Septic arthritis of the shoulder caused by E. coli infection in a premature infantPresentamos el caso de un prematuro de 33 semanas y 1600 g, con antecedente de traslado en las primeras 12 horas de vida a la Unidad de Cuidados Intensivos Neonatales de un hospital terciario por hipertensión pulmonar grave y afectación multiorgánica, que a su regreso a nuestro centro a las 37 semanas corregidas comienza con decaimiento y pausas de apnea. Tras un inicio de cuadro subagudo e inespecífico, con alteraciones analíticas discretas, presenta progresivamente tumefacción, dolor e impotencia funcional del hombro derecho. Se realiza el diagnóstico de artritis séptica del mismo tras evidenciar derrame articular por ecografía y obtener líquido articular purulento en la punción-aspiración. Recibe precozmente antibioterapia empírica, que se ajusta al antibiograma una vez que se conoce que crece un E. coli sin resistencias en el líquido articular. La mejoría es inicialmente lenta pero, tras tres semanas de antibioterapia intravenosa sin necesidad de cirugía abierta, la recuperación es franca aunque no total. Completa otras tres semanas de antibioterapia oral con cefuroxima-axetilo en dosis altas. La evolución en su seguimiento es adecuada, con normalización y desaparición del derrame articular a los cinco meses de edad.We present the case of a premature infant 33 weeks of gestational age and 1600 g, that had required intensive care at a tertiary hospital due to refractory pulmonary hipertensión and multiorganic illness, at his return to our center, at 37 weeks of corrected gestational age, with a peripheral line in his right axilla, presents with frequent apneas and feeding intolerance. The initial presentation is subacute and unspecific, with discrete alterations in his blood tests, but progressively starts with inflammatory signs, pain and shoulder movement limitations. Septic arthritis is diagnosed after revealing joint effusion by ultrasonography and obtaining synovial fluid with purulent characteristics by needle aspiration. He was started on empiric intravenous antibiotics that were later adjusted according to the antibiogram once the results for the synovial fluid culture turned positive for E. coli. Clinical recovery was slow at first, but clearly improved throughout a three week intravenous antibiotic course, and the infant did not need open surgery. At discharge, there was an almost full recovery in terms of movement range of the shoulder and he was pain free. The infant completed another three weeks of oral antibiotics with cefuroxime-axetile. Ongoing follow-up yielded excellent results.
Central cyanosis in a newborn secondary to over production of milk in the mother Presentamos el caso de un neonato que comienza con episodios de cianosis a las 48 horas de vida. Se realiza un diagnóstico diferencial completo y las pruebas complementarias indicadas, descartando patología cardiaca, neurológica, infecciosa o metabólica como causante. A partir de su ingreso, se evidencia clínicamente una hiperproducción de leche materna con cuadros de desaturación en clara relación con las tomas. Se implementan medidas de control de la producción de leche y del flujo de eyección de la misma con excelentes resultados. Evolutivamente, la niña pasa a tolerar bien las tomas, y la producción de leche se va regulando acorde a sus necesidades. A two day old neonate presenting with central cianosis episodes, undergoes a full differential diagnosis and the necessary laboratory and ultrasound tests. No cardiac, neurologic, infectious or metabolic cause is found for these episodes. Upon being admitted to the neonatal unit, the mother presents with clear signs of milk overproduction and the baby is seen to have desaturation falls during breastfeeding. Complete clinical improvement occurs after implementing milk production and ejection flow control strategies. The baby is found to tolerate breastfeeding perfectly thereafter and the mother's milk production gradually descends according to the baby's needs.
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