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GUAS NACIONALES DE NEONATOLOGA

NDICE
Pgina

GENERALIDADES
Situacin epidemiolgica actual.
Criterios de admisin.
Atencin inmediata.
Reanimacin neonatal.
Enfermera del prematuro.
Termorregulacin.
Transporte neonatal.

PROBLEMAS NUTRICIONALES Y METABLICOS

Alimentacin enteral.
Alimentacin parenteral.
Drogas y lactancia.
Trastornos de calcio, fsforo y magnesio.
Hipoglicemia.
Hiperglicemia.
Hijo de madre diabtica.
Enfermedad seo-metablica.
Errores innatos del metabolismo.

PROBLEMAS RESPIRATORIOS
Pulmn hmedo.
SDR adaptativo.
Membrana hialina.
Bronconeumona.
Sndrome aspirativo meconial.
Hipertensin pulmonar persistente.
Rupturas alveolares.
Hemorragia pulmonar.
Apnea del prematuro.
Displasia broncopulmonar.
Muerte sbita.
Ventilacin mecnica convencional.
Ventilacin de alta frecuencia.

PROBLEMAS CARDIOVASCULARES
Shock.
Cardiopatas congnitas.
Ductus arterioso persistente.
Hidrops fetal.

13
19
21
31
39
49
53

65
73
87
97
103
109
113
119
125

135
135
137
141
145
149
155
159
163
169
175
181
193

203
213
223
227

PROBLEMAS NEUROLGICOS
Asfixia neonatal.
Hemorragia intracraneana.
Convulsiones neonatales.
Disrrafia espinal.

235
245
251
257

PROBLEMAS HEMATOLGICOS E ICTERICIA

Alteraciones de la coagulacin.
Anemia.
Poliglobulia.
Hiperbilirrubinemia.

265
271
277
281

INFECCIONES
Infeccin connatal.
Infecciones virales connatales.
Infecciones nosocomiales.
Infeccin por hongos.
Infecciones parasitarias connatales.
Les congnita.
Hijo de madre VIH.
Enterocolitis necrotizante.

295
301
313
319
323
327
335
339

PATOLOGA RENAL E HIDROELECTROLTICA

Terapia de lquidos.
Trastornos renales.
Alteraciones nefrourolgicas fetales.

PROBLEMAS ENDOCRINOS
Hiperplasia suprarrenal.
Trastornos tiroideos.

347
353
365

377
381

PROBLEMAS QUIRRGICOS
Gastrosquisis y onfalocele.
Hernia diafragmtica.
Atresia esofgica.

387
393
397

PROBLEMAS OFTALMOLGICOS
Retinopata del prematuro.

403

Pgina

MISCELNEOS.
Malformaciones congnitas.
Traumatismo del parto.
Kinesioterapia en el RN.
Drogas ilcitas y embarazo.
Sedacin.

411
415
421
427
433

ASPECTOS BIOSICOSOCIALES
Enfrentamiento del duelo.
Aspectos ticos.

441
447

PROCEDIMIENTOS
Intubacin endotraqueal.
Puncin lumbar.
Cateterismo de vasos umbilicales.
Toracotomia.

453
455
457
459

ANEXOS
Listado de diagnsticos y CIE-10.
Tablas de presin arterial.
Tablas de factores de coagulacin.
Valores serie roja.

463

GUAS NACIONALES DE NEONATOLOGA

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El Ministerio de Salud se ha planteado Objetivos Sanitarios para la dcada,

en relacin a la mortalidad infantil la meta para el perodo 2000-2010 es
reducirla en un 25% a nivel nacional, lo que signica alcanzar una tasa al
2010 de 7.5 por 1000 nacidos vivos.

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EFM
QBrT
TF
EJWJEFO
JOUFSOBNFOUF
FO
WBSJPT
TFDUPSFT

DPO
FM
PCKFUP
EF
QSFTUBS
DVJEBEPT
FO
EJGFSFOUFT
OJWFMFT
EF
DPNQMFKJEBE
$PNQMFUBO
FTUPT

4FSWJDJPT
MB
6OJEBE
EF
3FDJnO
/BDJEP
*ONFEJBUP
EPOEF
TF
SFDJCF
BM
3/
Z
MB
1VFSJDVMUVSB

EPOEF
FTUg
FM
3/
TBOP
DPO
TV
NBESF
-PT
TFDUPSFT
EFOUSP
EFM
4FSWJDJP
EF
3FDJnO
/BDJEPT
TPO
q
6OJEBE
EF
5SBUBNJFOUP
*OUFOTJWP
65*

q
6OJEBE
EF
$VJEBEP
*OUFSNFEJP
6$*

q
6OJEBE
EF
$VJEBEP
.rOJNP
P
#gTJDP
&T
JNQPSUBOUF
EFTUBDBS
RVF
FM
TFDUPS
EF
3FDJnO
/BDJEP
*ONFEJBUP
OP
FT
VO
MVHBS
EF

IPTQJUBMJ[BDJwO
TwMP
EF
USBOTJDJwO
OP
NgT
EF

IPSBT

QPS
MP
RVF
VO
QBDJFOUF
RVF
SFRVJF
SB
FYgNFOFT
QSPDFEJNJFOUPT
FUD
EFCF
JOHSFTBS
B
VO
TFDUPS
EFUFSNJOBEP
EFM
4FSWJDJP

QBSB
BMMr
TFHVJS
TV
FTUVEJP
QPTUFSJPS

-B
EFDJTJwO
|MUJNB
EFM
MVHBS
EF
JOHSFTP
BM
4FSWJDJP
FT
EF
SFTQPOTBCJMJEBE
NnEJDB
-PT
TJHVJFOUFT
DSJUFSJPT
TF
SFDPNJFOEBO
QBSB
BENJUJS
B
VO
3/
FO
VOP
V
PUSP
TFDUPS

1 

1
"- / -6"-

Criterios de Ingreso:
q

q

q

q

q

q

3/
DPO
4%3
BHVEP
RVF
SFRVJFSF
PYJHFOPUFSBQJB
DPO
'J0



3/
RVF
SFRVJFSF
EF
BQPZP
WFOUJMBUPSJP
$1"1
P
7FOUJMBDJwO
.FDgOJDB

3/
DPO
JOFTUBCJMJEBE
DBSEJPDJSDVMBUPSJB
WBTPBDUJWPT

3/
DPO
TrOESPNF
DPOWVMTJWP
FO
FUBQB
BHVEB

























3/
DPO
DMrOJDB
EF
TFQTJT
ZP
NFOJOHJUJT
CBDUFSJBOB
3/
FO
TV
QPTUPQFSBUPSJP
JONFEJBUP

19

q
3/
DPO
BQOFBT
TFWFSBT
Z
SFQFUJEBT
EF
DVBMRVJFS
PSJHFO
q
3/
DPO
SJFTHP
WJUBM
EF
DVBMRVJFS
PUSB
FUJPMPHrB

Criterios de Egreso
q
3FDJnO
OBDJEP
DPO
FODFGBMPQBUrB
IJQwYJDPJTRVnNJDB
TVQFSBEB
TJO
DPOWVMTJP
OFT
q
3FDJnO
OBDJEP
DPO
JOGFDDJwO
DPOUSPMBEB
IFNPEJOgNJDBNFOUF
FTUBCMF
TJO
ESP
HBT
WBTPBDUJWBT
q
3FDJnO
OBDJEP
DPO
EJDVMUBE
SFTQJSBUPSJB
FO
SFHSFTJwO
'J0


q
3FDJnO
OBDJEP
TJO
BQOFBT
QPS
NBT
EF

IST
q
3FDJnO
OBDJEP
TJO
SJFTHP
WJUBM

1 

1
" / , "
Criterios de Ingreso:
1BDJFOUFT
QSPWFOJFOUFT
EF
MB
65*
EF
BDVFSEP
B
DSJUFSJPT
EF
FHSFTP
ZP
QBDJFOUFT
QSPWFOJFOUFT
EF
DVBMRVJFS
PUSP
TFDUPS
RVF
OFDFTJUFO
DVBMRVJFSB
EF
MPT

NBOFKPT
q
0YrHFOPUFSBQJB
DPO
'J0
NFOPS
EF

q
.POJUPSJ[BDJwO
DBSEJBDB
ZP
SFTQJSBUPSJB
ZP
TBUVSBDJwO
q
*ODVCBEPSB
P
DVOB
DBMFGBDDJPOBEB
q
'MFCPDMJTJT
q
1BDJFOUF
JOFTUBCMF
OP
DSrUJDP

1 

1
"-
-
"Criterios de Ingreso:
q
3/
RVF
OP
DVNQMB
OJOHVOP
EF
MPT
SFRVFSJNJFOUPT
BOUFSJPSFT
q
3/
QSFNBUVSP
FO
DSFDJNJFOUP
FTUBCJMJ[BEP
DPO
BMJNFOUBDJwO
FOUFSBM
DPNQMFUB

q
3/
EF
UnSNJOP
FO
CVFOBT
DPOEJDJPOFT
HFOFSBMFT
RVF
OP
SFRVJFSB
NPOJUPSJ[BDJwO

DBSEJPSSFTQJSBUPSJB
OJ
TBUVSBDJwO
QFSNBOFOUF

20

GUAS NACIONALES DE NEONATOLOGA

%,2%#)..!#)$/./2-!,

#5)$!$/3%.!4%.#).
).-%$)!4!42!.3)#).9
05%2)#5,452!
%6!,5!#).$%%$!$'%34!#)/.!,

iwVi
v 1FSrPEP
OFPOBUBM
&T
FM
QFSrPEP
DPNQSFOEJEP
FOUSF
MPT

ErBT
EF
WJEB
DBSBDUFSJ
[BEP
QPS
VOB
TFSJF
EF
DBNCJPT
DMrOJDPT
RVF
TPO
OPSNBMFT
Z
RVF
SFFKBO
MB
BEBQUBDJwO

TJPMwHJDB
wSHBOPT
Z
TJTUFNBT

B
MB
WJEB
BVUwOPNB
v
3FDJnO
OBDJEP
OPSNBM
&T
BRVFM
RVF
UJFOF

P
NgT
TFNBOBT
EF
HFTUBDJwO
Z
RVF

FTUg
MJCSF
EF
NBMGPSNBDJPOFT
DPOHnOJUBT
V
PUSB
QBUPMPHrB
v
"UFODJwO
OFPOBUBM
&T
VO
DPOKVOUP
EF
BDDJPOFT
NnEJDBT
Z
EF
FOGFSNFSrB
RVF
WJHJMBO

Z
DBVUFMBO
MB
OPSNBM
FWPMVDJwO
EF
FTUPT
DBNCJPT
q
3FBEFDVBDJwO
DBSEJPSSFTQJSBUPSJB
Z
DJSDVMBUPSJB
q
1VFTUB
FO
NBSDIB
EF
NFDBOJTNPT
EF
IPNFPTUBTJT
q
.BEVSBDJwO
EF
EJWFSTPT
TJTUFNBT
FO[JNgUJDPT

&TUF
QSPDFTP
FT
EJOgNJDP
QPS
MP
RVF
FM
DPODFQUP
EF
OPSNBMJEBE
QVFEF
WBSJBS
DPO

FM
UJFNQP
&T
JOEJTQFOTBCMF
DPOPDFS
TV
TJPMPHrB
Z
FYQSFTJwO
DMrOJDB
QBSB
QPEFS
FWBMVBS
OPSNB
MJEBE
0USPT
PCKFUJWPT
q
1FTRVJTB
PQPSUVOB
EF
NBMGPSNBDJPOFT
DPOHnOJUBT
V
PUSBT
QBUPMPHrBT
q
'PNFOUP
EFM
BQFHP
Z
QSFQBSBDJwO
QBSB
VOB
MBDUBODJB
FYJUPTB
q
"ZVEB
B
MB
NBESF
FO
MB
DPNQSFOTJwO
EF
GFOwNFOPT
TJPMwHJDPT
|OJDPT
FO
nTUF

QFSrPEP
EF
MB
WJEB
q
&EVDBDJwO
B
MPT
QBESFT
FO
DVJEBEPT
QPTUFSJPSFT
EF
TV
IJKP

21


/
$ " /" 

 /"
Objetivos principales:
v
%FUFDDJwO
Z
FWBMVBDJwO
EF
SJFTHPT
EF
BEBQUBDJwO
DBSEJPSSFTQJSBUPSJB
EFDJFOUF
EF
QSFTJwO
OFPOBUBM
v
1SFWFODJwO
EF
FOGSJBNJFOUP
FM
SFDJnO
OBDJEP
JOUFSDBNCJB
DBMPS
DPO
FM
BNCJFOUF
Z
TVT

NFDBOJTNPT
EF
SFHVMBDJwO
UnSNJDB
TPO
MJNJUBEPT

Requisitos:
v
.nEJDP
Z
QFSTPOBM
FOUSFOBEP
FO
SFBOJNBDJwO
Z
BEJFTUSBEPT
FO
USBCBKP
FO
FRVJQP
v
-VHBS
GrTJDP
BEFDVBEP
q
"NCJFOUF
UnSNJDP
OFVUSBM
q
$VOB
SBEJBOUF
q
&RVJQP
EF
SFBOJNBDJwO
EJTQPOJCMF

-BSJOHPTDPQJP
DPO
IPKBT
EF
EJGFSFOUF
UBNBvP

'VFOUF
EF
BTQJSBDJwO
DPOUSPMBEB

5&5
EF
EJTUJOUPT
DBMJCSFT

#PMTB
BVUPJOBCMF
DPO
NBTDBSJMMBT
EF
EJWFSTPT
EJgNFUSPT
$POPDJNJFOUP
QSFWJP
FO
MP
QPTJCMF
EF
BOUFDFEFOUFT
QFSJOBUBMFT

/
$ -

 *
,/"
v
3FBMJ[BS
BTQJSBDJwO
BM
BTPNBS
MB
DBCF[B
FO
q
-rRVJEP
BNOJwUJDP
DMBSP
TwMP
TJ
FT
NVZ
BCVOEBOUF
q
-rRVJEP
BNOJwUJDP
DPO
NFDPOJP
BTQJSBDJwO
TVBWF
EF
GPTBT
OBTBMFT
Z
PSPGBSJOHF
v
3FBMJ[BS
QJO[BNJFOUP
EFM
DPSEwO
q
6OB
WF[
FTUBCMFDJEP
FM
MMBOUP
DPO
P
TJO
FTUJNVMP

q
4JO
BQVSP
Tr
OBDF
EFQSJNJEP
DJBOwUJDP
&O
FTUF
DBTP
TF
EFCF
FTUJNVMBS
BOUFT
EF

MJHBS
FM
DPSEwO
QBSB
JOUFOUBS
MPHSBS
FM
MMBOUP
q
3gQJEP
OP
JOTJTUJS
FO
FM
MMBOUP
Tr
OBDF
EFQSJNJEP
WBTPDPOUSBJEP
QgMJEP

DPO
JODB
QBDJEBE
QBSB
MPHSBS
FM
MMBOUP
EFTQVnT
EF
FTUJNVMBSMP
q
&YDFQDJPOBMNFOUF
*ONFEJBUP
TPMP
TJ
IBZ

4VGSJNJFOUP
GFUBM
BHVEP
Z
OBDF
EFQSJNJEP
DPO
MrRVJEP
BNOJwUJDP
DPO
NFDP
OJP
FTQFTP

$JSDVMBS
JSSFEVDUJCMF
B
QFTBS
EF
NBOJPCSBT
QBSB
JOUFOUBS
SFEVDJS
MB
DJSDVMBS

"OFTUFTJB
HFOFSBM
Z
OBDF
EFQSJNJEP
v
-B
SFDFQDJwO
EFM
SFDJnO
OBDJEP
q "
DBSHP
EF
QFSTPOBM
DBQBDJUBEP
q
&O
TBCBOJMMB
FTUnSJM
UJCJB
q
5SBTMBEP
B
DVOB
SBEJBOUF
DPNQMFUBNFOUF
DVCJFSUP

22

GUAS NACIONALES DE NEONATOLOGA


.VFTUSB
EF
HBTFT
EF
DPSEwO
FO
DBTP
EF
SFRVFSJS
HBTFT
EF
DPSEwO
nTUPT
EFCFO
TFS

BSUFSJBMFT
SFFKBO
FTUBEP
GFUBM
4F
EFCF
DPMFDUBS
TBOHSF
VOB
WF[
DPMPDBEB
MB
QJO[B
B


DN
EF
MB
JOTFSDJwO
BCEPNJOBM
QPS
DPNQSFTJwO
QPS
FODJNB
EF
FTUB
Z
DPMPDBS
VOB
TFHVOEB

QJO[B
4F
SFBMJ[B
QVODJwO
EF
VOB
EF
MBT
EPT
BSUFSJBT
RVF
TPO
MBT
NgT
EFMHBEBT
NFOPT

UPSUVPTBT
4F
SFDPNJFOEB
EFTBSSPMMBS
QSPHSBNBT
EF
BQFHP
EFKBOEP
BM
OFPOBUP
DPO
TV
NBESF

EVSBOUF
FM
QFSJPEP
JONFEJBUP
Z
EJGFSJS
MPT
QSPDFEJNJFOUPT
RVF
B
DPOUJOVBDJwO
TF
EFUBMMBO

/
$
1
 *,"
 /"
Atencin de enfermera:
q
3FDFQDJwO
EF
TBMB
EF
1BSUP
q
&WBMVBDJwO
EFM
QSPDFTP
EF
BEBQUBDJwO
JOJDJBM
DPO
UFTU
EF
"QHBS
TF
SFBMJ[B
TJNVM
UgOFBNFOUF
DPO
MB
BUFODJwO
JONFEJBUB

q
"TQJSBDJwO
EF
TFDSFDJPOFT
TFH|O
OPSNBT
q
4FDBEP
Z
DBNCJP
EF
TBCBOJMMBT
q
4FDDJwO
Z
MJHBEVSB
EFM
DPSEwO
q
.VFTUSB
EF
TBOHSF
EF
DPSEwO
QBSB
DMBTJDBDJwO
EF
HSVQP
Z
3I
q
*EFOUJDBDJwO
DPO
CSB[BMFUF
BQSPQJBEP
q
1BTP
EF
MB
TPOEB
OBTPHgTUSJDB
q
7JUBNJOB
,
JN

NHS
BM


HST
Z
 
NHS
BM


HST
q
5FNQFSBUVSB
SFDUBM
q
"TFP
DVUgOFP
DPO
BDFJUF
FTUnSJM
NJOFSBM
q
1SPMBYJT
PDVMBS
q
"OUSPQPNFUSrB
q
3FHJTUSP
DPNQMFUP
EF
EBUPT
BOUFDFEFOUFT
EFM
SFDJnO
OBDJEP
FYgNFOFT
FGFDUVBEPT

FNJTJwO
EF
PSJOB
ZP
EFQPTJDJPOFT
SFTQPOTBCJMJEBE
DPNQBSUJEB
EF
NBUSPOB
Z
NnEJDP


/ ,",, 1

$
3FDPSEBS
RVF
BM
OBDFS
MB
UFNQFSBUVSB
DPSQPSBM
DBF
SgQJEBNFOUF
&TUP
FT
NBZPS
TJ
MB

UFNQFSBUVSB
BNCJFOUBM
FT


$
-B
DBrEB
EF
MB
UFNQFSBUVSB
TF
QSPEVDF
FO
FM
SFDJnO
OBDJEP
QPS
FWBQPSBDJwO
EFM
MrRVJEP

BNOJwUJDP
Z
QPS
SBEJBDJwO
FO
HSBO
QBSUF
-B
DBQBDJEBE
UFSNPHnOJDB
FO
MBT
QSJNFSBT
IPSBT

EF
WJEB
FT
CBKB
OP
IBZ
FOUSFOBNJFOUP

&M
FOGSJBNJFOUP
MMFWB
B
NBZPS
HBTUP
FOFSHnUJDP

SJFTHP
EF
IJQPHMJDFNJB
Z
BDJEPTJT
NFUBCwMJDB

23

Medidas preventivas.
q
"UFODJwO
Z
DVJEBEPT
EFM
SFDJnO
OBDJEP
FO
BNCJFOUF
UnSNJDP
OFVUSBM
UFNQFSBUVSB

B
MB
RVF
TF
PCUJFOF
FM
NFOPS
DPOTVNP
EF
PYrHFOP
QBSB
NBOUFOFS
TV
DPOEJDJwO

CBTBM

q
%JGFSJS
BTFP
DVUgOFP
TJ
UFNQFSBUVSB
BYJMBS

 
$
P
SFDUBM


$

1
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-

$
Caractersticas del perodo de transicin:
$BNCJPT
TJPMwHJDPT
RVF
TJHVFO
VOB
EFUFSNJOBEB
TFDVFODJB
FO
MBT
QSJNFSBT

IP
SBT
EF
WJEB
RVF
TF
NBOJFTUBO
FO
WBSJBDJPOFT
FO
MB
GSFDVFODJB
DBSErBDB
GSFDVFODJB
SFTQJ
SBUPSJB
FTUBEP
EF
BMFSUB
Z
BDUJWJEBE
NPUPSB
q
1SJNFS
QFSrPEP
EF
SFBDUJWJEBE
DPSSFTQPOEF
B
MPT
QSJNFSPT

B

NJOVUPT
EF

WJEB
Z
TF
DBSBDUFSJ[B
QPS

5BRVJDBSEJB
NBZPS
EF

YA

3FTQJSBDJwO
JSSFHVMBS

B

YA
DPO
SFUSBDDJPOFT
SVJEPT
SFTQJSBUPSJPT
Z
BMF
UFP
OBTBM

1SFTFODJB
EF
TFDSFDJPOFT
NVDPTBT
FO
MB
CPDB

5FNQFSBUVSB
DPSQPSBM
FO
EJTNJOVDJwO

-MBOUP
BDUJWJEBE
NPUPSB
q

B

IPSBT
TJHVJFOUFT

'SFDVFODJB
DBSErBDB
EJTNJOVZF
B

YA

'SFDVFODJB
SFTQJSBUPSJB

YA
P
NFOPT

&M
SFDJnO
OBDJEP
UJFOEF
B
EPSNJS
q

B

IPSBT
TJHVJFOUFT
FT
FM
TFHVOEP
QFSrPEP
EF
SFBDUJWJEBE

"VNFOUP
EF
MB
BDUJWJEBE
NPUPSB
Z
FTUBEP
EF
BMFSUB

4BMJWBDJwO

3VJEPT
IJESPBnSFPT
BVNFOUBEPT

1BTP
EF
NFDPOJP

'SFDVFODJB
DBSErBDB
MgCJM
&TUB
TFDVFODJB
TF
BMUFSB
TJ

-B
NBESF
IB
SFDJCJEP
TFEBDDJwO
P
ESPHBT
BOFTUnTJDBT

4J
FM
SFDJnO
OBDJEP
FTUg
FOGFSNP

Acciones en periodo de transicin:

q
4VQFSWJTJwO
Z
SFHJTUSP
EF
TJHOPT
WJUBMFT
UPOP
BDUJWJEBE
DPMPS
IBTUB
TV
OPSNBMJ[B
DJwO

24

GUAS NACIONALES DE NEONATOLOGA

q

q

q

q

4VQFSWJTJwO
Z
SFHJTUSP
EF
QSJNFSPT
SVJEPT
Z
FMJNJOBDJwO
EF
NFDPOJP
0CTFSWBDJwO
Z
SFHJTUSP
EF
TJHOPT
EF
QBUPMPHrB
TFH|O
QSPUPDPMP
EF
FOGFSNFSrB
5PNB
EF
NVFTUSBT
QBSB
FYgNFOFT
TJ
FTUgO
JOEJDBEPT
7BDVOBDJwO
DPO
#$(
BM


HST
Z
TJO
QBUPMPHrB

6
1

$ 




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Examen fsico:
-B
JOTQFDDJwO
EFM
SFDJnO
OBDJEP
OPT
EF
DFSDB
EFM

EF
MB
JOGPSNBDJwO
q
"DUJUVE
HFOFSBM
FYJwO
BDUJWB
Z
TJNnUSJDB
TBMWP
QSFTFOUBDJwO
QPEgMJDB
Z
DBSB

q
1JFM
VOUP
DPMPS
EFTDBNBDJwO
MBOVHP
IFNBOHJPNBT
QMBOPT
NBODIB
NPOHwMJ
DB
FSJUFNB
UwYJDP
QJFM
NBSNPSBUB
BSMFRVrO
q
0NCMJHP
Z
DPSEwO
)FSOJBT
DPMPS
O|NFSP
EF
WBTPT
q
(FOJUBMFT


.BTDVMJOPT
&TDSPUP
UBNBvP
Z
BTQFDUP
WBSJBCMF
IJESPDFMF
IJQPTQBEJB
NPTJT

'FNFOJOPT
7BSJBCJMJEBE
TFDSFDJwO
WBHJOBM
QTFVEPNFOTUSVBDJwO
IJQFSUSPB

EFM
DMrUPSJT
q
3FHJwO
BOBM
'rTUVMBT
WFSJDBS
FTGrOUFS
GPTFUB
TBDSPDPDDJHFB
GrTUVMB
QJMPOJEBM

q
&YUSFNJEBEFT


4VQFSJPSFT
QBSgMJTJT
QPMJEBDUJMJB
TJOEBDUJMJB
DMJOPEBDUJMJB

*OGFSJPSFT
$BEFSBT
TJNFUSrB
0SUPMBOJ

EFGPSNJEBEFT
QPTUVSBMFT
EF
MPT
QJFT
q
$PMVNOB
EFGPSNBDJPOFT
Z
EJTSBBT

Examen segmentario:
q
$SgOFP
EFGPSNBDJwO
QMgTUJDB
DFGBMPIFNBUPNB
TVCQFSJwTUJDP
TVCBQPOFVSwUJDP

GPOUBOFMBT
TVUVSBT
CPMTB
TFSPTBOHVrOFB
q
$BSB
BTJNFUSrB
QPTUVSBM
QBSgMJTJT

0KPT
IFNPSSBHJBT
DPOKVOUJWBMFT
QVQJMBT
SPKP
QVQJMBS

/BSJ[
FTUSJEPS
NJMMJVN
BUSFTJB
EF
DPBOBT

#PDB
EJFOUFT
GSFOJMMPT
1FSMBT
EF
&CTUFJO
NJDSPHOBUJB
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34

GUAS NACIONALES DE NEONATOLOGA


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/1
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"
"
/

1. Reanimacin con oxgeno al 100%.
v
&M
SFBOJNBS
DPO
PYrHFOP
BM

TF
IB
VTBEP
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FT
MB
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2. Cundo aspirar la trquea de un RN con lquido amnitico (LA)

con meconio?
v
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VO

EF
MPT
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FM
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3. Qu dosis de adrenalina debe usarse en la reanimacin?

q
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35

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4. Manejo de la acidosis del recin nacido con bicarbonato: con o

sin gases arteriales?
v
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5. Conducta a seguir en neonatos muy severamente asxiados.

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DROGAS PARA REANIMACIN DEL RECIN NACIDO.


