Transcutaneous bilirubin in exclusively breastfed healthy term newborns up to 12 days of life.

OBJECTIVE: To determine the curve of transcutaneous bilirubin in breastfed term neonates up to 12 days of life. METHODS: In a prospective cohort study, we performed a 12-day evaluation of 223 healthy, exclusively breastfed, appropriate-for-gestational-age neonates who roomed-in for at least 48 hours. Each newborn had forehead transcutaneous bilirubin and body weight measured at the end of 1, 2, 3, 4, 5, 6, 8, 10, and 12 days. Regression analysis was used with bilirubin as a third-degree polynomial function of time. The 25th, 50th, 75th, 90th, and 95th percentile curves were constructed by using the residual mean square for each day. RESULTS: Patients were 46% white, 34% mixed race, and 20% black, the mean birth weight was 3260 g (range: 2560-4090 g), the mean gestational age was 39.4 weeks (range: 37.0-41.9 weeks), 51% were male, 74% were born by vaginal delivery, and 66% had been breastfed since delivery. The mean highest weight loss was 4.7% (range: 1%-12%) at the second or third day, and in most infants the weight returned to the birth weight at the fifth day. With 2007 total bilirubin measurements, bilirubin concentrations reached the 50th percentile level (5.6 mg/dL) at the third and fourth days and returned to the 24-hour level (4.8 mg/dL) at the sixth day. The 95th percentile bilirubin level was 8.2 mg/dL at 24 hours of life, reached 12.2 mg/dL on the fourth day, and declined to 8.5 mg/dL on the 12th day. CONCLUSIONS: The transcutaneous bilirubin curve represents the natural history of bilirubinemia in exclusively breastfed healthy term newborns in the first 12 days of life.

Public conceptions of schizophrenia in urban Brazil : symptom identification and causal attributions.

OBJECTIVE: Little is known about public conceptions of mental disorders in Latin America and the Caribbean. The aim of this article is to assess how the population identifies symptoms of schizophrenia and the causes attributed to this disorder in the city of São Paulo, Brazil. METHOD: A household survey was carried out in 2002 with a probabilistic sample of 500 individuals, residents of São Paulo with ages ranging from 18 to 65. Vignette describing in colloquial language an individual with schizophrenia (according to DSM-IV and ICD-10) was presented together with a structured questionnaire with questions about the vignette. RESULTS: The symptoms of schizophrenia were identified by 23.4% as depression. The term schizophrenia was used in only 2.2% of the responses. A bit more than half of the respondents believed it was a mental illness. The main causes attributed were "drug use" and "isolation". Factors most influencing responses about causes were years of schooling and identification as a mental illness. CONCLUSIONS: Medical-scientific concepts are used less in São Paulo than in other countries. The main causes attributed by the public relate to psychosocial stress. Causes of biological or moral nature are considered less relevant.

Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period.

OBJECTIVE: To assess the neurobehavior of full-term neonates of adolescent mothers exposed to marijuana during pregnancy. STUDY DESIGN: This prospective cross-sectional study included full-term infants within 24 to 72 hours of life born to adolescent mothers at a single center in Brazil. Data on sociodemographic and obstetrical and neonatal characteristics were collected. The mothers underwent the Composite International Diagnostic Interview, and the infants were assessed with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Maternal hair and neonatal meconium were analyzed. Neonates exposed in utero to tobacco, alcohol, cocaine, and/or any other drugs except marijuana were excluded. RESULTS: Of 3685 infants born in the study hospital, 928 (25%) were born to adolescent mothers. Of these, 561 infants met the inclusion criteria and were studied. Marijuana exposure was detected in 26 infants (4.6%). Infants exposed (E) or not exposed (NE) to marijuana differed in the following NNNS variables: arousal (E, 4.05 +/- 1.19 vs NE, 3.68 +/- 0.70), regulation (E, 5.75 +/- 0.62 vs NE, 6.04 +/- 0.72), and excitability (E, 3.27 +/- 1.40 vs NE, 2.40 +/- 1.57). After controlling for confounding variables, the effect of marijuana exposure on these scores remained significant. CONCLUSIONS: Marijuana exposure during pregnancy alters the neurobehavioral performance of term newborn infants of adolescent mothers.

Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality.

