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2.
J Perinatol ; 41(4): 786-793, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33589728

RESUMO

OBJECTIVE: This study aims to determine the immediate outcome of persistent pulmonary hypertension of the newborn (PPHN) and risk factors for mortality in the era of inhaled nitric oxide (iNO). STUDY DESIGN: This observational cross-sectional study includes 195 confirmed PPHN with a gestational age of ≥34 weeks without congenital heart disease. Multivariable logistic regression was used to identify risk factors for mortality. RESULTS: The mortality rate was 16.4%, with the highest mortality with pulmonary hypoplasia. Of 195, 65% received iNO; 18% were iNO non-responders with the majority having pulmonary hypoplasia. Independent risk factors for mortality were the presence of reversal of flow at the descending aorta, pulmonary hypoplasia, APGAR scores ≤ 5 at 5 min, and idiopathic PPHN with an adjusted odds ratio of 15.9, 7.5, 6.7, and 6.4, respectively. CONCLUSIONS: Despite the usage of iNO, mortality due to PPHN remains high and is related to etiology and cardiac function.


Assuntos
Hipertensão Pulmonar , Síndrome da Persistência do Padrão de Circulação Fetal , Administração por Inalação , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Lactente , Recém-Nascido , Malásia/epidemiologia , Óxido Nítrico/uso terapêutico , Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Fatores de Risco
3.
Early Hum Dev ; 155: 105323, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33578219

RESUMO

BACKGROUND: Alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV) is a rare and fatal disorder that occurs in the developing fetal lungs; at birth, infants exhibit an oxygenation disorder accompanied by severe pulmonary hypertension (PH) and have a very short life span. ACDMPV is definitively diagnosed by pathological findings, and infants born with unexplained severe PH may not be properly diagnosed without a biopsy or autopsy. METHODS: Japanese infants with unexplained severe PH were enrolled in this study. Genetic analyses were performed on DNA extracted from peripheral blood leukocytes. Sanger sequencing or next-generation sequencing was performed by coding exons and introns for FOXF1 in all samples. For individuals without pathogenic exonic variants, multiplex ligation-dependent probe amplification was performed to identify copy number variations (CNVs) in exons, introns, and in the upstream region of FOXF1. RESULTS: This study included 30 infants who were diagnosed over the course of nine years. Four individuals had the pathogenic variations on the exon 1 of FOXF1, including two frameshift and two missense variations. Pathogenic CNVs were found in another five individuals. CONCLUSION: In the pathologically proven ACDMPV patients, the ratios of cases with exonic variations, CNVs, and no genetic findings were reported as 45%, 45% and 10%, respectively. We estimate that about 30% (10 (9 + 1) out of 30) of individuals with unexplained severe PH had ACDMPV.


Assuntos
Hipertensão Pulmonar , Síndrome da Persistência do Padrão de Circulação Fetal , Variações do Número de Cópias de DNA , Fatores de Transcrição Forkhead/genética , Testes Genéticos , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/genética , Incidência , Lactente , Recém-Nascido , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Síndrome da Persistência do Padrão de Circulação Fetal/genética
4.
Arch Dis Child Fetal Neonatal Ed ; 106(4): 446-455, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33478959

RESUMO

In persistent pulmonary hypertension of the newborn (PPHN), the ratio of pulmonary vascular resistance to systemic vascular resistance is increased. Extrapulmonary shunts (patent ductus arteriosus and patent foramen value) allow for right-to-left shunting and hypoxaemia. Systemic hypotension can occur in newborns with PPHN due to variety of reasons, such as enhanced peripheral vasodilation, impaired left ventricular function and decreased preload. Systemic hypotension can lead to end organ injury from poor perfusion and hypoxaemia in the newborn with PPHN. Thus, it must be managed swiftly. However, not all newborns with PPHN and systemic hypotension can be managed the same way. Individualised approach based on physiology and echocardiographic findings are necessary to improve perfusion to essential organs. Here we present a review of the physiology and mechanisms of systemic hypotension in PPHN, which can then guide treatment.


