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1.
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
2.
Adv Exp Med Biol ; 1232: 285-290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893422

RESUMO

In neonatal intensive care units (NICUs), 87.5% of alarms by the monitoring system are false alarms, often caused by the movements of the neonates. Such false alarms are not only stressful for the neonates as well as for their parents and caregivers, but may also lead to longer response times in real critical situations. The aim of this project was to reduce the rates of false alarms by employing machine learning algorithms (MLA), which intelligently analyze data stemming from standard physiological monitoring in combination with cerebral oximetry data (in-house built, OxyPrem). MATERIALS & METHODS: Four popular MLAs were selected to categorize the alarms as false or real: (i) decision tree (DT), (ii) 5-nearest neighbors (5-NN), (iii) naïve Bayes (NB) and (iv) support vector machine (SVM). We acquired and processed monitoring data (median duration (SD): 54.6 (± 6.9) min) of 14 preterm infants (gestational age: 26 6/7 (± 2 5/7) weeks). A hybrid method of filter and wrapper feature selection generated the candidate subset for training these four MLAs. RESULTS: A high specificity of >99% was achieved by all four approaches. DT showed the highest sensitivity (87%). The cerebral oximetry data improved the classification accuracy. DISCUSSION & CONCLUSION: Despite a (as yet) low amount of data for training, the four MLAs achieved an excellent specificity and a promising sensitivity. Presently, the current sensitivity is insufficient since, in the NICU, it is crucial that no real alarms are missed. This will most likely be improved by including more subjects and data in the training of the MLAs, which makes pursuing this approach worthwhile.


Assuntos
Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Aprendizado de Máquina , Monitorização Fisiológica , Oximetria , Teorema de Bayes , Circulação Cerebrovascular , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Terapia Intensiva Neonatal/métodos , Monitorização Fisiológica/métodos , Oximetria/métodos , Oximetria/normas
3.
Adv Exp Med Biol ; 1232: 347-354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893430

RESUMO

In preterm infants, there is a risk of long-term cognitive, motor and behavioral impairments due to hemorrhagic and/or ischemic lesions. If detected early, lesions can be prevented. A bedside imaging modality, capable of early detection of both disorders, is necessary. We present the state of development of a tomographic imager (named Pioneer), that will be capable of determining the oxygenation of the preterm-infant brain with high spatial resolution. Pioneer is a time-resolved near-infrared optical tomography (TR NIROT) instrument. It employs multiple wavelength laser light in short pulses on 11 distinct locations and measures the re-emerging light in a contactless fashion by means of a time-correlated single-photon counting (TCSPC) camera (named Piccolo) covering ~4.9 cm2 with 300 detectors. Timing response of the entire system is 116 ps. An in-house designed biocompatible source ring ensures fixed relative positions of sources and detectors and provides a secure interface between the patient and the probe. At the present state, the NIROT Pioneer system successfully detected a 6x6x50 mm3 inclusion 3 cm deep inside a phantom. These results confirm that the Pioneer imager is working as expected and is on a solid path towards full 3D tissue oxygenation imaging.


Assuntos
Encéfalo , Recém-Nascido Prematuro , Oximetria , Oxigênio , Encéfalo/diagnóstico por imagem , Humanos , Recém-Nascido , Oximetria/instrumentação , Oximetria/métodos , Oximetria/normas , Oxigênio/metabolismo , Imagens de Fantasmas
4.
Adv Exp Med Biol ; 1232: 19-24, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893389

RESUMO

The Consensus on Resuscitation Science and Treatment Recommendations indicate the target SpO2 values during the first 10 min of life. There are a few studies of values of brain regional saturation of oxygen (rSO2) in newborns, conventional instruments are large and not suitable for measuring in the delivery room. The purpose of this study was to develop reference values for brain rSO2 up to 10 min after birth and to review the changes in cerebral oxygenation in late preterm and term newborn infants immediately after birth. METHOD: We evaluated both brain rSO2 and SpO2 at 1, 3, 5 and 10 min after birth in 100 neonates. rSO2, was measured at the forehead using a finger-mounted oximeter. This is 1/100 the size of conventional NIRS and can be carried. To measure SpO2, a Radical-7 was used. This study was approved by the institutional review board at our hospital. RESULTS: The gestational age and birth weight were 37.9 ± 1.2 weeks and 2825 ± 429 g, respectively. Eighty-seven infants and 13 infants were term and late preterm infants, respectively, and there were 21 vaginal deliveries and 79 cesarean sections. In all cases, rSO2 levels were measured at 1, 3, 5, and 10 min after birth. For the SpO2 measurements, nine cases at 1 min, 40 cases at 3 min, 81 cases at 5 min and 93 cases at 10 min were available. The median rSO2 level was 43% at 1 min after birth, 48% at 3 min, 52% at 5 min and 57% at 10 min. CONCLUSION: We used a finger-mounted oximeter to observe changes in brain rSO2 values of 100 normal transition infants. It was easier to detect rSO2 in comparison to the peripheral oxygen saturation monitored by our pulse oximeter. Brain rSO2 values might be useful to evaluate oxygenation immediately after birth.


