Impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and/or death in pre-term infants
Objective: To assess the effect of a protocolised intervention for low systemic blood flow (SBF) in the occurrence of severe intraventricular haemorrhage (IVH) or death in pre-term infants. Methods: A study with a quasi-experimental design with retrospective controls was conducted on pre-term infant...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | Spanish |
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Elsevier
2018-12-01
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| Series: | Anales de Pediatría (English Edition) |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2341287918301741 |
| _version_ | 1818657929739370496 |
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| author | Ignacio Oulego Erroz Paula Alonso Quintela Aquilina Jiménez Gonzalez Sandra Terroba Seara Silvia Rodríguez Blanco María Rosón Varas Leticia Castañón López |
| author_facet | Ignacio Oulego Erroz Paula Alonso Quintela Aquilina Jiménez Gonzalez Sandra Terroba Seara Silvia Rodríguez Blanco María Rosón Varas Leticia Castañón López |
| author_sort | Ignacio Oulego Erroz |
| collection | DOAJ |
| description | Objective: To assess the effect of a protocolised intervention for low systemic blood flow (SBF) in the occurrence of severe intraventricular haemorrhage (IVH) or death in pre-term infants. Methods: A study with a quasi-experimental design with retrospective controls was conducted on pre-term infants of less than 30 weeks of gestational age, born between January 2016 and July 2017, who were consecutively included in the intervention period. The control cohort included pre-term infants (born between January 2013 and December 2015) matched by gestational age, birth weight, and gender (two controls for each case). The cases of low SBF diagnosed according to functional echocardiography during the study period received dobutamine (5–10 μg/kg/min) for 48 h. Results: The study included 29 cases (intervention period) and 54 controls (pre-intervention period). Ten out of 29 (34.5%) infants received dobutamine for low SBF during the intervention period, with 3/29 (10.3%) cases of severe IVH and/or death compared to 17/54 (31.5%) in the control cohort (P = .032). There was an independent association between the intervention and a decreased occurrence of severe IVH/death after adjusting for confounding factors both in the logistic regression model [OR 0.11 (95% CI: 0.01–0.65), P = .015], as well as in the sensitivity analysis using inverse probability of treatment weighting [OR 0.23 (95% CI: 0.09–0.56); P = .001]. Conclusions: In this study with retrospective controls, a protocolised screening, and treatment for low SBF was associated with a decreased occurrence of severe IVH or death in preterm infants. Large, adequately powered trials, are needed in order to determine whether postnatal interventions directed at low SBF can improve neurological outcomes. Resumen: Objetivo: Evaluar el efecto de un protocolo de cribado y tratamiento del bajo flujo sistémico (BFS) durante el periodo transicional en la aparición de hemorragia intraventricular (HIV) grave y/o muerte en prematuros. Métodos: Estudio cuasi-experimental con controles retrospectivos. En la fase de intervención se incluyeron los prematuros de menos de 30 semanas de edad gestacional (enero 2016-julio 2017). Los controles (enero de 2013-diciembre de 2015) fueron pareados por edad gestacional, peso al nacimiento y sexo con una relación 1:2. Los casos diagnosticados de BFS por ecocardiografía funcional durante el protocolo recibieron tratamiento con dobutamina (DB) entre 5-10 μg/kg/min durante 48 h. Resultados: Se incluyeron 29 casos en la fase de intervención (aplicación del protocolo) y 54 controles (fase preintervención). Diez de 29 (34,5%) casos durante el protocolo recibieron DB por BFS con 3/29 (10,3%) casos de HIV grave y/o muerte comparado con 17/54 (31,5%) en la fase pre-protocolo (p = 0,032). El protocolo se asoció de forma independiente a una reducción en la HIV grave y/o muerte tanto en la regresión logística (OR: 0,11 [IC 95%: 0,01-0,65], p = 0,015] como en el análisis de ponderación por la probabilidad inversa de tratamiento (OR: 0,23 [IC 95%: 0,09-0,56]; p = 0,001]. Conclusiones: En un estudio con controles retrospectivos, la aplicación de un protocolo de cribado y tratamiento del BFS en prematuros se asoció a una reducción en la HIV grave y/o muerte. Son necesarios ensayos clínicos de suficiente potencia para determinar si las intervenciones posnatales sobre el BFS pueden mejorar el pronóstico neurológico. |
| first_indexed | 2024-12-17T03:49:17Z |
| format | Article |
| id | doaj.art-218cc05c53e640aebce7828b3cab25ed |
| institution | Directory Open Access Journal |
| issn | 2341-2879 |
| language | Spanish |
| last_indexed | 2024-12-17T03:49:17Z |
| publishDate | 2018-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Anales de Pediatría (English Edition) |
