64revealed adequate intake of macro and micronutri<strong>en</strong>ts.On the examination, the pati<strong>en</strong>t was small and thin,pigm<strong>en</strong>ted skin, thyroid, lungs heart, and abdom<strong>en</strong>examination was normal. Pubertal stage was Tanner2. CBC was normal, Lev<strong>el</strong>s of glucose, total protein,albumin, globulin, calcium, phosphorus, magnesium,<strong>el</strong>ectrolytes were normal, thyroid profile was normal,IGF1 147ng/ml. sinus radiograph was normal, boneage 8 ª 6m, karyotype 46XX. Her chest X-ray showedalterations suggestive with tuberculosis injuries plus amantoux test 8mm. in spite of ziehl Ni<strong>el</strong>s<strong>en</strong> in sputumfor tuberculous bacteria negative. Therapeutic trialbegins with antituberculosis drugs, showing a growthspurt during the first months of treatm<strong>en</strong>t.Conclusions: In childr<strong>en</strong> from poor urban areas shouldbe considered non-symptomatic tuberculosis as acause of stunting and surveys to rule this pathologicalcondition.EDADPESOKg.PER-CENTILTALLAcm.EVOLUCIÓN DEL CRECIMIENTOPER-CENTILSD IMC SDV. CRE.cm/añoEDADÓSEAESTADÍOPUBERALTanner 2 M211ª1m 22
Temas <strong>libres</strong> <strong>pres<strong>en</strong>tados</strong> <strong>en</strong> <strong>el</strong> XXVI <strong>congreso</strong> peruana de pediatría - Iquitos 2010 65cansancio fácil, llanto irritable, deposiciones 8veces/ día. Exam<strong>en</strong>; Peso 2400g Talla 44cm. PC31,3, irritable, fr<strong>en</strong>te abombada, fontan<strong>el</strong>a posteriorcerrada, fontan<strong>el</strong>a anterior 2*1.5cm. CV taquicardia,no soplos. Neurológico: Llanto agudo, tono muscularincrem<strong>en</strong>tado, hiperactiva, hiperrefléxica, resto deexploración normal.Caso 2:Neonato ♂ de 15 días, EG 37 semanas, cesárea porpreclampsia, peso nacimi<strong>en</strong>to 2820g Talla 50cm PC33 cm. hijo de madre con <strong>en</strong>fermedad de Graves,diagnosticada cinco años antes, recibió I131ochomeses antes de la gestación, Dado de alta <strong>en</strong>óptimas condiciones. Es traído por agitación al lactary pres<strong>en</strong>tar más de 8 deposiciones/día.Exam<strong>en</strong> Físico: Peso 3380g Talla 51 cm. PC 34cmFC 180´FR 60´, llanto agudo, respiración superficial,fontan<strong>el</strong>a posterior cerrada, fontan<strong>el</strong>a anterior 2*1.cm. CV taquicardia. Abdom<strong>en</strong>, hígado a 2cm.Debajo d<strong>el</strong> reborde costal derecho, Neurológico:Llanto agudo, tono muscular increm<strong>en</strong>tado, resto sinalteraciones.En ambos paci<strong>en</strong>tes se inicia tratami<strong>en</strong>to conpropanolol 2mg/k/día, no requiri<strong>en</strong>do <strong>el</strong> uso de drogasantitroideas. No se aprecia <strong>en</strong> ningún mom<strong>en</strong>toefectos secundarios por <strong>el</strong> tratami<strong>en</strong>to.Conclusiones: Los recién nacidos de madrescon historia de <strong>en</strong>fermedad de Graves, deb<strong>en</strong>ser cuidadosam<strong>en</strong>te monitorizados clínica ybioquímicam<strong>en</strong>te a los 7 días de vida,La tirotoxicosis neonatal es una condición transitoria,sin tratami<strong>en</strong>to puede afectar muchos órganosy sis<strong>temas</strong>, y dejar secu<strong>el</strong>as perman<strong>en</strong>tes. Elreconocimi<strong>en</strong>to y tratami<strong>en</strong>to precoz (antitroideos,Badr<strong>en</strong>érgicos) puede