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1.
An Pediatr (Barc) ; 2020 Jan 08.
Artigo em Espanhol | MEDLINE | ID: mdl-31926888

RESUMO

INTRODUCTION: Extreme prematurity is associated with high mortality rates. The probability of death at different points in time is a priority for professionals and parents, and needs to be established on an individual basis. The aim of this study is to carry out a systematic review of predictive models of mortality in premature infants that have been published recently. METHODS: A double search was performed for article published in PubMed on models predicting mortality in premature neonates. The population studied were premature neonates with a gestational age of ≤30 weeks and / or a weight at birth of ≤1500g. Works published with new models from June 2010 to July 2019 after a systematic review by Medlock (2011) were included. An assessment was made of the population, characteristics of the model, variables used, measurements of functioning, and validation. RESULTS: Of the 7744 references (1st search) and 1435 (2nd search) found, 31 works were selected, with 8 new models finally being included. Five models (62.5%) were developed in North America and 2 (25%) in Europe. A sequential model (Ambalavanan) enables predictions of mortality to be made at birth, 7, 28 days of life, and 36 weeks post-menstrual. A multiple logistic regression analysis was performed on 87.5% of the models. The population discrimination was measured using Odds Ratio (75%) and the area under the curve (50%). "Internal Validation" had been carried out on 5 models. Three models can be accessed on-line. There are no predictive models validated in Spain. CONCLUSIONS: The making of decisions based on predictive models can lead to the care given to the premature infant being more individualised and with a better use of resources. Predictive models of mortality in premature neonates in Spain need to be developed.

2.
J Pediatr (Rio J) ; 2018 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-30423323

RESUMO

OBJECTIVE: Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation. METHOD: Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009-2011), patients who failed medical treatment underwent surgical closure; in second period (2012-2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival-without-morbidity were compared. RESULTS: This study included 188 patients (27±2 weeks, 973±272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85.7% P1 versus 56% P2, p<0.001) and surgical closure (34.5% P1 versus 16.1% P2, p<0.001) were observed. No differences were found in chronic lung disease (28.8% versus 13.9%, p=0.056), severe retinopathy of prematurity (7.5% versus 11.8%, p=0.403), necrotizing enterocolitis (15.5% versus 6.9%, p=0.071), severe intraventricular hemorrhage (25.4% versus 18.4%, p=0.264), mortality (17.5% versus 15.2%, p=0.690) or survival-without-morbidity adjusted OR=1.10 (95% CI: 0.55-2.22); p=0.783. In P2, 24.5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (n=82) showed significant differences: lower incidence of chronic lung disease (50% versus 19.6%, p=0.019) and more survival-without-morbidity (20% versus 45.6%, p=0.028) were found. CONCLUSION: A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival-without-morbidity. However, two-thirds of preterm infants under 26 weeks are still treated.

3.
Acta Paediatr ; 106(6): 897-903, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28218962

RESUMO

AIM: Neonatal resuscitation surveys have showed practice variations between countries, centres and levels of care. We evaluated delivery room practices after a nationwide neonatal resuscitation training programme focused on nontertiary centres. METHODS: A 2012 survey sent to all Spanish hospitals handling deliveries covered staff availability and training, equipment and practices in the delivery room and during transfers to neonatal intensive care units. The results from 98 centres that had completed a previous survey in 2007 were analysed by levels of care. Pearson's chi-square test was used to compare the proportions. RESULTS: The following had significantly improved in 2012 compared to 2007: the availability of T-piece resuscitators (71.4% vs. 41.8%), plastic wraps (69.4% vs. 31.6%), gas blenders (79.6% vs. 40.8%), pulse oximetry (92.9% vs. 61.2%), use of continuous positive airway pressure (82.7% vs. 43.9%) (all p < 0.01), the availability of instructors (55.6% vs. 83.3%, p < 0.05) and neonatal resuscitation courses (40.8% vs. 79.6%, p < 0.05) in nontertiary centres. In 2012, the use of exhaled carbon dioxide detectors was <7% and endotracheal administration of adrenaline was >90%. CONCLUSION: Neonatal resuscitation equipment and practices improved over time, but several aspects needed to be reinforced in training programmes, namely preterm infants' management, monitoring and adrenaline administration.


