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Introduction: Bartter syndrome (BS) is a rare inherited tubulopathy that has two presentation forms, the first one is a severe form of antenatal onset (neonatal Bartter) and the second one is a later onset form during the first years of life (classic Bartter). In the antenatal form, it manifests with fetal polyuria, polyhydramnios of early and severe onset, premature delivery, and intrauterine growth restriction. In the postnatal stage, it presents recurrent episodes of dehydration and electrolyte imbalance that can compromise the survival of the patient. Objective: To report a clinical case of neonatal BS and a review of the literature. Clinical Case: Premature newborn of 35 weeks of gestation with history of severe polyhydramnios diagnosed at 27 weeks of gestation, without apparent cause. From birth, the patient presented polyuria and hypokalemic metabolic alkalosis making a diagnosis of Neonatal Bartter Syndrome in the first week of life. Laboratory tests confirmed urinary electrolyte losses. The patient was treated with strict water balance and sodium and potassium supplementation, achieving weight and electrolyte imbalance stabilization. The patient remains in control in the nephrology unit, with potassium gluconate and sodium chloride supplementation. At the fourth month, ibuprofen was added as part of treatment. At the seventh month of life, renal ultrasound showed nephrocalcinosis. At one year of life, profound sensorineural hearing loss was observed requiring a cochlear implant. Conclusion: The presence of severe polyhydramnios of early onset with no identified cause should lead to suspicion of neonatal BS which even when infrequent determines severe hydroelectrolytic alterations and should be treated early.

Bartter syndrome (BS) is a rare inherited tubulopathy that has two presentation forms, the first one is a severe form of antenatal onset (neonatal Bartter) and the second one is a later on set form during the first years of life (classic Bartter). In the antenatal form, it manifests with fetal polyuria, polyhydramnios of early and severe onset, premature delivery, and intrauterine growth restriction. In the postnatal stage, it presents recurrent episodes of dehydration and electrolyte im balance that can compromise the survival of the patient.To report a clinical case of neo natal BS and a review of the literature.Premature newborn of 35 weeks of gestation with history of severe polyhydramnios diagnosed at 27 weeks of gestation, without apparent cause. From birth, the patient presented polyuria and hypokalemic metabolic alkalosis making a diagnosis of Neonatal Bartter Syndrome in the first week of life. Laboratory tests confirmed urinary electrolyte losses. The patient was treated with strict water balance and sodium and potassium supplementa tion, achieving weight and electrolyte imbalance stabilization. The patient remains in control in the nephrology unit, with potassium gluconate and sodium chloride supplementation. At the fourth month, ibuprofen was added as part of treatment. At the seventh month of life, renal ultrasound showed nephrocalcinosis. At one year of life, profound sensorineural hearing loss was observed re quiring a cochlear implant.The presence of severe polyhydramnios of early onset with no identified cause should lead to suspicion of neonatal BS which even when infrequent determines severe hydroelectrolytic alterations and should be treated early.

Serious adverse events in the transition period of the newborn Introduction: The postpartum skin to skin contact (SSC) facilitates breastfeeding, newborn adaptation and the relationship between mother and child. Clinical observation of this transition period is essential. Case study: Two cases of serious adverse events produced in the postpartum SSC period are presented without identified pathology to explain the event. One case presented neurologic sequelae. Both cases were under the parents’ watch. Discussion: The literature has reported these cases during neonatal period, usually in early stage, in primiparous mothers, and often in prone position. Providing early contact between the two of them should consider a therapeutic environment and adequate clinical observation, without delegating this respon-sibility to the parents.( Key words: Skin to skin, bond, serious adverse events).Rev Chil Pediatr 2013; 84 (2): 177-181 RESUMENIntroduccion: El contacto piel a piel postparto es importante pues favorece la lactancia, la adaptacion del recien nacido y la relacion entre la madre y el hijo. La observacion clinica de este periodo de transicion es fundamental.

Neonatal encephalopathy secondary to birth asphyxia,the hypoxic ischemic encephalopathy, remains a major cause of postnatal death and neurological sequelae worldwide. Supportive therapy has been the mainstay of treatment. Recently series of multicenter clinical trials show the benefits of therapeutic hypothermia in this high risk population. The International Liaison Committee on Resuscitation (ILCOR) has recommended hypothermia as a standard of care and a beneficial therapy using the protocols followed in large clinical trials. Our objective was to develop a practical guide to be used at a national level in Chile, compatible with published protocols and standardized on an international basis, practical and compatible with the country's situation, and considering an integral management of the asphyxiated neonates, rescue and neuroprotective therapies. In summary, to establish rescue therapies, with the aim objective of support measures that promote cerebral and systemic oxygenation/perfusion, ensuring optimal cellular homeostasis, which are the basis of the rescue measures in asphyxiated neonates. Along with these rescue therapies, the objective is to perform the more beneficial neuroprotective therapy known today, hypothermia. Hypothermia should be conducted in a level 3 Neonatal Intensive Care Unit, with multidisciplinary care and standardized protocols and also multidiscipli nary follow-up and rehabilitation therapies.

