Association of fatty acid composition in human milk with breast milk jaundice in neonates / 中国当代儿科杂志

OBJECTIVE@#To study the association of fatty acid composition in human milk with breast milk jaundice (BMJ) in neonates.@*METHODS@#A total of 30 full-term neonates who were admitted to the neonatal intensive care unit from October 2016 to October 2017 and were diagnosed with late-onset BMJ were enrolled as the BMJ group. Thirty healthy neonates without jaundice or pathological jaundice who were admitted to the confinement center during the same period of time were enrolled as the control group. Related clinical data were collected, including sex, mode of birth, feeding pattern, gestational age, birth weight, gravida, parity, and peak level of total serum bilirubin. Breast milk was collected from the mothers, and the MIRIS human milk analyzer was used to measure macronutrients (fat, protein, and carbohydrate) and calorie. Gas chromatography was used to analyze the content of different fatty acids in breast milk.@*RESULTS@#The control group had higher levels of macronutrients in human milk than the BMJ group, with significant differences in fat, dry matter, and calorie (@*CONCLUSIONS@#Some macronutrients and fatty acid composition in human milk may be associated with the pathogenesis of BMJ in neonates.

Hipotiroidismo congénito, reporte de un caso / Congenital hypothyroidism, a case report

El hipotiroidismo congénito (HC) es la endocrinopatía más frecuente en el recién nacido, presenta una frecuencia de 1:3163 nacimientos. En Chile el tamizaje neonatal se realiza mediante un test de determinación de la tirotrofina (TSH)en papel filtro. CASO CLÍNICO: recién nacido de parto eutócico de3180 gr. y Apgar 9-10 a los 5 minutos; que ingresó al servicio de Neonatología al sexto día de vida por cuadro de ictericia asociado a hipoactividad y dificultad para alimentarse. Se diagnosticó hiperbilirrubinemia neonatal con sospecha de un cuadro infeccioso. Se trató con antibióticos y fototerapia intensiva disminuyendo la bilirrubinemia total de 28,57 a 14 mg/dl. Posterior al tratamiento recae en hipoactividad y con dificultad para alimentarse. Se solicitan exámenes de control, encontrándose bilirrubinemia mantenida de 18 mg/dl y hematocrito 35,7 por ciento, planteándose la posibilidad de una enfermedad metabólica, por lo que se realizaron exámenes que son enviados a Santiago para confirmación de patología metabólica; desde Santiago confirman una TSH venosa alterada de762 uIU/ml y una T4 total de 0.53 ug/dl, diagnosticando un hipotiroidismo congénito, por lo que se inició tratamiento con Levotiroxina15 ug/Kg/día. DISCUSIÓN: el hipotiroidismo congénito es una patología poco común de difícil diagnóstico, pero fácilmente detectable tamizaje neonatal midiendo TSH. En Chile, la estrategia de toma de este examen en los tiempos especificados según la categoría del recién nacido, facilita la prevención de complicaciones. En cambio cuando el tamizaje es retrasado, sólo queda la sospecha de esta entidad patológica...

Congenital hypothyroidism (CH) is the most common endocrinopathy newborn, and occurs in approximately1:3163 births. In Chile the newborn screening test is performed by a determination of thyrotropin (TSH) on filter paper. CASE REPORT: Newborn by eutocic delivery of 3180 gr. and 9-10 Apgar at 5 minutes; was admitted to the neonatology unit at six day of life because of jaundice associated with hypoactivity and poor feeding. Neonatal hyperbilirubinemia with suspected infectious condition was diagnosed and treated with antibiotics and intensive phototherapy decreasing total bilirubin 28.57 to14 mg/dl. Although treatment, the patient remains hypoactive and with poor feeding. Screening tests showed a persistent billirubin of 18mg/dl and hematocrit 35.7 percent, raising the possibility of a metabolic disease. Test were performed and sent to Santiago for confirmation, and congenital hypothyroidism was confirmed with and elevated serum TSH 762 uIU/ml and low T40.53 ug/dl, treatment with levothyroxine 15 ug/kg/day was started. DISCUSSION: Congenital hypothyroidism is a rare disease difficult to diagnose, but easily detected by neonatal screening of TSH measurement. In Chile the strategy of taking this exam at specific times according newborn categorization, facilitates the prevention of complications. However, when the screening is delayed, we can only suspect this pathological entity...

