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Percorsi Assistenziali Neonatologici Anno 2008<br />

3. Caffeina ev:<br />

bolo: 10 mg/kg + mantenimento: 2,5 mg/kg/die, ogni 24 ore<br />

(utile per lo svezzamento dal respiratore, ma meno efficace come broncodilatatore).<br />

Steroidi<br />

1. Desametazone ev con dosaggi e schemi di trattamento in funzione della<br />

grav<strong>it</strong>à clinica<br />

2. Idrocortisone ev con dosaggi e schemi di trattamento in funzione della<br />

grav<strong>it</strong>à clinica<br />

3. Betametasone ev: 0.1 mg/kg/die per 3 giorni<br />

4. Beclometasone per aerosol: 0,25 mg/kg/dose, ogni 6 ore<br />

5. Budesonide per aerosol: 400 γ/kg ogni 12 ore<br />

Broncodilatatori per inalazione (util<strong>it</strong>à non certa e costante ed effetti negativi sull’apparato<br />

cardiovascolare)<br />

1. Salbutamolo per aerosol: 0,2 mg/kg/dose ogni 6 ore<br />

(Broncovaleas 1 gtt = 0,25 mg)<br />

2. Ipratropio per aerosol: 0,025 mg/kg/dose ogni 6 ore<br />

(Atem)<br />

Vasodilatatori polmonari<br />

1. Ossido N<strong>it</strong>rico inalatorio (iNO)<br />

2. Nifedipina: 0,5 mg/kg/dose ogni 6 ore, per os<br />

N.B. Le modal<strong>it</strong>à di riduzione della farmacoterapia variano da soggetto a<br />

soggetto in funzione dei risultati raggiunti e degli effetti collaterali che si<br />

verificano durante il trattamento. In linea di massima la terapia di base (diuretico<br />

+ xantina) dovrebbe essere mantenuta per almeno 7 giorni dopo la sospensione<br />

dell’ossigenoterapia.<br />

6<br />

1. Ambalavanan N, Carlo WA. Bronchopulmonary dysplasia: new insights. Clin Perinatol 2004;31:613-628.<br />

2. Ed<strong>it</strong>orial. A new look at Bronchopulmonary dysplasia classification. Journal of Perinatology 2006 26, 207–209<br />

3. A Cluster-Randomized Trial of Benchmarking and Multimodal Qual<strong>it</strong>y Improvement to Improve Rates of Survival Free of<br />

Bronchopulmonary Dysplasia for Infants W<strong>it</strong>h Birth Weights of Less Than 1250 Grams. Walsh M, Laptook A, Kazzi N, Engle<br />

WA, Yao O, Rasmussen M, Buchter S, Heldt G, Rhine W, Higgins R, Poole K and for the National Inst<strong>it</strong>ute of Child Health<br />

and Human Development Neonatal Research Network. Pediatrics 2007;119;876-890<br />

4. Walsh MC, Yao Q, Horbar JD, Carpenter JH, Lee SK, Ohlsson A. Changes in the Use of Postnatal Steroids for<br />

Bronchopulmonary Dysplasia in 3 large neonatal network. Pediatrics 2006;118:1328-1335.<br />

5. Walsh MC, Yao Q, Gettner P, Hale E, Collins M, Hensman A, Everette R, Peters N, Miller N, Muran G, Auten K, Newman N,<br />

Rowan G, Grisby C, Arnell K, Miller L, Ball B, McDavid G and for the National Inst<strong>it</strong>ute of Child Health and Human<br />

Development Neonatal Research Network..Impact of a Physiologic Defin<strong>it</strong>ion on Bronchopulmonary Dysplasia Rates.<br />

Pediatrics 2004;114;1305-1311.<br />

6. Bancalari E, Wilson-Costello D, Iben SC. Management of infants w<strong>it</strong>h Bronchopulmonary dysplasia in North America. Early<br />

Hum Dev 2005;81:171-179.<br />

7. Shaw NJ, Kotheca S. Management of infants w<strong>it</strong>h chronic lung disease of prematur<strong>it</strong>y in the Un<strong>it</strong>ed Kingdom. . Early Hum<br />

Dev 2005;81:165-170.<br />

8. Watterberg KL. Postnatal Steroids for Bronchopulmonaryu Displasia: where are we now? J Pediatr 2007; AprK 150(4):327-8<br />

67<br />

Respiratori

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