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OBJECTIVE: To assess trends in racial disparity in supine sleep positioning (SSP) across racial/ethnic groups of infants born early preterm (Early preterm; <34 weeks) and late preterm (Late preterm; 34-36 weeks) from 2000 to 2015. STUDY DESIGN: We analyzed Pregnancy Risk Assessment Monitoring System data (a population-based perinatal surveillance system) from 16 US states from 2000 to 2015 (Weighted N = 1 020 986). Marginal prevalence of SSP by year was estimated for infants who were early preterm and late preterm, adjusting for maternal and infant characteristics. After stratifying infants who were early preterm and late preterm, we compared the aOR of SSP trends across racial/ethnic groups by testing the time-race interaction. RESULTS: From 2000 to 2015, Non-Hispanic Black infants had lower odds of SSP compared with Non-Hispanic White infants for early preterm (aOR 0.61; 95% CI 0.47-0.78) and late preterm (aOR 0.44; 95% CI 0.34-0.56) groups. For Hispanic infants, there was no statistically significant difference for either preterm group when compared with Non-Hispanic White infants. aOR of SSP increased (on average) annually by 10.0%, 7.3%, and 7.7%, respectively, in Non-Hispanic White, Non-Hispanic Black, and Hispanic early preterm infants and by 5.8%, 5.9%, and 4.8% among Non-Hispanic White, Non-Hispanic Black, and Hispanic late preterm infants. However, there were no significant between-group differences in annual changes (Early preterm: P = .11; Late preterm: P = .25). CONCLUSIONS: SSP increased for all racial/ethnic preterm groups from 2000 to 2015. However, the racial/ethnic disparity in SSP among early preterm and late preterm groups persists.
Assuntos
Recém-Nascido Prematuro , Grupos Raciais/estatística & dados numéricos , Sono , Decúbito Dorsal , Adulto , Escolaridade , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Estado Civil , Idade Materna , Mães , Vigilância da População , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To describe perinatal and neonatal outcomes in newborns exposed to SARS-CoV-2. METHODS: A systematic review was conducted by searching PubMed Central, LILACS, and Google Scholar using the keywords 'covid ' AND 'newborn' OR 'child' OR 'infant,' on 18 March 2020, and again on 17 April 2020. One researcher conducted the search and extracted data on demographics, maternal outcomes, diagnostic tests, imaging, and neonatal outcomes. RESULTS: Of 256 publications identified, 20 met inclusion criteria and comprised neonatal outcome data for 222 newborns whose mothers were suspected or confirmed to be SARS-CoV-2 positive perinatally (17 studies) or of newborns referred to hospital with infection/pneumonia (3 studies). Most (12 studies) were case-series reports; all were from China, except three (Australia, Iran, and Spain). Of the 222 newborns, 13 were reported as positive for SARS-CoV-2; most of the studies reported no or mild symptoms and no adverse perinatal outcomes. Two papers among those from newborns who tested positive reported moderate or severe clinical characteristics. Five studies using data on umbilical cord blood, placenta, and/or amniotic fluid reported no positive results. Nine studies reported radiographic imaging, including 5 with images of pneumonia, increased lung marking, thickened texture, or high-density nodular shadow. Minor, non-specific changes in biochemical variables were reported. Studies that tested breast milk reported negative SARS-CoV-2 results. CONCLUSIONS: Given the paucity of studies at this time, vertical transmission cannot be confirmed or denied. Current literature does not support abstaining from breastfeeding nor separating mothers and newborns. Further evidence and data collection networks, particularly in the Americas, are needed for establishing definitive guidelines and recommendations.
