Effects Of Therapeutic Approach On The Neonatal Evolution Of Very Low Birth Weight Infants With Patent Ductus Arteriosus

Objective To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD.Methods This was a multicentric, cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment), G2 - pharmacologic (indomethacin or ibuprofen), G3 - surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. Outcomes: death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significantResults 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) and ROPsur were observed in G3 (23.5%). The lowest occurrence of death/BPD36wks occurred in G2 (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments were protective for the outcome death/BPD36wks. Conclusion The conservative approach of PDA was associated to high mortality, the surgical approach to the occurrence of BPD36wks and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks.906616623Clyman, R.I., Mechanisms regulating the ductus arteriosus (2006) Biol Neonate., 89, pp. 330-335Benitz, W.E., Treatment of persistent patent ductus arteriosus in preterm infants: Time to accept the null hypothesis? (2010) J Perinatol., 30, pp. 241-252Redline, R.W., Wilson-Costello, D., Hack, M., Placental and other perinatal risk factors for chronic lung disease in very low birth weight infants (2002) Pediatr Res., 52, pp. 713-719Evans, N., Kluckow, M., Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants (1996) Arch Dis Child Fetal Neonatal Ed., 75, pp. 183-F186Noerr, B., Current controversies in the understanding of necrotizing enterocolitis Part 1 (2003) Adv Neonatal Care., 3, pp. 107-120Koch, J., Hensley, G., Roy, L., Brown, S., Ramaciotti, C., Rosenfeld, C.R., Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less (2006) Pediatrics., 117, pp. 1113-1121Afiune, J.Y., Singer, J.M., Leone, C.R., Evolução ecocardiográfica de recém-nascidos com persistência do canal arterial (2005) J Pediatr (Rio J)., 81, pp. 454-460Sosenko, I.R., Fajardo, M.F., Claure, N., Bancalari, E., Timing of patent ductus arteriosus treatment and respiratory outcome in premature infants: A double-blind randomized controlled trial (2012) J Pediatr., 160, pp. 929-935. , e1Laughon, M.M., Simmons, M.A., Bose, C.L., Patency of the ductus arteriosus in the premature infant: Is it pathologic? Should it be treated? (2004) Curr Opin Pediatr., 16, pp. 146-151Clyman, R.I., Chorne, N., Patent ductus arteriosus: Evidence for and against treatment (2007) J Pediatr., 150, pp. 216-219Bose, C.L., Laughon, M., Treatment to prevent patency of the ductus arteriosus: Beneficial or harmful? (2006) J Pediatr., 148, pp. 713-714Clyman, R.I., Couto, J., Murphy, G.M., Patent ductus arteriosus: Are current neonatal treatment options better or worse than no treatment at all? (2012) Semin Perinatol., 36, pp. 123-129Alexander, G.R., Himes, J.H., Kaufman, R.B., Mor, J., Kogan, M., A United States national reference for fetal growth (1996) Obstet Gynecol., 87, pp. 163-168Jhaveri, N., Moon-Grady, A., Clyman, R.I., Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment (2010) J Pediatr., 157. , 381-7, 387.e1Clyman, R., Cassady, G., Kirklin, J.K., Collins, M., Philips, J.B., III, The role of patent ductus arteriosus ligation in bronchopulmonary dysplasia: Reexamining a randomized controlled trial (2009) J Pediatr., 154, pp. 873-876Mirea, L., Sankaran, K., Seshia, M., Ohlsson, A., Allen, A.C., Aziz, K., Treatment of patent ductus arteriosus and neonatal mortality/morbidities: Adjustment for treatment selection bias (2012) J Pediatr., 161, pp. 689-694. , e1Youn, Y., Lee, J.Y., Lee, J.H., Kim, S.Y., Sung, I.K., Lee, J.Y., Impact of patient selection on outcomes of PDA in very low birth weight infants (2013) Early Hum Dev., 89, pp. 175-17

Evaluation Of The Neonatal Outcomes Of The Kangaroo Mother Method In Brazil [avaliação Dos Resultados Neonatais Do Método Canguru No Brasil]