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NH
DD


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36

GUAS NACIONALES DE NEONATOLOGA

2. Bicarbonato de Sodio:

4PMVDJwO
TUPDL
 
N&RNM 
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P
BM

N&RNM



%JMVDJwO
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3. Expansores de volumen:
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q
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q
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q
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EF
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q
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NMLH

3. Naloxone:
4PMVDJwO
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NHNM

%PTJT
 
NHLH
QPS
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q
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37

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38

GUAS NACIONALES DE NEONATOLOGA

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RECEPCIN EN ATENCIN INMEDIATA:

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39

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INGRESO A UTI:
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FM
USBCBKP
TJTUFNgUJDP

q
&T
DPOWFOJFOUF
WFTUJS
BM
OJvP
MP
BOUFT
QPTJCMF
EFOUSP
EF
MB
JODVCBEPSB
NBOUFOJFO
EP
TV
NPOJUPSFP
FTUSJDUP

q
&O
QSFNBUVSPT
EF
FYUSFNP
CBKP
QFTP
FT
QMBOUFBCMF
BHSFHBS
IVNFEBE
BNCJFOUBM

FO
MB
JODVCBEPSB
FTQFDJBMNFOUF
FO
MB
QSJNFSB
TFNBOB
EF
WJEB
MP
RVF
UBNCJnO

BZVEB
FO
MB
UFSNPSSFHVMBDJwO
EF
FTUF
HSVQP
EF
OJvPT
-PT
USBTUPSOPT
EF
MB
UFSNPSSFHVMBDJwO
TPO
q
)JQPUFSNJB
MB
QnSEJEB
DSwOJDB
EF
DBMPS
FO
VO
3/
EF
CBKP
QFTP
EF
OBDJNJFOUP

TF
NBOJFTUB
FO
VO
JOTVDJFOUF
BVNFOUP
EF
QFTP
Z
DPOTVNP
FYDFTJWP
EF
0
4J

MB
IJQPUFSNJB
FT
NPEFSBEB
TF
QSPEVDJSg
BDJEPTJT
QPS
NFUBCPMJTNP
BOBFSPCJP
F

50

GUAS NACIONALES DE NEONATOLOGA

IJQPHMJDFNJB
4J
MB
IJQPUFSNJB
FT
TFWFSB
DPNP
QVFEF
PDVSSJS
FO
VO
QBSUP
GVFSB
EF

MB
NBUFSOJEBE
MB
UFNQFSBUVSB
CBKB
MPT


QVFEF
BQBSFDFS
IJQPUFOTJwO
CSBEJ
DBSEJB
CSBEJQOFB
JSSFHVMBS
IJQPBDUJWJEBE
EJTNJOVDJwO
EF
SFFKPT
TVDDJwO
JOTV
DJFOUF
EJTUFOTJwO
BCEPNJOBM
P
WwNJUPT
q
)JQFSUFSNJB
QVFEF
EFCFSTF
B
VO
BNCJFOUF
SFMBUJWBNFOUF
DgMJEP
JOGFDDJPOFT
EFT
IJESBUBDJwO
EJTGVODJwO
EFM
4/$
P
SFBDDJwO
B
NFEJDBNFOUPT

BIBLIOGRAFIA:

4BVFS
1++
FU
BM
/FX
TUBOEBSET
GPS
OFVUSBM
UIFSNBM
FOWJSPONFOU
PG
IFBMUIZ
WFSZ
MPX

CJSUIXFJHIU
JOGBOUT
JO
XFFL
POF
PG
MJGF
"SDI
%JT
$IJME



4DPQFT
+
"INFE
*
3BOHF
PG
JOJUJBM
UFNQFSBUVSFT
JO
TJDL
BOE
QSFNBUVSF
OFXCPSO
CB
CJFT
"SDI
%JT
$IJME


5SBUBEP
EF
OFPOBUPMPHrB
EF
"WFSZ
1BSUF
7*
3FHVMBDJwO
EF
MB
UFNQFSBUVSB
FO
FM
MBDUBO
UF
QSFNBUVSP


&EJDJwO
FO
FTQBvPM



$VJEBEPT
JOUFOTJWPT
OFPOBUBMFT
EF
"VHVTUP
4PMB
Z
+PSHF
6SNBO
5FSNPSSFHVMBDJwO



51

TEMPERATURAS DE AMBIENTE TRMICO NEUTRO

Segn edad y peso
&EBE
Z
1FTP


IPSBT

.FOPS
B
H





.BZPS
B

H
Z


TFN
EF
HFTUBDJwO

5FNQFSBUVSB
$
 

 
 

 
 

 
 

 


IPSBT

.FOPS
B
H





.BZPS
B

H
Z


TFN
EF
HFTUBDJwO

 

 
 

 
 

 
 

 


IPSBT

.FOPS
B
H





.BZPS
B

H
Z


TFN
EF
HFTUBDJwO

 

 
 

 
 

 
 

 


IPSBT

.FOPS
B
H





.BZPS
B

H
Z


TFN
EF
HFTUBDJwO

 

 
 

 
 

 
 

 


IPSBT

.FOPS
B
H





.BZPS
B

H
Z


TFN
EF
HFTUBDJwO

 

 
 

 
 

 
 

 


IPSBT

.FOPS
B
H





.BZPS
B

H
Z


TFN
EF
HFTUBDJwO

 

 
 

 
 

 
 

 


IPSBT

.FOPS
B
H





.BZPS
B

H
Z


TFN
EF
HFTUBDJwO

 

 
 

 
 

 
 

 


ErBT

.FOPS
B




.BZPS
B

H
Z


TFN
EF
HFTUBDJwO

ErBT


ErBT


ErBT


ErBT


ErBT

 

 
 

 
 

 
 

 
 

 
 

 
 

 


ErBT

.FOPS
B




.BZPS
B

H
Z


TFN
EF
HFTUBDJwO

 

 
 

 
 

 

.FOPS
B




 

 
 

 

.FOPS
B




 

 
 

 

.FOPS
B




 

 
 

 

.FOPS
B




 

 
 

 


TFN


TFN


TFN


TFN

52

GUAS NACIONALES DE NEONATOLOGA

42!.30/24%
.%/.!4!,$%2%3#!4%

&T
VO
TJTUFNB
PSHBOJ[BEP
QBSB
FM
USBTMBEP
EF
3FDJnO
/BDJEPT
RVF
SFRVJFSBO
QSPDF
EJNJFOUPT
EJBHOwTUJDPT
ZP
UFSBQnVUJDPT
FO
DFOUSPT
EF
NBZPS
DPNQMFKJEBE
Z
FTQFDJBMJ[B
DJwO
P
RVF
EJTQPOHBO
EF
MB
UFDOPMPHrB
SFRVFSJEB

Objetivo General:
%JTNJOVJS
MB
NPSCJNPSUBMJEBE
OFPOBUBM
B
USBWnT
EF
VOB
BUFODJwO
PQPSUVOB
Z
FTQFDJBMJ
[BEB
FO
BRVFMMPT
3/
HSBWFNFOUF
FOGFSNPT
"RVFMMPT
FNCBSB[PT
DPO
EJBHOwTUJDP
QSFOBUBM
EF
BMUP
SJFTHP
EFCFSgO
TFS
USBTMBEBEPT

PQPSUVOBNFOUF
QSFWJP
B
TV
SFTPMVDJwO

Objetivo especco:
3FBMJ[BS
FM
USBTMBEP
EFM
3/
FO
GPSNB
wQUJNB
EF
NPEP
UBM
RVF
OP
TJHOJRVF
VO
EFUFSJP
SP
BEJDJPOBM
B
TV
DPOEJDJwO
QBUPMwHJDB
QSFFYJTUFOUF

Caractersticas del Transporte:

q
7rB
5FSSFTUSF
q
7rB
"nSFB
q
$PO
WFOUJMBDJwO
NFDgOJDB
q
4JO
WFOUJMBDJwO
NFDgOJDB
&M
UJQP
EF
USBOTQPSUF
TFMFDDJPOBEP
EFQFOEFSg
EF
MB
EJTUBODJB
FOUSF
FM
DFOUSP
EFSJWBEPS

Z
FM
DFOUSP
EF
SFGFSFODJB
$VBOEP
SFRVJFSF
WFOUJMBDJwO
NFDgOJDB
FT
GVOEBNFOUBM
BTFHVSBS
GVFOUFT
EF
PYJHFOP

Z
BJSF
DPNQSJNJEP
EVSBOUF
FM
UJFNQP
FTUJNBEP
EF
USBOTQPSUF
NgT
VO
SBOHP
EF
TFHVSJEBE

EFTUJOBEP
B
QSFWFS
DVBMRVJFS
JODJEFOUF
RVF
SFRVJFSB
VO
NBZPS
DPOTVNP
P
RVF
SFUBSEF
FM

UJFNQP
EF
USBOTQPSUF
NgT
BMMg
EF
MP
QMBOJDBEP
SFDPSEBS
RVF
MPT
CBMPOFT
&
EF
0
EJTQPOJ
CMFT
FO
OVFTUSPT
TFSWJDJPT
UJFOFO
VO
UJFNQP
NgYJNP
EF
EVSBDJwO
EF

NJOVUPT


53

&O
DBTP
EF
SFRVFSJS
EF
USBOTQPSUF
BnSFP
TF
TVHJFSF
DPOTVMUBS
FO
BRVFMMBT
JOTUJUVDJP
OFT
DPO
FYQFSJFODJB
Z
QFSTPOBM
FOUSFOBEP
DPNP
q
'VFS[B
"nSFB
EF
$IJMF
q
1SFGFDUVSB
"FSPQPMJDJBM
EF
$BSBCJOFSPT
EF
$IJMF

ORGANIZACIN DEL SISTEMA DE TRANSPORTE:


4JTUFNB
EF
DPNVOJDBDJPOFT
WJUBM
FO
FM
nYJUP
EF
VO
USBTMBEP
SFRVJFSF
EF
VO
DFOUSP

DPPSEJOBEPS
VO
FRVJQP
EJTQPOJCMF
MBT

IPSBT
EFM
ErB
Z
VO
TJTUFNB
EF
JOGPSNBDJwO
Z

SFHJTUSP
FDJFOUFT


1FSTPOBM
DBQBDJUBEP
FRVJQP
EF
USBOTQPSUF


$POTUJUVJEP
QPS

q
.nEJDP
DPPSEJOBEPS
DBQB[
EF
BDFQUBS
P
SFDIB[BS
VOB
TPMJDJUVE
EF
USBOTQPSUF
Z
B

TV
WF[
TVHFSJS
NBOFKP
JOJDJBM
QBSB
MB
FTUBCJMJ[BDJwO
EF
VO
3/
HSBWF

q
.nEJDP
EF
USBOTQPSUF
FT
FM
MrEFS
EFM
FRVJQP
EFCF
UFOFS
FYQFSJFODJB
FO
DVJEBEP

JOUFOTJWP
OFPOBUBM
QBSB
DPPSEJOBS
MB
FTUBCJMJ[BDJwO
NBOFKP
Z
NPOJUPSJ[BDJwO
EFM

QBDJFOUF
EVSBOUF
FM
USBOTQPSUF

q
.BUSPOB
P
FOGFSNFSB
EF
USBOTQPSUF
EFCF
FTUBS
DBQBDJUBEB
FO
DVJEBEP
JOUFOTJWP

OFPOBUBM
DPO
MBT
EFTUSF[BT
Z
IBCJMJEBEFT
OFDFTBSJBT
QBSB
FM
DVJEBEP
EF
VO
3/

DSrUJDBNFOUF
FOGFSNP

q
1BSBNnEJDP
EF
USBOTQPSUF
BTJTUF
BM
SFTUP
EF
MPT
NJFNCSPT
EFM
FRVJQP
FO
MB
FTUB
CJMJ[BDJwO
Z
NBOFKP
EFM
QBDJFOUF
EVSBOUF
FM
USBOTQPSUF
q
1FSTPOBM
EF
NPWJMJ[BDJwO
B
DBSHP
EFM
DVJEBEP
Z
NBOUFODJwO
FO
wQUJNBT
DPOEJ
DJPOFT
EFM
WFIrDVMP
EF
USBOTQPSUF
DPO
FTQFDJBM
BEJFTUSBNJFOUP
FO
USBTMBEP
EF

QBDJFOUFT
DSrUJDPT
Z
DVJEBEP
EF
FRVJQPT
F
JOTVNPT


&RVJQBNJFOUP
F
JOTVNPT
B

*ODVCBEPSB
EF
USBOTQPSUF

DPO
CBUFSrB
BVUwOPNB
Z
DBQBDJEBE
EF
DPOFYJwO
B
SFE
FMnDUSJDB
KB
Z
NwWJM



WFOUJMBEPS
NFDgOJDP
EF
USBOTQPSUF
TJ
QPS
QBUPMPHrB
TF
SFRVJFSF

NPOJUPS
EF
TJHOPT
WJUBMFT
Z
TBUVSBDJwO


DJMJOESPT
EF
PYrHFOP
Z
BJSF
DPNQSJNJEP
JODPSQPSBEPT

CPNCBT
EF
JOGVTJwO
DPOUJOVB

TJTUFNBT
EF
KBDJwO
EFM
3/
B
MB
JODVCBEPSB
Z
EF
MB
JODVCBEPSB
BM
NwWJM
C


&RVJQPT
QBSB
QSPDFEJNJFOUPT


TJTUFNB
EF
WFOUJMBDJwO
NBOVBM
Z
BTQJSBDJwO

BDDFTPT
WFOPTPT
P
BSUFSJBMFT


JOUVCBDJwO
FOEPUSBRVFBM

54

GUAS NACIONALES DE NEONATOLOGA


ESFOBKF
QMFVSBM
FUD
D

*OTVNPT
Z
GgSNBDPT


%FCJEBNFOUF
PSEFOBEPT
QSPUFHJEPT
F
JEFOUJDBEPT
TFH|O
MJTUBEP
BEIPD

BOFYP


E

4JTUFNB
EF
SFHJTUSP


'PSNVMBSJPT
QBSB
SFHJTUSP
EF
EBUPT
DMrOJDPT
Z
BENJOJTUSBUJWPT
BOFYP


F

0USPT
BDDFTPSJPT


"MBSHBEPSFT
FODIVGFT
FYUFOTJPOFT
EF
BJSF
Z
PYrHFOP
EF
BDPQMF
SgQJEP

7FIrDVMP
EF
USBOTQPSUF
BnSFP
ZP
UFSSFTUSF


&TUF
EFCF
TFS
BNQMJP
EJTQPOFS
EF
BEFDVBEB
JMVNJOBDJwO
F
JOUFSJPS
DMBSP
TJTUFNB
EF

DBMFGBDDJwO
ZP
BJSF
BDPOEJDJPOBEP
TJTUFNB
EF
KBDJwO
QBSB
MB
JODVCBEPSB
EF
USBOTQPSUF

TJTUFNB
EF
DPNVOJDBDJPOFT
FRVJQBEB
DPO
CBMPOFT
EF
PYrHFOP
Z
BJSF
DPNQSJNJEP
DPO

FODIVGFT
QBSB
DPOFYJwO
B
CBUFSrBT
EF
WFIrDVMP
DPO
TJTUFNB
EF
TPQPSUF
QBSB
FCPDMJTJT
Z

DJOUVSPOFT
EF
TFHVSJEBE
QBSB
MPT
NJFNCSPT
EFM
FRVJQP
NnEJDP

Consideraciones especiales respecto al transporte areo:

B

&GFDUP
EF
MB
BMUVSB
TPCSF
MB
1SFTJwO
CBSPNnUSJDB
B
NBZPS
BMUVSB
EJTNJOVZF
MB
QSF
TJwO
CBSPNnUSJDB
QPS
MP
DVBM
B
TV
WF[
EJTNJOVZF
MB
QSFTJwO
QBSDJBM
EF
PYrHFOP
QPS

MP
DVBM
EFCFO
SFBMJ[BSTF
MPT
BKVTUFT
OFDFTBSJPT
FO
MB
'J0
QBSB
MPHSBS
TBUVSBDJP
OFT
BEFDVBEBT
"OFYP


C

&GFDUP
EF
MB
1SFTJwO
CBSPNnUSJDB
TPCSF
FM
WPMVNFO
EF
HBTFT
-FZ
EF
#PZMF

B
VOB

UFNQFSBUVSB
DPOTUBOUF
B
NFEJEB
RVF
EJTNJOVZF
MB
QSFTJwO
CBSPNnUSJDB
BVNFOUB

FM
WPMVNFO
EFM
HBT
FO
GPSNB
QSPQPSDJPOBM
*NQPSUBOUF
FO
DBTPT
EF
FTDBQF
BnSFP

ESFOBKF
EF
OFVNPUwSBY

Z
EF
EJTUFOTJwO
BCEPNJOBM
EFTDPNQSFTJwO
HgTUSJDB

D

*NQBDUPT
EF
GVFS[B
EF
BDFMFSBDJwO
Z
EFTBDFMFSBDJwO
3/
DPO
DPNQSPNJTP
IFNP
EJOgNJDP
EFCF
WJBKBS
DPO
TV
DBCF[B
PSJFOUBEB
IBDJB
MB
QBSUF
QPTUFSJPS
EF
MB
BFSP
OBWF
Z
B
MB
JOWFSTB
3/
DPO
EBvP
IJQwYJDPJTRVnNJDP
w
)*$
MP
IBSg
DPO
TV
DBCF[B

PSJFOUBEB
IBDJB
MB
QBSUF
BOUFSJPS

DEFINICIN DE RESPONSABILIDADES DE LOS EQUIPOS

PROFESIONALES QUE INTERVIENEN EN UN TRANSPORTE
NEONATAL
&RVJQP
EFM
DFOUSP
BTJTUFODJBM
SFGFSFOUF
q
"QPSUB
BOUFDFEFOUFT
QFSJOBUBMFT
Z
EFM
3/
q
%JBHOwTUJDPT
QSFTVOUJWPT
Z
TFWFSJEBE
EFM
DVBESP
QBUPMwHJDP
SJFTHPT
Z
SFRVFSJ
NJFOUPT

q
*OGPSNB
FYgNFOFT
Z
USBUBNJFOUPT
FGFDUVBEPT

55

q
&T
SFTQPOTBCMF
EFM
NBOFKP
Z
FTUBCJMJ[BDJwO
EFM
3/
IBTUB
RVF
TF
IBHB
FGFDUJWP
FM

USBOTQPSUF
q
0CUJFOF
FM
DPOTFOUJNJFOUP
JOGPSNBEP
EF
MPT
QBESFT
QBSB
USBTMBEP
Z
QSPDFEJNJFO
UPT
FO
FM
DFOUSP
EF
EFTUJOP

q
$FSUJDBDJwO
QSFWJTJPOBM

&RVJQP
EFM
DFOUSP
BTJTUFODJBM
SFDFQUPS
q
4VHJFSF
JOEJDBDJPOFT
QSFMJNJOBSFT
QPS
UFMnGPOP
QBSB
MB
FTUBCJMJ[BDJwO
EFM
3/
q
*OGPSNB
TPCSF
USgNJUFT
BENJOJTUSBUJWPT
QBSB
MB
BENJTJwO
EFM
3/
JEFBM
FOWJBS
GBY

q
$PPSEJOB
MBT
BDDJPOFT
DPO
FM
FRVJQP
EF
USBOTQPSUF
OFPOBUBM
q
*OGPSNB
BM
DFOUSP
BTJTUFODJBM
SFGFSFOUF
TPCSF
UJFNQP
FTUJNBEP
QBSB
FGFDUVBS
FM

USBOTQPSUF
q
1SFQBSB
MB
VOJEBE
EF
6$*
OFPOBUBM
QBSB
SFDFQDJwO
EFM
QBDJFOUF
EF
BDVFSEP
B
QB
UPMPHrB
Z
TFWFSJEBE
JOGPSNBEBT
q
$PPSEJOB
MBT
FWBMVBDJPOFT
EF
TVCFTQFDJBMJEBE
TFH|O
MB
QBUPMPHrB
EFM
3/

EQUIPO DE TRANSPORTE NEONATAL:


1SFQBSBDJwO
QBSB
FM
USBOTQPSUF
q
7FSJDB
RVF
FM
FRVJQBNJFOUP
FTUF
DPNQMFUP
Z
GVODJPOF
BEFDVBEBNFOUF
q
*ODPSQPSB
FRVJQPT
F
JOTVNPT
EF
BDVFSEP
B
MPT
SFRVFSJNJFOUPT
JOEJWJEVBMFT
JOGPS
NBEPT
QBSB
FM
QBDJFOUF
q
1SPHSBNB
UFNQFSBUVSB
EF
MB
JODVCBEPSB
EF
BDVFSEP
B
BOUSPQPNFUSrB
JOGPSNBEB

EFM
3/
q
7FSJDB
BEFDVBEB
EJTQPOJCJMJEBE
EF
SFHJTUSPT
OFDFTBSJPT
EVSBOUF
FM
USBOTQPSUF

DIB
EF
USBOTQPSUF
IPKB
EF
GgSNBDPT
DPO
EPTJT
Z
EJMVDJwO
IPKB
EF
JODJEFOUFT

GPSNVMBSJP
EF
DPOTFOUJNJFOUP
JOGPSNBEP
SFHJTUSP
EF
NBOUFODJwO
EF
FRVJQPT


&WBMVBDJwO
JOJDJBM
Z
FTUBCJMJ[BDJwO
EFM
3/
q
7FSJDB
JEFOUJDBDJwO
EFM
3/
BM
MMFHBS
q
$POUSPMB
FTUBCJMJ[BDJwO
UnSNJDB
EFM
3/
q
7FSJDB
QFSNFBCJMJEBE
EF
WrB
BnSFB
Z
DPOEJDJwO
SFTQJSBUPSJB
q
$POUSPMB
ZP
JOTUBMB
BDDFTPT
WFOPTPT
Z
BSUFSJBMFT
QBSB
BENJOJTUSBDJwO
EF
VJEPT
Z

GgSNBDPT

q
&WBM|B
DPOEJDJwO
IFNPEJOgNJDB
F
JOEJDB
NFEJEBT
EF
FTUBCJMJ[BDJwO
q
3FBMJ[B
EFTDPNQSFTJwO
HgTUSJDB
QSFWJB
BM
USBTMBEP
q
&GFDU|B
QSPDFEJNJFOUPT
EJBHOwTUJDPT
ZP
UFSBQnVUJDPT
FO
DBTP
OFDFTBSJP
*OUV
CBDJwO
DBUFUFSJ[BDJwO
ESFOBKF
QMFVSBM
FUD

q
5SBTMBEB
F
JONPWJMJ[B
B
3/
B
MB
JODVCBEPSB
EF
USBOTQPSUF

56

GUAS NACIONALES DE NEONATOLOGA

q

q

q

q

q

3FDFQDJPOB
QFSUFOFODJBT
EFM
3/
*OGPSNB
B
MPT
QBESFT
TPCSF
TJUVBDJwO
Z
USBTMBEP
EFM
3/

7FSJDB
EJSFDDJwO
Z
UFMnGPOP
EF
MB
GBNJMJB
*OGPSNB
BM
DFOUSP
EF
SFGFSFODJB
TPCSF
IPSB
EF
TBMJEB
Z
SFRVFSJNJFOUPT
FTQFDJBMFT

5SBOTQPSUB
VOB
NVFTUSB
EF
TBOHSF
NBUFSOB
DPO
Z
TJO
BOUJDPBHVMBOUF

QBSB
FWFO
UVBMFT
FTUVEJPT


"UFODJwO
EFM
3/
EVSBOUF
FM
USBTMBEP
q
7FSJDB
DPOFYJwO
BEFDVBEB
EF
MPT
FRVJQPT
SFE
EF
FOFSHrB
NwWJM
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57

CONSIDERACIONES ESPECIALES SEGN PATOLOGA

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58

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62

GUAS NACIONALES DE NEONATOLOGA

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63

64

GUAS NACIONALES DE NEONATOLOGA

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SBOHPT
EF
WPM|NFOFT
EFTEF
FM
QSJNFS
BM
TFYUP
ErB
EF


















NM,HErB
1PTUFSJPSNFOUF
TJ
MB
DPOEJDJwO

MP
QFSNJUF
PGSFDFS
BE
MJCJUVN
VOB
GwSNVMB
DPO

B

,DBMEM

Recin nacido de trmino con factores de riesgo asociados:

q
-PT
GBDUPSFT
EF
SJFTHP
TPO
BTYJB
TFWFSB
DBSEJPQBUrB
EF
CBKP
VKP
QPMJHMPCVMJB

TJOUPNgUJDB
TFWFSB
BMUFSBDJwO
EFM
EPQQMFS
GFUBM
DPNQSPNJTP
IFNPEJOgNJDP
OP

DPOUSPMBEP
NJFMPNFOJOHPDFMF
DPO
QBSBQBSFTJB
TJHOJDBUJWB
TPTQFDIB
EF
FOUF
SPDPMJUJT
OFDSPUJ[BOUF

q
&O
FTUPT
DBTPT
TF
EFCF
NBOUFOFS
TJO
BMJNFOUBDJwO
QPS

IPSBT
5SBOTDVSSJEP

FTF
QFSrPEP
JOJDJBS
BQPSUF
FOUFSBM
EF
MFDIF
NBUFSOB
P
GwSNVMB
QBSB
MBDUBOUF
FO

WPMVNFO
EF

NM
,HErB
Z
BVNFOUBS
FO

NM
,HErB
QPTUFSJPSNFOUF
DPO
FT
USJDUP
DPOUSPM
EF
UPMFSBODJB
EJTUFOTJwO
SFTJEVP
SFHVSHJUBDJwO

Recin nacido de bajo peso de nacimiento:

$VgOEP
q
&M
SFDJnO
OBDJEP
EF
CBKP
QFTP
EF
OBDJNJFOUP
RVF
OP
UFOHB
GBDUPSFT
EF
SJFTHP
TF

BQMJDBO
MPT
NJTNPT
DSJUFSJPT
EFTDSJUPT
QBSB
FM
SFDJnO
OBDJEP
EF
UnSNJOP

QVFEF
BMJ
NFOUBSTF
EFTEF
FM
QSJNFS
ErB
EF
WJEB
4J
UJFOF
GBDUPSFT
EF
SJFTHP
EJGFSJS
QPS

IST
$VgOUP
q
*OJDJBS
DPO

NM
LHErB
Z
BVNFOUBS
EJBSJBNFOUF
FO
WPM|NFOFT
TJNJMBSFT
IBT
UB

NMLHErB
%FTQVnT
EF
MPT

B

ErBT
EF
WJEB
QVFEF
BVNFOUBSTF
FM
WP
MVNFO
HSBEVBMNFOUF
IBTUB



NMLHErB
TFH|O
OFDFTJEBE
UPMFSBODJB
Z

BVTFODJB
EF
DPOUSBJOEJDBDJPOFT
&O
DBTP
EF
OJvPT
DPO
SFUBSEP
EF
DSFDJNJFOUP

TFWFSP
FO
QFSrPEPT
EF
DSFDJNJFOUP
SFDVQFSBDJPOBM
QVFEFO
OFDFTJUBSTF
WPM|NF
OFT
NBZPSFT
q
*OEJWJEVBMJDF
FM
SFRVFSJNJFOUP
FO
QSFNBUVSPT
FYUSFNPT
RVF
ZB
UJFOF
NgT
EF


TFNBOBT
EF
FEBE
DPSSFHJEB
Z
FO
FM
SFDJnO
OBDJEP
EF
UnSNJOP
TFH|O
TVT
TFvBMFT

EF
IBNCSF
Z
TBDJFEBE
$wNP
q
"ENJOJTUSBS
FO
CPMP
MFOUP
DBEB

IPSBT
QPS
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OBTPHgTUSJDB
TJ
FT
QPTJCMF
P

QPS
TPOEB
PSPHgTUSJDB
TJ
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EJDVMUBE
SFTQJSBUPSJB
P
FT
NFOPS
EF

H
q
&TUJNVMBS
TVDDJwO
EVSBOUF
FM
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EF
BMJNFOUBDJwO

67

q
4J
UJFOF

P
NgT
TFNBOBT
EF
FEBE
HFTUBDJPOBM
FWBM|F
BMJNFOUBDJwO
QPS
TVDDJwO
q
&M
QSFUnSNJOP
EF
NVZ
CBKP
QFTP
EF
OBDJNJFOUP
QVFEF
JOJDJBS
MB
TVDDJwO
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BM

QFDIP
JOJDJBMNFOUF
FYUSBrEP
EF
MFDIF
B
MBT



TFNBOBT
EF
FEBE
QPTUDPO
DFQDJPOBM
"Tr
TF
FTUJNVMB
MB
MBDUBODJB
Z
TF
QSFQBSB
FM
BNBNBOUBNJFOUP
EJSFDUP
q
$POTJEFSF
FM
VTP
EF
BMJNFOUBDJwO
FOUFSBM
DPOUJOVB
FO
MPT
DBTPT
EF
QFSTJTUFOUF

NBMB
UPMFSBODJB
BM
BVNFOUP
EF
WPMVNFO
FO
DBTP
EF
EJTQMBTJB
CSPODPQVMNPOBS

TFWFSB
P
DBSEJPQBUrB
DPO
JOTVDJFODJB
DBSErBDB
DPOHFTUJWB
2Vn

q
-FDIF
NBUFSOB
FYUSBrEB
EF
TV
QSPQJB
NBESF

q
-FDIF
NBUFSOB
EPOBEB
QBTUFVSJ[BEB
q
'wSNVMB
MgDUFB
QBSB
QSFNBUVSP

$VgOEP
TVTQFOEFS
BQPSUF
FOUFSBM
q
3FTJEVPT
CJMJPTPT
IFNgUJDPT
P
QPSSgDFPT
FO
DVBMRVJFS
WPMVNFO
NM

q
3FTJEVP
BMJNFOUBSJP
NBZPS
B


EF
BMJNFOUBDJwO
SFDJCJFOEP
NgT
EF

NM

QPS
WF[
q
7wNJUPT
q
%FQPTJDJPOFT
DPO
TBOHSF
P
FOUFSPDwMJDBT
q
4PTQFDIB
EF
&OUFSPDPMJUJT
OFDSPUJ[BOUF
q
/JvP
FOGFSNP
DPO
BMJNFOUBDJwO
DPO
DIVQFUF
P
QFDIP
RVF
SFDIB[B
JOFTQFSBEB
NFOUF
MB
BMJNFOUBDJwO
6TP
EF
MFDIF
NBUFSOB
q
-FDIF
NBUFSOB
EF
TV
QSPQJB
NBESF
GSFTDB
SFGSJHFSBEB
P
DPOHFMBEB
q
3FDVFSEF
RVF
FM
BQPSUF
EF
QSPUFrOBT
DBMDJP
Z
GwTGPSP
FT
IBCJUVBMNFOUF
JOTVDJFO
UF
QBSB
FM
QSFNBUVSP
EF
NVZ
CBKP
QFTP
EF
OBDJNJFOUP
4VQMFNFOUBS
DPO
GPSUJDBO
UF
QBSB
MFDIF
NBUFSOB
BM
BENJOJTUSBS

NM

,HErB
P
NgT
*OJDJBMNFOUF
BENJOJT
USBS
BM

P

TPCSFT
FO
NM
q
%FTEF
MB

TFNBOB
VTBS
BM


P

TPCSFT
FO

NM
q
$POUSPMBS
FWPMVDJwO
OVUSJDJPOBM
q
3FDVFSEF
MBT
WBSJBDJPOFT
JOEJWJEVBMFT
EF
DPNQPTJDJwO
EF
MFDIF
NBUFSOB
Z
MB
OF
DFTJEBE
EF
IPNPHFOJ[BS
QPS
BHJUBDJwO
MB
NF[DMB
BOUFT
EF
BENJOJTUSBSMB
4J
IBZ

SFTUSJDDJwO
EF
BQPSUF
EF
WPMVNFO
P
BVNFOUP
EFM
HBTUP
FOFSHnUJDP
CBTBM
DPNP

FO
MB
EJTQMBTJB
CSPODPQVMNPOBS
P
MB
JOTVDJFODJB
DBSErBDB
DPOHFTUJWB
BENJOJTUSF

TVQMFNFOUP
FOFSHnUJDP
BEFNgT
EFM
GPSUJDBOUF
Z
FWFOUVBMNFOUF
VUJMJDF
MB
BMJNFO
UBDJwO
FOUFSBM
DPOUJOVB
q
4J
FT
OFDFTBSJP
TVQMFNFOUBS
TPEJP
VTBS
OBUSFNJB


N&RM


N&R
LHErB

P
;JOD
VTBS
NHLHErB

68

GUAS NACIONALES DE NEONATOLOGA

4VQMFNFOUP
EF
FSSP

"QPSUBS
EFTEF
MBT

B

TFNBOBT
EF
FEBE
QPTUOBUBM
3FTUF
MB
DBOUJEBE
RVF
BQPSUB
MB

GwSNVMB
B
MB
TJHVJFOUF
SFDPNFOEBDJwO



1FTP

"QPSUF
UPUBM





HST

NHLHErB



HST


NHLHErB



HST


NHLHErB
"QPSUF
NgYJNP
DPNP
TVQMFNFOUP

NHErB
.BOUFOFS
EVSBOUF
QSJNFS
BvP
EF
WJEB

CONTROL NUTRICIONAL DEL RN DE BAJO PESO DE NACIMIENTO:

"OUSPQPNFUSrB
q
3FHJTUSBS
FWPMVDJwO
BOUSPQPNnUSJDB
FO
DVSWBT
EF
SFGFSFODJB
&ISFODSBO[
FU
BM

q
3FDVQFSBDJwO
EFM
QFTP
EF
OBDJNJFOUP
B
MPT



ErBT
EF
WJEB
FO
3/5


ErBT


H


ErBT


H


ErBT


H
q
*ODSFNFOUP
EF

H
LHErB
EFTEF
SFDVQFSBDJwO
EF
1/
FO
NFOPS
EF

H
q
*ODSFNFOUP
EF
UBMMB

DNTFNBOB
q
*ODSFNFOUP
EF
$$

DNTFNBOB
OEJDFT
CJPRVrNJDPT
DPOUSPM
RVJODFOBM

q
#6/

NHEM
4VQMFNFOUBS
QSPUFrOBT
DPO
WBMPSFT
CBKP

NHEM
q
"MC|NJOB
 
HEM
q
/B

N&R-
q
#&


q
1

NHEM
4VQMFNFOUBS
DPO
DJGSBT
NFOPSFT
B

NH
EM
q
$B

NHEM
q
'PTGBUBTBT
"MDBMJOBT
WBMPS
OPSNBM
IBTUB

WFDFT
FM
WBMPS
EF
SFGFSFODJB
EFM
MBCPSB
UPSJP
4PCSF
FTUF
OJWFM
TVHJFSF
PTUFPQFOJB
#BKP
FM
OJWFM
OPSNBM
TVHJFSF
EnDJU
EF

;JOD
q
4FSJF
SPKB
WFS
OPSNB
EF
BOFNJB

69

70

GUAS NACIONALES DE NEONATOLOGA

/VUSJFOUFT

3FDPNFOEBDJwO



,HErB

&OFSHrB
,DBM




1SPUFrOBT
H


 

-rQJEPT
H


  

$BSCPIJESBUPT
H


 

$BMDJP
NH




'wTGPSP
NH




4wEJP
NH




1PUBTJP
NH




$MPSP
NH




.BHOFTJP
NH


 

)JFSSP
NH


  

$JOD
VH




$PCSF
VH




.BOHBOFTP
VH


 

:PEP



7JU
"
6*




7JU
%
6*




7JU
$
NH


 

7JU
&
6*


 

7JU
#

VH




7JU
#

VH




7JU
#

VH




7JU
#

VH


 

/JBDJOB
NH


  

'PMBUP
NH




#JPUJOB
VH


 

"D
1BOUPUn
NH


  

"D
-JOPMFJDP
NH

-FDIF
.BUFSOB


1PS
DBEB

NM



 

 

 











 

 





 







 

 

 





 

 

 

 

 

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4QFDJBM
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NPEJDBEBT
QBSB
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Composicin de Leches para Prematuros. Por cada 100 ml.

