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1.
Cardiol Young ; : 1-9, 2024 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-39410754

RESUMEN

BACKGROUND: New drugs to target different pathways in pulmonary hypertension has resulted in increased combination therapy, but details of this use in infants are not well described. In this large multicenter database study, we describe the pharmacoepidemiology of combination pulmonary vasodilator therapy in critically ill infants. METHODS: We identified inborn infants discharged home from a Pediatrix neonatal ICU from 1997 to 2020 exposed to inhaled nitric oxide, sildenafil, epoprostenol, or bosentan for greater than two consecutive days. We compared clinical variables and drug utilisation between infants receiving simultaneous combination and monotherapy. We reported each combination's frequency, timing, and duration and graphically represented drug use over time. RESULTS: Of the 7681 infants that met inclusion criteria, 664 (9%) received combination therapy. These infants had a lower median gestational age and birth weight, were more likely to have cardiac and pulmonary anomalies, receive cardiorespiratory support, and had higher in-hospital mortality than those receiving monotherapy. Inhaled nitric oxide and sildenafil were most frequently used, and utilisation of combination and monotherapy for all drugs increased over time. Inhaled nitric oxide and epoprostenol were used in infants with a higher gestational age, earlier postnatal age, and shorter duration than sildenafil and bosentan. Dual therapy with inhaled nitric oxide and sildenafil was the most common combination therapy. CONCLUSION: Our study revealed an increased use of combination pulmonary vasodilator therapy, favouring inhaled nitric oxide and sildenafil, yet with considerable practice variation. Further research is needed to determine the optimal combination, sequence, dosing, and disease-specific indications for combination therapy.

2.
J Perinatol ; 2024 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-39394454

RESUMEN

OBJECTIVE: Describe the epidemiology and clinical characteristics of infants in the neonatal intensive care unit (NICU) with acyclovir exposure and herpes simplex virus (HSV) infection. STUDY DESIGN: Our primary analysis was to evaluate the prevalence of HSV infection among infants in the NICU who received acyclovir. We compared characteristics of infants with and without HSV and used multivariable regression analyses to assess associations between infection and clinical outcomes. RESULT: Of 1,057,061 infants, 17,910 (2%) received acyclovir. Of those who received acyclovir, 1090 (5%) had HSV. Infection was associated with lower gestational age and lower birth weight. Multivariable models demonstrated that infected infants had higher mortality, greater postmenstrual age at discharge, and longer length of stay. CONCLUSION: Infants in the NICU who received acyclovir and have HSV are more likely to be born at lower gestational age, have lower birth weight, and have higher morbidities and mortality.

3.
J Perinatol ; 2024 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-39271917

RESUMEN

OBJECTIVE: Unplanned healthcare utilization after neonatal intensive care unit (NICU) discharge challenges families and healthcare systems. The impact of social needs on post-NICU healthcare utilization is underexplored. Our objective was to identify social needs among NICU graduates and examine associations between social needs and post-NICU healthcare utilization. STUDY DESIGN: A prospective cohort design was used to screen for social needs and track healthcare utilization among 112 NICU graduates attending a NICU follow-up clinic (2021-2022). Associations between social needs and healthcare utilization were analyzed using non-parametric statistical tests. RESULTS: Of 112 patients screened, 20 (18%) had some social need. Infants with social needs experienced statistically significant higher rates of hospitalizations, overall encounters, and missed appointments. CONCLUSION: Social needs are associated with increased unplanned healthcare utilization and missed appointments. Addressing these needs during NICU follow-up may improve preventative care attendance and reduce unplanned healthcare use, leading to better outcomes for vulnerable infants and cost-savings for healthcare systems.

