[Anthropometric evaluation of pediatric patients with non-progressive chronic encephalopathy according to different methods of classification]. / Avaliação antropométrica de pacientes pediátricos com encefalopatia crônica não progressiva segundo diferentes métodos de classificação.

OBJECTIVE: To perform anthropometric assessment of patients with quadriplegic, chronic non-progressive encephalopathy, comparing two distinct references of nutritional classification, and to compare the estimated height to the length measured by stadiometer. METHOD: Cross-sectional study including 0-3-year children with quadriplegic, chronic non-progressive encephalopathy in secondary public hospital. Length, weight, arm circumference, triceps skinfold and knee height were measured. The arm muscle circumference and estimated height were calculated. The following relations were evaluated: weight-for-age, length-for-age and weight-for-length, using as reference the charts of the the World Health Organization (WHO) and those proposed by Krick et al. RESULTS: Fourteen children with a mean age of 21 months were evaluated. Assessment of anthropometric indicators showed significant difference between the two classification methods to assess nutritional indicators length/age (p=0.014), weight/age (p=0.014) and weight/length (p=0.001). There was significant correlation between measured length and estimated height (r=0.796, p=0.001). Evaluation of arm circumference and triceps skinfold showed that most patients presented some degree of malnutrition. According to arm muscle circumference, most were eutrophic. CONCLUSIONS: Specific curves for children with chronic non-progressive encephalopathy appear to underestimate malnutrition when one takes into account indicators involving weight. Curves developed for healthy children can be a good option for clinical practice and weight-for-length indicator and body composition measurements should be considered as complementary tools.

Avaliação antropométrica de pacientes pediátricos com encefalopatia crônica não progressiva segundo diferentes métodos de classificação / Anthropometric evaluation of pediatric patients with nonprogressive chronic encephalopathy according to different methods of classification

Objetivo: Realizar a avaliação antropométrica de pacientes com encefalopatia crônica não progressiva quadriplégica, usando referências distintas de classificação do estado nutricional, e comparar a altura estimada com o comprimento mensurado por antropômetro. Métodos: Estudo transversal descritivo, incluindo crianças com encefalopatia crônica não progressiva quadriplégica de 0-3 anos em hospital público secundário. Foram aferido scomprimento, peso, circunferência do braço, prega cutânea tricipital e altura do joelho. Foram calculadas a circunferência muscular do braço e a estimativa da altura. Foram avaliadas as relações peso/idade, comprimento/idade e peso/comprimento, utilizando como referência os gráficos da Organização Mundial de Saúde e os propostos por Krick et al. Resultados: Foram avaliadas 14 crianças com idade média de 21 meses. A avaliação dos indicadores antropométricos mostrou diferença significativa entre os dois métodos de classificação nutricional ao avaliar os indicadores comprimento/idade (p=0,014), peso/idade (p=0,014) e peso/comprimento (p=0,001). Houve correlação significativa entre comprimento mensurado e estatura estimada (r=0,796; p=0,001). A avaliação da circunferência do braço e prega cutânea tricipital mostrou que a maioria dos pacientes apresentava algum grau de desnutrição, mas, de acordo com a medida da circunferência muscular do braço, a maioria estava eutrófica. Conclusões: Curvas específicas para crianças com encefalopatia parecem subestimar a desnutrição, quando se leva em consideração indicadores que envolvem peso. Curvas elaboradas para crianças hígidas podem ser boa opção para prática...

Objective: To perform anthropometric assessment of patients with quadriplegic, chronic non-progressive encephalopathy, comparing two distinct references of nutritional classification and to compare the estimated height to the length measured by stadiometer. Method: Cross-sectional study including 0-3-year children with quadriplegic chronic non-progressive encephalopathy in secondary public hospital. Length, weight, arm circumference, triceps skinfold and knee height were measured. The arm muscle circumference and estimated height were calculated. The following relations were evaluated: weight-for-age, length-for-age and weight-for-length, using as reference the charts of the World Health Organization (WHO) and those proposed by Krick et al. Results: Fourteen children with a mean age of 21 months were evaluated. Assessment of anthropometric indicators showed significant difference between the two classification methods to assess nutritional indicators length/age (p=0.014), weight/age (p=0.014) and weight/length (p=0.001). There was significant correlation between measured length and estimated height (r=0.796, p=0.001). Evaluation of arm circumference and triceps skinfold showed that most patients presented some degree of malnutrition. According to arm muscle circumference, most were eutrophic. Conclusions: Specific curves for children with chronic non-progressive encephalopathy appear to underestimate malnutrition when one takes into account indicators involving weight. Curves developed for healthy children can be a good option for clinical practice and weight-for-length indicator and body composition measurements should be considered as complementary tools...

