao nascer e praticamente todos são diagnosticados nos primeiros seis meses de vida. Relato de Caso: Recém-nascido (RN) do sexo masculino, evoluiu com desconforto respiratório precoce, sendo encaminhado ao centro de terapia intensiva. Após uso de continuous positive airway pressure (CPAP) e cateter nasal de oxigênio de 12 horas, resultou em bom padrão respiratório e boa saturação. Após realização de tomografia computadorizada, foi diagnosticado o EPC. Conclusão: O EPC é uma patologia rara e deve ser suspeitado em RN com desconforto respiratório, atribuindo-se importância aos vários diagnósticos diferenciais possíveis. Apesar da etiologia incerta, é de fácil diagnóstico e possui opções de manejo clínico e cirúrgico.

Introduction: Congenital pulmonary emphysema (EPC) is a rare disease, with an incidence of 1:20-30 thousand births, it is more common in males than in females, in a ratio of 3:1 and its etiology remains unknown. One third of the cases are symptomatic at birth and practically all are diagnosed in the first six months of life. Case Report: Newborn (NB) male, developed early respiratory distress, being referred to the intensive care unit. After using continuous positive airway pressure (CPAP) and a 12-hour oxygen nasal catheter, it resulted in a good breathing pattern and good saturation. After performing computed tomography, EPC was diagnosed. Conclusion: EPC is a rare pathology and should be suspected in newborns with respiratory distress, with importance being given to the various possible differential diagnoses. Despite its uncertain etiology, it is easy to diagnose and has options for clinical and surgical management.

Manifestaciones extrapulmonares de COVID-19. Una revisión / Extrapulmonary manifestations of covid-19. A review

La enfermedad por coronavirus 2019 (covid-19) se presenta en una amplia variedad de cuadros clínicos que van desde formas completamente asintomáticas o leves hasta una enfermedad rápidamente progresiva, incluidas manifestaciones pulmonares y extrapulmonares. El SARSCoV-2, el agente etiológico del covid-19, accede a sus células diana a sistema renina-angiotensina. Esta enzima se expresa en células endoteliales vasculares, epitelio tubular renal, células de Leydig en los testículos, pulmones, riñones, cerebro, corazón, vasculatura y tracto gastrointestinal. ,,,,,, Como tal, las manifestaciones clínicas del covid-19 se explican por la distribución tisular de la ECA-2. Más allá de la afectación tisular "per se", otra característica patológica es el fenómeno de la "tormenta de citocinas" (CS). El CS es una respuesta inmune exagerada caracterizada por un alto nivel de citocinas inflamatorias circulantes sostenidas en el tiempo. Es rápidamente progresivo y tiene una alta mortalidad. El CS se ha detectado en pacientes críticos con covid-19 y se considera una de las principales causas de síndrome de dificultad respiratoria aguda (SDRA) e insuficiencia multiorgánica. Los niveles séricos de citocinas proinflamatorias aumentan significativamente en pacientes con causar inflamación y lesión del sistema nervioso central (SNC). Respaldando este punto de vista, los niveles de IL-6 se correlacionan positivamente con la gravedad del covid-19. Este síndrome se ha descrito en sepsis, síndrome hemofagocítico y en otras infecciones por coronavirus como el síndrome respiratorio agudo severo (SARS) o el síndrome respiratorio de Oriente Medio (MERS). Aunque la afectación pulmonar se ha descrito bien en muchos informes, las manifestaciones extrapulmonares todavía están mal descritas. Este artículo revisará las manifestaciones no pulmonares del covid-19. Los principales síntomas extrapulmonares comprenden los neurológicos, cardíacos, oftalmológicos, musculares, hematológicos, cutáneos y gastrointestinales, así como la afectación hepática y renal. Cada una de estas manifestaciones puede surgir durante la evolución de la enfermedad o construir su manifestación inicial

