Effect of postnatal malnutrition on hyperoxia-induced newborn lung development.

Several factors are associated with bronchopulmonary dysplasia. Among them, hyperoxia and lung immaturity are considered to be fundamental; however, the effect of malnutrition is unknown. Our objective was to evaluate the effects of 7 days of postnatal malnutrition and hyperoxia on lung weight, volume, water content, and pulmonary morphometry of premature rabbits. After c-section, 28-day-old New Zealand white rabbits were randomized into four groups: control diet and room air (CA, N = 17), control diet and > or = 95% O2 (CH, N = 17), malnutrition and room air (MA, N = 18), and malnutrition and > or = 95% O2 (MH, N = 18). Malnutrition was defined as a 30% reduction of all the nutrients provided in the control diet. Treatments were maintained for 7 days, after which histological and morphometric analyses were conducted. Lung slices were stained with hematoxylin-eosin, modified orcein-resorcin or picrosirius. The results of morphometric analysis indicated that postnatal malnutrition decreased lung weight (CA: 0.83 +/- 0.19; CH: 0.96 +/- 0.28; MA: 0.65 +/- 0.17; MH: 0.79 +/- 0.22 g) and water content, as well as the number of alveoli (CA: 12.43 +/- 3.07; CH: 8.85 +/- 1.46; MA: 7.33 +/- 0.88; MH: 6.36 +/- 1.53 x 10-3/mm) and elastic and collagen fibers. Hyperoxia reduced the number of alveoli and increased septal thickening and the mean linear intercept. The reduction of alveolar number, collagen and elastic fibers was intensified when malnutrition and hyperoxia were associated. These data suggest that dietary restriction enhances the magnitude of hyperoxia-induced alveolar growth arrest and lung parenchymal remodeling. It is interesting to consider the important influence of postnatal nutrition upon lung development and bronchopulmonary dysplasia.

Effect of postnatal malnutrition on hyperoxia-induced newborn lung development

Several factors are associated with bronchopulmonary dysplasia. Among them, hyperoxia and lung immaturity are considered to be fundamental; however, the effect of malnutrition is unknown. Our objective was to evaluate the effects of 7 days of postnatal malnutrition and hyperoxia on lung weight, volume, water content, and pulmonary morphometry of premature rabbits. After csection, 28-day-old New Zealand white rabbits were randomized into four groups: control diet and room air (CA, N = 17), control diet and ¡Ý95% O2 (CH, N = 17), malnutrition and room air (MA, N = 18), and malnutrition and ¡Ý95% O2 (MH, N = 18). Malnutrition was defined as a 30% reduction of all the nutrients provided in the control diet. Treatments were maintained for 7 days, after which histological and morphometric analyses were conducted. Lung slices were stained with hematoxylin-eosin, modified orcein-resorcin or picrosirius. The results of morphometric analysis indicated that postnatal malnutrition decreased lung weight (CA: 0.83 ¡À 0.19; CH: 0.96 ¡À 0.28; MA: 0.65 ¡À 0.17; MH: 0.79 ¡À 0.22 g) and water content, as well as the number of alveoli (CA: 12.43 ¡À 3.07; CH: 8.85 ¡À 1.46; MA: 7.33 ¡À 0.88; MH: 6.36 ¡À 1.53 x 10-3/mm) and elastic and collagen fibers. Hyperoxia reduced the number of alveoli and increased septal thickening and the mean linear intercept. The reduction of alveolar number, collagen and elastic fibers was intensified when malnutrition and hyperoxia were associated. These data suggest that dietary restriction enhances the magnitude of hyperoxia-induced alveolar growth arrest and lung parenchymal remodeling. It is interesting to consider the important influence of postnatal nutrition upon lung development and ronchopulmonary dysplasia.

Non-nutritive sucking scoring system for preterm newborns.

