Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease / Extensa linfadenite cervical mimetizando adenite bacteriana como primeira manifestação da doença de Kawasaki

Cervical adenitis >1.5cm in diameter is the less frequently observed criteria in patients with Kawasaki disease and it is usually found in association with other symptoms during the acute phase. Moreover, the finding of fever and lymphadenitis with intense local signs of inflammation and phlegmon is rarely seen as the initial manifestation of Kawasaki disease. We report the case of a 7-year-old boy who had cervical lymphadenitis with adjacent cellulitis and phlegmon mimicking bacterial adenitis as the first presentation of Kawasaki disease. The patient had fever, cervical lymphadenitis with adjacent cellulitis, and severe headache. Cefadroxil was prescribed based on the clinical diagnosis of bacterial adenitis. Because he remained febrile and phlogistic signs worsened, after 1 day of hospitalization, antibiotics were administrated intravenously (ceftriaxone and oxacillin). The computed tomography of the neck showed primary infectious/inflammatory process. On the fourth day, the patient had dry and scaly lips, and treatment with oxacillin was replaced by clindamycin because the patient was still febrile. On the ninth day, he presented non-exudative bilateral conjunctival injection. On the tenth day of febrile disease, a rash appeared on his trunk, hands and feet. Patient’s symptoms resolved after intravenous administration of immunoglobulin (2g/kg/dose), and he was discharged 2 days later. On the 14th day, the patient had lamellar desquamation of fingers. Kawasaki disease should be considered as a differential diagnosis in children with febrile cervical lymphadenitis unresponsive to empiric antibiotics even if they have adjacent cellulitis and phlegmon.

Adenite cervical >1,5cm é o critério menos frequentemente observado em pacientes com doença de Kawasaki e manifesta-se habitualmente em associação com os demais sintomas da fase aguda. Entretanto, linfadenite febril isolada com intensos sinais flogísticos e flegmão é raramente observada como primeira manifestação da doença de Kawasaki. Assim, relatou-se aqui um caso de uma criança que apresentou linfadenite cervical com celulite adjacente e flegmão mimetizando adenite bacteriana como primeira manifestação da doença de Kawasaki. Paciente previamente hígido, 7 anos, masculino, iniciou quadro de febre, adenite cervical com celulite adjacente e cefaleia intensa, sendo prescrita cefadroxila devido ao diagnóstico clínico de linfadenite bacteriana. Por se manter febril e com piora dos sinais flogísticos, após 1 dia foi internado para receber antibioticoterapia endovenosa (oxacilina e ceftriaxona). Tomografia computadorizada da região cervical mostrou processo infeccioso/inflamatório primário. No quarto dia, apresentou lábios ressecados e descamativos, sendo a oxacilina substituída por clindamicina devido à persistência da febre e sinais flogísticos. No nono dia, iniciou hiperemia ocular não exsudativa. No décimo dia de febre, apresentou exantema em tronco, membros, mãos e pés. Recebeu gamaglobulina endovenosa (2g/kg/dose), evoluiu com resolução dos sintomas e, após 2 dias, recebeu alta hospitalar. No 14odia, apresentou descamação lamelar dos dedos das mãos. Portanto, doença de Kawasaki deve ser considerada no diagnóstico diferencial das linfadenites cervicais febris na infância não responsivas à antibioticoterapia empírica, mesmo que esteja presentes celulite adjacente e flegmão.

Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease.

Cervical adenitis >1.5cm in diameter is the less frequently observed criteria in patients with Kawasaki disease and it is usually found in association with other symptoms during the acute phase. Moreover, the finding of fever and lymphadenitis with intense local signs of inflammation and phlegmon is rarely seen as the initial manifestation of Kawasaki disease. We report the case of a 7-year-old boy who had cervical lymphadenitis with adjacent cellulitis and phlegmon mimicking bacterial adenitis as the first presentation of Kawasaki disease. The patient had fever, cervical lymphadenitis with adjacent cellulitis, and severe headache. Cefadroxil was prescribed based on the clinical diagnosis of bacterial adenitis. Because he remained febrile and phlogistic signs worsened, after 1 day of hospitalization, antibiotics were administrated intravenously (ceftriaxone and oxacillin). The computed tomography of the neck showed primary infectious/inflammatory process. On the fourth day, the patient had dry and scaly lips, and treatment with oxacillin was replaced by clindamycin because the patient was still febrile. On the ninth day, he presented non-exudative bilateral conjunctival injection. On the tenth day of febrile disease, a rash appeared on his trunk, hands and feet. Patient's symptoms resolved after intravenous administration of immunoglobulin (2g/kg/dose), and he was discharged 2 days later. On the 14th day, the patient had lamellar desquamation of fingers. Kawasaki disease should be considered as a differential diagnosis in children with febrile cervical lymphadenitis unresponsive to empiric antibiotics even if they have adjacent cellulitis and phlegmon.

