Perfil clínico de pacientes con diabetes gestacional e incidencia de complicaciones neonatales en un centro de referencia materno-fetal colombiano / Clinical profile of patients with gestational diabetes and incidence of neonatal complications in a Colombian maternal-fetal reference center

OBJETIVO: determinar el perfil clínico de pacientes con diabetes gestacional (DG) y la incidencia de las complicaciones neonatales. MÉTODOS: estudio descriptivo de una cohorte retrospectiva de gestantes con DG según criterios HAPO/ (IADPSG) International Association of Diabetes and Pregnancy Study Groups y Carpenter-Coustan y sus hijos, en un servicio de alta complejidad obstétrica de Medellín, Colombia entre 2012-2015. Se presentan medidas descriptivas de características maternas y neonatales e incidencia de las complicaciones neonatales. RESULTADOS: se incluyeron 197 maternas y 203 neonatos; 90,5 % maternas tenían sobrepeso u obesidad; la comorbilidad más frecuente fue el trastorno hipertensivo asociado al embarazo en 22,8 %. El manejo de la DG fue 59,3% nutricional exclusivo, 37,1% nutricional más insulina y 3.6% nutricional más metformina. La media de edad gestacional al parto fue 37 sem y 3 días; la DG fue la indicación más frecuente de inducción del parto en 76 % (38/50); 56,4 %, fueron partos vaginales y el 34,6% fueron cesáreas indicadas por DG. Un 11,3 % de los recién nacidos fueron grandes para la edad gestacional (P >90) y se encontraron 2 recién nacidos con peso > 4000 gr. La incidencia de al menos una complicación neonatal fue 27,6 %, 16,7 % presentaron hiperbilirrubinemia, 9,9 % síndrome de dificultad respiratoria (SDR), 3.0% hipoglicemia, 10.8% otras complicaciones y 12,3 % ingresaron a la unidad de cuidados intensivos neonatales. CONCLUSIONES: la DG es una indicación frecuente de inducción del parto y de indicación de cesárea. Las complicaciones neonatales ocurren en uno de cuatro recién nacidos, aunque observamos una baja incidencia de grandes para la edad gestacional (recién nacidos con peso > percentil 90), hubo 2 otras morbilidades neonatales relacionados con el diagnóstico materno como hiperbilirrubinemia y SDR.

AIM: To determine the clinical profile pregnant women with gestational diabetes and incidence of the neonatal complications. METHODS: Descriptive analysis of a retrospective cohort of pregnant women with gestational diabetes (GD) according to HAPO and Carpenter-Coustan criteria and their children, under a high complexity obstetric service in Medellin, Colombia between 2012-2015. Descriptive measures of maternal and neonatal characteristics and incidence of neonatal complications are presented. RESULTS: The study included 197 pregnant women and 203 neonates: 90.5 % of pregnancies were overweight or obese; the most frequent comorbidity was the hypertensive disorder associated with pregnancy in 22.8 %. The management of the DG was 99.0% nutritional, 37.1% insulin and 3.6 % metformin. The average gestational age at delivery was 37 weeks and 3 days; DG was the most frequent indication of induction of labor in 76 % (38/50); 56.4% were vaginal deliveries and 34.6 % were DG related caesarean sections, 11.3 % of newborns were large for gestational age (P > 90) and two newborns weighing > 4000 gr. The incidence of at least one neonatal complication was 27.6 %, 16.7 % had hyperbilirubinemia, 9.9 % respiratory distress syndrome (RDS), 3.0 % hypoglycemia, 10.8 % other complications and 12.3 % were admitted to the neonatal intensive care unit. CONCLUSIONS: DG is a frequent indication of induction of labor and indication of caesarean section. Neonatal complications occur in one of four newborns, although we observed a low incidence of macrosomia, there were other neonatal morbidities related to maternal diagnosis such as hyperbilirubinemia and RDS.

