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1.
Medicine (Baltimore) ; 99(4): e18986, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977915

RESUMO

RATIONALE: Anesthetic management of pregnant women with Fontan circulation remains challenging. There are few reports that describe the anesthetic management of cesarean section after Fontan surgery. Here, we present a case of successful epidural anesthesia in a woman with Fontan circulation who required emergency cesarean section. PATIENT CONCERNS: A 29-year-old woman at gestational week 28 was scheduled for emergency cesarean section because of fetal distress. Her past medical history was significant for congenital transposition of the great arteries that had been treated by Fontan surgery 26 years earlier. Her postoperative course had been uneventful and she had reached a near normal level of activity with no arrhythmias or thrombotic complications. On presentation, her oxygen saturation was approximately 84% and she had digital clubbing. Arterial blood gas analysis showed a PCO2 of 35 mmHg, PO2 of 55.5 mmHg, and hemoglobin of 16.3 g/dL. Her blood coagulation parameters were within normal limits except for a high fibrinogen concentration (4.55 g/L). DIAGNOSIS: The diagnosis was pregnancy requiring emergency cesarean section because of fetal distress. INTERVENTIONS: Before anesthesia, a radial artery line was established for continuous measurement of blood pressure. An air pressure pump was placed on the patient's lower limbs and a low-dose dobutamine infusion was started. Next, epidural anesthesia was successfully performed at L2-3. Five milliliters of 2% lidocaine followed by 10 mL of 0.75% ropivacaine were injected. Dobutamine was infused to maintain a target blood pressure of 100-120/60-70 mmHg. OUTCOMES: The procedure was uneventful with the patient maintaining a stable heart rate of 80 to 90 beats/min and an oxygen saturation of 90% to 94%. A male infant weighing 840 g was delivered. The Apgar score was 9 at 1 and 5 minutes. The patient was transferred to the intensive care unit for 20 hours of monitoring and discharged 9 days later. The neonate was discharged after 2 months of specialist neonatal treatment. LESSONS: Epidural anesthesia may be used in women with Fontan circulation undergoing emergency cesarean section. Knowledge of the physiology of the heart lesion and that of pregnancy are critical to the outcome.


Assuntos
Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Técnica de Fontan/efeitos adversos , Adulto , Cesárea/métodos , Feminino , Sofrimento Fetal , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/terapia
2.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945037

RESUMO

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Assuntos
Anormalidades Congênitas/mortalidade , Mortalidade Infantil/tendências , Afro-Americanos/estatística & dados numéricos , Anormalidades Congênitas/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Recém-Nascido , Criança Pós-Termo , Recém-Nascido Prematuro , Masculino , Estados Unidos/epidemiologia
3.
N Engl J Med ; 382(3): 233-243, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-31940698

RESUMO

BACKGROUND: High-dose erythropoietin has been shown to have a neuroprotective effect in preclinical models of neonatal brain injury, and phase 2 trials have suggested possible efficacy; however, the benefits and safety of this therapy in extremely preterm infants have not been established. METHODS: In this multicenter, randomized, double-blind trial of high-dose erythropoietin, we assigned 941 infants who were born at 24 weeks 0 days to 27 weeks 6 days of gestation to receive erythropoietin or placebo within 24 hours after birth. Erythropoietin was administered intravenously at a dose of 1000 U per kilogram of body weight every 48 hours for a total of six doses, followed by a maintenance dose of 400 U per kilogram three times per week by subcutaneous injection through 32 completed weeks of postmenstrual age. Placebo was administered as intravenous saline followed by sham injections. The primary outcome was death or severe neurodevelopmental impairment at 22 to 26 months of postmenstrual age. Severe neurodevelopmental impairment was defined as severe cerebral palsy or a composite motor or composite cognitive score of less than 70 (which corresponds to 2 SD below the mean, with higher scores indicating better performance) on the Bayley Scales of Infant and Toddler Development, third edition. RESULTS: A total of 741 infants were included in the per-protocol efficacy analysis: 376 received erythropoietin and 365 received placebo. There was no significant difference between the erythropoietin group and the placebo group in the incidence of death or severe neurodevelopmental impairment at 2 years of age (97 children [26%] vs. 94 children [26%]; relative risk, 1.03; 95% confidence interval, 0.81 to 1.32; P = 0.80). There were no significant differences between the groups in the rates of retinopathy of prematurity, intracranial hemorrhage, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, or death or in the frequency of serious adverse events. CONCLUSIONS: High-dose erythropoietin treatment administered to extremely preterm infants from 24 hours after birth through 32 weeks of postmenstrual age did not result in a lower risk of severe neurodevelopmental impairment or death at 2 years of age. (Funded by the National Institute of Neurological Disorders and Stroke; PENUT ClinicalTrials.gov number, NCT01378273.).


