Prematuridad tardía: una población de riesgo / Late preterm: A population at risk

Antecedentes: Desde hace una década se pone de manifiesto el riesgo significativamente superior de morbimortalidad del prematuro tardío (RNPT) en relación al nacido a término. Población y método: Estudio prospectivo clínico-epidemiológico de los nacidos entre la 340 y 366 semanas de gestación de 34 hospitales del Grupo SEN34-36 recogidos durante 5años. Análisis de los resultados y comparación con nacidos a término. Resultados: Se obtuvieron datos de 9.121 RNPT, con una tasa de prematuridad tardía del 5,9% (71,8% de los prematuros). Fallecieron el 2,8 por mil . El parto se indujo en el 7%. En el 47,9% se practicó cesárea (44,4% programada), con un 18,8% de causa desconocida o no justificada. Presentaron diagnósticos de patología gestacional el 41,4%, siendo los más frecuentes: rotura prematura de membranas, síndromes hipertensivos, diabetes, amenaza de parto prematuro y crecimiento intrauterino restringido. La causa de prematuridad figuró como desconocida en el 29%, y en el 3,1% como injustificada, con un incremento significativo paralelo al de la edad gestacional. Ingresaron el 58,6% (15% cuidados intensivos). Los diagnósticos más frecuentes fueron hiperbilirrubinemia (43,5%), hipoglucemia (30%) y trastornos respiratorios (28,7%). Conclusiones: La morbimortalidad asociada a la prematuridad tardía justifica la revisión de los protocolos a la hora de finalizar la gestación antes de término y ajustarlos a criterios acordes a la evidencia científica, sin empeorar la morbimortalidad feto-materna. Pediatras y obstetras no debemos desestimar los efectos a corto y a largo plazo de la prematuridad tardía

Background: For the last decade, significant higher rates of morbidity and mortality in late preterm infants (LPI) have been observed when compared with term babies. Population and method: A prospective epidemiological study of late preterm babies registered for 34 hospitals in the SEN34-36 database for a five years period. A comparison with data from term babies was established. Results: 9,121 LPI were enrolled. Late prematurity rate was 5.9% (71.8% of premature infants). Mortality rate was 2.8 per-mille . Labor was induced in 7% of births. A cesarean section was performed in 47.9% of pregnancies, 44.4% of them were planned, and in 18.8% there was not a justified reason to perform it. 41.4% of pregnacies presented diagnoses of gestational pathology, being the most frequent diagnoses: premature rupture of the membranes, hypertensive syndromes, diabetes, preterm labor and restricted intrauterine growth. The reason of prematurity was unknown in 29% of births, and in 3.1% it was considered as unjustified, with a significant increase of this percentage in higher gestational ages. 58.6% of LPI were admitted to the Neonatal Unit (15% to the Neonatal Intensive Care Unit). The most frequent diagnoses were hyperbilirubinemia (43.5%), hypoglycaemia (30%) and respiratory disorders (28.7%). Conclusions: the increased rates of morbidity and mortality in LPI make necessary the revision of obstetrics protocols related to ending gestation before term according to the best evidence, although maternal and fetus morbidity and mortality shouldn't be increased. Pediatricians and obstetricians should not misconsider the effects of late prematurity and create protocols for perinatal care and follow-up for this population at risk

Recomendaciones para el manejo perinatal y seguimiento del recién nacido prematuro tardío / Recommendations for the perinatal management and follow up of late preterm Newborns

La prematuridad es la primera causa de morbimortalidad neonatal e infantil, y constituye uno de los problemas de salud más importantes de la sociedad, especialmente en las más industrializadas. La tasa de prematuridad ha ido incrementándose paulatinamente en los 2 últimos decenios, sobre todo debido al aumento de los denominados prematuros tardíos con edad gestacional entre 34+0 y 36+6 semanas. Las complicaciones, tanto perinatales como a medio y largo plazo, de este grupo de población son considerablemente más frecuentes que las de los recién nacidos a término, y con una incidencia más similar a la de los prematuros de inferiores edades gestacionales. La Sociedad Espa˜nola de Neonatología, a través de su Grupo SEN34-36, ha elaborado unas recomendaciones genéricas para la atención de este grupo de pacientes. Se proponen pautas tanto para la detección precoz como para el manejo de los problemas más habituales en el periodo perinatal más inmediato, incluyendo estrategias de cuidados centrados en el desarrollo y la familia. Asimismo, se insiste en la necesidad de seguimiento a medio y largo plazo, por el mayor riesgo de complicaciones tardía

