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Stolz C, Costa-Nobre DT, Sanudo A, Ferreira DMDLM, Sales Alves JM, Dos Santos JP, Miyoshi MH, Silva NMDM, Melo FPDG, da Silva RVC, Barcala D, Vale MS, de Souza Rugolo LMS, Diniz EMA, Ribeiro M, Marba STM, Cwajg S, Duarte JLMB, Gonçalves Ferri WA, Procianoy RS, Anchieta LM, de Andrade Lopes JM, de Almeida MFB, Guinsburg R. Bronchopulmonary dysplasia: temporal trend from 2010 to 2019 in the Brazilian Network on Neonatal Research. Arch Dis Child Fetal Neonatal Ed 2024; 109:328-335. [PMID: 38071522 DOI: 10.1136/archdischild-2023-325826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/15/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To evaluate the temporal trend of bronchopulmonary dysplasia (BPD) in preterm infants who survived to at least 36 weeks' post-menstrual age (PMA) and BPD or death at 36 weeks' PMA, and to analyse variables associated with both outcomes. DESIGN Retrospective cohort with data retrieved from an ongoing national registry. SETTING 19 Brazilian university public hospitals. PATIENTS Infants born between 2010 and 2019 with 23-31 weeks and birth weight 400-1499 g. MAIN OUTCOME MEASURES Temporal trend was evaluated by Prais-Winsten model and variables associated with BPD in survivors or BPD or death were analysed by logistic regression. RESULTS Of the 11 128 included infants, BPD in survivors occurred in 22%, being constant over time (annual per cent change (APC): -0.80%; 95% CI: -2.59%; 1.03%) and BPD or death in 45%, decreasing over time (APC: -1.05%; 95% CI: -1.67%; -0.43%). Being male, small for gestational age, presenting with respiratory distress syndrome, air leaks, needing longer duration of mechanical ventilation, presenting with treated patent ductus arteriosus and late-onset sepsis were associated with an increase in the chance of BPD. For the outcome BPD or death, maternal bleeding, multiple gestation, 5-minute Apgar <7, late-onset sepsis, necrotising enterocolitis and intraventricular haemorrhage were added to the variables reported above as increasing the chance of the outcome. CONCLUSION The frequency of BPD in survivors was constant and BPD or death decreased by 1.05% at each study year. These results show some improvement in perinatal care in Brazilian units which resulted in a reduction of BPD or death, but further improvements are still needed to reduce BPD in survivors.
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Affiliation(s)
- Camila Stolz
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Milton Harumi Miyoshi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Geral de Pirajussara, Taboão da Serra, São Paulo, Brazil
| | | | | | | | - Dafne Barcala
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | | | | | | | - Manoel Ribeiro
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sérgio T M Marba
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Silvia Cwajg
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, Brazil
| | | | | | - Renato S Procianoy
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leni Marcia Anchieta
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Maria de Andrade Lopes
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, Brazil
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Santiago LTC, Freitas NAD, Meira Junior JDD, Corrente JE, Paula VG, Damasceno DC, de Souza Rugolo LMS. Oxidative status in colostrum and mature breast milk related to gestational age and fetal growth. J Matern Fetal Neonatal Med 2023; 36:2183763. [PMID: 36852433 DOI: 10.1080/14767058.2023.2183763] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION The effect of gestational age and fetal growth on the oxidant/antioxidant status of breast milk is poorly understood. OBJECTIVE To evaluate the oxidative stress biomarkers in colostrum and mature milk according to gestational age and fetal growth. METHOD A longitudinal study with mothers of premature and term infants, born in a tertiary referral hospital between 2014-2018. Inclusion criteria: postpartum women with a singleton pregnancy, who intended to exclusively breastfeed. Exclusion criteria: maternal diabetes, use of medication, drug addiction, congenital infection or malformation, mastitis, and failure to collect colostrum. Four groups were formed according to gestational age and birth weight (appropriate and small): Preterm small (n = 37), Preterm appropriate (n = 99), Full-term small (n = 65), and Full-term appropriate (control, n = 69). The colostrum samples were collected between 24-72 h and the mature milk was sampled in the 4th week of lactation for malondialdehyde (biomarker for lipid peroxidation) and Glutathione peroxidase, Catalase, and Superoxide dismutase measurements. The data were compared among groups using the Chi-square test or Fisher's exact test, one-way analysis of variance followed by Wald's Distribution test and repeated measures analysis of variance. RESULTS We found a lower malondialdehyde level in colostrum in preterm groups and term small for gestational age, and the antioxidant enzymes Superoxide dismutase and Catalase activities were higher for preterm compared to term groups. The malondialdehyde levels differed in mature milk samples (Full-term small > Full-term appropriate > Preterm small > Preterm appropriate). The malondialdehyde levels increased during lactation in all groups except Preterm appropriate, and the levels of Catalase decreased in preterm groups. CONCLUSION The oxidative status in breast milk is influenced by gestational age and fetal growth, which increased antioxidant defense for preterm infants and decreased oxidative stimuli for small for gestational age infants. These findings contribute to encouraging breastfeeding for newborns.
