The extent of postpartum cardiac reverse remodeling is reflected in urine proteome.

The association of postpartum cardiac reverse remodeling (RR) with urinary proteome, particularly in pregnant women with cardiovascular (CV) risk factors who show long-term increased risk of cardiovascular disease and mortality is unknown. We aim to profile the urinary proteome in pregnant women with/without CV risk factors to identify proteins associated with postpartum RR. Our study included a prospective cohort of 32 healthy and 27 obese and/or hypertensive and/or diabetic pregnant women who underwent transthoracic echocardiography, pulse-wave-velocity, and urine collection at the 3rd trimester and 6 months postpartum. Shotgun HPLC-MS/MS profiled proteins. Generalized linear mixed-effects models were used to identify associations between urinary proteins and left ventricle mass (LVM), a surrogate of RR. An increase in arterial stiffness was documented from 3rd trimester to 6 months after delivery, being significantly elevated in women with CV risk factors. In addition, the presence of at least one CV risk factor was associated with worse LVM RR. We identified 6 and 11 proteins associated with high and low LVM regression, respectively. These proteins were functionally linked with insulin-like growth factor (IGF) transport and uptake regulation by IGF binding-proteins, platelet activation, signaling and aggregation and the immune system's activity. The concentration of IGF-1 in urine samples was associated with low LVM regression after delivery. Urinary proteome showed a predicting potential for identifying pregnant women with incomplete postpartum RR.

Neonatal polycythemia: prevalence, risk factors and predictors of severity.

BACKGROUND: Polycythemia is a disorder with several causes and risk factors. The clinical presentation is variable, ranging from asymptomatic newborns to cases with severe physiological changes. The aim of this study was to assess the prevalence, risk factors and predictors of severity of polycythemia in a Portuguese level III Neonatal Intensive Care Unit (NICU). METHODS: Case-control study of all term newborns with the diagnosis of polycythemia admitted to the NICU of the São João Universitary Hospital Center, Porto, Portugal, from January 1, 1999 to December 31, 2019; and who met one of the following inclusion criteria were eligible for the study: 1) Hct>65% or Hb>22 g/dL; and 2) Hb≥21 g/dL with clinical manifestations of polycythemia. RESULTS: A total of 53 newborns fulfilled the inclusion criteria and were included in the study, corresponding to a prevalence of 0.57%. Birth outside the hospital was the only risk factor with statistical significance. Of 53 cases, 51 (96.23%) had symptomatic polycythemia. The most frequent symptoms were: hyperbilirubinemia (69.81%), hypoglycemia (52.83%), thrombocytopenia (50.94%), cardiorespiratory (33.96%), and neurological symptoms (33.96%). Of the 53 newborns evaluated, 41 (77.36%) needed treatment. The only risk factors that influenced the hematocrit value were maternal diabetes and fetal growth restriction. CONCLUSIONS: The best way to improve the prognosis of polycythemia is to identify the risk factors present throughout pregnancy and make an early diagnosis and treatment. Out-of-hospital births should be avoided. The diagnosis should not be excluded, even if hemoglobin and hematocrit are within normal limits.

A maternal age of 35 years and over may increase the risk for cystic periventricular leukomalacia in very preterm infants.

BACKGROUND: Some studies have shown increased risk for neonatal morbidity and mortality with increasing maternal age. The aim of this study was to assess the influence of a maternal age of 35 years, and older, on the neonatal morbidities and mortality of very preterm infants. METHODS: Obstetrical and neonatal data on mothers and preterm infants with gestational age 24 to 30 weeks, born during 2015 and 2016 after a surveilled pregnancy at 11 Portuguese level III centers were analyzed according to a mother's age <35 years versus ≥35. Statistical analysis was performed using IBM SPSS statistics 23 (IBM, Armonk, NY, USA) and a P value <0.05 was considered significant. RESULTS: A total of 415 mothers and 499 infants were included; 340 (68.1%) infants were delivered to mothers <35 years old and 159 (31.9%) to mothers ≥35. There were no differences in birthweight, gestational age and gender in both groups of preterm infants. Rupture of membranes over 18 hours and chronic hypertension with superimposed preeclampsia were significantly more frequent in mothers ≥35 years. Cystic periventricular leukomalacia (cPVL) assessed by cranial ultrasound was significantly more prevalent in infants delivered to mothers ≥35 years. The multivariate analysis by logistic regression revealed an association between cPVL and a maternal age ≥35 years (OR=2.34, 95% CI: 1.20-4.54; P=0.012). CONCLUSIONS: Our study revealed a significant association between a maternal age ≥35 years and echographic cPVL in preterm infants below 30 weeks of gestational age.

