Longitud cráneo raquis: predictora del crecimiento fetal y de la condición trófica del recién nacido / Cranio-spinal length: predictor of fetal growth and the trophic condition of the newborn

RESUMEN Fundamento: la edad y el crecimiento fetal se determinan mediante la longitud céfalo-caudal o cráneo raquis entre las semanas cinco y 10 de la gestación y después se recurre a una combinación de medidas de otras variables biométricas. Objetivo: identificar correlación de las variables biométricas y condición trófica al nacer con la longitud cráneo raquis del primer trimestre. Métodos: se realizó una investigación con diseño analítico longitudinal retrospectivo en la provincia Villa Clara, se recurrió al período comprendido entre enero de 2013 a octubre de 2018. La población estuvo conformada por 6 050 gestantes. La muestra se realizó a través de un muestreo no probabilístico intencional por criterios, constituida por 3 910 gestantes. Se obtuvieron datos de libros, registros de las consultas de genética de áreas de salud seleccionadas. En el análisis, se utilizaron el coeficiente de correlación lineal de Pearson, de Rho de Spearman y diagramas de dispersión. Resultados: existió correlación entre longitud cráneo raquis con las variables y con la condición trófica del recién nacido. Los gráficos que definieron la trayectoria de las variables biométricas desde el segundo trimestre hasta el parto mostraron compactación de los valores hasta la semana 25 y dispersión entre la 25 y la 30 con rasgos diferenciales en las mismas. Conclusiones: la correlación encontrada de la longitud cráneo raquis con las variables biométricas y con la condición trófica del recién nacido demuestra la utilidad del empleo de esta variable en la evolución del embarazo tanto por el obstetra como por el médico general integral; en lo particular en gestantes en las que se sospeche alguna alteración del crecimiento. Los resultados obtenidos motivan a la profundización al subdividir la muestra en subgrupos como las afectadas de diabetes mellitus o hipertensión arterial u otra, porque no existe en la literatura información sobre la misma.

ABSTRACT Background: age and fetal growth are determined by head length or cranial-spinal length between weeks 5 and 10 of gestation and then a combination of measurements of other biometric variables is used. Objective: to identify the correlation of biometric variables and trophic condition at birth with the cranial-spinal length of the first trimester. Methods: an investigation with a retrospective longitudinal analytical design was carried out in Villa Clara province; it was appealed in the period from January 2013 to October 2018. The population consisted of 6050 pregnant women. The sample was made through an intentional non-probabilistic sampling by criteria, consisting of 3 910 pregnant women. Data were obtained from genetics consultation record books from selected health areas. In the analysis, Pearson's linear correlation coefficient, Spearman's Rho, and scatter diagrams were used. Results: there was a correlation between the cranial-spinal length with the variables and with the trophic condition of the newborn. The graphs that defined the trajectory of the biometric variables from the second trimester to delivery showed compaction of the values ​​up to week 25 and dispersion between week 25 and 30 with differential features in them. Conclusions: the correlation found of cranial-spinal length with biometric variables and with the trophic condition of the newborn demonstrates the usefulness of the use of this variable in the evolution of pregnancy by both the obstetrician and the comprehensive general practitioner; particularly in pregnant women in whom some growth alteration is suspected. The results obtained motivate further study by subdividing the sample into subgroups such as those affected by diabetes mellitus or arterial hypertension or another, particularly because there is no information on it in the literature.

Orofacial characteristics of the very low-birth-weight preterm infants

Abstract Objective: To evaluate the orofacial characteristics of very low-birth-weight preterm infants through anthropometric facial measures, orofacial anteroposterior analysis and the relationship between the gum pads. Method: Orofacial examinations was performed in 154 infants, classified into two groups: Group A comprised 54 very low-birth-weight infants who were examined after clinical stabilization and before hospital discharge, and Group B comprised 100 full-term infants. Results: The average anthropometricmeasurements in millimetres for Group A and Group B were as follows: upper third:30.2 and 31.1; middle third: 24.2 and 25.9; lower third: 27.6 and 29.9; facial width: 64.8and 81.4. Regarding the orofacial anteroposterior analysis, the results showed that in99% of these infants, the mandible was in a retrognathic position relative to the maxilla.Group A and Group B had the following distributions of the relationship between thegum pads: overbite-overjet: 43% and 77%; overjet: 39% and 17%; open bite: 15% and3%; end-to-end: 2% and 1%; overbite: both 2%. Conclusion: The very low-birth-weight preterm infants showed the upper third with the highest values in the facialharmony analysis, followed by the lower third and the middle third; and exhibited themandible in a retrognathic position relative to the maxilla, and with overbite-overjet themost prevalent type of gum pad relationship. The study emphasizes the importance of orofacial examination during neonatal hospitalization and the investigation of birth weight and gestational age in a multidisciplinary therapeutic approach that includes orofacial neonatal evaluation and actions that promote oral health, besides foster follow-up studies.

