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1.
Medicine (Baltimore) ; 99(9): e19216, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118723

RESUMO

To explore the clinical effects of less invasive surfactant administration (LISA) via a gastric tube on the treatment of respiratory distress syndrome (RDS) in premature infants aged 32 to 36 weeks.A total of 97 premature infants with RDS admitted to the Children's Hospital of Shanxi from February 2017 to January 2018 were randomly divided into LISA (47 cases) and (intubation-surfactant-extubation,) INSURE groups (50 cases). In the LISA group, 6F gastric tubes were inserted into the trachea through direct laryngoscopy under nasal continuous positive airway pressure (NCPAP), and pulmonary surfactant (PS) was injected. In the INSURE group, PS was injected via tracheal intubation and NCPAP was performed after extubation. The incidence of technical-related adverse events and various complications in the two groups were observed.PS was successfully injected through gastric tube in the LISA group. There were no significant differences in reflux, asphyxia, bradycardia (<100 beats/min), apnea, FiO2, changes in PaO2 and PaCO2 at 1 hour post-treatment between the groups. During the course of administration, blood pressure and SpO2 in the LISA group were more stable, and significant differences between the 2 groups were observed. However, no significant differences in the complications and outcomes between the 2 groups occurred.The LISA technique can be used to treat premature infants with RDS aged 32 to 36 weeks with stronger spontaneous breathing ability. Further clinical studies are required to determine the optimal strategy of LISA administration and the most profitable patient population.


Assuntos
Recém-Nascido Prematuro , Intubação Intratraqueal/instrumentação , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Surfactantes Pulmonares/administração & dosagem , Resultado do Tratamento
2.
Niger J Clin Pract ; 23(1): 71-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929210

RESUMO

Background: Neonatal hyperglycemia (NNH) like hypoglycemia is a dangerous metabolic disorder often associated with adverse consequences, if undetected and untreated. This study was set out to determine the prevalence, risk factors, and outcomes of babies with the point of admission hyperglycaemia at the Wesley Guild Hospital (WGH), Ilesa. Methods: The study was descriptive and cross-sectional, involving 300 consecutively recruited neonates admitted into the special care baby unit (SCBU) of the hospital. All subjects had blood glucose done at the point of admission using Accu-Chek Active® glucometer (Roche Diagnostics GmbH, Germany). Hyperglycemia was defined as blood glucose ≥7.0 mmol/L. Factors associated with NNH were determined using univariate and multivariate analyses. Results: Of the 300 subjects (Male: Female 1.5:1), there were 74 (24.7%) preterms, 35 (11.7%) small-for-gestational age and 85 (28.3%) low-birth-weight babies. Eighteen (6.0%) babies had hyperglycemia. Parental low socioeconomic class, maternal lack of antenatal care (ANC), vaginal delivery, grand multiparity, outborn status, respiratory distress, probable sepsis, and neonatal anemia at presentation were associated with NNH (P < 0.05). Respiratory distress (OR = 3.800, 95% CI = 1.122-12.873, P = 0.032), and probable sepsis (OR = 4.090, 95% CI = 1.206-13.872, P = 0.024) were independent predictors of hyperglycemia. Hyperglycemia was significantly associated with mortality. (38.9% vs. 11.0%; P = 0.001). Conclusion: Neonatal hyperglycemia was detected in 6.0% of neonatal admission at the WGH, Ilesa and it was associated with increased mortality. Hyperglycemia should be suspected and promptly managed at the point of admission of ill newborns particularly those with respiratory distress and signs of sepsis.


Assuntos
Hospitalização/estatística & dados numéricos , Hiperglicemia/epidemiologia , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Sepse Neonatal/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Estudos Transversais , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/mortalidade , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Sepse Neonatal/epidemiologia , Sepse Neonatal/mortalidade , Nigéria/epidemiologia , Gravidez , Prevalência , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Fatores de Risco
4.
Mymensingh Med J ; 29(1): 60-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915337

