RESUMO Objetivo: Verificar a utilização e identificar as vantagens dos métodos moleculares para diagnóstico de infecções congênitas no líquido cefalorraquidiano de neonatos. Fontes de dados: A revisão foi registrada na base PROSPERO (International Prospective Register of Systematic Reviews) sob CRD42021274210. A busca bibliográfica foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde/ Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BVS/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, e EBSCOhost. A busca foi feita no período de agosto a outubro de 2021 e atualizada em dezembro de 2022, respeitando as orientações do Preferred Reporting Items for Systematic Reviews e Meta-Analyises (PRISMA). A sequência da seleção dos estudos foi: 1) Remoção de duplicatas; 2) Exame de títulos e resumos; 3) Recuperação dos textos completos potencialmente relevantes; e 4) Avaliação do texto completo conforme critérios de elegibilidade por dois autores independentes. O critério de inclusão considerou ensaios clínicos randomizados e não randomizados, estudos longitudinais, transversais, revisados por pares, estudos em humanos, publicados em inglês, espanhol, italiano e português, com recém-nascidos de até 28 dias que sofreram neuroinfecções congênitas pelos agentes toxoplasmose, rubéola, citomegalovírus, herpes simples (TORCH), e outros como Treponema pallidum, Zika, parvovírus B-19, varicela zoster, Epstein-Barr, e SARS-CoV-2, diagnosticadas por reação em cadeia de polimerase (PCR). Dois avaliadores extraíram as seguintes informações: autor, ano de publicação, nacionalidade, sujeitos, tipo de estudo, métodos, resultados e conclusão. Síntese dos dados: O patógeno mais estudado foi Herpes Simples. Muitos artigos relataram somente sintomas iniciais inespecíficos, motivando a coleta de líquido cefalorraquidiano e realização da PCR para investigação etiológica. Conclusões: Os métodos moleculares são eficazes para detectar o genoma do patógeno no líquido cefalorraquidiano, o que pode impactar na evolução clínica e no prognóstico neurológico. Objetivo neonatos International CRD42021274210 CRD PubMed LatinoAmericano Latino Americano BVS/BIREME, BVSBIREME BVS/BIREME , BVS BIREME (BVS/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyises Meta Analyises PRISMA. PRISMA . (PRISMA) 1 duplicatas 2 resumos 3 relevantes 4 independentes longitudinais transversais pares humanos inglês espanhol português recémnascidos recém nascidos toxoplasmose rubéola citomegalovírus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV 2, SARS-CoV-2 PCR. (PCR) informações autor publicação nacionalidade sujeitos estudo conclusão Simples inespecíficos etiológica Conclusões neurológico CRD4202127421 (BVS/BIREME (EMBASE 20 (PRISMA (TORCH B1 B-1 SARS-CoV- (PCR CRD420212742 B- SARS-CoV CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

ABSTRACT Objective: To verify the use and identify advantages of molecular methods for congenital infections diagnosis in cerebrospinal fluid of neonates. Data source: The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under CRD42021274210. The literature search was performed in databases: PubMed, Virtual Health Library/ Latin American and Caribbean Center on Health Sciences Information (VHL/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, and EBSCOhost. The search was carried out from August to October 2021 and updated in December 2022, respecting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The selection sequence was: 1) Duplicate title removal; 2) Examination of titles and abstracts; 3) Full-text retrieval of potentially relevant reports; and 4) Evaluation of the full text according to eligibility criteria by two independent authors. Inclusion criteria considered randomized and non-randomized control trials, longitudinal, cross-sectional, and peer-reviewed studies in humans, published in English, Spanish, Italian, and Portuguese, with newborns up to 28 days old who had congenital neuroinfections by toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH), and others such as Treponema pallidum, Zika, parvovirus B-19, varicella zoster, Epstein-Barr, and SARS-CoV2, diagnosed by polymerase chain reaction (PCR). Two evaluators extracted the following information: author, year of publication, nationality, subjects, study type, methods, results, and conclusion. Data synthesis: The most studied pathogen was herpes simplex. Several articles reported only nonspecific initial symptoms, motivating the collection of cerebrospinal fluid and performing PCR for etiological investigation. Conclusions: Molecular methods are effective to detect pathogen genomes in cerebrospinal fluid, which can impact clinical evolution and neurological prognosis. Objective neonates source PROSPERO, PROSPERO , (PROSPERO) CRD42021274210 CRD databases PubMed Library VHL/BIREME, VHLBIREME VHL/BIREME VHL BIREME (VHL/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyses Meta Analyses PRISMA (PRISMA guidelines 1 removal 2 abstracts 3 Fulltext Full reports 4 authors nonrandomized non trials longitudinal crosssectional, crosssectional cross sectional, sectional cross-sectional peerreviewed peer reviewed humans English Spanish Italian Portuguese toxoplasmosis rubella cytomegalovirus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV2, CoV2 CoV SARS-CoV2 PCR. . (PCR) information author publication nationality subjects type results conclusion synthesis symptoms investigation Conclusions prognosis (PROSPERO CRD4202127421 (VHL/BIREME (EMBASE 20 (TORCH B1 B-1 SARS-CoV (PCR CRD420212742 B- CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

