ABSTRACT
INTRODUCTION AND OBJECTIVES: The aim of this study is to identify respiratory clinic and pulmonary arterial hypertension (PAH) in congenital diaphragmatic hernia (CDH) and whether these could be predicted by prenatal measures. MATERIAL AND METHODS: We studied fetal ultrasound: Observed/expected Lung to Head Ratio (O/E LHR) and classified patients according to their outcome (group 1: O/E LHR <25%, group 2: 26-35%, group 3: 36-45%, group 4: >55%) as well as the severity of PAH (group 0: non-PAH, group 1: mild, group 2: moderate, group 3: severe) in echocardiograms at birth, 1st, 6th, 12th and 24 months of life. We also evaluated gestational age, weight, bronchodilator treatment and number of hospital admissions. RESULTS: 58 patients with CDH, 13 without prenatal diagnosis. 36 patients out of 45 had O/E LHR calculated at 22.4 ± 5.8 weeks. O/E LHR had significant association with the severity of PAH at birth and in the 1st, 6th, 12th and 24th months (p <0.05). At 6 months, only 30.4% had PAH without any association with a higher risk of hospital admission [OR 1.07 (0.11-10.1)] and only three patients (5.1%) required bronchodilator treatment. CONCLUSION: In CDH, PAH and the respiratory clinic improve over time, being uncommon the need for treatment as of the 6th month. O/E LHR predicts the presence and severity of PAH in short and long term.
INTRODUCCION Y OBJETIVOS: Nuestro objetivo es estudiar la presencia en hernia diafragmática congénita (HDC) de clínica respiratoria e hipertensión pulmonar (HTP) a largo plazo y si estas pueden predecirse prenatalmente. MATERIAL Y METODOS: Estudiamos en ecografía fetal: Lung to Head Ratio observado/esperado (LHR O/E) y clasificamos a los pacientes según su resultado (grupo 1: LHR O/E <25%, grupo 2: 26-35%, grupo 3: 36-45%, grupo 4: >55%) así como la gravedad de HTP (grupo 0: no HTP, grupo 1: leve, grupo 2: moderada, grupo 3: grave) en los ecocardiogramas al nacimiento, 1º, 6º, 12º y 24º meses de vida. Estudiamos también edad gestacional, peso, tratamiento broncodilatador y número de ingresos hospitalarios. RESULTADOS: Se identificaron 58 pacientes con HDC, 13 de ellos sin diagnóstico prenatal. De los 45 restantes, 36 tenían calculado el LHR O/E registrado a las 22,4 ± 5,8 semanas. El LHR O/E se relacionó significativamente con la gravedad de la HTP al nacimiento y en los meses 1º, 6º, 12º y 24º (p <0,05). A los 6 meses únicamente el 30,4% presentaban HTP sin que ello asociara más riesgo de ingresos hospitalarios [OR 1,07 (0,11-10,1)] y siendo solo n = 3 (5,1%) los que precisaban algún tipo de tratamiento broncodilatador. CONCLUSION: En HDC, la HTP y la clínica respiratoria mejoran con el tiempo, siendo infrecuente la necesidad de tratamiento a partir del 6º mes. El LHR O/E predice la presencia y gravedad de HTP a corto y largo plazo.
Subject(s)
Gestational Age , Hernias, Diaphragmatic, Congenital/diagnostic imaging , Hypertension, Pulmonary/diagnostic imaging , Ultrasonography, Prenatal/methods , Age Factors , Bronchodilator Agents/administration & dosage , Child, Preschool , Echocardiography , Female , Head/embryology , Hospitalization/statistics & numerical data , Humans , Hypertension, Pulmonary/physiopathology , Infant , Infant, Newborn , Lung/embryology , Pregnancy , Retrospective Studies , Severity of Illness Index , Time FactorsABSTRACT
AIM OF THE STUDY: The aim of this study is to identify potential perinatal risk or protective factors associated with NEC. MATERIALS AND METHODS: Single-center, retrospective case-control study of newborns admitted to the neonatal intensive care unit with NEC from 2014 to 2015. Clinical charts were reviewed recording maternal factors (fever, positive recto-vaginal swab and signs of corioamnionitis or fetal distress), and neonatal factors analyzed were: birth-weight and weeks gestation, umbilical vessel catheterization, time of enteral feedings and the use of probiotics, antibiotics and antifungal agents. Cases and controls were matched for all of these factors. Parametric tests were used for statistical analysis and p < 0.05 deemed significant. RESULTS: We analyzed 500 newborns of which 44 developed NEC (cases) and 456 controls. Univariate analysis did not identify any maternal risk factors for NEC. We did not found statistical differences between patients either time of enteral feedings or probiotics. Nevertheless, patients with signs of fetal distress and early sepsis had a higher risk of NEC (p < 0.0001). CONCLUSIONS: Infants with history of fetal distress and signs of early sepsis are at a higher risk of NEC. The use of prophylactic catheter infection or orotracheal intubation with antifungal treatment seemed to elevate the incidence of NEC. However, antibiotic treatment couldn´t be demonstrated to increase the risk of NEC.
