[The therapeutic use of pulmonary surfactant in neonatal hyaline membrane disease]. / Uso terapéutico del surfactante pulmonar en la enfermedad de membrana hialina neonatal.

Preliminary report of our experience with the therapeutic use of pulmonary surfactant in newborn infants of less than 30 weeks gestation with hyaline membrane disease. The use of pulmonary surfactant was held under the "rescue" modality, with up to 36 hours of postnatal life. The blood gas changes are described and the assisted ventilation progress, as well as the general response on the clinical condition of each case. Discussion in centered in the risk of use and in the criteria for prescribing the therapeutic pulmonary surfactant. It is concluded that meeting the recommended requirements for its use, the pulmonary surfactant is a therapeutic alternative in the treatment of hyaline membrane disease in newborn infants of less than 33 weeks gestation, being different the immediate ventilatory response in terms of therapeutic control, with one or other forms of pulmonary exogenous surfactant, without differences in the final result.

[Hearing and language sequelae in survivors of a neonatal intensive care unit]. / Secuelas de audición y lenguaje en sobrevivientes de una Unidad de Cuidados Intensivos Neonatales.

INTRODUCTION: The purpose of this study is to record the hearing and language sequelae in a sample of children from the Intensive Care Unit between the ages of two and three. MATERIALS AND METHODS: Forty-one children were studied after being submitted to neuropsychological, hearing and language tests. Both normal and abnormal parameters for each test allowed the categorization of the children. RESULTS: In the general sample there were 24 full-term children versus 17 preterm children. The neurological testing showed a tendency towards normality. The same was seen in language testing since the proportion of normality corresponded to those children born after a full term. There were practically no differences in those suspected from both groups and a greater percentage of abnormal children were found among the pre-term infants. From an audiological standpoint there was a predominance of normal children; there was only one patient with severe bilateral hypoacusis who needed an electric auxiliary hearing device and two other patients with peripheral ear dysfunction classified as serous middle ear otitis. CONCLUSIONS: The incidence of hypoacusis in this sampling type is similar to that reported in the literature. Those patients with a history of assisted mechanical ventilation have been later found to have, as a sequelae, serous middle ear otitis, which corresponds to that reported by Paradise. The development of language stages were altered more so in preterm children. In some patients, the lack of stimulation associated with a low socioeconomic back group favors the delay in the development of language skills.

[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.

[The Apgar score as a predictor of neurologic sequellae]. / El puntaje de Apgar como predictor de secuelas neurológicas.

65 newborns with Apgar score less than 7 were studied. Initially 2 groups were formed. Group 1 with severe asphyxia Apgar 0-3 and group 2 with moderate asphyxia Apgar 4-7. Each group was divided according to Apgar score at 5 minutes; with good recuperation Apgar greater than or equal to 6 and bad recuperation Apgar less than 6. So four subgroups were formed. All patients were evaluated with Amiel Tison neurological examination at 12 months old. Of the 65 newborns, 52 (80%) had a normal neurologic examination, and only 12 (20%) were not normal. There were not significant statistic differences neither between the moderate and severely asphyxiated groups nor between the four subgroups at 5 minutes and their neurological examination. We conclude that the Apgar score at 5 minutes is not a good predictive of neurological sequelae, because there is a myriad of factors difficult to investigate in relation to the etiology of neurologic sequelae. We stress the importance of reviewing the original idea about the Apgar score as a useful method (instrument) to evaluate the hemodynamic and homeostatic conditions of the newborns.

[Clinical characterization of a sample of newborns at risk of presenting with an altered neurologic evaluation]. / Caracterización clínica de una muestra de recién nacidos en riesgo de presentar una evaluación neurológica alterada.

Being the Prachtl's Neurological Sieve a systematic condense analysis of neurologic screening which allows to establish a normal or suspicious neurologic condition at a sensibility of 0.85, and specificity of 0.77 with a predictive value of 0.78 (in our experience), we take it as an axis variable capable to discriminate among the population with and without risk of neurologic injury or sequela. Thirty-five newborn infants with an Apgar score at birth equal or below 6, were taken into study for the purpose of featuring the group of neonates on risk to show an altered neurologic evaluation. The study was held under the hypothesis that: low Apgar score, and morbidity and mortality risk index, need to be complemented with hospital outcome (Casaer) and the estimation of factors affecting physical and mental development (Eggermont), in order to be able to feature those neonates in risk for developing a neurologic injury or sequela. Findings showed that Prechtl's Neurological Sieve is directly influenced by the magnitude of recovery from the one to five minutes Apgar Score, by the Casaer's first or initial score and by the Eggermont's assessment items. It is also related in an indirect way to the birth weight, the gestational age, the morbidity and mortality risk index, the 1 and 5 minutes Apgar score and the final or discharge Casaer evaluation.

[Neurologic follow-up of polycythemic newborn infants]. / Seguimiento neurológico de neonatos policitémicos.

