RESUMEN
OBJECTIVE: The objective of this study was to examine the association of cardiorespiratory events, including apnea, periodic breathing, intermittent hypoxemia (IH), and bradycardia, with late-onset sepsis for extremely preterm infants (<29 weeks of gestational age) on vs off invasive mechanical ventilation. STUDY DESIGN: This is a retrospective analysis of data from infants enrolled in Pre-Vent (ClinicalTrials.gov identifier NCT03174301), an observational study in 5 level IV neonatal intensive care units. Clinical data were analyzed for 737 infants (mean gestational age: 26.4 weeks, SD 1.71). Monitoring data were available and analyzed for 719 infants (47 512 patient-days); of whom, 109 had 123 sepsis events. Using continuous monitoring data, we quantified apnea, periodic breathing, bradycardia, and IH. We analyzed the relationships between these daily measures and late-onset sepsis (positive blood culture >72 hours after birth and ≥5-day antibiotics). RESULTS: For infants not on a ventilator, apnea, periodic breathing, and bradycardia increased before sepsis diagnosis. During times on a ventilator, increased sepsis risk was associated with longer events with oxygen saturation <80% (IH80) and more bradycardia events before sepsis. IH events were associated with higher sepsis risk but did not dynamically increase before sepsis, regardless of ventilator status. A multivariable model including postmenstrual age, cardiorespiratory variables (apnea, periodic breathing, IH80, and bradycardia), and ventilator status predicted sepsis with an area under the receiver operator characteristic curve of 0.783. CONCLUSION: We identified cardiorespiratory signatures of late-onset sepsis. Longer IH events were associated with increased sepsis risk but did not change temporally near diagnosis. Increases in bradycardia, apnea, and periodic breathing preceded the clinical diagnosis of sepsis.
Asunto(s)
Apnea , Bradicardia , Hipoxia , Recien Nacido Extremadamente Prematuro , Sepsis , Humanos , Bradicardia/epidemiología , Bradicardia/etiología , Apnea/epidemiología , Estudios Retrospectivos , Recién Nacido , Hipoxia/complicaciones , Femenino , Masculino , Sepsis/complicaciones , Sepsis/epidemiología , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/diagnóstico , Respiración Artificial , Unidades de Cuidado Intensivo Neonatal , Edad GestacionalRESUMEN
OBJECTIVES: To describe the prevalence of apnea in otherwise healthy term newborns, identify attributable length of stay (LOS) and healthcare utilization (cost) of apnea, and measure hospital variation in attributable LOS and cost of apnea in this population. STUDY DESIGN: We conducted a secondary analysis of a national administrative dataset, the 2012 Kids' Inpatient Database, which included 3.4 million newborn discharges in the US. The birth hospitalizations of approximately 2.6 million otherwise healthy, full-term newborns were included for analysis. Attributable LOS and cost of apnea were calculated using multivariate analyses. RESULTS: Apnea was diagnosed in 1 in 1000 healthy full-term newborns. Multivariate analyses showed that newborns with apnea had 0.6 days longer LOS (P < .001) and $483 greater costs (P < .001) compared with healthy term newborns, per birth hospitalization. Newborns diagnosed with apnea plus hypoxia and/or bradycardia had 1.4 days longer LOS (P < .001) and $653 greater costs (P < .001). The attributable LOS and cost attributable to apnea varied between individual hospitals and differed by hospital region. CONCLUSIONS: Apnea is associated with higher LOS and cost in the newborn hospitalization, with variation in hospital practice. This suggests the need for better comprehension of the underlying physiology and standardization of practice in its management in the term newborn.
Asunto(s)
Apnea/economía , Apnea/epidemiología , Hospitalización/economía , Tiempo de Internación/economía , Nacimiento a Término , Apnea/diagnóstico , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Estado de Salud , Costos de Hospital , Humanos , Recién Nacido , Pacientes Internos/estadística & datos numéricos , Masculino , Análisis Multivariante , Prevalencia , Índice de Severidad de la EnfermedadRESUMEN
We evaluated the effects of bolus vs continuous tube feeding on cardiorespiratory events, detected by polysomnographic monitoring, in healthy preterm infants. Continuous tube feeding resulted in a significant increase of apneas and apneas-related hypoxic episodes compared with bolus feeding.