Factores neonatales asociados a ictericia en el recién nacido a término, en el Hospital Nacional PNP Luis N. Sáenz. Período Enero 2012 - Diciembre 2012 / Neonatal factors associated with jaundice in the newborn at term, at the National Hospital of PNP. Luis N. Saenz. Period January 2012 - December 2012

Introducción: La ictericia neonatal se define como la coloración amarillenta de piel y mucosas, por concentraciones de bilirrubina sérica anormalmente altas. Puede ser causada a expensas de la bilirrubina indirecta, y tiene relevancia clínica cuando dichas concentraciones superan el percentil 95 comparadas con la edad en horas, usando normogramas. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo; la muestra fue el total de neonatos a término nacidos entre enero 2012 a diciembre 2012 en el HNPNP con diagnóstico clínico y laboratorial de ictericia. La información se obtuvo de historias clínicas, recolectada en una ficha de datos. Se procesó la información, utilizando el programa SPSS 22, y estadística descriptiva (distribuciones de frecuencias, medidas de tendencia central y dispersión, tablas de contingencia) y correlaciones bivariadas. Resultados: De los 68 pacientes, 64.7 por ciento iniciaron ictericia al 3er día de vida, y la duración fue de 3 días en el 33.8 por ciento de neonatos, 47.1 por ciento no presentó patología asociada, 17.6 por ciento presentó sepsis temprana y malformaciones congénitas. 52.9 por ciento recibió lactancia mixta desde el nacimiento, seguido de LME (38.2 por ciento), valores de Bilirrubina Total (BT) séricos fueron de 12-17 mg/dl en el 45.6 por ciento, 8-12 mg/dl en el 39.7 por ciento, se observó una media de 12.32 mg/dl de BT y de 2.79 días de duración de la ictericia. El 72.1 por ciento no recibió tratamiento alguno para la ictericia. También que existía correlación entre el valor de Bilirrubina total y la duración de la ictericia en el neonato a término con un p<0.05. Conclusiones: Los neonatos a término que desarrollan ictericia tienen como factores predisponentes a la lactancia materna (exclusiva o lactancia mixta), así como condiciones patológicas como la sepsis neonatal, sea temprana o tardía, y las malformaciones congénitas. La ictericia es multifactorial. Así mismo la ictericia en neonatos a término...

Introduction: Neonatal jaundice is defined as yellowing of the skin and mucous membranes, by concentrations of abnormally high serum bilirubin. It can be caused at the expense of indirect bilirubin, and has clinical relevance when these concentrations exceed 95p compared with age in hours using normograms. Materials and Methods: An observational, descriptive, retrospective; the sample was the total of term infants born between January 2012 and December 2012 at the HNPNP with clinical and laboratory diagnosis of jaundice. The information was obtained from medical records, collected on a data sheet. Information was processed using SPSS 22 and descriptive statistics (frequency distributions, contingency tables), and bivariate correlations. Results: Of the 68 patients, 64.7 per cent began jaundice the 3rd day of life, and the duration was 3 days in 50 per cent of infants, 47.1 per cent had no associated disease, 17.6 per cent had early sepsis and congenital malformations. 52.9 per cent received mixed feeding from birth, followed by LMB (38.2 per cent), Total Bilirubin values (BT) serum were 12-17 mg/dl in 45.6 per cent, 8-12 mg/dl at 39.7 per cent, was observed an average of 12.32 mg/dl and 2.79 BT day jaundice. The 72.1 per cent did not receive any treatment for jaundice. Also that there was correlation between total bilirubin value and duration of jaundice in the term newborn with p<0.05. Conclusions: Term infants who develop jaundice have predisposing factors such as breastfeeding (exclusive or mixed feeding) as well as pathological conditions such as neonatal sepsis, whether early or late, and congenital malformations. Jaundice is multifactorial. Also jaundice in term infants starts at 72 hours of life and duration is longer than 3-4 days.

