[Neonatal viral meningitis. The importance of the polymerase chain reaction in their diagnosis]. / Meningitis viricas neonatales. Importancia de la reaccion en cadena de la polimerasa en su diagnostico.

INTRODUCTION: The different types of viral meningitis constitute a condition that is relatively frequent in newborn infants, although in many cases they are underdiagnosed due to the absence of pleocytosis in the cerebrospinal fluid (CSF). AIMS: To describe the clinical features and laboratory findings of newborn infants with viral meningitis and to highlight the importance of the polymerase chain reaction (PCR) in the CSF to diagnose this condition. PATIENTS AND METHODS: A retrospective review of the medical records of newborn infants hospitalised in the neonatology section who had been diagnosed with viral meningitis between May 2014 and May 2017. RESULTS: Altogether 17 cases of viral meningitis were registered (15 caused by enterovirus and two due to parechovirus), which accounts for 14.8% of all newborns hospitalised owing to febrile symptoms. All of them had fever (100%), and other notable symptoms were irritability (76%) and rejection of feeding (65%). Normal cellularity was found in the CSF without high protein levels in 88% of them, and without hypoglycorrhachia in all of them (100%), which meant that many of these children had previously been left with a diagnosis of a febrile syndrome with no focus. These data stress the need to perform the PCR in the CSF of newborn infants who have a fever without a focus, due to the normal status of the results of the complementary tests in most cases. Subsequent neurological follow-up was performed in 64.7% of the children in the neurology service, without any neurological sequelae being found, except in one case. CONCLUSIONS: Multiple PCR in the CSF has become an essential diagnostic technique in cases of newborn infants with a suspected infection, and replaces viral culture as the reference test due its being quicker and more sensitive.

TITLE: Meningitis viricas neonatales. Importancia de la reaccion en cadena de la polimerasa en su diagnostico.Introduccion. Las meningitis viricas representan una entidad relativamente frecuente en los recien nacidos, aunque en muchos casos infradiagnosticadas, ante la ausencia de pleocitosis en el liquido cefalorraquideo (LCR). Objetivos. Describir las caracteristicas clinicas y los hallazgos de laboratorio de neonatos con meningitis viricas y destacar la importancia de la reaccion en cadena de la polimerasa (PCR) en el LCR para diagnosticar esta patologia. Pacientes y metodos. Revision retrospectiva de historias clinicas de neonatos ingresados en la seccion de neonatologia diagnosticados de meningitis virica entre mayo de 2014 y mayo de 2017. Resultados. Se registraron 17 casos de meningitis virica (15 causadas por enterovirus y dos por parechovirus), que constituyen el 14,8% de los neonatos ingresados por sindrome febril. Todos manifestaron fiebre (100%), y otros sintomas destacados fueron irritabilidad (76%) y rechazo de la ingesta (65%). El 88% curso con celularidad normal en el LCR y sin hiperproteinorraquia, y el 100%, sin hipoglucorraquia, por lo que previamente muchos de estos niños quedaban con el diagnostico de sindrome febril sin foco. Estos datos resaltan la necesidad de realizar la PCR en el LCR a neonatos con fiebre sin foco, debido a la normalidad de las pruebas complementarias en la mayoria de los casos. El 64,7% de los niños recibio seguimiento neurologico posterior en consulta de neurologia, sin objetivarse secuelas neurologicas, salvo en uno de ellos. Conclusiones. La PCR multiple en el LCR se ha convertido en una tecnica diagnostica imprescindible en el recien nacido con sospecha de infeccion y sustituye al cultivo viral como prueba de referencia por su mayor rapidez y sensibilidad.

Enterocolitis necrotizante y perforaciones intestinales en prematuros de muy bajo peso. ¿Cuál es la mejor opción quirúrgica? / Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option?