Asunto(s)
Apnea/epidemiología , Bradicardia/epidemiología , Nutrición Enteral/métodos , Hipoxia/epidemiología , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , PolisomnografíaRESUMEN
CONTEXT AND OBJECTIVE Obstructive sleep apnea syndrome (OSAS) is one of the leading causes of morbidity and mortality in adults. Early detection of the disorder and discovery of risk factors through standardized questionnaires will lead to reduction of the OSAS burden. The main aim of this study was to estimate the prevalence of OSAS symptoms and examine their association with housing characteristics. DESIGN AND SETTING Cross-sectional study at a medical school. METHODS Demographic, housing and body measurement data on 5,545 individuals aged 16 years and over of various races were selected from the National Health and Nutrition Examination Survey. We analyzed the probability of OSAS based on habitual snoring combined with daytime sleepiness and/or witnessed apnea. Univariate and multiple linear regression were used. RESULTS 9.8% of the men and 6.9% of the women reported symptoms suggestive of OSAS (habitual snoring, daytime sleepiness and/or apnea). The following prevalences of symptoms were found among males and females respectively: frequent snoring 35.1%, 22.3%, excessive daytime sleepiness 6.4%, 3.4% and frequent apnea 14.9%, 20.6%. Using multiple linear regression, OSAS symptoms were correlated with gender, age, body mass index (BMI), marital status and education. Regarding housing characteristics, mildew or musty smell and pets in the environment were associated with a high probability of OSAS. CONCLUSION OSAS symptoms were more prevalent than in developing countries. The environment was an important risk factor, but environmental factors are easier to control and manage than other variables like BMI or socioeconomic status.
Asunto(s)
Trastornos de Somnolencia Excesiva/epidemiología , Vivienda , Apnea Obstructiva del Sueño/epidemiología , Adulto , Factores de Edad , Apnea/epidemiología , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Apnea Obstructiva del Sueño/etiología , Ronquido/epidemiología , Factores Socioeconómicos , Encuestas y Cuestionarios , Factores de Tiempo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
CONTEXT AND OBJECTIVE Obstructive sleep apnea syndrome (OSAS) is one of the leading causes of morbidity and mortality in adults. Early detection of the disorder and discovery of risk factors through standardized questionnaires will lead to reduction of the OSAS burden. The main aim of this study was to estimate the prevalence of OSAS symptoms and examine their association with housing characteristics. DESIGN AND SETTING Cross-sectional study at a medical school. METHODS Demographic, housing and body measurement data on 5,545 individuals aged 16 years and over of various races were selected from the National Health and Nutrition Examination Survey. We analyzed the probability of OSAS based on habitual snoring combined with daytime sleepiness and/or witnessed apnea. Univariate and multiple linear regression were used. RESULTS 9.8% of the men and 6.9% of the women reported symptoms suggestive of OSAS (habitual snoring, daytime sleepiness and/or apnea). The following prevalences of symptoms were found among males and females respectively: frequent snoring 35.1%, 22.3%, excessive daytime sleepiness 6.4%, 3.4% and frequent apnea 14.9%, 20.6%. Using multiple linear regression, OSAS symptoms were correlated with gender, age, body mass index (BMI), marital status and education. Regarding housing characteristics, mildew or musty smell and pets in the environment were associated with a high probability of OSAS. CONCLUSION OSAS symptoms were more prevalent than in developing countries. The environment was an important risk factor, but environmental factors are easier to control and manage than other variables like BMI or socioeconomic status. .
