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1.
Zhonghua Er Ke Za Zhi ; 57(12): 934-942, 2019 Dec 02.
Artigo em Chinês | MEDLINE | ID: mdl-31795560

RESUMO

Objective: To study the short-term outcomes and their related risk factors of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI) in Guangdong province. Methods: The neonatal and corresponding maternal medical records of 2 392 cases of EPI and ELBWI discharged from 26 tertiary hospitals in Guangdong province during 2013-2017 were collected. Chi-square test or linear-by-linear association chi-square was used to analyze the following data on an annual basis: (1) the proportion of EPI and ELBWI in all discharged infants and preterm infants; (2) the difference in survival rate of EPI and ELBWI in different regions and types of hospital; and (3) the difference in incidence of complications. A binary Logistic regression model was established to analyze the death-related risk factors. Results: From 2013 to 2017, the enrolled infants each year were 331, 418, 458, 574 and 611, respectively. Totally, there were 1 352 (56.5%) male infants. The gestational age was (27.7±1.9) weeks, and the birth weight was (919±158) g. The proportion of EPI and ELBWI in all discharged infants increased from 2013 to 2017 (χ(2)=68.636, P<0.01), and so did the proportion in all discharged preterm infants (χ(2)=73.463, P<0.01). The overall survival rate was 60.4% (1 445/2 392), which increased from 2013 to 2017 (χ(2)=11.424, P<0.01). Besides, the survival rate was higher in the Pearl River Delta region than that in the non-Pearl River Delta region (61.7% (1 325/2 146) vs. 48.8% (120/246), χ(2)=15.505, P<0.01), and also higher in women and children specialist hospitals than that in general hospitals (66.5% (702/1 056) vs. 55.6% (743/1 336), χ(2)=29.104, P<0.01). The overall incidence of complications was 89.0% (2 130/2 392) for neonatal respiratory distress syndrome (NRDS), 72.2% (1 041/1 442) for bronchopulmonary dysplasia (BPD), 40.5% (625/1 544) for retinopathy of prematurity (ROP), 12.3% (237/1 922) for necrotizing enterocolitis (NEC), 31.0% (578/1 865) for periventricular-intraventricular hemorrhage (PV-IVH), 34.1% (656/1 922) for nosocomial infection, 26.9% (625/2 327) for patent ductus arteriosus (PDA), and 4.4% (82/1 865) for periventricular leukomalacia (PVL). From 2013 to 2017, the incidence of PVL decreased (χ(2)=6.093, P=0.014), but the incidence of BPD and PDA increased (χ(2)=24.476 and 11.741, respectively, both P<0.01). Multivariate Logistic regression analysis showed that Apgar score ≤7 at 5-minute (OR=1.830, 95%CI 1.373-2.437, P<0.01), NRDS (OR=1.407, 95%CI 1.222-1.621, P<0.01), invasive assisted ventilation (OR=1.825, 95%CI 1.241-2.683, P<0.01), maternal cervical insufficiency (OR=2.044, 95%CI 1.002-4.169, P=0.049), and medical care withdrawal (OR=25.532, 95%CI 18.867-34.553, P<0.01) increased the risk of early neonatal death, while the increase in gestational age (OR=0.869, 95%CI 0.802-0.941, P<0.01), discharged from Guangzhou and Shenzhen (OR=0.606, 95%CI 0.451-0.813, P<0.01), antenatal use of steroids (OR=0.624, 95%CI 0.471-0.828, P<0.01), premature rupture of membranes (OR=0.667, 95%CI 0.466-0.955, P=0.027), and pulmonary surfactant treatment (OR=0.532, 95%CI 0.419-0.676, P<0.01) could decrease the risk. For the mortality in the late or post-neonatal period, placenta previa (OR=2.355, 95%CI 1.006-5.516, P=0.048), cervical insufficiency (OR=3.306, 95%CI 1.259-8.679, P=0.015), PV-IVH (OR=1.486, 95%CI 1.135-1.946, P<0.01), invasive assisted ventilation (OR=2.143, 95%CI 1.208-3.801, P<0.01), and medical care withdrawal (OR=286.532, 95%CI 87.840-934.661, P<0.01) increased the risk, while the increase of birthweight (OR=0.997, 95%CI 0.996-0.999, P<0.01) decreased the risk. Conclusions: The survival rate of EPI and ELBWI increases annually, but the incidence of complications is still high. Invasive assisted ventilation, medical care withdrawal and maternal cervical insufficiency are associated with mortality in both early and late neonatal or post-neonatal period.


