1,720,979 research outputs found
Influence of ventilation mode on neonatal cerebral blood flow and volume
No full textBACKGROUND:
Cerebral hemodynamics is supposed to be influenced by the different ventilation approach. Ventilation support can be classified as non-invasive (N-CPAP) or invasive (SIMV and HFV), the last known to induce endotrauma. Our aim was the non-invasive NIRS assessment of neonatal absolute cerebral blood flow (CBF) and relative cerebral blood volume changes (DeltaCBV) during synchronized intermittent ventilation (SIMV), or high frequency ventilation (HFV) and nasal continuous positive airways pressure (CPAP).
METHODS:
An observational study in a tertiary referral NICU. CBF and DeltaCBV changes were assessed in 41 preterm newborn infants with respiratory distress syndrome treated using mechanical ventilation or the CPAP device.
RESULTS:
Basal chromophore traces enabled DeltaCBV (mL/100 g) changes to be calculated. CBF was calculated in mL/100 g/min from the saturation rise integral and rate of rise [O(2)Hb-HHb]. Median DeltaCBV was 0.07 (range 0.01-0.13) in SIMV group, 0.07 (0.01-0.19) in HFV group and 0.13 (0.10-1.28) in CPAP group. Median CBF was 14.44 (2.70-32.10), 9.20 (2.94-19.58) and 31.69 (13.59-34.93) respectively. A multiple regression model showed a significant correlation between DeltaCBV or CBF and ventilation approach.
CONCLUSION:
In the light of our results, we might speculate that, assuming that hemodynamic autoregulation is safe and arterial blood pressure is preserved, ventilation per se influences brain circulation
Impact of anxiety in the puerperium on breast-feeding outcomes: Role of parity
No full textOBJECTIVE:: Studies in animals indicate that stress and anxiety can depress lactation, but there is much less information available concerning humans. We aimed to determine whether maternal anxiety in puerperium, potentially exacerbated by the primiparity inexperience, has a negative impact on breast-feeding outcomes. SUBJECTS AND METHODS:: The state-trait anxiety inventory Y form (Spielberger, 1983) was administered to a total of 204 mothers, 101 primiparae, and 103 pluriparae on the third to fourth day postpartum. RESULTS:: We found that primiparae had state anxiety (T) scores significantly higher than pluriparae (44.57 ± 5.85 vs 43.28 ± 7.10, P = 0.03). Increased state anxiety levels impaired breast-feeding success. In addition, in the logistic regression analysis model used to assess factors predictive of breast-feeding longer than 3 months, maternal state anxiety was the most significant risk factor (odds ratio 0.99; 0.88-0.98, P < 0.01). CONCLUSIONS:: In the puerperium, anxiety, potentially exacerbated by primiparae inexperience, is associated with impaired lactation. Alleviating maternal anxiety could be beneficial for stimulating breast-feeding in more vulnerable women. Copyright © 2009 by Lippincott Williams & Wilkins
Early versus late cord clamping: effects on peripheral blood flow and cardiac function in term infants.
No full textPeripheral perfusion and oxygenation assessment using near-infrared spectroscopy (NIRS) and the oximeter pulsatility index in healthy neonates
No full textEarly versus late cord clamping: effects on peripheral blood flow and cardiac function in term infants.
No full textBACKGROUND:
In the debate on the best cord clamping time in newborn infants, we hypothesized that late cord clamping enables an increased volemia due to blood transfer to the newborn from the placenta.
AIM:
To assess whether clamping time can affect limb perfusion and heart hemodynamics in a group of 22 healthy term newborn infants.
STUDY DESIGN:
A case-control study.
SUBJECTS:
Eleven early-clamped (at 30 s) vaginally-delivered newborn infants were compared with eleven late-clamped (at 4 min) newborns.
OUTCOME MEASURES:
The two groups were studied using near-infrared spectroscopy and M-mode echocardiography.
RESULTS:
Late cord clamping coincided with a higher hematocrit (median 62% versus 54%) and hemoglobin concentration (median 17.2 versus 15 g/dL), whilst there were no changes in bilirubin level. Echocardiography showed a larger end-diastolic left ventricle diameter (1.7 cm median value versus 1.5) coupled with unvaried shortening and ejection fraction values. There were no changes in calf blood flow, oxygen delivery, oxygen consumption or fractional oxygen extraction calculated from the NIRS measurements, or in foot perfusion index.
CONCLUSIONS:
Our results demonstrated that late cord clamping coincides with an increased placental transfusion, expressed by higher hematocrit and hemoglobin values, and larger left ventricle diameter at the end of the diastole, with no changes in peripheral perfusion or oxygen metabolism
Lo sviluppo psicomotorio nei primi 18 mesi: confronto fra un gruppo di pretermine e un gruppo di controllo di nati a termine
No full textNegli ultimi anni, la sopravvivenza dei neonati di bassa età gestazionale
(≤28 settimane) e di peso basso ed estremamente basso (rispettivamente,
≤1500g e ≤1000g), è progressivamente aumentata grazie al contributo delle
moderne tecnologie e all’alta qualità dell’assistenza medica ed infermieristica
nelle terapie intensive neonatali.
