No abstract

Background Prenatal penetrating gunshot trauma represents a challenging scenario for healthcare providers. Trauma is the leading non-obstetric cause of morbidity and mortality during pregnancy, and even though rare, firearm injuries have the most fatal outcomes and higher fetus mortality rates. Understanding the mechanism of injury in order to identify the possible injuries and adequate management is essential. In this paper, we discuss the case of a newborn with prenatal gunshot trauma, the treatment used, and the outcome of conservative and minimally invasive management. Case presentation We present the case of a male newborn, 37 weeks of gestational age and weighing 3050 g, delivered through an emergency cesarean section with prenatal gunshot trauma. Two skin wounds were found, one in the arm and another in the left thoracic region. The patient presented with respiratory distress, bilateral pneumothorax, and pneumoperitoneum, requiring high-frequency mechanical ventilation and the placement of bilateral thoracic drains. The pneumoperitoneum was attributed to pulmonary barotrauma, with no suspicion of abdominal hollow viscera lesion. A right thoracoscopy was performed after 24 h of conservative management for the removal of the foreign body. Both the mother and the baby had a positive outcome, with no further treatment needed. Conclusions For the improvement in the result of trauma events, an adequate intervention and coordinated efforts from multidisciplinary clinical and surgical teams are required. For gunshot wounds, entry, trajectory, the final position of the bullet, and pathological findings in images need to be analyzed before taking the patient to the operative room. Chosen with strict selection criteria, some patients could benefit from conservative management.

We present a set of female thoracoomphalopagus conjoined twins who were separated at ten months of age. Tissue expanders were used to expand the available soft tissue to cover the defect. The abdominal wall was closed by making a release incision on the outer aspect of the anterior sheath of the rectus muscle, detaching the anterior sheath of the muscle fibers, and flipping it over towards the midline. Meshes of decellularized collagen matrix were used to close the thorax. They had no major complications and were discharged from the hospital 60 days later. The girls are currently 5 years old and lead a normal life according to their age. We believe that the use of tissue expanders combined with the mobilization of aponeurotic flaps through discharge incisions adds a useful tool for the treatment of these patients.

South America should be familiar with these clinical presentations and with the different risk factors of Amazonian Toxoplasmosis.

In recent years, admission of critical newborn infants (NBIs) to the neonatal intensive care unit of Hospital Garrahan (HG) has been limited due to the hospitalization of infants younger than 30 days old through spontaneous demand for services. This is probably a multifactorial situation, and one of its causes is a lack of regionalization, which results in an inadequate use of resources or a distorted use of resources intended for more complex care. The objective of this study was to establish the profile of NBIs who make a spontaneous demand for services at HG and to assess the level of care required based on their medical condition. Material and methods. Cross-sectional study. All infants ≤ 30 days old who sought care at HG in a period of 12 months were assessed. The analysis included clinical characteristics of NBIs, prior visits, parental reason for consultation at HG, and whether NBIs could have been seen at a primary or secondary care facility. Results. A total of 307 consultations were analyzed; NBI age was 18 days ± 7.6. Of these, 78% required hospitalization. The most common reason for hospitalization was acute respiratory tract infection. Thirty-five percent had health insurance coverage; 54% had sought care more than once at a different facility. Only 15% of NBIs had a highly complex condition that should have actually been solved at HG. Conclusion. Based on the analysis of NBIs seen at HG through spontaneous demand for services, a high requirement of hospitalization for low and medium complexity pathologies was observed.