Assuntos
Eritropoetina/administração & dosagem , Lactente Extremamente Prematuro , Doenças do Prematuro/prevenção & controle , Transtornos do Neurodesenvolvimento/prevenção & controle , Encéfalo/diagnóstico por imagem , Pré-Escolar , Método Duplo-Cego , Eritropoetina/efeitos adversos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Ultrassonografia
5.
Acta Odontol Scand ; 78(1): 52-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31401921

RESUMO

Objective: To compare the prevalence of malocclusions in the primary and early mixed dentition of very preterm and full-term children.Material and methods: Study subjects consisted of 205 very preterm (90 girls and 115 boys), and 205 age- and gender-matched full-term children. Data were collected from the register of Turku University Hospital (children born before the 37th week of pregnancy with a birth weight of less than 1500 g, and all infants born before the 32nd week of pregnancy) and from public health centre dental registers.Results: In primary dentition, case children had a higher odds of dental crowding (OR = 2.94, 95% CI 1.17-7.35, p = .021), a tendency toward increased overbite (OR = 1.55, 95% CI 0.93-2.59, p = .096), and a lower odds of increased overjet (OR = 0.19, 95% CI 0.07-0.57, p = .003) compared to control children. In early mixed dentition, there were no statistically significant differences in occlusal traits; however, case children were significantly more likely to have received orthodontic treatment (OR = 2.80, 95% CI 1.50-5.23, p = .001) compared to controls.Conclusions: The results indicate that in primary dentition, the prevalence of malocclusion varies between very preterm and full-term children. In early mixed dentition, the distribution of occlusal traits is more similar.


Assuntos
Dentição Mista , Sucção de Dedo , Lactente Extremamente Prematuro , Má Oclusão/epidemiologia , Dente Decíduo , Estudos de Casos e Controles , Criança , Feminino , Finlândia/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Má Oclusão de Angle Classe II , Mordida Aberta/epidemiologia , Sobremordida/epidemiologia , Prevalência
6.
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
7.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 33-40, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31079068

RESUMO

OBJECTIVE: To compare the risk of mortality and morbidity between outborn and propensity score-matched inborn extremely preterm neonates. SETTING: Multiple neonatal intensive care units (NICU) across the USA. PATIENTS: Singleton neonates born at 22-29 weeks' gestation with no major anomalies who were admitted to a NICU and discharged between 2000 and 2014. Outborn neonates were restricted to those who transferred into a NICU on the day of birth. METHODS: The association between inborn-outborn status and the time-to-event outcomes of in-hospital mortality and necrotising enterocolitis (NEC) were assessed using Cox proportional hazards regression. Logistic regression was used to assess the remaining secondary outcomes: retinopathy of prematurity requiring treatment (tROP), chronic lung disease (CLD), periventricular leucomalacia (PVL) and severe intraventricular haemorrhage (IVH). Since outborn status was not random, we used 1:1 propensity score matching to reduce the imbalance in illness severity. RESULTS: There were 59 942 neonates (7991 outborn) included in the study. Outborn neonates had poorer survival than inborns and higher rates of NEC, severe IVH, tROP and PVL. Inborn-outborn disparities in mortality were reduced over the study period. When analysing the matched cohort (6524 matched pairs), outborns were less likely to die in-hospital compared with inborns (HR 0.84, 95% CI 0.77 to 0.91). However, outborns experienced higher rates of NEC (HR 1.14, 95% CI 1.04 to 1.25), severe IVH (OR 1.52, 95% CI 1.38 to 1.68), tROP (OR 1.45, 95% CI 1.25 to 1.69) and CLD (OR 1.12, 95% CI 1.01 to 1.24). CONCLUSION: Additional research is needed to understand the contributors to increased morbidity for outborn extremely preterm neonates and identify interventions that mitigate this risk.


