Exposición a temperaturas extremas y su efecto en la gestación en un departamento de Colombia / Exposure to extreme temperatures and its effect on pregnancy in a department of Colombia

Introducción: Diversas investigaciones han establecido la relación entre temperatura y duración del embarazo, la exposición a temperaturas altas durante el embarazo plantea interrogantes en especial el papel que esta juega frente a los partos prematuros y partos de bajo peso, es indispensable determinar si las temperaturas altas o bajas tienen un comportamiento protector o de riesgo sobre el feto durante la gestación en regiones tropicales. Objetivo: describir la relación entre la exposición a temperaturas altas y bajas durante el embarazo y su efecto en la edad gestacional y peso al momento del parto en los recién nacidos del departamento del Guaviare-Colombia. Metodología: Estudio tipo observacional, analítico, retrospectivo de corte transversal que busco determinar la relación entre exposición a temperaturas altas y bajas durante el embarazo y su efecto en la edad gestacional y peso al momento del parto en los recién nacidos, el universo estuvo conformado por 10.137 nacidos vivos, de los cuales 9.932 cumplieron los criterios de inclusión. Se determinó Odds Ratio para estimar la asociación entre las variables. Resultados: Dentro de la semana de retraso 3 el estar expuesto a temperaturas máximas percentil 90 es un factor protector para la ganancia ponderal de peso OR < 1, la exposición a temperaturas mínimas percentil 10 se asoció como factor protector para el parto prematuro en la semana de retraso 1 y 2 OR < 1.Conclusión: A pesar del beneficio de las altas y bajas temperaturas durante el embarazo en la ganancia ponderal de peso y disminución del parto prematuro, es recomendable prevenir la exposición a temperaturas extremas durante el periodo de gestación[AU]

Introduction: Various investigations have established the relationship between temperature and duration of pregnancy. Exposure to high temperatures during pregnancy raises questions, especially the role it plays in premature births and low-weight births. It is essential to determine whether high temperatures or low have a protective or risky behavior on the fetus during pregnancy in tropical regions.Objective: to describe the relationship between exposure to high and low temperatures during pregnancy and its effect on gestational age and weight at the time of delivery in newborns in the department of Guaviare-Colombia.Methodology:Observational, analytical, retrospective cross-sectional study that sought to determine the relationship between exposure to high and low temperatures during pregnancy and its effect on gestational age and weight at the time of delivery in newborns. The universe was made up of 10,137 births. alive, of which 9,932 met the inclusion criteria. Odds Ratio was determined to estimate the association between the variables.Results:Within the 3rd week of delay, being exposed to maximum temperatures at the 90th percentile is a protective factor for weight gain OR < 1, exposure to minimum temperatures at the 10th percentile was associated as a protective factor for premature birth in the week. of delay 1 and 2 OR < 1. Conclusion: Despite the benefit of high and low temperatures during pregnancy in weight gain and reduction in premature birth, it is advisable to prevent exposure to extreme temperatures during the gestation period[AU]

Introdução: Várias investigações estabeleceram a relação entre temperatura e duração da gravidez. A exposição a altas temperaturas durante a gravidez levanta questões, especialmente o papel que desempenha nos partos prematuros e nos nascimentos de baixo peso. É essencial determinar se as temperaturas altas ou baixas têm um comportamento protetor ou de risco para o feto durante a gravidez em regiões tropicais. Objetivo:descrever a relação entre a exposição a altas e baixas temperaturas durante a gravidez e seu efeito na idade gestacional e no peso no momento do parto em recém-nascidos no departamento de Guaviare-Colômbia. Metodologia: Estudo observacional, analítico, retrospectivo e transversal que buscou determinar a relação entre a exposição a altas e baixas temperaturas durante a gravidez e seu efeito na idade gestacional e no peso no momento do parto em recém-nascidos. O universo foi composto por 10.137 nascimentos. vivos, dos quais 9.932 preencheram os critérios de inclusão. O Odds Ratio foi determinado para estimar a associação entre as variáveis. Resultados:Na 3ª semana de atraso, a exposição a temperaturas máximas no percentil 90 é fator de proteção para ganho de peso OR < 1, a exposição a temperaturas mínimas no percentil 10 foi associada como fator de proteção para parto prematuro na semana. de atraso 1 e 2 OR < 1.Conclusão:Apesar do benefício das altas e baixas temperaturas durante a gravidez no ganho de peso e redução do parto prematuro, é aconselhável evitar a exposição a temperaturas extremas durante o período de gestação[AU]

Prevalência de nascimentos prematuros como desfechos de infecções pela COVID-19 na gestação / Prevalence of Preterm Birth as an Outcome of COVID-19 Infections during Pregnancy / Prevalencia de nacimientos prematuros producto de la infección por COVID-19 durante el embarazo

Objetivo: estimar a prevalência de nascimento prematuro em gestantes infectadas pela Covid-19, comparar índices de prematuridade entre infectadas e não infectadas e elucidar fatores associados à prematuridade. Métodos: coorte retrospectiva, com coleta de dados por inquérito online, de abril a dezembro de 2022, com mulheres que estiveram gestantes durante a pandemia, com acesso à internet, idade superior a 18 anos e que preencheram o primeiro inquérito online. Protocolo de pesquisa aprovado pelo Comitê de Ética. Resultados: primeiro inquérito respondido por 304 gestantes/puérperas, e o segundo por 82 (27%), compondo a amostra final. O índice de prematuridade no primeiro inquérito foi de 7,2% (n=14), já no segundo, 8,5% (n=7). A infecção pela Covid-19 não foi associada à prematuridade. A prematuridade associou-se a baixo peso, à necessidade de internação em centros de terapia intensiva neonatal e internações após o nascimento. Conclusão: a infecção pela Covid-19 não influenciou no aumento de nascimentos prematuros.

Objective: to estimate the prevalence of preterm birth in pregnant women infected with Covid-19, compare prematurity rates between infected and non-infected, and elucidate factors associated with prematurity. Methods: a retrospective cohort study was conducted using online survey data collected from April to December 2022, involving women who were pregnant during the pandemic, had internet access, were over 18 years old, and completed the initial online survey. The research protocol was approved by the Ethics Committee. Results: the initial survey was completed by 304 pregnant/postpartum women, and the follow-up survey by 82 (27%), comprising the final sample. The preterm birth rate in the initial survey was 7.2% (n=14), and in the follow-up survey, it was 8.5% (n=7). Covid-19 infection was not associated with prematurity. Prematurity was associated with low birth weight, the need for neonatal intensive care unit admission, and postnatal hospitalizations. Conclusion: Covid-19 infection did not influence an increase in preterm births.

