[The magnetic resonance imaging of the cerebral lesions in a newborn infant with tuberous sclerosis]. / Imagen por resonancia magnética de lesiones cerebrales en un recién nacido con esclerosis tuberosa.

Tuberous sclerosis is a neurocutaneous disease characterized of mental retardation, facial fibroangiomas, hypochromic stain and seizures. Is presented a case of a newborn that in the third day of life presenting seizures and in the physical exam show hypochromic CT scans irregular of 3-10 mm in thorax and limbs. The seizures presented during hospitalization were tonics, it was need treatment with three anticonvulsants for the control; the parents studies were normal. Magnetic resonance showed characteristic images of this pathology like nodular subependymal lesions, hyperintense, in lateral ventricles and a cortical tuberous lesion in the right frontal region. Tuberous sclerosis has a dominant autosomic transmission; the defect is in the chromosome 9, the prenatal diagnosis is not possible and 50-80% the of case are mutations. Affect a different organs as skin, eyes, heart, brain, kidney, bone and lung. The prognostic is variable and death is caused for epileptic state, brain tumor, heart failure, renal or intercurrent infection. The magnetic resonance imaging is the landmark study for diagnosis of this pathology of ample use in the present.

[Comparison of 2 methods of partial exchange transfusion in newborns with polycythemia: peripheral-peripheral and central-peripheral]. / Comparación de dos métodos para realizar exanguinotransfusión parcial en recién nacidos con policitemia: periférica-periférica y central-periférica.

Oneself presents the result of the prospective study from evaluate the morbility of the partial exchange-transfusion (exchange-dilution) to effect in two forms in newborn with polycythemia. The A group was newborn in the which extraction of blood volume was on peripheric vein is oneself administration crystalloid solution for another periphery vein; the B group was utilized umbilical vein to remove blood volume for another periphery vein is administration the crystalloid. To have 20 newborn in each group; to predisponent prenatal factors global were toxemic (12%); the plethora was the more frequent sing (55%) and nausea in (37%). Were not encountered difference in both groups for: gestational age, weight, birth rate, trophism, polycythemia type (asymptomatic vs symptomatic); neither to have difference in the seric electrolytes, protein and vital signs before and after procedure. Were encountered more infections process in the B group (P < 0.05). Were concluded what the exchange-dilution for polycythemia in newborn of term must be for periphery vein exclusive with security of not production metabolic and hemodynamic changes and without risk for sepsis and/or enterocolitis for manipulation of umbilical vessels.

[Variation in the blood lipids in premature newborns during the use of the "all-in-one" total nutritional mixture]. / Variación de los lípidos sanguíneos en recién nacidos prematuros durante la mezcla nutricional total "todo en uno".

This prospective study was performed for the evaluation of the lipids in serum; the metabolic and other effects related with septicaemia, stability and compatibility of the parenteral nutrition combining in one continent amino acids, carbohydrates and fats; this system is called nutritional total mixture, "all in one" or three in one. Twenty prematures neonates were included in the study. The variables analyzed were: weight, gestational age; the laboratory exams taken before the installation of the system and seven days after were: total lipids, triglycerides, phospholipids, cholesterol, sodium, potassium, chloride, glucose, urea nitrogen, creatinine, hepatic enzymes and proteins, cellular blood count and coagulations tests. We obtained the next results: the mean gestational age and weight were 34 +/- 5 weeks and 1327 +/- 172 g, have been observed rise of lipids (P < 0.001), declination of potassium levels (P < 0.001), increment of calcium levels (P < 0.001), increment of albumin (P < 0.001) and platelets (P < 0.01). It is concluded that nutritional total mixture is a sure method in management of premature newborn with good stability, compatibility, with a increment of fats in serum physiological levels, with metabolic tolerance without repercussion renal, hepatic, hematological and without infections.

[Acute gastric distension due to sepsis in a newborn infant]. / Distensión gástrica aguda por sepsis en un recién nacido.

