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1.
Medicina (B.Aires) ; 81(4): 574-580, ago. 2021. graf
Article in English | LILACS | ID: biblio-1346509

ABSTRACT

Abstract The growth hormone receptor (GHR) mediates the effect of growth hormone (GH) on linear growth and metabolism. In humans, it exists as two isoforms differing by the retention or exclusion of exon 3; a full-length GHR isoform (GHRfl) and the exon 3-deleted isoform (GHRd3). The genotypic frequency of this polymorphism was analyzed in several studies and in different human populations. However scarce information in Argentinean population is available. Associations between GHRd3 and growth have been reported previously. Some studies have shown that the presence of GHRd3 polymorphism might be a potential variant that improves growth response to recombinant human GH (rhGH) therapy in patients born small for gestational age (SGA), among others. However, over the years the results have been controversial and inconclusive. Based on this, it would be proposed that variants at the genomic level are not completely reflected at the mRNA level. Our aim was to evaluate the genotypic frequencies (%) of the GHR gene polymorphism (GHRfl/GHRfl; GHRfl/GHRd3; GHRd3/GHRd3) in normal Argentinean population (n = 94) and SGA patients (n = 65), and the expression of these polymorphisms at mRNA level in the fetal side of placenta tissues was analyzed. In addition, their asso ciation with spontaneous postnatal catch-up growth in SGA patients was also evaluated. In this study, we show a significant increment of compensatory growth in small for gestational age children (SGA) associated to the presence of the GHRd3 allele polymorphism. In addition, the expression of GHR in healthy placentas revealed that no alternative splicing mechanism occurs.


Resumen El receptor de la hormona de creci miento (GHR) media la acción de la hormona de crecimiento (GH) en el crecimiento lineal y el metabolismo. En los seres humanos, existen dos isoformas que difieren en la retención (GHRfl) o exclusión del exón 3 (GHRd3). La frecuencia genotípica de este polimorfismo fue analizada en varios estudios y en diferentes poblaciones. Sin embargo, la información disponible en la población argentina es escasa. Se ha reportado anteriormente asociación entre el polimorfismo GHRd3 y el crecimiento. Varios estudios ha n demostrado que la presencia del polimorfismo GHRd3 podría mejorar, en pacientes nacidos pequeños para la edad gestacional, entre otros, la respuesta a la terapia con GH humana recombinante (rhGH). Sin embargo, a lo largo de los años los resultados han sido con trovertidos y no concluyentes. En base a esto, se propondría que las variantes a nivel genómico no se reflejan completamente a nivel del ARNm. Nuestro objetivo fue evaluar la frecuencia genotípica de los polimorfismos del gen del GHR (GHRfl/GHRfl; GHRfl/GHRd3; GHRd3/GHRd3) en la población argentina normal (n = 94) y en niños pequeños para la edad gestacional (n = 65), y se analizó la expresión de estos polimorfismos a nivel de ARNm en la porción fetal de placentas sanas. Además, se evaluó la asociación de este polimorfismo con el cre cimiento postnatal espontáneo en pacientes pequeños para la edad gestacional. En este estudio, mostramos un incremento significativo del crecimiento compensatorio en niños pequeños para la edad gestacional asociado a la presencia del polimorfismo del alelo GHRd3. Además, los ensayos de expresión de GHR en placentas sanas revelaron que no se produciría ningún mecanismo de splicing alternativo.


Subject(s)
Humans , Female , Pregnancy , Child , Receptors, Somatotropin/genetics , Human Growth Hormone , Polymorphism, Genetic , Carrier Proteins , Exons , Gestational Age
2.
Cuad. Hosp. Clín ; 62(1): 51-56, jun. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1284309

ABSTRACT

La gasometría arterial es fundamental en el diagnóstico y manejo del medio interno. El objetivo es caracterizar los valores de gasometría arterial en gestantes sanas con embarazo normoevolutivo residentes a 4 150 metros sobre el nivel del mar. Serie de casos llevada a cabo durante la gestión 2019, la cual incluye pacientes sin clínica ni antecedentes de enfermedades cardiopulmonares o hematológicas, así como ausencia de tabaquismo y residencia de al menos los últimos 6 meses. Se incluye 30 pacientes, media de edad 25.23 años (desvío estándar 3.69), con edad gestacional media de 26 semanas (desvío estándar 5.5). El valor de pH tiende a ser más alto, así como los valores de PaO2, PaCO2, HCO3 y SatpO2% son más bajos, incluso en comparación con adultos sanos residentes de la misma altitud. Existe cierta tendencia positiva hacia el incremento progresivo del pH mientras la edad gestacional avanza. La gasometría arterial en la altura, debe ser interpretada con suma precaución en relación a las condiciones barométricas, proporcionándose así, valiosa información con aplicación a la obstetricia crítica a muy alta altitud.


