RESUMO

Abstract Objective To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. Method Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson's correlation. The study considered a significance level of 0.05. Results There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. Conclusion Serial measurements of head circumference provide knowledge of the trajectory of growth, with early catch-up between discharge and 1 month, as well as its association with neurodevelopment. Head circumference is therefore a valuable clinical marker for neurodevelopment, especially in very preterm newborns.

RESUMO

Compared with full-term infants, preterm infants have fat-free mass deficit in the first months of life, which increases the risk of metabolic diseases in the future. In this cohort of children born under 32-week gestational age or less than 1500 g, we aimed to evaluate the associations of body composition at term equivalent age and in the first 3 months of life with fat-free mass and fat mass percentage at 4 to 7 years of life. Body composition assessments by air displacement plethysmography and anthropometry were performed at term, at 3 months of corrected age, and at 4 to 7 years of age. Multiple linear regression analysis was used to observe the associations between body composition at these ages. At term, fat mass percentage showed a negative association and fat-free mass a positive association with fat-free mass at 4 to 7 years. The fat-free mass at 3 months and the gain in fat-free mass between term and 3 months showed positive associations with fat-free mass at 4 to 7 years.   Conclusion: Body composition at preschool age is associated with fat-free mass in the first 3 months of life, a sensitive period for the risk of metabolic diseases. What is Known: • Preterm infants have a deficit in fat-free mass and high adiposity at term equivalent age compared to full-term infants. • Fat-free mass reflects metabolic capacity throughout life and therefore is considered a protective factor against the risk of metabolic syndrome. What is New: •Fat-free mass gain in the first 3 months of corrected age is associated with fat-free mass at preschool and school ages. •The first 3 months of life is a sensitive period to the risk of metabolic diseases.

Assuntos

Composição Corporal , Recém-Nascido Prematuro , Humanos , Feminino , Masculino , Pré-Escolar , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido , Lactente , Criança , Estudos de Coortes , Adiposidade/fisiologia , Pletismografia , Antropometria

RESUMO

OBJECTIVE: To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. METHOD: Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson's correlation. The study considered a significance level of 0.05. RESULTS: There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. CONCLUSION: Serial measurements of head circumference provide knowledge of the trajectory of growth, with early catch-up between discharge and 1 month, as well as its association with neurodevelopment. Head circumference is therefore a valuable clinical marker for neurodevelopment, especially in very preterm newborns.

Assuntos

Cefalometria , Desenvolvimento Infantil , Cabeça , Humanos , Recém-Nascido , Estudos Prospectivos , Cabeça/anatomia & histologia , Cabeça/crescimento & desenvolvimento , Masculino , Feminino , Desenvolvimento Infantil/fisiologia , Lactente , Pré-Escolar , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Idade Gestacional , Cognição/fisiologia

RESUMO

High-risk newborns are exposed to neonatal conditions such as prematurity, very low birth weight, and congenital malformations that can affect development and behavior. Coronavirus disease 2019 (COVID-19) restraint and control measures have been identified as important stressor events and cumulative risk factors for behavioral changes in these children. This study examined social isolation-related factors that contribute to internalizing and externalizing behavior problems in children already at risk for neurodevelopmental disorders. This cross-sectional, multicenter study included 113 children (18 months to 9 years) who were followed in reference services for neonatal follow-up in tertiary units of the public health system in the city of Rio de Janeiro, Brazil. Behavior was assessed using the child behavior checklist, and a structured questionnaire was used to assess sociodemographic aspects. In the bivariate analysis, prematurity was associated with externalizing problems and change in eating habits with internalizing problems. The logistic model indicated that both parents having completed high school and both sharing care of the child were protective factors for behavioral problems; however, reports of sleep problems and living with another child were risk factors. In conclusion, the study identified internalizing and externalizing behavior problems related to prematurity and aspects of family structure and routine in children at risk. The findings confirm the importance of family functioning for child health and family-centered interventions.

