scholarly journals Prophylactic Use of Fluconazole in Very Premature Infants

2021 ◽  
Vol 9 ◽  
Author(s):  
Deshuang Zhang ◽  
Dongke Xie ◽  
Na He ◽  
Xiaoling Wang ◽  
Wenbin Dong ◽  
...  
Keyword(s):  
Premature Infants ◽  
Periventricular Leukomalacia ◽  
Pathogenic Fungi ◽  
Adverse Outcomes ◽  
Short Term ◽  
Drug Induced ◽  
Prophylaxis Group ◽  
Significant Difference ◽  
Prophylactic Use ◽  
Very Premature Infants

Objective: To evaluate the efficacy, safety, and fungal sensitivity of prophylactic fluconazole use in very premature infants.Methods: We performed a retrospective historical comparative analysis of 196 very premature infants (113 in the prophylaxis group and 83 in the rescue group). The incidence of nosocomial fungal infection (NCFI) and pathogenic fungi, their drug sensitivity, and the minimum inhibitory concentration (MIC) of fluconazole were compared between the two groups. We also analyzed differences in short-term adverse outcomes, such as drug-induced liver or renal function disruption, fungal-attributable death, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC), between the groups. The effects of the prophylactic fluconazole strategy on NCFI and short-term adverse outcomes were assessed by multivariate logistic regression.Results:Candida albicans (46.7%) and Candida glabrata (43.3%) were the main culprit pathogens causing NCFI. The incidence of NCFI was significantly lower in the prophylaxis group than in the rescue group (15.9 vs. 45.8%, P < 0.001). However, fewer fungi were completely sensitive to fluconazole (40 vs. 85%, P < 0.05) and the MIC of fluconazole was higher [16.0 (3.5 ~ 16.0) vs. 3.0 (1.0 ~ 8.0) μg/ml, P < 0.001] in the prophylaxis group than in the rescue group. Compared with the rescue group, the prophylaxis group had a lower risk of NCFI (adjusted OR 0.25; 95% CI 0.11, 0.55). Additionally, the prophylaxis group had significantly lower risks of combined outcomes (one or more complications, such as BPD, ROP needing interventions, PVL/IVH (grade > 2), NEC stage ≥2, and fungal-attributable death) (adjusted OR 0.44; 95% CI 0.21, 0.92). There was no significant difference in serum alanine transferase (ALT), aspartate transaminase (AST), creatinine (Cr), or direct bilirubin (DBIL) levels between the two groups.Conclusions: Fluconazole prophylaxis reduced NCFI and improved combined clinical outcomes in very premature infants, with no increased risks of serious short-term adverse side effects; however, the MIC of fluconazole showed significant increases. Therefore, further optimization of preventive strategies is necessary to maintain the sensitivity of fluconazole against fungal isolates.

Echocardiographic Monitoring of Cardiac Parameters to Predict Bronchial Dysplasia in Very Premature Infants

2021 ◽  
Vol 11 (7) ◽  
pp. 1413-1417
Author(s):  
Xiaofang Yan ◽  
Yan Gao ◽  
Peipei Wu ◽  
Xing Feng
Keyword(s):  
Statistical Analysis ◽  
Premature Infants ◽  
Observational Studies ◽  
Early Stage ◽  
Single Center ◽  
Cardiac Chamber ◽  
Cardiac Health ◽  
Significant Difference ◽  
Bronchial Dysplasia ◽  
Very Premature Infants

Echocardiography was used to measure the cardiac parameters in high-risk premature infants prone to bronchopulmonary dysplasia (BPD). These measurements were used to determine the correlation between the parameters and BPD and whether they could be used to predict the parameters associated with cardiac health of BPD in very premature infants at a very early stage. Seventy-four very premature infants (gestational age < 32 weeks) were recruited in this retrospective, single-center, observational studies. All infants were examined using echocardiography within a week after birth, and the cardiac chamber parameters were recorded. Of these, 14 infants with BPD were reexamined at 4 weeks after birth. Statistical analysis and comparison of the data of these 14 infants indicated that 1-week after birth, the inner diameters of PA/AS/AO/LA/ROVT/LVPW/LV were significantly smaller (P < 0.05), and that of AS/AO/LA/LV were highly significantly smaller (P < 0.001) in the BPD group compared with the non-BPD group. Comparing the cardiac parameters between 1 and 4 weeks after birth in infants with BPD showed a significant difference in the diameter of PA/AS/AO/ROVT/IVS/LVPW/LV, suggesting that the ventricular cavity developed more efficiently during growth.

