Birthweight, postnatal growth and blood pressure in adolescents of low socioeconomic condition: a cohort study in Northeast Brazil

Abstract Objective To verify the influence of low birth weight and rapid postnatal weight gain and associated factors on blood pressure in adolescence in a population of low socioeconomic status, considering that injuries occur in the perinatal period can be predictors of future metabolic changes and are still poorly explored. Methods A cohort study was carried out with 208 adolescents, 78 born with low weight and 130 born with appropriate weight. The infants were followed up during the first six postnatal months and reassessed at 8 and 18 years of age. The independent variables were birthweight and postnatal weight gain. Rapid postnatal weight gain was defined when above 0.67 z score. The co-variables were sex, maternal height and family income at birth, nutritional status at eight years old, socioeconomic conditions, nutritional status, fat mass index, and physical activity level at 18 years. The outcome variable was blood pressure at 18 years old. The bivariate and multivariable logistic regression analysis were realized and p < 0,05 was considered significant. Results The proportion of adolescents with elevated blood pressure was 37.5%. The multivariable logistic regression analysis showed the variables independently associated with a higher chance of elevated blood pressure in adolescence were rapid postnatal weight gain (OR = 2.74; 95% CI 1.22-6.14; p= 0.014), male sex (OR = 4.15; 95% CI 1.66-10.38; p= 0.002) and being physically active (OR = 2.70; 95% CI 1.08-6.74; p= 0.034). Conclusions The rapid postnatal weight gain was a predictor for elevated blood pressure in adolescence, independently of other factors.

Poor nutritional status of fifteen-year-old or younger adolescent mothers enhances the risk of small-for-gestational-age newborns

Introduction: To analyze the factors (socio-demographic, clinical, prenatal care, delivery, postpartum data and anthropometric measures) associated with the birth of small for gestational age newborns.Methods: A cross-sectional study was performed with 15 years old or younger postpartum adolescents divided into small-for-gestational-age newborn (SGA) and non-small-for-gestational age newborn groups (NSGA). Socio-demographic, clinical, prenatal care, delivery, postpartum data and anthropometric measures (triceps skinfold (TS), and mid-arm circumference, (MAC)) were collected.Results: 8,153 women gave birth at the obstetric ward and 364 (4.46%) ≤ 15 years old adolescents were enrolled in the study. The proportion of SGA newborns was 34.61%. The SGA group attended fewer prenatal visits (p = 0.037), had a higher prevalence of nutritional status classified as "very low weight" (p < 0.001) and vaginal delivery (p = 0.023), compared to the NSGA group. The nutritional status and vaginal delivery remained significant even after adjustment for confounders. The prevalence risk for SGA birth was 30% higher in the group of mothers with nutritional status classified as "very low weight" (odds ratio 1.30, 95% confidence interval 1.13 to 1.50) (p < 0.001).Conclusions: 15.4% of adolescents ≤ 15 years of age had an arm circumference compatible with the "very low weight" condition, demonstrating the high prevalence of poor maternal nutritional status in this group. The birth of SGA among adolescents ≤ 15 years of age is independently associated with maternal nutritional status classified as "very low weight" by the mid-arm circumference measures (MAC).

Child Undernutrition among the Bhoksa Tribe of Uttarakhand in India.

Aim: The study aimed to investigate the prevalence of undernutrition in terms of low birth weight, stunting, wasting, and underweight among children up to 3 years of age. Materials and Methods: We recruited 150 children of the Bhoksa Tribe aged between 2 to 36 months. Information related to nutritional indicators (length-for-age, weight-for-age, and weight-for-length) of the child and socio-demographic variables of the household were collected. Results: The prevalence of undernutrition in terms of low birth weight, stunting, wasting, and underweight was 15.4%, 32%, 29.98%, and 36.66%, respectively. The prevalence percentage of undernutrition was high among girls but the difference based on sex was not significant. A significant difference in mean birth weight was observed between low and high SES (2.45 kg v/s 2.93 kg). Conclusion: High prevalence of undernutrition concerning birth weight among the children of the Bhoksa Tribe was observed which may be due to socioeconomic inequality in the population.

