Peso al nacer en el noroeste argentino. Comparación con una referencia nacional y un estándar internacional / Birth weight in the Northwest region of Argentina. Comparison with a national reference and an international standard

Introducción. El tamaño al nacer se encuentra sujeto a influencias genéticas y ambientales; la altura geográfica es muy influyente. El peso al nacer (PN) es el indicador más utilizado para evaluarlo; existen diferentes estándares y referencias. Debido a la variabilidad de la distribución del PN en relación con la altura en la provincia de Jujuy (Argentina), este trabajo analiza la distribución percentilar del PN para tierras altas (TA) y tierras bajas (TB) jujeñas según edad gestacional (EG) y sexo, y su comparación con una referencia nacional y el estándar internacional INTERGROWTH-21st (IG-21). Población y métodos. Se analizaron los registros de 78 524 nacidos vivos en Jujuy en el período 20092014. Utilizando el método LMS, se estimaron los percentiles 3, 10, 50, 90 y 97 de PN/EG por sexo, para TA (≥2000 msnm), TB (<2000 msnm) y el total provincial, y se compararon gráficamente con la referencia poblacional argentina de Urquía y el estándar IG-21. La significación estadística se determinó mediante la prueba de Wilcoxon. Resultados. El PN en Jujuy presentó distribución heterogénea, con diferencias estadísticamente significativas (p <0,05) entre TB y TA. Al comparar con la referencia nacional y el estándar IG-21, se observaron diferencias por altitud, principalmente en los percentiles 90 y 97 para ambas regiones, y en los percentiles 3 y 10 en TA comparados con el estándar. Conclusiones. Se observó variabilidad de la distribución del PN asociada a la altura geográfica, por lo que, para evaluar el crecimiento intrauterino, resulta fundamental incluir la EG y el contexto donde transcurre la gestación.

Introduction. Size at birth is subject to genetic and environmental influences; altitude is highly influential. Birth weight (BW) is the most widely used indicator to assess size at birth; different standards and references are available. Due to the variability in BW distribution in relation to altitude in the province of Jujuy (Argentina), the purpose of this study is to analyze the percentile distribution of BW in the highlands (HL) and the lowlands (LL) of Jujuy based on gestational age (GA) and sex and compare it with a national reference and the INTERGROWTH-21 st (IG-21) international standard. Population and methods. The records of 78 524 live births in Jujuy in the 2009­2014 period were analyzed. Using the LMS method, the 3 rd, 10 th, 50 th, 90 th, and 97 th percentiles of BW/GA by sex were estimated for the HL (≥ 2000 MASL), the LL (< 2000 MASL), and the total for Jujuy, and compared with the Argentine population reference by Urquía and the IG-21 standard using growth charts. The statistical significance was established using the Wilcoxon test. Results. BW in Jujuy showed a heterogeneous distribution, with statistically significant differences (p < 0.05) between the LL and the HL. When compared with the national reference and the IG-21 standard, differences in terms of altitude were observed, mainly in the 90 th and 97 th percentiles for both regions and the 3 rd and 10 th percentiles in the HL compared with the international standard. Conclusions. BW distribution varied in association with altitude; therefore, to assess intrauterine growth, it is critical to include GA and the environment in which the pregnancy takes place.

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.

Prevalencia de osteopenia del prematuro antes y después de la implementación de una estrategia temprana de manejo fosfocálcico / Prevalence of osteopenia of prematurity before and after implementing an early strategy with the use of calcium and phosphate

Introducción. Con el uso de la nutrición parenteral agresiva en recién nacidos de muy bajo peso, se detectaron alteraciones del metabolismo fosfocálcico. En 2016 se implementó una estrategia de prevención a través del monitoreo fosfocálcico y su suplementación temprana. El objetivo fue estudiar si esta estrategia disminuye la prevalencia de osteopenia e identificar factores de riesgo asociados. Población y métodos. Estudio cuasiexperimental que comparó la prevalencia de osteopenia entre dos grupos: uno después de implementar la estrategia de monitoreo y suplementación fosfocálcica (01/01/2017-31/12/2019), y otro previo a dicha intervención (01/01/2013-31/12/2015). Resultados. Se incluyeron 226 pacientes: 133 pertenecen al período preintervención y 93 al posintervención. La prevalencia de osteopenia global fue del 26,1 % (IC95% 20,5-32,3) y disminuyó del 29,3 % (IC95% 21,7-37,8) en el período preintervención al 21,5 % (IC95% 13,6-31,2) en el posintervención, sin significancia estadística (p = 0,19). En el análisis multivariado, el puntaje NEOCOSUR de riesgo de muerte al nacer, recibir corticoides posnatales y el período de intervención se asociaron de manera independiente a osteopenia. Haber nacido luego de la intervención disminuyó un 71 % la probabilidad de presentar fosfatasa alcalina >500 UI/L independientemente de las restantes variables incluidas en el modelo. Conclusión. La monitorización y suplementación fosfocálcica precoz constituye un factor protector para el desarrollo de osteopenia en recién nacidos con muy bajo peso al nacer.

Introduction. With the use of aggressive parenteral nutrition in very low birth weight infants, alterations in calcium and phosphate metabolism were detected. In 2016, a prevention strategy was implemented through calcium phosphate monitoring and early supplementation. Our objective was to study whether this strategy reduces the prevalence of osteopenia and to identify associated risk factors. Population and methods. Quasi-experiment comparing the prevalence of osteopenia between two groups: one after implementing the calcium phosphate monitoring and supplementation strategy (01/01/2017­12/31/2019) and another prior to such intervention (01/01/2013­12/31/2015). Results. A total of 226 patients were included: 133 in the pre-intervention period and 93 in the post-intervention period. The overall prevalence of osteopenia was 26.1% (95% CI: 20.5­32.3) and it was reduced from 29.3% (95% CI: 21.7­37.8) in the pre-intervention period to 21.5% (95% CI: 13.6­31.2) in the post-intervention period, with no statistical significance (p = 0.19). In the multivariate analysis, the NEOCOSUR score for risk of death at birth, use of postnatal corticosteroids, and the intervention period were independently associated with osteopenia. Being born after the intervention reduced the probability of alkaline phosphatase > 500 IU/L by 71%, regardless of the other variables included in the model. Conclusion. Calcium phosphate monitoring and early supplementation is a protective factor against the development of osteopenia in very low birth weight infants.

