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.

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.

Birth weight and bone mineral density at 18-19 years: birth cohort 1997-1998 / Peso ao nascer e densidade mineral óssea aos 18-19 anos: coorte de nascimentos 1997-1998

ABSTRACT OBJECTIVE To analyze the association between birth weight and bone mineral density (BMD) in adolescence. METHODS A birth cohort study in São Luís, Maranhão, using data from two moments: at birth and at 18-19 years. Exposure was the birth weight in grams, continuously analyzed. The outcome was BMD, using the Z-score index (whole body) measured by double X-ray densitometry (Dexa). A theoretical model was constructed in acyclic graphs to identify the minimum set of adjustment variables - household income, the mother knowing how to read and write at the time of birth, prenatal care, tobacco use during pregnancy, and parity — to evaluate the association between birth weight and bone mineral density in adolescence. Multiple linear regression was used in Stata 14.0 software. A 5% significance level was adopted. RESULTS From 2,112 adolescents, 8.2% had low birth weight and 2.8% had a low BMD for their age. The mean full-body Z-score was 0.19 (± 1.00). The highest birth weight was directly and linearly associated with BMD values in adolescence (Coef.: 0.10; 95%CI: 0.02-0.18), even after adjustment for the variables household income (Coef.: -0.33; 95%CI: -0.66-0.33) and the mother knowing how to read and write (Coef.: 0.23%; 95%CI: 0.03-0.43). CONCLUSION Although after adjusting the variables the association attenuated, birth weight positively and linearly relates to BMD in adolescence.

RESUMO OBJETIVO Analisar a associação entre o peso ao nascer e a densidade mineral óssea (DMO) na adolescência. MÉTODOS Estudo de coorte de nascimentos em São Luís, Maranhão, utilizando dados de dois momentos: ao nascimento e aos 18-19 anos. A exposição foi o peso ao nascer em gramas, analisado de forma contínua. O desfecho foi a DMO, utilizando o índice Z-escore (corpo inteiro) medido pela densitometria por dupla emissão de raios X (DEXA). Foi construído modelo teórico em gráficos acíclicos direcionados para identificar o conjunto mínimo de variáveis de ajuste - renda familiar, a mãe saber ler e escrever à época do nascimento, realização de pré-natal, tabagismo durante a gestação e paridade - para avaliar a associação entre o peso ao nascer e a densidade mineral óssea na adolescência. Utilizou-se regressão linear múltipla no software Stata 14.0. O nível de significância adotado foi de 5%. RESULTADOS Dos 2.112 adolescentes, 8,2% apresentaram baixo peso ao nascer e 2,8% apresentaram DMO considerada baixa para a idade. O Z-escore médio de corpo inteiro foi de 0,19 (± 1,00). O maior peso ao nascer foi associado de forma linear e direta aos valores de DMO na adolescência (Coef.: 0,10; IC95% 0,02-0,18), mesmo após ajuste para as variáveis renda familiar (Coef.: -0,33; IC95% -0,66-0,33) e a mãe saber ler e escrever (Coef.: 0,23; IC95% 0,03-0,43). CONCLUSÕES Apesar de a associação ter sido atenuada após ajuste das variáveis, o peso ao nascer está associado de forma positiva e linear à DMO na adolescência.

Cord Blood Lipid Profile of Term and Preterm Newborns in a Tertiary Hospital in South East Nigeria: Relationship with Gestational Age and Birth Weight

Background: Early-onset atherosclerosis is a marker of future cardiovascular diseases. However, indicators of early dyslipidemia for primary prevention are generally lacking in sub-Saharan Africa. This study aimed at describing the cord blood lipid profile among apparently healthy newborns in a tertiary hospital in Southeast Nigeria, and its relationship with gestational age and birth weight.Methods: Cross-sectional study of 167 consecutively recruited apparently well newborns in a tertiary hospital whose cord blood lipid profile parameters (total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL ­C), low-density lipoprotein cholesterol (LDL ­C) and very low-density lipoprotein cholesterol (VLDL ­C)) were assessed using an autoanalyzer (BiOLis 24i). Lipid variables were presented with descriptive statistics whereas their relationship with gestational age and birth weight was highlighted using Spearman's rank correlation analysis. Dunnett's T3 Post Hoc analysis was used for pairwise comparisons.Results: The 167 newborns recruited included 15 (9%) moderate preterm, 46 (27.5%) late preterm and 106 (63.5%) term babies of which 79 (47.3%) were males and 88 (52.7%) were females. The number of recruited SGA, AGA and LGA were respectively 13 (7.8%), 142 (85%), 12 (7.2%). Mode of delivery was majorly vaginal delivery (69.5%) while the rest (30.5%) was by caesarean section. The median values (in mg/dL) of TC, TG, HDL ­C, LDL ­C and VLDL ­C were 60.0, 30.5, 29.0, 25.8 and 6.1 respectively, all within the normal international ranges. Triglycerides and VLDL-C had a moderate positive correlation with gestational age (rs = 0.4;p < 0.001) and were significantly higher in small-for-gestational-age newborns. Total cholesterol, HDL ­C, and LDL-C had a weak negative correlation with gestational age and birth weight (spearman rs˂-0.3). Birth weight, gestational age, and paternal age were the common predictors of lipid profile variability.Conclusion: The finding of a significant relationship between lipid variables with gestational age and birth weight underscores the need to clinically interpret these given the relationship. The relationship with paternal age is another interesting finding which needs to be replicated and the mechanism(s) elucidated.