Hiperbilirrubinemia severa en recién nacidos, factores de riesgo y secuelas neurológicas / Severe hyperbilirubinemia in newborns, risk factors and neurological outcomes

INTRODUCCIÓN: La hiperbilirrubinemia es altamente prevalente en los recién nacidos, con riesgo de compromiso neurológico con bilirrubinemias mayor a 20-25 mg/dl. Esta progresión es prevenible con detección y tratamiento precoz. OBJETIVO: Describir incidencia y factores asociados en pacientes hospitalizados con hiperbilirrubinemia mayor de 20 mg/dl, y el seguimiento de casos sintomáticos durante hospitalización. PACIENTES Y MÉTODO: Estudio retrospectivo de pacientes con hiperbilirru- binemia severa, entre el 2013 y 2016. Se evaluaron factores de riesgo, estratificándose por nivel de bilirrubina, edad de ingreso y edad gestacional. Se compararon los datos con test exacto de Fisher, chi cuadrado y riesgo relativo (RR) en una base de excel, con un error alfa de un p<0.05. Los datos fueron obtenidos a través de la epicrisis electrónica y de la ficha de control a nivel secundarios. RESULTADOS: Durante el periodo, de 25.288 recién nacidos vivos (RNV), 593 se hospitalizaron por hiperbilirrubinemia mayor de 20 mg/dl, 1 por cada 42 RNV; y 59 con bilirrubinemia mayor a 25 mg/dl, 1 por cada 428 RNV. La hiperbilirrubinemia fue más frecuente en varones, con RR 1,22 (IC 95% 1,04-1,44) y en pretérminos tardíos, con un RR 2,39 (IC 95% 1,96-2,93) comparado con RN de término. En los ingresados con más de 4 días, el principal factor asociado fue la baja de peso excesiva, y en los primeros 3 días, la incompatibilidad de grupo clásico. Tres de 10 pacientes con encefalopatía aguda, persistieron con compromiso neurológico, lo que significa 11,8 por 100.000 nacidos vivos. CONCLUSIONES: Los principales factores de riesgo para desarrollar hiperbilirrubinemia severa fueron prematurez, baja de peso excesiva, incompatibilidad de grupo clásico y sexo masculino. Estos hallazgos permiten focalizar la atención en grupos de riesgo y disminuir la probabilidad de daño neurológico.

INTRODUCTION: Hyperbilirubinemia is highly prevalent in newborns, with risk of neurological invol vement with bilirubinemia higher than 20 to 25 mg/dl. This progression is preventable with early de tection and treatment. OBJECTIVE: To describe the incidence and associated factors in hospitalized pa tients with hyperbilirubinemia higher than 20 mg/dl, and the follow-up of symptomatic cases during hospitalization. OATIENTS Y METHOD: Retrospective study of patients with severe hyperbilirubine mia, between 2013 and 2016. Risk factors were evaluated, stratifying by bilirubin level, admission age, and gestational age. The data were compared with Fisher's exact test, chi-square test, and relative risk (RR) in an Excel database, with an alpha error of p <0.05. The data were obtained from the electronic discharge summary and the medical record of secondary level follow-up. RESULTS: During the studied period, out of 25,288 live newborns (NB), 593 were hospitalized due to hyperbilirubinemia higher than 20 mg/dl, one per each 42 live NB; and 59 with bilirubinemia higher than 25 mg/dl, one per each 428 live NB. Hyperbilirubinemia was more frequent in males, with RR 1.22 (95% CI 1.04-1.44), and in late preterm newborns, with RR 2.39 (95% CI 1.96-2.93) compared with term NB. In those admitted with more than four days, the main associated factor was excessive weight loss, whereas in the first three days was classic group incompatibility. Three of ten cases with acute encephalopathy persisted with neurological involvement, which means 11.8 per 100,000 live births. CONCLUSIONS: The main risk factors for developing severe hyperbilirubinemia were prematurity, excessive weight loss, classic group incompatibility, and male sex. These findings allow to focus attention on risk groups and decrease the probability of neurological damage.

Morbilidad neonatal de los prematuros tardíos en embarazos únicos: estudio de caso-control / Neonatal morbidity of late preterm: a case-control study

