Trombosis venosa renal neonatal: diagnóstico precoz con ecografía Doppler y secuelas a largo plazo / Neonatal renal vein thrombosis: early diagnosis using Doppler ultrasonography and long-term sequelae

Objetivo: Describir los mecanismos fisiopatológicos de las trombosis venosas renales perinatales y los factores de riesgo asociados, haciendo hincapié en las características clínico rradiológicas y en su evolución a largo plazo. Material y métodos: Se han estudiado retrospectivamente un total de 11 casos de trombosis venosa renal neonatal, con una edad media al diagnóstico de 3 días. Se analizaron la forma de presentación, las manifestaciones clínicas, los hallazgos de imagen obtenidos mediante ecografía (modos B y Doppler), el tratamiento instaurado y las secuelas a largo plazo. Resultados: En el momento del diagnóstico, la tríada de masa palpable, hematuria franca y trombocitopenia estaba presente únicamente en el 63,63% de los pacientes. Resultados: En el 45,45% de los casos pudo identificarse un factor de riesgo protrombótico en los recién nacidos o en sus madres. Todos los recién nacidos mostraron aumento del tamaño renal y pérdida de la diferenciación corticomedular en el estudio ecográfico. En 4 de los 11 casos se identificaron imágenes lineales hiperecogénicas intramedulares, características del estadio inicial de la trombosis. Los estudios funcionales de seguimiento con ácido dimercaptosuccínico (DMSA) y ácido mercapto-acetil-triglicina (MAG-3) revelaron anomalías morfológicas en todos los pacientes, con un riñón no funcionante en 7 casos. Conclusiones: Visualizar bandas ecogénicas intramedulares alerta de la fase inicial de una trombosis venosa renal, por lo que debe instaurarse precozmente un tratamiento adecuado. Exceptuando los casos acontecidos intraútero, la trombosis de la vena renal conlleva un mal pronóstico, con atrofia y fallo renal a largo plazo (AU)

Objective: To describe the physiopathological mechanisms in perinatal renal vein thrombosis and the associated risk factors, with emphasis on the clinical and radiological characteristics and on the long-term evolution. Material and methods: We retrospectively studied a total of 11 cases of neonatal renal vein thrombosis; the mean age of patients at diagnosis was 3 days. We analyzed the type of presentation, the clinical manifestations, and the findings at B-mode and Doppler ultrasonography, as well as the treatment undertaken and the long-term sequelae. Results: At the time of diagnosis, the triad of a palpable mass, unequivocal hematuria, and thrombocytopenia was present in only 63.63% of patients. Results: A prothrombotic risk factor was identified in the newborn or mother in 45.45% of cases. At ultrasonographic examination, all newborns had enlarged kidneys and in all cases it was impossible to differentiate between the renal cortex and the renal medulla. In 4 of the 11 cases, hyperechogenic intramedullary linear images characteristic of the initial stage of thrombosis were identified. Functional follow-up studies using DMSA (dimercaptosuccinic acid) and MAG-3 (mercaptoacetyl triglycine acid) revealed morphological abnormalities in all patients; 7 patients had a nonfunctioning kidney. Conclusions: Visualizing echogenic bands within the medulla should alert radiologists to the initial phase of renal vein thrombosis and enable the appropriate treatment to be administered. With the exception of cases discovered before birth, renal vein thrombosis has a poor prognosis, with atrophy and renal failure in the long term (AU)

[Neonatal renal vein thrombosis: early diagnosis using Doppler ultrasonography and long-term sequelae]. / Trombosis venosa renal neonatal: diagnóstico precoz con ecografía Doppler y secuelas a largo plazo.