Prematurity is the main reason for neonatal morbidity and mortality, and has become one of the greatest problems in public health, especially in developed countries. Prematurity rate has increased during the last 2 decades. This increase may be attributed to late preterm babies, that is, those with a gestational age between 34+0 and 36+6 weeks. Perinatal morbidities, as well as long term complications, are more frequent in this population than in term babies. The incidence is more similar to the one observed in earlier premature babies. The SEN34-36 group of the Spanish Society of Neonatology suggests these recommendations for the management of late preterm babies. Strategies are offered not only for the early detection of possible complications, but also for the correction of these morbidities, and from the point of view of a family and development centered care. Follow up is strongly recommended due to the high rate of late morbidities

[Recommendations for the perinatal management and follow up of late preterm newborns]. / Recomendaciones para el manejo perinatal y seguimiento del recién nacido prematuro tardío.

Prematurity is the main reason for neonatal morbidity and mortality, and has become one of the greatest problems in public health, especially in developed countries. Prematurity rate has increased during the last 2 decades. This increase may be attributed to late preterm babies, that is, those with a gestational age between 34(+0) and 36(+6) weeks. Perinatal morbidities, as well as long term complications, are more frequent in this population than in term babies. The incidence is more similar to the one observed in earlier premature babies. The SEN34-36 group of the Spanish Society of Neonatology suggests these recommendations for the management of late preterm babies. Strategies are offered not only for the early detection of possible complications, but also for the correction of these morbidities, and from the point of view of a family and development centered care. Follow up is strongly recommended due to the high rate of late morbidities.

Prematuros tardíos: una población de riesgo infravalorada / Late preterm infants: A population at underestimated risk

Introducción y objetivo: La tasa de prematuridad ha experimentado un incremento progresivo en los últimos años, a costa casi exclusivamente de los prematuros tardíos (34 a 36 semanas). Es una población que, si bien con menor riesgo que los prematuros de menor edad gestacional, tiene una tasa de morbimortalidad significativamente mayor que los recién nacidos a término. Sin embargo, hay una cierta infravaloración respecto a su evolución a corto y a largo plazo. El objetivo de este trabajo es revisar la incidencia de prematuridad en este centro y analizar la morbimortalidad en los prematuros tardíos comparada con los recién nacidos a término. Población y métodos: Revisión retrospectiva de los recién nacidos en el hospital desde el 1 de enero de 1992 hasta el 31 de diciembre de 2008. Entre las 340/7 y las 366/7 semanas de gestación formaron el grupo de prematuros tardíos (n=2.003), y los de 37 a 42 semanas cumplidas de gestación conformaron el grupo de recién nacidos a término (n=32.015). Se formaron 2 subgrupos según 2 períodos de tiempo (de 1992 a 1998 y de 2000 a 2008). Se analizaron las tasas de morbimortalidad, para cada uno de los grupos y subgrupos, y se compararon, así como la morbilidad semana a semana desde la semana 34 a la semana 42. Resultados: Durante el período estudiado, la tasa de prematuridad aumentó del 3,9 al 9,8%, a expensas exclusivamente de los prematuros tardíos (el 79% del total).La tasa de mortalidad en los prematuros tardíos fue del 5% comparada con el 1,1% en los a término (p<0,0001; odds ratio de 4,71; intervalo de confianza del 95%: 2,3 a 9,5). La incidencia de ingreso en la Unidad de Neonatología, tasa de cesáreas, gemelaridad, trastornos respiratorios, necesidad de asistencia respiratoria en forma de presión positiva continua en la vía respiratoria nasal o ventilación mecánica, incidencia de apneas, ictericia que precisó fototerapia, hipoglucemia y necesidad de nutrición parenteral fueron significativamente superiores (p<0,0001) en el grupo de pretérminos tardíos comparado con los recién nacidos a término. La tasa de morbilidad fue descendente a medida que aumentaba la edad gestacional, con el valor más bajo a partir de las 39 semanas. Conclusiones: La morbimortalidad en los prematuros tardíos es significativamente superior a la de los recién nacidos a término. Es necesario revisar las pautas ante estos prematuros nacidos cerca de término, buscar las posibles causas de su prematuridad, intentar reducir su incidencia y elaborar un cuidadoso protocolo de atención y vigilancia para minimizar la morbimortalidad asociada. Sería aconsejable establecer un seguimiento a largo plazo, a fin de conocer cuáles son las consecuencias sobre su desarrollo psicomotor. El colectivo obstétrico debe sensibilizarse del verdadero riesgo del nacimiento en estas edades gestacionales cercanas a término (AU)

