Renal deficit and associated factors in children born with low birth weight / Déficit renal e fatores associados em crianças nascidas com baixo peso

ABSTRACT Introduction: Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. Methods: Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children's variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. Results: Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children's current weight and use of nephrotoxic drugs. Discussion: Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs.

RESUMO Introdução: Problemas renais podem ser devido apenas ao baixo peso ao nascer ou podem ocorrer em associação com outras condições. O objetivo deste estudo foi avaliar a associação entre características maternas e de nascimento, medidas antropométricas e déficit da função renal em bebês de baixo peso ao nascer. Métodos: Estudo transversal com crianças que nasceram com peso < 2500 gramas e estavam sob acompanhamento ambulatorial. Os fatores maternos investigados foram cuidados pré-natal e presença de hipertensão, diabetes e infecção durante a gravidez. As variáveis das crianças foram sexo, idade gestacional, peso ao nascer, índice Apgar, uso de medicamentos nefrotóxicos, idade, peso corporal no momento da avaliação, altura e dosagens séricas de creatinina e cistatina C. A taxa de filtração glomerular (TFG) foi estimada com a equação combinada de Zapittelli. Utilizou-se um modelo de regressão logística multivariada para identificação de fatores associados, com déficit da função renal (TFG < 60 mL/min/1,73 m2) como variável dependente. Resultados: Das 154 crianças avaliadas, 34,42% apresentaram déficit da função renal. A maioria tinha idade gestacional > 32 semanas (56,6%), peso médio ao nascer de 1439,7 gramas, e TFG média estimada de 46,9 ± 9,3 mL/min/1,73 m2. Houve uma associação significativa da TFG < 60 mL/min/1,73 m2 com o peso atual das crianças e o uso de medicamentos nefrotóxicos. Discussão: Crianças nascidas com baixo peso apresentaram alta prevalência de déficit da função renal e o peso atual normal foi um fator de proteção, enquanto o uso de medicamentos nefrotóxicos durante o período perinatal aumentou a chance de déficit renal. Estes achados reforçam a necessidade de avaliar a função renal destas crianças, especialmente aquelas que usam medicamentos nefrotóxicos.

Early motor development: risk factors for delay in a population study in Southern Brazil

ABSTRACT OBJECTIVE To assess risk factors associated with motor development delay at three months of age. METHODS Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p < 0.001), and with low birth weight (p < 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems.

Home visit to premature and low birth weight newborns: nurse's experience report / Visita domiciliaria al recién nacido prematuro y de peso bajo: informe de experiencia de enfermeros / Visita domiciliar ao recém-nascido prematuro e de baixo peso: relato de experiência de enfermeiros

ABSTRACT Objective: To report the structures of the experience of nurse's home visits to premature and low birth weight newborns. Method: This is a descriptive study of the experience report type, structured on the experience of the nurse authors in the development of 48 home visits in a city in the state of São Paulo and its microregion between August 2020 and 2021 with eight mothers of premature and low weight newborns. Results: The guiding documents "Home visit for families with preterm and low birth weight newborns" and "Strategy of guiding questions for home visits" were created and used to promote open narratives from parental caregivers about caring for at-risk newborns, creating a relational space aimed at joint construction. Conclusion: The documents used have favored home visits, helping nurses to establish professional bonds and build relational space through dialogue when conducting their activities in the home environment.

RESUMEN Objetivo: Informar los factores estructurantes de la experiencia de visitas domiciliarias de enfermeros a recién nacidos prematuros y de bajo peso. Método: Se trata de un estudio descriptivo de informe de experiencia, estructurado sobre la vivencia de las enfermeras autoras en el desarrollo de 48 visitas domiciliarias en una ciudad del interior de São Paulo y su microrregión, entre agosto de 2020 y 2021, entre ocho madres de recién nacidos prematuros y de bajo peso. Resultados: Se elaboraron y utilizaron los documentos orientadores "Visita domiciliaria para familias con RN Prematuro y de Peso Bajo al Nacer" y "Estrategia de preguntas guía para visita domiciliaria" con el fin de promover narraciones abiertas de los cuidadores parentales sobre el cuidado del recién nacido de riesgo, creando así, un espacio relacional con miras a la construcción conjunta. Conclusión: Los documentos utilizados favorecieron la realización de las visitas domiciliarias, ayudando al enfermero a establecer un vínculo profesional y a construir un espacio relacional a través del diálogo en la conducción de sus actividades en el entorno domiciliario.

RESUMO Objetivo: Relatar os estruturantes da experiência de visitação domiciliar realizada por enfermeiros aos recém-nascidos prematuros e de baixo peso. Método: Trata-se de estudo descritivo do tipo relato de experiência, estruturado na vivência das enfermeiras autoras no desenvolvimento de 48 visitas domiciliares, em cidade do interior paulista e sua microrregião, entre agosto de 2020 e de 2021, com oito mães de recém-nascidos prematuros e de baixo peso. Resultados: Foram criados e utilizados os documentos orientadores "Visita domiciliar para famílias com RN Prematuro e de Baixo Peso ao Nascer" e "Estratégia de perguntas norteadoras para visita domiciliar" para promover narrativas abertas dos cuidadores parentais sobre o cuidado com o recém-nascido de risco, criando um espaço relacional direcionado à construção conjunta. Conclusão: Os documentos utilizados favoreceram a condução das visitas domiciliares, auxiliando o enfermeiro a estabelecer vínculo profissional e construir espaço relacional através do diálogo na condução de suas atividades em ambiente domiciliar.