Assuntos
Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Hemorragia Cerebral Intraventricular/epidemiologia , Conjuntos de Dados como Assunto , Enterocolite Necrosante/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Recém-Nascido , Leucomalácia Periventricular/epidemiologia , Lesão Pulmonar/epidemiologia , Masculino , Análise por Pareamento , Transferência de Pacientes , Retinopatia da Prematuridade/epidemiologia , Estados Unidos/epidemiologia
8.
Zhonghua Er Ke Za Zhi ; 57(12): 934-942, 2019 Dec 02.
Artigo em Chinês | MEDLINE | ID: mdl-31795560

RESUMO

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


Assuntos
Displasia Broncopulmonar/epidemiologia , Enterocolite Necrosante/epidemiologia , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Retinopatia da Prematuridade/epidemiologia , China , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Fatores de Risco
9.
Medicine (Baltimore) ; 98(50): e18368, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852143

RESUMO

This study evaluated the accuracy of intracavitary electrocardiogram (IC-ECG) guidance for placement of peripherally inserted central catheters (PICCs) in premature infants, relative to chest X-ray.Premature infants (n = 173) underwent placement of a PICC monitored by ECG, and a stable heart rhythm was shown. Changes in the P wave of the ECG reflected the position of the catheter tip, and a characterized P wave indicated the correct position. The P wave results were compared with a chest X-ray.P wave changes were observed in 157 (90.75%) of the premature infants on the ECG. Among them, the catheter tips of 148 (85.55%) and nine (5.20%) patients were in the correct and non-correct position, respectively, which was confirmed by chest X-ray. No characteristic P wave changes were observed in 16 (9.32%) patients on ECG, in which the catheter tips of eight (4.62%) patients each were in the correct and non-correct position, according to the chest X-ray. The accuracy of IC-ECG guidance for placement of the PICC was 90.17%. The PICC tip location results of the IC-ECGs were statistically similar to that of the chest X-rays.IC-ECG guidance is accurate for placement of PICC in premature infants, and provides an economical assessment without radiation.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Radiografia Torácica
11.
JAMA ; 322(16): 1580-1588, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31638681

RESUMO

Importance: Preterm birth has been associated with cardiometabolic, respiratory, and neuropsychiatric disorders in adulthood. However, the prevalence of survival without any major comorbidities is unknown. Objective: To determine the prevalence of survival without major comorbidities in adulthood among persons born preterm vs full-term. Design, Setting, and Participants: National cohort study of all 2 566 699 persons born in Sweden from January 1, 1973, through December 31, 1997, who had gestational age data and who were followed up for survival and comorbidities through December 31, 2015 (ages 18-43 years). Exposures: Gestational age at birth. Main Outcomes and Measures: Survival without major comorbidities among persons born extremely preterm (22-27 weeks), very preterm (28-33 weeks), late preterm (34-36 weeks), or early term (37-38 weeks), compared with full-term (39-41 weeks). Comorbidities were defined using the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) Comorbidity Index, which includes conditions that commonly manifest in adolescence or young adulthood, including neuropsychiatric disorders; and the Charlson Comorbidity Index (CCI), which includes major chronic disorders predictive of mortality in adulthood. Poisson regression was used to determine prevalence ratios and differences, adjusted for potential confounders. Results: In this study population, 48.6% were female, 5.8% were born preterm, and the median age at end of follow-up was 29.8 years (interquartile range, 12.6 years). Of all persons born preterm, 54.6% were alive with no AYA HOPE comorbidities at the end of follow-up. Further stratified, this prevalence was 22.3% for those born extremely preterm, 48.5% for very preterm, 58.0% for late preterm, 61.2% for early term, and 63.0% for full-term. These prevalences were significantly lower for earlier gestational ages vs full-term (eg, adjusted prevalence ratios: extremely preterm, 0.35 [95% CI, 0.33 to 0.36; P < .001]; all preterm, 0.86 [95% CI, 0.85 to 0.86; P < .001]; adjusted prevalence differences: extremely preterm, -0.41 [95% CI, -0.42 to -0.40; P < .001]; all preterm, -0.09 [95% CI, -0.09 to -0.09; P < .001]). Using the CCI, the corresponding prevalences were 73.1% (all preterm), 32.5% (extremely preterm), 66.4% (very preterm), 77.1% (late preterm), 80.4% (early term), and 81.8% (full-term) (adjusted prevalence ratios: extremely preterm, 0.39 [95% CI, 0.38 to 0.41; P < .001]; all preterm, 0.89 [95% CI, 0.89 to 0.89; P < .001]; adjusted prevalence differences: extremely preterm, -0.50 [95% CI, -0.51 to -0.49; P < .001]; all preterm, -0.09 [95% CI, -0.09 to -0.09; P < .001]). Conclusions and Relevance: Among persons born preterm in Sweden between 1973 and 1997, the majority survived to early to mid-adulthood without major comorbidities. However, outcomes were worse for those born extremely preterm.