Coronavirus disease 2019 (covid-19) presents in a wide variety of clinical pictures ranging from completely asymptomatic or mild forms to rapidly progressive disease, including pulmonary and extrapulmonary manifestations. SARS-CoV-2 ­the etiological agent of covid-19- access to their target cells via a transmembrane protein, the angiotensin-converting enzyme II (ACE2). ACE-2 is a type-I metallocarboxypeptidase with homology to ACE, an essential enzyme in the Renin-Angiotensin System. [1] This enzyme is expressed in vascular endothelial cells, renal tubular epithelium, Leydig cells in the testes, lungs, kidneys, brain, heart, vasculature, and gastrointestinal tract.[2-7] As such, the clinical manifestations of covid-19 are explained by the tissular distribution of ACE-2. Beyond the tissular affectation "per se", another pathological feature is the "cytokine storm" phenomenon (CS). CS is an exaggerated immune response characterized by a high level of circulating inflammatory cytokines sustained over time. It is rapidly progressive and has a high mortality. CS has been detected in critical patients with covid-19 and it is considered a major cause of acute respiratory distress syndrome (ARDS) and multiorgan failure. Serum levels of proinflammatory cytokines are significantly increased in patients with ARDS, and their levels are positively correlated with mortality.[8, 9] CS may also cause inflammation and injury of the Central Nervous System (CNS) Supporting this view, IL-6 levels positively correlate with covid-19 severity.[10] This syndrome has been described in sepsis, hemophagocytic syndrome and in other coronavirus infections like the severe acute respiratory syndrome (SARS) or the Middle East respiratory syndrome (MERS). Although lung involvement has been well described in many reports, extra-pulmonary manifestations are still poorly described. This paper will review the non-pulmonary manifestations of covid-19. Main extra-pulmonary symptoms comprise the neurologic, cardiac, ophthalmologic, muscular, hematologic, cutaneous, and gastrointestinal ones, as well as hepatic and renal involvement. Each one of these manifestations can arise during the disease evolution or constitute their initial manifestation.

Caracterización clínica, humoral y epidemiológica de pacientes graves y críticos con la COVID-19 / Clinical, humoral and epidemiological characterization of serious and critically ill patients with COVID-19

Introducción: Los investigadores advierten sobre la existencia de personas con formas muy graves de la COVID-19. Es notable el reporte de estos enfermos, la existencia de complicaciones favorecedoras de situaciones de amenaza vital y las diferencias hemogasométricas y en otros parámetros bioquímicos. Objetivo: Caracterizar aspectos clínicos, epidemiológicos y humorales de enfermos con la COVID-19 durante su estadía en la unidad de cuidados intensivos. Métodos: Se realizó un estudio descriptivo y transversal en 9 pacientes con la COVID-19 ingresados en la unidad de cuidados intensivos, de marzo a mayo de 2020. Los datos se obtuvieron de las historias clínicas. La información procesada se expresó en frecuencias absolutas y porcientos y los resultados se reflejaron en tablas y gráficos. Entre las variables analizadas figuraron: la edad, sexo, estado clínico y al egreso de los pacientes y la letalidad. Resultados: Predominaron los hombres (77,8 por ciento), las mujeres evolucionaron mejor (33,3 por ciento graves, ninguna crítica). El 88,8 por ciento de los enfermos tenían al menos una enfermedad crónica asociada. El 33,3 por ciento de los pacientes fueron asintomáticos al ingreso, la neumonía grave y el síndrome de distrés respiratorio agudo, fueron la causa más frecuente de complicación. Conclusiones: Los pacientes fueron mayoría del sexo masculino y todos los críticos fueron de este sexo; con proporciones similares en los grupos etarios; con comorbilidades, el mayor porcentaje, fundamentalmente hipertensión arterial; al ingreso presentaron tos, fiebre, disnea y decaimiento. Todos los críticos demoraron 4 días o más en solicitar asistencia médica. El motivo de ingreso a cuidados intensivos fue la neumonía grave/síndrome de dificultad respiratoria del adulto (AU)

