Bronchopulmonary dysplasia: temporal trend from 2010 to 2019 in the Brazilian Network on Neonatal Research.

OBJECTIVE: To evaluate the temporal trend of bronchopulmonary dysplasia (BPD) in preterm infants who survived to at least 36 weeks' post-menstrual age (PMA) and BPD or death at 36 weeks' PMA, and to analyse variables associated with both outcomes. DESIGN: Retrospective cohort with data retrieved from an ongoing national registry. SETTING: 19 Brazilian university public hospitals. PATIENTS: Infants born between 2010 and 2019 with 23-31 weeks and birth weight 400-1499 g. MAIN OUTCOME MEASURES: Temporal trend was evaluated by Prais-Winsten model and variables associated with BPD in survivors or BPD or death were analysed by logistic regression. RESULTS: Of the 11 128 included infants, BPD in survivors occurred in 22%, being constant over time (annual per cent change (APC): -0.80%; 95% CI: -2.59%; 1.03%) and BPD or death in 45%, decreasing over time (APC: -1.05%; 95% CI: -1.67%; -0.43%). Being male, small for gestational age, presenting with respiratory distress syndrome, air leaks, needing longer duration of mechanical ventilation, presenting with treated patent ductus arteriosus and late-onset sepsis were associated with an increase in the chance of BPD. For the outcome BPD or death, maternal bleeding, multiple gestation, 5-minute Apgar <7, late-onset sepsis, necrotising enterocolitis and intraventricular haemorrhage were added to the variables reported above as increasing the chance of the outcome. CONCLUSION: The frequency of BPD in survivors was constant and BPD or death decreased by 1.05% at each study year. These results show some improvement in perinatal care in Brazilian units which resulted in a reduction of BPD or death, but further improvements are still needed to reduce BPD in survivors.

Evaluation of two polyethylene bags in preventing admission hypothermia in preterm infants: a quasi-randomized clinical trial.

OBJECTIVE: To compare two polyethylene bags in preventing admission hypothermia in preterm infants born at <34 weeks gestation. METHOD: Quasi-randomized unblinded clinical trial conducted at a level III neonatal unit between June 2018 to September 2019. The authors assign infants between 240/7 and 336/7 weeks' gestation to receive NeoHelp™ bag (intervention group) or a usual plastic bag (control group). The primary outcome was admission hypothermia, considering an axillary temperature at admission to the neonatal unit of <36.0 °C. Hyperthermia was considered if the admission temperature reached 37.5 °C or more. RESULTS: The authors evaluated 171 preterm infants (76, intervention group; 95, control group). The rate of admission hypothermia was significantly lower in the intervention group (2.6% vs. 14.7%, p = 0.007), with an 86% reduction in the admission hypothermia rate (OR, 0.14; 95% CI, 0.03-0.64), particularly for infants weighing >1000 g and >28 weeks gestation. The intervention group also had a higher median of temperature at admission - 36.8 °C (interquartile range 36.5-37.1) vs. 36.5 °C (interquartile range 36.1-36.9 °C), p = 0.001, and showed a higher hyperthermia rate (9.2% vs. 1.0%, p = 0.023). Birth weight was also associated to the outcome, and it represented a 30% chance reduction for every 100-g increase (OR, 0.997; 95% CI, 0.996-0.999). The in-hospital mortality rate was similar between groups. CONCLUSION: The intervention polyethylene bag was more effective in preventing admission hypothermia. Nonetheless, the risk of hyperthermia is a concern during its use.

Evaluation of two polyethylene bags in preventing admission hypothermia in preterm infants: a quasirandomized clinical trial