Anthelmintic usage on the Reproductive Parameters in Captive reared Agoutis (Dasyprocta leporina) in Trinidad and Tobago, West Indies / Uso de anti-helmíntico nos parâmetros reprodutivos em cutias criadas em cativeiro (Dasyprocta leporina) em Trinidad e Tobago, Índias Ocidentais

The agouti (Dasyprocta leporina) is a rodent that is found in the Neo-tropical region. This animal is hunted for its meat but has recently been reared in captivity as a source of meat protein in rural communities. A 20-month experiment was carried out to evaluate the effect of an anthelmintic on the reproductive performance of the agouti (Dasyprocta leporina) reared in captivity. This experiment was conducted in the humid tropics of Trinidad and Tobago. Sixteen animals (15 females, 1 male) placed in each of the two treatment groups in a completely randomized study design. In treatment 1 (T1) animals were given subcutaneous injections of Endovet Ces® (Ivermectin/Praziquantel) at 0.2 mg/kg every three months. Treatment 2 (T2) was the negative control group where animals were not exposed to an anthelmintic. Reproductive data were collected at parturition which included birth weight, litter weight, litter size and gender of offspring. The results showed that there was no statistical difference (p > 0.05) between the treatment groups with respect to birth weight, litter weight, litter size and gender. However, agoutis that were dewormed had a higher birth weight (220.24 g vs 209.1 g) and litter weight (369.8 g vs 343 g). The same values were obtained for the litter size (1.7 vs 1.7) and animals that were dewormed had a higher female offspring to male offspring (2.41:1 vs 1.11:1). This experiment demonstrated that the use of an anthelmintic strategically in the management of captive reared agoutis had no statistical effect (p > 0.05) on the reproductive parameters. Therefore, these animals can be kept in captive conditions without being dewormed and produce efficiently with proper feeding and housing management.

A cutia (Dasyprocta leporina) é um roedor que se encontra na região neo-tropical. Esse animal é caçado por sua carne, mas recentemente foi criado em cativeiro como fonte de proteína de carne em comunidades rurais. Um experimento de 20 meses foi realizado para avaliar o efeito de um anti-helmíntico no desempenho reprodutivo de cutias (Dasyprocta leporina) criadas em cativeiro. Esse experimento foi conduzido nos trópicos úmidos de Trinidad e Tobago. Dezesseis animais (15 fêmeas, 1 macho) colocados em cada um dos dois grupos de tratamento em um desenho de estudo completamente randomizado. No tratamento 1 (T1) os animais receberam injeções subcutâneas de Endovet Ces® (Ivermectina / Praziquantel) na dose de 0,2 mg / kg a cada três meses. O tratamento 2 (T2) foi o grupo de controle negativo onde os animais não foram expostos a um anti-helmíntico. Os dados reprodutivos foram coletados no parto, incluindo peso ao nascer, peso da ninhada, tamanho da ninhada e sexo da prole. Os resultados mostraram que não houve diferença estatística (p > 0,05) entre os grupos de tratamento com relação ao peso ao nascer, peso da ninhada, tamanho da ninhada e sexo. No entanto, cutias desparasitadas tiveram maior peso ao nascer (220,24 g vs. 209,1 g) e peso da ninhada (369,8 g vs. 343 g). Os mesmos valores foram obtidos para o tamanho da ninhada (1,7 vs. 1,7) e os animais que foram desparasitados tiveram uma prole feminina maior do que a prole masculina (2,41: 1 vs. 1,11: 1). Esse experimento demonstrou que o uso de anti-helmíntico estrategicamente no manejo de cutias criadas em cativeiro não teve efeito estatístico (p > 0,05) sobre os parâmetros reprodutivos. Portanto, esses animais podem ser mantidos em cativeiro sem serem vermifugados e produzir de forma eficiente com alimentação adequada e manejo do alojamento.

Meta-analysis of the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates / 中华儿科杂志

Objective: To systematically evaluate the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates. Methods: Eight databases in either Chinese or English, including PubMed, the Cochrane Library, Embase, Medline, Scopus, CNKI, Wanfang and VIP, were searched to extract the studies on the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates published from the establishment of each database to December 2022. The Meta-analysis was performed using Stata 14.0 statistical software. Results: A total of 9 studies were included in this Meta-analysis, including 6 retrospective cohort studies, 2 prospective cohort studies and 1 randomized controlled trial (RCT) study, involving 9 143 premature infants. The Meta-analysis showed that prenatal steroid exposure increased the risk of late preterm neonatal hypoglycemia (RR=1.55, 95%CI 1.25-1.91, P<0.001). The similar correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates was all found in the following subgroups: North America (RR=1.57, 95%CI 1.37-1.80, P<0.001), enrolling pregnant women with gestational diabetes (RR=1.62, 95%CI 1.26-2.08, P<0.001), A-grade literature quality (RR=1.43, 95%CI 1.14-1.79, P=0.002), criteria for hypoglycemia ≤40 mg/dl (1 mg/dl=0.056 mmol/L, RR=1.49, 95%CI 1.28-1.73, P<0.001), sample size of 501-1 500 (RR=1.69, 95%CI 1.19-2.40, P=0.003) and >1 500 (RR=1.65, 95%CI 1.48-1.83, P<0.001), steroid injection dosage and frequency of 12 mg 2 times (RR=1.66, 95%CI 1.50-1.84, P<0.001), the time interval from antenatal corticosteroid administration to delivery of 24-47 h (RR=1.98, 95%CI 1.26-3.10, P=0.003), unadjusted gestational age (RR=1.78, 95%CI 1.02-3.10,P=0.043) and unadjusted birth weight (RR=1.80, 95%CI 1.22-2.66, P=0.003). Meta-regression results showed that steroid injection frequency and dose were the main sources of high heterogeneity among studies (P=0.030). Conclusion: Prenatal steroid exposure may be a risk factor for hypoglycemia in late preterm neonates.