RESUMO

This cohort study evaluated the nutritional supply in 78 very preterm newborns, with 20.5% developing bronchopulmonary dysplasia (BPD). This work aimed to evaluate the nutritional intake and the calorie/protein ratio received in the first 4 weeks of life. Anthropometric measures at birth and term age, the weight at each of the first 4 weeks of life, and the feeding practices were registered. The mean gestational age and birth weight were lower in those who developed BPD. At term age, head circumference and length Z-scores were significantly lower in newborns with BPD, who started enteral feeding and reached full diet later, staying longer in parenteral nutrition. The protein rate received by all newborns was similar, whether developing BPD or not, but those who developed BPD received significantly lower fluid volume and calorie rates after the second week. The daily calorie/protein ratio (30 kcal/1-g protein) was reached by 88.7% of the newborns who did not develop BPD in the third week, with those who developed BPD receiving less than this ratio until the second week, persisting in 56.3% of them on the fourth week.Conclusion: A calorie/protein ratio below that recommended for growth was found in preterm newborns who developed BPD, and providing nutrition for these newborns remains a challenge. What is Known: • The importance of preterm newborn nutrition is well known. • Early nutritional support may avoid severe BPD. What is New: • Newborns who developed BPD received a calorie/protein ratio below that recommended for preterm newborns' growth during the first 2 weeks of life, lasting until the fourth week in most of these newborns.

Assuntos

Displasia Broncopulmonar , Displasia Broncopulmonar/prevenção & controle , Estudos de Coortes , Ingestão de Alimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro

RESUMO

Abstract Objective: To evaluate the influence of gestational and perinatal factors on body composition and birth weight of full-term newborns. Method: This was a cross-sectional study, within a prospective cohort, consisting of 124 postpartum women and their newborns. Data included the following: maternal age; ethnicity; pre-gestational body mass index; gestational weight gain; parity; gestational morbidities (hypertension and gestational diabetes mellitus); gestational age at birth; birth weight; and newborn's gender. Anthropometric and body composition data of the newborns were collected using air-displacement plethysmography (PeaPod® Infant Body Composition System-LMI; Concord, CA, USA). The stepwise technique was applied to a multiple linear regression model. Results: The significant variables in the model that explained 84% of the variation in neonatal fat-free mass were: birth weight; maternal age; newborn's gender and gestational age. For body fat mass: birth weight; newborn's gender; gestational arterial hypertension; gestational diabetes; and gestational weight gain. These variables explained 60% and 46% of fat mass, in grams and as a percentage, respectively. Regarding birth weight, the significant factors were gestational age, pre-gestational BMI, and gestational weight gain. Female newborns showed higher body fat mass and male newborns had higher fat-free mass. Conclusion: Gestational and perinatal factors influence neonatal body composition. Early identification of these gestational factors, which may be modifiable, is necessary to prevent obesity and chronic noncommunicable diseases in the future.

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Resumo Objetivo: Avaliar a influência de fatores gestacionais e perinatais na composição corporal e no peso de nascimento de recém-nascidos a termo. Método: Estudo transversal, dentro de uma coorte prospectiva, composto por 124 puérperas e seus recém-nascidos. Os dados incluíram: idade materna; etnia; índice de massa corpórea pré-gestacional; ganho de peso gestacional; paridade; morbidades gestacionais, (hipertensão arterial e diabetes mellitus gestacional); idade gestacional do nascimento; peso de nascimento; e sexo do recém-nascido. Os dados antropométricos e de composição corporal dos recém-nascidos foram coletados com a pletismografia por deslocamento de ar (PeaPod®). Foi aplicada a técnica de stepwise no modelo de regressão linear múltipla. Resultados: As variáveis significativas do modelo que explicou 84% da variação da massa livre de gordura neonatal foram: peso de nascimento; idade materna; sexo do recém-nascido; e idade gestacional. Para a massa de gordura corporal: peso de nascimento; sexo do recém-nascido; hipertensão arterial gestacional; diabetes gestacional; e ganho de peso gestacional. Essas variáveis explicaram 60% e 46% da massa de gordura, em gramas e percentual, respectivamente. Em relação ao peso de nascimento os fatores significativos foram: idade gestacional; IMC pré-gestacional; e ganho de peso gestacional. Os recém-nascidos do sexo feminino apresentaram maior massa de gordura corporal e os do sexo masculino maior massa livre de gordura. Conclusão: Fatores gestacionais e perinatais influenciam a composição corporal neonatal. A identificação precoce desses fatores gestacionais, que podem ser modificáveis, é necessária para prevenção de obesidade e de doenças crônicas não transmissíveis no futuro.