High-Frequency Jet Ventilation in the Early Management of Respiratory Distress Syndrome Is Associated With a Greater Risk for Adverse Outcomes

PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1035-1043 ◽  
Author(s):  
Thomas E. Wiswell ◽  
Leonard J. Graziani ◽  
Michael S. Kornhauser ◽  
James Cullen ◽  
Daniel A. Merton ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Premature Infants ◽  
High Frequency ◽  
Distress Syndrome ◽  
Periventricular Leukomalacia ◽  
Adverse Outcomes ◽  
Jet Ventilation ◽  
Early Management ◽  
The Mean

Objective. The objective of this investigation was to determine if high-frequency jet ventilation (HFJV) used early in the treatment of premature infants with respiratory distress syndrome was effective in reducing pulmonary morbidity without increasing the occurrence of adverse neurologic outcomes. Study Design. A total of 73 premature infants who met the inclusion criteria (gestational age of less than 33 weeks, birth weight of more than 500 g, age of less than 24 hours, need for assisted ventilation with peak inspiratory pressure of more than 16 and FIO2 more than 0.30, and roentgenographic evidence of respiratory distress syndrome) were randomized to either conventional (n = 36) or to high-frequency jet (n = 37) ventilation. Our goals were to maintain the infants on the assigned ventilator for at least 7 days unless they could either be extubated or meet crossover criteria. Univariate analyses were initially used to compare the two groups. Stepwise logistic regression was subsequently used to assess whether various factors independently influenced adverse outcomes. Results. The two groups of infants were similar in all obstetrical, perinatal, and neonatal demographic characteristics. The mean birth weight and gestational age in the conventional group were 930 g and 26.6 weeks and in the HFJV group, 961 g and 26.9 weeks. The infants were randomized at similar ages (7.1 and 7.3 hours of life, respectively). Their prerandomization ventilator settings and arterial blood gases were nearly identical. There were no differences in pulmonary outcomes (occurrence of air leaks, need for oxygen or ventilation at 36 weeks postconception), and there were no differences in the mean number of days oxygen was required, number of days ventilated, or length of hospital stay. Infants ventilated with HFJV were significantly more likely to develop cystic periventricular leukomalacia (10 vs 2, P = .022) or to have a poor outcome (grade IV hemorrhage, cystic periventricular leukomalacia, or death) (17 vs 7, P = .016). Logistic regression analysis revealed HFJV to be a significant independent predictor of both cystic periventricular leukomalacia and a poor outcome. The presence of hypocarbia was not an independently significant predictor of adverse outcomes. Conclusions. With the HFJV treatment strategy that we used, use of the high-frequency jet ventilator in the early management of premature infants with respiratory distress syndrome resulted in significantly more adverse outcomes than in those treated with conventional mechanical ventilation.

Does Prophylactic Use of Bovine Surfactant Change Drug Utilization in Very Premature Infants during Neonatal Period?

