RESUMEN
BACKGROUND: the periventricular leukomalacia (PLM) is considered a lesion of the central nervous system secondary to a hypoxic-ischemic insult, and affects more to premature than term neonates. However, the reported rates in the literature are between 2 % to 25 % in premature neonates. The objective was to determine the prevalence of PLM in premature neonates. METHODS: a two year prospective screening program with transfontanel ultrasound in premature neonates weighing < 2000 g was carried out at 4 weeks of age. RESULTS: from 38 355 consecutive deliveries 562 were premature neonates weighted = 2000 g who fulfilled inclusion criteria and all were studied with transfontanel ultrasonography; we found 36 (6.34 %) premature neonates with PLM. Of the 346 neonates weighing = 1500 g, 26 (7.5 %) had a positive examination for PLM. In the 1501 g to 2000 g group, 10 of 216 (4.6 %) had PLM. The PLM prevalence was higher in male (2:1). Neurological exam was normal at the time of study. CONCLUSIONS: the PLM was present in 6.3 % of premature neonates weighing < 2000 g with 2 affected males for each female.
Asunto(s)
Recien Nacido Prematuro , Leucomalacia Periventricular/epidemiología , Femenino , Humanos , Recién Nacido , Masculino , Prevalencia , Estudios ProspectivosRESUMEN
BACKGROUND: The incidence of multiple pregnancies has increased over the last decade and hence the hospital stay and perinatal morbidity and mortality. OBJECTIVE: to know the perinatal mortality rate of multiple pregnancies treated in a regional hospital. MATERIAL AND METHODS: Retrospective study conducted from the hospital records of deaths that occurred from January 2002 to December 2007 at the Hospital Regional de Especialidades No. 23 IMSS, Monterrey, Nuevo Leon, Mexico. RESULTS: during the study period (six years) were 122,822 births and 95 were multiple pregnancies (0.77/1000 births): 81 (85%) of triplets, 11 (11%) of quadruplets, two of quintillizos and one sextillizos with a total of 303 newborns. 26% (25/95) of multiple pregnancies had one or more deaths. The perinatal mortality rate was 165/1000 births (50/303) compared with that of pregnancies with one fetus in the same period 14.5/1000 births (p<0.0001). 20.9% (17/81) of triplet pregnancies and 54.5% (6/11) of the four had one or more deaths (p<0.02), with a perinatal mortality rate of 131/1000 births (32/243) and 295/1000 births (13/44) (p<0.006), respectively. Only 2/10 (20%) of newborns in two pregnancies quintillizos died and 3/6 (50%) of a pregnancy sextillizos. There was no difference in the proportion of sexes, but in the average weight of newborns: the weight of the triplets was alive vs dead vs 1659 g 713 g (p<0.0001) and the quadruplets from 750 g vs 1341 g (p<0.0007), respectively. CONCLUSIONS: 26% of multiple pregnancies had one or more deaths and 15% of the neonates died (165/1000 births). Multiple pregnancies were complicated with one or more deaths at 20% of triplets, 54% of quadruplets and 100% of quintillizos. The perinatal mortality rate of pregnancies with multiple fetuses 3 and 4 was No. 131/1000 and No. 295/1000, respectively.
Asunto(s)
Mortalidad Infantil/tendencias , Embarazo Múltiple , Femenino , Humanos , Recién Nacido , EmbarazoRESUMEN
OBJECTIVE: To estimate the perinatal mortality rates over a 35 year period in neonates 22 weeks' gestation or above 500 g at birth until seven days postdelivery. METHODS: Data was obtained from medical records and the fetal death (FD) and neonatal death (ND) certificates. RESULTS: There were 889 282 deliveries (D) with 10,178 FD (11.2/1000 D) and 10,126 ND [11.3/1000 live newborns (LNB) with a significant reduction from 1972 to 2006 of 57 % in fetal mortality rate (p <0.0001) and 18.8 % in neonatal mortality rate (p <0.01). We registered 8081/10,126 (79.84 %) neonates who died from 0 to 6 days (9.2/1000 LNB). The overall perinatal mortality rate was 20.5/1000 D, with a 48.4 % significant reduction from 1972 to 2006 (p < 0.0001), 27.8/1000 ND, a 13.5/1000 ND respectively. We observed 4161 immature neonates (0.47 %); 55,340 premature newborns (6.2 %) and 9055 twin pregnancies (1 %). CONCLUSIONS: The fetal, neonatal and perinatal mortality rates were below the national media and presented a significant decrease from 1972 to 2006, more accentuated in fetal mortality rate (57 %) and perinatal mortality rate (48.4 %).
