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1.
Eur. respir. j ; 54(3)Sept. 2019.
Artigo em Inglês | BIGG | ID: biblio-1026259

RESUMO

This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and were discharged from the hospital, or who were older than 36 weeks of postmenstrual age. The guideline was based on pre-defined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature, and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the Task Force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding day care attendance. With regards to treatment, we suggest to use bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function, no treatment with inhaled or systemic corticosteroids, natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period, and to treat with supplemental oxygen with a saturation target range of 90­95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.


Assuntos
Humanos , Masculino , Feminino , Criança , Broncodilatadores/uso terapêutico , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/terapia , Administração dos Cuidados ao Paciente/métodos , Nascimento Prematuro/enfermagem
2.
Clin Drug Investig ; 39(11): 1093-1107, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31414269

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) is the need for oxygen therapy at 36 weeks postmenstrual age (PMA). Sildenafil has been shown to enhance the lung alveolarization and vascularization in newborn animal models after lung injury and has possible therapeutic potential for the prevention of BPD. OBJECTIVE: To perform a proof-of-concept, Phase II, pilot randomized, double-blind, clinical trial to study the efficacy of sildenafil in preventing BPD, in postnatal (< 24 h), extremely and very preterm infants. METHODS: This Phase II, pilot randomized, double-blind, clinical trial was conducted in the Neonatal Intensive Care Unit of Women's Wellness and Research Center, Doha, Qatar during 2012-2014. Infants of 240/7-296/7 weeks' gestation were eligible if they needed respiratory or oxygen support ≥ 25% at randomization, and if they were at a postnatal age of < 24 h at randomization. Forty preterm infants were randomly assigned to receive off-label oral sildenafil (0.5 mg/kg every 6 h) or a placebo solution, for one week. The primary endpoints were the incidence of BPD and death at 36 weeks PMA, and the side effects. Secondary outcomes included the incidence of BPD and the respiratory support at day 28 of life, duration of oxygen use, fraction of inspired oxygen use at 36 weeks and 28 days of life, duration of hospitalization, and the incidence of significant retinopathy of prematurity, severe intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, and late sepsis. RESULTS: No significant differences were observed between the sildenafil and placebo study groups in mortality at 36 weeks PMA (10% vs 20%, p = 1), respiratory support at 36 weeks (30% vs 25%, p = 0.57), and side effects (0% vs 0%). For all other secondary outcomes, no significant differences were detected. CONCLUSIONS: While not associated with side effects, off-label oral sildenafil did not demonstrate benefits in the prevention of BPD or death in the extreme and very preterm infants. Future studies of dosing and efficacy that target different regimens of sildenafil are warranted before sildenafil is recommended for the prevention of BPD.


Assuntos
Displasia Broncopulmonar/prevenção & controle , Recém-Nascido Prematuro , Profilaxia Pré-Exposição/métodos , Estudo de Prova de Conceito , Citrato de Sildenafila/administração & dosagem , Vasodilatadores/administração & dosagem , Displasia Broncopulmonar/diagnóstico , Método Duplo-Cego , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Masculino , Projetos Piloto , Fatores de Risco
3.
J Perinat Med ; 47(6): 671-676, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31365347

RESUMO

Background Antioxidant enzymes may play a significant role in the development of bronchopulmonary dysplasia (BPD). The aim of the study was to assess the relationship between the level of extracellular superoxide dismutase (SOD3) in the serum at days 1 and 7 of life and the risk of developing BPD. Methods The study comprised 103 neonates born before 32 weeks' gestation with a birth weight of ≤1500 g. Results In the investigated group, the median serum SOD3 level at day 1 of life was 4.01 ng/mL [interquartile range (IQR) 2.59-5.09 ng/mL] and at day 7 of life 3.13 ng/mL (IQR 2.49-4.34 ng/mL). A statistically significant decrease in the serum SOD3 level was found in the first week of life, P < 0.0001. No correlation was found between the serum SOD3 level at day 1 of life and gestational age R = 0.07, P = 0.4543 and birth weight R = 0.10, P = 0.3083. No statistically significant correlation was found between the dynamics of change in the SOD3 level in serum at days 1 and 7 of life and the risk of BPD development for the definition of BPD at day 28 of life, P = 0.8764 nor at 36 weeks' postmenstrual age, P = 0.6598. Conclusion The study revealed a statistically significant decrease in the serum SOD3 level in the first week of life in very and extremely low birth weight infants born before 32 weeks of gestation. In the clinical setting, no relationship was observed between the level of SOD3 in serum and the risk of developing BPD.


