Browsing by Author "Mora Velasco, Christian Alejandro"

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    “Ictericia secundaria a sepsis neonatal”
    (Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-06-01) Mora Velasco, Christian Alejandro; Vaca Pazmiño Dr. Esp. PhD., Carlos Fernando
    We present the case of a newborn, 35 weeks of gestational age, product of the 4th pregnancy, mother of 31 years, well-controlled pregnancy poorly tolerated, with urinary tract infection from the 4th month of gestation, receiving outpatient treatment , irregular uterine activity from the 5th month of pregnancy until the moment of delivery. At the maternal admission urinary tract infection is detected, antibiotics are administered, uteroinhibition and pulmonary maturation. Institutional vaginal cephalogenesis occurs. Anthropometry at birth, weight 1880gr, size 42cm, APGAR 6-9, amniotic fluid with meconium dye, initial respiratory distress, positive pressure ventilation is administered for 15 seconds, after stabilizing it, the patient is admitted to the neonatal ward. At the initial physical examination: FC: 90 bpm; FR: 65 rpm; T: 38.5 ° C thorax with subcostal retractions, therapeutic management of respiratory distress is achieved, stabilizing it. At 24 hours of age, it has icteric skin, Kramer II area. Initially it is presumed that jaundice is secondary to group incompatibility (O-A), however hemolysis, direct negative coombs and increased bilirubins are not evident at the expense of direct bilirubin. Newborn hemodynamically unstable, with thermal variations, bradycardia, tachypnea, moans, retractions, desaturation, with a history of urinary tract infection of the mother is suspected in a clinical picture of early neonatal sepsis, antibiotic therapy is initiated prior to taking blood culture , treatment that is maintained for 10 days. Presents laboratory values altered in the liver profile, abdominal ultrasound that reports liver and normal bile ducts. Pediatric Gastroenterology is consulted, whose report suggests that it is multifactorial neonatal cholestasis, associated with its prematurity and concomitant pathology (sepsis). The bilirubin values decrease as the child overcomes the septic condition, which clinically demonstrates that it is the direct cause of jaundice.