Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) remains a serious complication in the preterm newborn. The significant increase of survival rates in extremelye preterm newborns has also contributed to increase the absolute number of patients developing GMH-IVH. However, there are relatively few available animal models to understand the underlying mechanisms and peripheral markers or prognostic tools. In order to further characterize central complications and evolution of GMH-IVH, we injected collagenase intraventricularly to P7 CD1 mice and assessed them in the short (P14) and the long term (P70). Early complications at P14 included ventricle enlargement, increased bleeding, and inflammation. These alterations were maintained at P70, when increased tau phosphorylation and decreased neurogenesis were also observed, resulting in impaired learning and memory in these early adult mice. We additionally analyzed peripheral blood biomarkers in both our mouse model and preterm newborns with GMH-IVH. While MMP9 levels were not significantly altered in mice or newborns, reduced gelsolin levels and increased ubiquitin carboxy-terminal hydrolase L1 and tau levels were detected in GMH-IVH patients at birth. A similar profile was observed in our mouse model after hemorrhage. Interestingly, early changes in gelsolin and carboxy-terminal hydrolase L1 levels significantly correlated with the hemorrhage grade in newborns. Altogether, our data support the utility of this animal model to reproduce the central complications and peripheral changes observed in the clinic, and support the consideration of gelsolin, carboxy-terminal hydrolase L1, and tau as feasible biomarkers to predict the development of GMH-IVH.

BackgroundNew ultrasound measurements to diagnose diaphragmatic dysfunction, including diaphragmatic shortening fraction (DSF), have been studied in adults and children, but there are no data on reference values for neonates.ObjectiveTo describe DSF reference values for term neonate (TN) and preterm neonate (PTN), and to calculate its reproducibility.MethodsWe included asymptomatic TN and PTN during their first 24 hours of life. We measured DSF at the zone of apposition in both hemithoraces. Reproducibility of image acquisition, including inter‐ and intra‐rater agreement of the measurements were calculated among an experienced and a novel operator (after completion of a 1‐day course on lung ultrasound [LU] and performance of 10 diaphragm ultrasounds [DUs] under supervision), and a more‐trained examiner (completion of a 1‐day course on LU and performance of 60 DUs under supervision).ResultsTwo groups of 33 TN and 33 PTN were studied. Median DSF values did not differ between the groups, although diaphragm thickness was higher in the TN group. Intra‐observer reproducibility: the intraclass correlation coefficient (ICC) was 0.95 (95% confidence interval [95% CI] 0.86‐0.98). Interobserver reproducibility with novel operator had an ICC of 0.42 (95% CI −0.74 to 0.81), and with a more experienced operator improved to 0.76 (95% CI 0.27‐0.92). Both intra‐ and interobserver agreement were high.ConclusionsAsymptomatic TN and PTN have similar DSF values in the first 24 hours of life. The intra‐ and interobserver agreement is high. Reproducibility is acceptable, but intensive training is necessary to perform adequate DU.

The results of our study suggest that SGA infants with a good prognosis have a more mature aEEG pattern than preterm adequate-for-gestational-age patients with the same outcome. These findings support the brain sparing theory in SGA infants.

