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.

Relação entre a condição bucal de gestantes internadas e desfechos adversos na gestação / Relationship between the oral condition of hospitalized pregnant women and adverse pregnancy outcomes

Objetivo: avaliar se a condição bucal favoreceu a presença de desfechos adversos da gestação (DAG) em mulheres internadas e acompanhadas em um hospital escola. Métodos: um estudo de coorte retrospectiva com mulheres grávidas que foram internadas entre setembro de 2019 e início de março de 2020 e que continuaram o acompanhamento obstétrico. Resultados: Das 65 gestantes que seguiram acompanhamento, 27 (41,5%) dos bebês nasceram pré-termo e 20 (30,8%) com baixo peso, sendo que as duas condições estavam presentes em 15 crianças (23,1%), sendo significantemente relacionadas com a menor semana gestacional na internação. Ao relacionar diferentes fatores com o desfecho pré-termo, houve diferença significante em gestantes com a ocupação "do lar" e com o tempo de internação igual ou maior que 10 dias e com a presença de baixo peso ao nascer. Não foi observada relação dos dados avaliados da condição bucal das gestantes na internação com o parto pré-termo. Conclusões: Gestantes que necessitam de internação hospitalar durante a gravidez, independente da condição bucal, aumentam a possibilidade de apresentarem DAG, sendo fundamental a realização do correto acompanhamento pré-natal.(AU)

Objective: to assess whether the oral condition favored the presence of adverse effects during pregnancy in pregnant women hospitalized and followed up at a teaching hospital. Methods: a retrospective cohort study with mothers who were hospitalized during pregnancy between September 2019 and early March 2020 and who continued obstetric follow-up. Results: 83 pregnant women were interviewed and 65 were followed up Of the 65 pregnant women who followed up, 27 (41.5%) of the babies were born preterm and 20 (30.8%) with low birth weight, and both conditions were present in 15 children (23.1%), being significantly related to the shortest gestational week at admission. When relating different factors with the preterm outcome, there was a significant difference in pregnant women with the occupation "housewife" and with the length of hospital stay equal to or greater than 10 days and with the presence of low birth weight. There was no relationship between the evaluated data on the oral condition of pregnant women during hospitalization and preterm delivery. Conclusions: Pregnant women who require hospitalization during pregnancy, regardless of oral condition, increase the possibility of having negative pregnancy outcomes, and correct prenatal care is essential. (AU)

A internação da gestante pode afetar a condição bucal do filho no terceiro ano de vida? / Can a pregnant woman's hospitalization affect the child's oral condition in the third year of life?

Objetivo: Avaliar se a hospitalização na gestação pode influenciar na condição bucal do filho no terceiro ano de vida. Métodos: Estudo longitudinal com bebês de gestantes internadas e acompanhadas no setor da Obstetrícia de um Hospital Escola em Pelotas, RS, Brasil. Os dados referentes a hospitalização e ao parto foram coletados do prontuário hospitalar e no terceiro de vida do filho (a) de um questionário aplicado a mãe e do exame bucal da criança. Cada agravo bucal foi avaliado com critérios específicos, por uma examinadora calibrada e analisado no programa IBM SPSS Statistics com 5% de nível de significância. Resultados: Participaram 20 díades mãe-filho (a). Alterações da oclusão acometeram 95% das crianças, sendo a mordida aberta anterior (MAA) a principal. Ainda, 25% das crianças apresentaram opacidades demarcas e/ou hipoplasia do esmalte, sendo significativamente maior em filhos de mães mais jovens e 20% tinham cárie da primeira infância (CPI), estando relacionada à ausência de creme dental fluoretado e à qualidade da higiene bucal. Conclusão: O reflexo mais evidente da hospitalização na gestação na saúde bucal no terceiro ano de vida do filho (a) foi a oclusão alterada, especialmente a MAA.(AU)

Objective: To assess whether hospitalization during pregnancy can influence the child's oral condition in the third year of life. Methods: Longitudinal study with babies of pregnant women hospitalized and followed up in the Obstetrics sector of a Teaching Hospital in Pelotas, RS, Brazil. Data referring to hospitalization and childbirth were collected from the hospital records and in the child's third of life through a questionnaire applied to the mother and the child's oral examination. Each oral condition was evaluated with specific criteria, by a calibrated examiner and analyzed in the IBM SPSS Statistics program with a 5% minimum significance level. Results: 20 mother-child participated. Occlusion alterations affected 95% of the children, with anterior open bite (AOB) being the main. Still, 25% of the children had opacities and/or enamel hypoplasia, which was significantly higher in children of younger mothers, and 20% had early childhood caries, which is related to the absence of fluoride toothpaste and the quality of oral hygiene. Conclusion: The clearest reflection of hospitalization during pregnancy on oral health in the third year of the child's life was altered occlusion, especially the AOB.(AU)

Relación entre biometría fetal, producto de acumulación de los lípidos y condición trófica al nacer / Relationship between fetal biometry, lipid accumulation product and the trophic condition at birth

