Mortalidad en recién nacidos de muy bajo peso al nacer en la Red Neonatal NEOCOSUR: causalidad y temporalidad / Mortality in very low birth weight (VLBW) infants in South American NEOCOSUR Neonatal Network: timing and causes

Introducción. La mortalidad de los recién nacidos de muy bajo peso de nacimiento (RNMBPN) se ha mantenido en ~26 % en los últimos 16 años en la Red Neonatal NEOCOSUR. Objetivo. Determinar la causa de muerte de los RNMBPN y su temporalidad en el período 20072016 en la Red Neonatal NEOCOSUR. Población y métodos. Estudio observacional de cohorte multicéntrica; análisis retrospectivo de datos obtenidos prospectivamente. Se incluyeron recién nacidos entre 24 y 31+6 semanas de edad gestacional y peso de nacimiento de 500-1500 g, en 26 centros de la Red Neonatal NEOCOSUR. Las causas de muerte se analizaron según ocurriera en sala de partos (SP) o durante la estadía en la unidad de cuidados intensivos neonatales (UCIN). La edad posnatal de muerte se determinó a través de análisis de Kaplan-Meier. Resultados. Se incluyeron un total de 11.753 RNMBPN con una mortalidad global del 25,6 %. Las causas de muerte predominantes en SP fueron malformaciones congénitas (43,3 %), enfermedades respiratorias (14,3 %) y prematuridad (11,4 %). Las causas de muerte predominantes en UCIN fueron las respiratorias (24,2 %) e infecciosas (24,1 %). La edad promedio de muerte fue de 10,2 días y mediana de 4 días. El 10,2 % de las muertes ocurrieron en SP; el 21,5 %, durante el primer día; el 52 % ocurrió en los primeros 4 días y el 63,8 %, durante la primera semana de vida. Conclusiones. Se encuentran importantes diferencias en las causas de muerte de RNMBPN según ocurra en SP o en UCIN. Las infecciosas y respiratorias son las más relevantes luego del ingreso a la unidad de cuidados intensivos.

Introduction. Mortality in very low birth weight infants (VLBWIs) has remained at ~26% in the past 16 years in the NEOCOSUR Neonatal Network. Objective. To determine the cause of death of VLBWIs and its temporality in the 2007-2016 period in the NEOCOSUR Neonatal Network. Population and methods. Observational, multicenter cohort study; retrospective analysis of data collected prospectively. Newborn infants born between 24 and 31+6 weeks of gestation age with a birth weight between 500 and 1500 g in the 26 sites of the NEOCOSUR Neonatal Network were included. The causes of death were analyzed depending on whether they occurred in the delivery room (DR) or in the neonatal intensive care unit (NICU). The postnatal age at time of death was determined using the KaplanMeier test. Results. A total of 11 753 VLBWIs were included; overall mortality was 25.6%. The prevailing causes of death in the DR were congenital malformations (43.3%), respiratory diseases (14.3%), and prematurity (11.4%). The prevailing causes of death in the NICU were respiratory diseases (24.2%) and infections (24.1%). The average and median age at death were 10.2 and 4 days, respectively. Also, 10.2% of deaths occurred in the DR; 21.5% on day 1, 52% in the first 4 days, and 63.8% in the first week of life. Conclusions. Important differences were observed in the causes of death of VLBWIs depending on their occurrence in the DR or the NICU. Infectious and respiratory conditions were the most relevant factors following admission to the NICU.