Placenta: a possible predictor of vitamin A deficiency.

The objective of the present study is to assess the association between vitamin A deficiency (VAD) evaluated by serum retinol concentration from the mother and umbilical cord and placental concentration of retinol and carotenoids to propose placental values representative of deficiency. Two hundred and sixty-two puerperal women and their newborns were assessed. Concentration of serum and placental retinol and carotenoids was determined by the spectrophotometric method. Receiver operating characteristic (ROC) curve analysis was performed according to two cut-off points (0.70 and 1.05 mumol/l) to represent deficiency in the placental concentration. No difference between averages of placental retinol and carotenoids was observed in the puerperal women regardless of the cut-off point used to define VAD. In relation to the newborns, a decrease (P = 0.012) in placental retinol averages in individuals with VAD was observed when the 1.05 mumol/l cut-off point was adopted. In respect to the placental carotenoid averages, a decrease is observed for both the cut-off points (P = 0.013 and 0.019 for 1.05 and 0.7 mumol/l, respectively). The ROC curve results point to the value of 0.80 mumol/l as representing deficiency with greater values found for sensitivity (66.7 %), specificity (41.7 %) and accuracy (65 %) when the 0.70 mumol/l cut-off point was adopted. The results of the present study show an association between the placental concentration of retinol and carotenoids with clinical VAD, suggesting the need for further studies on more severe cases of deficiency.

Influência de características maternas e história de abortamento no resultado obstétrico / Influence of maternal characteristics and abortion history in pregnancy outcome

The present study aimed to describe the history of abortion in adult women,the maternal characteristics associated and its relation with pregnancyoutcomes. A total of 225 adult pregnants women and their newborn were analyzed in a Public Maternity Hospital in Rio de Janeiro between 2005-2006. Data assessed included abortion history, gestational intercurrences, socoeconomic and demographic information, maternal and newborn anthropometry, present gestational and prenatal characteristics. Abortion history, considering the previous pregnancy, was reported by 27.4% of the women, from which 39.4% were spontaneous abortions (miscarriages) and 51.5% were induced abortions. The most frequent intercurrences were anemia (28.4%), hypertensive disorders of pregnancy (6.2%), urinary tract infection (2.2%) and gestational diabetes (1.8%) Night blindness occurred in 18.7% of the pregnant women. No associations were found between abortion history and maternal level of education (p=0,611); marital status (p= 0,603); skin colour (p= 0,800); prepregnancy BMI (p=0,754); adequacy of the gestational weight gain (p= 0,394) and birth weight (p= 0,480). Equal averages of maternal age (p=0,122), inter-gestational interval (p= 0,08), percapita family income (p= 0,178) and hemoglobin levels during pregnancy(p > 0,05) were found among women with and without abortion history.There was a higher risk of night blindness among women with previousabortion history (OR=2.6; IC 95% = 1.15-5.89). The results suggest thatabortion history may be investigated at the pregnant nutritional assessment,because it is associated with night blindness and gestational intercurrences,recognized as an indicator of risk in pregnancy.

