Actualización de las recomendaciones sobre sueño seguro / Update on safe sleep recommendatios

La muerte súbita de un lactante puede ser de causa explicada, indeterminada ­si no se investigó en forma suficiente­ o inexplicada ­cuando una investigación completa no permite determinar su causa­. La muerte súbita inexplicada, o síndrome de muerte súbita infantil, afecta en particular a las poblaciones más vulnerables. La muerte de estos niños que nacen con alteraciones del neurodesarrollo es la parte visible de una problemática que se origina en el embarazo. Disminuir la cantidad de niños vulnerables depende de políticas de salud y, sobre todo, de lograr mejorar las condiciones de vida de la población. Son acciones a largo plazo. Conocer a fondo los factores de riesgo que pueden desencadenar la muerte inesperada es lo que se puede hacer ya. La actualización de las recomendaciones sobre sueño seguro refleja nuevos conocimientos basados en la evidencia científica y un enfoque integral de los aspectos socioculturales relacionados con esta problemática.

Sudden unexpected infant death may be explained, cause by an etiology, unexplained but insufficiently investigated, or unexplained when a full investigation fails to determine the cause. Unexplained sudden death in infancy or sudden infant death syndrome particularly affects the most vulnerable populations. The death of these children who are born with alterations in their neurodevelopment is the visible part of a problem that originates in pregnancy. Reducing the number of vulnerable children depends on health policies and, above all, on improving the living conditions of the population. These are long-term actions. Knowing in depth the risk factors that can trigger unexpected death is what can be done now. The update of the recommendations on safe sleep reflects new knowledge based on scientific evidence and a comprehensive approach to the sociocultural aspects related to this problem.

Malos hábitos de sueño en lactantes: factor de riesgo para síndrome de muerte súbita del lactante: estudio piloto / Bad sleeping habits in infants: risk factor for sudden infant death syndrome: pilot study

INTRODUCCIÓN: La Academia Americana de Pediatría recomienda que los lactantes menores de un año duerman en posición supina para prevenir el síndrome de muerte súbita en lactantes (SMSL). OBJETIVO: Describir la posición en que duermen un grupo de lactantes y factores de riesgo asociados al SMSL. SUJETOS Y MÉTODO: Estudio piloto, prospectivo concurrente, de lactantes < 45 días de vida en control sano en Centro Médico San Joaquín UC Christus. Criterios de exclusión: prematurez (edad gestacional < 37 semanas) y patología de base (respiratorias, metabólicas, cardiológicas). Se aplicó encuesta al cuidador principal respecto a datos demográficos y hábitos de sueño, basada en encuesta BISQ (Brief Screening Questionnaire for Infant Sleep Problems) validada en español, dado la inexistencia de instru mentos para < 3 meses. RESULTADOS: Se obtuvo muestra de 100 lactantes de edad 16,78 ± 12,88 días de vida, siendo 57% mujeres. La madre fue el principal informante (84%). El 79% de los lactantes dor mían en decúbito supino, 19% lo hacía de lado y 2% en prono. El 66% dormía en cuna en habitación de los padres, 31% en la cama de los padres. El 74% se quedaban dormidos durante la alimentación. El 28% de los lactantes estaban expuestos a tabaquismo pasivo. El 91% cuidadores estaba informa do sobre la posición segura de sueño, siendo el principal informante el pediatra (54%). CONCLUSIONES: En esta muestra se encontró alto porcentaje de lactantes < 45 días que duermen en posición no segura, siendo frecuente el colecho. Es importante implementar campañas locales de prevención del SMSL que refuercen el hábito de dormir seguro.

