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1.
S D Med ; 74(1): 28-35, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33691054

RESUMO

Respiratory distress is a commonly encountered problem in newborn infants. Recognizing an infant with respiratory distress is not difficult, but determining the etiology and initiating proper management can be challenging. This review will focus on pulmonary causes of respiratory distress in the late preterm (34-366/7 weeks gestation) through late term (41-416/7 weeks gestation) infant with guidance for diagnosis and proper management of these infants. Many newborns with respiratory distress will require transfer to a higher level of care, but a select group may be safely managed at the delivery hospital.


Assuntos
Síndrome do Desconforto Respiratório do Recém-Nascido , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
2.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504527

RESUMO

The clinical manifestation of Escherichia coli could vary from asymptomatic bacteraemia to systemic bloodstream infection and meningitis. We describe an unusual course of E. coli infection in twins, emphasising commencement of appropriate antimicrobial therapy. A set of male dichorionic diamniotic twins were delivered at 34 weeks of gestation by caesarian section. Pregnancy was complicated by diabetes, pre-eclampsia and cholestasis. Antenatal ultrasounds noted a congenital pulmonary airway malformation in twin A. Following delivery, twin A developed respiratory distress, but twin B was asymptomatic. Partial septic work-up at admission in the neonatal intensve care unit was done. Twin A's blood culture grew E. coli, while twin B's blood culture was negative. Twin A was treated with 7 days of intravenous antibiotics. At 11 days of age, twin B acutely developed a scrotal swelling. On suspicion of testicular torsion, he was taken for urgent surgery, which revealed a scrotal abscess positive for E. coli The scrotum was irrigated and successfully treated with 4 weeks of antibiotics. Both twins were doing well at 3 months of follow-up.


Assuntos
Abscesso/diagnóstico , Bacteriemia/diagnóstico , Doenças em Gêmeos/diagnóstico , Infecções por Escherichia coli/diagnóstico , Pneumonia Bacteriana/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Abscesso/terapia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Cesárea , Pressão Positiva Contínua nas Vias Aéreas , Doenças em Gêmeos/terapia , Infecções por Escherichia coli/terapia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Sepse Neonatal/diagnóstico , Sepse Neonatal/terapia , Pneumonia Bacteriana/terapia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Escroto , Gêmeos , Adulto Jovem
3.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370995

RESUMO

A 7-month-old-term male infant presented with cough, tachypnoea, hypoxaemia and post-tussive emesis. Clinical history was significant for respiratory failure and pulmonary hypertension in the neonatal period requiring assisted ventilation, congenital hypothyroidism, mild hypotonia, recurrent respiratory infections, hypoxaemia requiring supplemental oxygen and nasogastric tube feeds. Physical examination showed tachypnoea, coarse bilateral breath sounds and mild hypotonia. Chest radiograph revealed multifocal pulmonary opacities with coarse interstitial markings and right upper lobe atelectasis. Following antibiotic therapy for suspected aspiration pneumonia, chest CT scan was performed and showed multiple areas of pulmonary consolidation and scattered areas of bilateral ground-glass opacities. Genetic studies showed a large deletion of chromosome 14q13.1-14q21.1, encompassing the NK2 homeobox 1 (NKX2-1) gene consistent with a diagnosis of brain-thyroid-lung (BTL) syndrome. Our case highlights the importance of genetic studies to diagnose BTL syndrome in infants with hypothyroidism, hypotonia and lung disease.


