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1.
Int J Gynaecol Obstet ; 148(1): 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31556455

RESUMO

OBJECTIVE: To clarify the association between postpartum depression (PPD) and anemia in each stage of pregnancy as well as in the postpartum period. METHODS: A prospective cohort study was conducted between May 2010 and November 2013 at a tertiary hospital in Japan. In total, 1128 women were assessed using the Edinburgh Postpartum Depression Scale (EPDS) at postpartum week 4 and a blood test was performed in the second trimester (24-28 weeks of gestation), third trimester (35-36 weeks of gestation), and postpartum week 1. The primary outcome was PPD, defined as an EPDS score of 9 or higher. Multivariate logistic regression analysis was used to elucidate the association between anemia and PPD for each period. Additionally, trend analysis was conducted to determine if there was a linear association between maternal hemoglobin concentration and PPD. RESULTS: Postpartum anemia was significantly associated with increased PPD risk (adjusted odds ratio 1.63, 95% confidence interval 1.17-2.26) whereas anemia in the second and third trimesters was not. Similarly, a significant inverse association was observed between the quintiles of maternal hemoglobin levels in the puerperium and the PPD risk (P value for trend 0.004). CONCLUSION: Postpartum anemia was associated with an increased risk of PPD.


Assuntos
Anemia/etiologia , Depressão Pós-Parto/complicações , Doenças do Recém-Nascido/etiologia , Adulto , Anemia/diagnóstico , Depressão Pós-Parto/diagnóstico , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Japão , Razão de Chances , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Adulto Jovem
2.
BMJ ; 367: l5517, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615781

RESUMO

OBJECTIVES: To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions. DESIGN: Pragmatic, multicentre, stepped wedge cluster randomised trial. SETTING: 60 midwifery practices in the Netherlands. PARTICIPANTS: 13 046 women aged 16 years or older with a low risk singleton pregnancy. INTERVENTIONS: 60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). After 3, 7, and 10 months, a third of the practices were randomised to the intervention strategy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks' gestation. The same multidisciplinary protocol for detecting and managing fetal growth restriction was used in both strategies. MAIN OUTCOME MEASURES: The primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score <4, impaired consciousness, asphyxia, seizures, assisted ventilation, septicaemia, meningitis, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leucomalacia, or necrotising enterocolitis. Secondary outcomes were two composite measures of severe maternal morbidity, and spontaneous labour and birth. RESULTS: Between 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks' gestation). 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. Small for gestational age at birth was significantly more often detected in the intervention group than in the usual care group (179 of 556 (32%) v 78 of 407 (19%), P<0.001). The incidence of severe adverse perinatal outcomes was 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for usual care. After adjustment for confounders, the difference between the groups was not significant (odds ratio 0.88, 95% confidence interval 0.70 to 1.20). The intervention strategy showed a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). Maternal outcomes and other obstetric interventions did not differ between the strategies. CONCLUSION: In low risk pregnancies, routine ultrasonography in the third trimester along with clinically indicated ultrasonography was associated with higher antenatal detection of small for gestational age fetuses but not with a reduced incidence of severe adverse perinatal outcomes compared with usual care alone. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies. TRIAL REGISTRATION: Netherlands Trial Register NTR4367.


Assuntos
Doenças do Recém-Nascido , Ultrassonografia Pré-Natal , Adolescente , Índice de Apgar , Análise por Conglomerados , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Humanos , Incidência , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Tocologia/métodos , Tocologia/estatística & dados numéricos , Países Baixos/epidemiologia , Mortalidade Perinatal , Gravidez , Resultado da Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Gravidez na Adolescência , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/estatística & dados numéricos
3.
Yonsei Med J ; 60(11): 1061-1066, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637888