Epidemiology of neonatal jaundice at the University Hospital of the West Indies / Epidemiología de la ictericia neonatal en el Hospital Universitario de West Indies

OBJECTIVE: To describe the epidemiology of neonatal jaundice at the University Hospital of the West Indies (UHWI). METHODS: A retrospective review of all neonates at the UHWI with clinically significant jaundice between January 1, 2006 and June 30, 2007 was performed. Demographic, clinical and laboratory data were collected. Descriptive analyses were performed. RESULTS: The incidence of clinically significant neonatal jaundice at the UHWI was 4.6% for the study period. There were 103 male (61%) and 67 (39%) female infants. The aetiology of jaundice in the infant was attributed to ABO incompatibility in 59 (35%), infection in 30 (18%), prematurity in 19 (11%), G6PD deficiency in 8 (5%), Rhesus incompatibility in 6 (3.5%) and no cause was identified in 16 (9%) infants. There was a low incidence (26%) of screening for G6PD deficiency although it was the most common aetiology for infants presenting from home. Nine (5%) neonates required exchange blood transfusion. Infants admitted from home had a significantly higher mean total bilirubin value at presentation, a significantly higher mean peak bilirubin level and presented significantly later than those who were admitted from the postnatal ward (p < 0.001). One patient was discharged with a diagnosis of bilirubin encephalopathy but defaulted from follow-up. Two neonates died but from causes unrelated to neonatal jaundice. Sixty-two patients (37%) were followed-up post discharge; 50% had hearing tests done, all tests were normal. Sixty-one (98%) infants had normal development at the time of the study; one patient had impaired motor development but this infant also had a myelomeningocoele. CONCLUSION: To further reduce morbidity associated with neonatal jaundice at the UHWI, there should be increased screening for G6PD deficiency; current systems in place for follow-up and monitoring of infants discharged from hospital prior to 72 hours must also be expanded and strengthened.

OBJETIVO: Describir la epidemiología de ictericia neonatal en el Hospital Universitario de West Indies (UHWI). MÉTODOS: Se llevó a cabo una revisión retrospectiva de todos los recién nacidos con ictericia clínicamente significativa, en UHWI entre el 1ero de enero de 2006 y el 30 de junio de 2007. Se recogieron datos demográficos, clínicos y de laboratorio. Se realizaron análisis descriptivos. RESULTADOS: La incidencia de la ictericia neonatal clínicamente significativa en UHWI fue de 4.6% para el periodo en estudio. Había 103 recién nacidos varones (61%) y 67 (39%) hembras. La etiología de la ictericia en los neonatos se atribuyó a la incompatibilidad de ABO en 59 (35%), infección en 30 (18%), prematuridad en 19 (11%), deficiencia de G6PD en 8 (5%), e incompatibilidad de Rhesus en 6 (3.5%). No se identificó ninguna causa en 16 (9%) de los recién nacidos. Hubo una baja incidencia (26%) de tamizaje para la deficiencia de G6PD, aún cuando ésta es la etiología más común en el caso de los infantes provenientes de casa. Nueve (5%) recién nacidos requirieron cambio de sangre mediante transfusión. Infantes ingresados desde sus casas presentaban un valor promedio de bilirrubina total significativamente mayor en el momento de su hospitalización, así como un nivel pico promedio de bilirrubina significativamente más alto, y se presentaron significativamente más tarde que aquellos ingresados directamente de las sala de atención postnatal (p < 0.001). Un paciente fue dado de alta con un diagnóstico de encefalopatía bilirrubínica, pero no se presentó a las sesiones de seguimiento. Dos recién nacidos murieron, pero por causas no relacionadas con la ictericia neonatal. Sesenta y dos pacientes (37%) tuvieron seguimiento luego del alta; al 50% se les realizó pruebas de audición; todas las pruebas arrojaron resultados normales. Sesenta y un infantes (98%) presentaban un desarrollo normal en el momento del estudio. Un paciente tenía discapacidad del desarrollo motor, pero también presentaba un mielomeningocele CONCLUSIÓN: A fin de lograr una reducción de la morbosidad asociada con la ictericia neonatal en UHWI, debe realizarse un tamizaje de la deficiencia de G6PD. Asimismo, es necesario ampliar y fortalecer los sistemas actuales establecidos para el seguimiento y monitoreo de los infantes dados de alta del hospital antes de las 72 horas.