La enterocolitis necrotizante (ECN) y la perforación intestinal aislada(PIA) son frecuentes en recién nacidos de muy bajo peso (RNMBP) y requieren cirugía el 20-40%. Hemos revisado retrospectivamente los RNMBP intervenidos por ECN y PIA entre el 2000 y el 2010, dividiendo la muestra en 3 grupos: 1) laparotomía inicial; 2) drenaje peritoneal temporal y laparotomía diferida; 3) drenaje peritoneal. De los 487 RNMBP ingresados en nuestro Hospital, 80 casos fueron ECN o PIA y de estos, el 31% (n= 25)fueron intervenidos quirúrgicamente. La edad gestacional media fue de 26 +3 semanas, 14 niñas y 11 niños, peso medio de 801,4 g (rango: 460 a 1.490g). Tuvieron neumoperitoneo el 48% (n= 12). Realizamos laparotomía inicial en 12 casos, drenaje más laparotomía en 10 y drenaje en 3 pacientes. El promedio de horas entre el drenaje y la laparotomía fue de 69,6. El 68%eran ECN y el 32% PIA. La laparotomía inicial aportó mayor supervivencia(P= 0,001) y la mortalidad general fue del 32% (8 éxitus). El procedimiento quirúrgico óptimo debe basarse en las condiciones clínicas del paciente .Consideramos que la laparotomía inicial debería ser el tratamiento para los pacientes con perforación intestinal por ECN y PIA (AU)

Necrotizing enterocolitis (NEC) and isolated intestinal perforation(IP) are common diseases in very low birth weight infants (VLBW) and require surgery in 20-40% of cases. We have performed a retrospective ereview of VLBW infants with NEC or IP who underwent a surgical procedure between 2000 and 2010, either initial laparotomy (group 1),peritoneal drain placement and subsequent laparotomy (group 2) orperitoneal drainage (group 3). Of 487 VLBW infants admitted to our hospital in the last ten years, 80 patients had NEC or IP, out of these,31% (n= 25) were treated surgically. The study population consisted of 14 girls and 11 boys with a mean gestational age of 26+3 weeks and mean birth weight of 801.4 g (range460 to 1,490 g). Pneumoperitoneum was seen in 48% of cases (n= 12).Twelve patients underwent initial laparotomy, 10 patients were treated with peritoneal drainage and subsequent laparotomy and in 3 patient a peritoneal drainage was placed .Mean time between drainage and laparotomy was 69.6 hours Sixty eight percent of patients had NEC and thirty-two percent were IP. Survivalrate was higher in the group who underwent initial laparotomy(p= 0.001) with an overall mortality of 32% (8 deaths). Optimal surgical procedure must be decided upon clinical condition of individual patients.We consider that initial laparotomy should be the treatment option inVLBW infants with intestinal perforation due to NEC or IP (AU)

[Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option?]. / Enterocolitis necrotizante y perforaciones intestinales en prematuros de muy bajo peso. Cuá1 es la mejor opción quirúrgica?

Necrotizing enterocolitis (NEC) and isolated intestinal perforation (IP) are common diseases in very low birth weight infants (VLBW) and require surgery in 20-40% of cases. We have performed a retrospective review of VLBW infants with NEC or IP who underwent a surgical procedure between 2000 and 2010, either initial laparotomy (group 1), peritoneal drain placement and subsequent laparotomy (group 2) or peritoneal drainage (group 3). Of 487 VLBW infants admitted to our hospital in the last ten years, 80 patients had NEC or IP, out of these, 31% (n=25) were treated surgically. The study population consisted of 14 girls and 11 boys with a mean gestational age of 26+3 weeks and mean birth weight of 801.4 g (range 460 to 1490 g). Pneumoperitoneum was seen in 48% of cases (n=12). Twelve patients underwent initial laparotomy, 10 patients were treated with peritoneal drainage and subsequent laparotomy and in 3 patients a peritoneal drainage was placed. Mean time between drainage and laparotomy was 69.6 hours. Sixty-eight percent of patients had NEC and thirty-two percent were IP. Survival rate was higher in the group who underwent initial laparotomy (p = 0.001) with an overall mortality of 32% (8 deaths). Optimal surgical procedure must be decided upon clinical condition of individual patients. We consider that initial laparotomy should be the treatment option in VLBW infants with intestinal perforation due to NEC or IP.