Assuntos
Comorbidade , Recém-Nascido Prematuro , Adolescente , Adulto , Estudos de Coortes , Epidemiologia , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Masculino , Distribuição de Poisson , Prevalência , Sistema de Registros , Suécia/epidemiologia , Adulto Jovem
12.
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
14.
Lakartidningen ; 1162019 Oct 07.
Artigo em Sueco | MEDLINE | ID: mdl-31593283

RESUMO

Advances in perinatal intensive care have resulted in increased survival of the most immature preterm infants (born before 28 gestational weeks) and these new survivors are now entering school. While the clear majority of all children born preterm have a normal development, the extremely preterm infant is at a considerable risk for long term disabilities and rates of adverse development increase at lower gestational ages. Lung function is commonly affected in children born extremely preterm, and many have treatment for obstructive symptoms. The incidences of major neuromotor impairments, i.e. cerebral palsy, are low, but there is an increasing awareness of common cognitive and neuropsychiatric problems in extremely preterm children and their special needs in school. Extremely preterm children therefore need follow up of lung function and neurodevelopment at least until school start.


Assuntos
Nascimento Prematuro , Assistência ao Convalescente/organização & administração , Transtorno do Espectro Autista/epidemiologia , Criança , Desenvolvimento Infantil , Pré-Escolar , Feminino , Humanos , Hipertensão/epidemiologia , Lactente , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Pneumopatias/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Fatores de Risco , Tempo
15.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593285

RESUMO

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


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Nascimento Prematuro , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/prevenção & controle , Serviços Centralizados no Hospital , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/prevenção & controle , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/prevenção & controle , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/prevenção & controle , Assistência Perinatal/organização & administração , Gravidez , Nascimento Prematuro/mortalidade , Retinopatia da Prematuridade/sangue , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/prevenção & controle , Taxa de Sobrevida , Suécia/epidemiologia
16.
Cochrane Database Syst Rev ; 9: CD013201, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31549743

RESUMO

BACKGROUND: Germinal matrix-intraventricular haemorrhage (GMH-IVH) remains a substantial issue in neonatal intensive care units worldwide. Current therapies to prevent or treat GMH-IVH are limited. Stem cell-based therapies offer a potential therapeutic approach to repair, restore, and/or regenerate injured brain tissue. These preclinical findings have now culminated in ongoing human neonatal studies. OBJECTIVES: To determine the benefits and harms of stem cell-based interventions for prevention or treatment of germinal matrix-intraventricular haemorrhage (GM-IVH) in preterm infants. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1), in the Cochrane Library; MEDLINE via PubMed (1966 to 7 January 2019); Embase (1980 to 7 January 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 7 January 2019). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: We attempted to identify randomised controlled trials, quasi-randomised controlled trials, and cluster trials comparing (1) stem cell-based interventions versus control; (2) mesenchymal stromal cells (MSCs) of type or source versus MSCs of other type or source; (3) stem cell-based interventions other than MSCs of type or source versus stem cell-based interventions other than MSCs of other type or source; or (4) MSCs versus stem cell-based interventions other than MSCs. For prevention studies, we included extremely preterm infants (less than 28 weeks' gestation), 24 hours of age or less, without ultrasound diagnosis of GM-IVH; for treatment studies, we included preterm infants (less than 37 weeks' gestation), of any postnatal age, with ultrasound diagnosis of GM-IVH. DATA COLLECTION AND ANALYSIS: For each of the included trials, two review authors independently planned to extract data (e.g. number of participants, birth weight, gestational age, type and source of MSCs, other stem cell-based interventions) and assess the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). Primary outcomes considered in this review are all-cause neonatal mortality, major neurodevelopmental disability, GM-IVH, and extension of pre-existing non-severe GM-IVH. We planned to use the GRADE approach to assess the quality of evidence. MAIN RESULTS: Our search strategy yielded 769 references. We did not find any completed studies for inclusion. One randomised controlled trial is currently registered and ongoing. Five phase 1 trials are described in the excluded studies. AUTHORS' CONCLUSIONS: Currently no evidence is available to show the benefits or harms of stem cell-based interventions for treatment or prevention of GM-IVH in preterm infants.


