[Neonatal seizures, our experience]. / Convulsiones neonatales, experiencia en la unidad.

AIM: To study retrospectively all newborns admitted between 1992 and 1998 in our Neonatology Unit with convulsions before 30 days of life. PATIENTS AND METHODS: 77 patients, 63.6% male, with an average gestational age of 36.42 weeks, and an average birth weight of 2,653 g. Apgar score at five minutes was below 4 in 4 newborns. RESULTS: In 35 patients the first convulsion occurred in the first 48 hours of life, 7 patients showed status epilepticus. There was a single type of seizure in 49 newborns (65.3%), specially tonic and clonic (multifocal and focal). Head ultrasound was abnormal in 33 newborn, CT scan and/or MRI abnormal in 24, EEG was pathologic in 55. Phenobarbital was the initial treatment in 81.8%, half of them required a therapeutical change. 34 patients (55.7%) still received treatment at hospital discharge. The etiology was hypoxic ischaemic encephalopathy (39%), though less important than in previous studies, intracranial hemorrhage (13%), central nervous system malformations (9%), among other. 16 patients died, 35 showed an abnormal outcome (45.4%): cognitive delay in 24, epilepsy in 19, motor abnormalities in 12. CONCLUSION: The worst outcome was found in malformations, meningitis, intracranial hemorrhages, metabolic diseases and hypoxic ischaemic encephalopathy, while the best in hypoglycemia and in benign idiopathic neonatal seizures.

Convulsiones neonatales, experiencia en la unidad / Neonatal seizures, our experience

Objetivo. Estudio retrospectivo de los pacientes atendidos en nuestra Unidad de Neonatología, en el período 1992-1998, con convulsiones neonatales iniciadas antes de los 30 días. Pacientes y métodos. 77 pacientes (63,6 por ciento sexo masculino), edad gestacional media 36,42 semanas, peso medio de nacimiento 2.653 g. Test de Apgar a los 5 minutos inferior a 4 en cuatro casos. Resultados. En 35 pacientes (47,3 por ciento) la primera crisis se manifestó en las primeras 48 horas de vida, siete pacientes presentaron estado de mal convulsivo. Se describió un único tipo de crisis en 49 neonatos (65,3 por ciento), especialmente tónicas, y clónicas (multifocales y focales). Ecografía craneal transfontanelar anormal en 33 casos, TAC o RM alteradas en 24, EEG patológico en 55. Se inició tratamiento con fenobarbital en el 81,8 por ciento, la mitad requirió una modificación terapéutica; 34 pacientes (55,7 por ciento) prosiguieron tratamiento anticonvulsionante al alta. Diagnóstico de encefalopatía hipoxicoisquémica (39 por ciento), aunque con menor incidencia respecto a series previas, hemorragia intracraneal (13 por ciento), y malformaciones del sistema nervioso central (9 por ciento). 16 pacientes fallecieron, manifestaron secuelas 35 (45,4 por ciento): afectación cognitiva 24, epilepsia 19, afectación motora 12. Conclusión. Se observa peor evolución en malformaciones del sistema nervioso central, meningitis, hemorragias intracraneales, metabolopatías y encefalopatía hipoxicoisquémica, mientras que en hipoglucemias y en las convulsiones neonatales idiopáticas benignas el pronóstico es mejor (AU)

Aim. To study retrospectively all newborns admitted between 1992 and 1998 in our Neonatology Unit with convulsions before 30 days of life. Patients and methods. 77 patients, 63,6% male, with an average gestational age of 36.42 weeks, and an average birth weight of 2,653 g. Apgar score at five minutes was below 4 in 4 newborns. Results. In 35 patients the first convulsion occurred in the firsts 48 hours of life, 7 patients showed status epilepticus. There was a single type of seizure in 49 newborns (65.3%), specially tonic and clonic (multifocal and focal). Head ultrasound was abnormal in 33 newborn, CT scan or MRI abnormal in 24, EEG was pathologic in 55. Phenobarbital was the initial treatment in 81.8%, half of them required a therapeutical change. 34 patients (55.7%) still received treatment at hospital discharge. The etiology was hypoxic ischaemic encephalopathy (39%), though less important than in previous studies, intracranial hemorrhage (13%), central nervous system malformations (9%), among other. 16 patients died, 35 showed an abnormal outcome (45.4%): cognitive delay in 24, epilepsy in 19, motor abnormalities in 12. Conclusion. The worst outcome was found in malformations, meningitis, intracranial hemorrhages, metabolic diseases and hypoxic ischaemic encephalopathy, while the best in hypoglycemia and in benign idiopathic neonatal seizures (AU)

[Non-traumatic cerebral hemorrhage in childhood: etiology, clinical manifestations and management]. / Hemorragia cerebral no traumática en la infancia: etiología, manifestaciones clínicas y manejo.