Este estudio tuvo por objetivo describir el histórico de abortos, asociarlo a características maternas y compararlo también al resultado obstétrico. Se analizaron para esto 225 gestantesadultas y sus recién nacidos en la Maternidad Pública de Rio de Janeiro,Brasil, entre 2005-2006. Los datos colectados fueron: histórico de abortamiento, informaciones sociodemográfi cas,antropométricas maternas y las características de la actual gestación y su prenatal. Solo 27,4%de las mujeres relataron sobre abortos, siendo que 39.4% fueron casos de aborto espontáneoy 51,5% provocado. Las complicaciones más frecuentes de la gestación habían sido anemia (28.4%), síndrome hipertensiva del embarazo (6.2%), diabetes (1.8%) e infección urinaria(2.2%). La ceguera nocturna acometió 18.7% de las gestantes. No se encontró relación entre la historia de abortamientos y la instrucciónmaterna (p=0,611), estado marital (p= 0.603), saneamiento domiciliar (p= 0.460), color de la piel (p= 0.800), IMC pregestacional (p=0,754), adecuación del aumento de peso durante lagestación (p= 0.394) y peso al nacer (p= 0.480). Se comprobaron promedios semejantes de edad materna (p=0,122), intervalo inter gestacional(p= 0.08), renta familiar per capita (p=0.178) y niveles de hemoglobina durante la gestación (p> 0,05), entre mujeres con y sin historia de aborto.Se encontró mayor riesgo de ceguera nocturna gestacional en mujeres con historia de aborto (OR=2,6; IC 95% = 1.15-5.89). Los resultados sugieren que el histórico de abortamiento debe ser evaluada durante el prenatal, puesto que se asocia a ceguera nocturna gestacional que es considerada un marcador de gestación de alto riesgo.

O presente estudo objetivou descrever a história de abortamento em mulheres adultas, bem como a sua associação com características maternase resultado obstétrico. No estudo, analisou-se 225 gestantes adultas e seus recém-nascidos atendidos em maternidade pública do municípiodo Rio de Janeiro entre 2005-2006. Os dados coletados foram história de abortamento; informações sociodemográficas; antropométricasmaternas e dos conceptos; características da gestação atual e do pré-natal. A história de abortamento foi referida por 27,4% das mulheres,sendo 39,4% dos casos de abortamentoespontâneo e 51,5% provocado, em relação à gestação anterior. As intercorrências gestacionaismais frequentes foram anemia (28,4%),síndromes hipertensivas da gravidez (6,2%), infecção do trato urinário (2,2%) e diabetes gestacional (1,8%). A cegueira noturna acometeu18,7% das gestantes. Não foi encontrada associação entre a história de abortamento e instrução materna (p=0,611); estado marital(p= 0,603); saneamento da moradia (p= 0,460); cor da pele (p= 0,800); IMC pré-gestacional (p=0,754); adequação do ganho de pesogestacional (p= 0,394) e do peso ao nascer (p= 0,480). Verifi cou-se médias semelhantes de idade mate rna (p=0,122), intervalointergestacional (p= 0,08), renda familiar per capita (p= 0,178) e níveis de hemoglobina ao longo da gestação (p > 0,05), dentre as mulherescom e sem história de abortamento. Verificou-se maior risco de cegueira noturna gestacionaldentre as mulheres com história de abortamento (OR=2,6; IC 95% = 1,15-5,89). Os resultadossugerem que a história de abortamento deve ser investigada na avaliação nutricional gestacional, uma vez que associa-se com a cegueira noturna, apontada como marcador de gestação de alto risco.

Níveis de retinol e carotenóides séricos e intercorrências gestacionais em puérperas / Vitamin A serum and gestational intercurrences in postpartum women

OBJETIVO: Investigar a associação entre intercorrências gestacionais e níveis de retinol e carotenóides em puérperas atendidas em maternidade pública do Rio de Janeiro. MÉTODOS: A amostra foi constituída por 262 puérperas atendidas na Maternidade Escola da Universidade Federal do Rio de Janeiro. O estado nutricional antropométrico foi avaliado pelo do índice de massa corporal pré-gestacional e pelo ganho ponderal gestacional, e foram coletadas informações sobre intercorrências gestacionais nos registros médicos dos prontuários. Foram adotados os pontos de corte 1,05µmol/L e 80µg/dL para definir inadequação dos níveis de retinol e carotenóides séricos, respectivamente. RESULTADOS: Quarenta e dois vírgula sete por cento da amostra foi acometida por intercorrências gestacionais, destacando-se anemia (29,0 por cento), inadequação dos níveis de retinol (24,4 por cento), e síndromes hipertensivas da gravidez (5,7 por cento). Observou-se maior proporção de obesidade pré-gestacional entre mulheres com síndromes hipertensivas da gravidez, em comparação com as não portadoras de tal intercorrência. Verificou-se menor nível médio de carotenóides séricos entre as que desenvolveram síndromes hipertensivas da gravidez e 91,7 por cento destas apresentaram inadequação destes nutrientes. CONCLUSÃO: Os resultados revelam acometimento importante de mulheres por intercorrências gestacionais e por deficiências nutricionais. Além disso, apontam a obesidade pré-gestacional como um possível fator de risco para o desenvolvimento de síndromes hipertensivas da gravidez e sugerem uma associação entre baixos níveis de carotenóides e tal intercorrência.

