RESUMO
Fusobacterium nucleatum is an oral pathogen associated with preterm birth. Presented is a case of acute chorioamnionitis that progressed to maternal sepsis in a term patient with intact membranes. In addition to its role in periodontal disease and preterm birth, our case demonstrates that intrauterine infection with Fusobacterium nucleatum can result in severe disease at term.
Assuntos
Corioamnionite/diagnóstico , Infecções por Fusobacterium/diagnóstico , Fusobacterium nucleatum , Doenças Periodontais/complicações , Complicações Infecciosas na Gravidez/diagnóstico , Nascimento Prematuro , Sepse/diagnóstico , Corioamnionite/microbiologia , Feminino , Infecções por Fusobacterium/microbiologia , Humanos , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Sepse/microbiologia , Adulto JovemRESUMO
PURPOSE: The purpose of this investigation was to describe the ability of a transport mattress (TransWarmer Infant Transport Mattress), produced by Cooper Surgical (Trumbull, Connecticut), to reduce hypothermia in a group of very low birth-weight infants. SUBJECTS: Convenience sample of 115 infants weighing less than 1500 g who were born at Women & Infants' Hospital, Providence, Rhode Island, and admitted to the neonatal intensive care unit. DESIGN: A quality assurance study using a nonrandomized experimental design. Infants placed on the TransWarmer Infant Transport Mattress were compared with those treated with standard care. METHODS: Charts were reviewed and data abstracted on the 115 very low birth-weight infants delivered at Women & Infants' Hospital, Providence, Rhode Island. MAIN OUTCOME MEASURE: Hypothermia was significantly lower in the mattress group than for controls (52.5% vs 77.3% using a definition of hypothermia as body temperature less than 97.4 degrees F, P = .01). The difference resulted despite the fact that the mattress group was at increased risk based on various risk factors, lower mean age (26 vs 28.5 wk, P = .001), a lower birth weight (876 vs 1091 g, P = .004), and a higher proportion of Apgar scores of less than 5 at 5 minutes (13.2% vs 6.4%, P = .29) compared with controls. A linear regression model adjusted for birth weight, gender, and gestational age showed that the use of the heated gel mattress raised body temperatures by a mean of 0.7 degrees F per infant (P < .001). PRINCIPAL RESULTS: The occurrence of hypothermia was significantly lower in the mattress group. CONCLUSION: The results of this investigation suggest that further research of the TransWarmer Transport Mattress is warranted using an adequately powered randomized controlled trial. Information on the safety and cost-effectiveness is needed. Long-term follow-up evaluating admission temperatures and long-term outcomes is also warranted.
Assuntos
Leitos/normas , Temperatura Alta/uso terapêutico , Hipotermia/prevenção & controle , Doenças do Prematuro/prevenção & controle , Recém-Nascido de muito Baixo Peso , Temperatura Corporal , Pesquisa em Enfermagem Clínica , Desenho de Equipamento , Géis , Humanos , Hipotermia/diagnóstico , Hipotermia/etiologia , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Terapia Intensiva Neonatal/métodos , Modelos Lineares , Enfermagem Neonatal/métodos , Admissão do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Rhode Island , Fatores de Risco , Transporte de Pacientes/métodos , Resultado do TratamentoRESUMO
Maternal use of the antispasmodic baclofen during pregnancy is an uncommon clinical scenario and leads to uncertainty regarding neonatal risks. We present a team-based, peripartum management plan designed for safe monitoring and minimizing the risk of neonatal withdrawal after unusual drug exposure. Incorporating the expertise of neonatology, nursing, pharmacy, neurology, and the lactation service, as well as parental input, this consensus approach was implemented in a case of maternal oral baclofen use with a successful outcome for the infant and family.