Abstract Objective: To compare two polyethylene bags in preventing admission hypothermia in preterm infants born at <34 weeks gestation. Method: Quasi-randomized unblinded clinical trial conducted at a level III neonatal unit between June 2018 to September 2019. The authors assign infants between 240/7 and 336/7 weeks' gestation to receive NeoHelpTM bag (intervention group) or a usual plastic bag (control group). The primary outcome was admission hypothermia, considering an axillary temperature at admission to the neonatal unit of <36.0 °C. Hyperthermia was considered if the admission temperature reached 37.5 °Cor more. Results: The authors evaluated 171 preterm infants (76, intervention group; 95, control group). The rate of admission hypothermia was significantly lower in the intervention group (2.6% vs. 14.7%, p = 0.007), with an 86% reduction in the admission hypothermia rate (OR, 0.14; 95% CI, 0.03-0.64), particularly for infants weighing >1000 g and >28 weeks gestation. The intervention group also had a higher median of temperature at admission - 36.8 °C (interquartile range 36.5-37.1) vs. 36.5 °C (interquartile range 36.1-36.9 °C), p = 0.001, and showed à higher hyperthermia rate (9.2% vs. 1.0%, p = 0.023). Birth weight was also associated to the outcome, and it represented a 30% chance reduction for every 100-g increase (OR, 0.997; 95% CI, 0.996-0.999). The in-hospital mortality rate was similar between groups. Conclusion: The intervention polyethylene bag was more effective in preventing admission hypothermia. Nonetheless, the risk of hyperthermia is a concern during its use.

Neonatal Sequential Organ Failure Assessment as a late-onset sepsis mortality predictor in very low birth weight newborns: a Brazilian cohort study.

Death is a frequent occurrence in late-onset neonatal sepsis (LOS). We aimed to evaluate if the Neonatal Sequential Organ Failure Assessment (nSOFA) is associated with mortality due to LOS in very low birth weight (VLBW) infants. This is a single-center Brazilian cohort study including VLBW infants admitted between 2006 and 2020 who were diagnosed with LOS caused by Staphylococcus aureus, Enterococcus sp or Gram-negative bacteria. The primary outcome was mortality associated with sepsis. Two groups of patients-survivors and non-survivors-were compared regarding descriptive maternal and neonatal variables and the nSOFA score, evaluated at nine moments, from 48 hours before the diagnosis of sepsis to 48 hours later (T-48, T-24, T-12, T-6, T0, T+6, T+12, T+24, T+48). Diagnostic accuracy was expressed as the area under the curve (AUC). Among the 1574 VLBW infants hospitalized in the period, 114 episodes of culture-confirmed LOS occurred. There were 21 sepsis-related deaths (18.4%), mostly from Gram-negative bacteria and Enterococcus sp. There were no statistically significant differences between the groups regarding maternal and neonatal variables. Median nSOFA was significantly higher in the non-survivor group at all time points (range 2 to 13 versus 1 to 3). In the logistic regression analysis, each increment of one point in the score significantly increases the risk of death in eight of the nine moments, but no difference was found in T-24. Time T-6 had the best accuracy (88.1%).   Conclusion: The nSOFA score was significantly associated with the risk of death from LOS in VLBW infants. What is Known: • The neonatal sepsis may result in organ dysfunction and death, and it is important to find indicators that could identify this clinical progression. • The nSOFA score was proposed in 2020 to predict mortality from LOS, but since it is recent and still in the research phase, further studies are important to improve it before being widely used in clinical practice. What is New: • We showed a significative association between higher nSOFA scores and mortality. Our results corroborate the validity and the importance of the nSOFA score and highlight its high NPV.

Skin-to-skin contact and deaths in newborns weighing up to 1800 grams: a cohort study

Abstract Objective: To evaluate the association between dose of skin-to-skin contact (SSC) per day and initiation time with the occurrence of deaths in newborns with weight up to 1800g. Method: Multicentric cohort in five Brazilian neonatal units, including newborns with a birth weight of ≤1800g. The time of SSC was registered in individual file, by the team or family during the hospitalization. Maternal and newborn data were obtained through questionnaires applied to mothers and in medical records. Classification Tree was used for data analysis. Results: The performance of the first SSC after 206h was significantly associated with death (p = 0.02). Although there was no association between SSC/day and death (p = 0.09), the number of deaths among those who performed more than 146.9 minutes/day was lower (3;1.5%) than among those who performed this practice for a shorter time (13;6.4%), a fact considered of great clinical importance. Early and late infections present statistically significant associations with the outcome. The chance of death was equal to zero when there was no early infection in the group with the longest duration of SSC. This probability was also equal to zero in the absence of late sepsis for the group with less than 146.9 minutes/day of SSC. Conclusions: The first SSC before 206 hours of life is recommended in order to observe a reduction in the risk of neonatal death. Staying in SSC for more than 146.9 min/day seems to be clinically beneficial for these neonates mostly when it was associated with the absence of infection.

Skin-to-skin contact and deaths in newborns weighing up to 1800 grams: a cohort study.

