Fractura craneal deprimida congénita... ¿actitud a seguir? / Congenital depressed skull fracture: the steps to follow?

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El colecho favorece la práctica de la lactancia materna y no aumenta el riesgo de muerte súbita del lactante. Dormir con los padres / Bed-sharing favours the practice of breastfeeding and does not increase the risk of sudden infant death syndrome. Sleeping with parents

La práctica de los padres de dormir junto a sus hijos ha sido una constante en la humanidad. Con el aumento en la prevalencia y duración de la lactancia materna, se ha observado paralelamente un aumento de esa práctica, que posiblemente se dé con más frecuencia que la reconocida en las encuestas. Los estudios han demostrado interrelación y mutua potenciación entre lactancia materna y colecho. Las asociaciones y organizaciones pediátricas recomiendan evitar el colecho, por relacionarlo con la muerte súbita del lactante. Se basan, sin embargo, en estudios en su mayoría no controlados, bajo la influencia de factores de riesgo no tenidos en cuenta. Los autores, tras una revisión exhaustiva sobre colecho, lactancia y muerte súbita del lactante, encuentran el colecho como una práctica beneficiosa para la lactancia y concluyen que, bien practicado, evitando factores de riesgo, no guarda relación con la muerte súbita del lactante (AU)

The practice of bed-sharing by parents and their offspring has been a common behaviour among humans. In parallel with the increase of breastfeeding rates, a higher frequency of bed-sharing has been observed worldwide. And, it is probable that it occurs more frequently than what appears reflected in surveys. There seems to be an interrelated and mutually enhanced effect between breastfeeding and bed-sharing. Pediatric associations and health organizations have warned against the practice of bed-sharing based on studies that describe a link between this practice and Sudden Infant Death Syndrome (SIDS). However, many were non-controlled studies that did not include other potentially risky circumstances. After a thoroughly review of the available literature, the authors have found the practice of bed-sharing to be of benefit on the basis of a warm and close-up infant care approach and calls for recognition and avoidance of risky situations that could represent a threat for infant life (AU)

Uso del chupete y lactancia materna / Use of pacifiers and breastfeeding

El uso del chupete se encuentra muy arraigado en las sociedades desarrolladas, ya que calma el llanto del bebé, ayuda a conciliar el sueño, y reduce el estrés y el dolor en procedimientos desagradables. Su uso se ha relacionado con una menor duración y exclusividad de la lactancia materna, aumento de otitis media, problemas dentales y riesgo de accidentes. Además, estudios recientes relacionan su uso, particularmente durante el sueño, con disminución del riesgo de muerte súbita del lactante. Otros beneficios demostrados son su efecto analgésico y el estímulo de la succión no nutritiva en niños pretérmino y a término. El debate sobre su utilización o no es actualmente motivo de controversia, pero es importante que los profesionales de la salud y los padres conozcan los riesgos y beneficios que conlleva el uso del chupete. Dada la controversia actual, el Comité de Lactancia Materna de la Asociación Española de Pediatría ha realizado, a la luz de las pruebas disponibles actualmente, una revisión del tema en relación con la lactancia materna (AU)

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant is sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breast feeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant (AU)

[Use of pacifiers and breastfeeding]. / Uso del chupete y lactancia materna.

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant́s sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breastfeeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant.

Lactancia materna dolorosa: estrategias de tratamiento para el pediatra / Breast pain during lactation: management strategies for the pediatrician

El dolor y los problemas del pecho son habituales en las madres que amamantan: originan importantes molestias, disminuyen la confianza de las madres en su capacidad para amamantar y, con frecuencia, son causa de abandonos precoces. A menudo, los profesionales no conocemos el mejor modo de prevenir o tratar estos problemas, ya que su abordaje no suele estar incluido en los programas de formación de pregrado o posgrado. Con esta revisión, los autores pretenden ofrecer al profesional que atiende a la díada madre-hijo una herramienta básica basada en los conocimientos más actuales sobre el tema (AU)

Breast pain and other breast problems are frequent among breastfeeding mothers. They cause significant distress, undermine the mother’s self-confidence in her ability to feed the baby and often contribute to early cessation of lactation. However, more than often, health professionals do not have the necessary knowledge for prevention or resolution of these specific problems as, in general, these topics are not included in preservice or in-service training. The purpose of this review is to provide all professionals in charge of the health of the mother-infant dyad with a practical tool based on present scientific knowledge (AU)

El método de la madre canguro / Kangaroo mother care

Desde hace tiempo, las unidades de neonatología están tratando de introducir los cuidados centrados en el desarrollo, que pretenden mejorar el desarrollo del prematuro a través de intervenciones especiales, entendiendo al recién nacido y a su familia como una unidad. En estos cuidados se incluye el método de la madre canguro (MMC), que se define como el contacto piel con piel entre la madre y el niño prematuro de la forma más precoz, continua y prolongada posible con lactancia materna, para que ambos se beneficien de sus ventajas. El MMC debería ofrecerse a todos los niños prematuros o recién nacidos a término enfermos como una alternativa al cuidado en la incubadora, dado que es efectivo para el control de la temperatura, reduce el riesgo de infecciones y de episodios de apnea, favorece la lactancia materna, permite y fortalece la vinculación madre/padre-hijo, devuelve a los padres el protagonismo del cuidado de sus hijos y reduce la estancia hospitalaria