RESUMO

In spite of the recommendation for rescue antenatal corticosteroids (ACS), the optimal time interval between primary and rescue courses has not been clearly demonstrated. The aim of this retrospective study was to determine the effects of the interval between a single ACS (Dexamethasone) course and delivery on the incidence of respiratory distress syndrome (RDS) in neonates at Mymensingh Medical College Hospital Center from 1st January 2017 to 30th June 2017. Injection Dexamethasone 2 doses (12.5mg IM 12 hourly for 2 doses) or 4 doses (6mg IM every 12 hours for 4 doses) use to arrest preterm labor as well as to prevent RDS delivered beyond 48 hours after ACS administration between 24 and 34 weeks gestation. The risk of RDS was compared between patients who delivered within seven days (Group I) and 7-14 days (Group II) after ACS administration. We included 140 and 60 patients in Group I and Group II respectively. After adjusting for confounders, the ACS delivery interval was significantly associated with RDS in Group II (adjusted odds ratio 12.8, 95% confidence interval 1.31-164.7). A longer ACS delivery interval is associated with a higher risk of RDS. Thus, the use of a rescue course could be expected to reduce the incidence of RDS in patients beyond seven days after ACS administration who remain at risk for preterm delivery within seven days, especially in cases of placenta previa and/or women bearing a male fetus.


Assuntos
Corticosteroides/administração & dosagem , Dexametasona/administração & dosagem , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Corticosteroides/efeitos adversos , Bangladesh/epidemiologia , Dexametasona/efeitos adversos , Feminino , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 87-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31123057

RESUMO

OBJECTIVE: High-flow nasal cannula (HFNC) therapy is increasingly used in preterm infants despite a paucity of physiological studies. We aimed to investigate the effects of HFNC on respiratory physiology. STUDY DESIGN: A prospective randomised crossover study was performed enrolling clinically stable preterm infants receiving either HFNC or nasal continuous positive airway pressure (nCPAP). Infants in three current weight groups were studied: <1000 g, 1000-1500 g and >1500 g. Infants were randomised to either first receive HFNC flows 8-2 L/min and then nCPAP 6 cm H2O or nCPAP first and then HFNC flows 8-2 L/min. Nasopharyngeal end-expiratory airway pressure (pEEP), tidal volume, dead space washout by nasopharyngeal end-expiratory CO2 (pEECO2), oxygen saturation and vital signs were measured. RESULTS: A total of 44 preterm infants, birth weights 500-1900 g, were studied. Increasing flows from 2 to 8 L/min significantly increased pEEP (mean 2.3-6.1 cm H2O) and reduced pEECO2 (mean 2.3%-0.9%). Tidal volume and transcutaneous CO2 were unchanged. Significant differences were seen between pEEP generated in open and closed mouth states across all HFNC flows (difference 0.6-2.3 cm H2O). Infants weighing <1000 g received higher pEEP at the same HFNC flow than infants weighing >1000 g. Variability of pEEP generated at HFNC flows of 6-8 L/min was greater than nCPAP (2.4-13.5 vs 3.5-9.9 cm H2O). CONCLUSIONS: HFNC therapy produces clinically significant pEEP with large variability at higher flow rates. Highest pressures were observed in infants weighing <1000 g. Flow, weight and mouth position are all important determinants of pressures generated. Reductions in pEECO2 support HFNC's role in dead space washout.


Assuntos
Oxigenoterapia/métodos , Respiração com Pressão Positiva , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Peso Corporal , Dióxido de Carbono/sangue , Pressão Positiva Contínua nas Vias Aéreas , Estudos Cross-Over , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oxigênio/sangue , Estudos Prospectivos , Volume de Ventilação Pulmonar , Sinais Vitais
6.
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
7.
JAMA ; 322(22): 2179-2190, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31821429

RESUMO

Importance: The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial. Objective: To determine if the transfusion of fresh red blood cells (stored ≤7 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children. Design, Setting, and Participants: The Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15 568 patients were screened, and 13 308 were excluded. Interventions: Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group. Main Outcomes and Measures: The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death. Results: Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P < .001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, -2.0% to 6.1%; P = .33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P = .34). Conclusions and Relevance: Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells. Trial Registration: ClinicalTrials.gov Identifier: NCT01977547.


