RESUMO
OBJECTIVE: To compare the effectiveness of a prophylactic surfactant treatment strategy (PRO) to the effectiveness of a rescue (RESC) surfactant treatment strategy in patients at high risk for developing hyaline membrane disease (HMD). STUDY DESIGN: We analyzed data from a retrospective cohort consisting of all patients admitted to the neonatal intensive care units at the centers participating in the recently completed Infasurf-Survanta Comparative Trial. To be in the cohort, a patient had to be admitted during the trial, be <48 hours of age on admission, have a gestational age of <30 weeks, have a birth weight of 501 to 1250 gm, and be free of congenital anomalies. Twelve centers participated in this study. They contributed 1097 patients of whom 381 were treated with a PRO strategy. RESULTS: Survival was significantly higher in the PRO-strategy patients (84% vs 72%, p < 0.05) as was survival without oxygen requirement at a postconceptional age of 36 weeks (60% vs 46%, p < 0.05). In addition, the patients with PRO had a lower prevalence of grade III and IV intraventricular hemorrhage (IVH, 9% vs 14%, p < 0.05). All analyses were controlled for birth weight and type of study center. CONCLUSION: These data support the conclusion that using a PRO treatment strategy results in improved survival in patients at risk for developing HMD. A PRO treatment strategy may also decrease the likelihood of developing a severe IVH.
Assuntos
Doença da Membrana Hialina/prevenção & controle , Mortalidade Infantil , Recém-Nascido de muito Baixo Peso , Surfactantes Pulmonares/uso terapêutico , Hemorragia Cerebral/complicações , Humanos , Recém-Nascido , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To compare the relative safety and efficacy of Infasurf (calf lung surfactant extract; ONY, Inc, Amherst, NY, IND #27169) versus Survanta (Beractant, Ross Laboratories, Columbus, OH) in reducing the acute severity of respiratory distress syndrome (RDS) when given at birth and to infants with established RDS. DESIGN: A prospective, randomized, double-blind, multicenter clinical trial. SETTING: Thirteen neonatal intensive care units participated in the treatment arm: seven of these concurrently participated in the prevention arm. PATIENTS: The treatment arm enrolled infants of =2000 g birth weight with established RDS, and the prevention arm enrolled infants of =29 weeks' gestation with birth weights <1250 g. INTERVENTION: Infants were randomly assigned to receive Infasurf (n = 303, treatment arm; n = 180, prevention arm) or Survanta (n = 305, treatment arm; n = 194, prevention arm) in accordance with the Survanta package insert instructions. OUTCOME MEASURES: We projected a 25% reduction between groups in the need for a third dose of surfactant for infants with established RDS, and a 25% reduction in the need for a second dose of surfactant for infants who received prophylactic surfactant. Secondary outcomes included the severity of RDS measured by inspired oxygen concentrations and mean airway pressure, air leaks, complications associated with surfactant administration, and survival to 36 weeks' postmenstrual age without the need for oxygen supplementation. RESULTS: In the treatment arm, there was no difference between groups in the number of infants requiring more than two doses of surfactant. The interval between doses was significantly longer for Infasurf, suggesting an increased duration of treatment effect. The inspired oxygen concentration and mean airway pressure were lower in the Infasurf infants during the first 48 hours in the treatment arm. In the prevention arm, there were no differences with respect to the number of surfactant doses. The dosing intervals were longer for Infasurf infants after the second dose. No difference in inspired oxygen or mean airway pressure was noted during the first 72 hours. There were no significant differences in the incidence of air leaks, complications associated with dosing, complications of prematurity, mortality, or survival without chronic lung disease in the prevention or treatment arm. CONCLUSIONS: Infants treated with Infasurf have a modest benefit in the acute phase of RDS. Infasurf seems to produce a longer duration of effect than Survanta.