Prevalence of Gilbert syndrome in parents of neonates with pathologic indirect hyperbilirubinemia

The cause of hyperbilirubinemia cannot be found in about 45% of cases of neonatal jaundice. Gilbert syndrome [GS] is the most common congenital disease associated with bilirubin metabolism in the liver. Since the screening value of genetic tests cannot be fully determined until accurate data on the prevalence and penetrance of the GS genotype are known, we sought to estimate whether the prevalence of GS is higher in the parents of neonates with severe unexplained indirect hyperbilirubinemia. Case-control study of parents of neonates with severe unexplained indirect hyperbilirubinemia admitted to a neonatal ward. We used the rifampin test [checked bilirubin before and 4 hours after administration of 600 mg rifampin] for diagnosis of GS in parents of 115 neonates with severe unexplained indirect hyperbilirubinemia. We compared the prevalence of GS in these parents with that of a control group of 115 couples referred for premarital counseling. The 115 neonates were aged 5.2 [1.6] days [mean, standard deviation], all were breast-fed, and males constituted 56.5%. Mean total serum bilirubin [TSB] level was 20.96 [5.48] mg/dL. 14.8% were glucose 6 phosphate dehydrogenase [G6PD] deficiency was present in 14.8%, and 10.4% had A, B or O blood group [ABO] incompatibilities with their mothers. There was no difference in the prevalence of GS between parents of the group with hyperbilirubinemia [22.2%] and the control group [19.13%] [P=.42]. Mean TSB in neonates with parents who had GS was more [about 3 mg/dL] than in neonates with normal parents [P=.004]. Fathers had GS twice as often as the mothers among the parents of neonates with hyperbilirubinemia [P=.003], among the control group [P=.009] and among neonates [P=.014]. This study showed that GS cannot cause severe indirect hyperbilirubinemia by itself, but it may have a summative effect on rising bilirubin when combined with other factors, for example, G6PD. Our results showed that in GS, males are affected about twice as much as the females

Ictericia colestásica neonatal: por quiste de colédoco en hospitaltipo III / Neonatal cholestatic jaundice: choledochal cyst in a type III hospital

La ictericia colestásica neonatal representa un grupo de desórdenes hepatobiliares, constituyendo urgencia médica. Un diagnóstico a descartar es el quiste coledociano. Su tratamiento es quirúrgico por asociación a colangiocarcinoma, existiendo otras complicaciones: daño hepático, pancreatitis aguda. Se presenta el primer caso clínico de quiste coledociano en el hospital de Parral, recinto tipo III. Lactante menor femenino con disminución de 10 por ciento del peso de nacimiento, ictericia leve hasta región inguinal, masa abdominal derecha. lmageneología muestra quiste coledociano 9x9x8cm, derivándose a centro terciario para abordaje quirúrgico, evolucionando en buenas condiciones. Se enfatiza conducta activa ante hiperbilirrubinemia neonatal por riesgo de etiología obstructiva.

Recién nacido prematuro tardío: incidencia y morbilidad neonatal precoz / Late preterm infant: incidence and early neonatal morbidity