| spelling | doaj.art-218cc05c53e640aebce7828b3cab25ed2022-12-21T22:04:49ZspaElsevierAnales de Pediatría (English Edition)2341-28792018-12-01896369377Impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and/or death in pre-term infantsIgnacio Oulego Erroz0Paula Alonso Quintela1Aquilina Jiménez Gonzalez2Sandra Terroba Seara3Silvia Rodríguez Blanco4María Rosón Varas5Leticia Castañón López6Corresponding author.; Unidad de Neonatología, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, SpainUnidad de Neonatología, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, SpainUnidad de Neonatología, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, SpainUnidad de Neonatología, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, SpainUnidad de Neonatología, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, SpainUnidad de Neonatología, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, SpainUnidad de Neonatología, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, SpainObjective: To assess the effect of a protocolised intervention for low systemic blood flow (SBF) in the occurrence of severe intraventricular haemorrhage (IVH) or death in pre-term infants. Methods: A study with a quasi-experimental design with retrospective controls was conducted on pre-term infants of less than 30 weeks of gestational age, born between January 2016 and July 2017, who were consecutively included in the intervention period. The control cohort included pre-term infants (born between January 2013 and December 2015) matched by gestational age, birth weight, and gender (two controls for each case). The cases of low SBF diagnosed according to functional echocardiography during the study period received dobutamine (5–10 μg/kg/min) for 48 h. Results: The study included 29 cases (intervention period) and 54 controls (pre-intervention period). Ten out of 29 (34.5%) infants received dobutamine for low SBF during the intervention period, with 3/29 (10.3%) cases of severe IVH and/or death compared to 17/54 (31.5%) in the control cohort (P = .032). There was an independent association between the intervention and a decreased occurrence of severe IVH/death after adjusting for confounding factors both in the logistic regression model [OR 0.11 (95% CI: 0.01–0.65), P = .015], as well as in the sensitivity analysis using inverse probability of treatment weighting [OR 0.23 (95% CI: 0.09–0.56); P = .001]. Conclusions: In this study with retrospective controls, a protocolised screening, and treatment for low SBF was associated with a decreased occurrence of severe IVH or death in preterm infants. Large, adequately powered trials, are needed in order to determine whether postnatal interventions directed at low SBF can improve neurological outcomes. Resumen: Objetivo: Evaluar el efecto de un protocolo de cribado y tratamiento del bajo flujo sistémico (BFS) durante el periodo transicional en la aparición de hemorragia intraventricular (HIV) grave y/o muerte en prematuros. Métodos: Estudio cuasi-experimental con controles retrospectivos. En la fase de intervención se incluyeron los prematuros de menos de 30 semanas de edad gestacional (enero 2016-julio 2017). Los controles (enero de 2013-diciembre de 2015) fueron pareados por edad gestacional, peso al nacimiento y sexo con una relación 1:2. Los casos diagnosticados de BFS por ecocardiografía funcional durante el protocolo recibieron tratamiento con dobutamina (DB) entre 5-10 μg/kg/min durante 48 h. Resultados: Se incluyeron 29 casos en la fase de intervención (aplicación del protocolo) y 54 controles (fase preintervención). Diez de 29 (34,5%) casos durante el protocolo recibieron DB por BFS con 3/29 (10,3%) casos de HIV grave y/o muerte comparado con 17/54 (31,5%) en la fase pre-protocolo (p = 0,032). El protocolo se asoció de forma independiente a una reducción en la HIV grave y/o muerte tanto en la regresión logística (OR: 0,11 [IC 95%: 0,01-0,65], p = 0,015] como en el análisis de ponderación por la probabilidad inversa de tratamiento (OR: 0,23 [IC 95%: 0,09-0,56]; p = 0,001]. Conclusiones: En un estudio con controles retrospectivos, la aplicación de un protocolo de cribado y tratamiento del BFS en prematuros se asoció a una reducción en la HIV grave y/o muerte. Son necesarios ensayos clínicos de suficiente potencia para determinar si las intervenciones posnatales sobre el BFS pueden mejorar el pronóstico neurológico.http://www.sciencedirect.com/science/article/pii/S2341287918301741Bajo flujo sistémicoPrematurosEcocardiografía funcionalHemorragia intraventricular |
| spellingShingle | Ignacio Oulego Erroz Paula Alonso Quintela Aquilina Jiménez Gonzalez Sandra Terroba Seara Silvia Rodríguez Blanco María Rosón Varas Leticia Castañón López Impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and/or death in pre-term infants Anales de Pediatría (English Edition) Bajo flujo sistémico Prematuros Ecocardiografía funcional Hemorragia intraventricular |
| title | Impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and/or death in pre-term infants |
| title_full | Impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and/or death in pre-term infants |
| title_fullStr | Impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and/or death in pre-term infants |
| title_full_unstemmed | Impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and/or death in pre-term infants |
| title_short | Impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and/or death in pre-term infants |
| title_sort | impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and or death in pre term infants |
| topic | Bajo flujo sistémico Prematuros Ecocardiografía funcional Hemorragia intraventricular |
| url | http://www.sciencedirect.com/science/article/pii/S2341287918301741 |
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