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1.
Electron Mark ; 32(4): 2381-2404, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36158525

RESUMO

Open government data (OGD) holds great potential for firms and the digital economy as a whole and has attracted increasing interest in research and practice in recent years. Governments and organizations worldwide are struggling in exploiting the full potential of OGD and require a comprehensive understanding of this phenomenon. Although scientific debates in OGD research are intense and heterogeneous, the field lacks theoretical integration of OGD topics and their systematic consideration in the context of the digital economy. In addition, OGD has been widely neglected by information systems (IS) research, which promises great potential for advancing our knowledge of the OGD concept and its role in the digital economy. To fill in this gap, this study conducts a systematic literature review of 169 empirical OGD studies. In doing so, we develop a theoretical review framework of Antecedents, Decisions, Outcomes (ADO) to unify and grasp the accumulating isolated evidence on OGD in context of the digital economy and provide a theory-informed research agenda to tap the potential of IS research for OGD. Our findings reveal six related key topic clusters of OGD research and substantial gaps, opening up prospective research avenues and particularly outlining how IS research can inform and advance OGD research. Supplementary information: The online version contains supplementary material available at 10.1007/s12525-022-00582-8.

2.
BMC Complement Altern Med ; 16: 12, 2016 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-26758035

RESUMO

BACKGROUND: The objective of this study was to investigate neurological short-term effects of craniosacral therapy as an ideal form of osteopathic manipulative treatment (OMT) due to the soft kinaesthetic stimulation. METHODS: Included were 30 preterm infants, with a gestational age between 25 and 33 weeks, who were admitted to the neonatal intensive care unit of the University Hospital of Graz, Austria. The infants were randomized either into the intervention group (IG) which received standardised craniosacral therapy, or the control group (CG) which received standard care. To guarantee that only preterm infants with subsequent normal neurodevelopment were included, follow up was done regularly at the corrected age (= actual age in weeks minus weeks premature) of 12 and 24 months. After 2 years 5 infants had to be excluded (IG; n = 12; CG: n = 13). General Movements (GMs) are part of the spontaneous movement repertoire and are present from early fetal life onwards until the end of the first half year of life. To evaluate the immediate result of such an intervention, we selected the General Movement Assessment (GMA) as an appropriate tool. Besides the global GMA (primary outcome) we used as detailed GMA, the General Movement Optimality Score (GMOS- secondary outcome), based on Prechtl's optimality concept. To analyse GMOS (secondary outcome) a linear mixed model with fixed effects for session, time point (time point refers to the comparisons of the measurements before vs. after each session) and intervention (IG vs. CG), random effect for individual children and a first order autoregressive covariance structure was used for calculation of significant differences between groups and interactions. Following interaction terms were included in the model: session*time point, session*intervention, time point*intervention and session*time point*intervention. Exploratory post hoc analyses (interaction: session*time point*intervention) were performed to determine group differences for all twelve measurement (before and after all 6 sessions) separately. RESULTS: Between groups no difference in the global GMA (primary outcome) could be observed. The GMOS (secondary outcome) did not change from session to session (main effect session: p = 0.262) in the IG or the CG. Furthermore no differences between IG and CG (main effect group: p = 0.361) and no interaction of time*session could be observed (p = 0.658). Post hoc analysis showed a trend toward higher values before (p = 0.085) and after (p = 0.075) the first session in CG compared to IG. At all other time points GMOS were not significantly different between groups. CONCLUSION: We were able to indicate that a group of "healthy" preterm infants undergoing an intervention with craniosacral therapy (IG) showed no significant changes in GMs compared to preterm infants without intervention (CG). In view of the fact that the global GMA (primary outcome) showed no difference between groups and the GMOS (detailed GMA-secondary outcome) did not deteriorate in the IG, craniosacral therapy seems to be safe in preterm infants. TRIAL REGISTRATION: German Clinical Trials Register DRKS00004258 .


