RESUMO
BACKGROUND: The use of cerebral oximetry monitoring in the care of extremely preterm infants is increasing. However, evidence that its use improves clinical outcomes is lacking. METHODS: In this randomized, phase 3 trial conducted at 70 sites in 17 countries, we assigned extremely preterm infants (gestational age, <28 weeks), within 6 hours after birth, to receive treatment guided by cerebral oximetry monitoring for the first 72 hours after birth or to receive usual care. The primary outcome was a composite of death or severe brain injury on cerebral ultrasonography at 36 weeks' postmenstrual age. Serious adverse events that were assessed were death, severe brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis. RESULTS: A total of 1601 infants underwent randomization and 1579 (98.6%) were evaluated for the primary outcome. At 36 weeks' postmenstrual age, death or severe brain injury had occurred in 272 of 772 infants (35.2%) in the cerebral oximetry group, as compared with 274 of 807 infants (34.0%) in the usual-care group (relative risk with cerebral oximetry, 1.03; 95% confidence interval, 0.90 to 1.18; P = 0.64). The incidence of serious adverse events did not differ between the two groups. CONCLUSIONS: In extremely preterm infants, treatment guided by cerebral oximetry monitoring for the first 72 hours after birth was not associated with a lower incidence of death or severe brain injury at 36 weeks' postmenstrual age than usual care. (Funded by the Elsass Foundation and others; SafeBoosC-III ClinicalTrials.gov number, NCT03770741.).
Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Oximetria , Humanos , Lactente , Recém-Nascido , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/etiologia , Displasia Broncopulmonar/etiologia , Circulação Cerebrovascular , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/mortalidade , Doenças do Prematuro/terapia , Oximetria/métodos , Cérebro , Ultrassonografia , Retinopatia da Prematuridade/etiologia , Enterocolite Necrosante/etiologia , Sepse Neonatal/etiologiaRESUMO
UNLABELLED: The aim of this study was the analysis of the clinical state of newborns infected with various species of ureaplasma. METHODS: 50 prematurely born patients with respiratory disturbances and confirmed presence of ureaplasma in the respiratory tract were analyzed. Endotracheal aspirates were collected for examination. Presence of ureaplasma was confirmed by culture and a commercial test (Biomerieux), the ureaplasma species were identified using PCR. RESULTS: In 40 examined newborns Ureaplasma parvum (U.p.) was found, in 10 Ureaplasma urealyticum (U.u.). Newborns infected with U.u. were subject to more frequent and longer therapeutic procedures supporting respiration (respirator, nCPAP), needed more frequent surfactant and antibiotic administration. In the mentioned group the mortality rate was 33%, while in newborns infected with U.p. it was 15%. CONCLUSIONS: Initial results suggest worse clinical status and higher mortality of prematurely born infected with Ureaplasma urealyticum.