Assuntos

Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Peso ao Nascer , Composição Corporal , Índice de Massa Corporal , Fatores Sexuais , Estudos Transversais , Estudos Prospectivos , Idade Gestacional

RESUMO

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 Prospectivos

RESUMO

OBJECTIVE: To evaluate the influence of gestational and perinatal factors on body composition and birth weight of full-term newborns. METHOD: This was a cross-sectional study, within a prospective cohort, consisting of 124 postpartum women and their newborns. Data included the following: maternal age; ethnicity; pre-gestational body mass index; gestational weight gain; parity; gestational morbidities (hypertension and gestational diabetes mellitus); gestational age at birth; birth weight; and newborn's gender. Anthropometric and body composition data of the newborns were collected using air-displacement plethysmography (PeaPod® Infant Body Composition System-LMI; Concord, CA, USA). The stepwise technique was applied to a multiple linear regression model. RESULTS: The significant variables in the model that explained 84% of the variation in neonatal fat-free mass were: birth weight; maternal age; newborn's gender and gestational age. For body fat mass: birth weight; newborn's gender; gestational arterial hypertension; gestational diabetes; and gestational weight gain. These variables explained 60% and 46% of fat mass, in grams and as a percentage, respectively. Regarding birth weight, the significant factors were gestational age, pre-gestational BMI, and gestational weight gain. Female newborns showed higher body fat mass and male newborns had higher fat-free mass. CONCLUSION: Gestational and perinatal factors influence neonatal body composition. Early identification of these gestational factors, which may be modifiable, is necessary to prevent obesity and chronic noncommunicable diseases in the future.

Assuntos

Peso ao Nascer , Composição Corporal , Índice de Massa Corporal , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Prospectivos , Fatores Sexuais

RESUMO

The implications of Zika Virus exposure in pregnancy for early infant growth remains poorly described. The main goal of this study is to compare the growth, body composition, and feeding modality of infants in the first three months of life by prenatal Zika Virus exposure status. We selected an analytical cohort of 115 infants born without microcephaly, comprising 56 infants with qRT-PCR confirmed exposure to ZIKV during gestation and 59 infants born to women with presumptively no evidence of ZIKV in pregnancy. Infants were evaluated at birth, 1 and 3 months of age in terms of anthropometrics, body composition All the results were adjusted by maternal age, maternal BMI and gestational age. We observe no differences between anthropometric measurements at birth. Mothers in exposed group showed higher BMI. At 1 month and 3 months of age there were differences in mid arm circumference, arm muscle circumference and fat free mass. Weight and length was less in the ZIKV exposed in pregnancy infants and statistically different at 3 month of age. The findings of this investigation provide new evidence that ZIKV exposure in pregnancy may be associated with differences in body composition.

Assuntos

Composição Corporal/fisiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Infecção por Zika virus/complicações , Zika virus/patogenicidade , Adulto , Peso Corporal/fisiologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Microcefalia/fisiopatologia , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Estudos Prospectivos

RESUMO

ABSTRACT Objective: To create an electronic instrument in order to analyze the adequacy of the preterm infants' nutritional therapy, checking the difference between the prescribed and the administered diet. Methods: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. Results: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. Conclusions: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers' decisions about the nutritional approach, which can contribute to patients' safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.

