ABSTRACT
La taquicardia supraventricular (TSV) es la principal taquiarritmia en el recién nacido (RN) que requiere una resolución urgente. Por su parte, la enterocolitis necrosante (ECN) es la emergencia gastrointestinal más común que afecta principalmente a RN prematuros. Aunque estas se reconocen como patologías distintas, la bibliografía sugiere que los episodios de TSV pueden predisponer a los pacientes a la ECN a través de alteraciones en el flujo sanguíneo mesentérico y una disminución de la perfusión tisular. Se presenta aquí el caso clínico de un neonato prematuro que desarrolló un cuadro de ECN luego de un evento aislado de TSV con bajo gasto cardíaco
Supraventricular tachycardia (SVT) is the main tachyarrhythmia in the newborn (NB) that requires urgent resolution. Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency that mainly affects premature infants. Although these conditions are recognized as distinct pathologies, literature reports suggest that episodes of SVT may predispose patients to NEC secondary to disturbances in mesenteric blood flow and a decrease in tissue perfusion. We present here the clinical case of a premature neonate who developed NEC after an isolated SVT event with low cardiac output
Subject(s)
Humans , Male , Infant, Newborn , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/etiology , Enterocolitis, Necrotizing/complications , Enterocolitis, Necrotizing/diagnosis , Infant, Newborn, Diseases , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/etiology , Fetal DiseasesABSTRACT
OBJECTIVE@#To study the value of fecal calprotectin (FC) in the diagnosis of neonatal necrotizing enterocolitis (NEC) through a Meta analysis.@*METHODS@#Web of Science, Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Weipu Periodical Database, Wanfang Data, Chinese Biomedical Literature Database were searched for related studies published up to May 2020, with manual search as supplementation. The QUADAS criteria were used to evaluate the quality of the articles included. Meta-DiSc 1.4 and Stata 15.0 software were used to perform the Meta analysis, including the evaluation of specificity, sensitivity, likelihood ratio, and diagnostic odds ratio. The sensitivity analysis and heterogeneity testing were performed, and the summary receiver operating characteristic (SROC) curve and Fagan diagram were plotted.@*RESULTS@#A total of 15 articles were enrolled, involving 1 719 neonates. Among these articles, 4 had low quality, 2 had high quality, and the rest had medium quality. There was high heterogeneity between studies, and there was no threshold effect or publication bias. The random effects model analysis showed that FC had a pooled specificity of 0.80 (95%@*CONCLUSIONS@#FC has high potential and efficiency in the early diagnosis of NEC. FC measurement can be used for the diagnosis of NEC, but it should be combined with clinical manifestations and other related laboratory examinations.
Subject(s)
Humans , Infant, Newborn , China , Enterocolitis, Necrotizing/diagnosis , Feces , Leukocyte L1 Antigen Complex , ROC Curve , Sensitivity and SpecificityABSTRACT
Resumen La enterocolitis necrotizante (ECN) es la urgencia más frecuente en el periodo neonatal asociada al sistema digestivo; afectando principalmente a los neonatos pretérmino con muy bajo peso al nacer. La etiología continúa siendo desconocida, se considera una enfermedad multifactorial, donde la prematuridad es el principal factor de riesgo, todo esto relacionado con la inmadurez del tracto gastrointestinal, una motilidad disminuida que genera una mayor permeabilidad en la mucosa y con esto facilita la translocación bacteriana. Su diagnóstico suele ser muy complejo y suele pasar desapercibido en muchas ocasiones generando una mortalidad importante de hasta el 30% donde su principal complicación es la perforación intestinal y el consiguiente shock séptico. Las opciones terapéuticas se dividen en 2 grupos: médico y quirúrgico, ambos con complicaciones importantes que afectan el desarrollo de los niños que la padecen donde las más importantes abarcan desde alteraciones del crecimiento y neurodesarrollo hasta síndrome de intestino corto y desnutrición.
Abstract Necrotizing enterocolitis (NEC) is the most common emergency in the neonatal period associated with the digestive system; mainly affecting preterm neonates with very low birth weight. Etiology remains unknown, considered a multifactorial disease, all this related to the immaturity of the gastrointestinal tract, a decreased motility that generates greater permeability in the mucosa and with this facilitates bacterial translocation. Diagnosis is usually very complex and often goes unnoticed on many occasions leading to a significant mortality of up to 30% where its main complication is intestinal perforation and consequent septic shock. Therapeutic options are divided into 2 groups: medical and surgical, both with major complications affecting the development of children with it where the most important from growth and neurodevelopmental alterations to short bowel syndrome and malnutrition.
