RESUMO
Objective: To evaluate the mode of delivery according to Robson classification (RC) and the perinatal outcomes in fetal growth restriction (FGR) and small for gestational age (SGA) fetuses. Methods: Retrospective cohort study by analyzing medical records of singleton pregnancies from two consecutive years (2018 and 2019). FGR was defined according to Delphi Consensus. The Robson groups were divided into two intervals (1-5.1 and 5.2-10). Results: Total of 852 cases were included: FGR (n = 85), SGA (n = 20) and control (n=747). FGR showed higher percentages of newborns < 1,500 grams (p<0.001) and higher overall cesarean section (CS) rates (p<0.001). FGR had the highest rates of neonatal resuscitation and neonatal intensive care unit admission (p<0.001). SGA and control presented higher percentage of patients classified in 1 - 5.1 RC groups, while FGR had higher percentage in 5.2 - 10 RC groups (p<0.001). FGR, SGA and control did not differ in the mode of delivery in the 1-5.1 RC groups as all groups showed a higher percentage of vaginal deliveries (p=0.476). Conclusion: Fetuses with FGR had higher CS rates and worse perinatal outcomes than SGA and control fetuses. Most FGR fetuses were delivered by cesarean section and were allocated in 5.2 to 10 RC groups, while most SGA and control fetuses were allocated in 1 to 5.1 RC groups. Vaginal delivery occurred in nearly 60% of FGR allocated in 1-5.1 RC groups without a significant increase in perinatal morbidity. Therefore, the vaginal route should be considered in FGR fetuses.
RESUMO
Background: According to the World Health Organization, tuberculosis (TB) ranks among the top 10 causes of death worldwide. The significance of TB during pregnancy lies in its symptoms, which can be mistaken for physiological changes associated with pregnancy. This confusion can lead to maternal-perinatal complications. Objective: To evaluate the association between pulmonary TB in pregnancy and adverse neonatal outcomes in two Peruvian hospitals. Methods: This is a retrospective cohort study. The target population consisted of pregnant women with and without pulmonary TB whose deliveries were attended at two public hospitals, located in Lima, Peru. The adverse neonatal outcomes were prematurity, low birth weight (LBW), and being small for gestational age (SGA). Crude and adjusted relative risks (RRa) were calculated with their respective 95% confidence intervals (95%CI). Results: Information from 212 patients was analyzed; 48.1% had TB during pregnancy, and 23.1% had adverse neonatal outcomes (8%, 11.3%, and 12.3% for LBW, prematurity, and SGA, respectively). In the adjusted model, pregnant women with pulmonary TB had a 3.52 times higher risk of having a newborn with at least one of the adverse outcomes than those who were not exposed (aRR, 3.52; 95%CI: 1.93-6.68). Conclusion: Pulmonary TB in pregnancy was jointly and independently associated with adverse neonatal outcomes, including LBW, prematurity, and being SGA.
RESUMO
ABSTRACT Objective: To assess the effect of recombinant growth hormone (rGH) on body composition and metabolic profile of prepubertal short children born small for gestational age (SGA) before and after 18 months of treatment. Methods: It is a clinical, non-randomized, and paired study. Children born SGA, with birth weight and/or length <-2 standard deviations (SD) for gestational age and sex, prepubertal, born at full term, of both genders, with the indication for treatment with rGH were included. The intervention was performed with biosynthetic rGH at doses ranging from 0.03 to 0.05 mg/kg/day, administered subcutaneously, once a day at bedtime. Total lean mass (LM) and total fat mass (FM) were carried out using dual-energy X-ray absorptiometry (DXA), and the metabolic profile was assessed for insulin, glycemia, IGF-1 levels and lipid profile. Results: Twelve patients (nine girls, 8.17±2.39 y) were evaluated; three patients dropped out of the study. There was an increase of LM adjusted for length (LMI) (p=0.008), LMI standard deviation score (SDS) adjusted for age and sex (p=0.007), and total LM (p<0.001). The percentage of body fat (BF%) and abdominal fat (AF) remained unaltered in relation to the beginning of treatment. Among the metabolic variables, blood glucose remained within normal levels, and there was a reduction in the number of participants with altered cholesterol (p=0.023). Conclusions: The effect of rGH treatment was higher on LM than in FM, with increased LM adjusted for length and standardized for age and sex. Glycemia remained within the normal limits, and there was a decreased number of children with total cholesterol above the recommended levels.