Assuntos
Ressuscitação/normas , Salas de Parto/normas , Fidelidade a Diretrizes , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Ressuscitação/instrumentação , Inquéritos e Questionários , Recursos Humanos
4.
Pediatrics ; 138(6)2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27940687

RESUMO

BACKGROUND AND OBJECTIVES: Stabilization of preterm infants after birth frequently requires oxygen supplementation. At present the optimal initial oxygen inspiratory fraction (Fio2) for preterm stabilization after birth is still under debate. We aimed to compare neurodevelopmental outcomes of extremely preterm infants at 24 months corrected age randomly assigned to be stabilized after birth with an initial Fio2 of 0.3 versus 0.6 to 0.65 in 3 academic centers from Spain and the Netherlands. METHODS: Randomized, controlled, double-blinded, multicenter, international clinical trial enrolling preterm infants <32 weeks' gestation assigned to an initial Fio2 of 0.3 (Lowox group) or 0.6 to 0.65 (Hiox group). During stabilization, arterial pulse oxygen saturation and heart rate were continuously monitored and Fio2 was individually titrated to keep infants within recommended ranges. At 24 months, blinded researchers used the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) to assess visual acuity, neurosensory deafness, and language skills. RESULTS: A total of 253 infants were recruited and 206 (81.4%) completed follow-up. No differences in perinatal characteristics, oxidative stress, or morbidities during the neonatal period were assessed. Mortality at hospital discharge or when follow-up was completed didn't show differences between the groups. No differences regarding Bayley-III scale scores (motor, cognitive, and language composites), neurosensorial handicaps, cerebral palsy, or language skills between groups were found. CONCLUSIONS: The use of an initial lower (0.3) or higher (0.6-0.65) Fio2 during stabilization of extremely preterm infants in the delivery room does not influence survival or neurodevelopmental outcomes at 24 months.


Assuntos
Desenvolvimento Infantil , Transtornos do Neurodesenvolvimento/epidemiologia , Oxigenoterapia/métodos , Ressuscitação/métodos , Pré-Escolar , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Países Baixos , Oxigenoterapia/efeitos adversos , Ressuscitação/efeitos adversos , Espanha , Taxa de Sobrevida
5.
Nutr Clin Pract ; 31(5): 666-72, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27207940

RESUMO

BACKGROUND AND AIMS: Postnatal growth restriction remains a serious problem in very low-birth-weight infants. Enhanced parenteral supply of nutrients as soon as possible after birth is one of the strategies addressed to avoid extrauterine growth restriction. We aimed to analyze changes in growth patterns and in clinical outcomes in our unit after a change in our parenteral nutrition (PN) protocol. METHODS: We collected data from 2 time periods, comprising the 2 years before (period I) and the 2 years after (period II) the change of protocol. We included 142 very low-birth-weight infants ≤32 weeks of gestation with a birth weight ≤1500 g. Data regarding nutrition intakes (parenteral and enteral) in the first week of life, growth during admission, and clinical outcomes were retrieved from clinical charts. RESULTS: Babies in period II received a higher nutrition supply during the first week of life, but no further differences were found after this period. Weight at 14 days of life was significantly higher in period II but not at day 28 of life or discharge. CONCLUSIONS: In our population, an enhanced PN regimen for very low-birth-weight infants led to a better growth at 14 days of life. However, this positive effect had disappeared at day 28 of life. Strategies to improve nutrient supply once the preterm baby is stable and on full enteral feeds should be implemented and analyzed.


Assuntos
Peso Corporal/efeitos dos fármacos , Desenvolvimento Infantil/efeitos dos fármacos , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Estado Nutricional , Nutrição Parenteral/métodos , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Masculino , Nutrição Parenteral/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
6.
Neonatology ; 110(3): 198-203, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27220313

