Factors associated with cholestasis in newborns with gastroschisis.

OBJECTIVE: To describe the incidence and to analyze risk factors associated with cholestasis in neonates with gastroschisis. METHODS: This is a retrospective cohort study in a tertiary single center analyzing 181 newborns with gastroschisis between 2009 and 2020. The following risk factors associated with cholestasis were analyzed: gestational age, birth weight, type of gastroschisis, silo closure or immediate closure, days of parenteral nutrition, type of lipid emulsion, days of fasting, days to reach a full diet, days with central venous catheter, presence of infections, and outcomes. RESULTS: Among the 176 patients evaluated, 41 (23.3%) evolved with cholestasis. In the univariate analysis, low birth weight (p=0.023), prematurity (p<0.001), lipid emulsion with medium-chain triglycerides and long-chain triglycerides (p=0.001) and death (p<0.001) were associated with cholestasis. In the multivariate analysis, patients who received lipid emulsion with fish oil instead of medium chain triglycerides/long chain triglycerides (MCT/LCT) emulsion had a lower risk of cholestasis. CONCLUSIONS: Our study shows that lipid emulsion with fish oil is associated with a lower risk of cholestasis in neonates with gastroschisis. However, this is a retrospective study and a prospective study should be performed to confirm the results.

Thyroid dysfunction in infants with severe intestinal insufficiency: a case series.

OBJECTIVE: The aim of this study was to describe the status of thyroid function in infants with severe intestinal dysfunction. CASE DESCRIPTION: A retrospective study was conducted in a tertiary neonatal intensive care center, including newborns and infants with severe intestinal dysfunction, hospitalized between 2015 and 2020. From the medical records, the following data were collected: gestational age, birth weight, underlying pathology that led to intestinal dysfunction, hospital stay, presence of thyroid dysfunction, age from the onset of thyroid dysfunction, initial and maximum dose of levothyroxine replacement, and levothyroxine administration route and outcome. Seven children (0.76% of 914 hospitalizations) developed severe intestinal insufficiency: vanishing gastroschisis (42.9%), Berdon syndrome (28.5%), apple peel (14.3%), and OIES syndrome (14.3%) - omphalocele, exstrophy of cloaca, imperforate anus, and spina bifida. The mean gestational age was 33.3±1.6 weeks, the mean birth weight was 2,113.9±370.9 g, the median hospitalization was 420 days, and mortality was 42.9%. Of these seven cases, four (57.1%) presented thyroid dysfunction, evaluated by blood hormone dosages and the dose of levothyroxine replacement ranged from 25 to 100 µg/day, administered by gastric or rectal route. COMMENTS: This series of cases draws attention to thyroid dysfunction (hypothyroidism) in children with severe intestinal insufficiency receiving exclusive parenteral nutrition for a prolonged period, whose etiology is iodine deficiency, because, in Brazil, micronutrient solutions added to parenteral nutrition do not contain iodine.

Factors associated with cholestasis in newborns with gastroschisis / Fatores associados à colestase em recém-nascidos com gastrosquise

ABSTRACT Objective: To describe the incidence and to analyze risk factors associated with cholestasis in neonates with gastroschisis. Methods: This is a retrospective cohort study in a tertiary single center analyzing 181 newborns with gastroschisis between 2009 and 2020. The following risk factors associated with cholestasis were analyzed: gestational age, birth weight, type of gastroschisis, silo closure or immediate closure, days of parenteral nutrition, type of lipid emulsion, days of fasting, days to reach a full diet, days with central venous catheter, presence of infections, and outcomes. Results: Among the 176 patients evaluated, 41 (23.3%) evolved with cholestasis. In the univariate analysis, low birth weight (p=0.023), prematurity (p<0.001), lipid emulsion with medium-chain triglycerides and long-chain triglycerides (p=0.001) and death (p<0.001) were associated with cholestasis. In the multivariate analysis, patients who received lipid emulsion with fish oil instead of medium chain triglycerides/long chain triglycerides (MCT/LCT) emulsion had a lower risk of cholestasis. Conclusions: Our study shows that lipid emulsion with fish oil is associated with a lower risk of cholestasis in neonates with gastroschisis. However, this is a retrospective study and a prospective study should be performed to confirm the results.

