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1.
World Neurosurg ; 127: e1051-e1056, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30980971

RESUMO

OBJECTIVES: The neutrophil-to-lymphocyte ratio (NLR) reflects the balance between innate and adaptive inflammatory responses. This study intended to evaluate parameters associated with admission high NLR and its impact on clinical outcome in patients with primary intraventricular hemorrhage (PIVH). METHODS: This study retrospectively analyzed consecutive patients with PIVH without a history of head trauma or parenchymal/subarachnoid hemorrhage on computed tomography scan between 2010 and 2016 in a single center. Clinical outcomes at discharge and 90 days were assessed with the modified Rankin Score (mRS) and dichotomized as good (mRS 0-2) and poor (mRS 3-6) outcomes. Associations were estimated using multivariable logistic regression. RESULTS: We had 171 patients with PIVH included in the present study. There were 94 male (55.0%) and 77 female (45.0%) patients, with an average age of 46.1 ± 17.2 years. Multivariable logistic analyses revealed independent associations of high NLR (≥8.25) with higher Graeb score, Moyamoya disease, higher admission blood glucose level, and lower platelet count. The patients with high NLR had poorer outcome at discharge and 90 days. After adjustment, the patients with high NLR tended to be associated with poor outcome both at discharge and 90 days. In addition, NLR exhibited a superior predictive power of pneumonia in PIVH than absolute neutrophil count and white blood cell count. CONCLUSIONS: NLR tended to be associated with 90-day clinical outcomes of patients with PIVH and exhibited independent predictive power for pneumonia in PIVH.


Assuntos
Hemorragia Cerebral Intraventricular/sangue , Hemorragia Cerebral Intraventricular/diagnóstico , Linfócitos/metabolismo , Neutrófilos/metabolismo , Adulto , Idoso , Hemorragia Cerebral Intraventricular/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/sangue , Pneumonia/diagnóstico , Pneumonia/etiologia , Estudos Retrospectivos
2.
Cerebrovasc Dis ; 47(3-4): 105-111, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947170

RESUMO

BACKGROUND: Homozygosity of this p.R4810K founder variant of RNF213moyamoya disease (MMD) susceptibility gene is known to influence the severity of the clinical disease phenotype at disease onset. However, the association between this genotype and long-term clinical manifestations has remained unclear. OBJECTIVES: The principal goal of this study was to investigate whether and how the p.R4810K variant of RNF213influences the long-term phenotype in Japanese patients with MMD. METHOD: This retrospective cohort study included 94 Japanese patients with MMD who underwent direct or combined bypass for revascularization with the p.R4810K genotype determined in our hospital. The following phenotypic parameters were analyzed at disease onset and over a long-term period: age and initial presentation at onset, recurrent stroke after initial revascularization, and final modified Rankin Scale. RESULTS: The p.R4810K genotype was significantly associated with the phenotype at onset, especially in younger patients. Over a median follow-up period of 100 months, recurrent stroke occurred in 6 out of 94 patients: none out of 5 patients with the homozygous variant, 5 out of 64 with the heterozygous variant, and 1 out of 25 in the wild-type group. There were no significant differences among the genotypes. In particular, recurrent cerebral hemorrhage occurred in 5 patients, all possessing the heterozygous variant. The log-rank test showed no difference between the genotypes in the stroke-free survival rate. Furthermore, the p.R4810K genotype was not associated with a poor functional condition. CONCLUSIONS: The p.R4810K founder variant of RNF213 affects the phenotype at disease onset. However, the optimal revascularization may be effective, regardless of the genotype, even for the homozygous variant, which has been thought to be the most pathogenic. This genotype may not strongly influence the long-term clinical manifestations or poor prognosis in MMD.


Assuntos
Adenosina Trifosfatases/genética , Infarto Encefálico/genética , Hemorragia Cerebral/genética , Variação Genética , Ataque Isquêmico Transitório/genética , Doença de Moyamoya/genética , Ubiquitina-Proteína Ligases/genética , Adolescente , Adulto , Infarto Encefálico/diagnóstico , Infarto Encefálico/cirurgia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/cirurgia , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/genética , Hemorragia Cerebral Intraventricular/cirurgia , Revascularização Cerebral , Criança , Pré-Escolar , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Lactente , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/cirurgia , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico , Doença de Moyamoya/terapia , Fenótipo , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tóquio , Adulto Jovem
3.
J Korean Med Sci ; 34(5): e40, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30718992