Arterial blood gases analysis is essential in the diagnosis and management of pathologies. The objective is to characterize arterial blood gases values in healthy pregnant residents at 4150 meters above sea level. Series case performed during 2019, including patients without a clinical features or antecedents of cardiopulmonary or hematological diseases as well as absence of smoking and residence for at least the last 6 months. Thirty patients are included, mean age 25.23 years (standard deviation 3.69), with average gestational age of 26 weeks (standard deviation 5.5). The pH tends to be higher, as well as the values of PaO2, PaCO2, HCO3 and SatpO2% are lower, even compared to healthy adults living at the same altitude. There is some positive trend towards progressive pH is higher such as gestational age progresses. Arterial gas blood analysis at altitude, should be interpreted with extreme caution in relation to barometric conditions, thus providing, valuable information to critical care obstetrics at very high altitude


Subject(s)
Humans , Female , Pregnancy , Adult , Blood Gas Analysis , Atmospheric Pressure , Gestational Age , Sea Level , Pregnant Women , Obstetrics
3.
Cuad. Hosp. Clín ; 62(1): 19-24, jun. 2021.
Article in Spanish | LILACS | ID: biblio-1284121

ABSTRACT

OBJETIVO: conocer la frecuencia y los factores relacionados a hemorragia intraventricular en neonatos prematuros atendidos en el Servicio de Neonatología del Hospital Materno Infantil C.N.S durante la gestión 2015. MÉTODO: estudio transversal. Se incluyó a todo recién nacido prematuro menor o igual a 34 semanas nacidos en la institución, que presentaron hemorragia intraventricular. Se utilizó estadística descriptiva, se determinaron porcentajes en las variables nominales y medidas de tendencia central de variables maternas y neonatales. RESULTADOS: se registraron el nacimiento de 102 pacientes menores de 34 semanas de edad gestacional, presentaron hemorragia intraventricular el 13,7%; de los mismos el 43% de los pacientes presentó hemorragia intraventricular grado I, el 28,6% grado II, 21,4% grado III y 7,1% grado IV, pertenecieron al sexo masculino 78%, el 64% de pacientes con hemorragia intraventricular fueron prematuros precoces, seguido del prematuro moderado 21% y 14% prematuro extremo. Los grados severos se presentaron en el prematuro extremo con predominio. El 50% de los prematuros con hemorragia intraventricular no recibió maduración prenatal, 86% presentó alteraciones ventilatorias con hipoxemia en 42,9%, recibió soporte inotrópico 42,9%, usó de cargas con solución fisiológica en las primeras 72 horas de vida el 57% y soluciones hiperosmolares el 35%, fueron politransfundidos 42,9%. CONCLUSIONES: los factores con mayor frecuencia presentes en neonatos prematuros con hemorragia intraventricular fueron menor peso y edad gestacional; requerimiento de reanimación, alteraciones ventilatorias, hemodinámicas, uso de cargas, soluciones hiperosmolares, transfusión.


OBJECTIVE: to know the frequency and related factors with intraventricular hemorrhage in newborn premature infants treated in the Neonatology Service of the Maternal and Child Hospital C.N.S during the 2015 management. METHOD: cross sectional study. All premature infants less than or equal to 34 weeks born in the institution with intraventricular hemorrhage were included. Maternal and neonatal variables were analyzed using descriptive statistics. RESULTS: the birth of 102 patients under 34 weeks of gestational age were registered, 13.7% presented intraventricular hemorrhage; of these, 43% of the patients presented grade I intraventricular hemorrhage, 28.6% grade II, 21.4% grade III and 7.1% grade IV, belonged to 78% male, 64% of patients with Intraventricular hemorrhage were premature, followed by moderate premature 21% and extreme 14% premature. Severe grades occurred in the extreme premature with predominance. 50% of premature infants with intraventricular hemorrhage did not receive prenatal maturation, 86% presented ventilatory abnormalities with hypoxemia in 42.9%, received inotropic support 42.9%, used loads with physiological solution in the first 72 hours of life 57 % and hyperosmolar solutions 35%, 42.9% were transfused. CONCLUSIONS: the factors most frequently related with intraventricular hemorrhage in the premature infant are lower weight and gestational age; requirement of resuscitation, ventilatory, hemodynamic alterations, load use, hyperosmolar solutions, transfusion.


