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1.
Medicine (Baltimore) ; 99(9): e19216, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118723

RESUMEN

To explore the clinical effects of less invasive surfactant administration (LISA) via a gastric tube on the treatment of respiratory distress syndrome (RDS) in premature infants aged 32 to 36 weeks.A total of 97 premature infants with RDS admitted to the Children's Hospital of Shanxi from February 2017 to January 2018 were randomly divided into LISA (47 cases) and (intubation-surfactant-extubation,) INSURE groups (50 cases). In the LISA group, 6F gastric tubes were inserted into the trachea through direct laryngoscopy under nasal continuous positive airway pressure (NCPAP), and pulmonary surfactant (PS) was injected. In the INSURE group, PS was injected via tracheal intubation and NCPAP was performed after extubation. The incidence of technical-related adverse events and various complications in the two groups were observed.PS was successfully injected through gastric tube in the LISA group. There were no significant differences in reflux, asphyxia, bradycardia (<100 beats/min), apnea, FiO2, changes in PaO2 and PaCO2 at 1 hour post-treatment between the groups. During the course of administration, blood pressure and SpO2 in the LISA group were more stable, and significant differences between the 2 groups were observed. However, no significant differences in the complications and outcomes between the 2 groups occurred.The LISA technique can be used to treat premature infants with RDS aged 32 to 36 weeks with stronger spontaneous breathing ability. Further clinical studies are required to determine the optimal strategy of LISA administration and the most profitable patient population.


Asunto(s)
Recien Nacido Prematuro , Intubación Intratraqueal/instrumentación , Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/tratamiento farmacológico , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Surfactantes Pulmonares/administración & dosificación , Resultado del Tratamiento
2.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(3): 231-237, 2020 Mar.
Artículo en Chino | MEDLINE | ID: mdl-32204759

RESUMEN

OBJECTIVE: To identify risk factors for minimally invasive surfactant administration (MISA) failure in the treatment of preterm infants with respiratory distress syndrome (RDS) and the influence of MISA failure on neonatal outcome. METHODS: A retrospective analysis was performed for the clinical data of 148 preterm infants with a gestational age of ≤32 weeks and a clinical diagnosis of RDS, who were admitted to the neonatal intensive care unit of eight tertiary hospitals in Beijing, Tianjin and Hebei Province from July 1, 2017 to December 31, 2018 and were treated with MISA (bovine pulmonary surfactant, PS). According to whether MISA failure (defined as the need for mechanical ventilation within 72 hours after MISA) was observed, the infants were divided into two groups: MISA failure group (n=16) and MISA success (n=132). A logistic regression analysis was used to investigate the risk factors for MISA failure and its influence on neonatal outcome. RESULTS: The MISA failure rate was 10.8% (16/148). The logistic regression analysis showed that a high incidence rate of grade >II RDS before PS administration, low mean arterial pressure and high pulse pressure before administration, a low dose of initial PS administration, and long injection time and operation time were the risk factors for MISA failure (OR=5.983, 1.210, 1.183, 1.055, 1.036, and 1.058 respectively, P<0.05). After the control for the above risk factors, the logistic regression analysis showed that the MISA failure group had a significantly higher incidence rate of bronchopulmonary dysplasia (BPD) (OR=8.537, P<0.05). CONCLUSIONS: A high grade of RDS, a low mean arterial pressure, and a high pulse pressure before administration are independent risk factors for MISA failure, and a low dose of initial PS administration, a long injection time, and a long operation time may increase the risk of MISA failure. MISA failure may increase the incidence rate of BPD in preterm infants.


Asunto(s)
Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/tratamiento farmacológico , Animales , Displasia Broncopulmonar , Bovinos , Humanos , Recién Nacido , Recien Nacido Prematuro , Respiración Artificial , Estudios Retrospectivos , Factores de Riesgo , Tensoactivos
3.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(3): 245-250, 2020 Mar.
Artículo en Chino | MEDLINE | ID: mdl-32204761

