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1.
Arch Dis Child Fetal Neonatal Ed ; 106(1): 17-24, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32451356

RESUMO

OBJECTIVE: Infant boys have worse outcomes than girls. In twins, the 'male disadvantage' has been reported to extend to female co-twins via a 'masculinising' effect. We studied the association between sex pairing and neonatal outcomes in extremely preterm twins. DESIGN: Retrospective cohort study SETTING: Eleven countries participating in the International Network for Evaluating Outcomes of Neonates. PATIENTS: Liveborn twins admitted at 23-29 weeks' gestation in 2007-2015. MAIN OUTCOME MEASURES: We examined in-hospital mortality, grades 3/4 intraventricular haemorrhage or cystic periventricular leukomalacia (IVH/PVL), bronchopulmonary dysplasia (BPD), retinopathy of prematurity requiring treatment and a composite outcome (mortality or any of the outcomes above). RESULTS: Among 20 924 twins, 38% were from male-male pairs, 32% were from female-female pairs and 30% were sex discordant. We had no information on chorionicity. Girls with a male co-twin had lower odds of mortality, IVH/PVL and the composite outcome than girl-girl pairs (reference group): adjusted OR (aOR) (95% CI) 0.79 (0.68 to 0.92), 0.83 (0.72 to 0.96) and 0.88 (0.79 to 0.98), respectively. Boys with a female co-twin also had lower odds of mortality: aOR 0.86 (0.74 to 0.99). Boys from male-male pairs had highest odds of BPD and composite outcome: aOR 1.38 (1.24 to 1.52) and 1.27 (1.16 to 1.39), respectively. CONCLUSIONS: Sex-related disparities in outcomes exist in extremely preterm twins, with girls having lower risks than boys and opposite-sex pairs having lower risks than same-sex pairs. Our results may help clinicians in assessing risk in this large segment of extremely preterm infants.


Assuntos
Mortalidade Hospitalar/tendências , Lactente Extremamente Prematuro , Doenças do Prematuro/mortalidade , Displasia Broncopulmonar/mortalidade , Hemorragia Cerebral Intraventricular/mortalidade , Países Desenvolvidos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Leucomalácia Periventricular/mortalidade , Masculino , Retinopatia da Prematuridade/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Gêmeos
2.
Laryngoscope ; 131(2): 417-422, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32652622

RESUMO

OBJECTIVES: To study a case series of preterm and extremely preterm infants, comparing their decannulation and survival rates after tracheostomy. METHODS: We performed a single-institution longitudinal study of preterm infants with a tracheostomy. Infants were categorized as premature (born > 28 weeks and < 37 weeks) and extremely premature (born ≤ 28 weeks). Decannulation and survival rates were determined using the Kaplan-Meier method. Neurocognitive quality of life (QOL) was reported as normal, mild/moderately, and severely impaired. Statistical significance was set at P < .05. RESULTS: This study included 240 patients. Of those, 111 were premature and 129 were extremely preterm. The median age (interquartile range) at tracheostomy was 4.8 months (0.4). Premature infants were more likely than extremely preterm to have airway obstruction (54% vs. 32%, P < .001); whereas extremely preterm infants were more likely to have bronchopulmonary dysplasia (68% vs. 15%, P < .001) and to be ventilation-dependent (68% vs. 54%, P < .001). The 5-year decannulation rate for premature infants was 46% and for extremely preterm was 64%. The 5-year survival rate post-tracheostomy for preterm was 79% and for extremely preterm was 73%. The log-rank test of equality showed that decannulation and survival were similar (P > .05) for both groups, even after controlling for potentially confounding factors like race, age, gender, birth weight, and age at tracheostomy. For neurocognitive QOL, 47% of patients survived with severely impaired QOL after tracheostomy. Preterm had 56% with severely impaired QOL and extremely preterm had 40% with severely impaired QOL (P = .03). CONCLUSION: This study demonstrated that the time to decannulation and the likelihood of survival did not vary among premature and extremely premature infants even when controlling for other confounding variables. LEVEL OF EVIDENCE: 3b Laryngoscope, 131:417-422, 2021.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Displasia Broncopulmonar/cirurgia , Doenças do Prematuro/cirurgia , Recém-Nascido Prematuro , Traqueostomia/mortalidade , Obstrução das Vias Respiratórias/mortalidade , Displasia Broncopulmonar/mortalidade , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/mortalidade , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Qualidade de Vida , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
4.
Isr Med Assoc J ; 22(9): 542-546, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33236551

