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1.
Arch Dis Child Fetal Neonatal Ed ; 106(1): 88-92, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32847833

RESUMO

OBJECTIVE: Early decrease in fetal haemoglobin (HbF) is an indicator of loss of endogenous blood components that might have predictive value for development of bronchopulmonary dysplasia (BPD). The link between HbF and BPD has not been evaluated. DESIGN: Retrospective observational study. SETTING: Tertiary level neonatal intensive care unit, referral centre for Southern Sweden. PATIENTS: 452 very preterm infants (<30 gestational weeks) born 2009-2015. INTERVENTIONS: Regular clinical practice. MAIN OUTCOME MEASURES: Mean HbF, haemoglobin (Hb) and partial oxygen pressure (PaO2) levels calculated from 11 861 arterial blood gas analyses postnatal week 1. Relationship between HbF (%) and BPD (requirement of supplemental oxygen at 36 weeks' postmenstrual age) and the modifying influence of PaO2 (kPa) and total Hb (g/L) was evaluated. RESULTS: The mean gestational age (GA) at birth was 26.4 weeks, and 213 (56%) infants developed BPD. A 10% increase in HbF was associated with a decreased prevalence of BPD, OR 0.64 (95% CI 0.49 to 0.83; p<0.001). This association remained when adjusting for mean PaO2 and Hb. Infants with an HbF in the lowest quartile had an OR of 27.1 (95% CI 11.6 to 63.4; p<0.001) for development of BPD as compared with those in the highest quartile. The area under the curve for HbF levels and development of BPD in the full statistical model was 0.871. CONCLUSIONS: Early rapid postnatal decline in HbF levels was associated with development of BPD in very preterm infants. The association between HbF and BPD was not mediated by increased oxygen exposure. The potential benefit of minimising loss of endogenous blood components on BPD outcome will be investigated in a multicentre randomised trial.


Assuntos
Displasia Broncopulmonar/sangue , Displasia Broncopulmonar/epidemiologia , Hemoglobina Fetal/metabolismo , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Masculino , Estudos Retrospectivos
2.
Cochrane Database Syst Rev ; 10: CD002975, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33058139

RESUMO

BACKGROUND: The application of continuous positive airway pressure (CPAP) has been shown to have some benefits in the treatment of preterm infants with respiratory distress. CPAP has the potential to reduce lung damage, particularly if applied early before atelectasis has occurred. Early application may better conserve an infant's own surfactant stores and consequently may be more effective than later application. OBJECTIVES: • To determine if early compared with delayed initiation of CPAP results in lower mortality and reduced need for intermittent positive-pressure ventilation in preterm infants in respiratory distress ○ Subgroup analyses were planned a priori on the basis of weight (with subdivisions at 1000 grams and 1500 grams), gestation (with subdivisions at 28 and 32 weeks), and according to whether surfactant was used ▫ Sensitivity analyses based on trial quality were also planned ○ For this update, we have excluded trials using continuous negative pressure SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 6), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literatue (CINAHL), on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA: We included trials that used random or quasi-random allocation to either early or delayed CPAP for spontaneously breathing preterm infants in respiratory distress. DATA COLLECTION AND ANALYSIS: We used the standard methods of Cochrane and Cochrane Neonatal, including independent assessment of trial quality and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We found four studies that recruited a total of 119 infants. Two were quasi-randomised, and the other two did not provide details on the method of randomisation or allocation used. None of these studies used blinding of the intervention or the outcome assessor. Evidence showed uncertainty about whether early CPAP has an effect on subsequent use of intermittent positive-pressure ventilation (IPPV) (typical risk ratio (RR) 0.77, 95% confidence interval (CI) 0.43 to 1.38; typical risk difference (RD) -0.08, 95% CI -0.23 to 0.08; I² = 0%, 4 studies, 119 infants; very low-certainty evidence) or mortality (typical RR 0.93, 95% CI 0.43 to 2.03; typical RD -0.02, 95% CI -0.15 to 0.12; I² = 33%, 4 studies, 119 infants; very low-certainty evidence). The outcome 'failed treatment' was not reported in any of these studies. There was an uncertain effect on air leak (pneumothorax) (typical RR 1.09, 95% CI 0.39 to 3.04, I² = 0%, 3 studies, 98 infants; very low-certainty evidence). No trials reported intraventricular haemorrhage or necrotising enterocolitis. No cases of retinopathy of prematurity were reported in one study (21 infants). One case of bronchopulmonary dysplasia was reported in each group in one study involving 29 infants. Long-term outcomes were not reported. AUTHORS' CONCLUSIONS: All four small trials included in this review were performed in the 1970s or the early 1980s, and we are very uncertain whether early application of CPAP confers clinical benefit in the treatment of respiratory distress, or whether it is associated with any adverse effects. Further trials should be directed towards establishing the appropriate level of CPAP and the timing and method of administration of surfactant when used along with CPAP.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Recém-Nascido Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Viés , Displasia Broncopulmonar/epidemiologia , Humanos , Recém-Nascido , Ventilação com Pressão Positiva Intermitente/estatística & dados numéricos , Pneumotórax/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade
4.
Zhonghua Er Ke Za Zhi ; 58(9): 747-752, 2020 Sep 02.
Artigo em Chinês | MEDLINE | ID: mdl-32872715

