ABSTRACT
El síndrome "blueberry muffin" es una dermatosis maculopapular eritematoviolácea como resultado de una hematopoyesis extramedular. Se ha asociado con infecciones del espectro TORCH y causas no infecciosas. Presentamos el caso de un recién nacido pretérmino, quien desde el control prenatal presentó una ecografía con signos sugerentes de infección congénita por citomegalovirus (microcefalia, ventriculomegalia y calcificaciones intracerebrales). Al examen físico presentaba una dermatosis macular violácea compatible con síndrome "blueberry muffin". Se detectó carga viral de citomegalovirus en orina (81,200 copias/ml) e inició tratamiento con ganciclovir, con desenlace fatal. La infección congénita por CMV debe considerarse ante el síndrome "blueberry muffin"; el adecuado abordaje diagnóstico debe ser oportuno y debe incluir antecedentes maternos y perinatales, así como estudios serológicos para infecciones por TORCH con el fin del inicio precoz de tratamiento para evitar complicaciones y secuelas.
Blueberry muffin syndrome is characterized by an erythematousviolaceous maculopapular dermatosis due to extramedullary hematopoiesis. This entity has been associated with TORCH spectrum infections and noninfectious causes. We present the case of a preterm newborn, who since the prenatal control gave an ultrasound with data suggestive of congenital infection by cytomegalovirus (microcephaly, ventriculomegaly, intracerebral calcifications). On physical examination, he presented a violaceous macular dermatosis compatible with blueberry muffin syndrome. Cytomegalovirus viral load was detected in urine (81,200 copies/ml), with fatal outcome. Congenital cytomegalovirus infection should be considered in the presence of a blueberry muffin syndrome; an adequate diagnostic approach that includes maternal and perinatal history is essential, as well as serology studies for diseases of the TORCH spectrum in order to start early with treatment and avoid major comorbidities.
Subject(s)
Humans , Male , Infant, Newborn , Cytomegalovirus Infections/congenital , Cytomegalovirus Infections/diagnosis , Antiviral Agents/therapeutic use , Ganciclovir/therapeutic use , Fatal Outcome , Cytomegalovirus Infections/drug therapyABSTRACT
INTRODUCCIÓN: El uso de ultrasonografía para la inserción de catéteres centrales ha mostrado ser coste-efectivo en adultos; en neonatos se desconoce esta información. El objetivo del estudio fue comparar el coste-efectividad de la cateterización venosa umbilical guiada por ultrasonografía con la cateterización convencional en un servicio de cuidados intensivos neonatales de un hospital universitario y público. PACIENTES Y MÉTODOS: Estudio observacional retrospectivo en recién nacidos que requirieron catéter venoso umbilical antes de cumplir las primeras 24 h de vida extrauterina; se conformaron 2 cohortes históricas, una con cateterización guiada por ultrasonografía y otra con cateterización convencional. La efectividad se midió con 2 variables: colocación de posición ideal e inserción sin complicaciones. Se estimó el coste de recursos humanos y materiales (fungibles y no fungibles), la razón coste-efectividad y la razón coste-efectividad incremental; y se realizó análisis de sensibilidad. RESULTADOS: La obstrucción del catéter fue más frecuente en la cateterización guiada que en la convencional (7,7 vs. 0%, p = 0,04) y la disfunción del catéter fue superior en esta última (79 vs. 3,8%, p < 0,0001). La razón coste-efectividad de la cateterización guiada fue 153,9 euros y de la convencional 484,6 euros; la razón coste-efectividad incremental fue 45,5 euros. El análisis de sensibilidad incrementó 2,6 euros en la razón coste-efectividad de la cateterización guiada y 47 euros, en la convencional. CONCLUSIONES: El uso de la ultrasonografiacute;a para guiar la cateterización umbilical es más eficiente ya que, a pesar de suponer un mayor consumo de recursos económicos, ofreció una mayor efectividad
INTRODUCTION: Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital. PATIENTS AND METHODS: A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis. RESULTS: Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p = .04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p < .0001). The cost-effectiveness ratio of the guided catheterisation was 153.9, and 484.6 for the conventional one. The incremental cost-effectiveness ratio was 45.5. The sensitivity analysis showed a 2.6 increase in the cost-effectiveness ratio of the guided catheterisation and 47 in the conventional one. CONCLUSIONS: The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness
Subject(s)
Humans , Infant, Newborn , Ultrasonography, Interventional/economics , Cost Efficiency Analysis , Catheterization/methods , Catheterization/economics , Umbilical Veins , Hospitals, University , Retrospective Studies , Hospitals, PublicABSTRACT
INTRODUCTION: Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital. PATIENTS AND METHODS: A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis. RESULTS: Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p=.04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p<.0001). The cost-effectiveness ratio of the guided catheterisation was 153.9, and 484.6 for the conventional one. The incremental cost-effectiveness ratio was 45.5. The sensitivity analysis showed a 2.6 increase in the cost-effectiveness ratio of the guided catheterisation and 47 in the conventional one. CONCLUSIONS: The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness.
