[Perinatal aspects, growth and feeding of infants born small for gestational age]. / Aspectos perinatales, crecimiento y tipo de lactancia de los nacidos pequeños para su edad gestacional.

INTRODUCTION: Being born small for gestational age (SGA) has short and long term risks. The aim of this study was to describe perinatal and socio-cultural characteristics, and the pattern of growth and diet of SGA infants during their first 6 months of life. MATERIALS AND METHODS: Anthropometry and diet were evaluated during six months in a representative sample of 1596 newborns the population of Aragon (Spain). RESULTS: Mothers of SGA (N=94) infants gained less weight during pregnancy (10.5±5.8 vs 12.0±5.07 kg, P=.012), gestational age at birth was lower (37.84±1.7 vs 39.06±1.6 weeks, P<.001), and the probability of cesarean delivery was higher (37.2% vs 20.5%, P=.001). The height of the mother was lower in the SGA group (1.61±0.58 vs 1.63±0.06 metres, P=.004), but their body mass index was similar. No differences were found between groups in social or cultural aspects. Mothers of SGA infants smoked more during pregnancy (32.3% vs 18.5%, P=.003) (RR = 1.92; 95% CI; 1.31 to 3.02). Infants born SGA remained smaller during the first 6 months of life, and the monthly weight gain was similar to the rest. In the SGA group, the prevalence of breastfeeding was lower at 4 months of age (54.9% vs 68.2%, RR = 0.58, 95% CI; 0.38 to 0.89). CONCLUSIONS: Infants born SGA are more likely to converge a number of characteristics that must be considered together because they may lead to health risks. SGA do not show a rapid recovery pattern of postnatal growth, and their smaller size persists at six months.

[Socio-cultural, obstetric and anthropometric characteristics of newborn children of mothers who smoke in Spain]. / Características socioculturales, obstétricas y antropométricas de los recién nacidos hijos de madre fumadora.

INTRODUCTION: One in every four women smoke at the beginning of the pregnancy in Spain; of these, 25-50% give up smoking during gestation and most of them smoke again after childbirth. Maternal smoking has harmful effects on babies, such as low birth-weight with its resulting morbidity. The objective of this study is to compare the anthropometric and socio-cultural characteristics between newborns from smoking mothers and those from non- smoking ones. MATERIALS AND METHODS: Smoking habits and the socio-cultural characteristics were assessed from a sample of 1499 pregnant women, as well as their newborn anthropometric variables of their newborn babies during 2009 in the Aragon region of Spain. RESULTS: In the sample of 1499 pregnant women the prevalence of smoking during pregnancy was 19.6%; among the Spanish women, 23% of them smoked during the gestation compared with only 11% in women from other countries. The smoker mothers were younger and they had a lower educational level than the non smoker ones; however, there were no statistical differences between their anthropometric characteristics. Newborns from smoker women in Aragon had a lower weigh at delivery (3155 vs. 3295 grams: p<.001) and a relative risk of low weight at birth for their gestational age of 2.1 (95% CI: 1.35 - 2.97). The length and the rest of newborn anthropometric variables were also affected. CONCLUSION: The prevalence of smoking during gestation is high in Aragon. The mothers who smoke are younger and have different socio-cultural characteristics compared with non-smoker mothers. Maternal smoking habits have a harmful effect on newborn nutritional status, representing an avoidable risk of low weight at birth.

[Nutritional characteristics of newborns of overweight and obese mothers]. / Características nutricionales de los recién nacidos de madres con sobrepeso y obesidad.

INTRODUCTION: Maternal nutritional status is an important factor of adequate intrauterine growth and neonatal weight. The aim of this study is to evaluate the relationship between pre-gestational BMI (Body Mass Index) and breastfeeding duration, as well as infant anthropometric measurements during their first six months of life. MATERIALS AND METHODS: Anthropometric measurements and the type of feeding were evaluated in a representative sample of 1,547 newborns from our population during 2009, according to their maternal BMI, and also in a sub-cohort of 759 infants followed up to 6 months of life. RESULTS: A total of 72.9% of women had a normal weight, 18.7% were overweight and 8.4% obese. Women with a BMI ≥ 25 kg/m(2) had lower weight gain during pregnancy (P < .001), lower socioeconomic and cultural level (P < .001), and their infants had higher weight at delivery (P=.003) and at 6 months of life, with no differences in body length. Newborn weight increased in relation to maternal BMI, but over 35 kg/m(2) it decreased progressively (P < .001). Breastfeeding prevalence in obese women was 58.5% at hospital postpartum discharge, and 8.6% at six months of life; as opposed to 70.8% and 13.9%, respectively in women with normal BMI. CONCLUSIONS: In our sample, maternal obesity is associated with a low socioeconomic and cultural level, higher infant weight at delivery and at 6 months of life, and less prevalence of exclusive breastfeeding; all of them nutritional risk factors in the short and long term.

