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1.
Nutrients ; 11(11)2019 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-31717933

RESUMEN

Postnatal steroids, often used to prevent and treat bronchopulmonary dysplasia, may influence the growth of preterm infants, although data are scarce in the literature. This is a multicenter cohort study including surviving preterm infants <32 weeks at birth (n = 17,621) from the Spanish Neonatal Network SEN1500 database, without major congenital malformations. Linear regression models were adjusted for postnatal steroids, respiratory severity course (invasive mechanical ventilation at 28 days), progression to moderate-severe bronchopulmonary dysplasia (O2 at 36 weeks), length of stay, sex, gestational age and z-scores at birth. A subgroup analysis depending on the timing of administration, ventilation status at 28 days and moderate-severe BPD diagnosis was also performed. Overall, systemic postnatal steroids were not independently associated with poorer weight gain (0.1; 95% CI: -0.05 to 0.2 g/kg/day), linear growth (0; 95% CI: -0.03 to 0.01 cm/week) or head circumference growth (-0.01; 95% CI: -0.02 to 0 cm/week). Patients who received steroids after 28 days or who were not O2 dependent at 36 weeks after having received steroids gained more weight (0.22; 95% CI: 0.04 to 0.4 and 0.2; 95% CI: 0.004 to 0.5 g/kg/day, respectively). Globally, systemic postnatal steroids had no significant adjusted effect on postnatal growth.


Asunto(s)
Corticoesteroides , Tamaño Corporal/efectos de los fármacos , Displasia Broncopulmonar , Recien Nacido Prematuro , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Displasia Broncopulmonar/tratamiento farmacológico , Displasia Broncopulmonar/epidemiología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Respiración Artificial
3.
J Perinat Med ; 47(5): 568-573, 2019 Jul 26.
Artículo en Inglés | MEDLINE | ID: mdl-30998502

RESUMEN

Background Transcutaneous bilirubinometers are a non-invasive tool to estimate serum bilirubin. However, once on phototherapy (PHT) and after PHT, its usefulness is precluded. The objective of this study was to prove the hypothesis that transcutaneous bilirubin (TcB) assessment in a covered skin area during PHT could be used to guide the duration of PHT in term and moderate-late preterm infants with non-isoimmune hyperbilirubinemia. Methods A small area of parasternal skin was covered before starting on PHT. Total serum and TcB (both in exposed and non-exposed areas) were determined before starting treatment, every 12 h once on PHT and 12 h after its discontinuation. Pearson's correlation coefficient and paired mean differences between TcB and total serum bilirubin (TSB) were calculated. Bland-Altman plots were obtained. The percentage of correct treatment decisions made based on non-exposed TcB values was calculated. Results During PHT, there was a relatively good correlation between TSB and non-exposed TcB (0.74) estimates, in contrast to exposed TcB estimates (0.52). However, even when comparing non-exposed TcB with TSB, there was a wide range of agreement limits (-3.8 to 4.6 mg/dL). Decisions based on non-exposed TcB values would have been incorrect in 26.6% of the cases. Conclusion Although there is a relatively strong correlation between total serum and TcB in non-PHT-exposed regions, the difference is not narrow enough to be utilized in guiding clinical decisions on the duration of PHT.


Asunto(s)
Bilirrubina/sangre , Hiperbilirrubinemia/terapia , Fototerapia , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Estudios Prospectivos
4.
Acta Paediatr ; 108(10): 1793-1800, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31002411

RESUMEN

AIM: We describe the postnatal weight gain, linear and head growth trends of surviving preterm infants from 2005 to 2017. METHODS: Multicentre cohort study, including surviving preterm infants <32 weeks (n = 21 084), from the Spanish Neonatal Network database, without major congenital malformations who were less than 50 weeks postmenstrual age at discharge. Outcomes were weight gain (g/kg/day), linear and head growth (cm/week) and changes in weight, length and head circumference z-scores from birth to discharge. The study period was divided into 2005-8, 2009-11, 2012-14 and 2015-17. RESULTS: Weight gain, linear growth and head growth were slightly higher in 2015-2017 than in 2005-2008: 12.2 ± 2.6 to 13.1 ± 2.5 g/kg/day, 0.98 ± 0.6 to 1.03 ± 0.6 cm/week and 0.76 ± 0.2 to 0.77 ± 0.3 cm/week, respectively. It was associated with a decreased fall in weigh, length and head circumference z-scores from birth to discharge (-1.32 ± 0.9 to -1.01 ± 0.84, -1.38 ± 1.2 to -1.18 ± 1.2 and -0.41 ± 1.2 to -0.33 ± 1.3, respectively). CONCLUSION: Postnatal growth restriction remained a common complication of prematurity despite some increment over the last years. Growth disproportionality seemed to be worsening as weight gain was increased more than linear growth.