Manual Method vs Breast Pump for Breast Milk Expression in Mothers of Preterm Babies During First Postnatal Week: A Randomized Controlled Trial

Objectives: To compare breast milk volume between manual method and breast pump expression in mothers of preterm infants at different time point of first week. Design: Randomized controlled trial. Setting: Postpartum ward of Obstetrics department and tertiary level neonatal intensive care unit (NICU) in a single institution in Orissa between October, 2020 and May, 2021. Participants: Mothers who delivered before 34 completed weeks of gestation. Interventions: Manual breastmilk expression (ME) group using Marmet technique and breast pump milk expression (PE) group using pigeon manual breast pump, initiated milk expression within one hour of delivery. Outcome measures: Expressed breast milk (EBM) volume in mothers of preterm infants at different time point of first week, and cumulative milk volume. Results: Out of 170 mothers (83 PE and 87 ME group), 7-days milk volume data was available for 137 (71 ME and 66 PE) mothers. In per protocol analysis for 126 mothers (63 in each group), the median (IQR) EBM volume on day 2 and day 7 of ME and PE groups were similar [10 (5,20) vs 12 (5,28), P=0.10] and [280 (220-356) vs 280 (220-360), P=0.66]. The median (IQR) cumulative EBM volume over first 7 days in ME group was not significantly different from PE group [733 (593-995) vs 848.5 (571-1009)] P=0.55). A similar number of mothers in the PE and ME group [56 (88.9%) vs 58 (92%); P=0.14] provided exclusive breast milk for their neonates during the first week. Similar results were found on intention to treat analysis. Conclusion: EBM volume expressed was comparable between mothers expressing manually or with breast pump.

Impact of socioeconomic factors on deciduous teeth eruption among infants born after low-risk pregnancy compared to infants diagnosed with intrauterine growth restriction

Aim: The aim is to assess the impact of socioeconomic factors on deciduous teeth eruption among infants born after low-risk pregnancy and infants diagnosed with intrauterine growth restriction (IUGR). Materials and Methodology: The cross-sectional study included 110 neonates recruited at birth using stratified random sampling based on inclusion and exclusion criteria. Neonates diagnosed without IUGR were allocated to Group I (n = 55) and those diagnosed with IUGR were allocated to Group II (n = 55). The perinatal case history was recorded, followed by intraoral examination at birth, 6 months, and monthly up to 1 year or till first evidence of teeth eruption. Results: The difference between both groups based on socioeconomic status (SES) was found statistically significant (P = 0.043). The first evidence of eruption of deciduous teeth was found delayed in Group II (P = 0.0001). Secondary school education was found statistically significant between both the groups (P = 0.024). The difference between the two groups based on religion (P = 0.353) and gravidity (P = 0.571) was found statistically insignificant. Conclusion: Lower SES and secondary maternal education can be considered statistically significant risk factors of IUGR and delayed deciduous teeth eruption. No correlation of IUGR with religion and gravidity was found.

A prospective study on the efficacy and safety of kangaroo mother care as an alternative means of transport of preterm and term small-for-gestational age infants

Background@#The unavailability of transport incubators in resource-limited areas increases the risk for hypothermia in low birthweight neonates requiring transfer to another hospital. The kangaroo mother care (KMC) position may be a better alternative than swaddling the neonates during transport.@*Objective@#To determine the safety and efficacy of KMC as an alternative means of transport of preterm and term small-for-gestational age (SGA) infants who need to be transferred to a higher level of care. Specifically, it aims to establish if KMC is safe and efficacious in terms of thermoregulation during inter-facility transfers. It also aims to determine the impact of transport distance from the referring hospital, age of gestation, sex, birthweight, and Apgar score on the efficacy of KMC in preventing hypothermia. @*Methods@#We did a prospective, single-blinded, parallel-randomized controlled trial from September 2016 to October 2017 from a community-based primary care facility to a tertiary government hospital. We included newborn preterm infants and term SGA infants weighing 1200–1800 grams, delivered at health centers, district and provincial hospitals who needed to be transferred for a higher level of care. Outcomes included physiologic variables such as temperature, heart rate, respiratory rate. We conducted statistical analysis using t-test, risk ratio, and multiple regression analysis. @*Results@#Thirty-one neonates were randomized to KMC transport (n=15) and conventional transport (swaddled) (n=16). Fifty percent of the swaddled infants developed hypothermia against none in the KMC infants. The risk of hypothermia was reduced by 93.75% in the neonates transported in KMC. The gestational age, birthweight, sex, Apgar scores and distance travelled had no confounding effect on the neonates’ temperature during transport. @*Conclusions@#Kangaroo mother care transport is a safe, effective, and low-cost alternative in inter-facility neonatal transport especially in limited-resource areas.

