Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23
Filtrar
1.
Am J Perinatol ; 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666386

RESUMO

OBJECTIVE: To evaluate the correlation between the oxygen index (OI) and the oxygen saturation index (OSI, measured by pulse oximetry and noninvasively) in neonates with acute respiratory failure and to predict the OI from the OSI. STUDY DESIGN: A retrospective cohort study was conducted in neonates requiring invasive mechanical ventilation who had arterial blood gas between 2018 to 2019 at a neonatal intensive care unit. The correlation between OI and OSI was analyzed by using the Pearson correlation coefficient. RESULTS: A total of 636 measurements from 68 neonates (35 preterm and 33 terms) were recruited into the study. There was a strong correlation between the OI and the OSI (r = 0.90) in all neonates. The correlation between the OI and the OSI in persistent pulmonary hypertension of the newborn, congenital cyanotic heart disease, and other causes of respiratory failure also showed a strong correlation (r = 0.88, 0.93, and 0.88, respectively). The correlation was strong in neonates with an oxygen saturation less than 85% (r = 0.88), those with oxygen saturation ranging from 85% to 95% (r = 0.87), and also in preterm and term infants (gestational age < 28, 28-34, 34-36, and ≥ 37 weeks, r = 0.87, 0.92, 0.89, and 0.90, respectively). There were strong accuracy measures of the OI for OI cutoffs of 5, 10, 15, and 20 (area under the curve > 0.85). The equation relating the OI and OSI was represented by: OI = (2.3 × OSI) - 4. CONCLUSIONS: The OSI has a strong correlation with the OI, is a reliable assessor of the severity of respiratory failure in neonates without arterial sampling, and has high accuracy when the OI < 40.

2.
J Trop Pediatr ; 67(3)2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34345902

RESUMO

OBJECTIVES: The purpose of the study was to determine the clinical features of NLE and to compare the neonatal outcomes between newborns born to pregnant women with SLE and healthy pregnant women. METHODS: We conducted a retrospective cohort analysis between 2007 and 2019 in a tertiary referral hospital in Thailand. A total of 118 pregnant women with SLE with 132 neonates compared with 264 randomly selected healthy pregnant women. RESULTS: The median (interquartile range) gestational age and birth weight of 132 neonates born to women with SLE were 37 (35-38) weeks and 2687 g (2045-3160 g), respectively. The clinical features of NLE infants were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. Moreover, logistic regression analysis found that neonates born to women with SLE increased the risk of preterm birth [odd ratio (OR) 8.87, 95% confidence interval (95% CI) 4.32-18.21, p < 0.001], low birth weight (OR 10.35, 95% CI 5.08-21.08, p < 0.001), birth asphyxia (OR 2.91, 95% CI 1.26-6.73, p = 0.011) and NICU admission (OR 4.26, 95% CI 2.44-7.42, p < 0.001). SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE. CONCLUSION: The major clinical features of NLE patients were hematologic and hepatobiliary abnormalities in our study. Pregnancies with SLE dramatically increased the risk of preterm delivery and neonatal complications. LAY SUMMARY: Neonatal lupus erythematosus (NLE) is the consequence of the transplacental passage of autoantibodies to newborns during pregnancy. The clinical features of NLE infants in our study were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. We also compared the neonatal outcomes between 118 pregnant women with SLE and 264 randomly selected healthy pregnant women. Our study found that the neonates born to women with SLE increased the risk of preterm birth, low birth weight, birth asphyxia and NICU admission. Moreover, SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE.


Assuntos
Lúpus Eritematoso Sistêmico , Complicações na Gravidez , Nascimento Prematuro , Feminino , Humanos , Lactente , Recém-Nascido , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gestantes , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Tailândia/epidemiologia
3.
J Infect Dev Ctries ; 15(7): 1021-1026, 2021 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-34343128