Reference values and growth curves of length for weight and head circumference for weight among Chinese newborns / 中华儿科杂志

Objective: To establish the reference values and growth curves of length for weight and head circumference for weight among Chinese newborns in order to provide a reference for the assessment of body proportionality at birth. Methods: A cross-sectional design was applied. A total of 24 375 singleton live birth newborns with gestational ages at birth of 24+0 to 42+6 weeks were recruited from June 2015 to November 2018 from 13 cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha, and Shenzhen, excluding those with maternal or newborn conditions that may impact the establishment of the reference values. The generalized additive model for location, scale, and shape was employed to establish reference values in terms of percentile and growth curves of length for weight and head circumference for weight for male and female newborns. The random forest machine learning method was employed to analyze the importance of variables between the established reference values in this study and the previous published weight/length, body mass index (BMI), ponderal index (PI), weight/head circumference, length/head circumference in the assessment of symmetrical and asymmetrical small for gestational age (SGA) newborns. Results: A total of 24 375 newborns with 13 197 male infants (preterm birth 7 042 infants and term birth 6 155 infants) and 11 178 female infants (preterm birth 5 222 infants and term birth 5 956 infants) were included in this study. The reference values in terms of percentile (P3, P10, P25, P50, P75, P90, P97) and growth curves of length for weight and head circumference for weight were obtained for male and female newborns with gestational ages of 24+0 to 42+6 weeks. The median birth lengths corresponding to the birth weights of 1 500, 2 500, 3 000, and 4 000 g were 40.4, 47.0, 49.3 and 52.1 cm for males and 40.4, 47.0, 49.2, and 51.8 cm for females, respectively; the median birth head circumferences were 28.4, 32.0, 33.2 and 35.2 cm for males and 28.4, 32.0, 33.1, and 35.1 cm for females, respectively. The differences of length for weight between males and females were minimum, with the difference range of -0.3 to 0.3 cm at P50; the differences of head circumference for weight between males and females were minimum, with the difference range of 0 to 0.2 cm at P50. Based on the match between birth length and birth weight for classifying symmetrical and asymmetrical SGA, length for weight and PI contributed the most, accounting for 0.32 and 0.25, respectively; based on the match between birth head circumference and birth weight, head circumference for weight and weight/head circumference contributed the most, accounting for 0.55 and 0.12, respectively; based on the match between birth length or head circumference with birth weight, head circumference for weight and length for weight contributed the most, accounting for 0.26 and 0.21, respectively. Conclusion: The establishment of the new standardized growth reference values and growth curves of length for weight and head circumference for weight among Chinese newborns are useful for clinical practice and scientific research.

Establishment method and significance of birthweight curve and reference in single center / 中华妇产科杂志

Objective: To establish neonatal birthweight percentile curves based on single-center cohort database using different methods, compare them with the current national birthweight curves and discuss the appropriateness and significance of single-center birthweight standard. Methods: Based on a prospective first-trimester screening cohort at Nanjing Drum Tower Hospital from January 2017 to February 2022, the generalized additive models for location, scale and shape (GAMLSS) and semi-customized method were applied to generate local birthweight percentile curves (hereinafter referred to as the local GAMLSS curves, semi-customized curves) for 3 894 cases who were at low risk of small for gestation age (SGA) and large for gestation age (LGA). Infants were categorized as SGA (birth weight<10th centile) by both semi-customized and local GAMLSS curves, semi-customized curves only, or not SGA (met neither criteria). The incidence of adverse perinatal outcome between different groups was compared. The same method was used to compare the semi-customized curves with the Chinese national birthweight curves (established by GAMLSS method as well, hereinafter referred to as the national GAMLSS curves). Results: (1) Among the 7 044 live births, 404 (5.74%, 404/7 044), 774 (10.99%, 774/7 044) and 868 (12.32%, 868/7 044) cases were diagnosed as SGA according to the national GAMLSS curves, the local GAMLSS curves and the semi-customized curves respectively. The birth weight of the 10th percentile of the semi-customized curves was higher than that of the local GAMLSS curves and the national GAMLSS curves at all gestational age. (2) When comparing semi-customized curves and the local GAMLSS curves, the incidence of admission to neonatal intensive care unit (NICU) for more than 24 hours of infants identified as SGA by semi-customized curves only (94 cases) and both semi-customized and local GAMLSS curves (774 cases) was 10.64% (10/94) and 5.68% (44/774) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks of infants identified as SGA by the semi-customized curves only and both semi-customized and local GAMLSS curves was 12.77% (12/94) and 9.43% (73/774), 9.57% (9/94) and 2.71% (21/774), 24.47% (23/94) and 7.24% (56/774) respectively, which were significantly higher than those of the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. (3) When comparing semi-customized curves and the national GAMLSS curves, the incidence of admission to NICU for more than 24 hours of infants identified as SGA by semi-customized curves only (464 cases) and both semi-customized and national GAMLSS curves (404 cases) was 5.60% (26/464) and 6.93% (28/404) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); all P<0.001]. The incidence of emergency cesarean section or forceps delivery for non-reassuring fetal status (NRFS) in infants identified as SGA by semi-customized curves only and both semi-customized and national GAMLSS curves was 4.96% (23/464) and 12.38% (50/404), both significantly higher than that in the non SGA group [2.57% (159/6 176); all P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks in the semi-customized curves only group and both semi-customized and national GAMLSS curves group was 8.84% (41/464) and 10.89% (44/404), 4.31% (20/464) and 2.48% (10/404), 10.56% (49/464) and 7.43% (30/404) respectively, all significantly higher than those in the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. Conclusion: Compared with the national GAMLSS birthweight curves and the local GAMLSS curves, the birth weight curves established by semi-customized method based on our single center database is in line with our center' SGA screening, which is helpful to identify and strengthen the management of high-risk infants.

