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Iglesias-Deus A, Pérez-Muñuzuri A, López-Suárez O, Crespo P, Couce ML. Tension pneumocephalus induced by high-flow nasal cannula ventilation in a neonate. Arch Dis Child Fetal Neonatal Ed 2017; 102:F173-F175. [PMID: 28213557 DOI: 10.1136/archdischild-2015-309777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/08/2016] [Accepted: 09/25/2016] [Indexed: 11/04/2022]
Abstract
The use of high-flow nasal cannula (HFNC) therapy as respiratory support for preterm infants has increased rapidly worldwide. The evidence available for the use of HFNC is as an alternative to nasal continuous positive airway pressure (CPAP) and in particular to prevent postextubation failure. We report a case of tension pneumocephalus in a preterm infant as a complication during HFNC ventilation. Significant neurological impairment was detected and support was eventually withdrawn. Few cases of pneumocephalus as a complication of positive airway pressure have been reported in the neonatal period, and they all have been related to CPAP. This report reinforces the need to be aware of this rare but possible complication during HFNC therapy, as timely diagnosis and treatment can prevent neurological sequelae. We also stress the importance of paying close attention to flow rate, nasal cannula size and insertion, and mouth position, and of regularly checking insertion depth.
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Affiliation(s)
- Alicia Iglesias-Deus
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago, IDIS (Health Research Institute of Santiago de Compostela), Santiago de Compostela, Spain
| | - Alejandro Pérez-Muñuzuri
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago, IDIS (Health Research Institute of Santiago de Compostela), Santiago de Compostela, Spain
| | - Olalla López-Suárez
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago, IDIS (Health Research Institute of Santiago de Compostela), Santiago de Compostela, Spain
| | - Pilar Crespo
- Neonatal Unit, Department of Pediatrics, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Maria-Luz Couce
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago, IDIS (Health Research Institute of Santiago de Compostela), Santiago de Compostela, Spain
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Iglesias-Deus A, Campos F, Correa-Paz C, Sobrino T, Fraga JM, Castillo J, Couce ML. Hepatic damage and glutamate oxaloacetate transaminase elevations during fetal asphyxia. Dev Med Child Neurol 2017; 59:233-234. [PMID: 28044319 DOI: 10.1111/dmcn.13310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alicia Iglesias-Deus
- Neonatology Unit, Department of Pediatrics, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Clara Correa-Paz
- Clinical Neurosciences Research Laboratory, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - José María Fraga
- Neonatology Unit, Department of Pediatrics, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - María-Luz Couce
- Neonatology Unit, Department of Pediatrics, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Iglesias-Deus A, Pérez-Muñuzuri A, Urisarri A, Bautista-Casasnovas A, Couce ML. Umbilical cord and visceral hemangiomas diagnosed in the neonatal period: A case report and a review of the literature. Medicine (Baltimore) 2016; 95:e5196. [PMID: 27759656 PMCID: PMC5079340 DOI: 10.1097/md.0000000000005196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Umbilical cord hemangioma is very rare and may not be detected prenatally. However, it should be considered in differential diagnosis with other umbilical masses because it can cause significant morbidity. METHODS We report the case of a newborn referred with suspected omphalitis and umbilical hernia. RESULTS Physical examination showed an irreducible umbilical tumor, the size of olive, with dubious secretion. The initial suspected diagnosis was urachal or omphalomesenteric duct remnants. Abdominal ultrasound and magnetic resonance imaging showed an umbilical and a mesenteric mass. Tumor markers were negative. A definitive diagnosis of umbilical cord and intestinal hemangioma was established after surgical excision and histologic examination of the umbilical mass. Propranolol was prescribed due to the extent of the intestinal lesion. CONCLUSION This report highlights the diagnostic challenges of hemangiomas in unusual locations. Apart from the rarity of these tumors, few tests are available to guide diagnosis, and surgery and histologic examination are generally required for a definitive diagnosis. Finally, it is essential to rule out associated malformations and hemangiomas in other locations.
