Résumé
Introducción. La hipoglucemia neonatal es una complicación de la diabetes mellitus gestacional Son pocos los estudios que avalan la pesquisa sistemática en este grupo poblacional durante las primeras horas de vida. Objetivos. Evaluar la asociación entre tratamiento materno recibido (dieta versus insulina) y el desarrollo de hipoglucemia, e identificar los factores de riesgo asociados. Población y métodos. Estudio observacional, analítico y retrospectivo realizado en en las sedes de Buenos AIres y San Justo de un hospital general de tercer nivel entre el 1 de enero de 2017 y el 31 de diciembre de 2018. Se estimó la incidencia de hipoglucemia (≤47 mg/dl) en recién nacidos según el manejo de la diabetes materna y se realizó un análisis multivariable para evaluar factores asociados. Resultados. Se incluyeron 195 pacientes. No se encontró diferencia estadística en la incidencia de hipoglucemia según el tratamiento materno recibido (45,3 % versus 39,7 %; p = 0,45) ni se identificaron factores de riesgo asociados. Modificando el valor de corte a ≤40 mg/dl, tampoco se encontraron diferencias en la incidencia (23,4 % versus 19 %, p = 0,48); no obstante, los pacientes hipoglucémicos presentaron un hematocrito significativamente mayor y una menor prevalencia de lactancia exclusiva al egreso. El análisis multivariable mostró una asociación independiente entre alto peso al nacer con hipoglucemia que requiere corrección. Conclusiones. La incidencia de hipoglucemia neonatal en la población estudiada no presentó diferencia según el tratamiento materno recibido. El estudio realizado fundamenta el control de la glucemia en estos niños en la práctica diaria.
Introduction. Neonatal hypoglycemia is a complication of gestational diabetes mellitus. Few studies have been conducted to support a systematic screening in the first hours of life of this population group. Objectives. To assess the association between the treatment administered to the mother (diet vs. insulin) and the development of hypoglycemia, and to identify associated risk factors. Population and methods. Observational, analytical, and retrospective study carried out at the Buenos Aires and San Justo maternal centers of a general, tertiary care hospital between 01-01-2017 and 12-31-2018. The incidence of neonatal hypoglycemia (≤ 47 mg/dL) based on the management of maternal diabetes was estimated and a multivariate analysis was done to assess related factors. Results. A total of 195 patients were included. No statistical difference was found in the incidence of hypoglycemia based on the treatment administered to the mother (45.3% vs. 39.7%; p = 0.45) and no associated risk factors were identified. Once the cutoff point was changed to ≤ 40 mg/dL, no differences were found in the incidence either (23.4% versus 19%, p = 0.48); however, patients with hypoglycemia had a significantly higher hematocrit level and a lower prevalence of exclusive breastfeeding upon discharge. Multivariate analysis showed an independent association between a high birth weight and hypoglycemia, requiring correction. Conclusions. The incidence of neonatal hypoglycemia in the studied population did not vary based on the treatment received by the mother. This study supports the control of glycemia in these infants in daily practice.
Sujets)
Humains , Grossesse , Nouveau-né , Diabète gestationnel/épidémiologie , Maladies foetales , Hypoglycémie/étiologie , Hypoglycémie/épidémiologie , Maladies néonatales/étiologie , Maladies néonatales/épidémiologie , Incidence , Études rétrospectives , MèresRésumé
La hepatitis B es una infección vírica que afecta al hígado, puede dar lugar tanto a un cuadro agudo como a una enfermedad crónica, y se transmite por la vía sexual, vertical y parenteral. En este informe, se describe la situación mundial y nacional de esta patología, y su transmisión vertical, así como la caracterización de niños expuestos al virus durante el embarazo, nacidos en el Hospital Materno Infantil Ramón Sardá entre 2018 y 2021.
Sujets)
Humains , Femelle , Grossesse , Nouveau-né , Transmission verticale de maladie infectieuse/prévention et contrôle , Transmission verticale de maladie infectieuse/statistiques et données numériques , Hépatite B/transmission , Hépatite B/épidémiologie , Surveillance épidémiologique , Maladies néonatales/épidémiologieRésumé
RESUMEN Introducción: La depresión cardiorrespiratoria neonatal es un problema clínico que, en dependencia de su etiología, conduce a una alta morbilidad neurológica y elevada mortalidad. Objetivo: Caracterizar al recién nacido con depresión cardiorrespiratoria en el servicio de Neonatología del Hospital Ginecobstétrico "Fé del Valle Ramos", de Manzanillo, Granma. Método: Se realizó un estudio retrospectivo, observacional, descriptivo y transversal. Se seleccionaron 88 neonatos que cumplieron con los criterios de inclusión de recién nacido con depresión cardiorrespiratoria. Los datos se recolectaron durante el período de enero de 2017 a diciembre de 2018. Se tomaron en cuenta las siguientes variables: puntaje de Apgar, años de estudio, sexo, tipo de depresión cardiorrespiratoria, peso al nacer, factores maternos, edad gestacional y afecciones asociadas. Resultados: La depresión severa al nacer predominó en la mayoría de los neonatos (56,8 %). Prevalecieron los recién nacido de buen peso (73,9 %), nacidos a término (77,2 %). Las infecciones maternas (45,5 %) durante la gestación, el tiempo de rotura de membranas prolongado (31,8 %) y la presencia de líquido amniótico meconial (30,7 %), constituyeron los factores maternos que mayor vínculo guardaron con el neonato deprimido. Conclusiones: Las infecciones maternas, la rotura prematura de membranas, la presencia de líquido amniótico meconial, los nacimientos por cesárea, la nuliparidad, prematuridad y el embarazo en la adolescencia, son algunos de los factores de riesgo relacionados en este estudio que guardan vínculo estrecho con el predominio de estas afecciones en los neonatos deprimidos.
ABSTRACT Introduction: The cardiorespiratory depression in neonates is a clinical complication that, depending on its etiology, leads to high neurological morbidity and mortality. Objective: To characterize neonates with cardiorespiratory depression treated in the neonatology service at the Hospital Ginecobstétrico "Fé del Valle Ramos" in Manzanillo, Granma. Method: A retrospective, observational, descriptive and cross-sectional study was carried out. A total of 88 neonates with cardiorespiratory depression criteria were selected in the study. All information gathered includes the period January 2017 throughout December 2018. Variables assessed were as follow: Apgar score, years of study, sex, type of cardiorespiratory depression, birth weight, maternal factors, gestational age and associated conditions. Results: Severe depression at birth was predominant in most of neonates (56.8%). Newborn infants with a normal birth weight (73.9%), and born at term (77.2%) were predominant. Maternal infections during gestation (45.5%), prolonged rupture of membranes (31.8%) and the presence of meconium in the amniotic fluid (30.7%) were the maternal factors most associated with depressed neonate. Conclusions: The maternal infections, premature rupture of membranes, the presence of meconium in the amniotic fluid, cesarean birth, nulliparous status, premature and adolescent pregnancy are some of the risk factors assessed in this study that are closely linked to the prevalence of arising conditions in depressed neonates.
RESUMO Introdução: A depressão cardiorrespiratória neonatal é um problema clínico que, dependendo de sua etiologia, leva a alta morbidade neurológica e alta mortalidade. Objetivo: Caracterizar o recém-nascido com depressão cardiorrespiratória no serviço de Neonatologia do Hospital Gineco-obstétrico "Fé del Valle Ramos", Manzanillo, Granma. Método: Foi realizado um estudo retrospectivo, observacional, descritivo e transversal. Foram selecionados oitenta e oito lactentes que atenderam aos critérios de inclusão de um recém-nascido com depressão cardiorrespiratória. Os dados foram coletados no período de janeiro de 2017 a dezembro de 2018. Foram consideradas as seguintes variáveis: índice de Apgar, anos de estudo, sexo, tipo de depressão cardiorrespiratória, peso ao nascer, fatores maternos, idade gestacional e condições associadas. Resultados: A depressão grave ao nascer prevaleceu na maioria dos neonatos (56,8%). Prevaleceram os recém-nascidos de bom peso (73,9%) e a termo (77,2%). Infecções maternas (45,5%) durante a gestação, tempo prolongado de ruptura da membrana (31,8%) e presença de líquido amniótico mecônio (30,7%) foram os fatores maternos mais associados ao neonato deprimido. Conclusões: Infecções maternas, ruptura prematura de membranas, presença de líquido amniótico mecônio, partos cesáreos, nuliparidade, prematuridade e gravidez na adolescência, são alguns dos fatores de risco relacionados neste estudo que estão intimamente ligados ao predomínio dessas condições na recém-nascidos deprimidos.
