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1.
Cochrane Database Syst Rev ; 6: CD007644, 2019 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-31250435

RESUMO

BACKGROUND: Human milk banking has been available in many countries for the last three decades. The milk provided from milk banking is predominantly term breast milk, but some milk banks provide preterm breast milk. There are a number of differences between donor term and donor preterm human milk. OBJECTIVES: To determine the effect of banked donor preterm milk compared with banked donor term milk regarding growth and developmental outcomes in very low birth weight infants (infants weighing less than 1500 grams). SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 7), MEDLINE via PubMed (1966 to 23 October 2018), Embase (1980 to 23 October 2018), and CINAHL (1982 to 23 October 2018). We also searched clinical trial databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing banked donor preterm milk with banked donor term milk regarding growth and developmental outcomes in very low birth weight infants DATA COLLECTION AND ANALYSIS: We planned to perform assessment of methodology regarding blinding of randomisation, intervention and outcome measurements as well as completeness of follow-up. We planned to evaluate treatment effect using a fixed-effect model using relative risk (RR), relative risk reduction, risk difference (RD) and number needed to treat for an additional beneficial outcome (NNTB) or the number needed to treat for an additional harmful outcome (NNTH) for categorical data; and using mean, standard deviation and weighted mean difference (WMD) for continuous data. We planned to use the GRADE approach to assess the quality of evidence. MAIN RESULTS: No studies met the inclusion criteria. AUTHORS' CONCLUSIONS: We found no evidence to support or refute the effect of banked donor preterm milk compared to banked term milk regarding growth and developmental outcomes in very low birth weight infants.


Assuntos
Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Bancos de Leite , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Leite Humano , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Eur J Pediatr ; 178(6): 923-928, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30949889

RESUMO

Previous studies have identified numerous risk factors associated with necrotizing enterocolitis (NEC) in very low birth weight (VLBW; birth weight less than 1500 g) infants. One of the potential pathophysiological contributors could be antibiotic therapy. Our aim was to explore the association between antibiotic exposure and NEC in VLBW infants. We designed a retrospective 1:2 case-control cohort study in a level III neonatal intensive care unit. Our study group composed of VLBW infants born between January 2012 and December 2014 with a diagnosis of NEC stage IIA or greater (Bell's modified criteria). Our intent was to match every case in the study group to two controls. Our primary outcome was an association between antibiotic exposure and NEC. Twenty-two cases of NEC were matched to 32 controls. The infants who developed NEC were exposed to a statistically significantly more frequent number of antibiotic courses and to more days on any antibiotic prior to the development of NEC. There were significant differences between cases and controls with respect to the duration of exposure to gentamicin and meropenem specifically.Conclusion: The data from our study demonstrate that prolonged exposure to antibiotic therapy is associated with an increased risk of NEC among VLBW infants. Furthermore, gentamicin and meropenem, but not other antibiotics, had a significant association with the incidence of NEC. What is known: • Early antibiotic exposure is a risk factor for the development of necrotising enterocolitis (NEC) in very low birth weight infants • Prolonged initial empirical antibiotic course for ≥ 5 days, despite sterile blood culture, is associated with an increased risk of developing NEC What is new: • The cumulative total number of days of antibiotic exposure is associated with an increased risk of developing NEC • Gentamicin and meropenem, but not other antibiotics, had a significant association with the incidence of NEC in our study.


Assuntos
Antibacterianos/efeitos adversos , Enterocolite Necrosante/etiologia , Gentamicinas/efeitos adversos , Meropeném/efeitos adversos , Estudos de Casos e Controles , Enterocolite Necrosante/epidemiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
3.
JPEN J Parenter Enteral Nutr ; 43(7): 883-890, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30613992