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Affiliation(s)
- Alicia Iglesias-Deus
- Neonatal Unit, Department of Pediatrics. Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela)
| | - Alejandro Pérez-Muñuzuri
- Neonatal Unit, Department of Pediatrics. Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela)
| | - Adela Urisarri
- Neonatal Unit, Department of Pediatrics. Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela)
| | | | - Maria-Luz Couce
- Neonatal Unit, Department of Pediatrics. Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela)
- Correspondence: María-Luz Couce, Neonatal Unit, Department of Pediatrics, Santiago de Compostela University Hospital, Travesía Choupana, s/n, Santiago de Compostela, Galicia, España (e-mail: )
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Pérez-Mato M, Iglesias-Deus A, Rujido S, da Silva-Candal A, Sobrino T, Couce ML, Fraga JM, Castillo J, Campos F. Potential protective role of endogenous glutamate-oxaloacetate transaminase against glutamate excitotoxicity in fetal hypoxic-ischaemic asphyxia. Dev Med Child Neurol 2016. [PMID: 26205194 DOI: 10.1111/dmcn.12851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Fetal blood contains higher concentrations of glutamate-oxaloacetate transaminase (GOT; a blood enzyme able to metabolize glutamate) than maternal blood. The aim of this study was to determine the relationship between GOT and glutamate levels in arterial blood samples from umbilical cord in control newborn infants and newborn infants with hypoxic-ischaemic insult and/or symptoms of hypoxia-ischemia after delivery. METHOD A total of 46 newborn infants (28 females, 18 males) were prospectively included in the study. Twenty-three infants (18 females, five males) were included as control participants and 23 (10 females, 13 males) were included as newborn infants at risk of adverse neurological outcome (defined as umbilical blood with pH <7.1). RESULTS Analysis of glutamate concentration and GOT activity in umbilical blood samples showed that newborn infants with pH <7.1 had higher levels of glutamate (142.4 μmol/L [SD 61.4] vs 62.8 μmol/L [SD 25.5]; p<0.001) and GOT (83.1 U/L [SD 60.9] vs 34.9 U/L [SD 18.2]; p<0.001) compared to newborn infants without fetal distress. Analysis of Apgar scores and blood pH values (markers of perinatal distress) showed that conditions of severe distress were associated with higher glutamate and GOT levels. INTERPRETATION During fetal development, the ability of GOT to metabolize glutamate suggests that this enzyme can act as an endogenous protective mechanism in the control of glutamate homeostasis.
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Affiliation(s)
- María Pérez-Mato
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Alicia Iglesias-Deus
- Neonatology Unit, Department of Pediatrics, Hospital Clinico Universitario de Santiago, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Susana Rujido
- Neonatology Unit, Department of Pediatrics, Hospital Clinico Universitario de Santiago, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Andrés da Silva-Candal
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - María-Luz Couce
- Neonatology Unit, Department of Pediatrics, Hospital Clinico Universitario de Santiago, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
| | - José María Fraga
- Neonatology Unit, Department of Pediatrics, Hospital Clinico Universitario de Santiago, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Pérez-Muñuzuri A, Couce-Pico ML, Baña-Souto A, López-Suárez O, Iglesias-Deus A, Blanco-Teijeiro J, Fernández-Lorenzo JR, Fraga-Bermúdez JM. Preclinical screening for retinopathy of prematurity risk using IGF1 levels at 3 weeks post-partum. PLoS One 2014; 9:e88781. [PMID: 24523937 PMCID: PMC3921187 DOI: 10.1371/journal.pone.0088781] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 01/16/2014] [Indexed: 11/18/2022] Open
Abstract
Following current recommendations for preventing retinopathy of prematurity (ROP) involves screening a large number of patients. We performed a prospective study to establish a useful screening system for ROP prediction and we have determined that measuring serum levels of IGF1 at week three and the presence of sepsis have a high predictive value for the subsequent development of ROP. A total of 145 premature newborn, with birthweight <1500 g and/or <32 weeks gestational age, were enrolled. 26.9% of them showed some form of retinopathy. A significant association was found between the development of retinopathy and each of the following variables: early gestational age, low birthweight, requiring mechanical ventilation, oxygen treatment, intracranial haemorrhage, sepsis during the first three weeks, bronchopulmonary dysplasia, the need for erythrocyte transfusion, erythropoietin treatment, and low levels of serum IGF1 in the third week. A multiple logistic regression analysis was used to obtain curves for the probability of developing ROP, based on the main factors linked with ROP, namely serum levels of IGF1 and presence of sepsis. Such preclinical screening has the ability to identify patients with high-risk of developing retinopathy and should lead to better prediction for ROP, while at the same time optimising the use of clinical resources, both human and material.
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Affiliation(s)
- Alejandro Pérez-Muñuzuri
- Neonatology Service, Department of Paediatrics, Clinical Hospital of the University of Santiago de Compostela, Santiago de Compostela, Spain
- * E-mail:
| | - Ma Luz Couce-Pico
- Neonatology Service, Department of Paediatrics, Clinical Hospital of the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana Baña-Souto
- Neonatology Service, Department of Paediatrics, Clinical Hospital of the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Olalla López-Suárez
- Neonatology Service, Department of Paediatrics, Clinical Hospital of the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alicia Iglesias-Deus
- Neonatology Service, Department of Paediatrics, Clinical Hospital of the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Blanco-Teijeiro
- Ophthalmology Service, Clinical Hospital of the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ramón Fernández-Lorenzo
- Neonatology Service, Department of Paediatrics, Clinical Hospital of the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José María Fraga-Bermúdez
- Neonatology Service, Department of Paediatrics, Clinical Hospital of the University of Santiago de Compostela, Santiago de Compostela, Spain
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