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

Antenatal Corticosteroid Use And Clinical Evolution Of Preterm Newborn Infants

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection. Copyright © 2004 by Sociedade Brasileira de Pediatria.804277284Liggins, G.C., Howie, R.N., A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants (1972) Pediatrics, 50, pp. 515-525Crowley, P., Prophylactic corticosteroids for preterm birth (2002) Cochrane Database Syst Rev, (3), pp. CD000065Ryan, C.A., Finer, N.N., Antenatal corticosteroid therapy to prevent respiratory distress syndrome (1995) J Pediatr, 126, pp. 317-319Chien, L., Ohlsson, A., Seshia, M.M.K., Boulton, J., Sankaran, K., Lee, S.K., Variations in antenatal corticosteroid therapy: A persistent problem despite 30 years of evidence (2002) Obstet Gynecol, 99, pp. 401-408Albuquerque, I.C.C., Amorim, M.M.R., Meneses, J., Katz, L., Santos, L.C., Avaliação do impacto da corticiterapia antenatal para a aceleração da maturidade pulmonar fetal nos recém-nascidos em maternidade escola brasileira (2002) RBGO, 24, pp. 655-661Krauss-Silva, L., Costa, T.P., Reis, A.F., Iamada, N.O., Azevedo, A.P., Albuquerque, C.P., Avaliação da qualidade da assistência hospitalar obstétrica: Uso de corticóides no trabalho de parto prematuro (1999) Cad Saúde Pública, 15, pp. 817-829Chung, C.S., Myrianthopoulos, N.C., Congenital anomalies: Mortality and morbidity, burden and classification (1987) Am J Med Genet, 27, pp. 505-523Ballard, J.L., Khoury, J.C., Wedig, K., Wang, L., Eilers-Walsman, B.L., Lipp, R., New Ballard Score, expanded to include extremely premature infants (1991) J Pediatr, 119, pp. 417-423Alexander, 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. 163-168Niermeyer, S., Kattwinkel, J., Van Reempts, P., Nadkarni, V., Phillips, B., Zideman, D., International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines (2000) Pediatrics, 106 (3), pp. E29Apgar, V., A proposal for a new method of evaluation of the newborn infant (1953) Curr Res Anesth Analg, 32, pp. 260-267Richardson, 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. 92-100Walsh, M.C., Kliegman, R.M., Necrotizing enterocolitis: Treatment based on staging criteria (1986) Pediatr Clin North Am, 33, pp. 179-201Papile, L.A., Burstein, J., Burstein, R., Koffler, H., Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm (1978) J Pediatr, 92, pp. 529-534Bloom, S.L., Leveno, K.J., Corticosteroid use in special circumstances: Preterm ruptured membranes, hypertension, fetal growth restriction, multiple fetuses (2003) Clin Obstet Gynecol, 45, pp. 150-160Gardner, M.O., Goldenberg, R.L., Gaudier, F.L., Dubard, M.B., Nelson, K.G., Hauth, J.C., Predicting low Apgar scores of infants weighing less than 1000 grams: The effect of corticosteroids (1995) Obstet Gynecol, 85, pp. 170-174Banks, B.A., Macones, G., Cnaan, A., Merrill, J.D., Ballard, J.D., Ballard, R.A., Multiple courses of antenatal corticosteroids are associated with early severe lung disease in preterm neonates (2002) J Perinatol, 22, pp. 101-107Vermillion, S.T., Soper, D.E., Chasedunn-Roak, J., Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes (1999) Am J Obstet Gynecol, 181, pp. 320-327Gunkel, J.H., Mitchell, B.R., Observational evidence for the efficacy of antenatal steroids from randomized studies of surfactant replacement (1995) Am J Obstet Gynecol, 173, pp. 281-285Antenatal corticosteroid therapy for fetal maturation (2002) Obstet Gynecol, 99, pp. 871-873. , ACOG Committee Opinio