Producción de leche materna y estado emocional en madres de recién nacidos de muy bajo peso / Breast milk production and emotional state in mothers of very low birth weight infants

Introducción. Existe poca evidencia de la influencia de variables emocionales en la lactancia de madres de recién nacidos de muy bajo peso al nacer (RNMBPN). El objetivo de este estudio fue medir la producción de leche materna (PLM) en dos momentos de la internación neonatal y su asociación con los niveles de ansiedad, depresión y autoeficacia en lactancia en madres de RNMBPN.Población y métodos. Estudio prospectivo, observacional, multicéntrico en madres de RNMBPN (500-1500 g), en 9 centros de la Red NEOCOSUR. La PLM se obtuvo midiendo lo extraído por cada madre. Se utilizaron las escalas STAI para ansiedad, BDI para depresión, y, la escala piloto ALMA para autoeficacia. Estas fueron aplicadas a los 14 días de vida y a las 36 semanas posmenstruales. Se registraron, además, las características biosociales de madres y neonatos. Resultados. Participaron 118 madres. La PLM media a los 14 días fue de 169 ml (desvío estándar ­DE­ ± 132,4) y de 285 ml (DE ± 266,9) a las 36 semanas, y se asoció significativamente con percepción de autoeficacia en lactancia (p < 0,001), que se mantuvo durante la hospitalización. Existió una tendencia a menor producción en madres con mayores índices de depresión a los 14 días de vida de su hijo, pero no a las 36 semanas. No se encontró asociación entre PLM y ansiedad. No se encontraron asociaciones consistentemente significativas con variables biosociales. Conclusión. La PLM se asoció positivamente con autoeficacia en lactancia; no se encontró asociación con ansiedad y depresión en madres de RNMBPN

Introduction. There is little evidence regarding the influence of emotional variables on breastfeeding among mothers of very low birth weight infants (VLBWIs). The objective of this study was to measure breast milk production (BMP) at two points in time during neonatal hospitalization and its association with anxiety, depression, and breastfeeding self-efficacy levels among mothers of VLBWIs.Population and methods. Prospective, observational, and multicenter study in mothers of VLBWIs (500-1500 g) from 9 NEOCOSUR Network centers. BMP was obtained by measuring the amount extracted by each mother. The STAI scale was used for anxiety, the BDI scale for depression, and the ALMA pilot scale for self-efficacy. They were administered at 14 days of life and at 36 weeks of postmenstrual age. The biosocial characteristics of mothers and neonates were also recorded.Results. A total of 118 mothers participated. Mean BMP was 169 mL (standard deviation [SD]: ± 132.4) at 14 days and 285 mL (SD: ± 266.9) at 36 weeks, and it was significantly associated with the perception of breastfeeding self-efficacy (p < 0.001), which was maintained during hospitalization. There was a lower production trend among mothers with higher depression indices at 14 days of life, but not at 36 weeks. No association was observed between BMP and anxiety. No consistently significant associations were observed with biosocial variables.Conclusion. BMP was positively associated with breastfeeding self-efficacy; no association was observed with anxiety and depression among mothers of VLBWIs

Estrés en padres de recién nacidos prematuros de muy bajo peso hospitalizados en unidades de cuidados intensivos neonatales. Estudio multicéntrico / Stress in parents of very low birth weight preterm infants hospitalized in neonatal intensive care units. A multicenter study

Introducción. El nacimiento de un hijo prematuro es un evento estresante para sus padres. El objetivo de este estudio fue determinar el estrés inicial de padres de recién nacidos de muy bajo peso de nacimiento (RNMBPN) hospitalizados en 12 unidades de cuidados intensivos neonatales en una red neonatal sudamericana, identificar los factores asociados y comparar el nivel de estrés parental en centros públicos vs. privados. Población y métodos. Estudio transversal en madres/padres de RNMBPN (de 500 a 1500 g). El estrés parental inicial se midió utilizando la Escala de Estrés Parental en una escala de 1 (bajo estrés) a 5 (alto estrés). Las características sociodemográficas de las madres/padres y de los neonatos fueron recolectadas y asociadas a los niveles de estrés parental. Resultados. Participaron del estudio 273 padres / madres de un total de 218 RNMBPN. La encuesta fue aplicada en el 5,9 ± 2,0 días de vida del recién nacido. El estrés parental total promedio fue de 3,1 ± 0,8, y la subescala rol parental fue aquella que puntuó más alto (3,6). Tener un menor nivel educacional, estar desempleado, no haber tomado al recién nacido en brazos y el requerimiento de apoyo ventilatorio se asociaron a mayor estrés parental. El estrés fue mayor en madres que en padres y en centros públicos que en privados. Conclusiones. En padres de RNMBPN, se encontró un estrés inicial moderado. El factor más relevante fue la alteración en su rol parental. El estrés parental fue mayor en las madres y en los centros públicos. Se requiere una mayor sensibilización, investigación e intervención en esta área.

