Influence of morbidity, early nutritional intake, and total energy: protein ratio on longitudinal extrauterine growth restriction of very preterm newborns at term-equivalent age: an observational study.

To evaluate the influence of early nutritional intake on the growth pattern of very preterm infants. This was an observational study including 109 newborns (< 32 weeks gestational age). Perinatal morbidities, nutritional therapy (first four weeks of life), and weight, length, and head circumference (HC) growth at term-equivalent age were evaluated. Growth restriction was defined as a difference > 1.2 SD between the birth and term age measurements. Growth restriction at term-equivalent age: 52.3% (weight), 42.9% (length), and 22% (HC). Morbidities were positively correlated with nutrition therapy and negatively correlated with the total energy provision: protein ratio. The duration of parenteral nutrition, the time to reach full enteral feedings, and the total energy provision: protein ratio were significantly correlated. Nutrient intake influenced weight, length, and HC growth, and cumulative energy deficit was significantly associated with HC growth restriction.   Conclusion: Perinatal morbidities interfere with nutritional therapy and early nutrient intake, leading to insufficient energy and energy provision: protein ratio for growth. What is Known: • The intake of macronutrients early in life, mainly protein, is important for the optimal growth of pretem infants. • The severity of morbidities and low gestational ages impact the nutritional management of preterm infants. What is New: • The number of morbidities, reflecting the severity of the neonatal clinical course, had a detrimental effect on the nutritional therapy and nutrients intake. • The inadequate energy provision per gram of protein ratio was significantly associated with growth restriction in all growth measures at the second week of life, persisting for head circumference up to the fourth week, highlighting the importance of its measurement, as it could be a precocious sign of development risk.

Energy expenditure and body composition in infants with bronchopulmonary dysplasia at term age.

In this cross-sectional study, conducted in a cohort of infants with a gestational age of < 32 weeks, we aimed to evaluate and compare resting energy expenditure (REE) and body composition between infants who developed bronchopulmonary dysplasia (BPD) and those who did not. REE and body composition were assessed at term equivalent age using indirect calorimetry and air displacement plethysmography. Anthropometric measurements (weight, head circumference, and length) were obtained and transformed into Z-scores per the Fenton (2013) growth curve, at birth and at term equivalent age. Forty-two infants were included in this study, of which 26.2% developed BPD. Infants with BPD had significantly higher energy expenditure at term equivalent age, with no difference in body composition between the two groups. CONCLUSION: Despite expending more energy, infants with BPD maintained a similar body composition distribution to those without BPD, and this is likely due to the recommended nutritional approach. WHAT IS KNOWN: • Greater resting energy expenditure impairs growth of preterm infants with bronchopulmonary dysplasia. WHAT IS NEW: • Although preterm infants with bronchopulmonary dysplasia had a higher resting energy expenditure at the corrected term age, this did not affect their body composition and growth.

Assessment of early nutritional intake in preterm infants with bronchopulmonary dysplasia: a cohort study.

This cohort study evaluated the nutritional supply in 78 very preterm newborns, with 20.5% developing bronchopulmonary dysplasia (BPD). This work aimed to evaluate the nutritional intake and the calorie/protein ratio received in the first 4 weeks of life. Anthropometric measures at birth and term age, the weight at each of the first 4 weeks of life, and the feeding practices were registered. The mean gestational age and birth weight were lower in those who developed BPD. At term age, head circumference and length Z-scores were significantly lower in newborns with BPD, who started enteral feeding and reached full diet later, staying longer in parenteral nutrition. The protein rate received by all newborns was similar, whether developing BPD or not, but those who developed BPD received significantly lower fluid volume and calorie rates after the second week. The daily calorie/protein ratio (30 kcal/1-g protein) was reached by 88.7% of the newborns who did not develop BPD in the third week, with those who developed BPD receiving less than this ratio until the second week, persisting in 56.3% of them on the fourth week.Conclusion: A calorie/protein ratio below that recommended for growth was found in preterm newborns who developed BPD, and providing nutrition for these newborns remains a challenge. What is Known: • The importance of preterm newborn nutrition is well known. • Early nutritional support may avoid severe BPD. What is New: • Newborns who developed BPD received a calorie/protein ratio below that recommended for preterm newborns' growth during the first 2 weeks of life, lasting until the fourth week in most of these newborns.

