RESUMO

OBJECTIVE: To evaluate changes in mortality or significant neurodevelopmental impairment (NDI) in children born at <29 weeks of gestation in association with national quality improvement initiatives. STUDY DESIGN: This longitudinal cohort study included children born at 220/7 to 286/7 weeks of gestation who were admitted to Canadian neonatal intensive care units between 2009 and 2016. The primary outcome was a composite rate of death or significant NDI (Bayley Scales of Infant and Toddler Development, Third Edition score <70, severe cerebral palsy, blindness, or deafness requiring amplification) at 18-24 months corrected age. To evaluate temporal changes, outcomes were compared between epoch 1 (2009-2012) and epoch 2 (2013-2016). aORs were calculated for differences between the 2 epochs accounting for differences in patient characteristics. RESULTS: The 4426 children included 1895 (43%) born in epoch 1 and 2531 (57%) born in epoch 2. Compared with epoch 1, in epoch 2 more mothers received magnesium sulfate (56% vs 28%), antibiotics (69% vs 65%), and delayed cord clamping (37% vs 31%) and fewer infants had a Score for Neonatal Acute Physiology, version II >20 (31% vs 35%) and late-onset sepsis (23% vs 27%). Death or significant NDI occurred in 30% of children in epoch 2 versus 32% of children in epoch 1 (aOR, 0.86; 95% CI, 0.75-0.99). In epoch 2, there were reductions in the need for hearing aids or cochlear implants (1.4% vs 2.6%; aOR, 0.50; 95% CI, 0.31-0.82) and in blindness (0.6% vs.1.4%; aOR, 0.38; 95% CI, 0.18-0.80). CONCLUSIONS: Among preterm infants born at <29 weeks of gestation, composite rates of death or significant NDI and rates of visual and hearing impairment were significantly lower in 2013-2016 compared with 2009-2012.

Assuntos

Doenças do Prematuro , Transtornos do Neurodesenvolvimento , Cegueira , Canadá/epidemiologia , Feminino , Idade Gestacional , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Estudos Longitudinais , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Estudos Retrospectivos

RESUMO

OBJECTIVE: To provide comprehensive, contemporary information on the actuarial survival of infants born at 22-25 weeks of gestation in Canada. STUDY DESIGN: In a retrospective cohort study, we included data from preterm infants of 22-25 weeks of gestation admitted to neonatal intensive care units participating in the Canadian Neonatal Network between 2010 and 2017. Infants with major congenital anomalies were excluded. We calculated gestational age using in vitro fertilization date, antenatal ultrasound dating, last menstrual period, obstetrical estimate, or neonatal estimate (in that order). Infants were followed until either discharge or death. Each day of gestational age was considered a category except for births at 22 weeks, where the first 4 days were grouped into one category and the last 3 days were grouped into another category. For each day of life, an actuarial survival rate was obtained by calculating how many infants survived to discharge out of those who had survived up to that day. RESULTS: Of 4335 included infants, 85, 679, 1504, and 2067 were born at 22, 23, 24, and 25 weeks of gestation, respectively. Survival increased from 32% at 22 weeks to 83% at 254-6/7 weeks. Graphs of actuarial survival developed for the first 6 weeks after birth in male and female children indicated a steep increase in survival during the first 7-10 days postnatally. CONCLUSIONS: Survival increased steadily with postnatal survival and was dependent on gestational age in days and sex of the child.

Assuntos

Idade Gestacional , Lactente Extremamente Prematuro , Peso ao Nascer , Canadá , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/organização & administração , Masculino , Admissão do Paciente , Estudos Retrospectivos , Centros de Atenção Terciária