INTRODUCTION: The American Academy of Pediatrics recommends, through the implementation of the "Back to Sleep (BTS)" campaign, the supine sleeping position for infant sleeping since it prevents to prevent Sudden Infant Death Syndrome (SIDS). OBJECTIVE: To describe the sleeping position of a group of infants and the risk factors associated with sudden infant death syndrome (SIDS). SUBJECTS AND METHOD: Prospective pilot study, including infants < 45 days of life in well-child care visits at a medical center. Exclusion criteria: Preterm-born infant (gestational age < 37 weeks) and/or comorbidities (pulmonary, metabolic, cardiologic). A brief parental questionnaire was conducted regarding general demographic data and sleep habits. The questioner was based on the BISQ - Spanish version, due to the lack of validated instruments for infants < 3-month-old. RESULTS: We included a sample of 100 infants between 16.78 ± 12.88 days old (57% girls). Mothers were the main information source (84%). 79% of the infants slept in supine position, 19% slept on their sides, and 2% in prone position. Regarding the place where the infants slept, 66% did in their crib in the parents' room and 31% slept in parents' bed. 74% of infants fell asleep while being fed. 28% of infants were exposed to passive smoking at home. 91% of parents were informed about safe sleep positions, reporting that pediatricians were the main source of information (54%). CONCLUSION: We found a high percentage of infants < 45 days of life who slept in an unsafe position, and frequently co-sleep with their parents. Thus, it is important to implement local SIDS prevention campaigns to reinforce safe infant sleep.

Muerte inesperada del lactante: Análisis de 591 casos / Sudden infant death: 591 cases analysis

Antecedentes: la muerte inesperada del lactante (MIL) sin asistencia, ya sea en domicilio o a su arribo al hospital conlleva a un impedimento en la firma del certificado de defunción y al necesario peritaje forense a los efectos de descartar las causas no naturales. Conocer la causa de muerte es de suma importancia no sólo para las autoridades sanitarias sino para los Pediatras a afectos actuar sobre los factores implicados. Objetivos: el objetivo de esta revisión es analizar las patologías encontradas y las circunstancias que rodearon a la muerte en los casos MIL, a los efectos de identificar factores de riesgo. Métodos: se incluyeron en este estudio 591 menores de un año fallecidos en forma súbita e inesperada, en domicilio o a su arribo a un centro asistencial, ingresados al Programa MIL, entre octubre de 1998 y diciembre de 2015, con intervalo libre 2002-2006. No todos los fallecidos en dicho período en iguales circunstancias fueron enviados para su estudio. Se reunió historia clínica, circunstancias de la muerte y la familia fue entrevistada. Los casos fueron analizados por el grupo interdisciplinario. Se clasificó como: Muerte Explicable cuando se encuentra una causa y Muerte Indeterminada cuando no se encuentra una causa. Estas últimas están constituidas por Síndrome de Muerte Súbita del Lactante (SMSL) y las Zonas Grises (ZG). Se agruparon como ZG aquellos casos en los que no había una causa que con certeza explicara la muerte, pero había factores predisponentes que pudieron causarla o favorecerla. Estas ZG fueron distribuidas en 6 categorías. Para clasificar como SMSL el grupo exige la ausencia de colecho, de decúbito prono, de almohada y de otros entornos factibles de causar sofocación. Resultados: se estudiaron 591 casos. Se identificó una causa de muerte en 339 casos (57.4%). En 252 la muerte fue indeterminada (42.6%). Se encontró infección respiratoria en 29% de los casos (50% de las muertes explicables); anomalía cardíaca en 15%; diarrea con deshidratación en 4.5%; sofocación accidental en 3%; se identificó una causa violenta en 1.5%. Hubo variación entre los dos períodos (1998-2001 y 2007-2015). De los casos indeterminados, 242 correspondieron ZG y 10 a SMSL. En 91% de las ZG menores de 4 meses de edad que tienen el dato evaluable, hubo un entorno de sueño inseguro. El colecho se observó en 72%, principalmente múltiple o asociado a decúbito prono u otros factores de riesgo. En neonatos, el 81% de las ZG evaluables, tuvo un factor de riesgo asociado a las condiciones de sueño. Conclusiones: se identificaron patologías sobre las que es posible actuar desde la prevención (infecciones respiratorias, diagnóstico prenatal de cardiopatías). En los casos indeterminados, se identificaron factores de riesgo modificables desde el primer nivel de atención con la implementación de campañas educativas y recomendaciones sobre sueño seguro dirigidas a la comunidad.

