RESUMO
OBJECTIVE: To analyze adverse fetal and neonatal outcomes of Zika virus infection by the timing of infection during pregnancy. Method: Cohort study of 190 pregnancies with 193 offspring with a positive RT-PCR test for Zika virus (March/2016 to April/2017). RESULTS: Death or defects related to congenital Zika virus infection were identified in 37.3% of fetuses and newborns, and microcephaly in 21.4% of the newborns. The proportion of small for gestational age newborns was 21.9%. Maternal symptoms in the first trimester were significantly associated with the birth of newborns with microcephaly/cerebral atrophy, small for gestational age and with the deaths (one abortion, one stillbirth and the two neonatal deaths). Maternal infection during the second trimester was further associated with asymptomatic newborns at birth. The study showed that 58.5% of the offspring with microcephaly and / or cortical atrophy were small for gestational age, with an evident decrease in symptomatic offspring without microcephaly, 24.1%, and with only 9.1% in the asymptomatic group. CONCLUSION: This study showed that the earlier the symptoms appear during gestation, the more severe the endpoints. We found a higher percentage of small for gestational age newborns exposed to Zika virus early in gestation. We also found a group of apparently asymptomatic newborns with proven Zika infection, which highlights the importance of follow up studies in this population.
Assuntos
Doenças Fetais/patologia , Doenças do Recém-Nascido/patologia , Complicações Infecciosas na Gravidez/patologia , Infecção por Zika virus/patologia , Adulto , Brasil/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/virologia , Feto , Seguimentos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/virologia , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Zika virus , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/virologiaRESUMO
BACKGROUND: The association between gestational weight gain and neonatal body composition has been inconsistent, exposing the need for further research. The aim of this study was to evaluate whether gestational weight gain influences the body composition of full-term newborns and infants up to 4 months old. METHODS: A cohort study was performed with 124 participants divided into categories of gestational weight gain according to the 2009 Institute of Medicine guidelines. The anthropometric and body composition data of newborns and infants acquired using air displacement plethysmography (PeaPod®) were collected at 96 h, 1 month, 2 months and 4 months of life. In the statistical analysis, the chi-square test was used to analyze categorical variables, and ANOVA was used to analyze numerical variables. Univariate analysis was performed, and the absolute and relative frequencies of the categorical variables, as well as mean and standard deviation of the numerical variables, were obtained. Bivariate analysis was performed for the categories of gestational weight gain and gestational and neonatal characteristics. When adjustments to gestational hypertension, gestational diabetes, and pregestational body mass index (BMI) were analyzed by linear regression, gestational weight gain remained a significant variable for newborn percent fat mass. For all analyses, a significance level of 5% was adopted. RESULTS: Gestational weight gain was adequate in 33.8% of the participants, excessive in 41.1% and insufficient in 25%. Women with excessive weight gain had higher pregestational BMIs and a higher incidence of gestational hypertension. Their newborns had a higher body mass, body fat mass in grams and percent fat mass than the infants born to mothers with adequate or insufficient gestational weight gain. No significant differences were observed in body composition at 1, 2 and 4 months of life during infant follow-up. CONCLUSION: Excessive gestational weight gain may alter the body composition of newborns at birth. Further studies are required to better evaluate infant follow-up. TRIAL REGISTRATION: Clinical Trial Registry: NCT00875251 on April 3, 2009.
Assuntos
Peso ao Nascer/fisiologia , Composição Corporal/fisiologia , Ganho de Peso na Gestação/fisiologia , Adulto , Antropometria , Índice de Massa Corporal , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Pletismografia , Gravidez , Estudos ProspectivosRESUMO
BACKGROUND/PURPOSE: Gastroschisis is increasing in incidence and has low mortality and high morbidity. We describe the clinical and surgical characteristics of gastroschisis patients in a Brazilian referral center. METHODS: Single-center prospective case series of gastroschisis patients. The following two groups were formed depending on the intestinal characteristics: simple and complex patients. RESULTS: In total, 79 patients were enrolled, 89% of whom were classified as simple and 11% as complex. The baseline characteristics were similar between the groups, with the exception of the illness severity score. The complex group had a significantly smaller defect size, more reoperations and worse clinical outcomes than the simple group, with the initiation of feeding taking 1.5 times longer, the duration of total parenteral nutrition taking twice as long, and the length of hospitalization being 2.5 times longer; the complex group also included all the deaths that occurred. Overall, the survival rate was 96%. Patients who underwent the sutureless technique had significantly fewer wound infections and a decreased duration of mechanical ventilation than sutured patients. CONCLUSIONS: This study provides a comprehensive picture of gastroschisis during the neonatal period in a Brazilian referral center, emphasizing the significantly higher risk for morbidity and mortality among complex patients than among simple patients and the few advantages of the sutureless technique over the sutured technique in terms of closing the defect. TYPE OF STUDY: Prognostic. LEVEL OF EVIDENCE: IV.
