BACKGROUND: Intraventricular hemorrhage (IVH) is an important cause of neurodevelopmental impairment in preterm infants. A number of risk factors for IVH have already been proposed; however, some controversies regarding optimal perinatal management persist. This study aimed to identify perinatal and neonatal attributes associated with IVH in a representative population of preterm infants. METHODS: Perinatal data on 1,279 very preterm infants (<32 weeks of gestation) admitted to a tertiary neonatal intensive care unit were analyzed. The records were assessed using univariate analysis and logistic regression model to evaluate the risk factors for any and high-grade IVH (grade III-IV according to the classification by Papile) within the first week after birth. RESULTS: The incidence of any IVH was 14.3% (183/1,279); the rate of low-grade (I-II) and high-grade (III-IV) IVH was 9.0% (115/1,279) and 5.3% (68/1,279), respectively. Univariate analysis revealed multiple factors significantly associated with intraventricular hemorrhage: lower gestational age and birth weight, absence of antenatal steroids, vaginal delivery, low Apgar score at 5 min, delivery room intubation, surfactant administration, high frequency oscillation, pulmonary hypertension, pulmonary hemorrhage, tension pneumothorax, persistent ductus arteriosus, hypotension and early onset sepsis. Logistic regression confirmed lower gestational age, vaginal delivery, ductus arteriosus and early onset sepsis to be independent predictors for any IVH. Pulmonary hemorrhage, tension pneumothorax and early onset sepsis were independent risk factors for high-grade IVH. Complete course of antenatal steroids was associated with a lower risk for any (odds ratio 0.58, 95% confidence interval 0.39-0.85; P = .006) and for high-grade intraventricular hemorrhage (odds ratio 0.36, 95% confidence interval 0.20-0.65; P < .001). CONCLUSION: The use of antenatal steroids and mode of delivery are crucial in the prevention of IVH; however, our study did not confirm the protective effect of placental transfusion. Severe respiratory insufficiency and circulatory instability remain to be powerful contributors to the development of IVH. Early detection and management of perinatal infection may also help to reduce the rate of brain injury and improve neurodevelopment in high-risk newborns.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The use of cerebral oximetry monitoring in the care of extremely preterm infants is increasing. However, evidence that its use improves clinical outcomes is lacking. METHODS: In this randomized, phase 3 trial conducted at 70 sites in 17 countries, we assigned extremely preterm infants (gestational age, <28 weeks), within 6 hours after birth, to receive treatment guided by cerebral oximetry monitoring for the first 72 hours after birth or to receive usual care. The primary outcome was a composite of death or severe brain injury on cerebral ultrasonography at 36 weeks' postmenstrual age. Serious adverse events that were assessed were death, severe brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis. RESULTS: A total of 1601 infants underwent randomization and 1579 (98.6%) were evaluated for the primary outcome. At 36 weeks' postmenstrual age, death or severe brain injury had occurred in 272 of 772 infants (35.2%) in the cerebral oximetry group, as compared with 274 of 807 infants (34.0%) in the usual-care group (relative risk with cerebral oximetry, 1.03; 95% confidence interval, 0.90 to 1.18; P = 0.64). The incidence of serious adverse events did not differ between the two groups. CONCLUSIONS: In extremely preterm infants, treatment guided by cerebral oximetry monitoring for the first 72 hours after birth was not associated with a lower incidence of death or severe brain injury at 36 weeks' postmenstrual age than usual care. (Funded by the Elsass Foundation and others; SafeBoosC-III ClinicalTrials.gov number, NCT03770741.).
