Assuntos
COVID-19/terapia , Terapia Respiratória/métodos , Telemedicina , Humanos , Pandemias , SARS-CoV-2RESUMO
OBJECTIVE: To investigate whether intravenous administration of lipid nutrition (Intralipid) within 12 hours of birth to ventilator-dependent premature infants would decrease the incidence or severity, or both, of chronic lung disease. METHOD: We randomly assigned 133 infants to Intralipid or control groups, using two weight strata: 42 Intralipid versus 37 control subjects in the 600 to 800 gm stratum, and 28 Intralipid versus 26 control subjects in the 801 to 1000 gm stratum. The Intralipid group received 20% Intralipid at < 12 hours after birth, starting at a dose of 0.5 gm/kg and increasing to a maximum of 1.5 gm/kg, maintained through day 7. Control infants received no lipid until after day 7. Neither group received enteral feedings until after day 7. RESULTS: No significant differences in mortality rates were present in the total population (23/70 = 32.9% vs 16/63 = 25.4%; p = 0.35, Intralipid vs control); however, the mortality rate increased significantly in 600 to 800 gm infants receiving Intralipid versus the control infants (20/41 = 47.5% vs 9/37 = 24.3%; p = 0.032). No significant differences were found in the number of infants in whom chronic lung disease developed (requiring oxygen for > or = 28 days), proportion requiring oxygen for > or = 60 days, number of survivors without chronic lung disease, or total oxygen and ventilation requirements. However, 600 to 800 gm infants receiving Intralipid had significantly more pulmonary hemorrhage, and greater numbers of infants receiving Intralipid in both weight categories required supplemental oxygen at day 7. The incidence of other complications of prematurity, time required to regain birth weight, and duration of hospital stay did not differ between groups. CONCLUSION: Intralipid administration initiated at < 12 hours after birth failed to protect very low birth weight premature infants from chronic lung disease. Some of the results raise questions about possible deleterious effects of Intralipid when administered early in the first week of life.
Assuntos
Emulsões Gordurosas Intravenosas/uso terapêutico , Doenças do Prematuro/prevenção & controle , Pneumopatias/prevenção & controle , Doença Crônica , Emulsões Gordurosas Intravenosas/administração & dosagem , Emulsões Gordurosas Intravenosas/metabolismo , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Pneumopatias/mortalidade , Taxa de SobrevidaRESUMO
The relationship between Hemoglobin S (Hb S) level and simultaneous values of reticulocyte count, hemoglobin (Hb), and hematocrit (Hct) were studied in six patients with sickle cell disease who were receiving a transfusion protocol because of cerebrovascular accidents. There was good correlation between Hb S and reticulocyte count (r = 0.601), Hb (r = -0.530), and Hct (r = 0.479). Although three of the six patients had similar patterns of relationship of Hb S to reticulocyte count and four of six had similar patterns of relationship of Hb S to Hb and Hct, the other patients had distinctly different patterns. "Decision levels" of reticulocyte count, Hb and Hct, indicating the probable need for transfusion, were determined by the point at which the regression line plus 1 standard error would yield the maximum Hb S considered safe. Although all individual decision levels could separate patients with regard to the need for transfusion, decision levels for the group as a whole could not do so for Hb or Hct and could do so for reticulocyte count only with reduced specificity and predictive value. After an individual patient's pattern of relationship has been established, estimates of Hb S based on reticulocyte count, Hb, or Hct can be used as an inexpensive screen for the need for transfusion.