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1.
Arch. pediatr. Urug ; 92(2): e306, dic. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1278306

ABSTRACT

Los estafilococos coagulasa negativos son microorganismos frecuentemente aislados cuya significancia clínica puede ser difícil de establecer por su carácter de comensales habituales de la piel. En la población neonatal estos patógenos han ido adquiriendo mayor protagonismo debido a la sobrevida de pacientes mas prematuros que en el pasado, así como sus necesidades de tratamiento, que determinan mayores tiempos de estadía hospitalaria. Estos elementos representan factores de riesgo también para el desarrollo de endocarditis en estos pacientes, particularmente debido a la utilización de catéteres intravasculares centrales por tiempo prolongado. En este caso clínico se presenta un paciente pretérmino severo que presentó una endocarditis a estafilococo coagulasa negativo a partir del cual discutiremos las características de las infecciones por estos microorganismos, las características de la endocarditis infecciosa en el recién nacido pretérmino y la utilización de antibióticos en estos pacientes, así como algunos elementos asociados a la vigilancia activa en el uso de antibióticos.


Coagulase negative staphylococcus (CoNS) are commonly isolated microorganisms whose clinical importance may be difficult to establish due to their role as part of our usual skin microbiota. These pathogens have gained relevance in neonatal population due to an improvement in neonatal care that determine longer survival rates and hospitals stays. Neonatal endocarditis is also affected by these microorganisms and particularly by the use of central intra vascular lines for long periods of time. In this clinical case we introduce a severe preterm patient who developed a CoNS endocarditis and discuss the characteristics of CoNS infections and endocarditis in preterm newborns as well as some antibiotic vigilance principles.


Os estafilococos coagulase negativos são microrganismos frequentemente isolados, cujo significado clínico pode ser difícil de estabelecer devido ao seu caráter de comensais cutâneos comuns. Na população neonatal, esses patógenos vêm adquirindo maior destaque devido à sobrevida de pacientes mais prematuros do que no passado, bem como suas necessidades de tratamento, as quais determinam tempos de internação mais longos. Esses elementos também representam fatores de risco para o desenvolvimento de endocardite nesses pacientes, principalmente pelo uso prolongado de cateter intravascular central. Neste caso clínico apresentaremos um paciente pré-termo grave que apresentou endocardite estafilocócica coagulase-negativa a partir do qual discutiremos as características das infecções por esses microrganismos, as características da endocardite infecciosa no recém-nascido pré-termo e o uso de antibióticos nesses pacientes bem como alguns elementos associados à vigilância ativa no uso de antibióticos.


Subject(s)
Humans , Female , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis/virology , Vancomycin/therapeutic use , Endocarditis/diagnosis , Anti-Bacterial Agents/therapeutic use , Staphylococcal Infections/complications , Coagulase , Infant, Very Low Birth Weight , Endocarditis/etiology , Infant, Extremely Premature
2.
Arch. argent. pediatr ; 119(3): 185-191, Junio 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1222950

ABSTRACT

Introducción. Existe evidencia del beneficio de los probióticos en prevenir enterocolitis necrotizante en prematuros extremos. Desde 2015, se usa probiótico preventivo en el Servicio de Neonatología, Hospital Hernán Henríquez Aravena, Temuco, Chile.Objetivo. Evaluar el impacto de este probiótico en la incidencia, gravedad, necesidad de terapia quirúrgica y letalidad por enterocolitis necrotizante en prematuros extremos. Pacientes y método. Estudio retrospectivo de cohortes. Datos analizados con Stata. Se aplicó la prueba exacta de Fisher para comparar porcentajes y, para los promedios, la prueba t para varianzas distintas. Los egresados entre 2015 y 2017 recibieron Lactobacillus reuteri Protectis (LRP), dosis única (1 x 108 unidades formadora de colonias) desde los primeros días de vida hasta cumplir las 36 semanas de edad gestacional corregida. Los controles egresados entre 2012 y 2014 no recibieron LRP.Resultados. El 3,45 % de los casos tuvo algún grado de enterocolitis: grado i (el 64 %), ii (el 18 %), iii (el 18 %); requirió cirugía el 18 % y no hubo letalidad. El 3,75 % de los controles históricos presentaron enterocolitis: grado i (el 12 %), ii (el 35 %), iii (el 53 %); el 64,7 % requirió cirugía, y el 47 % falleció. El grupo intervenido presentó grado ii o iii en un 36 %; en el grupo control, la sumatoria de estos estadios fue del 88 %.Conclusión.LRP administrado en dosis única diaria al prematuro extremo no modificó la incidencia de enterocolitis, pero disminuyó su gravedad, la letalidad y necesidad de tratamiento quirúrgico.