Assuntos
Displasia Broncopulmonar/epidemiologia , Enterocolite Necrosante/epidemiologia , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Retinopatia da Prematuridade/epidemiologia , China , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Fatores de Risco
2.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593285

RESUMO

The recently documented high survival of extremely preterm infants in Sweden is related to a high degree of centralization of pre- and postnatal care and to recently issued national consensus guidelines providing recommendations for perinatal care at 22-24 gestational weeks. The prevalence of major neonatal morbidity remains high and exceeded 60 % in a recent study of extremely preterm infants born at < 27 gestational weeks delivered in Sweden in 2014-2016 and surviving to 1 year of age. Damage to immature organ systems inflicted during the neonatal period causes varying degrees of functional impairment with lasting effects in the growing child. There is an urgent need for evidence-based novel interventions aiming to prevent neonatal morbidity with a subsequent improvement of long-term outcome.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Nascimento Prematuro , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/prevenção & controle , Serviços Centralizados no Hospital , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/prevenção & controle , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/prevenção & controle , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/prevenção & controle , Assistência Perinatal/organização & administração , Gravidez , Nascimento Prematuro/mortalidade , Retinopatia da Prematuridade/sangue , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/prevenção & controle , Taxa de Sobrevida , Suécia/epidemiologia
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.
Orv Hetil ; 160(32): 1270-1278, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31387373

RESUMO

Introduction: During recent decades, the perinatal mortality of extremely low-birth weight infants has decreased. An important task is to recognize complications of prematurity. Aim: We made an attempt to explore the relationship between complications of prematurity and neonatal hyperglycemia. Method: From 1 January 2014 to 31 December 2017, 188 infants with birth weight below 1000 g were admitted. For each infant, the frequencies of hyperglycemia (blood glucose >8.5 mmol/l), retinopathy of prematurity, intraventricular hemorrhage, and bronchopulmonary dysplasia were determined. Animal studies were performed in Sprague Dawley rats. Hyperglycemia was achieved by intraperitoneal injection of streptozotocin (100 mg/kg). On the 7th day of life, aorta sections were prepared and stained with hematoxylin eosin. Wall thickness was measured using QCapture Pro 7 image analysis software. Results: The mean ± SD gestational age and birth weight were 27.1 ± 2.2 weeks and 814.9 ± 151.9 g; 33 infants (17.5%) died. Hyperglycemia was confirmed in 62 cases (32.9%), and insulin treatment was given to 43 infants (22.8%). The gestational age and birth weight of the hyperglycemic infants were significantly lower (p<0.001), the incidence of severe retinopathy (p = 0.012) and the mortality of insulin-treated patients were higher (p = 0.02) than in normoglycemic infants. Among survivors (n = 155), we found by logistic regression analysis that hyperglycemia was a risk factor for severe retinopathy (p<0.001). In the rat model, neonatal hyperglycemia caused significant thickening of the aortic wall. Conclusion: Our studies indicate that hyperglycemia is common in extremely low birth-weight infants. Monitoring of these infants for retinopathy of prematurity, kidney dysfunction, and hypertension is recommended. Orv Hetil. 2019; 160(32): 1270-1278.


Assuntos
Diabetes Mellitus Experimental , Hiperglicemia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Doenças do Prematuro , Retinopatia da Prematuridade/etiologia , Animais , Peso ao Nascer , Displasia Broncopulmonar/epidemiologia , Hemorragia Cerebral Intraventricular/epidemiologia , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/tratamento farmacológico , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Gravidez , Ratos , Ratos Sprague-Dawley , Retinopatia da Prematuridade/epidemiologia
5.
J Neonatal Perinatal Med ; 12(2): 161-171, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256080