Background and objective: There has been a gradual rise in prematurity rates recent years, almost exclusively at the expense of the late preterm (34 to 36 weeks). This population, although with less risk than smaller preterm gestational age, has a morbidity rate significantly higher than term infants. However, there is some underestimation regarding developments in the short and long term. The aim of this study was to look at the incidence of prematurity in our institution and to analyze morbidity and mortality in late preterm compared with term infants. Subjects and methods: We performed a retrospective review of newborns in our Hospital from January 1992 until December 31, 2008. Late preterm group was defined as between 340/7 and 366/7 weeks gestation (N=2003) and term infants from 37 to 42 weeks gestation (N=32015). We formed 2 subgroups according two time periods (1992–1998 and 2000–2008). The morbidity and mortality for each of the groups and subgroups, and the morbidity from week 34 to 42, were analysed and compared. Results: During the period studied, the prematurity rate increased from 3.9% to 9.8%, exclusively at the expense of the late preterm (79%). The rate of mortality in late preterm was 5 ‰ compared to 1.1 ‰ in the term (P <0.0001, OR 4.71, 95% CI 2.3–9.5). The incidence of admission to the Neonatal Unit, Cesarean rate, twin, respiratory disorders, need for respiratory support in the form of nasal CPAP or mechanical ventilation, incidence of apnea, jaundice requiring phototherapy, hypoglycaemia and need for parenteral nutrition were significantly higher (P<0.0001) in the late preterm group compared with term infants. The morbidity rate decreased significantly as gestational age increased, with the lowest value from 39 weeks. Conclusions: Morbidity and mortality in late preterm infants is significantly higher than in term infants. The guidelines for these near term premature babies need to be reviewed, looking for possible causes of prematurity, and trying to reduce their impact, as well as developing a protocol for their care and close monitoring to minimize the associated morbidity. There should be long-term monitoring to find out the consequences on their psychomotor development. The obstetrics group should be made aware of the true risks of births in the near-term gestational ages (AU)

[Influence of socioeconomic factors on weight, length and head circumference measurements in newborns from 35 to 42 weeks gestational age]. / Influencia de los factores socioeconómicos en el peso, la longitud y el perímetro occipitofrontal de los recién nacidos entre 35 y 42 semanas de gestación.

BACKGROUND AND OBJECTIVE: gestational age and anthropometric measurements, i.e. weight, length and head circumference at birth, have all been used as predictors of neonatal morbidity-mortality and adult morbidity. Differences in ethnic or socioeconomic background of newborn cohorts, as well as methodological differences between studies limit the validity and application of current anthropometric curves across different populations. Thus, we conducted a study to obtain local reference data in a Hospital that had a medium-high socio-economic class population, probably different to others recently published in our geographic area, and to compare them. PATIENTS AND METHOD: Weight, length and head circumference at birth were retrospectively analysed in 31,397 live Caucasian neonates born at 23-42 weeks in SCIAS-Hospital de Barcelona between 1992 and 2006. Only single gestations were selected and no other exclusion by materno-fetal or neonatal pathology criteria were applied. Percentile values, mean and standard deviation for each anthropometric measurement were calculated according to gestational age and gender. They were compared with the results from recent publications of our geographic area. RESULTS: Males were found to have significantly higher weight, length and head circumference values than females from 36 weeks. There was a trend towards higher values in our population when compared with others in our geographic area. CONCLUSIONS: The influence of socioeconomic factors on fetal growth seems evident. Nevertheless, it is difficult to assume that the observed differences must be exclusively due to the population characteristics or the different methodologies in the selection of the sample. Thus, it is desirable to have anthropometric reference curves obtained from populations of surrounding areas, with epidemiological methodologies that might be more appropriate in identifying valid outcome predictors, and enable us to compare with others groups according to racial, socioeconomic and disease factors.

