RESUMO
Shortly after being weaned off the respirator, 43 infants with severe chronic bronchopulmonary dysplasia (BPD) were transferred from an intensive-care nursery at a teaching hospital to an affiliated children's rehabilitation hospital in a program that included special staff instruction. Morbidity, measured by rate of transfer back to the acute-care hospital, was lower than in a comparison group of 15 infants treated for severe BPD during the previous two years. Average length of stay was significantly shortened and an average of $60,000 per patient was saved. Using a rehabilitation hospital as a step-down unit shifts the emphasis from acute needs to chronic and developmental needs and from intensive monitoring and nursing care to care given at home by parents with nursing assistance.
Assuntos
Displasia Broncopulmonar/reabilitação , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Displasia Broncopulmonar/economia , Displasia Broncopulmonar/epidemiologia , Doença Crônica , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Morbidade , Philadelphia , Assistência Progressiva ao PacienteRESUMO
Serial ultrasound imaging of the brain was used to determine the ventricular index (VI), and the ratio (VR) of the VI to the cranial hemidiameter during the nursery course and first year post-term in preterm infants of less than 33 weeks gestation. Twenty-nine of the infant survivors with no intracranial hemorrhage or major medical complication during their nursery course composed group 1. Twenty-two survivors with intracranial hemorrhage unassociated with early ventricular dilation composed group 2. Group 3 was comprised of 10 other survivors who had neonatal intraventricular hemorrhage with early ventriculomegaly; all 10 infants had at least one major medical complication during their neonatal course. In groups 1 and 2 the VR decreased and the VI increased significantly with age post-conception. Infants in group 3, compared with those in groups 1 or 2, had decreased occipitofrontal growth during the early postnatal period and increased VR and VI during the neonatal period and first year post-term. These results suggest that the ventriculomegaly associated with neonatal intracranial hemorrhage cannot be explained by posthemorrhagic hydrocephalus alone and may also be related to cerebral atrophy or decreased brain growth or both. Neurodevelopmental assessments at 20 to 30 months of age disclosed significantly lower Bayley Motor Development scores in group 3 compared with groups 1 or 2. Four infants in group 3, but none in groups 1 or 2, had cerebral palsy. The neurodevelopmental deficits in group 3 infants may reflect the complex pathogenesis of the ventriculomegaly as well as the effects of the intraventricular hemorrhage and posthemorrhagic hydrocephalus.
Assuntos
Hemorragia Cerebral/diagnóstico , Ventrículos Cerebrais/fisiopatologia , Recém-Nascido Prematuro , Ultrassonografia , Cefalometria , Hemorragia Cerebral/fisiopatologia , Ventrículos Cerebrais/patologia , Desenvolvimento Infantil/fisiologia , Dilatação Patológica , Crescimento , Humanos , Hidrocefalia/patologia , Hidrocefalia/fisiopatologia , Recém-Nascido , Estudos Longitudinais , Fatores de TempoRESUMO
Serial ultrasound studies of cerebral ventricular size were obtained in 40 small preterm infants, 26 of whom were believed to be at risk for intracranial hemorrhage or hydrocephalus secondary to ICH or both. Hydrocephalus was diagnosed by ultrasound study in 12 of the high-risk infants, eight of whom required a surgical shunt procedure because of progressive ventricular enlargement. Serial ultrasound studies in the other 28 infants, including the 14 believed to be at low risk for ICH, disclosed normal ventricular size, defined as a ratio of lateral ventricular width to intracranial hemidiameter of less than 35%. The ultrasound methods utilized a portable A-mode echoscope that permitted unidimensional intracranial measurements at the infants' bedside, and a nonportable automated B-scanner that produced two-dimensional gray-scale images of the brain. The serial ultrasound measurements and images proved clinically useful in the initial detection of hydrocephalus and subsequent evaluation of the infant subjects.