Assuntos
Atetose/diagnóstico , Coreia/diagnóstico , Deleção Cromossômica , Cromossomos Humanos Par 14/genética , Hipotireoidismo Congênito/diagnóstico , Hipóxia/genética , Hipotonia Muscular/genética , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Combinação Amoxicilina e Clavulanato de Potássio/administração & dosagem , Atetose/complicações , Atetose/genética , Atetose/terapia , Coreia/complicações , Coreia/genética , Coreia/terapia , Hipotireoidismo Congênito/complicações , Hipotireoidismo Congênito/genética , Hipotireoidismo Congênito/terapia , Nutrição Enteral , Hidratação , Testes Genéticos , Humanos , Hipóxia/diagnóstico , Hipóxia/terapia , Lactente , Intubação Gastrointestinal , Pulmão/diagnóstico por imagem , Masculino , Hipotonia Muscular/diagnóstico , Hipotonia Muscular/terapia , Oxigênio/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/genética , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Fator Nuclear 1 de Tireoide/genética , Tomografia Computadorizada por Raios X
4.
PLoS One ; 15(8): e0236695, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785282

RESUMO

The goal of this study is to investigate the effectiveness of the neonatal diagnosis-related group scheme in patients affected by respiratory distress syndrome. The variable costs of individual patients in the same group are examined. This study uses the data of infants (N = 243) hospitalized in the Neonatal Intensive Care Unit of the Gaslini Children's Hospital in Italy in 2016. The care unit's operating and management costs are employed to estimate the average cost per patient. Operating costs include those related to personnel, drugs, medical supplies, treatment tools, examinations, radiology, and laboratory services. Management costs relate to administration, maintenance, and depreciation cost of medical equipment. Cluster analysis and Tobit regression are employed, allowing for the assessment of the total cost per patient per day taking into account the main cost determinants: birth weight, gestational age, and discharge status. The findings highlight great variability in the costs for patients in the same diagnosis-related group, ranging from a minimum of €267 to a maximum of €265,669. This suggests the inefficiency of the diagnosis-related group system. Patients with very low birth weight incurred costs approximately twice the reimbursement set by the policy; a loss of €36,420 is estimated for every surviving baby with a birth weight lower than 1,170 grams. On the contrary, at term, newborns cost about €20,000 less than the diagnosis-related group reimbursement. The actual system benefits hospitals that mainly treat term infants with respiratory distress syndrome and penalizes hospitals taking care of very low birth weight patients. As a result, strategic behavior and "up-coding" might occur. We conduct a cluster analysis that suggests a birth weight adjustment to determine new fees that would be fairer than the current costs.


Assuntos
Grupos Diagnósticos Relacionados/economia , Unidades de Terapia Intensiva Neonatal/economia , Síndrome do Desconforto Respiratório do Recém-Nascido/economia , Feminino , Idade Gestacional , Custos Hospitalares/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso/fisiologia , Itália/epidemiologia , Tempo de Internação/economia , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Fatores de Risco
5.
Eur Rev Med Pharmacol Sci ; 24(14): 7804-7815, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32744708

RESUMO

OBJECTIVE: To evaluate the clinical manifestations and outcomes of neonates born to women who had Coronavirus Disease 2019 (COVID-19) during pregnancy. MATERIALS AND METHODS: A systematic literature search was conducted on PubMed and Embase till April 15, 2020, by combining the terms (COVID-19, Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2, Novel Coronavirus, 2019-nCov, Wuhan pneumonia) and (pregnancy, pregnant women, mother, fetus, neonate, newborn, infant). RESULTS: We included 16 case series and 12 case reports describing a total of 223 pregnant women and 201 infants. Four newborns born to mothers affected by COVID-19 were reported to have laboratory-confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection within 48 hours after birth. However, Reverse Transcription-Polymerase Chain Reaction tests of the breast milk, placenta, amniotic fluids, and cord blood and maternal vaginal secretions were all negative for SARS-CoV-2 in the reported cases. Fetal death was reported in two cases, and 48 of 185 newborns (25.9%) were born prematurely. Infants born small for gestational age and low birth weight (< 2,500 g) accounted for 8.3% and 15.6% of reported cases, respectively. Birth asphyxia and respiratory distress syndrome were observed in 1.8% and 6.4% of neonates, respectively. There was one neonatal death due to intractable gastric bleeding among the SARS-CoV-2-negative infants. CONCLUSIONS: Current evidence suggests that COVID-19 during pregnancy rarely affects fetal and neonatal mortality, but can be associated with adverse neonatal morbidities. Vertical transmission has not been observed in the majority of the reported cases. The infants born to mothers with COVID-19 are carefully monitored for accompanying complication, and quarantine of infected mothers is warranted.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Asfixia Neonatal/diagnóstico , Asfixia Neonatal/epidemiologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Mães , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Natimorto
6.
Hum Genet ; 139(10): 1273-1283, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32367404