RESUMO

INTRODUCTION: This study aimed to compare the risks and case fatality rate (CFR) between neonatal multidrug-resistant (MDR) and non-MDR meningitis. METHODOLOGY: a secondary analysis of a case-control studies in a Thai neonatal intensive care unit between 1990 and 2018 was performed. The pathogenic organisms causing neonatal meningitis were Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae, Acinetobacter spp., and Pseudomonas aeruginosa. A MDR organism was defined as an isolate that was non-susceptible to at least 1 agent in at least 3 antimicrobial categories. The multivariate regression was analyzed for MDR and non-MDR samples of neonatal meningitis. RESULTS: Over a period of 29 years, the number of neonatal MDR and non-MDR meningitis cases were 17 and 21, respectively. The medians (interquartile ranges) of gestational age, birthweight and onset of meningitis were 35 (29.5-38) weeks, 1,945 (1,218-2,859) grams and 6.5 (2.8-17.9) days, respectively. The most common organism was Acinetobacter baumannii (32%). By multivariate analysis, neonates who had MDR meningitis were more likely to have a lower Apgar score at 5 minutes (adjusted odds ratio: 95% confidence intervals = 0.66 [0.44-0.99], p = 0.04). The crude CFR of neonatal meningitis was 32%. Non-survivors in MDR meningitis (58.8%) were significantly higher than non-MDR meningitis (9.5%, p = 0.004). The most common pathogen in non-survivors was carbapenem-resistant Acinetobacter baumannii. CONCLUSIONS: Neonatal MDR meningitis has an association with lower APGAR scores, and higher CFR as well as Acinetobacter baumannii. Multifaceted infection prevention, and control programs for MDR organisms are crucial, and must be strictly implemented in high MDR areas.

4.
Pediatr Infect Dis J ; 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34260484

RESUMO

BACKGROUND: Acinetobacter baumannii sepsis constitutes an extreme threat with a poor prognosis and is a difficult infection to control, especially in Asia. Moreover, a knowledge gap in the risk of mortality in neonatal A. baumannii sepsis still exists. METHODS: This study aimed to identify the risk factors of mortality in neonates with A. baumannii sepsis in Thailand from 1996 to 2019. A multivariable logistic regression model was analyzed for nonsurvivors and survivors of neonatal A. baumannii sepsis. RESULTS: In a 24-year period, 91 neonates with A. baumannii sepsis were reviewed. The median (interquartile range) gestational age and birth weight were 33 (28.5, 37.5) weeks and 1740 (987.5, 2730.0) g, respectively. The 30-day case fatality rate was 36.3% (33/91). In univariable analysis, nonsurvivors of neonatal A. baumannii sepsis was associated with smaller neonates, lower Apgar scores, septic shock, mechanical ventilation, umbilical catheterization, neutropenia, severe thrombocytopenia, carbapenem-resistant A. baumannii sepsis, inadequate empiric antimicrobial therapy, and acute kidney injury. In multivariable analysis, nonsurvivors of neonatal A. baumannii sepsis were associated with septic shock (adjusted odds ratio [OR] = 41.38; 95% confidence intervals [CI]: 3.42-501.13; P = 0.003), severe thrombocytopenia (adjusted OR = 33.70; 95% CI: 3.44-330.55; P = 0.002), and inadequate empiric antimicrobial therapy (adjusted OR = 10.05; 95% CI: 1.40-71.98; P = 0.02). CONCLUSION: In high multidrug-resistant areas, empiric treatment with broader spectrum antimicrobials should be considered in neonates with sepsis shock or severe thrombocytopenia.