RESUMO Objetivo: Avaliar o efeito do hormônio de crescimento recombinante (rHC) na composição corporal e no perfil metabólico de crianças pré-púberes com baixa estatura, nascidas pequenas para a idade gestacional (PIG) antes e depois de 18 meses de tratamento. Métodos: Estudo clínico, não randomizado e pareado. Foram incluídas crianças nascidas PIG, com peso e/ou altura ao nascer <-2 desvios padrão (DP) para idade gestacional e sexo, pré-púberes, nascidas a termo, de ambos os sexos, com indicação de tratamento com rGH. A intervenção foi realizada com rGH biossintético com doses variando de 0,03 a 0,05 mg/kg/dia, administrado por via subcutânea, uma vez ao dia ao deitar-se. A massa magra total (LM) e a massa gorda total (MG) foram determinadas por meio de absorciometria de raios X de dupla energia (DXA), e o perfil metabólico foi avaliado com dosagens de insulina, glicemia, IGF-1 e perfil lipídico. Resultados: Doze pacientes (nove meninas, 8,17±2,39 anos) foram avaliados; três pacientes abandonaram o estudo. Houve aumento da LM ajustada para estatura (LMI) (p=0,008), LMI standard deviation scores (SDS) ajustada para idade e sexo (p=0,007) e LM total (p<0,001). O percentual de gordura corporal (GC%) e gordura abdominal (AF) permaneceu inalterado em relação ao início do tratamento. Entre as variáveis metabólicas, a glicemia manteve-se na normalidade, e houve redução do número de participantes com colesterol alterado (p=0,023). Conclusões: O efeito do tratamento com HCr foi maior na MM do que na MG, com o aumento da MM ajustada para altura e padronizada para idade e sexo. A glicemia permaneceu normal e houve redução do número de crianças com colesterol total acima do recomendado.
RESUMO
Abstract Objective To evaluate the mode of delivery according to Robson classification (RC) and the perinatal outcomes in fetal growth restriction (FGR) and small for gestational age (SGA) fetuses. Methods Retrospective cohort study by analyzing medical records of singleton pregnancies from two consecutive years (2018 and 2019). FGR was defined according to Delphi Consensus. The Robson groups were divided into two intervals (1-5.1 and 5.2-10). Results Total of 852 cases were included: FGR (n = 85), SGA (n = 20) and control (n=747). FGR showed higher percentages of newborns < 1,500 grams (p<0.001) and higher overall cesarean section (CS) rates (p<0.001). FGR had the highest rates of neonatal resuscitation and neonatal intensive care unit admission (p<0.001). SGA and control presented higher percentage of patients classified in 1 - 5.1 RC groups, while FGR had higher percentage in 5.2 - 10 RC groups (p<0.001). FGR, SGA and control did not differ in the mode of delivery in the 1-5.1 RC groups as all groups showed a higher percentage of vaginal deliveries (p=0.476). Conclusion Fetuses with FGR had higher CS rates and worse perinatal outcomes than SGA and control fetuses. Most FGR fetuses were delivered by cesarean section and were allocated in 5.2 to 10 RC groups, while most SGA and control fetuses were allocated in 1 to 5.1 RC groups. Vaginal delivery occurred in nearly 60% of FGR allocated in 1-5.1 RC groups without a significant increase in perinatal morbidity. Therefore, the vaginal route should be considered in FGR fetuses.
RESUMO
Introduction: Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births. Methods: This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs). Results: The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors. Discussion: The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil.
RESUMO
Abstract Objective The present study aimed to evaluate the effects of GH treatment on the body composition of children born with SGA. Methods This study is a systematic review of the literature. CINAHL, Embase; Medline/Pubmed, Scopus and Web of Science were searched from inception to March 2022. Results Four studies met the inclusion criteria, with an intervention time of 1 to 3 years, using doses from 0.03 to 0.07 mg/kg/day of GH. Bone densitometry by dual-energy X-ray absorptiometry (DXA) with whole-body scans was the most used method to assess body composition. Most studies (n= 3) had SGA children as a control group with the same characteristics as the case group; the mean age was similar between the groups (minimum of 5.1 ± 1.4 years and maximum of 6.7 ± 1 0.8 years) and all participants had an average height ≤ -3DP. The Lean Mass (LM) and Fat Mass (FM) outcomes of the studies were not presented in a standardized manner; thus, they cannot be compared. There was a significant increase in LM in the group treated with GH in relation to the pre-treatment period and in comparison, to the untreated control group. Three studies showed a significant decrease in FM at the end of the intervention period, and in two studies, this decrease occurred in the control group. Conclusions Despite the differences in the presentation of results and in the evaluation periods, the results of the studies showed that growth hormone favors the gain and maintenance of lean mass, and it also affects fat mass reduction and redistribution.
RESUMO
OBJECTIVE: The present study aimed to evaluate the effects of GH treatment on the body composition of children born with SGA. METHODS: This study is a systematic review of the literature. CINAHL, Embase; Medline/Pubmed, Scopus and Web of Science were searched from inception to March 2022. RESULTS: Four studies met the inclusion criteria, with an intervention time of 1 to 3 years, using doses from 0.03 to 0.07 mg/kg/day of GH. Bone densitometry by dual-energy X-ray absorptiometry (DXA) with whole-body scans was the most used method to assess body composition. Most studies (n = 3) had SGA children as a control group with the same characteristics as the case group; the mean age was similar between the groups (minimum of 5.1 ± 1.4 years and maximum of 6.7 ± 1 0.8 years) and all participants had an average height ≤ -3DP. The Lean Mass (LM) and Fat Mass (FM) outcomes of the studies were not presented in a standardized manner; thus, they cannot be compared. There was a significant increase in LM in the group treated with GH in relation to the pre-treatment period and in comparison, to the untreated control group. Three studies showed a significant decrease in FM at the end of the intervention period, and in two studies, this decrease occurred in the control group. CONCLUSIONS: Despite the differences in the presentation of results and in the evaluation periods, the results of the studies showed that growth hormone favors the gain and maintenance of lean mass, and it also affects fat mass reduction and redistribution.
