Propranolol en hemangiomas congénitos. Serie de casos ricArDo ávilA-reyes*, rocío isAbel cAMAcho-rAMíreZ y norA inés veláZqueZ-quintAnA

Microcephaly associated to Zika virus infection during pregnancyriCardo Ávila-reyes 1 *, Trinidad lópez-vega 2 , roCío i. CamaCHo-ramírez 1 , gabriela C. ConsTanTino-lópez 2 , laura e. guTiérrez-méndez 2 y nora i. velÁzquez-quinTana 1

Introduction: Jaundice in newborns requires precise monitoring to provide timely treatment; determination of total serum bilirubin levels is the accurate measurement. Alternatives such as transcutaneous bilirubin determination are expensive. Transcutaneous bilirubin may be evaluated by the BiliScan ® mobile phone application. Methods: A total of 59 neonates with jaundice was evaluated; total serum bilirubin levels were measured and, simultaneously, transcutaneous bilirubin was determined by the BiliScan ® mobile application for the IOS system, in two levels of luminosity (lux < 100 and lux > 100) and different skin tones. Results: The average serum bilirubin was 14.5 mg/dl, and the average with BiliScan ® was 12.2 (p < 0.001). There were differences according to the different skin tones between the serum results and BiliScan ® ; there was no positive linear correlation between both groups. Sensitivity was 63.3%, specificity 93.1%, with positive predictive value of 90.5%, and negative predictive value of 71.1%; positive likelihood value was 9.17 and negative likelihood value of 0.39. Conclusions: The BiliScan ® application was useful to measure total bilirubin non-invasively in newborns who did not require phototherapy. BiliScan ® had a moderate sensitivity to detect icteric neonates who required phototherapy. There was a positive linear correlation between serum bilirubin and bilirubin levels determined with BiliScan ® . There were no significant differences between measurements taken with high or low luminosity, or according to skin color. The average difference between serum bilirubin and BiliScan ® was 2.3 mg/dl.

Introducción: La hipotermia selectiva cefálica se emplea para el recién nacido con encefalopatía hipóxico-isquémica de moderada a severa y demuestra que la conjugación discapacidad/muerte disminuye notablemente. Caso clínico: Recién nacido con asfixia severa al nacer, con Apgar de 1-4 y que ameritó maniobras de resucitación neonatal. Gasometría con pH, bicarbonato (HCO 3 ) de 11.9, exceso de base (EB-27) y convulsiona a los pocos minutos de nacer. Se decide realizar hipotermia selectiva cefálica mediante dispositivos (gorros) con gel congelado (ice Fast ® ) y se llevó a hipotermia de 34-35 o C por 72 h. Presentó hiponatremia, hipocalcemia e hipercalemia durante la hipotermia. Sale de la hipotermia y a los 11 días se extuba y se alimenta por sonda, y posteriormente por succión. Egresa al mes de edad y se le diagnostica parálisis cerebral motora a los 8 meses. Discusión: Se efectuó hipotermia selectiva cefálica de «baja gama» por no contar con el equipo específico para el enfriamiento cefálico. La discapacidad motora fue la única secuela determinada a los 8 meses de edad. Es posible realizar hipotermia selectiva cefálica en centros hospitalarios de segundo nivel.