RESUMEN
Perinatal inflammation triggers breathing disturbances early in life and affects the respiratory adaptations to challenging conditions, including the generation of amplitude long-term facilitation (LTF) by acute intermittent hypoxia (AIH). Some of these effects can be avoided by anti-inflammatory treatments like minocycline. Since little is known about the effects of perinatal inflammation on the inspiratory rhythm generator, located in the preBötzinger complex (preBötC), we tested the impact of acute lipopolysaccharide (LPS) systemic administration (sLPS), as well as gestational LPS (gLPS) and gestational chronic IH (gCIH), on respiratory rhythm generation and its long-term response to AIH in a brainstem slice preparation from neonatal mice. We also evaluated whether acute minocycline administration could influence these effects. We found that perinatal inflammation induced by sLPS or gLPS, as well as gCIH, modulate the frequency, signal-to-noise ratio and/or amplitude (and their regularity) of the respiratory rhythm recorded from the preBötC in the brainstem slice. Moreover, all these perinatal conditions inhibited frequency LTF and amplitude long-term depression (LTD); gCIH even induced frequency LTD of the respiratory rhythm after AIH. Some of these alterations were not observed in slices pre-treated in vitro with minocycline, when compared with slices obtained from naïve pups, suggesting that ongoing inflammatory conditions affect respiratory rhythm generation and its plasticity. Thus, it is likely that alterations in the inspiratory rhythm generator and its adaptive responses could contribute to the respiratory disturbances observed in neonates that suffered from perinatal inflammatory challenges.
Asunto(s)
Antiinflamatorios/farmacología , Generadores de Patrones Centrales/fisiopatología , Hipoxia/fisiopatología , Enfermedades del Recién Nacido/fisiopatología , Inflamación/tratamiento farmacológico , Inflamación/fisiopatología , Minociclina/farmacología , Plasticidad Neuronal/fisiología , Centro Respiratorio/fisiopatología , Frecuencia Respiratoria/fisiología , Animales , Animales Recién Nacidos , Antiinflamatorios/administración & dosificación , Modelos Animales de Enfermedad , Humanos , Recién Nacido , Enfermedades del Recién Nacido/tratamiento farmacológico , Inflamación/inducido químicamente , Minociclina/administración & dosificaciónRESUMEN
OBJECTIVE: The present study seeks to assess the impact of gestational hypertensive disorders on premature newborns below 34 weeks and to establish the main morbidities and mortality in the neonatal period and at 18 months. MATERIALS AND METHODS: A retrospective observational study was carried out with 695 premature newborns of gestational age (GA) between 24 and 33 weeks and 6 days, born alive in the Neonatal ICU of Brasília's Mother and Child Hospital (HMIB), in the period from January 1, 2014, to July 31, 2019. In total, 308 infants were born to hypertensive mothers (G1) and 387 to normotensive mothers (G2). Twin pregnancies and diabetic patients with severe malformations were excluded. Outcomes during hospitalization and outcomes of interest were evaluated: respiratory distress syndrome (RDS), brain ultrasonography, diagnosis of bronchopulmonary dysplasia (BPD), diagnosis of necrotizing enterocolitis, retinopathy of prematurity, breastfeeding rate at discharge, survival at discharge and at 18 months of chronological age and relationship between weight and gestational age. RESULTS: Newborns with hypertensive mothers had significantly lower measurements of birth weight and head circumference. The G1 group had a higher risk small for gestational age (OR 2.4; CI 95% 1.6-3.6; p <0.00), as well as a greater risk of being born with a weight less than 850 g (OR 2.4; 95% CI 1.2-3.5; p <0.00). Newborns of mothers with hypertension presented more necrotizing enterocolitis (OR 2.0; CI 95% 1.1-3.7); however, resuscitation in the delivery room and the need to use surfactant did not differ between groups, nor did the length of stay on mechanical ventilation, or dependence on oxygen at 36 weeks of gestational age. Survival was better in newborns of normotensive mothers, and this was a protective factor against death (OR 0.7; 95% CI 0.5-0.9; p <0.01). In the follow-up clinic, survival at 18 months of chronological age was similar between groups, with rates of 95.3% and 92.1% among hypertensive and normotensive mothers, respectively. Exclusive breastfeeding at discharge was 73.4% in the group of hypertensive women and 77.3% in the group of normotensive mothers. There were no significant differences between groups. CONCLUSION: Among the analyzed outcomes, arterial hypertension during pregnancy can increase the risk of low weight, small babies for gestational age (SGA), deaths in the neonatal period and enterocolitis, with no differences in weight and survival at 18 months of chronological age. Arterial hypertension presents a high risk of prematurity in the neonatal period, with no difference at 18 months of age.