RESUMO

BACKGROUND: The prognosis of neonatal respiratory distress may be difficult to estimate at admission. Lung ultrasound is a useful diagnostic tool that is quick, requires little training, and is radiation free. OBJECTIVE: This study aims to analyze whether early lung ultrasound can predict respiratory failure. METHODS: From January to December 2014, lung ultrasound was performed on neonates admitted with breathing difficulties if they were older than 32 weeks and not intubated. A neonatologist, not aware of the patient's clinical condition, analyzed the stored ultrasound images. The findings were classified into the following 2 groups according to the potential risk of a bad respiratory outcome: low risk (normal or transient tachypnea of the newborn) or high risk (respiratory distress syndrome, meconium aspiration syndrome, pneumothorax, or pneumonia). A second investigator made the same classification after reading the chest X-rays. Respiratory failure was defined as a need for mechanical ventilation during the first day of life. RESULTS: In total, 105 neonates were recruited (64.8% in the low-risk sonography group and 35.2% in the high-risk sonography group). Of those, 20% needed intubation, and this was more frequent in the high-risk group (relative risk = 17.5; 95% CI 4.3-70.9, p < 0.01). As predictors of respiratory failure, lung ultrasound and chest X-ray showed a high index of agreement (κ coefficient = 0.91; 95% CI 0.83-1, p < 0.01) and good accuracy (ultrasound: 95% sensitivity, 82.5% specificity, and a negative predictive value of 98.5%). CONCLUSIONS: Early lung ultrasound is a useful tool to determine which neonates admitted with respiratory distress will require mechanical ventilation. It may help the clinician to carrying out appropriate transfers.


Assuntos
Recém-Nascido Prematuro , Pulmão/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico por imagem , Progressão da Doença , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Prognóstico , Radiografia Torácica , Respiração Artificial , Sensibilidade e Especificidade , Espanha , Ultrassonografia
7.
Rev Neurol ; 56(2): 72-8, 2013 Jan 16.
Artigo em Espanhol | MEDLINE | ID: mdl-23307352

RESUMO

INTRODUCTION: Hypotonia is one of the most frequent signs of neurological pathology in newborn infants. AIMS: To determine, in a 12-year retrospective study, the relative frequency of neurological pathologies that can be accompanied by hypotonia during the neonatal period and to describe the neurological development after two years' follow-up. PATIENTS AND METHODS: We conducted a systematic review of the newborn infants with hypotonia due to an identifiable cause who were admitted to the neonatal unit of the Hospital Sant Joan de Deu between January 1996 and December 2008. Information collected referred to family history, data related with the pregnancy and childbirth, clinical features and complementary tests. RESULTS. A total of 73 hypotonic newborn infants were identified, 21 (28.7%) of whom met eligibility criteria. The majority, 81% (n = 17), were classified as central hypotonias and the remaining 19% (n = 4) were graded as peripheral hypotonias. In the first group, 47% (n = 8) presented chromosomal disorders, 29.4% (n = 5) had metabolic diseases and 23.5% (n = 4) displayed malformations of the central nervous system. CONCLUSIONS: The central causes of hypotonia continue to be the most prevalent in the neonatal period and, within these, chromosomal disorders are the most frequent. Peripheral causes are less common and have a more severe prognosis. Advances in molecular genetics have allowed many neuromuscular diseases to be diagnosed both genetically and at the molecular level. The diversity and complexity of the pathologies justifies a multidisciplinary approach being taken to treat these newborn infants.


Assuntos
Hipotonia Muscular , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Hipotonia Muscular/diagnóstico , Hipotonia Muscular/epidemiologia , Hipotonia Muscular/etiologia , Estudos Retrospectivos , Fatores de Tempo
8.
Rev. neurol. (Ed. impr.) ; 56(2): 72-78, 16 ene., 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-109363

RESUMO

Introducción. La hipotonía es uno de los signos más frecuentes de patología neurológica en el neonato. Objetivos. Determinar, en un estudio retrospectivo a 12 años, la frecuencia relativa de patologías neurológicas que pueden cursar con hipotonía durante el período neonatal y describir la evolución neurológica a los dos años de seguimiento. Pacientes y métodos. Revisión sistemática de los recién nacidos hipotónicos sin causa identificable que ingresaron en la unidad neonatal del Hospital Sant Joan de Déu de enero de 1996 a diciembre de 2008. Se han recogido antecedentes familiares, datos relacionados con el embarazo y parto, características clínicas y pruebas complementarias. Resultados. Se identificaron 73 recién nacidos hipotónicos, de los cuales 21 (28,7%) cumplieron los criterios de inclusión. El 81% (n = 17) se clasificó como hipotonías centrales y el 19% (n = 4) como hipotonías periféricas. En el primer grupo, el 47% (n = 8) presentó alteraciones cromosómicas; el 29,4% (n = 5), enfermedades metabólicas, y el 23,5% (n = 4), malformaciones del sistema nervioso central. Conclusiones. Las causas centrales de hipotonía siguen siendo las más prevalentes en el período neonatal y, dentro de éstas, las cromosomopatías. Las causas periféricas son menos frecuentes y de pronóstico más grave. Los avances en genética molecular han permitido el diagnóstico genético y molecular de numerosas enfermedades neuromusculares. La diversidad y complejidad de patologías justifica el abordaje multidisciplinar de estos recién nacidos (AU)


