Admission hypothermia, neonatal morbidity, and mortality: evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center.

This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH. What is Known: • Admission hypothermia is associated with early neonatal death. • The association of admission hypothermia with major neonatal morbidities has not been fully established. What is New: • Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates. • Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.

Risk factors for central venous catheter-related infections in a neonatal population - systematic review / Fatores de risco para infecção associada a cateteres venosos centrais em população neonatal - revisão sistemática

Abstract Objective: This was a systematic review of the incidence density and risk factors for central venous catheter-related infections in a neonatal population. Data source: The MEDLINE, Embase, Cochrane, BDENF, SciELO, and LILACS databases were used without date or language restriction. Studies that analyzed risk factors for bloodstream infections in newborns were identified. Data synthesis: A total of 134 articles were found that met the eligibility criteria. Of these articles, 14 were selected that addressed risk factors for central venous catheter-related infection in neonates. Catheter-related bloodstream infections remain an important complication, as shown by the incidence rates reported in the studies included in this review. The observed risk factors indicate that low birth weight, prematurity, and longer catheter permanence are related to a higher incidence of bloodstream infections. It has been observed that low rates of catheter-related infections, i.e., close to zero, are already a reality in health institutions in developed countries, since they use infection surveillance and control programs. Conclusion: Catheter-related bloodstream infections still show high incidence density rates in developing countries. The authors emphasize the need for further longitudinal studies and the need for better strategies to prevent risk factors, aiming at the reduction of catheter-related infections.

Resumo Objetivo: Revisão sistemática sobre a densidade de incidência e de fatores de risco para infecção associada a cateter venoso central em população neonatal. Fontes dos dados: Usaram-se os bancos de dados Medline, Embase, Cochrane, Bdenf, Scielo e Lilacs, sem restrição de data ou de idioma. Identificaram-se os estudos que analisaram fatores de risco para infecção da corrente sanguínea em recém-nascidos. Síntese dos dados: Foram encontrados 134 artigos conforme os critérios de elegibilidade. Desses, foram selecionados 14 que abordaram fatores de risco para infecção associada a cateter venoso central em neonatos. A infecção da corrente sanguínea associada a cateter continua a mostrar-se como uma importante complicação, conforme demonstram as taxas de incidência relatadas nos estudos incluídos nesta revisão. Os fatores de risco observados apontam que baixo peso ao nascer, prematuridade e maior tempo de permanência do cateter estão relacionados a maior incidência de infecção da corrente sanguínea. Observou-se que taxas de infecção associada a cateter em valores baixos, próximos a zero, já são uma realidade em instituições de saúde de países desenvolvidos, uma vez que usam programas de vigilância e controle de infecção. Conclusão: A infecção da corrente sanguínea associada a cateter ainda apresenta altas taxas de densidade de incidência em países em desenvolvimento. Destaca-se a necessidade de mais estudos longitudinais e a necessidade de melhores estratégias de prevenção dos fatores de risco para a redução de infecção associada a cateter.

Risk factors for central venous catheter-related infections in a neonatal population - systematic review.

OBJECTIVE: This was a systematic review of the incidence density and risk factors for central venous catheter-related infections in a neonatal population. DATA SOURCE: The MEDLINE, Embase, Cochrane, BDENF, SciELO, and LILACS databases were used without date or language restriction. Studies that analyzed risk factors for bloodstream infections in newborns were identified. DATA SYNTHESIS: A total of 134 articles were found that met the eligibility criteria. Of these articles, 14 were selected that addressed risk factors for central venous catheter-related infection in neonates. Catheter-related bloodstream infections remain an important complication, as shown by the incidence rates reported in the studies included in this review. The observed risk factors indicate that low birth weight, prematurity, and longer catheter permanence are related to a higher incidence of bloodstream infections. It has been observed that low rates of catheter-related infections, i.e., close to zero, are already a reality in health institutions in developed countries, since they use infection surveillance and control programs. CONCLUSION: Catheter-related bloodstream infections still show high incidence density rates in developing countries. The authors emphasize the need for further longitudinal studies and the need for better strategies to prevent risk factors, aiming at the reduction of catheter-related infections.

Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus / Efeitos da abordagem terapêutica da persistência de canal arterial sobre a evolução neonatal de recém-nascidos de extremo baixo peso

OBJECTIVE: To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD. METHODS: This was a multicentric cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment), G2 - pharmacologic (indomethacin or ibuprofen), G3 - surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. Outcomes: death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significant. RESULTS: 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) ...