Subject(s)
Humans , Infant, Newborn , Gestational Age , Hemorrhage , Infant, Premature , Child Health Services , Child Health , Neonatology
4.
Arch. argent. pediatr ; 119(5): e499-e503, oct. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292670

ABSTRACT

Gracias al avance de la tecnología, es posible realizar el diagnóstico prenatal de distintas malformaciones congénitas que ponen en riesgo la vida del recién nacido. Entre estas, el teratoma oral o epignathus es una forma poco frecuente de teratoma congénito entre los que se localizan en cabeza y cuello. Suelen ser benignos y abarcan el 4 % de los teratomas neonatales.A partir del desarrollo de la técnica de tratamiento intraparto extraútero (EXIT, por su sigla en inglés), que se implementó en los años 90 para mantener la circulación fetal hasta asegurar la vía aérea del recién nacido, se logra planificar una estrategia de manejo multidisciplinario que permite el abordaje correcto de estas patologías. Se presenta un caso de teratoma oral gigante en una paciente de sexo femenino de 35 semanas de gestación, en quien se aplicó la técnica EXIT, y su evolución posterior.


Thanks to technological advances, it has been possible to carry out the prenatal diagnosis of different life-threatening congenital malformations. Among these, oral teratoma, or epignathus, is a rare form of congenital teratoma within those located in the head and neck. They are generally benign and comprise 4 % of neonatal teratomas. From the development of the EXIT technique (ex utero intrapartum treatment), which has been implemented since the 90's to support fetal circulation until the newborn's airway is secured, it is possible to plan a multidisciplinary management strategy that enables the correct approach of these pathologies.We present a case of giant epignathus in a 35-week gestation female patient, whose airway was secured using the EXIT technique, and follow up.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Teratoma , Airway Obstruction , Prenatal Diagnosis , Cesarean Section , Ultrasonography, Prenatal , Gestational Age
5.
Arch. argent. pediatr ; 119(5): e480-e486, oct. 2021. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1292126

ABSTRACT

El bajo peso al nacer (BP, < 2500 g), la restricción del crecimiento intrauterino (RCIU) y el parto prematuro (PP, < 37 semanas de gestación) son los factores clínicos más habituales para la programación alterada del número de nefronas y se asocian con un mayor riesgo de hipertensión, proteinuria y enfermedad renal futura en la vida. En la actualidad la evaluación indirecta del número total de nefronas mediante el uso de marcadores en el período posnatal representa el enfoque principal para evaluar el riesgo de evolución futura de los trastornos renales en los recién nacidos con BP, RCIU o PP.Se presentan los avances en la investigación en animales y sobre marcadores bioquímicos en humanos, y recomendaciones para la prevención del daño renal preconcepcional, incluidos los factores sociales y las enfermedades crónicas. La evidencia demuestra que la restricción de crecimiento y la prematuridad solas son capaces de modular la nefrogénesis y la función renal y, cuando son concurrentes, sus efectos tienden a ser acumulativos.


A low birth weight (LBW, < 2500 g), intrauterine growth restriction (IUGR), and preterm birth (PB, < 37 weeks of gestational age) are the most common clinical factors for an altered programming of nephron number and are associated with a greater risk for hypertension, proteinuria, and kidney disease later in life. At present, an indirect assessment of total nephron number based on postnatal markers is the most important approach to evaluate the risk for future kidney disorders in newborn infants with a LBW, IUGR or PB.Here we describe advances made in animal experiments and biochemical markers in humans, and the recommendations for the prevention of preconception kidney injury, including social factors and chronic diseases. According to the evidence, IUGR and prematurity alone can modulate nephrogenesis and kidney function, and, if occurring simultaneously, their effects tend to be cumulative.


Subject(s)
Humans , Animals , Female , Pregnancy , Infant, Newborn , Adult , Premature Birth , Kidney Diseases/etiology , Kidney Diseases/epidemiology , Infant, Low Birth Weight , Gestational Age , Kidney , Nephrons
6.
Rev. Soc. Argent. Diabetes ; 55(1): 13-20, ene. - abr. 2021. tab, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1248270

ABSTRACT

Introducción: en la provincia de La Pampa no hay registro del número de pacientes con diabetes gestacional (DG) que vuelve a control metabólico posparto, cuando se conoce el riesgo que evolucione a diabetes mellitus tipo 2 (DM2). Objetivos: analizar en el Hospital Público Interzonal (Dr. Lucio Molas) el porcentaje de mujeres con DG que volvió a control metabólico posparto y desarrolló DM2 durante seis años de seguimiento. Materiales y métodos: estudio descriptivo ambispectivo en 44 pacientes con DG diagnosticada en 2013 con seguimiento hasta el 31/12/2019. Se analizaron antecedentes previos de DG y familiares de diabetes (AFD), edad, semana de gestación del diagnóstico con glucemia/prueba de tolerancia oral a la glucosa (PTOG), índice de masa corporal (IMC), presión arterial, vía del parto, peso del recién nacido, HbA1c. Resultados: en 2013 se efectuaron 1.238 partos, 44 pacientes (3,7%) tenían DG diagnosticada, 68% mediante PTOG. Presentaban 43% AFD, 38,6% sobrepeso, 20,45% obesidad, 68,2% cesáreas y 11,4% recién nacidos con alto peso. En seis años de seguimiento, 54,5% de estas pacientes realizó control metabólico; este grupo, a diferencia del grupo sin control, presentó mayor IMC al inicio del embarazo (t:2,103; p<0,02), glucemia basal (t:10,59; p<0,001), presión arterial sistólica (t:2,629; p<0,01), diastólica (t:1,965; p<0,05) y macrosomía fetal (4 vs 1). El 33,3 % manifestó DM2 predominantemente a partir de tres años del posparto. Conclusiones: el 54,5% de las pacientes con DG concurrió a control metabólico posparto tardíamente, y el 33,3% evolucionó a DM2; incluso estas pacientes presentaron mayor número de factores de riesgo obstétricos y cardiometabólicos que el grupo sin control al inicio del embarazo.