Introduction. Hypotonia is one of the most frequent signs of neurological pathology in newborn infants. Aims. To determine, in a 12-year retrospective study, the relative frequency of neurological pathologies that can be accompanied by hypotonia during the neonatal period and to describe the neurological development after two years’ follow-up. Patients and methods. We conducted a systematic review of the newborn infants with hypotonia due to an identifiable cause who were admitted to the neonatal unit of the Hospital Sant Joan de Déu between January 1996 and December 2008. Information collected referred to family history, data related with the pregnancy and childbirth, clinical features and complementary tests. Results. A total of 73 hypotonic newborn infants were identified, 21 (28.7%) of whom met eligibility criteria. The majority, 81% (n = 17), were classified as central hypotonias and the remaining 19% (n = 4) were graded as peripheral hypotonias. In the first group, 47% (n = 8) presented chromosomal disorders, 29.4% (n = 5) had metabolic diseases and 23.5% (n = 4) displayed malformations of the central nervous system. Conclusions. The central causes of hypotonia continue to be the most prevalent in the neonatal period and, within these, chromosomal disorders are the most frequent. Peripheral causes are less common and have a more severe prognosis. Advances in molecular genetics have allowed many neuromuscular diseases to be diagnosed both genetically and at the molecular level. The diversity and complexity of the pathologies justifies a multidisciplinary approach being taken to treat these newborn infants (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Hipotonia Muscular/diagnóstico , Doenças Neurodegenerativas/epidemiologia , Doenças Neurodegenerativas/prevenção & controle , Transtornos Cromossômicos/complicações , Transtornos Cromossômicos/diagnóstico , Biologia Molecular/métodos , Biologia Molecular/tendências , Doenças Neuromusculares/complicações , Doenças Neuromusculares/genética , Hipotonia Muscular/epidemiologia , Hipotonia Muscular/etiologia , Estudos Retrospectivos , Transtornos Cromossômicos/genética , Biologia Molecular/organização & administração , Biologia Molecular/normas , Idade Gestacional
10.
Rev. logop. foniatr. audiol. (Ed. impr.) ; 31(3): 169-179, jul.-sept. 2011.
Artigo em Espanhol | IBECS | ID: ibc-91464

RESUMO

Diversos trabajos previos han mostrado que el desarrollo léxico y gramatical puede estar comprometido en niños nacidos muy prematuramente, aunque los resultados de distintas investigaciones no siempre resultan coincidentes. Se presentan aquí los resultados de una muestra de niños sanos, nacidos muy prematuramente ≤ 32 semanas gestación y ≤ 1.500 g de peso al nacer), en los que se obtuvieron medidas del vocabulario expresivo a los 12, 18 y 24 meses (edad corregida por gestación) mediante el Inventario de Desarrollo Comunicativo MacArthur. Los datos de esta muestra se comparan con los obtenidos por tres grupos independientes de nacidos a término, procedentes del mismo hospital y comparables en lengua familiar y estatus socioeconómico. Los resultados muestran diferencias significativas en el vocabulario total expresivo alcanzado a los 18 y los 24 meses, pero no así en el primer nivel de edad analizado. En la composición del vocabulario, distinguiendo entre rutinas, nombres, predicados y palabras gramaticales, observamos diferencias significativas en todas las categorías a los 18 meses, aunque a los 24 meses sólo se mantienen las diferencias relativas a rutinas y nombres. En un segundo análisis de los datos, dividiendo la muestra según el sexo, se comprueba que, tanto a los 18 como a los 24 meses, las diferencias significativas entre prematuros y controles se sitúan exclusivamente en la muestra de niños y se manifestaban en todas las categorías analizadas. En conjunto, estos resultados apuntan a un ritmo inicial de crecimiento léxico (expresivo) más lento en el prematuro, sólo aparente a partir de los 18 meses y con mayor incidencia en la población masculina. Se discute el valor de estos datos en relación con el desarrollo lingüístico posterior en esta población de riesgo (AU)


