Leucoencefalopatía posterior reversible: una observación poco frecuente / Reversible posterior leukoencephalopathy syndrome: an unusual observation

La leucoencefalopatía posterior reversible es un síndrome clinicorradiológico que se presenta con cefaleas, vómitos, alteración de la conciencia, trastornos visuales y convulsiones. Su etiología es múltiple, y entre sus causas más frecuentes está la hipertensión arterial. Se produce como consecuencia de un fracaso en la autorregulación del flujo sanguíneo cerebral que origina un edema preferentemente de la sustancia blanca en las regiones posteriores del cerebro. Tras la orientación clínica, la confirmación diagnóstica se realiza por medio de las imágenes obtenidas por resonancia magnética. Presentamos el caso de un niño de 7 años de edad que desarrolló una leucoencefalopatía reversible asociada a hipertensión (AU)

Reversible posterior leukoencelopathy syndrome is a clinicalradiological syndrome that presents itself with headaches, vomiting, and loss of consciousness, seizures and visual disturbances. The etiology is multiple and the most frequent is arterial hypertension. It is produced as consequence of a failure of the auto regulation of the cerebral blood flow, which causes an edema mainly of a white substance in the posterior regions of the brain. After the clinical suspicion the confirmation of the diagnosis is made by means of the MRI. We present a 7 years old boy who developed a reverse leucoencephalopathy associated with hypertension (AU)

Early-onset neonatal sepsis due to Cellulosimicrobium cellulans.

Cellulosimicrobium cellulans represents a rare human pathogen. Infections have been reported in immunocompromised hosts or in patients with an underlying disease. The authors describe a rare case of early-onset neonatal sepsis due to Cellulosimicrobium cellulans in an infant without any underlying disease. The infant was successfully treated with vancomycin.

[Body composition analysis using bioelectrical and anthropometric parameters]. / Análisis de la composición corporal por parámetros antropométricos y bioeléctricos.

BACKGROUND: Interest in the study of body composition in childhood is increasing. Bioelectrical impedance analysis (BIA) is an accurate and reliable method. OBJECTIVES: To determine anthropometric parameters, fat-free body mass and fat body mass using BIA and anthropometry, and to establish their relationship. MATERIAL AND METHOD: A total of 365 healthy children (188 boys, 177 girls) aged 6.0 to 14.9 years were studied. Weight, height, arm circumference, skinfolds (bicipital, tricipital, subscapular and suprailiac) and bioelectrical parameters were measured. Body density was calculated from the four skinfold measurements using Brook's formula. Bioelectrical impedance was measured with a BIA-101 S (RJL Systems) using a fixed frequency (50 kHz). Fat-free body mass from BIA was calculated using Deurenberg's equation (FFM = 0.82 x height2/resistance). RESULTS: We present the mean, standard deviation and 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th percentiles of anthropometric variables and fat mass and fat-free mass estimated using BIA. Correlations were found between fat-free mass estimated using BIA and anthropometric variables. The reliability of BIA in estimating fat mass was assessed with intraclass correlation coefficients, which were excellent (0.948 in boys, and 0.945 in girls). CONCLUSIONS: BIA is an easy, low-cost, and highly reliable method, making it a useful technique for studying human body composition. This method shows excellent correlation with anthropometric variables.

Análisis de la composición corporal por parámetros antropométricos y bioeléctricos / Body composition analysis using bioelectrical and anthropometric parameters

Antecedentes. El estudio de la composición corporal en la infancia tiene un interés creciente. El análisis de la impedancia bioeléctrica (BIA) es un método fiable y reproducible. Objetivos. Determinar los parámetros antropométricos, la masa magra y grasa mediante BIA y antropometría, y sus relaciones. Material y método. Se estudiaron 365 niños sanos (188 varones y 177 mujeres) de edades entre los 6,0 y 14,9 años. Se midió: peso, talla, perímetro braquial, pliegues cutáneos (bicipital, tricipital, subescapular y suprailíaco) y parámetros bioeléctricos. La densidad corporal se calculó a partir de las medidas de los cuatro pliegues con la fórmula de Brook. La impedancia bioeléctrica se midió con un BIA-101 S (RJL Systems) que usa una frecuencia fija (50 kHz). La masa magra por BIA se calculó con la ecuación de Deurenberg (MM=0,82 x talla2/resistencia).Resultados. Se presentan la media, desviación estándar y percentiles 3, 5, 10, 25, 50, 75, 90, 95 y 97, de los parámetros antropométricos y de la masa magra y grasa estimadas por BIA. Se encontraron correlaciones de la masa grasa por BIA con los parámetros antropométricos. La fiabilidad del BIA para estimar la masa grasa se evaluó mediante el cálculo del coeficiente de correlación interclase, que fueron excelentes (0,948 en varones y 0,945 en mujeres). Conclusiones. El BIA es una técnica de fácil manejo, bajo coste y alta fiabilidad por lo que es muy útil para el estudio de la composición corporal humana y posee una excelente correlación con los parámetros antropométricos (AU)

Leuconostoc bacteremia in a healthy infant.