Introduction: there is no register of the number of women with gestational diabetes (GD) that have undergone metabolic post-partum control in the province of La Pampa, even though it is well-known the increased associated risk of becoming a diabetes type 2 patient (T2DM). Objectives: to analyze at the Interzonal Public Hospital (Dr. Lucio Molas) the percentage of women with GD who returned to postpartum metabolic control and developed T2DM during six years of follow-up. Materials and methods: descriptive ambispective study in 44 patients with GD diagnosed in 2013 with follow-up until 31 December 2019. Different characteristics were analyzed in all participants: previous history of GD and family members of diabetes (FHD), age, gestational week of the diagnosis with fasting glucose or oral glucose tolerance test (OGTT), body mass index (BMI), blood pressure, delivery route, newborn weight, glycated hemoglobin (HbA1C). Results: a number of 1,238 of deliveries were performed in 2013, 44 women (3.7%) developed GD diagnosed by OGTT (68%), 43% presented FHD, 38.6% overweight, 20.45% obesity. Among the totality of deliveries 68.2% were by caesarea and 11.4% high birth weight newborns. In six years of follow-up, 54.5% of these patients underwent metabolic control, presenting this group, unlike the group without control, higher BMI at the beginning of pregnancy (t:2.103; p<0.02), fasting blood glucose (t:10 .59; p<0.001), systolic blood pressure (t:2.629; p<0.01), diastolic blood pressure (t; 1.965; p<0.05) and fetal macrosomia (4 vs 1). 33.3% developed T2DM predominantly from at three years postpartum. Conclusions: the present study reported that 54.5% of women with GD performed a late metabolic postpartum control evolving 33.3% developed T2DM presenting higher obstetric and cardiometabolic risk factors than the group without control at the beginning of pregnancy.


Subject(s)
Humans , Diabetes, Gestational , Blood Glucose , Gestational Age , Diabetes Mellitus, Type 2
7.
Rev. cuba. pediatr ; 93(1): e1122, ene.-mar. 2021. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1251755

ABSTRACT

Introducción: La incontinencia pigmentaria es un trastorno neuroectodérmico sistémico que en el recién nacido se diagnostica por la presencia de lesiones cutáneas de tipo eritemato-vesiculosas o vesículo-pustulosas, con distribución según las líneas de Blaschko, asociadas a eosinofilia en muestra de sangre. Objetivo: Mostrar que es factible diagnosticar la incontinencia pigmentaria en el período neonatal, aún en casos esporádicos, mediante un adecuado ejercicio del método clínico. Presentación de los casos: Se trata de dos recién nacidas femeninas, nacidas a término, con peso adecuado para la edad gestacional y sin antecedentes pre- y perinatales de interés; la primera de las cuales se presenta al tercer día de nacida con lesiones en piel, de aspecto vesículo-pustuloso, que seguían el recorrido del nervio ciático poplíteo externo. El segundo caso se presenta al 11no día de nacida con lesiones de tipo vesículo-ampulosas, en región externa de los cuatro miembros, con mejoría a los 26 días de vida. En ambos casos se plantea el diagnóstico de incontinencia pigmentaria esporádica. Conclusiones: El diagnóstico de la incontinencia pigmentaria en el período neonatal constituye un reto, el cual es posible asumir si se lleva a cabo un adecuado uso del método clínico, con un minucioso diagnóstico diferencial. Para el diagnóstico, resulta útil establecer consenso a partir de un enfoque multidisciplinario(AU)


Introduction: Pigment incontinence is a systemic neuroectodermal disorder that in the newborn is diagnosed by the presence of skin lesions of erythematous-vesiculosus or vesicle-pustulous type, with distribution according to the Blaschko lines, associated with eosinophilia in the blood sample. Objective: Show that it is feasible to diagnose pigment incontinence in the neonatal period, even in sporadic cases, through proper performance of the clinical method. Presentation of cases: These are two female newborns, born full-term, with a suitable weight for gestational age and without a pre- and perinatal history of interest; the first case occurs on the third day of life, presenting skin lesions, vesicle-pustulous in appearance, which followed the path of the external popliteal sciatic nerve. The second case occurs on the 11th day of life with vesicle-ampulose lesions in the outer region of the four limbs, with improvement at 26 days of life. Diagnosis of sporadic pigment incontinence is stated in both cases. Conclusions: Diagnosing pigment incontinence in the neonatal period is a challenge, which can be assumed if proper use of the clinical method is carried out, with a thorough differential diagnosis(AU)


