Tamaño del léxico en niños(as) muy prematuros y prematuros extremos de 24 meses: un estudio transversal / Vocabulary size in very preterm and extremely preterm infants: a cross-sectional study

Las investigaciones muestran que un número importante de niños nacidos prematuros (antes de las 37 semanas de gestación) presentan dificultades en su desarrollo, entre ellas el desarrollo lingüístico. Las investigaciones previas indican que algunas complicaciones biomédicas, como la hemorragia intraventricular (los grados III y IV), la leucomalacia periventricular y la displasia broncopulmonar, incrementan la probabilidad de presentar alteraciones en el desarrollo de la cognición y/o del lenguaje, por lo que se hace necesario realizar investigaciones que proporcionen más información y con ello poder anticiparse a posibles consecuencias en los aprendizajes futuros de estos niños nacidos bajo la condición de prematuridad. Es así, que los objetivos de este estudio fueron medir el tamaño del léxico temprano en niños muy prematuros y prematuros extremos (con y sin complicaciones biomédicas) a los 24 meses de edad corregida, así como también determinar la asociación entre número de complicaciones biomédicas presentes y el tamaño del léxico. Para ello, se trabajó con 108 niños divididos en tres grupos: 39 niños prematuros de alto riesgo (con complicaciones biomédicas), 36 niños prematuros de bajo riesgo (sin complicaciones biomédicas asociadas a alteraciones del lenguaje y /o cognición) y 33 niños nacidos de término. Todos fueron evaluados con el Inventario II de Desarrollo de Habilidades Comunicativas MacArthur-Bates. Los resultados muestran que los niños nacidos de término tienen significativamente mayor tamaño del léxico que los prematuros, no existiendo diferencias en los resultados entre prematuros de bajo riesgo y los prematuros de alto riesgo. Por otra parte, el tamaño del léxico no presenta correlación con las complicaciones biomédicas.

Research shows that a significant number of children born preterm (before 37 weeks of gestation) have developmental difficulties, among them disturbances in language development. Studies indicate that some biomedical complications such as intraventricular hemorrhage (grades III and IV), periventricular leukomalacia, and bronchopulmonary dysplasia increase the probability of cognitive and/or language development disorders. Therefore, there is a need to conduct more studies that provide information that allows anticipating possible consequences in the learning process of children born prematurely. The aims of this study were to measure the early vocabulary size in very preterm and extremely preterm children (with and without biomedical complications) at 24 months of corrected age and to determine the association between the number of biomedical complications and vocabulary size. To that effect, we worked with 108 children divided into three groups: 39 high-risk preterm children (with biomedical complications), 36 low-risk preterm children (without biomedical complications associated with language and/or cognitive disturbances), and 33 full-term children. All children were evaluated using the MacArthur-Bates Communicative Development Inventory II. The results show that the vocabulary size of full-term children is significantly larger than that of preterm children and that no differences exist between the group of high-risk versus low-risk preterm children. On the other hand, vocabulary size does not correlate withbiomedical complications.

Complicaciones en la hemorragia intraventricular del recién nacido, a propósito de un caso / Complications in the intraventricular hemorrhage of the newborn, a propos of a case

RESUMEN La hemorragia interventricular es una complicación frecuente en el recién nacido prematuro. Se presentó el caso con el objetivo de describir las complicaciones en la hemorragia intraventricular en el recién nacido. Se trató de una recién nacida, producto de un embarazo de 30 semanas de gestación, con peso al nacer de 1 600 g. Desarrolló una hemorragia intraventricular e hidrocefalia que requirió diferentes intervenciones neuroquirúrgicas y desarrolló complicaciones sépticas graves. La ventriculitis y los abscesos cerebrales fueron las complicaciones más peligrosas. Se realizaron lavados ventriculares. Se utilizó antibióticos intraventriculares y también antibioticoterapia sistémica, cambios frecuentes de catéter de derivación al exterior y permanencia de una derivación ventricular externa por 102 días. Después de seis meses de evolución, de más de veinte intervenciones quirúrgicas, y de haber sufrido severas complicaciones sépticas, se logró realizar la derivación ventrículo-peritoneal definitiva, lográndose su egreso. Al año de vida, la paciente mantiene un desarrollo psicomotor adecuado (AU).

