[Neonatal chylothorax and conservative treatment]. / Quilotórax neonatal y tratamiento conservador.

Four cases of chylothorax are reported. Three cases were congenital and the fourth was secondary to surgical repair of esophageal atresia. Of the three cases of congenital chylothorax, two were diagnosed prenatally. In all three patients with congenital chylothorax, the clinical course was favorable and pleural effusion was resolved in 19-80 days. Treatment consisted of pleural taps when respiratory function was compromised, parenteral nutrition, and respiratory support as required. Enteral nutrition was started with a formula containing medium-chain triglycerides while some effusion remained. Weight gain during this period was slow. Follow-up oscillated between 12 months and 6 years with no recurrences. The case of postsurgical chylothorax appeared several days after the intervention. Pleural effusion increased to 705 ml/day and the patient received no enteral nutrition. The patient died from intestinal complications and multiorgan failure 8 days after the onset of chylothorax. The etiology and clinical features of this condition, as well as the short- and long-term outcome with conservative treatment, are reviewed.

Quilotórax neonatal y tratamiento conservador / Neonatal chylothorax and conservative treatment

Se presentan 4 casos de quilotórax neonatal; en 3 casos se trataba de quilotórax congénito y el cuarto fue posquirúrgico tras la corrección de atresia de esófago. De los 3 quilotórax congénitos, dos fueron diagnosticados prenatalmente. Los 3 casos evolucionaron de manera favorable y el derrame desapareció en 19-80 días. Todos fueron tratados con punciones pleurales cuando había compromiso respiratorio, soporte respiratorio según necesidad y nutrición parenteral. La nutrición enteral se inició con una fórmula con triglicéridos de cadena media (MCT), cuando aún persistía algo de derrame. La ganancia ponderal durante este período fue lenta. El seguimiento ha oscilado entre 6 años y 12 meses, no observándose recidivas. El caso de quilotórax posquirúrgico apareció varios días después de la intervención con un volumen de drenaje pleural creciente hasta de 705 ml/día sin estar recibiendo nutrición enteral. La evolución fue mala y el paciente falleció con un cuadro de sufrimiento intestinal y fallo multiorgánico 8 días después del inicio del quilotórax. Se revisa la etiología, clínica y evolución con tratamiento conservador a corto y largo plazo (AU)

Trisomía 18q parcial derivada de translocación recíproca 4;18 materna / Partial trisomy 18q due to maternal reciprocal translocation 4;18

Se presenta un nuevo caso de trisomía 18q parcial derivada de translocación balanceada 4;18 materna. La niña era portadora de una trisomía parcial del brazo largo del cromosoma 18, asociada a una monosomía parcial de 4q distal. La niña mostraba un fenotipo con muchas de las principales características de la trisomía 18, entre otros: dismorfia facial, cardiopatía congénita, manos con dedos segundo y quinto situados sobre el tercero y cuarto con contracturas no reducibles y anomalías genitales. Creemos que el fenotipo de la trisomía 18 requiere una amplia región de 18q para su presentación y tiene una expresión más grave cuanto mayor es el fragmento trisómico. El consejo genético en las familias portadoras de translocaciones equilibradas es de gran importancia. Es necesario valorar el riesgo en cada caso particular, e informar sobre las posibilidades de diagnóstico prenatal existentes (AU)

[Partial trisomy 18q due to maternal reciprocal translocation 4;18]. / Trisomía 18q parcial derivada de translocación recíproca 4;18 materna.

We report a new case of partial trisomy 18q due to a balanced reciprocal translocation 4;18 in the mother. The female infant had a partial trisomy of the long arm of chromosome 18 associated with a partial monosomy of distal 4q. The infant showed many of the main clinical features of trisomy 18, such as dysmorphic face, congenital heart defect, crossing of the second and fifth fingers over the third and fourth with flexion contractures, and abnormal genitalia. We believe that the trisomy 18 phenotype requires a large region of 18q and that the greater the trisomic fragment, the more severe the expression. We stress the importance of genetic counseling to carriers of balanced translocations. The risk for each case should be evaluated and information should be given on the possibility of prenatal diagnosis.

[Prospective study of infective complications in newborns with fine silicone catheters used for parenteral nutrition infusion]. / Estudio prospectivo de las complicaciones infecciosas en recién nacidos con catéteres de silicona finos utilizados para infusión de nutrición parenteral.

OBJECTIVE: Percutaneous silastic central venous catheters have contributed to improve the care of neonates. They are quite safe; however, sometimes complications occur, with infections being the most frequent. A prospective study was undertaken in our NICU to know the rate of catheter-related sepsis, the influence of the duration of catheterization, the predominant portal of entry and the microorganisms isolated. PATIENTS AND METHODS: Fifty-two catheters were analyzed. Cultures were obtained once a week by aspiration from the catheter hub, the luer-lock connection and parenteral nutrition solution directly from the bag. If sepsis was suspected, blood cultures were obtained from a different vein. The tip was cultured after catheter withdrawal by the semiquantitative technique of Maki. RESULTS: Nineteen catheters (36.5%), 19 luer-lock connections (21.3%) and 7 parenteral nutrition solutions were colonized. We found a significant increase of the rate of colonization after the catheter had been in place 3 weeks or more (p < 0.05). Coagulase negative Staphylococcus was isolated in 75.7% of the samples. The rate of catheter related sepsis was 15.4% (7/8 caused by coagulase negative Staphylococcus). CONCLUSIONS: Catheter related sepsis may be more frequent than expected it colonization of the catheter were analyzed systematically. Screening catheter colonization allows an earlier diagnosis of pathogens if sepsis develops. Finally, we believe that the use of sterile techniques to handle the catheter and connections will further decrease catheter related infections.