RESUMO
Se plantea la relación entre la discapacidad y la justicia. Con base en la perspectiva política de John Rawls ante la discapacidad. La posición de éste autor es conceder a grupos minoritarios, en este caso a las personas con discapacidad, la maximización de los bienes sociales (empleo, ingresos, educación y salud entre otros) ya que su dotación en bienes primarios naturales y al azar es escasa o diferente (salud, talentos, y funcionamientos). El texto busca contribuir a la comprensión de la discapacidad desde la justicia ya que es lo que lleva a que el hombre pueda realizarse plenamente en cualquier ámbito. Reconoce que es prioritario que las instituciones elijan lo correcto para todos y no lo bueno para pocos. Se concluye que la discapacidad es una categoría moral - política y que es la justicia quien exigirá a las instituciones sociales, actores externos y entes gubernamentales (familia, comunidad, estado y sociedad) el reconocimiento y visibilidad de las personas con discapacidad como sujetos políticos
Assuntos
Política , Pessoas com Deficiência/reabilitação , Justiça SocialRESUMO
OBJECTIVE: To examine the effect of neonatal risk factors and treatment strategy on pulmonary, growth, and neurodevelopmental outcome of candidates for extracorporeal membrane oxygenation (ECMO). DESIGN: We prospectively assessed growth and neurodevelopmental outcome in a cohort of 190 neonates who had severe respiratory failure, no major congenital anomalies, and met institutional criteria for the use of ECMO. The relationships among perinatal risk factors, neonatal outcome, postnatal growth, and neurodevelopmental outcome were studied by univariate and multivariate analyses. RESULTS: Compared with 52 infants successfully treated with conventional or high-frequency ventilation, the 138 ECMO survivors were more mature, had earlier, more severe pulmonary disease, and were more likely to have meconium aspiration. The ECMO survivors had significantly fewer ventilator days (9 vs 11), hospital days (23 vs 29), and less (12% vs 25%) chronic lung disease (CLD). At 12 to 30 months, mean developmental scores of ECMO survivors were similar to those of infants who survived without ECMO. Infants with CLD had significantly lower motor scores (86 +/- 23 vs 100 +/- 19) and were more likely to have cerebral palsy (27% vs 6%) than those without CLD. The risk of adverse neurodevelopmental outcome was independently increased by CLD (odds ratio, 2.4; confidence interval, 1.2 to 4.6) and moderate or severe neonatal neuroimaging abnormalities (odds ratio, 6.4; confidence interval, 1.9 to 21.9). CONCLUSIONS: Neonatal ECMO candidates treated with ECMO did as well or better than neonates whose conditions were managed with alternate treatment strategies. Adverse neurodevelopmental outcome was predicted by moderate or severe neonatal neuroimaging abnormalities and CLD, not by treatment with ECMO.
Assuntos
Oxigenação por Membrana Extracorpórea , Pneumopatias/fisiopatologia , Análise de Variância , Pré-Escolar , Doença Crônica , Humanos , Lactente , Recém-Nascido , Pneumopatias/terapia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Desempenho Psicomotor/fisiologia , Fatores de Risco , Resultado do TratamentoRESUMO
Real-time ultrasonography was used to assess the position of umbilical venous catheters tips in 79 newborn infants (birth weight range, 400 to 4200 gm). The position of the umbilical venous catheters determined by ultrasonography was compared with the projection of the catheter tip on the closest vertebral body shown on a standard chest radiograph. Of the catheters initially placed with radiographic guidance, 56% were repositioned because of unsatisfactory location. Ultrasonography is more precise than radiography because it allows direct visualization of the catheter tips in relation to internal vascular structures. When ultrasonography is unavailable, placement at the ninth thoracic vertebral body ensures safe positioning.
Assuntos
Cateteres de Demora , Ultrassonografia Doppler , Veias Umbilicais , Cateterismo/métodos , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Radiografia Torácica , Vértebras Torácicas , Veias Umbilicais/diagnóstico por imagemRESUMO
We compared ultrasonography with radiography for placement of transpyloric feeding tubes. Ultrasound study successfully determined tube tip position and gave functional information unavailable with radiography, allowing for greater accuracy of placement and the observation of transpyloric reflux of feedings.
Assuntos
Nutrição Enteral/métodos , Piloro/diagnóstico por imagem , Adolescente , Bradicardia/etiologia , Criança , Pré-Escolar , Nutrição Enteral/efeitos adversos , Nutrição Enteral/instrumentação , Feminino , Humanos , Lactente , Recém-Nascido , Radiografia , Estômago/diagnóstico por imagem , UltrassonografiaRESUMO
We compared the neurodevelopmental outcome of extremely premature, surfactant-deficient infants who received either prophylactic surfactant at birth, "rescue" surfactant after the clinical diagnosis of respiratory distress syndrome was established, or placebo. Infants studied were participants in a randomized, bicenter (San Diego, Calif., and Helsinki, Finland), controlled trial of human surfactant therapy. One hundred fifty infants (prophylaxis group, 63 infants; rescue group, 57; placebo group, 30) were prospectively enrolled at 38 weeks of gestational age. There were no neonatal intergroup differences in the incidence or severity of sonographic central nervous system abnormality or retinopathy. One hundred forty-five infants were alive at 1 year of adjusted age, at which time growth, neurosensory, and neurologic outcome were similar in all three treatment groups at both centers. Cerebral palsy occurred in 20% overall. Five infants (3.5%) were functionally blind. However, infants treated at birth had lower mean mental and motor scores on the Bayley Scales of Infant Development compared with those of infants rescued with surfactant after the onset of respiratory distress syndrome (Mental Development Index: 78 vs 96, p = 0.02; Psychomotor Development Index: 73 vs 87, p = 0.04). Chronic lung disease occurred more frequently in the prophylactically treated group and contributed to the subjects' neurologic and developmental morbidity. Because prophylactic surfactant treatment offered no neurodevelopmental advantage and may contribute to poorer outcome, we currently recommend early surfactant replacement only for those infants who have postnatal evidence of respiratory distress syndrome.
