[Prenatal diagnosis of choledochal cyst]. / Quiste de colédoco detectado prenatalmente.

The choledocal cyst is a defect of the biliary extrahepatic route, the incidence is 1 in 100-150,000 newborns. This paper reports the case of a female newborn with choledocal cyst detected prenatally, from a 32-year-old mother, 2nd term pregnancy, who was diagnosed in the routine obstetric ultrasound as an abdominal fetal cyst. An anatomic obstetric ultrasound confirmed the diagnosis that was defined of a probable hepatic origin. Newborn was delivered at 39 weeks by caesarean section, with weight of 3,980 g and Apgar score 9-9 in conventional time. Newborn presented a maxim bilirubin level of 16 mg, controlled with phototherapy; the hepatic function was normal. Ultrasound showed a choledocal cyst which measured 50 x 49 x 48 mm, with dilatation of the hepatic common conduct, the gall bladder was normal. The abdominal scan reported a cystic mass in the middle abdominal region of 44 x 53 x 52 mm confirming a choledocal cyst. The diagnosis was confirmed after surgery. Patient had a satisfactory post-surgical evolution.

[Pituitary tumor detected prenatally]. / Tumor hipofisiario detectado prenatalmente.

INTRODUCTION: Brain tumors are present in 2.9 per 100,000 newborn. Craniopharyngioma is a benign and slow growing brain tumor, frequently localized in the sellar and suprasellar region. There are few reports of pituitary tumor detected prenatally. CASE REPORT: We report a neonate with a craniopharyngioma detected prenatally as a pituitary tumor. In a 23 year old mother, second gestation, with no important history, was detected a sellar tumor at 31 gestation weeks, the obstetric ultrasound reported a suprasellar tumor of 2 per 3 cm diameter. Pregnancy ended in a vaginal delivery at 39 weeks, and obtained a 3.9 kg female, with cephalic diameter of 37.5 cm, the Apgar score was 8-9 at 1st and 5th minutes. In early neonatal period was scanned and confirmed a 3.2/2.3/2.9 cm suprasellar tumor with calcium deposits. The Paediatric Oncology department suggested a surgery and was realized a craniotomy at 3rd week of age. The surgery allowed to obtain 30% of the tumor and confirmed by histology craniopharyngioma. Patient had favourable evolution and was discharged at 3 months of age. CONCLUSIONS: We report a neonate in who was detected by prenatal ultrasound the presence of a suprasellar solid tumor, scan and magnetic resonance images in neonatal period defined its size and location and a craniopharyngioma was confirmed by histology. Patient had a satisfactory postsurgical evolution and was discharged at 3 months of age.

Infarto cerebral espontáneo en un recién nacido de término / Spontaneous cerebral infarction in a full-term neonate

Introducción. Un accidente cerebro-vascular de origen isquémico y/o hemorrágico aumenta la morbi-mortalidad neonatal. Se estima que ocurre en 1:4,000 recién nacidos. En este trabajo se reporta un recién nacido de término con un accidente cerebro-vascular aparentemente espontáneo. Caso Clínico. Se trata de un recién nacido, madre de 31 años, segunda gesta de término que cursó con diabetes gestacional y fue tratada sólo con dieta. Inició con trabajo de parto a las 41.5 semanas de gestación por FUM; se efectuó cesárea por desproporción céfalo pélvica. Se obtuvo producto femenino de 3,640 g calificado con Apgar 8-9, se le aplicaron sólo pasos iniciales de reanimación. En el primer día de vida presentó desviación de la comisura labial a la derecha y movimientos tónico-clónicos en hemicuerpo derecho en 2 ocasiones; se inició fenobarbital. Los resultados de laboratorio para glucemia, sodio, calcio, potasio, creatinina, tiempos de coagulación y biometría hemática fueron normales; los cultivos de líquido cefalo-raquídeo fueron negativos, la punción lumbar se consideró traumática. El ultrasonido fontanelar no mostró alteraciones sugestivas de un evento hemorrágico ni alteraciones a nivel ventricular; sin embargo, al tercer día de vida se practicó tomografía axial computarizada de cráneo simple visualizándose una zona hipodensa con un patrón geográfico hacia la región tempo-parietal izquierda con aspecto de evento vascular isquémico en el territorio de la arteria cerebral media. Conclusiones. Se continuó con fenobarbital y ácido acetilsalicílico. Permaneció asintomática por lo que se egresó al séptimo día de vida. Se citó a consulta externa en Neurología Pediátrica.