OBJETIVO: Analisar os efeitos da terapêutica adotada para o canal arterial (CA) em recém-nascidos (RN) < 1.000gadmitidos em unidades neonatais (UN) da Rede Brasileira de Pesquisas Neonatais (RBPN), sobre os desfechos: óbito, displasia broncopulmonar (DBP), hemorragia intraventricular grave (HIVIII/IV), retinopatia da prematuridade cirúrgica (ROPcir), enterocolite necrosante cirúrgica (ECNcir) e o desfecho combinado óbito e DBP. MÉTODOS: Estudo multicêntrico, de coorte, coleta de dados retrospectiva, incluindo RN de 16 UN da RBPN de 01/01/2010 a 31/12/2011, PN < 1.000 g, idade gestacional (IG) < 33 semanas e diagnóstico ecocardiográfico de PCA. Excluídos: óbitos ou transferências até o terceiro dia de vida, infecções congênitas ou malformações. Grupos:G1 - conservadora (sem intervenção medicamentosa ou cirúrgica), G2 - farmacológica (indometacina ou ibuprofeno) e G3 - cirúrgico (com ou sem tratamento farmacológico anterior). Analisou-se: uso de esteroide antenatal, parto cesárea, PN, IG, Apgar5' < 4, sexo masculino, SNAPPE II, síndrome do dDesconforto respiratório (SDR), sepse tardia, ventilação mecânica (VM), surfactante < 2 horas de vida, tempo de VM e os desfechos: óbito, dependência de oxigênio com 36 semanas (DBP36s), HIV III/IV, ROPcir, ECNcir e óbito/DBP36s. Estatística: Teste t-Student, Qui-Quadrado ou teste Exato de Fisher. Testes de Regressão Binária Logística e Regressão Múltipla Stepwise Backward. MedCalc (Medical Calculator) software, versão 12.1.4.0.p < 0,05. RESULTADOS: Foram selecionados 1.097 RN e 494 foram incluídos: G1-187 (37,8%), G2-205 (41,5%) e G3-102 (20,6%). Verificou-se: maior mortalidade (51,3%) no G1 e menor no G3(14,7%); maior frequência DBP36s (70,6%) e ROPcir (23,5%) ...

Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus.

OBJECTIVE: To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD. METHODS: This was a multicentric, cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment), G2 - pharmacologic (indomethacin or ibuprofen), G3 - surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. OUTCOMES: death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. STATISTICS: Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significant. RESULTS: 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) and ROPsur were observed in G3 (23.5%). The lowest occurrence of death/BPD36wks occurred in G2 (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments were protective for the outcome death/BPD36wks. CONCLUSION: The conservative approach of PDA was associated to high mortality, the surgical approach to the occurrence of BPD36wks and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks.

Evaluation of national health-care related infection criteria for epidemiological surveillance in neonatology / Avaliação dos critérios nacionais de infecção relacionada à assistência à saúde para a vigilância epidemiológica em neonatologia

OBJECTIVE: to assess the use of the Brazilian criteria for reporting of hospital-acquired infections (HAIs) in the neonatal unit and compare them with the criteria proposed by the National Healthcare Safety Network (NHSN). METHODS: this was a cross-sectional study conducted from 2009 to 2011. It included neonates with HAI reporting by at least one of the criteria. Statistical analysis included calculation of incidence density of HAIs, distribution by weight, and by reporting criterion. Analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the national criteria was performed considering the NHSN as the gold standard, with agreement assessed by kappa. RESULTS: a total of 882 newborns were followed, and 330 had at least one infection notified by at least one of the criteria. A total of 522 HAIs were reported, regardless of the criteria. An incidence density of 27.28 infections per 1,000 patient-days was observed, and the main topographies were sepsis (58.3%), candidiasis (15.1%), and conjunctivitis (6.5%). A total of 489 (93.7%) were notified by both criteria, eight infections were notified only by the national criteria (six cases of necrotizing enterocolitis and two cases of conjunctivitis), and 25 cases of clinical sepsis were reported by NHSN criteria only. The sensitivity, specificity, PPV, and NPV were 95.1%, 98.6%, 98.4%, and 95.7%, respectively, for all topographies, and were 91.8%, 100%, 100%, and 96.3% for the analysis of sepsis. Kappa analysis showed an agreement of 96.9%. CONCLUSION: there was a high rate of agreement between the criteria. The use of the national criteria facilitates the reporting of sepsis in newborns, and can help to improve the specificity and PPV. .