OBJECTIVE: The objective was to investigate an association between pregnancy complications and serum retinol and carotenoid levels in puerpere seen at a public maternity of Rio de Janeiro. METHODS: The sample consisted of 262 puerpere seen at the Maternity School of the Federal University of Rio de Janeiro. Nutritional status was assessed by determining the body mass index before pregnancy and by the weight gained during pregnancy. Information on pregnancy complications was collected from the medical records. Low levels of serum retinol and carotenoids were defined as those below the cut-off points of 1.05mmol/L and 80mg/dL respectively. RESULTS: Almost half the sample (42.7 percent) had pregnancy complications which included anemia (29.0 percent), low retinol levels (24.4 percent) and gestational hypertension (5.7 percent). Women with gestational hypertension were more likely to be obese before pregnancy when compared with those without gestational hypertension. The mean serum levels of carotenoids were also found to be lower among women who developed gestational hypertension and 91.7 percent of these women had inadequate levels of these nutrients. CONCLUSION: The results show that many women suffer pregnancy complications and have nutritional deficiencies. Furthermore, they indicate that pregestational obesity may be a risk factor for the development of gestational hypertension and suggest an association between low serum carotenoid levels and gestational hypertension.

Vitamina A e broncodisplaisa pulmonar / Vitamin and bronchopulmonary dysplasia

A broncodisplasia pulmonar tem evolução crônica que pode ser desencadeada por diversos fatores, como infecção, barotrauma, maturação pulmonar extra-uterina, espécies reativas de oxigênio e deficiência nutricional. A hipovitaminose A é a carência nutricional que mais se associa com tal enfermidade devido ao seu papel na diferenciação celular e reparação de lesão pulmonar. A baixa reserva hepática de vitamina A em recém-nascidos prematuros e de muito baixo peso, aliada a sua imaturidade fisiológica, os torna mais susceptíveis a hipovitaminose A e ao desenvolvimento de broncodisplasia pulmonar. Com o objetivo de investigar as evidências sobre o papel da suplementação de vitamina A na prevenção ou auxílio no tratamento da broncodisplasia pulmonar, realizou-se um levantamento bibliográfico em bases de dados do Medline e Lilacs nos últimos vinte anos (1984-2004). Os resultados n~eo definem um padrão no tratamento da broncodisplasia pulmonar, tanto na via de administração quanto na dosagem da vitamina A. Restam dúvidas quanto à dose administrada, tendo em vista os riscos decorrentes de uma possível toxidade por doses excessivas de vitamina A.

Papel da vitamina A na prevencão do estresse oxidativo em recém-nascidos / Vitamin A role preventing oxidative stress in newborns

A vitamina A é um micronutriente essencial ao ser humano, sobretudo nos momentos de intenso crescimento e desenvolvimento, como a gestacão e a infância. Além da atuacão dessa vitamina em diversos processos metabólicos, atualmente têm-se destacado o efeito antioxidante desempenhado principalmente pelas formas pró-vitamínicas (carotenóides). Essa funcão antioxidante da vitamina A é de grande importância no nascimento, período no qual o recém-nascido produz grande quantidade de radicais livres em resposta à exposicão a elevadas concentracões de oxigênio. Devido às baixas reservas dessa vitamina, cuja transferência trans-placentária ocorre principalmente no terceiro trimestre de gestacão e devido à imaturidade dos demais sistemas antioxidantes, os recém-nascidos prematuros são os mais vulneráveis aos efeitos do estresse decorrente do nascimento. No entanto, ainda existem controvérsias quanto aos benefícios da suplementacão da vitamina A no período gestacional, com o objetivo de prevenir a deficiência de vitamina A e suas conseqüências. O presente trabalho tem por objetivo reunir artigos referentes ao tema e publicados em periódicos indexados nas bases de dados MEDLINE e LILACS, no período de 1990 e 2003.