RESUMEN

OBJECTIVE: To systematically review the effect of sustained lung inflation (SLI) in preterm infants with a gestational age of <34 weeks. METHODS: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Biology Medicine disc, Chinese Journal Full-text Database, and Weipu Database were searched for randomized controlled trials (RCTs) on the application of SLI versus noninvasive positive pressure ventilation alone in preterm infants. Revman 5.3 was used to perform a Meta analysis for the RCTs which met the inclusion criteria. RESULTS: A total of 9 RCTs were included, with 1 432 preterm infants in total (with a gestational age of 23-33.7 weeks). The Meta analysis showed that compared with the control group, the SLI group had a significantly lower proportion of the infants who needed mechanical ventilation within 72 hours (51.9% vs 56.9%, RR=0.91, P=0.04, 95%CI: 0.83-0.99). There were no significant differences between the two groups in the mortality rate, rate of use of pulmonary surfactant, and incidence rates of related complications (bronchopulmonary dysplasia, pneumothorax, and grade III-IV intracranial hemorrhage) (P>0.05). CONCLUSIONS: SLI can reduce the use of mechanical ventilation in preterm infants with a gestational age of <34 weeks and does not increase the risk of other complications.


Asunto(s)
Recien Nacido Prematuro , China , Edad Gestacional , Humanos , Recién Nacido , Surfactantes Pulmonares , Síndrome de Dificultad Respiratoria del Recién Nacido
4.
Medicine (Baltimore) ; 99(9): e19356, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118777

RESUMEN

BACKGROUND: Patent ductus arteriosus (PDA) is a particularly common problem in preterm infants. Although surgical ligation is rarely performed in many contemporary neonatal intensive care units, it remains a necessary treatment option for preterm infants with a large hemodynamically significant PDA under strict clinical criteria, and it can reduce mortality in preterm infants. However, the optimal timing of surgical ligation is still controversial. We conducted this systematic review and meta-analysis to compare the mortality and morbidity of early and late surgical ligation of PDA in preterm or very-low-birth-weight (VLBW) infants. METHODS: This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019133686). We searched the databases of PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform up to May 2019. RESULTS: This review included 6 retrospective studies involving 397 premature or VLBW infants with PDA. Pooled analysis showed that compared with the late ligation group, the early ligation group had a lower fraction of inspired oxygen (FiO2) at 24 hours postoperatively (mean difference [MD] -6.34, 95% confidence interval [CI] -9.45 to -3.22), fewer intubation days (MD -19.69, 95% CI -29.31 to -10.07), earlier date of full oral feeding (MD -22.98, 95% CI -28.63 to -17.34) and heavier body weight at 36 weeks of conceptional age (MD 232.08, 95% CI 57.28 to 406.88). No significant difference in mortality or other complications was found between the early and late groups. CONCLUSION: Our meta-analysis implies that compared with late surgical ligation, early ligation might have a better respiratory outcome and nutritional status for PDA in preterm or VLBW infants. There was no difference in mortality or postoperative complications between early and late ligation. A randomized prospective clinical trial with a possible large sample size is urgently needed to reinvestigate this conclusion. PROSPERO REGISTRATION NUMBER: CRD42019133686.


Asunto(s)
Conducto Arterioso Permeable/cirugía , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Ligadura/clasificación , Factores de Tiempo , Conducto Arterioso Permeable/complicaciones , Femenino , Humanos , Lactante , Recién Nacido , Ligadura/métodos , Ligadura/estadística & datos numéricos , Masculino
5.
Am J Occup Ther ; 74(1): 7401205080p1-7401205080p9, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32078519

RESUMEN

IMPORTANCE: When a neonate's sucking, swallowing, and breathing are disorganized, oropharyngeal aspiration often occurs and results in illness, developmental problems, and even death. Occupational therapists who work in the neonatal intensive care unit (NICU) need to identify neonates who are at risk for aspirating so they can provide appropriate treatment. OBJECTIVE: To ascertain whether client factors and performance skills of infants ages 0-6 mo during occupational therapy feeding evaluations are related to results of videofluoroscopic swallowing studies (VFSSs). DESIGN: Retrospective chart reviews. SETTING: 187-bed NICU in a nonprofit teaching hospital. PARTICIPANTS: A purposive sample of 334 infants ages 0-6 mo, ≥33 wk gestational age at birth, admitted to a Level II, III, or IV NICU as defined by the American Academy of Pediatrics. OUTCOMES AND MEASURES: Neonates were administered a feeding evaluation by an occupational therapist and a VFSS by a speech-language pathologist, which yielded information about client factors and performance skills. RESULTS: Signs and symptoms of aspiration on the evaluations were significantly associated with VFSS results. Of 310 patients, 79 had silent aspiration. Of 55 infants who demonstrated no aspiration symptoms during the feeding evaluation, 45% demonstrated aspiration symptoms on the VFSS, and 55% aspirated on the VFSS but demonstrated no symptoms of aspiration. CONCLUSIONS AND RELEVANCE: Aspiration among infants occurs inconsistently and depends on client factors, contexts, and environments. Occupational therapists are encouraged to assess an infant's feeding over several sessions to obtain a more accurate picture of the infant's feeding status. WHAT THIS ARTICLE ADDS: This study provides information that helps occupational therapists identify infants at risk for aspiration and make optimal recommendations regarding safe feeding practices and appropriate referrals for a VFSS. Making appropriate referrals for VFSS is also important in preventing unnecessary exposure to radiation for preterm infants.


Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Terapia Ocupacional , Preescolar , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro/psicología , Estudios Retrospectivos
7.
Rev Med Liege ; 75(2): 105-110, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32030935

RESUMEN

Late preterm infants are born between 34 weeks of amenorrhea and 36 weeks 6 days. Late preterms represent the largest proportion of premature infants (about 75 %). Late prematurity is increasing in recent decades. While studies initially focused on mortality and morbidity related to very preterm birth, the late preterms have been the subject of increased attention over the past 15 years. Late preterm infants have an increased risk of respiratory complications, infections, feeding problems, hypothermia and hypoglycemia. Neonatal, infant and during adulthood mortalities are significantly higher in late preterm than in term infants. In addition, late preterm infants carry an increased risk of long-term morbidities, such as neurodevelopmental delay, cerebral palsy, chronic respiratory or metabolic diseases. This review highlights the evidence that late preterm infants are high risk newborns and require adapted follow-up.


Asunto(s)
Enfermedades del Prematuro , Recien Nacido Prematuro , Nacimiento Prematuro , Adulto , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Morbilidad , Embarazo
8.
Medicine (Baltimore) ; 99(8): e19084, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080082

RESUMEN

BACKGROUND: Sustained Inflations (SI) and Intermittent Positive Pressure Ventilation (IPPV) are two interventions to prevent Bronchopulmonary dysplasia (BPD). The aim of this study is to assess the effect of these two interventions. METHODS: The databases of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) will be comprehensively searched from inception to September 2019. All RCTs and quasi-RCTs which compare the efficacy of SI vs IPPV among preterm infants are eligible. We will assess the methodological quality using the Cochrane Handbook version 5.1.0. A meta-analysis will be performed using RevMan 5.3 software and the results will be presented using risk ratios (RRs) and 95% confidence intervals (CIs). CONCLUSIONS: This study will provide strong evidence for assessing the effect of SI and IPPV on BPD or death among preterm infants. PROSPERO REGISTRATION NUMBER: CRD42019135816.


Asunto(s)
Displasia Broncopulmonar/prevención & control , Insuflación/efectos adversos , Ventilación con Presión Positiva Intermitente/efectos adversos , Lesión Pulmonar Inducida por Ventilación Mecánica/prevención & control , Peso al Nacer , Displasia Broncopulmonar/mortalidad , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Insuflación/instrumentación , Ventilación con Presión Positiva Intermitente/instrumentación , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Lesión Pulmonar Inducida por Ventilación Mecánica/mortalidad
11.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(2): 130-135, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-32051079

RESUMEN

OBJECTIVE: To study the efficacy and safety of caffeine used in the early (≤72 hours after birth) and late (>72 hours after birth) stage in preterm infants with a gestational age of ≤31 weeks. METHODS: A retrospective analysis was performed for 640 preterm infants (with a gestational age of ≤31 weeks) who were admitted to the neonatal intensive care unit of eight hospitals in Jiangsu Province, China. Of the 640 preterm infants, 510 were given caffeine in the early stage (≤72 hours after birth; early use group) and 130 were given caffeine in the late stage (>72 hours after birth; late use group). The clinical data were compared between the two groups. RESULTS: There were no significant differences in birth weight, Apgar score, sex, gestational age, and age on admission between the two groups (P>0.05). Compared with the late use group, the early use group had a significantly younger age at the beginning and withdrawal of caffeine treatment (P<0.05) and a significantly shorter duration of caffeine treatment (P<0.05). There was no significant difference in respiratory support on admission between the two groups (P>0.05). Compared with the late use group, the early use group had significantly lower incidence rate of apnea (P<0.05) and significantly shorter oxygen supply time and length of hospital stay (P<0.05). There were no significant differences between the two groups in the incidence rates of neonatal intracranial hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity, and patent ductus arteriosus at discharge and NBNA score at the corrected gestational age of 40 weeks (P>0.05). However, significant differences were found in the incidence of bronchopulmonary dysplasia and the rate of home oxygen therapy, but there was no significant difference in the mortality rate between the two groups (P>0.05). CONCLUSIONS: Early use of caffeine can shorten the duration of caffeine treatment, oxygen supply time, and length of hospital stay, with little adverse effect, in preterm infants with a gestational age of ≤31 weeks.