Subject(s)
Infant, Premature , Enterocolitis, Necrotizing/diagnosis , Costa RicaABSTRACT
β-Glucosidase activity assays constitute an important indicator for the early diagnosis of neonatal necrotizing enterocolitis and qualitative changes in medicinal plants. The drawbacks of the existing methods are high consumption of both time and reagents, complexity in operation, and requirement of expensive instruments and highly trained personnel. The present study provides a simplified, highly selective, and miniaturized glucometer-based strategy for the detection of β-glucosidase activity. Single-factor experiments showed that optimum β-glucosidase activity was exhibited at 50 °C and pH 5.0 in a citric acid-sodium citrate buffer when reacting with 0.03 g/mL salicin for 30 min. The procedure for detection was simplified without the need of a chromogenic reaction. Validation of the analytical method demonstrated that the accuracy, precision, repeatability, stability, and durability were good. The linear ranges of β-glucosidase in a buffer solution and rat serum were 0.0873-1.5498 U/mL and 0.4076-2.9019 U/mL, respectively. The proposed method was free from interference from β-dextranase, snailase, β-galactosidase, hemicellulase, and glucuronic acid released by baicalin. This demonstrated that the proposed assay had a higher selectivity than the conventional dinitrosalicylic acid (DNS) assay because of the specificity for salicin and unique recognition of glucose by a personal glucose meter. Miniaturization of the method resulted in a microassay for β-glucosidase activity. The easy-to-operate method was successfully used to detect a series of β-glucosidases extracted from bitter almonds and cultured by Aspergillus niger. In addition, the simplified and miniaturized glucometer-based assay has potential application in the point-of-care testing of β-glucosidase in many fields, including medical diagnostics, food safety, and environmental monitoring.
Subject(s)
Animals , Rats , Aspergillus niger , Calibration , Cellulase/analysis , Chemistry, Clinical/methods , Dextranase/analysis , Enterocolitis, Necrotizing/diagnosis , Equipment Design , Flavonoids/analysis , Glucose/analysis , Glucuronic Acid/analysis , Glucuronidase/analysis , Glycoside Hydrolases/analysis , Hydrogen-Ion Concentration , Linear Models , Multienzyme Complexes/analysis , Plants, Medicinal , Polygalacturonase/analysis , Reproducibility of Results , beta-Galactosidase/analysis , beta-Glucosidase/analysisABSTRACT
Introducción: El bebé colodión es una ictiosis neonatal muy poco frecuente. La piel apergaminada, amarilla y dura que recubre el cuerpo resulta ser una barrera ineficaz, que predispone a la deshidratación, pérdida de calor e infecciones. El mejor manejo de estos pacientes ha permitido aumentar su supervivencia, pero su comorbi-lidad requiere de un seguimiento estricto y cauteloso. Objetivo: Describir un caso de enterocolitis fulminante desarrollada en un bebé colodión, con el fin de ayudar a la identificación más precoz de esta patología. Caso clínico: Recién nacido de 34 semanas, con membrana colodión, que ingresa en la unidad de cuidados intensivo con dificultad respiratoria severa. Se mantiene en una incubadora con humedad, aplicando emolientes y lubricación cutánea y oftalmológica. Se inició tratamiento antibiótico de amplio espectro. El quinto día de vida, comenzó con intolerancia a la alimentación, desarrollándose una enterocolitis fulminante que le ocasionó el fallecimiento. Conclusiones: La asociación con enterocolitis necrosante en un bebé colodión no ha sido descrita en la literatura, por lo que, ocasiona una demora diagnóstica y esto contribuye a una evolución fulminante que puede ocasionar la muerte. El tener presente esta infrecuente comorbilidad podrá favorecer su pesquisa para el manejo oportuno.
Introduction: Collodion baby is a rare neonatal ichthyosis. The leathery, hard and yellow skin that covers the body is an ineffective barrier that predisposes to dehydration, heat loss and infections. A better management of these patients has been shown to increase survival, but the comorbidity requires strict and cautious monitoring. Objective: To describe a case of fulminant enterocolitis in a collodion infant in order to help to identify early this pathology. Case report: A 34-week newborn with collodion membrane was admitted to the intensive care unit with severe respiratory distress. The baby was maintained in an incubator with humidity, applying emollients and skin and eye lubrication. Broad-spectrum antibiotic treatment was initiated. The patient presented feeding intolerance on the fifth day of life, developing a fulminant enterocolitis resulting in death. Conclusion: The necrotizing enterocolitis associated with a collodion baby has not been described in the literature, causing a delay in diagnosis and contributing to a fulminant course that can lead to death. Keeping in mind this rare comorbidity may facilitate a timely management.