Associação entre as condições de nascimento e a densidade mineral óssea de adultos das coortes de nascimentos de 1982 e 1993 de Pelotas, Rio Grande do Sul, Brasil / Association between birth conditions and bone mineral density in adults from the 1982 and 1993 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil / Asociación entre las condiciones de nacimiento y la densidad mineral ósea de adultos de las cohortes de nacimiento de 1982 y 1993 en Pelotas, Rio Grande do Sul, Brasil

Resumo: Este estudo avaliou a associação do peso ao nascer, idade gestacional e crescimento intrauterino com a densidade mineral óssea (DMO) aos 22 e 30 anos, nas coortes de nascimentos de 1982 e 1993 de Pelotas, Rio Grande do Sul, Brasil. A DMO foi medida por absorciometria por raios X com dupla energia (DXA), a associação foi avaliada usando análise de variância e a regressão linear múltipla para o controle de confundimento por: sexo, renda familiar ao nascer, tabagismo materno na gestação, escolaridade materna, cor da pele materna e índice de massa corporal pré-gestacional. Foi testado se a gordura corporal na vida adulta era mediadora da associação analisada, por meio da G-computation Formula. Foram avaliados 6.803 participantes das coortes de 1982 e 1993, aos 30 e 22 anos, respectivamente. O peso ao nascer teve associação com a DMO em todos os sítios, com maior diferença no colo femoral. Os nascidos com menos de 2.000g apresentaram, em média, -0,036g/cm2 (IC95%: -0,064; -0,008) de DMO no colo femoral em comparação àqueles com mais de 3.500g. Aqueles com escore-z de crescimento intrauterino com pelo menos 1,28 desvio padrão abaixo da média apresentaram, em média, -0,013g/cm2 (IC95%: -0,024; -0,002) de DMO na coluna lombar, em relação aos com escore-z acima da média. A análise de mediação mostrou que gordura corporal na idade adulta não mediou a associação. As condições de nascimento foram associadas com a densidade mineral óssea na vida adulta, e a identificação dos fatores precoces relacionados à perda de DMO é essencial devido à inversão demográfica em progresso em países de média e baixa renda.

Abstract: This study assessed the association of birth weight, gestational age, and intrauterine growth with bone mineral density (BMD) at 22 and 30 years of age in the 1982 and 1993 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil. BMD was measured by dual-energy X-ray absorptiometry (DXA) and the association was assessed using analysis of variance. Multiple linear regression was used to control for confounding factors: sex; household income at birth; maternal smoking during pregnancy; maternal schooling; maternal ethnicity/skin color; and pre-pregnancy body mass index. The study tested whether body fat in adulthood was a mediator of the association analyzed, using the G-computation Formula. A total of 6,803 participants from the 1982 and 1993 cohorts were evaluated at 30 and 22 years of age, respectively. Birth weight was associated with BMD at all sites, with a greater difference at the femoral neck. Individuals born weighing less than 2,000g had on average -0.036g/cm2 (95%CI: -0.064; -0.008) of BMD in the femoral neck than individuals weighing more than 3,500g. Individuals with an intrauterine growth z-score at least 1.28 standard deviation below the mean had an average of -0.013g/cm2 (95%CI: -0.024; -0.002) of BMD in the lumbar spine compared with individuals with an above-average z-score. The mediation analysis showed that body fat in adulthood did not mediate the association. Birth conditions have been associated with BMD in adulthood and the identification of early factors related to bone loss is essential due to the demographic inversion that has been taking place in low- and middle-income countries.

Resumen: Este estudio evaluó la asociación del peso al nacer, la edad gestacional y el crecimiento intrauterino con la densidad mineral ósea (DMO) a los 22 y 30 años de edad, en las Cohortes de Nacimiento de 1982 y 1993 de Pelotas, Rio Grande do Sul, Brasil. La DMO se midió mediante absorciometría de rayos X de doble emisión (DXA), y la asociación se evaluó mediante ANOVA y regresión lineal múltiple para controlar la confusión por sexo, ingresos familiares al nacer, tabaquismo materno durante el embarazo, escolaridad materna, color de piel materno e índice de masa corporal antes del embarazo. Se comprobó si la grasa corporal en la edad adulta era un mediador de la asociación analizada, utilizando G-computation Formula. Se evaluaron 6.803 participantes de las cohortes 82 y 93, de 30 y 22 años, respectivamente. El peso al nacer se asoció con la DMO en todos los sitios, con la mayor diferencia en el cuello femoral. Los nacidos con un peso inferior a 2.000g tuvieron una media de -0,036g/cm2 (IC95%: -0,064; -0,008) de DMO en el cuello femoral, que aquellos con más de 3.500g. Aquellos con una puntuación z de crecimiento intrauterino de al menos 1,28 desviaciones estándar por debajo de la media presentaron un promedio de -0,013g/cm2 (IC95%: -0,024; -0,002) de DMO en la columna lumbar, con relación a aquellos con un puntaje z superior a la media. El análisis de mediación mostró que la grasa corporal en la edad adulta no medió la asociación. Las condiciones de nacimiento se asociaron con la DMO en la edad adulta, y la identificación temprana de factores relacionados con la pérdida de DMO es esencial debido a la inversión demográfica que ha estado ocurriendo en los países de ingresos medios y bajos.

Percepção materna do cuidado à recém-nascidos com baixo peso: revisão sistemática qualitativa

Introdução: O peso ao nascer tem grande influência sobre o desenvolvimento global da criança, que por sua vez sofre influência direta dos cuidados maternos. Objetivo: Identificar na literatura científica a percepção materna sobre o cuidado de recém-nascidos com baixo peso. Métodos: Trata-se de uma revisão sistemática de estudos qualitativos conduzida em conformidade com as diretrizes metodológicas do Instituto Joanna Briggs. A pesquisa foi realizada entre abril de 2021 e março de 2023 nas bases de dados PubMed, MedLine, BVS, Scielo, EMBASE e Web of Science, com os descritores: "percepção materna", "baixo peso ao nascer" e "cuidado da criança", em diferentes combinações. Incluíram-se estudos em português, inglês e espanhol, publicados entre 2013 e 2023, que tratassem do cuidado materno de recém-nascidos com baixo peso no contexto hospitalar ou domiciliar. Os resultados foram categorizados de acordo com a análise de conteúdo. Resultados: Foram identificados 1129 estudos, dos quais apenas 11 foram incluídos nesta revisão, nas seguintes categorias: sentimentos maternos, necessidades e desafios do cuidado, aleitamento materno, vínculo mãe-bebê e apoio social. Considerações finais: Mães de recém-nascidos com baixo peso experimentam insegurança e problemas gerais de adaptação que afetam os cuidados para suprimento das necessidades essenciais da criança. Apoio familiar e de profissionais de saúde podem reforçar a segurança materna e contribuir para o cuidado integral de recém-nascidos com baixo peso.

