RESUMEN
BACKGROUND: Bronchopulmonary dysplasia (BPD) carries a risk of long-term pulmonary sequelae. High-resolution computed tomography (HRCT) is a method of detecting such structural changes. This study is aimed at characterizing structural abnormalities associated with BPD and at evaluating the clinical findings in the newborn period associated with HRCT scores. METHODS: 28 patients born with a mean gestation age of 30 ± 2.9 weeks and diagnosed as BPD in their neonatal period were reevaluated when they were between the postnatal ages of 6 and 12 months. HRCT was performed in 20 patients with a history of moderate and severe BPD. Scans were interpreted by one radiologist using a scoring system. RESULTS: Patients were 9.8 ± 2.3 months at the time of reevaluation. The average HRCT score of patients was, respectively, 7.20 ± 4.05 with moderate and 7.40 ± 2.84 with severe BPD. The difference between them was not significant (p = 0.620). When moderate and severe groups were collected as a whole on the basis of physical findings and drug treatment, 6 had normal physical examination findings, no oxygen and no drug requirement; 14 had at least one finding at the time of reevaluation. No significant difference was detected in terms of HRCT score between the two groups (6.50 ± 3.83 versus 7.64 ± 3.30). CONCLUSIONS: More studies are needed in terms of the role of HRCT in the assessment of BPD prognosis. A contemporary definition of BPD that correlates with respiratory morbidity in childhood is needed. Also, a new lung ultrasound technique for predicting the respiratory outcome in patients with BPD can be used instead of HRCT.
Asunto(s)
Displasia Broncopulmonar , Displasia Broncopulmonar/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Pulmón/diagnóstico por imagen , Oxígeno , Tomografía Computarizada por Rayos X/métodosRESUMEN
PURPOSE: Intravenous immunoglobulin (IVIG) therapy is used in inflammatory diseases but the use of immunoglobulin as a treatment for acute lung injury (ALI) has not been previously studied. Transforming growth factor beta (TGF-ß) plays a critical role in the pathogenesis of of ALI. Therefore we examined the levels of TGF-ß and lung inflammation scores in IVIG treated ALI models. METHODS: Intratracheal lipopolysacccharide was given to rats. Groups 1 and 3 received saline, whereas group 2 received IVIG. 24h later saline was given to groups 1 and 2 and IVIG to group 3. Blood samples and bronchoalveolar lavage (BAL) fluids were obtained from each group and sacrificed for pathological evaluation. RESULTS: BAL TGF-ß levels of groups 2 and 3 on day 30, were lower compared to their levels of day 2 (p=0.01, p=0.01). BAL TGF-ß levels of groups 2 and 3 were lower than the levels of group 1 on day 30 (p=0.002, p=0.001). Pathological examination revealed that the inflammation scores of groups 2 and 3 on day 30, were lower than the scores of day 2 (p=0.02, p=0.01). Inflammation scores of group 2 were lower than group 1 on day 30 (p=0.02). Moderate fibrosis was seen in half of the rats from group 1 and one rat from group 2. CONCLUSION: High-dose IVIG decreased lung inflammation scores and BAL TGF-ß1 levels and this therapy would give even better results if it is given earlier.