RESUMO

BACKGROUND: Pulmonary hemorrhage (PH) is occasionally seen in premature infants after surfactant treatment for respiratory distress syndrome (RDS). These infants receive frequent chest radiographs (CXR) during and after hospitalization enabling long-term radiographic-clinical correlation. OBJECTIVE: To chart the natural evolution of CXR findings of PH in RDS and correlate radiographic patterns to supplemental oxygen requirement. MATERIALS AND METHODS: Retrospective review of clinical notes for gestational age (GA), birth weight (BW), intraventricular hemorrhage (IVH) and oxygen requirement were performed. CXRs were reviewed at 4 time-points; during PH, 28 days postnatal age, 36 weeks and at farthest available clinical follow-up. RESULTS: 18 infants born (2003-2016), GA (24-30 weeks); BW (482-1590 grams) were included. Mean onset of PH was 1.94 (0-5) days. 9/18 (50%) had IVH. 3 died during PH; all had IVH. During PH, CXR showed whiteout 9/18 (50%); patchy opacities 5/18 (27%); diffuse haziness 1/18 (6%) and no change 3/18 (17%). At 28 days postnatal age, CXR showed fine-interstitial (FI) markings 14/15 (93%) and whiteout 1/15 (7%). At 36 weeks,12/14 (85%) had FI and 2/14 (15%) developed cystic-interstitial changes. At farthest follow-up, FI 3/13 (23%); coarse-interstitial 4/13 (30%); peri-bronchial cuffing 5/13 (38%); normal 1/13 (9%) and the majority had hyperinflation 9/13 (69%). At discharge, 9/14 (64%) required home-oxygen and 5/14 (36%) were on room-air. At farthest follow-up, 6/14 (42%) required home-oxygen and 8/14 (58%) were on room-air. CONCLUSION: Premature infants that survive PH may later develop chronic lung disease of prematurity with an evolving interstitial pattern on CXR that clears overtime as they outgrow the need for supplemental oxygen.


Assuntos
Displasia Broncopulmonar/epidemiologia , Hemorragia/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Administração Tópica , Displasia Broncopulmonar/prevenção & controle , Hemorragia Cerebral Intraventricular/epidemiologia , Criança , Pré-Escolar , Comorbidade , Progressão da Doença , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Surfactantes Pulmonares/uso terapêutico , Radiografia Torácica , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Estudos Retrospectivos
6.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31164440

RESUMO

CONTEXT: Previous studies have suggested that intervention with omega-3 long-chain polyunsaturated fatty acids (N-3 LCPUFAs), especially docosahexaenoic acid, can reduce the incidence of bronchopulmonary dysplasia (BPD) in preterm infants. However, conflicting results have been reported. OBJECTIVE: We conducted this meta-analysis to investigate the effect of intervention with N-3 LCPUFAs on the incidence of BPD in preterm infants. DATA SOURCES: PubMed, Embase, and the Cochrane Library were searched for articles published from database inception to October 1, 2018. STUDY SELECTION: We included randomized controlled trials (RCTs) in which the effect of intervention with N-3 LCPUFAs on the incidence of BPD was examined. DATA EXTRACTION: Two independent authors conducted the literature search and data extraction. The risk ratio was determined, and subgroup analyses were performed. RESULTS: After applying the inclusion criteria, 14 RCTs with 3531 preterm infants were included in the study. Intervention with N-3 LCPUFAs revealed no significant effect on the incidence of BPD in preterm infants (risk ratio: 0.99; 95% confidence interval: 0.84-1.18; Z = 0.08; P = .93). Our secondary subgroup analysis, which was stratified by gestational age, birth weight, dosage of docosahexaenoic acid, and duration of intervention, also revealed no significant effects. LIMITATIONS: The populations, protocols, and pharmaceutical ingredients of N-3 LCPUFAs vary among the included RCTs. CONCLUSIONS: The results of our meta-analysis indicate that intervention with N-3 LCPUFAs cannot prevent BPD in preterm infants. These findings provide no support for intervention with N-3 LCPUFAs in preterm infants.


Assuntos
Anti-Inflamatórios/uso terapêutico , Displasia Broncopulmonar/prevenção & controle , Ácidos Graxos Ômega-3/uso terapêutico , Displasia Broncopulmonar/epidemiologia , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Resultado do Tratamento
7.
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
8.
Arch Dis Child Fetal Neonatal Ed ; 104(6): F631-F635, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30894396

RESUMO

OBJECTIVE: To investigate the association between invasive mechanical ventilation (IMV) duration and long-term neurodevelopmental outcomes in preterm infants in an era of restricted IMV. DESIGN: Retrospective cohort study. SETTING: Single neonatal intensive care unit in Amsterdam. PATIENTS: All ventilated patients with a gestational age between 24 and 30 weeks born between 2010 and 2015. MAIN OUTCOME MEASURES: Neurodevelopmental impairment (NDI) at 24 months corrected age (CA). Data on patient characteristics, respiratory management, neonatal morbidities, mortality and bronchopulmonary dysplasia were collected. The relationship between IMV duration and NDI was determined by multivariate logistic regression analysis. RESULTS: During the study period, 368 admitted infants received IMV for a median duration of 2 days. Moderate and severe bronchopulmonary dysplasia was diagnosed in 33% of the infant. Multivariate regression analysis with adjustment for gestational age, small for gestational age and socioeconomic status showed a significant association between every day of IMV and NDI at 24 months CA (adjusted OR [aOR] 1.08, 95% CI 1.004 to 1.16, p=0.04). This association only reached borderline significance when also adjusting for severe neonatal morbidity (aOR 1.08, 95% CI 1.00 to 1.17, p=0.05). CONCLUSION: Even in an era of restricted IMV, every additional day of IMV in preterm infants is strongly associated with an increased risk of NDI at 24 months CA. Limiting IMV should be an important focus in the treatment of preterm infants.