Asunto(s)
Recien Nacido Prematuro , Displasia Broncopulmonar , Cafeína , China , Edad Gestacional , Humanos , Lactante , Recién Nacido , Estudios Retrospectivos
12.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(2): 136-140, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-32051080

RESUMEN

OBJECTIVE: To study the effect of low-dose dopamine adjuvant therapy on inflammatory factors and prognosis in preterm infants with necrotizing enterocolitis (NEC). METHODS: A total of 100 preterm infants with NEC from June 2017 to June 2019 were enrolled and divided into a dopamine treatment group and a conventional treatment group using a random number table, with 50 infants in each group. The infants in the conventional treatment group were given symptomatic treatment, and those in the dopamine treatment group were given low-dose dopamine adjuvant therapy in addition to the conventional treatment. ELISA was used to measure the levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-8 (IL-8). The two groups were compared in terms of time to relief of clinical symptoms, fasting time, treatment outcome, prognosis, and adverse reactions. RESULTS: Both groups had significant reductions in the levels of CRP, TNF-α, and IL-8 after treatment, and the dopamine treatment group had significantly lower levels of these markers than the conventional treatment group after treatment (P<0.05). Compared with the conventional treatment group, the dopamine treatment group had significantly shorter time to defecation improvement, time to relief of abdominal distension and diarrhea, and fasting time (P<0.05), a significantly higher response rate (P<0.05), and a significantly lower surgery rate (P<0.05). There were no significant differences in the mortality rate and incidence of adverse events between the two groups (P>0.05). CONCLUSIONS: Low-dose dopamine adjuvant therapy can effectively improve the levels of inflammatory factors and clinical symptoms in preterm infants with NEC and has good safety, and therefore, it holds promise for clinical application.


Asunto(s)
Enterocolitis Necrotizante , Enfermedades del Recién Nacido , Dopamina , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Pronóstico
13.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(2): 141-145, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-32051081

RESUMEN

OBJECTIVE: To study the association of single nucleotide polymorphisms (SNPs) of interleukin-23 receptor (IL-23R) rs10889677, interleukin-17A (IL-17A) rs227591, and interleukin-17F (IL-17F) rs763780 with necrotizing enterocolitis (NEC) in Chinese Han preterm infants. METHODS: A total of 100 Chinese Han preterm infants with NEC who were admitted to the neonatal intensive care unit from January 2017 to January 2019 were prospectively enrolled. Of the 100 preterm infants, 63 had stage II NEC and 37 had stage III NEC. A total of 100 preterm infants, matched for age and sex, were selected as the control group. PCR and Sanger sequencing were used to determine the SNPs of rs10889677, rs2275913, and rs763780. An unconditional logistic regression analysis was used to investigate the association of SNPs with NEC susceptibility and severity. RESULTS: The genotype and allele frequencies of rs10889677 and rs2275913 had no influence on the development of NEC (P>0.05). The genotype of rs763780 had no influence on the development of NEC (P>0.05), but the risk of NEC in the infants carrying C allele was 1.652 times that in those carrying T allele (95%CI: 1.052-2.695, P<0.05). The risk of NEC in the infants carrying TC+CC genotype was 1.856 times that in those carrying TT genotype (95%CI: 1.045-3.201, P<0.05). The risk of stage III NEC in the infants carrying TC+CC genotype was 2.965 times that in those carrying TT genotype (95%CI: 1.052-6.330, P<0.05). The risk of stage III NEC in the infants carrying C allele was 2.363 times that in those carrying T allele (95%CI: 1.034-4.093, P<0.05). CONCLUSIONS: The SNPs of IL-23R rs10889677 and IL-17A rs2275913 are not associated with the susceptibility to NEC in Chinese Han preterm infants, while TC+CC genotype and C allele of IL-17F rs763780 are associated with the susceptibility to NEC and the severity of NEC.