RESUMO Objetivo: Analisar a incidência e os fatores de risco associados à colestase em recém-nascidos com gastrosquise. Métodos: Estudo de coorte retrospectivo em um único centro terciário, que analisou 181 recém-nascidos com gastrosquise entre 2009 e 2020. Foram examinados os seguintes fatores de risco associados à colestase: idade gestacional, peso ao nascer, tipo de gastrosquise, fechamento com silo ou fechamento imediato, dias de uso nutrição parenteral, tipo de emulsão lipídica, dias de jejum, dias para atingir a dieta completa, dias com cateter venoso central, presença de infecções e desfechos. Resultados: Dos 176 pacientes avaliados, 41 (23,3%) evoluíram com colestase. Baixo peso ao nascer (p=0,023), prematuridade (p<0,001), emulsão lipídica com triglicerídeos de cadeia média e triglicerídeos de cadeia longa (p=0,001) e óbito (p<0,001) foram associados à colestase. Na análise multivariada, os pacientes que receberam emulsão lipídica com óleo de peixe em vez da emulsão diária de triglicérides de cadeia média/triglicérides de cadeia longa (MCT/LCT) apresentaram menor risco de colestase. Conclusões: Nosso estudo mostra que a emulsão lipídica com óleo de peixe está associada a menor risco de colestase em neonatos com gastrosquise, porém este é um estudo retrospectivo, e um estudo prospectivo deve ser realizado para confirmar os resultados.

Thyroid dysfunction in infants with severe intestinal insufficiency: a case series / Disfunção tireoidiana em lactentes com insuficiência intestinal grave: descrição de uma série de casos

Abstract Objective: The aim of this study was to describe the status of thyroid function in infants with severe intestinal dysfunction. Case description: A retrospective study was conducted in a tertiary neonatal intensive care center, including newborns and infants with severe intestinal dysfunction, hospitalized between 2015 and 2020. From the medical records, the following data were collected: gestational age, birth weight, underlying pathology that led to intestinal dysfunction, hospital stay, presence of thyroid dysfunction, age from the onset of thyroid dysfunction, initial and maximum dose of levothyroxine replacement, and levothyroxine administration route and outcome. Seven children (0.76% of 914 hospitalizations) developed severe intestinal insufficiency: vanishing gastroschisis (42.9%), Berdon syndrome (28.5%), apple peel (14.3%), and OIES syndrome (14.3%) - omphalocele, exstrophy of cloaca, imperforate anus, and spina bifida. The mean gestational age was 33.3±1.6 weeks, the mean birth weight was 2,113.9±370.9 g, the median hospitalization was 420 days, and mortality was 42.9%. Of these seven cases, four (57.1%) presented thyroid dysfunction, evaluated by blood hormone dosages and the dose of levothyroxine replacement ranged from 25 to 100 μg/day, administered by gastric or rectal route. Comments: This series of cases draws attention to thyroid dysfunction (hypothyroidism) in children with severe intestinal insufficiency receiving exclusive parenteral nutrition for a prolonged period, whose etiology is iodine deficiency, because, in Brazil, micronutrient solutions added to parenteral nutrition do not contain iodine.