RESUMO

PURPOSE: Newborn screening (NBS) programs are important for appropriate management of susceptible neonates to prevent serious clinical problems. Neonates admitted to neonatal intensive care units (NICU) are at a potentially high risk of false-positive results, and repetitive NBS after total parenteral nutrition is completely off results in delayed diagnosis. Here, we present the usefulness of a targeted next-generation sequencing (TNGS) panel to complement NBS for early diagnosis in high-risk neonates. MATERIALS AND METHODS: The TNGS panel covered 198 genes associated with actionable genetic and metabolic diseases that are typically included in NBS programs in Korea using tandem mass spectrometry. The panel was applied to 48 infants admitted to the NICU of Severance Children's Hospital between May 2017 and September 2017. The infants were not selected for suspected metabolic disorders. RESULTS: A total of 13 variants classified as likely pathogenic or pathogenic were detected in 11 (22.9%) neonates, including six genes (DHCR7, PCBD1, GAA, ALDOB, ATP7B, and GBA) associated with metabolic diseases not covered in NBS. One of the 48 infants was diagnosed with an isobutyl-CoA dehydrogenase deficiency, and false positive results of tandem mass screening were confirmed in two infants using the TNGS panel. CONCLUSION: The implementation of TNGS in conjunction with conventional NBS can allow for better management of and earlier diagnosis in susceptible infants, thus preventing the development of critical conditions in these sick infants.


Assuntos
Sequenciamento de Nucleotídeos em Larga Escala/métodos , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/genética , Triagem Neonatal/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mutação/genética , República da Coreia , Fatores de Risco
4.
Neonatal Netw ; 38(2): 107-108, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470374

RESUMO

Babies in the NICU should be managed in a neurodevelopment-friendly environment. Frequent handling by multiple examiners potentially increases the risk of cross infection. Interruption in kangaroo care is not advisable unless urgent. A minimum of three-point exam should be done (chest, heart, and abdomen) using a stethoscope and gentle palpation. However, the infant should not be wakened from sleep and all handling should be synchronized with the touch time.


Assuntos
Cuidado do Lactente , Doenças do Recém-Nascido , Terapia Intensiva Neonatal , Administração dos Cuidados ao Paciente , Humanos , Cuidado do Lactente/ética , Cuidado do Lactente/métodos , Cuidado do Lactente/psicologia , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/terapia , Unidades de Terapia Intensiva Neonatal/organização & administração , Terapia Intensiva Neonatal/ética , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/psicologia , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Conforto do Paciente , Exame Físico/métodos , Exame Físico/psicologia , Relações Profissional-Família , Fatores de Tempo
6.
Rev Soc Bras Med Trop ; 52: e20180522, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31340358

RESUMO

Listeria is an unusual pathogen that causes neonatal infection with high morbidity and mortality. We present the case of a premature newborn whose mother had a rash during pregnancy; the newborn had severe early sepsis because of Listeria monocytogenes and histopathologically suggestive findings of the placenta. Obstetricians and neonatologists should suspect listeriosis in cases with compatible epidemiological history, clinical features, and examination findings of the placenta.


Assuntos
Doenças do Recém-Nascido/diagnóstico , Listeria monocytogenes/isolamento & purificação , Listeriose/microbiologia , Sepse/microbiologia , Adulto , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/microbiologia , Transmissão Vertical de Doença Infecciosa , Unidades de Terapia Intensiva Neonatal , Listeriose/diagnóstico , Listeriose/transmissão , Masculino , Gravidez , Complicações Infecciosas na Gravidez , Sepse/diagnóstico , Adulto Jovem
7.
Handb Clin Neurol ; 162: 239-266, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324313

RESUMO

Perinatal arterial ischemic stroke is a relatively common and serious neurologic disorder that can affect the fetus, the preterm, and the term-born infant. It carries significant long-term disabilities. Herein we describe the current understanding of its etiology, pathophysiology and classification, different presentations, and optimal early management. We discuss the role of different brain imaging modalities in defining the extent of lesions and the impact this has on the prediction of outcomes. In recent years there has been progress in treatments, making early diagnosis and the understanding of likely morbidities imperative. An overview is given of the range of possible outcomes and optimal approaches to follow-up and support for the child and their family in the light of present knowledge.