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Affiliation(s)
| | | | | | - José Eduardo Corrente
- Institute of Biosciences of Botucatu, UNESP_Univ Estadual Paulista, São Paulo State, Brazil
| | - Verônyca Gonçalves Paula
- Laboratory of Experimental Research on Gynecology and Obstetrics, Postgraduate Course on Tocogynecology, Univ Estadual Paulista_Unesp, Botucatu, São Paulo State, Brazil
| | - Debora Cristina Damasceno
- Laboratory of Experimental Research on Gynecology and Obstetrics, Postgraduate Course on Tocogynecology, Univ Estadual Paulista_Unesp, Botucatu, São Paulo State, Brazil
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Poliseli GB, Hamamoto JF, Rugolo LMSDS, Zanini MA, Hamamoto Filho PT. Addressing expectations of therapeutic options for children with hydrocephalus-A comment on "Fetal Cerebral Ventriculomegaly. What do we tell the prospective parents?". Prenat Diagn 2023; 43:404-405. [PMID: 36639924 DOI: 10.1002/pd.6304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Gianfelipe Belini Poliseli
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Juliana Fattori Hamamoto
- Department of Pediatrics, Botucatu Medical School, UNESP - Universidade Estadual Paulista. Botucatu, Botucatu, São Paulo, Brazil
| | | | - Marco Antonio Zanini
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
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Lyra JC, Guinsburg R, de Almeida MFB, Variane GFT, Souza Rugolo LMSD. Use of laryngeal mask for neonatal resuscitation in Brazil: A national survey. Resusc Plus 2022; 13:100336. [PMID: 36582476 PMCID: PMC9792880 DOI: 10.1016/j.resplu.2022.100336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/06/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background The International Liaison Committee on Resuscitation suggests using the laryngeal mask airway (LMA) as an alternative to the face mask for performing positive pressure ventilation (PPV) in the delivery room in newborns ≥34 weeks. Because not much is known about the health professionals' familiarity in using LMA in Brazil, this study aimed to describe the health professionals' knowledge and practice of using LMA, who provide neonatal care in the country. Methods An online questionnaire containing 29 questions was sent to multi-healthcare professionals from different regions in the country through email and social media groups (WhatsApp®, Instagram®, Facebook®, and LinkedIn®). The participants anonymously answered the questions regarding their knowledge and expertise in using LMA to ventilate newborns in the delivery room. Results We obtained 749 responses from all the regions in Brazil, with 80% from health professionals working in public hospitals. Most respondents were neonatologists (73%) having > 15 years of clinical practice. Among the respondents, 92% recognized the usefulness of LMA for performing PPV in newborns, 59% did not have specific training in LMA insertion, and only 8% reported that they have already used LMA in the delivery room. In 90% of the hospitals, no written protocol was available to use LMA; and in 68% of the hospitals, LMA was not available for immediate use. Conclusion This nationwide survey showed that most professionals recognize the usefulness of LMA. However, the device is scarcely available and underused in the routine of ventilatory assistance for newborns in delivery rooms in Brazil.
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Affiliation(s)
- João Cesar Lyra
- Department of Pediatrics, UNESP – Univ Estadual Paulista, Sao Paulo State, Brazil,Corresponding author at: Department of Pediatrics, UNESP – Univ Estadual Paulista, Sao Paulo State, Distrito de Rubiao Junior – Av. Prof, Mario Rubens Guimaraes Montenegro s/n; Botucatu, Sao Paulo 18618-687, Brazil.
| | - Ruth Guinsburg
- Division of Neonatal Medicine - Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil
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Pelícia SMDC, Fekete SMW, Corrente JE, Rugolo LMSDS. Impact of early-onset preeclampsia on feeding tolerance and growth of very low birth weight infants during hospitalization. Rev Paul Pediatr 2022; 41:e2021203. [PMID: 36102397 PMCID: PMC9462405 DOI: 10.1590/1984-0462/2023/41/2021203] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/10/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The provision of adequate enteral nutrition to preterm infants is a great challenge, and preeclampsia (PE) may have a detrimental effect on the safety of nutrition supply. This study aims to investigate the influence of early-onset PE on preterm infants' enteral feeding tolerance and growth during hospitalization. METHODS This is a prospective study with 55 preterm infants <34 weeks born to PE mothers matched by gestational age with 55 preterm infants born to normotensive mothers from 2013 to 2016. We evaluated maternal, gestational, and neonatal clinical data. The outcomes were feeding intolerance and growth during hospitalization. Comparison between groups was performed by Student's t-test or Mann-Whitney U test, chi-square test, or Fisher's exact test. Multiple logistic regression was used to investigate whether PE was an independent risk factor for feeding intolerance. RESULTS The mean gestational age was 30 weeks. Preterm infants of mothers with PE had lower birth weight and were smaller at discharge. Feeding intolerance was frequent, but necrotizing enterocolitis was rare in this sample (PE=4% vs. control=2%) with no difference between groups. Preterm infants of mothers with PE had worse growth outcomes; however, PE was not an independent risk factor for feeding intolerance. The increase in gestational age was a protective factor, and being born small for gestational age (SGA) increased the risk of feeding intolerance by six times. CONCLUSIONS Preterm infants of mothers with early-onset PE were more likely to be born SGA and had a worse growth trajectory during hospitalization. In adjusted analyses, however, low gestational age and SGA were independent predictors of feeding intolerance.
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Affiliation(s)
- Simone Manso de Carvalho Pelícia
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu – Botucatu, SP, Brazil.,Corresponding author. E-mail: (S. M. C. Pelícia)
| | | | - Jose Eduardo Corrente
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu – Botucatu, SP, Brazil
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Rugolo LMSDS, Bentlin MR, Almeida MFBD, Guinsburg R, Carvalho WBD, Marba STM, Almeida JHCLD, Luz JH, Procianoy RS, Duarte JLMB, Anchieta LM, Ferreira DMDLM, Alves Júnior JMS, Diniz EMDA, Santos JPFD, Gimenes CB, Silva NMDME, Ferrari LL, Silva RPGVCD, Meneses J, Gonçalves-Ferri WA, Vale MSD, Brine H, Weiner GM. Risk Perception and Decision Making about Early-Onset Sepsis among Neonatologists: A National Survey. Am J Perinatol 2022; 39:1117-1123. [PMID: 33341925 DOI: 10.1055/s-0040-1721691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions. STUDY DESIGN Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients. RESULTS In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions. CONCLUSION Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS. KEY POINTS · Neonatologists overestimate the risk of EOS.. · There is wide variation in diagnostic/treatment thresholds for EOS.. · Clinical decision on EOS is not consistent with risk thresholds.. · Knowledge of risk may increase investigation and treatment of EOS..