RESUMO

BACKGROUND: Peripherally inserted central catheters (PICCs) are used to administer parenteral nutrition (PN) in very low birth weight infants (VLBW; <1500 g). Clinicians try to optimize early nutrition but also minimize the risks associated with intravascular devices. The objective of this study was to examine the early nutrition impact of discontinuing PN at different enteral feed volumes in VLBW infants. METHODS: In this unmasked, multicenter, randomized controlled trial, patients were randomly assigned to PICC removal and PN discontinuation at an enteral feed volume of 100 mL/kg/day (intervention) or 140 mL/kg/day (control). Clinically stable VLBW infants with a PICC in situ who were receiving PN were eligible for inclusion. Infants with major congenital anomalies were excluded. A total of 139 patients were enrolled; 69 and 70 patients were randomized to the intervention and control groups, respectively. The primary outcome measure was the mean difference in time (days) to regain birth weight. RESULTS: The groups were well matched at study entry. Patients in the intervention group regained birth weight more slowly (mean difference 1.5 days CI: 0.3-2.7 days, P = 0.01). The mean difference in time to regain birth weight for infants <1000 g was 2.8 days (95% CI: 0.8-4.8 days, P = 0.008). CONCLUSIONS: In VLBW infants, early PICC removal at an enteral feed volume of 100 mL/kg/day compared with later removal at 140 mL/kg/day resulted in a significant delay in time to regain birth weight, and this delay was more pronounced in infants <1000 g.

5.
Front Pediatr ; 6: 84, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29666787

RESUMO

Maintaining optimal circulatory status is a key component of preterm neonatal care. Low-cardiac output (CO) in the preterm neonate leads to inadequate perfusion of vital organs and has been linked to a variety of adverse outcomes with heightened acute morbidity and mortality and adverse neurodevelopmental outcomes. Having technology available to monitor CO allows us to detect low-output states and potentially intervene to mitigate the unwanted effects of reduced organ perfusion. There are many technologies available for the monitoring of CO in the preterm neonatal population and while many act as useful adjuncts to aid clinical decision-making no technique is perfect. In this review, we discuss the relative merits and limitations of various common methodologies available for monitoring CO in the preterm neonatal population. We will discuss the ongoing challenges in monitoring CO in the preterm neonate along with current gaps in our knowledge. We conclude by discussing emerging technologies and areas that warrant further study.

6.
Arch Dis Child Fetal Neonatal Ed ; 103(2): F101-F106, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29074717

RESUMO

OBJECTIVE: To determine whether 2% chlorhexidine gluconate-70% isopropyl alcohol (CHX-IA) is superior to 10% aqueous povidone-iodine (PI) in preventing catheter-related blood stream infection (CR-BSI) when used to clean insertion sites before placing central venous catheters (CVCs) in preterm infants. DESIGN: Randomised controlled trial. SETTING: Two neonatal intensive care units (NICUs). PATIENTS: Infants <31 weeks' gestation who had a CVC inserted. INTERVENTIONS: Insertion site was cleaned with CHX-IA or PI. Caregivers were not masked to group assignment. MAIN OUTCOME MEASURES: Primary outcome was CR-BSI determined by one microbiologist who was masked to group assignment. Secondary outcomes included skin reactions to study solution and thyroid dysfunction. RESULTS: We enrolled 304 infants (CHX-IA 148 vs PI 156) in whom 815 CVCs (CHX-IA 384 vs PI 431) were inserted and remained in situ for 3078 (CHX-IA 1465 vs PI 1613) days. We found no differences between the groups in the proportion of infants with CR-BSI (CHX-IA 7% vs PI 5%, p=0.631), the proportion of CVCs complicated by CR-BSI or the rate of CR-BSI per 1000 catheter days. Skin reaction rates were low (<1% CVC insertion episodes) and not different between the groups. More infants in the PI group had raised thyroid-stimulating hormone levels and were treated with thyroxine (CHX-IA 0% vs PI 5%, p=0.003). CONCLUSIONS: We did not find a difference in the rate of CR-BSI between preterm infants treated with CHX-IA and PI, and more infants treated with PI had thyroid dysfunction. However, our study was not adequately powered to detect a difference in our primary outcome and a larger trial is required to confirm our findings. TRIAL REGISTRATION: This study was registered with the EU clinical trials register before the first patient was enrolled (Eudract 2011-002962-19). (https://www.clinicaltrialsregister.eu).