OBJECTIVE: To evaluate the association between dose of skin-to-skin contact (SSC) per day and initiation time with the occurrence of deaths in newborns with weight up to 1800g. METHOD: Multicentric cohort in five Brazilian neonatal units, including newborns with a birth weight of ≤1800g. The time of SSC was registered in individual file, by the team or family during the hospitalization. Maternal and newborn data were obtained through questionnaires applied to mothers and in medical records. Classification Tree was used for data analysis. RESULTS: The performance of the first SSC after 206h was significantly associated with death (p = 0.02). Although there was no association between SSC/day and death (p = 0.09), the number of deaths among those who performed more than 146.9 minutes/day was lower (3;1.5%) than among those who performed this practice for a shorter time (13;6.4%), a fact considered of great clinical importance. Early and late infections present statistically significant associations with the outcome. The chance of death was equal to zero when there was no early infection in the group with the longest duration of SSC. This probability was also equal to zero in the absence of late sepsis for the group with less than 146.9 minutes/day of SSC. CONCLUSIONS: The first SSC before 206 hours of life is recommended in order to observe a reduction in the risk of neonatal death. Staying in SSC for more than 146.9 min/day seems to be clinically beneficial for these neonates mostly when it was associated with the absence of infection.

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.

Women's sense of coherence and its association with early weaning / Senso de coerência da mulher e sua associação com o desmame precoce

Abstract Objective: To investigate whether there is an association between sense of coherence levels and early weaning. Method: This study had a quantitative nature and a cross-sectional design. Factors associated with early weaning (interruption of maternal breastfeeding) were investigated in a sample of 425 women older than 18 years, mothers of children up to 36 months of age who were not twins, with no sensory or motor deficiencies, without distinction of ethnicity or social class. The chi-squared test, with a significance level of 5%, was used to evaluate the association between the dependent variable (early weaning) and the independent variables (socioeconomic, demographic factors and sense of coherence level). Variables with p ≤ 0.20 were tested by the multiple logistic regression model. Odds ratio and the respective 95% confidence intervals were estimated. All statistical tests were performed using the SAS 9.2 software. Results: The results showed that mothers with greater sense of coherence were 1.82 times more likely to maintain breastfeeding for longer periods (p = 0.02). Conclusions: The identification of mothers with low sense of coherence allows the early intervention of health professionals, contributing to decrease the rates of early weaning in the population.

Resumo Objetivo: Investigar se há associação entre níveis de senso de coerência e desmame precoce. Método: O presente estudo tem natureza quantitativa e delineamento transversal. Foram investigados fatores associados ao desmame precoce (interrupção da oferta do leite materno à criança) em uma amostra de 425 mulheres com idade superior a 18 anos, sem distinção de etnia ou classe social, mães de crianças com até 36 meses, que não fossem gêmeos ou apresentassem deficiências sensoriais ou motoras. Foi feito o teste de qui-quadrado, com nível de significância de 5%, para testar a associação entre a variável dependente (desmame precoce) e as variáveis independentes (socioeconômicas, demográficas e nível de senso de coerência). As variáveis que apresentaram p ≤ 0,20 foram testadas no modelo de regressão logística múltipla. Os odds ratio e os respectivos intervalos de 95% de confiança foram estimados. Todos os testes estatísticos foram feitos com o programa SAS 9.2. Resultados: Os resultados apontaram que mães com maior senso de coerência possuem 1,82 vez mais chance de manter o aleitamento por mais tempo (p = 0,02). Conclusões: A identificação de mães com baixo senso de coerência permite a intervenção precoce dos profissionais de saúde, contribui para diminuir as taxas de desmame precoce na população.

Women's sense of coherence and its association with early weaning.

OBJECTIVE: To investigate whether there is an association between sense of coherence levels and early weaning. METHOD: This study had a quantitative nature and a cross-sectional design. Factors associated with early weaning (interruption of maternal breastfeeding) were investigated in a sample of 425 women older than 18 years, mothers of children up to 36 months of age who were not twins, with no sensory or motor deficiencies, without distinction of ethnicity or social class. The chi-squared test, with a significance level of 5%, was used to evaluate the association between the dependent variable (early weaning) and the independent variables (socioeconomic, demographic factors and sense of coherence level). Variables with p≤0.20 were tested by the multiple logistic regression model. Odds ratio and the respective 95% confidence intervals were estimated. All statistical tests were performed using the SAS 9.2 software. RESULTS: The results showed that mothers with greater sense of coherence were 1.82 times more likely to maintain breastfeeding for longer periods (p=0.02). CONCLUSIONS: The identification of mothers with low sense of coherence allows the early intervention of health professionals, contributing to decrease the rates of early weaning in the population.

