Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.869
Filtrar
1.
Hu Li Za Zhi ; 67(1): 106-112, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960402

RESUMO

Preterm infants face increased rates of mortality and developmental complications, which are a burden on children's parents (and caregivers), who suffer from exhaustion and situational uncertainty. This case focused on an extremely-low-birth-weight (908 gm) premature infant with initial unstable vital signs complicated by a grade 4 intraventricular hemorrhage (IVH) that led to partial brain atrophy and enlarged brain ventricles. A poor neurological outcome was expected due to the high risk of cerebral palsy and impaired cognitive abilities. Long-term healthcare for this critical infant was causing tremendous physical, emotional, and financial strains on the family. The parents suffered from worries over the poor prognosis, resulting in stress, sleep disorders, and relationship difficulties with the healthcare professionals. Considering the poor prognosis of the infant, the parents faced a medical dilemma between choosing aggressive treatment and withdrawal of treatment, which led to stress and sleep disorders. Differences between the parents and health professionals regarding disease severity perception and treatment opinions further strained their mutual relationship. To ameliorate this issue, the author implemented family-centered care (the FOCUS family intervention) to help the patient and his family. This intervention is designed to increase family involvement, foster an optimistic attitude and effective stress coping techniques, and reduce uncertainty and negative emotions. For the patient, we provided symptom-relief management to improve abnormal muscle tone and development delay. Our intervention ameliorated the negative emotions, insomnia symptoms, and imbalanced family relationships and improved the life quality of the caregivers. Furthermore, the intervention enhanced the patient's autoregulatory ability, and both physical and neurological development. This case study is expected to provide experience in critical care for premature infants with a poor prognosis and their family using a FOCUS family intervention as well as to improve the quality of healthcare delivery in intensive clinical settings.


Assuntos
Hemorragia Cerebral/terapia , Família/psicologia , Doenças do Prematuro/terapia , Relações Profissional-Família , Hemorragia Cerebral/patologia , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/patologia
3.
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
4.
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
5.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(10): 1038-1043, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31642441

RESUMO

OBJECTIVE: To study the clinical features and pathogenic bacteria of late-onset sepsis (LOS) in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. METHODS: Among the VLBW/ELBW infants with a gestational age of <32 weeks who were admitted to the hospital between January 2012 and December 2016, those with LOS were enrolled as the LOS group, and those without sepsis were matched for the infant with LOS in gestational age were enrolled as the control group. According to the presence or absence of in-hospital death, the LOS group was further divided into a death subgroup and a survival subgroup. Risk factors for LOS, clinical features, distribution of pathogenic bacteria, drug resistance, and high-risk factors for LOS-related death were analyzed. RESULTS: A total of 513 VLBW/ELBW infants were enrolled, and there were 65 infants in the LOS group and 130 in the control group. The incidence rate of LOS was 12.7%. In the LOS group, 6 infants died and 59 survived. Compared with the control group, the LOS group had a significantly lower birth weight (P<0.05) and significantly longer indwelling time of peripherally inserted central catheter (PICC), duration of mechanical ventilation, and length of hospital stay (P<0.05). Compared with the control group, the LOS group had a significantly higher proportion of small-for-gestational-age infants, infants undergoing mechanical ventilation, infants with neonatal necrotizing enterocolitis, or infants who died (P<0.05). Low birth weight, small-for-gestational-age infant, and long indwelling time of PICC were independent risk factors for LOS in VLBW/ELBW infants (OR=1.396, 2.550, and 1.068 respectively, P<0.05). Purulent meningitis was an independent risk factor for LOS-related death in VLBW/ELBWIs infants (OR=13.443, P<0.05). A total of 65 strains of pathogenic bacteria were cultured in the LOS group, among which there were 39 strains (60%) of Gram-negative bacteria, including 15 strains producing extended spectrum beta-lactamases (ESBLs), and antibiotics were applied for 67% (10/15) of the ESBL strains within 2 weeks before the onset of LOS. The rate of antibiotic use for ESBL strains was significantly higher than that for non-resistant strains [67% (10/15) vs 29% (7/24); P<0.05]. CONCLUSIONS: Low birth weight, SGA infant, and long indwelling time of PICC are independent risk factors for LOS in VLBW/ELBW infants, and death tends to occur in LOS infants with purulent meningitis. Most pathogenic bacteria of LOS are Gram-negative bacteria, and use of antibiotics within 2 weeks before disease onset may increase the risk of ESBL strain infection.


Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer , Sepse , Peso ao Nascer , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Recém-Nascido de muito Baixo Peso , Fatores de Risco
6.
Prensa méd. argent ; 105(9 especial): 563-570, oct 2019. tab
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1046604

RESUMO

Mothers increasingly mention poor health of the newborn child as the reason for abandoning the child. One of the factors causing the unsatisfactory state of the child's health is the child's premature birth, a little or long before the due date. According to the data of most developed countries of the world, from 5% to 10% of children in the general population are born prematurely. In the Russian Federation, these premature births amount for around 75% of infant mortality. Moreover, the most vulnerable ones among premature infants are children with extremely low and very low body weight. In this regard, the goal of the study has been formulated to assess the state of health of the children born with very low and extremely low body weight and left without parental care. Material and Methods. For this, a retrospective analysis of the labor and delivery records has been conducted for 182 newborns abandoned by mothers in maternity hospitals in the Chelyabinsk region in the period from 2012 to 2017. Results and discussion. Over the study period, the average proportion of newborns with low and extremely low body weight was as follows: 12.1% in the big urban center, 12.0% in urban districts and 12.7% in rural municipalities of the total number of early social orphans. The proportion of newborns with very low body weight was 69.0%; 31.0% had extremely low body weight. The smallest of the examined infants was a newborn with a birth weight of 840 grams. It was found that children born with extremely low and very low body weight had from two to three pathologies already at birth. Conclusion. The identified risk factors for the birth of premature babies are the following: extragenital diseases of the mother, complicated obstetric and gynecological history, infectious diseases of the mother. A high proportion of newborns with very low and extremely low body weight (12.0-12.7%) among abandoned children indicates that the latter are at risk for this pathology.


Assuntos
Cuidado Pós-Natal , Recém-Nascido Prematuro , Criança Abandonada , Mortalidade Infantil , Estudos Retrospectivos , Fatores de Risco , Recém-Nascido de Peso Extremamente Baixo ao Nascer
7.
Medicine (Baltimore) ; 98(31): e16689, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374055

RESUMO

Paracetamol (acetaminophen) has been proposed as an alternative medication for closing hemodynamically significant patent ductus arteriosus (PDA). However, the clinical outcomes remain inconclusive in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.The aim of this study was to compare the efficacy and safety of oral paracetamol and ibuprofen for pharmacological closure of PDA in premature infants from a real-world study.This retrospective study enrolled 255 preterm infants with birthweights of ≤1.5 kg, and echocardiographically confirmed significant PDA. Subjects were classified into 3 groups: Group I (standard-dose ibuprofen group) received 10 mg/kg oral ibuprofen followed by 5 mg/kg/day for 2 days. Group II (high-dose ibuprofen group) received 10 mg/kg/day oral ibuprofen for 3 days. Group III (paracetamol group) received 15 mg/kg/6 h oral paracetamol for 3 days.On day 9 after medication start, PDA closure was achieved in 61 (71.7%) patients assigned to the high-dose ibuprofen group, (63.8%) in the standard-dose ibuprofen group, and 33 (37.9%) of those in the oral paracetamol group (P <.001). Oral standard-dose ibuprofen was more effective than oral paracetamol (P = .001). The ductus closed faster in the high-dose ibuprofen group than in the standard-dose group (median closure time 3.9 ± 1.0 versus 4.4 ±â€Š1.0 days, P = .009). Total bilirubin significantly increased in the high-dose ibuprofen group (P = .02). No gastrointestinal, renal, or hematological adverse effects were reported. Subgroup analyses indicated paracetamol was minimally effective in ELBW infants (PDA closure 13%).This study demonstrated that paracetamol may be a poor medical alternative for PDA management in VLBW and ELBW infants. High dosage ibuprofen was associated with a faster clinical improvement and higher rate of PDA closure.