Introduction. There is evidence of the beneficial effects of probiotics to prevent necrotizing enterocolitis in extremely preterm infants. Probiotic prevention has been used since 2015 in the Division of Neonatology of Hospital Hernán Henríquez Aravena, Temuco, Chile.Objective. To assess the impact of this probiotic on the incidence, severity, surgical treatment requirement, and fatality rate of necrotizing enterocolitis in extremely preterm infants.Patients and methods. Retrospective, cohort study. Data were analyzed using Stata. Fisher's exact test was used to compare percentages, and the unequal variances t-test, for averages. Infants discharged between 2015 and 2017 received Lactobacillus reuteri Protectis (LRP), in a single dose (1 x 108 colony forming units), since the first days of life until 36 weeks of corrected gestational age. Controls discharged between 2012 and 2014 did not receive LRP.Results. Some degree of enterocolitis was observed in 3.45 % of cases: stage I (64 %), stage II (18 %), stage III (18 %); 18 % required surgery, and there were no deaths. Among historical controls, 3.75 % had enterocolitis: stage I (12 %), stage II (35 %), stage III (53 %); 64.7 % required surgery, and 47 % died. In the intervention group, stage II or III accounted for 36 % of cases, whereas in the control group, for 88 %.Conclusion. Administering a single daily dose of LRP to extremely preterm infants did not affect the incidence of enterocolitis, but reduced its severity, fatality rate, and surgical treatment requiremen


Subject(s)
Humans , Male , Female , Infant, Newborn , Probiotics/therapeutic use , Enterocolitis, Necrotizing/prevention & control , Chile , Retrospective Studies , Cohort Studies , Probiotics/administration & dosage , Lactobacillus reuteri , Infant, Extremely Premature , Infusions, Parenteral/methods
3.
Article in Chinese | WPRIM | ID: wpr-888469

ABSTRACT

OBJECTIVE@#To study whether there are differences in the resuscitation process and early outcomes between the extremely preterm infants delivered on off-hours (6 pm to 8 am of working days, weekends, and national holidays) and those delivered on working hours.@*METHODS@#A retrospective analysis was performed on the medical data of extremely preterm infants who were born in the Peking University Third Hospital from January 1, 2010 to December 31, 2020 and transferred to the neonatal intensive care unit (NICU). According to the time of birth, they were divided into two groups:working hours (@*RESULTS@#Compared with the working hours group, the off-hours group had a significantly lower proportion of infants with the use of full-dose dexamethasone before delivery (@*CONCLUSIONS@#Extremely preterm infants delivered on off-hours tend to have a low Apgar score at 1 minute after birth, with a higher proportion of infants requiring positive pressure ventilation or tracheal intubation during resuscitation than those delivered on working hours, and they tend to develop neonatal respiratory distress syndrome and intrauterine pneumonia. This suggests that it is important to make adequate preparations in terms of personnel and supplies for resuscitation of extremely preterm infants after birth and that NICUs should develop a detailed management plan for extremely preterm infants at each period of time before, during, and after birth.


Subject(s)
Humans , Infant , Infant, Extremely Premature , Infant, Newborn , Intensive Care Units, Neonatal , Respiratory Distress Syndrome, Newborn , Resuscitation , Retrospective Studies
4.
Article in Chinese | WPRIM | ID: wpr-879842

ABSTRACT

OBJECTIVE@#To study the clinical features of very preterm small-for-gestational-age infants born by cesarean section due to severe preeclampsia.@*METHODS@#Forty-two small-for-gestational-age infants who were admitted from August 2017 to July 2018 and were born due to severe preeclampsia were enrolled as the observation group. Forty very preterm infants who were born to healthy mothers since uterine contractions could not be suppressed were enrolled as the control group. Perinatal features, clinical manifestations of infection, complications, and clinical outcomes were analyzed for the two groups.@*RESULTS@#Within 6 hours and 2-3 days after birth, the observation group had significantly lower white blood cell count (WBC), absolute neutrophil count (ANC), and platelet count (PLT) than the control group (@*CONCLUSIONS@#Very preterm small-for-gestational-age infants born due to severe preeclampsia have a high incidence rate of infection and severe conditions. Early manifestations include reductions in the infection indicators WBC, ANC, and PLT, and CRP does not increase significantly in the early stage and gradually increases at 2-3 days after birth. Most of these infants require invasive ventilation after birth, with bronchopulmonary dysplasia as the main complication. Clinical changes should be closely observed and inflammatory indicators should be monitored for early identification of infection, timely diagnosis, and timely adjustment of antibiotic treatment, so as to improve the outcome.


Subject(s)
Bronchopulmonary Dysplasia , Cesarean Section , Female , Gestational Age , Humans , Infant , Infant, Extremely Premature , Infant, Newborn , Infant, Premature, Diseases , Infant, Very Low Birth Weight , Pre-Eclampsia , Pregnancy
5.
Article in Chinese | WPRIM | ID: wpr-879804

ABSTRACT

OBJECTIVE@#To study the influence of premature rupture of membranes (PROM) on the early prognosis of extremely premature infants, and to provide a basis for the management of extremely premature infants and prenatal consultation.@*METHODS@#A total of 179 extremely premature singleton infants who were born from 2017 to 2019 were enrolled. According to the presence or absence of PROM, they were divided into two groups: PROM group (@*RESULTS@#Compared with the non-PROM group, the PROM group had significantly higher incidence rates of earlyonset sepsis and necrotizing enterocolitis (NEC) (@*CONCLUSIONS@#PROM increases the incidence rates of early-onset sepsis and NEC in extremely premature infants and does not increase the incidence rates of other adverse outcomes. For pregnant women with PROM at the risk of extremely preterm delivery, prevention of miscarriage and chorioamnionitis is recommended to prolong gestational weeks, reduce the incidence rate of infection, and thus improve the outcome of extremely premature infants.


