ABSTRACT
OBJECTIVE: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). METHOD: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. OUTCOME: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. RESULTS: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92-2.31)/1.60 (1.27-2.02) for SGA; 0.90 (0.55-1.47)/1.05 (0.55-1.99) for LGA; 1.65 (1.08-2.51)/1.58 (1.28-1.96) for stunting; and 1.48 (1.02-2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. CONCLUSION: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.
Subject(s)
Infant, Premature , Infant, Very Low Birth Weight , Female , Infant, Newborn , Humans , Retrospective Studies , Brazil/epidemiology , Hospital Mortality , Infant, Small for Gestational Age , Fetal Growth Retardation , Phenotype , Birth Weight , Gestational AgeABSTRACT
OBJECTIVE: To analyze unfavorable outcomes at hospital discharge of preterm infants born at Brazilian public university centers. METHODS: Prospective cohort of 2646 inborn infants with gestational age 23-33 weeks and birth weight 400-1499 g, without malformations, born at 20 centers in 2012-2013. Unfavorable outcome was defined as in-hospital death or survival at hospital discharge with ≥1 major morbidities: bronchopulmonary dysplasia (BPD) at 36 corrected weeks, intraventricular hemorrhage (IVH) grades 3-4, periventricular leukomalacia (PVL) or surgically treated retinopathy of prematurity (ROP). RESULTS: Among 2646 infants, 1390 (53%) either died or survived with major morbidities: 793 (30%) died; 497 (19%) had BPD; 358 (13%) had IVH 3-4 or PVL; and 84 (3%) had ROP. Logistic regression adjusted by center showed association of unfavorable outcome with: antenatal steroids (OR 0.70; 95%CI 0.55-0.88), C-section (0.72; 0.58-0.90), gestational age <30 (4.00; 3.16-5.07), being male (1.44; 1.19-1.75), small for gestational age (2.19; 1.72-2.78), 5th-min Apgar <7 (3.89; 2.88-5.26), temperature at NICU admission <36.0 °C (1.42; 1.15-1.76), respiratory distress syndrome (3.87; 2.99-5.01), proven late sepsis (1.33; 1.05-1.69), necrotizing enterocolitis (3.10; 2.09-4.60) and patent ductus arteriosus (1.69; 1.37-2.09). CONCLUSIONS: More than half of the VLBW infants born at public university level 3 Brazilian hospitals either die or survive with major morbidities.
Subject(s)
Academic Medical Centers/statistics & numerical data , Infant Mortality , Infant, Very Low Birth Weight , Brazil , Female , Humans , Infant , Infant, Newborn , Male , Prospective StudiesABSTRACT
Em recém-nascidos que näo podem receber dieta enteral por dias ou semanas, o uso p[arenteral de lipídios tem sido considerado de grande importância parase obter uma nutriçq2o adequada. As soluçöes lipídicas garantem a oferta de acidos glaxos essenciais, apresentam alto valor energético em volume pequeno com baixa osmolaridade, além de reduzirem a produçäo de CO 2 associada ao excesso de glicose. O uso rotineiro ainda gera controvérsias tais como: o momento do início,o tipo de soluçäo mais adequada, o modo de administraçäo e sua influência em condiçöes clínicas relacionadas ao período neonatal (insuficiencia respiratória, hiperbilirrubinemia, displasia broncopulmonar, disfunçäo imunológica e formaçäo de radicais livres). Este artigo apresenta uma revisäo da literatura, uma análise crítica das controvérsias do uso parenteral de lipídios no recém-nascido e, a partir disto, recomendaçöes para seu uso no período neonatal.(au)
Subject(s)
Humans , Infant, Newborn , Fat Emulsions, Intravenous , Lipids/deficiency , Lipids/adverse effects , Parenteral NutritionABSTRACT
Nesta revisäo atualizada, os autores ressaltam a importância da avaliaçäo nutricional do recém-nascido pré-termo, com a finalidade de prevenir as seqüelas de uma nutriçäo perinatal inadequada. Basicamente a avaliaçäo do "status" nutricional do recém-nascido é realizada por parâmetros antropométricos e bioquímicos. Dentre os parâmetros antropométricos, destacam-se: o peso, o comprimento, o perímetro cefálico, o perímetrro branquial, o índice ponderal, as dobras cutâneas e suas respectivas relaçöes, como, por exemplo, entre o perímetro branquial e cefálico. Na avaliaçäo bioquímica, salientam-se as que utilizam a mensuraçäo do pool protéico: pré-albumina, proteína ligada ao retinol e tranferrina. Finalizam enfatizando que as relaçöes antropométricas säo métodos rápidos, simples e de baixo custo para se realizar a correta avaliaçäo nutricional longitudinal do recém-nescido pré-termo.(au)