Assuntos
Acetaminofen/administração & dosagem , Inibidores de Ciclo-Oxigenase/administração & dosagem , Permeabilidade do Canal Arterial/tratamento farmacológico , Ibuprofeno/administração & dosagem , Administração Oral , Relação Dose-Resposta a Droga , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
8.
J Perinat Med ; 47(6): 671-676, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31365347

RESUMO

Background Antioxidant enzymes may play a significant role in the development of bronchopulmonary dysplasia (BPD). The aim of the study was to assess the relationship between the level of extracellular superoxide dismutase (SOD3) in the serum at days 1 and 7 of life and the risk of developing BPD. Methods The study comprised 103 neonates born before 32 weeks' gestation with a birth weight of ≤1500 g. Results In the investigated group, the median serum SOD3 level at day 1 of life was 4.01 ng/mL [interquartile range (IQR) 2.59-5.09 ng/mL] and at day 7 of life 3.13 ng/mL (IQR 2.49-4.34 ng/mL). A statistically significant decrease in the serum SOD3 level was found in the first week of life, P < 0.0001. No correlation was found between the serum SOD3 level at day 1 of life and gestational age R = 0.07, P = 0.4543 and birth weight R = 0.10, P = 0.3083. No statistically significant correlation was found between the dynamics of change in the SOD3 level in serum at days 1 and 7 of life and the risk of BPD development for the definition of BPD at day 28 of life, P = 0.8764 nor at 36 weeks' postmenstrual age, P = 0.6598. Conclusion The study revealed a statistically significant decrease in the serum SOD3 level in the first week of life in very and extremely low birth weight infants born before 32 weeks of gestation. In the clinical setting, no relationship was observed between the level of SOD3 in serum and the risk of developing BPD.


Assuntos
Displasia Broncopulmonar , Recém-Nascido de Peso Extremamente Baixo ao Nascer/sangue , Recém-Nascido Prematuro/sangue , Superóxido Dismutase/sangue , Peso ao Nascer , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/epidemiologia , Correlação de Dados , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Polônia , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
9.
Orv Hetil ; 160(32): 1270-1278, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31387373

RESUMO

Introduction: During recent decades, the perinatal mortality of extremely low-birth weight infants has decreased. An important task is to recognize complications of prematurity. Aim: We made an attempt to explore the relationship between complications of prematurity and neonatal hyperglycemia. Method: From 1 January 2014 to 31 December 2017, 188 infants with birth weight below 1000 g were admitted. For each infant, the frequencies of hyperglycemia (blood glucose >8.5 mmol/l), retinopathy of prematurity, intraventricular hemorrhage, and bronchopulmonary dysplasia were determined. Animal studies were performed in Sprague Dawley rats. Hyperglycemia was achieved by intraperitoneal injection of streptozotocin (100 mg/kg). On the 7th day of life, aorta sections were prepared and stained with hematoxylin eosin. Wall thickness was measured using QCapture Pro 7 image analysis software. Results: The mean ± SD gestational age and birth weight were 27.1 ± 2.2 weeks and 814.9 ± 151.9 g; 33 infants (17.5%) died. Hyperglycemia was confirmed in 62 cases (32.9%), and insulin treatment was given to 43 infants (22.8%). The gestational age and birth weight of the hyperglycemic infants were significantly lower (p<0.001), the incidence of severe retinopathy (p = 0.012) and the mortality of insulin-treated patients were higher (p = 0.02) than in normoglycemic infants. Among survivors (n = 155), we found by logistic regression analysis that hyperglycemia was a risk factor for severe retinopathy (p<0.001). In the rat model, neonatal hyperglycemia caused significant thickening of the aortic wall. Conclusion: Our studies indicate that hyperglycemia is common in extremely low birth-weight infants. Monitoring of these infants for retinopathy of prematurity, kidney dysfunction, and hypertension is recommended. Orv Hetil. 2019; 160(32): 1270-1278.


Assuntos
Diabetes Mellitus Experimental , Hiperglicemia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Doenças do Prematuro , Retinopatia da Prematuridade/etiologia , Animais , Peso ao Nascer , Displasia Broncopulmonar/epidemiologia , Hemorragia Cerebral Intraventricular/epidemiologia , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/tratamento farmacológico , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Gravidez , Ratos , Ratos Sprague-Dawley , Retinopatia da Prematuridade/epidemiologia
10.
BMJ Case Rep ; 12(7)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31350226

RESUMO

This case report is about a boy born extremely preterm at gestational age of 24 weeks, with extremely low birth weight, developing severe bronchopulmonary dysplasia and in need of mechanical ventilation for 155 days. He also had five recurrent infections with group B streptococcus (GBS) within 4 months from birth, and his respiratory condition clearly deteriorated with every GBS infection. It was difficult to wean him from mechanical ventilation. Finally he was extubated when he was 7 months old and kept out of mechanical ventilation after receiving high-dose methylprednisolone, given according to international recommendations. After GBS was cultured for the fifth time, he received oral rifampicin along with intravenous penicillin and after this treatment, GBS did not occur again. At the age of 22 months, the boy no longer needed any respiratory support and he was about 6 months late in his neurological development.