Sujets)
Humains , Mâle , Femelle , Nouveau-né , Score d'Apgar , Insuffisance respiratoire/épidémiologie , Maladies néonatales/mortalité , Maladies néonatales/épidémiologie , Complications de la grossesse/étiologie , Épidémiologie Descriptive , Études transversales , Études rétrospectives , Études observationnelles comme sujetRésumé
RESUMEN Objetivo: Determinar la incidencia y las características clínicas, bacteriológicas y del líquido cefalorraquídeo de la meningitis neonatal en hospitales de Lima. Materiales y métodos: Se realizó un estudio observacional, multicéntrico en seis hospitales de la ciudad de Lima, con una vigilancia epidemiológica durante un año. Resultados: La incidencia acumulada hospitalaria fue de 1,4 casos por mil nacidos vivos. Fueron incluidos 53 casos de meningitis neonatal, 34% (18/53) fueron tempranos y 66% (35/53) tardíos. Los factores maternos asociados fueron líquido amniótico meconial e infección de tracto urinario. El 58,8% (30/51) presentó controles prenatales insuficientes. El factor neonatal más asociado fue sepsis. Los principales síntomas fueron fiebre, irritabilidad, hipoactividad y dificultad respiratoria. En el líquido cefalorraquídeo (LCR) se destacó la pleocitosis, sin predominio de polimorfonucleares (PMN), hipoglucorraquia y proteinorraquia. Los patógenos aislados con mayor frecuencia fueron Escherichia coli y Listeria monocytogenes. Conclusiones: La incidencia hospitalaria de meningitis neonatal fue de 1,4 por mil nacidos vivos, siendo diez veces mayor en prematuros. La dificultad respiratoria fue el síntoma más frecuente en la forma temprana, mientras que la fiebre e irritabilidad en la forma tardía. El LCR mostró pleocitosis sin predominio de PMN. Los gérmenes más frecuentes fueron Escherichia coli y Listeria monocytogenes. La ventriculitis e hidrocefalia fueron las complicaciones neurológicas más comunes.
ABSTRACT Objective: To determine the incidence and the clinical, bacteriological and cerebrospinal fluid characteristics of neonatal meningitis in Lima hospitals. Materials and methods: An observational, multicenter study was conducted in six hospitals in the city of Lima during 1 year of epidemiological surveillance. Results: The cumulative hospital incidence was 1.4 cases per 1000 live births. A total of 53 cases of neonatal meningitis were included, 34% (18/53) were early and 66% (35/53) late. The associated maternal factors were meconium-stained amniotic fluid and urinary tract infection. Insufficient prenatal check-ups were found in 58.8% (30/51). The most associated neonatal factor was sepsis. The main symptoms were fever, irritability, hypoactivity and respiratory distress. Pleocytosis in cerebrospinal fluid (CSF) was significant, without predominance of polymorphonuclear lymphocytes (PMN), hypoglycorrhagia and proteinorrhagia. The most frequent pathogens isolated were Escherichia coli and Listeria monocytogenes. Conclusions: The hospital incidence of neonatal meningitis was 1.4 per 1000 live births, being ten times higher in preterm infants. Breathing difficulty was the most frequent symptom in the early stage, while fever and irritability in the late stage. CSF showed pleocytosis without predominance of PMN. The most frequent germs were Escherichia coli and Listeria monocytogenes. Ventriculitis and hydrocephalus were the most common neurological complications.
Sujets)
Humains , Nouveau-né , Prématuré , Liquide cérébrospinal , Maladies néonatales , Méningite , Pérou , Pérou/épidémiologie , Signes et symptômes , Nouveau-né , Incidence , Villes/épidémiologie , Naissance vivante , Surveillance épidémiologique , Hôpitaux , Maladies néonatales/microbiologie , Maladies néonatales/épidémiologie , Méningite/microbiologie , Méningite/épidémiologieRésumé
OBJETIVO: determinar el perfil clínico de pacientes con diabetes gestacional (DG) y la incidencia de las complicaciones neonatales. MÉTODOS: estudio descriptivo de una cohorte retrospectiva de gestantes con DG según criterios HAPO/ (IADPSG) International Association of Diabetes and Pregnancy Study Groups y Carpenter-Coustan y sus hijos, en un servicio de alta complejidad obstétrica de Medellín, Colombia entre 2012-2015. Se presentan medidas descriptivas de características maternas y neonatales e incidencia de las complicaciones neonatales. RESULTADOS: se incluyeron 197 maternas y 203 neonatos; 90,5 % maternas tenían sobrepeso u obesidad; la comorbilidad más frecuente fue el trastorno hipertensivo asociado al embarazo en 22,8 %. El manejo de la DG fue 59,3% nutricional exclusivo, 37,1% nutricional más insulina y 3.6% nutricional más metformina. La media de edad gestacional al parto fue 37 sem y 3 días; la DG fue la indicación más frecuente de inducción del parto en 76 % (38/50); 56,4 %, fueron partos vaginales y el 34,6% fueron cesáreas indicadas por DG. Un 11,3 % de los recién nacidos fueron grandes para la edad gestacional (P >90) y se encontraron 2 recién nacidos con peso > 4000 gr. La incidencia de al menos una complicación neonatal fue 27,6 %, 16,7 % presentaron hiperbilirrubinemia, 9,9 % síndrome de dificultad respiratoria (SDR), 3.0% hipoglicemia, 10.8% otras complicaciones y 12,3 % ingresaron a la unidad de cuidados intensivos neonatales. CONCLUSIONES: la DG es una indicación frecuente de inducción del parto y de indicación de cesárea. Las complicaciones neonatales ocurren en uno de cuatro recién nacidos, aunque observamos una baja incidencia de grandes para la edad gestacional (recién nacidos con peso > percentil 90), hubo 2 otras morbilidades neonatales relacionados con el diagnóstico materno como hiperbilirrubinemia y SDR.
AIM: To determine the clinical profile pregnant women with gestational diabetes and incidence of the neonatal complications. METHODS: Descriptive analysis of a retrospective cohort of pregnant women with gestational diabetes (GD) according to HAPO and Carpenter-Coustan criteria and their children, under a high complexity obstetric service in Medellin, Colombia between 2012-2015. Descriptive measures of maternal and neonatal characteristics and incidence of neonatal complications are presented. RESULTS: The study included 197 pregnant women and 203 neonates: 90.5 % of pregnancies were overweight or obese; the most frequent comorbidity was the hypertensive disorder associated with pregnancy in 22.8 %. The management of the DG was 99.0% nutritional, 37.1% insulin and 3.6 % metformin. The average gestational age at delivery was 37 weeks and 3 days; DG was the most frequent indication of induction of labor in 76 % (38/50); 56.4% were vaginal deliveries and 34.6 % were DG related caesarean sections, 11.3 % of newborns were large for gestational age (P > 90) and two newborns weighing > 4000 gr. The incidence of at least one neonatal complication was 27.6 %, 16.7 % had hyperbilirubinemia, 9.9 % respiratory distress syndrome (RDS), 3.0 % hypoglycemia, 10.8 % other complications and 12.3 % were admitted to the neonatal intensive care unit. CONCLUSIONS: DG is a frequent indication of induction of labor and indication of caesarean section. Neonatal complications occur in one of four newborns, although we observed a low incidence of macrosomia, there were other neonatal morbidities related to maternal diagnosis such as hyperbilirubinemia and RDS.
