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1.
Urology ; 135: 136-138, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31568794

RESUMO

Neonatal testicular torsion is an uncommon event that rarely results in testicular salvage. We present 2 cases in the neonatal intensive care unit of extremely premature males (<28 weeks gestation) with witnessed testicular torsion, prompt diagnosis, surgical detorsion, and good short-term outcomes. Although an uncommon scenario, we present the feasibility of surgery in the extremely premature infant and potential for testicular salvage.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro/cirurgia , Terapia de Salvação/métodos , Torção do Cordão Espermático/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Estudos de Viabilidade , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Unidades de Terapia Intensiva Neonatal , Masculino , Torção do Cordão Espermático/diagnóstico , Testículo/diagnóstico por imagem , Testículo/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler
2.
BMJ ; 367: l5678, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619384

RESUMO

OBJECTIVE: To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. DESIGN: Observational cohort study with propensity score matching. SETTING: National health service neonatal care in England; population data held in the National Neonatal Research Database. PARTICIPANTS: Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. MAIN OUTCOME MEASURES: Death, severe brain injury, and survival without severe brain injury. RESULTS: 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). CONCLUSIONS: In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.


Assuntos
Lesões Encefálicas , Salas de Parto , Doenças do Prematuro , Transferência de Pacientes , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Lesões Encefálicas/mortalidade , Salas de Parto/classificação , Salas de Parto/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Doenças do Prematuro/mortalidade , Masculino , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Pontuação de Propensão , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos
3.
Turk J Pediatr ; 61(1): 26-33, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559718

RESUMO

Özkan H, Köksal N, Dogan P, Güney-Varal I, Bagci O, Özgür T. The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants. Turk J Pediatr 2019; 61: 26-33. Parenteral nutrition (PN) has been widely used in premature infants untill enteral feeding can be tolerated. Cholestasis is an important complication of PN. The objective of this study was to evaluate the role of serial measurements of serum amyloid A (SAA) during PN and compare its` effectiveness with C-reactive protein (CRP) and procalcitonin (PCT). We also aimed to determine the risk factors for PN associated cholestasis (PNAC). Premature infants ( < 34 weeks` gestational age) who were started on PN during hospitalization were included in this prospective study. SAA, CRP and PCT levels were measured on days 0, 3, 7, 14, and 21 of PN in all infants. Infants who had PN for less than 2 weeks, who developed sepsis and/or necrotizing enterocolitis were excluded. A total of 85 infants were included. The mean birth weight was 1226±329 g, and the mean gestational age was 29.4±1.8 weeks. The birth weight of infants who developed cholestasis were significantly lower. Enteral nutrition was started significantly later in infants with cholestasis. CRP and PCT did not correlate with conjugated bilirubin levels at any time point. SAA levels on days 7 and 14 showed a significant correlation with conjugated bilirubin levels. SAA levels on day 7 was found to have the highest sensitivity for prediction of PNAC. Low birth weight, late commencement of enteral feeding, and prolonged PN were the main risk factors for PNAC development. This is the first study that shows the predictive value of SAA for PNAC development. We suggest that SAA may be used as an accurate and useful biomarker for prediction of PNAC in high risk premature infants receiving PN.


Assuntos
Colestase/diagnóstico , Colestase/etiologia , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Nutrição Parenteral/efeitos adversos , Proteína Amiloide A Sérica/metabolismo , Biomarcadores/sangue , Peso ao Nascer , Colestase/sangue , Colestase/terapia , Diagnóstico Precoce , Nutrição Enteral , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/sangue , Doenças do Prematuro/terapia , Recém-Nascido de muito Baixo Peso , Masculino , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade
4.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31160512

