RESUMO
OBJECTIVE: To describe the clinical features and outcome of pneumococcal meningitis in Jamaican children. METHODS: All patients admitted to the Bustamante Hospital for Children, during the period 1995-1999, who had pneumococcus isolated from cerebrospinal fluid (CSF) or pleocytosis in association with a blood culture isolate of pneumococcus were selected. Demographic, clinical and laboratory data were collected. RESULTS: Twenty-five (23%) of 111 patients with pneumococcal infections satisfied criteria for meningitis. The median age was 8 months (range 0.5-60 months). There were 4 (16%) cases of sickle cell disease, 2 (50%) of whom were first diagnosed during the current illness. This represents a 53-fold increased risk of pneumoccocal meningitis in patients with Sickle-cell disease based on population prevalence rates. Oxacillin resistance occurred in 3 (12%) patients, one of whom died. Mortality rate was 12% (3) with all deaths occurring in infants < 1 year. Poor outcome occurred in 36% (9) of the patients. Of the (35%) 8 survivors who had follow-up evaluation, (38%) 3 had documented hearing loss. CONCLUSIONS: Meningitis is a common clinical syndrome of invasive pneumococcal disease, occurring in 23% of cases resulting in mortality and high morbidity among Jamaican children. Local seroepidemiological studies are urgently needed to inform national vaccine decisions. As an interim plan, policymakers should consider a risk-based strategy to vaccine prophylaxis that will ensure that high risk groups such as children with sickle cell disease are offered currently available conjugate pneumococcal vaccines.
OBJETIVO: Describir las características clínicas y evolución de la meningitis meningocócica en niños jamaicanos. MÉTODOS: Se escogieron todos los pacientes que ingresaron al Hospital Infantil Bustamante, durante el período de 1995-1999, y que tuvieron pneumococos aislados del líquido cefalorraquídeo (LCR) o pleocitosis asociada con un aislado de pneumococos en un cultivo de sangre. Se recogieron los datos demográficos y clínicos, así como los datos de laboratorio. RESULTADOS: Veinticinco (23%) de los pacientes con infecciones pneumocócicas correspondían a los criterios de la meningitis. La edad promedio fue de 8 meses (rango 0.5 - 60 meses). Hubo 4 (16%) casos de anemia falciforme, 2 (50%) de los cuales fueron diagnosticados primeramente durante la enfermedad corriente. Esto representa un aumento de riesgo de meningitis meningocócica 53 veces mayor en pacientes con anemia ciclémica, teniendo en cuenta las tasas de prevalencia poblacional. Se halló resistencia a la oxacilina en 3 (12%) pacientes, uno de los cuales murió. La tasa de mortalidad fue del 12% (3), correspondiendo todas las muertes a infantes < 1 año. Resultados pobres se produjeron en (9) 36% de los pacientes. De los 8 (35%) supervivientes que tuvieron evaluación de seguimiento, 3 (38%) tuvieron pérdida de la audición documentada. CONCLUSIONES: La meningitis es un síndrome clínico común de la enfermedad pneumocócica invasiva, que tiene lugar en 23 % de los casos, y que trae por consecuencia mortalidad y una alta morbilidad entre los niños jamaicanos. Se requieren con urgencia estudios seroepidemiológicos locales a fin de tener información para las decisiones nacionales sobre las vacunas. A modo de plan provisional, los encargados de trazar las políticas deben considerar una estrategia de riesgo para la profilaxis de vacuna, a fin de asegurar que los grupos de alto riesgo, tales como los niños con anemia falciforme, puedan tener a su alcance las vacunas pneumocócicas conjugadas actualmente disponibles.
Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meningite Pneumocócica/mortalidade , Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Perda Auditiva/microbiologia , Hospitais Pediátricos/estatística & dados numéricos , Incidência , Jamaica/epidemiologia , Meningite Pneumocócica/complicaçõesRESUMO
OBJECTIVE: To describe the clinical features and outcome of pneumococcal meningitis in Jamaican children. METHODS: All patients admitted to the Bustamante Hospital for Children, during the period 1995-1999, who had pneumococcus isolated from cerebrospinal fluid (CSF) or pleocytosis in association with a blood culture isolate of pneumococcus were selected. Demographic, clinical and laboratory data were collected. RESULTS: Twenty-five (23%) of 111 patients with pneumococcal infections satisfied criteria for meningitis. The median age was 8 months (range 0.5-60 months). There were 4 (16%) cases of sickle cell disease, 2 (50%) of whom were first diagnosed during the current illness. This represents a 53-fold increased risk of pneumoccocal meningitis in patients with Sickle-cell disease based on population prevalence rates. Oxacillin resistance occurred in 3 (12%) patients, one of whom died. Mortality rate was 12% (3) with all deaths occurring in infants < 1 year. Poor outcome occurred in 36% (9) of the patients. Of the (35%) 8 survivors who had follow-up evaluation, (38%) 3 had documented hearing loss. CONCLUSIONS: Meningitis is a common clinical syndrome of invasive pneumococcal disease, occurring in 23% of cases resulting in mortality and high morbidity among Jamaican children. Local seroepidemiological studies are urgently needed to inform national vaccine decisions. As an interim plan, policymakers should consider a risk-based strategy to vaccine prophylaxis that will ensure that high risk groups such as children with sickle cell disease are offered currently available conjugate pneumococcal vaccines.
Assuntos
Meningite Pneumocócica/mortalidade , Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Pré-Escolar , Feminino , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Perda Auditiva/microbiologia , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Jamaica/epidemiologia , Masculino , Meningite Pneumocócica/complicaçõesRESUMO
A retrospective chart review of the case notes of all children aged 6 months to 8 years presenting with fever and seizures to the University Hospital of the West Indies (UHWI) between January 2000 and December 2004 was conducted. Descriptive analyses were performed. Fifty-nine children (median age 1.58 years, range 0.58 to 6.83 years) were entered into the study. The main laboratory abnormalities were metabolic acidosis (23%), anaemia (10%), leukocytosis (35%) and hypomagnesaemia (3%). These were not significantly associated with meningitis or an underlying bacterial infection. There were no significant episodes of hyponatraemia, hypocalcaemia or hypoglycaemia. Meningitis was uncommon and occurred in only two (3.4%) children both younger than 16 months of age and who had other abnormal clinical signs. This study demonstrated that routine performance of haematological and biochemical investigations in children presenting with seizures and fever were of limited value. Lumbar punctures in children older than age 18 months with no other abnormal clinical signs were also found to be of low yield. Current American Academy of Paediatrics (AAP) recommendations that serum electrolytes, calcium, phosphate, magnesium, complete blood count and blood glucose should not be performed routinely in a child with a first simple febrile seizure can be safely applied to this study population.
Se llevó a cabo un estudio retrospectivo de las historias clínicas en busca de notas sobre los casos de todos los niños de 6 meses a 8 años de edad que se presentaron con fiebre y convulsiones en el Hospital Universitario de West Indies (HUWI) entre enero de 2000 y diciembre de 2004. Se realizaron análisis descriptivos. Cincuenta y nueve niños (edad mediana (1.58 años, rango 0.58 a 6.83 años) formaron parte de este estudio. Las principales anormalidades halladas mediante el laboratorio fueron: acidosis metabólica (23%), anemia (10%), leucocitosis (35%), e hipomagnesemia (3%). Éstas no estuvieron significativamente asociadas con meningitis o alguna infección bacteriana subyacente. No hubo episodios significativos de hiponatremia, hipocalcemia o hipoglicemia. La meningitis fue poco común, ocurriendo sólo en dos niños (3.4%), ambos con menos de 16 meses de edad y con otros signos clínicos anormales. Este estudio demostró que el trabajo de rutina realizado en las investigaciones hematológicas y bioquímicas en los niños que se presentaron con fiebre y convulsiones, tuvo un valor limitado. También se halló que las punciones lumbares realizadas a niños de más de 18 meses sin ningún otro signo clínico anormal, tuvieron poco valor. Las recomendaciones actuales de la Academia Americana de Pediatría (AAP) en cuanto a que las pruebas de electrolitos en suero, las mediciones de calcio, fosfato, magnesio, el conteo sanguíneo completo, y la prueba de glucosa en sangre, no deben ser realizadas rutinariamente en un niño con una primera simple convulsión febril, pueden ser aplicadas con seguridad a esta población bajo estudio.