Assuntos
Hipotensão/epidemiologia , Hipotensão/terapia , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Vasoconstritores/uso terapêutico , Monitores de Pressão Arterial , Oxigenação por Membrana Extracorpórea/métodos , Hidratação/métodos , Hemodinâmica , Humanos , Hipotensão/fisiopatologia , Recém-Nascido , Síndrome da Persistência do Padrão de Circulação Fetal/fisiopatologia , Guias de Prática Clínica como Assunto , Vasoconstritores/administração & dosagem , Vasoconstritores/efeitos adversos
5.
Respir Res ; 21(1): 53, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054482

RESUMO

AIMS: Persistent pulmonary hypertension of the newborn (PPHN) is characterized by sustained high levels of pulmonary vascular resistance after birth with etiology unclear; Arterial blood oxygen saturation of Tibetan newborns at high latitudes is higher than that of Han newborns at low latitudes, suggesting that genetic adaptation may allow sufficient oxygen to confer Tibetan populations with resistance to pulmonary hypertension; We have previously identified genetic factors related to PPHN through candidate gene sequencing; In this study, we first performed whole exome sequencing in PPHN patients to screen for genetic-related factors. METHODS AND RESULTS: In this two-phase genetic study, we first sequenced the whole exome of 20 Tibetan PPHN patients and compared it with the published genome sequences of 50 healthy high-altitude Tibetanshypoxia-related genes, a total of 166 PPHN-related variants were found, of which 49% were from 43 hypoxia-related genes; considering many studies have shown that the differences in the genetic background between Tibet and Han are characterized by hypoxia-related genetic polymorphisms, so it is necessary to further verify whether the association between hypoxia-related variants and PPHN is independent of high-altitude life. During the validation phase, 237 hypoxia-related genes were sequenced in another 80 Han PPHN patients living in low altitude areas, including genes at the discovery stage and known hypoxia tolerance, of which 413 variants from 127 of these genes were shown to be significantly associated with PPHN.hypoxia-related genes. CONCLUSIONS: Our results indicates that the association of hypoxia-related genes with PPHN does not depend on high-altitude life, at the same time, 21 rare mutations associated with PPHN were also found, including three rare variants of the tubulin tyrosine ligase-like family member 3 gene (TTLL3:p.E317K, TTLL3:p.P777S) and the integrin subunit alpha M gene (ITGAM:p.E1071D). These novel findings provide important information on the genetic basis of PPHN.


Assuntos
Variação Genética/genética , Hipertensão Pulmonar/genética , Hipóxia/genética , Mutação/genética , Síndrome da Persistência do Padrão de Circulação Fetal/genética , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Pulmonar/epidemiologia , Hipóxia/epidemiologia , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Recém-Nascido , Masculino , Peptídeo Sintases/genética , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Tibet/epidemiologia
6.
J Matern Fetal Neonatal Med ; 33(24): 4090-4095, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30880515

RESUMO

Objective: To determine the risk factors and outcomes of persistent pulmonary hypertension of the newborn (PPHN)-associated pneumothorax (PTX).Study design: The medical records of infants diagnosed with PPHN with or without PTX from January 2012 to July 2017 were retrospectively reviewed.Results: Of the 102 included PPHN infants, PTX was found in 32 (31.4%) infants with 43.8% (14/32) mortality. PTX was significantly associated with increased mortality with an odds ratio (OR) of 5.27 (95% confidence interval [CI] 1.96-14.17). Unilateral PTX was more common than bilateral PTX (53.1 versus 46.9%, respectively). Multivariate logistic regression analysis indicated that a 1-minute Apgar score of ≤7 was associated with an increased risk for PTX (adjusted OR = 2.67 [95% CI 1.14-6.25]). In subgroup analysis, each increase of maximum peak inspiratory pressure (PIP) of 1 cmH2O significantly increased the odds of PTX by 1.46 (95% CI 1.02-2.07), while each 1 mmHg increase in arterial partial pressure of oxygen (PaO2) decreased the odds of PTX (adjusted OR = by 0.98 [95% CI 0.97-0.99]).Conclusions: PTX was significantly associated with higher mortality in PPHN infants. Lower Apgar score and increasing PIP in conventional mechanical ventilation were risk factors for PTX. Higher PaO2 was associated with a decreased rate of PTX.


