RESUMO
OBJECTIVE: To identify factors leading to readmission for tracheostomized, ventilator-dependent infants <2 years of age. STUDY DESIGN: Retrospective cohort study of 117 tracheostomized, ventilator-dependent infants followed through 2 years of age. RESULTS: Home ventilator use (at hospital discharge, 6 and 12 months of age), inhaled steroid use (at 12 and 24 months of age), oxygen dependence (at 6 and 12 months of age) and tracheostomy (at discharge, 6 and 12 months of age) were increased risks for rehospitalization. Equipment malfunction throughout the first 2 years also contributed to readmissions. Viral infection, with rhinovirus/enterovirus the most commonly identified pathogen, was the most common etiology for rehospitalization. Diuretic use and initial comorbid diagnoses were not associated with increased risk of rehospitalization. CONCLUSION: The risk for rehospitalization for infants requiring tracheostomy and ventilator support was affected by prolonged oxygen use, prolonged ventilator dependence, inhaled steroid use and equipment malfunction, and was equally distributed throughout the first 2 years of life.
Assuntos
Oxigenoterapia/métodos , Readmissão do Paciente/estatística & dados numéricos , Esteroides/administração & dosagem , Traqueostomia , Administração por Inalação , Comorbidade , Falha de Equipamento , Feminino , Serviços de Assistência Domiciliar , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Pneumopatias/terapia , Masculino , Missouri , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Viroses/epidemiologiaRESUMO
OBJECTIVE: Assess the impact of intercurrent respiratory infections in infants <29 weeks gestational age (GA). STUDY DESIGN: A retrospective cohort study of 111 infants born <29 weeks GA, controlling for bronchopulmonary dysplasia (BPD) severity and assessing pulmonary health over the first year of life through oxygen, diuretic and inhaled steroid use. RESULT: Regression analysis showed viral infections increased oxygen use (odds ratio (OR) of 15.5 (confidence interval (CI)=3.4, 71.3)). The trend test showed increasing numbers of viral infections were associated with increased oxygen (OR (95% CI)=6.4 (2.3 to 17.4), P=0.0003), diuretic (OR (95% CI)=2.4 (1.1to 5.2), P=0.02) and inhaled steroid use (OR (95% CI)=2.2 (1.003 to 5.2), P=0.049), whereas bacterial infections were not. CONCLUSION: Viral infections caused more long-term pulmonary morbidity/mortality than bacterial infections on premature lung health, even when controlling for BPD.
Assuntos
Infecções Bacterianas/complicações , Displasia Broncopulmonar/complicações , Pneumopatias/etiologia , Infecções Respiratórias/complicações , Esteroides/uso terapêutico , Viroses/complicações , Administração por Inalação , Diuréticos/uso terapêutico , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro , Modelos Logísticos , Pneumopatias/tratamento farmacológico , Masculino , Oxigenoterapia/estatística & dados numéricos , Estudos RetrospectivosRESUMO
OBJECTIVE: To assess pulmonary outcomes of infants <29 weeks gestational age (GA), delivered at level I, II and III facilities, to identify potentially modifiable factors affecting bronchopulmonary dysplasia (BPD) severity and to assess the external generalizability of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) BPD Outcome Estimator. STUDY DESIGN: Outcomes for infants <29 weeks GA born during (2008-2010) and delivered either at an inborn level III center or in a level II or III metropolitan area hospital with transfer to a level IV center, or delivered in a distant level I or II center and then transported to a level IV center were assessed. BPD severity was compared with the NICHD Neonatal BPD Outcome Estimator. RESULT: Of 158 infants who comprised the cohort, 28 (17.8%) had no BPD, 39 (24.2%) had mild BPD, 45 (28.7%) had moderate BPD, 31 (19.7%) had severe BPD and 15 (9.6%) died at ≤36 weeks post menstrual age. Site of birth did not predict severe BPD or death. Receiver operator characteristic curves showed fair predictability for none/mild and severe BPD. CONCLUSION: BPD severity was not dependent on site of birth. The NICHD BPD outcome estimator provides fair prediction for extreme outcomes.
Assuntos
Displasia Broncopulmonar/epidemiologia , Lactente Extremamente Prematuro , Avaliação de Resultados em Cuidados de Saúde/métodos , Displasia Broncopulmonar/classificação , Displasia Broncopulmonar/mortalidade , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Prognóstico , Curva ROC , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: The objective of this study is to determine the effects that sildenafil citrate has on gas exchange in infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH). STUDY DESIGN: A retrospective review was performed from 2005 to 2009. Infants treated with sildenafil citrate for greater than 48 h were included. Standard patient data was collected, including echocardiogram, inspired oxygen and systemic blood pressure, before and during administration of sildenafil citrate. RESULT: Sildenafil citrate was used in 21 preterm infants with BPD-associated PH. A significant reduction in estimated right ventricular peak systolic pressure was seen after initiation of sildenafil citrate, with the majority of infants showing no improvement in gas exchange at 48 h of treatment. Four infants died during treatment. CONCLUSION: Sildenafil citrate reduced estimated pulmonary artery pressures, but this reduction was not reflected in improved gas exchange within the first 48 h.
Assuntos
Displasia Broncopulmonar/tratamento farmacológico , Hipertensão Pulmonar/tratamento farmacológico , Inibidores da Fosfodiesterase 5/uso terapêutico , Piperazinas/uso terapêutico , Troca Gasosa Pulmonar/efeitos dos fármacos , Sulfonas/uso terapêutico , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/fisiopatologia , Feminino , Idade Gestacional , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/fisiopatologia , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Inibidores da Fosfodiesterase 5/farmacologia , Piperazinas/farmacologia , Purinas/farmacologia , Purinas/uso terapêutico , Estudos Retrospectivos , Índice de Gravidade de Doença , Citrato de Sildenafila , Sulfonas/farmacologia , Resultado do TratamentoRESUMO
We present a case of a late-preterm infant admitted for suspected cyanotic heart disease who was found to have a thrombosed ductus arteriosus. Maternal history was significant for heterozygosity for Factor V Leiden, treated with enoxaparin during her pregnancy, and congenital hearing loss. The neonate did not have a Factor V Leiden mutation detected, but was found to have a heterozygous mutation within the MFTHR gene. He was treated with anticoagulation, with improving hemodynamics measured by echocardiogram. This case presents a rare disease, which is potentially fatal if diagnosis is delayed.