Enterocolitis necrosante posterior a evento aislado de taquicardia supraventricular: reporte de un caso de presentación neonatal atípica / Necrotizing enterocolitis after an isolated event of supraventricular tachycardia. Case report of atypical neonatal presentation

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

Primary peritoneal drainage in neonates with necrotizing enterocolitis associated with congenital heart disease: a single experience in a Brazilian tertiary center

Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.

Endocarditis micótica en un recién nacido de extremadamente bajo peso al nacer: A propósito de un caso / Fungal endocarditis in an extremely low birth weight infant: Case report

Las tasas de supervivencia de los recién nacidos prematuros se han incrementado gracias a los avances tecnológicos y los conocimientos en constante evolución, aunque la sepsis de aparición tardía es más frecuente debido a los períodos prolongados de hospitalización de estos niños. Presentamos el caso de un recién nacido prematuro de extremadamente bajo peso al nacer hospitalizado con síndrome de dificultad respiratoria, enterocolitis necrosante y sepsis fúngica con endocarditis por Candida albicans. Se le administró tratamiento antimicótico hasta que se resolvió la vegetación fúngica. La sepsis y la endocarditis de origen micótico podrían ser una causa de morbilidad significativa en los recién nacidos prematuros. En este artículo revisamos las publicaciones científicas recientes acerca de los factores de riesgo, el diagnóstico, el tratamiento y la prevención de la sepsis fúngica en estos neonatos de alto riesgo.

Survival rates of premature infants have increased with developing technology and evolving knowledge but late-onset sepsis is more frequent due to prolonged hospitalization periods of these infants. We report the case of an extremely low birth weight premature infant who was admitted with respiratory distress syndrome, developed necrotizing enterocolitis and fungal sepsis with endocarditis by Candida albicans. He was treated with antifungal therapy until fungal vegetation resolved. Fungal sepsis and endocarditis may be an important morbidity in preterm infants; we review the recent literature about the risk factors, diagnosis, treatment and prevention of fungal sepsis in these high risk infants.

Initial Resuscitation at Delivery and Short Term Neonatal Outcomes in Very-Low-Birth-Weight Infants

Survival of very-low-birth-weight infants (VLBWI) depends on professional perinatal management that begins at delivery. Korean Neonatal Network data on neonatal resuscitation management and initial care of VLBWI of less than 33 weeks gestation born from January 2013 to June 2014 were reviewed to investigate the current practice of neonatal resuscitation in Korea. Antenatal data, perinatal data, and short-term morbidities were analyzed. Out of 2,132 neonates, 91.7% needed resuscitation at birth, chest compression was performed on only 104 infants (5.4%) and epinephrine was administered to 80 infants (4.1%). Infants who received cardiac compression and/or epinephrine administration at birth (DR-CPR) were significantly more acidotic (P or = grade 3 (OR, 2.71; 95% CI 1.57-4.68), periventricular leukomalacia (OR, 2.94; 95% CI 1.72-5.01), and necrotizing enterocolitis (OR, 2.12; 95% CI 1.15-3.91) compared with those infants who needed only PPV. Meticulous and aggressive management of infants who needed DR-CPR at birth and quality improvement of the delivery room management will result in reduced morbidities and early death for the vulnerable VLBWI.

Enterocolitis necrotizante fulminante en un bebé colodión: caso clínico / Fulminant necrotizing enterocolitis in a collodion baby: a case report

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.

Valor preditivo da distensão de alças intestinais em radiografias no prognóstico de enterocolite necrosante / Dilatation of bowel loops on radiological images: prognostic value in necrotizing enterocolitis

OBJETIVO: Avaliar o valor prognóstico da distensão de alças intestinais observada em radiografias na evolução e mortalidade de neonatos com enterocolite necrosante. MATERIAIS E MÉTODOS: Nas radiografias de abdome de 53 pacientes obtidas no momento da suspeita diagnóstica de enterocolite necrosante, foi realizada a medida do diâmetro da alça mais distendida (AD), assim como a distância entre a borda superior da primeira vértebra lombar e a borda inferior da segunda (L1-L2), a distância entre as bordas laterais dos pedículos da primeira vértebra lombar (L1), e foram estabelecidas as associações entre AD/L1-L2 e AD/L1. Esta medida foi considerada como possível determinante de potenciais complicações, intervenção cirúrgica e mortalidade. RESULTADOS: Os pacientes que necessitaram de tratamento cirúrgico, aqueles que tiveram complicações durante a evolução e aqueles que morreram da doença tiveram a relação entre AD e AD/L1-L2 maiores (p < 0,05). Os valores de AD/L1 e a localização da alça mais distendida não foram diferentes nos grupos com evolução desfavorável. CONCLUSÃO: Distensão de alça intestinal detectada em radiografias de abdome realizadas na admissão sugerem pior prognóstico em enterocolite necrosante. Outrossim, medidas do diâmetro da alça mais distendida nessas radiografias são um método simples e reprodutível que oferece informações diagnósticas e prognósticas.