Pregnancy-induced hypertension, preterm birth, and cord blood adipokine levels.

Maternal hypertension may alter physiological parameters, dysregulating the release of hormones such as adipokines, thus influencing the fetal growth course. This study investigated whether hypertensive disorders of pregnancy alter cord blood adipokine levels and correlate these with anthropometric parameters in preterm infants. This is a prospective cohort study with pregnant women < 37-week gestation with and without hypertension and their offspring. Cord blood leptin, adiponectin, and ghrelin were analyzed by LUMINEX®. These adipokines were compared between the groups exposed or not to gestational hypertension using non-parametric statistical tests. The hypertensive pregnancies had significantly higher cord blood leptin (1.00 (IQR 0.67-1.20 ng/mL)) and adiponectin (18.52 (IQR 17.52-25.13 µg/mL)) levels than those without hypertension (0.07 (IQR 0.06-0.08 ng/mL) and 8.13 (IQR 6.50-8.68 µg/mL), respectively, p < 0.0001). The adipokine levels were higher in AGA and SGA infants in the exposed group for both moderate and late preterm. SGA had significantly higher ghrelin levels than the AGA infants. Ghrelin levels were negatively correlated with birth weight (r = - 0.613, p < 0.001), birth length (r = - 0.510, p < 0.001), head circumference (- 0.346, p < 0.002), and gestational age (r = - 0.612, p < 0.001).Conclusions: Our findings demonstrate an increase in adipokine levels in the cord blood of preterm newborn infants exposed to maternal hypertension. What is Known: • Clinical evidence suggests that concentration of the serum adipokines may be affected by risk of hypertension in both adults and pregnant women. • Maternal profile as hypertension alters intrauterine environment and could affect the function of fetal metabolism, impairing fetal growth. What is New: • Gestational hypertension modifies the adipokine profile, with higher rates already present at birth in cord blood samples. • Within the hypertensive group and stratifying for gestation age, ghrelin concentrations were higher in SGA newborns, both in the moderate and late preterm, compared with AGA newborns.

The trajectory of head circumference and neurodevelopment in very preterm newborns during the first two years of life: a cohort study.

OBJECTIVE: To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. METHOD: Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson's correlation. The study considered a significance level of 0.05. RESULTS: There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. CONCLUSION: Serial measurements of head circumference provide knowledge of the trajectory of growth, with early catch-up between discharge and 1 month, as well as its association with neurodevelopment. Head circumference is therefore a valuable clinical marker for neurodevelopment, especially in very preterm newborns.

Use of prophylactic phototherapy for RhD neonatal disease in a referral service.

OBJECTIVE: This study aimed to describe the effect of prophylactic phototherapy in the treatment of infants with Neonatal Hemolytic Disease. METHOD: A retrospective cohort study was carried out with 199 RhD-positive infants, born to RhD-negative mothers, alloimmunized for RhD antigen, between January 2009 and December 2018. RESULTS: The incidence of exchange transfusions in the study population was 9.5%, with a mean maximum bilirubin value of 11.3 mg % (± 4.3mg %). Bilirubin's maximum peak was achieved with a mean of 119.2 life hours (± 70.6h). CONCLUSION: The low incidence of exchange transfusion, the extended maximum bilirubin peak for later ages, and the low mean of the maximum bilirubin values may indicate a positive effect of prophylactic phototherapy in the treatment of this disease. Further studies must be carried out to confirm these findings.

Physical and social activities constraint and its effects on Body Mass Index of former Neonatal Intensive Care children.