Background: sudden unexpected death in infancy (SUDI) carries an impediment to sign the death certificate. A legal autopsy is mandatory to exclude unnatural death. To know the cause of death in infancy is relevant to health authorities and paediatrics. Objectives: to investigate the pathologies and risk factors in the cases of SUDI studied. Methods: autopsies between October 1998 and December 2015 were analysed. There was a free interval (2002 to 2006). It does not include every case of SUDI in the local population. The clinical records were gathered, the circumstances of death investigated and the family was interviewed. The cases were discussed in a multidisciplinary team. The cases were classified as Explained Death or Undetermined. The undetermined deaths were classified either as Gray Zone (GZ) or SIDS cases. Six categories were considered in GZ. To consider a case as SIDS, a safe sleep environment is required; that means no co-sleeping, no prone sleeping and no pillows use that could eventually cause suffocation. Cases were coded as GZ when a clear cause of death was not identified, but abnormalities were found that could have predisposed or contributed to death. GZ were divided in 6 categories. Results: 591 cases were examined. A cause of death was identified in 339 cases (57.4%). In 252 cases, it was undetermined (42.6%). A respiratory infection was found in 29% of the autopsies (50% of the explained deaths). A cardiac anomaly was found in 15%; dehydration secondary to diarrhoea in 4.5%; suffocation in 3%; a violent cause was identified in 1.5%. There were variations between both periods (1998-2001 and 2007-2015). 252 deaths remained unexplained after the autopsy (42.6%), these were the undetermined cases. 242 were classified as Gray Zone (GZ) and 10 as SIDS cases. 91% of the evaluable GZ cases <4 months old had an unsafe sleeping environment. Co-sleeping was observed in 72% of the evaluable <4 month cases; it was mainly multiple or associated with prone sleeping position. In newborns, 81% of the evaluable ZG cases had a sleep related risk factor. Conclusions: The study improved allowed to identify pathologies amenable to intervention and prevention (respiratory infections, prenatal diagnosis of congenital heart disease). Sleep related risk factors were identified, amenable to prevention through community education programs.

Tabaco y salud infantil: un aspecto no suficientemente valorado / Cigarette smoking and child health: an issue that has not yet been assessed enough

La campaña que se desarrolla en Uruguay contra el consumo de tabaco enfatiza sobre los efectos nocivos que produce el cigarrillo en la salud de la población adulta que fuma y en fumadores pasivos. La disminución de afecciones cardiovasculares como el infarto de miocardio y del cáncer de pulmón ha mostrado resultados alentadores en relación a la disminución del número de consumidores, si bien aún no se ha logrado el descenso esperado. La campaña enfoca varios aspectos dirigidos a la presentación de los envoltorios, el precio, pero la que ha mostrado mejores resultados ha sido el consejo personal brindado en los consultorios a fumadores, en especial a embarazadas. Desde hace casi una década han surgido publicaciones que demuestran aspectos de la morbilidad infantil asociada al uso de tabaco por mujeres gestantes. En la etapa prenatal se han evidenciado alteraciones del desarrollo del aparato respiratorio, bajo peso al nacer, parto prematuro así como propensión al aborto. Otras investigaciones han observado que un hogar con fumadores, especialmente durante los primeros meses de la vida del niño constituye un ambiente hostil, negativo para lograr condiciones de sueño seguro, práctica que se describe asociada a la disminución del riesgo a sufrir el síndrome de la muerte súbita del lactante. Es evidente que el consumo de tabaco constituye también un problema real para la salud de la población infantil especialmente aquellos más vulnerables. Los pediatras y médicos que atienden niños podrán promover consejos sobre crianza saludable aconsejando a la madre sobre condiciones para sueño seguro y que evite los fumadores intradomiciliarios.

In Uruguay the tobacco control campaign emphasized the adverse effects of smoking for the adult population as well as secondhand smoking. A reduction in cardiovascular diseases and lung cancer has been achieved, although not as much as expected. The campaign addressed the appearance of cigarette boxes and the price of the product. But what proved the most useful resource was the advice given to pregnant women. In the last decade many articles on the consequences of smoking during pregnancy have been published. Fetal loss, low birth weight and preterm delivery have been widely accepted as consequences of maternal smoking. After birth, smoking near the infant is a risk factor for sudden infant death syndrome. Pediatricians, neonatologists and general practitioners that care for infants and children, should advice mothers and family on smoking and health.

