Studies indicate the effectiveness of prophylaxis with fluconazole, with reduction in the incidence of colonization and invasive fungal disease. The benefits of prophylaxis should be evaluated considering the incidence of candidiasis in the unit, the mortality associated with candidiasis, the safety and toxicity of short and long-term medication, and the potential for development of resistant pathogens.
Introdução: O nascimento é um momento crítico na vida. 10% dos RN necessitarão de algum tipo de manobra de reanimação. O boletim de Apgar não indica procedimentos, mas permite avaliar a resposta do RN às manobras realizadas. Objetivos: Avaliar a vitalidade de RN ao nascimento e descrever a resposta aos procedimentos de reanimação neonatal em recém-nascidos (RN) com boletim de Apgar de 1º minuto ≤ 3, considerando a importância da adequada assistência no minuto de ouro. Método: Estudo retrospectivo da evolução da população de RN vivos até o 5º minuto de vida. Dados foram obtidos através do sistema de informação SISMater, referente a janeiro de 2010 a dezembro de 2015. Para análise, utilizou-se o Statistical Program for Social Science. Resultados: Um total de 154 RN apresentaram Apgar de 1º minuto ≤ 3 (112 ≥ 34 semanas e 42 < 34 semanas de Idade Gestacional). Todos foram submetidos aos passos iniciais e 64,3% apresentaram recuperação no Apgar de 5º minuto. Dos RN submetidos a procedimentos, 63,8% recuperou com ventilação com máscara, sendo que houve menor taxa de recuperação em RN com idade gestacional < 34 semanas. Conclusão: A ventilação adequada do recém-nascido é o principal procedimento para recuperação do Apgar no 50 minuto, mas um terço de RN com Apgar ≤ 3 no primeiro minuto de vida necessitarão de procedimentos avançados da reanimação. Assim, considera-se que a presença de um pediatra capacitado em sala de parto é essencial para assistência adequada de RN sem vitalidade.
Background:
The survival of premature newborns increased in the last decades due to advances in neonatal care. The physiology of this group is still under investigation, once the incomplete organogenesis entails functional particularities that are not yet clarified by current clinical knowledge. The immature kidneys are especially susceptible to acute injury with potential long-term impacts. Current diagnostic parameters of acute kidney injury are limited among the preterm population. The commonly used serum creatinine protein constitutes a poor biomarker to predict early lesions as it is susceptible to several factors, including muscle mass and gestational age.
Objective:
The present review explores the evidence on nephrogenesis, renal function, and acute kidney injury in neonatology, as well as studies on renal function biomarkers and their potential application for diagnosis, follow-up, and prognosis in preterm newborns.
Results:
Premature newborns reach full-term gestational age with reduced number and quality of nephrons. Consequently, the glomerular filtration rate and tubular function become impaired and are proportional to the gestational age. Despite having a high incidence among the pediatric population, acute kidney injury is still underdiagnosed and poorly managed due to the absence of proper, sensible, and non-invasive biomarkers. Although cystatin C, NGAL, and KIM-1, are promising urinary markers, current literature remains inconsistent.
Conclusion:
Further research is needed to properly identify and standardize sensible and specific urinary biomarkers to better assess kidney function in preterm newborns.
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