RESUMO

Background: This study was performed to determine survival and morbidity rates in very low birth weight infants (VLBWIs) in the Korean Neonatal Network (KNN), and to compare neonatal outcomes with those in other countries. Methods: Data were collected for 8,269 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. Results: The survival rate of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 86% (total), 33%, 65%, 84%, 94%, 97%, and 98%, respectively. The bronchopulmonary dysplasia (BPD) rates of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 30% (total), 88%, 64%, 47%, 26%, 14%, and 5%, respectively. The intraventricular hemorrhage rates (≥ grade III) of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 10% (total), 45%, 27%, 12%, 5%, 2%, and 1%, respectively. In an international comparison, the survival rate of VLBWIs with GA 24-27 weeks in KNN was lower, and the BPD rate of VLBWIs in the KNN was higher than that of the neonatal networks of other countries. Conclusion: Despite overall improvements in neonatal outcomes, the survival and morbidity rates of more immature infants with GA 22-27 weeks need further improvement. Therefore, it would be necessary to develop more optimal treatment strategies and perform more active quality improvement to further improve neonatal outcomes of VLBWIs in Korea.


Assuntos
Displasia Broncopulmonar/diagnóstico , Hemorragia Cerebral Intraventricular/diagnóstico , Recém-Nascido de muito Baixo Peso , Adulto , Displasia Broncopulmonar/mortalidade , Hemorragia Cerebral Intraventricular/mortalidade , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , República da Coreia , Taxa de Sobrevida
4.
J Neonatal Perinatal Med ; 12(1): 103-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30530977

RESUMO

A 710 g male infant was born at a referring hospital at a gestational age of 23 weeks and 2 days via vaginal delivery and was transferred to our facility at 14 days of age. His delivery was complicated by the breech presentation with difficult head extraction. The infant's initial course was significant for respiratory distress syndrome, grade III-IV intraventricular hemorrhage (IVH), acute kidney injury, and large PDA. On the day of life 29, a gradual increase in serum sodium level refractory to increasing total fluid volume was noted. The combination of persistent hypernatremia (150-160 mmol/l), polyuria (8.4 ml/kg/hr), high plasma osmolality (323 mosm/kg), hyposthenuria (75 mosm/kg) and an undetectable serum ADH (<0.8 pg/ml) confirmed the diagnosis of central diabetes insipidus (CDI). Serum sodium and urine output decreased and urine osmolality increased after subcutaneous DDAVP administration.CDI is an uncommon cause of hypernatremia in the neonatal period. The diagnosis can be difficult as excessive urine output and high serum sodium can often be attributed to high insensible water loss in the extremely premature newborn. CDI in our patient was thought to be due to grade III-IV IVH complicated by post-hemorrhagic hydrocephalus.In conclusion, the diagnosis of central DI should be considered as a complication of severe IVH in the extremely premature neonate who demonstrates persistent hypernatremia, polyuria, decreased urine osmolality, and increased plasma osmolality. Serum ADH levels can be helpful in confirming the central origin of DI and subcutaneous desmopressin can be an effective treatment in the preterm infant.


Assuntos
Hemorragia Cerebral Intraventricular/complicações , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido Neurogênico/etiologia , Hemostáticos/uso terapêutico , Lactente Extremamente Prematuro , Recém-Nascido de muito Baixo Peso , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/tratamento farmacológico , Hemorragia Cerebral Intraventricular/fisiopatologia , Diabetes Insípido Neurogênico/tratamento farmacológico , Diabetes Insípido Neurogênico/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Resultado do Tratamento
5.
Neonatal Netw ; 37(5): 310-318, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30567813

RESUMO

PURPOSE: This study examined the neurobehavioral functioning in preterm infants diagnosed with intraventricular hemorrhage (IVH) grades III and IV, using the Assessment of Preterm Infants' Behavior (APIB). DESIGN AND SAMPLE: The APIB was completed on nine infants with IVH III/IV at 36 and 40weeks postmenstrual age to determine the effects of IVH on the neurobehavioral functioning and maturation over time. The APIB neurobehavioral scores (i.e., physiologic, motor, state, attention/interaction, regulatory, and examiner facilitation subsystem scores) were examined in relation to the two different testing times and to infants without lesion. RESULTS: APIB scores at 36weeks suggested easily disorganized and poorly modulated behavioral regulation and low threshold of disorganization and stress. At 40 weeks, poor overall behavioral regulation persisted; only motor differences statistically improved between the two ages. Neurobehavior was significantly poor in all but state subsystems when tested at both ages in infants with a brain lesion.