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Affiliation(s)
| | - Maria Regina Bentlin
- Division of Neonatology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista-UNESP, Botucatu, Brazil
| | | | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Jorge Hecker Luz
- Department of Pediatrics, Hospital São Lucas-Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato Soibelmann Procianoy
- Division of Neonatology, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre -HCPA, Porto Alegre, Brazil
| | - José Luiz Muniz Bandeira Duarte
- Department of Pediatrics, Hospital Universitário Pedro Ernesto-Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leni Márcia Anchieta
- Division of Neonatology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Edna Maria de Albuquerque Diniz
- Division of Neonatology, University of São Paulo, Brazil da Universidade de São Paulo, Hospital Universitário, São Paulo, Brazil
| | | | | | | | - Lígia Lopes Ferrari
- Department of Pediatrics, Hospital Universitário-Universidade Estadual de Londrina, Londrina, Brazil
| | | | - Jucille Meneses
- Department of Pediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Walusa Assad Gonçalves-Ferri
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Holly Brine
- Departent of Pediatrics, Promedica Toledo Children's Hospital, University of Toledo, Ohio
| | - Gary M Weiner
- Department of Pediatrics, Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, Michigan
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Assad Gonçalves-Ferri W, Martinez FE, Martins-Celini FP, de Almeida JHCL, Procianoy R, Duarte JLMB, Carvalho EAA, de Lima Mota Ferreira DM, Alves Filho N, Santos JP, Gimenez CB, do Santos CN, Ferrari LSL, Venzon PS, Meneses J, do Vale MS, de Souza Rugolo LMS, de Almeida MFB, Krebs VLJ, de Albuquerque Diniz EM, Fiori HH, Marba STM. Evaluation of the effectiveness of antenatal corticoid in preterm twin and single pregnancies: a multicenter cohort study. J Matern Fetal Neonatal Med 2021; 35:3502-3508. [PMID: 34157931 DOI: 10.1080/14767058.2020.1822806] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND The effects of antenatal corticosteroids (ANSs) on twins are not well established. OBJECTIVE To determine the impact of ANS use according to the number of fetuses. METHODS Retrospective cohort study of newborns between 23 and 33 weeks of gestational age, birth weight from 400 to 1499 g, without malformations, delivered at 20 public university hospitals from 2010 to 2014.Exposed group: Received ANS (any time, any dose) and no exposed group: no received ANS. Analysis of birth conditions and clinical outcomes. Association of variables, relative risks, and 95% confidence intervals estimated from the adjustment of log-binomial regression models. RESULTS About 7165 premature infants were analyzed: 5167 singleton, 937 twins, and 104 triplets. Characteristics of gestations with one, two, or three fetuses not receiving ANS were similar. Reduced hemodynamic instability in single and twins gestations in the first 72 h were observed (Adj R2 Twins = 0.78; 95% CI = 0.69-0.86) (Adj R2 Singles = 0.79; 95% CI = 0.62-0.99). Reduced peri-intraventricular hemorrhage (Adj R2 Twins = 0.54; 95% CI = 0.36-0.78) (Adj R2 singles = 0.54; 95% CI = 0.36-0.78); and early sepsis reduction on single and triplex gestations (Adj R2 triplex = 0.51; 95% CI = 0.27-0.94) (Adj single R2 = 0.51; 95% CI = 0.27-0.94) were observed. CONCLUSIONS This study demonstrates ANS produces an important protective factor for severe intraventricular hemorrhage and hemodynamic instability in single and multiple pregnancies. ANS had a protective effect on death and birth conditions improvement just in single gestations. Regarding respiratory aspects was not observed the protective effect in the single or multiple gestations.