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[Abstract]. Objective. To describe perinatal and neonatal outcomes in newborns exposed to SARS-CoV-2. Methods. A systematic review was conducted by searching PubMed Central, LILACS, and Google Scholar using the keywords ‘covid ’ AND ‘newborn’ OR ‘child’ OR ‘infant,’ on 18 March 2020, and again on 17 April 2020. One researcher conducted the search and extracted data on demographics, maternal outcomes, diagnostic tests, imaging, and neonatal outcomes. Results. Of 256 publications identified, 20 met inclusion criteria and comprised neonatal outcome data for 222 newborns whose mothers were suspected or confirmed to be SARS-CoV-2 positive perinatally (17 studies) or of newborns referred to hospital with infection/pneumonia (3 studies). Most (12 studies) were case-series reports; all were from China, except three (Australia, Iran, and Spain). Of the 222 newborns, 13 were reported as positive for SARS-CoV-2; most of the studies reported no or mild symptoms and no adverse perinatal outcomes. Two papers among those from newborns who tested positive reported moderate or severe clinical characteristics. Five studies using data on umbilical cord blood, placenta, and/or amniotic fluid reported no positive results. Nine studies reported radiographic imaging, including 5 with images of pneumonia, increased lung marking, thickened texture, or high-density nodular shadow. Minor, non-specific changes in biochemical variables were reported. Studies that tested breast milk reported negative SARS-CoV-2 results. Conclusions. Given the paucity of studies at this time, vertical transmission cannot be confirmed or denied. Current literature does not support abstaining from breastfeeding nor separating mothers and newborns. Further evidence and data collection networks, particularly in the Americas, are needed for establishing definitive guidelines and recommendations.
[Resumen]. Objetivo. Describir los resultados perinatales y neonatales de los recién nacidos expuestos al SARS-CoV-2. Métodos. Se realizó una revisión sistemática con búsqueda bibliográfica en PubMed Central, LILACS, y Google Scholar usando las palabras clave 'covid' Y 'newborn' O 'child' O 'infant', el 18 de marzo de 2020, y de nuevo el 17 de abril de 2020. Un investigador llevó a cabo la búsqueda y extrajo datos sobre demografía, resultados maternos, pruebas de diagnóstico, imágenes y resultados neonatales. Resultados. De las 256 publicaciones identificadas, 20 cumplieron los criterios de inclusión y comprendían datos de resultados neonatales de 222 recién nacidos cuyas madres eran casos sospechosos o positivos confirmados de SARS-CoV-2 en el período perinatal (17 estudios) o bien recién nacidos internados en el hospital con infección/neumonía (3 estudios). La mayoría (12 estudios) eran informes de series de casos; todos procedían de China, excepto tres (de Australia, España e Irán). De los 222 recién nacidos, 13 tenían resultados positivos para SARS-CoV-2; en la mayoría de los estudios se informó que los recién nacidos eran asintomáticos o tenían síntomas leves y que no se habían producido resultados perinatales adversos. Entre los estudios con recién nacidos positivos, en dos se informaron características clínicas moderadas o graves. En cinco estudios se analizó la sangre del cordón umbilical, la placenta o el líquido amniótico y no se informaron resultados positivos. En nueve estudios se reportaron imágenes radiográficas, entre ellos cinco con imágenes de neumonía, aumento de la trama pulmonar, textura engrosada u opacidades nodulares de alta densidad. Se informaron alteraciones menores e inespecíficas de los parámetros bioquímicos. En los estudios en que se analizó la leche materna se informaron resultados negativos para el SARS-CoV-2.
[Resumo]. Objetivo. Descrever os resultados perinatais e neonatais dos recém-nascidos expostos à SARS-CoV-2. Métodos. Uma revisão sistemática com pesquisa bibliográfica em PubMed Central, LILACS e Google Scholar foi realizada utilizando as palavras-chave 'covid' E ('newborn' OU 'child' OU 'infant') em 18 de março de 2020, e novamente em 17 de abril de 2020 por um pesquisador. Foram analisados dados sobre demografia, resultados maternos, testes de diagnóstico, técnicas de imagem e resultados neonatais. Resultados. Das 256 publicações identificadas, 20 preenchiam os critérios de inclusão e incluíam dados de resultados neonatais de 222 recém-nascidos cujas mães eram suspeitas ou positivas para a SARSCoV-2 no período perinatal (17 estudos) ou recém-nascidos internados no hospital com infecção/pneumonia (3 estudos). A maioria (12 estudos) eram relatos de séries de casos; todos, exceto três (Austrália, Irão e Espanha), eram provenientes da China. Dos 222 recém-nascidos, 13 eram positivos para SARS-CoV-2; a maioria dos estudos relatou que os recém-nascidos eram assintomáticos ou tinham sintomas leves e que não foram observados resultados perinatais adversos. Entre os estudos com recém-nascidos positivos, dois descreviam características clínicas moderadas ou graves. O sangue do cordão umbilical, a placenta ou o líquido amniótico foram analisados em cinco estudos, não tendo sido relatados resultados positivos. Imagens radiográficas foram descritas em nove estudos, incluindo cinco com imagens de pneumonia, aumento da trama pulmonar, espessamento da textura ou opacidades nodulares de alta densidade. Foram relatadas alterações menores e não específicas dos parâmetros bioquímicos. Estudos que analisaram leite materno mostraram resultados negativos para SARS-CoV-2. Conclusões. Dada a escassez de estudos, neste momento a transmissão vertical não pode ser confirmada ou excluída. A literatura atual não apoia a abstenção da amamentação ou a separação dos recém-nascidos das suas mães. São necessárias mais provas e mais dados, especialmente na Região das Américas, para estabelecer orientações e recomendações definitivas.
