RESUMO
OBJECTIVE: To determine the characteristics of term infants with persistent pulmonary hypertension of the newborn (PPHN) associated with moderate or severe hypoxic ischemic encephalopathy (HIE). METHODS: We compared infants with and without PPHN enrolled in 2 randomized trials of therapeutic hypothermia: the induced hypothermia trial of cooling to 33.5°C for 72 hours vs normothermia, and the "usual-care" arm (33.5°C for 72 hours) of the optimizing cooling trial. RESULTS: Among 303 infants with HIE from these 2 studies, 67 (22%) had PPHN and 236 (78%) did not. We compared infants with PPHN with those without PPHN. The proportion of patients treated with therapeutic hypothermia was similar in PPHN and no-PPHN groups (66% vs 65%). Medication use during resuscitation (58% vs 44%), acidosis after birth (pH: 7.0 ± 0.2 vs 7.1 ± 0.2), severe HIE (43% vs 28%), meconium aspiration syndrome (39% vs 7%), pulmonary hemorrhage (12% vs 3%), culture-positive sepsis (12% vs 3%), systemic hypotension (65% vs 28%), inhaled nitric oxide therapy (64% vs 3%), and extracorporeal membrane oxygenation (12% vs 0%) were more common in the PPHN group. Length of stay (26 ± 21 vs 16 ± 14 days) and mortality (27% vs 16%) were higher in the PPHN group. CONCLUSIONS: PPHN is common among infants with moderate/severe HIE and is associated with severe encephalopathy, lung disease, sepsis, systemic hypotension, and increased mortality. The prevalence of PPHN was not different between those infants receiving therapeutic hypothermia at 33.5°C in these 2 trials (44/197 = 22%) compared with infants receiving normothermia in the induced hypothermia trial (23/106 = 22%).
Assuntos
Asfixia Neonatal/terapia , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/diagnóstico , Hipóxia-Isquemia Encefálica/terapia , Acidose , Comorbidade , Interpretação Estatística de Dados , Feminino , Humanos , Hipertensão Pulmonar/complicações , Hipóxia-Isquemia Encefálica/complicações , Recém-Nascido , Tempo de Internação , Masculino , Idade Materna , Síndrome de Aspiração de Mecônio/complicações , Síndrome de Aspiração de Mecônio/diagnóstico , Síndrome de Aspiração de Mecônio/terapiaRESUMO
OBJECTIVES: To assess the feasibility of pulse oximetry (PO) screening in settings with home births and very early discharge. We assessed this with an adapted protocol in The Netherlands. STUDY DESIGN: PO screening was performed in the Leiden region in hospitals and by community midwives. Measurements were taken ≥ 1 hour after birth and on day 2 or 3 during the midwife visit. Primary outcome was the percentage of screened infants with parental consent. The time point of screening, oxygen saturation, false positive (FP) screenings, critical congenital heart defects (CCHDs), and other detected pathology were registered. RESULTS: In a 1-year period, 3625 eligible infants were born. Parents of 491 infants were not approached for consent, and 44 refused the screening. PO screening was performed in 3059/3090 (99%) infants with obtained consent. Median (IQR) time points of the first and second screening were 1.8 (1.3-2.8) and 37 (27-47) hours after birth. In 394 infants with screening within 1 hour after birth, the median pre- and postductal oxygen saturations were 99% (98%-100%) and 99% (97%-100%). No CCHD was detected. The FP prevalence was 1.0% overall (0.6% in the first hours after birth). After referral, important noncritical cardiac and other noncardiac pathology was found in 62% of the FP screenings. CONCLUSIONS: PO screening for CCHD is feasible after home births and very early discharge from hospital. Important neonatal pathology was detected at an early stage, potentially increasing the safety of home births and early discharge policy.
Assuntos
Cardiopatias Congênitas/diagnóstico , Parto Domiciliar , Oximetria/estatística & dados numéricos , Alta do Paciente , Estudos de Viabilidade , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico , Recém-Nascido , Infecções/diagnóstico , Síndrome de Aspiração de Mecônio/diagnóstico , Tocologia , Países Baixos , Oxigênio/sangue , Consentimento dos Pais/estatística & dados numéricos , Policitemia/diagnóstico , Gravidez , Estudos Prospectivos , Fatores de TempoRESUMO
Early-onset respiratory distress and a radiographic appearance of an aspiration syndrome occurred in three neonates who had not passed meconium before delivery. In each case there was evidence of inhalation of blood, associated with very high plasma protein concentration in lung fluid. Blood aspiration syndrome is a distinct diagnostic entity that can result in significant respiratory distress in the neonate.