Assuntos
Gastrosquise , Brasil , Gastrosquise/epidemiologia , Gastrosquise/mortalidade , Gastrosquise/cirurgia , Humanos , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Estudos Prospectivos , Encaminhamento e ConsultaRESUMO
Abstract Objective: Neonatal mortality rate remains high in Brazil. The aim of the study was to evaluate the factors associated with hospitalization during the neonatal period. Methods: Cross-sectional study conducted in ten randomly-selected Brazilian municipalities. Mothers of children under the age of 6 who were carrying the child's health booklet were interviewed in basic health units. Hierarchical modeling of sociodemographic factors (distal level), maternal variables (intermediate level), and features of the newborns (proximal level) was performed. The variables that presented a value of p ≤ 0.20 in the univariate analysis were included in the multivariate hierarchical modeling process, with block input according to their hierarchical level. The variables with a value of p ≤ 0.05 were considered statistically significant. Results: 2022 mothers were included, allowing 258 (12.8%) cases of hospitalization during the neonatal period to be identified, of which 49.7% were male, 8.9% were premature, and 8.4% had low birth weight (<2500 g). After analysis by hierarchical approach, factors associated with neonatal hospitalization (prevalence ratio [95% CI]) included: history of prematurity (2.03 [1.25-3.30], p = 0.004), gestational risk (2.02 [1.46-2.79], p < 0.001); intrapartum risk (3.73 [2.33-5.99], p < 0.001); gestational age (32-37 weeks: 13.83 [1.74-110.09], p = 0.01; and < 32 weeks: 25.03 [3.03-207.12], p = 0.003); low birth weight (3.95 [2.56-6.09], p < 0.001), and male gender (1.44 [1.09-1.98], p = 0.01). Conclusion: Factors associated with maternal and neonatal history are associated with neonatal hospitalization.
Resumo Objetivo: A taxa de mortalidade neonatal permanece alta no Brasil. O objetivo do estudo foi avaliar os fatores associados à internação durante o período neonatal. Métodos: Estudo transversal feito em dez municípios brasileiros aleatoriamente selecionados. As mães das crianças com menos de seis anos que estavam com a caderneta de informações de saúde da criança foram entrevistadas nas unidades básicas de saúde. Foi realizada a modelagem hierárquica dos fatores sociodemográficos (nível distal), das variáveis maternas (nível intermediário) e das características dos recém-nascidos (nível proximal). As variáveis que apresentaram um valor de p ≤ 0,20 na análise univariada foram incluídas no processo multivariado de modelagem hierárquica com entrada em blocos de acordo com seu nível hierárquico. As variáveis com valor de p ≤ 0,05 foram consideradas estatisticamente significativas. Resultados: 2022 mães foram incluídas, nos possibilitando identificar 258 (12,8%) casos de internação durante o período neonatal, dos quais 49,7% foram meninos, 8,9% foram prematuros e 8,4% apresentaram baixo peso ao nascer (< 2.500 g). Após a análise por abordagem hierárquica, os fatores associados à internação neonatal (IP [IC de 95%]) incluíram: histórico de prematuridade (2,03 [1,25-3,30], p = 0,004), risco gestacional (2,02 [1,46-2,79], p < 0,001); risco intraparto (3,73 [2,33-5,99], p < 0,001); idade gestacional (32-37 semanas: 13,83 [1,74-110,09], p = 0,01) e (< 32 semanas: 25,03 [3,03-207,12], p = 0,003); baixo peso ao nascer (3,95 [2,56-6,09], p < 0,001) e sexo masculino (1,44 [1,09-1,98], p = 0,01). Conclusão: Os fatores associados a histórico materno e neonatal foram associados à internação neonatal.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Hospitalização/estatística & dados numéricos , Doenças do Recém-Nascido/epidemiologia , Fatores Socioeconômicos , Brasil/epidemiologia , Estudos Transversais , Entrevistas como Assunto , Fatores de Risco , Idade GestacionalRESUMO