Assuntos
Encéfalo , Oximetria , Encéfalo/fisiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Oximetria/instrumentação , Oximetria/métodos , Oxigênio/análise , Valores de Referência
5.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(12): 1153-1158, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31874651

RESUMO

OBJECTIVE: To study the effect of bronchopulmonary dysplasia (BPD) on lung function in preterm infants. METHODS: According to the presence/absence or the severity of BPD, 72 preterm infants were divided into non-BPD group (n=44), mild BPD group (n=15) and moderate BPD group (n=13). Lung function was assessed by plethysmography on days 7, 14 and 28 after birth. RESULTS: The preterm infants in the three groups had gradual increases in tidal volume per kilogram (TV/kg), functional residual capacity (FRC), ratio of time to peak tidal expiratory flow to total expiratory time (%T-PF) and ratio of volume to peak tidal expiratory flow to total expiratory volume (%V-PF) on days 7, 14 and 28 after birth, while there were gradual reductions in effective airway resistance per kilogram (Reff/kg) and respiratory rate (RR) (P<0.05). Compared with the non-BPD group on days 7, 14 and 28 after birth, the mild and moderate BPD groups had significantly lower TV/kg, FRC, %T-PF, and %V-PF and significantly higher Reff/kg and RR (P<0.05). On day 7 after birth, the moderate BPD group had significantly higher airway resistance, Reff/kg and FRC/kg than the mild BPD group (P<0.05). CONCLUSIONS: There is a certain degree of pulmonary function impairment in preterm infants with BPD. Dynamic monitoring of lung function by plethysmography is useful for assessing lung development in the neonatal period in these infants.


Assuntos
Displasia Broncopulmonar , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Pulmão , Pletismografia , Testes de Função Respiratória
6.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(12): 1159-1163, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31874652

RESUMO

OBJECTIVE: To study the clinical effect of white noise combined with glucose in reducing the procedural pain of retinopathy screening in preterm infants. METHODS: A total of 396 preterm infants with a gestational age of 28-34 weeks and a birth weight of ≤2 000 g were randomly divided into 4 groups according to the intervention method for reducing pain in retinopathy screening: control group with 100 infants (no white noise or glucose intervention), white noise group with 96 infants, glucose group with 98 infants and white noise + glucose group with 102 infants. The Premature Infant Pain Profile (PIPP) was used to determine pain score during retinopathy screening, and the four groups were compared in terms of PIPP score before and after retinopathy screening. RESULTS: There were no significant differences in PIPP score, heart rate and blood oxygen saturation between the four groups at 3 minutes before screening (P>0.05). At 1 and 5 minutes after screening, the white noise, glucose and white noise + glucose groups had significantly lower heart rate and PIPP score but significantly higher blood oxygen saturation than the control group (P<0.05).The white noise + glucose group had significantly lower heart rate and PIPP score but significantly higher blood oxygen saturation than the white noise and glucose groups (P<0.05). CONCLUSIONS: White noise combined with glucose can reduce the procedural pain of retionopathy screening and keep vital signs stable in preterm infants.


Assuntos
Recém-Nascido Prematuro , Manejo da Dor , Glucose , Frequência Cardíaca , Humanos , Lactente , Recém-Nascido , Dor
7.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(12): 1234-1238, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31874666

RESUMO

Neonatal respiratory failure is a serious clinical illness commonly seen in the neonatal intensive care unit (NICU). Although clinicians want to maximize noninvasive respiratory support, some low-birth-weight preterm infants may require invasive respiratory support from the beginning. As an important respiratory management technique for the treatment of respiratory failure, high-frequency oscillatory ventilation (HFOV) allows gas exchange by rapid delivery at a tidal volume lower than or equal to anatomy death volume. Continuous distending pressure was applied to achieve uniform lung expansion, reduce repeated contraction of lung tissue, and exert a protective effect on lung tissue, and so it is preferred by clinicians and has been widely used in clinical practice. However, no consensus has been reached on the methods for weaning from HFOV. This article reviews the methods for weaning from HFOV, so as to provide help for clinical practice.