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Affiliation(s)
- Walusa Assad Gonçalves-Ferri
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, State of São Paulo, Brazil
| | - Francisco Eulógio Martinez
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, State of São Paulo, Brazil
| | - Fábia Pereira Martins-Celini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, State of São Paulo, Brazil
| | | | - Renato Procianoy
- Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre Clinic Hospital, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - José Luiz Muniz Bandeira Duarte
- Department of Pediatrics, Universitary Hospital Pedro, Rio de Janeiro State University, Rio de Janeiro, State of Rio de Janeiro, Brazil
| | | | | | - Navantino Alves Filho
- Department of Pediatrics, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, State of Minas Gerais, Brazil
| | - Juliana Paula Santos
- Department of Pediatrics, Sumare State Hospital, State University of Campinas, Campinas, State of São Paulo, Brazil
| | - Carolina Boschi Gimenez
- Pirajussara State Hospital, Department of Pediatrics, Federal University of São Paulo, São Paulo, State of São Paulo, Brazil
| | - Cristina Nunes do Santos
- State Hospital Diadema, Neonatal Unit, São Paulo Federal University, São Paulo, State of São Paulo, Brazil
| | - Ligia S Lopes Ferrari
- Department of Pediatrics, Londrina State University Health Sciences Center, Londrina, State of Paraná, Brazil
| | - Paulyne Stadler Venzon
- Department of Pediatrics, Federal University of Parana, Curitiba, State of Paraná, Brazil
| | - Jucille Meneses
- Department of Pediatrics, Professor Fernando Figueira Institute of Integral Medicine, Recife, State of Pernambuco, Brazil
| | - Marynéa Silva do Vale
- Department of Pediatrics, University Hospital of the Federal University of Maranhão, São Luiz, State of Maranhão, Brazil
| | - Ligia Maria Suppo de Souza Rugolo
- Department of Pediatrics, Botucatu Medical School- São Paulo State University Julio de Mesquita Neto, Botucatu, State of São Paulo, Brazil
| | | | - Vera Lucia Jornada Krebs
- Department of Pediatrics, Children's Institute, São Paulo Medical School, University of São Paulo, São Paulo, State of São Paulo, Brazil
| | - Edna Maria de Albuquerque Diniz
- Department of Pediatrics, University Hospital, São Paulo Medical School, University of São Paulo, São Paulo, State of São Paulo, Brazil
| | - Humberto Holmer Fiori
- Department of Pediatrics, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, State of Rio Grande do Sul, Brazil
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Pelicia SMDC, Fekete SMW, Corrente JE, Rugolo LMSDS. The effect of early-onset preeclampsia on the intestinal blood flow of preterm infants. J Matern Fetal Neonatal Med 2019; 34:2235-2239. [PMID: 31455129 DOI: 10.1080/14767058.2019.1661378] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Preeclampsia is associated with important vascular maternal changes. However, its repercussions on newborns' circulation have hardly been reported. OBJECTIVE To investigate whether early-onset preeclampsia is associated with altered blood flow of the superior mesenteric artery (SMA) in preterm infants. MATERIALS AND METHODS Prospective study with 60 preterm infants of mothers with early-onset preeclampsia (PE) and 60 of normotensive mothers, paired according to the gestational age, from 2013 to 2016. Maternal, gestational, and neonatal clinical data were evaluated. The outcome of interest was the blood flow velocity in SMA, evaluated by the peak systolic velocity and end-diastolic velocity and by the resistance index and pulsatility index, through the Doppler ultrasound in the first 72 h of life. Covariance analysis was used to determine the PE effect on the SMA blood flow, controlling for possible confounding variables. RESULTS The mean gestational age was 30 weeks. Infants of mothers with PE had significantly lower values of peak systolic and end-diastolic velocity (57.75 ± 17.49 and 12.29 ± 5.74) compared with the control group (67.17 ± 29.57 and 15.03 ± 7.52), even after control of covariates. CONCLUSION Early-onset preeclampsia is associated with decreased blood flow of SMA in preterm infants on the first days of life.
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Padrini-Andrade L, Balda RDCX, Areco KCN, Bandiera-Paiva P, Nunes MDV, Marba STM, Carvalho WBD, Rugolo LMSDS, Almeida JHCD, Procianoy RS, Duarte JLMB, Rego MAS, Ferreira DMDLM, Alves Filho N, Guinsburg R, Diniz EMDA, Santos JPFD, Testoni D, Silva NMDME, Gonzales MRC, Silva RVCD, Meneses J, Gonçalves-Ferri WA, Perussi-E-Silva R, Bomfim O. EVALUATION OF USABILITY OF A NEONATAL HEALTH INFORMATION SYSTEM ACCORDING TO THE USER'S PERCEPTION. ACTA ACUST UNITED AC 2018; 37:90-96. [PMID: 30569950 PMCID: PMC6362369 DOI: 10.1590/1984-0462/;2019;37;1;00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/04/2017] [Indexed: 11/23/2022]
Abstract
Objective: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. Methods: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. Results: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as “good”, “excellent” or “better than imaginable”. The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. Conclusion: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ruth Guinsburg
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Jucille Meneses
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil
| | | | | | - Olga Bomfim
- Rede Brasileira de Pesquisas Neonatais, Rio de Janeiro, RJ, Brasil
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Freitas NAD, Santiago LTC, Kurokawa CS, Meira Junior JDD, Corrente JE, Rugolo LMSDS. Effect of preeclampsia on human milk cytokine levels. J Matern Fetal Neonatal Med 2018; 32:2209-2213. [DOI: 10.1080/14767058.2018.1429395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Natália Alves de Freitas
- Department of Pediatrics, Botucatu School of Medicine, University Estadual Paulista (UNESP), Botucatu, Brazil
| | | | - Cilmery Suemi Kurokawa
- Department of Pediatrics, Botucatu School of Medicine, University Estadual Paulista (UNESP), Botucatu, Brazil
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Guinsburg R, de Almeida MFB, de Castro JS, Gonçalves-Ferri WA, Marques PF, Caldas JPS, Krebs VLJ, Souza Rugolo LMSD, de Almeida JHCL, Luz JH, Procianoy RS, Duarte JLMB, Penido MG, Ferreira DMDLM, Alves Filho N, Diniz EMDA, Santos JP, Acquesta AL, Santos CND, Gonzalez MRC, da Silva RPVC, Meneses J, Lopes JMDA, Martinez FE. T-piece versus self-inflating bag ventilation in preterm neonates at birth. Arch Dis Child Fetal Neonatal Ed 2018; 103:F49-F55. [PMID: 28663283 DOI: 10.1136/archdischild-2016-312360] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 11/12/2016] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. DESIGN Pragmatic prospective cohort study. SETTING 20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded. INTERVENTIONS Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome. RESULTS 1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695). CONCLUSION This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.
