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[PMID]:29320647
[Au] Autor:Bassler D; Shinwell ES; Hallman M; Jarreau PH; Plavka R; Carnielli V; Meisner C; Engel C; Koch A; Kreutzer K; van den Anker JN; Schwab M; Halliday HL; Poets CF; Neonatal European Study of Inhaled Steroids Trial Group
[Ad] Endereço:From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee,
[Ti] Título:Long-Term Effects of Inhaled Budesonide for Bronchopulmonary Dysplasia.
[So] Source:N Engl J Med;378(2):148-157, 2018 01 11.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The long-term effects on neurodevelopment of the use of inhaled glucocorticoids in extremely preterm infants for the prevention or treatment of bronchopulmonary dysplasia are uncertain. METHODS: We randomly assigned 863 infants (gestational age, 23 weeks 0 days to 27 weeks 6 days) to receive early (within 24 hours after birth) inhaled budesonide or placebo. The prespecified secondary long-term outcome was neurodevelopmental disability among survivors, defined as a composite of cerebral palsy, cognitive delay (a Mental Development Index score of <85 [1 SD below the mean of 100] on the Bayley Scales of Infant Development, Second Edition, with higher scores on the scale indicating better performance), deafness, or blindness at a corrected age of 18 to 22 months. RESULTS: Adequate data on the prespecified composite long-term outcome were available for 629 infants. Of these infants, 148 (48.1%) of 308 infants assigned to budesonide had neurodevelopmental disability, as compared with 165 (51.4%) of 321 infants assigned to placebo (relative risk, adjusted for gestational age, 0.93; 95% confidence interval [CI], 0.80 to 1.09; P=0.40). There was no significant difference in any of the individual components of the prespecified outcome. There were more deaths in the budesonide group than in the placebo group (82 [19.9%] of 413 infants vs. 58 [14.5%] of 400 infants for whom vital status was available; relative risk, 1.37; 95% CI, 1.01 to 1.86; P=0.04). CONCLUSIONS: Among surviving extremely preterm infants, the rate of neurodevelopmental disability at 2 years did not differ significantly between infants who received early inhaled budesonide for the prevention of bronchopulmonary dysplasia and those who received placebo, but the mortality rate was higher among those who received budesonide. (Funded by the European Union and Chiesi Farmaceutici; ClinicalTrials.gov number, NCT01035190 .).
[Mh] Termos MeSH primário: Displasia Broncopulmonar/prevenção & controle
Budesonida/administração & dosagem
Deficiências do Desenvolvimento/epidemiologia
Glucocorticoides/administração & dosagem
Lactente Extremamente Prematuro
[Mh] Termos MeSH secundário: Administração por Inalação
Cegueira/epidemiologia
Paralisia Cerebral/epidemiologia
Transtornos Cognitivos/epidemiologia
Feminino
Seguimentos
Idade Gestacional
Perda Auditiva/epidemiologia
Seres Humanos
Recém-Nascido
Doenças do Prematuro/mortalidade
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Glucocorticoids); 51333-22-3 (Budesonide)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180111
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1708831


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[PMID]:28747364
[Au] Autor:Lorenz L; Marulli A; Dawson JA; Owen LS; Manley BJ; Donath SM; Davis PG; Kamlin COF
[Ad] Endereço:Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.
[Ti] Título:Cerebral oxygenation during skin-to-skin care in preterm infants not receiving respiratory support.
[So] Source:Arch Dis Child Fetal Neonatal Ed;103(2):F137-F142, 2018 Mar.