Subject(s)
Humans , Female , Infant, Newborn , Enterocolitis, Necrotizing/complications , Enterocolitis, Necrotizing/diagnosis , Ichthyosiform Erythroderma, Congenital/complications , Dehydration , Enterocolitis, Necrotizing/therapy , Fatal OutcomeABSTRACT
A male preterm infant, first-born of twins delivered by cesarean section at 31 weeks' gestation. Birth weight was 1720 g and APGAR scores were 5 and 8 at 1 and 5 min, respectively. The initial clinical course of the infant was unremarkable except mild respiratory distress which required supplemental oxygen. Enteral feeding with breast milk was started at 16 hours of age and increased with amounts of 20 ml/kg/day over the next days. On day 5 of life, clinical deterioration occurred with fecaloid vomiting, abdominal distention and bloody stools. Serum C-reactive protein and interleukin-6 levels were 37,8 mg/L and 482,1 pg/mL, respectively. Throm-bocytopenia [118x10[6]L] was detected. White blood cell count and immature-to-total ratio of the blood count remained normal. What is your diagnosis of the infant whose abdominal graph is shown below?
Subject(s)
Humans , Male , Infant, Newborn , Pneumatosis Cystoides Intestinalis/diagnosis , Enterocolitis, Necrotizing/diagnostic imaging , Enterocolitis, Necrotizing/diagnosis , PrognosisABSTRACT
Objetivo: Caracterizar la Enterocolitis Necrotizante (ENC) en los recién nacidos de la Unidad de Neonatología del Hospital Roosevelt en el 2006. Resultados: se estudiaron 81 recién nacidos con ENC, mediante un estudio descriptivo, encontrando 47 masculinos y 34 femeninos, que representó una incidencia de 10.2x1000 nacidos vivos(nv), de los cuales 4.9 por ciento fueron a término y 95.1 por ciento fueron pretérmino...
Subject(s)
Infant, Newborn , Enterocolitis, Necrotizing/diagnosis , Enterocolitis, Necrotizing/epidemiology , Enterocolitis, Necrotizing/etiology , Enterocolitis, Necrotizing/pathology , Infant, Premature, DiseasesABSTRACT
En Cuba, entre el 1ero. de enero de 1986 y el 30 de abril de 2007 nacieron 280 niños hijos de madres VIH+. De ellos solo 22 (7,8 por ciento) nacieron con edad gestacional menor de 37 semanas y solo uno (4,5 por ciento) presentó una enterocolitis necrosante. En el presente artículo se describe un episodio de esta enfermedad en un niño prematuro hijo de padres VIH+, supuestamente asociado al uso profiláctico de zidovudina en las madres seropositivas por la posibilidad de producir toxicidad mitocondrial en el feto. Con el tratamiento quirúrgico empleado, la evolución del niño fue favorable. El caso presentado constituye una evidencia que el personal médico debe tener en cuenta para el cuidado y diagnóstico de estos pacientes.
In Cuba, from January 1, 1986 to April 30, 2007 were born 280 children from HIV+ mothers. Only 22 (7, 8 percent) had a gestational age under 37 weeks and only one (4, 5 percent) presented with a necrotizing enterocolitis. In present paper we describe an episode of this disease in a premature baby son of HIV+ parents, supposedly associated with prophylactic use of Zidovudine in seropositive mothers by possibility to produce mitochondria toxicity in fetus. This case is an evidence that family physician must to assess for care and diagnosis of these patients.
Subject(s)
Humans , Male , Infant, Newborn , Enterocolitis, Necrotizing/surgery , Enterocolitis, Necrotizing/diagnosis , Enterocolitis, Necrotizing/drug therapy , Zidovudine/therapeutic use , Case ReportsABSTRACT
Necrotizing enterocolitis is the most common gastrointestinal emergency of the neonate, affecting 5-10% of infants, yet the pathogenesis remains unclear. Widely accepted risk factors include prematurity, enteral feeds, bacterial colonization and mucosal injury. How these or other yet identified factors come together to create the classic clinical and pathologic features is the subject of much research. The activation of the cytokine cascade, in part by bacterial ligands, appears to play a key role in mucosal injury. Two mediators that may also contribute are platelet activating factor and intestinal toll-like receptors. Short chain fatty acids, the products of bacterial fermentation of carbohydrates, have been thought to cause mucosal injury. Overgrowth of pathogenic bacteria in the face of a decreased commensal population may play a key role. A current focus of clinical research involves probiotics, enterally fed forms of commsenal bacteria. This may set the stage for a healthier intestinal ecosystem and possibly, decreased risk of NEC.
