RESUMO
PURPOSE: Very low birth weight (VLBW) infants are at a risk of spontaneous focal intestinal perforation (FIP). Treatment includes supportive care, antibiotics, and drainage with/without surgery. Broad-spectrum antibiotic agents like carbapenems are applied frequently, although their use is not well-supported by the limited evidence of causal pathogens. We hypothesize that the use of carbapenems may not be necessary in VLBW infants with FIP. Our primary objective was to evaluate the antimicrobial use in VLBW infants with FIP in a cohort of the German Neonatal Network (GNN). The secondary objective was to characterize a subset in detail as a benchmark for future targets of stewardship. METHODS: Data on VLBW infants with FIP was collected prospectively within the GNN, a collaboration of 68 neonatal intensive care units (NICU). With regards to the primary objective, patient characteristics and antimicrobial treatment were extracted from the predefined GNN database. To address our secondary objective, an additional on-site assessment of laboratory and microbiological culture results were performed. RESULTS: In the GNN cohort, 613/21,646 enrolled infants (2.8%) developed FIP requiring surgery. They were frequently treated with carbapenems (500/613 (81.6%)) and vancomycin (497/613 (81.1%)). In a subset of 124 VLBW infants, 77 (72.6%) had proof of gram-positive bacteria in the abdominal cavity, coagulase-negative staphylococci (CoNS) predominantly. Despite the low prevalence of gram-negative bacteria (n = 6 (4.8%)), the combination of meropenem and vancomycin was prescribed most frequently (n = 96 (78.0%)). CONCLUSION: The use of carbapenems as broad-spectrum antimicrobials agents might not be justified in most VLBW infants with FIP. Knowledge on the development of the neonatal gut microbiota, local resistance patterns and individual microbiological findings should be taken into consideration when implementing antimicrobial stewardship programs (ASPs).
Assuntos
Antibacterianos , Recém-Nascido de muito Baixo Peso , Perfuração Intestinal , Humanos , Recém-Nascido , Antibacterianos/uso terapêutico , Masculino , Feminino , Estudos Prospectivos , Carbapenêmicos/uso terapêutico , Carbapenêmicos/farmacologia , Alemanha , Unidades de Terapia Intensiva Neonatal , Estudos de CoortesRESUMO
BACKGROUND: We assessed the incidence of and risk factors for acute kidney injury (AKI) in very low birthweight infants (VLBW) in a center with a specific neonatal management protocol focusing on avoidance of early mechanical ventilation (MV). METHODS: This retrospective single center analysis includes 128 infants born in 2020 with a gestational age ≥ 22 weeks who were screened for AKI using the nKDIGO criteria. RESULTS: AKI was identified in 25/128 patients (19.5%) with eight of them (6.3%) presenting with severe AKI. Low gestational age, birthweight and 10-minute Apgar score as well as high CRIB-1 score were all associated with incidence of AKI. Forty-five percent of the infants with MV developed AKI vs. 8.9% of those without MV (p < 0.001). Early onset of MV and administration of more than 3 dosages of NSAIDs for patent duct were identified as independent risk factors for AKI in a logistic regression analysis. CONCLUSIONS: We report a substantially lower frequency of AKI in VLBW infants as compared to previous studies, along with a very low rate of MV. A neonatal protocol focusing on avoidance of MV within the first days of life may be a key factor to decrease the risk of AKI in immature infants.