Objetivo: Comparar los riesgos de morbilidad neonatal entre los prematuros tardíos (PT) y neonatos de término. Método: Estudio de caso control. Se revisan fichas clínicas de partos durante el año 2007. Se excluyen neonatos con malformaciones congénitas mayores, alteración neuromuscular, embarazos múltiples y aneuploidias. Los casos corresponden a todo PT nacido durante el periodo estudiado y los controles a nacidos de término en el mismo periodo. Los resultados neonatales fueron obtenidos y los riesgos calculados usando pruebas de Chi cuadrado y exacto de Fisher. Resultados: Se identifican 1536 partos, con una tasa de PT de 7,1 por ciento (109 casos), 62 cumplieron con criterios de inclusión. El grupo control consistió en 124 partos de término. PT presentaron 2 veces más riesgo de cesárea (p=0,0094) que los de término. El riesgo de ser admitido en UCIN fue de 88 (p=0,000). Los riesgos de morbilidad neonatal fueron: SDR (OR 23; p=0,000), hipoglicemia (OR 6; p=0,014), hipocalcemia (OR 6; p=0,014), hiperbilirrubinemia (OR 28; p=0,000) y necesidad de fototerapia (OR 23; p=0,000). No hubo diferencias en la presentación de enterocolitis necrotizante (p=0,478) ni sepsis neonatal (p=0,615). La mortalidad neonatal fue significativamente superior en los PT (p=0,044). Conclusión: Los PT deben ser considerados de alto riesgo en el período neonatal. Nuestros resultados son importantes para tomar decisiones clinicas respecto al mejor momento de finalizar un embarazo con riesgo inminente de prematurez.

Objective: To compare neonatal morbidity risks between late preterm (LP) and term deliveries. Methods: Case control study. Medical records in 2007 were reviewed. Major congenital malformations, neuromuscular handicap, twin pregnancies and aneuploidies were excluded. The Study group corresponds to all LP births during that period and the control group to term deliveries in the same period. Neonatal outcomes were collected and different risks were calculated using Chi square test and Fisher exact tests. Results: 1536 deliveries with a LP rate of 7.1 percent (109 cases) were observed, 62 cases met inclusion criteria. The control group consisted in 124 single term deliveries. LP had 2 times more risk of cesarean section (p=0.0094) than term deliveries. The risk of NICU admission was 88 (p=0.000). Neonatal morbidity risks were: RDS (OR 23, p=0.000), hypoglycemia (OR 6, p=0.014), hypocalcaemia (OR 6, p=0.014), hyperbillirrubinemia (OR 28, p=0.000) and phototherapy (OR 23, p=0.000). There were no differences in necrotizing enterocolitis (p=0.478) and risk of neonatal sepsis (p=0.615). Neonatal mortality was significantly higher in LP babies (p=0.044). Conclusion: LP newborn must be considered as high risk in the neonatal period. These results are important in making clinical decisions about the better time to end pregnancy.

Acompanhamento sistematizado da hiperbilirrubinemia em recém-nascidos com 35 a 37 semanas de idade gestacional / Systematic follow-up of hyperbilirubinemia in neonates with a gestational age of 35 to 37 weeks

OBJETIVOS: Identificar os resultados do acompanhamento da bilirrubinemia na primeira semana de vida em uma coorte de recém-nascidos (RNs) de 35(0/7) a 37(6/7) semanas de idade gestacional e estabelecer fatores de risco para reinternação para fototerapia pós-alta hospitalar (bilirrubinemia total > 18 mg/dL). MÉTODOS: Estudo de coorte retrospectivo em hospital público universitário. Os recém-nascidos tiveram acompanhamento da bilirrubina total plasmática ou transcutânea pré- e pós-alta da enfermaria de alojamento conjunto para avaliação da necessidade de fototerapia. Foi empregada uma abordagem sistematizada, utilizando-se os percentis de risco de uma curva de referência. RESULTADOS: Foram estudados 392 RNs. Uma consulta ambulatorial foi necessária em 61,7 por cento dos RNs. Tiveram valores máximos de bilirrubinemia total > 20 mg/dL 34 RNs (8,7 por cento), e três RNs (0,8 por cento) apresentaram bilirrubinemia total entre 25-30 mg/dL. Fototerapia foi indicada após alta em 74 RNs (18,9 por cento). Os fatores de risco foram a perda de peso do nascimento até o primeiro retorno e os percentis à alta acima do P40. A bilirrubinemia total à alta acima do P95 foi associada ao maior risco de reinternação [RR = 49,5 (6,6-370,3)]. A perda de peso até o primeiro retorno foi o único preditor clínico independente [RR = 1,16 (1,04-1,17)]. CONCLUSÃO: A abordagem sistematizada da bilirrubinemia na 1ª semana foi efetiva na prevenção de hiperbilirrubinemias perigosas. O suporte à amamentação e a alta hospitalar após a estabilização da perda de peso podem ser medidas preventivas da reinternação por hiperbilirrubinemia.

