Lumbosacral spinal cutaneous pits and their relationship with occult spinal dysraphim at birth in the Hospital de Guapiles in the period between June 2012 and December 2012

Occult spinal dysraphim must be known and suspected by general practitioners and pediatricians. Many are not diagnosed promptly, with the consequent risk of permanent neurological damage. Abnormal lumbosacral spinal cutaneous pits and/or associated with other cutaneous markers are usually the only clinical manifestation. Hence the importance of making a differential diagnosis between the pathological and the non-pathological, since some pits are considered normal anatomical variations. In our environment, especially in the Hospital de Guapiles, there are no studies that characterize children with this diagnosis; it is known to be a cause for consultation and referral, as well as anguish for parents. For this reason, this study intends to acquire more clinical knowledge, in order to reconsider the diagnostic and therapeutic approach of this clinical entity, which justifies the need for this review. The general objective is to describe the lumbosacral spinal cutaneous pits present in healthy asymptomatic neonates born at the Hospital de Guapiles in the period from June to December 2012 and their relationship with occult spinal dysraphim. In this epidemiological, observational, retrospective and descriptive study based on surveys, in which an analysis of central tendency of measurement of averages, ranges and frequencies was carried out, on the clinical and ultrasound findings of the lumbosacral spine, in all newborns at the Hospital de Guapiles between June and December 2012, who presented lumbosacral spinal cutaneous pits and other associated cutaneous markers; analyzing the general clinical variables of the newborn and the mother. The review of the clinical records of the mother of all the newborns that presented spinal cutaneous pits was carried out, specifically thirty-one records. The analysis of the information was carried out using the statistical method of the Epi Info version 3.5.1 and Excel 2007 programs. The data is shown in tables or figures according to the type of variable. Thirty-one records were reviewed. It was observed that 58% of the patients were female and 42% male, for a female:male ratio of 1.38:1. 90.3% corresponded to term newborns, only 3.2% to preterm newborns, and 6.5% to post-term newborns, with adequate weights ranging between 2,500 and 4,000 grams. 77.32% corresponded to children of mothers between 20 and 39 years old, 16.13% to adolescent mothers and 6.5% to women over 40 years of age. The spinal cutaneous pits were evaluated in number, location, diameter, distance in centimeters from the anal edge, and their association with other cutaneous markers; the most frequent clinical finding being the central lumbosacral pit in 82%, and 18% located lateral to the spine. Only 17% of the pits were associated with cutaneous markers, the most frequent being double folds in 80%. Lumbosacral spine ultrasound was performed on the 31 patients, which was reported normal in 93.5% and doubtful in two newborns, corresponding to 6.45%. Timely clinical assessment of lumbosacral spinal cutaneous pits, isolated or associated with other cutaneous markers, is sufficient for diagnosis and correct management. In doubtful cases of suspected occult spinal dysraphim, an ultrasound of the spine should be performed for an early diagnosis, thus avoiding a risk of permanent neurological damage, coinciding with what has been reported in the consulted bibliography