- MeSH
- bronchopulmonální dysplazie etiologie MeSH
- kojenec MeSH
- lidé MeSH
- mozkový krevní oběh MeSH
- nekrotizující enterokolitida etiologie MeSH
- nemoci nedonošenců * diagnóza mortalita terapie MeSH
- novorozenci extrémně nezralí * MeSH
- novorozenec MeSH
- novorozenecká sepse etiologie MeSH
- oxymetrie * metody MeSH
- poranění mozku diagnostické zobrazování etiologie MeSH
- retinopatie nedonošených etiologie MeSH
- ultrasonografie MeSH
- velký mozek MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze III MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
Kriticky nemocní, oběhově nestabilní novorozenci na jednotkách intenzivní péče až ve třetině případů nereagují adekvátně na volumexpanzi nebo oběhovou podporu katecholaminy. Výskyt této refrakterní hypotenze nebo vazopresor-rezistentní hypotenze (VRH) stoupá s mírou nezralosti a může mít zásadní dopad na mortalitu a morbiditu nejen těžce nezralých pacientů. Za její hlavní příčinu je v současnosti považována adrenální insuficience, především ve smyslu relativní adrenální insuficience (RAI), kdy je množství produkce kortizolu v nadledvinách nedostatečné vzhledem k tíži onemocnění. Tento přehledový článek shrnuje jak základy fyziologie hypothalamo-pituitárně-adrenální osy v embryonálním a fetálním období a elementární aspekty patofyziologie RAI a VRH u kriticky nemocných a těžce nezralých novorozenců, tak diagnostické a terapeutické možnosti, včetně nežádoucích účinků, s ohledem na dlouhodobou prognózu exponovaných.
A significant proportion of critically ill neonates with hypotension in intensive care units do not respond to volume administration or vasopressors/inotropic circulatory support. The incidence of this refractory hypotension, or vasopressor-resistant hypotension (VRH), is inversely proportional to gestational age. VRH can have a major impact on the mortality and morbidity of these patients. Adrenal insufficiency is currently considered to be its main cause. Particularly relative adrenal insufficiency (RAI) occurs when the amount of cortisol production in the adrenal glands is insufficient for to the severity of illness. This review article summarizes the basics of hypothalamic-pituitary-adrenal axis physiology in the embryonic and fetal period and the fundamental aspects of RAI and VRH pathophysiology in critically ill and very preterm neonates. Diagnostic and therapeutic options, including side effects with regard to the long-term prognosis of exposed patients, are also discussed.
- Klíčová slova
- vazopresor-rezistentní hypotenze,
- MeSH
- adrenální insuficience * diagnóza patofyziologie terapie MeSH
- hydrokortison terapeutické užití MeSH
- hypotenze diagnóza terapie MeSH
- intenzivní péče o novorozence * metody MeSH
- lidé MeSH
- novorozenec MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
V novorozeneckém věku se s přechodnou hypertrofií myokardu nejčastěji setkáváme u dětí diabetických matek (infant of diabetic mother, IDM), po transfuzním syndromu dvojčat (twin to twin transfusion syndrome, TTTS), u nezralých novorozenců léčených steroidy, u novorozenců po intrauterinním uzávěru tepenné dučeje (ductus arteriosus, DA) a např. u novorozenců po těžkém fetálním distresu, kteří prodělali městnavé srdeční selhání. U řady případů je možné předpokládat i kombinaci příčin – například hyperinzulinismus s léčbou steroidy nebo inotropy. Přes různou etiologii bývají echokardiografické nálezy podobné a principy léčby nejvážnějších případů shodné.
Transient myocardial hypertrophy in the neonate is most frequently seen in infants of diabetic mothers, in monochorionic twins after transfusion syndrome, in premature infants given steroids, in neonates after intrauterine closure of arterial duct or severe fetal distress with congestive heart failure. In many cases we assume combined etiology e.g. hyperinsulinism and steroids or inotropes administration. Echocardiographic findings and management of most severe cases are very similar regardless different etiologies.
- MeSH
- kardiomegalie * diagnóza etiologie MeSH
- lidé MeSH
- novorozenec MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
Systemic infection may negatively modulate the development of cerebral white matter and long-term outcome of neonates. We analyzed the growth of corpus callosum (using cranial ultrasonography) and neurodevelopment (Bayley Scales of Infant Development, Third Edition) in 101 very low-birth-weight newborns. We observed significantly reduced corpus callosum length at 3 months of corrected age (44.5 mm vs 47.7 mm, P = .004) and diminished corpus callosum growth (0.07 mm/d vs 0.08 mm/d, P = .028) in infants who experienced systemic infection. The subgroup exhibited inferior neurodevelopmental outcomes with predominant motor impairment. The results suggest that length and growth of corpus callosum might be affected by systemic inflammatory response in preterm newborns. The changes in corpus callosum can contribute to adverse neurodevelopment at 2 years of corrected age. Serial ultrasonographic measurements of the corpus callosum may be suitable to identify preterm infants with increased risk of neurodevelopmental impairment.