Interaction of B-group streptococcal infection and chorioamnionitis in low birth weight infants during late pregnancy / 中国医师杂志

Objective:To investigate the interaction of B-group streptococcal infection and chorioamnionitis (CAM) with late pregnancy and low birth weight infant (LBWI).Methods:A retrospective study was conducted on 524 postpartum women who underwent regular prenatal examinations and completed delivery at the Taizhou Second People′s Hospital from October 2019 to April 2022. According to their newborn birth weight, they were divided into normal group (466 cases) and LBWI group (58 cases). The age, pregnancy times, birth times, pregnancy body mass index (BMI), cesarean section history, abortion history, anemia during pregnancy, hypertensive disorder during pregnancy, diabetes during pregnancy, vaginitis, B-group streptococcal infection, CAM, premature rupture of membranes, postpartum hemorrhage, puerperal infection, neonatal preterm delivery, neonatal asphyxia, neonatal infection, fetal distress were compared between the two groups. The influencing factors of LBWI were analyzed using logistic regression. The correlation and interaction between B-group streptococcal infection and CAM on LBWI were analyzed.Results:There was a statistically significant difference in age, history of miscarriage, gestational hypertension, vaginitis, B-group streptococcal infection, CAM, premature rupture of membranes, neonatal preterm birth, neonatal infection and fetal distress between the two groups (all P<0.05). The results of logistic regression analysis showed that gestational hypertension, B-group streptococcal infection, CAM, premature rupture of membranes, preterm birth, neonatal infection, and fetal distress were risk factors for LBWI (all P<0.05). B-group streptococcal infection, CAM, and LBWI were positively correlated ( r=0.587, 0.604, all P<0.001). The interaction analysis results showed a positive correlation between B-group streptococcal infection, CAM, and LBWI (all P<0.001). Conclusions:B-group streptococcal infection in late pregnancy, CAM, and LBWI are positively correlated, and their coexistence can increase the risk of LBWI.

Preterm birth, low birth weight and risk of hypospadias: a meta-analysis / 中国医师杂志

Objective:To investigate the association between preterm birth, low birth weight and the risk of hypospadias.Methods:According to the search strategy of Cochrance Collaborative Network, the China National Knowledge Internet (CNKI), VIP, Wanfang, Pubmed, Cochrance and Embase were searched from the establishment of the database to April 2022. The literature on the relationship between preterm birth, low birth weight and the risk of hypospadias was included. Meta analysis was conducted on the relationship between preterm birth, low birth weight and the risk of hypospadias.Results:A total of 13 articles were included, including cases from Asia, Europe, Australia and America. Newcastle-ottawa Scale was used for evaluation, and the scores were all above 6. There were 10 articles on the relationship between preterm birth and the risk of hypospadias, all of which were case-control studies. Heterogeneity test I2=46%, P=0.05. There were 3 521 cases in the case group and 95 816 cases in the control group. Compared with the control group, preterm birth was a risk factor for hypospadias ( OR: 2.13, 95% CI: 1.89-2.41), and the difference was statistically significant ( Z=12.21, P<0.01). There were 11 articles on the association between low birth weight and the risk of hypospadias, all of which were case-control studies. Heterogeneity test I2=47%, P=0.04. There were 2 460 cases in the case group and 94 260 cases in the control group. Compared with the control group, low birth weight was a risk factor for hypospadias ( OR: 3.29, 95% CI: 2.57-4.22), and the difference was statistically significant ( Z=9.40, P<0.01). Conclusions:Based on meta-analysis of published literature, preterm birth and low birth weight increase the risk of hypospadias.

Management of congenital diaphragmatic hernia in preterm and low birth weight infants / 中华围产医学杂志

Objective:To investigate the treatment of preterm and low birth weight infants with congenital diaphragmatic hernia (CDH) and to share the experience.Methods:This retrospective study enrolled 117 newborns with CDH who underwent major surgery at Children's Hospital, Capital Institute of Pediatrics from May 1, 2011, to March 31, 2022. Based on gestational age and birth weight, the infants were divided into the preterm and/or low birth weight group (gestational age < 37 weeks and/or birth weight less than 2 500 g, n=41) and the control group (gestational age ≥ 37 weeks and birth weight ≥ 2 500 g, n=76). Furthermore, the preterm and/or low birth weight infants were divided into the thoracoscopic surgery subgroup ( n=31) and the open surgery subgroup ( n=10) according to the surgical approach. Statistical analysis of the data was performed using two independent sample t-tests, rank sum tests, Chi-square test, or Fisher's exact probability test. Results:Preoperative data showed that the Apgar scores at 1 min [7.0 (6.0-8.0) vs 9.0 (8.0-9.8), Z=－4.03] and 5 min [9.0 (8.0-10.0) vs 9.0 (9.0-10.0), Z=－2.13] of the preterm and/or low birth weight infants were both lower than those in the control group (both P<0.05), while the proportion of infants with moderate to severe pulmonary hypertension was higher [68.3% (28/41) vs 38.2% (29/76), χ 2=9.68, P<0.05]. There were no statistically significant differences between the two groups in terms of the proportion of thoracoscopic surgery, operation time, right diaphragmatic hernia, presence of hernia sac, grading of the defect, presence of liver herniation, and application of mesh (all P>0.05). Regarding the postoperative outcomes, the death rate in the preterm and/or low birth weiht group was higher compared to the control group [36.6% (15/41) vs 13.2% (10/76), χ 2=8.70, P<0.05]. Additionally, the time required to resume full enteral nutrition after surgery was longer in the preterm and/or low birth weight group than that in the control group [25 d (18-29 d) vs 16 d (10-25 d), Z=2.31, P<0.05]. The thoracoscopic subgroup had a lower mortality compared to the open surgery subgroup [25.8% (8/31) vs 7/10, P<0.05]. The thoracoscopic surgery subgroup had a higher Apgar score at 1 min after birth [(7.4±1.6) vs (6.0±2.2), t=2.20, P<0.05], later age at operation (hours after birth) [31.0 h (23.0-48.0 h) vs 17.0 h (4.7-24.5 h), Z=2.57, P<0.05], a lower proportion of infants operated within 24 hours after birth [32.3% (10/31) vs 8/10, P<0.05], and longer duration of operation [170.0 min (122.0-200.0 min) vs 110.0 min (87.3-120.0 min), Z=3.65, P<0.05]. Conclusions:In this study, a higher mortality in the preterm and/or low birth weight group compared to the control group was observed, which may be attributed to the higher proportion of neonates with moderate-severe pulmonary hypertension. The thoracoscopic diaphragmatic repair can be attempted for preterm and low birth weight infants who have relatively stable respiratory and circulatory functions.

