Mortalidade no primeiro dia de vida: tendências, causas de óbito e evitabilidade em oito Unidades da Federação brasileira, entre 2010 e 2015 / Mortalidad en el primer día de vida: tendencias, causas de muerte y evitabilidad en ocho Unidades de la Federación brasileña, entre 2010 y 2015 / Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015

Objetivo: calcular taxas de mortalidade no primeiro dia de vida entre 2010 e 2015 em oito Unidades da Federação brasileira com melhor qualidade de informação, avaliar fatores associados e classificar os óbitos segundo causa básica e evitabilidade. Métodos: estudo descritivo; as taxas foram comparadas conforme características maternas e da criança; a análise de evitabilidade usou a 'Lista brasileira de causas de mortes evitáveis'. Resultados: 21,6% (n=20.791) dos óbitos infantis ocorreram no primeiro dia de vida; a taxa de mortalidade reduziu-se de 2,7 para 2,3 óbitos/1.000 nascidos vivos; observaram-se maiores taxas em NV com baixo peso, nascidos pré-termo e filhos de mães sem escolaridade; as principais causas dos óbitos foram síndrome da angústia respiratória (8,9%) e imaturidade extrema (5,2%); 66,3% das causas de óbito foram consideradas evitáveis. Conclusão: dois terços dos óbitos no primeiro dia de vida poderiam ser evitados por atenção adequada à mulher na gestação e no parto, e ao NV.

Objetivo: calcular la mortalidad en el primer día de vida entre 2010 y 2015 en ocho Unidades de la Federación brasileña con mejor calidad de información, analizar factores asociados y clasificar las causas básicas y la evitabilidad de los óbitos. Métodos: estudio descriptivo; las tasas de mortalidad fueron comparadas según las características maternas y del recién nacido (RN); el análisis de evitabilidad utilizó la 'Lista brasileña de causas de muertes evitables'. Resultados: un 21,6% (n=20.791) de los óbitos infantiles ocurrió en el primer día de vida; la tasa de mortalidad se redujo de 2,7 a 2,3 óbitos/1.000 nacidos vivos (NV); las tasas fueron mayores en NV de bajo peso, prematuros e hijos de madres sin escolaridad; las principales causas de óbito fueron síndrome de angustia respiratoria (8,9%) e inmadurez extrema (5,2%); un 66,3% de las causas de óbito fueron consideradas evitables. Conclusión: 2/3 de los óbitos en el primer día de vida podrían haber sido evitados con una atención adecuada a la mujer embarazada, al parto y al NV.

Objective: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. Methods: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. Results: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. Conclusion: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.

Mortality for Critical Congenital Heart Diseases and Associated Risk Factors in Newborns. A Cohort Study / Mortalidade para Cardiopatias Congênitas e Fatores de Risco Associados em Recém-Nascidos. Um Estudo de Coorte

Abstract Background: Congenital heart diseases are the most common type of congenital defects, and account for more deaths in the first year of life than any other condition, when infectious etiologies are ruled out. Objectives: To evaluate survival, and to identify risk factors in deaths in newborns with critical and/or complex congenital heart disease in the neonatal period. Methods: A cohort study, nested to a randomized case-control, was performed, considering the Confidence Interval of 95% (95% CI) and significance level of 5%, paired by gender of the newborn and maternal age. Case-finding, interviews, medical record analysis, clinical evaluation of pulse oximetry (heart test) and Doppler echocardiogram were performed, as well as survival analysis, and identification of death-related risk factors. Results: The risk factors found were newborns younger than 37 weeks (Relative Risk - RR: 2.89; 95% CI [1.49-5.56]; p = 0.0015), weight of less than 2,500 grams (RR: 2.33 [; 95% CI 1.26-4.29]; p = 0.0068), occurrence of twinning (RR: 11.96 [95% CI 1.43-99.85]; p = 0.022) and presence of comorbidity (RR: 2.27 [95% CI 1.58-3.26]; p < 0.0001). The incidence rate of mortality from congenital heart disease was 81 cases per 100,000 live births. The lethality attributed to critical congenital heart diseases was 64.7%, with proportional mortality of 12.0%. The survival rate at 28 days of life decreased by almost 70% in newborns with congenital heart disease. The main cause of death was cardiogenic shock. Conclusion: Preterm infants with low birth weight and comorbidities presented a higher risk of mortality related to congenital heart diseases. This cohort was extinguished very quickly, signaling the need for greater investment in assistance technology in populations with this profile.