[Assessment of nutritional status in esophageal atresia]. / Valoración del estado nutricional en los pacientes afectos de atresia de esófago.

OBJECTIVE: The aim of the study was to find out whether patients who underwent esophageal atresia (EA) surgery suffered from nutritional problems, to compare the nutritional status of these patients with a control group, and to determine if there is a relationship between the type of atresia and the nutritional condition. MATERIAL AND METHODS: We selected 25 patients out of a total of 32 who underwent EA surgery in our hospital from 2000 to 2006. A retrospective was conducted study based on the information obtained from the medical histories. A case-control study was also carried out by selecting a control group from a randomized population. RESULTS: The analyses performed showed that the mean weight and height Z-score was always negative, but not below -2 SD. There was a significant decrease in the weight Z-score between 3 and 9 months and in the weight/size Z-score between 3 and 24 months. Significant differences in weight and size Z-score were found between cases and controls, but not in skin-fold thickness. Independently of the type of atresia and the presence or not of congenital heart defects, no significant differences were found. CONCLUSIONS: There are significant differences in the weight and height Z-score between cases and controls. We stress the need to be aware of the nutritional status in order to prevent changes that could lead to a further deterioration of the patient.

Edema agudo hemorrágico del lactante / Acute hemorrhagic edema of the infant

El edema hemorrágico agudo del lactante (EHAL) es una vasculitis leucocitoclástica de pequeño vaso confinada a la piel, típica entre los 4 y 24 meses, que se caracteriza por placas purpúricas y edema doloroso de las extremidades con buen estado general. El diagnóstico es clínico, existiendo una gran controversia entre si el EHAL y la púrpura de Schönlein-Henoch (PSH) son 2 entidades diferentes o manifestaciones clínicas del mismo proceso. Presentamos el caso de una lactante de 8 meses con buen estado general, fiebre y lesiones purpúricas-petequiales bien delimitadas, algunas en diana, en extremidades inferiores junto con edema doloroso localizado en tobillos y en dorso de ambos pies. No afectación de mucosas. Pruebas complementarias dentro de la normalidad. En las horas siguientes al ingreso, la lesiones purpúricas se extienden al área genital y planta de pies y edema se extiende a pabellón auricular presentando posteriormente una púrpura en dicha localización. Ante la sospecha de EHAL, se instaura tratamiento sintomático, con desaparición completa de las lesiones en 5 días (AU)

Acute hemorrahagic edema of infancy (AHEI) is a cutaneus small vessel leukocytoclastic vasculitis that affects children 2-24 months old, characterized by purpuric plaques and painful edema of limbs, in a healthy infant. The diagnosis is based in clinical symptoms. Although there is a great controversy if AHEI and Schönlein-Henoch Purpura are different disease or signs of the same clinical profile. We report a case of an 8 months-old healthy infant with fever, well delimited purpuric-potechial lesions in limbs and painful edema located in ankles and in the back of both feet. The patient had some target lesions. Mucosas were not admission, purpuric lesions spread to genital area and soles, the edema spread to external ear and purpura appeared at this location. The boy was admitted to hospital with possible diagnosis of AHEI. Symptomatic treatment was applicated and lesions disappeared completely in five days (AU)

[Baboon syndrome]. / Síndrome del babuino.

The cases of three children diagnosed with baboon syndrome are described, being defined by the appearance of dermatological lesions, with characteristic distribution and morphology, as a result of having been in contact with mercury. Other substances have been described associated with the appearance of this syndrome; however their pathogenis is not completely known, and it has been suggested that it could be another form of contact dermatitis. Diagnosis is based on patient clinical history and physical examination and there is no specific treatment.

