Our estimates of neonatal radiation exposure fall short of reality.

The purpose of this study is to evaluate radiation exposure in newborns undergoing imaging tests during the first 30 days of neonatal intensive care unit (NICU) hospitalization. A retrospective cohort study was conducted from November 2018 to April 2019 with newborns admitted to the NICU. Thermoluminescent dosimeters (TLD-100™) measured radiation emitted during imaging exams over 1 month, with a comparison between measured and estimated radiation. The cohort exhibited a median gestational age of 33.0 (31.0, 37.0) weeks, a median birth weight of 1840 (1272, 2748) g, and a median length of stay of 25.5 (11.7, 55.0) days. Eighty-four patients underwent 314 imaging tests, with an estimated radiation dose (ERD) per patient of 0.116 mSv and a measured radiation dose (MDR) of 0.158 mSv. ERD consistently underestimated MDR, with a mean difference of -0.043 mSv (-0.049 to -0.036) in the Bland-Altman analysis. The regression equation was as follows: difference MRD - ERD = -1.7 × (mean (MRD + ERD)) + 0.056. The mean estimated radiation dose per exam was 0.030 mSv, and the chest X-rays accounted for 63.26% of total exams. The median number of radiographic incidences per patient was 2 (1, 4), with 5 patients undergoing three or more exams in a single day. CONCLUSION: Radiation exposure in these newborns was underestimated, emphasizing the need for awareness regarding associated risks and strict criteria for requesting radiological exams. Lung ultrasound is a radiation-free and effective option in managing respiratory diseases in newborns, reducing the reliance on chest X-rays. WHAT IS KNOWN: • Radiation used in diagnostic exams is not risk-free. • Radiation risk is much higher in small Infants due to the exposure area and the prolonged expectance of life. WHAT IS NEW: • Radiation exposure is underestimated in the neonatal population. • The study found a mean radiation exposure in neonates about 5% of the mean annual dose in the general population.

Gestational Diabetes in the Population Served by Brazilian Public Health Care. Prevalence and Risk Factors.

OBJECTIVE: To assess the prevalence of gestational diabetes mellitus and the main associated risk factors in the population served by the Brazilian Unified Health System in the city of Caxias do Sul, state of Rio Grande do Sul. MATERIALS AND METHODS: A descriptive, cross-sectional and retrospective study was conducted. Maternal variables were collected from the medical records of all pregnant women treated at the basic health units in 2016. Hyperglycemia during pregnancy (pregestational diabetes, overt diabetes and gestational diabetes mellitus) was identified by analyzing the results of a 75-g oral glucose tolerance test, as recommended by the Brazilian Ministry of Health. Based on the data, the women were allocated into two groups: the gestational diabetes group and the no gestational diabetes group. RESULTS: The estimated prevalence of gestational diabetes among 2,313 pregnant women was of 5.4% (95% confidence interval [95%CI]: 4.56-6.45). Pregnant women with 3 or more pregnancies had twice the odds of having gestational diabetes compared with primiparous women (odds ratio [OR] = 2.19; 95%CI: 1.42-3.37; p < 0.001). Pregnant women aged 35 years or older had three times the odds of having gestational diabetes when compared with younger women (OR = 3.01; 95%CI: 1.97-4.61; p < 0.001). Overweight pregnant women were 84% more likely to develop gestational diabetes than those with a body mass index lower than 25 kg/m2 (OR = 1.84; 95%CI: 1.25-2.71; p = 0.002). A multivariable regression analysis showed that being overweight and being 35 years old or older were independent variables. CONCLUSION: In this population, the prevalence of gestational diabetes mellitus was of 5.4%. Age and being overweight were predictive factors for gestational diabetes.