Assuntos
Recém-Nascido Prematuro/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Transtornos do Neurodesenvolvimento/epidemiologia , Respiração Artificial/estatística & dados numéricos , Índice de Apgar , Displasia Broncopulmonar/epidemiologia , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Testes de Função Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Fatores de Tempo
9.
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
10.
J Neonatal Perinatal Med ; 12(2): 221-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829622

RESUMO

BACKGROUND: Premature neonates are often subjected to multiple transfusions with red blood cells during their hospitalization in the neonatal intensive care unit (NICU). The hemoglobin threshold for transfusion prior to discharge from the NICU varies significantly among different centers. The aim of the present study is to investigate the association between hemoglobin concentration at discharge with neurodevelopmental outcomes in premature neonates. METHODS: Retrospective observation study with regression analysis was performed with follow up assessment in the neuro-developmental outpatient clinic at 30 months of adjusted age. RESULTS: Data from 357 neonates born at less than 37 weeks' gestation were analyzed. Sensory and motor neurodevelopment at 30 months of adjusted age, were not associated with the hemoglobin concentration at discharge (p=0.5891 and p=0.4575, respectively). There was no association between the hemoglobin concentration at discharge with fine or gross motor development (p=0.1582 and p=0.3805, respectively). Hemoglobin concentration at discharge was not associated with poor neurodevelopmental outcomes up until 30 months of adjusted age. CONCLUSIONS: The data of the present study indicate that the hemoglobin concentration of premature neonates at the time of discharge is not associated with poorer markers of neurodevelopmental outcomes at 30 months of adjusted age. Comorbidities such as BPD and IVH that are present to premature neonates were identified as potential risk factors for certain aspects of the neurodevelopment.


Assuntos
Anemia/metabolismo , Desenvolvimento Infantil , Hemoglobinas/metabolismo , Anemia/epidemiologia , Anemia/terapia , Displasia Broncopulmonar/epidemiologia , Hemorragia Cerebral Intraventricular/epidemiologia , Pré-Escolar , Comorbidade , Enterocolite Necrosante/epidemiologia , Transfusão de Eritrócitos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Alta do Paciente , Estudos Retrospectivos
11.
PLoS One ; 14(2): e0211484, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735531

RESUMO

OBJECTIVE: To investigate the impact of different stages of intrauterine inflammation (IUI) on neonatal outcomes, before and after adjusting for gestational age (GA) and other perinatal confounders. METHODS: This was an observational, prospective, single-center cohort study including all eligible neonates with GA < 35 weeks and/or birth weight ≤ 1500 g born at a 3rd level Neonatal Intensive Care Unit between 2011 and 2014. Pathological patterns of placenta, membranes and cord were classified according to Redline's criteria. Multivariable linear and logistic regression models were applied, either including or not GA among the covariates. RESULTS: Of the 807 enrolled neonates, 134 (16.6%) had signs of IUI: among these, 54.5% showed just histological chorioamnionitis (HCA), 25.4% had HCA + funisitis (FUN) stage 1, and 20.1% had HCA + FUN stage 2-3. At univariate analysis, HCA increased the risk for retinopathy of prematurity (ROP) and bronchopulmonary dysplasia, while FUN (any stage) had a deleterious impact on all outcomes investigated. After adjustment for covariates not including GA, HCA was a risk factor only for ROP (OR = 2.8, CI: 1-7.8), while FUN (any stage) was still associated with increased ORs for all outcomes (p <0.01). Upon inclusion of GA in the regression model, the results differed remarkably. HCA was associated with lower risk for mechanical ventilation (OR = 0.3, CI: 0.1-0.7) and need for surfactant (OR = 0.5, CI: 0.2-0.9), while FUN (any stage) worsened clinical conditions at birth (p <0.05), increased the risk for early-onset sepsis (p <0.01), and increased the length of mechanical ventilation (FUN stage 2-3 only, RC = 6.5 days, CI: 2-11). No other outcome was affected. CONCLUSIONS: IUI, especially FUN, negatively impact most neonatal morbidities, but its effect is partially reverted adjusting for GA. Considered that GA is an intermediate variable interposed between prenatal causes of prematurity and outcomes, the appropriateness of adjusting for GA may be questionable.