Aparente amenaza para la vida por el síndrome de QT prolongado / An apparent life threatening secondary to long Qt syndrome

Se presenta el caso de un lactante con un episodio de pérdida de conocimiento, en quien se diagnosticó fibrilación ventricular. Se realizó desfibrilación externa con éxito, permitiendo luego arribar al diagnóstico etiológico de síndrome de QT prolongado, constituyendo un ejemplo documentado de esta entidad como causa del síndrome de muerte súbita del lactante.

We report the case of an infant with an episode of loss of consciousness, in whom ventricular fibrillation was diagnosed. He was successfully defibrillated and long QT syndrome was diagnosed as his baseline disease. This case constitutes a documented example of this entity as a cause of the sudden infant death syndrome.

Application of plasma exchange in patients with history of unexplained recurrent abortion: a case series

Immune-mediated recurrent pregnancy loss [RPL] has received more attention than any other single etiologic classification. Individuals with rare blood group P have an anti-pp1pk antibody in their serum, which causes recurrent abortion in the early stages. In this case series study, 11 patients with unexplained RPL who had anti-P antibody in their serum were treated by plasma exchange during their next pregnancies. To evaluate the efficacy of the treatment, we monitored fetal development using ultrasonography and intensive prenatal care. All calculations were performed with the SPSS version 16. All patients who were treated by plasma exchange progressed to live birth. The mean gestational age at the time of termination was 37.5 +/- 0.69 weeks. The mean weight of the newborns was 2729.09 +/- 389.88 g. None of the newborns required exchange transfusion. P-incompatibility is one rare but important cause of unexplained RPL and also a basis for therapeutic intervention via early antibody removal by plasma exchange

Familial history and recurrence of febrile seizures; a systematic review and meta-analysis

Febrile seizure [FS] as the most common form of seizures in childhood, affects 2-5% of all children across the world. The present study reviews available reports on FS recurrence frequency and evaluates its associated risk factors in Iran. We searched the Persian database such as: SID, MagIran, Medlip, Irandoc, Iranmedex as well as English databases PubMed, ISI, and Scopus. Random effects models were used to calculate 95% confidence intervals. Meta regression was introduced to explore the heterogeneity between studies. The overall FS recurrence rate was 20.9% [95% confidence interval [CI]: 12.3-29.5%]. The frequency of FS simple and complex types was 69.3% [95% CI: 59.5-79.0] and 25.3% [95% CI: 19.6-31.0], respectively. A positive familial history of 28.8% [95% CI: 19.3-38.4%] was observed for childhood FS including 36.2% [95% CI: 27.3-39.6%] for the simple and 29.4% [95% CI: 23.1-33.5%] for the complex type. The heterogeneity of recurrent FS was significantly affected by sample size [P=0.026]. Almost one-third of FS children had a positive familial history. The increased risk of recurrence in patients with symptomatic seizures needs to be fully considered by parents, physicians, nurses and health policy makers

Perfil epidemiológico e estratégias para o diagnóstico de SMSL em um país em desenvolvimento / Epidemiological profile and strategies for diagnosing SIDS in a developing country

