Sociodemographic, behavioral, obstetric, and healthcare factors associated with low weight at birth: a case-control study

ABSTRACT BACKGROUND: Understanding social determinants is crucial for implementing preventive strategies, especially for low birth weight (LBW)—a public health issue that severely increases the risk of morbimortality in children. OBJECTIVE: This study aimed to identify the factors associated with LBW among newborns, assisted by the Brazilian Unified Health System. DESIGN AND SETTING: It analyzed data from newborns and their mothers. The sample was selected by convenience from users of the public health system in Francisco Beltrão (Paraná, Brazil). METHODS: Cases (n = 26) were babies weighing ≤ 2,500 g and controls (n = 52) > 2,500 g. All babies were assessed and paired by sex and date of birth in a 1:2 proportion. Statistical power was computed a posteriori, revealing a power of 87% (α = 0.05). RESULTS: Strong and significant differences were found in the bivariate analysis, in which the number of current smokers or those who quit during pregnancy was higher among mothers of babies with LBW. Moreover, the gestational weeks were lower among these cases. Logistic regression models indicated that the gestational week (odds ratio [OR] = 0.17, 95% confidence interval [CI]:0.05-0.54) and fathers' educational level (high school or above; OR = 0.22, 95% CI:0.06-0.99) were related to lower chances of low birth weight. CONCLUSIONS: Our findings confirm previous investigations on LBW's multi-causality, showing that the gestational week could reduce up to 82% chances of a baby being born with ≤ 2,500 g. Its association with paternal education underlines the importance of comprehensive policies to protect newborns.

Índice pronóstico de bajo peso al nacer / Prognostic index of low weight at birth

RESUMEN Introducción: diversos son los factores mancomunados a un mayor riesgo de recién nacidos con bajo peso al nacer en gestantes. Objetivos: aplicar y validar un índice pronóstico para la estratificación de riesgo de recién nacidos con bajo peso al nacer. Material y métodos: se realizó un estudio observacional de corte longitudinal, prospectivo o de cohortes en gestantes atendidas en el área de salud del municipio de Guanabacoa, en el período comprendido desde el 1º de enero de 2016 hasta el 31 de diciembre del 2019, para aplicar un índice pronóstico de bajo peso al nacer, con elementos clínicos. Mediante la función de regresión logística apreciada se calcularon las probabilidades de bajo peso al nacer en la muestra de estimación, y esa distribución empírica fue fragmentada en terciles para escrutar zonas que permitieran clasificar a las gestantes como de bajo, mediano y alto riesgo de bajo peso. Resultados: el (85,7 %) de las gestantes poseían baja probabilidad de bajo peso al nacer. El 60,4 % de las gestantes estuvieron clasificadas como pacientes con una alta probabilidad de bajo peso al nacer, y la mayoría de los pacientes clasificados de riesgo medio con bajo peso al nacer; 11 pacientes no fueron clasificados adecuadamente por el Índice pronostico. Conclusiones: el índice construido mostró eficacia y robustez adecuadas, siendo útil para realizar pronóstico de bajo peso al nacer en gestantes del área de salud (AU).

SUMMARY Introduction: there are many factors associated to a bigger risk for newborns with low weight at birth. Objective: to apply and to validate a prognostic index for the risk stratification in newborns with low weight at birth. Materials and methods: a cohort or prospective, longitudinal, observational study was carried out in pregnant women attending the health area of Guanabacoa municipality in the period from January 1st 2016 until December 31st 2019 to apply a prognostic index of low weight at birth, with clinical elements. Through the appreciated logistic regression function the possibilities of low weight at birth were calculated in the estimation sample, and that empiric distribution was fragmented in tertils to scrutinize zones allowing classifying pregnant women as low, medium and high risk of low weight births. Results: 85.7% of the pregnant women showed low probability of low birth weight. 60.4% of them was classified as patient with a high probability of low birth weight, and most of the patients classified as of medium risk of low birth weight; 11 patients were not adequately classified by the prognostic index. Conclusions: the conformed index showed suitable efficacy and reliability, being useful to carry out prognosis of low weight at birth in pregnant women of the health area (AU).

Factores de riesgo del bajo peso al nacer. Policlínico Universitario José Jacinto Milanés. 2013-2014 / Low weight risk factors at birth. University Policlinic José Jacinto Milanes. 2013-2014