Subject(s)
Humans , Female , Infant, Newborn , Peroneal Nerve , Sciatic Nerve , Incontinentia Pigmenti , Clinical Diagnosis , Gestational Age
8.
Arch. argent. pediatr ; 119(1): 18-24, feb. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147062

ABSTRACT

Introducción. A nivel mundial, hay una tendencia ascendente en nacimientos prematuros y cesáreas. El objetivo fue describir edad gestacional (EG), vía de parto, distribución en días y horarios, y relación entre la vía de parto y el momento del nacimiento en dos instituciones privadas.Población y métodos. Estudio prospectivo, transversal, analítico.Resultados. Se incluyeron los 1500 nacidos vivos entre 9-2017 y 8-2018 (1465 embarazadas). El 99,4 % fueron embarazos controlados; el 66,8 % terminaron por cesárea. La causa fue cesárea previa en el 36,4 %, falta de progresión y descenso en el 18,9 % y elección materna en el 9,2 %. El peso promedio al nacer fue de 3232 g ± 561,1 g y la mediana de EG, 39 semanas (rango 38-40) por fecha de última menstruación. El 88,2 % fueron nacidos de término y, de los prematuros, el 76,1 % fueron pretérminos tardíos. Los nacidos de término temprano tuvieron mayor índice de cesáreas (p < 0,001). Los nacimientos por cesárea en días hábiles fueron 849/1201 (el 74,5 %) y, en los días de fin de semana y feriados, 173/299 (el 57,9 %, p < 0,001). Se encontró una relación estadísticamente significativa entre el horario de nacimiento y la realización de cesárea.Conclusiones. La mediana de EG fue 39 semanas. La cesárea fue la vía de nacimiento más frecuente. Los nacimientos se produjeron, predominantemente, de lunes a viernes entre las 8 y las 21 h. El 82,9 % de los nacimientos por cesárea ocurrieron en días de semana laborables


Introduction. There is a worldwide growing trend of preterm births and C-sections. Our objective was to describe gestational age (GA), mode of delivery, day and time distribution, and the relation between the mode of delivery and the time of birth in two private facilities.Population and methods. Prospective, cross-sectional, analytical study.Results. A total of 1500 live newborn infants were included between September 2017 and August 2018 (1465 pregnant women). Of these, 99.4 % had received antenatal care; 66.8 % of pregnancies ended via C-section. The reason was a previous C-section in 36.4 %, lack of progression and descent in 18.9 %, and maternal choice in 9.2 %. The average birth weight was 3232 g ± 561.1 g and the median GA was 39 weeks (range: 38-40) based on the date of the last menstrual period; 88.2 % were term births and, among preterm births, 76.1 % corresponded to late preterm babies. Early term births showed a higher rate of C-sections (p < 0.001). There were 849/1201 (74.5 %) C-sections on weekdays and 173/299 (57.9 %, p < 0.001) on weekends and holidays. A statistically significant relation was observed between the time of birth and the performance of a C-section.Conclusions. The median GA was 39 weeks. C-sections were the most common mode of delivery. Births occurred predominantly Mondays through Fridays between 8 a.m. and 9 p.m.; 82.9 % of C-sections took place on weekdays.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Cesarean Section , Gestational Age , Time Factors , Infant, Premature , Cross-Sectional Studies , Prospective Studies , Parturition
9.
Braz. j. med. biol. res ; 54(1): e10235, 2021. tab
Article in English | LILACS, ColecionaSUS | ID: biblio-1142572

ABSTRACT

A prospective cohort study was conducted on a convenience sample of 1370 pregnant women with a gestational age of 20 to 25 weeks in the city of Ribeirão Preto. Data on obstetrical history, maternal age, parity, smoking habit, and a history of preterm delivery was collected with the application of a sociodemographic questionnaire. Cervical length was determined by endovaginal ultrasound, and urine and vaginal content samples were obtained to determine urinary tract infection (UTI) and bacterial vaginosis (BV), respectively. The aim of this study was to verify the association of cervical length and genitourinary infections with preterm birth (PTB). Ultrasound showed no association of UTI or BV with short cervical length. PTB rate was 9.63%. Among the women with PTB, 15 showed UTI (RR: 1.55, 95%CI: 0.93-2.58), 19 had BV (RR: 1.22, 95%CI: 0.77-1.94), and one had both UTI and BV (RR: 0.85, 95%CI: 0.13-5.62). Nineteen (14.4%) PTB occurred in women with a cervical length ≤2.5 cm (RR: 2.89, 95%CI: 1.89-4.43). Among the 75 patients with PTB stratified as spontaneous, 10 showed UTI (RR: 2.02, 95%CI: 1.05-3.86) and 14 had a diagnosis of BV (RR: 1.72, 95%CI: 0.97-3.04). A short cervical length between 20 and 25 weeks of pregnancy was associated with PTB, whereas UTI and BV determined at this age were not associated with short cervical length or with PTB, although UTI, even if asymptomatic, was related to spontaneous PTB.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Young Adult , Cervix Uteri/anatomy & histology , Premature Birth/epidemiology , Female Urogenital Diseases/microbiology , Vagina/microbiology , Brazil , Cervix Uteri/diagnostic imaging , Prospective Studies , Ultrasonography , Gestational Age
10.
Braz. j. med. biol. res ; 54(1): e10118, 2021. tab
Article in English | LILACS, ColecionaSUS | ID: biblio-1132562