OBJECTIVES: To determine the outcomes of an intervention for follow-up of bilirubinemia in the first week of life in a cohort of newborn infants with gestational ages between 35(0/7) and 37(6/7) weeks and to determine risk factors for readmission for phototherapy (total bilirubin > 18 mg/dL). METHODS: Retrospective cohort study carried out at a public teaching hospital. Neonates underwent periodic monitoring of total bilirubin levels (measured in serum or by transcutaneous device) before and after discharge to assess the need for phototherapy. A systematic approach, based on risk percentiles of a bilirubin reference curve, was employed. RESULTS: The study sample comprised 392 neonates. Only one outpatient visit was required in 61.7 percent of newborns. Peak total bilirubin was > 20 mg/dL in 34 neonates (8.7 percent), and reached 25-30 mg/dL in three (0.8 percent). Phototherapy was indicated after discharge in 74 neonates (18.9 percent). Weight loss between birth and first follow-up visit and total bilirubin above the 40th percentile at discharge were risk factors for requiring phototherapy. Total bilirubin above the 95th percentile at discharge was associated with greater risk of readmission (RR = 49.5 [6.6-370.3]). Weight loss between discharge and first follow-up visit was the sole independent clinical predictor (RR = 1.16 [1.04-1.17]). CONCLUSION: Systematic follow-up during the first week of life was effective in preventing dangerous hyperbilirubinemia. Encouraging breastfeeding and discharging neonates only after weight loss has been stabilized may prevent readmission due to hyperbilirubinemia.

Caracterização da triagem auditiva neonatal da Clínica Limiar em Porto Velho - Rondônia / Newborn hearing screening in the Limiar Clinic in Porto Velho - Rondônia

Triagem auditiva neonatal de rotina é capaz de detectar precocemente alterações auditivas que poderão interferir na vida do indivíduo. OBJETIVO: Caracterizar o programa de triagem auditiva neonatal em uma população de neonatos. MATERIAL E MÉTODO: Estudo de coorte histórico longitudinal. Levantamento no banco de dados da clínica responsável pela triagem auditiva neonatal na cidade Porto Velho-RO do período de fevereiro de 2004 a outubro de 2006. RESULTADOS: Dos 6889 recém-nascidos cadastrados, 5700 (82,7 por cento) passaram e 1189 (17,3 por cento) falharam na primeira etapa da triagem. Dos que falharam 900 (75,7 por cento) compareceram para o reteste. Dentre estes, 15 (0,22 por cento) recémnascidos tiveram deficiência auditiva confirmada. A deficiência auditiva mais prevalente foi à perda auditiva neural com 46,7 por cento dos casos confirmados, tendo como indicador de risco mais prevalente a hiperbilirrubinemia. CONCLUSÃO: A hiperbilirrubinemia apresentou maior prevalência dentre os indicadores de risco encontrados nos recém-nascidos com deficiência auditiva confirmada. A prevalência de perda auditiva observada é de dois recém-nascidos para cada 1000 nascidos. Observa-se ainda uma correlação estatisticamente significante entre a perda auditiva neural com o indicador de risco hiperbilirrubinemia e perda auditiva neurossensorial com a etiologia desconhecida.

With the universal hearing screening we can prevent auditory disorders in children. AIM: To characterize the program of neonatal auditory screening into a population of neonates. MATERIALS AND METHODS: longitudinal cohort study. We surveyed the clinic's database on neonatal auditory screening in the city of Porto Velho, Rondônia. RESULTS: Among the 6,889 newborns in the database, 5,700 (82.7 percent) passed and 1,189 (17.3 percent) failed the first screening. Of the group which failed 900 (75.7 percent) returned for retesting. Among these, 15 (0.22 percent) newborns had hearing loss confirmed. The most prevalent was neural hearing loss with 46.7 percent confirmed cases; they had hyperbilirubinemia as the most prevalent risk factor. CONCLUSION: hyperbilirubinemia was the most prevalent risk factor found in the group of hearing impaired children. The prevalence of hearing loss was of 2 in 1,000 newborns. It is important to highlight the relevant association between neural hearing loss caused by hyperbilirubinemia and sensorineural hearing loss of unknown causes.

