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1.
Niger Postgrad Med J ; 26(4): 239-243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621665

RESUMO

Background: Congenital anomalies (CAs) refer to defects that are present in a newborn but occurred during intrauterine life. They can be due to genetic, modifiable environmental or multifactorial causes. There was no prior report of their burden in our state. Aims: This study aims to describe the incidence, spectrum, predisposing factors and outcome of CAs in our setting. Methods: It was a total population study of all neonates with major birth defects admitted into the unit during the study period. Their clinical-demographic features, diagnoses and outcome were entered into an excel sheet. Clinical detection of birth defects was based on standard diagnostic criteria. The data were analysed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Patterns and outcome of birth defects were presented as proportions. Selected characteristics were tested for possible association with birth defect using Fisher's exact test. The level of significance was set at P < 0.05. Results: The incidence of major CAs was 4.3/1000 live births. Female neonates were more affected (59.0%). Participants' mean gestational age was 37.7 ± 3.3 weeks. Central nervous system anomalies were the most common (38.5%) birth defects. These were followed by musculoskeletal, body wall and digestive system anomalies: 28.2%, 23.1% and 10.3%, respectively. One-third (33.3%) of the infants had multiple anomalies. Nearly three quarters of them (74.0%) were referred, 18.0% died while 5.0% were discharged alive. Conclusion: A wide range of CAs occur in our setting with dire consequences. Provision of relevant specialised multidisciplinary care is desirable. Furthermore, pubic enlightenment on its modifiable possible causes can reduce the burden.


Assuntos
Sistema Nervoso Central/anormalidades , Anormalidades Congênitas/epidemiologia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano , Criança , Anormalidades Congênitas/classificação , Estudos Transversais , Anormalidades do Sistema Digestório/epidemiologia , Feminino , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Anormalidades Musculoesqueléticas/epidemiologia , Nigéria/epidemiologia
2.
Lancet ; 394(10204): 1181-1190, 2019 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-31472930

RESUMO

BACKGROUND: In women with late preterm pre-eclampsia, the optimal time to initiate delivery is unclear because limitation of maternal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether planned earlier initiation of delivery reduces maternal adverse outcomes without substantial worsening of neonatal or infant outcomes, compared with expectant management (usual care) in women with late preterm pre-eclampsia. METHODS: In this parallel-group, non-masked, multicentre, randomised controlled trial done in 46 maternity units across England and Wales, we compared planned delivery versus expectant management (usual care) with individual randomisation in women with late preterm pre-eclampsia from 34 to less than 37 weeks' gestation and a singleton or dichorionic diamniotic twin pregnancy. The co-primary maternal outcome was a composite of maternal morbidity or recorded systolic blood pressure of at least 160 mm Hg with a superiority hypothesis. The co-primary perinatal outcome was a composite of perinatal deaths or neonatal unit admission up to infant hospital discharge with a non-inferiority hypothesis (non-inferiority margin of 10% difference in incidence). Analyses were by intention to treat, together with a per-protocol analysis for the perinatal outcome. The trial was prospectively registered with the ISRCTN registry, ISRCTN01879376. The trial is closed to recruitment but follow-up is ongoing. FINDINGS: Between Sept 29, 2014, and Dec 10, 2018, 901 women were recruited. 450 women (448 women and 471 infants analysed) were allocated to planned delivery and 451 women (451 women and 475 infants analysed) to expectant management. The incidence of the co-primary maternal outcome was significantly lower in the planned delivery group (289 [65%] women) compared with the expectant management group (338 [75%] women; adjusted relative risk 0·86, 95% CI 0·79-0·94; p=0·0005). The incidence of the co-primary perinatal outcome by intention to treat was significantly higher in the planned delivery group (196 [42%] infants) compared with the expectant management group (159 [34%] infants; 1·26, 1·08-1·47; p=0·0034). The results from the per-protocol analysis were similar. There were nine serious adverse events in the planned delivery group and 12 in the expectant management group. INTERPRETATION: There is strong evidence to suggest that planned delivery reduces maternal morbidity and severe hypertension compared with expectant management, with more neonatal unit admissions related to prematurity but no indicators of greater neonatal morbidity. This trade-off should be discussed with women with late preterm pre-eclampsia to allow shared decision making on timing of delivery. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Cesárea , Trabalho de Parto Induzido , Pré-Eclâmpsia/terapia , Nascimento Prematuro , Adulto , Pressão Sanguínea , Parto Obstétrico/métodos , Gerenciamento Clínico , Inglaterra , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação , Morte Materna , Morbidade , Morte Perinatal , Gravidez , País de Gales , Adulto Jovem
3.
PLoS Med ; 16(8): e1002866, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31386658