Assuntos
Injúria Renal Aguda , Respiração Artificial , Recém-Nascido , Lactente , Humanos , Pré-Escolar , Incidência , Estudos Retrospectivos , Respiração Artificial/efeitos adversos , Recém-Nascido de muito Baixo Peso , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Fatores de RiscoRESUMO
PURPOSE: In recent years an earlier step down to oral antibiotic therapy has been advocated for numerous infections. Trained infectious disease specialists regularly consulting their colleagues may speed up the implementation of such recommendations into clinical practice and thus may improve treatment. METHODS: We retrospectively analyzed bone and joint infections in children admitted to the University Hospital of Cologne between 2010 and 2021. We assessed clinical, imaging, and microbiological findings and treatment modalities. Additionally, we assessed both the impact of a newly implemented pediatric infectious diseases consultation service and publications on revised treatment recommendations by comparing antibiotic therapy in two periods (2010-2016 versus 2017 to 2021). RESULTS: In total, 29 children presented with osteomyelitis, 16 with bacterial arthritis and 7 with discitis. In period 2 (2017-2021) we observed shorter duration of intravenous treatment (p = 0.009) and a higher percentage of oral antibiotic treatment in relation to the total duration of antibiotics (25% versus 59%, p = 0.007) compared to period 1 (2010-2016). Yet, no differences were identified for the total length of antibiotic treatment. Additionally, biopsies or synovial fluid samples were retrieved and cultured in more children in period 2 (p = 0.077). The main pathogen identified in osteomyelitis and bacterial arthritis was Staphylococcus aureus (MSSA), diagnosis was confirmed predominantly with MRI. CONCLUSION: Recent guidelines addressing the safety of an earlier step-down (to oral) antibiotic therapy have influenced clinical practice in the treatment of bone and joint infections in our hospital. A newly implemented pediatric infectious diseases consultation service might have accelerated this progress resulting in a faster step down to oral treatment.
Assuntos
Artrite Infecciosa , Doenças Transmissíveis , Osteomielite , Infecções Estafilocócicas , Criança , Humanos , Antibacterianos/uso terapêutico , Estudos Retrospectivos , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Infecções Estafilocócicas/microbiologia , Osteomielite/microbiologia , Hospitais Universitários , Doenças Transmissíveis/tratamento farmacológicoRESUMO
AIM: In preterm infants, insecure attachment is associated with behavioural and emotional problems but data on attachment beyond toddler age are scarce. This study assessed attachment security at 6-8 years in very and moderate or late preterm infants. The results were compared to a non-clinical full-term sample. METHODS: Attachment security of 38 very and 20 moderate or late preterm infants was assessed during a home visit with the German version of the Attachment Story Completion Task. Attachment patterns of 28 full-term controls were taken from a previous study. Primary outcomes were attachment security and attachment security score. Secondary outcomes for the preterm groups were infant behavioural problems, parental stress, perceived social support, maternal depressive symptoms, and infant development. RESULTS: Very preterm infants had the highest rate of insecure attachment (81%) compared to moderate or late preterm infants (60%) and full-term infants (47%); (p = 0.013). Attachment security scores differed significantly between very preterm and full-term infants (p = 0.001). Secondary outcomes were similar in very and moderate or late preterm cohorts. CONCLUSION: Prematurity was associated with an increased risk of insecure attachment at early school age. Interventions targeting attachment security are reasonable considering the high rate of behavioural problems following premature birth.
Assuntos
Recém-Nascido Prematuro , Nascimento Prematuro , Lactente , Feminino , Gravidez , Recém-Nascido , Humanos , Recém-Nascido Prematuro/psicologia , Relações Mãe-Filho/psicologia , Pais/psicologia , Desenvolvimento InfantilRESUMO
AIM: We explored whether subnormal forced expiratory volume within 1 s (FEV1 ) at 5-9 years of age was lower in children born preterm who received less invasive surfactant administration (LISA) rather than surfactant via an endotracheal tube. METHODS: The multi-centre, randomised Nonintubated Surfactant Application trial enrolled 211 preterm infants born at 23-26 weeks of gestation from 13 level III neonatal intensive care units from April 2009 to March 2012. They received surfactant via LISA (n = 107) or after conventional endotracheal intubation (n = 104). The follow-up assessments were carried out by a single team blinded to the group assignments. The main outcome was FEV1 < 80% of predicted values. RESULTS: Spirometry was successful in 102/121 children. The other children died or were lost to follow-up. Median FEV1 was 93% (interquartile range 80%-113%) of predicted values in the LISA group and 86% (interquartile range 77-102%) in the control group (p = 0.685). Rates of FEV1 < 80% were 11/57 (19%) and 15/45 (33%), respectively, which was an absolute risk reduction of 14% (95% confidence interval -3.1% to 31.2%, p = 0.235). There were no differences in other outcome measures. CONCLUSION: The proportion of children aged 5-9 years with subnormal FEV1 was not significantly different between the groups.