RESUMO

Objective: To analyze clinical features, prognosis and risk factors of bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH). Methods: Clinical data of 338 infants with BPD were collected from the neonatal intensive care unit (NICU) in Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University between January 2016 and December 2018. These infants were divided into PH group and non-PH group. The clinical features and prognosis were compared between these two groups by Chi-square test or nonparametric test. Risk factors for BPD-PH were analyzed with binary logistic regression model. Results: Among the 338 BPD infants, 314 had no PH (92.9%) and 24 had PH (7.1%), with an average gestational age of (27.1±1.8) weeks, and 206 were males and 132 females.PH infants had younger gestational age ((26.4±2.1) vs. (27.2±1.7) weeks, t=2.201, P=0.028) and lower birth weight ((798±255) vs. (1 003±240) g, t=4.030, P<0.01), compared to non-PH infants. Besides, duration of mechanical ventilation and non-invasive positive pressure ventilation were higher in PH group than that in non-PH group (14.3 (2.1, 43.7) vs. 0.5 (0, 4.7) d, Z=-4.553, P<0.01; 30.0 (22.5, 64.2) vs. 15.0 (7.0, 26.0) d, Z=-4.838, P<0.01). The proportions of maternal hypertension, small for gestational age (SGA), late onset sepsis, ventilator associated pneumonia, hemodynamically significant patent ductus arteriosus (hsPDA), patent ductus arteriosus (PDA) requiring ligation, severe BPD and severe extrauterine growth retardation (EUGR) were higher in PH group than those in non-PH group ((20.8% (5/24) vs. 6.4% (20/314), 33.3% (8/24) vs. 7.6% (24/314), 54.2% (13/24) vs. 7.3% (23/314), 25.0% (6/24) vs. 6.1% (19/314), 75.0% (18/24) vs. 39.2% (123/314), 45.8% (11/24) vs. 1.9% (6/314), 66.7% (16/24) vs. 7.3% (23/314), 75.0% (18/24) vs. 45.5% (143/314), all P<0.05). Multivariate logistic regression analysis showed that maternal hypertension (OR=12.950, 95%CI: 1.740-96.385), severe bronchopulmonary dysplasia (OR=10.160, 95%CI: 2.725-37.884), SGA (OR=4.992, 95%CI: 1.432-16.920), PDA requiring ligation (OR=19.802, 95%CI: 3.297-118.921), severe EUGR (OR=20.316, 95%CI: 2.221-185.853) were independent risk factors of BPD associated PH. In the 24 infants with PH, all 7 mild PH infants and 8 moderate PH infants survived, while 4 out of 9 severe PH infants died. Among the survivors, the longest duration of oxygen therapy was up to the corrected gestational age of 1 year and 2 months. Conclusions: PH is a severe complication of BPD, and associated with higher mortality and poor prognosis. Echocardiography screening and regular post-discharge follow up are recommended for BPD infants with risk factors of PH.


Assuntos
Displasia Broncopulmonar , Hipertensão Pulmonar , Assistência ao Convalescente , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/epidemiologia , Feminino , Idade Gestacional , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Alta do Paciente , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco
5.
PLoS One ; 15(7): e0235332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628705

RESUMO

Neonatal vitamin D deficiency is common and is associated with development of pulmonary disease in children and adults. While the role of vitamin D in normal lung development is well established, the association between vitamin D deficiency and bronchopulmonary dysplasia (BPD) remains unclear. The present meta-analysis was conducted to evaluate the relationship between vitamin D and BPD. We identified relevant studies (n = 8) using the PubMed, EMBASE, Cochrane Library, and KoreaMed databases and applied the Newcastle-Ottawa Scale to assess the methodological components of each study, and used I2 statistic to evaluate heterogeneity. Comprehensive Meta-Analysis software version 3.3 was used for the statistical analysis. A total of 909 infants were included, of whom 251 (27.6%) were diagnosed with BPD. We found that both vitamin D deficiency at birth (four studies; OR 2.405; 95% CI 1.269 to 4.560; p = 0.007) and low levels of vitamin D at birth (four studies; standardized mean difference -1.463; 95% CI -2.900 to -0.027; p = 0.046) were associated with BPD. The compiled data suggest that antenatal vitamin D deficiency and low vitamin D levels are associated with neonatal BPD.


