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Kakoo Brioso E, Moscoso J, Malveiro D, Aguiar M, Tuna M. Bronchopulmonary Dysplasia: A Five-Year Retrospective Cohort Study on Differences in Clinical Characteristics and Morbidities According to Severity Grading. Cureus 2023; 15:e42720. [PMID: 37654925 PMCID: PMC10466257 DOI: 10.7759/cureus.42720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Bronchopulmonary dysplasia (BPD) is the most common complication associated with extreme prematurity. Although several criteria defining severity were developed over time, there are a few studies describing the differences in BPD phenotype and neonatal morbidities and complications between severity groups. We aimed to describe these differences in BPD patients of a neonatal intensive care unit (NICU). METHODS We conducted an observational retrospective cohort study through a medical record review over a five-year period. Participants were newborns admitted to an NICU who were diagnosed with BPD. We performed a descriptive statistical analysis of gestational complications and the use of antenatal corticosteroid therapy, birth-related data, and complications throughout the NICU stay, as well as the respiratory support used. We also compared different severity groups across these variables. The patients were divided into severe and non-severe BPD using the severity criteria of the 2001 NICHD/NHLBI/ORD consensus workshop. RESULTS A total of 101 newborns with BPD participated in the study and 73 had data on BPD severity. The median gestational age was 27 weeks, ranging from 23 to 32 weeks. Of these 73 newborns, 36 had mild BPD (49.3%), 10 had moderate BPD (13.7%), and 27 had severe BPD (37.0%). When comparing severe and non-severe BPD, we found that extreme prematurity, extremely low birth weight, and small size for gestational age were more frequent in the severe BPD group (p-value=0.012, p-value<0.001, and p-value=0.012, respectively). Infants with severe BPD had a longer duration of invasive ventilation than those with mild or moderate BPD (p-value<0.001). Late sepsis, necrotizing enterocolitis, severe brain injury, and retinopathy of prematurity were more frequent in severe BPD (p-value=0.017, p-value=0.045, p-value=0.033, p-value=0.003, respectively). DISCUSSION Previously published evidence describing causal links between BPD development and comorbidities exists but data on their impact on BPD severity are scarce. In our study, severe BPD seemed to be associated with a higher frequency of comorbidities and complications. Further studies are needed to ascertain the impact of each morbidity on the severity of BPD and if measures to prevent them could lead to potentially milder BPD disease.
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Affiliation(s)
- Estela Kakoo Brioso
- Pediatrics, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
- Pediatrics, Hospital De Cascais Dr. José De Almeida, Lisbon, PRT
| | - Joana Moscoso
- Pediatrics, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | | | - Marta Aguiar
- Pediatrics, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
| | - Madalena Tuna
- Pediatrics, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT
- Comprehensive Health Research Center, Nova Medical School, Lisbon, PRT
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Affiliation(s)
- Joana Soares
- Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Neonatal Intensive Care Unit, Lisboa, Portugal; Centro Hospitalar de Leiria, Pediatrics Department, Lisboa, Portugal
| | - Melissa Brigham de Figueiredo
- Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Neonatal Intensive Care Unit, Lisboa, Portugal
| | - Ana Rita Prior
- Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Neonatal Intensive Care Unit, Lisboa, Portugal
| | - Duarte Malveiro
- Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Neonatal Intensive Care Unit, Lisboa, Portugal
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Ferreira S, Costa R, Malveiro D, Vieira F, Tuna M. Warfarin embryopathy: Balancing maternal and fetal risks with anticoagulation therapy. Pediatr Neonatol 2018; 59:534-535. [PMID: 29501347 DOI: 10.1016/j.pedneo.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/08/2017] [Accepted: 02/05/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sara Ferreira
- Pediatrics Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - Raquel Costa
- Pediatrics Department, Hospital Espírito Santo, Évora, Portugal
| | - Duarte Malveiro
- Neonatal Intensive Care Unit, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Filipa Vieira
- Neonatal Intensive Care Unit, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Madalena Tuna
- Neonatal Intensive Care Unit, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Fernandes RM, Andrade MG, Constant C, Malveiro D, Magalhães M, Abreu D, Azevedo I, Sousa E, Salgado R, Bandeira T. Acute viral bronchiolitis: Physician perspectives on definition and clinically important outcomes. Pediatr Pulmonol 2016; 51:724-32. [PMID: 26595365 DOI: 10.1002/ppul.23346] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 08/09/2015] [Accepted: 08/22/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Two key limitations hamper intervention research in bronchiolitis: the absence of a clear definition of disease, and the heterogeneous choice of outcome measures in current clinical trials. We assessed how paediatricians and general practitioners (GPs) perceived definition and clinically important outcomes in bronchiolitis. METHODS A nationwide online survey (ABBA study) was conducted through the Portuguese Society of Paediatrics and GPs' mailing lists. We assessed agreement with statements on bronchiolitis definition, and participants were asked to score the relative importance of several outcomes. Principal component analysis (PCA) explored dimensions underlying disease definition. Outcomes were ranked by mean score and proportion given highest score. RESULTS We included 514 paediatricians and 165 GPs (overall 59% were board-certified). Most paediatricians (76.5%) agreed with a definition based on coryza, wheezing and/or crackles/rales, compared to 38.1% GPs (P < 0.001). Less than 5% physicians agreed with a definition commonly used in clinical trials (<12 months, first episode of wheeze). We retained three dimensions on PCA: one based on coryza, rales/crepitations and no sudden onset; another on number of episodes and age; and a third on wheeze. Dimensions varied by physician specialization and training (P < 0.01). Hospital admission and respiratory distress were top rated outcomes by both groups of physicians. CONCLUSIONS Physician definitions of bronchiolitis have considerable variability and often mismatch those of clinical trials. Rating of important outcomes was consistent. Our results highlight the need for a robust standardized definition of acute bronchiolitis in infants and support the development of a core outcome set for future clinical trials. Pediatr Pulmonol. 2016;51:724-732. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Ricardo M Fernandes
