To evaluate the accuracy of the ROPScore algorithm as a predictor of retinopathy of prematurity (ROP).
A prospective cohort of 220 preterm infants with a birth weight ≤1500 g and/or gestational age ...≤32 weeks was included. The ROPScore was determined in the sixth week of life in 181 infants who then survived until a corrected gestational age of 45 weeks. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the algorithm were analyzed.
ROP was found in 17.6% of the preterm infants. The sensitivity of this test for any stage of ROP was 87.5%, while that for severe ROP was 95.4% (21/22 cases). The PPV and NPV were 59.6% and 97%, respectively, for any stage of ROP and 44.7% and 99.25%, respectively, for severe ROP. The ROPScore could therefore hypothetically reduce the number of ophthalmologic examinations required to detect ROP by 71.8%.
The ROPScore is a useful screening tool for ROP and may optimize examinations and especially the identification of severe ROP.
Despite being a relatively rare pathology, neonatal lupus erythematosus can affect the body in different ways, with a risk of death, especially in the first three months of life. Studies show that in ...asymptomatic pregnant women or those with autoimmune disease with positive Ro/SSA, La/SSB and RNP antibodies, the transplacental passage of these antibodies after the 16th week can cause damage to target organs. Most of the lesions, especially the skin, gradually decrease and disappear, as these antibodies are eliminated from the circulation; however, in the heart, fibrosis can induce permanent damage. Despite the knowledge of the importance of these antibodies in the pathophysiology of neonatal lupus, it is necessary to better understand the genetic and environmental factors of the disease. Lesions caused by lupus are generally benign and self-limiting. However, atrioventricular block is an exception, causing significant morbidity and mortality. This paper seeks to focus on the investigation of neonatal lupus erythematosus, on understanding the systemic manifestations of the disease, in order to understand the involvement of fetal organs.
The objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis.
Patients that exhibited clinical signs and radiographic ...evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full-width at half-maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full-width at half-maximum and wavelet-based texture feature were then calculated and compared using the Mann–Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated.
The full-width at half-maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively.
The developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.
O objetivo deste estudo foi desenvolver e validar uma ferramenta computacional para auxiliar as decisões radiológicas na enterocolite necrotizante.
Pacientes que exibiam sinais clínicos e evidências radiográficas do estágio 2 ou superior de Bell foram incluídos no estudo, que resultou em 64 exames. A ferramenta foi usada para classificar o aumento localizado da espessura da parede intestinal e a pneumatose intestinal com medidas de largura total a meia altura e análises de textura baseadas na decomposição da energia wavelet. Os achados radiológicos de aumento suspeito da espessura da parede intestinal e das alças na pneumatose intestinal foram confirmados pela cirurgia e análise histopatológica do paciente. Dois radiologistas experientes selecionaram um intestino afetado e um intestino normal na mesma radiografia. A largura total a meia altura e a característica da textura baseada em wavelet foram então calculadas e comparadas com o uso do teste U de Mann-Whitney. Foram calculados a especificidade, sensibilidade, valores preditivos positivos e negativos.
Os resultados da largura total a meia altura foram significativamente diferentes entre a alça normal e a distendida (mediana de 10,30 e 15,13, respectivamente). Medidas de energia wavelet horizontal, vertical e diagonal foram avaliadas em oito níveis de decomposição. Os níveis 7 e 8 na direção horizontal apresentaram diferenças significativas. Para o nível 7, as medianas foram 0,034 e 0,088 para os grupos normal e com pneumatose intestinal, respectivamente, e para o nível 8, as medianas foram 0,19 e 0,34, respectivamente.
A ferramenta desenvolvida pode detectar diferenças nos achados radiográficos do aumento da espessura da parede intestinal e PI de difícil diagnóstico, demonstra seu potencial na rotina clínica. A ferramenta desenvolvida no presente estudo pode ajudar os médicos a investigar alças intestinais suspeitas e melhorar consideravelmente o diagnóstico e as decisões clínicas.
To compare the use of analgesia versus neonatologists’ perception regarding analgesic use in painful procedures in the years 2001, 2006, and 2011.
