Sepse neonatal como fator de risco para leucomalácia periventricular em pré-termos de muito baixo peso

Abstract

Objective: To investigate the association between periventricular leukomalacia (PVL) and neonatal sepsis in very low birth weight infants (VLBWI). Methods:We studied VLBWI with a clinical suspicion of infection who had been born at our institution between the 1st of August, 2005 and the 31st of July, 2007. Children were excluded if they died before reaching 14 days, had malformations of the central nervous system or congenital infections. Ultrasound brain scans were carried out on the third day and weekly up until the sixth week of life or discharge. Periventricular leukomalacia was diagnosed by persistent diffuse periventricular hyperechogenecity for more than 7 days, or by periventricular cysts. The VLBWI were separated into two groups on the basis of the presence or absence of PVL. Sepsis was defined as clinical manifestation plus a positive culture. The Mann-Whitney, chi-square and t tests were applied followed by logistic regression.Results: A total of 88 VLBWI were studied. Of these, 62 (70.5%) survived and 51 (57.8%) had PVL. Both groups were similar in terms of birth weight, gestational age, Apgar score, type of delivery, SNAPPE-II score, presence of necrotizing enterocolitis, persistent ductus arteriosus and deaths. Sepsis and mechanical ventilation were more common in the group with PVL (23.5 and 2.7%, p = 0.005; 86 and 59%, p = 0.004, respectively). Both of these were identified as, independent risk factors for PVL by logistic regression (p = 0.027 and 0.015, respectively). Conclusions:Chorioamnionitis has been defined as a risk factor for PVL. We have demonstrated that neonatal sepsis is also an important risk factor. We believe that the systemic inflammatory response is the principal factor involved in the etiopathogenesis of PVL among VLBWI.J Pediatr (Rio J). 2008;84(3):211-216: Prematurity, neonatal sepsis, periventricular leukomalacia, very low birth weight.

Infectious diseases in the neonatal period: A literature review

“…According to Silveira (2012), the diagnosis of early neonatal sepsis should be anticipated due to its high morbidity and mortality, based on maternal and neonatal risk factors, clinical manifestations of the newborn, and laboratory tests, such as: blood culture (gold standard), blood count, C-reactive protein (CRP), cerebrospinal fluid, urine, among others. And in order to confirm the diagnosis of neonatal sepsis, the presence of three or more clinical signs of the newborn or at least two of these clinical signs, associated with maternal risk factors, are necessary.…”

Avaliação de recém nascidos pré-termo com hemorragia peri-intraventricular e/ou leucomalácia periventricular

“…Pesquisas têm demonstrado que quanto mais precoce é o nascimento do bebê, maior é a influência sob a anatomia e a biodinâmica desta criança, podendo interferir no seu desenvolvimento motor [14][15][16] .…”

Terapia nutricional e sepse neonatal

“…(17,18) The pathophysiological changes are mostly dependent on the host and the toxins released by the offending organism. (5,19) These toxins may trigger the release of acute inflammatory response mediators (20) and increase the amount of circulating pro-inflammatory and antiinflammatory cytokines. The balance between the host and the pathogen defenses will determine the infant's outcome.…”

“…Early life malnutrition may have permanent effects on the development of the central nervous system and body growth. (20,21,23) Nutrition, both enteral and parenteral, has an important role in the prevention of neonatal sepsis by minimizing nutrient loss and stimulating the maturation of the gastrointestinal tract. The use of breast milk and early enteral nutrition are important for reducing the risk of infections.…”