Introduction: The infection of a cephalohematoma is an infrequente but potentially fatal condition due to its possible complications such as osteomyelitis, meningitis or sepsis.

Case report: The report describes a newborn delivered by cesarean section, and a history of duodenal atresia with surgical correction, who develops, at 8 days of life, an infection of a cephalohematoma with sepsis and meningitis. After aspiration of the cephalohematoma and a three week course of antibiotics, she showed a favorable outcome.

Conclusion: When the infection of a cephalohematoma is suspected, its drainage is both a diagnostic and therapeutic tool, as antibiotic therapy alone is often insufficient. Possible complications such as meningitis, osteomyelitis and sepsis must be ruled out.

C. Cortés Ledesma. Departamento de Neonatología. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo, 46. 28007 Madrid.
Correo electrónico: crispucortes@gmail.com

Introduction: The postnatal period is important for intestinal microbiota establishment, which is involved with the intestinal development, prevention of pathogens colonization, digestion and synthesis of nutrients, as well as immune and neuronal systems maturation. Intestinal colonization takes place during the first days of life, being influenced by the method of delivery, type of lactation, and the environment. Furthermore, the microbiota composition and functionality might be influenced by maternal and neonatal diet. The objective of this review was to present scientific evidence published during the last years regarding the role of delivery methods, type of lactation, supplementation with pre and probiotics on neonatal intestinal microbiota composition.
Methods: In this work, more than 19 articles published dur­ing the last 15 years and obtained from different specialized databases (NCBI, Web of Science, Elsevier Journal, Science Direct) are included. We have analysed studies related to humans.
Results: The method of delivery and type of lactation might modify the intestinal microbiota in new-borns. Supplementation with probiotics increased the Bifidobacterium and Lactobacillus genera. More studies are needed to evaluate the effects of probiotics in the development and functionality of intestinal microbiota in the newborns. Supplementation with prebiotics may induce the production of secondary metabolites that are able to modulate the newborn epigenome's.
Conclusions: More studies are needed to elucidate the exact mechanisms that modifies in the microbiota composition and describe personalized nutritional strategies to enhance the newborn development.

Introduction: Congenital lung malformations are rare and generally have an asymptomatic development in the neonatal period. The detection of this condition is done by antenatal studies and it is later confirmed at birth with imaging tests. Although an expectant attitude towards asymptomatic patients may be adopted, the recommendation is to perform a surgical resection programmed between 3-6 months of life, given the serious complications these patients can suffer.
Clinical cases: This study presents 4 cases of congenital lung malformations –detected antenatally in our center in the last 6 years– focusing on their diagnosis, characteristics and further development.
Results: All four cases were unilateral malformations detected antenatally by the second quarter ultrasound, of which three were also detected by nuclear magnetic resonance. One of them was a hybrid lesion (congenital malformation of the lung-pulmonary sequestration) associated with an intralobar sequestration in the contralateral lung. Only one of the cases presented respiratory distress at birth, the others being asymptomatic. The chest-X-ray and axial tomography (CT) done postnatally confirmed the diagnosis in three of the patients; the fourth patient was diagnosed after a CT showed bronchial atresia, despite having a normal chest-X-ray. Lobectomy was performed on the patient with neonatal distress and the patient with the hybrid lesion, who had had a pulmonary infection at 3 months of life.
Conclusions: This study provides 4 cases of exceptional observation. Congenital lung malformation is a potentially serious pathology, so it is important for all pediatricians to know about it. Thus, a multidisciplinary involvement is needed so as to unify criteria in order to provide patients with the best specialised care.

Background: Persistent pulmonary hypertension of the newborn is a complex, multifactorial clinical syndrome, associated with primary and secondary cardiopulmonary diseases. It is responsible for 2% of the admissions to the newborn intensive care unit.

Material and methods: A review of the recent literature (up until September 2004) in basic and clinical science, indexed in Medline, that mentions the MeSh term "Persistent pulmonary hypertension of the newborn" in basic and clinical science.

Results: In all, we selected 87 articles that provide information on the epidemiology, pathogenesis, diagnostic criteria, etiology, clinical features, differential diagnosis, treatment and prognosis of persistent pulmonary hypertension of the newborn.

Conclusions: The main objective of the treatment of newborns with persistent pulmonary hypertension is to lower the peripheral vascular resistance, while maintaining the blood pressure and the cardiac output. It may be associated with significant respiratory and neurological morbidity. The mortal¬ity rate ranges between 10% and 40%.