RESUMO

BACKGROUND: Women who undergo bariatric surgery prior to pregnancy are less likely to experience comorbidities associated with obesity such as gestational diabetes and hypertension. However, bariatric surgery, particularly malabsorptive procedures, can make patients susceptible to deficiencies in nutrients that are essential for healthy fetal development. The objective of this systematic review and meta-analysis is to investigate the association between pregnancy after bariatric surgery and adverse perinatal outcomes. METHODS AND FINDINGS: Searches were conducted in Medline, Embase, PsycINFO, CINAHL, Scopus, and Google Scholar from inception to June 2019, supplemented by hand-searching reference lists, citations, and journals. Observational studies comparing perinatal outcomes post-bariatric surgery to pregnancies without prior bariatric surgery were included. Outcomes of interest were perinatal mortality, congenital anomalies, preterm birth, postterm birth, small and large for gestational age (SGA/LGA), and neonatal intensive care unit (NICU) admission. Pooled effect sizes were calculated using random-effects meta-analysis. Where data were available, results were subgrouped by type of bariatric surgery. We included 33 studies with 14,880 pregnancies post-bariatric surgery and 3,979,978 controls. Odds ratios (ORs) were increased after bariatric surgery (all types combined) for perinatal mortality (1.38, 95% confidence interval [CI] 1.03-1.85, p = 0.031), congenital anomalies (1.29, 95% CI 1.04-1.59, p = 0.019), preterm birth (1.57, 95% CI 1.38-1.79, p < 0.001), and NICU admission (1.41, 95% CI 1.25-1.59, p < 0.001). Postterm birth decreased after bariatric surgery (OR 0.46, 95% CI 0.35-0.60, p < 0.001). ORs for SGA increased (2.72, 95% CI 2.32-3.20, p < 0.001) and LGA decreased (0.24, 95% CI 0.14-0.41, p < 0.001) after gastric bypass but not after gastric banding. Babies born after bariatric surgery (all types combined) weighed over 200 g less than those born to mothers without prior bariatric surgery (weighted mean difference -242.42 g, 95% CI -307.43 to -177.40 g, p < 0.001). There was low heterogeneity for all outcomes (I2 < 40%) except LGA. Limitations of our study are that as a meta-analysis of existing studies, the results are limited by the quality of the included studies and available data, unmeasured confounders, and the small number of studies for some outcomes. CONCLUSIONS: In our systematic review of observational studies, we found that bariatric surgery, especially gastric bypass, prior to pregnancy was associated with increased risk of some adverse perinatal outcomes. This suggests that women who have undergone bariatric surgery may benefit from specific preconception and pregnancy nutritional support and increased monitoring of fetal growth and development. Future studies should explore whether restrictive surgery results in better perinatal outcomes, compared to malabsorptive surgery, without compromising maternal outcomes. If so, these may be the preferred surgery for women of reproductive age. TRIAL REGISTRATION: PROSPERO CRD42017051537.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Resultado da Gravidez/epidemiologia , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Mortalidade Perinatal , Gravidez
4.
Ethiop J Health Sci ; 29(3): 333-342, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31447501

RESUMO

Background: Globally, sepsis remains one of the major causes of morbidity and mortality in neonates, in spite of recent advances in health care units. The major burden of the problem occurs in the developing world while most evidence is derived from developed countries. The objective of this study was to evaluate the epidemiology of neonatal sepsis and associated factors among neonates admitted to Neonatal Intensive Care Unit (NICU). Methods: Hospital based prospective cross-sectional study was conducted from April 2016 to May 2017. Neonates with clinical sepsis were included into the study. Data were analyzed using SPSS version 20. Frequencies, proportion and summary statistics were used to describe the study population in relation to relevant variables. Multivariate logistic regressions were used to assess factors associated with neonatal sepsis. p-values of < 0.05 were considered statistically significant. Results: A total of 901neonates were admitted to NICU of which 303 neonates were admitted with diagnosis of clinical sepsis making the prevalence of neonatal sepsis to be 34%. Bacteremia were confirmed in 88/303(29.3%) of clinical sepsis, and gram-positive bacteria constituted 47/88(53.4%). Of all positive blood cultures, 52/88(59.1%) were reported from late onset sepsis. Coagulase negative staphylococcus (CoNS) accounted for 22/88(25%) followed by E. coli and S. aureus, each contributing 18/88(20.3%) and 16/88(18.2%) respectively. Prolonged PROM, low fifth Apgar score, prematurity and low birth weight were strongly associated with increased risk of neonatal sepsis. Neonates born to mothers who received antibiotics during labor and delivery were at significantly lower risk of acquiring neonatal sepsis. Conclusion: The prevalence of neonatal sepsis was high, and most causes of neonatal sepsis were gram positive bacteria and most bacteria isolates were from late onset sepsis. Obstetric factors were strongly associated with development of neonatal sepsis. Intrapartal antibiotic administration significantly reduces neonatal sepsis.