Clinical and echocardiographic characteristics associated with the evolution of the ductus arteriosus in the neonate with birth weight lower than 1,500g.

OBJECTIVE: To identify clinical and echocardiographic parameters associated with the evolution of the ductus arteriosus in neonates with birth weight lower than 1,500g. METHODS: Retrospective study of 119 neonates in which clinical parameters (Prenatal: maternal age, risk of infection and chorioamnionitis, use of corticosteroid, mode of delivery and gestational age. Perinatal: weight, Apgar score, gender and birth weight/gestational age classification; Postnatal: use of surfactant, sepsis, fluid intake, heart murmur, heart rate, precordial movement and pulses, use of diuretics, oxygenation index, desaturation/apnea, ventilatory support, food intolerance, chest radiography, renal function, hemodynamic instability, and metabolic changes) and echocardiographic parameters (ductus arteriosus diameter, ductus arteriosus/weight ratio, left atrium/ aorta ratio, left ventricular diastolic diameter, and transductal flow direction, pattern and velocity) were analyzed. The clinical and echocardiographic parameters analyzed were considered statistically significant when p<0.05. RESULTS: In the 119 neonates, the incidence of patent ductus arteriosus was 61.3%; 56 received treatment (46 pharmacological and 10 surgical treatment), 11 had spontaneous closure, 4 died, and 2 were discharged with patent ductus arteriosus. A higher incidence of chorioamnionitis, use of surfactant, lower weight and gestational age, sepsis, heart murmur, ventilatory support and worse oxygenation indices were observed in the neonates receiving treatment. The group with spontaneous closure had a smaller ductus arteriosus diameter, lower ductus arteriosus/weight ratio, and higher transductal flow velocity. CONCLUSION: Based on clinical and echocardiographic parameters, the neonates with spontaneous closure of the ductus arteriosus could be differentiated from those who required treatment.

Características clínicas e ecocardiográficas associadas à evolução do canal arterial em recém-nascidos com peso de nascimento inferior a 1.500g / Clinical and echocardiographic characteristics associated with the evolution of the ductus arteriosus in the neonate with birth weight lower than 1, 500g

OBJETIVO: Identificar parâmetros clínicos e ecocardiográficos associados à evolução do canal arterial em recém-nascidos com peso de nascimento <1.500g. MÉTODOS: Estudo retrospectivo de 119 recém-nascidos, no qual foram analisados parâmetros clínicos (pré-natais: idade materna, risco infeccioso e corioamnionite, uso de corticoide, tipo de parto e idade gestacional; perinatais: peso, Apgar, gênero e classificação peso/idade gestacional; pós-natais: surfactante, sepse, oferta hídrica, sopro cardíaco, frequência cardíaca, movimento precordial e pulsos, diurético, índice de oxigenação, queda de saturação/apneia, suporte ventilatório, intolerância alimentar, radiografia de tórax, função renal, instabilidade hemodinâmica e alterações metabólicas); parâmetros ecocardiográficos (diâmetro do canal arterial, relação canal arterial/peso, relação átrio esquerdo/ aorta, diâmetro diastólico ventrículo esquerdo, direção, padrão e velocidade de fluxo pelo canal arterial). Os parâmetros clínicos e ecocardiográficos analisados foram considerados estatisticamente significantes quando p<0,05. RESULTADOS: Nos 119 recém-nascidos, a incidência de canal arterial foi de 61,3%, 56 receberam tratamento (46 medicamentoso e 10 cirúrgico), 11 tiveram fechamento espontâneo, 4 foram a óbito e 2 receberam alta com persistência do canal arterial. Houve maior incidência de corioamnionite, uso de surfactante, menor peso e idade gestacional, sepse, sopro cardíaco, ventilação e piores índices de oxigenação nos recém-nascidos tratados. O grupo com fechamento espontâneo apresentou menor diâmetro do canal arterial, menor relação canal arterial/peso e maior velocidade do fluxo pelo canal arterial. CONCLUSÃO: Com base em parâmetros clínicos e ecocardiográficos, foi possível diferenciar os recém-nascidos com fechamento espontâneo do canal arterial daqueles com necessidade de tratamento.