- Department of Paediatrics, Hospital de Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Maria Gabriela Andrade
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Carolina Constant
- Department of Paediatrics, Hospital de Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.,Department of Paediatrics, Unidade de Torres Vedras, Centro Hospitalar do Oeste, Torres Vedras, Portugal
| | - Duarte Malveiro
- Department of Paediatrics, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Manuel Magalhães
- Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Research in Health Technologies and Information Systems, Porto, Portugal
| | - Daisy Abreu
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Inês Azevedo
- Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.,EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Eduarda Sousa
- Department of Paediatrics, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Rizério Salgado
- Unidade de Saúde Familiar S. Julião, Centro de Saúde de Oeiras, Oeiras, Portugal
| | - Teresa Bandeira
- Department of Paediatrics, Hospital de Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.,Clínica Universitária de Pediatria, Faculty of Medicine, University of Lisbon, Portugal
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Escobar C, Malveiro D, Salgado A, Santos MI, Lameirão Campagnolo J, Cassiano Neves M. [Osteogenesis imperfecta--experience of Dona Estefânia's Hospital orthopedics' department]. ACTA MEDICA PORT 2013; 26:5-11. [PMID: 23697351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 12/21/2012] [Indexed: 06/02/2023]
Abstract
INTRODUCTION/AIMS Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and osteopenia. Treatment involves a multidisciplinary approach and aims to improve the quality of life. The authors aimed to describe the characteristics of a sample of children with OI, to evaluate the treatment and clinical outcome before and after therapy. MATERIAL AND METHODS An observational, longitudinal, retrospective and analytic study based on data obtained from the analisys of the clinical files of all patients with OI included in the pamidronate treatment protocol in Dona Estefânia's Hospital. The studied variables were: gender, age at diagnosis, familiar history of OI, age at fracture, fracture location, number of fractures, medical/surgical therapy, age at onset of treatment, number of courses of medical therapy, age at surgical treatment and its complications. A five percent statistics significance level was adopted. RESULTS in 21 patients, 61.9% were male and 11 had its OI type registered (five type I, three type III, three type IV). The average age of diagnosis was 20.6 months and there were two diagnostic peaks: the first month - 37%, and 24 months - 26%. On average patients had 0.62 fractures/patient/year, of which 17.4% in the perinatal period and 62% before age three. Most of the fractures occurred in the lower limbs (55.6%). All patients underwent medical treatment, starting at an average of 4.3 years. In follow-up sample (n=14) there was a decrease in the number of fractures after starting treatment with pamidronate (0.76 to 0.35 fractures/patient/year). Intramedullary rods were placed in nine patients (64.3%). In eight patients they were placed in the femur, four unilateral and four bilateral, with no prior history of fracture in three cases. There were no new fractures in the surgically treated bones. CONCLUSION OI is a disease with a wide clinical variability that mainly depends on its type. Despite no cure has been found, medical treatment with biphosphonates and surgical treatment, with intramedullary rods, seems to reduce the incidence of new fracture occurrence.
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Affiliation(s)
- Carlos Escobar
- Departamento de Pediatria, Hospital Fernando Fonseca, Amadora, Portugal
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Malveiro D, Flores P, Sousa E, Guimarães JC. [The 2009 pandemic influenza A (H1N1) virus infection: experience of a paediatric service at a third-level hospital in Lisbon, Portugal]. Rev Port Pneumol 2012; 18:175-81. [PMID: 22534160 DOI: 10.1016/j.rppneu.2012.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 01/31/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The 2009 pandemic influenza A (H1N1) (i.e., Pandemic Influenza) is an acute, infectious illness caused by the influenza A (H1N1) 2009 virus. This disease involves respiratory, gastrointestinal and systemic symptoms along with a high incidence occurring at a paediatric age. OBJECTIVE To study the epidemiology, approach and complications of Pandemic Influenza in the paediatric population of a third-level hospital in Lisbon, Portugal, between September and December 2009. MATERIALS AND METHODS A retrospective study of children who had received the influenza A (H1N1) 2009 virus test by real time reverse transcriptase-polymerase chain reaction (RT-PCR) were included. The following parameters were analysed: number of tests, days of illness, sex, outcome, age, symptoms, hospitalisation and reason for testing. The distribution and test results were compared with the Pandemic Influenza activity in Portugal. Moreover, among the confirmed cases of infection, the need for hospitalisation, risk factors, severity, chest radiography, treatment and complications were also examined. RESULTS A total of 351 tests were performed, on average, 2.6 days after initial symptoms, which included 71.8% outpatients and 30% children younger than three years of age. Overall, 54.4% of the tests were positive for the influenza A (H1N1) 2009 virus and the main comorbidities were respiratory and cardiovascular in nature. One hundred ninety-one cases were confirmed by laboratory studies, and 13.6% required hospitalisation, which lasted an average of 2.7 days. In 82.2% of the cases, the severity was mild, with fever and cough as the most frequent symptoms at 91.9% and 93.7%, respectively. Therapy with the antiviral drug, oseltamivir, was implemented in 35.6% of the cases. Additionally, oseltamivir was used in twelve infants younger than one year in age, including a one-month-old infant with no observed side effects. DISCUSSION The epidemiological data obtained are consistent with the published national and international studies. The scientific information available and the recommendations of the irectorate-General for Health contributed to the uniformity of the approaches and the successful outcome.
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Affiliation(s)
- D Malveiro
- Serviço de Pediatria, Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
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