Herniación diafragmática en un recién nacido con sepsis por estreptococo «agalactiae» y distrés respiratorio / Postnatal diaphragmatic hernia in a newborn with group B streptococcal sepsis and respiratory distress

La hernia diafragmática congénita constituye una importante causa de morbimortalidad neonatal, no tanto por su incidencia (1 de cada 2.500-5.000 recién nacidos vivos), sino por su elevada mortalidad, próxima al 40-50%, según series, y pese a su correcto diagnóstico prenatal y manejo posnatal. Si bien la entidad clásica constituye un defecto diafragmático con presencia intratorácica de vísceras abdominales y un grado variable de hipoplasia pulmonar, en general, mediante el diagnóstico prenatal se han establecido otras posibilidades en su presentación, como formas más leves de diagnóstico tardío o, como en el caso que se presenta, la herniación posnatal en un recién nacido afectado por distrés respiratorio persistente y sepsis por estreptococo agalactiae. Se remarca la importancia de un alto grado de sospecha diagnóstica ante la asociación neonatal de clínica respiratoria persistente y de infección por estreptococo agalactiae

Congenital diaphragmatic hernia represents an important cause of neonatal morbidity and mortality; not for its frequency (1 in 2,500 to 5,000 live births) as much as the high mortality, nearly 40% to 50% according to different authors, despite correct prenatal diagnosis and postnatal management. The classical presentation is that of a diaphragmatic defect with herniation of abdominal organs into the thoracic cavity and varying degrees of pulmonary hypoplasia. It is usually diagnosed prenatally and symptoms generally are detected early. Nevertheless, there are milder forms with delayed diagnosis, but better prognosis. We present the case of a newborn with postnatal diaphragmatic hernia in association with persistent respiratory distress and group B streptococcal infection. We stress the importance of a high index of suspicion in a newborn with persistent respiratory symptoms and group B streptococcal sepsis

Chronic granulomatous disease: a case study of a symptomatic carrier.

An adolescent aged fifteen, with no family history of interest, presented the following cutaneous lesions from the age of two onwards: photosensitive dermatitis in the form of erythematous plaques on the face, purplish erythematous papules on fingers, scaly inflammatory plaques in the nostrils histologically compatible with discoid lupus, and frequent skin infections in the form of folliculitis, furuncles and abscesses (with positive cultures for Staphylococcus aureus) evolving slowly into cold sores in various sites. Slow, partial improvement occurred after treatment with topical corticoids and topical and oral antibiotics. Of the complementary explorations performed, general analysis, immunity and autoimmunity examinations were either negative or normal. The only notable result was the patient's inability to reduce nitroblue tetrazolium (activity 0%). The patient was diagnosed as a carrier of chronic granulomatous disease and treatment based on antibiotic prophylaxis with cotrimoxazole was initiated; skin infections were treated with antiseptic soaps. Subsequent evolution has been favourable, with the gradual resolution and granulation of old lesions and without cutaneous relapses.

[Alcoholic embryofetopathy. Neonatal case reports for the past twelve years]. / Embriofetopatía alcohólica. Casuística neonatal propia en los últimos doce años.

OBJECTIVE: Alcohol embryopathy represents an important pediatric and obstetric problem, not only for the high risk of adverse effects on the neurodevelopment of the fetus and child, but for the imperative need for detecting and preventing alcohol consumption during pregnancy. In this study the clinical manifestations of newborns with maternal antecedents of alcohol consumption are reviewed. PATIENTS AND METHODS: Our experience from 1985 to 1996 with all newborns diagnosed as "children of an alcoholic mother, without associated clinical findings or partial forms (fetal alcohol effect) or as "alcohol embryofetopathy (complete forms) is reviewed. In this study we have reviewed the obstetric and neonatal records of 33 newborns born to 33 alcohol abusers, collecting both maternal (serological tests, alcohol and other substances consumed during pregnancy) and neonatal (gestational age, birth weight, birth length, head circumference, pathology, physical anomalies, cardiovascular defects and acute withdrawal symptoms) data. RESULTS: Our findings are similar to those described in other reports as regards to the incidence (1.9/1,000 newborns) and clinical manifestations, with the exception only in the low proportion of microcephalia. In our experience, alcohol consumption in pregnancy is associated with a high risk of low birth weight (39%) and intrauterine growth retardation (21%), malformations (42%, 9% cardiopathies), prematurity (54%) and maternal drug addiction (24%, with HIV serology positive in 18%). Acute withdrawal symptoms were detected in 24% of these newborns.