Objetivo: estimar la prevalencia de partos prematuros en gestantes infectadas por Covid-19, comparar las tasas de prematuridad entre gestantes infectadas y no infectadas y determinar los factores asociados a la prematuridad. Métodos: estudio de cohorte retrospectivo, con recolección de datos mediante encuesta online, de abril a diciembre de 2022, con mujeres que estuvieron embarazadas durante la pandemia, con acceso a internet, mayores de 18 años y que completaron la primera encuesta online. El protocolo de investigación fue aprobado por el Comité de Ética. Resultados: la primera encuesta fue respondida por 304 gestantes/puérperas, y la segunda por 82 (27%), que conformaron la muestra final. La tasa de prematuridad en la primera encuesta fue del 7,2% (n=14), en la segunda, del 8,5% (n=7). La infección por Covid-19 no se asoció con la prematuridad. La prematuridad se asoció con bajo peso, necesidad de internación en centros de cuidados intensivos neonatales e internaciones después del nacimiento. Conclusión: La infección por Covid-19 no influyó en el aumento de nacimientos prematuros.

Association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from the 2010/2011 BRISA birth cohort

Abstract Objective: To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. Method: This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. Results: 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. Conclusions: Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities.

Atención de parto respetado en Venezuela: fundamentos legales / Respected Childbirth Care in Venezuela: Legal Foundations

El parto humanizado es un modelo de atención que considera el respeto a las opiniones y necesidades de las mujeres y sus familias, e incluye la atención durante el embarazo, parto, puerperio y, por supuesto, la atención del recién nacido. En Venezuela, existe legislación suficiente que respalda la atención del parto humanizado o respetado, sin embargo, la misma no es conocida por gran parte del personal de salud involucrado en la atención obstétrica. Es necesario que tal legislación se conozca ampliamente y se aplique. La presente revisión se realizó con la intención de revisar los fundamentos legales que respaldan la atención del parto respetado(AU)

Humanized childbirth is a model of care that considers respect for the opinions and needs of women and their families, and includes care during pregnancy, childbirth, puerperium and, of course, newborn care. In Venezuela, there is sufficient legislation that supports humanized or respected childbirth care, however, it is not known by a large part of the health personnel involved in obstetric care. Such legislation needs to be widely known and implemented. This review was conducted with the intention of reviewing the legal foundations that support respected childbirth care(AU)

Volvamos al parto humanizado / Let's go back to humanized childbirth

Actualmente, en la mayoría de los países, el parto se ha transformado en una práctica patológica requiriendo un seguimiento institucionalizado y conllevando acciones de violencia obstétrica sobre la mujer. El parto humanizado es un modelo de atención que considera las opiniones, necesidades y valoraciones emocionales de las mujeres y sus familias en los procesos de atención del embarazo, parto y puerperio. En el presente se describe el parto humanizado, historia, importancia, recomendaciones y beneficios para la familia gestante, así como la violencia obstétrica, priorizando la humanización y creando condiciones para que se cumplan las dimensiones espirituales, psicológicas y biológicas del ser humano. Se seleccionaron 12 artículos de investigación, siendo el español el idioma de mayor publicación. El modelo de parto humanizado incluye todo el proceso, desde el embarazo hasta el puerperio tardío, genera un impacto muy importante en el recién nacido y su desarrollo futuro(AU)

Currently, in most countries, childbirth has become a pathological practice, requiring institutionalized followup and leading to actions of obstetric violence against women. Humanized childbirth is a model of care that considers the opinions, needs and emotional evaluations of women and their families in the processes of pregnancy, childbirth and puerperium care. This paper describes humanized childbirth, history, importance, recommendations and benefits for the pregnant family, as well as obstetric violence, prioritizing humanization and creating conditions for the spiritual, psychological and biological dimensions of the human being to be fulfilled. 12 research articles were selected, with Spanish being the language with the most publications. The humanized birth model includes the entire process, from pregnancy to the late puerperium, it generates a very important impact on the newborn and its future development(AU)

A decade of analysis describe of maternal and neonatal characteristics of live births in southern Brazil / Una década de descripción de las características maternas y neonatales de los nacidos vivos en el sur de Brasil

Introduction: Child health is conditioned by the circumstances of pregnancy, childbirth, and early life. Objective: To describe the maternal and neonatal characteristics of live births (LBs) in the Information System on Live Births of Santa Catarina (SC), Brazil. Materials and methods: A cross-sectional study describedthe maternal and neonatal characteristics of 940,059 LBs, from 2010 to 2019. Pearson's chi-square test and Fisher's exact test were conducted, with a statistical significance level of p < 0.05. Results: The mean values of maternal age, number of live children, and number of fetal deaths as well as abortions were 27.1 years, 0.9, and 0.2, respectively. The averages of the number of gestation weeks, number of prenatal consultations, the start date of the prenatal care, and birth weight were 38.5 weeks, 8.1 months, 2.5 monthsand 3,217.1 grams, respectively. Low birth weight (LBW) was prevalent among mothers without education (p < 0.001), including those without prenatal visits (p < 0.001). A higher prevalence of being underweight was observed among female neonates (p < 0.001) and with a maternal age of ≥ 40 years (10.8%; p < 0.001) compared to newborns with good vitality. Newborns with good vitality had a low prevalence of underweight (p < 0.001). The frequency of the variables studied increased, comparing the beginning and end of the period and whether the differences are statistically significant. Conclusions: The study draws attention to the need for interventions to improve the indicators that determine LBW(AU)