RESUMO

Unlike disorders of primary cilium, primary ciliary dyskinesia (PCD) has a much narrower clinical spectrum consistent with the limited tissue distribution of motile cilia. Nonetheless, PCD diagnosis can be challenging due to the overlapping features with other disorders and the requirement for sophisticated tests that are only available in specialized centers. We performed exome sequencing on all patients with a clinical suspicion of PCD but for whom no nasal nitric oxide test or ciliary functional assessment could be ordered. Among 81 patients (56 families), in whom PCD was suspected, 68% had pathogenic or likely pathogenic variants in established PCD-related genes that fully explain the phenotype (20 variants in 11 genes). The major clinical presentations were sinopulmonary infections (SPI) (n = 58), neonatal respiratory distress (NRD) (n = 2), laterality defect (LD) (n = 6), and combined LD/SPI (n = 15). Biallelic likely deleterious variants were also encountered in AKNA and GOLGA3, which we propose as novel candidates in a lung phenotype that overlaps clinically with PCD. We also encountered a PCD phenocopy caused by a pathogenic variant in ITCH, and a pathogenic variant in CEP164 causing Bardet-Biedl syndrome and PCD presentation as a very rare example of the dual presentation of these two disorders of the primary and motile cilia. Exome sequencing is a powerful tool that can help "democratize" the diagnosis of PCD, which is currently limited to highly specialized centers.


Assuntos
Cílios/metabolismo , Transtornos da Motilidade Ciliar/genética , Predisposição Genética para Doença , Pneumonia/genética , Síndrome do Desconforto Respiratório do Recém-Nascido/genética , Sinusite/genética , Autoantígenos/genética , Cílios/patologia , Transtornos da Motilidade Ciliar/complicações , Transtornos da Motilidade Ciliar/diagnóstico , Transtornos da Motilidade Ciliar/patologia , Consanguinidade , Proteínas de Ligação a DNA/genética , Feminino , Expressão Gênica , Proteínas da Matriz do Complexo de Golgi/genética , Humanos , Masculino , Proteínas dos Microtúbulos/genética , Mutação , Proteínas Nucleares/genética , Linhagem , Fenótipo , Pneumonia/complicações , Pneumonia/diagnóstico , Pneumonia/patologia , Proteínas Repressoras/genética , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/patologia , Mucosa Respiratória/metabolismo , Mucosa Respiratória/patologia , Arábia Saudita , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/patologia , Fatores de Transcrição/genética , Ubiquitina-Proteína Ligases/genética , Sequenciamento Completo do Exoma
7.
Medicine (Baltimore) ; 99(12): e19650, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195974

RESUMO

RATIONALE: Mutations of the NKX2-1 gene are associated with brain-lung-thyroid syndrome, which is characterized by benign hereditary chorea, hypothyroidism, and pulmonary disease with variable presentation. Surfactant protein C (SFTPC) gene mutations result in chronic interstitial lung disease in adults or severe neonatal respiratory distress syndrome. PATIENT CONCERNS: Recurrent hypoxemia was observed shortly after birth in a baby at a gestational age of 40 weeks and birth weight of 3150 g. The need for respiratory support gradually increased. He had hypothyroidism and experienced feeding difficulties and irritability. DIAGNOSIS: Genetic examination of the peripheral blood revealed combined mutations of the NKX2-1 and SFTPC genes. INTERVENTIONS: The patient was administered respiratory support, antibiotics, low-dose dexamethasone, supplementary thyroxine, venous nutrition, and other supportive measures. OUTCOMES: The patient's guardian stopped treatment 3 months after commencement of treatment, due to the seriousness of his condition and the patient died. LESSONS: Combined mutations of NKX2-1 and SFTPC genes are very rare. Thus, idiopathic interstitial pneumonia with hypothyroidism and neurological disorders require special attention.


