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1.
Acta Ophthalmol ; 99(1): 97-103, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32701185

RESUMEN

PURPOSE: Compare patients treated for Retinopathy of Prematurity (ROP) in two consecutive periods. METHODS: Retrospective inventory of anonymized neonatal and ophthalmological data of all patients treated for ROP from 2010 to 2017 in the Netherlands, subdivided in period (P)1: 1-1-2010 to 31-3-2013 and P2: 1-4-2013 to 31-12-2016. Treatment characteristics, adherence to early treatment for ROP (ETROP) criteria, outcome of treatment and changes in neonatal parameters and policy of care were compared. RESULTS: Overall 196 infants were included, 57 infants (113 eyes) in P1 and 139 (275 eyes) in P2, indicating a 2.1-fold increase in ROP treatment. No differences were found in mean gestational age (GA) (25.9 ± 1.7 versus 26.0 ± 1.7 weeks, p = 0.711), mean birth weight (791 ± 311 versus 764 ± 204 grams, p = 0.967) and other neonatal risk factors for ROP. In P2, the number of premature infants born <25 weeks increased by factor 1.23 and higher oxygen saturation levels were aimed at in most centres. At treatment decision, 59.6% (P1) versus 83.5% (P2) (p = 0.263) infants were classified as Type 1 ROP (ETROP classification). Infants were treated with laser photocoagulation (98 versus 96%) and intravitreal bevacizumab (2 versus 4%). Retreatment was necessary in 10 versus 21 (p = 0.160). Retinal detachment developed in 6 versus 13 infants (p = 0.791) of which 2 versus 6 bilateral (p = 0.599). CONCLUSION: In period 2, the number of infants treated according to the ETROP criteria (Type 1) increased, the number of ROP treatments, retinal detachments and retreatments doubled and the absolute number of retinal detachments increased. Neonatal data did not provide a decisive explanation, although changes in neonatal policy were reported.


Asunto(s)
Bevacizumab/administración & dosificación , Coagulación con Láser/métodos , Retinopatía de la Prematuridad/terapia , Agudeza Visual , Inhibidores de la Angiogénesis/administración & dosificación , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Incidencia , Lactante , Recién Nacido , Inyecciones Intravítreas , Masculino , Países Bajos/epidemiología , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/epidemiología , Estudios Retrospectivos , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores
2.
Fertil Steril ; 111(6): 1151-1158, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31005312

RESUMEN

OBJECTIVE: To evaluate the growth, health, and motor development of children born after preimplantation genetic diagnosis (PGD). DESIGN: Observational cohort study and comparison of 5-year-old children born after PGD to similar aged children born after IVF/intracytoplasmic sperm injection (ICSI) and children from families with a genetic disorder born after natural conception (NC). SETTING: University hospital. PATIENT(S): One hundred three children were included in the PGD group. The two control groups consisted of 90 children born after IVF/ICSI and 58 children born after NC. INTERVENTION(S): PGD. MAIN OUTCOME MEASURE(S): We measured height, weight, body circumferences, body mass index, and blood pressure and performed a dysmorphological and neurological examination. We also collected data about the children's medical history, health care consultations, and motor milestones. RESULT(S): The mean height, weight, and body mass index were comparable for all groups. Six (5.8%) PGD, four (4.4%) IVF/ICSI, and five (8.6%) NC children had a major congenital abnormality. The incidence of acute and chronic illnesses was similar in all groups. Motor milestones were achieved on time, but the IVF/ICSI group had a slightly younger mean sitting age. None of the children had severe neurological problems. CONCLUSION(S): Five-year-old children born after PGD show normal growth, health, and motor development when compared with children born after IVF/ICSI and NC children from families with a genetic disorder. TRIAL REGISTRATION NUMBER: NCT02149485.