AIM: To validate a non-nutritive sucking (NNS) scoring system for oral feeding in preterm newborns (PTNB). METHODS: A cohort study was carried out in two phases. In phase one of the study, 22 mastered speech-language pathologists received the protocol and procedure for a NNS scoring system to evaluate the content and presentation of the form and to define the grading scale. In phase two, six speech-language pathologists evaluated 51 PTNBs weekly, using the defined scoring system. SETTING: This study was carried out in the Nursery Annex to the Maternity at the Intensive and Neonatal Pediatrics Service, Instituto da Criança, Hospital das Clinicas, School of Medicine, University of São Paulo (FMUSP) during the period from May 2004 to May 2006. PARTICIPANTS: A total of 28 speech-language pathologist experts and 51 PTNBs. RESULTS: In the first phase of the study, 22 speech-language pathologists selected the criteria, utilized in the NNS evaluation with 80% agreement. In the second phase of the study, the NNS evaluation was carried out on 51 PTNB, and a scoring system of 50 points was proposed, which corresponds to the smallest number of false positive and negative results regarding oral feeding ability. CONCLUSION: An NNS evaluation system was validated that was able to indicate when oral feeding could safely begin in PTNBs with a high level of agreement among the speech-language pathologists who have participated.

Neonatal arterial hypertension in nephro-urological malformations in a tertiary care hospital.

An increase in the survival of neonates with antenatal diagnosis of malformations was achieved by the recent technical advances in neonatal intensive care units. The aim of this article is to describe the experience with neonatal arterial hypertension, in newborns with nephro-urological malformations, in a tertiary care referral Nursery, in a period of 4 years. Newborn medical records from the Nursery Annex to the Maternity of Hospital das Clinicas, School of Medicine, University of Sao Paulo, with the diagnosis of nephro-urological malformations and systemic arterial hypertension (SAH) at hospital discharge, in a period from January 1999 to January 2003, were retrospectively analysed. Among 10.278 live newborns in the studied period, 15 (0.15%) newborns were compatible with our inclusion criteria. Of these 15 newborns, 12 (80%) were male and three were premature (20%). In relation to aetiology, 13 (87%) showed urological malformations, 1 (6%) chronic renal insufficiency secondary to kidney dysplasia and one (6%) autosomal recessive polycystic kidney disease. SAH control was achieved with monotherapy in eight patients (53%), five patients (33%) needed an association of two drugs (calcium-channel blocker and angiotensin converting enzyme (ACE) inhibitor), one child used three types of antihypertensive drugs (calcium-channel blocker, ACE inhibitor and hydrochlorothiazide) for pressoric control and one child's blood pressure (BP) was controlled exclusively by peritoneal dialysis. The incidence of nephro-urological malformations in our service during the studied period was 0.89%. SAH incidence among these newborns was 19%. Our data reinforce previous studies pointing to the necessity to consider children with nephro-urological malformations as a risk group for SAH, who should have the BP evaluated since the neonatal period.

Role of plasma and urinary calcium and phosphorus measurements in early detection of phosphorus deficiency in very low birthweight infants.

AIM: To analyse the role of serum and urinary calcium and phosphorus levels in early detection of mineral deficiency in very low birthweight (VLBW) infants born appropriate (AGA) and small for gestational age (SGA). METHODS: 64 VLBW infants were included in a cohort study and divided into two groups: AGA (n = 30) and SGA infants (n = 34). Then, they were divided according to the presence of radiological signs of metabolic bone disease (MBD): with MBD (n = 21) and without MBD (n = 34). Blood samples and 6 h urine collections were obtained for calcium, phosphorus, alkaline phosphatase activity and creatinine determinations between 3 and 5 wk of life. RESULTS: There were no biochemical differences between AGA and SGA. Higher values of urinary calcium (MBD = 31.9 +/- 20.2, without MBD = 19.8 +/- 15.4; p = 0.017), calciuria (MBD = 2.3 +/- 0.3, without MBD = 1.4 +/- 0.8; p = 0.037) and alkaline phosphatase activity (MBD = 369 +/- 114, without MBD = 310 +/- 93; p = 0.04) were found in infants who developed MBD. Both groups showed high tubular phosphorus reabsorption indicating mineral deficiency. CONCLUSION: Serum calcium and phosphorus levels are not good markers in early detection of mineral deficiency. However, the monitoring of calcium urinary levels may be helpful in early detection of mineral deficiency.

