Tuberculosis in pregnancy and adverse neonatal outcomes in two peruvian hospitals.

Background: According to the World Health Organization, tuberculosis (TB) ranks among the top 10 causes of death worldwide. The significance of TB during pregnancy lies in its symptoms, which can be mistaken for physiological changes associated with pregnancy. This confusion can lead to maternal-perinatal complications. Objective: To evaluate the association between pulmonary TB in pregnancy and adverse neonatal outcomes in two Peruvian hospitals. Methods: This is a retrospective cohort study. The target population consisted of pregnant women with and without pulmonary TB whose deliveries were attended at two public hospitals, located in Lima, Peru. The adverse neonatal outcomes were prematurity, low birth weight (LBW), and being small for gestational age (SGA). Crude and adjusted relative risks (RRa) were calculated with their respective 95% confidence intervals (95%CI). Results: Information from 212 patients was analyzed; 48.1% had TB during pregnancy, and 23.1% had adverse neonatal outcomes (8%, 11.3%, and 12.3% for LBW, prematurity, and SGA, respectively). In the adjusted model, pregnant women with pulmonary TB had a 3.52 times higher risk of having a newborn with at least one of the adverse outcomes than those who were not exposed (aRR, 3.52; 95%CI: 1.93-6.68). Conclusion: Pulmonary TB in pregnancy was jointly and independently associated with adverse neonatal outcomes, including LBW, prematurity, and being SGA.

Feeding practices and anthropometric classification of nutritional status in low-birth-weight infants at term. A prospective cohort study.

BACKGROUND: About 50 % of LBW occurs in term newborns, which is associated with higher infant mortality rates compared to infants of average birth weight. Analysis of feeding practices in at-risk groups is essential to address malnutrition and stunting in infancy. AIM: To identify feeding practices and anthropometric classification of nutritional status in a cohort of low-birth-weight term infants. METHODS: Methods: Cohort study. A prospective follow-up of 73 term newborns with low birth weight up to six months of age was performed. Feeding practices and anthropometric classification of nutritional were analysed. Data were processed by univariate analysis and multivariate linear regression. RESULTS: The most common feeding practice was exclusive breastfeeding. Breast milk substitutes are frequent in this population group. The risk of undernutrition ranged from 2.7 % to 19.2 % and of overweight from 4.1 % to 11.0 % during the first six months of life. Low height-for-age risk was the most frequent anthropometric classification during the follow-up period. Average head circumference was consistent in infants with low birth weight. Gestational risk classification, breastfeeding during the first hour of life, and sex of the newborn were predictors of variations in anthropometric indicators. CONCLUSIONS: Exclusive breastfeeding is the most common feeding practice in the population group studied, but using breast milk substitutes is also prevalent. Low height-for-age is the most frequent anthropometric classification. The weight growth rate seems reasonable, but further studies are needed based on gender differences, analysis of the composition of breast milk, and socio-environmental factors involved in growth.

Kangaroo care: Benefits, challenges, and future perspectives in neonatal care. An integrative review / Método canguro: Beneficios, desafíos y perspectivas futuras en el cuidado neonatal. Una revisión integrativa / Cuidado canguru: benefícios, desafios e perspectivas futuras na assistência neonatal. Uma revisão integrativa

Objective: To review current scientific evidence on the physiological effects of kangaroo care, explore barriers and facilitators to its implementation, and identify areas requiring further research. Materials and methods: An integrative review was conducted using PubMed, Scopus, Web of Science, and Cochrane databases without language restrictions. Studies included quantitative and qualitative review studies. Critical appraisal of studies was performed using the Joanna Briggs Institute tool. Results: Sixteen studies were analyzed, providing heterogeneous support for the efficacy of kangaroo care  in improving various neonatal physiological parameters including heart rate, body temperature, and oxygen saturation. Major barriers to implementation included restricted visiting hours, healthcare staff workload, negative cultural beliefs, lack of information and empowerment for mothers, and limited involvement of fathers. Conclusions: kangaroo care positively impacts premature or low birth weight neonatal development, though implementation is influenced by sociocultural factors. Further research is needed to better assess real effects on neonatal physiological parameters. Additional qualitative studies could aid in developing culturally adapted strategies to optimize kangaroo care implementation across contexts by better understanding family and medical team perspectives.