Assuntos
Antibacterianos/uso terapêutico , Displasia Broncopulmonar/fisiopatologia , Respiração Artificial , Infecções Respiratórias/fisiopatologia , Infecções Estreptocócicas/fisiopatologia , Streptococcus agalactiae/isolamento & purificação , Displasia Broncopulmonar/imunologia , Displasia Broncopulmonar/terapia , Deficiências do Desenvolvimento , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer/imunologia , Lactente Extremamente Prematuro/imunologia , Recém-Nascido , Masculino , Metilprednisolona/uso terapêutico , Penicilinas/uso terapêutico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Rifampina/uso terapêutico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , Streptococcus agalactiae/efeitos dos fármacos , Resultado do Tratamento
11.
Invest Ophthalmol Vis Sci ; 60(8): 2888-2894, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31266060

RESUMO

Purpose: Extremely preterm infants are at increased risk for retinopathy of prematurity (ROP). We previously identified several inflammatory proteins that were expressed early in life and are associated with an increased risk of ROP and several angiogenic and neurotrophic growth factors in the neonatal systemic circulation that are associated with a lower risk of ROP. In this paper, we report the results of a set of analyses designed to test the hypothesis that placental CpG methylation levels of 12 inflammation-, angiogenic-, and neurotrophic-associated genes predict the occurrence of prethreshold ROP in extremely preterm newborns. Methods: We used placental CpG methylation data from 395 newborns from the Extremely Low Gestational Age Newborns study. Results: Multivariable regression models revealed that placental DNA methylation of 16 CpG sites representing 8 genes were associated with prethreshold ROP. Specifically, CpG methylation in the serum amyloid A SAA1 and SAA2, brain-derived neurotrophic factor (BDNF), myeloperoxidase (MPO), C-reactive protein (CRP), angiopoietin 1 (ANGPT1), and tumor necrosis factor receptor superfamily member 1B (TNFRSF1B) genes was associated with a lower risk of prethreshold ROP. Conversely, CpG methylation at three probes within tumor necrosis factor receptor superfamily member 1A (TNFRSF1A) and in two alternative probes within the BDNF and ANGPT1 genes was associated with an increased risk of ROP. Conclusions: CpG methylation may be a useful marker for improving ROP prediction, opening the opportunity for early intervention to lessen disease severity.


Assuntos
Proteínas Angiogênicas/genética , Ilhas de CpG/fisiologia , Metilação de DNA , Inflamação/genética , Fatores de Crescimento Neural/genética , Placenta/metabolismo , Retinopatia da Prematuridade/genética , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Peptídeos e Proteínas de Sinalização Intercelular/genética , Masculino , Razão de Chances , Gravidez , Fatores de Risco
12.
Nutrients ; 11(7)2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31248006

RESUMO

BACKGROUND: For preterm infants, human milk (HM) has to be fortified to cover their enhanced nutritional requirements and establish adequate growth. Most HM fortifiers are based on bovine protein sources (BMF). An HM fortifier based on human protein sources (HMF) has become available in the last few years. The aim of this study is to investigate the impact of an HMF versus BMF on growth in extremely low birth weight (ELBW, <1000 g) infants. METHODS: This was a retrospective, controlled, multicenter cohort study in infants with a birthweight below 1000 g. The HMF group received an exclusive HM diet up to 32+0 weeks of gestation and was changed to BMF afterwards. The BMF group received HM+BMF from fortifier introduction up to 37+0 weeks. RESULTS: 192 extremely low birth weight (ELBW)-infants were included (HMF n = 96, BMF n = 96) in the study. After the introduction of fortification, growth velocity up to 32+0 weeks was significantly lower in the HMF group (16.5 g/kg/day) in comparison to the BMF group (18.9 g/kg/day, p = 0.009) whereas all other growth parameters did not differ from birth up to 37+0 weeks. Necrotizing enterocolitis (NEC) incidence was 10% in the HMF and 8% in the BMF group. CONCLUSION: Results from this study do not support the superiority of HFM over BMF in ELBW infants.


