[Arterial stroke after birth trauma]. / Infarto cerebral arterial tras traumatismo al nacimiento.

Perinatal arterial stroke is a significant cause of neurological deficit, including mental retardation, delayed motor development, epilepsy, and severe cognitive impairment. Most strokes occur in term neonates, due to thromboembolism from an intracranial or extracranial vessel associated with a risk factor such as asphyxia at birth and heart, hematological or infectious diseases. An association with instrumental delivery has not been clearly demonstrated, although several cases have been described in the literature. The incidence of stroke in the perinatal period is estimated to be 1/4000 term neonates per year. We describe three new cases of stroke in term neonates with instrumental delivery and describe the etiopathogenesis, diagnosis and outcome of this entity.

Infarto cerebral arterial tras traumatismo al nacimiento / Arterial stroke after birth trauma

El infarto arterial perinatal representa una importante causa de déficit neurológicos que incluyen retraso mental, del desarrollo motor, epilepsia y defectos cognitivos graves. La mayoría de los infartos ocurren en recién nacidos a término, por un tromboembolismo desde un vaso intracraneal o extracraneal asociado a un factor de riesgo tal como asfixia al nacimiento, enfermedades cardíacas, hematológicas o infecciosas. La asociación con el parto instrumental no ha sido claramente demostrada, aunque existen casos descritos en la literatura especializada. La incidencia en el período perinatal se estima en uno de cada 4.000 recién nacidos a término y año. Se describen tres nuevos casos en recién nacidos a término con antecedentes de parto instrumental y se revisa la etiopatogenia, el diagnóstico y la evolución de esta entidad

Perinatal arterial stroke is a significant cause of neurological deficit, including mental retardation, delayed motor development, epilepsy, and severe cognitive impairment. Most strokes occur in term neonates, due to thromboembolism from an intracranial or extracranial vessel associated with a risk factor such as asphyxia at birth and heart, hematological or infectious diseases. An association with instrumental delivery has not been clearly demonstrated, although several cases have been described in the literature. The incidence of stroke in the perinatal period is estimated to be 1/4000 term neonates per year. We describe three new cases of stroke in term neonates with instrumental delivery and describe the etiopathogenesis, diagnosis and outcome of this entity

Estenosis hipertrófica de píloro en gemelos / Hypertrophic pyloric stenosis in twins

No disponible

Drogas en el embarazo y morbilidad neonatal / Drug abuse in pregnancy and neonatal morbidity

No disponible

[Congenital chylothorax]. / Quilotórax congénito.

OBJECTIVE: The aim of this study was to study the prenatal diagnosis, clinical manifestations and karyotype results in congenital chylothorax. PATIENTS AND METHODS: A retrospective survey of a 20 year period was carried out. The prenatal diagnosis, maneuvers following delivery, malformations and clinical outcome were studied. RESULTS: We found 10 cases of congenital chylothorax. Four were diagnosed by prenatal ultrasound with pleural effusion and no other signs of hydrops and six were diagnosed postnatally. Of the later, five had respiratory distress and one was diagnosed by radiological procedures. In all 10 cases, postnatal thoracocentesis was performed for diagnosis and therapy, five infants required mechanical ventilation and four parenteral nutrition. One patient died 72 hours after birth and three within 24 hours of birth. The clinical outcome of the rest was successful and were placed on a medium-chain triglyceride formula that was given orally. Of the eight karyotypes studied, six trisomy 21 were found. CONCLUSIONS: The prenatal diagnosis of pleural effusion permits prompt recognition of congenital chylothorax and allow for appropriate treatment upon birth. Medical therapy including pleural drainage and total parenteral nutrition and medium-chain triglyceride formula for oral feedings is successful in the majority of cases. Down's syndrome should be considered in fetuses or newborns with pleural effusion.

[HIV infection in day-care and school centers]. / La infección por VIH en guarderías y centros escolares.

