RESUMO
Infants with severe bronchopulmonary dysplasia may require high doses of neurosedative medications to ensure pain control and stability following tracheostomy placement. Subsequent weaning of these medications safely and rapidly is a challenge. We describe a 24-hour propofol infusion to reduce neurosedative medications in 3 high-risk infants following tracheostomy placement.
Assuntos
Displasia Broncopulmonar , Propofol , Traqueostomia , Humanos , Propofol/administração & dosagem , Traqueostomia/métodos , Masculino , Recém-Nascido , Feminino , Lactente , Hipnóticos e Sedativos/administração & dosagem , Infusões Intravenosas , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Anestésicos Intravenosos/administração & dosagem , Dor Pós-Operatória/tratamento farmacológicoRESUMO
This population-based study showed that maternal opioid plus marijuana use during pregnancy was associated with increased odds of prematurity and low birth weight but lower odds of neonatal abstinence syndrome and prolonged hospitalization compared with opioid exposure without marijuana use. Further research should evaluate the biologic mechanisms responsible for these outcomes.
Assuntos
Abuso de Maconha/epidemiologia , Uso da Maconha/efeitos adversos , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Adulto , Analgésicos Opioides/efeitos adversos , Cannabis/efeitos adversos , Criança , Coleta de Dados , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/prevenção & controle , Masculino , Abuso de Maconha/complicações , Abuso de Maconha/prevenção & controle , Fumar Maconha/efeitos adversos , Massachusetts/epidemiologia , Síndrome de Abstinência Neonatal/complicações , Síndrome de Abstinência Neonatal/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Complicações na Gravidez , Adulto JovemRESUMO
OBJECTIVES: To assess the effect of pulmonary hypertension on neonatal intensive care unit mortality and hospital readmission through 1 year of corrected age in a large multicenter cohort of infants with severe bronchopulmonary dysplasia. STUDY DESIGN: This was a multicenter, retrospective cohort study of 1677 infants born <32 weeks of gestation with severe bronchopulmonary dysplasia enrolled in the Children's Hospital Neonatal Consortium with records linked to the Pediatric Health Information System. RESULTS: Pulmonary hypertension occurred in 370 out of 1677 (22%) infants. During the neonatal admission, pulmonary hypertension was associated with mortality (OR 3.15, 95% CI 2.10-4.73, P < .001), ventilator support at 36 weeks of postmenstrual age (60% vs 40%, P < .001), duration of ventilation (72 IQR 30-124 vs 41 IQR 17-74 days, P < .001), and higher respiratory severity score (3.6 IQR 0.4-7.0 vs 0.8 IQR 0.3-3.3, P < .001). At discharge, pulmonary hypertension was associated with tracheostomy (27% vs 9%, P < .001), supplemental oxygen use (84% vs 61%, P < .001), and tube feeds (80% vs 46%, P < .001). Through 1 year of corrected age, pulmonary hypertension was associated with increased frequency of readmission (incidence rate ratio [IRR] = 1.38, 95% CI 1.18-1.63, P < .001). CONCLUSIONS: Infants with severe bronchopulmonary dysplasia-associated pulmonary hypertension have increased morbidity and mortality through 1 year of corrected age. This highlights the need for improved diagnostic practices and prospective studies evaluating treatments for this high-risk population.
Assuntos
Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/epidemiologia , Ecocardiografia Doppler/métodos , Mortalidade Hospitalar , Hipertensão Pulmonar/epidemiologia , Recém-Nascido Prematuro , Estudos de Coortes , Comorbidade , Feminino , Idade Gestacional , Humanos , Hipertensão Pulmonar/diagnóstico , Lactente , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Análise Multivariada , Readmissão do Paciente/estatística & dados numéricos , Gravidez , Prevalência , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de SobrevidaRESUMO
OBJECTIVES: To evaluate state-level prevalence estimates of prenatal and early postnatal cannabis use in a state with legalized medical and recreational marijuana and the association with adverse neonatal outcomes. STUDY DESIGN: We conducted a cross-sectional study on 3,207 respondents from the 2014-2015 Colorado Pregnancy Risk Assessment Monitoring System with state-developed questions on cannabis use. Differences in perinatal cannabis use were evaluated according to maternal characteristics, breastfeeding patterns, and pregnancy intendedness. Multiple logistic regression models evaluated the relationship between prenatal cannabis use and adverse neonatal outcomes including low birth weight, small for gestational age, preterm birth, and admission to the neonatal intensive care unit. RESULTS: The self-reported prevalence of cannabis use at any time during pregnancy was 5.7 ± 0.5% and the prevalence of early postnatal cannabis use among women who breastfed was 5.0% (95% CI, 4.1%-6.2%). Prenatal cannabis use was associated with a 50% increased likelihood of low birth weight, independent of maternal age, race/ethnicity, level of education, and tobacco use during pregnancy (OR, 1.5; 95% CI, 1.1-2.1; P = .02). Small for gestational age, preterm birth, and neonatal intensive care unit admission were not associated with prenatal cannabis use, independent of prenatal tobacco use. CONCLUSIONS: Our findings underscore the importance of screening for cannabis use during prenatal care and the need for provider counselling about the adverse health consequences of continued use during pregnancy and lactation.
Assuntos
Cannabis/efeitos adversos , Uso da Maconha/epidemiologia , Maconha Medicinal/efeitos adversos , Resultado da Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adolescente , Adulto , Aleitamento Materno/estatística & dados numéricos , Colorado/epidemiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Uso da Maconha/efeitos adversos , Gravidez , Prevalência , Fatores de Risco , Adulto JovemRESUMO
In many centers presurgical term neonates with prostaglandin-dependent cardiac lesions experience nutritional deficiency because of postponed enteral feeds. We recently adopted early enteral feeding in these infants. This retrospective study demonstrates feeding tolerance in 33 of 34 neonates fed enterally while receiving prostaglandin, suggesting the safety of this practice.