CONTEXT: Although the benefits of antenatal corticosteroids have been widely demonstrated in other countries, there are few studies among Brazilian newborn infants. OBJECTIVE: To evaluate the effectiveness of antenatal corticosteroids on the incidence of respiratory distress syndrome and intra-hospital mortality among neonates with a gestational age of less than 34 weeks. TYPE OF STUDY: Cross-sectional. SETTING: A tertiary-care hospital. PARTICIPANTS: Neonates exposed to any dose of antenatal corticosteroids for fetal maturation up to 7 days before delivery, and newborns paired by sex, birth weight, gestational age and time of birth that were not exposed to antenatal corticosteroids. The sample obtained consisted of 205 exposed newborns, 205 non-exposed and 39 newborns exposed to antenatal corticosteroids for whom it was not possible to find an unexposed pair. PROCEDURES: Analysis of maternal and newborn records. MAIN MEASUREMENTS: The primary clinical outcomes for the two groups were compared: the incidence of respiratory distress syndrome and intra-hospital mortality; as well as secondary outcomes related to neonatal morbidity. RESULTS: Antenatal corticosteroids reduced the occurrence of respiratory distress syndrome (OR: 0.33; 95% CI: 0.21-0.51) and the protective effect persisted when adjusted for weight, gestational age and the presence of asphyxia (adjusted OR: 0.27; 95% CI: 0.17-0.43). The protective effect could also be detected through the reduction in the need for and number of doses of exogenous surfactant utilized and the number of days of mechanical ventilation needed for the newborns exposed to antenatal corticosteroids. Their use also reduced the occurrence of intra-hospital deaths (OR: 0.51: 95% CI: 0.38-0.82). However, when adjusted for weight, gestational age, presence of prenatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis and use of mechanical ventilation, the antenatal corticosteroids did not maintain the protective effect in relation to death. With regard to other outcomes, antenatal corticosteroids reduced the incidence of intraventricular hemorrhage grades III and IV (OR: 0.28; 95% CI: 0.10-0.77). CONCLUSIONS: Antenatal corticosteroids were effective in the reduction of morbidity and mortality among premature newborns in the population studied, and therefore their use should be stimulated within our environment.

Reliability of two behavioral tools to assess pain in preterm neonates.

CONTEXT: One of the main difficulties in adequately treating the pain of neonatal patients is the scarcity of validated pain evaluation methods for this population. OBJECTIVE: To analyze the reliability of two behavioral pain scales in neonates. TYPE OF STUDY: Cross-sectional. SETTING: University hospital neonatal intensive care unit. PARTICIPANTS: 22 preterm neonates were studied, with gestational age of 34 +/- 2 weeks, birth weight of 1804 +/- 584 g, 68% female, 30 +/- 12 hours of life, and 30% intubated. PROCEDURES: Two neonatologists (A and B) observed the patients at the bedside and on video films for 10 minutes. The Neonatal Facial Coding System and the Clinical Scoring System were scored at 1, 5, and 10 minutes. The final score was the median of the three values for each observer and scale. A and B were blinded to each other. Video assessments were made three months after bedside evaluations. MAIN MEASUREMENTS: End scores were compared between the observers using the intraclass correlation coefficient and bias analysis (paired t test and signal test). RESULTS: For the Neonatal Facial Coding System, at the bedside and on video, A and B showed a significant correlation of scores (intraclass correlation score: 0.62), without bias between them (t test and signal test: p > 0.05). For the Clinical Scoring System bedside assessment, A and B showed correlation of scores (intraclass correlation score: 0.55), but bias was also detected between them: A scored on average two points higher than B (paired t test and signal test: p < 0.05). For the Clinical Scoring System video assessment, A and B did not show correlation of scores (intraclass correlation score: 0.25), and bias was also detected between them (paired t-test and signal test: p < 0.05). CONCLUSION: The results strengthen the reliability of the Neonatal Facial Coding System for bedside pain assessment in preterm neonates.

Studies on functional and morphological aspects in human multinodular simple goiter tissues.

Samples from 2 different locations within the same euthyroid multinodular goiters (SMG) and normal (N) human thyroids were assayed for their content of DNA, thyroglobulin (Tg), and stable iodine (1271), and determined the response of adenosine 3',5'-cyclic monophosphate (cAMP) to TSH and NaF. Quantitative morphological estimation of histological components in the thyroid was performed and correlated with functional parameters. Regardless the zonal evaluation, in SMG the mean (± SD) DNA content (⧎g/mg tissue) (1.04 ± 0.86) was not statistically different from that in N (1.13 ± 0.21). The mean127I concentration (⧎g/⧎g DNA) in N tissues (0.357 ± 0.091) was greater than that in SMG (0.176 ± 0.074). In these tissues, the Tg mean level (± SD) (⧎g/⧎g DNA) was lower (28.3 ± 21.5) than that in N (75.6 ± 41.1). The mean relative proportion (Vv) of epithelial cells in SMG (range, 6.0-30.6%) was statistically different (p <0.00) from that observed in N tissues (range, 10.4-18.2%). The meanbasal (± SD) cAMP level (pmol/⧎g DNA) in these tissues (0.11 1 ± 0.036) was different (p < 0.05) from that in SMG (0.231 ± 0.026). In response to TSH (10 mU), both SMG and N increased their cAMP contents to 0.454 ± 0.045 and 0.572 ± 0.020, respectively. A further elevation in cAMP levels was observed in N (1.154 ± 0.210) after 75 mU TSH, whereas in SMG tissues, no consistent increase (0.609 ± 0.496) occurred. Goiter and normal thyroid slices were unable to increase their cAMP concentrations in response to NaF in vitro. No correlation was found between functional and morphological data in SMG samples. In contrast, this relation was quite uniform in normal thyroids. The results are concordant with the intrathyroidal pathogenic processes often cited for the heterogeneity in human goiter.