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Introducción: La hiperbilirrubinemia (HB) es la principal causa de ingreso en unidades neonatales de bajo riesgo. Nuevos dispositivos de fototerapia (FT) permiten el uso de irradiación a dosis alta. Objetivo: Comparar la eficacia de la FT aplicada con equipos de tubos de luz azul (30 µW/cm2/nm) y FT con tecnología LED’s a dos niveles de irradiancia (30 y 40 µW/ cm2/nm) en términos de duración del tratamiento. Material y métodos: Estudio prospectivo, controlado y randomizado. Los recién nacidos de término o cercanos al término que necesitaban tratamiento con luminoterapia fueron aleatorizados a tres grupos: 1) luz azul a 30 µW/cm2/nm (LC), 2) LED a 30 µW/cm2/nm (L30), y 3) LED a 40 µW/cm2/nm (L40). Resultados: Se incluyeron 165 pacientes, 54 en LC, 56 en L30 y 55 en el grupo L40. El peso al nacer, edad gestacional, horas a la aleatorización y los valores BST al ingreso a FT (18,9 ± 2 mg/dl en BL, 18,9 ± 2,2 en L30 y 19 ± 1,6 en L40) fueron similares. El tiempo total (horas) de FT fue: 54,4 ± 6,9 en LC, 53,4 ± 10,7 en L30 y 41,7 ± 6 en L40 (p <0,001). Los niveles de BST en la interrupción de FT (10,1 ± 1,7 mg/dl, 9,9 ± 1 y 8,9 ± 1,8, p = 0,002) y 24 horas después (9,6 ± 1,3 mg/dl, 9,8 ± 1,4 y 9 ± 1,8, p = 0,04) fueron menor en el grupo L40. Conclusiones: El tratamiento con LEDs a 40 µW/cm2/nm reduce en 12 horas la duración del tratamiento en comparación con LEDs o luz azul a 30 µW/cm2/nm.

Introduction: Hyperbilirubinemia (HB) is the main cause of admission to low risk neonatal units. New phototherapy devices (PT) allow the use of high dose of irradiance. Objective: To compare the efficacy of PT in terms of hours of treatment between blue light tubes and LEDs equipments with two levels of irradiance. Material and methods: Prospective controlled trial. Term or near-term infants with need of PT treatment according to AAP recommendations were randomized into three groups: blue lights PT with 30 µW/cm2/nm (BL) or LEDs PT with 30 µW/cm2/nm (L30) or 40 µW/cm2/nm (L40) at skin level. Results: 165 patients were included, 54 in the BL group, 56 in L30 and 55 in L40 group. Birth weight, gestational age, postnatal hours at randomization and total serum bilirubin (TSB) level at entry (18.9 ± 2 mg/dl in BL, 18.9 ± 2.2 in L30 and 19 ± 1.6 in L40) were similar between groups. Total time of PT were 54.4 ± 6.9 hours in BL, 53.4 ± 10.7 in L30 and 41.7 ± 6 in L40 (p <0.001). TSB levels at PT discontinuation (10.1 ± 1.7 mg/dl, 9.9 ± 1 and 8.9 ± 1.8, p = 0.002) and 24 hours later (9.6 ± 1.3 mg/dl, 9.8 ± 1.4 and 9 ± 1.8, p = 0.04) were lower in L40 group.Conclusions: PT treatment with LEDs at µW/cm2/nm reduced the duration of treatment in 12 hours compared with BL or LEDs at 30 µW/cm2/nm.