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RESUMO Objetivo: Elaborar um instrumento eletrônico para análise da adequação da terapia nutricional dos recém-nascidos pré-termo, verificando a diferença entre a dieta prescrita e a administrada. Métodos: Estudo observacional prospectivo em recém-nascidos com peso de nascimento ≤1.500 g e/ou idade gestacional ≤32 semanas, sem malformações congênitas. O instrumento eletrônico foi desenvolvido com base em planilhas do Microsoft Excel 2010 para calcular automaticamente ganho de peso corporal, calorias e macronutrientes diariamente recebidos pelos pacientes por meio de dietas parenteral e enteral. Para comparar a dieta prescrita e a administrada, foram utilizados os resultados das médias semanais. Resultados: Para avaliar o instrumento, foram incluídos 60 recém-nascidos com peso de nascimento de 1.289±305 g e idade gestacional de 30±2 semanas. Destes, 9,6% apresentavam restrição de crescimento no nascimento e 55% no momento da alta. A média de internação foi de 45±17 dias. Foram verificadas diferenças significativas entre a dieta prescrita e a administrada para todos os macronutrientes e calorias totais nas três primeiras semanas. O lipídeo foi o macronutriente com o maior erro percentual na primeira semana. Conclusões: O emprego de uma rotina computacional foi importante para verificar discrepâncias entre a dieta prescrita e a administrada. Essa análise é necessária para minimizar erros de cálculo e agilizar as decisões da equipe de saúde acerca da abordagem nutricional, podendo contribuir para a segurança do paciente e para a boa prática nutricional. Os recém-nascidos de muito baixo peso são extremamente vulneráveis às deficiências nutricionais e qualquer redução nos macronutrientes recebidos pode ser deletéria para o crescimento satisfatório.

Assuntos

Humanos , Masculino , Feminino , Recém-Nascido , Apoio Nutricional/normas , Erros Médicos/estatística & dados numéricos , Registros Eletrônicos de Saúde , Cuidado do Lactente/normas , Padrões de Prática Médica , Brasil , Recém-Nascido Prematuro/fisiologia , Estudos Prospectivos , Apoio Nutricional/estatística & dados numéricos , Erros Médicos/prevenção & controle , Segurança do Paciente , Cuidado do Lactente/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição

RESUMO

OBJECTIVE: To create an electronic instrument in order to analyze the adequacy of the preterm infants' nutritional therapy, checking the difference between the prescribed and the administered diet. METHODS: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. RESULTS: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. CONCLUSIONS: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers' decisions about the nutritional approach, which can contribute to patients' safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.

Assuntos

Registros Eletrônicos de Saúde , Cuidado do Lactente/normas , Recém-Nascido Prematuro , Erros Médicos/estatística & dados numéricos , Apoio Nutricional/normas , Brasil , Feminino , Humanos , Cuidado do Lactente/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Masculino , Erros Médicos/prevenção & controle , Apoio Nutricional/estatística & dados numéricos , Segurança do Paciente , Padrões de Prática Médica , Estudos Prospectivos

RESUMO

Abstract Objective: To evaluate the resting energy expenditure, growth, and quantity of energy and macronutrients intake in a group of preterm newborns. Methods: The cohort study was performed with appropriate and small for gestational age preterm infants (birth weight lower than 1500 g or gestational age < 32 weeks). Resting energy expenditure was measured using indirect calorimetry on the 7th, 14th, 21st, and 28th days of life, and at discharge. Length, head circumference and body weight were assessed weekly. Nutritional therapy was calculated during the hospital stay and the information for each type of food was recorded in software that calculates the total amount of energy and macronutrients. Results: 61 preterm infants were followed; 43 appropriate and 18 small for gestational age infants. There was no statistical difference for resting energy expenditure between the groups, and it increased from the first to the fourth week of life (appropriate: 26.3% and small: 21.8%). Energy intake in the first two weeks of life was well below the energy requirement. Conclusion: Considering that the results demonstrate high energy expenditure during the first weeks of life, there is an evident need to provide the best quality of nutrition for each child in the first weeks of life so that preterm infants with or without intrauterine growth restriction can achieve their maximum potential for growth and development.