Peri-intraventricular hemorrhage and oxidative and inflammatory stress markers in very-low birth weight newborns / Hemorragia peri-intraventricular e marcadores de estresse oxidativo e inflamatório em RNs de muito baixo peso ao nascer

OBJECTIVES: To evaluate the association between oxidative and inflammatory stress markers with peri-intraventricular hemorrhage (PIVH) in very-low birth weight newborns.METHODS: This was a prospective study conducted in a level III neonatal unit. Basal and stimulated reactive oxygen intermediates (ROIs), reduced glutathione (GSH), and interleukin-6 (IL-6) levels were measured in umbilical cord blood. Newborns underwent serial ultrasound at the bedside, at 6, 12, 24, and 72 hours of life and at seven days for the diagnosis of PIVH, classified as grades I to IV. Two groups were assessed, those with and without PIVH; maternal and neonatal control variables were used for comparison. Univariate and multiple regression analyses were applied.RESULTS: A total of 125 newborns were assessed. PIVH incidence rate was 12.0%. In the univariate analysis, basal ROI, the use of two or more doses of corticosteroids, birth weight < 1,000 g, ventilatory support use, and SNAPPE II value ≥ 22 were significantly associated with PIVH. However, in the multivariate analysis, only antenatal steroid use was independently associated with the disease (OR 0,194; 95% CI: 0,048 to 0,773; p=0,02).CONCLUSION: ROI, GSH, and IL-6 levels were not associated with the occurrence of PIVH in very-low birth weight infants.

OBJETIVOS: Avaliar a associação entre marcadores de estresse oxidativo e inflamatório com a hemorragia peri- e intraventricular (HPIV) em recém-nascidos (RN) de muito baixo peso ao nascer.MÉTODOS: Estudo prospectivo em unidade neonatal nível III. Foi feita dosagem em sangue de cordão umbilical de intermediários reativos de oxigênio (ROI) basal e estimulado, glutationa reduzida (GR) e interleucina-6 (IL-6). Recém-nascidos foram submetidos a ultrassonografia seriada, à beira do leito, com seis, 12, 24 e 72 horas de vida e sete dias para o diagnóstico de HPIV, classificada em graus de I a IV. Foram avaliados dois grupos: com e sem HPIV e variáveis de controle maternas e neonatais foram usadas para comparação. Análise univariada e de regressão múltipla foram aplicados.RESULTADOS: Foram avaliados 125 recém-nascidos. A taxa de incidência de HPIV foi de 12%. Na análise univariada o valor basal de ROI, o uso de duas ou mais doses de corticosteroide, peso ao nascer menor do que 1.000 g, o uso de assistência respiratória e valor de SNAPPE II maior ou igual a 22 foram significativamente associados à HPIV. Porém, na análise multivariada, apenas o uso antenatal de esteroides se mostrou independentemente associado à doença (OR 1,94 IC95% 0,048-0,773 p = 0,02).CONCLUSÃO: ROI, GR e Il-6 não foram associados à ocorrência de HPIV em RN de muito baixo peso ao nascer.

Peri-intraventricular hemorrhage and oxidative and inflammatory stress markers in very-low birth weight newborns.

OBJECTIVES: To evaluate the association between oxidative and inflammatory stress markers with peri-intraventricular hemorrhage (PIVH) in very-low birth weight newborns. METHODS: This was a prospective study conducted in a level III neonatal unit. Basal and stimulated reactive oxygen intermediates (ROIs), reduced glutathione (GSH), and interleukin-6 (IL-6) levels were measured in umbilical cord blood. Newborns underwent serial ultrasound at the bedside, at 6, 12, 24, and 72hours of life and at seven days for the diagnosis of PIVH, classified as grades I to IV. Two groups were assessed, those with and without PIVH; maternal and neonatal control variables were used for comparison. Univariate and multiple regression analyses were applied. RESULTS: A total of 125 newborns were assessed. PIVH incidence rate was 12.0%. In the univariate analysis, basal ROI, the use of two or more doses of corticosteroids, birth weight<1,000g, ventilatory support use, and SNAPPE II value ≥ 22 were significantly associated with PIVH. However, in the multivariate analysis, only antenatal steroid use was independently associated with the disease (OR 0,194; 95% CI: 0,048 to 0,773; p=0,02). CONCLUSION: ROI, GSH, and IL-6 levels were not associated with the occurrence of PIVH in very-low birth weight infants.