OBJETIVO: avaliar a aplicação dos critérios nacionais para notificação de infecções relacionadas à assistência à saúde (IRAS) em Unidade Neonatal e comparar com os critérios propostos pelo National Healthcare Safety Network (NHSN). MÉTODOS: estudo transversal realizado de 2009 a 2011. Forma incluídos os neonatos que apresentaram notificação de IRAS por pelo menos um dos critérios. Análise estatística incluiu cálculo de densidade de incidência de IRAS e distribuição por peso e por critério de notificação. Foi realizada análise da sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) para os critérios nacionais, considerando o NHSN como padrão-ouro e a concordância avaliada pelo Kappa. RESULTADOS: foram acompanhados 882 neonatos, e 330 apresentaram pelo menos uma infecção notificada por, no mínimo, um dos critérios. Foram notificadas 522 IRAS, independentemente do critério. Observou-se densidade de incidência de 27,28 infecções por 1.000 pacientes-dia, e as principais topografias foram sepse (58,3%), monilíase (15,1%) e conjuntivite (6,5%). Um total de 489 (93,7%) notificações foram por ambos os critérios; oito infecções foram notificadas apenas pelo critério nacional (duas conjuntivites e seis enterocolites necrosantes); e 25 casos de sepse clínica foram notificadas apenas pelo NHSN. A sensibilidade, especificidade, VPP e VPN foram de 95,1%, 98,6%, 98,4%, 95,7%, respectivamente, para todas as topografias, e para análise de sepse foram 91,8%, 100%, 100% e 96,3%. O Kappa revelou concordância de 96,9%. CONCLUSÃO: verificou-se uma elevada concordância entre os critérios. A utilização dos critérios nacionais facilita a n...

Evaluation of national health-care related infection criteria for epidemiological surveillance in neonatology.

OBJECTIVE: to assess the use of the Brazilian criteria for reporting of hospital-acquired infections (HAIs) in the neonatal unit and compare them with the criteria proposed by the National Healthcare Safety Network (NHSN). METHODS: this was a cross-sectional study conducted from 2009 to 2011. It included neonates with HAI reporting by at least one of the criteria. Statistical analysis included calculation of incidence density of HAIs, distribution by weight, and by reporting criterion. Analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the national criteria was performed considering the NHSN as the gold standard, with agreement assessed by kappa. RESULTS: a total of 882 newborns were followed, and 330 had at least one infection notified by at least one of the criteria. A total of 522 HAIs were reported, regardless of the criteria. An incidence density of 27.28 infections per 1,000 patient-days was observed, and the main topographies were sepsis (58.3%), candidiasis (15.1%), and conjunctivitis (6.5%). A total of 489 (93.7%) were notified by both criteria, eight infections were notified only by the national criteria (six cases of necrotizing enterocolitis and two cases of conjunctivitis), and 25 cases of clinical sepsis were reported by NHSN criteria only. The sensitivity, specificity, PPV, and NPV were 95.1%, 98.6%, 98.4%, and 95.7%, respectively, for all topographies, and were 91.8%, 100%, 100%, and 96.3% for the analysis of sepsis. Kappa analysis showed an agreement of 96.9%. CONCLUSION: there was a high rate of agreement between the criteria. The use of the national criteria facilitates the reporting of sepsis in newborns, and can help to improve the specificity and PPV.

Risk factors and lethality of laboratory-confirmed bloodstream infection caused by non-skin contaminant pathogens in neonates.

OBJECTIVE: To evaluate risk factors and lethality of late onset laboratory-confirmed bloodstream infection (LCBI) in a Brazilian neonatal unit for progressive care (NUPC). METHODS: This was a case-control study, performed from 2008 to 2012. Cases were defined as all newborns with late onset LCBI, excluding patients with isolated common skin contaminants. Controls were newborns who showed no evidence of late onset LCBI, matched by weight and time of permanence in the NUPC. Variables were obtained in the Hospital Infection Control Committee (HICC) database. Analysis was performed using the Statistical Package for the Social Sciences (SPSS). The chi-squared test was used, and statistical significance was defined as p < 0.05, followed by multivariate analysis. RESULTS: 50 patients with late onset LCBI were matched with 100 patients without late onset LCBI. In the group of patients with late onset LCBI, a significant higher proportion of patients who underwent surgical procedures (p = 0.001) and who used central venous catheter (CVC) (p = 0.012) and mechanical ventilation (p = 0.001) was identified. In multivariate analysis, previous surgery and the use of CVC remained significantly associated with infection (p = 0.006 and p = 0.047; OR: 4.47 and 8.99, respectively). Enterobacteriacea was identified in 14 cases, with three (21.4%) deaths, and Staphylococcus aureus was identified in 20 cases, with three (15%) deaths. CONCLUSIONS: Surgical procedures and CVC usage were significant risk factors for LCBI. Therefore, prevention practices for safe surgery and CVC insertion and manipulation are essential to reduce these infections, in addition to training and continuing education to surgical and assistance teams.

