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1.
Am J Perinatol ; 2019 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-31858502

RESUMO

OBJECTIVE: Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula = weight in kilograms + 6 cm; and nasal septum-tragus length [NTL] + 1 cm) used to determine the endotracheal tube (ETT) insertion depth. STUDY DESIGN: Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL + 1 cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2). RESULTS: A total of 167 infants (22-42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants < 34 weeks of gestational age and 56.8 vs. 45.0% in infants > 34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of <34 weeks, especially in the NTL group (46% in the Tochen group and 60.7% in the NTL group). CONCLUSION: The NTL + 1 cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of <1,500 g. Therefore, more studies are needed to determine the optimal ETT insertion depth.

2.
BMC Infect Dis ; 19(1): 695, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387523

RESUMO

BACKGROUND: Diagnosis is the most strenuous step in the evaluation of neonatal sepsis. No gold standard diagnostic method is available except for blood culture. We aimed to investigate the role of positive and negative acute phase reactants, namely presepsin and fetuin-A, in the diagnosis of culture-proven late-onset sepsis. METHODS: A prospective, case-control study with the infants ≤32 weeks of age with a diagnosis of culture-proven late-onset sepsis was designed. Twenty-nine preterm infants with similar gestational and postnatal ages without sepsis constituted the control group. Serum values of presepsin, fetuin-A, C-reactive protein and interleukin-6 were evaluated at the enrollment, third and seventh days of the diagnosis in the infants with positive blood culture results. RESULTS: First-day presepsin values were significantly higher in the culture-positive infants than the control group [1583 ng/L (1023-1731) vs. 426 ng/L (287-589), p = < 0.0001]. Presepsin was found to have an 88.9% sensitivity and 88.9% specificity with a cut-off value of 823 ng/ml for culture-proven LOS in our study, and area under the receiver-operating curve was 0.939. Fetuin-A levels were similar between the study and control groups (p > 0.05). CONCLUSION: Presepsin may be an accurate marker for both diagnosis and monitoring of treatment response for culture-proven late-onset sepsis in preterm infants. However, fetuin-A does not seem to be a useful tool for the diagnosis of sepsis.


Assuntos
Recém-Nascido Prematuro , Receptores de Lipopolissacarídeos/sangue , Sepse Neonatal/diagnóstico , Fragmentos de Peptídeos/sangue , alfa-2-Glicoproteína-HS/análise , Bacteriemia/sangue , Bacteriemia/diagnóstico , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro/sangue , Interleucina-6/sangue , Masculino , Sepse Neonatal/sangue , Sepse Neonatal/microbiologia , Estudos Prospectivos , Sensibilidade e Especificidade
3.
Mediterr J Hematol Infect Dis ; 11(1): e2019014, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30858952

RESUMO

Background: Neonatal sepsis remains an important and potentially life-threatening clinical syndrome and a major cause of neonatal mortality and morbidity. The aim of this study to investigate whether values of base excess before the onset of clinical signs and symptoms of sepsis indicate infection in the early diagnosis of neonatal sepsis. Methods: In this study, a total of 118 infants were enrolled. The infants were classified into two groups: group 1 (sepsis, n=49) and group 2 (control, n=69). Blood gas analysis investigated for the screening of neonatal sepsis. Results: A total of 49 newborns with neonatal sepsis and 69 healthy controls were enrolled. Comparison of markers of sepsis revealed C-reactive protein, interleukin-6 level to be significantly higher and pH, pCO2, HCO3, and base excess values to be significantly lower in newborns with sepsis compared healthy controls (p<0.01). The optimum cut-off value in the diagnosis of neonatal sepsis was found to be -5 mmol/L for base excess. Sensitivity, specificity, positive predictive value and negative predictive value of this base excess cut-off for neonatal sepsis were 75, 91, 86 and 84% respectively. Conclusion: This is the first study to determine the relationship between the decreased value of the base excess and early stage of neonatal sepsis. If the value of base excess <-5 mmol/L without an underlying another reason, may need close follow up of infants for neonatal sepsis and it may help early diagnosis.