- MeSH
- corpus callosum diagnostické zobrazování růst a vývoj MeSH
- kauzalita MeSH
- kohortové studie MeSH
- kojenec MeSH
- lidé MeSH
- následné studie MeSH
- neurovývojové poruchy epidemiologie MeSH
- novorozenec nedonošený MeSH
- novorozenec s velmi nízkou porodní hmotností MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- sepse epidemiologie MeSH
- ultrasonografie metody MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
Systemic infection may negatively modulate the development of cerebral white matter and long-term outcome of neonates. We analyzed the growth of corpus callosum (using cranial ultrasonography) and neurodevelopment (Bayley Scales of Infant Development, Third Edition) in 101 very low-birth-weight newborns. We observed significantly reduced corpus callosum length at 3 months of corrected age (44.5 mm vs 47.7 mm, P = .004) and diminished corpus callosum growth (0.07 mm/d vs 0.08 mm/d, P = .028) in infants who experienced systemic infection. The subgroup exhibited inferior neurodevelopmental outcomes with predominant motor impairment. The results suggest that length and growth of corpus callosum might be affected by systemic inflammatory response in preterm newborns. The changes in corpus callosum can contribute to adverse neurodevelopment at 2 years of corrected age. Serial ultrasonographic measurements of the corpus callosum may be suitable to identify preterm infants with increased risk of neurodevelopmental impairment.
- MeSH
- corpus callosum diagnostické zobrazování růst a vývoj MeSH
- kauzalita MeSH
- kohortové studie MeSH
- kojenec MeSH
- lidé MeSH
- následné studie MeSH
- neurovývojové poruchy epidemiologie MeSH
- novorozenec nedonošený MeSH
- novorozenec s velmi nízkou porodní hmotností MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- sepse epidemiologie MeSH
- ultrasonografie metody MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
OBJECTIVES: Patent ductus arteriosus (PDA) remains a challenging issue in very low birth weight (VLBW) infants, and its management varies widely. Our aim in this study was to document the natural course of ductus arteriosus in a cohort of VLBW infants who underwent conservative PDA management with no medical or surgical intervention. METHODS: A retrospective cohort study conducted in 2 European level-3 neonatal units. RESULTS: A total of 368 VLBW infants were born within the study period. Two hundred and ninety-seven infants were free of congenital malformations or heart defects and survived to hospital discharge. Out of those, 280 infants received truly conservative PDA management. In 237 (85%) of nontreated infants, the PDA closed before hospital discharge. The Kaplan-Meier model was used to document the incidence proportion of PDA closure over time for different gestational age groups. The median time to ductal closure was 71, 13, 8, and 6 days in <26+0, 26+0 to 27+6, 28+0 to 29+6, and ≥30 weeks, respectively. For different birth weight groups, the median was 48, 22, 9, and 8 days in infants weighing <750, 750 to 999, 1000 to 1249, and 1250 to 1500 g, respectively. No statistically significant relationship was found between PDA closure before hospital discharge and neonatal morbidities. CONCLUSIONS: The likelihood of PDA spontaneous closure in VLBW infants is extremely high. We provide in our findings a platform for future placebo-controlled trials focused on the smallest and youngest infants.
- MeSH
- echokardiografie MeSH
- gestační stáří MeSH
- kohortové studie MeSH
- kojenec MeSH
- konzervativní terapie MeSH
- lidé MeSH
- mortalita v nemocnicích MeSH
- následné studie MeSH
- novorozenec s velmi nízkou porodní hmotností * MeSH
- novorozenec MeSH
- otevřená tepenná dučej diagnóza mortalita terapie MeSH
- propuštění pacienta MeSH
- retrospektivní studie MeSH
- spontánní remise MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- databáze faktografické MeSH
- dítě MeSH
- komplikace těhotenství epidemiologie etiologie MeSH
- lidé MeSH
- nemoci novorozenců klasifikace mortalita MeSH
- novorozenec MeSH
- novorozenecký screening * MeSH
- registrace * normy MeSH
- reprodukční zdraví statistika a číselné údaje MeSH
- těhotenství MeSH
- výsledek těhotenství MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
