LUCAS HIRANO ARRUDA MORAES
Projetos de Pesquisa
Unidades Organizacionais
SCNEON-62, Hospital Universitário
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- Severe irritability in a critically ill preterm infant: a case of delirium at the neonatal intensive care unit(2023) MORAES, Lucas Hirano Arruda; MAROPO, Vanessa Lisbethe Bezerra; ZOBOLI, Ivete; FALCÃO, Mário Cícero; CARVALHO, Werther Brunow deAbstract Delirium is a common disorder in intensive care units, being associated with greater morbidity and mortality. However, in neonatal intensive care units, delirium is rarely diagnosed, due to the low familiarity of the neonatologist with the subject and the difficulties in the applicability of diagnostic questionnaires. This case report aimed to assess the presence of this disorder in this group of patients and identify the difficulties encountered in the diagnosis and treatment. We report the case of a premature newborn with necrotizing enterocolitis during hospitalization and underwent three surgical approaches. The newborn exhibited intense irritability, having received high doses of fentanyl, dexmedetomidine, clonidine, ketamine, phenytoin, and methadone, without the control of the symptoms. A diagnosis of delirium was then made and treatment with quetiapine was started, with a complete reversal of the symptoms. This is the first case reported in Brazil and the first describing the withdrawal of the quetiapine.
- Bullous lesions following phototherapy in a newborn(2023) TOSCANO, Marina Moura; CINTRA, Flavia Fernandes; RESENDE, Ludmila Oliveira; CASTELETI, Paula; MORAES, Lucas Hirano Arruda; RIVITTI-MACHADO, Maria Cecilia da Matta; NICO, Marcello Menta Simonsen; BIGIO, Juliana Zoboli Del; CARVALHO, Werther Brunow deA male infant presented with progressive jaundice immediately after birth. Fecal acholia and choluria associated with extensive bullous skin lesions in his trunk, abdomen, and upper and lower limbs developed during phototherapy. Several diagnostic hypotheses were presented, including neonatal porphyria, hemochromatosis, Alagille syndrome, and neonatal lupus. A 24-hour urine sample for the dosage of urinary porphyrins was collected, showing high results (1823.6 & mu;g in 100mL). At 50 days of life, fluorescence spectroscopy using a Wood's lamp revealed simultaneous bright red fluorescence of urine-stained diapers and sample blood. A definitive diagnosis of congenital erythropoietic porphyria was made following identification of a mutation of the uroporphyrinogen synthetases III gene on genetic testing. The patient was subsequently maintained in a low light environment since then, resulting in improvement of the lesions. Congenital erythropoietic porphyria is a disease of the group of porphyrias that presents shortly after birth with blistering occurring in regions exposed to the sun or other ultraviolet light. Atrophic scars, mutilated fingers, and bright red fluorescence of the urine and teeth may also be observed. There is no specific treatment, and prophylaxis comprising a total avoidance of sunlight is generally recommended. A high degree of suspicion is required for diagnosis. An early diagnosis can lead to less damage. Here, we present the case of a newborn with congenital erythropoietic porphyria diagnosed after presenting with bullous lesions secondary to phototherapy.
- Use of budesonide associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia in premature newborns- A systematic review(2023) MORAES, Lucas Hirano Arruda; COELHO, Rachel Mocelin Dias; BEOZZO, Glenda Priscila Neves dos Santos; YOSHIDA, Renata de Araujo Monteiro; DINIZ, Edna Maria de Albuquerque; CARVALHO, Werther Brunow deObjective: Among the mechanisms proposed for the development of bronchopulmonary dysplasia is the increase in the pulmonary inflammatory process and oxidative stress. Thus, the control of this process may result in improvements in bronchopulmonary dysplasia-related outcomes. This study aims to analyze the current scientific evidence regarding the use of budesonide, a potent anti-inflammatory drug, associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia.Methods: A systematic review of the literature was performed on the Embase and MEDLINE plat-forms, and studies that compared budesonide with pulmonary surfactant versus pulmonary sur-factant for treating respiratory distress syndrome were included. The primary outcome was a reduction in bronchopulmonary dysplasia or death. Results: Four randomized clinical trials and two observational studies were included in this systematic review. Three of the randomized clinical trials found a reduction in bronchopulmonary dysplasia or death in the use of budesonide with the surfactant, all the other studies (1 clinical trial and 2 observa-tional studies) found no statistical differences between the groups for the primary outcomes. The three main studies showed a reduction in the primary outcome; however, all studies showed great heteroge-neity regarding the type of surfactant (poractant or beractant) and the method of administration. Conclusion: Robust clinical studies, in a heterogeneous population, using porcine surfactant associated with budesonide, with administration by a minimally invasive technique are necessary for there to be a recommendation based on scientific evidence for its widespread use.(c) 2022 Sociedade Brasileira de Pediatria.
- Risk factors of acute kidney injury in very low birth weight infants in a tertiary neonatal intensive care unit(2023) MORAES, Lucas Hirano Arruda; KREBS, Vera Lucia Jornada; KOCH, Vera Hermina Kalika; MAGALHAES, Natalia Assis Medeiros; CARVALHO, Werther Brunow deObjective: Acute kidney injury (AKI) in the neonatal period is associated with worst outcomes as increased mortality and increased length of hospital stay. Very low birth weight (VLBW) newborns are at higher risk for developing several other conditions that are associated with worst outcomes. Understanding the risk factors for AKI may help to prevent this condition and improve neonatal care for this population. Methods: This retrospective cohort study included 155 very low birth weight newborns admitted between 2015 and 2017. The authors compared the newborns who developed neonatal AKI with the non-AKI group and analyzed the main risk factors for developing AKI in the population. The authors also performed an analysis of the main outcomes defined as the duration of mechanical ventilation, length of stay, and death. Results: From the cohort, a total of 61 (39.4%) patients had AKI. The main risk factors associated with Neonatal AKI were necrotizing enterocolitis (aOR 7.61 [1.69 - 34.37]; p = 0.008), neonatal sepsis (aOR 2.91 [1.17 - 7.24], p = 0.021), and hemodynamic instability (aOR 2.99 [1.35 - 6.64]; p = 0.007). Neonatal AKI was also associated with an increase in the duration of mechanical ventilation in 9.4 days (p = 0.026) and in an increase in mortality 4 times (p = 0.009), after adjusting for the other variables. Conclusion: The present results highlight the importance of minimizing sepsis and necrotizing enterocolitis, as well as the importance of identifying hemodynamic instability, to prevent AKI and diminish the burden of morbimortality in VLBW newborns. (c) 2022 Sociedade Brasileira de Pediatria.