Síndrome de Lemierre / Lemierre's syndrome

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[Recognition of the child at risk of cardiopulmonary arrest]. / Reconocimiento del niño con riesgo de parada cardiorrespiratoria.

Early treatment is a major factor to improve the outcome of children at risk of cardiopulmonary arrest. That's why it is essential to recognize as soon as possible clinical signs that indicate a respiratory and/or circulatory dysfunction. Immediate systematic assessment and re-assessment of oxygenation, ventilation and organ perfusion status is one of the keys in the prevention of cardiorespiratory arrest in children. Health care staff must assure that a child with signs of acute respiratory and/or circulatory dysfunction is under constant surveillance by a person with ability to interpret signs, identify problems and to initiate emergency treatment, if needed. Respiratory assessment must include respiratory rate, signs of mechanical respiratory failure (nasal flaring, respiratory noises, paradoxical breathing, prolonged expiration) as well as skin-mucous colour. Cardiocirculatory failure assessment includes heart rate, blood pressure, peripheral perfusion (capillary refill time and temperature gradient), level of consciousness and urinary output. In a child with impending signs of cardio-respiratory failure, the priority is to warrant adequate ventilation and oxygenation. If, despite this treatment, there is no improvement in perfusion, treatment of circulatory failure with fluids and vasoactive drugs is necessary.

Reconocimiento del niño con riesgo de parada cardiorrespiratoria / Recognition of the child at risk of cardiopulmonary arrest

El pronóstico de los niños con riesgo de sufrir una parada cardiorrespiratoria es mejor cuanto antes se inicie el tratamiento. Por eso, es muy importante reconocer cuanto antes los signos clínicos que ponen de manifiesto el compromiso respiratorio y/o circulatorio. Una de las claves de la prevención de la parada cardiorrespiratoria en los niños críticamente enfermos radica en la evaluación rápida, sistemática y constante del estado de oxigenación, ventilación y perfusión. El personal sanitario debe asegurarse de que el niño con insuficiencia respiratoria y/o circulatoria permanezca en todo momento bajo la vigilancia de una persona capaz de identificarlos, interpretarlos, y actuar con rapidez. En la evaluación respiratoria hay que analizar la frecuencia respiratoria, los signos de insuficiencia mecánica respiratoria (aleteo nasal, tiraje, ruidos respiratorios, respiración paradójica, espiración alargada) y la coloración cutáneo mucosa. Los signos más importantes a analizar en la evaluación cardiocirculatoria son la frecuencia cardíaca, presión arterial, perfusión periférica (relleno capilar y gradiente térmico) estado de conciencia y diuresis. Ante un niño con signos de insuficiencia cardiorrespiratoria lo primero es garantizar que la ventilación y oxigenación sean adecuadas y si, a pesar de ello, la perfusión no mejora se realizará tratamiento de la insuficiencia circulatoria con líquidos y fármacos vasoactivos

Early treatment is a major factor to improve the outcome of children at risk of cardiopulmonary arrest. That's why it is essential to recognize as soon as possible clinical signs that indicate a respiratory and/or circulatory dysfunction. Immediate systematic assessment and re-assessment of oxygenation, ventilation and organ perfusion status is one of the keys in the prevention of cardiorespiratory arrest in children. Health care staff must assure that a child with signs of acute respiratory and/or circulatory dysfunction is under constant surveillance by a person with ability to interpret signs, identify problems and to initiate emergency treatment, if needed. Respiratory assessment must include respiratory rate, signs of mechanical respiratory failure (nasal flaring, respiratory noises, paradoxical breathing, prolonged expiration) as well as skin-mucous colour. Cardiocirculatory failure assessment includes heart rate, blood pressure, peripheral perfusion (capillary refill time and temperature gradient), level of consciousness and urinary output. In a child with impending signs of cardio-respiratory failure, the priority is to warrant adequate ventilation and oxygenation. If, despite this treatment, there is no improvement in perfusion, treatment of circulatory failure with fluids and vasoactive drugs is necessary

[Embryopathy due to valproic acid with severe malformations in the central nervous system]. / Embriopatía por ácido valproico con malformaciones graves del sistema nervioso central.