Assuntos
Displasia Broncopulmonar , Recém-Nascido de Peso Extremamente Baixo ao Nascer/sangue , Recém-Nascido Prematuro/sangue , Superóxido Dismutase/sangue , Peso ao Nascer , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/epidemiologia , Correlação de Dados , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Polônia , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
4.
Rev Chil Pediatr ; 90(1): 36-43, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31095217

RESUMO

INTRODUCTION: Multiple factors influence the risk of morbidity and mortality of premature infants with intrauterine growth restriction (IUGR). The comparison of twins with different intrauterine growth allows evaluating the effect of the restriction, excluding maternal factors and prenatal mana gement. Our objective was to assess the effect of IUGR on acute and chronic morbidity, and mortality of extreme preterm twins. PATIENTS AND METHOD: Twins weighing less than 1500 grams and gesta tion equal to or less than 30 weeks, of the Neocosur Network. Separate analyses were performed on concordant twin pairs, and on mild and severe discordant twins, evaluating the effect of IUGR on morbidity and mortality. A multivariate analysis was performed in order to establish the impact of this effect. RESULTS: 459 twin pairs, 227 concordant twins, 110 of mild discordance, and 122 of severe discordance. Among the concordant ones, there was only a difference in oxygen uptake at 36 weeks. In those of mild discordance, the smaller twin presented a lower frequency of hyaline membrane disease and required fewer doses of surfactant, but had a higher risk of bronchopulmonary dysplasia (BPD) or death. In severe discordant twins, the smaller one presented higher mortality, sepsis, use and permanence in mechanical ventilation, despite the lower frequency of hyaline membrane disease. In multiple regression analysis, the combined risk of BPD or death was higher in the smaller twin and of severe discordance. CONCLUSION: In discordant twins, the acute respiratory pathology was more frequent in the larger one, although the risk of BPD or death was higher in the one with IUGR.


Assuntos
Displasia Broncopulmonar/etiologia , Doenças em Gêmeos/etiologia , Retardo do Crescimento Fetal/fisiopatologia , Sepse Neonatal/etiologia , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/mortalidade , Estudos de Casos e Controles , Doenças em Gêmeos/diagnóstico , Doenças em Gêmeos/mortalidade , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Modelos Logísticos , Masculino , Sepse Neonatal/diagnóstico , Sepse Neonatal/mortalidade , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco
5.
Respir Res ; 20(1): 102, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31126291

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a risk factor for respiratory disease in adulthood. Despite the differences in underlying pathology, patients with a history of BPD are often treated as asthmatics. We hypothesized that pulmonary outcomes and health-related quality of life (HRQoL) were different in adults born preterm with and without a history of BPD compared to asthmatics and healthy individuals. METHODS: We evaluated 96 young adults from the LUNAPRE cohort ( clinicaltrials.gov/ct2/show/NCT02923648 ), including 26 individuals born preterm with a history of BPD (BPD), 23 born preterm without BPD (preterm), 23 asthmatics and 24 healthy controls. Extensive lung function testing and HRQoL were assessed. RESULTS: The BPD group had more severe airway obstruction compared to the preterm-, (FEV1- 0.94 vs. 0.28 z-scores; p ≤ 0.001); asthmatic- (0.14 z-scores, p ≤ 0.01) and healthy groups (0.78 z-scores, p ≤ 0.001). Further, they had increased ventilation inhomogeneity compared to the preterm- (LCI 6.97 vs. 6.73, p ≤ 0.05), asthmatic- (6.75, p = 0.05) and healthy groups (6.50 p ≤ 0.001). Both preterm groups had lower DLCO compared to healthy controls (p ≤ 0.001 for both). HRQoL showed less physical but more psychological symptoms in the BPD group compared to asthmatics. CONCLUSIONS: Lung function impairment and HRQoL in adults with a history of BPD differed from that in asthmatics highlighting the need for objective assessment of lung health.


