RESUMO
BACKGROUND: Low selenium (SE) status has been documented in preterm infants and has been suggested to be a risk factor for chronic lung disease. METHODS: A total of 534 infants with birth weight <1500 g were enrolled in 8 New Zealand centers in a double-blind placebo-controlled randomized trial of SE supplementation from week 1 of life until 36 weeks' postmenstrual age or discharge home. Supplemented infants received 7 microg/kg/d of SE when fed parenterally and 5 microg/kg/d when fed orally. Plasma SE and glutathione peroxidase concentrations were measured in mothers after delivery and in infants before randomization and at 28 days and 36 weeks' postmenstrual age. Primary outcome measures were oxygen dependency at 28 days and total days oxygen dependency. RESULTS: No significant differences were seen between the groups with respect to primary or secondary outcome measures, with the exception that fewer supplemented infants had an episode of sepsis after the first week of life (P <.038). Mean plasma SE concentrations were 0.33 micromol/L before randomization in both groups and at 28 days had risen in the supplemented group (0.56 micromol/L) but fallen in the control group (0.29 micromol/L) (P <.0001). There was no association between outcome measures and SE concentrations at 28 days or 36 weeks' postmenstrual age. However, lower maternal and infant prerandomization SE concentrations were associated with increased respiratory morbidity. CONCLUSIONS: Postnatal SE supplementation in very low birth weight infants did not improve neonatal outcome. Further investigation of SE supplementation of mothers from the second half of pregnancy is warranted.
Assuntos
Recém-Nascido de muito Baixo Peso , Resultado da Gravidez , Selênio/administração & dosagem , Método Duplo-Cego , Feminino , Glutationa Peroxidase/sangue , Humanos , Doença da Membrana Hialina/sangue , Doença da Membrana Hialina/terapia , Lactente , Recém-Nascido , Masculino , Oxigenoterapia , Nutrição Parenteral , Gravidez , Selênio/sangue , Fatores de TempoRESUMO
OBJECTIVE: We hypothesized that a pulsed course of dexamethasone would result in better linear growth than a 42-day reducing course in preterm infants at risk for chronic lung disease of prematurity. STUDY DESIGN: Forty infants with a birth weight of < or =1,250 g who required mechanical ventilation at 7 days of age were randomly assigned to a repeatable 3-day pulse course of dexamethasone commencing immediately or a 42-day (long) course commencing at 14 days of age if they still required mechanical ventilation and supplemental oxygen. The primary outcome measure was linear growth at 36 weeks' postmenstrual age measured by knemometry. RESULTS: There was no difference in lower leg length at 36 weeks' postmenstrual age. Infants receiving the pulse course had lower rises in blood pressure, less myocardial hypertrophy, and less adrenal suppression. However, more infants required supplemental oxygen at 28 days' postnatal age (14/18 vs 8/21, P < .05) and 36 weeks' PMA (8/16 vs 5/20, P = .12). CONCLUSION: In preterm infants at risk for chronic lung disease, a pulsed course of dexamethasone has fewer side effects than a long course but may be less effective at preventing chronic lung disease.
Assuntos
Anti-Inflamatórios/efeitos adversos , Dexametasona/efeitos adversos , Glucocorticoides/efeitos adversos , Doenças do Prematuro/prevenção & controle , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Pneumopatias/prevenção & controle , Administração por Inalação , Glândulas Suprarrenais/efeitos dos fármacos , Insuficiência Adrenal/prevenção & controle , Anti-Inflamatórios/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Estatura , Cardiomegalia/prevenção & controle , Doença Crônica , Dexametasona/administração & dosagem , Esquema de Medicação , Feminino , Glucocorticoides/administração & dosagem , Humanos , Hipertensão/prevenção & controle , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Perna (Membro)/crescimento & desenvolvimento , Masculino , Oxigenoterapia , Respiração Artificial , Fatores de Risco , Resultado do TratamentoRESUMO
We retrospectively assessed atelectasis in 297 postextubation radiographs from 220 babies who underwent ventilation over a 2-year period. All 95 babies in the first year received peri-extubation chest physiotherapy; none of the 125 babies in the second year received chest physiotherapy. There was no difference in the incidence of postextubation atelectasis between the two groups.
Assuntos
Intubação Intratraqueal/efeitos adversos , Atelectasia Pulmonar/prevenção & controle , Terapia Respiratória , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
OBJECTIVES: To determine whether a characteristic form of brain damage (encephaloclastic porencephaly) was associated with chest physiotherapy treatment in preterm babies. METHODS: A retrospective case-control study was undertaken among 454 infants of birth weight less than 1500 gm cared for during the 3-year period of 1992 to 1994. Thirteen babies of 24 to 27 weeks of gestation who weighed 680 to 1090 gm at birth had encephaloclastic porencephaly. Twenty-six control subjects were matched for birth weight and gestation. RESULTS: The patients received two to three times as many treatments with chest physiotherapy in the second, third, and fourth weeks of life as did control infants (median 79 vs 19 treatments in the first 4 weeks, p < 0.001). Patients also had more prolonged and severe hypotension in the first week than did control subjects (median duration of hypotension 4 vs 0.5 days, p < 0.01), and were less likely to have a cephalic presentation (31% vs 81%, p < 0.01). Since December 1994 no very low birth weight baby has received chest physiotherapy treatment in the first month of life in our nursery, and no further cases have occurred. CONCLUSIONS: Encephaloclastic porencephaly may be a previously unrecognized complication of chest physiotherapy in vulnerable extremely preterm infants.