1. Director Rama de Neonatologia.2. Jefe de Neonatologia Clinica Santa Maria. Docente Departamento de Pediatria, Universidad de Los Andes. 3. Jefe de Neonatologia Hospital Padre Hurtado. Profesor Departamento de Pediatria, Facultad de Medicina Universidad del Desarrollo Clinica Alemana. 4. Presidente Rama de Neonatologia. Profesor Asistente de Pediatria, Departamento de Pediatria, Pontifi cia Universidad Catolica de Chile. Servicio de Neonatologia Hospital Clinico Pontifi cia Universidad Catolica de Chile.5. Vice-Presidente Rama de Neonatologia, Profesor Adjunto, Departamento de Pediatria, Universidad de Chile Campus Occidente. Servicio de Neonatologia Hospital San Juan de Dios.6. Profesor Asistente de Pediatria, Departamento de Obstetricia y Ginecologia. Universidad de Chile Campus Centro. Miembro del Consejo de la Escuela de Medicina Universidad de Chile.

1. Presidente Rama de Neonatologia, Jefe de Neonatologia Hospital Padre Hurtado. Profesor Departamento de Pediatria,Facultad de Medicina Universidad del Desarrollo-Clinica Alemana.2. Vice-Presidente Rama de Neonatologia, Jefe de Neonatologia Clinica Santa Maria. Docente Departamento de Pediatria,Universidad de Los Andes.3. Director Rama de Neonatologia.4. Jefe de Neonatologia Hospital Felix Bulnes. Profesor Titular de Neonatologia. Universidad Mayor.5. Neonatologo, Servicio de Neonatologia Hospital Clinico Universidad Catolica de Chile. Profesor Asistente de Pediatria,Departamento de Pediatria. Pontificia Universidad Catolica de Chile.6. Neonatologo, Servicio de Neonatologia Hospital Clinico Universidad de Chile. Profesor Asistente de Pediatria,Departamento de Obstetricia y Ginecologia. Universidad de Chile.

RESUMENAntecedentes: Citomegalovirus (CMV) es la infeccion congenita mas frecuente, demostrado en el 1% de recien nacidos en paises desarrollados. Es la primera causa de sordera y alteraciones del desarrollo neuro-logico infantil. Recientes estudios han demostrado que la seropositividad no evita una reinfeccion materna ni la enfermedad congenita, por lo que la caracterizacion de la seroprevalencia permite saber si la infeccion congenita proviene mayoritariamente de primoinfeccion o de reinfeccion. Objetivos: Conocer la seropre-valencia al parto en 583 mujeres beneficiarias del Hospital Padre Hurtado durante mayo y junio del 2006. Metodos: Estudio prospectivo, observacional, en que se estudio la presencia de IgG anti CMV en sangre materna al parto. Resultados: Se obtuvo una seroprevalencia de 95%, sin casos de infeccion sintomatica al nacer. Conclusion: La seroprevalencia es elevada, lo que sugiere que la reinfeccion seria la forma principal de infeccion congenita. Un estudio en recien nacidos con cultivos virales o PCR permitiria conocer la tasa de infeccion congenita real, y no un estudio basado en seroconversion pues omitiria todos los casos que reinfeccion, que serian mayoritarios.PALABRAS CLAVE: Citomegalovirus congenito, tamizaje, serologia, prevalenciaSUMMARYBackground: Cytomegalovirus is the most frequent congenital infection, affecting 1% of the population in developed countries, and the leading cause of deafness and brain development abnormalities in children. Recent studies have demonstrated that seropositivity do not avoid reinfection and congenital disease. Ob-jective: To study the seroprevalence in 583 pregnant women at delivery at Padre Hurtado Hospital, during 2006. Methods: Prospective, observational study, in which maternal blood at delivery was studied for the presence of anti CMV IgG. Results: There was 95% seroprevalence, without any case of symptomatic infec-tion. Conclusion: The high prevalence supports that most of the cases of congenital disease would occur in seropositive women, supporting that reinfection is the main way of neonatal compromise. This supports that a study with direct detection in liveborns would be suitable to reveal the impact of cytomegalovirus in our population and not that of seroconversion. KEY WORDS: Congenital cytomegalovirus, screening, serology, prevalence

RESUMENLa tasa de cesareas en Chile se ubico entre las mas altas del mundo en el ano 2000: 39% a 83% enla practica privada y 20% a 28% en los hospitales publicos. El objetivo de nuestro estudio es comunicarel impacto que ha tenido en la tasa de cesareas y el resultado neonatal la aplicacion de Guias Clinicas parael manejo del trabajo de parto y monitoreo fetal. Entre el 1 de enero de 1999 y el 31 de diciembre de 2004,la tasa global de cesareas del periodo fue de 23,2% y la tasa de forceps oscilo entre 7,5 y 9,7%. Laincidencia de encefalopatia hipoxico-isquemica (EHI) para el periodo de estudio fue de 3,5/1.000 nacidosvivos, con una progresiva tendencia a la disminucion. Las tasas de cesarea y de EHI son comparables alas reportadas en la literatura internacional. Luego de revisar la literatura, esta es la primera comunicacionnacional sobre el impacto de Guias Clinicas en la atencion del parto.PALABRAS CLAVES: Tasa de cesareas, encefalopatia hipoxico-isquemica, trabajo de partoSUMMARYCesarean section rate in Chile is one of the highest in the world: 39% - 83% in private practice and 20%- 28% in the public health system. The aim of this report is to communicate the impact of a standardizedmanagement based in Clinical Guidelines for labor management and fetal monitoring. From January 1, 1999through December 31, 2004, the cesarean section rate in the institution was of 23.2%. The incidence ofhypoxic-ischemic encephalopathy (HIE) was of 3.5/1000 live born. These rates are comparable to thereports in international references. To our knowledge, this is the first report in our country regarding theimpact of the application of Clinical Guidelines for labor management.KEY WORDS: Cesarean section rate, hypoxic-ischemic encephalopathy, labor