Hypertensive Disorders: Prevalence, Perinatal Outcomes and Cesarean Section Rates in Pregnant Women Hospitalized for Delivery / Distúrbios hipertensivos: Prevalência, resultados perinatais e taxas de cesarianas em gestantes hospitalizadas para o parto

Abstract Objective: To evaluate the prevalence of hypertensive disorders, perinatal outcomes (preterm infants, low birthweight infants and Apgar score < 7 at the 5th minute and fetal deaths) and the cesarean rates in pregnant women hospitalized for delivery at the Maternidade Hilda Brandão da Santa Casa de Belo Horizonte, Belo Horizonte, state of Minas Gerais, Brazil, from March 1, 2008 to February 28, 2018. Methods: A case-control study was performed, and the groups selected for comparison were those of pregnant women with and without hypertensive disorders. Out of the 36,724 women, 4,464 were diagnosed with hypertensive disorders and 32,260 did not present hypertensive disorders Results: The prevalence of hypertensive disorders was 12.16%; the perinatal outcomes and cesarean rates between the 2 groups with and without hypertensive disorders were: preterm infants (21.70% versus 9.66%, odds ratio [OR] 2.59, 95% confidence interval [CI], 2.40-2.80, p < 0.001); low birthweight infants (24.48% versus 10.56%; OR 2.75; 95% CI, 2.55-2.96; p < 0.001); Apgar score < 7 at the 5th minute (1.40% versus 1.10%; OR 1.27; 95% CI, 0.97-1.67; p = 0.84); dead fetuses diagnosed prior to delivery (1.90% versus 0.91%; OR 2.12; 95% CI, 1.67-2.70; p < 0.001); cesarean rates (60.22% versus 31.21%; OR 3.34; 95% CI, 3.14-3.55; p < 0.001). Conclusion: Hypertensive disorders are associated with higher rates of cesarean deliveries and higher risk of preterm infants, low birthweight infants and a higher risk of fetal deaths.

Resumo Objetivo: Avaliar a prevalência dos distúrbios hipertensivos, resultados perinatais (recém-nascidos pré-termo, recém-nascidos de baixo peso, índice de Apgar < 7 no 5° minuto e óbitos fetais) e as taxas de cesarianas nas gestantes internadas para assistência ao parto na Maternidade Hilda Brandão da Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil, no período de 1° de março de 2008 a 28 de fevereiro de 2018. Métodos: Foi realizado um estudo analítico, observacional, longitudinal. Os grupos selecionados para comparação foram gestantes com e sem distúrbios hipertensivos. Do total de 36.724 gestantes, 4.464 foram diagnosticadas com distúrbios hipertensivos e 32.260 não apresentavam distúrbios hipertensivos. Resultados: A prevalência dos distúrbios hipertensivos foi de 12,16%; Os resultados perinatais e as taxas de cesarianas entre os 2 grupos de gestantes com e sem distúrbios hipertensivos foram: recém-nascidos pré-termo (21,70% versus 9,66%; odds ratio [OR] 2,59; intervalo de confiança [IC] 95%, 2,40-2,80; p < 0,001); recém-nascidos de baixo peso (24,48% versus 10,56%; OR 2,75; IC 95%, 2,55-2,96; p < 0,001); índice de Apgar < 7 no 5° minuto (1,40% versus 1,10%; OR 1,27; IC 95%, 0,97-1,67; p = 0,084); fetos mortos diagnosticados previamente ao parto (1,90% versus 0,91%; OR 2,12; IC 95%, 1,67-2,70; p < 0,001); taxas de cesarianas (60,22% versus 31,21%; OR 3,34; IC 95%, 3,14-3,55; p < 0,001). Conclusão: Os distúrbios hipertensivos estão associados a maiores taxas de cesarianas, ao maior risco de recém-nascidos pré-termo, recém-nascidos de baixo peso e a um maior risco de óbitos fetais.

Maternal exposure to alcohol and low birthweight: A systematic review and meta-analysis / Exposição maternal ao álcool e baixo peso ao nascer: revisão sistemática e metanálise

Abstract Objective To investigate the relationship between maternal exposure to alcohol and low birthweight (LBW). Methods The literature search was performed in January 2017 using the following electronic databases: Medline, Embase, LILACS, SciELO, Web of Science, Scopus, CINHAL, Proquest, and PsychInfo. The search strategy used the following terms: alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol addiction/ use/abuse/consumption, light/moderate/social/low drinking, low birthweight, case-control studies, retrospective studies, and cohort studies. No restrictions regarding language or publication date were considered. The literature search yielded 2,383 articles, and after screening and eligibility assessment, 39 articles were included in the systematic review, and 38 studies were included in the meta-analysis. Results Maternal alcohol consumption was associated with LBWamong retrospective cohort studies (relative risk [RR] = 1.37; 95%CI [confidence interval]:1.10-1.77; I2 = 98.4%; p < 0.01). Prospective cohort studies (RR = 1.11; 95%CI: 0.98-1.25; I2 = 81.5%; p < 0.01), and case-control studies (odds ration [OR] = 1.16; 95%CI: 0.68-1.97; I2 = 61.2%; p = 0.05) showed no association between alcohol and LBW.No publication bias was identified, and the meta-regression showed that the sample size influenced the high heterogeneity among retrospective cohort studies. The subgroup analysis showed differences in association between groups when compared by sample size, type of adjustment, or crude measures and publication year. Conclusions We have not found an association between alcohol consumption during gestation and LBW in the analysis in all of the subgroups. In addition, we have found a high heterogeneity between the primary studies, which is related to methodological differences in the conduction of these studies.