Assuntos
Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Sepse Neonatal/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Sepse Neonatal/etiologia , Estudos Prospectivos , Fatores de Risco
5.
BMC Ophthalmol ; 19(1): 189, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429728

RESUMO

BACKGROUND: Severe Retinopathy of Prematurity (ROP) is a serious vasoproliferative disorder that can affect extremely premature infants. It continues to be one of the most important preventable causes of blindness in children. Our study is aimed at finding the incidence of ROP and its association with some risk factors in Palestine. METHODS: From the 1st of January 2016 to 31st December 2016, a total number of 115 infants who met the criteria for ROP screening in three neonatal intensive care units were included in the study. The medical records of infants were reviewed retrospectively and multiple factors that may be associated with the development of ROP were collected manually. RESULTS: The incidence of ROP and severe type 1 ROP that require treatment was 23.5 and 11.3% respectively. After conducting univariate analysis of risk factors, statistically significant risk factors affecting the development of ROP in our study were: low gestational age, low birth weight, type of multiple gestation, the presence of affected sibling, low level of Hemoglobin at birth, respiratory distress syndrome, low Hemoglobin level, blood transfusion and days on oxygen supplements with either mechanical, non-mechanical methods or both combined. High bilirubin levels were found as a protective factor against the development of ROP. However, when a multivariate analysis was performed, only low gestational age, total days on oxygen supplement and high bilirubin levels were significant regarding the development of ROP. CONCLUSION: The incidence of ROP is considered a relatively low percentage compared to neighboring countries that have higher levels of human development index. Statistically significant risk factors need to be considered when clinicians deal with premature infants.


Assuntos
Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Retinopatia da Prematuridade , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Oriente Médio/epidemiologia , Análise Multivariada , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/etiologia , Estudos Retrospectivos , Fatores de Risco
6.
BMC Health Serv Res ; 19(1): 586, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426785

RESUMO

BACKGROUND: A number of parents in neonatal care are foreign-born and do not speak the local language, which makes communication between healthcare professionals and parents more difficult. Interpreters can be used when language barriers exist - parent interactions, medical communication and communication about the care of the child. The aim in this study was to examine healthcare professionals' use of interpreters and awareness of local guidelines for interpreted communication in neonatal care. METHOD: A survey was distributed to all 2109 employees at all 38 neonatal units in Sweden, thus to all physicians, registered nurses and nurse assistants in active service. Data were analysed with descriptive statistics and dichotomized so the professionals were compared in groups of two using the Mantel-Haenszel Chi Square test and Fisher's Non Parametric Permutation test. RESULTS: The survey was answered by 41% (n = 858) representing all neonatal units. The study showed a difference between the professional groups in awareness of guidelines, availability of interpreters, and individual resources to communicate through an interpreter. Nurse assistants significantly lesser than registered nurses (p < .0001) were aware of guidelines concerning the use of interpreters. In emergency communications nurse assistants used authorized interpreters to a significantly lesser extent than physicians (p < .0001) and registered nurses (p < .0001). Physicians used authorized interpreters to a significantly higher extent than registered nurses (p 0.006) and non-authorized interpreters to a significantly lesser extent than registered nurses (p 0.013). In planned communications, nurse assistants used authorized interpreters to a significantly lesser extent than physicians (p < .0001) and registered nurses (p < .0001). Nurse assistants rated their ability to communicate with parents through an interpreter to a significantly lesser extent than physicians (p 0.0058) and registered nurses (p 0.0026). No other significant differences were found. CONCLUSION: The results of the study show insufficient awareness of guidelines in all neonatal units in Sweden. Clinical implications might be to provide healthcare professionals with guidelines and training clinical skills in using interpreters and increasing the availability of interpreters by having interpreters employed by the hospital.


Assuntos
Barreiras de Comunicação , Comunicação , Assistência Perinatal/métodos , Relações Médico-Paciente , Tradução , Adulto , Idoso , Pessoal Técnico de Saúde , Competência Clínica/normas , Estudos Transversais , Assistência à Saúde/normas , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/normas , Terapia Intensiva Neonatal/estatística & dados numéricos , Linguagem , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Assistência Perinatal/normas , Médicos/estatística & dados numéricos , Inquéritos e Questionários , Suécia
7.
Rev Lat Am Enfermagem ; 27: e3167, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432920

RESUMO

OBJECTIVE: analyze the safety culture of multidisciplinary teams from three neonatal intensive care units of public hospitals in Minas Gerais, Brazil. METHOD: a cross-sectional survey conducted with 514 health professionals, using the Hospital Survey on Patient Safety Culture; data were subjected to a descriptive statistical analysis in software R-3.3.2. RESULTS: the findings showed that none of the dimensions had a positive response score above 75% to be considered as a strength area. The dimension 'Nonpunitive response to error' was classified as a critical area of the patient safety culture, present in 55.45% of the responses. However, areas with potential for improvements were identified, such as 'Teamwork within units' (59.44%) and 'Supervisor/manager's expectations and actions to promote patient safety' (49.90%). CONCLUSION: none of the dimensions was considered as a strength area, which indicates safety culture has not been fully implemented in the evaluated units. A critical look at the weaknesses of the patient safety process is recommended in order to seek strategies for the adoption of a positive safety culture to benefit patients, family members and health professionals.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Feminino , Hospitais Públicos/normas , Humanos , Unidades de Terapia Intensiva Neonatal/normas , Masculino , Cultura Organizacional , Equipe de Assistência ao Paciente/normas , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Gestão da Segurança/normas , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
8.
Medicine (Baltimore) ; 98(32): e15837, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393341