Assuntos
Isquemia Encefálica/congênito , Isquemia Encefálica/terapia , Doenças do Recém-Nascido/terapia , Acidente Vascular Cerebral/congênito , Acidente Vascular Cerebral/terapia , Adulto , Animais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/diagnóstico por imagem , Neuroimagem , Gravidez , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/diagnóstico por imagem
8.
Handb Clin Neurol ; 162: 415-433, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324323

RESUMO

Although the majority of seizures in neonates are related to acute brain injury, a substantial minority are the first symptom of a neonatal-onset epilepsy often linked to a pathogenic genetic variant. Historically, studies on neonatal seizures including treatment response and long-term consequences have lumped all etiologies together. However, etiology has been consistently shown to be the most important determinant of outcome. In the past few years, an increasing number of monogenic disorders have been described and might explain up to a third of neonatal-onset epilepsy syndromes previously included under the umbrella of Ohtahara syndrome and early myoclonic encephalopathy. In this chapter, we define the concept of genetic epilepsy and review the classification. Then, we review the most relevant monogenic neonatal-onset epilepsies, detail their underlying pathophysiologic mechanisms, and present their electroclinical phenotypes. We highlight that, in some cases, such as neonates with KCNQ2 or KCNT1 gene mutations, the early recognition of the electroclinical phenotype can lead to targeted diagnostic testing and precision medicine treatment, enabling the possibility of improved outcome.


Assuntos
Epilepsia/congênito , Epilepsia/genética , Doenças do Recém-Nascido/genética , Adulto , Epilepsia/diagnóstico , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Canal de Potássio KCNQ2/genética , Mutação , Proteínas do Tecido Nervoso/genética , Gravidez
9.
Handb Clin Neurol ; 162: 435-448, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324324

RESUMO

The differential diagnosis of neonatal hypotonia is a complex task, as in newborns hypotonia can be the presenting sign of different underlying causes, including peripheral and central nervous system involvement and genetic and metabolic diseases. This chapter describes how a combined approach, based on the combination of clinical signs and new genetic techniques, can help not only to establish when the hypotonia is related to peripheral involvement but also to achieve an accurate and early diagnosis of the specific neuromuscular diseases with neonatal onset. The early identification of such disorders is important, as this allows early intervention with disease-specific standards of care and, more importantly, because of the possibility to treat some of them, such as spinal muscular atrophy, with therapeutic approaches that have recently become available.


Assuntos
Doenças do Recém-Nascido/terapia , Hipotonia Muscular/congênito , Hipotonia Muscular/terapia , Doenças Musculares/congênito , Doenças Musculares/terapia , Adulto , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/genética , Doenças do Recém-Nascido/fisiopatologia , Técnicas de Diagnóstico Molecular , Hipotonia Muscular/diagnóstico , Hipotonia Muscular/genética , Doenças Musculares/diagnóstico , Doenças Musculares/genética , Gravidez
10.
Handb Clin Neurol ; 162: 449-481, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324325

RESUMO

Inborn errors of metabolism, also known as inherited metabolic diseases, constitute an important group of conditions presenting with neurologic signs in newborns. They are individually rare but collectively common. Many are treatable through restoration of homeostasis of a disrupted metabolic pathway. Given their frequency and potential for treatment, the clinician should be aware of this group of conditions and learn to identify the typical manifestations of the different inborn errors of metabolism. In this review, we summarize the clinical, laboratory, electrophysiologic, and neuroimaging findings of the different inborn errors of metabolism that can present with florid neurologic signs and symptoms in the neonatal period.


Assuntos
Doenças do Recém-Nascido/terapia , Erros Inatos do Metabolismo/terapia , Adulto , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/diagnóstico por imagem , Doenças do Recém-Nascido/fisiopatologia , Erros Inatos do Metabolismo/diagnóstico , Erros Inatos do Metabolismo/diagnóstico por imagem , Erros Inatos do Metabolismo/fisiopatologia , Neuroimagem , Gravidez
11.
Medicine (Baltimore) ; 98(29): e16458, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335703