Resumo Fundamento: As cardiopatias congênitas configuram o tipo mais comum de defeitos congênitos, sendo responsáveis por mais mortes no primeiro ano de vida do que em qualquer outra condição, quando etiologias infecciosas são excluídas. Objetivo: Avaliar a sobrevida e identificar os fatores de risco nos óbitos em recém-nascidos com cardiopatia congênita crítica e/ou complexa no período neonatal. Métodos: Realizou-se um estudo de coorte, aninhado a um caso-controle aleatorizado, considerando Intervalo de Confiança de 95% (IC95%) e nível de significância de 5%, pareado por sexo do recém-nascido e idade materna. Foram feitas buscas ativas de casos, entrevistas, análise de prontuário, avaliação clínica da oximetria de pulso (teste do coraçãozinho) e do ecoDopplercardiograma, bem como análise de sobrevida e identificação dos fatores de risco relacionados ao óbito. Resultados: Os fatores de risco encontrados foram recém-nascidos com menos de 37 semanas (Risco Relativo − RR: 2,89; IC95% 1,49-5,56; p = 0,0015), peso inferior a 2.500 g (RR: 2,33; IC95% 1,26-4,29; p = 0,0068), ocorrência de gemelaridade (RR: 11,96; IC95% 1,43-99,85; p = 0,022) e presença de comorbidade (RR: 2,27; IC95% 1,58-3,26; p < 0,0001). A taxa de incidência de mortalidade por cardiopatias congênitas foi de 81 casos por 100 mil nascidos vivos. A letalidade atribuída às cardiopatias congênitas críticas foi de 64,7%, com mortalidade proporcional de 12,0%. A taxa de sobrevida aos 28 dias de vida diminuiu em quase 70% nos recém-nascidos com cardiopatias congênitas. A principal causa de óbito foi o choque cardiogênico. Conclusão: Recém-nascidos prematuros, com baixo peso e presença de comorbidades apresentaram maior risco de mortalidade relacionada às cardiopatias congênitas. Esta coorte se extinguiu muito rapidamente, sinalizando para a necessidade de maior investimento em tecnologia assistencial em populações com este perfil.

Dyslipidemia and maternal obesity: Prematurity and neonatal prognosis / Dislipidemia e obesidade materna: prematuridade e prognóstico neonatal

Summary Objective: To identify the changes caused by dyslipidemia and obesity in pregnancy suggesting causes for premature birth, and the prognosis for the newborn. Method: Systematic review based on the Medline, Lilacs, Embase and Cochrane library databases between 1996 and 2016. The search for studies included the following keywords: "dyslipidemia, pregnancy, obesity, preterm birth." A protocol was programmed and a protocol for inclusion/exclusion of studies was implemented. Results: Of the 5,789 articles initially selected between March 1996 and July 2016, only 32 were in accordance with the established criteria. Of these, 28.12% discussed risk factors of prematurity; 37.50%, metabolic alterations and gestational dyslipidemia; 21.87%, dyslipidemic complications in preterm birth; and 12,50%, lipid metabolism, glycemic and placental transfer. Conclusion: There is a reduced adaptation of obese pregnant women to the metabolic changes of gestation. This favors dyslipidemic intercurrences in the mother, which, directly or indirectly, suggests the occurrence of premature births and high lipid transfer to the fetus. Therefore, preterm newborns, whose mothers were dyslipidemic during pregnancy, have greater risk of epicardial fat, both in early (first year of life) and in later (adult) phases of life.

Resumo Objetivo: Identificar as alterações provocadas pela dislipidemia e pela obesidade na gestação que sugerem causas de partos prematuros e o prognóstico para o recém-nascido. Método: Revisão sistemática nas bases de dados Medline, Lilacs, Embase e da biblioteca Cochrane entre os anos de 1996 e 2016. O processo de seleção ocorreu a partir dos descritores dislipidemia, gravidez, obesidade, nascimento prematuro. Um protocolo foi programado, havendo uma etapa seletiva de inclusão/exclusão das pesquisas. Resultados: Dentre os 5.789 artigos inicialmente selecionados entre março e julho de 2016, somente 32 estavam de acordo com os critérios estabelecidos. Desses, 28,12% focavam nos fatores de risco da prematuridade; 37,50%, em alterações metabólicas e dislipidemia gestacional; 21,87%, em intercorrências dislipidêmicas no parto prematuro; 12,50%, em metabolismo lipídico, glicêmico e transferências pela placenta. Conclusão: Existe uma menor adaptação da gestante obesa às mudanças metabólicas da gestação, favorecendo intercorrências dislipidêmicas na mãe, o que, direta ou indiretamente, sugere a ocorrência de partos prematuros e uma elevada transferência de lipídios para o feto. Portanto, recém-nascidos prematuros de mães dislipidêmicas durante a gravidez apresentam maior risco de desenvolver gordura epicárdica tanto na fase precoce (primeiro ano de vida) quanto na tardia (vida adulta).