Abstract Objective To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. Method Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson's correlation. The study considered a significance level of 0.05. Results There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. Conclusion Serial measurements of head circumference provide knowledge of the trajectory of growth, with early catch-up between discharge and 1 month, as well as its association with neurodevelopment. Head circumference is therefore a valuable clinical marker for neurodevelopment, especially in very preterm newborns. neurodevelopment cognitive years 9 3 150 g excluded termequivalent term equivalent 12 2 BayleyIII III (Bayley-III 8 mildmoderate mild moderate 7 Pearsons Pearson s 005 0 05 0.05 0.18 018 -0.1 catchup catch up an 081 81 0.8 score. . score) 15 00 0.0 0.1 01 -0. 08 0. -0 -

Abstract Background: Patent Ductus Arteriosus (PDA) is the most common congenital heart disease, particularly prevalent among preterm newborns (PTNB) and those with low birth weight. Surgical closure is traditionally considered after the failure of pharmacological treatment. The aim was to analyze the immediate and long-term outcomes of surgical PDA closure in PTNB. Methods: This analytical study evaluated PTNB who underwent PDA surgery between January 2002 and December 2023 at the Hospital Clínico Regional “Dr. Guillermo Grant Benavente” in Concepción, Chile. The databases were reviewed with prior approval from the Ethical-Scientific Committee. PTNB were defined as those with a gestational age (GA) of less than 37 weeks. Data analysis was performed using SPSS® v29, and survival rates were graphed using the Kaplan-Meier method. Results: Since 1993, a total of 263 cases have been recorded in the PDA protocol registry. During the study period, 167 cases were identified, of which 131 (78.3%) were PTNB. Among them, 65 (49.6%) were male. The average GA was 26.4±2.3 weeks and the average birth weight was 900±348 grams. Pharmacological treatment failed in all cases included. At the time of surgery, the average age was 35.0±43.2 days, and the average weight was 1,443±1,716 grams. A left posterolateral thoracotomy with an extrapleural approach and primary closure with clips was performed. Immediate complications included post-ligation syndrome in 42 (32.1%) cases and atelectasis in 14 (10.7%) cases. There was no intraoperative mortality. The 30-day mortality rate was 15 (11.5%) cases. The 10-year survival rate was 82.4%. Conclusion: Clipping is the preferred technique at our center and has shown results comparable to other series. Mortality was mainly due to medical comorbidities such as sepsis and respiratory tract immaturity.

Resumen Antecedentes: El Ductus Arterioso Persistente (DAP) es la cardiopatía congénita más frecuente. Es más prevalente en recién nacidos de pretérmino (RNPT) y bajo peso al nacer. El cierre quirúrgico está indicado tradicionalmente tras el fracaso del cierre farmacológico. El objetivo es analizar los resultados inmediatos y alejados del cierre quirúrgico del DAP en RNPT. Métodos: Estudio analítico de RNPT operados por DAP en el período desde enero-2002 y diciembre-2023 en el Hospital Clínico Regional “Dr. Guillermo Grant Benavente”, Concepción-Chile. Se revisaron bases de datos previa aprobación de Comité Ético-Científico. Se consideró RNPT <37 semanas de edad gestacional (EG). Se utilizó SPSS® v29, se graficó supervivencia mediante método de KaplanMeier. Resultados: En el período de análisis hubo 167 casos, de es de los cuales 131 (78,3%) eran RNPT. Fueron hombres 65 (49,6%) y la edad gestacional (EG) promedio fue 26,4±2,3 semanas, con peso al nacer de 900±348 gramos. Todos los casos tuvieron tratamiento farmacológico previo. Al momento de la cirugía, la edad promedio era 35,0±43,2 días y el peso promedio 1.443±1.716 gramos. Se realizó una toracotomía posterolateral izquierda, con abordaje extrapleural y cierre principalmente mediante clipaje. Las complicaciones inmediatas fueron: síndrome post ligadura en 42 (32,1%) y atelectasia en 14 (10,7%). No hubo mortalidad intraoperatoria. A 30 días post cirugía fallecieron 15 casos, (11,5%) La supervivencia a 10 años fue 82,4%. Conclusiones: El cierre mediante clipaje es la técnica de elección en nuestro centro y demostró resultados comparables a diferentes series incluidas en la discusión. La mortalidad fue debida principalmente a comorbilidades médicas como sepsis e inmadurez del tracto respiratorio.

