Alan Araújo Vieira

Avaliação do diagnóstico da sepse neonatal: uso de parâmetros laboratoriais e clínicos como fatores diagnósticos

The purpose of this study was to describe and compare the clinical, laboratory and health care characteristics of newborns (NBs) with confirmed late onset sepsis and NBs with unconfirmed late sepsis, verify if there were any differences between the groups, and describe the germs prevalent in the studied neonatal unit. This is a descriptive study, involving 168 cases. It was observer that 33.3% had a confirmed diagnosis for late onset sepsis. The age at the time of sepsis onset, the length of stay, the total number of neutrophils, the number of immature neutrophils and the value of PC-r proved good parameters to differentiate between the two groups when analyzed separately. The most common isolated bacteria were: Klebsiella pneumoniae, Staphylococcus coagulase negative and S. aureus.Se objetivo describir y comparar las caracteristicas clinicas, laboratoriales y asistenciales de RN que presentaron sepsis comprobada tardia y de RN que presentaron sepsis no comprobada tardia para, entonces, evaluar si hubo diferencia entre los grupos, ademas de describir los germenes prevalentes en la unidad neonatal estudiada. Estudio descriptivo, involucrando 168 casos, 33,3% tuvieron sepsis tardia probada. La edad al momento de la sepsis, el tiempo total de internacion, la cantidad total de neutrofilos, la cantidad de neutrofilos inmaduros y el valor de la PC-r mostraron buenos parametros en la diferenciacion entre los dos grupos cuando fueron analizados en forma aislada. La Klebsiella pneumoniae, el Staphylococcus coagulase negativo y el S. aureus fueron las bacterias aisladas con mayor prevalencia.

Surgical mitral valve repair in children with rheumatic fever

FUNDAMENTO: La reconstruccion mitral tiene buena aceptacion en ninos con fiebre reumatica. OBJETIVO: Analizar los resultados de la reconstruccion quirurgica mitral en ninos con lesiones reumaticas despues de cuatro anos de evolucion. METODOS: Estudio retrospectivo de 40 pacientes menores de 18 anos, operados en el Instituto Nacional de Cardiologia (RJ), entre enero de 1998 y enero de 2003. Se analizo el grado de regurgitacion mitral por ecocardiograma, la tecnica quirurgica, la clase funcional pre y post operatoria, la evolucion de los casos, la necesidad de cambio valvular y obitos. RESULTADOS: Veintiun pacientes (52,5%) eran del sexo femenino. La insuficiencia mitral era grave en 32 pacientes (80%) y moderada en ocho (20%). Ocurrieron tres obitos inmediatos (7,5%). Despues de tres meses de cirugia, el ecocardiograma mostro que en 35/37 (94,6%) no habia regurgitacion valvular o era leve, y en dos pacientes (5,2%) era grave. La clase funcional en el preoperatorio era III y IV en 33 casos (82,5%), y tres meses despues de la cirugia los 37 casos (100%) estaban en clase funcional I y II. La diferencia entre los datos del grados de regurgitacion mitral y clase funcional en el pre y post operatorio fueron estadisticamente significativos (p<0,01). El cambio valvular antes de cuatro de evolucion ocurrio en siete (19%) de los casos. CONCLUSION: La reconstruccion de la valvula mitral mostro resultado favorable en la mayoria de los casos al considerar el grado de regurgitacion mitral y la clase funcional pre y post quirurgica, y solo el 19% de los pacientes necesitaron cirugia para cambio valvular antes de cuatro anos de evolucion.The accumulation of chyle in the pericardial space, or chylopericardium, is a condition occurring most frequently after trauma, cardiac and thoracic surgery, or in association with tumors, tuberculosis or lymphangiomatosis. When its precise cause cannot be identified, it is called primary or idiopathic chylopericardium. This is a rare clinical entity. We report the case of a surgically treated 20-year-old female patient. A brief review of the literature and comments on the clinical presentation, etiopathogenesis, ancillary diagnostic tests and treatment options are also presented.BACKGROUND Mitral repair is well accepted in children with rheumatic fever. OBJECTIVE To analyze the outcomes of surgical mitral repair in children with rheumatic lesions after four years of follow-up. METHODS Retrospective study of 40 patients younger than 18 years, who underwent surgery in the National Institute of Cardiology (Rio de Janeiro) between January 1998 and January 2003. The echocardiographic degree of mitral regurgitation; surgical technique used; pre and postoperative functional class; patient outcome; need for valve replacement; and deaths were analyzed. RESULTS Twenty one patients (52.5%) were females. Severe mitral regurgitation was observed in 32 patients (80%) and moderate in eight (20%). Three immediate deaths occurred (7.5%). Three months after surgery, echocardiography showed no valve regurgitation or mild regurgitation in 35 of 37 cases (94.6%) patients, and severe regurgitation in two (5.2%). Thirty three cases (82.5%) were in functional class III or IV in the preoperative period, and three months after surgery all the 37 cases (100%) were in functional class I or II. The differences between the degree of mitral regurgitation and functional class in pre and postoperative periods were statistically significant (p<0.01). Seven (19%) patients underwent heart valve replacement before four years of follow-up. CONCLUSION Mitral valve repair showed favorable results in most of the cases as regards the degree of mitral regurgitation and the pre and postoperative functional class. Only 19% of the patients required surgical valve replacement before four years of follow-up.