Introduction. The birth of a premature baby is a stressful event for parents. The objective of this study was to determine early stress in parents of very low birth weight infants (VLBWIs) hospitalized in 12 neonatal intensive care units from a South American Neonatal Network, to identify associated factors, and to compare the level of parental stress in public versus private healthcare facilities. Population and Methods. Cross-sectional study in mothers/fathers of VLBWIs (500 to 1500 g). Early parental stress was measured using the Parental Stressor Scale, with a score from 1 (low stress) to 5 (high stress). The sociodemographic characteristics of parents and newborn infants were collected and associated with levels of parental stress. Results. The study included273 fathers/mothers of a total of218 VLBW preterm infants. The survey was administered at 5.9 ± 2.0 days of life. The average total parental stress was 3.1 ± 0.8, and the highest score was obtained for the parental role subscale (3.6). A lower education level, unemployment, not having held the newborn infant, and respiratory support requirement were associated with higher parental stress levels. Stress was higher among mothers than fathers, and at public facilities versus private ones. Conclusions. Among parents of VLBWIs, a moderate early parental stress was observed. Parental role alteration was the most relevant factor. Parental stress was higher among mothers and at public healthcare facilities. A greater sensitization, further research and interventions in this area are required.

Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study / Impacto da diabetes mellitus maternal sobre a mortalidade e morbidade de crianças com muito baixo peso ao nascer: um estudo em diversos centros da América Latina

OBJECTIVES: To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). METHODS: This was a cohort study with retrospective data collection (2001-2010, n = 11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. RESULTS: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p = 0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). CONCLUSIONS: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC. .

OBJETIVOS: Comparar mortalidade e morbidade em crianças de muito baixo peso (MBP) filhas de mães com e sem diabetes mellitus (DM). MÉTODOS: Estudo de coorte com coleta retrospectiva de dados (2001-2010, n = 11.991) da rede Neocosur. Odds ratios ajustados foram calculados para mortalidade e morbilidade neonatal em função da DM materna. Mulheres sem DM serviram como grupo de referência. RESULTADOS: A taxa de DM materna foi de 2,8% (IC 95% 2,5-3,1), mas um aumento significativo (p = 0,019) entre 2001-2005 (2,4%) e 2006-2010 (3,2%) foi observado. As mães com DM eram mais propensas a ter recebido um curso completo de esteroides pré-natais do que as sem DM. Os bebês de mães diabéticas tinham uma idade gestacional e peso ao nascer um pouco maior do que crianças filhas de não DM. A distribuição dos escores z do peso ao nascer, pequeno para idade gestacional e de Apgar foi semelhante. Não houve diferenças significativas entre os dois grupos em termos de síndrome do desconforto respiratório, displasia broncopulmonar, hemorragia intraventricular, leucomalácia periventricular e persistência do ductus arteriosus. Mortalidade na sala de parto, mortalidade total, necessidade de ventilação mecânica e taxas de sepse neonatal precoce foram significativamente menores no grupo diabético, enquanto enterocolite necrosante (NEC) foi significativamente maior em recém-nascidos de mães diabéticas. Em análises de regressão logística NEC foi a única condição independentemente associada com DM (OR ajustado 1,65 [IC 95% 1,21 -2,27]). CONCLUSÕES: Crianças MBP de DM não parecem estar em um excesso de risco de mortalidade ou morbidade precoce, exceto NEC. .