Características do contato pele a pele em unidades neonatais brasileiras: estudo multicêntrico / Características del contacto piel con piel en unidades neonatales brasileñas: estudio multicéntrico / Characteristics of skin-to-skin contact in Brazilian neonatal units: a multicenter study

Resumo Objetivo Descrever o início, duração, local e quem realiza o contato pele a pele em unidades neonatais brasileiras. Métodos Estudo multicêntrico descritivo, longitudinal, realizado de maio de 2018 a março de 2020, em cinco unidades neonatais referência para o Método Canguru no Brasil, que incluiu recém-nascidos com peso até 1800g. As características maternas e dos recém-nascidos foram coletadas em prontuários e entrevistas. A prática do contato pele a pele era registrada em cartões anexados ao leito, preenchidos pela equipe e pelos pais. A análise ocorreu por meio de estatística descritiva. Resultados Foram incluídos 405 recém-nascidos, 51,4% do sexo masculino, mediana de idade gestacional de 31,4 semanas e de peso ao nascimento de 1.412g. Em relação ao tempo de realização do contato pele a pele, a mediana da frequência do contato diário foi de 1,5 vezes (IIQ: 1,2 - 2,4), o tempo/dia de 147 min/dia (IIQ: 106,7 - 263,0) e a realização do primeiro contato aos cinco dias de vida (IIQ:4,0-8,0). O maior tempo de contato/dia foi realizado pelas mães, com mediana de 137,8 min/dia (IIQ:95,6-232,1) e a segunda etapa do Método Canguru, Unidade de Cuidados Intermediários Canguru, foi o local onde se realizou por maior tempo o contato, com mediana de 184,4 min/dia (IIQ:124,7-455,4). Conclusão Nas unidades avaliadas, o contato pele a pele é praticado de forma intermitente, poucas vezes por dia, predominantemente pelas mães e com maior tempo de exposição na segunda etapa. É necessário buscar meios que possibilitem mais encontros entre mãe/pai-filho e que dê condições de maior permanência dos genitores no hospital.

Resumen Objetivo Describir el inicio, duración, lugar y quién realiza el contacto piel con piel en unidades neonatales brasileñas. Métodos Estudio multicéntrico descriptivo, longitudinal, realizado de mayo de 2018 a marzo de 2020, en cinco unidades neonatales de referencia del Método Canguro en Brasil, que incluyó recién nacidos de hasta 1800 g de peso. Las características maternas y de los recién nacidos fueron recopiladas en historias clínicas y entrevistas. La práctica del contacto piel con piel fue registrada en tarjetas anexadas a la cama, completadas por el equipo y por los padres. El análisis se realizó mediante estadística descriptiva. Resultados Se incluyeron 405 recién nacidos, 51,4 % de sexo masculino, mediana de 31,4 semanas de edad gestacional y de 1412 g de peso al nacer. Con relación al tiempo de realización del contacto piel con piel, la mediana de la frecuencia del contacto diario fue 1,5 veces (IIQ: 1,2 - 2,4), el tiempo/día fue de 147 min/día (IIQ: 106,7 - 263,0) y la realización del primer contacto a los cinco días de vida (IIQ:4,0-8,0). El mayor tiempo de contacto/día fue realizado por las madres, con una mediana de 137,8 min/día (IIQ:95,6-232,1) y la segunda etapa del Método Canguro, la Unidad de Cuidados Intermedios Canguro, fue el lugar donde se realizó el contacto por mayor tiempo, con una mediana de 184,4 min/día (IIQ:124,7-455,4). Conclusión En las unidades analizadas, el contacto piel con piel se practica de forma intermitente, pocas veces por día, predominantemente por las madres y con mayor tiempo de exposición en la segunda etapa. Es necesario buscar medios que permitan más encuentros entre madre/padre-hijo y que ofrezcan condiciones de mayor permanencia de los progenitores en el hospital.

