Dificultad respiratoria neonatal en un niño cuya madre presentaba colestasis / Intrahepatic cholestasis of pregnancy and neonatal respiratory distress syndrome

El síndrome de dificultad respiratoria en niños cuyas madres presentan colestasis intrahepática, también llamado neumonía por ácidos biliares, fue descrito por primera vez en 2004. Los ácidos biliares maternos producen una neumonitis química e inactivan el surfactante endógeno. Ante la presencia de dificultad respiratoria en estos recién nacidos, a pesar de ser a término o prematuros moderados con maduración pulmonar confirmada, debemos recordar que se benefician de la administración precoz de surfactante (AU)

Severe respiratory distress syndrome in neonates from mothers with intrahepatic cholestasis of pregnancy, or bile acids pneumonia, was first described in 2004. Bile acids produce acute neonatal lung injury with chemical pneumonia and surfactant dysfunction. Neonatal respiratory distress syndrome in this term or near-term infants, even in the presence of normal lung maturity in amniotic fluid, will require exogenous surfactant (AU)

Consideraciones actuales sobre la prevención de la transmisión vertical del estreptococo β - hemolítico del grupo B / Current considerations on the prevention of vertical transmission of group B beta´hemolytic streptococcus

La sepsis bacteriana del neonato es un síndrome clínico caracterizado por signos de infección sistémica acompañados de bacteriemia. Denominamos infección neonatal de transmisión vertical aquella que es transmitida por la madre al feto o al recién nacido (RN) durante el embarazo, el parto el período neonatal. Las bacterias implicadas son las que se encuentran en el canal del parto que en su mayoría son de baja virulencia, pero ocasionalmente pueden infectar a la madre o al RN. Actualmente el principal agente de infección bacteriana de transmisión vertical es el Streptococcus agalactiae (estreptococo β – hemolítico del grupo B) (EGB), siendo menos frecuente la infección por Escherichia coli y otros bacilos gran negativos y se suele observar, sobre todo, en RN prematuros y de muy bajo peso (AU)

Neonatal bacterial sepsis is a clinical syndrome characterized by signs of systemic infection accompanied by bacteriemia. Neonatal infection due to vertical transmission refers to that which is transmitted by the mother to the fetus or to the newborn (NB) during the pregnancy, delivery and neonatal period. The bacterias involved are those found in the delivery canal, which mostly have low virulence, but they may sometimes infect the mother or NB. Currently the primary agent of vertical transmission bacterial infection is the Streptococcus agalactiae (group B β-hemolytic streptococcus) (EGB) infection by Escherichia coli and other gram negative bacilli being less frequent and it is generally observed, above all, in premature very low weight NB (AU)

[Spanish cross-sectional growth study 2008. Part I: weight and height values in newborns of 26-42 weeks of gestational age]. / Estudio transversal español de crecimiento 2008. Parte I: valores de peso y longitud en recién nacidos de 26-42 semanas de edad gestacional.

INTRODUCTION: Gestational age and neonatal anthropometric parameters are related to neonatal and postnatal morbidity and mortality. SUBJECTS AND METHODS: Weight and vertex-heel length were evaluated in 9.362 caucasian newborns (4.884 males and 4.478 females) products of single pregnancies, 26-42 weeks of gestational age, born between 1999 and 2002 in Vall d'Hebron (Barcelona, Spain) and Miguel Servet (Zaragoza, Spain) Children's Hospitals. RESULTS: Mean and standard deviation and percentile distribution values of weight, and length according to sex and gestational age are presented. A progressive increase in these parameters with gestational age and a sexual dimorphism was observed from the 30 week of gestational age onwards, with statistically-significant differences (p<0.01) from 35 weeks of gestational age. At 38 and 42 weeks of gestational ages these differences were 170 g, 160 g, 0.8 cm and 0.9 cm respectively. An increase in weight and length values in relation to previous Spanish studies (1987-1992) was also documented. CONCLUSIONS: A sexual dimorphism in intrauterine anthropometric growth parameters was observed. These parameters change with time and may be updated.