Assuntos
Preservação de Sangue , Estado Terminal/terapia , Transfusão de Eritrócitos , Insuficiência de Múltiplos Órgãos/prevenção & controle , Adolescente , Criança , Pré-Escolar , Estado Terminal/mortalidade , Progressão da Doença , Transfusão de Eritrócitos/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Estimativa de Kaplan-Meier , Masculino , Insuficiência de Múltiplos Órgãos/mortalidade , Gravidade do Paciente , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Sepse/etiologia
9.
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
10.
Arch. argent. pediatr ; 117(6): 397-404, dic. 2019. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1046389

RESUMO

Objetivo. Evaluar la percepción del dolor de recién nacidos prematuros a quienes se les administró surfactante mediante diferentes técnicas, utilizando la variabilidad de la frecuencia cardíaca (VFC).Métodos. Se aleatorizó a los recién nacidos que requirieron tratamiento con surfactante por SDR a los grupos INSURE o MIST. El análisis de la VFC se realizó con la tecnología NIPE para evaluar el componente parasimpático del sistema nervioso autónomo de los recién nacidos. Se registró la VFC antes, durante y después de administrar el surfactante. La evaluación del dolor se determinó con la escala PIPP. Resultados. Se incluyó a 14 recién nacidos en el estudio. Los grupos tenían características demográficas similares. Los puntajes de la escala PIPP no difirieron entre los grupos INSURE y MIST (p = 0,05). Se observó una diferencia estadísticamente significativa en la mediana de la VFC durante la administración del surfactante entre los grupos INSURE y MIST (52 frente a 56, p = 0,03). El análisis de la VFC fue similar entre los grupos antes y después de administrar el surfactante.Conclusión. La administración de surfactante mediante la técnica MIST podría ser más cómoda para los recién nacidos prematuros con SDR. No obstante, es necesario realizar otros estudios con series más importantes.


Objective. We aimed to assess the pain perception of preterm infants treated with different surfactant administration techniques by using heart rate variability (HRV).Methods. Preterm infants who required surfactant therapy for RDS were randomized to INSURE or MIST groups. HRV analysis was performed by Newborn Infant Parasympathetic Evaluation monitor. HRV was recorded before, during and after surfactant administration. Pain assessment was determined by Premature Infant Pain Profile (PIPP) score.Results. Fourteen infants were enrolled in the study. Demographic characteristics of the groups were similar. PIPP scores did not differ between INSURE and MIST groups (p = 0.05). Statistically significant difference in median HRV during surfactant administration was observed between INSURE and MIST groups (52 vs. 56, p = 0.03). HRV analysis was similar between groups before and after surfactant administration. Conclusion. Surfactant administration with MIST technique might be more comfortable for preterm infants with RDS. However further studies with larger series are needed.


Assuntos
Humanos , Recém-Nascido , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Surfactantes Pulmonares/uso terapêutico , Recém-Nascido Prematuro , Dor , Estudos Prospectivos , Unidades de Terapia Intensiva , Intubação
11.
Niger J Clin Pract ; 22(11): 1621-1625, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719287

RESUMO

Congenital pulmonary airway malformation (CPAM), formerly known as congenital cystic adenomatoid malformation (CCAM), is a rare developmental dysplastic lesion of the fetal tracheobronchial tree. CPAM is a rare cause of neonatal respiratory distress; however, its presence may span fetal to adult period. In two previous case-reports from Nigeria, CPAM was present in post-neonatal infants. We report the case of a neonate, who presented with increasing respiratory distress and an abnormal chest radiograph, initially assumed as pneumonic changes. A revised diagnosis of CPAM was made after a chest computed tomography (CT) scan. The neonate subsequently had a successful excision of the affected lobe with remarkable clinical improvement. The case highlights the need to utilize superior imaging studies such as CT when plain radiographs are inconclusive.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico , Pulmão/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Tomografia Computadorizada por Raios X/métodos , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico por imagem , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Feminino , Humanos , Recém-Nascido , Pulmão/patologia , Masculino , Nigéria , Doenças Raras , Insuficiência Respiratória
12.
Scand J Trauma Resusc Emerg Med ; 27(1): 95, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665094

RESUMO

The population of the Kingdom of Bhutan is scattered in small villages throughout the eastern Himalaya. Infants born prematurely in villages have no access to neonatal intensive care until they are transported to the national referral hospital, a process that once took hours, if not days. After the introduction of a helicopter critical-care retrieval team, we were able to send a trained team to a remote location that successfully administered surfactant and initiated critical care to a premature, extreme low birth weight infant in severe respiratory distress in the first hour of life. Although the infant was in shock and in a near-arrest state at the time the team arrived, he made an excellent recovery after resuscitation by the team.


