Hyaline membrane disease (HMD) therapy in Latin America: impact of exogenous surfactant administration on newborn survival, morbidity and use of resources.

Impact of surfactant administration, on neonatal mortality, morbidity and resource use, was assayed in a historically controlled study in 19 NICUs from 5 Latin American countries. Data from clinical records of infants with HMD were retrospectively reviewed for the previous 2 years (PRE phase n = 666 cases), and prospectively in cases that received surfactant (SURF phase, 348 cases). Birth weight stratified relative risk, with 95% confidence interval (RR +/-95% CI) for death, in the SURF as compared to the PRE was 0.60 (0.49-0.74), 0.79 (0.68-0.92) and 0.82 (0.71-0.94), for days 7, 28 and at discharge, respectively. At all ages mortality was significantly lower during SURF. Significant increases were observed in the occurrence of pulmonary interstitial emphysema, pulmonary hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, intrahospital infection and necrotizing enterocolitis. Resource use increased significantly. It is concluded that the use of surfactant in the region is an important advance, and the efficacy of management of the late complications of the very premature and labile HMD survivors must increase. More attention should be given to thermal regulation, nutrition and management of infection in the survivors, before a more marked effect of surfactant can be seen.

[Intrauterine growth curves: study of 4413 single live births of normal pregnancies]. / Curvas de Crescimento Intra-Uterino: estudo de 4413 recém-nascidos únicos de gestações normais.

Having the purpose of identifying those newborn who have suffered from abnormal intrauterine growth, a standard of intrauterine growth has been drawn at the maternity ward of Hospital Regional da Asa Sul (HRAS-FHDF-Brasília), by studying the variables of weight, length, cephalic perimeter, weight of the placenta (with the cord and membranes), weight rate and the relative placentary rate. The starting number of 8,271 live births which happened between July 1989 and March 1991 was cut down to 4,413 due to the exclusion of interfering factors of foetus growth (smoking mother, multiple gestation, hemorrhage during the 2nd and 3rd trimesters chronic anaemia, arterial hypertension, pre-eclampsia and eclampsia), in addition to the exclusion of those mothers who could not remember the date of their last period or were in doubt about it. Comparing this standard of intrauterine growth to the ones in literature, the present values are higher, most of the times, from weeks 30 to 37-38, and after that there is a slowing down similar to the pattern observed in placentary growth. This study proposes a standard adequate to the assessment of intrauterine growth in Brasília and other regions, mainly at the Centre-West Region, where the population should be similar to the one studied here.