RESUMO

Peripherally inserted central catheters (PICCs) can provide nutritional and medical support for very low birth weight or critically ill newborns. The aim of this study was to retrospectively analyze the use of PICCs in our clinic for critically ill newborns to evaluate the relationship between catheter related factors and the occurrence of complications.Retrospective analysis was conducted for all newborns consecutively admitted at the Neonatal Intensive Care Unit (NICU), Chongqing Health Center for Women and Children, who underwent PICC insertion between May 2011 and March 2018. Data collected included total puncture success rate, one puncture success rate, infection rate, complication rate, unplanned catheter withdrawal rate, device days, and catheter indwelling time.Five-hundred eighty-eight infants (304 males and 284 females) aged 3.4 ±â€Š3.9 days, mean gestational age of 30.9 ±â€Š2.7 weeks and a mean body mass of 1.38 ±â€Š0.47 kg at insertion were included. Total puncture success rate was 99.65%, one puncture success rate was 77.77%. The mean catheter retention was 13.6 ±â€Š6.7 days: more than 30 days in 15 (2.61%) cases, 20 to 30 days in 60 (10.43%) cases, 10 to 19 days in 372 (64.70%) cases, and 62 days in 1 case. Complications occurred in 63 (10.71%) cases: with PICC insertion within 24 hours after birth in 29 (15.43%), within 48 hours in 13 (6.63%), and after 48 hours in 21 (10.99%) cases. Catheter tip culture was positive in 3 cases and there was 1 case of catheter-related bloodstream infection.Nursing measures of the maintenance of body temperature and the evaluation of blood vessels were important conditions for improving the success rate of one puncture in critically ill neonates. PICC catheterization as early as 48 hours will not increase the difficulty of PICC puncture. Nor did it increase the incidence of PICC complications.


Assuntos
Cateterismo Periférico/estatística & dados numéricos , Cateteres de Demora/estatística & dados numéricos , Estado Terminal , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Estudos Retrospectivos
9.
Lancet ; 394(10201): 849-860, 2019 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-31378395

RESUMO

BACKGROUND: Intrahepatic cholestasis of pregnancy, characterised by maternal pruritus and increased serum bile acid concentrations, is associated with increased rates of stillbirth, preterm birth, and neonatal unit admission. Ursodeoxycholic acid is widely used as a treatment without an adequate evidence base. We aimed to evaluate whether ursodeoxycholic acid reduces adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy. METHODS: We did a double-blind, multicentre, randomised placebo-controlled trial at 33 hospital maternity units in England and Wales. We recruited women with intrahepatic cholestasis of pregnancy, who were aged 18 years or older and with a gestational age between 20 weeks and 40 weeks and 6 days, with a singleton or twin pregnancy and no known lethal fetal anomaly. Participants were randomly assigned 1:1 to ursodeoxycholic acid or placebo, given as two oral tablets a day at an equivalent dose of 500 mg twice a day. The dose could be increased or decreased at the clinician's discretion, to a maximum of four tablets and a minimum of one tablet a day. We recommended that treatment should be continued from enrolment until the infant's birth. The primary outcome was a composite of perinatal death (in-utero fetal death after randomisation or known neonatal death up to 7 days after birth), preterm delivery (<37 weeks' gestation), or neonatal unit admission for at least 4 h (from birth until hospital discharge). Each infant was counted once within this composite. All analyses were done according to the intention-to-treat principle. The trial was prospectively registered with the ISRCTN registry, number 91918806. FINDINGS: Between Dec 23, 2015, and Aug 7, 2018, 605 women were enrolled and randomly allocated to receive ursodeoxycholic acid (n=305) or placebo (n=300). The primary outcome analysis included 304 women and 322 infants in the ursodeoxycholic acid group, and 300 women and 318 infants in the placebo group (consent to use data was withdrawn for 1 woman and 2 infants). The primary composite outcome occurred in 74 (23%) of 322 infants in the ursodeoxycholic acid group and 85 (27%) of 318 infants in the placebo group (adjusted risk ratio 0·85 [95% CI 0·62-1·15]). Two serious adverse events were reported in the ursodeoxycholic acid group and six serious adverse events were reported in the placebo group; no serious adverse events were regarded as being related to treatment. INTERPRETATION: Treatment with ursodeoxycholic acid does not reduce adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy. Therefore, its routine use for this condition should be reconsidered. FUNDING: National Institute for Health Research Efficacy and Mechanism Evaluation Programme.