OBJECTIVE: To describe the physiopathological mechanisms in perinatal renal vein thrombosis and the associated risk factors, with emphasis on the clinical and radiological characteristics and on the long-term evolution. MATERIAL AND METHODS: We retrospectively studied a total of 11 cases of neonatal renal vein thrombosis; the mean age of patients at diagnosis was 3 days. We analyzed the type of presentation, the clinical manifestations, and the findings at B-mode and Doppler ultrasonography, as well as the treatment undertaken and the long-term sequelae. RESULTS: At the time of diagnosis, the triad of a palpable mass, unequivocal hematuria, and thrombocytopenia was present in only 63.63% of patients. A prothrombotic risk factor was identified in the newborn or mother in 45.45% of cases. At ultrasonographic examination, all newborns had enlarged kidneys and in all cases it was impossible to differentiate between the renal cortex and the renal medulla. In 4 of the 11 cases, hyperechogenic intramedullary linear images characteristic of the initial stage of thrombosis were identified. Functional follow-up studies using DMSA (dimercaptosuccinic acid) and MAG-3 (mercaptoacetyltriglycine acid) revealed morphological abnormalities in all patients; 7 patients had a nonfunctioning kidney. CONCLUSIONS: Visualizing echogenic bands within the medulla should alert radiologists to the initial phase of renal vein thrombosis and enable the appropriate treatment to be administered. With the exception of cases discovered before birth, renal vein thrombosis has a poor prognosis, with atrophy and renal failure in the long term.

Herniación diafragmática en un recién nacido con sepsis por estreptococo «agalactiae» y distrés respiratorio / Postnatal diaphragmatic hernia in a newborn with group B streptococcal sepsis and respiratory distress

La hernia diafragmática congénita constituye una importante causa de morbimortalidad neonatal, no tanto por su incidencia (1 de cada 2.500-5.000 recién nacidos vivos), sino por su elevada mortalidad, próxima al 40-50%, según series, y pese a su correcto diagnóstico prenatal y manejo posnatal. Si bien la entidad clásica constituye un defecto diafragmático con presencia intratorácica de vísceras abdominales y un grado variable de hipoplasia pulmonar, en general, mediante el diagnóstico prenatal se han establecido otras posibilidades en su presentación, como formas más leves de diagnóstico tardío o, como en el caso que se presenta, la herniación posnatal en un recién nacido afectado por distrés respiratorio persistente y sepsis por estreptococo agalactiae. Se remarca la importancia de un alto grado de sospecha diagnóstica ante la asociación neonatal de clínica respiratoria persistente y de infección por estreptococo agalactiae

Congenital diaphragmatic hernia represents an important cause of neonatal morbidity and mortality; not for its frequency (1 in 2,500 to 5,000 live births) as much as the high mortality, nearly 40% to 50% according to different authors, despite correct prenatal diagnosis and postnatal management. The classical presentation is that of a diaphragmatic defect with herniation of abdominal organs into the thoracic cavity and varying degrees of pulmonary hypoplasia. It is usually diagnosed prenatally and symptoms generally are detected early. Nevertheless, there are milder forms with delayed diagnosis, but better prognosis. We present the case of a newborn with postnatal diaphragmatic hernia in association with persistent respiratory distress and group B streptococcal infection. We stress the importance of a high index of suspicion in a newborn with persistent respiratory symptoms and group B streptococcal sepsis

Patología hepatobiliar y pancreática en la fibrosis quística: hallazgos ecográficos / Hepatobiliary and pancreatic pathology in cystic fibrosis: sonographic findings

Los avances terapéuticos han incrementado significativamente la supervivencia de los pacientes con fibrosis quística (FQ), lo que ha conllevado un aumento en la incidencia de complicaciones. El propósito de nuestro estudio fue analizar el espectro de alteraciones ecográficas pancreáticas y extrapancreáticas en la FQ, tanto las formas de presentación habituales como las inusuales. Material y Métodos: Se revisaron retrospectivamente los estudios ecográficos de 174 pacientes diagnosticados de FQ, con edades comprendidas entre 0 y 19 años. Los hallazgos se clasificaron según el órgano afectado y se correlacionaron con la edad de los pacientes, para determinar si existían diferencias significativas entre los pacientes más jóvenes y los adolescentes. Resultados: El páncreas fue normal en 16 casos; 117 pacientes presentaban los hallazgos ecográficos clásicos, y tres presentaban una forma inusual de enfermedad caracterizada por macroquistes de diferentes tamaños distribuidos por toda la glándula. El 40 por ciento de los pacientes tenían anomalías en la vesícula. El 12 por ciento de los pacientes desarrollaron pericolangitis y el 6 por ciento cirrosis biliar multinodular. Complicaciones como hipertensión portal, esplenomegalia y varices se presentaron en el 3 por ciento de los casos. Conclusión: El seguimiento ecográfico es esencial en los pacientes con FQ debido a la alta incidencia de complicaciones hepatobiliares que pueden presentarse en el curso de la enfermedad, difíciles de valorar con otras modalidades de imagen (AU)

[Experience with ventriculitis at a neonatology department]. / Ventriculitis: experiencia en un servicio de neonatología.

