RESUMO
AIM: To evaluate whether the ventricular septal defect (VSD) size, along with the degree of preoperative growth impairment and age at repair, may influence postoperative growth, and if VSD size can be useful to identify children at risk for preoperative failure to thrive. METHODS: Sixty-eight children submitted to VSD repair in a Brazilian tertiary-care institution were evaluated. Weight and height measurements were converted to Z-scores. Ventricular septal defect size was normalized by dividing it by the aortic root diameter (VSD/Ao ratio). RESULTS: Twenty-six patients (38%) had significantly low weight-for-height, 10 patients (15%) had significantly low height-for-age and 13 patients (19%) had both conditions at repair. Catch-up growth occurred in 82% of patients for weight-for-age, in 75% of patients for height-for-age and in 89% of patients for weight-for-height. Weight-for-height Z-scores at surgery were significantly lower in patients who underwent repair before 9 months of age. The VSD/Ao ratio did not associate with any other data. On multivariate analysis, weight-for-age Z-scores and age at surgery were independent predictors of long-term weight and height respectively. CONCLUSION: The VSD/Ao ratio was not a good predictor of preoperative failure to thrive. Most patients had preoperative growth impairment and presented catch-up growth after repair. Preoperative growth status and age at surgery influenced long-term growth.
Assuntos
Ecocardiografia , Insuficiência de Crescimento/prevenção & controle , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Pesos e Medidas Corporais , Brasil , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Estudos Longitudinais , Análise Multivariada , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
Fourteen neonates with septic arthritis of the hip, which had been diagnosed late, were reviewed with the aim of establishing the difficulties of making an early diagnosis. The history, physical signs, blood tests and examination of the synovial fluid are the most important guidelines. Radiography was not helpful as less than 50% of cases show early signs, most often a joint effusion. Early diagnosis and surgical drainage are necessary to avoid permanent damage to the cartilaginous femoral head.