The acute distention of stomach in the newborn is conditional by metabolic alterations like hypocalcemia or by septic states. We present the case of a newborn with antecedents of membrane rupture for 12 hours obtained by cesarean procedure, of 38 weeks by Capurro, score without perinatal asphyxia and 3320 g of birth weight, which evolutioned with respiratory distress and its first exams showed leukopenia, low platelet count and the cerebrospinal fluid showed 390 cells with polymorphonuclear predominium considering the diagnosis of neonatal sepsis and meningitis. At the second day he presented abdominal distention secondary to gastric camera dilatation, were made a laparotomy to descart congenital obstruction and only found gastric distention. In all newborn with acute gastric distention its important for first instance descart congenital intestinal obstruction and is on sidered this entity by exclusion. We recommend in this patients sepsis worshop. The treatment is drainage by orogastric tube and antibiotics. The prognosis is good once upon treating the basic problem.

[Utilization of percutaneous catheters in neonatology: insertion of 105 catheters]. / Utilización de los catéteres percutáneos en neonatología: colocación de 105 catéteres.

We present the results of one prospective study made it to evaluated central percutaneous catheters morbi-mortality in newborns critically sick ingresed in a Neonatal Intensive Care Unit (NICU). The total of 105 percutaneous catheter put it on in 97 newborns from one total 1554 catheter-days. We found in 53.3% were premature newborns, 74.2% weighted less than 2500 g, the femoral veins was used in 90%. The predominant morbidity at the moment of the colocations was respiratory problems, sepsis and mayor congenital malformation, the 30% the percutaneous catheter was had bacterial colonization when were retired; the catheter infection was 1.2 x 1000 catheter days. Our conclusion are the percutaneous catheter was the prime election to the vein access in the newborn critically stick, with low mortality rate during colocation and permanency, low sepsis incidence by catheter, and less quantity of venopunture stress and veins mutilation.

[Diaphragmatic hernia, secondary to a phrenic nerve lesion, in a newborn infant]. / Eventración diafragmática en un neonato secundaria a lesión del nervio frénico.

The diaphragmatic eventration will be congenital or acquired; the damage to the phrenic nerve its for elongenest, cruch, gun ball or iatrogenic; this last one could be during cardiac surgery, birth trauma, venodissection and colocation of one thorax drill. We presented the case of one premature newborn of 32 weeks with 1374g of weight, with respiratory distress syndrome which evolutioned to bilateral pneumothorax and posteriorly left diaphragmatic eventration secondary to a phrenic nerve damage by the thorax drill which one reach to mediastinum. The diagnosis of these entity will suspect by abnormal elevation of the affected hemidiaphragm and confirmed by fluoroscopy. The treatment its a early diaphragmatic pleat.

[Hepatic hemangioma in a premature newborn. The magnetic resonance images]. / Hemangioma hepático en un recién nacido prematuro. Imágenes por resonancia magnética.

Hepatic hemangiomas are benign vascular tumors that represent 5-15% of all liver tumors. They occur more often in females than in males (relation 2:1). They may produce cardiac failure, because of high output; less frequently hemolytic anemia, thrombocytopenia or bleeding are observed. We present a case of a newborn premature child with a gestation age of 34 weeks and weight of 1359 g who presents a palpable abdominal tumor in the right hypochondrium without additional symptoms. The diagnosis was confirmed by ultrasound with Doppler system any by means of the magnetic resonance imaging (MRI) both methods were able localize the hemangioma in the posterior segment of the right hepatic lobulus. MRI is a diagnostic tool which can provide finer anatomic details than ultrasound or axial computed tomography in hepatic hemangiomas. MRI has a sensitivity of 90% and specificity of 92%; the treatment depends of the complications which the patient presents.

[A giant follicular cyst of the ovary in a newborn infant]. / Quiste folicular gigante de ovario en una recién nacida.