ABSTRACT The interventricular hemorrhage is a frequent complication in the premature newborn baby. The case was presente with the aim of describing the complications of intraventricular hemorrhage in the newborn baby. It dealed with a female newborn baby, product of a 30 weeks pregnancy, with weight at birth of 1 600 g. She developed intraventricular hemorrhage and hydrocephalus that required different neurosurgical interventions and developed serious septic complications. Ventriculitis and brain abscesses were the most dangerous complications. Ventricular lavages were performed. Intraventricular antibiotics were used as well as systemic antibiotic therapy, frequent changes of bypass catheter to the exterior and permanence of an external ventricular bypass for 102 days. And permanence of an external ventricular shunt for 102 days. After six months of evolution, more than twenty surgical interventions, and having suffered severe septic complications, it was possible to perform the definitive ventricular-peritoneal bypass, achieving her discharge. At a year of life, the patient maintains adequate psychomotor development (AU).

Mínimo manuseio em recém-nascidos prematuros na unidade de terapia intensiva neonatal: estudo observacional / Minimal handling of premature newborns in the neonatal intensive care unit: observational study

Introdução: O mínimo manuseio é realizado para minimizar frequentes procedimentos que ocasionam dor e estresse e a ocorrência de hemorragia peri-intraventricular que podem desencadear agravos ao cérebro em desenvolvimento. Objetivos: Identificar os procedimentos dolorosos e estressantes, o grau de hemorragia peri-intraventricular e as medidas de alívio da dor realizados em recém-nascidos prematuros submetidos aos cuidados de mínimo manuseio nas primeiras 96 horas de vida; Descrever os parâmetros fisiológicos e comportamentais de dor e estresse de recém-nascidos prematuros submetidos aos cuidados de mínimo manuseio, durante a manipulação; Correlacionar os parâmetros fisiológicos e comportamentais de dor e estresse de recém-nascidos prematuros submetidos aos cuidados de mínimo manuseio com o tipo de procedimento realizado na UTIN nas primeiras 96 horas de vida. Método: Trata-se de uma pesquisa quantitativa, do tipo estudo observacional, transversal, realizada na unidade de terapia intensiva neonatal de um instituto da rede pública no munícipio do Rio de Janeiro com amostra de 21 recém-nascidos prematuros. Foi utilizado dois instrumentos de coleta de dados para registro da caracterização do nascimento e para observação do prematuro durante a manipulação aplicados simultaneamente com a escala Perfil de Dor no Recém-Nascido Pré-termo (PIPP) e registrados os sinais de estresse. Resultados: Dos 21 recém-nascidos prematuros, 61,90% pertence ao gênero masculino e apresentaram mediana de idade gestacional ao nascer de 32,0 semanas e de peso ao nascer de 1572,0 gramas. Os procedimentos mais prevalentes observados durante a manipulação foram a inserção da sonda orogástrica, punção de calcâneo e a troca de fralda e observou-se que estes foram realizados sem associação de medidas para alivio da dor. As respostas comportamentais apresentadas foram sobrancelhas salientes 33,33%, olhos espremidos 41,67% e sulco nasolabial 66,67%, mantidos presentes entre 0-9% do tempo conforme escala PIPP. Em relação as respostas fisiológicas, a média da frequência cardíaca máxima foi de 154,0 bpm (DP ± 15,4 bpm), a média da saturação de oxigênio mínima foi de 95,5% (DP ± 3,8%). A pontuação média da escala PIPP foi de 9,1 (DP ± 3,7) durante os procedimentos prevalentes. Durante a manipulação, 80,00% apresentaram sinais de estresse autonômico sendo palidez, moteamento ou pletora e 94,41% apresentaram sinais de estresse motor sendo flacidez facial e de extremidades, hiperextensão de pernas e braços, afastamento de dedos. Estes sinais estiveram associados a inserção da sonda orogástrica e punção de calcâneo. Em relação aos sinais de estresse no controle e atenção, 56,16% apresentaram estados de alerta com choro durante a troca de fralda, punção de calcâneo e punção venosa. Conclusão: Os procedimentos prevalentes foram troca de fralda, punção de calcâneo e inserção da sonda gástrica associados ao estresse e dor sem medidas para seu alívio. Há necessidade de maior vigilância das respostas comportamentais do prematuro a dor e ao estresse, capacitação continua quanto ao protocolo de mínimo manuseio existente na unidade. Apesar do prematuro não ser muito manipulado em quantidade de procedimentos, a duração do procedimento deve ser considerada. A manipulação de forma única é amplamente empregada, quando agrupados haja vista para cuidados contingentes.