Objetivo. El objetivo es revisar la evidencia científica actual sobre los efectos fisiológicos del método canguro, explorar las barreras y facilitadores para su aplicación, además de identificar áreas de conocimiento aún no exploradas. Materiales y métodos. Revisión Integrativa, que incluyó estudios de revisión cuantitativos y cualitativos, en las bases de datos PubMed, Scopus, Web of Science y Cochrane, sin restricción de idioma. La valoración crítica de los estudios se realizó con la herramienta del Joanna Briggs Institute. Resultados. Se analizaron 16 estudios, entre los cuales se encontró evidencia que respalda la eficacia del método canguro en la mejora de diversos parámetros fisiológicos del neonato. Entre estos parámetros se encuentran la frecuencia cardíaca, la temperatura corporal y la saturación de oxígeno. Sin embargo, los resultados son heterogéneos. Las principales barreras para la implementación del método canguro incluyen: restricciones de las horas de visita, carga de trabajo del personal sanitario, creencias culturales negativas, falta de información y empoderamiento de las madres, además de la limitada participación de los padres. Conclusiones. El método canguro tiene un impacto positivo en el desarrollo los neonatos prematuros o de bajo peso. Sin embargo, su implementación se ve afectada por diversos factores socioculturales. Futuras investigaciones deben identificar los efectos reales sobre los parámetros fisiológicos del neonato.  Se necesitan estudios cualitativos para comprender mejor las perspectivas de las familias, de los equipos médicos, y así desarrollar estrategias de adaptación cultural que optimicen la aplicación del este método en diferentes contextos.

Objetivo: O objetivo deste estudo é revisar as evidências científicas atuais sobre os efeitos fisiológicos do Método Canguru, explorar as barreiras e facilitadores para sua aplicação, além de identificar áreas do conhecimento ainda não exploradas.Materiais e Métodos: Foi realizada uma Revisão Integrativa, incluindo estudos de revisão quantitativa e qualitativa, nas bases de dados PubMed, Scopus, Web of Science e Cochrane, sem restrição de idioma. A avaliação crítica dos estudos foi conduzida com a ferramenta Joanna Briggs Institute.Resultados: Foram analisados 16 estudos, nos quais foram encontradas evidências que sustentam a eficácia do Método Canguru na melhoria de diversos parâmetros fisiológicos do recém-nascido, tais como frequência cardíaca, temperatura corporal e saturação de oxigênio. No entanto, os resultados apresentaram heterogeneidade. As principais barreiras à implementação do Método Canguru incluem restrições nos horários de visita, carga de trabalho do pessoal de saúde, crenças culturais negativas, falta de informação e empoderamento das mães, além da participação limitada dos pais.Conclusões: O Método Canguru demonstrou ter impacto positivo no desenvolvimento de neonatos prematuros ou de baixo peso. Contudo, sua implementação é afetada por diversos fatores socioculturais. Pesquisas futuras devem identificar os reais efeitos nos parâmetros fisiológicos do neonato. Estudos qualitativos são necessários para melhor compreender as perspectivas das famílias e das equipes médicas, visando desenvolver estratégias de adaptação cultural que otimizem a aplicação deste método em diferentes contextos.

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

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

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

Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events: with a consideration of the COVID-19 pandemic period.