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Introducción: La hiperbilirrubinemia (HB) es la principal causa de ingreso en unidades neonatales de bajo riesgo. Nuevos dispositivos de fototerapia (FT) permiten el uso de irradiación a dosis alta. Objetivo: Comparar la eficacia de la FT aplicada con equipos de tubos de luz azul (30 AW/cm2/nm) y FT con tecnología LEDÆs a dos niveles de irradiancia (30 y 40 AW/ cm2/nm) en términos de duración del tratamiento. Material y métodos: Estudio prospectivo, controlado y randomizado. Los recién nacidos de término o cercanos al término que necesitaban tratamiento con luminoterapia fueron aleatorizados a tres grupos: 1) luz azul a 30 AW/cm2/nm (LC), 2) LED a 30 AW/cm2/nm (L30), y 3) LED a 40 AW/cm2/nm (L40). Resultados: Se incluyeron 165 pacientes, 54 en LC, 56 en L30 y 55 en el grupo L40. El peso al nacer, edad gestacional, horas a la aleatorización y los valores BST al ingreso a FT (18,9 ± 2 mg/dl en BL, 18,9 ± 2,2 en L30 y 19 ± 1,6 en L40) fueron similares. El tiempo total (horas) de FT fue: 54,4 ± 6,9 en LC, 53,4 ± 10,7 en L30 y 41,7 ± 6 en L40 (p <0,001). Los niveles de BST en la interrupción de FT (10,1 ± 1,7 mg/dl, 9,9 ± 1 y 8,9 ± 1,8, p = 0,002) y 24 horas después (9,6 ± 1,3 mg/dl, 9,8 ± 1,4 y 9 ± 1,8, p = 0,04) fueron menor en el grupo L40. Conclusiones: El tratamiento con LEDs a 40 AW/cm2/nm reduce en 12 horas la duración del tratamiento en comparación con LEDs o luz azul a 30 AW/cm2/nm. (AU)

Introduction: Hyperbilirubinemia (HB) is the main cause of admission to low risk neonatal units. New phototherapy devices (PT) allow the use of high dose of irradiance. Objective: To compare the efficacy of PT in terms of hours of treatment between blue light tubes and LEDs equipments with two levels of irradiance. Material and methods: Prospective controlled trial. Term or near-term infants with need of PT treatment according to AAP recommendations were randomized into three groups: blue lights PT with 30 AW/cm2/nm (BL) or LEDs PT with 30 AW/cm2/nm (L30) or 40 AW/cm2/nm (L40) at skin level. Results: 165 patients were included, 54 in the BL group, 56 in L30 and 55 in L40 group. Birth weight, gestational age, postnatal hours at randomization and total serum bilirubin (TSB) level at entry (18.9 ± 2 mg/dl in BL, 18.9 ± 2.2 in L30 and 19 ± 1.6 in L40) were similar between groups. Total time of PT were 54.4 ± 6.9 hours in BL, 53.4 ± 10.7 in L30 and 41.7 ± 6 in L40 (p <0.001). TSB levels at PT discontinuation (10.1 ± 1.7 mg/dl, 9.9 ± 1 and 8.9 ± 1.8, p = 0.002) and 24 hours later (9.6 ± 1.3 mg/dl, 9.8 ± 1.4 and 9 ± 1.8, p = 0.04) were lower in L40 group.Conclusions: PT treatment with LEDs at AW/cm2/nm reduced the duration of treatment in 12 hours compared with BL or LEDs at 30 AW/cm2/nm. (AU)

