BackgroundEarly skin-to-skin contact promotes infant physiologic stability, provides warmth and makes breast milk readily available. Despite the known benefits of early skin-to-skin contact, this practice is not included within standard care in the Mexican public healthcare system. After birth, newborns are usually taken to an incubator in the nursery where they transition to extrauterine life and receive either dextrose 5% or infant formula for their first feed. The aim of this study was to assess if a dual educational intervention in a rural hospital in Mexico could modify current practice and accomplish early skin-to-skin contact and early breastfeeding.MethodsA two-step educational intervention was designed. The first step was to educate the labor and birthing staff of the hospital, and the second step was to educate all pregnant women with uncomplicated pregnancies at 36 weeks’ gestation. The educational intervention explored the benefits, implications and steps of early skin-to-skin contact and early breastfeeding. All births were registered for the three month period following the intervention. The time of onset of skin-to-skin (SSC) contact, its duration and time of initiation of breastfeeding were recorded and analyzed using ANOVA testing.ResultsA total of 142 births met our inclusion criteria, from those, 77% (n = 109) received skin-to-skin contact and early breastfeeding. The average time of initiation of skin-to-skin contact in the first and last month of the study was 18.5 (± 2.2) and 9.6 (± 2.2) minutes of life, respectively (p < 0.001). The average duration of SSC in the first and last month was 22 (± 10.9) and 40.9 (± 17.4) minutes, respectively (p < 0.001). The average time of onset of breastfeeding in the first and last month was 48.9 (± 15) and 34.4 (± 16.7) minutes of life, respectively (p < 0.001).ConclusionsA simple and low-cost educational intervention achieved the inclusion of skin-to-skin contact and early breastfeeding as part of standard care in a rural hospital. Further studies could replicate our intervention in similar settings to test the generalizability of the findings.

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Sturge-Weber syndrome (SWS) is a congenital, sporadic, and rare neurocutaneous disorder, characterized by the presence of a facial port-wine birthmark (PWB), glaucoma, and neurological manifestations including leptomeningeal angiomatosis and seizures. It is caused by a postzygotic, somatic, gain-of-function variant of the GNAQ gene, and more recently, the GNA11 gene in association with distinctive clinical features. Neuroimaging can help identify and stratify patients at risk for significant complications allowing closer follow-up; although no presymptomatic treatment has been demonstrated to be effective to date, these patients could benefit from early treatment and/or supportive interventions. Choroid plexus (CP) thickness measurements in brain magnetic resonance imaging (MRI) have a high sensitivity and specificity for early and incipient changes in SWS. In contrast, the absence of pathologic findings makes it possible to rule out associated neurological involvement and leads to periodical observation, with new imaging studies only in cases of new clinical signs/symptoms. Periodic ophthalmological examination is also recommended every 3 months during the first year and yearly afterwards to monitor for glaucoma and choroidal hemangiomas. Treatment for SWS depends on the extent and areas that are affected. These include laser surgery for PWB, anticonvulsants in the case of brain involvement, with either seizures or abnormal EEG, and medical treatment or surgery for glaucoma. Sirolimus has been used in a limited number of patients and appears to be a safe and potentially effective treatment for cutaneous and extra-cutaneous features, however controlled clinical studies have not been carried out. Better knowledge of GNAQ/GNA11 molecular pathways will help to develop future targeted treatments.

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BackgroundKawasaki Disease (KD) is the second most common vasculitis in the pediatric population and the leading cause for pediatric acquired heart disease in developed countries. It is commonly diagnosed in the Mexican pediatric population, epidemiology in this country is not established, since cases are not usually reported to the healthcare system. The clinical features are quite variable, but diagnosis and prompt treatment will decrease morbidity and mortality. Coronary artery aneurysms are the most common complication, which represent the leading cause of acute coronary syndrome before 40 years of age. Recurrence of KD is estimated to be around 3% in Japanese patients and 1% in the United States, nevertheless, this data in Latin-American children is unknown. It usually affects patients before reaching 3 years old and within 2 years of the initial attack, presenting with an abrupt onset and higher complication rates, requiring aggressive workup, treatment and follow-up.ObjectivesTo review an atypical presentation of KD and early recurrence in a 7-month-old female.MethodsWe present a 7-month-old female diagnosed with KD at 48 days old. She presented to the emergency unit with irritability, high and persistent fever and acholia. During workup, she was found with cholestasis and gallbladder hydrops. Negative CSF, blood and urine cultures were documented during hospitalization, and fulfilled the KD criteria. The cardiac ultrasound revealed coronary abnormalities: a RCA of 2.8mm (Z-Score +4.79), LCA of 3.3mm (Z-Score +5.69) and LAD of 2.4mm (Z-SCORE +4.25), which fit into classification 3 and 4, as small and medium aneurysms, according to AHA 2017. Immunoglobulin (2g/kg) and aspirin (80mg/kg) were administered and she was discharged 36 hours after the IVIg infusion, afebrile and with ambulatory follow-up, 30 days later the coronary abnormalities showed RCA of 2.0mm (Z-Score +2.3), LCA of 3.0mm (Z-Score +6), LAD 2.3mm (Z-Score +2.9). Six months later, she presented fever for 6 days, irritability and polymorphous rash. On physical exam BCGitis, non-suppurative conjunctivitis and pallor in hands and feet, elevated CRP and ESR, leukocytosis, thrombocytosis and sterile leukocyturia. Echocardiography reported RCA od 2.4mm (Z-Score +4.8), LCA of 3.1 (Z-Score +4.2) and LAD of 2.3mm (Z-Score +3.2), diagnosing KD recurrence, admitting the patient for IVIg and aspirin administration.ResultsThe patient was treated with IVIg and aspirin. Follow-up by Cardiology determined improvement of Z-Scores. Recurrence occurred with worsening of the cardiac abnormalities. Cardiac prognosis is importantly affected due to the atypical age, vascular abnormalities and repeated vasculitic process. Rheumatologic consult should be considered since disease like Takayasu Arteritis, Polyarteritis Nosa and ADA2 deficiency need to be ruled out.ConclusionKD needs prompt diagnosis and treatment due to the potential consequences when delayed. Clinical suspicion is important due to the possible atypical presentation. As with this patient, age, gender and ...

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