Estudio transversal español de crecimiento 2008. Parte I: valores de peso y longitud en recién nacidos de 26-42 semanas de edad gestacional / Spanish cross-sectional growth study 2008. Part I: weight and height values in newborns of 26-42 weeks of gestational age

Introducción: La edad gestacional, el peso y la longitud al nacer son factores relacionados con la morbilidad y mortalidad en el período neonatal y en la vida adulta. Sujetos y métodos: Valoración del peso y la longitud vértice-talón al nacer, en 9.362 recién nacidos vivos de raza caucásica (4.884 varones y 4.478 niñas) y de gestaciones únicas (26-42 semanas de edad gestacional), nacidos entre 1999 y 2002 en el Hospital Materno-Infantil Vall d’Hebron de Barcelona y en el Hospital Materno-Infantil Miguel Servet de Zaragoza. Resultados: Valores de la media y desviación estándar, y distribución percentilada del peso y de la longitud en los recién nacidos de ambos sexos según su edad gestacional. Existe un incremento progresivo con la edad gestacional y un dimorfismo sexual a partir de la semana 30 de gestación con diferencias estadísticamente significativas entre ambos sexos para ambos parámetros (p < 0,01) a partir de la semana 35 de edad gestacional. A las 38 y 42 semanas de edad gestacional los valores de la media para el peso y para la longitud son, respectivamente, 170 y 160 g, y 0,8 y 0,9 cm superiores en los varones que en las niñas. También se observó un incremento en los valores de la media de peso y longitud respecto a estudios previos (1987-1992). Conclusiones: Existe un dimorfismo sexual en el peso y la longitud de los recién nacidos pretérmino y a término. Estos parámetros cambian con el tiempo y deben ser revisados periódicamente (AU)

Introduction: Gestational age and neonatal anthropometric parameters are related to neonatal and postnatal morbidity and mortality. Subjects and methods: Weight and vertex-heel length were evaluated in 9.362 caucasian newborns (4.884 males and 4.478 females) products of single pregnancies, 26-42 weeks of gestational age, born between 1999 and 2002 in Vall d’Hebron (Barcelona, Spain) and Miguel Servet (Zaragoza, Spain) Children’s Hospitals. Results: Mean and standard deviation and percentile distribution values of weight, and length according to sex and gestational age are presented. A progressive increase in these parameters with gestational age and a sexual dimorphism was observed from the 30 week of gestational age onwards, with statistically-significant differences (p < 0.01) from 35 weeks of gestational age. At 38 and 42 weeks of gestational ages these differences were 170 g, 160 g, 0,8 cm and 0,9 cm respectively. An increase in weight and length values in relation to previous Spanish studies (1987-1992) was also documented. Conclusions: A sexual dimorphism in intrauterine anthropometric growth parameters was observed. These parameters change with time and may be updated (AU)

[Neonatal outcome of triplets]. / Evolución neonatal de los recién nacidos trillizos (desde el nacimiento hasta el alta hospitalaria).

OBJECTIVE: To determine the neonatal morbidity and mortality in triplets. METHOD: Retrospective study of 189 triplets born between January'98 and December'04. RESULTS: Mean maternal age was 33 years. Of the pregnancies, 71.4 % were achieved using fertilization techniques, 84 % received antenatal steroids and 96.8 % of births were by caesarean section. The mean gestational age was 32 weeks (246-355), with a mean birth weight of 1,500 g (450-2,650). There 53.4 % were female neonates. Cardiopulmonary resuscitation (CPR) at birth was not required by 82 %, 13.5 % required bag-mask ventilation and 4.9 % required advanced CPR. Low/moderate respiratory distress syndrome was observed in 27 % of the infants (oxygen/CPAP), and 19 % required mechanical ventilation and surfactant. 12 % showed patent ductus arteriosus was seen in 12 %, necrotizing enterocolitis in 4.2 %, sepsis (vertical and nosocomial), 17 %, grade III retinopathy in 1.1 % and 7.4 % had bronchopulmonary dysplasia. Grade III/IV intraventricular haemorrhage was present in 4.2 %, and 3.2 % periventricular leukomalacia. Survival rate at discharge from hospital was 95.2 %. Of those, 10 % showed risk of serious sequelae defined as: grade III-IV intraventricular haemorrhage, periventricular leukomalacia, grade III retinopathy and bronchopulmonary dysplasia. There were no major complications in 64.5 % of the children. Despite a prematurity rate of 100 %, this large series of triplets shows an excellent survival and a relatively low serious associated morbidity. It is also important to point out the intensive perinatological follow-up to which these pregnancies are subject.

[Neonatal chylothorax: aetiology, clinical course and efficacy of treatment]. / Quilotórax neonatal: etiología, evolución y respuesta al tratamiento.