Plastia mitral cirúrgica em crianças com febre reumática

FUNDAMENTO: La reconstruccion mitral tiene buena aceptacion en ninos con fiebre reumatica. OBJETIVO: Analizar los resultados de la reconstruccion quirurgica mitral en ninos con lesiones reumaticas despues de cuatro anos de evolucion. METODOS: Estudio retrospectivo de 40 pacientes menores de 18 anos, operados en el Instituto Nacional de Cardiologia (RJ), entre enero de 1998 y enero de 2003. Se analizo el grado de regurgitacion mitral por ecocardiograma, la tecnica quirurgica, la clase funcional pre y post operatoria, la evolucion de los casos, la necesidad de cambio valvular y obitos. RESULTADOS: Veintiun pacientes (52,5%) eran del sexo femenino. La insuficiencia mitral era grave en 32 pacientes (80%) y moderada en ocho (20%). Ocurrieron tres obitos inmediatos (7,5%). Despues de tres meses de cirugia, el ecocardiograma mostro que en 35/37 (94,6%) no habia regurgitacion valvular o era leve, y en dos pacientes (5,2%) era grave. La clase funcional en el preoperatorio era III y IV en 33 casos (82,5%), y tres meses despues de la cirugia los 37 casos (100%) estaban en clase funcional I y II. La diferencia entre los datos del grados de regurgitacion mitral y clase funcional en el pre y post operatorio fueron estadisticamente significativos (p<0,01). El cambio valvular antes de cuatro de evolucion ocurrio en siete (19%) de los casos. CONCLUSION: La reconstruccion de la valvula mitral mostro resultado favorable en la mayoria de los casos al considerar el grado de regurgitacion mitral y la clase funcional pre y post quirurgica, y solo el 19% de los pacientes necesitaron cirugia para cambio valvular antes de cuatro anos de evolucion.The accumulation of chyle in the pericardial space, or chylopericardium, is a condition occurring most frequently after trauma, cardiac and thoracic surgery, or in association with tumors, tuberculosis or lymphangiomatosis. When its precise cause cannot be identified, it is called primary or idiopathic chylopericardium. This is a rare clinical entity. We report the case of a surgically treated 20-year-old female patient. A brief review of the literature and comments on the clinical presentation, etiopathogenesis, ancillary diagnostic tests and treatment options are also presented.BACKGROUND Mitral repair is well accepted in children with rheumatic fever. OBJECTIVE To analyze the outcomes of surgical mitral repair in children with rheumatic lesions after four years of follow-up. METHODS Retrospective study of 40 patients younger than 18 years, who underwent surgery in the National Institute of Cardiology (Rio de Janeiro) between January 1998 and January 2003. The echocardiographic degree of mitral regurgitation; surgical technique used; pre and postoperative functional class; patient outcome; need for valve replacement; and deaths were analyzed. RESULTS Twenty one patients (52.5%) were females. Severe mitral regurgitation was observed in 32 patients (80%) and moderate in eight (20%). Three immediate deaths occurred (7.5%). Three months after surgery, echocardiography showed no valve regurgitation or mild regurgitation in 35 of 37 cases (94.6%) patients, and severe regurgitation in two (5.2%). Thirty three cases (82.5%) were in functional class III or IV in the preoperative period, and three months after surgery all the 37 cases (100%) were in functional class I or II. The differences between the degree of mitral regurgitation and functional class in pre and postoperative periods were statistically significant (p<0.01). Seven (19%) patients underwent heart valve replacement before four years of follow-up. CONCLUSION Mitral valve repair showed favorable results in most of the cases as regards the degree of mitral regurgitation and the pre and postoperative functional class. Only 19% of the patients required surgical valve replacement before four years of follow-up.