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Affiliation(s)
- Ruth Guinsburg
- Division of Neonatal Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Walusa Assad Gonçalves-Ferri
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Jamil Pedro Siqueira Caldas
- Department of Pediatrics, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, Brazil
| | | | | | | | - Jorge Hecker Luz
- Department of Pediatrics, Hospital São Lucas - Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato S Procianoy
- Division of Neonatology, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - José Luiz Muniz Bandeira Duarte
- Department of Pediatrics, Hospital Universitário Pedro Ernesto - Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Gomes Penido
- Division of Neonatology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Navantino Alves Filho
- Department of Pediatrics, Maternidade Hilda Brandão - Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | | | - Jucile Meneses
- Department of Pediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | | | - Franciscó Eulógio Martinez
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Prestes ACY, Balda RDCX, Santos GMSD, Rugolo LMSDS, Bentlin MR, Magalhães M, Pachi PR, Marba STM, Caldas JPDS, Guinsburg R. Painful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten‐year period? Jornal de Pediatria (Versão em Português) 2016. [DOI: 10.1016/j.jpedp.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Prestes ACY, Balda RDCX, Santos GMSD, Rugolo LMSDS, Bentlin MR, Magalhães M, Pachi PR, Marba STM, Caldas JPDS, Guinsburg R. Painful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten-year period? J Pediatr (Rio J) 2016; 92:88-95. [PMID: 26453514 DOI: 10.1016/j.jped.2015.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 03/12/2015] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the use of analgesia versus neonatologists' perception regarding analgesic use in painful procedures in the years 2001, 2006, and 2011. METHODS This was a prospective cohort study of all newborns admitted to four university neonatal intensive care units during one month in 2001, 2006, and 2011. The frequency of analgesic prescription for painful procedures was evaluated. Of the 202 neonatologists, 188 answered a questionnaire giving their opinion on the intensity of pain during lumbar puncture, tracheal intubation, mechanical ventilation, and postoperative period using a 10-cm visual analogic scale (VAS; pain >3cm). RESULTS For lumbar puncture, 12% (2001), 43% (2006), and 36% (2011) were performed using analgesia. Among the neonatologists, 40-50% reported VAS >3 for lumbar puncture in all study periods. For intubation, 30% received analgesia in the study periods, and 35% (2001), 55% (2006), and 73% (2011) of the neonatologists reported VAS >3 and would prescribe analgesia for this procedure. As for mechanical ventilation, 45% (2001), 64% (2006), and 48% (2011) of patient-days were under analgesia; 56% (2001), 57% (2006), and 26% (2011) of neonatologists reported VAS >3 and said they would use analgesia during mechanical ventilation. For the first three post-operative days, 37% (2001), 78% (2006), and 89% (2011) of the patients received analgesia and more than 90% of neonatologists reported VAS >3 for major surgeries. CONCLUSIONS Despite an increase in the medical perception of neonatal pain and in analgesic use during painful procedures, the gap between clinical practice and neonatologist perception of analgesia need did not change during the ten-year period.
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Affiliation(s)
- Ana Claudia Yoshikumi Prestes
- Division of Neonatal Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Rita de Cássia Xavier Balda
- Division of Neonatal Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Ligia Maria Suppo de Souza Rugolo
- Department of Pediatrics, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP, Brazil
| | - Maria Regina Bentlin
- Department of Pediatrics, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP, Brazil
| | - Mauricio Magalhães
- Department of Pediatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil; Service of Neonatology, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Paulo Roberto Pachi
- Department of Pediatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | | | - Jamil Pedro de Siqueira Caldas
- Division of Neonatology, Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Centro de Atenção Integral à Saúde da Mulher (CAISM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
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Kiy AM, Rugolo LMSDS. Author's reply: Maternal hypertension and infant growth. J Pediatr (Rio J) 2015; 91:604-5. [PMID: 26387710 DOI: 10.1016/j.jped.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Alice Maria Kiy
- Neonatal Unit, Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.
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Rugolo LMSDS, de Sá MPA, Kurokawa CS, Madoglio RJ, Bentlin MR, Rugolo A, Corrente JE. There is no difference in nitric oxide metabolites and neonatal outcome between premature infants born to pre-eclamptic and those born to normotensive women. Paediatr Int Child Health 2015; 35:47-52. [PMID: 25547177 DOI: 10.1179/2046905514y.0000000127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The pathophysiology of pre-eclampsia (PE) is complex, and nitric oxide (NO) may be a factor. The neonatal outcome in pregnancies complicated by PE is controversial, and the PE/NO/neonatal diseases relationship has not been well established. AIMS To measure nitrate and nitrite levels in the placenta, umbilical cord blood, blood and urine of preterm neonates born to pre-eclamptic and normotensive women and to investigate the relationship between placental, fetal and neonatal NO metabolites and neonatal outcome. METHODS A prospective study was undertaken of 30 preterm infants <34 weeks of gestation, born to pre-eclamptic mothers and matched by gestational age with 30 infants born to normotensive mothers. Samples from the placental tissue, venous cord blood and the newborns' blood on day 4 and urine on days 1 and 4 were assayed for NO metabolites (nitrate and nitrite). Clinical variables and NO metabolites were compared between the groups. Generalised linear models were fitted to associate NO metabolites levels with adverse neonatal outcomes. RESULTS There were no differences in NO metabolites and neonatal outcomes between the two groups. Increased levels of NO metabolites were found in the placenta and cord blood of small-for-gestational-age infants, and in the cord blood of newborns with necrotising enterocolitis and those who died. CONCLUSION NO metabolite levels in the placenta and fetal and neonatal circulation were not associated with PE; however, cord blood levels of NO metabolites differed according to fetal growth and neonatal outcome.