Changes and significance of type 2 innate lymphoid cells and their related factors in bronchopulmonary dysplasia / 中国当代儿科杂志

OBJECTIVES@#To investigate the changes and significance of type 2 innate lymphoid cells (ILC2), interleukin-33 (IL-33), interleukin-25 (IL-25), thymic stromal lymphopoietin (TSLP), interleukin-5 (IL-5), and interleukin-13 (IL-13) in peripheral blood of preterm infants with bronchopulmonary dysplasia (BPD).@*METHODS@#A total of 76 preterm infants with a gestational age of <32 weeks and a length of hospital stay of ≥14 days who were admitted to the Department of Pediatrics of the Affiliated Hospital of Jiangsu University from September 2020 to December 2021 were enrolled. According to the diagnostic criteria for BPD, they were divided into a BPD group with 30 infants and a non-BPD group with 46 infants. The two groups were compared in terms of the percentage of ILC2 and the levels of IL-33, IL-25, TSLP, IL-5, and IL-13 in peripheral blood on days 1, 7, and 14 after birth.@*RESULTS@#The BPD group had significantly lower birth weight and gestational age than the non-BPD group (P<0.05). On days 7 and 14 after birth, the BPD group had significantly higher levels of ILC2, IL-33, TSLP, and IL-5 than the non-BPD group (P<0.05), and these indices had an area under the curve of >0.7 in predicting the devolpment of BPD (P<0.05). Multivariate logistic regression analysis showed that after adjusting for gestational age and birth weight, peripheral blood IL-33, TSLP and IL-5 on days 7 and 14 after birth were closely related to the devolpment of BPD (P<0.05).@*CONCLUSIONS@#Early innate immune activation and upregulated expression of related factors may be observed in preterm infants with BPD. ILC2, IL-33, TSLP, and IL-5 may be used as biological indicators for early diagnosis of BPD.

Association between early-life factors and pubertal timing in girls / 中国当代儿科杂志

OBJECTIVES@#To study the association between early-life factors (including birth weight, method of birth, gestational age, and history of gestational metabolic disorders) and pubertal timing in girls.@*METHODS@#The stratified cluster sampling method was used to select the girls in grades 2-3 and 7-8 from three primary schools and three middle schools in Guangzhou, China from March to December, 2019, and breast development was examined for all girls. A questionnaire survey was performed to collect the information on early-life factors. The multivariate logistic regression model was used to evaluate the association of gestational metabolic disorders, birth weight, method of birth, and gestational age with pubertal timing in girls. The Bootstrap method was used to assess the mediation effect of body mass index (BMI) (Z score) between high birth weight (≥4 000 g) and pubertal timing.@*RESULTS@#A total of 1 665 girls were enrolled, among whom 280 (16.82%) were judged to have early pubertal timing. The multivariate logistic regression analysis showed that high birth weight was associated with the increased risk of early pubertal timing (OR=2.12, 95%CI: 1.19-3.66, P=0.008). Nevertheless, no significant association was observed between other early-life factors and pubertal timing (P>0.05). The OR for the mediation effect of BMI (Z score) between high birth weight and early pubertal timing was 1.25 (95%CI: 1.09-1.47), accounting for 29.33% of the total effect of high birth weight on early pubertal timing.@*CONCLUSIONS@#High birth weight is associated with the increased risk of early pubertal timing in girls, and overweight/obesity may play a partial mediating role in the association between high birth weight and early pubertal timing in girls.

Outcome of neonates born to mothers with chronic kidney disease / 中国当代儿科杂志

About 3% of pregnant women suffer from chronic kidney disease (CKD). This article reviews the literature on the outcomes of neonates born to mothers with CKD (including those undergoing dialysis and kidney transplantation), and the results show that CKD during pregnancy may increase the risk of preterm birth, low birth weight, and small for gestational age infant, but it does not increase the risk of congenital anomalies. As for long-term outcomes, CKD during pregnancy has no significant impact on offspring's physical development and immune function. Neurodevelopmental outcome of offspring is associated with preterm birth and low birth weight, rather than intrauterine drug exposure. However, further research and follow-up are needed to investigate the outcome of neonates born to mothers with CKD.

Dwelling time and complications of umbilical venous catheterization with different tip positions in preterm infants: a multicenter prospective cohort study / 中华儿科杂志

Objective: To compare the dwelling time and complications of low lying umbilical venous catheterization (UVC) in preterm infants with that of central UVC. Methods: This was a prospective cohort study. A total of 3 020 preterm infants from 44 neonatal intensive care units (NICU) who had UVC inserted from October 2019 to August 2021 were enrolled. Demographic and general baseline data, dwelling time of UVC and reasons for removal, complications and their occurrence time were collected. According to the position of the catheter tip, the preterm infants were divided into low lying UVC group (insertion depth of 3-5 cm) and central UVC group (the catheter tip was close to the entrance of right atrium, or at the 8th-9th thoracic vertebra level). The Mann-Whitney U test was used to compare the dwelling time and incidence of complications (cases/1 000 catheter days), and the independent t test and Chi-square test were used to compare the characteristics between the 2 groups. The receiver operating characteristic (ROC) curve was used to analyze the optimal cut-off value of UVC dwelling time. Results: Among the included 3 020 preterm infants, 1 624 (53.8%) were males, the gestational age was 29.9 (28.4, 31.6) weeks, the birth weight was (1 264±301) g, and 2 172 (71.9%) premature babies had central UVC. There were no significant differences in the proportion of males, the gestational age and the birth weight of neonates between the 2 groups (all P>0.05). There were also no significant differences in the rate of maternal history, PPROM>18 hours, chorioamnionitis, antenatal antibacterial angents exposure and antibacterial angents usage through UVC (all P>0.05). The dwelling time of central UVC was longer than that of low lying UVC (7 (6, 10) vs. 4 (3, 7) days, U=23.42, P<0.001). The complication incidence of central and low lying UVC were 20.0 and 70.8 cases/1 000 catheter days, respectively. The top 3 complications of central UVC were occlusion, catheter tip migration, and CLABSI (9.3, 3.5, 3.0 cases/1 000 catheter days). The top 3 complications of low lying UVC were catheter occlusion, CLABSI, and catheter tip migration (45.8, 6.3, 5.4 cases/1 000 catheter days). The ROC curve of UVC dwelling time and complications showed that the cut-off values ​​of central UVC and low lying UVC were 6.5 and 4.5 days, respectively. The 2 groups both showed a trend of increases in the 3 complications with the prolonged dwelling time. Cox regression analysis showed that the overall difference in the proportion of occlusion between the central UVC and low lying UVC groups was statistically significant (χ2=30.18, P=0.024). There were both no significant differences in catheter tip migration and CLABSI (both P>0.05). Conclusions: The most common UVC complication in preterm infants is occlusion. It is not recommended to keep a low lying UVC for longer than 4.5 days. During the whole dwelling period, a close monitoring for UVC complications is required.