Introducción: El peso al nacer tiene una gran influencia en el desarrollo global del niño, el cual a su vez está directamente influido por los cuidados maternos. Objetivo: Identificar en la literatura científica la percepción de la madre sobre el cuidado del niño nacido con bajo peso. Métodos: Esta es una revisión sistemática de estudios cualitativos realizados de acuerdo con las pautas metodológicas del Instituto Joanna Briggs. La investigación fue realizada entre abril de 2021 y marzo de 2023 en las bases de datos PubMed, MedLine, BVS, Scielo, EMBASE y Web of Science, con los descriptores: "percepción materna", "bajo peso al nacer" y "cuidado del niño", en diferentes combinaciones. Se incluyeron estudios en portugués, inglés y español, publicados entre 2013 y 2023, que abordaran el cuidado materno de niños nacidos con bajo peso en el contexto hospitalario o domiciliario. Los resultados se clasificaron según el análisis de contenido. Resultados: Se identificaron 1129 estudios, de los cuales solo 11 fueron incluidos en esta revisión, en las siguientes categorías: sentimientos maternos, necesidades y desafíos de cuidado, lactancia materna, vínculo madre-hijo y apoyo social. Consideraciones finales: Las madres de niños nacidos con bajo peso experimentan inseguridad y problemas generales de adaptación que afectan los cuidados para satisfacer las necesidades esenciales del niño. El apoyo familiar y el apoyo de los profesionales de la salud pueden reforzar la seguridad materna y contribuir a la atención integral en salud de los niños nacidos con bajo peso.

Introduction: Birth weight has a great influence on the child's global development, which in turn is directly influenced by maternal care. Objective: To identify in the scientific literature the mother's perception about the care of children born with low birth weight. Methods: This is a systematic review of qualitative studies conducted in accordance with the methodological guidelines of the Joanna Briggs Institute. The research was carried out between April/2021 and March/2023 in the databases: PubMed, Medline, VHL, SciELO, EMBASE and Web of Science, with the descriptors: maternal perception, low birth weight and child care, in different combinations. Studies in Portuguese, English and Spanish, published between 2013 and 2023, that addressed the maternal care of children born with low birth weight in the hospital or home context were included. Results were categorized according to content analysis. Results: 1129 studies were identified, of which only 11 were included in this review, in the following categories: maternal feelings, care needs and challenges, breastfeeding, mother-infant bonding and social support. Final considerations: Mothers of children born with low birth weight experience insecurity and general adaptation problems that affect care to meet the child's essential needs. Family support and support from health professionals can reinforce maternal security and contribute to the comprehensive health care of low birth weight children.

A systematic review to investigate whether birth weight affects the autonomic nervous system in adulthood / Uma revisão sistemática para investigar se o peso ao nascer afeta o sistema nervoso autônomo na vida adulta

ABSTRACT Objective: To evaluate the relationship between birth weight and the autonomic nervous system in adulthood through a systematic review. Data source: This is a systematic review of publications without limitation of year and language. We included studies involving the autonomic nervous system and birth weight in adults. Manuscripts were selected based on electronic searches of Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Cochrane Library and Scopus databases, using "Autonomic Nervous System" OR "Heart Rate" OR "Heart Rate Variability" AND "Birth Weight" as a search strategy. This review is registered on the International Prospective Register of Systematic Reviews — PROSPERO (ID: CRD42020165622). Data synthesis: We found 894 articles; 215 were excluded for duplicity. Of the remaining 679 studies, 11 remained. Two were excluded because they did not specifically treat the autonomic nervous system or birth weight. There were nine publications, two cohort and seven cross-sectional studies. The main findings were that extreme, very low, low or high birth weight may have some impact on the autonomic nervous system in adult life. Conclusions: Birth weight outside the normality rate may have a negative influence on the autonomic nervous system, causing autonomic dysfunction and increasing the risk of cardiovascular diseases in adult life. Thus, the importance of the follow-up of health professionals from pregnancy to gestation and throughout life, with preventive care being emphasized.

RESUMO Objetivo: Avaliar a relação entre o peso ao nascer e o sistema nervoso autônomo na vida adulta por meio de uma revisão sistemática. Fontes de dados: Esta é uma revisão sistemática de publicações, sem limitação de ano e idioma. Incluímos estudos envolvendo o sistema nervoso autônomo e peso ao nascer em adultos. Os manuscritos foram selecionados das bases de dados eletrônicos Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Cochrane Library e Scopus, utilizando "Autonomic Nervous System" OR "Heart Rate" OR "Heart Rate Variability" AND "Birth Weight" como estratégia de busca. Esta revisão está registrada pelo International Prospective Register of Systematic Reviews — PROSPERO (ID: CRD42020165622). Síntese dos dados: Nós encontramos 894 artigos. Deles, 215 foram excluídos por duplicidade. Entre os 679 remanescentes, 11 permaneceram, dos quais dois foram excluídos por não tratarem especificamente do sistema nervoso autônomo ou do peso ao nascer. Restaram nove publicações, sendo duas longitudinais e sete transversais. Os principais achados foram que o peso extremo baixo, muito baixo, baixo ou alto ao nascer pode ter algum impacto no sistema nervoso autônomo na vida adulta. Conclusões: O peso ao nascer fora da normalidade pode influenciar negativamente o sistema nervoso autônomo, causando disfunção autonômica e aumentando o risco de doenças cardiovasculares na vida adulta. Assim, ressalta-se a importância do acompanhamento dos profissionais de saúde desde a gravidez até a gestação, pré-natal e ao longo da vida, com cuidados preventivos para esta situação.

Infección congénita por citomegalovirus en neonatos muy bajo peso

Introducción: La infección congénita por el citomegalovirus en neonatos menores de 1500 gramos puede ser causa de morbilidad, mortalidad y discapacidad. Objetivo: Describir el comportamiento de la infección congénita por citomegalovirus en un servicio de neonatología. Métodos: Se realizó un estudio descriptivo y transversal con 61 neonatos. Se les realizó detección de citomegalovirus en la primera semana de vida en suero y orina, mediante reacción en cadena de la polimerasa, para determinar infección congénita. Se evaluaron variables perinatales en todos los neonatos, así como elementos clínicos y resultados de exámenes complementarios en los infectados. Resultados: La incidencia de infección congénita fue de un 10 % (6/61). El 5 % de los estudios fueron positivos (6/122). Ninguna muestra de orina resultó positiva (0/61) y en el 10 % de las muestras de suero (6/61) se detectó el genoma del virus. Se encontró asociación entre valoración nutricional al nacer e infección por citomegalovirus (p< 0,05). El 83 % de los neonatos infectados presentaron algún signo clínico y el síndrome de dificultad respiratoria fue el más frecuente (67 %). En todos los neonatos con infección congénita el ultrasonido cerebral fue normal y en el 33 % se detectó retinopatía de la prematuridad en el fondo de ojo. Conclusiones: La incidencia de infección congénita por citomegalovirus es alta en este grupo de riesgo. Los signos clínicos encontrados y los resultados del fondo de ojo en neonatos con infección congénita se relacionaron con la prematuridad y la valoración nutricional de hipotrófico se asoció con esta infección.

