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1.
Cardiol Young ; 32(4): 668-670, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34486517

RESUMO

A 4-hour-old infant with profound cyanosis on an alprostadil infusion was urgently transferred to Rady Children's Hospital with suspected CHD. Upon arrival, urgent echocardiography was performed but could not confirm the presence of discrete pulmonary veins or pulmonary venous drainage. Given the difficulty in delineating the anatomy, a cardiac CT scan was performed and demonstrated a nearly atretic common pulmonary vein with multiple small collaterals that drained to systemic veins. Due to the high risk of mortality associated with operative repair, the decision was made to proceed with compassionate withdrawal of care. The described anatomy of common pulmonary vein atresia remains rare, and to our knowledge, fewer than 40 cases have been reported in the literature. Albeit rare, common pulmonary vein atresia should be considered in the differential diagnosis of a severely cyanotic neonate.


Assuntos
Cardiopatias Congênitas , Veias Pulmonares , Malformações Vasculares , Criança , Cianose/complicações , Ecocardiografia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Veias Pulmonares/anormalidades , Malformações Vasculares/complicações
2.
J Pediatr ; 166(4): 856-61.e1-2, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25684087

RESUMO

OBJECTIVE: To determine if temperature regulation is improved during neonatal transport using a servo-regulated cooling device when compared with standard practice. STUDY DESIGN: We performed a multicenter, randomized, nonmasked clinical trial in newborns with neonatal encephalopathy cooled during transport to 9 neonatal intensive care units in California. Newborns who met institutional criteria for therapeutic hypothermia were randomly assigned to receive cooling according to usual center practices vs device servo-regulated cooling. The primary outcome was the percentage of temperatures in target range (33°-34°C) during transport. Secondary outcomes included percentage of newborns reaching target temperature any time during transport, time to target temperature, and percentage of newborns in target range 1 hour after cooling initiation. RESULTS: One hundred newborns were enrolled: 49 to control arm and 51 to device arm. Baseline demographics did not differ with the exception of cord pH. For each subject, the percentage of temperatures in the target range was calculated. Infants cooled using the device had a higher percentage of temperatures in target range compared with control infants (median 73% [IQR 17-88] vs 0% [IQR 0-52], P < .001). More subjects reached target temperature during transport using the servo-regulated device (80% vs 49%, P <.001), and in a shorter time period (44 ± 31 minutes vs 63 ± 37 minutes, P = .04). Device-cooled infants reached target temperature by 1 hour with greater frequency than control infants (71% vs 20%, P < .001). CONCLUSIONS: Cooling using a servo-regulated device provides more predictable temperature management during neonatal transport than does usual care for outborn newborns with neonatal encephalopathy.


Assuntos
Asfixia Neonatal/complicações , Temperatura Corporal/fisiologia , Encefalopatias/terapia , Hipotermia Induzida/métodos , Doenças do Recém-Nascido/terapia , Unidades de Terapia Intensiva Neonatal , Transporte de Pacientes/métodos , Asfixia Neonatal/terapia , Encefalopatias/etiologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Prognóstico
3.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32385134

RESUMO

BACKGROUND AND OBJECTIVES: There are no US Food and Drug Administration-approved therapies for neonatal seizures. Phenobarbital and phenytoin frequently fail to control seizures. There are concerns about the safety of seizure medications in the developing brain. Levetiracetam has proven efficacy and an excellent safety profile in older patients; therefore, there is great interest in its use in neonates. However, randomized studies have not been performed. Our objectives were to study the efficacy and safety of levetiracetam compared with phenobarbital as a first-line treatment of neonatal seizures. METHODS: The study was a multicenter, randomized, blinded, controlled, phase IIb trial investigating the efficacy and safety of levetiracetam compared with phenobarbital as a first-line treatment for neonatal seizures of any cause. The primary outcome measure was complete seizure freedom for 24 hours, assessed by independent review of the EEGs by 2 neurophysiologists. RESULTS: Eighty percent of patients (24 of 30) randomly assigned to phenobarbital remained seizure free for 24 hours, compared with 28% of patients (15 of 53) randomly assigned to levetiracetam (P < .001; relative risk 0.35 [95% confidence interval: 0.22-0.56]; modified intention-to-treat population). A 7.5% improvement in efficacy was achieved with a dose escalation of levetiracetam from 40 to 60 mg/kg. More adverse effects were seen in subjects randomly assigned to phenobarbital (not statistically significant). CONCLUSIONS: In this phase IIb study, phenobarbital was more effective than levetiracetam for the treatment of neonatal seizures. Higher rates of adverse effects were seen with phenobarbital treatment. Higher-dose studies of levetiracetam are warranted, and definitive studies with long-term outcome measures are needed.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia Neonatal Benigna/tratamento farmacológico , Epilepsia Neonatal Benigna/fisiopatologia , Levetiracetam/uso terapêutico , Fenobarbital/uso terapêutico , Relação Dose-Resposta a Droga , Método Duplo-Cego , Epilepsia Neonatal Benigna/diagnóstico , Feminino , Humanos , Recém-Nascido , Masculino , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Convulsões/fisiopatologia
4.
J Clin Neurophysiol ; 36(1): 9-13, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30289769