RESUMENLa sepsis tardía es especialmente frecuente en los recién nacidos pretérmino, y los bacilos gramnegativos son responsables de los casos más graves con una elevada mortalidad asociada. Pantoea agglomerans es un bacilo gramnegativo que pocas veces se ha descrito como patógeno en el ser humano, menos aún en el recién nacido. Se presenta el caso clínico de un recién nacido pretérmino que sufrió una sepsis fulminante por Pantoea agglomerans en una unidad de cuidados intensivos neonatales. Hasta la fecha no se ha descrito ningún caso de sepsis por P. agglomerans en esta población en España. Palabras clave: neonato, Pantoea agglomerans, sepsis tardía. SUMMaRyLate-onset sepsis is very frequent among preterm infants and cases due to Gram negative pathogens have elevated morbidity and mortality. Pantoea agglomerans is a Gram negative organism which has been rarely reported causing disease in humans. We present a case of P. agglomerans late-onset fulminant sepsis in a preterm newborn at a neonatal intensive care unit. Up to date none P. agglomerans sepsis has been reported among this population in our country. Keywords: newborn, Pantoea agglomerans, late-onset sepsis.http://dx.doi.org/10.5546/aap.2012.e77 INTRODUCCIÓNPantoea agglomerans es una enterobacteria aislada frecuentemente en plantas, frutas y vegetales, pero que también se ha encontrado en heces humanas y de animales.1 Como patógeno, se ha descrito clásicamente como causante de infecciones localizadas (sinovitis, artritis) postraumatismo con plantas. CaSO CLÍNICORecién nacida pretérmino de 32 semanas y dos días de gestación, fruto de gestación gemelar (2ª gemela). Oligoamnios y crecimiento intrauterino retardado desde la semana 20 de gestación. Serologías para Toxoplasma, citomegalovirus, rubéola y herpes virus negativas, marcadores hepáticos negativos. Nace mediante cesárea electiva por detectarse en ecografía Doppler flujos arteriales alterados en el segundo gemelar. Apgar de 5 y 7 al primer minuto y a los cinco minutos, respectivamente. Peso de RN: 750 g.Permaneció respiratoriamente estable sin necesidad de soporte respiratorio u oxigenoterapia.Requirió catéter venoso umbilical, retirado a los 7 días de vida (cultivo del catéter negativo, se sustituyó por catéter epicutáneo) y de NP. Antibioterapia con ampicilina y gentamicina y profilaxis de candidiasis con fluconazol desde el nacimiento. A los 8 días de vida presentó sepsis tardía, con fiebre, elevación de reactantes de fase aguda y crisis de apnea-bradicardia, por lo que se inició tratamiento con vancomicina. En el hemocultivo se aisló Staphylococcus coagulasa negativo.A los 19 días de vida comenzó con mala perfusión periférica (piel reticulada, frialdad acra, palidez, pulsos filiformes), dificultad respiratoria (polipnea, respiración superficial, tiraje subcostal) con necesidad creciente de oxigenoterapia para mantener una adecuada saturación de oxí-geno, taquicardia (de hasta 195 latidos por minuto) y oligoanuria. Fue intubada y conectada a ventilación mecánica. Además se inició soporte hemodinámic...

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Listeriosis is a sporadic infectious disease, which affects high-risk populations, such as the elderly, pregnant women, newborns, and immunocompromised patients. During pregnancy, listeriosis usually presents like a mild non-specific infection, but it may be responsible for fetal loss, preterm labor, early onset neonatal sepsis, and neonatal death. We report the case of a late stillbirth secondary to maternal chorioamnionitis. Listeria monocytogenes was isolated from the amniotic fluid and the fetal pleural fluid. The fetal autopsy revealed a disseminated inflammatory response with multi-organ involvement. This case illustrates the importance of the prevention and the diagnosis of listeriosis during gestation and may help us to understand the physiopathology of fetal loss due to listeriosis.

Pulmonary sequestration is an unusual cause of heart failure in infants. We report a preterm newborn with signs of congestive heart failure supposed secondary to a ductus arteriosus that was finally diagnosed as a coexistent extralobar pulmonary sequestration. In this case, Doppler echocardiography was essential for diagnosis, revealing an abnormal systemic arterial supply to the sequestered lung and abnormal venous drainage.

Chest pain is the second most common reason for referral to a pediatric cardiologist, because cardiovascular-related disorders are a major concern for children and their families when seeking medical attention. On the rare occasions when pediatric chest pain is a result of severe heart disease, it is usually associated with well-known cardiovascular risk factors such as fibrillinopathies. Type 1 fibrillinopathies are heritable disorders caused by mutations in the fibrillin genes that lead to a broad spectrum of connective tissue phenotypes ranging from Marfan syndrome, at the most severe end, to patients displaying mild marfanoid features, or milder Marfan (MM). We report the case of an adolescent patient with MM and suspected acute coronary syndrome, with chest pain and electrocardiographic changes suggestive of myocardial ischemia. Despite the low risk of coronary or aortic dissection/aneurysm in MM, these possibilities should be tested. Once they are ruled out, mitral valve prolapse should be considered as the main cause of chest pain with ischemic-like changes in the inferior electrocardiogram leads. We emphasize that clinical and echocardiographic follow-up over years is warranted in the pediatric population to ensure that the aortic root does not show progressive dilatation or a tendency to dissect. Finally, genotyping is clinically indicated for early and complete diagnosis in patients with MM as well as de novo Marfan syndrome to take advantage of educational and clinical programs for young carriers of the mutation.