RÉSUMÉ
Orotracheal intubation and mechanical ventilation (MV) have become routine practices in intensive care units. Unplanned extubation (UE) is one of the most important complications, particularly in premature infants and critically ill newborns. The objective of this study was to determine the prevalence of UE in a tertiary care neonatal intensive care unit (NICU). In this analytical cross-sectional retrospective study, all data, including perinatal data, indications for ventilatory support, days of MV at the time of UE, work shift, month of the event, reintubation, and postextubation complications, were obtained from the manual review of clinical charts. In total, 151 neonates, who received invasive MV, were included in this study. The prevalence of UE was 2.0/100 days of ventilation. The most affected were premature infants, with a gestational age of ≤ 32 weeks (54.7%) and a birth weight of ≤ 1500 g. The main cause for UE was deficient fixation of the endotracheal tube (ETT) (27.7%). Most UE events occurred during night shifts (48.1%). Reintubation was required in 83.3% of newborns. Immediate complications developed in 96.3% of the UE events, including desaturation (57.7%) and bradycardia (36.5%). The prevalence of UE was high, particularly in premature infants, with a high rate of reintubation and immediate complications. Standardized protocols for ETT care must be implemented to reduce these events.
Sujet(s)
Extubation , Prématuré , Unités de soins intensifs néonatals , Intubation trachéale , Ventilation artificielle , Humains , Nouveau-né , Études transversales , Études rétrospectives , Extubation/effets indésirables , Extubation/statistiques et données numériques , Prévalence , Femelle , Intubation trachéale/statistiques et données numériques , Mâle , Ventilation artificielle/statistiques et données numériques , Âge gestationnel , Centres de soins tertiaires , Soins de santé tertiairesRÉSUMÉ
One of the measures for monitoring microbial resistance is the calculation of the defined daily dose of antimicrobial agents. For this calculation, the weight of an adult of 70 kg is used as a standard, so that application in neonatology is not possible. The aim of this study is to describe the use profile and calculate the defined daily dose (DDD) of antimicrobials in a neonatal intensive care unit (NICU) of a public hospital in the interior of Bahia, Brazil. From March 2020 to December 2021, the medical records of 712 newborns admitted to a NICU between September 2018 and June 2020 were analyzed. A total of 410 newborns diagnosed with neonatal sepsis were included. The most used antimicrobials per patient were gentamicin (408/410; 99.5%), ampicillin (407; 99.3%), amikacin (29; 7.1%) and oxacillin (21; 5.1%), with a mean (SD) treatment duration of 9.8 (3.9) days. The most commonly used combination of antimicrobials was ampicillin with gentamicin, which was used in 406 patients (99.0%). The values for neonatal DDDs were on average 26 times lower than those for adult DDDs. The neonatal DDDs were similar to those observed in other studies. Ampicilin and cefepime were the antimicrobials for which the greatest differences were observed in neonatal DDDs compared with adult DDDs, which differed mainly between maintenance doses, reflecting the lack of international standards in neonatology. Standardization of DDDs as a surveillance measure has the potential to clarify the pattern of antimicrobial use in neonatal patients worldwide and, in particular, to prevent indiscriminate use and bacterial resistance.
Sujet(s)
Antibactériens , Unités de soins intensifs néonatals , Néonatologie , Humains , Nouveau-né , Néonatologie/méthodes , Antibactériens/administration et posologie , Antibactériens/usage thérapeutique , Femelle , Mâle , Brésil , Gentamicine/administration et posologie , Gentamicine/usage thérapeutique , Sepsis néonatal/traitement médicamenteux , Sepsis néonatal/microbiologie , Ampicilline/administration et posologie , Anti-infectieux/administration et posologie , Anti-infectieux/usage thérapeutique , Amikacine/administration et posologie , Amikacine/usage thérapeutique , Études rétrospectivesRÉSUMÉ
BACKGROUND: Hypoxic-ischemic encephalopathy (HIE) affects 1.5 newborns per 1 thousand term live births. Therapeutic hypothermia (TH) does not prevent all adverse outcomes. The experience with TH is still limited in Latin America. In Rio de Janeiro, Hospital Universitário Pedro Ernesto treats neonates with HIE since 2017 using the servo-controlled system. OBJECTIVE: To describe the frequency of epilepsy, altered neurological exam, and neurodevelopmental delay at 12 months of age in patients treated with TH in a reference hospital in Rio de Janeiro and to evaluate the possible risk associations with clinical data and data from complementary exams. METHODS: We evaluated medical records from the Neonatal Intensive Care Unit hospitalization and from first evaluation recorded at 12 months of age in the High-Risk Neonate Follow-up Outpatient Sevice. RESULTS: A total of 30 subjects were included in the study. We found epilepsy in 18.2% of the patients, altered neurological exam in 40.9%, and neurodevelopmental delay in 36.4%. We also found a significant relationship between altered magnetic resonance imaging scan and subsequent altered neurological exam. Our findings are in line with those of the international literature, which shows that adverse outcomes are still observed, even when TH is applied. Brazilian data shows our limited access to complementary exams. The rate of loss to follow-up was of 26.6%, probably due to the coronavirus disease 2019 (COVID-19) pandemic and to unfavorable socioeconomic conditions. More time for prospective follow-up and protocol adjustments should contribute to improve our data. CONCLUSION: High incidences of epilepsy, altered neurological exams, and neurodevelopmental delay were found, despite the use of TH. A more efficient use of resources is needed, as well as measures such as early intervention.