4.
J Matern Fetal Neonatal Med ; 32(21): 3662-3665, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29921134

RESUMO

Objective: Hemodynamically significant PDA (hsPDA) is one of the most common problems in preterm infants. This study was conducted to investigate the effect of combined pharmacological (paracetamol + ibuprofen) therapy on monotherapy-resistant hsPDA in infants. Subject and methods: The study included infants with persistent hsPDA, unresponsive to monotherapy. Combined treatment (paracetamol + ibuprofen) was started as paracetamol at a dose of 15 mg/kg every 6 hours for 5 days, and ibuprofen at an initial dose of 10 mg/kg followed by 5 mg/kg at 24 and 48 hours. Echocardiographic evaluation was performed at 2 days after the end of treatment. If hsPDA persisted after the combined treatment, a surgical PDA ligation was considered. Results: A total of 12 infants were enrolled and 9 infants (75%) with monotherapy-resistant PDA were successfully treated with combined therapy. In three patients, no response was obtained to the combined treatment so surgical ligation was applied. Conclusions: Combined therapy may be a useful treatment option for monotherapy-resistant hsPDA in preterm infants. Before surgical ligations, this combined therapy option should be considered.

5.
Korean J Pediatr ; 61(10): 322-326, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30304911

RESUMO

PURPOSE: The EDIN scale (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) and heart rate variability has been used for the evaluation of prolonged pain. The aim of our study was to assess the value of the newborn infant parasympathetic evaluation (NIPE) index and EDIN scale for the evaluation of prolonged pain in preterm infants with chest tube placement due to pneumothorax. METHODS: This prospective observational study assessed prolonged pain in preterm infants with a gestational age between 33 and 35 weeks undergoing installation of chest tubes. Prolonged pain was assessed using the EDIN scale and NIPE index. RESULTS: There was a significant correlation between the EDIN scale and NIPE index (r=-0.590, P=0.003). Prolonged pain is significantly more severe in the first 6 hours following chest tube installation (NIPE index: 60 [50-86] vs. 68 [45-89], P<0.002; EDIN score: 8 [7-11] vs. 6 [4-8], P<0.001). CONCLUSION: Prolonged pain can be accurately assessed with the EDIN scale and NIPE index. However, evaluation with the EDIN scale is time-consuming. The NIPE index can provide instantaneous assessment of prolonged and continuous pain.

7.
Am J Perinatol ; 34(12): 1185-1189, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28395364

RESUMO

Objective This study aims to determine the effects of paracetamol versus ibuprofen treatment given to preterm infants for the pharmacological closure of patent ductus arteriosus (PDA) on neurodevelopmental outcomes at 18 to 24 months' corrected age. Method A follow-up study was conducted to evaluate the neurodevelopmental outcomes of preterm infants (gestational age ≤ 30 weeks) enrolled in a randomized controlled trial comparing oral paracetamol versus oral ibuprofen for the closure of PDA. The developmental assessment was done by using "Bayley Scales of Infant Development, Second Edition" at 18 to 24 months' corrected age. Results A total of 80 infants completed the trial protocol. Of the 75 infants eligible for follow-up, 61 infants (30 in the paracetamol group and 31 in the ibuprofen group) were evaluated. There was no significant difference in neurodevelopmental outcomes between the two groups. Conclusion The neurodevelopmental outcomes did not differ among the preterm infants who receive either paracetamol or ibuprofen at 18 to 24 months' corrected age.