Assuntos
Hipertensão Pulmonar , Síndrome da Persistência do Padrão de Circulação Fetal , Pneumotórax , Análise Fatorial , Humanos , Lactente , Recém-Nascido , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Estudos Retrospectivos , Fatores de Risco , Tailândia/epidemiologia
7.
Clin Perinatol ; 46(2): 215-234, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010557

RESUMO

Risks, benefits, alternatives, and appropriateness of psychotropic medications, including risks of no treatment, are discussed for antidepressants, mood-stabilizing medications, anxiolytic/sedative hypnotic medications, stimulants, and medication-assisted treatment of substance use disorders. Early screening, diagnosis, and intervention prior to and/or during pregnancy often reduce morbidity and mortality of mental health disorders for mothers and infants.


Assuntos
Transtornos Mentais/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Psicotrópicos/uso terapêutico , Antidepressivos/uso terapêutico , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Feminino , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Humanos , Troca Materno-Fetal , Transtornos Relacionados ao Uso de Opioides , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Transtornos Psicóticos/tratamento farmacológico , Índice de Gravidade de Doença , Síndrome de Abstinência a Substâncias , Transtornos Relacionados ao Uso de Substâncias/terapia
8.
J Matern Fetal Neonatal Med ; 32(19): 3209-3214, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29642731

RESUMO

Background: Acute kidney injury (AKI) in preterm neonates is becoming an increasingly recognized morbidity in the neonatal intensive care unit neonatal intensive care unit (NICU), yet its epidemiology, delineation and relation to numerous toxic exposures and common morbidities such as systemic hypertension is just evolving. With a frequency of the patent ductus arteriosus (PDA) as high as 70% in preterm infants born before 28-week gestation, the role of the hemodynamically significant PDA (hs-PDA) remains unclear. Objective: To determine if AKI and systemic hypertension is more common in extremely low gestational age newborns (ELGAN) with hs PDA compared to ELGAN with no or non-hs PDA using modified AKIN and Neonatal Risk, Injury, Failure, Loss of Kidney Function, and End-stage (N-RIFLE) scoring systems. Methods: This was a retrospective cohort study of infants ≤28 weeks gestational age born between 2010 and 2016 who had echocardiographic PDA evaluation completed for hemodynamical significance as well as serial serum creatinine and urine output measurement documented, needed for the two AKI scoring systems: modified AKIN (based on serial serum creatinine) and N-RIFLE (using urine output data). Blood pressure measurements and therapy were evaluated during the hospitalization and on the day of NICU discharge. Baseline characteristics and outcome variables were compared between the hs-PDA and no or non-hs PDA using unpaired t-tests for continuous variables and chi square tests for categorical data. Results: One hundred fifty-one infants were eligible of which 110 had hs-PDA. Infants with hs-PDA were smaller (777 versus 867 g, p = .026), less mature (25.8 versus 26.4 weeks, p = .023) and had greater exposure to nephrotoxic drugs (14 versus 9.4 days, p = .001). Other clinical and demographic variables were similar between the two groups. The overall incidence of AKI was not different between the hs-PDA and no PDA or non-hs PDA groups when evaluated by the acute kidney injury network (AKIN) or N-RIFLE staging; however, preterm newborns with hs-PDA demonstrated a trend towards increased risk of AKI injury (12.7 versus 0.02%, p = .06). The N-RIFLE and AKIN scoring systems demonstrated very poor degree of agreement (kappa = 0.00853) in our study. There was no difference in the rates of hypertension during the hospitalization as well as on the day of NICU discharge. Conclusion: Preterm neonates with hs-PDA had similar rates of AKI and hypertension as neonates with no or non-hs PDA.