Introducción: el bajo peso al nacer en los niños, continúa siendo un problema de salud y se considera que la mortalidad durante el primer año de vida es 40 veces mayor en ellos, que en los que nacen con peso normal a término. Objetivo: describir los factores de riesgo del bajo peso al nacer en el Policlínico Universitario José Jacinto Milanés en el período 2013-2014. Materiales y Métodos: teniendo en cuenta la repercusión biopsicosocial del bajo peso al nacer, se realizó una investigación descriptiva, transversal, acerca de los factores de riesgo que influyeron en que estas gestantes del policlínico José Jacinto Milanés de Matanzas, en el período 2013- 2014, aportaran este indicador; para ello se recogieron los datos del Departamento de Estadísticas de dicho policlínico, las Historias Clínicas Individuales y los carnets obstétricos de las gestantes. Resultados: las gestantes con edades comprendidas entre 25 y 29 años constituyeron el mayor porciento con 35.2; la multiparidad representó el 52.9%; la presencia de sepsis cérvico-vaginal estuvo presente en el 58.8% de las gestantes con recién nacidos bajo peso. De de las enfermedades maternas, el asma bronquial, la aparición de placenta previa y la preeclampsia representaron el 14.7%. Conclusiones: en el estudio los autores encontraron como factores de riesgo más frecuentes causantes de bajo peso al nacer, el grupo etario de 25 y 29 años, las mujeres multíparas, la sepsis vaginal en la gestante, el coito desprotegido y la anemia durante la gestación, la preeclampsia, la placenta previa y el asma bronquial (AU).

Introduction: Low weight at birth in children is still being a health problem and it is considered that mortality in the first year of life is 40 times higher in these children than in children born full term with normal weight. Objective: to describe the low weight risk factors at birth in the University Policlinic "José Jacinto Milanes" in the period 2013-2014. Materials and methods: taking into account the biopsychosocial repercussion of low weight at birth, a cross sectional, descriptive research was carried out, on the risk factors influencing the contribution of the pregnant women belonging to the Policlinic "Jose Jacinto Milanes" of Matanzas to this indicator in the period 2013-2014. Data were gathered in the Department of Statistics of the policlinic, the individual clinical records and the pregnant women´s obstetric carnets. Results: pregnant women aged 25-29 years old were the highest percent with 35.2 %; multiparity represented 52.9 %. Cervical vaginal sepsis was present in 58.8 % of the pregnant women with low birth newborns; bronchial asthma, placenta previa and preeclampsia were 14.7 % of the maternal diseases. Conclusions: the authors of the study found that the most frequent risk factors causing low weight at birth were being in the 25-29 age group, multipara women, the presence of vaginal sepsis in pregnant women, having unprotected coitus and anemia during pregnancy, preeclampsia, placenta previa and bronchial asthma (AU).

Associação entre a doença periodontal materna e o parto prematuro e/ou baixo peso ao nascer / Associação entre a doença periodontal materna e o parto prematuro e/ou baixo peso ao nascer

Os mediadores químicos produzidos nas doenças periodontais podem gerar a antecipação das contrações uterinas, levando ao nascimento precoce do bebê e seu baixo peso. Objetivo: realizar uma revisão da literatura abordando a doença periodontal e seus fatores de riscos que se associam às complicações obstétricas, como o parto prematuro e/ou baixo peso ao nascer. Material e métodos: foram utilizadas as bases de dados Lilacs, PubMed e Scielo no período entre janeiro de 2014 e julho de 2014. A busca incluiu artigos publicados em periódicos, dissertações e teses, sem restrições de idioma. Conclusão: é possível que haja participação da doença periodontal como fator de risco ao parto prematuro e/ou baixo peso ao nascer, porém, através da literatura essa relação se mostrou inconclusiva.

The chemical mediators produced in the periodontal diseases, can generate the anticipation of the uterine contractions leading to the early birth of the baby and consequently its low weight. Objective: to review the literature addressing periodontal disease and its risk factors associated with obstetric complications such as preterm birth and/or low birth weight. Material and methods: Lilacs, PubMed, and Scielo databases were screenedbetween January 2014 and July 2014. The search included articles published in periodicals, dissertations and theses, without language restrictions. Conclusion: it is possible that periodontal disease maybe a risk factor for preterm birth and/or low birth weight, but this relationship was inconclusive through the literature.

Factores de riesgo asociados al bajo peso al nacer en la provincia Matanzas. 2013 / Risk factors associated to low weight at birth in the province of Matanzas. 2013

Introducción: el bajo peso al nacer constituye una preocupación a nivel mundial. El peso del niño al nacer es uno de los indicadores más útiles para evaluar los resultados de la atención prenatal y la supervivencia infantil. En análisis realizado en el período 2010-2012 en la provincia de Matanzas, la tasa de mortalidad infantil se encuentra en ascenso al igual que el índice de bajo peso al nacer, y no se han realizado investigaciones recientes sobre los factores de riesgo. Métodos: se realizó un estudio observacional, analítico de casos y controles, en la provincia en el año 2013, para identificar los factores de riesgos asociados al bajo peso al nacer. La variable dependiente fue el bajo peso al nacer y se consideraron como independientes factores de riesgo sociodemográficos, médicos anteriores al embarazo, médicos dependientes del embarazo y hábitos tóxicos. Se utilizó una encuesta confeccionada por los autores para la recolección de los datos. Se calcularon medidas de resumen para variables cuantitativas, y para medir la fuerza de asociación se utilizó la razón de disparidad con un intervalo de confianza del 95 % y p< 0,05. Las variables asociadas al bajo peso al nacer resultantes, se analizaron en regresión logística del programa Epi 2000. Resultados: los factores de riesgo identificados por su asociación significativa con el bajo peso al nacer que resultaron también los más importantes para el trabajo preventivo fueron: el parto pretérmino, la sepsis vaginal, la anemia, la enfermedad hipertensiva en el embarazo y la ganancia insuficiente de peso durante la gestación.

