Seshia, Embedded Systems -- A Cyber-Physical Systems Approach, MIT Press, Second Edition, 2017, available as a paperback and PDF download. This book strives to identify and introduce the durable intellectual ideas of embedded systems as a technology and as a subject of study. ![]() Abstract Importance Advantages of caffeine for apnea of prematurity have prompted clinicians to use it prophylactically even before apnea. Objective To determine the effect of early initiation of caffeine therapy on neonatal outcomes in very preterm infants born in Canada. Design, Setting, and Participants A retrospective cohort study was conducted. Patients included preterm neonates born at less than 31 weeks’ gestation admitted to 29 participating Canadian Neonatal Network neonatal intensive care units between January 1, 2010, and December 31, 2012. Exposures Neonates who received caffeine were divided into 2 groups based on the following timing of caffeine initiation: within the first 2 days after birth (early) and on or after the third day following birth (late). Main Outcome and Measure A composite of death or bronchopulmonary dysplasia. Results Of 5517 eligible neonates, 5101 (92.5%) received caffeine (early: 3806 [74.6%]; late: 1295 [25.4%]). There was no difference in weight or gestational age at birth between the groups. Neonates in the early group had decreased odds of a composite outcome of death or bronchopulmonary dysplasia (adjusted odds ratio [AOR], 0.81; 95% CI, 0.67-0.98) and patent ductus arteriosus (AOR, 0.74; 95% CI, 0.62-0.89). There was no difference between the groups in mortality (AOR, 0.98; 95% CI, 0.70-1.37), necrotizing enterocolitis (AOR, 0.88; 95% CI, 0.65-1.20), severe neurological injury (AOR, 0.80; 95% CI, 0.63-1.01), or severe retinopathy of prematurity (AOR, 0.78; 95% CI, 0.56-1.10). Conclusions and Relevance In very preterm neonates, early (prophylactic) caffeine use was associated with a reduction in the rates of death or bronchopulmonary dysplasia and patent ductus arteriosus. No adverse impact on any other outcomes was observed. Introduction Methylxanthines are the most commonly used medications for apnea of prematurity in neonates. - At least 84% of neonates who weigh less than 1000 g at birth and 25% of neonates who weigh less than 2500 g at birth experience apnea during the newborn period., Apneic episodes often occur on the first day after birth in infants associated with respiratory distress but are delayed and often commence between 3 to 7 days after birth in infants who initially present with respiratory distress syndrome. Design and Study Participants This retrospective observational study cohort included all preterm neonates who were born at less than 31 weeks’ gestational age and admitted to 29 participating neonatal intensive care units (NICUs) in the Canadian Neonatal Network (CNN) between January 1, 2010, and December 31, 2012. Neonates born outside a tertiary-level NICU, moribund neonates, those with major congenital anomalies, and neonates who died before day 3 after birth were excluded from the study. Data collection was approved by either the research ethics board or institutional quality improvement committee at each participating site. Parents/guardians did not provide consent owing to the retrospective nature of this study. ![]() Data Collection The data were collected as part of the CNN routine data collection. Of a total of 30 tertiary NICUs in Canada, 29 participated in the CNN during the study period and all preterm neonates (. Definitions Outcomes were defined according to the CNN data abstractor’s manual. Gestational age was defined as the best estimate based on obstetric history, obstetric examination, and first prenatal ultrasonography examination. Data on the severity of illness were collected using the Score for Neonatal Acute Physiology version II (SNAP-II). Artificial girl download. Dashlane download for internet explorer. Bronchopulmonary dysplasia was defined as supplemental oxygen use at 36 weeks’ postmenstrual age or at discharge from the NICU. Diagnosis of PDA was made clinically (a wide pulse pressure, prominent precordial pulsations, bounding pulses and continuous systolic murmur at the 2nd left parasternal area, and/or signs of heart failure), with or without echocardiography. Intraventricular hemorrhage was diagnosed and classified according to the Canadian Pediatric Society’s Cranial Ultrasound Statement. Retinopathy of prematurity was defined according to the international classification. Necrotizing enterocolitis was defined according to Bell criteria and was classified as medical or surgical.
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