Concentración de lactato deshidrogenasa en grupos de edad pediátrica diferentes / Lactate dehydrogenase concentration in different pediatric age groups

La normalización del nivel de LDH en sangre se asocia con una mejor supervivencia en muchos estudios realizados en adultos, en niños y recién nacidos. El estudio tuvo como objetivo estimar la LDH para diferentes grupos de edad de pediatría. Se realizó un estudio observacional en Pediatrics Ward, Hospital General de Abu Ghraib, de enero de 2018 a diciembre de 2019. La muestra de estudio incluyó a 250 niños, su edad osciló entre 1 día y 16 años. Se calcularon los niños de ambos género con estos grupos de edad admitidos en Ward, y se calcularon LDH en sangre. La historia materna, la fiebre, la infección umbilical, la sollozo, la hipoxia, la sepsis y el síndrome de dificultad respiratoria (RDS) se documentaron en consecuencia. LDH medido como siguió: Recién nacido: 160 a 450 unidades por litro (unidades/L) y niño: 60 a 170 unidades/l. Dividimos la muestra a dos grupos, bebés recién nacidos (1 día a 1 año) y CHID (> 1 año a 16 años), y se documentaron las variables de estudio. La correlación de concentración y variables de LDH calculada. Se confirma el valor pronóstico del monitoreo de LDH en suero en serie para predecir la morbilidad y la mortalidad en los niños enfermos. Hay una correlación, aunque muy clara, entre los niveles de LDH en plasma con infección, asfixia y RDS

Normalisation of blood LDH level is associated with improved survival in many studies conducted in adults, in children and neonate. The study aimed to estimate the LDH for different pediatrics age groups. An observational study was conducted at Pediatrics ward, Abu Ghraib General Hospital, from January 2018 to December 2019. Study sample included 250 children; their age ranged from 1 day to 16 years. Children of both gender with these age groups admitted to ward, and blood LDH were calculated. The maternal history, fever, umbilical infection, SOB, hypoxia, sepsis, and respiratory distress syndrome (RDS) were documented accordingly. LDH measured as followed: New born: 160 to 450 units per litre (units/L) and child: 60 to 170 units/L. We divided sample to two-groups, newborn babies (1 day to 1 year) and chid (>1 year to 16 years), and the study variables were documented. The LDH concentration and variables correlation calculated. The prognostic value of serial serum LDH monitoring for predicting morbidity and mortality in sick children is confirmed. There is a correlation, although very clear, between the plasma LDH levels with infection, asphyxia, and RDS

Resveratrol as an anti-asthmatic agent: could this stilbenoid help against COVID-19 in any way? a meta-analysis / Resveratrol como agente antiasmático: ¿podría este estilbenoide ayudar contra el COVID-19 de alguna manera? un metaanálisis

Resveratrol is a phenolic phytoconstituent found in many plants. This molecule has always caught the attention of scientists because of biological potentials such as inhibition of inflammation, oxidative stress and platelet aggregation as well as to prevent/protect against cardiovascular and neurodegenerative disease/disorders. Literature search have been conducted over resveratrol in covid-19 and asthma studies published in Pubmed and Google Scholars until 30 September 2020. The criteria used in the literature review were determined and were reviewed works on resveratrol including 368 articles and 47 articles on covid-19 and asthma, respectively. As a result of meta-analysis, TNF-α values of the studies showed a significant difference (heterogeneity) of I2=68.39% from each other in total (Cohran Q:6.33, p<0.0423). This study shows that resveratrol would have a potential to reduce ARDS symptoms, by suppressing the cytokine storm and severe inflammation caused by SARS-CoV-2, and by showing strong activity against various types of DNA/RNA viruses.

