RESUMENLa descripción de la úlcera de Bednar es escasa en la literatura actual. Se ha relacionado con el efecto traumático de la tetina del biberón y/o chupetes no ortodóncicos durante la lactancia. Presentamos a un recién nacido de 20 días de vida que acudió a Urgencias por irritabilidad y se asoció, como único hallazgo al momento de la exploración física, dos úlceras bucales. Describimos la presentación clínica, la evolución y el tratamiento. La normalidad de las pruebas complementarias, las características clínicas y la evolución condujeron al diagnóstico de úlcera de Bednar. Palabras clave: úlceras bucales, úlcera de Bednar, úlcera pterigoidea, patología bucal, recién nacido. ABSTRACTThe description of the Bednar's ulcer is uncommon in the current literature. It has been associated with the traumatic effect of the bottle's nipple and/or no orthodontic soothers while breastfeeding. We present a newborn of 20 days of life attended at the emergency room for irritability, with the only finding on physical examination of two oral ulcers. We describe the clinical presentation, evolution and treatment. The normality of the diagnostic test, clinical characteristics and evolution lead to the diagnosis of Bednar´s ulcer.
Arch Argent Pediatr 2011;109(4):e85-e87 / e85Presentación de casos clínicos RESUMEN Actualmente, Streptococcus grupo A es una causa infrecuente de infección en el período neonatal. La descripción de casos de infección grave en el recién nacido es esporádica. Presentamos un recién nacido de 12 días de vida que acudió al servicio de urgencias por síndrome febril sin foco, que durante su ingreso desarrolló afectación neurológica y sistémica. Describimos la presentación clínica, la evolución y el tratamiento. El aislamiento de Streptococcus grupo A en el hemocultivo confirma la sepsis tardía por este germen con probable meningitis asociada. Palabras clave: Sepsis, infección neonatal, Streptococcus pyogenes, meningitis, recién nacido. SUMMARYCurrently, the group A Streptococcus is a unusual cause of infection in the neonatal period. The description of cases of severe infection in the newborn is sporadic. We present a 12-days-old newborn attended at the emergency room for fever without focus, which developed neurological and systemic involvement during admission. Clinical presentation, evolution and treatment are described. Blood culture isolation of group A Streptococcus confirmed late sepsis by this bacteria, probably with associated meningitis.
Objectives: To study the reliability of a transcutaneous bilirubinometer (Bilicheck) to determine bilirubin levels in neonates consulting for jaundice in a Paediatric Emergency Department (ED), and to evaluate its usefulness as a screening method. Methods: Prospective observational study realized between June of 2005 and December of 2005 in neonates consulting at a paediatric emergency department for jaundice, in whom we realized both transcutaneous and total serum bilirubin measurements (TcB and TSB). We collected demographic variables, analytical variables (serum and transcutaneous bilirubin levels), length of stay in the ED, and need for treatment. Results: 66 children were included aged 2 to 31 days (81% of the sample were 2 to 7 days old). There was a close and statistically significant correlation between TcB and TSB (r = 0.81, p < 0.001). The area under the ROC curve was of 0.90, allowing detecting newborns with jaundice susceptible of treatment with TcB levels ≥ 13 mg/dL (sensitivity 92%, specificity 63, 5%, a positive predictive value 39% and a negative predictive value 97%). The number of venous punctures could be reduced in 50%. The medium stay in the ED was of 2 hours when performing serum measurements. Conclusions: A linear correlation exists between TcB-TSB. TcB measurement cannot replace that of TsB, however it could be used as a screening method in an ED to determine which neonates need confirmation by TsB measurement. The use of transcutaneous bilirubinometer would reduce both the number of painful interventions in neonates and the medium length of stay in ED, consequently reducing iatrogenesis.
Presentación de casos clínicos RESUMEN La transfusión feto-materna es el paso de eritrocitos fetales a la circulación materna. Cuando es masiva, tiene una incidencia aproximada del 0,2-0,9 ‰. Generalmente, se desconoce el agente desencadenante, pero, en ocasiones, se pueden identificar factores de riesgo. En el embarazo, suele ser asintomática; el síntoma más frecuente es la disminución de los movimientos fetales (el 26 %) en relación con la anemia grave. Se diagnostica mediante la detección de hemoglobina fetal en la sangre materna (test de Kleihauer o citometría de flujo). Se presenta a un recién nacido con anemia crónica secundaria a la transfusión fetomaterna, que, después del tratamiento con transfusión de concentrado de hematíes, tuvo como complicación síntomas de sobrecarga de volumen y empeoramiento clínico. Tras la realización de una exanguinotransfusión, evolucionó favorablemente, sin secuelas.
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