RESUMO
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.
Assuntos
Apneia , Bradicardia , Hipóxia , Lactente Extremamente Prematuro , Sepse , Humanos , Bradicardia/epidemiologia , Bradicardia/etiologia , Apneia/epidemiologia , Estudos Retrospectivos , Recém-Nascido , Hipóxia/complicações , Feminino , Masculino , Sepse/complicações , Sepse/epidemiologia , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/diagnóstico , Respiração Artificial , Unidades de Terapia Intensiva Neonatal , Idade GestacionalRESUMO
OBJECTIVES: To compare the number of intermittent hypoxia events before and after packed red blood cell (pRBC) and non-pRBC transfusions in very low birth weight infants, and to compare the time spent with saturations of ≤85% before and after transfusions in the same population. STUDY DESIGN: This prospective observational study was conducted from April 2014 to August 2017. It included 92 transfusions (81 pRBC, 11 non-pRBC) from 41 very low birth weight infants between 230/7 and 286/7 weeks of gestation. The primary outcome was number of intermittent hypoxia events. Secondary outcomes included the percent time of Peripheral capillary oxygen saturation (SpO2)of ≤85%, ≤80%, and ≤75%. A mixed ANOVA model was used to examine the relationship between event rate and covariates. RESULTS: The mean number of intermittent hypoxia events per hour decreased from 5.27 ± 5.02 events per hour before pRBC transfusion to 3.61 ± 3.17 per hour after pRBC transfusions (P < .01) and intermittent hypoxia did not change after non-RBC transfusions (before, 4.45 ± 3.19 vs after, 4.47 ± 2.78; P = NS). The percent time with saturations of ≤80% and ≤75% significantly decreased after pRBC transfusions (P = .01). The time with saturations of ≤85% did not significantly change after non-pRBC transfusion. CONCLUSIONS: In very low birth weight infants with a hematocrit of 20%-42%, pRBC transfusions are associated with decreased frequency of intermittent hypoxia. No such diminution of intermittent hypoxia events was observed in infants who had received a non-pRBC transfusion. This finding suggests that the observed beneficial effects of RBC transfusions on apnea and its clinical manifestations of intermittent hypoxia are mediated through an enhanced oxygen carrying capacity.
Assuntos
Transfusão de Eritrócitos , Hipóxia/prevenção & controle , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Estudos ProspectivosRESUMO
OBJECTIVE: To characterize actual achieved patterns of oxygenation in infants born appropriate vs small for gestational age (SGA) randomized to a lower (85-89%) vs higher (91%-95%) oxygen saturation target in the Surfactant Positive Pressure and Oxygen Trial. To determine the association between achieved oxygen saturation levels and survival in infants born appropriate vs SGA enrolled in the Surfactant Positive Pressure and Oxygen Trial. STUDY DESIGN: Median oxygen saturation and intermittent hypoxemia events (<80%, 20 seconds-5 minutes) were documented in 1054 infants of 240/7-276/7 weeks of gestation while receiving supplemental oxygen during the first 3 days of life. RESULTS: Lower target infants who were small for gestational age had the lowest oxygen saturation and highest incidence of intermittent hypoxemia during the first 3 days of life. The lowest quartile of oxygen saturation (≤92%) during the first 3 days of life was associated with lower 90-day survival for both infants born appropriate and SGA. An increased incidence of intermittent hypoxemia events during the first 3 days of life was associated with lower 90-day survival only in infants born SGA. CONCLUSION: Lower achieved oxygen saturation during the first 3 days of life was associated with lower 90-day survival in extremely preterm infants. Infants born SGA had enhanced vulnerability to lower oxygen saturation targets as evidenced by lower achieved oxygen saturation and an association between increased intermittent hypoxemia events and lower survival. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00233324.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Hipóxia/terapia , Doenças do Prematuro/metabolismo , Doenças do Prematuro/terapia , Oxigenoterapia , Surfactantes Pulmonares/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Hipóxia/metabolismo , Hipóxia/mortalidade , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/mortalidade , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Taxa de SobrevidaRESUMO
BACKGROUND: Patients with refractory asthma frequently have elements of laryngopharyngeal reflux (LPR) with potential aspiration contributing to their poor control. We previously reported on a supraglottic index (SGI) scoring system that helps in the evaluation of LPR with potential aspiration. However, to further the usefulness of this SGI scoring system for bronchoscopists, a teaching system was developed that included both interobserver and intraobserver reproducibility. METHODS: Five pulmonologists with expertise in fiber-optic bronchoscopy but novice to the SGI participated. A training system was developed that could be used via Internet interaction to make this learning technique widely available. RESULTS: By the final testing, there was excellent interreader agreement (κ of at least 0.81), thus documenting reproducibility in scoring the SGI. For the measure of intrareader consistency, one reader was arbitrarily selected to rescore the final test 4 weeks later and had a κ value of 0.93, with a 95% CI of 0.79 to 1.00. CONCLUSIONS: In this study, we demonstrate that with an organized educational approach, bronchoscopists can develop skills to have highly reproducible assessment and scoring of supraglottic abnormalities. The SGI can be used to determine which patients need additional intervention to determine causes of LPR and gastroesophageal reflux. Identification of this problem in patients with refractory asthma allows for personal, individual directed therapy to improve asthma control.