Asunto(s)
Hipertensión Inducida en el Embarazo/epidemiología , Enfermedades del Recién Nacido/epidemiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Displasia Broncopulmonar , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/fisiopatología , Femenino , Edad Gestacional , Humanos , Hipertensión Inducida en el Embarazo/fisiopatología , Lactante , Mortalidad Infantil , Recien Nacido Extremadamente Prematuro/fisiología , Recién Nacido , Enfermedades del Recién Nacido/fisiopatología , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/fisiopatología , Recién Nacido Pequeño para la Edad Gestacional/fisiología , Recién Nacido de muy Bajo Peso/fisiología , Unidades de Cuidado Intensivo Neonatal , Embarazo , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Síndrome de Dificultad Respiratoria del Recién Nacido/fisiopatología , Estudios RetrospectivosRESUMEN
There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons. KEY POINTS: · We report a severe presentation of COVID-19 in pregnancy requiring invasive ventilatory support.. · This is a case of positive RT-PCR in first day of life, suggesting possible vertical transmission.. · There were no detectable maternal antibodies for COVID-19 until after delivery..
Asunto(s)
Betacoronavirus , Cesárea/métodos , Infecciones por Coronavirus , Enfermedades del Recién Nacido , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Respiración Artificial/métodos , Insuficiencia Respiratoria , Adulto , Betacoronavirus/aislamiento & purificación , Betacoronavirus/patogenicidad , COVID-19 , Prueba de COVID-19 , Vacunas contra la COVID-19 , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/fisiopatología , Enfermedades del Recién Nacido/terapia , Enfermedades del Recién Nacido/virología , Transmisión Vertical de Enfermedad Infecciosa , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/terapia , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , SARS-CoV-2 , Índice de Severidad de la EnfermedadRESUMEN
Seizures in the newborn are associated with high morbidity and mortality, making their detection and treatment critical. Seizure activity in neonates is often clinically obscured, such that detection of seizures is particularly challenging. Amplitude-integrated EEG is a technique for simplified EEG monitoring that has found an increasing clinical application in neonatal intensive care. Its main value lies in the relative simplicity of interpretation, allowing nonspecialist members of the care team to engage in real-time detection of electrographic seizures. Nevertheless, to avoiding misdiagnosing rhythmic artifacts as seizures, it is necessary to recognize the electrophysiological ictal pattern in the conventional EEG trace available in current devices. The aim of this paper is to discuss the electrophysiological basis of the differentiation of epileptic seizures and extracranial artifacts to avoid misdiagnosis with amplitude-integrated EEG devices.
Asunto(s)
Electroencefalografía/métodos , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/fisiopatología , Convulsiones/diagnóstico , Convulsiones/fisiopatología , Errores Diagnósticos , Humanos , Recién Nacido , Cuidado Intensivo NeonatalRESUMEN
ABSTRACT Seizures in the newborn are associated with high morbidity and mortality, making their detection and treatment critical. Seizure activity in neonates is often clinically obscured, such that detection of seizures is particularly challenging. Amplitude-integrated EEG is a technique for simplified EEG monitoring that has found an increasing clinical application in neonatal intensive care. Its main value lies in the relative simplicity of interpretation, allowing nonspecialist members of the care team to engage in real-time detection of electrographic seizures. Nevertheless, to avoiding misdiagnosing rhythmic artifacts as seizures, it is necessary to recognize the electrophysiological ictal pattern in the conventional EEG trace available in current devices. The aim of this paper is to discuss the electrophysiological basis of the differentiation of epileptic seizures and extracranial artifacts to avoid misdiagnosis with amplitude-integrated EEG devices.