Assuntos
Infecções por Coronavirus , Viroses , Pandemias , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Doenças e Anormalidades Congênitas, Hereditárias e Neonatais , Transmissão Vertical de Doenças Infecciosas , Infecções por Coronavirus , Viroses , Pandemias , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Doenças e Anormalidades Congênitas, Hereditárias e Neonatais , Transmissão Vertical de Doenças Infecciosas , Infecções por Coronavirus , Viroses , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Doenças e Anormalidades Congênitas, Hereditárias e Neonatais , Transmissão Vertical de Doenças Infecciosas , COVID-19RESUMO
Objective. To describe perinatal and neonatal outcomes in newborns exposed to SARS-CoV-2. Methods. A systematic review was conducted by searching PubMed Central, LILACS, and Google Scholar using the keywords 'covid ' AND 'newborn' OR 'child' OR 'infant,' on 18 March 2020, and again on 17 April 2020. One researcher conducted the search and extracted data on demographics, maternal outcomes, diagnostic tests, imaging, and neonatal outcomes. Results. Of 256 publications identified, 20 met inclusion criteria and comprised neonatal outcome data for 222 newborns whose mothers were suspected or confirmed to be SARS-CoV-2 positive perinatally (17 studies) or of newborns referred to hospital with infection/pneumonia (3 studies). Most (12 studies) were case-series reports; all were from China, except three (Australia, Iran, and Spain). Of the 222 newborns, 13 were reported as positive for SARS-CoV-2; most of the studies reported no or mild symptoms and no adverse perinatal outcomes. Two papers among those from newborns who tested positive reported moderate or severe clinical characteristics. Five studies using data on umbilical cord blood, placenta, and/or amniotic fluid reported no positive results. Nine studies reported radiographic imaging, including 5 with images of pneumonia, increased lung marking, thickened texture, or high-density nodular shadow. Minor, non-specific changes in biochemical variables were reported. Studies that tested breast milk reported negative SARS-CoV-2 results. Conclusions. Given the paucity of studies at this time, vertical transmission cannot be confirmed or denied. Current literature does not support abstaining from breastfeeding nor separating mothers and newborns. Further evidence and data collection networks, particularly in the Americas, are needed for establishing definitive guidelines and recommendations.(AU)
Objetivo. Describir los resultados perinatales y neonatales de los recién nacidos expuestos al SARS-CoV-2. Métodos. Se realizó una revisión sistemática con búsqueda bibliográfica en PubMed Central, LILACS, y Google Scholar usando las palabras clave 'covid' Y 'newborn' O 'child' O 'infant', el 18 de marzo de 2020, y de nuevo el 17 de abril de 2020. Un investigador llevó a cabo la búsqueda y extrajo datos sobre demografía, resultados maternos, pruebas de diagnóstico, imágenes y resultados neonatales. Resultados. De las 256 publicaciones identificadas, 20 cumplieron los criterios de inclusión y comprendían datos de resultados neonatales de 222 recién nacidos cuyas madres eran casos sospechosos o positivos confirmados de SARS-CoV-2 en el período perinatal (17 estudios) o bien recién nacidos internados en el hospital con infección/neumonía (3 estudios). La mayoría (12 estudios) eran informes de series de casos; todos procedían de China, excepto tres (de Australia, España e Irán). De los 222 recién nacidos, 13 tenían resultados positivos para SARS-CoV-2; en la mayoría de los estudios se informó que los recién nacidos eran asintomáticos o tenían síntomas leves y que no se habían producido resultados perinatales adversos. Entre los estudios con recién nacidos positivos, en dos se informaron características clínicas moderadas o graves. En cinco estudios se analizó la sangre del cordón umbilical, la placenta o el líquido amniótico y no se informaron resultados positivos. En nueve estudios se reportaron imágenes radiográficas, entre ellos cinco con imágenes de neumonía, aumento de la trama pulmonar, textura engrosada u opacidades nodulares de alta densidad. Se informaron alteraciones menores e inespecíficas de los parámetros bioquímicos. En los estudios en que se analizó la leche materna se informaron resultados negativos para el SARS-CoV-2.(AU)