[Is] ISSN:1468-2052
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Skin-to-skin care (SSC) has proven benefits in preterm infants, but increased hypoxic and bradycardic events have been reported. This may make clinicians hesitant to recommend SSC as standard care. We hypothesised that regional cerebral oxygenation (rStO ) measured with near infrared spectroscopy is not worse during SSC compared with standard incubator care. DESIGN: Prospective, observational, non-inferiority study. SETTING: Single tertiary perinatal centre in Australia. PATIENTS: Forty preterm infants (median (IQR) 30.6 (29.1-31.7) weeks' gestation) not receiving respiratory support were studied on day 14 (8-38). INTERVENTIONS: Recordings during 90 min of incubator care, followed by 90 min of SSC. Each infant acted as their own control and caregivers were blinded to the rStO measurements. MAIN OUTCOME MEASURES: The primary outcome was the mean difference in rStO between SSC and incubator care. The prespecified margin of non-inferiority was -1.5%. Secondary outcomes included heart rate (HR), peripheral oxygen saturation (SpO ), time in quiet sleep, temperature and hypoxic (SpO <80% for >5 s) or bradycardic events (HR <80 bpm for >5 s) and time spent in cerebral hypoxia (rStO <55%) and hyperoxia (rStO >85%). RESULTS: Mean (SD) rStO was lower during SSC compared with incubator care: 73.6 (6.0)% vs 74.8 (4.6)%, mean difference (95% CI) 1.3 (2.2 to 0.4)%. HR was 5 bpm higher, SpO 1% lower and time in quiet sleep 24% longer during SSC. Little evidence of a difference was observed in temperature. The number of hypoxic or bradycardic events as well as the proportion of time spent in cerebral hypoxia and hyperoxia was very low in both periods. CONCLUSIONS: Mean rStO was marginally lower during SSC without observed differences in hypoxic or bardycardic events but an increase in time spent in quiet sleep. TRIAL REGISTRATION NUMBER: This trial is linked to Australian New Zealand Clinical Trials Registry: identifier 12616000240448. It was registered pre-results.
[Mh] Termos MeSH primário: Circulação Cerebrovascular/fisiologia
Recém-Nascido Prematuro
Método Canguru/métodos
Oxigênio/sangue
[Mh] Termos MeSH secundário: Austrália
Feminino
Seres Humanos
Lactente Extremamente Prematuro
Recém-Nascido
Masculino
Oximetria
Estudos Prospectivos
Espectroscopia de Luz Próxima ao Infravermelho
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
S88TT14065 (Oxygen)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1136/archdischild-2016-312471


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[PMID]:28747362
[Au] Autor:Travers S; Martinerie L; Boileau P; Lombès M; Pussard E
[Ad] Endereço:Inserm, U1185, Le Kremlin-Bicêtre, France.
[Ti] Título:Alterations of adrenal steroidomic profiles in preterm infants at birth.
[So] Source:Arch Dis Child Fetal Neonatal Ed;103(2):F143-F151, 2018 Mar.
[Is] ISSN:1468-2052
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Preterm infants have relative adrenal and kidney immaturity. Recently, we linked their urine sodium loss to a hypoaldosteronism at variance with an appropriate stimulation of the renin-angiotensin system. To investigate this defective aldosterone secretion, we analyse the biosynthesis pathways of adrenal steroids in neonates according to gestational age (GA). DESIGN: Multicentre study (Premaldo) including 152 neonates classified into three groups: group 1 (very preterm (VPT)): <33 gestational weeks (GW); group 2 (preterm (PT)): 33-36 GW and group 3 (term (T)): ≥GW. METHOD: Steroidomic profiles of mineralocorticoids, glucocorticoids and adrenal androgens were established from umbilical cord at birth (n=152) and peripheral blood at day 3 (n=70) using a recently developed liquid chromatography mass spectrometry method (LC-MS/MS). The enzymatic activity of each biosynthesis step was estimated by the product-to-substrate ratio. RESULTS: At birth, VPT infants exhibit a global defect in adrenal steroid synthesis pathways leading to lower levels of aldosterone, cortisol and androstenedione than in term infants. This defect was strongly related to GA. On day 3, steroid precursors (progesterone, 11-deoxycorticosterone (DOC), 17-hydroxyprogesterone(17-OH-P) and 11-deoxycortisol (S)) were higher in VPT and negatively correlated with GA. Despite of precursors' accumulation, aldosterone and cortisol were similar in the three groups. At birth and day 3, a low cortisol/11-deoxycortisol ratio was found in preterm infants, suggesting an 11-beta-hydroxylase activity ( ) deficiency. CONCLUSIONS: At birth, VPT infants exhibit a global deficit in mineralocorticoids, glucocorticoids and adrenal androgens that attenuates on day 3 of life. Steroid profiling using LC-MS/MS provides evidence for a partial defect in 11-hydroxylase along with prematurity.