RESUMO

OBJECTIVE: To compare mortality and neurodevelopmental outcomes of outborn and inborn preterm infants born at <29 weeks of gestation admitted to Canadian neonatal intensive care units (NICUs). STUDY DESIGN: Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants born at <29 weeks of gestation admitted to NICUs from April 2009 to September 2011. Rates of death, severe neurodevelopmental impairment (NDI), and overall NDI were compared between outborn and inborn infants at 18-21 months of age, corrected for prematurity. RESULTS: Of 2951 eligible infants, 473 (16%) were outborn. Mean birth weight (940 ± 278 g vs 897 + 237 g), rates of treatment with antenatal steroids (53.9% vs 92.9%), birth weight small for gestational age (5.3% vs 9.4%), and maternal college education (43.7% vs 53.9%) differed between outborn and inborn infants, respectively (all P values <.01). The median Score for Neonatal Acute Physiology-II (P = .01) and Apgar score at 5 minutes (P < .01) were higher in inborn infants. Severe brain injury was more common among outborn infants (25.3% vs 14.7%, P < .01). Outborn infants had higher odds of death or severe NDI (aOR 1.7, 95% CI 1.3-2.2), death or overall NDI (aOR 1.6, 95% CI 1.2-2.2), death (aOR 2.1, 95% CI 1.5-3.0), and cerebral palsy (aOR 1.9, 95% CI 1.1-3.3). CONCLUSIONS: The composite outcomes of death or neurodevelopmental impairment were significantly higher in outborn compared with inborn infants admitted to Canadian NICUs. Adverse outcomes were mainly attributed to increased mortality and cerebral palsy in outborn neonates.

Assuntos

Mortalidade Infantil , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Doenças do Prematuro/terapia , Unidades de Terapia Intensiva Neonatal , Índice de Apgar , Peso ao Nascer , Canadá , Paralisia Cerebral/epidemiologia , Coleta de Dados , Bases de Dados Factuais , Técnicas de Diagnóstico Neurológico , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Masculino , Sistema Nervoso/crescimento & desenvolvimento , Assistência Perinatal , Gravidez , Estudos Retrospectivos , Risco , Atenção Terciária à Saúde

RESUMO

OBJECTIVE: To compare the effect of prolonged inhalation of a low concentration of CO(2) with theophylline for the treatment of apnea of prematurity. STUDY DESIGN: Prospective, randomized, double-blind controlled trial of 87 preterm infants with apnea of prematurity (27-32 weeks' gestational age) assigned to either theophylline plus 0.5 L/min of room air via nasal prongs or placebo plus 0.5 L/min with CO(2) (about 1% inhaled) by nasal prongs for 3 days. RESULTS: Apnea time significantly decreased in the theophylline group from 189±33 s/h (control) to 57±11, 50±9, and 61±13 (days 1-3) (P=.0001) and in the CO(2) group from 183±44 (control) to 101±26, 105±29, and 94±26 s/h (days 1-3) (P=.03). Seven infants in the CO(2) group but none in the theophylline group failed to complete the study due to severe apneas (P=.003). CONCLUSIONS: Because theophylline was more effective in reducing the number and severity of apneas, inhalation of low concentration of CO(2), as used in the present study, cannot be considered as an alternative to theophylline in the treatment of apnea of prematurity. The less effectiveness of CO(2) treatment may have been related to the variability of the delivery of CO(2).

Assuntos

Apneia/tratamento farmacológico , Broncodilatadores/uso terapêutico , Dióxido de Carbono/administração & dosagem , Dióxido de Carbono/uso terapêutico , Recém-Nascido Prematuro , Teofilina/uso terapêutico , Administração por Inalação , Broncodilatadores/administração & dosagem , Terapia Combinada/métodos , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Teofilina/administração & dosagem , Resultado do Tratamento

RESUMO

OBJECTIVE: To examine the relationships between intensity of delivery room resuscitation and short- and long-term outcomes of very low birth weight infants enrolled in the Caffeine for Apnea of Prematurity (CAP) Trial. STUDY DESIGN: The CAP Trial enrolled 2006 infants with birthweights between 500 and 1250 g who were eligible for caffeine therapy. All levels of delivery room resuscitation were recorded in study participants. We divided infants in 4 groups of increasing intensity of resuscitation: minimal, n = 343; bag-mask ventilation, n = 372; endotracheal intubation, n = 1205; and cardiopulmonary resuscitation (chest compressions/epinephrine), n = 86. We used multivariable logistic regression models to compare outcomes across the 4 groups. RESULTS: The observed rates of death or disability, death, cerebral palsy, cognitive deficit, and hearing loss at 18 months increased with higher levels of resuscitation. Risk of bronchopulmonary dysplasia, severe retinopathy of prematurity, and brain injury also increased with higher levels of resuscitation. Adjustment for prognostic variables reduced the differences between the groups for most outcomes. Only the adjusted rates of bronchopulmonary dysplasia and severe retinopathy remained significantly higher after more intense resuscitation. CONCLUSIONS: In CAP Trial participants, the risk of death or neurodevelopmental disability at 18 months did not increase substantially with increasing intensity of delivery room resuscitation.