4JNJMBD


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QBSB
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BIBLIOGRAFA

,MFJO
$+
/VUSJUJPO
3FRVJSFNFOUT
GPS
QSFUFSN
*OGBOU
'PSNVMBT
+
/VUS
4
4

;JFHMFS
&&
5IVSFFO
1+
$BSMTPO
4+
"HHSFTJWF
OVUSJUJPO
PG
UIF
WFSZ
MPX
CJSUIXFJHIU

JOGBOU
$MJO
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4IBOMFS
3+
4IVMNBO
3+
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$
FU
BM
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TUSBUFHJFT
GPS
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JOGBOUT
SBO
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PG
HBTUSPJOUFTUJOBM
QSJNJOH
BOE
UVCFGFFEJOH
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/
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+
FU
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5IF
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PG
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CSFBTUGFFEJOH
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JOGBOUT
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71

72

GUAS NACIONALES DE NEONATOLOGA

.542)#).
0!2%.4%2!,

-B
BENJOJTUSBDJwO
QBSFOUFSBM
EF
BHVB
HMVDPTB
Z
FMFDUSPMJUPT
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QBSUF
EF
MBT
NFEJ
EBT
IBCJUVBMFT
EF
BUFODJwO
EFM
SFDJnO
OBDJEP
FOGFSNP
"HSFHBOEP
BNJOPgDJEPT
MrQJEPT

Z
WJUBNJOBT
TF
PCUJFOF
MB
OVUSJDJwO
QBSFOUFSBM
UPUBM
&M
SJFTHP
EF
MB
OVUSJDJwO
QBSFOUFSBM
BV
NFOUB
DPO
MB
DPNQMFKJEBE
EF
MB
NF[DMB
&M
CBMBODF
EF
SJFTHPCFOFDJP
EFCF
DPOTJEFSBSTF

DVJEBEPTBNFOUF
FO
DBEB
QBDJFOUF

`V>Vi\
q
1BUPMPHrB
HBTUSPJOUFTUJOBM


3FDJnO
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DVBMRVJFS
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NgT
EF

ErBT
q
3FDJnO
OBDJEP
EF
NVZ
CBKP
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EF
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3/


H
EFTEF
FM
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3/

H
DPO
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P
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EF
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RVF
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QPS
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ErBT
q
3FDJnO
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EF
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RVF
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FOUFSBM
QPS
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EF

ErBT
P
RVF
TF
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VO
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NVZ
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EF
MB
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iV>\
q
5SFT
FO
VOP
-PT
MrQJEPT
TF
NF[DMBO
FO
VO
NJTNP
NBUSB[
DPO
HMVDPTB
BNJOPgDJ
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Z
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MB
DPODFOUSBDJwO
EF
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B

P
NFOPT
q
%PT
FO
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-PT
MrQJEPT
TF
DPMPDBO
FO
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EF
MB
NF[DMB
EF

HMVDPTB
BNJOPgDJEPT
Z
NJOFSBMFT
-PT
MrQJEPT
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DPOFDUBSTF
DPO
MMBWF
FO

:
BM
SFTUP
EF
MB
JOGVTJwO

73

6>`i>`>V\
1FSJGnSJDB
SFRVJFSF
BEFDVBEPT
BDDFTPT
WFOPTPT
q
4F
SFDPNJFOEB
QBSB
OVUSJDJwO
QBSFOUFSBM
EF
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EVSBDJwO
Z
CBKB
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-B
DPODFOUSBDJwO
NgYJNB
EF
HMVDPTB
FT
BM
 
DPO

EF
BNJOPgDJEPT
0TNP
MBSJEBE
NgYJNB

N0TNM
q
$POWJFOF
DPMPDBS
MPT
MrQJEPT
QPS
MB
NJTNB
WrB
DPO
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FO
:
QPS
FM
FGFDUP
WFOP
QSPUFDUPS
EF
MPT
NJTNPT
TJ
TF
VTBO
NF[DMBT
EPT
FO
VOP
$FOUSBM

q
&M
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FT
MB
WrB
NgT
SFDPNFOEBEB

q
&YDFQDJPOBMNFOUF
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DBUnUFS
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EF

WJEB

*",/  

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Volumen de lquidos:
&O
QSPNFEJP
VO
3/
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DDLHErB
EFTQVnT
EFM
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DFSP
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EF
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3FDVFSEF
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FO
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FM
3/
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OBDFS

HS
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EFTFRVJMJCSJPT
IJESPFMFDUSPMrUJDPT
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B
MB
BMUB
DPODFOUSBDJwO
EF
HMVDPTB
QSPUFrOBT

MrQJEPT
FMFDUSPMJUPT
Z
NJOFSBMFT
RVF
TF
VTBO
FO
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Energa:
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EF
VO
3/
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TV
NBEVSF[
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WTQBSFOUFSBM


74

#BTBM

"DUJWJEBE

&TUSnT
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1FSEJEBT
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GUAS NACIONALES DE NEONATOLOGA

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DBMPSrBT
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P
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Aminocidos (aa).
q

H
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BB
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q
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q
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q
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FTQFDJBMNFOUF
FO
MPT
QSJNFSPT
ErBT
EF
JOJDJBEB
MB
QBSFOUFSBM

Deciencias de oligonutrientes:
&O
MB
OVUSJDJwO
QBSFOUFSBM
FYDMVTJWB
QSPMPOHBEB
FM
TVQMFNFOUP
JOBEFDVBEP
ZP
MB
QnS
EJEB
JOUFTUJOBM
FYDFTJWB
QVFEF
QSPWPDBS
EFDJFODJB
EF
PMJHPOVUSJFOUFT
"MHVOPT
TF
EFUB
MMBO
B
DPOUJOVBDJwO

$-/*$"

."/&+0

'JFSSP

%JTNJOVDJwO
EF
IFNPHMPCJOB


GFSSJUJOB
Z
TBUVSBDJwO
EF


USBOTGFSSJOB
5BRVJQOFB
UBRVJDBSEJB
1PDP
BVNFOUP
EF
QFTP

"ENJOJTUSF
'F
QBSFOUFSBM



NH
QPS
ErB
/P
BENJOJTUSF
TJ
TF


USBOTGVOEF

;JOD

$BSEJPNJPQBUrB
%FCJMJEBE
NVTDVMBS
)JQPQJHNFOUBDJwO
EFM
QFMP
Z
VvBT
"OFNJB
IFNPMrUJDB
%JTNJOVDJwO
EF
HMVUBUJPO


QFSPYJEBTB

"VNFOUF
BQPSUF
%FTDBSUF
BDSPEFSNBUJUJT


FOUFSPQgUJDB

81

4FMFOJP

$BSEJPNJPQBUrB
%FCJMJEBE
NVTDVMBS
%JTNJOVDJwO
EF
MB
HMVUBUJPO


QFSPYJEBTB
)JQPQJHNFOUBDJwO
EFM
QFMP
Z
MBT


VvBT
"OFNJB
IFNPMrUJDB

$BSOJUJOB

%JTGVODJwO
IFQgUJDB
&TUFBUPTJT
.JPQBUrB
QSPHSFTJWB
3FUBSEP
EF
DSFDJNJFOUP
)JQFSUSJHMJDFSJEFNJB
)JQPHMJDFNJB

$POUSPMF
OJWFMFT
TnSJDPT
"QPSUF
DBSOJUJOB
PSBM
TJ
OP


TF
EJTQPOF
EF
QBSFOUFSBM

1BSB
MB
FOGFSNFEBE
wTFP
NFUBCwMJDB
WFB
OPSNB
SFTQFDUJWB
3FDPSEBS
RVF
OP
IBZ
EBUPT
TPCSF
DPOUBNJOBDJwO
DPO
BMVNJOJP
EF
MBT
TPMVDJPOFT
EF

VTP
FOEPWFOPTP
FO
FM
QBrT
"ENJOJTUSBDJwO
EF
NgT
EF

ErBT
EF
QBSFOUFSBM
DPO
DPODFO
USBDJPOFT
BMUBT
EF
"M
QSPEVDFO
EFUFSJPSP
EF
MB
DBQBDJEBE
DPHOJUJWB
QSPDVSF
FO
MP
QPTJCMF

OP
SFBMJ[BS
QBSFOUFSBMFT
EF
NgT
EF

ErBT
FO
MPT
QSFNBUVSPT

" -/
-
 /,
 */

\
q
&T
VOB
DPNQMJDBDJwO
GSFDVFOUF
FO
QSFNBUVSPT
DPO
DJSVHrB
EJHFTUJWB
Z
OVUSJDJwO

QBSFOUFSBM
QSPMPOHBEB
4V
JODJEFODJB
TF
IB
SFEVDJEP
DPO
FM
NFKPS
CBMBODF
EF
OV
USJFOUFT
Z
FM
VTP
EF
TPMVDJPOFT
EF
BNJOPgDJEPT
EJTFvBEBT
QBSB
FM
SFDJnO
OBDJEP
q
4F
QFTRVJTB
QPS
FM
BVNFOUP
EF
CJMJSSVCJOB
EJSFDUB
GPTGBUBTBT
BMDBMJOBT
Z
B
WFDFT

USBOTBNJOBTBT

q
&UJPMPHrB
NVMUJGBDUPSJBM
BZVOP
UJQP
Z
DBOUJEBE
EF
"" NFOPS
TFDSFDJwO
EF
FO[J
NBT
Z
NFEJBEPSFT
HBTUSPJOUFTUJOBMFT
TPCSFDSFDJNJFOUP
CBDUFSJBOP
Z
USBOTMPDBDJwO

Manejo para minimizar el riesgo:

q

q

q

q

q

q

q

q

82

"ENJOJTUSBS
BQPSUF
FOUFSBM
QSFDP[NFOUF
BVORVF
TFB
NrOJNP
6TBS
TPMVDJPOFT
EF
BNJOPgDJEPT
EJTFvBEBT
QBSB
SFDJnO
OBDJEP
"QPSUF
EF
UBVSJOB
Z
HMVUBNJOB
"EFDVBS
SFMBDJwO
QSPUFrOBTFOFSHrB
OP
QSPUFJDB
HLDBM
$POUSPMBS
BQPSUF
FYDFTJWP
EF
HMVDPTB
6TBS
BOUJCBDUFSJBOP
JOUFTUJOBM
QBSB
FWJUBS
QSPMJGFSBDJwO
CBDUFSJBOB
1SFGFSJS
WJUBNJOBT
DPO
NFOPT
QSFTFSWBOUFT
$FSOBWJU
4J
SFDJCF
BQPSUF
FOUFSBM
OP
BENJOJTUSBS
WJUBNJOBT
QPS
WrB
QBSFOUFSBM

GUAS NACIONALES DE NEONATOLOGA

Tratamiento:
q

q

q

q

q

4VTQFOEFS
BMJNFOUBDJwO
QBSFOUFSBM
DVBOEP
TFB
QPTJCMF
&GFDUVBS
BMJNFOUBDJwO
QBSFOUFSBM
DrDMJDB
.BOUFOFS
BQPSUF
EF
MrQJEPT
&MJNJOBS
BQPSUF
EF
NBOHBOFTP
Z
DPCSF
"ENJOJTUSBS
gDJEP
VSTPEFPYJDwMJDP

"*


" -/


%FSJWBEBT
EF
MBT
WrBT
EF
BENJOJTUSBDJwO
FCJUJT
USPNCPTJT
FNCPMJBT
NJHSBDJwO
EF

DBUnUFS
FYUSBWBTBDJwO
OFDSPTJT
-BT
DPNQMJDBDJPOFT
EJTNJOVZFO
DPO
MB
TVQFSWJTJwO
Z
NBOFKP
QPS
VO
FRVJQP
DPPSEJ
OBEP
EF
OVUSJDJwO
QBSFOUFSBM
RVF
JODMVZF
BM
NnEJDP
FOGFSNFSB
P
NBUSPOB
Z
RVrNJDP
GBS
NBDnVUJDP
Z
BM
FWJUBS
FM
VTP
JOBQSPQJBEP
P
JOOFDFTBSJBNFOUF
QSPMPOHBEP
EF
OVUSJDJwO
QB
SFOUFSBM
.BOUFOHB
VO
TJTUFNB
EF
WJHJMBODJB
QFSNBOFOUF
EF
MBT
DPNQMJDBDJPOFT
UnDOJDBT

NFUBCwMJDBT
F
JOGFDDJPTBT
-BT
JOEJDBDJPOFT
JOEJWJEVBMFT
QBSB
DBEB
QBDJFOUF
SFRVJFSF
EF
QSFQBSBDJwO
JOEJWJEVBM

QPS
MP
RVF
EFQFOEF
EF
MB
DBQBDJEBE
EF
GBSNBDJB
4J
FTUB
DBQBDJEBE
FT
MJNJUBEB
FT
QSF
GFSJCMF
DPOUBS
DPO
TPMVDJPOFT
UJQP
RVF
NJOJNJDFO
MPT
SJFTHPT
EF
QSFQBSBDJwO
Z
VTBS
FO

DBTPT
FYDFQDJPOBMFT
MB
JOEJDBDJwO
JOEJWJEVBM

CONTROL DE ALIMENTACIN PARENTERAL

1FTP
5BMMB
$JSD
$SgOFP
(MJDFNJB
(MVDPTVSJB
&MFDUSPMJUPT
QMBTNB
$B
1
.H
1I
&#
/JUSwHFOP
VSFJDP
"MC|NJOB
'PTGBUBTBT
BMDBMJOBT
#JMJSSVCJOB
%
Z
UPUBM
5SJHMJDnSJEPT


TFNBOB
%JBSJP
4FNBOBM
4FNBOBM
%JBSJP

ErB
$BEB

IPSBT

QPS
TFNBOB
$BEB

IPSBT

QPS
TFNBOB
TFNBOBM

TFNBOBM


QPS
TFNBOB


TFNBOB
%JBSJP
4FNBOBM
4FNBOBM

Y
TFNBOB
%JBSJP
4FNBOBM
2VJODFOBM
4FNBOBM
4FNBOBM
2VJODFOBM
2VJODFOBM
2VJODFOBM
2VJODFOBM

83

RECOMENDACIONES DE APORTE DIARIO DE NUTRIENTES:

$PNQPOFOUF

"QPSUF

"NJOPgDJEPT

 
H

(MVDPTB


H

-rQJEPT

  
H

4PEJP


N&R

1PUBTJP


N&R

$MPSP


N&R

$BMDJP


NH

'wTGPSP


NH

.BHOFTJP
;JOD


NH

VH

$PCSF


VH

:PEP


VH

.BOHBOFTP


VH

$SPNP

 
VH

4FMFOJP


VH

Composicin de las soluciones de minerales por ml

N&RNM
/B
$M


.HNM
 
EF
/B
 
$M

 
NH
EF
/B
 
EF
$M

 
EF
,
 
$M

 
EF
,
 
EF
$M

 
EF
$B

 
EF
$B

 
EF
1
 
EF
,


EF
1

EF
,


EF
.H

 
EF
.H

,
$M

(MVDPOBUP
EF
$B

'PTGBUP
EF
,

4VMGBUP
EF
.H

"DFUBUP
EF
TPEJP


 
EF
/B
 
EF
BDFUBUP

4VMGBUP
EF
;O
#JDBSCPOBUP
EF
/B

84


NH
EF
;O

 
EF
CJDBSCPOBUP
 
EF
/B


NH
EF
CJDBSCPOBUP
 
EF
/B

GUAS NACIONALES DE NEONATOLOGA

Composicin de las soluciones de vitaminas por ml

$PNQPOFOUF

$FSOBWJU
Y
NM

3FDPNFOEBDJwO
Y
LH
Y
ErB

7JUBNJOB
"


6*



7JUBNJOB
%


6*



7JUBNJOB
&

 
6*

 

5JBNJOB
C

 
NH

  

3JCPBWJOB
C

 
NH

  

1JSJEPYJOB
C

 
NH

  

/JBDJOBNJEB

 
NH



%FYQBOUFOPM

 
NH



#JPUJOB

 
VH



"D
BTDPSCJDP $


NH



"DJEP
'PMJDP


VH



$JBOPDPCBMBNJOB

#

 
VH

 

BIBLIOGRAFA

5IVSFFO
1+
.FMBSB
%
'FOOFTTFZ
17
FU
BM

&GGFDU
PG
MPX
WT
IJHI
JOUSBWFOPVT
BNJOP

BDJE
JOUBLF
PO
WFSZ
MPX
CJSUI
XFJHIU
JOGBOUT
JO
UIF
FBSMZ
OFPOBUBM
QFSJPE
1FEJBUS
3FT



;JFHMFS
&&
5IVSFFO
1+
$BSMTPO
4+
"HHSFTJWF
OVUSJUJPO
PG
UIF
WFSZ
MPX
CJSUIXFJHIU

JOGBOU
$MJO
1FSJOBUPM


8JMTPO
%$
$BJSOT
1
)BMMJEBZ
)-
FU
BM
3BOEPNJTFE
DPOUSPMMFE
USJBM
PG
BO
BHHSFTJWF
OV
USJUJPOBM
SFHJNFO
JO
TJDL
WFSZ
MPX
CJSUIXFJHIU
JOGBOUT
"SDI
%JT
$IJME
''

85

86

GUAS NACIONALES DE NEONATOLOGA

-%$)#!#).$%$2/'!3
$52!.4%,!#4!.#)!-!4%2.!

 /,"1

$
q
-B
QSFTDSJQDJwO
EF
NFEJDBNFOUPT
EVSBOUF
MB
MBDUBODJB
NBUFSOB
UJFOF
RVF
CBMBO
DFBS
FOUSF
FM
CFOFDJP
NBUFSOP
Z
FM
SJFTHP
EF
OP
BNBNBOUBNJFOUP
P
FM
SJFTHP

QPUFODJBM
EF
MB
FYQPTJDJwO
EFM
OFPOBUP
B
EJDIP
GgSNBDP
q
&M
QBTP
EF
NFEJDBNFOUPT
EFQFOEF
EF
VOB
HSBEJFOUF
EF
DPODFOUSBDJwO
RVF
QFSNJ
UF
MB
EJGVTJwO
QBTJWB
EF
MB
QPSDJwO
OP
JPOJ[BEB
OJ
MJHBEB
B
QSPUFrOBT
EF
MB
ESPHB

-"*
/""

6OB
EJWFSTJEBE
EF
GBDUPSFT
JOVFODJBO
MB
DBOUJEBE
EF
ESPHB
B
MB
DVBM
FM
3/
FTUB
FY
QVFTUP

Factores maternos
q
.FUBCPMJTNP
IFQgUJDP
Z
SFOBM
NBUFSOP

q
%PTJT
Z
EVSBDJwO
EF
MB
UFSBQJB
q
7rB
EF
BENJOJTUSBDJwO
%VSBOUF
MBT
|MUJNBT
TFNBOBT
EFM
FNCBSB[P
MB
GBSNBDPDJOnUJDB
EF
BMHVOPT
NFEJDB
NFOUPT
FTUg
BMUFSBEB
OFDFTJUBOEP
BVNFOUP
EF
EPTJT
FK
BOUJDPOWVMTJWBOUFT

&M
OP
EJT
NJOVJS
EPTJT
QPTU
QBSUP
QVFEF
EBS
MVHBS
B
OJWFMFT
UwYJDPT
FO
MB
NBESF
Z
B
OJWFMFT
BMUPT
FO

MB
MFDIF
NBUFSOB
$VBMRVJFS
GBDUPS
RVF
SFUBSEF
MB
NFUBCPMJ[BDJwO
P
FMJNJOBDJwO
EFM
GgSNBDP
FO
MB
NBESF

QVFEF
EBS
MVHBS
B
VOB
HSBO
FYQPTJDJwO
EF
FTUB
ESPHB
FO
FM
OFPOBUP
-B
EPTJT
Z
EVSBDJwO
EF
MB
UFSBQJB
TPO
JNQPSUBOUFT
QBSB
EFUFSNJOBS
MB
TFHVSJEBE
EFM

VTP
EF
MB
ESPHB
EVSBOUF
FM
BNBNBOUBNJFOUP

87

q
&O
BMHVOPT
NFEJDBNFOUPT
TF
EFTDPOPDF
MB
NBHOJUVE
EF
FYDSFDJwO
B
USBWnT
EF
MB

MFDIF
EF
BIr
RVF
TFB
OFDFTBSJP
VTBS
NFEJDBNFOUPT
QSPCBEPT
DPO
JOGPSNBDJwO

DPOPDJEB
q
-B
CJPEJTQPOJCJMJEBE
PSBM
EF
NFEJDBNFOUPT
FO
MB
TFHVSJEBE
EFM
GgSNBDP
FT
JN
QPSUBOUF
"MHVOPT
NFEJDBNFOUPT
FOEPWFOPTPT
QVFEFO
TFS
BENJOJTUSBEPT
B
MB

NBESF
Z
OP
UFOFS
VOB
CJPEJTQPOJCJMJEBE
PSBM
FO
FM
3/
JOTVMJOB
BNJOPHMJDwTJEPT
Z

TVMGBUP
EF
NBHOFTJP

q
-B
DBOUJEBE
EF
MFDIF
NBUFSOB
RVF
MB
NBESF
BQPSUF
BM
3/
FT
JNQPSUBOUF
q
-B
UPYJDJEBE
OP
EFQFOEJFOUF
EF
MB
EPTJT
FT
UBNCJnO
JNQPSUBOUF
4F
EFCF
DPOTJEF
SBS

FM
QPUFODJBM
EF
BMFSHJOJ[BDJwO
EF
VO
3/
EF
VOB
ESPHB
JOHFSJEB
QPS
MB
NBESF

BMUFSBDJPOFT
FO
MB
PSB
HBTUSPJOUFTUJOBM
TFDVOEBSJB
BOUJCJwUJDPT

OFPOBUPT
DPO
EnDJU
EF
HMVDPTB


GPTGBUP
EFTIJESPHFOBTB
TPO
TVTDFQUJCMFT

B
BOFNJB
IFNPMrUJDB
DBVTBEBT
QPS
QFRVFvBT
DBOUJEBEFT
EF
BHFOUFT
FO
MB

MFDIF
NBUFSOB
FK
MBT
TVMGPOBNJEBT


q
"MHVOPT
NFEJDBNFOUPT
DPNP
OJDPUJOB
Z
FTUSwHFOPT
QVFEFO
EJTNJOVJS
MB
JSSJHB
DJwO
EF
MB
NBNB
MBDUBOUF

Factores del Neonato

q

q

q

q

q

&EBE
EFM
SFDJnO
OBDJEP
"CTPSDJwO
EF
MB
ESPHB
.FUBCPMJTNP
SFOBM
Z
IFQgUJDP
$BOUJEBE
EF
MFDIF
JOHFSJEB
4FHVSJEBE
EFM
GgSNBDP
VTBEP

-B
BCTPSDJwO
EF
VOB
ESPHB
Z
TV
NFUBCPMJTNP
EFQFOEF
FO
FM
OFPOBUP
EF
q
Q)
HgTUSJDP
BMUP
q
UFOEFODJB
BM
SFVKP
q
UJFNQP
EF
WBDJBNJFOUP
HgTUSJDP
q
UJFNQP
BVNFOUBEP
EFM
USgOTJUP
HBTUSPJOUFTUJOBM
q
TVQFSDJF
EF
BCTPSDJwO
JOUFTUJOBM
QFRVFvB
q
SFEVDDJwO
EF
DBOUJEBEFT
EF
TBMFT
CJMJBSFT
Z
FO[JNBT
QBODSFgUJDBT
q
MPT
OFPOBUPT
QVFEFO
BCTPSCFS
JONVOPHMPCVMJOB
B
USBWnT
EF
MB
MBDUBODJB
Z
QPS
MP

UBOUP
ESPHBT
EF
QFTP
NPMFDVMBS
BMUP
q
FM
NFUBCPMJTNP
IFQgUJDP
Z
MB
FYDSFDJwO
SFOBM
EF
MPT
GgSNBDPT
FT
CBKP
FO
MPT
QSJNF
SPT
ErBT
NBEVSBOEP
MB
QSJNFSB
TFNBOB
EF
WJEB

q
)BZ
ESPHBT
RVF
TF
VOFO
B
QSPUFrOBT
Z
QVFEFO
EFTQMB[BS
MB
CJMJSSVCJOB
DPO
VO
BV
NFOUP
EFM
SJFTHP
EF
FODFGBMPQBUrB
TFDVOEBSJP
B
JDUFSJDJB

88

GUAS NACIONALES DE NEONATOLOGA

Factores de la droga:
q

q

q

q

q

q

q

Q,B
4PMVCJMJEBE
FO
BHVB
P
MrQJEPT
&OMBDF
QSPUFJDP
5BNBvP
EF
MB
NPMnDVMB
#JPEJTQPOJCJMJEBE
PSBM
%PTJT
OP
SFMBDJPOBEB
DPO
UPYJDJEBE
&GFDUPT
TPCSF
MB
QSPEVDDJwO
EF
MFDIF

7BSJPT
GBDUPSFT
JOVFODJBO
FM
QBTBKF
EF
VOB
ESPHB
EFTEF
FM
TVFSP
B
MB
MFDIF
IVNBOB

JODMVZF
q
UBNBvP
EF
NPMnDVMB
q
Q,B
EF
MB
ESPHB
q
TPMVCJMJEBE
FO
MrQJEPT
Z
BHVB
&O
DPODMVTJwO
FM
SJFTHP
EF
VOB
ESPHB
EFQFOEF
EF
VOB
TFSJF
EF
GBDUPSFT
q
-B
WrB
QPS
MB
DVBM
MB
NBESF
FT
FYQVFTUB
BM
GgSNBDP
MB
BCTPSDJwO
NFUBCPMJTNP
Z

FYDSFDJwO
q
&M
NPEFMP
EF
EPTJT
5FSBQJB
DPO
EPTJT
|OJDB
QBSB
QSPCMFNBT
BHVEPT
WFSTVT
DPO
DFOUSBDJPOFT
NgT
BMUBT
Z
FTUBCMFT
DPNP
FT
FM
DBTP
EF
MBT
ESPHBT
BOUJEFQSFTJWBT

VTBEBT
FO
UFSBQJBT
NgT
QSPMPOHBEBT
q
'BSNBDPDJOnUJDB
EF
MB
TVTUBODJB
q
.BEVSBDJwO
TJPMwHJDB
EFM
3/
FO
TV
DBQBDJEBE
EF
BCTPSCFS
NFUBCPMJ[BS
Z
FYDSF
UBS
MB
TVTUBODJB

GUAS GENERALES Y RECOMENDACIONES

SEGN CONDICIONES ESPECFICAS:
Rinitis alrgicas:
B

1TFVEPFGFESJOB
FT
FYDSFUSBEB
FO
MB
MFDIF
NBUFSOB
FO
QFRVFvB
DBOUJEBE
EF

BDVFSEP
B
MB
""1
"NFSJDBO
"DBEFNZ
PG
1FEJBUSJDT

TV
VTP
FT
DPNQBUJCMF
DPO

MB
MBDUBODJB
BVORVF
FTUB
QVFEF
EJTNJOVJS
MB
QSPEVDDJwO
MgDUFB
&WJUBS
EVSBOUF
MBT

QSJNFSBT

TFNBOBT
IBTUB
RVF
MB
MBDUBODJB
FTUn
CJFO
FTUBCMFDJEB
C

%JGFOJMIJESBDJOB
TF
FODVFOUSB
FO
MB
MFDIB
FO
NFOPS
DBOUJEBE
DVBMRVJFSB
EF
FTUPT

NFEJDBNFOUPT
QVFEF
DBVTBS
MFUBSHJB
P
JSSJUBCJMJEBE
FO
OFPOBUP
TF
SFEVDF
BM
SJFT
HP
EF
UPNBSMP
JONFEJBUBNFOUF
EFTQVnT
EF
IBCFS
BNBNBOUBEP
1VFEF
EJTNJOVJS

MB
QSPEVDDJwO
EF
MFDIF
FTQFDJBMNFOUF
DVBOEP
TF
VTB
DPNCJOBEB
DPO
QTFVEP
FGFESJOB

89

D

-PT
OVFWPT
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90

GUAS NACIONALES DE NEONATOLOGA

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GUAS GENERALES Y RECOMENDACIONES SEGN

GRUPOS DE MEDICAMENTOS:
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91

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92

GUAS NACIONALES DE NEONATOLOGA

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93

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94

GUAS NACIONALES DE NEONATOLOGA

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95

96

GUAS NACIONALES DE NEONATOLOGA

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97

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B


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98

GUAS NACIONALES DE NEONATOLOGA

Fisiopatologa:
q

q

q

q

q

q

q

q

q

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Tratamiento: Segn etiologa y gravedad

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NHEM
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NHEM

Sintomatologa:
)JQPUPOrB
MFUBSHJB
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DPNQSPNJTP
HFOFSBM
$PO
OJWFMFT
TnSJDPT

NHE-
BMUFSBDJwO

EF
MB
SFTQJSBDJwO
DFMVMBS

Fisiopatologa:
-B
IJQPGPTGFNJB
TF
QSPEVDF
GSFDVFOUFNFOUF
QPS
q
"QPSUF
JOTVDJFOUF
EF
1
ZB
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q
4JHOP
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MB
FOGFSNFEBE
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q
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q
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q
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99