Evaluation of the neonatal sepsis diagnosis: use of clinical and laboratory parameters as diagnosis factors

The purpose of this study was to describe and compare the clinical, laboratory and health care characteristics of newborns (NBs) with confirmed late onset sepsis and NBs with unconfirmed late sepsis, verify if there were any differences between the groups, and describe the germs prevalent in the studied neonatal unit. This is a descriptive study, involving 168 cases. It was observer that 33.3% had a confirmed diagnosis for late onset sepsis. The age at the time of sepsis onset, the length of stay, the total number of neutrophils, the number of immature neutrophils and the value of PC-r proved good parameters to differentiate between the two groups when analyzed separately. The most common isolated bacteria were: Klebsiella pneumoniae, Staphylococcus coagulase negative and S. aureus.Se objetivo describir y comparar las caracteristicas clinicas, laboratoriales y asistenciales de RN que presentaron sepsis comprobada tardia y de RN que presentaron sepsis no comprobada tardia para, entonces, evaluar si hubo diferencia entre los grupos, ademas de describir los germenes prevalentes en la unidad neonatal estudiada. Estudio descriptivo, involucrando 168 casos, 33,3% tuvieron sepsis tardia probada. La edad al momento de la sepsis, el tiempo total de internacion, la cantidad total de neutrofilos, la cantidad de neutrofilos inmaduros y el valor de la PC-r mostraron buenos parametros en la diferenciacion entre los dos grupos cuando fueron analizados en forma aislada. La Klebsiella pneumoniae, el Staphylococcus coagulase negativo y el S. aureus fueron las bacterias aisladas con mayor prevalencia.

Correlação entre a concentração de lactato plasmático e a mortalidade neonatal precoce

OBJECTIVE: To assess the correlation between plasma lactate concentrations in the first 6 hours of life and early neonatal mortality. METHODS: The patients were divided in 2 groups based on the cutoff point, obtained from a receiver operating characteristic (ROC) curve, of the plasma lactate concentration that best predicted neonatal mortality during the first 3 days of life. The differences between groups and the correlations between the investigated variables and the plasma lactate concentrations measured in the first 6 hours of life were analyzed using the Chi-square, Students t, or Mann-Whitney tests and logistic regression. RESULTS: The best cutoff point of the plasma lactate concentration as determined by the ROC curve for death during the first 3 days of life was 4.2 mmol/L. The investigated groups differed with regards to the average birth weight, which was lower in the group with serum lactate levels > 4.2 mmol/L, and the match between birth weight and gestational age, where the group with serum lactate levels > 4.2 mmol/L exhibited a higher number of newborns small for their gestational age. Seizures, intracranial hemorrhage, and death during the first 3 days of life occurred more frequently in the group with serum lactate levels > 4.2 mmol/L. CONCLUSION: In the investigated samples, the presence of plasma lactate concentrations > 4.2 mmol/L in the first 6 hours of life correlated with neonatal death during the first 3 days of life, a higher frequency of neurologic morbidity, and newborns that were small for their gestational age.

