RESUMO
OBJECTIVES: A placebo-controlled, randomized, double-blind study was performed to determine whether prenatal dexamethasone (DEX) treatment improves the outcome of the preterm infant when exogenous surfactant is available. METHODS: 157 pregnant women at five hospitals with threatened preterm delivery and with lengths of gestation < 32 weeks received either DEX (dose 6 mg four times at 12-hour intervals) or placebo (PL). Prenatal treatment was not repeated. Preterm infants received rescue therapy of human surfactant (maximum four doses) if they required ventilatory support and at least 40% oxygen for the treatment of respiratory distress syndrome (RDS). RESULTS: Enrolled pregnant women delivered 188 live-born neonates, of whom 79 (DEX 41 and PL 38 neonates) were born 1 to 14 days after the prenatal treatment. Neonates born within 1 to 14 days after the initial DEX treatment had a lower incidence of RDS (DEX, 44%; PL, 79%; P < .01), lower requirements of surfactant (DEX, 22%; PL, 53%; P < .01), shorter duration of ventilatory support (DEX, 2.0 days; PL, 5.3 days; P < .05) and oxygen therapy (DEX, 2.0 days; PL, 7.0 days; P < .01), and a higher neonatal survival without ventilatory support (P < .05) than PL-treated neonates. DEX-treated neonates had higher mean blood pressure than PL-treated neonates during the first 3 days after birth. Among all neonates treated with DEX, there was a lower incidence of intraventricular hemorrhage or periventricular leucomalacia (DEX, 13%; PL, 33%; P < .01). Reduction in the incidence of intraventricular hemorrhage or periventricular leucomalacia in DEX-treated neonates was particularly associated with exogenous human surfactant therapy (DEX+surfactant 10%; PL+surfactant 48%; P < .01). CONCLUSIONS: Prenatal DEX treatment combined with exogenous human surfactant therapy in preterm infants decreases pulmonary morbidity and cerebral complications, and increases survival without severe morbidity.
Assuntos
Hemorragia Cerebral/prevenção & controle , Dexametasona/uso terapêutico , Pneumopatias/prevenção & controle , Cuidado Pré-Natal , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Doença Crônica , Método Duplo-Cego , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Trabalho de Parto Prematuro , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológicoRESUMO
AIMS: To elucidate the development of primary and permanent teeth and to interpret the effect of different calcium, phosphorus, and vitamin D supplementation in the neonatal period on dental maturation in preterm children. METHODS: Preterm infants were randomised to four groups to receive a vitamin D dose of 500 or 1000 IU/day and calcium and phosphorus supplemented or unsupplemented breast milk. The maturity of the primary and permanent teeth was recorded in 30 preterm children. Sixty children aged 2 years and 60 children aged 9-11 years served as controls. Bone mineral content/density was assessed in the preterm infants. RESULTS: The median (range) corrected teething age was 7 (2-16) months in preterm infants and 6 (2-12) months in controls (p = 0.43). The median (range) number of erupted teeth at 2 years of age was 16 (11-19) in preterm infants and 16 (12-20) in controls (p = 0.16). Maturation of the permanent teeth in the preterm infants was not delayed compared with the controls (mean Demirjian SDS 0.16 v 0.49, p = 0.14). Early dietary intake of either mineral or vitamin D did not affect maturation of the primary dentition in preterm children. Children receiving the higher vitamin D dose in the neonatal period had more mature permanent dentition than those receiving the lower dose, but mineral intake did not affect maturation of the permanent teeth. Dental maturation did not correlate with bone mineral status. CONCLUSIONS: This is the first longitudinal study to follow primary and permanent tooth maturation in the same preterm children. Premature birth has no appreciable late sequelae in tooth maturation.