4.
J Perinatol ; 44(9): 1300-1306, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39095524

RESUMEN

OBJECTIVE: Evaluate the association between results of the room air (RA) challenge and death, respiratory morbidity, and neurodevelopmental impairment (NDI) at 2 years' corrected age. STUDY DESIGN: Cohort study of infants born <27 weeks' gestational age who underwent a RA challenge to determine BPD diagnosis at 36 weeks postmenstrual age. RESULTS: Of 1022 infants eligible for the RA challenge, 554 underwent testing and 223 passed. Test result was not associated with death or serious respiratory morbidities [adjusted relative risk (aRR) 1.01, 95% confidence interval (CI) 0.65-1.56] or death or moderate/severe NDI (aRR 1.06, 95% CI 0.81-1.39) at 2 years. CONCLUSION: Results of the RA challenge were not associated with differences in respiratory or neurodevelopmental morbidity at 2 years, suggesting the RA challenge does not add prognostic value in contemporary extremely preterm infants. GOV ID: Generic Database: NCT00063063.


Asunto(s)
Edad Gestacional , Recien Nacido Extremadamente Prematuro , Humanos , Recién Nacido , Femenino , Masculino , Displasia Broncopulmonar/epidemiología , Trastornos del Neurodesarrollo/epidemiología , Trastornos del Neurodesarrollo/etiología , Lactante , Preescolar , Estudios de Cohortes
5.
Sci Rep ; 14(1): 19082, 2024 08 17.
Artículo en Inglés | MEDLINE | ID: mdl-39154109

RESUMEN

Therapeutic hypothermia is the standard treatment for hypoxic-ischemic encephalopathy (HIE), but despite its widespread use, the rates of mortality and neurodevelopmental impairment for moderate to severe HIE remain around 30%. Methylxanthines, such as caffeine and aminophylline, have potential neuroprotective effects in the setting of hypoxic-ischemic injury. However, data on the safety and efficacy of methylxanthines in the setting of therapeutic hypothermia for HIE are limited. This retrospective multicenter study examined in-hospital outcomes in 52 infants with HIE receiving methylxanthines and therapeutic hypothermia. The frequency of mortality and in-hospital morbidities were similar to those of infants enrolled in clinical trials undergoing therapeutic hypothermia without adjunctive therapies. Clinical trials of methylxanthines for neuroprotection in HIE are needed to determine safety and efficacy and should explore optimal dosing and timing of methylxanthine administration.


Asunto(s)
Hipotermia Inducida , Hipoxia-Isquemia Encefálica , Fármacos Neuroprotectores , Xantinas , Humanos , Hipoxia-Isquemia Encefálica/tratamiento farmacológico , Estudios Retrospectivos , Masculino , Femenino , Xantinas/uso terapéutico , Recién Nacido , Fármacos Neuroprotectores/uso terapéutico , Hipotermia Inducida/métodos , Cafeína/uso terapéutico , Cafeína/administración & dosificación , Lactante , Resultado del Tratamiento , Aminofilina/uso terapéutico , Aminofilina/administración & dosificación
6.
Pediatr Infect Dis J ; 2024 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-39105512

RESUMEN

Congenital cytomegalovirus is a leading cause of neurodevelopmental impairment and sensorineural hearing loss. We evaluated infants ≤21 days postnatal age who had both urine and saliva cytomegalovirus testing and determined concordance between the 2 tests and influence of very low birth weight on concordance. Discordance was low overall between urine and saliva testing; however, discordance was high in very low birth weight infants.

7.
J Perinatol ; 2024 Jul 26.
Artículo en Inglés | MEDLINE | ID: mdl-39060554

RESUMEN

OBJECTIVE: Examine pathogen distribution, antibiotic resistance patterns, and hospital outcomes of infants with bacterial meningitis in neonatal intensive care units (NICUs) in the US from 2013-2018. STUDY DESIGN: Infants were divided into 2 groups based on age at the time of meningitis: early-onset (0-3 days) and late-onset (>3 days). We compared demographics, clinical characteristics, epidemiology, hospital outcomes, distribution of organisms and resistance, and blood culture timing relative to cerebrospinal fluid culture. RESULTS: From 345 NICUs, 659 infants were diagnosed with bacterial meningitis. The cumulative incidence was 1.1-1.3 cases/1000 NICU discharges. Median gestational age was 33 weeks, median birth weight was 1910 grams, 12% failed hearing screening, and 9% died prior to discharge. Of 141 cases of E. coli meningitis, 53% were resistant to ampicillin. CONCLUSIONS: Significant morbidities occur in infants with culture-proven meningitis in NICUs. Culture and subsequent discernment of sensitivity are crucial to guide definitive therapy.

