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1.
J Pediatr Gastroenterol Nutr ; 65(1): 107-110, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28644358

RESUMEN

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 (P < 0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.


Asunto(s)
Antibacterianos/efectos adversos , Nutrición Enteral/estadística & datos numéricos , Enterocolitis Necrotizante/inducido químicamente , Trastornos de Alimentación y de la Ingestión de Alimentos/inducido químicamente , Enfermedades del Prematuro/inducido químicamente , Nutrición Parenteral Total/estadística & datos numéricos , Enterocolitis Necrotizante/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/epidemiología , Masculino , Evaluación de Resultado en la Atención de Salud , Prevalencia , Estudios Retrospectivos
2.
J Pediatr (Rio J) ; 99(2): 105-111, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36436670

RESUMEN

OBJECTIVE: Among the mechanisms proposed for the development of bronchopulmonary dysplasia is the increase in the pulmonary inflammatory process and oxidative stress. Thus, the control of this process may result in improvements in bronchopulmonary dysplasia-related outcomes. This study aims to analyze the current scientific evidence regarding the use of budesonide, a potent anti-inflammatory drug, associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia. METHODS: A systematic review of the literature was performed on the Embase and MEDLINE platforms, and studies that compared budesonide with pulmonary surfactant versus pulmonary surfactant for treating respiratory distress syndrome were included. The primary outcome was a reduction in bronchopulmonary dysplasia or death. RESULTS: Four randomized clinical trials and two observational studies were included in this systematic review. Three of the randomized clinical trials found a reduction in bronchopulmonary dysplasia or death in the use of budesonide with the surfactant, all the other studies (1 clinical trial and 2 observational studies) found no statistical differences between the groups for the primary outcomes. The three main studies showed a reduction in the primary outcome; however, all studies showed great heterogeneity regarding the type of surfactant (poractant or beractant) and the method of administration. CONCLUSION: Robust clinical studies, in a heterogeneous population, using porcine surfactant associated with budesonide, with administration by a minimally invasive technique are necessary for there to be a recommendation based on scientific evidence for its widespread use.


Asunto(s)
Displasia Broncopulmonar , Surfactantes Pulmonares , Síndrome de Dificultad Respiratoria del Recién Nacido , Humanos , Animales , Porcinos , Recién Nacido , Budesonida/uso terapéutico , Displasia Broncopulmonar/tratamiento farmacológico , Displasia Broncopulmonar/prevención & control , Tensoactivos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto
3.
J Matern Fetal Neonatal Med ; 35(18): 3502-3508, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34157931

RESUMEN

BACKGROUND: The effects of antenatal corticosteroids (ANSs) on twins are not well established. OBJECTIVE: To determine the impact of ANS use according to the number of fetuses. METHODS: Retrospective cohort study of newborns between 23 and 33 weeks of gestational age, birth weight from 400 to 1499 g, without malformations, delivered at 20 public university hospitals from 2010 to 2014.Exposed group: Received ANS (any time, any dose) and no exposed group: no received ANS. Analysis of birth conditions and clinical outcomes. Association of variables, relative risks, and 95% confidence intervals estimated from the adjustment of log-binomial regression models. RESULTS: About 7165 premature infants were analyzed: 5167 singleton, 937 twins, and 104 triplets. Characteristics of gestations with one, two, or three fetuses not receiving ANS were similar. Reduced hemodynamic instability in single and twins gestations in the first 72 h were observed (Adj R2 Twins = 0.78; 95% CI = 0.69-0.86) (Adj R2 Singles = 0.79; 95% CI = 0.62-0.99). Reduced peri-intraventricular hemorrhage (Adj R2 Twins = 0.54; 95% CI = 0.36-0.78) (Adj R2 singles = 0.54; 95% CI = 0.36-0.78); and early sepsis reduction on single and triplex gestations (Adj R2 triplex = 0.51; 95% CI = 0.27-0.94) (Adj single R2 = 0.51; 95% CI = 0.27-0.94) were observed. CONCLUSIONS: This study demonstrates ANS produces an important protective factor for severe intraventricular hemorrhage and hemodynamic instability in single and multiple pregnancies. ANS had a protective effect on death and birth conditions improvement just in single gestations. Regarding respiratory aspects was not observed the protective effect in the single or multiple gestations.