Background: low weight at birth is a preoccupation around the world. Child weight at birth is one of the most useful indicators to evaluate prenatal care results and the infantile survival. In an analysis carried out in the period 2010-2012 in the province of Matanzas, the infantile mortality rate is increasing, as much as the low weight at birth one, and there have not been carried out recent research on the risk facts. Method: We made an observational, case analytic and control study in the province of Matanzas in 2013 to identify the risk factors associated to low weight at birth. The dependent variable was low weight at birth and as independent ones we considered socio-demographic risk factors, before-pregnancy and pregnancy-dependent medical risk factors, and toxic habits. To collect data we used an enquiry worked out by the authors. We calculated summed up measures for quantitative variables, and to measure the association force we used the disparity ratio with a 95 % confidence interval and p< 0,05. The resulting variables associated to low weight at birth were analyzed in logistic regression of the Epi 2000 program. Outcomes: the risk facts identified by their significant association with low weight at birth were also the most important for the preventive work and were: preterm childbirth, vaginal sepsis, hypertensive disease in pregnancy and insufficient weight gain during pregnancy.

Factores de riesgo asociados al bajo peso al nacer en el Policlínico Universitario Carlos Verdugo / Risk factors associated to low weight at birth in the University Policlinic Carlos Verdugo

Introducción: el peso del niño al nacer es uno de los indicadores más útiles para evaluar los resultados de la atención prenatal, las perspectivas de supervivencia infantil y la salud de este durante su primer año de vida. Existen diferentes factores de riesgo que favorecen la aparición de recién nacidos con bajo peso. Durante el período 2011-2012 se produjo un incremento de estos casos en el Policlínico Universitario Carlos Verdugo, del municipio Matanzas, y no se han realizado investigaciones sobre los factores de riesgo que influyeron en la aparición de los mismos. Métodos: se realizó un estudio observacional, analítico de caso y control, en el Policlínico Universitario Carlos Verdugo, con el objetivo de identificar los factores de riesgo que se asociaron al bajo peso al nacer. La variable dependiente fue el bajo peso al nacer y se consideraron como independientes factores de riesgo sociodemográficos, médicos anteriores al embarazo, médicos dependientes del embarazo, cuidados prenatales inadecuados y hábitos tóxicos. Se utilizó la encuesta empleada por el Departamento Materno Infantil provincial para estos casos. Se calcularon medidas de resumen para variables cuantitativas y para medir la fuerza de asociación se utilizó la razón de disparidad con un Intervalo de confianza del 95 %. Resultados: el factor de riesgo asociado al bajo peso al nacer fue la ganancia de peso total inadecuada durante la gestación. Si se elimina este factor de riesgo en la población expuesta estudiada, se reduce la probabilidad de aparición de recién nacidos bajo peso en un 81,5 %.

Introduction: child weight at birth is one of the most useful indicators to evaluate prenatal care results, child survival perspectives and child's health status during the first life year. There are several risk factors favoring of low-weight children birth. In the period 2011-2012 there it was an increase of these cases in the University Policlinic Carlos Verdugo, of Matanzas municipality, and no research were carried out on the risk factors leading to that. Methods: an observational, case-analysis, control study was carried out in the University Policlinic Carlos Verdugo aimed to identifying the risk factors associated to low weight at birth. The dependent variables was low weight at birth; and as independent variables were considered socio demographic risk factors, medical risk factors preceding pregnancy, medical risk factors related with pregnancy, inadequate prenatal care and toxic habits. The inquiry used was the one the provincial Maternal-Infantile Department uses for these cases. There were calculated summing-up measures for quantitative variables and to measure the association force we used disparity ratio with a 95 % confidence interval. Outcome: the risk factor associated to low weight at birth was the inadequate total weight gaining during pregnancy. If this risk factor is eliminated among the studied exposed population, the probability of low-weigh newborns appearance will be reduced in 81,5 %.

El bajo peso como consecuencia de la hipertensión inducida por el embarazo. Factores de riesgo / Under weight as consequence of hypertension induced by pregnancy. Risk factors

La preeclampsia es una nefasta enfermedad peculiar del embarazo que conlleva a morbimortalidad perinatal elevada, bajo peso al nacer y prematurez. Nos propusimos evaluar algunos factores de riesgo que anticiparan la aparición de la hipertensión inducida por el embarazo; caracterizar las variables maternas: edad, paridad, la edad gestacional al parto y el modo de terminación de este e identificar la relación entre el antecedente materno de preeclampsia y el bajo peso al nacer. Se estudiaron 60 recién nacidos bajo peso, conformándose dos grupos; en el primer grupo se incluyeron 30 nacimientos de madres hipertensas y en el segundo 30 de no hipertensas. En el grupo de madres con hipertensión inducida por el embarazo encontramos un predominio de nulíparas, partos pretérminos y cesáreas. Las edades extremas no constituyeron un factor de riesgo en este estudio. La hipertensión inducida por el embarazo es un importante factor de riesgo para la obtención de un bajo peso al nacer.