ANTECEDENTES: A encefalopatia hipóxico-isquêmica (EHI) afeta 1,5 a cada mil nascidos vivos a termo. A hipotermia terapêutica (HT) não previne todos os desfechos negativos. A experiência com HT ainda é limitada na América Latina. No Rio de Janeiro, o Hospital Universitário Pedro Ernesto trata neonatos com EHI desde 2017 usando o sistema servo-controlado. OBJETIVO: Relatar a frequência de epilepsia, de alteração em exame neurológico e de atraso no desenvolvimento neuropsicomotor aos 12 meses de idade nos pacientes submetidos a HT em um hospital de referência no estado do Rio de Janeiro e avaliar as associações de risco com dados clínicos e de exames complementares. MéTODOS: Foi feita análise de dados do prontuário médico da internação na UTI Neonatal e da primeira avaliação registrada a partir de 12 meses completos de idade no Ambulatório de Seguimento de Recém-Nascido de Alto Risco. RESULTADOS: Ao todo, 30 pacientes foram incluídos. As frequências de epilepsia, de alteração em exame neurológico e de atraso no desenvolvimento neuropsicomotor aos 12 meses de idade foram, respectivamente, de 18,2%, 40,9% e 36,4%. Observamos relação significativa entre alteração na ressonância magnética e posterior alteração no exame neurológico. Nossos achados corroboram a literatura internacional, em que desfechos desfavoráveis ocorrem mesmo aplicando-se HT. Dados brasileiros mostram a limitação da disponibilidade dos exames complementares. Houve perda de seguimento de 26,6%, provavelmente pela pandemia da doença do coronavírus 2019 (coronavirus disease 2019, COVID-19, em inglês) e condições socioeconômicas desfavoráveis. Mais tempo de seguimento e ajustes no protocolo devem contribuir para melhorar nossos dados. CONCLUSãO: Foram encontradas elevadas incidências de epilepsia, de exame neurológico alterado e de atraso no neurodesenvolvimento, apesar da HT. Faz-se necessário uso mais eficiente dos recursos disponíveis, bem como de medidas como intervenção precoce.
Sujet(s)
Épilepsie , Hypothermie provoquée , Hypoxie-ischémie du cerveau , Troubles du développement neurologique , Humains , Nouveau-né , Hypoxie-ischémie du cerveau/thérapie , Mâle , Femelle , Brésil/épidémiologie , Troubles du développement neurologique/étiologie , Troubles du développement neurologique/épidémiologie , Épilepsie/thérapie , Pays en voie de développement , Nourrisson , Résultat thérapeutique , Incapacités de développement/étiologie , Examen neurologique , Imagerie par résonance magnétique , Facteurs de risque , Études rétrospectives , Unités de soins intensifs néonatalsRÉSUMÉ
One in ten babies are born preterm, as defined as being less than 37 weeks of gestational age. Premature births are associated with a high risk of poor neurodevelopmental outcomes, including hearing, visual, motor, and cognitive impairments. Currently, there is no specific standardization for neurological follow-up infants born premature. Most formal neonatal intensive care units, follow-up programs monitor children until early childhood. However, some deficits, such as mild cognitive impairment, may only become apparent in school years. This review outlines a neurological follow-up timeline, as well as the different standardized measures that can be used to monitor development to ensure that children born preterm receive timely and appropriate therapies and services.
Uno de cada diez bebés nacidos es prematuro, el cual se define como el nacido antes de las 37 semanas de edad gestacional. La prematuridad está asociada con un alto riesgo de trastornos del neurodesarrollo con limitaciones en la audición, visión, área cognitiva y motora. Actualmente, no existen programas estandarizados específicos para el seguimiento neurológico de los prematuros. La mayoría son desarrollados por las unidades de cuidados intensivos neonatales y dan seguimiento hasta la edad pre-escolar. Sin embargo, algunas deficiencias, como el deterioro cognitivo leve, son reconocidos tardíamente. Esta revisión describe un cronograma para el seguimiento neurológico y las herramientas estandarizadas que pueden utilizarse para vigilar el desarrollo y asegurar que los niños nacidos prematuros reciban terapias y otros servicios adecuados y oportunos.
Sujet(s)
Prématuré , Humains , Nouveau-né , Études de suivi , Unités de soins intensifs néonatals , Troubles du développement neurologique , Examen neurologique/méthodes , Examen neurologique/normes , Guides de bonnes pratiques cliniques comme sujetRÉSUMÉ
OBJECTIVE: to analyze the reliability of the items that compose the instrument for classifying newborns according to the degree of dependence on nursing care in a neonatal intensive care unit. METHOD: methodological study that analyzed the agreement and reliability of the instrument in a neonatal intensive care unit. Six care nurses and a research nurse assessed 35 newborns and completed the instrument, which was made up of 15 areas of care. The weighted Kappa coefficient and the Intraclass Correlation Coefficient were used for analysis. RESULTS: the areas of: weight (92%), oxygenation (93%) and catheter control (95%) had almost perfect agreement and the area of reaction to stimuli (50%) had poor agreement. The areas of elimination and vital signs showed low reliability, due to the low variability of responses. The Intraclass Correlation Coefficient was 0.94. CONCLUSION: there are variations in the evaluations of some areas of care due to the imprecise description of items to which scores are assigned, however the instrument is reliable for categorizing the type of care (minimal, intermediate and intensive). Its use can contribute to measuring the quality and safety of newborn care.