Antenatal Corticosteroid Use And Clinical Evolution Of Preterm Newborn Infants [uso Antenatal De Corticosteóide E Evolução Clínica De Recém-nascidos Pré-termo]

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection. © 2007 Sociedad Chilena de Pediatría.775531532Liggins, G.C., Howie, R.N., A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants (1972) Pediatrics, 50, pp. 515-525Crowley, P., Prophylactic corticosteroids for preterm birth (2002) Cochrane Database Syst Rev, (3). , CD000065Ryan, C.A., Finer, N.N., Antenatal corticosteroid therapy to prevent respiratory distress syndrome (1995) J Pediatr, 126, pp. 317-319Chien, L., Ohlsson, A., Seshia, M.M.K., Boulton, J., Sankaran, K., Lee, S.K., Variations in antenatal corticosteroid therapy: A persistent problem despite 30 years of evidence (2002) Obstet Gynecol, 99, pp. 401-408Albuquerque, I.C.C., Amorim, M.M.R., Meneses, J., Katz, L., Santos, L.C., Avaliação do impacto da corticiterapia antenatal para a aceleração da maturidade pulmonar fetal nos recém-nascidos em maternidade escola brasileira (2002) RBGO, 24, pp. 655-661Krauss-Silva, L., Costa, T.P., Reis, A.F., Iamada, N.O., Azevedo, A.P., Albuquerque, C.P., Avaliação da qualidade da assistência hospitalar obstétrica: Uso de corticóides no trabalho de parto prematuro (1999) Cad Saúde Pública, 15, pp. 817-829Chung, C.S., Myrianthopoulos, N.C., Congenital anomalies: Mortality and morbidity, burden and classification (1987) Am J Med Genet, 27, pp. 505-523Ballard, J.L., Khoury, J.C., Wedig, K., Wang, L., Eilers-Walsman, B.L., Lipp, R., New Ballard Score, expanded to include extremely premature infants (1991) J Pediatr, 119, pp. 417-423Alexander, 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. 163-168Niermeyer, S., Kattwinkel, J., Van Reempts, P., Nadkarni, V., Phillips, B., Zideman, D., International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines (2000) Pediatrics, 106 (3), pp. E29Apgar, V., A proposal for a new method of evaluation of the newborn infant (1953) Curr Res Anesth Analg, 32, pp. 260-267Richardson, 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. 92-100Walsh, M.C., Kliegman, R.M., Necrotizing enterocolitis: Treatment based on staging criteria (1986) Pediatr Clin North Am, 33, pp. 179-201Papile, L.A., Burstein, J., Burstein, R., Koffler, H., Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm (1978) J Pediatr, 92, pp. 529-534Bloom, S.L., Leveno, K.J., Corticosteroid use in special circumstances: Preterm ruptured membranes, hypertension, fetal growth restriction, multiple fetuses (2003) Clin Obstet Gynecol, 45, pp. 150-160Gardner, M.O., Goldenberg, R.L., Gaudier, F.L., Dubard, M.B., Nelson, K.G., Hauth, J.C., Predicting low Apgar scores of infants weighing less than 1000 grams: The effect of corticosteroids (1995) Obstet Gynecol, 85, pp. 170-174Banks, B.A., Macones, G., Cnaan, A., Merrill, J.D., Ballard, J.D., Ballard, R.A., Multiple courses of antenatal corticosteroids are associated with early severe lung disease in preterm neonates (2002) J Perinatol, 22, pp. 101-107Vermillion, S.T., Soper, D.E., Chasedunn-Roak, J., Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes (1999) Am J Obstet Gynecol, 181, pp. 320-327Gunkel, J.H., Mitchell, B.R., Observational evidence for the efficacy of antenatal steroids from randomized studies of surfactant replacement (1995) Am J Obstet Gynecol, 173, pp. 281-285Antenatal corticosteroid therapy for fetal maturation (2002) Obstet Gynecol, 99, pp. 871-873. , ACOG Committee Opinio