OBJECTIVE: To identify clinical and echocardiographic parameters associated with the evolution of the ductus arteriosus in neonates with birth weight lower than 1,500g. METHODS: Retrospective study of 119 neonates in which clinical parameters (Prenatal: maternal age, risk of infection and chorioamnionitis, use of corticosteroid, mode of delivery and gestational age. Perinatal: weight, Apgar score, gender and birth weight/gestational age classification; Postnatal: use of surfactant, sepsis, fluid intake, heart murmur, heart rate, precordial movement and pulses, use of diuretics, oxygenation index, desaturation/apnea, ventilatory support, food intolerance, chest radiography, renal function, hemodynamic instability, and metabolic changes) and echocardiographic parameters (ductus arteriosus diameter, ductus arteriosus/weight ratio, left atrium/ aorta ratio, left ventricular diastolic diameter, and transductal flow direction, pattern and velocity) were analyzed. The clinical and echocardiographic parameters analyzed were considered statistically significant when p<0.05. RESULTS: In the 119 neonates, the incidence of patent ductus arteriosus was 61.3%; 56 received treatment (46 pharmacological and 10 surgical treatment), 11 had spontaneous closure, 4 died, and 2 were discharged with patent ductus arteriosus. A higher incidence of chorioamnionitis, use of surfactant, lower weight and gestational age, sepsis, heart murmur, ventilatory support and worse oxygenation indices were observed in the neonates receiving treatment. The group with spontaneous closure had a smaller ductus arteriosus diameter, lower ductus arteriosus/weight ratio, and higher transductal flow velocity. CONCLUSION: Based on clinical and echocardiographic parameters, the neonates with spontaneous closure of the ductus arteriosus could be differentiated from those who required treatment.

Electrical impedance tomography to evaluate air distribution prior to extubation in very-low-birth-weight infants: a feasibility study.

OBJECTIVES: Nasal continuous positive airway pressure is used as a standard of care after extubation in very-low-birth-weight infants. A pressure of 5 cmH2O is usually applied regardless of individual differences in lung compliance. Current methods for evaluation of lung compliance and air distribution in the lungs are thus imprecise for preterm infants. This study used electrical impedance tomography to determine the feasibility of evaluating the positive end-expiratory pressure level associated with a more homogeneous air distribution within the lungs before extubation. METHODS: Ventilation homogeneity was defined by electrical impedance tomography as the ratio of ventilation between dependent and non-dependent lung areas. The best ventilation homogeneity was achieved when this ratio was equal to 1. Just before extubation, decremental expiratory pressure levels were applied (8, 7, 6 and 5 cmH(2)0; 3 minutes each step), and the pressure that determined the best ventilation homogeneity was defined as the best positive end-expiratory pressure. RESULTS: The best positive end-expiratory pressure value was 6.3 ± 1.1 cmH(2)0, and the mean continuous positive airway pressure applied after extubation was 5.2 ± 0.4 cmH(2)0 (p = 0.002). The extubation failure rate was 21.4%. X-Ray and blood gases after extubation were also checked. CONCLUSION: This study demonstrates that electrical impedance tomography can be safely and successfully used in patients ready for extubation to suggest the best ventilation homogeneity, which is influenced by the level of expiratory pressure applied. In this feasibility study, the best lung compliance was found with pressure levels higher than the continuous positive airway pressure levels that are usually applied for routine extubation.

Electrical impedance tomography to evaluate air distribution prior to extubation in very-low-birth-weight infants: a feasibility study

OBJECTIVES: Nasal continuous positive airway pressure is used as a standard of care after extubation in very-low-birth-weight infants. A pressure of 5 cmH2O is usually applied regardless of individual differences in lung compliance. Current methods for evaluation of lung compliance and air distribution in the lungs are thus imprecise for preterm infants. This study used electrical impedance tomography to determine the feasibility of evaluating the positive end-expiratory pressure level associated with a more homogeneous air distribution within the lungs before extubation. METHODS: Ventilation homogeneity was defined by electrical impedance tomography as the ratio of ventilation between dependent and non-dependent lung areas. The best ventilation homogeneity was achieved when this ratio was equal to 1. Just before extubation, decremental expiratory pressure levels were applied (8, 7, 6 and 5 cmH(2)0; 3 minutes each step), and the pressure that determined the best ventilation homogeneity was defined as the best positive end-expiratory pressure. RESULTS: The best positive end-expiratory pressure value was 6.3 ± 1.1 cmH(2)0, and the mean continuous positive airway pressure applied after extubation was 5.2 ± 0.4 cmH(2)0 (p = 0.002). The extubation failure rate was 21.4%. X-Ray and blood gases after extubation were also checked. CONCLUSION: This study demonstrates that electrical impedance tomography can be safely and successfully used in patients ready for extubation to suggest the best ventilation homogeneity, which is influenced by the level of expiratory pressure applied. In this feasibility study, the best lung compliance was found with pressure levels higher than the continuous positive airway pressure levels that are usually applied for routine extubation.