Introduction: Researchers warn of people with severe forms of COVID-19. It is notable the report of these patients, the existence of complications favoring life-threatening situations and the hemogasometric differences and in other biochemical parameters. Objective: To characterize clinical, epidemiological and humoral aspects of patients with COVID-19 during their stay in the intensive care unit. Methods: A descriptive and cross-sectional study was carried out in 9 patients with COVID-19 admitted to the intensive care unit from March to May 2020. Data were obtained from medical records. The processed information was expressed in absolute frequencies and percentages and the results were reflected in tables and graphs. Among the variables analyzed were: age, sex, clinical status and at discharge of the patients and fatality. Results: Men predominated (77,8 percent), women evolved better (33,3 percent serious, no critical). 88,8 percent of the patients had at least one associated chronic disease. 33,3 percent of the patients were asymptomatic upon admission, severe pneumonia and acute respiratory distress syndrome were the most frequent cause of complication. Conclusions: Most of the patients were male and all the critics were male; with similar proportions in age groups; with comorbidities the highest percentage, mainly hypertension; on admission they presented cough, fever, dyspnea and decay; all critical patients took 4 days or more to request medical assistance. The reason for admission to the intensive care unit was severe pneumonia/adult respiratory distress syndrome(AU)

Reactive airways dysfunction syndrome following inhalation of hydrogen chloride vapor

Hydrogen chloride is available commercially as an anhydrous gas or an aqueous solution, hydrochloric acid. Exposure to this gas has been associated with the development of reactive airways dysfunction syndrome. However, there are few published reports. A 37-year-old woman developed progressive bronchospasm and acute respiratory failure after cleaning an enclosed space with an unknown concentration of hydrochloric acid gas from a cleaning substance. She had no prior history of asthma or atopy. Severe bronchospasm developed, leading to hypoxemia and diffuse interstitial infiltrates, necessitating orotracheal intubation and admission to the intensive care unit. Asthma-like symptoms such as cough, wheezing, and dyspnea; requiring bronchodilators, and repeated hospitalizations are persistent a year after the accident. Pulmonary function testing showed mild airflow obstruction.

Caso clínico: Síndrome de distrés respiratorio del adulto en paciente COVID-19 en ventilación mecánica con aspergilosis pulmonar invasiva / Clinical case: Adult respiratory distress syndrome in COVID-19 patient on mechanical ventilation with invasive pulmonary aspergillosis

The bibliography on the management of the COVID-19 patient in intensive care units is increasing. Research and publication of results help to optimize the management of these patients and the consequent improvement of results. We present the case of a patient admitted to intensive care due to adult respiratory distress syndrome secondary to COVID-19 pneumonia and personal history of liver transplantation the previous year and pulmonary hypertension under treatment. During admission, the patient requires pronation, neuromuscular blockers, and nitric oxide. Invasive aspergillosis is diagnosed and requires percutaneous tracheostomy.

La bibliografía sobre el manejo del paciente COVID-19 en las unidades de cuidados intensivos va en aumento. La investigación y publicación de resultados ayudan a la optimización del manejo de estos pacientes y la mejora consecuente de resultados. Presentamos el caso de un paciente que ingresa en cuidados intensivos (UCI) por síndrome de distrés respiratorio del adulto secundario a neumonía COVID-19 y antecedentes de trasplante hepático el año previo e hipertensión pulmonar en tratamiento. Durante el ingreso, el paciente precisa pronación, relajación neuromuscular y óxido nítrico. Se diagnostica de aspergilosis invasiva y precisa traqueostomía percutánea.

COVID-19 associated pulmonary aspergillosis (CAPA) in a pregnant woman

Viral or bacterial co-infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in the literature. However, the knowledge on Aspergillus co-infection among patients with coronavirus disease 2019 (COVID-19) is limited. COVID‐19‐associated pulmonary aspergillosis (CAPA) has been seen in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS), which has raised concerns about the worsening disease course of COVID-19 and increasing mortality. We describe a clinical case of CAPA infection and acute respiratory distress syndrome (ARDS) with a deathly outcome in a previously well, non-immunocompromised pregnant woman with intrauterine death of the fetus. Hence, we suggest that clinicians and pathologists keep alerting the possible occurrence of pulmonary aspergillosis in severe/critical COVID-19 patients, and aggressive investigations should be done to rule out the possibility of CAPA so that early treatment can be administrated.