Complications in adolescent pregnancy: systematic review of the literature / Complicações da gravidez na adolescência: revisão sistemática da literatura

Sexual activity during adolescence can lead to unwanted pregnancy, which in turn can result in serious maternal and fetal complications. The present study aimed to evaluate the complications related to adolescent pregnancy, through a systematic review using the Medical Subject Headings: “pregnancy complication” AND “adolescent” OR “pregnancy in adolescence”. Only full original articles in English or Portuguese with a clearly described methodology, were included. No qualitative studies, reviews or meta-analyses, editorials, case series, or case reports were included. The sample consisted of 15 articles; in that 10 were cross-sectional and 5 were cohort studies. The overall prevalence of adolescent pregnancy was 10%, and among the Brazilian studies, the adolescent pregnancy rate was 26%. The cesarean delivery rate was lower than that reported in the general population. The main maternal and neonatal complications were hypertensive disorders of pregnancy, prematurity and low birth weight, respectively. Adolescent pregnancy is related to increased frequency of neonatal and maternal complications and lower prevalence of cesarean delivery.

A atividade sexual na adolescência pode levar a uma gravidez indesejável que por sua vez pode trazer sérias complicações maternais e fetais. O presente estudo teve por objetivo avaliar as complicações relacionadas à gravidez na adolescência, por meio de uma revisão sistemática, utilizando como descritores do Medical Subject Headings: “pregnancy complication” AND “adolescent”OR “pregnancy in adolescence”. Foram considerados os artigos originais completos em inglês ou português, na íntegra, que apresentassem descrição clara da metodologia. Não foram incluídos estudos qualitativos, revisões ou metanálises, editoriais, série de casos e relatos de caso. A amostra foi constituída por 15 publicações, sendo 10 com delineamento transversal e 5 com delineamento coorte. A prevalência geral de gestação na adolescência foi de 10% e, entre os trabalhos nacionais, de 26%. A prevalência de parto cesárea foi menor que a descrita na população geral. As principais complicações maternas e neonatais de mães adolescentes foram doença hipertensiva específica da gestação, prematuridade e baixo peso ao nascer respectivamente. A gestação na adolescência se relacionou a maior frequência de complicações neonatais e maternas e à menor prevalência de parto cesariana.

Nascer em Belo Horizonte: desfechos neonatais desfavoráveis / Born in Belo Horizonte: adverse neonatal outcomes

Introdução: O Brasil tem obtido, nas últimas décadas, importantes avanços nas políticas públicas com impactos positivos na saúde materna e infantil. Embora o país já tenha alcançado a meta dos Objetivos do Desenvolvimento do Milênio para a mortalidade infantil, alguns indicadores ainda persistem em situação desfavorável, entre eles a prematuridade, o baixo peso ao nascer e morbidades resultantes dessas situações. Esses problemas tem sido associados à excessiva medicalização na atenção ao parto e nascimento, traduzida especialmente nas altas taxas de cesáreas no país. Objetivo: Analisar a ocorrência de desfechos neonatais desfavoráveis em crianças nascidas em Belo Horizonte segundo determinantes maternos, neonatais e assistenciais e identificar as variáveis que caracterizam o near miss neonatal. Métodos: Trata-se de um estudo de coorte desenvolvido em maternidades públicas e privadas de Belo Horizonte, Minas Gerais, no período de novembro de 2011 a março de 2013. A amostra foi constituída por puérperas hospitalizadas por motivo de parto hospitalar e seus conceptos vivos, independente de peso e idade gestacional, e quando mortos com peso maior que 500 gramas e idade gestacional maior que 22 semanas. Foi feita análise univariada para verificar a associação entre fatores de risco e os desfechos prematuridade, baixo peso ao nascer e desfecho neonatal desfavorável. A extração dos modelos finais foi realizada por regressão logística. Resultados: Foram avaliados 1088 recém-nascidos. Algum desfecho neonatal desfavorável foi evidenciado em mais de um terço dos recém-nascidos, com destaque para a prematuridade e o baixo peso ao nascer (cerca de 10% cada), manobras de reanimação na sala de parto (19,1%), a utilização de oxigênio após o nascimento (12%) e a internação em unidades de terapia intensiva neonatal (7,1%). No modelo da prematuridade, as variáveis número de consultas de pré-natal, parto cesáreo, filho prematuro anterior, classe econômica D ou E e intercorrência...