Introducción: La salud infantil está condicionada por las circunstancias del embarazo, parto y primeras etapas de la vida. Objetivo: Describir las características maternas y neonatales de los nacidos vivos en el Sistema de Información de Nacidos Vivos de Santa Catarina, Brasil. Materiales y métodos: Estudio transversal describiendo las características maternas y neonatales de 940.059 nacidos vivos entre 2010 y 2019. Se realizó la prueba de chi cuadrado de Pearson y exacta de Fisher y se estableció p < 0,05. Resultados: Los valores medios para la edad materna, el número de nacidos vivos y el número de mortinatos y abortos espontáneos fueron 27,1, 0,9 y 0,2, respectivamente. Las medias del número de semanas de gestación, el número de visitas prenatales, la fecha de inicio de la atención prenatal y el peso al nacer fueron 38,5 semanas (DE 2,2), 8,1 meses, 2,5 meses y 3 217,1 gramos, respectivamente. El bajo peso al nacer (BPN) fue prevalente entre las madres sin estudios (p < 0,001), incluidas las que no acudieron a una cita prenatal (p < 0,001). Hubo una mayor prevalencia de BPN en neonatos de sexo femenino (p < 0,001) con madres de edad ≥ 40 años (10,8%; p < 0,001). Los neonatos con buena vitalidad tuvieron una baja prevalencia de BPN (p < 0,001). La frecuencia de las variables estudiadas aumentó al comparar el inicio y el final del período y si las diferencias son estadísticamente significativas. Conclusiones: El estudio llama la atención sobre la necesidad de intervenciones para mejorar los indicadores que determinan el BPN(AU)

Repensando o Nascimento como um Direito Integral na Luta contra a Violência Obstétrica no Brasil / Rethinking Birth as a Comprehensive Right in the Fight against Obstetric Violence in Brazil / Reconsiderando el Nacimiento como un Derecho Integral en la Lucha contra la Violencia Obstétrica en Brasil

Objetivo: analisar o impacto da ausência de legislação federal e normativas na mitigação da violência obstétrica no Brasil, por meio de uma análise crítica, com ênfase na regulação legal. Metodologia: inicialmente, realizou-se uma revisão narrativa de abordagem qualiquantitativa e exploratória-descritiva nas bases de dados da Biblioteca Virtual em Saúde e da Scientific Electronic Library Online, no período entre 2018 e 2023. Os artigos foram selecionados utilizando descritores do Medical Subject Headings, como "obstetric violence" e "violence against women", combinados através do operador booleano "AND". Posteriormente, foi conduzida uma pesquisa documental buscando consultar a legislação estadual vigente no Brasil e identificar possíveis lacunas. Resultados: Identificou-se uma lacuna considerável em relação à violência obstétrica e à conscientização limitada sobre os direitos à autonomia das mulheres, que são preocupações evidentes. Em relação às legislações estaduais analisadas, 14 fazem menção à "violência obstétrica" e 8 abordam a "humanização do parto". Dessas, 19 têm caráter informativo, 28 são preventivas e 2 são punitivas. Considerações Finais: A ausência de consenso na definição da violência obstétrica e a escassa capacitação dos profissionais de saúde resultam em práticas obsoletas. A elevada taxa de cesarianas desnecessárias e a carência de estudos sobre mulheres quilombolas e indígenas são preocupantes. No âmbito jurídico, a falta de compreensão por parte dos magistrados e a fragmentação das legislações estaduais representam desafios significativos. Torna-se crucial adotar uma abordagem multidisciplinar e políticas públicas claras para prevenir essa violência e assegurar uma assistência ao parto segura e centrada nas necessidades das mulheres.

Objective: To analyze the impact of the absence of federal legislation and regulations on the mitigation of obstetric violence in Brazil through a critical analysis, with emphasis on legal regulation. Methodology: Initially, a narrative review with a qualiquantitative and exploratory-descriptive approach was conducted on the databases of the Virtual Health Library and the Scientific Electronic Library Online, between 2018 and 2023. Articles were selected using Medical Subject Headings descriptors such as "obstetric violence" and "violence against women", combined with the boolean operator "AND". Subsequently, a documentary search was conducted to consult the current state legislation in Brazil and identify possible gaps. Results: A considerable gap was identified regarding obstetric violence and limited awareness of women's autonomy rights, which are evident concerns. Regarding the analyzed state laws, 14 mention "obstetric violence" and 8 address "humanization of childbirth". Of these, 19 are informative, 28 are preventive, and 2 are punitive. Final Considerations: The lack of consensus in defining obstetric violence and the scarce training of healthcare professionals result in obsolete practices. The high rate of unnecessary cesarean sections and the lack of studies on quilombola and indigenous women are concerning. In the legal sphere, the lack of understanding by judges and the fragmentation of state legislation represent significant challenges. It is crucial to adopt a multidisciplinary approach and clear public policies to prevent this violence and ensure safe and woman-centered childbirth care.

Objetivo: Analizar el impacto de la ausencia de legislación federal y normativas en la mitigación de la violencia obstétrica en Brasil mediante un análisis crítico, con énfasis en la regulación legal. Metodología: Inicialmente, se realizó una revisión narrativa con enfoque cualicuantitativo y exploratorio-descriptivo en las bases de datos de la Biblioteca Virtual en Salud y la Scientific Electronic Library Online, entre 2018 y 2023. Se seleccionaron artículos utilizando descriptores del Medical Subject Headings como "obstetric violence" y "violence against women", combinados con el operador booleano "AND". Posteriormente, se realizó una búsqueda documental para consultar la legislación estatal vigente en Brasil e identificar posibles lagunas. Resultados: Se identificó una brecha considerable en relación con la violencia obstétrica y la conciencia limitada de los derechos de autonomía de las mujeres, que son preocupaciones evidentes. En cuanto a las leyes estatales analizadas, 14 mencionan "violencia obstétrica" y 8 abordan la "humanización del parto". De estas, 19 son informativas, 28 son preventivas y 2 son punitivas. Consideraciones Finales: La falta de consenso en la definición de la violencia obstétrica y la escasa formación de los profesionales de la salud resultan en prácticas obsoletas. La alta tasa de cesáreas innecesarias y la falta de estudios sobre mujeres quilombolas e indígenas son preocupantes. En el ámbito legal, la falta de comprensión por parte de los jueces y la fragmentación de la legislación estatal representan desafíos significativos. Es crucial adoptar un enfoque multidisciplinario y políticas públicas claras para prevenir esta violencia y garantizar una atención al parto segura y centrada en las necesidades de las mujeres.