Orofacial characteristics of the very low-birth-weight preterm infants.

OBJECTIVE: To evaluate the orofacial characteristics of very low-birth-weight preterm infants through anthropometric facial measures, orofacial anteroposterior analysis and the relationship between the gum pads. METHOD: Orofacial examinations was performed in 154 infants, classified into two groups: Group A comprised 54 very low-birth-weight infants who were examined after clinical stabilization and before hospital discharge, and Group B comprised 100 full-term infants. RESULTS: The average anthropometricmeasurements in millimetres for Group A and Group B were as follows: upper third:30.2 and 31.1; middle third: 24.2 and 25.9; lower third: 27.6 and 29.9; facial width: 64.8and 81.4. Regarding the orofacial anteroposterior analysis, the results showed that in99% of these infants, the mandible was in a retrognathic position relative to the maxilla.Group A and Group B had the following distributions of the relationship between thegum pads: overbite-overjet: 43% and 77%; overjet: 39% and 17%; open bite: 15% and3%; end-to-end: 2% and 1%; overbite: both 2%. CONCLUSION: The very low-birth-weight preterm infants showed the upper third with the highest values in the facialharmony analysis, followed by the lower third and the middle third; and exhibited themandible in a retrognathic position relative to the maxilla, and with overbite-overjet themost prevalent type of gum pad relationship. The study emphasizes the importance of orofacial examination during neonatal hospitalization and the investigation of birth weight and gestational age in a multidisciplinary therapeutic approach that includes orofacial neonatal evaluation and actions that promote oral health, besides foster follow-up studies.

Potential pregnancy days lost: an innovative measure of gestational age / Dias potenciais de gravidez perdidos: uma medida inovadora da idade gestacional

ABSTRACT In Brazil, the excess of interventions that anticipate childbirth, such as cesarean sections and labor inductions, has resulted in the shortening of pregnancy, with negative consequences on maternal-infant outcomes. This commentary presents a novel way to measure gestational age: the continuous variable "Potential pregnancy days lost." Using data from the Live Birth Information System (SINASC), we counted the missing days between the period until childbirth and the average duration of pregnancy (280 days), or the lost weeks. This measure can be used as an outcome variable (socioeconomic-demographic characteristics of the mother, type of childbirth, financing, etc.) or exposure variable (for neonatal, infant, and maternal outcomes). The indicator can be used in municipal and national cohorts and intervention studies to analyze hospitals and regions. We discuss the limits and scope of gestational age measures and, given their inaccuracies, the importance of studying their trends.

RESUMO No Brasil, o excesso de intervenções que antecipam o parto, como cesarianas e induções, tem resultado no encurtamento da gestação, com consequências negativas nos desfechos materno-infantis. Neste comentário apresentamos uma medida inovadora da idade gestacional que estamos desenvolvendo: a variável contínua "dias potenciais de gravidez perdidos". Utilizando dados do Sistema de Informações de Nascidos Vivos, contamos, quando possível, os dias faltantes entre o período até o nascimento e a duração média da gestação (280 dias), ou então as semanas perdidas. Essa medida pode ser usada como variável desfecho (de características socioeconômico-demográficos da mãe, do tipo de parto, de financiamento etc.) ou de exposição (para desfechos neonatais, infantis e maternos). O indicador pode ser usado em coortes municipais e nacionais e em estudos de intervenção, para analisar hospitais e territórios. Discutimos os limites e alcances das medidas de idade gestacional e, diante de suas imprecisões, a importância de estudar suas tendências.

Birth weight distribution of Hospital Geral do Grajaú population compared to São Paulo city population / Distribuição do peso ao nascer da população do Hospital Geral do Grajaú comparada à da população da cidade de São Paulo

Objective: To compare the growth curves from a population from a large city suburban hospital with those of the city of São Paulo, São Paulo State, Brazil. Methods: At Hospital Geral do Grajaú, that serves the high pregnancy risk population lacking health facilities, of low education level and smaller number of prenatal visits and great morbidity, a growth curve was built for the newborns, as the Hospital is provided with updated equipment and personnel. The curve was built from the database available containing information on live births during the 2003 to 2007 period and totaling 9,952 newborns, as their weight at birth and gestational age were taken as parameters. The distribution curves of 3%, 10%, 50% and 90% of the Grajaú were compared to those of the city of São Paulo curve. Results: The curves did not significantly differ from those of the São Paulo curve percentiles, as shown by the mean deviation (Z score) calculation, notwithstanding the higher rates for prematurity, low weight, teenager mothers and lack of prenatal visits among the Grajaú population as compared to those of São Paulo. Conclusions: The São Paulo city curve showed to be appropriate for the suburban population despite the existing differences.