Infections by Leuconostoc species bacteria are uncommon, and usually affect patients with an underlying disease, or those fitted with a venous catheter or subjects previously treated with vancomycin. The most common clinical presentation is fever secondary to a central venous line infection. We report a case of Leuconostoc sp. bacteremia in an otherwise apparently healthy 2.5 month-old infant. The patient was successfully treated with cefotaxime. Leuconostoc sp. is an emerging pathogen that should be considered in the differential diagnosis of vancomycin-resistant Gram-positive bacteremia.

[Usefulness of ultrasound in the assessment of bone mineralization in newborns]. / Utilidad de los ultrasonidos para la valoración de la mineralización ósea en recién nacidos.

BACKGROUND: The study of bone mineralization in the neonatal period and of bone disease is receiving increasing interest. Osteosonography is a new method for measuring bone mineralization without exposing the patient to radiation. OBJECTIVE: To determine the speed of ultrasound in healthy newborns, the possible variations in preterm infants, and their relationship with gestational age and anthropometry. METHODS: One-hundred newborns (53 term infants [26 males, 27 females] and 47 preterm infants [27 males and 20 females]) were studied. The variables measured were gestational age, length, weight, circumferences (head and thoracic) and amplitude-dependent speed of sound (Ad-SOS). A prior study was carried out to select the area of measurement with ultrasound between both femora and humeri. RESULTS: No significant differences in Ad-SOS were found between the right and left femora or humeri, but there were significant differences between femora and humeri (p 0.001). The mean Ad-SOS in the population was 1706.6 36.3 m/s. Ad-SOS was 1726 26.2 m/s in term infants and 1679 36.7 m/s in preterm infants; this difference was statistically significant. Correlations were also found between Ad-SOS and gestational age and anthropometric variables. CONCLUSIONS: Ad-SOS is an effective method for bone mineralization screening in newborns and for detecting postnatal changes.

Early onset of neonatal sepsis due to group A streptococcus.

Neonatal infections by group A beta-hemolytic streptococcus are very rare in the antibiotic era. There are only a few cases in the first 72 hours after birth. The authors describe a case in which it was confirmed that the bacteria responsible, group A beta-hemolytic streptococcus, had grown in the newborn's blood and in the mother's lochia. The transmission mechanisms are also reviewed.

Análisis del pliegue submandibular como parámetro estimativo de la masa grasa / Analysis of submandibular skinfold thickness as parameter to estimate fat mass

Antecedentes: La exploración del estado nutricional mediante métodos antropométricos incluye la medida de los pliegues cutáneos. El pliegue submandibular ha sido muy poco empleado en dicha valoración. Objetivos: Conocer los valores normales del pliegue submandibular en nuestra población y sus relaciones con otros parámetros antropométricos. Material y métodos: Se han estudiado 188 niños y 177 niñas sanos de 6 a 14 años de edad. Se midieron: peso, talla, perímetro braquial, pliegues cutáneos (submandibular, bicipital, tricipital, subescapular, suprailiaco), índice de masa corporal, índices de distribución grasa, indicadores de grasa corporal, para cada edad y sexo. Se calcularon los percentiles del pliegue submandibular, para cada edad y sexo; se compararon sus medidas entre sexos para cada edad mediante el test t de Student, y sus correlaciones con todos los parámetros antropométricos. Resultados: El valor máximo del pliegue submandibular en los niños es a los 12 años y en las niñas a los 11. No se han encontrado diferencias entre sexos. Las correlaciones más elevadas son con los otros pliegues cutáneos, con la suma de los pliegues y con el área grasa del brazo. Conclusiones: El pliegue submandibular tiene una alta correlación con los indicadores de grasa corporal. Por ello puede ser útil para valorar el estado nutricional en la infancia (AU)

Tratamiento con metadona durante el embarazo: repercusión en el recién nacido / Treatment with methadone during pregnancy: repercussion in the newborn

El objetivo de este estudio es conocer el perfil epidemiológico de las madres en tratamiento con metadona durante la gestación y caracterizar el síndrome de abstinencia en el recién nacido. Se revisan los aspectos maternos, perinatales y neonatales de 30 recién nacidos de madres en tratamiento con metadona que ingresaron en nuestra Unidad de Neonatología desde enero de 1995 hasta mayo de 2001.Los antecedentes más frecuentes en las madres estudiadas son: edad cercana a los 29 años, familia monoparental, con más de dos embarazos y frecuentes antecedentes de abortos, sin control obstétrico durante la gestación. El parto es generalmente eutócico y los test de Apgar, también suelen estar acordes a la normalidad. El neonato presenta bajo peso al nacimiento y el síndrome de abstinencia con casi total seguridad (29 de 30). El síndrome de abstinencia es de inicio precoz e intensidad y duración elevadas. Menos de tres horas de sueño y el llanto agudo son los síntomas más comunes al inicio y los más frecuentes en aparecer son los generales y neurológicos (AU)