1991 ◽  
Vol 16 (1) ◽  
pp. 1-6 ◽  
Author(s):  
L. Gortner ◽  
U. Bernsau ◽  
H.H. Hellwege ◽  
G. Hieronimi ◽  
G. Jorch ◽  
...  
Keyword(s):  
Drug Utilization ◽  
Premature Infants ◽  
Neonatal Period ◽  
Prophylactic Use ◽  
Very Premature Infants

scholarly journals Caffeine citrate improves outcomes of apnea of prematurity based on gestational ages

2019 ◽  
Author(s):  
Dongchi Zhao ◽  
Li Lijun ◽  
Wang Xia ◽  
Yang Pu ◽  
Zheng Junwen
Keyword(s):  
Clinical Outcomes ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Abdominal Distension ◽  
Short Term ◽  
Neurobehavioral Development ◽  
Significant Difference ◽  
Caffeine Citrate ◽  
Apnea Of Prematurity ◽  
The Impact

Abstract ObjectiveThis study aimed to evaluate the therapeutic effect of caffeine citrate on early premature infants with apnea of prematurity (AOP), and the impact on movement and neurobehavioral development in their early lives.Study designAmongst 397 premature infants whose gestational age (GA) were less than 32 weeks, 172 premature infants were eligible for this study from January 2014 to May 2017. 94 infants received caffeine citrate intervention, 20 infants were given aminophyline and the rest 58 infants didn't received any methylxanthines. According to the incidence of apnea, caffeine using was divided into two situations of therapeutic and preventive administration. The primary clinical outcomes were recorded which included length of stay (LOS), duration of mechanical ventilation, the incidence of complications and outcomes.Results62 cases (66%) were assigned to receive caffeine within 3 days after birth, and 69 cases (74%) received caffeine less than one month. Caffeine could reduce LOS, duration of MV and nasal continues positive airway pressure (nCPAP), the incidence of nosocomial infection and bronchial pulmonary dysplasia (BPD) (p<0.05). There was no significant difference in the incidence of abdominal distension, necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH) compared with aminophylline and conservative groups (P >0.05). Caffeine showed different effects on clinical outcomes in early premature infants based on their GAs, and premature infants with larger GA could benefit more from the intervention (p<0.001), and caffeine didn’t affect their early lives in short-term prognosis by follow-up.Conclusion Caffeine can improve AOP clinical outcomes in those premature infants with larger GA, and didn't have side effects on the movement and neurobehavioral development in short-term prognosis.

scholarly journals Oral paracetamol versus oral ibuprofen for treatment of patent ductus arteriosus

2017 ◽  
Vol 46 (2) ◽  
pp. 811-818 ◽  
Author(s):  
Manar Al-lawama ◽  
Iyad Alammori ◽  
Tariq Abdelghani ◽  
Eman Badran
Keyword(s):  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Primary Closure ◽  
Ductus Arteriosus ◽  
Randomized Study ◽  
Inclusion Criteria ◽  
Short Term ◽  
Significant Difference ◽  
Oral Ibuprofen ◽  
Patent Ductus

Objective This study was performed to investigate the safety and efficacy of oral paracetamol versus oral ibuprofen in the treatment of patent ductus arteriosus (PDA) in premature infants. Methods Premature infants with PDA with a gestational age of ≤32 weeks or birth weight of ≤1500 g were included in this randomized study. Results A total of 120 premature infants fulfilled the inclusion criteria. Of these 120 infants, 34 fulfilled the treatment criteria and 22 were finally randomized. We found no significant difference in the mortality or primary closure rates between the two groups. We also found no significant difference in the short-term neonatal outcomes. Conclusions Either oral paracetamol or oral ibuprofen can be used safely and effectively to treat PDA in premature infants.

Antenatal Glucocorticoid Treatment and Cystic Periventricular Leukomalacia in Very Premature Infants

2000 ◽  
Vol 55 (3) ◽  
pp. 137-138
Author(s):  
Olivier Baud ◽  
Laurence Foix-L’Helias ◽  
Monique Kaminski ◽  
François Audibert ◽  
Pierre-Henri Jarreau ◽  
...  
Keyword(s):  
Premature Infants ◽  
Periventricular Leukomalacia ◽  
Glucocorticoid Treatment ◽  
Very Premature Infants

Short-term results of upper airway stimulation in obstructive sleep apnoea patients: the Amsterdam experience