OBJECTIVE: It is reported weight gain in children due to the confinement measures during the Covid-19 pandemic. We aimed to describe the effect of these measures on the nutritional status of former Neonatal Intensive Care Unit children. METHODS: Cross-sectional study, including former Neonatal Intensive Care Unit children. The outcome was the Body mass index (BMI). RESULTS: We enrolled 126 children (74.6 % preterm; 31 % small-for-gestational-age). Weight excess was greater in the youngest group (≤5 years: 33.8 %; >5 years: 15.2 %). Prematurity was associated with weight excess in both groups (≤5 years: p value 0.006; >5 years: p value 0.046; Pearson test). Mealtime changes, lack of physical activity, socioeconomic factors and the perinatal morbidities significantly influenced the mean BMI. Birth length Z score less than -1.28 was negatively associated with BMI, while gestational age at birth presented a positive association with BMI (linear regression model). CONCLUSIONS: The BMI increase due to the confinement measures associated with the gestational age at birth and in those born with intrauterine growth restriction is a matter of concern, as it might indicate a risk for future obesity.

High-risk children and social isolation: the importance of family functioning.

High-risk newborns are exposed to neonatal conditions such as prematurity, very low birth weight, and congenital malformations that can affect development and behavior. Coronavirus disease 2019 (COVID-19) restraint and control measures have been identified as important stressor events and cumulative risk factors for behavioral changes in these children. This study examined social isolation-related factors that contribute to internalizing and externalizing behavior problems in children already at risk for neurodevelopmental disorders. This cross-sectional, multicenter study included 113 children (18 months to 9 years) who were followed in reference services for neonatal follow-up in tertiary units of the public health system in the city of Rio de Janeiro, Brazil. Behavior was assessed using the child behavior checklist, and a structured questionnaire was used to assess sociodemographic aspects. In the bivariate analysis, prematurity was associated with externalizing problems and change in eating habits with internalizing problems. The logistic model indicated that both parents having completed high school and both sharing care of the child were protective factors for behavioral problems; however, reports of sleep problems and living with another child were risk factors. In conclusion, the study identified internalizing and externalizing behavior problems related to prematurity and aspects of family structure and routine in children at risk. The findings confirm the importance of family functioning for child health and family-centered interventions.

Resting energy expenditure in preterm newborns with bronchopulmonary dysplasia.

BACKGROUND & AIMS: Greater energy expenditure is reported in newborns with bronchopulmonary dysplasia (BPD). This study assessed resting energy expenditure (REE) in newborns with BPD. METHODS: BPD was classified as mild and moderate/severe. REE was assessed using indirect calorimetry between the time points of the discontinuation of oxygen (O2) (T1) and at term-equivalent age (T2) in preterm newborns with BPD. RESULTS: The moderate group (10 newborns) presented with higher REE (kcal/kg/day) after discontinuation of mechanical ventilation and a decrease of 18% between the two time points; 72.7 and 59.6 kcal/kg/day at T1 and T2 respectively (p value 0.08). No differences were observed in REE in the mild BPD group between timepoints; 50.9-56.4 kcal/kg/day at T1 and T2 respectively (p value 0.73). CONCLUSION: Newborns with BPD presented different metabolic behaviors depending on the classification criteria: those classified as having moderate BPD showed a decrease in REE toward term-equivalent age.

Neurodevelopment of children exposed intra-uterus by Zika virus: A case series.

The main goal of this manuscript was to investigate the neurodevelopment of children exposed by Zika virus in the intrauterine period who are asymptomatic at birth. Newborns with documented Zika virus exposure during the intrauterine period who were asymptomatic at birth were followed in the first two years of life for neurodevelopment using Bayley III test. Children were classified as having normal or delayed neurodevelopment for age based on most recent Bayley III evaluation results. Eighty-four infants were included in the study. The first Bayley III evaluation was performed at a mean chronological age of 9.7±3.1 month; 13 children (15%) had a delay in one of the three domains, distributed as follow: 10 (12%) in the language domain and 3 (3.5%) in the motor domain. The most recent Bayley III evaluation was performed at a mean age 15.3±3.1 months; 42 children (50%) had a delay in one of the three domains: 4 (5%) in cognition, 31 (37%) in language, and 20 (24%) in motor performance. There were no statistical differences in Gender, Gestational Age, Birth Weight and Head Circurference at birth between children with normal and delayed neurodevelopment for age. A very high proportion of children exposed ZIKV during pregnancy who were asymptomatic at birth demonstrated a delay in neurodevelopment, mainly in the language domain, the first two years of life.