Preeclampsia is a harmful disease peculiar of pregnancy that produces elevated perinatal morbid-mortality, underweight at birth and premature children. Our aims were to assess some risk factors that anticipate the presence of hypertension induced by pregnancy; to characterise maternal variables like age, number of childbirth, gestational age at birth and the way to finish it; and to relate maternal background for preeclampsia and the underweight at birth. We studied 60 underweight newborns forming two groups; first one included 30 newborns from hypertensive mothers and the second one with 30 newborns from non hypertensive mothers. In the group of hypertensive mothers induced by pregnancy we found a predominance of nuliparas, preterm birth and cesarean. Extreme ages not contribute as a risk factor in our study. The hypertension induced by pregnancy is an important risk factor for the incidence of under weight at birth.

Influencia del estado nutricional sobre el peso al nacer en el tercer trimestre de la gestación / Influence of nutritional status on birth weight in the third trimester

Introducción: el estado nutricional materno es un factor determinante en el crecimiento fetal y en el peso del recién nacido. Existe evidencia científica de que el inadecuado estado nutricional y la anemia en la gestación, generan efectos deletéreos en la salud materno-fetal. Objetivo: determinar la influencia del estado nutricional en el 3er. trimestre sobre el peso al nacer en gestantes del municipio Bayamo. Métodos: se realizó un estudio observacional analítico y longitudinal en una muestra de 53 gestantes en las áreas de salud del municipio Bayamo, Granma, en el período comprendido desde diciembre de 2011 hasta abril de 2012. Se estudió la influencia de indicadores antropométricos como: índice de masa corporal a la captación, la evolución ponderal realizada en el 3er. trimestre, así como el consumo de energía y nutrientes e indicadores bioquímico-nutricionales y metabólicos sobre el peso al nacer. Resultados: los parámetros del índice de masa corporal a la captación y la evolución ponderal se asociaron de manera significativa con los grupos de peso al nacer. De los indicadores nutricionales, el índice de masa corporal a la captación y el consumo de vitamina E correlacionaron positiva y significativamente con el peso al nacer, mientras que el consumo de hierro lo hizo de forma inversa y significativa. Conclusiones: los resultados confirman que los parámetros de los indicadores antropométricos del estado nutricional de las gestantes se asocian con el peso al nacer, no así los del consumo de energía, proteínas y algunos micronutrientes en las embarazadas del estudio, así como, los indicadores bioquímicos nutricionales y metabólicos estudiados.

Introduction: maternal nutritional status is a factor in fetal growth and weight of the newborn. There is scientific evidence that inadequate nutritional status and anemia in pregnancy generate deleterious effects on maternal and fetal health. Objective: to determine the influence of nutritional status at the 3rd. trimester on birth weight in pregnant in Bayamo. Methods: a longitudinal observational study was conducted in a sample of 53 pregnant women from the health areas of Bayamo municipality, Granma, from December 2011 to April 2012. The influence of anthropometric indicators such as body mass index at enrollment, weight changes made in the 3rd. quarter as well as energy and nutrient intake, biochemical indicators of nutritional and metabolic-birth weight were studied. Results: the parameters of body mass index at enrollment and weight changes were significantly associated with birth weight groups. Nutritional indicators, body mass index at enrollment and consumption of vitamin E significantly positively correlated with birth weight, whereas iron intake significantly did inversely. Conclusions: the results confirm that the parameters of anthropometric indicators of nutritional status of pregnant women are associated with birth weight, but not the consumption of energy, protein and some micronutrients in pregnant women in this study, as well as biochemical indicators nutritional and metabolic studied.

Hiperandrogenización prenatal en ratas y el metabolismo lipídico en la vida adulta / The role of prenatal hyperandrogenism on lipid metabolism during adult life in a rat model

El síndrome del ovario poliquístico (PCOS) es una afección de alta incidencia en mujeres en edad fértil. Si bien la etiología de la enfermedad se desconoce, se cree que la exposición a andrógenos durante la vida intrauterina generaría reprogramación fetal afectando vías endocrinas y metabólicas que, junto a alteraciones génicas y ambientales, inducirían la aparición de PCOS en etapas muy tempranas de la vida. Es por ello que se buscan marcadores tempranos del desarrollo de PCOS. Utilizando un modelo murino de hiperandrogenización prenatal (HA) recreamos dos fenotipos de PCOS: ovulatorio y anovulatorio. La HA no alteró el colesterol circulante pero disminuyó el colesterol HDL y aumentó el LDL y los triglicéridos (TG) con respecto a los controles. La relación colesterol total/HDL como marcador de riesgo cardiovascular y la relación TG/HDL se vieron incrementadas con respecto a los controles, resultando mayor en el grupo PCOS anovulatorio. El presente trabajo demuestra la importancia de la determinación del perfil lipídico a edades tempranas en poblaciones de riesgo (como es el caso de hijas de madres con PCOS).