Assuntos
Doenças do Prematuro/epidemiologia , Doenças Uterinas/complicações , Útero/patologia , Adulto , Displasia Broncopulmonar/epidemiologia , Corioamnionite/epidemiologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Inflamação/complicações , Masculino , Gravidez , Análise de Regressão , Retinopatia da Prematuridade/epidemiologia , Fatores de Risco , Doenças Uterinas/patologia
12.
Zhonghua Er Ke Za Zhi ; 57(1): 33-39, 2019 Jan 02.
Artigo em Chinês | MEDLINE | ID: mdl-30630229

RESUMO

Objective: To analyze clinical characteristics and risk factors of very low birth weight and extremely low birth weight infants with bronchopulmonary dysplasia (BPD). Methods: A retrospective epidemiological study was performed in 768 neonates (376 males) with birth weights<1 500 g and gestational age ≤ 34 weeks who survived ≥28 days. Clinical data were obtained from the multi-center clinical database of neonatal intensive care units (NICU) in 19 hospitals of Jiangsu Province between January 1, 2017 and December 31, 2017. These infants were divided into non-BPD group and BPD group according to BPD diagnositic criteria. Clinical features and potential risk factors were compared between groups with Chi-square test or nonparametric test. Risk factors for BPD were analyzed with Logistic regression analysis. Results: Among the total of 768 eligible neonates, 577 without BPD, 191 with BPD (24.9%). Mild, moderate and severe BPD accounted for 73.3% (140/191), 23.6% (45/191) and 3.1% (6/191) of all BPD cases respectively. There were significant differences in the average gestational age (29 (28, 30) vs. 30 (29, 31) weeks) or the average birth weight (1 170 (990, 1 300) vs. 1 300 (1 160, 1 400) g) between BPD group and non-BPD group (Z=-9.959,-7.202, both P=0.000). The incidences of BPD in the infants with gestational age of<28 weeks, 28-31 weeks and 32-34 weeks were 51.7% (46/89), 24.8% (139/561), 5.1% (6/118) respectively. The incidences of BPD in infants with birth weight<1 000 g, 1 000- 1 249 g and 1 250-1 500 g were 62.3% (48/77), 25.9% (70/270) and 17.3% (73/421) respectively. Proportion of male (55.5% (106/191) vs. 46.8% (270/577)), rate and length of conventional mechanical ventilation (48.7% (93/191) vs. 14.9% (86/577), 120 (72, 259) vs. 80 (29, 144)h), initial inhaled oxygen concentration and maximum inhaled oxygen concentration (0.35 (0.30, 0.40) vs. 0.30(0.25, 0.40), 0.40 (0.30, 0.50) vs. 0.30 (0.30, 0.40)) and volume of red blood cell transfusion (53(30, 90) vs.38(28, 55) ml) were higher in BPD group than in non-BPD group (χ(2)=4.350, 91.640, Z=-3.557, -2.848, -3.776, -4.677, all P<0.05). Rate of continuous positive airway pressure (12.6%(24/191) vs. 19.4%(112/577)) during neonatal resuscitation in delivery room was lower in BPD group than that in non-BPD group (χ(2)=4.614, P=0.032). The incidences of complications in BPD group including severe asphyxia, neonatal respiratory distress syndrome (NRDS), persistent pulmonary hypertension in newborns (PPHN), patent ductus arteriosus, anemia of prematurity, early onset sepsis, clinical sepsis and ventilator associated pneumonia were higher than that in non-BPD group (15.2%(29/191) vs. 4.5% (26/577), 91.1% (174/191) vs. 56.7% (327/577), 2.6% (5/191) vs. 0.2% (1/577), 43.5% (83/191) vs. 34.2% (197/577), 88.0% (168/191) vs. 58.8% (339/577), 15.7% (30/191) vs. 9.9% (57/577), 42.9% (82/191) vs. 18.6% (107/577), 14.1% (27/191) vs. 2.3% (13/577); χ(2)=24.605, 74.993, 9.167, 5.373, 61.866, 4.557, 43.149, 34.315, all P<0.05). Multivariate logistic regression analysis showed that NRDS (OR=4.651, 95%CI: 1.860-11.625), clinical sepsis (OR=1.989, 95%CI: 1.067-3.708), ventilator associated pneumonia (OR=3.155, 95%CI: 1.060-9.388), conventional mechanical ventilation (OR=2.298, 95%CI: 1.152-4.586), and volume of red blood cell transfusion (OR=1.013, 95%CI: 1.002-1.024) were risk factors of BPD. Conclusions: BPD is more common in very low birth weight infants of male with gestational age less than 32 weeks. Using CPAP in the delivery room, active treatment of NRDS, preventing nosocomial infection, and reducing invasive ventilation and red blood cell transfusion may decrease the incidence of BPD.