Introduction: The minimal handling is performed to minimize frequent procedures that cause pain and stress and the occurrence of peri-intraventricular hemorrhage that can trigger injuries to the developing brain. Objectives: To identify the painful and stressful procedures, level of peri-intraventricular hemorrhage and pain relief measures performed in premature newborns submitted to minimal handling care in the first 96 hours of life; Describe the physiological and behavioral parameters of pain and stress in premature newborns submitted to minimal handling care during manipulation; Correlate the physiological and behavioral parameters of pain and stress in premature newborns submitted to minimal handling care with the type of procedure performed at the NICU in the first 96 hours of life. Method: This is a quantitative, observational, cross-sectional study carried out in the neonatal intensive care unit of a public institute in the city of Rio de Janeiro with a sample of 21 premature newborns. For data collection a form was used for characterization of the participants and a form for recording observations of the infant premature and pain scores using the Preterm Infant Pain Profile (PIPP) scale and signs of stress respectively during procedures at minimal handling. Results: Of the 21 infants premature, 61.90% belong to the male gender, had a median gestational age, at birth, of 32.0 weeks and a birth weight of 1572.0 grams. The prevalent procedures observed during manipulation were the insertion of the orogastric tube, heel puncture and diaper change. Most of the procedures were performed without association of measures for pain relief. The behavioral responses presented were raised eyebrows 33.33%, squeezed eyes 41.67% and nasolabial fold 66.67%, kept present between 0-9 % of the time according to the PIPP scale. Regarding physiological responses, the mean maximum heart rate was 154.0 bpm (SD ± 15.4 bpm), the mean minimum oxygen saturation was 95.5% (SD ± 3.8%). The mean score on the PIPP scale was 9.1 (SD ± 3.7), during the prevalent procedures. During manipulation, 80.00% showed signs of autonomic stress like pallor, mottling, or plethora and 94.41% showed signs of motor stress such as facial and extremity flaccidity, hyperextension of legs and arms, and toes apart. These signs were associated with insertion of the orogastric tube and heel puncture. Regarding the signs of stress in control and attention, 56.16% presented alert states with crying during diaper change, heel puncture and venipuncture. Conclusion: The prevalent procedures were diaper chang, calcaneus puncture and insertion of the gastric tube associated to stress and pain without measures for their relief. There is a need for greater surveillance of behavioral responses to premature pain and stress, training continues regarding the minimal handling protocol in the unit. Although the preterm infant is not handled in a large number of procedures, the duration of the procedure should be considered. Single handling is widely used, when grouped for contingent care.

Riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica, Lima, Perú / Risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis Lima, Peru