Subject(s)
Chorioamnionitis , Enterocolitis, Necrotizing/etiology , Female , Fetal Membranes, Premature Rupture/epidemiology , Gestational Age , Humans , Infant , Infant, Extremely Premature , Infant, Newborn , Pregnancy , Prognosis
6.
Chinese Medical Journal ; (24): 1561-1568, 2021.
Article in English | WPRIM | ID: wpr-887583

ABSTRACT

BACKGROUND@#Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.@*METHODS@#The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD.@*RESULTS@#A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082-4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606-3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044-1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061-2.424), DRI (OR, 2.094; 95% CI, 1.328-3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679-4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777-6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996-0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379-0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160-0.467) were preventive factors for BPD (all P < 0.05).@*CONCLUSION@#Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.


Subject(s)
Birth Weight , Bronchopulmonary Dysplasia , China/epidemiology , Delivery Rooms , Female , Gestational Age , Humans , Infant , Infant, Extremely Low Birth Weight , Infant, Extremely Premature , Infant, Newborn , Male , Pregnancy
7.
Clinics ; 76: e2242, 2021. tab
Article in English | LILACS | ID: biblio-1153934

ABSTRACT

OBJECTIVES: Pneumothorax is a catastrophic event associated with high morbidity and mortality, and it is relatively common in neonates. This study aimed to investigate the association between ventilatory parameters and the risk of developing pneumothorax in extremely low birth weight neonates. METHODS: This single-center retrospective cohort study analyzed 257 extremely low birth weight neonates admitted to a neonatal intensive care unit between January 2012 and December 2017. A comparison was carried out to evaluate the highest value of positive end-expiratory pressure (PEEP), peak inspiratory pressure (PIP), and driving pressure (DP) in the first 7 days of life between neonates who developed pneumothorax and those who did not. The primary outcome was pneumothorax with chest drainage necessity in the first 7 days of life. A matched control group was created in order to adjust for cofounders associated with pneumothorax (CRIB II score, birth weight, and gestational age). RESULTS: There was no statistically significant difference in PEEP, PIP, and DP values in the first 7 days of life between extremely low birth weight neonates who had pneumothorax with chest drainage necessity and those who did not have pneumothorax, even after adjusting for potential cofounders. CONCLUSIONS: Pressure-related ventilatory settings in mechanically ventilated extremely low birth weight neonates are not associated with a higher risk of pneumothorax in the first 7 days of life.


Subject(s)
Humans , Infant, Newborn , Pneumothorax/etiology , Pneumothorax/epidemiology , Retrospective Studies , Positive-Pressure Respiration , Gestational Age , Infant, Extremely Premature
8.
Arch. argent. pediatr ; 117(5): 509-513, oct. 2019. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1054973

ABSTRACT

La utilización de probióticos en la población neonatal ha contribuido a una disminución de la morbilidad y mortalidad en esta población a través de la reducción en la incidencia de entidades como enterocolitis necrosante, infecciones asociadas al cuidado de la salud y sepsis neonatal. A pesar de los múltiples efectos beneficiosos descritos, este tipo de medicamentos debe ser administrado con precaución en los pacientes de alto riesgo, debido a que se han documentado reportes de casos de sepsis neonatal por Lactobacillus rhamnosus, Saccharomyces boulardii y Bifidobacterium, entre otros. Se presenta un caso atípico de sepsis neonatal por Lactobacillus reuteri en un recién nacido pretérmino extremo en una institución de alta complejidad en la ciudad de Bogotá D. C., Colombia. El desenlace, en nuestro caso, fue fatal, pese al manejo médico establecido.


The use of probiotics in the neonatal population has contributed to a decrease in morbidity and mortality in this population through the reduction in the incidence of entities such as necrotizing enterocolitis, infections associated with health care and neonatal sepsis. Despite the multiple beneficial effects described due to the use of probiotics, this type of medication should be administered with caution in high-risk patients because reports of cases of neonatal sepsis by Lactobacillus rhamnosus, Saccharomyces boulardii and Bifidobacterium, among others, have been documented. We present an atypical case of neonatal sepsis due to Lactobacillus reuteri in an extreme preterm newborn in a highly complex institution in the city of Bogotá D. C., Colombia. The outcome in our case was fatal despite the established medical management.


Subject(s)
Humans , Male , Infant, Newborn , Lactobacillus reuteri , Neonatal Sepsis , Pre-Eclampsia , Fatal Outcome , Probiotics/adverse effects , Infant, Extremely Premature
9.
Arch. argent. pediatr ; 117(4): 413-415, ago. 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1054947

ABSTRACT

La hipertensión pulmonar es una complicación frecuente de la displasia broncopulmonar. A pesar de su alta incidencia, existen pocos tratamientos disponibles. El epoprostenol y el treprostinil son análogos de las prostaglandinas I2, que activan la adenilato ciclasa e incrementan el adenosín monofosfato cíclico en las células de la musculatura lisa de la arteria pulmonar y pueden resultar eficaces en el tratamiento de estos pacientes. Se presenta el caso de un prematuro de extremado bajo peso con hipertensión pulmonar secundaria a displasia broncopulmonar grave, no respondedora a óxido nítrico inhalado y sildenafilo, que fue tratado con análogos de prostaglandinas I2. En nuestro paciente, este tratamiento evidenció mejoría clínica y ecocardiográfica significativa tras varias semanas de tratamiento.