Correlação entre o uso de corticoterapia antenatal, a reanimação e a mortalidade de recém-nascidos prematuros de muito baixo peso

PURPOSE To evaluate the correlation between the use of antenatal corticosteroid therapy (AC), the frequency of resuscitation in delivery room and mortality of newborn infants under 1,500 g and gestational age less than or equal to 34 weeks. METHODS A cohort study was conducted on all newborn infants under 1,500 g and with a gestational age less than or equal to 34 weeks admitted at the neonatal ICU between January 2006 and December 2011. Newborns who had congenital anomalies, genetic syndromes, congenital infections and those who were transferred to or came from other institutions were excluded. The studied infants were divided into 2 groups: those who received (n=182) and those who did not receive (n=38) AC. The main outcomes studied were the necessity of neonatal resuscitation, the presence of the main neonatal diseases and mortality during hospitalization. The means of the variables were compared using Students t-test or non-parametric test and frequencies were compared by χ2test with Fishers correction. The variables that presented difference between groups were assessed by logistic regression. The Statistical Package for the Social Sciences (SPSS) 16.0 was used and the significance level was set at 0.05. RESULTS In this study, 220 patients were evaluated. The groups were similar concerning birth weight, gestational age and the presence of the main neonatal morbidity during hospitalization. The infants who received antenatal corticosteroids showed lower mortality (OR=3.0; 95%CI 1.4-6.5) and required less resuscitation (OR=2.4; 95%CI 1.1-5.0). Besides, they required less advanced resuscitation procedures, such as tracheal cannula (OR=3.7; 95%CI 1.7-7.6), cardiac massage (OR=5.7; 95%CI 2.0-16.5) and medications (OR=8.9; 95%CI 2.0-39.4). CONCLUSIONS The use of antenatal corticosteroids reduced the need for resuscitation in delivery room, especially advanced procedures, and reduced the mortality in the studied groups.

Evaluación del diagnóstico de sepsis neonatal: uso de parámetros laboratoriales y clínicos como factores diagnósticos

The purpose of this study was to describe and compare the clinical, laboratory and health care characteristics of newborns (NBs) with confirmed late onset sepsis and NBs with unconfirmed late sepsis, verify if there were any differences between the groups, and describe the germs prevalent in the studied neonatal unit. This is a descriptive study, involving 168 cases. It was observer that 33.3% had a confirmed diagnosis for late onset sepsis. The age at the time of sepsis onset, the length of stay, the total number of neutrophils, the number of immature neutrophils and the value of PC-r proved good parameters to differentiate between the two groups when analyzed separately. The most common isolated bacteria were: Klebsiella pneumoniae, Staphylococcus coagulase negative and S. aureus.Se objetivo describir y comparar las caracteristicas clinicas, laboratoriales y asistenciales de RN que presentaron sepsis comprobada tardia y de RN que presentaron sepsis no comprobada tardia para, entonces, evaluar si hubo diferencia entre los grupos, ademas de describir los germenes prevalentes en la unidad neonatal estudiada. Estudio descriptivo, involucrando 168 casos, 33,3% tuvieron sepsis tardia probada. La edad al momento de la sepsis, el tiempo total de internacion, la cantidad total de neutrofilos, la cantidad de neutrofilos inmaduros y el valor de la PC-r mostraron buenos parametros en la diferenciacion entre los dos grupos cuando fueron analizados en forma aislada. La Klebsiella pneumoniae, el Staphylococcus coagulase negativo y el S. aureus fueron las bacterias aisladas con mayor prevalencia.