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Resumo Objetivo: Avaliar o gasto energético de repouso, o crescimento e a quantidade ofertada de energia e macronutrientes em um grupo de recém-nascidos pré-termo. Método: Foi feito estudo de coorte com recém-nascidos pré-termo adequados e pequenos para a idade gestacional (peso de nascimento inferior a 1.500 gramas ou idade gestacional < 32 semanas). O gasto energético foi avaliado com a calorimetria indireta nos dias 7°, 14°, 21°, 28° dias de vida e alta hospitalar. Medidas do comprimento, perímetro cefálico e peso corporal foram avaliadas semanalmente. A terapia nutricional foi calculada durante a internação do recém-nascido e as informações de cada tipo de alimentação foram registradas em um software que calcula a quantidade total de energia e macronutrientes. Resultados: Foram acompanhados 61 recém-nascidos, sendo 43 adequados e 18 pequenos para idade gestacional. O gasto energético de repouso não apresentou diferença estatística entre os grupos e aumentou entre a primeira e quarta semana de vida (adequados: 26,3% e pequenos: 21,8%). O aporte energético nas duas primeiras semanas de vida mostrou-se bem abaixo do requerimento energético mensurado pela calorimetria. Conclusão: Considerando os resultados que demonstram um gasto energético alto ao longo das primeiras semanas de vida, fica evidente a necessidade de fornecer ao recém-nascido pré-termo um melhor aporte energético já nas primeiras semanas de vida, para que os neonatos com ou sem restrição intrauterina possam atingir o seu potencial máximo de crescimento e desenvolvimento.

Assuntos

Humanos , Masculino , Feminino , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Prematuro/metabolismo , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Recém-Nascido Pequeno para a Idade Gestacional/metabolismo , Apoio Nutricional/métodos , Metabolismo Energético/fisiologia , Valores de Referência , Fatores de Tempo , Metabolismo Basal/fisiologia , Peso Corporal , Ingestão de Energia/fisiologia , Calorimetria Indireta/métodos , Cefalometria , Estado Nutricional/fisiologia , Estudos de Coortes , Idade Gestacional , Resultado do Tratamento , Estatísticas não Paramétricas , Hospitalização

RESUMO

This paper aims to evaluate the prevalence of breastfeeding among premature infants following hospital discharge. Cohort (< 33 gestation weeks) followed up to 12 months (adjusted age). VARIABLES: breastfeeding, anthropometric measurements, social and family information. The proportion of breastfeeding during follow-up was calculated. Survival analysis was conducted to estimate breastfeeding duration. In total, 242 of the 258 infants (93.7%) returned to follow-up; 170 (69.9%) at 6 months and 139 (57.2%) at 12 months (adjusted age). A history of miscarriages (27.5%), stillbirths (11.7%), neonatal deaths (9.5%) and preterm births (21.1%) was noted in 65.5% of women. At hospital discharge: 5.5% received exclusive breastfeeding, 65.8% breastfeeding and formula, 28.6% formula. At month 1, 81.3% received breastfeeding, decreasing to 68.5% at month 2, 62.4% at month 3, 48.1% at month 4 and 22.4% at month 6 (adjusted age). The median of breastfeeding duration was 4 months. Breastfeeding occurred up to four months adjusted age in almost half of the population. Despite the need to improve these rates, the results could reflect the profile of the Child-Friendly Hospital Initiative Unit. Maintaining breastfeeding amongst preterm infants following hospital discharge is still a challenge, for both mothers and health professionals.