Asunto(s)
Enterocolitis Necrotizante , Interleucina-17/genética , Polimorfismo de Nucleótido Simple , Receptores de Interleucina/genética , Grupo de Ascendencia Continental Asiática , Estudios de Casos y Controles , Enterocolitis Necrotizante/genética , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Recién Nacido , Recien Nacido Prematuro
14.
Orv Hetil ; 161(5): 183-192, 2020 Feb.
Artículo en Húngaro | MEDLINE | ID: mdl-31984771

RESUMEN

Introduction: Over the last few years, in the development of neonatology, the limits to which it is possible to sustain the lives of premature babies have been extended, and thus the proportion of survivors with chronic morbidities has increased. Retinopathy of prematurity (ROP), intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD), all of which deeply influence the quality of life, life expectancy and social integration, are the most significant morbidities among premature newborns. Aim: Description of psychomotor development of low birth weight (<2500 g) premature infants at the age of 2 years, in relation to the most common chronic morbidities. Method: Psychomotor development (Brunet-Lézine scale, 1980) of low-birth-weight preterm infants at the age of 2 years (n = 200) was measured and the neonatal final reports were analysed retrospectively. Results: After age correction, birth weight positively correlated with the developmental quotient (DQ), while the length of stay in hospital correlated negatively. Grades I/II of neonatal IVH were not significant predictors of lower DQ, while the opposite was true for grades III/IV. We identified a similar relationship with the stages of ROP. According to the result of the homogeneity test, we can consider the independent effects of significant diseases. We also observed that the more diagnoses the premature baby received, the more they are at risk of later developmental delay at the age of 2 years. Conclusions: We recommend the early childhood interventions of the most vulnerable children of ≤1500 g birth weight with severe ROP and IVH - to reduce deficiencies in capabilities and prevent future mental and motor difficulties. Orv Hetil. 2020; 161(5): 183-192.


Asunto(s)
Displasia Broncopulmonar , Hemorragia Cerebral Intraventricular , Desarrollo Infantil/fisiología , Recien Nacido Prematuro , Desempeño Psicomotor/fisiología , Calidad de Vida/psicología , Retinopatía de la Prematuridad , Preescolar , Femenino , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Masculino , Morbilidad , Destreza Motora/fisiología , Embarazo , Estudios Retrospectivos
15.
Hu Li Za Zhi ; 67(1): 106-112, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-31960402

RESUMEN

Preterm infants face increased rates of mortality and developmental complications, which are a burden on children's parents (and caregivers), who suffer from exhaustion and situational uncertainty. This case focused on an extremely-low-birth-weight (908 gm) premature infant with initial unstable vital signs complicated by a grade 4 intraventricular hemorrhage (IVH) that led to partial brain atrophy and enlarged brain ventricles. A poor neurological outcome was expected due to the high risk of cerebral palsy and impaired cognitive abilities. Long-term healthcare for this critical infant was causing tremendous physical, emotional, and financial strains on the family. The parents suffered from worries over the poor prognosis, resulting in stress, sleep disorders, and relationship difficulties with the healthcare professionals. Considering the poor prognosis of the infant, the parents faced a medical dilemma between choosing aggressive treatment and withdrawal of treatment, which led to stress and sleep disorders. Differences between the parents and health professionals regarding disease severity perception and treatment opinions further strained their mutual relationship. To ameliorate this issue, the author implemented family-centered care (the FOCUS family intervention) to help the patient and his family. This intervention is designed to increase family involvement, foster an optimistic attitude and effective stress coping techniques, and reduce uncertainty and negative emotions. For the patient, we provided symptom-relief management to improve abnormal muscle tone and development delay. Our intervention ameliorated the negative emotions, insomnia symptoms, and imbalanced family relationships and improved the life quality of the caregivers. Furthermore, the intervention enhanced the patient's autoregulatory ability, and both physical and neurological development. This case study is expected to provide experience in critical care for premature infants with a poor prognosis and their family using a FOCUS family intervention as well as to improve the quality of healthcare delivery in intensive clinical settings.