This was a prospective cohort study of all newborns ...admitted to four university neonatal intensive care units during one month in 2001, 2006, and 2011. The frequency of analgesic prescription for painful procedures was evaluated. Of the 202 neonatologists, 188 answered a questionnaire giving their opinion on the intensity of pain during lumbar puncture, tracheal intubation, mechanical ventilation, and postoperative period using a 10-cm visual analogic scale (VAS; pain >3cm).
For lumbar puncture, 12% (2001), 43% (2006), and 36% (2011) were performed using analgesia. Among the neonatologists, 40–50% reported VAS >3 for lumbar puncture in all study periods. For intubation, 30% received analgesia in the study periods, and 35% (2001), 55% (2006), and 73% (2011) of the neonatologists reported VAS >3 and would prescribe analgesia for this procedure. As for mechanical ventilation, 45% (2001), 64% (2006), and 48% (2011) of patient-days were under analgesia; 56% (2001), 57% (2006), and 26% (2011) of neonatologists reported VAS >3 and said they would use analgesia during mechanical ventilation. For the first three post-operative days, 37% (2001), 78% (2006), and 89% (2011) of the patients received analgesia and more than 90% of neonatologists reported VAS >3 for major surgeries.
Despite an increase in the medical perception of neonatal pain and in analgesic use during painful procedures, the gap between clinical practice and neonatologist perception of analgesia need did not change during the ten-year period.
Confrontar o uso de analgesia versus a percepção de neonatologistas quanto ao emprego de analgésicos para procedimentos dolorosos nos anos de 2001, 2006 e 2011.
Coorte prospectiva de todos recém-nascidos internados em quatro unidades universitárias. Avaliou-se a frequência do emprego de analgésicos para procedimentos dolorosos por um mês dos anos de estudo. Dos 202 neonatologistas atuantes nas unidades nos três períodos, 188 assinalaram em escala analógica visual de 10cm (dor >3cm) a intensidade da dor sentida pelo recém-nascido na punção lombar, intubação traqueal, ventilação mecânica e pós-operatório.
Para PL, 12%, 43% e 36% foram realizadas com analgesia em 2001, 2006 e 2011 e 40-50% dos neonatologistas referiam indicar analgésicos na punção lombar nos três períodos. Na intubação, 30% foram realizadas sob analgesia nos três períodos e 35% (2001), 55% (2006) e 73% (2011) dos médicos diziam indicar analgésicos. Quanto à ventilação mecânica, 45-64% dos ventilados-dia estavam sob analgesia nos três períodos e 56% (2001), 57% (2006) e 26% (2011) dos neonatologistas diziam usar analgésicos. Dos pacientes-dia nos três primeiros dias de pós-operatório, 37% (2001), 78% (2006) e 89% (2011) receberam alguma dose de analgésico, sendo que mais de 90% dos médicos referiam usar analgesia para essa situação.
Entre 2001 e 2011, ocorreu aumento no uso de analgésicos para procedimentos dolorosos nas unidades neonatais e uma percepção mais acentuada por parte dos médicos de que o recém-nascido sente dor, mas o lapso entre a prática clínica e a percepção médica quanto à presença de dor persistiu.
To understand the practices related to late-onset sepsis (LOS) in the centers of the Brazilian Neonatal Research Network, and to propose strategies to reduce the incidence of LOS.
This was a ...cross-sectional descriptive multicenter study approved by the Ethics Committee. Three questionnaires regarding hand hygiene, vascular catheters, and diagnosis/treatment of LOS were sent to the coordinator of each center. The center with the lowest incidence of LOS was compared with the others.
All 16 centers answered the questionnaires. Regarding hand hygiene, 87% use chlorhexidine or 70% alcohol; alcohol gel is used in 100%; 80% use bedside dispensers (50% had one dispenser for every two beds); practical training occurs in 100% and theoretical training in 70% of the centers, and 37% train once a year. Catheters: 94% have a protocol, and 75% have a line insertion team. Diagnosis/treatment: complete blood count and blood culture are used in 100%, PCR in 87%, hematological scores in 75%; oxacillin and aminoglycosides is the empirical therapy in 50% of centers. Characteristics of the center with lowest incidence of LOS: stricter hand hygiene; catheter insertion and maintenance groups; use of blood culture, PCR, and hematological score for diagnosis; empirical therapy with oxacillin and aminoglycoside.