Síndrome de Gilbert: estudio de 12 observaciones y revisión de la bibliografía médica / Gilbert’s syndrome: a study of 12 observations and review of the literature

El síndrome de Gilbert es el hallazgo de hiperbilirrubinemia indirecta leve-moderada con pruebas de función hepática normales y sin signos de hemólisis. Es un trastorno hereditario del metabolismo de la bilirrubina, benigno, con una prevalencia mundial cercana al 10%. Tiene un patrón de herencia variable, con polimorfismo genético. Se diagnostica mediante pruebas confirmatorias de provocación, como la prueba del ayuno, aunque el diagnóstico definitivo es genético. Su pronóstico es bueno y actualmente se discute sobre los diversos efectos de la hiperbilirrubinemia. En este artículo, se revisan los casos diagnosticados de síndrome de Gilbert en el servicio de pediatría de un hospital universitario en los últimos años, y se describen las principales características halladas

Gilbert’s syndrome is characterized by a mild or moderate elevation of unconjugated bilirubin, with normal liver function and no evidence of hemolysis. It is a benign inherited disorder of bilirubin metabolism, with a worldwide prevalence of nearly 10%. It has a variable pattern of inheritance, with genetic polymorphism. Diagnosis is based on a confirmatory provocation test, such as the fasting test, although the definitive diagnosis requires a genetic study. The prognosis is good and, at the present time, the varied effects of hyperbilirubinemia are a matter of debate. The cases of Gilbert’s syndrome diagnosed in the pediatric service of a university hospital in recent years were reviewed and the main characteristics are described

[Idiopathic soft palate hemiparalysis]. / Hemiparálisis velopalatina idiopática.

Idiopathic soft palate paralysis is an infrequent clinical entity, both in children and adults. We describe the clinical manifestations in two new cases, manifested by fluid dysphagia, rhinolalia, absent gag reflex, and nasal escape of fluids. The remission period is the shortest observed in published cases. Thirty-three reports have been published in the literature to data, 32 in children and adolescents and one in an adult. This paralysis suggests a viral etiology, affects mainly children, and resolves spontaneously.

[Asperger syndrome associated with macrosomia and sexual identity disorder]. / Síndrome de Asperger asociado a macrosomía y trastorno de identidad sexual.

Asperger Syndrome is a pervasive developmental disorder of unknown origin, characterized by pedantic language, lack of reciprocity in social interactions, unusual interests, motor clumsiness and normal or above average intelligence quotient, among other symptoms. Since 1994 it has been defined as a specific entity. We describe the case of a boy with this syndrome, with elevated body weight and height and sexual identity disorder. These alterations have not previously been described in the scientific literature on Asperger syndrome.

[Carbon monoxide poisoning]. / Intoxicación por monóxido de carbono.

OBJECTIVE: To describe epidemiological and clinical data from a series of children hospitalized for acute carbon monoxide (CO) poisoning. PATIENTS AND METHODS: We reviewed the medical records of children admitted to the Pediatrics Department of the Hospital Clinico Universitario de Zaragoza with acute CO poisoning from 1993 to 2003. All the children were clinically monitored and venous blood levels of carboxyhemoglobin (COHb) were determined. RESULTS: There were 14 patients (seven boys and seven girls) aged 1.3 to 13.8 years (mean age: 8.2 years; SD: 3.9). The peak incidence was in the winter months (seven cases in December). All poisonings took place in poorly ventilated rooms and were produced by gas inhalation due to incomplete combustion of organic fuels (charcoal, propane and butane). Clinical symptoms were gastrointestinal (nausea, vomiting, abdominal pain) and neurologic (dizziness, headache and alterations in level of consciousness). COHb levels in blood were elevated (from 4.8% to 27.6% in the first determination). Outcome was favorable in all patients. CONCLUSIONS: Despite environmental improvements introduced in the last few years, CO poisoning is highly frequent in our environment and children are at higher risk. The best preventive measure is proper adjustment of gas appliances.

[Serum selenium levels in neonates]. / Concentraciones séricas de selenio en recién nacidos.