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Acidose/diagnóstico , Anemia/diagnóstico , Febre/diagnóstico , Leucocitose/diagnóstico , Deficiência de Magnésio/diagnóstico , Convulsões/diagnóstico , Acidose/complicações , Anemia/complicações , Testes de Química Clínica , Diagnóstico Diferencial , Febre/etiologia , Testes Hematológicos , Leucocitose/complicações , Deficiência de Magnésio/complicações , Meningite , Fatores de Risco , Convulsões/etiologia , Índias OcidentaisRESUMO
OBJECTIVE: The aim of this study was to describe the epidemiology of urinary tract infection in neonates, with serious bacterial infections, admitted to the University Hospital of the West Indies. METHODS: Admission records of all neonates admitted to the neonatal unit of the University Hospital of the West Indies between January 1995 and December 2000 for sepsis evaluation were reviewed. Infants who had positive bacterial cultures were identified using laboratory records. Those satisfying the criteria for urinary tract infection were selected for detailed analysis. Demographic, clinical and laboratory data were collected using a pre-coded questionnaire. Descriptive analyses were performed. RESULTS: Fifty-one (38%) of 135 babies with positive bacterial isolates had confirmed urinary tract infection. Male: female ratio was 6:1. Common presenting features included fever (32%), poor feeding (30%) and irritability (22%). The mean white cell count was 14 ± 6.26. E coli and Klebsiella species were most frequently identified. Factors associated with a diagnosis of urinary tract infection included male gender (p < 0.001), age > 48 hours (p < 0.05) and a presenting complaint of poor feeding (p < 0.003). Imaging studies of the renal tract detected abnormalities in 5 (10.4%) neonates. CONCLUSIONS: Urinary tract infection is an important cause of serious bacterial infection in neonates affecting 1 in 3 babies with proven bacterial infection and may be the first indicator of underlying structural abnormalities. The absence of specific distinguishing clinical features makes it necessary to include urine cultures in the sepsis evaluation of neonates presenting with symptoms suggestive of sepsis.
OBJETIVO: El propósito de este trabajo fue describir la epidemiología de la infección de las vías urinarias en neonatos con serias infecciones bacterianas, ingresados en el Hospital Universitario de West Indies. MÉTODOS: Se revisaron las historias clínicas de todos los neonatos ingresados en la Unidad Neonatal del Hospital Universitario de West Indies entre enero de 1995 y diciembre de 2000 para una evaluación de sepsis. Los infantes que presentaron cultivos bacterianos positivos, fueron identificados usando los registros de laboratorio. Aquellos que satisfacían los criterios de infección de las vías urinarias, fueron seleccionados para un análisis detallado. Se compilaron datos demográficos, clínicos y de laboratorio usando un cuestionario pre-codificado. Se llevaron a cabo análisis descriptivos. RESULTADOS: Cincuenta y uno (38%) de los bebés con aislados bacterianos positivos tuvieron infección confirmada de las vías urinarias. La proporción varón:hembra fue 6:1. Las características comunes que se presentaron, incluyeron fiebre (32%), pobre alimentación (30%) e irritabilidad (22%). El conteo promedio de leucocitos fue 14 ± 6.26. Las especies identificadas con mayor frecuencia fueron E coli y Klebsiella. Los factores asociados con un diagnóstico de la infección de las vías urinarias incluyeron género masculino (p < 0.001), edad > 48 horas (p < 0.05) y quejas en cuanto a pobre alimentación (p < 0.003). Los estudios de imágenes de las vías renales detectaron anormalidades en 5 (10.4%) neonatos. CONCLUSIONES: La infección de las vías urinarias es una causa importante de seria infección bacteriana en neonatos, que afecta a 1 de cada 3 recién nacidos con infección bacteriana demostrada, y puede ser el primer indicador de anormalidades estructurales subyacentes. La ausencia de características clínicas distintivas, hace necesario que se incluyan cultivos de orina en la evaluación de la sepsis en neonatos que se presentan con síntomas que sugieren la presencia de sepsis.