Management and prognosis of extremely preterm infants with gestational age ≤25+6 weeks / 中华儿科杂志

Objective: To investigate the outcomes including major complications and prognosis of extremely preterm infants with gestational age ≤25+6 weeks. Methods: The cross-sectional study enrolled 233 extremely preterm infants with gestational age ≤25+6 weeks who were admitted to the Department of Neonatology of Shenzhen Maternity and Child Healthcare Hospital from January 2015 to December 2021. The clinical data including perinatal factors, treatments, complications, and prognosis were extracted and analyzed. These extremely preterm infants were also grouped according to gestational age and year of admission to further analyze their survival rate, major complications, causes of death, and long-term outcomes. The comparisons between the groups were performed with Chi-square test and Kruskal-Wallis. Results: Among these 233 extremely preterm infants, 134 (57.5%) were males and 99 (42.5%) females. The gestational age was (24.6±0.9) weeks, the birth weight was 710.0 (605.0,784.5) g, and the overall survival rate was 61.8% (144/233). Among the surviving extremely preterm infants, the earliest gestational age was 22+2 weeks and the lowest birth weight was 390 g. There were 17.6% (41/233) of extremely preterm infants had treatment withdrawn and were discharged in line with the will of guardians. Among the rest 192 extremely preterm infants managed with aggressive treatments, 14 (7.3%) died in hospital and 34 (17.7%) had treatment withdrawn later due to severe complications. Of the 192 extremely preterm infants, 144 (75.0%) survived, and the survival rate increased year by year (χ2=26.28, P<0.001) while the mortality decreased year by year (χ2=14.09, P=0.027). Among the survivors, 20.8%(30/144) had no major complications, and the incidence of complications was also negatively related with the gestational age (χ2=7.24, P=0.044), and the length of invasive ventilation was negatively related to the gestational age (χ2=29.14, P<0.001). In the group of less than 23+6 weeks, all extremely preterm infants had one or more major complications. The follow-up were completed in 122 infants and revealed that delayed motor development, language retardation, and hearing and vision impairment accounted for 17.2% (21/122), 8.2% (10/122) and 17.2% (21/122), respectively. Conclusions: Extremely preterm infants with gestational age ≤25+6 weeks are difficult to treat, but the survival rate of infants undergoing aggressive treatments increases year by year. Although the prevalence of major complications is still high, most extremely preterm infants have acceptable prognosis during follow-up.

Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China / 中华儿科杂志

Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34+0 weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.

Correlation analysis between prenatal exposure of per-/polyfluoroalkyl compounds and neonatal outcome / 中华预防医学杂志

Objective: To investigate the correlation between the prenatal exposure of per-/polyfluoroalkyl substances (PFASs) and the neonatal outcome. Methods: A total of 506 maternal infant cohort samples were collected in Hangzhou, Zhejiang province from 2020 to 2021. The exposure levels of seven PFASs in maternal serum before delivery were detected by solid-phase extraction-ultra performance liquid chromatography tandem mass spectrometry. Multivariable linear regression model was used to analyze the influence of prenatal exposure of PFASs on birth weight, birth length and Apgar score. Results: The maternal age, prenatal body mass index and gestation age were (31.3±4.3) years old, (26.7±3.2) kg/m2 and (265.0±28.3) days, respectively. The birth weight, birth length and scores of Apgar-1 and Apgar-5 were (3.1±0.8) kg, (49.3±2.9) cm, (9.88±0.47) points and (9.99±0.13) points, respectively. PFASs were widely distributed in maternal serum, with the highest concentration of (18.453±19.557) ng/ml, (6.756±9.379) ng/ml and (5.057±8.555) ng/ml for perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS) and 6∶2 chlorinated polyfluorinated ether sulfonate (Cl-PFESA), respectively. Maternal age, parity and delivery mode were associated with the exposure level of PFASs (P<0.05). Subgroup analysis showed that PFOS had negative effects on birth weight (β=-0.958), birth length (β=-0.073) and Apgar-5 score (β=-0.288) for neonates in the low birth weight (LBW) group. 6∶2 Cl-PFESA and 8∶2 Cl-PFESA inhibited the birth weight (β=-0.926; β=-0.552) and length (β=-0.074; β=-0.045) of newborn in the LBW group. In addition, 4∶2 fluorotelomer sulfonate (FTS) was associated with increased birth weight (β=0.111) and decreased Apgar-5 score (β=-0.030) in the normal weight group. Conclusion: Prenatal exposure to PFASs is associated with birth weight, birth length and Apgar-5 score. It is necessary to continue to pay attention to the impact of PFASs on fetal growth and development through maternal-fetal transmission.