5.
Infect Control Hosp Epidemiol ; 41(6): 710-715, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32131902

RESUMO

OBJECTIVE: To investigate the effects of environmental cleaning and the installation of heat and moisture exchangers (HMEs) to reduce neonatal carbapenem-resistant Acinetobacter baumannii (CRAB) sepsis and colonization as well as antimicrobial use. DESIGN: We conducted a 7-year, quasi-experimental study. SETTING AND PATIENTS: All neonates admitted to a neonatal intensive care unit (NICU). METHODS: We compared the trends for CRAB sepsis and colonization before (period 1, 2011-2013) and after (period 3, 2015-2017) a 12-month intervention period in 2014 (period 2) to incorporate a combination of HME use and sodium hypochlorite cleaning (5,000 ppm in the NICU and 500 ppm in the neonatal environment) using interrupted time series analysis with segmented regression. RESULTS: During the 7-year study period, 3,367 neonates were admitted to the NICU; the prevalence rates of CRAB sepsis and endotracheal CRAB colonization were 0.5 per 1,000 patient days, and 19.4 per 1,000 ventilator days. A comparison of period 1 to period 3 showed significant decreases in the percentages of both CRAB of A. baumannii sepsis (100% versus 11%) and endotracheal colonization (76% vs 52%) following the introduction of disposable HMEs and sodium hypochlorite cleaning (both P < .001). In period 3, compared with period 1, segmented regression analysis showed significant reductions in endotracheal CRAB colonization per 1,000 ventilator days (ie, change in level) and both carbapenem and colistin use (changes in both level and slope) (P < .001). CONCLUSIONS: Interventions featuring environmental cleaning and use of HMEs led to a sustainable reduction of CRAB colonization coupled with a reduction in broad-spectrum antimicrobial use in the NICU.

6.
Am J Perinatol ; 37(4): 409-414, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30780186

RESUMO

OBJECTIVE: This study aimed to compare the endotracheal reintubation between nasal high-frequency oscillation (nHFO) and nasal continuous positive airway pressure (nCPAP) with face mask groups who were followed up for up to 7 days. STUDY DESIGN: We performed a retrospective cohort study of extubated neonates admitted between 2013 and 2017. We used a Cox's proportional hazards model to adjust for significant between-group differences in baseline characteristics. RESULTS: One hundred and ninety-nine neonates were on either nHFO or nCPAP after extubation. The median (interquartile range) gestational age and birth weight were 31 (29, 33) weeks and 1,450 (1,065, 1,908) grams, respectively. From the univariate analysis, gestational age, ventilator modes, mean airway pressure, fraction of inspired oxygen, oxygen index, caffeine therapy, and initial continuous positive airway pressure level were significantly different between the nHFO and nCPAP groups. There was no significant difference in the 7-day reintubation rate of neonates on nHFO compared with nCPAP (hazard ratio: 2.39; 95% confidence interval: 0.97-5.84; p = 0.05). By multivariate analysis, there was no statistically significant difference of reintubation rate between nHFO and nCPAP by Cox's proportional hazards model. CONCLUSION: The nHFO mode with face mask is the choice for noninvasive ventilation to prevent reintubation during the week following extubation.


Assuntos
Extubação , Pressão Positiva Contínua nas Vias Aéreas , Ventilação de Alta Frequência , Estudos Retrospectivos , Análise de Variância , Feminino , Ventilação de Alta Frequência/instrumentação , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Intubação Intratraqueal , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais
7.
Am J Perinatol ; 37(7): 689-694, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31087314

RESUMO

OBJECTIVE: Multidrug-resistant gram-negative bacilli (MDR-GNB) have emerged globally as a serious threat and with a high case fatality rate (CFR). STUDY DESIGN: We performed a case-control study in a Thai neonatal intensive care unit to identify the risk factors for 30-day CFR of GNB sepsis between 1991 and 2017. The CFR was analyzed by Cox's proportional hazards model. RESULTS: For 27 years, the percentage of MDR-GNB from GNB sepsis was 66% (169/257). The medians (interquartile ranges) of gestational age and birth weight of the neonates with GNB sepsis were 33 (29-38) weeks and 1,817 (1,100-2,800) grams, respectively. The 30-day CFRs of the neonates with MDR-GNB and non-MDR-GNB sepsis were 33% (56/169) and 20% (18/88), respectively, (hazard ratio [HR] = 1.74; 95% confidence interval [CI]: 1.03-2.97; p = 0.04). Using Cox's proportional hazards model, nonsurvivors in GNB sepsis were more likely to have septic shock (adjusted HR [aHR] = 6.67; 95% CI: 3.28-13.57; p < 0.001) or no microbiological cure (aHR = 10.65; 95% CI: 4.98-22.76; p < 0.001) than survivors. CONCLUSION: Neonates suspected of sepsis with septic shock need broad-spectrum empirical antimicrobial therapy until the second successive negative culture, especially in high MDR areas.