Assuntos
Recém-Nascido Prematuro , Osteopatia , Movimento , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Massagem , Atividade Motora , Projetos Piloto
3.
Am J Obstet Gynecol ; 209(6): 542.e1-542.e11, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23994220

RESUMO

OBJECTIVE: The aim of this study was to show and discuss an association between fetal inflammatory response syndrome (FIRS) and an adverse neonatal outcome defined as combined severe neonatal morbidity and mortality in preterm neonates hospitalized in our neonatal intensive care unit. STUDY DESIGN: This was an observational study including all preterm neonates hospitalized in our neonatal intensive care unit over a 21 month period. FIRS was defined as cord blood interleukin (IL)-6 greater than 11 pg/mL. Main outcome parameter was an adverse neonatal outcome defined as hospital mortality and/or the presence of any of 5 prespecified morbidities (bronchopulmonary dysplasia, periventricular leukomalacia, intraventricular hemorrhage, and early- or late-onset sepsis). RESULTS: Fifty-seven of 176 preterm infants hospitalized during the study period (32%) had an adverse neonatal outcome and 62 of these 176 infants (35%) had FIRS with median IL-6 values of 51.8 pg/mL (range, 11.2 to >1000 pg/mL). In a regression analysis, FIRS was significantly associated with adverse neonatal outcome (P < .001) and with the single outcome parameters, intraventricular hemorrhage and early-onset sepsis (P = .006 and P = .018, respectively). In the bivariate analysis, FIRS was associated with death and bronchopulmonary dysplasia (P = .004 and P < .001, respectively). IL-6 correlated with adverse neonatal outcome (r = 0.411, P < .001). When comparing the correlation in neonates less than 32 weeks' gestational age (r = 0.481, P < .001) with neonates 32 weeks or longer (r = 0.233, P = .019), the difference was nearly significant (P = .065). CONCLUSION: FIRS is a risk factor for adverse neonatal outcome in preterm infants. In particular, the combination of IL-6 greater than 11 pg/mL and low gestational age increased the risk for severe neonatal morbidity or death.


Assuntos
Doenças Fetais , Doenças do Prematuro/mortalidade , Recém-Nascido Prematuro/fisiologia , Interleucina-6/sangue , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Ensaio de Imunoadsorção Enzimática , Feminino , Sangue Fetal/imunologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Razão de Chances , Curva ROC , Análise de Regressão , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/mortalidade
5.
Paediatr Respir Rev ; 14(2): 130-6, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23375547

RESUMO

Respiratory syncytial virus (RSV) is the most significant cause of acute respiratory tract infections (RTI) in infants and young children throughout the world. Preterm infants are at increased risk for severe RSV lower respiratory tract infection due to small lung volumes, a reduced lung surface area, small airways and an increased air space wall thickness. Additionally, the airways of preterm infants have been ventilated mechanically and suctioned and potentially damaged by many microtraumas with disruption of endothelial surfaces enabling pathogens to invade more easily. The immune system of preterm infants is immature resulting in low antibody titers (incomplete transplacental transfer of maternal antibodies) and a reduced cellular immunity with reduced viral clearance. Rehospitalization rates of preterm compared to term infants due to RSV infection are increased as are total morbidity and mortality associated with RSV disease. Palivizumab effectively reduces RSV related rehospitalisation in this high-risk population.


Assuntos
Doenças do Prematuro/prevenção & controle , Recém-Nascido Prematuro , Unidades de Cuidados Respiratórios , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Vírus Sinciciais Respiratórios/imunologia , Vacinas Virais/uso terapêutico , Humanos , Lactente , Doenças do Prematuro/epidemiologia , Infecções por Vírus Respiratório Sincicial/epidemiologia
6.
J Pediatr ; 163(2): 394-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23434123