8.
Pediatr Infect Dis J ; 43(10): 991-996, 2024 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-38900075

RESUMEN

BACKGROUND: In the neonatal intensive care unit, infants are at risk for late-onset sepsis. When blood cultures are negative, antibiotic stewardship efforts encourage stopping antibiotics, yet the duration of therapeutic exposure after the last dose is unknown. METHODS: This retrospective cohort study of simulated antibiotic exposures used published population pharmacokinetic models within drug-specific neonatal intensive care unit cohorts of preterm and term infants, postnatal age 7-60 days and exposed to cefepime, piperacillin-tazobactam or tobramycin. Monte Carlo simulations (NONMEM 7.3) were used to predict steady-state exposures after a 72-hour antibiotic course per Neofax dosing. Exposure was assessed relative to drug-specific minimum inhibitory concentration (MIC) targets between 1 and 16 mcg/mL for Pseudomonas and Enterobacteriaceae species. Postdiscontinuation antibiotic exposure (PDAE) was defined as the time from the last dose to when antibiotic concentration decreased below a specific MIC. RESULTS: Piperacillin-tazobactam, cefepime and tobramycin cohorts included infants with median gestation age 29, 32 and 32 weeks and postnatal age 17, 19 and 15 days, respectively. The mean PDAE was 19-68 hours, depending on the specific antibiotic/MIC combination. PDAE was longer for infants <28 days old and preterm (vs. term) infants. Cefepime exhibited the longest mean PDAE of 68 hours for Enterobacteriaceae MIC 1. Piperacillin mean PDAE was 25 hours for Enterobacteriaceae MIC 8. Tobramycin had a short mean PDAE of 19 hours. CONCLUSIONS: Piperacillin and cefepime exposures remained therapeutic long after the expected 8- to 12-hour dosing interval. PDAE is an important consideration for antibiotic stewardship among hospitalized infants, particularly premature infants and those within 1 month postbirth.


Asunto(s)
Antibacterianos , Unidades de Cuidado Intensivo Neonatal , Pruebas de Sensibilidad Microbiana , Sepsis , Humanos , Antibacterianos/farmacocinética , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Recién Nacido , Estudios Retrospectivos , Masculino , Femenino , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Tobramicina/administración & dosificación , Tobramicina/farmacocinética , Tobramicina/uso terapéutico , Tobramicina/farmacología , Cefepima/farmacocinética , Cefepima/uso terapéutico , Cefepima/farmacología , Cefepima/administración & dosificación , Lactante , Método de Montecarlo , Combinación Piperacilina y Tazobactam/uso terapéutico , Combinación Piperacilina y Tazobactam/farmacocinética , Combinación Piperacilina y Tazobactam/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos , Recien Nacido Prematuro
9.
Pediatr Infect Dis J ; 2024 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-38920385

RESUMEN

BACKGROUND: Acyclovir is the first-line therapy for neonatal herpes simplex virus infections. Therapy can mitigate morbidity and mortality but carries a risk for toxicity. We aimed to compare acyclovir dosing in neonatal intensive care units to published recommendations based on population pharmacokinetic (PopPK) analysis. METHODS: We performed a multicenter cohort study of infants in neonatal intensive care units managed by the Pediatrix Medical Group from 1997 to 2020. We included all infants who received acyclovir with complete dosing information. Our primary outcome was the proportion of courses with dosing within 80%-120% of the PopPK recommended daily dose and at the recommended dosing frequency. We compared dosing before and after the publication of the 2014 PopPK recommendations using linear probability modeling. RESULTS: We identified 6862 infants with complete dosing information across 308 centers. Dosing met PopPK recommendations for 41% of treatment courses for infants <30 weeks postmenstrual age (PMA), 71% for infants 30 to <36 weeks PMA and <1% for infants ≥ 36 weeks PMA. Comparison of dosing from 1997 to 2013 with that from 2015 to 2020 showed a significant increase in dosing meeting PopPK recommendations for infants <30 weeks PMA (P = 0.008) and infants 30 to <36 weeks PMA (P = 0.02) but not infants ≥ 36 weeks PMA (P = 0.29). No significant increase in dosing meeting PopPK recommendations was seen for any PMA group when comparison was limited to more recent years (2008-2013 vs. 2015-2020). CONCLUSIONS: Dosing meeting PopPK recommendations increased over time for some PMA groups, but dosing different than PopPK recommendations remains common. More research is needed to clarify optimal dosing strategies in these infants.

