RESUMO
OBJECTIVE: A neonate with a perforated appendix vermiformis in our neonatal intensive care unit (NICU) (case 1) prompted us to review our cases of exploratory laparotomy due to spontaneous intestinal perforation (SIP), surgical necrotizing enterocolitis (NEC), and other neonatal abdominal emergencies to identify additional cases of pathological appendiceal involvement (appendicopathy). METHODS: A retrospective chart review was done for all the cases of exploratory laparotomy in our 16-bed community level-3 NICU between June 2003 and May 2014. RESULTS: A total of 34 patients with exploratory laparotomies were identified. Among the 11 cases with histopathology of the appendix available, only 3 cases had appendicopathy. Of these, only one was conclusive regarding the etiology. CONCLUSIONS: A perforated and/or inflamed appendix does not equal a diagnosis of true appendicitis. The term appendicopathy is in our opinion, therefore preferable because it can be either primary or secondary to more common diagnoses, such as NEC and SIP. The possibility of perforation of the appendix must be considered in all cases of appendicopathy but this diagnosis is difficult to make. Once appendicopathy is found, attempts should be made to identify its etiology to optimize treatment and prognosis. We thus propose an etiologic classification of neonatal appendicopathy.
Assuntos
Apendicite/etiologia , Enterocolite Necrosante/complicações , Doenças do Íleo/complicações , Apendicite/diagnóstico , Técnicas de Diagnóstico por Cirurgia , Enterocolite Necrosante/diagnóstico , Humanos , Doenças do Íleo/diagnóstico , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Estudos Retrospectivos , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico , Terminologia como AssuntoAssuntos
Retardo do Crescimento Fetal , Hiperbilirrubinemia , Doenças do Prematuro , Trombocitopenia , Retardo do Crescimento Fetal/diagnóstico , Humanos , Hiperbilirrubinemia/diagnóstico , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/diagnóstico , Trombocitopenia/diagnósticoRESUMO
The objective of the Registry was to characterize the population of infants receiving prophylaxis for respiratory syncytial virus (RSV) disease by describing the patterns and scope of usage of palivizumab in a cross section of US infants. RSV hospitalization outcomes were also described. The Palivizumab (Synagis, MedImmune, Inc., 25 West Watkins Mill Road, Gaithersburg, MD 20878) Outcomes Registry was a prospective multicenter survey conducted at 63 sites. Demographics, injection history, and RSV hospitalization outcomes were collected on 2,116 infants receiving palivizumab. Infants were enrolled in the Registry between September 1, 2000-March 1, 2001, at the time of their first injection. Infants born at less than 32 weeks of gestation accounted for 47% of infants enrolled, and those between 32-35 weeks accounted for 45%; approximately 8% were greater than 35 weeks of gestation. Lower RSV hospitalization rates were observed in infants who had greater adherence to regularly scheduled injections. Nearly one-half of all hospitalizations occurred within the first and second injection intervals, suggesting the importance of early RSV protection. The confirmed RSV hospitalization rate of all infants in the Registry was 2.9%; the rate was 5.8% in infants with chronic lung disease of infancy, and 2.1% in premature infants without chronic lung disease. In conclusion, these data support the continued effectiveness of palivizumab prophylaxis for severe RSV lower respiratory tract disease in a large cohort of high-risk infants from geographically diverse pediatric offices and clinics. The Palivizumab Outcomes Registry provides an opportunity to assess palivizumab utilization and clinical effectiveness in the US.