RESUMO

BACKGROUND: Neonatal hypothermia (< 36°C) has been associated with both neonatal morbidity and mortality. OBJECTIVES: To develop a multifactorial approach to reduce the incidence of neonatal hypothermia at admission to the neonatal intensive care unit. METHODS: The approach involved a detailed quality improvement (QI) plan, which included the use of occlusive wrapping and exothermic mattresses as well as higher delivery and operating room environmental temperatures. The improvement plan was implemented over a 10-month period. Retrospective comparison to the same 10-month period during the previous year assessed the effectiveness of the approach in reducing the incidence of admission hypothermia. RESULTS: The QI project included 189 patients. These patients were compared to 180 patients during the control period. The characteristics of the patient groups were similar and included preterm infants, who were subsequently analyzed as a subgroup. We found a significant reduction in the incidence of hypothermia, which was most profound for the subgroup of premature infants born at < 32 weeks gestation. Neonatal hyperthermia was identified as an unintended consequence of the project, and subsequently improved after initiating simple preventive measures. CONCLUSIONS: Occlusive wrapping, exothermic mattresses, and higher delivery and operating room environmental temperature may be successful in reducing admission neonatal hypothermia.


Assuntos
Hipotermia/prevenção & controle , Doenças do Prematuro/prevenção & controle , Unidades de Terapia Intensiva Neonatal , Estudos de Casos e Controles , Feminino , Humanos , Hipotermia/epidemiologia , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Israel/epidemiologia , Masculino
5.
N Engl J Med ; 383(26): 2514-2525, 2020 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-33095526

RESUMO

BACKGROUND: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain. METHODS: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale. RESULTS: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.).


Assuntos
Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Doenças do Prematuro/prevenção & controle , Morte Perinatal/prevenção & controle , Cuidado Pré-Natal , Adulto , Países em Desenvolvimento , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Injeções Intramusculares , Gravidez , Nascimento Prematuro , Risco , Natimorto/epidemiologia
6.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(10): 1047-1055, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33059799

RESUMO

Feeding intolerance (FI) is one of the most common clinical problems in preterm infant and often leads to the delay in reaching total enteral nutrition and prolonged hospital stay. The prevention and treatment of FI are of great significance in improving the survival rate of preterm infants. With reference to current evidence in China and overseas, the clinical guidelines for the diagnosis and treatment of FI in preterm infants were developed based on Grading of Recommendations Assessment, Development and Evaluation (GRADE), so as to help neonatal pediatricians, nursing staff, and nutritionists with early identification and standard management of FI in preterm infants.


Assuntos
Doenças do Prematuro , Recém-Nascido Prematuro , China , Nutrição Enteral , Humanos , Lactente , Recém-Nascido , Tempo de Internação
8.
Harefuah ; 159(10): 717-720, 2020 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-33103388

RESUMO

INTRODUCTION: According to a recent publication in the Lancet, infants who are born today will live to be up to 100 years of age. Neonatology is a medical specialty with great and grave responsibility. The way we administer the treatment of infants today and their subsequent neurodevelopmental outcome will affect not only their own lives but the lives of their families as well, in addition to impacting society, for many decades. Challenges encountered in neonatology subspecialties are enormous. We treat various systems in the human body that are not yet fully developed, taking upon ourselves the onus of directing the most optimal development. We are committed to address the physical challenges and the complex emotional burdens of the whole family unit. Indeed, the new parents and the baby-parents dyad are in our hands alone. We recognize that these infants deserve the best head start that we can provide. We treat a variety of conditions, including term newborns who are born with congenital malformations as well as those who sustain major injury through delivery complications, and provide 24-hour care during the long-term hospitalizations of very preterm infants. In this journal, we will share the very broad spectrum of challenges that will be described in case studies and original reports, and highlight the various approaches that reflect the versatility of our profession, from the baby's first breath to diagnosis, to choosing the therapeutic management most suitable for the infant and the family.


