Intensive phototherapy treatment for severe haemolytic disease of the newborn

Abstract

ResumoObjetivo: O tétano neonatal é uma infecção com alta mortalidade, constituindo-se um problema em países subdesenvolvidos, onde há deficiente assistência pré-natal. A despeito desse fato e da decrescente incidência da doença no estado do Rio Grande do Sul, relata-se um caso de tétano neonatal ocorrido em 1997.Métodos: Entrevista da mãe e verificação de seu estado vacinal, exame clínico do recém-nascido, exame cultural de coto umbilical e revisão do prontuário médico. Revisão da literatura e verificação do perfil epidemiológico do tétano neonatal no Rio Grande do Sul.Resultados: Mãe saudável, com esquema completo de vacina antitetânica há 4 anos, pré-natal sem intercorrências e parto hospitalar. Família de bom nível socioeconômico, diferenciando-se dos demais casos notificados no Estado, em que a maioria não teve acompanhamento pré-natal nem parto hospitalar. O paciente é um menino que no 24º dia de vida iniciou com febre, crises de cianose, hipertonia dos membros superiores e inferiores e opistótono. Crescimento de Clostridium tetani ao exame cultural de secreção do coto umbilical. Tratado com penicilina G, gentamicina, sedação e antitoxina tetânica. Alta em boas condições.Conclusões: A deficiente assistência pré-natal em países subdesenvolvidos é o maior fator de risco para a elevada incidência da doença nestas regiões. Contudo, em gestantes com bom nível socioconômico e acompanhamento pré-natal, como ocorre no caso descrito, o diagnóstico não deve ser excluído diante da constatação de sinais sugestivos. AbstractObjective: Neonatal tetanus is an infection with high mortality, constituting a problem in underdeveloped countries, where there is faulty prenatal attendance. In spite of this and of the decreasing incidence of the disease in the state of Rio Grande do Sul, we report a case of neonatal tetanus identified in 1997.Method: We interviewed the infant's mother and verified her vaccination history. We conducted a clinical examination of the newborn, anaerobic culture of umbilical stump and review of medical records. We also reviewed the literature and verified the epidemic profile of neonatal tetanus in Rio Grande do Sul.Results: Healthy mother, with complete outline of tetanus vaccination 4 years ago, prenatal uncomplicated and hospital delivery. Family of good socioeconomic level, differing from the other cases notified in the State, in that most did not have prenatal care nor hospital delivery. The patient is a boy. In the 24 th day of life he presented fever, cyanosis, lower and upper limbs muscle hypertonia and opisthotonos episodes. An anaerobic culture of the umbilical stump grew Clostridium tetani. He was treated with penicillin G, gentamicin, sedation and tetanus immunoglobulin. He left hospital in good conditions.Conclusions: Faulty prenatal care in underdeveloped countries is the largest risk factor for high incidence of this disease in these areas. However, in pregnant women with good socioeconomic level and prenatal care, as in the case described here, this diagnosis should not be excluded i...

Effectiveness of single and double phototherapy on indirect hyperbilirubinemia in neonates

“…15 Similar studies, including one in Saudi Arabia, also showed that double phototherapy with blue light was more effective than single phototherapy, with minimal side effects. [16][17][18] light intensity is the factor that determines the effectiveness of phototherapy.…”

Efektivitas Fototerapi Ganda dan Fototerapi Tunggal dengan Tirai Pemantul Sinar pada Neonatus yang Mengalami Jaundice

“…[17][18] Hal ini disebabkan iradiasi spektrum yang lebih tinggi dan lebih luas permukaan tubuh yang terpapar pada fototerapi ganda. Model fototerapi ganda disebut juga sebagai fototerapi intensif yang diberikan pada neonatus yang mengalami peningkatan bilirubin serum yang sangat cepat, [19][20][21][22] seperti yang sering terjadi pada pada bayi berat lahir rendah. [23][24] Studi mengenai efektifitas fototerapi standar dengan memakai tirai pemantul sinar dan fototerapi ganda telah banyak dipublikasikan.…”

“…[23][24] Studi mengenai efektifitas fototerapi standar dengan memakai tirai pemantul sinar dan fototerapi ganda telah banyak dipublikasikan. [15][16][17][18][19][20][21][22][23] Namun belum ada studi yang membandingkan efektifitas dari kedua fototerapi. Penelitian bertujuan untuk membandingkan penurunan bilirubin pada fototerapi tunggal yang menggunakan tirai putih pemantul sinar dengan fototerapi ganda.…”

Dampak Lama Fototerapi Terhadap Penurunan Kadar Bilirubin Total pada Hiperbilirubinemia Neonatal

“…8 Keuntungan fototerapi tidak invasif, efektif, tidak mahal dan mudah digunakan. 9 Fototerapi mengurangi hiperbilirubinemia melalui tiga proses yaitu fotoisomerisasi, isomerisasi struktural dan fotooksidasi. 10 Efektivitas fototerapi tergantung pada kualitas cahaya yang dipancarkan lampu (panjang gelombang), intensitas cahaya (iradiasi), luas permukaan tubuh, ketebalan kulit dan pigmentasi, lama paparan cahaya, kadar bilirubin total saat awal fototerapi.…”