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FOEPWFOPTP

* ,"- 
\

Denicin:
/JWFMFT
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EF
1
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NHEM

Sintomatologa:
4PMP
TF
NBOJFTUB
DMrOJDBNFOUF
TJ
IBZ
IJQPDBMDFNJB
RVF
TF
BTPDJB
GSFDVFOUFNFOUF

Fisiopatologa:
q
-B
IJQFSGPTGFNJB
QSPEVDF
JOIJCJDJwO
EF
MB
15)
Z
WJUBNJOB
%
DPO
MP
RVF
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Tratamiento:
q
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1
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MB
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Diagnstico:
&T
VO
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$PSSFTQPOEF
B
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B
 
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HFOFSBMNFOUF
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DPO
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NFOPSFT

B
 
NHEM

Sntomas:
q
*HVBM
RVF
MB
IJQPDBMDFNJB
q
4F
EFCF
TPTQFDIBS
BM
QFTRVJ[BS
VOB
DBMDFNJB
QFSTJTUFOUFNFOUF
CBKB
RVF
OP
TF

DPSSJHF
q
%PDVNFOUBS
DPO
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EF
NBHOFTJP
4J
FM
DBMDJP
FTUg
OPSNBM
OP
QJFSEB
FM
UJFN
QP
FO
DIFRVFBS
FM
NBHOFTJP

100 GUAS NACIONALES DE NEONATOLOGA

Fisiopatologa:
*OIJCJDJwO
EF
MB
TFDSFDJwO
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EF
MB
BDDJwO
QFSJGnSJDB
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MB
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1VFEF
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FO
q
/VUSJDJwO
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TJO
.H
q
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q
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q
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q
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q
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q
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q
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q

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Tratamiento:
q
4VMGBUP
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NMLHEPTJT
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IPSBT
q
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Denicin:
7BMPSFT
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Diagnstico:
&T
SBSP
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HFOFSBMNFOUF
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JBUSPHnOJDP
4F
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MPT
3/
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BMUBT
EPTJT
EF
TVMGBUP
EF
NBHOFTJP
FO
CPMP
Z
FO
3/
DPO
"-1"3

Sntomas:
/P
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EF
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Tratamiento:
q
3FHJNFO

IBTUB
RVF
TF
PCTFSWF
CVFO
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JOUFTUJOBM
FMJNJOBDJwO
EF
NFDPOJP

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q
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FO
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HSBWF
q
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EF
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BM



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FO
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q
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101

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102 GUAS NACIONALES DE NEONATOLOGA

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Nota: El riesgo se potencia con la combinacin de factores

103

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104 GUAS NACIONALES DE NEONATOLOGA

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154 GUAS NACIONALES DE NEONATOLOGA

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155

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FO
FM
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EFM
QVMNwO

q
4F
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FO
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TF
EFUFSJPSB
q
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VOJMBUFSBM
EFM
UwSBY
q
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VOJMBUFSBM
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q
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EFM
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DBSErBDP
q
4J
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q
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FM
EJBHOwTUJDP
EFCFS
UPNBSTF
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Z
EFD|CJUP

MBUFSBM

Cuadro clnico y manejo:

4F
EFCF
EJTUJOHVJS
DMBSBNFOUF
FM
OFVNPUwSBY
FTQPOUgOFP
FM
DVBM
TF
QSPEVDF
FO
MBT

QSJNFSBT
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DJBEP
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UJFOFO
EJGFSFOUF
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DMrOJDB
Z
FOGSFOUBNJFOUP
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Neumotrax espontneo:
q
4JO
QBUPMPHrB
QVMNPOBS
BTJOUPNgUJDP
P
FTDBTPT
TJHOPT
EF
EJDVMUBE
SFTQJSBUPSJB

TJO
P
DPO
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EF
0

q
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q
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NVZ
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q
4F
FTQFSB
VOB
SFBCTPSDJwO
FTQPOUgOFB
FO

B

IST

Neumotrax a tensin:
4J
FYJTUF
QBUPMPHrB
QVMNPOBS
BTPDJBEB
FTDBQF
DPOUJOVP
EF
BJSF
OFDFTJEBE
EF
WFOUJMB
DJwO
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EFM
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DPO
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CBKP
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BHVB
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DPO
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DPOUJ
OVB
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MPT
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4F
EFCF
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MB
TPOEB
QMFVSBM
TJ
DPOEJDJwO
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EFM
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MP
QFSNJUF
q
1VMNwO
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q
-B
TPOEB
EFKB
EF
ESFOBS
BJSF

156 GUAS NACIONALES DE NEONATOLOGA

ENFISEMA PULMONAR INTERSTICIAL (EPI):

$PSSFTQPOEF
B
VOB
SVQUVSB
BMWFPMBS
HSBWF
DPNP
DPNQMJDBDJwO
EF
MB
WFOUJMBDJwO
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MB
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FO
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&M
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FO
FM
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MB
GVODJwO

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DPO
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FM
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DPO
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FM
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4V
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DPO
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FT
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IST

FO
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6O
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Tratamiento general:
q

q

q

q

q

5SBUBNJFOUP
DPOTFSWBEPS
%JTNJOVJS
QSFTJPOFT
WFOUJMBUPSJBT
7PM|NFOFT
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BMUBT
Z
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DPSUPT
7FOUJMBDJwO
EF
BMUB
GSFDVFODJB

Tratamiento en EPI unilateral:

q
%FD|CJUP
MBUFSBM
TPCSF
FM
MBEP
BGFDUBEP
q
%JTNJOVJS
,53
P
NVZ
DVJEBEPTB
q
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EFM
QVMNwO
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FM
DPMBQTP
EFM
QVMNwO
BGFDUB
EP

NEUMOMEDIASTINO:
&M
BJSF
EJTFDB
QMFVSB
NFEJBTUrOJDB

Cuadro clnico:
q

q

q

q

q

q

&O
HFOFSBM
BTJOUPNgUJDP
%JTNJOVDJwO
MFWF
EF
MPT
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MB
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157

Tratamiento:
q
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WF[
QSPEVDF
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P
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q
$POUSPM
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NEUMOPERICARDIO:
1SFTFODJB
EF
BJSF
FO
MB
DBWJEBE
QFSJDgSEJDB
&T
MB
NFOPT
GSFDVFOUF
EF
MBT
SVQUVSBT

BMWFPMBSFT

Diagnstico:
%FQFOEF
EF
MB
DBOUJEBE
EF
BJSF
BDVNVMBEP

Casos leves:
q
4VFMFO
TFS
BTJOUPNgUJDPT
-B
3Y
EF
UwSBY
NVFTUSB
VOB
JNBHFO
BnSFB
RVF
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DB
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MB
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q
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B
MB
BVTDVMUBDJwO
q
5SBUBNJFOUP
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Z
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Casos graves:
q
-B
QSFTJwO
BVNFOUB
QSPEVDJnOEPTF
VO
UBQPOBNJFOUP
DBSEJBDP
DPMBQTP
DBSEJP
WBTDVMBS
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FUD
q
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FT
VOB
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EFM
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DPO
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4J
FM
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EF
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TF
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VOB
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ESFOBKF

BIBLIOGRAFIA

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158 GUAS NACIONALES DE NEONATOLOGA

(%-/22!')!
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159

1.- Ductus
q
&M
BVNFOUP
EFM
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q
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q
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EF
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FO
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2.- Infeccin a Gram (-)

q
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3.- Neurognico
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160 GUAS NACIONALES DE NEONATOLOGA

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162 GUAS NACIONALES DE NEONATOLOGA

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JOUFSNJUFOUFT
GSFDVFOUFT
RVF
OP
SFTQPOEFO
B
USBUBNJFOUP
DPO
YBOUJOBT
OJ

B
$1"1
OBTBM

q
5SBUBNJFOUP
QSFDP[
DVBOEP
MB
WFOUJMBDJwO
NFDgOJDB
TF
VUJMJ[B
QPS
EFUFSJPSP
HBTP
NnUSJDP
QSPHSFTJWP
q
"MJWJP
EFM
USBCBKP
SFTQJSBUPSJP
FO
OFPOBUP
DPO
EJDVMUBE
SFTQJSBUPSJB
q
*OJDJP
EF
USBUBNJFOUP
DPO
TVSGBDUBOUF
FO
3/
DPO
EJDVMUBE
SFTQJSBUPSJB

Tipos de Soporte Ventilatorio:


$1"1
q
&T
MB
NBOUFODJwO
EF
VOB
QSFTJwO
TVQSB
BUNPTGnSJDB
QPTJUJWB

FO
VO
QBDJFOUF
RVF
SFT
QJSB
FTQPOUgOFBNFOUF
FGFDUP
RVF
TF
QSPEVDF
FO
MB
FTQJSBDJwO
NBOUFOJFOEP
MB
QFS
NFBCJMJEBE
BMWFPMBS
FWJUBOEP
BTr
FM
DPMBQTP
BMWFPMBS
Z
FM
VTP
EF
WFOUJMBDJwO
BTJTUJEB

183

q
-B
QSFTJwO
QPTJUJWB
EF
MB
WrB
BnSFB
QSPWFF
EF
VOB
CBKB
QSFTJwO
EF
EJTUFOTJwO
BM

QVMNwO
EVSBOUF
MB
FYQJSBDJwO
DPOTUJUVZnOEPTF
FO
VOP
EF
MPT
USBUBNJFOUPT
NgT

FGFDUJWPT
FO
NFEJDJOB
OFPOBUBM
q
&M
$1"1
NFKPSB
MB
DPNQMJBODF
QVMNPOBS
Z
FM
WPMVNFO
DPSSJFOUF
EF
QVMNPOFT
Sr
HJEPT
DPO
CBKB
$'3
FTUBCJMJ[BOEP
MB
QBSFE
UPSgDJDB
Z
FWJUBOEP
MPT
NPWJNJFOUPT

QBSBEwKJDPT
q
&M
$1"1
DPOUSJCVZF
B
QSFTFSWBS
FM
TVSGBDUBOUF
QVMNPOBS
q
&M
VTP
EF
$1"1
QSFDP[
UJFOF
WFOUBKBT
QPS
TPCSF
FM
VTP
EF
)BMP
Z
FT
VOB
CVFOB

BMUFSOBUJWB
BM
VTP
EF
WFOUJMBDJwO
BTJTUJEB
q
6TBS
DgOVMBT
OBTBMFT
P
DPO
1SFTJwO
.FEJB
EF



DN
EF
)
q
&WJUBS
VTP
EF
5&5

*OEJDBDJPOFT
q
5SBUBNJFOUP
QSFDP[
EF
&.)
MFWF
q
&QJTPEJPT
BQOFJDPT
NPEFSBEBNFOUF
GSFDVFOUFT
q
%FTQVnT
EF
FYUVCBDJwO
SFDJFOUF
DPNP
QFSJPEP
EF
USBOTJDJwO
q
%FTUFUF
EF
*.7
FO
OFPOBUPT
EFQFOEJFOUFT
EF
SFTQJSBEPS
q
1VMNwO
I|NFEP
DPO
BQSFNJP
SFTQJSBUPSJP

q
1BTP
QSFDP[
B
$1"1
FO
3/
DPO
.C
IJBMJOB
QPTUBENJOJTUSBDJwO
EF
TVSGBDUBOUF

.nUPEP
*/463&
*OUVCBDJwO4VSGBDUBOUF&YUVCBDJwO
q
1FSJPEPT
QSPMPOHBEPT
FO
$1"1
FO
QSFNBUVSPT
FYUSFNPT
DPNP
NnUPEP
EF
QSF
WFODJwO
EF
%#1
EFNPTUSBEP
FO
FTUVEJPT
SFUSPTQFDUJWPT

V. Mecnico de ujo continuo, ciclado por tiempo y limitado por presin:

No sincronizados: IMV o CMV (Vent. Mec. Convencional)
q
4F
MPHSB
DPO
VO
TJTUFNB
TJNQMF
VO
CVFO
DPOUSPM
EF
1SFTJPOFT
SFTQJSBUPSJBT
Z
EF

5JFNQPT
JOTQJSBUPSJP
Z
FTQJSBUPSJP
EF
NBOFSB
JOEFQFOEJFOUF
q
1FSNJUF
FTGVFS[PT
SFTQJSBUPSJPT
FTQPOUgOFPT
EFM
3/
FOUSF
MBT
SFTQJSBDJPOFT
QSP
HSBNBEBT
FO
FM
WFOUJMBEPS

*OEJDBDJPOFT
q
6UJM
FO
DVBMRVJFS
GPSNB
EF
FOGFSNFEBE
QVMNPOBS
%FTWFOUBKBT
q
3JFTHP
EF
EFTBDPQMF
Z
MVDIB
DPOUSB
FM
WFOUJMBEPS
DPO
FM
DPOTJHVJFOUF
SJFTHP
EF

CBSPUSBVNB

q
/P
TF
MPHSB
VO
BEFDVBEP
DPOUSPM
EFM
7PMVNFO
$PSSJFOUF
ZB
RVF
OP
TF
BKVTUB
B

MPT
DBNCJPT
EF
DPNQMJBODF
EFM
QBDJFOUF
OJ
BM
EFTBSSPMMP
EF
FTGVFS[P
SFTQJSBUPSJP

QSPQJP

184 GUAS NACIONALES DE NEONATOLOGA

Sincronizados y activados por el paciente (trigger):

q
"$
"TJTUJEB
$POUSPMBEB
q
4*.7
7FOUJMBDJwO
NBOEBUBSJB
JOUFSNJUFOUF
TJODSPOJ[BEB
q
147
7FOUJMBDJwO
DPO
QSFTJwO
EF
TPQPSUF

-P
GVOEBNFOUBM
EF
FTUF
UJQP
EF
WFOUJMBEPSFT
FT
RVF
FOUSFHBO
HSBO
QBSUF
EFM

DPOUSPM
EF
MB
WFOUJMBDJwO
BM
QBDJFOUF
7FOUJMBEPS
QPTFF
VO
TFOTPS
EF
QSFTJwO
GMVKP
P
NPWJNJFOUPT
SFTQJSBUPSJPT


RVF
QFSNJUF
TJODSPOJ[BS
FM
FTGVFS[P
JOTQJSBUPSJP
EFM
3/
TFH|O
MB
GSFDVFODJB

QSFGJKBEB
FO
FM
WFOUJMBEPS
4*.7

P
FO
DBEB
FTGVFS[P
JOTQJSBUPSJP
EFM
3/

"$

4J
FM
3/
QSFTFOUB
VOB
"QOFB
P
'3
QSPQJB
NFOPS
RVF
MB
KBEB
FO
FM
WFOUJMBEPS

TF
HBUJMMB
VO
DJDMP
QSFKBEP
FO
FM
WFOUJMBEPS
QBSB
DVNQMJS
MPT
DJDMPT
QPS
NJOVUP

QSPHSBNBEPT
*.7

&M
3/
TF
QVFEF
BDPQMBS
NFKPS
BM
7FOUJMBEPS
NFOPS
VTP
EF
TFEBDJwO
Z
NFKPS

EFTUFUF


MODALIDADES:
4*.7
7FOUJMBDJwO
NBOEBUPSJB
JOUFSNJUFOUF
TJODSPOJ[BEB

FM
WFOUJMBEPS
FOUSFHB

WFOUJMBDJPOFT
NFDgOJDBT
FO
GPSNB
JOUFSNJUFOUF
B
VOB
GSFDVFODJB
KBEB
QPS
FM
Nn
EJDP
RVF
FTUgO
TJODSPOJ[BEBT
DPO
FM
FTGVFS[P
JOTQJSBUPSJP
EFM
QBDJFOUF
4F
EFCF

VTBS
FO
QBDJFOUF
DPO
SFTQJSBDJwO
FTQPOUBOFB
"$
7FOUJMBDJwO
BTJTUJEBDPOUSPMBEB

DBEB
SFTQJSBDJwO
FTQPOUgOFB
EFM
QBDJFOUF

HBUJMMB
P
FT
BTJTUJEB
QPS
VOB
WFOUJMBDJwO
NFDgOJDB
DPNQMFUB
4J
FM
QBDJFOUF
OP
SFT
QJSB
P
TJ
FM
FTGVFS[P
JOTQJSBUPSJP
EFM
QBDJFOUF
OP
BMDBO[B
B
TVQFSBS
FM
VNCSBM
EF

HBUJMMBDJwO
FM
WFOUJMBEPS
FOUSFHB
SFTQJSBDJPOFT
NFDgOJDBT
B
MB
GSFDVFODJB
KBEB

QPS
FM
NnEJDP
147
7FOUJMBDJwO
DPO
QSFTJwO
EF
TPQPSUF

7FOUJMBDJwO
HBUJMMBEB
QPS
FM
QBDJFOUF
FO

MB
DVBM
FM
FTGVFS[P
JOTQJSBUPSJP
FT
BTJTUJEP
QPS
VO
BVNFOUP
EFM
VKP
JOTQJSBUPSJP

1VFEF
VTBSTF
TPMB
P
BTPDJBEB
B
WPMVNFO
HBSBOUJ[BEP
*OEJDBDJPOFT
EF
WFOUJMBDJwO
BTJTUJEB
4*.7
-BT
NJTNBT
RVF
QBSB
*.7

"$
q
3/
FO
GBTF
BHVEB
EF
GBMMB
SFTQJSBUPSJB
TFWFSB
FO
MPT
QSJNFSPT
NJOVUPT
EF
DP
OFYJwO

185

q
"MUP
SJFTHP
EF
QSPEVDJS
BVNFOUP
TFWFSP
EF
."1
F
IJQPDBQOJB
TFWFSB
QPS
IJQFS
WFOUJMBDJwO
147
q
%FTUFUF
EF
7
.FDgOJDB
FO
3/
DPOFDUBEP
FO
GPSNB
DSwOJDB

-/,
/ 
-6 /
/",
- -/
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*
/"$
"- -*

"Enfermedad membrana hialina:
"

$1"1
q
$PO
&.)
RVF
OP
SFRVJFSB
JOUVCBDJwO
OJ
VTP
EF
TVSGBDUBOUF

q
1BTP
QSFDP[
B
$1"1
FO
3/
QPTUBENJOJTUSBDJwO
EF
TVSGBDUBOUF
.nUPEP
*/463&

*OUVCBDJwO4VSGBDUBOUF&YUVCBDJwO

q
*OJDJBS
$1"1
DPO

DN
)
QPS
DgOVMB
OBTBM
BVNFOUBS
QSFTJwO
IBTUB

DN

)
DPNP
NgYJNP
FWBMVBOEP
SFUPSOP
WFOPTP
Z
TFH|O
WPMVNFO
QVMNPOBS

#

7FOU
.FD
q
$VBOEP
BMUFSBDJwO
72
FT
HSBWF
EFTEF
VO
DPNJFO[P
DPO
'J0
FMFWBEB
Z
EJDVM
UBE
SFTQJSBUPSJB
SgQJEBNFOUF
QSPHSFTJWB

q
"QBSJDJwO
EF
"QOFB
q
"QBSJDJwO
QSFDP[
EF
SFUFODJwO
EF
$
QSPEVDJFOEP
BDJEPTJT
SFTQJSBUPSJB
Q)




q
4J
GSBDBTB
$1"1
OBTBM
P
OBTPGBSrOHFP

'J0


DPO
1&&1

DN
EF
BHVB

"HPUBNJFOUP
DMrOJDP
&TUSBUFHJB
7FOUJMBUPSJB
q
'J0
OFDFTBSJB
QBSB
1B0

NN
)H
Z
TBUVSBDJwO
)C


q
7$
QFRVFvPT


NM,H

q
'3
FMFWBEBT
BMSFEFEPS
EF

QPS
NJOVUP
QBSB
DPNFO[BS

q
5*.
DPSUPT
 
TFH

q
1*.
BMSFEFEPS
EF



DN
)
MB
NFOPS
QPTJCMF
QBSB
MB
FYDVSTJwO
EFM
UPSBY

q
1&&1
OP
JOGFSJPS
B



DN
)
q
'MVKP
OFDFTBSJP
QBSB
MPHSBS
POEB
'MVKP5JFNQP
BEFDVBEB



MUTNJO
$PO
'3


QPS
NJO

BKVTUBS
VKP
B



MUTNJO
q
.BOUFOFS
HBTPNFUSrB
FO
Q0



NN
)H
Z
1B$0
FO
SBOHP
EF


NN

)H

186 GUAS NACIONALES DE NEONATOLOGA

%FTUFUF
q
1BDJFOUF
FTUBCMF
q
%JTNJOVJS
QSJNFSP
'J0
Z
1*.
q
"MUFSOBS
DPO
EJTNJOVDJwO
EF
'3
TFH|O
TBUVSPNFUSrB
(4"
Z
BVTDVMUBDJwO
EF
NVS
NVMMP
QVMNPOBS
q
6TP
EF
9BOUJOBT

B

IST
QSFWJBT
B
FYUVCBDJwO
FO
3/


TFN

"NJOPMJOB
%PTJT
EF
DBSHB

NHLH
&7

%PTJT
EF
NBOUFODJwO

NHLHEPTJT
&7
D
IPSBT
q
&YUVCBDJwO
P
QBTP
B
$1"1
DVBOEP
TF
BMDBODF
'3

QPS
NJO
'J0


1*.



DN
)
Z
."1DN
)0
$

7
"MUB
'SFDVFODJB
7FS
OPSNB
FTQFDJDB

Bronconeumona:
q
$POFYJwO
QSFDP[
B
7
.FDgOJDB
TJ
FWPMVDJwO
FT
SgQJEBNFOUF
QSPHSFTJWB
q
$POFDUBS
TJ

'J0
FOUSF



QBSB
NBOUFOFS
Q0


NN
)H
Z
TBUVSBDJwO



P
QSFTFODJB
EF
SFUFODJwO
EF
$0
RVF
DPOEJDJPOF
BDJEPTJT
SFTQJSBUPSJB
Q)





1SFTFODJB
EF
)511

"TPDJBEP
B
4IPDL
TnQUJDP

&TUSBUFHJB
7FOUJMBUPSJB
q
'J0
/FDFTBSJB
QBSB
TBUVSBS




q
1*.
4JFNQSF
VTBS
FM
OFDFTBSJP
QBSB
MPHSBS
BEFDVBEB
FYDVSTJwO
SFTQJSBUPSJB
TJO

TPCSFEJTUFOEFS
&O
DPOUSPM
SBEJPMwHJDP
PCUFOFS

FTQBDJPT
JOUFSDPTUBMFT

q
1&&1



DN
)0
q
5*.
 

 
TFH
q
'3



QPS
NJO
P
NgT
FO
IJQPYFNJB
TFWFSB
q
'MVKPT
TFH|O
'3
Z
GPSNB
EF
MB
'MVKP5JFNQP
DVBESBEB

MUTTFH
q


1SJNFSBT

B

IST


.BOUFOFS
HBTPNFUSrB
DPO
Q0


NN
)H
P
TBUVSBDJwO
)C



Z
Q$0

FOUSF



NN
)H
QBSB
NBOFKBS
)511
q
)PSBT
QPTUFSJPSFT


.BOUFOFS
TBU


Z
Q$0
BMSFEFEPS
EF



NN
)H
q
.BOUFOFS
TJFNQSF
DPOEJDJwO
IFNPEJOgNJDB
wQUJNB
FM
NBOFKP
EFM
TIPDL
FT
WJ
UBM

187

%FTUFUF
q
1BDJFOUF
FTUBCMF
q
1SJPSJ[BS
QPS
EJTNJOVDJwO
EF
CBSPUSBVNB
ZP
WPMVUSBVNB
EJTNJOVJS
."1

KVOUP

DPO
MB
'J0
q
%JTNJOVJS
QSJNFSP
'J0
Z
1*.
q
"MUFSOBS
DPO
EJTNJOVDJwO
EF
'3
TFH|O
TBUVSPNFUSrB
(4"
Z
BVTDVMUBDJwO
EF
NVS
NVMMP
QVMNPOBS

Sindrome aspirativo meconial:

&M
NBOFKP
WFOUJMBUPSJP
FT
DPOUSPWFSTJBM

q
6OB
UFOEFODJB
FT
FWJUBS
MB
DPOFYJwO
B
WFOUJMBDJwO
NFDgOJDB
Z
IBDFSMP
TJ
DVSTB

DPO
EFUFSJPSP
DMrOJDP
SgQJEBNFOUF
QSPHSFTJWP
P
DPO
'J0
NgYJNB
QPS
)PPE
OP

MPHSB
NBOUFOFS
Q0


NN
)H
P
TBUVSBDJwO


B
QFTBS
EF
BMDBMJOJ[BDJwO

TFEBDJwO
Z
NFEJEBT
IFNPEJOgNJDBT
JOTUBVSBEBT
P
BDJEPTJT
Q)

 
DPO
Q$0

NBZPS
EF

NN
)H

q
-B
PUSB
BMUFSOBUJWB
FT
DPOTJEFSBS
MB
DPOFYJwO
B
$1"1
OBTPGBSJOHFP
P
*.7
FO
DBTP

EF
'J0
DFSDBOB
B

&TUSBUFHJBT
7FOUJMBUPSJBT
q
'J0

q
1*.

4JFNQSF
VTBS
FM
OFDFTBSJP
QBSB
MPHSBS
BEFDVBEB
FYDVSTJwO
SFTQJSBUPSJB
TJO

TPCSFEJTUFOEFS
&O
DPOUSPM
SBEJPMwHJDP
PCUFOFS

FTQBDJPT
JOUFSDPTUBMFT


1&&1



DN
)
&O
DBTP
EF
'3
BMUBT
NBZPSFT
EF


VTBS
1&&1
EF

EFCJEP

B
RVF
MBT
GSFDVFODJBT
BMUBT
DPOEJDJPOBO
1&&1
JOBEWFSUJEP
DPO
BUSBQBNJFOUP
EF

BJSF
SJFTHP
EF
FTDBQF
BnSFP

q
5*.
FOUSF
 

 
TFH
BM
DPNJFO[P
7JHJMBS
SFMBDJwO
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QBSB
FWJUBS
UJFNQPT
FTQJSB
UPSJPT
DPSUPT
q
'3
JOJDJBS
DPO



QPS
NJO
WJHJMBOEP
TJFNQSF
5*.
Z
1&&1
QBSB
FWJUBS
BUSBQB
NJFOUP
EF
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PDBTJPOFT
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IJQPYFNJB
TFWFSB
VTBS
GSFDVFODJBT
NBZPSFT
B


DVJEBOEP
1&&1
JOBEWFSUJEP
q
4FEBDJwO
BEFDVBEB
EF
TFS
QPTJCMF
QSJPSJ[BS
QPS
NPEBMJEBE
4*.7
QBSB
EJTNJOVJS

SJFTHP
EF
FTDBQF
BnSFP
q
&O
3/
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)511
NBOUFOFS
HBTPNFUSrB
DPO
1B0



NN
)H
Z
Q)
 
B
 

6TBS
CJDBSCPOBUP
FO
FCPDMJTJT
BMDBMJOJ[BOUF
TFH|O
OPSNBT
EF
)511
q
7FOUJMBDJwO
EF
"MUB
'SFDVFODJB
TFH|O
OPSNB

Hipertensin Pulmonar Persistente: Ver norma especica.