Pulmonary hypertension is a common complication of bronchopulmonary dysplasia, with a high mortality rate. Despite the high incidence of pulmonary hypertension, there are few available treatments. Epoprostenol and treprostinil are prostaglandin I2 analogs that activate adenylate cyclase and increase cyclic adenosine monophosphate in the pulmonary arterial smooth muscle cells. Therefore, they may be an effective treatment for these patients. We report the use of prostaglandin I2 analogs in an extremely low birth weight preterm baby with severe bronchopulmonary dysplasia associated with pulmonary hypertension non-responding to inhaled nitric oxide and sildenafil. In our patient this treatment resulted in remarkable clinical and echocardiographic improvement, evident after a few weeks of treatment.


Subject(s)
Humans , Male , Infant, Newborn , Bronchopulmonary Dysplasia/complications , Hypertension, Pulmonary/diagnosis , Tracheostomy , Epoprostenol/therapeutic use , Infant, Extremely Premature , Hypertension, Pulmonary/drug therapy
10.
Neonatal Medicine ; : 233-239, 2019.
Article in Korean | WPRIM | ID: wpr-786435

ABSTRACT

Chylothorax, the accumulation of chyle in the pleural space, is a rare condition, but can lead to serious complications in neonates. Conservative therapy for chylothorax includes enteral feeding with medium-chain triglyceride-enriched diet or parenteral nutrition and administration of octreotide. Surgical management is considered in cases where there is no response to conservative therapy; however, the standardized approach to refractory neonatal chylothorax is still controversial. Chemical pleurodesis can be used when medical therapies for chylothorax fail, to avoid more invasive surgical procedures. We report an extremely preterm infant born at 26 weeks of gestation with refractory chylothorax after patent ductus arteriosus ligation. The infant was successfully treated with pleurodesis using 4% povidone-iodine, without long-term side effects.


Subject(s)
Chyle , Chylothorax , Diet , Ductus Arteriosus, Patent , Enteral Nutrition , Humans , Infant , Infant, Extremely Low Birth Weight , Infant, Extremely Premature , Infant, Newborn , Infant, Premature , Ligation , Octreotide , Parenteral Nutrition , Pleurodesis , Povidone-Iodine , Pregnancy
11.
S. Afr. j. child health (Online) ; 13(2): 78-83, 2019. tab
Article in English | AIM, AIM | ID: biblio-1270362

ABSTRACT

Background. Diabetes mellitus (DM) is a common metabolic disorder affecting pregnant women and is associated with adverse outcomes in their offspring, including hypoglycaemia. The incidence and factors associated with development of hypoglycaemia in infants of diabetic mothers (IDM) from developing countries such as South Africa are not well known. Objectives. To determine the incidence of hypoglycaemia and factors associated with its development in IDM. Methods. Medical records of mothers diagnosed with DM, and their infants who were term and/or late preterm and admitted to the neonatal unit at Chris Hani Baragwanath Academic Hospital, were retrieved and reviewed. Maternal characteristics, type and management of diabetes, infant characteristics and glucose measurements were captured for analysis. Results. Over the 2-year period, 234 infants were born to diabetic mothers (median age 33 years) and 207 met the diagnostic criteria and were admitted for monitoring of blood glucose using the hemoglucotest. Among the mothers with DM, 56% had gestational diabetes; ~19% of IDM were large for gestational age (LGA) and 10% were macrosomic. Hypoglycaemia occurred in 39% of IDM, and 85% of the infants were diagnosed within the first 6 hours of life. There were no statistically significant differences in maternal characteristics, including type of maternal diabetes and its management between hypoglycaemic and normoglycaemic infants. Hypoglycaemic infants were more likely to be LGA (28.2% v. 12.8%; p=0.009). Conclusion: Hypoglycaemia is a common finding in IDM. It presents early (within the first 6 hours of life) and rarely beyond 24 hours after birth. The only characteristic found to be associated with development of hypoglycaemia in IDM was a neonate being LGA


Subject(s)
Hypoglycemia , Incidence , Infant, Extremely Premature , Infant, Premature , Neonatal Sepsis , South Africa , Women
12.
Epidemiol. serv. saúde ; 28(1): e2018132, 2019. tab
Article in English, Portuguese | LILACS | ID: biblio-984376

ABSTRACT

Objetivo: calcular taxas de mortalidade no primeiro dia de vida entre 2010 e 2015 em oito Unidades da Federação brasileira com melhor qualidade de informação, avaliar fatores associados e classificar os óbitos segundo causa básica e evitabilidade. Métodos: estudo descritivo; as taxas foram comparadas conforme características maternas e da criança; a análise de evitabilidade usou a 'Lista brasileira de causas de mortes evitáveis'. Resultados: 21,6% (n=20.791) dos óbitos infantis ocorreram no primeiro dia de vida; a taxa de mortalidade reduziu-se de 2,7 para 2,3 óbitos/1.000 nascidos vivos; observaram-se maiores taxas em NV com baixo peso, nascidos pré-termo e filhos de mães sem escolaridade; as principais causas dos óbitos foram síndrome da angústia respiratória (8,9%) e imaturidade extrema (5,2%); 66,3% das causas de óbito foram consideradas evitáveis. Conclusão: dois terços dos óbitos no primeiro dia de vida poderiam ser evitados por atenção adequada à mulher na gestação e no parto, e ao NV.