Asunto(s)
Desarrollo Infantil , Salud Infantil , Fertilización In Vitro/efectos adversos , Enfermedades Genéticas Congénitas/genética , Pruebas Genéticas , Infertilidad/terapia , Destreza Motora , Diagnóstico Preimplantación/métodos , Factores de Edad , Presión Sanguínea , Estatura , Índice de Masa Corporal , Preescolar , Femenino , Enfermedades Genéticas Congénitas/diagnóstico , Enfermedades Genéticas Congénitas/fisiopatología , Estado de Salud , Humanos , Infertilidad/diagnóstico , Infertilidad/fisiopatología , Masculino , Medición de Riesgo , Factores de Riesgo , Inyecciones de Esperma Intracitoplasmáticas/efectos adversos , Resultado del Tratamiento , Aumento de Peso
4.
J Assist Reprod Genet ; 35(11): 1995-2002, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30187425

RESUMEN

PURPOSE: We aim to evaluate the safety of PGD. We focus on the congenital malformation rate and additionally report on adverse perinatal outcome. METHODS: We collated data from a large group of singletons and multiples born after PGD between 1995 and 2014. Data on congenital malformation rates in live born children and terminated pregnancies, misdiagnosis rate, birth parameters, perinatal mortality, and hospital admissions were prospectively collected by questionnaires. RESULTS: Four hundred thirty-nine pregnancies in 381 women resulted in 364 live born children. Nine children (2.5%) had major malformations. This percentage is consistent with other PGD cohorts and comparable to the prevalence reported by the European Surveillance of Congenital Anomalies (EUROCAT). We reported one misdiagnosis resulting in a spontaneous abortion of a fetus with an unbalanced chromosome pattern. 20% of the children were born premature (< 37 weeks) and less than 15% had a low birth weight. The incidence of hospital admissions is in line with prematurity and low birth weight rate. One child from a twin, one child from a triplet, and one singleton died at 23, 32, and 37 weeks of gestation respectively. CONCLUSIONS: We found no evidence that PGD treatment increases the risk on congenital malformations or adverse perinatal outcome. TRIAL REGISTRATION NUMBER: NCT 2 149485.


Asunto(s)
Anomalías Congénitas/diagnóstico , Pruebas Genéticas/métodos , Atención Perinatal , Diagnóstico Preimplantación/efectos adversos , Adulto , Niño , Anomalías Congénitas/etiología , Errores Diagnósticos , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Embarazo , Estudios Prospectivos , Factores de Tiempo
5.
BMC Pediatr ; 18(1): 84, 2018 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-29475450

RESUMEN

BACKGROUND: In critically ill (preterm) neonates, central venous catheters (CVCs) are increasingly used for administration of medication or parenteral nutrition. A serious complication, however, is the development of catheter-related thrombosis (CVC-thrombosis), which may resolve by itself or cause severe complications. Due to lack of evidence, management of neonatal CVC-thrombosis varies among neonatal intensive care units (NICUs). In the Netherlands an expert-based national management guideline has been developed which is implemented in all 10 NICUs in 2014. METHODS: The NEOCLOT study is a multicentre prospective observational cohort study, including 150 preterm and term infants (0-6 months) admitted to one of the 10 NICUs, developing CVC-thrombosis. Patient characteristics, thrombosis characteristics, risk factors, treatment strategies and outcome measures will be collected in a web-based database. Management of CVC-thrombosis will be performed as recommended in the protocol. Violations of the protocol will be noted. Primary outcome measures are a composite efficacy outcome consisting of death due to CVC-thrombosis and recurrent thrombosis, and a safety outcome consisting of the incidence of major bleedings during therapy. Secondary outcomes include individual components of primary efficacy outcome, clinically relevant non-major and minor bleedings and the frequency of risk factors, protocol variations, residual thrombosis and post thrombotic syndrome. DISCUSSION: The NEOCLOT study will evaluate the efficacy and safety of the new, national, neonatal CVC-thrombosis guideline. Furthermore, risk factors as well as long-term consequences of CVC-thrombosis will be analysed. TRIAL REGISTRATION: Trial registration: Nederlands Trial Register NTR4336 . Registered 24 December 2013.