Assuntos
Injúria Renal Aguda/complicações , Injúria Renal Aguda/diagnóstico , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico , Hipertensão/complicações , Hipertensão/diagnóstico , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/fisiopatologia , Permeabilidade do Canal Arterial/epidemiologia , Permeabilidade do Canal Arterial/fisiopatologia , Feminino , Idade Gestacional , Hemodinâmica/fisiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Incidência , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Unidades de Terapia Intensiva Neonatal , Masculino , Síndrome da Persistência do Padrão de Circulação Fetal/complicações , Síndrome da Persistência do Padrão de Circulação Fetal/diagnóstico , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Síndrome da Persistência do Padrão de Circulação Fetal/fisiopatologia , Prognóstico , Estudos Retrospectivos
9.
Am J Obstet Gynecol ; 220(1): 57.e1-57.e13, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30170040

RESUMO

BACKGROUND: There is a marked increase in the use of selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors in the last decade. Many newborns are likely to be exposed during pregnancy and labor. OBJECTIVE: We aimed to evaluate the association between exposure to selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors during pregnancy and the risk for persistent pulmonary hypertension of the newborn. We sought to compare the risk for persistent pulmonary hypertension of the newborn between specific selective serotonin reuptake inhibitor agents. STUDY DESIGN: MEDLINE, Embase, and Cochrane were searched up to July 2017. No language restrictions were applied. Search key words included: "SSRI," "SNRI," "pregnancy," "risk," "new-born," and "pulmonary hypertension." Retrospective cohort studies and case-control studies reporting the risk for persistent pulmonary hypertension of the newborn in the offspring of women exposed to selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors during pregnancy, were extracted. Two independent researchers identified relevant data. Random effects meta-analysis was used to pool results. Odds ratios were calculated with subsequent 95% confidence intervals. Network meta-analysis was conducted, incorporating direct and indirect comparisons among different selective serotonin reuptake inhibitors. The primary outcome was risk for persistent pulmonary hypertension of the newborn after exposure to selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors during pregnancy. RESULTS: A total of 11 studies were identified. A total of 156,978 women and their offspring were exposed to selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors during pregnancy. Persistent pulmonary hypertension of the newborn was detected among 452 exposed offspring, representing an incidence rate of 2.9 cases per 1000 live births and a number needed to harm of 1000. The risk for persistent pulmonary hypertension of the newborn was significantly increased in the analysis of exposure to selective serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor in any trimester (odds ratio, 1.82; 95% confidence interval, 1.31-2.54; I2 = 72%), as well as in analysis restricted to exposure week >20 (odds ratio, 2.08; 95% confidence interval, 1.44-3.01; I2 = 76%). In network meta-analysis, sertraline was ranked most likely to have the lowest risk for persistent pulmonary hypertension of the newborn among the different selective serotonin reuptake inhibitors (P = .83). CONCLUSION: Exposure to selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors during pregnancy is associated with an increased risk for persistent pulmonary hypertension of the newborn. According to our findings, sertraline ranked as most likely to have the lowest risk for persistent pulmonary hypertension of the newborn compared to other selective serotonin reuptake inhibitors, suggesting it may have the best safety profile for use in pregnancy in this regard. Further studies are needed to fully establish these results.


Assuntos
Transtorno Depressivo/tratamento farmacológico , Norepinefrina/antagonistas & inibidores , Síndrome da Persistência do Padrão de Circulação Fetal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Transtorno Depressivo/diagnóstico , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Metanálise em Rede , Norepinefrina/administração & dosagem , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Síndrome da Persistência do Padrão de Circulação Fetal/fisiopatologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Terceiro Trimestre da Gravidez , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Medição de Risco , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem
10.
J Womens Health (Larchmt) ; 28(3): 331-338, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30407100

RESUMO

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition associated with substantial mortality and morbidity. Previous studies have suggested a possible link between maternal selective serotonin reuptake inhibitor (SSRI) use and the risk of PPHN. This study aimed to provide an up-to-date review and meta-analysis of the topic. METHODS: Using the search terms [SSRI OR SSRIs OR selective serotonin reuptake inhibitors OR antidepressant OR Prozac OR fluoxetine OR Lexapro OR escitalopram] AND [pregnancy OR maternal OR newborn OR persistent pulmonary hypertension OR PPHN OR neonat* OR fet*], a preliminary search on the PubMed, Medline, EMBASE, Web of Science, and Google Scholar database yielded 7327 articles published in English between January 1, 1960 and October 1, 2017. RESULTS: A total of 9 cohort and case-control studies, with a total of 7,540,265 subjects were systematically reviewed. Random-effects meta-analysis of eight studies revealed a significantly increased risk of PPHN with maternal SSRI use during pregnancy, with a pooled OR of 1.516 (95% confidence interval: 1.035-1.997, p < 0.001). Overall, the absolute increase in risk of PPHN with SSRI use appears small, with an absolute risk difference of 0.619 per 1000 livebirths and a number needed to harm of 1615 women. CONCLUSIONS: Current evidence suggests that there were significantly greater odds of PPHN with SSRI use during pregnancy. However, the clinical significance of this association remains modest and likely outweighed by the potential benefits of treatment of perinatal depression. The risk of PPHN associated with SSRI therapy might not warrant the recommendation to withdraw antidepressant therapy, as evidence from other studies show that untreated perinatal depression presents additional adverse maternal and fetal outcomes. Given the increasing prevalence of maternal depression and consequent use of antidepressant medications, further research with robust longitudinal or randomized, controlled studies and mechanistic investigations are needed.