Objetivo: calcular la mortalidad en el primer día de vida entre 2010 y 2015 en ocho Unidades de la Federación brasileña con mejor calidad de información, analizar factores asociados y clasificar las causas básicas y la evitabilidad de los óbitos. Métodos: estudio descriptivo; las tasas de mortalidad fueron comparadas según las características maternas y del recién nacido (RN); el análisis de evitabilidad utilizó la 'Lista brasileña de causas de muertes evitables'. Resultados: un 21,6% (n=20.791) de los óbitos infantiles ocurrió en el primer día de vida; la tasa de mortalidad se redujo de 2,7 a 2,3 óbitos/1.000 nacidos vivos (NV); las tasas fueron mayores en NV de bajo peso, prematuros e hijos de madres sin escolaridad; las principales causas de óbito fueron síndrome de angustia respiratoria (8,9%) e inmadurez extrema (5,2%); un 66,3% de las causas de óbito fueron consideradas evitables. Conclusión: 2/3 de los óbitos en el primer día de vida podrían haber sido evitados con una atención adecuada a la mujer embarazada, al parto y al NV.


Objective: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. Methods: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. Results: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. Conclusion: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Adult , Cause of Death , Premature Birth/mortality , Perinatal Mortality/trends , Infant, Extremely Premature , Perinatal Death , Respiratory Distress Syndrome, Newborn/mortality , Respiratory Distress Syndrome, Newborn/epidemiology , Brazil/epidemiology , Infant, Low Birth Weight , Epidemiology, Descriptive , Perinatal Death/prevention & control , Maternal Health Services/standards
13.
Rev. ecuat. pediatr ; 19(2): 55-57, diciembre 2018.
Article in Spanish | LILACS | ID: biblio-996449

ABSTRACT

Introducción. La neonatología del Hospital de los Valles (HDLV) es un centro de referencia de cuarto nivel con atención de pacientes prematuros que presentan un mayor riesgo de morbimortalidad y en quienes aún hay debate sobre la edad gestacional aceptable para aunar esfuerzos en tratamiento y sobrevida. En los Estados Unidos, la tasa de nacimientos prematuros, que había aumentado constantemente durante la década de 1990 y principios de 2000, ha disminuido anualmente durante 7 años y ahora es aproximadamente del 11,39%. La viabilidad humana, definida como la edad gestacional en la que la posibilidad de supervivencia es del 50%, actualmente es de aproximadamente 23 a 24 semanas en los países desarrollados, con una supervivencia de prematuros de 25 semanas superior al 60%. Materiales y Métodos. Es un estudio descriptivo transversal de tipo retrospectivo, en el que se tomó como población a todos los niños nacidos antes de las 28 semanas de gestación atendidos en el Hospital de los Valles desde enero del 2014 a diciembre del 2018, se obtuvieron los datos de la base de datos EpicLatino y de las historias clínicas de los pacientes, Los datos obtenidos fueron ingresados en el programa Excel para su tabulación y análisis. Resultados. Entre enero del 2014 a diciembre del 2018 se registraron 1710 pacientes de los cuales 479 son prematuros y de estos 29 son prematuros extremos. Se registraron 8 fallecimientos 5 de los cuales nacieron fuera de la institución, la edad gestacional más temprana con sobrevida es de 24.5 semanas y el menor peso registrado es de 575 gramos, la morbilidad más comúnmente asociada a la prematurez extrema en orden descendente es enfermedad de membrana hialina, anemia, sepsis y broncodisplasia pulmonar, no hay registro de retinopatía y se reportaron 6 casos de hemorragia intraventricular. El peso promedio de alta es de 2045 gramos, con 16 pacientes enviados a casa con oxigeno domiciliario. Conclusión. La neonatología del HDLV presta atención de cuarto nivel con una sobrevida en pacientes menores de 28 semanas de edad gestacional comparable con otras instituciones a nivel mundial, con una mejor respuesta en pacientes nacidos dentro de la propia institución, es importante que los pacientes que tengan riesgo de nacer a edades gestacionales muy cortas sean derivados oportunamente a instituciones con mayor capacidad resolutiva en bien del paciente y su familia.


is an increased risk of morbidity and mortality and in whom there is still debate about the acceptable gestational age to combine efforts in treatment and survival. In the United States, the rate of premature births, which had steadily increased during the 1990s and early 2000s, has decreased annually for 7 years and now is approximately 11.39%. Human viability, defined as gestational age in which the possibility of survival is 50%, currently is approximately 23 to 24 weeks in developed countries, with a survival of preterm infants of 25 weeks greater than 60% . Materials and methods. This is a cross-sectional, retrospective descriptive study, in which all children born before the 28 weeks of gestation attended at the Hospital de los Valles from January 2014 to December 2018 were taken as a population. EpicLatino database and the patient's medical records. The data obtained were entered into the Excel program for tabulation and analysis. Results Between January 2014 and December 2018, 1710 patients were registered, of whom 479 are premature and of these 29 are premature preterm infants. There were 8 deaths 5 of which were born out of the institution, the earliest gestational age with survival is 24.5 weeks and the lowest recorded weight is 575 grams, the morbidity most commonly associated with extreme prematurity in descending order is disease. hyaline membrane, anemia, sepsis and pulmonary bronchodysplasia, there is no record of retinopathy and 6 cases of intraventricular hemorrhage were reported. The average dischange weight is 2045 grams, with 16 patients sent home with home oxygen. Conclusion. HDLV neonatology provides fourth level care with a survival in patients younger than 28 weeks gestational age comparable with other institutions worldwide, with a better response in patients born within the institution itself, it is important that patients at risk of being born at very short gestational ages are opportunely referred to institutions with greater resolutive capacity for the good of the patient and his family.