Fatores de risco e letalidade de infecção da corrente sanguínea laboratorialmente confirmada, causada por patógenos não contaminantes da pele em recém-nascidos / Risk factors and lethality of laboratory-confirmed bloodstream infection caused by non-skin contaminant pathogens in neonates

OBJECTIVE: To evaluate risk factors and lethality of late onset laboratory-confirmed bloodstream infection (ICSLC) in a Brazilian neonatal unit for progressive care (NUPC). Methods: This was a case-control study, performed from 2008 to 2012. Cases were defined as all newborns with late onset ICSLC, excluding patients with isolated common skin contaminants. Controls were newborns who showed no evidence of late onset ICSLC, matched by weight and time of permanence in the NUPC. Variables were obtained in the Hospital Infection Control Committee (HICC) database. Analysis was performed using the Statistical Package for the Social Sciences (SPSS). The chi-squared test was used, and statistical significance was defined as p < 0.05, followed by multivariate analysis. RESULTS: 50 patients with late onset ICSLC were matched with 100 patients without late onset ICSLC. In the group of patients with late onset ICSLC, a a significant higher proportion of patients who underwent surgical procedures (p = 0.001) and who used central venous catheter (CVC) (p = 0.012) and mechanical ventilation (p = 0.001) was identified. In multivariate analysis, previous surgery and the use of CVC remained significantly associated with infection (p = 0.006 and p = 0.047; OR: 4.47 and 8.99, respectively). Enterobacteriacea was identified in 14 cases, with three (21.4%) deaths, and Staphylococcus aureus was identified in 20 cases, with three (15%) deaths. CONCLUSIONS: Surgical procedures and CVC usage were significant risk factors for ICSLC. Therefore, prevention practices for safe surgery and CVC insertion and manipulation are essential to reduce these infections, in addition to training and continuing education to surgical and assistance teams.

OBJETIVO: Avaliar os fatores de risco e a letalidade da infecção da corrente sanguínea laboratorialmente confirmada (ICSLC) de início tardio em uma Unidade Neonatal de Cuidados Progressivos (UNCP) brasileira. MÉTODOS: Trata-se de um estudo caso-controle realizado de 2008 a 2012. Os casos foram definidos como todos os recém-nascidos com ICSLC de início tardio, excluindo pacientes isolados com contaminantes da pele comuns. Os controles foram recém-nascidos que não mostraram qualquer evidência de ICSLC de início tardio, sendo separados por peso e tempo de permanência na UNCP. As variáveis foram obtidas na base de dados da Comissão de Controle de Infecção Hospitalar (CCIH). A análise foi realizada utilizando o Pacote Estatístico para Ciências Sociais. O teste χ² foi utilizado e a relevância estatística foi definida como p < 0,05, seguida pela análise multivariada. RESULTADOS: No estudo, 50 pacientes com ICSLC de início tardio foram combinados com 100 pacientes sem ICSLC de início tardio. No grupo de pacientes com ICSLC de início tardio, identificamos uma proporção significativamente maior de pacientes que foram submetidos a procedimentos cirúrgicos (p = 0,001) e que usaram cateter venoso central (CVC) (p = 0,012) e ventilação mecânica (p = 0,001). Na análise multivariada, cirurgia prévia e uso de CVC permaneceram significativamente associados à infecção (p = 0,006 e p = 0,047; OU: 4,47 e 8,99, respectivamente). A Enterobacteriacea foi identificada em 14 casos, com três (21,4%) óbitos, e Staphylococcus aureus foi identificado em 20 casos, com três (15%) óbitos. CONCLUSÕES: Procedimentos cirúrgicos e uso de CVC constituíram fatores de risco significativos para ICSLC. Portanto, práticas de prevenção para cirurgia segura, inserção e manipulação de CVC são essenciais para reduzir essas infecções, além de treinamento e educação contínua às equipes cirúrgicas e de assistência.