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Objetivo deste artigo é avaliar a prevalência de amamentação entre prematuros após a alta hospitalar. Coorte (idade gestacional < 33 semanas) acompanhada até 12 meses (idade corrigida). Variáveis: amamentação, medidas antropométricas, informações sociofamiliares. Calculadas as proporções de amamentação durante o acompanhamento. Realizada análise de sobrevida para estimar a duração da amamentação. Retornaram ao ambulatório 242/258 crianças (93,7%); 170 (69,9%) aos 6 e 139 (57,2%) aos 12 meses (idade corrigida). História de abortos (27,5%), natimortos (11,7%), óbito neonatal (9,5%), partos prematuros (21,1%) em 65,5% das mulheres. Alimentação na alta: 5,5% amamentação exclusiva, 65,8% leite materno e fórmula, 28,6% fórmula. Com 1 mês 81,3% estavam em aleitamento materno, diminuindo para 68,5 % aos 2 meses, 62,4% aos 3 meses, 48,1% aos 4 meses e 22,4% aos 6 meses (idade corrigida). A mediana da duração da amamentação foi de 4 meses. O aleitamento materno ocorreu até os quatro meses de idade corrigida em quase metade da população. Apesar da necessidade de melhorar estas taxas, estes resultados podem refletir o perfil da Unidade, pertencente à Iniciativa Hospital Amigo da Criança. A manutenção do aleitamento materno em lactentes pré-termos após a alta hospitalar continua sendo um desafio, para as mães e para os profissionais de saúde.

Assuntos

Aleitamento Materno/estatística & dados numéricos , Comportamento Alimentar , Fórmulas Infantis/estatística & dados numéricos , Recém-Nascido Prematuro , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Mães/estatística & dados numéricos , Prevalência , Fatores de Tempo , Adulto Jovem

RESUMO

Resumo Objetivo deste artigo é avaliar a prevalência de amamentação entre prematuros após a alta hospitalar. Coorte (idade gestacional < 33 semanas) acompanhada até 12 meses (idade corrigida). Variáveis: amamentação, medidas antropométricas, informações sociofamiliares. Calculadas as proporções de amamentação durante o acompanhamento. Realizada análise de sobrevida para estimar a duração da amamentação. Retornaram ao ambulatório 242/258 crianças (93,7%); 170 (69,9%) aos 6 e 139 (57,2%) aos 12 meses (idade corrigida). História de abortos (27,5%), natimortos (11,7%), óbito neonatal (9,5%), partos prematuros (21,1%) em 65,5% das mulheres. Alimentação na alta: 5,5% amamentação exclusiva, 65,8% leite materno e fórmula, 28,6% fórmula. Com 1 mês 81,3% estavam em aleitamento materno, diminuindo para 68,5 % aos 2 meses, 62,4% aos 3 meses, 48,1% aos 4 meses e 22,4% aos 6 meses (idade corrigida). A mediana da duração da amamentação foi de 4 meses. O aleitamento materno ocorreu até os quatro meses de idade corrigida em quase metade da população. Apesar da necessidade de melhorar estas taxas, estes resultados podem refletir o perfil da Unidade, pertencente à Iniciativa Hospital Amigo da Criança. A manutenção do aleitamento materno em lactentes pré-termos após a alta hospitalar continua sendo um desafio, para as mães e para os profissionais de saúde.