Assuntos
Feminino , Humanos , Recém-Nascido , Masculino , Infecções Urinárias/epidemiologia , Hospitais Universitários , Incidência , Infecções Urinárias/diagnóstico , Índias Ocidentais/epidemiologiaRESUMO
OBJECTIVE: To determine knowledge, perception and practices of healthcare professionals at tertiary level hospitals in Kingston, Jamaica, regarding neonatal pain management. DESIGN AND METHODS: Physicians and nurses actively involved in providing neonatal care at three tertiary level hospitals were invited to participate. A 21-item self-administered questionnaire was used to obtain information on knowledge, perception and practice of neonatal pain management. Descriptive analyses were performed. RESULTS: A total of 147 healthcare workers participated giving a response rate of 85%. Male to female ratio was 1: 4.4. Nurses accounted for 76 (52%) of the respondents while 70 (48%) were physicians. Seventy-three (50%) individuals were unaware of the degree of pain neonates were capable of experiencing and only 38 (27%) knew that premature infants were capable of feeling pain. One hundred and four (71%) respondents were able to identify physiological markers of pain and most respondents were able to discriminate between painful and non-painful procedures. However, 100 (68%) respondents rarely prescribed analgesia for procedures previously rated as painful. Seventy-one (51%) respondents admitted to not using analgesia for alleviating procedural pain in neonates. Twenty-five (18%) individuals thought that the procedure was too short to require analgesic support while 41 (30%) stated that medication was not usually prescribed for procedural pain. Physician scores were significantly higher than those attained by nurses for knowledge (p = 0.003) and for pain perception (p = 0.001) but no significant differences were noted for practice (p = 0.18).> CONCLUSION : There is an overwhelming deficiency in the knowledge, perception and practice of neonatal pain management at tertiary level institutions in Kingston, Jamaica. There is the urgent need for the education of health professionals on neonatal pain management. This will in turn facilitate change in perception and eventually, along with the institution of local policies and protocols, influence practice.
OBJETIVO: Determinar los conocimientos, percepciones y prácticas de los profesionales de la salud en los hospitales de nivel terciario en Kingston, Jamaica, en relación con el tratamiento del dolor neonatal DISEÑO Y MÉTODOS: Los médicos y enfermeras comprometidos activamente en brindar atención neonatal en tres hospitales de nivel terciario, fueron invitados a participar. Se aplicó un cuestionario auto-administrado de 21 incisos a fin de obtener información sobre conocimientos, percepciones y prácticas del tratamiento del dolor neonatal. Se realizaron análisis descriptivos. RESULTADOS: Un total de 147 trabajadores de la salud participaron para una tasa de respuesta de 85%. La proporción de varones frente a hembras fue 1:4.4. Las enfermeras representaron 76 (52%) de los encuestados, mientras que 70 (48%) fueron médicos. Setenta y tres (50%) de los individuos no tenían noción del grado de dolor que los neonatos podían experimentar y sólo 28 (27%) sabían que los infantes prematuros podían sentir dolor. Ciento cuatro (71%) de los encuestados pudieron identificar los marcadores fisiológicos del dolor y la mayor parte de los encuestados pudieron discriminar entre procedimientos dolorosos y no dolorosos. Sin embargo, 100 (68%) encuestados raras veces prescribieron analgésicos para procedimientos previamente clasificados como dolorosos. Setenta y uno (51%) de los encuestados admitieron no usar analgésicos para aliviar el dolor en los procedimientos con los neonatos. Veinticinco (18%) individuos pensaron que el procedimiento era demasiado breve para requerir apoyo analgésico, en tanto que 41 (30%) plantearon que usualmente no se prescribían medicamentos para el dolor en los procedimientos. Las puntuaciones de los médicos fueron significativamente más altas que las alcanzadas por las enfermeras en relación con los conocimientos (p = 0.003) y la percepción del dolor (p = 0.001), pero no se observaron diferencias significativas en relación con la práctica (p = 0.18). CONCLUSIÓN: Existe una deficiencia abrumadora en cuanto a conocimientos, percepciones y prácticas en relación con el manejo de los dolores en neonatos en las instituciones de nivel terciario en Kingston, Jamaica. Hay una urgente necesidad de educar a los profesionales de la salud en el tratamiento del dolor en los neonatales. Esto a su vez facilitará un cambio en la percepción, y finalmente - junto con la institución de protocolos y políticas locales - influirá en la práctica.