RESUMO

OBJECTIVE: To evaluate peripheral regional oxygen saturation (rpSO2) and cerebral regional oxygen saturation (rcSO2) during the immediate postnatal transition in late preterm infants with and without the need for respiratory support. STUDY DESIGN: This was a prospective observational study using near-infrared spectroscopy to evaluate changes in rpSO2 and rcSO2. These variables were measured during the first 15 minutes of life after elective cesarean delivery. Peripheral oxygen saturation (SpO2) and heart rate were measured continuously by pulse oximetry, and cerebral fractional tissue oxygen extraction (cFTOE) was calculated. Two groups were compared based on their need for respiratory support: a respiratory support group and a normal transition group. Positive-pressure ventilation was delivered with a T-piece resuscitator, and oxygen was adjusted based on SpO2 values. A Florian respiratory function monitor was used to record the ventilation variables. RESULTS: There were 21 infants in the normal transition group and 21 infants in the respiratory support group. Changes in heart rate over time were similar in the 2 groups. SpO2, rcSO2, and rpSO2 values were consistently higher in the normal transition group. In the respiratory support group, cFTOE values remained significantly elevated for a longer period. CONCLUSION: This systematic analysis of rpSO2, rcSO2, and cFTOE in late preterm infants found significantly lower oxygen saturation values in infants who received respiratory support compared with a normal transition group. We hypothesize that the elevated cFTOE values in the respiratory support group represent compensation for lower oxygen delivery.


Assuntos
Encéfalo/metabolismo , Recém-Nascido Prematuro/metabolismo , Oxigênio/metabolismo , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Fatores de Tempo
8.
Resuscitation ; 84(7): 974-8, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23313424

RESUMO

AIM OF THE STUDY: During resuscitation no routine cerebral monitoring is available. We aimed at monitoring cerebral activity and oxygenation continuously during neonatal transition and resuscitation. METHODS: Neonates ≥34 weeks of gestation born via cesarean section were included. Cerebral activity was continuously measured with amplitude-integrated-EEG (aEEG) and cerebral oxygenation (rSO2) with near-infrared-spectroscopy (NIRS) during the first 10 min after birth. For quantitative analysis of aEEG every minute the mean minimum amplitude (V(min)) and maximum amplitude (V(max)) was determined. Uncompromised neonates were compared to neonates in need of resuscitation. RESULTS: Out of 224 eligible neonates 31 uncompromised and 15 in need of respiratory support were included. Uncompromised neonates showed higher values for V(min) in the third minute and higher values for V(max) in the third and fourth minute compared to the tenth minute post-partum. In uncompromised neonates rSO2 values during the first 6 min after birth were lower compared to minute ten. Neonates in need of respiratory support had lower rSO2 values over the first 8 min after birth compared to minute ten. CONCLUSIONS: This is the first study demonstrating that monitoring of aEEG and NIRS to measure cerebral activity and oxygenation during immediate postpartum transition is feasible. During transition compromised neonates requiring resuscitation showed a different cerebral activity pattern compared to uncompromised neonates.


Assuntos
Encéfalo/irrigação sanguínea , Eletroencefalografia , Monitorização Fisiológica/métodos , Oxigenoterapia , Espectroscopia de Luz Próxima ao Infravermelho , Circulação Cerebrovascular/fisiologia , Cesárea , Feminino , Humanos , Recém-Nascido , Masculino , Oxigênio/sangue , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
9.
Pediatr Crit Care Med ; 14(2): 157-63, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23254982

RESUMO

OBJECTIVE: Fecal carriage of extended-spectrum ß-lactamase-producing enterobacteriaceae may contribute to the spread of extended-spectrum ß-lactamase-producing enterobacteriaceae into the community. The objective of this study was to assess the duration of fecal carriage after discharge and the occurrence of intrafamilial transmission. DESIGN: Case series. SETTING: Quaternary care children's hospital. PATIENTS: Patients colonized with extended-spectrum ß-lactamase-producing enterobacteriaceae at the neonatal ICU and the respective household members. INTERVENTIONS: Screening for intestinal extended-spectrum ß-lactamase-producing enterobacteriaceae colonization was done at 1, 2, 4, 6, 9, and 12 months after discharge. Genetic relatedness of isolated extended-spectrum ß-lactamase-producing enterobacteriaceae strains was determined using automated rep-PCR. RESULTS: Twenty-five neonates (case-patients) colonized with extended-spectrum ß-lactamase-producing enterobacteriaceae (one extended-spectrum ß-lactamase-Escherichia coli; six extended-spectrum ß-lactamase-Klebsiella pneumoniae; 11 extended-spectrum ß-lactamase-Klebsiella oxytoca; and seven extended-spectrum ß-lactamase-Serratia marcescens) were included. Duration of fecal carriage was longer (up to 1 yr) in case-patients colonized with Klebsiella species than in case-patients colonized with Serratia marcescens (<4 months). During follow-up, strains and species of extended-spectrum ß-lactamase-producing enterobacteriaceae different from the primary strain were found in four and three case-patients, respectively. In nine of 49 (18.4%) included household members, extended-spectrum ß-lactamase-producing enterobacteriaceae were found during the follow-up period. In two of nine colonized household members, the isolated extended-spectrum ß-lactamase-producing enterobacteriaceae was identical to the primary strains of the respective case-patients. CONCLUSIONS: After intestinal colonization with extended-spectrum ß-lactamase-producing enterobacteriaceae at the neonatal ICU, infants potentially remain carriers during the first year after discharge. Intrafamilial spread has been proven.