Assuntos
2-Propanol/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/métodos , Clorexidina/análogos & derivados , Povidona-Iodo/administração & dosagem , 2-Propanol/efeitos adversos , 2-Propanol/química , Anti-Infecciosos Locais/efeitos adversos , Clorexidina/administração & dosagem , Clorexidina/efeitos adversos , Clorexidina/química , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Povidona-Iodo/efeitos adversos , Dermatopatias/prevenção & controle
8.
Pediatr Res ; 82(5): 789-795, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28665923

RESUMO

BackgroundNoninvasive hemodynamic monitoring of infants with neonatal encephalopathy (NE) undergoing therapeutic hypothermia (TH) would be a potentially useful clinical tool. We aimed to assess the feasibility and reliability of noninvasive cardiac output monitoring (NICOM) and near-infrared spectroscopy (NIRS) in this cohort.MethodsNICOM and NIRS were commenced to measure cardiac output (CO), systemic vascular resistance (SVR), blood pressure (BP), and cerebral regional oxygen saturations (SctO2) during TH and rewarming. NICOM measures of CO were also compared with simultaneous echocardiography-derived CO (echo-CO).ResultsTwenty infants with a median gestation of 40 weeks were enrolled. There was a strong correlation between NICOM- and echo-CO (r2=0.79, P<0.001). NICOM-CO was systematically lower than echo-CO with a bias of 27% (limits of agreement 3-51%). NICOM illustrated lower CO during TH, which increased during rewarming. SctO2 increased over the first 30 h of TH and stayed high for the remainder of the study. There was a rise in SVR over the first 30 h of TH and a decrease during rewarming (all P<0.05).ConclusionsNoninvasive hemodynamic assessment of infants with NE is feasible and illustrates potentially important changes. Larger studies are needed to assess the clinical applicability of those methods in this cohort.


Assuntos
Encefalopatias/diagnóstico , Débito Cardíaco , Circulação Cerebrovascular , Doenças do Recém-Nascido/diagnóstico , Monitorização Fisiológica/métodos , Neonatologia/métodos , Pressão Sanguínea , Encefalopatias/fisiopatologia , Encefalopatias/terapia , Ecocardiografia , Estudos de Viabilidade , Feminino , Idade Gestacional , Frequência Cardíaca , Humanos , Hipotermia Induzida , Recém-Nascido , Doenças do Recém-Nascido/fisiopatologia , Doenças do Recém-Nascido/terapia , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Reaquecimento , Espectroscopia de Luz Próxima ao Infravermelho , Fatores de Tempo , Resultado do Tratamento
9.
Pediatrics ; 140(2)2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28701390

RESUMO

OBJECTIVES: Patent ductus arteriosus (PDA) remains a challenging issue in very low birth weight (VLBW) infants, and its management varies widely. Our aim in this study was to document the natural course of ductus arteriosus in a cohort of VLBW infants who underwent conservative PDA management with no medical or surgical intervention. METHODS: A retrospective cohort study conducted in 2 European level-3 neonatal units. RESULTS: A total of 368 VLBW infants were born within the study period. Two hundred and ninety-seven infants were free of congenital malformations or heart defects and survived to hospital discharge. Out of those, 280 infants received truly conservative PDA management. In 237 (85%) of nontreated infants, the PDA closed before hospital discharge. The Kaplan-Meier model was used to document the incidence proportion of PDA closure over time for different gestational age groups. The median time to ductal closure was 71, 13, 8, and 6 days in <26+0, 26+0 to 27+6, 28+0 to 29+6, and ≥30 weeks, respectively. For different birth weight groups, the median was 48, 22, 9, and 8 days in infants weighing <750, 750 to 999, 1000 to 1249, and 1250 to 1500 g, respectively. No statistically significant relationship was found between PDA closure before hospital discharge and neonatal morbidities. CONCLUSIONS: The likelihood of PDA spontaneous closure in VLBW infants is extremely high. We provide in our findings a platform for future placebo-controlled trials focused on the smallest and youngest infants.