RESUMO Las convulsiones neonatales están asociadas a una alta morbi-mortalidad por lo que su correcto diagnóstico y tratamiento es fundamental. Las convulsiones en los recién nacidos son frecuentemente subclínicas lo que hace que su detección sea dificultosa. La electroencefalografía integrada por amplitud es una técnica de monitoreo electroencefalográfico simplificado que ha encontrado una creciente aplicación clínica en las unidades de terapia intensiva neonatales. Su principal ventaja es la relativa simplicidad de su interpretación lo que permite a personal no especializado del equipo neonatal diagnosticar convulsiones electrográficas en tiempo real. Sin embargo, para evitar diagnosticar erróneamente artefactos rítmicos como crisis epilépticas es necesario reconocer los patrones electrofisiológicos ictales en el EEG convencional disponible en los dispositivos actuales. El objetivo de este artículo es describir las bases electrofisiológicas para la diferenciación de convulsiones neonatales y artefactos extracraneanos para evitar errores diagnósticos con el uso de EEG integrado por amplitud.
Asunto(s)
Humanos , Recién Nacido , Convulsiones/diagnóstico , Convulsiones/fisiopatología , Electroencefalografía/métodos , Enfermedades del Recién Nacido/diagnóstico , Cuidado Intensivo Neonatal , Errores Diagnósticos , Enfermedades del Recién Nacido/fisiopatologíaRESUMEN
RESUMO Objetivo: Relatar um caso de pênfigo neonatal em paciente que manifestou lesões cutâneas extensas e críticas ao nascimento. Descrição do caso: Recém-nascido do sexo masculino com lesões vesicobolhosas extensas em região anterior do tórax e abdome, desde o nascimento. Admitido na ala pediátrica de um hospital para diagnóstico etiológico e tratamento. Com base na história materna e na avaliação clínica, concluiu tratar-se de pênfigo vulgar neonatal. O paciente apresentou evolução satisfatória, sem a necessidade de intervenção farmacológica. Comentários: Os casos descritos na literatura e as referências avaliadas revelam o pênfigo neonatal como uma doença de ocorrência rara, porém cujo conhecimento e diagnóstico precoce têm grande relevância clínica, considerando-se que geralmente se manifesta com lesões epidérmicas extensas e de aspecto crítico, embora apresente curso clínico transitório e benigno, sem necessidade de tratamento específico e sem relação com doença futura.
ABSTRACT Objective: To report on the case of a patient with neonatal pemphigus that had extensive and critical skin lesions at birth. Case description: A newborn male with extensive vesico-bullous lesions on the anterior side of his chest and abdomen at birth. He was admitted to the pediatric ward of a hospital for an etiological diagnosis and for treatment. Based on maternal history and a clinical evaluation, the patient was diagnosed with neonatal vulgar pemphigus. His progression was satisfactory and, in the end, he did not need pharmacological interventions. Comments: The cases reported in the literature and the references evaluated reveal that neonatal pemphigus is rare, but that knowledge about the disease allows for an early diagnosis to be made. This has great clinical relevance considering that the disease usually manifests itself in the form of extensive epidermal lesions, even though it is transient and benign, it does not require specific treatment, and it does not have any relation with possible future diseases.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Adulto , Enfermedades del Recién Nacido/diagnóstico , Remisión Espontánea , Pénfigo/diagnóstico , Pénfigo/fisiopatología , Enfermedades del Recién Nacido/fisiopatología , Anamnesis , MadresRESUMEN
OBJECTIVE: To report on the case of a patient with neonatal pemphigus that had extensive and critical skin lesions at birth. CASE DESCRIPTION: A newborn male with extensive vesico-bullous lesions on the anterior side of his chest and abdomen at birth. He was admitted to the pediatric ward of a hospital for an etiological diagnosis and for treatment. Based on maternal history and a clinical evaluation, the patient was diagnosed with neonatal vulgar pemphigus. His progression was satisfactory and, in the end, he did not need pharmacological interventions. COMMENTS: The cases reported in the literature and the references evaluated reveal that neonatal pemphigus is rare, but that knowledge about the disease allows for an early diagnosis to be made. This has great clinical relevance considering that the disease usually manifests itself in the form of extensive epidermal lesions, even though it is transient and benign, it does not require specific treatment, and it does not have any relation with possible future diseases.
