Dimensiones ecográficas del hígado de recién nacidos de término de bajo peso para la edad gestacional. Relación con variables antropométricas y parámetros normales / Ultrasonographic dimensions of the liver in the full term low weight newborn for gestational age. Relationship of anthropometric variables and normal parameters

Introducción: la desnutrición intrauterina continúa siendo una causa frecuente de morbimortalidad perinatal en nuestro medio. El hígado es un órgano que en la vida fetal, está relacionado con las condiciones maternas y placentarias. Diversas patologías afectan el crecimiento hepático. Los objetivos del trabajo son: conocer las dimensiones hepáticas y la relación de éstas en neonatos de término desnutridos y comparar los resultados con los valores de neonatos eutróficos. Material y Métodos: se estudiaron neonatos de término, dentro de las primeras 72 horas después del nacimiento, sin patologías que afectaran las dimensiones hepáticas. Se solicitó el consentimiento por escrito a los padres y el estudio se aprobó por el Comité de Investigación. Los neonatos se pesaron y midieron en la misma báscula y cinta métrica plástica. Las dimensiones hepáticas se realizaron por un solo investigador de acuerdo con lo publicado anteriormente. Los datos se analizaron mediante el programa para computadora personal NCSS utilizando estadística descriptiva, correlación para comparar las dimensiones hepáticas con las variables antropométricas y prueba 't' de Student para comparar los datos actuales con parámetros de neonatos eutróficos. Resultados: se estudiaron 31 recién nacidos de término, con peso menor a 2.500 g. Dieciséis niñas y 15 varones. Se encontró correlación entre el diámetro longitudinal y el peso al nacimiento. Al comparar los resultados con neonatos eutróficos, todas las dimensiones hepáticas fueron significativamente menores en el grupo de estudio, especialmente las que miden dimensiones en el eje vertical. Discusión: el diámetro longitudinal sigue siendo el mejor indicador de los cambios en las dimensiones hepáticas. Todas las dimensiones fueron menores en los niños de bajo peso al nacer en comparación con los de peso adecuado, sin embargo, sigue siendo necesario nuevos estudios para confirmar los resultados (AU)

[Evaluation of fetal well-being using a modified Doppler flowmetric profile]. / Valoración del bienestar fetal mediante el perfil flujométrico Doppler modificado.

Decreasing perinatal morbimortality rates still represents an essential objective of antenatal care, so better diagnostic test for detecting fetal well-being are needed. The aim of this study was to compare a modified Doppler Ultrasonography Profile (DUP) with the Manning Fetal Biophysical Profile (FBP). One hundred and thirty eight high risk pregnant women between 38 and 42 gestational age, were prospectively studied with the proposed technique. The modified DUP is a quick-easy method that included five variables: umbilical Doppler velocimetry, amniotic fluid volume, fetal movements, placental grading and fetal growth pattern. The modified DUP diagnostic accuracy was compared with FBP diagnostic accuracy and a logistical regression analysis was performed to find predictors of fetal well-being. The sensitivity, specificity, and positive and negative predictive values of DUP in predicting perinatal outcome were 28%, 97%, 40% and 96.2%, respectively. On the other hand sensitivity, specificity, and positive and negative predictive values of the FBP were: 20%, 91%, 11% and 95.6%, respectively. The 95% confidence intervals for sensitivity and specificity wore 20.7-25.2 and 94.5-99.4, for the modified DUP whereas were obtained for FBP 12.2-27.7 and 85.6-96.3. The concordance between evaluated tests was 89%, with a Kappa value of 0.80. The multivariate logistical analysis showed two predictor variables as significant in the modified DUP model (umbilical Doppler velocimetry, P < 0.05, and fetal growth pattern, P < 0.05) but in the FBP no parameter reached statistical significance. Although the modified DUP had better diagnostic values an overlapping was clearly found in 95% confidence intervals, therefore it was concluded that the modified DUP proposed had similar diagnostic accuracy as FBP and could be alternatively used for assessing fetal well-being in high-risk pregnancies.

[Prenatal corticosteroids. Use and attitudes of the gynecology-obstetrics medical staff]. / Corticoesteroides antenatales. Empleo y actitudes del personal médico ginecoobstetra.