Prevalence of anemia in pregnancy and its association with birth weight / Prevalencia de anemia en la gestación y su relación con el peso al nacer

Abstract Objectives: to assess the prevalence of maternal gestational anemia and its association with the birth weight. Methods: retrospective longitudinal observational study in a cohort of 370 pregnant women. Anthropometric, biochemical, ginecobstetric and sociodemographic data of both mothers and newborns were evaluated. The results of maternal erythrocyte indices were analyzed and contrasted with newborns anthropometrical data. Results: the mean age of the pregnant women was 27±6 years, with a mean gestational age of 32±6 weeks at the assessment moment, 56.2% were overweight. The prevalence of anemia was 28.6%. 47.2% women with anemia and 36% women without anemia had low birth weight/very low birth weight newborns (p=0.009). Of the children born to mothers with iron deficiency anemia, 20% had low birth weight and 15% very low birth weight. 54.3% newborns with global undernutrition or at risk of developing it were born to women with underweight(p=0.046), in addition, the higher the maternal weight, the lower the number of term newborns with risk of short height (p<0.001). Conclusions: there is relationship between the anemia, the maternal nutritional status and the birth weight.

Resumen Objetivos: evaluar la prevalencia de anemia gestacional materna y su relación con el peso al nacer. Métodos: estudio observacional longitudinal retrospectivo en una cohorte 370 mujeres gestantes. Se evaluaron variables demográficas clínicas y antropométricas tanto de las madres como de los recién nacidos. Se analizaron los resultados de los índices eritrocitarios maternos y se contrastaron con los datos antropométricos de los neonatos. Resultados: la edad promedio de las gestantes fue de 27±6 años con edad gestacional promedio al momento de la evaluación nutricional de 32±6 semanas, el 56,2% presentaron exceso de peso. La prevalencia de anemia fue de 28,6%. El 47,2% de gestantes con anemia y el 36% de gestantes sin anemia tuvieron neonatos con bajo peso/muy bajo al nacer (p=0,009). De los niños nacidos de madres con anemia ferropénica 20% tuvo bajo peso y 15% muy bajo peso al nacer. El 54,3% de neonatos con desnutrición global o en riesgo de desarrollarla fueron hijos de madres con bajo peso (p=0,046), además a mayor peso materno, menor cantidad de neonatos a término con riesgo de baja talla (p<0,001). Conclusiones: existe relación entre la anemia, el estado nutricional materno y el peso al nacer.

Índice de massa corpórea de recém-nascidos de gestações de baixo risco segundo idade gestacional e sexo / Newborns' body mass index from low-risk pregnancies according to gestational age and sex

O estado nutricional e o crescimento alcançado pelo recém-nascido tem sido utilizados como marcador/indicador de riscos de morbimortalidade precoce e até de problemas em idades mais avançadas. Como consequência o Indice de Massa Corpórea (IMC) pode ser instrumento útil para esta finalidade. O objetivo foi analisar o IMC de recém-nascidos de 34 a 41 semanas completas de idade gestacional (IG) de gestações de baixo risco. Trata-se de um estudo descritivo, analítico e quantitativo, desenvolvido a partir do banco de dados do projeto "Características biométricas ao nascimento, de filhos de mulheres adultas jovens, em um município de elevado índice de desenvolvimento humano". Foram incluídos no estudo todos os RN nascidos vivos no período de maio de 2015 e março de 2018 no Hospital Universitário de Taubaté, filhos de mulheres sem morbidade, que apresentavam em seus registros: a data do parto, idade e/ou data de nascimento materna, tipo de gestação, tipo de parto, IG, sexo, peso, comprimento e perímetro craniano ao nascimento. Foram excluídos os recém-nascidos de gestações gemelares, portadores de malformações ou outras morbidades. Também foram excluídos os que apresentavam valores extremos, acima de 3 desvios padrão em relação à média ou dados inconsistentes no arquivo. Realizaram-se análises de tendência central e dispersão dos valores, além das correlações entre IG e o peso do RN, e o comprimento do RN, e análise da correlação entre IG e o IMC do RN, sempre por sexo. Além disso, foram feitas comparações entre a evolução dos valores estimados de IMC por IG e sexo e os valores publicados por Olsen et.al (2015), Brock et.al (2008) e Davidson et.al (2011) e das tendências de evolução do IMC segundo a classificação ao nascimento em: pequenos para a idade gestacional (PIG), adequados para a IG (AIG) e grandes para a IG (GIG). Dos 6.321 nascidos no período, 6.138 preencheram os critérios de inclusão, destes 3.074 (50,1%) eram do sexo masculino. Metade da população de estudo nasceu entre 38 e 40 semanas de IG, com peso AIG, comprimento entre 46,5cm e 49 cm. A prevalência de partos vaginais foi de 60,1%. A descrição dos valores de IMC, mostrou um crescimento compatível com a evolução da idade gestacional tanto para recém-nascidos do sexo masculino quanto feminino. O comportamento do IMC ao nascimento, tanto em valor absoluto quando em escore-z, mostrou diferenças entre os três grupos de classificação da adequação dos RN, com os maiores valores observados entre os GIG e os menores para os PIG, tanto em meninos quanto em meninas, segundo IG. A tendência de evolução de acordo com a IG dos valores estimados de IMC foi semelhante com a tendência dos outros autores, embora em patamares de valores absolutos distintos. A interpretação destes resultados aponta a necessidade de se desenvolver novas pesquisas para estudar o comportamento do IMC, particularmente no Brasil, para verificar se resultados do IMC semelhantes são observados também em outras cidades/Estados/regiões e confirmar o possível papel do crescimento em comprimento na produção de valores de IMC aparentemente favoráveis. Além disso é também de interesse verificar uma possível influência intergeracional nos valores de crescimento do comprimento intraútero, no nosso meio.