[Mh] Termos MeSH primário: Corticosteroides/metabolismo
Recém-Nascido Prematuro
[Mh] Termos MeSH secundário: Corticosteroides/sangue
Androgênios/metabolismo
Cromatografia Líquida
Sistema Enzimático do Citocromo P-450/metabolismo
Sangue Fetal/química
Idade Gestacional
Glucocorticoides/metabolismo
Seres Humanos
Hipoaldosteronismo/metabolismo
Lactente Extremamente Prematuro
Recém-Nascido
Mineralocorticoides/metabolismo
Espectrometria de Massas em Tandem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Androgens); 0 (Glucocorticoids); 0 (Mineralocorticoids); 9035-51-2 (Cytochrome P-450 Enzyme System)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1136/archdischild-2016-312457


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[PMID]:28468901
[Au] Autor:Janssen LMA; Tostmann A; Hopman J; Liem KD
[Ad] Endereço:Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
[Ti] Título:0.2% chlorhexidine acetate as skin disinfectant prevents skin lesions in extremely preterm infants: a preliminary report.
[So] Source:Arch Dis Child Fetal Neonatal Ed;103(2):F97-F100, 2018 Mar.
[Is] ISSN:1468-2052
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The skin disinfectant '0.5% chlorhexidine gluconate in 70% alcohol' (0.5% CHG-70% alc) may cause skin lesions in extremely preterm infants (gestational age <26 weeks). In April 2013, 0.2% chlorhexidine gluconate solution in acetate (0.2% CHG-acetate) was introduced as skin disinfectant for extremely preterm infants in our neonatal intensive care units. We aimed to compare the incidence of skin lesions and central line-associated bloodstream infection (CLABSI) among extremely preterm infants when using 0.5% CHG-70% alc and 0.2% CHG-acetate. DESIGN: Retrospective pre-post comparison cohort study. PATIENTS: All electronic patient records of extremely preterm infants born between January 2011-March 2013 ('0.5% CHG-70% alc' cohort) and April 2013-October 2015 ('0.2% CHG-acetate' cohort) were reviewed. MAIN OUTCOME MEASURES: The incidence of skin lesions and CLABSI. Skin lesions were defined as the presence of erythema, blisters, excoriation, oedema or induration. CLABSI was defined according to the definition of the US Centers for Disease Control and Prevention. RESULTS: The incidence of skin lesions was 22% (95% CI 11% to 37%) in the '0.5% CHG-70% alc' cohort (n=41) and 5% (95% CI 1% to 15%; p=0.02) in the '0.2% CHG-acetate' cohort (n=41). The incidence of CLABSI was the same in both groups (28%; 95% CI 14% to 46% in '0.5% CHG-70% alc' vs 27%; 95% CI 14% to 44% in '0.2% CHG-acetate'; p=0.98). CONCLUSIONS: Using 0.2% CHG-acetate as skin disinfectant in extremely preterm infants resulted in statistically significant reduction of skin lesions, without increasing the risk of CLABSI as compared with 0.5% CHG-70% alc.
[Mh] Termos MeSH primário: Anti-Infecciosos Locais/administração & dosagem
Infecções Relacionadas a Cateter/prevenção & controle
Clorexidina/análogos & derivados
Infecção Hospitalar/prevenção & controle
Lactente Extremamente Prematuro
Dermatopatias/prevenção & controle
[Mh] Termos MeSH secundário: Cateteres Venosos Centrais
Clorexidina/administração & dosagem
Registros Eletrônicos de Saúde
Feminino
Idade Gestacional
Seres Humanos
Recém-Nascido
Unidades de Terapia Intensiva Neonatal
Masculino
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); MOR84MUD8E (chlorhexidine gluconate); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1136/archdischild-2017-312694


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[PMID]:29246358
[Au] Autor:Laptook AR; Bell EF; Shankaran S; Boghossian NS; Wyckoff MH; Kandefer S; Walsh M; Saha S; Higgins R; Generic and Moderate Preterm Subcommittees of the NICHD Neonatal Research Network
[Ad] Endereço:Department of Pediatrics, Brown University, Providence, RI. Electronic address: alaptook@wihri.org.