188 GUAS NACIONALES DE NEONATOLOGA

Displasia Broncopulmonar:
&O
GBTF
DSwOJDB
MB
FTUSBUFHJB
EFCF
TFS
UFOEJFOUF
B
EFTIBCJUVBS
BM
OFPOBUP
EFM

WFOUJMBEPS
MP
BOUFT
QPTJCMF
SJFTHP
EF
CBSPWPMVUSBVNB
Z
UPYJDJEBE
QPS
0

&TUSBUFHJB
7FOUJMBUPSJB
q
'J0
NrOJNB
OFDFTBSJB
QBSB
NBOUFOFS
Q0



NN
)H
P
TBUVSBDJwO
)C


DPO
BEFDVBEP
JODSFNFOUP
EF
QFTP
q
1*.
TFH|O
DMrOJDB
&WFOUVBMNFOUF
IBZ
RVF
BVNFOUBS
QSFTJPOFT
QPS
SJHJEF[
QVMNPOBS
q
1&&1
NgT
CJFO
CBKBT



DN
)
TFH|O
WPMVNFO
QVMNPOBS
q
'3
CBKBT



QPS
NJO

q
5*.
QSPMPOHBEPT
 

 
TFH
q
.BOUFOFS
HBTPNFUSrB
DPO
Q0


NN
)H
Z
1B$0
RVF
QFSNJUB
NBOUFOFS
Q)

TPCSF

IJQFSDBQOJB
QFSNJTJWB

%FTUFUF
q
$PO
EJTNJOVDJwO
EF
'3



QPS
NJO
QPS
ErB
IBTUB
MPHSBS
NrOJNPT
SFRVFSJNJFOUPT

EF
QBSgNFUSPT
q
"QPZP
GBSNBDPMwHJDP
TFH|O
OPSNB
EF
%#1
q
*OUFOUBS
VTP
EF
NPEBMJEBE
147
QBSB
FM
EFTUFUF

Escapes Areos:

/FVNPUwSBY
Z
&OTFNB
*OUFSTUJDJBM
1VMNPOBS
TPO
MPT
QSPCMFNBT
NgT
GSFDVFOUFT
&O

TJ
OP
DPSSFTQPOEFO
B
JOEJDBDJwO
QSJNBSJB
EF
WFOUJMBDJwO
NFDgOJDB
Z
FO
HFOFSBM
TF

QSFTFOUBO
DPNP
DPNQMJDBDJPOFT
EF
nTUB
&TUSBUFHJBT
7FOUJMBUPSJBT
FO
3/
DPOFDUBEP
B
7.
DPNQMJDBEP
DPO
FTDBQF
BnSFP
q
0CKFUJWP
QSJODJQBM
FT
EJTNJOVJS
."1
QSFTJwO
NFEJB
EF
MB
WrB
BnSFB

BM
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196 GUAS NACIONALES DE NEONATOLOGA

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198 GUAS NACIONALES DE NEONATOLOGA

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200 GUAS NACIONALES DE NEONATOLOGA

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201

202 GUAS NACIONALES DE NEONATOLOGA

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Signos y sntomas:
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DIFERENCIA DE DISTINTOS TIPOS DE SHOCK:

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204 GUAS NACIONALES DE NEONATOLOGA

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MONITOREO DEL SHOCK:

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ALGUNOS SISTEMAS INVOLUCRADOS SON:

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206 GUAS NACIONALES DE NEONATOLOGA

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)FNBUPMwHJDBT
"OFNJB
F
IJQFSWJTDPTJEBE
q
"OPNBMrBT
FTUSVDUVSBMFT

207

q
4IPDL
TnQUJDP
UBSErP
q
0CTUSVDDJwO
BM
SFUPSOP
WFOPTP


/FVNPUwSBY

)FSOJB
EJBGSBHNgUJDB

&OTFNB
JOUFSTUJDJBM

5BQPOBNJFOUP
DBSEJBDP

."/&+0

&TQFDJDP
EF
MB
DBVTB
EF
EJTGVODJwO
NJPDgSEJDB

$PSSFHJS
BDJEPTJT
Z
DBMDFNrB

%SPHBT
WBTPBDUJWBT

1SFTJwO
EF
QFSGVTJwO
BEFDVBEB


"TFHVSBS
CVFOB
FOUSFHB
EF
PYrHFOP
EFQFOEF
($
Z
1B0

-"
 /""
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-


&O
OFPOBUP
DSJUJDP
DPO
TJHOPT
EF
TIPDL
JOJDJBEP
BMSFEFEPS
EF
MBT

IPSBT
EF
WJEB
TF

EFCF
DPOTJEFSBS
EFOUSP
EF
MBT
FUJPMPHrBT
MB
QPTJCJMJEBE
EF
&OGFSNFEBE
.FUBCwMJDB
4P
MJDJUBS
BNPOFNJB
Z
MBDUBDJEFNJB
(VBSEBS
BOUFT
EF
DVBMRVJFS
USBOTGVTJwO
TVFSP
Z
PSJOB

DPOHFMBEB
BEFNgT
EF
TBOHSF
UPUBM
FO
QBQFM
MUSP
QBSB
FTUVEJP
QPTUFSJPS
0USB
QPTJCJMJEBE
DPSSFTQPOEF
B
*OTVDJFODJB
4VQSBSSFOBM
'SFOUF
B
FTUF
QMBOUFBNJFO
UP
EJBHOwTUJDP
TF
EFCF
HVBSEBS
TVFSP
QBSB
FTUVEJPT
IPSNPOBMFT
Z
QSPDFEFS
B
TVQMFNFO
UBS
DPSUJTPM


" ,
 -"

\
&O
UPEP
OFPOBUP
DSJUJDP
TF
EFCF
PQUJNJ[BS
QFSGVTJwO
q
"EFDVBEB
PYJHFOBDJwO
q
"TFHVSBS
BEFDVBEB
WPMFNJB
q
$PSSFDDJwO
EF
GBDUPSFT
JOPUSPQPT
OFHBUJWPT
q
"QPZP
EF
CPNCB
q
*OJDJBS
JONFEJBUP
NBOFKP
QSFWFOUJWP
EF
)511

OXIGENACION:
&M
NBOFKP
EFM
TIPDL
TJFNQSF
TF
JOJDJB
HBSBOUJ[BOEP
VOB
WrB
BnSFB
QFSNFBCMF
FWB
MVBOEP
MB
WFOUJMBDJwO
Z
TVNJOJTUSBOEP
PYJHFOP
TVQMFNFOUBSJP

208 GUAS NACIONALES DE NEONATOLOGA

q
%FCF
NBOUFOFSTF
BEFDVBEB
PYJHFOBDJwO
DFOUSBM
Z
UJTVMBS
QBSB
FMMP
EBS
BEFDVBEP

BQPSUF
EF
PYJHFOP
FWJUBOEP
MB
IJQFSPYJB

q
$POFYJwO
QSFDP[
B
WFOUJMBDJwO
NFDgOJDB
QBSB
FWJUBS
BQOFBT
Z
EJTNJOVJS
FM
DPOTV
NP
FOFSHnUJDP
EBEP
TV
HSBO
DBUBCPMJTNP

REPOSICIN DE VOLUMEN:
6UJM
FO
TIPDL
IJQPWPMnNJDP
Z
TnQUJDP
"ENJOJTUSBS
TPMVDJwO
TJPMwHJDB
QMBTNB
GSFTDP

DPOHFMBEP
P
HMwCVMPT
SPKPT
TFH|O
DPSSFTQPOEB

$SJTUBMPJEFT
4PMVDJwO
TJPMwHJDB
q
&YDFMFOUF
BMUFSOBUJWB
QBSB
NBOFKBS
JOJDJBM
EF
TIPDL
IJQPWPMnNJDP
NJFOUSBT
TF
PC
UJFOF
UFSBQJB
EF
SFQPTJDJwO
FTQFDJDB

q
&O
TIPDL
TnQUJDP
DPOTJEFSBS
EF
QSJNFSB
MrOFB
EF
NBOFKP
q
&T
EF
NVZ
CBKP
DPTUP
Z
TJFNQSF
FTUB
EJTQPOJCMF
q
4PCSFDBSHB
EF
TPEJP
Z
DMPSP
q
-B
BM[B
EF
1"
FT
USBOTJUPSJB
EFCJEP
B
RVF
TPMP
FM

QFSNBOFDF
FO
FM
JOUSBWBT
DVMBS
$PMPJEFT
BMC|NJOB
BM

&T
EF
VTP
FYDFQDJPOBM
q
4PO
EF
BMUP
DPTUP
q
7JEB
NFEJB

IST
q
3JFTHP
EF
QBTP
BM
JOUFSTUJDJP
QVMNPOBS
Z
TVCTFDVFOUFNFOUF
DPOEJDJPOBS
FEFNB

QVMNPOBS
q
4V
NBZPS
VUJMJEBE
FT
FO
QBDJFOUF
DPO
UFSDFS
FTQBDJP
NVZ
BVNFOUBEP
&O
FTUF

DBTP
TF
VTB
DPO
FM
O
EF
QBTBS
MrRVJEP
BM
JOUSBWBTDVMBS

CORRECCIN DE FACTORES INOTROPICOS NEGATIVOS

$PSSFHJS
IJQPYJB
BDJEPTJT
IJQPHMJDFNJB
IJQPDBMDFNJB
FOUSF
PUSPT
&M
BQPSUF
EF
CJDBS
CPOBUP
EF
TPEJP
B
EPTJT
EF

N&RLH
FTUg
JOEJDBEP
QBSB
DPSSFHJS
MB
BDJEPTJT
NFUBCwMJDB

DPO
VO
Q)
JOGFSJPS
B
 
TJ
FYJTUF
BEFDVBEB
WFOUJMBDJwO
4J
QFSTJTUF
BDJEPTJT
NFUBCwMJDB

QVFEF
JOJDJBSTF
JOGVTJwO
EF
FCPDMJTJT
BMDBMJOJ[BOUF

ESTADO METABOLICO:
$BMDJP

.BOUFOFS
BEFDVBEB
DBMDFNJB
$POTJEFSBS
EJTNJOVDJwO
EFM
DBMDJP
JwOJDP
Z
UPUBM
FO
BDJ
EPTJT
NFUBCwMJDB
FO
DPSSFDDJwO
.BHOFTJP

&WBMVBS
NBHOFTFNJB
FO
QBDJFOUF
DSJUJDP
&O
DBTP
EF
IJQPNBHOFTFNJB
BENJOJTUSBS

 
N&RLHEPTJT
DBEB

IPSBT

209

DROGAS VASOACTIVAS:
.FKPSBO
MB
IFNPEJOBNJB
Z
GVODJwO
NJPDgSEJDB
q
%PQBNJOB
%PTJT
EFQFOEJFOUF


NHLN
WBTPEJMBUBEPS
SFOBM
DFSFCSBM
(*
DPSPOBSJP


NHLN

BDUJWB
GVODJwO
NJPDgSEJDB


NHLN


WBTPDPOUSJDUPS
*OEJDBDJPOFT
4IPDL
TnQUJDP
Z
TIPDL
EJTUSJCVUJWP
q
%PCVUBNJOB

Z

"VNFOUB
DPOUSBDUJMJEBE
NJPDgSEJDB
FM
WPMVNFO
FYQVMTJWP

Z
EJTNJOVZF
MB
371

*OEJDBDJPOFT
4IPDL
DBSEJPHnOJDP
Z
TIPDL
TnQUJDP
UBSErP
%PTJT
SFDPNFOEBEB



NDHLHNJO
q
"ESFOBMJOB
"VNFOUB
FM
JOPUSPQJTNP
DSPOPUSPQJTNP
Z
MB
371

&GFDUP



  
NDHLHNJO



  
NDHLHNJO


Z

%PTJT
SFDPNFOEBEB
  
NDHLHNJO
q
/PSBESFOBMJOB
.FKPS
VTP
FO
TIPDL
TnQUJDP
SFGSBDUBSJP

%PTJT

NDHLHNJO

OTRAS DROGAS VASOACTIVAS:

"NSJOPOB
Z
NJMSJOPOB
"VNFOUB
FM
JOPUSPQJTNP
Z
FT
VO
WBTPEJMBUBEPS
QFSJGnSJDP
JO
IJCF
MB
GPTGPEJFTUFSBTB
"VNFOUB
FM
".1
DrDMJDP
Z
FM
DBMDJP
JOUSBDFMVMBS
4F
IB
VUJMJ[BEP
FO

TIPDL
SFGSBDUBSJP
FO
3/
DPO
DBSEJPQBUrBT
DPOHnOJUBT
/P
IBZ
FTUVEJPT
RVF
GVOEBNFOUFO

TV
VTP
FO
OFPOBUPT

COMO ADECUAR LA TERAPIA?

*EFBMNFOUF
FWBMVBS
GVODJwO
NJPDgSEJDB
DPO
FDPDBSEJPTDPQrB
TFSJBEB
QBSB
BEFDVBS

WBTPBDUJWPT
*OJDJBS
BQPZP
WBTPBDUJWP
DPO
EPQBNJOB


NDHLHNJO
&WBMVBS
SFTQVFTUB
4r
1".

TJHVF
CBKB
TF
EFCF
SFQFUJS
WPMVNFO
"VNFOUBS
EPQBNJOB

NDHLHNJO
NBOUFOFS

GSFDVFODJB
DBSEJBDB
CBKP

Y
NJO

Z
BHSFHBS
EPCVUBNJOB

NDHLHNJO

$POTJEFSBS
RVF
EPTJT
NBZPSFT
EF
EPQBNJOB
QVEJFTFO
BVNFOUBS
MB
SFTJTUFODJB
WBTDV
MBS
QVMNPOBS
QPS
PUSB
QBSUF
MB
EPCVUBNJOB
FT
VO
WBTPEJMBUBEPS
QFSJGnSJDP
QPS
MP
UBOUP
OP

FTQFSBS
BVNFOUP
EF
1".
QFSP
Tr
NFKPSrB
EF
DPOUSBDUJMJEBE
NJPDgSEJDB
4r
QFSTJTUF
FTUBEP

EF
TIPDL
BVNFOUBS
EPCVUBNJOB

NDHLHNJO
IBTUB

NDHLHNJO

4J
OP
TF
MPHSB
FMFWBS
1
"SU
P
FTUBCJMJ[BS
BM
QBDJFOUF
NBOFKBS
DPNP
TIPDL
SFGSBDUBSJP

VUJMJ[BOEP
BESFOBMJOB
  
NDHLHNJO
EPTJT
NgYJNB
 
NDHLHNJO
Z
DPOTJEFSBS
FM

210 GUAS NACIONALES DE NEONATOLOGA

VTP
EF
DPSUJDPJEFT
FO
TIPDL
QFSTJTUFOUF
FO
RVF
TF
QMBOUFB
FM
BHPUBNJFOUP
EF
SFDFQUPSFT

P
BTPDJBDJwO
DPO
JOTVDJFODJB
TVQSBSSFOBM

1PTUFSJPSNFOUF
TJ
DPOUJOVB
FO
IJQPUFOTJwO
SFGSBDUBSJB
VTBS
OPSBESFOBMJOB
 
 

NDHLHNJO

CORTICOIDES:
%VSBOUF
FM
FTUBEP
DSrUJDP
EFM
TIPDL
TF
IB
EFTDSJUP
VOB
EFTFOTJCJMJ[BDJwO
HSBEVBM
EF

SFDFQUPSFT
BESFOnSHJDPT
EFM
TJTUFNB
DBSEJPWBTDVMBS
SFRVJSJFOEP
DBEB
WF[
EPTJT
NgT
BMUB

EF
WBTPBDUJWPT
QBSB
NBOUFOFS
FM
NJTNP
FGFDUP

-PT
DPSUJDPJEFT
SFHVMBO
MB
FYQSFTJwO
EF
MPT
SFDFQUPSFT
Z
BMHVOPT
DPNQPOFOUFT
EFM
TJTUF
NB
TFHVOEP
NFOTBKFSP
&TUB
BMUFSBDJwO
EF
MB
SFHVMBDJwO
EF
SFDFQUPSFT
UJFOF
SFMBDJwO
DPO
q
)PSBT
EF
FYQPTJDJwO
B
BHPOJTUB
q
%JTNJOVDJwO
EF
3/"
NFOTBKFSP
q
%JTNJOVDJwO
EF
USBOTDSJQDJwO
q
/FDFTJEBE
EF
OVFWB
TrOUFTJT
QSPUFJDB

&O
TIPDL
QFSTJTUFOUF
FO
RVF
TF
QMBOUFB
FM
BHPUBNJFOUP
EF
SFDFQUPSFT
VUJMJ[BS
)JESP
DPSUJTPOB

NHLHEPTJT
4J
FT
FDB[
SFQFUJSMB
DBEB

IPSBT
QPS

B

ErBT
4J
TF
QMBOUFB

*OTVDJFODJB
4VQSBSSFOBM
VTBS
)JESPDPSUJTPOB

NHLHEPTJT
SFQFUJEBT
DBEB

IPSBT

QPS

IST

FORMULAS PARA PREPARAR CUALQUIER VASOACTIVOS:

Calculo en ml de la droga:


1FTP
LH

Y

NJO

Y

NM
UPUBM
B
QSFQBSBS

Y
O
HBNBLHNJO
B
QBTBS
FO

NMIPSB


NM
EF
ESPHB
QBSB

NM
UPUBMFT

$PODFOUSBDJwO
EFM
WBTPBDUJWP
HBNBNM

&K
3/
EF

LH
TF
SFRVJFSF
RVF
B

NMIPSB
TF
FOUSFHVFO

HBNBLHNJO
%PQBNJOB


NH
NM


NHNM


Y

Y

Y








HBNBNM


 
NM
EF
%PQBNJOB

NH
NM

FO
 
NM
EF
4(

Calculo en mg de la droga:


Y
QFTP
LH

Y
O
HBNBLHNJO
B
QBTBS
FO

NMIPSB


NH
EF
ESPHB
QBSB

NM
UPUBMFT

211

&K
3/
EF

LH
TF
SFRVJFSF
RVF
B

NMIPSB
TF
FOUSFHVFO

HBNBLHNJO
%PQBNJOB

NH
NM


NHNM


Y

Y



NH
EF
%PQBNJOB

-VFHP

NH
FTUgO
FO

NM
QPS
UBOUP

NH
FTUgO
FO
 
NM


"EJDJPOBS
 
NM
EF
%PQBNJOB

NH
NM

FO
 
NM
EF
4(

$PNP
FO
HFOFSBM
SFRVFSJNPT
QFRVFvPT
WPM|NFOFT
TF
QVEF
QSFQBSBS
QSPQPSDJPOBM
NFOUF
FO
NFOPT
4(
QBSB
BIPSSP
EF
NFEJDBNFOUP

BIBLIOGRAFIA

#SPXO
+. 
6TF
PG
FDIPDBSEJPHSBGZ
GPS
IFNPEZOBNJD
NPOJUPSJOH
$SJUJDBM
$BSF
.FEJ
DJOF

+VOF

,PVSFNCBOBT
4
&O
$MPIFSUZ
+PIO
.BOVBM
EF
$VJEBEPT
/FPOBUBMFT

&EJDJwO



&E
.BTTPO

$BSDJMMP
+"
'JFMET
"*
"NFSJDBO
$PMMFHF
PG
$SJUJDBM
$BSF
.FEJDJOF
5BTL
'PSDF
$PNNJU
UFF
.FNCFST
$SJU
$MJOJDBM
QSBDUJDF
QBSBNFUFST
GPS
IFNPEZOBNJD
TVQQPSU
PG
QFEJBUSJD

BOE
OFPOBUBM
QBUJFOUT
JO
TFQUJD
TIPDL
$BSF
.FE

+VO 



,MFJONBO
.&
$MJOJDBM
QSBDUJDF
QBSBNFUFST
GPS
QFEJBUSJD
BOE
OFPOBUBM
TFQUJD
TIPDL
UP

IBWF
PS
UP
IBWF
OPU

$SJU
$BSF
.FE

+VO
 




"TUJ[
.&
3BDLPX
&$
$SZTUBMMPJEDPMMPJE
DPOUSPWFSTZ
SFWJTJUFE
$SJU
$BSF
.FE


+BO 


4FSJ
*
&WBOT
+
$POUSPWFSTJFT
JO
UIF
EJBHOPTJT
BOE
NBOBHFNFOU
PG
IZQPUFOTJPO
JO
UIF

OFXCPSO
JOGBOU
$VSSFOU
0QJOJPO
JO
1FEJBUSJDT
"CSJM


212 GUAS NACIONALES DE NEONATOLOGA

#!2$)/0!4!3
#/.'.)4!3
.%/.!4!,%3

-BT
DBSEJPQBUrBT
DPOTUJUVZFO
VOB
DBVTB
JNQPSUBOUF
EF
NPSCJNPSUBMJEBE
FO
FM
QFSrPEP

OFPOBUBM
4V
SFDPOPDJNJFOUP
QSFDP[
Z
TV
USBUBNJFOUP
PQPSUVOP
FT
GVOEBNFOUBM
ZB
RVF

VOB
DBSEJPQBUrB
DPNQMFKB
EFKBEB
B
TV
FWPMVDJwO
FTQPOUgOFB
UJFOF
VOB
NPSUBMJEBE
DFSDB
OB
BM

)PZ
FO
ErB
FYJTUF
USBUBNJFOUP
DVSBUJWP
P
BM
NFOPT
QBMJBUJWP
QBSB
MB
NBZPSrB
EF

MBT
DBSEJPQBUrBT




\
&TUBErTUJDBT
NPEFSOBT
SFWFMBO
RVF
BQSPYJNBEBNFOUF
FM

EF
MPT
3/
QSFTFOUBO
VOB

DBSEJPQBUrB
6O
UFSDJP
EF
nTUBT
DPSSFTQPOEFO
B
DBSEJPQBUrBT
DJBOwUJDBT
"MSFEFEPS
EF
VO


EF
MBT
DBSEJPQBUrBT
TPO
RVJS|SHJDBT


 -/

" -
 

-\
&O
FM
QFSrPEP
OFPOBUBM
TF
EFCF
TPTQFDIBS
VOB
DBSEJPQBUrB
GSFOUF
B
MPT
TJHVJFOUFT

IFDIPT
DMrOJDPT
q
$JBOPTJT
q
%JDVMUBE
SFTQJSBUPSJB
P
QPMJQOFB
EF
DBVTB
OP
QSFDJTBEB
q
*OTVDJFODJB
DBSErBDB
q
4PQMPT
DBSErBDPT
q
5SBTUPSOPT
EFM
SJUNP
q
"MUFSBDJPOFT
EF
MPT
QVMTPT
QFSJGnSJDPT
Z
QSFTJwO
BSUFSJBM
q

)BMMB[HPT
SBEJPMwHJDPT
DBSEJPNFHBMJB
FEFNB
QVMNPOBS


213

CIANOSIS
-B
QSFTFODJB
EF
DJBOPTJT
FO
VO
3/
FT
VOB
FNFSHFODJB
ZB
RVF
QVFEF
TJHOJDBS
MB
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TFODJB
EF
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DBSEJPQBUrB
DPOHnOJUB
DPNQMFKB
EVDUVT
EFQFOEJFOUF
RVF
QVFEF
DFSSBSTF

QPDP
EFTQVnT
EF
OBDFS
Z
QSPWPDBS
FM
GBMMFDJNJFOUP
EF
FTF
QBDJFOUF

-P
QSJNFSP
FT
EFTDBSUBS
MBT
DBVTBT
EF
DJBOPTJT
OP
DBSErBDBT
UBMFT
DPNP
q
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QVMNPOBS
QFSTJTUFOUF
q
1PMJHMPCVMJB
q
4%3
TFWFSPT
NFNCSBOB
IJBMJOB
CSPODPOFVNPOrB
4%3
BTQJSBUJWP

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q
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EF
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UJTVMBS
TIPDL
TFQUJDFNJB
IJQPUFSNJB

q
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-BT
DBVTBT
EF
DJBOPTJT
DBSErBDBT
NgT
JNQPSUBOUFT
EF
EJBHOPTUJDBS
B
MB
CSFWFEBE
FO

FM
3/
TPO
q
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QVMNPOBS
q
"USFTJB
USJDVTQrEFB
DPO
FTUFOPTJT
QVMNPOBS
q
5FUSBMPHrB
EF
'BMMPU
DPO
BUSFTJB
QVMNPOBS
q
7FOUSrDVMP
|OJDP
DPO
FTUFOPTJT
QVMNPOBS
q
%PCMF
TBMJEB
EF
7%
DPO
FTUFOPTJT
QVMNPOBS
q
%SFOBKF
WFOPTP
BOwNBMP
PCTUSVDUJWP
UPUBM
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FM
DBTP
EF
VO
3/
DPO
DJBOPTJT
FO
RVJnO
TF
TPTQFDIB
VOB
DBSEJPQBUrB
FM
FYB
NFO
GrTJDP
DVJEBEPTP
MPT
FYgNFOFT
EF
MBCPSBUPSJP
Z
MPT
BOUFDFEFOUFT
GBNJMJBSFT
QVFEFO

BZVEBS
B
DPSSPCPSBSMB
QFSP
FT
MB
&DPDBSEJPHSBGrB
MB
RVF
DPOSNBSg
FM
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Z
QPS
MP

UBOUP
EFCF
SFBMJ[BSTF
MP
BOUFT
QPTJCMF
VOB
WF[
RVF
TF
QMBOUFw
FTUB
QPTJCJMJEBE

Qu hacer frente al paciente con probable cardiopata ciantica?

q

q

q

q

q

"NCJFOUF
UnSNJDP
OFVUSP
QBSB
EJTNJOVJS
FM
SFRVFSJNJFOUP
EF
PYrHFOP
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FM
IFNBUPDSJUP
FO
DJGSBT
EF

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BQPSUF
EF
WPMVNFO
4r
IBZ
JOTVDJFODJB
DBSEJBDB
SFTUSJDDJwO
EF
nTUF
4JFNQSF
EFTDBSUBS
IJQFSUFOTJwO
QVMNPOBS
DPNP
QSJNFSB
NFEJEB
4J
MB
IJQPYFNJB
FT
NVZ
TFWFSB
TBU


Z
FTUB
EFTDBSUBEB
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BENJOJTUSBS
0

4J
TF
BMDBO[B
TBUVSBDJwO
EF

TF
EFCF
EJTNJOVJS
BM
NrOJNP
P
TVTQFOEFS
QPS
FM

SJFTHP
EF
DJFSSF
EVDUBM
P
EF
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214 GUAS NACIONALES DE NEONATOLOGA

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215

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216 GUAS NACIONALES DE NEONATOLOGA



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217

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218 GUAS NACIONALES DE NEONATOLOGA

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220 GUAS NACIONALES DE NEONATOLOGA

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222 GUAS NACIONALES DE NEONATOLOGA

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224 GUAS NACIONALES DE NEONATOLOGA

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Precauciones durante el uso de indometacina:

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q

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Dosis cada 12 horas:

q
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226 GUAS NACIONALES DE NEONATOLOGA

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1-
Hidrops fetal inmune:

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228 GUAS NACIONALES DE NEONATOLOGA

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230 GUAS NACIONALES DE NEONATOLOGA



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232 GUAS NACIONALES DE NEONATOLOGA

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234 GUAS NACIONALES DE NEONATOLOGA

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MANEJO SEGN COMPROMISO EN DIFERENTES RGANOS.

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236 GUAS NACIONALES DE NEONATOLOGA



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237

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-PSB[FQBN
  
NHLHEPTJT
WrB

&7
JOGVOEJEP
FO

NJO
P
.JEB[PMBN
FO
JOGVTJwO
DPOUJOVB
  
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SJFTHP
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MP
DVBM
TF
EFCF
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DPO
TPQPSUF
WFOUJMBUPSJP
Z
DJSDVMBUPSJP

BEFDVBEP

MEDIDAS GENERALES:
q
1PTJDJwO
TVQJOP
'PXMFS
$BCF[B
FO
MrOFB
NFEJB
&WJUBS
FYJwO
P
IJQFSFYUFO
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q
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q
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q
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q
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DBSEJBDB
'SFD
SFTQ
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4BU
EF
0
q
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EF
EJVSFTJT

EXMENES:
q
&YgNFOFT
JOJDJBMFT
)FNBUPDSJUP
HMJDFNJB

DBMDFNrB

HBTFT
q
&YgNFOFT
EF
FWPMVDJwO
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MBT

IST
P
BOUFT
TFH|O
FWPMVDJwO

DMrOJDB
&-1
#6/
HMJDFNJB
DBMDFNJB
HBTFT

238 GUAS NACIONALES DE NEONATOLOGA

q
4PMP
BOUF
TPTQFDIB
EF
DPNQSPNJTP
NJPDgSEJDP
DPOUSPMBS
$,$1,.#

q
&&(
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MBT

IST
5"$
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II.

EFECTO SOBRE EL CORAZN

4F
QVFEF
QSPEVDJS
JTRVFNJB
NJPDgSEJDB
USBOTJUPSJB
FYQSFTBEB
QPS
4%3
P
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DBSErBDB
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q
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Manejo:
q

q

q

q

q

q

III.

"EFDVBEB
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.BOUFOFS
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EFECTO SOBRE EL RION.

&M
OFPOBUP
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4*"%)

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q
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q
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q
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PSJOB

Manejo:
q
&O
PMJHVSJB

 
NMLHIPSB

B
MBT


IST
EF
WJEB
TF
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QSFSFOBM

q
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239



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9


 

 

 

 





 





 

4PEJP
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&O
DBTP
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PMJHVSJB
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TF
EFCF
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FO
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Z
FO
/5"

Secrecin inapropiada de hormona antidiurtica. (SIADH):

Diagnstico:
q

q

q

q

"VNFOUP
EF
QFTP
0MJHVSJB
)JQPOBUSFNJB
0TNPMBSJEBE
VSJOBSJB
BVNFOUBEB
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FT
EF

N0TNMU
Z
EF

FO
3/
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UnSNJOP

240 GUAS NACIONALES DE NEONATOLOGA

Manejo:
q
3FTUSJDDJwO
EF
MrRVJEPT
q
4r
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SF
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BM


Necrosis tubular aguda (NTA).

Diagnstico:
q
"VNFOUP
EF
QFTP
q
0MJHVSJB
q
4FEJNFOUP
VSJOBSJP
NVZ
BMUFSBEP
QSFTFODJB
EF
DJMJOESPT
FUD

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q
3FTUSJDDJwO
EF
MrRVJEPT
q
5SBUBNJFOUP
EF
IJQFSLBMFNJB
7FS
OPSNB
FTQFDJDB

q
$POTJEFSBS
QFSJUPOFPEJgMJTJT
P
IFNPMUSBDJwO

IV.

EFECTO SOBRE EL APARATO GASTROINTESTINAL

1SFWFODJwO
EF
FOUFSPDPMJUJT
OFDSPUJ[BOUF
q
*OJDJBS
BQPSUF
PSBM
VOB
WF[
FMJNJOBEP
NFDPOJP
Z
DPO
SVJEPT
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QSF
TFOUFT
Z
3/
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FTUBCMF

q
"VNFOUBS
TFH|O
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HgTUSJDB
B
SB[wO
EF

NMLHErB
q
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F
JOTJTUJS
FO
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MFDIF
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Z
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EF
TVTUBODJBT
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FO
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V.

EFECTO SOBRE EL APARATO RESPIRATORIO

$POTJEFSBS
FO
MPT
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EF
MB
BTYJB
FM
BVNFOUP
EF
MB
SFTJTUFODJB

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EF
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NP
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FO
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241

VI.

EFECTOS HEMATOLGICOS

VII.

1VFEF
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$*%
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MFTJPOFT
WBTDVMBSFT
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GBMMB
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q
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TPTQFDIB
DMrOJDB
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$*%
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DPBHVMB
DJwO
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QMBRVFUBT
q
3FQPOFS
TFH|O
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GSFTDP
DPOHFMBEP
Z

P
QMBRVFUBT

EFECTO HEPATICO
1VFEF
QSPEVDJSTF
JOTVDJFODJB
IFQgUJDB
QPTUBTDUJDB
q
.POJUPSJ[BS
TPMP
FO
DBTP
EF
TPTQFDIB
DMrOJDB
FO[JNBT
IFQgUJDBT
CJMJSSVCJOB

UPUBM
Z
EJSFDUB
GBDUPSFT
EF
DPBHVMBDJwO
Z
BNPOJP

PRONSTICO DE LA ASFIXIA PERINATAL

7B
B
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EFM
FTUBEJP
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4BSOBU
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q

q

q

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q

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MPT

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IST
&&(
BOPSNBM
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Pronstico segn Apgar en RN de trmino con EHI Grado II y III.

"QHBS
EF

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242 GUAS NACIONALES DE NEONATOLOGA

CLASIFICACIN DE SARNAT Y SARNAT PARA ENCEFALOPATIA HI.

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&&(

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HSBWFT
243

REFERENCIAS

7PMQF
+
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244 GUAS NACIONALES DE NEONATOLOGA

(%-/22!')!
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PATOGENIA:
-B
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TF
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NVTDVMBS
q
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q
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245

Factores que afectan ujo de entrada:

q

q

q

q

q

q

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$POWVMTJPOFT
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P
WFMPDJEBE
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EF
QSFTJwO
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"QOFB

Factores que afectan ujo de salida:

q

q

q

q

q

*OTVDJFODJB
DBSEJBDB
DPOHFTUJWB
1SFTJwO
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B
UFOTJwO
5SBVNB
EFM
QBSUP

Factores estructurales vasculares y extravasculares:

q

q

q

q

q

-FTJwO
IJQwYJDPJTRVnNJDB
EF
MB
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246 GUAS NACIONALES DE NEONATOLOGA

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252 GUAS NACIONALES DE NEONATOLOGA

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254 GUAS NACIONALES DE NEONATOLOGA

MONITOREO DE DROGAS:
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Control un mes post alta en Neurologa:

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256 GUAS NACIONALES DE NEONATOLOGA

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258 GUAS NACIONALES DE NEONATOLOGA

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MANEJO POSTPARTO
q
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259

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EF
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Manejo Urolgico:
q
4PCSF
FM

EF
MPT
QBDJFOUFT
DPO
NJFMPNFOJOHPDFMF
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BMHVOB
GPSNB
EF
WF
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q
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q
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q
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NBOJPCSB
EF
$SFEn

q
3FBMJ[BS
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Manejo Traumatolgico:
q
'SFDVFOUF
BTPDJBDJwO
DPO
QJF
#PU
Z
FTDPMJPTJT
SFRVJFSF
FWBMVBDJwO
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260 GUAS NACIONALES DE NEONATOLOGA

Prevencin:
q
$POTFKP
HFOnUJDP
SFDVSSFODJB

IFSNBOP
BGFDUBEP


IFSNBOPT
BGFDUBEPT


q
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gDJEP
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NJDSPHSBNPT
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q
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DBTP
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EF
VO
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CORRELACIN INERVACIN SEGMENTARIA, FUNCIN MOTORA

Y REFLEJOS.