Assuntos
Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/mortalidade , Sepse Neonatal/mortalidade , Análise de Variância , Peso ao Nascer , Estudos de Casos e Controles , Farmacorresistência Bacteriana Múltipla , Feminino , Idade Gestacional , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/microbiologia , Fatores de Risco , Análise de Sobrevida
8.
Pediatr Int ; 61(8): 812-816, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31264305

RESUMO

BACKGROUND: Congenital pulmonary malformations (CPM) are a group of rare abnormal lung development lesions that can have various presentations. The aim of this study was to define the differences in the clinical presentations of CPM in neonates, infants, and children, and to review the outcomes. METHODS: A retrospective study was conducted at a tertiary care hospital in southern Thailand between 1992 and 2016. RESULTS: Fifty-four patients were diagnosed with CPM, and the median age at onset was 1.7 months (IQR, 0.03-10 months). There were 33 cases (61.1%) of congenital pulmonary airway malformations, two (3.7%) of bronchogenic cyst, eight of (14.8%) congenital lobar emphysema, seven of (13.0%) pulmonary sequestrations, and four of (7.4%) congenital lung cysts. Twenty patients under 1 month old and 16 patients who were 1-12 months old had symptoms of respiratory distress. In contrast, 13 patients >1 year old had symptoms of pulmonary infection. There were significant differences in the numbers of patients who had cyanosis (P = 0.006), cough (P < 0.001), and fever (P < 0.001) between the three age groups. Thirty-eight patients (70%) required surgical treatment involving lobectomy (78.9%). Median follow-up duration was 28.1 months (IQR, 3.7-9.4 months). Nine of 10 patients had abnormal lung function tests, and 80.6% of patients had no subsequent limitations in physical activities. CONCLUSIONS: Respiratory distress is the important clinical feature in neonates and infants, whereas the signs of pulmonary infection usually occur in children >1 year old. Good outcomes usually occur after surgery but need long-term follow up including lung function assessment.


Assuntos
Pulmão/anormalidades , Anormalidades do Sistema Respiratório/diagnóstico , Terapia Combinada , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Anormalidades do Sistema Respiratório/fisiopatologia , Anormalidades do Sistema Respiratório/terapia , Estudos Retrospectivos , Tailândia , Resultado do Tratamento
9.
Indian J Pediatr ; 86(4): 347-353, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30790187

RESUMO

OBJECTIVE: To evaluate the association between red blood cell (RBC) transfusion leading to necrotizing enterocolitis (NEC) within 48 h, known as transfusion-associated necrotizing enterocolitis (TANEC). METHODS: A nested case-control study using historical data was conducted in the neonatal intensive care unit of Songklanagarind Hospital, Thailand. All very low birth weight (VLBW) infants delivered between November 2009 and July 2016 were enrolled. The infants were identified as RBC transfusion received and NEC developed. Logistic regression was used to evaluate risk factors for transfusion and the association between RBC transfusion and NEC. RESULTS: Four hundred and forty-four VLBW infants were enrolled in the study. The median (interquartile range) gestational age was 29 (27, 31) wk. The overall incidence of NEC was 13%. Three (5.2%) of the NEC infants had TANEC. The infants who received RBC transfusion had a lower gestational age [odds ratio, OR 0.64; 95% confidence interval (95%CI) 0.57, 0.73, p < 0.001] and were more likely to have pneumonia (OR 9.86; 95%CI 5.02, 19.35, p < 0.001) or to have received H2 blocker (OR 2.92; 95%CI 1.73, 4.93, p < 0.001). The ORs (95% CI) after adjusting for confounders, the association between RBC transfusion and NEC for transfusions ≤2 d, >2 to 4 d, and > 4 to 6 d prior to NEC were 1.83 (0.41, 8.16; p = 0.43), 1.7 (0.26, 11.16; p = 0.58) and 1.19 (0.31, 4.62; p = 0.80) respectively. CONCLUSIONS: After controlling of confounders, no evidence of association was found between RBC transfusion and TANEC.