Developmental care was introduced in many neonatal care units some time ago. The aim of this initiative is to improve preterm outcomes through comprehensive interventions that consider the newborn infant and his or her family as a closed unit. Kangaroo mother care, which is included among these interventions, is defined as mother and infant skin-to-skin contact as early as possible, as continuously as possible and as long as possible, together with breastfeeding, which will benefit both mother and infant. Kangaroo mother care should be offered to all preterm or sick newborns as an alternative to care in an incubator as it is effective in terms of temperature control, reduces the risk of infections and episodes of apnea, favors breastfeeding, enables and strengthens mother/fatherinfant bonding, restores the predominant role of the family in infant care and reduces hospital stays

Reanimación del recién nacido / Neonatal resuscitation

Un 10 % de todos los recién nacidos a término o próximos al término, necesitan maniobras de estabilización para iniciar el llanto o una respiración regular, mantener una frecuencia cardíaca mayor de 100 lat./min, y un color sonrosado así como buen tono muscular. Aproximadamente el 1 % van a necesitar ventilación y muy pocos masaje cardíaco o medicación. Sin embargo, la asfixia al nacimiento representa un problema importante a nivel mundial ya que puede producir en el recién nacido la muerte o secuelas graves. Recientemente el European Resuscitation Council (ERC) y el International Liaison Committee on Resuscitation (ILCOR) han publicado nuevas recomendaciones para la reanimación neonatal. En ellas han sido revisadas cuestiones específicas como el uso de aire o oxígeno al 100 % en la sala de partos, dosis y ruta de administración de la adrenalina, actuación en caso de líquido amniótico meconial, control de la temperatura, breve referencia a la ventilación en caso de niños prematuros, o referencia a nuevos dispositivos capaces de mejorar la atención al recién nacido, como la mascarilla laríngea o el detector de CO2 que nos va a permitir saber si el tubo endotraqueal está bien colocado. En este documento se recogen los cambios que ha habido en algunas de las prácticas de reanimación neonatal

At birth approximately 10 % of term or near-term neonates require initial stabilization maneuvers to establish a cry or regular breathing, maintain a heart rate greater than 100 beats per minute (bpm), and good color and muscular tone. About 1 % requires ventilation and very few infants receive chest compressions or medication. However, birth asphyxia is a worldwide problem and can lead to death or serious sequelae. Recently, the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR) published new guidelines on resuscitation at birth. These guidelines review specific questions such as the use of air or 100 % oxygen in the delivery room, dose and routes of adrenaline delivery, the peripartum management of meconium-stained amniotic fluid, and temperature control. Assisted ventilation in preterm infants is briefly described. New devices to improve the care of newborn infants, such as the laryngeal mask airway or CO2 detectors to confirm tracheal tube placement, are also discussed. Significant changes have occurred in some practices and are included in this document

[Neonatal resuscitation]. / Reanimación del recién nacido.

At birth approximately 10 % of term or near-term neonates require initial stabilization maneuvers to establish a cry or regular breathing, maintain a heart rate greater than 100 beats per minute (bpm), and good color and muscular tone. About 1 % requires ventilation and very few infants receive chest compressions or medication. However, birth asphyxia is a worldwide problem and can lead to death or serious sequelae. Recently, the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR) published new guidelines on resuscitation at birth. These guidelines review specific questions such as the use of air or 100 % oxygen in the delivery room, dose and routes of adrenaline delivery, the peripartum management of meconium-stained amniotic fluid, and temperature control. Assisted ventilation in preterm infants is briefly described. New devices to improve the care of newborn infants, such as the laryngeal mask airway or CO2 detectors to confirm tracheal tube placement, are also discussed. Significant changes have occurred in some practices and are included in this document.

La lactancia materna. Cómo promover y apoyar la lactancia materna en la práctica pediátrica. Recomendaciones del Comité de Lactancia de la AEP / Breastfeeding. How to promote and support breastfeeding in pediatric practice. Recommendations of the Breastfeeding Committee

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Síndrome de Peutz-Jeghers / Peutz-Jeghers syndrome

El síndrome de Peutz-Jeghers es una rara enfermedad hereditaria, aunque se ha descrito hasta un 20% de casos esporádicos. Clínicamente se diagnostica por la asociación de una pigmentación mucocutánea facial y la presencia de pólipos intestinales de tipo hamartomatosos. Entre los problemas asociados se describen las intervenciones quirúrgicas secundarias a los pólipos intestinales, así como la alta incidencia de desarrollo de tumores que presentan en la edad adulta. Se presenta un caso de una niña de 10 años de edad, e historia de anemia rebelde al tratamiento, sin otros síntomas clínicos. El estudio demostró la presencia de pigmentación en la mucosa oral, así como la existencia de múltiples pólipos en aparato digestivo (estómago e intestino delgado). El estudio histológico de la biopsia intestinal confirmó la existencia de lesiones hamartomatosas. No existen antecedentes familiares conocidos de pigmentación o pólipos intestinales. En su evolución presentó un cuadro de invaginación intestinal que requirió practicar una resección limitada del intestino delgado (AU)

[Peutz-Jegher's syndrome]. / Síndrome de Peutz-Jeghers.