Hormonal Biomarkers for Evaluating the Impact of Fetal Growth Restriction on the Development of Chronic Adult Disease.

The hypothesis of fetal origins to adult diseases proposes that metabolic chronic disorders, including cardiovascular diseases, diabetes, and hypertension originate in the developmental plasticity due to intrauterine insults. These processes involve an adaptative response by the fetus to changes in the environmental signals, which can promote the reset of hormones and of the metabolism to establish a "thrifty phenotype". Metabolic alterations during intrauterine growth restriction can modify the fetal programming. The present nonsystematic review intended to summarize historical and current references that indicated that developmental origins of health and disease (DOHaD) occur as a consequence of altered maternal and fetal metabolic pathways. The purpose is to highlight the potential implications of growth factors and adipokines in "developmental programming", which could interfere in the development by controlling fetal growth patterns. These changes affect the structure and the functional capacity of various organs, including the brain, the kidneys, and the pancreas. These investigations may improve the approach to optimizing antenatal as well as perinatal care aimed to protect newborns against long-term chronic diseases.

A hipótese das origens fetais de doenças em adultos propõe que distúrbios crônicos metabólicos, incluindo doenças cardiovasculares, diabetes e hipertensão, se originam na plasticidade do desenvolvimento devido a insultos intrauterinos. Estes processos envolvem uma resposta adaptativa do feto a mudanças nos sinais ambientais que podem promover a redefinição dos hormônios e do metabolismo para estabelecer um "fenótipo poupador". Alterações metabólicas durante a restrição de crescimento intrauterino podem modificar a programação fetal. A presente revisão não-sistemática pretendeu resumir referências históricas e atuais que indicassem que as origens desenvolvimentistas da saúde e doença (DOHaD, na sigla em inglês) ocorrem como consequência de alterações nas vias metabólicas materna e fetal. O propósito é destacar as potenciais implicações de fatores de crescimento e adipocinas na "programação do desenvolvimento", que poderia interferir no desenvolvimento, controlando os padrões de crescimento fetal. Estas alterações afetam a estrutura e a capacidade funcional de inúmeros órgãos, incluindo o cérebro, os rins e o pâncreas. Estas investigações podem melhorar a abordagem para otimizar os cuidados pré-natais e perinatais, com o objetivo de proteger os recém-nascidos contra doenças crônicas em longo prazo.

Estratégia materna de enfrentamento à confirmação de infecção pelo vírus Zika na gravidez: reflexo no neurodesenvolvimento dos seus filhos / Maternal strategy for coping with confirmation of Zika virus infection during pregnancy: reflection on the neurodevelopment of their children

Resumo A infecção pelo vírus Zika na grávida resulta em alterações do desenvolvimento neuropsicomotor nas crianças afetadas, sendo importante fator de estresse para essas mulheres. O objetivo deste estudo foi avaliar a estratégia de enfrentamento das mães a essa situação e como isto se refletiu no neurodesenvolvimento dos seus filhos. Estudo transversal com 46 mulheres e seus filhos. A estratégia de enfrentamento foi avaliada pelo Inventário Brief Cope, aplicado às mães, e o desenvolvimento neuropsicomotor das crianças, foi avaliado aos 24 meses de idade pelas Escalas Bayley III. A estratégia predominante de enfrentamento mais frequentemente usada pelas mães foi a de aproximação (73,9%), com destaque para o componente planejamento. A utilização da estratégia de negação esteve associada aos escores mais baixos na escala Bayley III, sendo nessa escala o componente mais utilizado o de auto culpabilização. A religião foi o componente de apoio auxiliar mais utilizado pelas mães. A utilização da negação como estratégia predominante de enfrentamento pelas mães mostrou associação com os piores resultados na avaliação do desenvolvimento infantil e reforça a necessidade do apoio a estas mulheres, para que possam lidar mais diretamente com os sentimentos decorrentes das situações vivenciadas.