RESUMO

OBJECTIVES: To develop a nationwide, evidence-based framework to support prenatal counseling in extreme prematurity, focusing on organization, decision-making, content, and style aspects. METHODS: A nationwide multicenter RAND-modified Delphi method study was performed between November 2016 and December 2017 in the Netherlands. Firstly, recommendations were extracted from literature and previous studies. Secondly, an expert panel (n = 21) with experienced parents, obstetricians, and neonatologists rated the recommendations on importance for inclusion in the framework. Thirdly, ratings were discussed in a consensus meeting. The final set of recommendations was approved and transformed into a framework. RESULTS: A total of 101 recommendations on organization, decision-making, content, and style were included in the framework, including tools to support personalization. The most important recommendations regarding organization were to have both parents involved in the counseling with both the neonatologist and obstetrician. The shared decision-making model was recommended for deciding between active support and comfort care. Main recommendations regarding content of conversation were explanation of treatment options, information on survival, risk of permanent consequences, impossibility to predict an individual course, possibility for multiple future decision moments, and a discussion on parental values and standards. It was considered important to avoid jargon, check understanding, and provide a summary. The expert panel, patient organization, and national professional associations (gynecology and pediatrics) approved the framework. CONCLUSIONS: A nationwide, evidence-based framework for prenatal counseling in extreme prematurity was developed. It contains recommendations and tools for personalization in the domains of organization, decision-making, content, and style of prenatal counseling.


Assuntos
Aconselhamento/normas , Pessoal de Saúde/normas , Lactente Extremamente Prematuro , Doenças do Prematuro/diagnóstico , Cuidado Pré-Natal/normas , Desenvolvimento de Programas/normas , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica/métodos , Aconselhamento/métodos , Técnica Delfos , Feminino , Humanos , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/terapia , Países Baixos/epidemiologia , Gravidez , Cuidado Pré-Natal/métodos , Desenvolvimento de Programas/métodos , Inquéritos e Questionários
5.
Pediatr Cardiol ; 40(6): 1165-1170, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31175403

RESUMO

The objective is to examine the correlation between plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) echocardiographic parameters in the first 28 days of life in very-low-birth-weight infants (VLBWI). VLBWI admitted to the Neonatal Intensive Care Unit (NICU) at Hospital Puerta del Mar, Spain, from January 2015 to January 2017 were prospectively enrolled. Weekly determination of plasma NT-proBNP (pg/mL), and echocardiograms were done during the first 28 days of life. 101 preterm infants with a mean GA of 28.85 weeks (± 1.85 SD) and mean birth weight of 1152 g (± 247.4 SD) were included. A total of 483 echocardiograms and 139 NT-proBNP determinations were performed. We found a negative correlation between plasma NT-proBNP levels and diastolic velocities: mitral A' (ρ = - 0.15, p = 0.04), mitral E' (ρ = - 0.17, p = 0.02), tricuspid A' (ρ = - 0.20, p = 0.006), tricuspid E' (ρ = - 0.24, p = 0.0009). In the first 24 h of life, NT-proBNP levels were strongly correlated with mitral A' and E' velocities in patients with no patent ductus arteriosus (PDA) (ρ = - 0.75, p = 0.04). In preterm patients, elevated NT-proBNP levels are related to worse diastolic myocardial function. In the first 24 h, this correlation is much stronger in the absence of PDA.


Assuntos
Doenças do Prematuro/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Disfunção Ventricular/diagnóstico , Biomarcadores/sangue , Ecocardiografia Doppler , Feminino , Humanos , Lactente , Recém-Nascido Prematuro , Doenças do Prematuro/sangue , Doenças do Prematuro/genética , Recém-Nascido de muito Baixo Peso , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha , Disfunção Ventricular/sangue
6.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31196939