Assuntos
Hormônio do Crescimento , Hormônio do Crescimento Humano , Criança , Pré-Escolar , Humanos , Recém-Nascido , Composição Corporal , Estatura , Idade Gestacional , Hormônio do Crescimento Humano/uso terapêutico , Hormônio do Crescimento Humano/farmacologia , Recém-Nascido Pequeno para a Idade Gestacional , Lactente , AdolescenteRESUMO
OBJECTIVES: To identify the prevalence of viral congenital infections in newborns classified as premature, low-birthweight, small for gestational age or intrauterine growth restriction. METHODS: The definition considered for selecting papers were: P as newborns younger than 28 days; V as low-birthweight, prematurity and intrauterine growth restriction; O as frequency of congenital infections with Cytomegalovirus, Parvovirus B19, Herpes Simplex, and Zika virus. The research was performed using EMBASE, LILACS, SCOPUS and MEDLINE databases, with no limitations on date and language. RESULTS: Eight studies were included. Manuscripts including Herpes Simplex, Zika virus or Parvovirus B19 did not fulfill the defined criteria. A wide variation in the frequency of CMV congenital infection (0-4.8%) was found, which might be attributed to regional and methodological differences between investigations. CONCLUSIONS: Newborn characteristics associated with CMV congenital infections may direct investigations towards these patients with a higher probability of infection. However, as data are controversial, studies concerning screening of infection are important to define recommendations of diagnosis.
Assuntos
Infecções por Citomegalovirus , Herpes Simples , Doenças do Recém-Nascido , Parvovirus B19 Humano , Complicações Infecciosas na Gravidez , Infecção por Zika virus , Zika virus , Peso ao Nascer , Citomegalovirus , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/epidemiologia , Herpes Simples/complicações , Herpes Simples/diagnóstico , Herpes Simples/epidemiologia , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Simplexvirus , Infecção por Zika virus/complicações , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologiaRESUMO
ABSTRACT Objective: Our aim was to describe the prevalence of diseases during pregnancy and the association between fetal exposure to the most frequent maternal diseases and the risk of preterm (PTB) and/or small for gestational age (SGA) newborns in an unselected sample of women who gave birth in South American countries. Methods: We conducted a descriptive, cross-sectional study including 56,232 mothers of non-malformed infants born between 2002 and 2016, using data from the Latin American Collaborative Study of Congenital Malformations (ECLAMC). Diseases with higher- than-expected PTB/SGA frequencies were identified. Odds ratios of confounding variables for diseases and birth outcomes were calculated with a multivariable logistic regression. Results: Of the 14 most reported diseases, hypertension, genitourinary infection, epilepsy, hypothyroidism, diabetes, and HIV/AIDS showed higher PTB and/or SGA frequencies. Advanced and low maternal age, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with PTB, while advanced maternal age, primigravidity, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with SGA. After adjusting for the associated variables, the identified illnesses maintained their association with PTB and all, except epilepsy, with SGA. Conclusion: The description of an unselected population of mothers allowed identifying the most frequent diseases occurring during gestation and their impact on pregnancy outcomes. Six diseases were associated with PTB and two with SGA newborns. To the best of our knowledge, there are no similar reports about women not intentionally selected by specific diseases during pregnancy in South American populations.
RESUMO Objetivo: Descrever a prevalência de doenças durante a gravidez e a associação entre a exposição fetal às doenças maternas mais prevalentes e o risco de recém-nascidos prematuros (PP) e/ou pequenos para a idade gestacional (PIG) em uma amostra não selecionada de mulheres que deram à luz em países da América do Sul. Métodos: Estudo descritivo transversal que incluiu 56.232 mães de crianças não malformadas nascidas entre 2002 e 2016, utilizando dados do Estudo Colaborativo Latino-americano de Malformações Congênitas (ECLAMC). Foram identificadas as doenças com maior número de casos observado/esperado de PP/PIG. O esperado foi obtido dos controles sem doenças. Odds ratios para variáveis de confusão de doença e eventos ao nascimento foram calculadas usando regressão logística multivariada. Resultados: Das 14 doenças mais referidas, hipertensão, infecção geniturinária, epilepsia, hipotireoidismo, diabetes e HIV/AIDS apresentaram maiores frequências de PP e/ou PIG. Idade materna nos dois extremos, perda fetal prévia, baixo nível socioeconômico e ascendência afro-americana foram associados a PP, enquanto idade materna avançada, primigravidez, perda fetal prévia, baixo nível socioeconômico e ascendência afro-americana foram associados a PIG. Após ajuste para as variáveis associadas, as doenças identificadas mantiveram associação com PP e todas, exceto epilepsia, com PIG. Conclusão: A descrição de uma população não selecionada de gestantes possibilitou identificar as doenças mais frequentes e seu impacto nos resultados adversos na gravidez. Seis doenças foram associadas a PP e duas a recém-nascidos PIG. Até onde sabemos, não há relatos semelhantes sobre mulheres não selecionadas intencionalmente por doenças específicas durante a gravidez em populações sul-americanas.
