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Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery is a rare congenital heart disease and a cause of myocardial ischemia during childhood. Most undiagnosed cases die in the first year of life as an extensive collateral network is essential for survival. The diagnosis requires a high index of clinical suspicion. The authors present the case of an 8-year-old black asymptomatic child referred from Cape Verde Island in order to clarify left ventricular dilatation and dysfunction with systo-diastolic turbulent flows observed at the interventricular septum. At the age of 3 months, she was diagnosed with heart failure, in the context of showing dilated cardiomyopathy. She was managed and clinically improved with anticongestive therapy, which she was still taking at the time of admission to our Center. The echocardiogram findings suggested Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery and the diagnosis was confirmed by computerized angiotomography and cardiac catheterization. The patient was successfully submitted to direct implantation of the left coronary artery into the aorta, allowing the creation of a double coronary perfusion system. This case illustrates an unusual presentation of a rare pathology that survived without a diagnosis after the first year of life. It also reinforces the importance of multimodality image screening in these cases.

RESUMOIntrodução: As infeções associadas aos cuidados de saúde constituem uma importante causa de morbi-mortalidade neonatal, levando a um aumento do tempo de internamento e consequentemente dos seus custos. O objetivo deste estudo foi avaliar a taxa de incidência de infeções associadas aos cuidados de saúde e os seus principais fatores de risco em recém-nascidos de muito baixo peso. Material e Métodos: Estudo retrospetivo dos recém-nascidos de muito baixo peso internados numa maternidade com apoio perinatal diferenciado, durante um período de 10 anos (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) ABSTRACT Introduction: Healthcare associated infections in very low birth weight infants are associated with significant morbidity and mortality and are also a cause of increased length of stay and hospital costs. The objective of this study was to evaluate the rate of healthcareassociated sepsis and associated risk factors in very low birth weight infants. Material and Methods:Retrospective observational study including very low birth weight infants hospitalized in a Neonatal Intensive Care Unit during ten years (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014). We evaluated the association between several risk factors and healthcare-associated sepsis. Results: 461 very low birth weight infants were admitted. There were 110 episodes of HS in 104 very low birth weight infants and 53 episodes of sepsis associated with central vascular catheter. The density of the sepsis was 7.5/1 000 days of hospitalization and the density of central vascular catheter -associated sepsis was 22.6/1 000 days of use. The infants with HS had lower average birth weight and gestational age (959 ± 228 g vs 1191 ± 249 g and 27.6 ± 2 vs 29.8 ± 2.2 weeks), p < 0.001. After adjusting for birth weight and gestational age we verified an association between healthcare-associated sepsis and antibiotic therapy in D1, the duration of parenteral nutrition and central vascular catheter. After logistic regression only the gestational age and duration of parenteral nutrition remained as independent significant risk factors for healthcare-associated sepsis. Discussion: The independent factors for healthcare-associated sepsis are gestational age and duration of parenteral nutrition. Conclusion: For each extra week on gestational age the risk declined in 20% and for each day of NP the risk increased 22%. Keywords: Cross Infection; Infant, Low Birth Weight; Risk Factors; Sepsis. INTRODUÇÃOAs infeções associadas aos cuidados de saúde (IACS) constituem um problema grave e temível nas unidades de cuidados intensivos neonatais, estando associadas ao aumento da morbi-mortalidade, do tempo de internamento e dos seus custos. 1,2As taxas de IACS neonatais com gravidade associada, como sépsis, reportadas em estudos internacionais variam entre 0,1% nos recém-nascidos de termo e 21-30% nos recém-nascidos de muito baixo peso (RNMBP), tendo uma relação inversamente proporcional ao peso ao nascimento. 1,3Nos últimos anos, os avanços técnicos e a melh...

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SUMMARYA previously well 4-year-old boy presented to the emergency room with progressive cyanosis, pallor and vomiting over the last 5 h. Oxygen saturation on pulse oximetry was 87-89% despite 9 L/min of supplemental oxygen. He was tachypnoeic and had a systolic heart murmur, with no other findings on clinical examination. In his medical history, there was record of a restrictive atrial septal defect, with a normal echocardiogram from 3 years before. He had no relevant family history. His shoes appeared to have been recently painted, which raised the suspicion of methaemoglobinaemia, presumptively caused by aniline-containing shoe dye. The shoes were removed promptly and his feet washed profusely. After confirming the diagnosis, methylene blue was started. The level of methaemoglobin decreased rapidly and the boy made a full recovery. BACKGROUND