Assuntos
Atetose/genética , Coreia/genética , Hipotireoidismo Congênito/genética , Proteína C/metabolismo , Surfactantes Pulmonares/metabolismo , Síndrome do Desconforto Respiratório do Recém-Nascido/genética , Fator Nuclear 1 de Tireoide/genética , Atetose/sangue , Atetose/diagnóstico , Atetose/terapia , Coreia/sangue , Coreia/diagnóstico , Coreia/terapia , Hipotireoidismo Congênito/sangue , Hipotireoidismo Congênito/diagnóstico , Hipotireoidismo Congênito/terapia , Evolução Fatal , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/etiologia , Hipóxia/diagnóstico , Hipóxia/etiologia , Recém-Nascido , Cariotipagem , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Masculino , Mutação , Cuidados Paliativos/métodos , Recidiva , Síndrome do Desconforto Respiratório do Recém-Nascido/sangue , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
8.
PLoS One ; 15(2): e0228213, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32074108

RESUMO

INTRODUCTION: Previous studies of fetal effects have suggested that intrahepatic cholestasis of pregnancy is associated with a higher rate of adverse neonatal outcomes including preterm birth, neonatal respiratory distress syndrome, meconium-stained amniotic fluid, neonatal intensive care unit admission, and stillbirth. The objective was to compare the neonatal and maternal consequences in pregnancies affected by intrahepatic cholestasis and normal pregnancies. MATERIAL AND METHODS: This case-control study compares pregnancies affected by intrahepatic cholestasis (pruritus and bile acid ≥ 10 µmol/L) with low-risk pregnancies managed between December 2006 and December 2014 at a French university hospital center. RESULTS: There were 83 (59.3%) cases of mild cholestasis (10≤ BA ≤39 µmol/L), 46 (32.8%) of moderate cholestasis (40≤ BA ≤99 µmol/L), and 11 (7.9%) of severe cholestasis (BA ≥100 µmol/L). No in utero fetal deaths occurred in the 140 women with cholestasis or the 560 controls analyzed. The rate of respiratory distress syndrome was higher in neonates of women with intrahepatic cholestasis (17.1% vs. 4.6%, P<0.001; crude OR 4.46 (CI95% 2.49-8.03)). This risk was also significant after adjustment for gestational age at birth and mode of delivery, adjusted OR 2.56 (CI95%1.26-5.18). The postpartum hemorrhage rate was twice as high among the case mothers (25% versus 14.1% for controls, P = 0.002). CONCLUSION: After adjustment on the confounding factors we found a higher rate of respiratory distress syndrome and neonatal morbidity among neonates of the cholestasis group.


Assuntos
Colestase Intra-Hepática/diagnóstico , Resultado da Gravidez , Adulto , Ácidos e Sais Biliares/análise , Estudos de Casos e Controles , Colestase Intra-Hepática/patologia , Feminino , Idade Gestacional , Hemorragia/epidemiologia , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Razão de Chances , Mortalidade Perinatal , Período Pós-Parto , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Fatores de Risco , Índice de Gravidade de Doença
9.
Pediatr Emerg Care ; 35(12): 881-883, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31790074

RESUMO

Perforation of a Meckel diverticulum in a preterm neonate is very rare. To our knowledge, only 7 cases of spontaneous Meckel perforation in a preterm neonate have previously been described in the literature. The etiology is uncertain. We present the case of a 30-week preterm female twin with a spontaneous Meckel diverticulum perforation discovered on day 3 of life and review the published cases. A possible etiological explanation for this rare entity at this age group is also suggested.