2020 ◽  
Vol 134 (5) ◽  
pp. 447-452
Author(s):  
P E Vonk ◽  
M J L Ravesloot ◽  
J P van Maanen ◽  
N de Vries
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Consecutive Series ◽  
Short Term ◽  
Drug Induced ◽  
Upper Airway Stimulation ◽  
Surgical Success ◽  
Obstructive Sleep ◽  
Significant Difference

AbstractObjectivesThis paper aimed to: retrospectively analyse single-centre results in terms of surgical success, respiratory outcomes and adverse events after short-term follow up in obstructive sleep apnoea patients treated with upper airway stimulation; and evaluate the correlation between pre-operative drug-induced sleep endoscopy findings and surgical success.MethodsA retrospective descriptive cohort study was conducted, including a consecutive series of obstructive sleep apnoea patients undergoing implantation of an upper airway stimulation system.ResultsForty-four patients were included. The total median Apnoea–Hypopnea Index and oxygen desaturation index significantly decreased from 37.6 to 8.3 events per hour (p < 0.001) and from 37.1 to 15.9 events per hour (p < 0.001), respectively. The surgical success rate was 88.6 per cent, and did not significantly differ between patients with or without complete collapse at the retropalatal level (p = 0.784). The most common therapy-related adverse event reported was (temporary) stimulation-related discomfort.ConclusionUpper airway stimulation is an effective and safe treatment in obstructive sleep apnoea patients with continuous positive airway pressure intolerance or failure. There was no significant difference in surgical outcome between patients with tongue base collapse with or without complete anteroposterior collapse at the level of the palate.

Antenatal Glucocorticoid Treatment and Cystic Periventricular Leukomalacia in Very Premature Infants

1999 ◽  
Vol 341 (16) ◽  
pp. 1190-1196 ◽  
Author(s):  
Olivier Baud ◽  
Laurence Foix-L'Helias ◽  
Monique Kaminski ◽  
François Audibert ◽  
Pierre-Henri Jarreau ◽  
...  
Keyword(s):  
Premature Infants ◽  
Periventricular Leukomalacia ◽  
Glucocorticoid Treatment ◽  
Very Premature Infants

Acetaminophen: Macula densa hypersecretory activity by induced hepatotoxicity

1987 ◽  
Vol 45 ◽  
pp. 934-935
Author(s):  
S.S. Poolsawat ◽  
C.A. Huerta ◽  
S.TY. Lae ◽  
G.A. Miranda
Keyword(s):  
Cell Proliferation ◽  
Liver Function ◽  
Chronic Inflammation ◽  
Foam Cell ◽  
Term Effect ◽  
Short Term ◽  
Drug Induced ◽  
Experimental Induction ◽  
Tissue Alterations ◽  
Toxic Responses

Introduction. Experimental induction of altered histology by chemical toxins is of particular importance if its outcome resembles histopathological phenomena. Hepatotoxic drugs and chemicals are agents that can be converted by the liver into various metabolites which consequently evoke toxic responses. Very often, these drugs are intentionally administered to resolve an illness unrelated to liver function. Because of hepatic detoxification, the resulting metabolites are suggested to be integrated into the macromolecular processes of liver function and cause an array of cellular and tissue alterations, such as increased cytoplasmic lysis, centrilobular and localized necroses, chronic inflammation and “foam cell” proliferation of the hepatic sinusoids (1-4).Most experimentally drug-induced toxicity studies have concentrated primarily on the hepatic response, frequently overlooking other physiological phenomena which are directly related to liver function. Categorically, many studies have been short-term effect investigations which seldom have followed up the complications to other tissues and organs when the liver has failed to function normally.