OBJECTIVE: There is uncertainty around the safety of SSRIs for treating depression during pregnancy. Nevertheless, the use of SSRIs has been gradually increasing, especially during the COVID-19 pandemic period. We aimed to (1) characterize maternal depression rate and use of SSRIs in a recent 10-year period, (2) address confounding by indication, as well as socioeconomic and environmental factors, and (3) evaluate associations of the timing of SSRI exposure in pregnancy with risk for preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) infants among women with depression before pregnancy. METHODS: We conducted propensity score-adjusted regression to calculate odds ratios (ORs) of PTB, LBW, and SGA. We accounted for maternal/pregnancy characteristics, comorbidity, depression severity, time of delivery, social vulnerability, and rural residence. RESULTS: There were 50.3% and 40.3% increases in the prevalence rate of prenatal depression and prenatal SSRI prescription rate during the pandemic. We identified women with depression ≤180 days before pregnancy (n = 8406). Women with no SSRI order during pregnancy (n = 3760) constituted the unexposed group. The late SSRI exposure group consisted of women with an SSRI order after the first trimester (n = 3759). The early-only SSRI exposure group consisted of women with SSRI orders only in the first trimester (n = 887). The late SSRI exposure group had an increased risk of PTB of OR = 1.5 ([1.2,1.8]) and LBW of OR = 1.5 ([1.2,2.0]), relative to the unexposed group. Associations between late SSRI exposure and risk of PTB/LBW were similar among a subsample of patients who delivered during the pandemic. CONCLUSIONS: These findings suggest an association between PTB/LBW and SSRI exposure is dependent on exposure timing during pregnancy. Small for gestational age is not associated with SSRI exposure.

Low Birth Weight is Associated with Sperm DNA Fragmentation and Assisted Reproductive Technology Outcomes in Primary Infertile Men: Results of a Cross-Sectional Study.

PURPOSE: To assess the relationship between clinical and semen characteristics and assisted reproductive technology (ART) outcomes with different birth weight (BW) categories in a cohort of infertile men. MATERIALS AND METHODS: Data from 1,063 infertile men were analyzed. Patients with BW ≤2,500, 2,500-4,000, and ≥4,000 g were considered as having low BW (LBW), normal BW (NBW), and high BW (HBW), respectively. Testicular volume (TV) was assessed with a Prader orchidometer. Serum hormones were measured in all cases. Semen analyses were categorized based on 2021 World Health Organization reference criteria. Sperm DNA fragmentation (SDF) was tested in every patient and considered pathological for SDF >30%. ART outcomes were available for 282 (26.5%) patients. Descriptive statistics and logistic regression analyses detailed the association between semen parameters and clinical characteristics and the defined BW categories. RESULTS: Of all, LBW, NBW, and HBW categories were found in 79 (7.5%), 807 (76.0%), and 177 (16.5%) men, respectively. LBW men had smaller TV, presented higher follicle-stimulating hormone (FSH) but lower total testosterone levels compared to other groups (all p<0.01). Sperm progressive motility (p=0.01) and normal morphology (p<0.01) were lower and SDF values were higher (all p<0.01) in LBW compared to other groups. ART pregnancy outcomes were lower in LBW compared to both NBW and HBW categories (26.1% vs. 34.5% vs. 34.5%, p=0.01). At multivariable logistic regression analysis, LBW was associated with SDF >30% (odd ratio [OR] 3.7; p<0.001), after accounting for age, Charlson Comorbidity Index (CCI), FSH, and TV. Similarly, LBW (OR 2.2; p<0.001), SDF >30% (OR 2.9; p<0.001) and partner's age (OR 1.3; p=0.001) were associated with negative ART outcomes, after accounting for the same predictors. CONCLUSIONS: LBW was associated with impaired clinical and semen characteristics in infertile men compared to both NBW and HBW. SDF and ART outcomes were significantly worse in the LBW group.

Placement of permanent pacemaker in a low-birth-weight infant with congenital heart block: a case report.

One of the rare diseases with a high mortality rate in infants is congenital heart block (CHB) with neonatal lupus erythematosus (NLE) as the most common cause. A permanent pacemaker (PPM) is indicated for symptomatic bradycardia. The choice of PPM in the paediatric population is different from that in the adult population because of several reasons like small size, account of somatic growth, and difference in physiological changes. Here, we present a case in which a 2.6 kg and 45 days old baby with CHB secondary to NLE was successfully treated with a single-chambered adult-sized PPM with epicardial lead. According to our knowledge, this is the smallest baby in Pakistan in which PPM has been implanted.

The effectiveness of breastfeeding self-efficacy intervention on implementation of breastfeeding in low-birth-weight infants: A systematic review.