Assuntos
Surfactantes Pulmonares , Criança , Pré-Escolar , Humanos , Recém-Nascido Prematuro , Intubação Intratraqueal , Surfactantes Pulmonares/administração & dosagem , EspirometriaRESUMO
AIM: The aim of this study was to evaluate neurocognitive outcome at 24 months of corrected age after less invasive surfactant application (LISA) in preterm infants born at 23-26 weeks of gestational age. METHODS: Surviving participants of a LISA trial conducted in 13 German level III neonatal intensive care units were reviewed for assessment of developmental outcome, hearing and vision problems, growth and rehospitalisation days. Maternal depression, breastfeeding rates and socio-economic factors were evaluated as potentially confounding factors. RESULTS: In total, 156/182 infants took part in the study, 78 had received surfactant via LISA and 78 via endotracheal intubation. 22% of LISA infants compared to 42% of intubated infants had a psychomotor development index (PDI) <70 (0.012). A significant difference in mental development index (MDI) was observed in the stratum of more mature infants (25 and 26 weeks of GA). For this group, MDI < 70 was observed in 4% of LISA infants vs 21% of intubated infants (P = 0.008). CONCLUSION: At 24 months of age, the LISA-treated infants scored less often PDI < 70 and had similar results in MDI. Infants born at 25 and 26 weeks treated with LISA had lower rates of severe disability. LISA is safe and may be superior.
Assuntos
Lactente Extremamente Prematuro , Surfactantes Pulmonares , Humanos , Lactente , Recém-Nascido , Surfactantes Pulmonares/uso terapêutico , Respiração Artificial , Tensoativos , Resultado do TratamentoRESUMO
Our study was designed to assess the rates of exclusive breastfeeding (defined as direct breastfeeding) and the use of mother's own milk (MOM) in preterm infants and sick term infants at discharge and to identify potential influencing factors such as gestational age, early colostrum, and privacy. The study was conducted at a German level III neonatal department. All preterm and sick term infants admitted to the neonatal intensive care unit, the pediatric intensive care unit, the intermediate care unit, and the low care ward were included in the study. Infants were recruited between March and October 2015 (phase 1) and April to July 2016 (phase 2). Due to an emergency evacuation, privacy was limited during the first phase. Breastfeeding and the use of MOM were assessed daily using a self-designed score. In total, 482 infants of 452 mothers were included. More than 90% initiated breastfeeding and one-third were exclusively breastfed at discharge. Extremely immature infants and late preterm infants were less likely to be exclusively breastfed at discharge. Privacy (p<0.001) and early colostrum (p=0.002) significantly increased exclusive breastfeeding. Conclusion Extremely immature and late preterm infants were least likely to be exclusively breastfed at discharge and need special support. Interventions such as privacy and early colostrum should be promoted to increase breastfeeding.
Assuntos
Aleitamento Materno , Colostro , Criança , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Mães , Gravidez , PrivacidadeRESUMO
AIM: To investigate the effects of 60 minutes delivery room skin-to-skin contact (DR-SSC) compared with 5 minutes visual contact (VC) on mother-child interaction (MCI), salivary cortisol, maternal depression, stress and bonding at 6 months corrected age. METHODS: A single-centre randomized controlled trial conducted in a German level III NICU. Eighty-eight preterm infants (25-32 weeks of gestational age) were randomized after initial stabilization to either 60 minutes DR-SSC or 5 minutes VC. Forty-five infants were allocated to DR-SSC, 43 to VC. RESULTS: Delivery room skin-to-skin contact dyads showed a higher quantity of maternal motoric (18 vs 15, P = .030), infant's vocal (7 vs 5, P = .044) and motoric (20 vs 15, P = .032) responses. Moreover, the combined score of maternal and infant responsive behaviour was higher (86 vs 71, P = .041) in DR-SSC dyads. DR-SSC mothers had lower risk of both, early postpartum depression (15% vs 45%, P = .003) and impaired bonding (Score 3 vs 5, P = .031). CONCLUSION: In addition to regular intermittent kangaroo mother care, DR-SSC promotes MCI and decreases risk of maternal depression and bonding problems. Thus, DR-SSC may have positive effects on preterm development.