Assuntos
Acetaminofen/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Permeabilidade do Canal Arterial/tratamento farmacológico , Ibuprofeno/uso terapêutico , Administração Oral , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Lactente Extremamente Prematuro/psicologia , Recém-Nascido , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/psicologia , Modelos Logísticos , Masculino , Turquia
8.
J Matern Fetal Neonatal Med ; 30(4): 411-415, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27045204

RESUMO

OBJECTIVE: The aim of the study was to evaluate the neurodevelopment outcomes of very low birth weight (VLBW) preterm infants supplemented with oral probiotics for the prevention of necrotizing enterocolitis (NEC). METHODS: A prospective follow-up study was performed in a cohort of VLBW preterm infants enrolled in a single center randomized controlled clinical trial to evaluate the efficacy of oral probiotics for the prevention of NEC. Cognitive and neuromotor developments were assessed by using the Bayley scales of infant development II. Sensory and neurological performance was evaluated by standard techniques. The primary outcome was neurodevelopmental impairment at 18-24 months' corrected age. RESULTS: A total of 400 infants completed the trial protocol. Of the 370 infants eligible for follow-up, 249 infants (124 in the probiotics group and 125 in the control group) were evaluated. There was no significant difference in any of the neurodevelopmental and sensory outcomes between the two groups. CONCLUSION: Oral probiotic given to VLBW infants to reduce the incidense and severity of NEC started with the first feed did not affect neuromotor, neurosensory and cognitive outcomes at 18-24 months' corrected age.


Assuntos
Desenvolvimento Infantil , Suplementos Nutricionais , Recém-Nascido de muito Baixo Peso , Transtornos do Neurodesenvolvimento/prevenção & controle , Probióticos/administração & dosagem , Pré-Escolar , Enterocolite Necrosante/prevenção & controle , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/prevenção & controle , Masculino , Estudos Prospectivos
9.
Ren Fail ; 38(6): 882-8, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27055689

RESUMO

BACKGROUND: Acute kidney injury (AKI) affects up to 60% of severely asphyxiated neonates. The diagnosis of AKI can be and is further challenged by a lack of good biomarkers. We studied the role of novel markers for AKI, neutrophil gelatinase-associated lipocalin (NGAL), interleukin-8 (IL-18), Netrin-1 (NTN-1), and sodium hydrogen exchanger isoform 3 (NHE3) on development and early diagnosis of AKI in newborns with perinatal asphyxia (PA). METHODS: Forty-one newborns with a diagnosis of PA (15 with AKI and 26 without AKI) and 20 healthy matched controls were involved to the study. Urinary samples were obtained on postnatal days 1 and 4 for patients with PA and on postnatal day 1 for the control subjects. AKI was defined using a serum creatinine-based modification of the acute kidney injury network criteria. RESULTS: The levels of NGAL, NTN-1, NHE3, and IL-18 on the first postnatal day urine samples were higher in patients compared to controls (p < 0.001, p <0.001, p  <0.02, p  <0.001, respectively). In patients with AKI, the levels of NGAL and IL-18 were higher when compared to patients without AKI (p = 0.002, p  <0.001, respectively). The levels of NTN-1 and NHE3 were similar in both groups. For the samples obtained on postnatal day 4, only NGAL levels were significantly higher in patients with AKI (p = 0.004) compared to those without AKI. CONCLUSION: To our knowledge, this is the largest study, which evaluated the utility of urinary biomarkers in the diagnosis of AKI in newborns with PA. First day, urine NGAL and IL-18 levels have an important diagnostic power in such patients.


Assuntos
Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/urina , Asfixia/urina , Interleucina-18/urina , Lipocalina-2/urina , Fatores de Crescimento Neural/urina , Trocadores de Sódio-Hidrogênio/urina , Proteínas Supressoras de Tumor/urina , Asfixia/complicações , Biomarcadores/urina , Estudos de Casos e Controles , Creatinina/sangue , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Masculino , Netrina-1 , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Trocador 3 de Sódio-Hidrogênio , Turquia
10.
Neonatology ; 109(4): 258-64, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26859512

