Necrotizing Enterocolitis in a 34-Week Premature Infant with COVID-19

Coronavirus disease 2019 (COVID-19) is a viral respiratory infection caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). While SARS-CoV-2 is a leading cause of morbidity and mortality in older adults, COVID-19 also affects newborn infants in nurseries and the Neonatal Intensive Care Units (NICUs). The majority of infected neonates are believed to acquire SARS-CoV-2 by horizontal transmission, and most of them have asymptomatic or mild symptomatic infections. In rare cases, infants with COVID-19 may have severe complications resulting in death. We report a case of COVID-19 in a premature neonate born at 34 weeks gestational age who presented with hypothermia and respiratory distress and subsequently developed clinical and radiological signs of necrotizing enterocolitis (NEC). The neonate received medical management, including antibiotics, suspension of gastric feeds, and intensive NICU support. The neonate’s clinical condition improved without surgical intervention, and after 10 days of antibiotics and gradual reestablishment of gastric feeds, patient health condition returned to normal, and weeks later, he was discharged home. COVID-19 in infants is frequently asymptomatic or associated with mild disease, and in rare cases, it may be associated with severe gastrointestinal complications including NEC.

Airway injury and pneumomediastinum associated with less invasive surfactant administration in a premature neonate: a case report

Background The use of less invasive surfactant administration (LISA)/minimally invasive surfactant therapy (MIST) has increased due to its potential advantage over traditional surfactant delivery methods through an endotracheal tube. Known complications for this procedure include failure of the first attempt at insertion, desaturation, and bradycardia. To the best of our knowledge, this is the first reported case of pneumomediastinum and subcutaneous emphysema following LISA. Case presentation A preterm newborn born at 27 weeks of gestation presented with respiratory distress syndrome requiring surfactant replacement. LISA using the Hobart method was completed. There was a report of procedural difficulty related to increased resistance to insertion of the 16G angiocath. The newborn was subsequently noted to have subcutaneous emphysema over the anterior aspect of the neck and substantial pneumomediastinum on radiological assessment. Associated complications included hypotension requiring inotropic support. The newborn was successfully managed conservatively, with complete resolution of the air leak. Conclusions Upper airway injury leading to air leak syndrome is a rare complication of the Hobart method for LISA. Awareness of such procedural complications is important as the use of the LISA method increases.

Divergências metodológicas entre os estudos que avaliaram a associação entre as síndromes hipertensivas da gestação e a prematuridade: uma revisão integrativa da literatura

Objetivos: Avaliar as divergências metodológicas entre os estudos que analisaram a associação entre as síndromes hipertensivas da gestação e a prematuridade. Métodos: Trata-se de em uma revisão integrativa da literatura, realizada entre setembro de 2020 e janeiro de 2021. A busca dos artigos foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde, Embase, Web of Science e Scopus com base na combinação dos seguintes descritores: (“Pregnancy Induced Hypertension” OR “High Risk Pregnancy”) AND (“Prematurity” OR “Prematury Birth” OR “Premature Neonate” OR “Neonate Prematurity”). Resultados e Discussão: Foram encontrados 582 artigos, sendo apenas nove foram selecionados. As principais disparidades metodológicas observadas foram relativas à classificação das síndromes hipertensivas da gestação e da prematuridade, idade das participantes e controle de confundidores. Do total de estudos selecionados, cinco informaram as diferentes diretrizes utilizadas para a classificação das síndromes e seis utilizaram o ponto de corte inferior a 37 semanas para a prematuridade. A maior parte dos artigos encontraram associação entre as diferentes categorias das síndromes hipertensivas e a prematuridade. Conclusão: Mesmo diante das divergências metodológicas observadas entre os estudos, foi verificada associação entre as síndromes hipertensivas da gestação e a prematuridade. Para fins comparativos, é recomendável que novos estudos utilizem as diretrizes internacionais vigentes para definição das síndromes hipertensivas e da prematuridade. Além disso, é importante ressaltar a importância da adequação do pré-natal com intuito de acompanhar e tratar as mulheres com síndromes hipertensivas visando a diminuição das complicações decorrentes desta condição clínica, sobretudo a prematuridade.

Infección metastásica por Staphylococcus aureus en neonatos: a propósito de un caso

Metastatic infection as an infrequent complication of Staphylococcus aureus bacteremia in neonates is challenging due to the limited literature. To report the clinical case of a premature neonate who developed a metastatic infection as a complication of S. aureus bacteremia. We present the case of a premature neonate admitted to the Neonatal Intensive Care Unit, diagnosed with bacterial sepsis, neonatal respiratory distress syndrome, and involvement by premature rupture of the membrane. A patch catheter was inserted, and he was successfully treated for E. coli bacteremia. He was re-admitted for late sepsis due to infection with multi-sensitive S. aureus in a patch catheter. An abscess appears on the front of the chest due to S. aureus, confirming metastatic infection. The abscess was drained with a favorable resolution of the clinical picture. In neonates submitted to invasive procedures, it is essential to monitor the clinical evolution and early identification of metastatic infection after Staphylococcus aureus bacteremia and provide early treatment to avoid sequelae.

Transcatheter mechanical thrombectomy of neonatal occlusive aortic thrombus using an Amplatzer Piccolo PDA occluder

Neonatal aortic thrombus is a rare and critical condition that can present mimicking severe coarctation of the aorta or interrupted aortic arch. Transcatheter thrombectomy for this lesion has not been well described. We report a premature neonate with an occlusive proximal descending aorta thrombus, who underwent transcatheter mechanical thrombectomy using an Amplatzer Piccolo PDA occluder (Abbott, North Chicago, IL, USA). The procedure was successful with no subsequent distal thromboembolic events.