Please use this identifier to cite or link to this item: http://repositorio.uta.edu.ec/jspui/handle/123456789/28153
Title: “Ictericia secundaria a sepsis neonatal”
Authors: Vaca Pazmiño Dr. Esp. PhD., Carlos Fernando
Mora Velasco, Christian Alejandro
Keywords: ICTERICIA_SEPSIS
TEMPRANA_ HIPERBILIRRUBINEMIA
DIRECTA_COLESTASIS NEONATAL
Issue Date: 1-Jun-2018
Publisher: Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina
Abstract: We present the case of a newborn, 35 weeks of gestational age, product of the 4th pregnancy, mother of 31 years, well-controlled pregnancy poorly tolerated, with urinary tract infection from the 4th month of gestation, receiving outpatient treatment , irregular uterine activity from the 5th month of pregnancy until the moment of delivery. At the maternal admission urinary tract infection is detected, antibiotics are administered, uteroinhibition and pulmonary maturation. Institutional vaginal cephalogenesis occurs. Anthropometry at birth, weight 1880gr, size 42cm, APGAR 6-9, amniotic fluid with meconium dye, initial respiratory distress, positive pressure ventilation is administered for 15 seconds, after stabilizing it, the patient is admitted to the neonatal ward. At the initial physical examination: FC: 90 bpm; FR: 65 rpm; T: 38.5 ° C thorax with subcostal retractions, therapeutic management of respiratory distress is achieved, stabilizing it. At 24 hours of age, it has icteric skin, Kramer II area. Initially it is presumed that jaundice is secondary to group incompatibility (O-A), however hemolysis, direct negative coombs and increased bilirubins are not evident at the expense of direct bilirubin. Newborn hemodynamically unstable, with thermal variations, bradycardia, tachypnea, moans, retractions, desaturation, with a history of urinary tract infection of the mother is suspected in a clinical picture of early neonatal sepsis, antibiotic therapy is initiated prior to taking blood culture , treatment that is maintained for 10 days. Presents laboratory values altered in the liver profile, abdominal ultrasound that reports liver and normal bile ducts. Pediatric Gastroenterology is consulted, whose report suggests that it is multifactorial neonatal cholestasis, associated with its prematurity and concomitant pathology (sepsis). The bilirubin values decrease as the child overcomes the septic condition, which clinically demonstrates that it is the direct cause of jaundice.
Description: Se presenta el caso de un recién nacido, de 35 semanas de edad gestacional, producto de la 4ta gesta, de madre de 31 años, embarazo bien controlado mal tolerado, cursa con infección del tracto urinario desde el 4to mes de gestación, recibiendo tratamiento ambulatorio, actividad uterina irregular desde el 5to mes de embarazo hasta el momento del parto. Al ingreso materno se detecta infección del tracto urinario, se administran antibióticos, uteroinhibición y maduración pulmonar. Se produce parto céfalo vaginal institucional. Antropometría al nacer, peso 1880gr, talla 42cm, APGAR 6-9, líquido amniótico con tinte meconial, dificultad respiratoria inicial, se administra ventilación a presión positiva durante 15 segundos, luego de estabilizarlo se ingresa a sala neonatal. Al examen físico inicial: FC: 90 lpm; FR: 65 rpm; T: 38.5 °C tórax con retracciones subcostales, se brinda manejo terapéutico del distrés respiratorio logrando estabilizarlo. A las 24 horas de vida presenta piel ictérica, zona de Kramer II. Inicialmente se presume que la ictericia es secundaria a incompatibilidad de grupo (O-A), sin embargo no se evidencia hemolisis, coombs directo negativo y bilirrubinas aumentadas a expensas de la bilirrubina directa. Recién nacido hemodinamicamente inestable, con variaciones térmicas, bradicardia, taquipnea, quejido, retracciones, desaturación, con el antecedente de infección del tracto urinario de la madre se sospecha en un cuadro clínico de sepsis neonatal temprana, se inicia antibioticoterapia previo a la toma de hemocultivo, tratamiento que se mantiene por 10 días. Presenta valores de laboratorio alterados en el perfil hepático, se realiza ecografía abdominal que reporta hígado y vías biliares normales. Se interconsulta a Gastroenterología pediátrica, cuyo informe sugiere que se trata de colestasis neonatal multifactorial, asociada a su prematurez y patología concomitante (sepsis). Los valores de bilirrubinas decrecen conforme el niño supera el cuadro séptico, lo que clínicamente nos demuestra que, es la causa directa de ictericia
URI: http://repositorio.uta.edu.ec/jspui/handle/123456789/28153
Appears in Collections:Medicina

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