Abstract Objective: Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed. The objective of this study was to analyze the clinical characteristics of newborns and infants with osteomyelitis and septic arthritis to improve understanding of the disorder and to assist clinicians with diagnosis. Methods: A retrospective multicenter study was conducted on neonates (0-28 days old, n = 94) and infants (1–12 months old, n = 415) with osteoarticular infections. Data consisting of clinical characteristics, complications, laboratory outcomes, and the pathogenic microorganisms causing osteomyelitis were tabulated. The statistics were further broken down into two regions and the significant differences between neonates and infants were evaluated and compared to the literature. Results: Compared to infants, neonates had significantly lower incidences of fever (p < 0.0001), higher incidences of localized swelling (p = 0.0021), higher rate of infection at the humerus (p = 0.0016), higher percentage of Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p = 0.0039) infections, lower percentage of Staphylococcus aureus infections (p < 0.0001) and were more likely to develop septic arthritis (p < 0.0001). Conclusion: Distinct differences were found between neonatal and infants with osteoarticular infections. Future studies should focus on improving diagnosis and subsequent treatment regimens for younger age groups. Objective earlystage early stage unnoticed Methods 028 0 28 (0-2 old 94 1–12 112 1 12 (1–1 415 complications outcomes tabulated literature Results p 0.0001, 00001 0.0001 , 0001 0.0021, 00021 0.0021 0021 0.0021) 0.0016, 00016 0.0016 0016 0.0016) 0.0039 00039 0039 0.0001. . Conclusion groups 02 2 (0- 9 1–1 11 (1– 41 0000 0.000 000 0002 0.002 002 0.001 001 0.003 0003 003 (0 1– (1 4 0.00 00 ( 0.0 0.

Abstract: High-frequency oscillatory ventilation with volume guarantee (HFOV-VG) is a ventilatory mode that controls small tidal volumes at supraphysiological frequencies, potentially beneficial for preterm infants with respiratory distress syndrome (RDS). Objective: To identify the physiological and clinical effects of HFOV-VG in preterm newborns with RDS, compared with conventional HFOV. Method: Exploratory review of studies published between 2019 and 2023 of preterm newborns from 23 to 36 weeks of gestation with RDS, weighing ≥ 450g, with invasive HFOV support, using PRISMA flow diagram. For their critical evaluation, the MINORS and PEDro scales were used. Results: 1,386 articles were initially identified, of which 7 articles were selected. Compared with conventional HFOV, the use of lower tidal volumes (VThf) and higher respiratory rate stands out, as well as better and more stable gas exchange, both as an elective or early rescue strategy in preterm newborns with RDS. Furthermore, an inverse relationship is observed between VThf and respiratory rate. Conclusion: HFOV-VG, used in preterm neonates with RDS, consistently improves oxygenation and ventilation compared with conventional HFOV. Control and reduction of VThf could provide additional lung protection.

Resumen: La ventilación de alta frecuencia (VAF) con volumen garantizado es un modo ventilatorio que controla pequeños volúmenes corriente a frecuencias suprafisiológicas, potencialmente beneficioso para prematuros con síndrome de dificultad respiratoria (SDR). Objetivo: Identificar los efectos fisiológicos y clínicos de la VAF con volumen garantizado en recién nacidos pretérmino con SDR, en comparación con VAF convencional. Método: Revisión exploratoria de estudios publicados entre 2019 y 2023, de recién nacidos prematuros de 23 a 36 semanas de gestación con SDR, con un peso ≥ 450 g soportados con VAF invasiva, utilizando diagrama de flujo PRISMA. Para su evaluación crítica se utilizaron las escalas MINORS y PEDro. Resultados: Se identificaron inicialmente 1,386 artículos, de los cuales se seleccionaron 7 artículos. En comparación con VAF convencional destaca el uso de menores volúmenes corriente (VThf) y mayores frecuencias respiratorias, un intercambio de gases mejor y más estable, tanto como estrategia electiva o de rescate temprano en recién nacidos prematuros con SDR. Además se observa una relación inversa entre VThf y frecuencia respiratoria. Conclusión: La VAF con volumen garantizado, aplicada en recién nacidos prematuros con SDR, consistentemente mejora la oxigenación y ventilación en comparación con la VAF convencional. El control y la reducción de VThf pudiera proporcionar una protección pulmonar adicional.