Assuntos
Colagogos e Coleréticos/administração & dosagem , Colestase Intra-Hepática/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Ácido Ursodesoxicólico/administração & dosagem , Administração Oral , Adulto , Alanina Transaminase/sangue , Ácidos e Sais Biliares/sangue , Biomarcadores/sangue , Colestase Intra-Hepática/sangue , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Nascimento Vivo/epidemiologia , Morte Perinatal/prevenção & controle , Gravidez , Complicações na Gravidez/sangue , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Prurido/prevenção & controle , Natimorto/epidemiologia
10.
Med Arch ; 73(2): 92-96, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391694

RESUMO

Introduction: It is known for many years, that grand multiparity is associated with poor pregnancy outcome with or without considering increasing maternal age. Aim: To examine the impact of grand multiparity on pregnancy outcome in young women aged 18-34 years (Young grand multiparas). Material and Methods: A prospective comparative cross-sectional study conducted at Omdurman Maternity Hospital, Sudan from January to September 2018. A standard questionnaire was used to gather data on pregnancy outcome in the low-risk group, grand multiparas age < 35 years and grand multiparas age ≥ 35 years. The association between variables was tested with Chi-square test. Results: Young grand multiparas have a significant risk of PPH and increased length of hospital stay => 3 days and babies born to young grand multiparas women were more likely of low birth weight and have a higher rate of admission to NICU. Young grand multiparas were similar in their maternal and fetal complication to low-risk pregnancies and significantly less in several complications when compared to older grand multiparas women. Conclusion: Young grand multiparas are less likely to develop several pregnancy complications compared to older grand multiparas women. The occurrences of intra-partum complications match that in low-risk pregnancy.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Extração Obstétrica/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Idade Materna , Paridade , Hemorragia Pós-Parto/epidemiologia , Adolescente , Adulto , Índice de Apgar , Estudos Transversais , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Sudão/epidemiologia , Adulto Jovem
11.
Clin Lab ; 65(7)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31307181

RESUMO

BACKGROUND: Neonatal sepsis represents one of the common diseases in the neonatal intensive care unit. Here we aim to evaluate the differences between a group of preterm newborns with sepsis and a control group in relation to clinical and laboratory variables. In addition, our goal is to establish potential predictors of early-onset sepsis (EOS) and late-onset sepsis (LOS). METHODS: The study included 113 preterm newborns with sepsis (EOS-63.72%/LOS-36.28%). Laboratory deter-minations included full blood count, CRP, biochemical determinations, blood culture. RESULTS: The most important univariate neonatal predictors were gestational age (p < 0.001), surfactant adminis-tration (p < 0.001), mechanical ventilation (p < 0.001), heart failure (p < 0.001), a history of hypocalcemia (p = 0.037), Apgar score at 1 minute lower than 7 (p = 0.001), birth weight < 1,500 g (p = 0.005), number of hospi-talization days (p = 0.048), and number of weight recovery days < 10 (p < 0.05). The WBC and CRP parameters remained significant univariate predictors of sepsis on day 7 (p = 0.002; OR = 2.01 per 10,000 mm3 increase of WBC, 95% CI: (1.30; 3.09) and p = 0.001; OR = 4.27, 95% CI: (1.85; 9.88), respectively). Logistic regression anal-ysis showed maternal urinary tract infection (OR = 3.05), heart failure (OR = 5.28), the number of hospitalization days (OR = 1.09) and CRP (OR = 3.26) were significant independent risk factors for neonatal sepsis in preterms. The univariate predictors of EOS were gestational age (p = 0.002), birth weight (p = 0.014), 1-minute Apgar score (p = 0.012), maternal urinary tract infection (p = 0.008), surfactant administration (p < 0.001), heart failure (p < 0.001), and CRP level (p < 0.001). Surfactant administration (OR = 6.73) and CRP level (OR = 3.51) represent predictors of EOS in preterms according to the multivariate model. The univariate predictors of LOS were gesta-tional age (p = 0.001), birth weight (p = 0.048), 1-minute Apgar score (p = 0.001), surfactant administration (p < 0.001), hypocalcemia (p = 0.03), heart failure (p = 0.003), CRP level (p < 0.001), mechanical ventilation (p < 0.001), and the number of hospitalization days (p < 0.001). In the multivariate model, the number of hospitali-zation days (OR = 1.11) and heart failure (OR = 5.98) are independent predictors for LOS in preterms. CONCLUSIONS: The study confirms the presence of maternal urinary tract infection, hospitalization days, heart fail-ure, and CRP level as predictors of neonatal sepsis in preterms with differences between EOS and LOS.


Assuntos
Doenças do Recém-Nascido/diagnóstico , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Sepse/diagnóstico , Centros de Atenção Terciária/estatística & dados numéricos , Idade de Início , Proteína C-Reativa/análise , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Complicações Infecciosas na Gravidez , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Sepse/complicações , Infecções Urinárias/complicações
12.
Ann Clin Microbiol Antimicrob ; 18(1): 20, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269955