OBJETIVO: Descrever o perfil epidemiológico, os fatores de risco e as melhores estratégias para diagnosticar a síndrome da morte súbita do lactente (SMSL) em um país em desenvolvimento. MÉTODOS: Estudo caso-controle populacional com crianças nascidas entre 01/01/2001 e 31/12/2003 em Porto Alegre (RS), divididas em três grupos: casos de SMSL (33) e controles - óbitos esclarecidos (192) e crianças vivas (192) -, que foram pareados por idade e sexo aos casos. As famílias com casos de lactentes menores de 1 ano que faleceram em casa foram identificadas, e as informações das certidões de óbito e autópsias foram comparadas para confirmar a SMSL. Os óbitos esclarecidos foram os ocorridos em hospitais, e os controles vivos foram selecionados na vizinhança dos casos de SMSL. Os pais foram entrevistados para obter informações sobre a saúde e os hábitos de sono da criança. Realizou-se uma análise multivariada para identificar fatores de risco na população estudada. RESULTADOS: A incidência da SMSL na população avaliada foi de 0,55/1.000 nascidos vivos. A análise revelou os seguintes fatores de risco: etnia (autorreferida como negra), prematuridade, baixo peso ao nascer, mãe adolescente, tabagismo na gravidez e renda familiar abaixo de um salário mínimo. Além disso, 94 por cento dos casos de SMSL foram mal-diagnosticados na certidão de óbito. CONCLUSÕES: Embora a SMSL tenha sido mal-diagnosticada, seu perfil epidemiológico é semelhante ao da literatura, assim como os fatores de risco, que poderiam ser reduzidos com campanhas preventivas. Investigar a SMSL em países em desenvolvimento requer estratégias especiais para evitar erros de diagnóstico.

OBJECTIVE: To describe the epidemiological profile, risk factors and best strategies for diagnosing sudden infant death syndrome (SIDS) in a developing country. METHODS: Population-based, case-control study with children born between January 1st, 2001, and December 31st, 2003, in Porto Alegre, southern Brazil, who were allocated into three groups: SIDS cases (33), explained death controls (192), and living controls (192). Children in the latter two groups were age- and sex-paired with SIDS cases. Families in which an infant had died at home within the first year of life were identified, and the information available on death certificates and autopsy reports was compared to confirm the diagnosis of SIDS. Explained death controls consisted of infants who had died at city hospitals, and living controls were selected in the same neighborhood as SIDS cases. All parents were interviewed to obtain information on children’s health and sleep habits. Multivariate analysis was performed to identify risk factors in the study population. RESULTS: The incidence of SIDS in the population assessed was 0.55/1,000 live births. The analysis revealed the following risk factors: ethnicity (characterized by self-reported black skin color), prematurity, low birth weight, adolescent mother, smoking during pregnancy, and family income of less than one minimum wage. Ninety-four percent of SIDS cases were misdiagnosed in the death certificate. CONCLUSIONS: Although SIDS was misdiagnosed in official death certificates, the epidemiological profile is similar to the literature, as well as risk factors, which could be reduced with preventive campaigns. Investigating SIDS in developing countries requires special strategies to avoid misdiagnosis.

Efectos clínicos de la exposición directa e indirecta a tabaco en los niños / Health effects of passive smoking exposure on children

El tabaquismo es fuente importante de contaminación intra domiciliaria. La prevención de la exposición al humo de tabaco tiene un impacto significativo en morbilidad y mortalidad en aquellos expuestos en forma indirecta, especialmente cuando se trata de un individuo en desarrollo activo como ocurre en la vida intrauterina y durante los primeros años de vida. La evidencia es contundente respecto del riesgo que existe en la disminución de la función pulmonar, aparición de sibilancias recurrentes, asma, neumonía y muerte súbita. La exposición al humo de tabaco en los niños debe recibir mayor atención de parte del equipo de salud, especialmente del pediatra.

Canalopatías arritmogénicas como causa de muerte súbita en pediatría / Arrhythmic canal diseases causing sudden death in children

La muerte súbita cardíaca de niños con corazón estructuralmente sano está estrechamente relacionada con las canalopatías arritmogénicas. Se presenta una revisión actualizada sobre las canalopatías y la relación de éstas con la muerte súbita. Se analiza especialmente la aplicación del método clínico y la importancia del trazado electrocardiográfico como herramientas indispensables para el certero diagnóstico de estas entidades.

Cardiac sudden death in children with a heart structurally healthy is closely related to arrhythmic canal diseases. An update review on canal diseases and its relation to the sudden death is presented. The application of clinical method is analyzed, as well as the significance of electrocardiographic recordings like essential tools for an accuracy diagnosis of these entities.

Síndrome de muerte súbita del lactante / Sudden infant death syndrome

Se presenta una revisión actualizada sobre el síndrome de muerte súbita del lactante. Se hace referencia a un grupo de factores de riesgo relacionados con el síndrome y a elementos anatomopatológicos y mecanismos etiopatogénicos que lo explican. Finalmente se recomiendan algunas medidas que deben aplicarse para disminuir la ocurrencia del síndrome.