Assuntos
Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/terapia , Recém-Nascido de muito Baixo Peso , Estudos de Coortes , Tratamento Conservador , República Tcheca , Permeabilidade do Canal Arterial/mortalidade , Ecocardiografia , Feminino , Seguimentos , Idade Gestacional , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Alta do Paciente , Remissão Espontânea , Estudos Retrospectivos
10.
Arch Dis Child Fetal Neonatal Ed ; 102(4): F329-F332, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28011792

RESUMO

OBJECTIVE: To compare the time taken by preterm infants with evolving chronic lung disease to achieve full oral feeding when supported with humidified high flow nasal cannula (HFNC) or nasal continuous positive airway pressure (NCPAP). DESIGN: Single centre randomised controlled trial. SETTING: Level III neonatal intensive care unit at the Coombe Women and Infants University Hospital, Dublin, Ireland. PATIENTS: Very low birthweight (birth weight <1500 g) infants born before 30 weeks' gestation who were NCPAP-dependent at 32 weeks corrected gestational age were eligible to participate. INTERVENTIONS: Enrolled infants were randomised in a 1:1 ratio to receive HFNC or NCPAP. Participants were monitored daily until full oral feeding was established and the baby was off respiratory support. MAIN OUTCOME MEASURES: Our primary outcome was the number of days taken to establish full oral feeds (defined as oral intake ≥120 mL/kg/day) from the time of randomisation. We estimated that enrolling 44 subjects (22 in each group) would allow us demonstrate a 7-day difference in our primary outcome with 80% power and α of 5%. RESULTS: Forty-four infants were randomised (22 to HFNC vs 22 to NCPAP). The mean time to achieve full oral feeding was not different between the groups (HFNC 36.5 (±18.2) days vs NCPAP 34.1 (±11.2) days, p=0.61). CONCLUSIONS: Preterm infants treated with HFNC did not achieve full oral feeding more quickly than infants treated with NCPAP. TRIAL REGISTRATION NUMBER: ISRCTN66716753.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Comportamento Alimentar , Lactente Extremamente Prematuro/fisiologia , Ventilação não Invasiva/métodos , Oxigenoterapia/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Alimentação Artificial , Feminino , Humanos , Recém-Nascido , Masculino , Desmame do Respirador
11.
Acta Paediatr ; 106(1): 22-29, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27611695

RESUMO

Neonatologists have begun using superior vena cava flow as assessed by functional echocardiography to facilitate real-time decision-making on cardiovascular care. This review aims to describe the basis of the technique, summarise the evidence for its use and compare the technique to existing clinical, biochemical and radiological techniques for assessing neonatal circulatory status. CONCLUSION: Although echocardiographic measurements of superior vena cava flow, like other measures of perfusion, are not perfect, their noninvasive nature and ability to facilitate real-time decision-making means that at present, they remain the best available methodology of monitoring central perfusion in the neonatal population.


Assuntos
Ecocardiografia Doppler/métodos , Neonatologia/métodos , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/fisiopatologia , Velocidade do Fluxo Sanguíneo , Humanos , Recém-Nascido
12.
Eur J Pediatr ; 175(12): 2015-2018, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27743030