OBJECTIVES: To investigate the aetiology, clinical course and response to treatment of neonatal chylothorax. PATIENTS AND METHOD: Prospective study over a 2-year period in a neonatal intensive care unit of a tertiary university hospital. All newborns followed a predefined therapeutic protocol that included the sequential administration of total parenteral nutrition (TPN), octreotide and surgery. The influence of aetiology on outcome and response to treatment was investigated. RESULTS: The study included 22 newborns. Surgery for congenital heart disease (CHD) (n = 14) and congenital diaphragmatic hernia (n = 4) were the most common aetiologies. The incidence of chylothorax in these aetiological groups was 11.2 % (95 % CI 5.7-16.8 %) and 26.6 % (95 % CI 4.3-40 %), respectively. Medical treatment was successful in 17 patients. Five of the 10 patients who did not respond to TPN were successfully treated with octreotide; none of the patients in whom octreotide failed responded to the subsequent 3 weeks of TPN. No side-effects were observed during octreotide administration. No significant association between aetiology and response to treatment was found, although all 4 patients who ultimately required surgery were in the CHD group. All patients had complications attributable to chylothorax. Five patients died during the 6 months of follow-up although mortality was never directly attributed to chylothorax. CONCLUSIONS: Most patients can be successfully managed with medical treatment but early surgery should be considered in patients who do not respond to medical treatment. Aetiology is the main determinant of mortality. Randomized controlled studies are needed to demonstrate the efficacy and adequate timing of application of each therapeutic intervention.

Evolución neonatal de los recién nacidos trillizos (desde el nacimiento hasta el alta hospitalaria) / Neonatal outcome of triplets

Objetivo: Determinar la morbilidad y la mortalidad neonatales de los trillizos. Método: Estudio retrospectivo de 189 trillizos nacidos entre enero de 1998 y diciembre de 2004. Resultados: La edad media materna fue de 33 años. El 71,4 % de las gestaciones se obtuvieron mediante técnicas de reproducción asistida. El 84 % recibió corticoides prenatales. El 96,8 % nació mediante cesárea. La edad gestacional media fue de 32 semanas (246-355), con peso medio de 1.500 g (450-2.650). El 53,4 % fueron niñas. El 82 % no necesitó reanimación al nacer, el 13,5 % requirió reanimación con bolsa autoinflable y el 4,9 %, reanimación avanzada. El 27 % de los neonatos presentaron síndrome de distrés respiratorio leve/moderado (oxígeno/CPAP) y el 19 %, grave (ventilación mecánica/agente tensiactivo). El 12 % presentó ductus arterioso persistente; el 4,2 %, enterocolitis; el 17 %, sepsis (vertical y nosocomial); el 1,1 %, retinopatía de grado III, y el 7,4 %, displasia broncopulmonar. El 4,2 % presentó hemorragia intraventricular (HIV) grado III-IV, y el 3,2 %, leucomalacia periventricular. La supervivencia al recibir el alta fue del 95,2 %, el 10 % mostraron signos de riesgo de secuelas graves, definidas como: HIV grado III-IV, leucomalacia periventricular, retinopatía grado III y displasia broncopulmonar. El 64,5 % de los neonatos no presentaron ninguna complicación destacable durante su ingreso. Aunque la incidencia de prematuridad es del 100 %, esta serie larga de trillizos muestra una excelente supervivencia y una morbilidad grave asociada relativamente baja. Destaca el elevado control perinatológico de estas gestaciones (AU)

Objective: To determine the neonatal morbidity and mortality in triplets. Method: Retrospective study of 189 triplets born between January'98 and December'04. Results: Mean maternal age was 33 years. Of the pregnancies, 71.4 % were achieved using fertilization techniques, 84 % received antenatal steroids and 96.8 % of births were by caesarean section. The mean gestational age was 32 weeks (246-355), with a mean birth weight of 1,500 g (450-2,650). There 53.4 % were female neonates. Cardiopulmonary resuscitation (CPR) at birth was not required by 82 %, 13.5 % required bag-mask ventilation and 4.9 % required advanced CPR. Low/moderate respiratory distress syndrome was observed in 27 % of the infants (oxygen/CPAP), and 19 % required mechanical ventilation and surfactant. 12 % showed patent ductus arteriosus was seen in 12 %, necrotizing enterocolitis in 4.2 %, sepsis (vertical and nosocomial), 17 %, grade III retinopathy in 1.1 % and 7.4 % had bronchopulmonary dysplasia. Grade III/IV intraventricular haemorrhage was present in 4.2 %, and 3.2 % periventricular leukomalacia. Survival rate at discharge from hospital was 95.2 %. Of those, 10 % showed risk of serious sequelae defined as: grade III-IV intraventricular haemorrhage, periventricular leukomalacia, grade III retinopathy and bronchopulmonary dysplasia. There were no major complications in 64.5 % of the children. Despite a prematurity rate of 100 %, this large series of triplets shows an excellent survival and a relatively low serious associated morbidity. It is also important to point out the intensive perinatological follow-up to which these pregnancies are subject (AU)