The knowledge of the practices of each center allowed for the identification of aspects to be improved as a strategy to reduce LOS, including: alcohol gel use, hand hygiene training, implementation of catheter teams, and wise use of antibiotic therapy.
Conhecer as práticas relacionadas a sepse tardia (ST) nos centros da Rede Brasileira de Pesquisas Neonatais (RBPN) e propor estratégias para redução da ST.
Estudo transversal, multicêntrico da RBPN, aprovado pelo CEP. Três questionários sobre higienização das mãos, cateteres vasculares e diagnóstico/tratamento da ST foram elaborados e enviados aos coordenadores de cada centro. O centro com a menor incidência de ST foi comparado aos demais.
Todos os 16 centros responderam aos questionários. Quanto a higienização das mãos: 87% utilizam chlorhexidine ou álcool 70%; 100% álcool gel; almotolia/leito em 80% (50% dispõe de 1 dispensador para cada 2 leitos); Treinamento prático ocorre em 100%, teórico em 70% dos centros e 37% treinam 1 vez/ano. Cateteres: 94% tem protocolo para passagem, 75% grupo de inserção. Diagnóstico/tratamento: Hemograma e hemocultura são utilizados em 100% dos centros; PCR em 87%; 75% usam escores hematológicos; oxacilina e aminoglicosídeo são usados como terapia empírica em 50% dos centros. Características do centro com menor incidência de ST: rigorosa higienização das mãos; grupos de inserção e manutenção de cateteres; uso de hemocultura, PCR e escores hematológicos para diagnóstico da ST; tratamento empírico com oxacilina e aminoglicosídeo.
O conhecimento das práticas de cada centro permitiu identificar aspectos a serem otimizados como estratégia para a redução da ST incluindo: uso de álcool gel, treinamento em higienização das mãos, implantação de grupos de cateteres e uso racional de antibióticos.
The objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis.
Patients that exhibited clinical signs and radiographic ...evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full‐width at half‐maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full‐width at half‐maximum and wavelet‐based texture feature were then calculated and compared using the Mann–Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated.
The full‐width at half‐maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively.
The developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.
O objetivo deste estudo foi desenvolver e validar uma ferramenta computacional para auxiliar as decisões radiológicas na enterocolite necrotizante.
Pacientes que exibiam sinais clínicos e evidências radiográficas do estágio 2 ou superior de Bell foram incluídos no estudo, que resultou em 64 exames. A ferramenta foi usada para classificar o aumento localizado da espessura da parede intestinal e a pneumatose intestinal com medidas de largura total a meia altura e análises de textura baseadas na decomposição da energia wavelet. Os achados radiológicos de aumento suspeito da espessura da parede intestinal e das alças na pneumatose intestinal foram confirmados pela cirurgia e análise histopatológica do paciente. Dois radiologistas experientes selecionaram um intestino afetado e um intestino normal na mesma radiografia. A largura total a meia altura e a característica da textura baseada em wavelet foram então calculadas e comparadas com o uso do teste U de Mann‐Whitney. Foram calculados a especificidade, sensibilidade, valores preditivos positivos e negativos.
Os resultados da largura total a meia altura foram significativamente diferentes entre a alça normal e a distendida (mediana de 10,30 e 15,13, respectivamente). Medidas de energia wavelet horizontal, vertical e diagonal foram avaliadas em oito níveis de decomposição. Os níveis 7 e 8 na direção horizontal apresentaram diferenças significativas. Para o nível 7, as medianas foram 0,034 e 0,088 para os grupos normal e com pneumatose intestinal, respectivamente, e para o nível 8, as medianas foram 0,19 e 0,34, respectivamente.
A ferramenta desenvolvida pode detectar diferenças nos achados radiográficos do aumento da espessura da parede intestinal e PI de difícil diagnóstico, demonstra seu potencial na rotina clínica. A ferramenta desenvolvida no presente estudo pode ajudar os médicos a investigar alças intestinais suspeitas e melhorar consideravelmente o diagnóstico e as decisões clínicas.