Influencia de los factores socioeconómicos en el peso, la longitud y el perímetro occipitofrontal de los recién nacidos entre 35 y 42 semanas de gestación / Influence of socioeconomic factors on weight, length and head circumference measurements in newborns from 35 to 42 weeks gestational age

Introducción y objetivo: la clasificación del recién nacido según peso, longitud y perímetro occipitofrontal al nacer en relación con la edad gestacional se ha utilizado como indicador de morbimortalidad neonatal, así como factor pronóstico de enfermedades de la edad adulta. Las diferentes poblaciones analizadas y metodologías en la recogida de datos hacen que los resultados sean dispares entre publicaciones. El objetivo es establecer los valores antropométricos de referencia para nuestro hospital, que atiende a una población caracterizada por un nivel socioeconómico medio-alto, distinta, probablemente, de otras publicadas recientemente en nuestro entorno, y compararlas. Pacientes y método: análisis del peso, la longitud y el perímetro occipitofrontal al nacimiento de 31.397 recién nacidos vivos consecutivos en SCIAS-Hospital de Barcelona, de 1992 a 2006, con edades gestacionales entre 23 y 42 semanas. Se seleccionaron las gestaciones únicas y se separaron según sexo. Todos ellos de raza caucásica. No hubo exclusiones por enfermedad materna, fetal o neonatal. Se obtuvieron los valores en percentiles, media y desviación estandar, y se compararon según sexo. Se realizaron curvas según la edad gestacional a partir de las 35 semanas. Se compararon con los resultados de publicaciones recientes referidas a poblaciones de nuestro entorno geográfico. Resultados: se aprecian diferencias significativas en el peso, la longitud y el perímetro occipitofrontal al nacer según sexo a partir de las 36 semanas, con valores más altos en los varones. Se observa una tendencia a valores más altos en nuestra población al compararlos con otras de nuestro entorno geográfico. Conclusiones: la influencia del factor socioeconómico sobre el crecimiento fetal parece evidente. Sin embargo, es difícil asegurar que las diferencias observadas sean debidas, exclusivamente, a las características poblacionales o a las diferentes metodologías en la selección de la muestra. Es recomendable disponer de valores antropométricos poblacionales de referencia de la zona geográfica a la que pertenecemos, obtenidos a partir de metodologías epidemiológicas, para clasificar al recién nacido de forma adecuada y poder establecer comparaciones con sectores poblacionales diferenciados según factores raciales, socioeconómicos o por enfermedades (AU)

Background and objective: gestational age and anthropometric measurements, i.e. weight, length and head circumference at birth, have all been used as predictors of neonatal morbidity-mortality and adult morbidity. Differences in ethnic or socioeconomic background of newborn cohorts, as well as methodological differences between studies limit the validity and application of current anthropometric curves across different populations. Thus, we conducted a study to obtain local reference data in a Hospital that had a medium-high socio-economic class population, probably different to others recently published in our geographic area, and to compare them. Patients and method: Weight, length and head circumference at birth were retrospectively analysed in 31,397 live Caucasian neonates born at 23–42 weeks in SCIAS-Hospital de Barcelona between 1992 and 2006. Only single gestations were selected and no other exclusion by materno-fetal or neonatal pathology criteria were applied. Percentile values, mean and standard deviation for each anthropometric measurement were calculated according to gestational age and gender. They were compared with the results from recent publications of our geographic area. Results: Males were found to have significantly higher weight, length and head circumference values than females from 36 weeks. There was a trend towards higher values in our population when compared with others in our geographic area. Conclusions: The influence of socioeconomic factors on fetal growth seems evident. Nevertheless, it is difficult to assume that the observed differences must be exclusively due to the population characteristics or the different methodologies in the selection of the sample. Thus, it is desirable to have anthropometric reference curves obtained from populations of surrounding areas, with epidemiological methodologies that might be more appropriate in identifying valid outcome predictors, and enable us to compare with others groups according to racial, socioeconomic and disease factors (AU)

[Cord blood levels of interleukin 6 in preterm infants as an early marker of neonatal morbidity]. / Determinación de interleucina 6 en sangre de cordón en prematuros, como indicador precoz de morbilidad neonatal.