Quilotórax neonatal: etiología, evolución y respuesta al tratamiento / Neonatal chylothorax: aetiology, clinical course and efficacy of treatment

Objetivos: Investigar la etiología, curso clínico y respuesta al tratamiento del quilotórax neonatal. Pacientes y método: Estudio prospectivo en la unidad de cuidados intensivos neonatales de un hospital terciario durante un período de 2 años. Se aplicó un protocolo terapéutico predefinido consistente en la administración secuencial de nutrición parenteral total (NPT), octreótide y cirugía. Se investigó la influencia de la etiología sobre la evolución y respuesta al tratamiento. Resultados: Se incluyeron 22 recién nacidos. Las causas más frecuente fueron la cirugía cardíaca (n = 14) y la hernia diafragmática (n = 4), en las que la incidencia de quilotórax fue del 11,2 % (intervalo de confianza del 95 % [IC 95 %]: 5,7-16,8 %) y del 26,6 % (IC 95 %: 4,3-40 %), respectivamente. Un total de 17 pacientes respondieron al tratamiento médico. El octreótide fue eficaz en 5 de los 10 pacientes en que fracasó la NPT; ninguno de los pacientes en que fracasó el octreótide mejoraron tras 3 semanas de NPT. No se observaron complicaciones atribuibles al octreótide. No observamos una asociación significativa entre la etiología y la respuesta al tratamiento, aunque los 4 pacientes que requirieron cirugía pertenecieron al grupo de recién nacidos postoperados de cardiopatía congénita. Todos presentaron complicaciones atribuibles al quilotórax. Fallecieron 5 pacientes durante los 6 meses de seguimiento pero en ningún caso la muerte fue directamente atribuible al quilotórax. Conclusiones: Debe considerarse una cirugía precoz en la minoría de pacientes que no responden al tratamiento médico. La etiología es el principal determinante de la mortalidad. Son necesarios estudios aleatorizados controlados que establezcan la eficacia y momento de aplicación de las diferentes opciones terapéuticas (AU)

Objectives: To investigate the aetiology, clinical course and response to treatment of neonatal chylothorax. Patients and method: Prospective study over a 2-year period in a neonatal intensive care unit of a tertiary university hospital. All newborns followed a predefined therapeutic protocol that included the sequential administration of total parenteral nutrition (TPN), octreotide and surgery. The influence of aetiology on outcome and response to treatment was investigated. Results: The study included 22 newborns. Surgery for congenital heart disease (CHD) (n = 14) and congenital diaphragmatic hernia (n = 4) were the most common aetiologies. The incidence of chylothorax in these aetiological groups was 11.2 % (95 % CI 5.7-16.8 %) and 26.6 % (95 % CI 4.3-40 %), respectively. Medical treatment was successful in 17 patients. Five of the 10 patients who did not respond to TPN were successfully treated with octreotide; none of the patients in whom octreotide failed responded to the subsequent 3 weeks of TPN. No side-effects were observed during octreotide administration. No significant association between aetiology and response to treatment was found, although all 4 patients who ultimately required surgery were in the CHD group. All patients had complications attributable to chylothorax. Five patients died during the 6 months of follow-up although mortality was never directly attributed to chylothorax. Conclusions: Most patients can be successfully managed with medical treatment but early surgery should be considered in patients who do not respond to medical treatment. Aetiology is the main determinant of mortality. Randomized controlled studies are needed to demonstrate the efficacy and adequate timing of application of each therapeutic intervention (AU)

Probable early-onset group B streptococcal neonatal sepsis: a serious clinical condition related to intrauterine infection.