Objetivo: Comparar a curva de crescimento intrauterino de uma população que se serve de um hospital da região periférica com a curva de crescimento intrauterino da cidade de São Paulo, Brasil. Métodos: O Hospital Estadual do Grajaú serve a uma população com gestação de alto risco, com falta de recursos de saúde, baixo nível de escolaridade, poucas consultas de pré-natal e grande morbidade. O hospital que atende a essa população tem recursos e pessoal especializado, o hospital escola de medicina. A curva foi construída por meio de programa de dados confiáveis que contém informações sobre todos os recém-nascidos vivos durante os anos de 2003 a 2007, totalizando 9.952 recém-nascidos, tomando-se os dados de peso e idade gestacional como parâmetros. As curvas de distribuição de peso para os percentis 3, 10, 50 e 90 para os grupos de idade gestacional foram comparados àqueles da curva da cidade de São Paulo. Resultados: As curvas não diferiram significativamente, como demonstrado pelo cálculo do desvio das médias (Z score), não obstante as taxas de prematuridade, baixo peso, mães adolescentes e falta de consultas ao pré-natal fossem significativamente maiores na população do Hospital Estadual do Grajaú do que na população do município de São Paulo. Conclusões: A curva da cidade de São Paulo se mostrou apropriada para aquela população da periferia da cidade, ainda que existam as diferenças epidemiológicas.

O abandono da consulta de enfermagem por mães adolescentes em um centro de saúde de Belo Horizonte-MG / Lack of compliance to nursing care by adolescent mothers in a Health Center in Belo Horizonte, State of Minas Gerais / Abandono de la consulta de enfermería por madres adolescentes en un Centro de Salud de Belo Horizonte-MG

Trata-se de um estudo exploratório, retrospectivo, realizado no Centro de Saúde São Paulo, Belo Horizonte/MG, que teve como objetivo identificar os motivos que levaram as mães adolescentes a abandonar a consulta de enfermagem direcionada ao acompanhamento do crescimento e desenvolvimento (CD) de seu filho. Participaram do estudo 13 adolescentes. Os dados foram coletados por meio de questionário contendo perguntas abertas e fechadas. Ausência de problemas de saúde na criança (15,38%); dificuldade de remarcação de consultas (23,8%); transferência do controle do CD para o pediatra (15,38%); não remarcação dos retornos (53,84%) e falta de estímulo às mães por parte dos profissionais para dar continuidade ao acompanhamento do CD (23,08%) foram os principais motivos do abandono da consulta de enfermagem pelas mães adolescentes.

This is a retrospective, exploratory study at the São Paulo Health Center in Belo Horizonte, State of Minas Gerais, with the objective of identifying the reasons for the lack of compliance by adolescent mothers to nursing follow up of their children's growth and development. Thirteen adolescents participated in the study. An open-ended questionnaire was used to collect the data. The results showed that 15.38% of the mothers dropped the growth and development nursing follow-up because their children did not have any other health problem; 15.38% because they were referred to doctors; 23.8% because they had difficulties in making appointments; 53.84% because they did not make the follow up appointments; 23.08% because they did not feel motivated enough by the health professionals.

Se trata de un estudio retrospectivo realizado en el Centro de Salud São Paulo, Belo Horizonte, Estado de Minas Gerais, con el objetivo de identificar los motivos que llevaron a las madres adolescentes a abandonar la consulta de enfermería con miras a efectuar el seguimiento de crecimiento y desarrollo (CD) de sus hijos. Participaron de este estudio 13 adolescentes. Los datos se recopilaron por medio de cuestionarios con preguntas abiertas y cerradas. Los principales motivos de las madres adolescentes para abandonar la consulta de enfermería fueron: ausencia de problemas de salud en los niños (15.38%), inconveniencias para volver a marcar consultas (23.8%), transferencias de control de CD al pediatra (15.38%), regresos obligatorios a las consultas que no se vuelven a marcar (53.84%) y madres poco estimuladas por los profesionales para dar continuidad al seguimiento del CD (23.08%)