CONTEXTO E OBJETIVO Síndrome de apneia obstrutiva do sono (SAOS) é uma das principais causas de morbidade e mortalidade em adultos. Detecção precoce da doença e descoberta de fatores de risco com questionários padronizados levarão a redução dos danos por SAOS. O principal objetivo deste estudo foi estimar a prevalência de sintomas de SAOS e examinar sua associação com características da habitação. TIPO DE ESTUDO E LOCAL Estudo transversal em faculdade de medicina. MÉTODOS Dados demográficos, habitacionais e de medidas corporais sobre 5.545 indivíduos de 16 anos ou mais, de diversas raças, foram selecionados do National Health and Nutrition Examination Survey. Analisamos a probabilidade de SAOS com base no ronco habitual combinada com sonolência diurna e/ou apneia testemunhada. Análise univariada e regressão linear múltipla foram usadas. RESULTADOS 9,8% dos homens e 6,9% das mulheres relataram sintomas sugestivos de SAOS (ronco habitual, sonolência diurna e/ou apneia). A prevalência de sintomas em homens e mulheres, respectivamente, foi: ronco frequente 35,1%, 22,3%, sonolência excessiva diurna 6,4%, 3,4% e apneia frequente 14,9%, 20,6%. Através de regressão linear múltipla, sintomas de SAOS foram relacionados com gênero, idade, índice de massa corpórea (IMC), estado civil e educação. Das características da habitação, mofo ou cheiro de mofo e animais de estimação no ambiente foram associados com alta probabilidade de SAOS. CONCLUSÃO Sintomas de SAOS foram mais prevalentes do que nos países em desenvolvimento. O meio ambiente foi um fator de risco importante, porém é mais fácil controlar e manejar fatores ambientais do que outras variáveis, como IMC ou status socioeconômico. .
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Trastornos de Somnolencia Excesiva/epidemiología , Vivienda , Apnea Obstructiva del Sueño/epidemiología , Factores de Edad , Apnea/epidemiología , Índice de Masa Corporal , Estudios Transversales , Modelos Lineales , Prevalencia , Encuestas y Cuestionarios , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Apnea Obstructiva del Sueño/etiología , Ronquido/epidemiología , Factores Socioeconómicos , Factores de Tiempo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To examine the relationship between primary vaccination of preterm infants and prevalence ratios of associated factors for unwanted cardiorespiratory events, following the recommendation of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices for immunization of preterm infants at 2 months of chronological age. METHODS: Two-year retrospective study of very low birth weight infants receiving their primary vaccination. Major cardiorespiratory events, such as apnea, bradycardia, SpO(2) desaturation, and minor adverse events, such as temperature instability, poor handling and local reactions, were recorded. Prevalence ratio with 95% confidence interval for associated factors between infants with and without cardiorespiratory events was calculated. RESULTS: Eighty neonates were studied (median [range] birth weight 970 g [428-1,490]), gestational age of 27.4 weeks (23.3-33). Adverse reactions occurred in 35 (44%): minor events in 19 (24%) patients, major events in 28 (35%). Infants with major events had significantly lower gestational age (p = 0.008) and a higher incidence of bronchopulmonary dysplasia (71% vs. 48%; p < 0.05). In very low birth weight infants with major events, O(2) desaturations before vaccination were 3.40 (1.41-8.23) times higher and treatment with methylxanthines for apnea and bradycardia syndrome was 8.05 (2.50-25.89) times higher compared to infants without major events. CONCLUSION: Major cardiorespiratory events occurred in over 1/3 of all very low birth weight infants after vaccination. Associated factors were low gestational age, bronchopulmonary dysplasia, methylxanthine treatment, and persisting O(2) desaturations before vaccination. Primary vaccination of very low birth weight infants should be performed under continuous monitoring of vital parameters.
