Lack of effect of maternal body mass index on anthropometric characteristics of newborns in twin gestations

We examined the correlation between maternal prepregnancy body mass index (BMI) and newborn weight, length, BMI, and gestational order, in singleton and twin births. The sample comprised 381 mothers of multiple babies (562 twins), and 7979 singleton pregnancies, used as controls. The Mann-Whitney non-parametric test was used to compare the values between the two groups, and the Spearman's correlation test (rS) was applied to the quantitative variables. A significant positive correlation was found with singleton baby variables: the higher the maternal BMI, the higher the newborn's BMI, weight, length, and gestational order. However, no significant correlation was found between maternal BMI and any of these variables in twins. Maternal weight gain, in the twin group, showed a significant positive correlation with the newborn gestational order (rS = 0.154; P = 0.002), weight (rS = 0.493; P < 0.001), length (rS = 0.469; P < 0.001), and BMI (rS = 0.418; P < 0.001). In singletons, the correlation was positive with all the variables, except for the gestational order. The newborn BMI was significantly higher in twins born by C-section than those born by vaginal birth (Z = -4.974; P < 0.001). Mothers of singletons delivered by C-section had a significantly higher BMI than those of singletons born by vaginal birth (Z = -1.642; P < 0.001); however, no significant differences were observed in mothers of twins. Prepregnancy maternal BMI in twin births would not be predictive of newborns weight, length and BMI in this population. Maternal weight gain during pregnancy proved to be the most adequate for predicting the weight, length and BMI of twins delivered by C-section

Twinning rate in a sample from a Brazilian hospital with a high standard of reproductive care.

CONTEXT: Epidemiological studies on twin births have been motivated mostly by the positive correlation between twinning rate and human fertility, prematurity, low birth weight, increased risk of infant death and long term risk for morbidity. OBJECTIVE: This paper intends to estimate the incidence of multiple births in a private hospital in Brazil with a high standard of reproductive care, and to evaluate the effects of maternal age, gestation order and assisted fertilization on twinning rate. DESIGN: Retrospective analysis. SETTING: First-class tertiary private hospital, São Paulo, Brazil. PARTICIPANTS: The multiple birth rate was investigated among 7,997 deliveries from 1995 to 1998, including 7,786 singletons, 193 twins, 17 triplets and one quadruplet. RESULTS: The rates per 1,000 dizygotic and monozygotic pairs and for triplets were estimated as 19.51, 4.50 and 2.13, respectively. The dizygotic and triplet rates were the highest observed in Brazil up to the present day. The twinning rate among primigravidae older than 30 years was very high (45.02 per 1,000) and was due to a disproportionately high frequency of dizygotic pairs. The triplet rate was also very high among the mothers of this age group (5.71 per 1,000). These facts are strong indicators that these women were the ones most frequently submitted to assisted reproductive techniques. The mean maternal age of the studied population was about six years higher than that estimated for mothers in the general population of southeastern Brazil. Primigravidae aged under 30 years as well as multigravidae showed similar twinning rates, which were almost 20 per 1,000. Among the deliveries of multigravidae older than 30 years, an unusually high frequency of monozygotic twins was observed (7.04 per 1,000), probably as a consequence of the residual effect of long-term use of oral contraceptives. CONCLUSIONS: The dizygotic twinning rate increased from 13.51 to 28.98 per 1,000 over the four years studied, with the twinning rate for primigravidae over 30 years old in 1998 being twice that observed in 1995. The mean maternal age was also high during this period, but the extremely high increase in twinning rate observed cannot be attributed solely to this variable. Assisted fertilization seems to be the most probable cause of this unusually high twinning rate.

Risk factors for nosocomial infections in critically ill newborns: a 5-year prospective cohort study.

BACKGROUND: Nosocomial infections (NIs) are one of the most important causes of morbidity in neonatal intensive care units (NICUs). The aim of this study was to identify risk factors (RFs) for NIs among critically ill newborn patients in a Brazilian NICU. METHODS: This 5-year prospective cohort study in an 8-bed NICU included all infants born in the hospital and admitted to the NICU from 1993 to 1997. Exposure variables were maternal and newborn data prospectively collected from patient records. Univariate and multivariate analyses were used to determine independent RFs associated with NIs. RESULTS: Univariate analysis indicated gestational age, congenital abnormality, premature rupture of membranes, maternal illness, birth weight, mechanical ventilation, central venous catheter, total parenteral nutrition, peripheral venous catheter, and length of stay as possible RFs. Multivariate analysis identified 5 independent RFs for NIs: premature rupture of membranes (hazard ratio [HR] = 1.51 [95% CI, 1.15-1.99]), maternal disease (HR = 1.57 [95% CI, 1.18-2.07]), mechanical ventilation (HR = 2.43 [95% CI, 1.67-3.53]), central venous catheter (HR = 1.70 [95% CI, 1.21-2.41]), and total parenteral nutrition (HR = 4.04 [95% CI, 2.61-6.25]). CONCLUSION: The recognition of RFs for NIs is an important tool for the identification and development of interventions to minimize such risks in the NICU.