Assuntos
Displasia Broncopulmonar/epidemiologia , Deficiência de Vitamina D/epidemiologia , Vitamina D/sangue , Displasia Broncopulmonar/etiologia , Humanos , Incidência , Lactente , Recém-Nascido , Razão de Chances , Fatores de Risco , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico
6.
PLoS One ; 15(7): e0235901, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32673340

RESUMO

OBJECTIVE: To investigate the risk factors for BPD severity by gestational age (GA) and identify a way to reduce the incidence of moderate-to-severe BPD. STUDY DESIGN: This was a retrospective cohort study of very-low-birth-weight-infants (VLBWIs) delivered at 24 to 28 weeks GA from Korean Neonatal Network registry between 2013 and 2016. BPD was defined using the National Institutes of Health criteria. Study populations were divided by GA and subdivided into no/mild BPD and moderate/severe BPD. The initial statuses of all infants, including those who died before BPD diagnosis and the maternal and neonatal factors of the live infants were compared. Statistical methods included descriptive statistics, comparative tests, and logistic regression. RESULTS: Of 3,976 infants, 3,717 were included (24weeks, n = 456; 25 weeks, n = 650, 26 weeks, n = 742; 27 weeks, n = 836; 28 weeks, n = 1,033). The overall mortality rate was 18% and the rates by GA were 43%, 29%, 11%, and 6% in the 24-, 25-, 26-, 27-, 28-GA groups, respectively. Small for GA (SGA), treated patent ductus arteriosus (PDA), hypotension, and late-onset sepsis were significant risk factors for developing moderate/severe BPD in the 25 to 28-week GA groups in the multivariate analyses. However, for infants born at 24 weeks GA, there were no significant risk factors apart from initial resuscitation. CONCLUSIONS: Effective initial resuscitation was the most important factor for infants delivered at 24 weeks GA determining the severity of BPD. For infants delivered between 25 and 28 weeks, judicious care of SGA infants, aggressive treatment for PDA and hypotension, and intense efforts to decrease the sepsis rate are needed to reduce the development of moderate-to-severe BPD.


Assuntos
Displasia Broncopulmonar/patologia , Idade Gestacional , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/etiologia , Displasia Broncopulmonar/mortalidade , Permeabilidade do Canal Arterial/complicações , Feminino , Humanos , Hipotensão/complicações , Incidência , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Modelos Logísticos , Masculino , Sistema de Registros , República da Coreia , Ressuscitação/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Sepse/complicações , Índice de Gravidade de Doença , Taxa de Sobrevida
7.
JAMA ; 324(2): 157-167, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32662862

RESUMO

Importance: Maternal docosahexaenoic acid (DHA) supplementation may prevent bronchopulmonary dysplasia, but evidence remains inconclusive. Objective: To determine whether maternal DHA supplementation during the neonatal period improves bronchopulmonary dysplasia-free survival in breastfed infants born before 29 weeks of gestation. Design, Setting, and Participants: Superiority, placebo-controlled randomized clinical trial at 16 Canadian neonatal intensive care units (June 2015-April 2018 with last infant follow-up in July 2018). Lactating women who delivered before 29 weeks of gestation were enrolled within 72 hours of delivery. The trial intended to enroll 800 mothers, but was stopped earlier. Interventions: There were 232 mothers (273 infants) assigned to oral capsules providing 1.2 g/d of DHA from randomization to 36 weeks' postmenstrual age and 229 mothers (255 infants) assigned to placebo capsules. Main Outcomes and Measures: The primary outcome was bronchopulmonary dysplasia-free survival in infants at 36 weeks' postmenstrual age. There were 22 secondary outcomes, including mortality and bronchopulmonary dysplasia. Results: Enrollment was stopped early due to concern for harm based on interim data from this trial and from another trial that was published during the course of this study. Among 461 mothers and their 528 infants (mean gestational age, 26.6 weeks [SD, 1.6 weeks]; 253 [47.9%] females), 375 mothers (81.3%) and 523 infants (99.1%) completed the trial. Overall, 147 of 268 infants (54.9%) in the DHA group vs 157 of 255 infants (61.6%) in the placebo group survived without bronchopulmonary dysplasia (absolute difference, -5.0% [95% CI, -11.6% to 2.6%]; relative risk, 0.91 [95% CI, 0.80 to 1.04], P = .18). Mortality occurred in 6.0% of infants in the DHA group vs 10.2% of infants in the placebo group (absolute difference, -3.9% [95% CI, -6.8% to 1.4%]; relative risk, 0.61 [95% CI, 0.33 to 1.13], P = .12). Bronchopulmonary dysplasia occurred in 41.7% of surviving infants in the DHA group vs 31.4% in the placebo group (absolute difference, 11.5% [95% CI, 2.3% to 23.2%]; relative risk, 1.36 [95% CI, 1.07 to 1.73], P = .01). Of 22 prespecified secondary outcomes, 19 were not significantly different. Conclusions and Relevance: Among breastfed preterm infants born before 29 weeks of gestation, maternal docosahexaenoic acid supplementation during the neonatal period did not significantly improve bronchopulmonary dysplasia-free survival at 36 weeks' postmenstrual age compared with placebo. Study interpretation is limited by early trial termination. Trial Registration: ClinicalTrials.gov Identifier: NCT02371460.