Assuntos
Ventilação de Alta Frequência , Doenças do Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente
8.
Medicine (Baltimore) ; 98(50): e18229, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852083

RESUMO

BACKGROUND: The relationships between chorioamnionitis (CA) and neurodevelopmental outcomes in preterm infants remain controversial. The meta-analysis aims to evaluate the associations between CA and neurodevelopmental deficits in preterm infants. METHODS: All studies exploring the associations between CA and neurodevelopmental deficits in preterm infants were retrieved from the following databases: PubMed, Embase, OVID, EBSCO, ProQuest, CDSR, and CENTRAL. The NOS was used to evaluate the quality of the studies, RevMan was adopted to analyze the data. RESULTS: Twelve studies involving 4267 preterm infants were included. The ORs across studies was 0.95 (P = .77, I = 51%) for cognitive deficits, 1.09 (P = .44, I = 10%) for psychomotor deficits, 1.21 (P = .08, I = 25%) for language deficits, 2.34 (P = .02, I = 0%) for performance intelligence quotient impairment and 2.81 (P = .03, I = 0%) for verbal intelligence quotient impairment. Subgroup analyses based on the severity of cognitive deficits indicated that CA might be correlated with severe cognitive deficits (P = .01, I = 0%) but not with mild cognitive deficits (P = .40, I = 19%). In terms of the CA category, clinical CA may be related to overall psychomotor deficits (P = .01, I = 25%) and overall language deficits (P < .00001, I = 23%) other than histological CA. CONCLUSION: In preterm infants, CA might be a risk factor for performance and verbal intelligence quotient impairment and severe cognitive deficits, and clinical CA might be a risk factor for overall psychomotor and language deficits.


Assuntos
Corioamnionite/epidemiologia , Doenças do Prematuro/etiologia , Recém-Nascido Prematuro , Transtornos do Neurodesenvolvimento/etiologia , Feminino , Saúde Global , Humanos , Incidência , Recém-Nascido , Doenças do Prematuro/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Fatores de Risco
9.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(11): 1138-1143, 2019 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-31753098

RESUMO

While the survival rate of preterm infants has continually increased with the development of perinatal and neonatal monitoring techniques, the incidence of brain injury in preterm infants has been increasing, resulting in varying degrees of cognitive impairment and movement disorders. Measuring the biomarkers of brain damage is an important means to diagnose brain injury. The biomarkers can be divided into neuroglial damage markers, neuronal damage markers and other markers according to the features of injured cells. The biomarkers widely used in clinical practice include S100B protein, myelin basic protein and neuron-specific enolase. Recent studies have newly discovered a collection of markers that can suggest potential brain injury in preterm infants, such as glial fibrillary acidic protein, neurofilament light chain protein, α-II spectrin breakdown products, chemokines, melatonin and urinary metabolomics. These biomarkers can contribute to the early diagnosis and treatment of preterm brain injury, essential for improving neural development and prognosis. This article reviews the latest research advances in the biomarkers of preterm brain injury, in order to provide evidence for the early diagnosis and treatment of this condition.


Assuntos
Lesões Encefálicas , Recém-Nascido Prematuro , Biomarcadores , Encéfalo , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Subunidade beta da Proteína Ligante de Cálcio S100
10.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(11): 1144-1147, 2019 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-31753099

RESUMO

Adverse environmental stimulation in the neonatal intensive care unit (NICU) can affect neurodevelopment through epigenetic modification and thus has adverse effects on the long-term developmental outcome of preterm infants. Developmental care can reverse epigenetic changes in genes and promote neurodevelopment in preterm infants. This article reviews the influence of environmental stress in the NICU and developmental care on neurodevelopment in preterm infants, as well as related epigenetic effects, in order to provide a reference for epigenetic studies of preterm infants.