Sujet(s)
Soins intensifs néonatals , Humains , Nouveau-né , Reproductibilité des résultats , Femelle , Mâle , Soins intensifs néonatals/normes , Soins intensifs néonatals/classification , Unités de soins intensifs néonatals/normes , Soins infirmiers en néonatalogie/normesRÉSUMÉ
OBJECTIVE: Analyse the incidence, risk factors, antimicrobial susceptibility profile, and fatality in neonates infected with oxacillin-resistant Staphylococcus spp. (ORS). METHODS: In this retrospective observational descriptive cohort study, the medical records of neonates admitted to the Neonatal Intensive Care Unit (NICU) from January 2015 to June 2022 were analysed. Participants were monitored daily through the National Healthcare Safety Network. RESULTS: Among the 1610 neonates, 193 (12â¯%) developed ORS infections, primarily in the bloodstream (96.8â¯%). The incidence of these infections/patient-days decreased by 51.8â¯% between 2016 (8.3) and 2022 (4). The median age of affected neonates was 17.5 days (IQR:12-28.7). Pre-emptive prescription of fourth-generation cephalosporins (OR=14.36; P<0.01) emerged as a risk factor in the multivariate analysis. Staphylococcus epidermidis was the most prevalent species (60.1â¯%), with one isolate showing a "susceptible, increased exposure" profile to vancomycin. Additionally, 2â¯% of pathogens were extensively drug-resistant (XDR). ORS infections were associated with prolonged hospital stays (from 10 to 46 days) and increased mortality (from 10.2â¯% to 19.2â¯%). The median time between infection and the fatal outcome was 15 days (IQR:8-40), and Staphylococcus capitis was the most lethal species (26.7â¯%). CONCLUSIONS: The high incidence of ORS infections was linked to extended hospitalisation and increased mortality, highlighting the complexity of this situation - a "perfect storm." This underscores the urgency of implementing effective interventions for managing and preventing ORS infections in the NICU.
Sujet(s)
Antibactériens , Unités de soins intensifs néonatals , Oxacilline , Infections à staphylocoques , Staphylococcus , Femelle , Humains , Nouveau-né , Mâle , Antibactériens/usage thérapeutique , Brésil/épidémiologie , Résistance bactérienne aux médicaments/effets des médicaments et des substances chimiques , Incidence , Tests de sensibilité microbienne , Oxacilline/usage thérapeutique , Études rétrospectives , Facteurs de risque , Infections à staphylocoques/microbiologie , Infections à staphylocoques/traitement médicamenteux , Infections à staphylocoques/mortalité , Infections à staphylocoques/épidémiologie , Staphylococcus/effets des médicaments et des substances chimiques , Staphylococcus/isolement et purificationRÉSUMÉ
CONTEXT: The Qualineo Strategy is an effective measure for reducing neonatal mortality in regions with the highest death rates. In addition, it is a relevant Brazilian tool for strengthening teamwork and neonatal assistance. This study aims to analyze the predictors of neonatal death in the indicators of care provided by the Qualineo Strategy at a reference maternity hospital in Piauí, in the years 2021 to 2022. METHODS: This is a retrospective study of 1856 newborn records. Pearson's chi-squared test was used to assess the association between the variables; a predictive regression model was used to identify the variables that predict neonatal mortality. RESULTS: There was a significant association between all neonatal variables and the outcome of death (p < 0.05). The predictor variables for death in term newborns were the use of drugs by the mother and admission to the Neonatal Intensive Care Unit. For premature newborns, the predictor variables were, as follows: the use of cannula ventilation, an Apgar score in the 1st minute <7; and admission to the Neonatal Intensive Care Unit. CONCLUSIONS: The results will make it possible to visualize better strategies for the reality analyzed and reinforce the importance of prenatal care.
Sujet(s)
Mortalité infantile , Humains , Nouveau-né , Études transversales , Brésil/épidémiologie , Études rétrospectives , Femelle , Nourrisson , Mâle , Unités de soins intensifs néonatals , Mort périnatale/prévention et contrôleRÉSUMÉ
OBJECTIVE: To analyze the skin injuries of hospitalized newborns and identify factors related to the number of lesions. METHOD: This was a cross-sectional epidemiological study carried out over a period of one year in a Neonatal Intensive Care Unit in the west of Paraná. The study included 74 newborns with a score ≥5 on the Newborn Skin Condition Scale. Data analysis by chi-square and Pearson's test (p < 0.05). RESULTS: The frequency was 25.4%, 59.4% had more than one lesion, mainly dermatitis and pressure injury. Birth characteristics were not related to the number of lesions. Not using antibiotics and parenteral nutrition, hemoglobin >11g/dl, phototherapy, pain score <4 and hospitalization >30 days were related to the number of lesions. The presence of two injuries led to longer healing time and three to longer hospitalization. A higher score on the Skin Condition Scale was related to healing time and late start of the diet. CONCLUSION: Skin injuries were found to be infrequent among newborns, but there is still a need to improve practices to prevent and maintain skin integrity.
