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Enterocolite necrosante no recém-nascido de termo e pré-termo tardio : análise de pequena série
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Resumo(s)
A enterocolite necrosante (ECN) constitui a emergência gastrointestinal mais comum do período neonatal, estando associada a elevadas taxas de mortalidade e morbilidade. Os recém-nascidos em maior risco para o desenvolvimento desta doença são os grandes prematuros, representando cerca de 90% dos casos. Os restantes 10% ocorrem em recém-nascidos de termo e peritermo, constituindo, portanto, uma entidade mais rara. Nesta população, ao contrário dos recém-nascidos prematuros, associam-se frequentemente comorbilidades de base que tornam estes recém-nascidos mais suscetíveis ao desenvolvimento de ECN. As manifestações da doença, marcha diagnóstica e tratamento são sobreponíveis entre recém-nascidos prematuros e de termo. O diagnóstico é dificultado pela reduzida especificidade das manifestações da doença, sendo as radiografias seriadas de abdómen o meio complementar de diagnóstico goldstandard, com ou sem recurso à ecografia abdominal. O tratamento médico inclui a instituição de antibioterapia empírica de largo-espetro, pausa alimentar, nutrição parentérica e sonda nasogástrica para descompressão abdominal, sendo muitas vezes necessária intervenção cirúrgica. Além da prevenção da própria prematuridade e da evicção do uso de antibioterapia de largo espectro, a prevenção da doença passa pela administração de leite materno, sendo a maturação fetal com corticoterapia pré-natal e a administração de probióticos possíveis estratégias preventivas a adotar.
Neste trabalho apresentam-se três casos clínicos de recém-nascidos de termo e pré-termo tardio, com idades gestacionais entre as 36 e as 38 semanas, que foram tratados num serviço de neonatologia de nível terciário. São casos exemplificativos de ECN em idades gestacionais avançadas, ilustrando as manifestações clínicas associadas à doença, a marcha diagnóstica realizada, os tratamentos a que foram submetidos, e os possíveis fatores de risco associados a esta população.
Necrotizing Enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal period, and is associated with high mortality and morbidity rates. The newborns at higher risk are the very preterm, accounting for about 90% of the cases. The remnant 10% occur in term and near-term newborns, hence being a much rarer occurrence. In this population, unlike in premature newborns, the presence of basal comorbidities is frequent, putting them at a greater risk for development of NEC. Clinical manifestations of the disease, diagnosis work-up and treatment are similar among premature and full-term newborns. The diagnosis can prove difficult due to lack of specificity of clinical presentation, and can be aided by serial abdominal radiographs, currently the goldstandard, with or without abdominal ultrasound. Medical treatment includes broad-spectrum antibiotics, withdrawal of enteral feeding, parenteral nutrition, abdominal decompression and, frequently, surgical intervention. Aside from preventing prematurity and avoiding broad-spectrum antibacterial therapy, other preventive measures include the administration of breast milk. Fetal maturation with antenatal corticosteroid therapy and administration of probiotics are also preventive strategies up for consideration. In this paper we report three clinical reports of term and late preterm newborns, gestational ages ranging between 36 weeks and 38 weeks, treated for NEC in a tertiary-level neonatology service. These are illustrative cases of NEC at an advanced gestational age, showing the clinical manifestations associated to the disease, the diagnostic work-up, treatment, and risk factors in this small group.
Necrotizing Enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal period, and is associated with high mortality and morbidity rates. The newborns at higher risk are the very preterm, accounting for about 90% of the cases. The remnant 10% occur in term and near-term newborns, hence being a much rarer occurrence. In this population, unlike in premature newborns, the presence of basal comorbidities is frequent, putting them at a greater risk for development of NEC. Clinical manifestations of the disease, diagnosis work-up and treatment are similar among premature and full-term newborns. The diagnosis can prove difficult due to lack of specificity of clinical presentation, and can be aided by serial abdominal radiographs, currently the goldstandard, with or without abdominal ultrasound. Medical treatment includes broad-spectrum antibiotics, withdrawal of enteral feeding, parenteral nutrition, abdominal decompression and, frequently, surgical intervention. Aside from preventing prematurity and avoiding broad-spectrum antibacterial therapy, other preventive measures include the administration of breast milk. Fetal maturation with antenatal corticosteroid therapy and administration of probiotics are also preventive strategies up for consideration. In this paper we report three clinical reports of term and late preterm newborns, gestational ages ranging between 36 weeks and 38 weeks, treated for NEC in a tertiary-level neonatology service. These are illustrative cases of NEC at an advanced gestational age, showing the clinical manifestations associated to the disease, the diagnostic work-up, treatment, and risk factors in this small group.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Enterocolite necrosante Recém-nascido de termo Recém-nascido pré-termo Prevenção Factores de risco Pediatria