OBJECTIVE: Non-traumatic intracranial hemorrhage is a rare occurrence in children, with the most frequent etiology being vascular malformation. Our aim was to review the etiology and management of spontaneous cerebral hemorrhage in children. PATIENTS AND METHODS: We have reviewed the patients admitted to our intensive care unit (ICU) with spontaneous intracranial hemorrhage from 1980 to 1998. The etiology, symptoms and their clinical management were analyzed. RESULTS: Forty patients with non-traumatic intracranial hemorrhage were admitted during this time period. The mean age was 6.8 years and the male/female ratio was 2.4/1. This condition presented with a sudden onset in 83%. The most common form of presentation was headache, vomiting and altered consciousness. The most frequent etiology was vascular malformation (32.2%). Initial management was symptomatic and addressed the prevention or treatment of intracranial hypertension and seizures. Mortality was 38% and there were sequelae in 35%. CONCLUSIONS: Management of critical non-traumatic intracranial hemorrhage consists in preventing or treating cerebral hypertension. The monitoring of intracranial pressure, jugular oxygen saturation and transcranial Doppler allows an indirect measurement of cerebral blood flow. Prompt excision of the hematoma improves the outcome. In vascular malformations, endovascular embolization or radiosurgery are possible.

[Neurological and growth follow-up of cardiac patients operated on before 45 days of life]. / Seguimiento neurológico y somatométrico de operados cardíacos antes de los 45 días de vida.

OBJECTIVE: Our aim was to study the neurological and growth disorders in patients undergoing cardiac surgery during the neonatal period. PATIENTS AND METHODS: Ninety clinical records of newborns with congenital heart disease that were operated between 1985 and 1996 and were under the age of 45 days with a minimum follow-up period of 12 months were reviewed. RESULTS: Of the 37 patient records considered, 33 (89.1%) were neurosensorially normal, 2 had minor handicaps and 2 moderate handicaps. There were 15 (40.5%) with the weight and 9 (24.3%) with the length below the 10th percentile. Although exitus, handicaps and growth disorders were more frequent in those patients operated in the extracorporal circulation, there were no significant differences. The growth disorders were greater in complex heart diseases and in pulmonary atresia, but significant differences were only related to the weight. CONCLUSIONS: Because at least 11% of these patients showed neurological disorders, a neurological follow-up is necessary. The number of post-operated patients with growth disorders was high, but catch-up growth resulted in recovery. A greater number of neurological and growth disorder has been found in complex heart disease, where only a palliative treatment could be employed. Although the complete correction of the cardiopathy may imply an early mortality, long time prognosis for survivors is much better.

[Morbidity of the newborn infant born to a diabetic mother in relation to macrosomia]. / Morbilidad del recién nacido hijo de madre diabética en relación con la macrosomía.

OBJECTIVE: A descriptive study of an infant of a diabetic mother was carried out in order to analyze if macrosomia (weight greater than P90 for gestational age) is a good criteria in order to predict associated complications. PATIENTS AND METHODS: A total of 382 diabetic mothers were attended between January 1994 and December 1996. RESULTS: Most of the complications were similar to those reported in the literature. In infants of diabetic mothers there is a significant increase in malformations (7.1%), sepsis (10.7%), hypertrophic cardiomyopathy (12.1%), respiratory distress (12.7%), hypoglycemia (50%), polyglobulia (30.4%) and jaundice (7.1%). We did not find any differences for traumatisms (8.25%), acute fetal suffering (19.6%) or hypocalcemia (1.8%). Respiratory distress was related to gestational age. CONCLUSIONS: The high weight for gestational age is a good parameter to predict complications in the infants of diabetic mothers.