OBJECTIVE: To study the characteristics, treatment and follow-up of patients with ventriculitis in our neonatal unit. PATIENTS AND METHODS: Retrospective study of patients diagnosed with ventriculitis from January 1990 to December 1997. Diagnostic criteria were the identification of any bacteria in the ventricular fluid and pleocytosis (> or = 100 leukocytes per microl). Personal history, clinical and analytical findings and evolution after diagnosis were studied. RESULTS: We recorded ten cases of ventriculitis in nine patients. Six of them occurred as a complication of previous meningitis and four occurred after neurosurgical treatment. The mean age at diagnosis was of 38.8 days (range 8-130), and mean gestational age was 29.4 weeks (range 25-38). Clinical and ventricular fluid anomalies were seen in six cases and in four the diagnosis was made at autopsy. Treatment was systemic antibiotics. In two cases intraventricular antibiotics were added. Six patients died, ventriculitis being the direct cause of death in five. Of the three survivors, one had mental retardation and cerebral palsy and the other two had minor disabilities. CONCLUSIONS: During the neonatal period, a high degree of clinical suspicion and techniques for an early diagnosis and treatment are needed for ventriculitis.

Consenso de actuación ante determinadas patologías del aparato digestivo en fibrosis quística. Tratamiento de la insuficiencia pancreática exocrina y síndrome de obstrucción del intestino distal / Cystyc fibrosis: treatment of pancreatic insufficiency and distal intestinal obstruction syndrome

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Ventriculitis: experiencia en un servicio de neonatología / Experience of ventriculitis in a neonatology department

Objetivo: Estudiar las características, tratamiento y evolución de los pacientes diagnosticados de ventriculitis en nuestro servicio de neonatología. Pacientes y métodos: Estudio retrospectivo de los casos de ventriculitis diagnosticados desde enero de 1990 a diciembre de 1997. Los criterios diagnósticos fueron presencia de germen en el líquido cefalorraquídeo (LCR) ventricular y pleocitosis ( >= 100 leucocitos/µl). Se estudiaron los antecedentes de cada paciente, sus hallazgos clínicos y analíticos y su evolución tras el diagnóstico de ventriculitis. Resultados Se registraron 10 episodios de ventriculitis en 9 pacientes. Seis de los episodios cursaron como complicación de una meningitis previa y los cuatro restantes fueron secundarios a intervenciones neuroquirúrgicas. La edad media al diagnóstico fue de 38,8 días (rango, 8-130) y la edad gestacional media de 29,4 semanas (rango, 25-38) Las alteraciones clínicas o del LCR estuvieron presentes en 6 de los episodios, diagnosticándose los otros cuatro por la autopsia. Se trataron con antibioterapia sistémica, y se añadió antibiótico intraventricular en 2 casos. Fallecieron 6 pacientes, siendo la ventriculitis causa directa de la muerte en cinco de ellos. De los 3 pacientes supervivientes, uno presenta retraso psicomotor profundo y leve los otros dos. Conclusión: En el período neonatal, son necesarios un elevado grado de sospecha clínica y ciertas técnicas diagnósticas para la detección precoz y tratamiento adecuado de la ventriculitis (AU)

[Periventricular leukomalacia and persistent hyperechogenicity: relationship between ultrasound findings and sequelae]. / Leucomalacia periventricular e hiperecogenicidad persistente: relación entre hallazgos ecográficos y secuelas.