Assuntos
Dentição Permanente , Recém-Nascido Prematuro/fisiologia , Dente Decíduo , Densidade Óssea , Cálcio/administração & dosagem , Criança , Pré-Escolar , Suplementos Nutricionais , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Leite Humano , Fósforo/administração & dosagem , Vitamina D/administração & dosagemRESUMO
AIMS: To test the hypothesis that a vitamin D dose of 200 IU/kg, maximum 400 IU/day, given to preterm infants will maintain normal vitamin D status and will result in as high a bone mineral density as that attained with the recommended dose of 960 IU/day. METHODS: Thirty nine infants of fewer than 33 weeks of gestational age were randomly allocated to receive vitamin D 200 IU/kg of body weight/day up to a maximum of 400 IU/day or 960 IU/day until 3 months old. Vitamin D metabolites, bone mineral content and density were determined by dual energy x-ray absorptiometry, and plasma ionised calcium, plasma alkaline phosphatase, and intact parahormone measurements were used to evaluate outcomes. RESULTS: The 25 hydroxy vitamin D concentrations tended to be higher in infants receiving 960 IU/day, but the differences did not reach significance at any age. There was no difference between the infants receiving low or high vitamin D dose in bone mineral content nor in bone mineral density at 3 and 6 months corrected age, even after taking potential risk factors into account. CONCLUSIONS: A vitamin D dose of 200 IU/kg of body weight/day up to a maximum of 400 IU/day maintains normal vitamin D status and as good a bone mineral accretion as the previously recommended higher dose of 960 IU/day. Vitamin D is a potent hormone which affects organs other than bone and should not be given in excess to preterm infants.
Assuntos
Densidade Óssea/efeitos dos fármacos , Suplementos Nutricionais , Recém-Nascido Prematuro , Vitamina D/administração & dosagem , 25-Hidroxivitamina D 2/sangue , Absorciometria de Fóton , Esquema de Medicação , Humanos , Recém-Nascido , Recém-Nascido Prematuro/sangueAssuntos
Hemorragia Cerebral/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Leucomalácia Periventricular/diagnóstico por imagem , Masculino , Avaliação de Resultados em Cuidados de SaúdeAssuntos
Morte Fetal , Mortalidade Infantil , Feminino , Finlândia , Humanos , Recém-Nascido , Serviços de Saúde Materna , GravidezAssuntos
Infecções por Escherichia coli/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estreptocócicas/epidemiologia , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Finlândia , Humanos , Recém-Nascido , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificaçãoRESUMO
The best nutrient for newborn babies is breast milk and preferably provided via breast feeding. Pooled human milk must be used when the babies' own mother's milk is not available. Very often pooled milk is pasteurised. Recent studies, however, suggest avoidance of any sterilisation procedures in view of the decreased nutritional value and loss of anti-infective benefits associated with heating of human milk. In this study a quality control system of banked human milk based on the recent literature is presented. The purpose of systematic bacteriological monitoring is to separate those milk samples contaminated with pathogenic bacteria from the bulk of the collected milk which has only light contamination with likely nonpathogenic skin bacteria. According to our new standards of classification, over 60 per cent of the collected milk proved to be sufficiently free of bacteria to be fed unheated to pre-term infants. Most of the remainder could be fed unheated to full-term infants and less than 10 per cent had to be pasteurised.
Assuntos
Leite Humano/microbiologia , Finlândia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Controle de Qualidade , EsterilizaçãoRESUMO
Serum alpha fetoprotein (AFP) levels were studied in 15 neonatally hyperbilirubinaemic children and 15 controls matched for sex and gestational age. All children were born between 38 and 40 weeks of gestation. During the first seven weeks of postnatal life hyperbilirubinaemic children had serum AFP concentrations over twice as high as controls. At the age of 5-7 days the mean (+/- S.E.M.) serum AFP values were 52.4 +/- 5.8 mg/l for hyperbilirubinaemic children and 24.8 +/- 4.3 mg/l for controls (p less than 0.001). At 20-25 days of age they were 7.28 +/- 1.10 and 2.75 +/- 0.45 mg/l, respectively (p less than 0.001), and at 40-49 days 1.39 +/- 0.21 and 0.46 +/- 0.07 mg/l (p less than 0.001). However, no correlation was found between serum bilirubin and AFP concentrations in hyperbilirubinaemic children.
Assuntos
Icterícia Neonatal/sangue , alfa-Fetoproteínas/análise , Fatores Etários , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fatores SexuaisRESUMO
A randomised double blind placebo controlled study was conducted to determine whether a one week course of dexamethasone could reduce the severity of bronchopulmonary dysplasia in preterm infants without compromising their adrenal function. Forty one infants with a mean birth weight of 880 g and a gestational age of 27 weeks who were ventilator dependent at 10 days of age were enrolled. At the age of 28 days pulmonary outcome was significantly better in the girls treated with dexamethasone but not in all infants. There was no difference between the groups in the long term outcome, except for a shorter duration of supplemental oxygen in dexamethasone treated female infants. After the one week dexamethasone treatment there was a significant but short lived suppression of the basal cortisol concentrations and the adrenal response to corticotrophin (ACTH). No serious side effects were observed. It is concluded that early one week dexamethasone treatment improves short term pulmonary outcome in premature infants, but there is no clear evidence of long term benefits.