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EF
MB
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261

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262 GUAS NACIONALES DE NEONATOLOGA

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263

264 GUAS NACIONALES DE NEONATOLOGA

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ETIOLOGIA:
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q

q

q

q

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EF
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q
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265

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EXAMENES DE LABORATORIO:
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VALORES NORMALES DE LOS EXAMENES DE COAGULACION EN RN.

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Recin nacidos prematuros entre 30-36 semanas de gestacin.

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266 GUAS NACIONALES DE NEONATOLOGA

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267

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268 GUAS NACIONALES DE NEONATOLOGA

COAGULACIN INTRAVASCULAR DISEMINADA:

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WF
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551
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Manejo prenatal:
q
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EF
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TF
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DPO
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Manejo neonatal:
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269

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PRPURA TROMBOCITOPNICO NEONATAL ISOINMUNE:

q
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270 GUAS NACIONALES DE NEONATOLOGA

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Cambios en las cifras de hemoglobina durante el primer ao de vida.

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271

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272 GUAS NACIONALES DE NEONATOLOGA

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274 GUAS NACIONALES DE NEONATOLOGA

BIBLIOGRAFIA

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275

276 GUAS NACIONALES DE NEONATOLOGA

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277

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FIGURA 1.

278 GUAS NACIONALES DE NEONATOLOGA

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EF
MPT
3/

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TF
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EF
MPT
BEVMUPT

Z
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DJSSPTJT
P
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FO
MB
BEVMUF[
TJ
OP
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UFSBQJB
BEFDVBEB

CUADRO CLINICO
/P
QSPEVDF
NBMGPSNBDJPOFT
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MPT
3/
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USBOTQMBDFOUBSJB
QSFTFOUBO
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BM
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MPT
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FO
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DBOBM
EFM
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MB
QVFEFO
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Z

ErBT
EFTQVnT
MPT
TrOUPNBT
TPO
MFWFT

308 GUAS NACIONALES DE NEONATOLOGA

DIAGNOSTICO
q
4F
IBDF
NFEJBOUF
EFUFDDJwO
EF
BOUrHFOPT
WrSBMFT
Z
BOUJDVFSQPT
DPOUSB
nTUPT
q
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DPO
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Z
)#F"H


TJ
BNCPT
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q
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OBDJEP
DPO
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FO
MPT
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EF
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USBOT
QMBDFOUBSJB

q
)#T"H
B
MPT

P

NFTFT
JOGFDDJwO
QFSJOBUBM

TRATAMIENTO
5PEP
3/
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EF
NBESF
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q
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VO
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MB
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MPT

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Z
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NFTFT
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PREVENCION
q
6TP
EF
WBDVOBT
FO
QPCMBDJwO
EF
SJFTHP
q
"DUVBMNFOUF
OP
TF
SFDPNJFOEB
MB
TVTQFOTJwO
EF
MB
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DPOEVDUBT
BEFDVBEBT

 *
//-

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EF
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FT
VO
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3/"
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EF
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GBNJMJB
EF
MPT
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FT
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FT
CBKB

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EPIDEMIOLOGA
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309

CUADRO CLNICO
%FCF
TPTQFDIBSTF
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EF
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MB
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IBO
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3/
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GFUPT
DPO
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Z
IFQBUJUJT

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q
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FTQFDrDB
Z
UrUVMPT
FO
BTDFOTP
EF
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q
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EF
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1$3

FO
TBOHSF

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q
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FYJTUF
UFSBQJB
FTQFDrDB
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EFM
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DPO
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q
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TF
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CUADRO CLINICO.
7B
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DVBESPT
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FO
3/
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NBUFSOPT

-BT
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DMrOJDBT
QVFEFO
TFS
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FYBOUFNB

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q
$VMUJWP
WJSBM
EF
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PSJOB
Z
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q
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FT
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FT
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FO
-$3

TRATAMIENTO.
q
&M
VTP
EF
HBNBHMPCVMJOB
&7
IB
TJEP
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FO
JOGFDDJPOFT
OFPOBUBMFT
TFWFSBT
q
1MFDPSBOJM
BOUJWJSBM
FTQFDrDP
FTUg
FO
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310 GUAS NACIONALES DE NEONATOLOGA

TABLA 1
MANIFESTACIONES CLINICAS DE INFECCIONES VIRALES DE
TRANSMISION CONGENITA O PERINATAL.
Rubola:
v
%BvP
UFSBUPHnOJDP
EFGFDUPT
DBSErBDPT
EVDUVT
QFSTJTUFOUF
FTUFOPTJT
BSUFSJB
QVMNPOBS


DBUBSBUBT
TPSEFSB
NJDSPDFGBMJB

v
%BvP
JOBNBUPSJP
FODFGBMJUJT
SFUJOJUJT
BOFNJB
Z
USPNCPDJUPQFOJB
IFQBUJUJT
OFVNPOrB

FTUSJBDJwO
wTFB
SFUSBTP
EFM
DSFDJNJFOUP

Citomegalovirus:
v
$POHnOJUP

1SFNBUVSF[
SFUSBTP
EFM
DSFDJNJFOUP
JOUSBVUFSJOP
*OGFDDJwO
TJTUFNB
SFUJDVMPFOEPUFMJBM
IFQBUPFTQMFOPNFHBMJB
JDUFSJDJB

USPNCPDJUPQFOJB
Q|SQVSB

%BvP
4/$
Z
wSHBOPT
EF
MPT
TFOUJEPT
FODFGBMJUJT
SFUJOJUJT
TPSEFSB
%BvP
JOBNBUPSJP
DSwOJDP
BUSPB
DFSFCSBM
NJDSPDFGBMJB
DBMDJDBDJPOFT

QFSJWFOUSJDVMBSFT
BMUFSBDJwO
EFM
FTNBMUF
EFOUBM

v
1FSJOBUBM
/FVNPOrB
EFM
MBDUBOUF
NFOPS

Herpes simple:
v
$POHnOJUB
IJESPBOFODFGBMJB
DBMDJDBDJPOFT
DFSFCSBMFT
DPSJPSSFOUJOJUJT
DJDBUSJDFT
EF

QJFM

v
1FSJOBUBM
*OGFDDJwO
EJTFNJOBEB
FODFGBMJUJT
JOGFDDJwO
MPDBMJ[BEB
EF
MB
QJFM
PKPT
P
NVDPTB

PSBM

Varicela:
v
$POHnOJUB
&YUFOTBT
DJDBUSJDFT
EF
QJFM
FYUSFNJEBEFT
IJQPQMgTJDBT
DPSJPSSFUJOJUJT

NJDSPGUBMNrB
BUSPB
DFSFCSBM

v
1FSJOBUBM
*OGFDDJwO
EJTFNJOBEB

Parvovirus B19:
v
)JESPQT
GFUBMJT
OP
JONVOF

Hepatitis B:
v
)FQBUJUJT
QPSUBEPS
DSwOJDP
EF
)#T"H

HIV:
v
3FUBSEP
EFM
DSFDJNJFOUP
Z
EFTBSSPMMP
JOGFDDJPOFT
SFDVSSFOUFT
N|MUJQMFT
JOGFDDJPOFT

PQPSUVOJTUBT
FODFGBMJUJT
EJBSSFB
DSwOJDB
IFQBUPFTQMFOPNFHBMJB
OFVNPOrB
MJOGPDrUJDB

Enterovirus:
1FSJOBUBM
NFOJOHJUJT
BTnQUJDB
NJPDBSEJUJT
JOGFDDJwO
HFOFSBMJ[BEB

311

BIBLIOGRAFIA:

/FXUPO
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%JBHOPTJT
PG
QFSJOBUBM
503$)
JOGFDUJPOT
$MJO
0CTUFU
(ZOFDPM

.BS

 


3FWJFX

3FE
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PG
UIF
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O

KVMJP


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EF
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4UBSL

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(SFFOPVHI
"
5IF
503$)
TDSFFO
BOE
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/FPOBUBM
&E

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3FWJFX

312 GUAS NACIONALES DE NEONATOLOGA

).&%##)/.%3
./3/#/-)!,%3

-B
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OPTPDPNJBMFT
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TJFOEP
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FO
MBT
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MB
65*
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NgT
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VO

EF
MPT
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EF

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Z
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EF
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EF


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DEFINICIN:
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P
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TF
EFOF
DPNP
BRVFMMB
JOGFDDJwO
BERVJSJEB

EFTQVnT
EF
MBT

IPSBT
EF
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EFM
BNCJFOUF
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OP
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EF

MB
NBESF
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PDVSSF
EFTQVnT
EF
MPT

ErBT
EF
WJEB
MP
RVF
TF
IB
MMBNBEP
MBUF
POTFU
TFQTJT
P
TFQTJT
EF
JOJDJP
UBSErP
QBSB
EJGFSFODJBSMB
EF
MBT
JOGFDDJPOFT
QFSJOBUBMFT

MICROBIOLOGA:
-PT
QBUwHFOPT
SFTQPOTBCMFT
EF
MBT
**)
IBO
WBSJBEP
ESgTUJDBNFOUF
FO
MPT
|MUJNPT


BvPT
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NgT
EFM

EF
MBT
JOGFDDJPOFT
OPTPDPNJBMFT
TPO
QSPWPDBEBT
QPS
FT
UBMPDPDPT
DPBHVMBTB
OFHBUJWPT
VO

QPS
FTUBMPDPDP
BVSFVT
NFUJDJMJOPSFTJTUFOUFT


VO

TPO
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1TFVEPNPOB
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,
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Z
PUSPT

PUSP


TPO
IPOHPT
FTQFDJBMNFOUF
$gOEJEB
BMCJDBOT

Z
NFOPT
EFM

QPS
FOUFSPDPDPT

FACTORES DE RIESGO:
Extrnsecos:
q
6TP
EF
DBUnUFSFT
JOUSBWFOPTPT
UVCPT
FOEPUSBRVFBMFT
ErBT
EF
WFOUJMBDJwO
NFDg
OJDB
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313

q
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q
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Z
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EF
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EF
BNQMJP
FTQFDUSP
q
6TP
EF
DPSUJDPJEFT
Z
CMPRVFBEPSFT
TFDSFDJwO
gDJEB
HgTUSJDB
q
1VODJPOFT
N|MUJQMFT
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q
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q
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EF
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q
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Z
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RVF
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3/
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JOBEFDVBEP
EF
NBOPT

Intrnsecos:
q
5PEB
MB
*H(
EFM
GFUP
Z
3/
TPO
EF
MB
NBESF
Z
MPT
OJWFMFT
DBFO
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q
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DPNP
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HBTUSP
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q
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WrB
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$

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q
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EF
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EF
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DVBOEP

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B
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q
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Z
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q
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q
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NgT
JONBEVSF[
JONVOPMwHJDB
Z
NBZPS
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EF
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DJPOFT

DIAGNSTICO CLNICO:
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TPO
JOFTQFDrDPT
q
3FTQJSBUPSJPT
"QOFB
EJDVMUBE
SFTQJSBUPSJB
BVNFOUP
EF
MPT
SFRVFSJNJFOUPT
EF

PYrHFOP
q
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UnSNJDB
FCSF
P
EJDVMUBE
QBSB
UFSNPSSFHVMBS
q
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BMJNFOUBSJB
SFTJEVPT
HgTUSJDPT
BVNFOUBEPT
EJTUFOTJwO
BCEPNJOBM

rMFP
GVODJPOBM
q
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DPNQSPNJTP
EFM
FTUBEP
HFOFSBM
MFUBSHJB
IJQPUPOrB
q
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QFUFRVJBT
Q|SQVSB
q
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q
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NBMB
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TIPDL

314 GUAS NACIONALES DE NEONATOLOGA

LABORATORIO SUGERENTE:
Hemocultivos.
q
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FM
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TJO
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MB
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CBKB

B



q
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q
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q
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VO
NM

q
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Z
NVFTUSB

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Z
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B

WFDFT
FT
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q
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EF
DBUnUFS

q
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EF
MPT
IFNPDVMUJWPT
FT
DFSDBOP
BM

DPO

IPSBT


DPO

IPSBT

DPO

IPSBT
Z
 
DPO

IPSBT
EF
IFNPDVMUJWPT
OF
HBUJWPT
1PS
MP
UBOUP
FT
TFHVSP
TVTQFOEFS
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DPO

IPSBT
EF
USBUBNJFO
UP
FNQrSJDP

Hemograma:
q
-BT
BMUFSBDJPOFT
EFM
IFNPHSBNB
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MB
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MB
TFQTJT
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IFNPHSBNB
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SFGFSFODJBT

EF
DPNQBSBDJwO

q
4J
FM
IFNPHSBNB
UJFOF
rOEJDFT
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.BEVSPT
NBZPS
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MB
QSPCBCJMJEBE
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TFQTJT
FT
NBZPS
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q
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EF
MFVDPDJUPT
NBZPSFT
B

P
NFOPSFT
EF

DPO
OFVUSPMPT
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B

P
SFDVFOUP
EF
QMBRVFUBT
NFOPS
B

TPO
TVHFSFOUFT

q
/FVUSPMJBT
NBZPSFT
B

Z
SFDVFOUPT
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CBDJMJGPSNFT
NBZPSFT
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B


EFT
QVnT
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MB
QSJNFSB
TFNBOB
EF
WJEB
TPO
TPTQFDIPTPT

q
3FDPSEBS
RVF
OPSNBMNFOUF
IBZ
VO
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FO
FM
QSFUnSNJ
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NBZPS
EF

ErBT
RVF
JODMVTP
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MBT

B

TFNBOBT
TF
QSFTFOUB
DPO
VOB
MFWF

OFVUSPQFOJB
SFMBUJWB
q
&O
MBT
TFQTJT
QPS
FTUBMPDPDP
DPBHVMBTB
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MBT
BMUFSBDJPOFT
EFM
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NB
QVFEFO
TFS
NrOJNBT
QVEJFOEP
IBCFS
TwMP
OFVUSPMJB

q
-B
TVTQFOTJwO
EFM
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315

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q
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VO
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BQPZB
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BOPSNBM

q
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VO
CVFO
FYBNFO
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q
1PS
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QBSUF

WBMPSFT
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1$3
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WBMPS
QSFEJDUJWP
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TFQ
TJT
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VO

Z

1$3
CBKBT
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q
0USBT
NFEJDJPOFT
EF
QSPUFrOBT
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GBTF
BHVEB
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Puncin Lumbar.
q
&O
FTUVEJPT
SFUSPTQFDUJWPT
FO
OFPOBUPT
DPO
TFQTJT
OPTPDPNJBM
TF
EFUFDUw
NFOJO
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TwMP
FO

B

EF
MPT
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q
4JO
FNCBSHP
TF
EFCJFSB
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MVNCBS
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UPEP
OFPOBUP
TJOUPNgUJDP
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DPO
FYgNFOFT
JOGFDDJPTPT
BMUFSBEPT
EBEP
RVF
FM

EF
MPT
DBTPT
EF
NFOJOHJUJT

PDVSSJFSPO
DPO
IFNPDVMUJWPT
OFHBUJWPT

Otros cultivos.
q
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MB
TPTQFDIB
EJBHOwTUJDB
TF
EFCF
SFBMJ[BS
DVMUJWP
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QJFM
DFMVMJUJT
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BOUFDFEFOUF
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MrRVJEP
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FOEPUSBRVFBM

QPS
FM
UVCP
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QPS
WFOUJMBDJwO
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BTDJUJT
BSUJDVMBS
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SSFTQPOEB

TRATAMIENTO:
q
4F
SFDPNJFOEB
DVCSJS
FTQFDJBMNFOUF
&TUBMPDPDP
FQJEFSNJEJT
Z
&TUBMPDPDP
BV
SFVT
NgT
VO
BOUJCJwUJDP
DPO
FTQFDUSP
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HSBN
OFHBUJWPT
JOJDJBS
USB
UBNJFOUP
DPO
$MPYBDJMJOB
Z
VO
BNJOPHMJDwTJEP
P
$FGPUBYJNB
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FO

DBTP
EF
NFOJOHJUJT


q
&O
VOJEBEFT
DPO
GSBODP
QSFEPNJOJP
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&TUBMPDPDP
BVSFVT
NVMUJSFTJTUFOUFT
TF

EFCF
JOJDJBS
USBUBNJFOUP
DPO
7BODPNJDJOB
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JOGFDDJwO
QPS
&TUBMPDPDP
FQJEFS
NJEJT
DPBHVMBTB
OFHBUJWP

EB
UJFNQP
QBSB
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FM
FTRVFNB
BOUJCJwUJDP

q
-P
NgT
JNQPSUBOUF
FT
DVCSJS
EFTEF
VO
DPNJFO[P
MPT
(SBN
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TFH|O
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MPDBM
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q
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DPNQFUJS
DPO
nTUB
q
4F
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TPO
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IPOHPT
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q
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nM
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316 GUAS NACIONALES DE NEONATOLOGA

q

q

q

q

DVMUJWPT
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ErBT
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EF
TFQTJT
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ErBT
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ESTRATEGIAS DE PREVENCIN:
q
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EF
NBOPT
FTUSJDUP

B

TFHVOEPT
BOUFT
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EFTQVnT
EF
BUFOEFS
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q
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317

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318 GUAS NACIONALES DE NEONATOLOGA

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319


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331

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342 GUAS NACIONALES DE NEONATOLOGA

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344 GUAS NACIONALES DE NEONATOLOGA

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348 GUAS NACIONALES DE NEONATOLOGA

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DPO
VO
PSJDP
VSF
USBM
OPSNBM
EFCFNPT
TPTQFDIBS
VOB
EVQMJDBDJwO
WBHJOBM

q
4J
QSPUSVZF
QPS
FM
PSJDJP
VSFUSB
VOB
NBTB
RVrTUJDB
IBZ
RVF
TPTQFDIBS
VO
VSFUFSP
DFMF
FDUwQJDP


 $-/
"
/
/
 ," ,"-6OB
EF
MBT
DPOTVMUBT
VSPMwHJDBT
NgT
GSFDVFOUFT
FT
FM
EJBHOwTUJDP
BOUFOBUBM
EF
IJESP
OFGSPTJT
&TUF
EJBHOwTUJDP
QMBOUFB
WBSJPT
QSPCMFNBT
ZB
RVF
FT
VO
EJBHOwTUJDP
JOFTQFDr
DP
Z
MB
HSBO
NBZPSrB
EF
FTUPT
QBDJFOUFT
TPO
TwMP
VO
IBMMB[HP
EF
MB
FDPHSBGrB
QSFOBUBM
Z

QPS
MP
UBOUP
OP
SFRVJFSFO
EF
FTUVEJPT
JOWBTJWPT
1PS
PUSP
MBEP
IJESPOFGSPTJT
MFWFT
QVFEFO

DPSSFTQPOEFS
B
QBUPMPHrBT
VSPMwHJDBT
JNQPSUBOUFT
DPNP
FM
SFVKP
WFTJDPVSFUFSBM

Manejo diagnstico antenatal de hidronefrosis

1BSB
IBDFS
EJBHOwTUJDP
EF
IJESPOFGSPTJT
TVHFSJNPT
FO
MB
FDPHSBGrB
SFOBM
FM
VTP
EFM

EJgNFUSP
BOUFSP
QPTUFSJPS
"1

EF
MB
QFMWJT
SFOBM
FO
FM
QMBOP
USBOTWFSTP
&TUF
QBSgNFUSP
FT

EF
HSBO
VUJMJEBE
ZB
RVF
OPT
QFSNJUF
q
$PNQBSBS
MB
TFWFSJEBE
EF
VOB
IJESPOFGSPTJT
BOUFOBUBM
q
4FHVJS
TV
FWPMVDJwO
EVSBOUF
FM
FNCBSB[P
QSPHSFTJwO
P
EJTNJOVDJwO

q
$PNQBSBDJwO
DPO
FM
NJTNP
EJgNFUSP
NFEJEP
EFTQVnT
EFM
OBDJNJFOUP

Criterios para diagnstico antenatal de hidronefrosis.

q
%JgNFUSP
"1
NBZPS
B

NN
BOUFT
EF
MBT

TFNBOBT
EF
HFTUBDJwO
q
%JgNFUSP
"1
NBZPS
B

NN
EFTQVnT
EF
MBT

TFNBOBT
EF
HFTUBDJwO
4FH|O
FTUF
EJgNFUSP
FM
QSPOwTUJDP
EF
EJMBUBDJPOFT
BOUFOBUBMFT
NFOPSFT
EF

NN

367

Z
QPTU
OBUBMFT
NFOPSFT
EF

NN
RVF
OP
UFOHBO
EJMBUBDJwO
EF
DgMJDFT
UJFOFO
VO
CBKP

SJFTHP
EF
SFRVFSJS
DJSVHrB
FO
FM
GVUVSP

Conducta frente a diagnstico antenatal de hidronefrosis

q
3FDPMFDUBS
UPEB
MB
JOGPSNBDJwO
BOUFOBUBM
FDPHSBGrBT
QSPDFEJNJFOUPT
SFVOJPOFT


RVF
HFOFSBMNFOUF
FTUgO
FO
MB
DIB
NBUFSOB
Z
RVF
DPOTUJUVZFO
MB
IJTUPSJB
BOUFOB
UBM
q
%FKBS
QSPMBYJT
BOUJCJwUJDB
DPO
DFGBESPYJMP

NH,HErB
EFTEF
FM
QSJNFS
ErB

EF
WJEB

q
4PMJDJUBS
FDPUPNPHSBGrB
SFOBM
Z
WFTJDBM
EFTQVnT
EF
MBT

IPSBT
EF
WJEB
"OUFT
EF

MBT

IPSBT
EF
WJEB
EFCJEP
B
MB
PMJHVSJB
EFM
SFDJnO
OBDJEP
TF
TVCWBMPSBO
MBT
IJ
ESPOFGSPTJT
F
JODMVTP
QVFEFO
BQBSFDFS
FYgNFOFT
GBMTBNFOUF
OPSNBMFT
)BZ
RVF

TPMJDJUBS
FYQMrDJUBNFOUF
MB
NFEJDJwO
EFM
EJgNFUSP
"1
EF
MB
QFMWJT
q
6OB
WF[
EJBHOwTUJDBEB
MB
IJESPOFGSPTJT
CJMBUFSBM
FO
SFDJnO
OBDJEP
EF
TFYP
NBTDV
MJOP
TF
EFCF
SFBMJ[BS
VOB
VSFUSPDJTUPHSBGrB
QSFWJB
BM
BMUB
QBSB
EFTDBSUBS
MBT
WBMWBT

EF
VSFUSB
QPTUFSJPS
q
%FSJWBS
B
VSwMPHP
JOGBOUJM

6
6
- 1, /,
*"-/ ,",

&T
MB
DBVTB
NgT
DPN|O
EF
PCTUSVDDJwO
VSFUSBM
DPOHnOJUB
TJFOEP
BMSFEFEPS
EF

FO


B

SFDJnO
OBDJEP
WJWPT
/P
TPO
WBMWBT
QSPQJBNFOUF
UBMFT
TJ
OP
QMJFHVFT
QBS
DJBMNFOUF
PCTUSVDUJWPT
RVF
OBDFO
EFM
WFSV
NPOUBOVN
B
OJWFM
EF
MB
VSFUSB
QPTUFSJPS
FO

FM
QBDJFOUF
EF
TFYP
NBTDVMJOP
&TUB
PCTUSVDDJwO
TF
QSPEVDF
FO
MB
FUBQB
NgT
DSrUJDB
EFM

EFTBSSPMMP
EF
MPT
SJvPOFT
VSnUFSFT
Z
WFKJHB
QSPEVDF
DPOTFDVFODJBT
EFWBTUBEPSBT
FO
FTUPT

wSHBOPT
FTUP
EFCJEP
B
QSFTJPOFT
EF
BMNBDFOBNJFOUP
Z
NJDDJwO
TVNBNFOUF
FMFWBEBT

RVF
TF
USBOTNJUFO
B
UPEP
FM
TJTUFNB
VSJOBSJP
$POTFDVFODJBT
EF
MB
IJQFSQSFTJwO
QSPWPDBEB
QPS
MBT
WBMWBT
TPO
q

q

q

q

3FVKP
WFTJDPVSFUFSBM
HFOFSBMNFOUF
EF
BMUP
HSBEP
%JTQMBTJB
SFOBM
HFOFSBMNFOUF
BM
MBEP
SFVZFOUF
.FHBVSnUFS
TFDVOEBSJP
7FKJHB
WBMWVMBS
WFKJHB
IJQFSUSwDB
RVF
BMNBDFOB
PSJOB
Z
TF
WBDrB
B
HSBOEFT
QSF
TJPOFT
QSPWPDBOEP
FM
EBvP
EFM
USBDUP
VSJOBSJP
TVQFSJPS
B
QFTBS
EF
IBCFSTF
SFTF
DBEP
MBT
WBMWBT
FO
GPSNB
FYJUPTB

368 GUAS NACIONALES DE NEONATOLOGA

Presentacin clnica:
4F
QSFTFOUBO
DPO
VO
BNQMJP
SBOHP
EF
TrOUPNBT
RVF
WBO
EFTEF
MB
EJTGVODJwO
NJDDJPOBM

B
MB
JOTVDJFODJB
SFOBM
UFSNJOBM
&TUP
EFQFOEF
EFM
HSBEP
EF
PCTUSVDDJwO
RVF
QSPWPRVFO

MBT
WBMWBT

q
7BMWBT
NVZ
PCTUSVDUJWBT
TF
QSFTFOUBO
EFTEF
MB
WJEB
JOUSBVUFSJOB
DPNP
NFHBWFKJ
HB
IJESPVSFUFSPOFGSPTJT
CJMBUFSBMFT
Z
PMJHPBNOJPT
TFWFSPT

q
7BMWBT
NFOPT
PCTUSVDUJWBT
TF
QSFTFOUBO
DPNP
JOGFDDJwO
VSJOBSJB
HMPCP
WFTJDBM

DIPSSP
NJDDJPOBM
EnCJM
F
JODPOUJOFODJB
&TUF
EJBHOwTUJDP
FT
QPTJCMF
EF
QMBOUFBS
FO
MB
FDPHSBGrB
QSFOBUBM

Manejo del recin nacido con valvas:

q
4J
IBZ
TPTQFDIB
FO
MB
FDPHSBGrB
QSFOBUBM
IJESPVSFUFSPOFGSPTJT
CJMBUFSBM
Z
NFHB
WFKJHB
FO
GFUP
TFYP
NBTDVMJOP

TF
EFCFSrB
SFGFSJS
B
MB
NBESF
Z
BM
GFUP
B
VO
DFOUSP

UFSDJBSJP
q
1SPMBYJT
BOUJCJwUJDB
DPO
DFGBESPYJMP
B
SB[wO
EF
NH,HErB
q
&DPHSBGrB
QPTUOBUBM
QBSB
DPOSNBS
IBMMB[HPT
QSFOBUBMFT
q
6SFUSPDJTUPHSBGrB
MB
DVBM
DPOSNB
FM
EJBHOwTUJDP
q
&WBMVBS
GVODJwO
SFOBM
DVSWB
EF
DSFBUJOJOB
OJUSwHFOP
VSFJDP
FMFDUSPMJUPT
QMBTNgUJ
DPT
Z
Q)
Z
HBTFT
q
6OB
WF[
DPOSNBEP
FM
EJBHOwTUJDP
TF
EFCF
DPMPDBS
VOB
TPOEB
'PMFZ
/

TJ
FM

3/
QFTB
NgT
EF

HSBNPT
4J
QFTB
NFOPT
EFCFSrB
DMPDBSTF
VOB
TPOEB
EF

BMJNFOUBDJwO
OB

'SFODI
USBOTVSFUSBM
q
3FTFDDJwO
EF
WBMWBT
EF
VSFUSB
QPTUFSJPS
FO
FM
3/
TJ
FM
DBMJCSF
VSFUSBM
QFSNJUF
FM

QBTP
EFM
DJTUPTDPQJP
OFPOBUBM
(FOFSBMNFOUF
Z
DPO
MPT
FRVJQPT
BDUVBMFT
FTUP
TF

QVFEF
SFBMJ[BS
FO
3/
EF
NgT
EF

,H
q
4J
FM
3/
QFTB
NFOPT
EF

,H
P
OP
TF
QVFEF
QBTBS
FM
DJTUPTDPQJP
OFPOBUBM
EFCF
SrB
SFBMJ[BSTF
VOB
WFTJDPTUPNrB
q
4J
OP
TF
EJTQPOF
EF
DJTUPTDPQJP
OFPOBUBM
TF
EFCF
EFSJWBS
BM
QBDJFOUF
B
VO
DFOUSP

RVF
EJTQPOHB
EFM
JOTUSVNFOUBM
BEFDVBEP
q
4J
MB
DSFBUJOJOB
/0
EFTDJFOEF
EFTQVnT
EF

IPSBT
EF
SFTFDBEBT
MBT
WBMWBT
ZP

EF
MB
DPMPDBDJwO
EF
MB
TPOEB
USBOTVSFUSBM
DPOTJEFSBS
MB
QPTJCJMJEBE
EF
EFSJWBDJwO

BMUB
VSFUFSPTUPNrB

EFQFOEJFOEP
EFM
EBvP
QBSFORVJNBUPTP
SFOBM

369

- 8"
 1"
4F
IBDF
EJBHOwTUJDP
EF
TFYP
BNCJHVP
DVBOEP
DMrOJDBNFOUF
FT
JNQPTJCMF
P
NVZ
EV
EPTP
EF
BTJHOBS
FM
TFYP
B
VO
SFDJnO
OBDJEP

Conducta:
q
/P
IBZ
RVF
BQSFTVSBSTF
FO
BTJHOBS
VO
TFYP
EFUFSNJOBEP
4F
EFCF
FYQMJDBS
B
MPT

QBESFT
RVF
OP
IB
IBCJEP
VO
EFTBSSPMMP
DPNQMFUP
EF
MPT
HFOJUBMFT
1PS
FTUP
TF

IBSgO
VOB
TFSJF
EF
FYgNFOFT
UBOUP
DMrOJDPT
DPNP
EF
MBCPSBUPSJP
RVF
QFSNJUJSgO

B
VO
FRVJQP
NVMUJEJDJQMJOBSJP
BTJHOBS
FM
TFYP
BM
3/

Examen fsico:
q
TJ
TF
QBMQBO
HwOBEBT
B
OJWFM
FTDSPUBM
MP
NgT
QSPCBCMF
FT
RVF
TFBO
UFTUrDVMPT
ZB

RVF
MPT
PWBSJPT
OP
EFCFSrBO
EFTDFOEFS
FO
FM
DBOBM
q
TJ
OP
TF
QBMQBO
HwOBEBT
B
OJWFM
FTDSPUBM
Z
FYJTUF
VO
GBMP
EF
BTQFDUP
NBTDVMJOP