RESUMO

Our aim was to assess the utility of serum thyroxine and thyroid stimulating hormone performed at 10-14 days of life in diagnosing congenital hypothyroidism (CH) in babies born to mothers with hypothyroidism. This was a retrospective study of all babies born in a tertiary referral centre for neonatology over a 12-month period. Infants who had thyroid function testing (TFT) checked at 10-14 days of life because of maternal hypothyroidism during the period of study were included. The results of the newborn bloodspot and day 10-14 TFT were recorded along with whether or not patients were subsequently treated. Of the 319 patients included in the study, only two patients were found to have CH and in both cases the newborn blood spot had been abnormal. CONCLUSION: No extra cases of CH were detected from the thyroid test at 10-14 days and this practice should be discontinued due to the robust nature of existing newborn screening programmes. What is Known: • Congenital hypothyroidism(CH) is the commonest preventable cause of childhood intellectual impairment. • Family history of hypothyroidism has been implicated as a risk factor for CH. • CH has formed part of newborn screening since the 1970s. What is New: • There is no research recommending thyroid function testing at 10-14 days of life to detect CH in neonates born to mothers with hypothyroidism. • Thyroid function testing at 10-14 days of life does not improve diagnostic yield for CH in babies born to mothers with hypothyroidism. • Newborn blood spot remains the mainstay for accurate and timely diagnosis of CH.


Assuntos
Hipotireoidismo Congênito/diagnóstico , Hipotireoidismo , Complicações na Gravidez , Testes de Função Tireóidea , Hipotireoidismo Congênito/sangue , Feminino , Humanos , Recém-Nascido , Triagem Neonatal , Gravidez , Estudos Retrospectivos , Fatores de Risco
13.
Acta Obstet Gynecol Scand ; 95(12): 1391-1395, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27623283

RESUMO

INTRODUCTION: A recent meta-analysis has suggested that routine measurement of the cervical length should be performed in conjunction with the anomaly scan to identify a group of women at increased risk of preterm delivery. We decided to investigate whether this recommendation is justifiable in a population where the risk of preterm birth is low. MATERIAL AND METHODS: We reviewed 12 years of obstetric data from the Coombe Women and Infants University Hospital. Relative risks of adverse outcomes from the randomized controlled trial were applied and we extrapolated the possible numbers of women requiring intervention. We then used published neonatal data to estimate the cost of neonatal care and estimated the costs of providing the service. RESULTS: Over 12 years from 2000 until 2011, there were 94 646 singleton deliveries, 1776 happening before 34 weeks. Spontaneous onset occurred in 882 (49.7%) of this group. These 882 births were studied. If we apply the figures from a randomized controlled trial, 1609 women (1.7% from our total population) would be expected to have a cervical length 15 mm. If we gave vaginal progesterone to all women with a sonographically short cervix, we would reduce the delivery rate before 34 weeks by 27.7%. The annual costs of providing the service were estimated to be €109 249 and the cost of immediate neonatal care was estimated to be €380 514. CONCLUSION: Given the implications associated with preterm delivery, routine measurement of cervical length at the time of the anomaly scan may be justifiable from a cost point of view in a population where the risk of preterm birth is low.


Assuntos
Medida do Comprimento Cervical/economia , Análise Custo-Benefício , Nascimento Prematuro/economia , Incompetência do Colo do Útero/diagnóstico por imagem , Adulto , Feminino , Seguimentos , Custos Hospitalares/estatística & dados numéricos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Irlanda , Masculino , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Risco , Incompetência do Colo do Útero/economia
14.
Arch Dis Child Fetal Neonatal Ed ; 100(3): F253-6, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25653299

RESUMO

OBJECTIVE: To investigate the effect of late treatment with intravenous paracetamol on patent ductus arteriosus (PDA) closure prior to possible PDA ligation. METHODS: A retrospective review of infants with a haemodynamically significant PDA, considered for PDA ligation and treated with intravenous paracetamol prior to possible ligation. RESULTS: Thirty six infants with a median gestation of 26.1 weeks received paracetamol at a median age of 27 days. Paracetamol was associated with immediate closure in nine (25%) infants. There was no response to paracetamol treatment in four (11%) infants who subsequently underwent a PDA ligation. In 23 (64%) infants, the PDA constricted and all but one of this group demonstrated complete PDA closure prior to discharge. CONCLUSIONS: There may be a role for intravenous paracetamol in late closure of infants with a significant PDA to avoid ligation. The use of paracetamol for late treatment of PDA should be systematically evaluated.