RESUMEN Objetivos: Evaluar el riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH). Materiales y métodos: Se realizó un estudio de cohortes en el Hospital Cayetano Heredia, durante el 2015. Fueron incluidos prematuros menores de 34 semanas que tuvieran examen histopatológico de la placenta. Los tipos de CAH evaluados fueron subcorionitis, corionitis, corioamnionitis, con o sin funisitis. El daño cerebral se evaluó en tres periodos de edad, entre 0 y 7 días, entre 7 y 30 días y a las 40 semanas gestacionales corregidas. Se realizó un seguimiento neurológico y controles con ecografía cerebral. Resultados: Se estudiaron 85 prematuros, 47,1% eran mujeres y la media de la edad gestacional fue de 30,9 semanas. El 42% (36/85) nacieron expuestos a CAH. La ruptura prematura de membrana fue la principal generatriz de sepsis, y la sepsis se relacionó con daño neurológico. La CAH estuvo asociada con hemorragia intraventricular (HIV) durante la primera semana y con lesiones de la sustancia blanca entre los 7 y 30 días de edad (p = 0,035). El tipo corioamnionitis de CAH se asoció al daño neurológico durante la primera semana (RR = 2,11; IC 95%: 1,09-4,11) y entre los 7 y 30 días de vida (RR = 2,72; IC 95%: 1,07-6,88). Conclusiones: La corioamnionitis fue un factor de riesgo para desarrollar lesiones cerebrales en prematuros menores de 34 semanas, para HIV durante los primeros 7 días y lesiones de sustancia blanca entre los 7 y los 30 días de edad. A las 40 semanas de edad corregida, los prematuros extremos con CAH tuvieron lesiones cerebrales más extensas.

ABSTRACT Objectives: To assess the risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis (HCA). Materials and methods: A cohort study was conducted at the Hospital Cayetano Heredia, during 2015. Premature infants under 34 weeks of gestational age, who had histopathological examination of the placenta, were included. The types of HCA evaluated were sub-chorionitis, chorionitis, chorioamnionitis, with or without funisitis. Brain damage was evaluated in three age periods, between 0 and 7 days, between 7 and 30 days and at 40 weeks of corrected gestational age. A neurological follow-up and regular controls were performed with brain ultrasound. Results: A total of 85 premature infants were included, 47.1% were women and the mean gestational age was 30.9 weeks. From the total, 42% (36/85) were born exposed to HCA. Premature rupture of membranes was the main cause of sepsis, which was related to neurological damage. HCA was associated with intraventricular hemorrhage (IVH) during the first week and with white matter lesions between 7 and 30 days of age (p = 0.035). The chorioamnionitis type of HCA was associated with neurological damage during the first week (RR = 2.11, 95% CI: 1.09-4.11) and between 7 and 30 days of age (RR = 2.72, 95% CI: 1.07-6.88). Conclusions: Chorioamnionitis was a risk factor for developing brain injuries in premature infants under 34 weeks of gestational age. It was also a risk factor for HIV during the first 7 days and for white matter injuries between 7 and 30 days of age. At 40 weeks of corrected gestational age, extreme premature infants with HCA had more extensive brain damage.

Aspectos desconocidos de la relación entre el sistema de grupo sanguíneo ABO y las morbilidades en prematuros / Unknown aspects of the relationship between ABO blood group system and preterm morbidities

Objetivos. Se ha demostrado, en diversos estudios llevados a cabo en adultos, que los grupos sanguíneos desempeñan un papel importante en muchas enfermedades. El objetivo fue investigar si hay una relación entre las morbilidades y el sistema de grupos sanguíneos ABO en lactantes prematuros.Metodología. En este estudio de cohorte retrospectivo, se incluyó a recién nacidos prematuros que habían nacido con menos de 32 semanas de gestación y con un peso al nacer inferior a 1500 g. Se los agrupó por grupo sanguíneo (0, A, B, AB) y por morbilidades de la prematurez y se los comparó.Resultados. Se analizaron los datos de 1785 recién nacidos prematuros de muy bajo peso al nacer. La comparación entre los grupos sanguíneos A y no A reveló que los lactantes de grupo sanguíneo A tenían una incidencia más alta de conducto arterial persistente (CAP) (48,7 % frente a 39,7 %, p = 0,005) y displasia broncopulmonar (DBP) (27 % frente a 20,8 %, p = 0,04), mientras que la incidencia de la hemorragia intraventricular de grado ≥3 era más baja (5,1 % frente a 10,1 %, p = 0,006).Conclusión. Este estudio es la primera y más grande investigación sobre la relación entre los grupos sanguíneos y las morbilidades en los prematuros. Con estos resultados se demuestra que el grupo sanguíneo A podría ser un factor de riesgo de CAP y DBP

