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Letters to the Editor

机译：致编辑的信

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Suprapubic aspiration (SPA) of the bladder is the most reliable technique to identify bacteriuria. The technique is simple, relatively safe and causes minimum discomfort. SPA should be performed in infants with palpable bladder who have not voided recently. After cleaning the suprapubic area with an antiseptic solution, a 23 or 25 gauge needle syringe is inserted (vertically with stabbing movement in midline) perpendicular to the baby, approximately 2,5 inches above the pubic symphysis, aspirating gently while advancing the needle. The needle is angled 10 to 15 degrees cranially to avoid puncturing the trigone. In recent literature, ultrasound guidance improved the yield of urine compared to unguided aspiration.1 Any growth of a urinary pathogen is significant. The most common complication of SPA is microscopic haematuria. Major complications, such as gross haematuria, haematoma and anterior abdominal wall abscess are rarely seen.2 Intestinal perforation can occur if a loop of bowel overlies the bladder, but this complication rarely leads to peritonitis. It has not been reported to occur in the neonate previously.3 In this report, a newborn male infant who experienced intestinal perforation secondary to suprapubic aspiration is described. A male baby with a birth weight of 3600 grams and a gestational age of 40 weeks was born with caesarean section from a 26-year-old mother in her first pregnancy in our hospital. On the 7th day of life the infant was hospitalised with a diagnosis of indirect hyperbilirubinemia. Laboratory tests revealed the final diagnosis of breast milk jaundice and following 2 days of phototherapy the infant was discharged. Four days after discharge, on the 13th postnatal day he was admitted with poor sucking reflex and discomfort. In physical examination body weight was 3400 gr (6% weight loss), length was 48 cm, head circumference 36 cm, body temperature 36.5°C, hearth rate 140/min and respiratory rate was 48/min. bowel sounds were increased and the baby seemed restless. Other physical examination findings were quite normal. Laboratory tests were as follows; Hb: 15.7 g/dL, haematocrit: 44.5%, white blood cell (WBC): 9300/mm3 platelets: 255000/mm3 Peripheral smear, liver function tests, renal function tests, electrolytes and C-reactive protein (CRP) were normal. SPA was performed with 23-gauge needle to rule out a urinary tract infection (UTI). During the aspiration, intestinal content was seen and procedure was stopped immediately. Abdominal X-ray showed sub-diaphragmatic free air (Figure 1) and the diagnosis of intestinal perforation was considered. Patient was hospitalised; intravenous fluids and broad-spectrum antibiotic therapy were started, oral feeding was stopped. Stool examination was performed because of hyperactive bowel sounds and watery diarrhea; however, microscopic examination was normal and the stool cultures were negative. On the second day of hospitalisation leucocyte count and CRP were raised to 24000/mm3 and 35 mg/dL, respectively. Peripheral smear was reported as neutrophils: 76%, bant neutrophile: 10% and lymphocytes: 14%. Abdominal X-ray taken on the third day of treatment was normal. Free air that persisted for two days in direct radiography was lost in the third day of treatment. The general condition of the infant was good with normal bowel sounds and stool output. Oral feeding was started in the third day and the patient was fed completely oral on the fourth day. CRP and WBC count returned to normal values, blood culture was negative on the fourth day, and patient was discharged on the 7th day after completion of antibiotic treatment. Two weeks later patient's physical examination was normal; no infection nor abcess was seen on suprapubic region.
机译：膀胱耻骨上吸引术（SPA）是鉴定细菌尿症的最可靠技术。该技术简单，相对安全并且引起的不适感最小。 SPA应在近期未排尿的可触及膀胱的婴儿中进行。用消毒液清洁耻骨上区域后，将一根23或25号针头注射器（在中线处以刺伤方式垂直插入），垂直于婴儿，位于耻骨联合上方约2.5英寸处，并在前进针头时轻轻吸出。针向后倾斜10至15度，以免刺破三角骨。在最近的文献中，超声引导与无引导抽吸相比提高了尿量。 1 尿液病原体的任何生长都是显着的。 SPA最常见的并发症是镜下血尿。很少见到严重的并发症，如肉眼血尿，血肿和前腹壁脓肿。 2 如果肠loop覆盖在膀胱上会发生肠穿孔，但这种并发症很少导致腹膜炎。 3 在此报告中，描述了一种新生的男婴，该男婴经历了耻骨上抽吸继发肠穿孔。出生时体重为3600克，胎龄为40周的一名男婴在我们医院的第一次妊娠中来自一名26岁的母亲剖腹产。在生命的第7天，婴儿被诊断出患有间接高胆红素血症。实验室测试显示对母乳性黄疸的最终诊断是，经过2天的光疗后，该婴儿已出院。出院后四天，在出生后的第13天，他因吸吮反射和不适而入院。在体格检查中，体重为3400 gr（体重减轻6％），身长为48 cm，头围为36 cm，体温为36.5°C，炉膛速率为140 / min，呼吸速率为48 / min。肠鸣音增加，婴儿似乎不安。其他体格检查结果也很正常。实验室检查如下：血红蛋白（Hb）：15.7 g / dL，血细胞比容：44.5％，白细胞（WBC）：9300 / mm 3 血小板：255000 / mm 3 外周涂片，肝功能检查，肾功能检查，电解质和C反应蛋白（CRP）正常。用23号针头进行SPA，以排除尿路感染（UTI）。在抽吸过程中，可以看到肠内容物并立即停止手术。腹部X线片显示-下游离空气（图1），并考虑诊断为肠穿孔。患者已住院;开始静脉输液和广谱抗生素治疗，停止口服喂养。由于肠蠕动亢进和水样腹泻，进行了粪便检查。然而，镜检正常，粪便培养阴性。住院第二天，白细胞计数和CRP分别升高至24000 / mm 3 和35 mg / dL。据报道外周涂片为嗜中性粒细胞：76％，弯曲嗜中性粒细胞：10％，淋巴细胞：14％。治疗第三天腹部X光检查正常。在治疗的第三天，直接放射线检查中持续两天的自由空气消失了。婴儿的一般情况良好，肠鸣音正常，大便排出。在第三天开始口服喂养，并且在第四天给患者完全口服喂养。 CRP和WBC计数恢复正常，第四天血培养阴性，抗生素治疗完成后第7天出院。两周后患者的身体检查正常;耻骨上区域未见感染或脓肿。

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