Asunto(s)
Corticoesteroides , Nacimiento Prematuro , Corticoesteroides/uso terapéutico , Estudios de Cohortes , Femenino , Edad Gestacional , Hemorragia , Humanos , Lactante , Recién Nacido , Embarazo , Embarazo Múltiple , Embarazo Gemelar , Nacimiento Prematuro/prevención & control , Estudios Retrospectivos
4.
Eur J Paediatr Neurol ; 39: 65-73, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35696888

RESUMEN

BACKGROUND: Intraventricular hemorrhage (IVH) is a serious problem in preterm infants. Brazilian national data are unknown. OBJECTIVE: To evaluate the incidence and temporal trend of IVH in very low birth weight (VLBW) preterm infants of 18 centers of the Brazilian Network on Neonatal Research. STUDY DESIGN: National prospective multicenter cohort study including inborn VLBW preterm infants aged 230/7- 336/7 weeks' gestation, admitted between 2013 and 2018. The center with the mean incidence rate was used as reference. We applied two adjustments models using perinatal variables, and perinatal + neonatal diseases. RESULTS: Of 6,420 infants, 1951/30.4% (range 27.1-33.8%) had IVH and the disease showed a significant trend towards an overall increase in incidence over time (p = 0.003), especially in three centers. Severe IVH (grade III or IV) occurred in 32.2% (range 29.2-34.5%) of those affected by IVH, with a stable incidence. After adjustments for perinatal variables, the differences persisted among centers: for global IVH, 7 centers had significantly lower rates (OR ranging from 0.31 to 0.62), and 2 presented rates higher than the reference center (OR ranging from 2.00 to 12.46) for severe HIV. Considering perinatal and neonatal variables, 6 centers had significantly lower rates (OR ranging from 0.36 to 0.60) for global IVH than the reference center and 3 had statistically higher rates (OR 1.72, 1.86 and 11.78) for severe forms. CONCLUSION: The incidence rate of IVH in this Brazilian cohort was high and it revealed an increasing trend towards over time. The severe IVH rate was also worrisome.


Asunto(s)
Enfermedades del Prematuro , Recien Nacido Prematuro , Brasil/epidemiología , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/etiología , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/epidemiología , Embarazo , Estudios Prospectivos
5.
J Hum Lact ; 21(4): 439-43, 2005 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-16280560

RESUMEN

This study compared concentrations of total protein, lysozyme, and immunoglobulins (IgA, IgG, IgM) in samples of colostrum (n=101) obtained from mothers of infants<32 weeks, 32 to 36(6) 7 weeks, and >or=37 weeks gestational age, both before and after pasteurization. Total protein was measured by refraction index, lysozyme by the lysoplate method, and immunoglobulins through the radial immunodiffusion technique. The total protein concentration was greater in colostrum of the <32 weeks and 32 to 36(6) 7 weeks categories compared to full-term (P<.001), while concentrations of lysozyme and IgM were similar. IgA concentrations were higher in the <32 weeks group compared to the full-term and similar to the 32 to 36(6) 7 weeks group (P<.05). The IgG was higher in the <32 weeks category compared to 32 to 36(6) 7 weeks, and both were similar to the full-term (P<.05). Pasteurization significantly decreased all of the factors analyzed.


Asunto(s)
Calostro/inmunología , Manipulación de Alimentos/métodos , Calor , Leche Humana/inmunología , Adulto , Análisis de Varianza , Femenino , Edad Gestacional , Calor/efectos adversos , Humanos , Inmunoglobulina A/análisis , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Muramidasa/análisis
6.
Hum Immunol ; 75(7): 662-6, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24759676

RESUMEN

B+NK+SCID (severe combined immunodeficiency) due to IL7Rα deficiency represents approximately 10% of American SCID cases. To better understand the spectrum of autoimmune disorders associated with IL7Rα deficiency, we describe two unrelated IL7Rα-deficient female SCID infants whose clinical picture was dominated by autoimmune manifestations: one with intrauterine Omenn syndrome (OS) and another with persistent thrombocytopenic purpura since 4months of age. The OS baby harbored a homozygous p.C118Y mutation in IL7R. She presented dense eosinophilic infiltrates in several organs, including pancarditis, which may have contributed to her death (on the 2nd day of life). B cells were observed in lymph nodes, spleen, bone marrow and thymus. The second patient harbored compound heterozygous p.C118Y and p.I121NfsX8 mutations. She underwent a successful unrelated cord blood transplant. In conclusion, early OS can be observed in patients with IL7R mutations, and autoimmune cytopenias could also complicate the clinical course of SCID babies with this type of defect.


Asunto(s)
Mutación , Púrpura Trombocitopénica Trombótica/genética , Receptores de Interleucina-7/genética , Inmunodeficiencia Combinada Grave/genética , Secuencia de Bases , Trasplante de Células Madre de Sangre del Cordón Umbilical , Femenino , Heterocigoto , Homocigoto , Humanos , Lactante , Recién Nacido , Datos de Secuencia Molecular , Púrpura Trombocitopénica Trombótica/inmunología , Púrpura Trombocitopénica Trombótica/patología , Púrpura Trombocitopénica Trombótica/terapia , Receptores de Interleucina-7/inmunología , Inmunodeficiencia Combinada Grave/inmunología , Inmunodeficiencia Combinada Grave/patología
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