RESUMO

OBJECTIVES: We previously reported a clinical prediction rule to estimate the probability of rebound hyperbilirubinemia using gestational age (GA), age at phototherapy initiation, and total serum bilirubin (TSB) relative to the treatment threshold at phototherapy termination. We investigated (1) how a simpler 2-variable model would perform and (2) the absolute rebound risk if phototherapy were stopped at 2 mg/dL below the threshold for treatment initiation. METHODS: Subjects for this retrospective cohort study were infants born 2012-2014 at ≥35 weeks' gestation at 1 of 17 Kaiser Permanente hospitals who underwent inpatient phototherapy before age 14 days. TSB reaching the phototherapy threshold within 72 hours of phototherapy termination was considered rebound. We simplified by using the difference between the TSB level at the time of phototherapy termination and the treatment threshold at the time of phototherapy initiation as 1 predictor, and kept GA as the other predictor. RESULTS: Of the 7048 infants treated with phototherapy, 4.6% had rebound hyperbilirubinemia. The area under the receiver operating characteristic curve was 0.876 (95% confidence interval, 0.854 to 0.899) for the 2-variable model versus 0.881 (95% confidence interval, 0.859 to 0.903) for the 3-variable model. The rebound probability after stopping phototherapy at 2 mg/dL below the starting threshold was 2.5% for infants ≥38 weeks' GA and 10.2% for infants <38 weeks' GA. CONCLUSIONS: Rebound hyperbilirubinemia can be predicted by a simpler 2-variable model consisting of GA and the starting threshold-ending TSB difference. Infants <38 weeks' gestation may need longer phototherapy because of their higher rebound risk.


Assuntos
Hiperbilirrubinemia Neonatal/terapia , Doenças do Prematuro/terapia , Fototerapia/métodos , Feminino , Idade Gestacional , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Modelos Logísticos , Masculino , Razão de Chances , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
7.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31248939

RESUMO

BACKGROUND: Parents and clinicians caring for premature infants face high-stakes and time-sensitive decisions about care. We aimed to characterize how parents and clinicians discuss outcome in the context of decision-making for premature infants. METHODS: In this qualitative descriptive study, we used a case-based, prospective design. Cases of extreme prematurity were targeted. Parents and clinicians completed semistructured interviews about care decisions longitudinally in the first year of life. Interview data were analyzed by using directed content analysis. RESULTS: Sixteen parents and 53 clinicians of 10 infants completed 178 interviews (n = 115 parent; n = 63 clinician). Two primary themes emerged. First, parents and clinicians discussed prognostic information differently from each other. Parents focused on whether their infant would survive, whereas clinicians concentrated on neurologic outcome and the potential for life with disability. Parent discussion of the future was broad and rooted in hope and spirituality. Clinician prognostic language was narrowly focused and probabilistic. Second, we identified barriers and facilitators to a shared understanding of infant outcome. Clinicians perceived that parents were unaware of or unable to process important information about the big picture. Parents valued consistent therapeutic relationships; transitions of care and underused roles of the care team undermined this consistency. Clinical uncertainty forced parents and clinicians to "wait and see" about the future. CONCLUSIONS: Parents and clinicians discuss and weigh information about the future differently from each other as they consider choices for extremely premature infants. Future work should characterize the impact of these differences on prognostic communication and decision-making.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisão Clínica , Tomada de Decisões , Lactente Extremamente Prematuro , Doenças do Prematuro , Doenças do Sistema Nervoso , Pais/psicologia , Adulto , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/terapia , Estudos Longitudinais , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Relações Profissional-Família , Prognóstico , Estudos Prospectivos , Pesquisa Qualitativa
8.
Surgery ; 165(6): 1176-1181, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31040040