Assuntos
Portador Sadio/microbiologia , Infecções por Enterobacteriaceae/transmissão , Enterobacteriaceae/metabolismo , Fezes/microbiologia , beta-Lactamases/biossíntese , Infecção Hospitalar/microbiologia , Enterobacteriaceae/genética , Infecções por Enterobacteriaceae/microbiologia , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Família , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Klebsiella oxytoca/genética , Klebsiella oxytoca/isolamento & purificação , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Masculino , Serratia marcescens/genética , Serratia marcescens/isolamento & purificação , Fatores de Tempo
10.
J Perinat Med ; 40(5): 587-90, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23120762

RESUMO

AIMS: The aim of this study was to examine the applicability of the definitions of the systemic inflammatory response syndrome (SIRS) and sepsis to neonates during the first 3 days of life. METHODS: This is a retrospective study of all term neonates hospitalized within the first 24 h of life from 2004 to 2010 at our neonatal intensive care unit. RESULTS: Of 476 neonates, 30 (6 %) had a diagnosis of culture-proven early-onset sepsis (EOS) and 81 (17 %) had culture-negative clinical EOS or suspected EOS. SIRS and sepsis criteria were applied to 116 (24 %) and 61 (13 %) neonates, respectively. Of 30 neonates with culture proven, EOS 14 (53 %) fulfilled SIRS and sepsis criteria. The single diagnostic criterion of SIRS applied to 20 % (hypothermia or fever), 43 % (white blood cell count/immature-to-total neutrophil ratio), 87 % (respiratory symptoms), and 33 % (cardiocirculatory symptoms) of all neonates with culture-proven EOS. CONCLUSIONS: The definitions of SIRS and sepsis did not apply to about half of all cases of culture-proven EOS. An evidence-based approach to find the appropriate criteria for defining EOS in the neonate is needed.


Assuntos
Sepse/diagnóstico , Terminologia como Assunto , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Masculino , Estudos Retrospectivos
12.
Clin Chem Lab Med ; 50(8): 1429-32, 2012 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-22868809

RESUMO

BACKGROUND: To determine the predictive value of the immature granulocyte count and the immature myeloid information in neonatal early onset sepsis we examined 133 blood samples of patients admitted to our neonatal intensive care unit. METHODS: Measurements were performed using the Sysmex XE-2100, an automated hematological analyzer. Patients were divided into two groups: 1) symptomatic neonates with diagnosis of early onset sepsis; and 2) controls including asymptomatic neonates who were admitted because of prematurity, low birth weight, or delayed postnatal transition. RESULTS: The number of immature granulocytes and the immature myeloid information were significantly elevated in neonates with early onset sepsis compared to controls (median 280/µL vs. 50/µL, p=0.049 and 639/µL vs. 89/µL, p<0.0001, respectively). CONCLUSIONS: Automated determinations of immature granulocytes and immature myeloid information seem to be useful adjunctive methods in the diagnosis of neonatal early onset sepsis.


