A preterm neonate underwent emergent laparotomy for presumed necrotizing enterocolitis (NEC). Intraoperatively, neonatal perforated appendicitis (NPA) was encountered. This may represent a form of NEC localized to the appendix. A high index of clinical suspicion and early laparotomy are recommended.Key words: Neonatal perforated appendicitis; Neonatal appendicitis; Necrotizing enterocolitis; Localized NEC CASE REPORTAn 1890-g male product of a dichorionic-diamniotic twin intrauterine pregnancy was born at 36 0/7 weeks' gestation to a 27-year-old G2P3 mother who had received regular antenatal care. The prenatal labs and habit history were unremarkable; prenatal ultrasound demonstrated intrauterine growth restriction (IUGR). Following spontaneous onset of labor, twin-A was delivered vaginally, and our patient was then delivered by cesarean section for footling breech presentation. Apgar scores at 5 and 10 minutes were 8 and 10, respectively, with initial heart rate between 100-120 beats per minute and oxygen saturation <70% responsive to brief positive pressure ventilation. The patient was admitted to the Neonatal Intensive Care Unit (NICU) for further management and care. His initial NICU stay was uneventful aside from physiologic hyperbilirubinemia requiring phototherapy and recalcitrant hypoglycemia requiring parenteral alimentation and glucose infusion. He remained hemodynamically normal on room air through the first nine days of life.He was tolerating oral feeds on fortified breast milk and appropriately gained weight to 1960-grams. On the tenth day of his NICU stay he developed feeding intolerance and mild fever to 38 °C. The abdomen was moderately distended with mild diffuse tenderness to palpation and hypoactive bowel sounds in all 4 quadrants. Minimal abdominal wall erythema was noted but no overt signs of peritonitis, palpable hernias, or masses were appreciated. Abdominal radiograph demonstrated gaseous distension and pneumatosis intestinalis of bowel loops in the right lower and upper quadrants (Fig.1A). The white blood cell count was 6,000 cells/mm3 with 8% bands. C-reactive protein was 168mg/dL. Comprehensive metabolic panel was within normal range. He was made nil per oral, a nasogastric tube was placed, blood cultures were drawn, and he was started on intravenous vancomycin (15mg/kg), amikacin (15mg/kg), and a loading dose of metronidazole (15mg/kg). Repeat abdominal radiograph three hours later revealed intraperitoneal free air (Fig.1B). Patient was emergently brought to the operating room for exploratory laparotomy, washout and possible bowel resection, for a CASE REPORT
Objectives Intranasal fentanyl and midazolam use is increasing in the acute care setting for analgesia and anxiolysis, but there is a lack of literature demonstrating their use, alone or in combination, at pediatric urgent care centers. Methods This retrospective study investigated intranasal fentanyl and midazolam use at an urgent care center located within Le Bonheur Children's Hospital and 2 affiliated off-site centers from September 22, 2011, to December 30, 2015. Data collected included patient demographics, initial fentanyl dose, initial midazolam dose, type of procedure, and serious adverse drug reactions. Results Of the 490 patients who met the inclusion criteria, 143 patients received intranasal fentanyl alone, 92 received intranasal midazolam alone, and 255 received fentanyl in combination with midazolam. The overall patient population was 50% male with a median (range) age of 4.5 (0.2–17.9) years, and most patients were black at 57.1%. The median (range) initial intranasal fentanyl dose was 2.02 (0.99–4.22) μg/kg, and the median initial (range) intranasal midazolam dose was 0.19 (0.07–0.42) mg/kg. In cases where fentanyl and midazolam were administered in combination, the median (range) initial fentanyl dose was 2.23 (0.6–4.98) μg/kg and median (range) initial midazolam dose was 0.2 (0.03–0.45) mg/kg. There were no serious adverse drug reactions reported. Conclusions Intranasal fentanyl and midazolam when administrated alone and in combination can provide analgesia and anxiolysis for minor procedures in pediatric patients treated in the urgent care setting.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.