An updated review of the sudden infant death syndrome is presented. Reference is made to a group of risk factors related to the syndrome and to anatomopathological elements and etiopathogenic mechanisms that explain it. Finally, some measures that should be applied to reduce the occurrence of the syndrome are recommended.

Sudden infant death syndrome in Brazil: fact or fancy?

CONTEXT AND OBJECTIVE: The true incidence of sudden infant death syndrome (SIDS) in Brazil is unknown. The aim here was to identify SIDS cases in the city of Ribeirão Preto, State of São Paulo, between 2000 and 2005, in order to estimate its incidence. DESIGN AND SETTING: Retrospective analysis of data on live births and infant deaths in Ribeirão Preto and from autopsies of infants performed at the Death Verification Service of the Interior (SVOI) between 2000 and 2005. RESULTS: There were 47,356 live births and 537 deaths, with infant mortality rates ranging from 12.9‰ to 10.9‰ of live births. Among the 24 infants who died possibly due to SIDS and who were autopsied at the SVOI, six were from families living in the municipality (0.13‰ of live births): three (50 percent) were diagnosed as SIDS, and one each (16.66 percent) as indeterminate cause, bronchoaspiration and cerebral edema. Two deaths occurred in the first month of life (33.33 percent) and one each (16.66 percent) at two, four, six and eight months. Two deaths each (33.33 percent) occurred in the months of February and December, one each in August and October (16.66 percent). Four cases (66.7 percent) occurred in the summer and one each (16.66 percent) in winter and spring. There was 5:1 predominance of males over females. CONCLUSIONS: The frequency of SIDS was lower than what has been reported worldwide and in the Brazilian literature, thus suggesting underdiagnosis, indicating the lack of any specific postmortem protocol for SIDS identification and showing the need to implement this.

CONTEXTO E OBJETIVO: A real incidência da síndrome da morte súbita na infância (SIDS) no Brasil é desconhecida. O objetivo foi identificar casos de SIDS na cidade de Ribeirão Preto, SP, entre os anos de 2000 e 2005 para estimar a sua incidência. TIPO DE ESTUDO E LOCAL: Análise retrospectiva dos dados relativos aos nascidos vivos e óbitos em Ribeirão Preto, além das necropsias de menores de um ano de idade realizados no Serviço de Verificação de Óbito do Interior (SVOI) entre 2000 e 2005. RESULTADOS: Houve 47.356 nascidos vivos e 537 óbitos de menores de um ano de idade, com mortalidade infantil variando de 12,9‰ a 10,9‰ nascidos vivos e pós-neonatal de 5,0 por cento a 3,8‰. Dos 24 óbitos possivelmente devidos a SIDS autopsiados no SVOI, 6 eram do município (0,13‰ nascidos vivos), 3 (50 por cento) diagnosticados como SIDS, 1 (16,66 por cento) cada como causa indeterminada, broncoaspiração e edema cerebral. Dois óbitos ocorreram no primeiro mês de vida (33,33 por cento) e um óbito (16,66 por cento) com dois, quatro, seis e oito meses. Dois óbitos (33,33 por cento) ocorreram nos meses de fevereiro e dezembro cada, um caso em agosto e outro em outubro (16,66 por cento). Foram quatro casos (66,7 por cento) no verão, um caso (16,66 por cento) cada no inverno e na primavera. Houve predomínio do gênero masculino sobre o feminino numa proporção de 5:1. CONCLUSÕES: A freqüência de síndrome da morte súbita na infância foi inferior à da literatura mundial e brasileira, sugerindo subdiagnóstico, falta de protocolo de investigação post mortem específico e necessidade de sua implantação.

