Thyroid abnormalities in term infants with fungal sepsis.

OBJECTIVE:: To describe thyroid alterations in term newborns (TNB) with fungal sepsis during NICU hospitalization. METHOD:: The study included six TNB that during the clinical and laboratory manifestations of sepsis with positive cultures for fungus showed changes in thyroid hormones, called low T3 syndrome and low T3-T4 syndrome. TNB that could present hormonal changes caused by disease as those born to mothers with thyroid disease, or who had perinatal asphyxia and major surgeries were excluded. RESULTS:: Of six TNB with fungal sepsis, five had positive culture for Candida albicans and one had positive culture for Candida tropicalis. Low T3 syndrome was observed in two TNB (50%), while T3-T4 syndrome was observed in other two (100%). The four children progressed to septic shock. CONCLUSION:: Fungal sepsis is becoming more common among newborns admitted to NICU. Thyroid insufficiency could be a marker of disease severity with possible need for hormone supplementation.

Thyroid abnormalities in term infants with fungal sepsis / Alterações tireoidianas no recém-nascido de termo com sepse fúngica

Summary Objective: To describe thyroid alterations in term newborns (TNB) with fungal sepsis during NICU hospitalization. Method: The study included six TNB that during the clinical and laboratory manifestations of sepsis with positive cultures for fungus showed changes in thyroid hormones, called low T3 syndrome and low T3-T4 syndrome. TNB that could present hormonal changes caused by disease as those born to mothers with thyroid disease, or who had perinatal asphyxia and major surgeries were excluded. Results: Of six TNB with fungal sepsis, five had positive culture for Candida albicans and one had positive culture for Candida tropicalis. Low T3 syndrome was observed in two TNB (50%), while T3-T4 syndrome was observed in other two (100%). The four children progressed to septic shock. Conclusion: Fungal sepsis is becoming more common among newborns admitted to NICU. Thyroid insufficiency could be a marker of disease severity with possible need for hormone supplementation.

Resumo Objetivo: descrever as alterações tireoidianas em recém-nascidos de termo (RNT) que apresentaram sepse fúngica durante internação na UTI neonatal. Método: foram incluídos seis RNT que, durante as manifestações clínicas e laboratoriais de sepse, com culturas positivas para fungo, apresentaram alterações dos hormônios tireoidianos, denominadas síndrome do T3 baixo e síndrome do T3 e T4 baixo. Foram excluídos RNT que apresentaram alteração hormonal por doença, como RNT filhos de mães com doença tireoidiana, asfixia perinatal e cirurgias de grande porte. Resultados: dos seis RNT com sepse fúngica, cinco apresentavam cultura positiva para Candida albicans e um para C. tropicalis. A síndrome do T3 baixo foi observada em duas crianças (50%) e a do T3 e T4 baixo em dois RN (100%). As quatro crianças evoluíram com choque séptico. Conclusão: a sepse fúngica é cada vez mais frequente nos recém-nascidos internados em UTI neonatal. A insuficiência tireoidiana pode vir a ser marcadora de gravidade da doença, e a suplementação hormonal pode ser necessária.

Nonthyroidal illnesses syndrome in full-term newborns with sepsis.

OBJECTIVE: To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. MATERIALS AND METHODS: We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. RESULTS: 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. CONCLUSIONS: This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock.

Nonthyroidal illnesses syndrome in full-term newborns with sepsis

ABSTRACT Objective To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. Materials and methods We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. Results 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. Conclusions This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock. Arch Endocrinol Metab. 2015;59(6):528-34.

Funcao tireoidiana em recem-nascidos doentes / Thyroid function in sick newborns

Revisar as alteracoes da funcao em recem-nascidos doentes...

A tireoide no feto e no recem-nascido: peculiaridades funcionais e principais doencas tireoidianas / The thyroid in fetus and newborn infants: functional peculiarities and main thyroid diseases

Revisar a fisiologia e a disfuncao tireoidiana no feto e no recem-nascido. Fontes pesquisadas: literatura das bases de...