Lo scopo di questo studio è quello di verificare l’andamento dello sviluppo
psicomotorio di un gruppo di bambini pretermine (di età gestazionale<30
settimane) senza compromissione neurologica rispetto a quello di un gruppo
di controllo di bambini sani nati a termine. In particolare sono state valutate
nei due gruppi le fasi del controllo posturale e della locomozione (controllo
del capo, raggiungimento della posizione seduta autonoma, andatura quadrupede,
stazione eretta, cammino autonomo) e alcune tappe dello sviluppo linguistico
significative (prime parole, denominazione oggetti, denominazione
parti del corpo). Sono stati pertanto arruolati nello studio 40 neonati pretermine,
20 maschi e 20 femmine, ricoverati nel periodo 2000-2001 presso l’Unità
di Terapia Intensiva Neonatale del Dipartimento di Pediatria dell’Università
di Padova, con EG inferiore a 30 settimane, ed un gruppo di controllo
composto da 59 bambini nati a termine, 32 maschi e 27 femmine, nati nel
corso degli anni 2000-2001 privi di problemi medici rilevanti riguardanti la
gravidanza, il parto e il periodo perinatale, reclutato in cinque diverse Scuole
dell’Infanzia e Asili Nido. I bambini pretermine hanno eseguito esame neurologico
classico al momento della dimissione dal reparto (36a-40a settimana di
EG) e poi seguiti con un follow-up neurologico a 3, 6, 12 e 18 mesi di età
corretta, indagando la funzione motoria nella quale era compresa anche la
valutazione della motricità fine, la capacità visiva, la capacità di udito e di linguaggio,
l’abilità e lo sviluppo sociale. Per il gruppo di controllo i dati sono
stati raccolti attraverso la compilazione di un questionario somministrato ad
un parente del bambino e con l’ausilio del Libretto Sanitario Pediatrico
Dai nostri risultati emerge che le tappe principali dello sviluppo psicomotorio
sono raggiunte più tardivamente nei pretermine rispetto al gruppo
di controllo, nonostante l’utilizzo dell’età corretta e l’esclusione di soggetti
con compromissione neurologica. Molto spesso si interviene nello sviluppo
dei bambini pretermine con una care personalizzata nelle terapie intensive
neonatali e successivamente con interventi fisioterapici per favorire lo sviluppo
armonico delle competenze motorie e l’adeguata acquisizione delle
varie tappe funzionali. Pensiamo, pertanto, siano necessari ulteriori studi e la
formulazione di programmi di osservazione a lungo termine dello sviluppo
neuroevolutivo del bambino pretermine, utile anche per quello a basso
rischio, per valutare l’efficacia degli interventi attualmente propost
Comparison between the perinatal risk inventory and the nursery neurobiological risk score for predicting development in high-risk newborn infants.
No full textBACKGROUND:
The availability of a score for predicting neonatal outcome prior to discharge may help us to define the risk of developmental disorders in very low birth weight infants.
AIM:
To compare Scheiner's Perinatal Risk Inventory (PERI) with Brazy's Neurobiological Risk Score (NBRS) when applied at discharge, in predicting developmental delay at 24 months of age.
STUDY DESIGN:
To evaluate the predictive power of the two tests, we measured their sensitivity and specificity in predicting outcome (Mental Development Index, MDI, Psychomotor Development Index, PDI, and Amiel-Tison Neurological Examination) in an observational study.
SUBJECTS:
102 very low birth weight infants (BW <1,500 g) admitted to our NICU at the Pediatric Department of Padova University.
RESULTS:
In the cohort studied, 75.5% of the patients had a normal MDI, while 24.5% showed a delayed performance (8.8% mildly and 15.7% severely so); the PDI was normal in 74.5% patients, whilst 25.5% had a delayed performance (9.8% mildly and 15.7% severely so). According to the Amiel-Tison test, neurological performance was normal in 66% patients, impaired without disability in 19% and impaired with disability in 15%. NBRS showed a sensitivity and specificity respectively of 0.96 and 0.23 (MDI), 0.96 and 0.24 (PDI), 0.94 and 0.25 (Amiel-Tison test); for PERI were 0.88 and 0.54 (MDI), 0.77 and 0.51 (PDI), 0.82 and 0.57 (Amiel-Tison test). The PERI and NBRS can predict the MDI with an AUC >0.8 and the PDI or Amiel-Tison findings with an AUC of 0.7-0.8. No significant differences were found between the areas under the ROC curves using the NBRS and the PERI.
CONCLUSIONS:
: In assessing the prognosis for individual babies, the physician can choose either the PERI or the NBRS to predict PDI, MDI or Amiel-Tison performance
Surgical closure of patent ductus arteriosus reduces the cerebral tissue oxygenation index in preterm infants: a near-infrared spectroscopy and Doppler study
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