El resveratrol es un fitoconstituyente fenólico que se encuentra en muchas plantas. Esta molécula siempre ha llamado la atención de los científicos debido a sus potenciales biológicos como la inhibición de la inflamación, el estrés oxidativo y la agregación plaquetaria, así como para prevenir/proteger contra enfermedades/trastornos cardiovasculares y neurodegenerativos. Se han realizado búsquedas bibliográficas sobre resveratrol en covid-19 y estudios sobre asma publicados en Pubmed y Google Scholars hasta el 30 de septiembre de 2020. Se determinaron los criterios utilizados en la revisión bibliográfica y se revisaron trabajos sobre resveratrol que incluyen 368 artículos y 47 artículos sobre covid-19 y asma, respectivamente. Como resultado del metanálisis, los valores de TNF-α de los estudios mostraron una diferencia significativa (heterogeneidad) de I2=68,39% entre sí en total (Cohran Q: 6,33, p<0,0423). Este estudio muestra que el resveratrol podría reducir los síntomas del ARDS al suprimir la tormenta de citocinas y la inflamación severa causada por el SARS-CoV-2, y al mostrar una fuerte actividad contra varios tipos de virus de ADN/ARN.

Is there a role for antenatal corticosteroids in term infants before elective cesarean section?

Abstract Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. Results A total of 334 newborns met the inclusion criteria. One third of the population study (n=129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR]=1.250; 95% confidence interval [CI]: 0.454-3.442), transient TTN (OR=1.,623; 95%CI: 0.556-4.739), and NIUC admission (OR=2.155; 95%CI: 0.474-9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR=0,732; 95%CI: 0.240-2.232), TTN (OR=0.959; 95%CI: 0.297--3.091), and NIUC admission (OR=0,852; 95%CI: 0.161-4.520) become lower in the ACS exposed group. Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

Betametasona fosfato para la prevención de Síndrome de Dificultad Respiratoria (SDR) del recién nacido de pretérmino / Betamethasone phosphate for the prevention of Respiratory Distress Syndrome (RDS) in the preterm newborn

RESUMEN Introducción: El estándar para inducción de madurez pulmonar en fetos con riesgo de nacer prematuramente es la administración de 12 mg de betametasona acetato/fosfato por dos veces espaciada cada 24 horas. El uso establecido en algunos hospitales públicos en Chile es con dos dosis de 12 mg betametasona fosfato aunque no existen estudios publicados sólo con betametasona fosfato sobre la incidencia de Síndrome de Distress Respiratorio (SDR). Objetivo: Evaluar efecto de betametasona en su forma fosfato como tratamiento antenatal para inducción de madurez fetal pulmonar en la incidencia SDR debido a membrana hialina en prematuros menores de 34 semanas de edad gestacional. Comparar el efecto de betametasona fosfato con el efecto publicado de betametasona acetato/fosfato. Material y método: Análisis de incidencia de SDR en prematuros nacidos en Hospital Padre Hurtado entre 24+0 y 34+0 semanas que recibieron betametasona fosfato para madurez pulmonar y aquellos que no la recibieron. Resultados: De 1.265 neonatos estudiados, 722 completaron dos dosis (57,5%); 436 sólo una dosis (34,5%) y 107 (8,5%) no recibieron corticoides antenatales. La incidencia de SDR debido a membrana hialina en el grupo con dos dosis fue 8,7%, una dosis 25,3% y 32,7% en los no tratados (p<0,001). Para SDR severo las incidencias fueron 6,7%, 12,6% y 16,8% respectivamente (p<0,001). Conclusiones: Inducción de madurez fetal pulmonar con betametasona fosfato en dos dosis de 12 mg IM separadas por 24 horas otorga una reducción significativa de incidencia de SDR semejante a la publicada con betametasona acetato/fosfato en iguales dosis.