Objetivo. Descrever os resultados perinatais e neonatais dos recém-nascidos expostos à SARS-CoV-2. Métodos. Uma revisão sistemática com pesquisa bibliográfica em PubMed Central, LILACS e Google Scholar foi realizada utilizando as palavras-chave 'covid' E ('newborn' OU 'child' OU 'infant') em 18 de março de 2020, e novamente em 17 de abril de 2020 por um pesquisador. Foram analisados dados sobre demografia, resultados maternos, testes de diagnóstico, técnicas de imagem e resultados neonatais. Resultados. Das 256 publicações identificadas, 20 preenchiam os critérios de inclusão e incluíam dados de resultados neonatais de 222 recém-nascidos cujas mães eram suspeitas ou positivas para a SARSCoV-2 no período perinatal (17 estudos) ou recém-nascidos internados no hospital com infecção/pneumonia (3 estudos). A maioria (12 estudos) eram relatos de séries de casos; todos, exceto três (Austrália, Irão e Espanha), eram provenientes da China. Dos 222 recém-nascidos, 13 eram positivos para SARS-CoV-2; a maioria dos estudos relatou que os recém-nascidos eram assintomáticos ou tinham sintomas leves e que não foram observados resultados perinatais adversos. Entre os estudos com recém-nascidos positivos, dois descreviam características clínicas moderadas ou graves. O sangue do cordão umbilical, a placenta ou o líquido amniótico foram analisados em cinco estudos, não tendo sido relatados resultados positivos. Imagens radiográficas foram descritas em nove estudos, incluindo cinco com imagens de pneumonia, aumento da trama pulmonar, espessamento da textura ou opacidades nodulares de alta densidade. Foram relatadas alterações menores e não específicas dos parâmetros bioquímicos. Estudos que analisaram leite materno mostraram resultados negativos para SARS-CoV-2. Conclusões. Dada a escassez de estudos, neste momento a transmissão vertical não pode ser confirmada ou excluída. A literatura atual não apoia a abstenção da amamentação ou a separação dos recém-nascidos das suas mães. São necessárias mais provas e mais dados, especialmente na Região das Américas, para estabelecer orientações e recomendações definitivas.(AU)
Assuntos
Humanos , Pneumonia Viral/transmissão , Infecções por Coronavirus/transmissão , Transmissão Vertical de Doenças Infecciosas , Betacoronavirus/isolamento & purificaçãoRESUMO
BACKGROUND: Helping Babies Breathe (HBB) is a neonatal resuscitation curriculum that teaches life-saving interventions utilized in the first minutes after birth, reducing morbidity and mortality. Traditionally, it requires in-person facilitators for didactic and hands-on training. OBJECTIVES: The aim of this study was to offer HBB to nurses and nursing students in Guatemala, with the lead facilitator presenting concepts via telehealth and in-person facilitators providing hands-on demonstration. METHODS: Learners completed pre- and post-tests that included the standard HBB knowledge check, as well as an assessment of the course teaching model. Learners also completed the standard Objective Structured Clinical Evaluations (OSCEs). RESULTS: Eighteen learners were included in the analysis. All but one learner (94%) passed the course, and the average percent improvement from the pre- to post-test was 12%. All learners achieved passing scores on the OSCEs. Learners responded positively to questions regarding the technology, connection with the instructor, and ability to ask questions. Ninety-four percent of the learners agreed with the statement "this lecture was as good via telehealth as in person." A cost analysis demonstrated approximately USD 3,979.00 in savings using telehealth compared to a standard in-person course. CONCLUSIONS: The telehealth model was successful in delivering course material to the learners and was well received. This model represents a cost-effective way to improve access to HBB. This study may not be generalizable to other populations, and the ability to use telehealth requires reliable internet connectivity, which may not be available in all settings. Further study and expansion of this pilot are needed to assess success in other settings.