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Abstract This paper aims to evaluate the prevalence of breastfeeding among premature infants following hospital discharge. Cohort (< 33 gestation weeks) followed up to 12 months (adjusted age). Variables: breastfeeding, anthropometric measurements, social and family information. The proportion of breastfeeding during follow-up was calculated. Survival analysis was conducted to estimate breastfeeding duration. In total, 242 of the 258 infants (93.7%) returned to follow-up; 170 (69.9%) at 6 months and 139 (57.2%) at 12 months (adjusted age). A history of miscarriages (27.5%), stillbirths (11.7%), neonatal deaths (9.5%) and preterm births (21.1%) was noted in 65.5% of women. At hospital discharge: 5.5% received exclusive breastfeeding, 65.8% breastfeeding and formula, 28.6% formula. At month 1, 81.3% received breastfeeding, decreasing to 68.5% at month 2, 62.4% at month 3, 48.1% at month 4 and 22.4% at month 6 (adjusted age). The median of breastfeeding duration was 4 months. Breastfeeding occurred up to four months adjusted age in almost half of the population. Despite the need to improve these rates, the results could reflect the profile of the Child-Friendly Hospital Initiative Unit. Maintaining breastfeeding amongst preterm infants following hospital discharge is still a challenge, for both mothers and health professionals.

Assuntos

Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Adolescente , Adulto , Adulto Jovem , Aleitamento Materno/estatística & dados numéricos , Recém-Nascido Prematuro , Fórmulas Infantis/estatística & dados numéricos , Comportamento Alimentar , Fatores de Tempo , Prevalência , Seguimentos , Mães/estatística & dados numéricos

Assuntos

Composição Corporal , Retardo do Crescimento Fetal/patologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Tecido Adiposo/crescimento & desenvolvimento , Tecido Adiposo/patologia , Adiposidade , Peso ao Nascer , Brasil , Desenvolvimento Infantil , Estudos de Coortes , Feminino , Humanos , Lactente , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Masculino , Magreza/patologia

RESUMO

BACKGROUND: Extremely preterm infants with weights less than the 10th percentile at discharge have a fat-free mass deficit. AIM: To analyze the relationship of weight Z-scores less than -2SD at term age with fat-free mass and fat mass at term age and at 1 and 3 months of corrected age in very preterm infants. STUDY DESIGN: COHORT STUDY: Subjects: Sixty-six preterm infants born before or at 32 weeks gestation with birth weight equal or greater than the 10th percentile for age were included at term age. They were classified according to weight Z-score as either: "term (-)" (n = 18) if weight Z-scores were less -2SD or "term (+)" (n = 48) if the weight Z-scores were equal or greater than -2SD at term age. OUTCOME MEASURES: Growth and body composition by an air displacement plethysmography system and bioimpedance were assessed at term age and 1 and 3 months of corrected age. RESULTS: Lower fat-free mass persisted up to 3 months in the "term (-)" group [4137 g (645) vs 4592 g (707), p < .01]. Fat mass was lower in the "term (-)" group at term and at 1 month but was similar at 3 months of corrected age [1295 g (774) vs 1477 g (782), p = .109]. Weight, length and head circumference Z-scores were lower in the "term (-)" group compared to those in the "term (+)" group. CONCLUSIONS: The lean tissue deficits were maintained in the "term (-)" group while the differences in body fat percentage were not.

Assuntos

Composição Corporal , Peso Corporal , Desenvolvimento Infantil , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Adiposidade , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino

RESUMO

OBJECTIVE: To evaluate the resting energy expenditure, growth, and quantity of energy and macronutrients intake in a group of preterm newborns. METHODS: The cohort study was performed with appropriate and small for gestational age preterm infants (birth weight lower than 1500g or gestational age<32 weeks). Resting energy expenditure was measured using indirect calorimetry on the 7th, 14th, 21st, and 28th days of life, and at discharge. Length, head circumference and body weight were assessed weekly. Nutritional therapy was calculated during the hospital stay and the information for each type of food was recorded in software that calculates the total amount of energy and macronutrients. RESULTS: 61 preterm infants were followed; 43 appropriate and 18 small for gestational age infants. There was no statistical difference for resting energy expenditure between the groups, and it increased from the first to the fourth week of life (appropriate: 26.3% and small: 21.8%). Energy intake in the first two weeks of life was well below the energy requirement. CONCLUSION: Considering that the results demonstrate high energy expenditure during the first weeks of life, there is an evident need to provide the best quality of nutrition for each child in the first weeks of life so that preterm infants with or without intrauterine growth restriction can achieve their maximum potential for growth and development.