Objective: To evaluate the results of the kangaroo mother method in Brazil. Methods: A prospective cohort study comparing 16 units that have or do not have the second phase of the kangaroo mother method: eight were national centers of excellence for the kangaroo mother method (study group) and eight were part of the Brazilian Neonatal Research Network (control group). A total of 985 newborn infants with birth weights of 500 to 1,749 g were enrolled. Multivariate analyses employedmultiple linear regression and Poisson regression with robust adjustment. Results: The adjusted analysis (controlled for birth weight, gestational age, Score for Neonatal Acute Physiology Perinatal Extension II, Neonatal Therapeutic Intervention Scoring System, and maternal age and educational level) demonstrated that mean length of hospital stay (p = 0.14) and intercurrent clinical conditions in the intermediate or kangaroo unit were equal for both groups. Weight (p = 0.012), length (p = 0.039) and head circumference (p = 0.006) at 36 weeks' corrected gestational age were all lower at the kangaroo units. The kangaroo units exhibited superior performance in relation to exclusive breastfeeding at discharge (69.2 vs. 23.8%, p=0.022). Conclusions: The evidence suggests that the humanization strategy adopted by the Brazilian Ministry of Health is a safe alternative to conventional treatment and a good strategy for promoting breastfeeding. Copyright © 2008 by Sociedade Brasileira de Pediatria.845428435Mathelin, C., (1999) Osorriso da Gioconda: Clínica psicanalí ticacombebês prematuros, , Rio de Janeiro: Companhia de Freud;Lamy, Z.C., (2000) Unidade neonatal: Um espaço de conflitos e negociações [Tese], , Rio de Janeiro, RJ: Fundação Oswaldo Cruz;Walsh-Sukys M, Reitenbach A, Hudson-Barr D, DePompei P. Reducing light and sound in the neonatal intensive care unit: an evaluation of patient safety, staff satisfaction, and costs. J Perinatol. 2001;21:230-5. Erratum in: J Perinatol. 2001;21:572Martín Ancel, A., Iriondo Sanz, M., Fina Martí, A., Roqués Serradilla, V., García Del Río, M., López Sastre, J.B., On recommendations, protocols, and clinical guidelines (2001) An Esp Pediatr, 55, pp. 99-100Brasil. Ministério da Saúde. Norma da atenção humanizada ao recém-nascido de baixo peso - Método Canguru. Brasília, DF: MS1999Brasil. Ministério da Saúde. Norma da atenção humanizada ao recém-nascido de baixo peso - Método Canguru. Brasília, DF: MS2000Rey, E., Martínez, H., Manejo racional del niño prematuro (1983) Bogotá, (Colombia): Universidad NacionalCurso de Medicina FetalAnderson GC, Marks EA, Wahlberg V. Kangaroo care for premature infants. AmJ Nurs. 1986;86:807-9. Erratum in: Am J Nurs. 1986;86:1000Anderson, G.C., Current knowledge about skin-to-skin (kangaroo) care for preterm infants (1991) J Perinatol, 11, pp. 216-226Conde-Agudelo A, Diaz-Rossello JL, Belizan JM. Mãe canguru para reduzir morbidade e mortalidade em recém-nascidos com baixo peso ao nascer (Cochrane Review). In: Resumos de Revisões Sistemáticas em Português, Issue 2, 2007. Oxford: Update SoftwareFeldman, R., Weller, A., Sirota, L., Eidelman, A.I., Skin-to-Skin contact (Kangaroo care) promotes self-regulation in premature infants: Sleep-wake cyclicity, arousal modulation, and sustained exploration (2002) Dev Psychol, 38, pp. 194-207Kirsten, G.F., Bergman, N.J., Hann, K.M., Kangaroo mother care in the nursery (2001) Pediatr Clin North Am, 48, pp. 443-452Ramanathan, K., Paul, V.K., Deorari, A., Taneja, U., George, G., Kangaroo Mother Care in very low birth weight infants (2001) Indian J Pediatr, 68, pp. 1019-1023Ludington-Hoe, S.M., Johnson, M.W., Morgan, K., Lewis, T., Gutman, J., Wilson, P.D., Neurophysiologic assessment of neonatal sleep organization: Preliminary results of a randomized, controlled trial of skin contact with preterm infants (2006) Pediatrics, 117, pp. e909-e923Gray, L., Watt, L., Blass, E.M., Skin-to-skin contact is analgesic in healthy newborns (2000) Pediatrics, 105, pp. e14Charpak, N., Ruiz-Pelaez, J.G., Figueroa de, C.Z., Charpak, Y., A randomized, controlled trial of kangaroo mother care: Results of follow-up at 1 year of corrected age (2001) Pediatrics, 108, pp. 1072-1079Penalva, O., Schwartzman, J.S., Descriptive study of the clinical and nutritional profile and follow-up of premature babies in a Kangaroo Mother Care Program (2006) J Pediatr (Rio J), 82, pp. 33-39Charpak, N., Ruiz-Pelaez, J.G., Figueroa de, C.Z., Charpak, Y., Kangaroo mother versus traditional care for newborn infants >/= 2,000 grams: A randomized, controlled trial (1997) Pediatrics, 100, pp. 682-688Ruiz-Peláez, J.G., Charpak, N., Cuervo, L.G., Kangaroo Mother Care, an example to follow from developing countries (2004) BMJ, 329, pp. 1179-1181Venancio, S.I., Almeida, H., Método Mãe Canguru: Aplicação no Brasil, evidências científicas e impacto sobre o aleitamento materno. (2004) J Pediatr (Rio J), 80, pp. S173-S180Richardson, D.K., Corcoran, J.D., Escobar, G.J., Lee, S.K., SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores (2001) J Pediatr, 138, pp. 92-100Gray, J.E., Richardson, D.K., McCormick, M.C., Workman-Daniels, K., Goldmann, D.A., Neonatal therapeutic intervention scoring system: A therapy-based severity-of-illness index (1992) Pediatrics, 90, pp. 561-567Barros, A.J., Hirakata, V.N., Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio (2003) BMC Med Res Methodol, 3, p. 21Roberts, K.L., Paynter, C., McEwan, B., A comparison of kangaroo mother care and conventional cuddling care (2000) Neonatal Netw, 19, pp. 31-35Cattaneo, A., Davanzo, R., Worku, B., Surjono, A., Echeverria, M., Bedri, A., Kangaroo mother care for low birth weight infants: A randomised controlled trial in different settings (1998) Acta Paediatr, 87, pp. 976-985Kadam, S., Binoy, S., Kanbur, W., Mondkar, J.A., Fernandez, A., Feasibility of kangaroo mother care in Mumbai (2005) Indian J Pediatr, 72, pp. 35-38Sloan, N.L., LeonCamacho, L.W., PintoRojas, E., Stern, C., Maternidad IsidroAyora Study Team. Kangaroo mother method: Randomised controlled trial of an alternative method of care for stabilised low-birthweight infants. Maternidad Isidro Ayora Study Team (1994) Lancet, 344, pp. 782-78