Sujets)
Humains , Mâle , Femelle , Nouveau-né , Adulte , Complications de la grossesse/épidémiologie , Diabète gestationnel , Maladies néonatales/épidémiologie , Macrosomie foetale/épidémiologie , Comorbidité , Soins intensifs néonatals , Césarienne , Épidémiologie Descriptive , Incidence , Études rétrospectives , Colombie , Hyperbilirubinémie néonatale/épidémiologie , Surpoids , Hypoglycémie , Accouchement provoquéRésumé
Objetivo: descrever o perfil epidemiológico da sífilis congênita no estado do Tocantins, Brasil, de 2007 a 2015. Métodos: estudo transversal descritivo, realizado com dados do Sistema de Informação de Agravos de Notificação (Sinan) e do Sistema de Informações sobre Nascidos Vivos (Sinasc). Resultados: foram notificados 1.029 casos da doença; a incidência média foi de 4,6 casos por 1 mil nascidos vivos (NV), com aumento de 3,1/1 mil NV em 2007 para a 9,8/1 mil NV em 2015 (aumento de 216,1%); municípios localizados no centro e no norte do estado apresentaram maiores taxas; a maioria das mães dos recém-nascidos tinha 15-24 anos de idade, ensino fundamental, iniciou o pré-natal no 3º trimestre de gestação e recebeu assistência pré-natal inadequada. Conclusão: a elevada ocorrência da sífilis congênita no Tocantins demanda imediata intensificação da vigilância da doença e melhoria da qualidade do acompanhamento pré-natal, especialmente nos municípios com maior incidência.
Objetivo: describir el perfil epidemiológico de la sífilis congénita (SC) en Tocantins, de 2007 a 2015. Métodos: estudio transversal descriptivo, con datos del Sistema Nacional de Agravamientos de Información (Sinan) y del Sistema de Informaciones sobre Nacidos Vivos (Sinasc). Resultados: se notificaron 1.029 casos de SC; la incidencia promedio fue de 4,6/1000 nacidos vivos (NV), con aumento variando de 3,1/1000 NV en 2007 a 9,8/1000 NV en 2015 (aumento del 216,1%); los municipios ubicados en el centro y norte del estado presentaron mayores tasas; la mayoría de las madres tenía entre 15-24 años, enseñanza primaria, iniciaron el prenatal en el 3º trimestre de gestación y la asistencia prenatal recibida fue inadecuada. Conclusión: la situación epidemiológica de la sífilis congénita en Tocantins es muy preocupante y demanda la inmediata intensificación de esfuerzos, principalmente en lo que se refiere a mejorar la calidad del prenatal, especialmente en los municipios con mayor incidencia de la enfermedad.
Objective: to describe the epidemiological profile of congenital syphilis (CS) in Tocantins, from 2007 to 2015. Methods: this was a cross-sectional descriptive study conducted with data from the Notifiable Health Conditions Information System (SINAN) and the Live Birth Information System (SINASC). Results: 1,029 CS cases were reported; mean CS incidence was 4.6/1,000 Live Births (LB), increasing from 3.1/1,000 LB in 2007 to 9.8/1,000 LB in 2015 (increase of 216.1%); municipalities located in the central and northern regions of the state had the highest rates; the majority of mothers of newborn babies were 15-24 years old, had elementary school education, started prenatal care in the third trimester of pregnancy, and received inadequate prenatal care. Conclusion: high occurrence of congenital syphilis in Tocantins requires immediate intensification of CS surveillance and improved prenatal care quality, especially in municipalities with higher incidence.
Sujets)
Humains , Mâle , Femelle , Grossesse , Nouveau-né , Adulte , Syphilis congénitale/épidémiologie , Syphilis/diagnostic , Syphilis/épidémiologie , Transmission verticale de maladie infectieuse/statistiques et données numériques , Maladies néonatales/épidémiologie , Complications infectieuses de la grossesse/épidémiologie , Prise en charge prénatale , Brésil/épidémiologie , Épidémiologie Descriptive , Incidence , Notification des maladiesRésumé
Abstract Background: Both necrotizing enterocolitis and acute kidney injury are tightly related conditions, which independently increase mortality in newborns. Necrotizing enterocolitis is an inflammatory disease with a systemic repercussion that leads to inflammatory kidney changes predisposing to renal damage. Methods: This study assessed risk factors for the development of acute kidney injury in patients diagnosed with necrotizing enterocolitis and compared mortality between patients with or without acute kidney injury. Thirty-nine patients with the diagnosis of necrotizing enterocolitis were included, regardless of the gestational age. Results: Of 39 patients, 38.5% developed acute kidney injury. Survival showed to be significantly lower in patients with acute kidney injury (54.4 days) when compared to newborns without acute kidney injury (76.22 days; p = 0.014). Mortality in patients with acute kidney injury was 46.7%, increasing up to 62.5% with severe kidney damage. The hazard ratio for mortality was 4.708 for acute kidney injury (p = 0.025). The severity of enterocolitis showed to be an independent risk factor in developing acute kidney injury and severe kidney injury (odds ratio [OR] = 1.841, p = 0.034 and OR = 1.917, p = 0.027, respectively). Conclusions: Newborns with necrotizing enterocolitis should be evaluated for early recognition of acute kidney injury. Prospective studies with a higher number of patients are needed to identify modifiable risk factors to impact in the prevention of these conditions.
Resumen Introducción: La enterocolitis necrosante y el daño renal agudo son condiciones íntimamente relacionadas que incrementan independientemente la mortalidad en recién nacidos. La enterocolitis necrosante es una enfermedad inflamatoria sistémica que desencadena cambios renales inflamatorios, predisponiendo el desarrollo de daño renal. Métodos: Se analizaron los factores de riesgo para el desarrollo de daño renal agudo en pacientes con diagnóstico de enterocolitis necrosante y se comparó la mortalidad entre los pacientes sin daño renal y los pacientes con daño renal agudo. Se incluyeron 39 pacientes con diagnóstico de enterocolitis necrosante, independientemente de la edad gestacional. Resultados: De los 39 pacientes, el 38.5% desarrolló daño renal agudo. La sobrevida de los que desarrollaron daño renal agudo (54.4 días) mostró ser significativamente menor al compararse con los recién nacidos que no presentaron daño renal (76.22 días; p = 0.014). La mortalidad en los pacientes con daño renal agudo fue del 46.7%, que se incrementó hasta el 62.5% en aquellos con daño renal grave. El riesgo de mortalidad fue de 4.708 para daño renal agudo (p = 0.025). La gravedad de la enterocolitis necrosante demostró ser un factor de riesgo independiente para el desarrollo de daño renal agudo y de daño renal agudo severo (razón de momios [RM] = 1.841; p = 0.034 y RM = 1.917; p = 0.027, respectivamente). Conclusiones: Los recién nacidos con diagnóstico de enterocolitis necrosante deben ser evaluados para reconocer de forma temprana la presencia de daño renal agudo. Se requiere de estudios prospectivos con mayor número de pacientes para identificar factores de riesgo modificables que puedan impactar en la prevención de estas patologías.
Sujets)
Femelle , Humains , Nouveau-né , Mâle , Entérocolite nécrosante/épidémiologie , Atteinte rénale aigüe/épidémiologie , Maladies néonatales/épidémiologie , Indice de gravité de la maladie , Taux de survie , Études rétrospectives , Facteurs de risque , Études de cohortes , Âge gestationnel , Entérocolite nécrosante/physiopathologie , Entérocolite nécrosante/mortalité , Atteinte rénale aigüe/étiologie , Atteinte rénale aigüe/mortalité , Maladies néonatales/mortalitéRésumé
ABSTRACT Objective: To evaluate the prevalence of neonatal dermatoses in the early neonatal period and to associate them with neonatal, demographic and obstetric variables. Methods: A cross-sectional study with neonates and their respective mothers, who were hospitalized in a public maternity hospital in Curitiba, PR, Brazil. Data collection was performed using information present in the medical records and a physical examination of the newborn during the period between April 2015 and May 2016. Results: 350 neonates were evaluated. 54.8% were male, and 94.8% (332/350) presented a dermatosis. Among them, 84.6% had, concomitantly, two or more dermatoses. A total of 23 types of dermatoses were diagnosed. The most prevalent were: sebaceous hyperplasia (66%); fluff (42.6%); and salmon patches (41.4%). The mean age of the mothers was 24.9±4.9 years old, and they were predominately white (57.7%). Vernix caseosa was associated with the female gender (p=0.034). Nonwhite mothers were associated with genital hyperpigmentation (p=0.03) and Mongolian spots (p=0.001). Physiological flaking was associated with cesarean deliveries (p=0.03) and a gestational age of over 40 weeks (p=0.054). Salmon patches was associated with primiparity (p=0.0001). Conclusions: There was a high prevalence of neonatal dermatosis in the studied population. Each newborn had, on average, three different dermatoses. Dermatosis in neonates was associated with primiparity, nonwhites, a gestational age of over 40 weeks, and the sex of the newborn.