Hiperbilirrubinemia neonatal agravada / Aggravated neonatal hyperbilirubinemia

INTRODUCCIÓN. La mayoría de las veces la ictericia en el recién nacido es un hecho fisiológico, causado por una hiperbilirrubinemia de predominio indirecto, secundario a inmadurez hepática e hiperproducción de bilirrubina. El objetivo de este estudio fue determinar el comportamiento de la hiperbilirrubinemia neonatal en el Hospital Docente Ginecoobstétrico de Guanabacoa en los años 2007 a 2009. MÉTODOS. Se realizó un estudio descriptivo y retrospectivo de 173 recién nacidos que ingresaron al Departamento de Neonatología con diagnóstico de hiperbilirrubinemia agravada. RESULTADOS. La incidencia de hiperbilirrubinemia neonatal agravada fue del 3,67 por ciento y predominó en hermanos con antecedentes de ictericia (56,65 por ciento). El tiempo de aparición fue de 48 a 72 h (76,87 por ciento) y entre los factores agravantes se hallaron el nacimiento pretérmino y el bajo peso al nacer. La mayoría de los pacientes fueron tratados con luminoterapia (90,17 por ciento). CONCLUSIËN. La hiperbilirrubinemia neonatal agravada constituye un problema de salud. Los factores agravantes son la prematuridad y el bajo peso al nacer. La luminoterapia es una medida terapéutica eficaz para su tratamiento

INTRODUCTION. Most of times jaundice in newborn is a physiological fact due to hyperbilirubinemia of indirect predominance, secondary to liver immaturity and to bilirubin hyperproduction. The aim of present of present study was to determine the behavior of neonatal hyperbilirubinemia in the Gynecology and Obstetrics Teaching Hospital of Guanabacoa municipality from 2007 to 2009. METHODS. A retrospective and descriptive study was conducted in 173 newborn patients admitted in the Neonatology Department diagnosed with severe hyperbilirubinemia. RESULTS. The incidence of severe neonatal hyperbilirubinemia was of 3,67 percent with predominance in brothers with a history of jaundice (56,65 percent). The time of appearance was of 48 to 72 hrs (76,87 percent) and among the aggravating factors were the preterm birth and a low birth weight. Most of patients were treated with luminotherapy (90,17 percent). CONCLUSION. The severe neonatal hyperbilirubinemia is a health problem. Aggravating factors include the prematurity and the low birth weight. Luminotherapy is an effective therapeutic measure for its treatment

Morbilidad neonatal y peso al nacimiento en diabéticas gestacionales con tratamiento insulínico preventivo / Neonatal morbidity and birth weight in gestational diabetes patients under preventive insulin-treatment

OBJETIVO: reportar la morbilidad neonatal y el peso de los recién nacidos en diabéticas mellitus gestacionales (DMG), con tratamiento insulínico preventivo o no, portadoras de factores de riesgo para hiperglucemias tardías.MÉTODOS: estudiamos 230 embarazadas DMG en el período 2004-08, las cuales se dividieron en dos grupos, en uno se administró insulina regular humana Novo Nordisk a dosis de 0,3 Ud/kg de peso ideal, dividida en 3 dosis preprandiales según método de Valdés y Márquez más dieta calculada (grupo de intervención), y al otro (grupo control), solo se le administró dieta calculada, en ninguno de los dos grupos menos de 1 800 kcal/día. Utilizamos el test chi-cuadrado y la t de Student para el análisis de los resultados con valor de p<0,05. RESULTADOS: la morbilidad neonatal en lo referente a hiperbilirrubinemia e hipoglucemia neonatal se comportó con una frecuencia de 5,2 y 2,6 por ciento para el grupo de intervención y ello se elevó a 10,4 y 6,1 respectivamente en el grupo control. La frecuencia de exceso de peso corporal neonatal fue de 6,1 por ciento para el grupo de intervención y 25,2 por ciento para el de tratamiento solo con la dieta calculada, la frecuencia de recién nacidos con más de 4 200g fue del 3,5 por ciento en el grupo de insulina preventiva y ello se elevó significativamente a 11,3 por ciento en el grupo control con sólo la dieta calculada. CONCLUSIONES: el tratamiento insulínico preventivo en diabéticas gestacionales con factores de riesgo para hiperglucemia tardía, logró una reducción significativa tanto del exceso de peso corporal como de la macrosomía neonatal según nuestros resultados, muy probablemente por la anticipación lograda a la hiperglucemia tardía