Assuntos
Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Epigênese Genética , Humanos , Lactente , Recém-Nascido
11.
Pan Afr Med J ; 33: 262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692740

RESUMO

Hyperbilirubinemia is one of the most widely seen cause of neonatal morbidity. Besides ABO and Rh isoimmunization, minor blood incompatibilities have been also been identified as the other causes of severe newborn jaundice. We report a newborn with indirect hyperbilirubinemia caused by minor blood group incompatibilities (P1, M, N, s and Duffy) whose hemolysis was successfully managed with intravenous immunoglobulin therapy. A thirty-two gestational weeks of preterm male baby became severely icteric on postnatal day 11, with a total bilirubin level of 14.66 mg/dl. Antibody screening tests revealed incompatibility on different minor groups (P1, M, N, s and Duffy (Fya ve Fyb)). On postnatal day thirteen, the level of bilirubin increased to 20.66 mg/dl although baby was under intensive phototherapy. After the administration of intravenous immunoglobulin and red blood cell transfusion, hemoglobin and total bilirubin levels became stabilised. Minor blood incompatibilities should be kept in mind during differential diagnosis of hemolytic anemia of the newborn. They share the same treatment algorithm with the other types hemolytic anemia. New studies revealed that intravenous immunoglobulin treatment in hemolytic anemia have some attractive and glamorous results. It should be seriously taken into consideration for treatment of minor blood incompatibilities.


Assuntos
Anemia Hemolítica/etiologia , Bilirrubina/metabolismo , Hiperbilirrubinemia/etiologia , Imunoglobulinas Intravenosas/administração & dosagem , Anemia Hemolítica/diagnóstico , Incompatibilidade de Grupos Sanguíneos/complicações , Diagnóstico Diferencial , Transfusão de Eritrócitos/métodos , Hemoglobinas/metabolismo , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Icterícia Neonatal/etiologia , Masculino
12.
JAMA ; 322(19): 1877-1886, 2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31742630

RESUMO

Importance: Umbilical cord milking as an alternative to delayed umbilical cord clamping may provide equivalent benefits to preterm infants, but without delaying resuscitation. Objective: To determine whether the rates of death or severe intraventricular hemorrhage differ among preterm infants receiving placental transfusion with umbilical cord milking vs delayed umbilical cord clamping. Design, Setting, and Participants: Noninferiority randomized clinical trial of preterm infants (born at 23-31 weeks' gestation) from 9 university and private medical centers in 4 countries were recruited and enrolled between June 2017 and September 2018. Planned enrollment was 750 per group. However, a safety signal comprising an imbalance in the number of severe intraventricular hemorrhage events by study group was observed at the first interim analysis; enrollment was stopped based on recommendations from the data and safety monitoring board. The planned noninferiority analysis could not be conducted and a post hoc comparison was performed instead. Final date of follow-up was December 2018. Interventions: Participants were randomized to umbilical cord milking (n = 236) or delayed umbilical cord clamping (n = 238). Main Outcomes and Measures: The primary outcome was a composite of death or severe intraventricular hemorrhage to determine noninferiority of umbilical cord milking with a 1% noninferiority margin. Results: Among 540 infants randomized, 474 (88%) were enrolled and completed the trial (mean gestational age of 28 weeks; 46% female). Twelve percent (29/236) of the umbilical cord milking group died or developed severe intraventricular hemorrhage compared with 8% (20/238) of the delayed umbilical cord clamping group (risk difference, 4% [95% CI, -2% to 9%]; P = .16). Although there was no statistically significant difference in death, severe intraventricular hemorrhage was statistically significantly higher in the umbilical cord milking group than in the delayed umbilical cord clamping group (8% [20/236] vs 3% [8/238], respectively; risk difference, 5% [95% CI, 1% to 9%]; P = .02). The test for interaction between gestational age strata and treatment group was significant for severe intraventricular hemorrhage only (P = .003); among infants born at 23 to 27 weeks' gestation, severe intraventricular hemorrhage was statistically significantly higher with umbilical cord milking than with delayed umbilical cord clamping (22% [20/93] vs 6% [5/89], respectively; risk difference, 16% [95% CI, 6% to 26%]; P = .002). Conclusions and Relevance: In this post hoc analysis of a prematurely terminated randomized clinical trial of umbilical cord milking vs delayed umbilical cord clamping among preterm infants born at less than 32 weeks' gestation, there was no statistically significant difference in the rate of a composite outcome of death or severe intraventricular hemorrhage, but there was a statistically significantly higher rate of severe intraventricular hemorrhage in the umbilical cord milking group. The early study termination and resulting post hoc nature of the analyses preclude definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT03019367.