Supervivencia y morbilidad en recién nacidos de muy bajo peso al nacer en una Red Neonatal sudamericana / Survival and morbidity of very low birth weight infant in a South American Neonatal Network

Objetivo. Analizar la supervivencia y morbilidad relevante según edad gestacional (EG) en recién nacidos de muy bajo peso de nacimiento (RNMBPN) o < 1500 g y, con estos resultados, confeccionar una cartilla para proporcionar información a profesionales de la salud perinatal y padres de prematuros de muy bajo peso. Diseño del estudio. Se utilizaron los datos recogidos prospectivamente de los recién nacidos con peso al nacer de 500 a 1500 g ingresados a 45 centros participantes de la Red Neonatal Neocosur entre enero de 2001 y diciembre de 2011. Resultados. Se analizaron los datos de 8234 RNMBPN con EG entre 24 +0 y 31 +6 semanas. La mortalidad global fue 26% (IC 95% 25,0-26,9), que incluye 2,6% que falleció en sala de partos. Las cartillas de supervivencia y morbilidad para cada semana de gestación se construyeron a partir de los datos obtenidos. La supervivencia al momento del alta aumentó de 29% a las 24 semanas de EG a 91% a las 31 semanas (p < 0,001). La incidencia de morbilidad neonatal relevante se relacionó inversamente con la EG (p < 0,001). Globalmente, 30,8% presentó retinopatía del prematuro; 25%, displasia broncopulmonar; 10,9%, enterocolitis necrotizante; 7,2%, hemorragia intraventricular grave; y 4,6%, leucomalacia periventricular. De los sobrevivientes, 47,3% no presentó ninguna de estas 5 patologías. Conclusiones. Se desarrolló un instrumento de utilidad clínica, con datos regionales actualizados, que determina semana a semana la supervivencia y morbilidad de los RN que nacen entre las 24 +0 y las 31 +6 semanas de EG. Esta información puede emplearse en la toma de decisiones perinatales y en la información parental.

Objective. To analyze survival and relevant morbidity by gestational age (GA) in very low birth weight (VLBW) infants (<1500 g) and, based on these data, develop a fact sheet to provide information to perinatal healthcare providers and very low birth weight preterm infants ́parents. Study Design. Data were prospectively collected in relation to newborn infants with a birth weight between 500 g and 1500 g admitted to 45 sites of the Neocosur Neonatal Network (Red Neonatal Neocosur) between January 2001 and December 2011. Results. Data on 8234 VLBW with a GA between 24 +0 and 31 +6 weeks were analyzed. Overall mortality was 26% (95% CI: 25.0-26.9), including 2.6% of deaths in the delivery room. Fact sheets for survival and morbidity for each week of gestation were developed based on collected data. Survival at discharge increased from 29% at 24 weeks of GA to 91% at 31 weeks of GA (p < 0.001). The incidence of relevant neonatal morbidity was inversely related to GA (p < 0.001). Overall, 30.8% had retinopathy of prematurity, 25% bronchopulmonary dysplasia, 10.9% necrotizing enterocolitis, 7.2% severe intraventricular hemorrhage, and 4.6% periventricular leukomalacia. Among survivors, 47.3% had none of these five conditions. Conclusions. A tool for use in a clinical setting was developed based on updated regional data for establishing week-to-week survival and morbidity of newborn infants born between 24 +0 and 31 +6 weeks of GA. This information could be used to make decisions related to perinatal care and for counseling parents.

Clinical utility of early amplitude integrated EEG in monitoring term newborns at risk of neurological injury / Utilidade clínica de um monitoramento por EEG de amplitude integrada precoce em recém-nascidos a termo com risco de lesão neurológica