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de Souza Rugolo LMS, Bentlin MR, Mussi-Pinhata M, de Almeida MFB, Lopes JMDA, Marba STM, Fiori HH, Procianoy RS, Leone CR. Late-onset sepsis in very low birth weight infants: a Brazilian Neonatal Research Network Study. J Trop Pediatr 2014; 60:415-21. [PMID: 25063461 DOI: 10.1093/tropej/fmu038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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] [Indexed: 11/14/2022]
Abstract
BACKGROUND Late-onset sepsis (LOS) is an important cause of morbidity and mortality in very low birth weight (VLBW) infants. AIM To determine the incidence, risk factors and etiology of LOS. METHODS LOS was investigated in a multicenter prospective cohort of infants at eight public university neonatal intensive care units (NICUs). Inclusion criteria included inborn, 23-33 weeks of gestational age, 400-1499 g birth weight, who survived >3 days. RESULTS Of 1507 infants, 357 (24%) had proven LOS and 345 (23%) had clinical LOS. Infants with LOS were more likely to die. The majority of infections (76%) were caused by Gram-positive organisms. Independent risk factors for proven LOS were use of central venous catheter and mechanical ventilation, age at the first feeding and number of days on parenteral nutrition and on mechanical ventilation. CONCLUSION LOS incidence and mortality are high in Brazilian VLBW infants. Most risk factors are associated with routine practices at NICU.
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Affiliation(s)
| | - Maria Regina Bentlin
- Department of Pediatrics, Botucatu School of Medicine, Sao Paulo State University-UNESP, Botucatu, SP, Brazil
| | | | | | | | | | - Humberto Holmer Fiori
- Department of Pediatrics, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Riboli DFM, Lyra JC, Silva EP, Valadão LL, Bentlin MR, Corrente JE, Rugolo LMSDS, da Cunha MDLRDS. Diagnostic accuracy of semi-quantitative and quantitative culture techniques for the diagnosis of catheter-related infections in newborns and molecular typing of isolated microorganisms. BMC Infect Dis 2014; 14:283. [PMID: 24886379 PMCID: PMC4051137 DOI: 10.1186/1471-2334-14-283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 04/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catheter-related bloodstream infections (CR-BSIs) have become the most common cause of healthcare-associated bloodstream infections in neonatal intensive care units (ICUs). Microbiological evidence implicating catheters as the source of bloodstream infection is necessary to establish the diagnosis of CR-BSIs. Semi-quantitative culture is used to determine the presence of microorganisms on the external catheter surface, whereas quantitative culture also isolates microorganisms present inside the catheter. The main objective of this study was to determine the sensitivity and specificity of these two techniques for the diagnosis of CR-BSIs in newborns from a neonatal ICU. In addition, PFGE was used for similarity analysis of the microorganisms isolated from catheters and blood cultures. METHODS Semi-quantitative and quantitative methods were used for the culture of catheter tips obtained from newborns. Strains isolated from catheter tips and blood cultures which exhibited the same antimicrobial susceptibility profile were included in the study as positive cases of CR-BSI. PFGE of the microorganisms isolated from catheters and blood cultures was performed for similarity analysis and detection of clones in the ICU. RESULTS A total of 584 catheter tips from 399 patients seen between November 2005 and June 2012 were analyzed. Twenty-nine cases of CR-BSI were confirmed. Coagulase-negative staphylococci (CoNS) were the most frequently isolated microorganisms, including S. epidermidis as the most prevalent species (65.5%), followed by S. haemolyticus (10.3%), yeasts (10.3%), K. pneumoniae (6.9%), S. aureus (3.4%), and E. coli (3.4%). The sensitivity of the semi-quantitative and quantitative techniques was 72.7% and 59.3%, respectively, and specificity was 95.7% and 94.4%. The diagnosis of CR-BSIs based on PFGE analysis of similarity between strains isolated from catheter tips and blood cultures showed 82.6% sensitivity and 100% specificity. CONCLUSION The semi-quantitative culture method showed higher sensitivity and specificity for the diagnosis of CR-BSIs in newborns when compared to the quantitative technique. In addition, this method is easier to perform and shows better agreement with the gold standard, and should therefore be recommended for routine clinical laboratory use. PFGE may contribute to the control of CR-BSIs by identifying clusters of microorganisms in neonatal ICUs, providing a means of determining potential cross-infection between patients.
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Affiliation(s)
- Danilo Flávio Moraes Riboli
- Departamento de Microbiologia e Imunologia, Instituto de Biociências, UNESP - Univ Estadual Paulista, Botucatu, SP, Brasil.
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de Almeida MFB, Guinsburg R, Sancho GA, Rosa IRM, Lamy ZC, Martinez FE, da Silva RPGVC, Ferrari LSL, de Souza Rugolo LMS, Abdallah VOS, Silveira RDC. Hypothermia and early neonatal mortality in preterm infants. J Pediatr 2014; 164:271-5.e1. [PMID: 24210925 DOI: 10.1016/j.jpeds.2013.09.049] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/22/2013] [Accepted: 09/20/2013] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate intervention practices associated with hypothermia at both 5 minutes after birth and at neonatal intensive care unit (NICU) admission and to determine whether hypothermia at NICU admission is associated with early neonatal death in preterm infants. STUDY DESIGN This prospective cohort included 1764 inborn neonates of 22-33 weeks without malformations admitted to 9 university NICUs from August 2010 through April 2012. All centers followed neonatal International Liaison Committee on Resuscitation recommendations for the stabilization and resuscitation in the delivery room (DR). Variables associated with hypothermia (axillary temperature <36.0 °C) 5 minutes after birth and at NICU admission, as well as those associated with early death, were analyzed by logistic regression. RESULTS Hypothermia 5 minutes after birth and at NICU admission was noted in 44% and 51%, respectively, with 6% of early neonatal deaths. Adjusted for confounding variables, practices associated with hypothermia at 5 minutes after birth were DR temperature <25 °C (OR 2.13, 95% CI 1.67-2.28), maternal temperature at delivery <36.0 °C (OR 1.93, 95% CI 1.49-2.51), and use of plastic bag/wrap (OR 0.53, 95% CI 0.40-0.70). The variables associated with hypothermia at NICU admission were DR temperature <25 °C (OR 1.44, 95% CI 1.10-1.88), respiratory support with cold air in the DR (OR 1.40, 95% CI 1.03-1.88) and during transport to NICU (OR 1.51, 95% CI 1.08-2.13), and cap use (OR 0.55, 95% CI 0.39-0.78). Hypothermia at NICU admission increased the chance of early neonatal death by 1.64-fold (95% CI 1.03-2.61). CONCLUSION Simple interventions, such as maintaining DR temperature >25 °C, reducing maternal hypothermia prior to delivery, providing plastic bags/wraps and caps for the newly born infants, and using warm resuscitation gases, may decrease hypothermia at NICU admission and improve early neonatal survival.