Assuntos
Hemorragia Cerebral Intraventricular/complicações , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/terapia , Comportamento do Lactente/fisiologia , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Feminino , Humanos , Illinois , Lactente , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/terapia , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/terapia , Masculino
7.
Z Geburtshilfe Neonatol ; 222(6): 245-253, 2018 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-30267395

RESUMO

BACKGROUND: In a project to carefully observe and minimize risk factors of intraventricular hemorrhages (IVH) in preterm infants, the incidence decreased markedly at the perinatal Center in Ulm, Germany. By comparing its data with the perinatal center in Leipzig, Germany, we sought to identify what improvements could still be made. METHODS: A retrospective survey was performed, including 189 infants from Leipzig and 89 from Ulm, all of whom weighed less than 1000 grams. A comparison between both perinatal centers was made. RESULTS: IVH was more frequently detected in Leipzig (28.4%) than in Ulm (14.6%, p=0.011), yet only the incidence of mild IVH (grade 1-2) was affected since the incidence of severe IVH did not differ between the 2 centers (p=0.59, Leipzig 6.1%, Ulm 4.5%). Furthermore, several potentially avoidable risk factors of IVH were differentially distributed between the 2 centers. For example, postnatal hypocapnia and postnatal hypothermia occurred with higher frequency in Leipzig than in Ulm. Conversely, rapid postnatal application of surfactant was the rule in Leipzig but not in Ulm. Furthermore, sodium bicarbonate application occurred more frequently in Ulm. CONCLUSION: Both centers avoided certain risk factors for IVH with varying success. These results allow both centers to specifically target the risk factors that occurred with greater frequency to further reduce the incidence of IVH.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Hemorragia Cerebral Intraventricular/prevenção & controle , Doenças do Prematuro/prevenção & controle , Recém-Nascido de muito Baixo Peso , Assistência Perinatal , Centros de Assistência à Gravidez e ao Parto/normas , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/epidemiologia , Hemorragia Cerebral Intraventricular/etiologia , Estudos Transversais , Alemanha , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Assistência Perinatal/normas , Melhoria de Qualidade/normas , Estudos Retrospectivos , Fatores de Risco
8.
Pediatr Res ; 84(3): 403-410, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29967524

RESUMO

BACKGROUND: Extrauterine life is an important factor when considering brain maturation. Few studies have investigated the development of visual evoked potentials (VEP) in extremely preterm infants, and only a minority have taken into consideration the impact of extrauterine life. The aim of this study was to assess the normal maturation of VEP in infants born prior to 29 weeks gestational age (GA) and to explore the potential influence of extrauterine life. METHODS: VEP were prospectively recorded in extremely preterm infants, and principal peaks (N0, N1, P1, N2, P2, N3) were identified. The mean of peak-time and percentages of peak appearances were assessed for three GA groups (23/24, 25/26, 27/28 weeks) and four subgroups of increasing postnatal age (PNA), up to 8 weeks after birth. RESULTS: A total of 163 VEP recordings in 38 preterm infants were analyzed. With increasing GA at birth, peak-times decreased. When comparing infants with equal GA but longer extrauterine life, those with the highest PNA demonstrated the shortest VEP peak-times. However, this effect was less present in infants born prior to 25 weeks GA. CONCLUSION: Provided that a certain maturational threshold is reached, extrauterine life appears to accelerate maturation of the visual system in preterm infants.


Assuntos
Potenciais Evocados Visuais , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Visão Ocular/fisiologia , Encéfalo/diagnóstico por imagem , Hemorragia Cerebral Intraventricular/diagnóstico , Eletrofisiologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Leucomalácia Periventricular/diagnóstico , Modelos Lineares , Masculino , Rede Nervosa/crescimento & desenvolvimento , Parto , Estudos Prospectivos , Retinopatia da Prematuridade/diagnóstico , Transdução de Sinais , Córtex Visual/crescimento & desenvolvimento
9.
Thromb Haemost ; 118(7): 1185-1193, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29864780