Asunto(s)
Apnea/epidemiología , Displasia Broncopulmonar/epidemiología , Recién Nacido de muy Bajo Peso , Consumo de Oxígeno/fisiología , Vacunación/efectos adversos , Apnea/tratamiento farmacológico , Displasia Broncopulmonar/complicaciones , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Consumo de Oxígeno/efectos de los fármacos , Fármacos del Sistema Respiratorio/uso terapéutico , Estudios Retrospectivos , Factores de Riesgo , Xantinas/uso terapéuticoRESUMEN
OBJECTIVE: To compare the frequency and severity of apneic events in very low birth weight (VLBW) infants before and after blood transfusions using continuous electronic waveform analysis. STUDY DESIGN: We continuously collected waveform, heart rate, and oxygen saturation data from patients in all 45 neonatal intensive care unit beds at the University of Virginia for 120 weeks. Central apneas were detected using continuous computer processing of chest impedance, electrocardiographic, and oximetry signals. Apnea was defined as respiratory pauses of >10, >20, and >30 seconds when accompanied by bradycardia (<100 beats per minute) and hypoxemia (<80% oxyhemoglobin saturation as detected by pulse oximetry). Times of packed red blood cell transfusions were determined from bedside charts. Two cohorts were analyzed. In the transfusion cohort, waveforms were analyzed for 3 days before and after the transfusion for all VLBW infants who received a blood transfusion while also breathing spontaneously. Mean apnea rates for the previous 12 hours were quantified and differences for 12 hours before and after transfusion were compared. In the hematocrit cohort, 1453 hematocrit values from all VLBW infants admitted and breathing spontaneously during the time period were retrieved, and the association of hematocrit and apnea in the next 12 hours was tested using logistic regression. RESULTS: Sixty-seven infants had 110 blood transfusions during times when complete monitoring data were available. Transfusion was associated with fewer computer-detected apneic events (P < .01). Probability of future apnea occurring within 12 hours increased with decreasing hematocrit values (P < .001). CONCLUSIONS: Blood transfusions are associated with decreased apnea in VLBW infants, and apneas are less frequent at higher hematocrits.
Asunto(s)
Anemia/epidemiología , Apnea/epidemiología , Transfusión Sanguínea , Recién Nacido de muy Bajo Peso , Algoritmos , Apnea/fisiopatología , Cardiografía de Impedancia , Comorbilidad , Electrocardiografía , Hematócrito , Humanos , Procesamiento de Imagen Asistido por Computador , Recién Nacido , Recién Nacido de muy Bajo Peso/fisiología , Modelos Logísticos , Oximetría , Oxígeno/sangreRESUMEN
OBJETIVO: Examinar a relação entre vacinação primária de recém-nascidos pré-termo e razões de prevalência de fatores associados a eventos cardiorrespiratórios indesejados, seguindo recomendações do Comitê Consultivo de Práticas de Imunização do Centers for Disease Control and Prevention para imunização de recém-nascidos pré-termo aos 2 meses de idade cronológica. MÉTODOS: Estudo retrospectivo de 2 anos de recém-nascidos de muito baixo peso que receberam vacinação primária. Foram registrados eventos cardiorrespiratórios maiores, como apneia, bradicardia, dessaturação de SpO2, e eventos menores, como instabilidade de temperatura, comportamento inapropriado e reações locais. Foi calculada a razão de prevalência com intervalo de confiança de 95% para fatores associados entre recém-nascidos com e sem eventos cardiorrespiratórios. RESULTADOS: Foram estudados 80 recém-nascidos (mediana de peso ao nascer [:intervalo]: de 970 g [:428-1.490]:), idade gestacional de 27,4 semanas (23,3-33). Ocorreram reações adversas em 35 (44%): eventos menores em 19 (24%) pacientes, eventos maiores em 28 (35%). Recém-nascidos com eventos maiores tiveram idade gestacional significativamente menor (p = 0,008) e incidência mais alta de displasia broncopulmonar (71% versus 48%; p < 0,05). Em recém-nascidos de muito baixo peso com eventos maiores, o número de casos de dessaturação de O2 antes da vacinação foi 3,40 (1,41-8,23) vezes maior, e o tratamento com metilxantina para síndrome de apneia e bradicardia foi 8,05 (2,50-25,89) vezes maior em comparação com recém-nascidos sem eventos maiores. CONCLUSÃO: Eventos cardiorrespiratórios maiores ocorreram em mais de 1/3 de todos os recém-nascidos de muito baixo peso após a vacinação. Os fatores associados foram baixa idade gestacional, displasia broncopulmonar, tratamento com metilxantina e dessaturação de O2 persistente antes da vacinação. A vacinação primária de recém-nascidos de muito baixo peso deve ser realizada sob monitoramento contínuo de parâmetros vitais.