Introduction: Congenital cytomegalovirus infection in neonates weighing less than 1500 grams can be a cause of morbidity, mortality, and disability. Objective: To describe the behavior of congenital cytomegalovirus infection in a neonatal service. Methods: A descriptive and cross-sectional study was conducted with 61 neonates. Cytomegalovirus was detected in the first week of life in serum and urine, by polymerase chain reaction, to determine congenital infection. Perinatal variables were evaluated in all neonates, as well as clinical elements and results of complementary examinations in infected infants. Results: The incidence of congenital infection was 10% (6/61). 5% of the studies were positive (6/122). No urine samples were positive (0/61) and the virus genome was detected in 10% of serum samples (6/61). An association was found between nutritional assessment at birth and cytomegalovirus infection (p < 0.05). A total of 83% of infected neonates had some clinical sign, with respiratory distress syndrome being the most common (67%). In all neonates with congenital infection, brain ultrasound was normal, and retinopathy of prematurity was detected in 33% of patients with fundus retinopathy. Conclusions: The incidence of congenital cytomegalovirus infection is high in this risk group. The clinical signs found and the results of the fundus in neonates with congenital infection were related to prematurity and the nutritional assessment of hypotrophic was associated with this infection.

Sociodemographic, behavioral, obstetric, and healthcare factors associated with low weight at birth: a case-control study

ABSTRACT BACKGROUND: Understanding social determinants is crucial for implementing preventive strategies, especially for low birth weight (LBW)—a public health issue that severely increases the risk of morbimortality in children. OBJECTIVE: This study aimed to identify the factors associated with LBW among newborns, assisted by the Brazilian Unified Health System. DESIGN AND SETTING: It analyzed data from newborns and their mothers. The sample was selected by convenience from users of the public health system in Francisco Beltrão (Paraná, Brazil). METHODS: Cases (n = 26) were babies weighing ≤ 2,500 g and controls (n = 52) > 2,500 g. All babies were assessed and paired by sex and date of birth in a 1:2 proportion. Statistical power was computed a posteriori, revealing a power of 87% (α = 0.05). RESULTS: Strong and significant differences were found in the bivariate analysis, in which the number of current smokers or those who quit during pregnancy was higher among mothers of babies with LBW. Moreover, the gestational weeks were lower among these cases. Logistic regression models indicated that the gestational week (odds ratio [OR] = 0.17, 95% confidence interval [CI]:0.05-0.54) and fathers' educational level (high school or above; OR = 0.22, 95% CI:0.06-0.99) were related to lower chances of low birth weight. CONCLUSIONS: Our findings confirm previous investigations on LBW's multi-causality, showing that the gestational week could reduce up to 82% chances of a baby being born with ≤ 2,500 g. Its association with paternal education underlines the importance of comprehensive policies to protect newborns.

Prevalencia de la arteria umbilical única en gestantes: su relación con otras malformaciones y el bajo peso al nacer

Introducción: La arteria umbilical única tiene una incidencia del 1 % en los recién nacidos. Se le asocia frecuentemente con gemelaridad, malformaciones y crecimiento intrauterino retardado, y constituye un factor de riesgo de prematuridad, muerte fetal y neonatal. Objetivos: Determinar la prevalencia de la arteria umbilical única en gestantes, y la asociación de esta entidad con otras malformaciones y el bajo peso al nacer. Materiales y métodos: Estudio descriptivo retrospectivo, con datos obtenidos de las historias clínicas y del modelo de seguimiento lineal existente en las consultas de genética comunitaria del municipio Matanzas, de enero de 2015 a diciembre de 2019. Resultados: La prevalencia de la arteria umbilical única fue del 0,3 %. Las malformaciones más frecuentes fueron las renales; el 27,7 % de los nacimientos fueron pretérmino y el 33,3 % de los nacidos fue con un peso inferior a 2500 g. Conclusiones: La arteria umbilical única constituye un marcador para otras malformaciones. Cuando coexisten ambas existe riesgo de prematuridad y bajo peso al nacer. Se recomienda realizar examen clínico posnatal a todo recién nacido con arteria umbilical única, pesquisando defectos renales y cardíacos.

Introduction: The single umbilical artery has an incidence of 1% in newborns. It is frequently associated with twinning, malformations and delayed intrauterine growth, and is a risk factor of prematurity, fetal and neonatal death. Objective: To determine the prevalence of single umbilical artery in pregnant women and the association of this entity with other malformations and low birth weight. Materials and methods: Retrospective descriptive study, with data obtained from medical records and the linear follow-up model existing in the community genetic clinics of the municipality of Matanzas, from January 2015 to December 2019. Results: The prevalence of the single umbilical artery was 0.3%. The most frequent malformations were renal ones; 27.7% of births were pre-term and 33.3% of those born weighed less than 2500g. Conclusions: The single umbilical artery is a marker for other malformations. When both coexist there is a risk of prematurity and low birth weight. Postnatal clinical examination is recommended for all newborns with single umbilical artery, checking for renal and heart defects.

Características clínicas y epidemiológicas de madres con recién nacidos prematuros y de bajo peso / Clinical and epidemiological characteristics of mothers with preterm and low weight infants i: en

Introducción: El parto prematuro y el bajo peso al nacer constituyen un problema de salud a escala mundial, ya que representan un predictor importante del desarrollo y crecimiento posnatal, así como un indicador de morbilidad y mortalidad infantil. Objetivo: Caracterizar a madres con recién nacidos prematuros y de bajo peso según variables clínicas y epidemiológicas. Métodos: Se realizó un estudio descriptivo, de corte transversal, desde enero hasta diciembre de 2022, de 35 madres con recién nacidos prematuros y de bajo peso, pertenecientes al Policlínico Docente Área Este de la ciudad de Camagüey. Entre las variables analizadas figuraron: edad, estado nutricional, clasificación del riesgo, control prenatal, riesgo reproductivo preconcepcional, consulta multidisciplinaria, enfermedades propias del embarazo, estado al nacer, deficiencias detectadas y causas. Resultados: En la serie predominaron el grupo etario de 35 y más años (25,7 %), la obesidad (37,1 %), las madres con elevados riesgos (45,7 %), quienes recibieron entre 8-14 controles prenatales, y malos antecedentes obstétricos (31,4 %). Por otra parte, 22,9 % de las madres tuvieron hijos con bajo peso y 31,4 %, prematuros; en tanto, hubo dificultades en el seguimiento por ausencias (57,1 %). Conclusiones: Las madres presentaron características clínicas y epidemiológicas desfavorables, tales como la edad de 35 y más años, la obesidad, el alto riesgo, los malos antecedentes obstétricos y la infección vaginal como enfermedad propia del embarazo, que influyeron en que los neonatos fueran prematuros o de bajo peso, o ambos.