Fundamento: Las alteraciones del estado nutricional materno generalmente se relacionan con desviaciones del crecimiento fetal, que pueden detectarse por los parámetros biofísicos fetales e identifican la posible condición trófica al nacer. Objetivo: Determinar la posible relación entre los parámetros biométricos fetales, la condición trófica al nacer y el producto de acumulación de los lípidos. Metodología: Se realizó un estudio transversal en el Policlínico Chiqui Gómez Lubian del municipio Santa Clara, durante el año 2019, en una población de 253 gestantes normopeso supuestamente sanas al inicio de la gestación. La muestra no probabilística fue de 144 gestantes. Las variables de estudio fueron: producto de acumulación de los lípidos, biometría fetal y condición trófica al nacer. Se utilizaron métodos teóricos, empíricos y estadísticos. Resultados: En el segundo trimestre ningún parámetro biométrico coincidió con la condición al nacer de pequeño, mientras que para el grande coincidieron las circunferencias cefálica y abdominal. En el tercer trimestre la longitud del fémur y la circunferencia abdominal coinciden en la identificación del pequeño y del grande. El PAL se correlacionó con la circunferencia abdominal del tercer trimestre y con el peso al nacer; presentando mayor frecuencia de valores en el tercer tertil para los nacimientos grandes. Conclusiones: La circunferencia abdominal fue el parámetro biométrico con mayor coincidencia con la condición trófica al nacer, la que se asoció con valores en el tercer tertil del PAL para la detección de nacimientos grandes, relacionándose el fenotipo normopeso metabólicamente obeso con el crecimiento fetal por exceso.

Background: Maternal nutritional status disorders are usually related to fetal growth deviations, which can be detected by fetal biophysical parameters and identify the possible trophic condition at birth. Objective: To determine the possible relationship between fetal biometric parameters, the birth trophic state and lipid accumulation product. Methodology: A cross-sectional study was conducted at the Chiqui Gómez Lubian Polyclinic in Santa Clara municipality, during 2019, in a population of 253 normal-weight pregnant women who were apparently healthy at the beginning of their gestation. The non-probability sample was made up of 144 pregnant women. Study variables were: lipid accumulation product, fetal biometry and trophic condition at birth. Theoretical, empirical and statistical methods were used. Results: In the second trimester, none of the biometric parameters matched the condition at birth as a small child, while in the large one the head and abdominal circumferences matched. In the third trimester, femoral length and abdominal circumference coincide in identifying the small one and the large one. LAP correlated with third trimester abdominal circumference and birth weight, presenting higher frequency of values in the third tertile for large births. Conclusions: Abdominal circumference was the biometric parameter with the highest coincidence with trophic condition at birth, associated with values in the third tertile of the LAP for detecting large births, relating the metabolically obese normal weight phenotype with excessive fetal growth.

Capacidad del diámetro biparietal para predecir los recién nacidos grandes para edad gestacional. Estudio de cohorte retrospectivo / Ability of biparietal diameter to predict large for gestational age newborns. A retrospective cohort study

Fundamento: Predecir el recién nacido grande para la edad gestacional es una acción de salud que necesita de herramientas tecnológicas de probada eficiencia. Objetivo: Determinar la capacidad predictiva del diámetro biparietal en los recién nacidos grandes para la edad gestacional. Metodología: Estudio de cohorte retrospectivo que incluyó 1959 gestantes cubanas con embarazo simple con captación y término del embarazo entre enero del 2009 y diciembre de 2017. En cada trimestre de gestación se compararon las condiciones tróficas adecuado para la edad gestacional (AEG) y grandes para la edad gestacional (GEG) mediante estadígrafos de tendencia central (media) y de dispersión (rango, desviación estándar) correspondientes al diámetro biparietal. Se calculó además el intervalo de confianza (IC) de 95 % para la diferencia de medias del diámetro biparietal. Asimismo, se realizó un análisis de curvas ROC para determinar si el diámetro biparietal y el peso fetal predicen la condición trófica grande para la edad gestacional en el segundo y tercer trimestre de gestación. Los datos fueron recogidos del libro registro de genética del área de salud. Resultados: El diámetro biparietal en el segundo y tercer trimestre de gestación tuvo un área bajo curva de 0.60 (IC 95 %: 0.54-0.65) y 0.59 (IC 95 %: 0.54-0.64) respectivamente. Los puntos de corte establecidos (T2: 56.55 mm, T3: 81.55 mm) tienen una especificidad y exactitud superior al 78 %. Conclusiones: El diámetro biparietal y los modelos de regresión de Shepard y de Hadlock V mostraron capacidad para discriminar el nacimiento grande para la edad gestacional del adecuado para la edad gestacional, a partir del segundo trimestre de gestación siendo más eficaces en el tercero.

