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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In order to grasp the characteristics and outcomes with infants hospitalized long-term in NICUs, we reviewed all summary charts of 18 perinatal medical centers in Tokyo for the period from January 1989 to December 1998. We sampled 3,000 infants who required neonatal intensive care over 90 consecutive days out of 46,309 registered cases during the decade. The duration of hospital stay, making a comparative analysis of the number of days for the 50 percentile, was as follows. As a whole the infants required 125 days until discharge. Infants with 29-30 weeks gestation and infants with birth weights 1,000-1,499 g required shorter stays (106 days in both cases). The "discharge with complications" group required 136 days, and the "discharge on remission" group 119 days. Within the 31-32 weeks gestation group, those with "discharge with complications" required 107 days. Within the 29-30 weeks gestation group, those with "discharge on remission" required 104 days. Infants with 1,000-1,499 g birth weights for the "discharge with complications" and "discharge on remission" groups required 116 and 104 days respectively. Focusing on birthplace, the group of "inside-born" (born at perinatal medical centers) infants required 124 days, and the "outside-born" (born at non-perinatal medical centers) required 127 days. Respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and chronic lung disease (CLD) were often seen in patients under 29 weeks gestation and under 1,000 g birth weight. Hypoxic ischemic encephalopathy (HIE), convulsions, congenital malformations and chromosomal abnormalities were frequent in the groups over 31 weeks and over 1,500 g. Apnoea and transient tachypnoea of newborn (TTN) often occurred in these at 29-30 weeks and 1,000-1,499 g. Also, apnoea and TTN were often seen in the "discharge on remission" group. RDS, apnoea and TTN occurRed frequently in the "inside-born" infants with over 31 weeks of gestation and over 1,500 g birth weight. There were many cases of HIE and convulsions in the "outside-born" infants of these groups. We found infants who required long-term intensive care to comprise three main groups. The first group consisted of infants of 29-30 weeks gestation and 1,000-1,499 g birth weight and demonstrated mild or few complications. The second consisted of under 29 weeks and under 1,000 g and exhibited complications of chronic lung diseases caused by immaturity of respiratory organs. The third was the group of over 31 weeks and over 1,500 g who had complications due to central nervous system disease, congenital malformations and chromosomal abnormalities.
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PMID:[A survey of infants requiring long-term neonatal intensive care in Tokyo: 1989-1998]. 1240 75

Acute lung injury occurs mostly in the very low birth weight and extremely low birth weight infants. The pathological process leading to acute lung injury includes immature and/or diseased lung that experienced oxidative stress, inflammation and mechanical insult with the bronchial, alveolar and capillary injuries and cell death. It may be the first step to the subsequent development of chronic lung disease of prematurity or bronchopulmonary dysplasia. The mechanisms of lung injury are extensively investigated in the experimental models and clinical studies, mostly performed on the adult patients. At present, the explanations of the mechanism(s) leading to lung tissue injury in tiny premature babies are just derived from these studies. Acute lung injury seems to be rather a syndrome than a well-defined nosological unit and is of multifactorial etiology. The purpose of this review is to discuss the main factors contributing to the development of acute lung injury in the very low or extremely low birth weight infants--lung immaturity, mechanical injury, oxidative stress and inflammation. Nevertheless, numerous other factors may influence the status of immature lung after delivery.
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PMID:Immature lung and acute lung injury. 1453 25

The Wilson-Mikity syndrome is a differential diagnosis of chronic lung disease in the neonate and primarily related to immaturity. It is characterized by the absence of typical clinical and radiological findings of the respiratory distress syndrome (RDS). Infectious causes are being discussed.
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PMID:[Wilson-Mikity syndrome as a cause of respiratory insufficiency of prematurity]. 1458 12

This is the fifth paper in a review series that summarizes available data and critically discusses the potential role of lung function testing in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy (CLDI). This review focuses on respiratory mechanics, including chest-wall and tissue mechanics, obtained in the intensive care setting and in infants during unassisted breathing. Following orientation of the reader to the subject area, we focused comments on areas of enquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically with respect to relevant methods, equipment and study design, limitations and strengths of different techniques, and availability and appropriateness of reference data. Recommendations to guide future investigations in this field are provided. Numerous different methods have been used to assess respiratory mechanics with the aims of describing pulmonary status in preterm infants and assessing the effect of therapeutic interventions such as surfactant treatment, antenatal or postnatal steroids, or bronchodilator treatment. Interpretation of many of these studies is limited because lung volume was not measured simultaneously. In addition, populations are not comparable, and the number of infants studied has generally been small. Nevertheless, results appear to support the pathophysiological concept that immaturity of the lung leads to impaired lung function, which may improve with growth and development, irrespective of the diagnosis of chronic lung disease. To fully understand the impact of immaturity on the developing lung, it is unlikely that a single parameter such as respiratory compliance or resistance will accurately describe underlying changes. Assessment of respiratory mechanics will have to be supplemented by assessment of lung volume and airway function. New methods such as the low-frequency forced oscillation technique, which differentiate the tissue and airway components of respiratory mechanics, are likely to require further development before they can be of clinical significance.
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PMID:Lung function tests in neonates and infants with chronic lung disease: lung and chest-wall mechanics. 1649 64