Assuntos
Enterocolite Necrosante/etiologia , Transfusão de Eritrócitos/efeitos adversos , Recém-Nascido de muito Baixo Peso , Estudos de Casos e Controles , Enterocolite Necrosante/epidemiologia , Transfusão de Eritrócitos/métodos , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Fatores de Risco , Tailândia/epidemiologia
11.
J Infect Dev Ctries ; 13(7): 603-611, 2019 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32065817

RESUMO

INTRODUCTION: To identify the risks and outcomes for multidrug-resistant Gram-negative bacilli (MDRGNB) sepsis in neonates. METHODOLOGY: This was a retrospective case-case-control study between 1991 and 2016. The control group was selected from the same source records of all neonates with clinical or suspected sepsis but not culture-proven. RESULTS: The numbers of patients in the MDRGNB sepsis, non-MDRGNB sepsis, and control groups were 157, 88, and 218, respectively. MDRGNB sepsis was significantly associated with outborn infants [adjusted odds ratio (aOR) 2.08; p = 0.003] and infants who had a neurologic sequela (aOR 11.58; p = 0.04), lower gestational age (p = 0.03) or previous aminoglycoside use (aOR 2.43; p < 0.001) compared with the control group. Non-MDRGNB sepsis was associated with outborn infants (aOR 2.63; p < 0.001), and infants who had neurologic sequelae (aOR 48.25; p = 0.001) and previous cephalosporin use (aOR 6.28; p < 0.001) or cefoperazone plus sulbactam use (aOR 6.48; p = 0.02) compared with the control group. Case fatality (OR 3.63; p < 0.001) and septic shock (OR 12.81; p < 0.001) rates, length of stay (p < 0.001), and daily hospital costs (p = 0.01) were higher in the MDRGNB sepsis group than in the control group. CONCLUSIONS: Smaller preterm neonate with previous aminoglycoside use had a higher MDRGNB than non-MDRGNB sepsis compared with the control group. Intervention to reduce MDRGNB sepsis in the NICU is cost-effective.


Assuntos
Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Sepse Neonatal/epidemiologia , Estudos de Casos e Controles , Infecção Hospitalar/microbiologia , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Sepse Neonatal/microbiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
12.
Pediatr Neonatol ; 59(1): 58-64, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28735030

RESUMO

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) contributes to neonatal hypoxemia and is associated with a high mortality. Some PPHN patients are unresponsive to inhaled nitric oxide (iNO). Bosentan, an oral endothelin-1 receptor antagonist, reduces pulmonary vascular resistance and hence may play a role in the treatment of PPHN. METHODS: A retrospective medical records review was performed in newborns who received oral bosentan as an adjunctive therapy for treatment of PPHN between January 2013 and February 2016 at the neonatal intensive care unit of Songklanagarind Hospital. The main outcomes were the effect of bosentan on oxygenation and hemodynamic status after commencement of treatment and the safety of bosentan. RESULTS: Forty neonates at a median (IQR) gestation of 38 (36.8-40) weeks and an initial median (IQR) oxygen index (OI) of 29.2 (13.4-40.1) received bosentan therapy. Oral bosentan was commenced at a median (IQR) age of 27 (14.5-40.2) hours and the mean (SD) duration of treatment was 6.2 (3.1) days. The OI, alveolar-arterial oxygen difference (AaDO2) and oxygen saturation (SpO2) improved significantly at 2 h after treatment (p = 0.002, p = 0.01 and p < 0.001, respectively). In 21 (52.5%) neonates who received iNO and bosentan, the median OI (IQR) was 34.2 (29.0-42.6) with a significant decrease of OI at 6 h (p = 0.005) after treatment. In 19 (47.5%) neonates who received bosentan alone, the median OI (IQR) was 13.0 (9.8-30.9) with a significant decrease of OI in 2 h (p = 0.01) after treatment. The blood pressures before and after bosentan treatment were not statistically significantly different. The mortality rate was 12.5% (5/40). CONCLUSION: Oral bosentan may be a safe and effective treatment to improve oxygenation in neonates with PPHN. Bosentan can be used as an adjuvant therapy with iNO and can be an alternative therapy option in mild-to-moderate PPHN.


