Impacts of different causes of preterm birth on the outcomes of late preterm infants / 中国新生儿科杂志

Objective:To study the impacts of different causes of preterm birth on the clinical outcomes of late preterm infants.Methods:From 2016 to 2022, clinical data of late preterm infants and their mothers delivered in our hospital were retrospectively analyzed. The infants were assigned into spontaneous preterm group, premature rupture of membranes (PROM) group and iatrogenic preterm group according to the causes of preterm birth. Perinatal data and neonatal outcomes were compared among these groups. Composite neonatal adverse outcomes (CNAO) included more than one of the following conditions: respiratory diseases, the need for respiratory support, hypoglycemia and neonatal asphyxia. Logistic regression analysis was used to analyze the correlation between causes of preterm birth and CNAO.Results:A total of 553 late preterm infants were enrolled in the study, including 111 cases (20.1%) in spontaneous preterm group, 305 cases (55.2%) in PROM group and 137 cases (24.8%) in iatrogenic preterm group. Iatrogenic preterm group had higher incidences of maternal hypertension during pregnancy, antenatal corticosteroid use, C-section delivery, neonatal respiratory diseases, respiratory support and CNAO than the other two groups ( P<0.05). Additionally, iatrogenic preterm group showed lower birth weight (BW) than the other two groups ( P<0.05). No significant differences existed in above-mentioned items between spontaneous preterm group and PROM group ( P>0.05). Iatrogenic preterm group had significantly lower gestational age (GA) and higher incidences of neonatal asphyxia and small-for-gestational-age (SGA) than PROM group ( P<0.05). Logistic regression analysis showed that iatrogenic preterm birth ( OR=1.983, 95% CI 1.037-3.791) and lower GA at delivery (34 weeks: OR=2.412, 95% CI 1.250-4.656; 35 weeks: OR =1.909,95% CI 1.197-3.044) were independent risk factors for CNAO in late preterm infants. Conclusions:In addition to immaturity caused by lower GA, iatrogenic preterm birth also increases the incidence of CNAO in late preterm infants.

Ocular sequelae of retinopathy of prematurity in Manaus, Amazonas / Sequelas oculares estruturais da retinopatia da prematuridade em crianças em Manaus, Amazonas

Abstract Purpose: To evaluate the structural ocular sequelae of retinopathy of prematurity in children at risk for the disease in Manaus, Amazonas, Brazil. Methods: A prospective, cohort-type, observational study was conducted. Fifty-seven children at risk for this retinopathy, who were born in the public health system facilities, were referred for ophthalmic evaluation at a secondary eye hospital. Inclusion criteria were gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g. Results: Eighteen (31.6%) children were diagnosed with any stage of retinopathy of prematurity during the study period, and four (7.0%) of them needed treatment. Structural ocular sequelae were identified in 3 of 56 children (5.3%), consisting of peripheral retinal detachment with macular dragging in 3 eyes of 3 children and macular involving retinal detachment in 2 eyes of 2 children. Associations between occurrence of retinopathy of prematurity and birth weight, gestational age at birth and days in oxygen were observed (p<0.05). Indication of treatment was associated with birth weight (p<0.05). Conclusion: Retinopathy of prematurity stands out as an important cause of avoidable blindness in Amazonas, affected 31.6 % of children at risk in the present paper, which in this same context, led to ocular strucutral sequelae in about 5.3% of these infants, either peripheral or macular involving retinal detachment. A local program for screening and treatment of the population at risk is necessary in order to avoid blindness from this disease, providing care to the public health system users that contemplates equality and universality of access.

