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El páncreas anular es una malformación congénita rara caracterizada por un anillo pancreático que rodea la porción descendente del duodeno. Se reporta en 1/20 000 recién nacidos vivos. La edad de presentación depende de la severidad de la obstrucción intestinal. El diagnóstico requiere estudios de imagenología y exploración quirúrgica. Presentamos el caso de un neonato de trece días, hospitalizado en la Unidad de Cuidados Intensivos Neonatales del Hospital Nacional Arzobispo Loayza. Cursa con residuo gástrico, vómitos y distensión abdominal intermitente. Dada la persistencia de una sintomatología gastrointestinal a pesar del manejo instaurado, se realiza el examen radiológico de las vías digestivas altas con medio de contraste, donde se evidencia signos de estenosis duodenal. Se realizó una laparotomía exploratoria, con diagnóstico posoperatorio de páncreas anular. El tratamiento definitivo es mediante la cirugía de Kimura.

Aim: To determine the management perspective of early-onset neonatal sepsis among neonatologists from Lima – Perú and to compare it with international society guideline recommendations. Material and Methods: We collected data from August to December 2018 from 151 neonatologists working in neonatal units in Lima-Perú with an anonymous survey. The survey contained three questions related to the participant's general characteristics and eight questions regarding the management of early-onset sepsis, including the risk factors relating to the initiation of postnatal antibiotics, the management of a low-risk febrile neonate, laboratory cutoff values, indications for a lumbar puncture, and first-line therapy and antibiotic therapy duration in culture-proven and culture-negative sepsis. Results: The mean age of the participants was 46.2 ± 8.1 years, with a median duration of clinical practice of 6 years (4.0 – 12.0). Chorioamnionitis (76.2%), maternal fever (62.3%) and prolonged rupture of the membranes (52.3%) were the most common risk factors considered for postnatal antibiotic therapy. Of the participants, 91.4% would not prescribe antibiotic therapy for a low-risk febrile neonate and would, instead, track the fever (82.8%) and do a sepsis workup (65.6%). In addition, 97.4% would do a lumbar puncture in a neonate with seizures and EOS. Only 43.1% would do a lumbar puncture in cases with a positive blood culture. Of the neonatologist, 98% defined leukopenia as a leukocyte count ≤5 × 109/L and 47.7% defined leukocytosis as a count of ≥25 × 109/L. An immature to total neutrophil ratio of ≥0.20 was used by 57.6% of them. Ampicillin/amikacin is the most common first-line drug combination for EOS, followed by ampicillin/gentamicin and ampicillin/cefotaxime. Median duration of antibiotic therapy for Gram-positive and Gram-negative organisms is 7 days (7.0 – 10.0) and 10 days (10.0 – 14.0), respectively. In culture-negative early-onset sepsis, the median antibiotic therapy duration is 7 days (5.0 – 7.0). Conclusion: There are significant differences in the approach to and management of EOS among neonatologists from Lima – Perú. A local standardized protocol would prevent this variability and minimize unnecessary procedures, antibiotic exposure, bacterial resistance, prolonged hospital stay, and mother-newborn separation.