RESUMO

We evaluated the clinical value of the cerebroplacental ratio (CPR) in predicting neonatal acidosis according to the gestational weeks in late pregnancy.From July 2016 to June 2017, 1018 neonates without acidosis and 218 neonates with acidosis (confirmed postpartum) underwent a prenatal examination and hospital delivery at 28 to 41 weeks in our hospital. The CPR was calculated as the ratio of the prenatal middle cerebral artery-pulsation index (MCA-PI) to the umbilical artery-pulsation index (UA-PI).In neonates without acidosis, the fetal UA-PI decreased with increased gestational age during late pregnancy. Similarly, the MCA-PI decreased with increased gestational age, and decreased significantly during the full pregnancy term. Additionally, the CPR peaked in the middle of the late pregnancy period and then decreased. In contrast, in neonates with acidosis, the prenatal UA-PI increased significantly, MCA-PI declined significantly, and CPR declined significantly in relation to normal values (P < .05). For the prediction of neonatal acidosis, the UA-PI was suitable after 32 weeks and the MCA-PI was suitable before 37 weeks. The cutoff values of the CPR for the prediction of neonatal acidosis at 28 to 31 weeks, 32 to 36 weeks, and 37 to 41 weeks were 1.29, 1.36, and 1.22, respectively. Unlike the UA-PI and MCA-PI, the CPR was suitable as an independent predictor of neonatal acidosis at all late pregnancy weeks. In neonates with acidosis, the z score of the UA-PI increased significantly, whereas the z scores of the MCA-PI and CPR decreased significantly, in relation to normal values (P < .05).The CPR can be used to evaluate the adverse status of fetuses during late pregnancy, providing an early prediction of neonatal acidosis.


Assuntos
Acidose/diagnóstico , Doenças do Recém-Nascido/diagnóstico , Artéria Cerebral Média/diagnóstico por imagem , Fluxo Pulsátil , Artérias Umbilicais/diagnóstico por imagem , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Feto/metabolismo , Feto/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/metabolismo , Doenças do Recém-Nascido/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Diagnóstico Pré-Natal/métodos , Prognóstico , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Pré-Natal/métodos
12.
Nutrients ; 11(8)2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31349739

RESUMO

Probiotics intervention has been proposed as a feasible preventative approach against adverse health-related complications in infants. Nevertheless, the umbrella concept of probiotics has led to a massive application of probiotics in a range of products for promoting infant health, for which the strain-specificity, safety and efficacy findings associated with a specific probiotics strain are not clearly defined. Bifidobacterium breve M-16V is a commonly used probiotic strain in infants. M-16V has been demonstrated to offer potential in protecting infants from developing the devastating necrotising enterocolitis (NEC) and allergic diseases. This review comprehends the potential beneficial effects of M-16V on infant health particularly in the prevention and treatment of premature birth complications and immune-mediated disorders in infants. Mechanistic studies supporting the use of M-16V implicated that M-16V is capable of promoting early gut microbial colonisation and may be involved in the regulation of immune balance and inflammatory response to protect high-risk infants from NEC and allergies. Summarised information on M-16V has provided conceptual proof of the use of M-16V as a potential probiotics candidate aimed at promoting infant health, particularly in the vulnerable preterm population.


Assuntos
Bifidobacterium breve/fisiologia , Microbioma Gastrointestinal , Saúde do Lactente , Doenças do Recém-Nascido/prevenção & controle , Probióticos/uso terapêutico , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/microbiologia , Recém-Nascido Prematuro , Probióticos/efeitos adversos
14.
Clin Lab ; 65(7)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31307162

RESUMO

BACKGROUND: Neonatal infections, especially neonatal pneumonia, are clinically common and have a high mortality rate. Early diagnosis and the duration of appropriate antibiotic treatment are critical. PCT is an indication of infection and may be valuable. METHODS: This is a retrospective cohort of 269 neonates within 24 hours after birth, analyzing the value of procalcitonin, C-reactive protein, and white blood cell count in neonatal infections, especially neonatal pneumonia, and antibiotic therapy. RESULTS: The median of PCT, CRP, and WBC in the severely infected group, neonatal pneumonia group, neonatal infection group, and non-infectious disease group were (1.76, 5.25, 15.8), (0.20, 0.53, 13.8), (0.22, 3.64, 10.4), and (0.15, 0.39, 10.6), respectively. In ROC curves, PCT had an area under the curve (AUC) of 0.64 (95% CI, 0.49 - 0.0.79); CRP had an AUC of 0.61 (95% CI, 0.49 - 0.74); WBC had an AUC of 0.78 (95% CI, 0.67 - 0.88). There was a significant difference between the neonatal pneumonia with PCT results group and the neonatal pneumonia without PCT results group, p < 0.001. The median of antibiotic treatment was 4.0 d (95% CI 3.7 - 4.8) in the neonatal pneumonia with PCT results group vs. 4.9 d (95% CI 4.5 - 5.6) in the standard group; p < 0.001. CONCLUSIONS: PCT helps identify neonate infections and grades of infections and assists pediatricians in deciding when to stop antibiotic treatment; PCT and WBC help improve the accuracy of neonatal pneumonia diagnosis.