RESUMO
Tecnologia: Somatropina. Indicação: Transtorno de crescimento em crianças nascidas pequenas para a idade gestacional (PIG). Pergunta: A somatropina é eficaz e segura para promover aumento da curva de crescimento em crianças nascidas PIG? Métodos: Levantamento bibliográfico foi realizado na base de dados PUBMED, seguindo estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews version 2). Resultados: Foi selecionada uma revisão sistemática que atendeu aos critérios de inclusão. Conclusão: evidências de moderada certeza indicam que somatropina é eficaz e segura para tratamento de crianças nascidas PIG, pois promove recuperação do crescimento e não há relatos de eventos adversos graves na literatura científica
Technology: Somatropin. Indication: Growth disorder in children born small for gestational age (SGA). Question: Is somatropin effective, safe and cost effective for promoting height gain in children born SGA? Methods: A bibliographic search was done in PUBMED database, following predefined search strategies. The methodological quality of systematic reviews was evaluated using the AMSTAR-2 tool (A MeaSurement Tool to Assess systematic Reviews version 2). Results: Only a systematic review met the inclusion criteria and was selected. Conclusion: Evidence of moderate certainty indicates that somatropin is effective and safe for the treatment of children born SGA, because the treatment improve the growth and there are no reports of serious adverse events in the scientific literature
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Recém-Nascido Pequeno para a Idade Gestacional , Hormônio do Crescimento Humano/uso terapêutico , Transtornos do Crescimento/tratamento farmacológico , Resultado do Tratamento , Revisões Sistemáticas como AssuntoRESUMO
ABSTRACT Objective To compare in-hospital outcomes between small-for-gestational-age and appropriate-for-gestational-age preterm neonates who needed intensive care. Methods A retrospective cohort study with preterm newborns, from January to December 2017. The results are presented as median, frequency, and odds ratio. Numerical variables were compared using the Wilcoxon test. Categorical variables were compared using the χ2 test. We considered p<0.05 as significant. Results Out of 129 preterm newborns included, 20.9% were small-for-gestational-age. Median gestational age was 31 2/7 weeks, birthweight was 1,450g, and length of hospital stay was 39 days. Preterm small-for-gestational-age newborns presented a higher chance of peri-intraventricular hemorrhage (odds ratio of 3.23; p=0.02), retinopathy of prematurity (odds ratio of 2.78 p=0.02), patent ductus arteriosus (odds ratio of 2.50; p=0.04) and a lower chance of presumptive early-onset sepsis (odds ratio of 0.37; p=0.03). Conclusion Preterm small-for-gestational-age neonates were associated with peri-intraventricular hemorrhage, retinopathy of prematurity and patent ductus arteriosus. This emphasizes the need of special care for these neonates.
RESUMO
Abstract Objective: To perform a systematic review in order to verify the association between full-term birth of small for gestational age (SGA) children and the outcomes in the development of oral language. Data source: Articles from MEDLINE/PubMed, Web of Science, Embase, Lilacs, SciELO and Cochrane Library databases were identified, selected and critically evaluated by two independent reviewers and a judge, blindly, without language restriction and publication period. The PRISMA tool was used, and original studies with a theme involving children born full-term and SGA were included, outcome related to aspects of oral language development, as well as the use of tests, scales and/or specific questionnaires for the investigation, whose methodology was described in full, with children as the target population. Data synthesis: The researchers included nine articles based on the eligibility criteria. Studies have shown that being born SGA can interfere in aspects related to language and reported greater chances of under performance in SGA children when compared to children with appropriate size for gestational age. It was observed that the different studies did not have a uniform design, and the objectives were quite diverse. Furthermore, few of them had as focus issues related to the assessment of language, as well as the variability of instruments used to investigate this domain. Conclusions: The effects of low weight for gestation age in full-term infants continue beyond the neonatal period and may impact on children's performance, mainly with regard to oral language development.
Resumo Objetivo: Realizar uma revisão sistemática para verificar a associação entre o nascimento a termo de crianças pequenas para a idade gestacional (PIG) e os desfechos no desenvolvimento da linguagem oral. Fontes de dados: Artigos dos bancos de dados MEDLINE/PubMed, Web of Science, Embase, LILACS, SciELO e Cochrane Library foram identificados, selecionados e avaliados criticamente por dois revisores independentes e um juiz, às cegas, sem restrições de idioma e período de publicação. A ferramenta PRISMA foi utilizada e foram incluídos estudos originais envolvendo crianças nascidas a termo e PIG, desfechos relacionados a aspectos do desenvolvimento da linguagem oral, bem como o uso de testes, escalas e/ou questionários específicos para a investigação, cuja metodologia estava descrita na íntegra, com crianças como população-alvo. Síntese dos dados: Nove artigos foram incluídos a partir dos critérios de elegibilidade. Os estudos demonstraram que nascer PIG pode interferir em aspectos relacionados à linguagem e relataram que as chances de crianças PIG apresentarem um desempenho inferior são maiores quando comparadas as com tamanho adequado para a idade gestacional. Observou-se que os diferentes estudos não tinham um delineamento uniforme e seus objetivos eram bastante diversificados. Além disso, poucos focavam em questões relacionadas à avaliação da linguagem e foi possível notar uma variabilidade de instrumentos utilizados para investigar esse domínio. Conclusões: Os efeitos do baixo peso ao nascer em nascidos a termo persistem além do período neonatal e podem ter impacto no desempenho infantil, principalmente no que se refere ao desenvolvimento da linguagem oral.