OBJECTIVE: To report the neonatal morbidity and the newborn weight in diabetes mellitus pregnants (DMP) under preventive or not insulin-treatment, carriers of risk factors for late hyperglycemias. METHODS: A total of 230 DMPs were studied during 2004-2008, who were divided into two groups, in one we administered Nordisk Novo human regular insulin at 0.3 Ud/kg dose of ideal weight, divided into 3 preprandial doses according to ValdÚs and Mßrquez method plus a estimated diet (intervention group) and in the other group (control group) only a estimated diet was administered, in no two groups less than 1 800 kcal/day. Chi² test and t Student test were used for results analysis with a value of p < 0.05. RESULTS: The neonatal morbidity concerning the neonatal hyperbilirubinemia and hypoglycemia had a frequency of 5.2 and 2.6 percent for intervention group with a increase of 10,.4 and 6.1, respectively in control group. Frequency of neonatal body weight gain was of 6.1 percent for intervention group and of 25.2 percent for the treatment group only with a estimated diet, newborn frequency above 4.200 g was of 3.5 percent in preventive insulin group increasing significantly to 11.3 percent in control group with only the estimated diet. CONCLUSIONS: Preventive insulin treatment in diabetic pregnants with risk factors for a later hyperglycemia, achieve a significant reduction in body weight excess and in neonatal macrosomia according to our results, very probable by achieved anticipation to late hyperglycemia

Predicting neonatal hyperbilirubinemia using first day serum bilirubin levels.

Objective. To determine the first day total serum bilirubin (TSB) value which will predict with reasonable accuracy, neonates likely to develop subsequent significant hyperbilirubinemia. Methods. Serum bilirubin was estimated for all enrolled cases within 18 to 30 hr of life by microcapillary. The babies were then followed up clinically by 2 observers for the appearance and progression of jaundice every 12 hr till discharge and then daily upto fifth day of life. TSB estimation was repeated if the clinical assessment of jaundice was more than 10 mg/dl by any observer using Kramers Rule. Hyerbilirubinemia was defined as TSB level ≥12 mg/dl between 24 to 48 hr of life ≥15 mg/dl between 48 to 72 hr of life and 17 mg/dl beyond 72 hours of life. Results. A total of 200 neonates were enrolled in the study. Of these, 24 neonates (i.e., 12%) developed hyperbilirubinemia. The mean first day TSB value in the neonates who subsequently developed hyperbilirubinemia was 7.716 mg/dl as compared to a value of 5.154 mg/dl in those who did not. The difference was significant (p=0.000). Using Receiver operating characteristic (ROC) curve analysis, a value of 6.4 mg/dl (first day TSB) was determined to have the best predictive ability for subsequent hyperbilirubinemia with a sensitivity of 87.5%, specificity of 80.11%, positive predictive value of 37.5% and a negative predictive value of 97.92%. Conclusion. First day TSB estimation can serve as a reliable screening test for neonates at risk for subsequent hyperbilirubinemia. Neonates with the first day TSB level of less than 6.4 mg/dl have minimum risk of subsequent hyperbilirubinemia.

Icterícia como causa de internação neonatal: a experiência em um serviço terciário de Porto Alegre, RS / Jaundice in healthy term newborns treated at a tertiary center in Porto Alegre, RS

Introdução: Cerca de 60-80% dos recém-nascidos (RN) tornam-se ictéricos durante os primeiros dias de vida. Apesar de geralmente representar um fenômeno transitório, alguns pacientes necessitam de tratamento hospitalar. O objetivo deste estudo foi determinar a causa principal de icterícia neonatal em recém-nascidos saudáveis internados no Hospital Luterano e possíveis associações com diversas variáveis clínicas. Metodologia: Estudo retrospectivo em que foram estudados todos os casos de RN com icterícia neonatal internados para tratamento de hiperbilirrubinemia na UTI Neonatal do Hospital Luterano da ULBRA, no período de abril de 2007 a dezembro de 2008. Os resultados foram expressos em estatística descritiva e foi utilizado o teste exato de Fischer e o teste Qui-quadrado. O limite alfa considerado foi de 5%, com nível de significância de 0,05. Resultados: Dentre os RNs estudados (74), 52,7% eram do sexo masculino e 45,9% eram do sexo feminino. 14,8% dos pacientes nasceram de parto vaginal, enquanto que 85,1% nasceram de cesárea. A maioria dos recém-nascidos estudados (74,3%) foi considerada a termo. O diagnóstico mais frequente (37,8%) de icterícia dos pacientes internados para tratamento no serviço foi o de baixo aporte. Os pacientes do sexo masculino necessitaram de maior tempo de fototerapia do que as pacientes do sexo feminino (p=0,056). Conclusão: O diagnóstico de baixo aporte recebido pelos pacientes foi a causa mais frequente de icterícia. Os meninos necessitaram de um tempo significativamente maior de fototerapia para o tratamento da icterícia do que as meninas; também houve associação positiva da hiperbilirrubinemia com a baixa idade.

