RESUMEN
AIM: To assess the electrocardiography and echocardiography changes during therapeutic hypothermia and rewarming period in encephalopathic infants with long-term adverse neurological outcome. METHODS: Prospective multicentre longitudinal study. We included 64 consecutive infants with moderate or severe hypoxic ischaemic encephalopathy undergoing therapeutic hypothermia who had 18-24 month-outcome data. We analysed electrocardiography and heart rate changes before, during and after therapeutic hypothermia. Superior vena cava flow, left ventricular cardiac output and stroke volume were studied using echocardiography during and immediately after therapeutic hypothermia. An abnormal outcome was defined as death or moderate/severe disability at 18-24 months. RESULTS: Neonates with higher superior vena cava flow pre-rewarming had signiï¬cantly higher odds of documented long-term adverse outcome when compared to newborns with good outcome (OR 1.57; 95%CI, 1.1-1.78; p = 0.01 after adjustment). QTc and RR intervals were significantly longer at 12, 24, 36 and 48 h in infants with good outcome compared with those with adverse outcome (p < 0.001). During therapeutic hypothermia, infants with poor outcome had a higher heart rate at 12, 24, 36, 48, 60 h after birth compared with those with good outcome (p < 0.001). From 36 h on, heart rate gradually increased and RR and QTc intervals progressively shortened with values back to normal after rewarming. CONCLUSIONS: Infants with hypoxic ischaemic encephalopathy who have adverse neurological outcome show a preferential cerebral blood flow redistribution during therapeutic hypothermia. Infants with poor outcome have higher heart rate and shorter RR and QTc intervals during therapeutic hypothermia.
Asunto(s)
Asfixia Neonatal/complicaciones , Gasto Cardíaco , Circulación Cerebrovascular , Hipotermia Inducida , Hipoxia-Isquemia Encefálica , Recalentamiento/métodos , Volumen Sistólico , Ecocardiografía/métodos , Electrocardiografía/métodos , Femenino , Humanos , Hipotermia Inducida/efectos adversos , Hipotermia Inducida/métodos , Hipoxia-Isquemia Encefálica/diagnóstico , Hipoxia-Isquemia Encefálica/etiología , Hipoxia-Isquemia Encefálica/mortalidad , Hipoxia-Isquemia Encefálica/terapia , Recién Nacido , Efectos Adversos a Largo Plazo/diagnóstico , Estudios Longitudinales , Masculino , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/etiología , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Vena Cava Superior/fisiopatologíaRESUMEN
BACKGROUND: Several studies have determined the effects of non-nutritive sucking habits on malocclusions, but provided conflicting results. AIM: To analyse the influence of infant feeding In the presence of non-nutritive sucking habits in children after the first year of life and to assess the effects of non-nutritive sucking habits on occlusion in mixed dentition. DESIGN: Data were collected by self-reported questionnaire and confirmed by personal interview. Parents of 1451 children (aged 7-11) were asked about their children's infant feeding and non-nutritive sucking habits. A clinical evaluation of dental arches included classification of molar relationship (Angle classification), presence or absence of crossbite and open bite. RESULTS: Children with bottle or complementary feeding showed a higher risk of acquiring non-nutritive sucking habits after the first year of life (P < 0.01). Non-nutritive sucking habits are associated with a greater risk of crossbite, open bite, Class II molar relationship (P < 0.01). CONCLUSIONS: Parents should be educated about benefits of the exclusive breast feeding in the first 6 months of age on mixed dentition. The activity of non-nutritive sucking should be diagnosed in a timely manner in order to reduce the development of posterior crossbite, anterior open bite, and Class II molar relationship.
Asunto(s)
Oclusión Dental , Dentición Mixta , Métodos de Alimentación , Conducta en la Lactancia/fisiología , Alimentación con Biberón , Lactancia Materna , Niño , Arco Dental/patología , Femenino , Succión del Dedo , Humanos , Lactante , Italia , Masculino , Maloclusión/clasificación , Maloclusión Clase II de Angle/etiología , Diente Molar/patología , Mordida Abierta/etiología , ChupetesRESUMEN
Large facial haemangiomas have a high rate of complications and can be associated with neurological, ophthalmological and cardiac abnormalities (PHACE syndrome; Posterior fossa malformations, Haemangiomas, Arterial anomalies, Coarctation of the aorta and cardiac defects, and Eye abnormalities). However, a thorough clinical examination is absolutely necessary. In fact, even in the absence of a PHACE syndrome, large haemangiomas can induce important complications. In the present brief report we describe a case of left ventricular dilatation in a 6-month-old girl due to a giant facial haemangioma. Left ventricular dilatation has been evaluated by two-dimensional echocardiography. Studies to identify other major arteriovenous malformations were negative. Medical therapy with diuretics, angiotensin-converting enzyme (ACE) inhibitors and steroids was able to halt the progression towards left ventricular dysfunction, avoiding an early surgical approach for a disease that very often is self-limiting.