EFCF
TPTQFDIBSTF
MB
IJQFSQMBTJB
TVQSBSSFOBM
DPOHnOJUB
FTUB
DPOTUJUVZF
NgT
EFM


EF
UPEPT
MPT
QBDJFOUFT
DPO
TFYP
BNCJHVP
q
4J
TF
FODVFOUSB
VOB
IJQPTQBEJB
TFWFSB
DPO
DSJQUPSRVJEJB
EFCF
TPTQFDIBSTF
VOB

BMUFSBDJwO
DSPNPTwNJDB
%JTHFOFTJB
HPOBEBM
IFSNBGSPEJUB
WFSEBEFSP
Z
PUSBT

P

VOB
SFTJTUFODJB
QBSDJBM
B
BOESwHFOPT
q
%FCF
SFBMJ[BSTF
VO
UBDUP
SFDUBM
TJ
OP
TF
EJTQPOF
EF
FDPHSBGrB
QBSB
FWBMVBS
MB
QSF
TFODJB
EF
|UFSP
FM
DVBM
FT
GgDJMNFOUF
QBMQBCMF
FO
MB
3/

Exmenes:
q

q

q

q

$BSJPHSBNB

BMGB
)JESPYJQSPHFTUFSPOB
&DPHSBGrB

&-1
Z
Q)
HBTFT

Conducta:
q
.BOUFOFS
IPTQJUBMJ[BEP
IBTUB
UFOFS
BTJHOBEP
FM
TFYP
q
5FOFS
DPOUBDUBEP
BM
FRVJQP
NVMUJEJDJQMJOBSJP
OFPOBUwMPHP
FOEPDSJOwMPHP
HFOF
UJTUB
Z
VSwMPHP
JOGBOUJM


q
4J
TF
IB
IFDIP
FM
EJBHOwTUJDP
EF
IJQFSQMBTJB
TVQSBSSFOBM
DPOHnOJUB
TF
EFCF

JOTUBVSBS
FM
USBUBNJFOUP
IPSNPOBM
DPSSFTQPOEJFOUF
QBSB
FWJUBS
MB
DSJTJT
TVQSB
SSFOBM

370 GUAS NACIONALES DE NEONATOLOGA

 8/,"
6 -


-B
WFKJHB
TF
FODVFOUSB
BCJFSUB
FO
MB
QBSFE
BCEPNJOBM
BOUFSJPS
BTPDJBEB
B
VO
QFOF

FQJTQgEJDP
Z
B
VOB
TrOTJT
Q|CJDB
BCJFSUB
*ODJEFODJB
EF
FO

B

3/
WJWPT
4F
QVFEF
TPTQFDIBS
FO
MB
FDPHSBGrB
QSFOBUBM
DVBOEP
OP
TF
MPHSB
JEFOUJDBS
MB
WFKJHB
/P
TF
BTPDJB
FO
HFOFSBM
B
PUSBT
NBMGPSNBDJPOFT

Conducta clsica:
q
%FSJWBS
B
VO
DFOUSP
DPO
FYQFSJFODJB
FO
FYUSPB
WFTJDBM
q
$VCSJS
FM
EFGFDUP
DPO
VO
BQPTJUP
FTUnSJM
q
$JFSSF
EF
WFKJHB
BOUFT
EF
MBT

B

IPSBT
EF
WJEB
ZB
RVF
TF
FWJUB
MB
PTUFPUPNrB

FO
FM
DJFSSF
EF
MB
QFMWJT
q
3FQBSBDJwO
EF
MB
FQJTQBEJB
BM
BvP
EF
WJEB
q
3FQBSBDJwO
EFM
DVFMMP
WFTJDBM
FOUSF
MPT

B

BvPT
EF
WJEB

6-$ 1,"$

 
-
",

" -

",
/
 -BT
NBMGPSNBDJPOFT
BOP
SFDUBMFT
TF
BTPDJBO
FO
NgT
EF
VO

B
BMUFSBDJPOFT
OFGSP

VSPMwHJDBT
.JFOUSBT
NgT
BMUB
MB
NBMGPSNBDJwO
NBT
GSFDVFOUF
FT
MB
BTPDJBDJwO
DPO
QBUP
MPHrB
VSPMwHJDB
&M
EJBHOwTUJDP
FT
DMrOJDP
Z
EFCF
IBDFSTF
BM
DPNQSPCBS
MB
QFSNFBCJMJEBE
EFM
DBOBM
BOP
SFDUBM
FO
MB
BUFODJwO
JONFEJBUB
EFM
3/

Conducta:
q
4F
EFCF
SFBMJ[BS
VO
FYBNFO
NJOVDJPTP
EF
MB
[POB
QFSJOFBM
EFM
3/
CVTDBOEP
VOB

GrTUVMB
B
OJWFM
QFSJOFBM
TBMJEB
EF
NFDPOJP

P
B
OJWFM
EF
MB
PSRVJMMB
WVMWBS
NBMGPSNB
DJwO
GFNFOJOB
NgT
GSFDVFOUF

q
4F
EFCF
DPMPDBS
VO
SFDPMFDUPS
EF
PSJOB
QBSB
EFUFDUBS
MB
QSFTFODJB
EF
NFDPOJP

&TUP
OPT
DFSUJDB
MB
QSFTFODJB
EF
VOB
GrTUVMB
SFDUP
VSJOBSJB
q
4J
TF
FODVFOUSB
VOB
GrTUVMB
SFDUP
QFSJOFBM
TF
QVFEF
EFQFOEJFOEP
EF
MB
FYQFSJFO
DJB
EFM
DJSVKBOP
SFBMJ[BS
VOB
BOPSFDUPQMBTUrB
TJO
SFRVFSJS
VOB
DPMPTUPNrB
q
4J
IBZ
TBMJEB
EF
NFDPOJP
FO
PSJOB
EFCF
SFBMJ[BSTF
TJFNQSF
VOB
DPMPTUPNrB
ZB
RVF

TF
USBUB
EF
NBMGPSNBDJPOFT
BOP
SFDUBMFT
BMUBT

371

q
4J
OP
TF
JEFOUJDB
VOB
GrTUVMB
SFDUP
QFSJOFBM
Z
OP
IBZ
TBMJEB
EF
NFDPOJP
FO
PSJOB

EFCF
SFBMJ[BSTF
VO
JOWFSUPHSBNB
q
4J
FM
GPOEP
EF
TBDP
SFDUBM
FTUg
B
NgT
EF
DN
EFM
QMJFHVF
rOUFS
HM|UFP
EFCF
SFBMJ[BS
TF
DPMPTUPNrB
q
4J
FM
GPOEP
EF
TBDP
SFDUBM
FTUB
B
NFOPT
EF

DN
QVFEF
SFBMJ[BSTF
MB
BOP
SFDUP
QMBTUrB
TJO
DPMPTUPNrB

Estudio:
q
"MUBT

&DPHSBGrB
SFOBM
Z
WFTJDBM

6SFUSPDJTUPHSBGrB
PKBMg
QSFWJP
B
DVBMRVJFS
DJSVHrB

3Y
DPMVNOB
MVNCPTBDSB

&DPHSBGrB
MVNCBS
q
#BKBT

&DPHSBGrB
SFOBM
Z
WFTJDBM

4F
QVFEF
EJGFSJS
MB
VSFUSPDJTUPHSBGrB
P
OP
IBDFSMB

3Y
DPMVNOB
MVNCPTBDSB

&DPHSBGrB
MVNCPTBDSB


NFTFT


"



&T
MB
NBMGPSNBDJwO
BOP
SFDUBM
NgT
DPNQMFKB
Z
TF
BTPDJB
FO
BMUP
HSBEP
B
NBMGPSNBDJP
OFT
OFGSP
VSPMwHJDBT
WBHJOBMFT
Z
EF
NFEVMB
FTQJOBM
&M
EJBHOwTUJDP
FT
DMrOJDP
Z
EFCF
IBDFSTF
BM
DPOTUBUBS
MB
QSFTFODJB
EF
VO
PSJDP
|OJDP
B

OJWFM
QFSJOFBM
FO
WF[
EF
MPT

PSJDJPT
OPSNBMFT
EFM
QFSJOFP
GFNFOJOP

Evaluacin
q

q

q

q

&DPHSBGrB
BCEPNJOBM
3Y
DPMVNOB
MVNCPTBDSB
&DPHSBGrB
EF
MVNCPTBDSB
$JTUPTDPQJB

&M
FTUVEJP
FTUg
PSJFOUBEP
B
EFTDVCSJS
QBUPMPHrBT
RVF
SFRVJFSBO
VOB
JOUFSWFODJwO
VSP
MwHJDB
UFNQSBOB
DPNP
q
SFVKP
WFTJDPVSFUFSBM
NBTJWP
q
PCTUSVDDJPOFT
q
WFKJHB
OFVSPHnOJDB
q
IJESPDPMQPT

372 GUAS NACIONALES DE NEONATOLOGA

Conducta quirrgica
q
$PMPTUPNrB
EFSJWBUJWB
%FQFOEJFOEP
EF
MPT
IBMMB[HPT
TF
EFCF
QSJPSJ[BS
QPS
EFTPCTUSVJS
MB
WrB
VSJOBSJB
ZB
TFB

DPO
DBUFUFSJTNP
JOUFSNJUFOUF
WFTJDPTUPNrB
Z
P
QPS
NFEJP
EF
DPMQPTUPNrB

, +1 ,  / ,
" -1/
1,"$


 1,


q

q

q

q

q

q

q

q

q

q

q

)JESPOFGSPTJT
VOJMBUFSBMFT
TFWFSBT
)JESPOFGSPTJT
CJMBUFSBMFT
6SFUFSPDFMFT
0MJHPBNOJPT
EVSBOUF
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UnSNJOP
-B
JOUFSSVQDJwO
EFM
FNCBSB[P
TF
QMBOUFB
FO
DBTP
EF
TPCSFEJTUFOTJwO

EF
BTBT
ZP
BQBSJDJwO
EF
QFFM

q
-B
EFDJTJwO
TPCSF
VOB
V
PUSB
PQDJwO
TF
EFCF
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FM

CFOFDJP
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MB
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q
4F
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B
VO
DFOUSP
BEFDVBEP
EPOEF
IBZB
BQP
ZP
OFPOBUBM
JEwOFP
Z
FYQFSJFODJB
RVJS|SHJDB

Manejo Neonatal Inmediato:

q
%VSBOUF
MB
BUFODJwO
JONFEJBUB
TF
EFCF
SFDJCJS
BM
OJvP
CBKP
DVOB
DBMFGBDDJPOBEB

$PO
SPQB
FTUnSJM
q
4F
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MP
NgT
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EF
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VO
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NBOF
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FO
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EF
PSJOB
QBSB
DPOUFOJ
EPT
HSBOEFT
MB
DVBM
TF
EFCF
TVKFUBS
DPO
DJOUBT
EF
HBTB
EFTEF

PKBMFT
IFDIPT

IBDJB
MPT
FYUSFNPT
EF
MB
CPMTB
RVF
IBDFO
DPOUBDUP
DPO
MB
QJFM
EFM
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CBT
DJOUBT
EF
HBTB
TVQFSJPSFT
EFCFO
BOVEBSTF
FOUSF
Tr
BM
JHVBM
RVF
MBT
JOGFSJPSFT

IBDJB
FM
EPSTP
EFM
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TF
EFCFO
TFMMBS
DPO
UFMB
BEIFTJWB
MPT

CPSEFT
EF
MB
CPMTB
DPO
MB
QJFM

'JHVSB
/


q
1SPDFEFS
B
BTQJSBS
DPOUFOJEP
HgTUSJDP
FM
DVBM
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FT
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q
4F
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VOB
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PSP
P
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'
DPO
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GSFDVFOUF
P

TPOEB
EF
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MB
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EF
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IVF
DBT
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EF
BJSF

388 GUAS NACIONALES DE NEONATOLOGA

Figura N1

q
4F
EFCF
BUFOEFS
DPO
NPWJNJFOUPT
TVBWFT
QVFT
TF
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SPNQFS
FM
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EFM
PO
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Manejo preoperatorio:
"M
SFDJCJS
VO
SFDJnO
OBDJEP
DPO
VO
EFGFDUP
FYQVFTUP
EF
MB
QBSFE
BCEPNJOBM
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FYUSFNBSTF
BM
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MBT
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FO
TV
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IJQP
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Z
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QPS
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q
&O
JODVCBEPSB
QBSB
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MB
QFSEJEB
FYBHFSBEB
EF
BHVB
Z
FMFDUSPMJUPT
QPS
DBMPS

EJSFDUP
TPCSF
WJTDFSBT
IVFDBT

q
4F
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FO
EFD|CJUP
EPSTBM
GPXMFS
FO
DBTP
EF
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Z
FO
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TJT
EFKBS
FO
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BDPNPEBOEP
MBT
BTBT
EF
NBOFSB
EF
FWJUBS
FM
SJFTHP

JTRVnNJDP
JOUFTUJOBM
q
3nHJNFO

$PMPDBS
TPOEB
PSP
P
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'
DPO
BTQJSBDJwO
GSFDVFOUF
P

TPOEB
EF
BTQJSBDJwO
EPCMF
MVNFO
QBSB
FWJUBS
MB
TPCSFEJTUFOTJwO
EF
WrTDFSBT
IVF
DBT
QPS
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EF
BJSF
q
7JHJMBS
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Z
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q
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TFH|O
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389

q
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EF
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DPO
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FO
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FM
NPNFOUP
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q
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EF
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q
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MB
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q
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GFOUBOJMP

Z
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FO
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q
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VTP
EF
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q
&OGFSNFSrB
EF
65*

-rOFB
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$BUnUFS
QFSDVUgOFP

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EF
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Ciruga.
&M
DJFSSF
EFM
EFGFDUP
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FO
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TJ
MBT
DPOEJDJPOFT
MP
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MP
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FUBQBT
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RVF
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BM
VTP
EF
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RVF
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QSPUFHFS
FM
JOUFTUJOP
NJFOUSBT
TF
MPHSB
TV
SFEVDDJwO
DPNQMFUB
B

MB
DBWJEBE
BCEPNJOBM
1BSB
FTUP
TF
VTB
MB
UnDOJDB
EF
TJMP
DIJNOFZ
P
DBvwO
EF
DIJNFOFB


MB
DVBM
DPOTJTUF
FO
DPMPDBS
VO
TBDP
EF
TJMJDPOB
QPMJNnSJDB
TPCSF
MBT
WrTDFSBT
FTUSVKgOEPMBT

FO
GPSNB
HSBEVBM
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FM
BCEPNFO
FO

ErBT
NPNFOUP
FO
FM
DVBM
TF
SFNVFWF
MB
TJMJDP
OB
Z
TF
DJFSSB
MB
BQPOFVSPTJT

1SFWJP
B
WPMWFS
FM
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BM
DPOUJOFOUF
EFCF
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VO
BEFDVBEP
WBDJBNJFOUP

EF
DPOUFOJEP
JOUFTUJOBM
NFDPOJP

QBSB
PQUJNJ[BS
FTQBDJPT

Manejo postoperatorio.
q
.POJUPSJ[BS
TJHOPT
WJUBMFT
-PT
NgT
DSrUJDPT
TPO
VKP
VSJOBSJP
TBUVSBDJwO
FO
FYUSF
NJEBEFT
JOGFSJPSFT
Z
GSFDVFODJB
DBSEJBDB
EFCJEP
B
RVF
VO
DJFSSF
NVZ
FTUSFDIP

QVFEF
BMUFSBS
FM
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WFOPTP
q
.BOUFOFS
BTQJSBDJwO
DPOUJOVB
QPS
TPOEB
EF
EPCMF
MVNFO
NFEJS
Z
SFQPOFS
EnCJUP

DPO
TPMVDJwO
TJPMwHJDB
"HSFHBS
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FO
FTUB
SFQPTJDJwO
TwMP
TJ
FT
OFDFTBSJP
q
4J
FM
DJFSSF
QSJNBSJP
GVF
FTUSFDIP
P
UJFOF
TJMP
FM
QBDJFOUF
SFRVFSJSg
BOBMHFTJB
Z

TFEBDJwO
BEFNgT
EF
QBSBMJ[BDJwO
QPS
MBT
QSJNFSBT

B

IPSBT

q
$POTJEFSF
VOB
OVUSJDJwO
QBSFOUFSBM
UPUBM
DPO
WPMVNFO
KP
Z
MBT
NPEJDBDJPOFT
EFM

BQPSUF
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DPO
VO
BQPSUF
FOEPWFOPTP
BDDFTPSJP
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BM
CBMBODF
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FT
GVOEBNFOUBM
3FDVFSEF
RVF
MB
TFEPQBSBMJ[BDJwO
BDVNVMB
MrRVJEP
JOUFSTUJDJBM

390 GUAS NACIONALES DE NEONATOLOGA

q
&M
QBDJFOUF
JOJDJBSg
BMJNFOUBDJwO
FOUFSBM
DVBOEP
FM
DJSVKBOP
Z
FM
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MP

FTUJNFO
DPOWFOJFOUF
q
-B
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DPOUJOVB
Z
FM
VTP
EF
GwSNVMBT
FTQFDJBMFT
EFCF
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MB
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PRONSTICO:
q
&O
BVTFODJB
EF
NBMGPSNBDJPOFT
BTPDJBEBT
TFWFSBT
RVF
TF
QSFTFOUBO
NgT
GSF
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FO
MPT
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FM
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FT
CVFOP
DPO
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DFSDB
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BM


q
1BSB
BNCBT
QBUPMPHrBT
TF
IB
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VOB
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QSPMPOHBEB
QPS

MP
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MB
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FT
DMBWF
BM
JHVBM
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MB
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VO

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q
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BMUP
SJFTHP
EF
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B


FO
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&$/

TrOESPNF
EF
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1BUPMPHrB
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EF
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BTPDJBEBT

391

BIBLIOGRAFIA

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4
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FO
FM
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+
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FE



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.
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8
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FE
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392 GUAS NACIONALES DE NEONATOLOGA

(%2.)!
$)!&2!'-4)#!

  
$
$JFSSF
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P
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P
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EFM
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Z
MB
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MB
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RVF
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EFM
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EF
MB
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Z
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TF
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DPO
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Z
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DPO
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HSB
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EF
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INCIDENCIA:

3/
WJWPT

ETIOLOGA:
%FTDPOPDJEB
-B
NBZPSrB
FT
EF
BQBSJDJwO
FTQPSgEJDB
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FM

TF
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MB
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VO

QSFTFOUBO
NBMGPSNBDJPOFT
WFS
TVT
VO

EF
MPT
RVF
TPCSFWJWFO

DIAGNSTICO PRENATAL:
q
&DPHSgDP
4F
EJBHOPTUJDB
BM
FODPOUSBS
WrTDFSBT
BCEPNJOBMFT
FO
FM
UwSBY
FTUwNB
HP
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SJvwO
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Z
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q
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DBTP
EF
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FM
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FT
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NgT
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EFCJEP
B

RVF
FM
IrHBEP
Z
FM
QVMNwO
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TJNJMBSFT
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FDPHnOJDBT

q
-B
BTPDJBDJwO
B
QPMJIJESPBNOJPT
PDVSSF
FO
VO


393

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IFSOJBT
EJBHOPTUJDBEBT
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q
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MB
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EF
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GFUBM

RVF
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MB
BOBUPNrB
EF
MB
IFSOJB
QFSP
OP
DBNCJB
FM
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CUADRO CLNICO:
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EFM
HSBEP
EF
IJQPQMBTJB
QVMNPOBS
TVT
NBOJGFTUBDJPOFT
DMrOJDBT
WBO
EFTEF

JOTVDJFODJB
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DIAGNSTICO POST-NATAL:
q
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FM
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BEF
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q
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FO
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FO
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PUSPT

FTUVEJPT
DPNQMFNFOUBSJPT
EF
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MANEJO:
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EFCFO
CVTDBS
MPT
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EF
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F
JS
JOTUBVSBOEP
FM
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4JO
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DJwO
q
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EF
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Medidas especiales:
q
-B
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FO
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PMJHPTJOUPNgUJDP
DPO
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EF
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OP
FT
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EF
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Z
FM
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q
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q
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q
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Ventilacin mecnica:
q
&M
PCKFUJWP
FT
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VOB
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PYJHFOBDJwO
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QSFTJPOFT
MP
NgT
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QPTJCMF

394 GUAS NACIONALES DE NEONATOLOGA

q
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VOB
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FM

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q
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Alcalinizacin:
q
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EF
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MP
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TF
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VO
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Vasoactivos:
q
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VTP
EF
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FT
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VOB
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EF
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EF
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q
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FM
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B
MB
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EF

)511
DPO
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QVMNPOBS
TFWFSB

Sedacin y relajacin:
q
&M
PCKFUJWP
FT
EJTNJOVJS
MBT
BGFSFODJBT
RVF
EFTFODBEFOBO
VOB
NBZPS
WBTPDPOT
USJDDJwO
B
OJWFM
QVMNPOBS
Z
RVF
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MB
)511
UBMFT
DPNP
BTQJSBDJwO
USBRVFBM

QVODJPOFT
WFOPTBT
EPMPS
SVJEP
FUD
QSJODJQBMNFOUF
EVSBOUF
FM
QFSJPEP
QSF
Z

QPTUPQFSBUPSJP
EPOEF
MB
)511
TF
IBDF
NgYJNB
q
-PT
GgSNBDPT
EF
FMFDDJwO
TPO
GFOUBOZM
FO
HPUFP
DPOUJOVP
DPNP
TFEBOUF
Z
DPNP

SFMBKBOUF
NVTDVMBSFT
WFDVSPOJP
FO
JOGVTJwO
DPOUJOVB

Tratamiento quirrgico:
q
&TUF
DVBESP
OP
DPOTUJUVZF
VOB
VSHFODJB
-B
DJSVHrB
OP
TF
EFCF
SFBMJ[BS
BOUFT
EF

MBT

IPSBT
EF
WJEB
Z
TPMP
FO
VO
QBDJFOUF
IFNPEJOgNJDBNFOUF
DPNQFOTBEP

q
-B
DJSVHrB
TF
SFBMJ[B
QPS
WrB
BCEPNJOBM
Z
TVT
FUBQBT
TPO
DPOSNBDJwO
EJBHOwTUJ
DB
SFEVDJS
UPEP
FM
DPOUFOJEP
WJTDFSBM
EFM
UwSBY
SFTFDBS
FM
TBDP
DVBOEP
FTUF
QSF
TFOUF



PCTFSWBDJwO
EJSFDUB
EFM
QVMNwO
JEFOUJDBS
MPT
CPSEFT
EFM
EJBGSBHNB

Z
DFSSBS
FM
EFGFDUP
GSFOPSSBB
EJSFDUB
VTP
EF
NBMMB
EF
QSPMFOF
BQ
NVTDVMBS


q
3FQBSBDJwO
EF
NBMGPSNBDJPOFT
DPODPNJUBOUFT
NBMSPUBDJwO
JOUFTUJOBM
PCTUSVD
DJPOFT
JOUFTUJOBMFT
SFTFDDJwO
EF
TFDVFTUSP
QVMNPOBS
q
/P
VUJMJ[BS
ESFOBKF
QMFVSBM
FO
FM
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395

q
&M
BJSF
QMFVSBM
SFTJEVBM
TF
SFBCTPSCF
QBVMBUJOBNFOUF
Z
OP
IBDF
FM
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EF
OFV
NPUwSBY
B
UFOTJwO

ECMO:
q
-B
PYJHFOBDJwO
DPO
NFNCSBOB
FYUSBDPSQwSFB
BIPSB
EJTQPOJCMF
FO
VO
DFOUSP
QSJ
WBEP
EF
OVFTUSP
QBrT
TF
IB
DPOTJEFSBEP
DPNP
VOB
BMUFSOBUJWB
QBSB
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DPO
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TFWFSB
EFQFOEJFOEP
EFM
HSBEP
EF
IJQPQMBTJB
QVMNPOBS
Z
RVF
OP
IBO

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PUSPT
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4JO
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DVFOUB
EF

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BMUB
NPSUBMJEBE
EVSBOUF
FM
QSJNFS
BvP
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FO
MB

NBZPSrB
EF
MPT
TPCSFWJWJFOUFT

BIBLIOGRAFA

#PMPLFS
+
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%
8VOH
+5
$POHFOJUBM
EJBGSBHNBUJD
IFSOJB
+
1FEJBUSJDT
4VS
HFSZ
7PM

/


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+5 4BINJ
3 .PGUU
45
$POHFOJUBM
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+
1FEJBUSJDT
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7PM



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. 4UPSL
&
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PG
1F
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7PM

/


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4
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PG
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$MJOJDT
PG
1FSJOBUPMPHZ
7PM




)PTHPS
.
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%
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GFX
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4

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1
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PG
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396 GUAS NACIONALES DE NEONATOLOGA

!42%3)!
%3/&')#!

-B
BUSFTJB
FTPGgHJDB
FT
VOB
NBMGPSNBDJwO
EFM
JOUFTUJOP
BOUFSJPS
DPOTJTUFOUF
FO
MB
GBMUB

EF
DPOUJOVJEBE
EFM
FTwGBHP
B
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B
FTUP
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FOUSF
FM
FTw
GBHP
Z
MB
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VOB
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DPNCJOBDJPOFT
QPTJCMFT
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MPT
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BUSnTJDPT
Z
MB
DPNVOJDBDJwO
DPO
MB
USBRVFB

TVSHF
MB
DMBTJDBDJwO
EF
MB
FOGFSNFEBE

CLASIFICACIN:
q

q

q

q

q

"USFTJB
FTPGgHJDB
DPO
GrTUVMB
USBRVFPFTPGgHJDB
EJTUBM



"&
DPO
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"USFTJB
FTPGgHJDB
TJO
GrTUVMB
USBRVFPFTPGgHJDB


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TJO
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FTPGgHJDB
DPO
GrTUVMB
USBRVFPFTPGgHJDB
QSPYJNBM


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BUSFTJB
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FO
)



"USFTJB
FTPGgHJDB
DPO
EPCMF
GrTUVMB
QSPYJNBM
Z
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INCIDENCIA:
0DVSSF
FO

B

SFDJnO
OBDJEPT
TF
BTPDJB
B
PUSBT
NBMGPSNBDJPOFT
FO
VO


EF
MPT
DBTPT

DIAGNOSTICO:
Sospecha pre-natal:
q
1SFTFODJB
EF
QPMJIJESPBNOJPT
q
"VTFODJB
EF
WJTVBMJ[BDJwO
QSFOBUBM
EF
CPMTB
HgTUSJDB

Sospecha al nacer:
q
3/
DPO
TJBMPSSFB
ZP
DJBOPTJT
TFDVOEBSJB
B
FMMB
-BT
TFDSFDJPOFT
EFTBQBSFDFO
BM

TFS
BTQJSBEBT
QFSP
SgQJEBNFOUF
FM
3/
WVFMWF
B
MMFOBSTF
EF
TFDSFDJPOFT
q
/P
QBTP
EF
MB
TPOEB
HgTUSJDB
EVSBOUF
BUFODJwO
JONFEJBUB

397

Conrmacin:
q
*OTUBMBS
QPS
CPDB
VOB
TPOEB
OVNFSP

FWJUBS
RVF
TF
EPCMF

UPNBS
3Y
TJO
NFEJP

EF
DPOUSBTUF
$PMPDBS
QSFWJBNFOUF

NM
EF
BJSF
QBSB
NFKPS
WJTVBMJ[BDJwO
EFM
DBCP

QSPYJNBM
EFM
FTwGBHP

q
-B
SBEJPHSBGrB
EF
UwSBY
"1
Z
MBUFSBM
NVFTUSB
EJTDPOUJOVJEBE
EFM
FTwGBHP
DPO
EJ
MBUBDJwO
EFM
DBCP
QSPYJNBM
EF
FTUF
4J
IBZ
BJSF
FO
FM
UVCP
EJHFTUJWP
JOEJDB
GrTUVMB

USBRVFP
FTPGgHJDB

q
-B
SBEJPHSBGrB
QVFEF
NPTUSBS
BTPDJBDJwO
DPO
NBMGPSNBDJPOFT
WFSUFCSBMFT
"TP
DJBDJwO
7"$5&3


MANEJO Y TRATAMIENTO:
6OB
WF[
SFBMJ[BEP
FM
EJBHOwTUJDP
EFCF
JOJDJBSTF
FM
NBOFKP
NFEJDP
RVJS|SHJDP
q
*OTUBMBS
JONFEJBUBNFOUF
TPOEB
EF
EPCMF
MVNFO
DPO
BTQJSBDJwO
DPOUJOVB
F
JOTUJMB
DJwO
EF
TVFSP
TJPMwHJDP
B
SB[wO
EF

DDIS
q
3nHJNFO
$FSP

q
1PTJDJwO
EFM
3/
DPO
MB
DBCF[B
NgT
FMFWBEB
'PXMFS


QBSB
NJOJNJ[BS
FM
SFVKP

EFM
DPOUFOJEP
HgTUSJDP
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EF
MB
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QPS
GrTUVMB
EJTUBM
P
BTQJSBDJwO
EF
DPO
UFOJEP
EFM
DBCP
FTPGgHJDP
QSPYJNBM

q
0YJHFOPUFSBQJB
TJ
FT
OFDFTBSJB
QBSB
NBOUFOFS
VOB
TBUVSBDJwO
OPSNBM

q
&O
MPT
3/
DPO
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SFTQJSBUPSJB
JOUVCBDJwO
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Z
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TFH|O
HBTFT
&WJUBS
WFOUJMBS
DPO
CPMTB
Z
NgTDBSB
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QVFEF

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HgTUSJDB
JNQPSUBOUF
FO
OFPOBUPT
DPO
BUSFTJB
Z
'5&
EJTUBM

q
*OJDJBS
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DPO
BOUJgDJEPT
SBOJUJEJOB

Z
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BNJOPHMVDPTJEP

QF
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EF
MB
BTQJSBDJwO
EF
DPOUFOJEP
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B
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EF
MB
'5&

q
3FBMJ[BS
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QBSB
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MPT
3/

DPO
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FTPGgHJDB
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EF
FMMBT

DPOTUJUVZFO
MB
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7"$5&3-
7
BOPNBMrBT
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$
DBSEJPQBUrB
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5&
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-