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Affiliation(s)
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
| | - Guilherme Assis Sancho
- Division of Neonatal Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Izilda Rodrigues Machado Rosa
- Department of Pediatrics, Universidade Estadual de Campinas/Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Campinas, SP, Brazil
| | - Zeni Carvalho Lamy
- Department of Public Health, Universidade Federal do Maranhão/Hospital Universitário, São Luís, MA, Brazil
| | - Francisco Eulógio Martinez
- Department of Pediatrics, Universidade de São Paulo/Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | - Lígia Silvana Lopes Ferrari
- Department of Pediatrics and Pediatric Surgery, Universidade Estadual de Londrina/Hospital Universitário, Londrina, PR, Brazil
| | | | | | - Rita de Cássia Silveira
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Kurokawa CS, Hashimoto M, de Souza Rugolo LMS, Bentlin MR, Golin MDA, Peraçoli JC, da Silva MG, Corrente JE, Fekete SMW. Cord blood cytokine levels in focal early-onset neonatal infection after preterm premature rupture of membranes. Turk J Pediatr 2013; 55:598-605. [PMID: 24577977] [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] [Indexed: 06/03/2023]
Abstract
This study aimed to evaluate the levels of pro- and anti-inflammatory cytokines in umbilical cord blood of preterm neonates who developed focal early-onset infection (EOI) after preterm premature rupture of membranes (PPROM). This is a prospective study conducted on 46 preterm infants from mothers with PPROM. The cytokines were measure by flow cytometry. Newborns were classified into two groups as focal EOI (n=19) and non-infected (n=27). Interleukin (IL)-6 and IL-8 levels were higher, whereas IL-10 and IL-12 p70 levels were lower in the EOI when compared to the non-infected group. The best combination of cytokines was IL-6+IL-8, with a diagnostic accuracy of 0.97. Focal EOI after PPROM is associated with increased levels of IL-6 and IL-8 and diminished IL-10 and IL-12 in the cord blood of preterm infants. Combined assessment of IL-6 and IL-8 in cord blood may provide an additional tool for identifying preterm infants who develop EOI after PPROM.
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MESH Headings
- Biomarkers/blood
- Cytokines/metabolism
- Enzyme-Linked Immunosorbent Assay
- Female
- Fetal Blood/metabolism
- Fetal Membranes, Premature Rupture/blood
- Fetal Membranes, Premature Rupture/immunology
- Flow Cytometry
- Follow-Up Studies
- Humans
- Immunity, Innate
- Infant, Premature
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/immunology
- Pregnancy
- Prospective Studies
- Sepsis/blood
- Sepsis/diagnosis
- Time Factors
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Affiliation(s)
- Cilmery Suemi Kurokawa
- Department of Pediatrics Bioscience Institute of Botucatu, UNESP, Botucatu, São Paulo, Brazil. ,
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Bentlin MR, Ferreira GL, Rugolo LMSDS, Silva GHS, Mondelli AL, Rugolo Júnior A. Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center. Arq Neuropsiquiatr 2011; 68:882-7. [PMID: 21243246 DOI: 10.1590/s0004-282x2010000600010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 05/17/2010] [Indexed: 11/22/2022]
Abstract
The aim of this study was to evaluate the incidence of and mortality due to meningitis and compare data according to microbiological diagnosis. This was a ten-year retrospective study conducted at a neonatal intensive care unit (NICU). Newborns with meningitis confirmed by positive CSF culture were included; those with congenital infection or malformations that made lumbar puncture impossible were excluded. The variables investigated were birth weight, gestational and postnatal age, procedures, hematological and CSF parameters, and complications. Parametric and non-parametric tests were used (statistical value p<0.05). The incidence of meningitis was 0.6% and mortality was 27%. Of the 22 cases, 59% involved Gram-negative bacteria; 36% Gram-positive and 5% fungi. The groups did not differ in relation to birth weight, gestational and postnatal age, procedures or hematological and CSF parameters. Sepsis, convulsions and deaths were frequent in both groups, without statistical difference. Gram-negative cases showed abscesses and higher frequency of ventriculitis and hydrocephaly. Meningitis was infrequent, but presented high mortality and frequent complications.
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Affiliation(s)
- Maria Regina Bentlin
- Department of Pediatrics, Hospital das Clínicas, Botucatu Medical School, UNESP, SP, Brazil.
