Seudohipoparatiroidismo neonatal transitorio: una causa rara de hipocalcemia neonatal tardía / Transient neonatal pseudohypoparathyroidism: an uncommon cause of late neonatal hypocalcemia

El seudohipoparatiroidismo neonatal transitorio es un cuadro escasamente descrito, que cursa con hipocalcemia neonatal tardía, hiperfosfatemia y niveles elevados de hormona paratiroidea (PTH), lo que refleja resistencia periférica a su acción. Es una causa infrecuente de hipocalcemia neonatal tardía, y el defecto bioquímico parece residir en una inmadurez funcional de los receptores renales de la PTH. Para su corrección, se precisan aportes elevados de calcio y análogos de vitamina D. Su carácter autolimitado lo diferencia de otros seudohipoparatiroidismos persistentes. Exponemos el caso de una recién nacida pretérmino, con crecimiento intrauterino retardado, que presentó esta patología. Analizaremos los hallazgos clínicos y bioquímicos, así como el diagnóstico diferencial y el manejo de este raro trastorno(AU)

Transient neonatal pseudohypoparathyroidism is an uncommon pathology that causes late neonatal hypocalcemia, hyperphosphatemia and high levels of parathyroid hormone (PTH),which reflects peripheral resistance to its action. It is a rare cause of late neonatal hypocalcemia and the biochemical defect appears to lie in a functional immaturity of renal PTH receptors. High doses of calcium and vitamin D are necesary for its correction. Its self-limited evolution differences it with other persistent pseudohypoparathyroidism. We report a case of a premature newborn with intrauterine growth retardation who presented this pathology. We analyze the clinical and biochemical findings and differential diagnosis and management of this rare disorder(AU)

[Kawasaki disease: Diagnosis and treatment]. / Enfermedad de Kawasaki: diagnóstico y tratamiento.

INTRODUCTION: Kawasaki disease is the leading cause of acquired heart disease in children. In spite of the efficacy of intravenous immunoglobulin (IGIV), the absence of a specific diagnostic test and due to there being IGIV-refractory patients, Kawasaki disease is a major cause of coronary artery abnormalities (CAA). OBJECTIVES: To analyze the clinical and epidemiological characteristics of cases of Kawasaki disease, to evaluate the efficacy of treatments used and the CAA observed. METHODS: We retrospectively reviewed the medical records of children diagnosed with Kawasaki disease between January 2002 and December 2008 in a tertiary public Hospital in the South of Madrid. The diagnosis of Kawasaki disease was based on the clinical criteria proposed by the American Academy of Pediatrics in 2004. RESULTS: Twenty three children were identified. Median age was 26 months (range: 2 months-10 years). Nineteen children (82%) were younger than 5 years old. Fever and changes in the lips and oral cavity were present in all cases. Twenty-one patients (91%) received IGIV, all of them before the 10th day of disease. One child (4.7%) required the administration of more than one dose of IGIV, because persistence of fever. CAA was recorded in three patients [13.0%, (95% CI: 1-26%)], including a four month-old boy. All patients with CAA were treated with the recommended dose of IGIV, 2g/kg, between the 5th and 8th day of disease. CONCLUSIONS: Kawasaki disease was more common in children less than five years old. We observed a high rate of CAA in children with Kawasaki disease in spite of appropriate and timely treatment.