[Intrauterine growth curves in a high-income population] / Curvas de crescimento intra-uterino de uma população de alto nível socioeconômico.

OBJECTIVE: Growth curves can be used to assess intrauterine growth, to predict diseases in newborns, and to characterize different populations. The objective of this study was to obtain intrauterine growth curves of newborns from the maternity ward of the Hospital Albert Einstein (MAE) and compare them with intrauterine growth curves of a population from California, USA. METHODS: We plotted the growth curves according to weight at birth and gestational age, which was obtained according to information from the mother, after the 32nd week of gestation, between February 1995 and February 1999. We calculated the birth weights for the 10th, 50th, and 90th percentiles by each gestational age and compared them with those presented by California growth curves. RESULTS: The growth curves for the 10th and the 50th percentiles did not differ from the California growth curves. For the 90th percentile, however, the MAE growth curves were lower than those of California. The MAE population presented fewer small-for-gestational age (SGA) and big-for-gestational age (BGA) newborns when assessed according to the California curves. The categories of SGA, normal, and BGA for both male and female newborns indicated a statistically significant relation with the weight gain of mothers. CONCLUSIONS: The two populations assessed in this study were different according to intrauterine growth curves. Further studies should be carried out in order to identify specific factors that may be acting on the MAE population.

[Home blood pressure measurement and ambulatory blood pressure measurement versus office blood pressure measurement]. / Monitorização residencial da pressão arterial e monitorização ambulatorial da pressão arterial versus medida de pressão arterial no consultório.

PURPOSE: To compare both home blood pressure measurement (HBPM) and ambulatory blood pressure monitoring (ABPM) with office blood pressure measurement (OBP); and also to compare the correlation between HBPM and OBP with LVMI (left ventricular mass index). METHODS: Protocol 1--68 hypertensive patients (58 +/- 12 years, 37 females): a) self recorded blood pressure at home in the 7 days; b) recorded the ABPM during 24 hours; and c) the physician recorded blood pressure in the office. Protocol 2-41 hypertensive patients underwent the HBPM, OBP, and BI-dimensional echocardiogram. RESULTS: Protocol 1--OBP (153 +/- 24/96 +/- 13 mmHg) was higher (p < 0.05) than HBPM (133 +/- 18/84 +/- 12 mmHg) and ABPM (137 +/- 17/87 +/- 12 mmHg); Protocol 2--LVMI correlated better with HBPM (r = 0.39/0.49, p < 0.05, systolic and diastolic, respectively) than OBP (r = 0.02/ 0.22, p > 0.05, systolic and diastolic, respectively). CONCLUSION: This study showed that HBPM has a better correlation with LVMI than OBP.

[Relationship between maternal weight gain and birthweight] / Relação entre ganho de peso materno e peso do recém-nascido.

OBJECTIVE: To investigate the influence of gestational weight gain on birthweight of the newborn, in order to clarify if this weight increment results in heavier newborn. METHODS: Retrospective cohort in a tertiary level private institution that attends a high income population of São Paulo - Brazil; inclusion of all the mother-newborn pairs with complete data (2275) in the Cadastro de Informações Perinatais (CIP) in the software EPI 6; from February/95 till June/96.RESULTS: Gestational weight gain between 12 and 20 kg resulted in a greater number of newborn with birthweights between 3000 and 3499g. Pregnancies with a weight gain below or equal 10 kg correlated with newborn of low birthweight (Odds ratio= 1.81; CI= 1.20-2.73; 95% of significance). Gestational gain beneath or equal to 12 kg had a greater risk of a newborn with insufficient weight - 2499< birthweight < 3000g - (Odds ratio= 1.47; CI= 1.19-1.81; 95% of significance). Gestational gain above 16 kg did not correlate with increase in birthweight.CONCLUSIONS: The gestational weight gain of 12 kg is the minimum increase of weight in order that the newborn is over 3000g. The gestational weight gain above 16 kg did not increase birthweight. The high social economic level was not sufficient to avoid low birthweight or insufficient weight at birth.

Surfactant replacement therapy: a multicentric trial comparing two dosage approaches.

