Doença metabólica óssea em prematuros de muito baixo peso internados em UTI neonatal: ocorrência e fatores associados / Metabolic bone disease in extremely low birth weight premature infants admitted to a neonatal ICU: prevalence and associated factors

Introdução: Recém-nascidos (RN) prematuros de muito baixo peso (MBP) apresentam um risco aumentado de desenvolver doença metabólica óssea (DMO). A realização de suplementação mineral e de triagem para DMO em UTI Neonatal auxilia na prevenção, no diagnóstico e no tratamento desta condição clínica. Objetivos: Avaliar a ocorrência de DMO, a realização de suplementação mineral e de investigação para DMO em prematuros de MBP internados em UTI Neonatal de um Serviço Hospitalar Materno-Infantil de alto risco, vinculado ao SUS. Métodos: Estudo transversal, a partir de dados secundários coletados de prontuários eletrônicos. Foram avaliados os recém-nascidos prematuros de muito baixo peso internados em UTI neonatal. Estudaram-se perfil do recém-nascido, realização da triagem para DMO, ocorrência de DMO, regime alimentar, intercorrências clínicas, uso de suplementação de vitaminas e minerais, idade, peso, sexo, via de parto e Apgar. Resultados: Foram incluídos 112 participantes. A triagem para DMO foi feita em 56 pacientes (50%), com dosagem sérica de fosfatase alcalina, cálcio, fósforo e magnésio séricos. A ocorrência de DMO foi de 8,9% (5 casos). Todos os participantes com DMO apresentaram doença respiratória, quadro infeccioso e estavam recebendo nutrição parenteral. Conclusão: A ocorrência de DMO em recém-nascidos de muito baixo peso internados em UTI neonatal foi de 8,9%, inferior à descrita na literatura. Identificamos como fatores associados à DMO a ocorrência concomitante de doença respiratória, a sepse e o uso de nutrição parenteral.

Introduction: Extremely low birth weight (ELBW) premature infants have an increased risk of developing metabolic bone disease (MBD). The use of mineral supplementation and MBD screening in the neonatal ICU helps prevent, diagnose, and treat this clinical condition. Objectives: To evaluate the occurrence of MBD, as well as the presence of mineral supplementation and MBD screening in premature infants with MBD admitted to the neonatal ICU of a high-risk maternal-child hospital associated with the Brazilian Unified Health System. Methods: This was a cross-sectional study based on secondary data from electronic medical records. We evaluated ELBW premature infants admitted to a neonatal ICU. Infant profile, MBD screening, MBD occurrence, diet, clinical complications, vitamin and mineral supplementation use, age, weight, sex, delivery method, and Apgar score were assessed. Results: We included 112 participants in the study. MBD screening was conducted in 56 patients (50%) with serum levels of alkaline phosphatase, calcium, phosphorus, and magnesium. The rate of MBD occurrence was 8.9% (5 cases). All participants with MBD had respiratory disease, infection, and were receiving parenteral nutrition. Conclusions: The occurrence rate of MBD in ELBW infants admitted to a neonatal ICU was 8,9%, lower than that found in the literature. Factors associated with MBD were the concomitant occurrence of respiratory disease, sepsis, and parenteral nutrition.

Clinical significance of Clara cell secreted protein 16 and pulmonary surfactant protein-A in early diagnosis of neonatal acute respiratory distress syndrome / 中国小儿急救医学

Objective:To investigate the clinical significance of changes of serum Clara cell secretory protein(CC16) and pulmonary surfactant protein A(SP-A) in neonates with acute respiratory distress syndrome(ARDS).Methods:The data of 30 neonates with ARDS who needed mechanical ventilation in neonatal intensive care unit of Xi′an Children′s Hospital from January 2016 to November 2018 were collected as observation group, including 12 cases in mild group, 10 cases in moderate group and 8 cases in severe group.The data of healthy newborns during the same period were taken as control group.The serum levels of CC16 and SP-A were detected by ELISA.The serum levels of CC16 and SP-A among different groups were compared.Results:The levels of serum CC16 and SP-A in ARDS group were (59.35±3.67)mg/L and(75.38±6.27)mg/L respectively, (11.26±1.32)mg/L and(18.15±2.69)mg/L in healthy group.The difference was significant( P<0.05). And the differences of serum CC16 and SP-A levels among different degree ARDS groups were significant( P<0.05). The levels of serum CC16 in mild, moderate and severe subgroup were(38.27±16.01)mg/L, (51.25±15.63)mg/L, (84.76±13.12)mg/L and SP-A were(47.02±7.18)mg/L, (73.12±7.98)mg/L, (96.45±12.50)mg/L, which increased with disease severity. Conclusion:Serum CC16 and SP-A are increased and correlated with the severity of neonatal ARDS, which may be used as the index for evaluating the severity of neonatal ARDS in the future.