Introduction: Brazil has achieved in recent decades, important advances in public policy with positive impacts on maternal and child health. Although the country has already achieved the mark of the Millennium Development Goals for infant mortality, some indicators still remain at a disadvantage, including prematurity, low birth weight and morbidity resulting from these situations. These problems have been associated with excessive medicalization of childbirth care and birth, translated especially in the high cesarean rates in the country. Objective: To analyze the occurrence of adverse neonatal outcomes in children born in Belo Horizonte second determining maternal, neonatal and assistance and to identify events that characterize the neonatal near miss. Methods: This was a cohort study conducted in public and private maternity hospitals in Belo Horizonte, Minas Gerais, from November 2011 to March 2013. The sample consisted of mothers hospitalized for hospital birth of reason and its newborn regardless of weight and gestational age, and when dead weighing more than 500 grams and gestational age greater than 22 weeks. Univariate analysis was performed to assess the association between risk factors and outcomes prematurity, low birth weight and adverse neonatal outcome. The extraction of the final models was performed by logistic regression. Results: Were evaluated in 1088 newborns. Some unfavorable neonatal outcome was seen in more than a third of newborns, especially premature birth and low birth weight (about 10% each), resuscitation in the delivery room (19,1%), the use of oxygen after birth (12%) and hospitalization in units neonatal intensive care (7.1%). In the model of prematurity, the variables number of prenatal consultations, cesarean section, previous preterm infant, economy class D or E and clinical complications in the current...

Profile of Babies Born before Arrival at Hospital in a Peri-Uban Setting

Background. Babies born before arrival (BBAs) at hospital constitute a special group at risk of high morbidity and mortality.Objective. We conducted a 12-month retrospective review to describe maternal and neonatal characteristics of BBAs; and their outcomes compared with babies born in the state health sector.Methods. Using case-control sampling; all babies born outside a health facility and who presented to hospital within 24 hours of life were included and compared to the next in-hospital delivery occurring immediately after each BBA presented. Results. During the period reviewed; 135 BBAs (prevalence 1.8) presented; 71 after hours with most deliveries occurring at home (73.8). There was no birth attendant present at 70.5 of deliveries. Average birth weights were similar (2.86 kg in the BBA group; 95 confidence interval (CI) 2.73 - 2.95; 2.94 kg in the control group; 95 CI 2.78 - 3.02); but significantly more preterm babies were found in the BBA group (23 v. 9; respectively; p0.0001). Admitted BBAs had significantly lower average weights than those who were not admitted (2.19 kg v. 2.96 kg; respectively; p0.0001). No significant differences were found when maternal age; parity; co-morbidities and distance from the hospital were compared. There were significantly more unbooked mothers in the BBA group (23.0 v. 6.7; respectively;p0.0001). Only 54.40 of the admitted BBAs' mothers had booked antenatally; compared with 78.89 of mothers whose babies were discharged. Admission and complication rates were similar between the groups; but average length of stay was longer in admitted BBAs compared with controls. Conclusion. The prevalence of BBAs in this study is comparable to that in other developing countries; and is associated with poor antenatal attendance; prematurity; delay in presentation to hospital and lengthier hospital stays. These factors have implications for prehospital care of newborns and access to maternal and child healthcare in general

patterns and causes of neonatal mortality at a tertiary hospital in Oman

To report the patterns and causes of neonatal death from a tertiary care neonatal intensive care unit over a period of four years. This is a retrospective cohort study where four years data [January 2006 - December 2009] of all inborn neonatal admissions and deaths were collected from the neonatal intensive care unit at Sultan Qaboos University hospital on predesigned forms. All out born admissions and deaths were excluded. The causes of neonatal death were classified using Wigglesworth's classification. The number of inborn live births during the study period was 10064 and the total number of inborn neonatal admissions was 1475. The total deaths [neonatal and post neonatal] at the neonatal intensive care unit was 73 [63 inborn and 10 out born]. Among the inborn, five deaths were post neonatal deaths and hence, excluded from analysis. Among the remaining inborn neonatal deaths [n=58], 34 [59%] were males and 24 [41%] were females. The number of neonatal admissions increased over the years during the study period from 248 to 356, while the number of deaths also increased from 10 deaths in 2006, to 20 deaths in 2009. The primary causes of neonatal deaths were prematurity and its complications 52% [n=30]. Lethal congenital malformations lead to 17 [29%] newborn deaths, specific diagnosis in 7 newborns [12%], and birth asphyxia in four [7%] of cases. There was an increasing trend of neonatal admissions and deaths among inborn babies. Prematurity, with sepsis as its major complication and congenital malformations were the leading cause of neonatal mortality.