Assuntos
Asma/epidemiologia , Asma/fisiopatologia , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Adolescente , Asma/diagnóstico , Displasia Broncopulmonar/diagnóstico , Estudos de Coortes , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Recém-Nascido , Masculino , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/fisiopatologia , Qualidade de Vida/psicologia , Testes de Função Respiratória/métodos , Adulto Jovem
6.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30975699

RESUMO

OBJECTIVES: To compare medical and developmental outcomes over the first 2 years of life in extremely preterm infants with bronchopulmonary dysplasia (BPD) who were discharged on supplemental oxygen via nasal cannula with outcomes of infants with a similar severity of respiratory illness who were discharged breathing in room air. METHODS: We performed a propensity score-matched cohort study. Eligible infants were born at <27 weeks' gestation, were receiving supplemental oxygen or respiratory support at 36 weeks' postmenstrual age, and were assessed at 18 to 26 months' corrected age. Study outcomes included growth, resource use, and neurodevelopment between discharge and follow-up. Outcomes were compared by using multivariable models adjusted for center and age at follow-up. RESULTS: A total of 1039 infants discharged on supplemental oxygen were propensity score matched 1:1 to infants discharged breathing in room air. Infants on oxygen had a marginal improvement in weight z score (adjusted mean difference 0.11; 95% confidence interval [CI] 0.00 to 0.22), with a significantly improved weight-for-length z score (adjusted mean difference 0.13; 95% CI 0.06 to 0.20) at 22 to 26 months' corrected age. Infants on oxygen were more likely to be rehospitalized for respiratory illness (adjusted relative risk 1.33; 95% CI 1.16 to 1.53) and more likely to use respiratory medications and equipment. Rates of neurodevelopmental impairment were similar between the groups. CONCLUSIONS: In this matched cohort of infants with BPD, postdischarge oxygen was associated with marginally improved growth and increased resource use but no difference in neurodevelopmental outcomes. Ongoing and future trials are critical to assess the efficacy and safety of postdischarge supplemental oxygen for infants with BPD.


Assuntos
Displasia Broncopulmonar/terapia , Serviços de Assistência Domiciliar/tendências , Recém-Nascido Prematuro/crescimento & desenvolvimento , Oxigenoterapia/tendências , Displasia Broncopulmonar/diagnóstico , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Oxigenoterapia/métodos , Alta do Paciente/tendências , Pontuação de Propensão , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
7.
Pregnancy Hypertens ; 15: 57-63, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30825928

RESUMO

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is a severe common complication of preterm birth with considerable short and long-term consequences. As more evidence is emerging that dysregulation of angiogenesis is implicated in the pathogenesis of preeclampsia as well as in fetal lung development, we assessed if preeclampsia is associated with development of BPD in very preterm neonates. STUDY DESIGN: A retrospective cohort study of 308 infants born between 24+0 and 31+6 weeks of gestation in 2011 and 2012. We performed association analysis with univariable and multivariable logistic regression, adjusting for confounders. Models were additionally adjusted for intermediates, to show how an association can be disguised by over adjusting. MAIN OUTCOME MEASURE: BPD was diagnosed at 36+0 weeks postmenstrual age and defined as the need for oxygen (FiO2 > 0.21) for at least 12 h per day, for more than 28 days before or at 36+0 weeks postmenstrual age, and classified as mild, moderate or severe. RESULTS: After applying our exclusion criteria, we report our primary outcome on 247 mother-neonate pairs. Fifty-nine neonates developed BPD (23.9%) which was moderate to severe in 27 of them (10.9%). Preeclampsia was associated with BPD, adjusted odds ratio, 95% confidence interval: 4.22 (1.63, 10.91). However, after adjusting for additional intermediates no statistical significance remained, adjusted odds ratio, 95% confidence interval: 1.87 (0.49, 7.24). CONCLUSION: This study shows that early-onset preeclampsia is associated with development of BPD in the very preterm neonate. Part of this association is mediated by fetal growth restriction and mode of delivery.


Assuntos
Displasia Broncopulmonar/etiologia , Displasia Broncopulmonar/mortalidade , Lactente Extremamente Prematuro , Pré-Eclâmpsia/epidemiologia , Adulto , Displasia Broncopulmonar/diagnóstico , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pré-Eclâmpsia/fisiopatologia , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença
8.
PLoS One ; 14(3): e0213210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30840669