RESUMO Objetivo: Descrever o status da função tireoidiana em lactentes com disfunção intestinal grave. Descrição do caso: Estudo retrospectivo, realizado em um centro de terapia intensiva neonatal de nível terciário, que incluiu recém-nascidos e lactentes com disfunção intestinal grave, internados entre 2015 e 2020. Dos prontuários foram obtidos: idade gestacional; peso de nascimento; patologia de base que levou à disfunção intestinal; tempo de internação; presença de disfunção tireoidiana; idade no início da disfunção tireoidiana; dose inicial e máxima da reposição de levotiroxina; via de administração da levotiroxina e desfecho. Sete crianças (0,76% do total de 914 internações) evoluíram com insuficiência intestinal grave: vanishing gastrosquise (42,9%), síndrome de Berdon (28,5), apple peel (14,3%) e síndrome onfalocele, ânus imperfurado, extrofia de cloaca e espinha bífida — OIES (14,3%). A média de idade gestacional foi de 33,3±1,6 semanas e de peso ao nascimento de 2113,9±370,9 gramas; a mediana de internação foi de 420 dias e a mortalidade foi de 42,9%. Desses sete casos, quatro (57,1%) apresentaram disfunção tireoidiana, avaliada por dosagens hormonais séricas, e a dose de reposição de levotiroxina variou de 25 a 100 mcg/dia, administrada por via gástrica ou retal. Comentários: Esta série de casos chama a atenção para a disfunção tireoidiana (hipotireoidismo) em crianças com insuficiência intestinal severa que receberam nutrição parenteral exclusiva por tempo prolongado, cuja etiologia é a deficiência de iodo, pois no Brasil as soluções de micronutrientes adicionadas à nutrição parenteral não contêm iodo.

Ethanol lock prophylaxis in long-stay central venous catheters in children with severe intestinal dysfunction: a report of six cases.

The aim of this study was to report on use of ethanol lock in long-term catheters in newborns with severe intestinal dysfunction, dependent on total and prolonged parenteral nutrition, in a Neonatal Intensive Care Center (tertiary level), between 2015 and 2020. Six infants (0.65%) out of the 914 admitted during the period met the inclusion criteria. The median age at catheter placement was 121.5 days. Two Powerpicc (PICC Power Sinergy™, São Paulo), one Groshong (Groshong™ Central Venous Catheter BD, São Paulo), and three silicone catheters were used, all tunneled, and the median dwell duration was 182.5 days. Four patients had at least one episode of infection related to the central venous catheter, and Gram-positive, Gram-negative, and fungal agents were isolated. The median length of hospital stay was 555 days and mortality was 33.3%. The ethanol lock did not cause any side effects and was relatively effective in preventing infections related to the central venous catheter.

Gastroschisis and late-onset neonatal sepsis in a tertiary referral center in Southeastern Brazil

Abstract Objectives: To analyze late-onset sepsis and to describe the etiological agents in newborns with gastroschisis. Methods: A retrospective cohort, including newborns with gastroschisis whose admissions occurred in the period between January 2012 to December 2018 in a tertiary referral center. Maternal and newborn characteristics, surgical procedures and evolution in hospitalization were verified. A bivariate analysis was performed with patients with proven late-onset neonatal sepsis and according to the simple or complex gastroschisis category, the prevalent microorganisms in positive cultures were identified, statistical tests were carried out and the significance level adopted was p < 0,05. Results are presented in proportions, averages and standard deviation or medians. The level of significance adopted was p < 0.05. Results: 101 newborns were analyzed, 45 (44.5%) were confirmed late-onset sepsis. The median birth weight was 2285+498 grams, and the gestational age was 35.9 +1.74weeks. The incidence of complex gastroschisis was 17.8%, the hospitalization time was 48.2+29.67 days and mortality was 9.9%. The newborns were divided into 2 groups: Group 1: late-onset sepsis (44.6%), and Group 2: no late-onset sepsis. The presence of complex gastroschisis was a factor associated with infection (p < 0.009). Fasting time (p < 0.001), parenteral nutrition time (p < 0.001), time to achieve full diet (p < 0.001), and hospitalization stay (p < 0.001) were higher in group 2. Gram-positive were the most frequent (51.1%), followed by Gram-negative (20%), and fungi (4.4%). Conclusions: Newborns with gastroschisis have a higher risk of evolving with late-onset sepsis, despite this study did not calculate the risk of sepsis statistically, and the main germs detected by cultures were gram-positive bacteria, specifically Staphylococcus epidermidis.