Assuntos
Hemorragia Cerebral/prevenção & controle , Circulação Cerebrovascular/fisiologia , Mortalidade Infantil , Lactente Extremamente Prematuro , Doenças do Prematuro/prevenção & controle , Células-Tronco , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Prematuro/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Arch Dis Child Fetal Neonatal Ed ; 104(6): F598-F603, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31498775

RESUMO

BACKGROUND: Fentanyl is frequently used off-label in preterm newborns. Due to very limited pharmacokinetic and pharmacodynamic data, fentanyl dosing is mostly based on bodyweight. This study describes the maturation of the pharmacokinetics in preterm neonates born before 32 weeks of gestation. METHODS: 442 plasma samples from 98 preterm neonates (median gestational age: 26.9 (range 23.9-31.9) weeks, postnatal age: 3 (range 0-68) days, bodyweight 1.00 (range 0.39-2.37) kg) were collected in an opportunistic trial and fentanyl plasma levels were determined. NONMEM V.7.3 was used to develop a population pharmacokinetic model and to perform simulations. RESULTS: Fentanyl pharmacokinetics was best described by a two-compartment model. A pronounced non-linear influence of postnatal and gestational age on clearance was identified. Clearance (L/hour/kg) increased threefold, 1.3-fold and 1.01-fold in the first, second and third weeks of life, respectively. In addition, clearance (L/hour/kg) was 1.4-fold and 1.7-fold higher in case of a gestational age of 28 and 31 weeks, respectively, compared with 25 weeks. Volume of distribution changed linearly with bodyweight and was 8.7 L/kg. To achieve similar exposure across the entire population, a continuous infusion (µg/kg/hour) dose should be reduced by 50% and 25% in preterm neonates with a postnatal age of 0-4 days and 5-9 days in comparison to 10 days and older. CONCLUSION: Because of low clearance, bodyweight-based dosages may result in fentanyl accumulation in neonates with the lowest postnatal and gestational ages which may require dose reduction. Together with additional information on the pharmacodynamics, the results of this study can be used to guide dosing.


Assuntos
Peso ao Nascer/fisiologia , Fentanila/farmacocinética , Recém-Nascido Prematuro/fisiologia , Relação Dose-Resposta a Droga , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro/fisiologia , Recém-Nascido , Masculino , Taxa de Depuração Metabólica , Estudos Prospectivos
20.
Int J Gynaecol Obstet ; 147(3): 397-403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31402446

RESUMO

OBJECTIVE: To describe obstetrical care and in-hospital outcomes in very preterm triplet pregnancies in a European multiregional cohort. METHODS: Data from a prospective population-based study of very preterm births between 22 + 0 and 31 + 6 weeks of gestation in 19 regions from 11 European countries participating in the EPICE project in 2011/2012 were used to describe triplet pregnancies and compare them with twins and singletons. RESULTS: Triplets constituted 1.1% of very preterm pregnancies (97/8851) and 3.3% of very preterm live births (258/7900); these percentages varied from 0% to 2.6% and 0% to 6% respectively across the regions. In-hospital mortality after live birth was 12.4% and did not differ significantly from singletons or twins or by birth order. However, 28.9% of mothers with a triplet pregnancy experienced at least one neonatal death. Ninety percent of live-born triplets were delivered by cesarean. Vaginal delivery was associated with an Apgar score of less than 7, but not with in-hospital mortality. CONCLUSIONS: The prevalence of very preterm triplets varies across European regions. Most triplets were born by cesarean and those born vaginally had lower Apgar scores. Overall, in-hospital mortality after live birth was similar to singletons and twins.


Assuntos
Gravidez de Trigêmeos/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Trigêmeos/estatística & dados numéricos , Adulto , Peso ao Nascer , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Nascimento Vivo/epidemiologia , Gravidez , Estudos Prospectivos , Natimorto/epidemiologia
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