Subject(s)
Humans , Infant, Newborn , Indicators of Morbidity and Mortality , Fetal Viability , Infant, Extremely Premature , Health Services Research , Intensive Care, Neonatal , Gestational Age
14.
Ciênc. Saúde Colet ; 23(8): 2713-2720, Aug. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-952733

ABSTRACT

Resumo O objetivo deste artigo é identificar os fatores de risco de óbito neonatal em região do interior paulista. Estudo de casos e controles. O grupo casos foi constituído por 162 crianças/óbitos neonatais ocorridos em 2009 na região do Departamento Regional de Saúde VI- Bauru/SP. Compuseram o grupo controle 324 crianças selecionadas do Sistema de Informações de Nascidos Vivos dentre aquelas com o mesmo ano de nascimento e município de residência. Para identificar os fatores associados ao óbito neonatal, realizou-se análise de regressão logística univariada e múltipla hierarquizada, estimando-se as razões de odds (e respectivos intervalos de confiança de 95%) brutas e ajustadas para potenciais fatores de confusão. Apresentaram maior chance de óbito os neonatos cujas mães tinham história de óbito infantil, realizaram até três consultas pré-natais e idade gestacional inferior a 28 semanas. A influência do peso ao nascer foi observada apenas entre crianças com peso inferior a 1500g. Este estudo identificou, de maneira independente, cinco fatores de risco para o óbito neonatal, com destaque para a história materna de óbito infantil anterior, fator ainda não valorizado em estudos prévios.


Abstract The main objective of this study was to identify risk factors for neonatal death in an inland region of the State of São Paulo. A case-control study was conducted using a case group of 162 child deaths that occurred in 2009 in the state's VI Regional Health Department - Bauru. The control group consisted of 324 children selected from the Live Births Information System database who shared the same birth date and city of residence. Univariate and hierarchical multiple logistic regression analyses were performed to identify the factors associated with neonatal death by calculating crude odds ratios adjusted for potential confounders and respective 95% confidence intervals. Results: The likelihood of neonatal death was greater among women who had had a history of infant death (OR = 24.97, CI = 12.20 to 51.10) and who had had only up to three antenatal appointments (OR = 11.40, CI = 5, 92 to 21.93), and among infants born at less than 28 weeks of gestation (OR = 168.00, CI = 49.63 to 568.66). The influence of birth weight was also observed among newborns weighing under 1,500g. Conclusions: This study identified five independent risk factors for neonatal death, the most notable of which is maternal history of neonatal death, which has not been properly acknowledged as a risk factor by previous studies.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Infant , Adult , Young Adult , Prenatal Care/statistics & numerical data , Birth Weight , Gestational Age , Perinatal Death , Brazil/epidemiology , Case-Control Studies , Likelihood Functions , Logistic Models , Risk Factors , Databases, Factual , Infant, Extremely Premature
16.
ABCS health sci ; 43(1): 3-9, maio 18, 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-883994

ABSTRACT

INTRODUÇÃO: Recém-nascidos pré-termo (RNPT) com menos de 27 semanas de idade gestacional apresentam vulnerabilidade para o desenvolvimento de hemorragias peri e intraventriculares (HPIV), o que pode afetar a mielinização e organização do córtex cerebral, acarretando possíveis prejuízos ao desenvolvimento. OBJETIVO: Avaliar o comportamento neurológico de RNPT acometido por HPIV com e sem sepse segundo a versão resumida do Método Dubowitz, delimitar a presença de itens desviantes da avaliação e comparar com as respostas obtidas pelo grupo controle (sem HPIV). MÉTODOS: Estudo transversal realizado no Hospital Municipal Universitário de São Bernardo do Campo (SP). Os RNPT foram divididos em três grupos, sendo dois estudos (HPIV e HPIV + sepse) e um controle. Os participantes foram avaliados com idade correspondente ao termo. A versão resumida do método, utilizada como triagem para recém-nascidos de risco neurológico é constituída por 12 itens. As análises foram realizadas segundo pontuações desviantes nestes itens e comparadas com as pontuações esperadas para a normalidade. Os dados obtidos foram comparados na pontuação resumida e na pontuação da versão íntegra. RESULTADOS: A frequência de RNPT com pontuações atípicas foram: 40% no grupo HPIV + sepse, 10% no grupo HPIV e 15% no controle. CONCLUSÃO: A HPIV de forma isolada não parece ser um fator significante para presença de itens desviantes no Método Dubowitz resumido. A presença de HPIV em graus mais severos esteve associada à presença de sepse. Os RNPT com HPIV associada à sepse obtiveram pior desempenho neurológico.


INTRODUCTION: Preterm infants with less than 27 weeks of gestacional age present vulnerability for development of periand intraventricular hemorrhage (PIVH). This can affect the myelinization and organization of cerebral cortex, leading to possible developmental impairment. OBJECTIVE: To evaluate the neurological behavior of preterm infants affected by PIVH with and without sepsis according to the Dubowitz Method summary, to delimit the presence of deviant items of the evaluation and to compare with the results of the control group (without PIVH). METHODS: This is a cross-sectional study. The preterm infants were divided in three groups, two study groups (PIVH and PIVH + sepsis), and one control group. The summary version of the Dubowitz Method was used as a neurological screening for the risk in preterm infants. The analysis was performed according to scores with deviation in these items and compared to the expected normal score. Data obtained were compared using the summary score and the full version of the test. RESULTS: The frequency of abnormal scores was: 40% in the group with PIVH + sepsis, 10% in the group only with PIVH, 15% in the control group. CONCLUSION: The PIVH does not seem to be a significant factor for the presence of items with deviation in the summary version of Dubowitz Method. The presence of PIVH in more severe stages was associated with the presence of sepsis. The preterm infants with PIVH with sepsis obtained worse neurological performance in the test.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant, Premature/growth & development , Developmental Disabilities/physiopathology , Intracranial Hemorrhages/physiopathology , Infant, Extremely Premature/growth & development , Neonatal Sepsis , Neurologic Examination , Cross-Sectional Studies , Neonatal Sepsis/physiopathology
17.
Rev. chil. pediatr ; 89(2): 202-207, abr. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-900088

