Morbilidad perinatal en el desprendimiento prematuro de placenta. / Perinatal mortality in abruptio placentae

En 91 casos de desprendimiento prematuro de placenta estudiados, se encontro que la incidencia de la mortalidad perinatal es de 65.93 por ciento, porcentaje del que la mayor parte (51.65 por ciento) corresponde a muertes fetales. Hubo 14.28 por ciento de mortalidad neonatal , siendo las causas principales de muerte la insuficiencia respiratoria y las grandes malformaciones congenitas incompatibles con la vida. La mayoria de los ninos estudiados fueron prematuros (peso de 1.001 a 2.500 g y gestacion de 29 a 36 semanas) por lo que no llamo la atencion ver el gran indice de problemas respiratorios encontrados, sobre todo por la adicion del factor hipoxia a la condicion organica de prematurez. Se concluye que el mejor control de las pacientes durante el embarazo y el trabajo de parto, asi como la oportuna resolucion del mismo por via abdominal y la atencion pediatrica integral, pueden reducir notablemente el porcentaje correspondiente a mortalidad perinatal

[Diaphragmatic and Erb-Duchenne's paralysis: an infrequent obstetric trauma]. / Parálisis diafragmática y de Erb-Duchenne: un traumatismo obstétrico infrecuente.

The authors report a case of brachial paralysis and paralysis of the right hemidiaphragm which followed a favorable course. Comments are made on the symptomatology and course of the disease.

[Etiology of suppurative otitis media in pediatrics]. / Etiología de la otitis media supurada en pediatría.

A study on the etiology of bacterial infectious processes of the middle ear in children was carried out in 50 patients with ages between 3 months and 12 years at two of the children's hospitals depending from the Federal District Department. Male infants were found to be preferably affected. In 46% of cases, Staphylococcus aureus was found; also, gram-negative germs appeared in 26%. Comments are made on the possible causes of the variants this report presents in relation with the literature on the etiology of otitis media in pediatrics. Stress is placed on the necessity to support antimicrobial treatment with cultures to determine the etiology of the process.

[The potentially infected newborn infant]. / El recién nacido potencialmente infectado.

In order to establish relationship between premature rupture of membranes (RPM) and neonatal infection, together with the importance of other factors during this process, 50 newborns with history of RPM were studied. In a control group and in groups of newborns with less than and more than 24 hours of plain RPM, related to clinically healthy and vigorous infants, no case of infection was found. On the other hand, 30% and 60% respectively of infections were found in groups less than and more than 24 hours of RPM, but with the presence of other contaminating factors that impair immunological response of the newborn, such as: acute maternal infection, prolonged delivery, unexpected birth, pediatric reanimation procedures, organic immaturity, fetal suffering, immediatie neonatal depression and intercurrent pathology. There were two deaths: a case with RPM of 5 hours and another one with 38 hours, but both with high rating due to the presence and intensity of "aggravating factors" mentioned having internal action mechanism that apparently of restrains to the perpetuation of the hypoxia-acidosis cycle. A provisional sheet is presented to evaluate such "aggravating factors" considering that an RPM associated to them represents a high risk of neonatal infection. In cases of clinically healthy newborns with plain RPM, we advice only to watch over them for 3--5 day, but no antimicrobial treatment at all.

[Electrocardiographic disorders during sanguinotransfusion]. / Trastornos electrocardiográficos durante la exanguinotransfusión.

Electrocardiographic findings are analyzed out of a total of 80 exanguinotransfusion done in 70 newborns complaining of hyperbilirubinemia due to isoimmunization to Rh factor, to blood group, to subgroup and to liver enzymatic immaturity. Twenty-six of these babies showed subnormal weights. The technique used was especially that of closed circuit with two vessels and continuous droping. Seventeen patients with concomitant respiratory insuficiency were exanguinated. Electrocardiographic disorders were found in 70% with predominance of hypocalcemia --19 cases--and tachycardia in 9 cases. There were no cases of true hyperkalemia, even in the group of patients who were given blood of over three days of extraction. There were 5 cases of hypokalemia; another 5 with overload in right cavities as possible response to hypervolemia. Disorders of rhythm, bradycardia, ischemia lesions and A-V blockage were present as features of poor prognosis in the only two patients who died in one of whom hyperkalemia and in the other one, hypokalemia were identified. Stress is placed on the greater number of disorders present in the group of infants with subnormal weights, as in those affected with added respiratory insufficiencies or with severe hemolytic diseases.

[Electrocardiography and central venous pressure during exchange transfusion]. / Electrocardiografía y presión venosa central durante la exsanguinotransfusión

Electrocardiographic and central venous pressure (CVP) records were taken during 30 exchange transfusions practiced to 26 newborns. The technique of two vessels was employed in 26 cases. Operations lasted 84.8 minutes as an average. There was only one death and the transfusion was discontinued in another case because of clinical aggravation and many disorders in the ECG. These disorders reached 40% of the cases with marked predominance of hypocalcemia which appeared as "initial" in three babies with previous history of transfusion. CVP was usually higher than reported for normal newborns and was equal to values found in a similar group of isoimmuned infants. It was high in seven cases, out of which, four complained of severe hemolytic disease and obviously, of anemia. Initial removal of 10 to 20 ml. of blood in these cases, allowed a drop of 3 to 4 cm. of H2O in CVP and its further maintenance at stable levels.