Neonatologia
La Neonatologia… caso per caso
Neonatology case by case
Martina D’Agostin1, Maria Antonietta Catania2, Clara Giambrone2, Giovanni Corsello3
1Scuola di specializzazione, IRCCS Materno-Infantile “Burlo Garofolo”, Università di Trieste
2Scuola di Specializzazione in Pediatria, Università di Palermo
3Dipartimento Materno-Infantile, Università di Palermo
Gennaio 2023 - pagg. 38 -44 | DOI: 10.53126/MEB42038
Abstract
Neonatal hypotonia, bronchopulmonary dysplasia, necrotizing enterocolitis and persistent hypoglycemia are some of the main topics in neonatology. This work aims to summarize these four neonatal conditions through illustrative clinical cases. The first issue concerns neonatal hypotonia, which can constitute a pivotal sign in the diagnosis of hypoxic ischemic encephalopathy. However, neonatal hypotonia can be present in several other conditions, such as sepsis and neurological or neuromuscular diseases. The second issue is about bronchopulmonary dysplasia, a disease that mainly affects extremely premature infants. Many therapeutic strategies have been proposed to prevent this disease, such as less invasive ventilation and an early use of inhaled and systemic corticosteroids. Long-term respiratory sequelae in infants with bronchopulmonary dysplasia remain one of the main causes of hospitalization in these children in their early years of life. The third issue is necrotizing enterocolitis, a disease that can affect both term and preterm newborns. Multiple risk factors are involved in the pathogenesis of this disease such as an abnormal peripheral perfusion due to congenital heart diseases, small for gestational age (SGA), sepsis, hypoxic-ischemic encephalopathy, chorioamnionitis, intrauterine growth restriction (IUGR). On the other hand, breastfeeding can play as a preventive factor. Finally, the last topic is about the management of persistent hypoglycaemia, a condition that can be caused by the combination of one of the following mechanisms: inadequate glucose supply in an infant with low glycogen stores (preterm, IUGR, SGA); excessive insulin production (maternal diabetes, large for gestational age); failure of counter-regulatory response to hy-poglycaemia (pituitary or adrenal deficiency).
Riassunto
Attraverso quattro casi clinici vengono affrontati in questo articolo alcuni dei temi caldi della neo-natologia: l’ipotonia neonatale, la displasia broncopolmonare (BPD), l’enterocolite necrotizzante e l’ipoglicemia persistente. L’ipotonia neonatale può costituire un segno obiettivo dirimente nella diagnosi di encefalopatia ipossico ischemica. Può però essere spia di molte altre condizioni severe, come la sepsi e le patologie neurologiche o neuromuscolari. Il secondo tema è quello della displasia broncopolmonare, patologia che affligge prevalentemente i neonati estremamente prematuri. Molte sono le strategie terapeutiche che sono state proposte per prevenirla, come una modalità di ventila-zione più dolce, e un utilizzo precoce di corticosteroidi inalati e sistemici. Ridurre l’incidenza di BPD significa ridurre il rischio di sviluppare sequele respiratorie a lungo termine, che rimangono al momento una delle principali cause di ospedalizzazione di questi bambini nei loro primi anni di vi-ta. Il terzo tema è quello dell’enterocolite necrotizzante che può colpire sia neonati a termine che pretermine. Molteplici sono i fattori di rischio coinvolti nella patogenesi di questa malattia: altera-zioni della perfusione periferica da cardiopatie congenite, basso peso per età gestazionale (SGA), sepsi, encefalopatia ipossico-ischemica, corioamnionite, e alterazioni placentari con restrizione del-la crescita fetale (IUGR). Un effetto protettivo è svolto dal latte materno o dal latte umano di banca. Infine, l’ultimo tema si concentra sulla gestione dell’ipoglicemia persistente, che può essere deter-minata dalla combinazione di uno o più dei seguenti meccanismi: insufficiente apporto di glucosio in un neonato con scarse riserve di glicogeno (pretermine, IUGR, SGA); aumento dell'utilizzo del glucosio causato da un'eccessiva produzione di insulina (diabete materno, macrosomia fetale); il fallimento dei meccanismi controregolatori (insufficienza ipofisaria o surrenalica).
Classificazione MeSH
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Un neonato ipotonico
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Un neonato con la displasia
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Un neonato con enterocolite necrotizzante
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Una ipoglicemia persistente
e complicata
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Corrispondenza: giocors@alice.it