RESUMO
RESUMEN Fundamento: la restricción del crecimiento intrauterino constituye uno de los principales desafíos de la obstetricia moderna, en países en vías de desarrollo. Los individuos que fueron víctimas de restricción del crecimiento intrauterino son biológicamente diferentes, lo que incluye una mayor susceptibilidad a padecer enfermedades crónicas en la adultez. Objetivo: identificar variables maternas metabólicas y mixtas presumiblemente relacionadas con las restricciones del crecimiento intrauterino. Métodos: se realizó estudio analítico transversal engestantes del policlínico Chiqui Gómez Lubiándel municipio Santa Clara, que terminaron su embarazo entre septiembre de 2013 y octubre de 2018, y cuyos recién nacidos presentaron restricción del crecimiento intrauterino. La muestra se clasificó en pequeños y adecuados, según condición trófica al nacimiento. En cada grupo se estudió relación con variables maternas metabólicas y mixtas presumiblemente vinculadas con el fenómeno de restricción. Resultados: las madres de niños restringidos mantuvieron valores normales de variables metabólicas a la captación, pero mostraron alteración de las variables mixtas. Conclusiones: la restricción del crecimiento intrauterino pudiera estar relacionado con la alteración de las variables mixtas observadas en sus madres.
ABSTRACT Background: intrauterine growth restriction is one of the main challenges of modern obstetrics, mainly in developing countries. Individuals who were victims of intrauterine growth restriction are biologically different, which includes a greater susceptibility to suffering from chronic diseases in adulthood. Objective: to identify maternal, metabolic and mixed variables presumably related to intrauterine growth restrictions. Methods: a transverse analytic study of pregnant women, who ended their pregnancy between September 2013 and October 2018 and whose newborns had intrauterine growth restriction was carried out in the Chiqui Gómez Lubián polyclinic of the municipality of Santa Clara. The sample was classified as small and adequate, according to trophic condition at birth. In each group, a relationship with metabolic and mixed variables, presumably related to the intrauterine restriction phenomenon, was studied. Results: mothers of restricted children maintained normal values of metabolic variables upon uptake, but showed alteration of mixed variables. Conclusions: intrauterine growth restriction could be related to the alteration of the mixed variables observed in their mothers.
RESUMO
ABSTRACT Objective: To compare the incidence of small for gestational age infants among late preterm and term newborns, using the Fenton and Intergrowth-21st curves. Methods: Observational and retrospective study with newborns in a level II maternity. The study was approved by the Institution's Ethics Committee. Live births from July 2007 to February 2009 with a gestational age from 34 to 41 weeks and seven days were included. Neonates with incomplete data were excluded. Appropriate weight for gestational age was assessed by the Fenton and Intergrowth-21st intrauterine growth curves, considering birth weight <10th percentile as small for gestational age. The degree of agreement between the two curves was assessed by the Kappa coefficient. Numerical variables were compared using the Student t-test or the Mann-Whitney. Categorical variables were compared using the chi-square test. Statistical analyzes were performed using SPSS17® software, considering significant, p<0.05. Results: We included 2849 newborns with a birthweight of 3210±483 g, gestational age of 38.8±1.4 weeks; 51.1% male. The incidence of small for gestational age in the full sample was 13.0 vs. 8.7% (p<0.001, Kappa=0.667) by the Fenton and Intergrowth-21st curves, respectively. Among late preterm, the incidence of small neonates was 11.3 vs. 10.9% (p<0.001; Kappa=0.793) and among full-term infants it was 13.1% vs. 8.5% (p<0.001; Kappa=0.656), respectively for the Fenton and Intergrowth-21st curves. Conclusions: The incidence of small for gestational age newborns was significantly higher using the Fenton curve, with greater agreement between the Fenton and Intergrowth-21st curves among late preterm, compared to full term neonates.
