[
    {
        "page": 1,
        "title": "Enterocolitis Necrotizante ",
        "body": "<p>\n\n\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"ProgId\" content=\"Word.DocumentW\" \/>\n<meta name=\"Generator\" content=\"Microsoft Word 15\" \/>\n<meta name=\"Originator\" content=\"Microsoft Word 15\" \/>\n<link rel=\"File-List\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_filelist.xml\" \/>\n<link rel=\"Edit-Time-Data\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_editdata.mso\" \/>\n\n<style>\nv\\:* {behavior:url(#default#VML);}\no\\:* {behavior:url(#default#VML);}\nw\\:* {behavior:url(#default#VML);}\n.shape {behavior:url(#default#VML);}\n<\/style>\n<xml>\n \n  \n \n<\/xml>\n<link rel=\"themeData\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_themedata.thmx\" \/>\n<link rel=\"colorSchemeMapping\n\" href=\"file:\/\/\/C:\/Users\/Georgi\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_colorschememapping.xml\" \/>\n<xml>\n \n  <\/xml><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Definici\u00f3n<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Urgencia digestiva m\u00e1s frecuente del periodo\nneonatal, caracterizada por necrosis variable de la mucosa o de la pared\nintestinal. Su etiolog\u00eda es multifactorial.<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Incidencia: 5\u201310% en neonatos &lt;1500 g.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Mortalidad: 20\u201330%, hasta 50% si requiere cirug\u00eda.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Riesgo y mortalidad aumentan con menor peso y edad gestacional.<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Anatom\u00eda\nPatol\u00f3gica y Patogenia<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Zonas m\u00e1s afectadas: \u00edleon distal y colon proximal.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">ECN total: necrosis desde est\u00f3mago hasta recto en casos letales.<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hallazgos:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Isquemia mucosa<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Neumatosis intestinal (gas submucoso)<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Perforaci\u00f3n \u2192 peritonitis \u2192 sepsis \u2192 muerte<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Factores de\nriesgo principales<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Prematuridad (principal)<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Colonizaci\u00f3n bacteriana intestinal<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Alimentaci\u00f3n con f\u00f3rmula<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Mecanismos\nimplicados<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Inmadurez inmunitaria intestinal<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Disbiosis<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Isquemia mucosa<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Variantes gen\u00e9ticas: TLR-4, IL-6, VEGF, \u00f3xido n\u00edtrico<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Casos en\nneonatos a t\u00e9rmino (menos frecuente)<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Enfermedad secundaria asociada a:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Asfixia perinatal<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Cardiopat\u00edas cong\u00e9nitas<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">S\u00edndrome de Down<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecci\u00f3n por rotavirus<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Gastrosquisis<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Enfermedad de Hirschsprung<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Manifestaciones\nCl\u00ednicas<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Inicio<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Inicio variable: insidioso o abrupto<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">M\u00e1s frecuente entre la 2.\u00aa y 3.\u00aa semana de vida (m\u00e1s tard\u00edo en\n     PMBN)<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Edad de inicio inversamente proporcional a la edad gestacional<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Signos\ncl\u00ednicos<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Inespec\u00edficos<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     letargia, inestabilidad t\u00e9rmica<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Gastrointestinales<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Distensi\u00f3n abdominal<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Intolerancia alimentaria<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Vaciamiento g\u00e1strico retrasado<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Sangre en heces (macrosc\u00f3pica\/oculta)<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">V\u00f3mitos, masa abdominal, eritema de pared<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Sist\u00e9micos<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Apnea, dificultad respiratoria<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Acidosis metab\u00f3lica\/respiratoria<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Coagulopat\u00eda, hipoglucemia<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hipoperfusi\u00f3n, shock<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hemocultivos positivos<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Diagn\u00f3stico<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Evaluaci\u00f3n\ncl\u00ednica<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Alta sospecha en neonatos prematuros con factores de riesgo<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Puede simular sepsis inicialmente<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Estudios\npor imagen<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Radiograf\u00eda abdominal simple<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Neumatosis intestinal<\/span><\/b><span style=\"font-size:12.0pt;\n      font-family:&quot;Times New Roman&quot;,serif\">:\n      patognom\u00f3nica y diagn\u00f3stica (presente en 50\u201375%)<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Gas en vena porta<\/span><\/b><span style=\"font-size:12.0pt;\n      font-family:&quot;Times New Roman&quot;,serif\">:\n      signo de gravedad<\/span><\/li>\n  <li style=\"line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Neumoperitoneo<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n      &quot;Times New Roman&quot;,serif\">:\n      indica perforaci\u00f3n<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ecograf\u00eda con Doppler<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Eval\u00faa: l\u00edquido libre, abscesos, grosor parietal, peristaltismo y\n      perfusi\u00f3n<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Diagn\u00f3stico\ndiferencial<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecciones intestinales\/sist\u00e9micas<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Obstrucci\u00f3n gastrointestinal<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">V\u00f3lvulo<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Perforaci\u00f3n intestinal focal idiop\u00e1tica (asociada a\n     indometacina\/corticoides): presenta neumoperitoneo pero menor afectaci\u00f3n\n     sist\u00e9mica<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Tratamiento<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Inicial<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Suspender