Neonatal outcomes of multiple versus single very preterm infants.

BACKGROUND: Neonatal morbidity and mortality differ between very preterm infants that result from single and those that result from a multiple order pregnancy. The aim of our study was to assess and compare the neonatal morbidity and mortality of multiple versus single very preterm infants. METHODS: Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 at 11 level III perinatal centers after a surveilled pregnancy, were analyzed and compared. Statistical analysis was performed using IBM SPSS® statistics 25 and a p-value < 0.05 was considered statistically significant. RESULTS: A total of 494 infants delivered from 410 women were enrolled in the study; 320 (64.8%) infants resulted from single gestation and 174 (35.2%) resulted from multiple order gestation (153 double, 21 triple). Multiples were associated with a higher maternal age, a greater use of medically assisted reproduction techniques, higher C-section rates, more frequent full cycle use of antenatal corticosteroids, higher gestational age with adequate birth weight, spent less days on oxygen therapy, presented less prevalence of BPD and cPVL, needed less surgical closure of PDA and had a lower length of stay in NICU. Abruptio placenta, hypertensive disorders of pregnancy and preeclampsia were more frequent in single pregnancies. The multivariate analysis by logistic regression adjusted to gestational age and confounding variables did not show any significant difference on the outcomes of multiples compared to singles. CONCLUSIONS: The results of our study support the scientific evidence that, with the current practices, the neonatal morbidity and mortality of very premature infants are not different between those resulting from single and multiple gestations.

Interobserver agreement in CTG interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring.

BACKGROUND: Visual analysis of cardiotocographic (CTG) tracings has been shown to be prone to poor intra- and interobserver agreement when several interpretation guidelines are used, and this may have an important impact on the technology's performance. OBJECTIVES: The aim of this study was to evaluate agreement in CTG interpretation using the new 2015 FIGO guidelines on intrapartum fetal monitoring. STUDY DESIGN: A pre-existing database of intrapartum CTG tracings was used to sequentially select 151 cases acquired with a fetal electrode, with duration exceeding 60minutes, and signal loss less than 15%. These tracings were presented to six clinicians, three with more than 5 years' experience in the labor ward, and three with 5 or less years' experience. Observers were asked to evaluate tracings independently, to assess basic CTG features: baseline, variability, accelerations, decelerations, sinusoidal pattern, tachysystole, and to classify each tracing as normal, suspicious or pathologic, according to the 2015 FIGO guidelines on intrapartum fetal monitoring. Agreement between observers was evaluated using the proportions of agreement (Pa), with 95% confidence intervals (95%CI). RESULTS: A good interobserver agreement was found in the evaluation of most CTG features, but not bradycardia, reduced variability, saltatory pattern, absence of accelerations and absence of decelerations. For baseline classification Pa was 0.85 [0.82-0.90], for variability 0.82 [0.78-0.85], for accelerations 0.72 [0.68-0.75], for tachysystole 0.77 [0.74-0.81], for decelerations 0.92 [0.90-0.95], for variable decelerations 0.62 [0.58-0.65], for late decelerations 0.63 [0.59-0.66], for repetitive decelerations 0.73 [0.69-0.78], and for prolonged decelerations 0.81 [0.77-0.85]. For overall CTG classification, Pa were 0.60 [0.56-0.64], for classification as normal 0.67 [0.61-0.72], for suspicious 0.54 [0.48-0.60] and for pathologic 0.59 [0.51-0.66]. No differences in agreement according to the level of expertise were observed, except in the identification of accelerations, where it was better in the more experienced group. CONCLUSIONS: A good interobserver agreement was found in evaluation of most CTG features and in overall tracing classification. Results were better than those reported in previous studies evaluating agreement in overall tracing classification. Observer experience did not appear to play a role in agreement.