Factors associated with early initiation of breastfeeding / Fatores associados ao aleitamento materno na primeira hora de vida

INTRODUCTION: Early initiation of breastfeeding (EIBF) is still little stimulated in several hospitals in Brazil. Objective: To estimate the prevalence and factors associated with Early initiation of breastfeeding (EIBF). METHODS: Cross-sectional, quantitative study with retrospective secondary data collection in hospital records of 250 full-term newborns, regardless of the type of delivery, with no history of maternal gestational risk, seen in the last six months. Data collection period in a public maternity hospital in Greater São Paulo. Data collection was performed between November 2018 and January 2019, with approval from the hospital and the FMABC Research Ethics Committee under register n. 2,924,393. RESULTS: The prevalence of EIBF was 66%. BFH is associated with anesthesia at childbirth (p<0,001), APGAR less than or equal to 8 in the 1st and 5th minutes (p<0,001), and with c-section (p<0,001), which represented 29.2% of deliveries in the sample. Respiratory distress (38.82%), hypotonia (24.70%), followed by unfavorable maternal conditions (18.82%), were shown to be impeding factors for EIBF, although 90% of newborns received Apgar 9 /10 in the 5th minute. CONCLUSION: The prevalence of early breastfeeding is lower than recommended, but compatible with the most recent national frequency proportions.

INTRODUÇÃO: O aleitamento materno na primeira hora de vida ainda é pouco estimulado em vários hospitais do Brasil. OBJETIVO: Analisar a prevalência e os fatores associados ao aleitamento materno na primeira hora de vida (AMP) entre recém-nascidos a termo. MÉTODOS: Estudo transversal, de natureza quantitativa, com coleta de dados secundários retrospectivos em prontuários hospitalares de 250 recém-nascidos a termo, independentemente do tipo de parto, com histórico de gestacional de risco habitual, atendidos nos últimos seis meses anteriores ao período de coleta de dados, em uma maternidade pública da Grande São Paulo. Os dados foram coletados entre novembro de 2018 e janeiro de 2019, por meio de roteiro estruturado, mediante aprovação do hospital e do Comitê de Ética em Pesquisa da FMABC (Parecer n.º 2.924.393). O banco de dados e o tratamento estatístico foram realizados através do programa STATA®. Para a análise, utilizou-se proporções e teste qui-quadrado, adotando-se um nível de significância de 5% e 95% o intervalo de confiança. RESULTADOS: A prevalência de AMP foi de 66%. O AMP está associado a anestesia no parto (p<0,001), APGAR menor ou igual a 8 no 1º e 5º minutos (p<0,001) e ao parto cesárea (p<0,001), cuja proporção na amostra foi de 29,2%. Desconforto respiratório (38,82%), hipotonia (24,70%), seguido de condições maternas desfavoráveis (18,82%), mostraram-se como fatores impeditivos para o AMP, embora 90% dos recém-nascidos tenham recebido Apgar 9/10 no 5º minuto. CONCLUSÃO: A prevalência do aleitamento materno precoce é inferior ao recomendado, porém compatível com as proporções de frequência nacional mais recentes.

Assessment of obstetric history and cervical length as risk factors for preterm birth / Evaluación de la história obstétrica y la longitud cervical como factores de riesgo para el parto prematuro

Introduction: Preterm birth, before 37 weeks of gestation, is the main determinant of neonatal morbidity and mortality and is associated with serious consequences,including compromised quality of life for the affected individual and physical, psychological, and economic costs. Objective: To evaluate the correlation of obstetric history, cervicovaginal infections, and cervical length with preterm birth. A prospective, blind cohort study evaluated 1,370 pregnant women from Ribeirão Preto between 20 and 25 weeks of gestation. Materials and methods: The correlation between obstetric history, cervical length, and gestational age at birth was obtained by calculating the relative risk of the different variables. Results: The distribution of pregnant women according to cervical length (CL) showed a predominance of women with a cervix longer than 2.5 cm (n = 1,308, 95.8%), followed by women with a cervix between 2 and 2.49 cm (n = 42, 3.1%) and < 2 cm (n = 15, 1.1%). Among the 1,370 pregnant women evaluated, 133 had spontaneous preterm birth (< 259 days); 14 (10.5%) preterm births occurred in women under 19 years of age, 105 (79%) in women between 19 and 35 years, and 14 (10.5%) in women older than 35 years. Microbiological analysis showed the growth of Mycoplasma hominis, Ureaplasma urealyticum, and other bacteria in 8, 17, and 16 women with preterm birth, respectively. Among the 133 women with spontaneous preterm birth, CL was < 2.5 cm in 15 women, < 2 cm in 3, < 1.5 cm in 3, and < 1 cm in 2. Conclusion: The identification of pregnant women at high risk for preterm delivery can reduce the incidence of preterm birth. Although no gold standard test exists for the prediction of preterm birth, this study confirms that the measurement of CL is a good individual predictor.

Introducción: El nacimiento pretérmino, antes de las 37 semanas de gestación, es el principal determinante de la morbimortalidad neonatal y se asocia a graves consecuencias,incluyendo el compromiso de la calidad de vida del individuo afectado y costes físicos, psicológicos y económicos. Objetivo: Evaluar la correlación de los antecedentes obstétricos, infecciones cervicovaginales y longitud cervical con el parto prematuro. Estudio de cohorte prospectivo, ciego, evaluando 1.370 gestantes de Ribeirão Preto entre 20 y 25 semanas de gestación. Material y métodos: La correlación entre los antecedentes obstétricos, la longitud cervical y la edad gestacional al nacer se obtuvo calculando el riesgo relativo de las diferentes variables. Resultados: La distribución de las gestantes según la longitud cervical (LC) mostró un predominio de mujeres con cuello uterino mayor de 2,5 cm (n = 1,308, 95.8%), seguidas de mujeres con cuello uterino entre 2 y 2,49 cm (n = 42, 3.1%) y menor de 2 cm (n = 15, 1.1%). De las 1,370 embarazadas evaluadas, 133 tuvieron un parto prematuro espontáneo (< 259 días); 14 (10.5%) partos prematuros se produjeron en mujeres menores de 19 años, 105 (79%) en mujeres de entre 19 y 35 años, y 14 (10.5%) en mujeres mayores de 35 años. Los análisis microbiológicos mostraron la proliferación de Mycoplasma hominis, Ureaplasma urealyticum y otras bacterias en 8, 17 y 16 mujeres con parto prematuro, respectivamente. Entre las 133 mujeres con parto prematuro espontáneo, la CL fue < 2.5 cm en 15 mujeres, < 2 cm en 3, < 1.5 cm en 3 y < 1 cm en 2. Conclusión: La identificación de las gestantes con alto riesgo de parto prematuro puede reducir la incidencia de parto prematuro. Aunque no existe una prueba de referencia para la predicción del parto prematuro, este estudio confirma que la medición de la longitud cervical es una buena predicción individual.