RESUMO

INTRODUCTION: Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in childhood, related to prematurity, and the most common cause of pulmonary hypertension (PH) secondary to pulmonary disease in children. Moderate and severe BPD have a worse outcome and relate more frequently with PH. The prediction of moderate or severe BPD development in extremely premature newborns is vital to implement preventive strategies. Starting with the hypothesis that molecular biomarkers were better than clinical and echocardiographic factors, this study aims to explore the ability of clinical, echocardiographic and analytical variables to predict moderate or severe BPD in a cohort of extremely preterm infants. PATIENTS AND METHODS: We designed a prospective longitudinal study, in which we followed a cohort of preterm newborns (gestational age <28 weeks and weight ≤ 1250 grams). In these newborns we recorded weekly clinical and echocardiographic variables as well as blood and tracheal aspirate samples, to analyze molecular biomarkers (IL-6, IL-1, IP10, uric acid, HGF, endothelin-1, VEGF, CCL5). Variables and samples were collected since birth up to week 36 (postmenstrual age), time-point at which the diagnosis of BPD is established. RESULTS: We included 50 patients with a median gestational age of 26 weeks (IQR 25-27) and weight of 871 g (SD 161,0) (range 590-1200g). Three patients were excluded due to an early death. Thirty-five patients (74.5%) developed BPD (mild n = 14, moderate n = 15, severe n = 6). We performed a logistic regression in order to identify risk factors for moderate or severe BPD. We compared two predictive models, one with two variables (mechanical ventilation and inter-ventricular septum flattening), and another-one with an additional molecular biomarker (ET-1). CONCLUSIONS: The combination of clinical and echocardiographic variables is a valuable tool for determining the risk of BPD. We find the two variable model (mechanical ventilation and echocardiographic signs of PH) more practical for clinical and research purposes. Future research on BPD prediction should be oriented to explore the potential role of ET-1.


Assuntos
Biomarcadores/sangue , Displasia Broncopulmonar/diagnóstico , Ecocardiografia/métodos , Lactente Extremamente Prematuro/sangue , Recém-Nascido de Baixo Peso/sangue , Doenças do Prematuro/diagnóstico , Medição de Risco/métodos , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/metabolismo , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/metabolismo , Estudos Longitudinais , Masculino , Gravidez , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
9.
Eur J Pediatr ; 178(5): 755-761, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30820654

RESUMO

Bronchopulmonary dysplasia (BPD) is a severe complication of prematurity that impacts survival and neurodevelopment. Currently, no early marker exists which could help clinicians identify which preterm infants will develop BPD. Given the evidence that NTproBNP is elevated in children with BPD, we hypothesized that it could be used as an early marker of BPD development. We conducted a prospective cohort study including very low birth weight infants (VLBWI) admitted to our NICU between January 2015 and January 2017 in which we determined serial NTproBNP levels on days 1 and 3 and then weekly, until 49 days of life. A total of 101 patients were recruited (mean birth weight 1152 g (SD 247.5), mean gestational age 28.9 weeks (SD 1.9)). NTproBNP levels differed among infants who did and did not develop BPD from 14 to 35 days of life with the greatest difference on day 14 of life (non-BPD group (n = 86): 1155 (IQR 852-1908) pg/mL, BPD (n = 15): 9707 (IQR 3212-29,560) pg/mL; p = 0.0003). The presence of HsPDA did not account for higher levels of NTproBNP at day 14 (p = 0.165). We calculated an optimal cutoff point of 2264 pg/mL at 14 days of life (sensitivity 100%, specificity 86% and AUC 0.93).Conclusions: NTproBNP at 14 days of life could be used as an early marker of later BPD development in VLBWI. What is Known: • Children with BPD have elevated NTproBNP levels, which are related to the severity of BPD and the development of pulmonary hypertension. What is New: • NTproBNP at 14 days of life is higher in those who later develop BPD, regardless of the presence of hemodynamically significant patent ductus arteriosus. • A calculated cutoff point of 2264 pg/mL of NTproBNP at 14 days has a sensitivity of 100% and specificity of 86% in the prediction of BPD.


Assuntos
Displasia Broncopulmonar/diagnóstico , Recém-Nascido de muito Baixo Peso , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Biomarcadores/sangue , Displasia Broncopulmonar/sangue , Displasia Broncopulmonar/complicações , Estudos de Casos e Controles , Permeabilidade do Canal Arterial/complicações , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Estudos Longitudinais , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade
10.
J Korean Med Sci ; 34(5): e40, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30718992