RESUMO
Background: Reduction in neonatal mortality is central to achieving global child survival targets in the coming decades. Efforts to prevent the primary causes of neonatal death (prematurity, asphyxia, severe infections, congenital anomalies) must be complemented by development of systems to care for sick newborns, including safe neonatal transport. Objectives: This systematic review identifies and analyzes the evidence on neonatal transport in developing countries in order to highlight important conclusions and gaps in knowledge in preparation for development of clinical guidelines and practical tools to support safe neonatal transport. Methods: The electronic search strategy included terms related to transport, access, and referral of neonates. Data sources included MEDLINE, Embase, CINAHL, Web of Science, the Cochrane Library, LILACS, SciELO, and African Index Medicus. Eligible studies utilized a randomized, quasirandomized or non-randomized prospective design with a comparison group. Cross-sectional, caseseries, case-control, or cohort studies that identified modifiable outcomes were included when there were defined comparison groups or comparison with established standards or guidelines. The review focused on transport of infants with an age 28 days or less from the community or a primary care facility to a center with specialty neonatal care, as well as interfacility patient transfers between two neonatal specialty care centers and intra-facility patient transfers to/from a neonatal specialty care unit. Articles were evaluated for strength of study design, selection bias, control for confounders, and data collection methods. Results: Forty studies met inclusion criteria. There were no randomized controlled trials and five quasi-experimental pre/post studies; most studies were of moderate to weak quality. Fourteen studies examined physiologic stability during transport and identified potentially modifiable risk factors associated with clinical deterioration and mortality or differential outcomes between inborn and outborn (transported) neonates. Six studies compared management of neonatal transports with norms for performance or formal regional guidelines. Six studies examined the effect of team training/composition on knowledge and skills, physiologic indicators of stability, and/or mortality. Three studies reported trails of equipment (transport carriers or incubator). Eleven studies considered the role of neonatal transport in providing access to the health system. Conclusions and implications: Evidence supported the need for establishment of neonatal transport services to provide equitable and widespread access to high-quality care for infants in the first month of life. Improvement in the outcome of transported neonates can be readily achieved by focusing on issues of basic physiological stability. Specific training in patient assessment and management can improve outcome, but must be accompanied by necessary systems changes, including proper equipment, norms, and oversight.
Assuntos
Terapia Intensiva Neonatal , Países em Desenvolvimento , Transporte de Pacientes , Serviços Médicos de EmergênciaAssuntos
Parto Obstétrico/métodos , Intubação/métodos , Neonatologia/métodos , Ressuscitação/métodos , Feminino , Humanos , GravidezRESUMO
Antecedentes. Reducir la mortalidad neonatal es fundamental para alcanzar las metas mundiales de supervivencia infantil en los próximos decenios. Los esfuerzos para prevenir las principales causas de mortalidad neonatal (prematuridad, asfixia, infecciones graves, anomalías congénitas) deben complementarse con el desarrollo de sistemas para atender a los recién nacidos enfermos; entre ellos, el transporte neonatal seguro. Objetivos. En esta revisión sistemática se identifican y analizan los datos científicos disponibles sobre transporte neonatal en los países en desarrollo, con el fin de resaltar las conclusiones importantes y lagunas de conocimiento a modo de preparación para elaborar directrices clínicas y herramientas prácticas destinadas a apoyar el transporte neonatal seguro. Métodos. La estrategia de búsqueda electrónica incluyó términos relacionados con el transporte, el acceso y la derivación de los recién nacidos. Las bases de datos utilizadas fueron Medline, Embase, CINAHL, Web of Science, Biblioteca Cochrane, LILACS, SciELO e Index Medicus Africano. Los estudios considerados aptos fueron de diseño prospectivo aleatorizado, cuasialeatorizado o no aleatorizado con un grupo comparativo. Se incluyeron estudios transversales, de series de casos, de casos y testigos o de cohortes con desenlaces modificables identificados siempre y cuando se hubieran definido en ellos grupos de comparación o una comparación con normas o directrices establecidas. La revisión se centra en el transporte de los recién nacidos hasta los 28 días de edad desde la comunidad o un establecimiento de atención primaria hacia un centro con atención neonatal especializada, así como el traslado de pacientes entre dos centros de atención neonatal especializada y el traslado de pacientes dentro de un mismo centro, desde o hacia una unidad de atención neonatal especializada. En los distintos artículos se evaluó la solidez del diseño del estudio, el sesgo de selección, el control de los factores de confusión y los métodos de recopilación de datos. Resultados. Cuarenta estudios cumplieron los criterios de inclusión. No se encontró ningún ensayo controlado aleatorizado, y solo cinco estudios cuasiexperimentales de tipo antes-después; la mayoría de los estudios fueron de calidad débil o moderada. En catorce estudios se evaluó la estabilidad fisiológica durante el transporte y se identificaron los factores de riesgo potencialmente modificables asociados al deterioro clínico y la mortalidad o los desenlaces diferenciales entre recién nacidos dentro del centro especializado y fuera de él (esto es, transportados). En seis estudios se comparó la gestión del transporte neonatal con normas de desempeño o directrices regionales formales...