Assuntos
Adulto , Idoso , Feminino , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Competência Clínica , Dor/diagnóstico , Dor/tratamento farmacológico , Atitude do Pessoal de Saúde , Coleta de Dados , Recém-Nascido Prematuro , Jamaica , Enfermeiras e Enfermeiros , MédicosRESUMO
OBJECTIVE: To determine knowledge, perception and practices of healthcare professionals at tertiary level hospitals in Kingston, Jamaica, regarding neonatal pain management. DESIGN AND METHODS: Physicians and nurses actively involved in providing neonatal care at three tertiary level hospitals were invited to participate. A 21-item self-administered questionnaire was used to obtain information on knowledge, perception and practice of neonatal pain management. Descriptive analyses were performed. RESULTS: A total of 147 healthcare workers participated giving a response rate of 85%. Male to female ratio was 1: 4.4. Nurses accounted for 76 (52%) of the respondents while 70 (48%) were physicians. Seventy-three (50%) individuals were unaware of the degree of pain neonates were capable of experiencing and only 38 (27%) knew that premature infants were capable of feeling pain. One hundred and four (71%) respondents were able to identify physiological markers of pain and most respondents were able to discriminate between painful and non-painful procedures. However, 100 (68%) respondents rarely prescribed analgesia for procedures previously rated as painful. Seventy-one (51%) respondents admitted to not using analgesia for alleviating procedural pain in neonates. Twenty-five (18%) individuals thought that the procedure was too short to require analgesic support while 41 (30%) stated that medication was not usually prescribed for procedural pain. Physician scores were significantly higher than those attained by nurses for knowledge (p = 0.003) and for pain perception (p = 0.001) but no significant differences were noted for practice (p = 0.18). CONCLUSION: There is an overwhelming deficiency in the knowledge, perception and practice of neonatal pain management at tertiary level institutions in Kingston, Jamaica. There is the urgent need for the education of health professionals on neonatal pain management. This will in turn facilitate change in perception and eventually, along with the institution of local policies and protocols, influence practice.
Assuntos
Competência Clínica , Dor/diagnóstico , Dor/tratamento farmacológico , Adulto , Idoso , Atitude do Pessoal de Saúde , Coleta de Dados , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Jamaica , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Médicos , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to describe the epidemiology of urinary tract infection in neonates, with serious bacterial infections, admitted to the University Hospital of the West Indies. METHODS: Admission records of all neonates admitted to the neonatal unit of the University Hospital of the West Indies between January 1995 and December 2000 for sepsis evaluation were reviewed. Infants who had positive bacterial cultures were identified using laboratory records. Those satisfying the criteria for urinary tract infection were selected for detailed analysis. Demographic, clinical and laboratory data were collected using a pre-coded questionnaire. Descriptive analyses were performed. RESULTS: Fifty-one (38%) of 135 babies with positive bacterial isolates had confirmed urinary tract infection. Male:female ratio was 6:1. Common presenting features included fever (32%), poor feeding (30%) and irritability (22%). The mean white cell count was 14 +/- 6.26. E coli and Klebsiella species were most frequently identified. Factors associated with a diagnosis of urinary tract infection included male gender (p < 0.001), age > 48 hours (p < 0.05) and a presenting complaint of poor feeding (p < 0.003). Imaging studies of the renal tract detected abnormalities in 5 (10.4%) neonates. CONCLUSIONS: Urinary tract infection is an important cause of serious bacterial infection in neonates affecting 1 in 3 babies with proven bacterial infection and may be the first indicator of underlying structural abnormalities. The absence of specific distinguishing clinical features makes it necessary to include urine cultures in the sepsis evaluation of neonates presenting with symptoms suggestive of sepsis.