RESUMO

Background: This study was performed to determine survival and morbidity rates in very low birth weight infants (VLBWIs) in the Korean Neonatal Network (KNN), and to compare neonatal outcomes with those in other countries. Methods: Data were collected for 8,269 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. Results: The survival rate of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 86% (total), 33%, 65%, 84%, 94%, 97%, and 98%, respectively. The bronchopulmonary dysplasia (BPD) rates of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 30% (total), 88%, 64%, 47%, 26%, 14%, and 5%, respectively. The intraventricular hemorrhage rates (≥ grade III) of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 10% (total), 45%, 27%, 12%, 5%, 2%, and 1%, respectively. In an international comparison, the survival rate of VLBWIs with GA 24-27 weeks in KNN was lower, and the BPD rate of VLBWIs in the KNN was higher than that of the neonatal networks of other countries. Conclusion: Despite overall improvements in neonatal outcomes, the survival and morbidity rates of more immature infants with GA 22-27 weeks need further improvement. Therefore, it would be necessary to develop more optimal treatment strategies and perform more active quality improvement to further improve neonatal outcomes of VLBWIs in Korea.


Assuntos
Displasia Broncopulmonar/diagnóstico , Hemorragia Cerebral Intraventricular/diagnóstico , Recém-Nascido de muito Baixo Peso , Adulto , Displasia Broncopulmonar/mortalidade , Hemorragia Cerebral Intraventricular/mortalidade , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , República da Coreia , Taxa de Sobrevida
11.
J Perinat Med ; 47(4): 470-477, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-30789824

RESUMO

Background The pathogenesis of bronchopulmonary dysplasia (BPD) includes arrest of alveolar septation and enhanced fibrosis. We hypothesized that mesenchymal stromal cells (MSC) and transforming growth factor-ß1 (TGF-ß1) in tracheal aspirates of mechanically ventilated premature infants differ in BPD and non-BPD infants. Methods Tracheal aspirates were collected during the first week of life. Mononuclear cells were separated, cultured and immunophenotyped by flow cytometry. MSCs colony/cluster ratio was calculated as an index for dysplastic potentials. TGF-ß1 was assessed by enzyme-linked immunosorbent assay (ELISA). Setting: Neonatal intensive care unit. Patients Premature infants at risk for BPD. Results A total of 121 preterm infants were enrolled; 27 of them died and among the 94 survivors 23 infants had BPD. MSCs were identified in younger [gestational age (GA): 30.9±1.7 vs. 31.8±1.8, P=0.025] and smaller [birth weight (BW): 1.3±0.28 vs. 1.44±0.37 kg, P=0.04] infants with lower Apgar scores. The recovery rate of MSCs in BPD and non-BPD groups did not differ. BPD group had significantly smaller colony/cluster ratio compared to non-BPD (0.97 vs. 4.25, P=0.002). TGF-ß1 was significantly greater in BPD infants (4173.9±864.3 vs. 3705.8±540.5 pg/mL, P=0.021). Conclusion Infants with BPD had different MSCs morphology and greater TGF-ß1 expression. The pathogenesis for these morphological changes of resident lung MSCs needs further studying.


Assuntos
Displasia Broncopulmonar/diagnóstico , Células-Tronco Mesenquimais/patologia , Fator de Crescimento Transformador beta1/metabolismo , Displasia Broncopulmonar/metabolismo , Displasia Broncopulmonar/patologia , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Células-Tronco Mesenquimais/metabolismo , Traqueia/metabolismo , Traqueia/patologia
12.
Turk Patoloji Derg ; 35(1): 28-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30614512

RESUMO

OBJECTIVE: The microscopic and macroscopic features of the placenta can contribute to the clinical understanding of premature delivery. The aim of our study was to figure out the relationship between the histopathological findings of the placentas of premature deliveries and its effects on neonatal morbidity and mortality. MATERIAL AND METHOD: The placentas of 284 singleton preterm infants with < 35 weeks of gestation were examined. Three groups were created as the normal, chorioamnionitis and vasculopathy groups according to the histopathological findings in the placentas of the subjects. RESULTS: The mean gestational age of the infants in the study group was 30.5 ± 3.2 weeks, and the mean birth weight was 1588 ± 581 g. The pathology was normal in ninety-six (33.8%), vasculopathy in 153 (53.9%) and chorioamnionitis in 35 (12.3%). The gestation age of the infants was lower in the chorioamnionitis group. Moreover, retinopathy of prematurity, early onset neonatal sepsis, and duration of respiratory support were found to be higher in the chorioamnionitis group. In the vasculopathy group, preeclampsia and small for gestational age were found to be significantly higher. CONCLUSION: Histopathological findings of the placentas from preterm deliveries provided important data in determining the etiology of preterm delivery and outcomes of infants. Infants delivered by mothers with chorioamnionitis were particularly found to be more preterm, and these preterm infants would have a longer hospital stay, higher respiratory support requirement, and more serious morbidities.