Asunto(s)
Hemorragia Cerebral/terapia , Familia/psicología , Enfermedades del Prematuro/terapia , Relaciones Profesional-Familia , Hemorragia Cerebral/patología , Humanos , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/patología
17.
Niger J Clin Pract ; 23(1): 71-78, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31929210

RESUMEN

Background: Neonatal hyperglycemia (NNH) like hypoglycemia is a dangerous metabolic disorder often associated with adverse consequences, if undetected and untreated. This study was set out to determine the prevalence, risk factors, and outcomes of babies with the point of admission hyperglycaemia at the Wesley Guild Hospital (WGH), Ilesa. Methods: The study was descriptive and cross-sectional, involving 300 consecutively recruited neonates admitted into the special care baby unit (SCBU) of the hospital. All subjects had blood glucose done at the point of admission using Accu-Chek Active® glucometer (Roche Diagnostics GmbH, Germany). Hyperglycemia was defined as blood glucose ≥7.0 mmol/L. Factors associated with NNH were determined using univariate and multivariate analyses. Results: Of the 300 subjects (Male: Female 1.5:1), there were 74 (24.7%) preterms, 35 (11.7%) small-for-gestational age and 85 (28.3%) low-birth-weight babies. Eighteen (6.0%) babies had hyperglycemia. Parental low socioeconomic class, maternal lack of antenatal care (ANC), vaginal delivery, grand multiparity, outborn status, respiratory distress, probable sepsis, and neonatal anemia at presentation were associated with NNH (P < 0.05). Respiratory distress (OR = 3.800, 95% CI = 1.122-12.873, P = 0.032), and probable sepsis (OR = 4.090, 95% CI = 1.206-13.872, P = 0.024) were independent predictors of hyperglycemia. Hyperglycemia was significantly associated with mortality. (38.9% vs. 11.0%; P = 0.001). Conclusion: Neonatal hyperglycemia was detected in 6.0% of neonatal admission at the WGH, Ilesa and it was associated with increased mortality. Hyperglycemia should be suspected and promptly managed at the point of admission of ill newborns particularly those with respiratory distress and signs of sepsis.


Asunto(s)
Hospitalización/estadística & datos numéricos , Hiperglucemia/epidemiología , Recien Nacido Prematuro , Recién Nacido Pequeño para la Edad Gestacional , Sepsis Neonatal/etiología , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Estudios Transversales , Femenino , Humanos , Hiperglucemia/diagnóstico , Hiperglucemia/mortalidad , Recién Nacido de Bajo Peso , Recién Nacido , Masculino , Sepsis Neonatal/epidemiología , Sepsis Neonatal/mortalidad , Nigeria/epidemiología , Embarazo , Prevalencia , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Factores de Riesgo
18.
Ann Hematol ; 99(2): 355-356, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31897677
19.
CMAJ ; 192(4): E81-E91, 2020 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-31988152

RESUMEN

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.


Asunto(s)
Cuidado Intensivo Neonatal/métodos , Cuidado Intensivo Neonatal/normas , Mejoramiento de la Calidad , Canadá , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Evaluación de Programas y Proyectos de Salud , Indicadores de Calidad de la Atención de Salud , Estudios Retrospectivos , Análisis de Supervivencia
20.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(1): 1-6, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31948515

RESUMEN

Preterm infants are at higher risk of developing early-onset sepsis (EOS). Due to non-specific clinical manifestations and lack of laboratory tests for prompt diagnosis of EOS, inappropriate use of antibiotics is common in preterm infants. Prolonged exposure to antibiotics can lead to antibiotic resistance and significantly increases the risk of mortality and morbidity. Based on the latest progress in the diagnosis and treatment for EOS, both in China and overseas, and considering the current condition in Hunan Province, the expert panel of neonatologists in Hunan have reached this consensus after many discussions. This consensus clarifies the risk factors, proposes the diagnostic criteria, and recommends the antibiotic use strategies for EOS in preterm infants. It is emphasized that blood culture results and clinical manifestations are the main basis for the diagnosis of EOS and the duration of antibiotics use in preterm infants.


Asunto(s)
Recien Nacido Prematuro , Sepsis , Edad de Inicio , Antibacterianos , China , Consenso , Humanos , Recién Nacido , Factores de Riesgo , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico
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