RESUMO Objetivo: Comparar a incidência de neonatos pequenos para idade gestacional entre nascidos vivos pré-termo tardios e a termo utilizando as curvas de Fenton e Intergrowth-21st. Métodos: Estudo observacional retrospectivo com recém-nascidos de uma maternidade pública de nível secundário. Foram incluídos nascidos vivos de julho/2007 a fevereiro/2009 com idade gestacional de 34 a 41 semanas e seis dias. O estudo foi aprovado pelo Comitê de Ética da instituição. Foram excluídos recém-nascidos com dados incompletos. Para adequação do peso/da idade gestacional, utilizaram-se as curvas de crescimento intrauterino de Fenton e Intergrowth-21st, considerando-se pequeno aquele com peso ao nascer <10º percentil. O grau de concordância entre as duas curvas foi avaliado pelo coeficiente Kappa. As variáveis numéricas foram comparadas pelo teste t de Student ou de Mann-Whitney, conforme distribuição, e as categóricas pelo teste χ2. As análises estatísticas foram realizadas no programa Statistical Package for the Social Sciences (SPSS) 17®, considerando-se significante p<0,05. Resultados: Foram incluídos 2.849 recém-nascidos com peso ao nascer de 3210±483 g, idade gestacional de 38,8±1,4 semanas, sendo 51,1% masculinos. A incidência de recém-nascidos pequenos para a idade gestacional pela curva de Fenton e Intergrowth-21st na amostra total foi, respectivamente, de 13 e 8,7% (p<0,001; Kappa=0,667). Entre os pré-termo tardios, a incidência foi de 11,3 e 10,9% (p<0,001; Kappa=0,793) e entre os nascidos a termo foi de 13,1 e 8,5%, (p<0,001; Kappa=0,656), respectivamente, para as curvas de Fenton e Intergrowth-21st. Conclusões: A incidência de recém-nascidos pequenos para idade gestacional foi significantemente maior pela curva de Fenton, com maior concordância entre as curvas de Fenton e Intergrowth-21st em recém-nascidos pré-termo tardios do que nos nascidos a termo.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Peso ao Nascer , Recém-Nascido Pequeno para a Idade Gestacional , Valores de Referência , Brasil/epidemiologia , Recém-Nascido Prematuro , Incidência , Estudos Retrospectivos , Idade Gestacional , Nascido Vivo/epidemiologiaRESUMO
RESUMO Objetivo: Comparar o desenvolvimento neurocomportamental de bebês pré-termo com idade pós-concepcional entre 32 e 36 semanas e 6 dias, de acordo com a adequação do peso para a idade gestacional ao nascer. Métodos: Realizou-se um estudo transversal de comparação entre dois grupos independentes. Os 55 bebês prematuros que compuseram a amostra estavam internados em uma unidade de cuidados intermediários neonatais e foram avaliados por meio de Neurobehavioral Assessment of the Preterm Infant (NAPI) com idade pós-concepcional entre 32 e 36 semanas e 6 dias e comparados de acordo com a adequação do peso para a idade gestacional. Além da comparação entre os grupos, bebês nascidos pequenos para a idade gestacional (PIG) e os adequados para a idade gestacional (AIG) também foram comparados, considerando o tipo de crescimento intrauterino. Os seguintes instrumentos foram utilizados: NAPI, roteiro de anamnese, Critério de Classificação Econômica Brasil, da Associação Brasileira de Empresas de Pesquisa (ABEP), e prontuário médico. Resultados: Na população de estudo, a idade gestacional média foi de 32,0 semanas, enquanto a idade pós-conceptual e cronológica à avaliação foi de 34,8 semanas e 19,5 dias, respectivamente, sendo 55% dos bebês do sexo feminino. Não houve nenhuma diferença nos domínios do NAPI entre os grupos PIG e AIG, nem nos subgrupos de bebês PIG classificados segundo o crescimento em simétrico ou assimétrico. Conclusões: Não houve diferença entre os bebês PIG e AIG em relação ao desenvolvimento neurocomportamental avaliado antes de chegar ao termo.
ABSTRACT Objective: To compare the neurobehavioral development of preterm infants with postconceptional age between 32 and 36 weeks and 6 days, according to the adequacy of the weight for the gestational age at birth. Methods: A cross-sectional study was performed comparing two independent groups. The 55 preterm infants who were included in the sample were hospitalized in a neonatal intermediate care unit and were evaluated using the Neurobehavioral Assessment of the Preterm Infant (NAPI) at the postconceptional age between 32 and 36 weeks and 6 days and compared according to the adequacy of the weight for the gestational age. In addition to the comparison between the groups, infants who were born small for gestational age (SGA) and those ones adequate for gestational age (AGA) were also compared, considering the type of intrauterine growth. The following instruments were used: NAPI, anamnesis script, Brazilian Economic Classification Criteria, and medical records. Results: Infants were born with mean gestational age of 32.0 weeks, with the postconceptional age and postnatal age of 34.8 weeks and 19.5 days, respectively. The sample consisted of 55% of female infants. The results did not show any differences in NAPI domains between SGA and AGA groups, neither in the subgroups of SGA babies with symmetric or asymmetric growth. Conclusions: There was no difference between SGA and AGA babies in relation to neurobehavioral development evaluated before reaching term.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Desenvolvimento Infantil/fisiologia , Peso ao Nascer , Estudos Transversais , Idade GestacionalRESUMO
ABSTRACT CONTEXT AND OBJECTIVE: Alcohol consumption during pregnancy is a significant social problem that may be associated with adverse perinatal outcomes. The aim of this study was to describe alcohol consumption during pregnancy and to study its association with low birth weight, newborns small for gestational age and preterm birth. DESIGN AND SETTING: Nested cohort study, in the city of Ribeirão Preto, São Paulo, Brazil. METHODS: 1,370 women and their newborns were evaluated. A standardized questionnaire on health and lifestyle habits was applied to the mothers. Anthropometry was performed on the newborns. Alcohol consumption was defined as low, moderate or high, as defined by the World Health Organization. Adjusted logistic regression analysis was used. RESULTS: 23% of the women consumed alcohol during pregnancy. Consumption mainly occurred in the first trimester (14.8%) and decreased as the pregnancy progressed. The median alcohol intake was 3.89 g (interquartile range, IQR = 8 g) per day. In the unadjusted analysis, alcohol consumption increased the risk of low birth weight almost twofold (odds ratio, OR 1.91; 95% confidence interval, CI: 1.25-2.92). The risk was lower in the adjusted analysis (OR 1.62; 95% CI: 1.03-2.54). Alcohol consumption did not show associations with small for gestational age or preterm birth. There was greater risk of low birth weight and newborns small for gestational age and preterm birth among mothers who were both smokers and drinkers. CONCLUSIONS: The alcohol consumption rate during pregnancy was 23% and was independently associated with low birth weight, but there was no risk of newborns small for gestational age or preterm birth.