10.
JAMA Pediatr ; 178(6): 525-532, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38619854

RESUMEN

Importance: The function-based eat, sleep, console (ESC) care approach substantially reduces the proportion of infants who receive pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). This reduction has led to concerns for increased postnatal opioid exposure in infants who receive pharmacologic treatment. However, the effect of the ESC care approach on hospital outcomes for infants pharmacologically treated for NOWS is currently unknown. Objective: To evaluate differences in opioid exposure and total length of hospital stay (LOS) for pharmacologically treated infants managed with the ESC care approach vs usual care with the Finnegan tool. Design, Setting, and Participants: This post hoc subgroup analysis involved infants pharmacologically treated in ESC-NOW, a stepped-wedge cluster randomized clinical trial conducted at 26 US hospitals. Hospitals maintained pretrial practices for pharmacologic treatment, including opioid type, scheduled opioid dosing, and use of adjuvant medications. Infants were born at 36 weeks' gestation or later, had evidence of antenatal opioid exposure, and received opioid treatment for NOWS between September 2020 and March 2022. Data were analyzed from November 2022 to January 2024. Exposure: Opioid treatment for NOWS and the ESC care approach. Main Outcomes and Measures: For each outcome (total opioid exposure, peak opioid dose, time from birth to initiation of first opioid dose, length of opioid treatment, and LOS), we used generalized linear mixed models to adjust for the stepped-wedge design and maternal and infant characteristics. Results: In the ESC-NOW trial, 463 of 1305 infants were pharmacologically treated (143/603 [23.7%] in the ESC care approach group and 320/702 [45.6%] in the usual care group). Mean total opioid exposure was lower in the ESC care approach group with an absolute difference of 4.1 morphine milligram equivalents per kilogram (MME/kg) (95% CI, 1.3-7.0) when compared with usual care (4.8 MME/kg vs 8.9 MME/kg, respectively; P = .001). Mean time from birth to initiation of pharmacologic treatment was 22.4 hours (95% CI, 7.1-37.7) longer with the ESC care approach vs usual care (75.4 vs 53.0 hours, respectively; P = .002). No significant difference in mean peak opioid dose was observed between groups (ESC care approach, 0.147 MME/kg, vs usual care, 0.126 MME/kg). The mean length of treatment was 6.3 days shorter (95% CI, 3.0-9.6) in the ESC care approach group vs usual care group (11.8 vs 18.1 days, respectively; P < .001), and mean LOS was 6.2 days shorter (95% CI, 3.0-9.4) with the ESC care approach than with usual care (16.7 vs 22.9 days, respectively; P < .001). Conclusion and Relevance: When compared with usual care, the ESC care approach was associated with less opioid exposure and shorter LOS for infants pharmacologically treated for NOWS. The ESC care approach was not associated with a higher peak opioid dose, although pharmacologic treatment was typically initiated later. Trial Registration: ClinicalTrials.gov Identifier: NCT04057820.