Assuntos

Metabolismo Energético/fisiologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Prematuro/metabolismo , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Recém-Nascido Pequeno para a Idade Gestacional/metabolismo , Apoio Nutricional/métodos , Metabolismo Basal/fisiologia , Peso Corporal , Calorimetria Indireta/métodos , Cefalometria , Estudos de Coortes , Ingestão de Energia/fisiologia , Feminino , Idade Gestacional , Hospitalização , Humanos , Recém-Nascido , Masculino , Estado Nutricional/fisiologia , Valores de Referência , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento

RESUMO

OBJETIVO: Analisar o crescimento e a composição corporal de recém-nascidos pré-termo na idade gestacional corrigida de termo e ao alcançarem um peso entre 3,0 e 3,5 kg. MÉTODOS: Estudo longitudinal, realizado no Instituto Fernandes Figueira, Rio de Janeiro, com 39 recém-nascidos pré-termo e que apresentaram muito baixo peso ao nascer. Medidas antropométricas e água corporal total foram avaliadas no primeiro, no sétimo e no dia da recuperação do peso de nascimento, na idade gestacional corrigida do termo e em torno de três semanas de idade gestacional corrigida (correspondente ao tempo de vida para alcançar um peso entre 3,0 e 3,5 kg). O grupo de referência foi constituído por 32 recém-nascidos a termo, adequados para a idade gestacional, avaliados no segundo dia de vida. Considerou-se restrição de crescimento o escore-Z menor do que -2 para peso, comprimento e perímetro cefálico. RESULTADOS: Na idade de termo, 71,8% dos recém-nascidos pré-termo apresentaram restrição do crescimento para peso, 61,5% para comprimento e 25,6% para perímetro cefálico. Com três semanas de idade gestacional corrigida, esses recém-nascidos apresentaram a prega cutânea tricipital e a circunferência abdominal estatisticamente maiores que o grupo de referência enquanto o comprimento e a porcentagem de água corporal total foram menores. CONCLUSÃO: Os recém-nascidos pré-termo apresentaram perfil antropométrico e de água corporal diferente dos recém--nascidos a termo, sugerindo acúmulo de gordura. Houve recuperação do crescimento entre a idade de termo e três semanas de idade corrigida, sendo mais evidente esse crescimento em relação ao perímetro cefálico e peso.

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OBJECTIVE: To analyze growth and body composition of preemies at term gestational age and when they reach a weight of 3.0 to 3.5 kg. METHODS: This longitudinal study was conducted at Instituto Fernandes Figueira, Rio de Janeiro, and included 39 preemies with very low birth weight. Anthropometric measurements and bioelectrical impedance analysis were performed in 5 occasions: days 1 and 7 after birth; at birth weight recovery; at term-corrected gestational age; and at around three weeks of corrected gestational age (age needed to reach a weight of 3.0 to 3.5 kg). A reference group comprising 32 term newborns, appropriate for gestational age, was evaluated at day 2 after birth. Growth restriction was defined as a Z-score below -2 for weight, length, and head circumference. RESULTS: At term age, 71.8% of the preemies presented growth restriction for weight, 61.5% for length, and 25.6% for head circumference. When the preemies reached three weeks of corrected gestational age, triceps skinfold thickness and abdominal circumference were greater than those of the reference group, and length and percent of total body water were lower. CONCLUSION: The anthropometric profile and total body water of preemies were different from those of term newborns, suggesting fat deposition. There was catch up growth between term age and three weeks of corrected gestational age, which was more evident for head circumference and weight.

Assuntos

Humanos , Masculino , Feminino , Recém-Nascido , Composição Corporal , Água Corporal , Recém-Nascido Prematuro , Antropometria