Assuntos
Displasia Broncopulmonar/tratamento farmacológico , Dexametasona/uso terapêutico , Recém-Nascido Prematuro , Displasia Broncopulmonar/sangue , Feminino , Humanos , Hidrocortisona/sangue , Recém-Nascido , Masculino , Fatores Sexuais , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To establish the prevalence of upper gastrointestinal mucosal lesions in full-term and preterm infants under stress. DESIGN: A prospective, cohort study. SETTING: Neonatal intensive care unit at a university teaching hospital. PATIENTS: Seventeen (14 preterm, 3 term; median gestational age 29.7 wks; median birth weight 1230 g) consecutive, unselected infants treated in intensive care. INTERVENTIONS: Gastroscopy, using a prototype fiberoptic gastroscope designed for newborns, was performed for the first time at the age of 3 to 7 days. Biopsy specimens were taken when possible. Ranitidine treatment and follow-up endoscopies were performed in selected patients. Blood pressure, heart rate, oxygen saturation by pulse oximeter, and the general condition of the infants were monitored at 1-min intervals during the endoscopy. Central nervous system ultrasonography examination was repeatedly performed before and after the procedure. MEASUREMENTS AND MAIN RESULTS: At the time of first endoscopy, 15 of 17 infants were asymptomatic for gastrointestinal tract problems, one had melena, and one hematemesis. Upper gastrointestinal endoscopy revealed pathology in 16 (94%) infants, macroscopic esophagitis in six infants, hemorrhagic gastritis in nine infants, and gastritis with ulcers in six infants. Microscopically, the lesions were also clear. A peculiar finding was acute gastritis with cystic gland deformation ("cystic gastritis") seen in five of the infants under stress; one of these infants also had intestinal metaplasia in the gastric mucosa. Seven infants were treated with ranitidine without side-effects. Follow-up endoscopies demonstrated normalization of the lesions in five of six infants studied. The procedure, including biopsies, seemed to be safe, even for very low-birth weight infants. CONCLUSIONS: Gastric mucosal lesions are highly prevalent in preterm infants in intensive care before any symptoms occur. Further research on preterm infants under stress is needed in order to determine the risk factors and optimal treatment for the esophageal and gastric mucosal lesions described here.
Assuntos
Cuidados Críticos , Esofagite/epidemiologia , Gastrite/epidemiologia , Doenças do Prematuro/epidemiologia , Estresse Fisiológico/epidemiologia , Biópsia , Peso ao Nascer , Esofagite/diagnóstico , Esofagite/tratamento farmacológico , Esofagite/etiologia , Feminino , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Gastrite/etiologia , Gastroscópios , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/tratamento farmacológico , Unidades de Terapia Intensiva Neonatal , Masculino , Monitorização Fisiológica , Prevalência , Estudos Prospectivos , Ranitidina/uso terapêutico , Fatores de Risco , Estresse Fisiológico/diagnóstico , Estresse Fisiológico/tratamento farmacológico , Estresse Fisiológico/etiologiaRESUMO
BACKGROUND: The aim of this study was to investigate whether perinatal indomethacin treatment has effects on the development of esophageal and gastric lesions in preterm infants and to evaluate other potential etiologic factors behind these lesions. METHODS: Sixty-nine infants were born at less than 33 weeks' gestation. Forty-five of these infants underwent treatment with perinatal indomethacin (study group) and 24 did not (control group). All underwent upper gastrointestinal tract endoscopy and biopsy during the neonatal period. The correlation between gastrointestinal symptoms, abnormal endoscopic findings, and the factors correlating with the development of esophageal and gastric mucosal lesions was evaluated. RESULTS: Abnormal endoscopic findings were equally common in the study group (77.8%) and in controls (83.3%). There was no dependence between gastrointestinal symptoms and endoscopic findings because only 15 infants (21.7%) were symptomatic before endoscopy. The interval between endoscopy and the last perinatal indomethacin dose correlated significantly with abnormal esophageal findings and gastric mucosal lesions. Shorter duration of enteral feeding before endoscopy correlated with greater risk of abnormal esophageal findings. Older gestational age and need of ventilator treatment at the time of endoscopy remained the risk factors associated with abnormal gastric findings. CONCLUSIONS: Esophageal and gastric lesions diagnosed by endoscopy correlate poorly with the gastrointestinal symptoms of patients. Short duration of enteral feeding seems to be correlated with an increased risk of esophageal mucosal lesions, increasing gestational age and ventilator treatment with gastric mucosal lesions, and perinatal indomethacin with esophageal and gastric mucosal lesions in preterm infants. Ventilator-treated preterm infants not receiving enteral nutrition and patients with indomethacin exposure might benefit from ulcer prophylaxis.