OBJECTIVE: to test the clinical utility of an early amplitude-integrated electroencephalography (aEEG) to predict short-term neurological outcome in term newborns at risk of neurology injury. METHODS: this was a prospective, descriptive study. The inclusion criteria were neonatal encephalopathy, neurologic disturbances, and severe respiratory distress syndrome. Sensitivity, specificity, positive and negative predictive values, and likelihood ratio (LR) were calculated. Clinical and demographic data were analyzed. Neurological outcome was defined as the sum of clinical, electroimaging, and neuroimaging findings. RESULTS: ten of the 21 monitored infants (48%) presented altered short-term neurologic outcome. The aEEG had 90% sensitivity, 82% specificity, 82% positive predictive value, and 90% negative predictive value. The positive LR was 4.95, and the negative LR was 0.12. In three of 12 (25%) encephalopathic infants, the aEEG allowed for a better definition of the severity of their condition. Seizures were detected in eight infants (38%), all subclinical at baseline, and none had a normal aEEG background pattern. The status of three infants (43%) evolved and required two or more drugs for treatment. CONCLUSIONS: in infants with encephalopathy or other severe illness, aEEG disturbances occur frequently. aEEG provided a better classification of the severity of encephalopathy, detected early subclinical seizures, and allowed for monitoring of the response to treatment. aEEG was a useful tool at the neonatal intensive care unit for predicting poor short-term neurological outcomes for all sick newborn. .

OBJETIVO: testar a utilidade clínica do aEEG precoce em recém-nascidos a termo com risco delesão neurológica, para prever resultados neurológicos de curto prazo. MÉTODOS: estudo prospectivo e descritivo. Os critérios de inclusão foram encefalopatia neonatal, distúrbios neurológicos e bebês com SARA grave. Sensibilidade, especificidade, valor preditivo positivo e negativo e razão de verossimilhança foram calculados. Dados clínicos edemográficos foram analisados. O resultado neurológico foi definido como a soma de conclusões clínicas, de eletro e de neuroimagem. RESULTADOS: dentre os 21 neonatos monitorados, dez (48%) apresentaram resultado neurológico de curto prazo alterado. O aEEG apresentou sensibilidade de 90%, especificidade de 82%, valor preditivo positivo de 82% e valor preditivo negativo de 90%. A VR positiva foi de 4,95, e a RV negativa de 0,12. Em três dos 12 (25%) neonatos com encefalopatia foi possível definir melhora gravidade de sua condição pelo aEEG. Foram detectadas convulsões em oito neonatos (38%), todas subclínicas no início do estudo, e nenhum apresentou um padrão histórico normal no aEEG. O estado de três neonatos (43%) evoluiu e exigiu dois ou mais medicamentos para tratamento. CONCLUSÕES: em neonatos com encefalopatia ou outra doença grave, os distúrbios no aEEGocorrem com mais frequência. O aEEG forneceu uma classificação melhor da gravidade da encefalopatia, detectou convulsões subclínicas precoces e permitiu que fosse feito o monitoramento da resposta ao tratamento. O aEEG é uma ferramenta útil para prever resultados neurológicos de curto prazo em todos os bebês doentes na UTIN. .

Variabilidade do risco do tempo de permanência ajustado para lactentes de muito baixo peso ao nascer entre centros da Neocosur South American Network / Center variability in risk of adjusted length of stay for very low birth weight infants in the Neocosur South American Network

OBJETIVOS: Desenvolver um modelo de predição para o tempo de permanência hospitalar (TPH) em lactentes de muito baixo peso ao nascer (MBPN) e comparar esse resultado entre 20 centros de uma rede neonatal, visto que o TPH é utilizado como uma medida da qualidade da assistência em lactentes de MBPN. MÉTODOS: Utilizamos dados coletados prospectivamente de 7.599 lactentes com peso ao nascer entre 500 e 1.500 g no período entre os anos de 2001 a 2008. O modelo de regressão de Cox foi empregado para desenvolver dois modelos de predição: um modelo prévio com dados do nascimento e outro posterior, que acrescenta morbidades relevantes dos primeiros 30 dias de vida. RESULTADOS: A mediana do TPH estimado e ajustado a partir do nascimento foi de 59 dias; 28 dias depois do tempo de sobrevida de 30 dias. Houve uma alta correlação entre os modelos (r = 0,92). O TPH esperado e o TPH observado variaram bastante entre os centros, mesmo depois de correção para as morbidades relevantes após 30 dias. O TPH mediano (variação: 45-70 dias) e a idade concepcional na alta hospitalar (variação: 36,4-39,9 semanas) refletem uma variabilidade alta entre centros. CONCLUSÃO: Um modelo simples, com fatores apresentados no nascimento, pode predizer o TPH de um lactente de MBPN em uma rede neonatal. Observou-se uma variabilidade nos TPHs considerável entre unidades de terapia intensiva neonatal. Especulamos que os resultados sejam provenientes das diferenças entre as práticas dos centros.