Sujet(s)
Unités de soins intensifs néonatals , Humains , Études transversales , Nouveau-né , Mâle , Femelle , Peau/traumatismes , Escarre/épidémiologie , Hospitalisation/statistiques et données numériques , Durée du séjour/statistiques et données numériquesRÉSUMÉ
BACKGROUND: Studies comparing the frequency of different mental health conditions across different settings and evaluating their association with parental participation in newborn care are lacking. We aimed at evaluating the frequency of parental stress, anxiety and depression, along with the level of participation in newborn care, among parents of newborns in Italy, Brazil and Tanzania. METHODS: Parental stress, anxiety, depression and participation in care were assessed prospectively in parents of newborns in eight neonatal intensive care units (NICUs) utilising: the Parental Stressor Scale in NICU (PSS:NICU); the Edinburgh Postnatal Depression Scale (EPDS) and EPDS-Anxiety subscale (EPDS-A); the Index of Parental Participation in NICU (IPP-NICU). Univariate and multivariate analyses were conducted. RESULTS: Study outcomes were assessed on 742 parents (Brazil=327, Italy=191, Tanzania=224). Observed scores suggested a very high frequency of stress, anxiety and depression, with an overall estimated frequency of any of the mental health condition of 65.1%, 52.9% and 58.0% in Brazil, Italy, Tanzania, respectively (p<0.001). EPDS scores indicating depression (cut-off: ≥13 for Brazil and Tanzania, ≥12 for Italy) were significantly more frequent in Tanzania (52.3%) when compared with either Brazil (35.8%) and Italy (33.3%) (p<0.001). Parental participation in care was also significantly higher in Tanzania (median IPP-NICU=24) than in the other two countries (median=21 for Brazil, 18 for Italy, p<0.001). Severe stress (PSS:NICU ≥4) was significantly more frequently reported in Brazil (22.6%), compared with Italy (4.7%) and Tanzania (0%, p<0.001). Factors independently associated with either parental stress, anxiety or depression varied by country, and a significant association with parental participation in care was lacking. CONCLUSIONS: Study findings suggest that parental stress, anxiety and depression are extremely frequent in NICUs in all countries despite diversity in the setting, and requiring immediate action. Further studies should explore the appropriate level of parental participation in care in different settings.
Sujet(s)
Anxiété , Dépression , Unités de soins intensifs néonatals , Parents , Stress psychologique , Humains , Unités de soins intensifs néonatals/statistiques et données numériques , Études prospectives , Femelle , Mâle , Stress psychologique/épidémiologie , Anxiété/épidémiologie , Anxiété/psychologie , Nouveau-né , Dépression/épidémiologie , Dépression/psychologie , Italie/épidémiologie , Adulte , Parents/psychologie , Tanzanie/épidémiologie , Brésil/épidémiologie , Échelles d'évaluation en psychiatrieRÉSUMÉ
La electroencefalografía (EEG) siempre ha sido considerada una materia especializada, que amerita de entrenamiento para su aplicación e interpretación; esto ha provocado que el acceso a estos estudios quedara confinado a neurólogos y neurofisiólogos. El recién nacido ingresado en la unidad de cuidados intensivos neonatales (UCIN) amerita de monitorización neurológica para establecer diagnóstico y pronóstico, por lo que se necesita una herramienta sencilla y accesible para el personal de la UCIN. Estas características han sido cubiertas por el electroencefalograma de amplitud integrada (aEEG) que, a través de patrones visuales simples de la actividad cerebral, permite el abordaje de la condición neurológica. El objetivo de este ensayo se orienta al manejo de mnemotecnias que faciliten la identificación de patrones visuales normales y patológicos en el aEEG. La nomenclatura empleada, aunque puede parecer simple, pretende crear una idea fácilmente asimilable de los conceptos básicos para la aplicación e interpretación de la neuromonitorización con aEEG.
An electroencephalography (EEG) has always been considered a specialized field, whose use and interpretation requires training. For this reason, access to these monitoring studies has been restricted to neurologists and neurophysiologists. Newborn infants admitted to the neonatal intensive care unit (NICU) require neurophysiological monitoring to establish their diagnosis and prognosis, so a simple and accessible tool is required for NICU staff. Such features have been covered by amplitude-integrated electroencephalography (aEEG), which, through simple visual patterns of brain activity, allows to approach neurological conditions. The objective of this study is to help with the management of mnemonics that facilitate the identification of normal and pathological visual patterns in an aEEG. Although simple in appearance, this nomenclature is intended to create an easy-to-understand idea of basic concepts for the use and interpretation of neurophysiological monitoring with aEEG.
Sujet(s)
Humains , Nouveau-né , Unités de soins intensifs néonatals , Électroencéphalographie/méthodes , Monitorage neurophysiologique/méthodesRÉSUMÉ
OBJECTIVES: To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. METHODS: The authors studied 4062 surviving very preterm infants born < 32 weeks' gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. RESULTS: Infants' mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: -2.0, -1.8, and -1.5; head z: -1.3, -1.2 and -1.1 for exclusive human milk, mixed and exclusive formula respectively). CONCLUSION: Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time.