Profilaxia com lock de etanol em cateter venoso central de longa permanência em crianças com disfunção intestinal grave: relato de seis casos / Ethanol lock prophylaxis in long-stay central venous catheters in children with severe intestinal dysfunction: a report of six cases

Resumo O objetivo deste estudo foi relatar o uso de lock de etanol na profilaxia infecciosa de cateteres venosos de longa permanência em recém-nascidos com disfunção intestinal grave e dependentes de nutrição parenteral total e prolongada, internados em um Centro de Terapia Intensiva Neonatal (nível terciário) entre 2015 e 2020. Das 914 admissões, seis (0,65%) recém-nascidos preencheram os critérios de inclusão. A mediana da idade da passagem do cateter foi de 121,5 dias, sendo dois cateteres PowerPicc (PICC Power Sinergy™, São Paulo), um cateter Groshong (Groshong™ Central Venous Catheter BD, São Paulo) e três cateteres de silicone, todos tunelizados. O tempo de permanência apresentou mediana de 182,5 dias. Cinco pacientes apresentaram pelo menos um episódio de infecção associada ao cateter venoso central, sendo isolados agentes Gram-positivos, negativos e fungos. A mediana de dias de internação foi de 555, e a mortalidade, 33,3%. O lock de etanol não apresentou efeitos colaterais e foi relativamente eficaz na prevenção de infecções relacionadas ao cateter venoso central.

Abstract The aim of this study was to report on use of ethanol lock in long-term catheters in newborns with severe intestinal dysfunction, dependent on total and prolonged parenteral nutrition, in a Neonatal Intensive Care Center (tertiary level), between 2015 and 2020. Six infants (0.65%) out of the 914 admitted during the period met the inclusion criteria. The median age at catheter placement was 121.5 days. Two Powerpicc (PICC Power Sinergy™, São Paulo), one Groshong (Groshong™ Central Venous Catheter BD, São Paulo), and three silicone catheters were used, all tunneled, and the median dwell duration was 182.5 days. Four patients had at least one episode of infection related to the central venous catheter, and Gram-positive, Gram-negative, and fungal agents were isolated. The median length of hospital stay was 555 days and mortality was 33.3%. The ethanol lock did not cause any side effects and was relatively effective in preventing infections related to the central venous catheter.

GROWTH ANALYSIS OF PRETERM NEWBORNS WITH GASTROSCHISIS DURING HOSPITALIZATION IN A NEONATAL INTENSIVE CARE UNIT.

BACKGROUND: Gastroschisis, especially complex type, prematurity and low birth weight are associated with a worse clinical outcome with higher mortality, higher incidence of sepsis and catheter-related infection, cholestasis, short bowel syndrome, greater number of days to achieve full diet, longer time of parenteral nutrition and longer hospitalization time. OBJECTIVE: To evaluate the growth of preterm newborns with gastroschisis during their hospitalization in the neonatal intensive care unit. METHODS: Descriptive study, based on a retrospective cohort (January 2012 to December 2018), including preterm newborns (gestational age less than 37 weeks) with simple and complex gastroschisis admitted in a tertiary neonatal intensive care unit. The following parameters were analyzed: maternal age, parity, type of delivery, birth weight, gender, gestational age, nutritional adequacy, type of gastroschisis, fasting time, parenteral nutrition time, time until achieving full enteral nutrition, hospitalization time, weight gain and outcome. The results were expressed in percentage, average, and median. RESULTS: A total of 101 newborns with gastroschisis were admitted, of which 59.4% were premature (80.7% of late preterm infants). From the maternal data, the mean age was 21.2 years and 68.3% were primiparous. Regarding childbirth: 80% were cesarean sections. From newborns: the average birth weight was 2137 g, 56.6% were female, the average gestational age was 34.8 weeks, the average weight gain was 20.8 g/day during hospitalization and 83.3% were discharged from the hospital. CONCLUSION: The growth analysis by weight gain (grams/day) during hospitalization in the intensive care unit showed that more than 90% of the sample presented acceptable or adequate weight gain.