Assuntos
Alimentação Artificial , Desenvolvimento Infantil , Fórmulas Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer/crescimento & desenvolvimento , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Leite Humano , Estado Nutricional , Fatores Etários , Áustria , Peso ao Nascer , Alimentação Artificial/efeitos adversos , Enterocolite Necrosante/etiologia , Idade Gestacional , Humanos , Fórmulas Infantis/efeitos adversos , Recém-Nascido de Peso Extremamente Baixo ao Nascer/metabolismo , Lactente Extremamente Prematuro/metabolismo , Recém-Nascido , Valor Nutritivo , Estudos Retrospectivos , Fatores de Tempo
13.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(6): 562-566, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31208510

RESUMO

OBJECTIVE: To examine blood concentrations of free carnitine (FC) in preterm infants with different gestational ages (GA) and birth weights (BW). METHODS: A total of 3 368 preterm infants were enrolled as subjects. According to GA, they were divided into extremely preterm birth (EPTB) group (GA <28 weeks; n=39), very preterm birth (VPTB) group (28 ≤GA <32 weeks; n=405), moderately preterm birth (MPTB) group (32 ≤GA <34 weeks; n=507), and late preterm birth (LPTB) group (34 ≤GA <37 weeks; n=2 417); according to BW, they were divided into extremely low birth weight (ELBW) group (BW <1 000 g; n=36), very low birth weight (VLBW) group (1 000 g ≤BW <1 500 g; n=387), low birth weight (LBW) group (1 500 g ≤BW <2 500 g; n=1 873), and normal birth weight (NBW) group (2 500 g ≤ BW <4 000 g; n=1 072). Blood concentrations of FC were measured between 72 hours and 7 days after birth. RESULTS: The EPTB and VPTB groups had significantly higher FC concentrations than the MPTB and LPTB groups (P<0.05), and the MPTB group had significantly higher FC concentrations than the LPTB group (P<0.05). The lower limit of the 95% medical reference range of FC increased with the reduction in GA. The ELBW and VLBW groups had significantly higher FC concentrations than the LBW and NBW groups (P<0.05). The LBW group had significantly higher FC concentrations than the NBW group (P<0.05). The lower limit of the 95% medical reference range of FC increased with the reduction in BW. CONCLUSIONS: There is a significant increase in blood FC concentrations in very/extremely preterm infants and very/extremely low birth weight infants, and tend to decrease with the increases in GA and BW.


Assuntos
Recém-Nascido Prematuro , Peso ao Nascer , Carnitina , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Gravidez
14.
Indian Pediatr ; 56(4): 294-298, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31064897

RESUMO

BACKGROUND: In preterm neonates, enteral feeding is advanced slowly, considering the risk of necrotizing enterocolitis. Prolonged intravenous alimentation in these neonates, however, may increase the risk of sepsis-related morbidity and mortality, particularly in low resource settings. OBJECTIVES: Objective of this was study to evaluate impact of aggressive enteral feeding on mortality and morbidities among preterm neonates. DESIGN: Randomized controlled trial. PARTICIPANTS: Neonates with birthweight 750-1250 g. INTERVENTIONS: 131 preterm neonates with birth weight 750-1250 g, admitted to neonatal intensive care unit between April 2012 and June 2014, were randomized to aggressive feeding or conservative feeding regimen. OUTCOMES: The primary outcome of the study was all-cause mortality during hospital stay. The secondary outcomes included proportion of sepsis (blood culture proven), necrotizing enterocolitis, feed intolerance, survival without major morbidity at discharge, time to reach full enteral feed (180 mL/kg/d), duration of hospitalization, and average daily weight gain (g/kg). RESULTS: All-cause mortality was 33.3% in aggressive regimen and 43.1% in conservative regimen, [RR (95%) CI 0.77 (0.49, 1.20)]. Neonates with aggressive feeding regimen reached full enteral feed earlier; median (IQR) 7 (6, 8) days compared to conservative regimen, 10 (9, 14) days; P <0.001. There was no difference in culture positive sepsis rate, survival without major morbidities, feed intolerance, necrotizing enterocolitis, duration of hospitalization and average daily weight gain. CONCLUSIONS: In neonates with birth weight 750-1250 g, early aggressive feeding regimen is feasible but not associated with significant reduction in all-cause mortality, culture positive sepsis or survival without major morbidities during hospital stay. Neonates with aggressive regimen have fewer days on IV fluids and reach full feed earlier.


