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Ibarra-Ríos D, Serpa-Maldonado EV, Mantilla-Uresti JG, Guillén-Torres R, Aguilar-Martínez N, Sánchez-Cruz A, Morales-Barquet DA, Becerra-Becerra R, Márquez-González H. A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn. J Vis Exp 2023. [PMID: 37092840 DOI: 10.3791/64931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
The use of routine point-of-care ultrasound (POCUS) is increasing in neonatal intensive care units (NICUs), with several centers advocating for 24 h equipment availability. In 2018, the sonographic algorithm for life-threatening emergencies (SAFE) protocol was published, which allows the assessment of neonates with sudden decompensation to identify abnormal contractility, tamponade, pneumothorax, and pleural effusion. In the study unit (with a consulting neonatal hemodynamics and POCUS service), the algorithm was adapted by including consolidated core steps to support at-risk newborns, aiding clinicians in managing cardiac arrest, and adding views to verify correct intubation. This paper presents a protocol that can be applied in the NICU and the delivery room (DR) in relation to three scenarios: cardiac arrest, hemodynamic deterioration, or respiratory decompensation. This protocol can be performed with a state-of-the-art ultrasound machine or an affordable handheld device; the image acquisition protocol is carefully detailed. This method was designed to be learned as a general competence to obtain the timely diagnosis of life-threatening scenarios; the method aims to save time but does not represent a substitute for comprehensive and standardized hemodynamic and radiological analyses by a multidisciplinary team, which might not universally be on call but needs to be involved in the process. From January 2019 to July 2022, in our center, 1,045 hemodynamic consultation/POCUS consults were performed with 25 patients requiring the modified SAFE protocol (2.3%), and a total of 19 procedures were performed. In five cases, trained fellows on call resolved life-threatening situations. Clinical examples are provided that show the importance of including this technique in the care of critical newborns.
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Affiliation(s)
- Daniel Ibarra-Ríos
- Hemodynamic Consultation and Ultrasound in the Critically Ill Neonate, Hospital Infantil de México Federico Gómez (HIMFG);
| | - Eunice Valeria Serpa-Maldonado
- Hemodynamic Consultation and Ultrasound in the Critically Ill Neonate, Hospital Infantil de México Federico Gómez (HIMFG)
| | - José Guadalupe Mantilla-Uresti
- Hemodynamic Consultation and Ultrasound in the Critically Ill Neonate, Hospital Infantil de México Federico Gómez (HIMFG)
| | - Rogelio Guillén-Torres
- Hemodynamic Consultation and Ultrasound in the Critically Ill Neonate, Hospital Infantil de México Federico Gómez (HIMFG)
| | | | - Alejandra Sánchez-Cruz
- Neonatal Intensive Care Unit, Hospital de Ginecología y Obstetricia Número 4, Luis Castelazo Ayala, Instituto Mexicano del Seguro Social
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Sánchez-Becerra JC, Guillén-Torres R, Becerra-Becerra R, Márquez-González H, Ibarra-Ríos D. Targeted neonatal echocardiography and lung ultrasound in preterm infants with chronic lung disease with and without pulmonary hypertension, screened using a standardized algorithm. Front Pediatr 2023; 11:1104940. [PMID: 37033165 PMCID: PMC10076703 DOI: 10.3389/fped.2023.1104940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Increased recognition of the development of chronic pulmonary hypertension (cPH) in preterm infants with chronic lung disease (CLD) has prompted enhanced monitoring for the identification of different phenotypes. Methods All newborns consulted for oxygen/respiratory support dependency (CLD assessment) from January 2018 to December 2021 were included. TnECHO and LUS screening for cPH-CLD were performed at 36 weeks postmenstrual age. Cases of cPH related to increased pulmonary blood flow (cPH-IPBF) were referred to Pediatric Cardiology. The objective of the study was to identify all cases of cPH (cPH-CLD/IPBF) in the CLD patients screened and to compare outcomes. Following a standardized algorithm, cPH-CLD patients were treated with diuretics; ultrasounds taken before and after treatment were analyzed. Results Seventy-two patients with CLD were screened. Twenty-two (30%) had cPH-CLD, and nine (12%) had cPH-IPBF. cPH infants underwent more days of mechanical ventilation, were more likely to have retinopathy of prematurity, and showed increased mortality. The LUS pattern observed in the 72 CLD patients consisted of a thickened pleural line and a B-line interstitial heterogeneous pattern; 29% of patients were found to have lung consolidations. After diuretic therapy, step-down in respiratory support occurred in 59% of neonates with cPH-CLD. A decrease in respiratory rate (RR), right ventricular output (RVO), markers of pulmonary vascular resistance (PVR), and B-line pattern was observed. In tissue Doppler imaging, biventricular diastolic function was found to be modified after diuretics. Conclusions CLD infants with cPH showed increased morbidity and mortality. In cPH-CLD patients, a decrease in RR and step-down in respiratory support was observed after diuretic treatment. Follow-up ultrasound showed a decrease in RVO, markers of PVR, and B-lines.