OBJECTIVE: Neonatal mortality rate remains high in Brazil. The aim of the study was to evaluate the factors associated with hospitalization during the neonatal period. METHODS: Cross-sectional study conducted in ten randomly-selected Brazilian municipalities. Mothers of children under the age of 6 who were carrying the child's health booklet were interviewed in basic health units. Hierarchical modeling of sociodemographic factors (distal level), maternal variables (intermediate level), and features of the newborns (proximal level) was performed. The variables that presented a value of p≤0.20 in the univariate analysis were included in the multivariate hierarchical modeling process, with block input according to their hierarchical level. The variables with a value of p≤0.05 were considered statistically significant. RESULTS: 2022 mothers were included, allowing 258 (12.8%) cases of hospitalization during the neonatal period to be identified, of which 49.7% were male, 8.9% were premature, and 8.4% had low birth weight (<2500g). After analysis by hierarchical approach, factors associated with neonatal hospitalization (prevalence ratio [95% CI]) included: history of prematurity (2.03 [1.25-3.30], p=0.004), gestational risk (2.02 [1.46-2.79], p<0.001); intrapartum risk (3.73 [2.33-5.99], p<0.001); gestational age (32-37 weeks: 13.83 [1.74-110.09], p=0.01; and<32 weeks: 25.03 [3.03-207.12], p=0.003); low birth weight (3.95 [2.56-6.09], p<0.001), and male gender (1.44 [1.09-1.98], p=0.01). CONCLUSION: Factors associated with maternal and neonatal history are associated with neonatal hospitalization.
Assuntos
Hospitalização/estatística & dados numéricos , Recém-Nascido de Baixo Peso , Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Prematuro , Brasil/epidemiologia , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Masculino , Fatores de Risco , Fatores SocioeconômicosRESUMO
To assess cognitive, motor, and language development in preterm infants, and perinatal, neonatal and socioeconomic factors associated with abnormal development. Methods: a cross-sectional study was carried out with 104 preterm infants (gestational ages < 33 weeks) (17 - 30 months corrected ages) using the Bayley III Scale. Logistic regression analysis was performed and prevalence ratios calculated. Results: the average language score (81.9) was low, while cognitive (93.7) and motor (91.1) scores were within normal values. There were deficiencies in receptive but not in expressive language. Male sex (OR 2.55 CI 1.01-6.44) and neonatal pneumonia (OR 33.85 CI 3.3-337.8) were associated with abnormal language scores. No factor was associated with abnormal cognitive scores; male gender indicated an increased risk of abnormal motor scores. The lack of a father was a risk factor for impaired motor development (PR: 2.96, CI: 5.6 - 1.55). There was no statistically significant difference in the development of small and appropriate for gestational age children. Conclusions: the Bayley III Scale was useful for assessing language and cognition separately, discriminating between receptive and expressive language. There was a high frequency of language deficiencies, especially in receptive language. Although motor and cognitive average scores were within the normal range, there was a high frequency of children with delayed development in these areas, especially motor development...
Avaliar o desenvolvimento motor, linguagem e cognitivo em prematuros e fatores perinatais, neonatais e socioeconômicos associados ao desenvolvimento anormal. Métodos: estudo transversal: 104 recém-nascidos pré-termos (idade gestacional <33 semanas) foram avaliados (17 - 30 meses idade corrigida), utilizando a Escala Bayley III. Realizada análise de regressão logística e calculadas razões de prevalência. Resultados: a média do escore de linguagem (81,9) foi baixa, enquanto as dos escores cognitivo (93,7) e motor (91,1) estavam normais. Foram encontrados déficits na linguagem receptiva, não na expressiva. Sexo masculino (OR 2,55 IC 1,01-6,44) e pneumonia neonatal (OR 33,85 IC 3,3-337,8) foram associados com escores anormais de linguagem. Nenhum fator foi associado a pontuações cognitivas anormais; sexo masculino indicou risco aumentado de escores motores anormais. Ausência do pai foi risco para desenvolvimento motor (RP: 2,96 IC 5,6-1,55). Não houve diferença estatística entre o desenvolvimento de crianças pequenas e adequadas para idade gestacional. Conclusões: a escala Bayley III foi vantajosa para avaliar linguagem e cognição separadamente, discriminando linguagem receptiva e expressiva. Houve uma elevada frequência de déficit de linguagem, especialmente receptiva. Embora os escores motor e cognitivo médios estivessem na faixa normal, houve uma alta frequência de atraso nestas áreas, principalmente a motora...