Background: Predicting large for gestational age newborns is a medical action that requires technological tools with proven efficiency. Objective: To determine the predictive ability of biparietal diameter in large newborns for gestational age. Methodology: Retrospective cohort study that included 1959 Cuban pregnant women with a singleton pregnancy, with recruitment and pregnancy term between January 2009 and December 2017. In each gestational trimester, trophic conditions appropriate for gestational age (GAW) were compared and large for gestational age (GA) using central tendency (mean) and dispersion (range, standard deviation) statistics corresponding to the biparietal diameter. The 95% confidence interval (CI) for mean biparietal diameter difference was also calculated. In addition, an analysis of ROC curves was performed to determine if biparietal diameter and fetal weight predict large trophic condition for gestational age in the second and third gestational trimester. Data were gathered from the health area genetics registry book. Results: Biparietal diameter in the second and third trimester of gestation had an area under curve of 0.60 (95% CI: 0.54-0.65) and 0.59 (95% CI: 0.54-0.64) respectively. The established cut-off points (T2: 56.55 mm, T3: 81.55 mm) have a specificity and accuracy greater than 78%. Conclusions: Biparietal diameter and the Shepard and Hadlock V regression models showed ability to discriminate large for gestational age birth from adequate for gestational age birth from the second trimester of gestation onward, being more effective in the third trimester.

Tratamiento con hormona de crecimiento en niños nacidos pequeños para la edad gestacional. Experiencia de un centro / Growth hormone treatment in small for gestational age children. A single-center experience

Introducción. Los pequeños para la edad gestacional (PEG) suelen tener una talla final 1 DE bajo la media. Se diferencian tres grupos según antropometría al nacimiento: de peso reducido (PRN), de longitud reducida (LRN) o ambos. Objetivos. Describir las características de los pacientes PEG atendidos en el Servicio de Endocrinología Pediátrica de un hospital de tercer nivel, y analizar la evolución de niños PEG sin crecimiento recuperador a los 4 años de edad, en tratamiento con hormona del crecimiento (GH), según su diagnóstico. Métodos. Estudio retrospectivo de pacientes PEG atendidos desde 2004 hasta 2021. Resultados. Se estudiaron 89 PEG; 44/89 iniciaron tratamiento con GH (11/44 PRN, 8/44 LRN y 25/44 ambos). La edad media al diagnóstico fue de 3,87 años; la talla media al inicio del tratamiento fue de -2,99 DE en los PEG diagnosticados por PRN, -2,85 DE en aquellos diagnosticados por LRN y -3,17 DE en los diagnosticados por bajo PRN y LRN. La talla final fue de -1,77, -1,52 y -1,23 DE, respectivamente, lo que supone una ganancia total de 1,22, 1,33 y 1,93 DE, respectivamente, alcanzando así su talla diana con una diferencia de 0,36 ± 0,08 DE. Conclusión. Menos de la mitad de los PEG derivados a la consulta precisaron tratamiento con GH, por no tener la edad de 4 años aún, o haber completado el crecimiento recuperador. Aquellos pacientes PEG según peso y longitud al nacimiento presentaron percentiles peores al diagnóstico y una mayor respuesta a GH.

Introduction. Small for gestational age (SGA) children usually have a final height of 1 SD below the mean. Three groups are established based on anthropometric characteristics at birth: low birth weight (LBW), short birth length (SBL), or both. Objectives. To describe the characteristics of SGA patients seen at the Department of Pediatric Endocrinology of a tertiary care hospital and to analyze the course of SGA children without catch-up growth at 4 years of age who were receiving treatment with growth hormone (GH), according to their diagnosis. Methods. Retrospective study of SGA patients seen between 2004 and 2021. Results. A total of 89 SGA children were studied; 44/89 started treatment with GH (11/44 LBW, 8/44 SBL, and 25/44 both). Their mean age at diagnosis was 3.87 years; their mean height at treatment initiation was -2.99 SD in SGA children diagnosed by LBW, -2.85 SD in those with SBL, and -3.17 SD in those with both LBW and SBL. Their final height was -1.77, -1.52, and -1.23 SD, respectively, with a total gain of 1.22, 1.33, and 1.93 SD, respectively, thus reaching their target height with a difference of 0.36 ± 0.08 SD. Conclusion. Less than half of SGA children referred to the clinic required treatment with GH because they were not yet 4 years old or had not completed their catch-up growth. SGA patients according to birth weight and length had worse percentiles at diagnosis and a greater response to GH.