RESUMO

INTRODUCTION: Bleeds such as intra-ventricular (IVH) and pulmonary haemorrhage (PH) are life-threatening events in extremely low birth weight (ELBW) infants. Serial coagulation monitoring by measuring the international normalized ratio (INR) with small volume samples might facilitate early diagnosis and possibly prevent major bleeds. MATERIALS AND METHODS: This was a prospective longitudinal study performed in ELBW infants, who received serial INR monitoring by point of care testing during their first 30 days of life. The primary objective was to explore whether INR monitoring could predict major bleeding events (IVH, PH). Secondary objectives were mortality and feasibility in this patient population. RESULTS: A total of 127 ELBW infants were stratified into a bleeding and a non-bleeding group. Bleeding events occurred in 31% (39/127) of the infants, whereupon 24% developed IVH and 9% PH. Infants in the bleeding group were 4 days younger at birth (p = 0.05) and had a substantially higher mortality rate of 26% versus 5% in controls (p = 0.005). Median INR during the first 3 days before a bleeding event was 1.55 (95% confidence interval [CI]: 1.39-1.74) compared with the control group with 1.45 (95% CI: 1.44-1.58; p = 0.81). Platelet counts were significantly lower in the bleeding group on the 3rd day and during the 2nd to 4th week of life. DISCUSSION: Serial coagulation monitoring by an INR point of care testing is feasible in ELBW infants but could not predict bleeding events. Further studies with daily monitoring of INR and platelet counts during the first days of life might be able to more precisely detect a risk of major haemorrhage in ELBW infants.


Assuntos
Peso ao Nascer , Coagulação Sanguínea , Hemorragia Cerebral Intraventricular/etiologia , Hemorragia/etiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer/sangue , Coeficiente Internacional Normatizado , Pneumopatias/etiologia , Testes Imediatos , Hemorragia Cerebral Intraventricular/sangue , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/mortalidade , Diagnóstico Precoce , Estudos de Viabilidade , Feminino , Idade Gestacional , Hemorragia/sangue , Hemorragia/diagnóstico , Hemorragia/mortalidade , Humanos , Lactente Extremamente Prematuro/sangue , Recém-Nascido , Estudos Longitudinais , Pneumopatias/sangue , Pneumopatias/diagnóstico , Pneumopatias/mortalidade , Masculino , Contagem de Plaquetas , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
10.
World Neurosurg ; 116: e550-e555, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29772359

RESUMO

BACKGROUND: Ventriculostomy-associated cerebrospinal fluid infection (VAI) is a major complication limiting the use of an external ventricular drain (EVD) in treating patients with intraventricular hemorrhage (IVH). Risk factors of VAI are still under wide discussion. METHODS: We performed a retrospective review of 84 patients with IVH who underwent EVD at our center between January 2012 and January 2017. Preoperative clinical parameters, surgeon status, number of catheters and catheter-days, subgaleal tunneling distance, frequency of urokinase flush, and prophylactic antibiotics were compared between the infective and noninfective groups. RESULTS: The overall rate of VAI was 31.0%. Univariate analysis showed a higher modified Graeb Score (mGS), higher proportion of bilateral catheters, and longer hospital stay in patients with VAI. Binary logistic analysis of all clinical factors identified high mGS (≥16) as an independent risk factor for VAI (odds ratio, 3.242; P = 0.026). Among operative and postoperative factors, the use of bilateral catheters significantly contributed to VAI (odds ratio, 4.211; P = 0.031), but a subgroup comparison showed an increased VAI rate only in the low mGS group (mGS <15). No VAI occurred in patients with a single EVD in the low mGS group. Catheter-days and multiple urokinase flushes were not related to VAI. CONCLUSIONS: Patients with a high mGS are vulnerable to VAI. Bilateral EVD may be an appropriate treatment option for patients with a high mGS, but might increase the risk of infection in those with a low mGS.


Assuntos
Hemorragia Cerebral Intraventricular/cirurgia , Ventrículos Cerebrais/microbiologia , Ventrículos Cerebrais/cirurgia , Drenagem/efeitos adversos , Infecção da Ferida Cirúrgica/líquido cefalorraquidiano , Ventriculostomia/efeitos adversos , Adulto , Biomarcadores/líquido cefalorraquidiano , Hemorragia Cerebral Intraventricular/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/diagnóstico
11.
An Pediatr (Barc) ; 89(6): 369-377, 2018 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-29622414