ABSTRACT: This study determined the zootechnical, metabolic, and health performance of Girolando calves born with high or low birth weight, conceived through in vitro fertilization. The study was carried out on a commercial dairy farm located in Passos, Minas Gerais, Brazil. For this, a hundred Girolando calves were divided into two groups: The Control, which consisted of calves that were born weighing ≤ 35 kg; and high birth weight (HBW) calves, which were born weighing > 35 kg. The calves were monitored for zootechnical parameters; epidemiological indices, for diseases such diarrhea and pneumonia; as well as serum concentrations of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, cholesterol, triglycerides, paraoxonase1, albumin, urea, and globulin. Calves from the HBW group had a higher general mortality rate, but no effects on the zootechnical performance or metabolism were observed. The results obtained allow us to conclude that Girolando calves generated by IVF and heavier at birth have a greater chance to present diseases such as omphalophlebitis, tympany, and bovine parasitic sadness, and have a higher rate of general mortality. Conversely, birth weight of the calves does not influence diarrhea or pneumonia, the zootechnical performance, or the metabolism. ABSTRACT metabolic fertilization Passos Gerais Brazil this groups Control 3 kg (HBW parameters indices pneumonia aminotransferase phosphatase gammaglutamyl gamma glutamyl transferase cholesterol triglycerides paraoxonase1 paraoxonase albumin urea globulin observed omphalophlebitis tympany sadness Conversely

RESUMO: Este estudo determinou o desempenho zootécnico, metabólico e saúde de bezerras Girolando nascidas com alto ou baixo peso, concebidas por fertilização in vitro. O estudo foi realizado em uma fazenda leiteira comercial localizada em Passos, Minas Gerais, Brasil. Cem bezerras Girolando foram divididas em dois grupos: Controle, que consistiu em bezerras que nasceram com peso ≤ 35 kg; e HBW, bezerras que nasceram com peso > 35 kg. As bezerras foram monitoradas quanto aos parâmetros zootécnicos; índices epidemiológicos para doenças como diarreia e pneumonia; bem como as concentrações séricas de aspartato aminotransferase, alanina aminotransferase, fosfatase alcalina, gama-glutamil transferase, colesterol, triglicérides, paraoxonase1, albumina, uréia e globulina. As bezerras do grupo HBW apresentaram maior taxa de mortalidade, mas nenhum efeito no desempenho zootécnico ou metabolismo foram observados. Os resultados permitem concluir que bezerras Girolando provenientes de FIV que nascem mais pesadas têm maior chance de apresentar doenças, como onfaloflebite, timpanismo e tristeza parasitária bovina, tendo uma maior taxa de mortalidade geral. Porém, o peso ao nascimento das bezerras não influenciou a ocorrência de diarreia ou broncopneumonia, o desempenho zootécnico e o perfil metabólico. RESUMO vitro Passos Gerais Brasil grupos Controle 3 kg zootécnicos pneumonia aminotransferase alcalina gamaglutamil gama glutamil transferase colesterol triglicérides paraoxonase1 paraoxonase albumina globulina observados onfaloflebite bovina geral Porém broncopneumonia

Abstract Objectives: Fungal infections (FI) pose a public health concern and significantly increase mortality rates, especially within Neonatal Intensive Care Units (NICU). Thus, this study aimed to investigate epidemiological indicators, risk factors, and lethality predictors associated with FI in a NICU. Methods: This study included 1,510 neonates admitted to the NICU of a reference hospital in Brazil between 2015 and 2022. Demographic data, such as sex, birth weight, gestational age, and use of invasive devices were analyzed. Results: Thirty neonates developed invasive FI, totaling 33 episodes and an incidence of 1.2 per 1,000 patient days. Candida albicans was the most frequent species (52.9 %), the bloodstream was the most affected site (78.9 %), and 72.7 % of infections occurred between 2015 and 2018. The lethality rate associated with FI was 33.3 %, and 90 % of deaths occurred within 30 days of diagnosis of infection. Weight < 750 g, prolonged hospital stay, use of parenteral nutrition, and broad-spectrum antimicrobials were independent risk factors for infection occurrence, especially glycopeptides and 4th generation cephalosporins, having a considerable role in the increase in fungal infections. Weight < 750 g was considered a significant predictor of lethality, and C. albicans had the highest lethality rate (40 %). Conclusion: These findings highlight the elevated lethality rate associated with these infections, reinforcing the importance of developing strategies to control FI within NICU. Objectives (FI rates . (NICU) Thus indicators Methods 1510 1 510 1,51 201 2022 data sex weight age analyzed Results 3 12 2 1. 1000 000 1,00 52.9 529 52 9 (52. , %) 78.9 789 78 (78. 727 72 7 72. 2018 333 33. 75 stay nutrition broadspectrum broad spectrum occurrence th cephalosporins C 40 (4 %. Conclusion (NICU 151 51 1,5 20 202 100 00 1,0 52. 5 (52 78. (78 4 ( 15 1, 10 0 (5 (7