RESUMO

BACKGROUND: Nasal continuous positive airway pressure (NCPAP) is being widely used for the treatment of respiratory distress syndrome (RDS) in preterm infants. However, there are only a few studies which compare different interfaces of NCPAP delivery and their effects on respiratory outcomes. OBJECTIVE: We aimed to determine whether NCPAP applied with binasal prongs compared to that with a nasal mask (NM) reduces the rate of moderate/severe bronchopulmonary dysplasia (BPD) in preterm infants. METHODS: Infants between 26 and 32 weeks' gestation who suffered from RDS and were treated with NCPAP were assessed. Parallel randomization was performed to eligible infants to receive NCPAP either via binasal prongs or NM. Infants were intubated if they fulfilled the predefined failure criteria. Data were collected by using the intention-to-treat principle. RESULTS: One hundred and sixty infants were screened and 149 were randomized. Seventy-five infants in the binasal prong (NP) group and 74 in the NM group were analyzed. Mean gestational ages were 29.3 ± 1.6 vs. 29.1 ± 2.0 weeks (p = 0.55), and birth weights were 1,225 ± 257 vs. 1,282 ± 312 g (p = 0.22) in the NP and NM groups, respectively. The frequency of NCPAP failure within 24 h of life was higher in the NP than the NM group (8 vs. 0%; p = 0.09). The median duration of NCPAP was significantly higher in the NP group [median 4 (1-5) vs. 2 (1-3) h, p < 0.01]. The rate of moderate and severe BPD was significantly lower in the NM (n = 2, 2.7%) when compared with the NP group (n = 11, 14.6%; p < 0.01). The BPD/death rates were not different between the 2 groups (NM group: n = 18 or 24.3%; NP group: n = 19 or 25.3%; p = 0.51). CONCLUSIONS: The NM was successfully used for delivering NCPAP in preterm infants, and no NCPAP failure was observed within the first 24 h. These data show that applying NCPAP by NM yielded a shorter duration of NCPAP and statistically reduced the rates of moderate and severe BPD.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Máscaras , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Peso ao Nascer , Displasia Broncopulmonar/etiologia , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Turquia
11.
World J Clin Pediatr ; 5(1): 75-81, 2016 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-26862505

RESUMO

Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants which is inversely related to birth weight and gestational age. Cyclooxygenase inhibitors such as indomethacin and ibuprofen which block the prostaglandin conversion from arachidonic acid are the most commonly used drugs for ductal closure. This review focuses on the safety and efficacy oral medications in the management of PDA in preterm infants. Ibuprofen seems to be the first choice due to its higher safety profile, as it is associated with fewer gastrointestinal and renal side effects when compared to indomethacin. PDA closure rates are better with oral than with intravenous ibuprofen probably due to the pharmacokinetic of the drug. However, these medications were reported to be associated with several adverse including transient renal failure, gastrointestinal bleeding and perforation, hyperbilirubinemia and platelet dysfunction. Paracetamol seems be an alternative to PDA therapy with lower adverse events and side effects.