Assuntos
Nutrição Enteral , Doenças do Prematuro , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Nutrição Enteral/mortalidade , Nutrição Enteral/estatística & dados numéricos , Enterocolite Necrosante , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Doenças do Prematuro/mortalidade , Doenças do Prematuro/terapia , Sepse
15.
Percept Mot Skills ; 126(4): 656-674, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31067210

RESUMO

Poor motor coordination in childhood has been associated in adulthood with more negative affect, less positive affect, and an increased risk of psychopathology. While survivors of extremely low birth weight (ELBW; < 1,000 grams) are more likely to manifest poor motor coordination than people born at normal birth weight (NBW; > 2,500 g), they have had better mental health outcomes than those with NBW who have motor difficulties. How emotion is experienced is an important risk factor for mental illness; yet, little is known about the affective experience of survivors of ELBW who also have poor motor coordination. In this longitudinal study, we examined interactions between birth weight status and childhood motor coordination on affective experience among 88 ELBW and 89 NBW participants. We first assessed childhood motor coordination at eight years of age, using the Bruininks-Oseretsky Test of Motor Proficiency, and we later gathered self-report data regarding affective style, using the Positive and Negative Affect Scedule and the Affective Styles Questionnaire, when these participants were 30-35 years of age. We found a statistically significant interaction between motor coordination and birth weight status. As motor coordination worsened among ELBW survivors, positive affect increased, while we observed the opposite trend in NBW participants (p < 0.05). There was no interaction for negative affect. Positive affect may contribute to previous findings of better relative adult mental health among ELBW survivors with poor childhood motor coordination. Strategies aimed at optimizing positive affect may be fruitful for optimizing mental health outcomes among preterm survivors and others with reduced motor proficiency.


Assuntos
Afeto/fisiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer/fisiologia , Destreza Motora/fisiologia , Adulto , Criança , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino
16.
Eur J Pediatr ; 178(7): 1063-1068, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076842

RESUMO

Volutrauma is an important factor in the pathogenesis of bronchopulmonary dysplasia (BPD). Our aims were to identify risk factors in the first 24 h for prolonged ventilator dependence and assess volume delivery and carbon dioxide levels in infants with evolving BPD. A retrospective study was undertaken of 41 infants born at less than 32 weeks of gestational age (GA). A higher tidal volume, minute volume and resistance and a lower GA, birth weight and compliance were associated with a significantly higher risk of ventilator dependence at 28 days. The strongest relationships were with birth weight (area under the receiver operating characteristic curve, AUROC = 0.771) and GA (AUROC = 0.813). Tidal volume remained significantly higher after adjusting for GA in those who remained ventilator dependent at 28 days. The 18 who remained ventilator dependent at 28 days had increased mean carbon dioxide (PCO2) levels with increasing age from a mean of 41 mmHg in the first 24 h to 65 mmHg at 28 days PMA (p < 0.001). The increase in PCO2 occurred despite increases in peak inflation pressures (p < 0.001), tidal volumes (p = 0.002) and minute volumes (p < 0.001).Conclusion: These results suggest that initial volutrauma may contribute to the development of chronic ventilator dependence. What is Known: • In prematurely born infants, excessive tidal volumes are important in the pathogenesis of bronchopulmonary dysplasia (BPD), but a tidal volume that is too low will increase the risk of atelectasis, work of breathing and energy expenditure. What is New: • A high tidal volume in the first 24 h was associated with an increased risk of ventilator dependence at 28 days, which remained significant after adjusting for gestational age. Carbon dioxide levels significantly increased over the first month despite increased pressures and volumes in those who remained ventilator dependent.