Asunto(s)
Analgésicos Opioides , Síndrome de Abstinencia Neonatal , Humanos , Síndrome de Abstinencia Neonatal/tratamiento farmacológico , Femenino , Recién Nacido , Analgésicos Opioides/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Masculino , Tiempo de Internación/estadística & datos numéricos , Sueño/efectos de los fármacos
11.
Antimicrob Agents Chemother ; 68(4): e0153323, 2024 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-38477706

RESUMEN

Pharmacokinetic models rarely undergo external validation in vulnerable populations such as critically ill infants, thereby limiting the accuracy, efficacy, and safety of model-informed dosing in real-world settings. Here, we describe an opportunistic approach using dried blood spots (DBS) to evaluate a population pharmacokinetic model of metronidazole in critically ill preterm infants of gestational age (GA) ≤31 weeks from the Metronidazole Pharmacokinetics in Premature Infants (PTN_METRO, NCT01222585) study. First, we used linear correlation to compare 42 paired DBS and plasma metronidazole concentrations from 21 preterm infants [mean (SD): post natal age 28.0 (21.7) days, GA 26.3 (2.4) weeks]. Using the resulting predictive equation, we estimated plasma metronidazole concentrations (ePlasma) from 399 DBS collected from 122 preterm and term infants [mean (SD): post natal age 16.7 (15.8) days, GA 31.4 (5.1) weeks] from the Antibiotic Safety in Infants with Complicated Intra-Abdominal Infections (SCAMP, NCT01994993) trial. When evaluating the PTN_METRO model using ePlasma from the SCAMP trial, we found that the model generally predicted ePlasma well in preterm infants with GA ≤31 weeks. When including ePlasma from term and preterm infants with GA >31 weeks, the model was optimized using a sigmoidal Emax maturation function of postmenstrual age on clearance and estimated the exponent of weight on volume of distribution. The optimized model supports existing dosing guidelines and adds new data to support a 6-hour dosing interval for infants with postmenstrual age >40 weeks. Using an opportunistic DBS to externally validate and optimize a metronidazole population pharmacokinetic model was feasible and useful in this vulnerable population.


Asunto(s)
Recien Nacido Prematuro , Metronidazol , Humanos , Lactante , Recién Nacido , Antibacterianos/farmacocinética , Enfermedad Crítica , Edad Gestacional , Metronidazol/farmacocinética
12.
Neoreviews ; 25(4): e193-e206, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38556491

RESUMEN

Although necrotizing enterocolitis is a leading cause of morbidity and mortality among preterm infants, its underlying pathophysiology is not fully understood. Gut dysbiosis, an imbalance between commensal and pathogenic microbes, in the preterm infant is likely a major contributor to the development of necrotizing enterocolitis. In this review, we will discuss the increasing use of probiotics in the NICU, an intervention aimed to mitigate alterations in the gut microbiome. We will review the existing evidence regarding the safety and effectiveness of probiotics, and their potential to reduce rates of necrotizing enterocolitis in preterm infants.


Asunto(s)
Enterocolitis Necrotizante , Enfermedades del Prematuro , Probióticos , Humanos , Recién Nacido , Enterocolitis Necrotizante/prevención & control , Recien Nacido Prematuro , Enfermedades del Prematuro/terapia , Probióticos/efectos adversos
13.
Neoreviews ; 25(4): e193-e206, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38556499

RESUMEN

Although necrotizing enterocolitis is a leading cause of morbidity and mortality among preterm infants, its underlying pathophysiology is not fully understood. Gut dysbiosis, an imbalance between commensal and pathogenic microbes, in the preterm infant is likely a major contributor to the development of necrotizing enterocolitis. In this review, we will discuss the increasing use of probiotics in the NICU, an intervention aimed to mitigate alterations in the gut microbiome. We will review the existing evidence regarding the safety and effectiveness of probiotics, and their potential to reduce rates of necrotizing enterocolitis in preterm infants.