Assuntos
Produtos Biológicos , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Fatores Etários , Índice de Apgar , Peso ao Nascer , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Estudos Prospectivos , Surfactantes Pulmonares/administração & dosagem , Surfactantes Pulmonares/efeitos adversos , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controleRESUMO
Reference values for coagulation studies of premature infants (24 to 29 weeks' gestational age) are needed for the management of hemostatic disorders in the precariously ill infant. We collected data on the very low-birthweight infants admitted to our intensive care nursery who met criteria over a 4-year period to determine prothrombin time, activated partial thromboplastin time, and fibrinogen levels in this group. Fifty-two infants had a mean prothrombin time of 14.5 seconds, a mean activated partial thromboplastin time of 69.5 seconds, and a mean fibrinogen level of 1.35 g/L. Converting values to ratios of adult control values facilitated direct comparison of results to published reference ranges. Coagulation studies may vary over a broad range of prematurity, and normal ranges are needed for prospective, randomized protocols designed to prevent the complications of abnormal coagulation function.
Assuntos
Testes de Coagulação Sanguínea , Coagulação Sanguínea/fisiologia , Recém-Nascido de Baixo Peso/sangue , Recém-Nascido Prematuro/sangue , Humanos , Recém-Nascido , Valores de ReferênciaRESUMO
We investigated the possible effect of the Resource-Based Relative Value Scale (RBRVS) fee schedule on reimbursements for neonatologists. This payment system may prove attractive to most third-party payers and is predicted to result in lower procedural reimbursement, which is a significant component of neonatal care. We studied the charges and reimbursements for the portion of our intensive care nursery patient population covered by Medicaid for a 1-year period. Total, procedural, and nonprocedural reimbursements under three current systems and the RBRVS were compared. The RBRVS system produced overall improved reimbursement compared with Medicaid, but decreased reimbursement compared with the other two systems. Nonprocedural services were relatively better reimbursed than procedural services. The impact of RBRVS will depend on the population mix of third-party payers, the proportion of nonprocedural charges in a particular neonatal intensive care unit, and the conversion factor used by the third-party payer.
Assuntos
Medicaid/economia , Medicare Part B/economia , Neonatologia/economia , Mecanismo de Reembolso , Escalas de Valor Relativo , Honorários Médicos , Sistemas Pré-Pagos de Saúde/economia , Humanos , Recém-Nascido , Kansas , Estados UnidosRESUMO
EEGs were performed on 102 preterm low-birth-weight neonates within the first 7 days of life. Babies were later separated into those without intracranial hemorrhage, those who had only subependymal hemorrhage (SEH), and those with intraventricular/intracerebral hemorrhage. The incidence and types of EEG abnormalities, 42% overall and including positive rolandic sharp waves, did not differ in the three groups. The incidence and distribution of EEG abnormalities between groups were not influenced by perinatal events. Developmental follow-up of 73 patients was similarly not correlated with neonatal EEG results, although the most severe EEG abnormalities were associated with subsequent mortality or morbidity.
Assuntos
Hemorragia Cerebral/diagnóstico , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/fisiopatologia , Eletroencefalografia , Seguimentos , Crescimento , Humanos , Recém-Nascido , Tomografia Computadorizada por Raios XRESUMO
Heated water pads were placed underneath very-low-birth-weight preterm infants receiving care under overhead radiant warmers with plastic heat shields to evaluate the effects on their thermal environments. The electrical input (watts) to the overhead warmer was monitored and temperatures at various locations in the environment and on the infants were recorded. The electrical input to the radiant warmers decreased significantly (P = 0.0015) with the introduction of the heated water pads. Several of the temperatures recorded during the study also showed significant changes, including increased abdominal skin temperatures in these prone infants (P = 0.007) and decreased back-to-abdomen skin temperature gradients (P = 0.007). Less marked changes included higher mattress or pad temperatures (P = 0.019), lower ambient air temperatures within the plastic heat shields (P = 0.022), and increased infant foot temperatures (P = 0.036). We believe that conduction has a significant influence on the thermal environment of the VLBW infant cared for under an overhead radiant warmer and that the use of a heated water pad can markedly alter heat transfer. The impact of conduction appears to have been previously underestimated.