Displasia campomélica / Camptomelic dysplasia

La Displasia campomélica es un cuadro clínico caracterizado por la curvatura y acortamiento simétrico de extremidades inferiores, facies peculiar y generalmente mortal por insuficiencia respiratoria.Esta enfermedad se asocia en el 50 por ciento de las ocasiones a disgenesia gonadal con un fenotipo femenino y un cariotipo XY. Se trata de un proceso genéticamente determinado y ligado a mutaciones del gen SOX9.Presentamos el caso clínico de un recién nacido mujer, de 37 semanas de edad gestacional, diagnosticado prenatalmente de displasia ósea, con fenotipo y estudio radiológico compatible con las características de esta enfermedad. Destaca la concordancia entre el fenotipo femenino y su fórmula cromosómica XX.Durante su estancia presentó distress respiratorio progresivo, falleciendo a los 27 días de edad por fallo multiorgánico (AU)

[Copper in the neonatal period. Maternal-fetal relations]. / Cobre en el período neonatal. Relaciones materno-fetales.

UNLABELLED: The objective of this study has been to know the copper levels in maternal and cord blood at delivery, the relationships between them, and the influence that maternal age, parity, social class, sex, gestational age and anthropometric parameters have over them. MATERIAL AND METHOD: Copper levels in serum from one hundred mothers and their newborns have been determined by atomic absorption spectrophotometry. RESULTS: The mean copper level in maternal serum was 232.4 +/- 31.3 micrograms/100 ml, and 50.2 +/- 18.4 micrograms/100 ml in cord blood. We do not find any influence of maternal age, parity, sex and neonatal anthropometry over these levels. We see an ascending tendency of serum copper in the newborns as they increase their gestational age, and in mothers as soon as they belong to a lower socioeconomic level. There is a significant difference between the cord copper levels of newborns from mothers with serum copper levels less or equal to P25 or P50 and those from ones over P75, and a significant positive correlation between maternal and newborns ones. CONCLUSIONS: Our results show the relationship between the maternal and neonatal copper status, the influence of the socioeconomic situation on the maternal levels, and the age gestational age on the newborns ones.

[Neurologic alert signals in one-year-old infants: relation to signs of intrapartum hypoxia]. / Signos neurológicos de alerta al año de vida: relación con los signos de hipoxia intraparto.

As a method to evaluate the neurologic evolution and to establish if there exists any differences in the relation with the signs of intrapartum hypoxia, we have explored the neurologic "alert signs" at a certain age (12 months of life) in 80 full-term newborn infants with normal weight and without criteria of neurologic risk. We did not find statistically significant differences in the presence of alert signs in regards to sex, gestational risk, type of amniotic fluid, way of delivery, one-minute and five-minute Apgar scores or acid-base state in the umbilical artery at birth. We did find a significant increase in the number of alert signs in patients with cardiotocographic patterns that were suspicious or not tranquil in relation to those whose cardiotocographic patterns were tranquil.

[Adverse reactions to vaccines]. / Reacciones adversas a las vacunas.

The adverse reactions to vaccines are still a questioned subject because of the diversity of criteria they have been assessed with. We review the different etiopathogenic mechanisms that may be involved in their production, so as their local and general clinical features. We finally suggest that in despite of presentation of the adverse reactions that can be really attributed to vaccines, in order to known their real incidence it is necessary to develop a control system all over the vaccinated population.

[Usefulness of the determination of free erythrocyte protoporphyrin in relation to other hematologic parameters in iron deficiency]. / Utilidad de la determinación de la protoporfirina eritrocitaria libre en relación a otros parámetros hematimétricos en el déficit de hierro.

Hematological parameters and free eythrocyte protoporphyrin (FEP) on a capillary blood sample were measured in 175 apparently healthy children ranging from 6 months to six years of age. Thirty eight children had hematological parameters descended and/or FEP elevated were asked to return for blood counts, FEP, serum ferritin, serum iron, total iron binding, capacity, transferrin saturation and ALA-D activity, on a venous blood sample. Only 34 children returned. Twenty seven, 15.4%, had iron stores descended or iron deficiency, 18 of them with anemia. FEP had significant correlation coefficients with hematologic parameters (p less than 0.001), serum iron and transferrin saturation (p less than 0.01). On iron deficiency anemia detection, the FEP had a sensibility and specificity of 0.94 and 0.75 respectively.

[Evaluation of the treatment with clonidine of short stature in children]. / Valoración del tratamiento con clonidina en niños con talla corta.

We report the results obtained after a treatment with clonidine. 100 micrograms/m2/d, to 23 prepubertal children (11 boys and 12 girls) along six months. All of them presented the characteristics of constitutional growth delay, and responded to different stimuli with serum GH levels upper to 10 ng/ml. The growth speed and the somatomedin C levels increased and the height SD score decreased, in 87% of the subjects. We contrast this results with the ones obtained by others authors and we finally comment the clonidine acting mechanisms and the possible therapeutic indications.