Sujet(s)
Lait humain , État nutritionnel , Sortie du patient , Humains , Nouveau-né , Sortie du patient/statistiques et données numériques , Brésil , État nutritionnel/physiologie , Femelle , Mâle , Préparation pour nourrissons , Âge gestationnel , Unités de soins intensifs néonatals , Prématuré/croissance et développement , Nourrisson très faible poids naissance/croissance et développement , Poids de naissance/physiologie , Phénomènes physiologiques nutritionnels chez le nourrisson/physiologie , Très grand prématuré/croissance et développementRÉSUMÉ
OBJECTIVE: This study aimed to verify the dietary adequacy of full enteral feeding in preterm newborns (PTNB) and its relationship with birth weight (BW) during the period of hospitalization in the neonatal intensive care unit (NICU). METHODS: This is a prospective cohort study whose population were babies born at less than 37 gestational weeks and weighing less than 2500 g, admitted to a NICU. PTNB were monitored regarding their dietary evolution, considering parenteral and enteral nutrition and adequacy of diet supply in terms of volume, energy, and protein. For statistical analysis, the Statistical Package for the Social Sciences (SPSS) software was used, considering p < 0.05 as significant. RESULTS: A total of 76 PTNB were included. The mean time of using parenteral nutrition was 14 days. The mean time to reach the full enteral feeding for nutrition (FEF-N) was 29 days. However, half of the PTNB reached nutritional recommendations after this means. The time to achieve FEF-N was influenced by BW. Additionally, BW significantly influenced the length of stay in the NICU (p < 0.001). When reaching the recommended full enteral feeding for hydration (FEF-H), 60% of the sample was unable to reach the recommended energy and protein intake. CONCLUSIONS: BW influenced the time needed to reach the FEF-H and FEF-N. The lower the BW, the longer it took to achieve dietary adequacy. Despite achieving the FEF-H, most premature babies did not reach the necessary energy and protein intake at the appropriate time.
Sujet(s)
Nutrition entérale , Nourrisson à faible poids de naissance , Prématuré , Unités de soins intensifs néonatals , Nutrition parentérale , Humains , Nouveau-né , Nutrition entérale/méthodes , Études prospectives , Prématuré/croissance et développement , Femelle , Mâle , Nutrition parentérale/méthodes , Ration calorique , Besoins nutritifs , Durée du séjour/statistiques et données numériques , Phénomènes physiologiques nutritionnels chez le nourrisson , Poids de naissanceRÉSUMÉ
OBJECTIVE: The use of vasopressin as an adjunctive therapy in pulmonary hypertension associated with refractory systemic hypotension has increased. The objective of our study is to describe its effects on term infants. STUDY DESIGN: Retrospective observational study. Setting in a referral level IV neonatal intensive care unit from a middle-income region. The patients are term neonates admitted to our NICU who required vasopressin due to severe Pulmonary Hypertension and refractory hypotension during a 49-month period (December 2019 and December 2023). RESULTS: We identified 68 term infants, all in mechanical ventilation, receiving inhaled nitric oxide (iNO), and a phased protocol management for hypotension. Vasopressin was a started at a mean of 2 days with a mean duration of 80 h. Regarding hemodynamic outcome: diastolic, systolic, and median systemic pressure significantly increased during the first 4 h of treatment, as well as arterial pH and urine output. Accordingly, lactate and Vasoactive Inotropic Score (VIS) score decreased after 4 and 8 h, respectively, after vasopressin was started. Regarding oxygenation markers: oxygen requirements and mean airway pressure decreased significantly (and therefore the oxygenation index decreased in concordance) after 4 h of vasopressin. Echocardiographic indices of pulmonary hypertension progressively improved after vasopressin infusion with a significant decrease of tricuspid ingurgitation velocities and the rate of right-to- left ductal shunt through the ductus arteriosus. In the same way, left and right ventricular output increased after the initiation of vasopressin. CONCLUSION: This study showed that the use of vasopressin in neonates with persistent pulmonary hypertension was associated with a rapid and significant improvement in oxygenation and hemodynamic markers of perfusion, including blood pressure. Its effects begin early during the first hours of treatment.