12.
Arch Dis Child Fetal Neonatal Ed ; 101(4): F323-8, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26553376

RESUMO

OBJECTIVE: To compare the effectiveness of nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive-pressure ventilation (NIPPV) as the initial respiratory support within the minimally invasive surfactant therapy (MIST) approach in preterm infants with respiratory distress syndrome. DESIGN: Prospective, randomised controlled study. SETTING: Tertiary neonatal intensive care unit. PATIENTS AND INTERVENTIONS: This study enrolled 200 preterm infants with a gestational age of 26-32 weeks who showed signs of respiratory distress but did not require intubation in the delivery room. Surfactant therapy was performed using the MIST approach in the patients who met the criteria for surfactant administration. MAIN OUTCOME MEASURES: The primary outcomes were a need for intubation within the first 72 h of life and a surfactant requirement. RESULTS: The infants in the study displayed similar characteristics at birth. Fewer infants in the NIPPV group required surfactant therapy (38% vs 60%; p=0.002) or invasive ventilation during the first 72 h of life (13% vs 29%; p=0.005), and NIPPV reduced the rate of moderate-to-severe bronchopulmonary dysplasia (BPD) (7% vs 16%; p=0.046). Multivariate logistic regression analysis showed that NIPPV support (OR: 0.36, 95% CI 0.17 to 0.76; p=0.008) and higher gestational age (OR: 0.76, 95% CI 0.59 to 0.98; p=0.041) reduced the need for invasive ventilation within the first 72 h of life. Surfactant requirement was also decreased with NIPPV support (OR: 0.39, 95% CI 0.22 to 0.71; p=0.002). However, there was no impact on BPD, based on the multivariate analysis. CONCLUSIONS: In infants born at 26-32 weeks' gestation, NIPPV reduced the need for invasive ventilation and the surfactant requirement within the MIST approach. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov under identifier NCT01741129.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Ventilação com Pressão Positiva Intermitente , Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Ventilação com Pressão Positiva Intermitente/métodos , Masculino , Monitorização Fisiológica/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Resultado do Tratamento
13.
J Matern Fetal Neonatal Med ; 29(19): 3218-22, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26697923

RESUMO

OBJECTIVE: Platelet mass index (PMI) is related to the platelet functionality. The aim of this study was to evaluate the correlation between PMI and the occurrence of various inflammation-related morbidities of prematurity, such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis in very low-birth weight (VLBW) infants. METHODS: This retrospective analysis of VLBW infants admitted to a level 3 neonatal intensive care unit from October 2012 and 2014, n = 330. Platelet mass was calculated and recorded on the day of birth and between 3 and 7 days (second measure) for each patient. Statistical analysis included analysis of paired samples t test and independent samples t test. RESULT: Among VLBW neonates, PMI values were lower in infants with ROP (p = 0.016), BPD (p = 0.002), IVH (p = 0.018) and NEC (p = 0.011) when compared with the control group in the second measurement. CONCLUSIONS: In this study, we found that premature infants with BPD, NEC, ROP, IVH and sepsis had lower PMI levels in early postnatal life than infants without these diseases. This might be associated with the inflammatory process.


Assuntos
Plaquetas/citologia , Doenças do Prematuro/sangue , Recém-Nascido Prematuro/sangue , Recém-Nascido de muito Baixo Peso/sangue , Estudos de Casos e Controles , Sangue Fetal/citologia , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Contagem de Plaquetas , Estudos Retrospectivos , Turquia/epidemiologia
14.
J Invest Surg ; 29(1): 1-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26305557

RESUMO

PURPOSE: To determine whether prophylaxis with etanercept, an anti-inflammatory drug, would decrease the severity of lung injury in a neonatal rat model of bronchopulmonary dysplasia (BPD); MATERIALS AND METHODS: Rat pups were divided into three groups: pups exposed to room air (group 1; n = 10), to hyperoxia + placebo (group 2; n = 9), and to hyperoxia + etanercept (group 3; n = 8). Lung morphology was assessed by alveolar surface area percentage, which is a measure of alveolar size. The severities of lung inflammation and antioxidant capacity were assessed by quantifying tumor necrosis factor-α (TNF-α), transforming growth factor-ß (TGF-ß), malondialdehyde (MDA), and superoxide dismutase (SOD) from lung homogenate; RESULTS: The percentage of alveolar surface areas were significantly higher in group 3 compared to group 2 (p = .004) and similar in both group 1 and group 3 (p = .21). The mean level of lung MDA was significantly higher in group 2 compared to group 1 and group 3 (p < .05 for both). Lung homogenate SOD activities in group 3 was significantly higher than group 2 (p < .001). Furthermore, group 3 pups had lower levels of TNF-α and TGF-ß in lung homogenate than that in group 2 (p < .05 for both) but similar in both group 1 and group 3; CONCLUSION: Etanercept has favorable effects on alveolarization as well as inflammation and oxidative stress markers in a neonatal rat model of BPD.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Displasia Broncopulmonar/tratamento farmacológico , Etanercepte/uso terapêutico , Hiperóxia/complicações , Animais , Anti-Inflamatórios não Esteroides/administração & dosagem , Displasia Broncopulmonar/etiologia , Modelos Animais de Doenças , Etanercepte/administração & dosagem , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Pulmão/efeitos dos fármacos , Pulmão/metabolismo , Pulmão/fisiopatologia , Masculino , Malondialdeído/análise , Malondialdeído/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Superóxido Dismutase/análise , Fator de Crescimento Transformador beta/análise , Fator de Crescimento Transformador beta/metabolismo , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/metabolismo
15.
Arch Dis Child Fetal Neonatal Ed ; 101(2): F127-36, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26283668