La incidencia de prematuridad ha aumentado por el auge en el nacimiento de prematuros tardíos. La prematuridad tardía está asociada a un aumento de la morbilidad y mortalidad neonatal. Determinar la incidencia de nacimientos prematuros tardíos y su relación con complicaciones en el período neonatal. En un estudio cohorte prospectivo se analizó la población global de neonatos en un lapso de 9 meses. Se midieron la frecuencia de prematuridad tardía y los riesgos relativos de complicaciones, admisión a cuidados intensivos, enfermedad respiratoria, soporte ventilatorio y muerte, asociados a la prematuridad tardía. La frecuencia general de prematuridad fue 19 por ciento. Los prematuros tardíos conformaron 12 por ciento del total de nacidos y 66 por ciento de todos los prematuros. El 62,5 por ciento de los prematuros tardíos presentó alguna complicación aguda, mientras que esto ocurrió en 17,7 por ciento de los neonatos a término. Las causas primarias de admisión fueron las enfermedades respiratorias y la ictericia. La mortalidad en el grupo de prematuros tardíos fue 4,7 por ciento, mientras que en los niños a término fue 0,3 por ciento. Los prematuros tardíos manifestaron riesgos relativos aumentados en cuanto a complicaciones agudas, admisión a cuidados intensivos, dificultad respiratoria,  necesidad de ventilación  y muerte. Conclusiones: La frecuencia de prematuridad tardía es alta en nuestra población. Los prematuros tardíos representan dos tercios de todos los niños prematuros. Hay un riesgo aumentado de  hospitalización, dificultad respiratoria y muerte en el prematuro tardío, en comparación al niño a término. Los prematuros tardíos precisan una atención más cuidadosa por parte de los profesionales de salud.

The global incidence of prematurity has increased worldwide within the last twenty years, primarily because of a continuous increment in the birth of late preterm (LPT) infants. LPT infants entail a higher risk of morbidity and mortality than their term peers. To know the frequency of LPT births and their association with the risk of acute neonatal complications, as compared with term newborns. A prospective cohort study was undertaken during a nine-month period. Global incidence of LPT infants was estimated, and relative risks of complications, admission to intensive care, respiratory distress, need of ventilatory support and death in LPT infants were measured in comparison to their contemporaneous term neonates. Total frequency of prematurity was 19 percent. LPT infants represented 12 percent of total births and 66 percent of all preterm infants. 62.5 percent of all LPT infants had to be admitted because of complications, in contrast to 17.7 percent of all term infants. The main causes of admission were respiratory distress and jaundice. Overall mortality in LPT newborns was 4.7 percent, whereas in term infants it was 0.3 percent. LPT infants showed higher relative risks than term infants as regard to acute complications, hospitalizations, respiratory distress, need of ventilatory support and death. Conclusions: The frequency of LPT births in our institution is high. Two thirds of all preterm infants are LPT newborns. Late prematurity is associated with a high risk of hospitalizations, respiratory distress and death, as compared to term birth.  Greater attention needs to be paid to the management of LPT infants.

Clinical and laboratory evaluation of 101 patients with intrahepatic neonatal cholestasis / Avaliação clínica e laboratorial de 101 pacientes com colestase neonatal intra-hepática

BACKGROUND: Intrahepatic neonatal cholestasis can be the initial manifestation of a very heterogeneous group of illnesses of different etiologies. AIM: To evaluate and compare clinical and laboratory data among intrahepatic neonatal cholestasis groups of infectious, genetic-endocrine-metabolic and idiopathic etiologies. METHODS: The study evaluated retrospectively clinical and laboratory data of 101 infants, from March 1982 to December 2005, 84 from the State University of Campinas Teaching Hospital, Campinas, SP, Brazil, and 17 from the Child’s Institute of the University of São Paulo, SP, Brazil. The inclusion criteria consisted of: jaundice beginning at up to 3 months of age and hepatic biopsy during the 1st year of life. It had been evaluated: clinical findings (gender, age, birth weight, weight during the first medical visit, stature at birth, jaundice, acholia/hipocholia, choluria, hepatomegaly and splenomegaly) and laboratorial (ALT, AST, FA, GGT, INR). RESULTS: According to diagnosis, patients were classified into three groups: group 1 (infectious) n = 24, group 2 (genetic-endocrine-metabolic) n = 21 and group 3 (idiopathic) n = 56. There were no significant differences in relation to the variables: age, gender, stature at birth, jaundice, acholia/hipocholia, choluria, hepatomegaly, splenomegaly, AST, ALT, ALP, GGT, DB and albumin. Significant differences were observed in relation to the following variables: birth weight and weight during the first medical visit. Birth weight of group 1 was lower in relation group 2 and 3. Weight during the first medical visit followed the same pattern. There was a statistically significant difference in relation to the INR, as the patients of the group 2 presented higher values in relation to groups 2 and 3, despite the median was still pointing out normal values. CONCLUSIONS: There were no significant differences in relation to age, gender, stature at birth, jaundice, acholia/hipocholia, choluria, ...