BACKGROUND: The estimated incidence of true early-onset group B streptococcal (GBS) neonatal infection is based on positive GBS blood or cerebrospinal fluid (CSF) culture results, but the real burden of disease is underestimated owing to the high incidence of culture-negative sepsis possibly because of antibiotic administration to the mother. OBJECTIVE: To examine the rate of probable early-onset GBS neonatal sepsis and to assess its impact on total GBS neonatal disease. DESIGN: A multicentre longitudinal prospective surveillance of 107,021 deliveries. RESULTS: The rates of culture-proven and probable early-onset GBS sepsis were 0.39 and 0.47 per 1000 live births, respectively. Of great concern was the finding of three deaths related to the infection in the group with probable early-onset GBS sepsis. CONCLUSIONS: The use of chemoprophylaxis in GBS-colonised pregnant women, especially when it is incomplete, may not be sufficient to prevent clinical neonatal infection, but may inhibit the growth of GBS in blood and CSF cultures. In assessing the effectiveness of GBS prophylaxis, it is advisable to consider the incidence of culture-positive and probable culture-negative GBS neonatal infection.

[Continuous arteriovenous hemofiltration in the newborn infant]. / Hemofiltración arterio-venosa continua en el recién nacido.

OBJECTIVE: We present 12 newborns with acute renal failure (ARF) of different etiologies that were treated with continuous arterio-venous hemofiltration (CAVH). PATIENTS AND METHODS: Gestational age and birth weight ranged from 26-42 weeks and 700-4, 700 grams, respectively. The umbilical artery and vein were most frequently used as vascular accesses. Two types of filters were used: Gambro FH 22 and Amicon Minifilter. RESULTS: Treatment lasted from 8 to 120 hours. We obtained an ultrafiltration median of 25 ml/h ranging from 10.75 mL/h to 82.8 mL/h (4.1-31.8 mL/k/h). The volume balance was negative in all patients. Treatment was well tolerated. Complications included hypotension when the system was started and hypoglycemia. CAVH was stopped because of normalization of renal function in 6 cases and death in the other 6. In the latter, cardiac malformation was the cause of death in 3 cases and multiple organ failure in the other 3. CONCLUSIONS: CAVH is useful is the treatment of ARF in the oligoanuric newborn.

[Granulocyte colony-stimulating factor in the newborn neutropenic patient]. / Factor estimulante de colonias granulocíticas en el recién nacido neutropénico.

OBJECTIVE: To assess the therapeutic effect of G-CSF in newborns with neutropenia. METHODS: Newborn with evidence of both peripheral neutropenia and decreased granulocytic precursors in tibial bone marrow aspirate were included in the study. G-CSF was perfused intravenously over 2 hours at dose of 10 micrograms/kg/day, during 4-8 days. CBC were obtained immediately before each dose of G-CSF. RESULTS: Neutropenia followed neonatal sepsis in four cases and maternal pre-eclampsia in three. Prior to treatment, peripheral blood granulocyte (PMNL) counts ranged from 420 to 1,073/mm3. Once G-CSF infusion was started, counts returned to normal within 24-48 hours. No adverse effects related to G-CSF administration were noticed. CONCLUSIONS: G-CSF induces a significant increase in peripheral PMNL counts in newborn with neutropenia, in the absence of significant toxic effects. Our date suggest a potential role for G-CSF in the prophylaxis and treatment of sepsis in the neutropenic newborn, although widespread recommendation must await further, controlled studies.

[Characteristics of group b streptococcus vertical transmission]. / Características de la transmisión vertical madrefeto del estreptococo del grupo B.

OBJECTIVE: The goal of this study was to compare the characteristics of group B streptococcus (GBS) or Streptococcus agalactiae vertical transmission in woman, receiving or not intrapartum. antimicrobial prophylaxis, at risk of delivering an infant with GRS disease. MATERIALS AND METHODS: The study included 330 women, with risk factors for delivering an infant with GBS disease. The vaginal GBS colonization was studied by conventional culture. A clinical and microbiological follow-up was done in both women and neonates. RESULTS: GHS was detected in 37 women (11.2%). Among these, 21 (56.8%) received intrapartum antibiotics and 16 (43.2%) did not. Forty-one neonates were born from these 37 women. Of these, 11 showed signs of infection (3 with positive blood culture and 8 with blood culture negative for GBS) and 2 presented an asymptomatic bacteremia A GBS neonatal infection (with positive blood culture) was produced in 4.8% of newborns from mothers who received intrapartum antibiotics versus 25% of newborns from mothers who did not receive intrapartum antibiotics. However, this difference was not significant nor was the difference between external colonization by GBS between these two groups of newborns. On the contrary, significant differences were found in the percentage of clinically suspected sepsis (with negative blood cultures), which was more frequent among newborns from mothers without intrapartum antibiotics (30.4% vs 5.6%). A good correlation between the intensity of vaginal colonization and the incidence of microbiologically demonstrated sepsis, suspected sepsis an asymptomatic bacteremia in the newborn was found. CONCLUSION: In conclusion, in order to minimize the vertical transmission of GBS, the most efficient strategy seems to be to offer antibiotic prophylaxis to women identified as GBS carriers, since the antibiotic administration to women with "obstetric risks" often means that it is impossible that two hours elapse between antibiotic administration and delivery, resulting in the loss of efficacy of this second strategy.