Asunto(s)
Desarrollo Infantil , Trastornos del Crecimiento/etiología , Recien Nacido Prematuro/crecimiento & desarrollo , Estudios de Cohortes , Femenino , Cabeza/crecimiento & desarrollo , Humanos , Recién Nacido , Masculino , Aumento de Peso
5.
Neonatology ; 115(4): 348-354, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30893696

RESUMEN

BACKGROUND: Extrauterine growth restriction is common in the preterm infant, and it is associated with poor neurodevelopment. Nutrition plays an important role in postnatal growth, but growth is also influenced by other factors like co-morbidity, and, also, there might be sex differences. METHODS: This is a cohort study including preterm infants < 32 weeks at birth (n = 21,825) from the Spanish Neonatal Network database. The effect of sex and morbidity (patent ductus arteriosus, bronchopulmonary dysplasia, necrotizing enterocolitis and late-onset sepsis) on weight gain as well as linear and head growth from birth to discharge/death was assessed with linear regression models adjusted by gestational age and Z-scores at birth. RESULTS: The 4 selected morbidities had an independent effect on all 6 growth parameters studied, which was greater in the case of necrotizing enterocolitis: changes in weight, length and head Z-scores were -0.60 (95% CI: -0.66 to -0.55), -0.62 (95% CI: -0.70 to -0.54) and -0.63 (95% CI: -0.71 to -0.56), respectively. Weight gain and linear growth were overall more affected than head growth. Girls lost slightly more weight Z-scores (-0.03; 95% CI: -0.06 to -0.002) than boys after adjustment by morbidity. There were no significant gender differences regarding linear and head growth velocity (cm/week), although girls lost more head Z-scores (-0.14; 95% CI: -0.18 to -0.10). CONCLUSIONS: Main co-morbidities associated with prematurity have an impact on postnatal growth. Head growth is less affected than length and weight. Girls are at slightly higher risk of postnatal weight and head restriction after adjustment by morbidity.


Asunto(s)
Estatura , Peso Corporal , Cabeza/fisiología , Recien Nacido Extremadamente Prematuro/crecimiento & desarrollo , Enfermedades del Prematuro/epidemiología , Caracteres Sexuales , Comorbilidad , Bases de Datos Factuales , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Modelos Lineales , Masculino , Morbilidad , Análisis Multivariante , Estudios Retrospectivos , España/epidemiología
6.
Acta pediátr. costarric ; 18(1): 14-17, 2004. ilus
Artículo en Español | LILACS | ID: lil-403799

RESUMEN

Ojetivos: Analizar las complicaciones en el tratamiento quirúrgico en la CIA tipo ostium secumdum. Diseño: Estudio retrospectivo. Sitio de realización: Servicio de Cardiología y Servicio de Cirugía de Toráx, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica. Metodología: Se incluyeron 33 pacientes operados con CIA tipo ostium secundum, sin nnguna otra malformación cardiaca asociada, en el período comprendido de enero de 1999 a diciembre del 2000. Se identificaron complicaciones, mortalidad, estancia hospitalaria y aspectos epidemiológicos. Se excluyeron pacientes con CIA asociada a otra cardiopatía e intervenidos fuera del periodo estudiado. Resultados: La mayoría de casos fueron hombres. El principal grupo etario fue de 3 a 7 años. El diámetro del defecto fue principalmente de 16 a 24mm. El tiempo de clamp osciló entre 4 y 23 minutos; el de perfusión entre 13 y 81 minutos. La estancia hospitalaria promedió 5 días. La estancia en la UCI fue principalmente de un día (87.88 por ciento). Las principales complicaciones fueron los trastornos del ritmo. No hubo mortalidad. Conclusión: El cierre quirúrgico de la CIA tipo OS es un procedimiento seguro con muy buenos resultados y con una baja morbilidad.


Asunto(s)
Humanos , Masculino , Preescolar , Femenino , Niño , Cardiopatías Congénitas/cirugía , Cirugía General , Cartílago Auricular , Defectos del Tabique Interatrial , Tiempo de Internación , Costa Rica
7.
Rev. costarric. cardiol ; 2(3): 13-7, sept.-dic. 2000. ilus
Artículo en Español | LILACS | ID: lil-297361

RESUMEN

Se encontraron 43 pacientes con persistencia del conducto arteriosos en un período de 26 meses. Dos pacientes tenían además una estenosis pulmonar valvular y tres pacientes defectos septales (dos comunicaciones intraventriculares y un canal AV). Se observaron tres casos con migración del coil a la pulmonar, de los cuales se logró extraer dos. El tamaño del coil más usado es el de 5 mm y cinco vueltas y el siguiente es el de 8 mm y cinco vueltas. Cuatro pacientes ameritaron dos coils para cerrar el conducto arterioso. En siete pacientes se encontró hipertensión arterial pulmonar de leve a moderada de los cuales cinco eran síndrome de Down. El diámetro del ductus más frecuentemente observado fue el de 2 mm. con una variación de 1,7 a 4 mm. La edad al momento del cierre varió de 6 meses a 10 años con una media de 42,9 meses +- 26,3 meses; el peso varió de 7 a 30 kilos con una media de 14,9 kilos +- 5,5 kilos


Asunto(s)
Humanos , Lactante , Preescolar , Niño , Cateterismo Cardíaco , Cateterismo , Conducto Arterioso Permeable/terapia , Cardiopatías , Costa Rica , Síndrome de Down , Síndrome de Noonan , Estenosis de la Válvula Pulmonar
8.
Rev. costarric. cardiol ; 2(2): 7-10, mayo-ago. 2000. ilus
Artículo en Español | LILACS | ID: lil-297353

RESUMEN

La estenosis pulmonar valvular crítica en lactantes es una emergencia. El objetivo de este estudio es conocer nuestra casuística en dos centros ( Costa Rica y Guatemala). Método: se revisaron los expedientes de 24 lactantes menores de 4 meses, 12 de ellos menores de un mes, que se presentaron con estenosis pulmonar valvular crítica y que fueron sometidos a valvuloplastía. La edad varió de un ...


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Estenosis de la Válvula Pulmonar/diagnóstico , Estenosis de la Válvula Pulmonar/etiología , Estenosis de la Válvula Pulmonar/terapia , Costa Rica
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