Abstract Objective To describe the beginning, duration, location and who makes skin-to-skin contact in Brazilian neonatal units. Methods This is a descriptive, longitudinal multicenter study, carried out from May 2018 to March 2020, in five reference neonatal units for Kangaroo Mother Care in Brazil, which included newborns weighing up to 1,800 grams. Maternal and newborn characteristics were collected from medical records and interviews. Skin-to-skin contact was recorded on cards attached to the bed, filled in by the team and fathers. Analysis occurred through descriptive statistics. Results We included 405 newborns, 51.4% male, median gestational age of 31.4 weeks and birth weight of 1,412 grams. Regarding skin-to-skin contact time, the median daily contact frequency was 1.5 times (IQR: 1.2 - 2.4), the time/day was 147 min/day (IQR: 106.7 - 263.0) and the first contact at five days of life (IQR:4.0-8.0). The longest contact time/day was performed by mothers, with a median of 137.8 minutes per day (IQR:95.6-232.1), and the second stage of kangaroo Mother Care, kangaroo Intermediate Care Unit, was the place where contact was performed for the longest time, with a median of 184.4 minutes per day (IQR:124.7-455.4). Conclusion In the units assessed, skin-to-skin contact is practiced intermittently, a few times a day, predominantly by mothers and with longer exposure time in the second stage. It is necessary to seek ways that allow more encounters between mother/father-child and that gives conditions of greater permanence of fathers in the hospital.

Right ventricular myocardial performance index (Tei) in premature infants

SUMMARY OBJECTIVE: The objective of this study was to evaluate the right ventricular myocardial performance index) based on echocardiography in very low birth weight premature neonates, close to hospital discharge. METHODS: This was a prospective cross-sectional study that included premature neonates with birth weight <1,500 g and gestational age <37 weeks at the Intermediate Neonatal Unit of Bonsucesso Federal Hospital from July 2005 to July 2006. The infants underwent two-dimensional color Doppler echocardiography, being the right ventricular myocardial performance index evaluated close to hospital discharge. We compared the neonatal and echocardiographic variables in neonates with and without bronchopulmonary dysplasia. RESULTS: A total of 81 exams were analyzed. The mean birth (standard deviation) weight and gestational age were 1,140 (235) g and 30 (2.2) weeks, respectively. The incidence of bronchopulmonary dysplasia was 32%. The mean right ventricle myocardial performance index (standard deviation) of the sample was 0.13 (0.06). We found a significant difference in aortic diameter [non-bronchopulmonary dysplasia 0.79 (0.07) vs. bronchopulmonary dysplasia 0.87 (0.11) cm, p=0.003], left ventricle in diastole [non-bronchopulmonary dysplasia 1.4 (0.19) vs. bronchopulmonary dysplasia 1.59 (0.21) cm, p=0.0006], ventricular septal thickness [non-bronchopulmonary dysplasia 0.23 (0.03) vs. bronchopulmonary dysplasia 0.26 (0.05) cm, p=0.032], and "a" measurement [(= sum of the isovolumetric contraction time, ejection time, and isovolumetric relaxation time) when calculating the myocardial performance index (p=0.01)]. CONCLUSION: Higher "a" interval in neonates with bronchopulmonary dysplasia suggests right ventricle diastolic dysfunction. We conclude that the right ventricle myocardial performance index is an important indicator both of ventricular function and for serial follow-up testing of very low birth weight premature neonates, especially those with bronchopulmonary dysplasia.

Variables maternas relacionadas con la condición trófica al nacer / Maternal variables related to the trophic condition at birth

RESUMEN Introducción: El crecimiento y desarrollo prenatal tiene su expresión en el peso al nacer, que adquiere gran importancia por su relación con la morbilidad y mortalidad en cualquier etapa de la vida. Objetivo: Identificar las asociaciones de variables maternas con la condición trófica del recién nacido. Métodos: Se realizó un estudio descriptivo, en tres áreas de salud del municipio Santa Clara, en el periodo comprendido de enero 2013 a diciembre 2020. De una población de 6035 recién nacidos se seleccionó una muestra aleatoria de 2454. De los libros de genética se obtuvo la información de variables maternas y del neonato. Se aplicaron las pruebas no paramétricas de independencia basada en la distribución chi cuadrado y Kruskal Wallis en el análisis estadístico. Resultados: A excepción de la edad, las variables estudiadas mostraron relación con la condición trófica al nacer. El estado nutricional deficiente fue más frecuente en nacimientos pequeños y el obeso en los grandes. En nacimientos grandes se observó mayores porcentajes de gestantes con riesgo de diabetes gestacional. Los trastornos hipertensivos, la anemia, la infección del tracto urinario, la sepsis vaginal y el hábito de fumar se presentaron en mayores porcentajes en gestantes cuyos recién nacidos fueron pequeños. Conclusiones: De las variables estudiadas el riesgo de diabetes gestacional y los trastornos hipertensivos mostraron la mayor fuerza de asociación con la condición trófica al nacer.

ABSTRACT Introduction: prenatal growth and development have their expression in birth weight, which acquires great importance due to its relationship with morbidity and mortality at any stage of life. Objective: to identify the associations of maternal variables with the trophic condition of the newborn. Methods: a descriptive study was carried out in three health areas from Santa Clara municipality between January 2013 and December 2020. A random sample of 2,454 was selected from a population of 6,035 newborns. Information on maternal and newborn variables was obtained. Non-parametric tests of independence based on the Chi-square distribution and Kruskal Wallis were applied in the statistical analysis. Results: the variables studied showed a relationship with the trophic condition at birth, except for age. Poor nutritional status was more frequent in small births and obesity in large ones. In large births, higher percentages of pregnant women at risk of gestational diabetes were observed. Hypertensive disorders, anemia, urinary tract infection, vaginal sepsis and smoking were present in higher percentages in pregnant women whose newborns were small. Conclusions: from the studied variables, the risk of gestational diabetes and hypertensive disorders showed the strongest association with the trophic status at birth.

Qual Deve Ser o Tratamento de Primeira Linha para o Fechamento de Persistência de Canal Arterial Hemodinamicamente Significativo em Bebês Prematuros? / What Should be the First-line Treatment for the Closure of Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants?