Assuntos
Perfuração Intestinal/etiologia , Divertículo Ileal/complicações , Pneumoperitônio/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Anastomose Cirúrgica/métodos , Cesárea/métodos , Diagnóstico Diferencial , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Perfuração Intestinal/patologia , Apresentação no Trabalho de Parto , Laparotomia/métodos , Divertículo Ileal/patologia , Divertículo Ileal/cirurgia , Pneumoperitônio/etiologia , Gravidez , Radiografia/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Resultado do Tratamento , Gêmeos
10.
Rev Bras Ginecol Obstet ; 41(12): 688-696, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31856287

RESUMO

OBJECTIVE: To evaluate the association between early-onset fetal growth restriction (FGR), late-onset FGR, small for gestational age (SGA) and adequate for gestational age (AGA) fetuses and adverse perinatal outcomes. METHODS: This was a retrospective longitudinal study in which 4 groups were evaluated: 1 - early-onset FGR (before 32 weeks) (n = 20), 2 - late-onset FGR (at or after 32 weeks) (n = 113), 3 - SGA (n = 59), 4 - AGA (n = 476). The Kaplan-Meier curve was used to compare the time from the diagnosis of FGR to birth. Logistic regression was used to determine the best predictors of adverse perinatal outcomes in fetuses with FGR and SGA. RESULTS: A longer time between the diagnosis and birth was observed for AGA than for late FGR fetuses (p < 0.001). The model including the type of FGR and the gestational age at birth was significant in predicting the risk of hospitalization in the neonatal intensive care unit (ICU) (p < 0.001). The model including only the type of FGR predicted the risk of needing neonatal resuscitation (p < 0.001), of respiratory distress (p < 0.001), and of birth at < 32, 34, and 37 weeks of gestation, respectively (p < 0.001). CONCLUSION: Fetal growth restriction and SGA were associated with adverse perinatal outcomes. The type of FGR at the moment of diagnosis was an independent variable to predict respiratory distress and the need for neonatal resuscitation. The model including both the type of FGR and the gestational age at birth predicted the risk of needing neonatal ICU hospitalization.


Assuntos
Retardo do Crescimento Fetal/diagnóstico por imagem , Idade Gestacional , Recém-Nascido Pequeno para a Idade Gestacional , Cuidados Críticos , Feminino , Humanos , Estudos Longitudinais , Gravidez , Prognóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Ultrassonografia Pré-Natal
11.
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
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
15.
Semin Fetal Neonatal Med ; 24(6): 101039, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31645310

RESUMO

The majority of newborns transition to extra uterine life without support. However, respiratory emergencies in the delivery room are a common occurrence. Whilst some situations are predictable e.g. the anticipated birth of an extremely preterm infant, others are less so. In this chapter we address the most frequent scenarios that result in delivery room respiratory emergencies and discuss the latest recommendations for their management. We outline the need for a trained resuscitation team and appropriate equipment to provide respiratory support at every birth. We address the basic care that all infants should receive, the detailed application of non-invasive ventilation and the use of advanced airway techniques. We discuss the unique challenges presented by extreme prematurity including umbilical cord management, use of supplemental oxygen, initial modes of respiratory support and surfactant delivery. We will explore optimal techniques in the management of infants with lung hypoplasia, pneumothorax and meconium aspiration.


Assuntos
Salas de Parto/organização & administração , Emergências , Síndrome de Aspiração de Mecônio , Ventilação não Invasiva/métodos , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido , Manuseio das Vias Aéreas/métodos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Humanos , Lactente Extremamente Prematuro/fisiologia , Recém-Nascido , Síndrome de Aspiração de Mecônio/diagnóstico , Síndrome de Aspiração de Mecônio/fisiopatologia , Síndrome de Aspiração de Mecônio/terapia , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Ressuscitação/métodos
16.
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
17.
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
18.
Neonatal Netw ; 38(2): 80-87, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470370

RESUMO

PURPOSE: This evidence-based practice project evaluated the efficacy of a respiratory algorithm administered by specially trained transition nurses on the reduction of preventable NICU admissions for infants experiencing mild respiratory distress during transition. DESIGN: A retrospective chart review compared a cohort of newborn admission rates for seven months before and seven months after initiation of a respiratory algorithm. SAMPLE: Records of infants were included if they were born >35 weeks' gestation, had documented mild respiratory distress after birth, required <48 hours of noninvasive respiratory support, and had a length of stay less than four days. RESULTS: Ninety-six infants (before n = 34, after n = 62) were included. Before implementation of the respiratory algorithm, infants requiring noninvasive respiratory support were admitted to the NICU. Following implementation of the algorithm, NICU admissions for mild respiratory distress significantly decreased (86 percent), despite a concurrent increase in maternal acuity.