Malaria complicada por síndrome de dificultad respiratoria aguda en paciente embarazada: reporte de un caso / Malaria complicated by acute respiratory distress syndrome in a pregnant patient: case report

RESUMEN Introducción: El síndrome de dificultad respiratoria aguda del adulto se presenta como una rara complicación obstétrica, siendo una de sus posibles etiologías la infección derivada por Plasmodium falciparum. La malaria complicada es cada vez menos frecuente, pero se asocia a una alta morbilidad y mortalidad en regiones endémicas, especialmente en pacientes embarazadas, quienes presentan un mayor riesgo de contraerla. Caso clínico: Presentamos el caso clínico de una embarazada con síndrome de dificultad respiratoria aguda del adulto secundario a una malaria complicada y que tiene un aborto de 14 semanas de gestación como consecuencia de esta complicación materna. Discusión: Se realiza una descripción del manejo de la paciente, a quien, a pesar del resultado obstétrico desfavorable, evoluciona satisfactoriamente, sin secuelas a largo plazo. En los casos de malaria en gestantes, es crucial no solo el diagnóstico precoz, sino también el inicio inmediato del tratamiento, con el fin de evitar la progresión a sus formas más severas.

ABSTRACT Introduction: The acute respiratory distress syndrome of the adult presents as a rare obstetric complication, being one of its possible etiologies the Plasmodium falciparum infection. Complicated malaria cases are increasingly rare but are associated with a high morbidity and mortality in endemic regions, especially in pregnant patients who are at a high risk of contracting malaria. Clinical case: We present the case of a pregnant patient with acute respiratory distress syndrome due to complicated malaria with a 14 weeks miscarriage secondary to maternal complications Discussion: We describe the patient's approach, who despite of the unfavorable obstetric outcome, had a satisfactory evolution without long term sequels. In obstetric malaria cases, it is not only crucial the early diagnosis but also the immediate treatment, in order to avoid the development of severe stages.

Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study / Impacto da diabetes mellitus maternal sobre a mortalidade e morbidade de crianças com muito baixo peso ao nascer: um estudo em diversos centros da América Latina

OBJECTIVES: To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). METHODS: This was a cohort study with retrospective data collection (2001-2010, n = 11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. RESULTS: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p = 0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). CONCLUSIONS: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC. .

OBJETIVOS: Comparar mortalidade e morbidade em crianças de muito baixo peso (MBP) filhas de mães com e sem diabetes mellitus (DM). MÉTODOS: Estudo de coorte com coleta retrospectiva de dados (2001-2010, n = 11.991) da rede Neocosur. Odds ratios ajustados foram calculados para mortalidade e morbilidade neonatal em função da DM materna. Mulheres sem DM serviram como grupo de referência. RESULTADOS: A taxa de DM materna foi de 2,8% (IC 95% 2,5-3,1), mas um aumento significativo (p = 0,019) entre 2001-2005 (2,4%) e 2006-2010 (3,2%) foi observado. As mães com DM eram mais propensas a ter recebido um curso completo de esteroides pré-natais do que as sem DM. Os bebês de mães diabéticas tinham uma idade gestacional e peso ao nascer um pouco maior do que crianças filhas de não DM. A distribuição dos escores z do peso ao nascer, pequeno para idade gestacional e de Apgar foi semelhante. Não houve diferenças significativas entre os dois grupos em termos de síndrome do desconforto respiratório, displasia broncopulmonar, hemorragia intraventricular, leucomalácia periventricular e persistência do ductus arteriosus. Mortalidade na sala de parto, mortalidade total, necessidade de ventilação mecânica e taxas de sepse neonatal precoce foram significativamente menores no grupo diabético, enquanto enterocolite necrosante (NEC) foi significativamente maior em recém-nascidos de mães diabéticas. Em análises de regressão logística NEC foi a única condição independentemente associada com DM (OR ajustado 1,65 [IC 95% 1,21 -2,27]). CONCLUSÕES: Crianças MBP de DM não parecem estar em um excesso de risco de mortalidade ou morbidade precoce, exceto NEC. .