Determinación de valores de corte de 17 hidroxiprogesterona ajustados por edad gestacional para la pesquisa neonatal de la hiperplasia suprarrenal congénita / Assessment of gestational age-adjusted 17-hydroxyprogesterone cut-off values for neonatal screening of congenital adrenal hyperplasia

La pesquisa neonatal de hiperplasia suprarrenal congénita se realiza mediante la determinación de 17 hidroxiprogesterona (17OHP) en gotas de sangre seca en papel de filtro. Los bebés prematuros presentan valores más elevados que los bebés de término, siendo de utilidad contar con límites de corte apropiados. Nuestro objetivo fue actualizar los valores de corte de 17OHP ajustados por edad gestacional para la metodología en uso a nivel nacional por las jurisdicciones asistidas por el "Programa Nacional de Fortalecimiento de la Detección Precoz de Enfermedades Congénitas". La 17OHP se determinó utilizando el kit comercial de enzimo-inmunoanálisis (ELISA competitivo), Elizen Neonatal 17OHP Screening (Zentech, Bélgica). Se obtuvieron límites de corte utilizando percentiles de la distribución de los valores de 17OHP para cada edad gestacional. La sensibilidad obtenida fue 100%, especificidad 98,76 %, tasa de falsos positivos 1,24 % y el valor predictivo positivo 1,12 %. Destacamos la importancia de disponer de límites de corte adecuados a la población. La armonización de los mismos permitirá resultados comparables entre los programas regionales de pesquisa neonatal (AU)

Newborn screening for congenital adrenal hyperplasia is performed by the measurement of 17-hydroxyprogesterone (17OHP) in dried blood spots on filter paper. Premature infants have higher values than full-term infants, and appropriate cutoff values are useful. Our aim was to update the cut-off values of 17OHP adjusted for gestational age for the methodology used at a national level in regions assisted by the "National Program for Strengthening the Early Detection of Congenital Diseases". 17OHP was determined using the commercial enzyme-linked immunosorbent assay (competitive ELISA) kit, Elizen Newborn 17OHP Screening (Zentech, Belgium). Cut-off values were obtained using percentiles of the distribution of 17OHP values for each gestational age. Sensitivity was 100%, specificity 98.76%, false positive rate 1.24%, and positive predictive value 1.12%. It is important to have cut-off values that are adjusted to the population. Harmonization will allow for the comparison of results among regional newborn screening programs (AU)

Distribución espacial y tendencia secular (1991-2014) de nacidos pequeños para la edad gestacional en Jujuy / Spatial distribution and secular trend (1991­2014) of small for gestational age infants born in Jujuy

Introducción. El feto que no alcanza el potencial de crecimiento esperado en el útero se considera pequeño para la edad gestacional (PEG). Esta restricción depende de factores genéticos y/o ambientales; la altura geográfica es uno muy relevante. Este trabajo analiza la distribución espacial de las prevalencias de PEG y su tendencia secular en Jujuy (1991-2014). Materiales y métodos. Se analizaron los registros de 308 469 nacidos vivos de Jujuy (Dirección de Estadísticas e Información de Salud). Se estimaron prevalencias de PEG (peso/edad gestacional

Introduction. A fetus that does not reach the expected growth potential in utero is considered small for gestational age (SGA). Such restriction depends on genetic and/or environmental factors, being altitude a very relevant factor. This study analyzes the spatial distribution of the prevalence of SGA and its secular trend in Jujuy (1991­2014). Materials and methods. The records of 308 469 live births in Jujuy (Health Statistics and Information Department) were analyzed. The prevalence of SGA (weight/gestational age < P10 and < P3) was estimated for sex according to the INTERGROWTH-21 st standard in the ecoregions of Jujuy (Valle and Ramal ­less than 2000 MASL­, Puna, and Quebrada) across 3 periods (1991­2000, 2001­2009, 2010­2014) and proportions were compared. The secular trend was assessed using the Joinpoint regression analysis. Results. The overall prevalence of SGA was 2.3% (< P3) and 7% (< P10). Significantly higher values were observed in Puna and Quebrada in both SGA categories and across all periods. Only in Valle, significant differences were observed between sexes across all periods. The prevalence of SGA showed a significant downward secular trend at a provincial and regional level, and this was greater in Quebrada (5.2% < P3 and 3.5% < P10). Conclusions. A consistent and significant decrease in the prevalence of SGA has been observed since the 1990s in Jujuy, where altitude is itself a determining factor of size at birth, since the Puna and Quebrada regions showed the highest prevalence of SGA during the entire period.

Avaliação do crescimento e desenvolvimento infantil e fatores de risco de um município que integra uma universidade brasileira de cunho internacional / Evaluation of childhood growth and development and risk factors of a municipality that is part of an international brazilian university / Evaluación de los factores de crecimiento y desarrollo infantil y de riesgo de un municipio que forma parte de una universidad brasileña internacional

