The use of histamine-2 receptor antagonists (H2RA) in neonates is still debated because of possible risk of infection, necrotizing enterocolitis (NEC) and increased mortality.
To review whether the ...use of H2RA in neonates admitted to neonatal intensive care units (NICU) is associated with infection, NEC or mortality.
We performed a systematic search in PubMed, Web of Science and SCOPUS databases using the terms "histamine-2 receptor antagonists", "infection", "necrotizing enterocolitis", "mortality", "neonates" and related terms to identify studies published up to April 30, 2017. We included studies conducted in hospitalized neonates and exposed to H2RA. The primary outcomes were infection, NEC and mortality. We included reports of infections with clinical signs and positive culture, and NEC according to Bell stages (stage ≥II) based on standardised clinical and radiologic criteria. Among 1,144 studies identified, 10 fulfilled the selection criteria. Information extracted included study design, sample size and number of participants, along with the outcomes of interest. We conducted a meta-analysis of adjusted data and pooled estimates of infection, NEC and mortality are reported as odds ratios (OR) and 95% confidence intervals (95%CI).
Ten studies were analysed. There were substantial associations between H2RA and infection (pooled OR: 2.09; 95%CI: 1.35-3.24; P = 0.001) and NEC (pooled OR: 2.81, 95%CI: 1.19-6.64; P = 0.02) but not with the mortality risk (pooled OR: 1.76; 95%CI: 0.50-6.16; P: 0.38).
Current evidence suggests that H2RA is associated with an increased risk of infection and NEC, but not with mortality in neonates admitted to NICU. The use of H2RA in neonates must be stringently considered when necessary.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aim To assess the presence of Enterococcus faecalis after root canal treatment in single or multiple visits in an ex vivo model.
Methodology Forty‐five premolar teeth were infected ex vivo with E. ...faecalis for 60 days. The canals were then prepared using a crowndown technique with System GT and Gates–Glidden burs and irrigated with 2% chlorhexidine gel. The specimens were divided into five groups (G1, G2, G3, G4 and G5) according to the time elapsed between chemical–mechanical preparation and root canal filling, the irrigant solution used and the use or nonuse of a calcium hydroxide intra‐canal medicament. The teeth were then root‐filled and incubated for 60 days at 37 °C. Dentine chips were removed from the canal walls with sequential sterile round burs at low speed. The samples obtained with each bur were immediately collected in separate test tubes containing Brain–Heart Infusion broth. These samples were placed onto agar plates and colony forming units were counted after 24 h at 37 °C. Data were ranked and analysed using the Kruskal–Wallis statistical test.
Results Enterococcus faecalis was recovered from 20% (three of 15 specimens) of G1 (chlorhexidine irrigation and immediate root filling in a single visit), 25% (four of 15 specimens) of G2 (chlorhexidine irrigation and filling after 14 days use of a calcium hydroxide dressing in multiple visits), 40% (two of five specimens) of G3 (chlorhexidine irrigation and filling after 7 days), 60% (three of five specimens) of G4 (saline irrigation and filling after 7 days) and from 100% (five of five specimens) of G5 (saline irrigation and immediate filling without sealer).
Conclusions Neither single‐ nor multiple‐visit root canal treatment ex vivo, eliminated E. faecalis completely from dentinal tubules. Up to 60 days after root filling, E. faecalis remained viable inside dentinal tubules. When no sealer was used, E. faecalis presented a higher growth rate.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Purpose
To assess the association between maternal potentially life-threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD) with perinatal outcomes.
Methods
Cross-sectional ...study in 27 Brazilian referral centers from July, 2009 to June, 2010. All women presenting any criteria for PLTC and MNM, or MD, were included. Sociodemographic and obstetric characteristics were evaluated in each group of maternal outcomes. Childbirth and maternal morbidity data were related to perinatal adverse outcomes (5th min Apgar score < 7, fetal death, neonatal death, or any of these). The Chi-squared test evaluated the differences between groups. Multiple regression analysis adjusted for the clustering design effect identified the independently associated maternal factors with the adverse perinatal outcomes (prevalence ratios; 95% confidence interval).