Peso al nacer en el noroeste argentino. Comparación con una referencia nacional y un estándar internacional / Birth weight in the Northwest region of Argentina. Comparison with a national reference and an international standard

Introducción. El tamaño al nacer se encuentra sujeto a influencias genéticas y ambientales; la altura geográfica es muy influyente. El peso al nacer (PN) es el indicador más utilizado para evaluarlo; existen diferentes estándares y referencias. Debido a la variabilidad de la distribución del PN en relación con la altura en la provincia de Jujuy (Argentina), este trabajo analiza la distribución percentilar del PN para tierras altas (TA) y tierras bajas (TB) jujeñas según edad gestacional (EG) y sexo, y su comparación con una referencia nacional y el estándar internacional INTERGROWTH-21st (IG-21). Población y métodos. Se analizaron los registros de 78 524 nacidos vivos en Jujuy en el período 20092014. Utilizando el método LMS, se estimaron los percentiles 3, 10, 50, 90 y 97 de PN/EG por sexo, para TA (≥2000 msnm), TB (<2000 msnm) y el total provincial, y se compararon gráficamente con la referencia poblacional argentina de Urquía y el estándar IG-21. La significación estadística se determinó mediante la prueba de Wilcoxon. Resultados. El PN en Jujuy presentó distribución heterogénea, con diferencias estadísticamente significativas (p <0,05) entre TB y TA. Al comparar con la referencia nacional y el estándar IG-21, se observaron diferencias por altitud, principalmente en los percentiles 90 y 97 para ambas regiones, y en los percentiles 3 y 10 en TA comparados con el estándar. Conclusiones. Se observó variabilidad de la distribución del PN asociada a la altura geográfica, por lo que, para evaluar el crecimiento intrauterino, resulta fundamental incluir la EG y el contexto donde transcurre la gestación.

Introduction. Size at birth is subject to genetic and environmental influences; altitude is highly influential. Birth weight (BW) is the most widely used indicator to assess size at birth; different standards and references are available. Due to the variability in BW distribution in relation to altitude in the province of Jujuy (Argentina), the purpose of this study is to analyze the percentile distribution of BW in the highlands (HL) and the lowlands (LL) of Jujuy based on gestational age (GA) and sex and compare it with a national reference and the INTERGROWTH-21 st (IG-21) international standard. Population and methods. The records of 78 524 live births in Jujuy in the 2009­2014 period were analyzed. Using the LMS method, the 3 rd, 10 th, 50 th, 90 th, and 97 th percentiles of BW/GA by sex were estimated for the HL (≥ 2000 MASL), the LL (< 2000 MASL), and the total for Jujuy, and compared with the Argentine population reference by Urquía and the IG-21 standard using growth charts. The statistical significance was established using the Wilcoxon test. Results. BW in Jujuy showed a heterogeneous distribution, with statistically significant differences (p < 0.05) between the LL and the HL. When compared with the national reference and the IG-21 standard, differences in terms of altitude were observed, mainly in the 90 th and 97 th percentiles for both regions and the 3 rd and 10 th percentiles in the HL compared with the international standard. Conclusions. BW distribution varied in association with altitude; therefore, to assess intrauterine growth, it is critical to include GA and the environment in which the pregnancy takes place.

Renal deficit and associated factors in children born with low birth weight / Déficit renal e fatores associados em crianças nascidas com baixo peso

ABSTRACT Introduction: Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. Methods: Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children's variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. Results: Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children's current weight and use of nephrotoxic drugs. Discussion: Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs.

RESUMO Introdução: Problemas renais podem ser devido apenas ao baixo peso ao nascer ou podem ocorrer em associação com outras condições. O objetivo deste estudo foi avaliar a associação entre características maternas e de nascimento, medidas antropométricas e déficit da função renal em bebês de baixo peso ao nascer. Métodos: Estudo transversal com crianças que nasceram com peso < 2500 gramas e estavam sob acompanhamento ambulatorial. Os fatores maternos investigados foram cuidados pré-natal e presença de hipertensão, diabetes e infecção durante a gravidez. As variáveis das crianças foram sexo, idade gestacional, peso ao nascer, índice Apgar, uso de medicamentos nefrotóxicos, idade, peso corporal no momento da avaliação, altura e dosagens séricas de creatinina e cistatina C. A taxa de filtração glomerular (TFG) foi estimada com a equação combinada de Zapittelli. Utilizou-se um modelo de regressão logística multivariada para identificação de fatores associados, com déficit da função renal (TFG < 60 mL/min/1,73 m2) como variável dependente. Resultados: Das 154 crianças avaliadas, 34,42% apresentaram déficit da função renal. A maioria tinha idade gestacional > 32 semanas (56,6%), peso médio ao nascer de 1439,7 gramas, e TFG média estimada de 46,9 ± 9,3 mL/min/1,73 m2. Houve uma associação significativa da TFG < 60 mL/min/1,73 m2 com o peso atual das crianças e o uso de medicamentos nefrotóxicos. Discussão: Crianças nascidas com baixo peso apresentaram alta prevalência de déficit da função renal e o peso atual normal foi um fator de proteção, enquanto o uso de medicamentos nefrotóxicos durante o período perinatal aumentou a chance de déficit renal. Estes achados reforçam a necessidade de avaliar a função renal destas crianças, especialmente aquelas que usam medicamentos nefrotóxicos.