[Critical analysis of pathophysiological, diagnostic and therapeutic aspects of metabolic bone disease in very low birth weight infants] / Análise crítica dos aspectos fisiopatológicos, diagnósticos e terapêuticos da doença metabólica óssea em recém-nascidos de muito baixo peso.

OBJECTIVE: To perform a systematic review on the pathophysiology, diagnosis and approach of metabolic bone disease in very low birth weight infants. SOURCES: Literature review of articles published in Medline within the last twenty years. SUMMARY OF THE FINDINGS: The higher survival of very low birth weight infants was concurrent with the increased incidence of metabolic bone disease. The process of bone mineral acquisition suffers some alterations during the neonatal period, including low bone mineral content at birth, insufficient mineral supply in the neonatal period, and regulatory disorders, which may compromise growth and development on the long run. The diagnosis is based on the association of risk factors, and biochemical and radiological alterations. The early intervention in the neonatal period prevents the development of severe metabolic bone disease, reducing complications during the first year of life. CONCLUSIONS: The early diagnosis of metabolic bone disease allows for early intervention, thus preventing complications that may originate from the alterations in bone mineral acquisition.

Human milk mineral intake and serum concentrations of calcium and phosphorus in newborn term infants: influence of intrauterine growth restriction.

UNLABELLED: A prospective case-control study was performed to test the hypothesis that the milk Ca and P contents of term, small-for-gestational-age (SGA) newborns' mothers differs from that of term, adequate-for-gestational-age (AGA) newborns' mothers. We studied 71 pairs of mothers and newborns, divided into two groups: I (control): 41 pairs of mothers and term AGA newborns and II (study): 30 pairs of mothers and term SGA newborns. This latter group was subdivided according to type (symmetric: birthweight, length and head circumference <10th percentile; asymmetric: birthweight <10th percentile) and severity (P3 - P3 -

Urinary tract infection in full-term newborn infants: risk factor analysis.

OBJECTIVE: To analyze the correlation of risk factors to the occurrence of urinary tract infection in full-term newborn infants. PATIENTS AND METHODS: Retrospective study (1997) including full-term infants having a positive urine culture by bag specimen. Urine collection was based on: fever, weight loss > 10% of birth weight, nonspecific symptoms (feeding intolerance, failure to thrive, hypoactivity, debilitate suction, irritability), or renal and urinary tract malformations. In these cases, another urine culture by suprapubic bladder aspiration was collected to confirm the diagnosis. To compare and validate the risk factors in each group, the selected cases were divided into two groups: Group I - positive urine culture by bag specimen collection and negative urine culture by suprapubic aspiration, and Group II - positive urine culture by bag specimen collection and positive urine culture by suprapubic aspiration. RESULTS: Sixty one infants were studied, Group I, n = 42 (68.9%) and Group II, n = 19 (31.1%). The selected risk factors (associated infectious diseases, use of broad-spectrum antibiotics, renal and urinary tract malformations, mechanical ventilation, parenteral nutrition and intravascular catheter) were more frequent in Group II (p<0.05). Through relative risk analysis, risk factors were, in decreasing importance: parenteral nutrition, intravascular catheter, associated infectious diseases, use of broad-spectrum antibiotics, mechanical ventilation, and renal and urinary tract malformations. CONCLUSION: The results showed that parenteral nutrition, intravascular catheter, and associated infectious diseases contributed to increase the frequency of neonatal urinary tract infection, and in the presence of more than one risk factor, the occurrence of urinary tract infection rose up to 11 times.