Assuntos
Asma , Broncoscopia , Refluxo Gastroesofágico/diagnóstico , Refluxo Laringofaríngeo/diagnóstico , Asma/diagnóstico , Asma/etiologia , Asma/fisiopatologia , Broncoscopia/educação , Broncoscopia/métodos , Refluxo Gastroesofágico/complicações , Humanos , Refluxo Laringofaríngeo/complicações , Reprodutibilidade dos Testes , Projetos de Pesquisa , Aspiração Respiratória/etiologia , Aspiração Respiratória/fisiopatologia , Índice de Gravidade de Doença , Avaliação de Sintomas/métodos , EnsinoRESUMO
OBJECTIVE: To test the hypothesis that preterm infants randomized to a low vs high O(2) saturation target range have a higher incidence of intermittent hypoxemia. STUDY DESIGN: A subcohort of 115 preterm infants with high resolution pulse oximetry enrolled in the Surfactant, Positive Pressure, and Oxygenation Randomized Trial were randomized to low (85%-89%) or high (91%-95%) O(2) saturation target ranges. Oxygen saturation was monitored until 36 weeks postmenstrual age or until the infant was breathing room air without respiratory support for ≥72 hours. RESULTS: The low target O(2) saturation group had a higher rate of intermittent hypoxemia (≤80% for ≥10 seconds and ≤3 minutes) prior to 12 days and beyond 57 days of life (P < .05). The duration shortened (P < .0001) and the severity increased (P < .0001) with increasing postnatal age with no differences between target saturation groups. The higher rate of intermittent hypoxemia events in the low target group was associated with a time interval between events of <1 minute. CONCLUSION: A low O(2) saturation target was associated with an increased rate of intermittent hypoxemia events that was dependent on postnatal age. The duration and severity of events was comparable between target groups. Further investigation is needed to assess the role of intermittent hypoxemia and their timing on neonatal morbidity.
Assuntos
Hipóxia/etiologia , Doenças do Prematuro/etiologia , Oxigênio/sangue , Respiração Artificial/efeitos adversos , Fatores Etários , Feminino , Humanos , Hipóxia/sangue , Hipóxia/epidemiologia , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/sangue , Doenças do Prematuro/epidemiologia , Masculino , Modelos Estatísticos , Monitorização Fisiológica , Oximetria , Estudos Prospectivos , Análise de Regressão , Respiração Artificial/métodos , Índice de Gravidade de Doença , Método Simples-CegoRESUMO
BACKGROUND: The pathophysiology of refractory asthma is not well understood; thus, treatment modalities are not targeted to specific phenotypes but rather to a broad-based treatment approach. The objective of this study was to develop refractory asthma phenotypes based on bronchoscopic evaluation and to develop from this information specific, directed, personalized therapy. METHODS: Fifty-eight patients with difficult-to-treat (refractory) asthma were characterized by the use of fiber-optic bronchoscopy with visual scoring systems of the upper and lower airways as well as with BAL, endobronchial biopsy, and brush. Response to changes in therapy was evaluated by changes in the Asthma Control Test and pulmonary function. RESULTS: Five mutually exclusive phenotypes were formulated based on bronchoscopic evaluation: gastroesophageal reflux, subacute bacterial infection, tissue eosinophilia, combination, and nonspecific. Specific directed therapy yielded a significant improvement in the Asthma Control Test and pulmonary function for the entire group as well as for each defined subgroup except for the nonspecific group. Of interest, visual scoring of the supraglottic abnormalities identified 34 of 35 patients with gastroesophageal reflux and may give a better insight into asthmatic problems associated with chronic proximal reflux than standard testing. CONCLUSIONS: Bronchoscopic evaluation of the upper and lower airways can provide important information toward characterizing refractory asthma so as to better individualize therapeutic options and improve asthma control and lung function in patients with difficult-to-treat asthma.