OBJETIVO: Relatar um caso de pênfigo neonatal em paciente que manifestou lesões cutâneas extensas e críticas ao nascimento. DESCRIÇÃO DO CASO: Recém-nascido do sexo masculino com lesões vesicobolhosas extensas em região anterior do tórax e abdome, desde o nascimento. Admitido na ala pediátrica de um hospital para diagnóstico etiológico e tratamento. Com base na história materna e na avaliação clínica, concluiu tratar-se de pênfigo vulgar neonatal. O paciente apresentou evolução satisfatória, sem a necessidade de intervenção farmacológica. COMENTÁRIOS: Os casos descritos na literatura e as referências avaliadas revelam o pênfigo neonatal como uma doença de ocorrência rara, porém cujo conhecimento e diagnóstico precoce têm grande relevância clínica, considerando-se que geralmente se manifesta com lesões epidérmicas extensas e de aspecto crítico, embora apresente curso clínico transitório e benigno, sem necessidade de tratamento específico e sem relação com doença futura.
Asunto(s)
Enfermedades del Recién Nacido , Pénfigo , Adulto , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/fisiopatología , Masculino , Anamnesis , Madres , Pénfigo/diagnóstico , Pénfigo/fisiopatología , Remisión EspontáneaRESUMEN
OBJECTIVE: We assessed whether specific histologic placental lesions were associated with risk for neonatal encephalopathy, a strong predictor of death or cerebral palsy. STUDY DESIGN: Case-control study of singletons with gestational ages ≥35 weeks. Data were abstracted from a prospectively collected database of consecutive births at a hospital in which placental samples from specified sites are collected and stored for all inborn infants. Placentas of infants with neonatal encephalopathy were compared with randomly selected control infants (ratio of 1:3). Placental histologic slides were read by a single experienced perinatal pathologist unaware of case status, using internationally recommended definitions and terminology. Findings were grouped into inflammatory, maternal, or fetal vascular malperfusion (FVM) and other lesions. RESULTS: Placental samples were available for 73 of 87 (84%) cases and 253 of 261 (97%) controls. Delivery complications and gross placental abnormalities were more common in cases, of whom 4 died. Inflammation and maternal vascular malperfusion did not differ, and findings consistent with global FVM were more frequent in case (20%) than control (7%) placentas (P = .001). There was a trend toward more segmental FVM and high-grade FVM (fetal thrombotic vasculopathy) among cases. Some type of FVM was observed in 24% of placentas with neonatal encephalopathy. In infants with both neonatal encephalopathy and placental FVM, more often than in infants with neonatal encephalopathy without FVM, electronic fetal monitoring tracings were considered possibly or definitely abnormal (P = .028). CONCLUSIONS: Vascular malperfusion of subacute or chronic origin on the fetal side of the placenta was associated with increased risk of neonatal encephalopathy.