RESUMO

BACKGROUND: Necrotizing enterocolitis is the leading case of gastrointestinal-related morbidity in premature infants. Necrotizing enterocolitis totalis is an aggressive form of necrotizing enterocolitis, which has traditionally been managed with comfort care. Recent advances in management of short bowel syndrome have resulted in some reported long-term survival. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies that reported outcomes in children with necrotizing enterocolitis totalis were identified. The definition of necrotizing enterocolitis totalis was captured along with length of follow-up, patient demographics, and outcomes. RESULTS: A total of 766 articles were screened, of which 166 were selected for full article review. Of these, 32 articles included data on 414 patients with necrotizing enterocolitis totalis. In the majority of studies (52%), necrotizing enterocolitis totalis was not defined. Aggressive surgical therapy (defined as bowel resection or fecal diversion) was undertaken in 32 patients (7.7%), with a mortality rate of 68.8%. In contrast, nonaggressive surgical therapy was undertaken in 382 patients (92.3%), and the mortality in these patients was 95%. Long-term outcomes for necrotizing enterocolitis totalis survivors, such as length of time on parenteral nutrition, progression to liver and/or small bowel transplant, and quality of life, were not reported. CONCLUSION: We found that there is no accepted definition of necrotizing enterocolitis totalis. Aggressive surgical therapy is rarely pursued, which likely drives the overall high mortality rate. This study underscores the importance of standardizing the definition of necrotizing enterocolitis totalis and capturing short and long-term outcomes prospectively. With more aggressive surgical therapy, more infants are likely to survive this abdominal catastrophe, which was once thought to be uniformly fatal.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Enterocolite Necrosante/cirurgia , Doenças do Prematuro/cirurgia , Tratamento Conservador/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Enterocolite Necrosante/diagnóstico , Enterocolite Necrosante/mortalidade , Enterocolite Necrosante/patologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/mortalidade , Doenças do Prematuro/patologia , Resultado do Tratamento
10.
PLoS One ; 14(5): e0216498, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31063510

RESUMO

BACKGROUND: Premature infants are at risk for severe sepsis and meningitis, both infections associated with high mortality and morbidity. Cerebro-spinal fluid (CSF) culture is the gold standard method for meningitis diagnosis, but interpretation of biochemical parameters of CSF is essential at the moment of the analysis in order to start the appropriate treatment. The main objective of this study was to determine whether levels of CSF beta-2-microglobulin (B2M) were elevated in preterm infants with CNS infections or other inflammatory processes, and to establish if there were differences in B2M concentrations amongst various inflammatory settings (sepsis, meningitis, and progressive post-hemorrhagic ventricular dilatation (PHVD)). METHODS: This is a retrospective study of all very preterm and extremely preterm infants (< 32 weeks of gestation) admitted to our NICU between 2012 and 2017. All those who underwent a lumbar puncture during their stay as part of a sepsis work-up or PHVD were considered for inclusion. CSF biochemical parameters and B2M were tested in all of the patients. RESULTS: Fifty-nine patients were included in the study. In patients with CNS infections, the median value of B2M was 8.69 mg/L (3.92-18.5). B2M levels above 3.92 mg/L showed greater sensitivity and specificity than leukocyte levels in discriminating between patients with CNS infections or other inflammatory processes and those without CNS inflammation. CONCLUSIONS: In this population, CSF B2M proved to be an effective biomarker to discriminate between patients with CNS infections and other inflammatory processes and those without CNS inflammation.


Assuntos
Biomarcadores/líquido cefalorraquidiano , Lactente Extremamente Prematuro/líquido cefalorraquidiano , Doenças do Prematuro/diagnóstico , Inflamação/diagnóstico , Hemorragias Intracranianas/diagnóstico , Meningite/diagnóstico , Sepse/diagnóstico , Microglobulina beta-2/líquido cefalorraquidiano , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Recém-Nascido , Doenças do Prematuro/líquido cefalorraquidiano , Inflamação/líquido cefalorraquidiano , Hemorragias Intracranianas/líquido cefalorraquidiano , Masculino , Meningite/líquido cefalorraquidiano , Prognóstico , Estudos Retrospectivos , Sepse/líquido cefalorraquidiano
11.
Int J Pediatr Otorhinolaryngol ; 123: 110-115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31096068