Assuntos
Corioamnionite/patologia , Doenças do Prematuro/patologia , Placenta/patologia , Doenças Vasculares/patologia , Peso ao Nascer , Displasia Broncopulmonar/diagnóstico , Corioamnionite/mortalidade , Diabetes Gestacional/diagnóstico , Feminino , Ruptura Prematura de Membranas Fetais/diagnóstico , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Recém-Nascido Pequeno para a Idade Gestacional , Unidades de Terapia Intensiva Neonatal , Morbidade , Sepse Neonatal/diagnóstico , Pré-Eclâmpsia/diagnóstico , Gravidez , Estudos Prospectivos , Retinopatia da Prematuridade/diagnóstico , Doenças Vasculares/mortalidade
13.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30602545

RESUMO

BACKGROUND AND OBJECTIVES: Avoidance of delivery room intubation (DRI) reduces death or bronchopulmonary dysplasia (BPD) in preterm neonates. Our objective with this quality improvement project was to decrease DRI rates by improving face mask positive pressure ventilation (Fm-PPV) among infants born ≤29 weeks' gestation. METHODS: Key drivers of change were identified from a retrospective review of resuscitation records. A resuscitation bundle to optimize Fm-PPV including the use of a small round mask and end-tidal CO2 detectors, increasing peak inspiratory pressure when indicated, and debriefing after each intubation were implemented in consecutive plan-do-study-act cycles. The DRI rate was tracked by using a control chart. Resuscitation practice and outcomes of pre-quality improvement cohort (QIC) (January 2014-September 2015) were compared with post-QIC (October 2015-December 2016). RESULTS: Of the 314 infants who were resuscitated, 180 belonged to the pre-QIC and 134 to the post-QIC. The antenatal steroid administration rate was higher in the post-QIC (54% vs 88%). More infants in the post-QIC had resolution of bradycardia after Fm-PPV (56% vs 77%, P = .02). Infants in the post-QIC had lower DRI rates (58% vs 37%, P < .01), lower need for mechanical ventilation (85% vs 70%, P < .01), lower rates of BPD (26% vs 13%, P < .01), and severe retinopathy of prematurity (14% vs 5%, P = .01). Rates of DRI, BPD, and severe retinopathy of prematurity remained lower even after controlling for the potential confounders. CONCLUSIONS: Implementation of a resuscitation bundle decreased the DRI rate and improved outcomes of preterm infants.


Assuntos
Salas de Parto/normas , Recém-Nascido Prematuro/fisiologia , Melhoria de Qualidade/normas , Ressuscitação/normas , Adulto , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/terapia , Estudos de Coortes , Salas de Parto/tendências , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/terapia , Masculino , Gravidez , Melhoria de Qualidade/tendências , Ressuscitação/métodos , Ressuscitação/tendências , Estudos Retrospectivos
14.
J Matern Fetal Neonatal Med ; 32(21): 3640-3646, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29695207

RESUMO

Aim: Some infants with bronchopulmonary dysplasia (BPD) may require oxygen supplementation at home but a role for overnight polysomnography (PSG) in the management of home oxygen therapy has been rarely described. Methods: Forty-one infants with BPD born at less than 30 weeks gestational age were discharged with continuous home oxygen supplementation therapy between 2010 and 2013. PSG data were recorded on oxygen supplementation versus room air at median corrected age of 2 months (range 1-5 months) (first PSG after discharge to home). Those infants who continued oxygen supplementation therapy at home had at least one more PSG before oxygen therapy was discontinued (last PSG). We also collected PSG data in 10 healthy term infants (median age 3.5 months; range 2-4 months). Results: In infants with BPD in room air, increased numbers of central apneas, hypopneas, and SaO2 desaturations were the predominant PSG features with a median apnea-hypopnea index (AHI) of 16.8 events per hour (range 0-155). On oxygen supplementation therapy, median AHI dramatically improved (2.2, range 0-22; p < .001) and was not different from control infants (2.0, range 0-3.9; p = .31). AHI on room air at the last PSG when home oxygen was ceased was 4.1 per hour (range 0-13.8) slightly higher than in healthy infants. Conclusion: Central sleep disordered breathing in infants with BPD dramatically normalizes with low flow nasal cannula home oxygen therapy and improves with age. Mild central sleep disordered breathing remains detectable, although much improved, when compared with healthy infants at the time when the decision to cease home oxygen therapy was made by the physician.