Neonatal Morbidities Associated with Histologic Chorioamnionitis Defined Based on the Site and Extent of Inflammation in Very Low Birth Weight Infants

Conflicting results on the influences of histologic chorioamnionitis (HC) on neonatal morbidities might be partly originated from using different definition of HC. The aim of this study was to determine the relationship between HC and neonatal morbidities using definition of HC that reflects the site and extent of inflammation. This was a retrospective cohort study of 261 very low birth weight (VLBW) infants admitted at a tertiary academic center. Based on the site of inflammation, HC was categorized: any HC; amnionitis; funisitis; amnionitis+funisitis. The extent of inflammation in each site was reflected by sub-defining high grade (HG). The incidences of morbidities in infants with and without HC were compared. The bronchopulmonary dysplasia (BPD) rate was significantly higher in infants with amnionitis and the severe retinopathy of prematurity (ROP) rate was significantly higher in infants with any HC and funisitis. After adjustment for both gestational age and birth weight, the respiratory distress syndrome (RDS) rate was significantly lower in infants with all categories of HC except for HG amnionitis and HG funisitis, which are not associated with lower RDS rate. HG amnionitis was significantly associated with increased BPD rate but the association of HC with severe ROP disappeared. In conclusion, HC is significantly associated with decreased RDS and HG amnionitis with increased BPD while lacking association with other neonatal morbidities in VLBW infants. The association with HC and neonatal morbidities differs by the site and extent of chorioamnionitis.

Impacto del síndrome de dificultad respiratoria en recién nacidos de muy bajo peso de nacimiento: estudio multicéntrico sudamericano / Impact of respiratory distress syndrome in very low birth weight infants: a multicenter South-American study

Objetivo. Analizar la incidencia, factores de riesgo, morbilidad relevante, empleo de recursos y mortalidad, en recién nacidos (RN) de muy bajo peso de nacimiento (<1500 g) con síndrome dedificultad respiratoria (SDR).Población y métodos. Estudio observacional y analítico. Se incluyeron 5991 RN vivos <1500 g de las 20 unidades de la Red Sudamericana de Neonatología (Neocosur) entre 2002 y 2007. Los datos se ingresaron prospectivamente en fichaselectrónicas en línea en el sitio web.Resultados. La edad gestacional (media) fue de 29,1 semanas (IC 95 por ciento 29,06-29,2) y el peso de nacimiento (medio) de 1100,5 g (IC 95 por ciento 1093,79-1107,3). La incidencia de SDR fue del 74 por ciento (IC 95 por ciento73-75). El principal factor de riesgo para el SDR fue la menor edad gestacional (p< 0,001), mientrasque la administración antenatal de corticoides (OR: 0,59; IC 95 por ciento 0,49-0,72), sexo femenino (OR: 0,77; IC 95 por ciento 0,67-0,89) y rotura prematura de membranas (OR: 0,81; IC 95 por ciento 0,68-0,96)constituyeron factores protectores. En los RN con SDR, el empleo antenatal de corticoides se asoció a menor mortalidad (OR: 0,40; IC 95 por ciento0,34-0,47). El uso de recursos fue mayor en el grupo con SDR, con más empleo de surfactante(74,3 por ciento contra 7,3 por ciento, p< 0,001), de ventilaciónmecánica (82,1 por ciento contra 23,8 por ciento, p< 0,001), más días de oxigenoterapia (p< 0,001) y de hospitalización (p< 0,001).Conclusiones. El SDR tuvo una elevada incidencia en RN< 1500 g y produjo un aumento en la mortalidad, morbilidad y en el empleo de recursos.