[Usefulness of body surface cultures in newborns with early infection risk. Study of 735 neonates]. / Valoración de los cultivos superficiales del neonato con riesgo de infección precoz. Estudio de 735 pacientes.

OBJECTIVE: Difficulty in the diagnosis of neonatal sepsis has lead to the practice of superficial cultures. The usefulness of this practice has been criticized repeatedly. PATIENTS AND METHODS: Results of 3881 cultures performed on 735 newborns (age < or = 48 hr) with early infection risk were reviewed. The types of samples chosen were urine (UR), gastric aspirate (GA), pharyngeal (PS), external ear (ES), umbilical swab (US), meconium (MC) and blood. BBV for sepsis for the different samples is calculated, as well as which ones better reflect vertical transmission. RESULTS: At the time of the study, 342 newborns (46.5%) were already colonized. Bacteria most frequently isolated were: E. coli (92), PCN staphylococci (85), enterococci (83) and S. agalactiae (70). Twenty-nine newborns had bacteriemia, with S. agalactiae being the leading cause (16). ES correlated best with positive blood cultures (83.3%). UR culture sensitivity was significantly lower than that of all other samples. The Highest PPVs were for GA, PS and US. NPV was high and similar for all samples (98-99%). ES and US best reflected vertical transmission (p < 0.0001). MC provided the highest number of positive mixed cultures, most of them difficult to evaluate. CONCLUSIONS: Body surface sample advantages are: 1) The possibility of discarding a vertically transmitted infection. 2) Quicker positive results than those in blood whenever liquid blood culture media are employed. 3) The possible identification of the etiologic agent when the mother has been given antibiotics intrapartum. 4). Information about dangerous colonization without infection. In order not to lose this useful information, but to save cost and effort, we advise that the number of surface cultures be reduced, keeping only ES and PS?

[Umbilical colonization in normal newborns. A comparative study of 4 methods for umbilical antisepsis]. / Colonización umbilical en recién nacidos normales. Estudio comparativo de cuatro métodos de antisepsia umbilical.

We report the results of a prospective study in which the effectiveness of 70% alcohol (A), mercurochrome (M), a solution of alcohol and mercurochrome (AM) and 1% chlorhexidine (C) as umbilical antiseptics was tested on 311 normal newborn infants. Similar results were obtained by using A, M, or AM; however, when C was used umbilical colonization was significantly reduced as compared to when the other three antiseptic agents were used. The umbilical cords that had been scrubbed with A, M or AM were detached by the 8th day after birth, whereas those treated with C took 14 days to fall off. The use of chlorhexidine resulted in a marked increase in pure cultures positive for Gram negative bacteria (Proteus spp. and Pseudomonas spp.) which was not the case with the other three antiseptics tested.

[Nutritional support of premature newborn infants with birthweight below 1.500 g]. / Aporte nutritivo en recién nacidos prematuros de peso inferior a 1.500 g.

16 preterm babies with birthweights between 738 and 1,390 g (mean: 1,105. SD: +/- 176.7) and with gestational ages between 27 and 31 weeks (mean: 29.5. SD: +/- 1.32), were fed according to a combined scheme: parenteral nutrition, for a period of 12 days, plus enteral feedings of chemically defined diet, given by nasogastric tube through a continuous infusion, until the 35th week of postconceptional age. All 16 babies had a satisfactory course, with no significant side-effects. Their weight gain was between 9 and 22 g/day (mean: 13.8. SD: +/- 4.2). No significant blood biochemical abnormalities were detected. Our results showed that this combined feeding scheme (enteral & parenteral) worked satisfactorily in this group of newborn premature babies.

[Congenital mesoblastic nephroma]. / Nefroma mesoblástico congénito.

Authors report three cases of congenital mesoblastic nephroma. In two of them, diagnosis was neonatal, while the third was made at the 3rd-month. They discuss diagnostic procedures employed as well as pathological findings. Presence of a mass was the first clinical sign in all three cases. Nephrectomy was the only treatment employed, with favourable outcome.