RESUMO
Introduction: Urinary tract infections (UTIs) are widespread clinical disorder among early neonates. Neonates with UTIs were susceptible to higher rates of morbidity and mortality, particularly when presented with hyperbilirubinemia. Early diagnosis may help in complete recoveryrather than being threatened in terms of complications. The study aimed at determining the prevalence and predictive risk factors of UTIs in neonates with an unexplained hyperbilirubinemia. Method: A cross-sectional study was carried out in the NICU of Aswan University Hospital, Egypt from August 2018 to February 2019. The study was conducted on 140 newborns who were diagnosed with indirect hyperbilirubinemia in the first 4 weeks of life after exclusion of unrelated criteria. Demographic and clinical data were collected by an interview questionnaire. Biochemical markers including bilirubin level, CBC, urine analysis and urine cultures and sensitivity were determined. Results: The prevalence rate of UTIs in the studied newborns was 25%. Escherichia -coli was the dominant organism isolated. Amikacin was the most common antibiotic sensitive to the isolates. There was a significant difference between the UTI positive and negative neonates in the univariate analysis regarding some studied variables. While, an increase in the number of WBCs in the blood (OR = 6.90, P = 0.001), small for gestational age (OR = 4.07, P = 0.021), prolonged phototherapy (OR = 3.50, P = 0.034), and presence of maternal complications (OR = 2.92, P = 0.001) were statistically associated with a positive urine culture in multivariate analysis. Conclusions and recommendations: The prevalence rate of UTIs was 25%. The study indicated the importance of routine screening of UTI (urine culture) as part of the clinical assessment of unexplained hyperbilirubinemia in neonates with an increase in the number of WBCs in their blood, small for gestational age, prolonged duration of phototherapy, and neonates born from mothers who had a history of obstetric complications
Assuntos
Humanos , Recém-Nascido , Infecções Urinárias/terapia , Amicacina/uso terapêutico , Valor Preditivo dos Testes , Morbidade , Mortalidade , Técnicas de Laboratório Clínico , Diagnóstico Precoce , Hiperbilirrubinemia Neonatal/complicaçõesRESUMO
Introducción: Los recién nacidos pretérminos tardíos (RNPT-T) son los neonatos nacidos entre las 34 y 36 semanas de edad gestacional. Debido a su incremento es importante conocer el comportamiento de los mismos, a fin de adecuar el manejo y seguimiento posteriores al alta. Este estudio describe la morbimortalidad, mortalidad, síndrome de dificultad respiratoria (SDR), ictericia, dificultad en la alimentación e hipoglucemia asociada a los RNPT-T en comparación con los RNT. Población y métodos: Estudio de cohortes retrospectivo. Se incluyeron 500 RN entre 34 a 36,6 semanas (RNPT-T) y 500 entre 37-41,6 semanas (RNT) de edad gestacional nacidos en el HMI "Ramón Sardá" de Buenos Aires entre 2007 y 2008. Resultados: Los RNPT-T presentaron significativamente mayor mortalidad que los RNT (2,9 vs. 0,49 respectivamente (RR 4,1 IC 95% 3,2-15,7) y morbilidad, representada por mayor SDR, ictericia, dificultad en la alimentación, internación prolongada e hipoglucemias. Conclusión: Los recién nacidos pretérminos tardíos presentan mayor mortalidad y morbilidades que los recién nacidos de termino.
Introduction: Late preterm infants are the infants born between 34 and 36 weeks of gestational age. Because of the increase is important to know their behavior in order to adapt the management and follow-up after discharge. We described in this study the morbidity associated with late preterm infants compared to term infants, determine the incidence of complications often presented such as respiratory distress syndrome (RDS), jaundice, feeding difficulty, hypoglycemia, and death in comparison with infants of =37 weeks gestation age. Population and methods: Retrospective cohort study of infants from 34 to 36.6 weeks gestational age (M=500) born in the "Ramón Sardá" Maternity Hospital during 2007 and 2008. Results: We found that PNB-T had significantly higher mortality compared with the term infants (2.9 vs.0.49 , RR 4.1 95% CI 3.2 - 15.7). RDS, jaundice, feeding difficulty, prolonged and major hypoglycemia were higher in the study group. Conclusion: Late preterm infants have higher mortality and morbidity than term infants.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Doenças do Prematuro , Morbidade/tendências , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/mortalidade , Idade Gestacional , Hiperbilirrubinemia Neonatal , Hipoglicemia , Recém-Nascido Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido , Nascimento a TermoRESUMO
El egreso precoz del recién nacido, definido como el alta de las 48 horas del nacimiento, se ha convertido en una práctica clínica rutinaria, motivada en parte por la presión familiar de convertir el acto de nacer en un acontecimiento natural, y fomentada por la escasez de camas maternas en los institutos públicos de salud. A pesar de su frecuente aplicación, no existen estudios bien diseñados que demuestren la seguridad del egreso precoz cuando se emplea de manera colectiva. Aunque ofrece beneficios biológicos y sociales, el alta temprana puede ser un procedimiento riesgoso, debido a situaciones no detectadas que pueden amenazar el bienestar del neonato en el ambiente del hogar, cuando el niño no está siendo supervisado por personal de salud. Las complicaciones neonatales asociadas al egreso precoz son más frecuentes cuando el alta no se complementa con una visita temprana programada a las 48 horas del alta, y cuando se aplica de manera masiva, sin individualizar las necesidades particulares de cada pareja madre-niño. La condición neonatal más importante relacionada al alta precoz es la hiperbilirrubinemia excesiva, especialmente en el neonato prematuro tardío. La Academia Americana de Pediatría ha establecido un conjunto de criterios mínimos a cumplir para que el neonato se vaya al hogar antes de 48 horas, el seguimiento de los cuales es variable entre los pediatras. Estas normas son dificiles de cumplir en los hospitales públicos venezolanos, debido a la alta densidad de nacimientos y a características demográficas particulares. Es factible que se requiera la formulación de requisitos propios de egreso que se puedan aplicar en grupos bien seleccionados de nuestra población.
Early newborn discharge has progressively become a common clinical practice in many institutions, due to the mothers' wish to demedicalize the childbirth process and to the scarcity of maternal beds in public hospitals. Although early discharge provides social and biological benefits, its collective application may be associated with risks for the mother and the newborn, since immediate postnatal recovery has shifted from the hospital to the home, where the infant is not being supervised by health professionals. These risks are more relevant when short stays are not complemented with a follow-up visit within 48 hours, and when early discharge is massively applied without consideration for particular needs of mothers and infants. The most common neonatal complication seen after early newborn discharge is extreme hyperbilirubinemia, most notorious in late preterm infants. A list of minimal criteria for early discharge has been published by the American Academy of Pediatrics. The compliance with these guidelines is highly variable among pediatricians, and its suitability in our maternity wards is not warranted. Formulation of particular criteria adjusted to the demographic and behavioral characteristics of our perinatal population seems mandatory.