Assuntos
Hemorragia Cerebral Intraventricular/prevenção & controle , Constrição , Doenças do Prematuro/prevenção & controle , Recém-Nascido Prematuro , Cordão Umbilical , Término Precoce de Ensaios Clínicos , Feminino , Idade Gestacional , Humanos , Lactente , Morte do Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Masculino , Gravidez
13.
Codas ; 31(5): e20170233, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31721912

RESUMO

PURPOSE: To evaluate preterm infants' exposure and reactions to intense noise during incubator care. METHODS: An observational and prospective study was performed in the intermediary care unit of a hospital in Ribeirão Preto (SP). Thirty-five preterm infants participated in the first stage of the study (measuring noise) and 20 in the second (analysis of responses to intense noise). Noise was measured for two hours using a dosimeter, and the responses were video recorded by three cameras connected to a computer. The preterm infants' responses to an Lmax higher than 65 decibels were analyzed. RESULTS: Every preterm infant presented Leq above the limit recommended by international organizations, and more than half of the babies had a mean Leq above the limit permitted by the Brazilian standard. Regarding the babies' responses to the intense noise, the majority of them showed blink reflex, startle reflex, facial mimics, changed bodily activities or changed sleep and wake state, all with statistically significant differences. CONCLUSION: The sound levels measured were intense. The noises that preterm infants are exposed to while being cared for in incubators constitute a stressor event. Sudden, intense noises change their behavioral state and causes reflexive and bodily responses, facial manifestations and changes in their sleep and wake state.


Assuntos
Incubadoras para Lactentes/efeitos adversos , Recém-Nascido Prematuro , Ruído/efeitos adversos , Feminino , Humanos , Incubadoras para Lactentes/estatística & dados numéricos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Estudos Prospectivos
14.
Medicina (B Aires) ; 79 Suppl 3: 10-14, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603836

RESUMO

Preterm birth is one of the main country health indicators. It is associated with high mortality and significant morbidity in preterm newborns with cerebral palsy and potential long-term neurodevelopmental disabilities like cognitive and learning problems. The main lesions could be: a) white matter injuries, generally associated with cortical and other regions of grey matter neuronal-axonal disturbances; b) intracranial hemorrhage that includes germinal matrix, intraventricular and parenchymal, c) cerebellum injuries. The white matter lesions include cystic and non-cystic (with microscopic focal necrosis) periventricular leukomalacia and non-necrotic diffuse white matter injury. Multiple etiologic factors are associated with these injuries. Anatomical and physiological characteristics of periventricular vascular structures predispose white matter to cerebral ischemia and, interacting with infection/inflammation factors, activate microglia, generating oxidative stress (mediated by free oxygen and nitrogen radicals), pro-inflammatory cytokine and glutamate toxicity, energetic failure and vascular integrity disturbances. All these factors lead to a particular vulnerability of pre-oligodendrocytes that will affect myelination. Hypoxia-ischemia also may produce selective neuronal necrosis in different cerebral regions. Germinal matrix is a highly vascularized zone beneath ependymal or periventricular region that constitutes a capillary bed with a particular structural fragility that predispose it to hemorrhage.


Assuntos
Lesões Encefálicas/etiologia , Isquemia Encefálica/etiologia , Paralisia Cerebral/etiologia , Hipóxia-Isquemia Encefálica/etiologia , Recém-Nascido Prematuro , Leucomalácia Periventricular/etiologia , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/mortalidade , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Paralisia Cerebral/mortalidade , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/mortalidade , Recém-Nascido , Leucomalácia Periventricular/diagnóstico por imagem , Leucomalácia Periventricular/mortalidade , Substância Branca/patologia
15.
Medicina (B Aires) ; 79 Suppl 3: 15-19, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603837

RESUMO

If a difficulty arises during birth, due to a maternal or fetal anomaly, acute or chronic, asphyxia of the fetal brain constitutes a greater risk, because it could result in the destruction of neurons and the possibility of evolving towards a Ischemic Hypoxic Encephalopathy with long -term sequelae. This review highlights the most recent scientific aspects but at the same time it offers an essential margin of knowledge regarding pathophysiology, diagnosis and treatment, as well as offering a perspective on the future of clinical care of ischemic hypoxic encephalopathy.