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.

Antenatal maternal corticosteroid administration and markers of oxidative stress and inflammation in umbilical cord blood from very low birth weight preterm newborn infants.

OBJECTIVE: To investigate the association between antenatal maternal corticosteroid administration and blood levels of reactive oxygen intermediates (ROI), reduced glutathione (GR) and interleukin-6 (IL-6) in preterm, very low birth weight infants. METHODS: This was a cohort study in which cord blood samples were used for the following tests: baseline and stimulated granulocyte ROI were measured by flow cytometry; GR was assayed by spectrophotometry; and IL-6 by enzyme-linked immunosorbent assay. Two different comparative analyses of antenatal corticosteroid (betamethasone) were conducted: the first compared administration against no administration and the second compared mothers who received the complete cycle with those given only a partial antenatal corticosteroid cycle. Maternal and neonatal variables were analyzed in order to compare groups. Categorical variables were compared using the chi-square or Fischer tests, and blood marker test results were compared using the Mann-Whitney test. RESULTS: The different corticoid therapy groups were similar in terms of all of the maternal and neonatal variables with the exception of vaginal delivery, which was significantly associated with not receiving antenatal corticosteroid. The results for ROI, GR and IL-6 did not differ when the comparison was based on simple presence or absence of administration of the steroid. However, when the complete cycle was compared against incomplete administration, median ROI and IL-6 were lower among those given the complete cycle. CONCLUSION: Administration of the complete cycle of betamethasone to the mother had a suppressive effect on baseline ROI and IL-6 production in very low birth weight preterm newborn infants.

Uso materno antenatal de corticosteroide e marcadores de estresse oxidativo e de inflamação no sangue de cordão umbilical de recém-nascidos pré-termo de muito baixo peso / Antenatal maternal corticosteroid administration and markers of oxidative stress and inflammation in umbilical cord blood from very low birth weight preterm newborn infants

OBJETIVO: Avaliar a associação entre o uso materno antenatal de corticosteroide e os níveis sanguíneos de intermediários reativos de oxigênio (ROI), glutationa reduzida (GR) e interleucina-6 (IL-6) em recém-nascidos pré-termo de muito baixo peso ao nascer. MÉTODOS: Estudo de coorte. A dosagem foi feita em sangue de cordão umbilical. A dosagem de ROI por granulócitos foi realizada por citometria de fluxo nos estados basal e estimulado; a GR, por espectrofotometria; e a IL-6, por enzyme-linked immunosorbent assay. Foram considerados dois grupos em relação ao uso de corticosteroide (betametasona) antenatal: uso ou não da medicação; e, se presente, se foi de modo completo ou parcial. Variáveis maternas e neonatais foram consideradas para efeito de comparação dos grupos. As variáveis categóricas foram comparadas usando os testes do qui-quadrado ou de Fischer, e as comparações dos valores dos marcadores sanguíneos foram feitas usando-se o teste de Mann-Whitney. RESULTADOS: Os grupos de corticoterapia foram comparáveis em relação às variáveis maternas e neonatais, exceto a ocorrência de parto vaginal, o qual foi associado significativamente à ausência de uso de corticosteroide antenatal. Os valores de ROI, GR e IL-6 não se mostraram diferentes quando se avaliou a presença ou ausência da administração de esteroide; porém, quando o ciclo se fez de modo completo, encontraram-se menores medianas de ROI e IL-6. CONCLUSÃO: A administração de ciclo completo de betametasona à mãe exerceu um efeito supressor sobre a produção basal de ROI e de IL-6 em recém-nascidos pré-termo de muito baixo peso.