Subject(s)
Combined Modality Therapy , Enteral Nutrition , Enterocolitis, Necrotizing/diagnosis , Fatty Acids, Volatile/metabolism , Female , Fluid Therapy/methods , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/diagnosis , Inflammation Mediators/analysis , Intestinal Mucosa/pathology , Male , Probiotics/administration & dosage , Prognosis , Risk Factors , Severity of Illness Index , Survival Rate , Toll-Like Receptors/metabolismABSTRACT
Objetivo: avaliar a frequência e a evolução dos casos de enterocolite necrosante (ECN) em uma unidade neonatal que possui banco de leite humano. Métodos: estudo retrospectivo que avaliou os recém-nascidos com ECN no período entre janeiro de 2000...
Objective: to evaluate the frequency and evolution of necrotizing enterocolitis cases (NEC) in a newborn unit supported by a human milk banking. Methods: a retrospective study evaluated the newborns affected by ECN admitted to a university...
Subject(s)
Humans , Infant, Newborn , Enterocolitis, Necrotizing/diagnosis , Milk Banks , Milk, Human , Enterocolitis, Necrotizing/surgery , Enterocolitis, Necrotizing/diet therapy , Retrospective Studies , Risk FactorsABSTRACT
Objetivo: avaliar as características clínicas, radiológicas e laboratoriais dos casos de enterocolite necrosante (ECN) no início do quadro para aprimorar o diagnóstico e o prognóstico...
Objective: to evaluate necrotizing enterocolitis cases (NEC) under clinical, radiological and laboratorial profile at presentation to optimize the diagnostic and prognosis...
Subject(s)
Humans , Male , Female , Infant, Newborn , Critical Care , Enterocolitis, Necrotizing/diagnosis , Prognosis , Retrospective StudiesABSTRACT
Necrotising enterocolitis (NEC) is the most common acquired gastrointestinal emergency in neonates. Presence of pneumatosis intestinalis is taken as evidence of definite NEC. A distinctive but rare form of NEC called "pneumatosis coli" has been described, presenting with gross blood in stools and minimal or absent local and systemic signs. Radio-graph characteristically reveal isolated colonic pneumatosis without small bowel involvement. Pneumatosis coli has a more benign course compared with definite NEC. Total parenteral nutrition, antibiotics, an appropriate duration off feeds and close observation remain the corner stones of therapy assuring a benign course.
Subject(s)
Colonic Diseases/diagnosis , Enterocolitis, Necrotizing/diagnosis , Humans , Infant, Newborn , Infant, Premature, Diseases/diagnosis , Male , Pneumatosis Cystoides Intestinalis/diagnosis , PrognosisABSTRACT
Improvement in survival rates of low birth-weight infants particularly in the neonatal intensive care units of India appears to be accompanied by frequent recognition of Necrotizing enterocolitis (NEC) among early survivors. As the philosophy and practice of advanced care for tiny infants becomes more acceptable and affordable in the country, a steady increase in survival of such infants is predictable. However there is growing concern in India that NEC could become a significant contributor to morbidity and mortality in the future. NEC is currently regarded as the most common acquired gastrointestinal emergency in the newborn period, and the outcome of this disease is universally poor. Improved understanding of the pathophysiology and pathogenesis of this condition is required for formulating optimal principles of prevention and management.