Resumo Objetivo Investigar a associação entre a exposição maternal ao álcool e o baixo peso ao nascer. Método A busca na literatura ocorreu em janeiro de 2017 nas seguintes bases de dados eletrônicas: Medline, Embase, LILACS, SciELO, Web of Science, Scopus, CINHAL, Proquest, e PsychInfo. A estratégia de busca utilizou os seguintes termos: alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol addiction/use/ abuse/consumption, light/moderate/social/low drinking, low birthweight, case-control studies, retrospective studies, e cohort studies. Não houve restrição de idioma e ano de publicação. A busca na literatura identificou 2.383 artigos, e depois de analisados conforme os critério de elegibilidade, foram incluídos na revisão sistemática 39 estudos, e 38 estudos foram incluídos na metanálise. Resultados A amostra foi composta por 497.023 gestantes. O consumo materno de álcool foi associado ao baixo peso ao nascer entre os estudos de coorte retrospectiva (risco relativo [RR] = 1,37; IC [intervalo de confiança] 95%: 1,10-1,77; I2 = 98,4%; p < 0,01). Os estudos de coorte prospectiva (RR = 1,11; IC95%: 0,98-1,25; I2 = 81,5%; p < 0,01) e caso-controle (razão de chances [OR, na sigla em inglês] = 1,16; IC95%: 0,68-1,97; I2 = 61,2%; p = 0,05) não apresentaram associação entre o consumo e o desfecho. Não foi identificado viés de publicação, e a metarregressão mostrou que o tamanho da amostra influenciou a heterogeneidade entre os estudos de coorte prospectiva. Na análise por subgrupo, houve diferenças entre os grupos por tamanho de amostra, por tipo de ajuste e por ano de publicação. Conclusão Não encontramos associação entre o consumo e o baixo peso ao nascer em todas as análises por subgrupo. Além disso, encontramos alta heterogeneidade entre os estudos primários, e isto se deve possivelmente às diferenças metodológicas na condução destes estudos.

Effect of second-hand cigarette smoke exposure on neonatal birth weight and prematurity among pregnant patients in secondary hospitals in Manila: A prospective cohort study / Philippine Journal of Obstetrics and Gynecology

Background@#Smoking is a known risk factor for many maternal and perinatal morbidities. Regrettably, as many as 69.8% of mothers, though not active smokers themselves, are exposed to second-hand cigarette smoke (SHS). No level of SHS exposure is safe. Due to the potential harmful effects to the mother and her unborn child, it is important to establish the effect of SHS exposure on neonatal outcome among our pregnant patients. @*Objective@#To determining the effect of second hand cigarette smoke exposure on neonatal outcomes. @*Methods@#Participants are patients with low risk singleton pregnancies who were going for prenatal check up and eventually delivered in secondary hospitals in Manila. Descriptive statistics was used to summarize the demographic and clinical characteristics of the patients. Null hypotheses were rejected at 0.05 ?-level of significance. The computer software STATA 13.1 was used for data analysis. @*Results@#The husband was the most identified source of second-hand smoke. Maternal weight was also higher among the exposed group. The most significant effect of SHS exposure among newborns was a 103 grams difference in mean birth weight. There was no difference in pediatric aging, birth length, and anthropometric measurements. @*Conclusion@#The prevalence of smoking in Philippines remains high at 23.8% among adult population, majority being male adults. Exposure to second-hand smoke during pregnancy was noted to be as high as 69.8%. The most common source of second-hand smoke is the husband, and thus, he should be one of the targets of preventive strategies in second-hand smoke exposure.

Growth Patterns in Small for Gestational Age Babies and Correlation with Insulin-like Growth Factor-1 Levels

Objective: Correlation of catch-up growth and Insulin-like Growth Factor -1 levels (IGF-I) inSGA babies. Methods: 50 Full-term Small for Gestational Age children aged 12-18 monthswere analyzed for Catch-up growth (gain in weight and/or length, Standard Deviation Score/SDS >0.67). IGF-1 was measured after post-glucose load using ELISA method andcorrelated with catch-up growth. Results: Mean (SD) birthweight and length were 2.1 (0.3)Kg and 44.4 (3.1) cm, respectively. At enrollment, mean (SD) age, weight and length were15.0 (2.1) months, 7.7 (1.3) Kg, and 72.9 (5.6) cm, respectively. Catch-up growth was notedin 60% children. IGF-1 levels were significantly higher in children showing catch-up growth(56.6 (63.2) ng/mL) compared to those not having catch up growth (8.7 (8.3) ng/mL). IGF-1was positively correlated with both weight and length catch-up. Conclusion: Majority ofSmall for Gestational Age showed catch-up growth by 18 months, which had good correlationwith IGF-1 levels