Comparison of a computer system evaluation of intrapartum cardiotocographic events and a consensus of clinicians.

AIMS: To compare between computer analysis of intrapartum cardiotocography (CTG) features by the Omniview-SisPorto 3.5 and a consensus of clinicians. METHODS: Agreement study using 50 consecutively acquired tracings (206 h of signals) with >60 min duration, <10% signal loss and recorded in labor at term by internal fetal heart rate (FHR) monitoring. Tracings were divided into 10-min segments and independently analyzed by three experienced clinicians, in order to estimate the FHR baseline and identify periodic events. A consensus was reached using a three round Delphi procedure. Results were compared with the analysis provided by the Omniview-SisPorto 3.5 system. RESULTS: For baseline estimation, agreement between the computer and the consensus was high [intraclass correlation coefficient (ICC)=0.85; 95% confidence interval (CI) 0.46-0.93], with a mean difference of 3.7 bpm (limits of agreement -4.4-11.9 bpm), and 99% of differences under 15 bpm. A concordant identification was observed in 71% of accelerations (95% CI: 69%-73%), 68% of decelerations (95% CI: 66%-70%), and 87% of uterine contractions (95% CI: 85%-89%). CONCLUSIONS: A high agreement was observed between the Omniview-SisPorto 3.5 and a consensus of clinicians in evaluation of intrapartum CTG baseline, accelerations, decelerations and uterine contractions.

Congenital posthemorrhagic hydrocephalus: a case of fetomaternal alloimmune thrombocytopenia.

Fetal/neonatal alloimmune thrombocytopenia (NAIT) results from fetomaternal mismatch for human platelet alloantigens leading to antibody-mediated destruction of fetal platelets. This is one of the most common causes of severe thrombocytopenia in the newborn with an incidence of 1/800-1,000. In the most severe cases, NAIT may result in intracranial hemorrhage and may lead to death or neurologic sequelae. We report a case of fetal hydrocephalus caused by NAIT and discuss the importance of making an accurate prenatal diagnosis to improve the management of the current pregnancy and the outcome of subsequent pregnancies. Screening of female siblings of affected cases is recommended in order to detect at-risk individuals.

Projeto saúde: controle da parasitose intestinal: moradores da Vila Murici - Montes Claros/MG / Health project: control of intestinl parasitsis: residents of Murici Village - Montes Claros/MG

O referido estudo foi realizado em duas etapas, por alunos e professores da disciplina de parasitologia – Curso Médico – UNIMONTES, sendo a 1ª etapa (abril a agosto de 1996) e a 2ª etapa (outubro de 1997 a maio de 1998). Foram realizados exames parasitológicos pelo H.P.J. de 397 moradores da Vila Murici, sendo positivos 269 (67,76%); 125 adultos (46,47%) e 144 crianças até 12 anos (53,53%). As maiores prevalências foram de Entamoeba histolytica (50,56%), Entamoeba coli (45,35%) e Ancylostomatidae (16,36%). Foi feito o tratamento de todas as pessoas parasitadas, orientações de higiene e profilaxia através de audio-visual e cartilha educativa. Após 12 meses, repetimos os exames de 192 pessoas medicadas na 1ª etapa, das quais 77 positivas (40,1%), sendo 33 adultos (42,86%) e 44 crianças (57,14%$). Houve permanência de 40,8% do índice de parasitoses, o que se justifica, pela péssima condição sócio-econômica, carência de água potável, saneamento básico e o espaço decorrido entre a 1ª e 2ª etapa. Finalmente, repetimos o tratamento das pessoas e através da participação dos alunos do Curso Médico UNIMONTES e ROTARACT (Rotary Club de Jovens), doamos 1 filtro para cada moradia do bairro.