No abstract

No abstract

No abstract

Objective: To evaluate the trend of hospitalization for acute bronchiolitis in infants under one year of age, in the past eight years and after the implementation of the palivizumab immunization program in Brazil. Methods: The study is a retrospective analysis of data on infants younger than one year of age, who were hospitalized with acute bronchiolitis between 2008 and 2015 in Brazil. The Brazilian National Health System database was used. The rates of hospitalization in the pre-implementation (2008-2012) and post-implementation (2014-2015) periods of the palivizumab immunization program were evaluated. The total number of admissions in the same period was used as a comparison. Results: Between January 2008 and December 2015, 263,679 hospitalizations for bronchiolitis were recorded in infants younger than one year of age, 60% represented by boys. The incidence of hospitalization for bronchiolitis increased by 49% over this period (8.5 to 12.7 per 1,000 inhabitants per year). Between 2013 and 2014, the incidence rate of hospitalization for acute bronchiolitis decreased by 8% (12.5 to 11.5 per 1,000 inhabitants per year). However, in the second year of the program, hospitalization rate increased again by 10% (12.7 per 1,000 inhabitants per years). Conclusions: Acute bronchiolitis presented increasing rates of hospitalization over the study period. Hospitalization incidence for acute bronchiolitis declined one year after the implementation of palivizumab but increased again in the second year of the program.

Objectives: To evaluate the prevalence of congenital heart disease and their outcomes in a Brazilian cohort of very low birth weight preterm infants. Design: Post hoc analysis of data from the Brazilian Neonatal Network database, complemented by retrospective data from medical charts and a cross-sectional survey. Setting: Twenty public tertiary-care university hospitals. Patients: A total of 13,955 newborns weighing from 401 to 1,499 g and between 22 and 36 weeks of gestational age, born from 2010 to 2017. Interventions: None. Measurements and Main Results: The prevalence of congenital heart disease was 2.45% (95% CI, 2.20–2.72%). In a multivariate regression analysis, risk factors associated with congenital heart disease were maternal diabetes (relative risk, 1.55; 95% CI, 1.11–2.20) and maternal age above 35 years (relative risk, 2.09; 95% CI, 1.73–2.51), whereas the protection factors were maternal hypertension (relative risk, 0.54; 95% CI, 0.43–0.69), congenital infection (relative risk, 0.45; 95% CI, 0.21–0.94), and multiple gestation (relative risk, 0.73; 95% CI, 0.55–0.97). The pooled standardized mortality ratio in patients with congenital heart disease was 2.48 (95% CI, 2.22–2.80), which was significantly higher than in patients without congenital heart disease (2.08; 95% CI, 2.03–2.13). However, in multiple log-binomial regression analyses, only the presence of major congenital anomaly, gestational age (< 29 wk; relative risk, 2.32; 95% CI, 2.13–2.52), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20; relative risk, 3.76; 95% CI, 3.41–4.14) were independently associated with death, whereas the effect of congenital heart disease was spotted only when a conditional inference tree approach was used. Conclusions: The overall prevalence of congenital heart disease in this cohort of very low birth weight infants was higher and with higher mortality than in the general population of live births. The occurrence of a major congenital anomaly, gestational age (< 29 wk), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20) were significantly and independently associated with death, whereas the association of congenital heart disease and death was only evident when a major congenital anomaly was present.