Subject(s)
Enterocolitis, Necrotizing/diagnosis , Humans , India/epidemiology , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Prognosis , Risk Factors , Survival RateABSTRACT
El objetivo fue determinar las características clínicas, exámenes de laboratorio, radiografía de abdomen, evolución, tratamiento y sobrevida de los RN con ECN. Se analizaron las historias clínicas de 157 RN que desarrollaron ECN en un período de 15 años. En cada RN se evaluaron parámetros biomédicos, manifestaciones clínicas, exámenes complementarios, tratamiento efectuado y sobrevida. La incidencia de ECN fue de 1,8 por 1 000 RN de pretérmino fue de 12,1 días y de 4,4 días en los RN de término. Las manifestaciones clínicas más frecuentes fueron: distensión abdominal en el 94,3 por ciento, residuo gástrico en el 77,7 por ciento y sangre en deposiciones en el 36,9 por ciento. La radiografía de abdomen reveló dilatación asimétrica de asas intestinales en el 63 por ciento, neumatosis en el 45,9 por ciento y neumoperitoneo en el 14,6 por ciento. El tratamiento fue médico en el 62,4 por ciento y además quirúrgico en el 37,6 por ciento. La sobrevida fue de 60,5 por ciento. Se concluye que la ECN afecta principalmente a RN prematuros, cuyo inicio se presenta habitualmente a fines de la segunda semana de vida, en relación posiblemente a infección de predominio bacteriano
Subject(s)
Humans , Male , Female , Infant, Newborn , Enterocolitis, Necrotizing/diagnosis , Enterocolitis, Necrotizing/therapy , Enterocolitis, Necrotizing/epidemiology , Infant, Premature , Pneumatosis Cystoides Intestinalis/diagnosis , Retrospective StudiesABSTRACT
A study was conducted in of Sir Ganga Ram Hospital, Lahore to find out the prevalence and presentations of neonatal necrotizing enterocolitis [NEC]. The study population comprised of 786 consecutive newborns admitted in Neonatal Nursery during the study period of eight months I.e. 1st January 1999 to 31st August 1999. The neonates were screened for birth weight, gestational age, low Apgar scores, and eternal non-breast milk feeding. Seventy five neonates were labeled as suspected cases of NEC, representing 9.5 percent of all admissions. Low birth weight [defined as less than 2000 grams] and lack of breast- feeding were most commonly associated with NEC. Abdominal distension was the commonest presentation seen in 75 percent case
Subject(s)
Humans , Infant, Newborn , Infant, Newborn, Diseases , Enterocolitis, Necrotizing/diagnosis , PrevalenceABSTRACT
Objetivo: describir el perfil clínico y paraclínico de los casos de Enterocolitis Necrozante (ECN) observados durante dos años en el servicio de lactantes del Hospital de la Misericordia, Bogotá. Medición: Se obtuvieron varoables de tipo socio-demográfico, relacionadas con los antecedentes, el motivo de consulta, la condición clínica inicial y la evolución final. Se procesaron los datos para obtener medidas de resumen y correlaciones. Resultados: la muestra estuvo constituida por las historias clínicas de 24 pacientes. Episodios diarreicos relativamente prolongados (con inadecuado manejo ambulatorio), desplome nutricional, e importante deshidratación al ingreso, fueron antecedentes y hallazgos constantes. Hubo evidencia indirecta de colapso circulatorio en el momento de ingreso institucional, que no fue detectado ni tratado adecuadamente, y deterioro de la función renal. La enfermedad se hizo clínicamente aparente hacia el quinto día de internación. El tiempo de estancia fue cercano a 24 días. No hubo mortalidad en la serie. Conclusiones: Se proponen 12 hipótesis especificas y un modelo general. La ECN del lactante es una complicación grave y potencial de la Diarrea Aguda. La prevención y el manejo adecuado de los episodios diarréicos, disminuirán la probabilidad de que los niños desarrollen ECN.
Subject(s)
Humans , Infant, Newborn , Infant , Enterocolitis, Necrotizing/diagnosis , Enterocolitis, Necrotizing/epidemiology , Enterocolitis, Necrotizing/etiologySubject(s)
Humans , Colonic Diseases/classification , Colon/physiology , Hirschsprung Disease/diagnosis , Anus Neoplasms/classification , Anus, Imperforate/diagnosis , Appendicitis/diagnosis , Bacterial Infections/diagnosis , Colonic Diseases, Functional/diagnosis , Diverticulitis, Colonic/diagnosis , Enterocolitis, Necrotizing/diagnosis , Rectal Fistula/physiopathology , Herpesviridae Infections/physiopathology , Postoperative Complications , Tuberculosis, Gastrointestinal/diagnosisABSTRACT
Desde diciembre de 1984 a julio de 1987 se estudiaron 18 pacientes con enterocolitis necrotizante neonatal (NEC), aplicándose el protocolo de Vásquez-Estévez para determinar el momento de la intervención quirúrgica, considerando parámetros clínicos y de laboratorio que se ponderan en escala de 0-3 puntos con un total de 30 puntos. Todos los pacientes con más de 15 puntos fueron operados, lo que correspondió a 30% de nuestra serie. Los pacientes bajo 15 puntos no requirieron operación. La necrosis intestinal fue el hallazgo constante en el grupo operado, encontrándose perforación intestinal establecida en solo 2 de ellos. No hubo fallecimientos en el grupo de manejo médico y los quirúrgicos presentaron un 16% de mortalidad neonatal