Assuntos
Sangue , Pneumonia Aspirativa/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Resistência das Vias Respiratórias , Gasometria , Proteínas Sanguíneas/análise , Líquido da Lavagem Broncoalveolar/química , Líquido da Lavagem Broncoalveolar/citologia , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Síndrome de Aspiração de Mecônio/diagnóstico , Pneumonia Aspirativa/sangue , Pneumonia Aspirativa/diagnóstico , Surfactantes Pulmonares/análise , Respiração Artificial , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Fatores de RiscoRESUMO
El objetivo de este estudio es evaluar el efecto de la amnioinfusión salina transcervical sobre el resultado perinatal en pacientes con trabajo de parto complicado con meconio. Estudio prospectivo con control histórico, realizado en el Hospital Ramón González Valencia, en 115 pacientes en trabajo de parto con meconio espeso, de las cuales 55 fueron sometidas a amnioinfusión. El volumen de solución salina oscila entre 500 y 800 cc. En el grupo de amnioinfusión hubo disminución en la frecuencia de puntajes bajos de Apgar (<7), reducción en el hallazgo de meconio debajo de cuerdas vocales (12.7 por ciento vs. 50.9 por ciento) y en la necesidad de ventilación mecánica positiva (1.9 por ciento vs. 33.3 por ciento). Concluímos que la amnioinfusión transcervical mejora el resultado perinatal reduciendo la incidencia de síndrome de Broncoaspiración de meconio, disminuye el síndrome de dificultad respiratoria neonatal, presencia de meconio bajo cuerdas vocales y necesidad de ventilación mecánica
Assuntos
Humanos , Feminino , Gravidez , Síndrome de Aspiração de Mecônio/diagnóstico , Síndrome de Aspiração de Mecônio/epidemiologia , Síndrome de Aspiração de Mecônio/fisiopatologiaRESUMO
De los 3,872 nacimientos atendidos en el HNCH durante el año 1990, 470 (12.1 por ciento) presentaron líquido amniótico meconial, fueron estudiados retrospectivamente 456 neonatos, de los cuales 39 (8.5 por ciento) desarrollaron el Sindrome de Aspiración Meconial (SAM), asociándose a su presencia los siguientes factores de riesgo: líquido meconial espeso, cesárea, apgar bajo, taquicardia fetal, distocia de cordón, parto disfuncional y toxemia, sirviendo su presentación como señal de alerta para el médico tratante. La aspiración traqueal se realizó con mayor frecuencia en neonatos deprimidos y con probable lesión pulmonar por asfixia lo que explicaría la mayor frecuencia de SAM asociada con este procedimiento. La letalidad por Sam fue de 10.2 por ciento, con un riesgo de morir 15.3 veces mayor que los neonatos sin SAM. Lo que demuestra que el SAMaún sigue siendo una patología frecuente asociado a una alta morbimortalidad, siendo importante para su prevención la detección temprana de factores perinatales y una atención perinatal combinada.
Assuntos
Humanos , Recém-Nascido , Asfixia Neonatal/etiologia , Síndrome de Aspiração de Mecônio/diagnóstico , Fatores de Risco , Índice de Apgar , Asfixia Neonatal , Síndrome de Aspiração de Mecônio/etiologia , Síndrome de Aspiração de Mecônio/epidemiologia , Mecônio/fisiologiaRESUMO
Fifteen full term newborn infants with severe meconium aspiration syndrome and no evidence of hypoxic brain abnormalities, were prospectively followed under conservative treatment with oxygen given by hood at FiO2 > or = 70% (mean 80%) for periods of 12 hours to 4 days (mean 1.9 days). No significant rise in PaCO2 was recorded in these cases. Even though four patients had complications of their basic disease, consisting in pneumothorax, pneumomediatinum and atelectasis, all of them eventually recovered with usual medical management and the whole survival rate was 100%. Newborn infants with severe meconium aspiration syndrome without evidence of hypoxic insult to the central nervous system can be satisfactorily handled under a hood with high oxygen concentrations.