RESUMEN
Introducción. Un accidente cerebro-vascular de origen isquémico y/o hemorrágico aumenta la morbi-mortalidad neonatal. Se estima que ocurre en 1:4,000 recién nacidos. En este trabajo se reporta un recién nacido de término con un accidente cerebro-vascular aparentemente espontáneo. Caso Clínico. Se trata de un recién nacido, madre de 31 años, segunda gesta de término que cursó con diabetes gestacional y fue tratada sólo con dieta. Inició con trabajo de parto a las 41.5 semanas de gestación por FUM; se efectuó cesárea por desproporción céfalo pélvica. Se obtuvo producto femenino de 3,640 g calificado con Apgar 8-9, se le aplicaron sólo pasos iniciales de reanimación. En el primer día de vida presentó desviación de la comisura labial a la derecha y movimientos tónico-clónicos en hemicuerpo derecho en 2 ocasiones; se inició fenobarbital. Los resultados de laboratorio para glucemia, sodio, calcio, potasio, creatinina, tiempos de coagulación y biometría hemática fueron normales; los cultivos de líquido cefalo-raquídeo fueron negativos, la punción lumbar se consideró traumática. El ultrasonido fontanelar no mostró alteraciones sugestivas de un evento hemorrágico ni alteraciones a nivel ventricular; sin embargo, al tercer día de vida se practicó tomografía axial computarizada de cráneo simple visualizándose una zona hipodensa con un patrón geográfico hacia la región tempo-parietal izquierda con aspecto de evento vascular isquémico en el territorio de la arteria cerebral media. Conclusiones. Se continuó con fenobarbital y ácido acetilsalicílico. Permaneció asintomática por lo que se egresó al séptimo día de vida. Se citó a consulta externa en Neurología Pediátrica.
Background. Cerebral vascular accident (CVA) is an important cause of hemorrhagic or ischemic cerebral injury and increases neonatal morbidity and mortality. It occurs in 1/4000 term neonates. We report a case of a neonate with a spontaneous CVA. Case report. We present the case of a newborn (NB) who was delivered from a 31-year old mother. It was the second pregnancy with 41.5 gestation weeks. The mother presented gestational diabetes controlled only by dietary therapy. A 3640 g, apparently healthy female was obtained by cesarean delivery that was indicated due to cephalopelvic disproportion. Apgar scores were 8-9 according to the conventional time points. The pediatrician used only initial steps of reanimation. During the first day of life, the infant presented a deviation of the right mouth commissure and tonic-clonic movements on the right half of the body two times. The newborn was treated with phenobarbital intravenous infusion. Laboratory tests were all normal, and cultures of cerebrospinal fluid and blood were considered negative. A head sonogram showed no evidence of hemorrhage or ventricular distortion but a cranial CT reported a low-density zone suggesting a cerebral infarction in the left parietal and temporal regions. Conclusions. We continued to treat with phenobarbital and acetylsalicylic acid and the patient remained asymptomatic prior to discharge at the 7th day of life, recommending follow-up with a pediatric neurologist.
RESUMEN
BACKGROUND: Prematurity is observed in 5-8% of deliveries, and is frequent cause of handicap. Premature have 5-24% risk for developing periventricular leukomalacia (PLM). The use of antenatal steroids (AS) is controversial for preventing PLM. METHODS: We studied 110 premature neonates < 1500 g, divided in 2 groups: control (group 1, n = 55), and group 2 (n = 55) who received antenatal dexamethasone. We registered clinical data, evolution and use of oxygen or mechanical ventilation. At one month age a transfontanelar ultrasound was done looking specific PLM. RESULTS: In group 1, found 6/55 (10.9%) with PLM and 3/55 (5.4%) in group 2, RR = 0.5, CI 95% (0.13-1.90). In group 1: 30/55 (54.54%) the ultrasound was normal; in 16 (29%) had intraventricular haemorrhage, and in 3 cases (5.45%) had severe hydrocephalus. In group 2: 32/55 (58.18%) ultrasound was normal, 16/55 (29%) had intraventricular haemorrhage, 4/55 (7.27%) had severe hydrocephalus. We did not find significant difference between other variables in both groups. CONCLUSIONS: There was no significant difference in PLM incidence between patients who did or did not received antenatal dexamethasone.