Objectives. Blood groups have been shown to play an important role in a lot of diseases in various studies conducted in adults. The objective was to investigate whether there is a relationship between morbidities and ABO blood groups system in preterm infants.Methodology. This retrospective cohort study included preterm neonates born at < 32 weeks of gestation with a birth weight < 1500 g. Neonates were grouped by blood type (O, A, B, AB) and morbidities of prematurity were compared among these groups. Results. Data pertaining to 1785 very low birth weight preterm neonates were analyzed. Comparison of the A and non-A blood groups revealed that infants with blood group A had significantly higher incidence of patent ductus arteriosus (PDA) (48.7 % vs. 39.7 %, p = 0.005) and bronchopulmonary dysplasia (BPD) (27 % vs. 20.8 %, p = 0.04), while the incidence of grade ≥ 3 intraventricular hemorrhage was lower (5.1 % vs. 10.1 %, p = 0.006).Conclusion. This study represents the first and biggest series examination of the relationship between blood groups and preterm morbidities. Our results show that blood group A may be a risk factor for PDA and BPD.

Anterior Communicating Artery Aneurysm Uncommon Hemorrhagic Presentation: Case Report

Intracranial aneurysm rupture causes subarachnoid hemorrhage in 80% of the cases, and it may be associated with intracerebral hemorrhage and/or intraventricular hemorrhage (IVH) in 34% and 17% of the patients, respectively. However, on rare occasions, aneurysm rupturemay be present causing isolate intracerebral hemorrhage or IVH without subarachnoid hemorrhage. We describe an unusual case of an anterior communicating aneurysm rupture presented with IVH, without subarachnoid hemorrhage. Although isolated IVH is rare, aneurysm rupture is a possible condition. Patients presenting with head computed tomography revealing IVH without subarachnoid hemorrhage should be promptly investigated with contrasted image exam to identify and treat possible causes, even in the absence of subarachnoid hemorrhage.

Investigation of the relationship between umbilical cord pH and intraventricular hemorrhage of infants delivered preterm

SUMMARY OBJECTIVE: We measured the level of pH gases in premature infants at birth, and examined the relationship between brain ultrasonography on the third and seventh day after birth. A case-control study conducted at the Neonatal Intensive Care Unit (NICU) of Shahid Akbar Abadi Hospital, Iran, during the years 2016-2017. METHODS: All premature infants who were admitted to NICU were enrolled in the current study. At birth, a blood gas sample was taken from the umbilical cord of the infants. On the third and seventh day after birth, an ultrasound of the brain of each neonate was performed by a radiologist. The umbilical cord was evaluated for blood gases in 72 neonates (mostly boys). RESULTS: Sixty-six newborns had normal sonography, and 16.7% (12 cases) had anomalies. A total of 75% of the 8 infants with intravenous bleeding were girls, which were significantly different from those in the non-hemodynamic group (62.5% male) (P 0.049). However, the type of delivery, mean weight, height, head circumference, the circumference of the chest, and Apgar score did not differ between the two groups. Mean pH, HCO3- and PCO2 in umbilical cord blood gas samples were not significantly different between the two groups with or without intraventricular hemorrhage (IVH). Although it was not related to gender and type of delivery in newborns CONCLUSION: Blood gases do not help in determining the occurrence of IVH in infants. Nevertheless, it is associated with immaturity and fetal age.

