RESUMO
BACKGROUND: Preterm infants are at higher risk of sudden infant death syndrome (SIDS) compared with term born infants and the risk is inversely proportional to the gestational age and birthweight. Parents of these infants should have adequate knowledge and practise the recommended SIDS risk reduction measures. METHODS: A survey was conducted between December 2016 and August 2017 at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur. Parents of preterm infants ≤36 weeks' gestation were invited to answer a self-administered questionnaire to assess their knowledge and practise regarding SIDS risk reduction. RESULTS: Forty-nine (61.33%) of the 80 parents had heard of SIDS prior to the interview, with social media being the commonest source of information (67.3%). Only 35 (43.7%) correctly answered at least five of nine questions on knowledge of SIDS risk reduction ("good knowledge"). When compared with the group of parents who answered less than five questions correctly ("poor knowledge"), there was no significant difference in the demographic and infant characteristics between the groups. The majority (68.8%) of parents practised bed sharing with their infants, and this was significantly more common in the group of parents with poor knowledge (P = 0.01). Household smoking was also significantly more common in the group of parents with poor knowledge (P = 0.048). CONCLUSION: Knowledge on SIDS risk reduction measures was generally poor among parents of preterm infants in this study. Cigarette smoking, bed sharing and non-supine sleep positions, which are associated with increased risk of SIDS, were common practise among the present subjects.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Recém-Nascido Prematuro , Pais/psicologia , Morte Súbita do Lactente/prevenção & controle , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Malásia , Masculino , Morte Súbita do Lactente/etiologiaRESUMO
BACKGROUND: Occlusive body wrap using polyethylene plastic applied immediately after birth had been shown to reduce hypothermia among preterm infants. Various adjunct methods have been studied in an attempt to further reduce the incidence of hypothermia. This study was conducted to determine whether polyethylene cap is more effective than cotton cap as an adjunct to polyethylene occlusive body wrap in reducing hypothermia in preterm infants. METHODS: The subjects consisted of preterm infants 24-34 weeks' gestation born at Universiti Kebangsaan Malaysia Medical Centre. Infants were randomly assigned to NeoCap or control groups. Infants in both groups were wrapped in polyethylene sheets from the neck downwards immediately after birth without prior drying. Infants in the control group had their heads dried and subsequently covered with cotton caps while infants in the NeoCap group had polyethylene caps put on without drying. Axillary temperature was measured on admission to the neonatal intensive care unit (NICU), and after having been stabilized in the incubator. RESULTS: Among the 80 infants recruited, admission hypothermia (axillary temperature <36.5°C) was present in 37 (92.5%) and in 40 (100%) in the NeoCap and control groups, respectively. There was no significant difference in mean temperature on NICU admission between the two groups (35.3 vs 35.1°C, P = 0.36). Mean post-stabilization temperature, however, was significantly higher in the NeoCap group (36.0 vs 35.5°C, P = 0.01). CONCLUSION: Combined use of polyethylene body wrap and polyethylene cap was associated with a significantly higher mean post-stabilization temperature compared with polyethylene body wrap and cotton cap.
Assuntos
Bandagens , Vestuário , Fibra de Algodão , Hipotermia/prevenção & controle , Doenças do Prematuro/prevenção & controle , Terapia Intensiva Neonatal/métodos , Polietileno , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Resultado do TratamentoRESUMO
UNLABELLED: Lung lavage using two aliquots of 15 mL/kg of dilute surfactant was performed in 30 ventilated infants with severe meconium aspiration syndrome (MAS). Mean recovery of instilled lavage fluid was 46%, with greater fluid return associated with lower mean airway pressure at 24 h and a shorter duration of respiratory support. CONCLUSION: Recovery of instilled lavage fluid is paramount in effective lung lavage in MAS and must be afforded priority in the lavage technique.
Assuntos
Lavagem Broncoalveolar/métodos , Síndrome de Aspiração de Mecônio/terapia , Líquido da Lavagem Broncoalveolar , Terapia Combinada , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Recém-Nascido , Modelos Lineares , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate whether lung lavage with surfactant changes the duration of mechanical respiratory support or other outcomes in meconium aspiration syndrome (MAS). STUDY DESIGN: We conducted a randomized controlled trial that enrolled ventilated infants with MAS. Infants randomized to lavage received two 15-mL/kg aliquots of dilute bovine surfactant instilled into, and recovered from, the lung. Control subjects received standard care, which in both groups included high frequency ventilation, nitric oxide, and, where available, extracorporeal membrane oxygenation (ECMO). RESULTS: Sixty-six infants were randomized, with one ineligible infant excluded from analysis. Median duration of respiratory support was similar in infants who underwent lavage and control subjects (5.5 versus 6.0 days, P = .77). Requirement for high frequency ventilation and nitric oxide did not differ between the groups. Fewer infants who underwent lavage died or required ECMO: 10% (3/30) compared with 31% (11/35) in the control group (odds ratio, 0.24; 95% confidence interval, 0.060-0.97). Lavage transiently reduced oxygen saturation without substantial heart rate or blood pressure alterations. Mean airway pressure was more rapidly weaned in the lavage group after randomization. CONCLUSION: Lung lavage with dilute surfactant does not alter duration of respiratory support, but may reduce mortality, especially in units not offering ECMO.
