Early neonatal deaths with perinatal asphyxia in very low birth weight Brazilian infants.

OBJECTIVE: The objective of this study was to assess the frequency of early deaths associated with birth asphyxia of very low birth weight infants between 2005 and 2010, in Brazil. STUDY DESIGN: This population study enrolled all live births with birth weight from 400 to 1499 g, gestational age ⩾ 22 weeks, without malformations that died up to 6 days after birth with perinatal asphyxia. Asphyxia was defined if intrauterine hypoxia, asphyxia at birth or meconium aspiration syndrome were written in any line of the death certificate. Active search was carried out in 27 Brazilian federative units. RESULT: For every 1000 live births of very low birth weight infants without congenital malformations, 40.25 and 32.38 died with birth asphyxia in the first week after birth, respectively, in 2005 and 2010 (P<0.001). The contribution of birth asphyxia to early neonatal death of these infants was approximately 10 to 12% all study years. CONCLUSION: Reduction of birth asphyxia in very low birth weight infants is essential to reducing neonatal mortality in Brazil.

Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial.

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

Resuscitative procedures at birth in late preterm infants.

OBJECTIVE: Evaluate the need for resuscitative procedures at birth, in late prematures. STUDY DESIGN: This prospective cohort study enrolled all liveborn infants from 1 to 30 September 2003, with 34 to 41 weeks of gestation without congenital anomalies, born in 35 public hospitals of 20 Brazilian state capitals. Logistic regression analyzed variables associated with the need for bag and mask ventilation. RESULT: Of the 10 774 infants studied, 1054 were late preterms and 485 required resuscitative measures. Of the 1054, 338 (32%) received only free-flow oxygen, 143 (14%) were bag and mask ventilated, 27 (3%) were intubated and 10/27 received chest compressions and/or medications. Bag and mask ventilation in late preterms was associated with twin gestation, maternal hypertension, nonvertex presentation, cesarean delivery and lower gestational age. CONCLUSION: Improving control of maternal hypertension, prolonging gestation for 1 to 2 weeks and restricting operative deliveries could decrease the need of resuscitation of late preterms at birth.

Sorologia positiva para sífilis no período neonatal: prevalência em maternidade de nível secundário; associaçäo com fatores de risco maternos e com sorologia positiva para HIV-1 / Positive serology for syphilis in neonatal period: prevalence in secondary level maternity; association with maternal risk factors and with positive serology for HIV-1

Este estudo teve como objetivos: observar a incidência de soropositividade para sífilis (RSS+) em recém-mascidos (RN) de maternidade de nível secundário; verificar associaçäo entre RSS+ no RN e fatores de risco maternos para aquisiçäo de sífilis; definir o impacto dos critérios diagnósticados de sífilis congênita propostos pelo CDC; observar uma possível associaçäo entre sorologia positiva para sífilis e para HIV-1. De dez/91-jul/92 estudou-se 3.664 nascidos-vivos através do VDRL e hemaglutinaçäo indireta (HAI) para sifilis (sangue de cordäo). Nos RN RSS+ avaliou-se: se a mäe apresentava fatores de risco para sífilis; se o RN se enquadrava nos critérios diagnósticos propostos pelo CDC e se a sorologia para HIV-1 (ELISA) era positiva. O grupo controle constituiu-se de 200 RN com VDRL E HAI para sífilis negativos nascidos em jan/92. Análise estatística foi realizada pelo qui-quadrado (significante p < 0,05). Dentre os 3.664 RN estudados, 5,6// eram soropositivos para sífilis. Verificou-se forte associaçäo entre RN RSS+ e idade materna maior que 20 anos, falta de parceiro sexual fixo, promiscuidade sexual, uso de drogas, ausência de pré-natal, multiparidade e natimortalidade pregressa. Todos os RN soropositivos para sífilis enquadraram-se no diagnóstico de sífilis congênita provável segundo critérios do CDC: tratamento inadequado na gestaçäo. Dos 205 RN RSS+, em 50 foi feito o estudo do HIV-1 e 12// deles eram HIV-1 positivos. Poucas doenças säo mais atuais que a sífilis congênita