Assuntos
Antidepressivos/efeitos adversos , Síndrome da Persistência do Padrão de Circulação Fetal/etiologia , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal , Fatores de Risco , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico
11.
World J Pediatr ; 13(6): 517-527, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29058246

RESUMO

BACKGROUND: Several studies have clearly demonstrated a significantly higher incidence of persistent pulmonary hypertension of the newborn (PPHN) in neonates delivered by caesarean section (CS) compared to those delivered vaginally. The pathophysiological factors underlying the link between CS and PPHN are still poorly understood. In this review, we describe the mechanisms that could explain the association between CS delivery and subsequent PPHN, as well as potential preventive measures. DATA SOURCES: A literature search was conducted by electronic scanning of databases such as PubMed and Web of Science using the key words "persistent pulmonary hypertension of the newborn", "caesarean section", "iatrogenic prematurity", "oxidative stress", "late preterm", "labor" and "vasoactive agents". RESULTS: Iatrogenic prematurity, higher rates of late preterm delivery and lack of physiological changes of labor play an important role in the association between CS and PPHN. CS delivery also results in limited endogenous pulmonary vasodilator synthesis and lower levels of protective anti-oxidants in the neonates. In addition, CS delivery exposes infants to a higher risk of respiratory distress syndrome and its concomitant increase in endothelin-1 levels, which might indirectly lead to a higher risk of developing PPHN. We believe that neonates delivered by CS are exposed to a combination of these pathophysiological events, culminating in an endpoint of respiratory distress, hypoxia, acidosis, and delayed transition and thereby increased risks of PPHN. The use of antenatal corticosteroids prior to elective CS in late preterm deliveries, promoting accurate informedconsent process, delaying elective CS to 39 weeks of gestation or beyond and antenatal maternal anti-oxidant supplementation could potentially mitigate the effects of CS delivery and minimize CS-related PPHN. CONCLUSIONS: The link between CS delivery and PPHN is complex. In view of the rising rates of CS worldwide, there is an urgent need to further explore the mechanisms linking CS to PPHN and experimentally test therapeutic options in order to allow effective targeted interventions.


Assuntos
Cesárea/efeitos adversos , Doenças do Recém-Nascido/diagnóstico , Síndrome da Persistência do Padrão de Circulação Fetal/etiologia , China/epidemiologia , Procedimentos Cirúrgicos Eletivos , Feminino , Idade Gestacional , Humanos , Doença Iatrogênica , Incidência , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Masculino , Estresse Oxidativo/fisiologia , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Síndrome da Persistência do Padrão de Circulação Fetal/fisiopatologia , Gravidez , Prognóstico , Fatores de Risco
12.
Neonatology ; 112(4): 402-408, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28926832