RESUMO

OBJECTIVES: Aim of this study is to report and discuss the results of 4 years of Newborn hearing screening (NHS) program at the Neonatal Intensive Care Unit (NICU), particularly evaluating the clinical ABR results. METHODS: Retrospective study. NHS data from NICU newborns, admitted for ≥5 days, in the period from January 1st, 2013 and December 31st, 2016, were retrieved and analyzed. NHS results were classified as following: (i) "pass" when both ears for both the a-TEOAE (automated Transient-Evoked Otoacoustic Emissions) and the a-ABR (automated Auditory Brainstem Response) protocol resulted as "pass"; (ii) "fail" when one ear, at either one of the two performed tests resulted as "fail"; (iii) "missing" when the newborns were not tested with both protocols. All "fail" and "missing" newborns were retested (with both tests): in the case of a second "fail" result, a clinical ABR was performed within a period of 3 months. RESULTS: A total of 1191 newborns were screened. From those, 1044/1191 resulted as "pass", 108/1191 as "fail", and 39/1191 as "missing". During the re-testing of these 147 newborns, 43 were assigned as "missing", 63 were assigned as "pass" (showing bilaterally a wave V identifiable within 30 dB nHL) and 25 failed the retest and/or did not present an identifiable wave V within 30 dB nHL. Among the 147 retested infants, we identified a group of 16 subjects who resulted as NHS "refer" and who, during the audiological follow-up, showed either: (i) a unilateral or bilateral wave V identifiable over 30 dB nHL, at the first clinical ABR assessment; or (ii) a bilateral wave V identifiable within 30 dB nHL, in a following clinical ABR test during the first year of life. These 16 subjects were defined to have an 'Auditory Brainstem Maturation' issue. CONCLUSIONS: A possible "maturation" of the ABR response (and therefore of the auditory pathway) has been hypothesised in 16 out of 1191 infants (1.3%). A delay of the auditory pathway maturation in preterm babies compared to term newborns has already been suggested in the literature. A possible delay of the NHS retest could be considered, in selected cases, with significant savings in economic resources and parental anxiety.


Assuntos
Tronco Encefálico/crescimento & desenvolvimento , Transtornos da Audição/congênito , Transtornos da Audição/diagnóstico , Testes Auditivos , Doenças do Prematuro/diagnóstico , Triagem Neonatal , Audiologia , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Emissões Otoacústicas Espontâneas/fisiologia , Estudos Retrospectivos
12.
Neonatology ; 115(4): 363-370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30909270

RESUMO

OBJECTIVE: To examine the impact of medical complexity among very preterm infants on health care resource use, family, and neurodevelopmental outcomes at 18 months' corrected age. METHODS: This observational cohort study of Canadian infants born < 29 weeks' gestational age in 2009-2011 compared infants with and those without medical complexity defined as discharged home with assistive medical technology. Health care resource use and family outcomes were collected. Children were assessed for cerebral palsy, deafness, blindness, and developmental delay at 18 months. Logistic regression analysis was performed for group comparisons. RESULTS: Overall, 466/2,337 infants (20%) needed assistive medical technology at home including oxygen (79%), gavage feeding (21%), gastrostomy or ileostomy (20%), CPAP (5%), and tracheostomy (3%). Children with medical complexity were more likely to be re-hospitalized (OR 3.6, 95% CI 3.0-4.5) and to require ≥2 outpatient services (OR 4.4, 95% CI 3.5-5.6). Employment of both parents at 18 months was also less frequent in those with medical complexity compared to those without medical complexity (52 vs. 60%, p < 0.01). Thirty percent of children with medical complexity had significant neurodevelopmental impairment compared to 13% of those without medical complexity (p < 0.01). Lower gestational age, lower birth weight, bronchopulmonary dysplasia, sepsis, and surgical necrotizing enterocolitis were associated with a risk of medical complexity. CONCLUSION: Medical complexity is common following very preterm birth and has a significant impact on health care use as well as family employment and is more often associated with neurodevelopmental disabilities. Efforts should be deployed to facilitate care coordination upon hospital discharge and to support families of preterm children with medical complexity.


Assuntos
Tecnologia Biomédica/instrumentação , Serviços de Saúde da Criança/normas , Deficiências do Desenvolvimento/terapia , Doenças do Prematuro/terapia , Readmissão do Paciente/estatística & dados numéricos , Assistência Ambulatorial , Canadá , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/mortalidade , Avaliação da Deficiência , Emprego , Equipamentos e Provisões , Família , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/mortalidade , Recém-Nascido de muito Baixo Peso , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Retrospectivos
13.
Pediatrics ; 143(4)2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30846617