Assuntos
Recém-Nascido Prematuro , Método Canguru , Criança , Salas de Parto , Feminino , Humanos , Recém-Nascido , Relações Mãe-Filho , Mães , GravidezRESUMO
For nasal application of neurotrophins and mesenchymal stem cells, successful delivery to the brain and therapeutic effects are known from experimental data in animals. Human breast milk contains neurotrophins and stem cells, but gavage tube feeding in preterm infants bypasses the naso-oropharynx. This is a first exploration on additional nasal breast milk and neuromorphological outcome after severe neonatal brain injury. We present a retrospective summary of 31 very low birth weight preterm infants with intraventricular hemorrhage °3/4 from one third-level neonatal center. All were breast milk fed. Sixteen infants additionally received nasal drops of fresh breast milk daily with informed parental consent for at least 28 days. Cerebral ultrasound courses were reviewed by a pediatric radiologist blinded to the intervention. The main outcome measure was severity of porencephalic defects before discharge. Clinical covariates were comparable in both groups. With nasal breast milk, a trend to a lower incidence for severe porencephalic defects (21% vs. 58%) was detected. Incidences were lower for progressive ventricular dilatation (71% vs. 91%) and surgery for posthemorrhagic hydrocephalus (50% vs. 67%).Conclusion: The hypothesis is generated that early intranasal application of breast milk could have a beneficial effect on neurodevelopment in preterm infants. Controlled investigation is needed. What is Known: ⢠Successful delivery to the brain and therapeutic effects are known for nasal application of neurotrophins and mesenchymal stem cells from experimental data in animal studies. ⢠Human breast milk contains neurotrophins and stem cells, but gavage tube feeding in preterm infants bypasses the naso-oropharynx. What is New: ⢠This is the first report on additional nasal breast milk application in very low birth weight preterm infants with severe brain injury observing a trend for less severe porencephalic defects. ⢠The hypothesis is generated that nasal breast milk might exert neuroprotective effects in preterm infants.
Assuntos
Hemorragia Cerebral/terapia , Leite Humano , Fatores de Crescimento Neural/administração & dosagem , Transplante de Células-Tronco/métodos , Administração Intranasal , Aleitamento Materno , Estudos de Casos e Controles , Hemorragia Cerebral/complicações , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Masculino , Estudos Retrospectivos , Células-Tronco , Resultado do Tratamento , Ultrassonografia Doppler TranscranianaRESUMO
BACKGROUND: Previous studies on renal oligohydramnios (ROH) report highly variable outcome and identify early onset of ROH and presence of extrarenal manifestations as predictors of adverse outcome in most cases. Data on termination of pregnancy (TOP) and associated parental decision-making processes are mostly missing, but context-sensitive for the interpretation of these findings. We provide here a comprehensive analysis on the diagnosis, prenatal decision-making and postnatal clinical course in all pregnancies with ROH at our medical centre over an 8-year period. METHODS: We report retrospective chart review data on 103 consecutive pregnancies from 2008 to 2015 with a median follow-up of 554 days. RESULTS: After ROH diagnosis, 38 families opted for TOP. This decision was associated with onset of ROH (p < 0.001), underlying renal disease (p = 0.001) and presence of extrarenal manifestations (p = 0.02). Eight infants died in utero and 8 cases were lost to follow-up. Of the 49 liveborn children, 11 received palliative and 38 underwent active care. Overall survival of the latter group was 84.2% (n = 32) corresponding to 31% of all pregnancies (32 out of 103) analysed. One third of the surviving infants needed renal replacement therapy during the first 6 weeks of life. CONCLUSIONS: Over one third of pregnancies with ROH were terminated and the parental decision was based on risk factors associated with adverse outcome. Neonatal death was rare in the actively treated infants and the overall outcome promising. Our study illustrates that only careful analysis of the whole process, from prenatal diagnosis via parental decision-making to postnatal outcome, allows sensible interpretation of outcome data.