Assuntos
Asma/tratamento farmacológico , Asma/patologia , Broncoscopia/métodos , Fenótipo , Adulto , Idoso , Asma/etiologia , Infecções Bacterianas/complicações , Infecções Bacterianas/diagnóstico , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Medicina de Precisão , Eosinofilia Pulmonar/complicações , Eosinofilia Pulmonar/diagnóstico , Testes de Função RespiratóriaRESUMO
OBJECTIVE: Retinopathy of prematurity (ROP), a vasoproliferative disorder of the retina in preterm infants, is associated with multiple factors, including oxygenation level. We explored whether the common intermittent hypoxemic events in preterm infants are associated with the development of ROP. STUDY DESIGN: Oxygen desaturation events were quantified in 79 preterm infants (gestational age, 24 to 27-6/7 weeks) during the first 8 weeks of life. Infants were classified as requiring laser treatment for ROP versus having less severe or no ROP. A linear mixed model was used to study the association between the incidence of intermittent hypoxia and laser treatment of ROP, controlling for gestational age, sex, race, multiple births, and initial severity of illness. RESULTS: For all infants, hypoxemic events increased with postnatal age (P<.001). Controlling for all covariates, a higher incidence of oxygen desaturation events was found in the infants undergoing laser therapy for ROP (P<.001), males (P<.02), and infants of younger gestational age (P<.003). CONCLUSIONS: The incidence of hypoxemic events was higher in infants with ROP requiring laser therapy. Therapeutic strategies to optimize oxygenation in preterm infants should include minimization of desaturation episodes, which may in turn decrease serious morbidity in this high-risk population.
Assuntos
Hipóxia/complicações , Terapia a Laser , Oxigênio/metabolismo , Retinopatia da Prematuridade/epidemiologia , Fatores Etários , Feminino , Idade Gestacional , Humanos , Hipóxia/epidemiologia , Hipóxia/metabolismo , Hipóxia/fisiopatologia , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Modelos Lineares , Masculino , Ohio/epidemiologia , Oxigênio/administração & dosagem , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/cirurgia , Fatores de Risco , Índice de Gravidade de Doença , Fatores SexuaisRESUMO
OBJECTIVE: In a randomized multi-center trial, we demonstrated that inhaled nitric oxide begun between 7 and 21 days and given for 24 days significantly increased survival without bronchopulmonary dysplasia (BPD) in ventilated premature infants weighing <1250 g. Because some preventative BPD treatments are associated with neurodevelopmental impairment, we designed a follow-up study to assess the safety of nitric oxide. STUDY DESIGN: Our hypothesis was that inhaled nitric oxide would not increase neurodevelopmental impairment compared with placebo. We prospectively evaluated neurodevelopmental and growth outcomes at 24 months postmenstrual age in 477 of 535 surviving infants (89%) enrolled in the trial. RESULTS: In the treated group, 109 of 243 children (45%) had neurodevelopmental impairment (moderate or severe cerebral palsy, bilateral blindness, bilateral hearing loss, or score <70 on the Bayley Scales II), compared with 114 of 234 (49%) in the placebo group (relative risk, 0.92; 95% CI, 0.75-1.12; P = .39). No differences on any subcomponent of neurodevelopmental impairment or growth variables were found between inhaled nitric oxide or placebo. CONCLUSIONS: Inhaled nitric oxide improved survival free of BPD, with no adverse neurodevelopmental effects at 2 years of age.