OBJETIVO: Avaliar a prevalência de diabetes mellitus gestacional, e dos principais fatores de risco associados, em população usuária do Sistema Único de Saúde em Caxias do Sul-RS. MéTODOS: Um estudo descritivo, transversal e retrospectivo foi feito. As variáveis maternas foram coletadas de registros de prontuários de todas gestantes atendidas nas Unidades Básicas de Saúde do município em 2016. A identificação de hiperglicemia na gestação (diabetes pré-gestacional, diabetes identificado durante a gestação e diabetes mellitus gestacional) foi feita pela avaliação dos resultados do teste oral de tolerância com 75 g glicose, conforme preconizado pelo Ministério da Saúde. Com base nesses dados, as gestantes foram separadas em dois grupos: o grupo com diabetes gestacional e o grupo sem diabetes gestacional. RESULTADOS: A prevalência estimada de diabetes gestacional em 2.313 gestantes foi de 5,4% (intervalo de confiança de 95% [IC95%]: 4,56­6,45). Gestantes com 3 ou mais gestações apresentaram chance 2 vezes maior para a ocorrência de diabetes gestacional, quando comparadas às primigestas (razão de possibilidades [RP] = 2,19; IC95%: 1,42- 3,37; p < 0,001). Gestantes com idade de 35 anos ou mais apresentaram chance três vezes maior do que as mais jovens (RP = 3,01; IC95%: 1,97­4,61; p < 0,001). A chance de desenvolver diabetes gestacional em gestantes com sobrepeso foi 84% maior do que a das com índice de massa corporal inferior a 25 kg/m2 (RP = 1,84; IC95%: 1,25­2,71; p = 0,002). A análise de regressão multivariada mostrou sobrepeso e idade materna como variáveis com associação independente. CONCLUSãO: Nesta população, a prevalência de diabetes mellitus gestacional foi de 5,4%. Idade materna e sobrepeso pré-gestacional foram fatores preditivos para diabetes gestacional.

[Impact of vaginal delivery after a previous cesarean section on perinatal outcomes]. / Impacto do parto vaginal após uma cesárea prévia sobre os resultados perinatais.

PURPOSE: To analyze the impact of vaginal delivery after a previous cesarean section on perinatal outcomes. METHODS: Case-control study with selection of incident cases and consecutive controls. Maternal and perinatal variables were analyzed. We compared secundiparas who had a vaginal delivery after a previous cesarean delivery (VBAC) (n=375) with secundiparas who had a second cesarean section (CS) (n=375). Inclusion criteria were: secundiparas who underwent a cesarean section in the previous pregnancy; singleton and term pregnancy; fetus in vertex presentation, with no congenital malformation; absence of placenta previa or any kind of bleeding in the third quarter of pregnancy. RESULTS: The rate of vaginal delivery was 45.6%, and 20 (5.3%) women had forceps deliveries. We found a significant association between VBAC and mothers younger than 19 years (p<0.01), Caucasian ethnicity (p<0.05), mean number of prenatal care visits (p<0.001), time of premature rupture of membranes (p<0.01), labor duration shorter than 12 hours (p<0.04), Apgar score lower than seven at 5th minute (p<0.05), fetal birth trauma (p<0.01), and anoxia (p<0.006). In the group of newborns delivered by cesarean section, we found a higher frequency of transient tachypnea (p<0.014), respiratory disorders (p<0.048), and longer time of stay in the neonatal intensive care unit (p<0.016). There was only one case of uterine rupture in the VBAC group. The rate of neonatal mortality was similar in both groups. CONCLUSIONS: Vaginal delivery in secundiparas who had previous cesarean sections was associated with a significant increase in neonatal morbidity. Further studies are needed to develop strategies aimed at improving perinatal results and professional guidelines, so that health care professionals will be able to provide their patients with better counseling regarding the choice of the most appropriate route of delivery.

[Perinatal factors associated with pH<7.1 in umbilical artery and Apgar 5 min <7.0 in term newborn]. / Fatores perinatais associados a recém-nascidos de termo com pH<7.1 na artéria umbilical e índice de Apgar <7.0 no 5º minuto.

PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7.0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.