Assuntos
Antagonistas dos Receptores de Endotelina/uso terapêutico , Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Sulfonamidas/uso terapêutico , Administração Oral , Bosentana , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
13.
World J Pediatr ; 13(4): 328-334, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28120236

RESUMO

BACKGROUND: Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome. This study aimed to compare the incidence, risk factors, and outcomes of VAP and non- VAP conditions in neonates. METHODS: We performed a prospective cohort study in a neonatal intensive care unit (NICU) in Thailand from January 2014 to December 2014. All neonatal patients who were ventilated more than 48 hours were enrolled. RESULTS: There were 128 enrolled patients. The median (inter quartile range) gestational age and birthweight were 35 (30.2, 37.8) weeks and 2380 (1323.8, 3020.0) g. There were 17 VAP patients (19 episodes) and 111 non-VAP ones. The VAP rate was 13.3% or 10.1 per 1000 ventilator days. According to the multivariate analysis, a birthweight less than 750 g [adjusted odds ratio (aOR)=10.75, 95% confidence interval (CI)=2.35-49.16; P=0.002] and sedative medication use (aOR=4.00, 95% CI=1.23-12.50; P=0.021) were independent risk factors for VAP. Compared with the non-VAP group, the median difference in the VAP group yielded a significantly longer duration of NICU stay (18 days, P=0.001), total length of hospital stay (16 days, P=0.002) and higher hospital costs ($5113, P=0.001). The inhospital mortality rate in the VAP and non-VAP groups was 17.6% and 15.3% (P=0.73), respectively. CONCLUSIONS: A neonatal birthweight less than 750 g and sedative medication use were independent risk factors for VAP. Our VAP patients experienced a longer duration of both NICU and hospital stay, and incurred higher hospitalization costs.


Assuntos
Mortalidade Hospitalar , Pneumonia Associada à Ventilação Mecânica/mortalidade , Pneumonia Associada à Ventilação Mecânica/terapia , Estudos de Coortes , Terapia Combinada , Progressão da Doença , Feminino , Hospitais Pediátricos , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Modelos Logísticos , Masculino , Análise Multivariada , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Tailândia , Resultado do Tratamento
14.
J Infect Chemother ; 22(7): 444-9, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27229539

RESUMO

BACKGROUND: Carbapenem-resistant and susceptible Acinetobacter baumannii (CRAB and CSAB) have emerged as serious threats among critically ill neonates. We aimed to identify the risks and outcomes for CRAB and CSAB ventilator-associated pneumonia (VAP) compared with a control group. METHODS: We performed a retrospective and case-case-control study in a neonatal intensive care unit between 2009 and 2014. RESULTS: The numbers of patients in the CRAB VAP, CSAB VAP, and control groups were 63, 13, and 25, respectively. The mean gestational ages and median birthweights of CRAB VAP, CSAB VAP, and control groups were 33.2, 35.0, and 32.6 weeks and 1800, 2230, and 2245 g, respectively. By multivariate analysis, infants who had a birthweight of 1000-1499 g (P = 0.04), cesarean section (P = 0.01), history of cephalosporin use (P = 0.02), and surfactant replacement (P = 0.01) in CRAB VAP were significantly higher than in the control group. Inborn infant (P = 0.01), reintubation (P = 0.04), and umbilical artery catheterization (P = 0.04) in the CRAB VAP group were significantly more than in the CSAB VAP group. The crude mortality rates (CMRs) of CRAB VAP and CSAB VAP were 15.9% and 7.7%, respectively. By univariate analysis, the CMR, septic shock, and bronchopulmonary dysplasia in CRAB VAP were higher than in the control group. CONCLUSIONS: There are very high mortality and short-term morbidity rates in CRAB VAP. Surfactant replacement therapy, fewer cesarean sections, and the reduced use of cephalosporin in very preterm infants may reduce CRAB VAP.


Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Estudos de Casos e Controles , Cefalosporinas/administração & dosagem , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Surfactantes Pulmonares/administração & dosagem , Fatores de Risco , Resultado do Tratamento
15.
Indian Pediatr ; 50(10): 934-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23798625

RESUMO

OBJECTIVE: The aims of this study were to determine the effectiveness (oxygenation), safety (hemodynamic status) and short term outcomes of intravenous iloprost (IVI) administration as a rescue therapy in severe persistent pulmonary hypertension of the newborn (PPHN). DESIGN: Retrospective medical records review. SETTING: Tertiary neonatal intensive care unit at Songklanagarind Hospital, Songkhla Province, Hat Yai, Thailand. PARTICIPANTS: Newborns who received IVI as an adjunctive therapy for treatment of severe PPHN, as defined by an oxygen index (OI) of >20 and without response to conventional therapies. MAIN OUTCOME MEASURES: The change of OI and alveolar-arterial oxygen difference before and after commencement of IVI. RESULTS: 33 neonates with severe PPHN at a median gestation of 39 weeks and a baseline OI of 40 (range, 21-101) received IVI. The median OI and alveolar-arterial oxygen difference had a statistically significant decrease after 2 hours of treatment and continued to decline thereafter (P<0.05). All infants received one or more inotropic medications and volume expanders to provide blood pressure support with no statistically significant difference of blood pressure and heart rate before and after IVI treatment. The mortality rate was 15.2%, all of them had initially severe hypoxemia with a median OI of 53.6. CONCLUSION: Triglyceride and non-high-density lipoprotein cholesterol are better than low-density lipoprotein cholesterol as predictors of cardiovascular disease risk factors in Chinese Han children and adolescents.


Assuntos
Iloprosta/administração & dosagem , Iloprosta/efeitos adversos , Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Vasodilatadores/administração & dosagem , Vasodilatadores/efeitos adversos , Administração Intravenosa , Feminino , Humanos , Recém-Nascido , Masculino , Oxigênio/metabolismo , Estudos Retrospectivos , Fatores de Risco
16.
Pediatr Infect Dis J ; 32(2): 140-5, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22935872

RESUMO

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a serious threat among critically ill neonates. METHODS: We performed a case-case-control study in a Thai neonatal intensive care unit to identify risk factors and outcomes for CRAB bacteremia. Case group (CG) I was defined as cases with CRAB (n = 14), and CG II was defined as cases with carbapenem-susceptible A. baumannii (n = 38) bacteremia. The control group (n = 44) was selected from all patients admitted before and after 3 days that CG I was identified, but had no infection. RESULTS: The mean gestational age and birth weight of CG I, II and control were 33.5, 35.2 and 35.2 weeks and 1856.5, 2273.9 and 2309.5 g, respectively. By multivariate analysis, CG I was more likely to have had an umbilical artery catheter (adjusted odds ratio = 29.30; P = 0.019) whereas CG II was more likely exposed to ceftazidime (adjusted odds ratio = 5.19; P = 0.046) and aminoglycosides (adjusted odds ratio = 35.59; P = 0.002). There was a significant difference in history of cefoperazone/sulbactam (21.4% versus 0%; P = 0.01) and imipenem use (35.7% versus 0%; P < 0.001) among CG I compared with control. Crude mortality in CG I was higher than CG II (42.9% versus 13.2%; odds ratio = 5.0; P = 0.02). CONCLUSION: Our cohort of neonatal CRAB bacteremia is characterized by a very high mortality. Infection-control interventions inclusive of strict adherence to infection-control process for central vascular line placement and maintenance as well as antimicrobial stewardship program are essential to help reduce CRAB bacteremia.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/isolamento & purificação , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/efeitos dos fármacos , Análise de Variância , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Carbapenêmicos/farmacologia , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Razão de Chances , Fatores de Risco , Estatísticas não Paramétricas , Tailândia/epidemiologia , Resultado do Tratamento , Resistência beta-Lactâmica
17.
Artigo em Inglês | MEDLINE | ID: mdl-23082565

RESUMO

We report a case of neonatal meningitis due to Streptococcus gallolyticus subsp. pasteurianus born to a mother with an asymptomatic urinary tract infection due to Streptococcus group D and Escherichia coli. In the past, this organism may have been reported as Streptococcus bovis or S. bovis biotype II/2. Accurate identification of this organism is necessary to determine the etiology of infection and give correct treatment of neonatal meningitis, caused by this organism.