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dos Santos AMN, Guinsburg R, de Almeida MFB, Procianoy RS, Leone CR, Marba STM, Rugolo LMSDS, Fiori HH, Lopes JMDA, Martinez FE. Red blood cell transfusions are independently associated with intra-hospital mortality in very low birth weight preterm infants. J Pediatr 2011; 159:371-376.e1-3. [PMID: 21489555 DOI: 10.1016/j.jpeds.2011.02.040] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 01/04/2011] [Accepted: 02/28/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test the hypothesis that red blood cell (RBC) transfusions in preterm infants are associated with increased intra-hospital mortality. STUDY DESIGN Variables associated with death were studied with Cox regression analysis in a prospective cohort of preterm infants with birth weight <1500 g in the Brazilian Network on Neonatal Research. Intra-hospital death and death after 28 days of life were analyzed as dependent variables. Independent variables were infant demographic and clinical characteristics and RBC transfusions. RESULTS Of 1077 infants, 574 (53.3%) received at least one RBC transfusion during the hospital stay. The mean number of transfusions per infant was 3.3 ± 3.4, with 2.1 ± 2.1 in the first 28 days of life. Intra-hospital death occurred in 299 neonates (27.8%), and 60 infants (5.6%) died after 28 days of life. After adjusting for confounders, the relative risk of death during hospital stay was 1.49 in infants who received at least one RBC transfusion in the first 28 days of life, compared with infants who did not receive a transfusion. The risk of death after 28 days of life was 1.89 times higher in infants who received more than two RBC transfusions during their hospital stay, compared with infants who received one or two transfusions. CONCLUSION Transfusion was associated with increased death, and transfusion guidelines should consider risks and benefits of transfusion.
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Nakamura G, Ganem EM, Rugolo LMSDS, Castiglia YMM. Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia. Rev Assoc Med Bras (1992) 2009; 55:405-9. [DOI: 10.1590/s0104-42302009000400014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 12/04/2008] [Indexed: 11/22/2022] Open
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Nakamura G, Ganem EM, Módolo NSP, Rugolo LMSDS, Castiglia YMM. Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial. SAO PAULO MED J 2008; 126:102-6. [PMID: 18553032 DOI: 10.1590/s1516-31802008000200007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 03/28/2008] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group) or 15 ml of ropivacaine 0.0625% plus 75 microg clonidine (RC group). Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score). RESULTS There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. CONCLUSION Both low-dose ropivacaine and a lower dose plus clonidine relieved maternal pain during obstetric labor. Newborns of mothers who received only ropivacaine showed better neurological and adaptive capacity scores.
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Affiliation(s)
- Giane Nakamura
- Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
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Cunha MDLRDSD, Rugolo LMSDS, Lopes CADM. Study of virulence factors in coagulase-negative staphylococci isolated from newborns. Mem Inst Oswaldo Cruz 2007; 101:661-8. [PMID: 17072480 DOI: 10.1590/s0074-02762006000600014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 07/12/2006] [Indexed: 11/21/2022] Open
Abstract
Coagulase-negative staphylococci (CNS) have been identified as the etiological agent in various infections and are currently the microorganisms most frequently isolated in nosocomial infections. However, little is known about the virulence factors produced by CNS that contribute to the pathogenesis of infections caused by these microorganisms. The study of CNS isolated from infectious processes of newborns hospitalized in the Neonatal Unit of the Hospital of the Botucatu Medical School, UNESP, indicated Staphylococcus epidermidis as the most frequently isolated species (77.8%), which was also associated with clinically significant situations. The analysis of virulence factors revealed the production of slime in 20 (17.1%) of all CNS samples isolated and the synthesis of a broad spectrum of enzymes and toxins, including hemolysins (19.6%), lipase (17.1%), lecithinase (3.4%), DNAse (15.4%), thermonuclease (7.7%), and enterotoxin A, B or C (37.6%). Taking into consideration that the etiological importance of CNS has often been neglected, the present investigation confirmed that these microorganisms should not be ignored or classified as mere contaminants.
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Rugolo LMSDS, Bottino J, Scudeler SRM, Bentlin MR, Trindade CEP, Perosa GB, Rugolo Junior A. Sentimentos e percepções de puérperas com relação à assistência prestada pelo serviço materno-infantil de um hospital universitário. Rev Bras Saude Mater Infant 2004. [DOI: 10.1590/s1519-38292004000400012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: avaliar percepções e sentimentos de puérperas adultas e adolescentes, relacionados ao filho e a assistência materno-infantil, em hospital universitário de nível terciário. MÉTODOS: estudo transversal, envolvendo 180 puérperas, no Alojamento Conjunto (AC) e no Berçário Interno (BI) do Hospital das Clínicas da Faculdade de Medicina de Botucatu , entrevistadas no segundo e terceiro dia pós-parto e distribuídas em três grupos: adultas primíparas, adultas multíparas e adolescentes. Para comparação entre grupos e locais de internação utilizou-se o chi2 ou teste de Fisher. RESULTADOS: ultrasom obstétrico e cardiotocografia tiveram impacto positivo na emoção materna. Houve pouca diferença entre os grupos quanto aos sentimentos antes e após o parto, sendo felicidade, amor, responsabilidade, ansiedade e medo os mais freqüentes. A culpa predominou nas adolescentes do BI. As percepções relacionadas ao filho, a avaliação da assistência e equipe, não diferiram entre adultas e adolescentes. Nas duas enfermarias o relacionamento entre mães e cuidadores foi bom, as mães mostraram-se satisfeitas com a equipe e a assistência, mas o aleitamento materno foi pouco valorizado e poucas mães conheciam o médico. CONCLUSÕES: está ocorrendo um processo de humanização na assistência materno-infantil deste hospital universitário, mas alguns aspectos precisam ser melhorados, especialmente a valorização do aleitamento materno e a individualização no contato médico-paciente.
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