RESUMO

BACKGROUND AND OBJECTIVES: Exposure to negative social interactions (such as rudeness) has robust adverse implications on medical team performance. However, little is known regarding the effects of positive social interactions. We hypothesized that expressions of gratitude, a prototype of positive social interaction, would enhance medical teams' effectiveness. Our objective was to study the performance of NICU teams after exposure to expressions of gratitude from alternative sources. METHODS: Forty-three NICU teams (comprising 2 physicians and 2 nurses) participated in training workshops of acute care simulations. Teams were randomly assigned to 1 of 4 conditions: (1) maternal gratitude (in which the mother of a preterm infant expressed gratitude to NICU teams, such as the one that treated her child), (2) expert gratitude (in which a physician expert expressed gratitude to teams for participating in the training), (3) combined maternal and expert gratitude, or (4) control (same agents communicated neutral statements). The simulations were evaluated (5-point Likert scale: 1 = failed and 5 = excellent) by independent judges (blind to team exposure) using structured questionnaires. RESULTS: Maternal gratitude positively affected teams' performances (3.9 ± 0.9 vs 3.6 ± 1.0; P = .04), with most of this effect explained by the positive impact of gratitude on team information sharing (4.3 ± 0.8 vs 4.0 ± 0.8; P = .03). Forty percent of the variance in team information sharing was explained by maternal gratitude. Information sharing predicted team performance outcomes, explaining 33% of the variance in diagnostic performance and 41% of the variance in therapeutic performance. CONCLUSIONS: Patient-expressed gratitude significantly enhances medical team performance, with much of this effect explained by enhanced information sharing.


Assuntos
Doenças do Prematuro/terapia , Recém-Nascido Prematuro , Equipe de Assistência ao Paciente/normas , Qualidade da Assistência à Saúde , Treinamento por Simulação/métodos , Análise e Desempenho de Tarefas , Adulto , Pai/psicologia , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Unidades de Terapia Intensiva Neonatal , Relações Interpessoais , Israel , Masculino , Mães/psicologia
14.
Neonatology ; 115(4): 328-334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30836358

RESUMO

BACKGROUND: Attrition, or loss to follow-up, presents a significant threat to the integrity and validity of longitudinal clinical research. Little is known about predictors of attrition in neonatal clinical research, and no prior studies have examined how families' experiences participating in research with their infants influences study compliance. OBJECTIVE: To identify novel factors that were associated with attrition over 1 year of study follow-up among preterm infants enrolled in the multicenter Prematurity and Respiratory Outcomes Program (PROP) observational study. METHODS: At discharge, research coordinators estimated the likelihood of attrition. The parents completed questionnaires about their experience with the study at discharge and at 1 year corrected age. The primary endpoint was completion of 4 PROP interviews during the first year. Logistic models were used to evaluate the associations between infant, family, and center-based characteristics and attrition. RESULTS: Among 318 children, 283 (89%) met the primary endpoint. In bivariate analyses, lower maternal education, more people in the household, public insurance, and site were associated with attrition (p < 0.05). Parent survey responses, infant characteristics, and site characteristics were unrelated to attrition. Coordinators' prediction of attrition was associated with completion of early study interviews; this effect waned over time. In multivariable analyses, lower maternal education and more people in the household were the factors most strongly associated with attrition. CONCLUSION: Future neonatal research should evaluate novel strategies to decrease the burden associated with study participation and reinforcement of study goals with families who have lower educational levels to facilitate participation and decrease attrition bias.


Assuntos
Doenças do Prematuro/diagnóstico , Perda de Seguimento , Pais , Cooperação do Paciente/estatística & dados numéricos , Doenças Respiratórias/diagnóstico , Escolaridade , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Masculino , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Estados Unidos
15.
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
16.
Pediatr Clin North Am ; 66(2): 509-523, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30819351

RESUMO

There is increasing evidence of ongoing changes occurring in short-term and long-term motor and language outcomes in former premature infants. As rates of moderate to severe cerebral palsy (CP) have decreased, there has been increased awareness of the impact of mild CP and of developmental coordination disorder on the preterm population. Language delays and disorders continue to be among the most common outcomes. In conjunction with medical morbidities, there is increased awareness of the negative impact of family psycho-socioeconomic adversities on preterm outcomes and of the importance of intervention for these adversities beginning in the neonatal ICU.