Subject(s)
Catheterization, Central Venous/methods , Health Care Costs/statistics & numerical data , Ultrasonography, Interventional/economics , Umbilical Veins , Catheterization, Central Venous/economics , Cost-Benefit Analysis , Female , Humans , Infant, Newborn , Male , Mexico , Retrospective StudiesABSTRACT
Objective: The purpose of this study is to establish the prevalence of vitamin D deficiency and their newborns and analyze the risk factors related to this deficiency. Methods: This is an observational, transversal, and prospective study. It included 191 puerperal women and their full-term newborns. Serum 25 hydroxyvitamin D values were analyzes by enzyme immunoassay. Results: 61% of the puerperal presented deficiency and 26% insufficiency of vitamin D. In the newborn group 98% showed deficiency and 66% of them presented severe deficiency. There is a positive correlation between the values of vitamin D in mothers and their newborns (r2 = 0.173 ng/ml; p = 0.017). The lowest levels were in autumn. (15.75 ng/mL mothers, 6 ng/mL newborns). There was no correlation between vitamin D levels in mothers and their dietary intake, maternal skin type, sun time exposure and prenatal body mass index. Conclusions: This is the first study that shows the existence of a high deficiency of vitamin D in Mexican mothers and their newborns.
Subject(s)
Mothers/statistics & numerical data , Vitamin D Deficiency/epidemiology , Vitamin D/analogs & derivatives , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Immunoenzyme Techniques , Infant, Newborn , Prevalence , Prospective Studies , Risk Factors , Seasons , Severity of Illness Index , Vitamin D/blood , Vitamin D Deficiency/ethnology , Young AdultABSTRACT
BACKGROUND: intrauterine growth restriction (IUGR) is related with neonatal morbidity and mortality. The detection and prenatal monitoring are necessary for an early intervention. The objective was to establish the prevalence and risk factors associated with intrauterine growth restriction in the university hospital Dr. José Eleuterio González. METHODS: we performed an observational, cross-sectional study, during the period from May 2009 to April 2010. The sample was divided into two groups, asymmetrical and symmetrical IUGR. RESULTS: the global prevalence of IUGR was 13.5 %. We included 464 patients, 324 (70 %) with asymmetric IUGR and 140 (30 %) with symmetric IUGR. The maternal variables were not statistically significant (p = ns) between groups. We found a mean weight at birth higher (2548 ± 437.33) in the symmetric IUGR group (p < 0.01), as well as a higher vaginal delivery rate (p < 0.05) as compared with the asymmetrical IUGR group. The overall mortality rate was higher in the asymmetric IUGR group (p < 0.01). CONCLUSIONS: prevalence of IUGR in our population is higher than that reported in the literature; there were more preterm infants and higher mortality in the asymmetric group.