Introduction: Preterm birth and low birth weight constitute a health problem worldwide, since they represent an important predictor of development and postnatal growth, as well as an indicator of newborn morbidity and mortality. Objective: To characterize mothers with preterm and low weight infants according to clinical and epidemiological variables. Methods: A descriptive, cross-sectional study was carried out from January to December, 2022, of 35 mothers with preterm and low weight infants, belonging to the East Area Teaching Polyclinic in Camagüey city. Age, nutritional state, risk classification, prenatal control, preconcepcional reproductive risk, multidisciplinary visits, diseases characteristic of pregnancy, birth state, detected deficiencies and causes were among the analyzed variables. Results: In the series there was prevalence of the 35 and over age group (25.7%), obesity (37.1%), high risk mothers (45.7%) who received among 8-14 prenatal controls, and bad obstetric history (31.4%). On the other hand, 22.9% of the mothers had low weight children and 31.4% preterm children; as long as there were difficulties in follow up due to absences (57.1%). Conclusions: The mothers presented unfavorable clinical and epidemiological characteristics, such as the 35 and over years, obesity, high risk, bad obstetric history and vaginal infection as a disease characteristic of pregnancy, which influenced the infants to be preterm or low weight, or both.

Costo-efectividad de la calidad del control prenatal con respecto al bajo peso al nacer en el Cauca / Antenatal control quality cost-effectiveness regarding low birth weight in Cauca

Antecedentes: El departamento del Cauca en Colombia es multiétnico, multicultural y biodiverso, también con grandes diferencias en bajo peso al nacer (BPN), mortalidad perinatal y mortalidad neonatal tardía entre municipios. Objetivo: Determinar la relación de costo-efectividad del control prenatal (CPN) cuando ha tenido buena calidad frente al que ha tenido calidad deficiente con respecto al BPN en el departamento del Cauca entre 2018 y 2020. Método: Evaluación económica con diseño epidemiológico de una cohorte histórica desde la perspectiva de la institución pagadora. Se calculó la razón incremental de costo-efectividad (RICE), análisis de sensibilidad e impacto presupuestal. Resultados: La incidencia de BPN fue del 8,3% (348/4182). La calidad deficiente en el CPN incrementó el riesgo de BPN (OR: 3,38; IC95%: 1,05-8,2) y la buena calidad tuvo una mejor relación de costo-efectividad (RICE: USD 2727,75), con posición dominante frente a la calidad deficiente (6,14 veces el PIB per cápita de ahorro) y con un impacto presupuestal de USD 2.904.392. Conclusiones: La buena calidad del CPN en el departamento del Cauca durante 2018-2020 fue costo-efectiva y dominante por ser de menor costo y mayor efectividad.

Background: The department of Cauca in Colombia is multiethnic, multicultural, and biodiverse, also with large differences in low birth weight (LBW), perinatal mortality, and late neonatal mortality among municipalities. Objective: To determine the cost-effectiveness relationship of antenatal care (ANC) when it has had good quality compared to that which has had poor quality with respect to low birth weight in the department of Cauca between 2018 and 2019. Method: Economic evaluation with epidemiological cohort design historical from the perspective of the payer institution. Incremental cost-effectiveness ratio (RICE), sensitivity analysis, and budgetary impact were calculated. Results: The incidence of LBW was 8.3% (348/4182). Poor quality in ANC increased the risk of LBW (OR: 3.38; CI95%: 1.05-8.2), good quality had a better cost-effectiveness ratio (RICE: USD 2727.75), with dominant position against poor quality (6.14 times the GDP/capita savings) with a budgetary impact of USD 2,904,392. Conclusions: The good quality of the ANC in the department of Cauca during 2018-2020 was cost-effective and dominant because it is lower cost and more effective.

Potenciales evocados auditivos de tronco en neonatos nacidos a gran altitud / Brainstem auditory evoked potentials in newborn infants born in a high-altitude area

Introducción. Una forma no invasiva y segura de evaluar los parámetros neurofisiológicos en recién nacidos es la evaluación de los potenciales evocados auditivos del tronco encefálico (PEAT). Objetivo. Evaluar las latencias e intervalos de ondas de los PEAT en neonatos sanos nacidos a gran altitud (Cusco, 3399 msnm). Población y métodos. Estudio transversal y prospectivo. Se incluyeron neonatos menores a 14 días de vida, dados de alta a menos de 7 días de nacidos, evaluados para determinar los valores de los PEAT a intensidades sonoras de 70 dB, 80 dB y 90 dB. Se incluyeron las variables edad gestacional, peso al nacer, tipo de parto. Se calcularon las diferencias de las medianas de las latencias e intervalos de las ondas según edad gestacional y peso al nacer. Resultados. Se evaluaron 96 neonatos (17 pretérminos). Las medianas de las latencias de las ondas I a V a 90 dB fueron las siguientes: onda I 1,56 ms; onda II 2,74 ms; onda III 4,37 ms; onda IV 5,62 ms, onda V 6,63 ms. La latencia de la onda I para 80 dB fue de 1,71 ms y para 70 dB de 1,88 ms. Los intervalos para las ondas (I-III), (III-V) y (I-V) fueron de 2,8 ms, 2,2 ms y 5,0 ms respectivamente, sin diferencias entre intensidades (p >0,05). La prematuridad y el bajo peso estuvieron asociados a latencias de la onda I más prolongadas (p <0,05). Conclusiones. Se presentan valores ajustados de latencias e intervalos de los PEAT en neonatos nacidos a gran altitud. Se identificó que, a distintas intensidades sonoras, se ven diferencias en las latencias de las ondas, pero no en los intervalos entre ondas.