INTRODUCTION: The prematurity rate in our country is 8-9 %. Despite the decrease in neonatal mortality during the last decade, there is still a high incidence of neonatal morbidity and its subsequent sequelae. It is well known that the fetal inflammatory response plays an important role in the presence of neonatal morbidity. The aim of this study is to determine if interleukin 6 (IL-6) measurements in cord blood are a useful parameter to recognize those preterms with higher probability of suffering neonatal morbidity. PATIENTS AND METHOD: Descriptive and prospective study in newborns with gestational ages (GA) < or = 34 weeks. We determined IL-6 levels in cord blood; white cell count and C reactive protein (CRP) levels at 0, 12, 24 and 72 hours of life, and blood culture at admission. Clinical data was also collected, including perinatology factors, symptomatology on admission and subsequent evolution until discharge or death. RESULTS: We included 99 newborns with a GA between 23 and 34 weeks and birth weights between 480 and 2,855 g. Levels of IL-6 > 10 pg/ml show a significant correlation between maternal fever and/or chorioamnionitis (P = 0.005), a weak but significant correlation (P = 0.05, r = 0.3) between increased levels of CRP at 24 hours of life and Critical Risk Index for Babies (CRIB) score > or = 4 (P < 0.003, r = 0.2) and a significant correlation (P = 0.04) with the presence of periventricular leukomalacia (PVL) and with length of hospital stay (P = 0.0015). Patients with a lower GA show a trend to have higher levels of IL-6. CONCLUSIONS: IL-6 could be a useful and early marker of neonatal morbidity. Its rapid ability to predict neonatal morbidity gives it an advantage over other classical blood markers.

Determinación de interleucina 6 en sangre de cordón en prematuros, como indicador precoz de morbilidad neonatal / Cord blood levels of interleukin 6 in preterm infants as an early marker of neonatal morbidity

Introducción: La incidencia de prematuridad en nuestro país es aproximadamente del 8-9 %. A pesar del descenso de la mortalidad en este grupo de pacientes durante las últimas décadas, la morbilidad en el período neonatal y las secuelas posteriores siguen siendo elevadas. Se sabe que la respuesta inflamatoria fetal tiene un papel importante en la presencia de morbilidad neonatal. El objetivo de este estudio es determinar si la interleucina 6 (IL-6) en sangre de cordón es un parámetro útil para identificar a los prematuros que tienen mayor probabilidad de presentar morbilidad neonatal. Pacientes y método: Estudio descriptivo, prospectivo en recién nacidos con edad gestacional (EG) de hasta 34 semanas. Se determina IL-6 en sangre de cordón; recuento leucocitario y proteína C reactiva (PCR) a las 0, 12, 24 y 72 h de vida, y hemocultivo al ingresar. Se recogen factores perinatológicos, clínica en el momento del ingreso y evolución posterior hasta el alta o fallecimiento. Resultados: Se incluyen 99 recién nacidos con EG entre 23 y 34 semanas y peso al nacer entre 480 y 2.855 g. Los valores de IL-6 > 10 pg/ml muestran una correlación significativa con el antecedente de fiebre y/o corioamnionitis materna (p = 0,005), correlación débil pero significativa (p = 0,05; r = 0,3) con valores elevados de PCR a las 24 h de vida y con valores de la puntuación del índice de riesgo clínico para niños (CRIB) ≥ 4 (p = 0,003; r = 0,2) y correlación significativa (p = 0,04) con la presencia de leucomalacia periventricular (LPV) y con los días de ingreso (p = 0,015). En los pacientes con menor EG se observa una tendencia a mostrar valores de IL-6 más elevados. Conclusiones La IL-6 puede ser un marcador útil y precoz de morbilidad neonatal. Su precocidad para predecir morbilidad supone una ventaja frente a los marcadores analíticos clásicos (AU)

Introduction: The prematurity rate in our country is 8-9 %. Despite the decrease in neonatal mortality during the last decade, there is still a high incidence of neonatal morbidity and its subsequent sequelae. It is well known that the fetal inflammatory response plays an important role in the presence of neonatal morbidity. The aim of this study is to determine if interleukin 6 (IL-6) measurements in cord blood are a useful parameter to recognize those preterms with higher probability of suffering neonatal morbidity. Patients and method: Descriptive and prospective study in newborns with gestational ages (GA) ≤ 34 weeks. We determined IL-6 levels in cord blood; white cell count and C reactive protein (CRP) levels at 0, 12, 24 and 72 hours of life, and blood culture at admission. Clinical data was also collected, including perinatology factors, symptomatology on admission and subsequent evolution until discharge or death. Results: We included 99 newborns with a GA between 23 and 34 weeks and birth weights between 480 and 2,855 g. Levels of IL-6 > 10 pg/ml show a significant correlation between maternal fever and/or chorioamnionitis (P = 0.005), a weak but significant correlation (P = 0.05, r = 0.3) between increased levels of CRP at 24 hours of life and Critical Risk Index for Babies (CRIB) score ≥ 4 (P < 0.003, r = 0.2) and a significant correlation (P = 0.04) with the presence of periventricular leukomalacia (PVL) and with length of hospital stay (P = 0.0015). Patients with a lower GA show a trend to have higher levels of IL-6. Conclusions IL-6 could be a useful and early marker of neonatal morbidity. Its rapid ability to predict neonatal morbidity gives it an advantage over other classical blood markers (AU)