Extrakorporális és intrakorporális anasztomózis rövid távú eredményeinek összehasonlítása malignus daganat miatt végzett laparoszkópos jobb oldali hemikolektómia esetén

2020 ◽  
Vol 73 (4) ◽  
pp. 148-152
Author(s):  
Kornél Vajda ◽  
László Sikorszki
Keyword(s):  
Length Of Stay ◽  
Gold Standard ◽  
Average Length ◽  
Colon Surgery ◽  
Right Hemicolectomy ◽  
Malignant Tumours ◽  
Short Term ◽  
Significant Difference ◽  
Laparoscopic Assisted ◽  
Laparoscopic Hemicolectomy

Összefoglaló. Bevezetés: A laparoszkópia térhódítása a jobb oldali colon műtéteknél is nyilvánvaló. Ma legtöbb helyen a laparoszkóposan asszisztált jobb oldali hemikolektómia extrakorporális anasztomózissal a gold standard. A morbiditás randomizált vizsgálatok alapján még 30% körüli. A technikai fejlődés lehetővé tette az intrakorporális anasztomózist. Célkitűzés: Retrospektív módon elemezni rosszindulatú jobb oldali vastagbéldaganat miatt végzett laparoszkópos hemikolektómiák rövid távú eredményeit a két módszer összehasonlításával. Eredmények: 2018. 01. 01. – 2019. 12. 31. között 184 jobb oldali hemikolektómiát végeztünk, ezek közül 122 történt malignus betegség miatt. 51 esetben nyitott és 71 esetben laparoszkópos műtét történt. 37 férfi (átlagéletkor: 70,59 év) és 34 nő (átlagéletkor: 72,14 év) volt. 50 esetben extrakorporális (EA) és 21 esetben pedig intrakorporális anasztomózist (IA) végeztünk. Az EA csoportban 18, míg az IA csoportban 3 szövődmény alakult ki 30 napon belül (p = 0,067). Az EA csoportból 3, az IA csoportból 1 beteget veszítettünk el 30 napon belül (p = 0,66). Az átlagos ápolási idő az EA csoportban 9,48 (5–32) nap, míg az IA csoportban 6,52 (4–19) nap volt (p = 0,001) a szövődményes esetekkel együtt. A szövődményes esetek nélkül az EA csoportban 6,35 (5–10) nap, az IA csoportban pedig 5,55 (4–8) napnak bizonyult (p = 0,09). A műtéti idő pedig az EA csoportban 147 (90–240) perc, az IA csoportban pedig 146,47 (90–265) perc volt (p = 0,11). Konklúzió: Az irodalommal összhangban azt találtuk, hogy IA esetén kevesebb a szövődmény, ezzel is összefüggésben rövidebb az átlagos ápolási idő, és a műtéti időt tekintve nincs szignifikáns különbség. Ezeket figyelembe véve az intrakorporális anasztomózis javasolható jobb oldali laparoszkópos hemikolektómia esetén. Summary. Introduction: Laparoscopy became evident for right-sided colon surgery too. Today the laparoscopic-assisted right-hemicolectomy is the gold standard with extracorporeal anastomosis. Morbidity according to randomized trials is still approximately 30%. The development of the surgical technique resulted in the creation of intracorporeal anastomosis. Our aim was to compare the short-term results of the two methods. Aim: To analyse the short-term results of right-sided hemicolectomy that were performed due to malignant tumours with the comparison of the two methods. Results: A cohort of 184 right-sided hemicolectomy were performed from 01.01.2018 to 31.12.2019 from which 122 were operated on because of a malignant disease. 51 open and 71 laparoscopic operations were performed. The average age of 37 men and 34 women were 70.59 and 72.14 years, respectively. 50 patients underwent extracorporeal (EA) anastomosis and 21 intracorporeal (IA) anastomosis. Within 30 days the number of complications were 18 in the EA group and 3 in the IA group (p = 0.067). 3 from the EA group and 1 from IA group died within 30 days (p = 0.66). The average length of stay were 9.48 days in the EA group and 6.52 days in the IA group together with the complicated cases (p = 0.001) while 6.35 days and 5.55 days without the complicated cases (p = 0.09). The average duration of operation was 147 minutes in the EA and 146.47 minutes in the IA group (p = 0.11). Conclusion: We found concordance with the literature that there are fewer complications in case of IA which might be related to shorter length of stay. There is no significant difference between the surgical times. Bearing these facts in mind, IA might be suggested for right- sided laparoscopic hemicolectomy.

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