Abstract Zika virus infection in pregnant women results in changes in neuropsychomotor development in affected children, being an important stress factor for these women. This study aimed to evaluate the mothers' coping strategy in this situation and how this was reflected in the neurodevelopment of their children. Cross-sectional study with 46 women and their children. The coping strategy was assessed using the Brief Cope Inventory, applied to mothers, and the children's neuropsychomotor development was assessed at 24 months of age using the Bayley III Scales. The predominant coping strategy most frequently used by mothers was approach (73.9%), with emphasis on the planning component. The use of the avoidant coping was associated with lower scores on the Bayley III scale, with self-blame being the most used component on this scale. Religion was the auxiliary support component most used by mothers. The use of avoidant as the predominant coping strategy by mothers was associated with the worst results in the assessment of child development and reinforces the need to support these women, so that they can deal more directly with the feelings arising from the situations they experience.

Differences in energy expenditure in human donor milk versus formula milk in preterm newborns: A crossover study.

OBJECTIVE: The aim of this study was to compare the ratio between energy expenditure and caloric density in human donor milk versus formula milk in preterm newborn infants. METHODS: This was a crossover, randomized clinical trial with 29 preterm newborn infants receiving full diet. The infants were randomly assigned to receive either human milk or formula milk alternating, after a 24-h period. Energy expenditure was evaluated by indirect calorimetry. Total calorie and macronutrient values in the human milk were calculated individually with infrared technique; energy expenditure/caloric density ratio was calculated. RESULTS: Human donor milk energy expenditure/caloric density ratio was significantly greater than in formula milk at all time points. The total mean was 1.04 ± 0.27 for the human milk and 0.81 ± 0.11 for the formula. However, when we analyzed a subgroup of newborns that received human donor milk with >60 kcal/100 mL, there was no statistical difference (P = 0.36). The mean calorie values were 58.9 kcal/100 mL (human donor milk) and 81.4 kcal/100 mL (formula milk). CONCLUSION: Formula milk produced a better metabolic response than human donor milk. Human donor milk with higher caloric content showed no difference from formula, so the use of human donor milk with more caloric density should be reinforced.

Breastfeeding of preterm newborn infants following hospital discharge: follow-up during the first year of life. / Amamentação em lactentes nascidos pré-termo após alta hospitalar: acompanhamento durante o primeiro ano de vida.

This paper aims to evaluate the prevalence of breastfeeding among premature infants following hospital discharge. Cohort (< 33 gestation weeks) followed up to 12 months (adjusted age). VARIABLES: breastfeeding, anthropometric measurements, social and family information. The proportion of breastfeeding during follow-up was calculated. Survival analysis was conducted to estimate breastfeeding duration. In total, 242 of the 258 infants (93.7%) returned to follow-up; 170 (69.9%) at 6 months and 139 (57.2%) at 12 months (adjusted age). A history of miscarriages (27.5%), stillbirths (11.7%), neonatal deaths (9.5%) and preterm births (21.1%) was noted in 65.5% of women. At hospital discharge: 5.5% received exclusive breastfeeding, 65.8% breastfeeding and formula, 28.6% formula. At month 1, 81.3% received breastfeeding, decreasing to 68.5% at month 2, 62.4% at month 3, 48.1% at month 4 and 22.4% at month 6 (adjusted age). The median of breastfeeding duration was 4 months. Breastfeeding occurred up to four months adjusted age in almost half of the population. Despite the need to improve these rates, the results could reflect the profile of the Child-Friendly Hospital Initiative Unit. Maintaining breastfeeding amongst preterm infants following hospital discharge is still a challenge, for both mothers and health professionals.