Is glycosuria a reliable indicator of adequacy of glucose infusion rate in preterm infants?

CONTEXT: Adequacy of glucose infusion may be monitored via the glycosuria levels, as there is a relationship between glycemia and glycosuria regulated by the renal glucose threshold. In the neonatal period, however, this relationship is not so clear. OBJECTIVE: To evaluate the occurrence of glycosuria in preferm infants submitted to glucose infusion and to verify the relationship between glycosuria and blood glucose level. DESIGN: Accuracy study. SETTING: Neonatal intensive care unit of General Maternity Hospital. PATIENTS: 40 Preterm newborns receiving glucose infusion. PROCEDURES: 511 concomitant determinations of glycemia and glycosuria were performed. These 511 pairs were divided into stable and unstable, according to the clinical status of the newborn at the time of data collection, and they were studied in relation to the gestational age, birth weight and glucose infusion rate. RESULTS: The results revealed a greater frequency of glycosuria in gestational age < or = 30 weeks, birth weight < 1500 g and glucose infusion rate > 6 mg/kg/min. Eight (25.8%) episodes of positive glycosuria occurred in the absence of hyperglycemia, indicating only a moderate concordance between them. CONCLUSION: Glycosuria alone is an unreliable marker of blood glucose concentration and adequacy of glucose infusion rate. It is therefore necessary to monitor blood glucose levels in infants submitted to continuous glucose infusion.

Use of corticosteroids and the outcome of infants with bronchopulmonary dysplasia.

UNLABELLED: Ventilator-dependent premature infants are often treated with dexamethasone. Several trials showed that steroids while improve pulmonary compliance and facilitate extubation, some treated infants may have adverse effects, such as alterations of growth curves. We conducted this retrospective study to evaluate the effects of steroids on mechanical ventilation, oxygen therapy, hospital length stay and mortality, in ventilator-dependent infants with bronchopulmonary dysplasia (BPD) (defined as the need of oxygen supplementation at 28 days of life). Twenty-six newborns with BPD were evaluated during 9 - 42 days postpartum (mean = 31 days) and were divided into two groups: Group I - 14 newborns that did not receive dexamethasone, and Group II - 12 newborns that received dexamethasone at 14 - 21 days of life. Dexamethasone was given at a dose of 0.25 mg per kilogram of body weight twice daily intravenously for 3 days, after which the dose was tapered. RESULTS: There were no statistically significant differences in the mean length of mechanical ventilation (Group I - 37 days, Group II - 35 days); oxygen supplementation (Group I - 16 days, Group II - 29 days); hospital stay (Group I - 72 days, Group II - 113 days); mortality (Group I - 35.7%, Group II - 41.6%). At birth, Group II was lighter (BW: Group I - 1154 grams +/- 302, Group II - 791 grams +/- 165; p < 0.05) and smaller (height: Group I - 37.22 cm +/- 3.3, Group II - 33.5 +/- 2.4; p< 0.05) than Group I. At 40 weeks, there were no statistically significant differences between groups in relation to anthropometric measurements. CONCLUSIONS: The use of corticosteroids in bronchopulmonary dysplasic infants may influence the somatic growth during its use. However, after its suspension, a recovery seems to occur, suggesting that its influence could be transitory.

Prediction of length of hospital stay in neonatal units for very low birth weight infants.