OBJECTIVE: To examine the relationship between primary vaccination of preterm infants and prevalence ratios of associated factors for unwanted cardiorespiratory events, following the recommendation of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices for immunization of preterm infants at 2 months of chronological age. METHODS: Two-year retrospective study of very low birth weight infants receiving their primary vaccination. Major cardiorespiratory events, such as apnea, bradycardia, SpO2 desaturation, and minor adverse events, such as temperature instability, poor handling and local reactions, were recorded. Prevalence ratio with 95% confidence interval for associated factors between infants with and without cardiorespiratory events was calculated. RESULTS: Eighty neonates were studied (median [:range]: birth weight 970 g [:428-1,490]:), gestational age of 27.4 weeks (23.3-33). Adverse reactions occurred in 35 (44%): minor events in 19 (24%) patients, major events in 28 (35%). Infants with major events had significantly lower gestational age (p = 0.008) and a higher incidence of bronchopulmonary dysplasia (71% vs. 48%; p < 0.05). In very low birth weight infants with major events, O2 desaturations before vaccination were 3.40 (1.41-8.23) times higher and treatment with methylxanthines for apnea and bradycardia syndrome was 8.05 (2.50-25.89) times higher compared to infants without major events. CONCLUSION: Major cardiorespiratory events occurred in over 1/3 of all very low birth weight infants after vaccination. Associated factors were low gestational age, bronchopulmonary dysplasia, methylxanthine treatment, and persisting O2 desaturations before vaccination. Primary vaccination of very low birth weight infants should be performed under continuous monitoring of vital parameters.
Asunto(s)
Femenino , Humanos , Lactante , Recién Nacido , Masculino , Apnea/epidemiología , Displasia Broncopulmonar/epidemiología , Recién Nacido de muy Bajo Peso , Consumo de Oxígeno/fisiología , Vacunación/efectos adversos , Apnea/tratamiento farmacológico , Displasia Broncopulmonar/complicaciones , Edad Gestacional , Recien Nacido Prematuro , Consumo de Oxígeno/efectos de los fármacos , Estudios Retrospectivos , Factores de Riesgo , Fármacos del Sistema Respiratorio/uso terapéutico , Xantinas/uso terapéuticoRESUMEN
OBJECTIVE: To determine whether infants at sleep in the prone side positions are at higher risk for an extreme cardiorespiratory event compared with infants at sleep in the supine position. STUDY DESIGN: We used a case-control study to compare sleep position, determined with an accelerometer, in 116 infants during an extreme cardiorespiratory event with that in 231 matched control subjects (2 per case) who did not experience any extreme events during monitoring. RESULTS: From calculation of adjusted ORs and 95% CIs, infants placed in the prone or side position were no more likely to experience an extreme cardiorespiratory event compared with infants at sleep in the supine position. We used conditional logistic regression to account for the matched design of the study and to adjust for potential confounders or effect-modifiers. CONCLUSION: These findings, coupled with our earlier observation that the peak incidence of severe cardiorespiratory events occurred before the peak incidence of sudden infant death syndrome, strongly suggest that the supine sleeping position decreases the risk of sudden infant death syndrome by mechanisms other than by decreasing extreme cardiorespiratory events detected by monitoring.
Asunto(s)
Apnea/epidemiología , Bradicardia/epidemiología , Posición Prona , Sueño , Posición Supina , Estudios de Casos y Controles , Femenino , Humanos , Lactante , Masculino , Factores de RiesgoAsunto(s)
Obstrucción de las Vías Aéreas/epidemiología , Apnea/epidemiología , Cianosis/epidemiología , Hipotonía Muscular/epidemiología , Terminología como Asunto , Obstrucción de las Vías Aéreas/diagnóstico , Apnea/diagnóstico , Canadá/epidemiología , Comorbilidad , Cianosis/diagnóstico , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido , Monitoreo Fisiológico , Hipotonía Muscular/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Factores de Riesgo , Muerte Súbita del Lactante/diagnóstico , Muerte Súbita del Lactante/epidemiologíaRESUMEN
OBJECTIVE: To determine the incidence of apnea in infants hospitalized with respiratory syncytial virus (RSV) bronchiolitis and identify relevant risk factors from the available literature. STUDY DESIGN: A systematic search of available databases for studies reporting the rate of apnea in a consecutive cohort of infants hospitalized with RSV infection was performed. The overall incidence of apnea was extracted and analyzed in relation to preterm birth, age, and potentially confounding illnesses. RESULTS: The incidence of apnea in the study population of 5575 hospitalized patients with RSV ranged from a high of 23.8% to a low of 1.2%. Comparison of the cohort by term and preterm birth revealed an expected excess in apnea incidence in preterms, even in the absence of information about chronologic age. Many studies appeared to be confounded by the inclusion of impaired infants with neuromuscular disorders. CONCLUSIONS: Based on the available data, precisely quantifying the risk of apnea attributable to RSV infection is not possible. Factors intrinsic to the individual infants may account for a significant percentage of the apnea attributed to RSV. Recent studies have found a < 1% incidence of apnea with RSV in previously healthy term infants.
