Enterocolitis necrotizante neonatal: valor de la sangre oculta en heces fecales para su diagnóstico. Análisis de una casuística.
Fecha
2001
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Universidad de Guayaquil. Facultad de Ciencias Químicas
Resumen
La Enterocolitis Necrotizante gastrointestinal adquirida más común del recién nacido pretérmino. Es una enfermedad grave de origen complejo, manifestada por distensión abdominal, vómitos, hematoquezia (sangre en heces), perforación intestinal y peritonitis. Los hallazgos radiológicos confirman el diagnóstico al advertir neumatosis intestinal y gas venoso portal.
Se realizó un estudio retrospectivo en el Hospital Pediátrico Roberto Gilberth Elizalde en 60 neonatos que entraron por el área de emergencia entre el periodo de febrero a mayo del 2001 con sospecha de ECN, fueron sometidos al estudio de sangre oculta en heces fecales en el momento de su ingreso y de acuerdo al grado de positividad (trazas; x; xx; xxx) sirvió para clasificar el tipo de ECN y determinar su diagnóstico y pronóstico.
El 100% de los pacientes presentaron sangre oculta en heces fecales positivo de los cuales el 23.3% corresponden, una x de positividad, el 38.3% a xx y el 48.3% a xxx lo que indica el periodo avanzado dela ECN.
El grupo etáreos más vulnerable a hacer ECN en heces fecales positivo son los prenmaturos (<2.5 Kg.) .
Los niños recién nacidos hasta 1 mes tuvieron una prevalencia de 46.7% de la enfermedad, pero debido a que no contaba en su historia clínica la edad gestacional y presentaron signos y síntomas clínicos precisamente por su inmadurez, se deduce que más o menos el 50% de ellos (< de 1 mes con normal) habían sido prematuros, cifra que sumándose al número absoluto de prematuros (36.7%) que fueron considerados así por su bajo peso (<2.5 Kg) al momento de presentar el cuadro clínico, sobrepasan la mitad del total de los casos estudiados, concluyendo que el grupo etáreo más vulnerable a hacer ECN son los prematuros.
Los neonatos más afectados fueron del sexo masculino con un 65%, que habían recibido como alimentación leche de fórmula(23.3%), con una temperatura alterada del 56.7%, de los cuales el 33.3% tenían hipertermia y el 23.3% hipotermia, el 56.7% cursaron con vómito, frecuencia cardiaca y respiratoria alteradas (43.3 – 45%) respectivamente; perímetro abdominal distendido (68%) con leucocitosis 20%; segmentados elevados 93.3%, lo que indica que la infección es bacteriana.
El examen de rayos x simple y pie de abdomen demuestran resultados del 96.7% de pacientes con Edema Interasas (EIA) debido a la lesión intestinal; el 100% de Asas dilatadas correspondió, el 30% a leve dilatación, el 35% a moderada dilatación y el 35% con asas muy dilatadas. En cuanto al aire en ampolla rectal que normalmente debe existir, ya que demuestra peristalsis intestinal, el 58.3% correspondieron a neonatos con ausencia de él debido a la disminución o pérdida de la función intestinal.