RESUMO

OBJECTIVE: To assess the effect of a protocolised intervention for low systemic blood flow (SBF) in the occurrence of severe intraventricular haemorrhage (IVH) or death in pre-term infants. METHODS: A study with a quasi-experimental design with retrospective controls was conducted on pre-term infants of less than 30weeks of gestational age, born between January 2016 and July 2017, who were consecutively included in the intervention period. The control cohort included pre-term infants (born between January 2013 and December 2015) matched by gestational age, birth weight, and gender (two controls for each case). The cases of low SBF diagnosed according to functional echocardiography during the study period received dobutamine (5-10µg/kg/min) for 48hours. RESULTS: The study included 29 cases (intervention period) and 54 controls (pre-intervention period). Ten out of 29 (34.5%) infants received dobutamine for low SBF during the intervention period, with 3/29 (10.3%) cases of severe IVH and/or death compared to 17/54 (31.5%) in the control cohort (p=.032). There was an independent association between the intervention and a decreased occurrence of severe IVH/death after adjusting for confounding factors both in the logistic regression model [OR 0.11 (95%CI: 0.01-0.65), p=.015], as well as in the sensitivity analysis using inverse probability of treatment weighting [OR 0.23 (95%CI: 0.09-0.56); p=.001]. CONCLUSIONS: In this study with retrospective controls, a protocolised screening, and treatment for low SBF was associated with a decreased occurrence of severe IVH or death in preterm infants. Large, adequately powered trials, are needed in order to determine whether postnatal interventions directed at low SBF can improve neurological outcomes.


Assuntos
Hemorragia Cerebral Intraventricular/prevenção & controle , Dobutamina/administração & dosagem , Triagem Neonatal/métodos , Morte Perinatal/prevenção & controle , Peso ao Nascer , Circulação Sanguínea/efeitos dos fármacos , Cardiotônicos/administração & dosagem , Estudos de Casos e Controles , Hemorragia Cerebral Intraventricular/diagnóstico , Estudos de Coortes , Ecocardiografia/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Masculino , Estudos Retrospectivos
12.
Arch Dis Child Fetal Neonatal Ed ; 103(1): F59-F65, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28588126

RESUMO

BACKGROUND AND PURPOSE: The anatomy of the deep venous system plays an important role in the pathogenesis of brain lesions in the preterm brain as shown by different histological studies. The aims of this study were to compare the subependymal vein anatomy of preterm neonates with germinal matrix haemorrhage-intraventricular haemorrhage (GMH-IVH), as evaluated by susceptibility-weighted imaging (SWI) venography, with a group of age-matched controls with normal brain MRI, and to explore the relationship between the anatomical features of subependymal veins and clinical risk factors for GMH-IVH. METHODS: SWI venographies of 48 neonates with GMH-IVH and 130 neonates with normal brain MRI were retrospectively evaluated. Subependymal vein anatomy was classified into six different patterns: type 1 represented the classic pattern and types 2-6 were considered anatomic variants. A quantitative analysis of the venous curvature index was performed. Variables were analysed by using Mann-Whitney U and χ2 tests, and a multiple logistic regression analysis was performed to evaluate the association between anatomical features, clinical factors and GMH-IVH. RESULTS: A significant difference was noticed among the six anatomical patterns according to the presence of GMH-IVH (χ2=14.242, p=0.014). Anatomic variants were observed with higher frequency in neonates with GMH-IVH than in controls (62.2% and 49.6%, respectively). Neonates with GMH-IVH presented a narrower curvature of the terminal portion of subependymal veins (p<0.05). These anatomical features were significantly associated with GMH-IVH (p<0.05). CONCLUSION: Preterm neonates with GMH-IVH show higher variability of subependymal veins anatomy confirming a potential role as predisposing factor for GMH-IVH.


Assuntos
Hemorragia Cerebral Intraventricular , Veias Cerebrais , Ventrículos Cerebrais , Recém-Nascido Prematuro/fisiologia , Análise de Variância , Anatomia Regional/métodos , Causalidade , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/etiologia , Veias Cerebrais/anatomia & histologia , Veias Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Neuroimagem Funcional/métodos , Humanos , Recém-Nascido , Angiografia por Ressonância Magnética/métodos , Masculino , Flebografia/métodos , Medição de Risco
13.
J Perinatol ; 37(8): 932-937, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28617424

RESUMO

OBJECTIVE: We examined data from a contemporary cohort of extreme prematurity (EP) infants admitted to an all-referral Children's Hospital neonatal intensive care unit (NICU) to determine whether prophylactic indomethacin (PI) may continue to benefit these patients. STUDY DESIGN: An observational study utilizing the small baby ICU data registry that was queried for all EP infants admitted between 2005 and 2014 with documentation of PI use (671 total EP infants; 141 (21%) did not receive PI (control); 530 (79%) received PI (PI). This cohort of EP infants was born at outside hospitals and transferred to our level IV NICU with a mean age on admission of 13 days, well after the PI would have been administered. RESULTS: No difference existed between the control and PI groups in gestational age, birth weight, severity of illness, other in-hospital outcomes or developmental delay. PI infants had a significantly lower mortality rate (P=0.0004), lower relative risk (RR) for mortality 0.52 (95% confidence interval (CI) 0.37 to 0.73, P=0.0001) and lower RR of developing the combined outcome of death or bronchopulmonary dysplasia (RR 0.91, 95% CI 0.85 to 0.98, P=0.012) when compared with the control group. Notably, there was no significant effect of PI on incidence of severe intraventricular hemorrhage or patent ductus arteriosus ligation. CONCLUSION: PI administration was associated with improved survival in EP infants referred to a level IV Children's Hospital NICU.