RESUMO

BACKGROUND: Despite their critical role in antimicrobial stewardship programs, data on antimicrobial consumption among the pediatric and neonatal population is limited internationally and lacking in Saudi Arabia. The current study was done as part of our antimicrobial stewardship activities. OBJECTIVES: To calculate overall and type-specific antimicrobial consumption. METHODS: A prospective surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in two pediatric and one neonatal intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as days of therapy (DOT) per 1000 patient-days and as frequency of daily consumption. RESULTS: During the 33 months of the study, a total of 30,110 DOTs were monitored during 4921 admissions contributing 62,606 patient-days. Cephalosporins represented 38.0% of monitored antimicrobials in pediatric ICUs followed by vancomycin (21.9%), carbapenems (14.0%), aminoglycosides (8.8%), and piperacillin/tazobactam (8.8%). Their consumption rates were 265.1, 152.6, 97.6, 61.4, and 61.4 DOTs per 1000 patient-days (respectively). Aminoglycosides represented 45.4% of monitored antimicrobials in neonatal ICU followed by cephalosporins (30.4%) vancomycin (13.6%), and carbapenems (8.3%). Their consumption rates were 147.5, 98.7, 44.3, and 27 DOTs per 1000 patient-days (respectively). CONCLUSION: Cephalosporins are frequently used in pediatric ICU while aminoglycosides are frequently used in neonatal ICU. The local consumption of cephalosporins and carbapenems in both ICUs is probably higher than international levels. Such data can help in establishing and monitoring the functions of antimicrobial stewardship activities aiming to ensure judicious consumption of antimicrobials.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Adolescente , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Carbapenêmicos/uso terapêutico , Cefalosporinas/uso terapêutico , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Monitoramento Epidemiológico , Feminino , Humanos , Lactente , Masculino , Pediatria/estatística & dados numéricos , Estudos Prospectivos , Arábia Saudita/epidemiologia , Vancomicina/uso terapêutico
13.
Rev Bras Enferm ; 72(3): 617-623, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269124

RESUMO

OBJECTIVE: To analyze cost-effectiveness and to calculate incremental cost-effectiveness ratio of the use of infusion pumps with drug library to reduce errors in intravenous drug administration in pediatric and neonatal patients in Intensive Care Units. METHODS: Mathematical modeling for economic analysis of the decision tree type. The base case was composed of reference and alternative settings. The target population was neonates and pediatric patients hospitalized in Pediatric and Neonatal Intensive Care Units, comprising a cohort of 15,034 patients. The cost estimate was based on the bottom-up and top-down approaches. RESULTS: The decision tree, after RollBack, showed that the infusion pump with drug library may be the best strategy to avoid errors in intravenous drugs administration. CONCLUSION: The analysis revealed that the conventional pump, although it has the lowest cost, also has lower effectiveness.


Assuntos
Bombas de Infusão/economia , Bombas de Infusão/normas , Erros de Medicação/prevenção & controle , Administração Intravenosa/métodos , Administração Intravenosa/normas , Brasil , Análise Custo-Benefício , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/organização & administração , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Erros de Medicação/economia , Erros de Medicação/enfermagem , Método de Monte Carlo , Avaliação da Tecnologia Biomédica/métodos
14.
Indian J Public Health ; 63(2): 128-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219061

RESUMO

Background: To reduce neonatal mortality in North Bihar, evidence is required about the impact of sick newborn care units (SNCUs) in secondary level hospitals on mortality at the end of the neonatal period. Objectives: The objective of the study is to assess the profile of neonates admitted to an SNCU and the outcome at the completion of neonatal period. Methods: A cohort of neonates admitted from March to June 2014 to an SNCU was assessed through family interviews and hospital records. Demographic details (age, sex, and socioeconomic status) and clinical details (antenatal care, birthplace, weight, diagnosis, and family history) were documented. Follow-up was done at discharge or death or referral and the completion of neonatal period. The primary outcome was survival at the completion of neonatal period. Secondary outcomes were case fatality rate at discharge and weight gain. Results: Of 210 neonates assessed, 87.6% (95% confidence interval [CI] 82.4-91.4) survived till the end of the neonatal period. The case fatality rate at the time of discharge was 0.9% (95% CI 0.3-3.4). Majority of the diagnoses were infections, hyperbilirubinemia, and infant of diabetic mother. Mean weight gain at the end of neonatal period (n = 157) was 706 g (P = 0.00). Sex ratio at admission was 567 girls to 1000 boys (95% CI 428/1000-751/1000). No neonate from lower socioeconomic families was admitted. Conclusions: SNCUs in remote areas can bring down neonatal mortality in North Bihar. Unequal access of SNCUs services to girls and lower socioeconomic groups highlighted the existing barriers which require attention.


Assuntos
Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/mortalidade , Masculino , Admissão do Paciente/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Resultado do Tratamento
15.
Indian J Public Health ; 63(2): 147-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219065

RESUMO

The mobile phones have become an inevitable part of life for communication everywhere. Hospital-acquired infections are causing increased morbidity and mortality of hospitalized patients. After getting approval from the institutional review board, a total of 300 samples from mobile phones and dominant hands of resident doctors, nurses, and support staff working in neonatal intensive care unit, pediatric intensive care unit, intensive care unit, and emergency ward were tested according to standard guidelines for culture. Of 300 samples tested, 144 (96%) mobile phones and 145 (96.66%) dominant hands showed contamination with one or more types of microorganisms. Monomicrobial organisms were recovered from 247 samples and polymicrobial organisms were isolated from 42 samples. Mobile phones and hands of helath care workers serve as a potential reservoir for hospital acquired infections as multi-drug resistant pathogenic bacteria as well as normal flora of skin were recovered.