Assuntos
Diagnóstico Precoce , Doenças do Recém-Nascido/diagnóstico , Pneumonia/diagnóstico , Pró-Calcitonina/sangue , Antibacterianos/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/sangue , Doenças do Recém-Nascido/tratamento farmacológico , Contagem de Leucócitos , Masculino , Pneumonia/sangue , Pneumonia/tratamento farmacológico , Estudos Retrospectivos , Sensibilidade e Especificidade , Sepse/sangue , Sepse/diagnóstico , Sepse/tratamento farmacológico
15.
Clin Lab ; 65(7)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31307181

RESUMO

BACKGROUND: Neonatal sepsis represents one of the common diseases in the neonatal intensive care unit. Here we aim to evaluate the differences between a group of preterm newborns with sepsis and a control group in relation to clinical and laboratory variables. In addition, our goal is to establish potential predictors of early-onset sepsis (EOS) and late-onset sepsis (LOS). METHODS: The study included 113 preterm newborns with sepsis (EOS-63.72%/LOS-36.28%). Laboratory deter-minations included full blood count, CRP, biochemical determinations, blood culture. RESULTS: The most important univariate neonatal predictors were gestational age (p < 0.001), surfactant adminis-tration (p < 0.001), mechanical ventilation (p < 0.001), heart failure (p < 0.001), a history of hypocalcemia (p = 0.037), Apgar score at 1 minute lower than 7 (p = 0.001), birth weight < 1,500 g (p = 0.005), number of hospi-talization days (p = 0.048), and number of weight recovery days < 10 (p < 0.05). The WBC and CRP parameters remained significant univariate predictors of sepsis on day 7 (p = 0.002; OR = 2.01 per 10,000 mm3 increase of WBC, 95% CI: (1.30; 3.09) and p = 0.001; OR = 4.27, 95% CI: (1.85; 9.88), respectively). Logistic regression anal-ysis showed maternal urinary tract infection (OR = 3.05), heart failure (OR = 5.28), the number of hospitalization days (OR = 1.09) and CRP (OR = 3.26) were significant independent risk factors for neonatal sepsis in preterms. The univariate predictors of EOS were gestational age (p = 0.002), birth weight (p = 0.014), 1-minute Apgar score (p = 0.012), maternal urinary tract infection (p = 0.008), surfactant administration (p < 0.001), heart failure (p < 0.001), and CRP level (p < 0.001). Surfactant administration (OR = 6.73) and CRP level (OR = 3.51) represent predictors of EOS in preterms according to the multivariate model. The univariate predictors of LOS were gesta-tional age (p = 0.001), birth weight (p = 0.048), 1-minute Apgar score (p = 0.001), surfactant administration (p < 0.001), hypocalcemia (p = 0.03), heart failure (p = 0.003), CRP level (p < 0.001), mechanical ventilation (p < 0.001), and the number of hospitalization days (p < 0.001). In the multivariate model, the number of hospitali-zation days (OR = 1.11) and heart failure (OR = 5.98) are independent predictors for LOS in preterms. CONCLUSIONS: The study confirms the presence of maternal urinary tract infection, hospitalization days, heart fail-ure, and CRP level as predictors of neonatal sepsis in preterms with differences between EOS and LOS.


Assuntos
Doenças do Recém-Nascido/diagnóstico , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Sepse/diagnóstico , Centros de Atenção Terciária/estatística & dados numéricos , Idade de Início , Proteína C-Reativa/análise , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Complicações Infecciosas na Gravidez , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Sepse/complicações , Infecções Urinárias/complicações
16.
An Pediatr (Barc) ; 91(2): 128.e1-128.e14, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31235277

RESUMO

Newborn screening programs are key players in a country's public health strategies, preventing the burden of care associated with the screened disorders. Its importance has dramatically intensified in recent years due to the increasing number of disorders that fulfil criteria for screening. Since the 1960's, many countries implemented newborn screening programs that are now, at least in developed countries, universal, well established, and with excellent results. Nevertheless, much work is still to be done, mainly in developing countries of Africa, Asia, and South America. In some European countries, including Spain, uniformity of screening panels between different regions is still a challenge, being a source of health inequalities between citizens. The authors will present the current status of newborn screening programs in Spain and integrate it into the current European and world scenario.


