RESUMO
OBJECTIVE: To evaluate impact of a multihospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm. STUDY DESIGN: Twelve neonatal intensive care units were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Infants with very low birth weight between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room, delivery room continuous positive airway pressure, hypothermia (<36°C) upon neonatal intensive care unit admission, severe intraventricular hemorrhage, and mortality before hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect. RESULTS: Between March 2017 and December 2020, a total of 2626 eligible very low birth weight births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in March to August 2017 and 76.0% in July to December 2020 (risk ratio 1.03; [0.94-1.12]); no significant improvement occurred during the study period for both participating and nonparticipating sites. The effect of in situ simulation on all secondary outcomes was stable. CONCLUSIONS: Implementation of a multihospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.
Assuntos
Pneumopatias , Ressuscitação , Gravidez , Feminino , Recém-Nascido , Humanos , Lactente , Recém-Nascido de muito Baixo Peso , Idade Gestacional , Pressão Positiva Contínua nas Vias Aéreas , Unidades de Terapia Intensiva NeonatalRESUMO
Marine ecosystems are both stressed and threatened by pesticides that are used on land. Nevertheless, research on the impact of pesticides on coral reefs and the underlying mechanisms is still in its infancy. The insecticide chlordecone is a persistent organic pollutant with carcinogenic effects in rats and mice. Chlordecone has been detected in diverse marine organisms in the Caribbean, but unexpectedly, also in French Polynesia. We combined transcriptomic and morphologic analyses of analyses the response of the coral Pocillopora damicornis to chlordecone stress. We compared chlordecone stress with thermal stress to determine a chlordecone-specific response. We found eight transcripts related to the P450-1A or P450-3A families that were specifically overexpressed in response to chlordecone. There was also sequential overexpression of transcripts involved in apoptosis and degradation of cellular matrix proteins. Finally, we report the first observation of chlordecone-induced P. damicornis polyp bail-out. Altogether, these results strongly suggest that apoptosis and expression of genes belonging to the cathepsin family are sequentially regulated processes leading to coenosarc dissociation and loss.
Assuntos
Antozoários/efeitos dos fármacos , Clordecona/toxicidade , Animais , Apoptose/efeitos dos fármacos , Região do Caribe , Catepsinas/genética , Clordecona/farmacologia , Exposição Ambiental/efeitos adversos , Inseticidas/farmacologia , Inseticidas/toxicidade , Praguicidas/farmacologia , Ratos , Ativação Transcricional/efeitos dos fármacos , Índias OcidentaisRESUMO
The former use of chlordecone (CLD) in the French West Indies has resulted in long-term pollution of soils. CLD is known to be potentially transferred towards animal products of animals reared outdoors, mainly through accidental soil ingestion. Several studies indicate that soil bound CLD is bioavailable when administered to farm animals. Currently there is a need to quantify the level of CLD absorption and its toxicokinetic characteristics in the ruminant and particularly in the goat. These are considered as important farm species in the French West Indies. The objective of this study was to evaluate the absorption rate and the half-life of CLD in the non-lactating goat. The goats were administered either intravenously (i.v., n = 6) or orally (p.o., n = 6) one dose (1 mg kg-1 body weight) of CLD. Blood samples were collected at defined times up to 160 days post-dosing. CLD was analyzed in serum by high-resolution gas chromatography. A comparison of the area under the serum concentration-time curves (AUC) showed that the i.v. route is equivalent to the oral route. Thus, CLD is considered almost completely absorbed after p.o. administration, as shown by the mean absolute bioavailability. The comparison between the pharmacokinetic profiles of CLD following oral and intravenous dose showed a difference during the first 14 days and a similar kinetic after this period. The half-life of CLD in serum was close to 20 days. These results highlight a possible strategy of decontamination due to the short half-life of CLD, obtained in dry goats that did not excrete fat matter.