Resumo Fundamento É importante saber qual medicamento usar como tratamento de primeira linha para fechar o duto. Objetivos O objetivo deste estudo é comparar a eficácia e os efeitos colaterais das formas intravenosas (IV) de ibuprofeno e paracetamol e contribuir para a literatura investigando o primeiro medicamento selecionado no tratamento clínico da persistência do canal arterial (PCA). Métodos Nosso estudo foi realizado entre janeiro de 2017 e dezembro de 2019. Foram incluídos no estudo bebês prematuros com peso ao nascer (PN) ≤1500 g e idade gestacional (IG) ≤32 semanas. No período do estudo, todos os bebês com persistência do canal arterial hemodinamicamente significativa (hsPCA) receberam ibuprofeno intravenoso (IV) como resgate como tratamento clínico primário ou tratamento com paracetamol IV se houvesse contraindicações para o ibuprofeno. Os pacientes foram divididos em dois grupos: pacientes que receberam ibuprofeno IV e pacientes que receberam paracetamol IV. Resultados Desses pacientes, 101 receberam paracetamol IV e 169 receberam ibuprofeno IV. A taxa de sucesso do fechamento da PCA com o primeiro curso do tratamento foi de 74,3% no grupo de paracetamol IV e 72,8% no grupo de ibuprofeno IV (p=0,212). Conclusões Nossos resultados mostram que o paracetamol IV é tão eficaz quanto o ibuprofeno IV no tratamento de primeira linha de hsPCA, podendo se tornar o tratamento preferencial para o controle de hsPCA.

Abstract Background It is important which medicine to use as a first-line treatment to close the duct. Objectives The aim of this study is to compare the effectiveness and side effects of intravenous (IV) forms of ibuprofen and paracetamol and to contribute to the literature investigating the first drug selected in the medical treatment of patent ductus arteriosus (PDA). Methods Our study was conducted between January 2017 and December 2019. Premature infants with birth weight (BW) ≤1500 g and gestational age (GA) ≤32 weeks were included in the study. In the study period, all infants with hemodynamically significant patent ductus arteriosus (hsPDA) were given rescue intravenous (IV) ibuprofen as a primary medical treatment or IV paracetamol treatment if there were contraindications for ibuprofen. The patients were divided into two groups: patients receiving IV ibuprofen and patients receiving IV paracetamol. Results Of these patients, 101 were given IV paracetamol and 169 were given IV ibuprofen. The success rate of PDA closure with first-course treatment was 74.3% in the IV paracetamol group and 72.8% in the IV ibuprofen group (p=0.212). Conclusions Our results show that IV paracetamol is as effective as IV ibuprofen in the first-line treatment of hsPDA, and can become the preferred treatment for the management of hsPDA.

Adverse pregnancy and perinatal outcomes in Latin America and the Caribbean: systematic review and meta-analysis / Resultados adversos perinatales y del embarazo en América Latina y el Caribe: revisión sistemática y metanálisis / Desfechos gestacionais e perinatais adversos na América Latina e no Caribe: revisão sistemática e metanálise

ABSTRACT Objective. To estimate the point prevalence and likely ranges of pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, low birth weight and preterm delivery in Latin America and the Caribbean, and evaluate the heterogeneity of the estimates. Methods. We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of maternal and perinatal adverse outcomes in populations in Latin American and the Caribbean published between 2000 and 2019 in English, Spanish, or Portuguese. We searched PubMed, Embase, and LILACS. We estimated the point prevalence and evaluated overall heterogeneity and, in sub-group analyses, heterogeneity by study design and level of bias. Results. Of 1087 records retrieved, 50 articles were included in the review: two on hypertensive disorders of pregnancy, 14 on pre-eclampsia, six on gestational diabetes, nine on low birth weight and 19 on preterm birth. No meta-analysis for hypertensive disorders of pregnancy could be done because of the small number of studies. Point prevalence estimates and 95% confidence intervals (CIs) for pre-eclampsia, gestational diabetes, low birth weight, and preterm birth were: 6.6% (95% CI: 4.9%, 8.6%), 8.5% (95% CI: 3.9%, 14.7%), 8.5% (95% CI: 7.2%, 9.8%), and 10.0% (95% CI: 8.0%, 12.0%), respectively. We observed substantial heterogeneity overall and by study design. No major differences in estimates were observed by level of bias. Conclusions. The results of this study provide updated estimates of some of the most prevalent adverse pregnancy and perinatal outcomes in Latin America and the Caribbean. They highlight that important heterogeneity exists in prevalence estimates, which may reflect the diversity of populations in the region.