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Introducción: La pérdida insensible de agua (PIA) es mayor a menor edad gestacional y peso de nacimiento. El método estándar para reducirlas es mantener al recién nacido en un ônidoõ, con un gorro y cubierto por una lámina de plástico. Hipótesis: Una alta HR (HRA) en la incubadora (80 por ciento) es más eficaz para reducir la PIA durante las primeras 72 horas de vida, comparado con baja HR (HRB). Diseño: Ensayo clínico controlado y aleatorizado. Objetivo: Determinar si la PIA se reduce significativamente en una incubadora con alta HR. Población y Métodos: RN <1.500 g de peso y 32 semanas de edad gestacional colocados en una Incubadora NATAL CARE® fueron asignados a recibir HRB o alta. Se realizó control de peso, líquidos aportados, diuresis y natremia durante los primeros 3 días. Resultados: Ingresaron 20 pacientes con HRB y 21 con HRA. No se hallaron diferencias clínicas entre ellos. El máximo descenso de peso fue de 8,9 por ciento para el grupo HRA y de 14,5 por ciento para el grupo HRB (p <0,001); la recuperación del peso de nacimiento fue de 10,3 días para el grupo HRA y 16 días para el de HRB (p <0,001), la media de líquidos aportados fue de 87 y 104,4 ml/kg/día respectivamente (p <0,001). La natremia del grupo HRA fue de 134,1 mEq/l y 138,6 mEq/l para HRB (p<0,0001), se registraron 7 casos de hipernatremia en el grupo control. Conclusiones: Estos resultados indirectamente confirman que los recién nacidos prematuros manejados en un microclima de HRA, tienen menos PIA sin aumentar sus riesgos en los primeros días.

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Las enfermedades metabólicas pueden presentarse con síntomas, signos y laboratorios inespecíficos, que si no se consideran entre los diagnósticos diferenciales pueden retrasar el diagnóstico de estos pacientes, lo que lleva a un alto grado de secuelas neurológicas o muerte en etapas tempranas. La enfermedad de Orina a Jarabe de Arce es una enfermedad metabólica de baja incidencia caracterizada por la acumulación de niveles tóxicos de valina, isoleucina y principalmente leucina. Se presenta un paciente sin antecedentes que a los 11 días de vida comienza con mala actitud alimentaria, letargia y fontanela tensa. Descartadas las causas infectológicas se realizó un screening para enfermedades metabólicas. Se diagnosticó Leucinosis (Enfermedad de orina con olor a Jarabe de Arce) y se inició el tratamiento con restricción de leucina, valina e isoleucina en la dieta. A los pocos días del tratamiento el paciente mostró evidencias de mejoría clínica y en los parámetros de laboratorio.

Clinical signs, symptoms and lab tests of neonatal metabolic diseases may be unspecific and a high grade of suspicion is necessary to include them among the differential diagnosis avoiding a significant delay in recognizing this condition and consequent risk of neurologic handicap or early dead. Maple syrup urine disease is a congenital metabolic disorder with a low rate of prevalence and characterized by a toxic accumulation of the amino acids valine, isoleucine and mainly leucine. In this report we describe the history of a patient apparently healthy that on the 11th day after birth initiates symptoms like poor feeding, lethargy and tense fontanel. Excluded sepsis a work up for metabolic disease was performed, being diagnosed a leucinosis (Maple syrup urine disease). A dietary treatment with leucine, valine and isoleucine restriction was immediately initiated and a few days after the patient showed significant clinical and lab improvement. A short description and discussion of this disease is presented.

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OBJECTIVE: To compare postnatal growth and nutritional deficits after the implementation of two different nutritional strategies in two consecutives periods of time. METHODS: An early and aggressive nutritional regimen was used in a cohort of 117 very low birth weight (VLBW) infants. Amino acids were administered at the rate of 1.5 g/kg/day along with 5.6 mg/k/min of glucose flow on day 1 of life, and progressively increased to 4 g/kg/day and 13 mg/kg/min. Intravenous lipids were started at 0.5 g/kg/day at 24 h from birth, and increased to 3.5 g/kg/day; enteral feeding was begun at day 1 of life. Uni- and multivariate analyses were used to compare this group with the conventional group of 65 VLBW infants conservatively fed. RESULTS: Univariate analysis showed that in the aggressive group there was a 66% reduction in the risk of post natal malnutrition at 40 weeks of postmenstrual age (OR 0.34; 95% CI 0.17-0.67). This difference persisted in the multivariate analysis. Energy and protein deficits were lower in the aggressive group (P < 0.001). CONCLUSIONS: Early and aggressive introduction of total parenteral nutrition and enteral feeding resulted in better growth in weight, length and head circumference, and a reduction of nutritional deficits at 40 weeks of postmenstrual age.