prev<strong>en</strong>ir éstas.Neonatal ThyrotoxicosisABSTRACT:Introduction: Neonatal thyrotoxicosis is rare, occursin 1% of childr<strong>en</strong> of mothers with autoimmunethyroid disease (Graves disease). It is caused bytransplac<strong>en</strong>tal passage of antibodies to the TSHreceptor. Signs and symptoms (tachycardia, fetal/ neonatal, intrauterine growth retardation, pretermd<strong>el</strong>ivery, irritability, hypers<strong>en</strong>sitivity, tremors, hotand sweaty skin, fever, vomiting, diarrhea, cravingfor food, poor weight gain, vomiting, unusualfeatures: heart failure , arrhythmias and pulmonaryedema, rare features, goiter, and exophthalmos), withbiochemical evid<strong>en</strong>ce of thyrotoxicosis, usually occurin the first week of life but can may persist for threemonths or more. Untreated, has serious long-termconsequ<strong>en</strong>ces such as craniosynostosis (microcephalyand m<strong>en</strong>tal retardation). Mortality could be of 16% to25%, y. The diagnosis is confirmed by <strong>el</strong>evated lev<strong>el</strong>sof T3 and T4 total or free; and TSH decreaseCase 1:A female infant 45 days old, who was born at 34weeks by caesarean section d<strong>el</strong>ivery becausematernal thyrotoxicosis to a mother with Graves'disease (36 years) with irregular treatm<strong>en</strong>t. Herweight was 1950 grames, height 41cm.; the babygirl was hospitalized 28 days because sepsis andneonatal hyperthyroidism; the last condition wastreated with propranolol 0.75 mg./day. The motherreceived 131 Iodine at age 22; irregular treatm<strong>en</strong>tfor hyperthyroidism during the pregnancy . Fewdays after discharge from hospital is checked forpoor weight gain, restless while breastfeeding,irritable crying, and diarrhea. On examination, herweight 2400 g., height 44cm. cephalic circumfer<strong>en</strong>ce31.3cm., heart rate 160 lpm, respiratory rate 52rpm,irritable, bulging forehead, posterior fontan<strong>el</strong>le closed,anterior fontan<strong>el</strong> 2*1.5cm. tachycardia, no murmurs.Neurologic: pitched cry, increased muscle tone,hyperactive, hyperreflexic, rest of the examinationwas normal.Case 2A male neonate 15 days old, was born at full termby caesarean section because his mother dev<strong>el</strong>opedpreeclampsia; his weight was 2820g., height 50cm,cephalic circumfer<strong>en</strong>ce 33 cm. Was dischargedhealthy. Since sev<strong>en</strong> day of his life, has fast breathingand more than eight evacuations for a day. Hismother was diagnosed with Graves disease fiveyears ago. and received 131 iodine eight monthsbefore pregnancy.On examination: Weight 3380g., height 51 cm.Cefalic circunfer<strong>en</strong>ce 34cm., heart rate 180lpm,respiratory rate 60rpm., pitched cry, shallow breathing,posterior fontan<strong>el</strong>le closed, anterior fontan<strong>el</strong> 2*1.cm.tachycardia. abdom<strong>en</strong>: liver 2cm. b<strong>el</strong>ow the rightcostal margin, Neurologic: pitched cry, increasedmuscle tone, rest of examination was normal.Both pati<strong>en</strong>ts were treated with propanolol 2mg/k/día; antithyroid drugs not were necessary. No sideeffects were observed during treatm<strong>en</strong>t.Conclusions: Newborns of mothers with a historyof Graves' disease, should be clinically andbiochemically monitored at 7 days old. Neonatal
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