Anti-HBs Titers Following Pentavalent Immunization (DTwP- HBV-Hib) in Term Normal Weight vs Low Birthweight Infants

Objective: To compare anti-HBs titers between term low birthweight (1800-2499 g) infants and normal birthweight infants, 6weeks after last dose of primary immunization with pentavalentvaccine, and to study adverse events following immunization(AEFI) with pentavalent vaccine.Design: Cohort study.Setting: Tertiary-care hospital predominantly catering to urbanpoor population of East Delhi.Participants: 265 low birthweight (1800-2499 g) and 265 normalbirthweight (2500-4000 g) infants. Monovalent Hepatitis B vaccinewas administered within 24 hours of birth followed by three primarydoses of pentavalent vaccine at 6, 10 and 14 weeks. Anti-HBstiters were estimated after 6 weeks of third dose of pentavalentvaccine. Adverse events following immunization (AEFI) monthwere observed for a month after each dose of pentavalent vaccine.Main outcome measures: Anti HBs antibody titers after 6 weeksof primary immunization, and AEFI.Result: 443 (83.5%) infants (225 low birthweight and 218 normalbirthweight infants) completed the follow-up. Seroprotectionagainst hepatitis B virus was achieved in both groups afterpentavalent vaccine administration. Anti HBs GMTs in lowbirthweight infants (194.8 mIU/mL) and normal birthweight infants(204.2 mIU/mL) were comparable (P = 0.17). No serious adverseevents were observed in either group.Conclusion: Three primary doses of pentavalent vaccineadministered along with zero dose of Hepatitis B vaccine at birthprovide good seroprotection. The vaccine appears to be safe inboth low birth weight and normal birthweight infants born at term.

Outcomes into Adulthood of Survivors Born Either Extremely Low Birthweight or Extremely Preterm

We need to understand the outcomes into adulthood for survivors born either extremely low birthweight (ELBW; < 1,000 g) or extremely preterm (EP; < 28 weeks' gestational age), particularly their blood pressure and cardiovascular metabolic status,respiratory function, growth, psychological and mental health performance, and functional outcomes. Blood pressure is higher in late adolescence and early adulthood in ELBW/EP survivors compared with controls. In some studies, expreterm survivors have higher insulin and blood lipid concentrations than controls, which may also increase their risk for later cardiovascular disease. ELBW/EP survivors have more expiratory airflow obstruction than do controls. Those who had bronchopulmonary dysplasia (BPD) in the newborn period have even worse lung function than those who did not have BPD. As a group, they are unlikely to achieve their full lung growth potential, which means that more of them are likely to develop chronic obstructive airway disease in later life. Although they are smaller than term born controls, their weight gradually rises and ultimately reaches a mean z-score close to zero in late adolescence, and they ultimately attain a height z-score close to their mid-parental height z-score. On average, ex-preterm survivors have intelligence quotient (IQ) scores and performance on tests of academic achievement approximately 2/3 SD lower than do controls, and they also perform less well on tests of attention and executive function. They have similar high rates of anxiety and depression symptoms in late adolescence as do controls. They are, however, over-represented in population registries for rarer disorders such as schizophrenia and Autism Spectrum Disorder. In cohort studies, ex-preterm survivors mostly report good quality of life and participation in daily activities, and they report good levels of self-esteem. In population studies, they require higher levels of economic assistance, such as disability pensions, they do not achieve education levels as high as controls, fewer are married, and their rates of reproduction are lower, at least in early adulthood. Survivors born ELBW/EP will present more and more to health carers in adulthood, as they survive in larger numbers.

Births to Parents with Asian Origins in the United States, 1992–2012

Despite a remarkable increase in Asian births in the U.S., studies on their birth outcomes have been lacking. We investigated outcomes of births to Asian parents and biracial Asian/White parents in the U.S. From the U.S. birth data (1992–2012), we selected singleton births to Korean, Chinese, Japanese, Filipino, Asian Indian, and Vietnamese. These births were divided into three groups; births to White mother/Asian father, Asian mother/White father, and births to the both ethnic Asian parents. We compared birth outcomes of these 18 subgroups to those of the White mother/White father group. Mean birthweights of births to the Asian parents were significantly lower, ranging 18 g to 295 g less than to the White parents. Compared to the rates of low birthweight (LBW) (4.6%) and preterm birth (PTB) (8.5%) in births to the White parents, births to Filipino parents had the highest rates of LBW (8.0%) and PTB (11.3%), respectively, and births to Korean parents had the lowest rates of both LBW (3.7%) and PTB (5.5%). This pattern of outcomes had changed little with adjustments of maternal sociodemographic and health factors. This observation was similarly noted also in births to the biracial parents, but the impact of paternal or maternal race on birth outcome was different by race/ethnicity. Compared to births to White parents, birth outcomes from the Asian parents or biracial Asian/White parents differed depending on the ethnic origin of Asian parents. The race/ethnicity was the strongest factor for this difference while other parental characteristics hardly explained this difference.