Abstract: Some systemic inflammatory indices have been reported to be associated with intracerebral hemorrhage in adults. However, the relationship between systemic inflammatory indices and intraventricular hemorrhage (IVH) in premature neonates is still not completely understood. Objective: To evaluate the relationship between systemic inflammatory indices obtained on the first day of life in premature infants and the development of severe IVH. Patients and Method: Premature newborns < 32 weeks of gestational age were included. Eligible patients were divided into 2 groups: Group 1: without IVH or grade I and II hemorrhage, and Group 2: grade III and IV HIV. Demographic characteristics, clinical outcomes, monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), pan-immune inflammation value (PIV), and Systemic inflammation response index (SIRI) were compared between groups. Results: A total of 1176 newborns were included in the study, 1074 in Group 1 and 102 premature babies in Group 2. There was no difference between the groups in terms of the count of leukocytes, neutrophils, monocytes, lymphocytes and platelets (p > 0.05). The values of NLR, MLR, PLR, PIV, SII and SIRI were similar in both groups (p > 0.05). Conclusion: While the relationship between inflammation, hemodynamics and IVH is still under discussion, our results show that systemic inflammatory indices have no predictive value for IVH.

Abstract: Congenital Central Hypoventilation Syndrome (CCHS) is a rare genetic condition affecting the autonomic nervous system and respiratory center due to mutations in the PHOX2B gene, and it is associated with alveolar hypoventilation during sleep and sudden death. It requires early invasive mechanical ventilation (IMV). Objective: To report a neonatal case successfully treated with non-invasive ventilatory support (NVS), avoiding tracheostomy. Clinical Case: Full-term newborn, whose mother uses nocturnal NVS due to CCHS. During the transition period, she presented desaturations associated with hypercapnia and respiratory acidosis, without pulmonary involvement. She developed severe hypoventilation during sleep, with no respiratory effort, peripheral oxygen saturation (SpO2) < 80%, plus respiratory acidosis. While awake, she had good respiratory effort and normal SpO2 without assistance. Noninvasive continuous positive airway pressure and oxygen therapy worsened her condition while sleeping. Complete NVS with nasal interface and bi-level airway positive pressure, inspiratory/expiratory pressure 14-16/4 cm H2O, normalized SpO2 during sleep, and arterial blood gases while awake. Sequencing of the PHOX2B gene confirmed the presence of a heterozygous pathogenic variant with the 20/26 genotype. At 2 months of age, she was discharged maintaining NVS with nasal interface and 0 PEEP, achieving adequate neurodevelopment. Conclusion: We highlight the importance of genetic diagnosis of CCHS in neonates with clinical presentation of early alveolar hypoventilation, especially if there is a family history. We are not aware of other reports of neonatal onset in which NVS prevents IMV, in this potentially lethal pathology.

Resumen: El Síndrome de Hipoventilación Central Congénito (SHCC) es una condición genética infrecuente que afecta el sistema nervioso autónomo y centro respiratorio por mutaciones en el gen PHOX2B, se asocia a hipoventilación alveolar durante el sueño y muerte súbita. Requiere tempranamente de ventilación mecánica invasiva (VMI). Objetivo: Reportar un caso neonatal tratado exitosamente con soporte ventilatorio no invasivo (SVNI), evitando la traqueostomía. Caso Clínico: Recién nacido de término, cuya madre utiliza SVNI nocturno por SHCC. Durante el periodo de transición presentó desaturaciones asociadas a hipercapnia y acidosis respiratoria, sin compromiso pulmonar. Evolucionó con hipoventilación severa durante el sueño, sin esfuerzo respiratorio, saturación periférica de oxígeno (SpO2) < 80%, más acidosis respiratoria. En vigilia presentaba buen esfuerzo respiratorio y SpO2 normales sin asistencia. La presión positiva continua no invasiva en la vía aérea y la oxigenoterapia empeoraban su condición al dormir. El SVNI completo con interfaz nasal y presión positiva en 2 niveles, presión inspiratoria/espiratoria 14-16/4 cm H2O, normalizaron la SpO2 durante el sueño y los gases en sangre arterial en vigilia. La secuenciación del gen PHOX2B confirmó la presencia de una variante patogénica heterocigota con el genotipo 20/26. A los 2 meses de vida egresó manteniendo SVNI con interfaz nasal y PEEP 0, logrando neurodesarrollo adecuado. Conclusión: Resaltamos la importancia del diagnóstico genético del SHCC, en neonatos con presentación clínica de hipoventilación alveolar temprana, particularmente si existe el antecedente familiar. No conocemos otros reportes de debut neonatal en que el SVNI evite la VMI, en esta patología potencialmente letal.