Peutz-Jeghers syndrome is a rare hereditary disease, although in about 20 % of patients there is no known family history. Its clinical hallmarks are facial mucocutaneous pigmentation and diffuse gastrointestinal polyposis of hamartomatous origin. The major difficulty in the management of this disease lies in the complications of surgery for small bowel polyposis and the high incidence of tumors presented by these patients as adults. We present the case of a 10-year-old girl with treatment-resistant anemia and no other clinical symptoms. Further investigation revealed pigmentation in the oral mucosa and polyposis in the stomach and small intestine. Hamartomatous lesions were confirmed by histological study of intestinal biopsy. No familial antecedents of pigmentation or intestinal polyps were found. During evolution the patient required subtotal resection of the small intestine due to invagination.

[Cephalohemoatoma as the first manifestation of congenital factor XIII deficiency]. / Cefalohematoma como primera manifestación de déficit congénito de factor XIII.

Congenital factor XIII deficiency is a rare hereditary disorder characterized by a marked tendency to bleeding. We describe a male newborn with inherited factor XIII deficiency. The patient was from a family without known antecedents and presented cephalohematoma as the first manifestation of the disease. This presentation is very unusual. The patient was diagnosed during the neonatal period and was successfully treated with substitution therapy. Early diagnosis and treatment of this disorder are important to prevent complications of severe bleeding.

Cefalohematoma como primera manifestación de déficit congénito de factor XIII / Cephalohemoatoma as the first manifestation of congenital factor XIII deficiency

El déficit congénito de factor XIII es un trastorno hereditario muy poco frecuente caracterizado por una tendencia a las hemorragias graves. Presentamos el caso de un recién nacido afecto de un déficit hereditario, sin antecedentes familiares conocidos, que presentó un cefalohematoma como primera manifestación de la enfermedad, hecho muy poco habitual. Se diagnosticó en el período neonatal y se instauró tratamiento sustitutivo con buenos resultados. Se insiste en la necesidad de un diagnóstico y tratamiento precoz que prevenga la aparición de complicaciones hemorrágicas graves (AU)

[The prenatal development of nephrological abnormalities detected during pregnancy]. / Evolución en el periodo neonatal de las anomalías nefrourológicas detectadas durante el embarazo.

OBJECTIVE: The objective of the present study was to evaluate the conformity between the pathological prenatal ultrasound findings of the kidney and urinary tract during fetal life and in the neonatal period. PATIENTS AND METHODS: In a period of four years (1991-1994) 14,938 pregnant woman were controlled in our hospital by performing at least one prenatal ultrasound during the third trimester of their pregnancy to detect alterations of the kidneys and fetal urinary tract. In those newborns with a positive fetal ultrasound, a renal ultrasonography study was performed in the first week of life. RESULTS: Anomalous fetal images at the level of the kidney and/or urinary tract were found in 71 cases (0.5% of all fetuses studied), with sonography during the neonatal period confirming 46.5% of them. The most common fetal images found were pyelocaliceal dilatation in 58 cases (82% of the total) and amongst these mild cases (with renal pelvis diameter less than 10 mm) with 39 cases (55%) none of which malformation of the urinary tract could be diagnosed. In the extreme opposite, the images of severe pyelocaliceal dilatation (pelvic diameter greater than 15 mm), renal cystic images and images of agenesis or renal hypoplasia were interrelated very well (100%, 75% and 100%, respectively) with the neonatal ultrasound findings. CONCLUSIONS: We want to indicate the great help that fetal ultrasound provides in the precocious diagnosis of nephrourological malformations in the newborn.

[Vertical transmission of hepatitis C virus]. / Transmisión vertical del virus de la hepatitis C.

OBJECTIVE: The objectives of this study were to know the prevalence of hepatitis C virus (HCV) in a population of pregnant women, to evaluate the vertical transmission rates of HCV in a prospective study and to determine the repercussions and consequences in children born to infected mothers. PATIENTS AND METHODS: A total of 6556 pregnant women were tested for HCV antibodies from January 1993 to August 1995. We followed 50 babies born to infected mothers for at least 12 months (mean 15 months). Serological assays employed included a screening ELISA II confirmed with immunoblot. Viral detection was performed by qualitative and quantitative PCR for HCV-RNA. RESULTS: Fifty-nine pregnant women were AcHCV(+). This represents a seroprevalence of 0.9%. Of the 50 babies followed, 6 were PCR(+) and 44 were PCR(-). The risk of transmission is correlated with the titer of HCV-RNA in the mother. All mothers of infected babies were HIV (-). CONCLUSIONS: The rate of prevalence in our pregnant women population is 0.9%. We found a vertical transmission rate of 12%. The high serum HCV-RNA titers in the mothers are a risk factor of transmission of HCV. The viremia in the children does not predict the apparition of the clinical disease, although they can exhibit intermittent increases of transaminases.