Low birth weight as a marker of changes in ambulatory blood pressure monitoring.

BACKGROUND: Low birth weight (LBW) is associated with increased incidence of high blood pressure (BP) and cardiovascular diseases in adulthood. OBJECTIVE: To evaluate possible changes in Ambulatory Blood Pressure Monitoring (ABPM) in LBW children. METHODS: The birth weight (BW) of 1049 school children (ages 8 to 11) living in Goiânia was assessed. Children with low birth weight (BW or= 3.0 Kg). Information on birth weight was obtained from each child's health card. Casual BP and ABPM were measured. Height and weight measurements were obtained to calculate the body mass index (BMI), and sexual maturity was assessed according to Tanner's criteria (those at Tanner stage >or= 2 were excluded). RESULTS: Thirty-four children had low birth weight (LBW) and 34 had normal birth weight (NBW). Both groups were similar regarding age, gender, race, body weight, height, BMI, and family history of hypertension. Low-birth-weight children had higher casual systolic blood pressure (SBP) (p = 0.007). ABPM recordings showed that these children had higher 24-hour diastolic blood pressure (DBP) (p = 0.009), daytime DBP (p = 0.002), night-time DBP and SBP (p = 0.005 and p = 0.001), and reduced nocturnal dip in SBP and DBP (p = 0.001) than those born with normal weight. Birth weight was positively correlated with nocturnal dip in SBP (p = 0.022) and negatively correlated with sleep SBP (p = 0.032). CONCLUSION: Low-birth-weight children have higher BP and changes in circadian rhythm of blood pressure, with reduced nocturnal dipping. These findings may reflect increased risk of adult hypertension and cardiovascular diseases.

Baixo peso ao nascer como marcador de alterações na monitorização ambulatorial da pressão arterial / Bajo peso al nacer como marcador de alteraciones en el monitoreo ambulatorio de la presión arterial / Low birth weight as a marker of changes in ambulatory blood pressure monitoring

FUNDAMENTO: O baixo peso ao nascimento (BPN) está associado com aumento da pressão arterial (PA) e de doenças cardiovasculares no adulto. OBJETIVO: Avaliar as possíveis alterações na monitorização ambulatorial da pressão arterial (MAPA) em crianças com BPN. MÉTODOS: Avaliou-se o peso ao nascimento (PN) de 1.049 crianças, entre 8 e 11 anos, em escolas de Goiânia. Aquelas com BPN (PN < 2,5 kg) foram comparadas com crianças com peso ao nascimento normal - PNN (PN > 3,0 kg). O PN foi obtido no cartão da criança. Avaliaram-se PA casual e MAPA. Após a obtenção do peso e da estatura para cálculo do índice de massa corpórea (IMC), realizou-se avaliação da maturação sexual segundo os critérios de Tanner (excluídos Tanner >2). RESULTADOS: Obtiveram-se 34 crianças com BPN e 34 com PNN. Os grupos foram semelhantes quanto a idade, sexo, raça, peso, estatura, IMC e história familiar de hipertensão. As crianças com BPN apresentaram maior pressão sistólica (PS) casual (p = 0,007). Na MAPA, apresentaram maior pressão diastólica (PD) nas 24 horas (p = 0,009), maior PD de vigília (p = 0,002), maiores PS e PD no sono (p = 0,005 e p = 0,001) e menor descenso noturno da PS e PD (p = 0,001) do que as com PNN. Observou-se uma correlação positiva do PN com o descenso noturno da PS (p = 0,022) e negativa com a PS no sono (p = 0,032). CONCLUSÃO: As crianças com BPN apresentaram PA mais elevada e alteração do ritmo circadiano da pressão arterial, com atenuação do descenso noturno. Esses achados podem representar um risco aumentado para a hipertensão arterial e doença cardiovascular no adulto.