ABSTRACT

Gestational hypertension and pre-eclampsia are important causes of perinatal morbidity. The objective of the present study was to determine the increase in relative risk for developing hypertensive disorders of pregnancy based on the evaluation of pregnant women between 20 and 25 weeks of gestation, and to correlate the findings at this period with the outcome of pregnancy. We conducted a prospective cohort study, with a convenience sample of 1417 patients evaluated at this gestational age, of which 1306 were contacted at childbirth. We detected an increased relative risk of 2.69 (95%CI: 1.86 to 3.89) associated with pulsatility index of the uterine arteries, a 2.8 increase (95%CI: 1.58 to 5.03) in relative risk attributed to maternal age above 35 years, a 1.68 increase (95%CI: 1.17 to 2.40) attributed to parity greater than or equal to 3, and a 5.35 increase (95%CI: 4.18 to 6.85) attributed to chronic hypertension and obesity, with a progressive increase in relative risk according to the degree of overweight, i.e., grades 1, 2, 3, and morbid obesity (2.58, 3.06, 5.84, and 7.28, respectively).


Subject(s)
Humans , Female , Pregnancy , Child , Adolescent , Adult , Middle Aged , Young Adult , Pre-Eclampsia/etiology , Pre-Eclampsia/epidemiology , Uterus/physiopathology , Vascular Resistance , Hypertension, Pregnancy-Induced/etiology , Hypertension, Pregnancy-Induced/epidemiology , Parity , Pregnancy Outcome , Prospective Studies , Risk Factors , Gestational Age
11.
Braz. j. med. biol. res ; 54(1): e10115, 2021. tab, graf
Article in English | LILACS, ColecionaSUS | ID: biblio-1132561

ABSTRACT

The introduction of early complementary feeding (ECF) is determined by different factors depending on when it occurs. The objective of this study was to analyze factors associated with the introduction of ECF in two different moments of the infant's life: from zero to three and from four to five months of age. A cohort with 3,306 dyads studied in the BRISA survey in São Luis/MA in 2010 was used. Questionnaires were applied at birth and at follow-up when the infants were 15 to 36 months of age of women with more than 20 weeks of gestational age, residing in this municipality. A multivariate model of multinomial logistic regression was used to verify associations between independent variables and ECF at 0 to 3 months and at 4 to 5 months of age. A hierarchical analysis model was used to select variables for confounding adjustment. Variables with a P-value <0.05 were considered significant. For ECF introduced between 0-3 months, the variables "use of pacifier", "maternal paid activity", "smoking", and "postpartum pregnancy" were identified as risk factors. The variables "use of pacifier" and "maternal paid activity" remained associated as a risk for ECF introduced from 4-5 months. The variable 'mother without partner' (RR=1.26 and P=0.04) represented a risk factor for ECF only for the 4-5 months period. Although each period presented specific risk factors, the use of pacifier and maternal professional activity were associated in the two periods studied, indicating their importance for the introduction of ECF.


Subject(s)
Humans , Female , Pregnancy , Infant , Adult , Young Adult , Infant Nutritional Physiological Phenomena , Time Factors , Brazil , Breast Feeding , Smoking , Cesarean Section , Risk Factors , Cohort Studies , Gestational Age , Pacifiers , Employment
12.
Article in Chinese | WPRIM | ID: wpr-879899

ABSTRACT

OBJECTIVE@#To evaluate the clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation.@*METHODS@#A retrospective analysis was performed for the preterm infants with a birth weight less than 1 500 g and a gestational age less than 32 weeks who were treated in the neonatal intensive care unit of 20 hospitals in Jiangsu, China from January 2018 to December 2019. According to the intensity of resuscitation in the delivery room, the infants were divided into three groups:non-tracheal intubation (@*RESULTS@#Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly lower rates of cesarean section and use of antenatal corticosteroid (@*CONCLUSIONS@#For preterm infants with a birth weight less than 1 500 g, the higher intensity of resuscitation in the delivery room is related to lower rate of antenatal corticosteroid therapy, lower gestational age, and lower birth weight. The infants undergoing tracheal intubation or ECRP in the delivery room have an increased incidence rate of adverse clinical outcomes. This suggests that it is important to improve the quality of perinatal management and delivery room resuscitation to improve the prognosis of the infants.