Results
Among 8271 cases of severe maternal morbidity, there were 714 cases of adverse perinatal outcomes. Advanced maternal age, low level of schooling, multiparity, lack of prenatal care, delays in care, preterm birth, and adverse perinatal outcomes were more common among MNM and MD. Both MNM and MD were associated with Apgar score (2.39; 1.68–3.39); maternal hemorrhage was the most prevalent characteristic associated with fetal death (2.9, 95% CI 1.81–4.66) and any adverse perinatal outcome (2.16; 1.59–2.94); while clinical/surgical conditions were more related to neonatal death (1.56; 1.08–2.25).
Conclusion
We confirmed the association between MNM and MD with adverse perinatal outcomes. Maternal and perinatal issues should not be dissociated. Policies aiming maternal care should include social and economic development, and improvements in accessibility to specialized care. These, in turn, will definitively impact on childhood mortality rates.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective
To identify cases of severe maternal morbidity (SMM) during pregnancy and childbirth, their characteristics, and to test the feasibility of scaling up World Health Organization criteria for ...identifying women at risk of a worse outcome.
Design
Multicentre cross‐sectional study.
Setting
Twenty‐seven referral maternity hospitals from all regions of Brazil.
Population
Cases of SMM identified among 82 388 delivering women over a 1‐year period.
Methods
Prospective surveillance using the World Health Organization's criteria for potentially life‐threatening conditions (PLTC) and maternal near‐miss (MNM) identified and assessed cases with severe morbidity or death.
Main outcome measures
Indicators of maternal morbidity and mortality; sociodemographic, clinical and obstetric characteristics; gestational and perinatal outcomes; main causes of morbidity and delays in care.
Results
Among 9555 cases of SMM, there were 140 deaths and 770 cases of MNM. The main determining cause of maternal complication was hypertensive disease. Criteria for MNM conditions were more frequent as the severity of the outcome increased, all combined in over 75% of maternal deaths.
Conclusions
This study identified around 9.5% of MNM or death among all cases developing any severe maternal complication. Multicentre studies on surveillance of SMM, with organised collaboration and adequate study protocols can be successfully implemented, even in low‐income and middle‐income settings, generating important information on maternal health and care to be used to implement appropriate health policies and interventions.
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Surveillance of severe maternal morbidity was proved to be possible in a hospital network in Brazil.
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Surveillance of severe maternal morbidity was proved to be possible in a hospital network in Brazil.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective
To identify the burden of severe infection within the Brazilian Network for Surveillance of Severe Maternal Morbidity and factors associated with worse maternal outcomes.
Methods
This was a ...multicentre cross‐sectional study involving 27 referral maternity hospitals in Brazil. WHO′s standardised criteria for potentially life‐threatening conditions and maternal near miss were used to identify cases through prospective surveillance and the main cause of morbidity was identified as infection or other causes (hypertension, haemorrhage or clinical/surgical). Complications due to infection were compared to complications due to the remaining causes of morbidity. Factors associated with a severe maternal outcome were assessed for the cases of infection.
Results
A total of 502 (5.3%) cases of maternal morbidity were associated with severe infection vs. 9053 cases (94.7%) with other causes. Considering increased severity of cases, infection was responsible for one‐fourth of all maternal near miss (23.6%) and nearly half (46.4%) of maternal deaths, with a maternal near miss to maternal death ratio three times (2.8:1) that of cases without infection (7.8:1) and a high mortality index (26.3%). Within cases of infection, substandard care was present in over one half of the severe maternal outcome cases. Factors independently associated with worse maternal outcomes were HIV/AIDS, hysterectomy, prolonged hospitalisation, intensive care admission and delays in medical care.
Conclusions
Infection is an alarming cause of maternal morbidity and mortality and timely diagnosis and adequate management are key to improving outcomes during pregnancy. Delays should be addressed, risk factors identified, and specific protocols of surveillance and care developed for use during pregnancy.