BACKGROUND: Low birth weight (LBW) is associated with increased incidence of high blood pressure (BP) and cardiovascular diseases in adulthood. OBJECTIVE: To evaluate possible changes in Ambulatory Blood Pressure Monitoring (ABPM) in LBW children. METHODS: The birth weight (BW) of 1049 school children (ages 8 to 11) living in Goiânia was assessed. Children with low birth weight (BW < 2.5 Kg) were compared with those of normal birth weight (BW > 3.0 Kg). Information on birth weight was obtained from each child's health card. Casual BP and ABPM were measured. Height and weight measurements were obtained to calculate the body mass index (BMI), and sexual maturity was assessed according to Tanner's criteria (those at Tanner stage > 2 were excluded). RESULTS: Thirty-four children had low birth weight (LBW) and 34 had normal birth weight (NBW). Both groups were similar regarding age, gender, race, body weight, height, BMI, and family history of hypertension. Low-birth-weight children had higher casual systolic blood pressure (SBP) (p = 0.007). ABPM recordings showed that these children had higher 24-hour diastolic blood pressure (DBP) (p = 0.009), daytime DBP (p = 0.002), night-time DBP and SBP (p = 0.005 and p = 0.001), and reduced nocturnal dip in SBP and DBP (p = 0.001) than those born with normal weight. Birth weight was positively correlated with nocturnal dip in SBP (p = 0.022) and negatively correlated with sleep SBP (p = 0.032). CONCLUSION: Low-birth-weight children have higher BP and changes in circadian rhythm of blood pressure, with reduced nocturnal dipping. These findings may reflect increased risk of adult hypertension and cardiovascular diseases.

FUNDAMENTO: El bajo peso al nacer (BPN) está asociado al aumento de la presión arterial (PA) y de enfermedades cardiovasculares en el adulto. OBJETIVO: Evaluar las posibles alteraciones en el monitoreo ambulatorio de la presión arterial (MAPA) en niños con BPN. MÉTODOS: Se evaluó el peso al nacer (PN) de 1.049 niños, entre 8 y 11 años, en escuelas de la ciudad de Goiânia. Aquellos con BPN (PN < 2,5 kg) se compararon con niños con peso normal al nacer - PNN (PN > 3,0 kg). El PN se obtuvo en la tarjeta del niño. Se evaluaron la PA casual y el MAPA. Tras la medición del peso y de la estatura para cálculo del índice de masa corpórea (IMC), se evaluó la maduración sexual según los criterios de Tanner (excluidos Tanner >2). RESULTADOS: Se obtuvo un total de 34 niños con BPN y 34 con PNN. Los grupos fueron semejantes relación a la edad, sexo, raza, peso, estatura, IMC e historia familiar de hipertensión. Los niños con BPN presentaron mayor presión sistólica (PS) casual (p = 0,007). En el MAPA, presentaron mayor presión diastólica (PD) en las 24 horas (p = 0,009), mayor PD de vigilia (p = 0,002), mayores PS y PD en el sueño (p = 0,005 y p = 0,001) y menor descenso nocturno de la PS y PD (p = 0,001) que las con PNN. Se observó una correlación positiva del PN con el descenso nocturno de la PS (p = 0,022) y negativa con la PS en el sueño (p = 0,032). CONCLUSIÓN: Los niños con BPN presentaron PA más elevada y cambio del ritmo circadiano de la presión arterial, con atenuación del descenso nocturno. Esos hallazgos pueden representar un riesgo aumentado para la hipertensión arterial y enfermedad cardiovascular en el adulto.

Aspectos ultra-sonográficos da trombose da veia porta / Ultrasonographic features of portal vein thrombosis

A trombose da veia porta pode estar associada a várias alterações, como a presença de tumores (por exemplo: hepatocarcinoma, doença metastática hepática e carcinoma do pâncreas), pancreatite, hepatite, septicemia, trauma, esplenectomia, derivações porto-cava, estados de hipercoagulabilidade (por exemplo: gravidez), em neonatos (por exemplo: onfalite e cateterização da veia umbilical) e desidratação aguda. Os autores discutem, neste artigo, os aspectos ultra-sonográficos da trombose de veia porta e alguns aspectos de relevância clínica.