OBJECTIVE: To evaluate the prognostic value of bowel loops dilatation as a finding on radiographs in the development and mortality of neonates with necrotizing enterocolitis. MATERIALS AND METHODS: On abdominal radiographs of 53 patients for diagnostic suspicion of necrotizing enterocolitis, the major diameters of dilated bowel loops (AD) were measured, as well as the distance between the upper border of the first lumbar vertebra and the lower border of the second one (L1-L2), and the distance between the lateral borders of the first lumbar vertebra (L1) pedicles, and the subsequent association between AD/L1-L2, AD/L1. This measure was considered as a possible determining factor for potential complications, surgical intervention and mortality. RESULTS: The patients who needed surgical management and who had complications during progression and died of the disease had showed increased AD and AD/L1-L2 (p < 0.05). AD/L1 values and site of the most dilated bowel loop were not different in the groups with unfavorable progression. CONCLUSION: Bowel loop dilatation detected on initial supine abdominal radiographs suggests a worst prognosis in necrotizing enterocolitis. Furthermore, measurement of the most dilated bowel loop on these radiographs is a simple and reproducible method that adds diagnostic and prognostic information.

Estenosis intestinal secundaria a enterocolitis necrotizante / Intestinal stenosis following necrotizing enterocolitis

En forma secundaria a la Enterocolitis Necrotizante (ECN) podemos observar una estenosis cicatricial del segmento intestinal comprometido; situación que ha sido observada tanto en pacientes con tratamiento médico o quirúrgico de la enfermedad. Se analiza la historia clínica de 9 pacientes que requirieron reparación quirúrgica de esta patología. En tres de ellos por cuadro agudo de obstrucción intestinal y en el resto como hallazgo de laparotomía para reconstrucción del tránsito o en examen contrastado de colon. La estenosis comprometió exclusivamente al intestino grueso, con un predominio en el colon transverso y descendente, con una longitud variable, asociado a la presencia de múltiples adenopatías. Se realizó resección del segmento estrecho con anastomosis primaria termino-terminal en todos ellos. El estudio anátomo-patológico mostró tejido de granulación, fibrosis esclerótica de la pared y diversos grados de estrechez fibrosa de tipo cicatricial. Solo 1 paciente presentó una dehiscencia de sutura intestinal, con peritonitis secundaria, que requirió exploración y reanastomosis. No hubo mortalidad. En conclusión, es aconsejable realizar estudio contrastado de rutina a todos los pacientes que han sufrido este trastorno. Resolver los casos de estenosis secundaria con resección y anastomosis primaria del segmento comprometido.

Aspectos radiológicos relevantes no diagnóstico da enterocolite necrosante e suas complicações / Relevant radiological findings for the diagnosis of necrotizing enterocolitis and its complications

A enterocolite necrosante representa uma das emergências gastrintestinais mais freqüentes e graves no período neonatal. Na suspeita clínica dessa doença, o exame radiológico simples de abdome é um procedimento de rotina, desempenhando um papel fundamental no diagnóstico, acompanhamento e detecção de complicações. No presente trabalho, realizamos uma revisão da literatura pertinente e descrevemos os achados radiológicos da enterocolite necrosante, ilustrados com casos do nosso serviço. Concluímos que o diagnóstico radiológico da enterocolite necrosante realizado em todas as suas etapas, contribui para uma conduta terapêutica imediata, reduzindo as complicações e aumentando a sobrevida dos pacientes.

Necrotizing enterocolitis is one of the most frequent and severe gastrointestinal emergencies occurring in the neonatal period. Once necrotizing enterocolitis is suspected a simple abdominal x-ray is a routine examination and this film will play an essential role in the diagnosis of the disease and the follow-up care of the patient, as well as in the detection of complications. In the present study we reviewed the pertinent literature and described the radiological findings, illustrated with cases from our institution. We concluded that the radiological diagnosis of necrotizing enterocolitis done at all stages contributes for an immediate therapeutic management, reducing the complications and improving the patient's survival.

Concomitant involvement of the small intestine and the distal esophagus in an infant with massive necrotizing enterocolitis

A enterite necrosante é uma doença típica do período neo-natal que pode acometer o intestino delgado, colo e/ou estômago. Até o presente, a necrose maciça do intestino delgado com o acometimento concomitante do esôfago nunca foi relatada. É apresentado o caso de um lactente com 6 meses de idade com enterite necrosante e acometimento de todo intestino delgado, ceco e terço inferior do esôfago. Após setenta dias de tratamento, o trânsito intestinal foi re-estabelecido por anastomose entre o primeiro centímetro do jejuno e o colo ascendente. Finalmente, o trânsito esofagiano foi refeito pela transposição gástrica total e anastomose esôfago-gástrica cervical. O paciente foi mantido em nutrição parenteral durante 19 meses e ao fim deste período desenvolveu falência hepática aguda, tendo sido submetido a transplante duplo de fígado e intestino delgado. Dois meses após, faleceu em decorrência de complicações neurológicas, provavelmente relacionadas à infecção ou ao tratamento imunossupressor.

Transillumination for the diagnosis of pneumoperitoneum.

Transillumination of the abdomen with a cold fibreoptic light source was used for the rapid diagnosis of pneumoperitoneum in a sick premature infant with necrotising enterocolitis. The diagnosis was confirmed at laparotomy. The neonate survived the surgical procedure of resection and anastomosis of the perforated gut. Although additional diagnostic investigations such as X-rays and paracentesis of the abdomen were also positive in this case, transillumination of the abdomen proved to be a useful tool for early diagnosis. Transillumination thus is a valuable modality for early diagnosis of pneumoperitoneum, especially where facilities for in-house X-rays are not available.