Asunto(s)
Encefalopatías/fisiopatología , Enfermedades del Recién Nacido/fisiopatología , Placenta/patología , Circulación Placentaria/fisiología , Peso al Nacer , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Enfermedades Placentarias/patología , Enfermedades Placentarias/fisiopatología , Embarazo , Factores Sexuales , Trombosis/patología , Trombosis/fisiopatología , Enfermedades Vasculares/patología , Enfermedades Vasculares/fisiopatologíaRESUMEN
The recent Zika outbreak and its link to microcephaly and other birth defects in infants exposed in utero have garnered widespread international attention. Based on the severity of birth defects the extent of impairment in these infants is expected to be profound; however, virtually nothing is known regarding the developmental and behavioral sequela of congenital Zika syndrome. This pilot study collected parent-reported patterns of development and sleep in 47 infants with confirmed congenital Zika syndrome who are being followed for clinical services at the Altino Ventura Foundation (FAV) in Recife, Brazil. With assistance from clinicians at FAV, caregivers completed Brazilian Portuguese versions of the Ages and Stages Questionnaire, 3rd edition (ASQ-3) and the Brief Infant Sleep Questionnaire (BISQ). All infants were between 13-22 months of age at the time of the assessment. At 16 months of age, none of the children displayed age appropriate developmental skills. Most (~ 75%) mastered some communication and gross motor skills at around a 6-8-month level. Communication and gross motor skills were relative strengths for the sample, while problem-solving and fine motor skills were relative weaknesses. Sleep was noted to be a problem for around 18% of the sample. In utero exposure to the Zika virus will have lifelong consequences for affected children and their families. Understanding the developmental and behavioral trajectories of affected infants will help identify appropriate family supports to improve quality of life.
Asunto(s)
Desarrollo Infantil/fisiología , Cognición/fisiología , Enfermedades del Recién Nacido/fisiopatología , Enfermedades del Recién Nacido/psicología , Destreza Motora/fisiología , Infección por el Virus Zika/congénito , Adolescente , Adulto , Brasil/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/epidemiología , Masculino , Microcefalia/epidemiología , Microcefalia/fisiopatología , Microcefalia/psicología , Microcefalia/virología , Proyectos Piloto , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/psicología , Estudios Retrospectivos , Adulto Joven , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/fisiopatología , Infección por el Virus Zika/psicologíaRESUMEN
BACKGROUND: Nutritional interventions targeting the critical growth and development period before two years of age can have the greatest impact on health trajectories over the life course. Compelling evidence has demonstrated that interventions investing in maternal health in the first 1000 days of life are beneficial for both mothers and their children. One such potential intervention is deworming integrated into maternal postpartum care in areas where soil-transmitted helminth (STH) infections are endemic. METHODOLOGY/PRINCIPAL FINDINGS: From February to August 2014, 1010 mother-infant pairs were recruited into a trial aimed at assessing the effectiveness of maternal postpartum deworming on infant and maternal health outcomes. Following delivery, mothers were randomly assigned to receive either single-dose 400 mg albendazole or placebo. Participants were followed-up at 1 and 6 months postpartum. There was no statistically significant difference in mean weight gain between infants in the experimental and control groups (mean difference: -0.02; 95% CI: -0.1, 0.08) at 6 months of age. Further, deworming had no effect on measured infant morbidity indicators. However, ad hoc analyses restricted to mothers who tested positive for STHs at baseline suggest that infants of mothers in the experimental group had greater mean length gain in cm (mean difference: 0.8; 95% CI: 0.1, 1.4) and length-for-age z-score (mean difference: 0.5; 95% CI: 0.2, 0.8) at 6 months of age. CONCLUSIONS/SIGNIFICANCE: In a study population composed of both STH-infected and uninfected mothers, maternal postpartum deworming was insufficient to impact infant growth and morbidity indicators up to 6 months postpartum. Among STH-infected mothers, however, important improvements in infant length gain and length-for-age were observed. The benefits of maternal postpartum deworming should be further investigated in study populations having higher overall prevalences and intensities of STH infections and, in particular, where whipworm and hookworm infections are of public health concern. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01748929).