Ascaridíase hepatobiliar complicada por pneumonia lipoídica

OBJETIVO: Apresentar um caso de ascaridiase hepatobiliar complicado por pneumonia lipoidica e discutir as implicacoes anestesicas envolvidas. DESCRICAO DO CASO: Menina de dois anos de idade com ascaridiase hepatobiliar complicada por pneumonia lipoidica por aspiracao e desnutricao grave, advinda de familia em condicoes sociais precarias em zona rural, com quatro irmaos. Foi tratada com sucesso por uma combinacao de lavados broncopulmonares sucessivos e cirurgia. COMENTARIOS: Ascaridiase biliar corresponde a cerca de 10% dos casos de complicacoes de ascaridiase. Apenas uma minoria precisa de tratamento cirurgico. O uso de oleo mineral por via oral e um tratamento tradicional para a suboclusao intestinal pelo Ascaris lumbricoides, mas a broncoaspiracao do oleo e a consequente pneumonia lipoidica representam um risco alto para o seu uso. Anestesia geral para laparotomia exploradora em pre-escolar desnutrido com pneumonia lipoide e ascaridiase biliar e uma situacao pouco contemplada na literatura medica, o que exigiu um planejamento terapeutico especifico.

Interference of heart and transcutaneous oxygen monitoring in the measurement of bioelectrical impedance analysis in preterm newborns

OBJECTIVE To verify if the connection of electrodes for heart and transcutaneous oxygen monitoring interfere with the measurement of electrical bioimpedance in preterm newborns. METHODS This was a prospective, blinded, controlled, cross-sectional, crossover study that assessed and compared paired measures of resistance (R) and reactance (Xc) by BIA, obtained with and without monitoring wires attached to the preterm newborn. The measurements were performed in immediate sequence, after randomization to the presence or absence of electrodes. The sample size calculated was 114 measurements or tests with monitoring wires and 114 without monitoring wires, considering for a difference between the averages of 0.1 ohms, with an alpha error of 10% and beta error of 20%, with significance <0.05. RESULTS No differences were observed between the R (677.37±196.07 vs. 677.46±194.86) and Xc (31.15±9.36 vs. 31.01±9.56) values obtained with and without monitoring wires, respectively, with good correlation between them (R: 0.997 and Xc: 0.968). CONCLUSION The presence of heart and/or transcutaneous oxygen monitoring wires connected to the preterm newborn did not affect the values of R or Xc measured by BIA, allowing them to be carried out in this population without risks.

Avaliação dos fatores perinatais que interferem na incidência de enterocolite necrosante em recém-nascidos de muito baixo peso

PURPOSE To evaluate the perinatal factors that influence the incidence of necrotizing enterocolitis (NEC) in newborns infants (NBI) weighing less than 1,500 g. METHODS A prospective study that analyzed all infants with birth weight (BW) less than 1,500 g born between January 2006 to December 2010 (n=183). They were divided into two groups, i.e. infants diagnosed with NEC (n=18) and infants without a diagnosis of NEC (n=165), which were compared in terms of perinatal factors that could influence the incidence of NEC. Mean data were compared by Students t-test or nonparametric tests and percentages of categorical variables were compared by the χ² test. When the variables showed differences between groups, they were analyzed using logistic regression with the dependent variable as the presence of NEC. The statistical package used was SPSS 16.0 for Windows. RESULTS The two groups were similar in terms of most of the clinical and demographic neonatal and maternal data, except for the presence of preeclampsia (PE), which was higher in patients whose children developed NEC (61.1 versus 35,6%). The presence of PE increased the chance of occurrence of NEC by 2.84 times (95%CI 1.0 - 7.7). CONCLUSION The only factor that can interfere with the incidence of NEC in infants of very low birth weight was the presence of PE. Awareness of this fact can guide the perinatal team in providing more judicious care regarding the prevention of NEC in this specific population.