Assuntos
Clordecona/farmacocinética , Clordecona/toxicidade , Cabras , Inseticidas/farmacocinética , Inseticidas/toxicidade , Poluentes do Solo/farmacocinética , Poluentes do Solo/toxicidade , Animais , Clordecona/sangue , Feminino , Cabras/sangue , Cabras/metabolismo , Meia-Vida , Inseticidas/sangue , Medição de Risco , Poluentes do Solo/sangue , Toxicocinética , Índias OcidentaisRESUMO
OBJECTIVE: To evaluate the incidence of death or neurodevelopmental impairment (NDI) at 18-22 months corrected age in subjects enrolled in a trial of early dexamethasone treatment to prevent death or chronic lung disease in extremely low birth weight infants. STUDY DESIGN: Evaluation of infants at 18-22 months corrected age included anthropomorphic measurements, a standard neurological examination, and the Bayley Scales of Infant Development-II, including the Mental Developmental Index and the Psychomotor Developmental Index. NDI was defined as moderate or severe cerebral palsy, Mental Developmental Index or Psychomotor Developmental Index <70, blindness, or hearing impairment. RESULTS: Death or NDI at 18-22 months corrected age was similar in the dexamethasone and placebo groups (65% vs 66%, P = .99 among those with known outcome). The proportion of survivors with NDI was also similar, as were mean values for weight, length, and head circumference and the proportion of infants with poor growth (50% vs 41%, P = .42 for weight less than 10th percentile); 49% of infants in the placebo group received treatment with corticosteroid compared with 32% in the dexamethasone group (P = .02). CONCLUSION: The risk of death or NDI and rate of poor growth were high but similar in the dexamethasone and placebo groups. The lack of a discernible effect of early dexamethasone on neurodevelopmental outcome may be due to frequent clinical corticosteroid use in the placebo group.
Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/prevenção & controle , Dexametasona/administração & dosagem , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Pneumopatias/prevenção & controle , Causas de Morte/tendências , Doença Crônica , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/etiologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Incidência , Lactente , Injeções Intravenosas , Pneumopatias/complicações , Pneumopatias/epidemiologia , Exame Neurológico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: To compare proportions of infants at different gestational ages discharged from the neonatal intensive care unit (NICU) on home oxygen, to determine how many were classified with chronic lung disease based on timing of discharge on home oxygen, and to determine the percentage discharged on home oxygen who received mechanical ventilation. STUDY DESIGN: We evaluated a retrospective cohort of infants of 23-43 weeks' gestational age discharged from 228 NICUs in 2009, using the Pediatrix Clinical Data Warehouse. Multilevel logistic regression analysis identified predictors of home oxygen use among extremely preterm, early-moderate preterm, late preterm, and term infants. Duration of mechanical ventilation and median length of stay were calculated for infants discharged on home oxygen. RESULTS: For the 48877 infants studied, the rate of home oxygen use ranged from 28% (722 of 2621) in extremely preterm infants to 0.7% (246 of 34 934) in late preterm and term infants. Extremely preterm infants composed 56% (722 of 1286) of the infants discharged on home oxygen; late preterm and term infants, 19% (246 of 1286). After gestational age, mechanical ventilation was the main predictor of home oxygen use; however, 61% of the late preterm and term infants discharged on home oxygen did not receive ventilation. The median length of hospital stay was 95 days (IQR, 76-114 days) for extremely preterm infants discharged on home oxygen, but only 15 days (IQR, 10-22 days) for late preterm and term ventilated infants discharged on home oxygen. CONCLUSION: Although home oxygen use is uncommon in later-gestation infants, the greater overall numbers of later-gestation infants contribute significantly to the increased need for home oxygen for infants at NICU discharge. Neither respiratory failure nor lengthy hospitalization is a prerequisite for home oxygen use at later gestational age.
Assuntos
Assistência Domiciliar , Oxigênio/uso terapêutico , Doença Crônica/terapia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/terapia , Terapia Intensiva Neonatal , Tempo de Internação , Modelos Logísticos , Pneumopatias/terapia , Masculino , Alta do Paciente , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVE: Candida remains an important cause of late-onset infection in preterm infants. Mortality and neurodevelopmental outcome of extremely low birth weight (ELBW) infants enrolled in the Candida study were evaluated based on infection status. STUDY DESIGN: ELBW infants born at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) centers between March 2004 and July 2007 who were screened for suspected sepsis were eligible for inclusion in the Candida study. Primary outcome data for neurodevelopmental impairment (NDI) or death were available for 1317 of the 1515 infants (87%) enrolled in the Candida study. The Bayley Scales of Infant Development-II or -III was administered at 18 months' adjusted age. A secondary comparison was performed with 864 infants enrolled in the NRN Generic Database during the same cohort who were never screened for sepsis and therefore not eligible for the Candida study. RESULTS: Among ELBW infants enrolled in the Candida study, 31% with Candida and 31% with late-onset non-Candida sepsis had NDI at 18 months. Infants with Candida sepsis and/or meningitis had an increased risk of death and were more likely to have the composite outcome of death and/or NDI compared with uninfected infants in adjusted analysis. Compared with infants in the NRN registry never screened for sepsis, overall risk for death were similar but those with Candida infection were more likely to have NDI (OR 1.83, 95% CI 1.01-3.33, P = .047). CONCLUSIONS: In this cohort of ELBW infants, those with infection and/or meningitis were at increased risk for death and/or NDI. This risk was highest among those with Candida sepsis and/or meningitis.