Assuntos
Serviços Médicos de Emergência/métodos , Recém-Nascido de Baixo Peso , Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Ressuscitação/métodos , Humanos , Recém-Nascido , Masculino
13.
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
14.
Turk J Pediatr ; 61(1): 34-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559719

RESUMO

Bozkaya D, Yigit S, Yurdakök M. Is serum procalcitonin level a reliable indicator in early diagnosis of congenital pneumonia? Turk J Pediatr 2019; 61: 34-39. The clinical signs in congenital pneumonia mimic other conditions like transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS). Differential diagnosis is difficult since laboratory findings have limited value. Procalcitonin (PCT) is an important and widely studied marker of infection. The aim of this study was to determine the diagnostic value of PCT in newborn patients hospitalized in the neonatal intensive care unit (NICU) with the diagnosis of congenital pneumonia. The infants with respiratory distress who were born at Hacettepe University between 2005-2015 and hospitalized in the NICU were included in the study. A total of 200 newborn infants; 54 (27%) infants with congenital pneumonia (Group-1), 42 (21%) infants with TTN (Group-2), 40 (20%) infants with RDS (Group-3) and 64 (32%) healthy infants (group-4), were included in the study. There was no statistically significant difference between the groups for serum C-reactive protein (CRP) levels, sampling time for PCT and CRP and the characteristics of the mother (p > 0.05). Mean serum PCT level was higher in the congenital pneumonia group than in the other groups (p < 0.001). Result of this study shows that procalcitonin is an important early marker in the diagnosis of congenital pneumonia.


Assuntos
Pneumonia/congênito , Pneumonia/diagnóstico , Pró-Calcitonina/sangue , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Pneumonia/sangue , Síndrome do Desconforto Respiratório do Recém-Nascido/sangue , Estudos Retrospectivos , Sensibilidade e Especificidade , Taquipneia Transitória do Recém-Nascido/sangue , Taquipneia Transitória do Recém-Nascido/diagnóstico
15.
JNMA J Nepal Med Assoc ; 57(216): 92-97, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31477940

RESUMO

INTRODUCTION: Respiratory distress is one of the commonest problem seen in neonates during admission in Neonatal Intensive Care Unit. Hyaline Membrane disease, Meconium Aspiration Syndrome, septicemia, congenital pneumonia, Transient Tachypnea of Newborn are the major causes of respiratory distress in neonates. Bubble Continuous Positive Airway Pressure is a non-invasive respiratory support delivered to a spontaneously breathing newborn to maintain lung volume during expiration. The main objective of this study was to observe the outcome of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure. METHODS: This was a descriptive cross-sectional study conducted at Kathmandu Medical College Teaching Hospital over six months (October 2018 - March 2019) period. All preterm, term and post term babies with respiratory distress were included. Ethical clearance was received from Institutional Review Committee of Kathmandu Medical College and statistical analysis was done with SPSS 19 version. RESULTS: Sixty three babies with respiratory distress were included in this study with 45 (71%) male predominance. The mean birth weight receiving Bubble Continuous Positive Airway Pressure was 2661.75±84 gms and gestational age was 36.67±3.4 wks. The Bubble Continuous Positive Airway Pressure was started at 8.05±2 hr of life and duration of Bubble Continuous Positive Airway Pressure required for settling respiratory distress was 95.71±3 hrs. Out of 63 babies, improvement of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure was 39 (61%) with confidence interval of 38% to 62% whereas 24 (39%) babies required mechanical ventilation and other modalities. CONCLUSIONS: This study concludes usefulness of Bubble Continuous Positive Airway Pressure in neonates with respiratory distress.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Unidades de Terapia Intensiva Neonatal , Respiração Artificial/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Peso ao Nascer , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Centros de Atenção Terciária , Resultado do Tratamento
17.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31540968