RESUMO Objetivo: Avaliar a prevalência de dermatoses no período neonatal precoce e associar sua ocorrência a variáveis neonatais, demográficas e obstétricas. Métodos: Estudo transversal com neonatos e respectivas puérperas internados em alojamento conjunto de uma maternidade pública de Curitiba (PR). A coleta de dados foi realizada por meio de informações presentes nos prontuários e no exame físico do recém-nato durante o período de abril de 2015 a maio de 2016. Resultados: Foram avaliados 350 recém-nascidos, 54,8% do sexo masculino, e 332 (94,8%) apresentaram dermatoses. Desses 332, 84,6% tiveram, concomitantemente, duas ou mais dermatoses. Diagnosticou-se o total de 23 tipos de dermatoses, sendo mais prevalentes: hiperplasia sebácea (66,6%); lanugem (42,6%); e mancha salmão (41,4%). A média de idade das puérperas foi de 24,9±4,9 anos, com predomínio de etnia branca (57,7%). Vérnix foi associado a sexo feminino (p=0,034). A etnia materna não branca associou-se à hiperpigmentação genital (p=0,030) e mancha mongólica (p=0,001). A descamação fisiológica associou-se ao parto cesáreo (p=0,030) e à idade gestacional acima de 40 semanas (p=0,054); e mancha salmão, à primiparidade (p=0,0001). Conclusões: Verificou-se alta prevalência de dermatose neonatal na população estudada, sendo cada recém-nascido acometido em média por três tipos. Houve associação da presença de dermatoses com primiparidade, mães não brancas, idade gestacional superior a 40 semanas e sexo do neonato.
Sujets)
Humains , Mâle , Femelle , Grossesse , Nouveau-né , Adulte , Parité/physiologie , Maladies de la peau/épidémiologie , Maladies néonatales/épidémiologie , Maladies de la peau/anatomopathologie , Brésil/épidémiologie , Prévalence , Études transversales , Âge gestationnel , Maladies néonatales/anatomopathologie , MèresRésumé
Resumen Introducción: El citomegalovirus humano es reconocido como la causa más común de infección viral congénita, la cual puede darse como resultado de infección primaria, reinfección o reactivación en la mujer embarazada; además, puede ocasionar retraso en el desarrollo neuronal y pérdida auditiva sensoneural en el neonato. Objetivo: Identificar la infección por citomegalovirus humano en neonatos por PCR en tiempo real (PCR-TR) y cultivo celular. Método: Estudio observacional, longitudinal y retrospectivo con muestras de hisopado oral provenientes de 362 neonatos nacidos en un periodo de 10 meses en un hospital público de Mérida, Yucatán. Se realizó PCR-TR para la detección de citomegalovirus humano. Se obtuvo cultivo celular primario de fibroblastos a partir de tejido de prepucio humano para recuperar el virus. Se siguieron solo los casos positivos. Resultados: Se encontró 0.86 % de infección por citomegalovirus humano por PCR-TR. No se recuperó el virus en cultivo. En las visitas de seguimiento, la salud sensorial y el neurodesarrollo fueron adecuados. Conclusión: La prevalencia de infección por citomegalovirus humano en neonatos fue similar a la de reportes mundiales y solo pudo evidenciarse por PCR. La infección asintomática detectada entre las 12 a 24 horas del nacimiento no tuvo consecuencias a largo plazo.
Abstract Introduction: Human cytomegalovirus (HCMV) is recognized as the most common cause of congenital viral infection, which can occur as a result of primary infection, reinfection or infection reactivation in the pregnant woman and be the cause of delay in neuronal development and sensorineural hearing loss in the neonate. Objective: To identify CMVH infection in newborns by real-time polymerase chain reaction (RT-PCR) and cell culture. Method: Observational, cross-sectional, retrospective study with oral swab samples from 362 neonates born within a 10-month period in a public hospital of Mérida, Yucatán. RT-PCR was carried out for the detection of HCMV. Fibroblast primary cell culture was obtained from human foreskin tissue to isolate the virus. Only positive cases were followed. Results: A prevalence of HCMV infection of 0.86 % was found by RT-PCR. No virus was isolated with cell culture. In the follow-up visits, sensory health and neurodevelopment were adequate. Conclusion: The prevalence of HCMV infection is similar to that of worldwide reports, and only was detected by RT-PCR. Asymptomatic infection detected 12-14 h after birth had no long-term health consequences.
Sujets)
Humains , Mâle , Femelle , Nouveau-né , Infections à cytomégalovirus/épidémiologie , Cytomegalovirus/isolement et purification , Maladies néonatales/épidémiologie , Prévalence , Études transversales , Études rétrospectives , Infections à cytomégalovirus/congénital , Infections à cytomégalovirus/diagnostic , Réaction de polymérisation en chaine en temps réel , Hôpitaux publics , Maladies néonatales/diagnostic , MexiqueRésumé
RESUMO Objetivo: Descrever as características do teste do pezinho dos neonatos atendidos na unidade de terapia intensiva de um hospital universitário, bem como verificar se existiam condições maternas e fetais que pudessem interferir no resultado desse exame. Métodos: Estudo retrospectivo longitudinal de abordagem quantitativa que avaliou 240 prontuários médicos. Os dados coletados foram submetidos à análise estatística descritiva. Resultados: Houve predomínio de gestantes com idades entre 20 a 34 anos, com Ensino Médio completo e que realizaram mais de seis consultas pré-natais. As intercorrências ou patologias maternas ocorreram em 60% das mães, e a maioria (67,5%) não apresentou nenhuma condição que pudesse interferir no resultado do teste do pezinho. A maioria dos neonatos era prematura e exibiu baixo peso ao nascimento. Cerca de 90% dos neonatos exibiram condições que poderiam influenciar no exame, principalmente prematuridade, nutrição parenteral e transfusão sanguínea. Dos 240 neonatos, 25% apresentaram resultado alterado no teste do pezinho, sobretudo para fibrose cística e hiperplasia adrenal congênita. Conclusão: Existem condições maternas e neonatais que podem interferir no teste do pezinho e, nesse sentido, sua investigação é imprescindível, visando direcionar ações que promovam a saúde materno-infantil e consolidem a triagem neonatal nessa população.
ABSTRACT Objective: To describe the characteristics of the heel prick test in newborns admitted to the intensive care unit of a university hospital as well as to determine whether maternal and fetal conditions could have affected the results of this test. Methods: Retrospective longitudinal study with a quantitative approach that evaluated 240 medical records. The data collected were analyzed by descriptive statistical analysis. Results: There was a predominance of pregnant women aged 20 to 34 years who had a complete secondary education and who had more than six prenatal care visits. Maternal complications or pathologies occurred in 60% of the mothers, and most (67.5%) did not present any condition that could have affected the heel prick test results. Most newborns were premature and exhibited low birth weight. Approximately 90% of newborns exhibited conditions that could have influenced the test, especially prematurity, parenteral nutrition and blood transfusion. Of the 240 newborns, 25% had abnormal heel prick test results, especially for cystic fibrosis and congenital adrenal hyperplasia. Conclusion: There are maternal and neonatal conditions that can affect heel prick test results, and therefore, their investigation is essential, aiming to guide measures that promote mother and child health and consolidate neonatal screening in this population.