RESUMO

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is associated with severe morbidity and mortality. Twin-twin transfusion syndrome (TTTS) is suggested to increase the risk of PPHN. OBJECTIVES: To describe the incidence of PPHN in TTTS twins and to identify risk factors in TTTS twins for the development of severe PPHN. METHODS: Cases with severe PPHN were extracted from our monochorionic twin database (2002-2016). Severe PPHN was defined as severe hypoxaemia requiring mechanical ventilation and inhaled nitric oxide (iNO) treatment, confirmed by strict echocardiographic criteria. A case-control comparison within TTTS survivors was conducted to identify risk factors for PPHN. RESULTS: The incidence of PPHN in TTTS twins was 4% (24/598, 95% confidence interval [CI] 2.7-5.9%) and 0.4% (2/493, 95% CI 0.1-1.5%) in uncomplicated monochorionic twins (odds ratio [OR] 10.3, 95% CI 2.4-43.9; p = 0.002). Two risk factors were independently associated with PPHN: severe prematurity (OR 3.3, 95% CI 1.0-11.4) and recipient status (OR 3.9, 95% CI 1.4-11.0). In TTTS recipients, another risk factor for PPHN is anaemia at birth (OR 7.2, 95% CI 1.8-29.6). CONCLUSION: Clinicians caring for neonates with TTTS should be aware of the 10-fold increased risk of PPHN compared to uncomplicated monochorionic twins. PPHN occurs more often in case of premature delivery and in recipient twins, particularly in the presence of anaemia at birth. As the development of severe PPHN is difficult to predict, we advise that all TTTS twins should be delivered in a tertiary care centre with iNO treatment options.


Assuntos
Transfusão Feto-Fetal/epidemiologia , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Gêmeos Monozigóticos , Administração por Inalação , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Transfusão Feto-Fetal/diagnóstico , Transfusão Feto-Fetal/fisiopatologia , Transfusão Feto-Fetal/terapia , Humanos , Incidência , Modelos Logísticos , Análise Multivariada , Países Baixos/epidemiologia , Óxido Nítrico/administração & dosagem , Razão de Chances , Síndrome da Persistência do Padrão de Circulação Fetal/diagnóstico , Síndrome da Persistência do Padrão de Circulação Fetal/fisiopatologia , Síndrome da Persistência do Padrão de Circulação Fetal/terapia , Gravidez , Respiração Artificial , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Vasodilatadores/administração & dosagem
13.
Ginekol Pol ; 88(1): 36-42, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28157249

RESUMO

Over the last few years, several reports on the safety of antidepressants use in pregnancy have been published. Studies concerning the adverse effects of exposure to selective serotonin reuptake inhibitors (SSRI) during pregnancy on the developing foetus have indicated an increased risk of various congenital malformations and untoward effects such as poor neonatal adaptation syndrome or persistent pulmonary hypertension, but there still remain inconsistencies between various study results. This paper aims at reviewing the literature on the risks of exposure to antidepressants during pregnancy. SSRIs are generally considered as first-line antidepressant treatment in pregnancy, as they are generally safe and effective. To minimize the teratogenic risks, pregnant women should receive the minimal effective dose of the medication. Depression during pregnancy must not be left untreated, and it should also be remembered that the condition may extend into the postpartum period.


Assuntos
Antidepressivos/uso terapêutico , Anormalidades Congênitas/epidemiologia , Transtorno Depressivo Maior/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Gravidez
15.
Pediatrics ; 139(1)2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27940508

RESUMO

BACKGROUND AND OBJECTIVES: There are limited epidemiologic data on persistent pulmonary hypertension of the newborn (PPHN). We sought to describe the incidence and 1-year mortality of PPHN by its underlying cause, and to identify risk factors for PPHN in a contemporary population-based dataset. METHODS: The California Office of Statewide Health Planning and Development maintains a database linking maternal and infant hospital discharges, readmissions, and birth and death certificates from 1 year before to 1 year after birth. We searched the database (2007-2011) for cases of PPHN (identified by International Classification of Diseases, Ninth Revision codes), including infants ≥34 weeks' gestational age without congenital heart disease. Multivariate Poisson regression was used to identify risk factors associated with PPHN; results are presented as risk ratios, 95% confidence intervals. RESULTS: Incidence of PPHN was 0.18% (3277 cases/1 781 156 live births). Infection was the most common cause (30.0%). One-year mortality was 7.6%; infants with congenital anomalies of the respiratory tract had the highest mortality (32.0%). Risk factors independently associated with PPHN included gestational age <37 weeks, black race, large and small for gestational age, maternal preexisting and gestational diabetes, obesity, and advanced age. Female sex, Hispanic ethnicity, and multiple gestation were protective against PPHN. CONCLUSIONS: This risk factor profile will aid clinicians identifying infants at increased risk for PPHN, as they are at greater risk for rapid clinical deterioration.