Assuntos
Tomada de Decisões , Nefropatias/epidemiologia , Rim/anormalidades , Oligo-Hidrâmnio/diagnóstico , Diagnóstico Pré-Natal/métodos , Aborto Induzido/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Nefropatias/etiologia , Nefropatias/terapia , Masculino , Oligo-Hidrâmnio/mortalidade , Pais , Gravidez , Prognóstico , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Adulto JovemAssuntos
Recém-Nascido Prematuro , Método Canguru , Lactente , Gravidez , Recém-Nascido , Humanos , Criança , Feminino , Salas de Parto , Pele , Relações Mãe-FilhoRESUMO
BACKGROUND: Differential diagnosis of prenatally detected hyperechogenic and enlarged kidneys can be challenging as there is a broad phenotypic overlap between several rare genetic and non-genetic disorders. Metabolic diseases are among the rarest underlying disorders, but they demand particular attention as their prognosis and postnatal management differ from those of other diseases. METHODS: We report two cases of cystic, hyperechogenic and enlarged kidneys detected on prenatal ultrasound images, resulting in the suspected diagnosis of autosomal recessive polycystic kidney disease (ARPKD). Postnatal clinical course and work-up, however, revealed early, neonatal forms of disorders of fatty acid oxidation (DFAO) in both cases, namely, glutaric acidemia type II, based on identification of the novel, homozygous splice-site mutation c.1117-2A > G in the ETFDH gene, in one case and carnitine palmitoyltransferase II deficiency in the other case. RESULTS: Review of pre- and postnatal sonographic findings resulted in the identification of some important differences that might help to differentiate DFAO from ARPKD. In DFAO, kidneys are enlarged to a milder degree than in ARPKD, and the cysts are located ubiquitously, including also in the cortex and the subcapsular area. Interestingly, recent studies have pointed to a switch in metabolic homeostasis, referred to as the Warburg effect (aerobic glycolysis), as one of the underlying mechanisms of cell proliferation and cyst formation in cystic kidney disease. DFAO are characterized by the inhibition of oxidative phosphorylation, resulting in aerobic glycolysis, and thus they do resemble the Warburg effect. We therefore speculate that this inhibition might be one of the pathomechanisms of renal hyperproliferation and cyst formation in DFAO analogous to the reported findings in ARPKD. CONCLUSIONS: Neonatal forms of DFAO can be differentially diagnosed in neonates with cystic or hyperechogenic kidneys and necessitate immediate biochemical work-up to provide early metabolic management.
Assuntos
Ácidos Graxos/metabolismo , Rim/diagnóstico por imagem , Erros Inatos do Metabolismo Lipídico/diagnóstico por imagem , Rim Policístico Autossômico Recessivo/diagnóstico por imagem , Adulto , Flavoproteínas Transferidoras de Elétrons/genética , Evolução Fatal , Feminino , Glutaratos/sangue , Humanos , Recém-Nascido , Proteínas Ferro-Enxofre/genética , Erros Inatos do Metabolismo Lipídico/metabolismo , Erros Inatos do Metabolismo Lipídico/terapia , Mutação , Oxirredutases atuantes sobre Doadores de Grupo CH-NH/genética , Rim Policístico Autossômico Recessivo/metabolismo , Rim Policístico Autossômico Recessivo/terapia , Gravidez , Ultrassonografia , Ultrassonografia Pré-Natal , Adulto JovemAssuntos
Cuidados Críticos/métodos , Idade Gestacional , Lactente Extremamente Prematuro/fisiologia , Manuseio das Vias Aéreas , Encéfalo/crescimento & desenvolvimento , Encéfalo/fisiologia , Enterocolite Necrosante/prevenção & controle , Feminino , Viabilidade Fetal , Glucocorticoides/uso terapêutico , Coração/crescimento & desenvolvimento , Coração/fisiologia , Humanos , Recém-Nascido , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/prevenção & controle , Rim/crescimento & desenvolvimento , Rim/fisiologia , Transtornos do Neurodesenvolvimento/prevenção & controle , Guias de Prática Clínica como Assunto , Gravidez , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal , Sepse/prevenção & controle , Fenômenos Fisiológicos da Pele , Equilíbrio Hidroeletrolítico/fisiologiaRESUMO
UNLABELLED: The aims of this study were to compare the skin conductance (SC) of newborns with opiate-induced neonatal abstinence syndrome (NAS) to that of unexposed newborns and to evaluate the potential of SC readings to detect distress in the context of NAS objectively. The SC of 12 newborns with NAS and 12 unexposed newborns was measured at nine specific times during their first 6 weeks of life. The number of SC fluctuations per second (NSCF/s), the amplitude of SC fluctuation, and the mean level of SC were recorded and analyzed. The SC of newborns treated for symptoms of NAS differed significantly from the SC of unexposed newborns with regard to the NSCF/s (p = 0.04). With the mean level of SC, we observed an interaction between groups over time (p value for interaction = 0.02). With increasing postnatal age, we observed higher values in all three SC parameters. CONCLUSION: The NSCF/s and the mean level of SC appear to be suitable to reflect the distress of newborns suffering from NAS. As it is known that the sensitivity of SC increases with the level of stress experienced, its potential to indicate elevated stress levels in infants with NAS should be investigated in future studies evaluating different therapy regimens. WHAT IS KNOWN: ⢠Skin conductance is a result of the filling of palmar and plantar sweat glands innervated by the sympathetic nervous system ⢠Skin conductance can be used as a measure of stress and pain in newborns What is New: ⢠Skin conductance of newborns with neonatal abstinence syndrome (NAS) differs significantly from the SC of non-substance-exposed newborns during the first 6 weeks of life ⢠Skin conductance appears to reflect the increased distress of infants with NAS.