Assuntos
Doenças do Recém-Nascido/diagnóstico , Doenças Metabólicas/diagnóstico , Triagem Neonatal/métodos , Países em Desenvolvimento , Humanos , Recém-Nascido , Saúde Pública , Espanha
17.
Clin Lab ; 65(6)2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31232045

RESUMO

BACKGROUND: Neonatal pneumonia (NP) is one of the major causes of neonatal death. Current NP diagnosis depends on a detailed history, physical examination, and radiographic and laboratory findings. There is no specific biomarker or diagnostic indicator of NP. METHODS: In this study, we tried to find a reliable biomarker for quick NP diagnosis by collecting peripheral blood from neonates with NP and transient tachypnea of the newborn (TTN), and subsequently tested the expression of CD64 on white blood cells using flow cytometry. The cellularity of each blood cell population was also quantified. Furthermore, procalcitonin (PCT) and C-reactive protein (CRP) levels were evaluated in the blood sera. RESULTS: We found that NP patients had moderately increased polymorphonuclear cells (PMNs), as well as elevated PCT and CRP levels in the blood sera. Importantly, the expression of CD64 on PMNs was profoundly increased in NP patients but not TTN patients. The receiver operating characteristic (ROC) curve of PMN CD64 index suggests that PMN CD64 index is sensitive and specific for NP diagnosis. CONCLUSIONS: Our study reveals that PMN CD64 could be a fast and reliable biomarker for NP diagnosis.


Assuntos
Biomarcadores/sangue , Doenças do Recém-Nascido/sangue , Neutrófilos/metabolismo , Pneumonia/sangue , Receptores de IgG/sangue , Proteína C-Reativa/metabolismo , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Contagem de Leucócitos , Masculino , Pneumonia/diagnóstico , Pró-Calcitonina/sangue , Curva ROC , Taquipneia/sangue , Taquipneia/diagnóstico
18.
J Pediatr Endocrinol Metab ; 32(7): 767-774, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31211689

RESUMO

Background Persistent hypoglycemia (PH) beyond 3 days of life warrants investigation which includes a critical sample. We report our case series of five neonates who presented with PH as the first sign of congenital hypopituitarism. Design This is a case series. Methods/Results This is a case series of five neonates evaluated at our academic institution in a 3-year period (2013-2016), who presented with persistent severe hypoglycemia and were subsequently diagnosed with congenital hypopituitarism. All neonates were full term (mean gestational age 39.8 ± 1.4 weeks) born by caesarian section with a mean weight of 3.5 ± 0.16 kg and a mean length of 51.2 ± 1.2 cm at birth. All five neonates had PH beyond 3 days with an average blood glucose (BG) <35 mg/dL at presentation, requiring a mean glucose infusion rate (GIR) of 7.22 ± 1.98 mg/kg/min. The average BG during the critical sample was 42 ± 0.16 mg/dL (three patients). The mean duration of requirement of the glucose infusion was 6.2 ± 3 days during the immediate neonatal period. Diagnosis of the hypopituitarism took 2-52 days from the initial presentation of hypoglycemia. Besides growth hormone (GH) deficiency, cortisol deficiency was diagnosed in all the five neonates. Neuroimaging findings in all the neonates were consistent with pituitary stalk interruption syndrome (hypoplastic anterior pituitary, ectopic posterior pituitary [EPP] and interrupted pituitary stalk). Conclusions Hypoglycemia is a common metabolic complication affecting an infant in the immediate neonatal period. Delay in the diagnosis of hypopituitarism presenting as hypoglycemia is the result of the lack of awareness among neonatologists and/or pediatricians. We propose that providers be cognizant that PH can be the only presentation of hypopituitarism in the neonatal period. Therefore, having a high index of suspicion about this condition can avoid a delay in the evaluation, diagnosis and treatment of hypopituitarism.