Objetivo deste artigo é avaliar a prevalência de amamentação entre prematuros após a alta hospitalar. Coorte (idade gestacional < 33 semanas) acompanhada até 12 meses (idade corrigida). Variáveis: amamentação, medidas antropométricas, informações sociofamiliares. Calculadas as proporções de amamentação durante o acompanhamento. Realizada análise de sobrevida para estimar a duração da amamentação. Retornaram ao ambulatório 242/258 crianças (93,7%); 170 (69,9%) aos 6 e 139 (57,2%) aos 12 meses (idade corrigida). História de abortos (27,5%), natimortos (11,7%), óbito neonatal (9,5%), partos prematuros (21,1%) em 65,5% das mulheres. Alimentação na alta: 5,5% amamentação exclusiva, 65,8% leite materno e fórmula, 28,6% fórmula. Com 1 mês 81,3% estavam em aleitamento materno, diminuindo para 68,5 % aos 2 meses, 62,4% aos 3 meses, 48,1% aos 4 meses e 22,4% aos 6 meses (idade corrigida). A mediana da duração da amamentação foi de 4 meses. O aleitamento materno ocorreu até os quatro meses de idade corrigida em quase metade da população. Apesar da necessidade de melhorar estas taxas, estes resultados podem refletir o perfil da Unidade, pertencente à Iniciativa Hospital Amigo da Criança. A manutenção do aleitamento materno em lactentes pré-termos após a alta hospitalar continua sendo um desafio, para as mães e para os profissionais de saúde.

Energy expenditure, growth, and nutritional therapy in appropriate and small for gestational age preterm infants.

OBJECTIVE: To evaluate the resting energy expenditure, growth, and quantity of energy and macronutrients intake in a group of preterm newborns. METHODS: The cohort study was performed with appropriate and small for gestational age preterm infants (birth weight lower than 1500g or gestational age<32 weeks). Resting energy expenditure was measured using indirect calorimetry on the 7th, 14th, 21st, and 28th days of life, and at discharge. Length, head circumference and body weight were assessed weekly. Nutritional therapy was calculated during the hospital stay and the information for each type of food was recorded in software that calculates the total amount of energy and macronutrients. RESULTS: 61 preterm infants were followed; 43 appropriate and 18 small for gestational age infants. There was no statistical difference for resting energy expenditure between the groups, and it increased from the first to the fourth week of life (appropriate: 26.3% and small: 21.8%). Energy intake in the first two weeks of life was well below the energy requirement. CONCLUSION: Considering that the results demonstrate high energy expenditure during the first weeks of life, there is an evident need to provide the best quality of nutrition for each child in the first weeks of life so that preterm infants with or without intrauterine growth restriction can achieve their maximum potential for growth and development.

Use of prophylactic phototherapy for RhD neonatal disease in a referral service

Abstract Objective: This study aimed to describe the effect of prophylactic phototherapy in the treatment of infants with Neonatal Hemolytic Disease. Method: A retrospective cohort study was carried out with 199 RhD-positive infants, born to RhD-negative mothers, alloimmunized for RhD antigen, between January 2009 and December 2018. Results: The incidence of exchange transfusions in the study population was 9.5%, with a mean maximum bilirubin value of 11.3 mg % (± 4.3mg %). Bilirubin's maximum peak was achieved with a mean of 119.2 life hours (± 70.6h). Conclusions: The low incidence of exchange transfusion, the extended maximum bilirubin peak for later ages, and the low mean of the maximum bilirubin values may indicate a positive effect of prophylactic phototherapy in the treatment of this disease. Further studies must be carried out to confirm these findings.

Growth and body composition of preterm infants less than or equal to 32 weeks: Cohort study.

BACKGROUND: Extremely preterm infants with weights less than the 10th percentile at discharge have a fat-free mass deficit. AIM: To analyze the relationship of weight Z-scores less than -2SD at term age with fat-free mass and fat mass at term age and at 1 and 3 months of corrected age in very preterm infants. STUDY DESIGN: COHORT STUDY: Subjects: Sixty-six preterm infants born before or at 32 weeks gestation with birth weight equal or greater than the 10th percentile for age were included at term age. They were classified according to weight Z-score as either: "term (-)" (n = 18) if weight Z-scores were less -2SD or "term (+)" (n = 48) if the weight Z-scores were equal or greater than -2SD at term age. OUTCOME MEASURES: Growth and body composition by an air displacement plethysmography system and bioimpedance were assessed at term age and 1 and 3 months of corrected age. RESULTS: Lower fat-free mass persisted up to 3 months in the "term (-)" group [4137 g (645) vs 4592 g (707), p < .01]. Fat mass was lower in the "term (-)" group at term and at 1 month but was similar at 3 months of corrected age [1295 g (774) vs 1477 g (782), p = .109]. Weight, length and head circumference Z-scores were lower in the "term (-)" group compared to those in the "term (+)" group. CONCLUSIONS: The lean tissue deficits were maintained in the "term (-)" group while the differences in body fat percentage were not.