Assuntos
Infecções Urinárias/epidemiologia , Feminino , Hospitais Universitários , Humanos , Incidência , Recém-Nascido , Masculino , Infecções Urinárias/diagnóstico , Índias Ocidentais/epidemiologiaRESUMO
A retrospective chart review of the case notes of all children aged 6 months to 8 years presenting with fever and seizures to the University Hospital of the West Indies (UHWI) between January 2000 and December 2004 was conducted. Descriptive analyses were performed. Fifty-nine children (median age 1.58 years, range 0.58 to 6.83 years) were entered into the study. The main laboratory abnormalities were metabolic acidosis (23%), anaemia (10%), leukocytosis (35%) and hypomagnesaemia (3%). These were not significantly associated with meningitis or an underlying bacterial infection. There were no significant episodes of hyponatraemia, hypocalcaemia or hypoglycaemia. Meningitis was uncommon and occurred in only two (3.4%) children both younger than 16 months of age and who had other abnormal clinical signs. This study demonstrated that routine performance of haematological and biochemical investigations in children presenting with seizures and fever were of limited value. Lumbar punctures in children older than age 18 months with no other abnormal clinical signs were also found to be of low yield Current American Academy of Paediatrics (AAP) recommendations that serum electrolytes, calcium, phosphate, magnesium, complete blood count and blood glucose should not be performed routinely in a child with a first simple febrile seizure can be safely applied to this study population.
Assuntos
Acidose/diagnóstico , Anemia/diagnóstico , Febre/diagnóstico , Leucocitose/diagnóstico , Deficiência de Magnésio/diagnóstico , Convulsões/diagnóstico , Acidose/complicações , Anemia/complicações , Criança , Pré-Escolar , Testes de Química Clínica , Diagnóstico Diferencial , Feminino , Febre/etiologia , Testes Hematológicos , Humanos , Lactente , Leucocitose/complicações , Deficiência de Magnésio/complicações , Masculino , Meningite , Fatores de Risco , Convulsões/etiologia , Índias OcidentaisRESUMO
A 15-year retrospective review of neonates ventilated in the main intensive care unit at the University Hospital of the West Indies was conducted. During the study period, 153 neonates were ventilated, of whom 80 (52%) survived. The most common reason for admission was respiratory distress syndrome, which accounted for 67% (102/153) of admissions, 53 (52%) of these infants survived. Improving outcome will require strategies directed at improving neonatal intensive care.
Assuntos
Hospitais Universitários , Doenças do Prematuro , Unidades de Terapia Intensiva , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido , Feminino , Mortalidade Hospitalar , Humanos , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Prematuro/mortalidade , Doenças do Prematuro/terapia , Recém-Nascido de muito Baixo Peso , Tempo de Internação , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Taxa de Sobrevida , Resultado do Tratamento , Índias Ocidentais/epidemiologiaRESUMO
There have been several reports in the literature about hypernatraemic dehydration and severe malnutrition in exclusively breastfed infants. The authors report a series of four such cases admitted to the Newborn Special Care Unit of the University Hospital of the West Indies over a seven-year period. All four were term infants who had weight loss of greater than 20of their birthweight, serum sodium levels greater than 175 mmol/L, metabolic acidosis and pre-renal failure at presentation. Three of the infants had seizures shortly after presentation. One of the infants died soon after admission to hospital, the three others had normal neurological development clinically at the time of last review.
Ha habido varios reportes en la literatura sobre deshidratación hipernatrémica y malnutrición severa en bebés amamantados exclusivamente al pecho. Los autores reportan una serie de cuatro de estos casos, ingresados en la Unidad de Cuidados Especiales para Recién Nacidos del Hospital Universitario de West Indies, a lo largo de un período de siete años. En los cuatro casos se trataba de infantes a término que habían perdido más del 20% de su peso al nacer, tenían niveles de sodio en suero superiores a 175 mmol/l, acidosis metabólica, y presentaban fallo pre-renal al ser atendidos. Tres de los bebés presentaron convulsiones poco después de ser vistos por el médico. Uno de los bebés murió poco después del ingreso al hospital, en tanto que los otros tres presentaban un desarrollo neurológico normal al momento del último examen.