Introduction. A non-invasive and safe way to assess neurophysiological parameters in newborn infants is the evaluation of brainstem auditory evoked potentials (BAEPs). Objective. To assess the latencies and wave intervals of BAEPs in healthy newborn infants born in a high-altitude area (Cusco, 3399 MASL). Population and methods. Cross-sectional and prospective study. Newborn infants younger than 14 days of age, discharged less than 7 days after birth, were assessed to determine BAEP values at intensities of 70 dB, 80 dB, and 90 dB. The study variables were gestational age, birth weight, and type of delivery. The median differences in wave latencies and intervals were estimated according to gestational age and birth weight. Results. A total of 96 newborn infants (17 preterm infants) were assessed. The median latencies of waves I­V at 90 dB were for wave I: 1.56 ms, wave II: 2,74 ms, wave III: 4.37 ms, wave IV: 5.62 ms, and wave V: 6.63 ms. The latency of wave I for 80 dB was 1.71 ms and for 70 dB, 1.88 ms. Wave intervals (I­III, III­V, I­V) were 2.8 ms, 2.2 ms, and 5.0 ms, respectively, without differences among intensities (p > 0.05). Prematurity and low birth weight were associated with a longer wave I latency (p < 0.05). Conclusions. Here we describe adjusted BAEP latency and interval values for newborn infants born at high altitude. At different sound intensities, we identified differences in wave latencies, but not in interwave intervals.

Warning Signs on Short Hammersmith Neonatal Neurological Examination and Correlation With Hammersmith Infant Neurological Examination Global Score in Preterm Infants: A Prospective Cohort Study

Objective: To describe the findings of short Hammersmith Neonatal Neurologic examination (HNNE) in preterm small for gestational age (SGA) and appropriate for gestational age (AGA) infants at term equivalent age (TEA) and to correlate it with the global score of Hammersmith Infant Neurologic Examination (HINE) performed at 4-6 months of corrected age. Methods: This prospective cohort study was conducted at the high risk follow-up clinic of our center. 52 preterm infants born <35 weeks gestation were examined using HNNE at TEA and followedup till 4-6 months of corrected age to estimate HINE. Results: 20 infants (38.5%) had warning signs and 9 (17.3%) had abnormal signs on short HNNE. 12 (37.5%) AGA infants and 6 (30%) SGA infants had global score <65 at mean corrected age (SD) of 4.3 (0.7) weeks and 4.5 (0.8) weeks, respectively. Very preterm, birth weight <1000 g and SGA was significantly associated with global scores <65. Conclusion: Early identification of warning signs among SGA infants using Short HNNE screening at TEA can be useful to initiate early intervention. There was no statistically significant difference in global scores by HINE among AGA and SGA infants in early infancy.

Significados de vivencias en cuidados gestacionales de nacidos con bajo peso

El bajo peso al nacer se considera un problema en salud pública multifactorial, con consecuencias como la morbimortalidad neonatal, deficiencias en el desarrollo cognitivo y el aumento del riesgo de desarrollo de enfermedades crónicas en etapas posteriores de la vida. Objetivo: interpretar los significados de las vivencias en cuidados gestacionales de las mujeres con hijos con bajo peso al nacer a término, que permitan identificar aspectos de salud, socioeconómicos, emocionales, entre otros, que sean relevantes durante la gestación y que puedan ser caracterizados e incluidos en el marco de las políticas públicas vinculantes en Sincelejo, Sucre. Metodología: fenomenología aplicada a ocho mujeres madres de niños/as con bajo peso al nacer a término. La información fue procesada con el método Colaizzi. Resultados: derivaron cinco macro categorías: 1) Cuidado y cuidado de sí en la gestación. 2) La salud en movimiento durante los cuidados de la gestación. 3) El cambio como vivencia permanente en la gestación. 4) Economía y gestación. 5) Las emocionalidades habitan la gestación. Conclusiones: El estudio atiende al nacimiento y a los factores contextuales, sociales y familiares relacionados. Se convirtió en una vía hacia el conocimiento protagonizado por las gestantes de gran utilidad para las políticas públicas.

Low birth weight is considered a multifactorial public health problem with consequences such as neonatal morbidity and mortality, deficiencies in cognitive development and increased risk of developing chronic diseases in later stages of life. Objective: To interpret the meanings of the experiences in pregnancy care of women with low birth weight babies at term, which allow the identification of health, socioeconomic and emotional aspects, among others, that are relevant during pregnancy, and that can be characterized and included in the framework of binding public policies in Sincelejo, Sucre. Method: Phenomenology applied to eight mothers of low-birth-weight babies at term. The information was processed with the Colaizzi method. Results: Five macro-categories were derived: 1) Care and self-care during pregnancy; 2) Health in motion during pregnancy care 3) Change as a permanent experience in pregnancy 4) Economy and gestation 5) Emotionality inhabiting gestation. Conclusions: The study addresses birth, contextual, social and family related factors. This study became a path towards knowledge carried out by pregnant women, which is very useful for public policies.

O baixo peso ao nascer se considera um problema na saúde pública multifatorial, com consequências como a morbimortalidade neonatal, deficiências no desenvolvimento cognitivo e o aumento do risco de desenvolvimento de doenças crônicas em etapas posteriores da vida. Objetivo: interpretar os significados das vivências em cuidados gestacionais das mulheres com filhos com baixo peso ao nascer a termo, identificar aspeitos de saúde, socioeconómicos, emocionais, entre outros, que sejam relevantes durante a gestação e que possam ser caracterizados e incluídos no marco das políticas públicas vinculantes em Sincelejo, Sucre. Metodologia: fenomenologia aplicada a oito mulheres mães de meninos/as com baixo peso ao nascer a termo. A informação foi processada com o método Colaizzi. Resultados: derivaram cinco macro categorias: 1) Cuidado e cuidado de si na gestação. 2) A saúde em movimento durante os cuidados da gestação. 3) O câmbio como vivência permanente na gestação. 4) Economia e gestação. 5) As emocionalidades tem a gestação. Conclusões: O estudo atende ao nascimento e aos fatores contextuais, sociais e familiares relacionados. Tornou-se em uma via para o conhecimento protagonizado pelas gestantes é de grande utilidade para as políticas públicas.

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g? / Comparación entre las fórmulas de Wright y de Shukla: ¿cuál es mejor para la colocación de catéteres umbilicales en recién nacidos ≤ 1500 g?