Fatores de risco, incluindo os de cunho materno, interferem no crescimento e desenvolvimento infantil. Nesse sentido, o conhecimento desses fatores e avaliação ade- quada desses processos são necessários para articulação de estratégias preventivas de transtornos futuros. Assim, o estudo visou investigar o crescimento e desenvolvimento de crianças atendidas em consulta de puericultura em unidades básicas de saúde de um mu- nicípio cearense, que integra uma universidade brasileira de cunho internacional, e seus fatores de risco. Trata-se de estudo observacional, analítico, transversal e de abordagem quantitativa, conduzido com crianças e suas mães no Centro de Saúde de Acarape e Posto de Saúde São Benedito (Acarape ­ CE), no período de fevereiro a julho de 2021. Após consentimento, as mães preencheram um questionário, seguido de avaliação do cresci- mento e desenvolvimento das crianças. Os dados obtidos foram analisados. Das 70 crian- ças, 50,00% (n = 17) e 51,43% (n = 18) dos meninos e meninas tinham baixa estatura para idade, respectivamente. Para o desenvolvimento psicossocial, dos 284 testes condu- zidos, 86,27% (n = 245) foram realizados em plenitude pelas crianças. Observou-se as- sociação significativa entre a gestante ter concebido o filho com, no mínimo, 9 meses de período gestacional e esse apresentar relação Peso/Idade adequada e Estatura/Idade ina- dequada. Houve associação significativa entre a criança não ingerir refresco em pó e apre- sentar relação Peso/Idade adequada. Conclui-se que as crianças tinham idade gestacional adequada e apresentavam estado nutricional apropriado, apesar da baixa estatura para idade. Manifestavam desenvolvimento psicossocial, de linguagem e físico normais. Sobre os fatores de risco, esses envolveram os de cunho materno e o consumo de alimentos cariogênicos.

Risk factors, including maternal ones, interfere with child growth and de- velopment. In this sense, knowledge of these factors and adequate evaluation of these processes are necessary to articulate preventive strategies for future disorders. Thus, the study aimed to investigate the growth and development of children seen in childcare con- sultations in primary health units in Ceará, part of a Brazilian university of international character, and their risk factors. This is an observational, analytical, cross-sectional study with a quantitative approach, conducted with children and their mothers at the Acarape Health Center and São Benedito Health Center (Acarape ­ CE), from February to July 2021. After consent, the mothers completed a questionnaire, followed by an assessment of the children's growth and development. The data obtained were analyzed. Of the 70 children, 50.00% (n = 17) and 51.43% (n = 18) of the boys and girls were short for their age, respectively. Of the 284 tests conducted for psychosocial development, 86.27% (n = 245) were entirely performed by the children. A significant association was observed between the pregnant woman having conceived her child at least nine months of gestation and having an adequate Weight/Age and Height/Age ratio. There was a significant asso- ciation between the child not ingesting powdered soft drinks and having an appropriate Weight/Age ratio. It was concluded that the children had an adequate gestational age and had an appropriate nutritional status, despite their low height for their age. They showed normal psychosocial, language, and physical development. The risk factors involved those of mother nature and the consumption of cariogenic foods.

Los factores de riesgo, incluidos los maternos, interfieren en el crecimiento y desarrollo infantil. En este sentido, el conocimiento de estos factores y la evaluación adecuada de estos procesos son necesarios para articular estrategias preventivas de futu- ros trastornos. Así, el estudio tuvo como objetivo investigar el crecimiento y desarrollo de niños atendidos en consultas de puericultura en unidades básicas de salud de un muni- cipio de Ceará, que forma parte de una universidad brasileña de carácter internacional, y sus factores de riesgo. Se trata de un estudio observacional, analítico, transversal, con enfoque cuantitativo, realizado con niños y sus madres en el Centro de Salud de Acarape y el Centro de Salud São Benedito (Acarape ­ CE), de febrero a julio de 2021. Después del consentimiento, las madres completaron un cuestionario, seguido de una evaluación del crecimiento y desarrollo de los niños. Los datos obtenidos fueron analizados. De los 70 niños, el 50,00% (n = 17) y el 51,43% (n = 18) de los niños y niñas eran bajos para su edad, respectivamente. Para el desarrollo psicosocial, de las 284 pruebas realizadas, el 86,27% (n = 245) fueron realizadas íntegramente por los niños. Se observó una asociación significativa entre la gestante haber concebido a su hijo con al menos 9 meses de gesta- ción y tener una adecuada relación Peso/Edad y Talla/Edad. Hubo asociación significativa entre el niño que no ingiere gaseosas en polvo y presentar una adecuada relación Peso/Edad. Se concluyó que los niños tenían una edad gestacional adecuada y un estado nutricional adecuado, a pesar de su baja talla para su edad. Presentaron un desarrollo psi- cosocial, lingüístico y físico normal. En cuanto a los factores de riesgo, estos involucraron los de naturaleza materna y el consumo de alimentos cariogénicos.

Determinants of successful labor induction in a teaching hospital in Nigeria: a 10-year review / Determinantes da indução do trabalho de parto bem sucedida em hospital-escola na Nigéria: uma revisão de 10 anos

Abstract Objectives: to evaluate the success rate of labor induction and determinants of successful outcome. Methods: retrospective cohort study of parturients that undergone labor induction between 2006 and 2015. Data was retrieved from the medical records and multivariate logistic regression was used to evaluate the determinants of successful labor induction. Results: the rate of labor induction was 10.9%. Out of the 940 women analysed, six hundred and fifty-six women (69.8%) had successful vaginal delivery. Labor induction at 39-40 weeks (OR=2.70; CI95%=1.17-6.36), 41 weeks (OR=2.44; CI95%=1.14-5.28), estimated fetal weight between 2.5 and 3.4kg (OR=4.27, CI95%=1.96-5.59) and estimated fetal weight of 3.5-3.9kg (OR=5.45; CI95%=2.81-10.60) increased the odds of achieving vaginal delivery. Conclusions: our findings suggest that 39, 40 and 41 weeks are optimal gestational ages for labor induction with respect to successful vaginal delivery. Also, estimated fetal weight between 2.5kg and 3.9kg favours successful vaginal delivery.