Assuntos
Displasia Broncopulmonar/prevenção & controle , Suplementos Nutricionais , Ácidos Docosa-Hexaenoicos/administração & dosagem , Adulto , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/mortalidade , Estudos de Equivalência como Asunto , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Lactação , Cooperação do Paciente/estatística & dados numéricos , Tamanho da Amostra
8.
J Pediatr ; 225: 44-50.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32454113

RESUMO

OBJECTIVE: To describe trends in mortality, major morbidity, and perinatal care practices of very low birth weight infants born at NEOCOSUR Neonatal Network centers from January 1, 2001, through December 31, 2016. STUDY DESIGN: A retrospective analysis of prospectively collected data from all inborn infants with a birthweight of 500-1500 g and 23-35 weeks of gestation. RESULTS: We examined data for 13 987 very low birth weight infants with a mean birth weight of 1081 ± 281 g and a gestational age of 28.8 ± 2.9 weeks. Overall mortality was 26.8% without significant changes throughout the study period. Decreases in early onset sepsis from 6.3% to 2.8% (P <.001), late onset sepsis from 21.1% to 19.5% (P = .002), retinopathy of prematurity from 21.3% to 13.8% (P <.001), and hydrocephalus from 3.8% to 2.4% (P <.001), were observed. The incidence for bronchopulmonary dysplasia decreased from 17.3% to 16% (P = .043), incidence of severe intraventricular hemorrhage was 10.4%, necrotizing enterocolitis 11.1%, and periventricular leukomalacia 3.8%, and did not change over the study period. Administration of antenatal corticosteroids increased from 70.2% to 82.3% and cesarean delivery from 65.9% to 75.4% (P <.001). The use of conventional mechanical ventilation decreased from 67.7% to 63.9% (P <.001) and continuous positive airway pressure use increased from 41.3% to 64.3% (P <.001). Survival without major morbidity increased from 37.4% to 44.5% over the study period (P <.001). CONCLUSIONS: Progress in perinatal and neonatal care at network centers was associated with an improvement in survival without major morbidity of very low birth weight infants during a 16-year period. However, overall mortality remained unchanged.


Assuntos
Recém-Nascido de muito Baixo Peso , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Corticosteroides/uso terapêutico , Adulto , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/mortalidade , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/mortalidade , Cesárea , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/mortalidade , Feminino , Idade Gestacional , Humanos , Hidrocefalia/epidemiologia , Hidrocefalia/mortalidade , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/mortalidade , Idade Materna , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/mortalidade , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/mortalidade , Resultado do Tratamento
10.
Am J Respir Crit Care Med ; 202(3): 422-432, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32302489

RESUMO

Rationale: Growth and development during adolescence may modify the respiratory and vascular differences seen among extremely preterm (EP) individuals in childhood and early adolescence.Objectives: To assess the trajectory of respiratory and cardiovascular outcomes during transition to adulthood in a national longitudinal cohort study of births before 26 weeks of gestation in the United Kingdom and Ireland.Methods: A total of 129 EP participants and 65 control subjects attended for a center-based evaluation at 19 years of age. Standardized measures of spirometry, hemodynamics, functional capacity, and markers of inflammation were obtained from EP subjects with and without neonatal bronchopulmonary dysplasia and term-born control subjects at 19 years of age and compared with previous assessments.Measurements and Main Results: Compared with the control group, the EP group was significantly impaired on all spirometric parameters (mean FEV1 z-score, -1.08 SD [95% confidence interval, -1.40 to -0.77]) and had lower fractional exhaled nitric oxide concentrations (13.9 vs. 24.4 ppb; P < 0.001) despite a higher proportion with bronchodilator reversibility (27% vs. 6%). The EP group had significantly impaired exercise capacity. All respiratory parameters were worse after neonatal bronchopulmonary dysplasia, and respiratory function differences were similar at 11 and 19 years. The augmentation index was 6% higher in the EP group and associated with increased total peripheral resistance (difference in means, 96.4 [95% confidence interval, 26.6-166.2] dyne/s/cm-5) and elevation in central, but not peripheral, blood pressure. Central systolic and diastolic blood pressures increased more quickly during adolescence in the EP group than in the control group.Conclusions: Clinicians should address both cardiovascular and respiratory risks in adult survivors of extremely preterm birth.