RACIONAL: A colestase neonatal intra-hepática pode ser a manifestação inicial de um grupo muito heterogêneo de doenças de diferentes causas. OBJETIVO: Avaliar e comparar características clínicas e laboratoriais entre os grupos de colestase neonatal intra-hepática de causa infecciosa, genético-endócrino-metabólica e idiopática. MÉTODOS: Foram revistos os prontuários de 101 pacientes com diagnóstico de colestase neonatal intra-hepática no período de março de 1982 a dezembro de 2005, 84 avaliados no Hospital das Clínicas da Universidade Estadual de Campinas, SP, e 17 no Instituto da Criança da Universidade de São Paulo. Os critérios de inclusão foram: história de surgimento de icterícia até 3 meses de idade e realização da biopsia hepática durante o primeiro ano de vida. Foram avaliados: quadro clínico (gênero, idade, peso ao nascimento, peso à primeira consulta, estatura ao nascimento, icterícia, acolia ou hipocolia, colúria, hepatomegalia e esplenomegalia) e laboratorial (ALT, AST, FA, GGT, INR, BD). RESULTADOS: Os pacientes foram divididos em grupos, de acordo com o diagnóstico etiológico: grupo 1 (infeccioso) n = 24; grupo 2 (genético-endócrino-metabólico) n = 21 e grupo 3 (idiopático) n = 56. Não houve diferença estatisticamente significante em relação às variáveis: gênero, idade, estatura ao nascimento, icterícia, acolia/hipocolia, colúria, hepatomegalia, esplenomegalia, AST, ALT, FA, GGT, BD e albumina. O peso ao nascimento e o peso na primeira consulta dos pacientes com colestase neonatal intra-hepática de etiologia infecciosa foi menor. Houve diferença estatisticamente significante em relação ao INR: os pacientes com causas genético-endócrino-metabólicas apresentaram valor mais prolongado, porém com a mediana se situando dentro dos valores de normalidade. CONCLUSÃO: Não houve diferença estatisticamente significativa entre os grupos em relação às variáveis: gênero, idade, estatura ao nascimento, icterícia, acolia/hipocolia, colúria, ...

Gestational diabetes and its association with unpleasant outcomes of pregnancy

Diabetes Mellitus account for over 8% of all pregnancies and is associated with increased risk of complications of pregnancy, and prenatal mortality. This study was conducted to determine the disadvantages of gestational diabetes on mother and her baby, in order to prevent neonatal and marital unpleasant outcomes. The present historical cohort study includes 420 mothers referred to Shiraz hospitals in 2006. Seventy cases with diabetes and 350 were controls. Data was collected by questionnaire and analyzed by t-test and fisher exact tests in SPSS v.13 software. The recurrence rate of gestational diabetes was 72.4%. There was a significant difference between the two groups in still birth [RR= 8.87], macrosommia [RR= 7.38], respiratory distress [RR= 5.16], hypoglycemia [RR= 13.38], neonatal jaundice [RR= 3.28], need for respiratory support [RR= 3.17], congenital anomalies [RR= 7.28] and cesarean delivery [RR= 1.96] [p<0.05]. However it did not show any significant difference in intra uterine growth retardation [IUGR], shoulder dystocia, breech labor, need for insulin, meconium problems, induction of labor, episiotomy and placenta disorders [P>0.05]. Stillbirth, macrosomia, respiratory distress, hypoglycemia and neonatal jaundice are more common in women with gestational diabetes. Hence in view of the unfavourable outcome, preventive measures and control of diabetes are essential

Glucose-6-phosphate dehydrogenase [G6PD] deficency in neonates presenting with Jaundice