Asunto(s)
Apnea/epidemiología , Bronquiolitis Viral/epidemiología , Recien Nacido Prematuro , Infecciones por Virus Sincitial Respiratorio/epidemiología , Apnea/diagnóstico , Apnea/terapia , Bronquiolitis Viral/diagnóstico , Bronquiolitis Viral/terapia , Estudios de Cohortes , Terapia Combinada , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/terapia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To compare the efficacy and safety of bubble continuous positive airway pressure (CPAP) and Infant Flow Driver (IFD) CPAP for the post-extubation management of preterm infants with respiratory distress syndrome (RDS). STUDY DESIGN: A total of 140 preterm infants at 24 to 29 weeks' gestation or with a birth weight of 600 to 1500 g who were ventilated at birth for RDS were randomized to receive either IFD CPAP (a variable-flow device) or bubble CPAP (a continuous-flow device). A standardized protocol was used for extubation and CPAP. No crossover was allowed. The primary outcome was successful extubation maintained for at least 72 hours. Secondary outcomes included successful extubation maintained for 7 days, total duration of CPAP support, chronic lung disease, and complications of prematurity. RESULTS: Seventy-one infants were randomized to bubble CPAP, and 69 were randomized to IFD CPAP. Mean gestational age and birth weight were similar in the 2 groups, as were the proportions of infants who achieved successful extubation for 72 hours and for 7 days. However, the median duration of CPAP support was 50% shorter in the infants on bubble CPAP. Moreover, in the subset of infants who were ventilated for less than 14 days, the infants on bubble CPAP had a significantly lower extubation failure rate. There was no difference in the incidence of chronic lung disease or other complications between the 2 study groups. CONCLUSIONS: Bubble CPAP is as effective as IFD CPAP in the post-extubation management of infants with RDS; however, in infants ventilated for < or = 14 days, bubble CPAP is associated with a significantly higher rate of successful extubation. Bubble CPAP also is associated with a significantly reduced duration of CPAP support.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/instrumentación , Presión de las Vías Aéreas Positiva Contínua/métodos , Recien Nacido Prematuro , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Acidosis Respiratoria/epidemiología , Apnea/epidemiología , Enfermedad Crónica , Enterocolitis Necrotizante/mortalidad , Femenino , Humanos , Recién Nacido , Enfermedades Pulmonares/epidemiología , Masculino , Estudios Prospectivos , Retratamiento , Sepsis/epidemiología , Factores de Tiempo , Desconexión del VentiladorRESUMEN
OBJECTIVE: To determine the population-based inpatient disease burden of parainfluenza virus in children <5 years of age. STUDY DESIGN: The New Vaccine Surveillance Network (NVSN) enrolled children <5 years of age who were hospitalized with febrile or acute respiratory illnesses. Surveillance hospitals admitted >95% of all hospitalized children from each county. Combined nasal turbinate/throat swabs were tested for parainfluenza virus (PIV), respiratory syncytial virus, and influenza virus with culture and reverse-transcription-polymerase chain reaction. Both parental interviews and medical chart reviews were conducted. Age-specific population-based hospitalization rates were calculated. RESULTS: From October 2000 through September 2004, 2798 children were enrolled. A total of 191 PIVs were identified from 189 children (6.8% of enrolled: 73 PIV type 1, 23 PIV type 2, and 95 PIV type 3), compared with 521 respiratory syncytial viruses and 159 influenza viruses. Mean PIV hospitalization rates were 3.01, 1.73, 1.53, 0.39, and 1.02 per 1000 children per year for ages 0 to 5 months, 6 to 11 months, 12 to 23 months, 24 to 59 months, and 0 to 59 months, respectively. CONCLUSIONS: PIV accounted for 6.8% of all hospitalizations for fever, acute respiratory illnesses, or both in children <5 years of age. The pediatric PIV inpatient burden is substantial and highlights the need to find an effective vaccine candidate.