[Ti] Título:Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants.
[So] Source:J Pediatr;192:53-59.e2, 2018 Jan.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the temperature distribution among moderately preterm (MPT, 29-33 weeks) and extremely preterm (EPT, <29 weeks) infants upon neonatal intensive care unit (NICU) admission in 2012-2013, the change in admission temperature distribution for EPT infants between 2002-2003 and 2012-2013, and associations between admission temperature and mortality and morbidity for both MPT and EPT infants. STUDY DESIGN: Prospectively collected data from 18 centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were used to examine NICU admission temperature of inborn MPT and EPT infants. Associations between admission temperature and mortality and morbidity were determined by multivariable logistic regression. EPT infants from 2002-2003 and 2012-2013 were compared. RESULTS: MPT and EPT cohorts consisted of 5818 and 3213 infants, respectively. The distribution of admission temperatures differed between the MPT vs EPT (P < .01), including the percentage <36.5°C (38.6% vs 40.9%), 36.5°C-37.5°C (57.3% vs 52.9%), and >37.5°C (4.2% vs 6.2%). For EPT infants in 2012-2013 compared with 2002-2003, the percentage of temperatures between 36.5°C and 37.5°C more than doubled and the percentage of temperatures >37.5°C more than tripled. Admission temperature was inversely associated with in-hospital mortality. CONCLUSIONS: Low and high admission temperatures are more frequent among EPT than MPT infants. Compared with a decade earlier, fewer EPT infants experience low admission temperatures but more have elevated temperatures. In spite of a change in distribution of NICU admission temperature, an inverse association between temperature and mortality risk persists.
[Mh] Termos MeSH primário: Temperatura Corporal
Mortalidade Hospitalar
Lactente Extremamente Prematuro
Doenças do Prematuro/etiologia
[Mh] Termos MeSH secundário: Feminino
Febre/diagnóstico
Febre/epidemiologia
Seres Humanos
Hipotermia/diagnóstico
Hipotermia/epidemiologia
Recém-Nascido
Doenças do Prematuro/diagnóstico
Doenças do Prematuro/epidemiologia
Unidades de Terapia Intensiva Neonatal
Modelos Logísticos
Masculino
Admissão do Paciente
Fatores de Risco
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE


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[PMID]:29381949
[Au] Autor:Ho CY; He ZR; Yang SN; Yang YN
[Ad] Endereço:Department of Pediatrics, E-Da Hospita.
[Ti] Título:Late-onset transient adrenal insufficiency in preterm twins with twin-to-twin transfusion syndrome: A case report.
[So] Source:Medicine (Baltimore);96(47):e8686, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Late-onset transient adrenal insufficiency with circulatory collapse is a rare condition that occurs in preterm infants. Although the incidence of late-onset transient adrenal insufficiency in preterm infants has been reported in Japan, reports from Western countries are lacking. In addition, no study has investigated the effect of twin-to-twin transfusion syndrome (TTTS) in monozygotic twins. PATIENT CONCERNS: A pair of extremely low birth weight twins presented with TTTS. DIAGNOSES: Both twins developed late-onset adrenal insufficiency with oliguria, hypotension, hyponatremia, and pulmonary edema at a postnatal age of 24 days and 51 days, respectively. INTERVENTION: Temporary administration of intravenous hydrocortisone was initiated. OUTCOMES: Their symptoms improved dramatically and they survived the event without any neurologic sequelae after 3 years of follow-up. LESSONS: Late-onset circulatory collapse may occur, especially in extremely preterm infants, even at 2 months after birth. Hydrocortisone therapy is an effective treatment to rescue circulatory collapse caused by adrenal insufficiency in preterm infants and may not affect long-term neuromotor and cognitive outcomes.