Análise da morbiletalidade neonatal em recém-nascidos pré-termo tardios / Analysis of neonatal morbidity and mortality in late-preterm newborn infants

OBJETIVO: Comparar as taxas de óbito e as principais intercorrências clínicas entre recém-nascidos pré-termo tardios nascidos com idade gestacional entre 34 semanas completas e 36 semanas e 6 dias e recém-nascidos a termo. MÉTODOS: Estudo transversal envolvendo todos os recém-nascidos pré-termo tardios nascidos entre agosto de 2010 e agosto de 2011. A população do estudo foi constituída pelos recém-nascidos pré-termo tardios (casos) e um grupo de recém-nascidos a termo (controles), sendo selecionados três controles para cada caso. Foram analisadas variáveis maternas, da gestação e neonatais. Na análise estatística, utilizaram-se médias, desvios padrão e testes t de Student e de Mann-Whitney para variáveis numéricas, o qui-quadrado de Pearson para variáveis categóricas e estimativa de risco pela odds ratio com intervalo de confiança de 95%. RESULTADOS: A população do estudo foi constituída por 239 recém-nascidos pré-termo tardios e 698 recém-nascidos a termo. As gestantes com mais de 35 anos e/ou história de prematuros prévios tiveram um número maior de pré-termo tardios. As variáveis da gestação relacionadas com o pré-termo tardio foram a hipertensão, doenças infecciosas, ruptura de membrana há mais de 18 horas e gravidez gemelar. Os recém-nascidos pré-termo, em comparação com os recém-nascidos a termo, apresentaram estatisticamente mais hipo/hipertermia, hipoglicemia, patologias respiratórias, necessidade de reanimação em sala de parto, necessidade de fototerapia, uso de complemento alimentar, necessidade de ventilação mecânica, infusão venosa, uso de antibiótico e internação em unidade de tratamento intensivo neonatal, sendo a sua taxa de óbito neonatal nove vezes maior. As intercorrências se mostraram inversamente relacionadas à idade gestacional. CONCLUSÃO: Os recém-nascidos pré-termo tardios apresentaram uma taxa de óbito nove vezes maior do que os recém-nascidos a termo e maior risco de intercorrências no período neonatal, sendo estas inversamente relacionadas com a idade gestacional.

OBJECTIVE: To compare mortality and the principal intercurrent clinical conditions suffered by late-preterm newborn infants born with gestational ages of 34 full weeks to 36 weeks and 6 days, and full term newborns. METHODS: This was a cross-sectional study of all preterm newborn infants born at a public hospital from August 2010 to August 2011. The study sample comprised late-preterm infants (cases) and a group of full term newborns (controls). Three controls were enrolled for each case. Maternal, gestational and neonatal variables were analyzed. Means and standard deviations were used to compare numerical variables between case and control groups using Student's t test and the Mann-Whitney test; Pearson's chi-square was used for categorical variables. Odds ratios and 95% confidence intervals were calculated to estimate risk. RESULTS: The study sample comprised 239 late-preterm infants and 698 full term newborns. Mothers aged over 35 years and/or with a history of previous premature deliveries had a higher proportion of late-preterm children. The following gestational variables were associated with late-preterm delivery: hypertension, infectious diseases, rupture of membranes more than 18 hours previously and multiple pregnancies. When compared with full term newborns, late-preterms were statistically more likely to be subject to hypothermia/hyperthermia, hypoglycemia, respiratory pathologies, resuscitation in the delivery room, phototherapy, supplementary feeding, mechanical ventilation, venous infusions, antibiotics and admission to the neonatal intensive care unit, resulting in a nine times greater neonatal mortality rate. Intercurrent conditions were inversely related to gestational age. CONCLUSIONS: Late-preterm newborn infants had a mortality rate nine times that of full term infants and were exposed to a greater risk of intercurrent conditions during the neonatal period. These intercurrent conditions were inversely related to gestational age.

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.