Seventy five newborn infants with neonatal polycythemia diagnosis (venous hematocrit levels greater than 65% were studied). They were born in the Instituto Nacional de Perinatologia and follow through their first year of life searching for neurologic findings. The more frequent signs related to polycythemia in this group were: presence of plethora, respiratory distress, cyanosis and tremors; the associated findings were hypoglycemia, hyperbilirubinemia, necrotizing enterocolitis and meconium aspiratum. Sixty eight of the seventy five neonates developed symptomatology and seven didn't. The eight neonates who developed neurologic transient impairments belonged to the symptomatic group in a 0.11 proportion. We concluded that the number of babies with neurologic findings in our sample was small in comparison with other reference studies; we also found that the exchange transfusion is not a preventive measure for neurologic sequel, but it is useful to diminish the symptomatology caused by polycythemia; besides we don't recommend this procedure in asymptomatic babies because the complication risks as the enterocolitis. We propose a simple treatment scheme.

Intervalos electromecanicos sistolicos derechos e izquierdos en recien nacidos de termino sanos. / Right and left systolic electromechanic intervals in full-term mewborn infants

Se investigaron los valores normales de los intervalos electromecanicos en recien nacidos de termino sanos por ecocardioelectrografia en cuatro grupos de diferente edad postnatal. Se discrimino la influencia que podia tener el tipo de nacimiento (vaginal o cesarea) determinandose en 26 casos la duracion de los periodos de preeyeccion ventricular de ambos ventriculos, asi como las relaciones entre los periodos de preeyeccion y eyeccion ventricular derechos e izquierdos. No se encontro a traves de la prueba "t" de Student diferencia significativa entre los valores observados en recien nacidos obtenidos por parto vaginal o por cesarea, dentro de la comparacion de los grupos de edad estudiados. Por lo tanto se considero el total de la muestra en sus valores como representativa de normalidad

Leucomalacia periventricular en un recien nacido. / Periventricular leuKomalakia in a newborn infant

La leucomalacia periventricular en el recien nacido de pretermino en vida, puede presentarse con manifestaciones clinicas sugestivas de meningitis. Se describe un caso en que los signos neurologicos que describen a la meningitis, tales como: estupor, convulsiones, abombamiento de la fontanela anterior, rigidez de extensores (opistotonos), signos focales cerebrales (desviacion de los ojos), rigidez de nuca, asi como la expresion citoquimica del liquido cefalorraquideo y la cuenta diferencial de globulos blancos en la biometria hematica, se presentaron en un recien nacido de pretermino al que por ultrasonografia del cerebro se le diagnostico leucomalacia periventricular. Los cultivos de liquido cefalorraquideo y frotis para la tincion de Gram no mostraron bacterias asi como tampoco pudieron ser aisladas o detectadas en sangre. Las manifestaciones neurologicas y los hallazgos de laboratorio se correlacionan con la lesion identificada por ultrasonido, durante el curso clinico del padecimiento y se confirmaron con la autopsia descartandose meningitis.La importancia de identificar lesiones de leucomalacia periventricular em vida, permitira evitar especulaciones sobre signos neurologicos que pueden sustentar la impresion clinica de meningitis en cuadros donde no puede aislarse un agente patogeno

Estudio ecocardiografico de la persistencia del conducto arterioso (PCA) en neonatos de pretermino. / Echocardiographic study of the persistence of patent ductus arteriosus in preterm newborn infants

En 107 neonatos de pretermino se midio la relacion auricula izquierda/aorta (AI/AO) por medio de la ecocardiografia modo M. Se comprobo que los recien nacidos de pretermino afectados de persistencia del conducto arterioso (PCA) (42 pacientes) presentaron una relacion AI/AO mayor que la observada en los neonatos sin este padecimiento (57 pacientes). En cinco casos el, estudio ecocardiografico mostro la existencia de PCA antes de la aparicion de los sintomas clinicos. Los neonatos sin PCA presentaron en casi todos los casos una relacion AI/AO inferior a 1,0, mientras que los afectados de PCA tuvieron un valor promedio de la relacion AI/AO mayor de 1,20. En los neonatos de pretermino en los que se analizo la evolucion de la relacion AI/AO luego del tratamiento de la PCA, se observo una estrecha relacion entre el descenso de la relacion AI/AO y la mejoria clinica, aunque los cambios ecocardiograficos precedieron a la desaparicion completa de los signos clinicos de PCA

Mortalidad fetal y neonatal / Fetal and neonatal mortality

Se presenta la prueba experimental de un programa de computacion para analizar los eventos del periodo perinatal en el Centro Hospitalario 20 de Noviembre, del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE). Se espera que el modelo presentado contribuya a mejorar la informacion estadistica del periodo perinatal haciendola actualizada y versatil a traves de la incorporacion de tecnologia moderna