OBJETIVOS: Identificar factores perinatales que favorezcan el desarrollo de enterocolitis necrotizante (ECN) en las unidades de cuidados intensivos neonatales (UCIN). METODOS: Estudio de casos y controles de los recién nacidos (RN) tratados entre 2014-2015. Se evaluaron factores de riesgo materno-fetal (fiebre, corioamnionitis, cultivos rectovaginales y sufrimiento intrauterino) y neonatales (edad gestacional, canalización de vasos umbilicales, hemocultivos, sepsis, nutrición y probióticos) y su asociación a la ECN. Estudiamos también la existencia de tratamiento antibiótico y antifúngico intravenoso previo al cuadro de ECN. Se estimó la odds ratio con un nivel de significación p < 0,05. RESULTADOS: Se analizaron 500 neonatos: 44 ECN y 456 controles. En el análisis univariante ninguno de los factores de riesgo maternos se relacionó con el desarrollo de ECN. No se encontraron diferencias significativas en los RN que recibieron alimentación enteral o probióticos. Los RN con sufrimiento fetal y los diagnosticados de sepsis precoz presentaron mayor riesgo de desarrollo de ECN (p < 0,0001). CONCLUSION: La pérdida de bienestar fetal y la sepsis precoz favorecen el desarrollo de ECN, que también parece aumentar con el uso de antibioterapia sistémica así como el tratamiento antifúngico profiláctico para las infecciones de catéter o intubaciones orotraqueales prolongadas.
Subject(s)
Enterocolitis, Necrotizing/epidemiology , Fetal Distress/epidemiology , Sepsis/epidemiology , Anti-Bacterial Agents/administration & dosage , Antifungal Agents/administration & dosage , Case-Control Studies , Enterocolitis, Necrotizing/etiology , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Male , Pregnancy , Probiotics/administration & dosage , Protective Factors , Retrospective Studies , Risk FactorsABSTRACT
UNLABELLED: Mixed venous oxygen saturation monitoring is useful to know about the balance of oxygen supply and consumption in patient with shock as well as a form of assessing the effects of different therapeutic maneuvers. Because of newborn peculiarities this measurement is difficult and therefore, the monitoring of the shock state is limited. OBJECTIVES: To investigate the validity of central venous oxygen saturation at right atria as a reflection of mixed venous oxygen saturation in an experimental model of neonatal sepsis. METHODS: In six newborn piglets septic shock was induced by 180 minutes continuous infusion of Group B Streptococcus. Blood samples were obtained from aortic and pulmonary arteries and from right atrium at baseline and at 30-minutes intervals after the bacterial infusion was begun. Changes in arterial pressures, vascular resistances, cardiac index, oxygen delivery and consumption and the oxygen extraction index were also analyzed. RESULTS: Group B Streptococcus infusion induced significant decreases versus baseline situation of both, oxygen delivery and oxygen tissular extraction index, without changes in oxygen consumption, at 30 minutes of bacterial infusion, with a significant correlation between mixed venous and central venous oxygen saturations. Mixed venous oxygen saturation significantly correlates with right atrium oxygen saturation, r2 = 0,88, along all the period of study. CONCLUSIONS: Mixed venous oxygen saturation is a useful measurement of the oxygen delivery and consumption state in the critically ill newborn infant, and central venous oxygen saturation at the right atrium can be a sure, efficient and easy alternative for the neonatal patient.
Subject(s)
Disease Models, Animal , Myocardium/metabolism , Oxygen Consumption , Oxygen/blood , Shock, Septic/metabolism , Streptococcal Infections/metabolism , Streptococcus agalactiae , Animals , Animals, Newborn , Biological Transport , Heart Atria/metabolism , Hemodynamics , Humans , Hypertension, Pulmonary/metabolism , Hypertension, Pulmonary/physiopathology , Infant, Newborn , Shock, Septic/physiopathology , Streptococcal Infections/physiopathology , Swine , Time FactorsABSTRACT
We have studied retrospectively the effects of dopamine in 31 hypotensive newborn infants four hours to twenty days of age, which did not improve with conventional therapy. Hypotension aetiology was in 23 septic, cardiogenic and hypovolemic shock, in 6 hemodynamic instability in patients with hyalin membrane disease (HMD), and in two patients after tolazoline treatment in neonatal persistent pulmonary hypertension. Arterial blood pressure significantly increased when doses 5 to 10 mg/kg/min dopamine were used. Diuresis significantly increased comparing 8 hours before and after dopamine infusion. Dopamine was considered to be clinically effective in similar rates in septic (47.6%) and cardiogenic shock (40%), in all cases of hypovolemic shock (after volume infusion) and in hypotension produced by tolazoline; in hypotensive newborn infants with HMD was effective in 83.3%. Tachycardia was present in five infants with high dose (17.4 +/- 8.4 mcg/kg/min.), it returned to normal value when dopamine was decreased or discontinued. Dopamine efficacy and its lack of severe secondary effects justifies its use in neonatal hypotension.