Asunto(s)
Cateterismo Venoso Central/efectos adversos , Trombosis/terapia , Protocolos Clínicos , Terapia Combinada , Femenino , Estudios de Seguimiento , Adhesión a Directriz , Humanos , Lactante , Recién Nacido , Masculino , Países Bajos , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Factores de Riesgo , Trombosis/diagnóstico , Trombosis/etiología
6.
Eur J Obstet Gynecol Reprod Biol ; 221: 97-104, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29277048

RESUMEN

OBJECTIVE: To compare, in women with twin pregnancy with the first twin in cephalic position, neonatal morbidity and mortality rates after planned caesarean delivery (CD) versus planned vaginal delivery (VD). STUDY DESIGN: A nationwide cohort study on women pregnant with twins and the first child in cephalic position, who delivered between 32 + 0-41 + 0 weeks between 2000 and 2012 in the Netherlands, using multivariate logistic regression analysis to compare neonatal morbidity and mortality according to planned delivery mode, and looking at subgroups 32 + 0-36 + 6 and 37 + 0-41 + 0 weeks. RESULTS: We included 21,107 women, of whom 1384 (6.6%) had a planned CD. Of the 19,723 women (93.4%) who had a planned VD, 19.7% delivered by intrapartum CD. We found no significant differences in 'any mortality' (aOR planned CD vs. planned VD 1.34 (95% CI 0.63-2.60)), the outcome 'Apgar score (AS) < 4 or death within 28 days' (aOR 1.28 (95% CI 0.77-2.11) or asphyxia-related morbidity (aOR 0.57 (95% CI 0.32-1.03)). After planned CD more prematurity-related morbidity (aOR 1.55 (95% CI 1.21-1.98)), other morbidity (aOR 1.50 (95% CI 1.26-1.78)) and 'any morbidity or mortality' (aOR 1.41 (95% CI 1.20-1.66) was noted. Trauma-associated morbidity was absent after planned CD and occurred 45 times (0.2%) after planned VD. Before 36 + 6 weeks, planned CD resulted in more perinatal mortality (aOR 2.10 (95% CI 0.92-4.76)), while asphyxia-related morbidity did not differ (aOR 0.80 (95% CI 0.41-1.54). Planned CD resulted in more 'any morbidity or mortality' (aOR 1.52 (95% CI 1.25-1.84)), 'AS < 4 or death within 28 days' (aOR 1.77 (95% CI 1.02-3.09)), prematurity-related morbidity (aOR 1.73 (95% CI 1.34-2.23)), and 'other morbidity' (aOR 1.56 (95% CI 1.28-1.90)). After 37 weeks, no significance differences in mortality, 'any morbidity or mortality <28 days' (aOR 0.96 (95% CI 1 (0.67-1.38)), or 'AS < 4 or death within 28 days' (aOR 0.41 (95% CI (0.10-1.70)) were found. There was less asphyxia-related morbidity after planned CD (aOR 0.24 (95% CI 0.06-1.002)). CONCLUSION: Planned VD results in comparable neonatal outcomes as planned CD for twin pregnancy with the first twin in cephalic position, even with a low intrapartum CD rate of 19.7%. At term, a planned CD may result in less asphyxia- and trauma-related outcomes.


Asunto(s)
Cesárea/efectos adversos , Parto Obstétrico/efectos adversos , Resultado del Embarazo , Embarazo Gemelar , Adulto , Cesárea/mortalidad , Estudios de Cohortes , Parto Obstétrico/métodos , Parto Obstétrico/mortalidad , Femenino , Edad Gestacional , Humanos , Recién Nacido , Países Bajos , Parto , Mortalidad Perinatal , Embarazo , Gemelos , Adulto Joven
7.
Early Hum Dev ; 103: 209-218, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27825040