Asunto(s)
Crup/epidemiología , Hospitalización/estadística & datos numéricos , Vigilancia de la Población , Infecciones por Respirovirus/epidemiología , Enfermedad Aguda , Apnea/epidemiología , Apnea/virología , Asma/epidemiología , Bronquiolitis/epidemiología , Bronquiolitis/virología , Preescolar , Femenino , Fiebre/virología , Humanos , Lactante , Recién Nacido , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Paramyxovirinae/aislamiento & purificación , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Estaciones del Año , Sepsis/epidemiología , Sepsis/virología , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To determine whether known risk factors for cardiorespiratory illnesses will help identify infants who could experience extreme events during an admission for an apparent life-threatening event (ALTE) or later at home. STUDY DESIGN: Retrospective cohort study of all patients admitted for ALTE between 1996 and 2006. Extreme events included central apnea >30 seconds, bradycardia >10 seconds, and desaturation >10 seconds at hemoglobin-oxygen saturation value with pulse oximetry <80%. RESULTS: Of the 625 patients included in the study, 46 (7.4%) had extreme cardiorespiratory events recorded, usually within 24 hours of hospital admission. The most frequent diagnosis was upper respiratory tract infection (URTI, 30 infants). These factors increased the likelihood of having extreme events (P < .0001): post-conceptional age <43 weeks (5.2-fold increase), premature birth (6.3-fold), and URTI symptoms (11.2-fold). The most frequent events were extreme desaturations (43/46 infants), preceded by a central apnea. Seven infants had extreme events recorded later during home monitoring (4 with URTI); all 7 infants had sustained extreme events in the hospital. CONCLUSION: Extreme events were identified mostly in association with symptoms of URTIs, in infants born prematurely, and in infants <43 weeks post-conceptional age. Monitoring with a pulse oximeter should identify infants who sustain these events.
Asunto(s)
Obstrucción de las Vías Aéreas/epidemiología , Apnea/epidemiología , Cianosis/epidemiología , Obstrucción de las Vías Aéreas/diagnóstico , Apnea/diagnóstico , Canadá/epidemiología , Estudios de Cohortes , Comorbilidad , Cianosis/diagnóstico , Femenino , Edad Gestacional , Hospitalización/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro , Pacientes Internos/estadística & datos numéricos , Masculino , Monitoreo Fisiológico , Oximetría , Infecciones del Sistema Respiratorio/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores SexualesRESUMEN
We evaluated the tolerance to immunization of 64 very low birth weight preterm infants. Thirty-three of the infants experienced a cardiorespiratory event after the first vaccination, and 6 of these 33 (18%) had a recurrence after the second vaccination, including 2 infants previously discharged to home. A cardiorespiratory event associated with the first vaccination was the sole risk factor for recurrence identified.
Asunto(s)
Apnea/epidemiología , Bradicardia/inducido químicamente , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/efectos adversos , Inmunización/métodos , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Apnea/inducido químicamente , Bradicardia/epidemiología , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Humanos , Incidencia , Lactante , Recién Nacido , Pronóstico , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Suiza/epidemiologíaRESUMEN
BACKGROUND AND OBJECTIVES: Benefits of adopting restrictive guidelines for erythrocyte transfusions are still controversial. The objective of this study was to verify if a very strict guideline could reduce erythrocyte transfusions in preterm infants without adverse outcomes. MATERIALS AND METHODS: Two prospective cohorts of neonates with gestational age < 37 weeks and birth weight < 1500 g were studied. Neonates born in Period 1 were submitted to a strict guideline for erythrocyte transfusions. In Period 2, a new stricter protocol was introduced. Infants of both periods were compared regarding number of transfusions and clinical outcome. RESULTS: The median number of transfusions decreased from 2 (1 to 14) in Period 1 to 1 (1-9), P = 0.001, in Period 2. The linear regression multivariate analysis showed that the implementation of the stricter guideline was associated with a reduction in the number of transfusions received by patients by 0.55 (95% confidence interval: -0.08; -1.02) units/patients. Number of apnea episodes, weight at 28 days of life and days of hospital stay were similar in both periods. Intra-hospital death was lower in Period 2. CONCLUSION: A very strict guideline reduced the number of erythrocyte transfusions in preterm infants, without threatening their clinical course.