[Teaching neonatal resuscitation at public hospitals in Brazilian state capitals]. / Ensino da reanimação neonatal em maternidades públicas das capitais brasileiras.

OBJECTIVE: To analyze the teaching of neonatal resuscitation offered by Brazilian public hospitals to undergraduate doctors and nurses, pediatric residents and neonatal fellows. METHODS: This cross-sectional multicenter study included 36 hospitals in 20 Brazilian State capitals during June/2003. Local coordinators collected data regarding what the institutions offer to undergraduate doctors and nurses, pediatric residents and neonatal fellows in terms of neonatal resuscitation training and practical activities in neonatal delivery room care. Descriptive analysis was performed. RESULTS: Twenty-three of the 36 institutions had undergraduate doctors: at 13 of them students had clinical activities in the delivery room, 12 offered neonatal resuscitation training, and at two of the 13 hospitals, interns cared for neonates in the delivery room without specific training. Twenty-three of the 36 hospitals had undergraduate nurses: at eight of them students had clinical activities in the delivery room and at seven of them nursing students cared for neonates in the delivery room without specific training. Twenty-seven of the 36 institutions had pediatric residence programs: at all of them, trained residents cared for neonates in the delivery room, but the training was heterogeneous: theoretical training (2-3 hours) at four institutions and theoretical and practical training (4-64 hours) at 23. Additionally, 15 had neonatal fellowship programs: at all of these, trained fellows cared for neonates in the delivery room, but the training was heterogeneous: theoretical training (2 hours) at one hospital and theoretical and practical training (3-68 hours) at 14. CONCLUSION: Formal neonatal resuscitation training is insufficient during medical and nursing graduation and heterogeneously offered to pediatric residents and neonatal fellows.

[Growth velocity of preterm appropriate for gestational age newborns]. / Velocidade de crescimento de recém-nascidos pré-termo adequados para a idade gestacional.

OBJECTIVE: To assess the growth velocity of preterm appropriate for gestational age newborns through growth curves. METHOD: A longitudinal and prospective study was carried out at two state-operated maternity hospitals in Belo Horizonte. Two hundred and sixty appropriate for gestational age preterm infants with birth weight < 2,500 g were evaluated weekly for body weight, head circumference and length. Growth velocity curves were constructed based on the derivative of the mathematical equation of the Count's model applied to somatic growth. Two analyses were made in the present study: absolute velocity, i.e., weight gain (g/day), and head circumference and length gains (cm/week); and relative velocity, i.e., weight gain(g/kg/day), and head circumference and length gains (cm/m/week). RESULTS: The curves of weight gain (g/day) were proportional to birth weight (the lowest and the highest birth weight neonates gained 15.9 and 30.1 g/day, respectively). The curves of weight gain (g/kg/day) were inversely proportional to birth weight with increasingly higher rates of weight gain between the first and fourth weeks (during the third week, the lowest and the highest weight newborns gained 18 and 11.5 g/kg/day, respectively). Later there was a drop, and by the 12th week the rates were similar for all groups (7.5 to 10.2 g/kg/day). The curves of relative velocity (cm/m/week) for head circumference and length were inversely proportional to birth weight; the lower weight preterm newborns had, the higher head circumference and length growing rates were, compared with those with more weight. CONCLUSION: The relative velocity is the best parameter to describe the growth dynamics of preterm infants, especially of those with lower birth weight. Lower birth weight infants gained more weight, head circumference and length.

Velocidade de crescimento de recém-nascidos pré-termo adequados para a idade gestacional / Growth velocity of preterm appropriate for gestational age newborns