Background. Cerebral vascular accident (CVA) is an important cause of hemorrhagic or ischemic cerebral injury and increases neonatal morbidity and mortality. It occurs in 1/4000 term neonates. We report a case of a neonate with a spontaneous CVA. Case report. We present the case of a newborn (NB) who was delivered from a 31-year old mother. It was the second pregnancy with 41.5 gestation weeks. The mother presented gestational diabetes controlled only by dietary therapy. A 3640 g, apparently healthy female was obtained by cesarean delivery that was indicated due to cephalopelvic disproportion. Apgar scores were 8-9 according to the conventional time points. The pediatrician used only initial steps of reanimation. During the first day of life, the infant presented a deviation of the right mouth commissure and tonic-clonic movements on the right half of the body two times. The newborn was treated with phenobarbital intravenous infusion. Laboratory tests were all normal, and cultures of cerebrospinal fluid and blood were considered negative. A head sonogram showed no evidence of hemorrhage or ventricular distortion but a cranial CT reported a low-density zone suggesting a cerebral infarction in the left parietal and temporal regions. Conclusions. We continued to treat with phenobarbital and acetylsalicylic acid and the patient remained asymptomatic prior to discharge at the 7th day of life, recommending follow-up with a pediatric neurologist.

Retardo grave en el crecimiento intrauterino en un neonato de 480 g al nacer / Intrauterine growth retardation in a 480 g neonate at birth

Introducción. Existen pocos reportes de neonatos vivos de <500g con retardo en el crecimiento intrauterino (RCIU). Caso clínico. Se reporta el caso de un recién nacido con RCIU grave, madre de 30 años, primera gesta, 31 semanas de gestación y oligohidramnios grave, obtenido por cesárea, femenino, de 480 g, talla 30 cm, Apgar de 7-7, recibió oxígeno al 80% por 48 horas y, a partir de entonces, se inicia vía oral y nutrición parenteral. Las IgG e IgM para citomegalovirus y cuerpos de inclusión citomegálica fueron negativos. A los 20 días de vida pesó 500 g, cursó asintomático y toleró bien su fórmula, aumentando hasta los 1 700 g antes de su egreso a los 5 meses. A los 12 meses, con peso de 2.8 kg y retraso en el desarrollo psicomotor de 6 meses para la edad cronológica, no desarrolló retinopatía del prematuro, leucomalacia periventricular ni hemorragia intrancraneal. Conclusión. Se reporta el caso de un neonato de 480 g al nacer, de 31 semanas de gestación, que presenta RCIU grave y retraso en el desarrollo psicomotor. Sin embargo, no presenta leucomacia paraventricular ni hemorragia paraventricular.

Background. There are few cases of live neonates with intrauterine growth retardation (IGR) <500 g with a satisfactory outcome, including apparent normal neurodevelopment. Clinical case. We report the case of a female 480 g neonate diagnosed with severe IGR who was the product of a 30-year-old mother. This was the first gestation and delivery was at 31 gestation weeks. The neonate demonstrated severe oligoamnios and was delivered by Cesarean section. Apgar score was 7-7, oxygen was administered at 48 h, and parenteral nutrition and formula for premature infants was initiated. Serum cytomegalovirus IgG and IgM and cytomegalic urine inclusion were all negative. The infant accepted formula and was asymptomatic. She reached 500 g at 20 days of life. At 5 months old, her weight increased to 1 700 g before hospital discharge. Patient was followed-up until 1 year of age. She weighed 2.8 kg and demonstrated a 6-month delay in psychomotor neurodevelopment. It is important to mention that she did not develop retinopathy of prematurity, periventricular leukomalacia or intracranial hemorrhage. Conclusion. The patient presented here was born after 31 weeks gestation with a birth weight of 480 g. She showed severe IGR with neurodevelopmental delay; however, no retinopathy of prematurity, periventricular leukomalacia or intracranial hemorrage was demonstrated.

[Periventricular leukomalacia prevalence in premature newborn]. / Prevalencia de leucomalacia periventricular en neonatos prematuros.

BACKGROUND: the periventricular leukomalacia (PLM) is considered a lesion of the central nervous system secondary to a hypoxic-ischemic insult, and affects more to premature than term neonates. However, the reported rates in the literature are between 2 % to 25 % in premature neonates. The objective was to determine the prevalence of PLM in premature neonates. METHODS: a two year prospective screening program with transfontanel ultrasound in premature neonates weighing < 2000 g was carried out at 4 weeks of age. RESULTS: from 38 355 consecutive deliveries 562 were premature neonates weighted = 2000 g who fulfilled inclusion criteria and all were studied with transfontanel ultrasonography; we found 36 (6.34 %) premature neonates with PLM. Of the 346 neonates weighing = 1500 g, 26 (7.5 %) had a positive examination for PLM. In the 1501 g to 2000 g group, 10 of 216 (4.6 %) had PLM. The PLM prevalence was higher in male (2:1). Neurological exam was normal at the time of study. CONCLUSIONS: the PLM was present in 6.3 % of premature neonates weighing < 2000 g with 2 affected males for each female.