Assuntos
Granulócitos/patologia , Contagem de Leucócitos/métodos , Neutrófilos/patologia , Sepse/sangue , Bacteriemia/sangue , Bacteriemia/diagnóstico , Feminino , Humanos , Recém-Nascido , Contagem de Leucócitos/instrumentação , Masculino , Valor Preditivo dos Testes , Gravidez , Fatores de Risco , Sepse/diagnóstico
13.
Paediatr Anaesth ; 22(11): 1132-4, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22686122

RESUMO

BACKGROUND: For measurement of cerebral regional oxygen saturation (crSO2) in neonates, one of the frequently used near-infrared spectroscopy devices is the INVOS 5100 with either the neonatal or pediatric sensor. Measurements between adult and pediatric sensors use different algorithms and differ by 10%. There are no published data comparing neonatal and pediatric sensors. OBJECTIVE: Aim of this study was to compare the neonatal sensor with the pediatric sensor of the INVOS 5100 device in a mixed cohort of neonates to recognize possible differences and enable interpretation of data. METHODS: In 40 neonates, crSO2 was measured in identical positions using both the neonatal and the pediatric sensor under identical conditions. Each sensor was reapplied five times to calculate mean values and standard deviations. RESULTS: Cerebral regional oxygen saturation measurements using the neonatal sensor (mean, 76.1 ± 7.9) and crSO2 measurements using the pediatric sensor (mean, 76.4 ± 8.1) were not different. Reproducibility was not significantly different with similar means of standard deviations (neonatal, 3.7 ± 1.6; pediatric, 3.1 ± 1.3). CONCLUSION: In a mixed cohort of neonates, crSO2 measurements were identical when using the INVOS 5100 neonatal sensor and the pediatric sensor. We conclude that studies using the INVOS 5100 neonatal or pediatric sensor are well comparable.


Assuntos
Encéfalo/metabolismo , Oxigênio/metabolismo , Espectroscopia de Luz Próxima ao Infravermelho/instrumentação , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes
14.
Artigo em Inglês | MEDLINE | ID: mdl-22666295

RESUMO

In children, laser acupuncture is used more often than needle acupuncture in Western countries, due to their aversion to needles. When applying laser acupuncture to premature babies and neonates, firstly the degree of the thermal increase to the skin has to be evaluated so as to guarantee safe application. The patients were premature neonates before their discharge from hospital. The measurements were carried out by means of a polygraphy while they were asleep shortly. The large intestine 4 acupoint (LI4, Hegu) was stimulated by a microlaser needle (10 mW, 685 nm) twice (5 and 10 min). Local thermographic pictures were taken with a thermal camera (Flir i5, Flir Systems Inc., Portland, USA), and the warmest point was determined and subsequently compared. The study included 10 premature neonates (7 male, 3 female). The measurements were carried out on the 33rd day of life (weight 2030 g, gestational age 36 + 3 weeks of pregnancy). In comparison to the initial temperature (32.9°C), after 5 minutes of stimulation (33.9°C) (P = 0.025) and also after 10 minutes of stimulation (34.0°C) (P = 0.01), there was found to be a significant increase in the skin temperature. The singular maximum value of 37.9°C bears a potential danger; however, compared to the local temperatures reached in transcutaneous blood gas measurements it appears not to entail any risks.

15.
Neonatology ; 102(1): 25-36, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22507868

RESUMO

C-reactive protein (CRP) is one of the most studied and most used laboratory tests for neonatal sepsis. As part of the acute-phase reaction to infection, it plays a central role in the humoral response to bacterial invasion. The delayed synthesis during the inflammatory response accounts for its low sensitivity during the early phases of the disease. Diagnostic accuracy clearly improves by the performance of serial determinations and by the combination with earlier markers such as interleukins or procalcitonin. CRP is as well particularly useful for monitoring the response to treatment and guiding antibiotic therapy, though nothing replaces the clinical impression and the gold standard (i.e. culture results). In spite of the large amount of research done on CRP in neonates, some topics are still not fully understood, such as the influence of noninfectious factors on CRP levels in healthy as well as in symptomatic neonates and the role of gestational age and birthweight on CRP kinetics. In this review, we aim to give an update on the current evidence on the use of CRP in neonates.