Abstract Background: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. Methods: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. Results: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). Conclusions: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

Resumen Introducción: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. Métodos: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. Resultados: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. Conclusiones: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Asociación entre antropometría materna y peso del neonato a término. Cienfuegos, 2020-2021

Fundamento los indicadores antropométricos maternos constituyen una herramienta útil en el pronóstico de posibles resultados desfavorables en relación con la evaluación nutricional del producto de la concepción. Objetivo determinar la relación existente entre el estado nutricional antropométrico materno y el peso del recién nacido a término. Métodos se realizó un estudio descriptivo en 66 embarazadas y sus recién nacidos, en el periodo enero de 2020- diciembre de 2021, en el Policlínico Octavio de la Concepción y de la Pedraja, de Cienfuegos. Se consideraron las variables maternas: edad, peso, talla, índice de masa corporal gestacional, ganancia de peso global y circunferencia media del brazo; además del peso del recién nacido. Se calcularon estadísticos descriptivos básicos y coeficiente de correlación de Pearson. Resultados predominaron las adolescentes (n=42), la desnutrición materna (n=32), la ganancia deficiente de peso global y las gestantes evaluadas como bajo peso por los valores de la circunferencia media del brazo. El peso materno deficiente se asoció con 57,1 % y 20,8 % de recién nacidos bajo peso de madres adolescentes y adultas respectivamente. Estas variables mostraron asociación con el nacimiento de recién nacido bajo peso o con peso insuficiente. Conclusiones existe relación entre el estado nutricional antropométrico materno y el peso del neonato a término. Las variables maternas más asociadas al nacimiento de niños bajo peso o con peso insuficiente fueron: edad inferior a los 19 años, índice de masa corporal deficiente, escasa ganancia de peso global y valores de la circunferencia media del brazo > 5 y ≤ 10 percentil.

SUMMARY Background maternal anthropometric indicators constitute a useful tool in the prognosis of possible unfavorable results in relation to the product of conception nutritional evaluation. Objective to determine the relationship between the maternal anthropometric nutritional status and the newborn at term weight. Methods a descriptive study was carried out in 66 pregnant women and their newborns, from January 2020 to December 2021, at the Octavio de la Concepción y de la Pedraja Polyclinic, in Cienfuegos. Maternal variables: age, weight, height, gestational body mass index, overall weight gain, and mean arm circumference; in addition to the weight of the newborn were considered. Basic descriptive statistics and Pearson's correlation coefficient were calculated. Results adolescents (n=42), maternal malnutrition (n=32), deficient global weight gain and pregnant women evaluated as low weight by the values of the mean arm circumference predominated. Low maternal weight was associated with 57.1% and 20.8% of low birth weight newborns of adolescent and adult mothers, respectively. These variables showed an association with the birth of a newborn underweight or with insufficient weight. Conclusions there is a relationship between the maternal anthropometric nutritional status and the newborn at term weight. The maternal variables most associated with the underweight birth were: age less than 19 years, poor body mass index, low overall weight gain, and mean arm circumference values > 5 and ≤ 10 percentile.

Risk factors of acute kidney injury in very low birth weight infants in a tertiary neonatal intensive care unit

Abstract Objective Acute kidney injury (AKI) in the neonatal period is associated with worst outcomes as increased mortality and increased length of hospital stay. Very low birth weight (VLBW) newborns are at higher risk for developing several other conditions that are associated with worst outcomes. Understanding the risk factors for AKI may help to prevent this condition and improve neonatal care for this population. Methods This retrospective cohort study included 155 very low birth weight newborns admitted between 2015 and 2017. The authors compared the newborns who developed neonatal AKI with the non-AKI group and analyzed the main risk factors for developing AKI in the population. The authors also performed an analysis of the main outcomes defined as the duration of mechanical ventilation, length of stay, and death. Results From the cohort, a total of 61 (39.4%) patients had AKI. The main risk factors associated with Neonatal AKI were necrotizing enterocolitis (aOR 7.61 [1.69 - 34.37]; p = 0.008), neonatal sepsis (aOR 2.91 [1.17 - 7.24], p = 0.021), and hemodynamic instability (aOR 2.99 [1.35 - 6.64]; p = 0.007). Neonatal AKI was also associated with an increase in the duration of mechanical ventilation in 9.4 days (p = 0.026) and in an increase in mortality 4 times (p = 0.009), after adjusting for the other variables. Conclusion The present results highlight the importance of minimizing sepsis and necrotizing enterocolitis, as well as the importance of identifying hemodynamic instability, to prevent AKI and diminish the burden of morbimortality in VLBW newborns.

Prediction of Perinatal and Neurodevelopmental Outcomes in Newborns with a Birth Weight below the 3rd Percentile: Performance of Two International Curves - Prospective Cohort from a Brazilian City / Predição de resultados perinatais e de neurodesenvolvimento em recém-nascidos com peso ao nascer abaixo do percentil 3: Desempenho de duas curvas internacionais - coorte prospectiva de uma cidade brasileira

Abstract Objectives To evaluate the performance of Intergrowth-21 st (INT) and Fetal Medicine Foundation (FMF) curves in predicting perinatal and neurodevelopmental outcomes in newborns weighing below the 3rd percentile. Methods Pregnant women with a single fetus aged less than 20 weeks from a general population in non-hospital health units were included. Their children were evaluated at birth and in the second or third years of life. Newborns (NB) had their weight percentiles calculated for both curves. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and area under the ROC curve (ROC-AUC) for perinatal outcomes and neurodevelopmental delay were calculated using birth weight < 3rd percentile as the cutoff. Results A total of 967 children were evaluated. Gestational age at birth was 39.3 (± 3.6) weeks and birth weight was 3,215.0 (± 588.0) g. INT and FMF classified 19 (2.4%) and 49 (5.7%) newborns below the 3rd percentile, respectively. The prevalence of preterm birth, tracheal intubation >24 hours in the first three months of life, 5th minute Apgar <7, admission to a neonatal care unit (NICU admission), cesarean section rate, and the neurodevelopmental delay was 9.3%, 3.3%, 1.3%, 5.9%, 38.9%, and 7.3% respectively. In general, the 3rd percentile of both curves showed low sensitivity and PPV and high specificity and NPV. The 3rd percentile of FMF showed superior sensitivity for preterm birth, NICU admission, and cesarean section rate. INT was more specific for all outcomes and presented a higher PPV for the neurodevelopmental delay. However, except for a slight difference in the prediction of preterm birth in favor of INT, the ROC curves showed no differences in the prediction of perinatal and neurodevelopmental outcomes. Conclusion Birth weight below the 3rd percentile according to INT or FMF alone was insufficient for a good diagnostic performance of perinatal and neurodevelopmental outcomes. The analyzes performed could not show that one curve is better than the other in our population. INT may have an advantage in resource contingency scenarios as it discriminates fewer NB below the 3rd percentile without increasing adverse outcomes.