The tumoral lesions proceeding of ovary in the newborns are the 3-6% of all abdominal tumors. The most frequent tumor is ovarian follicular cyst which will be diagnosed prenatally. As a result of ovarian stimulation by fetal gonadotrophins, maternal estrogen and placenta + gonadotrophins. Maternal antecedents reported diabetes, toxemia and isoimmunization. The most frequent complication is torsion. We present the case of one female newborn, with abdominal mass present by abdominal palpation referred of the first gestation of mother with 27 years of age, with primary sterility of 11 years without treatment, with toxemia during the pregnancy. The abdominal x-film show a intraperitoneal mass the ultrasound show cystic and solid mass, without determined origin, and the scan magnetic resonance (MR) a tumoral mass with origin in the pelvic hole with extension to the infrahepatic zone. The surgical finding was left ovarian cyst with left oophorectomy and salpingectomy.

[Right pulmonary hyperplasia with bronchoesophageal fistula]. / Hipoplasia pulmonar derecha con fístula bronquioesofágica.

The pulmonary hypoplasia with bronchoesophageal fistula is a rarely-seen disease which can be confused with total pulmonary agenesis. This case study concerns to one day old male newborn which was hospitalized in our hospital with respiratory difficulties, accompanied by pulmonary opacity of the right side. After having carried out diagnosis studies, including bronchography, we concluded that it was a case of pulmonary agenesis. The patient died from persistent pulmonary hypertension. The anatomopathologic diagnosis, was right pulmonary hypoplasia with bronchoesophageal fistula. This pathology originated during early embryonic stage when the bronchoplastic and esophagoplastic tissue are incompletely separated an thus a fistula between the esophagus and the principal bronchus is formed. The presence of a fistula could not be proven by bronchography. However, esophagography or esophagoscopy would have proven the presence of the fistula.

[Indomethacin in the prevention of subependymal-intraventricular hemorrhage in preterm newborns with conventional mechanical ventilation]. / Indometacina en la prevención de la hemorragia subependimaria-intraventricular del recién nacido pretérmino con ventilación mecánica convencional.

The results of a double blind study to evaluate the efficiency of prophylactic endovenous indomethacin versus placebo for prevention of intraventricular hemorrhage (IVH) in newborn infants between 28 to 36 weeks of age who were intubated at the delivery room and required mechanical ventilation in NICU are presented. Fourty six patients required mechanical ventilation, but 14 neonates had IVH evaluated by ultrasound when were admitted to the Unit. At least 32 infants were studied, 16 for each group. There were no differences between the groups in weight, gestational age, sex and delivery way. The mobility was the same in relation to hialine membrane disease, sepsis, pneumonie and pneumotorax. The placebo group had more frequency of PDA and mortality (P < 0.5). There were no differences in mean airway pressure and arterial gases, also in glucose, platelets and urinary volume. The indomethacin group had mayor urinary density and FeNa but the results were always in normal ranges. The IVH was the same in both groups. We concluded that the indomethacin at the levels used did not produced alterations, and if the IVH is not prevented, were observed lesser severity of the same and the frequency of PDA and mortality are lesser. But still is necessary more number of cases for best conclusions.

[Survival of very low birth weight newborns (less than 1,500 grams) in relation to conventional mechanical ventilation]. / Sobrevida en recién nacidos de muy bajo peso al nacer (menores de 1.500 gramos) con relación a la ventilación mecánica convencional.

One hundred and five very low birth weight neonates, selected through convenience sampling during 1989, were subdivided into those who received mechanical ventilation (MCV) and those who did not receive mechanical ventilation (W/O MCV) and later analyzed. The maternal morbidity in both groups were very similar; 66 of the cases were placed in group MCV and 39 in the W/O MCV. There were differences in birth weight, gestational age, severe asphyxia and hospital stay in the patients with MCV. The neonatal morbidity (SDR, intraventricular hemorrhaging, bronchopulmonary dysplasia, etc.) was more frequently seen in this group. The global mortality was 47%, all of the cases were from the ventilated group. The ventilated patients who died were in the hospital a lesser number of days and had a lesser frequency of prenatal control. We conclude that low weight neonates who require mechanical respiratory assistance have a greater risk of morbidity and mortality. The lesser weight and gestational age, the greater the risk. A group of neonates will have a lesser capacity to synthesize phospholipids and therefore a greater risk of dying. Physicians should be more attentive to the complications related to ventilated low-weight premature neonates.