Objective. To analyze the incidence, risk factors, major morbidity, mortality and resource employment in very low birth weight infants (< 1500 g) with respiratory distress syndrome (RDS).Methods. Descriptive study using prospectively obtained on-line information from a data base of 20 units belonging to the South American Neocosur Network. A total of 5991 VLBW infants were registered during years 2002-2007. Results. The mean gestacional age was 29.1 weeks (95 percent CI 29.06-29.21) and the mean of birth weight was 1100.5 g (95 percent CI 1093.79-1107.37). The global incidence of RDS was 74 percent (95 percent CI 73-75). Antenatal steroids were administered to 73 percent of this population. The main risk factor was lower gestational age (p< 0.001); where as prenatal steroids (OR: 0.59; 95 percent CI 0.49-0.72), female gender (OR: 0.77; 95 percent CI 0.67-0.89) and premature rupture of membranes (OR: 0.81; 95 percent CI 0.68-0.96) were protective factors. Antenatal steroids was also associated with a decrease in mortality in those infants that presented with RDS (OR: 0.40; 95 percent CI 0.34-0.47). Use of resources was higher in the group with RDS, with a greater use of surfactant (74.3 percent vs. 7.3 percent, p< 0.001), mechanical ventilation (82.1 percent vs. 23.8 percent, p< 0.001), and more days of oxygen (median of 8 vs. 1 day, p< 0.001) and hospitalization (median of 61 vs. 45 days, p< 0.001). RDS was associated to an increase risk in the incidence of ROP, PDA, late onset sepsis, severe IVH and oxygen requirement at 36 weeks of corrected gestational age. Conclusions. RDS had a high incidence in very low birth weight infants, despite the frequent use of antenatal steroids. VLBW Infants withRDS had a higher mortality and an increase risk of relevant morbidity. RDS also increased use of resources.

Prevalence and predisposing factros of retinopathy of prematurity in very low-birth-weight infants discharged from NICU

Retinopathy of prematurity [ROP] is a disease of the eye caused by disorganized growth of retinal blood vessels resulting in scarring and retinal detachment. All preterm babies are at high risk for ROP, and very low birth weight is an additional risk factor. An increased incidence of ROP is expected in Iran because of improved survival of low birth weight and premature babies, and it is obvious that pediatricians and ophthalmologists are concerned about prevention and timely treatment of ROP in these children. To asses the real situation of ROP in our NICU we studied its prevalence and risk factors. This was a retrospective analysis of premature infants with birth weight of

Factores de riesgo para diabetes gestacional en población obstétrica / Risk factors for gestacional diabetes in obstetric popullation

La diabetes mellitus gestacional (DMG) se define como una intolerancia a los carbohidratos de severidad variable, que comienza o que es detectada por primera vez durante el embarazo.Su prevalencia es del 7% según la población estudiada y la prueba de diagnóstico utilizada. En Colombia los datos son inferiores a los descritos en la literatura con reportes que van desde 0,34% a 2,03%. Los hispanos son considerados población de alto riesgo para diabetes gestacional, estosdatos son disímiles de lo reportado en la literatura internacional y sería pertinente preguntarse si esta población considerada como de alto riesgo corresponde únicamente a los hispanos que viven en Estados Unidos ó Europa. No existen estudios propios que determinen cuáles son los factores de riesgo para nuestra población obstétrica. Conociendo la controversia sobre la realización del tamizaje, es importante identificar a través de la revisión de la evidencia los factores de riesgo para diabetes gestacional.

Gestational Diabetes Mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. it’s the literature reports prevalence of 7%, rate which varies according to the population studied and the diagnostic test utilized. In Colombia the scant data available, shows prevalencerates that are lower ranging from 0,34 % to 2,03 %. In the United States the population identified as Hispanicis considered to be at high risk for GDM. These data are different to the international literature and would be then pertinent to ask if ethnicity as a risk factor and as described before, corresponds only to the Hispanicpoulations that live in the United States or Europe. There aren´t studies available that determine which are therisk factors for our obstetric population. Due to the controversy currently existing in the literatureabout the tests that should be used or not for screening for GDM, it is important to review the current evidence available.