OBJECTIVE: To update the topic through a literature review. METHODS: A search was performed on the MEDLINE, PubMed, SciELO, LILACS and Cochrane platforms, using keywords on the topic and, after ...selecting the main articles, they were analyzed. CONCLUSION: Necrotizing enterocolitis (NEC) is an inflammation that affects the gastrointestinal tract (GIT) of newborns. The modified Bell stagind criteria classifies it, according to clinical and radiographic findings, into suspicion, confirmed or advanced. Pathogenesis is not completely understood. In term babies it occurs due to poor mesenteric perfusion. The classic form occurs in preterm infants, with multifactorial pathophysiology that includes: immaturity of the GIT, genetic predisposition, changes in the intestinal microbiota, pathogenic bacteria, characteristics of enteral nutrition and hypoxic-ischemic intestinal injury. All of these factors activate an intense inflammatory cascade, which can lead to intestinal necrosis. Risk factors are prematurity, low birth weight, sepsis, persistence of the ductus arteriosus, anemia and/or transfusion, among others. In addition to gastrointestinal symptoms (abdominal distention and pain, gastric residuals, vomiting and rectal bleeding), it has nonspecific symptoms such as temperature instability, apneas, hypoglycemia or even shock. On radiographic examination, bowel distention, pneumatosis, portal vein gas, pneumoperitoneum, intraperitoneal fluid or persistent dilated loops are found. The therapeutic approach includes fasting, broad-spectrum antibiotics, hemodynamic monitoring. Surgery is indicated when clinical worsening, perforation or suspicion of necrosis occurs. Among the preventive measures are: infection control, breastfeeding, protocols for the initiation and progression of enteral nutrition and administration of probiotics.
INTRODUCTION: incomplete. RESULTS: Fatty necrosis of the subcutaneous tissue is an uncommon inflammation, with a still unknown pathogenesis, which appears in newborns in the first weeks of life. The ...lesions are characterized by areas of edema and erythema that progress to hardened and painless subcutaneous plaques or nodules. The risk factors for this panniculitis are hypoxia and perinatal stress, such as traumatic or prolonged delivery and, more recently, therapeutic hypothermia. The diagnosis is clinical, the evolution is self-limited and benign, but the level of serum calcium should be monitored, as hypercalcemia can occur, leading to severe symptoms. In our report, we describe a case of subcutaneous adipose necrosis associated with prolonged expulsive and therapeutic hypothermia. CONCLUSION: Although infrequent, early recognition of this condition, especially in newborns with risk factors, is important, and can guide clinical follow-up including monitoring calcium, pain control and not using antibiotics.
OBJECTIVE: To update the topic through a literature review. METHODS: A search was performed on the MEDLINE, PubMed, SciELO, LILACS and Cochrane platforms, using keywords on the topic and, after ...selecting the main articles, they were analyzed. CONCLUSION: Necrotizing enterocolitis (NEC) is an inflammation that affects the gastrointestinal tract (GIT) of newborns. The modified Bell stagind criteria classifies it, according to clinical and radiographic findings, into suspicion, confirmed or advanced. Pathogenesis is not completely understood. In term babies it occurs due to poor mesenteric perfusion. The classic form occurs in preterm infants, with multifactorial pathophysiology that includes: immaturity of the GIT, genetic predisposition, changes in the intestinal microbiota, pathogenic bacteria, characteristics of enteral nutrition and hypoxic-ischemic intestinal injury. All of these factors activate an intense inflammatory cascade, which can lead to intestinal necrosis. Risk factors are prematurity, low birth weight, sepsis, persistence of the ductus arteriosus, anemia and/or transfusion, among others. In addition to gastrointestinal symptoms (abdominal distention and pain, gastric residuals, vomiting and rectal bleeding), it has nonspecific symptoms such as temperature instability, apneas, hypoglycemia or even shock. On radiographic examination, bowel distention, pneumatosis, portal vein gas, pneumoperitoneum, intraperitoneal fluid or persistent dilated loops are found. The therapeutic approach includes fasting, broad-spectrum antibiotics, hemodynamic monitoring. Surgery is indicated when clinical worsening, perforation or suspicion of necrosis occurs. Among the preventive measures are: infection control, breastfeeding, protocols for the initiation and progression of enteral nutrition and administration of probiotics.
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