The study showed that abnormal RI within the first 72 hours was associated with healing complications in newborn infants with cerebral WML. Abnormal RI results were not correlated with the fatal outcome. Therefore, RI is an important parameter that should be measured in newborn infants.
Objective: To investigate whether the resistance index (RI) within the first 72 hours of life of newborn infants with cerebral white matter lesion (WML) is correlated with the adverse outcome of WML.Methods: Retrospective study. Newborn infants with WML were identified based on cranial ultrasound results, and those with Doppler imaging and RI measurement were selected. The newborn infants were placed in three groups: low (< 0.61), normal (0.61-0.85) or high (> 0.85) RI. The sample was analyzed as a whole at first and then stratified according to birth weight.Results: According to the RI, cerebral blood flow was abnormal in 46 (68.7%) patients, low in 42 (62.7%), and high in four (6%). Among those with a low RI, 15 (35.7%) had an adverse outcome, with ultrasonographic signs of cerebral atrophy in 10 (23.8%) and intraventricular hemorrhage in five (11.9%) patients. The four newborn infants with a high RI also had an adverse outcome, one (25%) with signs of cerebral atrophy and three (75%) with intraventricular hemorrhage. No statistically significant differences were observed between RI groups and the group with a fatal outcome. Conclusion:The study showed that abnormal RI within the first 72 hours was associated with healing complications in newborn infants with cerebral WML. Abnormal RI results were not correlated with the fatal outcome. Therefore, RI is an important parameter that should be measured in newborn infants. Cranial Doppler resistance index measurement in preterm newborns with cerebral white matter lesion
RESUMO -Para analisar a associação entre fatores natais com a gravidade da lesão da substância branca (LSB) cerebral neonatal, controlando o peso de nascimento, identificaram os neonatos pela ultra-sonografia craniana, que foram divididos em: aqueles com evolução da LSC para resolução da imagem ao ultra-som (menor gravidade) e, aqueles que evoluiram com formação de cistos e/ou ventriculomegalia e/ou hemorr a g i a (maior gravidade). Doze variáveis (hiponatremia, anemia, infecção, retinopatia, displasia bro n c o p u l m o n a r, hipoalbuminemia, persistência do canal arterial, audiometria alterada, desconforto respiratório pre c o c e , peso de nascimento <2500g, peso por categoria e prematuridade) tiveram diferenças entre os dois gru p o s (p<0,05), sendo que 9 (hiponatremia, infecção, retinopatia, hipoalbuminemia, persistência do canal art e r i a l , d e s c o n f o rt o respiratório precoce, baixo peso, prematuridade e peso por categorias) se mantiveram estatisticamente diferentes (p<0,01) após análise por re g ressão logística. Quando analisadas por categoria de peso de nascimento, nenhuma variável demonstrou significância estatística. O estudo sugere que o peso de nascimento é o maior fator -provavelmente o único -associado com gravidade da LSB cerebral neonatal.PA L AV R A S -C H AVE: recém nascido, lesão da substância branca cerebral, leucomalácia periventricular, infart o da substância branca periventricular, peso de nascimento. Birth weight as predictor for the severity of neonatal brain white matter lesionABSTRACT -To analyze the association of natal factors with the severity of neonatal brain white matter lesion (WML) by controlling the birth weight, we identified newborns with WML who were divided into: those with WML evolution towards resolution of the ultrasound image (less severe), and those who evolved with cist formation and/or ventriculomegalia and/or hemorrhage (greater severity). There were diff e re n c e s among the twelve variables (hyponatremia, anemia, infection, re t i n o p a t h y, bro n c o p u l m o n a ry dysplasia, hypoalbuminemia, persistence of the arterial canal, altered audiometry, early re s p i r a t o ry distress, birt h weigh below 2,500 g, weight per category, and prematurity) between the two groups (p<0.05), being that nine variables (hyponatremia, infection, retinopathy, hypoalbuminemia, persistence of the arterial canal, early re s p i r a t o ry distress, low weight, pre m a t u r i t y, and weight per category) remained statistically diff e re n t (p<0.01) after the logistic re g ression analysis. When the variables were analyzed by birth weight category none of them presented statistical significance. This study suggests that birth weight is the major factorlikely the only one -associated to the severity of neonatal brain white matter lesion.KEY WORDS: newborn, brain white matter lesion, periventricular leukomalacia, periventricular white matter infarction, birth weight.A lesão da substância branca (LSB) é a lesão cerebral mais freqüente no neonato pré-termo e a te...
OBJECTIVES: to describe hospital lethality rates and factors correlated to death in neonates with brain white matter lesions. METHODS: a retrospective study was performed from January 1994 to December 2001. Neonates with white brain matter lesions were divided into survival and death groups and their medical files reviewed through the single blind method to determine evolution. Death certificates provided the cause of death. The groups were compared through correlation coefficients. Hospital lethality rate was calculated. RESULTS: ninety three cases of white brain matter lesions and seven deaths were determined. Hospital lethality rate was of 8.2.% (95%CI: 2.4-14.0) independently from lesion occurrence time, and of 10.3% (95%CI: 3.3-17.3) for deaths occurred during prenatal and perinatal periods. Death was correlated to: Apgar score, non-cephalic presentation, gestational age, hyperglicemia, hypercalcemia, convulsion, respiratory insufficiency and atelectasy. CONCLUSIONS: hospital lethality was of 10.3% generating the following hypothesis: perinatal asphyxia must be the principal direct and indirect etiologic factor (aggravating the expression of prematurity and infection diseases), of prenatal and perinatal mortality among newborns with white brain matter lesions; and <7 Apgar score in the 5th minute associated to brain white matter lesions, are markers for perinatal asphyxia diagnosis.
Objective: To assess the effects of parenteral nutrition (PN) initiation time in very low birth weight neonates on: the birth weight recovery time, enteral nutrition (EN) initiation time, duration of hospitalization, and incidence of death. Methods: This retrospective case-control study was performed in the neonatal intensive care unit (NICU) of a tertiary center: Santo Amaro Hospital, Salvador, Brazil. All infants with birth weights ≤ 1500 g who were treated in the NICU during the study period (n= 114) were included. The sample was divided in two groups: early (≤ 48 h after birth) and late (> 48 h after birth) onset of PN. We also analyzed a subgroup of neonates with birth weights ≤ 750g, as well as a group for whom PN was initiated very early (≤ 24 h after birth). Results: A total of 114 neonates (n=48 / 39.8% in early PN group),were included in the study. Birth weight recovery time (9.9 ± 4.0 vs 12.8 ± 6.1, p = 0.007), lenght of hospitalization (43.2 ± 4.0 vs 71.8 ± 41.7, p = 0.007), and time of EN onset (2.2 ± 1.2 vs 7.9 ± 5.8, p <0.001) , were significantly lower in the early PN onset group than in the late onset group. Lenght of hospitalization was positively correlated with the timing of EN onset (r= 0,37, p = 0,001). No significant difference in adverse outcomes: death (18.6% vs 13.6%, p = 0.6), intracranial hemorrhage (ICH) (8.3% vs 12.1%, p = 0.9 ) and patent ductus arteriosus (PDA) (8.3% vs 31.8%, p = 0.1) was obbserved between groups. Conclusion: In this study, the early initiation of nutritional support in very low birth weight neonates can reduce the length of hospitalization thereby reducing costs, without increasing the incidence of adverse effects.
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