Assuntos
Acetaminofen/administração & dosagem , Permeabilidade do Canal Arterial/tratamento farmacológico , Administração Intravenosa , Permeabilidade do Canal Arterial/cirurgia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Ligadura , Masculino , Estudos Retrospectivos
15.
Eur J Pediatr ; 173(11): 1491-6, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24898778

RESUMO

UNLABELLED: The aim of the study was to assess the role of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration as a predictor of patent ductus arteriosus (PDA) in very low birth weight infants beyond the first week of life. This was a prospective observational study; newborns with a birth weight < 1500 g were eligible for enrolment. Enrolled infants were screened by echocardiography on day seven of life for the presence of a PDA. This was paired with a blood sample for NT-proBNP level. Echocardiography and NT-proBNP levels were repeated at weekly intervals. The primary outcome was correlation between PDA and NT-proBNP level and between measurements of PDA significance and NT-proBNP. Sixty-nine neonates were enrolled following parental consent. The mean birth weight was 1119 ± 257 g and mean gestational age was 28.6 ± 2.6 weeks. Median NT-proBNP level on day seven was 11469 ng/l in infants with a PDA vs. 898 ng/l in infants without a PDA (p < 0.0001). There was a statistically significant correlation between PDA diameter and NT-proBNP level on day seven, day 14 and day 21. CONCLUSION: NT-proBNP concentration is significantly increased in infants with a PDA and correlates well with PDA diameter in the first three weeks of life.


Assuntos
Biomarcadores/sangue , Permeabilidade do Canal Arterial/diagnóstico , Recém-Nascido Prematuro/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Permeabilidade do Canal Arterial/sangue , Permeabilidade do Canal Arterial/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Estudos Prospectivos
16.
J Pediatr ; 163(1): 79-83, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23312683

RESUMO

OBJECTIVE: To determine if low-flow nasal prongs therapy with room air, compared with no treatment, facilitates weaning from nasal continuous positive airway pressure (NCPAP) in very low birth weight (VLBW, birth weight <1500 g) infants. STUDY DESIGN: VLBW infants who received respiratory support for ≥ 48 hours and who were stable on NCPAP for 24 hours were eligible for inclusion in this multicenter, randomized controlled trial. On stopping NCPAP, infants were randomized to receive 1 L/min air via nasal prongs or to spontaneous breathing in room air. The primary outcome measure was failure to wean. Secondary outcome measures included length of time to failure and change in heart rate, respiratory rate, oxygen saturation, and respiratory distress score. RESULTS: Seventy-eight infants were randomized: 39 to nasal prongs and 39 to spontaneous breathing. The groups were similar at birth and at randomization. Sixteen infants (41%) in the nasal prongs group failed the weaning process compared with 12 infants (31%) in the spontaneous breathing group (OR 1.57, 95% CI 0.56 to 4.43, P = .48). There were no significant differences between the groups in secondary outcomes. CONCLUSIONS: In this study, we did not demonstrate a benefit of low-flow room air via nasal prongs to wean VLBW infants from NCPAP.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Desmame do Respirador , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Desmame do Respirador/instrumentação
17.
Cochrane Database Syst Rev ; (6): CD007644, 2010 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-20556782