Morbimortalidad asociada a recién nacidos pretérminos tardíos / Morbidity and mortality associated with late preterm infants newborn

Introducción: Los recién nacidos pretérminos tardíos (RNPT-T) son los neonatos nacidos entre las 34 y 36 semanas de edad gestacional. Debido a su incremento es importante conocer el comportamiento de los mismos, a fin de adecuar el manejo y seguimiento posteriores al alta. Este estudio describe la morbimortalidad, mortalidad, síndrome de dificultad respiratoria (SDR), ictericia, dificultad en la alimentación e hipoglucemia asociada a los RNPT-T en comparación con los RNT. Población y métodos: Estudio de cohortes retrospectivo. Se incluyeron 500 RN entre 34 a 36,6 semanas (RNPT-T) y 500 entre 37-41,6 semanas (RNT) de edad gestacional nacidos en el HMI "Ramón Sardá" de Buenos Aires entre 2007 y 2008. Resultados: Los RNPT-T presentaron significativamente mayor mortalidad que los RNT (2,9‰ vs. 0,49‰ respectivamente (RR 4,1 IC 95% 3,2-15,7) y morbilidad, representada por mayor SDR, ictericia, dificultad en la alimentación, internación prolongada e hipoglucemias. Conclusión: Los recién nacidos pretérminos tardíos presentan mayor mortalidad y morbilidades que los recién nacidos de termino.

Introduction: Late preterm infants are the infants born between 34 and 36 weeks of gestational age. Because of the increase is important to know their behavior in order to adapt the management and follow-up after discharge. We described in this study the morbidity associated with late preterm infants compared to term infants, determine the incidence of complications often presented such as respiratory distress syndrome (RDS), jaundice, feeding difficulty, hypoglycemia, and death in comparison with infants of =37 weeks gestation age. Population and methods: Retrospective cohort study of infants from 34 to 36.6 weeks gestational age (M=500) born in the "Ramón Sardá" Maternity Hospital during 2007 and 2008. Results: We found that PNB-T had significantly higher mortality compared with the term infants (2.9‰ vs.0.49 ‰, RR 4.1 95% CI 3.2 - 15.7). RDS, jaundice, feeding difficulty, prolonged and major hypoglycemia were higher in the study group. Conclusion: Late preterm infants have higher mortality and morbidity than term infants.

Predição e prevenção do parto pré-termo / Prediction and prevention of preterm delivery

A prevenção da prematuridade é um dos maiores desafio obstétricos deste século, e as medidas preventivas do parto prematuro se baseiam em três níveis de ação: a prevenção primária (identificação e tratamento dos fatores de risco), secundária (diagnóstico precoce do trabalho de parto prematuro) e terciária (intervenções para minimizar as principais complicações do nascimento prematuro). A maioria dos esforços está concentrada na prevenção terciária (utilização de tocólise e corticoide). Tais medidas reduzem a mortalidade e morbidade perinatal, mas a incidência do nascimento prematuro permanece alta. Avanços na prevenção primária e secundária, seguidos de novas estratégias, são necessários para diminuir a incidência do parto prematuro e para prevenir as doenças associadas à prematuridade. O objetivo desta revisão é descrever os métodos de predição do parto prematuro mais utilizados e as principais medidas preventivas do nascimento prematuro.

The prevention of preterm birth is the most important challenge at present time. The interventions to reduce the morbidity and mortality of preterm birth can be primary (identification and treatment of risk factors), secondary (early diagnosis of preterm labor), or tertiary (intended to improve outcomes for preterm infants). Most efforts so far have been tertiary interventions, such as treatment with tocolytic agents and antenatal corticosteroids. These measures have reduced perinatal morbidity and mortality, but the incidence of preterm birth remains high. Advances in primary and secondary care, following new strategies, are needed to prevent prematurity-related illness in infants and children. The purpose of this review is to describe the useful methods of prediction of preterm delivery and the most important measures to prevent the preterm birth.

Morbidity and Mortality Pattern of Neonates Admitted into Nursery Unit in Wad Medani Hospital; Sudan

Background: Neonatal outcome is an important indicator of obstetrics and health care. Few or no published data are available concerning neonatal morbidity and mortality in Sudan. Objectives: To study morbidity and mortality pattern amongst inborn neonates admitted into nursery unit in Wad Medani Hospital; Sudan during the period Jan-June; 2009. Results: A total of 1211 (29.5) out of 4098 in-born neonates were admitted during study period. The major indications for neonatal admission were; infections 300 (24.8); low birth weight (LBW) 307(25.4) and asphyxia 130(10.7). There were 133(11) neonatal deaths; preterm delivery; LBW and birth asphyxia were the major causes of death among these neonates. Conclusion: neonatal infection; preterm birth and LBW were the common causes of neonatal morbidity and mortality. There is an urgent need for more research throughout the country concerning these common causes of morbidity and mortality

Morbilidad en pretérminos tardíos: estudio prospectivo caso control multicéntrico / Late preterm morbility: case-control multicenter prospective study