OBJECTIVE: To investigate the association between antenatal maternal corticosteroid administration and blood levels of reactive oxygen intermediates (ROI), reduced glutathione (GR) and interleukin-6 (IL-6) in preterm, very low birth weight infants. METHODS: This was a cohort study in which cord blood samples were used for the following tests: baseline and stimulated granulocyte ROI were measured by flow cytometry; GR was assayed by spectrophotometry; and IL-6 by enzyme-linked immunosorbent assay. Two different comparative analyses of antenatal corticosteroid (betamethasone) were conducted: the first compared administration against no administration and the second compared mothers who received the complete cycle with those given only a partial antenatal corticosteroid cycle. Maternal and neonatal variables were analyzed in order to compare groups. Categorical variables were compared using the chi-square or Fischer tests, and blood marker test results were compared using the Mann-Whitney test. RESULTS: The different corticoid therapy groups were similar in terms of all of the maternal and neonatal variables with the exception of vaginal delivery, which was significantly associated with not receiving antenatal corticosteroid. The results for ROI, GR and IL-6 did not differ when the comparison was based on simple presence or absence of administration of the steroid. However, when the complete cycle was compared against incomplete administration, median ROI and IL-6 were lower among those given the complete cycle. CONCLUSION: Administration of the complete cycle of betamethasone to the mother had a suppressive effect on baseline ROI and IL-6 production in very low birth weight preterm newborn infants.

Incidência de hemorragia peri-intraventricular em recém-nascidos de muito baixo peso: análise de 15 anos / Incidence of periventricular/intraventricular hemorrhage in very low birth weight infants: a 15-year cohort study

OBJETIVO: Avaliar a incidência da hemorragia peri-intraventricular (HPIV) em recém-nascidos de muito baixo peso. MÉTODOS: Foi realizado estudo de coorte prospectiva de recém-nascidos de muito baixo peso ao longo de 15 anos. Excluíram-se aqueles sem avaliação por ultrassonografia cerebral, com má-formação do sistema nervoso central ou falecidos antes de 24 horas de vida. Os exames foram realizados através da fontanela anterior, utilizando-se ecógrafo Aloka® 620 e transdutor de 5 mHz, entre o primeiro e o terceiro dia de vida, e também no sétimo e no 28º dia de vida e/ou na alta hospitalar. A incidência foi analisada pelo teste de qui-quadrado de tendência ou pelo Cochran-Armitage test, e pelo modelo de regressão linear simples (curva de tendência logarítmica). Para avaliação dos possíveis fatores associados, analisaram-se dados obstétricos, perinatais e neonatais nos períodos de 1991/1994 e 2002/2005, com cálculo do teste de qui-quadrado / Fisher e do risco relativo. O nível de significância foi de 5%. RESULTADOS: Nasceram 1.777 crianças de muito baixo peso, e 1.381 (77,7%) foram avaliadas. Dessas, 289 (20,9%) apresentaram HPIV. A distribuição anual mostrou queda na incidência, de 50,9% em 1991 para 11,9% em 2005 (p < 0,0001). A HPIV apresentou queda em todas as faixas de peso e nos grupos com grau I/II e III/IV. Observaram-se diferenças relacionadas a uso de esteroide antenatal, sexo masculino, peso < 1.000 g, doenças de membranas hialinas, ventilação mecânica, uso de surfactante, canal arterial e sepse. CONCLUSÃO: Houve queda significativa na incidência da doença em recém-nascidos de muito baixo peso ao nascer durante o período analisado.

OBJECTIVE: To assess the incidence of periventricular/intraventricular hemorrhage (PIVH) in very low birth rate neonates. METHODS: This was a prospective cohort study conducted on a sample of very low birth weight infants over a 15-year period. Neonates who did not undergo cerebral ultrasonography, had malformations affecting the central nervous system, or died within the first 24 hours of life were excluded. Ultrasonography was performed through the anterior fontanelle using an Aloka® 620 scanner with a 5 mHz probe, between days 1 and 3 of life, at 7 days, and at 28 days (or at discharge). Incidence was analyzed by means of the chi-square test for trend or Cochran-Armitage test and through a simple linear regression model with a logarithmic trendline as the output. For assessment of potential associated factors, a variety of obstetric, perinatal, and neonatal data collected between 1991-1994 and 2002-2005 were analyzed, using the chi-square and Fisher's exact tests for statistical analysis. The significance level was set at 5%. RESULTS: Of 1,777 very low birth weight infants born during the study period, 1,381 (77.7%) were examined. Of these, 289 (20.9%) had PIVH. The yearly distribution of cases showed a progressive decline in incidence, from 50.9% in 1991 to 11.9% in 2005 (p < 0.0001). The incidence of PIVH decreased across all weight ranges as well as at grades I/II and III/IV. Significant differences in antenatal corticosteroid use, gender (male), weight (< 1,000 g), hyaline membrane disease, mechanical ventilation, administration of surfactant, patent ductus arteriosus, and sepsis were found. CONCLUSION: The incidence of PIVH in very low birth weight infants declined significantly during the study period.