Assuntos
Analgésicos Opioides/efeitos adversos , Resposta Galvânica da Pele/fisiologia , Síndrome de Abstinência Neonatal/fisiopatologia , Transtornos Relacionados ao Uso de Opioides/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Abstinência Neonatal/sangue , Dor/fisiopatologia , Gravidez , Complicações na Gravidez , Estresse Psicológico/fisiopatologiaRESUMO
UNLABELLED: To investigate whether orally applied glucose reduces pain response during oropharyngeal suctioning in preterm infants with a birth weight >1500 g, we conducted a randomized, double-blind, placebo-controlled cross-over trial on 32 preterm infants undergoing oropharyngeal suctioning while on nasal continuous positive airway pressure (CPAP). The Premature Infant Pain Profile (PIPP) score was assessed and compared in a cross-over design to investigate whether there was a significant difference in the patients' pain response. The mean PIPP score during oropharyngeal suctioning after placebo was 8.6 (KI 7.8-9.4). After glucose administration, the mean PIPP score was 8.0 (KI 7.1-8.9). Comparison of the treatment effects reached no statistic significance (p = 0.23). During the oral study drug administration during nasal CPAP, we observed 47 adverse events, but none necessitated therapeutic intervention and none was classified as serious. CONCLUSION: In our study, late preterm infants in the first days of life did not benefit significantly from analgesia with glucose during oropharyngeal suctioning. The oral administration of glucose under nasal CPAP led to no serious adverse events.
Assuntos
Analgésicos/administração & dosagem , Glucose/administração & dosagem , Dor/prevenção & controle , Sucção/efeitos adversos , Administração Oral , Pressão Positiva Contínua nas Vias Aéreas , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Boca , Medição da Dor , Faringe , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapiaRESUMO
AIM: This study evaluated the impact of blood sampling via peripheral arterial catheters on cerebral oxygenation and blood volume as a function of blood sampling velocity. METHODS: Near-infrared spectroscopy was applied to 20 very low-birthweight infants during peripheral arterial blood sampling. Changes in cerebral oxygenated, deoxygenated and total haemoglobin, cerebral blood volume and cerebral oxygenation index were recorded. Heart rate and oxygen saturation were measured continuously. To assess the impact of blood sampling velocity, both fast 40-sec and slow 70-sec sampling procedures were performed in a crossover study design, in which the order of sampling velocities was randomised for each patient. RESULTS: Both fast and slow blood sampling procedures resulted in a significant decrease in cerebral oxygenation index (fast, p = 0.002, slow, p = 0.008), and an increase in mean heart rate (both p = 0.02) and mean blood pressure (p = 0.02 and 0.04). Oxygenated and total haemoglobin and cerebral blood volume only decreased significantly after slow blood sampling (p < 0.001). CONCLUSION: Blood sampling from peripheral arterial catheters leads to significant fluctuations in cerebral oxygenation independent of the sampling velocity. Changes are comparable to those reported from umbilical blood sampling. We advise that blood sampling should be restricted as much as possible.