Assuntos
Displasia Broncopulmonar/terapia , Dióxido de Carbono/sangue , Respiração Artificial/efeitos adversos , Volume de Ventilação Pulmonar , Feminino , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Respiração Artificial/métodos , Estudos Retrospectivos , Fatores de Tempo
17.
Zhonghua Yan Ke Za Zhi ; 55(4): 280-288, 2019 Apr 11.
Artigo em Chinês | MEDLINE | ID: mdl-30982290

RESUMO

Objective: To observe the incidence and severity of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) infants by strictly controlling the risk factors of ROP, such as oxygen inhalation after birth, to explore the related factors of ROP in ELBW infants. Methods: This was a cross-sectional study. 166 ELBW infants underwent neonatal screening were enrolled in this study, whose birth weight was less than 1 000 g. There were 79 males and 87 females infants, whose average gestational age was (27.99±1.73)weeks, and average birth weight was (904.45±80.23)g. According to the final screening results, the ELBW infants were grouped as follows: (1)ROP group and non-ROP group; (2)severe ROP group and mild or no ROP group. Risk factors included gestational age, birth weight, test-tube infants, fetuses number, complications during pregnancy, delivery mode and Apgar scores in 1 to 10 minutes, weight and weight gain proportion at 1-6 weeks after birth, postnatal feeding mode, history of oxygen inhalation, anemia and blood transfusion, and other systemic diseases were recorded. And their correlation with severe ROP was analyzed by SPSS 20.0 statistical software. Results: Ninty-four (56.63%) ELBW infants developed ROP, 16 (9.64%) were severe ROP and 14(8.43%) received treatment. Average birth weight between ROP group (911.95±72.80)g and non-ROP group (894.67±88.58)g had no difference(t=1.379, P=0.170). Average gestational age between ROP group (27.49±1.53) weeks and non-ROP group (28.64±1.76) weeks had significant difference(t=-4.491,P<0.001).And pregnancy-induced hypertension during pregnancy (χ(2)=4.479, P=0.034), Apgar score in 5 minutes (t=-2.760, P=0.006) and 10 minutes (t=-2.099, P=0.043), pneumonia (χ(2)=6.233, P=0.013), neonatal pneumonia (χ(2)=18.026, P<0.001) had significant difference between ROP group and non-ROP group. There was no effect on weight (F=0.009,P=0.753) or weight gain proportion (F=2.394,P=0.124) at 1-6 weeks after birth in ELBW infants with or without ROP. Average birth weight between severe ROP group(875.63±74.85)g and mild or no ROP group(907.53±80.41)g had no difference(t=-1.518, P=0.131).Average gestational age between severe ROP group(26.88±1.31)weeks and mild or no ROP group (28.11±1.73)weeks had significant difference(t=-2.766,P=0.006).And only fundus hemorrhage (χ(2)=4.507,P=0.034) had significant difference between severe ROP group and mild or no ROP group. There was no effect on weight (F=2.683,P=0.103) or weight gain proportion (F=0.431,P=0.513) at 1-6 weeks after birth in ELBW infants with or without ROP. Logistic regression analysis revealed that only gestational age was correlated to the incidence (ß=-0.437,P<0.001) and severity (ß=-0.616,P=0.007) of ROP significantly. Conclusion: By strictly controlling the risk factors of ROP, such as oxygen inhalation after birth, the severe rate of ROP in ELBW infants is low. However, gestational age is still the inevitable independent high risk factor for the incidence of ROP in ELBW infants. (Chin J Ophthalmol, 2019, 55:280-288).


Assuntos
Peso ao Nascer , Idade Gestacional , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Oxigenoterapia/efeitos adversos , Retinopatia da Prematuridade/etiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Retinopatia da Prematuridade/terapia , Fatores de Risco
18.
Cardiol Young ; 29(4): 547-548, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30968802

RESUMO

As survival rates and functional status of the adult single ventricle population have grown, some may become pregnant inadvertently or against our advice. The outcomes are often poor, being worse for the fetus/baby rather than the mother with a Fontan circuit. No reports of a successful delivery of a healthy baby to a Fontan mother with protein losing enteropathy were found in the literature. We present one such case.