RESUMO

PURPOSE: Continuous video electroencephalography (cEEG) monitoring is the recommended gold standard of care for at-risk neonates but is not available in many Neonatal Intensive Care Units (NICUs). To conduct a randomized treatment trial of levetiracetam for the first-line treatment of neonatal seizures (the NEOLEV2 trial), we developed a monitoring infrastructure at five NICUs, implementing recent technological advancements to provide continuous video EEG monitoring and real-time response to seizure detection. Here, we report on the feasibility of providing this level of care. METHODS: Twenty-five key informant interviews were conducted with study neurologists, neonatologists, coordinators, and EEG technicians from the commercial EEG monitoring company Corticare. A general inductive approach was used to analyze these qualitative data. RESULTS: A robust infrastructure for continuous video EEG monitoring, remote review, and real-time seizure detection was established at all sites. At the time of this survey, 260 babies had been recruited and monitored for 2 to 6 days. The EEG technician review by the commercial EEG monitoring company was reassuring to families and neonatologists and led to earlier detection of seizures but did not reduce work load for neurologists. Neurologists found the automated neonatal seizure detector algorithm provided by the EEG software company Persyst useful, but the accuracy of the algorithm was not such that it could be used without review by human expert. Placement of EEG electrodes to initiate monitoring, especially after hours, remains problematic. CONCLUSIONS: Technological advancements have made it possible to provide at-risk neonates with continuous video EEG monitoring, real-time detection of and response to seizures. However, this standard of care remains unfeasible in usual clinical practice. Chief obstacles remain starting a recording and resourcing the real-time specialist review of suspect seizures.


Assuntos
Eletroencefalografia , Terapia Intensiva Neonatal , Monitorização Neurofisiológica , Convulsões/diagnóstico , Algoritmos , Encéfalo/fisiopatologia , Eletroencefalografia/métodos , Família/psicologia , Estudos de Viabilidade , Pessoal de Saúde , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Entrevistas como Assunto , Monitorização Neurofisiológica/métodos , Reconhecimento Automatizado de Padrão , Pesquisa Qualitativa , Convulsões/fisiopatologia , Software , Fatores de Tempo
5.
J Reprod Med ; 53(3): 220-2, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18441730

RESUMO

BACKGROUND: MgSO4 is widely used for tocolysis. Serious complications are rare as long as dosing is carefully monitored. Adverse effects in muotonic dustrophy have not been previously described. CASE: A 35-year-old woman, gravida 1, para 0, was hospitalized with suspected mild myotonic dystrophy, polyhydramnios and preterm labor at 33 weeks. MgSO4 infusion rapidly resulted in respiratory compromise. Muscular strength returned to baseline after the infusion was stopped. Mother and infant proved to have myotonic dystrophy. CONCLUSION: The choice of tocolytic medication in maternal myotonic dystrophy is problematic. Beta-2 sympathomimetics have been reported to precipitate myotonia. This case illustrates the potential for MgSO4 to cause respiratory embarrassment. Indomethacin may be the tocolytic of choice in myotonic dystrophy.


Assuntos
Sulfato de Magnésio/efeitos adversos , Miotonia/induzido quimicamente , Distrofia Miotônica/tratamento farmacológico , Trabalho de Parto Prematuro/prevenção & controle , Insuficiência Respiratória/induzido quimicamente , Tocolíticos/efeitos adversos , Adulto , Feminino , Humanos , Recém-Nascido , Distrofia Miotônica/genética , Trabalho de Parto Prematuro/tratamento farmacológico , Gravidez , Tocólise
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