Sujets)
Humains , Femelle , Grossesse , Nouveau-né , Adolescent , Adulte , Jeune adulte , Complications de la grossesse/épidémiologie , Unités de soins intensifs néonatals , Dépistage néonatal/méthodes , Maladies néonatales/diagnostic , Prise en charge prénatale/statistiques et données numériques , Nourrisson à faible poids de naissance , Prématuré , Talon , Études rétrospectives , Études longitudinales , Maladies néonatales/épidémiologieRésumé
RESUMEN Introducción: Las cardiopatías congénitas inciden en 8 x 1 000 recién nacidos vivos en el mundo y en gran medida determinan su mortalidad. Objetivo: Precisar la morbilidad y mortalidad neonatal por cardiopatías congénitas. Métodos: Estudio descriptivo, longitudinal y prospectivo realizado en 97 recién nacidos con estas cardiopatías, diagnósticados en el Servicio de Neonatología del Hospital Dr. Agostinho Neto de Guantánamo durante los años 2015- 2017. Se consideró el análisis segmentario, probable mecanismos que la determinan y tipo de cardiopatía. Resultados: Se identificaron cardiopatías congénitas en el 12,9 por ciento de los recién nacidos; la letalidad fue de 1,0 por ciento. Lo más común fue que se identificaron modos y tipos de conexión auriculoventricular y ventriculoarterial fisiológicos. Las anomalías en la muerte celular (47,3 por ciento) fue el mecanismo genético y molecular más observado. La cardiopatía más frecuente fue la comunicación interventricular (63,9 por ciento). La mayoría de las cardiopatías se clasificaron como: aisladas (95,9 por ciento), de gravedad moderada (92,8 por ciento), acianóticas (93,8 por ciento), no se asociaran a síndromes o enfermedades genéticas (94,9 por ciento) pero sí a malformaciones extracardiacas (94,9 por ciento). Se manifestaron sobre todo por soplo cardiaco (85,6 por ciento). El diagnóstico de 70,1 por ciento de las cardiopatías se realizó en etapa prenatal. Conclusiones: Estas afecciones no constituyen un problema de salud en el servicio de este hospital, pero a pesar de que la mayoría de las cardiopatías congénitas se diagnostican en etapa prenatal, se requiere continuar laborando en función de potenciar más su diagnóstico en esta etapa(AU)
ABSTRACT Introduction: Neonatal congenital cardiopathies have a global incidence of 8 x 1000 live births and it greatly determines their mortality. Objective: To specify the neonatal morbidity and mortality by congenital cardiopathies. Method: Descriptive, longitudinal and prospective study of 97 newborns with these cardiopathies diagnosed in the Neonatolgy Service in ´Dr. Agostinho Neto Hospital, Guantánamo province from 2015 to 2017. It was considered: the segmental analysis, probable mechanisms that determine it and cardiopathy type. Results: Congenital cardiopathies were identified in 12.9 percent of the newborns; the lethality was of 1.0 percent. The most common aspect was the identification of ways and types of aurículo-ventricular and physiologic ventrículo-arterial connection. Anomalies in the cellular death (47.3 percent) were the most frequent genetic and molecular mechanism. The most frequent congenital heart disease was the interventricular communication (63.9 percent). Most of the cardiopathies were classified as: isolated (95.9 percent); of moderate graveness (92.8 percent); acyanotic (93.8 percent); not associated to syndromes or genetic diseases (94.9 percent) but yes to extracardiac malformations (94.9 percent); and they manifested mainly by heart murmur (85.6 percent ). The diagnosis of 70.1 percent of the cardiopathies was carried out in prenatal stage. Conclusions: Congenital cardiopathies don't constitute a health problem in the Neonatology service of the Hospital; but instead that these were mainly diagnosed in the prenatal stage, it is required to continue working in function of boosting their prenatal diagnosis(AU)
Sujets)
Humains , Mâle , Femelle , Nouveau-né , Cardiopathies congénitales/mortalité , Cardiopathies congénitales/épidémiologie , Maladies néonatales/épidémiologie , Épidémiologie Descriptive , Études prospectives , Études longitudinalesRésumé
ABSTRACT Objective: to analyze the prevalence and factors associated with acute kidney injury in preterm newborns. Method: a cross-sectional study based on records data of preterm newborns hospitalized in two neonatal units in northwest Paraná State in 2015. For data analysis, the logistic regression model was used by the stepwise forward method and Fisher's Exact Test. Results: 132 preterm newborns, with a prevalence of 7.5% of acute kidney injury, were hospitalized. Majority of males, extremely preterm and very low birth weight. Associated factors were the use of non-nephrotoxic antibiotics and the presence of mechanical pulmonary ventilation, increasing the chance of developing acute kidney damage by 2.98 and 1.33/day, respectively. Hospitalization days constituted a protection factor. Conclusion: this study was able to identify the prevalence, and outline the variables associated with acute kidney injury in preterm newborns in a particular care situation.
RESUMEN Objetivo: analizar la prevalencia y factores asociados a la lesión renal aguda en recién nacidos prematuros. Método: estudio transversal realizado a partir de datos de prontuarios de recién nacidos prematuros internados en 2 unidades neonatales del noroeste del estado de Paraná en 2015. Para el análisis de los datos, se utilizó el modelo de regresión logística por el método stepwise forward y Test Exacto de Fisher. Resultados: fueron internados 132 prematuros, con prevalencia del 7,5% de lesión renal aguda. La mayoría era del sexo masculino, prematuros extremos y con muy bajo peso al nacer. Los factores asociados fueron el uso de antibióticos no nefrotóxicos y la presencia de ventilación pulmonar mecánica, aumentando en 2,98 y 1,33/día la posibilidad del desarrollo de lesión renal aguda, respectivamente. Los días de hospitalización constituyeron un factor de protección. Conclusión: este estudio fue capaz de identificar la prevalencia y delinear las variables asociadas a la ocurrencia de lesión renal aguda en recién nacidos prematuros en una determinada realidad asistencial.
RESUMO Objetivo: analisar a prevalência e fatores associados à lesão renal aguda em recém-nascidos prematuros. Método: estudo transversal realizado a partir de dados de prontuários de recém-nascidos prematuros internados em duas unidades neonatais do noroeste paranaense em 2015. Para análise dos dados, utilizou-se o modelo de regressão logística pelo método stepwise forward e Teste Exato de Fisher. Resultados: foram internados 132 prematuros, com prevalência de 7,5% de lesão renal aguda. Maioria do sexo masculino, prematuros extremos e com muito baixo peso ao nascer. Os fatores associados foram o uso de antibióticos não nefrotóxicos e a presença de ventilação pulmonar mecânica, aumentando em 2,98 e 1,33/dia a chance do desenvolvimento de lesão renal aguda, respectivamente. Os dias de hospitalização constituíram fator de proteção. Conclusão: este estudo foi capaz de identificar a prevalência e delinear as variáveis associadas à ocorrência de lesão renal aguda em recém-nascidos prematuros numa determinada realidade assistencial.
Sujets)
Humains , Mâle , Femelle , Nouveau-né , Nourrisson , Enfant d'âge préscolaire , Enfant , Prématuré , Atteinte rénale aigüe/épidémiologie , Brésil/épidémiologie , Unités de soins intensifs néonatals , Dossiers médicaux , Prévalence , Études transversales , Études rétrospectives , Facteurs de risque , Maladies néonatales/épidémiologieRésumé
Abstract Twin pregnancy accounts for 2 to 4% of total births, with a prevalence ranging from 0.9 to 2.4% in Brazil. It is associated with worse maternal and perinatal outcomes. Many conditions, such as severe maternal morbidity (SMM) (potentially life-threatening conditions and maternal near-miss) and neonatal near-miss (NNM) still have not been properly investigated in the literature. The difficulty in determining the conditions associated with twin pregnancy probably lies in its relatively low occurrence and the need for larger population studies. The use of the whole population and of databases from large multicenter studies, therefore, may provide unprecedented results. Since it is a rare condition, it ismore easily evaluated using vital statistics from birth e-registries. Therefore, we have performed a literature review to identify the characteristics of twin pregnancy in Brazil and worldwide. Twin pregnancy has consistently been associated with SMM, maternal near-miss (MNM) and perinatal morbidity, with still worse results for the second twin, possibly due to some characteristics of the delivery, including safety and availability of appropriate obstetric care to women at a high risk of perinatal complications.