OBJETIVO: Avaliar a velocidade de crescimento de recém-nascidos pré-termo adequados para a idade gestacional através da construção de curvas. METODOLOGIA: Estudo longitudinal realizado em duas maternidades públicas de Belo Horizonte. Avaliou-se peso, perímetro cefálico e comprimento, semanalmente, em 260 recém-nascidos pré-termo adequados para a idade gestacional, com peso ao nascer menor que 2.500 g. Construíram-se curvas de velocidade a partir da derivada da equação matemática do modelo de Count, aplicado ao crescimento somático. Utilizaram-se duas análises de velocidade: absoluta, ou seja, a taxa de ganho de peso (g/dia), perímetro cefálico e comprimento (cm/semana); e a relativa, ou seja, a taxa de ganho de peso (g/kg/dia), perímetro cefálico e comprimento (cm/m/semana). RESULTADOS: As curvas de ganho de peso (g/dia) foram proporcionais ao peso de nascimento (os de menor peso ganharam 15,9, e os de maior, 30,1 g/dia na terceira semana). As curvas de ganho de peso (g/kg/dia) foram inversamente proporcionais ao peso de nascimento, com aumento das taxas entre a primeira e quarta semana (os de menor peso alcançaram, na terceira semana, 18, e os de maior, 11,5 g/kg/dia). A partir de então, houve diminuição gradativa, e na 12a semana ocorreu uma confluência das curvas, traduzindo taxas de ganho de peso muito próximas (7,5 a 10,2 g/kg/dia). As curvas de velocidade relativa (cm/m/semana) de perímetro cefálico e comprimento foram inversamente proporcionais ao peso de nascimento; os recém-nascidos de menor peso apresentam maior taxa de incremento dessas variáveis. CONCLUSAO: As curvas de velocidade relativa descrevem melhor a dinâmica de crescimento dos recém-nascidos pré-termo, principalmente para os de menores pesos, que incorporam maior ganho de peso, perímetro cefálico e comprimento.

[Growth of preterm newborns during the first 12 weeks of life]. / Crescimento de recém-nascidos pré-termo nas primeiras 12 semanas de vida.

OBJECTIVE: To assess the somatic growth of preterm newborns through growth curves during the first 12 weeks of life. METHOD: A longitudinal and prospective study was carried out at two state operated maternity hospitals in the city of Belo Horizonte. Three hundred and forty preterm infants with birth weight less than 2,500 g were weekly evaluated in terms of body weight, head circumference, and height. Growth curves were constructed and adjusted to Count's model. RESULTS: Count's model clearly showed that the dynamics of loss, stabilization and gain of weight of all curves are graphically similar. The growth curve was characterized by weight loss during the 1st week (4-6 days) ranging from 5.9 to 9.7% (the greater the percentage, the lower the birth weight). For all curves, recovery of birth weight ranged from 16 to 19 days, showing that these newborns took longer to recover their birth weight. After the 3rd week, the newborns maintained increasingly rates of weight gain. Head circumference and height curves are little affected by weight loss. However, newborns with low birth weight presented loss of head circumference and height, probably due to their lower gestational ages. CONCLUSION: The dynamics of the preterm infants evaluated was similar to that of previous studies. The infants also presented growth deficit. However, it was also noted that the infants present a high potential to recover their growth.

Crescimento de recém-nascidos pré-termo nas primeiras 12 semanas de vida / Growth of preterm newborns during the first 12 weeks of life

OBJETIVO: Avaliar o crescimento somático de recém-nascidos pré-termo através de curvas de crescimento nas primeiras 12 semanas de vida. MÉTODO: Estudo longitudinal prospectivo realizado em duas maternidades públicas de Belo Horizonte. Peso, perímetro cefálico e comprimento foram avaliados semanalmente em 340 recém-nascidos pré-termo, com peso ao nascer menor que 2.500 g, e construíram-se curvas de crescimento ajustadas pelo modelo de Count para cada variável. RESULTADOS: O modelo de Count demonstra claramente a dinâmica de perda, estabilização e ganho de peso de todas as curvas, que é graficamente semelhante nas diferentes faixas de peso de nascimento. A perda de peso ocorreu dentro da primeira semana (4 a 6 dias), variando de 5,9 por cento a 9,7 por cento, sendo tanto mais acentuada quanto menor o peso de nascimento. O tempo para a recuperação do peso de nascimento variou de 16 a 19 dias, evidenciando um tempo maior de recuperação do peso de nascimento. Uma vez recuperado o peso de nascimento, a partir da terceira semana os recém-nascidos mantiveram taxas crescentes de ganho de peso. As curvas de crescimento do perímetro cefálico e comprimento são pouco afetadas pela perda de peso, mas os recém-nascidos de menores pesos apresentaram perda de perímetro cefálico e comprimento, em função das menores idades gestacionais. CONCLUSAO: Os achados deste estudo evidenciam que, no que diz respeito à dinâmica, os nossos recém-nascidos apresentaram crescimento semelhante ao de outros estudos e apresentam um déficit de crescimento, mas também mostram que eles têm um grande potencial para recuperar seu crescimento.