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Affiliation(s)
| | - Rogelio Guillén-Torres
- Neonatology Department, National Institute of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Rosario Becerra-Becerra
- Cardiology Department, National Institute of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Horacio Márquez-González
- Clinical Investigation Department, National Institute of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Daniel Ibarra-Ríos
- Neonatology Department, National Institute of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
- Correspondence: Daniel Ibarra-Ríos
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Mota-Rojas D, Villanueva-García D, Solimano A, Muns R, Ibarra-Ríos D, Mota-Reyes A. Pathophysiology of Perinatal Asphyxia in Humans and Animal Models. Biomedicines 2022; 10:biomedicines10020347. [PMID: 35203556 PMCID: PMC8961792 DOI: 10.3390/biomedicines10020347] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Perinatal asphyxia is caused by lack of oxygen delivery (hypoxia) to end organs due to an hypoxemic or ischemic insult occurring in temporal proximity to labor (peripartum) or delivery (intrapartum). Hypoxic–ischemic encephalopathy is the clinical manifestation of hypoxic injury to the brain and is usually graded as mild, moderate, or severe. The search for useful biomarkers to precisely predict the severity of lesions in perinatal asphyxia and hypoxic–ischemic encephalopathy (HIE) is a field of increasing interest. As pathophysiology is not fully comprehended, the gold standard for treatment remains an active area of research. Hypothermia has proven to be an effective neuroprotective strategy and has been implemented in clinical routine. Current studies are exploring various add-on therapies, including erythropoietin, xenon, topiramate, melatonin, and stem cells. This review aims to perform an updated integration of the pathophysiological processes after perinatal asphyxia in humans and animal models to allow us to answer some questions and provide an interim update on progress in this field.
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Affiliation(s)
- Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, Universidad Autónoma Metropolitana (UAM), Mexico City 04960, Mexico
- Correspondence: (D.M.-R.); (D.V.-G.)
| | - Dina Villanueva-García
- Division of Neonatology, National Institute of Health Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico;
- Correspondence: (D.M.-R.); (D.V.-G.)
| | - Alfonso Solimano
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada;
| | - Ramon Muns
- Livestock Production Sciences Unit, Agri-Food and Biosciences Institute, Hillsborough BT26 6DR, UK;
| | - Daniel Ibarra-Ríos
- Division of Neonatology, National Institute of Health Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico;
| | - Andrea Mota-Reyes
- School of Medicine and Health Sciences, TecSalud, Instituto Tecnológico y de Estudios Superiores de Monterrey (ITESM), Monterrey 64849, Mexico;
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Ibarra-Ríos D, Enríquez-Estrada AC, Serpa-Maldonado EV, Miranda-Vega AL, Villanueva-García D, Vázquez-Solano EP, Márquez-González H. Lung Ultrasound Characteristics in Neonates With Positive Real Time Polymerase Chain Reaction for SARS-CoV-2 on a Tertiary Level Referral Hospital in Mexico City. Front Pediatr 2022; 10:859092. [PMID: 35463891 PMCID: PMC9033263 DOI: 10.3389/fped.2022.859092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Acute respiratory syndrome secondary to SARS-CoV-2 virus infection has been declared a pandemic since December 2019. On neonates, severe presentations are infrequent but possible. Lung ultrasound (LUS) has been shown to be useful in diagnosing lung involvement and following up patients, giving more information, and reducing exposure compared to traditional examination. METHODS LUS was performed after the diagnosis of SARS-CoV-2 infection with respiratory Real Time Polymerase Chain Reaction RT-PCR with portable equipment protected with a silicone sleeve. If hemodynamic or cardiology consultation was necessary, a prepared complete ultrasound machine was used. Ten regions were explored (anterior superior and inferior, lateral, and posterior superior and inferior, right and left), and a semiquantitative score (LUSS) was calculated. Disease severity was determined with a pediatric modified score. RESULTS Thirty-eight patients with positive RT-PCR were admitted, 32 (81%) of which underwent LUS. Included patients had heterogenous diagnosis and gestational ages as expected on a referral neonatal intensive care unit (NICU) (median, ICR: 36, 30-38). LUS abnormalities found were B-line interstitial pattern 90%, irregular/interrupted/thick pleural line 88%, compact B-lines 65%, small consolidations (≤5 mm) 34%, and extensive consolidations (≥5 mm) 37%. Consolidations showed posterior predominance (70%). LUSS showed a median difference between levels of disease severity and ventilatory support (Kruskal-Wallis, p = 0.001) and decreased with patient improvement (Wilcoxon signed-rank test p = 0.005). There was a positive correlation between LUSS and FiO2 needed (Spearman r = 0.72, p = 0.01). The most common recommendation to the attending team was pronation (41%) and increase in positive end expiratory pressure (34%). Five patients with comorbidities died. A significant rank difference of LUSS and FiO2 needed between survivors and non-survivors was found (Mann-Whitney U-test, p = 0.005). CONCLUSION LUS patterns found were like the ones described in other series (neonatal and pediatrics). Eighty-eight percent of the studies were performed with handheld affordable equipment. While there is no specific pattern, it varies according to gestational age and baseline diagnosis LUS, which were shown to be useful in assessing lung involvement that correlated with the degree of disease severity and respiratory support.
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Affiliation(s)
- Daniel Ibarra-Ríos
- Neonatology Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | - Ana Luisa Miranda-Vega
- Neonatology Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Dina Villanueva-García
- Neonatology Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Edna Patricia Vázquez-Solano
- Neonatology Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Horacio Márquez-González
- Clinical Investigation Department, National Institutes of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Ibarra-Ríos D, Márquez-González H, Quiroga-Valdés A, Guzmán-Arce AE, Villanueva-García D, Villegas-Silva R. Analysis of the results of the neonatal functional echocardiography program in a third-level pediatric hospital. Bol Med Hosp Infant Mex 2021; 77:178-185. [PMID: 32713948 DOI: 10.24875/bmhim.20000036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Echocardiography is useful in the group of comorbidities of critically ill newborns. The targeted neonatal echocardiography program trains neonatologists for acquiring and interpreting hemodynamic variables to support decision making. This study aimed to describe the results of the functional echocardiography program (fNE) and compare clinical and hemodynamic variables between survivors and non-survivors. Methods Observational, cross-sectional, and comparative study of neonates that received a fNE evaluation for hemodynamic disturbances related to patent ductus arteriosus (PDA), acute and chronic pulmonary hypertension (aPH, cPH), state of shock and thrombus/vegetations surveillance for two years. Functional parameters of the right and left ventricle, pulmonary pressure, and surrogates of pulmonary over circulation were assessed. Comparative analysis with U Mann Whitney test and Χ2 was performed. Based on the results, recommendations to start, adjust, or withdraw vasoactive medications were issued. Results Of 269 studies on 119 neonates (65% premature, 15% mortality), the reasons for consultation were aPH (38%), PDA (27%), shock (19%), cPH (14%), and thrombus surveillance (2%). A change in management was recommended on 45% of studies. Non-survivors presented significant differences in the right ventricular (RV) systolic performance and an increased right ventricular afterload. Conclusions The main indication for fNE was pulmonary hypertension. A pharmacological adjustment was recommended on 45% of the cases.