To determine the frequency of Glucose-6-phosphate dehydrogenase [G6PD] deficiency in infants presenting with jaundice. This retrospective study was conducted in Fazal Rahim Clinical Laboratory Timergara District Dir North West Frontier Province of Pakistan, from 1st January 2004 to 31st December 2004 on 120 neonates. Data regarding sex and age, serum bilirubin total, serum bilirubin direct and G6PD status was extracted using database software designed by the principal author. The inclusion criterion was neonates with high serum bilirubin and G6PD test performed simultaneously. The exclusion criterion was premature babies and incomplete request forms. Microsoft Excel 2000 was used for data analysis Out of 120 patients, 97 [80.8%] were male and 23 [19.2%] were female ranging in age from 3 - 10 days with mean 6.5 days and median 5 days. Thirty two [26.6%] neonates were found G6PD deficient. Among patients with normal G6PD level male to female ratio was 3.63:1. In G6PD deficient patients male to female ratio was 7:1. The serum bilirubin of the G6PD normal patients was 12.8 + 5.0 mg/dl and that of G6PD deficient patients was 13.5 + 6.8 mg/dl. G6PD deficiency is quite high in neonates presenting with jaundice. The diagnosis is simple and if left undetected may cause serious consequences in situations of oxidant stress

Neonatal biliary atresia

Bilrary atresia continues to emanate controversy and despair among Physicians and patients alike. With the development of liver transplant and new techniques a new insight in NBA surgical care has come forth. This condition is the most common cause of persistently direct [conjugated] hyper bilirubinemia in the first 03 month of life. Kasai portoenterostomy and liver transplantation battle to become todays leading therapy. The main focus of attention however remains that the results after portoenterostomy are decided by the promptness of the initial workup and referral to surgery. More then 80% of babies with NBA have satisfactory bile flow after hepatic portoenterostomy if the procedure is done before 8th week of life

Abdominal mass in a neonate: hepatoblastoma.

A term neonate born to a 37 year old mother was admitted to our Neonatology Unit because of jaundice and abdominal distention. Gastrointestinal examination revealed abdominal distention and a palpable abdominal mass in right upper quadrant. After the initial radiological studies, it was clear that the mass originated from liver. At postnatal 15th day alfa-feto protein was found to be 60.500 ng/ml (normal level (2 week-1 month):9.452+/-12.610 ng/ml). While due to relatively high frequency in infancy and the type of contrast material enhancement in imaging studies suggested an infantile hemangioendothelioma (IHE), heterogenous nature of the lesion and high AFP levels were consistent with a hepatoblastoma (HB). Since accurate diagnosis could not be achieved by radiological studies a liver biopsy is performed. After the pathological examination of the tru-cut liver biopsy specimen, histomorphological and immunohistochemical findings were consistent with the epithelial component of an embryonal type hepatoblastoma.

[Prevalence of urinary tract infection in neonates with prolonged jaundice referred to Aliasghar hospital in Zahedan [2005]]

Prolonged jaundice is defined as a type of icterus lasting over 14 dyas in term neonates or over 21 days in preterm neonates. Various pathologic causes such as urinary tract infection may induce prolonged jaundice. To determine the prevalence of urinary tract infection in neonates with prolonged jaundice. This was a cross sectional study carried out at Aliasghar hospital in Zahedan [Iran] during 2005. A total of 230 neonates with prolonged jaundice were investigated, conveniently. Using a urine bag, single sample was collected from all patients followed by culture. In case of a positive urine culture [>10[5] CFU/ml of a single pathogen], a second urine sample was taken by suprapublic method and cultured again. The reappearance of previously identified single pathogen was indicative of the presence of urinary tract infection. The data were analyzed using Chi square statistical test. Out of 230 neonates, 138 [60%] were males and 92 [40%] females. Positive urine culture was identified in 17 [7.4%] samples while the majority of samples [213] produced negative results. The organisms isolated in urine cultures were E coli in 13 samples [76.5%]. Klebsiella in 3 cases [17.6%] and Staphylococcus aureus in 1 sample [5.9%]. Regarding the gender, no statistically significant difference between the prevalence of urinary tract infection and the types of pathogens was found. Based on our data, a urine culture should be considered while bilirubin work-up of infants with unknown etiology of prolonged jaundice is carried out