OBJECTIVE: To develop models for estimating the length of hospital stay (LOS) of very low birth weight infants (VLBW), based on perinatal risk factors present during the first week of life and during the entire hospitalization period. STUDY DESIGN: The files of 155 VLBW were analyzed, and the influence of individual risk factors were initially evaluated by univariate analysis, using multiple-regression. Two mathematical models were built to estimate the LOS. RESULTS: The first model, using risk factors present during the first 3 days of life, is as follows: LOS = -0.074A + 22.06B + 22.85C - 16.78D - 2.07E + 10.51F + 203.12 (R2 = 0.63). (The letters are added to show what each number represents: A: birth weight; B: occurrence of respiratory distress syndrome; C: endotracheal intubation during resuscitation; D: 1-minute Apgar score; E: gestational age; F: presence of complications during delivery.) The second model, using factors present during the entire hospitalization period, is: LOS = 0.61G + 29.19H + 24.68I + 14.21J + 23.56K + 9.54L + 7.41M + 20.43 (R2 = 0.82). (G: age receiving nutritional support of > or = 120 kcal/kg per day; H: occurrence of systemic candidiasis; I: birth weight < 1000 gm; J: presence of delivery complication; K: occurrence of bronchopulmonary dysplasia; L: birth weight > or = 1000 gm and < or = 1249 gm; M: occurrence of anemia). CONCLUSION: Both models are applicable for estimating the hospitalization period, and the addition of variables present during the entire hospitalization period improved the accuracy of the model.

Intraventricular hemorrhage in very low birth weight infants: associated risk factors and outcome in the neonatal period.

Intraventricular hemorrhage (IVH) is a severe complication in very low birth weight (VLBW) newborns (NB). With the purpose of studying the incidence of IVH, the associated risk factors, and the outcomes for these neonates, we studied all the VLBW infants born in our neonatal unit. Birth weight, gestational age, presence of perinatal asphyxia, mechanical ventilation, length of hospitalization, apnea crisis, hydrocephalus, and periventricular leukomalacia were analyzed. The diagnosis of IVH was based on ultrasound scan studies (Papile's classification) performed until the tenth day of life and repeated weekly in the presence of abnormalities. Sixty-seven/101 neonates were studied. The mortality rate was 30.6% (31/101) and the incidence of IVH was 29.8% (20/67) : 70% grade I, 20% grade III and 10% grade IV. The incidence of IVH in NB <1,000 g was 53.8% (p = 0. 035) and for gestational age <30 weeks was 47.3% (p = 0.04), both considered risk factors for IVH. The length of hospitalization (p = 0.00015) and mechanical ventilation (p = 0.038) were longer in IHV NB. The IVH NB had a relative risk of 2.3 of developing apnea (p = 0. 02), 3.7 of hydrocephalus (p = 0.0007), and 7.7 of periventricular leukomalacia (p < 0.00001). The authors emphasize the importance of knowing the risk factors related to IVH so as to introduce prevention schemes to reduce IVH and to improve outcomes of affected newborns.

Urinary tract infection in full-term newborn infants: value of urine culture by bag specimen collection.

OBJECTIVE: To evaluate the efficacy of urine culture by bag specimen for the detection of neonatal urinary tract infection in full-term newborn infants. Retrospective study (1997) including full-term newborn infants having a positive urine culture (> 100,000 CFU/ml) by bag specimen collection. The urinary tract infection diagnosis was confirmed by positive urine culture (suprapubic bladder aspiration method). The select cases were divided into three groups, according to newborn infant age at the bag specimen collection: GI (< 48 h, n = 17), GII (48 h to 7 d, n = 35) and GIII (> 7 d, n = 9). Sixty one full-term newborn infants were studied (5.1% of total infants). The diagnosis was confirmed on 19/61 (31.1%) of full-term infants born alive. Distribution among the groups was: GI = 2/17 (11.8%), GII = 10/35 (28.6%), and GIII = 7/9 (77.7%). The most relevant clinical symptoms were: fever (GI--100%, GII--91.4%) and weight loss (GI--35.3%, GII--45.7%). Urine culture results for specimens collected by suprapubic aspiration were: E. coli GI (100%), GII (40%) and GIII (28.6%), E. faecalis GI (30%), Staphylococcus coagulase-negative GII (20%) and GIII (42.8%), and Staphylococcus aureus GII (10%). Correlation between positive urine culture collection (bag specimen method) and urinary tract infection diagnosis, using relative risk analysis, produced the following results: GI = 0.30 (CI 95% 0.08-1.15), GII = 0.51 (CI 95% 0.25-1.06) and GIII = 3.31 (CI 95% 1.8-6.06). The most frequent urinary tract infection clinical signs in the first week were fever and weight loss, while non-specific symptomatology occurred later. E. coli was most frequent infectious agent, although from the 7th day of life, staphylococcus was noted. The urine culture (bag specimen method) was effective in detecting urinary tract infection only after the 7th day of life.