RESUMO OBJETIVOS: Medimos o nível de gases de pH em bebês prematuros, no nascimento dos neonatos, e examinamos a relação entre a ecografia cerebral no terceiro e no sétimo dia após o nascimento. Um estudo de casos e controles realizados na Unidade de Cuidados Intensivos Neonatais (UCIN) do Hospital Shahid Akbar Abadi durante os anos de 2016-2017, Irã. MÉTODOS: Todos os recém-nascidos prematuros que deram entrada na UCIN foram inscritos no estudo atual. Ao nascer, foi retirada uma amostra de gás em sangue, do sangue do cordão umbilical dos bebês. No terceiro e sétimo dia após o nascimento, um radiologista realizou uma ecografia do cérebro de cada neonato. O cordão umbilical foi avaliado para detectar gases no sangue em 72 neonatos (em sua maioria do sexo masculino). RESULTADOS: Sessenta e seis recém-nascidos tinham ecografia normal e 16.7% (12 casos) tinham anomalias. 75% das 8 crianças com hemorragia intravenosa eram meninas, que foram significativamente diferentes das do grupo não hemodinâmico (62.5% homens) (P.0.049). Contudo, o tipo de parto, o peso médio, a altura, o perímetro cefálico, a circunferência do tórax e a pontuação de Apgar não foram diferentes entre os grupos. O pH médio, HCO3 e PCO2 nas amostras de gás no sangue do cordão umbilical não foram significativamente diferentes entre dois grupos com ou sem hemorragia intraventricular (Hiv). Apesar de não estar relacionado com o gênero e o tipo de parto em recém-nascidos. Conclusão: os gases sanguíneos não ajudam a determinar o aparecimento de Hiv nos bebês. Contudo, está associado com a imaturidade e idade fetal.

Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age / Hemorragia intraventricular de baixo grau e neurodesenvolvimento aos 24 meses de idade

AIMS: To evaluate the impact of low-grade intraventricular hemorrhage on neurodevelopmental outcome in preterm infants at 24 months of age. METHODS: We conducted a retrospective case-control study of infants with gestational age less than 34 weeks, admitted to a Neonatal Intensive Care Unit between January/2006 and December/2015. Cases were defined as those with low-grade intraventricular hemorrhage (grades I or II), diagnosed by cranial ultrasonography. For each case, a control with the same gestational age but without intraventricular hemorrhage was selected. Follow-up examinations of neurodevelopment were performed at 24 months of age in cases and controls using the Griffiths Mental Development Scale. Cerebral palsy, neurodevelopmental delay (developmental quotient <2 side deviations below the mean), hearing impairment and/or blindness were considered as severe neurodevelopmental impairment. RESULTS: The study included 172 preterm infants: 86 cases and 86 controls. In the univariate analysis, a difference between the two groups was identified for the following clinical findings: antenatal corticosteroid complete cycle (57% in cases vs. 80% in controls; p=0.001; OR: 0.33, 95%CI 0.17-0.64); male gender (63% cases vs. 41% controls; p=0.004; OR: 2.45, 95%CI 1.3-4.5); outborn (26% cases vs. 9% controls; p=0.005; OR: 3.3 95%CI 1.4-8.0); Clinical Risk Index for Babies higher than 5 (24% in cases vs. 12% in controls; p=0.029; OR: 2.4 95%CI 1.1-5.6); intubation in the delivery room (47% cases vs. 27% controls; p=0.007; OR: 2.38 95%CI 1.3-4.5); and neonatal sepsis (34% in cases vs. 20% in controls; p=0.039; OR: 2.1 95%CI 1.03-4.1). After logistic regression, differences were only maintained for antenatal corticosteroid (p=0.005; OR 0.34, 95%CI 0.16-0.72) and male gender (p=0.002; OR 2.9, 95%CI 1.4-5.8). A severe neurodevelopmental deficit was present in three cases (3.5%) and one control (1.2%). No statistically significant differences in outcome were found between cases and controls. CONCLUSIONS: In this sample, preterm infants with low-grade intraventricular hemorrhage diagnosed by cranial ultrasonography had no difference in early neurodevelopmental outcome when compared with controls.