Assuntos
Doenças do Prematuro , Recém-Nascido Prematuro , Adulto , Criança , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Pais
9.
Harefuah ; 159(10): 745-749, 2020 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-33103394

RESUMO

INTRODUCTION: Necrotizing enterocolitis (NEC) is a major cause for morbidity and mortality among neonates, especially among low birth weight premature infants. Even though NEC has been highly investigated during the last few decades, understanding of the pathogenesis is still relatively poor. Throughout the years protective measures, as well as risk factors, were identified, but there is still no clear prevention strategy, and the percentage of neonates suffering of NEC was not changed. Moreover, the treatment approach is controversial in many circumstances other than a few clear surgical indications. The decision between conservative and surgical treatment in many situations is in the hands of the medical staff. Herein we present the story of a premature infant who suffered from feeding intolerance since birth, with major clinical deterioration after receiving packed red blood cells (PRBCs) transfusion. She was diagnosed with NEC and was treated conservatively, with clinical improvement and worsening alternately, until a colonic stricture was identified and treated surgically. We will provide a short review on risk factors, preventive measures, as well as the research regarding PRBCS transfusion and NEC development.


Assuntos
Enterocolite Necrosante , Enterocolite Necrosante/diagnóstico , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/etiologia , Transfusão de Eritrócitos , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Fatores de Risco
10.
Harefuah ; 159(10): 754-758, 2020 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-33103396

RESUMO

INTRODUCTION: Apnea of prematurity affects the majority of infants born before 34 weeks of complete gestation. Significant recurrent apnea of prematurity is associated with both short and long term complications and is a risk factor for increased mortality and neurodevelopmental disability. The current review discusses the recent advances in the understanding of the pathophysiology of apnea of prematurity, as well as the clinical questions relevant to physicians and staff treating infants with apnea of prematurity. Finally, we discuss monitoring and discharge decisions, and present recommendations following discharge from the neonatal intensive care unit.


Assuntos
Apneia , Doenças do Prematuro , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Prognóstico
11.
PLoS One ; 15(9): e0238382, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881953

RESUMO

INTRODUCTION: Preterm birth is associated with increased risk of airway infections in childhood, more frequent purchase of prescription antibiotics and hospital admissions for airway infections. With this study, we aimed to investigate whether this association persists into adolescence. METHODS: We conducted a longitudinal observational register-based study of a national cohort of all infants born in Denmark in 1992-2007. We used purchase of antibiotics, including penicillins and macrolides, and hospital admissions as proxies for milder and more severe forms of airway infections respectively in 1995-2010. Associations between gestational age (GA), age, year and repeated cross-sectional evaluations of antibiotic purchase and hospital admissions were explored by logistic regression analyses. RESULTS: We included 1,043,411 children in our study population. We found a statistically significant association between GA and prescription of antibiotics as well as hospital admissions due to airway infections. In the youngest age groups, children with higher GA had lower adjusted mean rates of prescribed antibiotics for airway infections, but from the age of 10-11 years the opposite trend was noted in what appears to be a dose-response relationship. During childhood, we found an inverse dose-response relationship where ex-preterms with GA 23-27 at age 4-5 years had twice the odds of hospital admission compared to children in the same age group born at term. During adolescence, these higher odds diminished and appeared equivalent among teenagers born at term and preterm. We only found statistically significant interactions between gestational age and age. CONCLUSION: We confirmed that preterm birth is associated with higher rates of prescribed antibiotics and higher odds of hospitalization for airway infections during childhood. However, in adolescence we found that there was no increase in hospital admissions for airway infections among ex-preterms, whereas adolescents with low GA actually appeared to purchase less prescribed antibiotics. Whether this trend persists into adulthood and the physiological explanation therefor remains to be investigated.


Assuntos
Suscetibilidade a Doenças/epidemiologia , Nascimento Prematuro/fisiopatologia , Infecções Respiratórias/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Estudos Longitudinais , Masculino , Sistema Respiratório , Fatores de Risco
12.
Medicine (Baltimore) ; 99(37): e22166, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925782

RESUMO

We aim to summarize the evidence focusing on the effects of various doses of human milk on the risk of neonatal necrotizing enterocolitis (NEC). The eligible articles in the study were those investigating the association between human milk and NEC published before June 26, 2019, in the PubMed, EMBASE, the Cochrane Library, VIP database, CNKI database, and Wangfang database. The included criteria were as follows: premature infants of <37 weeks; randomly controlled trials (RCTs); those fed by mother's own milk or donor human milk; studies focused on the comparison of human milk and formula milk, involving various breast milk doses; and NEC-related studies. Compared with the exclusive formula, the incidence of NEC in the infants fed by exclusive human milk was significantly lower. The incidence of NEC in the infants fed by exclusive human milk was significantly lower than that of partial human milk [risk ratio (RR) = 0.54, 95% confidence interval (95% CI): 0.36-0.79, P < .05]. The incidence of NEC in the infants fed mainly by human milk was significantly lower than that of mainly fed by formula. Incidence of NEC in the infants fed by exclusive human milk was significantly lower than that of any formula (RR = 0.49, 95% CI: 0.34-0.71, P < .05). In summary, this meta-analysis was based on the RCTs involving the prevention of NEC using human milk. Exclusive human milk and partial human milk reduced the incidence of NEC in premature infants, especially in the those fed by high proportion of human milk. In addition, more RCTs are needed to further validate such conclusion.