Introducción: en el año 2005 la OMS establece la recomendación de denominar late preterm o prematuro tardío a los nacidos entre las 34 semanas 0 días y 36 semanas 7 días. Existe abundante bibliografía que documenta un aumento significativo de la morbimortalidad entre las 34 y 37 semanas pero se observa una infravaloración de su importancia debido a que la supervivencia de estos niños es elevada y las complicaciones menores que en los prematuros extremos. Objetivos: 1) Determinar la incidencia de complicaciones respiratorias y metabólicas en pretérminos tardíos. 2) Analizar si las complicaciones de los recién nacidos con 37 semanas de edad gestacional es mayor que a las 39-40 semanas.Metodología: se realizó un estudio casos-controles prospectivo en 4 maternidades del país. Los casos se dividieron en dos poblaciones de 34 a 36 semanas y 37 semanas cumplidas. Se tomaron como controles el evento posterior siguiente al caso en el mismo servicio con 39 y 40 semanas.Resultados: se incluyeron 86 casos y controles en CHPR, 36 de la ciudad de Salto y 43 de Maldonado con una población de 165 casos y 165 controles (n=330). Tenían 34 semanas 12 casos, 35 semanas 23 casos, 36 semanas 35 casos, 37 semanas 93 casos. En la población control los 12 casos (7,27%) de dificultad respiratoria se debieron a taquipnea transitoria. En los prematuros tardíos se observó 19 casos de dificultad respiratoria (26,3%) de los cuales 17 (23,6%) correspondieron a taquipnea transitoria, 1 caso de enfermedad de membrana hialina y un caso de hipertensión pulmonar severa (1,38%). La incidencia de síndrome de dificultad respiratoria tuvo diferencia estadísticamente significativa en los prematuros tardíos OR 4,57 (1,95-10,82) pero no a las 37 semanas. En 24 prematuros tardíos se observó trastornos metabólicos (33,3%) y 5 en el grupo control (3%) OR 16 IC 95% (5,40-50). A las 37 semanas se observó en 8 (8,6%) OR 3,01 IC 95% (0,86-10). ...

Introduction: in 2005 WHO established the recommendation called late preterm or premature late to those born between 34 weeks 0 days and 36 weeks 7 days. There is abundant literature documenting a significant increase in morbidity and mortality between 34 and 37 weeks but this is an underestimation of its importance because the survival of these children is high and minor complications in premature ends.Objectives: 1) determine the incidence of respiratory and metabolic complications in late preterm. 2) To examine whether the complications of newborns with gestational age 37 weeks is greater than at 39-40 weeks.Methods: we conducted a prospective case-control study in four maternity centers. The cases were divided into two populations of 34 to 36 weeks and 37 completed weeks. Were taken as controls subsequent event following event in the same service with 39 and 40 weeks.Results: the study included 86 cases and controls in CHPR, 36 of the city of Salto and 43 of Maldonado with a population of 165 cases and 165 controls (n = 330). 34 weeks were 12 cases, 35 weeks 23 cases, 36 weeks 35 cases, 37 weeks 93 cases. In the control population of 12 cases (7.27%) respiratory distress was due to TTN. In the late preterm noted 19 cases of respiratory distress (26.3%) of whom 17 (23.6%) were transient tachypnea, one case of hyaline membrane disease and one case of severe pulmonary hypertension (1.38%). The incidence of respiratory distress syndrome was statistically significant difference in late preterm OR 4.57 (1,95-10,82) but not at 37 weeks. In 24 late preterm metabolic disorders was observed (33.3%) and 5 in the control group (3%) OR 16 95% (5,40-50). At 37 weeks was observed in 8 (8.6%) OR 3.01 95% (0,86-10). ...

Progesterona e prevenção do parto prematuro: aspectos atuais / Progesterone and prevention of preterm delivery: and up-to-date report

A incidência de parto pré-termo varia de 7 a 11 porcento de todas as gestações e o nascimento prematuro é uma das principais causas de morbidade e mortalidade neonatal responsável por mais de dois terços das mortes neonatais por malformações congênitas. Objetivando reduzir as taxas de partos prematuros, inúmeras estratégias foram adotadas, entre estas, o uso profilático de progesterona ressurgiu como importante método terapêutico. Entre as principais ações desse hormônio, cita-se o efeito relaxante sobre a musculatura uterina, a capacidade de bloquear os efeitos da ocitocina, ação antiinflamatória e imunossupressora. Estudos recentes concluíram que a utilização de progesterona exôgena reduz as taxas de prematuridade em pacientes com risco de parto prematuro tais como história prévia de parto prematuro e aquelas com colo uterino curto demonstrado pela ultra-sonografia transvaginal no segundo trimestre de gestação. O objetivo desta revisão é, inicialmente, descrever os prováveis mecanismos de ação da progesterona, as suas principais vias de administração e seus efeitos adversos e, posteriormente, avaliar os principais estudos em pacientes assintomáticas e sintomáticas.