The nutritional status and growth of the newborn (NB) have been used as a marker/indicator of morbidity and mortality risks that may occur at more advanced ages. This study aimed to analyze NBs' body mass index (BMI) born between 33 and 41 completed weeks of gestational age (GA) of low-risk pregnancies. This descriptive, analytical, quantitative, and retrospective study was developed from the project's database "Biometric characteristics at birth, of children of young adult women, in a municipality with a high human development index". All NBs born alive from single pregnancies from adult women and were born between May 2015 and March 2018 at the University Hospital of Taubaté, who presented in their records at least the date of delivery, maternal age and/or maternal date of birth, type of pregnancy, type of delivery, gestational age (GA), sex, weight at birth, and length at birth were included in the study. Analysis of the correlation between GA and NB weight by sex was carried out by calculating the correlation coefficient and its respective significance. As well as the correlation between GA and NB length by sex and analysis of the correlation between GA and BMI of the NB by sex. Additionally, graphic comparisons were made with the evolution of BMI by GI and sex and the values published by researchers Olsen et al. (2015), Brock et al. (2008), and Davidson et al. (2011) and BMI evolution trends according to the classification at birth in small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). In the study period, 6.321 children were born, and 6,138 met the inclusion criteria, being 3,074 males and 3.064 females. Half of the study population was born between 38 and 40 weeks of gestation, with AGA birth weight, a length between 46.5cm and 49 cm, and a prevalence of 60.1% of vaginal deliveries. The description of BMI values showed growth compatible with the evolution of GA for both male and female NBs. The behavior of BMI at birth, both in absolute value and in z-scores, showed that there was a difference between the three groups for classifying the adequacy of NBs proposed by Battaglia and Lubchenco (1967), with the highest values observed among the LGA and the smallest for SGA, both for boys and girls at different GAs. The interpretation of these results also opens some perspectives for the development of new research, particularly in Brazil, to verify whether similar BMI results are also observed in other cities/states/regions, in addition to demonstrating a possible intergenerational influence and confirming the potential role of growth in length in producing favorable BMI values.

Association between prepregnancy and newborn body mass index / Associação entre o índice de massa corporal pré-gestacional e o do recém-nascido

Abstract Objectives: to investigate the association between prepregnancy body mass index (BMI) and newborns' (NB) BMI. Methods: cohort study with 1,365 pregnant women and their newborns from the BRISA survey (Brazilian Ribeirão Preto and São Luís Birth Cohort Studies) in São Luís-MA. Prepregnancy BMI was self-reported, and newborns' BMI was estimated using the weight and length measured at birth. A directed acyclic graph (DAG) was developed to identify the adjustment variables. The association between the prepregnancy BMI and newborns' BMI were analyzed using multiple linear and Poisson regression with robust variance estimation. Results: NBs had 13.4±1.7kg/m2 average BMI at birth. In the linear analysis, we observed that as the prepregnancy BMI increases, the NBs BMI also increases (ß=0.07; CI95%=0.05-0.09;p<0.001). Newborns of mothers with prepregnancy overweight were 3.58 times more likely to be overweight. Conclusion: prepregnancy BMI can affect newborn's BMI early. Thus, women planning to become pregnant should consider conducting nutritional planning to maintain or obtain a healthy weight to minimize the risk of overweight for the newborn.

Resumo Objetivos: investigar a associação entre o Índice de Massa Corporal (IMC) pré-gestacional e o IMC do recém-nascido (RN). Métodos: estudo de coorte, com 1365 gestantes e seus RN, participantes da pesquisa BRISA (Brazilian Ribeirão Preto and São Luís Birth Cohort Studies) em São Luís-MA. O IMC pré-gestacional foi autorreferido e o IMC do RN foi calculado por meio do peso e comprimento aferidos na ocasião do nascimento. Foi elaborado um Gráfico Acíclico Direcionado (DAG)para identificaras variáveis de ajuste. A associação entre o IMC pré-gestacional e IMC do RN foram analisados por regressão linear múltipla e regressão de Poisson com estimativa robusta da variância. Resultados: os RN tiveram IMC ao nascer médio de 13,4 ± 1,7 kg/m2. Na análise linear, foi observada que à medida que o IMC pré-gestacional aumenta, o IMC do RN também aumenta (ß= 0,07; IC95%= 0,05 - 0,09; p<0.001). RN de mães com excesso de peso pré-gestacional tiveram risco 3,58 vezes maior de terem excesso de peso. Conclusão: o IMC pré-gestacional pode afetar precocemente o IMC do RN. Dessa forma, recomenda-se que mulheres que planejem engravidar considerem realizar um planejamento nutricional para a manutenção ou obtenção de um peso saudável, a fim de minimizar o risco de excesso de peso para o RN.

Influencia de la anastomosis de las arterias umbilicales (Hyrtl's) en la morfometría y eficiencia placentaria / Influence of the anastomosis of the umbilical arteries (Hyrtl's) on the morphometry and efficiency of the placenta