The clinical management of respiratory failure in the newborn often focuses on lung parenchymal stiffness due to immaturity, surfactant deficiency, infiltrates, and other causes. However, health care personnel should also consider the airway, which plays an important role in gas exchange and lung mechanics. The airway can be easily injured, and an injured airway can significantly alter both the acute and chronic course of lung disease in infants. Further, there are developmental changes that affect the susceptibility of the neonatal airway to injury. Recognizing and preventing causes of airway injury can help to ensure optimal outcomes for the critically ill neonate.
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PMID:Ventilator-induced airway injury: a critical consideration during mechanical ventilation of the infant. 1674 70

The generalized anatomic and physiologic immaturity of preterm infants of very low birth weight (VLBW) (<or=1,500 g) and extremely low birth weight (ELBW) (<or=1,000 g) places them at high risk for death or associated negative sequelae, including chronic lung disease of infancy (CLDI). The standard treatment for pulmonary immaturity, mechanical ventilation (MV) at birth, can lead to barotrauma, volutrauma, pulmonary edema, infection, and inflammation. To minimize these negative outcomes, multiple treatment strategies have been proposed and evaluated as to their subsequent clinical course. This article compares, contrasts, and integrates the use of MV, nasal continuous positive airway pressure (NCPAP), and surfactant administration to encourage and support consideration of their use in the VLBW and ELBW population. Supporting a reduction of the use of MV in favor of NCPAP is safe and recommended because this practice is likely to decrease the probable sequelae of CLDI while permitting an individualized approach.
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PMID:Techniques of early respiratory management of very low and extremely low birth weight infants. 2047 32

Premature and systemically ill infants have a high risk of developing dermatologic infectious complications, displaying the consequences of skin barrier immaturity. Opportunistic infections are an increasing concern in neonates, with cutaneous fungal infections (Aspergillus, Rhizopus, Mucor, Fusarium) observed more commonly as pathogens. Neonates are especially susceptible due to stresses of the perinatal transition to ex-utero life, stratum corneum immaturity, and medical intervention during early life including intravenous catheters, non-sterile adhesive dressings, broad spectrum antibiotic use, and systemic corticosteroids for lung disease. Cutaneous presentations of these infections encompass a broad set of morphologies: papules, vesicles, pustules, ecchymoses, and necrotic, pupuric plaques. There are many etiologies that present as ecchymoses and scaly or crusted lesions. The presentation, diagnosis, and treatment options in the neonatal patient presenting with ecchymoses and crusts will be discussed.
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PMID:Approach to the neonate with ecchymoses and crusts. 2141 Jun 13

Continuous improvements in perinatal care have allowed the survival of ever more premature infants, making the task of protecting the extremely immature lung from injury increasingly challenging. Premature infants at risk of developing chronic lung disease or bronchopulmonary dysplasia (BPD) are now born at the late canalicular stage of lung development, just when the airways become juxtaposed to the lung vasculature and when gas-exchange becomes possible. Readily available strategies, including improved antenatal management (education, regionalization, steroids, and antibiotics), together with exogenous surfactant and exclusive/early noninvasive ventilatory support, will likely decrease the incidence/severity of BPD over the next few years. Nonetheless, because of the extreme immaturity of the developing lung, the extent to which disruption of lung growth after prematurity and neonatal management lead to an earlier or more aggravated decline in respiratory function in later life is a matter of concern. Consequently, much more needs to be learned about the mechanisms of lung development, injury, and repair. Recent insight into stem cell biology has sparked interest for stem cells to repair damaged organs. This review summarizes the exciting potential of stem cell-based therapies for lung diseases in general and BPD in particular.
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PMID:Lung injury in preterm neonates: the role and therapeutic potential of stem cells. 2240 Aug 13

The respiratory syncytial virus (RSV) is the major cause of lower respiratory tract illness (LRI) in infants worldwide. Also persons with heart/lung disease or an immunodeficiency disorder, and the elderly are at increased risk for severe LRI upon RSV infection. Although there is at present no licensed RSV vaccine available, it is a priority target for several vaccine developers. For the implementation of a future RSV vaccination within national immunization schemes, various strategies can be considered even without the availability of extended clinical data on RSV vaccines. For this purpose, the extensive knowledge on RSV with respect to disease pathology, epidemiology and immunology can be used. This article discusses different aspects that should be considered to enable a successful implementation of a new RSV vaccine in national immunization programs. In addition, gaps in knowledge that needs further attention are identified. The maternal immunization strategy is highlighted, but also vaccination in the youngest infants and specific risk group immunization strategies are evaluated in this paper. Key factors such as the seasonality of RSV disease, interference of maternal antibodies and the immaturity of the infants' immune system are addressed.
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PMID:Vaccination against RSV: is maternal vaccination a good alternative to other approaches? 2344 26

Neonatal mysthenia gravis (NMG) is a rare cause of arthrogryposis multiplex congenita (AMC) due to diaplacental transfer of maternal acetylcholine receptors (AChR) antibodies. 2 cases of severe NMG complicated by chronic lung disease and pulmonary arterial hypertension are reported. With respect to the severe course of the index patient, prenatal diagnosis and immunomodulation treatment were offered during the 2nd pregnancy. The combination of prenatal immunoadsorption (IA) therapy, administration of intravenous immunoglobulin (IVIG) and prednisolone failed. Failure may be partly explained by immaturity of the infant. However, considering the successful treatment of fetal/neonatal alloimmune thrombocytopenia (AIT) reported in literature, a treatment approach with IVIG doses up to 1-2 g/kg per week plus prednisone/prednisolone at a higher dose up to 1 mg/kg/d might be more effective.
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PMID:Prenatal immunomodulation treatment in neonatal myasthenia gravis. 2398 40


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