Síndrome del pulmón seco en el recién nacido / Dry lung syndrome in a neonate

No disponible

[Topiramate and pregnancy. Neonate with bone anomalies]. / Topiramato y embarazo. Recién nacido con anomalías óseas.

Topiramate is a new generation, antiepileptic drug used for the treatment of persistent partial crises. To date no specific teratogenic effects have been reported in humans, but they have appeared in experimental animals. We present the case of a neonate whose mother suffered from partial epilepsy, which was treated with topiramate throughout pregnancy at doses of 300 mg per day. When the child was born agenesis of the right thumb, hypoplasia of the left thumb, and syndactylia of the second and third toes of the foot with agnesis of some phalanges, and hypoplasia of the right orbicular muscle in the mouth were observed. No etiologic cause was found. We discuss whether there could have been a causal relationship with topiramate monotherapy.

Topiramato y embarazo. Recién nacido con anomalías óseas / Topiramate and pregnancy. Neonate with bone anomalies

El topiramato es un fármaco antiepiléptico de nueva generación utilizado entre otras indicaciones para tratamiento de las crisis parciales rebeldes a otros anticomiciales. Hasta la fecha no se han descrito efectos teratogénicos organoespecíficos en seres humanos, pero sí en animales de experimentación. Se presenta el caso de un recién nacido de madre con una epilepsia parcial tratada durante toda la gestación con topiramato en dosis de 300 mg al día. Al nacer se comprobó agenesia del dedo pulgar derecho, hipoplasia del pulgar izquierdo, sindactilia del segundo y tercer dedos de los pies y agenesia de algunas falanges, hipoplasia del músculo orbicular derecho de la boca. No se encontró ninguna causa etiológica y se especula si la monoterapia con topiramato pudiera tener relación causal

Topiramate is a new generation, antiepileptic drug used for the treatment of persistent partial crises. To date no specific teratogenic effects have been reported in humans, but they have appeared in experimental animals. We present the case of a neonate whose mother suffered from partial epilepsy, which was treated with topiramate throughout pregnancy at doses of 300 mg per day. When the child was born agenesis of the right thumb, hypoplasia of the left thumb, and syndactylia of the second and third toes of the foot with agnesis of some phalanges, and hypoplasia of the right orbicular muscle in the mouth were observed. No etiologic cause was found. We discuss whether there could have been a causal relationship with topiramate monotherapy

Tutor externo de ePTFE en estenosis traqueal. Aplicación clínica / External stent of ePTFE prosthesis in tracheal stenosis. Clinical application

Las estenosis traqueales adquiridas en el niño son secundarias bien a traumatismo directo cérvico-torácico o a secuelas postintubación. La resección y anastomosis término-terminal sigue siendo el tratamiento de elección. La tasa elevada de reestenosis está directamente relacionada con la tensión anastomótica en lesiones de más de 2 cm de longitud. Presentamos el caso clínico de un niño de 7 años que sufre politraumatismo severo por accidente de tráfico e intubación traumática en el lugar del accidente, con desarrollo subsecuente de estenosis traqueal cervical que precisa tratamiento endoscópico con láser y dilataciones con balón en tres ocasiones, sin éxito. Se practica resección del segmento traqueal estenótico, aplicando un tutor externo de ePTFE. El postoperatorio cursó sin complicaciones y fue posible una extubación precoz del niño. La evolución posterior ha sido satisfactoria; los estudios endoscópicos y de RNM postoperatorios muestran un diámetro anastomótico normal, sin estenosis. El niño se halla asintomático en la actualidad, 3 años después de la intervención y practica deporte de competición. Podemos concluir que el modelo descrito de tutor externo de ePTFE ha sido efectivo clínicamente en la prevención de la estenosis traqueal postanastomótica en el niño (AU)

[External tutor of ePTFE in tracheal stenosis. Clinical application]. / Tutor externo de ePTFE en estenosis traqueal. Aplicación clínica.