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Mortalidad Perinatal/tendencias , Ginecología , Unidades Hospitalarias , Humanos , Recién Nacido , Obstetricia , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: Perinatal period begins at 22 gestational weeks and ends seven days after birth. Perinatal mortality is an important quality indicator of the obstetric and pediatric care available, and representative of the population's health service. OBJECTIVE: To know fetal, early neonatal, and perinatal dead rates, and them main mortality causes. PATIENTS AND METHODS: Descriptive and retrospective study at IMSS's no. 32 UMAE (Monterrey, Nuevo León, México), from January 2002 to December 2006. Mortality rates during fetal and perinatal, or neonatal periods, were estimated per 1,000 births or 1,000 live born, respectively. RESULTS: There were 1,681 deaths: 747 stillbirths and 934 neonatal. Two hundred and nineteen (29.3%) stillbirths had 22 to 27 gestational weeks, and 528 (70.6%) had 28. Three hundred and sixty neonatal deaths (38.5%) occurred before 27th gestational week, 320 (34.2%) between weeks 28th and 35th, and 254 (27.1%) after 36 weeks of pregnancy. Seven hundred and sixty four neonates died within 0 to 6 days of life, and 170 (18%) between seventh to 28th days of life. Fetal, neonatal, early neonatal, and late neonatal mortality rates were 7.2 in 1,000 births, 9.08 in 1,000 live born, 7.42 in 1,000 live born, and 1.65 in 1,000 births, respectively, and overall perinatal mortality rate was 14.58 in 1,000 births. CONCLUSIONS: Stillbirth, early neonatal, and perinatal mortality rates of this study were under national mean. Main mortality causes (70%) were congenital defects and prematurity.
Asunto(s)
Mortalidad Perinatal/tendencias , Femenino , Hospitales Especializados , Humanos , Recién Nacido , Masculino , México , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: neural tube defects are a scourge for the population in nondeveloped countries. OBJECTIVE: to evaluate the prevalence of neural tube defects at a Gynecology and Obstetric Hospital at Instituto Mexicano del Seguro Social. METHODS: it was compared two 5 years periods: one before (1995-1999) and other after (2000-2004) a State Health Department program (Secretaría de Salud, Nuevo Léon) with 5 mg folic acid supplementation once a week to women in reproductive age. RESULTS: we registered 248,352 consecutive deliveries in a 10 year period, and we observed 319 cases of neural tube defects, with a global rate of 12.84 per 10,000 deliveries. From 1995 to 1999, there were 132,360 deliveries, with 212 neural tube defects (16.01 rate per 10,000 deliveries); the rate of anencephaly was 6.49, spina bifida 8.23, and encephalocele 1.28. After the folic acid program was established, during the following period 2000 to 2004, there were 115,992 deliveries, 108 with neural tube defects (9.31 rate per 10,000 newborns), with 41.8 % reduction (p <0.001). Also decreased were anencephaly rates: 28.3 % (nonsignificant) and spina bifida 63.4 % (p < 0.001). CONCLUSIONS: the neural tube defects rate has been declining in the last five years compared with the 5 years previous by 41 %, significantly more for spina bifida than anencephaly.
Asunto(s)
Defectos del Tubo Neural/epidemiología , Humanos , Incidencia , Recién Nacido , México/epidemiología , Prevalencia , Sistema de RegistrosRESUMEN
INTRODUCTION: congenital hearing loss is a serious health problem affecting 1 to 3 out of 1000 neonates, and is the most common cause of neurosensorial defect; hearing screening helps to identifying early permanent childhood hearing loss (HL). OBJECTIVE: to establish the percentage of hearing loss in newborns with and without risk factors through hearing screening. MATERIAL AND METHODS: by using a cross-sectional design, a group of neonates with risk factors and a group without risk factors were included in a two-stage hearing screening program. The otoacoustic emissions (OAEs) procedure was done in the first stage and the automated auditory brain stem response (AABR) procedure in the second stage. The latter was performed only in children with abnormal results in the OAE procedure. RESULTS: 518 newborns were included in the hearing screening procedures; 220 neonates with risk factors and 298 without risk factors. 35 had + OAE test and the ABBR procedure helped to confirm that 30 neonates had hearing loss, 26 had bilateral HL; 10 had asymmetric HL; 4 had unilateral HL and 5 were false positives. The AABR procedure ascertained 17 HL cases with a threshold > 40 dB (86 per 100,000), 11 cases (55 per 100,000) in the risk group and 6 (30 per 100,000) in the non-risk group (p < 0.05). The main risk factors were prematurity, craniofacial anomalies, mechanical ventilation, prescription of amikacin and cytomegalovirus infection. CONCLUSIONS: the two-stage hearing screening program ascertained that 5.7 % had HL. AABR (threshold > 40 dB) confirmed 17 (86 per 100,000) neonates with HL, which was more frequent in the risk group (5 %) than in the non-risk group (2 %; p < 0.05).