Improvement in ARDS experimental model installation: low mortality rate and maintenance of hemodynamic stability.

INTRODUCTION: Many experimental models using lung lavage have been developed for the study of acute respiratory distress syndrome (ARDS). The original technique has been modified by many authors, resulting in difficulties with reproducibility. There is insufficient detail on the lung injury models used, including hemodynamic stability during animal preparation and drawbacks encountered such as mortality. The authors studied the effects of the pulmonary recruitment and the use of fixed tidal volume (Vt) or fixed inspiratory pressure in the experimental ARDS model installation. METHODS: Adult rabbits were submitted to repeated lung lavages with 30 ml/kg warm saline until the ARDS definition (PaO2/FiO2 ≤ 100) was reached. The animals were divided into three groups, according to the technique used for mechanical ventilation: 1) fixed Vt of 10 ml/kg; 2) fixed inspiratory pressure (IP) with a tidal volume of 10 ml/kg prior to the first lung lavage; and 3) fixed Vt of 10 ml/kg with pulmonary recruitment before the first lavage. RESULTS: The use of alveolar recruitment maneuvers, and the use of a fixed Vt or IP between the lung lavages did not change the number of lung lavages necessary to obtain the experimental model of ARDS or the hemodynamic stability of the animals during the procedure. A trend was observed toward an increased mortality rate with the recruitment maneuver and with the use of a fixed IP. DISCUSSION: There were no differences between the three study groups, with no disadvantage in method of lung recruitment, either fixed tidal volume or fixed inspiratory pressure, regarding the number of lung lavages necessary to obtain the ARDS animal model. Furthermore, the three different procedures resulted in good hemodynamic stability of the animals, and low mortality rate.

CPAP em selo d'água versus CPAP com fluxo variável em recém-nascidos com desconforto respiratório: um ensaio controlado randomizado / Bubble CPAP versus CPAP with variable flow in newborns with respiratory distress: a randomized controlled trial

OBJETIVO: Avaliar a eficácia e segurança da pressão positiva contínua na via aérea (CPAP) utilizando aparelhos de fluxo variável e fluxo contínuo em selo d'água, quanto a falha do CPAP, ocorrência de escape de ar, tempo de uso de CPAP e de oxigênio e tempo de internação em unidade de terapia intensiva e hospitalar em neonatos com desconforto respiratório (DR) moderado e peso de nascimento (PN) > 1.500 g. MÉTODOS: Quarenta recém-nascidos que necessitavam de CPAP foram randomizados em dois grupos: um grupo tratado com fluxo variável (FV) e outro com fluxo contínuo (FC). O estudo foi realizado entre outubro de 2008 e abril de 2010. Foram registrados dados demográficos, falha do CPAP, ocorrência de escape de ar, tempo de uso de CPAP e de oxigênio, entre outros. Os desfechos categóricos foram analisados com o teste do qui-quadrado ou exato de Fisher e as variáveis contínuas com o teste de Mann-Whitney, com significância de p < 0,05. RESULTADOS: Não houve diferença quanto aos dados demográficos, falha do CPAP (21,1 e 20,0% para o FV e o FC, respectivamente; p = 1,000), síndrome de escape de ar (10,5 e 5,0%, respectivamente; p = 0,605), tempo de CPAP [mediana: 22,0 h, intervalo interquartil (IIQ): 8,00-31,00 h e mediana: 22,0 h, IIQ: 6,00-32,00 h, respectivamente; p = 0,822), e tempo de uso de oxigênio (mediana: 24,00 h, IIQ:7,00-85,00 h e mediana: 21,00 h, IIQ:9,50-66,75 h, respectivamente; p = 0,779). CONCLUSÃO: Em recém-nascidos com PN > 1.500 g e DR moderado, o CPAP nasal com fluxo contínuo apresentou os mesmos benefícios do CPAP nasal com fluxo variável.