Assuntos
Idade Gestacional , Síndrome da Persistência do Padrão de Circulação Fetal/diagnóstico , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , California , Estudos de Coortes , Estudos Transversais , Bases de Dados Factuais , Feminino , Registros Hospitalares , Humanos , Incidência , Recém-Nascido , Masculino , Síndrome da Persistência do Padrão de Circulação Fetal/etiologia , Síndrome da Persistência do Padrão de Circulação Fetal/mortalidade , Fatores de Risco , Taxa de Sobrevida
16.
Br J Clin Pharmacol ; 83(5): 1126-1133, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27874994

RESUMO

AIM: The use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the newborn (PPHN). Limited data are available on the risk of PPHN associated with serotonin norepinephrine reuptake inhibitors (SNRIs). We aimed to quantify both associations. METHODS: Using data from the Quebec Pregnancy Cohort between 1998 and 2009, we included women covered by the provincial drug plan who had a singleton live birth. Exposure categories were SSRI, SNRI and other antidepressant use; non-users were considered as the reference category. Generalized estimating equation models were used to obtain risk estimates and 95% confidence intervals (CIs). Confounding by indication was minimized by adjusting for history of maternal depression/anxiety before pregnancy. RESULTS: Overall, 143 281 pregnancies were included; PPHN was identified in 0.2% of newborns. Adjusting for maternal depression, and other potential confounders, SSRI use during the second half of pregnancy was associated with an increased risk of PPHN [adjusted odds ratio (aOR) 4.29, 95% CI 1.34, 13.77] compared with non-use of antidepressants; SNRI use during the same time window was not statistically associated with the risk of PPHN (aOR 0.59, 95% CI 0.06, 5.62). Use of SSRIs and SNRIs before the 20th week of gestation was not associated with the risk of PPHN. CONCLUSIONS: Use of SSRIs in the second half of pregnancy was associated with the risk of PPHN. Given our results on SNRIs and the lack of statistical power for these analyses, it is unclear whether SNRI use during pregnancy also increases the risk of PPHN.


Assuntos
Antidepressivos/efeitos adversos , Síndrome da Persistência do Padrão de Circulação Fetal/induzido quimicamente , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Adulto , Antidepressivos/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Trimestres da Gravidez , Quebeque , Sistema de Registros , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Inibidores da Recaptação de Serotonina e Norepinefrina/administração & dosagem , Adulto Jovem
17.
Clin Perinatol ; 43(1): 187-202, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26876130

RESUMO

Pulmonary hypertension in the perinatal period can present acutely (persistent pulmonary hypertension of the newborn) or chronically. Clinical and echocardiographic diagnosis of acute pulmonary hypertension is well accepted but there are no broadly validated criteria for echocardiographic diagnosis of pulmonary hypertension later in the clinical course, although there are significant populations of infants with lung disease at risk for this diagnosis. Contributing cardiovascular comorbidities are common in infants with pulmonary hypertension and lung disease. It is not clear who should be treated without confirmation of pulmonary vascular disease by cardiac catheterization, with concurrent evaluation of any contributing cardiovascular comorbidities.


Assuntos
Cardiopatias Congênitas/terapia , Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Vasodilatadores/uso terapêutico , Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/terapia , Comorbidade , Ecocardiografia , Cardiopatias Congênitas/epidemiologia , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/epidemiologia , Hérnias Diafragmáticas Congênitas/terapia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/epidemiologia , Recém-Nascido , Imageamento por Ressonância Magnética , Síndrome da Persistência do Padrão de Circulação Fetal/diagnóstico por imagem , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Resistência Vascular
18.
J Matern Fetal Neonatal Med ; 29(2): 324-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25586320