[Perinatal mortality in multiple pregnancies]. / Mortalidad perinatal en embarazos múltiples.

BACKGROUND: The incidence of multiple pregnancies has increased over the last decade and hence the hospital stay and perinatal morbidity and mortality. OBJECTIVE: to know the perinatal mortality rate of multiple pregnancies treated in a regional hospital. MATERIAL AND METHODS: Retrospective study conducted from the hospital records of deaths that occurred from January 2002 to December 2007 at the Hospital Regional de Especialidades No. 23 IMSS, Monterrey, Nuevo Leon, Mexico. RESULTS: during the study period (six years) were 122,822 births and 95 were multiple pregnancies (0.77/1000 births): 81 (85%) of triplets, 11 (11%) of quadruplets, two of quintillizos and one sextillizos with a total of 303 newborns. 26% (25/95) of multiple pregnancies had one or more deaths. The perinatal mortality rate was 165/1000 births (50/303) compared with that of pregnancies with one fetus in the same period 14.5/1000 births (p<0.0001). 20.9% (17/81) of triplet pregnancies and 54.5% (6/11) of the four had one or more deaths (p<0.02), with a perinatal mortality rate of 131/1000 births (32/243) and 295/1000 births (13/44) (p<0.006), respectively. Only 2/10 (20%) of newborns in two pregnancies quintillizos died and 3/6 (50%) of a pregnancy sextillizos. There was no difference in the proportion of sexes, but in the average weight of newborns: the weight of the triplets was alive vs dead vs 1659 g 713 g (p<0.0001) and the quadruplets from 750 g vs 1341 g (p<0.0007), respectively. CONCLUSIONS: 26% of multiple pregnancies had one or more deaths and 15% of the neonates died (165/1000 births). Multiple pregnancies were complicated with one or more deaths at 20% of triplets, 54% of quadruplets and 100% of quintillizos. The perinatal mortality rate of pregnancies with multiple fetuses 3 and 4 was No. 131/1000 and No. 295/1000, respectively.

[A 35 year period review of the perinatal mortality in a gynecology-obstetric unit]. / Mortalidad fetal, neonatal y perinatal en un hospital de ginecoobstetricia. Revisión de 35 años.

OBJECTIVE: To estimate the perinatal mortality rates over a 35 year period in neonates 22 weeks' gestation or above 500 g at birth until seven days postdelivery. METHODS: Data was obtained from medical records and the fetal death (FD) and neonatal death (ND) certificates. RESULTS: There were 889 282 deliveries (D) with 10,178 FD (11.2/1000 D) and 10,126 ND [11.3/1000 live newborns (LNB) with a significant reduction from 1972 to 2006 of 57 % in fetal mortality rate (p <0.0001) and 18.8 % in neonatal mortality rate (p <0.01). We registered 8081/10,126 (79.84 %) neonates who died from 0 to 6 days (9.2/1000 LNB). The overall perinatal mortality rate was 20.5/1000 D, with a 48.4 % significant reduction from 1972 to 2006 (p < 0.0001), 27.8/1000 ND, a 13.5/1000 ND respectively. We observed 4161 immature neonates (0.47 %); 55,340 premature newborns (6.2 %) and 9055 twin pregnancies (1 %). CONCLUSIONS: The fetal, neonatal and perinatal mortality rates were below the national media and presented a significant decrease from 1972 to 2006, more accentuated in fetal mortality rate (57 %) and perinatal mortality rate (48.4 %).

[Perinatal mortality at Hospital de Ginecoobstetricia No. 23 of Monterrey, Nuevo León, 2002-2006 period]. / Mortalidad perinatal en el Hospital de Ginecoobstetricia núm. 23 de Monterrey, Nuevo León (2002 a 2006).

BACKGROUND: Perinatal period begins at 22 gestational weeks and ends seven days after birth. Perinatal mortality is an important quality indicator of the obstetric and pediatric care available, and representative of the population's health service. OBJECTIVE: To know fetal, early neonatal, and perinatal dead rates, and them main mortality causes. PATIENTS AND METHODS: Descriptive and retrospective study at IMSS's no. 32 UMAE (Monterrey, Nuevo León, México), from January 2002 to December 2006. Mortality rates during fetal and perinatal, or neonatal periods, were estimated per 1,000 births or 1,000 live born, respectively. RESULTS: There were 1,681 deaths: 747 stillbirths and 934 neonatal. Two hundred and nineteen (29.3%) stillbirths had 22 to 27 gestational weeks, and 528 (70.6%) had 28. Three hundred and sixty neonatal deaths (38.5%) occurred before 27th gestational week, 320 (34.2%) between weeks 28th and 35th, and 254 (27.1%) after 36 weeks of pregnancy. Seven hundred and sixty four neonates died within 0 to 6 days of life, and 170 (18%) between seventh to 28th days of life. Fetal, neonatal, early neonatal, and late neonatal mortality rates were 7.2 in 1,000 births, 9.08 in 1,000 live born, 7.42 in 1,000 live born, and 1.65 in 1,000 births, respectively, and overall perinatal mortality rate was 14.58 in 1,000 births. CONCLUSIONS: Stillbirth, early neonatal, and perinatal mortality rates of this study were under national mean. Main mortality causes (70%) were congenital defects and prematurity.