Assuntos
Humanos , Recém-Nascido , Lactente , Desenvolvimento Infantil , Desenvolvimento da Linguagem , Testes de Inteligência , Transtornos Cognitivos , Recém-Nascido PrematuroRESUMO
OBJECTIVE: To examine the cognitive development of school-aged children born preterm and with very low birthweight. METHODS: A cohort of premature infants born between January, 1991, and September, 1993 was examined at pre-school age. All of them were born in a public Neonatal Intensive Care Unit, with birth weight less than 1,500 g. The WPPSI-R Test was used for cognitive evaluation and applied by psychologists. Babies with malformations, genetic syndromes, congenital infections, transferred from other institutions or born at home, and those with conditions which precluded the application of the test were excluded. A group of pre-school children in the same city, born at term, were tested for comparison. RESULTS: 79 children were studied, with mean birthweight 1,219.6 g (+/-168.9); of these, 44 (72.1%) attended school. No significant statistical difference was found between the groups (study and loss). The WPPSI-R Test mean scores were: 75.6+/-11.9 (total); 77+/-12.9 (performance) and 78.6+/-11.1 (verbal) for the study group, and 85.1+/-13.2 (total); 85.3+/-13.8 (performance) and 87.7+/-13.9 (verbal) for the comparison group. This difference was significant for total (p < 0.0001), verbal (p < 0.0001) and performance scores (p = 0.002), as well as for the subtests of the WPPSI-R Test. CONCLUSIONS: The children who entered this study had borderline intellectual functioning at the moment of the evaluation. Results indicate that they may face learning difficulties at school, thus requiring adequate stimuli that should be provided by the family and the school.
Assuntos
Desenvolvimento Infantil/fisiologia , Cognição/fisiologia , Recém-Nascido de muito Baixo Peso , Testes de Inteligência , Testes Neuropsicológicos , Estudos de Casos e Controles , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , PsicometriaRESUMO
Objetivo: Verificar os valores preditivos da ultra-sonografia cerebral neonatal em relaçäo ao desenvolvimeto motor e cognitivo de prematuros de muito baixo peso após os 12 meses de idade corrigida. Métodos: A populaçäo foi constituida de uma coorte de prematuros com peso de nascimento inferior a 1.500g, oriundos da UTI Neonatal do Instituto Fernandes Figueira, acompanhados até completarem 12 a 30 meses de idade corrigida para a prematuridade. Próximo à alta hospitalar, ralizou-se a ultra-sonografia cerebral. os resultados foram classificados em normal e anormal (hemorragia parenquimatosa, porencefalia, leucomalácia, dilataçäo ventricular). Os bebês foram acompanhados no Ambulatório de Seguimento e, entre 12 e 30 meses de idade corrigida, foram submetidos à avaliaçäo neurológica, observaçäo da aquisiçäo dos marcos motores do desenvolvimento e aplicaçäo da Escala de Bayley de desenvolvimento. Resultados: A populaçäo em estudo foi constituída de 83 crianças. Os exames ultra-sonográficos foram normais em 68 bebês (81,9 por cento) e anormais em 15 (18,0 por cento). Com idade média de 21 meses, 63 crianças (75,9 por cento) apresentaram desenvolvimento motor normal e 20(24,0 por cento), alteraçöes motoras. O desenvolvimento cognitivo foi normal em 68 crianças (81,9 por cento). O valor preditivo negativo da ultra-sonografia em relaçäo a desenvolvimento motor foi de 85,3 por cento e em relaçäo ao desenvolvimento cognitivo, 86,8 por cento. O valor preditivo positivo da ultra-sonografia cerebral em relaçäo ao desenvolvimento motor foi de 66,7 por cento e ao cognitivo, 42,9 por cento. Conclusöes: Os valores preditivos negativos foram superiores aos positivos nas duas áreas do desenvolvimento. Diante de um resultado ultra-sonográfico normal, a probabilidade de a criança ter desenvolvimento motor e cognitivo normais é superior a 85 por cento
Assuntos
Humanos , Recém-Nascido , Recém-Nascido Prematuro , Valor Preditivo dos Testes , Ultrassonografia , Unidades de Terapia Intensiva , Exame NeurológicoRESUMO
Um total de 100 criancas (53 prematuros), sobreviventes de uma Unidade de Cuidado Intensivo Neonatal, foram testadas entre as idades de 12 e 72 meses com as Escalas de Desenvolvimento de Gesell. A maioria dos pacientes com o peso e nasimento abaixo de 1500 g mostraram alteracoes significativas noTeste de Gesell, especialmente nas areas adaptativas, motora fina e linguagem. Os autores discutem as possiveis repercussoes destas alteracoes e ressaltam a importancia da Testagem Sistematizada da populacao de risco .