La anastomosis de Hyrtl's (AH), vaso único con amplia variabilidad anatómica, comunica las arterias umbilicales cerca de la inserción del cordón umbilical en las placentas humanas. El objetivo del presente trabajo fue determinar si existe relación entre las características morfométricas de la placenta y la presencia de anastomosis y analizar si esta tiene influencia en la eficiencia placentaria. Estudio descriptivo. Se analizaron 60 placentas provenientes de madres que aceptaron participar en la investigación, embarazo único, a término (entre 37,0 y 41,6 semanas), con edades entre 18 y 37 años, con al menos cuatro visitas a control prenatal, sin comorbilidades. Las características placentarias de peso, diámetros y grosor se tomaron en fresco. Una vez fijadas con formaldehido al 10 %, mediante disección se ubicó, clasificó y fotografió la anastomosis. El peso de la placenta fue 494,4 ± 87,1 gramos, el grosor central correspondió a 1,7 ± 0,4 cm, DM 19,9 ± 2,0 cm y Dm 18,4 ± 1,7 cm. La inserción de cordón predominante fue excéntrica (65 %) y la forma discoidea u ovalada (60 %). En 51 placentas se ubicó la presencia de anastomosis (85 %). En el grupo de placentas con presencia AH se encontró un peso placentario más bajo al compararlo con el grupo que no presentó AH, el resto de las características morfométricas de la placenta, incluido el tipo de inserción de cordón umbilical no presentaron relación con la anastomosis. La eficiencia placentaria expresada con la relación entre peso neonato/peso placenta presentó diferencias significativas en el grupo con presencia de anastomosis, con mayores valores comparados con el grupo sin anastomosis. La presencia de AH contribuye positivamente a la eficiencia placentaria. Sin embargo, el incremento del peso placentario puede ser un efecto compensador de la placenta y no siempre indica una mayor eficiencia funcional del órgano.

SUMMARY: Hyrtl's anastomosis (HA), a single vessel, with wide anatomical variability, communicates the umbilical arteries, near the insertion of the umbilical cord in human placentas. The objective of this study was to determine if there is a relationship between the morphometric characteristics of the placenta and the presence of the anastomosis and to analyze if this influences the placental efficiency. Descriptive study. We analyzed 60 placentas from mothers who agreed to participate in the study, single pregnancy, term (between 37.0 and 41.6 weeks), aged between 18 and 37 years with at least four visits to prenatal control, without comorbidities. The placental characteristics of weight, diameters and thickness were taken fresh. Once fixed with 10 % formaldehyde, the anastomosis was located, classified, and photographed by dissection. The weight of the placenta was 494.4 ± 87.1 g, the central thickness corresponded to 1.7 ± 0.4 cm, the MD 19.9 ± 2.0 cm and Dm 18.4 ± 1.7 cm: The predominant cord insertion was eccentric, with 65 % and the discoid or oval shape with 60 %. In 51 placentas the presence of anastomosis was found (85 %). In the group of placentas with AH presence, a lower placental weight was found when compared to the group that did not present AH, the rest of the morphometric characteristics of the placenta, including the type of umbilical cord insertion, were not related to the anastomosis. Placental efficiency expressed as the neonatal weight/placental weight ratio showed significant differences in the group with presence of anastomosis, with higher values compared to the group without anastomosis. The presence of HA contributes positively to placental efficiency. However, the increase in placental weight may be a compensatory effect of the placenta and does not always indicate a greater functional efficiency of the organ.

Perfil de morbidade no primeiro ano de vida entre recém-nascidos de alto risco / Morbidity profile in the first year of life among high-risk newborns

Os cuidados destinados aos recém-nascidos prematuros extremos têm propiciado importantes resultados na sobrevida dessas crianças. Objetivo: Caracterizar o perfil de morbidade no primeiro ano de vida entre recémnascidos de alto risco. Materiais e Métodos: Trata-se de uma pesquisa exploratória realizada no ambulatório de seguimento de recém-nascidos de alto risco do norte de Minas Gerais. A coleta de dados foi referente às admissões no período de março de 2014 a abril de 2015. O instrumento contemplava características: demográficas, sociais, condições de gestação e parto, intercorrências no pós-parto e condições de saúde das crianças acompanhadas ao longo do primeiro ano de vida. Realizou-se a análise estatística descritiva e o teste Qui-Quadrado, assumindo-se um nível de significância de 5% para comparação da distribuição das morbidades por faixas de peso. Resultados: Participaram deste estudo 282 recém-nascidos, sendo 53,9% do sexo masculino. Entre as mães, 58,2% era multípara e 35,8% hipertensas. Em relação ao peso de nascimento, 59,6% dos recém-nascidos acompanhados pesaram menos de 1500 gramas. As principais morbidades identificadas no primeiro ano de vida foram atraso do desenvolvimento neuro-psicomotor, infecções de vias aéreas superiores, as alterações neurológicas e as afecções respiratórias crônicas. Foram registradas diferenças estatisticamente significantes para o atraso do desenvolvimento neuro-psico-motor (p<0,001), intercorrências neurológicas (p=0,008) e episódios de diarreia (p=0,047), entre as faixas de peso de nascimento. Conclusão: A assistência ambulatorial para o recém-nascido prematuro de alto risco contribui para a identificação e a prevenção de doenças recorrentes nessa população(AU)

Introduction: Care for extremely premature newborns has provided important results in the survival of these children. Objective: To characterize the morbidity profile in the first year of life among high-risk newborns. Materials and Method: This is an exploratory research carried out at the follow-up clinic for high-risk newborns in the north of Minas Gerais. Data collection referred to admissions in the period from March 2014 to April 2015. The instrument included characteristics: demographic, social, pregnancy and delivery conditions, postpartum complications and health conditions of children monitored during the first year of life. Descriptive statistical analysis and the chisquare test were performed, assuming a significance level of 5% to compare the distribution of morbidities by weight range. Results: A total of 282 newborns participated in this study, 53.9% of whom were male. Among the mothers, 58.2% were multiparous and 35.8% were hypertensive. Regarding birth weight, 59.6% of newborns monitored weighed less than 1500 grams. The main morbidities identified in the first year of life were delayed neuro-psycho-motor development, upper airway infections, neurological disorders and chronic respiratory conditions. Statistically significant differences were recorded for delayed neuro-psycho-motor development (p<0.001), neurological complications (p=0.008) and episodes of diarrhea (p=0.047), between birth weight ranges. Conclusion: Outpatient care for high-risk premature newborns contributes to the identification and prevention of recurrent diseases in this population(AU)