Assuntos
Hipóxia-Isquemia Encefálica/diagnóstico , Humanos , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/fisiopatologia , Hipóxia-Isquemia Encefálica/terapia , Recém-Nascido , Recém-Nascido Prematuro , Fatores de Risco , Índice de Gravidade de Doença
16.
Medicine (Baltimore) ; 98(41): e17521, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593123

RESUMO

BACKGROUND: Previous studies have neglected to report the specific action of different probiotic genera in preterm infants. To evaluate the efficacy and safety of specific probiotic genera, we performed a network meta-analysis (NMA) to identify the best prevention strategy for necrotizing enterocolitis in preterm infants. METHODS: MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials had been searched for randomized control trials reporting the probiotics strategy for premature infants. RESULTS: We identified 34 eligible studies of 9161 participants. The intervention in the observation group was to add probiotics for feeding: Lactobacilli in 6 studies; Bifidobacterium in 8 studies; Bacillus in 1 study; Saccharomyces in 4 studies and probiotic mixture in 15 studies. This NMA showed a significant advantage of probiotic mixture and Bifidobacterium to prevent the incidence of necrotizing enterocolitis in preterm infants. A probiotic mixture showed effectiveness in reducing mortality in preterm infants. CONCLUSION: The recent literature has reported a total of 5 probiotic strategies, including Bacillus, Bifidobacterium, Lactobacillus, Saccharomyces, and probiotic mixture. Our thorough review and NMA provided a piece of available evidence to choose optimal probiotics prophylactic strategy for premature infants. The results indicated that probiotic mixture and Bifidobacterium showed a stronger advantage to use in preterm infants; the other probiotic genera failed to show an obvious effect to reduce the incidence of NEC, sepsis and all-cause death. More trials need to be performed to determine the optimal probiotic treatment strategy to prevent preterm related complications.


Assuntos
Enterocolite Necrosante/tratamento farmacológico , Enterocolite Necrosante/prevenção & controle , Doenças do Recém-Nascido/prevenção & controle , Probióticos/uso terapêutico , Bifidobacterium/fisiologia , Enterocolite Necrosante/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Prematuro , Lactobacillus/fisiologia , Placebos/administração & dosagem , Cuidado Pré-Natal/métodos , Probióticos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Sepse/epidemiologia , Sepse/mortalidade , Resultado do Tratamento
17.
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
18.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593284

RESUMO

Preterm delivery in Sweden constitutes 5.7 % of all deliveries, which is among the lowest rates in the world. There has not been any increase in the proportion of iatrogenic preterm deliveries during the last decades.The main hypothesis concerning the causality of preterm delivery is still that of the ascending infection from the vagina to the uterus and inflammation resulting in contractions, rupture of membranes and delivery. The mechanisms behind parturition at term are still elusive and this is also true for preterm delivery. The genetic contribution to preterm delivery is about 25-30 %. The first genes that are associated with preterm delivery and gestational duration have recently been published. Huge progress has been made in care of preterm born infants. Sweden has among the lowest rates of mortality and morbidity in the world, especially in the lowest gestational weeks. New modes of care, family-centered care and hospital-assisted home care, have empowered the parents and reduced the cost for care.


Assuntos
Nascimento Prematuro , Corioamnionite , Deficiências do Desenvolvimento/epidemiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/economia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Fatores de Risco , Suécia/epidemiologia
20.
Lakartidningen ; 1162019 Oct 07.
Artigo em Sueco | MEDLINE | ID: mdl-31593288

RESUMO

Late and moderately preterm infants, born between 32+0/7 and 36+6/7 gestational weeks, comprise more than 80 % of all preterm infants and account for almost 40 % of all days of neonatal care. While their total number of days of care has not changed, an increasing part of their neonatal stay (from 29 % in 2011 to 41 % in 2017) is now within home care programmes. Late and moderate preterm birth is often complicated by respiratory disorders, hyperbilirubinemia, hypothermia and feeding difficulties. These infants also have an increased risk of perinatal death and neurologic complications. In the long run, they have higher risks of cognitive impairment, neuropsychiatric diagnoses and need for asthma medication. As young adults, they have a lower educational level and a lower average salary than their full-term counterparts. They also have an increased risk of long-term sick leave, disability pension and need for economic assistance from society.


Assuntos
Nascimento Prematuro , Corticosteroides/administração & dosagem , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos Cognitivos/epidemiologia , Educação Especial/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro , Tempo de Internação , Pneumopatias/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Gravidez , Nascimento Prematuro/economia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/mortalidade , Nascimento Prematuro/prevenção & controle , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Fatores de Risco , Tempo
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