Neonatal seizures: a case report

Convulsões neonatais e grave paralisia cerebral são discutidas em um caso, no qual se registrou a evolução do edema cerebral, no período perinatal, para encefalomalácia multicística. Diagnóstico diferencial de encefalopatia hipóxico-isquêmica é considerada.Neonatal seizures and severe cerebral palsy are discussed in a clinical case, where the progress of a perinatal cerebral edema to multicystic encephalomalacia was documented. Differential diagnosis of hypoxic-ischemic encephalopathy is considered

Do our newly graduated medical doctors have adequate knowledge about neonatal resuscitation?

CONTEXT AND OBJECTIVE: Neonatal resuscitation should be part of medical school curriculums. We aimed to evaluate medical school graduates' knowledge of neonatal resuscitation. DESIGN AND SETTING: Cross-sectional study on the performance of candidates sitting a medical residency exam at Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, in 2004. METHODS: There were two questions on neonatal resuscitation. One question in the theory test aimed at evaluating basic knowledge on the initial approach towards newly born infants. The question in the practical exam was designed to evaluate the candidate's ability to perform the initial steps of resuscitation and to establish bag-mask ventilation. RESULTS: Out of 642 candidates from 74 medical schools, 151 (23.5%) answered the theory question correctly. Significantly more physicians from public medical schools in the State of São Paulo answered correctly than did those from other schools in Brazil (52.5% versus 9.2%; p < 0.05). A total of 436 candidates did the practical exam. The grades among graduates from medical schools belonging to the State of São Paulo were significantly higher than among those from other schools (5.9 ± 2.6 versus 4.1 ± 2.1; p < 0.001). The grades for the practical question among candidates who had answered the theory question correctly were significantly higher than those obtained by candidates who had given wrong answers (p < 0.05). CONCLUSION: Medical school graduates' knowledge of neonate resuscitation in the delivery room is quite precarious. Emphasis on neonatal resuscitation training is urgently needed in medical schools

Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report

CONTEXT: Central diabetes insipidus (CDI) is a rare cause of hypernatremia during the neonatal period. The diagnosis is particularly difficult in very low birth weight (VLBW) newborns. CASE REPORT: We report on a preterm newborn who presented CDI soon after birth. On the third day of life, signs of dehydration were present despite normal fluid supply. The diuresis rate was 4.4 ml/kg/h. Although the fluid supply was then increased, the dehydration continued, with hypernatremia, normal glycemia, diuresis of 7.4 ml/kg/h and urine density of 1005 mOsmol/l. Thus, a diagnostic hypothesis of diabetes insipidus was raised. A test with a nasal vasopressin analogue (dDAVP) was performed and CDI was confirmed. Reduction of the fluid supply became possible through appropriate treatment. CONCLUSION: The diagnosis of CDI is rarely made during the neonatal period, especially in VLBW newborns, because of the difficulty in detecting elevated diuresis. Persistent hypernatremia, usually accompanied by hyperthermia despite abundant fluid supply, weight loss and low urine osmolality are important signs of alert

Growth of exclusively breast-fed infants from a poor urban population

The growth of two groups of infants were evaluated, one of them exclusively breast-fed (105 infants) and the other exclusively bottle-fed (61 infants), and compared with one another and with international standards (NCHS). All infants were evaluated by anthropometry at 1, 2, 3, 4, 5 and 6 months of age. A fourth order polynomial was adopted for each infant and for each anthropometric measurement in order to estimate individual growth, and the 5th, 50th and 95th percentiles for weight and length were obtained. For the age of 6 months, the weights of breast-fed boys and girls were always statistically equal to or higher than those of infants fed cow's milk or those of NCHS standards. Breast-fed boys presented significantly longer length than bottle-fed boys but shorter than NCHS standards, and breast-fed girls presented significantly shorter length than both bottle-fed girls and than NCHS standards. The greater weight of exclusively breast-fed infants when compared to NCHS standards at six months of age, which differentiates the present study from several other ones carried out in developing countries, was probably due to the association of the beneficial effects of breast-feeding with those of pediatric follow-upCrescimento de crianças exclusivamente amamentadas ao seio em população urbana pobre. O crescimento de dois grupos de crianças foi avaliado, um deles amamentado exclusivamente ao seio (105 crianças) e o outro exclusivamente de forma artificial (61 crianças), comparando-os entre si e com os padrões internacionais (NCHS). Todas as crianças foram avaliadas por antropometria nas idades de 1, 2, 3, 4, 5 e 6 meses. Adotou-se um polinômio de quarta ordem para cada criança e para cada medida antropométrica, a fim de estimar o seu crescimento individual, obtendo-se os percentis 5, 50 e 95, para peso e comprimento. Para a idade de 6 meses, os pesos de meninos e meninas em aleitamento natural foram sempre estatisticamente maiores ou iguais em relação às crianças que usaram leite de vaca ou em relação aos padrões do NCHS. Os meninos em aleitamento natural apresentaram comprimento estatisticamente superior àqueles em aleitamento artificial mas inferior aos padrões do NCHS; as meninas em aleitamento natural apresentaram comprimento estatisticamente inferior tanto em relação àquelas em aleitamento artificial quanto aos padrões do NCHS. Ressalta-se que, provavelmente, o grande sucesso obtido em relação ao peso das crianças em aleitamento materno exclusivo ainda aos seis meses de idade, diferenciando esse estudo de vários outros realizados em países em desenvolvimento, deva-se à somatório dos efeitos benéficos do aleitamento materno ao acompanhamento de Puericultur