RESUMEN Objetivo. Estimar la prevalencia puntual y los rangos probables de hipertensión provocada por embarazo, preeclampsia, diabetes gestacional, peso bajo al nacer y parto prematuro en América Latina y el Caribe, y evaluar la heterogeneidad de las estimaciones. Métodos. Se llevó a cabo una revisión sistemática y metanálisis de los estudios de observación que notificaron la prevalencia de resultados adversos perinatales y maternos en poblaciones de América Latina y el Caribe, publicados entre los años 2000 y 2019 en inglés, español o portugués. Se realizaron búsquedas en PubMed, Embase y LILACS. Se estimó la prevalencia puntual y se evaluó la heterogeneidad general y, en los análisis de subgrupos, la heterogeneidad según el diseño del estudio y nivel de sesgo. Resultados. De 1 087 registros recuperados, se incluyeron 50 artículos en la revisión: 2 sobre los trastornos hipertensivos en el embarazo, 14 sobre preeclampsia, 6 sobre la diabetes gestacional, 9 sobre peso bajo al nacer y 19 sobre parto prematuro. No se pudo realizar ningún metanálisis de los trastornos hipertensivos del embarazo debido al número reducido de estudios. Las estimaciones de prevalencia puntual y los intervalos de confianza (IC) del 95% para la preeclampsia, la diabetes gestacional, el peso bajo al nacer y el parto prematuro fueron: 6,6% (IC de 95%: 4,9%, 8,6%), 8,5% (IC de 95%: 3,9%, 14,7%), 8,5% (IC de 95%: 7,2%, 9,8%) y 10,0% (IC de 95%: 8,0%, 12,0%), respectivamente. Se observó una heterogeneidad significativa en general, así como según el diseño del estudio. No se advirtieron grandes diferencias en las estimaciones según el nivel del sesgo. Conclusiones. Los resultados de este estudio ofrecen cálculos actualizados de algunos de los resultados adversos perinatales y del embarazo con mayor prevalencia en América Latina y el Caribe. Estos resultados ponen de manifiesto que existe una gran heterogeneidad en las estimaciones de prevalencia, que podría reflejar la diversidad de la población de la región.

RESUMO Objetivo. Estimar a prevalência pontual e os intervalos prováveis de hipertensão induzida pela gravidez, pré-eclâmpsia, diabetes gestacional, baixo peso ao nascer e parto prematuro na América Latina e no Caribe e avaliar a heterogeneidade das estimativas. Métodos. Realizou-se uma revisão sistemática com metanálise de estudos observacionais que relatam a prevalência de desfechos maternos e perinatais adversos em populações da América Latina e do Caribe, publicados entre 2000 e 2019 em inglês, espanhol ou português. Os bancos de dados PubMed, Embase e LILACS foram pesquisados. Estimou-se a prevalência pontual e avaliou-se a heterogeneidade geral, bem como, em análises de subgrupo, a heterogeneidade por delineamento do estudo e o nível de viés. Resultados. De 1 087 registros encontrados, 50 artigos foram incluídos na revisão: dois sobre distúrbios hipertensivos da gravidez, 14 sobre pré-eclâmpsia, seis sobre diabetes gestacional, nove sobre baixo peso ao nascer e 19 sobre parto prematuro. Não foi possível realizar metanálise para distúrbios hipertensivos da gravidez devido ao pequeno número de estudos. As estimativas de prevalência pontual e intervalos de confiança de 95% (IC) para pré-eclâmpsia, diabetes gestacional, baixo peso ao nascer e parto prematuro foram: 6,6%; (IC 95%: 4,9-8,6%), 8,5% (IC 95%: 3,9-14,7%), 8,5% (IC 95%: 7,2-9,8%) e 10,0% (IC 95%: 8,0-12,0%), respectivamente. Observou-se heterogeneidade considerável, tanto em geral como por delineamento de estudo. Não foram observadas diferenças importantes nas estimativas por nível de viés. Conclusões. Os resultados deste estudo fornecem estimativas atualizadas de alguns dos desfechos gestacionais e perinatais adversos mais prevalentes na América Latina e no Caribe. Destacam a existência de uma importante heterogeneidade nas estimativas de prevalência, o que pode refletir a diversidade das populações da região.

Research progress in influence of intrauterine hyper androgen on offspring health and mechanisms / 中华围产医学杂志

Maternal adverse endocrine environment severely affects the growth and development of offspring. This article reviews relevant cohort studies and animal experiments on the influence of intrauterine hyper androgen on offspring health and the mechanisms, aiming to provide a new perspective for further research, mechanism exploration, and early interventions in this field.

Evidence of changes in the oral language in children born full-term and small for gestational age: a systematic review / Evidências de alterações na linguagem oral de crianças nascidas a termo pequenas para a idade gestacional: uma revisão sistemática

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.

The role of skin-to-skin contact in exclusive breastfeeding: a cohort study

ABSTRACT OBJETIVE To understand the role of exposure to skin-to-skin contact and its minimum duration in determining exclusive breastfeeding at hospital discharge in infants weighing up to 1,800g at birth. METHODS A multicenter cohort study was carried out in five Brazilian neonatal units. Infants weighing ≤ 1,800g at birth were eligible. Skin-to-skin contact time was recorded by the health care team and parents on an individual chart. Maternal and infant data was obtained from maternal questionnaires and medical records. The Classification Tree, a machine learning method, was used for data analysis; the tree growth algorithm, using statistical tests, partitions the dataset into mutually exclusive subsets that best describe the response variable and calculates appropriate cut-off points for continuous variables, thus generating an efficient explanatory model for the outcome under study. RESULTS A total of 388 infants participated in the study, with a median of 31.6 (IQR = 29-31.8) weeks of gestation age and birth weight of 1,429g (IQR = 1,202-1,610). The exclusive breastfeeding rate at discharge was 61.6%. For infant's weighting between 1,125g and 1,655g, exposed to skin-to-skin contact was strongly associated with exclusive breastfeeding. Moreover, infants who made an average > 149.6 min/day of skin-to-skin contact had higher chances in this outcome (74% versus 46%). In this group, those who received a severity score (SNAPPE-II) equal to zero increased their chances of breastfeeding (83% versus 63%). CONCLUSION Skin-to-skin contact proved to be of great relevance in maintaining exclusive breastfeeding at hospital discharge for preterm infants weighing 1,125g-1,655g at birth, especially in those with lower severity scores.