RESUMO

OBJECTIVES: Our aim in this observational study was to monitor continuous positive airway pressure (CPAP) usage and outcomes in newborn wards at 26 government hospitals in Malawi after the introduction of CPAP as part of a quality-improvement initiative. CPAP was implemented in 3 phases from 2013 through 2015. METHODS: Survival to discharge was analyzed for neonates treated with nasal oxygen and/or CPAP with admission weights of 1 to 2.49 kg at 24 government hospitals with transfer rates <15%. This analysis includes neonates admitted with respiratory illness for 5.5 months before (621 neonates) and 15 months immediately after CPAP implementation (1836 neonates). A follow-up data analysis was completed for neonates treated with CPAP at all hospitals during an additional 11 months (194 neonates). RESULTS: On implementation of CPAP, survival to discharge improved for all neonates admitted with respiratory distress (48.6% vs 54.5%; P = .012) and for those diagnosed with respiratory distress syndrome (39.8% vs 48.3%; P = .042). There were no significant differences in outcomes for neonates treated with CPAP during the implementation and follow-up periods. Hypothermia on admission was pervasive and associated with poor outcomes. Neonates with normal mean temperatures during CPAP treatment experienced the highest survival rates (65.7% for all neonates treated with CPAP and 60.0% for those diagnosed with respiratory distress syndrome). CONCLUSIONS: A nurse-led CPAP service can improve outcomes for neonates in respiratory distress in low-resource settings. However, the results show that real-world improvements in survival may be limited without access to comprehensive newborn care, especially for small and sick infants.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Temperatura Corporal , Pressão Positiva Contínua nas Vias Aéreas/mortalidade , Hospitais Públicos/estatística & dados numéricos , Humanos , Hipotermia/mortalidade , Recém-Nascido , Recém-Nascido Prematuro , Estimativa de Kaplan-Meier , Malaui/epidemiologia , Oxigenoterapia/estatística & dados numéricos , Melhoria de Qualidade , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Taxa de Sobrevida , Resultado do Tratamento
18.
Life Sci ; 236: 116737, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505194

RESUMO

AIMS: The purpose of this study was to investigate the pathophysiology and discover novel predictors of neonatal respiratory distress syndrome (NRDS) from a peptidomics perspective. MAIN METHODS: Comparative profiling of umbilical cord blood from NRDS and control patients was performed by liquid chromatography tandem mass spectrometry technology. The underlying biological functions of the differentially expressed peptides (DEPs) were predicted by Gene Ontology (GO) and KEGG pathway analyses. The interactions of DEPs and their precursor proteins were explored by ingenuity pathway analysis (IPA). The sources and stability of DEPs were determined by online databases, including UniProt, SMART and ProtParam tool. KEY FINDINGS: A total of 251 DEPs were identified, of which 139 peptides were upregulated, and 112 peptides were downregulated (fold change ≥2.0, P < 0.05). These DEPs were predicted to be associated with respiratory failure, atelectasis, and morphogenesis of endothelial cells. These processes indicated that DEPs may play a role in NRDS. Among them, eleven stable DEPs might be used as preclinical biomarkers. SIGNIFICANCE: Our findings improve our understanding of NRDS and facilitate the discovery of candidate diagnostic biomarkers for NRDS from the perspective of peptidomics.


Assuntos
Biomarcadores/sangue , Sangue Fetal/metabolismo , Fragmentos de Peptídeos/sangue , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Estudos de Casos e Controles , Humanos , Recém-Nascido , Prognóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/sangue
20.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399490

RESUMO

BACKGROUND: In 2011, the Neonatal Resuscitation Program (NRP) added consideration of continuous positive airway pressure (CPAP) for spontaneously breathing infants with labored breathing or hypoxia in the delivery room (DR). The objective of this study was to determine if DR-CPAP is associated with symptomatic pneumothorax in infants 35 to 42 weeks' gestational age. METHODS: We included (1) a retrospective birth cohort study of neonates born between 2001 and 2015 and (2) a nested cohort of those born between 2005 and 2015 who had a resuscitation call leading to admission to the NICU and did not receive positive-pressure ventilation. RESULTS: In the birth cohort (n = 200 381), pneumothorax increased after implementation of the 2011 NRP from 0.4% to 0.6% (P < .05). In the nested cohort (n = 6913), DR-CPAP increased linearly over time (r = 0.71; P = .01). Administration of DR-CPAP was associated with pneumothorax (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 4.4-6.8); the OR was higher (P < .001) in infants receiving 21% oxygen (OR: 8.5; 95% CI: 5.9-12.3; P < .001) than in those receiving oxygen supplementation (OR: 3.5; 95% CI: 2.5-5.0; P < .001). Among those with DR-CPAP, pneumothorax increased with gestational age and decreased with oxygen administration. CONCLUSIONS: The use of DR-CPAP is associated with increased odds of pneumothorax in late-preterm and term infants, especially in those who do not receive oxygen in the DR. These findings could be used to clarify NRP guidelines regarding DR-CPAP in late-preterm and term infants.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Salas de Parto , Pneumotórax/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Risco
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