Análise do crescimento de recém-nascidos pré-termo com gastrosquise durante a Internação em Unidade de Terapia Intensiva Neonatal / Growth analysis of preterm newborns with gastroschisis during hospitalization in a neonatal intensive care unit

ABSTRACT BACKGROUND: Gastroschisis, especially complex type, prematurity and low birth weight are associated with a worse clinical outcome with higher mortality, higher incidence of sepsis and catheter-related infection, cholestasis, short bowel syndrome, greater number of days to achieve full diet, longer time of parenteral nutrition and longer hospitalization time. OBJECTIVE: To evaluate the growth of preterm newborns with gastroschisis during their hospitalization in the neonatal intensive care unit. METHODS: Descriptive study, based on a retrospective cohort (January 2012 to December 2018), including preterm newborns (gestational age less than 37 weeks) with simple and complex gastroschisis admitted in a tertiary neonatal intensive care unit. The following parameters were analyzed: maternal age, parity, type of delivery, birth weight, gender, gestational age, nutritional adequacy, type of gastroschisis, fasting time, parenteral nutrition time, time until achieving full enteral nutrition, hospitalization time, weight gain and outcome. The results were expressed in percentage, average, and median. RESULTS: A total of 101 newborns with gastroschisis were admitted, of which 59.4% were premature (80.7% of late preterm infants). From the maternal data, the mean age was 21.2 years and 68.3% were primiparous. Regarding childbirth: 80% were cesarean sections. From newborns: the average birth weight was 2137 g, 56.6% were female, the average gestational age was 34.8 weeks, the average weight gain was 20.8 g/day during hospitalization and 83.3% were discharged from the hospital. CONCLUSION: The growth analysis by weight gain (grams/day) during hospitalization in the intensive care unit showed that more than 90% of the sample presented acceptable or adequate weight gain.

RESUMO CONTEXTO: Gastrosquise, principalmente o tipo complexo, prematuridade e baixo peso ao nascer estão associados a um pior desfecho clínico com maior mortalidade, maior incidência de sepse e infecção relacionada ao cateter, colestase, síndrome do intestino curto, maior número de dias para atingir dieta plena, maior tempo de nutrição parenteral e maior tempo de internação. OBJETIVO: Avaliar o crescimento de recém-nascidos pré-termo com gastrosquise durante sua internação na unidade de terapia intensiva neonatal. MÉTODOS: Estudo descritivo, baseado em uma coorte retrospectiva (janeiro de 2012 a dezembro de 2018), incluindo recém-nascidos pré-termo (idade gestacional inferior a 37 semanas) com gastrosquise simples e complexa, admitidos em uma unidade de terapia intensiva neonatal de nível terciário. Foram analisados: idade materna, paridade, tipo de parto, peso de nascimento, gênero, idade gestacional, adequação nutricional, tipo de gastrosquise, tempos de jejum, de nutrição parenteral, até atingir nutrição enteral plena e de internação, ganho de peso e desfecho. Os resultados estão expressos em porcentagem, médias e medianas. RESULTADOS: Foram admitidos 101 recém-nascidos com gastrosquise, dos quais 59,4% eram prematuros (80,7% prematuros tardios). Dos dados maternos, a idade média foi de 21,2 anos e 68,3% eram primigestas. Com relação ao parto: 80% foram cesarianas. Dos recém-nascidos: o peso médio de nascimento foi de 2137 g, 56,6% eram do sexo feminino, a idade gestacional média foi de 34,8 semanas, o ganho médio de peso de 20,8 g/dia durante a internação e 83,3% receberam alta hospitalar. CONCLUSÃO: A análise do crescimento por meio de ganho de peso (gramas/dia) durante a internação na unidade de terapia intensiva mostrou que mais de 90% da amostra apresentou ganho aceitável ou adequado de peso.