Previous research has shown that lexical and grammatical development may be compromised in very preterm infants, although results from different studies are not always coincident. Expressive lexicon measures were obtained in a sample of healthy very preterm infants (≤ 32 gestation weeks and birth weight ≤ 1500 g), using the MacArthur Communicative Development Inventory at 12, 18 and 24 months of age (corrected for gestation). Data from this sample were compared with results from three independent groups of full term infants born in the same hospital and with comparable language background and socioeconomic status. Significant differences were found in total number of words produced at 18 and 24 months of age, but not at the first age level under analysis. Regarding vocabulary composition, significant differences were observed in all categories under study (social words, nouns, predicates and function words) at 18 months of age, but at 24 months significant differences were restricted to the categories of social words and nouns. Further analysis of the data by gender revealed that differences between full term and preterm infants reached significance in the male subgroup, both at 18 and 24 months of age and for all lexical categories. Taken together these results suggest an initially slower expressive lexicon development in the population of infants born preterm, but differences are only evident from age 18 months and with a higher incidence in the male subgroup. The paper discusses the predictive value of these data for later language outcomes in this at risk population (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Desenvolvimento da Linguagem , Fala/fisiologia , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/psicologia , Recém-Nascido Prematuro/fisiologia , Recém-Nascido Prematuro/psicologia , Nascimento Prematuro/fisiopatologia , Doenças do Prematuro/epidemiologia , Testes de Linguagem , Vocabulário , Análise de Dados/métodos , Análise de Dados/estatística & dados numéricos
11.
Am J Infect Control ; 31(8): 505-7, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14647114

RESUMO

BACKGROUND: Health care improvements and technical advances for diagnostic and therapeutic management in the neonatal care unit (NCU) have made possible the increasing survival of neonates with severe pathologic conditions. However, nosocomial infections (NI) still represent an important cause of morbidity and mortality in this population. OBJECTIVE: To describe the epidemiologic profile of NI in the NCU. METHODS: A prospective surveillance study was performed in the NCU at a university hospital in Barcelona during 6 months. Two hundred sixty-eight neonates were admitted during the study period. Centers for Disease Control and Prevention criteria were used as standard definitions for NI. Data including risk factors associated with NI were recorded. RESULTS: Sixty-five neonates had a total of 88 NI. The incidence rate of NI was 1.6 per 100 patient-days. The accumulative rate of NI was 32.7 per 100 admissions. Bacteremia (28.4%), conjunctivitis (19.5%), respiratory infection (10.2%), and urinary tract infection (7.9%) were the most common episodes observed. Gram-positive bacteria were the most commonly isolated germs (76.4%), with coagulase-negative Staphylococcus (72.5%) being the main pathogen. Intrinsic risk factors related to NI were low birth weight (<1000 g) and urinary catheter and peripheral venous catheter (P<.01). CONCLUSIONS: NI represent an important and frequent problem in neonates. Knowledge of the incidence of NI allows the targeting and implementation of preventive strategies for reducing morbidity and mortality related to NI in an NCU.


Assuntos
Infecções Bacterianas/epidemiologia , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Cateterismo/efeitos adversos , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
12.
In. Ortlieb, Luc, ed; Macharé, José, ed. Paleo - ENSO records international symposium : Extended abstracts. Lima, Perú. Nuevo Mundo, 1992. p.155-8.
Monografia em Espanhol | Desastres | ID: des-9248
13.
In. Argentina. Ministerio de Obras y Servicios Públicos. Secretaría de Recursos Hídricos; UNESCO. Actas del coloquio. Buenos Aires, Secretaría de Recursos Hídricos, 1984. p.1205-38.
Monografia em Espanhol, Espanhol | BINACIS | ID: bin-135840

RESUMO

Explica que para el estudio integral de la cuenca del río Salado en la provincia de Santa Fe, se confeccionó el mapa geomorfológico orientado hacia el comportamiento hidrológico del sistema. Identifica y analiza los elementos morfológicos de mayor incidencia en el funcionamiento hídrico


Assuntos
Argentina , Rios , Bacias , Hidrologia
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