[Perforated gastric ulcer: an increasing neonatal ICU disease? Report of 4 cases]. / Ulcera gástrica perfurada: doença em ascensão em UTI neonatais? Particularidades neste período e relato de quatro casos.

Between november 1994 and september 1995, there were 4 cases of premature infants in our Neonatal Intensive Care Unit (NICU) who developed gastrointestinal perforation and bleeding due to peptic ulcer and 3 died of this complication. In the first case, the neonate developed pneumoperitonium when weaning from the ventilator and was submitted to the operation with clinical diagnosis of Necrotizing Enterocolitis. Surprisingly, during the procedure, a perforated gastric ulcer was disclosed. Ever since, this NICU is aware of this diagnosis and try to better identify the possible risks factors. Asphyxia, prematurity, stress and situations where low gastrointestinal flow (asphyxia, exchange transfusion, pneumothorax, hemodynamic shock, cardiac arrest) were observed in almost every case. Treatment with dexamethasone or aminophilline was used in 3 of 4 cases and this potential serious side effect should be considered in all babies treated with steroids. The association of ranitidine (2 mg/kg 12/12 h) could not prevent the perforation in cases 1 and 3. Better understanding of physiopathology of the ulcer in this period of life and a effective preventable drug is still lacking.

[Propionic acidemia in the neonatal period]. / Acidemia propiônica no período neonatal.

Propionic Acidemia is an inherited disorder of organic acid metabolism characterized by a wide spectrum of clinical and biochemical findings. Many times is present in the neonatal period, when mortality is high and neurologic residua in survivors is severe. The present case concerns to a healthy male newborn who started with a picture of refusing to feed, lethargy and hypothermia at 49 hours of life. He developed a severe neurotoxicity state with metabolic acidosis. The laboratory evaluation showed high levels of 3-hidroxi-propionic, 2-metil-hidroxibutiric and metil-citric in urine, confirming the diagnosis of proprionic acidemia.

[Predictive value of the "Clinical Risk Index for Babies" for the risk of neonatal death]. / Valor preditivo do "Clinical Risk Index for Babies" para o risco de mortalidade neonatal.

OBJECTIVE: Several indicators, mainly birthweight and gestational age, have been used to predict the mortality risk in neonatal intensive care units. In order to assess the potential value of CRIB in predicting neonatal mortality, the score was used over the first 12 hours of life of the newborns admitted to this unit, during the year of 1996. METHOD: The inclusion criteria consisted of all infants without inevitably lethal congenital malformations, birthweight below 1,500 g and/or gestational age less than 31 weeks. Newborn children who died within 12 hours after delivery were excluded. The CRIB score covers birth weight, gestational age, the presence of congenital malformations (not inevitably lethal) and three indexes of physiological status during first 12 hours after birth-maximum and minimum appropriate fraction of inspired oxygen and maximum (most acidotic) base excess. RESULTS: In a prospective cohort, seventy one newborn children were studied. The birthweight (average) was 1,119 +/- 275.6 g, gestational age 30 weeks 4/7 +/- 2 weeks 3/7; male (57%); Apgar 1(0) min. score < or = 3 (36.2%) and Apgar 5 degrees min. score < 5 (5.8%). The mortality rate was 29.6% (gold standard). But mortality rate by birthweight less than 1,000 gr. or gestational age lower than 29 weeks was 60.0% and for the CRIB score above 10 was 100%. DISCUSSION: The specificity and predictive positive values for CRIB score above 10 were greater than any other two parameters. The area under the receiver operating characteristic (ROC) curve for predicting death was significantly greater for CRIB than for birthweight alone. It was concluded that the CRIB score is a better predictive indicator for mortality than are birthweight and gestational age.