Assuntos
Assistência ao Convalescente/métodos , Paralisia Cerebral/complicações , Desenvolvimento Infantil , Transtornos do Neurodesenvolvimento/terapia , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/terapia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/etiologia , Fatores de Risco
17.
PLoS One ; 14(1): e0211427, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703154

RESUMO

OBJECTIVES: Moderately and late preterm children (MLPs, 32.0-36.9 weeks gestational age) have a greater risk of poorer growth. This seems to be associated with poorer neuropsychological functioning. Evidence is limited on whether this also holds for emotional and behavioral (EB) problems. Therefore, we assessed whether longitudinal growth from birth until age 7 was associated with EB problems at age 7 in MLPs. STUDY DESIGN: This study was part of the Longitudinal Preterm Outcome Project, a prospective cohort study. Data on growth (height, weight, head circumference, and extent of catch-up growth) were obtained from assessments from birth until age 7. EB problems were assessed at age 7 with the Child Behavior Checklist. We assessed whether growth and EB problems were associated using logistic regression analyses, adjusting for multiple birth, parity, and socioeconomic status. RESULTS: We included 248 MLPs. Median gestational age was 34 weeks (interquartile range: 33-35 weeks). Mean birth weight was 2.2 kg (standard deviation: 0.5 kg). Postnatal growth measures were below the Dutch reference norm. EB problems were more prevalent in MLPs than in the general Dutch population. Generally, we found no associations between growth and EB problems; odds ratios ranged from 0.20 to 2.72. CONCLUSIONS: In MLPs, postnatal growth from birth until age 7 was not associated with EB problems at age 7. Poorer growth thus seems to relate to neuropsychological problems, but not to EB problems. This suggests that the etiologies of these problems differ at least partially.


Assuntos
Transtornos do Comportamento Infantil/etiologia , Desenvolvimento Infantil , Emoções/fisiologia , Cabeça/crescimento & desenvolvimento , Doenças do Prematuro/etiologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Prematuro/psicologia , Criança , Transtornos do Comportamento Infantil/diagnóstico , Pré-Escolar , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/diagnóstico , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Gravidez , Nascimento Prematuro , Estudos Prospectivos , Fatores de Risco
18.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30705140

RESUMO

CONTEXT: Survival of infants born at the limit of viability varies between high-income countries. OBJECTIVE: To summarize the prognosis of survival and risk of impairment for infants born at 22 + 0/7 weeks' to 27 + 6/7 weeks' gestational age (GA) in high-income countries. DATA SOURCES: We searched 9 databases for cohort studies published between 2000 and 2017 in which researchers reported on survival or neurodevelopmental outcomes. STUDY SELECTION: GA was based on ultrasound results, the last menstrual period, or a combination of both, and neurodevelopmental outcomes were measured by using the Bayley Scales of Infant Development II or III at 18 to 36 months of age. DATA EXTRACTION: Two reviewers independently extracted data and assessed the risk of bias and quality of evidence. RESULTS: Sixty-five studies were included. Mean survival rates increased from near 0% of all births, 7.3% of live births, and 24.1% of infants admitted to intensive care at 22 weeks' GA to 82.1%, 90.1%, and 90.2% at 27 weeks' GA, respectively. For the survivors, the rates of severe impairment decreased from 36.3% to 19.1% for 22 to 24 weeks' GA and from 14.0% to 4.2% for 25 to 27 weeks' GA. The mean chance of survival without impairment for infants born alive increased from 1.2% to 9.3% for 22 to 24 weeks' GA and from 40.6% to 64.2% for 25 to 27 weeks' GA. LIMITATIONS: The confidence in these estimates ranged from high to very low. CONCLUSIONS: Survival without impairment was substantially lower for children born at <25 weeks' GA than for those born later.