Resumo Objetivos: avaliar a taxa de sucesso da indução do trabalho de parto e determinantes de um resultado bem sucedido. Métodos: estudo de coorte retrospectivo de parturientes que submeteram a indução de trabalho de parto entre 2006 e 2015. Os dados foram recuperados dos registros médicos e a regressão logística multivariada foi utilizada para avaliar os determinantes da indução de trabalho de parto bem sucedida. Resultados: a taxa de indução de trabalho de parto foi de 10,9%. Das 940 mulheres analisadas, seiscentas e cinquenta e seis mulheres (69,8%) tiveram um parto vaginal bem sucedido. A indução de trabalho de parto nas 39-40 semanas (OR=2,70; IC95%=1,17-6,36), 41 semanas (OR=2,44; IC95%=1,14-5,28), peso fetal estimado entre 2,5 e 3,4kg OR=4,27; IC95%=1,96-5,59) e peso fetal estimado entre 3,5-3,9kg (OR=5,45; IC95%=2,81-10,60) aumentou as probabilidades de conseguir um parto vaginal. Conclusões: as nossas conclusões sugerem que as 39, 40 e 41 semanas são idades gestacionais ideais para a indução do trabalho de parto no que diz respeito ao sucesso do parto vaginal. Além disso, o peso fetal estimado entre 2,5kg e 3,9kg favorece o parto vaginal bem sucedido.

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.

Malformations fœtales diagnostiquées à l'échographie obstétricale au CHU de Bouaké: à propos de 43 cas (Côte d'Ivoire) / Fetal Malformations diagnosed by Obstetrical Ultrasound at the University Hospital of Bouake : 43 cases reported (Cote d'Ivoire)

L'échographie obstétricale est l'examen de référence dans l'étude et le suivi des malformations fœtales que sont des anomalies morphologiques et fonctionnelles congénitales. L'objectif était de déterminer la fréquence et les types de malformations fœtales diagnostiquées à l'échographie obstétricale à Bouaké. Méthodes. Il s'agissait d'une étude transversale rétrospective descriptive de 2010 à 2019 au centre hospitalier et universitaire (CHU) de Bouaké. Ont été incluses dans l'étude, toutes les femmes enceintes ayant présenté au moins une malformation fœtale au cours de la grossesse. Les variables étudiées étaient : l'âge de la mère, l'âge gestationnel, le sexe du fœtus et les caractéristiques échographiques des malformations fœtales retrouvées. L'analyse statistique s'est faite à l'aide des tests de Khi2 et de Fisher au seuil de signifi cativité situé à 5% (P<005). Résultats : Les malformations fœtales représentaient 43 cas sur 11879 échographies obstétricales soit une prévalence de 0,36%. L'âge moyen des gestantes était de 40,23 ± 6,34 ans avec des extrêmes de 16 et 43 ans. Les malformations fœtales découvertes au troisième trimestre représentaient 67,44% des cas. Les anomalies malformatives prédominaient sur les fœtus de sexe masculin avec 62,8%. Les anomalies du système nerveux central (SNC) étaient les plus représentées avec 51,16 % suivies des anomalies uro-génitales (30,23 %). L'hydrocéphalie était la principale malformation du SNC avec 63,63% des cas. L'hydronéphrose représentait 76,93% des anomalies uro-génitales et l'omphalocèle était la malformation abdominale la plus représentée avec 60% des cas. Conclusion: L'échographie obstétricale occupe une place incontournable dans le dépistage, le suivi et la prise en charge des malformations fœtales

Intraocular pressure values using icare® rebound tonometer and correlation with postconceptional age in premature infants

Purpose: This study aimed to determine a normative range of intraocular pressure (IOP) values measured with Icare rebound tonometer in premature infants and evaluate IOP variation over time and its correlation with the progression of postconceptional age (PCA). By doing so, we also evaluated advantages of this IOP-measuring method in this population when compared to more traditional methods. Methods: We conducted a single-center prospective study that included premature infants (gestational age ≤32 weeks) who were admitted to the neonatal intensive care unit (NICU) in Hospital Professor Doutor Fernando Fonseca. The study took place between January and December 2021. IOP was measured using Icare tonometer on the occasion of the first retinopathy of prematurity (ROP) screening requested by the NICU and again after a two-week interval if PCA was still ≤37 weeks. IOP measurements were stopped at 37 weeks or if the infant was discharged. The evaluated outcomes were mean IOP values and their correlation with PCA. Results: Thirty-four eyes of 17 preterm infants with a mean gestational age of 29.4 ± 2.3 weeks and a mean birth weight of 1222.9 ± 361.9 gr were evaluated. The mean IOP registered was 16.1 ± 6.4 mmHg, with a median value of 15.3 mmHg. The top 90 mmHg. The average IOP reduction was 4.8 ± 6.7 mmHg (P = 0.0019) within the two-week interval of PCA.