OBJECTIVES: To develop a prediction model for hospital length of stay (LOS) in very low birth weight (VLBW) infants and to compare this outcome among 20 centers within a neonatal network. METHODS: Data from 7,599 infants with birth weights of 500-1,500 g born between the years 2001-2008 were prospectively collected. The Cox regression model was employed to develop two prediction models: an early model based upon variables present at birth, and a late one that adds relevant morbidities for the first 30 days of life. RESULTS: Median adjusted estimated LOS from birth was 59 days ‒ 28 days after 30-day point of survival. There was a high correlation between models (r = 0.92). Expected/observed LOS varied widely among centers, even after correction for relevant morbidity after 30 days. Median observed LOS (range: 45-70 days), and postmenstrual age at discharge (range: 36.4-39.9 weeks) reflect high inter-center variability. CONCLUSION: A simple model, with factors present at birth, can predict a VLBW infant's LOS in a neonatal network. Significant variability in LOS was observed among neonatal intensive care units. We speculate that the results originate in differences in inter-center practices.

Impacto del síndrome de dificultad respiratoria en recién nacidos de muy bajo peso de nacimiento: estudio multicéntrico sudamericano / Impact of respiratory distress syndrome in very low birth weight infants: a multicenter South-American study

Objetivo. Analizar la incidencia, factores de riesgo, morbilidad relevante, empleo de recursos y mortalidad, en recién nacidos (RN) de muy bajo peso de nacimiento (<1500 g) con síndrome dedificultad respiratoria (SDR).Población y métodos. Estudio observacional y analítico. Se incluyeron 5991 RN vivos <1500 g de las 20 unidades de la Red Sudamericana de Neonatología (Neocosur) entre 2002 y 2007. Los datos se ingresaron prospectivamente en fichaselectrónicas en línea en el sitio web.Resultados. La edad gestacional (media) fue de 29,1 semanas (IC 95 por ciento 29,06-29,2) y el peso de nacimiento (medio) de 1100,5 g (IC 95 por ciento 1093,79-1107,3). La incidencia de SDR fue del 74 por ciento (IC 95 por ciento73-75). El principal factor de riesgo para el SDR fue la menor edad gestacional (p< 0,001), mientrasque la administración antenatal de corticoides (OR: 0,59; IC 95 por ciento 0,49-0,72), sexo femenino (OR: 0,77; IC 95 por ciento 0,67-0,89) y rotura prematura de membranas (OR: 0,81; IC 95 por ciento 0,68-0,96)constituyeron factores protectores. En los RN con SDR, el empleo antenatal de corticoides se asoció a menor mortalidad (OR: 0,40; IC 95 por ciento0,34-0,47). El uso de recursos fue mayor en el grupo con SDR, con más empleo de surfactante(74,3 por ciento contra 7,3 por ciento, p< 0,001), de ventilaciónmecánica (82,1 por ciento contra 23,8 por ciento, p< 0,001), más días de oxigenoterapia (p< 0,001) y de hospitalización (p< 0,001).Conclusiones. El SDR tuvo una elevada incidencia en RN< 1500 g y produjo un aumento en la mortalidad, morbilidad y en el empleo de recursos.