Assuntos
Asma/fisiopatologia , Pressão Sanguínea/fisiologia , Displasia Broncopulmonar/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Tolerância ao Exercício/fisiologia , Pulmão/fisiopatologia , Asma/epidemiologia , Testes Respiratórios , Displasia Broncopulmonar/epidemiologia , Proteína C-Reativa/imunologia , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Creatinina , Feminino , Volume Expiratório Forçado , Taxa de Filtração Glomerular , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Inflamação/imunologia , Irlanda/epidemiologia , Estudos Longitudinais , Pulmão/fisiologia , Masculino , Manometria , Fluxo Máximo Médio Expiratório , Óxido Nítrico , Análise de Onda de Pulso , Espirometria , Reino Unido/epidemiologia , Resistência Vascular/fisiologia , Capacidade Vital , Teste de Caminhada , Adulto Jovem
11.
J Pediatr ; 220: 27-33, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32111378

RESUMO

OBJECTIVE: To evaluate the effects of immigrant mother status and risk factors on the rates of emergency room (ER) visits and rehospitalizations of preterm infants within 90 days after discharge. STUDY DESIGN: This was a retrospective cohort study of 732 mothers of 866 preterm infants (<37 weeks of gestational age) cared for in a neonatal intensive care unit (NICU) for >5 days. Medical and demographic data and number of ER visits and rehospitalizations were collected. The primary outcomes were the numbers of ER visits and rehospitalizations. Analysis included bivariate comparisons of immigrant and native mother-infant dyads. Regression models were run to estimate the effects of immigrant mother status and risk factors. RESULTS: Compared with native mothers, immigrant mothers (176 of 732; 24%) were more likely to be older, to be gravida >1, to be nonwhite, to have a non-English primary language, to have less than a high school education, and to have Medicaid insurance but less likely to have child protective services, substance abuse, and a mental health disorder. Infants of immigrant mothers (203 of 866; 23%) had higher rates of ER visits and more days of hospitalization compared with infants of native mothers. Among immigrant mothers only, >5 years living in the US, non-English primary language, and bronchopulmonary dysplasia (BPD) were predictive of ER visits, whereas Medicaid and BPD were predictive of rehospitalization. For the total cohort, after an interaction between Medicaid and immigrant status was added to the model, immigrant status became nonsignificant and immigrant mothers with Medicaid emerged as a strong predictor of hospitalization and a borderline predictor for ER visits. CONCLUSIONS: Among immigrant mothers, non-English primary language, >5 years living in the US, and BPD increased the odds of an ER visit. For the total cohort, however, the interaction of immigrant mother with Medicaid as a marker of poverty provided a significant modifying effect on increased rehospitalization and ER use.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Disparidades em Assistência à Saúde , Hospitalização/estatística & dados numéricos , Recém-Nascido Prematuro , Mães , Readmissão do Paciente/estatística & dados numéricos , Adulto , Displasia Broncopulmonar/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Idioma , Medicaid , Estudos Retrospectivos , Estados Unidos/epidemiologia
12.
J Pediatr ; 220: 40-48.e5, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32093927

RESUMO

OBJECTIVE: To determine associations between home oxygen use and 1-year readmissions for preterm infants with bronchopulmonary dysplasia (BPD) discharged from regional neonatal intensive care units. STUDY DESIGN: We performed a secondary analysis of the Children's Hospitals Neonatal Database, with readmission data via the Pediatric Hospital Information System and demographics using ZIP-code-linked census data. We included infants born <32 weeks of gestation with BPD, excluding those with anomalies and tracheostomies. Our primary outcome was readmission by 1 year corrected age; secondary outcomes included readmission duration, mortality, and readmission diagnosis-related group codes. A staged multivariable logistic regression was adjusted for center, clinical, and social risk factors; at each stage we included variables associated at P < .1 in bivariable analysis with home oxygen use or readmission. RESULTS: Home oxygen was used in 1906 of 3574 infants (53%) in 22 neonatal intensive care units. Readmission occurred in 34%. Earlier gestational age, male sex, gastrostomy tube, surgical necrotizing enterocolitis, lower median income, nonprivate insurance, and shorter hospital-to-home distance were associated with readmission. Home oxygen was not associated with odds of readmission (OR, 1.2; 95% CI, 0.98-1.56), readmission duration, or mortality. Readmissions for infants with home oxygen were more often coded as BPD (16% vs 4%); readmissions for infants on room air were more often gastrointestinal (29% vs 22%; P < .001). Clinical risk factors explained 72% of center variance in readmission. CONCLUSIONS: Home oxygen use is not associated with readmission for infants with BPD in regional neonatal intensive care units. Center variation in home oxygen use does not impact readmission risk. Nonrespiratory problems are important contributors to readmission risk for infants with BPD.