ABSTRACT

INTRODUCCIÓN: La función tiroidea del prematuro se ve alterada por la relativa inmadurez del eje hipotálamo-hipófisis-tiroides, junto a otros factores como la incidencia de enfermedades o el uso de algunos fármacos. Actualmente existe controversia sobre los niveles normales de tiroxina libre (T4L) en recién nacidos prematuros. Nuestro objetivo fue determinar la distribución de los valores de hormonas T4L y TSH, en recién nacidos menores de 32 semanas o 1.500g de peso al nacer, a los 15 días de edad cronológica, en el servicio de neonatología Hospital Dr. Hernán Henríquez Aravena, Temuco. Pacientes y MÉTODO: Estudio de corte trasversal, se analizaron los resultados de T4L y TSH desde una base de datos a 308 recién nacidos, los que fueron categorizados en tres rangos de edad gestacional: 31 a 34, 28 a 30 y 23 a 27 semanas. Se utilizó Chi-cuadrado de Pearson para asociaciones entre variables categóricas, y T-Test o ANOVA para comparaciones entre variables continuas. RESULTADOS: Observamos diferencias significativas entre los valores promedio de T4L por rangos de edad gestacional (p = 0,000), estos fueron 1,13 ng/dl para el rango de 31 a 34 semanas, 1,03 ng/dl para el rango de 28 a 30 semanas y 0,92 ng/dl para el rango de 23 a 27 semanas; no observamos diferencias significativas en los niveles de TSH por categorías de edad gestacional (p = 0,663). CONCLUSIONES: Establecimos la distribución de los niveles de T4L y TSH en nuestra población de recién nacidos muy prematuros y prematuros extremos, encontrando diferencias con reportes anteriores.


INTRODUCTION: The thyroid function of the pretern infant is altered by the relative immaturity of the hypothalamus-pituitary thyroid gland axis, along with other factors such as the incidence of diseases or the use of some drugs. Currently, there is controversy over normal levels of free thyroxine (FT4) in preterm infants. Our objective was to determine the distribution of FT4 and TSH values in newborn younger than 32 weeks or 1500 g of birth weight at 15 days of chronological age, in the neonatology service at Dr. Hernán Henríquez Aravena Hospital, Temuco. PATIENTS AND METHOD: Cross-sectional study; the results of FT4 and TSH from a database of 308 newborns, were analyzed, which were categorized into three gestational age ranges, 31-34, 28-30 and 23-27 weeks. It was used Pearson Chi-square for comparisons between categorical variables, and T-Test or ANOVA for categorical-variable ratios. RESULTS: Significant differences were observed between the average values of FT4 by gestatio nal age ranges (p = 0.000), these were 1.13 ng/dl for the range of 31 to 34 weeks, 1.03 ng/dl for the range of 28 to 30 weeks and 0.92 ng/dl for the range of 23 to 27 weeks; we did not observe significant differences in TSH levels by gestational age categories (p = 0.663). CONCLUSIONS: We established the distribution of FT4 and TSH levels in our population of very preterm and extremely preterm infants, finding differences with previous papers.


Subject(s)
Humans , Male , Female , Infant, Newborn , Thyroxine/blood , Thyrotropin/blood , Infant, Extremely Premature/blood , Reference Values , Biomarkers/blood , Cross-Sectional Studies , Retrospective Studies , Gestational Age
19.
Rev. chil. pediatr ; 89(1): 18-23, feb. 2018. tab
Article in Spanish | LILACS | ID: biblio-900064

ABSTRACT

Resumen: Introducción: Los prematuros extremos tienen mayor incidencia de Hipertensión Arterial (HTA) y riesgo de daño renal, secundario a un menor número de glomérulos con la consiguiente hiperfiltración de los remanentes. Objetivo: Evaluar la prevalencia de cifras tensionales alteradas usando monitorización ambulatoria de presión arterial (MAPA) y marcadores de daño renal en escolares con antecedentes de prematurez extrema. Pacientes y Método: Realización medición aislada de presión arterial, MAPA, y evaluación de función renal en el seguimiento de prematuros extremos de edad escolar. Resultados: Se reclutaron 30 pacientes, obteniéndose mediciones válidas de MAPA en 19 casos, de los cuales nueve (47,4%) presentaron alteraciones, principalmente ausencia de diferencia de presión día noche. No hubo alteraciones de la función renal en ellos. Discusión: Nuestro estudio detectó una alta prevalencia de alteraciones en MAPA en escolares con antecedentes de prematurez extrema, principalmente la ausencia de diferencia de presión día noche, que se relaciona con mayor riesgo de progresión a HTA. Se resalta la importancia de realizar MAPA dentro del estudio en pacien tes con factores de riesgo de desarrollar HTA a fin de detectar en forma precoz alteraciones y realizar un manejo y seguimiento estrecho.


