Multisistemski zapaljenski sindrom kod novorođenčadi tokom akutne infekcije SARS-CoV-2
Abstract
Uvod. Tokom razvoja i širenja epidemije izazvane severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pojavio se novi sindrom zapaljenskog odgovora kod novorođenčadi koji je označen kao multisistemski zapaljenski sindrom (MZS) kod novorođenčadi (MZS-N). Prikaz bolesnika. Terminsko novorođenče, devojčica, primljeno je u bolnicu zbog povišene telesne temperature i dijagnostikovane infekcije SARS-CoV-2. U laboratorijskim nalazima nađene su povišene vrednosti laktat dehidrogenaze, feritina, interleukina-6 i D-dimera. Po prijemu, započeta je dvojna antibiotska terapija (ceftazidim, vankomicin) parenteralno, a dan kasnije, i terapija heparinom niske molekulske mase (HNMM). Nakon pet dana hospitalizacije i febrilnosti, pri čemu su nalazi mikrobioloških analiza bili negativni, a zbog daljeg pogoršanja vrednosti laboratorijskih nalaza, primenjena je terapija intravenskim imunoglobulinom (IVIg) u dozi od 2 g/kg jedan dan i metilprednizolonom u dozi od 1 mg/kg/dan četiri dana, nakon čega je nastavljeno postepeno smanjenje terapije kortikosteroidima primenom prednizona. Jedan dan nakon primene IVIg-a, novorođenče je postalo afebrilno, uz postepenu normalizaciju laboratorijskih nalaza. Dete je otpušteno posle 16 dana hospitalizacije. Deset dana posle otpusta, prekinuta je terapija prednizonom. Dve nedelje nakon otpusta, prekinuto je davanje heparina. Sedam dana kasnije, vrednost D-dimera je značajno porasla i terapija antikoagulansom je ponovo započeta. Mesec dana kasnije, vrednost D-dimera se potpuno normalizovala, i terapija HNMM-om je prekinuta. Zaključak. Nakon primenjene terapije za MZS kod dece, došlo je do prestanka febrilnosti i postepene normalizacije vrednosti laboratorijskih parametara, što ukazuje da je novorođenče u ovom slučaju imalo MZS-N. Povišena vrednost D-dimera tokom produženog vremenskog perioda je najverovatnije bila posledica MZS.
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