Assuntos
Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/terapia , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Recém-Nascido Prematuro , Oxigenoterapia/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Enterocolite Necrosante/epidemiologia , Feminino , Gastrostomia , Idade Gestacional , Humanos , Renda , Recém-Nascido , Seguro Saúde , Unidades de Terapia Intensiva Neonatal , Masculino , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia
13.
Pediatr Allergy Immunol ; 31 Suppl 24: 16-18, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32017219

RESUMO

Chronic obstructive respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD) have their roots in the womb. Together with a genetic predisposition, prenatal and early-life factors, including maternal smoking, prematurity, and bronchopulmonary dysplasia (BPD), have a pivotal role in later respiratory health. Then, inappropriate responses to respiratory viruses (especially respiratory syncytial virus and rhinovirus) and early allergic sensitization are the strongest contributors to the inception of wheezing and early-onset asthma. There is an urgent need for early disease biomarkers to identify profiles at higher risk of chronic respiratory conditions. Applying the "-omic" technologies to urine, blood and breath condensate, and non-invasive inflammometry seem promising in this regard. The description of specific risk profiles may be the key to the use of targeted personalized therapies.


Assuntos
Asma/diagnóstico , Displasia Broncopulmonar/diagnóstico , Hipersensibilidade/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Infecções Respiratórias/diagnóstico , Viroses/diagnóstico , Asma/epidemiologia , Biomarcadores/metabolismo , Displasia Broncopulmonar/epidemiologia , Fumar Cigarros/efeitos adversos , Diagnóstico Precoce , Feminino , Humanos , Hipersensibilidade/epidemiologia , Exposição Materna/efeitos adversos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Infecções Respiratórias/epidemiologia , Risco , Viroses/epidemiologia
14.
Arch Dis Child Fetal Neonatal Ed ; 105(5): 526-531, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31969457

RESUMO

BACKGROUND: Use of bubble continuous positive airway pressure (CPAP) has generated considerable interest in neonatal care, but its comparative effectiveness compared with other forms of CPAP, especially in developed countries, remains unclear. OBJECTIVE: To systematically review and meta-analyse short-term clinical outcomes among preterm infants treated with bubble CPAP vs all other forms of CPAP. METHODS: Prospective experimental studies published from 1995 onward until October 2018 comparing bubble versus other CPAP forms in preterm neonates <37 weeks' gestational age were included after a systematic review of multiple databases using pre-specified search criteria. RESULTS: A total of 978 articles were identified, of which 19 articles were included in meta-analyses. Of these, 5 had a high risk of bias, 8 had unclear risk and 6 had low risk. The risk of the primary outcome (CPAP failure within 7 days) was lower with bubble CPAP (0.75; 95% CI 0.57 to 0.98; 12 studies, 1194 subjects, I2=21%). Among secondary outcomes, only nasal injury was higher with use of bubble CPAP (risk ratio (RR) 2.04, 95% CI 1.33 to 3.14; 9 studies, 983 subjects; I2=42%) whereas no differences in mortality (RR 0.82, 95% CI 0.47 to 1.92; 9 studies, 1212 subjects, I2=20%) or bronchopulmonary dysplasia (BPD) (RR 0.8, 95% CI 0.53 to 1.21; 8 studies, 816 subjects, I2=0%) were noted. CONCLUSION: Bubble CPAP may lead to lower incidence of CPAP failure compared with other CPAP forms. However, it does not appear to translate to improvement in mortality or BPD and potential for nasal injury warrants close monitoring during clinical application. TRIAL REGISTRATION NUMBER: CRD42019120411.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Recém-Nascido Prematuro , Displasia Broncopulmonar/epidemiologia , Mortalidade Hospitalar , Humanos , Recém-Nascido , Oxigênio/sangue , Estudos Prospectivos , Mecânica Respiratória
15.
Arch Dis Child Fetal Neonatal Ed ; 105(5): 520-525, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31980445

RESUMO

OBJECTIVE: To determine whether early low-dose hydrocortisone treatment in extremely preterm infants is associated with brain damage assessed by MRI at term equivalent of age (TEA). PATIENTS AND OUTCOMES: This is a predefined secondary analysis of brain abnormalities, observed by MRI at TEA, of patients randomly assigned to receive either placebo or hydrocortisone in the PREMILOC trial. Outcomes were based on brain abnormalities graded according to Kidokoro scores. RESULTS: Among 412 survivors at TEA, 300 MRIs were performed and 295 were suitable for analysis. Kidokoro scoring was completed for 119/148 and 110/147 MRIs in the hydrocortisone and placebo groups, respectively. The distribution of the Kidokoro white matter (WM) subscore and other subscores was not significantly different between the two groups. There was, however, a significant association between a higher overall Kidokoro score and hydrocortisone treatment (5.84 (SD 3.51) for hydrocortisone and 4.98 (SD 2.52) for placebo; mean difference, 0.86; 95% CI 0.06 to 1.66; p=0.04). However, hydrocortisone was not statistically associated with moderate-to-severe brain lesions (Kidokoro overall score ≥6) in a multivariate logistic regression model accounting for potential confounding variables (adjusted OR (95% CI) 1.27 (0.75 to 2.14), p=0.38). Bronchopulmonary dysplasia at 36 weeks postmenstrual age significantly predicted both WM damage (adjusted OR (95% CI) 2.70 (1.03 to 7.14), p=0.04) and global brain damage (adjusted OR (95% CI) 2.18 (1.19 to 3.99), p=0.01). CONCLUSIONS: Early hydrocortisone exposure in extremely preterm infants is not statistically associated with either WM brain damage or overall moderate-to-severe brain lesions when adjusted for other neonatal variables. TRIAL REGISTRATION NUMBER: EudraCT number 2007-002041-20, NCT00623740.