Introduction: About 60-80% of the newborns (NB) experience jaundice in the first days of life. Although jaundice is often a transitory phenomenon, some infants require hospital care. The aim of this study was to determine the main cause of neonatal jaundice among healthy newborns admitted to the Hospital Luterano and the possible associations with a number of clinical variables. Methods: A retrospective study in which all cases of NB with neonatal jaundice admitted for treatment of hyperbilirubinemia at the Neonatal ICU of the Hospital Luterano of ULBRA were studied, from Apr 2007 to Dec 2008. The results were expressed as descriptive statistics, and Fisher’s exact test and the Chi-square test were applied. The alpha limit considered was 5%, with level of significance at 0.05. Results: Among the 74 NB studied, 52.7% were males and 45.9% were females. 14.8% of the infants had a vaginal birth, while 85.1% had a cesarean delivery. Most of the studied infants (74.3%) were born full term. The most frequent cause for (37.8%) jaundice among these patients was inadequate intake. The male patients needed to stay longer on phototherapy than female patients (p=0.056). Conclusion: Low intake by the patient was the most frequent cause of jaundice in this series. The boys needed significantly more time on phototherapy than females, and there was a positive association of hyperbilirubinemia with low age.

Maternal and neonatal metabolic complications in cases of gestational diabetes about 220 cases

We report a retrospective study of 220 cases of gestational diabetes collected during a 5 year period [2001-2006]. Hypoglycemia was the most frequent maternal metabolic complication [11%], whereas ketoacidosis was rare, seen in only two patients [0.8%]. Neonatal metabolic complications were mostly hypoglycemia [19%] and hypocalcaemia [7%]. Pregnancy in diabetic women involves more risks than pregnancy in non-diabetic women. However, these risks are now better controlled

Overview of cases and prevalence of jaundice in neonatal intensive care unit.

This study was undertaken to know the pattern of jaundice prevalent among the babies admitted at the Neonatal Intensive Care Unit (NICU) of the B. P. Koirala Institute of Health Sciences (BPKIHS). A total of 293 neonates including 201 (68.6%) males and 92 (31.4%) females were admitted over a period of one year (15th June 2001 to 14th June 2002). Prematurity (30.0%), birth asphyxia (29.0%), neonatal septicemia (25.9%) and respiratory distress (23.9%) were the most common reasons for admission to the NICU. There were 42 cases of neonatal jaundice, among which babies born to primigravidae (59.5%), exceeded those born to multigravidae (40.5%). Pathological jaundice was found in 64.3% of the admitted cases of neonatal jaundice. Prematurity (33.3%) and neonatal septicemia (25.9%) were the most common causes of pathological jaundice, while prematurity with neonatal septicemia (14.8%), ABO incompatibility (11.1%), Rh incompatibility (7.4%) and prematurity, neonatal septicemia and ABO incompatibility combined (7.4%) accounted for the remaining cases of jaundice. A more detailed study related to the pathogenesis of jaundice among neonates is needed for the prevention of this disease in them.

Dehydration and hypernatremia in breast-fed term healthy neonates.

OBJECTIVE: The aim of the study was to determine the incidence of significant weight loss, dehydration, hypernatremia and hyperbilirubinemia in exclusively breast-fed term healthy neonates and compare the incidence of these problems in the warm and cool months. METHODS: During the study period 496 neonates were recruited. RESULTS: 157 neonates (31.6%) had significant weight loss (> 10 % cumulative weight loss or per day weight loss > 5%). Clinical dehydration was present in 2.2% of neonates. Of these 157 neonates, 31.8% had hypernatremia and 28 % had hyperbilirubinemia. CONCLUSION: The incidence of the above mentioned problems were higher in the warm months but the difference was not statistically significant.