Rotura prematura de membranas: diagnóstico y manejo / Premature Rupture of Membranes: Diagnosis and Management

La rotura prematura de membranas se clasifica según la edad gestacional: a término (a partir de las 37 semanas de gestación), y pretérmino (antes de las 37 semanas). Esta se subdivide en cerca del término (34 y menos de 37 semanas), lejos del término (24 a 34 semanas) y previable (antes de las 24 semanas). Afecta a 8 % de las gestaciones; en pretérmino: 2 % y 4 % de las gestaciones únicas, 7 % a 20 % de las gemelares. Conlleva riesgos como corioamnionitis y desprendimiento prematuro de placenta normoinserta. La infección intraamniótica ocurre en 15 % a 35 % de los casos. El diagnóstico oportuno y el manejo adecuado son vitales para reducir la morbimortalidad asociada. El objetivo de esta revisión es abordar el diagnóstico y el manejo de la rotura prematura de membranas de acuerdo a la edad gestacional(AU)

Premature rupture of membranes is classified according to gestational age: term (from 37 weeks of gestation), and preterm (before 37 weeks). This is subdivided into near-term (34 and less than 37 weeks), far from term (24 to 34 weeks), and previable (before 24 weeks). It affects 8% of pregnancies; Preterm: 2% to 4% of singleton pregnancies, 7% to 20% of twins. It carries risks such as chorioamnionitis and normoinserted placental abruption. Intra-amniotic infection occurs in 15% to 35% of cases. Timely diagnosis and appropriate management are vital to reduce associated morbidity and mortality. The aim of this review is to address the diagnosis and management of premature rupture of membranes according to gestational age(AU)

Mortalidad infantil en la provincia de Santiago de Cuba durante el período 2008-2022

Introducción: La tasa de mortalidad infantil es un indicador importante y sensible del bienestar y la calidad de vida de una población, muy usado para medir su estado de salud. Objetivo: Caracterizar la mortalidad infantil según semestres en la provincia de Santiago de Cuba durante 2008-2022. Métodos: Se realizó un estudio observacional descriptico y transversal sobre la mortalidad infantil en la provincia de Santiago de Cuba durante los años 2008-2022. Para ello se analizó la relación existente entre los semestres de cada año respecto a los nacimientos, las defunciones y su incidencia en la tasa del país. Resultados: Se observó una disminución de los nacimientos y un incremento de las defunciones en cada quinquenio estudiado respecto al anterior. El número de fallecidos menores de un año fluctuó, con una tendencia al aumento a partir del 2019; asimismo, los indicadores de mortalidad infantil fueron inestables, con propensión al incremento, sobre todo en el segundo semestre, y peores resultados en el 2021 y 2022. Existió un descenso mantenido de los nacimientos a partir del 2011, que alcanzó 25,6 % en el 2022. Respecto a los semestres, en el segundo hubo mayor número de nacimientos, defunciones y tasas. Conclusiones: La provincia de Santiago de Cuba influye de forma directa en los resultados de la mortalidad infantil nacional, con una tasa superior a la exhibida por el país. El segundo semestre es el período en el que se incrementan los nacimientos y las defunciones, lo que incide en la elevación de las tasas respectivas.

Introduction: The infant mortality rate is an important and sensitive indicator of the well-being and life quality of a population, very used to measure the health state. Objective: To characterize the infant mortality in Santiago de Cuba province during the period 2008-2022. Methods: An observational descriptive and cross-sectional study about the infant mortality was carried out in Santiago de Cuba during the years 2008-2022. The existent relationship among the semesters of every year regarding births, deaths and their incidence in the country rate was analyzed. Results: A decrease of births and an increment of deaths were observed in each five year period studied regarding the previous one. The number of deceased children under one year fluctuated, with a tendency to the increase starting from 2019; also, the indicators of infant mortality were unstable, with tendency to the increment, mainly in the second semester, and worse results in 2021 and 2022. There was a maintained decrease of births since 2011 that reached 25.6% in 2022. In relation to semesters, in the second one there was a higher number of births, deaths and rates. Conclusions: Santiago de Cuba province influences in a direct way on the results of national infant mortality, with a superior rate to the one exhibited by the country. The second semester is the period in which births and deaths are increased, what impacts in the elevation of the respective rates.

Asociación del bajo peso al nacer con el control prenatal, la anemia materna y ser madre soltera

Fundamento: la elevada frecuencia de recién nacidos con peso inferior al adecuado, en relación con la anemia materna, la atención prenatal insuficiente y la condición de madre soltera, puede tener importantes repercusiones en la salud de las madres y los niños. Objetivo: identificar la relación entre el control prenatal, la anemia materna y la condición de ser madre soltera con el bajo peso al nacer de los infantes. Método: se realizó un estudio observacional, analítico y retrospectivo de casos y controles en gestantes atendidas en un hospital de la región Sierra de Ecuador durante el año 2022. La muestra fue de 280 pacientes. El grupo de casos lo conformaron las gestantes con hijos con bajo peso al nacer (n = 70) y el grupo de control por gestantes con recién nacidos con peso normal (n = 210). Se realizó la prueba de Chi cuadrado de independencia y se calculó el Odds Ratio y su intervalo de confianza del 95 % para el nivel de asociación entre las variables. Resultados: la relación de la variable asistencia a controles prenatales con respecto al bajo peso al nacer mostró una asociación protectora (OR = 0,5). Se identificaron como factores de riesgo, la anemia materna (OR = 3,1) y la condición de madre soltera (OR = 2,3) por sus altos valores de asociación positiva y directa. Conclusiones: el control prenatal, la anemia materna y la condición de madre soltera resultaron tener un nivel de asociación significativa con el bajo peso al nacer.

Foundation: the high frequency of newborns with less than adequate weight, in relation to maternal anemia, insufficient prenatal care and single mother status, can have important repercussions on the health of mothers and children. Objective: to identify the relationship between prenatal control, maternal anemia and the condition of being a single mother with low birth weight of infants. Method: an observational, analytical and retrospective case-control study was carried out in pregnant women treated in a hospital in the Sierra region of Ecuador during the year 2022. The sample was 280 patients. The case group was made up of pregnant women with children with low birth weight (n = 70) and the control group was made up of pregnant women with newborns with normal weight (n = 210). The Chi square test of independence was performed and the Odds Ratio and its 95 % confidence interval were calculated for the level of association between the variables. Results: the relationship between the variable attendance at prenatal check-ups and low birth weight showed a protective association (OR = 0,5). Maternal anemia (OR = 3,1) and being a single mother (OR = 2,3) were identified as risk factors due to their high values of positive and direct association. Conclusions: prenatal control, maternal anemia and single mother status turned out to have a significant level of association with low birth weight.

