Denise N. Pereira

Infecção disseminada por Trichosporon spp em recém-nascido prematuro: relato de um caso

OBJECTIVE: To report the first case of disseminated Trichosporon spp infection in a newborn infant in Brazil, discussing a few aspects concerning management and treatment. A new spectrum of pathogens associated with severe infections in neonatal ICU has arisen, afflicting mainly newborn infants weighing less than 1,000 g at birth. Infection with Trichosporon asahii is rare and often fatal in this group of patients. DESCRIPTION: A case of Trichosporon spp fatal infection in a newborn weighing 815 g at birth is reported. Literature search in the main databases returned only nine articles, reporting 14 cases of infection with this fungus in preterm newborns. CONCLUSIONS: The rate of invasive fungal infection is around 6% in this group of patients, Trichosporon infection being a likely occurrence. Mortality rate in these cases is extremely high, but early treatment with triazole antifungals improves prognosis significantly.

Disseminated Trichosporon spp infection in preterm newborns: a case report

OBJECTIVE To report the first case of disseminated Trichosporon spp infection in a newborn infant in Brazil, discussing a few aspects concerning management and treatment. A new spectrum of pathogens associated with severe infections in neonatal ICU has arisen, afflicting mainly newborn infants weighing less than 1,000 g at birth. Infection with Trichosporon asahii is rare and often fatal in this group of patients. DESCRIPTION A case of Trichosporon spp fatal infection in a newborn weighing 815 g at birth is reported. Literature search in the main databases returned only nine articles, reporting 14 cases of infection with this fungus in preterm newborns. CONCLUSIONS The rate of invasive fungal infection is around 6% in this group of patients, Trichosporon infection being a likely occurrence. Mortality rate in these cases is extremely high, but early treatment with triazole antifungals improves prognosis significantly.

Evaluation of umbilical cord pH and its relationship with Apgar score in term newborn infants

The value of the Apgar score as an index of birth asphyxia has been recently questioned. The purpose of the present study is to evaluate the relationship between cord blood pH and Apgar score in term newborn infants.A cross-sectional study involving 76 term newborn infants was performed from March through September 1995 at the Obstetric Unit of Hospital de Clínicas de Porto Alegre. The blood samples were obtained from umbilical cord artery and vein at the moment of delivery. Infants were divided in three different groups according to the Apgar score: Group A (n=60): >or=7 at one and five minutes; Group B (n=13): < 7 at one minute and >or=7 at five minutes; Group C (n=3): < 7 at one and five minutes. The frequency of acidemia in Group A was 18.3% (11 newborn infants) considering arterial pH < 7.20 and 5% considering arterial pH <or= 7.10. Three newborn infants (23%) of Group B had arterial pH >or= 7.20 and nine (56.2%) had arterial pH > 7.10. None of the newborn infants in Group C had arterial pH > 7.10. The sensitivity and specificity values for Apgar score less than 7 at one minute for detection of fetal acidemia were, respectively, 54.1% and 94.1%. This study confirms a poor correlation between Apgar score and umbilical blood cord pH, even in a term newborn, and emphasizes the importance of obtaining umbilical cord pH to consider the diagnosis of perinatal asphyxia.

Effect of perinatal asphyxia on thyroid hormones

OBJECTIVE: to verify the effect of perinatal asphyxia on thyroid hormone levels in term newborn infants. METHODS: We carried out a case-control study with 17 term and asphyxiated (A) and 17 term and control (N) newborn infants at the Hospital de Clinicas de Porto Alegre. Patients were paired according to color of skin, sex, type of delivery, gestational age, and weight at birth. We collected umbilical cord plasma T4, T3, free T4, reverse T3, and TSH after 18 to 24 hours of life and from asphyxiated and control newborn infants. RESULTS: There were no differences in thyroid hormones of cord blood, with the exception of reverse T3, which was higher in A than in controls [median (25th-75th percentile): A= 2(1.4-2); N= 1.41 (1.13-1.92); P=0.037)]. Thyroid hormone levels were lower in A than in controls on samples collected within 18-24 hours after birth, except for reverse T3, which was similar in both groups [average ± SD: T4 A= 9.79 ± 2.59; N=14.68 ± 3.05; P<0.001; median T3 A= 40.83 (37.4-80.4); N= 164 (56.96-222.5); P=0.003; average ± SD: free T4 A=1.85 ± 0.92; N= 2.8 ± 0.74; P=0.004; median: reverse T3 A=1.54 (1.16-1.91); N=1.31(0.87-2); P=0.507; TSH A=9.1 (6.34-12.95); N=14.5(12.9-17.85); P=0.008]. CONCLUSIONS: Our data suggest that lower T4, free T4, and T3 levels are secondary to lower TSH levels in asphyxiated newborns; also, peripheral metabolism of T4 in asphyxiated infants can be altered due to low T3 and normal reverse T3 levels.