Assuntos
Gastroenteropatias/terapia , Indometacina/administração & dosagem , Doenças do Prematuro/terapia , Tocolíticos/administração & dosagem , Biópsia , Estudos de Casos e Controles , Permeabilidade do Canal Arterial/tratamento farmacológico , Endoscopia Gastrointestinal , Nutrição Enteral/efeitos adversos , Feminino , Gastroenteropatias/diagnóstico , Humanos , Indometacina/efeitos adversos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Terapia Intensiva Neonatal , Masculino , Assistência Perinatal , Fatores de Risco , Tocolíticos/efeitos adversosRESUMO
This study comprised 103 preterm infants with a gestational age less than 33 weeks who were born in Tampere University Hospital and who were followed up to two years of age. Sixty-four perinatal variables were compared to ultrasound findings in the neonatal period and neurologic handicap at the age of two years. Duration of hypocarbia (PCO2 < or = 30 mmHg) during the first 72 h and hyperbilirubinemia (the mean level of serum total bilirubin) at three days of age were independently and significantly related to periventricular leukomalacia, but not directly to cerebral palsy. The only perinatal variables related independently and significantly to cerebral palsy at two years of age were periventricular leukomalacia and ventriculomegaly. According to these results, periventricular leukomalacia was the main predictor of cerebral palsy in preterm infants. In addition to hypocarbia, hyperbilirubinemia may also be involved in the pathogenesis of extensive (severe cystic) periventricular leukomalacia.
Assuntos
Paralisia Cerebral/epidemiologia , Hiperbilirrubinemia/complicações , Hipocapnia/complicações , Recém-Nascido Prematuro , Leucomalácia Periventricular/complicações , Gasometria , Paralisia Cerebral/etiologia , Feminino , Finlândia/epidemiologia , Seguimentos , Idade Gestacional , Hospitais Universitários , Humanos , Hiperbilirrubinemia/sangue , Hipocapnia/sangue , Recém-Nascido , Leucomalácia Periventricular/diagnóstico , Leucomalácia Periventricular/patologia , Modelos Logísticos , Masculino , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
The objective of this study was to evaluate the performance of dual energy x-ray absorptiometry (DXA) in forearm measurements of preterm and newborn term infants. The accuracy and linearity of DXA in measuring low mineral content levels (ranging from 30 to 300 mg) was assessed using bone-simulating K2HPO4 phantoms. For in vivo precision, DXA was performed twice on left forearms of four new-born term babies, 21 preterm infants at corrected age 3 mo, and 20 at corrected age 6 mo. Bone mineral content (BMC in mg) and areal bone mineral density (BMD in mg/cm2) at distal forearm and forearm shaft were measured. A special software program allowing a free adjustment of the bone detection threshold was used in the analysis of the scan data. The threshold level affected the overall ability of analysis to detect bone tissue and altered significantly the BMC and BMD values too. Given absolute success in detecting low amounts of bone mineral (BMC > 100 mg), the lowest bone detection threshold evaluated (0.040 g/cm2) became the preferable choice. The relationships between the actual and measured data were highly linear (r was 0.94 for BMC and 0.97 for BMD) but showed underestimation (corresponding slopes were 0.66 and 0.64). In vivo precision expressed as 95% limits of agreement was approximately +/-45 mg for BMC and +/-16 mg/cm2 for BMD. We conclude that DXA provides adequate reliability for in vivo determinations of BMC and areal BMD in the distal and shaft sites of forearm in term and preterm infants and thus strongly supports the clinical utility of DXA in the diagnosis and monitoring of metabolic disease of prematurity. Movements during scanning are typical of pediatric measurements and may decrease the precision considerably. Therefore, every effort must be made to prevent movement artefacts. In addition, special attention must be paid to keeping the analysis procedures consistent.