BACKGROUND. Hypoxic-ischaemic encephalopathy (HIE) remains a leading cause of death and disability in term neonates despite therapeutic hypothermia. Hyperglycaemia in the first 12 hours of life is associated with poor outcomes in some studies. This relationship has not yet been explored in South African (SA) cohorts. OBJECTIVE. To describe the association between hyperglycaemia (in the first 12 hours of life) and poor outcome, which was defined as death or a severely abnormal amplitude-integrated electroencephalogram (aEEG) at 48 hours, in neonates with moderate-to-severe HIE who were treated with hypothermia at an SA tertiary hospital. METHODS. Folders from a database of 57 neonates with moderate-to-severe HIE treated with hypothermia between January 2011 and December 2012, were reviewed to obtain glycaemic profiles. Maternal and neonatal characteristics and outcomes were extracted from the database. RESULTS. Only 47 neonates had adequate glucose and aEEG data. Seventeen neonates (36%) had hyperglycaemia (>8.3 mmol/L), 25 (53%) were normoglycaemic and 5 neonates (10%) were hypoglycaemic (<2.3 mmol/L). Hyperglycaemia was only associated with death or severely abnormal aEEG at a glucose value >25.6 mmol/L. Hyperglycaemia was significantly associated with a low 5-minute Apgar score (p=0.007), severely abnormal aEEG at 6 hours (p=0.029), and a higher HIE score at 6 hours (p=0.002). Hyperglycaemia was associated with death (odds ratio 10; 95% confidence interval 1 - 96; p=0.045), but the association was not independent of the 5-minute Apgar score. CONCLUSION. Early hyperglycaemia in neonates with moderate-to-severe HIE was associated with disease severity at birth and death despite cooling.

Abstract Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction which is characterized by compression of the duodenum due to narrowing of the space between the superior mesenteric artery and aorta. Incomplete duodenal obstruction due to SMAS in neonates is rarely reported in the literature. In this case, it is a full-term 2-day-old male with the complaint of recurrent vomiting starting soon after birth. The patient was diagnosed with SMAS and duodenoduodenostomy was performed. Accompanying Meckel’s diverticulum was excised.

Resumen El síndrome de la arteria mesentérica superior (SMAS) es una causa rara de obstrucción duodenal que se caracteriza por la compresión del duodeno debido al estrechamiento del espacio entre la arteria mesentérica superior y la aorta. La obstrucción duodenal incompleta por SMAS en recién nacidos rara vez se informa en la literatura. En este caso se trata de un varón de 2 días nacido a término que presenta vómitos recurrentes desde poco después del nacimiento. El paciente fue diagnosticado de SMAS y se le realizó duodenoduodenostomía. Se extirpó el divertículo de Meckel que lo acompañaba.

ABSTRACT Foundation: atherosclerosis is a disease of multifactorial origin that is aggravated as a result of an adverse environment and unhealthy lifestyles. Evidence confirms its onset from the earliest stages of life. Objective: to describe the presence of early atherosclerotic lesions in the aortas of deceased fetuses and neonates born to hypertensive mothers. Method: a descriptive cross-sectional study was carried out that included fetuses older than 22 weeks and deceased neonates born to hypertensive mothers, who underwent autopsy in the pathological anatomy department of the Eusebio Hernández Pérez Gynecobstetric University Hospital, in the period between January 2021 and December 2022, with a total of 18. The following data were collected in the medical records: sex of the deceased, gestational age at the time of delivery, postpartum weight, maternal age, and history of arterial hypertension (chronic or gestational). The 18 aortas (thoracic and abdominal) of the selected deceased were analyzed. Results: of the total number of deceased studied, 70.6 % presented early atherosclerotic lesions, characterized by thickening of the intima as a cushion, presence of lymphocytes in the intima or in the arterial wall close to it and/or macrophages. In some cases, one of these histological variants was observed and in others a combination of two or three. Conclusions: early atherosclerotic lesions are present in the aortas of the majority of the fetuses and neonates studied, with a predominance in those with gestational hypertension.

