[Neonatal consequences of maternal autoimmune thrombocytopenic purpura]. / Repercusión neonatal de la púrpura trombocitopénica autoinmune materna.

PURPOSE: To describe the clinical characteristics in newborns of mothers with autoimmune thrombocytopenic purpura (ATP), as well as to evaluate the mother's platelet count in the prediction of the neonatal thrombocytopenia. PATIENTS AND METHODS: We included 33 mothers with their 40 newborns, who were classified in four groups: Group I: ten newborns whose mothers suffered of chronic autoimmune thrombocytopenic purpura who during the pregnancy remained in haematologic remission. Group II: nine newborns whose mothers were splenectomized for ATP in the preceding treatment but without symptoms during the actual pregnancy. Group III: eleven newborns whose mothers had chronic ATP and splenectomy, but during the actual pregnancy showed purpuric activity. Group IV: Ten newborns whose mothers had acute ATP during actual gestation with clinical data for bleeding. RESULTS: None of the newborns belonging to the group I presented thrombocytopenia. Mean platelet count at birth was 150 x 10(9)/L in group I, 124 x 10(9)/L u/L in group II, 47 x 10(9)/L in group III and 89 x 10(9)/L in group IV. There were significant differences between the focus groups (p < .01). The mean platelet count in groups III and IV, presented the lower values between days three and fourteen of postnatal age. In these same groups, we observed more morbility related with haemorrhagical activity or infectious complications derived from treatment with steroids. The presence of maternal thrombocytopenia was associated in the 86.7% of the cases with platelet count < 100 x 10(9)/L at the time of birth. CONCLUSION: The maternal background with low probability of fetal or neonatal thrombocytopenia included mothers with inactive ATP and the antecedent of splenectomy. On the contrary, the greatest probability of fetal and neonatal affection happens when the mother presents active chronic ATP and the previous antecedent of being refractory to the treatment with splenectomy or when acute ATP occurred during pregnancy.

[Lactic acidosis in recovered asphyctic newborn infants]. / Acidosis láctica en el recién nacido asfíctico recuperado.

Thirty newborn babies delivered by elective caesarean section were studied. They were randomly placed in two groups. The first group consisted of newborns who scored 3 or less on the Apgar scale at one minute and 8 or more after five minutes. The other group included newborns which scored 8 or higher at one minute and 9 at five minutes. Blood samples were obtained from the umbilical cord which allowed for the measuring of the infants' pH, serum gases and pyruvic lactic acid levels. An increased level lactate was found in asphyctic infants. Five cases presented lactic acidosis which continued to be persistent in four of them an hour after they were born. Although increased levels of lactate were found also in the control group, they never presented lactic acidosis. No correlation was found between the pH and lactate levels nor between lactate and bicarbonate. A clear correlation between lactic acidosis and fetal distress was documented. It was concluded that lactate quantification is a useful indicator of neonatal asphyxia. Lactic acidosis; Apgar scores; asphyxia.

[The anemic gap in depressed newborn infants]. / El hiato aniónico en el neonato deprimido.

Thirty cesarean section-delivered newborn were studied. Fifteen of them scored from 0 to 3 and, 8 and greater on the Apgar scale when measured at one and five minutes, respectively. The other 15 scored 8 or more at one minute and 9 at five minutes. Arterial electrolyte and blood gases were measured in samples obtained from the umbilical cord. The anion gap formula was then applied. The average weight of the depressed newborns was found to be less than for those of the control group. The mean gestational age for both groups was 39 weeks. The average values for electrolyte, bicarbonate and the anion gap were found to be practically the same in both groups. No correlation was found between the pH and the gap nor for the gap and the hydrogen ion concentration [H+]. The correlation between the gap and the bicarbonate was 0.78. No differences were seen between anion gap values for the newborn with lactic acidosis or hyperlactemia when compared to those of the control group. It is therefore concluded that the anion gap is not useful for the detection of newborns suffering from metabolic acidosis. Anion gap; bicarbonate; Apgar score; depressed neonates; metabolic acidosis.