Assuntos
Manuseio das Vias Aéreas/enfermagem , Enfermagem Neonatal/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido , Terapia Respiratória/métodos , Algoritmos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Masculino , Avaliação de Resultados em Cuidados de Saúde , Gravidade do Paciente , Medicina Preventiva/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Estudos Retrospectivos
19.
Neonatal Netw ; 38(2): 98-106, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470372

RESUMO

BACKGROUND: VACTERL association is a sporadic, nonrandom series of congenital malformations diagnosed by the presence of three or more of the following: vertebral malformations, anal atresia, cardiac defects, tracheoesophageal fistula, renal malformations, and limb malformations. Situs inversus totalis (SIT) and esophageal malformations are rarely associated. This is the first reported case in North America of VACTERL association with SIT. IMPLICATIONS FOR PRACTICE: Respiratory distress in the term infant requires full exploration of all possible causes because the etiology may be far more complex than routinely diagnosed respiratory distress syndrome. This particular case demonstrates physical exam findings and supportive imaging that would be observed in infants with VACTERL association and with SIT, highlighting considerations when, rarely, both occur simultaneously.


Assuntos
Canal Anal/anormalidades , Esôfago/anormalidades , Cardiopatias Congênitas , Rim/anormalidades , Deformidades Congênitas dos Membros , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Situs Inversus , Coluna Vertebral/anormalidades , Traqueia/anormalidades , Assistência ao Convalescente/métodos , Canal Anal/fisiopatologia , Diagnóstico Diferencial , Esôfago/fisiopatologia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Recém-Nascido , Rim/fisiopatologia , Deformidades Congênitas dos Membros/complicações , Deformidades Congênitas dos Membros/diagnóstico , Deformidades Congênitas dos Membros/fisiopatologia , Deformidades Congênitas dos Membros/terapia , Triagem Neonatal/métodos , Administração dos Cuidados ao Paciente/métodos , Exame Físico/métodos , Radiografia Abdominal/métodos , Radiografia Torácica/métodos , Situs Inversus/complicações , Situs Inversus/diagnóstico , Situs Inversus/fisiopatologia , Situs Inversus/terapia , Coluna Vertebral/fisiopatologia , Traqueia/fisiopatologia , Doenças do Nervo Vestibulococlear/congênito , Doenças do Nervo Vestibulococlear/diagnóstico
20.
Neonatology ; 116(3): 211-226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31461712

RESUMO

Exogenous surfactant replacement is the most effective evidence-based therapy for respiratory distress syndrome in preterm infants. The mode of administration has evolved in the last decade towards less invasive techniques that aim to effectively provide an adequate dose of surfactant, while allowing spontaneous respiration to continue, and with the support of continuous positive airway pressure. Surfactant delivery via aerosolisation, pharyngeal instillation, and laryngeal mask are being actively pursued in research, but have not yet been adopted to any significant degree in clinical practice. Surfactant administration via thin catheter, on the other hand, is becoming more widely used in neonatal intensive care units worldwide and is now an acknowledged alternative to the standard mode of surfactant delivery. Different devices, including nasogastric tubes, vascular catheters, and purpose-built surfactant instillation catheters are used. We present here a contemporary review of surfactant administration via thin catheter, in a practical guide format that reflects the individual and collective scientific opinions of the clinicians who participated in formulating the guide.


Assuntos
Cateterismo/instrumentação , Cateteres , Pulmão/efeitos dos fármacos , Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Cateterismo/efeitos adversos , Desenho de Equipamento , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Pulmão/fisiopatologia , Surfactantes Pulmonares/efeitos adversos , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Resultado do Tratamento
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