RESUMEN Fundamento: la aterosclerosis es una enfermedad de origen multifactorial que se agrava a consecuencia de un medio ambiente adverso y de estilos de vida no saludables. Las evidencias confirman su inicio desde las etapas más tempranas de la vida. Objetivo: describir la presencia de lesiones ateroscleróticas tempranas en las aortas de fetos y neonatos fallecidos hijos de madres hipertensas. Método: se realizó un estudio descriptivo de tipo transversal que incluyó a los fetos mayores de 22 semanas y neonatos fallecidos hijos de madres hipertensas, a quienes se les realizó autopsia en el departamento de anatomía patológica, del Hospital Universitario Ginecobstétrico Eusebio Hernández Pérez, en el período comprendido entre enero del 2021 hasta diciembre 2022, con un total de 18. Se recogieron los siguientes datos en las historias clínicas: sexo del fallecido, edad gestacional en el momento del parto, peso postparto, edad materna y antecedentes de hipertensión arterial (crónica o gestacional). Se analizaron las 18 aortas (torácicas y abdominales) de los fallecidos seleccionados. Resultados: del total de fallecidos estudiados el 70,6 % presentó lesiones ateroscleróticas tempranas, caracterizadas por engrosamiento de la íntima a modo de cojinete, presencia de linfocitos en la íntima o en la pared arterial cercana a ella y/o macrófagos. En algunos casos se observó una de estas variantes histológicas y en otros la combinación de dos o tres. Conclusiones: las lesiones ateroscleróticas tempranas están presentes en las aortas de la mayoría de los fetos y neonatos estudiados, con predominio en las que presentaban hipertensión gestacional.

Abstract Objective: Studies focusing on bone and joint infections (BJIs) in young infants are rare. Some cases of BJI are accompanied by sepsis. This study aimed to identify the clinical and bacteriological features of sepsis in neonates and young infants with BJIs. Methods: Neonates and infants younger than 3 months diagnosed with BJI in the present institution from 2014 to 2021 were retrospectively reviewed. Patient characteristics, clinical data, and outcomes were documented and compared between those with and without sepsis. Results: Twenty-five patients with a mean age of 34.8 days were included. Nine BJI cases had concomitant sepsis (group A), and 16 had BJI without sepsis (group B). Within group A, staphylococcus aureus was the major pathogenic germ (5 cases, of which 4 were of the methicillin-resistant staphylococcus aureus (MRSA) type). There was no statistical difference in male-to-female ratio, age, history of hospitalization, anemia, birth asphyxia, peripheral leukocyte counts, C-reactive protein on admission, and sequelae between groups. Univariate analyses indicated a significant difference in the incidence of septic arthritis (SA) combined with osteomyelitis (OM) (88.9% vs 37.5%), congenital deformities (44.4% vs 0%), and mean duration of symptoms (2.83 days vs 9.21 days) in comparisons between groups A and B. Conclusion: Staphylococcus aureus is the main pathogenic bacteria in BJI cases complicated with sepsis in neonates and young infants. Among infants younger than 3 months diagnosed with BJI, those with concurrent SA and OM, MRSA infection, or congenital deformities are more likely to develop sepsis. Objective BJIs (BJIs rare Methods 201 202 reviewed characteristics data Results Twentyfive Twenty five 348 34 8 34. included , A) 1 B . B) 5 ( methicillinresistant methicillin resistant (MRSA type. type type) maletofemale male female ratio hospitalization anemia asphyxia counts Creactive C reactive admission (SA OM (OM 88.9% 889 88 9 (88.9 37.5%, 375 37.5% 37 37.5%) 44.4% 444 44 (44.4 0%, 0 0% 0%) 2.83 283 2 83 (2.8 921 21 9.2 Conclusion infection 20 88.9 (88. 37.5 44.4 (44. 2.8 28 (2. 92 9. 88. (88 37. 44. (44 2. (2 (8 (4