Asunto(s)
Transfusión de Eritrocitos/estadística & datos numéricos , Adhesión a Directriz , Enfermedades del Prematuro/terapia , Guías de Práctica Clínica como Asunto , Apnea/epidemiología , Hemorragia Cerebral/epidemiología , Estudios de Cohortes , Transfusión de Eritrocitos/normas , Femenino , Edad Gestacional , Hematócrito , Mortalidad Hospitalaria , Humanos , Hipoxia/epidemiología , Hipoxia/prevención & control , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/prevención & control , Recién Nacido Pequeño para la Edad Gestacional , Recién Nacido de muy Bajo Peso , Tiempo de Internación/estadística & datos numéricos , Masculino , Flebotomía/efectos adversos , Respiración con Presión Positiva/estadística & datos numéricos , Estudios ProspectivosRESUMEN
Background: An Apparent Life-Threatening Event (ALTE) is an important challenge for the pediatrician, which requires guidelines for finding the etiology and making appropriate clinical decisions. Objective: To describe etiologies and clinical features of ALTE in infants, as determined by a standarized protocol. Methods: A prospective study including infants admitted to the Emergency Room and hospitalized due to an ALTE between May 2002 and May 2005. They were evaluated with an established protocol that considers the episode description, clinical history, and complementary laboratory studies. Results: 109 patients with ALTE and a mean age of 11 weeks had the following symptoms: apnea (100 percent), skin color changes (97 percent), and muscle tone changes (83 percent). 96 percent received CPR maneuvers or strong stimulation maneuvers for ending the episode. Fourteen percent of the cases were idiopathic, while other etiologies included respiratory infections (46 percent), gastroesophageal reflux (16 percent), seizures (6 percent), and urinary tract infections (6 percent). 3 patients expired. Conclusions: With this protocol, based on tools available in most public tertiary hospitals in Chile, we can identify the causes of ALTE similar to those reported in other studies, howeber with a lesser percentage of idiopathic episodes.
Introducción: Un Evento de Aparente Amenaza a la Vida (ALTE) plantea un importante desafío al pediatra, quién debe investigar la etiología para orientar su conducta. Esta labor se facilita con la aplicación de una guía. Objetivo: Describir la presentación clínica y determinar posibles causas de ALTE mediante un protocolo especifico. Pacientes y Método: Estudio prospectivo en lactantes que consultaron en un Servicio de Urgencia y se hospitalizaron por ALTE entre Mayo 2002 a Mayo 2005. Se evaluaron con un protocolo preestablecido considerando la descripción del episodio, antecedentes y estudios complementarios por pasos. Resultados: En 109 pacientes con ALTE, edad promedio 11 semanas, se observó apnea en 100 por ciento y cambio de color en 97 por ciento. El 83 por ciento presentó cambio de tono y en el 96 por ciento se utilizaron maniobras para abortar el episodio. Se consideró idiopático el 14 por ciento de los casos. Las principales causas atribuidas fueron: infecciones respiratorias (46 por ciento), reflujo gastroesofágico (16 por ciento), convulsiones (6 por ciento) e infecciones urinarias (6 por ciento). Fallecieron 3 pacientes. Conclusiones: Mediante este protocolo, que utiliza herramientas disponibles en la mayoría de los hospitales públicos terciarios de nuestro país, se atribuyeron causas similares a las reportadas en otros estudios prospectivos, donde destaca un menor porcentaje de episodios idiopáticos.