Sujet(s)
Hypertension pulmonaire , Hypotension artérielle , Vasopressines , Humains , Nouveau-né , Études rétrospectives , Hypotension artérielle/traitement médicamenteux , Hypotension artérielle/étiologie , Femelle , Mâle , Hypertension pulmonaire/traitement médicamenteux , Hypertension pulmonaire/étiologie , Vasopressines/usage thérapeutique , Vasopressines/administration et posologie , Vasoconstricteurs/usage thérapeutique , Vasoconstricteurs/administration et posologie , Monoxyde d'azote/administration et posologie , Ventilation artificielle , Unités de soins intensifs néonatals , Échocardiographie , Hémodynamique/effets des médicaments et des substances chimiquesRÉSUMÉ
OBJECTIVE: To determine the prevalence of C-reactive protein (CRP) use in early-onset sepsis (EOS) evaluations in neonatal intensive care units (NICUs) across the US over time and to determine the association between CRP use and antibiotic use. STUDY DESIGN: A retrospective cohort study of NICUs contributing data to Premier Healthcare Database from 2009 through 2021. EOS evaluation was defined as a blood culture charge ≤ 3 days after birth. CRP use for each NICU was calculated as the proportion of infants with a CRP test obtained ≤ 3 days after birth among those undergoing an EOS evaluation and categorized as, low (<25%); medium-low (25 to < 50%), medium-high (50 to < 75%), and high (≥75%). Outcomes included antibiotic use and mortality ≤ 7 days after birth. RESULTS: Among 572 NICUs, CRP use varied widely and was associated with time. The proportion of NICUs with high CRP use decreased from 2009 to 2021 (24.7% vs 17.4%, P < .001), and those with low CRP use increased (47.9% vs 64.8%, P < .001). Compared with low-use NICUs, high-use NICUs more frequently continued antibiotics > 3 days (10% vs 25%, P < .001). This association persisted in multivariable-adjusted regression analyses (adjusted risk ratio 1.95, 95%CI 1.54, 2.48). Risk of mortality was not different in high-use NICUs (adjusted risk difference -0.02%, 95%CI -0.04%, 0.0008%). CONCLUSIONS: CRP use in EOS evaluations varied widely across NICUs. High CRP use was associated with prolonged antibiotic therapy but not mortality ≤ 7 days after birth. Reducing routine CRP use in EOS evaluations may be a target for neonatal antibiotic stewardship efforts.
Sujet(s)
Antibactériens , Protéine C-réactive , Unités de soins intensifs néonatals , Sepsis néonatal , Humains , Protéine C-réactive/analyse , Antibactériens/usage thérapeutique , Études rétrospectives , Nouveau-né , Femelle , Mâle , Sepsis néonatal/traitement médicamenteux , Sepsis néonatal/sang , États-Unis/épidémiologie , Gestion responsable des antimicrobiensRÉSUMÉ
OBJECTIVE: To determine whether an enteral, clonidine-based sedation strategy (CLON) during therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy would decrease opiate use while maintaining similar short-term safety and efficacy profiles to a morphine-based strategy (MOR). STUDY DESIGN: This was a single-center, observational study conducted at a level IV neonatal intensive care unit from January 1, 2017, to October 1, 2021. From April 13, 2020, to August 13, 2020, we transitioned from MOR to CLON. Thus, patients receiving TH for hypoxic-ischemic encephalopathy were grouped to MOR (before April 13, 2020) and CLON (after August 13, 2020). We calculated the total and rescue morphine milligram equivalent/kg (primary outcome) and frequency of hemodynamic changes (secondary outcome) for both groups. RESULTS: The MOR and CLON groups (74 and 25 neonates, respectively) had similar baseline characteristics and need for rescue sedative intravenous infusion (21.6% MOR and 20% CLON). Both morphine milligram equivalent/kg and need for rescue opiates (combined bolus and infusions) were greater in MOR than CLON (P < .001). As days in TH advanced, a lower percentage of patients receiving CLON needed rescue opiates (92% on day 1 to 68% on day 3). Patients receiving MOR received a greater cumulative dose of dopamine and more frequently required a second inotrope and hydrocortisone for hypotension. MOR had a lower respiratory rate during TH (P = .01 vs CLON). CONCLUSIONS: Our CLON protocol is noninferior to MOR, maintaining perceived effectiveness and hemodynamic safety, with an apparently reduced need for opiates and inotropes.
Sujet(s)
Analgésiques morphiniques , Clonidine , Hypothermie provoquée , Hypoxie-ischémie du cerveau , Humains , Clonidine/administration et posologie , Clonidine/usage thérapeutique , Nouveau-né , Hypothermie provoquée/méthodes , Mâle , Femelle , Analgésiques morphiniques/administration et posologie , Analgésiques morphiniques/usage thérapeutique , Hypoxie-ischémie du cerveau/thérapie , Morphine/administration et posologie , Morphine/usage thérapeutique , Administration par voie orale , Hypnotiques et sédatifs/administration et posologie , Unités de soins intensifs néonatalsRÉSUMÉ
INTRODUCTION: Catheter-related thrombosis (CRT) accounts for most thrombotic events in the neonate. OBJECTIVE: Investigate CRT frequency, association with days of catheter use until diagnosis, and number of catheters used, in a single-center Neonatal Intensive Care Unit. METHODS: A case-control study that included 14 cases and 42 controls. Data collection occurred between January 2017 and December 2020 in a public NICU. Crude odds ratios (COR) were calculated. The study complied with ethical standards from national guidelines. RESULTS: Two hundred and ninety-four neonates used central venous catheters, of which 14 (4.7%) were diagnosed with CRT. Catheter in use when diagnosis was made was centrally inserted central catheters in 8 (57.1%). Before diagnosis, the cumulative duration of catheter use was 34.5 days and the median number of catheters used was three. A higher SNAPPE-II (COR 1.03; 95% CI 1.01-1.06; p=0.03), cumulative days of catheter use >30 (COR 19.11; 95% CI 2.28-160.10; p=0.007) and number of catheters used ≥3 (COR 7.66; 95% CI 1.51-38.70; p=0.01) were associated with CRT. CONCLUSION: CRT cases were associated with clinical severity; number of catheters and cumulative days of catheter use. We suggest that screening for thrombosis should be performed in neonates who need a long time of catheter use and more than three catheters. Reducing the duration and number of venous catheters used will help to reduce CRT.