Polycystic ovary syndrome (PCOS) is one of the commonest endocrine diseases that affect women in their reproductive ages; however, the etiology of the syndrome remains unknown. A hypothesis proposes that during gestation increased exposure of androgen would induce fetal programming that may increase the risk of PCOS development during the adult life. By means of a prenatally hyperandrogenized (HA) rat model we demonstrated the importance of determining the lipid profile at early ages. HA induced two different phenotypes: ovulatory and anovulatory PCOS. HA did not modify total cholesterol but decreased HDL cholesterol and increased both LDL and tryglicerides (TG) when compared with controls. Both, the ratio total cholesterol: HDL (marker of cardiovascular risk) and TG:HDL (marker of metabolic syndrome) were increased in the HA group with respect to controls. In addition, these abnormalities were stronger in the anovulatory than ovulatory phenotype. Our results point out the need to find early markers of PCOS in girls or adolescents with increased risk to develop PCOS (as in daughters of women with PCOS).

Factores de riesgo del peso insuficiente al nacer, en el Hospital Hipólito Unanue de Tacna, 2001 - 2010

Objetivos: Conocer incidencia y factores de riesgo del recién nacido de peso insuficiente en el hospital Hipólito Unanue de Tacna. Diseño: Estudio retrospectivo, epidemiológico, de casos y controles. Institución: Hospital Hipólito Unanue de Tacna, Perú. Población: Durante los años 2001 a 2010, se analizó los datos de 3 622 recién nacidos vivos con peso de 2 500 a 2 999 g, de embarazo único, y se comparó con 24 556 controles de 3 000 a 3 999 g. Intervenciones: Se realizó análisis bivariado, utilizando OR con intervalos de confianza al 95%, y análisis multivariado mediante regresión logística múltiple. Se utilizó base de datos del Sistema Informático Perinatal. Principales medidas de resultados: Factores de riesgo. Resultados: La frecuencia de recién nacidos de peso insuficiente fue 10,77 x 100 nacidos vivos. Los factores de riesgo fueron: madre analfabeta (OR=1,98), soltera (OR=1,41), estudiante (OR=1,4), adolescente (OR=1,38), desnutrida (OR=1,84), primípara (OR=1,35), con ausencia (OR=1,41) e inadecuado control prenatal (OR=1,55), enfermedad hipertensiva del embarazo (OR=2,72), rotura prematura de membranas (OR=2,09), hemorragia de la primera mitad (OR=1,37) y segunda mitad de embarazo (OR=1,83) y tuberculosis materna (OR=5,23). Conclusiones: Los factores de riesgo asociados a peso insuficiente al nacer en el hospital Hipólito Unanue de Tacna fueron condiciones socioeconómicas y biológicas maternas deficientes, ausencia o control prenatal inadecuado y patología materna.

Objectives: To determine incidence and risk factors for underweight newborns at Hospital Hipolito Unanue of Tacna. Design: Retrospective, epidemiological case-control study. Setting: Hospital Hipolito Unanue, Tacna, Peru. Population: During years 2 001 to 2 010 we analyzed data of 3 622 live births weighing 2 500 to 2 999 g, from single pregnancies, compared to 24 556 controls weighing 3 000 to 3 999 g. Interventions: We performed bivariate analysis using confidence intervals OR 95%, and multivariate analysis with logistic regression. Perinatal Data System was used. Main outcome measures: Risk factors. Results: The frequency of underweight newborns was 10,77 x 100 live births. Risk factors were illiterate mother (OR=1,98), unmarried (OR=1,41), student (OR=1,4), adolescent (OR=1,38), malnourished (OR=1,84), primiparous (OR=1,35), absence (OR=1,41) or inadequate prenatal care (OR=1,55), hypertensive disease of pregnancy (OR=2,72), premature rupture of membranes (OR=2,09), bleeding in the first (OR=1,37) and second half of pregnancy (OR=1,83) and maternal tuberculosis (OR=5,23). Conclusions: Risk factors associated with low birth weight at Tacnas Hipolito Unanue Hospital were poor maternal socioeconomic conditions, absent or inadequate prenatal care and maternal pathology.