Variables maternas metabólicas y mixtas, su relación con la restricción del crecimiento uterino / Metabolic and mixed maternal variables,theirrelationship with uterine growth restriction

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.

Relación entre anemia del primer trimestre y bajo peso al nacer en cuatro Centros de Salud Materno-Infantiles de Lima Sur durante el 2019 / Relationship between first trimester anemia and low birth weight in four mother-and-child health centers in Lima Sur during 2019

RESUMEN Objetivo: Determinar la relación entre la anemia materna del primer trimestre y el bajo peso al nacer de cuatro centros de salud maternos de Lima-Sur durante el 2019. Materiales y métodos: Se realizó un estudio cohorte retrospectivo de una base de datos secundaria donde se incluyeron gestantes atendidas en cuatro Centros de Salud con nivel de complejidad I-4 de Lima-Sur; cuyos partos se registraron durante el 2019, excluyendo a los recién nacidos pretérmino. Una hemoglobina del primer trimestre <11 g/dl se definió como anemia y un peso <2500 g como bajo peso al nacer. Se calculó la incidencia acumulada según anemia y se halló el riesgo relativo (RR) ajustado a potenciales confusores. Resultados: Se incluyó 221 gestantes y el 76 % tuvo una edad entre 18 a 35 años. Un 42 % fue primigesta, un 52 % presentó exceso de peso y el 60 % realizó 6 o más controles prenatales. Un 23,5 % de gestantes presentó anemia en el primer trimestre y se halló una incidencia de 2,7 % casos con bajo peso al nacer. La anemia del primer trimestre elevó en 11 veces la incidencia de recién nacidos con bajo peso, independiente de la edad, índice de masa corporal y paridad (RR ajustado = 11,1; IC 95 % 1,3 - 97,2; p=0,029). Conclusiones: De la muestra estudiada, una de cada cuatro gestantes presenta anemia durante el primer trimestre incrementando la incidencia acumulada de tener un neonato con bajo peso hasta en 11 veces.

ABSTRACT Objective: To determine the relationship between maternal anemia in the first trimester of pregnancy and low birth weight in four mother-and-child-health centers in Southern Lima during 2019. Material and methods: A retrospective cohort study from a secondary database was performed, where pregnant women from 4 middle-complexity Health Centers from Southern Lima were included. Deliveries took place during 2019, excluding preterm newborns. First trimester hemoglobin concentration <11 g/dL was defined as anemia and birth weight <2500 g was defined as low birth weight. Cumulative incidence for anemia was calculated, and relative risk (RR) adjusted for potential confounders was also calculated. Results: Two hundred and twenty one pregnant women were included. Seventy-six per cent were between 18 and 35 years old. Forty-two percent were primigravida, fifty-two percent had excess body weight, and sixty percent had six or more prenatal control visits. Nearly one quarter (23,5%) of all pregnant women had anemia during the first trimester, and there were 2,7% cases of low birth weight. Anemia during the first trimester of pregnancy increased 11 times the frequency of newborns with low birth weight, independently of age, body mass index, and parity (adjusted RR = 11,1; 95% CI: 1,3-97,2; p= 0,029). Conclusions: In the studied sample, one out of four pregnant women had anemia during the first trimester of pregnancy, increasing up to 11 times the cumulative incidence for having a neonate with low birth weight.

Factores de riesgo asociados al bajo peso al nacer en el municipio Pinar del Río / Risk factors associated with low birth weight. Pinar del Rio municipality

RESUMEN Introducción: el bajo peso al nacer es el índice más importante para determinar las posibilidades del recién nacido de sobrevivir, tener un crecimiento y desarrollo normal. Constituye uno de los principales problemas obstétricos actuales, relacionado con más del 75 % de la morbimortalidad perinatal. Objetivo: identificar los principales factores de riesgo asociados al bajo peso al nacer en el municipio Pinar del Río, durante el año 2018. Métodos: se realizó un estudio descriptivo, transversal. El universo constituido por 95 recién nacidos vivos bajo peso en el período estudiado y la muestra fue de 75 % que cumplieron con los criterios de inclusión establecidos en la investigación. Las variables empleadas fueron: edad materna, edad gestacional al nacimiento, factores de riesgo (hipertensión arterial, diabetes mellitus, asma bronquial, anemia, sepsis vaginal, sepsis urinaria, hábito de fumar) y ganancia de peso durante la gestación. Las fuentes empleadas fueron las historias clínicas de las madres y recién nacidos. Los datos se presentaron en frecuencias absolutas y relativas. Resultados: la incidencia del bajo peso al nacer fue de 4,4 %, donde la edad materna de 27 a 34 años (48 %) fue la más representada, el 52 % de ellos nacieron antes de la semana 37 de gestación. La sepsis vaginal estuvo presente en el 42,6 %, la ganancia de peso durante la gestación fue mayor de 8 kilogramos en el 54,7 %. Conclusiones: tanto la modificación como el conocimiento de los factores de riesgo asociados al bajo peso al nacer, serán impactos favorables para su disminución.

ABSTRACT Introduction: low birth weight is the most important index to determine the survival possibilities of newborn having a normal growth and development; it currently constitutes one of the main obstetric problems, associated with more than 75 % of perinatal morbidity and mortality rate. Objective: to identify the main risk factors associated with low birth weight in Pinar del Rio municipality during 2018. Methods: a descriptive and cross-sectional study was carried out. The target group comprised 95 low birth weight newborn babies in the period studied and the sample included 75 meeting the inclusion criteria established in the research. The variables applied were: maternal age, gestational age at birth, risk factors (hypertension, diabetes mellitus, bronchial asthma, anemia, vaginal sepsis, urinary sepsis and smoking habit), and weight gain during pregnancy. The sources used were clinical histories of the mothers and newborn babies. Data were summarized in absolute and relative frequencies. Results: the incidence of low birth weight was 4,4 %, the most represented maternal age from 27 to 34 years old (48 %), 52 % of babies were born at 37 weeks of gestation. Vaginal sepsis was present in 42,6 %, weight gain during gestation behaved greater than 8 kilograms in the 54,7 %. Conclusions: both the modification of knowledge and the risk factors associated with low birth weight will be of favorable impact for its decrease.