ABSTRACT The standard for induction of lung maturity in fetuses at risk of being born prematurely is the administration of 12 mg of betamethasone acetate/phosphate two doses separated by 24 hours. The established use in some public hospitals in Chile is with two doses of 12 mg betamethasone phosphate although there are no studies published with betamethasone phosphate alone on the incidence of respiratory distress syndrome (RDS). Objective: To evaluate the effect of betamethasone in its phosphate form as antenatal treatment for the induction of fetal lung maturity in the incidence of RDS due to hyaline membrane in preterm infants less than 34 weeks of gestational age. To compare the effect of betamethasone phosphate with the published effect of betamethasone acetate/phosphate. Material and method: Analysis of the incidence of RDS in preterm infants born at Hospital Padre Hurtado between 24 + 0 and 34 + 0 weeks who received betamethasone phosphate for lung maturity and those who did not receive it. Results: Of 1,265 infants studied, 722 completed two doses (57.5%); 436 only one dose (34.5%) and 107 (8.5%) did not receive antenatal corticosteroids. The incidence of RDS due to hyaline membrane in the group with two doses was 8.7%, one dose 25.3% and 32.7% in the untreated ones (p <0.001). For severe RDS, incidences were 6.7%, 12.6% and 16.8% respectively (p <0.001). Conclusions: Induction of fetal lung maturity with betamethasone phosphate in two doses of 12 mg IM separated by 24 hours gives a significant reduction in the incidence of RDS similar to that published with betamethasone acetate/phosphate in equal doses.

Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

Corticosteróides na aceleração da maturidade fetal: evidências atuais / Corticosteroids in fetal maturity acceleration: update evidences

A síndrome da dificuldade respiratória neonatal é grave complicação da prematuridade. Em 1969, Liggins constatou que a maturação do pulmão fetal estava acelerada nos fetos de cordeiros infundidos com corticosteróides. Liggins, em 1972, realizou estudo controlado e randomizado que comprovou a eficácia da terapia antenatal com corticosteróide em reduzir a incidência da síndrome de dificuldade respiratória neonatal (SDR), em seres humanos. Liggins e outros autores demonstraram que esta redução estava presente nos recém-nascidos entre 48 horas e sete dias após o tratamento, o que poderia, conseqüentemente, traduzir benefício em repetir-se a dose do corticosteróide antenatal nas mulheres que permanecem em risco de parto pré-termo por mais de sete dias após o ciclo inicial. Desde a década de 80, os estudos em animais e em seres humanos levantam polêmicas sobre o uso de doses repetidas, em função dos potenciais efeitos adversos para a prole. Hoje, a avaliação da evidência na eficácia da terapia antenatal com corticosteróide permite concluir que todas as gestantes em risco de parto pré-termo, entre 24 e 34 semanas, são candidatas potenciais a receberem um único ciclo de corticosteróide. Não há prova suficiente para avaliar o uso de doses repetidas de corticosteróide nas mulheres que permanecem em risco de parto pré-termo por mais de sete dias após a primeira dose.

The neonatal respiratory distress syndrome is a serious complication of prematurity. In 1969, Liggins showed that fetal lung maturation was sped up in the embryos of lambs infused with corticosteroids. In 1972, Liggins carried out a controlled and radomized study that proved the effectiveness of the antenatal therapy with corticosteroid in reducing the incidence of the neonatal respiratory distress syndrome (NRDS), in human beings. Liggins and other authors had demonstrated that this reduction was present in newborns within 48 hours and seven days after the treatment which could, consequently, be translated into repeating the dose of corticosteroid antenatal in those women who remained at risk of preterm delivery for more than seven days after the initial cycle. Since the 1980's, the studies in animals and human beings have raised controversies on the use of repeated doses due to the potential adverse effect for the offspring. Today, the assessment of the evidence in the effectiveness of the antenatal therapy with corticosteroid has showed that all pregnant women at risk for preterm delivery , between 24 and 34 weeks, are potential cadidates to receive a single cycle of corticosteroid. There is not enough evidence to evaluate the use of repeated doses of corticosteroid in women who remain at risk for preterm delivery for more than seven days after the first dose.

Multiple courses of antenatal steroids.