Objectives: To present an overview of breastfeeding self-efficacy interventions to enhance the implementation of exclusive breastfeeding for mothers with low birth weight infants. Method: The systematic review comprised search for randomised controlled trials and quasi-experimental studies published between January 2014 to January 2022 on Scopus, ScienceDirect, Sage journals, ProQuest, Google Scholar and PubMed databases using the Population-Intervention-Comparison-Outcome framework and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The analytical quality of the studies was assessed using the Critical Appraisal Skills Programme checklist. RESULTS: Of the 339 studies initially identified, 10(2.94%) qualified for detailed analysis. Breastfeeding self-efficacy interventions could notably enhance the implementation of exclusive breastfeeding. CONCLUSIONS: Breastfeeding self-efficacy interventions can be modified and effectively used by nurses to improve the implementation of exclusive breastfeeding for mothers with low birth weight infants.

Treatment of periodontal disease in pregnancy for the prevention of adverse pregnancy outcomes: a systematic review of systematic reviews.

OBJECTIVE: To assess the systematic reviews and meta-analyses investigating whether or not periodontal treatment in pregnancy was effective in reducing the adverse pregnancy outcomes of preterm birth, low birth weight, preterm low birth weight, stillbirth, foetal growth restriction, and pre-eclampsia. METHODS: The umbrella review was conducted on May 30, 2021, and comprised search of electronic databases MEDLINE, EMBASE, Cochrane Database of Systematic Reviews via Ovid and CINAHL via EBSCO for all systematic reviews and meta-analyses, regardless of the publication date, of randomised controlled trials which investigated the effects of periodontal treatment during pregnancy in preventing or reducing the frequency of at least one adverse pregnancy outcome. The selected studies were subjected to quality assessment and narrative synthesis. RESULTS: Of the 110 studies found, 17(15.5%) met the inclusion criteria. Of them, quality assessment was high for 1(5.9%), moderate 14(82.3%), and low 2(11.8%). A total of 8(47%) studies demonstrated an association with low birth weight, 7(41.2%) with preterm birth, 3(17.6%) with preterm low birth weight, 1(5.9%) with small for gestational age, and 1(5.9%) with stillbirth, while no study demonstrated any association with pre-eclampsia. CONCLUSIONS: Differential findings provided unclear evidence, but periodontal therapy in pregnancy is still recommended as it causes no harm and reduces the bacterial burden in periodontal disease.

Interaction of B-group streptococcal infection and chorioamnionitis in low birth weight infants during late pregnancy / 中国医师杂志

Objective:To investigate the interaction of B-group streptococcal infection and chorioamnionitis (CAM) with late pregnancy and low birth weight infant (LBWI).Methods:A retrospective study was conducted on 524 postpartum women who underwent regular prenatal examinations and completed delivery at the Taizhou Second People′s Hospital from October 2019 to April 2022. According to their newborn birth weight, they were divided into normal group (466 cases) and LBWI group (58 cases). The age, pregnancy times, birth times, pregnancy body mass index (BMI), cesarean section history, abortion history, anemia during pregnancy, hypertensive disorder during pregnancy, diabetes during pregnancy, vaginitis, B-group streptococcal infection, CAM, premature rupture of membranes, postpartum hemorrhage, puerperal infection, neonatal preterm delivery, neonatal asphyxia, neonatal infection, fetal distress were compared between the two groups. The influencing factors of LBWI were analyzed using logistic regression. The correlation and interaction between B-group streptococcal infection and CAM on LBWI were analyzed.Results:There was a statistically significant difference in age, history of miscarriage, gestational hypertension, vaginitis, B-group streptococcal infection, CAM, premature rupture of membranes, neonatal preterm birth, neonatal infection and fetal distress between the two groups (all P<0.05). The results of logistic regression analysis showed that gestational hypertension, B-group streptococcal infection, CAM, premature rupture of membranes, preterm birth, neonatal infection, and fetal distress were risk factors for LBWI (all P<0.05). B-group streptococcal infection, CAM, and LBWI were positively correlated ( r=0.587, 0.604, all P<0.001). The interaction analysis results showed a positive correlation between B-group streptococcal infection, CAM, and LBWI (all P<0.001). Conclusions:B-group streptococcal infection in late pregnancy, CAM, and LBWI are positively correlated, and their coexistence can increase the risk of LBWI.