RESUMEN

OBJECTIVE: To determine outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities). STUDY DESIGN: International cohort study and meta-analysis. PRIMARY OUTCOME: time to full enteral feeding (TFEF); secondary outcomes: Duration of mechanical ventilation, length of stay (LOS), mortality and differences in outcome between simple and complex gastroschisis (complex; born with bowel atresia, volvulus, perforation or necrosis). To compare the cohort study results with literature three databases were searched. Studies were eligible for inclusion if cases were born in developed countries with isolated gastroschisis after 1990, number of cases >20 and TFEF was reported. RESULTS: The cohort study included 204 liveborn cases of isolated gastroschisis. The TFEF, median duration of ventilation and LOS was, 26days (range 6-515), 2days (range 0-90) and 33days (range 11-515), respectively. Overall mortality was 10.8%. TFEF and LOS were significantly longer (P<0.0001) and mortality was fourfold higher in the complex group. Seventeen studies, amongst the current study, were included for further meta-analysis comprising a total of 1652 patients. Mean TFEF was 35.3±4.4days, length of ventilation was 5.5±2.0days, LOS was 46.4±5.2days and mortality risk was 0.06 [0.04-0.07 95%CI]. Outcome of simple and complex gastroschisis was described in five studies. TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 [1.95-6.83 95%CI] times higher in complex cases. CONCLUSIONS: These results give a good indication of the expected TFEF, ventilation time and LOS and mortality risk in children born with isolated gastroschisis, although ranges remain wide. This study shows the importance of dividing gastroschisis into simple and complex for the prediction of outcome.


Asunto(s)
Gastrosquisis/epidemiología , Gastrosquisis/diagnóstico , Gastrosquisis/terapia , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Nutrición Parenteral/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos
8.
Acta Obstet Gynecol Scand ; 93(3): 277-86, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24397702

RESUMEN

OBJECTIVE: To compare perinatal singleton and multiple outcomes in a large Dutch in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) population and within risk subgroups. Newborns were assigned to a risk category based on gestational age, birthweight, Apgar score and congenital malformation. DESIGN: Register-based retrospective cohort study. SETTING: Netherlands Perinatal Registry data. SAMPLE: A total of 3041 singletons and 1788 multiple children born from IVF/ICSI in 2003-2005. METHODS: Student's t-test or Mann-Whitney U-test was used to analyze continuous data, chi-squared analyses were used for categorical data. Multivariate logistic and linear regression analysis was performed to analyze whether the risk stratification criteria were associated with neonatal hospital admission and length of stay. MAIN OUTCOME MEASURES: Start of labor, mode of delivery, gestational age, birthweight, 5-min Apgar score, congenital malformation, neonatal hospital admission, neonatal intensive care unit admission and mortality. RESULTS: IVF/ICSI-conceived multiples had considerably poorer outcomes than singletons in terms of cesarean section rate, preterm birth, birthweight, being small-for-gestational-age, Apgar score, neonatal hospital admission, neonatal intensive care unit admission and neonatal mortality. As opposed to the results found in the total study population and the low-risk and moderate-risk populations, high-risk multiples showed better outcomes than high-risk singletons regarding cesarean section rate, birthweight and Apgar score. All risk stratification variables were associated with being hospitalized after birth. Length of stay was associated with all risk stratification criteria except Apgar score. CONCLUSIONS: Perinatal outcomes in IVF/ICSI-conceived multiples are considerably poorer than in singletons. This finding mainly pertains to low-risk children. High-risk multiples had significantly better perinatal outcomes than high-risk singletons.


Asunto(s)
Fertilización In Vitro , Progenie de Nacimiento Múltiple/estadística & datos numéricos , Resultado del Embarazo , Embarazo Múltiple/fisiología , Inyecciones de Esperma Intracitoplasmáticas , Adulto , Puntaje de Apgar , Peso al Nacer , Estudios de Cohortes , Anomalías Congénitas/epidemiología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Países Bajos , Embarazo , Embarazo Múltiple/estadística & datos numéricos , Sistema de Registros , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Clase Social
9.
J Child Health Care ; 17(1): 30-40, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23242810

RESUMEN

The concern about obesity in children has increased worldwide. The question arises, whether this trend to obesity already starts during the prenatal period and to what extent the increase of weight is related to a secular trend in height. For neonatal data, three studies, performed in The Netherlands, with neonatal data of birth weights were compared. For postnatal data, weight, height and body mass index (BMI) of two nationwide studies, performed in the Netherlands, were analyzed. No differences between birth weights were found between 1970 and 2007. In postnatal data a trend of increasing weight and BMI in both boys and girls starts from five years onwards. The secular trend in height starts from the age of two and a half years onward in both boys and girls. The increase in weight is more pronounced than the increase in height. No prenatal secular trend could be detected in The Netherlands. Postnatal, the secular trend is obvious for weight, height and BMI. The increase in skewness of the weight distribution may be ascribed to a metabolic disturbance of the population.


