Alteraciones extremas del sodio durante el periodo neonatal: presentación de dos casos

Resumen: Objetivo: Resaltar la importancia durante el periodo neonatal de las alteraciones del sodio que pueden llevar a situaciones extremas que pongan en compromiso la vida del paciente y supongan un desafío terapéutico. Casos clínicos: Presentamos 2 casos con alteraciones extremas del sodio.1°: Recién nacido a término de 17 días con deshidratación hipernatrémica: pérdida de peso del 32% respecto al nacimiento. Cifra máxima de sodio 195 mmol/L. Fallo multiorgánico con necesidad de soporte en oxigenación por membrana extracorpórea (ECMO) y hemodiafiltración.2°: Recién nacido prematuro de 31 semanas con cifra de sodio de 95 mmol/L a los 15 días de vida sin otra sintomatología acompañante. Precisa reposición hidroelectrolítica lenta intravenosa. Resultado: Buena evolución clínica. El caso 1 presenta un desarrollo psicomotor adecuado (actualmente 18 meses). El caso 2 presenta a los 7 años parálisis cerebral con diplejía espástica. Desde nacimiento presentaba lesiones compatibles con leucomalacia periventricular. Conclusiones: El periodo neonatal es probablemente el periodo de la vida con mayor riesgo de presentar alteraciones hidroelectrolíticas. Es importante realizar un seguimiento estrecho de la pérdida ponderal en los recién nacidos en los primeros días de vida para prevenir la deshidratación hipernatrémica, así como monitorizar los niveles de sodio en los recién nacidos prematuros. Las alteraciones severas de la natremia son una urgencia vital que puede requerir tratamientos avanzados para conseguir una supervivencia con mínimas secuelas. Abstract: Aim: To highlight the importance of sodium changes during the neonatal period, which can lead to extreme situations that pose therapeutic challenges and compromise patient lives. Case report: We present 2 cases with extreme sodium alterations.1st: A 17 day old full term newborn with hypernatremic dehydration: 32% of weight loss compared to birth weight and maximum sodium of 195 mmol/L. He suffered multiorgan failure requiring ECMO support and haemodiafiltration.2nd: A 31 week premature newborn with a sodium level of 95 mmol/L at 15 days of life without other accompanying symptoms. He required slow intravenous hydroelectrolytic replacement. Results: Good clinical evolution. Case one presents adequate psychomotor development (currently 18 months). Case two presents cerebral palsy with spastic diplegia at 7 years of age. From birth she presented cerebral injuries compatible with periventricular leukomalacia. Conclusions: The neonatal period is probably the period of life with the highest risk for hydroelectrolytic alterations. It is important to perform a strict weight control in newborns during their first days of life to prevent hypernatremic dehydration. It is also important to monitor sodium levels in preterm infants. Severe changes in natremia are a vital emergency that may require advanced treatments in order to achieve survival with minimal sequelae

Neonatal Infection Due to SARS-CoV-2: An Epidemiological Study in Spain

Objective: Coronavirus disease 2019 (COVID-19) cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to increase worldwide. Although some data from pediatric series are available, more evidence is required, especially in neonates, a group with specific characteristics that deserve special attention. This study aimed to describe general and clinical characteristics, management, and treatment of postnatal-acquired (community and nosocomial/hospital-acquired) COVID-19 neonatal cases in Spain. Methods: This was a national prospective epidemiological study that included cases from a National Registry supported by the Spanish Society of Neonatology. Neonates with postnatal SARS-CoV-2 infection were included in this study. General data and infection-related information (mode and source of transmission, age at diagnosis, clinical manifestations, need for hospitalization, admission unit, treatment administered, and complementary studies performed, hospital stay associated with the infection) were collected. Results: A total of 40 cases, 26 community-acquired and 14 nosocomial were registered. Ten were preterm newborns (2 community-acquired and 8 nosocomial COVID-19 cases). Mothers (in both groups) and healthcare workers (in nosocomial cases) were the main source of infection. Hospital admission was required in 22 community-acquired cases [18 admitted to the neonatal intermediate care unit (NIMCU) and 4 to the neonatal intensive care unit (NICU)]. Among nosocomial COVID-19 cases (n = 14), previously admitted for other reasons, 4 were admitted to the NIMCU and 10 to the NICU. Ten asymptomatic patients were registered (5 in each group). In the remaining cases, clinical manifestations were generally mild in both groups, including upper respiratory airways infection, febrile syndrome or acute gastroenteritis with good overall health. In both groups, most severe cases occurred in preterm neonates or neonates with concomitant pathologies. Most of the cases did not require respiratory support. Hydroxychloroquine was administered to 4 patients in the community-acquired group and to 2 patients in the nosocomial group. Follow-up after hospital discharge was performed in most patients. Conclusions: This is the largest series of COVID-19 neonatal cases in Spain published to date. Although clinical manifestations were generally mild, prevention, treatment, and management in this group are essential