Objectif
Identifier la charge de morbidité de l'infection sévère dans le Réseau Brésilien de Surveillance de la Morbidité Maternelle et les facteurs liés à une santé maternelle pire.
Méthodes
Etude transversale multicentrique impliquant 27 maternités de référence au Brésil. Les critères standard de l’OMS pour des conditions potentiellement mortelles et des décès maternels évités de justesse ont été utilisés pour identifier les cas à travers la surveillance prospective et la principale cause de morbidité a été identifiée comme l'infection ou d'autres causes (hypertension, hémorragie ou cliniques/chirurgicales). Les complications dues à une infection ont été comparées à celles dues aux autres causes de morbidité. Les facteurs associés à un résultat maternel sévère ont été évalués pour les cas d'infection.
Résultats
502 (5,3%) cas de morbidité maternelle ont été associés à une infection sévère contre 9053 cas (94,7%) associés à d'autres causes. Considérant la sévérité accrue des cas, l'infection était responsable d'un quart de tous les décès maternels évités de justesse (23,6%) et près de la moitié (46,4%) des décès maternels, avec un ratio décès maternels évités de justesse sur mortalité maternelle 3 fois (2,8: 1) celui du ratio pour les cas sans infection (7,8: 1) et un indice de mortalité élevé (26,3%). Dans les cas d'infection, des soins de qualité inférieure ont été observés dans plus de la moitié des cas de résultats maternels sévères. Les facteurs indépendamment associés à des résultats maternels pires étaient le VIH/SIDA, l'hystérectomie, une hospitalisation prolongée, l'admission aux soins intensifs et des retards dans les soins médicaux.
Conclusions
L'infection est une cause alarmante de morbidité maternelle et de mortalité. Un diagnostic opportun et une prise en charge adéquate sont alors essentiels pour l'amélioration des résultats pendant la grossesse. Les retards devraient être adressés, les facteurs de risque identifiés et des protocoles spécifiques de surveillance et de soins élaborés pour une utilisation pendant la grossesse.
Objetivo
Identificar la carga de infección severa dentro de la Red Brasilera para la Vigilancia de la Morbilidad Materna Severa y los factores asociados con los peores resultados maternos.
Métodos
Estudio crosseccional y multicéntrico que incluyó 27 hospitales maternos de referencia en Brasil. Se utilizaron los criterios estandarizados de la OMS para condiciones potencialmente letales y morbilidad materna extrema (MME) con el fin de identificar casos mediante vigilancia prospectiva y la principal causa de morbilidad, identificada como infección u otras causas (hipertensión, hemorragia o clínica/quirúrgica). Las complicaciones por una infección se compararon con complicaciones debidas a las otras causas de morbilidad. Los factores asociados con un resultado materno severo se evaluaron para los casos de infección.
Resultados
502 (5.3%) casos de morbilidad materna estaban asociados con una infección severa y 9053 casos (94.7%) con otras causas. Teniendo en cuenta el aumento de la gravedad de los casos, la infección era responsable de una cuarta parte de todas la MME (23.6%) y de casi la mitad (46.4%) de las muertes maternas, con una proporción tres veces mayor de MME a muerte materna (2.8:1) que los casos sin infección (7.8:1) y un alto índice de mortalidad (26.3%). Dentro de los casos de infección, existía una atención insuficiente en más de la mitad de los casos con resultados maternos severos. Los factores independientemente asociados con los peores resultados maternos eran el VIH/SIDA, la histerectomía, la hospitalización prolongada, la admisión a cuidados intensivos y el retraso en la recepción de atención médica.
Conclusiones
La infección es una causa alarmante de morbilidad y mortalidad materna, y un diagnóstico a tiempo y un manejo adecuado son claves para mejorar los resultados durante el embarazo. Deberían abordarse los retrasos, identificarse los factores de riesgo y desarrollarse protocolos específicos de vigilancia y cuidados para su uso durante el embarazo.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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