Objective. To analyze the incidence, risk factors, major morbidity, mortality and resource employment in very low birth weight infants (< 1500 g) with respiratory distress syndrome (RDS).Methods. Descriptive study using prospectively obtained on-line information from a data base of 20 units belonging to the South American Neocosur Network. A total of 5991 VLBW infants were registered during years 2002-2007. Results. The mean gestacional age was 29.1 weeks (95 percent CI 29.06-29.21) and the mean of birth weight was 1100.5 g (95 percent CI 1093.79-1107.37). The global incidence of RDS was 74 percent (95 percent CI 73-75). Antenatal steroids were administered to 73 percent of this population. The main risk factor was lower gestational age (p< 0.001); where as prenatal steroids (OR: 0.59; 95 percent CI 0.49-0.72), female gender (OR: 0.77; 95 percent CI 0.67-0.89) and premature rupture of membranes (OR: 0.81; 95 percent CI 0.68-0.96) were protective factors. Antenatal steroids was also associated with a decrease in mortality in those infants that presented with RDS (OR: 0.40; 95 percent CI 0.34-0.47). Use of resources was higher in the group with RDS, with a greater use of surfactant (74.3 percent vs. 7.3 percent, p< 0.001), mechanical ventilation (82.1 percent vs. 23.8 percent, p< 0.001), and more days of oxygen (median of 8 vs. 1 day, p< 0.001) and hospitalization (median of 61 vs. 45 days, p< 0.001). RDS was associated to an increase risk in the incidence of ROP, PDA, late onset sepsis, severe IVH and oxygen requirement at 36 weeks of corrected gestational age. Conclusions. RDS had a high incidence in very low birth weight infants, despite the frequent use of antenatal steroids. VLBW Infants withRDS had a higher mortality and an increase risk of relevant morbidity. RDS also increased use of resources.

Fototerapia simples versus dupla no tratamento de recém-nascidos a termo com hiperbilirrubinemia não-hemolítica / Single vs. double phototherapy in the treatment of full-term newborns with nonhemolytic hyperbilirubinemia

OBJETIVO: Comparar a eficácia da fototerapia simples (1 painel) versus dupla (2 painéis) na redução da hiperbilirrubinemia não-hemolítica em recém-nascidos a termo. MÉTODOS: Os recém-nascidos a termo foram randomizados prospectivamente para receber fototerapia simples ou dupla. Os níveis de bilirrubina foram medidos no momento da internação e em intervalos de 12 horas, assim como em seguimento 48 horas após a alta. RESULTADOS: Trinta e sete pacientes receberam fototerapia simples, e 40, dupla. A redução média dos níveis de bilirrubina nas primeiras 24 horas de tratamento foi maior no grupo que recebeu fototerapia dupla (5,1±2,2 mg/dL versus 4,3±2,1 mg/dL), porém sem significância estatística (p = 0,18). As taxas de readmissão foram similares e nenhum dos grupos apresentou efeitos adversos. CONCLUSÃO: A fototerapia dupla não foi mais eficaz do que a fototerapia simples no tratamento da hiperbilirrubinemia não-hemolítica em recém-nascidos a termo. Entretanto, nossos resultados sugerem que a fototerapia dupla possa ser mais eficaz em recém-nascidos a termo com níveis de bilirrubina mais altos no momento da internação.

OBJECTIVES: To compare the effectiveness of single (1 panel) vs. double (2 panels) phototherapy in reducing nonhemolytic hyperbilirubinemia in term newborns. METHODS: Term newborns with hyperbilirubinemia were prospectively randomized to receive double or single phototherapy. Bilirubin levels were measured at admission and at 12-hour intervals, as well as at a follow-up 48 hours after discharge. RESULTS: Thirty-seven patients received single and 40 double phototherapy. The mean decrease in bilirubin level in the first 24 hours of treatment was greater in the double phototherapy group (5.1±2.2 mg/dL vs. 4.3±2.1 mg/dL), but without statistical significance (p = 0.18). Readmission rates were similar and no adverse effects were found in either group. CONCLUSIONS: Double-surface was not more effective than single-surface phototherapy in the treatment of nonhemolytic hyperbilirubinemia in term newborns. However, our results suggest that double phototherapy may be more effective in those term newborns with higher bilirubin levels at admission.

