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Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus



شناسه مقاله
10.1016/j.jpedp.2014.04.009
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انگلیسی

Title: Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus

Authors: Lilian S.R. Sadeck and Cléa R. Leone and Renato S. Procianoy and Ruth Guinsburg and Sergio T.M. Marba and Francisco E. Martinez and Ligia M.S.S. Rugolo and M. Elisabeth L. Moreira and Renato M. Fiori and Ligia L. Ferrari and Jucille A. Menezes and Paulyne S. Venzon and Vânia Q.S. Abdallah and José Luiz M.B. Duarte and Marynea V. Nunes and Leni M. Anchieta and Navantino Alves Filho

Journal: Jornal de Pediatria (Versão em Português)

Year: 2014

Abstract:

AbstractObjective 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 significant. Results 1,097 newborns were selected and 494 newborns were included: {G1} ‐ ۱۸۷ (۳۷٫۸%), {G2} ‐ ۲۰۵ (۴۱٫۵%), and {G3} ‐ ۱۰۲ (۲۰٫۶%). 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: 0.14‐۰٫۶۲) and conservative (OR 0.34; 95% CI: 0.14‐۰٫۷۹) 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. ResumoObjetivo Analisar os efeitos da terapêutica adotada para o canal arterial (CA) em recém‐nascidos (RN) < 1.000gadmitidos em unidades neonatais (UN) da Rede Brasileira de Pesquisas Neonatais (RBPN), sobre os desfechos: óbito, displasia broncopulmonar (DBP), hemorragia intraventricular grave (HIVIII/IV), retinopatia da prematuridade cirúrgica (ROPcir), enterocolite necrosante cirúrgica (ECNcir) e o desfecho combinado óbito e DBP. Métodos Estudo multicêntrico, de coorte, coleta de dados retrospectiva, incluindo {RN} de 16 {UN} da {RBPN} de 01/01/2010 a 31/12/2011, {PN} < 1.000 g, idade gestacional (IG) < 33 semanas e diagnóstico ecocardiográfico de PCA. Excluídos: óbitos ou transferências até o terceiro dia de vida, infecções congênitas ou malformações. Grupos:G1 – conservadora (sem intervenção medicamentosa ou cirúrgica), {G2} – farmacológica (indometacina ou ibuprofeno) e {G3} – cirúrgico (com ou sem tratamento farmacológico anterior). Analisou‐se: uso de esteroide antenatal, parto cesárea, PN, IG, Apgar5’ < 4, sexo masculino, {SNAPPE} II, síndrome do dDesconforto respiratório (SDR), sepse tardia, ventilação mecânica (VM), surfactante < 2 horas de vida, tempo de {VM} e os desfechos: óbito, dependência de oxigênio com 36 semanas (DBP36s), {HIV} III/IV, ROPcir, {ECNcir} e óbito/DBP36s. Estatística: Teste t‐Student, Qui‐Quadrado ou teste Exato de Fisher. Testes de Regressão Binária Logística e Regressão Múltipla Stepwise Backward. MedCalc (Medical Calculator) software, versão 12.1.4.0.p < 0,05. Resultados Foram selecionados 1.097 {RN} e 494 foram incluídos: G1‐۱۸۷ (۳۷,۸%), G2‐۲۰۵ (۴۱,۵%) e G3‐۱۰۲ (۲۰,۶%). Verificou‐se: maior mortalidade (51,3%) no {G1} e menor no G3(14,7%); maior frequência {DBP36s} (70,6%) e {ROPcir} (23,5%) no G3; maior frequência de óbito/DBP36s no {G2} (58,0%). As abordagens farmacológica (OR‐۰,۲۹; ۹۵%, IC‐۰,۱۴‐۰,۶۲) e conservadora (OR‐۰,۳۴; ۹۵%, IC‐ ۰,۱۴‐۰,۷۹) foram protetoras somente para o desfecho óbito/DBP36sem. Conclusão Em {RN} com PCA, a abordagem conservadora relacionou‐se à maior mortalidade, a cirúrgica à ocorrência de {DBP36s} e ROPcir., enquanto o tratamento farmacológico mostrou‐se protetor para o desfecho óbito/DBP36sem.

Keywords: Preterm, Very low birth weight, Ligation, PDA management‐chave, Prematuridade, Muito baixo peso, Ligadura cirúrgica, Canal arterial

ترجمه فارسی
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عنوان: اثر روش درمانی در تکامل نوزادان نوزاد با وزن بسیار کم با مجرای شریانی

نویسندگان: Lilian S.R. Sadeck and Cléa R. Leone and Renato S. Procianoy and Ruth Guinsburg and Sergio T.M. Marba and Francisco E. Martinez and Ligia M.S.S. Rugolo and M. Elisabeth L. Moreira and Renato M. Fiori and Ligia L. Ferrari and Jucille A. Menezes and Paulyne S. Venzon and Vânia Q.S. Abdallah and José Luiz M.B. Duarte and Marynea V. Nunes and Leni M. Anchieta and Navantino Alves Filho

ژورنال: Jornal de Pediatria (Versão em Português)

سال: ۲۰۱۴

چکیده:
Estatística: Teste تی دانشجویی، شبه Quadrado OU teste Exato د فیشر بیضه د Regressão Binária LOGISTICA E Regressão MULTIPLA گام به گام رو به عقب (ماشین حساب پزشکی) نرم افزار MedCalc، versão 12140p به u0026 lt؛ ۰،۰۵ selecionados نمایش نتایج: از Foram 1097 {RN} E 494 foram incluídos: G1-187 (37،۸٪)، G2-205 (41،۵٪) E G3-102 (20،۶٪) Verificou-SE: maior mortalidade (51،۳٪) هیچ {G1} E menor هیچ G3 (14،۷٪)؛ maior frequência {DBP36s} (70،۶٪) E {ROPcir} (23،۵٪) هیچ G3؛ maior frequência د اوبیتو / DBP36s هیچ {G2} (58،۰٪) به عنوان abordagens farmacológica (OR-0،۲۹ ۹۵٪، IC-0،۱۴-۰،۶۲) E conservadora (OR-0،۳۴ ۹۵٪ ، IC- 0،۱۴-۰،۷۹) foram protetoras somente پارا O desfecho اوبیتو / DBP36sem Conclusão اونا {RN} کام PCA، یک abordagem conservadora relacionou-SE یک maior mortalidade، یک cirúrgica à ocorrência د {DBP36s} E ROPcir، enquanto O tratamento farmacológico mostrou-SE protetor پارا O desfecho اوبیتو / DBP36sem
کلمات کلیدی:   زودرس، وزن کم هنگام تولد بسیار، بستن، PDA مدیریت chave، Prematuridade، Muito baixo پزو، Ligadura cirúrgica، شریانی کانال

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