Subject(s)
Birth Weight , Cesarean Section , China , Female , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , Pregnancy , Retrospective Studies
13.
Article in Chinese | WPRIM | ID: wpr-879898

ABSTRACT

OBJECTIVE@#To investigate the factors contributing to the withdrawal from treatment in neonates with respiratory failure.@*METHODS@#The medical data of 2 525 neonates with respiratory failure were retrospectively studied, who were reported in 30 hospitals of Jiangsu Province from January to December, 2019. According to whether a complete treatment was given, they were divided into a complete treatment group with 2 162 neonates and a withdrawal group with 363 neonates. A multivariate logistic regression analysis was used to investigate the factors contributing to the withdrawal from treatment in neonates with respiratory failure.@*RESULTS@#The multivariate logistic regression analysis showed that small-for-gestational-age birth, congenital abnormality, gestational age < 28 weeks, living in the rural area or county-level city, and maternal age < 25 years were risk factors for the withdrawal from treatment in neonates with respiratory failure (@*CONCLUSIONS@#Small-for-gestational-age birth, congenital abnormality, gestational age, living area, maternal age, Apgar score at birth, and method of birth are contributing factors for the withdrawal from treatment in neonates with respiratory failure. A poor prognosis and a low quality of life in future might be major immediate causes of withdrawal from treatment in neonates with respiratory failure, which needs to be confirmed by further studies.


Subject(s)
Apgar Score , Cesarean Section , Female , Gestational Age , Humans , Infant , Infant, Newborn , Pregnancy , Quality of Life , Respiratory Insufficiency/therapy , Retrospective Studies , Risk Factors
14.
Article in Chinese | WPRIM | ID: wpr-879896

ABSTRACT

OBJECTIVE@#To study the clinical features of very preterm infants with prelabor rupture of membranes (PROM) and predictive factors for early-onset sepsis (EOS) and death.@*METHODS@#A retrospective analysis was performed for the clinical data of the very preterm infants with PROM (with a gestational age of < 32 weeks) who were admitted to the neonatal intensive care unit from January 2018 to May 2020. According to the time from membrane rupture to delivery, the infants were divided into four groups: < 18 hours (@*RESULTS@#There was no significant difference in the incidence rates of major neonatal complications and mortality rate among the very preterm infants with different times of PROM (@*CONCLUSIONS@#Prolonged PROM does not increase the incidence of neonatal complications and mortality in very preterm infants. Adverse outcomes of very preterm infants with PROM are mainly associated with lower birth weights, lung immaturity, and systemic infection.


Subject(s)
Female , Fetal Membranes, Premature Rupture , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases , Infant, Very Low Birth Weight , Pregnancy , Retrospective Studies
15.
Article in Chinese | WPRIM | ID: wpr-879880

ABSTRACT

OBJECTIVE@#To study the effect of oral motor intervention (OMI) on brain function development in preterm infants.@*METHODS@#A total of 112 preterm infants were stratified into small-gestational-age (30-31@*RESULTS@#On day 7 of OMI, the small-gestational-age intervention group had lower upper bounds of voltage and bandwidth and a higher aEEG score than the small-gestational-age control group (@*CONCLUSIONS@#OMI can promote the maturation of aEEG background activities, improve neurobehavioral manifestations, and accelerate brain function development in preterm infants.


Subject(s)
Brain , Electroencephalography , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Small for Gestational Age
16.
Article in Chinese | WPRIM | ID: wpr-879862

ABSTRACT

OBJECTIVE@#To explore the risk factors for endotracheal intubation during resuscitation in the delivery room among very preterm infants.@*METHODS@#A retrospective analysis was performed for 455 very preterm infants who were admitted to the neonatal intensive care unit from January 2017 to December 2019. They were divided into an intubation group (@*RESULTS@#The intubation rate was 17.4% (79/455). Compared with the intubation group, the non-intubation group had significantly higher gestational age, birth weight, and rates of caesarean birth, delayed cord clamping (DCC), resuscitation quality improvement, regular use of antenatal glucocorticoids in mothers and premature rupture of membranes > 18 hours (@*CONCLUSIONS@#Very preterm infants with younger gestational age, birth weight < 750 g, maternal diabetes mellitus, placenta previa or placenta previa status may have a higher risk for endotracheal intubation after birth. The regular use of antenatal glucocorticoids and DCC can reduce the risk of intubation during resuscitation in very preterm infants.