Assuntos
Meningites Bacterianas/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus bovis/isolamento & purificação , Humanos , Recém-Nascido , Masculino , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico
18.
Indian J Pediatr ; 79(5): 673-5, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21732018

RESUMO

Congenital hepatic arteriovenous malformation is a rarely seen vascular malformation with persistent pulmonary hypertension in neonates. The authors report a full-term female newborn presenting with intractable heart failure and respiratory distress soon after birth. Investigation by echocardiography showed severe persistent pulmonary hypertension of the newborn and patent ductus arteriosus. The hepatic angiogram revealed congenital hepatic arteriovenous malformation; therefore, secondary pulmonary artery hypertension complicated with 'steal' phenomenon was conclusively diagnosed.


Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Artéria Hepática/anormalidades , Veias Hepáticas/anormalidades , Hipertensão Pulmonar/etiologia , Malformações Arteriovenosas/complicações , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico por imagem , Evolução Fatal , Feminino , Artéria Hepática/diagnóstico por imagem , Veias Hepáticas/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Recém-Nascido , Radiografia , Ultrassonografia
19.
Nephrol Dial Transplant ; 27(3): 973-7, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21956250

RESUMO

BACKGROUND: Acute kidney injury (AKI) is a common contributor to morbidity and mortality in newborns, with prevalences varying by population and hospital. A study of AKI in newborns in tertiary care centers in Thailand, a developing country with limited resources, has not been conducted yet. METHODS: The aim of this study was to determine the prevalence of AKI in newborns in a tertiary care hospital in southern Thailand and to investigate the etiology, mortality and risk factors of mortality. The records of patients aged <30 days with high serum creatinine, admitted from 1984 to 2007, were retrospectively reviewed. RESULTS: Eighty-eight boys and 51 girls were enrolled; 61.4% were premature and 56.5% had a birth weight <2500 g. The prevalence of newborn AKI increased from 0.9 to 6.3% during the 24-year study period. Thirty-nine and 65% had renal failure within 2 and 7 days post-birth, respectively. Sepsis was the most common cause of AKI (30.9%) followed by hypovolemia (18.7%), kidney, ureter and bladder (KUB) anomalies (12.2%), congestive heart failure (12.2%) and birth asphyxia (11.5%). Indomethacin caused AKI in 24.4% with gestational age <32 weeks. Sepsis-induced AKI had the highest mortality rate (65.1%) with an overall mortality rate of 38.8% and nearly 14 times the risk of death compared to hypovolemia-induced AKI. CONCLUSIONS: The prevalence of newborn AKI in our Thai tertiary center over 24 years was 6.3% of admitted newborns. Sepsis was the most common cause of AKI and sepsis-induced AKI is the most common cause of death. Disease etiology was the only risk factor for mortality.


Assuntos
Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Sepse/complicações , Sepse/epidemiologia , Injúria Renal Aguda/mortalidade , Países em Desenvolvimento , Feminino , Humanos , Recém-Nascido , Masculino , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sepse/mortalidade , Taxa de Sobrevida , Tailândia/epidemiologia
20.
Blood Cells Mol Dis ; 45(1): 29-32, 2010 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-20421175

RESUMO

Southeast Asian Ovalocytosis (SAO), the most common red cell membrane disorder found in the Far-East and Pacific rim, appears to be innocuous in man since it has been identified mostly in non-anemic healthy individuals. To further substantiate our previous observation that this condition might be symptomatic particularly in the neonatal period, we studied 1567 newborns from Southern Thailand where SAO is prevalent. Thirty-one babies (1: 50 with allele frequency of 0.01) have been identified with SAO and confirmed molecularly to carry a single defective AE-1 (band 3) allele. These babies had significant anemia at birth due to hemolysis with 51.6% of them developing neonatal hyperbilirubinemia. Co-inheritance of common UGT1A1 variants in such cases was not associated with their degree of jaundice. Interestingly, hematology data of these SAO babies became "normalized" in the first 3 years of life without further evidence of on-going and/or even "compensated" hemolysis.


Assuntos
Alelos , Proteína 1 de Troca de Ânion do Eritrócito/genética , Grupo com Ancestrais do Continente Asiático/genética , Eliptocitose Hereditária/genética , Pré-Escolar , Eliptocitose Hereditária/complicações , Feminino , Frequência do Gene , Glucuronosiltransferase/genética , Hemólise , Humanos , Hiperbilirrubinemia Neonatal/etiologia , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Tailândia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...