Assuntos
Doenças do Prematuro/diagnóstico , Doenças do Prematuro/terapia , Lesão Pulmonar/diagnóstico , Lesão Pulmonar/terapia , Oxigenoterapia , Polissonografia , Austrália , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/etiologia , Displasia Broncopulmonar/terapia , Doença Crônica , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Oxigenoterapia/métodos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
15.
Congenit Heart Dis ; 14(1): 27-32, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30343505

RESUMO

Patent ductus arteriosus (PDA) is prevalent in premature newborns and has been linked to the development of bronchopulmonary dysplasia (BPD), a serious pulmonary complication of premature birth. Although a causal relationship has not been proven, the link is greatest among infants born at lower gestational age who are treated with mechanical ventilation in the presence of a large ductal shunt. Despite strong association in epidemiological studies, treatment of a patent ductus arteriosus has not been shown to prevent BPD, and some therapies may increase the risk of BPD. We describe preclinical and clinical data demonstrating the association of a PDA with BPD, highlight the effects of surgical and pharmacological treatment, and explore the implications of recent clinical trials for the management of PDA in the premature newborn.


Assuntos
Displasia Broncopulmonar , Hemodinâmica/fisiologia , Recém-Nascido Prematuro , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/etiologia , Displasia Broncopulmonar/fisiopatologia , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/fisiopatologia , Humanos , Recém-Nascido
16.
J Perinat Med ; 47(2): 247-251, 2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30335614

RESUMO

Background Small for gestational age (SGA) infants are less likely to develop respiratory distress syndrome (RDS), but more likely to develop bronchopulmonary dysplasia (BPD) and have a higher mortality. Our aim was to focus on outcomes of those with a birth weight less than or equal to 750 g. Methods The mortality, BPD severity, necrotising enterocolitis (NEC), home oxygen requirement and length of hospital stay were determined according to SGA status of all eligible infants in a 5-year period admitted within the first 24 h after birth. Results The outcomes of 84 infants were assessed, and 35 (42%) were SGA. The SGA infants were more mature (P<0.001), had a lower birth weight centile (P<0.001) and a greater proportion exposed to antenatal corticosteroids (P=0.022). Adjusted for gestational age (GA), there was no significant difference in mortality between the two groups (P=0.242), but a greater proportion of the SGA infants developed severe BPD (P=0.025). The SGA infants had a lower weight z-score at discharge (-3.64 vs. -1.66) (P=0.001), but a decrease in z-score from birth to discharge was observed in both groups (median -1.53 vs. -1.07, P=0.256). Conclusion Despite being more mature, the SGA infants had a similar mortality rate and a greater proportion developed severe BPD.


Assuntos
Displasia Broncopulmonar , Enterocolite Necrosante , Idade Gestacional , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido Pequeno para a Idade Gestacional , Peso ao Nascer , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/etiologia , Displasia Broncopulmonar/mortalidade , Correlação de Dados , Enterocolite Necrosante/diagnóstico , Enterocolite Necrosante/etiologia , Enterocolite Necrosante/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/etiologia , Doenças do Recém-Nascido/mortalidade , Masculino , Mortalidade , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Fatores de Risco , Reino Unido/epidemiologia
17.
Semin Perinatol ; 42(7): 432-443, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30384985

RESUMO

The past decade of neonatal care has been highlighted by increased survival rates in smaller and more premature infants. Despite reduction in mortality associated with extreme prematurity, long term pulmonary morbidities remain a concern, with growing recognition of the clinical burden attributable to infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH). Recent publications shed light on the critical contributions of maternal placental pathology and compromised intrauterine growth to fetal pulmonary vascular development. A body of literature has further clarified postnatal risk factors for PH, most notably the severity of BPD but surprisingly the additional presence of non-pulmonary morbidities including necrotizing enterocolitis (NEC). Limitations of current diagnostics persist with growing consideration of novel echocardiographic approaches as well as complementary non-invasive biomarkers to better identify infants at risk. In 2015, a joint report published by the American Heart Association and American Thoracic Society provided the first guidelines for the care of children with PH with limited content to address BPD-associated PH. These guidelines were expanded upon in an expert consensus report produced by the Pediatric Pulmonary Hypertension Network (PPHNet). These recommendations encouraged the use of standardized screening protocols and emphasized the importance of evaluation and treatment of comorbidities when PH is identified. Cardiac catheterization was recommended prior to initiation of therapy for more accurate quantification of pulmonary pressures, clarification of anatomy and guidance in the use of pharmacotherapy. Despite these guidelines, significant practice variation persists and gaps remain with respect to optimal evaluation and management of BPD-associated PH.