Efeitos da asfixia perinatal sobre os hormônios tireoidianos

Objetivo: verificar o efeito da asfixia perinatal sobre os hormônios tireóideos. Métodos: foi realizado um estudo de caso-controle, no hospital de Clínicas de Porto Alegre, envolvendo 17 recém-nascidos a termo asfixiados (A) e 17 não-asfixiados (N), pareados conforme a cor, sexo, tipo de parto, idade gestacional e peso de nascimento. Foram coletados T4, T3, T4 livre, T3 reverso e TSH do sangue do cordão e do recém-nascido com 18 a 24 horas de vida, entre os que sofreram ou não asfixia perinatal. Resultados: no sangue de cordão, não houve diferença na dosagem dos hormônios tireóideos, com exceção do T3 reverso, que foi mais elevado no grupo que sofreu asfixia [mediana (percentis 2575):A= 2(1,4-2); N= 1,41(1,13-1,92); p=0,037]. Com 18 a 24 horas de vida, foram significativamente menores no grupo de asfixiados, com exceção do T3 reverso, que foi semelhante entre os dois grupos [média ± DP: T4 A= 9,79 ± 2,59; N=14,68 ± 3,05; p<0,001/ mediana T3 A= 40,83(37,4-80,4); N= 164(56,96-222,5); P=0,003/ média ± DP T4 livre A=1,85 ± 0,92; N= 2,8 ± 0,74; p=0,004/ mediana T3 reverso A= 1,54(1,16-1,91); N= 1,31(0,87-2); p=0,507/ TSH A= 9,1(6,34-12,95); N=14,5(12,9-17,85); p=0,008]. Conclusões: nossos dados sugerem que os níveis diminuídos de T4, T4 livre e T3 no recém-nascido asfixiado com 18 a 24 horas de vida são secundários aos níveis diminuídos de TSH. Além disso, os valores baixos de T3 e normais de T3 reverso podem refletir alteração no metabolismo periférico do T4.

Clinical signs in term infants with different degrees of acidemia in cord blood

OBJECTIVE: To verify if Apgar score plus umbilical cord pH are adequate to predict which newborn infant will develop multiorgan system disfunction. METHODS: A study including all term newborn infants with Apgar scores in the first and fifth minutes of life < 7 and umbilical cord blood pH < 7.20 born in Hospital de Clínicas de Porto Alegre from March 1995 through March 1998 was performed. Venous umbilical cord blood was collected for blood gas analysis. Newborn infants were divided in two groups: Group A with pH < 7.0, and Group B with pH >/= 7.0 and < 7.20. Patients were evaluated for the presence of pulmonary hypertension, renal failure, inappropriate secretion of antidiuretic hormone, ischemic cardiopathy, early seizures, neurologic injury at hospital discharge and death. RESULTS: Twenty five newborn infants were included in the study.Twelve formed Group A, and 13, Group B. There were no differences between both groups in respect to mode of delivery, gender, color and birth weight. Group B had a lower gestational age than Group A. There were significant differences between both groups in mean cord blood pH, pCO(2) and BE (p<0.05). There was a positive association between umbilical cord blood pH and Apgar score. Higher occurrence of neurologic injury at hospital discharge in Group A was the only statistically significant clinical manifestation (p<0.05). CONCLUSION: Apgar score and umbilical cord pH are not adequate criteria to predict multiorgan system dysfunction.

Effect of Birth Asphyxia on Thyroid Hormones in Full Term Infants 1104

Objective: To evaluate thyroid hormones in cord blood and peripheral blood collected 18 to 24 hours after birth of asphyxiated (AG) and normal (CG) full term newborn infants.