Assuntos
Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Pulmão/embriologia , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Encéfalo/crescimento & desenvolvimento , Hemorragia Cerebral/etiologia , Paralisia Cerebral/etiologia , Feminino , Maturidade dos Órgãos Fetais , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal , Pneumopatias/etiologia , Masculino , Placebos , Desempenho Psicomotor , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Retinopatia da Prematuridade/etiologia , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Circulação Cerebrovascular/efeitos dos fármacos , Indometacina/farmacologia , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Monitorização Transcutânea dos Gases Sanguíneos , Pressão Sanguínea/efeitos dos fármacos , Permeabilidade do Canal Arterial/tratamento farmacológico , Humanos , Indometacina/administração & dosagem , Indometacina/uso terapêutico , Recém-Nascido , Infusões Intravenosas , Ultrassonografia , Vasoconstrição/efeitos dos fármacosRESUMO
Term neonates (n = 74) exposed antenatally to cocaine, methamphetamine, or cocaine and a narcotic but without any other known perinatal complications were prospectively examined with cranial ultrasonography to detect the presence of central nervous system injury. These studies were compared with those of a drug-free but clinically ill group of infants (n = 87) at risk for hypoxicischemic encephalopathy, and with those of infants who were well. Cranial abnormalities were detected by ultrasonography in 35.1% of the drug-exposed infants, similar to the incidence in the infants at risk for hypoxic-ischemic injury (p = 0.7) but significantly greater than the 5.3% incidence of abnormalities in normal infants (p less than 0.001). The lesions in the drug-exposed infants were intraventricular hemorrhage, echodensities known to be associated with necrosis, and cavitary lesions; they were focused in the basal ganglion, frontal lobes, and posterior fossa. The presence of ultrasonographic abnormalities was not predicted by standard neonatal clinical assessment or by other perinatal risk factors present in the drug-using population. The types of cerebral injury are consistent with those seen in adult cocaine and methamphetamine abusers and are probably related to the vasoconstrictive properties of these drugs. Antenatal exposure to stimulant drugs is associated with significant risk for cerebral injury, even among seemingly normal term neonates.
Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Hemorragia Cerebral/diagnóstico , Cocaína , Ecoencefalografia , Metanfetamina , Complicações na Gravidez , Transtornos Relacionados ao Uso de Substâncias , Peso ao Nascer , Doenças do Sistema Nervoso Central/epidemiologia , Cefalometria , Hemorragia Cerebral/epidemiologia , Feminino , Humanos , Recém-Nascido , Troca Materno-Fetal , Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , UltrassonografiaRESUMO
Sequential bleeding times were performed on 25 preterm infants receiving intravenous indomethacin for closure of the patent ductus arteriosus. Prolongation of bleeding time was observed after the initial dose of indomethacin, with an increase from a pretreatment mean of 3.6 minutes to 8.7 minutes. The bleeding time was not further prolonged at the end of the three-dose course of indomethacin, but was still elevated 48 hours after the completion of therapy. Clinical bleeding developed in six of the patients, but was generally limited to occult hematuria. Serial echoencephalography during indomethacin therapy showed progression from mild periventricular-intraventricular hemorrhage to moderate or severe grades in five of 21 infants at risk for this complication. However, no clear temporal relationship between indomethacin administration and intraventricular hemorrhage extension was observed, and no difference in the degree of bleeding time prolongation was noted between infants with and without hemorrhage extension. Other factors, including surfactant deficiency, amount of volume expansion used, and lowest PO2 in the first day of life, did distinguish those with hemorrhage extension. The results suggest that indomethacin-induced platelet dysfunction is not associated with major hemorrhagic complications in the majority of preterm infants with patent ductus arteriosus.
Assuntos
Tempo de Sangramento , Hemorragia Cerebral/induzido quimicamente , Permeabilidade do Canal Arterial/tratamento farmacológico , Hemorragia/induzido quimicamente , Indometacina/efeitos adversos , Doenças do Prematuro/tratamento farmacológico , Testes de Função Plaquetária , Permeabilidade do Canal Arterial/sangue , Feminino , Humanos , Indometacina/administração & dosagem , Indometacina/uso terapêutico , Recém-Nascido , Doenças do Prematuro/sangue , Masculino , Contagem de Plaquetas , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Fatores de TempoRESUMO
Hypoxanthine, the end product of purine metabolism, is usually very elevated in body fluids during severe hypoxia. We measured hypoxanthine in the cerebrospinal fluid of hydrocephalic preterm infants (12 with posthemorrhagic, one with congenital hydrocephalus) to determine whether hydrocephalus is associated with anaerobic metabolism of brain tissue. Cerebrospinal fluid hypoxanthine was undetectable in normal infants. In hydrocephalic infants, the concentration of hypoxanthine ranged from 7.5 mumol/L to 28 mumol (means = 14.3 mumol/L). The hypoxanthine concentrations fell from a mean of 12.8 mumol/L to a mean of 2.0 mumol/L (P less than 0.05) with successful treatment of the ventriculomegaly by lumbar puncture or by ventriculoperitoneal shunt. Patients with acute posthemorrhagic hydrocephalus had similar concentrations of hypoxanthine (means = 14.5 mumol/L) as patients with late or with congenital hydrocephalus (means = 13.8 mumol/L), indicating that brain hypoxia is probably a consequence of the ventriculomegaly and not of the hemorrhagic insult.