In this study the results of two different initial doses (Group A: 200 mg/kg--82 patients; Group B: 100 mg/kg--83 patients) of a porcine surfactant were compared in the treatment of neonatal respiratory distress syndrome. Main entry criteria were: birth weight between 700 and 2,000 grams, need of mechanical ventilation, FiO2 > or = 0.60 to obtain a PaO2 between 50 and 80 mmHg (PaO2/FiO2 < or = 133.3 mmHg) and less than 15 hours of postnatal age. Two further 100 mg/kg doses could be given in both groups at 12 hours interval if FiO2 was > 0.40. Birth weight (Group A: 1,231 +/- 281 g. and Group B: 1,324 +/- 355 g.), gestational age (Group A: 29.9 +/- 2.7 wk. and Group B: 30.6 +/- 2.6 wk.) and Apgar scores were similar in the two groups. Group A had a significantly higher mean PaO2/FiO2 ratio (p < 0.05) after 12 hours--178 (40-506) vs 133 (17-243) mmHg, before receiving a 2nd dose, after 24 hours--180 (17-431) vs 152 (39-360), and in the 3rd day--177 (40-333) vs 124 (24-249) and needed a lower FiO2 (p < 0.05) after 36 hours (0.47 +/- 0.20 vs 0.53 +/- 0.23) and on the 3rd day (0.51 +/- 0.23 vs 0.61 +/- 0.24). The mean peak inspiratory pressure was lower in Group A at 36 hours (17.5 +/- 4.5 vs 20.6 +/- 6.8) after the initial dose (p < 0.05). The time of exposure to high oxygen concentrations (FiO2 > or = 0.40) was lower in Group A--85 (3-643) vs 131 (3-672) hours; p < 0.05). Total amount of phospholipids given per patient was meanly 224 mg in Group A and 144 mg in Group B. Mortality was lower in group A but without significant difference (Group A: 17/82; Group B: 26/83). The analysis of the subgroup of babies with less than 1,500 gr. at birth showed a statistically significant difference in mortality (Group A: 15/70; Group B: 24/56; p < 0.02).

[Surfactant replacement therapy: a multicentric trial comparing two dosage approaches]. / Tratamento com surfactante pulmonar exógeno: um estudo multicêntrico comparativo entre duas diferentes doses iniciais.

This is an interim analysis of a multicentric trial that took place in 7 Neonatal Units to compare two initial doses of exigenous pulmonary surfactant (100 mg/kg and 200 mg/kg of phospholipids)by using a porcine surfactant for the treatment of very severe Hyaline Membrane Disease. The initial higher dose produced better oxigenation of arterial blood, reducing the time in high oxygen concentrations,while retreatments were necessary in less than half of the infants receiving 200 mg/kg as initial dose. The protocol of this study allowed the administration of additional doses only when FiO(2) was equal or greater than 0.40 instead of > 0.21, as in a large study recently published, where the same initial doses were given. This resulted in more than 40% reduction in the amount of surfactant administered,with apparently similar clinical outcome.

Phenobarbital in newborns with neonatal seizures. A study of plasma levels after intravenous administration.

Phenobarbital plasma levels were studied in a group of 25 newborn infants. Phenobarbital was administered i.v. in all cases throughout the study period. The mean loading dose was 19.4 mg/kg, ranging from 16.4 to 20.5, and the mean maintenance dose was 4.0 mg/kg/day, varying from 2.6 to 5.0. We obtained mean plasma levels of 22.9 micrograms/ml, 24 h after administering the loading dose. Mean plasma levels at 4, 7, 14 and 21 days were in the therapeutic range (15-40 micrograms/ml), with only a few cases falling outside of it. There was no difference in plasma phenobarbital levels between term and pre-term infants. Side effects were not seen in infants without a severe neurological impairment prior to drug administration.

Enterocolite necrotizante. Estudo evolutivo de 12 casos. / Necrotizing enterocolitis. Evolutional study of 12 cases

Os autores estudaram retrospectivamente 12 casos de enterocolite necrotizante (ECN) ocorridos em RNs no bercario do Hospital do Servidor Publico Estadual de Sao Paulo (HSPE), no periodo de l/l/77 a 3l/3/79,com o objetivo de analisar os fatores determinantes e as condutas para prevencao e controle desta patologia. Os dados referentes a estes RNs foram comparados aos da literatura, tendo sido feita uma analise estatistica referente a mortalidade do grupo, concluindo-se estar diretamente associada a anoxia perinatal, tempo de rotura de membranas, formula hiperosmolar para alimentacao, acidose metabolica e epoca do diagnostico no Servico. Nao houve relacao com o tipo de parto, idade gestacional, sexo, peso, tratamento cirurgico, aleitamento natural, numero de plaquetas e persistencia de canal arterial. Verificou-se ainda que nos primeiros seis casos da serie a mortalidade foi maior que nos seis ultimos, fato este relacionado com a precocidade do diagnostico e adequacao terapeutica