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Papers by Alexandra Almeida
Background: Children born before 32 weeks or very low birth weight have a high risk for neurodeve... more Background: Children born before 32 weeks or very low birth weight have a high risk for neurodevelopmental impairment. Aim: To analyze the condition of extreme low birth infants (weighing 1000g or less), born in the years 2005 and 2006, and included in the Portuguese National Very Low Birth Weight Network. Results: A total of 163 children were evaluated, 49.1% of which were males with a mean gestational age 27 weeks at birth, average birthweight 805.6 grams, and the average age at assessment 36 months. Children with birth weight under 25th percentile (p), were overweight (above p90) on the evaluation date. Moreover, children with birth weight higher than p50, on the evaluation date have had malnutrition (less than p5). Looking for sequels: four children (2.5%) had severe or pro- found deafness, three (1.9%) requiring hearing aids. One child was blind (0.9%) and 25 (17%) needed to wear glasses. Fifteen (9.7%) had cerebral palsy and thirteen (8.7%), neurological impairment (epilepsy, ...
NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 2015
Introduction: Over the last decades, survival of extremely preterm infants improved but there´s s... more Introduction: Over the last decades, survival of extremely preterm infants improved but there´s still significant morbidity among this group. We pretend to evaluate if specific attitudes/characteristics are associated with higher survival or survival without severe disabilities and elaborate predicting outcome models. Material and Methods: Observational descriptive study, including the 205 liveborn/stillborn infants -gestational age 22w0d-26w6d- born at an Obstetrics Unit or transferred to a Neonatology Unit of a Level III Hospital, from January-2000 to December-2009. We collected variables related to management in the prenatal/neonatal period, neonate performances and psychomotor development(18-24 months). Significant associations between variables/outcomes were identified by chi-square test or t-test; multivariate logistic regression models were used to describe and predict mortality/morbidity. Results: Advanced Gestational Age (GA) (p=0.001), antenatal corticotherapy(p=0.001), ce...
Introducao: Os recem -nascidos (RN) internados em unidades de cuidados intensivos (UCIN) apresent... more Introducao: Os recem -nascidos (RN) internados em unidades de cuidados intensivos (UCIN) apresentam um risco acrescido de infecoes associadas aos cuidados de saude (IACS). Na Maternidade Julio Dinis (MJD), apos ter sido constatada uma incidencia elevada de IACS, efetuaram-se alteracoes na pratica clinica diaria. Objetivos: Avaliar a eficacia das estrategias de prevencao de infecao implementadas na UCIN da MJD. Material e metodos: Estudo prospetivo incluindo os RN internados na UCIN da MJD nos 16 meses anteriores (grupo 1) e nos 16 meses subsequentes (grupo 2) as intervencoes, comparando-se os indices de infecao nestes dois periodos temporais. Resultados: O grupo 1, com 528 RN, e o grupo 2, com 593 RN, nao mostraram diferenca em relacao ao peso, idade gestacional, taxa de utilizacao de cateter vascular central (CVC) e duracao da nutricao parenterica e da ventilacao invasiva. Verificou-se uma diminuicao da incidencia global de infecao: densidade de incidencia de IACS – sepsis, pneumon...
NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 2021
Introduction: Minimally invasive surfactant therapy (MIST) is a surfactant administration procedu... more Introduction: Minimally invasive surfactant therapy (MIST) is a surfactant administration procedure that intends to reduce intubations and associated risks. The aim of this study was to compare MIST with INtubation-SURfactant-Extubation (INSURE) technique. Material and methods: Retrospective analysis (from January 2015 to June 2019) of preterm infants on nasal continuous positive airway pressure (nCPAP) treated with surfactant. Results: Fifty-four preterm infants were included and divided in two groups: MIST (n=34) and INSURE (n=20). No significant differences were found between groups regarding gestational age (p=0.480), birth weight (p=0.299), fraction of inspired oxygen (FiO2) prior to surfactant (p=0.220), oxygen therapy duration (p=0.306), progression to intubation (p=0.712), or length of Neonatal Intensive Care Unit stay (p=0.778). FiO2 variation before and after surfactant administration was higher in MIST group (14% vs 9%, p=0.078). No significant complications were reported...