Abstract: Introduction: Extremely premature children have a higher incidence of High Blood Pressure (HBP) and risk of renal damage due to decreased glomerular count with consequent hyperfiltration of the remnants. Objectives: To assess the prevalence of altered blood pressure values in outpatient measurement and ambulatory blood pressure monitoring (ABPM) in preterm infants ≤ 32 weeks and/ or ≤ 1,500 g birth weight between 5 and 7 years of age, as well as the presence of early renal damage markers. Patients and Methods: An isolated measurement of blood pressure, ABPM and laboratory tests (microalbuminuria/creatininuria ratio in an isolated urine sample, serum creatinine, blood urea nitrogen and urinalysis) were performed. Results: 30 patients were recruited, of whom valid measu rements of ABPM were obtained in 19 cases, of which nine (47,4%) presented some abnormalities, principally nocturnal day/night difference or DIP absent. No abnormal laboratory tests were found. Discussion: Our study detected a high prevalence of abnormalities in ABPM principally DIP absence, which has been related to an increased risk of progression to hypertension. The importance of per forming ABPM in the study is emphasized in patients with risk factors for developing hypertension in order to detect early alterations and close management and follow-up.


Subject(s)
Humans , Male , Female , Infant, Newborn , Child, Preschool , Child , Blood Pressure Monitoring, Ambulatory , Infant, Extremely Premature , Hypertension/diagnosis , Infant, Premature, Diseases/diagnosis , Chile/epidemiology , Prevalence , Follow-Up Studies , Hypertension/epidemiology , Infant, Premature, Diseases/epidemiology
20.
Rev. ecuat. pediatr ; 19(1): 28-30, enero 2018.
Article in Spanish | LILACS | ID: biblio-996430

ABSTRACT

Antecedentes: El peso al nacimiento es un factor importante y predictor de la morbimortalidad del neonato prematuro más aun en neonatos prematuros extremos y de peso bajo, sin embargo, las diferentes maneras de sustentar la alimentación enteral o parenteral nos permiten mejorar las la sobrevida y la calidad de vida. Los neonatos de muy bajo peso al nacer (menos de 1.500 g) tienen 200 veces más riesgo de morir, si sumamos esto a la edad gestacional la expectativa de vida es más complicada sobre todo en países en vías de desarrollo. Mantener guías de alimentación enteral y parenteral de manera precoz y sustentada evitan la desnutrición y proveen una mejor condición clínica para que el prematuro extremo pueda enfrentar esta primera etapa de la manera más satisfactoria. Varios son los nutrientes que tienen que ver en le crecimiento y desarrollo no solo de masa sino de funcionalidad y calidad sobre todo a nivel neurológico. Materiales y métodos: Es un estudio de tipo retrospectivo de cohorte descriptivo analizando la base de datos de EPIQ latino y las historias clínicas de los pacientes prematuros extremos, las variables a analizar son edad gestacional, peso, perímetro cefálico, tipo de alimentación enteral y parenteral al nacimiento, a los 28 dias de vida y a las 36 semanas de edad gestacional. Objetivo: Determinar el aporte nutricional en los pacientes prematuros extremos de la neonatología del Hospital de los Valles desde enero de 2015 hasta diciembre del 2018 Resultados: La mayoría de pacientes de la unidad de estudio reciben alimentación enteral dentro de las primeras 24 hs de vida, al igual modo el apoyo nutricional inmediato o casi inmediato protege de la desnutrición, la ganancia ponderal aumento de perímetro cefálico está garantizada con un adecuado aporte nutricional enteral o parenteral Recomendaciones: ampliar el estudio a todos los pacientes prematuros y correlaciona con la valoración sanguínea de los micronutrientes requeridos para el normal desempeño de las múltiples funciones del prematuro sobretodo neurológicas.


Background: Birth weight is an important factor and predictor of morbidity and mortality in premature neonates even in extreme premature and low birth weight neonates, however the different ways of sustaining enteral or parenteral feeding allow us to improve survival and quality of life, Very low birth weight infants (less than 1,500 g) have a 200 times higher risk of dying, if you add this to gestational age life expectancy is more complicated especially in developing countries. Keeping enteral and parenteral feeding guides early and sustained prevent malnutrition and provide a better clinical condition for the extreme premature to face this first stage in the most satisfactory way, several are the nutrients that have to do with growth and development not only mass but functionality and quality especially at the neurological level. Materials and methods: This is a retrospective study of a descriptive cohort analyzing the Latin EPIQ database and the clinical histories of the extreme premature patients, the variables to be analyzed are gestational age, weight, cephalic perimeter, type of enteral and parenteral feeding. at birth, at 28 days of age and at 36 weeks of gestational age. Objective: To determine the nutritional contribution in the extreme premature patients of the neonatology of the Hospital de los Valles from January 2015 to December 2018. Results: Most patients in the study unit receive enteral nutrition within the first 24 hours of life, as well as immediate or almost immediate nutritional support protects against malnutrition, weight gain and head circumference is guaranteed with an adequate contribution enteral or parenteral nutrition Recommendations: extend the study to all premature patients and correlate with the blood evaluation of the micronutrients required for the normal performance of the multiple functions of the premature, especially neurological.


Subject(s)
Humans , Infant, Newborn , Infant, Low Birth Weight , Cephalometry , Infant, Extremely Premature , Food , Enteral Nutrition , Parenteral Nutrition , Milk, Human
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