Assuntos
Displasia Broncopulmonar , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido de muito Baixo Peso , Peso ao Nascer , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/patologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido , Estudos Retrospectivos , Fatores de Risco
13.
J Obstet Gynaecol Res ; 45(5): 967-973, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30687995

RESUMO

AIM: The optimal antibiotic regimen for preterm premature rupture of membrane (pPROM) is still unclear. This study aimed to determine the effects of ampicillin-sulbactam (SBT/ABPC) and azithromycin (AZM) on the incidence of bronchopulmonary dysplasia (BPD). METHODS: This retrospective study included women with singleton gestations and a diagnosis of pPROM between 22 and 27 weeks of gestation. In patients presenting with a high risk of intra-amniotic infection between January 2011 and May 2013, piperacillin or cefmetazole + clindamycin (regimen 1 group; n = 11) was administered, whereas SBT/ABPC and AZM (regimen 2 group; n = 11) were administered in patients presenting a similar risk between June 2013 and May 2016. RESULTS: The incidence of moderate or severe infant BPD in the regimen 2 group was significantly lower than that in the regimen 1 group, even when adjusted for gestational age at the time of rupture of membrane, with an odds ratio (95% confidence interval) of 0.02 (1.8 × 10-5 -0.33). The incidence of BPD and total days on mechanical ventilation were significantly lower in the regimen 2 group than in the regimen 1 group. No significant differences were seen in other morbidities. CONCLUSION: In patients with pPROM between 22 and 27 weeks of gestation, the administration of SBT/ABPC and AZM may improve the perinatal outcomes.


Assuntos
Antibacterianos/farmacologia , Azitromicina/farmacologia , Displasia Broncopulmonar/prevenção & controle , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Adulto , Ampicilina/administração & dosagem , Ampicilina/farmacologia , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Displasia Broncopulmonar/epidemiologia , Cefmetazol/farmacologia , Clindamicina/farmacologia , Quimioterapia Combinada , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Incidência , Piperacilina/farmacologia , Gravidez , Estudos Retrospectivos , Sulbactam/administração & dosagem , Sulbactam/farmacologia
14.
J Neonatal Perinatal Med ; 12(2): 135-141, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30614810

RESUMO

BACKGROUND: Mechanical ventilation (MV) causes discomfort but whether it causes pain remains controversial. Around the world neonatal intensive care units (NICU) often utilize narcotics and/or sedatives during MV of vulnerable infants yet the association with adverse neonatal outcomes has not been adequately addressed. OBJECTIVE: Test for associations between the use of narcotics/sedatives during MV and mortality/morbidity in preterm infants in a large infant cohort in Canada. DESIGN/METHODS: Preterm infants born <35 weeks gestational age (GA) requiring MV for >24 hrs were identified retrospectively from the Canadian Neonatal Network database, 2010-12. Infants were categorized according to whether they received narcotics/sedatives for greater than 24 hours concurrently with MV. Infants were excluded if moribund on admission, had major congenital anomalies, diagnoses where narcotic administration is routine and suspected seizures. Multivariable logistic and linear regression analysis tested for association of narcotics/sedatives use during MV with mortality/morbidity (nosocomial infections, BPD, ROP, IVH) and length of MV. RESULTS: After exclusions the cohort included 2672 infants; 467(17%) exposed only to narcotics 101(4%) only to sedatives and 299(11%) to both. All models were adjusted for GA, gender, small for GA, SNAP-II score >20, multiple births, delivery mode, outborn, PDA status, MV type, use of high flow, muscle relaxant use, indwelling lines, caffeine and surfactant therapy. The composite mortality/morbidity, and MV days were significantly higher for MV infants exposed to narcotics, sedatives or both compared to infants not exposed. CONCLUSION: Mounting evidence of the adverse short and long-term impacts of narcotics/sedatives during MV supports the need for further work in alternative therapies.


Assuntos
Displasia Broncopulmonar/epidemiologia , Hemorragia Cerebral Intraventricular/epidemiologia , Infecção Hospitalar/epidemiologia , Hipnóticos e Sedativos/uso terapêutico , Entorpecentes/uso terapêutico , Respiração Artificial/métodos , Retinopatia da Prematuridade/epidemiologia , Canadá , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Masculino , Morbidade , Mortalidade , Estudos Retrospectivos , Fatores de Risco
15.
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
16.
Can J Physiol Pharmacol ; 97(3): 197-205, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30512966

RESUMO

In the premature infant, poor growth in utero (fetal growth restriction) and in the first weeks of life (postnatal growth restriction) are associated with increased risk for bronchopulmonary dysplasia and pulmonary hypertension. In this review, we summarize the epidemiologic data supporting these associations, present a novel rodent model of postnatal growth restriction, and review 5 promising mechanisms by which poor nutrition may affect the developing lung. These observations support the hypothesis that nutritional and (or) pharmacologic interventions early in life may be able to decrease risk of the pulmonary complications of extreme prematurity.


