Meconium-related Ileus in Extremely Low-birth Weight Newborn Infants Meconium-related Ileus in ELBWI

PURPOSE: Meconium-related ileus (MRI) is one of the major causes of bowel obstruction in extremely low-birth weight newborn infants (ELBWI). Hyperosmolar water-soluble contrast (HWSC) enemas been recognized to be an effective treatment for MRI. The purpose of this study is to observe clinical findings of MRI accompanied by ELBWI and evaluate the therapeutic efficacy and complications of HWSC enemas. METHODS: A total of 15 ELBWI with MRI were treated with HWSC enemas under the guidance of ultrasonography at the bedside in the NICU between 2008 and 2011. Clinical findings of 15 patients were reviewed and compared with those of 48 ELBWI without MRI administered to NICU during the same period. Radiological findings, therapeutic efficacy and complications of HWSC enemas in patients with MRI were also reviewed. RESULTS: Patients with MRI, compared to those without MRI, showed the following significantly lower Apgar score at 1 minute, higher incidence of preeclampsia, bronchopulmonary dysplasia and sepsis, and longer duration of the first meconium passing and non-feeding per oral. Fourteen patients with MRI had resolved bowel obstruction successfully following 1-2 trials of enema. One case was not relieved following 3 trials of enema, showed no clinical improvement, and died of severe intraventricular hemorrhage and multi-organ failure at 45 days old. No complications associated with HWSC enemas were observed in all cases. CONCLUSION: Administration of HWSC enemas under the guidance of abdomen ultrasonography in the NICU is safe and efficacious for the rapid diagnosis and treatment of MRI even accompanied by ELBWI.

Associação entre violência doméstica na gestação e peso ao nascer ou prematuridade / The association between domestic violence during pregnancy and low birth weight or prematurity

OBJETIVO: Avaliar se a violência doméstica na gestação está associada a desfechos desfavoráveis na saúde do lactente, medidos pelo baixo peso ao nascer ou prematuridade. MÉTODO: Estudo de coorte prospectiva, realizado com gestantes que fizeram pré-natal em 10 Unidades Básicas de Saúde do município de Campinas (SP), durante os anos de 2004 a 2006. Foi utilizado questionário estruturado e validado no Brasil. As gestantes tiveram, no mínimo, duas e, no máximo, três entrevistas realizadas durante pré e pós-natal. Foi utilizada análise descritiva dos dados. O teste t de Student foi utilizado para comparar as médias do peso ao nascer e da idade gestacional entre os grupos de gestantes que sofreram, durante a atual gestação, violência doméstica e aqueles que não sofreram. A análise de regressão logística foi utilizada para verificar os fatores associados ao baixo peso ou prematuridade. RESULTADOS: Foram acompanhadas durante o período de pré-natal e pós-natal (n = 1.229) 89,1 por cento das gestantes; 10,9 por cento representam as perdas de acompanhamento, basicamente por mudança de endereço. O peso médio ao nascer foi de 3.233 g; idade gestacional foi em média 38,56 semanas. Apresentaram baixo peso ao nascer ou prematuridade 13,8 por cento dos recém-nascidos. Condições de risco para baixo peso ao nascer ou prematuridade foram: gestante ter tido recém-nascido prematuro em outra gestação (p < 0,005), ser tabagista (p < 0,001), ter tido parto por cesárea (p < 0,001), ser baixa a escolaridade do parceiro (p < 0,008). CONCLUSÃO: Neste estudo, não foi observada associação estatisticamente significativa entre violência doméstica perpetrada pelo parceiro e baixo peso ao nascer ou prematuridade.

OBJECTIVE: To investigate whether domestic violence during pregnancy is associated with unfavorable infant health outcomes, measured by low birth weight or prematurity. METHODS: This was a prospective cohort study enrolling pregnant women whose prenatal care was provided by 10 basic health units in the city of Campinas, SP, Brazil, between 2004 and 2006. A structured questionnaire was employed that had previously been validated for use in Brazil. Each mother attended a minimum of two and a maximum of three interviews during the prenatal and postnatal periods. Data were analyzed using descriptive statistics. Student's t test was used to compare means for birth weight and gestational age between mothers who had suffered domestic violence during the current pregnancy and those who had not. Logistic regression analysis was employed to identify factors associated with low birth weight or prematurity. RESULTS: During the prenatal and postnatal periods, 89.1 percent (n = 1,229) of the pregnant women were followed up, 10.9 percent being lost to follow-up, basically due to changes of address. Mean birth weight was 3,233 g; mean gestational age was 38.56 weeks. A total of 13.8 percent of the infants had low birth weight or were premature. Conditions associated with risk of low birth weight or prematurity were: mothers who had previously given birth prematurely (p < 0.005), who smoked (p < 0.001), who delivered by caesarian (p < 0.001) and whose partners had a low educational level (p < 0.008). CONCLUSIONS: In this study, no statistically significant association was observed between domestic violence perpetrated by partners and low birth weight or prematurity.