Perinatal mortality and morbidity among low birth weight babies.

Background: This study was conducted to assess the perinatal mortality and morbidity among Low Birth Babies (LBW) and to determine the associated maternal health and sociodemographic factors. Methods: This was a hospital based cross sectional observational study conducted over a period of three years. All the babies (1002) with birth weight ˂2500 gm but >1000 gm born during this period and their mothers were included in the study. Babies were followed up for one week after birth and perinatal mortality and morbidity were assessed. Results: The perinatal mortality rate among LBW babies was 124.7/1000 babies. Very low birth weight babies (˂1500 g) had 10 times mortality rates than babies with birth weight between 1.5-2.5 kg. Preterm and growth restricted babies had the worst perinatal outcomes. The most common perinatal complication was hyperbilirubinemia (16.77%) followed by hypoglycemia (14.99%) and Hyaline membrane disease (14.86%). Preterm babies had higher rates of birth asphyxia, hypoglcemia, hyperbilirubinemia and neonatal ICU admissions (P ˂0.001).Intrauterine growth restricted babies had better perinatal outcomes than preterm babies. Majority of the mothers (96.87%) belonged to low socio-economic status. The most common maternal complications associated with LBW were anemia (43.36%) and hypertensive disorders of pregnancy (17.6%). Conclusions: Low birth weight babies had higher perinatal mortality and morbidity rates. To decrease the incidence of low birth weight, measures to improve the general health and nutrition of mothers should be employed. Appropriate referral of high risk pregnancies and delivery in centres with good neonatal facilities should be engaged.

Significado del cuidado materno cultural del niño(a) con oxígeno domiciliario / Meaning of cultural maternal care of the child with home oxygen

La presente investigación se realizó con el objetivo de describir el significado del cuidado materno cultural del niño(a) prematuro y/o de bajo peso al nacer con oxígeno domiciliario en el Programa Madre Canguro de un hospital de Bogotá. Estudio de tipo cualitativo con abordaje etnográfico, apoyado en el referente teórico de Madeleine Leininger a través de la teoría de la diversidad y de la universalidad de los cuidados culturales, el método de análisis se realizó con la entrevista etnográfica de James Spradley. Se realizaron 21 entrevistas a profundidad a 8 madres, que acudieron con sus hijos/as prematuros con oxígeno domiciliario al plan canguro de un hospital de Bogotá y se tomaron notas de campo a través de la observación participante. Como resultado se encontraron 9 dominios: 1. El oxígeno como una necesidad vital, 2. Conocimientos culturales, 3. Conocimientos y educación sobre la administración de oxígeno domiciliario al prematuro, 4. Trámites y sus dificultades, 5. El desplazamiento de la madre con el niño/a prematuro con oxígeno domiciliario, 6. Higiene y vestido del niño/a con oxígeno domiciliario, 7. Los costos se aumentan, 8. Participación del padre y familiar, y 9. Alteración de las emociones maternas. Conclusión: para las madres de los niños/as con oxígeno domiciliario, el cuidado materno cultural significa "estar pendiente" y "tener cuidado" e interpretan el oxígeno como una necesidad vital.

The goal of this research was to describe the meaning of cultural maternal care for prematury children and/or low birthweight infants with home oxygen in the KMC program at a hospital in Bogotá city. Qualitative research with an ethnographic approach, supported by Madeleine Leininger's theoretical benchmark on the theory of diversity and universality of cultural care. The analysis methodology was undertaken using the James Spradley´s ethnographic interview outline. 21 deep interviews were performed to 8 mothers being part of the KMC program, who came with their home oxygen premature children to a hospital in Bogota; field notes were also taken through participant´s observation. As a result 9 domains: 1. Oxygen as a vital necessity, 2. Cultural Knowledge, 3. Knowledge management and education on home oxygen to premature 4. Procedures and difficulties, 5. The displacement of the mother with child premature home oxygen, 6. Hygiene and child Dress with home oxygen, 7. The costs are increased, 8. Participation of father and family, and 9. Alteration of maternal emotions. Conclusion: for mothers of children with home oxygen, maternal cultural care means "be aware" and "be careful" and interpret oxygen as a vital necessity.