Asunto(s)
Albendazol/administración & dosificación , Antihelmínticos/administración & dosificación , Helmintiasis/tratamiento farmacológico , Enfermedades del Recién Nacido/tratamiento farmacológico , Aumento de Peso/efectos de los fármacos , Adulto , Método Doble Ciego , Femenino , Estudios de Seguimiento , Helmintiasis/parasitología , Helmintiasis/fisiopatología , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/parasitología , Enfermedades del Recién Nacido/fisiopatología , Masculino , Madres , Perú , Periodo Posparto , Adulto JovenRESUMEN
BACKGROUND: Crying is the first neurophysiological demonstration of the newborn. The acoustic analysis of crying episodes can provide useful information in the early diagnosis of several pathologies. METHODS: We carried out a spectrographic cry analysis of 40 infants with several diseases such as neonatal asphyxia, breathing disorders, deafness and neurological disorders. Statistical t-test was used in order to compare means of fundamental frequencies (F0) of cries among pathologies, as well as contingency tables for qualitative variables and melodic form. RESULTS: No significant differences of F0 were found by applying the t-test among pathologies. Time of inspiration in breathing disorders is higher compared with other groups. Infants with deafness and neurological disorders present poor melodic forms. Qualitative analysis revealed more often glottal roll and vibrato. CONCLUSIONS: Cry analysis is clinically useful for early detection of diseases in newborns as a result of alterations in the central nervous system that are reflected in phonoarticulatory and respiratory functions for sound emission.
Asunto(s)
Llanto/fisiología , Pérdida Auditiva/fisiopatología , Enfermedades del Recién Nacido/fisiopatología , Espectrografía del Sonido , Asfixia Neonatal/fisiopatología , Disfonía/etiología , Disfonía/fisiopatología , Femenino , Pérdida Auditiva/congénito , Humanos , Recién Nacido , Masculino , Enfermedades del Sistema Nervioso/congénito , Enfermedades del Sistema Nervioso/fisiopatología , Fonación/fisiología , Respiración , Trastornos Respiratorios/congénito , Trastornos Respiratorios/fisiopatología , Riesgo , Acústica del Lenguaje , Calidad de la VozRESUMEN
OBJECTIVES: To identify potential associations between fetal surveillance tests and acidosis at birth in pregnancies with abnormal but positive end-diastolic velocity in the umbilical artery. METHODS: A prospective case-control study [group 1: pH < 7.2; group 2: pH ≥ 7.2] including 46 fetuses with abnormal but positive end-diastolic velocity in the umbilical artery was conducted between February 2007 and March 2009. Outcome variables were evaluated by univariate analysis and compared between the two groups. Clinically relevant and statistically significant variables were analyzed by logistic regression. RESULTS: Abnormal nonstress test, presence of deceleration, and absent fetal breathing movements were statistically significant. Logistic regression analysis revealed that fetal heart rate (FHR) deceleration in the nonstress test is the only predictor of fetal acidosis at birth (p = 0.024; OR = 8.2; 95%CI: 1.2-52). CONCLUSIONS: In fetuses with positive end-diastolic flow velocity, acute variables of the antenatal surveillance tests are correlated with acidosis at birth and FHR deceleration in the nonstress test is the only predictor of fetal acidosis.