RESUMO

OBJECTIVES: We performed a systematic review and meta-analysis of all the available evidence to assess the efficacy and safety of paracetamol for the treatment of patent ductus arteriosus (PDA) in neonates, and to explore the effects of clinical variables on the risk of closure. DATA SOURCE: MEDLINE, Scopus and ISI Web of Knowledge databases, using the following medical subject headings and terms: paracetamol, acetaminophen and patent ductus arteriosus. Electronic and manual screening of conference abstracts from international meetings of relevant organisations. Manual search of the reference lists of all eligible articles. STUDY SELECTION: Studies comparing paracetamol versus ibuprofen, indomethacin, placebo or no intervention for the treatment of PDA. DATA EXTRACTION: Data regarding efficacy and safety were collected and analysed. RESULTS: Sixteen studies were included: 2 randomised controlled trials (RCTs) and 14 uncontrolled studies. Quality of selected studies is poor. A meta-analysis of RCTs does not demonstrate any difference in the risk of ductal closure (Mantel-Haenszel model, RR 1.07, 95% CI 0.87 to 1.33 and RR 1.03, 95% CI 0.92 to 1.16, after 3 and 6 days of treatment, respectively). Proportion meta-analysis of uncontrolled studies demonstrates a pooled ductal closure rate of 49% (95% CI 29% to 69%) and 76% (95% CI 61% to 88%) after 3 and 6 days of treatment with paracetamol, respectively. Safety profiles of paracetamol and ibuprofen are similar. CONCLUSIONS: Efficacy and safety of paracetamol appear to be comparable with those of ibuprofen. These results should be interpreted with caution, taking into account the non-optimal quality of the studies analysed and the limited number of neonates treated with paracetamol so far.


Assuntos
Acetaminofen/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Permeabilidade do Canal Arterial/tratamento farmacológico , Humanos , Ibuprofeno/uso terapêutico , Recém-Nascido , Recém-Nascido Prematuro
17.
Korean J Pediatr ; 58(6): 230-3, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26213552

RESUMO

Lethargy in newborns usually indicates central nervous system dysfunction, and many conditions such as cerebrovascular events, infections, and metabolic diseases should be considered in the differential diagnosis. Nonketotic hyperglycinemia is an autosomal recessive error of glycine metabolism, characterized by myoclonic jerks, hypotonia, hiccups, apnea, and progressive lethargy that may progress to encephalopathy or even death. Cerebral sinovenous thrombosis is a rare condition with various clinical presentations such as seizures, cerebral edema, lethargy, and encephalopathy. Here, we report the case of a newborn infant who presented with progressive lethargy. An initial diagnosis of cerebral venous sinus thrombosis was followed by confirmation of the presence of nonketotic hyperglycinemia.