Assuntos
Encéfalo/efeitos dos fármacos , Displasia Broncopulmonar/prevenção & controle , Hidrocortisona/administração & dosagem , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Encéfalo/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/epidemiologia , Displasia Broncopulmonar/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Hidrocortisona/efeitos adversos , Recém-Nascido , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Transtornos do Neurodesenvolvimento
16.
J Perinatol ; 40(4): 681-687, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31907398

RESUMO

BACKGROUND: Bronchopulmonary Dysplasia (BPD) is the most common prematurity complication. Although several practices have been proposed for BPD prevention, none of these in isolation prevent BPD. METHODS: Our initiative focused on two key drivers: oxygen management and noninvasive ventilation strategies. We created best practice guidelines and followed outcome measures using Shewhart control charts. RESULTS: PDSAs of protocols preceded a large-scale rollout of a "0.21 by 28" campaign in 2014 leading to a special cause reduction in the "any BPD" rate, and a decrease in severe BPD (from 57 to 29%). At the end of 2017, we reinvigorated the project, which led to dramatic decreases in the "any BPD" rate to 41% and the "severe BPD" rate to 21%. CONCLUSIONS: A multidisciplinary QI initiative focused on process improvement geared towards the pathophysiological contributors of BPD has successfully reduced the rate of BPD in an all referral level IV NICU.


Assuntos
Displasia Broncopulmonar/prevenção & controle , Oxigenoterapia/normas , Melhoria de Qualidade , Respiração Artificial/normas , Displasia Broncopulmonar/epidemiologia , Hospitais Pediátricos , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Ohio , Respiração Artificial/métodos
17.
J Perinatol ; 40(3): 481-487, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31911647

RESUMO

OBJECTIVE: To evaluate outcomes of preterm infants <26 weeks gestational age (GA) following postdelivery extensive cardiopulmonary resuscitation (ECPR) compared with airway and breathing support (ABS). STUDY DESIGN: Retrospective review of Canadian Neonatal Network data during January 2010 to December 2016. The primary outcome was death or severe morbidity (intraventricular hemorrhage ≥grade 3 or periventricular leucomalacia, retinopathy of prematurity ≥stage 3, bronchopulmonary dysplasia, or necrotizing enterocolitis). RESULT: Among 3633 infants analyzed, 433 (11.9%) received ECPR. In multivariable analysis, death or severe morbidity was higher in the ECPR versus ABS group [adjusted odds ratio 2.26 (95% confidence interval 1.49, 3.43)]. The majority of the difference was due to increased mortality, which occurred mostly during the first week of life. CONCLUSION: These data from a recent cohort of infants near the limits of viability may be useful for prognostication for health care providers and counseling of parents.


Assuntos
Reanimação Cardiopulmonar , Lactente Extremamente Prematuro , Morte Perinatal , Respiração com Pressão Positiva , Displasia Broncopulmonar/epidemiologia , Canadá , Hemorragia Cerebral/epidemiologia , Enterocolite Necrosante/epidemiologia , Feminino , Humanos , Recém-Nascido , Intubação Intratraqueal , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Prognóstico , Retinopatia da Prematuridade/epidemiologia , Estudos Retrospectivos
18.
J Matern Fetal Neonatal Med ; 33(4): 625-632, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30157682

RESUMO

Objective: To evaluate short-term respiratory outcomes, mortality and bronchopulmonary dysplasia (BPD) in preterm infants born to mothers with and without pregnancy induced hypertension (PIH).Methods: Exposed infants <33 weeks' gestation were matched to controls in a 1:2 ratio, based on gestation, sex and antenatal steroid exposure in this retrospective cohort study. Primary outcomes were a novel cumulative respiratory index (cRI) (product of mean airway pressure-hours and FiO2-hours while on invasive ventilation during first 72 hours), mortality and BPD.Results: Seventy-nine exposed infants were matched with 158 controls. cRI was higher in exposed infants (median 1854; IQR 186-13,901) versus controls (median 1359; IQR 210-11,302) but not statistically significant (p = .63). On conditional regression analysis, PIH did not predict cRI (adjusted ß = 0.96; 95% CI = 0.79-1.17; p = .712). No association between PIH and mortality (unadjusted odds ratio [OR] = 3.14; 95% CI = 0.76-13.0; p=.11) was identified. PIH was significantly associated with BPD on univariate analysis (OR = 2.29; 95% CI = 1.02-5.17; p=.046), but not after adjustment (aOR = 1.26; 95% CI = 0.38-4.19; p=.7).Conclusions: PIH was not associated with cRI, mortality or BPD in this study. Further validation of cRI and exploration of its relationship with PIH as well as neonatal outcomes is warranted.