Prevalencia de osteopenia del prematuro antes y después de la implementación de una estrategia temprana de manejo fosfocálcico / Prevalence of osteopenia of prematurity before and after implementing an early strategy with the use of calcium and phosphate

Introducción. Con el uso de la nutrición parenteral agresiva en recién nacidos de muy bajo peso, se detectaron alteraciones del metabolismo fosfocálcico. En 2016 se implementó una estrategia de prevención a través del monitoreo fosfocálcico y su suplementación temprana. El objetivo fue estudiar si esta estrategia disminuye la prevalencia de osteopenia e identificar factores de riesgo asociados. Población y métodos. Estudio cuasiexperimental que comparó la prevalencia de osteopenia entre dos grupos: uno después de implementar la estrategia de monitoreo y suplementación fosfocálcica (01/01/2017-31/12/2019), y otro previo a dicha intervención (01/01/2013-31/12/2015). Resultados. Se incluyeron 226 pacientes: 133 pertenecen al período preintervención y 93 al posintervención. La prevalencia de osteopenia global fue del 26,1 % (IC95% 20,5-32,3) y disminuyó del 29,3 % (IC95% 21,7-37,8) en el período preintervención al 21,5 % (IC95% 13,6-31,2) en el posintervención, sin significancia estadística (p = 0,19). En el análisis multivariado, el puntaje NEOCOSUR de riesgo de muerte al nacer, recibir corticoides posnatales y el período de intervención se asociaron de manera independiente a osteopenia. Haber nacido luego de la intervención disminuyó un 71 % la probabilidad de presentar fosfatasa alcalina >500 UI/L independientemente de las restantes variables incluidas en el modelo. Conclusión. La monitorización y suplementación fosfocálcica precoz constituye un factor protector para el desarrollo de osteopenia en recién nacidos con muy bajo peso al nacer.

Introduction. With the use of aggressive parenteral nutrition in very low birth weight infants, alterations in calcium and phosphate metabolism were detected. In 2016, a prevention strategy was implemented through calcium phosphate monitoring and early supplementation. Our objective was to study whether this strategy reduces the prevalence of osteopenia and to identify associated risk factors. Population and methods. Quasi-experiment comparing the prevalence of osteopenia between two groups: one after implementing the calcium phosphate monitoring and supplementation strategy (01/01/2017­12/31/2019) and another prior to such intervention (01/01/2013­12/31/2015). Results. A total of 226 patients were included: 133 in the pre-intervention period and 93 in the post-intervention period. The overall prevalence of osteopenia was 26.1% (95% CI: 20.5­32.3) and it was reduced from 29.3% (95% CI: 21.7­37.8) in the pre-intervention period to 21.5% (95% CI: 13.6­31.2) in the post-intervention period, with no statistical significance (p = 0.19). In the multivariate analysis, the NEOCOSUR score for risk of death at birth, use of postnatal corticosteroids, and the intervention period were independently associated with osteopenia. Being born after the intervention reduced the probability of alkaline phosphatase > 500 IU/L by 71%, regardless of the other variables included in the model. Conclusion. Calcium phosphate monitoring and early supplementation is a protective factor against the development of osteopenia in very low birth weight infants.

Experiencia de parto instrumental con vacuum en Hospital Público de Santiago de Chile / Experience of vacuum-assisted instrumental delivery in a Public Hospital in Santiago, Chile

Introducción: El vacuum es el instrumento de elección para asistir el parto instrumental en países desarrollados. Objetivo: El objetivo del estudio es exponer los resultados maternos y fetales del uso del vacuum en población chilena y promover su disponibilidad y uso en nuestro país y Latinoamérica. Método: El estudio se realizó entre octubre de 2017 y diciembre de 2021, incluyendo a pacientes que tuvieron parto instrumental con vacuum en el Hospital San Juan de Dios de Chile. Se compararon los partos exitosos con vacuum y los partos en los que se requirió el uso de otro instrumento o una cesárea posterior al uso del instrumento. Resultados: Se realizaron 153 vacuum, correspondientes al 28,59% del total de partos instrumentales. El 79,74% tuvo éxito. El 5,88% no recibió anestesia o se aplicó anestesia local. Solo el 3,27% presentó desgarro perineal con compromiso del esfínter anal. El 91,5% de los recién nacidos no tuvieron complicaciones fetales. Un 20,3% requirió reanimación neonatal. Conclusiones: El estudio muestra que el vacuum es una opción segura y efectiva de parto instrumental en nuestra población. La correcta capacitación y protocolos adecuados son necesarios para garantizar resultados exitosos.

Introduction: Vacuum extraction is the instrument of choice for assisting instrumental delivery in developed countries. Objective: The aim of the study is to present the maternal and fetal outcomes of vacuum use in the Chilean population and promote its availability and usage in our country and Latin America. Method: The study was performed between October 2017 and December 2021, including patients who underwent instrumental delivery with a vacuum extraction at the Hospital San Juan de Dios in Chile. Successful vacuum deliveries were compared with deliveries where another instrument was required, or a cesarean section was performed after instrument use. Results: A total of 153 vacuum deliveries were carried out, accounting for 28.59% of all instrumental deliveries. 79.74% were successful. 5.88% did not receive anesthesia or received local anesthesia. Only 3.27% experienced perineal tear with involvement of the anal sphincter. 91.5% of newborns had no fetal complications. 20.3% required neonatal resuscitation. Conclusions: The study demonstrates that the vacuum is a safe and effective option for instrumental delivery in our population. Proper training and appropriate protocols are necessary to ensure successful outcomes.

Anomalía de Ebstein: a propósito de un caso / Ebstein anomaly: about a case

La anomalía de Ebstein es una cardiopatía congénita rara y poco frecuente caracterizada por el adosamiento de los velos valvulares tricuspídeos; en la etapa prenatal se estima que su incidencia corresponde a un 3% de todas las cardiopatías diagnosticadas. Se presenta el caso de un feto con diagnóstico de anomalía de Ebstein a quien se le realizó un diagnóstico prenatal adecuado, lo que permitió planificar el nacimiento neonatal con un equipo multidisciplinario integral. Debido a la rareza del diagnóstico prenatal de esta entidad, se describe el caso clínico y los hallazgos imagenológicos representativos.

Ebsteins anomaly is a rare and infrequent congenital heart disease characterized by the attachment of the tricuspid valve leaflets; in the prenatal stage it is estimated that its incidence corresponds to 3% of all diagnosed heart diseases. We present the case of a fetus diagnosed with Ebsteins anomaly who underwent an adequate prenatal diagnosis, which made it possible to plan the neonatal birth with a comprehensive multidisciplinary team. Due to the rarity of the prenatal diagnosis of this entity, the clinical case and the representative imaging findings are described.