Acquired tracheal stenosis in children can be either to direct cervicothoracic trauma or to post-intubation. Resection and end-to-end anastomosis continues to be the treatment of choice. The high rate of restenosis is directly related to anastomotic tension in resections of more than 2 cm. We report a case of a 7 year old child who suffered severe injury caused by car crash and intubation at the scene of the accident, with subsequent development of a cervical tracheal stenosis which required preoperative iterative laser sessions and balloon dilatation on 3 occasions, without result. Resection and primary anastomosis with an external stent of ePTFE was performed. The patient was treated successfully and was extubated promptly. Post-operative endoscopic studies and magnetic resonance imaging showed widely patent tracheal lumina with no stenosis. Three years post-operatively, the child is asymptomatic and participates in competitive sport activities. We can conclude that the model described above was clinically effective in the prevention of post-anastomotic tracheal stenosis in the child.

[Pharmacokinetics of vancomycin in neonates of postconceptional age less than or equal to 32 weeks]. / Comportamiento farmacocinético de la vancomicina en neonatos de edad postconcepcional < or = 32 semanas. Propuesta de una pauta de dosificación.

The objective of the present study was to analyze the pharmacokinetic behavior of vancomycin in neonates of postconceptional age < or = 32 weeks (n = 44). The elimination of the antibiotic was influenced by the concomitant treatment with indomethacin and mechanical ventilation. Close monitoring of renal function of the neonate and vancomycin dosage individualization are mandatory when the above factors are present. Vancomycin dosage guidelines have been determined according to serum creatinine of these premature patients.

[Sepsis caused by coagulase-negative Staphylococcus in the newborn infant. Clinical and therapeutic aspects]. / Sepsis por estafilococo coagulasa negativo en el recién nacido. Aspectos clínicos y terapéuticos.

This study deals with sepsis caused by coagulase-negative stapylococci in a neonatal intensive care unit over a period of four years and eleven months. The global incidence was 20.7/1000 (50 cases out of a total of 2,416 admissions) and was higher in newborns with lower weight and with a shorter gestational age. The most significant clinical manifestations were fever, paleness, and apnea/bradycardia. In all cases the germ was sensitive to vancomycin. Evolution was favourable in all patients, in spite of the initial gravity of some cases. Sepsis due to coagulase-negative staphylococci is the most frequent cause of nosocomial infection in our environment.

[Perinatal factors predicting hypoxic-ischemic encephalopathy in asphyxic newborn infants]. / Factores perinatales predictivos de encefalopatía hipoxicoisquémica en el recién nacido asfíctico.

Between 1 May 1984 and 30 April 1985, 1,354 term or posterm neonates being white and having asphyxia in controlled delivery were studied to predict development of neurological signs and its seriousness. In each case correlations were estimated between the existence of neurological signs and its grade and 100 gestational, obstetric and neonatal factors of potential predictor. The discriminatory analysis indicated that the more significants predictors were: Apgar at five minutes, prolonged labor, twins, resuscitation, DIP I, cephalhematoma, caput succedaneum, umbilical artery pH, urgent cesarean section, hemorrhagic amniotic fluid, gestational edema, variable DIP, high forceps. A discriminatory value less than or equal to 2 predicts no neurological sign in 93.8%, while a value greater than or equal to 3 predicts moderate or serious signs is 98.4%.

[Leukemoid reactions in premature neonates with a very low birth weight]. / Reacciones leucemoides en recién nacidos prematuros con muy bajo peso al nacer.

Authors present three cases of leukemoid reaction in very low birth weight preterm infants. Hematologic evolution is detailed and was characterized by the presence of intense leukocytosis with marked shift to the left abundant immature forms. Leukocyte counts reached values of 70,000 and 106,000/mm3 between the second and third day of life, becoming normal around the eight day. No pathology known to cause such intense leukocytosis was observed in any case. Bibliography is reviewed and possible etiology is discussed, as until now this entity has been attributed to prenatal administration of glucocorticoids.

[Pseudoporoencephaly and congenital hydrocephaly as sequelae of a prenatal intracranial hemorrhage]. / Pseudoporencefalia e hidrocefalia congénitas como secuelas de una hemorragia intracraneal prenatal.

A term newborn with megacephaly and coagulation disease after a difficult delivery is reported. Images of pseudoporencephaly and hydrocephaly were seen in the scan as well as recent hemorrhages due to obstetric injury. Possibility of a prenatal intracranial hemorrhage being first cause is discussed.