RESUMO
The causative factors of neonatal feeding intolerance are poorly understood, but potentially related to clinical practices such as empiric antibiotic usage. The objective of this study was to evaluate whether early empiric antibiotic exposure negatively affects preterm infants' enteral feeding tolerance. Data from infants without risk factors for sepsis, 500 to 1499 g birth weight and 24 to 34 weeks gestational age were analyzed. The primary outcomes were the empiric antibiotic exposure effects on the infants' total parenteral nutrition usage duration and prevalence of necrotizing enterocolitis (NEC). Among the 901 infants included, 67 were exposed to early empiric antibiotic. A 50% increase in parenteral nutrition usage duration and a 4-fold greater prevalence of NEC was seen in the early empiric antibiotic-exposed neonates, when compared with control infants (Pâ<â0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.
Assuntos
Antibacterianos/efeitos adversos , Nutrição Enteral/estatística & dados numéricos , Enterocolite Necrosante/induzido quimicamente , Transtornos da Alimentação e da Ingestão de Alimentos/induzido quimicamente , Doenças do Prematuro/induzido quimicamente , Nutrição Parenteral Total/estatística & dados numéricos , Enterocolite Necrosante/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Estudos RetrospectivosRESUMO
OBJECTIVES: Functional echocardiography is a valuable tool in the neonatal intensive care unit, but training programs are not standardized. The aim was to report an functional echocardiography training program for neonatologists and to describe the agreement of their measurements with the pediatric cardiologist. METHODS: Functional echocardiography training lasted 32h. After training program, the neonatologists performed functional echocardiography in the neonatal intensive care unit and were required to measure left cardiac chambers dimensions, left ventricle systolic function, right and left ventricular output, ductus arteriosus diameter, and flow pattern. Images were recorded by the equipment and reviewed offline by the pediatric cardiologist. The Bland-Altman test was used for quantitative variables and the kappa test, for qualitative variables. RESULTS: Twenty-two trained neonatologists performed 100 functional echocardiography exams. Ductus arteriosus identification and flow pattern had substantial agreement (kappa=0.91 and 0.88, respectively), as well as its diameter (mean difference=0.04mm). The mean difference for the aortic root was -1.2mm; left atrium, 0.60mm; left ventricle diastolic diameter, -0.90mm; left ventricle systolic diameter, -0.30mm. Shortening fraction and ejection fraction correlated well with broad limits of agreement, -2.96% (14.88; -20.82%) and --3.43% (15.54; -22.40%), respectively. Right and left ventricular output had broad limits of agreement, 16.69mL/kg/min (222.76; -189.37) and 23.57mL/kg/min (157.88; -110), respectively. There was good agreement between interpretations of normal or low cardiac output (76.7% for right ventricular output; 75.7% for left ventricular output). CONCLUSION: This functional echocardiography training program enabled neonatologists to obtain adequate skills in performing the images, obtaining good agreement with the cardiologist in simple hemodynamic measurements and ductus arteriosus evaluation.
Assuntos
Cardiologistas , Criança , Permeabilidade do Canal Arterial , Ecocardiografia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva NeonatalRESUMO
OBJECTIVE: To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. DESIGN: Pragmatic prospective cohort study. SETTING: 20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded. INTERVENTIONS: Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome. RESULTS: 1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695). CONCLUSION: This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.
Assuntos
Doenças do Prematuro , Recém-Nascido Prematuro/fisiologia , Respiração com Pressão Positiva , Respiração Artificial , Ventiladores Mecânicos , Brasil/epidemiologia , Estudos de Coortes , Desenho de Equipamento , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Insuflação/métodos , Masculino , Alta do Paciente/estatística & dados numéricos , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/métodos , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Análise de Sobrevida , Ventiladores Mecânicos/efeitos adversos , Ventiladores Mecânicos/normasRESUMO
Objetivo: Analisar resultados desfavoráveis ââna alta hospitalar de prematuros nascidos em centros universitários públicos brasileiros. Métodos: Coorte prospectiva de 2646 recém-nascidos com idade gestacional de 23 a 33 semanas e peso ao nascer de 400 a 1499 g, sem malformações, nascidos em 20 centros no período de 2012 a 2013. O desfecho desfavorável foi definido como morte ou sobrevida hospitalar na alta hospitalar com ≥1 morbidades principais: displasia broncopulmonar (DBP) em 36 semanas corrigidas, hemorragia intraventricular (IVH) graus 3-4, leucomalácia periventricular (PVL) ou retinopatia tratada cirurgicamente prematuridade (ROP). Resultados: Entre 2646 crianças, 1390 (53%) morreram ou sobreviveram com as principais morbidades: 793 (30%) morreram; 497 (19%) tinham DBP; 358 (13%) tinham IVH 3-4 ou PVL; e 84 (3%) apresentaram ROP. A regressão logística ajustada pelo centro mostrou associação de desfecho desfavorável com: esteroides pré-natais (OR 0,70; IC 95% 0,55-0,88), cesariana (0,72; 0,58-0,90), idade gestacional <30 (4,00; 3,16-5,07), sendo masculino (1,44; 1,19-1,75), pequeno para a idade gestacional (2,19; 1,72-2,78), Apgar no quinto minuto <7 (3,89; 2,88-5,26), temperatura na admissão na UTIN <36,0 ° C (1,42; 1,15-1,76) , síndrome do desconforto respiratório (3,87; 2,995,01), sepse tardia comprovada (1,33; 1,051,69), enterocolite necrosante (3,10; 2,094,60) e persistência do canal arterial (1,69; 1,372,09). Conclusões: Mais da metade dos RNPT que nasceram em hospitais públicos estaduais de nível universitário 3 morrem ou sobrevivem com grandes morbidades.