Assuntos
Produtos Biológicos/administração & dosagem , Lavagem Broncoalveolar , Síndrome de Aspiração de Mecônio/terapia , Surfactantes Pulmonares/administração & dosagem , Oxigenação por Membrana Extracorpórea , Feminino , Ventilação de Alta Frequência , Humanos , Recém-Nascido , Masculino , Óxido Nítrico/uso terapêutico , Análise de Sobrevida , Fatores de TempoRESUMO
BACKGROUND: Occlusive plastic applied immediately after birth to reduce evaporative heat loss has been proven effective in preterm infants <28 weeks' gestation. However its effectiveness on preterm infants >28 weeks' gestation has not been shown. This study aimed to determine the effect of occlusive wrap at birth on the temperature at neonatal intensive care unit (NICU) admission among infants of greater than or equal to 24 weeks' and less than 34 weeks' gestation. METHODS: Study infants were randomly assigned to "wrap" or "control" groups. Newborns in the wrap group were wrapped with polyethylene plastic sheets within the first min after birth. Infants randomized to the control group were dried immediately after birth with warmed towels under a warmer, according to the guidelines of Neonatal Resuscitation. Infants' axillary temperatures were measured on admission to the NICU, and after having been stabilized in incubators in the NICU. RESULTS: A total of 110 infants were recruited into the study. The mean admission temperature was significantly higher in the wrap group (35.8 vs 34.8°C, P < 0.01). Admission hypothermia (axillary temperature <36.5°C) was present in 38 (78%) and 58 (98%) infants in the wrap and control groups, respectively. Among infants of <28 weeks' gestation, the post-stabilization temperature was significantly higher in the wrap group. CONCLUSIONS: Wrapping premature infants with gestational age <34 weeks in polyethylene plastics immediately after birth is associated with lower incidence of hypothermia.
Assuntos
Bandagens , Hipotermia/prevenção & controle , Doenças do Prematuro/prevenção & controle , Temperatura Corporal , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , PolietilenoRESUMO
OBJECTIVE: To study the prevalence of hearing loss (HL) and to identify the possible risk factors causing HL. METHODS: This retrospective study was conducted from January 2014-December 2016 at a tertiary hospital in Malaysia. All neonates admitted to the neonatal intensive care unit (NICU), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were screened with a two-step protocol using an automated auditory brain response (AABR) and/or Otoacoustic Emission and auditory brain response (ABR). Descriptive analysis was used for the prevalence of HL, degree of HL and number of risk factors per infant. RESULTS: A total of 2713 babies underwent hearing screening in NICU was enrolled in this study. Two thousand six hundred eight (96%) babies passed the screening test and 214 (4%) babies required further diagnostic test. Only 105 (49%) babies completed diagnostic tests. Out of 105 babies, 40 (38.1%) babies had HL. Mild HL was the commonest HL with 22 (55%), moderate HL was in seven babies (17.5%), severe HL in two babies (5%), and profound HL in nine babies (22.5%). The presence of craniofacial anomalies was the only significant independent risk factor for HL with p<0.05 with an odds ratio of 0.105 CI 95% [0.028-0.389]. Of Babies with the presence of three or more risk factors, 100% of them had HL.There was an increased risk of hearing loss in those with craniofacial anomalies up to 11 times higher compared to those without such anomalies. CONCLUSION: The prevalence of HL among the NICU babies was 1.5% and mild HL was the commonest degree of HL (55%).
RESUMO
BACKGROUND: Developmental disabilities have been reported in infants with persistent pulmonary hypertension of the newborn (PPHN) treated with inhaled nitric oxide (INO) or intravenous magnesium sulphate (MgSO(4)) and/or extracorporeal membrane oxygenation. This paper reports the rate of developmental disabilities at 2 years of age in a cohort of survivors of PPHN treated with INO, MgSO(4), or both during the neonatal period. METHODS: Sixteen survivors of PPHN were prospectively followed up. These infants were treated with intravenous MgSO(4) and/or INO during the neonatal period. Neurodevelopmental assessment was carried out at 2 years of age using the Bayley Scales of Infant Development 2nd Edition by a developmental psychologist. Eleven (68.8%) infants completed the 2-year follow-up. RESULTS: The median mental developmental index (MDI) and physical developmental index scores were 85 (interquartile range, IQR = 27) and 87 (IQR = 33), respectively. Two infants (18.2%) had developmental disability (MDI scores <70). CONCLUSION: Survivors of PPHN are at risk of developmental disabilities. Early intervention programme and long-term follow-up should be integrated in the management of these infants.
RESUMO
UNLABELLED: A randomized controlled study was carried out on 96 preterm infants (< 37 wk) with birthweight less than 2000 g admitted to a neonatal intensive care unit. The aim was to compare the weight gain between preterm infants exposed to 12 h cyclical lighting (intensity of light: 78.4 +/- 24.7 lux, mean +/- SD) and those exposed to a continuously dim environment (5.9 +/- 1.9 lux). The exclusion criteria were infants with major congenital malformations or who needed continuous lighting for treatment procedure and care. From day 7 of life until discharge, 50 infants were randomized to receive 12 h cyclical lighting and 46 infants to a continuously dim environment. There was no significant difference in the mean birthweight (12 h lighting vs continuously dim: 1482 vs 1465 g, p = 0.8), mean gestational age (31.6 vs 31.4 wk, p = 0.6), median duration of hospital stay (28.5 vs 28.5 d, p = 0.8), mean age to regain birthweight (13.0 vs 12.9 d, p = 0.3), mean weight gained by day 14 (27.6 vs 36.2 g, p = 1.0), median weight gain per day (11.9 vs 12.2 g, p = 0.9) or median body weight on discharge (1800 vs 1800 g, p = 0.4) between the two groups of infants. CONCLUSION: Exposing preterm infants to either 12 h cyglical lighting or continuously dim environment did not have any significant effect on their weight gain during the neonatal period.