RESUMO
Introduction: We present the case of a patient with an unexpected postnatal diagnosis of tracheal agenesis, a severe and rare pathology with fewer than 200 cases documented in the literature, typically diagnosed postmortem. In our instance, early diagnosis was achieved through collaborative efforts and teamwork among various professionals. We provide illustrative images and videos to assist colleagues in identifying this congenital anomaly. Case presentation: The patient is a term newborn with prenatal indicators of polyhydramnios and a single umbilical artery. Upon birth, the infant exhibited severe respiratory distress, and orotracheal intubation via direct laryngoscopy was unfeasible. Consequently, an urgent fibrobronchoscopy, conducted by pediatric surgeons, led to the diagnosis of tracheal agenesis with tracheoesophageal fistula and the placement of a directed endotracheal tube. This intervention facilitated temporary ventilation until parental consensus on management was achieved. Following a multidisciplinary consultation, the decision was made to proceed with extracorporeal membrane oxygenation. Unfortunately, the patient experienced a prolonged refractory cardiorespiratory arrest and died after 7â h of life in his mother's arms. Conclusion: Teamwork in neonatology is indispensable when addressing emergent pathologies. In our experience, multidisciplinary management, including anesthesiologists and pediatric surgeons, should be contemplated in complex scenarios.
RESUMO
BACKGROUND: Antibiotic use for early-onset sepsis represents a high percentage of antibiotic consumption in the neonatal setting. Measures to assess infants at risk of early-onset sepsis are needed to optimize antibiotic use. Our primary objective was to assess the impact of a departmental guideline on antibiotic use among term infants with suspected EOS not confirmed, in our neonatal unit. METHODS: Retrospective cohort study, to compare antibiotic use in term infants during a baseline period of January to December 2018, and a postintervention period from October 2019, to September 2020, respectively. The primary outcome was antibiotic use measured by days of therapy, the antibiotic spectrum index, the antibiotic use rate, and the length of therapy. RESULTS: We included 71 infants in the baseline period and 66 infants in the postintervention period. Compared to those in the baseline period, there was a significant reduction in overall antibiotic measures in the postintervention period, (P < 0.001). The total days of therapy/1000 patient-days decreased from 63/1000 patient-days during the baseline period to 25.8/1000 patient-days in the postintervention period, representing a relative reduction of 59%. The antibiotic use rate decreased by more than half of the infants, from 3.2% during the baseline period to 1.3% in the postintervention period. CONCLUSIONS: The use of a departmental guideline to assess infants at risk of early-onset sepsis based on their clinical condition and prompt discontinuation of antibiotics, is a simple and low-cost measure that contributed to an important decrease in antibiotic use.
Assuntos
Sepse Neonatal , Sepse , Recém-Nascido , Lactente , Humanos , Antibacterianos/uso terapêutico , Estudos Retrospectivos , Sepse/tratamento farmacológico , Sepse Neonatal/diagnóstico , Sepse Neonatal/tratamento farmacológicoRESUMO
In utero transmission of severe acute respiratory syndrome coronavirus 2 infection is a point of debate. We report a case of severe acute respiratory syndrome coronavirus 2 vertical transmission from asymptomatic mother, with molecular detection in mother's blood at delivery and neonatal nasopharyngeal swabs at 5 and 28 hours of life and later IgG seroconversion. The newborn was asymptomatic.
Assuntos
COVID-19/transmissão , Transmissão Vertical de Doenças Infecciosas , SARS-CoV-2/isolamento & purificação , Doenças Assintomáticas , COVID-19/diagnóstico , COVID-19/virologia , Feminino , Humanos , Recém-Nascido , Mães , Gravidez , SARS-CoV-2/genéticaRESUMO
No disponible
Assuntos
Humanos , Pré-Escolar , Terminologia como Assunto , Sintomas Inexplicáveis , Diagnóstico Tardio/prevenção & controle , Gerenciamento Clínico , Morte Súbita do Lactente/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Diagnóstico Tardio/tendências , Emergências , Apneia/diagnósticoAssuntos
Evento Inexplicável Breve Resolvido/diagnóstico , Terminologia como Assunto , Evento Inexplicável Breve Resolvido/etiologia , Evento Inexplicável Breve Resolvido/terapia , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Medição de Risco , Fatores de RiscoRESUMO
No disponible
Assuntos
Humanos , Recém-Nascido , Leite Humano , Segurança do Paciente , Alimentação com Mamadeira , Substitutos do Leite Humano , Serviços de Saúde da CriançaRESUMO
No disponible