OBJECTIVE: To evaluate the efficacy and safety of nasal continuous positive airway pressure (NCPAP) using devices with variable flow or bubble continuous positive airway pressure (CPAP) regarding CPAP failure, presence of air leaks, total CPAP and oxygen time, and length of intensive care unit and hospital stay in neonates with moderate respiratory distress (RD) and birth weight (BW) > 1,500 g. METHODS: Forty newborns requiring NCPAP were randomized into two study groups: variable flow group (VF) and continuous flow group (CF). The study was conducted between October 2008 and April 2010. Demographic data, CPAP failure, presence of air leaks, and total CPAP and oxygen time were recorded. Categorical outcomes were tested using the chi-square test or the Fisher's exact test. Continuous variables were analyzed using the Mann-Whitney test. The level of significance was set at p < 0.05. RESULTS: There were no differences between the groups with regard to demographic data, CPAP failure (21.1 and 20.0% for VF and CF, respectively; p = 1.000), air leak syndrome (10.5 and 5.0%, respectively; p = 0.605), total CPAP time (median: 22.0 h, interquartile range [IQR]: 8.00-31.00 h and median: 22.0 h, IQR: 6.00-32.00 h, respectively; p = 0.822), and total oxygen time (median: 24.00 h, IQR: 7.00-85.00 h and median: 21.00 h, IQR: 9.50-66.75 h, respectively; p = 0.779). CONCLUSION: In newborns with BW > 1,500 g and moderate RD, the use of continuous flow NCPAP showed the same benefits as the use of variable flow NCPAP.

Persistence of ventilatory defect after resolution of pulmonary interstitial emphysema in a preterm baby.

Pulmonary interstitial emphysema is a common complication of mechanical ventilation in preterm babies. We report a case of severe unilateral pulmonary interstitial emphysema in a premature newborn, treated with high-frequency oscillatory ventilation, lateral decubitus positioning and selective intubation. After complete radiological resolution of the pulmonary emphysema in the left lung, the patient was studied by electrical impedance tomography and a marked reduction of ventilation was identified in the left lung despite radiological resolution of the cysts. This finding indicates that functional abnormalities may persist for longer periods after radiologic resolution of such lesions.

Abordagem ventilatória protetora no tratamento da hérnia diafragmática congênita / Gentle ventilatory approach for the treatment of congenital diaphragmatic hernia

Objetivo: Descrever a evolução de recém-nascidos com diagnóstico de hérnia diafragmática congênita admitidos na Unidade de Terapia Intensiva Neonatal de um hospital privado de nível terciário, no qual aplicou-se uma estratégia ventilatória protetora. Métodos: Coorte histórica com análise de prontuários de pacientes portadores de hérnia diafragmática congênita, admitidos de junho de 2001 a julho de 2006. Avaliaram-se dados referentes ao recém-nascido (índices prognósticos antenatais, peso ao nascimento, idade gestacional, sexo), dados da reanimação e estabililização pré-operatória, cuidados pós-operatórios e taxa de sobrevida. Resultados: Oito neonatos tiveram diagnóstico de hérnia diafragmática congênita. O peso variou entre 2,38 e 3,45kg e a idade gestacional, entre 36 e 39 semanas; cinco deles eram do sexo masculino. Todos foram intubados em sala de parto até o final do primeiro minuto de vida. A correção cirúrgica ocorreu entre o segundo e o sexto dias de vida e, em quatro pacientes, houve necessidade do uso de patch. Uma estratégia ventilatória protetora foi utilizada em seis neonatos, com dados gasométricos visando PaO2 pré-ductal normal e tolerando-se hipercapnia (PaCO2 50 a 60mmHg). A extubação ocorreu entre o primeiro e o 12o dias do pós-operatório, com exceção de um paciente. Seis recém-nascidos receberam alta, em média, com 30 dias de vida (19 a 55 dias). A sobrevida foi de 75%. Conclusões: A sistematização do cuidado de pacientes com hérnia diafragmática congênita pode garantir, em nosso meio, uma sobrevida comparável aos principais centros mundiais que lidam com a doença.

