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1.
J Perinatol ; 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38664495

RESUMO

OBJECTIVE: To determine whether early echocardiography screening of low systemic blood flow reduces intraventricular hemorrhage in preterm infants. STUDY DESIGN: Prospective multicenter study in preterm infants below 33 weeks of gestational age at nine neonatal units. Five units performed early echocardiography screening for low systemic blood flow and guided clinical management (exposure group) and 4 units did not (control group). Our main outcome was ≥grade II intraventricular hemorrhage or death within the first 7 days of life. The main analysis used the inverse probability of treatment weighting. RESULTS: Three hundred and thirty-two preterm infants (131 in the exposure group and 201 in the control group) were included. Exposure to early echocardiography screening was associated with a significant reduction in ≥grade II intraventricular hemorrhage or early death [odds ratio 0.285 (95% CI: 0.133-0.611); p = 0.001]. CONCLUSIONS: Early echocardiography screening for low systemic blood flow may reduce the incidence of intraventricular hemorrhage in preterm infants.

2.
An. pediatr. (2003. Ed. impr.) ; 86(6): 321-328, jun. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-163357

RESUMO

Introducción: El ductus arterioso persistente (DAP) es una patología muy prevalente en el recién nacido pretérmino (RNPT), que puede relacionarse con mayor morbimortalidad en los prematuros más inmaduros. Estudios recientes han valorado la utilidad del propéptido natriurético cerebral (proBNP) en su diagnóstico. El objetivo fue evaluar la eficacia diagnóstica del proBNP como marcador de sobrecarga hemodinámica en el DAP y su capacidad para identificar la necesidad de tratamiento. Pacientes y métodos: Estudio retrospectivo observacional, que incluyó a RNPT menores de 32 semanas de gestación y/o 1.500 g, con estudio ecocardiográfico y determinación de niveles de proBNP. Se comparó por subgrupos en función de la presencia de DAP y sus características hemodinámicas. Resultados: De los 60 pacientes incluidos, el 71,7% presentó DAP, el 86% de los cuales fue hemodinámicamente significativo (DAP-HS). Todos, salvo uno, recibieron tratamiento médico con ibuprofeno o paracetamol. El 29,7% de los DAP-HS precisó cierre quirúrgico. Se encontraron valores superiores de proBNP en los pacientes con DAP-HS (33.338±34.494,47pg/mL; p=0,000), respecto a los pacientes con ductus cerrado o no hemodinámicamente significativo. Los pacientes que precisaron cirugía también presentaron valores más elevados (30.596,8±14.910,9pg/mL; p=0,004). El grupo en el que se constató cierre ductal tras tratamiento farmacológico presentó mayor descenso de los niveles de proBNP (68±24,69% vs. -12,22±99,4%; p=0,030). Mediante curva ROC se calculó valor de corte de proBNP para el diagnóstico de DAP-HS que fue de 9.321,5pg/mL (E 100%, S 94,6%). Conclusiones: Los niveles de proBNP se relacionan con la presencia o ausencia de ductus persistente hemodinámicamente significativo y sus variaciones con la respuesta al tratamiento. Valores elevados también se relacionan con la necesidad de cirugía (AU)


Introduction: Patent ductus arteriosus (PDA) is a prevalent condition in preterm infants, and may be related to increased morbidity and mortality in the most immature newborns. Recent studies have examined the usefulness of brain natriuretic propeptide (proBNP) in the diagnosis of this pathology. The aim of the study was to evaluate the diagnostic efficacy of proBNP as a marker of hemodynamic overload in PDA. Patients and methods: A retrospective study was conducted on preterm infants less than 32 weeks of gestation and/or weight less than 1500 grams. Echocardiogram and determination of proBNP levels were performed on all patients. Comparison was made by subgroups according to the presence of PDA and their haemodynamic characteristics. Results: Of the 60 patients enrolled, 71.7% had PDA, of which 86% had haemodynamically significant patent ductus arteriosus (HS-PDA). All of them, but one, received medical treatment with ibuprofen or acetaminophen. Surgical closure was required in 29.7% of HS-PDA. Higher values of proBNP were found in patients with HS-PDA (33338±34494.47pg/mL; p=.000) compared with patients with closed or non-haemodynamically significant ductus arteriosus. Higher values were also found in patients who required surgical closure of PDA (30596.8±14910.9; p=.004). A greater decrease inproBNP levels was found in the group of patients which duct closure after pharmacological treatment (68±24.69% vs -12.22±99.4%; p=.030). ProBNP cutoff-level for HS-PDA was calculated by ROC curve and it was 9321.5pg/mL (Specificity: 100%, Sensitivity: 94.6%). Conclusions: ProBNP levels are related to the presence or absence of haemodynamically significant patent ductus arteriosus; and its variations with treatment response. High values are also related to the need for surgical closure of PDA (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Permeabilidade do Canal Arterial/diagnóstico , Peptídeo Natriurético Encefálico/análise , Biomarcadores/análise , Doenças do Prematuro/diagnóstico , Triagem Neonatal , Sensibilidade e Especificidade , Estudos Retrospectivos
3.
An Pediatr (Barc) ; 86(6): 321-328, 2017 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-26936584

RESUMO

INTRODUCTION: Patent ductus arteriosus (PDA) is a prevalent condition in preterm infants, and may be related to increased morbidity and mortality in the most immature newborns. Recent studies have examined the usefulness of brain natriuretic propeptide (proBNP) in the diagnosis of this pathology. The aim of the study was to evaluate the diagnostic efficacy of proBNP as a marker of hemodynamic overload in PDA. PAIENTS AND METHODS: A retrospective study was conducted on preterm infants less than 32 weeks of gestation and/or weight less than 1500 grams. Echocardiogram and determination of proBNP levels were performed on all patients. Comparison was made by subgroups according to the presence of PDA and their haemodynamic characteristics. RESULTS: Of the 60 patients enrolled, 71.7% had PDA, of which 86% had haemodynamically significant patent ductus arteriosus (HS-PDA). All of them, but one, received medical treatment with ibuprofen or acetaminophen. Surgical closure was required in 29.7% of HS-PDA. Higher values of proBNP were found in patients with HS-PDA (33338±34494.47pg/mL; p=.000) compared with patients with closed or non-haemodynamically significant ductus arteriosus. Higher values were also found in patients who required surgical closure of PDA (30596.8±14910.9; p=.004). A greater decrease inproBNP levels was found in the group of patients which duct closure after pharmacological treatment (68±24.69% vs -12.22±99.4%; p=.030). ProBNP cutoff-level for HS-PDA was calculated by ROC curve and it was 9321.5pg/mL (Specificity: 100%, Sensitivity: 94.6%). CONCLUSIONS: ProBNP levels are related to the presence or absence of haemodynamically significant patent ductus arteriosus; and its variations with treatment response. High values are also related to the need for surgical closure of PDA.


Assuntos
Permeabilidade do Canal Arterial/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Precursores de Proteínas/sangue , Permeabilidade do Canal Arterial/sangue , Permeabilidade do Canal Arterial/fisiopatologia , Permeabilidade do Canal Arterial/terapia , Feminino , Hemodinâmica , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade
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