RESUMO
OBJECTIVE: To assess whether an oxygen saturation (Spo2) target of 85%-89% compared with 91%-95% reduced the incidence of the composite outcome of death or major disability at 2 years of age in infants born at <28 weeks' gestation. STUDY DESIGN: A total 340 infants were randomized to a lower or higher target from <24 hours of age until 36 weeks' gestational age. Blinding was achieved by targeting a displayed Spo2 of 88%-92% using a saturation monitor offset by ±3% within the range 85%-95%. True saturations were displayed outside this range. Follow-up at 2 years' corrected age was by pediatric examination and formal neurodevelopmental assessment. Major disability was gross motor disability, cognitive or language delay, severe hearing loss, or blindness. RESULTS: The primary outcome was known for 335 infants with 33 using surrogate language information. Targeting a lower compared with a higher Spo2 target range had no significant effect on the rate of death or major disability at 2 years' corrected age (65/167 [38.9%] vs 76/168 [45.2%]; relative risk 1.15, 95% CI 0.90-1.47) or any secondary outcomes. Death occurred in 25 (14.7%) and 27 (15.9%) of those randomized to the lower and higher target, respectively, and blindness in 0% and 0.7%. CONCLUSIONS: Although there was no benefit or harm from targeting a lower compared with a higher saturation in this trial, further information will become available from the prospectively planned meta-analysis of this and 4 other trials comprising a total of nearly 5000 infants.
Assuntos
Doenças do Prematuro/metabolismo , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso/metabolismo , Oxigenoterapia/métodos , Oxigênio/sangue , Austrália , Pré-Escolar , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Doenças do Prematuro/terapia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Medição de RiscoRESUMO
OBJECTIVES: To determine whether there is a relationship between electroencephalography patterns and hypoglycemia, by using simultaneous cot-side amplitude integrated electroencephalography (aEEG) and continuous interstitial glucose monitoring, and whether non-glucose cerebral fuels modified these patterns. STUDY DESIGN: Eligible babies were ≥ 32 weeks gestation, at risk for hypoglycemia, and admitted to the neonatal intensive care unit. Electrodes were placed in C3-P3, C4-P4 O1-O2 montages. A continuous interstitial glucose sensor was placed subcutaneously, and blood glucose was measured by using the glucose oxidase method. Non-glucose cerebral fuels were measured at study entry, exit, and during recognized hypoglycemia. RESULTS: A total of 101 babies were enrolled, with a median weight of 2179 g and gestation of 35 weeks. Twenty-four of the babies had aEEG recordings, and glucose concentrations were low (< 2.6 mM). There were 103 episodes of low glucose concentrations lasting 5 to 475 minutes, but no observable changes in aEEG variables. Plasma concentrations of lactate, beta-hydroxybutyrate, and glycerol were low and did not alter during hypoglycemia. CONCLUSIONS: Cot-side aEEG was not useful for the detection of neurological changes during mild hypoglycemia. Plasma concentrations of non-glucose cerebral fuels were low and unlikely to provide substantial neuroprotection.
Assuntos
Glicemia/análise , Eletroencefalografia , Hipoglicemia/diagnóstico , Monitorização Fisiológica , Sistemas Automatizados de Assistência Junto ao Leito , Ácido 3-Hidroxibutírico/sangue , Glucose Oxidase/sangue , Glicerol/sangue , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Ácido Láctico/sangue , MasculinoRESUMO
OBJECTIVE: To evaluate whether lung lavage with surfactant changes the duration of mechanical respiratory support or other outcomes in meconium aspiration syndrome (MAS). STUDY DESIGN: We conducted a randomized controlled trial that enrolled ventilated infants with MAS. Infants randomized to lavage received two 15-mL/kg aliquots of dilute bovine surfactant instilled into, and recovered from, the lung. Control subjects received standard care, which in both groups included high frequency ventilation, nitric oxide, and, where available, extracorporeal membrane oxygenation (ECMO). RESULTS: Sixty-six infants were randomized, with one ineligible infant excluded from analysis. Median duration of respiratory support was similar in infants who underwent lavage and control subjects (5.5 versus 6.0 days, P = .77). Requirement for high frequency ventilation and nitric oxide did not differ between the groups. Fewer infants who underwent lavage died or required ECMO: 10% (3/30) compared with 31% (11/35) in the control group (odds ratio, 0.24; 95% confidence interval, 0.060-0.97). Lavage transiently reduced oxygen saturation without substantial heart rate or blood pressure alterations. Mean airway pressure was more rapidly weaned in the lavage group after randomization. CONCLUSION: Lung lavage with dilute surfactant does not alter duration of respiratory support, but may reduce mortality, especially in units not offering ECMO.
Assuntos
Produtos Biológicos/administração & dosagem , Lavagem Broncoalveolar , Síndrome de Aspiração de Mecônio/terapia , Surfactantes Pulmonares/administração & dosagem , Oxigenação por Membrana Extracorpórea , Feminino , Ventilação de Alta Frequência , Humanos , Recém-Nascido , Masculino , Óxido Nítrico/uso terapêutico , Análise de Sobrevida , Fatores de TempoRESUMO
OBJECTIVE: To determine the usefulness of continuous glucose monitoring in babies at risk of neonatal hypoglycemia. STUDY DESIGN: Babies >/=32 weeks old who were at risk of hypoglycemia and admitted to newborn intensive care received routine treatment, including intermittent blood glucose measurement using the glucose oxidase method, and blinded continuous interstitial glucose monitoring. RESULTS: Continuous glucose monitoring was well tolerated in 102 infants. There was good agreement between blood and interstitial glucose concentrations (mean difference, 0.0 mmol/L; 95% CI, -1.1-1.1). Low glucose concentrations (<2.6 mmol/L) were detected in 32 babies (32%) with blood sampling and in 45 babies (44%) with continuous monitoring. There were 265 episodes of low interstitial glucose concentrations, 215 (81%) of which were not detected with blood glucose measurement. One hundred seven episodes in 34 babies lasted >30 minutes, 78 (73%) of which were not detected with blood glucose measurement. CONCLUSION: Continuous interstitial glucose monitoring detects many more episodes of low glucose concentrations than blood glucose measurement. The physiological significance of these previously undetected episodes is unknown.