Características de recién nacidos con enterocolitis necrotizante en un hospital universitario de tercer nivel en Colombia / Characteristics of newborns with necrotizing enterocolitis in a third-level university hospital in Colombia

Introducción: La enterocolitis necrotizante (ECN) es, de todas las afecciones quirúrgicas del período neonatal, la de mayor mortalidad, siendo la causa más frecuente de alteración del tracto gastrointestinal severa en unidades de cuidados intensivos neonatales y una emergencia médico-quirúrgica en la cual el diagnóstico precoz y el tratamiento oportuno pueden disminuir la necesidad de cirugía y la letalidad. Objetivo: Describir las características de los pacientes con enterocolitis necrotizante atendidos durante el ano 2006 en una unidad de cuidado intensivo neonatal de un hospital nivel III de la ciudad de Cali. Materiales y métodos: Se realizó un estudio descriptivo piloto retrospectivo donde se incluyeron 32 historias clínicas de neonatos con ECN quienes llegaron a Cuidados Intensivos de Recién Nacidos (CIRENA) del Hospital Universitario del Valle (HUV) con este diagnóstico o desarrollaron la enfermedad durante su estancia en la unidad. Finalmente, se realizó un análisis descriptivo utilizando el paquete estadístico Epi-Info. Resultados: En el ano 2006 ingresaron a CIRENA del HUV 1555 neonatos, de los cuales 32 (2%) desarrollaron enterocolitis necrotizante, porcentaje que es similar al registrado en otros países; la mitad tenía un peso menor a 1500 gramos y solo 3 gestantes tuvieron adecuado control prenatal. Fueron diagnosticados con ECN, 17 (53.1%) de sexo femenino y 15 (46.9%) de sexo masculino. Conclusión: A pesar de que la mayoría de casos de ECN se presentan en ninos prematuros y/o de muy bajo peso al nacer, se encontró en este estudio un número importante de casos en recién nacidos a término tanto por edad gestacional como por peso que desarrollaron ECN temprana. Existe una relación visible entre el bajo peso al nacer, la prematurez y el desarrollo de ECN, sobre todo en los grados más avanzados de esta enfermedad, en los que la tendencia es el desarrollo de la fase tardía.

Introduction: Necrotizing enterocolitis (NEC) is, over all newborn surgical afflictions, the most deathly, representing the main GI problem in neonatal intensive care units (NICU) and a medical/surgical emergency in which early diagnosis and opportune treatment may diminish surgical needs and mortality. Objective: To describe the features of patients with NEC attended at a third-level hospital NICU in the city of Cali in 2006. Method and materials: We conducted a pilot descriptive retrospective study that included 32 clinical records of newborns in the NICU (named CIRENA) from the Hospital Universitario del Valle (HUV) with NEC diagnosis. Finally, we made a descriptive analysis of the data by using the Epi-Info statistics program. Results: In 2006, 1555 newborns were admitted to HUV-CIRENA and 32 (2%) of them were diagnosed with NEC, a percentage that is similar to that of other countries; half of which weighed less than 1500 grams and only three pregnant women had adequate prenatal care, 17(53.1%) of these newborns were female and 15(46.9%) were male. Conclusions: Although the majority of NEC cases occurs in premature and/or very low weight children, it is outstanding the number of full-term newborns, either on gestational age and weight, that developed early NEC. There is a visible relationship among low birth weight, prematurity, and the development of NEC, especially in the higher degrees of the disease, where the tendency is the presentation of late NEC.

Audição de crianças com fissura labiopalatina e baixo peso: estudo comparativo / Hearing in children with cleft lip and palate and low weight: comparative study

INTRODUÇÃO: A presença de baixo peso ao nascer (BP), assim como a fissura labiopalatina (FLP), acabam por tornar as crianças mais propensas às alterações auditivas. OBJETIVO: verificar e comparar a audição de crianças com fissura labiopalatina com e sem baixo peso ao nascimento na avaliação audiológica convencional. MÉTODO: Foi realizado estudo retrospectivo e comparativo no que se refere ao gênero, peso ao nascimento, presença/ausência de FLP e ao resultado da audiometria e imitanciometria. Três grupos de crianças foram constituídos. G1 com 23 FLP e BP, G2 com 25 FLP e sem BP e G3 com 25 sem FLP e sem BP. RESULTADOS: Não foi encontrada diferença estatística significante entre os grupos na comparação do peso e gênero, bem como quanto, ao gênero e orelhas direita e esquerda, em relação ao tipo da curva timpanométrica, presença de perda auditiva, tipo de perda auditiva e grau da perda auditiva. CONCLUSÃO: Um maior comprometimento da audição, evidenciado pela presença de perda auditiva condutiva de grau leve a moderada foi encontrado nas crianças com fissura labiopalatina (G1 e G2), independente da presença de baixo peso ao nascimento, quando comparada as sem este tipo de malformação craniofacial.

INTRODUCTION: The presence of low weight at birth (LW), as well as cleft lip and palate (CLP), end up making children more prone to auditory alterations. OBJECTIVE: Verify and compare the hearing of children with cleft lip and palate with and without low weight at birth in the conventional audiological evaluation. METHOD: A retrospective and comparative study was made concerning gender, weight at birth, presence/absence of CLP and the result of audiometry and immittance measurements. Three groups of children were formed. G1 with 23 CLP and LW, G2 with 25 CLP but not LW and G3 with 25 children with neither CLP or LW. RESULTS: There wasn't found any statistically significant differences between the groups in none of the following comparisons: the weight and gender, gender and right/left ear, in relation to the kind of tympanometric curve, presence of hearing loss, type of hearing loss and degree of the hearing loss. CONCLUSION: A greater auditory impairment, evidenced by the presence of light to moderate degree of conductive hearing loss, was found in children with cleft lip and palate (G1 and G2), regardless of the presence of low weight at birth, when compared to those without this kind of malformation.

