[Perinatal asphyxia and heart problems]. / Asfixia perinatal e problemas cardíacos.

PURPOSE: To evaluate the severity of cardiac complications of neonatal asphyxia in relation to the length and degree of hypoxia. METHODS: Ninety babies with an Apgar score < or = 6 were examined in the intensive care unit at our institution during seven years. Arterial blood for measuring pH, glucose, LDH and MB fraction of CK, together with serial electrocardiogram (ECG), echocardiogram and chest X rays was obtained. The fatal cases were studied with macro and microscopic examination. RESULTS: From a total of 90 cases, 73 were premature: 30 (41%) appropriate for gestation age (AGA) and 43 (59%) small for gestation age (SGA). Twenty one (23%) cases had arterial pH < 7.2. The most common clinical conditions were: pneumonia 28 (31%), anemia 24 (26%) and jaundice 12 (13%). The main cardiological findings were: systolic murmur in 46 (50%), signs of heart hypertrophy in 18 (20%) and heart failure in 8 (9%). On ECG the main findings were ST and T abnormalities. The echocardiogram showed a patent ductus arteriosus (PDA) in 20 (22%), tricuspid regurgitation in 6 (7%), pulmonary hypertension in 6 (7%), dyskinesia and ventricular dilatation in 4 (5%). Necropsy was performed in 23 cases and macro and microscopy obtained in 14; the most frequent findings were: myocite necrosis in 8 (54%), congestion, vacuolization and loss of striae in 4 (29%). CONCLUSION: In the majority of cases, patients had a benign course, even those presenting with severe acidemia. Many abnormal EKGs and echocardiograms became normal after a few weeks. Among those who had a fatal outcome, the severity of histological lesions was observed in babies who had suffered asphyxia for more prolonged periods.

[Cardiac changes in children with AIDS]. / Alterações cardíacas em crianças com SIDA.

PURPOSE: To describe the cardiac findings in children with AIDS, the follow-up with treatment and the correlation between clinical and pathological features. METHODS: We studied prospectively 25 children with clinical-laboratorial diagnosis of AIDS, ages between 3 months and 11 years, even those without cardiac symptoms. We classified the signs of AIDS following that of CDC-Atlanta 1994. Eight children died and it was done necropsy in six with macro and microscopic examinations. RESULTS: Fifteen cases had already complications of AIDS and were classified as C2 and C3, 5 as B2, 3 B1 and 2 as A1. Beside the symptoms related to the disease and infections we found signs of congestive heart failure III and IV (NYHA) in 5 children, pericardial effusion in 5, (one of them had cardiac tamponade). In the electrocardiogram (EKG), 8 children had repolarization abnormalities. In 1st echocardiogram (ECHO) we found some features of dilated myocardiopathy in 8 (6 were asymptomatic) 5 of those had pericardial effusion, one child had huge amount of pericardial liquid and also increased measures of intraventricular septum and posterior wall of left ventricle by ECHO and confirmed by necropsy examination. All cases of diagnosis of myocardiopathy received treatment with captopril and 4 also received furosemide and digoxina. Even under oral treatment three of them had deterioration of heart failure but after combined anti-retroviral drugs they showed better cardiac functions. From the six necropsied cases, two had increased heart weight without myocarditis, one had toxoplasma pancarditis and other one had fibrocalcic vasculopathy. CONCLUSION: We found several assymptomatic cases already with decreased ventricular function. Some worsened of heart failure even under apropriate treatment and showed better cardiac index after combined anti-retroviral drugs.

Síndrome da secreçäo inadequada de hormônio antidiurético em recém-nascido de alto-risco em dois anos no Hospital Universitário Antônio Pedro / Inappropriate ADH syndrome in high-risk newborn during 2 years at the Hospital Universitário Antônio Pedro, Brazil

Foram estudados 49 recém-nascidos, correspondendo a todos os casos internados na Unidade de alto risco do Berçário do HUAP, num período dfe 24 meses. Foram analisados retrospectivamente quanto ao risco de SIADH segundo um protocolo em que constavam todos os critérios clássicos para a síndrome. Com isso obteve-se ima prevalência de 6,12% para esta populaçäo e um aumento do número de casos em valores absolutos, observado o diagnóstico feito durante a internaçäo. Verificou-se por outro lado que a síndrome incidiu em pacientes prematuros, com índice de Apgar de moderado a grave no primeiro minuto, necessitando uso de respirador mecânico. Pelo fato de o percentual encontado ter sido semelhante a outras séries com etiologias diferentes, concluiu-se que a mesma näo varia sua freqüência quando se analisam recém-nascidos de alto risco

Rotavírus como agente associado a diarréia protaída em criança de baixa renda / Rotavirus as the agent associated with protacted diarrhea in chidren of cow income

Em 50 casos de lactantes com gastroenterite aguda, com gastroenterite aguda, com idade entre 11 dias e oito meses e 22 días, observaram-se que 16 (32%) foram positivos para rotavírus. Dos positivos, 12% eram crianças com diarréia protraída que, talves, tenham se infectado pelo vírus, após a internaçäo. Foram analisados o sexo, idade, aspecto nutricional, momento da positividade nas fezes, associaçäo com outros agentes, alimentaçäo e uso de medicamentos em oito pacientes da amostra