OBJECTIVES: 1. To evaluate the frequency of use of antenatal corticosteroids (AC) and the reasons for withholding them. 2. To estimate the knowledge and attitudes, regarding AC, from obstetricians, in a large Women and Babies Hospital. METHODS: Through a prospective, observational and transversal study we evaluated: 1. The frequency of use of AC in pregnant with preterm labor (PL) and in mothers of preterm infants (P1). When AC were not given, the reasons were recorded. 2. With an anonymous inquiry we assessed the knowledge and attitude of obstetricians regarding AC, exploring different concepts such as usefulness, frequency of use, indications, risks and contraindications. Descriptive statistics was used. RESULTS: We studied 364 patients (240 mothers of Pl and 124 pregnant women). The mean gestational age (GA) was 28.9 + 2.4 weeks. The AC were used only in 136 out of 364 (37.4%) women, and diminished to 30.9% (102/330), if are excluded 34 patients who did not receive AC because imminent delivery. Another reasons for not using AC were irregular uterine activity (18.9%), prolonged rupture of membranes without chorioamnioitis (11.4%), and GA lower than 27 weeks (11.4%) and toxemia (9.6%). Only in 43 out of 136 patients (31.6%) who were on tocolytic drugs, received AC. The schedule and doses were correct. According to the inquiry, 48/68 (0.71) of obstetricians considered AC as definitively useful, although only 22/68 (0.32) as very effective. The knowledge level was acceptable, except in signaling with precision the neonatal problems that could be prevented, as well as the lowest gestational age for use the AC. CONCLUSIONS: We considered the use of AC in our institution as suboptimal. We found that the reasons for not using them were not valid in most cases. Physician's attitudes to AC are positive but it is not reflected on their clinical practice. It is necessary a strong promotion of the usefulness of the AC for the preterm infant.

[The echographic dimensions of the liver in the term newborn and its relation to anthropometric variables]. / Dimensiones ecográficas del hígado del recién nacido a término y su relación con variables antropométricas.

We decided to undergo a study looking for normal liver size in relation with other anthropometric measures. Fifty healthy, appropriate for gestational age term-babies, born at the Hospital de Ginecopediatría Número 48, Centro Médico Nacional del IMSS, León, Guanajuato, México, were examined by hepatic ultrasound. The vertical diameter was 6.0 +/- 0.75 cm, transverse 8.26 +/- 0.72 cm, AP 5.44 +/- 0.5 cm. The longitudinal cross section area was 16.21 +/- 2.5 cm2, and the transverse cross section area 22.53 +/- 3.4 cm2. We found most important correlation between vertical diameter and longitudinal cross section area with the anthropometric measures. The hepatic measures correlate better with the weight. Ultrasound provides a rapid, accurate and convenient method for study the liver size and morphology in the neonate.

[Echographic dimensions of the kidneys of full-term newborns and their relationship with anthropometric variables]. / Dimensiones ecográficas de los riñones de recién nacidos a término y su relación con variables antropométricas.

Ultrasound is the best non-invasive study to evaluate renal morphology in the neonate; so we decided to undergo a study looking for normal renal size in relation with other anthropometric measures. We performed renal ultrasounds in 50 healthy, appropriate for gestational age, term-babies. We found correlation between several anthropometric measures, but the most significant were weight and height. In most cases the left similar to others. It is important to know normal renal dimensions in newborns, since there are diseases that not only are associated with an increased incidence of renal malformations, but also with a reduced renal size such as Down syndrome, or increased renal size such as Beckwith-Wiedemann syndrome. Renal sonogram; term newborn babies; anthropometric correlation.

Curva de crecimiento cefalico fetal normal, por medicion seriada del diametro biparietal con ultraecosonografia. / Normal fetal cephalic growth curve, by serial measurement of biparietal diameter by ultrasound echography

Se presenta el resultado de las mediciones seriadas del diametro biparietal del feto (DBP), por medio de ultrasonido con tecnica de A-scan, en 70 casos seleccionados de embarazo normal, con fetos que llegaron al termino y cuyo peso al nacimiento fue mayor de 2,500 g. Se establecen los valores promedio y la variabilidad de las mediciones en razon de la edad gestacional, anotando leves diferencias con los encontrados por otros autores. Asi mismo, las tendencias de crecimiento del DBP entre las semanas 15 y 39 de gestacion. La medicion seriada iniciada alrededor de la semana 20, permite definir la tendencia de crecimiento fetal. La evaluacion aislada es poco confiable en terminos de prediccion del peso al nacimiento