Assuntos
Displasia Broncopulmonar/prevenção & controle , Deficiências do Desenvolvimento/prevenção & controle , Sequestradores de Radicais Livres/administração & dosagem , Recém-Nascido Prematuro , Óxido Nítrico/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Administração por Inalação , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/etiologia , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/etiologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To identify whether inhaled nitric oxide treatment decreased indicators of long-term pulmonary morbidities after discharge from the neonatal intensive care unit. STUDY DESIGN: The Nitric Oxide (to Prevent) Chronic Lung Disease trial enrolled preterm infants (<1250 g) between 7 to 21 days of age who were ventilated and at high risk for bronchopulmonary dysplasia. Follow-up occurred at 12 +/- 3 months of age adjusted for prematurity; long-term pulmonary morbidity and other outcomes were reported by parents during structured blinded interviews. RESULTS: A total of 456 infants (85%) were seen at 1 year. Compared with control infants, infants randomized to inhaled nitric oxide received significantly less bronchodilators (odds ratio [OR] 0.53 [95% confidence interval 0.36-0.78]), inhaled steroids (OR 0.50 [0.32-0.77]), systemic steroids (OR 0.56 [0.32-0.97]), diuretics (OR 0.54 [0.34-0.85]), and supplemental oxygen (OR 0.65 [0.44-0.95]) after discharge from the neonatal intensive care unit. There were no significant differences between parental report of rehospitalizations (OR 0.83 [0.57-1.21]) or wheezing or whistling in the chest (OR 0.70 [0.48-1.03]). CONCLUSIONS: Infants treated with inhaled nitric oxide received fewer outpatient respiratory medications than the control group. However, any decision to institute routine use of this dosing regimen should also take into account the results of the 24-month neurodevelopmental assessment.
Assuntos
Pneumopatias/epidemiologia , Pneumopatias/prevenção & controle , Óxido Nítrico/administração & dosagem , Administração por Inalação , Doença Crônica , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Pneumopatias/tratamento farmacológico , Readmissão do Paciente/estatística & dados numéricos , Sons Respiratórios , Resultado do TratamentoAssuntos
Refluxo Gastroesofágico/terapia , Doenças do Prematuro/terapia , Postura , Impedância Elétrica , Esôfago/fisiologia , Refluxo Gastroesofágico/fisiopatologia , Humanos , Concentração de Íons de Hidrogênio , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/fisiopatologia , Monitorização Fisiológica/métodos , Período Pós-PrandialRESUMO
OBJECTIVE: To determine if infants with cardiorespiratory events detected by home memory monitoring during early infancy have decreased neurodevelopmental performance. STUDY DESIGN: Infants (n = 256) enrolled in the Collaborative Home Infant Monitoring Evaluation also completed the Bayley Scales of Infant Development II at 92 weeks' postconceptional age. Infants were classified as having 0, 1 to 4, or 5+ cardiorespiratory events. Events were defined as apnea >or=20 seconds or heart rate <60 to 80 bpm or <50 to 60 bpm, for >or=5 to 15 seconds, depending on age. RESULTS: For term infants, having 0, 1 to 4, and 5+ cardiorespiratory events was associated with unadjusted mean Mental Developmental Index (MDI) values (+/-SD) of 103.6 (10.6), 104.2 (10.7), and 97.7 (10.9), respectively, and mean Psychomotor Developmental Index (PDI) values of 109.5 (16.6), 105.8 (16.5), and 100.2 (17.4). For preterm infants, having 0, 1 to 4, and 5+ cardiorespiratory events was associated with unadjusted mean MDI values of 100.4 (10.3), 96.8 (11.5), and 95.8 (10.6), respectively, and mean PDI values of 91.7 (19.2), 93.8 (15.5), and 94.4 (17.7). The adjusted difference in mean MDI scores with 5+ events compared with 0 events was 5.6 points lower in term infants ( P = .03) and 4.9 points lower in preterm infants ( P = .04). CONCLUSIONS: Having 5+ conventional events is associated with lower adjusted mean differences in MDI in term and preterm infants.
Assuntos
Apneia/fisiopatologia , Apneia/psicologia , Bradicardia/fisiopatologia , Bradicardia/psicologia , Desenvolvimento Infantil/fisiologia , Processos Mentais/fisiologia , Apneia/diagnóstico , Bradicardia/diagnóstico , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Monitorização Fisiológica , Testes Neuropsicológicos , Oximetria , Desempenho Psicomotor/fisiologiaRESUMO
OBJECTIVE: Correlate the ventilatory response of preterm infants to hypoxic exposure with incidence of neonatal apnea. Study design Seventeen stable convalescing premature infants underwent bedside cardiorespiratory monitoring of respiration using respiratory inductance plethysmography, heart rate, and oxygen saturation (SaO(2)) for a 12-hour period. These studies were scored for number of apneas > or =15 and > or =20 seconds. Infants then underwent a 3-minute hypoxic exposure. Minute ventilation (V(E)) was calculated for 30-second epochs from the time inspired oxygen reached 15%. Linear regression analysis was used to correlate the change in V(E) normalized for decrease in SaO(2) (DeltaV(E)/DeltaSaO(2)) during the first and third minutes of hypoxic exposure with the number of apneic episodes during the 12-hour study. RESULTS: The majority of infants exhibited an anticipated biphasic ventilatory response to hypoxia. There was a significant positive correlation between DeltaV(E)/DeltaSaO(2) during the first and third minutes of hypoxic exposure and number of apneic episodes > or =15 and > or =20 seconds during the preceding 12 hours. CONCLUSIONS: Preterm infants with a greater number of apneic episodes exhibit an increased ventilatory response to hypoxic exposure, suggesting that apnea of prematurity may be associated with enhanced peripheral chemoreceptor activity.