RESUMO CONTEXTO E OBJETIVO: O consumo de álcool durante a gravidez é um problema social significativo que pode estar associado a resultados perinatais adversos. O objetivo deste estudo foi descrever o consumo de álcool na gestação e avaliar sua associação com recém-nascido de baixo peso, pequeno para idade gestacional e pré-termo. TIPO DE ESTUDO E LOCAL: Estudo de coorte aninhado, na cidade de Ribeirão Preto, São Paulo, Brasil. Foram avaliadas 1.370 mulheres e seus recém-nascidos. Foi aplicado às mães um questionário padronizado sobre saúde e hábitos de vida. Antropometria foi realizada nos recém-nascidos. MÉTODOS:Consumo de álcool foi definido como baixo, moderado e elevado segundo a Organização Mundial de Saúde. Foi utilizada análise de regressão logística ajustada. RESULTADOS: 23% das gestantes consumiram álcool durante a gravidez. A maior parte do consumo ocorreu no primeiro trimestre (14,8%) e diminuiu conforme progredia a gravidez. A mediana de ingestão de álcool foi de 3,89 g (interval interquartil, IIQ = 8 g) por dia. Na análise não ajustada, o consumo de álcool aumentou em quase duas vezes (odds ratio , OR 1,91, intervalo de confiança, IC 95%; 1,25-2,92) o risco de baixo peso, que se reduziu após ajuste (OR 1,62; IC 95%; 1,03-2,54). Não houve associação entre consumo de álcool e pequeno para idade gestacional ou pré-termo. Observou-se maior risco de baixo peso, neonato pequeno para idade gestacional e pré-termo em gestantes simultaneamente fumadoras e bebedoras. CONCLUSÕES: O consumo de álcool na gestação foi de 23% e esteve associado independentemente com o baixo peso ao nascer, mas não houve risco para neonato pequeno para idade gestacional e pré-termo.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Adulto Jovem , Consumo de Bebidas Alcoólicas/efeitos adversos , Recém-Nascido de Baixo Peso/fisiologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Comportamento Materno/efeitos dos fármacos , Brasil , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Fumar/efeitos adversos , Estudos de Coortes , Idade GestacionalRESUMO
OBJETIVO: Foi comparar a aplicação de duas curvas de crescimento para o diagnóstico de recém-nascidos pequenos para a idade gestacional (PIG), utilizando o percentil 10 como referência. MÉTODOS: Estudo retrospectivo com informações do parto de 20.567 recém-nascidos vivos, de gestações únicas, ocorridos entre janeiro de 2003 e junho de 2014, divididos em grupos por idade gestacional: (a) 23 a 26, (b) 26 a 29, (c) 29 a 32, (d) 32 a 35, (e) 35 a 38, (f) 38 a 41 e (g) >41 semanas. Os dados foram pareados e os grupos comparados por teste de igualdade de proporções segundo método de McNemar. O nível de significância foi estabelecido em p<0,05. RESULTADOS: A curva de Alexander apresentou maior taxa de diagnóstico de PIG do que a curva de Fenton em todas as faixas de idade gestacional até a 41a semana, com maior diferença entre as curvas entre 32 e 35 semanas (18,5%). No período entre 37 e 40 semanas, o diagnóstico de PIG, empregando-se a curva de Alexander, superou o de Fenton em 9,1% dos casos. Com exceção dos grupos entre 23 e 26 semanas, todas as outras faixas de idade gestacional mostraram-se significativamente diferentes quanto ao diagnóstico de RN PIG. CONCLUSÃO: A curva de Fenton é um instrumento estatístico mais robusto, construída com informações mais recentes, e permite a avaliação do crescimento por três parâmetros e por sexo. .