Obstetric analgesia in labor and its association with neonatal outcomes / Analgesia obstétrica en el trabajo de parto y su asociación con resultados neonatales / Analgesia obstétrica no trabalho de parto e sua associação com desfechos neonatais

ABSTRACT Objetives: To investigate the association between analgesia during labor and occurrence of neonatal outcomes. Methods: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. Results: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. Conclusions: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.

RESUMEN Objetivos: Investigar la asociación entre la analgesia en el trabajo de parto y la aparición de resultados neonatales. Métodos: Estudio de cohorte retrospectivo con datos de 850 parturientas. La exposición fue recibir analgesia farmacológica en el trabajo de parto, resultados: Apgar del primer y quinto minuto < 7, maniobras de reanimación y derivación a la UCIN. La regresión logística se utilizó para obtener el Odds Ratio (OR) y el intervalo de confianza del 95% (IC95%), ajustado por variables de confusión. Resultados: De las mujeres estudiadas, el 35% recibió analgesia y su uso se asoció con una mayor probabilidad de resultados como: Apgar en el primer minuto < 7 (p<0,0001), maniobras de reanimación (p<0,001) y derivación a la UCIN (p=0,004). Conclusiones: el uso de analgesia farmacológica durante el trabajo de parto se asoció con Apgar < 7 en el primer minuto, maniobras de reanimación y derivación a la UCIN.

RESUMO Objetivos: Investigar a associação entre analgesia no trabalho de parto e ocorrência de desfechos neonatais. Métodos: Estudo de coorte retrospectiva com dados de prontuários de 850 parturientes. A exposição foi receber analgesia farmacológica no trabalho de parto e os desfechos: Apgar do primeiro e quinto minuto < 7, manobras de reanimação e encaminhamento para Unidade de Terapia Intensiva Neonatal (UTI). Utilizou-se regressão logística para obter Odds Ratio (OR) e intervalo de 95% de confiança (IC95%), sendo ajustados por confundidores. Resultados: Das mulheres estudadas, 35% receberam analgesia e seu uso esteve associado a maior chance de desfechos, como: Apgar do primeiro minuto < 7 (p<0,0001), manobras de reanimação (p<0,001) e encaminhamento para UTI Neonatal (p=0,004), principalmente entre gestantes de risco habitual, mesmo após ajustes. Conclusões: O uso de analgesia farmacológica durante o trabalho de parto foi associado a Apgar do primeiro minuto < 7, manobras de reanimação e encaminhamento para UTI neonatal.

Obstetric analgesia in labor and its association with neonatal outcomes / Analgesia obstétrica en el trabajo de parto y su asociación con resultados neonatales / Analgesia obstétrica no trabalho de parto e sua associação com desfechos neonatais

ABSTRACT Objetives: To investigate the association between analgesia during labor and occurrence of neonatal outcomes. Methods: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. Results: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. Conclusions: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.

RESUMEN Objetivos: Investigar la asociación entre la analgesia en el trabajo de parto y la aparición de resultados neonatales. Métodos: Estudio de cohorte retrospectivo con datos de 850 parturientas. La exposición fue recibir analgesia farmacológica en el trabajo de parto, resultados: Apgar del primer y quinto minuto < 7, maniobras de reanimación y derivación a la UCIN. La regresión logística se utilizó para obtener el Odds Ratio (OR) y el intervalo de confianza del 95% (IC95%), ajustado por variables de confusión. Resultados: De las mujeres estudiadas, el 35% recibió analgesia y su uso se asoció con una mayor probabilidad de resultados como: Apgar en el primer minuto < 7 (p<0,0001), maniobras de reanimación (p<0,001) y derivación a la UCIN (p=0,004). Conclusiones: el uso de analgesia farmacológica durante el trabajo de parto se asoció con Apgar < 7 en el primer minuto, maniobras de reanimación y derivación a la UCIN.

RESUMO Objetivos: Investigar a associação entre analgesia no trabalho de parto e ocorrência de desfechos neonatais. Métodos: Estudo de coorte retrospectiva com dados de prontuários de 850 parturientes. A exposição foi receber analgesia farmacológica no trabalho de parto e os desfechos: Apgar do primeiro e quinto minuto < 7, manobras de reanimação e encaminhamento para Unidade de Terapia Intensiva Neonatal (UTI). Utilizou-se regressão logística para obter Odds Ratio (OR) e intervalo de 95% de confiança (IC95%), sendo ajustados por confundidores. Resultados: Das mulheres estudadas, 35% receberam analgesia e seu uso esteve associado a maior chance de desfechos, como: Apgar do primeiro minuto < 7 (p<0,0001), manobras de reanimação (p<0,001) e encaminhamento para UTI Neonatal (p=0,004), principalmente entre gestantes de risco habitual, mesmo após ajustes. Conclusões: O uso de analgesia farmacológica durante o trabalho de parto foi associado a Apgar do primeiro minuto < 7, manobras de reanimação e encaminhamento para UTI neonatal.