Postnatal foot length in the estimation of gestational age in relation to intrauterine growth pattern among Nigerian neonates

Objectives: To determine the relationship between postnatal foot lengths and estimated gestational age (EGA) in relation to intrauterine growth patterns determined at birth among Nigerian neonates. Design: Hospital-based, cross-sectional. Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Participants: 260 neonates with EGA 30- 42 weeks within 48 hours of life. Interventions: Postnatal foot lengths (FL) were measured with Vernier digital calliper in millimetres. The intra-uterine growth pattern was determined using the Lubchenco chart. Pearson correlation and regression analysis tests were performed. Main outcome measures: Postnatal foot length in relation to Intra-Uterine Growth Pattern. Results: The mean postnatal FL had a strong positive correlation with the EGA from 30 through 42 weeks (r = 0.855, p < 0.001). The overall mean foot length for preterm neonates was 65.44 (6.92) mm, while that of term neonates was 77.92 (4.24) mm. The linear regression equation was generated as: EGA = 9.43 + (0.37 × FL), p < 0.001. The EGA as measured by FL had the highest positive correlation with Small for Gestational Age (SGA) intra-uterine-growth pattern, followed by Appropriate for Gestational Age (AGA) and least by Large for Gestational Age (LGA) respectively (r = 0.936> 0.861 > 0.666). Conclusion: The postnatal foot length correlated well with estimated gestational age, and the correlation was best among SGA infants

Violência sexual e aborto legal: possibilidades e desafios da atuação psicológica / Sexual offence and legal abortion: opportunities and challenges from psychological working / Violencia sexual y aborto legal: posibilidades y desafíos de la atención psicológica

A violência sexual e o aborto legal são temas tabus em nossa sociedade. No campo da saúde, a(o) psicóloga(o) atua em fases distintas, seja na avaliação psicológica do pedido pelo aborto legal, que culminará ou não em sua aquiescência; seja no momento posterior à solicitação, no atendimento em enfermarias ou ambulatorial. Partindo de relato de experiência, este artigo tem como objetivo refletir sobre as possibilidades e desafios da atuação psicológica no atendimento em saúde para pessoas em situação de gestação decorrente de violência sexual e que buscam pelo aborto legal. Para tanto, dividimos o artigo em três momentos. No primeiro deles, será possível encontrar dados conceituais, estatísticos e históricos sobre ambos os temas, trazendo recortes nacionais e internacionais. No segundo, trazemos apontamentos sobre o que chamamos de "eixos norteadores", ou seja, dialogamos com aspectos fundamentais para o trabalho nesta seara, sendo eles gênero, família, sexualidade e trauma. Por fim, no terceiro, aprofundamos a reflexão sobre o atendimento psicológico atrelado aos conceitos já discutidos, analisando de forma crítica principalmente um dos pontos mais espinhosos da atuação: a avaliação para aprovação (ou recusa) do pedido pelo aborto. Apoiamo-nos no referencial psicanalítico e defendemos que esta atuação psicológica é primordialmente uma oferta de cuidado, comprometido com as demandas das pessoas atendidas e com a promoção de saúde mental, e consideramos que o papel da psicologia é essencial para o reconhecimento do sofrimento e dos efeitos do abandono socioinstitucional na vida do público atendido.(AU)

Sexual abuse and legal abortion are taboo subjects in our society. On the health area, the psychologist works on different fields, such as psychological evaluation from the request of legal abortion, that will end or not on its approval, and also in a further moment, either the care on wards or ambulatorial treatment. Relying on a case report, this article aims to contemplate the possibilities and challenges from psychological work on healthcare to pregnant women from sexual violence and seek legal abortion. For this purpose, we divide this article in three moments. On the first, it will find definitions, statistics, and historical data about both issues, including national and international information. On the second, we bring notes called 'guiding pillar,' that is, we interact with fundamental aspects from this area, such as gender, family, sexuality, and trauma. On the third one, in-depth discussions we dwell on psychological care tied to the concepts previously addressed, critically analyzing one of the hardest moments of working in this area: the evaluation to approve (or refuse) the request for abortion. We lean over psychoanalytic thoughts and argue that this psychological work is primarily an offer of care, committed to the needs from those who seek us and to promoting good mental health and, also, we consider that psychology is essential to acknowledge the suffering and the effects of social and institutional neglect on the lives of the people seen.(AU)