PURPOSE: It was to compare the use of two growth curves for the diagnosis of small-for-gestational-age (SGA) infants, having the 10th percentile as reference. METHODS: In a retrospective study, data of 20,567 singleton live births from January 2003 to June 2014 were analyzed, and divided according to gestational age: (a) 23 to 26, (b) 26 to 29, (c) 29 to 32, (d) 32 to 35, (e) 35 to 38, (f) 38 to 41 and (g) >41 weeks. Data were paired and analyzed using the McNemar test, with the level of significance set at 0.05. RESULTS: The curve designed by Alexander indicated a higher percentage of diagnosis of SGA than the curve constructed by Fenton for every category of gestational age up to 41 weeks, more markedly in the 32-35 week group (18.5%). Between 37 and 40 weeks of gestational age, Alexander's curve exceeded Fenton's curve in 9.1% of the cases in the diagnosis of SGA. CONCLUSIONS: The Fenton curve provides a more accurate evaluation of an infant's growth since it is gender-specific and allows measurement of three parameters. It has also been constructed with newer data and more sophisticated statistical tools. .
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Gráficos de Crescimento , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Idade Gestacional , Estudos RetrospectivosRESUMO
Esta revisión analiza la importancia del valor de la hemoglobina en la gestante, y su implicancia sobre el embarazo. Discute el uso de combustible de biomasa y la repercusión en el peso del recién nacido, los valores de hemoglobina materna y el riesgo de muerte fetal tardía, parto pretérmino y nacer pequeño para la edad gestacional. Asimismo, se aborda la necesidad de corregir el punto de corte de los valores de hemoglobina para definir anemia en la altura. La evidencia actual sugiere no corregirla, así también, la suplementación de hierro a las gestantes debería ser dirigida a los casos de anemia moderada o severa. Se discute si se debería reorientar la suplementación de hierro a niños de 6 a menos de 36 meses de edad.
This review analyzes the importance of hemoglobin levels in pregnant women and its implications in pregnancy. It discuss the use of biomass fuel for cooking and the impact on birthweight, maternal hemoglobin levels and the risk of late fetal death, pre-term delivery, and small for gestational age. Furthermore, the need to correct the cut-off points of hemoglobin level to define anemia at high altitudes is addressed. Current evidence suggests that corrections should not be made and iron supplements should be given to pregnant mothers with moderate or severe anemia. It is discussed whether iron supplementation should change its target population from pregnant women to infants aged 6 to 36 months.
Assuntos
Feminino , Humanos , Recém-Nascido , Hemoglobinas/análise , Bem-Estar Materno , Gravidez/sangue , Altitude , Anemia/sangue , PeruRESUMO
OBJECTIVE: to assess the accuracy of the Capurro somatic and ultrasound methods, taking date of last menstruation as a reference point, for evaluating gestational age and anthropometric classification of term newborns. METHODS: a prevalence study was carried out involving 309 pregnant women and their term newborns, 92 of whom were small for gestational age and 217 appropriate sized for gestational age, at two public maternity hospitals in the Brazilian city of Salvador. The evaluation of the differences between the median gestational age according to the two methods was carried out using the non-parametric Wilcoxon Signed-Rank Test. The accuracy of the methods for evaluating gestational age for the small for gestational age newborns was estimated by calculating the sensitivity, specificity, positive predictive value, negative predictive value and ROC (Receiver Operating Characteristic) curve. RESULTS: compared to ultrasound, the Capurro method overestimated the gestational age in newbornsof less than 39 weeks and underestimated it in older newborns. Ultrasound underestimated gestational agein newborns with more than 37 weeks. CONCLUSION: ultrasound was found to have greater sensitivity for prediction of small for age newborns (96.6 percent), while the Capurro method presented greater specificity (75.5 percent). The highest accuracy was obtained using ultrasound in the 41st gestational week (ROC=77.0 percent).
OBJETIVOS: avaliar a acurácia dos métodos físico de Capurro e da ultrassonografia (USG), tomandocomo referência o método da data da última menstruação (DUM), na avaliação da idade gestacional e classificação antropométrica de recém-nascidos (RN) a termo. MÉTODOS: estudo de prevalência, envolvendo 309 puérperas e seus recém-nascidos a termo, sendo 92 pequenos para idade gestacional (PIG) e 217 adequados para idade gestacional (AIG), de duas maternidades públicas de Salvador. A avaliação das diferenças entre as medianas da idade gestacional segundo os métodos foi realizada utilizando-se o teste não paramétrico Wilcoxon Signed-Rank Test. A acurácia dos métodos na avaliação da idade gestacional para o diagnóstico de RN PIG foi verificada através do cálculo da sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e curva ROC (Receiver Operating Characteristic). RESULTADOS: comparado à ultrassonografia, o método de Capurro superestimou a idade gestacional em recém-natos menores de 39 semanas e substimou a naqueles acima deste patamar. A USG substimou aidade gestacional em recém-nascidos com mais de 37 semanas. CONCLUSÕES: na predição de RN PIG, maior sensibilidade foi observada para a USG (96,6 por cento) e maior especificidade para o Capurro (75,5 por cento). Melhor acurácia foi observada para a USG na 41ª semana gestacional (ROC=77,0 por cento).