[Neural defect prevalence in 248,352 consecutive newborns]. / Prevalencia de defectos del tubo neural en 248 352 nacimientos consecutivos.

BACKGROUND: neural tube defects are a scourge for the population in nondeveloped countries. OBJECTIVE: to evaluate the prevalence of neural tube defects at a Gynecology and Obstetric Hospital at Instituto Mexicano del Seguro Social. METHODS: it was compared two 5 years periods: one before (1995-1999) and other after (2000-2004) a State Health Department program (Secretaría de Salud, Nuevo Léon) with 5 mg folic acid supplementation once a week to women in reproductive age. RESULTS: we registered 248,352 consecutive deliveries in a 10 year period, and we observed 319 cases of neural tube defects, with a global rate of 12.84 per 10,000 deliveries. From 1995 to 1999, there were 132,360 deliveries, with 212 neural tube defects (16.01 rate per 10,000 deliveries); the rate of anencephaly was 6.49, spina bifida 8.23, and encephalocele 1.28. After the folic acid program was established, during the following period 2000 to 2004, there were 115,992 deliveries, 108 with neural tube defects (9.31 rate per 10,000 newborns), with 41.8 % reduction (p <0.001). Also decreased were anencephaly rates: 28.3 % (nonsignificant) and spina bifida 63.4 % (p < 0.001). CONCLUSIONS: the neural tube defects rate has been declining in the last five years compared with the 5 years previous by 41 %, significantly more for spina bifida than anencephaly.

Screening for retinopathy of prematurity: results of a 7-year study of underweight newborns.

BACKGROUND: Retinopathy of prematurity (ROP) is a serious complication of treatment and extension of survival in premature infants and leads to blindness unless recognized and treated early. An ROP prospective screening survey was performed, enrolling all premature newborns weighing <2000 g at delivery. METHODS: A total of 2014 infants had a retinal evaluation by indirect ophthalmoscopy at 4-6 weeks of age. If any ROP stage was detected, the patient was followed periodically to assess treatment. All premature infants with threshold retinopathy were treated by transscleral cryotherapy at the time of detection. RESULTS: We found 449 infants (22.2%) with ROP in any stage, and 230 (11.42%) with threshold retinopathy who underwent cryotherapy. In the 500-1000 g group (n = 334), 48.2% had ROP in any stage and 92 (27.5%) had threshold retinopathy. In the 1001-1500 g group (n = 1374), 257 (18.7%) had any ROP stage and 122 (8.8%) had stage 3. In the 1501-2000 g group, 306 neonates were evaluated, 31 (10%) had any ROP stage and 16 (5.2%) underwent cryotherapy. A total of 198/230 infants (86%) with threshold retinopathy who received cryotherapy had complete recovery, but 5% developed unilateral and 9% bilateral retinal detachment. There were no complications related to anesthesia. CONCLUSIONS: Overall ROP rate was 2.68/1000 deliveries and 22.2% of premature infants <2000 g had any ROP stage, 11.42% with retinal detachment risk received cryotherapy with 86% successful results.

[Normal parameters of ear acoustic emissions in neonates]. / Parámetros de normalidad de las otoemisiones acústicas en neonatos.

INTRODUCTION: The ear acoustic emissions (EAE) are produced from pure low intensity tones coming from the cochlea in response to a stimulus. Hypocusia in the neonate may be detected by universal hearing screening programs using EAE that have a sensitivity of 91% and specificity of 85%. OBJECTIVE: To define the normal limits we measured the EAE in a group of healthy newborns and calculated the media and standard deviation (SD). PATIENTS AND METHODS: We enrolled 280 healthy neonates, previous external ear evaluation for permeability and we measured the EAE at 7 to 30 days of life at 2000, 2500, 3187, 4000, 5062 y 6375 Hz, using a 55-65 dB stimulus for each frequency band. RESULTS: In each frequency band evaluated we calculated the media: 10.76, 9.16, 9.46, 7.89, 4.83, 2 dB SPL, and minus two SD: 0.54, -0.33, 0.06, -2.04, -4.37, -7.43 dB SPL, that we considered the lower limit of normality for both ears in each frequency band tested. There were no significant differences between measurements in both ears (p>0.05). CONCLUSIONS: The EAE measurement is an easy, and low cost test that can be used to make the universal hearing screening accessible. These results support the normal levels of EAE and the Corti organ function in healthy newborns.