INTRODUÇÃO: A trombose relacionada ao cateter (TRC) é responsável pela maioria dos eventos trombóticos no neonato. OBJETIVO: Investigar a frequência da TRC, a associação com os dias de uso do cateter até o diagnóstico e o número de cateteres utilizados em uma Unidade de Terapia Intensiva Neonatal unicêntrico. MÉTODOS: Estudo caso-controle que incluiu 14 casos e 42 controles. A coleta de dados ocorreu entre janeiro de 2017 e dezembro de 2020 em uma UTIN pública. Foram calculadas razões de chances brutas (COR). O estudo respeitou os padrões éticos das diretrizes nacionais. RESULTADOS: Duzentos e noventa e quatro neonatos utilizaram cateter venoso central, dos quais 14 (4,7%) foram diagnosticados com TRC. O cateter em uso no momento do diagnóstico foi o cateter central inserido centralmente em 8 (57,1%). Antes do diagnóstico, o tempo acumulado de uso do cateter foi de 34,5 dias e a mediana do número de cateteres utilizados foi de três. Um maior número de dias de uso do cateter >30 (COR 19,11; IC 95% 2,28-160,10; p=0,007) e número de cateteres utilizados >3 (COR 7,66; IC 95% 1,51-38,70; p=0,01). CONCLUSÃO: Os casos de TRC foram associados à gravidade clínica; número de cateteres e dias cumulativos de uso do cateter. Sugerimos que o rastreamento de trombose seja realizado em neonatos que necessitem de longo tempo de uso do cateter e mais de três cateteres. Reduzir a duração e o número de cateteres venosos usados ajudará a reduzir a TRC.
Sujet(s)
Humains , Nouveau-né , Unités de soins intensifs néonatals , Thrombose veineuse , Voies veineuses centrales , Études cas-témoinsRÉSUMÉ
OBJECTIVE: To analyze relationships between provider-documented signs prompting sepsis evaluations, assessments of illness severity, and late-onset infection (LOI). STUDY DESIGN: Retrospective cohort study of all infants receiving a sepsis huddle in conjunction with a LOI evaluation. Participants were ≥3 days old and admitted to a level IV neonatal intensive care unit (NICU) from September 2018 through May 2021. Data were extracted from standardized sepsis huddle notes in the electronic health record, including clinical signs prompting LOI evaluations, illness severity assessments (from least to most severe: green, yellow, and red), and management plans. To analyze relationships of sepsis huddle characteristics with the detection of culture-confirmed LOI (bacteremia, urinary tract infection, or meningitis), we utilized diagnostic test statistics, area under the receiver-operator characteristic analyses, and multivariable logistic regression. RESULTS: We identified 1209 eligible sepsis huddles among 604 infants. There were 111 culture-confirmed LOI episodes (9% of all huddles). Twelve clinical signs of infection poorly distinguished infants with and without LOI, with sensitivity for each ranging from 2% to 36% and area under the receiver-operator characteristic ranging 0.49-0.53. Multivariable logistic regression identified increasing odds of infection with higher perceived illness severity at the time of sepsis huddle, adjusted for gestational age and receipt of intensive care supports. CONCLUSIONS: Clinical signs prompting sepsis huddles were nonspecific and not predictive of concurrent LOI. Higher perceived illness severity was associated with presence of infection, despite some misclassification based on objective criteria. In level IV NICUs, antimicrobial stewardship through development of criteria for antibiotic noninitiation may be challenging, as presenting signs of LOI are similar among infants with and without confirmed infection.
Sujet(s)
Unités de soins intensifs néonatals , Indice de gravité de la maladie , Humains , Études rétrospectives , Nouveau-né , Mâle , Femelle , Sepsie/diagnostic , Sepsis néonatal/diagnosticRÉSUMÉ
Importance: Preterm children are at risk for neurodevelopment impairments. Objective: To evaluate the effect of a music therapy (MT) intervention (parent-led, infant-directed singing) for premature children during the neonatal intensive care unit (NICU) stay and/or after hospital discharge on language development at 24 months' corrected age (CA). Design, Setting, and Participants: This predefined secondary analysis followed participants in the LongSTEP (Longitudinal Study of Music Therapy's Effectiveness for Premature Infants and Their Caregivers) randomized clinical trial, which was conducted from August 2018 to April 2022 in 8 NICUs across 5 countries (Argentina, Colombia, Israel, Norway, and Poland) and included clinic follow-up visits and extended interventions after hospital discharge. Intervention: Participants were children born preterm (<35 weeks' gestation) and their parents. Participants were randomized at enrollment to MT with standard care (SC) or SC alone; they were randomized to MT or SC again at discharge. The MT was parent-led, infant-directed singing tailored to infant responses and supported by a music therapist and was provided 3 times weekly in the NICU and/or in 7 sessions across 6 months after discharge. The SC consisted of early intervention methods of medical, nursing, and social services, without MT. Main Outcome and Measures: Primary outcome was language development, as measured by the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) language composite score, with the remaining BSID-III composite and subscale scores as the secondary outcomes. Group differences in treatment effects were assessed using linear mixed-effects models using all available data. Results: Of 206 participants (103 female infants [50%]; mean [SD] GA, 30.5 [2.7] weeks), 51 were randomized to MT and 53 to SC at enrollment; at discharge, 52 were randomized to MT and 50 to SC. A total of 112 (54%) were retained at the 24 months' CA follow-up. Most participants (79 [70%] to 93 [83%]) had BSID-III scores in the normal range (≥85). Mean differences for the language composite score were -2.36 (95% CI, -12.60 to 7.88; P = .65) for the MT at NICU with postdischarge SC group, 2.65 (95% CI, -7.94 to 13.23; P = .62) for the SC at NICU and postdischarge MT group, and -3.77 (95% CI, -13.97 to 6.43; P = .47) for the MT group at both NICU and postdischarge. There were no significant effects for cognitive or motor development. Conclusions and Relevance: This secondary analysis did not confirm an effect of parent-led, infant-directed singing on neurodevelopment in preterm children at 24 months' CA; wide CIs suggest, however, that potential effects cannot be excluded. Future research should determine the MT approaches, implementation time, and duration that are effective in targeting children at risk for neurodevelopmental impairments and introducing broader measurements for changes in brain development. Trial Registration: ClinicalTrials.gov Identifier: NCT03564184.