[Prognostic factors for cognitive development of very low birth weight premature children]. / Fatores prognósticos para o desenvolvimento cognitivo de prematuros de muito baixo peso.

OBJECTIVE: Very low birth weight premature children often show cognitive development abnormalities. There is scarce information about the outcome of these children at preschool age in Brazil. The objective of the study is to describe the cognitive development of a population of premature newborns and to assess possible prognostic factors for abnormalities. METHODS: A cohort study was conducted in a preschool children population whose subjects were very low birth weight premature babies born between January 1991 and September 1993. WPPSI-R Test was used for cognitive evaluation and it was applied by psychologists. Two cut-offs were set to describe abnormality: scores below 1 and 2 standard deviations (SD). RESULTS: Seventy-nine children aged 4 and 5 years were studied. The mean full WIPPSI-R score was 75.6 (+/-11.9). The incidence of abnormal 1 and 2 SD full score was 77.2% and 32.9%, respectively. After adjusting for the method of delivery, small for gestational age (OR=6.19, 95% CI 1.60-23.86), abnormal cerebral ultrasound exam (OR=5.90, 95% CI 1.04-9.83) and male sex (OR=3.20, 95% CI 1.32-26.35) were predictors of full score <70. CONCLUSIONS: Compared to the literature, these children showed a more severe cognitive development impairment. Small for gestational age, abnormal cerebral ultrasound exam and male sex were prognostic factors for worse outcome.

Hormonal biomarkers for evaluating the impact of fetal growth restriction on the development of chronic adult disease / Biomarcadores hormonais para avaliar o impacto da restrição do crescimento fetal no desenvolvimento de doenças crônicas em adultos

Abstract The hypothesis of fetal origins to adult diseases proposes that metabolic chronic disorders, including cardiovascular diseases, diabetes, and hypertension originate in the developmental plasticity due to intrauterine insults. These processes involve an adaptative response by the fetus to changes in the environmental signals, which can promote the reset of hormones and of the metabolism to establish a "thrifty phenotype". Metabolic alterations during intrauterine growth restriction can modify the fetal programming. The present nonsystematic review intended to summarize historical and current references that indicated that developmental origins of health and disease (DOHaD) occur as a consequence of altered maternal and fetal metabolic pathways. The purpose is to highlight the potential implications of growth factors and adipokines in "developmental programming", which could interfere in the development by controlling fetal growth patterns. These changes affect the structure and the functional capacity of various organs, including the brain, the kidneys, and the pancreas. These investigations may improve the approach to optimizing antenatal as well as perinatal care aimed to protect newborns against long-termchronic diseases.

Resumo A hipótese das origens fetais de doenças em adultos propõe que distúrbios crônicos metabólicos, incluindo doenças cardiovasculares, diabetes e hipertensão, se originam na plasticidade do desenvolvimento devido a insultos intrauterinos. Estes processos envolvem uma resposta adaptativa do feto amudanças nos sinais ambientais que podem promover a redefinição dos hormônios e do metabolismo para estabelecer um "fenótipo poupador". Alteraçõesmetabólicas durante a restrição de crescimento intrauterino podem modificar a programação fetal. A presente revisão não-sistemática pretendeu resumir referências históricas e atuais que indicassem que as origens desenvolvimentistas da saúde e doença (DOHaD, na sigla em inglês) ocorrem como consequência de alterações nas vias metabólicas materna e fetal. O propósito é destacar as potenciais implicações de fatores de crescimento e adipocinas na "programação do desenvolvimento", que poderia interferir no desenvolvimento, controlando os padrões de crescimento fetal. Estas alterações afetam a estrutura e a capacidade funcional de inúmeros órgãos, incluindo o cérebro, os rins e o pâncreas. Estas investigações podemmelhorar a abordagempara otimizar os cuidados prénatais e perinatais, como objetivo de proteger os recém-nascidos contra doenças crônicas em longo prazo.