BACKGROUND: Despite their increasing importance in children's nutrition, studies on selenium levels in neonates in Spain are scarce and often contradictory. OBJECTIVES: To establish the standard serum levels of selenium in healthy full term neonates in our area and to contribute knowledge of the perinatal factors that influence these levels. METHODS: We determined selenium levels in serum by atomic absorption spectrophotometry in 247 neonates: 70 healthy full term neonates, 60 sick full term neonates, 18 neonates with intrauterine growth retardation (> 37 weeks; birthweight < 2500 g), 44 healthy preterm neonates and 55 sick preterm neonates. RESULTS: Healthy full term newborns showed higher serum selenium levels than healthy preterm neonates (35.11 6.94 g/l, range: 18.4-48 g/l versus 28.65 5.95 g/l, range: 15-44.4 g/l, p < 0.001). In the group with intrauterine growth retardation, serum selenium levels were higher than in the healthy preterm group (30.80 6.97 g/l, range: 20-45.6 g/l versus 28.65 5.95 g /L, range: 15-44.4 g/l) but lower than in the full term and normal birthweight group (idem versus 35.11 6.94 g/l, range 18.4-48 g/l). Likewise, the low birthweight group (< 2500 g) showed lower mean serum selenium levels than the normal birthweight group (27.98 6.75 g/l, range 15-48 g/l versus 33.09 7.52 g/l, range 14.4-48 g/l; p < 0.001). CONCLUSIONS: Prematurity and low birthweight are the best predictors for risk of neonatal hyposeleniemia.

HLA system. Phenotypic and gene frequencies in celiac and healthy subjects from the same geographical area.

OBJECTIVE: To compare the phenotypic and gene frequencies of the HLA system in celiac and healthy subjects the same geographical area. PATIENTS AND METHODS: HLA A, B, C, DR and DQ phenotypic and gene frequencies have been estimated in 38 celiac children and healthy subjects. The HLA typing has been done according to the microlymphocytotoxicity assay. The individual HLA antigen frequencies in each group have been compared by Chi-square test using Yates correction. For each specificity, the strength of association with celiac disease has been estimated by Odds Ratio and 95% confidence limit. RESULTS: The comparative study of both population show increased phenotypic and gene frequencies among celiac patients and significant differences compared with healthy subjects for B8, Cw7, DR3, DR7 and DQ2. On the contrary, Cw4 and DQ1 phenotypic and gene frequencies are significantly increased in the control population. CONCLUSIONS: Our findings support the role of HLA antigens as predisposing factors for celiac disease. The presence of Cw4 and DQ1 can be a protective factor against such disease.

[Two loci HLA haplotypes in celiac children. Linkage imbalance and haplotype frequencies. Comparative study with a control population]. / Haplotipos HLA de dos loci en niños celíacos. Desequilibrio de linkage y frecuencias haplotípicas. Estudio comparativo con una población control.

OBJECTIVE: Celiac disease is closely correlated with certain human lymphocyte antigen (HLA) alleles. The aim of this study was to compare linkage disequilibrium parameters and the frequencies of the two loci haplotypes: HLA A/B, A/C, A/DR, A/DQ; HLA B/C, B/DR, B/DQ; HLA C/DR, C/DQ and HLA DR/DQ in children with celiac disease and in a control population within the same geographical area. METHODS: Thirty-eight children with celiac disease, aged 5months to 18years at diagnosis, were HLA typed by microlymphocytotoxicity assay using T and Bcells separated by monoclonal antibody labeled immunomagnetic particles. The frequency of each haplotype of two loci (Hij) depends on the frequency of each allele (pi and pj) and on a correction factor delta, according to the formula: Hij5 Dij1(pi3pj). The existence of a correction factor delta, or linkage disequilibrium, was assessed by a chi square test using 2 X 2contingency tables for gametic association. RESULTS: Among children with celiac disease the most frequent and significant haplotypes were A1/B8, A9/B5, A19/B12, A28/B22, A28/Cw1, A9/DQ3, B8/Cw7, B18/Cw5, B22/Cw1, B5/DR5, B8/DR3, B12/DR7, B5/DQ3, DR3/DQ2, DR4/DQ8 (3) and DR5/DQ3, showing a positive linkage disequilibrium. Negative linkage disequilibrium was found between B18/Cw7, B12/DR3, Cw4/DR3 and DR3/DQ3. CONCLUSIONS: Our findings show that the frequency of A1/B8,A19/B12, B8/DR3,B12/DR7 and DR3/DQ2 haplotypes is higher in children with celiac disease than in the control population and suggest that these two loci haplotypes confer susceptibility to celiac disease.

