Effectiveness of palivizumab immunoprophylaxis in infants with respiratory syncytial virus disease in Colombia.

INTRODUCTION: Respiratory syncytial virus (RSV) is one of the most important childhood infections. OBJECTIVE: To evaluate the effectiveness and safety of palivizumab immunoprophylaxis in preterm infants at a high risk of severe respiratory syncytial virus infection during the RSV season in Colombia. METHODOLOGY: A prospective observational non-comparative multicenter study in six Colombian cities. At the beginning of the RSV infection season, palivizumab prophylaxis, up to five doses, was administered to infants born at ≤32 weeks of gestation, infants younger than six months, infants under one year of age with bronchopulmonary dysplasia (BPD), infants one year or less of age with hemodynamically significant acyanotic and non-acyanotic congenital heart disease (CHD), and with follow-up during the immunoprophylaxis until one month after the last dose. RESULTS: The study enrolled 600 patients, 91.8% of which were born at ≤ 32 weeks of gestation. BPD was observed in 54.9% of infants. 49% were born at < 32 weeks gestation and presented BPD. 6.9% had hemodynamically significant acyanotic and non-acyanotic CHD 53.3% received three or more doses of palivizumab. The mean interval between doses was 39.6 days. 1.8% of patients were hospitalized due to a confirmed RSV infection. Overall mortality was 1.2%, whereas the mortality by RSV in infants undergoing prophylaxis was 0.2%. CONCLUSIONS: Palivizumab was a clinically effective, well-tolerated treatment in the Colombian population. The safety profile of palivizumab reflects the findings from previous studies in developed countries.

Síndrome Lucey-Driscoll - Reporte de caso / Lucey-Driscoll Syndrome - Case Report

La hiperbilirrubinemia no conjugada es una condición producida por una alteración en el proceso de conjugación y excreción de la bilirrubina. La glucoronosiltransferasa uridin difosfato es la responsable en la conjugación de la bilirrubina, es codificada por el gen de UGT1A1 localizado en el brazo q del cromosoma 2 locus 37.1. La variación genética del UGT1A1 puede producir diferentes fenotipos desde el más severo llamado Sindrome Crigler-Najjar Tipo I y II, pasando por el Sindrome de Gilbert; hasta una hiperbilirrubinemia transitoria neonatal o síndrome LUCEY-DRISCOLL (HBLRTFN) fenotipo OMIM 237900 con producción de kernicterus y parálisis cerebral pero con resolución espontánea, todos ellos de herencia autosómica recesiva causada por mutación homocigota o heterocigota en el gen UGT1A1. En este reporte se presenta un caso en un recién nacido que a los 7 días presenta hiperbilirrubinemia severa con kernicterus, y la prueba genética muestra mutación heterocigota del *28 del gen UGT1A1

Unconjugated hyperbilirubinemia is produced by alteration in conjugation and excretion process of bilirubin. Glucoronosiltransferasa Uridine diphosphate enzyme is involved in bilirubin conjugation. Is encoded by the UGT1A1 gene located in chromosome 2q locus 37.1. UGT1A1 genetic variation can produce different phenotypes Crigler-Najjar Syndrome Type I and II, Gilbert Syndrome, and hyperbilirubinemia transited familial LUCEY-DRISCOLL (HBLRTFN) syndrome with kernicterus production but with spontaneous resolution, all autosomal recessive. We present here a case of newborn 7 days old with severe hyperbilirubinemia , kernicterus, and genetic testing shows heterozygous mutation of the UGT1A1 * 28 gene

Tos ferina neonatal, una enfermedad emergente / Newborn pertussis: a re-emergent disease

La tos ferina es una enfermedad del tracto respiratorio superior que ha incrementado últimamente su incidencia. Se ha demostrado que los adultos son la principal fuente de transmisión para los niños susceptibles. En la actualidad, la enfermedad afecta con más frecuencia a los niños menores de 3 meses, entre los cuales, los menores de 1 mes tienen mayor riesgo de complicaciones y letalidad. Se presenta un caso autóctono de una recién nacida de 16 días con episodios de tos quintosa, cianosante y emetizante, cuadro hemático que evidencia leucocitosis y linfocitosis, que se originó en un área donde está implementada, como política de salud pública, la vacunación para tos ferina en niños. La paciente tuvo una evolución tórpida complicada con convulsiones y necesidad de ventilación mecánica. Se identificó en la paciente Bordetella pertussis por inmunofluorescencia, reacción en cadena de la polimerasa y cultivo. Se hace una breve revisión de la literatura, haciendo énfasis en el panorama actual de la vacunación en neonatos.

Neonatal pertussis is an upper respiratory tract infection whose incidence has recently increased. Adults have been demonstrated to be the main source for neonatal infection, accounting for the rising rates of disease in this later population group. Currently, the disease affects chiefly infants under three months of age, among which, those younger than one moth have the highest rates of complication and death. Here we present an indigenous case of a 16 days old newborn that arose in an area where pertussis vaccination during the first months of life is the rule and very few cases had been documented throughout the last years. The patient presented whooping cough with cyanosis and emesis episodes, whose complete blood count showed markedly and increasingly high leukocytosis and lymphocytosis. Her clinical course complicated with seizures and required mechanical ventilation. B. pertussis was demonstrated by means of immunofluorescence, polymerase chain reaction and culture. A brief literature review is made with emphasis on current landmarks on pertussis vaccination.