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Affiliation(s)
- Daniel Ibarra-Ríos
- Departamento de Neonatología; Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Horacio Márquez-González
- Departamento de Investigación Clínica. Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Alejandra Quiroga-Valdés
- Departamento de Neonatología; Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Adrián E Guzmán-Arce
- Departamento de Neonatología, Hospital de Niños Roberto Gilbert E, Guayaquil, Ecuador
| | - Dina Villanueva-García
- Departamento de Neonatología; Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Raúl Villegas-Silva
- Departamento de Neonatología; Hospital Infantil de México Federico Gómez, Ciudad de México, México
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Villanueva-García D, Mota-Rojas D, Miranda-Cortés A, Ibarra-Ríos D, Casas-Alvarado A, Mora-Medina P, Martínez-Burnes J, Olmos-Hernández A, Hernández-Avalos I. Caffeine: cardiorespiratory effects and tissue protection in animal models. Exp Anim 2021; 70:431-439. [PMID: 34039788 PMCID: PMC8614017 DOI: 10.1538/expanim.20-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The aim of this review is to analyze the cardiorespiratory and tissue-protective effects of caffeine in animal models. Peer-reviewed literature published between 1975 and 2021 was retrieved from CAB Abstracts, PubMed, ISI Web of Knowledge, and Scopus. Extracted data were analyzed to address the mechanism of action of caffeine on cardiorespiratory parameters (heart rate and rhythm), vasopressor effects, and some indices of respiratory function; we close this review by discussing the existing debate on the research carried out on the effects of caffeine on tissue protection. Adenosine acts through specific receptors and is a negative inotropic andchronotropic agent. Blockage of its cardiac receptors can cause tachycardia (with arrhythmogenic potential) due to the intense activity of β1 receptors. In terms of tissue protection, caffeine produces inhibition of hyperoxia-induced pulmonary inflammation by decreasing proinflammatory cytokine expression in animal models. CONCLUSION The protection that caffeine provides to tissues is not limited to the CNS, as studies have demonstrated that it generates attenuation of inflammatory effects in pulmonary tissue, where it inhibits the effects of some pro-inflammatory cytokines and prevents functional and structural changes.
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Affiliation(s)
- Dina Villanueva-García
- Division of Neonatology, National Institute of Health, Hospital Infantil de México Federico Gómez
| | - Daniel Mota-Rojas
- Neurophysiology, Behavior, and Animal Welfare Assessment, Department of Animal Production and Agriculture (DPAA), Universidad Autónoma Metropolitana (UAM) Xochimilco Campus
| | - Agatha Miranda-Cortés
- Clinical Pharmacology and Veterinary Anaesthesia, Department of Biological Science, FESC, Universidad Nacional Autónoma de México (UNAM)
| | - Daniel Ibarra-Ríos
- Division of Neonatology, National Institute of Health, Hospital Infantil de México Federico Gómez
| | - Alejandro Casas-Alvarado
- Neurophysiology, Behavior, and Animal Welfare Assessment, Department of Animal Production and Agriculture (DPAA), Universidad Autónoma Metropolitana (UAM) Xochimilco Campus
| | - Patricia Mora-Medina
- Livestock Science Department, Universidad Nacional Autónoma de México (UNAM), Facultad de Estudios Superiores Cuautitlán
| | - Julio Martínez-Burnes
- Graduate and Research Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas
| | - Adriana Olmos-Hernández
- Division of Biotechnology, Department Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII)
| | - Ismael Hernández-Avalos
- Clinical Pharmacology and Veterinary Anaesthesia, Department of Biological Science, FESC, Universidad Nacional Autónoma de México (UNAM)
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Márquez-González H, Ibarra-Ríos D, Jean-Tron MG, Barajas-Nava LA. Uso de sildenafil para la hipertensión pulmonar en neonatos. BMHIM 2020; 77:202-206. [DOI: 10.24875/bmhim.20000041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Michel-Macías C, Morales-Barquet DA, Martínez-García A, Ibarra-Ríos D. Findings From Somatic and Cerebral Near-Infrared Spectroscopy and Echocardiographic Monitoring During Ductus Arteriosus Ligation: Description of Two Cases and Review of Literature. Front Pediatr 2020; 8:523. [PMID: 32984224 PMCID: PMC7492561 DOI: 10.3389/fped.2020.00523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Preterm infants with hemodynamically significant patent ductus arteriosus (HsPDA) are exposed to low cerebral tissue oxygen saturation (rScO2) values. Additionally, infants requiring surgical ligation are at risk of further changes in cerebral oxygenation and postligation cardiac syndrome (PLCS). Previous studies have assessed the effect of PDA ligation on rScO2 with variable results. Cases description: In this report we analyse near-infrared spectroscopy (NIRS) and echocardiographic findings of two patients who underwent ligation of PDA and presented low cardiac output. Literature on regional tissue oxygenation saturation (rSO2) before and after PDA ligation was briefly reviewed. Discussion: Cerebral oxygenation values before and after PDA ligation may be influenced by gestational age, vasopressor use, ductal shunt volume, time of exposure HsPDA, chronological age and the presence of cerebral autoregulation. PLCS complicates 28-45% of all PDA ligations and is associated with higher mortality. Cerebral and somatic NIRS monitoring in the postoperative period may enhance the identification of PLCS at early stages. Conclusion: Cerebral oxygenation in the perioperative period of PDA ligation may be influenced by numerous clinical factors. Early detection of PLCS using multisite NIRS after ligation could prevent further alterations in cerebral hemodynamics and improve outcomes. A decrease in somatic-cerebral difference and/or a significant drop in somatic NIRS values may precede clinical signs of hypoperfusion. NIRS values should be interpreted as trends along with echocardiographic findings to guide goal directed interventions.