Assuntos
Enterocolite Necrosante/prevenção & controle , Doenças do Prematuro/prevenção & controle , Leite Humano , Humanos , Fórmulas Infantis , Recém-Nascido , Recém-Nascido Prematuro , Bancos de Leite , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
JAMA Netw Open ; 3(9): e2018119, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32965499

RESUMO

Importance: In very preterm newborns, gut microbiota is highly variable with major dysbiosis. Its association with short-term health is widely studied, but the association with long-term outcomes remains unknown. Objective: To investigate in preterm newborns the associations among practice strategies in neonatal intensive care units (NICUs), gut microbiota, and outcomes at 2 years. Design, Setting, and Participants: EPIFLORE is a prospective observational cohort study that includes a stool sample collection during the fourth week after birth. Preterm newborns of less than 32 weeks of gestational age (GA) born in 2011 were included from 24 NICUs as part of the French nationwide population-based cohort, EPIPAGE 2. Data were collected from May 2011 to December 2011 and analyzed from September 2016 to December 2018. Exposures: Eight NICU strategies concerning sedation, ventilation, skin-to-skin practice, antibiotherapy, ductus arteriosus, and breastfeeding were assessed. A NICU was considered favorable to a practice if the percentage of that practice in the NICU was more than the expected percentage. Main Outcomes and Measures: Gut microbiota was analyzed by 16S ribosomal RNA gene sequencing and characterized by a clustering-based method. The 2-year outcome was defined by death or neurodevelopmental delay using a Global Ages and Stages questionnaire score. Results: Of 577 newborns included in the study, the mean (SD) GA was 28.3 (2.0) weeks, and 303 (52.5%) were male. Collected gut microbiota was grouped into 5 discrete clusters. A sixth cluster included nonamplifiable samples owing to low bacterial load. Cluster 4 (driven by Enterococcus [n = 63]), cluster 5 (driven by Staphylococcus [n = 52]), and cluster 6 (n = 93) were significantly associated with lower mean (SD) GA (26.7 [1.8] weeks and 26.8 [1.9] weeks, respectively) and cluster 3 (driven by Escherichia/Shigella [n = 61]) with higher mean (SD) GA (29.4 [1.6] weeks; P = .001). Cluster 3 was considered the reference. After adjustment for confounders, no assisted ventilation at day 1 was associated with a decreased risk of belonging to cluster 5 or cluster 6 (adjusted odds ratio [AOR], 0.21 [95% CI, 0.06-0.78] and 0.19 [95% CI, 0.06-0.62], respectively) when sedation (AOR, 10.55 [95% CI, 2.28-48.87] and 4.62 [1.32-16.18], respectively) and low volume of enteral nutrition (AOR, 10.48 [95% CI, 2.48-44.29] and 7.28 [95% CI, 2.03-26.18], respectively) was associated with an increased risk. Skin-to-skin practice was associated with a decreased risk of being in cluster 5 (AOR, 0.14 [95% CI, 0.04-0.48]). Moreover, clusters 4, 5, 6 were significantly associated with 2-year nonoptimal outcome (AOR, 6.17 [95% CI, 1.46-26.0]; AOR, 4.53 [95% CI, 1.02-20.1]; and AOR, 5.42 [95% CI, 1.36-21.6], respectively). Conclusions and Relevance: Gut microbiota of very preterm newborns at week 4 is associated with NICU practices and 2-year outcomes. Microbiota could be a noninvasive biomarker of immaturity.


