This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH. What is Known:• Admission hypothermia is associated with early neonatal death.• The association of admission hypothermia with major neonatal morbidities has not been fully established. What is New:• Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates.• Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.
RESUMO -O estudo das cefaléias crônicas infantis, principalmente o da enxaqueca, vem recebendo muitas atenções nestes últimos anos. As publicações reconhecem sua importância epidemiológica e são unânimes em afirmar que os diagnósticos realizados não correspondem a realidade clínica. Citam que uma das dificuldades que justifica esta divergência seria a inadequação à criança dos critérios diagnósticos existentes. O presente estudo analisa um grupo de pacientes pediátricos que se queixava de dor de cabeça e obtem resultados que reforçam esta impressão.PALAVRAS-CHAVE: enxaqueca na infância, dificuldades diagnósticas. Diagnosis of childhood migraineABSTRACT -The study of chronical headache in children, mainly migraine, has deserved special attention in the last years. The publications point out their epidemiological importance and are unanimous to affirm that the diagnosis made do not correspond to clinical reality. They emphasize that one of the difficulties that justify this diversity would be inadequate diagnosis criteria. This study analyses a group of pediatric patients complaining about headache and reaches results that support this impression.KEY WORDS: headache in children, migraine, diagnosis.Dor de cabeça é um dos sintomas mais comuns na prática médica e, desde a publicação do estudo de Bille 1 , em 1962, quando 9000 estudantes responderam a um questionário dirigido, sabese o quanto é frequente este tipo de queixa entre as crianças. No entanto, até há pouco tempo, o estudo das cefaléias crônicas insistia em privilegiar, apenas, os pacientes adultos. Somente a partir da década de 80, simpósios e congressos passaram a dedicar parte da sua programação à criança, sendo que o primeiro evento totalmente dirigido a avaliação desta faixa etária ocorreu em 1988, em Pávia, Itália, quando foi promovido o "Primeiro Simpósio Internacional sobre Cefaléia na Criança e no Adolescente" 2 . Provavelmente, por este motivo, os critérios usados no diagnóstico das cefaléias são baseados nas manifestações apresentadas por homens e mulheres, dificultando o reconhecimento clínico das cefaléias infantis. À medida que novas publicações dão especial atenção aos pacientes pediátricos observam-se características próprias ao grupo. A verificação sistemática destas particularidades tem mostrado a necessidade de se adaptar à criança os critérios diagnósticos conhecidos, principalmente aqueles definidos pela International Headache Society (IHS) 3 , cuja utilização é, no momento, recomendada.Neste estudo analisamos as queixas de 95 crianças que sofriam de cefaléia e verificamos que de acordo com o critério aplicado modifica-se o número de casos diagnosticados de enxaqueca.
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