Assuntos
Apneia/fisiopatologia , Hipóxia/fisiopatologia , Recém-Nascido Prematuro , Respiração , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Masculino , PletismografiaRESUMO
OBJECTIVES: The role of in utero and perinatal exposures in modifying asthma risk among children born prematurely was assessed. Study design Former preterm children (n=251) were identified from a birth cohort. Examinations, including lung function testing, were performed at ages 8 to 11 years. Perinatal exposures were ascertained from neonatal medical records. RESULTS: Univariate predictors of asthma included male gender, African American ethnicity, maternal asthma, and birth weight. Asthmatics were less likely to have been small for gestational age (SGA) than nonasthmatics (12.4% vs 22.7%, P=.04) and had more neonatal pulmonary disease. After adjusting for maternal asthma and demographic factors, asthma was associated with chronic lung disease of infancy, neonatal mechanical ventilation and corticosteroid use, and a higher childhood body mass index. Children who were septic postbirth and girls who were SGA were less likely to have asthma (OR for sepsis, 0.2; 95% CI, 0.1-0.6; OR for girls who were SGA compared with girls who were not SGA, 0.05; CI, 0.01-0.34). CONCLUSIONS: Among premature children, female SGA status and neonatal sepsis appear protective relative to the development of childhood asthma. Differential susceptibility to asthma among preterm children may relate to exposures that operate in the in utero and early postnatal environment to accelerate lung development, alter innate immunity, or both.
Assuntos
Asma/epidemiologia , Asma/fisiopatologia , Índice de Massa Corporal , Criança , Estudos de Coortes , Feminino , Glucocorticoides/uso terapêutico , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Prevalência , Respiração Artificial , Fatores de RiscoRESUMO
OBJECTIVE: Exhaled nitric oxide (FE(NO)) was evaluated in children with asthma after 4 to 6 years of treatment with budesonide, nedocromil, or albuterol as needed. STUDY DESIGN: FE(NO), spirometry, total eosinophil count, and serum eosinophil cationic protein levels were obtained from 118 children at the Denver site of the Childhood Asthma Management Program upon completion of treatment and after a 2- to 4-month washout. RESULTS: Budesonide-treated patients had significantly lower median (1st, 3rd quartile) FE(NO) (21.5 [13.2, 84.4] vs 62.5 [26.2, 115.0] ppb, P <.01) and eosinophil cationic protein levels (17.4 [10.1, 24.3] vs 24.0 [15.4, 33.9] mg/dL, P =.05) compared with placebo, whereas no differences were noted between nedocromil and placebo groups. After washout, FE(NO) levels were similar between the three treatments. FE(NO) levels significantly correlated with degree of bronchial hyperresponsiveness, bronchodilator reversibility, allergen skin prick tests, serum IgE, and total eosinophil count. FE(NO) levels were also higher in patients with nocturnal symptoms and in patients requiring beta-agonist use at least once weekly. CONCLUSIONS: Budesonide therapy was more effective than nedocromil in reducing FE(NO). Unfortunately, the effects of long-term budesonide were not sustained after its discontinuation. FE(NO) may be a complementary tool to current practice guidelines in assessing asthma control and medication response.