Assuntos
Disbiose/fisiopatologia , Microbioma Gastrointestinal/fisiologia , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Doenças do Prematuro/microbiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Transtornos do Neurodesenvolvimento/microbiologia , Estudos Prospectivos
14.
Sci Rep ; 10(1): 15072, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32934282

RESUMO

Survivors following very premature birth (i.e., ≤ 32 weeks gestational age) remain at high risk for neurodevelopmental impairments. Recent advances in deep learning techniques have made it possible to aid the early diagnosis and prognosis of neurodevelopmental deficits. Deep learning models typically require training on large datasets, and unfortunately, large neuroimaging datasets with clinical outcome annotations are typically limited, especially in neonates. Transfer learning represents an important step to solve the fundamental problem of insufficient training data in deep learning. In this work, we developed a multi-task, multi-stage deep transfer learning framework using the fusion of brain connectome and clinical data for early joint prediction of multiple abnormal neurodevelopmental (cognitive, language and motor) outcomes at 2 years corrected age in very preterm infants. The proposed framework maximizes the value of both available annotated and non-annotated data in model training by performing both supervised and unsupervised learning. We first pre-trained a deep neural network prototype in a supervised fashion using 884 older children and adult subjects, and then re-trained this prototype using 291 neonatal subjects without supervision. Finally, we fine-tuned and validated the pre-trained model using 33 preterm infants. Our proposed model identified very preterm infants at high-risk for cognitive, language, and motor deficits at 2 years corrected age with an area under the receiver operating characteristic curve of 0.86, 0.66 and 0.84, respectively. Employing such a deep learning model, once externally validated, may facilitate risk stratification at term-equivalent age for early identification of long-term neurodevelopmental deficits and targeted early interventions to improve clinical outcomes in very preterm infants.


Assuntos
Encéfalo , Bases de Dados Factuais , Deficiências do Desenvolvimento , Recém-Nascido Prematuro , Aprendizado de Máquina , Modelos Neurológicos , Transtornos do Neurodesenvolvimento , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Criança , Deficiências do Desenvolvimento/diagnóstico por imagem , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico por imagem , Doenças do Prematuro/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos do Neurodesenvolvimento/diagnóstico por imagem , Transtornos do Neurodesenvolvimento/fisiopatologia
15.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32938776

RESUMO

For healthy individuals, it is increasingly accepted that lung function follows along an individual percentile established early in life and that the level of maximal function reached as a young adult can affect the subsequent development of lung disease that occurs with the normal aging process. This emphasizes the need to maximize early lung function. The trajectories of lung function are at least partially established by perinatal factors, including prematurity and in utero exposures (tobacco exposure, nutrition, inflammation, etc), although they can also be affected by a variety of additional factors and exposures throughout the life span. Whether lung function trajectories can be impacted or reset if established under suboptimal conditions is an unanswered question, offering new avenues for research. In this review, we will summarize important articles outlining lung function trajectories and linking pediatric lung function tests to adult lung function tests decades later. We will focus on perinatal factors and outline progress and opportunities for further investigation into the potential ability to reset trajectories to impact long-term lung health.


Assuntos
Pneumopatias/fisiopatologia , Pulmão/fisiologia , Criança , Feminino , Humanos , Lactente , Recém-Nascido Prematuro , Doenças do Prematuro , Pulmão/embriologia , Pneumopatias/prevenção & controle , Assistência Perinatal , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Testes de Função Respiratória
18.
Am J Perinatol ; 37(S 02): S5-S9, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898875

RESUMO

Despite continued advances and developments in neonatal medicine, neonatal sepsis is the third leading cause of neonatal mortality and a major public health problem, especially in developing countries. Sepsis accounts for mortality for almost 50% of global children under 5 years of age.Over the past 50 years, there have been many advances in the diagnosis, prevention, and treatment of neonatal infections. The diagnostic advances include better culture techniques that permit more rapid confirmation of the diagnosis, advent of polymerase chain reaction (PCR) to rapidly diagnose viral infections, use of biologic markers indicating evidence of infection, and a better understanding of immunoglobulin markers of infection. From a therapeutic stand point, there have been a variety of antibiotics, antifungals, and antiviral agents, better approaches to prevent sepsis, specific immunotherapy, for example, respiratory syncytial virus (RSV); bundled approach to prevention of deep-line infection and better antibiotic stewardship, leading to earlier discontinuation of antibiotic therapy.Hand hygiene remains the benchmark and gold standard for late-onset sepsis prevention. The challenge has been that each decade, newer resistant bacteria dominate as the cause of sepsis and newer viruses emerge, for example, human immunodeficiency virus, zika virus, and novel coronavirus disease 2019.Future treatment options might include stem cell therapy, other antimicrobial protein and peptides, and targeting of pattern recognition receptors in an effort to prevent and/or treat sepsis in this vulnerable population. Also, the microbiome of premature infants has a smaller proportion of beneficial bacteria and higher numbers of pathogenic bacteria compared with term infants, likely owing to higher frequencies of cesarean sections, antibiotic use, exposure to the hospital environment, and feeding nonhuman milk products. Modifying the microbiome with more mother's milk and shorter duration of antibiotics in noninfected babies should be a goal. KEY POINTS: · Neonatal sepsis remains a leading cause of mortality.. · Challenges include bacterial resistance and newer viruses.. · Future treatments may include newer antibiotics/antivirals and stem cell therapy..