Assuntos
Displasia Broncopulmonar/epidemiologia , Adulto , Canadá/epidemiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Estudos Retrospectivos
19.
Chest ; 157(3): 595-602, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31862439

RESUMO

BACKGROUND: Bronchoscopy is the gold standard for evaluating tracheomalacia; however, reliance on an invasive procedure limits understanding of normal airway dynamics. Self-gated ultrashort echo-time MRI (UTE MRI) can assess tracheal dynamics but has not been rigorously evaluated. METHODS: This study was a validation of UTE MRI diagnosis of tracheomalacia in neonates using bronchoscopy as the gold standard. Bronchoscopies were reviewed for the severity and location of tracheomalacia based on standardized criteria. The percent change in cross-sectional area (CSA) of the trachea between end-inspiration and end-expiration was determined by UTE MRI, and receiver-operating curves were used to determine the optimal cutoff values to predict tracheomalacia and determine positive and negative predictive values. RESULTS: Airway segments with tracheomalacia based on bronchoscopy had a more than threefold change in CSA measured from UTE MRI (54.4 ± 56.1% vs 14.8 ± 19.5%; P < .0001). UTE MRI correlated moderately with bronchoscopy for tracheomalacia severity (ρ = 0.39; P = .0001). Receiver-operating curves, however, showed very good ability of UTE MRI to identify tracheomalacia (area under the curve, 0.78). A "loose" definition (> 20% change in CSA) of tracheomalacia had good sensitivity (80%) but low specificity (64%) for identifying tracheomalacia based on UTE MRI, whereas a "strict" definition (> 40% change in CSA) was poorly sensitive (48%) but highly specific (93%). CONCLUSIONS: Self-gated UTE MRI can noninvasively assess tracheomalacia in neonates without sedation, ionizing radiation, or increased risk. This technique overcomes major limitations of other diagnostic modalities and may be suitable for longitudinal population studies of tracheal dynamics.


Assuntos
Imagem por Ressonância Magnética/métodos , Técnicas de Imagem de Sincronização Respiratória/métodos , Traqueia/diagnóstico por imagem , Traqueomalácia/diagnóstico por imagem , Displasia Broncopulmonar/epidemiologia , Broncoscopia , Comorbidade , Atresia Esofágica/epidemiologia , Expiração , Feminino , Hérnias Diafragmáticas Congênitas/epidemiologia , Humanos , Lactente , Recém-Nascido , Inalação , Masculino , Valor Preditivo dos Testes , Curva ROC , Reprodutibilidade dos Testes , Fístula Traqueoesofágica/epidemiologia , Traqueomalácia/diagnóstico , Traqueomalácia/epidemiologia
20.
Pediatr Neonatol ; 61(3): 272-278, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31843363

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a common complication in very preterm infants. Despite advances in perinatal medicine, the number of BPD patients is increasing in Japan. The aim of this study was to conduct a nationwide survey of the strategies used for the prevention or treatment of BPD. METHODS: Questionnaires assessing the current strategies used to prevent or treat BPD, including neonatal resuscitation, drug therapy, and respiratory supportive care, were sent to secondary or tertiary perinatal units in 2015; responses were compared with those obtained from similar surveys in 2005 and 2010. The annual trend in incidence of BPD among the very low birth weight infants (VLBWIs) was determined using the Neonatal Research Network of Japan database. RESULTS: The response rates in 2005, 2010, and 2015 were 86.8% (230/265), 64.5% (185/287), and 82.8% (236/285) of units, respectively. The use of patient-triggered ventilation for initial management significantly increased from 50% of units in 2005 to 91% in 2015. By contrast, decreased use of high-frequency oscillatory ventilation (HFOV) from 72% to 65% and that of nasal continuous positive airway pressure from 79% to 68% were reported. The proportion of units where the upper limit of targeted blood oxygen saturation before a diagnosis of BPD was set to ≥95% decreased substantially from 92% to 56% over the 10-year period. Despite these changes in management of BPD, the incidence of BPD among VLBWIs in Japan was increasing over a decade. CONCLUSION: This survey demonstrated that there were various changes in practice regarding the prevention or treatment of BPD in Japan. Continuous surveys are required to understand the current clinical situation, and research is needed to develop and evaluate a novel treatment for BPD in premature infants.


Assuntos
Displasia Broncopulmonar/terapia , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/prevenção & controle , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Japão/epidemiologia , Masculino , Oxigênio/sangue , Inquéritos e Questionários
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