Assuntos
Telefone Celular , Mãos/microbiologia , Microbiota , Centros de Atenção Terciária/estatística & dados numéricos , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Contaminação de Equipamentos/estatística & dados numéricos , Humanos , Índia , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos
16.
Surgery ; 165(6): 1234-1242, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31056199

RESUMO

BACKGROUND: Congenital anomalies are the leading cause of infant death and pediatric hospitalization, but existing estimates of the associated costs of health care are either cross-sectional surveys or economic projections. We sought to determine the percent of total hospital health care expenditures attributable to major anomalies requiring surgery within the first year of life. METHODS: Utilizing comprehensive California statewide data from 2008 to 2012, cohorts of infants undergoing major surgery, with birth defects and with surgical anomalies, were constructed alongside a referent group of newborns with no anomalies or operations. Cost-to-charge and physician fee ratios were used to estimate hospital and professional costs, respectively. For each cohort, costs were broken down according to admission, birth episode, and first year of life, with additional stratifications by birth weight, gestational age, and organ system. RESULTS: In total, 68,126 of 2,205,070 infants (3.1%) underwent major surgery (n = 32,614) or had a diagnosis of a severe congenital anomaly (n = 57,793). These accounted for $7.7 billion of the $18.9 billion (40.7%) of the total health care costs/expenditures of the first-year-of-life hospitalizations, $7.0 billion (48.6%) of the costs for infants with comparatively long birth episodes, and $5.2 billion (54.7%) of the total neonatal intensive care unit admission costs. Infants with surgical anomalies (n = 21,264) totaled $4.1 billion (21.7%) at $80,872 per infant. Cardiovascular and gastrointestinal diseases accounted for most admission costs secondary to major surgery or congenital anomalies. CONCLUSION: In a population-based cohort of infant births compared with other critically ill neonates, surgical congenital anomalies are disproportionately costly within the United States health care system. The care of these infants, half of whom are covered by Medi-Cal or Medicaid, stands as a particular focus in an age of reform of health care payments.


Assuntos
Anormalidades Congênitas/economia , Anormalidades Congênitas/cirurgia , Utilização de Instalações e Serviços/economia , Gastos em Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , California , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Armazenamento e Recuperação da Informação , Unidades de Terapia Intensiva Neonatal/economia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/economia , Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino
17.
Eur J Pediatr ; 178(7): 1023-1032, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31056716

RESUMO

This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH. What is Known: • Admission hypothermia is associated with early neonatal death. • The association of admission hypothermia with major neonatal morbidities has not been fully established. What is New: • Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates. • Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.


Assuntos
Hipotermia/mortalidade , Mortalidade Infantil , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Brasil/epidemiologia , Enterocolite Necrosante/mortalidade , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Recém-Nascido de muito Baixo Peso , Estudos Prospectivos , Fatores de Proteção , Estudos Retrospectivos , Índice de Gravidade de Doença
18.
J Perinat Med ; 47(6): 677-679, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31091197

RESUMO

Objective To assess the effect of fetal gender in small-for-gestational age (SGA) neonates with birth weight less than the fifth percentile by gestational age. Methods We compared male and female SGA neonates for maternal and neonatal outcomes in the following gestational age subgroups: at <32 + 6, 33 + 0-36 + 6 and at ≥37 + 0 weeks of gestation. Results We examined 159, 154 and 2363 SGA neonates born at <32 + 6, 33 + 0 to 36 + 6 and ≥37 weeks of pregnancy, respectively, whose birth weight was below the fifth percentile for gestational age and who met our inclusion criteria. Overall, there were no significant differences between the mothers of males and females, except that there were more males at term and the incidence of nulliparas was greater among the mothers of males. In terms of outcomes, males had a similar incidence of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) and admissions to intensive care. Interestingly, low Apgar scores were more common in preterm females born at 33-37 weeks and vice versa in births over 37 weeks. Conclusion Our data do not support an advantage of either gender in preterm birth of infants who are most likely growth restricted.


Assuntos
Hemorragia Cerebral Intraventricular/epidemiologia , Retardo do Crescimento Fetal , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Fatores Sexuais , Índice de Apgar , Peso ao Nascer , Croácia/epidemiologia , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Paridade , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Medição de Risco
19.
Ultrasound Obstet Gynecol ; 54(1): 79-86, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31100188