INTRODUCTION: Embryogenetic disorders are one of the most serious problems in the life of an epileptic. Over the last few decades many antiepileptic drugs, including valproic acid, have been shown to have teratogenic properties. Embryopathy due to valproate, also known as fetal valproate syndrome, is a well-known and documented example of these conditions. CASE REPORT: We report the case of a preterm newborn infant who, at birth, exhibited a syndrome characterised by facial dysmorphia, gingival hyperplasia, neurological hyperexcitability and multiple malformations, the most striking of which was the presence of predominantly temporal atrophy in the left brain hemisphere. The most significant event in the medical history of the case was the mother's taking valproate in monotherapy throughout the entire period of gestation as treatment for generalised idiopathic epilepsy that was diagnosed during adolescence. Screening precluded the most common metabolic, hereditary or infectious causes that can cause embryopathies. CONCLUSIONS: The mother's history of taking valproic acid and the specific findings that coincided in the peculiar embryopathy of this patient enabled us to link them.

Embriopatía por ácido valproico con malformaciones graves del sistema nervioso central / Embryopathy due to valproic acid with severe malformations in the central nervous system

Introducción. Los trastornos de la embriogénesis son uno de los problemas más serios en la vida de una epiléptica. Muchos antiepilépticos, entre ellos el ácido valproico, han demostrado su capacidad teratogénica a lo largo de estas últimas décadas. La embriopatía por valproato, denominada síndrome fetal por valproato, es una de estas entidades, bien conocida y caracterizada. Caso clínico. Describimos un recién nacido pretérmino que presentó en el momento del nacimiento un síndrome caracterizado pordismorfia facial, hiperplasia gingival, hiperexcitabilidad neurológica y polimalformaciones, entre las que destacó la presencia de atrofia cerebral hemisférica izquierda de predominio temporal. El antecedente más significativo fue la toma materna de valproato enmonoterapia durante toda la gestación por epilepsia generalizada idiopática diagnosticada en la adolescencia. El cribado descartó las causas habituales implicadas en embriopatías, metabólicas, hereditarias o infecciosas. Conclusión. El antecedente de toma materna de ácido valproico y la especificidad de los hallazgos coincidentes en el paciente de esta peculiar embriopatía permitieron relacionarlos (AU)

Introduction. Embryogenetic disorders are one of the most serious problems in the life of an epileptic. Over the last few decades many antiepileptic drugs, including valproic acid, have been shown to have teratogenic properties. Embryopathy due to valproate, also known as fetal valproate syndrome, is a well-known and documented example of these conditions. Case report. We report the case of a preterm newborn infant who, at birth, exhibited a syndrome characterised by facial dysmorphia, gingival hyperplasia, neurological hyperexcitability and multiple malformations, the most striking of which was the presence of predominantly temporal atrophy in the left brain hemisphere. The most significant event in the medical history of the case was the mother’s taking valproate in monotherapy throughout the entire period of gestation as treatment for generalised idiopathic epilepsy that was diagnosed during adolescence. Screening precluded the most common metabolic, hereditary or infectious causes that can cause embryopathies. Conclusions. The mother’s history of taking valproic acid and the specific findings that coincided in the peculiar embryopathy of this patient enabled us to link them (AU)

Reconocimiento del niño con riesgo de parada cardiorrespiratoria / Identifying children at risk for cardiorespiratory arrest

La parada cardiorrespiratoria (PCR) de los niños que padecen una enfermedad grave no suele presentarse de una forma brusca o inesperada sino que, con frecuencia, es el resultado de un deterioro progresivo de la función respiratoria y/o circulatoria. Antes de que se produzca el fracaso de estas funciones aparecen una serie de signos clínicos que las ponen de manifiesto. Los sanitarios no sólo deben saber valorar los signos clínicos de alarma de insuficiencia respiratoria, circulatoria o de ambas, sino que han de ser capaces de hacerlo cuanto antes, preferiblemente en la fase de compensación, puesto que las posibilidades de que las medidas terapéuticas puedan revertir el proceso disminuyen con la progresión de éste (AU)

[Identifying children at risk for cardiorespiratory arrest]. / Reconocimiento del niño con riesgo de parada cardiorrespiratoria.