Economic burden of healthcare-associated infection in low birth weight in-fants / 中国感染控制杂志

Objective To analyze the economic burden due to healthcare-associated infection(HAI)in low birth weight(LBW)infants,and provide theoretical basis for formulating HAI related policies.Methods The data of LBW infants in a tertiary first-class hospital from January 2018 to December 2022 were retrospectively collected.Propensity score matching method and marginal analysis were adopted to evaluate the economic losses in LBW in-fants and hospitals due to HAI.Results A total of 1 048 LBW infants were included in analysis,124 of whom had HAI,with HAI incidence of 11.8％.A total of 109 pairs were successfully matched using the propensity score matching method.The median length of hospital stay for LBW infants in the HAI group and non-HAI group were 34.0 and 11.0 days,respectively,the length of hospital extended 23 days in LBW infants in the HAI group(P＜0.001).The median hospitalization expenses for LBW infants in HAI group and non-HAI group were 38 067.6 and 12 375.7 Yuan,respectively,the hospitalization expense for LBW infants in HAI group was 25 691.9 Yuan more than non-HAI group(P＜0.001).The major increased expenses were examination,treatment and medication fees.The total hospitalization expenses in different birth weight LBW infants in HAI group were all higher than non-HAI group,and the differences were all statistically significant(all P＜0.05).LBW infants with gestational age＜32 weeks had longer length of hospital stay and higher total hospitalization expense,differences were all statistically significant(all P＜0.05).When the marginal profit ratios were 5％,10％,and 15％,respectively,the economic losses caused by HAI were 371 000 Yuan,742 000 Yuan,and 1 114 000 Yuan,respectively;The ratios of loss-profit and loss-profit to infection coefficient were 0.33 and 2.79,respectively.Conclusion HAI cause significant economic losses to both LBW infants and hospitals.Infants with a birth weight ≤1 000 g and those with a gestational age＜32 weeks are key populations for prevention and control.The lost-profit to infection coefficient can be used to estimate the economic loss of the hospital,timely adjust infection control measures,and reduce the incidence of HAI.

Association between abnormal oral glucose tolerance test patterns in the second trimester and large for gestational age newborns / 中华妇产科杂志

Objective:To investigate the impact of abnormal patterns of 75 g oral glucose tolerance test (OGTT) in the second trimester on the risk of large for gestational age (LGA) newborn deliveries.Methods:General clinical data and OGTT results of 66 290 pregnant women who received regular prenatal care and delivered in Guangdong Maternal and Child Health Hospital from December 24, 2016 to July 26, 2022 were collected. According to the results of OGTT, the pregnant women were divided into 8 groups: normal blood glucose group (normal fasting blood glucose, 1-hour and 2-hour after oral glucose, 54 518 cases), gestational diabetes mellitus (GDM) 0 group (only abnormal fasting blood glucose, 1 430 cases), GDM 1 group (only abnormal blood glucose at 1-hour after oral glucose, 2 150 cases), GDM 2 group (only abnormal blood glucose at 2-hour after oral glucose, 3 736 cases), GDM 0+1 group (both fasting blood glucose and 1-hour after oral glucose were abnormal, 371 cases), GDM 0+2 group (both fasting blood glucose and 2-hour after oral glucose were abnormal, 280 cases), GDM 1+2 group (abnormal blood glucose at 1-hour and 2-hour after oral glucose, 2 981 cases) and GDM 0+1+2 group (abnormal fasting blood glucose, 1-hour and 2-hour after oral glucose, 824 cases). Multivariate logistic regression was used to analyze the effects of different abnormal OGTT patterns on LGA. In addition, the blood glucose measurements at the three time points of OGTT were combined and used as continuous variables in the receiver operating characteristic (ROC) curve to evaluate the predictive value of each blood glucose measurement mode for LGA and the area under the curve (AUC) was compared.Results:(1) Multivariate logistic regression analysis showed that the risks of LGA were significantly increased in GDM 0 group ( OR=1.76, 95% CI: 1.50-2.08; P<0.001), GDM 0+1 group ( OR=2.29, 95% CI: 1.72-3.04; P<0.001), and GDM 0+1+2 group ( OR=1.98, 95% CI: 1.61-2.43; P<0.001). (2) ROC curve analysis showed that fasting blood glucose, 1-hour after oral glucose, 2-hour after oral glucose, fasting+1-hour after oral glucose, fasting+2-hour after oral glucose, 1-hour+2-hour after oral glucose, and fasting+1-hour+2-hour after oral glucose had certain predictive value for LGA (all P<0.001). The AUC of fasting blood glucose measurement was higher than that of 2-hour blood glucose measurement in predicting LGA, and the difference was statistically significant ( P<0.05). There was no significant difference in the AUC between fasting blood glucose and other blood glucose measurement modes for predicting LGA (all P>0.05). Conclusions:In the abnormal OGTT patterns, pregnant women with abnormal fasting blood glucose, abnormal fasting+1-hour after oral glucose, and abnormal fasting+1-hour+2-hour after oral glucose have an increased risk of LGA. Fasting blood glucose measurement is of great significance for the prediction of LGA, and could be used as an optimal indicator to evaluate the risk of LGA in clinical practice.

Nursing care of an infant with severe bronchopulmonary dysplasia during the transition period from hospitalization to family / 中华护理杂志

To summarize the nursing care of a very low birth weight premature infant with severe type Ⅱbronchopulmonary dysplasia(BPD)during the transition period from hospitalization to home.The care of the infant was provided one-on-one by a BPD specialist nurse throughout the period.The key points of transitional care from hospitalization to home include:implementing tracheotomy and mechanical ventilation care to ensure stable blood oxygen saturation of the infant;providing nutritional support to improve the nutritional status of the infant;implementing step-by-step rehabilitation measures to improve the neuromotor development of the infant;implementing family integrated care to promote the primary caregivers of the infant to master nursing knowledge and skills;conducting personalized discharge follow-up with a multidisciplinary team to improve the quality of home care for this infant.After being hospitalized for 106 days,the infant was successfully discharged with a tracheotomy tube.At the age of 2 years and 6 months,a tracheotomy closure surgery was performed.After the surgery,the infant was able to breathe autonomously without symptoms of breathing difficulties and returned to normal family life.