19.
J Matern Fetal Neonatal Med ; 28(17): 2115-20, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25354288

RESUMO

OBJECTIVE: Our objective was to determine the neurodevelopmental outcome at 18-24 months' of corrected age (CA) in preterm infants with severe intraventricular hemorrhage (IVH). METHODS: This was a retrospective cohort study of all preterm infants who were <37 weeks' gestation, had Grade 3-4 IVH, were admitted between January 2009 and December 2010 and discharged. The cohort was divided into three groups. Group 1 was defined as infants born with a birth weight (BW) less than 1000 g, group 2 was defined as infants born with a BW between 1000 and 1500 g and group 3 was defined as infants born with a BW between 1501 and 2500 g. Severe IVH was defined as the presence of grade 3-4 IVH on cranial ultrasound. Cranial ultrasound was performed in the first week of life and subsequently at weekly intervals by a radiologist. A comprehensive assessment including hearing, vision, neurological and developmental evaluation with Bayley Scales of Infant Development, Second edition was performed by the experienced researchers at 18-24 months' CA. Neurodevelopmental impairment (NDI) was defined as at the presence of one or more of the following: cerebral palsy; Mental Developmental Index score lower than 70; Psychomotor Developmental Index score lower than 70; bilateral hearing impairment; or bilateral blindness. RESULTS: From January 2009 to December 2010, a total of 138 infants were diagnosed as severe IVH (grade 3-4). Of them, 74 (71.1%) infants (group 1 = 31, group 2 = 29 and group 3 = 14 infants) completed the follow-up visit and evaluated at 18-24 months' CA. Median Apgar score (p < 0.01) and resuscitation at birth (p < 0.01) were significantly different for groups 1-3. The use of catheterization, need for mechanical ventilation, need for phototherapy, retinopathy of premature and bronchopulmonary dysplasia were significantly higher in group 1 compared to groups 2 and 3 (p < 0.001, p < 0.001, p < 0.01, p < 0.01 and p = 0.014, respectively). The duration of hospitalization and mortality rates consistent with the degree of prematurity were significantly higher in group 1 compared to groups 2 and 3 (p = 0.03 and p = 0.01). Among the long-term outcomes, the rates of CP and NDI did not differ between the groups (p = 0.68 and p = 0.068). CONCLUSION: Our results demonstrated that long-term outcomes of preterm infants did not differ between the groups classified according to the BW at two years of age. This has leaded to the conclusion that severe IVH is alone represents a significant risk factor for poor neurodevelopmental outcome in this already high-risk population.


Assuntos
Doenças do Prematuro/fisiopatologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Hemorragias Intracranianas/fisiopatologia , Transtornos do Neurodesenvolvimento/epidemiologia , Peso ao Nascer , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/epidemiologia , Estudos de Coortes , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Transtornos do Neurodesenvolvimento/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia
20.
Curr Drug Saf ; 10(2): 106-12, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25323589

RESUMO

Patent ductus arteriosus (PDA) is the most common cardiac condition in preterm infants. The most commonly used drugs for this purpose are cyclooxygenase inhibitors, mainly indomethacin and ibuprofen, which block the conversion of arachidonic acid to prostaglandins. On the other hand, several adverse effects have been reported with such medications, including peripheral vasoconstriction, gastrointestinal bleeding and perforation, weakened platelet aggregation, hyperbilirubinemia and renal failure. The role of oral paracetamol as an alternative treatment for the closure of PDA has gained importance in recent years. In this review, we aimed to determine safety of therapeutic drugs used in management of PDA in preterm infants rather than their efficacy in ductal closure. Two worldwide commonly used therapeutics (indomethacin and ibuprofen) and a new alternative medication as paracetamol are discussed. Ibuprofen seems to be the first choice due to its higher safety profile, as it is associated with fewer gastrointestinal and renal side effects than indomethacin. Recent studies suggest that paracetamol may be a medical alternative in the management of PDA with low adverse events and side effects.


Assuntos
Inibidores de Ciclo-Oxigenase/efeitos adversos , Inibidores de Ciclo-Oxigenase/uso terapêutico , Permeabilidade do Canal Arterial/tratamento farmacológico , Acetaminofen/efeitos adversos , Acetaminofen/uso terapêutico , Feminino , Humanos , Ibuprofeno/efeitos adversos , Ibuprofeno/uso terapêutico , Indometacina/efeitos adversos , Indometacina/uso terapêutico , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Gravidez
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