[Mh] Termos MeSH primário: Insuficiência Adrenal
Hidrocortisona/administração & dosagem
Lactente Extremamente Prematuro
Choque/tratamento farmacológico
[Mh] Termos MeSH secundário: Corticosteroides/administração & dosagem
Insuficiência Adrenal/complicações
Insuficiência Adrenal/diagnóstico
Insuficiência Adrenal/tratamento farmacológico
Insuficiência Adrenal/fisiopatologia
Feminino
Seguimentos
Idade Gestacional
Seres Humanos
Lactente
Recém-Nascido de Peso Extremamente Baixo ao Nascer
Recém-Nascido
Choque/diagnóstico
Choque/etiologia
Choque/fisiopatologia
Taiwan
Resultado do Tratamento
Gêmeos Monozigóticos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008686


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[PMID]:29173320
[Au] Autor:Zivanovic S; Pushparajah K; Calvert S; Marlow N; Razavi R; Peacock JL; Greenough A
[Ad] Endereço:Division of Asthma, Allergy and Lung Biology, Medical Research Council Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom.
[Ti] Título:Pulmonary Artery Pressures in School-Age Children Born Prematurely.
[So] Source:J Pediatr;191:42-49.e3, 2017 Dec.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To test the hypothesis that pulmonary artery pressures were higher in school aged children born extremely premature than those born at term. We also wanted to assess whether pulmonary artery pressures differed between children born prematurely with or without bronchopulmonary dysplasia (BPD) or between those randomized in the neonatal period to different ventilation modes. STUDY DESIGN: Transthoracic echocardiography was performed on 193 children born extremely premature (106 had BPD) and 110 children born at term when they were 11-14 years of age. Ninety-nine children born extremely premature had been supported by high-frequency oscillation and 94 by conventional ventilation. Tricuspid regurgitation was assessed in the apical 4-chamber and modified parasternal long-axis views. Continuous-wave Doppler of the peak regurgitant jet velocity was used to estimate the right-ventricular-to-right-atrial systolic pressure gradient. RESULTS: Tricuspid regurgitation was measurable in 71% (137/193) of the children born preterm and 75% (83/110) of the children born at term (P .23). The children born prematurely compared with the children born at term had a greater peak tricuspid regurgitation velocity (2.21 vs 1.95 m/s, P < .001) and the children born prematurely who had BPD vs those without BPD had a greater peak tricuspid regurgitation velocity (P = .023). There were no significant differences in pulmonary artery pressures according to neonatal ventilation mode. CONCLUSIONS: Pulmonary artery pressures were estimated to be greater in 11- to 14-year-old children born extremely prematurely compared with those born at term and in those born prematurely who developed BPD compared with those who did not but did not differ significantly by neonatal ventilation mode.
[Mh] Termos MeSH primário: Hipertensão Pulmonar/etiologia
Lactente Extremamente Prematuro
Doenças do Prematuro/etiologia
Respiração Artificial/métodos
[Mh] Termos MeSH secundário: Adolescente
Displasia Broncopulmonar/complicações
Estudos de Casos e Controles
Criança
Ecocardiografia
Feminino
Seguimentos
Seres Humanos
Hipertensão Pulmonar/diagnóstico por imagem
Hipertensão Pulmonar/epidemiologia
Recém-Nascido
Doenças do Prematuro/diagnóstico por imagem
Doenças do Prematuro/epidemiologia
Doenças do Prematuro/terapia
Masculino
Artéria Pulmonar/diagnóstico por imagem
Respiração Artificial/efeitos adversos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:28463389
[Au] Autor:Domellöf M; Pettersson K
[Ad] Endereço:Umeå universitet, Institutionen för klinisk vetenskap - Pediatrik Umeå, Sweden Umea universitet Institutionen for Klinisk vetenskap - Pediatrics Umea, Sweden.
[Ti] Título:Riktlinjer vid hotande förtidsbörd ska ge bättre och mer jämlik vård - Konsensusdokument för enhetligt omhändertagande av gravida och extremt för tidigt födda barn..