Assuntos
Antibacterianos/uso terapêutico , Unidades de Terapia Intensiva Neonatal , Sepse Neonatal/mortalidade , Sepse Neonatal/prevenção & controle , Antivirais/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Doenças do Prematuro/prevenção & controle , Sepse Neonatal/tratamento farmacológico
19.
Sci Rep ; 10(1): 13609, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32788671

RESUMO

Preterm infants with periventricular-intraventricular hemorrhage (PV-IVH) have a high risk of neurological sequelae, with severity depending on the severity of the PV-IVH. Previous studies on the pathogenesis of PV-IVH have focused mainly on comparisons of perinatal risk factors between patients with and without PV-IVH. Notably, most cases of PV-IVH occur within the first 3 days after birth, and the condition may worsen within 1 week following the initial diagnosis. However, the risk factors that contribute to the deterioration of PV-IVH have not been investigated. In this cohort study, 514 PV-IVH infants with a gestational age (GA) < 32 weeks were enrolled. The dependent variable was initially diagnosed as mild PV-IVH (grade I or II) that subsequently progressed to severe PV-IVH (grade III or IV) within 1 week. A stepwise forward multivariate logistic regression model was adopted to select potential or related factors that affected the deterioration of PV-IVH in preterm infants. Overall, 42 of the 514 infants with PV-IVH (8.2%) showed deterioration within 1 week. The results showed that maternal lower genital tract infection (OR 3.73, 95% CI 1.75-7.95) was an independent risk factor for PV-IVH deterioration. Higher GA (OR 0.62, 95% CI 0.48-0.80) was a protective factor. Our results suggest that maternal lower genital tract infection and a lower GA may contribute to PV-IVH deterioration in preterm infants.


Assuntos
Hemorragia Cerebral/patologia , Doenças do Prematuro/patologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido Prematuro , Modelos Logísticos , Masculino , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
20.
AJNR Am J Neuroradiol ; 41(8): 1509-1516, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32796100

RESUMO

BACKGROUND AND PURPOSE: Brain MR imaging at term-equivalent age is a useful tool to define brain injury in preterm infants. We report pragmatic clinical radiological assessment of images from a large unselected cohort of preterm infants imaged at term and document the spectrum and frequency of acquired brain lesions and their relation to outcomes at 20 months. MATERIALS AND METHODS: Infants born at <33 weeks' gestation were recruited from South and North West London neonatal units and imaged in a single center at 3T at term-equivalent age. At 20 months' corrected age, they were invited for neurodevelopmental assessment. The frequency of acquired brain lesions and the sensitivity, specificity, and negative and positive predictive values for motor, cognitive, and language outcomes were calculated, and corpus callosal thinning and ventricular dilation were qualitatively assessed. RESULTS: Five hundred four infants underwent 3T MR imaging at term-equivalent age; 477 attended for assessment. Seventy-six percent of infants had acquired lesions, which included periventricular leukomalacia, hemorrhagic parenchymal infarction, germinal matrix-intraventricular hemorrhage, punctate white matter lesions, cerebellar hemorrhage, and subependymal cysts. All infants with periventricular leukomalacia, and 60% of those with hemorrhagic parenchymal infarction had abnormal motor outcomes. Routine 3T MR imaging of the brain at term-equivalent age in an unselected preterm population that demonstrates no focal lesion is 45% sensitive and 61% specific for normal neurodevelopment at 20 months and 17% sensitive and 94% specific for a normal motor outcome. CONCLUSIONS: Acquired brain lesions are common in preterm infants routinely imaged at term-equivalent age, but not all predict an adverse neurodevelopmental outcome.


Assuntos
Encefalopatias/patologia , Deficiências do Desenvolvimento/etiologia , Doenças do Prematuro/patologia , Encefalopatias/diagnóstico por imagem , Encefalopatias/epidemiologia , Estudos de Coortes , Deficiências do Desenvolvimento/epidemiologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico por imagem , Doenças do Prematuro/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino
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