Asunto(s)
Obesidad Infantil/epidemiología , Peso al Nacer , Estatura , Índice de Masa Corporal , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Países Bajos/epidemiología
10.
BMC Pediatr ; 10: 75, 2010 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-20961411

RESUMEN

BACKGROUND: Pregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. METHODS/DESIGN: A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost-effectiveness. DISCUSSION: This is, to our knowledge, the first study that investigates the long-term costs and health outcomes of IVF singleton and twin children and the long-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies.


Asunto(s)
Transferencia de Embrión/economía , Fertilización In Vitro/economía , Transferencia de un Solo Embrión/economía , Transferencia de un Solo Embrión/métodos , Gemelos , Niño , Análisis Costo-Beneficio , Transferencia de Embrión/métodos , Transferencia de Embrión/estadística & datos numéricos , Femenino , Fertilización In Vitro/métodos , Fertilización In Vitro/estadística & datos numéricos , Estudios de Seguimiento , Humanos , Embarazo , Estudios Retrospectivos , Transferencia de un Solo Embrión/estadística & datos numéricos , Factores de Tiempo
11.
BMC Pregnancy Childbirth ; 10: 60, 2010 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-20932350

RESUMEN

BACKGROUND: Preeclampsia and HELLP syndrome may have serious consequences for both mother and fetus. Women who have suffered from preeclampsia or the HELLP syndrome, have an increased risk of developing preeclampsia in a subsequent pregnancy. However, most women will develop no or only minor complications. In this study, we intend to determine cost-effectiveness of recurrence risk guided care versus care as usual in pregnant women with a history of early-onset preeclampsia. METHODS/DESIGN: We developed a prediction model to estimate the individual risk of recurrence of early-onset preeclampsia and the HELLP syndrome. In a before-after study, pregnant women with preeclampsia or HELLP syndrome in their previous pregnancy receiving care as usual (before introduction of the prediction model) will be compared with women receiving recurrence risk guided care (after introduction of the prediction model). Eligible and pregnant women will be recruited at six university hospitals and seven large non-university tertiary referral hospitals in the Netherlands. The primary outcome measure is the recurrence of early-onset preeclampsia or HELLP syndrome in women allocated to the regular monitoring group. For the economic evaluation, a modelling approach will be used. Costs and effects of recurrence risk guided care with those of care as usual will be compared by means of a decision model. Two incremental cost-effectiveness ratios will be calculated: 1) cost per Quality Adjusted Life Year (mother unit of analysis) and 2) cost per live born child (child unit of analysis). DISCUSSION: This is, to our knowledge, the first study that evaluates prospectively the efficacy of a multivariable prediction rule for recurrent hypertensive disease in pregnancy. Results of this study could either be integrated into the current guideline on Hypertensive Disorders in Pregnancy, or be used to develop a new guideline.


Asunto(s)
Técnicas de Apoyo para la Decisión , Síndrome HELLP/economía , Síndrome HELLP/terapia , Preeclampsia/economía , Preeclampsia/terapia , Análisis Costo-Beneficio , Femenino , Número de Embarazos , Síndrome HELLP/mortalidad , Humanos , Modelos Económicos , Monitoreo Fisiológico/métodos , Planificación de Atención al Paciente/economía , Guías de Práctica Clínica como Asunto , Preeclampsia/mortalidad , Embarazo , Embarazo de Alto Riesgo , Estudios Prospectivos , Años de Vida Ajustados por Calidad de Vida , Recurrencia , Riesgo , Medición de Riesgo/economía
12.
PLoS One ; 4(8): e6815, 2009 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-19714240