La violencia sexual y el aborto son temas tabús en nuestra sociedad. En el campo de la salud, el(la) psicólogo(a) actúa en diferentes fases: en la evaluación psicológica de la solicitud del aborto legal, que culminará o no en su obtención, y/o en el momento posterior a la solicitud en la atención en enfermería o ambulatorio. Desde un reporte de experiencia, este artículo pretende reflexionar sobre las posibilidades y los desafíos de la Psicología en la atención en salud para personas en estado de embarazo producto de violencia sexual y que buscan un aborto legal. Para ello, este artículo está dividido en tres momentos. En el primer, presenta datos conceptuales, estadísticos e históricos sobre los dos temas, trayendo recortes nacionales e internacionales. En el segundo, comenta los llamados "ejes temáticos", es decir, se establece un diálogo con aspectos fundamentales para el trabajo en este ámbito, como género, familia, sexualidad y trauma. Por último, en el tercer, profundiza en la reflexión sobre la atención psicológica asociada a los conceptos discutidos, analizando de forma crítica uno de los puntos más espinosos de la actuación: la evaluación para la aprobación (o negativa) de la solicitud de aborto. Se utilizó el referencial psicoanalítico y se argumenta que esta atención psicológica es sobre todo una forma de cuidado, comprometida con las demandas de las personas atendidas y la promoción de la salud mental, y el papel de la Psicología es esencial para reconocer el sufrimiento y los efectos del abandono socioinstitucional en la vida del público atendido.(AU)

Use of antenatal corticosteroids among infants with gestational age at 24 to 31 weeks in 57 neonatal intensive care units of China: a cross-sectional study / 中华医学杂志(英文版)

BACKGROUND@#Antenatal corticosteroids (ACS) can significantly improve the outcomes of preterm infants. This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units (NICU) and to explore perinatal factors associated with ACS use, using the largest contemporary cohort of very preterm infants in China.@*METHODS@#This cross-sectional study enrolled all infants born at 24 +0 to 31 +6 weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st, 2019 to December 30th, 2019. The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery. Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.@*RESULTS@#A total of 7828 infants were enrolled, among which 6103 (78.0%) infants received ACS. ACS use rates increased with increasing gestational age (GA), from 177/259 (68.3%) at 24 to 25 weeks' gestation to 3120/3960 (78.8%) at 30 to 31 weeks' gestation. Among infants exposed to ACS, 2999 of 6103 (49.1%) infants received a single complete course, and 33.4% (2039/6103) infants received a partial course. ACS use rates varied from 30.2% to 100% among different hospitals. Multivariate regression showed that increasing GA, born in hospital (inborn), increasing maternal age, maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.@*CONCLUSIONS@#The use rate of ACS remained low for infants at 24 to 31 weeks' gestation admitted to Chinese NICUs, with fewer infants receiving a complete course. The use rates varied significantly among different hospitals. Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.

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.

Clinical characteristics and placental pathology analysis of 14 cases of pregnancy with aortic dissection/aortic aneurysm / 中华病理学杂志

Objective: To investigate the pathological changes of placenta in pregnant women with aortic dissection/aneurysm and their relationship with clinical features. Methods: The placental samples of 14 pregnant women with aortic dissection/aneurysm diagnosed from January 2012 to October 2021 and 10 normal placental samples of pregnant women from January 2021 to December 2021 at Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China were selected. Routine H&E staining and immunohistochemistry were used to analyze the histological features under light microscope. The clinical data were also analyzed. Results: The age of 14 pregnant patients with aortic dissection/aneurysm for placental examination ranged from 22 to 38 years (median, 28 years). The gestational ages ranged from 22 to 39 weeks (median, 34 weeks). The pregnancy of second trimester was noted in 2 cases, and the third trimester in 12 cases. All cases were singleton pregnancy. Seven cases were Stanford type A aortic dissection, 6 cases were Stanford type B aortic dissection, and one case was aortic root aneurysm. Four of the pregnant women underwent aortic dissection surgery after caesarean section, three underwent caesarean section after aortic dissection surgery, and seven underwent both caesarean section and aortic dissection procedures. Among the newborns, 2 cases were full-term birth, and 12 cases were premature birth. Twelve cases had alive newborns, and 2 cases stillbirths. Fetal/placental weight ratio (FPR)<10th percentile was in 5 cases and FPR>90th percentile in one case. Compared with the normal group, accelerated villus maturation and distal villus dysplasia were more frequently found in pregnancy with aortic dissection group (P<0.05). There was no significant difference in villi infarction and decidua vascular lesions between the two groups (P>0.05), nor was there correlation between the type of aortic dissection and distal villus dysplasia and accelerated villus maturation of placentas (P>0.05). The number of villous interstitial blood vessels in the placentas of pregnancy with aortic dissection group was significantly fewer than that in the normal control group (P<0.01). Conclusions: There are considerable pathological changes in the placentas of pregnant women with aortic dissection/aneurysm. The main histological features are accelerated villus maturation and distal villus dysplasia, which are manifestations of villous ischemia and hypoxia, and also a part of the placental pathological manifestations of maternal vascular dysperfusion.