Trends in Early Growth Indices in the First 24 Months of Life in Uruguay over the Past Decade.

Early growth is an important indicator of health and wellbeing of children and a good predictor of adult health. The objective of this study was to examine trends and determinants of overweight and stunting among infants aged 0 to 23 month(s) over the past decade (1999-2011) in Uruguay. Data were used from four large representative samples of 11,056 infants aged 0-23 month(s), who attended public and private health services in 1999, 2003, 2007, and 2011, using a similar methodology. Linear regression analysis was used for assessing trends in early growth indices and binary logistic regression to estimate the probability of being stunted and overweight. Although prevalence of overweight fell from 12.5% (1999) to 9.5% (2011) and stunting from 13.6% to 10.9% respectively, both rates remained higher than expected. Low birthweight (LBW) was the main predictor of stunting [OR 6.5 (5.6-7.6)] and macrosomia of overweight [6.7 (5.3-8.3)]. We did not observe changes in LBW (7.8-8.8%) or macrosomia (5.9-6.7%) over the last decade. Boys showed increased chance of being overweight [OR 1.2 (1.04-1.3)]. Being stunted doubles the chances of being overweight [OR 2.5 (2.2-3.0)]. Overweight [OR 7.1 (6.1-8.3)], LBW [OR 13.2 (11.0-15.9)], and nonbreastfed infants [OR 1.9 (1.7-2.1)] showed rapid weight gain. Uruguay has taken positive steps to decline the prevalence of stunting and overweight but both remain excessively high.

The effect of air pollutants on birth weight in medium-sized towns in the state of São Paulo / O papel dos poluentes atmosféricos sobre o peso ao nascer em cidade de médio porte Paulista

OBJECTIVE: To investigate the effect of air pollution on birth weight in a medium-sized town in the State of São Paulo, Southeast Brazil. METHODS: Cross-sectional study using data from live births of mothers residing in São José dos Campos from 2005 to 2009. Data was obtained from the Department of Information and Computing of the Brazilian Unified Health System. Air pollutant data (PM10, SO2, and O3) and daily averages of their concentrations were obtained from the Environmental Sanitation & Technology Company. Statistical analysis was performed by linear and logistic regressions using the Excel and STATA v.7 software programs. RESULTS: Maternal exposure to air pollutants was not associated with low birth weight, with the exception of exposure to SO2 within the last month of pregnancy (OR=1.25; 95% CI=1.00-1.56). Maternal exposure to PM10 and SO2 during the last month of pregnancy led to lower weight at birth (0.28g and 3.15g, respectively) for each 1mg/m3 increase in the concentration of these pollutants, but without statistical significance. CONCLUSIONS: This study failed to identify a statistically significant association between the levels of air pollutants and birth weight, with the exception of exposure to SO2 within the last month of pregnancy...

OBJETIVO: Verificar o efeito da poluição do ar sobre o peso ao nascer numa cidade de médio porte paulista. MÉTODOS: Estudo transversal, com dados relativos a todos os nascidos vivos de mães residentes no Município de São José dos Campos nos anos de 2005 a 2009. Foram obtidos dados do Departamento de Informações e Informática do Sistema Único de Saúde. Os dados dos poluentes do ar (PM10, SO2 e O3), as médias diárias de suas concentrações, foram fornecidos pela Companhia de Tecnologia de Saneamento Ambiental. Aplicou-se a regressão linear e a logística para a análise dos dados, realizadas nos programas Excel e STATA v.7. RESULTADOS: A exposição materna aos poluentes do ar não se associou ao nascimento de crianças com baixo peso, com exceção do SO2, no último mês de gestação (OR=1,25; IC95% 1,00-1,56). Além disso, a exposição materna ao PM10 e SO2 no último mês levou à diminuição do peso ao nascer (0,28g e 3,15g, respectivamente) para cada 1mcg/m3 de aumento da concentração desses poluentes, porém sem significância estatística. CONCLUSÕES: Este estudo não permitiu identificar associação estatística entre os níveis de concentração dos poluentes atmosféricos e o peso ao nascer, com exceção da exposição SO2, no último mês de gestação...