Today it is known in what ways the transmission of HIV may occur in the child population. Most infected children are the offspring of infected mothers; according to the Study of the European Collaborative Community, only 13% of children of HIV infected mothers are infected. Different organizations all over the world have dictated specific regulations and laws to integrate the HIV infected child into groups of other children. In the Basque Country, the Plan of AIDS Prevention and Control was established in January 1988. This is a working plan involving the Departments of Health and Education of the Basque Government with the following objectives: 1) With the authorization of the family, to inform the director of the center where the child is of the child's situation. 2) To maintain the confidentiality. 3) To educate teaching staff in the adoption of measures designed to prevent the theoretical possibility of HIV infection in the school environment. Annually, a meeting of all schools which have enrolled are are to enroll an HIV (+) child is established with the multidisciplinary team. After seven academic years of experience, 53 infected children have been schooled in private and public centers. The periodic meetings between the schools and multidisciplinary team are very useful in developing the plan. The presence of an HIV (+) child in a school does not present special problems for the dynamics of how the school functions. In our opinion, all programmes for the schooling of HIV (+) children should involve coordination between hospital based pediatricians, educators and the Department of Health and Education.

[Responses to triple viral and tetanus vaccination in HIV-infected children]. / Respuesta a la vacunación triple vírica y tétanos en niños infectados por VIH.

Our objective was to study the antibody response to the parotiditis, rubella, measles and tetanus vaccines in HIV infected children. Forty-four children of HIV positive mothers, of which 14 were infected (SG) and 33 HIV negative (CG) were studied when they were between 2 and 3 years of age. Their response to vaccinations of four doses of tetanus toxoid and one dose of measles, rubella and parotiditis vaccines was assessed. Children in the SG were tested at the age of 5-6 years to study the evolution of the response. At the age of 2-3 years, all children had optimal protection against tetanus toxoid. The response to measles, parotiditis and rubella was poor (adequate levels of antibodies in 50%, 25% and 21%, respectively) in infected children and good (93%, 75% and 90%, respectively) in the CG. At 5-6 years of age, a decreased level of antitetanus antibodies were found in the SG, maintaining low protection levels. There was no evidence of any changes in the response to measles, while the number of cases with a good response to parotiditis and rubella increased. Further results are necessary to know the effectiveness of the booster. We conclude that: 1) The immunological response to vaccination is poor in HIV infected children. 2) There was no evidence of side effects or changes in the HIV symptoms after vaccination.

[Detection of HIV infection in mother and child. Criteria for suspicion]. / Detección de la infección VIH en la madre-hijo. Criterios de sospecha.

UNLABELLED: We look risk factors (RF) (other than i.v. drug addiction) leading to the suspicion of HIV infection. We have measured (ELISA) HIV antibodies in mothers and their children whenever the following circumstances were present: Maternal age under 22, previous abortions, sexually transmitted disease, uncontrolled pregnancy, unstable household, prostitution or neonatal irritability. We have studied 142 mother-child units and compared the results in HIV (+) and HIV (-) groups. RESULTS: 42 mother-child units were HIV (+) and 100 were HIV (-). Significant differences were only found for the following RF: Maternal age less than 22 (64% vs 32%), previous abortions (40% vs 16%) and venereal disease (30% vs 13%). CONCLUSIONS: We point out the need for defining local risk factors for every environment in order to adequately screen newborns for vertically transmitted HIV infection. Maternal age below 22, a history of previous abortions and of sexually transmitted disease should lead to HIV infection suspecion in our environment.

[Prospective study of newborn infants born to mothers infected with human immunodeficiency virus]. / Estudio prospectivo en recién nacidos, hijos de madres infectadas por el virus de la immunodeficiencia humana.

Perinatal transmission of Human immunodeficiency virus (HIV) from mother to child is at the present time the most important cause of AIDS in children. Since August 1985 we have observed 24 babies with anti-HIV antibodies born to HIV-infected mothers. Their present status is: 6 have symptomatic infection, 6 undetermined infection, 10 had became seronegative and 2 were lost for follow-up. Our results suggest that the risk of infection for the baby is high and the onset of symptoms relatively early. Follow-up studies in babies born to HIV-infected mothers are needed in order to classify the true risk of infection in them and the natural history of the disease.