The benefits and risks of multiple courses of antenatal steroids (ANS) are still unresolved issues. This was a prospective cohort study in a level III neonatal unit. Preterm babies < or = 35 wk gestation were included. Malformations, chronic maternal steroid intake, exchange transfusions prior to cortisol sampling and incomplete ANS courses were exclusion criteria. Subjects were classified into: No course (Group 0), 1 course (group 1), 2 courses (Group 2), > 2 courses (Group 3) of antenatal dexamethasone. The key outcome was adrenal function assessed by basal and post-ACTH cortisol on day 3. Other outcomes were neonatal morbidity, mortality, growth parameters at birth, long term growth and neuro-development. Of 210 eligible babies, 124 were enrolled. 38, 51, 10 and 25 babies belonged to groups 0, 1, 2 and 3 respectively. Basal and post-ACTH serum cortisol did not show any significant difference between groups (p=0.5 and p=0.9 respectively). Incidence of severe HMD requiring ventilation was significantly lower (p=0.02) in multiple course group (combined groups 2 and 3) compared to single course group. There were no differences in other neonatal morbidity, birth OFC and weight between single and multiple ANS groups. Follow up data at a mean age of 22 mth was available in 59 subjects (69%) belonging to groups 1-3. No differences were noted in the proportion of patients with abnormal neurological examination (p=0.1), abnormal PDI (p=0.9), abnormal MDI (p=0.9) and physical growth between multiple and single course groups. Multiple courses of antenatal dexamethasone resulted in a significant decrease in severe forms of RDS and they did not cause adrenal suppression, decreased growth or impaired neuro-development.

Effect of Antenatal Corticosteroid and Antibiotics in Pregnancies Complicated by Premature Rupture of Membranes between 24 and 28 weeks of Gestation

The aim of this study was to assess the effectiveness of active intervention with antenatal maternal corticosteroid and antibiotics therapy in infants delivered between 24 and 28 weeks of gestation after premature rupture of membrane. This retrospective study included pregnant women complicated by preterm delivery at the Dong-A University Hospital from 1998 to 2002. Patients were divided into labor induction group 1 (n=20), observation group 2 (n=19), and medication group 3 (n=20). We evaluated the effects of prolongation of pregnancy and intervention with maternal corticosteroids and antibiotics therapy on perinatal and neonatal outcomes. Each group did not have a significant difference (p<0.05) in neonatal outcomes, such as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, pneumonia, bronchopulmonary dysplasia, and sepsis. The mean latency period was 4.7 days and 7.6 days in groups 2 and 3, respectively. Therefore, this study was unable to demonstrate any beneficial effects of corticosteroids in improving neonatal outcomes and prolongation of the latency period with antibiotics.

Comparative study of the effectiveness of thyroxine and steroids on reduction of neonatal morbidity: outcome at 20 months follow-up

This study analyzes health, growth and neurodevelopmental outcome of infants who received prenatal corticosteroids with or without thyroxine for fetal lung maturation. During a 12 month period infants from a prospective double blind study who received either steroids or steroids combined with thyroxine for pulmonary maturation and who had reached 18 months of age were recalled for evaluation of health status, growth parameters and neurodevelopmental outcome using the Bayley Scales 2nd edition (BSID-II). Mental developmental index (MDI), psychomotor developmental index (PDI), language developmental age (LDA), cognitive developmental age (CDA), and behavioral rating scales (BRS) were compared for the two treatment groups. The Hollingshead Socioeconomic Status Index was determined for each infant. Of a total of 134 patients enrolled during the study period, 66 patients return for follow up. Data from 60 patients was included in the final analysis. Of these, 32 had received the combination regimen and 28 had solely received only steroids. Demographics and neonatal morbidity were similar in both groups. No statistical differences in growth parameters, hospital admissions, respiratory problems, surgical procedures or frequency of infections were found. Neurodevelopmental parameters (MDI, PDI) were similar in both treatment groups, although, below normal in both groups. Language delay was more common in infants who received prenatal corticosteroids. There were no difference in the incidence of neurologic abnormalities. The addition of thyroxine to steroids did not affect growth or neuro-developmental outcome of the infants at 18 to 22 postnatal age.