RESUMEN

BACKGROUND: Monochorionic (MC) twins are at increased risk for perinatal mortality and serious morbidity due to the presence of placental vascular anastomoses. Cerebral injury can be secondary to haemodynamic and hematological disorders during pregnancy (especially twin-to-twin transfusion syndrome (TTTS) or intrauterine co-twin death) or from postnatal injury associated with prematurity and low birth weight, common complications in twin pregnancies. We investigated neurodevelopmental outcome in MC and dichorionic (DC) twins at the age of two years. METHODS: This was a prospective cohort study. Cerebral palsy (CP) was studied in 182 MC infants and 189 DC infants matched for weight and age at delivery, gender, ethnicity of the mother and study center. After losses to follow-up, 282 of the 366 infants without CP were available to be tested with the Griffiths Mental Developmental Scales at 22 months corrected age, all born between January 2005 and January 2006 in nine perinatal centers in The Netherlands. Due to phenotypic (un)alikeness in mono-or dizygosity, the principal investigator was not blinded to chorionic status; perinatal outcome, with exception of co-twin death, was not known to the examiner. FINDINGS: Four out of 182 MC infants had CP (2.2%) - two of the four CP-cases were due to complications specific to MC twin pregnancies (TTTS and co-twin death) and the other two cases of CP were the result of cystic PVL after preterm birth - compared to one sibling of a DC twin (0.5%; OR 4.2, 95% CI 0.5-38.2) of unknown origin. Follow-up rate of neurodevelopmental outcome by Griffith's test was 76%. The majority of 2-year-old twins had normal developmental status. There were no significant differences between MC and DC twins. One MC infant (0.7%) had a developmental delay compared to 6 DC infants (4.2%; OR 0.2, 95% 0.0-1.4). Birth weight discordancy did not influence long-term outcome, though the smaller twin had slightly lower developmental scores than its larger co-twin. CONCLUSIONS: There were no significant differences in occurrence of cerebral palsy as well as neurodevelopmental outcome between MC and DC twins. Outcome of MC twins seems favourable in the absence of TTTS or co-twin death.


Asunto(s)
Sistema Nervioso Central/crecimiento & desarrollo , Gemelos Dicigóticos , Gemelos Monocigóticos , Preescolar , Estudios de Cohortes , Humanos , Lactante , Recién Nacido , Pruebas Neuropsicológicas
13.
Pediatrics ; 120(1): e20-8, 2007 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-17606544

RESUMEN

OBJECTIVE: Decisions regarding end-of-life care in critically ill newborns in The Netherlands have received considerable criticism from the media and from the public. This might be because of a lack of proper information and knowledge. Our purpose was to provide detailed information about how and when the implementation of end-of-life decisions, which are based on quality-of-life considerations, takes place. METHODS: We reviewed the charts of all infants who died within the first 2 months of life at 2 university hospitals in The Netherlands from January to July 2005 and extracted all relevant information about the end-of-life decisions. We interviewed the responsible neonatologists about the end-of-life decisions and the underlying quality-of-life considerations and about the process of implementation. RESULTS: Of a total of 30 deaths, 28 were attributable to withholding or withdrawing life-sustaining treatment. In 18 of 28 cases, the infant had no chance to survive; in 10 cases, the final decision was based on the poor prognosis of the infant. In 6 patients, 2 successive different end-of-life decisions were made. The arguments that most frequently were used to conclude that quality of life was deemed poor were predicted suffering and predicted inability of verbal and nonverbal communication. Implementation consisted of discontinuation of ventilatory support and alleviation of pain and symptoms. Neuromuscular blockers were added shortly before death in 5 cases to prevent gasping, mostly on parental request. CONCLUSIONS: The majority of deaths were attributable to withholding or withdrawing treatment. In most cases, the newborn had no chance to survive and prolonging of treatment could not be justified. In the remaining cases, withholding or withdrawing treatment was based on quality-of-life considerations, mostly the predicted suffering and predicted inability of verbal and nonverbal communication. Potentially life-shortening medication played a minor role as a cause of death.


Asunto(s)
Toma de Decisiones , Eutanasia Pasiva , Recién Nacido , Neonatología , Privación de Tratamiento , Eutanasia Activa , Humanos , Unidades de Cuidado Intensivo Neonatal , Inutilidad Médica , Países Bajos , Calidad de Vida
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