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EF
MBT
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-BT
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TFS
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FO
FM
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EF
WJEB
EF
FTUPT
SFDJnO
OBDJEPT
q
$POEVDUB
RVJS|SHJDB

TRATAMIENTO QUIRRGICO:
Atresia esofgica con FTE distal:
q
4F
SFBMJ[BSg
EFOUSP
EF
MBT
QSJNFSBT

IST
EF
WJEB
DJFSSF
EF
MB
'5&
EJTUBM
Z
BOBTUP
NPTJT
UnSNJOP
UFSNJOBM
FOUSF
MPT
DBCPT
B
USBWnT
EF
VOB
UPSBDPUPNrB
DPO
BCPSEBKF

FYUSBQMFVSBM
5BNCJnO
TF
QVFEF
SFBMJ[BS
BCPSEBKF
UPSBDPTDwQJDP

398 GUAS NACIONALES DE NEONATOLOGA

q
&T
EJTDVUJEP
FM
VTP
EF
ESFOBKF
NFEJBTUrOJDP
Z
FM
VTP
EF
TPOEB
OBTPHgTUSJDB
USBO
TBOBTUPNwUJDB

Atresia esofgica sin fstula:

q
"M
OBDFS
HBTUSPTUPNrB
EF
BMJNFOUBDJwO
TJO
FTPGBHPTUPNrB
FO
FTQFSB
EFM
DSFDJ
NJFOUP
EF
MPT
DBCPT
QBSB
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P
FTUnO
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MBT
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QBSB
VO
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DPO
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P
EF
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P
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EF
MBT
DPOEJDJPOFT
EFM
QBDJFOUF
Z
EF

MB
FYQFSJFODJB
EFM
FRVJQP
RVJS|SHJDP

q
.BOUFOFS
QFSNBOFOUFNFOUF
TPOEB
EF
EPCMF
MVNFO
DPO
BTQJSBDJwO
DPOUJOVB
Z

NBOFKP
QPTUVSBM
IBTUB
MB
SFTPMVDJwO
EFOJUJWB

Atresia Esofgica con FTE proximal:

q
%JGrDJM
EJBHOwTUJDP
QSFPQFSBUPSJP
Z
EJGFSFODJBSMP
EF
DBTPT
EF
BUSFTJB
TJO
'5&
q
&M
NBOFKP
RVJS|SHJDP
FT
TJNJMBS
B
MPT
QBDJFOUFT
DPO
GrTUVMB
EJTUBM

Atresia esofgica con FTE proximal y distal:

q
&M
NBOFKP
RVJS|SHJDP
FT
TJNJMBS
B
MPT
QBDJFOUFT
DPO
GrTUVMB
EJTUBM
QPOJFOEP
nOGBTJT

FO
MB
TPTQFDIB
Z
C|TRVFEB
EF
MB
'5&
QSPYJNBM
&M
EJBHOwTUJDP
QSFPQFSBUPSJP
FT

NVZ
EJGrDJM

Fstula Traqueo esofgica en H:

q
(FOFSBMNFOUF
TF
NBOJFTUB
FO
FM
QFSrPEP
EF
MBDUBOUF
QPS
JOGFDDJPOFT
SFTQJSBUP
SJBT
B
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TF
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QPS
WrB
DFSWJDBM
Z
DPOTJTUF
FO
TFDDJPOBS
Z

TVUVSBS
MB
GrTUVMB

TRATAMIENTO POSTOPERATORIO:
q
4F
EFCF
NBOUFOFS
USBUBNJFOUP
BOUJCJwUJDP
BOUJgDJEP
Z
BOBMHnTJDP
q
&O
DBTPT
EF
TVUVSBT
TPNFUJEBT
B
UFOTJwO
NBOUFOFS
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B
7FOUJMBDJwO
NF
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Z
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B

IST
q
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BQPSUF
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B
MBT



IST
QPS
TPOEB
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FO
DBTP
EF
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VUJMJ[BEP
P
QPS
WrB
PSBM
FO
WPM|NFOFT
DSFDJFOUFT
q
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EF
FOGFSNFSrB
4POEB
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OP
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FO
DBTP

EF
SFUJSP
BDDJEFOUBM

ESFOBKF
NFEJBTUrOJDP
Z
QPTJDJwO
FWJUBOEP
FYPFYUFOTJPOFT

DFSWJDBMFT
FYBHFSBEBT

q
6TBS
UFSBQJB
BOUJSSFVKP
&M
SFVKP
FT
GSFDVFOUF
FO
FTUPT
QBDJFOUFT
q
3FBMJ[BS
SBEJPHSBGrB
EF
UwSBY

Z

ErB
QPTU
PQFSBUPSJP

q
&TPGBHPHSBNB
BM
EnDJNP
ErB
QPTU
PQFSBUPSJP

399

COMPLICACIONES:
q
-BT
DPNQMJDBDJPOFT
QPTU
PQFSBUPSJBT
JONFEJBUBT
TPO
EFIJTDFODJB
EF
TVUVSBT
GrT
UVMB
FTwGBHP
QMFVSBM
OFVNPUwSBY
Z
SFQSPEVDDJwO
EF
MB
GrTUVMB
USBRVFP
FTPGgHJDB

q
-B
DPNQMJDBDJwO
QSFDP[
NgT
HSBWF
FT
MB
MUSBDJwO
DPO
NFEJBTUJOJUJT
TFDVOEBSJB

RVF
FT
JNQPSUBOUF
EFUFDUBS
Z
USBUBS
QSFDP[NFOUF
q
-BT
DPNQMJDBDJPOFT
UBSErBT
TPO
FTUFOPTJT
FTPGgHJDB
MP
RVF
TF
NBOJFTUB
QPS
EJT
GBHJB
"MHVOPT
OJvPT
PQFSBEPT
QPS
BUSFTJB
FTPGgHJDB
DPO
GrTUVMB
USBRVFP
FTPGgHJDB

QSFTFOUBO
DVBESPT
QVMNPOBSFT
B
SFQFUJDJwO
FO
FMMPT
TF
EFCF
EFTDBSUBS
USBRVFP

NBMBDJB
Z
SFVKP
HBTUSPFTPGgHJDP

PRONOSTICO:
%FQFOEFSg
EFM
QFTP
EF
OBDJNJFOUP
UJQP
EF
BUSFTJB
FTPGgHJDB
Z
EF
MBT
NBMGPSNBDJPOFT

BTPDJBEBT
q
3FDJnO
OBDJEP
DPO
QFTP
BEFDVBEP
P
EF
UnSNJOP
TJO
NBMGPSNBDJPOFT
BTPDJBEBT

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BIBLIOGRAFA

)FJO
4)
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#
4JNQTPO
+
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DPM
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PG
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+
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4VSH

 


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+
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1
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4UPOF
+
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1FSZOBUPM




400 GUAS NACIONALES DE NEONATOLOGA

02/",%-!
/&4!,-/,')#/

401

402 GUAS NACIONALES DE NEONATOLOGA

2%4)./0!4!
$%,02%-!452/

-B
SFUJOPQBUrB
EFM
QSFNBUVSP
301

FT
VOB
FOGFSNFEBE
BOHJPQSPMJGFSBUJWB
EF
MB
SF
UJOB
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WBTDVMBSJ[BEB
EFM
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EF
NVZ
CBKP
QFTP
EF
OBDJNJFOUP
P

NFOPS
EF

TFNBOBT
EF
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4F
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EF
BOPS
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FO
FM
GPOEP
EF
PKP
FO
FM
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Z
DPOTUJUVZF
BDUVBMNFOUF

MB
QSJNFSB
DBVTB
EF
DFHVFSB
JOGBOUJM
FO
$IJMF

Patognesis:
&OUSF
MBT

Z

TFNBOBT
EF
HFTUBDJwO
MPT
WBTPT
SFUJOBMFT
DPNJFO[BO
DSFDJNJFOUP

DFOUSrGVHP
EFTEF
FM
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IBDJB
MB
PSB
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GBDUPSFT
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MP
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FT
MB
BMUFSBDJwO
PYJEBUJWB
EFM
OPSNBM

EFTBSSPMMP
WBTDVMBS
SFUJOBM
4F
DPOTJEFSB
EFUFSNJOBOUF
FM
BVNFOUP
EF
MPT
SBEJDBMFT
MJCSFT
B
OJWFM
MPDBM
VOJEP

B
CBKPT
OJWFMFT
TBOHVrOFPT
EF
TVTUBODJBT
BOUJPYJEBOUFT
FO
SFMBDJwO
B
GFOwNFOPT
EF

IJQFSPYJB
IJQPYJB
JTRVFNJB
Z
TrOESPNF
EF
SFQFSGVTJwO

Incidencia:
7BSrB
TFH|O
MBT
DBSBDUFSrTUJDBT
EF
MPT
OJvPT
FTUVEJBEPT
FTQFDJBMNFOUF
FO
SFMBDJwO

JOWFSTB
B
MB
FEBE
HFTUBDJPOBM
QFTP
EF
OBDJNJFOUP
Z
SFMBDJwO
EJSFDUB
DPO
MB
NPSCJMJEBE

Factores de riesgo asociados:

4F
EFTDSJCFO
N|MUJQMFT
GBDUPSFT
SFMBDJPOBEPT
B
MB
BQBSJDJwO
EF
301
FOUSF
MPT
DVB
MFT
EFTUBDBO
q
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403

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***
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q
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IVTPT
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q
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FO
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EF
MPT
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QMVT

404 GUAS NACIONALES DE NEONATOLOGA

Enfermedad Plus:
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Curso clnico:
q
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405

Tratamiento preventivo:
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q
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Seguimiento Tardo:
q
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406 GUAS NACIONALES DE NEONATOLOGA

407

BIBLIOGRAFIA

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408 GUAS NACIONALES DE NEONATOLOGA

-)3#%,.%/3

409

410 GUAS NACIONALES DE NEONATOLOGA

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411

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412 GUAS NACIONALES DE NEONATOLOGA

AMOMALIAS MAYORES:
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EVALUACIN DE LOS HALLAZGOS EN RECIN NACIDO:

q
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RECURSOS DIAGNSTICOS:
Perodo Prenatal:
q

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q

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TRATAMIENTO:
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413

CONSEJO GENTICO:
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414 GUAS NACIONALES DE NEONATOLOGA

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CABEZA Y CUELLO:
Mscara equimtica:

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Cefalohematoma Subperistico:

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Cefalohematoma Subaponeurtico o Subgaleal:

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Fractura de Crneo:

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416 GUAS NACIONALES DE NEONATOLOGA

Hemorragia Subdural:

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Hemorragia Subaracnoidea:

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Hematoma del Esternocleidomastoideo:

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Parlisis Facial:

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Lesin de la mdula espinal:

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417

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Parlisis braquial:

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MPT
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TRAX
Fractura Clavcula:

&T
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418 GUAS NACIONALES DE NEONATOLOGA

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Lesin del nervio frnico:

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FO
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ABDOMEN:
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Traumatismo heptico:

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FO
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EFSFDIP
1VFEF
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EF
MB
DgQ
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FO
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3/15
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NBOPT
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TV
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NJTNP
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3FHJTUSBS
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425

BIBLIOGRAFA

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'JHVFSPB
1
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MBT
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$PNQMJDBDJPOFT
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3FQFS
DVTJwO
EFM
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MB
5nDOJDB
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426 GUAS NACIONALES DE NEONATOLOGA

()*/$%-!$2%
!$)#4!!$2/'!3

>>V`ii`iV>
&M
VTP
EF
ESPHBT
JMrDJUBT
EVSBOUF
FM
FNCBSB[P
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EF
DPNQMJDBDJwO
FO
MB
HFT
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FM
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JOBEFDVBEBT
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WJEB
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EF
ESPHB
FO
FM
OFPOBUP
BEFNgT
EF
MBT
EFTWFOUBKBT
BN
CJFOUBMFT
FO
MB
JOGBODJB

Factores de riesgo para uso de drogas ilcitas:

q

q

q

q

NBESF
GVNBEPSBT
Z
CFCFEPSBT
QBSFKB
OP
FTUBCMFT
TJO
USBCBKP
FNCBSB[P
NBM
w
OP
DPOUSPMBEP

Factores de riesgo para complicacin del embarazo:

q

q

q

q

QPCSF
OVUSJDJwO
JOBEFDVBEP
DPOUSPM
EF
FNCBSB[P
VTP
EF
NgT
EF
VOB
ESPHB
JMrDJUB
JOGFDDJwO
BTPDJBEB
B
VTP
EF
ESPHBT
JOUSBWFOPTBT
IFQBUJUJT
$
Z
#
7*)


Factores de riesgo para sndrome de abstinencia en el neonato:

-PT
TrOUPNBT
EF
BCTUJOFODJB
QVFEFO
PDVSSJS
DPO
VOB
WBSJFEBE
EF
ESPHBT
PQJgDFPT

DPDBrOB
EFSJWBEPT
EF
BOGFUBNJOB
BMDPIPM
USBUBNJFOUP
DPO
NFUBEPOB
QBSB
CMPRVFBS
MPT

FGFDUPT
FVGwSJDPT
EF
MB
IFSPrOB

427

CONSECUENCIA DE ABUSO DE DROGAS MS FRECUENTES Y

EMBARAZO
Tabaco:
q
3/
DPO
NFOPS
QFTP
QSPNFEJP
BM
OBDFS
EJSFDUBNFOUF
QSPQPSDJPOBM
BM
O|NFSP
EF

DJHBSSJMMPT
GVNBEPT

q
&M
UBCBRVJTNP
FO
MB
MBDUBODJB
SFEVDF
FM
WPMVNFO
UPUBM
EF
MFDIF
QSPEVDJEP NgT
EF


DJHBSSJMMPT
EJBSJPT


q
*ODSFNFOUP
FO
MB
UBTB
EF
QSFNBUVSJEBE
Z
QnSEJEB
GFUBM

q
4J
EFKB
EF
GVNBS
FO
FM
QSJNFS
USJNFTUSF
FM
QFTP
EFM
3/
FT
DPNQBSBCMF
DPO
FM
QFTP

EFM
3/
IJKP
EF
OP
GVNBEPSB

Alcohol:

1SFTFODJB
EF
TrOESPNF
BMDPIwMJDP
GFUBM

q
SFUBSEP
EF
DSFDJNJFOUP
JOUSBVUFSJOP
q
DPNQSPNJTP
EF
4/$
.JDSPDFGBMJB
q
EJTNPSBT
GBDJBMFT
TVSB
QBMQFCSBM
QUPTJT
FEFNB
QFSJPSCJUBSJP
QVFOUF
OBTBM

CBKP
IJQPQMBTJB
NBYJMBS
MBCJP
TVQFSJPS
EFMHBEP
TVSB
QBMBUJOB
q
IJESPOFGSPTJT
NBMGPSNBDJPOFT
FTRVFMnUJDBT
&M
FYDFTP
EF
BMDPIPM
FO
FNCBSB[P
FTUg
BTPDJBEP
DPO
BCPSUP
FO
FM
TFHVOEP
USJNFT
USF
QBSUP
QSFNBUVSP
3$*6
Z
DPOTUJUVZF
VOB
EF
MBT
DBVTBT
NgT
GSFDVFOUF
EF
SFUBSEP

NFOUBM
&M
OFPOBUP
QVFEF
QSFTFOUBS
TrOESPNF
EF
BCTUJOFODJB
UFNCMPS
CPTUF[PT
CBKB
BDUJWJ
EBE
FTUPSOVEPT
QPDB
SFTQVFTUB
B
FTUrNVMPT
BVEJUJWPT
&M
BMDPIPM
QBTB
MJCSFNFOUF
B
MFDIF
NBUFSOB
QPS
MP
UBOUP
OP
EFCF
TFS
DPOTVNJEP
QPS

MB
OPESJ[B

Cocana y derivados:

$SV[B
MB
QMBDFOUB
QPS
EJGVTJwO
GBDJMJUBEB
QPS
TPMVCJMJEBE
MrQJEJDB
-B
DPDBrOB
BDU|B
OP
DJWBNFOUF
QPS

NFDBOJTNPT
q
1PS
WBTPDPOUSJDDJwO
Z
UBRVJDBSEJB
NBUFSOB
Z
GFUBM
RVF
MMFWB
B

)JQPYJB
GFUBM
BVNFOUP
EF
MB
DPOUSBDUJMJEBE
VUFSJOB
EJTNJOVDJwO
EFM
VKP
|UFSP
QMB
DFOUBSJP
JTRVFNJB
VUFSJOB
EFTQSFOEJNJFOUP
EF
QMBDFOUB
3$*6
QBSUP
QSFUnSNJOP

BSSJUNJBT
Z
NBMGPSNBDJPOFT
DBSEJBDBT
HFOJUPVSJOBSJBT
BUSFTJB
JOUFTUJOBM
JOGBSUP

DFSFCSBM
FO
UFSSJUPSJP
EF
BSUFSJB
DFSFCSBM
NFEJB
DPO
MFTJPOFT
RVrTUJDBT
&$/
EF

JOJDJP
QSFDP[
EJTHFOFTJB
SFUJOBM
Z
DPMPCPNB
SFUJOBM
q
1PS
CMPRVFP
EF
MB
SFDBQUBDJwO
EF
DBUFDPMBNJOBT
QSPEVDF
JSSJUBCJMJEBE
EFM
4/$

UPYJDJEBE
EFM
4/$
GFUBM
BOPSNBMJEBEFT
DPOEVDUVBMFT
-B
$PDBrOB
Z
EFSJWBEPT
QBTBO
MB
CBSSFSB
IFNBUPFODFGgMJDB
Z
FKFSDF
FGFDUPT
UwYJDPT

428 GUAS NACIONALES DE NEONATOLOGA



FO
DFSFCSP
GFUBM
NBMGPSNBDJwO
DPOHnOJUB
Z
BTPDJBDJwO
DPO
IJQFSUFOTJwO
QVMNPOBS

1VFEF
QSFTFOUBS
JOGBSUPT
DFSFCSBMFT
RVJTUFT
QPS
NJDSPJOGBSUPT
NJDSPDFGBMJB
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GPOUBOFMB
BNQMJB
FEFNB
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QVFOUF
OBTBM
CBKP
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DPSUB

MBCJP
TVQFSJPS
EFMHBEP
MUSVN
BNQMJP
TVSB
QBMBUJOB
VvBT
EF
PSUFKPT
QFRVFvB
.FUBBOgMJTJT
EFNVFTUSBO
MB
BTPDJBDJwO
DPO
TrOESPNF
EF
NVFSUF
T|CJUB
RVF
BQBSFDF

NgT
DPN|O
FO
OJvPT
FYQVFTUPT
B
DPDBrOB

B

WFDFT
NgT
GSFDVFOUF

BVORVF
FTUB

BTPDJBDJwO
UBNCJnO
FT
NBZPS
FO
IJKPT
EF
VTVBSJBT
EF
QPMJESPHBT

-B
DPDBrOB
QBTB
B
MB
MFDIF
NBUFSOB
FTUg
DPOUSBJOEJDBEB
BCTPMVUBNFOUF
FO
MB
MBDUBODJB

Marihuana:

4F
IB
BTPDJBEP
DPO
NFOPS
QFTP
UBMMB
BM
OBDFS
Z
BOPSNBMJEBEFT
TVUJMFT
FO
FM
OFVSP
EFTBSSPMMP
&M
UFUSBIJESPDBOBCJOPM
BUSBWJFTB
MB
QMBDFOUB
Z
FT
DBQB[
EF
BVNFOUBS
MPT

OJWFMFT
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WFDFT
NgT
RVF
FM
UBCBDP
QSPEVDJFOEP
IJQPYJB
GFUBM

EJTNJOVZFOEP
FM
VKP
VUFSJOP
1BTB
B
MFDIF
NBUFSOB

Opiceos:

*ODSFNFOUP
EF
MBT
NBMGPSNBDJPOFT
DPOHnOJUBT

4F
QSFTFOUBO
DPOWVMTJPOFT
FO
 
EF
IJKPT
EF
NBESFT
DPO
NFUBEPOB
Z
 

EF
IJKPT

EF
VTVBSJBT
EF
IFSPrOB
4rOESPNF
EF
EFQSJWBDJwO
TF
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FO
FM

EF
MPT
3/

IJKPT
EF
VTVBSJBT
EF
IFSPrOB
Z
FO

EF
NFUBEPOB

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TrOUPNBT
EF
EFQSJWBDJwO
TF
JOJDJBO
EFOUSP
EF
MBT
QSJNFSBT

IPSBT
EF
WJEB
FO
MB

IFSPrOB
Z
FOUSF
MPT

ErBT
FO
MB
NFUBEPOB
-B
EFQSJWBDJwO
TVCBHVEB
QVFEF
QFSTJTUJS

QPS

NFTFT
-BT
QFSTPOBT
VTVBSJB
EF
ESPHBT
EFCFO
QFSJwEJDBNFOUF
JOWFTUJHBSTF
7*)
IFQBUJUJT
#
Z
$

Diagnsticos de farmacodependencia:

"OBNOFTJT
'BDUPSFT
EF
SJFTHP
NPSCJMJEBE
QTJRVJgUSJDB
NBZPS
EFNBOEB
EF
BOBM
HnTJDPT
Z
TFEBOUFT

5FTU
FO
SFDJnO
OBDJEP
&M
UFTU
EFCF
FTUBS
MJNJUBEP
B
TJUVBDJPOFT
EF
EJBHOwTUJDP
JO
DJFSUP
Z
EFCFSrB
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TFS
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DPO
FM
DPOTFOUJNJFOUP
EF
MB
NBESF
q
3BEJPJONVOPBOgMJTJT
FO
PSJOB
TFOTJCJMJEBE
EF

q
3BEJPJONVOPBOgMJTJT
EF
NFDPOJP
TFOTJCJMJEBE
EF

q
&TUVEJP
FO
QFMPT
Z
VvBT
UJFOF
BMUB
TFOTJCJMJEBE
Z
FTQFDJDJEBE
QFSP
FT
EF
BMUP

DPTUP
q
#VTDBS
NVFTUSB
FO
PSJOB
QBSB
DPDBrOB
IBTUB

ErBT
EFTQVnT
EF
DPOTVNP

QBSB
NBSJIVBOB
IBTUB

ErBT
q
.FDPOJP
QFSNJUF
FTUVEJP
SFUSPTQFDUJWP
ZB
RVF
BMNBDFOB
TVTUBODJB
DPOTVNJEB

TJFOEP
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EFUFDUBS
ESPHBT
VUJMJ[BEB
EFTEF
MBT

TFNBOBT
EF
HFTUBDJwO

429


%JBHOwTUJDP
EF
EFQSJWBDJwO

q
4rOESPNF
EF
BCTUJOFODJB
FT
UBCVMBEP
VTBOEP
FM
4DPSF
4"/

PUNTAJE PARA EVALUAR SINDROME DE ABSTINENCIA

NEONATAL
16/5"+&
4*(/04

*SSJUBCJMJEBE
MMBOUP
FYDFTJWP

/PSNBM

3FFKPT
%FQPTJDJPOFT

/PSNBMFT
/PSNBMFT

5POP
.VTDVMBS
&SPTJPOFT
FO
QJFM

/PSNBM
/P

'SFDVFODJB

3FTQJSBUPSJB
NJO
&TUPSOVEPT

SFQFUJEPT
#PTUF[PT

SFQFUJEPT
7wNJUP
'JFCSF





-FWF
BVNFOUP
DPO
.PEFSBEP
P

)BNCSF
P

NBSDBEP
BVNFOUP
BM

NBOJQVMBDJwO

UPDBSMP
4F
DBMNB
DPO

BMJNFOUP
P
BM

BDVOBSMP
-FWF
BVNFOUP
.PEFSBEB
B
TFWFSB

DVBOEP
TF
MF
UPDB
P

DPO
IBNCSF

"VNFOUBEPT
.VZ
BVNFOUBEPT
&YQMPTJWBT
QFSP

&YQMPTJWBT
NgT
EF

GSFDVFODJB
OPSNBM ErB
"VNFOUBEP
3rHJEP
3PEJMMBT
Z
DPEPT

&YDPSJBDJwO
EF
MB

DPO
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QJFM



/P

4J

/P

4J

/P
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4J
4J

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/PSNBM


.BSDBEP
BVNFOUP
P

USFNPSFT
DPOUJOVPT

B|O
TJO
UPDBSMP

1VFEFO
QBSFDFS
DPOWVMTJPOFT
.BSDBEB
B|O
TJO

UPDBSMP

Tomado de Lipsitz, PJ. Clin Pediatr. 1975;14:592-594.

*OUFSQSFUBDJwO

q
/FPOBUPT
DPO

QVOUBKFT
DPOTFDVUJWPT
TPCSF

NFEJEPT
DBEB

IPSBT
EFCFO
TFS

USBUBEPT

q
-B
FWBMVBDJwO
DPO
4"/
EFCF
TFS
DPOUJOVBEB
DBEB

IPSBT
IBTUB
RVF
FM
3/
TF

IBZB
FTUBCJMJ[BEP

Sntomas de deprivacin de opiceos.

4/$
UFNCMPS
MMBOUP
BHVEP
JSSJUBCJMJEBE
EJTUVSCJPT
BM
EPSNJS
4JTUFNB
SFTQJSBUPSJP
UBRVJQOFB
BMFUFP
OBTBM
SFUSBDDJwO
UPSgDJDB
4JTUFNB
OFSWJPTP
BVUwOPNP
BMJNFOUBDJwO
PKB
WwNJUPT
EJBSSFB

430 GUAS NACIONALES DE NEONATOLOGA

Intervenciones:

$VJEBEP
BOUFOBM

q
4r
TF
EFUFDUB
FO
DPOUSPM
EF
FNCBSB[P
SFGFSJS
B
QTJRVJBUSB
BTJTUFOUF
TPDJBM
q
5SBUBNJFOUP
EF
FNCBSB[BEB
VTVBSJB
EF
ESPHBT


&NCBSB[BEB
BEJDUB
B
PQJgDFPT
VTBS
NFUBEPOB
MB
EFQSJWBDJwO
EF
PQJg
DFPT
FT
EBvJOB
QBSB
FM
GFUP
Z
MB
FNCBSB[BEB
EFCF
TFS
FTUBCJMJ[BEB
DPO

BENJOJTUSBDJwO
EF
NFUBEPOB

*OGPSNBS
EF
SJFTHP
RVF
DPOMMFWB
VTP
EF
ESPHB

&OTFvBS
VTP
EF
KFSJOHBT
FTUnSJMFT
BOUF
MB
JNQPTJCJMJEBE
EF
EFUFOFS
FM
VTP

EF
ESPHBT
JOUSBWFOPTBT

*OUFOUBS
JOHSFTP
B
IPHBS
QSPUFHJEP
IPHBS
QBSB
BEPMFTDFOUF


$VJEBEP
QPTUOBUBM
q
&WJUBS
TFQBSBDJwO
EFM
3/
DPO
TV
NBESF
VTBS
UnDOJDBT
EF
SFMBKBDJwO
FOWPMWFS

FO
NBOUJMMB
NBTBKF
CBvP

Manejo de deprivacin segn puntaje NAS:

q
4r
QVOUBKF
FT

WFDFT
NBZPS
EF

w
JHVBM
P
NBZPS
EF

QPS

WFDFT
IPTQJUBMJ[BS
Z

DPOUJOVBS
DPO
QVOUBKF
DBEB

IPSBT
IBTUB
RVF
TFB
NFOPS
EF

QPS

IPSBT

q
$PO
QVOUBKF
NBZPS
EF

Z
NBESF
VTVBSJB
EF
PQJgDFPT
NPSOB
NFUBEPOB
IFSPr
OB
QFUJEJOB

VTBS
ESPHBT
EFQSFTPSBT
EFM
4/$
NPSOB
FT
NFKPS
RVF
FM
GFOPCBSCJ
UBM
FO
QSFWFOJS
DPOWVMTJPOFT

Rgimen de Morna
1VOUBKF
/"4

"DDJwO

1VOUBKF
NBZPS
P
JHVBM

QPS

WFDFT

.PSOB
 
NHLHErB
FO

EPTJT
PSBM

4r
QVOUBKF
QFSTJTUF
NBZPS
B

B
QFTBS
EF
NPSOB
 

.PSOB
 
NHLHErB
FO

EPTJT
PSBM

4r
QVOUBKF
QFSTJTUF
NBZPS

B
QFTBS
EF
NPSOB
 

.PSOB
 
NHLHErB
FO

EPTJT
PSBM

$VBOEP
SFDJCF
 
NHLHErB

.POJUPS
DBSEJPSFTQJSBUPSJP

%FTQVnT
EF

IPSBT
EF
EFTDFOTP
EFM
OJWFM
EF
QVOUBKF
SFEVDJS
NPSOB
FO
 
NH
QPS

EPTJT
DBEB

ErBT
&M
UJFNQP
VTVBM
EF
USBUBNJFOUP
DPO
NPSOB
FT
EF

NFTFT

Manejo del RN con deprivacin y vmitos:

q
"TFHVSBS
RVF
OJvP
OP
FTUn
TPCSFBMJNFOUBEP
VTBS
UnDOJDB
EF
BMJNFOUBDJwO
BEF
DVBEB
q
%BS
NPSOB
BOUFT
EF
BMJNFOUBS
Tr
WPNJUB
EFOUSP
EF

NJOVUPT
SFQFUJS
EPTJT
Tr

WPNJUB
EFTQVnT
EF

NJOVUPT
EBS

EPTJT
Tr
WPNJUB
BMFKBEP
EF
BMJNFOUBDJwO
OP

SFQFUJS
EPTJT

431

Deprivacin por depresores no opiceos del SNC

q
1PS
FK

BMDPIPM
CFO[PEJB[FQJOBT
CBSCJU|SJDPT
VTBS
'FOPCBSCJUBM

Rgimen de Fenobarbital
1VOUBKF
NBZPS
EF

QPS

WFDFT

'/#

NHLH
FW
JOJDJBM
MVFHP
NHLHErB
FO


EPTJT

4r
QFSTJTUF
QVOUBKF
NBZPS
EF

B
QFTBS
EF
'/#

'/#

NHLHErB
EJWJEJEP
FO

EPTJT
PSBM

4r
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PROBLEMAS TICOS QUE SURGEN FRECUENTEMENTE

EN PERINATOLOGA.
Diagnstico prenatal de malformacin severa o incompatible con la
vida.
&O
BMHVOPT
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448 GUAS NACIONALES DE NEONATOLOGA

El apoyo que debe recibir un prematuro extremo.

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El apoyo que debe recibir un asxiado severo.

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PRINCIPIOS TICOS BSICOS.

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INDICACIONES EN LA UTI NEONATAL:

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TCNICA:
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454 GUAS NACIONALES DE NEONATOLOGA

FM
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COMPLICACIONES:











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