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Acute neonatal appendicitis is a rare pathology, with few reports in the last 30 years. Since its clinical presentation and imaging studies are non-specific, most cases are diagnosed during a surgical pro cedure.To describe a neonatal case of acute perforated appendicitis associated with later appearance of inguinal hernia, with pre-surgical diagnosis and treated through laparoscopy.A 17-day-old preterm female newborn presented with fever, irritability, and increased milk intolerance. Physical examination showed abdominal distention, tenderness and both, abdominal X- ray and ultrasound showed compatible images with acute perforated appendicitis. Once the diagnosis was confirmed, we performed an appendicectomy through laparoscopy. Two weeks later, during an outpatient visit, we observed a bilateral inguinal hernia which was confirmed by ultrasound, and then it was surgically corrected.Acute appendicitis should be considered within the differential diagnosis in neonates with acute abdominal symptoms, mainly in premature infants. In this case, ultrasound scan allowed us to make the pre-operative diagnosis. The possible association with inguinal hernias should motivate to examine inguinal ducts during imaging assessment and surgical procedure.

Resumen Introducción: La apendicitis aguda neonatal es una patología de muy baja frecuencia, con escasos reportes en los últimos 30 años. La clínica e imágenes son inespecíficas, diagnosticándose la mayoría de las veces durante el procedimiento quirúrgico. Objetivo: Presentar un caso de apendicitis aguda perfora da en paciente prematura, con diagnóstico prequirúrgico y resolución laparoscópica, asociada a aparición posterior de hernia inguinal. Caso Clínico: Recién nacido femenino de 34 semanas que a los 17 días de vida presentó fiebre, irritabilidad y aumento del residuo lácteo. Al examen físico destacaba distensión y sensibilidad del abdomen y tanto la radiografía como ecografía abdominales eran compatibles con apendicitis aguda perforada, por lo cual ingresó a pabellón para laparoscopía. Confirmado el diagnóstico, se realizó apendicectomía. Dos semanas después en consulta ambulatoria, se evidenció y confirmó con ecografía una hernia inguinal bilateral que se corrigió quirúrgicamente. Conclusión: La apendicitis aguda debe considerarse dentro de los diagnósticos diferenciales en neonatos con clínica de abdomen agudo, principalmente en prematuros. En este caso, la ecografía permitió realizar el diagnóstico pre-operatorio. La posible asociación con hernia inguinal, debiera motivar a examinar siempre conductos inguinales durante la evaluación con imá genes y en el procedimiento quirúrgico.

Indomethacin has been useful in the treatment of patent ductus arteriosus. During the last 10 years, it has been used prophylactically to decrease the incidences of intraventricular haemorrhage and patent ductus arteriosus. Objetive: To compare 2 prophylactic protocols with a non prophylactic group. Patient and Methods: Very low birthweight newborn (VLBW) less than 1 500 g and/or less than 32 weeks gestational age, were included. A historical group without prophylaxis n = 74, born 1994-1996, group I n = 71 born 1997-99 and group 2 n = 83 born 1999-2001 were studied. Congenital heart disease, severe asphyxia, genetic disorders and major malformations were factors of exclusion. Group I were given indomethacin 0.1mg/kg iv over 30 minutes at 6, 30 and 54 hours of life. Group 2 recieved a single dose at 6 hours. All patients were evaluated with CNS ultrasound at 3, 10 and 30 days of life, with echocardiography at 7 days. Results: There were no differences in patient characteristics between the studied groups. The historic group presented PDA in 14 (18.9%), 4 requiring surgical closure and IVH in 13 (17.5%). In group 16 (8.4%) presented PDA with no surgical treatment necessary, IVH en 9.8%. In group 2, 6 (8.4%) had PDA and 13 (15.7%) had IVH. The incidence of PDA can be decreased using 3 doses or a single dose of indomethacin, 55.5% and 61.9% respectively (p < 0.01). However IVH is only reduced with 3 doses 44% vs 10.28% respectively. Conclusions: Early prophylactic use of indomethacin can decrease the incidence of PDA, a single dose is as effective as 3 doses. However to reduce the incidence of IVH 3 doses are needed. Thus the choice of which protocol should be based on therapeutic goals, the reduction in cerebral plasma flow is the main mechanism of preventing haemorrhage. These results should encourage a randomised controlled trial.