Assuntos
Transporte de Pacientes , Serviços Médicos de Emergência , Recém-Nascido , Acessibilidade aos Serviços de Saúde , Países em DesenvolvimentoRESUMO
High altitude decreases birth weight, but this effect is diminished in long vs. short-resident, high-altitude populations. We asked whether women from long vs. short-resident, high-altitude populations had higher arterial oxygenation levels by comparing 42 Andean and 26 European residents of La Paz, Bolivia (3,600 m), serially during pregnancy (weeks 20, 30, and 36) and again 4 mo postpartum. Pregnancy raised hypoxic ventilatory sensitivity threefold, resting ventilation (.Ve), and arterial O(2) saturation (Sa(O2)) in both groups. Ancestry, as identified using 81 genetic markers, correlated with respiratory pattern, such that greater Andean ancestry was associated with higher respiratory frequency and lower tidal volume. Pregnancy increased total blood and plasma volume approximately 40% in both groups without changing red blood cell mass relative to body weight; hence, hemoglobin fell. The hemoglobin decline was compensated for by the rise in .Ve and Sa(O2) with the result that arterial O2 content (Ca(O2)) was maintained near nonpregnant levels in both groups. Birth weights were similar for all Andean and European babies, but after adjusting for variation in gestational age, maternal height and parity, Andeans weighed 209 g more than Europeans. Babies with heavier birth weights and greater ponderal indices were born to Andean women with higher Ve during pregnancy. We concluded that while maternal .Ve and arterial oxygenation were important, some factor other than higher Ca(O2) was responsible for protecting Andeans from altitude-associated reductions in fetal growth.
Assuntos
Altitude , Oxigênio/sangue , Gravidez/sangue , Adulto , Peso ao Nascer/fisiologia , Gasometria , Volume Sanguíneo/fisiologia , Bolívia , Etnicidade , Europa (Continente) , Feminino , Retardo do Crescimento Fetal/fisiopatologia , Frequência Cardíaca Fetal/fisiologia , Hemoglobinas/metabolismo , Humanos , Mecânica Respiratória/fisiologiaRESUMO
Multigenerational (Andean) compared with shorter-term (European) high-altitude residents exhibit less hypoxia-associated reductions in birth weight. Because differences in arterial O(2) content are not responsible, we asked whether greater pregnancy-associated increases in uterine artery (UA) blood flow and O(2) delivery were involved. Serial studies were conducted in 42 Andean and 26 European residents of La Paz, Bolivia (3600 m) at weeks 20, 30, 36 of pregnancy and 4 mo postpartum using Doppler ultrasound. There were no differences postpartum but Andean vs. European women had greater UA diameter (0.65 +/- 0.01 vs. 0.56 +/- 0.01 cm), cross-sectional area (33.1 +/- 0.97 vs. 24.7 +/- 1.18 mm(2)), and blood flow at week 36 (743 +/- 87 vs. 474 +/- 36 ml/min) (all P < 0.05) and thus 1.6-fold greater uteroplacental O(2) delivery near term (126.82 +/- 18.47 vs. 80.33 +/- 8.69 ml O(2).ml blood(-1).min(-1), P < 0.05). Andeans had greater common iliac (CI) flow and lower external iliac relative to CI flow (0.52 +/- 0.11 vs. 0.95 +/- 0.14, P < 0.05) than Europeans at week 36. After adjusting for gestational age, maternal height, and parity, Andean babies weighed 209 g more than the Europeans. Greater UA cross-sectional area at week 30 related positively to birth weight in Andeans (r = +0.39) but negatively in Europeans (r = -0.37) (both P < 0.01). We concluded that a greater pregnancy-associated increase in UA diameter raised UA blood flow and uteroplacental O(2) delivery in the Andeans and contributed to their ability to maintain normal fetal growth under conditions of high-altitude hypoxia. These data implicate the involvement of genetic factors in protecting multigenerational populations from hypoxia-associated reductions in fetal growth, but future studies are required for confirmation and identification of the specific genes involved.