Relação entre cuidado pré-natal, fatores maternos e peso da criança ao nascer / Relationship between prenatal care, maternal factors and childs weight at birth

Introdução: A assistência pré-natal é importantíssima tanto para a evolução da gravidez quanto para o bem-estar da mãe, sendo o cuidado nutricional um promissor aliado para a otimização do crescimento fetal. Objetivo: Nesse estudo, objetivou-se analisar características maternas, gestacionais e do parto e relacioná-las com o estado nutricional pré-gestacional e com o peso da criança ao nascer, de mães usuárias do SUS. Métodos: Foi realizado um estudo transversal retrospectivo com 173 nascidos vivos de gravidez única. Resultados: Os resultados mostraram elevada prevalência de sobrepeso/obesidade pré-gestacional e sua associação com nascimento de recém-nascidos macrossômicos e maior número de partos cesáreos. Conclusão: A idade materna elevada e o grande número de filhos tidos em gestações anteriores contribuíram para essa prevalência, reforçando a importância da realização do pré-natal e da avaliação do estado nutricional pré-gestacional.

Introduction: The prenatal managing is important both for the development of pregnancy as the mother?s well being, being the nutritional care a promising ally to optimize fetal growth. Objective: This study aimed to examine maternal characteristics, pregnancy and childbirth and correlate them with nutritional status before pregnancy and the child?s weight at birth of mothers from SUS. Methods: This is a retrospective cross-sectional study with 173 live born in singleton pregnancies. Results: The results showed high prevalence of pre-pregnancy overweight / obesity and its relation with the birth of macrosomic newborns and greater number of cesarean deliveries. Conclusion: The increased maternal age and the high number of children from former pregnancies contributed to this prevalence, reinforcing the importance of prenatal exam and the nutritional evaluation before pregnancy.

Comportamento exploratório de bebês nascidos pré-termo em situação de brincar / Comportamiento exploratorio de bebés nacidos pretérmino en situación de jugar / Exploratory behavior of infants born preterm in playing context

O presente estudo teve por objetivo avaliar o comportamento exploratório em situação de brincar de 20 bebês nascidos pré-termo com muito baixo peso, aos 10 meses de idade cronológica corrigida, em grupos diferenciados quanto ao risco para problemas de desenvolvimento. A amostra foi dividida em dois grupos, de acordo com o desempenho no Teste de Denver-II, sendo oito bebês em risco de atraso no desenvolvimento (MBPR) e 12 bebês com desenvolvimento normal (MBPN). Foi realizada a observação sistemática da latência de resposta e dos comportamentos exploratórios dos bebês diante de brinquedos padronizados. Os resultados mostraram semelhanças entre os grupos quanto ao tempo de latência de resposta para explorar os brinquedos, a direção do olhar e vocalização. No entanto, os bebês MBPN olharam significativamente mais para a observadora, sorriram mais e permaneceram mais estáveis na posição sentada do que os bebês MBPR, o que facilitou a exploração dos brinquedos.

The exploratory behavior within a playing setting of 20 preterm newborn infants, with low weight at birth, corrected chronological age of 10 months, is evaluated. Infants were organized in groups which were differentiated according to their development risks. The sample was divided into two groups according to the infants' Denver-II Test performance, or rather, 8 infants with delayed development risks (VLBW-R) and 12 infants with normal development (VLBW-N). Systematic observation of infants' response latency and exploratory behaviors with standard toys was carried out. Results showed similarities between the groups with regard to response latency time in toy exploration, gazing direction and vocalization. However, VLBW-N infants looked significantly more at the observer, smiled more and remained more stable in the sitting position than VLBW-R infants. These behaviors facilitated toy exploration.

El presente estudio tiene por objeto evaluar el comportamiento exploratorio en situación de jugar de 20 bebés nacidos pretérmino, a los 10 meses de edad corregida, en grupos diferenciados en cuanto al riesgo para problemas de desarrollo. La muestra se ha dividido en dos grupos, de acuerdo con el desempeño en el Denver-II, con ocho bebés en riesgo de retraso en el desarrollo (MBPR) y 12 bebés con desarrollo normal (MBPN). Se ha realizado la observación sistemática de la latencia de respuesta y de los comportamientos exploratorios de los bebés frente a juguetes. Hubo semejanzas entre los grupos en cuanto al tiempo de latencia de respuesta para explorar los juguetes, la dirección de la mirada y vocalización. Sin embargo, los bebés MBPN miraron más significativamente hacia la observadora, sonrieron más y permanecieron más estables en la posición sentada que los bebés MBPR, lo que facilitó la exploración de los juguetes.