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Cruz-Martínez R, Etchegaray A, Molina-Giraldo S, Nieto-Castro B, Gil Guevara E, Bustillos J, Martínez-Rodríguez M, Gámez-Varela A, Saldivar-Rodríguez D, Chávez-González E, Keller R, Russo R, Yepez-García E, Coronel-Cruz F, Torres-Torres J, Rojas-Macedo A, Ibarra-Ríos D, Ordorica-Flores R, Nieto-Zermeño J, Alcocer-Alcocer M. A multicentre study to predict neonatal survival according to lung-to-head ratio and liver herniation in fetuses with left congenital diaphragmatic hernia (CDH): Hidden mortality from the Latin American CDH Study Group Registry. Prenat Diagn 2019; 39:519-526. [PMID: 30980408 DOI: 10.1002/pd.5458] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate natural history of fetuses congenital diaphragmatic hernia (CDH) prenatally diagnosed in countries where termination of pregnancy is not legally allowed and to predict neonatal survival according to lung area and liver herniation. METHODS Prospective study including antenatally diagnosed CDH cases managed expectantly during pregnancy in six tertiary Latin American centres. The contribution of the observed/expected lung-to-head ratio (O/E-LHR) and liver herniation in predicting neonatal survival was assessed. RESULTS From the total population of 380 CDH cases, 144 isolated fetuses were selected showing an overall survival rate of 31.9% (46/144). Survivors showed significantly higher O/E-LHR (56.5% vs 34.9%; P < .001), lower proportion of liver herniation (34.8% vs 80.6%, P < .001), and higher gestational age at birth (37.8 vs 36.2 weeks, P < 0.01) than nonsurvivors. Fetuses with an O/E-LHR less than 35% showed a 3.4% of survival; those with an O/E-LHR between 35% and 45% showed 28% of survival with liver up and 50% with liver down; those with an O/E-LHR greater than 45% showed 50% of survival rate with liver up and 76.9% with liver down. CONCLUSIONS Neonatal mortality in CDH is higher in Latin American countries. The category of lung hypoplasia should be classified according to the survival rates in our Latin American CDH registry.