Abstract Objective: Congenital hyperinsulinism (CHI) is a heterogeneous genetic disease characterized by increased insulin secretion and causes persistent hypoglycemia in neonates and infants due to dysregulation of insulin secretion by pancreatic β cells. Babies with severe hypoglycemia and for whom medical treatment has been ineffective usually require surgical treatment with near-total pancreatectomy. To evaluate the clinical and surgical aspects affecting survival outcomes in babies diagnosed with CHI in a single tertiary care center. Methods: Retrospective Cohort study involving a single university tertiary center for the treatment of CHI. The authors study the demographics, clinical, laboratory, and surgical outcomes of this casuistic. Results: 61 % were female, 39 % male, Birth weight: 3576 g (±313); Age of onset of symptoms: from the 2nd hour of life to 28 days; Time between diagnosis and surgery ranged between 10 and 60 days; Medical clinical treatment, all patients received glucose solution with a continuous glucose infusion and diazoxide. 81 % of the patients used corticosteroids, 77 %. thiazide, 72 % octreotide, 27 % nifedipine; Neurological sequelae during development and growth: 54 % had some degree of delay in neuropsychomotor development, 27 % obesity. Surgery was performed open in 6 and 12 minimally invasive surgery (MIS). Histopathology: 2 focal and 16 diffuse, Length of stay (days) was lower in MIS (p < 0.05). Survival was 100 %. Conclusions: CHI is a rare and difficult-to-manage tumor that must be performed in a multidisciplinary and tertiary center. Most surgical results are good and the laparoscopic approach to disease has been the best choice for patients. Objective (CHI cells neartotal near total pancreatectomy Methods demographics laboratory casuistic Results female 3 male weight 357 ±313 313 (±313) symptoms nd days 1 diazoxide 8 corticosteroids 7 thiazide octreotide nifedipine growth 5 obesity MIS. . (MIS) Histopathology diffuse (days p 0.05. 005 0.05 0 05 0.05) Conclusions difficulttomanage difficult manage 35 ±31 31 (±313 (MIS 00 0.0 ±3 (±31 0. ± (±3 (± (

RESUMEN Objetivo: Estimar la frecuencia de la hemorragia intraventricular y los factores asociados en neonatos pretérmino hospitalizados en una unidad de cuidado intensivo neonatal de alta complejidad. Metodología: Estudio de cohorte, en el que se incluyeron neonatos menores de 37 semanas de gestación, atendidos en una institución de alta complejidad, entre enero de 2015 hasta diciembre de 2018; se valoró el desarrollo de hemorragia intraventricular diagnosticada por métodos de imagen. Los datos se obtuvieron a partir de la revisión de las historias clínicas electrónicas y se analizaron variables sociodemográficas y clínicas. Resultados: Se incluyeron 296 pacientes, 128 (43,2%) eran mujeres; 23 pacientes (7,8%) desarrollaron hemorragia intraventricular, la cual predominó en el sexo femenino (11,7%). La mediana de edad gestacional fue de 34 semanas. Los factores asociados al desarrollo de hemorragia intraventricular fueron el peso al nacer por debajo de 1500 gr, las infecciones (p<0,0001), los cuadros de apneas (<0,0001), la hiperglicemia (p = 0,025) y la necesidad de surfactante (p= 0,019); por su parte, los esteroides prenatales se comportaron como un factor protector (p=0,002). Los pacientes con hemorragia intraventricular tuvieron mayor necesidad de ventilación mecánica, mayor uso de inotrópicos o vasopresores, más transfusiones y mayor estancia hospitalaria. Conclusiones: A pesar de que la hemorragia intraventricular resultó ser una patología poco frecuente en la población de neonatos analizada, existen factores de riesgo que se relacionan con su desarrollo, como la edad gestacional, el bajo peso al nacer, las infecciones, las apneas y la hiperglicemia.

ABSTRACT Objective: Estimate the frequency of intraventricular hemorrhage and associated factors in hospitalized preterm infants in a highly complex neonatal intensive care unit. Methodology: Cohort study, which included neonates younger than 37 weeks gestation, attended in a highly complex institution, between January 2015 and December 2018; The development of intraventricular hemorrhage diagnosed by imaging methods was assessed. The data was obtained from the review of the electronic medical records and sociodemographic and clinical variables were analyzed. Results: 296 patients were included, 128 (43.2%) were women; 23 patients (7.8%) developed intraventricular hemorrhage, which predominated in the female sex (11.7%). The median gestational age was 34 weeks. The factors associated with the development of intraventricular hemorrhage were birth weight below 1500 gr, infections (p <0.0001), apnea symptoms (<0.0001), hyperglycemia (p = 0.025) and surfactant requirement (p = 0.019); meanwhile, prenatal steroids behaved as a protective factor (p = 0.002). Patients with intra-ventricular hemorrhage had a greater need for mechanical ventilation, use of inotropics or vasopressors, more transfusions, and a longer hospital stay. Conclusions: Despite the fact that intraventricular hemorrhage turned out to be a rare pathology in the analyzed neonatal population, there are risk factors related to its development, such as gestational age, low birth weight, infections, apneas, and hyperglycemia.