Assuntos
Altitude , Gravidez/genética , Gravidez/fisiologia , Útero/irrigação sanguínea , Adulto , Biometria , Peso ao Nascer/fisiologia , Volume Sanguíneo/fisiologia , Bolívia , Parto Obstétrico , Europa (Continente)/etnologia , Feminino , Desenvolvimento Fetal/fisiologia , Hipóxia Fetal/fisiopatologia , Humanos , Indígenas Sul-Americanos , Recém-Nascido , Extremidade Inferior/irrigação sanguínea , Fluxo Sanguíneo Regional/genética , Fluxo Sanguíneo Regional/fisiologia , Resistência Vascular/fisiologiaRESUMO
OBJECTIVE: The chronic hypoxia of high-altitude (>/=2500 m) residence has been shown to decrease birth weight in all populations studied to date. However, multigenerational high-altitude populations appear protected relative to newcomer groups. This study aimed to determine whether such protection exists independently of other factors known to influence fetal growth and whether admixed populations (ie, people having both high- and low-altitude ancestry) show an intermediate level of protection. DESIGN: 3551 medical records from consecutive deliveries to Andean, European or Mestizo (ie, admixed) women at low, intermediate or high altitudes in Bolivia were evaluated for maternal characteristics influencing fetal growth as measured by birth weight and the frequency of small for gestational age births (SGA or
Assuntos
Altitude , Retardo do Crescimento Fetal/fisiopatologia , Hipóxia/fisiopatologia , Adulto , Peso ao Nascer/fisiologia , Peso Corporal/fisiologia , Bolívia/epidemiologia , Bolívia/etnologia , Europa (Continente)/etnologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etnologia , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Hipóxia/epidemiologia , Hipóxia/etnologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Paridade/fisiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Saúde da População UrbanaRESUMO
Electrocardiographic studies have reported persistent right ventricle predominance in high altitude children as an adaptive response. No information was provided on ethnicity and environmental factors in those studies. We assessed the electrocardiographic characteristics in healthy high altitude children with mixed ancestry and relatively high mobility to lower altitudes. A cross-sectional study of 321 children aged 2 months through 19 years old and living at high altitude (Tintaya, Peru, 4,100 m) was conducted. Standard 12-lead electrocardiography was performed. Information was obtained on ethnicity, medical history, place and altitude of pregnancy and birth, mobility of children and their parents and grandparents to lower altitudes, and housing conditions. A medical examination, echocardiography, hemoglobin, oxygen saturation, and anthropometric measurements were performed. Means between sexes were compared through Mann-Whitney test for independent samples not normally distributed. Potentially influential variables on electrocardiographic values were controlled through a general linear model. Electrocardiographic parameters including QRS axis, RV1, RSV1, RV1SV5, RSV5, RSV6, and SV1RV5 did not show a right predominance pattern at any age. Values were within sea level norms. None of the genetic or environmental factors controlled showed a consistent influence on the electrocardiographic variables. Our study showed an electrocardiographic pattern similar to that of sea level in high altitude children with some degree of high-altitude ancestry, comparatively well-nourished and with relatively high mobility to low altitudes.
Assuntos
Adaptação Fisiológica , Altitude , Eletrocardiografia/métodos , Função Ventricular/fisiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Estudos Transversais , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Lactente , Masculino , Peru , Estações do Ano , Distribuição por Sexo , UltrassonografiaRESUMO
Symptomatic high-altitude pulmonary hypertension and structural cardiac abnormalities related to high altitude have been reported previously. However, their true prevalence has not been systematically determined. We assessed clinical indicators of cardiovascular health or disease and correlated them with anatomic and physiologic cardiovascular features in preschool and schoolchildren living at 4000 m. We also estimated the prevalence of cardiovascular problems in the population, with emphasis on symptomatic high altitude pulmonary hypertension and structural cardiopathies. Three hundred and twenty-six children residents of Tintaya, Peru, were cross-sectionally studied. Methods included structured interviews, anthropometry and physical examination, arterial oxygen saturation, hemoglobin determination, electrocardiography, and echocardiography. The prevalence of structural cardiac problems was 1.5%, with less than 1% possibly attributable to high altitude. All children with structural cardiac abnormalities were identified by a focused physical exam prior to echocardiography. None were identified by the health interview. No symptomatic high altitude pulmonary hypertension was identified in the absence of underlying structural anomalies. The prevalence of structural cardiac problems was consistent with data from sea level. Active monitoring of the health status of a pediatric population at high altitude is valuable in the timely detection of cardiac abnormalities. Although our study children enjoyed generally excellent health, comparative, longitudinal studies are warranted to determine the incidence of high altitude cardiopulmonary problems and to identify risk factors and early markers for later disorders associated to life at high altitude. Our findings are applicable to children with some degree of high altitude genetic background and high mobility patterns to lower altitudes and living in comparatively good nutritional and socioeconomic conditions.