Objective: To compare blood pressure measurements in newborn infants using the flush method, pulse oximetry and oscillometry according to Doppler findings. Methods:Noninvasive blood pressure measurements were made using three techniques (flush method, pulse oximetry and oscillometry) in three groups of newborns: 15 normal term infants, 16 stable preterm infants, and 14 critically ill infants. All measurements were video recorded, edited separately, coded and analyzed independently by three neonatologists.Results: Fifty-seven measurements were made using each method. The flush method and pulse oximetry had a better correlation with Doppler findings than oscillometry (correlation coefficients: 0.89, 0.85, 0.71; p < 0.01). The difference between measurement means, their standard deviations and the 95% confidence intervals when compared with Doppler findings were: -5.2±7.9 (-21.1:10.7) mmHg for the flush method; 0.4±8.9 (-17.5:18.2) mmHg for pulse oximetry; and 6.4±16.1 (-25.8:8.6) mmHg for oscillometry. The flush method had a better agreement with Doppler findings for the diagnosis of hypotension than oximetry and oscillometry. Conclusions:The flush method and pulse oximetry seem to be useful techniques to measure systolic blood pressure in newborn infants; oscillometry had the poorest agreement with Doppler findings to detect hypotension.J Pediatr (Rio J). 2011;87(1):57-62: Hypotension, systolic blood pressure, newborn infant.

Objective: To compare blood pressure measurements in newborn infants using the flush method, pulse oximetry and oscillometry according to Doppler findings. Methods:Noninvasive blood pressure measurements were made using three techniques (flush method, pulse oximetry and oscillometry) in three groups of newborns: 15 normal term infants, 16 stable preterm infants, and 14 critically ill infants. All measurements were video recorded, edited separately, coded and analyzed independently by three neonatologists.Results: Fifty-seven measurements were made using each method. The flush method and pulse oximetry had a better correlation with Doppler findings than oscillometry (correlation coefficients: 0.89, 0.85, 0.71; p < 0.01). The difference between measurement means, their standard deviations and the 95% confidence intervals when compared with Doppler findings were: -5.2±7.9 (-21.1:10.7) mmHg for the flush method; 0.4±8.9 (-17.5:18.2) mmHg for pulse oximetry; and 6.4±16.1 (-25.8:8.6) mmHg for oscillometry. The flush method had a better agreement with Doppler findings for the diagnosis of hypotension than oximetry and oscillometry. Conclusions:The flush method and pulse oximetry seem to be useful techniques to measure systolic blood pressure in newborn infants; oscillometry had the poorest agreement with Doppler findings to detect hypotension.J Pediatr (Rio J). 2011;87(1):57-62: Hypotension, systolic blood pressure, newborn infant. ResumoObjetivo: Comparar a pressão arterial pelos métodos do flush, da oximetria de pulso e da oscilometria utilizando o Doppler em neonatos.Métodos: Foram realizadas medidas de pressão arterial não invasiva utilizando três métodos distintos (flush, oximetria de pulso e oscilometria automática) em três grupos de recém-nascidos selecionados por sorteio: 15 a termo e normais, 16 prematuros estáveis e 14 doentes. Todas as medidas foram filmadas, editadas separadamente, codificadas e analisadas independentemente por três neonatologistas. Resultados:Realizaram-se 57 medidas por cada método. Os méto-dos do flush e da oximetria de pulso mostraram melhor correlação com o Doppler do que a oscilometria (coeficiente de correlação 0,89, 0,85 e 0,71, respectivamente, p < 0,01). A diferença entre as médias das medidas, seus respectivos desvios padrão e o intervalo de confiança de 95% quando comparados com Doppler foram: -5,2±7,9 (-21,1:10,7) mmHg com o método do flush; 0,4±8,9 (-17,5:18,2) mmHg com a oximetria de pulso; e 6,4±16,1 (-25,8:8,6) mmHg com a oscilometria. O método do flush mostrou melhor concordância com o Doppler para diagnóstico de hipotensão do que os métodos da oximetria e da oscilometria. Conclusões:Os métodos do flush e da oximetria de pulso mostraram-se úteis para medir a pressão arterial sistólica de recém-nascidos, sendo que o método oscilométrico mostrou-se o menos concordante com o Doppler para detectar hipotensão. J Pediatr (Rio J) IntroduçãoA monitorização da pressão arterial é um componente essencial no manejo de recém-nascidos, especialmente prematuros. Entretanto, vári...

No conflicts of interest declared concerning the publication of this letter.