Sujet(s)
Prématuré , Musicothérapie , Humains , Musicothérapie/méthodes , Femelle , Mâle , Nouveau-né , Nourrisson , Unités de soins intensifs néonatals , Enfant d'âge préscolaire , Développement du langage oral , Études longitudinales , Développement de l'enfant/physiologie , Troubles du développement neurologique/prévention et contrôle , Colombie , Norvège , IsraëlRÉSUMÉ
An electroencephalography (EEG) has always been considered a specialized field, whose use and interpretation requires training. For this reason, access to these monitoring studies has been restricted to neurologists and neurophysiologists. Newborn infants admitted to the neonatal intensive care unit (NICU) require neurophysiological monitoring to establish their diagnosis and prognosis, so a simple and accessible tool is required for NICU staff. Such features have been covered by amplitude-integrated electroencephalography (aEEG), which, through simple visual patterns of brain activity, allows to approach neurological conditions. The objective of this study is to help with the management of mnemonics that facilitate the identification of normal and pathological visual patterns in an aEEG. Although simple in appearance, this nomenclature is intended to create an easy-to-understand idea of basic concepts for the use and interpretation of neurophysiological monitoring with aEEG.
La electroencefalografía (EEG) siempre ha sido considerada una materia especializada, que amerita de entrenamiento para su aplicación e interpretación; esto ha provocado que el acceso a estos estudios quedara confinado a neurólogos y neurofisiólogos. El recién nacido ingresado en la unidad de cuidados intensivos neonatales (UCIN) amerita de monitorización neurológica para establecer diagnóstico y pronóstico, por lo que se necesita una herramienta sencilla y accesible para el personal de la UCIN. Estas características han sido cubiertas por el electroencefalograma de amplitud integrada (aEEG) que, a través de patrones visuales simples de la actividad cerebral, permite el abordaje de la condición neurológica. El objetivo de este ensayo se orienta al manejo de mnemotecnias que faciliten la identificación de patrones visuales normales y patológicos en el aEEG. La nomenclatura empleada, aunque puede parecer simple, pretende crear una idea fácilmente asimilable de los conceptos básicos para la aplicación e interpretación de la neuromonitorización con aEEG.
Sujet(s)
Électroencéphalographie , Unités de soins intensifs néonatals , Humains , Électroencéphalographie/méthodes , Nouveau-né , Monitorage neurophysiologique/méthodesRÉSUMÉ
Fungal infections in neonatal intensive care units (NICU) are mainly related to Candida species, with high mortality rates. They are predominantly of endogenous origin, however, cross-infection transmitted by healthcare professionals' hands has occurred. The aim of this study was to identify Candida species isolated from the hands of healthcare professionals in a NICU before and after hygiene with 70% ethanol-based gel and evaluate virulence factors DNase, phospholipase, proteinase, hemolysin, biofilm biomass production, and metabolic activity. In vitro antifungal susceptibility testing and similarity by random amplified polymorphic DNA (RAPD) were also performed. C. parapsilosis complex was the most frequent species (57.1%); all isolates presented at least one virulence factor; three isolates (Candida parapsilosis complex) were resistant to amphotericin B, two (Candida famata [currently Debaryomyces hansenii] and Candida guilliermondii [currently Meyerozyma guilliermondii]) was resistant to micafungin, and six (Candida parapsilosis complex, Candida guilliermondii [=Meyerozyma guilliermondii], Candida viswanathi, Candida catenulata [currently Diutina catenulata] and Candida lusitaniae [currently Clavispora lusitaniae]) were resistant to fluconazole. Molecular analysis by RAPD revealed two clusters of identical strains that were in the hands of distinct professionals. Candida spp. were isolated even after hygiene with 70% ethanol-based gel, highlighting the importance of stricter basic measures for hospital infection control to prevent nosocomial transmission.