Neonatal appendicitis: a survival case study

Abstract

Objective: To report a case of neonatal appendicitis in a children's hospital in southern Brazil, demonstrating the impact on neonatal survival. Method: Case study with data collection from medical records, approved by the Institution and Ethics Committee for Research with Human Beings. Results: The clinical picture is initially characterized by food intolerance, evolving to hypoactivity, alteration of vital signs and septicemia due to intestinal perforation. Management is exclusively surgical, since no case described in the literature was diagnosed preoperatively and the findings usually point to acute abdomen. Conclusion: A focused clinical surveillance should be established when the infant presents peritoneal irritation. Follow-up of the evolution and the worsening of the symptoms by nurses, as part of the care team in partnership with the medical team, enables an early surgical intervention, thereby avoiding complications such as septicemia and death. Descriptors: Appendicitis; Neonatal Intensive Care Unit; Nursing; Neonate; Survival. RESUMO Objetivo: Divulgar um caso de apendicite neonatal ocorrido em um hospital infantil do Sul do Brasil, evidenciando o impacto na sobrevida do neonato. Método: Estudo de caso com coleta de dados em prontuário, aprovado pela Instituição e pelo Comitê de Ética em Pesquisa com Seres Humanos. Resultados: O quadro clínico é caracterizado inicialmente por intolerância alimentar, evoluindo para hipoatividade, alteração de sinais vitais e septicemia por perfuração intestinal. A conduta é exclusivamente cirúrgica, pois nenhum caso descrito na literatura foi diagnosticado no pré-operatório e os achados normalmente voltam-se para abdome agudo. Conclusão: Deve-se estabelecer uma vigilância clínica enfocada quando o recém-nascido apresenta quadro de irritação peritoneal. O acompanhamento da evolução e a piora dos sintomas pela enfermagem, como parte da equipe de cuidado e parceira da equipe médica, propicia intervenção cirúrgica precoce, evitando complicações como septicemia e óbito. Descritores: Apendicite; Unidade de Terapia Intensiva Neonatal; Enfermagem; Recém-Nascido; Sobrevida. RESUMEN Objetivo: Divulgar un caso de apendicitis neonatal ocurrido en un hospital infantil del Sur de Brasil, evidenciando el impacto en la sobrevida del neonato. Método: Estudio de caso con coleta de datos en prontuario, aprobado por la Institución y por El Comité de Ética en Pesquisa con Seres Humanos. Resultados: El cuadro clínico es caracterizado inicialmente por intolerancia alimentar, evolucionando para hipoactividad, alteración de señales vitales y septicemia por perforación intestinal. La conducta es exclusivamente quirúrgica, pues ningún caso descrito en la literatura fue diagnosticado en el preoperatorio y los allazgos normalmente se vuelven hacia el abdomen agudo. Conclusión: Se debe establecer una vigilancia clínica enfocada cuando el recién nacido presenta cuadro de irritación peritoneal. El acompañamiento de la evolución y la empeora de los síntomas por la enfermería, como parte del e...

An Experience with 31 Cases of Neonatal Appendicitis: A Retrospective Study

“…This often lead to appendicular perforation resulting in peritonitis and increased mortality. [2,15] In this study, the clinical findings (Table 2) were also nonspecific and consistent with literatures; other commonly occurring clinical features reported in literature are tachycardia, respiratory distress, and scrotal oedema [2,[15][16][17]. NA is usually reported in associated with Hirschsprung's Disease or NEC, and rarely as isolated or as an Amyand hernia.…”

“…Raveenthiran V, [1] found a slight male preponderance as also observed in our series. Premature neonates believed to be at higher risk for development of NA as reported by Reyes et al [14] and Secco et al [15]. In our study, term neonates were at more risk compared to preterm babies.…”

“…NA is usually reported in associated with Hirschsprung's Disease or NEC, and rarely as isolated or as an Amyand hernia. [1,9,11,15,18] Some authors believe that NA may be associated with cystic fibrosis [5]. In this study, 10 patients had NA secondary to NEC; none of our patients had Hirschsprung's Disease (HD) or Cystic Fibrosis (CF).…”

“…Most studies have not shown reliable investigations/biomarkers in the diagnosis of NA. [7,10,11,15,18] Plain radiographs, although not diagnostic of appendicitis, are helpful in detecting complications such as perforation. [1]Spiral computed tomography can also be a very useful diagnostic tool; [15][16][17] however, is less frequently used, which may be due to avoidance of radiation, higher cost, and development of early peritonitis also directs for early surgical intervention.…”

Apendicitis aguda perforada con diagnóstico prequirúrgico y hernia inguinal bilateral en recién nacido de pretérmino

“…También contribuyen la dieta láctea sin sólidos, la falta de coprolitos y la ausencia de hiperplasia linfoide 3,12 . Entre los factores causales, un ambiente de isquemia, y otras condiciones que promueven esta situación, como la hipoxia neonatal, preeclampsia, cateterismo umbilical, prematuridad, insuficiencia vascular asociada a anomalías cardíacas y estados de bajo flujo sanguíneo, podrían favorecer su desarrollo 1 .…”