Conteo de cuerpos lamelares en líquido amniótico: evaluación como test rápido para la predicción de la madurez pulmonar fetal / Lamellar bodies count in amniotic fluid: evaluation as rapid test for the prognosis of fetal lung maturity

El manejo y pronóstico perinatal de los embarazos de alto riesgo se basa principalmente en la estimación certera de la madurez pulmonar fetal. Objetivos. 1) Principal: evaluar la concordancia entre el Conteo de Cuerpos Lamelares (CCL) en Líquido Amniótico (LA) y el Test de Clements. 2) Secundario: evaluar la capacidad operativa del CCL en LA como predictor de madurez pulmonar fetal. Material y métodos. El estudio incluyó 111 casos de muestras de LA de embarazadas de edades gestacionales entre 30 y 42 semanas (media 36,1 semanas; DS 3,7). Se realizaron los cuatro tests que el laboratorio efectúa rutinariamente para evaluar maduración pulmonar: Test de Clements, Test de Freer (Ft50), Foam Stability Index (FSI) y Lectura Espectrofotométrica a 600 nm. A cada una de las muestras se le efectuó el CCL según técnica. Resultados. Se calcularon los siguientes Indices Diagnósticos: Prevalencia del Clements Positivo, Prevalencia del Clements Negativo, Falsos Positivos, Falsos Negativos, Sensibilidad y Especificidad. Se calculó la Eficiencia Pronóstica: Valor Predictivo de la Prueba Positiva, Valor Predictivo de la Prueba Negativa, Eficiencia de la Prueba, Razones de Verosimilitud Positiva y Negativa y Errores Pronósticos Positivo y Negativo. Conclusiones. El CCL contrastado con los tests biofísicos para madurez pulmonar demostró un moderado grado de correlación, elevada concordancia y eficiencia pronóstica, por lo que hemos incluido este test junto con nuestros parámetros para madurez pulmonar por su confiabilidad en conteos mayores de 30.000/mm3 y menores de 10.000/mm3 (esto obviaría el uso del IndiceL/E Lecitina/Esfingomielina, cromatografía), pero siempre acompañado de perfil tradicional. Además es un test rápido, de bajo costo, que requiere pequeño volumen de muestra y un instrumental accesible a la mayoría de los laboratorios de plaza.

Efeitos protetores do choque térmico na sepse e na síndrome da resposta inflamatória sistêmica / Protective effects of heat shock on sepsis and on the systemic inflammatory response syndrome

Sepse, disfunção orgânica múltipla e a síndrome da angústia respiratória aguda são as maiores causas e mortalidade nas unidades de terapia intensiva. Estudos em animais de laboratório demonstram que esta forma de lesão pode ser atenuada ou mesmo abolida se um fenômeno, conhecido como resposta ao estresse ou resposta ao choque térmico, for ativado. A resposta ao choque térmico, caracterizada pela suspensão transitória da produção da maioria das proteínas e pela ativação das proteínas do choque térmico (heat shock proteins - HSP), mostrou-se protetora a células e a animais de laboratório, se desencadeada antes, ou imediatamente após uma lesão letal...

Importância do diagnóstico pré-natal na prevençäo precoce da síndrome de angústia respiratória / Importance of antenatal screening in precocious prevention o respiratory distress syndrome

A síndrome da angústia respiratória (SAR) está sujeita até à atualidade a muitas controvérsias com respeito a seu manejo profilático e terapêutico. Nesta revisäo se expöe os critérios preconizados por diferentes autores, concluindo-se que no momento existe um consenso geral quanto ao significado da ultra-sonografia como estudo seguro de detecçäo daqueles casos de alto risco, contribuindo assim para diminuir a morbimortalidade neonatal, pois näo existe uma terapêutica eficaz reconhecida

Effect of prenatal T4 treatment in neonatal morbidity: preliminary findings

We report our experience with the use of intra-amniotic thyroxine to accelerate fetal maturation in preterm delivered infants. One hundred and fourteen infants who had received 500 micrograms of thyroxine weekly prenatally until an L/S ratio greater or equal to 2.0 was achieved, were compared to 113 premature infants who had not been given thyroxine or steroids prenatally. After stratification by weight, the relative incidence of respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and intraventricular hemorrhage (IVH) were compared. A decrease in the incidence of RDS was observed in the infants with birth weight between 1000 and 1500 g who had received more than one dose of intra-amniotic thyroxine. No difference in the incidence of RDS was observed in infants with birth weight of less than 1000 g or over 1500 g. One dose of thyroxine had no effect in decreasing the incidence of RDS, PDA, NEC, and IVH in any of the groups. We conclude intra-amniotic thyroxine seems to decreases the incidence of RDS in very low birth weight infants