RESUMEN
Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.
Asunto(s)
Enterocolitis Necrotizante , Cardiopatías Congénitas , Brasil/epidemiología , Enterocolitis Necrotizante/complicaciones , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Estudios RetrospectivosRESUMEN
Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.
Asunto(s)
Humanos , Recién Nacido , Lactante , Enterocolitis Necrotizante/complicaciones , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/complicaciones , Brasil/epidemiología , Recien Nacido Prematuro , Estudios RetrospectivosRESUMEN
Gastroschisis (GS) is an abdominal wall defect that results in histological and morphological changes leading to intestinal motility perturbation and impaired absorption of nutrients. Due to its anti-inflammatory, antioxidant, and neuroprotective effects, cannabidiol (CBD) has been used as a therapeutic agent in many diseases. Our aim was to test the effect of maternal CBD in the intestine of an experimental model of GS. Pregnant rats were treated over 3 days with CBD (30 mg/kg) after the surgical induction of GS (day 18.5 of gestation) and compared to controls. Fetuses were divided into 4 groups: 1) control (C); 2) C+CBD (CCBD); 3) gastroschisis (G), and 4) G+CBD (GCBD). On day 21.5 of gestation, the fetuses were harvested and evaluated for: a) body weight (BW), intestinal weight (IW), and IW/BW ratio; b) histometric analysis of the intestinal wall; c) immunohistochemically analysis of inflammation (iNOS) and nitrite/nitrate level. BW: GCBD was lower than CCBD (P<0.005), IW and IW/BW ratio: GCBD was smaller than G (P<0.005), GCBD presented lower thickness in all parameters compared to G (P<0.005), iNOS and nitrite/nitrate were lower concentration in GCBD than to G (P<0.005). Maternal use of CBD had a beneficial effect on the intestinal loops of GS with decreased nitrite/nitrate and iNOS expression.
Asunto(s)
Antiinflamatorios/uso terapéutico , Cannabidiol/uso terapéutico , Enteritis/prevención & control , Enfermedades Fetales/metabolismo , Gastrosquisis/metabolismo , Intestinos/efectos de los fármacos , Animales , Modelos Animales de Enfermedad , Femenino , Enfermedades Fetales/patología , Gastrosquisis/patología , Inmunohistoquímica , Nitratos/metabolismo , Óxido Nítrico Sintasa de Tipo II/análisis , Nitritos/metabolismo , Embarazo , Ratas , Ratas Sprague-DawleyRESUMEN
Cutaneous larva migrans is the result of infestation of human skin by helminth larvae, which burrow through the epidermis. This route of infestation makes the foot a typical site for origination of this infection. Children, who frequently play barefoot in locations where the most common of the helminth larvae, the dog and cat hookworms, are endemic, are at particular risk for this disorder. This article reviews the differential diagnosis of cutaneous larva migrans and current concepts in management. Two cases of related children who presented to their pediatricians with this condition are reported.
Asunto(s)
Enfermedades del Pie/parasitología , Larva Migrans , Animales , Antinematodos/uso terapéutico , Gatos , Niño , Perros , Enfermedades del Pie/diagnóstico , Enfermedades del Pie/tratamiento farmacológico , Humanos , Jamaica , Larva Migrans/diagnóstico , Larva Migrans/tratamiento farmacológico , Larva Migrans/parasitología , Masculino , Tiabendazol/uso terapéutico , ViajeRESUMEN
Cutaneous larva migrans is the result of infestation of human skin by helminth larvae, which burrow through the epidermis. This route of infestation makes the foot a typical site for origination of this infection. Children, who frequently play barefoot in locations where the most common the helminth larvae, the dog and cat hookworms, are endemic, are at particular risk of this disorder. This article reviews the differential diagnosis of cutaneous larva migrans and current concepts in management. Two cases of related children who presented to their pediatricians with this condition are reported(AU)