Cardiorespiratory arrest in children with severe disease does not usually present suddenly or unexpectedly but is often the result of a progressive deterioration of respiratory and/or circulatory function. Before failure of these functions occurs, there is a series of clinical signs that serve as a warning. Health professionals should not only evaluate clinical signs of respiratory and/or circulatory insufficiency but should also be able to identify these warning signs as early as possible, preferably in the compensation phase, given that the possibility that this process can be reversed by therapeutic measures decreases as the process progresses.

[Neonatal convulsions caused by incontinentia pigmenti with left opercular dysgenesia]. / Convulsiones neonatales por incontinencia pigmenti con disgenesia opercular izquierda.

AIMS: In this paper we review the main publications on incontinentia pigmenti (IP) and the current knowledge of the etiopathogenesis of the disease and of the convulsions in the neonatal period, by considering a clear case of neonatal IP, with skin, eye, brain and bone lesions. CASE REPORT: Our patient, a female, started with clonic seizures in the right half of the body at the age of three days. Method. IP, or Bloch Sulzberger syndrome, is a genetic multisystemic neuroectodermic disorder. It is a disease of low incidence (1% of all neuroectodermic disorders) which is transmitted by means of a pattern of dominant inheritance linked to X, and is lethal in males, except in rare cases of somatic mosaicism and Klinefelter. In the family forms the gene is located in the p11 (IP 1) and q28 (IP 2) regions of the X chromosome. It has recently been discovered that the cause lies in a mutation of a gene called NEMO (IKK gamma). Together with Bourneville s tuberous sclerosis it is the only neurocutaneous syndrome that can begin with neonatal convulsions. The convulsions start on the second or third day of life and are often limited to a single side of the body, although it can also appear as encephalitis. The origin of the convulsions has been linked with recurring encephalomyelitis, or with an alteration of the neuronal migration. CONCLUSIONS: The cause of the early convulsions in our patient, which we put down to a left perisylvian focal dysgenesia (unilateral opercular syndrome) observed in the computerised axial tomography (CAT scan), has not been reported up to the present associated with IP.

Lesión medular intraúteropor posición transversa. Imágenes de resonancia magnética / Intrauterine spinal cord injury resulting from a transverse lie. Magnetic resonance imaging

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A fatal case of congenital disseminated Langerhans cell histiocytosis.

The case of a newborn male infant with congenital Langerhans cell histiocytosis (LCH) is presented. At birth, showed cutaneous lesions (papules and vesicles with a haemorrhagic aspect), mucosal and ganglionic involvement. Biopsy of these lesions led to the diagnosis of LCH. At 24 hours of life the patient began with respiratory, hepatic, hematological and renal dysfunction, and died at 72 hours of life, despite corticoid treatment. LHC with vesicles and a rapid and fatal development, has previously only been described in three patients. The differential diagnosis of a disseminated and hemorrhagic vesicular eruption in a newborn infant is extensive and must include LHC.

[Central venous access by the Seldinger technic in neonatology]. / Accesos venosos centrales por técnica de Seldinger en neonatología.

Eighteen catheterizations were attempted in 17 patients catheters (Arrow 3ChFr and 4ChFr), between january of 1996 and december of 1997. The patients ranged in age from 3 to 148 days (mean of 43.3 and standard deviation of 47.5) and in weight from 1110 to 4000 grams (mean of 3182 grams and standard deviation 767.2 grams). Overall successful catheterization rate was 94.5%. Complications included a pneumothorax that needed pleural drainage, one self-limited femoral artery spasm and one stenosis of femoral vein that did not require any treatment. The mean catheterism time was 6.64 days (deviation of 3.84 days), and the causes of removal were end of treatment in 8 patients, accidental removal in 5, infectious suspicion in 2 and limb edema in 2. Seldinger technique may be a useful approach for central venous catheterization in neonates. Careful catheterization, extensive experience and appropriate selection of material, help to keep the risk of complications low.