RESUMO

AIM: To study the prevalence of persistent pulmonary hypertension (PPHN) in newborn with meconium aspiration syndrome (MAS) in western Rajasthan, India. MATERIAL AND METHODS: Hundred full-term newborns who had features of MAS at birth were included in this survey and were evaluated for PPHN using laboratory investigations, including pulse oximetry, ABG, chest X-ray, ECG and 2D color echocardiography. RESULTS: Nineteen neonates showed PPHN, of them 16 had a shunt reversal at PFO level and the rest at PDA level. Most of these newborns were delivered by emergency cesarean section and were unplanned. A majority of neonates of PPHN (84.21%) were diagnosed within 48 h of life and 73.69% had Downey's score more than 6. Neonates of PPHN had mean PH 7.21 ± 0.07, mean PCO2 53.73 ± 6.8, mean PaO2 61.10 ± 10.61 and mean PaO2/FiO2 144.03 ± 46.31. CONCLUSIONS: PPHN is a genuine problem in MAS-born neonates and is commonly seen in neonates born by unplanned and unmonitored delivery, and the prevalence of PPHN can be reduced by providing good antenatal care, regular follow up of high-risk pregnancy. 2D echocardiography is an important point of care in the diagnosis of PPHN in nursery and should be promoted in nurseries of developing countries as being engaged in developed countries for more reliable treatment.


Assuntos
Síndrome de Aspiração de Mecônio/complicações , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Masculino , Síndrome da Persistência do Padrão de Circulação Fetal/etiologia , Prevalência , Estudos Prospectivos
19.
Am J Perinatol ; 32(12): 1164-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25978842

RESUMO

OBJECTIVE: This study aims to evaluate impact of respiratory and other neonatal comorbidities on neurodevelopmental outcome in late preterm infants (LPT). METHOD: Retrospective study of LPT infants (34 (0/7)-36 (6/7) weeks' gestation) discharged from the New York University Langone Medical Center neonatal intensive care unit, during January 2006 to December 2010 and received follow-up care up to 2 years of age. Neonatal morbidities were correlated with neurodevelopmental outcomes and assessed by performance on the Mullen Scales of Early Learning during three developmental follow-up visits. RESULTS: A total of 99 LPT completed neurodevelopmental assessment up to 2 years of age. Infants with diagnosis of moderate-to-severe respiratory distress syndrome showed a significantly lower performance in the visual reception on the second (p<0.01) and third visit (p=0.02), as well as lower performance in the receptive language (visit 2, p=0.02; visit 3, p<0.01). A diagnosis of persistent pulmonary hypertension was found to be associated with significantly lower performance in the visual reception at all visits (p<0.01; p=0.02; p=0.02) and in the receptive language on the second and third visit (p=0.03; p=0.02). Combined respiratory morbidities were also associated with lower developmental scores in fine motor (visit 2, p<0.01; visit 3, p=0.04) as well as expressive language (visit 3, p=0.02). CONCLUSION: LPT with significant respiratory morbidities are at higher risk for long-term developmental delays, mainly affecting cognitive developmental domains.


Assuntos
Desenvolvimento Infantil , Recém-Nascido Prematuro/crescimento & desenvolvimento , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Taquipneia Transitória do Recém-Nascido/epidemiologia , Pré-Escolar , Comorbidade , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Modelos Lineares , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença
20.
Best Pract Res Clin Obstet Gynaecol ; 29(5): 754-64, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25976080

RESUMO

A proportion of women enter pregnancy with active psychiatric symptoms or disorders, with or without concomitant psychotropic medication. Studies report that exposure to untreated depression and stress during pregnancy may have negative consequences for birth outcome and child development. Studies also report that antenatal exposure to antidepressant medications may have adverse consequences for birth outcome and child development. Antidepressant medication use during pregnancy leads to a small increased risk of miscarriage, a possible small increased risk of congenital cardiac malformations, a small increased risk of preterm birth, a small increased risk of persistent pulmonary hypertension of the newborn (PPHN), and transient neonatal symptoms in up to one-third of neonates. In addition, there is a possible increased risk of delayed motor development in children. Several recent systematic reviews and meta-analyses of the existent literature emphasize that there are minimal definitive conclusions to guide treatment recommendations. This review describes best practices for the management of depression in pregnancy, and it provides suggestions for future research.


Assuntos
Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Depressão/psicologia , Transtorno Depressivo Maior/terapia , Complicações na Gravidez/psicologia , Antidepressivos/efeitos adversos , Antidepressivos/classificação , Ansiedade/psicologia , Desenvolvimento Infantil , Anormalidades Congênitas/epidemiologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Síndrome da Persistência do Padrão de Circulação Fetal/epidemiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Estresse Psicológico/psicologia
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