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La indemnidad del sistema nervioso central (SNC) depende de factores intrínsecos (genéticos y hormaonales) y extrínsecos (nutricionales, ambientales, sociales y emocionales) y es medida indirectamente por la valoración del neurodesarrollo. Tanto el retardo del crecimiento intrauterino como la falla del crecimiento postnatal que se observa en prematuros con muy bajo peso al nacer (RNMBP) han sido relacionados con la aparición tardía de problemas en el neurodesarrollo. Una intervención nutricional durante la primeras semanas de vida podría minimizar el déficit durante el tercer trimestre de gestación. Diche interrupción, sumada a la morbilidad asociada a la prematurez, condicionan la falla en el crecimiento postnatal...

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UNLABELLED: Birth-weight-for-gestational-age patterns in Argentina are scarce and outdated. The same study has been performed within our institution for 8 years already. Our hypothesis is that there could have been population changes with repercussions on fetal growth. The objectives were: 1) to determine new normal values of birth weight (BW)-for-gestational-age; 2) to study growth speed and acceleration, and 3) to compare these new results between trienniums. POPULATION: All liveborn babies between 1988-1998 (n = 67,857) were included. Those with BW lower than 500 g, gestational age (GA) lower than 25 weeks or mistakes in the appraisal of GA and outliers (birth-weight-for gestational-age > 2.5 DS of the median) were excluded. Those without maternal or obstetric history that could have influenced the BW were defined as "healthy newborns" (n = 55,706). The software Persi, that employs 34 of the 93 variables included in the Perinatal Clinical Record (SIP/OPS/OMS, Agustina v 5.1), was used. Birth weight median, standard deviation and error, coefficient of variation, skewness and kurtosis's coefficients, real and polynomial percentiles, standard distribution (Z), and the corresponding charts were generated in an automatic way for each gestational week and through the use of the method of least squares (polynomial models up to 4th grade). Results were as follows: maximum variability 15% as from the 30th week, maximum absolute speed in the 36th week (263 g/week) and a positive acceleration, up to the 36th week, and then a negative one (maximum -127 g/week2 in the 42nd week) was observed. Skewness varied between -0.247 (31st week) and 0.129 (38th week), and kurtosis was around 3, from which it can be inferred that the population has a normal distribution. Compared to the score z, the new curves showed a maximum error of 1.53% for the 10 percentile and 1.50% for the 50 percentile. By analyzing the data by trienniums (88-91, 91-93, 94-96 and 97-98) a growing mean BW (3243 +/- 539 g to 3286 +/- 508 g; p < 0.001) and 10 percentile (2600 to 2690 g, p < 0.001) trend was appreciated. IN CONCLUSION: new values of birth weight-for-gestational-age were determined, and a secular increase trend of the mean birth weight (+43 g) was observed.

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Birth-weight-for-gestational-age patterns in Argentina are scarce and outdated. The same study has been performed within our institution for 8 years already. Our hypothesis is that there could have been population changes with repercussions on fetal growth. The objectives were: 1) to determine new normal values of birth weight (BW)-for-gestational-age; 2) to study growth speed and acceleration, and 3) to compare these new results between trienniums. Population: All liveborn babies between 1988-1998 (n = 67,857) were included. Those with BW lower than 500 g, gestational age (GA) lower than 25 weeks or mistakes in the appraisal of GA and outliers (birth-weight-for gestational-age > 2.5 DS of the median) were excluded. Those without maternal or obstetric history that could have influenced the BW were defined as [quot ]healthy newborns[quot ] (n = 55,706). The software Persi, that employs 34 of the 93 variables included in the Perinatal Clinical Record (SIP/OPS/OMS, Agustina v 5.1), was used. Birth weight median, standard deviation and error, coefficient of variation, skewness and kurtosiss coefficients, real and polynomial percentiles, standard distribution (Z), and the corresponding charts were generated in an automatic way for each gestational week and through the use of the method of least squares (polynomial models up to 4th grade). Results were as follows: maximum variability 15