Sudden infant death syndrome (SIDS) and its forensic investigation / 法医学杂志

During the past two decades tremendous efforts have been made by the medical community, especially in the fields of forensic medicine and pediatrics, to better understand the etiology, epidemiology and pathophysiology of SIDS. There have been many SIDS reports from developed countries, but few from developing Asian countries. Despite a recent significant decrease in the incidence of SIDS in many developed countries, SIDS continues to be the most common cause of post-neonatal infant death in these countries. This article analyzes the SIDS data (1990-2006) from the Office of the Chief Medical Examiner for the State of Maryland, USA, along with review of the literature with regard to the history, epidemiological and pathophysiological characteristics of SIDS, as well as the recent advances in SIDS research. The changing trends in the diagnosis of SIDS and current challenges to its forensic investigation are also discussed.

Características clínicas de lactantes con eventos agudos amenazantes de la vida / Clinical characteristics of toddlers with apparent-life threatening events

Introducción: Los eventos aparentemente amenazantes de la vida son causa frecuente de consulta, hospitalización y determinan la realización de estudios prolongados y costosos. El objetivo de este estudio es describir las características de nuestros pacientes, establecer los principales diagnósticos, evaluar su evolución durante el primer año de vida y determinar si alguno de ellos falleció de muerte súbita. Materiales y Métodos: Se estudiaron 120 pacientes que se hospitalizaron en la Unidad de Lactantes y Nutrición del Hospital Luis Calvo Mackenna, entre mayo del 2001 y junio del 2004 y que al alta además se controlaran en el Policlínico de Seguimiento de Apneas. De acuerdo a las recomendaciones de la Sociedad Americana de Pediatría se estudiaron con exámenes generales tales como hemograma, gases y electrolitos plasmáticos y, de acuerdo a la orientación clínica, otros estudios, como pH metría esofágica de 24 horas, exámenes metabólicos, inmunofluorescencia para agentes de infecciones respiratorias, ecografía encefálica y EEG. Se realizó un monitoreo cardiorrespiratorio de 24 horas con el cual se objetivó la presencia de apneas. Para el análisis estadístico se utilizó el programa Stat View. Resultados: Un 52 por ciento eran hombres, la edad promedio fue de 2,5 meses y 48 por ciento eran recién nacidos. Las formas de presentación fueron: apneas (76 por ciento), cianosis (75 por ciento), hipotonía (36 por ciento) y palidez (23 por ciento). Un 37,8 por ciento de los pacientes presentó reflujo gastroesofágico; 14,4 por ciento infección respiratoria; 13,5 por ciento apnea idiopática; 10,8 por ciento síndrome convulsivo y un 6,3 por ciento apneas del prematuro. Ningún paciente falleció durante el primer año de vida y todos dejaron de hacer apneas antes de los 11 meses. Conclusiones: Las causas más frecuentes de ALTE son el reflujo gastroesofágico e infecciones respiratorias. Durante el período de seguimiento ningún paciente falleció, por lo que parece no haber relación entre apneas del lactante y síndrome de muerte súbita.

Eventos de aparente amenaza a la vida (ALTE): conceptos, etiología y manejo / Apparent life-threatening event (ALTE): concepts of etiology and management

Los Eventos de Aparente Amenaza a la Vida (ALTE) son un desafió para el médico por su diversidad etiológica y el estrés que experimentan los familiares al observar un episodio de muerte inminente. En este artículo se analizan las causas relacionadas con ALTE, se plantean estrategias de estudio y de seguimiento.

Muerte súbita del lactante / Sudden infant death

La muerte súbita (MS) del lactante es una de las condiciones más trágicas en la vida de una familia, representando una de las causas mas frecuentes de muerte infantil en los países desarrollados. Pese a todos los esfuerzo se desconoce muchos aspectos fisiopatológicos. Por otra parte, si bien existe una relación con ALTE, ésta aún no es fácil de entender. En ésta breve revisión se analizan algunos datos recientes en la literatura acerca de fisiopatología, factores de riesgo, manejo de MS y las recomendaciones y consensos para prevenir la MS.

Fatty acid oxidation disorder as a cause of sudden infant death syndrome (SIDS)--a case report.

Although the cause of sudden infant death syndrome (SIDS) remains unknown, extensive studies over the last 10 years have begun to shed some light on this family tragedy. 5% of all cases of SIDS are caused by fatty acid oxidation disorders. We report a case of fatty acid oxidation disorder causing SIDS.