Assuntos
Doença da Altitude/diagnóstico , Doença da Altitude/epidemiologia , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Adolescente , Altitude , Doença da Altitude/complicações , Criança , Proteção da Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Feminino , Nível de Saúde , Cardiopatias/etiologia , Humanos , Hipertensão Pulmonar/etiologia , Lactente , Recém-Nascido , Masculino , Peru/epidemiologia , Exame Físico , Prevalência , Valores de ReferênciaRESUMO
Non-echocardiographic studies in healthy high altitude children have shown right ventricle predominance during infancy and childhood, associated to asymptomatic pulmonary hypertension and an increased pulmonary artery pressure. Systematic studies on echocardiography in such children have not been performed. In a cross-sectional study, we measured right and left heart morphologic and functional parameters, through M-mode, two-dimensional Doppler, and color Doppler echocardiographies, in a population of 321 healthy children ranging in age from 2 months to 19 years and living at high altitude (Tintaya, Peru, 4,100 m). Structured ad-hoc interviews were done to obtain information on medical history, patterns of exposure to high altitude of children and their parents and grandparents, place and altitude of pregnancy and birth, and housing conditions. A complete physical examination was performed before echocardiography. Hemoglobin concentration, pulse oximetry, and anthropometry were measured in all participating children. The right and left heart morphologic and functional echocardiographic measurements expressed by age and by body surface area were generally similar to sea-level reference populations. They were not consistently influenced by sex, nutritional status, chest dimensions, pulse oximetry, hemoglobin concentration, ethnicity, length of residence at high altitude, or parental history of exposure to high altitude. Most children had at least some degree of high-altitude ancestry as assessed by ethnicity and history of parental exposure to altitude. The cardiovascular development at high altitude in children with some degree of high-altitude ancestry seems to follow a pattern similar to sea-level children. The results can be used as reference values to interpret individual echocardiographic studies in comparable children living in similar settings.
Assuntos
Altitude , Ecocardiografia Doppler , Ventrículos do Coração/diagnóstico por imagem , Função Ventricular/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Peru , Valores de ReferênciaRESUMO
Infant mortality and stillbirth rates in Bolivia are high and birth weights are low compared with other South American countries. Most Bolivians live at altitudes of 2500 m or higher. We sought to determine the impact of high altitude on the frequency of preeclampsia, gestational hypertension, and other pregnancy-related complications in Bolivia. We then asked whether increased preeclampsia and gestational hypertension at high altitude contributed to low birth weight and increased stillbirths. We performed a retrospective cohort study of women receiving prenatal care at low (300 m, Santa Cruz, n = 813) and high altitude (3600 m, La Paz, n = 1607) in Bolivia from 1996 to 1999. Compared with babies born at low altitude, high-altitude babies weighed less (3084 +/- 12 g versus 3366 +/- 18 g, p < 0.01) and had a greater occurrence of intrauterine growth restriction [16.8%; 95% confidence interval (CI): 14.9-18.6 versus 5.9%; 95% CI: 4.2-7.5; p < 0.01]. Preeclampsia and gestational hypertension were 1.7 times (95% CI: 1.3-2.3) more frequent at high altitude and 2.2 times (95% CI: 1.4-3.5) more frequent among primiparous women. Both high altitude and hypertensive complications independently reduced birth weight. All maternal, fetal, and neonatal complications surveyed were more frequent at high than low altitude, including fetal distress (odds ratio, 7.3; 95% CI: 3.9-13.6) and newborn respiratory distress (odds ratio, 7.3; 95% CI: 3.9-13.6; p < 0.01). Hypertensive complications of pregnancy raised the risk of stillbirth at high (odds ratio, 6.0; 95% CI: 2.2-16.2) but not at low altitude (odds ratio, 1.9; 95% CI: 0.2-17.5). These findings suggest that high altitude is an important factor worsening intrauterine mortality and maternal and infant health in Bolivia.