Associação entre hipertensão arterial materna e peso inferior a 3000g em nascimentos a termo / Association between maternal arterial hypertension and weight below 3000g in full-term births

Introdução: A hipertensão arterial na gestação preditor de baixo peso ao nascer. Objetivo: Investigar a associação entre hipertensão arterial materna e o peso ao nascer inferior a 3.000g, entre indivíduos a termo. Método: Estudo tipo caso­controle, realizado em Juazeiro ­ Bahia e Petrolina ­ Pernambuco, entre 2009 e 2011. Calculou­se Odds Ratio e intervalos de confiança de 95% na análise de dados. Resultados: Gestantes com hipertensão tiveram 49% de chance a mais de ter filhos com peso inferior a 3.000g, quando comparadas às sem hipertensão arterial. Conclusão: A identificação precoce da hipertensão arterial na gestação evita danos desse agravo, especialmente baixo peso ao nascer.

Introduction: Hypertension in pregnancy predicting low birth weight. Objective: To investigate the association between maternal arterial hyper­tension and birth weight below 3,000g among full­term individuals. Method: Case­control study, carried out in Juazeiro ­ Bahia and Petrolina ­ Pernambuco, between 2009 and 2011. Odds Ratio and 95% confidence intervals were calculated in data analysis. Results: Pregnant women with hypertension were 49% more likely to have children weighing less than 3,000g when compared to those wi­thout hypertension. Conclusion: The early identification of hypertension during pregnancy prevents damage from this disease, especially low birth weight.

Valor de las variables clínicas para el pronóstico del bajo peso al nacer / Value of clinical variables to predict low birth weight

RESUMEN Fundamento: establecer un pronóstico ha sido siempre una gran responsabilidad médica. Objetivo: identificar la influencia de variables clínicas en el pronóstico del recién nacido con bajo peso al nacer. Métodos: se realizó un estudio observacional de corte longitudinal, prospectivo o de cohortes en gestantes atendidas en el área de salud del municipio de Guanabacoa, desde el 1ro de enero de 2016 hasta el 31 de diciembre de 2019. Se incluyeron 364 gestantes con seguimiento por el área de salud en el periodo. Las pacientes fueron ubicadas, de forma aleatoria en dos grupos: estimación y validación. Se construyó un modelo matemático en el grupo de estimación que fue probado en el de validación. Se realizó la validación interna (Hosmer-Lemeshow C 9,853 p= 0,275, área bajo la curva 0,911); la validación externa confirma ajuste adecuado Hosmer-Lemeshow (C 5,271p= 0,728) con área bajo la curva 0,963. Resultados: las variables edad, hipertensión arterial gestacional, síndrome de flujo vaginal, infección del tracto urinario, fumadora, periodo inter-genésico corto, prematuro anterior y edema, influyeron de forma independiente sobre el pronóstico de bajo peso al nacer (p < 0,05, OR >1). Conclusiones: las variables clínicas empleadas resultaron eficaces para la predicción del recién nacido con bajo peso al nacer.

ABSTRACT Background: to establish a prognosis has always been a great medical responsibility. Objective: to identify the influence of clinical variables on the prognosis of the newborn with low birth weight. Methods: an observational study of longitudinal, prospective or cohort cuts in pregnant women was carried out in the health area of the Municipality of Guanabacoa, in the period from January 1st, 2016 to December 31st, 2019. 364 pregnant women were included and monitored by the health area in the period. Patients were randomly placed in two groups: estimation and validation. A mathematical model was built in the estimation group that was tested in the validation group. Internal validation was performed (Hosmer-Lemeshow C 9,853 p. 0.275, area under curve 0.911); External validation confirms proper Hosmer-Lemeshow adjustment (C 5,271p x 0.728) with area under curve 0.963. Results: age variables, gestational high blood pressure, vaginal discharge syndrome, urinary tract infection, smoking habits, short inter-genetic period, antecedent of preterm infant and edema, influenced independently on the prognosis of low birth weight (p < 0.05, OR >1). Conclusions: the clinical variables used were effective in predicting the newborn with low birth weight.

Pseudomonas aeruginosa necrotizing bronchopneumonia

Extremely low birth weight (ELBW) infants are at particularly high risk for infection due to an immature immune system, invasive procedures such as endotracheal intubation, intravascular catheterization, and other factors. Neonatal infections in this population are associated with a high mortality, poor growth, and neurodevelopmental outcomes. Pseudomonas aeruginosa (P. aeruginosa) infection is an uncommon but potentially devastating cause of pneumonia and sepsis in the ELBW population. P. aeruginosa is an important cause of healthcare-associated infections (HAI) or nosocomial infections. P. aeruginosa can perceive unfavorable environmental changes and orchestrate adaptations by developing plasmid-mediated and adaptive resistance to antibiotics. We describe an ELBW infant born at 26 weeks' gestation who succumbed at 13 days of life to P. aeruginosa infection. Some of the factors related to the pathogenesis and multidrug resistance are described.