Assuntos
Mortalidade Infantil/tendências , Lactente Extremamente Prematuro/fisiologia , Doenças do Prematuro/mortalidade , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/diagnóstico , Fatores de Risco , Taxa de Sobrevida/tendências
19.
PLoS One ; 14(2): e0212568, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785934

RESUMO

BACKGROUND: Premature neonates (PN) present multiple risk factors for high frequencies and high levels of colonization by C. difficile, yet data is missing about this specific pediatric population. Here, we investigated PN C. difficile carriage and colonization dynamics, analyzed the impact of perinatal determinants on colonization, and characterized the isolates. METHODS: A one year longitudinal monocentric prospective cohort study was performed on 121 PN. C. difficile strains isolated from fecal samples on selective medium were identified and characterized by PCR (tpi housekeeping gene; tcdA and tcdB, and binary toxin genes), capillary gel-based electrophoresis PCR-ribotyping, and Multi-Locus Variable-number tandem-repeat Analysis (MLVA). RESULTS: Of the 379 samples analyzed, 199 (52%) were C. difficile culture positive with the mean levels of C. difficile colonization decreasing significantly (P = .027) over time. During hospitalization, C. difficile colonization frequency increased up to 61% with 95% of the strains belonging to both non-toxigenic PCR-ribotypes (RTs) FR082 (35%) and 032 (60%). After hospital discharge, if a higher diversity in RTs was observed, RTs FR082 and 032 remained predominant (respectively 40% and 28%). MLVA showed clonal relationship within each FR082 and 032 RTs. Ten toxigenic strains (5%) were isolated, all tcdA+/tcdB+ except for one tcdA-/tcdB+, and all being acquired after hospitalization. At 1 week, the only factors found to be linked with a higher frequency of C. difficile colonization were a higher gestational age (P = 0.006) and a higher birth weight (P = 0.016). CONCLUSION: The dynamics of C. difficile colonization in PN followed a specific pattern. C. difficile colonization rapidly occurred after birth with a low diversity of non-toxigenic RTs. After hospitalization, non-toxigenic RTs diversity increased. Sporadic carriage of toxigenic strains was observed after hospitalization.


Assuntos
Infecções por Clostridium/diagnóstico , Clostridium difficile/isolamento & purificação , Doenças do Prematuro/diagnóstico , Infecções por Clostridium/microbiologia , Clostridium difficile/genética , Fezes/microbiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/microbiologia , Estudos Longitudinais , Masculino , Estudos Prospectivos , Ribotipagem
20.
Biol Res Nurs ; 21(2): 210-223, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30654634

RESUMO

BACKGROUND: Every year, an estimated 15 million babies are born preterm (<37 weeks' gestational age) globally. These preterm infants are exposed to repeated stressful and often painful procedures as part of routine life-saving care within the neonatal intensive care unit (NICU). Low thresholds for tactile and nociceptive input make it more difficult for neonates to discriminate between noxious and nonnoxious stimuli, which can result in continuous activation of stress responses in an attempt to achieve stability through adaptation, or allostasis. Rapidly reoccurring stressors can render stress-response systems over- or underactive, creating wear and tear, or allostatic load. A better understanding of biomarkers related to allostatic load might aid in early detection and prevention/alleviation of allostatic load in this population. PURPOSE: To identify stress biomarkers that have been studied in preterm infants at different time points in the NICU and as long-term outcome measures. METHOD/SEARCH STRATEGY: Systematic searches were conducted of PubMed, CINAHL, SCOPUS, and PsychInfo databases. FINDINGS/RESULTS: Twenty-one studies met inclusion criteria for this review. Several putative biomarkers were identified, including cortisol levels, epigenetic markers, brain microstructure, markers of oxidative stress, and the brain-gut-microbiome axis. CONCLUSION: The interaction of disease with therapeutic interventions may inadvertently increase infant allostatic load. In addition to human studies, future research should leverage newly available large data sets to conduct additional analyses.


Assuntos
Alostase/fisiologia , Biomarcadores/sangue , Recém-Nascido de Baixo Peso/sangue , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/terapia , Recém-Nascido Prematuro/sangue , Estresse Fisiológico/fisiologia , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Gravidez
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