[So] Source:Lakartidningen;114, 2017 Apr 25.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Mh] Termos MeSH primário: Lactente Extremamente Prematuro
Guias de Prática Clínica como Assunto
Nascimento Prematuro
[Mh] Termos MeSH secundário: Reanimação Cardiopulmonar
Serviços Centralizados no Hospital
Cesárea
Consenso
Feminino
Glucocorticoides/administração & dosagem
Seres Humanos
Recém-Nascido
Neonatologistas
Gravidez
Taxa de Sobrevida
Suécia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Glucocorticoids)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171207
[Lr] Data última revisão:
171207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:28982710
[Au] Autor:Puopolo KM; Mukhopadhyay S; Hansen NI; Cotten CM; Stoll BJ; Sanchez PJ; Bell EF; Das A; Hensman AM; Van Meurs KP; Wyckoff MH; NICHD Neonatal Research Network
[Ad] Endereço:Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; karen.puopolo@uphs.upenn.edu.
[Ti] Título:Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis.
[So] Source:Pediatrics;140(5), 2017 Nov.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Premature infants are at high risk of early-onset sepsis (EOS) relative to term infants, and most are administered empirical antibiotics after birth. We aimed to determine if factors evident at birth could be used to identify premature infants at lower risk of EOS. METHODS: Study infants were born at 22 to 28 weeks' gestation in Neonatal Research Network centers from 2006 to 2014. EOS was defined by isolation of pathogenic species from blood or cerebrospinal fluid culture at ≤72 hours age. Infants were hypothesized as "low risk" for EOS when delivered via cesarean delivery, with membrane rupture at delivery, and absence of clinical chorioamnionitis. Frequency of prolonged antibiotics (≥5 days) was compared between low-risk infants and all others. Risks of mortality, EOS, and other morbidities were assessed by using regression models adjusted for center, race, antenatal steroid use, multiple birth, sex, gestation, and birth weight. RESULTS: Of 15 433 infants, 5759 (37%) met low-risk criteria. EOS incidence among infants surviving >12 hours was 29 out of 5640 (0.5%) in the low-risk group versus 209 out of 8422 (2.5%) in the comparison group (adjusted relative risk = 0.24 [95% confidence interval, 0.16-0.36]). Low-risk infants also had significantly lower combined risk of EOS or death ≤12 hours. Prolonged antibiotics were administered to 34% of low-risk infants versus 47% of comparison infants without EOS. CONCLUSIONS: Delivery characteristics of extremely preterm infants can be used to identify those with significantly lower incidence of EOS. Recognition of differential risk may help guide decisions to limit early antibiotic use among approximately one-third of these infants.
[Mh] Termos MeSH primário: Lactente Extremamente Prematuro
Doenças do Prematuro/diagnóstico
Doenças do Prematuro/mortalidade
Sepse/diagnóstico
Sepse/mortalidade
[Mh] Termos MeSH secundário: Adulto
Antibacterianos/uso terapêutico
Feminino
Seres Humanos
Recém-Nascido
Doenças do Prematuro/tratamento farmacológico
Masculino
Sistema de Registros
Fatores de Risco
Sepse/tratamento farmacológico
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171007
[St] Status:MEDLINE


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[PMID]:28937572
[Au] Autor:American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine
[Ti] Título:Obstetric Care consensus No. 6: Periviable Birth.
[So] Source:Obstet Gynecol;130(4):e187-e199, 2017 10.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values.
[Mh] Termos MeSH primário: Parto Obstétrico/normas
Viabilidade Fetal
Lactente Extremamente Prematuro
Obstetrícia/normas
Nascimento Prematuro
[Mh] Termos MeSH secundário: Consenso
Parto Obstétrico/ética
Parto Obstétrico/métodos
Feminino
Seres Humanos
Recém-Nascido
Terapia Intensiva Neonatal/ética
Terapia Intensiva Neonatal/métodos
Terapia Intensiva Neonatal/normas
Obstetrícia/ética
Preferência do Paciente
Gravidez
[Pt] Tipo de publicação:CONSENSUS DEVELOPMENT CONFERENCE; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002352



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