alimentaci\u00f3n enteral<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Descompresi\u00f3n nasog\u00e1strica<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Hidrataci\u00f3n IV con cristaloides<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Antibioticoterapia emp\u00edrica de amplio espectro (cubrir Gram\n     negativos, positivos y anaerobios)<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Retiro de cat\u00e9teres umbilicales<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Soporte ventilatorio en caso de apnea o hipoventilaci\u00f3n<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Correcci\u00f3n de desequilibrios hidroelectrol\u00edticos, hematol\u00f3gicos y\n     \u00e1cido-base<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Monitoreo estrecho:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Examen f\u00edsico frecuente<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Radiograf\u00edas seriadas<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Perfil hematol\u00f3gico y \u00e1cido-base seriado<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Cirug\u00eda<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:12.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Indicaciones<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Absoluta<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">: neumoperitoneo en radiograf\u00eda<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Relativas<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Deterioro cl\u00ednico a pesar de tratamiento m\u00e9dico<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Asa intestinal fija en radiograf\u00edas seriadas<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Eritema de pared abdominal<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:12.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Modalidades\nquir\u00fargicas<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Drenaje peritoneal primario (DPP)<\/span><\/b><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Laparotom\u00eda exploradora<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Resecci\u00f3n de intestino necr\u00f3tico<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Creaci\u00f3n habitual de estoma<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:12.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Evidencia\ncomparativa<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Ensayos aleatorizados no muestran diferencias significativas entre\n     DPP y laparotom\u00eda<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">DPP se usa en pacientes m\u00e1s inestables \u2192 mayor mortalidad (~50%)<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Laparotom\u00eda primaria: mortalidad ~30%<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Elecci\u00f3n del m\u00e9todo depende del estado cl\u00ednico y preferencia\n     quir\u00fargica<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Pron\u00f3stico<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">20\u201340% con neumatosis no responden a tratamiento m\u00e9dico<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Mortalidad: 20\u201350% en casos quir\u00fargicos<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Complicaciones<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:12.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Agudas<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Infecciones de herida quir\u00fargica<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Dehiscencia<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Problemas del estoma (prolapso, necrosis)<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:12.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Tard\u00edas<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Estenosis intestinal (10%)<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">S\u00edndrome de intestino corto<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Malabsorci\u00f3n<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Desnutrici\u00f3n<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Retraso del crecimiento<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Sepsis por cat\u00e9ter venoso central<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Colestasis<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Mayor riesgo de secuelas neurol\u00f3gicas y de crecimiento en ECN\n     quir\u00fargica<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<div align=\"center\" style=\"text-align:center;\nline-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\n\n<hr size=\"2\" width=\"100%\" align=\"centerc\" \/>\n\n<\/span><\/div>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:18.0pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Prevenci\u00f3n<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Medidas\neficaces<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Lactancia materna exclusiva<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Reducci\u00f3n significativa de ECN<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Fortificaci\u00f3n necesaria en prematuros<\/span><\/li>\n <\/ul>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Dietas con leche materna fortificada con productos humanos (vs\n     bovinos) podr\u00edan reducir a\u00fan m\u00e1s el riesgo<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Estrategias\nadicionales<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Probi\u00f3ticos<\/span><\/b><span style=\"font-size:12.0pt;font-family:\n     &quot;Times New Roman&quot;,serif\">:\n     evidencia prometedora, pero sin consenso sobre f\u00f3rmula, dosis o duraci\u00f3n<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Prebi\u00f3ticos y simbi\u00f3ticos<\/span><\/b><span style=\"font-size:12.0pt;\n     font-family:&quot;Times New Roman&quot;,serif\">:\n     resultados variables<\/span><\/li>\n <li style=\"\n     line-height:normal\"><b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Evitar<\/span><\/b><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">:<\/span><\/li>\n <ul type=\"circlec\">\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Inhibidores de secreci\u00f3n \u00e1cida g\u00e1strica (bloqueantes H2, IBP)<\/span><\/li>\n  <li style=\"line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Antibioticoterapia emp\u00edrica prolongada en fase neonatal precoz<\/span><\/li>\n <\/ul>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<p style=\"\nline-height:normal\"><b><span style=\"font-size:13.5pt;\nfont-family:&quot;Times New Roman&quot;,serif\">Diagn\u00f3stico\nprecoz: investigaci\u00f3n en biomarcadores<\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<ul type=\"discd\">\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Prote\u00edna C reactiva (CRP)<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">I-FABP urinaria<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Claudina-3, calprotectina fecal<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">Acilcarnitina, IL-6, IL-8<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">\u00cdndice de caracter\u00edsticas de frecuencia card\u00edaca (CFC)<\/span><\/li>\n <li style=\"\n     line-height:normal\"><span style=\"font-size:12.0pt;font-family:&quot;Times New Roman&quot;,serif\">NIRS (espectroscopia infrarroja cercana): modalidad diagn\u00f3stica\n     emergente<\/span><\/li>\n<\/ul>\r\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\r\n<br \/>",
        "footer": "P\u00e1gina 1"
    }
]