Resumo A gestação gemelar é responsável por 2 a 4% do total de nascimentos, com uma prevalência variando de 0,9 a 2,4% no Brasil. Ela é associada a piores resultados maternos e perinatais. Muitas condições, como amorbidade materna grave (condições potencialmente ameaçadoras da vida e near-miss materno) e near-miss neonatal ainda não foram investigadas de forma apropriada na literatura. A dificuldade na determinação de condições associadas com a gestação gemelar provavelmente reside em sua ocorrência relativamente baixa e na necessidade de estudos populacionais maiores. O uso da população total e de bancos de dados de grandes estudosmulticêntricos podem então fornecer resultados sem precedentes. Considerando que esta é uma condição rara, ela émais facilmente avaliada usando estatísticas vitais de registros eletrônicos de
Sujets)
Humains , Femelle , Grossesse , Nouveau-né , Complications de la grossesse/épidémiologie , Grossesse gémellaire , Maladies néonatales/épidémiologie , MorbiditéRésumé
Abstract Objective: Neonatal mortality rate remains high in Brazil. The aim of the study was to evaluate the factors associated with hospitalization during the neonatal period. Methods: Cross-sectional study conducted in ten randomly-selected Brazilian municipalities. Mothers of children under the age of 6 who were carrying the child's health booklet were interviewed in basic health units. Hierarchical modeling of sociodemographic factors (distal level), maternal variables (intermediate level), and features of the newborns (proximal level) was performed. The variables that presented a value of p ≤ 0.20 in the univariate analysis were included in the multivariate hierarchical modeling process, with block input according to their hierarchical level. The variables with a value of p ≤ 0.05 were considered statistically significant. Results: 2022 mothers were included, allowing 258 (12.8%) cases of hospitalization during the neonatal period to be identified, of which 49.7% were male, 8.9% were premature, and 8.4% had low birth weight (<2500 g). After analysis by hierarchical approach, factors associated with neonatal hospitalization (prevalence ratio [95% CI]) included: history of prematurity (2.03 [1.25-3.30], p = 0.004), gestational risk (2.02 [1.46-2.79], p < 0.001); intrapartum risk (3.73 [2.33-5.99], p < 0.001); gestational age (32-37 weeks: 13.83 [1.74-110.09], p = 0.01; and < 32 weeks: 25.03 [3.03-207.12], p = 0.003); low birth weight (3.95 [2.56-6.09], p < 0.001), and male gender (1.44 [1.09-1.98], p = 0.01). Conclusion: Factors associated with maternal and neonatal history are associated with neonatal hospitalization.
Resumo Objetivo: A taxa de mortalidade neonatal permanece alta no Brasil. O objetivo do estudo foi avaliar os fatores associados à internação durante o período neonatal. Métodos: Estudo transversal feito em dez municípios brasileiros aleatoriamente selecionados. As mães das crianças com menos de seis anos que estavam com a caderneta de informações de saúde da criança foram entrevistadas nas unidades básicas de saúde. Foi realizada a modelagem hierárquica dos fatores sociodemográficos (nível distal), das variáveis maternas (nível intermediário) e das características dos recém-nascidos (nível proximal). As variáveis que apresentaram um valor de p ≤ 0,20 na análise univariada foram incluídas no processo multivariado de modelagem hierárquica com entrada em blocos de acordo com seu nível hierárquico. As variáveis com valor de p ≤ 0,05 foram consideradas estatisticamente significativas. Resultados: 2022 mães foram incluídas, nos possibilitando identificar 258 (12,8%) casos de internação durante o período neonatal, dos quais 49,7% foram meninos, 8,9% foram prematuros e 8,4% apresentaram baixo peso ao nascer (< 2.500 g). Após a análise por abordagem hierárquica, os fatores associados à internação neonatal (IP [IC de 95%]) incluíram: histórico de prematuridade (2,03 [1,25-3,30], p = 0,004), risco gestacional (2,02 [1,46-2,79], p < 0,001); risco intraparto (3,73 [2,33-5,99], p < 0,001); idade gestacional (32-37 semanas: 13,83 [1,74-110,09], p = 0,01) e (< 32 semanas: 25,03 [3,03-207,12], p = 0,003); baixo peso ao nascer (3,95 [2,56-6,09], p < 0,001) e sexo masculino (1,44 [1,09-1,98], p = 0,01). Conclusão: Os fatores associados a histórico materno e neonatal foram associados à internação neonatal.
Sujets)
Humains , Mâle , Femelle , Nouveau-né , Nourrisson , Nourrisson à faible poids de naissance , Prématuré , Hospitalisation/statistiques et données numériques , Maladies néonatales/épidémiologie , Facteurs socioéconomiques , Brésil/épidémiologie , Études transversales , Entretiens comme sujet , Facteurs de risque , Âge gestationnelRésumé
ABSTRACT Objective: To define the spectrum of medical disorders managed on the neonatal unit at the University Hospital of the West Indies (UHWI) over the past two decades. Method: A review of published data pertaining to neonatal medical disorders managed at the UHWI over the past 20 years was conducted. Pertinent findings, implications of these findings and recommendations based on these findings were collated and presented under themes. Results: Common medical disorders managed includes complications of prematurity and very low birthweight infants, neonatal sepsis, hypoxic ischaemic encephalopathy, meconium aspiration syndrome, neonatal jaundice, hypernatraemic dehydration, complications of macrosomia and complications resulting from neonatal transport. Conclusion: It is clear that a diverse spectrum of neonatal disorders is managed on the neonatal unit of the UHWI and that the fledgling neonatal unit providing basic care for neonates of the 1960s has matured into the level II Newborn Special Care Nursery and Level III NICU that it is today. The time is now opportune for Neonatology to gain independent status as a Division of Neonatology within the Department of Child and Adolescent Health at the UHWI.
RESUMEN Objetivo: Definir el espectro de trastornos médicos tratados en la Unidad Neonatal del Hospital Universitario de West Indies (UHWI) en las últimas dos décadas. Método: Se realizó una revisión de los datos publicados sobre los trastornos médicos neonatales tratados en UHWI durante los últimos 20 años. Los hallazgos pertinentes, las implicaciones de estos hallazgos y las recomendaciones basadas en estos hallazgos fueron recopiladas y presentadas en temas. Resultados: Los trastornos médicos comunes tratados incluyen complicaciones de la prematuridad y los neonatos de muy bajo peso al nacer, sepsis neonatal, encefalopatía isquémica, síndrome de aspiración de meconio, ictericia neonatal, deshidratación hipernatrémica, complicaciones de macrosomía y las complicaciones resultantes del transporte neonatal. Conclusión: Está claro que un espectro diverso de trastornos neonatales es tratado en la Unidad Neonatal de UHWI, y que la unidad neonatal incipiente que proporcionó atención básica a los neonatos de los años 60 ha madurado, llegando a ser hoy la Sala de Atención Especial a Neonatos de Nivel II y la Unidad de Cuidados Intensivos Neonatales (UCIN) de Nivel III. Es hora ya de que la Neonatología tenga estatus independiente como División de Neonatología dentro del Departamento de Salud de Niños y Adolescentes de UHWI.