Assuntos
Displasia Broncopulmonar , Hemorragia Cerebral Intraventricular , Quimioprevenção , Permeabilidade do Canal Arterial , Indometacina/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Peso ao Nascer , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/prevenção & controle , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/prevenção & controle , Quimioprevenção/métodos , Quimioprevenção/mortalidade , Quimioprevenção/estatística & dados numéricos , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/prevenção & controle , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Resultado do Tratamento , Estados Unidos
14.
Pediatr Int ; 59(7): 759-763, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28453903

RESUMO

Cardiovascular instability in preterm infants during the early postnatal period correlates with the development of intraventricular hemorrhage (IVH). Due to the correlation between hypotension and fluctuation of blood pressure, treatment was targeted specifically at hypotension to prevent IVH, but this was not successful. Recently, several novel perfusion markers have been found to be correlated with the development of IVH, and they are of current interest in cardiovascular management. In this review, the correlation between IVH and conventional, as well as novel, perfusion markers is examined.


Assuntos
Hemorragia Cerebral Intraventricular/diagnóstico , Doenças do Prematuro/diagnóstico , Microcirculação , Fluxo Sanguíneo Regional , Biomarcadores/sangue , Encéfalo/irrigação sanguínea , Hemorragia Cerebral Intraventricular/fisiopatologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/fisiopatologia , Fluxometria por Laser-Doppler , Monitorização Fisiológica , Oximetria , Espectroscopia de Luz Próxima ao Infravermelho , Ultrassonografia
15.
J Perinatol ; 37(8): 963-968, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28300820

RESUMO

OBJECTIVE: The objectives of this study were to (1) establish the proportion of cerebral palsy (CP) that occurs with a history suggestive of birth asphyxia in children born at 32 to 35 weeks and (2) evaluate their characteristics in comparison with children with CP born at ⩾36 weeks with such a history. STUDY DESIGN: Using the Canadian CP Registry, children born at 32 to 35 weeks of gestation with CP with a history suggestive of birth asphyxia were compared with corresponding ⩾36 weeks of gestation children. RESULTS: Of the 163 children with CP born at 32 to 35 weeks and 738 born at ⩾36 weeks, 26 (16%) and 105 (14%) had a history suggestive of birth asphyxia, respectively. The children born at 32 to 35 weeks had more frequent abruptio placenta (35% vs 12%; odds ratio (OR) 4.1, 95% confidence interval (CI) 1.5 to 11.2), less frequent neonatal seizures (35% vs 72%; OR 0.20, 95% CI 0.08 to 0.52), more frequent white matter injury (47% vs 17%; OR 4.3, 95% CI 1.3 to 14.0), more frequent intraventricular hemorrhage (IVH) (40% vs 6%; OR 11.2, 95% CI 3.4 to 37.4) and more frequent spastic diplegia (24% vs 8%; OR 1.8, 95% CI 1.2 to 12.2) than the corresponding ⩾36 weeks of gestation children. CONCLUSIONS: Approximately 1 in 7 children with CP born at 32 to 35 weeks had a history suggestive of birth asphyxia. They had different magnetic resonance imaging patterns of injury from those born at ⩾36 weeks and a higher frequency of IVH. Importantly, when considering hypothermia in preterm neonates with suspected birth asphyxia, prospective surveillance for IVH will be essential.


Assuntos
Asfixia Neonatal , Hemorragia Cerebral Intraventricular , Paralisia Cerebral , Asfixia Neonatal/diagnóstico , Asfixia Neonatal/epidemiologia , Canadá/epidemiologia , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/epidemiologia , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Imagem por Ressonância Magnética/métodos , Masculino , Gravidez , Nascimento Prematuro , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Estatística como Assunto
16.
Sci Rep ; 7: 42541, 2017 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-28211916