Bajo peso al nacer, desarrollo puberal y presión arterial en adolescentes del sexo femenino / Low weight at birth, pubertal development and blood pressure in female adolescents

Se estudió la presión arterial en una muestra de adolescentes del sexo femenino, sanas, con edades comprendidas entre doce y catorce años. Se determinó la condición de las muchachas con respecto a la menarquia. El objetivo de la investigación fue confirmar la conocida asociación inversa entre el peso al nacimiento y la presión arterial, estudiar la asociación entre el peso al nacimiento y la edad de la menarquia y poner a prueba una hipótesis sobre el tamaño relativo del riñón con respecto al volumen corporal y su asociación con las cifras de presión arterial. Se llevó a cabo un estudio descriptivo, observacional y transversal a dicha muestra. Los resultados evidenciaron que las adolescentes que tienen menarquia más temprana tienen cifras más altas de tensión arterial y mayor índice de masa corporal. Un indicador alométrico de la relación entre el volumen renal y el índice de masa corporal también se encuentra disminuido en este grupo de muchachas. En las adolescentes que nacieron con peso insuficiente, la menarquia ocurre, en promedio, casi un año antes que en las que nacieron con peso normal. Se concluye que el peso insuficiente al nacimiento favorece, bajo ciertas condiciones, un adelanto en los eventos puberales, lo cual se acompaña de reacciones adaptativas en el organismo, se determinó que existe correlación significativa entre estas variables con una p=0.014. Esta cadena de sucesos contribuye a un incremento en las cifras de prensión arterial.

Blood pressure was studied in a sample of 12-14-year-old healthy female adolescents, determining the condition of their menarche. The aim of the present research is to prove the known inverse association between the body weight at birth and blood pressure, to study the association between the body weight at birth and the age of the menarche and to prove a hypothesis on the relative size of the kidney with respect to the body volume and its association with the counts of the blood pressure. A descriptive observational and cross sectional study was performed in the sample. Results showed that adolescents with earlier menarche have higher counts of blood pressure as well as a greater body mass index. An alometric index in the relationship between the renal volume and the body mass index is also decreased in this group of adolescents. In those born with a low body weight, menarche appears almost a year before than in those born with a normal body weight. It is concluded that the low body weight at birth is in favour of , under some circumstances, an increase of the pubertal events, being accompanied by adaptative reactions in the economy, it was also determined that there is a significant correlation among these variables (p =0.014). This chain of events leads to an increase of blood pressure counts.

Prevalência da doença periodontal na gravidez e sua influência na saúde do recém-nascido / Prevalence of periodontal disease during pregnancy and its influence in the newborn health status

Objetivo: investigar a relação entre má qualidade de saúde bucal da gestante e condi- ções do recém-nascido através da associação entre periodontite materna, índice Apgar no 5o minuto e peso do recém-nascido. Delineamento: estudo transversal. Amostragem: após estudo-piloto, foram avaliadas 115 pacientes com idades entre 18 e 42 anos, entre os meses de abril e outubro de 2003, selecionadas por conveniência dentre as clientes da Maternidade Mário Totta (ISCMPA), que esclarecida e livremente consentiram em participar do estudo. Variável preditora ­ periodontite: critérios diagnósticos baseados na classificação da American Association of Periodontology (profundidade de sondagem e sangramento à sondagem). Variáveis dependentes ­ Índice de Apgar e peso ao nascer: conforme registro no prontuário. Resultados: Não foi encontrada associação entre a presença de periodontite na mãe, o índice de Apgar no 5o minuto e o peso do recém-nascido (α=0,05). Discussão: Diferenças metodológicas, incluindo o tipo de delineamento, a definição operacional de doença periodontal e, conseqüentemente, do grau de severidade dos casos, assim como procedimentos para controle de variáveis confundíveis, contribuem para explicar as variações observadas nos resultados dos diferentes estudos já publicados. Nesse estudo, optou-se por uma definição abrangente de doença periodontal, incluindo casos leves, podendo tal estratégia ter dificultado a identificação da associação pesquisada (AU)

Objective: to investigate the relationship between poor pregnant oral health and newborn health conditions through maternal periodontal disease and 5th minute Apgar Index and birth weight association. Design: cross-sectional study. Sampling: after a pilot study was conducted, 115 inpatients aged 18 to 42 years were selected by convenience among Maternidade Mário Totta's clients and studied from April to October 2003. All of them signed an informed consent. Predictor variable ­ periodontal disease: based upon criteria of the American Association of Periodontology (probing depth and bleeding at probing). Dependent variables ­ Apgar Index and birth weight: according to medical records. Results: No association was found between maternal periodontal disease, 5th minute Apgar Index and birth weight of the newborn (α=0,05). Discussion: methodological differences, including design, operational definition of periodontal disease and, consequently, of the severity of the cases, as much as confounding control procedures, help to explain the results' variability observed in the already published studies. In this present study, a comprehensive definition of periodontal disease, including mild cases, was adopted. The strategy may have brought difficulties to the identification of the researched association (AU)