Sujets)
Humains , Nouveau-né , Hôpitaux universitaires/statistiques et données numériques , Maladies néonatales/classification , Maladies néonatales/épidémiologie , Jamaïque/épidémiologieRésumé
INTRODUÇÃO: A fissura oral é a segunda maior causa de anomalias congênitas e representa a principal alteração craniofacial em nascidos vivos. O objetivo do presente estudo foi determinar os dados epidemiológicos do Centro de Atenção Integral ao Fissurado Labiopalatal, no período entre janeiro de 2011 e dezembro de 2014. MÉTODOS: Estudo retrospectivo utilizando prontuários clínicos. Foram avaliados 1262 prontuários de pacientes portadores de fissura oral. Após aplicação dos critérios de inclusão e exclusão, 52,7% prontuários foram incluídos no estudo. RESULTADOS: Entre os 666 prontuários, 57,4% foram do gênero masculino e 42,6% do feminino. Verificou-se que 34,8% dos pacientes apresentaram fissuras transforame, 27,2% fissuras pré-forame, 25,8% fissuras pós-forame e 12,2% outros tipos de fissuras. Pacientes oriundos de Curitiba e Região Metropolitana correspondem a 36,6%, aqueles do Interior do Paraná abrangem 61% dos atendimentos no Centro de Atenção. As medianas de idade na primeira consulta, entre os pacientes de Curitiba e Região Metropolitana e do Interior do Paraná, são de 1 mês e 2 meses, respectivamente. E a primeira cirurgia, realizada no Centro de Atenção, foi em torno de 6 meses, nos pacientes de Curitiba e Região Metropolitana, e de 7 meses naqueles oriundos do Interior do Paraná. CONCLUSÃO: Verificou-se predomínio de fissuras em meninos e maior frequência da fissura pós-forame incompleta. Observou-se que, apesar da distância, as crianças oriundas do Interior do Paraná realizaram a cirurgia de correção e chegaram ao centro de referência com apenas um mês de diferença em relação aquelas da cidade sede do Centro de Atenção Integral ao Fissurado Labiopalatal.
INTRODUCTION: Oral cleft is the second major cause of congenital anomalies and represents a major craniofacial alteration in live births. The objective of this study was to analyze the epidemiological data collected from the Center for Comprehensive Care to Individuals with Cleft Lip and Palate in the period from January 2011 to December 2014. METHODS: This retrospective study evaluated 1,262 medical records of patients with an oral cleft. After applying the inclusion and exclusion criteria, 52.7% of the medical records were included in the study. RESULTS: Among the 666 medical records, 57.4% were of male patients and 42.6% were of female patients. Of these, 34.8% of the patients had a trans-foramen cleft, 27.2% had a pre-foramen cleft, 25.8% had a post-foramen cleft, and 12.2% had another type of cleft. Patients from Curitiba and the metropolitan region constituted 36.6% of the cases, and patients from rural areas of Paraná represented 61% of the visits to the care center. The median age at the first visit of the patients from Curitiba/metropolitan region and rural areas of Paraná was 1 and 2 months, respectively. The first surgery was performed at the care center at the age of 6 months in patients from Curitiba and metropolitan region and 7 months in patients from rural areas of Paraná. CONCLUSION: There was a predominance of boys and a higher prevalence of incomplete post-foramen clefts in the total population. Despite the long distance to the care center, children from rural areas of Paraná underwent the correction surgery and were treated at the referral center with an age difference of only 1 month compared with patients who lived in Curitiba, where the care center is located.
Sujets)
Humains , Mâle , Femelle , Enfant d'âge préscolaire , Enfant , Adolescent , Histoire du 21ème siècle , Malformations multiples , Épidémiologie , Études transversales , Études rétrospectives , Bec-de-lièvre , , Maladies néonatales , Malformations multiples/chirurgie , Malformations multiples/anatomopathologie , Épidémiologie/normes , Bec-de-lièvre/chirurgie , Bec-de-lièvre/thérapie , Bec-de-lièvre/épidémiologie , /méthodes , Maladies néonatales/chirurgie , Maladies néonatales/anatomopathologie , Maladies néonatales/épidémiologieRésumé
Abstract Purpose To assess the impact of pre-pregnancy obesity (body mass index [BMI] ≥30 kg/m2) on the gestational and perinatal outcomes. Methods Retrospective cohort study of 731 pregnant women with a BMI ≥30 kg/m2 at the first prenatal care visit, comparing them with 3,161 women with a BMI between 18.5 kg/m2 and 24.9 kg/m2. Maternal and neonatal variables were assessed. Statistical analyses reporting the demographic features of the pregnant women (obese and normal) were performed with descriptive statistics followed by two-sided independent Student's t tests for the continuous variables, and the chi-squared (χ2) test, or Fisher's exact test, for the categorical variables. We performed a multiple linear regression analysis of newborn body weight based on the mother's BMI, adjusted by maternal age, hyperglycemic disorders, hypertensive disorders, and cesarean deliveries to analyze the relationships among these variables. All analyses were performed with the R (R Foundation for Statistical Computing, Vienna, Austria) for Windows software, version 3.1.0. A value of p < 0.05 was considered statistically significant. Results Obesity was associated with older age [OR 9.8 (7.8-12.2); p < 0.01], hyperglycemic disorders [OR 6.5 (4.8-8.9); p < 0.01], hypertensive disorders [OR 7.6 (6.1-9.5); p < 0.01], caesarean deliveries [OR 2.5 (2.1-3.0); p < 0.01], fetal macrosomia [OR 2.9 (2.3-3.6); p < 0.01] and umbilical cord pH [OR 2.1 (1.4-2.9); p < 0.01). Conversely, no association was observed with the duration of labor, bleeding during labor, Apgar scores at 1 and 5 minutes after birth, gestational age, stillbirth and early neonatal mortality, congenital malformations, and maternal and fetal injury. Conclusion We observed that pre-pregnancy obesity was associated with maternal age, hyperglycemic disorders, hypertension syndrome, cesarean deliveries, fetal macrosomia, and fetal acidosis.
Resumo Objetivo Avaliar o impacto da obesidade pré-gestacional (índice de massa corpórea [IMC] ≥30 kg/m2) sobre os resultados gestacionais e perinatais. Métodos Estudo transversal retrospectivo, com 731 gestantes que apresentaram IMC ≥ 30 kg/m2 na primeira consulta de pré-natal, comparando-as a 3.161 gestantes com IMC entre 18,5 kg/m2 e 24,9 kg/m2. Foram avaliadas variáveis maternas e neonatais. A análise estatística baseou-se nas características demográficas das gestantes (obesas e com peso normal), e foi realizada com estatísticas descritivas seguidas de testes t de Student independentes bicaudais para variáveis contínuas, e teste de qui-quadrado (χ2) ou exato de Fisher para as variáveis categóricas. Foi realizada uma regressão linear múltipla do peso do recém-nascido sobre o IMC materno, ajustado por idade materna, síndromes hiperglicêmicas, síndromes hipertensivas hipertensivas e operações cesarianas, a fim de analisar a relação entre essas variáveis. Todas as análises foram realizadas com o uso de R (R Foundation for Statistical Computing, Viena, Áustria) para Windows, versão 3.1.0. Um valor de p < 0,05 foi considerado estatisticamente significante. Resultados A obesidade associou-se à idade materna [OR 9,8 (7,8-12,2); p < 0,01], distúrbios hiperglicêmicos [OR 6.5 (4,8-8,9); p < 0,01], distúrbios hipertensivos (RP: 7,6 [6,1-9,5]; p < 0,01), maior taxa de operação cesariana [OR 2,5 (2,1-3,0); p < 0,01], macrossomia fetal [OR 2,9 (2,3-3,6); p < 0,01] e baixo pH na artéria umbilical [OR 2,1 (1,4-2,9); p < 0,01]. Não foi observada associação com tempo de trabalho de parto, sangramento durante o trabalho de parto, índice de Apgar no 1° e 5° minutos, idade gestacional, natimortalidade e mortalidade neonatal precoce, malformações congênitas e tocotraumatismo materno e fetal. Conclusões O estudo mostrou que a obesidade pré-gestacional associou-se com idade materna mais elevada, distúrbios hiperglicêmicos e hipertensivos, taxas mais altas de operação cesariana, macrossomia e acidose fetal.