Incidence of periventricular/intraventricular hemorrhage in very low birth weight infants: a 15-year cohort study.

OBJECTIVE: To assess the incidence of periventricular/intraventricular hemorrhage (PIVH) in very low birth rate neonates. METHODS: This was a prospective cohort study conducted on a sample of very low birth weight infants over a 15-year period. Neonates who did not undergo cerebral ultrasonography, had malformations affecting the central nervous system, or died within the first 24 hours of life were excluded. Ultrasonography was performed through the anterior fontanelle using an Aloka® 620 scanner with a 5 mHz probe, between days 1 and 3 of life, at 7 days, and at 28 days (or at discharge). Incidence was analyzed by means of the chi-square test for trend or Cochran-Armitage test and through a simple linear regression model with a logarithmic trendline as the output. For assessment of potential associated factors, a variety of obstetric, perinatal, and neonatal data collected between 1991-1994 and 2002-2005 were analyzed, using the chi-square and Fisher's exact tests for statistical analysis. The significance level was set at 5%. RESULTS: Of 1,777 very low birth weight infants born during the study period, 1,381 (77.7%) were examined. Of these, 289 (20.9%) had PIVH. The yearly distribution of cases showed a progressive decline in incidence, from 50.9% in 1991 to 11.9% in 2005 (p < 0.0001). The incidence of PIVH decreased across all weight ranges as well as at grades I/II and III/IV. Significant differences in antenatal corticosteroid use, gender (male), weight (< 1,000 g), hyaline membrane disease, mechanical ventilation, administration of surfactant, patent ductus arteriosus, and sepsis were found. CONCLUSION: The incidence of PIVH in very low birth weight infants declined significantly during the study period.

Influência do manuseio do balão autoinflável neonatal sobre o pico de pressão e o volume corrente / Peak pressure and tidal volume are affected by how the neonatal self-inflating bag is handled

OBJETIVO: Avaliar a influência do manuseio do ventilador pulmonar manual neonatal com bolsa autoinflável sobre pico de pressão e volume corrente. MÉTODOS: Estudo experimental com 141 profissionais de saúde (médicos, médicos residentes, fisioterapeutas, enfermeiros e técnicos de enfermagem) que ventilaram um pulmão artificial ajustado para reproduzir o pulmão de um recém-nascido a termo, utilizando ventilador pulmonar manual autoinflável com cinco diferentes modos de manuseio: com as duas mãos (10 dedos) e com uma mão, utilizando cinco, quatro, três e dois dedos. Valores de pico de pressão e volume corrente foram registrados pelo pulmão artificial. RESULTADOS: Observou-se alta variabilidade nos valores das variáveis estudadas. A média do pico de pressão foi 39,73 cmH2O (IC95 por cento 37,32-42,13), variando de 2,5 a 106,3 cmH2O, e do volume foi 39,56 mL (IC95 por cento 36,86-42,25), variando de 4 a 88 mL. Não foi detectada influência significativa da profissão sobre as variáveis estudadas (p > 0,05). Observou-se que o modo de manuseio do ventilador pulmonar manual influenciou significativamente o pico de pressão e o volume corrente (p < 0,0001), que foram maiores quando o ventilador foi manuseado com as duas mãos. CONCLUSÃO: A maioria dos profissionais gerou pico de pressão e volume corrente muito elevados, principalmente quando foram empregadas as duas mãos para ventilar, aumentando o risco de barotrauma e volutrauma. Por outro lado, parte dos profissionais forneceu pressões e volumes tão baixos que seriam insuficientes para a adequada expansão pulmonar, podendo levar a hipoventilação. Tais riscos não dependeram da formação profissional.

