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Estudo eletrofisiológico longitudinal da via auditiva em lactentes nascidos pequenos para a idade gestacional / Longitudinal electrophysiological study of the hearing pathway in small for gestational age infantsRosanna Mariangela Giaffredo Angrisani 13 December 2013 (has links)
A adequação do peso ao nascimento é um fator de risco para atrasos de desenvolvimento. Dentre outras causas de morbidade e mortalidade, encontra-se a prematuridade e a Restrição de Crescimento Intrauterino (RCIU). O termo \"Pequeno para a Idade Gestacional\" (PIG) é utilizado muitas vezes, como indicador de RCIU, cujo feto pode ter sido submetido a agravos em diferentes momentos da gestação. A literatura aponta o PIG como risco para atraso no desenvolvimento neuropsicomotor, incluindo a linguagem. Objetivo: Acompanhar a maturação da via auditiva em lactentes nascidos PIG, comparando-os aos lactentes nascidos Adequados para Idade Gestacional (AIG) a termo e pré-termo, por meio do estudo das respostas do PEATE por estímulo click e tone burst (TB) nos seis primeiros meses de vida. Método: Estudo longitudinal, observacional de caráter multicêntrico. Foram avaliados 172 lactentes nascidos PIG e AIG, a termo e pré-termo, nos períodos neonatal, aos três e aos seis meses, por meio do PEATE com estímulo tipo click e tone burst em 0,5 kHz e 1 kHz, a 80dBnNA. Resultados: no período neonatal, os RN T/PIG não se diferenciaram dos RN T/AIG quanto às respostas do PEATE, o mesmo ocorrendo entre PT/PIG e PT/AIG. Ao se comparar o grupo T e PT/PIG, observou-se diferença entre as latências das ondas III, V e intervalos interpicos (Itpc) I-III e I-V, com latências maiores nos PT/PIG; não foram evidenciadas diferenças com TB nas frequências avaliadas. Na comparação do grupo T e PT/AIG, observou-se diferença entre as latências das ondas III, V e nos Itpc III-V e I-V e latências maiores nos PT/AIG. Não houve diferenças no TB nas frequências avaliadas. Aos três meses, não houve diferenças entre os T/PIG e T/AIG; na comparação PT/PIG e PT/AIG, houve diferenças no Itpc III-V, com latência menor no grupo PT/PIG. Não houve diferenças entre T/PIG e PT/PIG; o grupo AIG mostrou diferença entre T e PT nas latências da onda V e Itpc I-V. Na terceira coleta, aos seis meses, os T/PIG e T/AIG evidenciaram diferenças significativas entre as latências da onda III e Itpc I-III, o mesmo não ocorrendo quando se comparou PT/PIG e PT/AIG, os quais se diferenciaram somente no Itpc III-V. Ao se comparar T/PIG e PT/PIG, verificou-se diferenças relevantes somente no TB 0,5 kHz. Conclusão: Os achados do presente estudo permitiram concluir que o processo maturacional da via auditiva em lactentes nascidos PIG ocorre em diferente velocidade quando comparado ao de lactentes AIG; os PIG têm maturação acelerada, principalmente nos três primeiros meses, caracterizando desta forma um período de recuperação do ponto de vista da audição; a prematuridade influencia mais a maturação do sistema nervoso auditivo central que o fator peso ao nascer no período neonatal; a maturação ocorreu no sentido caudo-rostral nos dois grupos. O PEATE com TB em 0,5 kHz e em 1 kHz evidenciou o processo maturacional, porém não de modo tão detalhado quanto o fez com o estímulo tipo click. As crianças PIG devem ser monitoradas até pelo menos os três anos de idade / The appropriateness of weight at birth is a risk factor for developmental delays. Prematurity and intrauterine growth restriction (IUGR) are among other causes of morbidity and mortality. The term \"small for gestational age\" (SGA) is often used as an indicator of IUGR, when the fetus may have been subjected to restrictions at different periods of pregnancy. The literature points SGA as a risk for neuropsychological developmental delay, including language. Objective: to monitor the maturation of the auditory pathway in SGA infants, comparing to term and preterm appropriate for gestational age (AGA) infants, through the analysis of the ABR responses to click and tone burst stimulus in the first six months of life. Method: A longitudinal, observational and multicenter study was conducted. A total of 172 SGA and AGA infants, term and preterm, were evaluated in the neonatal period and at three and six months of age through the ABR with click and tone burst stimulus with 0.5 kHz and 1 kHz at 80dBHL. Results: in the neonatal period, the term SGA infants did not differ from term AGA infants for ABR responses. The same was observed between preterm SGA and preterm AGA infants. When comparing the