Resumo Objetivos Avaliar o desempenho das curvas de Intergrowth-21 st (INT) e Fetal Medicine Foundation (FMF) na predição de resultados perinatais e de neurodesenvolvimento de recém-nascidos com peso abaixo do percentil 3. Métodos Foram incluídas gestantes de feto único com idade inferior a 20 semanas de uma população geral em unidades de saúde não hospitalares. Seus filhos foram avaliados ao nascimento e no segundo ou terceiro anos de vida. Os recém-nascidos tiveram seus percentis de peso calculados para ambas as curvas. Sensibilidade, especificidade, valor preditivo positivo (VPP) e negativo (VPN) e área sob a curva ROC (ROC-AUC) foram calculados para desfechos perinatais e atraso de neurodesenvolvimento considerando o peso ao nascimento menor que o percentil 3 como ponto de corte. Resultados Um total de 967 crianças foram avaliadas ao nascimento e no segundo ou terceiro anos de vida. A idade gestacional ao nascer foi de 39,3 (±3,6) semanas e o peso ao nascimento foi de 3.215,0 (±588,0) g. INT e FMF classificaram 19 (2,4%) e49 (5,7%) recém-nascidos abaixo do percentil 3, respectivamente. A prevalência de parto prétermo, intubação traqueal > 24 horas nos primeiros três meses de vida, Apgar de 5° minuto < 7, internação em unidade de terapia intensiva neonatal (internação em UTIN), taxa de cesariana e atraso de neurodesenvolvimento foi 9,3%, 3,3%, 1,3%, 5,9%, 38,9% e 7,3% respectivamente. Em geral, o percentil 3 de ambas as curvas apresentou baixa sensibilidade e VPP e alta especificidade e VPN. O percentil 3 de FMF mostrou sensibilidade superior para parto prematuro, internação em UTIN e taxa de cesariana. INT foi mais específico para todos os desfechos e apresentou maior VPP para o atraso do neurodesenvolvimento. Entretanto, exceto por uma pequena diferença na predição de parto pré-termo em favor de INT, as curvas ROC não mostraram diferenças na predição de resultados perinatais e de desenvolvimento neurológico. Conclusão O peso ao nascer abaixo do percentil 3 segundo INT ou FMF isoladamente foi insuficiente para um bom desempenho diagnóstico de desfechos perinatais e de neurodesenvolvimento. As análises realizadas não puderam mostrar que uma curva é melhor que a outra em nossa população. INT pode ter vantagem em cenários de contingência de recursos, pois discrimina menos recém-nascidos abaixo do percentil 3 sem aumentar os desfechos adversos.

Factors associated with skin-to-skin contact less than 180 min/day in newborns weighing up to 1,800 g: multicenter study / Fatores associados ao contato pele a pele inferior a 180 min/dia em recém-nascidos com peso até 1.800 g: estudo multicêntrico

Abstract This article aims to evaluate the factors associated with a skin-to-skin contact time <180 min/day in newborns weighing up to 1,800 g during neonatal hospitalization. Prospective observational cohort study conducted in neonatal units of reference for the Kangaroo Method in Brazil. Data from 405 dyads (mother/child) were analyzed from May 2018 to March 2020. Maternal and neonatal explanatory variables were collected from medical records and interviews. Skin-to-skin contact was recorded in forms posted at the bedside, filled out by parents and staff. The outcome variable was the mean time of skin-to-skin contact < 180 min/day. Hierarchical modeling was performed by Poisson regression with robust variance. The variables associated with the outcome were "without easy access to the hospital", "without previous knowledge of the kangaroo method" and "having had morbidities during pregnancy". Mothers without easy access to the hospital and who are unaware of the kangaroo method should be priority targets for health policies to develop strategies that promote greater exposure to skin-to-skin contact during the hospitalization period of their children.

Resumo O objetivo deste artigo é avaliar os fatores associados ao tempo de contato pele a pele < 180 min/dia em recém-nascidos com peso até 1.800 g durante a internação neonatal. Estudo observacional tipo coorte prospectivo conduzido em unidades neonatais de referência no Brasil. Foram analisados dados de 405 díades (mãe/filho), no período de maio de 2018 a março de 2020. As características da mãe e do recém-nascido foram coletadas em prontuários e entrevistas, a realização do contato pele-a-pele era registrada em fichas anexadas ao leito, preenchidas pela equipe e pelos pais. A variável desfecho foi o tempo médio diário de contato pele-a-pele inferior a 180 minutos. Foi realizada modelagem hierarquizada utilizando a regressão de Poisson com variância robusta para cálculo das razões de prevalência. As variáveis que permaneceram independentemente associadas foram: "não ter fácil acesso ao hospital" (morar longe ou ter dificuldade de transporte), "não possuir conhecimento prévio sobre o método canguru" e "ter apresentado morbidades durante a gestação". Mães sem fácil acesso ao hospital e que desconhecem o método canguru devem ser alvos prioritários das políticas de saúde para desenvolver estratégias que promovam maior exposição ao contato pele a pele durante o período de internação de seus filhos.

Doppler Indices of the Fetal Middle Cerebral and the Umbilical Arteries in Pregnancies at High Risk Followed Up for Suspected Fetal Growth Restriction

Background: Fetal growth restriction is related to compromised perinatal outcomes. The screening and prevention tools for fetal growth restriction like Doppler indices in high-risk groups compared with general antenatal populations. An evaluation of the correlation between Doppler indices and placental weight and birth weight of the neonate at term pregnancy in high-risk pregnancies is essential. For the early detection of fetal growth limitations in high-risk pregnancies, sensitive screening techniques are few. Objectives: To determine the most accurate indicator for predicting a poor perinatal outcome or intrauterine growth restriction by comparing and correlating the modifications in Doppler ultrasound studies of fetal circulation in general pregnant women with those of high-risk patients both with and without intrauterine growth retardation. Study design: A cross-sectional research including 81 healthy pregnancies and 19 high-risk patients at 31–40 weeks of gestation was conducted. The pulsatility index (PI) of the middle cerebral artery (MCA), the umbilical artery (UA), and the MCA PI to UA PI ratio were all analyzed. We compared the Doppler indices’ mean values. Then these values were correlated with placental weight and birth weight of the offspring. Results: A significantly low birth weight and less fetoplacental ratio and placental coefficient ratio were found in high-risk cases than in normal pregnant women (P <0.05). A strong positive relationship was observed between the middle cerebral artery pulsatility index and placental weight, while negative relationship between the pulsatility index of the middle cerebral artery and the Feto-placental ratio (P < 0.05). In addition, a positive association was found between the pulsatility index of the middle cerebral artery and placental coefficient, whereas a negative correlation was observed between the Cerebro-placental ratio and Feto-placental ratio in high-risk cases (P <0.05). Conclusion: Low birth weight can be predicted using Doppler indices since there is a definite correlation between it and unfavorable perinatal outcomes.