Estudio inmunohistoquímico de moléculas de adhesión en placentas de niños de bajo peso al nacer en el Hospital Universidad del Norte, Barranquilla (Colombia) / Immunohistochemical studies of adhesion molecules in placentas from low birth infants at Hospital Universidad of the Norte, Barranquilla (Colombia)

Objetivo: Observar la expresión de moléculas de adhesión VCAM-1, ICAM-1 en placentas de niños de bajo peso al nacer. Se estudiaron 21 placentas de pacientes atendidas en el Hospital Universidad del Norte en el periodo de mayo a diciembre de 2006. Materiales y métodos: Se realizó estudio macroscópico de las placentas: forma, peso, diámetro grosor, consistencia, color, olor. Para estudios microscópicos se realizaron 5 cortes de la placa corial, uno del rollo de membrana y otro del cordón umbilical. Los cortes fueron fijados en formol al 10 %, incluidos en parafina, coloreados con hematoxilia - eosina para estudios morfológicos. Para estudios inmunohistoquímicos se usaron anticuerpos mono-clonales Nova Castra para ICAM-1, VCAM-1, macrófagos. Resultados: Dieciocho placentas de forma redonda, 3 ovaladas; el peso varió entre 240 -400 gramos; 3 presentaron infarto en los cotiledones. En la micro 18 presentaron necrosis hialina de la media, hiperplasia de la intima, macrófagos xantomatosos, infiltrado linfoci-tario en tres. En la inmunohistoquímica se observó expresión de ICAM-1, VCAM-1, en la basal de las vellosidades coriales, en la basal de los vasos sanguíneos y macrófagos en el estroma conjuntivo Conclusiones: En dieciocho de los casos los cambios fueron compatibles con preeclampsia, tres con proceso virales. La expresión de moléculas de adhesión y macrófago en la inmunohistoquímica nos sugiere que estas moléculas son fundamentales en los proceso fisiopatológicos de la placenta.

Objective: To observe the expression of adhesion molecules VCAM -1, ICAM -1 in placentas of infants with low birthweight 21 placentas of patients treated at the University Hospital North in the period from May to December were studied 2006. Materials and methods: Macroscopic study of the placentas was performed; shape, weight, diameter, thickness, consistency, color, and odor: For five cuts microscopic studies chorionic plate, one membrane roll and another cord were performed. The sections were fixed in 10 % formalin, embedded in paraffin, stained with hematoxylin-eosin for morphological studies. For immunohistochemical studies monoclonal antibodies were used castra nova for ICAM1, VCAM1, macrophages. Results: 18 placentas round, three oval, the various weight between 240-400 grams, 3 had infarction in the cotyledons. In the micro 18 presented hyaline medial necrosis, hyperplasia of the intima, xanthomatous macrophages, lymphocytic infiltrate in three . In the immunohistochemical expression of ICAM-1, VCAM-1 was observed in the basal of chorionic villi in the basal blood vessel and macrophages in stroma. Conclusions: cases changes are compatible with pre -eclampsia, three viral process. The expression of adhesion molecules and macrophage in immunohistochemistry suggests that these molecules are critical in the pathophysiological process of the placenta.

Glycerin Suppository for Promoting Feeding Tolerance in Preterm Very Low Birthweight Neonates: A Randomized Controlled Trial.

Objective: To compare the efficacy of glycerin suppository versus no suppository in preterm very-low-birthweight neonates for improving feeding tolerance. Design: Randomized controlled trial. Setting: Level III neonatal unit from Mumbai, India. Participants: 50 very-low-birthweight (birth weight between 1000 to 1500 grams) preterm (gestational age between 28 to 32 weeks) neonates randomized to glycerine suppository (n=25) or no intervention (n=26). Intervention: Glycerin suppository (1g) once a day from day-2 to day-14 of life or no suppository, along with intermittent oral feeds and standardized care. Primary outcome: Time required to achieve full enteral feeds (180 mL/kg/d). Results: Baseline characteristics of neonates like gestational age, birthweight, gender and age at the time of introduction of feeds were comparable in both groups. The mean (SD) duration to reach full enteral feed was 11.90 (3.1) days in glycerin suppository group and was not significantly different (P=0.58) from control group, [11.33 (3.57) days]. Glycerin suppository group regained birth weight 2 days earlier than control group but this difference was not significant (P=0.16). There was no significant difference in duration of hospital stay or occurrence of necrotizing enterocolitis amongst the two study groups. Conclusion: Once daily application of glycerin suppository does not accelerate the achievement of full feeds in preterm very-lowbirthweight neonates.

Current Controversies in the Management of Patent Ductus Arteriosus in Preterm Infants.

Objective: Patent ductus arteriosus is very commonly seen in very low birth weight (VLBW) infants, affecting about one-third. The present review tries to identify the group of VLBW infants who need active intervention in day-to-day practice and to determine the mode of intervention, based on current published literatures. Methods: We searched the Cochrane library, MEDLINE, EMBASE and CINAHL databases, and reference that of identified trials. Results and Conclusions: Preterm infants with a birth weight of <800g are at risk of significant morbidity and mortality from PDA; it would be reasonable to treat them when symptomatic or if requiring positive pressure ventilator support. Those weighing >800g are unlikely to need treatment unless they are ventilator-dependent or show evidence of congestive heart failure.