RESUMO

In the pathogenesis of neonatal intraventricular hemorrhage (IVH) in preterm infants, an important role is played by changes in venous and arterial cerebral flows. It has been shown that the ability of autoregulation of cerebral flows in response to variations in arterial blood pressure in preterm infants is impaired. This impaired autoregulation causes an increased risk of germinal matrix rupture and IVH occurrence. We examined three polymorphisms of genes, related to regulation of blood flow, for an association with IVH in 100 preterm infants born from singleton pregnancy, before 32 + 0 weeks of gestation, exposed to antenatal steroids therapy, and without congenital abnormalities. These polymorphisms include: eNOS (894G > T and -786T > C) and EDN1 (5665G > T ) gene. We found that infants with genotype GT eNOS 894G > T have 3.4-fold higher risk developing of IVH born before 28 + 6 weeks of gestation. Our investigation did not confirm any significant prevalence for IVH development according to eNOS -786T > C genes polymorphism. Our novel investigations in EDN1 5665G > T polymorphism did not show any link between alleles or genotypes and IVH. Future investigations of polymorphisms in blood-flow associated genes may provide valuable insight into the pathogenetic mechanisms underlying the development of IVH.


Assuntos
Hemorragia Cerebral Intraventricular/genética , Endotelina-1/genética , Predisposição Genética para Doença , Recém-Nascido Prematuro , Óxido Nítrico Sintase Tipo III/genética , Polimorfismo Genético , Alelos , Índice de Apgar , Peso ao Nascer , Pressão Sanguínea , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/terapia , Endotelina-1/metabolismo , Feminino , Estudos de Associação Genética , Genótipo , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Óxido Nítrico Sintase Tipo III/metabolismo , Razão de Chances , Índice de Gravidade de Doença
17.
J Matern Fetal Neonatal Med ; 30(15): 1847-1850, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27550623

RESUMO

BACKGROUND: Intraventricular hemorrhage (IVH) is an important cause of death in premature infants. This study aimed to assess the association of the umbilical cord plasma levels of interleukin-6 (IL-6) and erythropoietin (EPO) with the occurrence and severity of IVH in premature infants. METHODS: Fifty premature newborns of mothers with chorioamnionitis risk factor were selected via nonprobability sampling. The concentration of the cord plasma's IL-6 and erythropoietin were measured by enzyme-linked immunosorbent assay (ELISA) for 3 days. Finally, all samples underwent sonography for the diagnosis of IVH. Results analyzed statistically. RESULTS: Among the samples, 68.98% of them were diagnosed with IVH grade 1. The most severe IVH cases were detected on the second day. The mean and standard deviation of IL-6 level was 74.71 ± 50.53 in the case group and 24.10 ± 46.10 in the control group. There was a correlation between IL-6 levels and IVH (p = 0.0005). The mean and standard deviation of EPO level was 18.38 ± 15.23 in the IVH group and 6.45 ± 13.48 in samples without IVH. A correlation was detected between EPO level and IVH (p = 0.005). CONCLUSION: The concentration of IL-6 and EPO levels of the cord plasma was higher in the premature newborns with IVH.


Assuntos
Hemorragia Cerebral Intraventricular/sangue , Eritropoetina/sangue , Sangue Fetal/química , Doenças do Prematuro/sangue , Recém-Nascido Prematuro , Interleucina-6/sangue , Biomarcadores/sangue , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/epidemiologia , Corioamnionite/epidemiologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Recém-Nascido , Irã (Geográfico) , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Ultrassonografia , Cordão Umbilical
18.
Neurocrit Care ; 27(1): 75-81, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28028788

RESUMO

BACKGROUND: Providing the correct level of care for patients with intracerebral hemorrhage (ICH) is crucial, but the level of care needed at initial presentation may not be clear. This study evaluated factors associated with admission to intensive care unit (ICU) level of care. METHODS: This is an observational study of all adult patients admitted to our institution with non-traumatic supratentorial ICH presenting within 72 h of symptom onset between 2009-2012 (derivation cohort) and 2005-2008 (validation cohort). Factors associated with neuroscience ICU admission were identified via logistic regression analysis, from which a triage model was derived, refined, and retrospectively validated. RESULTS: For the derivation cohort, 229 patients were included, of whom 70 patients (31 %) required ICU care. Predictors of neuroscience ICU admission were: younger age [odds ratio (OR) 0.94, 95 % CI 0.91-0.97; p = 0.0004], lower Full Outline of UnResponsiveness (FOUR) score (0.39, 0.28-0.54; p < 0.0001) or Glasgow Coma Scale (GCS) score (0.55, 0.45-0.67; p < 0.0001), and larger ICH volume (1.04, 1.03-1.06; p < 0.0001). The model was further refined with clinician input and the addition of intraventricular hemorrhage (IVH). GCS was chosen for the model rather than the FOUR score as it is more widely used. The proposed triage ICH model utilizes three variables: ICH volume ≥30 cc, GCS score <13, and IVH. The triage ICH model predicted the need for ICU admission with a sensitivity of 94.3 % in the derivation cohort [area under the curve (AUC) = 0.88; p < 0.001] and 97.8 % (AUC = 0.88) in the validation cohort. CONCLUSIONS: Presented are the derivation, refinement, and validation of the triage ICH model. This model requires prospective validation, but may be a useful tool to aid clinicians in determining the appropriate level of care at the time of initial presentation for a patient with a supratentorial ICH.