Assuntos
Coleta de Amostras Sanguíneas/métodos , Encéfalo/metabolismo , Cateterismo Periférico , Doenças do Prematuro/metabolismo , Oxigênio/metabolismo , Volume Sanguíneo/fisiologia , Circulação Cerebrovascular/fisiologia , Estudos Cross-Over , Feminino , Hemoglobinas/metabolismo , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/fisiopatologia , Recém-Nascido de muito Baixo Peso , Masculino , Espectroscopia de Luz Próxima ao Infravermelho , Fatores de TempoRESUMO
INTRODUCTION: Less invasive surfactant application (LISA) is associated with improved short-term outcomes in preterm infants. Data on LISA eligibility and success for infants <28 weeks of gestation are lacking. METHODS: Preterm infants <28 weeks of gestation who were born and actively treated in our tertiary care center in 2018 were included in the retrospective study. We assessed baseline characteristics, delivery room (DR) management, LISA success and complications, and short-term outcome. RESULTS: In total, 57 infants received LISA in the DR. LISA eligibility was 73% at 22 weeks, 88% at 23 weeks, and >90% at gestational ages >24 weeks. LISA was successful in 63% of infants. LISA failure was associated with increased risk for high-grade IVH (OR 17.88), death (OR 10.94), and a reduced chance for survival without complications (OR 8.75). CONCLUSION: Our report justifies LISA as a mode for surfactant application in preterm infants. It contributes to the call for studies to define risk factors for LISA failure.
Assuntos
Idade Gestacional , Lactente Extremamente Prematuro , Surfactantes Pulmonares , Síndrome do Desconforto Respiratório do Recém-Nascido , Humanos , Recém-Nascido , Estudos Retrospectivos , Feminino , Surfactantes Pulmonares/administração & dosagem , Surfactantes Pulmonares/uso terapêutico , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Monochorionic (MC) twins are at risk for severe twin-to-twin transfusion syndrome (TTTS) or twin anemia-polycythemia sequence (TAPS). In the case of preterm delivery, cesarean section (CS) with immediate umbilical cord clamping (ICC) of both twins is usually performed. While the recipient is at risk for polycythemia and may benefit from ICC, this procedure may result in aggravation of anemia with increased morbidity in the anemic donor. The purpose of this study was to demonstrate that the novel approach of selective extrauterine placental perfusion (EPP) with delayed umbilical cord clamping (DCC) in the donor infant is feasible in neonatal resuscitation of MC twins and may prevent severe anemia in donor and polycythemia in the recipient. METHODS: Preterm MC twins with antenatal suspected severe anemia of the donor as measured by Doppler ultrasound, born with birthweights < 1500 g by CS, were transferred to the neonatal resuscitation unit with placenta and intact umbilical cords. In the donor, the umbilical cord was left intact to provide DCC with parallel respiratory support (EPP approach), while the cord of the recipient was clamped immediately after identification. RESULTS: Selective EPP was performed in three cases of MC twins with TAPS and acute peripartum TTTS. All donor twins had initial hemoglobin levels ≥ 13.0 g/dL, and none of them required red blood cell transfusion on the first day after birth. CONCLUSIONS: Selective EPP may be a feasible strategy for neonatal resuscitation of MC preterm twins with high stage TAPS and TTTS to prevent anemia-related morbidities and may improve infant outcome.
RESUMO
UNLABELLED: Very low birth weight (VLBW) infants frequently receive analgesia and/or sedation for painful procedures and mechanical ventilation to avoid negative stress. Yet, concerns remain regarding potential adverse long-term effects of these drugs on VLBW infants' neurocognitive outcome. Recent studies have shown that less invasive surfactant application (LISA) and early nasal CPAP treatment reduce the need for mechanical ventilation and painful procedures. Therefore, these measures might also reduce the application of analgesic and/or sedative drugs in VLBW infants. To evaluate this hypothesis and to identify potential changes in analgesic treatment concepts in recent years, we retrospectively analyzed data on analgesia and sedation, respiratory support, and the method of surfactant application in VLBW infants enrolled in the German Neonatal Network (GNN) trial between 2003 and 2009 (period 1) and compared it with data from infants participating in GNN in 2010 (period 2). In both periods, about one third of all infants were treated with analgesic and/or sedative drugs using a wide variety of substances. The administration of novel drugs such as propofol, sufentanil, or intravenous paracetamol was higher in 2010 (6.7 vs. 12.2 %). Infants who were treated with CPAP only received significantly less analgesic/sedative medication than infants who were mechanically ventilated (12 vs. 65 %, p=<0.001). Similarly, infants treated with LISA received less analgesic or sedative drugs as compared to infants who received surfactant via endotracheal intubation (36 vs. 63 %, p=0.001). CONCLUSION: Although both avoidances of mechanical ventilation and less invasive surfactant application are associated with reduced analgesic or sedative treatment, the percentage of VLBW infants who received analgesia and/or sedation remained unchanged in Germany in recent years.