Assuntos
Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/etiologia , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Recém-Nascido Prematuro/fisiologia , Animais , Humanos , Risco
17.
Pediatr Pulmonol ; 54(1): 53-60, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30525314

RESUMO

OBJECTIVES: Tracheostomy is indicated for very-low-birth-weight infants (VLBWIs) with prolonged respiratory problems during the perinatal period. The objective of this study is to clarify the epidemiology and risk factors in VLBWIs with tracheostomy after birth in Japan. METHODS: A total of 40 806 VLBWIs were registered in the Neonatal Research Network of Japan database from 2003 to 2012. Among them, 34 674 infants (85%) survived over 28 days after birth and were subjected to this study. The clinical variables at birth, outcomes at hospital discharge and associated factors for tracheostomy were examined. RESULTS: The proportion of VLBWIs with tracheostomy did not increase during the study period (mean 36 cases per year, 0.93%). The rate of in-hospital death over 28 days after birth did not differ between tracheostomized and non-tracheostomized infants (2/324, 0.6% vs 314/34 350, 0.9%). Tracheostomized infants more frequently had severe or moderate bronchopulmonary dysplasia (BPD) (75.5% vs 26.0%, P < 0.01) and longer hospitalization (229 days vs 83 days, P < 0.01) than non-tracheostomized infants. Tracheostomized patients showed higher comorbidities with hypoxic ischemic encephalopathy (odds ratio [OR] 10.98, P < 0.01), muscular disease (OR 10.95, P < 0.01), severe or moderate BPD (OR 7.79, P < 0.01), chromosomal abnormality (OR 4.43, P < 0.01) or sepsis (OR 1.78, P < 0.05) at hospital discharge than non-tracheostomized patients. CONCLUSION: We demonstrated the non-increasing rate in tracheostomy for VLBWIs and such cases were associated with an excellent survival in Japan. These data provide evidence that more attentive care must be practiced in order to reduce the pulmonary and neuromuscular burdens of VLBWIs at birth.


Assuntos
Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/cirurgia , Traqueostomia , Causas de Morte , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Japão , Pulmão/fisiopatologia , Masculino , Alta do Paciente , Gravidez , Fatores de Risco , Sepse/complicações , Inquéritos e Questionários , Resultado do Tratamento
18.
Pediatr Int ; 61(1): 58-62, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30460724

RESUMO

BACKGROUND: Ureaplasma spp. in the maternal genitourinary tract has come to attention as a cause of preterm labor, spontaneous abortion, chorioamnionitis and adverse outcomes. A few controversies, however, still remain, namely, whether it should be treated aggressively or not. The aim of this study was to evaluate the effect of maternal azithromycin (AZ) treatment for Ureaplasma colonization on neonatal morbidities including bronchopulmonary dysplasia (BPD). METHODS: A retrospective case-control study of preterm babies delivered at ≤30 weeks of gestational age (GA) from 2012 to 2016 was conducted. Infants whose mothers had confirmed Ureaplasma colonization and treatment with AZ (m-AZ, cases) were matched by GA to control subjects whose mothers did not have Ureaplasma colonization. A subgroup analysis (nUU(+), infants with neonatal respiratory Ureaplasma colonization; nUU(-), infants without colonization) was also performed. RESULTS: Fifty-five control subjects were matched to 110 m-AZ subjects. The incidence of preterm premature rupture of membranes (P = 0.003) and of moderate-severe BPD (P = 0.010) was significantly higher in the m-AZ group. On subgroup analysis with post-hoc analysis (m-AZ + nUU(+) [I, n = 55] vs m-AZ + nUU(-) [II, n = 55] vs controls [n = 55]), the incidence of moderate-severe BPD was significantly different: 26% (I) vs 22% (II) vs 7% (controls), P = 0.033. CONCLUSIONS: Maternal Ureaplasma colonization was associated with moderate-severe BPD despite the use of AZ treatment. In addition, if the neonatal respiratory tract was colonized, then moderate-severe BPD developed even with maternal AZ treatment. Hence, selective antenatal and postnatal treatment of Ureaplasma colonization would be needed to control BPD development.