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Affiliation(s)
- Rogelio Cruz-Martínez
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | - Adolfo Etchegaray
- Unidad de Medicina Fetal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Saulo Molina-Giraldo
- Unidad de Terapia, Cirugía Fetal y Fetoscopia, División de Medicina Materno Fetal, Departmaneto de Ginecología y Obstetricia, Hospital de San José, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
| | - Belen Nieto-Castro
- Unidad de Medicina Materno-Fetal, Hospital Gineco-Obstétrico "Isidro Ayora", Quito, Ecuador
| | - Enrique Gil Guevara
- Instituto Unidad de Medicina Fetal, Peruano de Medicina y Cirugía Fetal, Lima, Peru
| | - Joaquin Bustillos
- Unidad de Medicina Fetal, Hospital CIMA San Jose, San José, Costa Rica
| | | | - Alma Gámez-Varela
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | | | | | - Rodolfo Keller
- Unidad de Medicina Fetal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Ricardo Russo
- Unidad de Medicina Fetal, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Eduardo Yepez-García
- Unidad de Medicina Materno-Fetal, Hospital Gineco-Obstétrico "Isidro Ayora", Quito, Ecuador
| | - Fausto Coronel-Cruz
- Departamento de Medicina Materno Fetal, Hospital General de México, Mexico City, Mexico
| | | | - Alejandro Rojas-Macedo
- Departamento de Neonatología, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
| | - Daniel Ibarra-Ríos
- Departamento de Cirugía Pediátrica, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Ricardo Ordorica-Flores
- Departamento de Cirugía Pediátrica, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Jaime Nieto-Zermeño
- Departamento de Cirugía Pediátrica, Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico
| | - Manuel Alcocer-Alcocer
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, Queretaro, Mexico
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Ibarra-Ríos D, Zapata-Tarres M, Villanueva-García D, Peña-del Castillo, H, Dorantes-Acosta EM, Juárez-Villegas LE. Leucemias neonatales: experiencia en el Hospital Infantil de México Federico Gómez (HIMFG). Acta Pediatr Mex 2017. [DOI: 10.18233/apm38no6pp394-4011507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCCIÓN: la leucemia neonatal (o congénita) es aquella diagnosticada en los primeros 30 días tras el nacimiento. Su incidencia se reporta en 1 a 5 por cada millón de recién nacidos vivos (corresponde a menos del 1% de las leucemias en pediatría).OBJETIVO: describir los casos diagnosticados en el Hospital Infantil de México Federico Gómez (HIMFG).PRESENTACIÓN DE LA SERIE DE CASOS: se incluyó pacientes menores de 30 días a los cuales se les realizó el diagnóstico morfológico de leucemias entre el 1º de enero de 1990 y el 1º de junio del 2012 en el HIMFG.RESULTADOS: en los 12 años del estudio se identificaron 3,061 casos de leucemias, de los cuales sólo cinco expedientes correspondieron a leucemias neonatales. Se describen tres pacientes femeninos y dos masculinos, con edad media al diagnóstico de 21 días (17-26 días), tratándose con mayor frecuencia de leucemia mieloide (LMA) en tres casos (60%) y leucemia linfoide en dos pacientes. Un caso de LMA asociado a síndrome de Down. En ningún caso se encontraron translocaciones de riesgo. Cuatro pacientes (80%) recibieron manejo para síndrome de lisis tumoral. Cuatro pacientes fallecieron con una mediana de edad de 84 días (57-176 días). El paciente que sobrevivió recibió tratamiento con doxorrubicina y metotrexate al 50% y en suúltimo seguimiento a los tres años de edad continuaba en remisión.CONCLUSIONES: la presentación de los casos corresponde a la reportada en literatura con respecto a frecuencias de leucemias linfoides y mieloides. La supervivencia global a largo plazo fue del 20% (33% para las mieloides) con un solo paciente en remisión. Este padecimiento tiene un pronóstico fatal que puede mejorar con el diagnóstico oportuno (incluso prenatal) y manejo con quimioterapia intensiva. Ésta es la serie más grande de leucemias neonatales reportada en México.
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Zapata-Tarrés M, Ibarra-Ríos D, Cruz-Rodríguez IV, Juárez-Villegas LE, Peña-Del Castillo H. [Malignant neoplasms in the neonate]. Bol Med Hosp Infant Mex 2014; 71:261-270. [PMID: 29421614 DOI: 10.1016/j.bmhimx.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 05/30/2014] [Indexed: 11/16/2022] Open
Abstract
Cancer in children has characteristics that differentiate it from other types reported in later ages. Overall survival at 3 years is up to 70% depending on the tumor studied. Major organs and systems affected are the hematopoietic system, central nervous system and sympathetic and mesenchymal tissues. The increased incidence of neonatal tumors observed in this and other studies is based on the increasing number of solid tumors (teratomas and neuroblastomas) because cases of central nervous system tumors and leukemias have remained constant. Ultrasonography is the first line of approach and can detect up to 70% of fetal anomalies. The physiology of the newborn causes the necessary multidisciplinary treatment in neoplastic disease to be modified substantially in this age group to avoid toxicity and sequelae. The most common treatment is surgery. Achieving timely diagnostic treatment options are effective in improving the survival of these patients.
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Affiliation(s)
- Marta Zapata-Tarrés
- Servicio de Oncología, Instituto Nacional de Pediatría, México D.F., México.
| | - Daniel Ibarra-Ríos
- Departamento de Neonatología, Hospital Infantil de México Federico Gómez, México D.F., México
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