[Cardiac abnormalities in children with neuromuscular diseases]. / Alteraciones cardiológicas en niños con enfermedad neuromuscular.

BACKGROUND: To evaluate cardiac abnormalities in children with different neuromuscular diseases (NMD) PATIENTS AND METHOD: In 40 patients with NMD, cardiac abnormalities were evaluated by cardiac auscultation, chest X-ray, electrocardiography (ECG), ambulatory Holter ECG and Doppler echography. RESULTS: Sinus tachycardia, high R/S complex, deep Q waves, repolarization disorders, electrical conduction abnormalities, auricular and ventricular extrasystoles, Wolff-Parkinson-White syndrome, mitral valve prolapse and dilated cardiomyopathy were found. CONCLUSIONS: The association of cardiac abnormalities in children with NMD is frequent. Conventional ECG monitorization, Holter ECG and echocardiography allow their diagnosis and follow-up.

[Secular increase of adipose tissue in adolescents from Zaragoza from 1980 to 1995]. / Incremento secular del tejido adiposo en adolescentes zaragozanos desde 1980 hasta 1995.

BACKGROUND: To quantify the differences between anthropometric measurements obtained nowadays in male and female adolescents and those obtained 15 years ago in a sample of similar characteristics. SUBJECTS AND METHODS: We have studied 658 healthy individuals, 329 males and 329 females from 10.0 to 15.0 years of age, from different socioeconomic levels. Weight, height, arm circumference and left skinfold thickness (biceps, triceps, subscapular and suprailiac) have been measured. We have calculated the body mass index (BMI), density, total body fat, percentage of body fat and the body adipose muscular index (BAMI), which is the ratio between body fat (kg) and non fat mass (kg). The values obtained have been compared with those obtained fifteen years ago, in another sample of 1,465 children with similar characteristics. The research team and the material used were the same in both studies. Mean differences were compared using the unpaired t-test. RESULTS: Weight has increased significantly (p < 0.05), except for males at 12 years and females at 13 and at 14 years. Height has increased significantly at all ages and in males and females (p < 0.05). BMI has only increased significantly at 10 and at 11 years in males, and at 10 years in females. Skinfold thicknesses have also increased significantly, except for biceps in males between ages of 12 and 14 years and biceps and subscapular in females at 14 years. Body fat mass and percentage of body fat have also increased significantly and, in consequence, the density has decreased and BAMI has increased both significantly (p < 0.05). CONCLUSIONS: Secular increase in weight and height during fifteen years has occurred. In general, BMI has not increased but skinfold thicknesses and body fat have increased significantly, this fact demonstrates that there has been increase in the body fat compartment.

[Neonatal conjunctivitis: microbiologic study and antibiotic sensitivity]. / Conjuntivitis neonatal: estudio microbiológico y sensibilidad antibiótica.

We have analyzed retrospectively fifty conjunctival samples from infants less than one month of age affected with conjunctivitis. Of these samples, 84% had a positive bacterial culture, with the microorganisms isolated, in order of frequency, being: Staphylococcus epidermidis (14%), Staphylococcus aureus (14%), Streptococcus pneumoniae (12%), Haemophilus sp, Chlamydia and alpha-hemolytic Streptococcus (8%). All of these showed a high sensitivity to most of the drugs tested, except to penicillin and its derivatives. Cefotaxime, ceftriaxone and ciprofloxacin showed the highest in vitro activities. Of the pharmacological ophthalmic preparations commercially available in our country, sulfonamides, chloramphenicol, rifampicin, erythromycin and tobramycin are the agents more active against the bacteria described above.

[Five cases of Goldenhar-Gorlin syndrome]. / Estudio de cinco casos de síndrome de Goldenhar-Gorlin.

Five patients with Goldenhar-Gorlin's syndrome (facio-auriculo-vertebral dysplasia) are presented in this study. Their clinical characteristics are commented on along with an illustrative iconography. The literature on this subject has been reviewed and we make some comments on the possible ethiopathogeny of this disease.