AbstractObjective: To describe the clinical evolution of newborns with congenital diaphragmatic hernia admitted to neoretal Intensive Care Unit of a tertiary private hospital and treated with a gentle ventilatory approach. Methods: Analysis of charts of patients born between June 2001 and July 2006. The following data were collected: birth weight, gestational age, sex, delivery room procedures, pre and post-surgery parameters and survival rate. Results: Eight newborns with diagnosis of congenital diaphragmatic hernia were included. They presented birth weight from 2.38 to 3.45kg, gestational age between 36 and 39 weeks; five of them were males. All infants were intubated at delivery within the first minute of life. The surgery was performed between the 2nd and the 6th days of life, and a patch was needed in four patients. A ôgentleõ ventilation strategy was used in six infants, targeting normal pre-ductal PaO2 and allowing hypercapnia (PaCO2 between 50 and 60mmHg). The extubation occurred between the 1st and 12th day after surgery, except for one infant who died. Six newborns were discharged with an average post-natal age of 30 days (19 to 55 days). The survival rate was 75%. Conclusions: The systematic care of infants with diagnosis of congenital diaphragmatic hernia can assure a survival rate comparable to reference centers.

Infecções estafilocócicas adquiridas nas unidades de terapia intensiva neonatais / Acquired staphylococcal infection in neonatal intensive care units

Objetivo: revisar o perfil das infecções estafilocócicas adquiridas nas unidades de terapia intensiva neonatais. Fontes pesquisadas: bases de dados MEDLINE E LILACS do período de 2000 a 2004, utilizando os termos: Staphylococcus aureus, Coagulase-negative Staphylococcus, newborn infant, nosocomial infection, antimicrobial resistance. Síntese dos dados: os estafilococos aureus, e coagulase negativos...

Candidiase sistemica neonatal: rastreamento rotineiro em UTI neonatal e seu efeito sobre a mortalidade associada / Neonatal systemic candidiasis: routine screening and the impact over mortality in a NICU

O diagnostico e o tratamento precoce sao fatores determinantes da mortalidade associada a candidiase sistemica, particularmente no periodo neonatal. Este estudo relata os resultados obtidos na UTI do bercario anexo a maternidade do HC-FMUSP, apos instituicao de triagem para candidiase - com base em coletas urinarias semanais, com realizacao de micologico direto e cultura - em RN de risco. Os dados obtidos foram tambem comparados aos de estudo realizado anteriormente ao inicio do rastreamento, acompanhado de revisao da literatura. Observou-se uma tendencia a reducao da mortalidade neonatal associada a candidiase sistemica. Com base nesses resultados, os autores recomendam a realizacao de rastreamento para deteccao precoce de quadros fungicos em unidades neonatais de alto risco

Displasia broncopulmonar e vitamina A: certezas e incertezas no manuseio do recém-nascido de muito baixo peso / Bronchopulmonary dysplasia and vitamin A: certainties and uncertainties in the care of very low birth weight newborn infants

De origem multifatorial, a displasia broncopulmonar e atualmente um grande desafio ao Pediatra e, em particular, ao Neonatologista. O recém-nascido de muito baixo peso (RNMBP) apresenta-se como um grupo de risco para complicaçöes pulmonares, assim como para deficiências nutricionais, inclusive de vitamina A. A associaçäo entre deficiência de vitamina A e doença pulmonar, já e bem conhecida. Contudo, estudos com suplementaçäo desta vitamina para RNMBP possuem resultados conflitantes em literatura. Apresentamos uma revisäo do equilibrio - ou desequilibrio - da vitamina A no RNMBP e uma análise crítica dos estudos de suplementaçäo, visando auxiliar a abordagem nutricional desses pacientes na prevençäo de lesäo pulmonar crônica

Calculose biliar associada com o uso de ceftriaxone em recem-nascidos: relato de dois casos / Ceftriaxone associated biliary lithiasis in newborns: report of two cases

A ocorrencia da calculose biliar como uma complicacao do uso do ceftriaxone foi descrita pela primeira vez em um paciente de 18 anos, portador de doenca granulomatosa cronica. Desde entao, varios relatos tem sido publicados com esse tipo de complicacao, tanto em criancas como em adultos; no entanto, ate o momento, essa complicacao nao havia sido descrita em recem-nascidos prematuros. Os autores descrevem dois casos de calculose biliar associada com o uso de ceftriaxone em recem-nascidos prematuros enfatizando que, devido a frequencia do uso deste antibiotico em unidades de terapia intensiva neonatal, o controle ultrassonografico de rotina sera realizado para diagnosticar essa possivel complicacao em todos os recem-nascidos prematuros recebendo ceftriaxone