The incidence of preterm delivery is about 7 to 11 of all pregnant women and the preterm birth is one the most important cause of neonatal morbidity and mortality. Preterm birth accounts for two thirds of neonatal mortality when fetal malformation is excluded. In order to reduce the preterm birth rate several strategies have been adopted, including the prophylactic using of progesterone. The main effects of this hormone are uterine muscle relaxation, blockage of oxytocin effects, anti-inflammatory properties and immunosuppressing effects in pregnancy. More recently, studies have concluded that the administration of prophylactic progesterone could reduce the preterm birth rate of high risk patients, including previous history of preterm birth and short cervical length at transvaginal scan at mid-trimester pregnancy. The purpose of this review is, firstly, to describe the possible mechanism of action of progesterone, its route of administration and its side-effects and, secondly, assess the most recent studies in both asymptomatic and symptomatic patients.

Evaluation of Preterm Delivery between 32(+0)-33(+6) Weeks of Gestation

Preterm labor after 34 weeks of gestation has shown no great difference from fullterm labor in terms of neonatal morbidity and mortality when proper antepartum management (antibiotics or steroids treatment) is done. However, various studies have discussed different views on the risks and safety of preterm delivery at 32(+0)- 33(+6) weeks of gestation. We evaluated the complications of different preterm groups that included the neonates born at 32(+0)-33(+6) weeks of gestation (142), stratified randomly selected neonates born at 34(+0)-36(+6) weeks of gestation (267) and neonates born after 37(+0) weeks of gestation (356) at our hospital between December 1999 and April 2006. As a result, it was found that neonates born at 3(+0)-36(+6) weeks of gestation showed no great difference from infants born at full term. However, neonates born at 32(+0)-33(+6) weeks were more likely to be admitted to neonatal intensive care unit or develop neonatal complications significantly than the neonates born at 34(+0)- 36(+6) weeks and at full term. Therefore, it is suggested that neonates born at 32(+0)-33(+6) weeks have higher risk of neonatal complications following their preterm labor than those born at later than 34(+0) weeks. Thus, it would be difficult to accept the idea that preterm labor at 32(+0)-33(+6) weeks is safe.

Neonatal Outcome after Preterm Delivery in HELLP Syndrome

The present study compares neonatal outcome after preterm delivery of infants in pregnancies complicated by the HELLP syndrome or severe preeclampsia (PS). The maternal and neonatal charts of 71 out of a total of 409 pregnancies that were complicated by hypertensive disorders at Severance hospital between January 1995 and December 2004 were reviewed. Twenty-one pregnancies were complicated by HELLP syndrome and 50 pregnancies were complicated by PS. Fifty normotensive (NT) patients who delivered because of preterm labor comprised the control group. Results were analyzed by the chi-square test and ANOVA. Gestational age and maternal age at delivery were matched among the three groups. The neonatal outcomes of the HELLP syndrome group were compared with the PS and NT groups. There were significant differences between the HELLP syndrome group and the PS group in the incidence of intraventricular hemorrhage (IVH) (61.9% vs. 26%, p=0.006), sepsis (85.7% vs. 44%, p =0.003) and mechanical ventilation (MV) rate (81% vs. 54%, p=0.039). There were significant differences between the HELLP syndrome group and the NT group in the incidence of neonatal death (ND) (19.5% vs. 2.0%, p=0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p=0.0045), IVH (61.9% vs. 4%, p < 0.0001), sepsis (85.7% vs. 14%, p < 0.0001), intensive care (IC) (85.7% vs. 24%, p < 0.0001) and MV rate (80.1% vs. 14%, p < 0.0001). There were also significant differences between the PS and NT groups in the incidence of ND (20% vs. 2%, p=0.0192), RDS (30% vs. 8%, p=0.0085), IVH (26% vs. 4%, p=0.0070), sepsis (44% vs. 14%, p=0.0015), IC (78% vs. 24%, p < 0.0001), MV rate (54% vs. 14%, p < 0.0001) and low 5-min APGAR score (50% vs. 16%, p=0.0005). This study shows increased morbidity in newborns of mothers complicated with HELLP syndrome and indicates that early, regular and high quality management of these patients is essential to improve both maternal and neonatal outcome.