Assuntos

Reanimação Cardiopulmonar/efeitos adversos , Salas de Parto , Recém-Nascido de muito Baixo Peso , Intubação Intratraqueal/efeitos adversos , Respiração Artificial/efeitos adversos , Lesões Encefálicas/epidemiologia , Displasia Broncopulmonar/epidemiologia , Paralisia Cerebral/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Enterocolite Necrosante/epidemiologia , Feminino , Perda Auditiva/epidemiologia , Humanos , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Máscaras , Análise Multivariada , Retinopatia da Prematuridade/epidemiologia

RESUMO

OBJECTIVE: To determine whether inhalation of 0.8% CO(2) in preterm infants decreases the duration and rate of apnea as effectively as or better than theophylline with fewer adverse side effects. STUDY DESIGN: A prospective, randomized, control study of 42 preterm infants of gestational age 27 to 32 weeks assigned to receive inhaled CO(2) (n = 21) or theophylline (n = 21). The study group had a mean (+/- standard error of the mean) birth weight of 1437 +/- 57 g, gestational age of 29.4 +/- 0.3 weeks, and postnatal age of 43 +/- 4 days. After a control period, 0.8% CO(2) or theophylline was given for 2 hours, followed by a recovery period. RESULTS: In the CO(2) group, apneic time and rate decreased significantly, from 9.4 +/- 1.6 seconds/minute and 94 +/- 15 apneic episodes/hour to 3.0 +/- 0.5 seconds/minute and 34 +/- 5 apneic episodes/hour. In the theophylline group, apneic time and rate decreased significantly, from 8 +/- 1 seconds/minute and 80 +/- 8 apneic episodes/hour to 2.5 +/- 0.4 seconds/minute and 28 +/- 3 apneic episodes/hour. Cerebral blood flow velocity (CBFV) decreased only during theophylline administration. CONCLUSIONS: Our findings suggest that inhaled low (0.8%) CO(2) concentrations in preterm infants is at least as effective as theophylline in decreasing the duration and number of apneic episodes, has fewer side effects, and causes no changes in CBFV. We speculate that CO(2) may be a better treatment for apnea of prematurity than methylxanthines.

Assuntos

Apneia/tratamento farmacológico , Broncodilatadores/uso terapêutico , Dióxido de Carbono/administração & dosagem , Doenças do Prematuro/tratamento farmacológico , Teofilina/uso terapêutico , Administração por Inalação , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Projetos Piloto , Resultado do Tratamento

RESUMO

Proyectar la infraestructura de un Laboratorio de Redes de Datos, en el cual se puedan hacer practicas de gabinete concernientes a la Interconexion de Redes y a la administracion tanto de las redes como de los dispositivos de interconexion. Objetivos especificos: Diseño de la red de interconexion.Diseño de las redes de area local.Eleccion de los dispositivos de interconexion.Administracion y programacion de los dispositivos de interconexion.Asignacion de permisos a traves de la administracion de la red.Identificacion de experimentos.Identificacion de aplicaciones y proyectos de investigacion.Topologia de la red de interconexion: La configuracion propuesta, como solucion para la implementacion del Laboratorio de Redes de Datos, esta compuesta por dispositivos que pueden ser divididos en dos categorias: -Enrutadores de acceso.-Conmutadores y concentradores Ethernet a estos dos dispositivos se debe añadir:-Software de administracion de redes.Esta topologia, bien podria representar un modelo de Empresa con Sucursales localizadas en distintas areas geograficas. En este modelo de Empresa a menudo se requiere: -Compartir informacion referente a clientes, productos, inventarios, facturacion, etc. -Transferir archivos e intercambiar correo electronico. Combinar los dispositivos de interconexion de redes en un ambiente de laboratorio, permitira a los estudiantes simular distintas topologias de interconexion.