Assuntos
Proteína C-Reativa/análise , Sepse/sangue , Biomarcadores/sangue , Humanos , Recém-Nascido , Sensibilidade e Especificidade , Sepse/diagnóstico
17.
Arch Dis Child Fetal Neonatal Ed ; 97(6): F444-8, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22294473

RESUMO

OBJECTIVE: C reactive protein (CRP) is a sensitive marker of acute inflammation of infectious and non-infectious origin. Aim was to use near-infrared spectroscopy (NIRS) to analyse peripheral oxygenation and perfusion in term and preterm neonates with elevated CRP levels, at a time when routine haemodynamic variables are still normal. DESIGN: Prospective observational study. SETTINGS: Peripheral-muscle NIRS was performed in the first week of life. Tissue-oxygenation index (TOI), mixed venous oxygenation (SvO(2)), fractional oxygen extraction (FOE), haemoglobin flow (Hbflow), oxygen delivery (DO(2)) and oxygen consumption (VO(2)) were assessed. Blood samples were taken within 3 h of the NIRS measurements. PATIENTS: Cardiocirculatory stable term and preterm neonates with infection-related and infection-unrelated CRP elevations >10 mg/l were compared with neonates without CRP elevation. The two groups were matched for gestational and postnatal age. RESULTS: 33 neonates with CRP elevation (gestational age 37.7±2.9 weeks) were compared with 33 controls (gestational age 37.3±2.9 weeks). In neonates with CRP elevation, TOI (68.9±6.6%), SvO(2) (66.9±7.3%) DO(2) (39.2±16.1 µmol/100ml/min) and VO(2) (10.9±3.4 µmol/100ml/min) were significantly lower compared with controls (TOI 72.9±3.8%, SvO(2) 70.2±4.7%, DO(2) 48.8±18.4 µmol/100ml/min, VO(2) 12.3±3.8 µmol/100ml/min). There was no significant difference in any other NIRS or routine haemodynamic parameter between the two groups. CONCLUSION: Inflammatory processes with CRP elevation cause impaired peripheral oxygenation and perfusion in neonates even when routine haemodynamic variables are still normal. NIRS might offer a new non-invasive tool for the early recognition and diagnosis of infectious and non-infectious inflammatory processes.


Assuntos
Proteína C-Reativa/análise , Recém-Nascido/sangue , Inflamação/metabolismo , Músculo Esquelético/metabolismo , Oxigênio/metabolismo , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Biomarcadores/sangue , Estudos de Casos e Controles , Hemoglobinas , Humanos , Recém-Nascido Prematuro/sangue , Doenças do Prematuro/sangue , Doenças do Prematuro/metabolismo , Inflamação/sangue , Inflamação/diagnóstico , Músculo Esquelético/irrigação sanguínea , Estudos Prospectivos , Fluxo Sanguíneo Regional/fisiologia
18.
Pediatr Int ; 54(4): 486-90, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22299645

RESUMO

BACKGROUND: In this study, we aimed to evaluate the role of fever, hypothermia, and temperature instability in term and preterm newborns during the first 3 days of life and to identify risk factors for early onset sepsis (EOS) among newborns presenting with these temperature symptoms. METHODS: In this retrospective cohort study set in our level III neonatal intensive care unit, we included all newborns hospitalized within the first 24 h of life from 2004 to 2007. RESULTS: Of 851 newborns, 127 presented with temperature symptoms during the first 3 days of life (15%): 69 had fever, 69 had hypothermia, and 55 had temperature instability (8%, 8%, and 6%, respectively). Of 127 newborns presenting with temperature symptoms, 14 had culture-proven EOS/pneumonia (33% of all 42 newborns with culture-proven EOS/pneumonia), 67 had clinical EOS (30% of all 209 newborns with clinical EOS) and 46 were EOS-negative (8% of all 600 EOS-negatives). Factors associated with culture-proven EOS/pneumonia in newborns presenting with temperature symptoms were maternal fever (P = 0.009), chorioamnionitis (P < 0.001), antibiotic therapy of the mother (P = 0.04), poor skin color (P = 0.001) and syndrome of persistent fetal circulation (P = 0.01). CONCLUSIONS: Every seventh newborn hospitalized at our neonatal intensive care unit developed fever, hypothermia and/or temperature instability during the first 3 days of life. Two-thirds of them had culture-proven or clinical sepsis. Temperature symptoms were rarely observed in EOS-negative newborns (8%) but despite low sensitivity, were highly specific for bacterial infection in preterm and term newborns.