Asunto(s)
Acidosis/diagnóstico , Velocidad del Flujo Sanguíneo/fisiología , Enfermedades Fetales/diagnóstico , Tamizaje Neonatal/métodos , Parto , Flujo Pulsátil/fisiología , Arterias Umbilicales/fisiopatología , Acidosis/diagnóstico por imagen , Acidosis/fisiopatología , Adolescente , Adulto , Estudios de Casos y Controles , Diástole , Femenino , Enfermedades Fetales/diagnóstico por imagen , Enfermedades Fetales/fisiopatología , Indicadores de Salud , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/fisiopatología , Masculino , Persona de Mediana Edad , Parto/sangre , Parto/metabolismo , Parto/fisiología , Embarazo , Pronóstico , Ultrasonografía , Arterias Umbilicales/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVE: To test the hypothesis that heart rate characteristics (HRC) monitoring improves neonatal outcomes. STUDY DESIGN: We conducted a two-group, parallel, individually randomized controlled clinical trial of 3003 very low birth weight infants in 9 neonatal intensive care units. In one group, HRC monitoring was displayed; in the other, it was masked. The primary outcome was number of days alive and ventilator-free in the 120 days after randomization. Secondary outcomes were mortality, number of ventilator days, neonatal intensive care unit stay, and antibiotic use. RESULTS: The mortality rate was reduced in infants whose HRC monitoring was displayed, from 10.2% to 8.1% (hazard ratio, 0.78; 95% CI, 0.61-0.99; P = .04; number needed to monitor = 48), and there was a trend toward increased days alive and ventilator-free (95.9 of 120 days compared with 93.6 in control subjects, P = .08). The mortality benefit was concentrated in infants with a birth weight <1000 g (hazard ratio, 0.74; 95% CI, 0.57-0.95; P = .02; number needed to monitor = 23). There were no significant differences in the other outcomes. CONCLUSION: HRC monitoring can reduce the mortality rate in very low birth weight infants.
Asunto(s)
Frecuencia Cardíaca , Enfermedades del Recién Nacido/mortalidad , Enfermedades del Recién Nacido/fisiopatología , Recién Nacido de muy Bajo Peso , Monitoreo Fisiológico , Femenino , Humanos , Recién Nacido , MasculinoRESUMEN
OBJECTIVE: To describe the interaction of spontaneous breaths, manual ventilation, and tidal volumes (V(T)) during stabilization of infants with congenital diaphragmatic hernia (CDH) in the delivery room. STUDY DESIGN: We studied infants with CDH receiving respiratory support at birth. Airway pressure, flow, and volume were measured, and each breath or inflation was analyzed. Each V(T) was classified as a manual inflation, a spontaneous breath, or a spontaneous breath coinciding with manual inflation on the basis of the timing of the pressure and flow waves. RESULTS: Twelve infants had 2957 breaths suitable for analysis, with spontaneous breathing in 11 infants (92%). The mean (+/-SD) proportion of manual inflations was 41% (+/-24%), spontaneous breaths 43% (+/-25%), spontaneous but coinciding with manual inflation 16% (+/-12%). V(T) was significantly different for spontaneous breaths (3.8 +/- 1.9 mL/kg), spontaneous breaths coinciding with manual inflation (4.7 +/- 2.5 mL/kg), and manual inflations alone (2.6 +/- 1.6 mL/kg). CONCLUSIONS: Most infants with CDH breathed spontaneously, and manual ventilation was mostly asynchronous. We observed large differences in tidal volumes between spontaneous breaths, manual inflations, or where these coincided, with manual inflations having the lowest V(T). Monitoring the respiratory pattern of these infants could improve respiratory support.
Asunto(s)
Hernia Diafragmática/terapia , Hernias Diafragmáticas Congénitas , Enfermedades del Recién Nacido/terapia , Ventilación Pulmonar , Respiración Artificial , Respiración , Hernia Diafragmática/fisiopatología , Humanos , Recién Nacido , Enfermedades del Recién Nacido/fisiopatología , Cuidado Intensivo Neonatal , Mecánica Respiratoria , Volumen de Ventilación PulmonarRESUMEN
Neonatal lupus erythematosus is an uncommon transplacentally acquired autoimmune disorder. The most common clinical manifestations are skin rash, congenital atrioventricular block, thrombocytopenia, leukopenia, anemia, and hepatosplenomegaly. Usually, the skin rash resembles subacute cutaneous lupus, but different forms of rash have been reported in neonatal lupus erythematosus and some are rare forms. NLE should be suspected in babies with atypical skin lesions, even if present at birth.