Assuntos
Antiasmáticos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Asma/tratamento farmacológico , Asma/metabolismo , Budesonida/uso terapêutico , Volume Expiratório Forçado/efeitos dos fármacos , Nedocromil/uso terapêutico , Óxido Nítrico/metabolismo , Respiração , Ribonucleases , Antiasmáticos/farmacologia , Anti-Inflamatórios/farmacologia , Asma/diagnóstico , Proteínas Sanguíneas/metabolismo , Broncoconstritores , Budesonida/farmacologia , Criança , Pré-Escolar , Estudos de Coortes , Proteínas Granulares de Eosinófilos , Eosinófilos , Feminino , Humanos , Hipersensibilidade/complicações , Hipersensibilidade/diagnóstico , Imunoglobulina E/sangue , Contagem de Leucócitos , Masculino , Cloreto de Metacolina , Nedocromil/farmacologia , Testes de Função Respiratória , Índice de Gravidade de Doença , Testes Cutâneos , Espirometria/métodos , Estatísticas não ParamétricasRESUMO
OBJECTIVES: To evaluate the extent to which sleep-disordered breathing (SDB) varies with putative demographic and medical risk factors and to estimate the prevalence of undiagnosed SDB. STUDY DESIGN: Prospective, cross-sectional study in a population-based cohort of 850 children (41% black, 46% preterm), 8 to 11 years of age. Participants' caretakers completed questionnaires about health and sleep. Children underwent overnight in-home cardiorespiratory recordings of airflow, respiratory effort, oximetry, and electrocardiography. SDB was identified by respiratory disturbance indices commonly applied in clinical practice. Risk factors were estimated by logistic regression. Prevalence was derived from cohort-specific estimates with birth weights from US live births data. RESULTS: Using the most inclusive definition, SDB was detected in 40 (4.7%) participants, with prevalence varying widely across population subsets. Depending on the definition used, SDB was 4 to 6 times more likely in black children compared with white children and almost 3 to 5 times more likely in former preterm compared with term children. The estimated population prevalence of SDB was 2.2% (95% CI, 1.2%, 3.2%). CONCLUSIONS: SDB is a relatively common condition in 8- to 11-year-old children. Potentially vulnerable subgroups, black children, and former preterm infants, are at increased risk.
Assuntos
Recém-Nascido Prematuro , Obesidade/complicações , Obesidade/epidemiologia , Grupos Raciais/genética , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/etiologia , Sistema Cardiovascular/fisiopatologia , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Obesidade/fisiopatologia , Prevalência , Estudos Prospectivos , Sistema Respiratório/fisiopatologia , Fatores de Risco , Síndromes da Apneia do Sono/fisiopatologiaRESUMO
OBJECTIVE: To determine whether hypoxemic episodes in ventilated extremely-low-birth-weight infants correlate with specific behavioral states. STUDY DESIGN: Three-hour video-electroencephalography-polysomnography was performed on 13 ventilated extremely-low-birth-weight infants with mean postconceptional age of 28.3 weeks. The electroencephalogram was scored for discontinuity. Rapid eye movements, body, head, and limb movements were scored from synchronized video. Sleep states were defined from electroencephalography, rapid eye movements, and movement criteria. Nonparametric statistics were used to test for differences in the proportion of time hypoxemic (oxygen saturation
Assuntos
Hipóxia/fisiopatologia , Recém-Nascido de muito Baixo Peso , Respiração Artificial , Sono , Feminino , Humanos , Recém-Nascido , Masculino , Ohio , Polissonografia , Fases do Sono , Estatísticas não ParamétricasRESUMO
BACKGROUND: Exercise is one of the most common triggers of asthmatic symptoms. Many factors, including hyperventilation, determine the prevalence and severity of exercise-induced bronchospasm (EIB). However, the influence of time of day has not been adequately described. OBJECTIVE: We sought to compare morning and evening EIB and minute ventilation during exercise (VE). METHODS: Twenty-two patients with stable asthma and 12 control subjects underwent exercise challenge at 7 am and 6 pm. The time of the first challenge was randomly assigned; the second challenge was performed within 1 week of the first. The primary outcomes were EIB intensity (maximum fall in FEV(1)) and VE. RESULTS: The asthma group exhibited lower EIB values in the morning: 14.8% +/- 3.7% at 7 am vs 21.4% +/- 4.2% at 6 pm (P =.004)-ie, 0.37 +/- 0.09 L vs 0.53 +/- 0.10 L, respectively (P =.002). VE was higher at 7 am (55.4 +/- 4.7 L/min) than at 6 pm (52.4 +/- 4.3 L/min; P =.03). Baseline FEV(1) increased from 2.33 +/- 0.13 L (morning) to 2.49 +/- 0.15 L (evening; P =.04), and a significant correlation between baseline FEV(1) and EIB was found in the evening (r = +0.5; P =.049) but not in the morning. Post-exercise FEV(1) was similar at 7 am (1.96 +/- 0.13 L) and 6 pm (1.97 +/- 0.14 L). For the control group, no changes were detected in FEV(1) fall or VE. CONCLUSION: Baseline airway caliber contributes to the mechanisms of the morning-to-evening EIB enhancement.