[Respiratory distress in low birth weight: influence of intrauterine growth retardation]. / Insuficiência respiratória em recém-nascidos de baixo peso: influência do retardo de crescimento intra-uterino.

The aim of this study is to evaluate the influence of intra-uterine growth retardation (IUGR), as well as it's types and severity on the development of respiratory distress among low-birth-weight infants. A total of 673 neonates were studied, the small-for-dates infants (SFD), 40% of total, were divided according to the type of IUGR, in proportionate and disproportionate, and according to the severity, in birth weight below 3rd and between 3rd and 10th percentile. Respiratory distress was more frequent among the appropriate for gestational age (57.3%) compared to the SFD infants (33.7%), (p < 0.0001), and among males (52.6%) compared to females (47.4%) (p = 0.01). There was an inverse relationship between gestational age, as well as birth weight and respiratory distress. It occurred in 90.6% of very-low-birth-weight infants and in 39% of the others, with a predominance among the appropriate for gestational age newborns. Respiratory distress occurred in 80% of neonates below 34 weeks of gestational age and in 26% of the neonates above it (p < 0.0001). Regarding to the small-for-dates infants, respiratory distress occurred more frequently among the disproportionate (42.5%), when compared to proportionate infants (28.1%) (p = 0.03). The severity of IUGR had no influence on these results. The authors concluded that among low birth weight infants, the groups with increased risk for respiratory distress are the appropriate for gestational age and, among small-for-dates and disproportionate infants, those weighing less than 1500 g.

Indicaçöes clínico-epidemiológicas para investigação ecocardiográfica no período neonatal: valor dos grupos de risco / Clinical-epidemiologic indications for echocardiography investigation in the neonatal period: value of risk groups

OBJETIVO - Estudo ecocardiográfico em recém-nascido (RN) de grupos de risco para cardiopatia congênita, a fim de se determinar a prevalência que justifique esse exame no período neonatal. MÉTODOS - Estudaram-se, de novembro/91 a abril/93, 156 RN do berçário anexo à Maternidade do HC-FMUSP, sendo RN de mães com cardiopatia congênita ou diabetes mellitus, crianças de muito baixo peso, com malformaçöes extracardíacas ou presença de sinais cardíacos, caracterizados por sopro, cianose, ou arritmia, todos submetidos ao ecocardiograma. RESULTADOS - A prevalência encontrada foi de 21,8 'por cento', superior ao da população geral (0,8 a 1,2 'por cento'), sendo que a maior entre os grupos, de 40,7 'por cento', ocorreu no grupo de malformaçöes extracardíacas. CONCLUSÄO - Nossos dados justificam a realização de ecocardiograma em RN pertencentes a um destes grupos de risco para cardiopatia congênita.

[Captopril use in pregnancy and its effects on the fetus and the newborn: case report]. / Uso de captopril durante a gestação e suas repercussões sobre o feto e o recém-nascido: relato de caso.

Angiotensin-converting enzyme (ACE) inhibitors have been widely used to control hypertension, but their use during gestation may result in fetal death, intra-uterine growth retardation, oligoamnium sequence, hypotension, acute renal failure and ductus arteriosus patency in the newborn. The aim of this case report is to highlight the risks of using this drug during gestation. The authors present a case of captopril use during pregnancy, whose newborn developed acute renal failure and ductus arteriosus patency early in the newborn period. This presentation strengthens the importance of not only monitoring amniotic fluid volume and fetal growth, but also, during the newborn period, control the weight gain, diuresis, systemic arterial pressure and renal function, mainly in the first 72 hours of life.