Resumo Objetivo: Avaliar as sequelas oculares estruturais da retinopatia da prematuridade em crianças com risco para a doença em Manaus, Amazonas, Brasil. Métodos: Foi conduzido um estudo observacional prospectivo, do tipo coorte. Cinquenta e sete crianças que nasceram em um hospital público, com risco desta retinopatia, foram referênciadas para avaliação oftamológica em um hospital de olhos secundário. Critérios de inclusão foram idade gestacional ≤ 32 semanas e/ou peso ao nascer ≤ 1500 g. Resultados: Dezoito (31.6%) crianças foram diagnosticadas com retinopatia da prematuridade em qualquer estágio durante o período de estudo, quatro (7.0%) delas precisaram de tratamento. Sequelas oculares estruturais foram identificadas em 3 de 56 (5.3%) crianças, consistindo de descolamento de retina periférico com tração macular em 3 olhos de 3 crianças e descolamento de retina envolvendo a mácula em 2 olhos de 2 crianças. Associações entre a ocorrência de retinopatia da prematuridade e peso, idade gestacional e dias em oxigênio foram observadas (p<0.05). Indicação de tratamento foi associada com peso ao nascer (p<0.05). Conclusão: A retinopatia da prematuridade constitui uma importante causa de cegueira prevenível no Amazonas, acometeu 31.6% das crianças em risco no presente estudo, que neste mesmo contexto, levou a seqüelas estruturais oculares em cerca de 5.3% destas, tanto descolamento de retina periférico quanto envolvendo a mácula. Um programa local de triagem e tratamento da população de risco é necessário a fim de evitar a cegueira por esta comorbidade em Manaus, proporcionando cuidados aos usuários do sistema público de saúde que contemplem a igualdade e universalidade de acesso.

Adolescencia como factor de riesgo para complicaciones maternas y neonatales / Adolescence as a risk factor for complications maternal and neonatal

RESUMEN Introducción: El embarazo adolescente se define como aquel que ocurre antes de los 19 años; muchos autores afirman que la adolescencia es un factor de riesgo para la morbimortalidad materna y neonatal; otros concluyen que el riesgo está ligado a su condición socioeconómica, más que a la edad misma. Objetivo: Determinar si la adolescencia es un factor de riesgo para complicaciones maternas y neonatales. Métodos: Estudio de casos y controles en un hospital de tercer nivel con muestra de 560 pacientes en una relación de 3 a 1, datos recogidos durante el periodo de noviembre de 2016 hasta julio de 2017; se recopilaron características sociodemográficas mediante encuesta (cuestionario semiestructurado) y revisión de historia clínica; con base en las variables significativas se generó un análisis bivariado y finalmente un multivariado por medio de una regresión logística. Resultados: Se evidenció que la adolescencia es factor de riesgo para trastornos hipertensivos del embarazo ORa: 2,06 (IC 95%: 1,31 - 3,25); preeclampsia con hallazgos de severidad ORa: 1,63 (IC 95%: 1,01 - 2,66); corioamnionitis ORa: 2,28 (IC 95%: 1,26 - 4,13); ingreso materno a UCI ORa: 3,51 (IC 95%: 1,08 - 11,37); prematurez ORa: 1,74 (IC 95%: 1,02 - 2,99). Conclusión: La adolescencia es un factor de riesgo para trastornos hipertensivos, corioamnionitis y prematurez.

SUMMARY Background: Adolescent pregnancy is that which happens before the 19th birthday. Many authors report adolescence as a risk factor for maternal and neonatal morbidity and mortality, and others conclude that the risk is associated to socioeconomic conditions rather than adolescence itself. Objective: To determine if adolescence is a risk factor contributing to maternal and neonatal complications. Methods: A case/control study in a high complexity hospital, with a total of 560 patients randomly selected during the 8 moths period from November 2016 to July 2017 in a ratio of 3 cases to 1 control. The sociodemographic characteristics were collected through survey (semi-structured questionnaire) and reviews of clinical history. Then, based on the significant variables, we generate a bivariate analysis and finally a multivariate analysis with logistic regression to adjust for possible confounding factors. Results: This study demonstrated that adolescence is a risk factor for: hypertensive disorders (odds ratio [OR]= 2.06; 95% confidence interval [95% CI]: CI: 1.31 - 3.25); preeclampsia with findings of severity (OR= 1.63;95% CI: 1.01 - 2.66); Chorioamnionitis (OR=2.28; 95% CI: 1.26 - 4.13); maternal admission to ICU (OR=3.51;95% CI: 1.08 - 11.37); and prematurity (OR= 1.74; 95% CI: 1.02 - 2.99). Conclusion: Adolescence is a risk factor for hypertensive disorders, chorioamnionitis and prematurity.