The Enterocolitis acquired gastrointestinal Necrotizante more common of the recently born pretérmino. It is a serious illness of complex origin, manifested by abdominal distension, vomits, hematoquezia (it bleeds in grounds), intestinal perforation and peritonitis. The radiological discoveries confirm the diagnosis when noticing intestinal neumatosis and gas veined portal. She/he was carried out a retrospective study in the Pediatric Hospital Roberto Gilberth Elizalde in 60 neonatos that entered for the emergency area among the period of February to May of the 2001 with suspicion of ECN, they were subjected to the study of hidden blood in fecal grounds in the moment of their entrance and according to the positividad degree (you trace; x; xx; xxx) it was good to classify the type of ECN and to determine their diagnosis and presage. 100% of the patients presented hidden blood in positive fecal grounds of which 13.3% corresponds, a positividad x, 38.3% to xx and 48.3% to xxx what indicates the advanced period of the ECN. The children recently born up to 1 month they had a prevalencia of 46% of the illness, but because it didn't count in their clinical history the age gestacional and they in fact presented signs and clinical symptoms for their immaturity, it is deduced that more or less 50% of them (<of 1 month with normal) they had been premature, it calculates that being added to the absolute number of premature (37%) that were considered this way by their first floor weight (<2.5 Kg) to the moment to present the clinical square, they surpass half of the total of the studied cases, concluding that the group more vulnerable etáreo to make ECN is the premature ones. The affected neonatos was of the masculine sex with 65% that you/they had received as feeding formula milk (23.3%), with an altered temperature of 56.7%, of which 33.4% had hipertermia and the 23.3% hypothermia, 56.7% studied with vomit; 40% cpn depositions diarréicas; altered heart and breathing frequency (43.3 - 45%) respectively; loosened abdominal perimeter (58.3%); with leucocitosis 20%; segmented high 93.3%, what indicates that the infection is bacterial. The exam of rays simple x and foot of abdomen demonstrate results of 96.7% of patient with Edema Interasas (EIA) due to the intestinal lesion; 100% of extensive Handles corresponded, 30% to light dilation, 35% to moderate dilation and 35% with very extensive handles. As for the air in rectal bladder that should exist usually, since demonstrates intestinal peristalsis, 58.3% they corresponded to neonatos with absence of him due to the decrease or loss of the intestinal function.
The Enterocolitis acquired gastrointestinal Necrotizante more common of the recently born pretérmino. It is a serious illness of complex origin, manifested by abdominal distension, vomits, hematoquezia (it bleeds in grounds), intestinal perforation and peritonitis. The radiological discoveries confirm the diagnosis when noticing intestinal neumatosis and gas veined portal. She/he was carried out a retrospective study in the Pediatric Hospital Roberto Gilberth Elizalde in 60 neonatos that entered for the emergency area among the period of February to May of the 2001 with suspicion of ECN, they were subjected to the study of hidden blood in fecal grounds in the moment of their entrance and according to the positividad degree (you trace; x; xx; xxx) it was good to classify the type of ECN and to determine their diagnosis and presage. 100% of the patients presented hidden blood in positive fecal grounds of which 13.3% corresponds, a positividad x, 38.3% to xx and 48.3% to xxx what indicates the advanced period of the ECN. The children recently born up to 1 month they had a prevalencia of 46% of the illness, but because it didn't count in their clinical history the age gestacional and they in fact presented signs and clinical symptoms for their immaturity, it is deduced that more or less 50% of them (<of 1 month with normal) they had been premature, it calculates that being added to the absolute number of premature (37%) that were considered this way by their first floor weight (<2.5 Kg) to the moment to present the clinical square, they surpass half of the total of the studied cases, concluding that the group more vulnerable etáreo to make ECN is the premature ones. The affected neonatos was of the masculine sex with 65% that you/they had received as feeding formula milk (23.3%), with an altered temperature of 56.7%, of which 33.4% had hipertermia and the 23.3% hypothermia, 56.7% studied with vomit; 40% cpn depositions diarréicas; altered heart and breathing frequency (43.3 - 45%) respectively; loosened abdominal perimeter (58.3%); with leucocitosis 20%; segmented high 93.3%, what indicates that the infection is bacterial. The exam of rays simple x and foot of abdomen demonstrate results of 96.7% of patient with Edema Interasas (EIA) due to the intestinal lesion; 100% of extensive Handles corresponded, 30% to light dilation, 35% to moderate dilation and 35% with very extensive handles. As for the air in rectal bladder that should exist usually, since demonstrates intestinal peristalsis, 58.3% they corresponded to neonatos with absence of him due to the decrease or loss of the intestinal function.
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ENTEROCOLITIS NECROTIZANTE NEONATAL, SANGRE OCULTA - HECES FECALES, CIENCIAS CLINICAS