[Evaluation of mortalitiy rate and complications of neonatal respiratory distress syndrome treated with mechanical ventilation and surfactant therapy]

Since the first successful report of endotracheal surfactant administration in 10 neonates with RDS in 1980 by Fujiwara, several studies have shown that surfactant administration would decrease neonatal mortality and morbidity such as Pulmonary Air leak [PAL] or Brochopulmonary dysplasia [BPD]. This study was conducted in NICU of Mahdieh hospital between March 2002 and March 2005 to evaluate the mortalitiy rate and complications of neonates with RDS who have recieved mechanical ventilation and surfactant. Between March 2002 and March 2005, 124 neonates [36% females and 64% Males] with RDS, admitted in NICU were enrolled in this study. 25% of the patients were fullterm and 75% were preterm. All of them underwent mechanical ventilation due to either O2 requirement of more than 60% [through Hood] or arterial PH of less than 7.25. Surfactant was administered as 4 cc/kg per dose [Maximum 2 doses] if mean Air way pressure [MAP] was equal or more than 7 cmH[2o] or fiO[2] equal or more than 40%. Neonatal Mortality Rate [NMR] in these 124 patients was 27%. PAL was noted in 23.3% and BPD in 12.9% of cases. This study showed that with administration of surfactant the incidence of NMR was the same as several previous studies, albeit BPD incidence was lower and the incidence of PAL was higher than that of recent studies. Higher incidence of PAL may be due to late low dose surfactant administration or the quality of medical and nursing care, which must be impressed. The lower incidence of BPD in our study may be resulted from preliminary administration of prenatal dexamethasone

Nager acrofacial dysostosis: an unusual association with both upper and lower eyelid colobomas.

Nager acrofacial dysostosis comprises defects of cranio facial region and limbs (mostly upper) with variable associated anomalies. The cranio- facial complex is indistinguishable from the mandibulo facial dysostosis (Treacher Collins syndrome). About 80 cases have been described in the literature. We describe the case of a one-day-old male neonate who presented with the typical features of the disease complex. Although normal life span has been reported, our patient died on the second day due to cardio respiratory failure. We report this case because of its rarity and an unusual associated feature of bilaterally symmetrical upper and lower eyelid colobomas.

Retinopatía del prematuro. Incidencia y factores de riesgo en la ciudad de Corrientes / Retinopathy of premature. Incidence and risk factors in the Corrientes city

Objetivo: detectar la incidencia y los factores de riesgo de la retinopatía del prematuro (ROP) en nuestro medio y analizar la influencia de éstos en el desarrollo de la enfermedad. Material y métodos: se analizaron 584 historias clínicas de neonatos de menos de 36 semanas de gestación, de menos de 2000 grs. de peso al nacer, y todos aquellos que estuvieron expuestos a oxigenoterapia o que hubieran presentado sepsis o síndrome de distress respiratorio (SDR), que fueron atendidos en el Hospital José Ramón Vidal por el Servicio de Oftalmología desde enero del año 1997 a enero de 2001. Resultados: De los 584 pacientes examinados, se encontro que 154 pacientes (26,4 por ciento) desarrollaron la ROP. En el primer examen realizado a estos pacientes que desarrollaron ROP, en el 74 por ciento de los casos se observó Estadio 1 de la Clasificación Internacional de ROP, y con relación a la evolución de la enfermedad en controles sucesivos y sin tratamiento se vió que en el 83,8 por ciento de los casos la evolución fue buena. Conclusiones: La incidencia de la ROP en la muestra estudiada fue 26,4 por ciento. Con respecto al peso al nacer y la edad gestacional ambas variables están estrechamente relacionadas con la presencia de la enfermedad; cuanto más bajo el peso y menor la edad gestacional, mayores son las probabilidades de presentar la ROP. Sin embargo en el grupo de pacientes con un peso al nacer mayor de 1500 grs. y con edad gestacional mayor de 32 semanas se observó una incidencia mayor a la publicada en estadísticas internacionales. Esto podría estar relacionado con la alta incidencia de sepsis neonatal en nuestro medio. El análisis estadístico de los factores de riesgo, demostró ser significativo para la oxigenoterapia y la sepsis (p<0,05). La enfermedad evolucionó con un 83,8 por ciento de remisión espontánea.