Asunto(s)
Lesión Pulmonar Aguda/tratamiento farmacológico , Fibrosis/tratamiento farmacológico , Inmunoglobulinas Intravenosas/administración & dosificación , Pulmón/efectos de los fármacos , Neumonía/tratamiento farmacológico , Lesión Pulmonar Aguda/inducido químicamente , Animales , Fibrosis/inducido químicamente , Humanos , Inmunoglobulinas Intravenosas/efectos adversos , Lipopolisacáridos/inmunología , Pulmón/inmunología , Masculino , Ratas , Ratas Wistar , Factor de Crecimiento Transformador beta/metabolismoRESUMEN
BACKGROUND: The aim of this study was to determine the rate of health care-associated infection (HC-AI) and device-associated health care-associated infections (DA-HAIs), and distribution of causative microorganisms and etiologic factors responsible for these infections in a neonatal intensive care unit (NICU) of a state hospital in southeastern Turkey. METHODS: A laboratory-based, active, prospective nosocomial infection surveillance study was performed in NICUs from January 2008 to December 2011. The rates of HC-AIs were determined on a daily basis. The findings were evaluated by applying the definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network. RESULTS: In a 4-year period, 580 HC-AIs, 81 of which were DA-HAIs, were detected among 6932 patients. The rate of hospital acquired infection was 8.3% and 7.69/1000 patient days. Ventilator-associated pneumonia (VAP) was the second most frequent (13.1%) HC-AI and the most frequent was DA-HAI. The VAP rate was 6.4 per 1000 ventilator days. Mechanical ventilation was the most frequently used invasive device. Median time to diagnosis of VAP was 32.11 ± 29.3 days from the time of admission. Acinetobacter baumannii (48%) and Pseudomonas aeruginosa (32%) were the most frequent microorganisms. Colistin was the most effective antibiotic by in vitro test. The antibiotic resistance ratios of A. baumannii were ≥54% for carbapenems, aminoglycosides, and cefoperazone-sulbactam; ≥88% for quinolones; and ≥92% for ceftazidime, ceftriaxone, and piperacillin-tazobactam. CONCLUSIONS: Device-associated nosocomial infections was a particularly important problem in NICU. Close monitoring will decrease the rates of device-related nosocomial infections.
Asunto(s)
Infección Hospitalaria/epidemiología , Unidades de Cuidado Intensivo Neonatal , Neumonía Asociada al Ventilador/epidemiología , Acinetobacter baumannii/aislamiento & purificación , Infección Hospitalaria/microbiología , Femenino , Humanos , Recién Nacido , Masculino , Neumonía Asociada al Ventilador/microbiología , Estudios Prospectivos , Pseudomonas aeruginosa/aislamiento & purificaciónRESUMEN
OBJECTIVES: To evaluate if cardiac dysfunctions are important in assessing the outcome in newborns with Bronchopulmonary Dysplasia (BPD), by evaluating cardiac functions with N-terminal prohormone of brain natriüretic peptide (NT-proBNP) levels, M-mode and tissue doppler echocardiography at 6-12 mo of age. METHODS: Twenty eight patients were retrospectively classified as mild, moderate and severe according to the diagnostic criterias for BPD. All cases were assessed with standard M-mode, tissue doppler echocardiography and NT-proBNP levels. Control group consisted of 28 healthy infants, having similar postnatal ages as patients and were assessed with standard M-mode and tissue doppler echocardiography. RESULTS: The age of patients with BPD was 9.8 ± 2.3 mo and control group was 9.5 ± 2.6 mo. There was no significant difference between the postnatal ages of two groups (p > 0.05). Neither pulmonary hypertension nor pulmonary/tricuspid regurgitation was detected. The M-mode echocardiography measurements did not differ between patients and control group (p > 0.05). Tissue doppler echocardiography, tricuspid valve medial segment early diastolic myocardial relaxation velocity (TME') measurements of patients were found significantly lower, peak transtricuspid filling velocity in the early diastole (TE)/TME' ratios and isovolumetric relaxation time (IVRT) measurements were found significantly higher than control group (p < 0.05). Tricuspid E, TE/TLE' (Tricuspid valve lateral segment early diastolic myocardial relaxation velocity), TE/RVLE'(Right ventricular lateral segment early diastolic myocardial relaxation velocity), TE/TME' levels were also found as significantly abnormal in patients with severe BPD. A significant correlation was found between right ventricular diastolic disfunctions and severity of BPD (p < 0.05). No statistically significant difference was found between NT-proBNP levels, BPD stages and tissue doppler echocardiography measurements (p > 0.05). CONCLUSIONS: This is the first study evaluating cardiac findings in patients with BPD by tissue doppler echocardiography and NT-proBNP at the same time. On the basis of cardiac evaluations, tissue doppler echocardiography measurements were found as significant and specific for the early assessment of right ventricular diastolic disfunctions.