OBJETIVOS: Avaliar o impacto da hemorragia intraventricular de baixo grau no neurodesenvolvimento de lactentes prematuros aos 24 meses de idade. MÉTODOS: Foi conduzido um estudo de caso-controle retrospectivo em lactentes com idade gestacional inferior a 34 semanas, internados em uma Unidade de Terapia Intensiva Neonatal entre janeiro de 2006 e dezembro de 2015. Os casos foram definidos como aqueles com hemorragia intraventricular de baixo grau (graus I ou II), diagnosticada por ultrassonografia craniana. Para cada caso, foi selecionado um controle com a mesma idade gestacional, mas sem hemorragia intraventricular. A avaliação do neurodesenvolvimento foi realizada aos 24 meses de idade, em casos e controles, com a Escala de Desenvolvimento Mental de Griffiths. Paralisia cerebral, atraso no neurodesenvolvimento (quociente de desenvolvimento <2 desvios padrões abaixo da média para a idade), deficiência auditiva e/ou cegueira foram considerados comprometimento grave do neurodesenvolvimento. RESULTADOS: O estudo incluiu 172 prematuros: 86 casos e 86 controles. Na análise univariada, identificou-se diferença entre os dois grupos para os seguintes achados clínicos: ciclo completo de corticosteroide pré-natal (57% nos casos vs. 80% nos controles; p=0,001; OR: 0,33; IC95% 0,17-0,64); sexo masculino (63% casos vs. 41% controles; p=0,004; OR: 2,45, IC95% 1,3-4,5); nascidos em outro hospital (26% casos vs. 9% controles; p=0,005; OR: 3,3 IC95% 1,4-8,0); Índice de Risco Clínico para Bebês acima de 5 (24% nos casos vs. 12% nos controles; p=0,029; OR: 2,4 IC95% 1,1-5,6); intubação na sala de parto (47% casos vs. 27% controles; p=0,007; OR: 2,38; IC95%: 1,3-4,5); e sepse neonatal (34% nos casos vs. 20% nos controlos; p=0,039; OR: 2,1 95% CI 1,03-4,1). Após a regressão logística, as diferenças foram mantidas apenas para o corticosteróide antenatal (p=0,005; OR 0,34, IC 95% 0,16-0,72) e sexo masculino (p=0,002; OR 2,9, IC95% 1,4-5,8). Um déficit grave de neurodesenvolvimento esteve presente em três casos (3,5%) e um controle (1,2%). Não houve diferenças estatisticamente significativas no desfecho entre casos e controles. CONCLUSÕES: Nesta amostra, os prematuros com hemorragia intraventricular de baixo grau diagnosticados pela ultrassonografia craniana não apresentaram diferença no desenvolvimento neurológico precoce quando comparados aos controles.

Incidencia de la hemorragia intraventricular en prematuros de muy bajo peso y sus factores asociados en un hospital nacional de Lima, Perú / Incidence of intraventricular hemorrhage in very low birth weight preterm infants and associated factors at a national hospital in Lima, Peru

Objetivos: Determinar la incidencia de hemorragia intraventricular (HIV) en un hospital nacional y los factores asociados. Material y métodos: Estudio Caso-control, retrospectivo, en una cohorte anidada desde julio 2010 hasta abril 2012. El diagnóstico se realizó por ecografía cerebral. Resultado: La incidencia anual general fue 33,53%. En las primeras 72 horas, la incidencia anual fue 17,23 % y el factor asociado fue la edad gestacional ≤ 28 semanas (OR: 2,41, IC: 1,10-5,34). La incidencia anual de HIV después de las 72 h hasta el séptimo día fue 16,30% y los factores asociados fueron: las complicaciones del soporte ventilatorio, como hipercapnia, neumotórax, hipocapnia y atelectasia (OR: 4,33, IC: 1,26-14,81). Conclusión: La incidencia anual general fue alta, y el factor asociado encontrado en las primeras 72 horas fue la menor edad gestacional y después de las 72 horas fueron las complicaciones del soporte ventilatorio. (AU)

Objectives: Determine the incidence of intraventricular hemorrhage (IH) in a national hospital and its associated factors. Methods: Nested case-control study conducted from July 2010 to April 2012. Diagnosis was confirmed by cerebral ultrasound. Results: Overall annual incidence was 33.53%. During the first 72 hours, the annual incidence was 17.23%, and the associated factor was gestational age ≤ 28 weeks (OR: 2.41, IC: 1.10-5.34). Annual incidence of IH from 72 hours to 7 days was 16.30%, and associated factors were ventilatory support complications such as hypercapnia, pneumothorax, hypocapnia and atelectasis (OR: 4.33, IC: 1.26-14.81). Conclusion: The overall annual incidence of IH was high. Low gestational age was associated with IH in the first 72 hours, while complications of ventilatory support were associated with IH after 72 hours. (AU)