Assuntos
Hipoglicemia/etiologia , Hipopituitarismo/congênito , Hipopituitarismo/complicações , Doenças do Recém-Nascido/etiologia , Índice de Gravidade de Doença , Biomarcadores/análise , Feminino , Humanos , Hipoglicemia/diagnóstico , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Masculino , Gravidez , Prognóstico
19.
BMC Med Inform Decis Mak ; 19(1): 116, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221158

RESUMO

BACKGROUND: In low-income settings, community health workers (CHWs) are frequently the first point of contact for newborns. Mobile technology may aid health workers in classifying illness and providing referral and management guidance for newborn care. This study evaluates the potential for mobile health technology to improve diagnosis and case management of newborns in Bangladesh. METHODS: A mobile application based on Bangladesh's Comprehensive Newborn Care Package national guidelines (mCNCP) was developed to aid CHWs in identifying and managing small and sick infants. After a 2-day training, CHWs assessed newborns at Sylhet Osmani Medical College Hospital and in the Projahnmo research site (Sylhet, Bangladesh) using either mCNCP or a comparable paper form (pCNCP), similar to standard IMCI-formatted paper forms. CHWs were randomized to conduct a block of ~ 6 newborn assessments starting with either mCNCP or pCNCP, then switched to the alternate method. Physicians using mCNCP served as gold standard assessors. CHW performance with mCNCP and pCNCP were compared using chi-squared tests of independence for equality of proportions, and logistic regressions clustered by CHW. RESULTS: Two hundred seven total CHW assessments were completed on 101 enrolled infants. mCNCP assessments were more often fully completed and completed faster than pCNCP assessments (100% vs 23.8%, p < 0.001; 17.5 vs 23.6 min; p < 0.001). mCNCP facilitated calculations of respiratory rate, temperature, and gestational age. CHWs using mCNCP were more likely to identify small newborns (Odds Ratio (OR): 20.8, Confidence Interval (CI): (7.1, 60.8), p < 0.001), and to correctly classify 7 out of 16 newborn conditions evaluated, including severe weight loss (OR: 13.1, CI: (4.6, 37.5), p < 0.001), poor movement (OR: 6.6, CI: (2.3, 19.3), p = 0.001), hypothermia (OR: 14.9, CI: (2.7, 82.2), p = 0.002), and feeding intolerance (OR: 2.1, CI: (1.3, 3.3), p = 0.003). CHWs with mCNCP were more likely to provide counseling as needed on 4 out of 7 case management recommendations evaluated, including kangaroo mother care. CONCLUSIONS: CHWs in rural Bangladesh with limited experience using tablets successfully used a mobile application for neonatal assessment after a two-day training. mCNCP may aid frontline health workers in Bangladesh to improve completion of neonatal assessment, classification of illnesses, and adherence to neonatal management guidelines.


Assuntos
Administração de Caso , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/terapia , Aplicativos Móveis , Bangladesh , Agentes Comunitários de Saúde , Feminino , Humanos , Recém-Nascido , Método Canguru , Masculino , Triagem Neonatal , Serviços de Saúde Rural
20.
Pediatr. aten. prim ; 21(82): 159-162, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184589

RESUMO

El lupus neonatal cutáneo es una entidad de buen pronóstico que se resuelve antes del año de vida con el aclaramiento de los anticuerpos maternos. El lupus eritematoso neonatal puede presentar manifestaciones cardiacas (50%), cutáneas (50%) o coexistencia de ambas (10%). Su diagnóstico requiere un alto índice de sospecha, incluyendo una buena historia clínica con antecedentes familiares


Cutaneous neonatal lupus is an entity with good prognosis, it is resolved within the first year of age with the clearance of maternal antibodies. Neonatal lupus erythematosus may present cardiac (50%), cutaneous (50%) or coexistence of both (10%). Its diagnosis requires a high index of suspicion, including a good clinical history with a family history


Assuntos
Humanos , Feminino , Lactente , Lúpus Eritematoso Sistêmico/congênito , Lúpus Eritematoso Cutâneo/congênito , Diagnóstico Diferencial , Doenças do Recém-Nascido/diagnóstico
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