Bronchopulmonary dysplasia: incidence, risk factors and resource utilization in a population of South-American very low birth weight infants

OBJECTIVE: To determine the incidence of bronchopulmonary dysplasia, its risk factors and resource utilization in a large South American population of very low birth weight infants. METHODS: Data were prospectively collected from infants weighing 500 to 1,500 g born at 16 NEOCOSUR Network centers from 10/2000 through 12/2003. Multivariate relative risk and 95% confidence intervals were estimated by Poisson regression with robust error variance to find factors that affected the risk of bronchopulmonary dysplasia. RESULTS: 1,825 very low birth weight infant survivors were analyzed. Mean birth weight and gestational age were 1085+279 g and 29+3 weeks respectively. Bronchopulmonary dysplasia incidence averaged 24.4% and survival without bronchopulmonary dysplasia augmented with increasing gestational age. Higher birth weight and gestational age and a female gender all decreased the risk for bronchopulmonary dysplasia. Factors that independently increased that risk were surfactant requirement, mechanical ventilation, air leak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. Bronchopulmonary dysplasia infants had more days of hospitalization (91±27 vs. 51±19), on mechanical ventilation (19±20 vs. 4±7) and oxygen therapy (72±30 vs. 8±14) in comparison with non BPD infants. CONCLUSIONS: Bronchopulmonary dysplasia incidence was 24.4% in a large South American population and is related to greater resource utilization. Risk factors for bronchopulmonary dysplasia in this study were: surfactant requirement, mechanical ventilation, air leak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. These studies may provide information useful to the design of effective preventive perinatal strategies.

Evaluación de la severidad, proporcionalidad y riesgo de muerte de recién nacidos de muy bajo peso con restricción del crecimiento fetal: análisis multicéntrico sudamericano / An assessment of the severity, proportionality and risk of mortality of very low birth weight infants with fetal growth restriction: a multicenter South American analysis

OBJETIVOS: 1) evaluar la severidad y la proporcionalidad de los PEG para diferentes grados de prematurez; 2) estimar el riesgo de mortalidad de los PEG según la severidad y proporcionalidad. MATERIAL Y MÉTODOS: Diseño observacional y analítico. Población: todos los recién nacidos de muy bajo peso (RNMPB) entre 25 y 36 semanas que mantiene el grupo NEOCOSUR (n = 1.518). índices antropométricos: a) peso de nacimiento (PN) < percentil 3 y 10; b) severidad (FGR, razón del crecimiento fetal - razón entre el PN observado y la media del PN para cada edad gestacional): normal: FGR 0,90-1,10, leve: 0,80-0,89, moderado: 0,75-0,79 y severo < 0,75; c) proporcionalidad: estimada por el Coeficiente de Bimodalidad (disarmónico: > 0,55) y la transformación z del índice ponderal (Ponderal Index, PI = g/cm x 100). Restricción del crecimiento intrauterino (RCIU) asimétrico: score z < -1. Mortalidad neonatal hasta el alta. RESULTADOS: PN < perc. 3: 13,5 por ciento; < perc. 10: 30,7 por ciento; FGR: 0,90±0,21; FGR leve 20,8 por ciento, moderado 8,7 por ciento y severo 32,6 por ciento. Coef. Bimodalidad: 0,53; índice ponderal: 2,27±0,51. Score z: 0,007±1,0; score z <-1: 7,9. La hipertensión materna se asoció con los riesgos ajustados de pequeño para la edad gestacional (PEG) (ORa 1,86, IC 95 por ciento 1,38-2,5), FGR < 0,89 (2,89, 2,18-3,83) y score z < -1 (1,81; 1,18-2,76). El riesgo ajustado de mortalidad fue 2,64 (IC 95 por ciento 1,71-3,92) para PEG, 3,04 (2,12-4,36) para FGR < 0,89 y 1,37 (0,80-2,32) para score z < -1. CONCLUSIONES: La condición de PEG en los recién nacidos de muy bajo peso (RNMBP) es elevada, siendo muy severa en 1/3. La mayoría de los casos tiene características de simétrico.