RESUMO

OBJECTIVE: To investigate the potential value of uterine artery pulsatility index (UtA-PI) and serum levels of the angiogenic placental growth factor (PlGF) and the antiangiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1) in the prediction of adverse perinatal outcome in small-for-gestational-age (SGA) and non-SGA neonates at 35-37 weeks' gestation. METHODS: This was a prospective observational study of 19 209 singleton pregnancies attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, sonographic estimation of fetal weight, color Doppler ultrasound for measurement of mean UtA-PI, and measurement of serum concentrations of PlGF and sFlt-1. Multivariable logistic regression analysis was carried out to determine which of the factors from maternal or pregnancy characteristics and measurements of UtA-PI, PlGF and sFlt-1 provided a significant contribution in the prediction of each of four adverse outcome measures: first, stillbirth; second, Cesarean delivery for suspected fetal compromise in labor; third, neonatal death or hypoxic ischemic encephalopathy Grade 2 or 3; and, fourth, admission to the neonatal unit (NNU) for ≥ 48 h. Predicted probabilities from logistic regression analysis were used to construct receiver-operating characteristics curves to assess the performance of screening for these adverse outcomes. RESULTS: First, 83% of stillbirths, 82% of Cesarean sections for presumed fetal compromise in labor, 91% of cases of neonatal death or hypoxic ischemic encephalopathy and 86% of NNU admissions for ≥ 48 h occurred in pregnancies with a non-SGA neonate. Second, UtA-PI > 95th percentile, sFlt-1 > 95th percentile and PlGF < 5th percentile were associated with increased risk of Cesarean delivery for suspected fetal compromise in labor and NNU admission for ≥ 48 h; the number of stillbirths and cases of neonatal death or hypoxic ischemic encephalopathy was too small to demonstrate significance in the observed differences from cases without these adverse outcomes. Third, multivariable logistic regression analysis demonstrated that, in the prediction of Cesarean delivery for suspected fetal compromise in labor, there was no significant contribution from biomarkers; the prediction of NNU admission for ≥ 48 h by maternal demographic characteristics and medical history was only marginally improved by the addition of sFlt-1 or PlGF. Fourth, for each biomarker, the detection rate of adverse outcome was higher in SGA than in non-SGA neonates, but this increase was accompanied by an increase in false-positive rate. Fifth, the relative risk of UtA-PI > 95th , sFlt-1 > 95th and PlGF < 5th percentiles for most adverse outcomes was < 2.5 in both SGA and non-SGA neonates. CONCLUSIONS: In pregnancies undergoing routine antenatal assessment at 35-37 weeks' gestation, measurements of UtA-PI, sFlt-1 or PlGF provide poor prediction of adverse perinatal outcome in both SGA and non-SGA fetuses. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Biomarcadores/sangue , Resultado da Gravidez/epidemiologia , Gravidez/metabolismo , Fluxo Pulsátil/fisiologia , Adulto , Cesárea , Feminino , Humanos , Hipóxia-Isquemia Encefálica/epidemiologia , Hipóxia-Isquemia Encefálica/mortalidade , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/metabolismo , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Morte Perinatal , Fator de Crescimento Placentário/metabolismo , Placentação , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Natimorto/epidemiologia , Ultrassonografia Doppler em Cores/métodos , Artéria Uterina/diagnóstico por imagem , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo
20.
Can J Ophthalmol ; 54(2): 269-274, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30975353

RESUMO

OBJECTIVE: To determine the incidence of retinopathy of prematurity and severity of disease at a large Canadian tertiary care centre, as well as to determine risk factors for disease and current treatment practices. METHODS: This was a retrospective cohort study of infants admitted to the neonatal intensive care unit (NICU) at McMaster Children's Hospital, who underwent screening for retinopathy of prematurity between August 2010 and August 2016. RESULTS: The overall incidence of retinopathy of prematurity was 67.1% (418/623 infants); severe retinopathy of prematurity was seen in 14.3% (89/623). This signified an increase compared to our previous study at the same institution, where the incidence of retinopathy of prematurity was 40.4% and severe retinopathy of prematurity was 9.2% between 2006 and 2010. Stage 1 disease showed the greatest increase, from 9.0% (38/423) to 21.0% (131/623). Our cohort had a higher proportion of infants born at 24 weeks GA or less (15.7% vs 8.7%). Predictors of retinopathy of prematurity in a multivariate regression model were gestational age (OR = 0.829, p = 0.002), birth weight (OR = 0.712, p = 0.003) and length of NICU stay (OR = 0.844, p = 0.00). Treatment was performed in 10.5% (44/418) of infants with retinopathy of prematurity, with infants earlier in the study period mainly receiving laser photocoagulation and infants born in more recent years receiving intravitreal bevacizumab. CONCLUSIONS: There has been an increase in retinopathy of prematurity incidence, both in early (stage 1) disease and in severe retinopathy of prematurity. This is partially explained by the almost doubling of the proportion of infants born at 24 weeks gestational age or less. Since mid-2013, intravitreal anti-VEGF therapy has replaced laser photocoagulation as the preferred treatment modality. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


Assuntos
Bevacizumab/administração & dosagem , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Fotocoagulação a Laser/métodos , Retinopatia da Prematuridade/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Inibidores da Angiogênese , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Injeções Intravítreas , Masculino , Ontário/epidemiologia , Oftalmoscopia , Prognóstico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/terapia , Estudos Retrospectivos , Fatores de Risco
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