Suporte nutricional na síndrome colestática: uma revisäo prática / Nutritional support in cholestasis: a practical review

A presença de colestase causa digestäo incompleta das gorduras, esteatorréia e má absorçäo de nutrientes, provocando desnutriçäo calórica e protéica, reduçäo regressiva da massa muscular e anorexia. Pacientes com doença hepática necessitam de constante monitorizaçäo do seu estado nutricional e de suporte alimentar específico, geralmente agressivo, pois estes säo determinantes importantes de qualidade de vida e de sobrevida. Dieta hipercalórica balanceada contendo TCM, LCPUFAs e derivados em proporçöes adequadas, bem como reposiçäo de vitaminas lipossolúveis têm sido preconizadas para estes pacientes. Os autores apresentam uma revisäo dos efeitos da colestase sobre a digestäo e absorçäo de nutrientes, bem como sugestöes de suporte e avaliaçäo nutricional para este tipo de paciente.(au)

Aspectos práticos da nutriçäo enteral do recém-nascido pré-termo / Pratical aspects on preterm enteral nutrition

Os autores revisam aspectos de importancia atual da nutriçäo do recém-nascido, especialmente o de alto risco; däo ênfase à nutriçäo enteral e o papel primordial que o leite materno tem na ontogenia do trrato gastro intestinal, nutriçäo adequada e na prevençäo da enterocolite necrosante do pré-termo. Discutem as fórmulas especiais, as suas inovaçöes e a melhor forma de administraçäo para estas crianças.(au)

Osteomielite neonatal com apresentacao clinica incomum: descricao de caso / Neonatal osteomyelitis with unusual apresentation: case report

Os autores descrevem um caso de osteomielite no periodo neonatal, de apresentacao clinica pouco frequente e diagnostico dificil, mas com boa resposta aos tratamentos clinico e cirurgico

Sequelas auditivas e neuropsicomotoras em recém-nascidos de termo ictericos tratados pelos metodos convencionais / Hearing deficits and neuropsicomotors alterations in jaundiced full-term infants treated by conventional methods

Desde o reconhecimento das possiveis sequelas da hiperbilirrubinemia no cerebro, se tem observado que alguns recém-nascidos ictericos sem doença hemolitica, mesmo com niveis considerados elevados, näo apresentam encefalopatia bilirrubinica. Objetivos: o objetivo deste estudo foi o de avaliar as possiveis sequelas auditivas e neuropsicomotoras da hiperbilirrubinemia em recém-nascidos ictericos tratados convencionalmente no período neonatal. Casuistica e metodos: foram observados prospectivamente 20 recém-nascidos de termo ictericos (11 com doença hemolitica) que necessitaram de fototerapia ou de exsanguineotransfusäo do Hospital Universitário da USP, através de exame neurológico, teste de Gesell e teste comportamental de Downs desde o periodo neonatal ate um ano de idade...

Aspectos imunohematologicos, genéticos e clínicos da aloimunizaçäo por anticorpos anti-C: relato de dois casos / Imunohematologics, genetics and clinics aspects of two cases about aloimunization of antibody anti-C

Os autores estudaram dois casos de recém-nascidos que apresentaram hiperbilirrubinemia por antigeno irregular do sistema Rh - c - sendo analisados seus aspectos imunohematologicos, genéticos e clínicos

Progress in phototherapy

The purpose of this article is to present a recent advance in phototherapy employed on newborn babies with jaudice. The efficacy of this treatment depends on the intensity of emitted light; it is believed that a dose between 6-12 nm is necessary. The usefulness of phototherapy in healthy, full-term infants is currently being questioned. Therefore, the adequate use of this therapy should be emphasized until a consensus is reached on its advantages and disadvantages.

Rotura prematura de membranas e sua relaçäo com infecçäo no recém-nascido / Premature rupture of membranes and its relation to infection in newborn infants

Os autores analisam retrospectivamente 136 casos de RPM, verificando a presença de infecçäo neonatal, anoxia e prematuridade em relaçäo ao tempo de latência entre a rotura e o parto. O índice de infecçäo neonatal relacionado com RPM foi de 8,8%, para casos comprovados clínica e laboratorialmente; em 6,6% de casos, ocorreu infecçäo presumível pelo quadro clínico, embora sem comprovaçäo bacteriológica. A incidência de infecçäo neonatal näo foi influenciada pelo tempo de latência decorrido entre a RPM e o parto. Sintomas maternos de infecçäo foram mais freqüentes no grupo com tempo de latência maior do que 24 horas e houve relaçäo significativa entre sintomas maternos de infecçäo e infecçöes neonatais. Prematuridade e anoxia estiveram presentes em 22% e 20%, respectivamente, sem relaçäo com a duraçäo do período de latência entre RPM e parto