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The significance of meconium-stained amniotic fluid (MSAF) is discussed, both in regards to obstetric and pediatric management. The primary concerns regarding MSAF have been its significance as a sign of fetal distress/perinatal asphyxia and the prevention of associated morbidity such as meconium aspiration syndrome. The objectives of our study were: (1) To know the incidence and type of MSAF, (2) to study the associated morbidity in newborns with MSAF admitted to the Neonatal Care Unit (NCU), and (3) to analyze the perinatal differences between newborns with moderate versus thick MSAF.A retrospective study was performed to know the incidence of MSAF in all of the deliveries in our hospital during a 4 year period. The consistency of meconium was classified into 3 classes, thin (light), moderate or thick (heavy). On the other hand, a prospective analysis was undertaken to determine the morbidity of all meconium-stained neonates admitted to our NCU during this period, mainly in relation to perinatal asphyxia, pulmonary, gastrointestinal and infectious pathology and neonatal mortality.The presence of MASF complicates 18% of all of our deliveries with it being mild in 10.8%, moderate in 4.4% and severe in 2.8%. Of all newborns with MSAF, one third were admitted to the NCU, mainly for two reasons, association with perinatal asphyxia (124 cases) and observation of a risk of meconium aspiration syndrome (85 cases). The main neonatal morbidities associated with MSAF in our populations were perinatal asphyxia in 56.1% (32 cases of severe perinatal asphyxia and 92 non-severe), pulmonary pathology in 34% (meconium aspiration syndrome in 32 cases and other respiratory abnormalities in 43) and gastrointestinal pathology in 30.5% (transitory feeding intolerance in all cases). Four cases of meconium-stained neonates were exitus. The neonatal morbidity is significantly more frequent in relation to thick meconium and also if perinatal asphyxia is associated to MSAF.Although the relationship between MSAF and perinatal asphyxia is controversial, their association increases neonatal morbidity. In accordance with our results, thick meconium is implicated as a risk factor influencing the well being during the intrapartum and postpartum periods.

The objective of this study was to compare the findings of renal ultrasonography and 99mTc-DMSA renal scintigraphy in children with their first acute febrile urinary tract infection to determine which method is better in detecting patients at risk of renal injury or reflux.Thirty-three children between 0.2 and 12.3 years of age with their first acute febrile urinary tract infection were studied by means of clinical and laboratory assessment, renal ultrasonography and 99mTc-DMSA renal scintigraphy. In 24 patients (72.7%) a voiding cystourethrography was made. The patients were divided into two groups, those under 2 years of age (n = 14) and those over 2 years old (n = 19).Cortical scintigraphy showed renal changes in 23 patients (69.7%) and ultrasonography showed renal changes in 2 (6.1%; p0.05). Children over 2 years of age had a higher incidence of renal lesions than did younger children (84.2% vs 50%; p0.05). There were no differences between girls and boys. Reflux was demonstrated in 13 patients (54.2%). Among those kidneys which presented abnormal cortical scintigraphy, vesicoureteral reflux was present in 76.5% of the studies. Furthermore, of those with abnormal ultrasonography vesicoureteral reflux was present in 17.6%.We found a high incidence of renal involvement in children with their first acute febrile urinary tract infection. The cortical scintigraphy is more sensitive than ultrasonography in detecting renal changes. The incidence of vesicoureteral reflux in febrile urinary tract infection is high. When there is a renal cortical defect the risk of reflux is higher. This suggests that cortical scintigraphy should be added to the initial examination of children with their first acute febrile urinary tract infection and this could be supplemented by voiding cystourethrography alone, with ultrasonography having a secondary role.

The effects of two pharmacological alpha-2-adrenergic stimuli (clonidine and guanfacine) on GH and cortisol concentrations in the blood in a group of non-growth-hormone-deficient children with short stature was compared.Seventeen children (10 males and 7 females) with short stature (height standard deviation score: -2.3 +/- 0.5) were studied. The mean age was 9.4 +/- 2.5 years. The GH response to the clonidine or guanfacine test was positive (10 ng/ml) in all subjects.Oral clonidine test: In 14 cases (82.4%) the GH response was positive (peak value: 17.2 +/- 6.3 ng/ml) and in 3 cases (17.6%) the GH response was negative (false negatives). A significant decrease in plasma cortisol concentration was noted, from a basal level of 17.0 +/- 8.0 to 5.9 +/- 3.8 micrograms/ml at 120 minutes (p0.05). Blood pressure decreased significantly (p0.05), but without symptoms of hypotension. Somnolence was noted in 16 cases (94.1%). Oral guanfacine test: In 8 cases (47%) the GH response was positive (peak value: 14.2 +/- 3.7 ng/ml) and in 9 cases (52.9%) the GH response was negative (false negatives). A significant decrease in plasma cortisol concentration was noted, from a basal level of 14.2 +/- 6.4 to 7.2 +/- 3.7 at 90 minutes (p0.05). Blood pressure did not change and none of the patients had somnolence during the test.The alpha-2-adrenergic agonists, clonidine and guanfacine, appear to be reliable agents for testing of the growth hormone reserve of the pituitary gland. Plasma cortisol levels decreased significantly with either stimuli. The clonidine test is more sensitive than the guanfacine test and can be recommended as a definitive test for the diagnosis of classical growth hormone deficiency.