Assuntos
Displasia Broncopulmonar/diagnóstico , Hipertensão Pulmonar/diagnóstico , Pulmão/fisiopatologia , Placenta/irrigação sanguínea , Biomarcadores/metabolismo , Displasia Broncopulmonar/mortalidade , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/terapia , Ecocardiografia , Feminino , Desenvolvimento Fetal/fisiologia , Humanos , Hipertensão Pulmonar/mortalidade , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Lactente , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido , Pulmão/crescimento & desenvolvimento , Programas de Rastreamento , Gravidez , Taxa de Sobrevida
19.
Eur Respir Rev ; 27(150)2018 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-30487291

RESUMO

Sustained inflations and avoidance of endotracheal mechanical ventilation (eMV) are delivery room interventions aimed at preventing bronchopulmonary dysplasia (BPD). Their effectiveness is the subject of the present meta-analysis.The databases MEDLINE, EMBASE and CENTRAL were searched for randomised controlled trials (RCTs) of preterm infants that compared: 1) sustained inflations with intermittent positive-pressure ventilation; and 2) a non-intubated strategy of respiratory support with one that prescribed eMV at an earlier stage. Data extraction and analysis followed the standard methods of the Cochrane Collaboration. The primary outcome was death or BPD, defined as need for oxygen or positive pressure treatment at 36 weeks' postmenstrual age.Avoiding eMV (nine RCTs, 3486 infants) reduced the risk of death or BPD, with a risk ratio of 0.90 (95% CI 0.84-0.97) and a number needed to treat of 35. After sustained inflations (six RCTs, 854 infants), the risk ratio was 0.85 (95% CI 0.65-1.12). A current multicentre RCT of sustained inflations in very preterm infants was halted for increased early mortality in the sustained inflations arm.While strategies aimed at avoiding eMV had a small but significant impact on preventing BPD, sustained inflations had no effect and may even increase mortality in very preterm infants.


Assuntos
Displasia Broncopulmonar/prevenção & controle , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Ventilação não Invasiva/efeitos adversos , Nascimento Prematuro , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/etiologia , Displasia Broncopulmonar/mortalidade , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Ventilação com Pressão Positiva Intermitente/mortalidade , Intubação Intratraqueal/efeitos adversos , Ventilação não Invasiva/mortalidade , Fatores de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Resultado do Tratamento
20.
BMC Genet ; 19(1): 94, 2018 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-30342483

RESUMO

BACKGROUND: Previous studies have identified genetic variants associated with bronchopulmonary dysplasia (BPD) in extremely preterm infants. However, findings with genome-wide significance have been rare, and not replicated. We hypothesized that whole exome sequencing (WES) of premature subjects with extremely divergent phenotypic outcomes could facilitate the identification of genetic variants or gene networks contributing disease risk. RESULTS: The Prematurity and Respiratory Outcomes Program (PROP) recruited a cohort of > 765 extremely preterm infants for the identification of markers of respiratory morbidity. We completed WES on 146 PROP subjects (85 affected, 61 unaffected) representing extreme phenotypes of early respiratory morbidity. We tested for association between disease status and individual common variants, screened for rare variants exclusive to either affected or unaffected subjects, and tested the combined association of variants across gene loci. Pathway analysis was performed and disease-related expression patterns were assessed. Marginal association with BPD was observed for numerous common and rare variants. We identified 345 genes with variants unique to BPD-affected preterm subjects, and 292 genes with variants unique to our unaffected preterm subjects. Of these unique variants, 28 (19 in the affected cohort and 9 in unaffected cohort) replicate a prior WES study of BPD-associated variants. Pathway analysis of sets of variants, informed by disease-related gene expression, implicated protein kinase A, MAPK and Neuregulin/epidermal growth factor receptor signaling. CONCLUSIONS: We identified novel genes and associated pathways that may play an important role in susceptibility/resilience for the development of lung disease in preterm infants.


Assuntos
Displasia Broncopulmonar/diagnóstico , Variação Genética , Displasia Broncopulmonar/genética , Estudos de Casos e Controles , DNA/química , DNA/metabolismo , Feminino , Loci Gênicos , Estudo de Associação Genômica Ampla , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Sequenciamento Completo do Exoma
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