Introduction: Arthrogryposis multiplex congenita (AMC) is a term used to describe a disorder characterized by multiple, nonprogressive joint contractures at birth. The classic form of peripheral AMC, referred to as amyoplasia, is always sporadic. In neurogenic arthrogryposis, the most frequent form (90%), the initial injury would be in the anterior horn cells of the spinal cord, the nerve roots or the peripheral nerve.

Case reports: We report the cases of two newborns who pre¬sented similar clinical signs of amyoplasia. One had joint contractures, muscle atrophy and incontinence. The other had flaccid paraplegia with muscle atrophy in lower limbs and abdominal muscle atony. Both mothers had consumed cocaine during pregnancy. In both patients, neurophysiological exam¬ination demonstrated denervation at different levels of spinal cord.

Discussion: Necrosis of the fetal spinal cord caused by systemic hypotension has been postulated as a cause of amyoplasia. The mechanism of cocaine-related cerebrovascular accidents in adults is probably related to adrenergic stimulation, cerebral vasoconstriction and a sudden surge in blood pres¬sure. In our two cases, the clinical findings reported at birth were due to denervation at different levels of the spinal cord. Therefore, the defects in our patients may be associated with maternal use of cocaine during pregnancy, producing small vessel vasoconstriction and vascular disruption in the fetal spinal cord.

We report a case of neonatal osteoarthritis in a 21-day-old girl who had required hospital admission at birth. This disease is uncommon in infants, but is of great importance because of the marked medium-term and long-term impact associated with delayed diagnosis and treatment. Therefore, this entity should not be overlooked in those newborns in whom there is clinical evidence, although nonspecific, of pain on joint movement or inexplicable crying, especially in those who have been subjected to hospital admission and those who have undergone techniques such as venipuncture. Early medical and/or surgical treatment improves the long-term results, reason for which it is so important.

Introduction: The incidence of staphylococcal scalded skin syndrome among newborn infants seems to be increasing in recent years.

Methods: We review the cases of neonatal staphylococcal scalded skin syndrome followed at our hospital over the last 10 years (1997-2006).

Results: Twenty-six cases of this syndrome were diagnosed, four of them (15%) during the first month of life. All of them presented erythroderma, bullae, perioral and nasal fissures and purulent conjunctivitis. None had fever, leukocytosis or an increase in C-reactive protein. Methicillin-sensitive Staphylococcus aureus was isolated in nasal or conjunctival samples. The patients were treated with intravenous cloxacillin for a mean period of 7 days and they presented desquamation without scarring.

Conclusions: Staphylococcal scalded skin syndrome appears during the neonatal period in up to 15% of cases. Early treatment with intravenous cloxacillin results in a favorable outcome.

Hemangiomas are the most common type of hepatic vascular tumors in infants. They are nearly always benign, and most of them are diagnosed incidentally and have no clinical significance. When they produce symptoms, medical treatment, such as corticosteroid therapy, is initially recommended. If medical management fails to control symptomatic hemangiomas, they should be treated aggressively (by hepatic artery ligation, embolization, resection, etc.). We report the case of a hepatic hemangioma in a newborn infant that was resistant to medical treatment, but was successfully treated by selective hepatic artery ligation.

Enteroviral meningitis is uncommon in the newborn infant. It may be underdiagnosed because the usual laboratory tests, except that performed in cerebrospinal fluid, may be normal. Two new cases in newborn infants are reported.

Introduction: The visits to the emergency services by the newborn babies can cause a great anxiety in their parents and in the emergency department staff. As a result of a shorter postpartum hospital stay, many childcare concerns, which traditionally have been managed in newborn nurseries, are appearing in the pediatric emergency department. The parents' education is fundamental to diminish the anxiety and to solve doubts and concern, and in that form diminish the congestion in these services, costs and all the implications that this brings.

Material and methods: We performed a retrospective study of patients younger than 28 days old of life who were attended at the pediatric emergency department in 2009. Information on sex, age, time and date, parents ethnic group, referral by another medical doctor/center, cause of consultation, complementary examinations, final diagnosis, and patients admission.

Results: There were 415 visits to newborn babies. The mean chronological age was 12.5 days, 51.3 % were boys. Visits were most frequent on evening shifts, and in the months of May and December. The most frequent main complaint was jaundice (15.4%) and changes in intestinal rhythm (14.4%). 27.5% were children of immigrants. The most frequent final diagnoses were childcare concerns (35.9%) and jaundice (15.7%). Complementary examinations were not required in 70.8%.The admission rate was of 12%, most commonly due to jaundice (3.9%) and fever (1.7%).

Conclusions: The vast majority of visits were due to minor problems that did not require complementary examinations and could have been resolved in primary care centers.