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Loureiro CV, Fonteles MM, Mascarenhas MB, Chaves EF, Firmino PY. Medication follow-up in newborns with extremely low birth-weight. Pharm Pract (Granada) 2020; 17:1584. [PMID: 31897251 PMCID: PMC6935551 DOI: 10.18549/pharmpract.2019.4.1584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/06/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: The medication follow-up in infants with extremely low birth-weight in a
neonatal intensive care unit is described, identifying drug-related problems
(DRP), drug-related negative outcomes, and the relationship between the
occurrence of DRP and birth-weight of newborns and their impact on
pharmacotherapy and length of hospital stay. Methods: A descriptive and exploratory study was performed in which medication
follow-up of a population of infants with extremely low birth-weight
admitted to the neonatal intensive care unit of a government-run maternity
hospital was carried out by clinical pharmacists. Monitoring comprised
assessment of patients’ pharmacotherapy needs through visits to the
neonatal unit, evaluation of prescriptions and information on medical
records, identification of issues associated with pharmacotherapy and
follow-up of the newborns’ clinical evolution to determine whether
desired results were achieved. Results: The subjects were 33 infants characterized by extremely low weight at birth.
Analysis of patients’ pharmacotherapy showed that 39.4% (n=13)
of the neonates presented some type of DRP, totaling 37 DRPs and a mean of
2.8 problems/patient. Fourteen drugs were identified with the occurrence of
DRP. Vancomycin and cefepime were the most prevalent, with 18.9%
(n=7). Occurrence of DRPs and several clinical characteristics of newborns
and their pharmacotherapy were compared. The most prevalent drug-related
negative outcomes identified were “untreated health problem”
(40%, n=10) and “quantitative ineffectiveness”
(32%, n=8). Pharmaceutical interventions were performed for all
problems associated with pharmacotherapy, with a prevalence of
“treatment day count correction” and “dose
correction”, both with 21.6% (n=8), and “correction of
dosage” (16.2%, n=6). Conclusion: The research evidenced the role of the clinical pharmacist in the solution
and prevention of drug-related problems, contributing with the
multidisciplinary team to obtain a safe and effective pharmacotherapy.
Further, current study confirmed that there is an association between the
characteristics of the newborns under analysis (eg. birth-weight,
pharmacotherapy) and the occurrence of drug-related problems.
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Affiliation(s)
- Catarine V Loureiro
- MSc (Pharm Sci). Post-graduate Program in Pharmaceutical Sciences, Federal University of Ceará. Fortaleza, CE (Brazil).
| | - Marta M Fonteles
- PhD (Pharmacol). Professor. Pharmacy Department, Federal University of Ceará. Fortaleza, CE (Brazil).
| | - Mylenne B Mascarenhas
- MSc in Pharmaceutical Sciences. Pharmacist. Department of Pharmacy, Federal University of Ceará. Fortaleza, CE (Brazil).
| | - Elana F Chaves
- Pharmacist. Walter Cantídio School Hospital, Federal University of Ceará. Fortaleza, CE (Brazil).
| | - Paulo Y Firmino
- PhD (Pharm Sci). Professor. Faculdade Metropolitana da Grande Fortaleza (FAMETRO). Fortaleza, CE (Brazil).
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Byun J, Kim HY, Jung SE, Yang HB, Kim EK, Shin SH, Kim HS. Comparison of Acute Abdominal Surgical Outcomes of Extremely-Low-Birth-Weight Neonates according to Differential Diagnosis. J Korean Med Sci 2019; 34:e222. [PMID: 31496138 PMCID: PMC6732259 DOI: 10.3346/jkms.2019.34.e222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/26/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Improvements in perinatal intensive care have improved survival of extremely-low-birth-weight (ELBW) neonates, although the risk of acute abdomen has increased. The differential diagnosis resulting in abdominal surgery can be categorized into necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), meconium-related ileus (MRI), and meconium non-related ileus (MNRI). The purpose of this study was to review our experience with abdominal surgery for ELBW neonates, and to evaluate characteristics and prognosis according to the differential diagnosis. METHODS Medical records of ELBW neonates treated between 2003 and 2015 were retrospectively reviewed. RESULTS Of 805 ELBW neonates, 65 (8.1%) received abdominal surgery. The numbers of cases by disease category were 29 for NEC, 18 for SIP, 13 for MRI, and 5 for MNRI. Ostoma formation was performed in 61 (93.8%) patients; primary anastomosis without ostoma was performed in 4 (6.2%). All patients without ostoma formation experienced re-perforation of the anastomosis site. Seven patients had 30-day postoperative mortality (6 had NEC). Long-term survival of the surgical and non-surgical groups was not statistically different. NEC was a poor prognostic factor for survival outcome (P = 0.033). CONCLUSION Abdominal surgery for ELBW neonates is feasible. Ostoma formation can lead to reduced complications compared to primary anastomosis.