OBJECTIVE: To evaluate how different ways of handling the neonatal self-inflating bag influence peak pressure and tidal volume. METHODS: This is an experimental study involving 141 different professionals (physicians, resident physicians, physiotherapists, nurses, and nursing technicians), who ventilated an artificial lung, adjusted to simulate the lung of a term neonate, using a self-inflating bag. Each professional handled the ventilator in five different ways: a) using both hands (10 fingers); and, with only one hand, b) five fingers, c) four fingers, d) three fingers, and e) two fingers. Peak pressure and tidal volume data were recorded by the artificial lung equipment. RESULTS: Both variables showed high variability, from 2.5 to 106.3 cmH2O (mean = 39.73 cmH2O; 95 percentCI 37.32-42.13) for peak pressure, and from to 4 to 88 mL (mean = 39.56 mL; 95 percentCI 36.86-42.25) for tidal volume. There was no significant influence of the profession on any of the variables (p > 0.05). However, bag handling significantly influenced both peak pressure and tidal volume (p < 0.0001), which were higher when the operator used both hands. CONCLUSION: The results indicate that most professionals delivered excessively high peak pressures and tidal volumes, which could increase the risk of barotrauma and volutrauma, especially when both hands were used to ventilate. On the other hand, a small number of professionals delivered insufficient pressure and volume for adequate lung expansion and ventilation. The delivery of inadequate ventilation was not dependent on profession.

Secular trend in length of hospital stay for healthy newborns: 1951-2000 / Tendência secular do tempo de permanência hospitalar de recém-nascidos sadios: 1951-2000

OBJETIVO: Estudar a tendência secular da permanência hospitalar de recém-nascidos com peso > 2.500 g em uma maternidade de grande porte. MÉTODOS: Estudo descritivo, analítico e retrospectivo. Foram coletados dados de 5.001 nascidos vivos de 1951 a 2000, sadios, de gestação única. As variáveis estudadas foram: tempo de permanência hospitalar, peso, idade materna, tipo de parto e categoria de internação. Foi utilizada análise de regressão linear com estimação pelo método dos quadrados mínimos. RESULTADOS: A média anual da permanência hospitalar diminuiu no tempo estudado, sendo de 123 horas em 1951 e 67,2 horas em 2000. Utilizando-se método de regressão segmentada, evidenciou-se tendência significativa de queda no período entre 1951 e 1970, estabilização de 1971 a 1990 e discreto aumento, sem significado estatístico, a partir de 1991. A permanência hospitalar variou significativamente apenas com o tipo de parto. CONCLUSÃO: Houve decréscimo na permanência hospitalar no período estudado, devido apenas ao tipo de parto.

OBJECTIVE: To assess the secular trend in length of hospital stay for healthy newborns with birth weight > 2,500 g in a large maternity hospital of Campinas, state of São Paulo, Brazil. METHODS: In this descriptive, analytical, retrospective study, data were collected from 5,001 live births from 1951 to 2000. Studied variables were length of hospital stay, birth weight, maternal age, type of delivery, and category of admission. Linear regression analysis was used, with least squares estimation. RESULTS: The annual mean length of stay decreased along the period assessed: 123 hours in 1951 and 67.2 hours in 2000. Segmented linear regression analysis revealed a significant decreasing trend between 1951 and 1970, a stable period between 1971 and 1990, and a non-significant increase between 1991 and 2000. Length of hospital stay varied significantly according to type of delivery. CONCLUSION: Length of hospital stay decreased significantly between 1951 and 2000 and was influenced by type of delivery only.

Secular trend in length of hospital stay for healthy newborns: 1951-2000.

OBJECTIVE: To assess the secular trend in length of hospital stay for healthy newborns with birth weight >or= 2,500 g in a large maternity hospital of Campinas, state of São Paulo, Brazil. METHODS: In this descriptive, analytical, retrospective study, data were collected from 5,001 live births from 1951 to 2000. Studied variables were length of hospital stay, birth weight, maternal age, type of delivery, and category of admission. Linear regression analysis was used, with least squares estimation. RESULTS: The annual mean length of stay decreased along the period assessed: 123 hours in 1951 and 67.2 hours in 2000. Segmented linear regression analysis revealed a significant decreasing trend between 1951 and 1970, a stable period between 1971 and 1990, and a non-significant increase between 1991 and 2000. Length of hospital stay varied significantly according to type of delivery. CONCLUSION: Length of hospital stay decreased significantly between 1951 and 2000 and was influenced by type of delivery only.