Cardiomyopathy and cardiac function in fetuses and newborns of diabetic mothers

Abstract Objective: To evaluate cardiac function and structural changes in children of diabetic mothers in the fetal and neonatal period using Doppler-echocardiographic data. Method: A prospective, descriptive observational study conducted in a private and tertiary care service for high-risk pregnant women. It included 48 children of mothers with gestational diabetes mellitus (GDM) considered clinically compensated during pregnancy, with a single fetus and absence of malformations. Myocardial thickness, shortening fraction, left ventricular (LVMPI) and right ventricular (RVMPI) myocardial performance index, and mitral and tricuspid valve E/A ratio were evaluated in 96 echocardiographic exams with Doppler. Results: The hypertrophic cardiomyopathy was 29% vs 6% p = 0.006 in the prenatal and postnatal periods respectively. The shortening fraction was 0% vs 6% p = 0.242 in the fetuses and newborns respectively. The myocardial performance index of the right ventricle was 12% vs 54% p ≤ 0.001, and on the left ventricle 27% vs 60% p = 0.001 in the prenatal and postnatal periods respectively. The ratio of mitral valve E/A waves was 6% vs 50% p ≤ 0.001 and the ratio of tricuspid valve E/A waves was 0% vs 27% p 0.001 in the fetuses and newborns respectively. Conclusion: A decrease in the rate of myocardial hypertrophy and changes in cardiac function parameters were observed in the fetal and neonatal periods.

Preventable causes of death and factors associated with newborn survival at a university hospital in Curitiba, Paraná, Brazil / Causas evitáveis de morte e fatores associados à sobrevida de recém-nascidos em um hospital universitário da cidade de Curitiba, Paraná, Brasil

ABSTRACT Introduction: The analysis of deaths occurred in the neonatal period and the association of these data to necropsy data are crucial to reduce infant mortality rate worldwide. Objective: To analyze the preventable causes of death and the factors associated with a higher risk of early newborn death. Methods: A cross-sectional and descriptive study was performed with data about newborns that died during the neonatal period at a university hospital located in Curitiba; 314 cases of pediatric necropsies were selected, and preventable causes of death, survival time, sex, weight, gestational age, first- and fifth-minute Apgar score, cyanosis, acidosis, meconium aspiration, the need for oxygen resuscitation, cause of death and baseline disease were analyzed. Results: When considering only the cause of death, 300 cases (95.54%) would have preventable causes, but when analyzing the underlying disease, the number of cases decreased to 209 (66.56%). The most frequent cause of death was hypoxia (85%), and the main baseline disease was diffuse alveolar damage (52.9%). There was a positive association between these variables with survival time: cyanosis (p = 0.02), gestational age (p = 0.012), cause of death (p < 0.001), Apgar score < 6 (p < 0.001) and pH value (p < 0.001). Conclusion: The incidence of preventable causes of death is probably lower when analyzed concurrently with the underlying disease. Cyanosis, gestational age, cause of death, Apgar < 6 and arterial blood pH are associated with survival time of newborns.

RESUMO Introdução: A análise de óbitos ocorridos no período neonatal e a associação desses dados aos de necrópsias são fundamentais no auxílio à redução da taxa de mortalidade infantil no mundo. Objetivos: Observar as causas evitáveis de morte e os fatores associados ao maior risco de óbito neonatal precoce. Métodos: Foi realizado estudo transversal e descritivo de recémnascidos que foram a óbito em um hospital da Universidade Federal do Paraná (UFPR). Foram selecionados 314 casos de necrópsias e analisadas as causas evitáveis de morte, tempo de sobrevida, gênero, peso, idade gestacional, índice de Apgar do primeiro e do quinto minuto, cianose, acidose, aspiração meconial, necessidade de reanimação com oxigênio, causa de morte e doença básica. Resultados: Quando se analisa apenas a causa de morte, 300 casos (95,54%) seriam de causas evitáveis, porém, quando se analisa a doença básica, o número de casos diminui para 209 (66,56%). A causa de morte mais frequente foi hipóxia (85%), e a doença básica principal foi dano alveolar difuso (52,9%). Houve associação positiva das seguintes variáveis com o tempo de sobrevida: cianose (p = 0,02), idade gestacional (p = 0,012), causa do óbito (p < 0,001), valor de Apgar < 6 (p < 0,001) e valor do pH (p < 0,001). Conclusão: A incidência de causa evitável de morte é provavelmente menor quando analisada concomitantemente com a doença básica. A cianose, a idade gestacional, a causa do óbito, o Apgar < 6 e o valor do pH do sangue arterial estão associados ao tempo de sobrevida de recém-nascidos.