Frontiers in Pediatrics, 2020
Introduction: In the last two decades there have been advances in the diagnosis and management of... more Introduction: In the last two decades there have been advances in the diagnosis and management of neonatal cholestasis, which may have changed its epidemiology, diagnostic accuracy, outcomes, and survival. Our goal was to characterize these changes over time in our setting. Methods: Retrospective cohort study in a tertiary center, enrolling patients born between January 1985 and October 2019. The cohort was divided into two periods, before (A; n = 67) and after (B; n = 87) the year 2000; and in two groups, according to patient's outcome (favorable, unfavorable). Overall survival and survival with and without orthotopic liver transplant (OLT) were evaluated in the two periods (A and B) and in different subgroups of underlying entities. Results: We found that the age of cholestasis recognition decreased significantly from period A to period B [median 43 days and 22 days, respectively, (p < 0.001)]; the changes in epidemiology were relevant, with a significant decrease in alpha-1-antitrypsin deficiency (p < 0.001) and an increase in transient cholestasis (p = 0.004). A next-generation sequencing (NGS) panel available since mid-2017 was applied to 13 patients with contributory results in 7, but, so far, only in 2 patients led to conclusive diagnosis of underlying entities. The number of cases of idiopathic cholestasis did not vary significantly. Over time there was no significant change in the outcome (p = 0.116). Overall survival and survival without OLT had no significant improvement during the period of observation (in periods A and B, 86 vs. 88%, and 85 vs. 87%, respectively). However, in period B, with OLT we achieved the goal of 100% of survival rate. Conclusions: Our data suggest that transient cholestasis became a very important subset of neonatal cholestasis, requiring specific guidance. The NGS panels can provide Santos Silva et al. Neonatal Cholestasis Over Time important inputs on disease diagnosis but, if applied without strict criteria and expertise, they can open a Pandora's box due to misinterpretation. Despite all the advances in accurate diagnosis and timely management-including early recognition of cholestasis-the improvement in patient outcomes and survival were still not significant. Keywords: neonatal cholestasis, transient cholestasis, neonatal cholestasis epidemiology, cholestasis risk factors, neonatal cholestasis survival, next generation sequencing panel NGS panel evolution Mid-2017 (54 genes) Since the end of 2019 (95 genes) Genes ABCB11,
Background: Children born before 32 weeks or very low birth weight have a high risk for neurodeve... more Background: Children born before 32 weeks or very low birth weight have a high risk for neurodevelopmental impairment. Aim: To analyze the condition of extreme low birth infants (weighing 1000g or less), born in the years 2005 and 2006, and included in the Portuguese National Very Low Birth Weight Network. Results: A total of 163 children were evaluated, 49.1% of which were males with a mean gestational age 27 weeks at birth, average birthweight 805.6 grams, and the average age at assessment 36 months. Children with birth weight under 25th percentile (p), were overweight (above p90) on the evaluation date. Moreover, children with birth weight higher than p50, on the evaluation date have had malnutrition (less than p5). Looking for sequels: four children (2.5%) had severe or pro- found deafness, three (1.9%) requiring hearing aids. One child was blind (0.9%) and 25 (17%) needed to wear glasses. Fifteen (9.7%) had cerebral palsy and thirteen (8.7%), neurological impairment (epilepsy, ...
Background: Children born before 32 weeks or very low birth weight have a high risk for neurodeve... more Background: Children born before 32 weeks or very low birth weight have a high risk for neurodevelopmental impairment. Aim: To analyze the condition of extreme low birth infants (weighing 1000g or less), born in the years 2005 and 2006, and included in the Portuguese National Very Low Birth Weight Network. Results: A total of 163 children were evaluated, 49.1% of which were males with a mean gestational age 27 weeks at birth, average birthweight 805.6 grams, and the average age at assessment 36 months. Children with birth weight under 25th percentile (p), were overweight (above p90) on the evaluation date. Moreover, children with birth weight higher than p50, on the evaluation date have had malnutrition (less than p5). Looking for sequels: four children (2.5%) had severe or pro- found deafness, three (1.9%) requiring hearing aids. One child was blind (0.9%) and 25 (17%) needed to wear glasses. Fifteen (9.7%) had cerebral palsy and thirteen (8.7%), neurological impairment (epilepsy, ...
NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 2015
Introduction: Over the last decades, survival of extremely preterm infants improved but there´s s... more Introduction: Over the last decades, survival of extremely preterm infants improved but there´s still significant morbidity among this group. We pretend to evaluate if specific attitudes/characteristics are associated with higher survival or survival without severe disabilities and elaborate predicting outcome models. Material and Methods: Observational descriptive study, including the 205 liveborn/stillborn infants -gestational age 22w0d-26w6d- born at an Obstetrics Unit or transferred to a Neonatology Unit of a Level III Hospital, from January-2000 to December-2009. We collected variables related to management in the prenatal/neonatal period, neonate performances and psychomotor development(18-24 months). Significant associations between variables/outcomes were identified by chi-square test or t-test; multivariate logistic regression models were used to describe and predict mortality/morbidity. Results: Advanced Gestational Age (GA) (p=0.001), antenatal corticotherapy(p=0.001), ce...
Introducao: Os recem -nascidos (RN) internados em unidades de cuidados intensivos (UCIN) apresent... more Introducao: Os recem -nascidos (RN) internados em unidades de cuidados intensivos (UCIN) apresentam um risco acrescido de infecoes associadas aos cuidados de saude (IACS). Na Maternidade Julio Dinis (MJD), apos ter sido constatada uma incidencia elevada de IACS, efetuaram-se alteracoes na pratica clinica diaria. Objetivos: Avaliar a eficacia das estrategias de prevencao de infecao implementadas na UCIN da MJD. Material e metodos: Estudo prospetivo incluindo os RN internados na UCIN da MJD nos 16 meses anteriores (grupo 1) e nos 16 meses subsequentes (grupo 2) as intervencoes, comparando-se os indices de infecao nestes dois periodos temporais. Resultados: O grupo 1, com 528 RN, e o grupo 2, com 593 RN, nao mostraram diferenca em relacao ao peso, idade gestacional, taxa de utilizacao de cateter vascular central (CVC) e duracao da nutricao parenterica e da ventilacao invasiva. Verificou-se uma diminuicao da incidencia global de infecao: densidade de incidencia de IACS – sepsis, pneumon...
NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 2021
Introduction: Minimally invasive surfactant therapy (MIST) is a surfactant administration procedu... more Introduction: Minimally invasive surfactant therapy (MIST) is a surfactant administration procedure that intends to reduce intubations and associated risks. The aim of this study was to compare MIST with INtubation-SURfactant-Extubation (INSURE) technique. Material and methods: Retrospective analysis (from January 2015 to June 2019) of preterm infants on nasal continuous positive airway pressure (nCPAP) treated with surfactant. Results: Fifty-four preterm infants were included and divided in two groups: MIST (n=34) and INSURE (n=20). No significant differences were found between groups regarding gestational age (p=0.480), birth weight (p=0.299), fraction of inspired oxygen (FiO2) prior to surfactant (p=0.220), oxygen therapy duration (p=0.306), progression to intubation (p=0.712), or length of Neonatal Intensive Care Unit stay (p=0.778). FiO2 variation before and after surfactant administration was higher in MIST group (14% vs 9%, p=0.078). No significant complications were reported...
Frontiers in Pediatrics, 2020
Introduction: In the last two decades there have been advances in the diagnosis and management of... more Introduction: In the last two decades there have been advances in the diagnosis and management of neonatal cholestasis, which may have changed its epidemiology, diagnostic accuracy, outcomes, and survival. Our goal was to characterize these changes over time in our setting. Methods: Retrospective cohort study in a tertiary center, enrolling patients born between January 1985 and October 2019. The cohort was divided into two periods, before (A; n = 67) and after (B; n = 87) the year 2000; and in two groups, according to patient's outcome (favorable, unfavorable). Overall survival and survival with and without orthotopic liver transplant (OLT) were evaluated in the two periods (A and B) and in different subgroups of underlying entities. Results: We found that the age of cholestasis recognition decreased significantly from period A to period B [median 43 days and 22 days, respectively, (p < 0.001)]; the changes in epidemiology were relevant, with a significant decrease in alpha-1-antitrypsin deficiency (p < 0.001) and an increase in transient cholestasis (p = 0.004). A next-generation sequencing (NGS) panel available since mid-2017 was applied to 13 patients with contributory results in 7, but, so far, only in 2 patients led to conclusive diagnosis of underlying entities. The number of cases of idiopathic cholestasis did not vary significantly. Over time there was no significant change in the outcome (p = 0.116). Overall survival and survival without OLT had no significant improvement during the period of observation (in periods A and B, 86 vs. 88%, and 85 vs. 87%, respectively). However, in period B, with OLT we achieved the goal of 100% of survival rate. Conclusions: Our data suggest that transient cholestasis became a very important subset of neonatal cholestasis, requiring specific guidance. The NGS panels can provide Santos Silva et al. Neonatal Cholestasis Over Time important inputs on disease diagnosis but, if applied without strict criteria and expertise, they can open a Pandora's box due to misinterpretation. Despite all the advances in accurate diagnosis and timely management-including early recognition of cholestasis-the improvement in patient outcomes and survival were still not significant. Keywords: neonatal cholestasis, transient cholestasis, neonatal cholestasis epidemiology, cholestasis risk factors, neonatal cholestasis survival, next generation sequencing panel NGS panel evolution Mid-2017 (54 genes) Since the end of 2019 (95 genes) Genes ABCB11,
Background: Children born before 32 weeks or very low birth weight have a high risk for neurodeve... more Background: Children born before 32 weeks or very low birth weight have a high risk for neurodevelopmental impairment. Aim: To analyze the condition of extreme low birth infants (weighing 1000g or less), born in the years 2005 and 2006, and included in the Portuguese National Very Low Birth Weight Network. Results: A total of 163 children were evaluated, 49.1% of which were males with a mean gestational age 27 weeks at birth, average birthweight 805.6 grams, and the average age at assessment 36 months. Children with birth weight under 25th percentile (p), were overweight (above p90) on the evaluation date. Moreover, children with birth weight higher than p50, on the evaluation date have had malnutrition (less than p5). Looking for sequels: four children (2.5%) had severe or pro- found deafness, three (1.9%) requiring hearing aids. One child was blind (0.9%) and 25 (17%) needed to wear glasses. Fifteen (9.7%) had cerebral palsy and thirteen (8.7%), neurological impairment (epilepsy, ...