term and preterm SGA groups, there was a difference between the latencies of waves III, V and interpeak intervals (lTPI) I-III and I-V, with longer latencies in preterm SGA; there were no differences with the tone burst stimuli in the analyzed frequencies. When comparing the AGA term and preterm groups, differences were observed on latencies of waves III, V and ITPI III-V and I-V, with longer latencies for preterm infants. There were no differences in the frequencies evaluated with the tone burst stimuli. At three months of age, there were no differences between the term SGA and AGA; when comparing preterm SGA and AGA, differences were found for ITPI III-V, with shorter latencies in preterm SGA. SGA term and preterm infants did not differ; there were differences between term and preterm AGA in latencies of wave V and ITPI I-V. In the third data collection, at six months of age, term SGA and AGA infants significantly differed on latencies of wave III and ITPI I-III, which did not occur when comparing preterm SGA and AGA infants, who differed only regarding ITPI III-V. Significant differences were only observed when comparing term and preterm SGA infants regarding the tone burst stimuli at 0.5 kHz. Conclusion: The findings of this study showed that the maturational process of the auditory pathway in SGA infants occurs at different speed when compared to AGA infants; SGA infants have accelerated maturation, especially in the first three months of age, thus characterizing a recovery period from the hearing standpoint; in the neonatal period, the maturation of the central auditory nervous system is more influenced by prematurity than birth weight; maturation occurred in caudo-rostral direction in the two groups. The ABR with tone burst at 0.5 kHz and 1 kHz evidenced maturational process, but not in such detail as with the click stimuli. The SGA infants should be monitored until at least three years of age
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Methicillin-resistant Staphylococcus Aureus in Canadian Hospitals from 1995 to 2007: A Comparison of Adult and Pediatric InpatientsLocke, Tiffany 12 September 2013 (has links)
The literature directly comparing the epidemiology of MRSA among adult and pediatric hospitalized patients is strikingly minimal. The objective of this thesis was to identify any differences between these two patient groups. The Canadian Nosocomial Infections Surveillance Program MRSA data (1995 to 2007: n=1,262 pediatric and 35,907 adult cases) were used to compare MRSA clinical and molecular characteristics and rates. Hospital characteristics were modeled using repeated measures Poisson regressions. The molecular and epidemiological characteristics of MRSA differed significantly between adults and children. Compared to children, MRSA in adults was more likely to be healthcare-associated, colonization, SCCmec type II, PVL negative, and resistant to most antibiotics. Rates of MRSA in Canada increased in both populations over time but were significantly higher in adults. The hospital characteristics associated with increased MRSA rates differed in adult and pediatric facilities. Implications for infection prevention and control strategies are discussed.
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Methicillin-resistant Staphylococcus Aureus in Canadian Hospitals from 1995 to 2007: A Comparison of Adult and Pediatric InpatientsLocke, Tiffany January 2013 (has links)
The literature directly comparing the epidemiology of MRSA among adult and pediatric hospitalized patients is strikingly minimal. The objective of this thesis was to identify any differences between these two patient groups. The Canadian Nosocomial Infections Surveillance Program MRSA data (1995 to 2007: n=1,262 pediatric and 35,907 adult cases) were used to compare MRSA clinical and molecular characteristics and rates. Hospital characteristics were modeled using repeated measures Poisson regressions. The molecular and epidemiological characteristics of MRSA differed significantly between adults and children. Compared to children, MRSA in adults was more likely to be healthcare-associated, colonization, SCCmec type II, PVL negative, and resistant to most antibiotics. Rates of MRSA in Canada increased in both populations over time but were significantly higher in adults. The hospital characteristics associated with increased MRSA rates differed in adult and pediatric facilities. Implications for infection prevention and control strategies are discussed.
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