RESUMO

BACKGROUND: Human milk banking has been available in many countries for the last three decades. The milk provided from milk banking is predominantly term breast milk, but some milk banks provide preterm breast milk. There are a number of differences between donor term and donor preterm human milk. OBJECTIVES: To determine the effect of banked preterm milk compared with banked term milk regarding growth and developmental outcome in very low birth weight infants (infants weighing less than 1500 g). SEARCH STRATEGY: We used the standard methods of the Cochrane Neonatal Review Group, including a search of the Cochrane Neonatal Group specialized register and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, January 2010). We searched the computerised bibliographic databases MEDLINE (1966 to February 2010), EMBASE (1988 to February 2010) and Web of Science (1975 to February 2010). We searched reference lists of all selected articles, review articles and the Oxford Database of Perinatal Trials. We also searched abstracts from neonatal and pediatric meetings (PAS electronic version from 2000 to 2009, ESPR hand search from 2000 to 2009). We applied no language restrictions. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing banked donor preterm milk with banked donor term milk regarding growth and developmental outcomes in very low birth weight infants DATA COLLECTION AND ANALYSIS: We planned to perform assessment of methodology regarding blinding of randomisation, intervention and outcome measurements as well as completeness of follow-up. We planned to evaluate treatment effect using a fixed-effect model using relative risk (RR), relative risk reduction, risk difference (RD) and number needed to treat (NNT) for categorical data and using mean, standard deviation and weighted mean difference (WMD) for continuous data. We planned an evaluation of heterogeneity. MAIN RESULTS: No studies met the inclusion criteria. AUTHORS' CONCLUSIONS: There are no randomised trials that compare preterm banked milk to banked term milk to promote growth and development in very low birth weight infants.


Assuntos
Desenvolvimento Infantil , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Bancos de Leite , Leite Humano , Humanos , Recém-Nascido , Leite Humano/química
18.
Eur J Pediatr ; 168(2): 195-201, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18758814

RESUMO

Clinically relevant apneas, which are common in preterm infants, may adversely affect later neuropsychological condition in this group of patients. Pharmacotherapy to stimulate respiratory functions may be unsuccessful. Polygraphic recording may help in the differential diagnosis of these clinically relevant events. Twenty-nine preterm neonates born before 36 weeks of gestational age were examined using polygraphic recording (respiration--two channels, perioral electromyography, oxygen saturation, heart rate, electroencephalography, electrocardiography, electrooculography). The examination was ordered by the attending physician after an unsuccessful treatment of apnea by Aminophylline, and it should contribute to the clarification of the causes of these events. In the course of the polygraphic examinations, altogether 63 episodes were recorded during which the pulse oximeter alarm signal was set off. In 42 cases, the alarm signal was set off in events during which SaO(2) fell below 85%. In the remaining 21 cases, the alarm signal was set off in episodes during which early bradycardia below 90/min occurred. The onset of apnea was very often associated with the phasic increase of the perioral electromyography and with electroencephalography arousal reaction. Because of suspicion that these apneas may be triggered by episodes of gastroesophageal reflux, the interruption of the Aminophylline treatment and setting up an antireflux regimen were recommended. These therapeutic measures had a positive effect: The frequency of alarm signals decreased within 48 h by a statistically significant 50%. In cases where the pharmacotherapy of apnea by stimulation of respiratory functions is not successful, differential diagnostic analysis should be performed. Polygraphy may contribute to the clarification of the causes underlying clinically relevant apneas in a view of newly described polygraphic signs. It is feasible to suspect, based on these signs, that gastroesophageal reflux is the cause for clinically significant apneas in that case.


Assuntos
Apneia/etiologia , Doenças do Prematuro/diagnóstico , Índice de Apgar , Nível de Alerta/fisiologia , Peso ao Nascer , Diagnóstico Diferencial , Eletrocardiografia , Eletroencefalografia , Eletromiografia , Feminino , Refluxo Gastroesofágico/congênito , Refluxo Gastroesofágico/diagnóstico , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Monitorização Fisiológica , Oxigênio/sangue , Apneia do Sono Tipo Central/diagnóstico
19.
Indian J Pediatr ; 71(12): e58-61, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15630330

RESUMO

The authors present a case of a preterm newborn with congenital infection of herpes simplex virus type 2. The patient was treated with newly recommended high intravenous doses of acyclovir. It can be supposed that it reduces mortality, but the high morbidity continues to be a problem.


Assuntos
Aciclovir/administração & dosagem , Encefalite Viral/tratamento farmacológico , Herpes Simples/tratamento farmacológico , Herpesvirus Humano 2 , Doenças do Prematuro/tratamento farmacológico , Humanos , Recém-Nascido
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