Assuntos
Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/etiologia , Resultado da Gravidez , Enteropatias Perdedoras de Proteínas/etiologia , Feminino , Técnica de Fontan/efeitos adversos , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Parto , Complicações Pós-Operatórias/terapia , Gravidez , Enteropatias Perdedoras de Proteínas/terapia , Adulto Jovem
19.
Neonatology ; 115(4): 384-391, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30974430

RESUMO

Bronchopulmonary dysplasia (BPD) is one of the few diseases in neonatal medicine that has continued to evolve since its first description about 50 years ago. Over these years, advancements in neonatal medicine such as antenatal steroids and exogenous surfactant therapy have significantly reduced neonatal mortality and lowered the limits of viability for preterm infants. Although the incidence of BPD continues to be high, especially in extremely low birth weight infants, the clinical picture has evolved into a milder disease with low mortality or significant morbidities. This new BPD is the result of complex interactions between altered alveolar and vascular development, injury by ante- and postnatal pathogenic factors, and reparative processes in the lung. There has been significant progress in our understanding of risk factors for BPD, but challenges persist in its definition, and in finding effective preventive strategies. There are promising developments with newer preventive interventions such as mesenchymal stem cells, exosomes, immunomodulators, and growth factors, but they are still in preclinical stage. The future challenges include finding ways to define BPD based on the severity of lung pathology, which can better predict long-term outcomes, development of early predictors of lung disease, and finding innovative and evidence-based preventive and management strategies.


Assuntos
Displasia Broncopulmonar/patologia , Displasia Broncopulmonar/prevenção & controle , Displasia Broncopulmonar/terapia , Recém-Nascido Prematuro , Prática Clínica Baseada em Evidências , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Alvéolos Pulmonares/patologia , Surfactantes Pulmonares/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Fatores de Risco , Esteroides/uso terapêutico
20.
Zhonghua Er Ke Za Zhi ; 57(4): 258-264, 2019 Apr 02.
Artigo em Chinês | MEDLINE | ID: mdl-30934197

RESUMO

Objective: To investigate the incidence and risk factors of severe intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI). Methods: The data were from "reduction of infection in Chinese neonatal intensive care units using the evidence-based practice for improving quality"study, which prospectively enrolled infants with gestational age less than 34 weeks, and were admitted within the first seven days of life in 25 tertiary neonatal intensive care units from May 2015 to April 2018. Clinical data of VLBWI and ELBWI, who had neuroimage examination during the hospitalization, were retrospectively extracted from the standard database and were secondarily-analyzed. Patients with congenital malformations were excluded. A total of 8 835 VLBWI and ELBWI were enrolled with 52.6% (4 643 cases) male, who were divided into severe IVH group and without IVH or mild IVH group. Descriptive statistics were used to analyze the incidence of severe IVH. Comparison between two groups and risk factors were analyzed with univariate and multivariate Logistic regression analysis. Results: The incidence of severe IVH in the 8 835 infants was 7.4% (650/8 835). And the incidences of severe IVH in ELBWI and preterm infants with gestational age ≤28 weeks were 13.5% (160/1 185) and 13.1% (368/2 800), respectively. The incidences of severe IVH in preterm infants with birth weight<750 g, 750-999 g, 1 000-1 249 g, 1 250-1 499 g were 21.1% (31/147), 12.4% (129/1 038), 8.3% (246/2 966) and 5.2% (244/4 684), respectively; and were 25.2% (55/218), 12.1% (313/2 582), 5.2% (243/4 649) and 2.8% (39/1 386) in the preterm infants with gestational age<26 weeks, 26-28(+6) weeks, 29-31(+6) weeks, 32-33(+6) weeks, respectively. Logistic regression analysis revealed that gestation age (OR=0.752, 95%CI: 0.687-0.823, P=0.000) and cesarean delivery (OR=0.733, 95%CI: 0.592-0.907, P=0.004) decreased the risks of severe IVH; while Apgar score ≤3 at 5 minutes (OR=1.897, 95%CI: 1.194-3.013, P=0.007), use of invasive mechanical ventilation within the first week (OR=1.499, 95%CI: 1.207-1.862, P=0.000), use of inotropic medications within the first week (OR=2.093, 95%CI: 1.724-2.541, P=0.000) increased the risks of severe IVH. Conclusions: The incidence of severe IVH is still significantly high among VLBWI and ELBWI. Low gestation age, non-cesarean delivery, Apgar score ≤3 at 5 minutes, use of invasive mechanical ventilation and inotropic medications within the first week of life will increase the risk of severe IVH.


Assuntos
Hemorragia Cerebral , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Doenças do Prematuro , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Estudos Retrospectivos , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA