848 A project to reduce admissions of term and near term infants with hypoglycaemia to a tertiary neonatal unit (original) (raw)
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einstein (São Paulo), 2024
Objective: To evaluate temporal trends in the use of dexamethasone for the treatment of bronchopulmonary dysplasia in very-low-birth-weight preterm infants. Methods: A cohort study was conducted using an electronic database and medical records of all very low birth-weight preterm infants admitted to a university tertiary neonatal unit between 2006 to 2022. The main outcome was the use of systemic dexamethasone to treat bronchopulmonary dysplasia, regardless of the dose or duration of treatment. Annual rates were evaluated using the Cochran-Armitage test. Results: A total of 1,691 very-low birthweight preterm infants were admitted during the study period, with a median birth weight of 1100 g (interquartile range [IQR] 850-1300g) and a median gestational age of 29 weeks (IQR= 27-31g). Infants exposed to dexamethasone were smaller (birth weight: 765 versus 1134g, p<0.001) and more immature (gestational age: 28 versus 31 weeks, p<0.001). The overall rate of dexamethasone use was 9.6% (annual variation 6.7% to 13.9%) and remained stable over the study period (p=0.287), including in infants aged <32 weeks (12.0%; p=0.203) and <28 weeks (24.6%; p=0.851). Mechanical ventilation and mortality rates remained stable at 58.8% (p=0.435) and 14.5% (p=0.078), respectively. However, the birth rate at <28 weeks of gestation increased (28.8%, annual variation of 16.0% to 43.8%, p<0.001). Conclusion: Approximately one in 10 preterm very low-birth weight infants and one in four of those <28 weeks received dexamethasone, with a trend towards stable use over time, despite a significant trend towards an increase in extreme preterm newborn infants.
Pediatric Research, 2005
Very preterm infants who develop bronchopulmonary dysplasia are often treated with dexamethasone (DEXA) to wean them from the ventilator. As DEXA has growth-suppressive and catabolic effects, which might have long-term consequences on growth and organ development, we investigated whether high-dose GH treatment could overcome these effects. In a randomized, double-blind, placebo-controlled trial, 30 ventilated very low birth weight infants were assigned to receive either GH or placebo treatment after start of DEXA. DEXA was given for 24 d (starting dose 0.5 mg • kg Ϫ1 • d Ϫ1 , tapering off every third day). Simultaneously, high-dose GH (0.3 mg • kg Ϫ1 • d Ϫ1) or placebo was administered during 6 wk. During high-dose DEXA treatment (dose 0.5-0.3 mg • kg Ϫ1 • d Ϫ1), no gain in head circumference, weight, crown-heel length, and knee-heel length occurred in the GH and placebo groups. Growth during the 6-wk study period was not different between the GH and the placebo groups. Two patients in the placebo group died, but the number and the severity of adverse effects was not statistically different between the GH and placebo groups. In conclusion, highdose GH treatment did not improve growth in DEXA-treated very preterm infants and thus cannot be recommended to prevent growth failure in these infants. During high-dose DEXA, a complete growth arrest occurred, including stunting of head growth. Growth in head circumference and weight with lower dose DEXA was comparable to growth after discontinuation of DEXA. (Pediatr Res 58: 705-712, 2005) Abbreviations BPD, bronchopulmonary dysplasia DEXA, dexamethasone IGFBP-3, IGF-binding protein-3 NICU, neonatal intensive care unit ROP, retinopathy of prematurity RWTh, relative wall thickness SGA, small for gestational age
The Journal of Pediatrics, 2019
Objective To compare pulmonary and neurodevelopmental outcomes in extremely preterm infants with evolving bronchopulmonary dysplasia treated with either a 42-day course of dexamethasone or 9-day course(s) of dexamethasone. Study design This was a prospective, randomized study in 59 infants £27 weeks of gestation born between October 2006 and December 2010, who at day 10-21 of life had ventilatory support with mean airway pressure ³8 cm H 2 O and FiO 2 ³60%. Infants received dexamethasone 0.5 mg/k/day  3 days followed by a slow taper (42-day group, n = 30) or dexamethasone 0.5 mg/k/day followed by a rapid taper (9-day group, n = 29). Infants in the 9-day group received additional 9-day courses if they again required entry support. The primary outcome was intact survival (normal neurologic examination, IQ >70, and functioning in school without supplemental educational support) at 7 years of age. Results The 42-day and 9-day groups were similar for mean gestational age (25 weeks) and all baseline characteristics. Nineteen of 29 infants (66%) in the 9-day group received only 1 course of dexamethasone; therefore, the total steroid dose for the 42-day group (7.56 mg/kg) was significantly greater than that for the 9-day group (4.04 mg/ kg), P < .001. Infants in the 42-day group had shorter duration of ventilation (25 vs 37 days), P < .005, received fewer transfusions (2 vs 3.5), P < .01, and reached full enteral feeds earlier (40 vs 46 days), P < .05. Intact survival at school age was significantly increased in the 42-day group (75%) compared with the 9-day group (34%), P < .005. Conclusion A 42-day tapering course of dexamethasone in extremely preterm infants at high risk for bronchopulmonary dysplasia decreased hospital morbidities and increased rate of survival without handicap compared with a treatment protocol that attempted to minimize steroid exposure.
Respiratory Support for Very Low Birth Weight Infants Receiving Dexamethasone
The Journal of pediatrics, 2017
To assess how neonatal intensive care units followed the American Academy of Pediatrics guidelines for use of dexamethasone in preterm infants by evaluating respiratory support at the time of dexamethasone administration. This is an observational study of infants discharged from one of 290 neonatal intensive care units from 2003 to 2010. The cohort included very low birth weight (<1500 g birth weight) infants born at ≤32 weeks gestational age. The main outcome was respiratory support at time of exposure to dexamethasone. Significant respiratory support was defined as invasive respiratory support (conventional or high-frequency ventilation) with a fraction of inspired oxygen (FiO2) > 0.3. Of 81 292 infants; 7093 (9%) received dexamethasone. At the time that dexamethasone was initiated, 4604 (65%) of infants were on significant respiratory support. In accordance with the American Academy of Pediatrics recommendations, a majority of infants were on significant respiratory support...
2. Neonatal hypoglycaemia: History, clinical picture, investigations, management and outcome
The Central European Journal of Paediatrics, 2018
The aim of this article is to present the problem of neonatal hypoglycaemia through clinical cases. Hypoglycaemia is the most common neonatal metabolic disturbance. It may be picked up incidentally in a neonate without clinical signs, or anticipated in a neonate at risk of hypoglycaemia. The lowest accepted blood glucose (BG) concentration is difficult to define, the one most often used in clinical practice it is a BG concentration of 2.2 mmol/L in the first 24 hours of life and of 2.6 mmol/L after the first day of life. After birth, transient mild decreases in BG levels are physiological. If hypoglycaemia persists, samples of blood and urine should be taken to diagnose the etiological factor causing it if the condition is not otherwise evident. Conclusion: Since persistent or recurrent hypoglycaemia may cause permanent long-term neurological impairment, it is important to diagnose and treat it appropriately and in good time in order to maintain normoglycaemia and assure normovolemia in a neonate. Moreover, the etiological factors causing hypoglycaemia should be sought so the therapy is also cause-targeted.
Neonatal Hypoglycemia: Article Review
2020
Introduction: Neonatal hypoglycemia is one of the most common metabolic problems in newborns and id defined as a plasma glucose level of less than 30 mg/dL in the first 24 hours after delivery and further up to 45 mg/dL. It poses a risk of neurological injury, mental retardation, recurrent seizure activity, personality disorders, and developmental delay in newborn babies. In this condition, the newborn should be fed immediately after the delivery as well their blood glucose level should be measured within 2 3 hours, half an hour after the feeding. Despite being one of the common problems after birth, the management of low blood glucose levels remains challenging due to the lack of a definitive approach provided by healthcare professionals. With the establishment of the right definitive approach, both transient and neonatal hypoglycemia can be treated well. There are various treatment options included, such as dextrose infusion, glucagon, glucocorticoids, diazoxide, octreotide, and n...
PRILOZI, 2017
aim: Severe neonatal hypoglycaemia (HG) leads to neurologic damage, mental retardation, epilepsy, impaired cardiac performance and muscle weakness. The aim was to assess the frequency and severity of HG in a population of newborns. Patients and methods: We investigated 739 patients with neonatal hypoglycaemia (HG) (M:F=370:369) born at the University Clinic for Gynaecology and Obstetritics in Skopje in the period 2014-2016 and treated at the neonatal intensive care unit (NICU). 1416 babies were treated in the same period in NICU, and HG was observed in 52.18%. The birth weight was dominated by children with low birth weight: very low birth weight (VLBW)(<1500g) 253 children, (34,23%), low birth weight (1500-2500g) 402 (54.39%), appropriate for gestational age (AGA) 78(10.55%), and high birth weight (>4000g) 6 babies (0.81%). The gestational age was also dominated by children with low gestational age: gestational week (GW) 20-25 four children (0.54%), 26-30 GW 133 babies (17.99%), 31-35 GW472 (63.87%), and 36-40 GW130 neonates (17.59 %). 241 mothers (32.61%) have had an infection during pregnancy, 82 preeclampsia or eclampsia (11.09%), 20 diabetes mellitus (2.70%), 78 placental situations (placenta previa, abruption) (10.55%). In this study 47 babies (6.35%) with HG and co-morbidities died. There was a significant positive correlation between HG birth weight (p<0.01), gestational age (p<0.05), and the lowest Apgar score (p<0.01). Neonatal deaths were significantly correlated with GA (р>0,01), co-morbidities of the mothers (р>0,05) but not with the birth weight (р>0,05). In contrast, a significant positive correlation was found between convulsions and body weight (р<0.05). The lowest Apgar score was positively correlated with the gestational age (0.01), but not with the birth weight (0.05). conclusion: Low birth weight, low gestational age, maternal risk factors, hypoxic-ischemic encephalopathy and neonatal infections are associated with HG and are a significant factor in overall neonatal mortality. Those results indicate that diminishing the frequency of the neonatal HG and the rates of neonatal mortality requires complex interaction of prenatal and postnatal interventions.
The Journal of Pediatrics, 1995
We c o n d u c t e d a prospective, randomized, double-blind trial to assess the eftic a c y and safety of pulse doses of dexamethasone on survival without supplemental oxygen in very Iow birth weight infants at high risk of having chronic lung disease. Seventy-eight infants with birth weights _<1500 gm who were ventilator d e p e n d e n t at 7 days of postnatal age were randomly assigned to receive pulse doses of dexamethasone, 0.5 mg/kg per day, divided twice daily (n = 39), or an equivalent volume of saline solution p l a c e b o (n = 39), for 3 days at 10-day intervals until they no Ionger required supplemental oxygen or assisted ventilation, or reached 36 weeks of postmenstrual age. At study entry, the groups did not differ by birth weight, gestational age, or severity of lung disease. At 36 weeks of postmenstrual age, there was both a significant increase in survival rates without oxygen supplementation (p = 0.03) and a significant decrease in the incidence of chronic lung disease (p = 0.047) in the group that received pulse therapy. Supplemental oxygen requirements were less throughout the study period in the group that received repeated pulse doses of dexamethasone (p = 0.013). The total numbers of deaths and the durations of supplemental oxygen, ventilator support, and hospital stay did not differ between groups. Recorded side effects in the pulse therapy group were minimal and included an increase in the use of insulin therapy for hyperglycemia (p <0.05). We c o n c l u d e that in this population of very Iow birth weight infants, treatment with pulse doses of dexamethasone resuited in improvement in pulmonary outcome without clinically significant side effects.