Asunto(s)
Enterocolitis Necrotizante , Enfermedades del Prematuro , Probióticos , Humanos , Recién Nacido , Enterocolitis Necrotizante/prevención & control , Recien Nacido Prematuro , Enfermedades del Prematuro/terapia , Probióticos/efectos adversos
14.
J Perinatol ; 44(6): 802-810, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38396053

RESUMEN

OBJECTIVE: To compare the rates of death or survival with severe neurodevelopmental impairment (sNDI) at 2 years among extremely preterm infants in relation to pre-pregnancy or first-trimester maternal body mass index (BMI). METHODS: This retrospective cohort study included extremely preterm infants (gestational age 220/7-266/7 weeks). The study was conducted at National Institute of Child Health and Human Development Neonatal Research Network sites. The primary outcome was death or sNDI at 2 years. RESULTS: Data on the primary outcome were available for 1208 children. Death or sNDI was not different among the three groups: 54.9% in normal, 56.1% in overweight, and 53.4% in obese group (p = 0.39). There was no significant difference in mortality, sNDI, moderate/severe cerebral palsy, Bayley Scales of Infant Development (BSID)-III cognitive composite score <70, BSID-III language composite score <70 in adjusted models. CONCLUSION: Neurodevelopmental outcome was not significantly associated with maternal pre-pregnancy BMI among extreme preterm infants.


Asunto(s)
Índice de Masa Corporal , Edad Gestacional , Recien Nacido Extremadamente Prematuro , Primer Trimestre del Embarazo , Humanos , Femenino , Estudios Retrospectivos , Recién Nacido , Embarazo , Masculino , Trastornos del Neurodesarrollo/epidemiología , Trastornos del Neurodesarrollo/etiología , Adulto , Lactante , Preescolar , Parálisis Cerebral , Obesidad/complicaciones
15.
Contemp Clin Trials Commun ; 38: 101261, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38298915

RESUMEN

Under traditional circumstances, most clinical trials rely on in-person operations to identify, recruit, and enroll study participants and to complete study-related visits. During unusual circumstances, such as the COVID-19 pandemic, the typical clinical trial model is challenged and forced to explore alternative approaches to implementing study recruitment, participant enrollment, and data collection strategies. One such alternative is a direct-to-participant approach which leverages electronic resources and relevant technological devices (e.g., smart phones) available to researchers and patients. This approach functions under the assumption that a participant has access to a device that connects to the internet such as a smart phone, tablet, or computer. Researchers are then able to transition a typical paper-based, in-person model to an electronic-based, siteless, remote study. This article describes the challenges clinicians and researchers faced when implementing a direct-to-participant study approach during the COVID-19 pandemic. The lessons learned during this study of infant populations could help increase efficiency of future trials, specifically, by lessening the burden on participants and clinicians as well as streamlining the process for enrollment and data collection. While direct-to-adult participant recruitment is not a novel approach, our findings suggest that studies attempting to recruit the infant population may benefit from such a direct-to-participant approach.

17.
J Perinatol ; 44(7): 953-956, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38297180

RESUMEN

OBJECTIVE: Despite limited safety and efficacy data, inhaled corticosteroids (ICS) are prescribed to premature infants in the neonatal intensive care unit (NICU). We examined contemporary use and risk factors for ICS use in the NICU. STUDY DESIGN: Infants <33 weeks gestational age and <1500 gm birth weight discharged from Pediatrix Medical Group NICUs between 2010 and 2020 were included. We evaluated the association between ICS prescription and clinical characteristics using univariable and multivariable logistic regression. RESULTS: Of 74,123 infants from 308 NICUs, 9253 (12.5%) were prescribed ICS: budesonide, fluticasone, or beclomethasone. Diagnosis of bronchopulmonary dysplasia (BPD), earlier gestational age, male sex, longer mechanical ventilation, oxygen support, and systemic steroids were independent risk factors for ICS prescription. CONCLUSIONS: Use of ICS is common in many NICUs and is associated with a diagnosis of BPD and healthcare utilization. Prospective trials are needed to establish the safety, efficacy, and optimal indication in this vulnerable population.