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Affiliation(s)
- Jeik Byun
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Sung Eun Jung
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Beom Yang
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ee Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Malikiwi AI, Lee YM, Davies-Tuck M, Wong FY. Postnatal nutritional deficit is an independent predictor of bronchopulmonary dysplasia among extremely premature infants born at or less than 28 weeks gestation. Early Hum Dev 2019; 131:29-35. [PMID: 30825742 DOI: 10.1016/j.earlhumdev.2019.02.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 11/09/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the relationship between growth, nutritional and fluid intake in the first month of life and the likelihood of developing bronchopulmonary dysplasia. DESIGN & SETTINGS This is a retrospective case-control study conducted in a tertiary perinatal centre between January 2011 and December 2013. PATIENTS Thirty-three preterm infants without bronchopulmonary dysplasia (BPD) were identified and matched with those with BPD, based on period of birth within a cohort of infants with a birth weight of ≤1000 g and gestational age ≤28 weeks that were admitted to the unit during the study period. MAIN OUTCOME MEASURES We reported the weekly and 4-week mean daily caloric and fluid intake, and growth status as changes in Fenton z-scores and weight velocity. The predictors of bronchopulmonary dysplasia were identified using multivariable logistic regression analysis. RESULTS The 4-week mean daily caloric and fluid intake were significantly lower in the BPD group. Mean z-scores of weights, weight velocity and proportions of infants with weights below the 10th percentile on day 28 of life were similar in both groups. The odds of developing BPD were increased when invasive ventilatory support was required at day 28 (OR = 16.5), and were decreased with a higher 4-week averaged daily caloric intake (OR = 0.89). CONCLUSIONS Infants with BPD received a lower caloric and fluid intake in the first month of life. In multivariable regression analysis, two independent predictors for BPD development were the need for invasive ventilatory support and a lower 4-week averaged daily caloric intake.
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Affiliation(s)
- Andra I Malikiwi
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia
| | - Yi-Man Lee
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia
| | - Miranda Davies-Tuck
- Department of Paediatrics, Monash University, Melbourne, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Flora Y Wong
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.
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Abstract
There have been amazing changes in outcomes of preterm (PT) infants in the past decades. Whereas early studies reported only survival rates, Dr. Julius Hess published the first outcome study of PT infants in Chicago in 1953. Dr. Lubchenco then published the 10-year follow-up of premature infants born in 1947-1953 and identified a 68% handicap rate. As a result of these early studies, the importance of evaluating NICU graduates both for surveillance and as an outcome of trials was recognized. During the 1970s, there was a gradual expansion in the number of follow-up programs in the United States (US) with an increasing number of follow-up studies published. In the 1980s, the importance of multicenter clinical research networks was recognized and the NICHD Neonatal Research Network (NRN) was initiated in 1986. Follow-up protocols, definitions, and outcomes have evolved over the last 30 years and will be reviewed with a focus on NICHD NRN studies.
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Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304
| | - Jamie E Newman
- Public Health Research Division, RTI International, Research Triangle Park, NC
| | - Betty R Vohr
- Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics Women & Infants Hospital of Rhode Island, Providence, RI.
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Gilarska M, Klimek M, Drozdz D, Grudzien A, Kwinta P. Blood Pressure Profile in the 7th and 11th Year of Life in Children Born Prematurely. Iran J Pediatr 2016; 26:e5080. [PMID: 28203328 PMCID: PMC5294932 DOI: 10.5812/ijp.5080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/04/2016] [Accepted: 03/27/2016] [Indexed: 01/11/2023]
Abstract
Background Several research trials have analyzed the impact of prematurity on the prevalence of hypertension (HT). However, prospective long-term studies are lacking. Objectives The aim of this study was to evaluate the prevalence of HT at the age of 7 and 11 years in a regional cohort of preterm infants with a birth weight of ≤ 1000 g. Patients and Methods This study included 67 children with a birth weight of ≤ 1000 g who were born in Malopolska between September 2002 and August 2004. The control group consisted of 38 children born at term, matched for age. Each child underwent 24-h ambulatory blood pressure measurement (ABPM) twice, once at the age of 7 and again at 11 years. The presence of HT was estimated according to the mean arterial pressure (MAP) and a number of individual measurements. Results At aged 7 years, preterm infants had a significantly higher incidence of HT, defined on the basis of MAP (15% vs. 0%; P < 0.02) and on the percent of individual measurements (56% vs. 33%, P < 0.036). After taking into account the group of patients who received anti-HT treatment after the first part of the study, the incidence of HT at the age of 11 years based on MAP was 19% vs. 10%. Based on the individual measurements, it was 36.5% in the preterm infants vs. 24% in the control group. The differences were not statistically significant. At both time points, the preterm group had a higher mean heart rate (HR) than the control group. Conclusions Children born prematurely are predisposed to HT in later life, in addition to the persistence of an increased HR.