Subject(s)
Delivery Rooms , Female , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , Intubation, Intratracheal , Pregnancy , Retrospective Studies , Risk Factors
17.
Article in Chinese | WPRIM | ID: wpr-879842

ABSTRACT

OBJECTIVE@#To study the clinical features of very preterm small-for-gestational-age infants born by cesarean section due to severe preeclampsia.@*METHODS@#Forty-two small-for-gestational-age infants who were admitted from August 2017 to July 2018 and were born due to severe preeclampsia were enrolled as the observation group. Forty very preterm infants who were born to healthy mothers since uterine contractions could not be suppressed were enrolled as the control group. Perinatal features, clinical manifestations of infection, complications, and clinical outcomes were analyzed for the two groups.@*RESULTS@#Within 6 hours and 2-3 days after birth, the observation group had significantly lower white blood cell count (WBC), absolute neutrophil count (ANC), and platelet count (PLT) than the control group (@*CONCLUSIONS@#Very preterm small-for-gestational-age infants born due to severe preeclampsia have a high incidence rate of infection and severe conditions. Early manifestations include reductions in the infection indicators WBC, ANC, and PLT, and CRP does not increase significantly in the early stage and gradually increases at 2-3 days after birth. Most of these infants require invasive ventilation after birth, with bronchopulmonary dysplasia as the main complication. Clinical changes should be closely observed and inflammatory indicators should be monitored for early identification of infection, timely diagnosis, and timely adjustment of antibiotic treatment, so as to improve the outcome.


Subject(s)
Bronchopulmonary Dysplasia , Cesarean Section , Female , Gestational Age , Humans , Infant , Infant, Extremely Premature , Infant, Newborn , Infant, Premature, Diseases , Infant, Very Low Birth Weight , Pre-Eclampsia , Pregnancy
18.
Article in Chinese | WPRIM | ID: wpr-879841

ABSTRACT

OBJECTIVE@#To study the association of different stages of histological chorioamnionitis (HCA) with the incidence rate and severity of respiratory distress syndrome (RDS) in preterm infants.@*METHODS@#Related data were collected from the infants and their mothers who were treated in the Neonatal Intensive Care Unit of Qingdao Women and Children's Hospital, Qingdao University, from January 2018 to June 2020. According to the presence or absence of HCA and its stage, the infants were divided into four groups: control (@*RESULTS@#Compared with the control and late-stage HCA groups, the early-stage HCA group had a significantly lower incidence rate of placental abruption and a significantly higher rate of prenatal use of antibiotics (@*CONCLUSIONS@#Early-, middle-, and late-stage HCA can reduce the incidence rate of RDS in preterm infants. HCA stage may not be correlated with RDS severity in preterm infants, which needs to be verified by further research.


Subject(s)
Birth Weight , Child , Chorioamnionitis/epidemiology , Female , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , Pregnancy , Respiratory Distress Syndrome, Newborn/etiology
19.
Article in Chinese | WPRIM | ID: wpr-879840

ABSTRACT

OBJECTIVE@#To study the perinatal complications of late preterm twins (LPTs) versus early term twins (ETTs).@*METHODS@#A retrospective analysis was performed for the complications of 246 LPTs, 496 ETTs, and their mothers. The risk factors for late preterm birth were analyzed. According to gestational age, the twins were divided into five groups: 34-34@*RESULTS@#Maternal hypertension, maternal thrombocytopenia, placenta previa, and premature rupture of membranes were independent risk factors for late preterm birth in twins (@*CONCLUSIONS@#Compared with ETTs, LPTs have an increased incidence of perinatal complications. The incidence of perinatal complications is associated with gestational ages in the LPTs and ETTs.


Subject(s)
Female , Gestational Age , Humans , Infant , Infant, Newborn , Pregnancy , Premature Birth , Respiratory Distress Syndrome, Newborn , Retrospective Studies , Twins
20.
Article in Chinese | WPRIM | ID: wpr-879839

ABSTRACT

OBJECTIVE@#To study the effect of weight growth velocity in the early stage after birth on the neurodevelopment of preterm infants at the corrected age of 12 months.@*METHODS@#Related data were collected from the preterm infants who were discharged from the Department of Neonatology, Third Affiliated Hospital of Guangzhou Medical University, from July 1, 2015 to December 31, 2019 and were followed up at the outpatient service of high-risk infants. According to the weight growth velocity from birth to the corrected gestational age of 40 weeks, the infants were divided into two groups: low velocity [< 10 g/(kg·d); @*RESULTS@#At the corrected age of 12 months, the low velocity group had a significantly lower score of fine motor (@*CONCLUSIONS@#The weight growth velocity from birth to the corrected age of 40 weeks affects the development of fine motor and language in preterm infants at the corrected age of 12 months; however it needs to be further verified by large-sample studies.


Subject(s)
Birth Weight , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , Patient Discharge
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