Asunto(s)
Displasia Broncopulmonar , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Pautas de la Práctica en Medicina , Humanos , Recién Nacido , Administración por Inhalación , Masculino , Femenino , Displasia Broncopulmonar/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Edad Gestacional , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Estudios Retrospectivos , Beclometasona/administración & dosificación , Beclometasona/uso terapéutico , Budesonida/administración & dosificación , Budesonida/uso terapéutico , Modelos Logísticos , Factores de Riesgo , Fluticasona/administración & dosificación , Fluticasona/uso terapéutico
18.
J Perinatol ; 44(1): 35-39, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37452116

RESUMEN

OBJECTIVE: Characterize the prevalence of coronavirus disease 2019 (COVID-19) diagnosis among mothers with infants hospitalized in 294 neonatal intensive care units (NICUs), and demographics and outcomes of infants with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure in utero. STUDY DESIGN: Cohort study of infants discharged from NICUs 01/2020-09/2021. We defined groups based on infant diagnosis, infant testing, and maternal SARS-CoV-2 infection status. We compared demographics, clinical characteristics, and outcomes. RESULTS: Of 150,924 infants, 94% had no COVID-related diagnosis or test; 247 (0.2%) infants tested positive for COVID-19 and were more likely to require mechanical ventilation. Infants with unknown maternal status and negative testing were more commonly premature, outborn, and had longer hospitalizations. CONCLUSION: In this large cohort of hospitalized infants, most had no known exposure to COVID-19. Adverse outcomes and mortality were rare. Further studies are needed to evaluate the long-term effects of COVID-19 in this population.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Recién Nacido , Lactante , Femenino , Humanos , Embarazo , COVID-19/diagnóstico , COVID-19/epidemiología , Unidades de Cuidado Intensivo Neonatal , SARS-CoV-2 , Estudios de Cohortes , Prueba de COVID-19 , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología
19.
J Perinatol ; 44(4): 508-512, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37587184

RESUMEN

OBJECTIVE: Caffeine provides neuroprotection following hypoxic-ischemic injury in animals. We characterized the safety of escalating doses of caffeine in infants with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia. STUDY DESIGN: Phase I trial of infants undergoing therapeutic hypothermia for HIE receiving IV caffeine 20 mg/kg followed by up to two daily doses of 5 mg/kg (n = 9) or 10 mg/kg (n = 8). Safety was evaluated based on adverse events and frequency of pre-specified outcomes compared to data from the Whole-Body Hypothermia for HIE trial (Shankaran, 2005). RESULTS: Twelve of 17 (71%) infants had ≥1 adverse event during the study period. The frequency of clinical outcomes related to HIE were not statistically different from outcomes in infants receiving hypothermia in the Whole-Body Hypothermia for HIE trial. CONCLUSION: Caffeine administration was well tolerated. A larger study is required to determine the optimal dose and evaluate drug safety and efficacy. CLINICAL TRIAL: ClinicalTrials.gov Identifier: NCT03913221.


Asunto(s)
Hipotermia Inducida , Hipoxia-Isquemia Encefálica , Lactante , Humanos , Cafeína/efectos adversos , Hipoxia-Isquemia Encefálica/terapia , Hipoxia-Isquemia Encefálica/etiología , Neuroprotección , Hipotermia Inducida/efectos adversos
20.
J Perinatol ; 44(1): 55-61, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37880407

RESUMEN

OBJECTIVE: To quantify immunization status among premature infants discharged from neonatal intensive care units (NICUs), and identify risk factors for underimmunization. STUDY DESIGN: We performed a cohort study of infants <33 weeks gestation discharged home between 2011 and 2020 from 241 NICUs. Using multivariable logistic regression, we examined the association between risk factors and underimmunization at discharge, defined as <1 dose of 5 vaccine types when discharged at 60-119 days of age and <2 doses when discharged at 120-179 days of age. RESULTS: Of 30,766 infants discharged at 60-119 days of age, 14% were underimmunized. Among 4358 infants discharged at 120-179 days of age, 53% were underimmunized. For infants discharged at 60-119 days of age, ventilator support within 30 days of discharge was associated with underimmunization. Having a surgical procedure was associated with underimmunization in both groups. CONCLUSION: A large proportion of premature infants discharged from the NICU are underimmunized.


Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Alta del Paciente , Recién Nacido , Lactante , Humanos , Estudios de Cohortes , Recién Nacido de muy Bajo Peso , Recien Nacido Prematuro
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