OBJECTIVES: The objective of this study was to know the incidence of periventricular leukomalacia and persistent periventricular echodensities in neonates with a birth weight < 1,500 g and to correlate cranial ultrasound findings with the developmental outcome of these babies at 18 months of corrected age. PATIENTS AND METHODS: We performed a cohort study of 319 newborns weighing 1500 g or less who were admitted to the Neonatal Intensive Care Unit of "12 de Octubre" Hospital between July 1990 and April 1994. Scans were performed while they were hospitalized and 183 surviving infants were followed up to 18 months of corrected age. Relative risks (rr) and 95% confidence intervals (95% CI) were calculated for sequelae according to neonatal cranial ultrasound abnormalities. Ninety-six infants with normal scans were considered as the control group. Persistent periventricular echodensities were classified as mild, moderate or severe. RESULTS: The incidence of periventricular leukomalacia was 3% (10/319) and of persistent periventricular echodensites was 11.2% (36/319). The percentage of sequelae was 5% for control infants, 15.6% (rr = 3, CI 95% = 0.94-8.8) for persistent periventricular echodensities, independent of its severity, 50% (rr = 9.7, CI 95% = 2.6-35) for moderate persistent periventricular echodensities and 78% (rr = 15.6, CI 95% = 6-38) for periventricular leukomalacia. CONCLUSIONS: Periventricular leukomalacia multiplies the number of sequelae by 15. Persistent periventricular echodensities, independent of its severity, does not multiply the number of sequelae significantly. However, moderate persistent periventricular echodensities multiply the number of sequelae by 9.

[Neonatal meningitis: study of 56 cases]. / Meningitis neonatal: Estudio de 56 casos.

OBJECTIVE: The objective of this study was to know the most common organisms causing neonatal meningitis in a defined region of southern Madrid, the developmental outcome of these babies and the risk factors associated with the prognosis. PATIENTS AND METHODS: This was an observational study of 56 cases of meningitis diagnosed in our Neonatal Service between 1988 and 1994. In order to study the handicaps of these babies, only those who were born before May 1993 were considered so that they had a corrected age of at least 2 years when the neurological evaluations were done. RESULTS: The most common causative organisms were group B Streptococcus (27%), E. coli (11%) and enteroviruses (9%). In the premature infants the leading organisms were E. coli and Candida albicans. The age at diagnosis was 8 +/- 6 days in the group of preterm infants (p = 0.002). The mortality was associated with the prematurity (risk ratio: 17.8), the isolation of a gram-negative organism in the cerebral fluid (RR: 3.3) and the presence of abnormal findings in cerebral ultrasound studies (RR: 12.7). Sequelae were associated with the presence of abnormal findings in cerebral ultrasound studies (RR: 24.7) or in the neurologic examination (R: 7) and with the presence of previous cerebral lesions (RR: 5.7). CONCLUSIONS: Neonatal ultrasound examination, as well as the gestational age, the causative organisms, the presence of a previous cerebral lesion and the neurological examination, seem to be very important in predicting the prognosis of these babies.

[Multicystic encephalomalacia. Review of 19 cases]. / Encefalomalacia multiquística. Revisión de 19 casos.

OBJECTIVE: Multicystic encephalomalacia (EMQ) is a pediatric entity where the brain tissue is substituted by cavities of variably sizes. PATIENTS AND METHODS: Nineteen children diagnosed of EMQ were studied retrospectively. We analyzed the etiology, diagnosis and the clinical and radiological evolution. RESULTS: There were three different etiologies: twin pregnancy, 12 cases; perinatal hypoxia, 4 cases; perinatal infection, 1 case; cardiac arrest, 1 case; and 1 patient with multiple embolism of unknown cause. The diagnosis of EMQ was made with cerebral ultrasonography (14 patients), computed tomography (19 patients) and magnetic resonance imaging (5 patients). We stress the utility of cerebral ultrasonography in early and reliable diagnosis of EMQ. The clinical development was unfavorable. We studied the outcome of 15 patients. Two children died. Eleven patients (73%) show severe consequences (mental retardation, microcephaly, spastic tetraplegia, and in 7 children epilepsy). In 2 cases, the radiological development was hydranencephaly. Examination of the 4 remaining children (26.66%) revealed a spastic hemiplegia. CONCLUSIONS: EMQ is a rare disease in childhood and has a very poor outcome, for this reason early diagnosis is very important. To this effect, cerebral ultrasonography is the imaging modality of choice.

[Conservative treatment of neonatal ovarian cysts]. / Tratamiento conservador de los quistes ováricos neonatales.

Treatment of choice of ovarian cysts diagnosed in the neonatal period has been until nowadays mainly surgical. Another possibility is a conservative approach, since these cysts have a natural tendency to spontaneous regression. We present 9 cases treated in our hospital in the last 8 years. 6 of them were treated surgically, while in 3 a conservative attitude was used, with sera ultrasound follow-up and disappearance of the cysts in 2 months in 2 cases and in 12 in the other. In cysts smaller than 5 cm we adopt a conservative management, leaving surgery only for those bigger or complicated.