Sujets)
Humains , Femelle , Grossesse , Nouveau-né , Adulte , Complications de la grossesse/étiologie , Obésité/complications , Complications de la grossesse/épidémiologie , Issue de la grossesse , Études rétrospectives , Études de cohortes , Maladies foetales/étiologie , Maladies foetales/épidémiologie , Maladies néonatales/étiologie , Maladies néonatales/épidémiologieRésumé
Abstract Objective: To determine the prevalence of neonatal dermatological findings and analyze whether there is an association between these findings and neonatal and pregnancy characteristics and seasonality. Methods: Newborns from three maternity hospitals in a Brazilian capital city were randomly selected to undergo dermatological assessment by dermatologists. Results: 2938 neonates aged up to three days of life were randomly selected, of whom 309 were excluded due to Intensive Care Unit admission. Of the 2530 assessed neonates, 49.6% were Caucasians, 50.5% were males, 57.6% were born by vaginal delivery, and 92.5% of the mothers received prenatal care. Some dermatological finding was observed in 95.8% of neonates; of these, 88.6% had transient neonatal skin conditions, 42.6% had congenital birthmarks, 26.8% had some benign neonatal pustulosis, 2% had lesions secondary to trauma (including scratches), 0.5% had skin malformations, and 0.1% had an infectious disease. The most prevalent dermatological findings were: lanugo, which was observed in 38.9% of the newborns, sebaceous hyperplasia (35%), dermal melanocytosis (24.61%), skin desquamation (23.3%), erythema toxicum neonatorum (23%), salmon patch (20.4%), skin erythema (19%), genital hyperpigmentation (18.4%), eyelid edema (17.4%), milia (17.3%), genital hypertrophy (12%), and skin xerosis (10.9%). Conclusions: Dermatological findings are frequent during the first days of life and some of them characterize the newborn's skin. Mixed-race newborns and those whose mothers had some gestational risk factor had more dermatological findings. The gestational age, newborn's ethnicity, gender, Apgar at the first and fifth minutes of life, type of delivery, and seasonality influenced the presence of specific neonatal dermatological findings.
Resumo Objetivo: Verificar a prevalência dos achados dermatológicos nos primeiros dias de vida e analisar se há associação com características neonatais, gestacionais e sazonalidade. Métodos: Recém-nascidos de três maternidades de uma capital brasileira foram selecionados aleatoriamente para serem submetidos ao exame dermatológico feito por dermatologistas. Resultados: Foram selecionados aleatoriamente 2.839 neonatos com até 72 horas de vida, 309 foram excluídos por terem sido admitidos em Unidade de Tratamento Intensivo. Dos 2.530 neonatos examinados, 49,6% eram da etnia branca e 50,5% do sexo masculino. Foi observado algum achado dermatológico em 95,8% dos recém-nascidos; desses, 88,6% tinham lesões cutâneas transitórias neonatais, 42,6% marca de nascimento, 26,8% pustulose benigna neonatal, 2% lesões secundárias ao trauma, 0,5% malformação cutânea e 0,1% doença infecciosa. O achado dermatológico mais frequente foi o lanugo, observado em 38,9% dos neonatos, seguido por hiperplasia de glândulas sebáceas (35%), melanocitose dérmica (24,6%), descamação da pele (23,3%), eritema tóxico neonatal (23%), mancha salmão (20,4%), eritema da pele (19%), hiperpigmentação da genitália (18,4%), edema palpebral (17,4%), cistos de mília (17,3%), hipertrofia da genitália (12%) e xerose cutânea (10,9%). Conclusões: Os achados dermatológicos são frequentemente identificados nos primeiros dias de vida e muitos deles caracterizam a pele do recém-nascido. Os neonatos pardos e aqueles cujas mães apresentavam algum fator de risco gestacional tiveram mais achados dermatológicos. A idade gestacional, a etnia do neonato, o gênero, o índice de Ápgar, o tipo de parto e a sazonalidade influenciaram na presença de manifestações cutâneas específicas.
Sujets)
Humains , Mâle , Femelle , Nouveau-né , Maladies de la peau/épidémiologie , Maladies néonatales/épidémiologie , Maladies de la peau/classification , Maladies de la peau/diagnostic , Brésil/épidémiologie , Facteurs sexuels , Prévalence , Études prospectives , Facteurs de risque , Facteurs âges , Âge gestationnel , Maladies néonatales/diagnosticRésumé
Abstract Objective The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs. Methods A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group. Results We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p < 0.001). Low birth weight (2,620 g versus 3,333 g on average, p < 0.001) and maternal syphilis (15.7% versus 0%, p < 0.001) were associated with the use of these illicit drugs. Conclusions The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs.
Resumo Objetivo Avaliar o resultado perinatal das gestantes usuárias de drogas ilícitas. Métodos: estudo retrospectivo, observacional de gestantes que procuraram espontaneamente ou foramencaminhadas nomomento do parto paramaternidade pública na Zona Leste do município de São Paulo. Comparamos os resultados perinatais do grupo de gestantes que utilizaram drogas ilícitas com um grupo de não usuárias, que tiveram o parto no mesmo período, para análise das variáveis obstétricas e neonatais. O teste t de Student foi utilizado para cálculo das médias entre os grupos. O teste do Quiquadrado e exato de Fisher foram usados para comparação de dados categóricos de cada grupo. Resultados Avaliamos 166 mulheres (83 usuárias e 83 não usuárias), com uma média de idade de 26 anos, em ambos os grupos. A cocaína pura ou sob a forma de crack foi utilizada isolada ou associada a outras substâncias psicoativas em 95% das que referiram uso de drogas durante a gravidez. Aproximadamente metade das usuárias não teve nenhuma consulta pré-natal enquanto que entre as não usuárias apenas 2,4% não tiveram consultas de pré-natal (p < 0,001). A menor média de peso ao nascer (2620 g versus 3333 g, p < 0,001) e a presença de sífilis materna (15,7% versus 0%, p < 0,001) foram associados ao uso de drogas ilícitas. Conclusão O uso de drogas ilícitas, principalmente crack, é um fator de risco perinatal significativo. Qualquer abordagem médica nesse grupo de gestantes usuárias de drogas ilícitas deve combinar a adesão ao pré-natal com estratégias voltadas à redução da exposição materna a essas substâncias.
Sujets)
Humains , Femelle , Grossesse , Nouveau-né , Adulte , Complications de la grossesse , Substances illicites/effets indésirables , Troubles liés à une substance , Complications de la grossesse/épidémiologie , Issue de la grossesse , Études rétrospectives , Troubles liés à une substance/épidémiologie , Maladies néonatales/épidémiologieRésumé
La probabilidad de padecer trombosis es mucho mayor en el período neonatal que en cualquier otra etapa pediátrica. La labilidad del particular sistema hemostático del neonato, sumada a los múltiples factores de riesgo a que está expuesto y la presencia casi constante de catéteres, son responsables de este hecho. Las trombosis venosas son más frecuentes que las arteriales y ocurren principalmente en los miembros, la aurícula derecha y las venas renales. El accidente cerebrovascular puede ser causado por la oclusión del flujo arterial que llega al cerebro o del sistema de drenaje venoso de este. La púrpura fulminans es una patología de altísima gravedad, que debe ser considerada una emergencia médica y se debe a la deficiencia grave de proteína C o, menos frecuentemente, de proteína S o antitrombina. La mayoría de los episodios trombóticos tienen indicación de tratamiento anticoagulante, que se puede realizar con heparina no fraccionada y/o con heparina de bajo peso molecular. La púrpura fulminans requiere terapia de sustitución con proteína C y/o plasma fresco. El tratamiento trombolítico se realiza con activador tisular del plasminógeno y debe quedar reservado solo para aquellas trombosis cuya localización implique compromiso de vida o pérdida de un órgano o de un miembro.
The incidence of thrombosis is higher among newborn infants than in any other stage of pediatric development. This fact is the consequence of labile characteristics of the neonatal hemostatic system, in addition to exposure to multiple risk factors and the wide use of vascular catheters. Venous thromboses, which mainly affect the limbs, the right atrium and renal veins, are more frequently seen than arterial thromboses. A stroke may be caused by the occlusion of the arterial flow entering the brain or by occlusion of its venous drainage system. Purpura fulminans is a very severe condition that should be treated as a medical emergency, and is secondary to severe protein C deficiency or, less frequently, protein S or antithrombin deficiency. Most thrombotic events should be managed with antithrombotic therapy, which is done with unfractionated and/or low molecular weight heparins. Purpura fulminans requires protein C replacement and/or fresh frozen plasma infusion. Thrombolytic therapy is done using tissue plasminogen activator and should only be used for life-, or limb-, or organ-threatening thrombosis.