Association between gestational night blindness and serum retinol in mother/newborn pairs in the city of Rio de Janeiro, Brazil.

OBJECTIVE: Gestational night blindness (XN) is associated with increased risk of reproductive morbidity and mortality. This study investigated the prevalence of gestational XN among postpartum women treated in a public maternity hospital in the city of Rio de Janeiro, Brazil and evaluated its association with maternal and neonatal (cord blood) serum retinol concentrations. METHODS: XN was evaluated retrospectively, using an interview according to guidelines of the World Health Organization, in 222 postpartum women (< or = 6 h after delivery) after singleton births who had low obstetric risk. Serum retinol concentrations were measured according to the modified Bessey method, with a cutoff point lower than 1.05 micromol/L for inadequate serum retinol concentration. RESULTS: Prevalence of gestational XN was 18%, and inadequate maternal and cord blood serum retinol concentrations were found in 24.4% and 45.5% of samples, respectively. The results associated gestational XN with inadequate maternal serum retinol concentration (P = 0.000), and an association was observed between maternal and neonatal serum retinol concentrations (P = 0.000). A poor association was observed between maternal XN and serum levels of retinol in newborn children (P = 0.06). CONCLUSIONS: The results suggest that prevalence of gestational XN and inadequate serum retinol concentration among postpartum women and newborns is a concern, calling attention to the need for studies in other parts of Brazil. In addition, the risk of inadequate serum retinol in newborns was significantly higher among infants of postpartum women with serum retinol levels below 1.05 micromol/L. Gestational XN was associated with inadequate levels of maternal serum retinol, and the results suggest a poor relation between maternal XN and vitamin A nutritional status of newborns.

Intraplacental retinol distribution.

With the objective of evaluating intraplacental vitamin A distribution, 234 placental samples were collected, corresponding to six samples from each of the placentas analyzed: two from the lateral maternal portion, one from the central maternal portion, two from the lateral fetal portion, and one from the central fetal portion. Samples were obtained from 39 adult puerperal mothers with low-risk pregnancies, without vitamin A deficiency or night blindness. Retinol content determination was achieved through spectrophotometry. Retinol values obtained for each region were correlated with the most probable value for each placenta (P < 0.001). Despite differences in retinol content between samples, statistical data analysis showed that intra-tissue variation had no influence on the conversion of data into information. Consequently, any portion of the placenta may be used for retinol level determination purposes, due to the correlation between all portions and the most probable value. The findings of the present study represent an advance for surveys intending to incorporate the collection and dosage of placental vitamin A levels into their analyses, thus increasing the arsenal of pre-pathological or subclinical vitamin A deficiency markers, which can allow for earlier intervention on the maternal-infant group.

Gestational nightblindness among women attending a public maternity hospital in Rio de Janeiro, Brazil.

This study evaluated the prevalence of gestational nightblindness among postpartum women seen at the University Maternal Hospital of the Federal University in Rio de Janeiro, Brazil and the association of this symptom with a biochemical indicator (serum retinol levels) and sociodemographic, anthropometric and antenatal care variables. In total, 262 postpartum women, who did not receive vitamin A supplementation during pregnancy, were interviewed. Gestational nightblindness was diagnosed through the standardized interview as proposed by WHO. Serum retinol levels were evaluated by spectrophotometry. Gestational nightblindness relating to low levels of serum retinol (<1.05 micromol/L, p = 0.000) was diagnosed in 17.9% of subjects interviewed. Less than five antenatal care appointments (odds ratio [OR] = 2.179; confidence interval [CI] 95% = 1.078 - 4.402) and a history of one or more miscarriage(s) (OR = 2.306; CI 95% = 1.185 - 4.491) were predictors for gestational nightblindness. These findings justify the need for nutritional counselling, aimed at improving the vitamin A nutritional status, especially among pregnant women with a history of previous miscarriages and poor antenatal care.