as from the 30th week, maximum absolute speed in the 36th week (263 g/week) and a positive acceleration, up to the 36th week, and then a negative one (maximum -127 g/week2 in the 42nd week) was observed. Skewness varied between -0.247 (31st week) and 0.129 (38th week), and kurtosis was around 3, from which it can be inferred that the population has a normal distribution. Compared to the score z, the new curves showed a maximum error of 1.53

for the 10 percentile and 1.50

for the 50 percentile. By analyzing the data by trienniums (88-91, 91-93, 94-96 and 97-98) a growing mean BW (3243 +/- 539 g to 3286 +/- 508 g; p < 0.001) and 10 percentile (2600 to 2690 g, p < 0.001) trend was appreciated. In conclusion: new values of birth weight-for-gestational-age were determined, and a secular increase trend of the mean birth weight (+43 g) was observed.

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OBJECTIVE: The administration of recombinant human erythropoietin (rHuEPO), started after the first 2 weeks of life, reduces the transfusion requirement in premature infants. However, its use throughout the first 2 weeks of life, when anemia results predominantly from phlebotomy losses, remains controversial. We investigated whether early use of rHuEPO would reduce the total transfusion requirement and/or the number of transfusions throughout the first 2 weeks of life. METHODS: We randomized 114 infants with birth weight (BW) <1250 g to receive rHuEPO (1250 units/kg/week; IV; early group: n = 57) or placebo (late group: n = 57) from day 2 to day 14 of life; subsequently, all the patients received rHuEPO (750 units/kg/week, subcutaneously) for 6 additional weeks. All infants were given oral iron (6 mg/kg/day) and folic acid (2 mg/day). RESULTS: The early group showed higher hematocrit and reticulocyte counts than the late group in the first 3 weeks of life, but there was no difference in the total number of transfusions (early: 1.8 +/- 2.3 vs late: 1.8 +/- 2.5 transfusion/patient) or the transfusion requirement throughout the first 2 weeks of life (early:.8 +/- 1.1 vs late:.9 +/- 1.3) could be demonstrated. In infants with BW <800 g and total phlebotomy losses >30 mL/kg (n = 29), a lower number of transfusions was received by infants in the early group, compared with late group, from the second week to the end of the treatment (early: 3.4 +/- 1.1 vs late: 5.4 +/- 3.7 transfusion/patient). No clinical adverse effects were observed. Thrombocytosis was detected during the treatment with rHuEPO in 31% of the infants. CONCLUSIONS: In the whole population, the early administration of rHuEPO induced a rise of reticulocyte counts, but not enough to reduce the transfusion requirement. The most severely ill infants (BW <800 g and phlebotomy losses >30 mL/kg) seemed to benefit from early use of rHuEPO, and this deserves additional study.

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BACKGROUND: Chloracne is a disease associated with toxicity of halogenated compounds used in some industrial processes. A patient affected by chloracne led us to study a total of nine cases from a single factory. METHODS: We studied the clinical features of nine patients exposed chronically to chlorobenzenes. On all of them blood samples were drawn and biopsies of affected skin and liver were taken. Their work environment was visited and studied. RESULTS: All nine patients were men and had polymorphic skin lesions, characterized mainly by comedones and cysts. They had chronic conjunctivitis and seven had cysts in the Meibomian glands. All of them had polyneuropathy and liver damage and seven had hypertriglyceridemia. Compounds known to cause chloracne were found in exceedingly high concentrations in the water used in the workplace. CONCLUSIONS: Every patient exposed to halogenated compounds with the cutaneous manifestations of chloracne should be carefully investigated for systemic complications (such as ophthalmic, neuropathic, hepatic, and lipoprotein abnormalities).

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