Assuntos
Febre/etiologia , Hipotermia/etiologia , Sepse/complicações , Sepse/diagnóstico , Estudos de Coortes , Diagnóstico Precoce , Feminino , Febre/epidemiologia , Hospitalização , Humanos , Hipotermia/epidemiologia , Recém-Nascido , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco
19.
Physiol Meas ; 33(1): 95-102, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22173332

RESUMO

The objective of this study was to evaluate regional oxygen saturation of the brain during immediate transition after birth, and to correlate it with pre-ductal arterial oxygen saturation in newborn infants. The prospective observational study including newborn infants in the first 15 min after spontaneous vaginal delivery and uncomplicated transitional period was undertaken. Regional cerebral oxygen saturation (rSO(2)brain) was measured using near-infrared spectroscopy. Arterial oxygen saturation (SpO(2)) and heart rate (HR) were measured on the right wrist by pulse oximetry. rSO(2)brain, SpO(2) and HR measurements were started immediately after birth and were performed in the first 15 min of life. Cerebral fractional tissue oxygen extraction (FTOE) was calculated for each minute. Of 145 newborn infants, 16 were included and the gender allocation was 31 females (49.2%) and 32 males (50.8%). rSO(2)brain increased rapidly from 39% (2 min) to 69% (5 min), SpO(2) increased from 72% (2 min) to 96% (14 min) and FTOE showed a significant decrease from minute 2 (0.47) until minute 4 (0.30) and an increase between 8 to 13 min. rSO(2)brain increased rapidly after vaginal delivery. Although SpO(2) increased within the first 14 min after delivery, rSO(2)brain showed no further significant changes after 5 min. FTOE decreased in the first 4 min and reached standard values subsequently.


Assuntos
Encéfalo/metabolismo , Parto Obstétrico , Oximetria/métodos , Consumo de Oxigênio/fisiologia , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Prospectivos , Fatores de Tempo
20.
J Pediatr Intensive Care ; 1(1): 17-23, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31214380

RESUMO

Objective: To examine the applicability of the 2002 International Pediatric Sepsis Consensus Conference definitions of the systemic inflammatory response syndrome (SIRS) and sepsis to term and preterm newborns in the diagnosis of early (EOS) and late onset sepsis (LOS). Methods: Retrospective cohort study including 1) all newborns with hospitalization within the first 72 hours of life and 2) infants with episodes of suspected LOS at a tertiary care neonatal intensive care unit between 2004 and 2008, and correlating the definitions of SIRS and sepsis with culture proven and clinical EOS and LOS. Results: Association with EOS: Among term newborns SIRS and sepsis definitions applied to 62 and 39/245 newborns (25% and 16%, respectively) and to 5/13 cases of culture proven EOS (38%) and 34/66 cases of clinical EOS (52%), respectively. Among preterm newborns SIRS and sepsis definitions applied to 202 and 124/505 newborns (40% and 25%, respectively) and to 17/24 cases of culture proven EOS (71%) and 107/160 cases of clinical EOS (67%), respectively. Sensitivity of SIRS and sepsis definitions was higher in preterm compared to term newborns in case of culture proven and clinical EOS (p=.047 and p=0.03, respectively). Association with LOS: SIRS and sepsis definitions applied to 5/5 episodes of culture proven LOS (100%) and to 4/9 episodes of clinical LOS (44%) in newborns who were term at onset of sepsis (corrected gestational age) and to 14/19 episodes of culture proven LOS (74%) and 24/28 episodes of clinical LOS (86%) in preterm newborns. Conclusion: The definitions of SIRS and sepsis correlated well with LOS but poorly with EOS, where nearly two thirds of term and one quarter of preterm newborns would have been missed. Postnatal age rather than gestational age had a positive influence on the correlation.

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