Clinical analysis of 30 cases of neonatal group B Streptococcus sepsis / 中华实用儿科临床杂志

Objective To explore the clinical characteristics,treatment and prognosis of neonatal group B streptococcus (GBS) sepsis.Methods According to the onset time and clinical features of the patients,30 cases of neonatal GBS sepsis in Department of Noonatology,Zhuhai People's Hospital and ICU of Newborn of Maternity and Child Care Health Hospital of Guangxi from January 2013 to February 2015 were divided into the early-onset group (onset day of the patients ≤7 days) and late-onset group (onset day of the patients ＞7 days).The clinical manifestations,the examination results of laboratory,imaging examination,treatment and prognosis were retrospectively analyzed.Results Among the newborns diagnosed as neonatal GBS sepsis,there were 19 cases of early-onset sepsis and 11 cases of late-onset sepsis,including 17 males and 13 females,consisting of 24 term infants and 6 premature infants.The early-onset newborns were mainly diagnosed with respiratory symptoms like anhelation,groaning (73.7％,14/19 cases),late-onset GBS sepsis with high fever (81.8％,9/11 cases),high frequency of early-onset intrauterine infection pneumonia (89.5％,17/19 cases) and late-onset intracranial infection (63.6％,7/11 cases).The differences between the 2 groups were statistically significant (all P ＜ 0.05).Laboratory tests of GBS sepsis showed that the early value of procalcitonin (PCT) increased,while the number of white blood cells,platelet decreased and C-reactive protein (CRP) increased relatively late.Chest X-ray examination showed 16 cases of pneumonia in children,1 case of pulmonary hemorrhage,1 case of bilateral pneumothorax.Head CT,B ultrasound,and magnetic resonance imaging discover 1 case of ventricular perivascular hemorrhnge,2 cases of intraventricular hemorrhage with ventricular dilatation and 1 case of subdural effusion.Drug sensitivity test showed that 30 cases of children were sensitive to Penicillin,Vanoomycin among which 17 cases (56.66％) were cured,4 cases (23.33％) were improved,9 cases died,6 cases died of abandoning treatment,and the total mortality was 30.00％ (9/30 cases).The 6-month follow-up of 9 cases of purulent meningitis newborns showed that there were 2 cases of mild mental retardation and motor dysfunction,1 case of mild ventricular dilatation with no progressive increase,and 6 cases with no significant sequelae.Conclusion The clinical manifestations of neonatal GBS sepsis are typical.Dynamically monitoring the changes of PCT,CRP,white blood cells and platelet helps to early identify GBS sepsis infection and use sensitive antibiotics to cure the newborns.

Analysis of the clinical diagnosis and treatment of neonatal severe disease complicated with hyponatremia / 中国基层医药

Objective To explore the best scheme of clinical diagnosis and treatment of neonatal severe disease complicated with hyponatremia.Methods 120 severe disease neonatal with hyponatremia were randomly divided into observation group and control group,60 cases in each group.The observation group was given special care and treatment for the cause,the control group was given conventional treatment in intensive care and conventional sodium.The incidence rate of severe disease and the treatment effect of hyponatremia were compared.Results After treatment,the total incidence rate of severe disease of the observation group was 8.3％,that was 23.3％ in the control group,there was significant difference between two groups (x2 =3.858,P ＜ 0.05).In observation group,the markedly effective rate of hyponatremia was 83.3％,that was 63.3％ in the control group,there was significant difference between two groups (x2 =10.231,P ＜ 0.05).Conclusion Special intensive care and aimed at pathogeny cure can obviously reduce the probability of hyponatremia complicated with severe disease,and it can significantly improve the treatment effect of hyponatremia,it has fairly well clinical value.

Changes of Systolic Time Interval after Neonatal Asphyxia and Its Relationship with Clinical Manifestation and Prognosis / 实用儿科临床杂志

Objective To observe the changes of systolic time interval after neonatal asphyxia and explore its relationship with clinical manifestation and prognosis. Methods Tow-dimensional and Doppler echocardiography were employed to detect tow - dimension parameters and left and right ventricular STI in 27 mild and 18 severe asphyxiated neonates as well as 14 normal controls and its relationship with clinical manifestation and prognosis was analyzed. Results There was no difference in cavity and thickness of heart and great arteries between normal and asphyxiated neonates. In acute stage mild and severe asphyxiated neonates had a shorter right ventricular ejection time (RVET) than normal neonates and a longer right ventricular prejection period (RPEP) was found in severe neonates than that in normal and mild asphyxiated neonates. Left ventricular preejection time (LPEP) was prolonged in comparison with normal neonates in acute stage and convalescence. There were more cases with increased RPEP/RVET in severe asphyxiaed group than those in mild and normal group in acute stage. The incidence of heart failure in acute stage and disability in late period was higher in cases with increased RPEP/RVET than that with normal RPEP/RVET. Conclusion Asphyxia has more severe damage to right ventricle than that to left ventricle. Cases with increased RPEP/RVET are prone to suffering from heart failure in acute stage and more likely to undergo disability in late period.