Urinary tract infection in term neonates with prolonged Jaundice

The aim of this study was to evaluate the frequency of urinary tract infection [UTI] in neonates with prolonged jaundice. Newborn infants with jaundice lasted more than 2 weeks were included in this study. Patients who had other signs or symptoms were excluded. Workup of prolonged hyperbilirubinemia was performed, including direct Coomb's test, blood group of the neonate and the mother, complete blood count, blood smear, glucose-6-phosphate dehydrogenase [G6PD], reticulocyte count, serum level of bilirubin [ unconjugated and conjugated], thyroid function tests [serum thyroxine [T4] and thyroid-stimulating hormone], urinalysis, and suprapubic urine culture. Pediatric nephrologists carried out further investigation including kidney function tests, renal ultrasonography, voiding cystourethrography, and Technetium Tc 99m dimercaptosuccinic acid renal scintigraphy for patients with positive urine culture for microorganisms. Of 100 neonates who were evaluated, 43 were boys and 57 were girls. All of the neonates were breastfed. Six suffered from UTI [4 boys and 2 girls]. Reflux was detected on voiding cystourethrography in 1 and cortical defect in the kidney of renal scan in 2 boys. In our region, with a high rate of breastfeeding, UTI remains as an important cause of prolonged jaundice. Despite the high rate of urogenital system abnormality accompanied by neonatal UTI, there was not a significant difference between the signs and symptoms of jaundice in patients with and without UTI. Performing urine cultures should be considered as a routine procedure in the evaluation of every infant with prolonged jaundice

Ictericia neonatal, principales causas y manejo (Hospital Materno Infantil German Urquidi) / s

Realizando un analisis en forma global se puede indicar que: El numero de recien nacidos que ingresaron al servicio de neonatologia durante la gestion 2000 que corresponde a casos con ictericia es de 44. En su mayoria presentaron este signo dentro de las primeras 24 horas de vida, siendo una de las principales causas la incompatibilidad ABO con un 25 por ciento, causas no registradas por parte del personal medico un 22 por ciento, sepsis un 11 por ciento, sifilis el 7 por ciento, incompatibilidad por factor Rh 5 por ciento e ictericia fisiologica un 5 por ciento

Efectividad de la esplenectomía parcial en el tratamiento de la esferocitosis hereditaria / Effectiveness of the partial splenectomy in the treatment of hereditary spherocytosis

Objetivos. Evaluar la respuesta hematológica y clínica a la esplenectomía parcial en un grupo de niños con esferocitosis hereditaria. Material y métodos. Se analizaron los principales hallazgos hematológicos y clínicos de 13 pacientes con esferocitosis hereditaria a los cuales se les realizó esplenectomía parcial. El diagnóstico de la enfermedad y los estudios hematológicos se efectuaron por las técnicas habituales. Para precisar el patrón de herencia se hizo también el estudio a los padres. La resección del bazo se realizó extirpando los dos tercios superiores del órgano, dejando el polo inferior intacto. A todos los pacientes se le administró fenoximetilpenicilina profiláctica a dosis de 250 mg dos veces al día por tres años. Resultados. El diagnóstico de la enfermedad se realizó en el primer año de vida en 11 casos. El 76.9 por ciento de los niños comenzó con ictericia neonatal. El 53.8 por ciento presentaron hepatomegalia y el 69.2 por ciento esplenomegalia. El 84.6 por ciento tuvieron requerimientos transfusionales. Las cifras de hemoglobina aumentaron significativamente y los reticulocitos disminuyeron después de la esplenectomía. Ningún paciente ha tenido crisis hemolíticas, requerimientos transfusionales ni infecciones después de la intervención quirúrgica. Conclusión. Aunque el número de pacientes es pequeño y el tiempo de evolución es corto, la recuperación hematológica observada en nuestros casos sugiere que la esplenectomía parcial es un proceder quirúrgico beneficioso para el tratamiento de la esferocitosis hereditaria típica o severa.