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Affiliation(s)
- Maja Gilarska
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
- Corresponding author: Maja Gilarska, Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland. Tel: +48-126582011, Fax: +48-126584446, E-mail:
| | - Malgorzata Klimek
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Dorota Drozdz
- Department of Pediatric Nephrology, Jagiellonian University Medical College, Cracow, Poland
| | - Andrzej Grudzien
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
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Reali A, Greco F, Marongiu G, Deidda F, Atzeni S, Campus R, Dessì A, Fanos V. Individualized fortification of breast milk in 41 Extremely Low Birth Weight (ELBW) preterm infants. Clin Chim Acta 2015; 451:107-10. [PMID: 25916695 DOI: 10.1016/j.cca.2015.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of breast milk presents numerous early and long-term advantages for ELBW preterms. However, breast milk without fortification does not cover the high nutritional needs of such patients. The aim of our study was to assess the effect of individualized fortification of breast milk on the growth of ELBWs hospitalized in a neonatal intensive care unit (NICU). METHODS Retrospective single-center observational study. RESULTS We assessed the growth of 41 consecutive ELBWs (21 females, 20 males) with gestational ages between 23 and 30 weeks (mean GA 26.31±1.8) fed with breast milk in an individualized way. The rate of growth as the mean weight increase with breast milk fortification was 16.04±3.13 g/kg/day, more than the growth of the fetus in the uterus (~15 g/kg/day). This result was confirmed also among the ELBWs of lower GA. However, only 24.4% of all the ELBWs at the time of discharge from the NICU presented an appropriate weight for their gestational age. No cases of Necrotizing Enterocolitis (NEC) were observed. CONCLUSIONS Despite high growth velocity, the ELBWs failed to remain in the same percentiles of birth and, at discharge, only 27.7% had a weight of >10 centiles. Further studies are needed to improve growth during early critical phases of development.
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Affiliation(s)
- Alessandra Reali
- Neonatal Intensive Care Unit, Neonatal Pathology, Puericulture Institute and Neonatal Section, AOU Cagliari, University of Cagliari, Italy
| | | | | | | | - Simona Atzeni
- Neonatal Intensive Care Unit, Neonatal Pathology, Puericulture Institute and Neonatal Section, AOU Cagliari, University of Cagliari, Italy
| | - Roberta Campus
- Neonatal Intensive Care Unit, Neonatal Pathology, Puericulture Institute and Neonatal Section, AOU Cagliari, University of Cagliari, Italy
| | - Angelica Dessì
- Neonatal Intensive Care Unit, Neonatal Pathology, Puericulture Institute and Neonatal Section, AOU Cagliari, University of Cagliari, Italy.
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology, Puericulture Institute and Neonatal Section, AOU Cagliari, University of Cagliari, Italy
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Shiva M, Shiva MR, Mohammadi Yeganeh L. The Survival of a 580 g Infant Conceived by In vitro. Int J Fertil Steril 2011; 5:116-8. [PMID: 24963369 PMCID: PMC4059948] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 04/23/2011] [Indexed: 11/05/2022]
Abstract
With recent improvements in maternal fetal medicine and neonatal intensive care, the survival rates of extremely low birth weight infants have been improved. In this report we describe the case of an extremely low birth weight infant due to preeclampsia, who was conceived by in vitro fertilization and is in complete physical and mental health after a one - year follow - up.
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Affiliation(s)
- Marzieh Shiva
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center,
Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran,P.O. Box: 16635-148Department of Endocrinology and Female InfertilityReproductive Biomedicine Research CenterRoyan Institute for Reproductive BiomedicineACECRTehranIran
| | - Mohammad Reza Shiva
- Department of Neonatology, Roointan-Arash Maternity Hospital, Tehran University of Medical
Sciences,Tehran, Iran
| | - Ladan Mohammadi Yeganeh
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center,
Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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