Assuntos
Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/terapia , Escala de Resultado de Glasgow , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Triagem/métodos , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Neurológicos , Estudos Retrospectivos , Triagem/normas
19.
J Perinatol ; 36(5): 352-6, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27010109

RESUMO

OBJECTIVE: To determine the association between antenatal steroids administration and intraventricular hemorrhage rates. METHODS: We used cross-sectional data from the California Perinatal Quality Care Collaborative during 2007 to 2013 for infants ⩽32 weeks gestational age. Using multivariable logistic regression, we evaluated the effect of antenatal steroids on intraventricular hemorrhage, stratified by gestational age. RESULTS: In 25 979 very-low-birth weight infants, antenatal steroid use was associated with a reduction in incidence of any grade of intraventricular hemorrhage (odds ratio=0.68, 95% confidence interval: 0.62, 0.75) and a reduction in incidence of severe intraventricular hemorrhage (odds ratio=0.51, 95% confidence interval: 0.45, 0.58). This association was seen across gestational ages ranging from 22 to 29 weeks. CONCLUSIONS: Although current guidelines recommend coverage for preterm birth at 24 to 34 weeks gestation, our results suggest that treatment with antenatal steroids may be beneficial even before 24 weeks of gestational age.


Assuntos
Hemorragia Cerebral Intraventricular , Glucocorticoides/uso terapêutico , Doenças do Prematuro , Recém-Nascido de muito Baixo Peso/fisiologia , Cuidado Pré-Natal/métodos , California/epidemiologia , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/prevenção & controle , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/prevenção & controle , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/fisiopatologia , Prognóstico , Qualidade da Assistência à Saúde , Índice de Gravidade de Doença
20.
J Perinatol ; 36(6): 453-8, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26890555

RESUMO

OBJECTIVE: To identify factors associated with responsiveness to dopamine therapy for hypotension and the relationship to brain injury in a cohort of preterm infants. STUDY DESIGN: The pharmacy database at St Louis Children's Hospital was retrospectively queried to identify infants who (a) were born <28 weeks gestation between 2012 and 2014, (b) received dopamine and (c) had blood pressure measurements from an umbilical arterial catheter. A control group was constructed from contemporaneous infants who did not receive dopamine. Mean arterial blood pressure (MABP) at baseline, 1 h and 3 h after initiating dopamine were obtained for each dopamine-exposed infant. MABP measurements at matched time points were obtained in the control group. RESULT: Sixty-nine dopamine-treated and 45 control infants were included. Mean ΔMABP at 3 h was 4.5±6.3 mm of Hg for treated infants vs 1±2.9 for the control. Median dopamine starting dose was 2.5 µg kg(-1) min(-1). Dopamine-treated infants were less mature and of lower birth weight while also more likely to be intubated at 72 h, diagnosed with intraventricular hemorrhage (IVH) and to die. Failure to respond to dopamine was associated with greater likelihood of developing IVH (odds ratio (OR) 5.8, 95% confidence interval (CI) 1.1-42.3), while a strong response (ΔMABP>10 mm Hg) was associated with a reduction in risk of IVH (OR 0.1, 95% CI 0.01-0.8). CONCLUSION: Low-moderate dose dopamine administration results in modest blood pressure improvements. A lack of response to dopamine is associated with a greater risk of IVH, whereas a strong response is associated with a decreased risk. Further research into underlying mechanisms and management strategies is needed.


Assuntos
Dopamina , Hipotensão , Doenças do Prematuro , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial/métodos , Cardiotônicos/administração & dosagem , Cardiotônicos/efeitos adversos , Hemorragia Cerebral Intraventricular/complicações , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/mortalidade , Dopamina/administração & dosagem , Dopamina/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Hipotensão/complicações , Hipotensão/diagnóstico , Hipotensão/tratamento farmacológico , Hipotensão/mortalidade , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/tratamento farmacológico , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia
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