Assuntos
Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Infecções por Ureaplasma/tratamento farmacológico , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/etiologia , Estudos de Casos e Controles , Feminino , Doenças Urogenitais Femininas/tratamento farmacológico , Doenças Urogenitais Femininas/microbiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/etiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Ureaplasma/efeitos dos fármacos , Infecções por Ureaplasma/complicações
19.
Eur J Pediatr ; 178(1): 81-87, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30324231

RESUMO

Bronchopulmonary dysplasia (BPD) is one of the most common chronic inflammatory lung disease of premature infants, with serious short- and long-term consequences. Early identification of premature infants at risk of BPD is critical to preventing the pathogenesis of disease. Thus, in the present study, we recruited 126 premature infants, collected peripheral blood samples at different time points during early life, and measured the concentration of Th1 (MCP-1, IP-10, and MIG) and Th2 (eotaxin-1, eotaxin-2, and MCP-4) chemokines in serum. We found serum eotaxin-2 levels were significantly higher in the BPD group than in the non-BPD group on day 1 [1662 pg/ml vs. 1221 pg/ml, P < 0.05], day 7 [1533 pg/ml vs. 1089 pg/ml, P < 0.05], and day 14 [1246 pg/ml vs. 704 pg/ml, P < 0.05] after birth, and serum MCP-4 levels were also significantly higher in the BPD group than in the non-BPD group on day 1 [186 pg/ml vs. 128 pg/ml, P < 0.05], day 7 [199 pg/ml vs. 101 pg/ml, P < 0.05], and day 14 [238 pg/ml vs. 106 pg/ml, P < 0.05] of life.Conclusions: Increased levels of Th2 chemokines, eotaxin-2, and MCP-4, are associated with BPD in premature infants. What is Known: • The pathogenesis of BPD is multifactorial and it is difficult to predict and prevent. • Previous studies have demonstrated that inflammation plays a major role in the pathogenesis of BPD. What is New: • Increased Th2 chemokines, eotaxin-2 and MCP-4, were associated with BPD in premature infants. • Abnormal Th1/Th2 response in early life maybe associated with the subsequent development of BPD, which provide a new insight to understand the pathogenesis of the disease.


Assuntos
Displasia Broncopulmonar/sangue , Quimiocinas/sangue , Recém-Nascido Prematuro/sangue , Linfócitos T Auxiliares-Indutores/imunologia , Biomarcadores/sangue , Displasia Broncopulmonar/epidemiologia , China , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos
20.
J Pediatr ; 205: 91-97, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30340934

RESUMO

OBJECTIVE: To determine whether a sustained neonatal systemic inflammatory response was associated with poor postnatal growth among infants born very preterm during the first year of life. STUDY DESIGN: We studied prospectively 192 infants born preterm (birth weight ≤1.5 kg and gestational age ≤31 weeks). Weight, length, and head circumference were measured at birth, term, 4, and 12 months of corrected age. Serial C-reactive protein and procalcitonin were measured at 1, 3, 7, 14, and 28 days of age and averaged for each infant. A sustained neonatal systemic inflammatory response was defined as an average C-reactive protein level greater than the median for the group. Analysis was undertaken with linear mixed models. RESULTS: Decreases in mean z scores for weight, length, and head circumference were associated with the presence of a sustained neonatal systemic inflammatory response from birth to 12 months of corrected age (ß [95% CI] = -0.282 [-0.306 to -0.258]; -1.899 [-2.028,-1.769]; -0.806 [-0.910, to -0.701], P < .001, respectively) in main effect models. This association remained significant after including interaction terms for bronchopulmonary dysplasia, neonatal sepsis, and necrotizing enterocolitis (ß [95% CI] = -0.393 [-0.520 to -0.265]; -2.128 [-2.754, -1.503]; -1.102 [-1.604, -0.600]; P < .001; respectively) in interaction models. CONCLUSIONS: A sustained neonatal systemic inflammatory response was associated with poor postnatal growth, particularly poor linear growth. Serial C-reactive protein and procalcitonin may be useful markers for identifying infants at risk for postnatal growth failure.


Assuntos
Lactente Extremamente Prematuro/crescimento & desenvolvimento , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Biomarcadores/sangue , Peso ao Nascer , Índice de Massa Corporal , Displasia Broncopulmonar/epidemiologia , Proteína C-Reativa/análise , Estudos de Casos e Controles , Enterocolite Necrosante/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Sepse Neonatal/epidemiologia , Prevalência , Pró-Calcitonina/sangue , Estudos Prospectivos , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
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