Preterm birth, low birth weight and risk of hypospadias: a meta-analysis / 中国医师杂志

Objective:To investigate the association between preterm birth, low birth weight and the risk of hypospadias.Methods:According to the search strategy of Cochrance Collaborative Network, the China National Knowledge Internet (CNKI), VIP, Wanfang, Pubmed, Cochrance and Embase were searched from the establishment of the database to April 2022. The literature on the relationship between preterm birth, low birth weight and the risk of hypospadias was included. Meta analysis was conducted on the relationship between preterm birth, low birth weight and the risk of hypospadias.Results:A total of 13 articles were included, including cases from Asia, Europe, Australia and America. Newcastle-ottawa Scale was used for evaluation, and the scores were all above 6. There were 10 articles on the relationship between preterm birth and the risk of hypospadias, all of which were case-control studies. Heterogeneity test I2=46%, P=0.05. There were 3 521 cases in the case group and 95 816 cases in the control group. Compared with the control group, preterm birth was a risk factor for hypospadias ( OR: 2.13, 95% CI: 1.89-2.41), and the difference was statistically significant ( Z=12.21, P<0.01). There were 11 articles on the association between low birth weight and the risk of hypospadias, all of which were case-control studies. Heterogeneity test I2=47%, P=0.04. There were 2 460 cases in the case group and 94 260 cases in the control group. Compared with the control group, low birth weight was a risk factor for hypospadias ( OR: 3.29, 95% CI: 2.57-4.22), and the difference was statistically significant ( Z=9.40, P<0.01). Conclusions:Based on meta-analysis of published literature, preterm birth and low birth weight increase the risk of hypospadias.

Early motor development: risk factors for delay in a population study in Southern Brazil

ABSTRACT OBJECTIVE To assess risk factors associated with motor development delay at three months of age. METHODS Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p < 0.001), and with low birth weight (p < 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems.

Home visit to premature and low birth weight newborns: nurse's experience report / Visita domiciliaria al recién nacido prematuro y de peso bajo: informe de experiencia de enfermeros / Visita domiciliar ao recém-nascido prematuro e de baixo peso: relato de experiência de enfermeiros

ABSTRACT Objective: To report the structures of the experience of nurse's home visits to premature and low birth weight newborns. Method: This is a descriptive study of the experience report type, structured on the experience of the nurse authors in the development of 48 home visits in a city in the state of São Paulo and its microregion between August 2020 and 2021 with eight mothers of premature and low weight newborns. Results: The guiding documents "Home visit for families with preterm and low birth weight newborns" and "Strategy of guiding questions for home visits" were created and used to promote open narratives from parental caregivers about caring for at-risk newborns, creating a relational space aimed at joint construction. Conclusion: The documents used have favored home visits, helping nurses to establish professional bonds and build relational space through dialogue when conducting their activities in the home environment.

RESUMEN Objetivo: Informar los factores estructurantes de la experiencia de visitas domiciliarias de enfermeros a recién nacidos prematuros y de bajo peso. Método: Se trata de un estudio descriptivo de informe de experiencia, estructurado sobre la vivencia de las enfermeras autoras en el desarrollo de 48 visitas domiciliarias en una ciudad del interior de São Paulo y su microrregión, entre agosto de 2020 y 2021, entre ocho madres de recién nacidos prematuros y de bajo peso. Resultados: Se elaboraron y utilizaron los documentos orientadores "Visita domiciliaria para familias con RN Prematuro y de Peso Bajo al Nacer" y "Estrategia de preguntas guía para visita domiciliaria" con el fin de promover narraciones abiertas de los cuidadores parentales sobre el cuidado del recién nacido de riesgo, creando así, un espacio relacional con miras a la construcción conjunta. Conclusión: Los documentos utilizados favorecieron la realización de las visitas domiciliarias, ayudando al enfermero a establecer un vínculo profesional y a construir un espacio relacional a través del diálogo en la conducción de sus actividades en el entorno domiciliario.

RESUMO Objetivo: Relatar os estruturantes da experiência de visitação domiciliar realizada por enfermeiros aos recém-nascidos prematuros e de baixo peso. Método: Trata-se de estudo descritivo do tipo relato de experiência, estruturado na vivência das enfermeiras autoras no desenvolvimento de 48 visitas domiciliares, em cidade do interior paulista e sua microrregião, entre agosto de 2020 e de 2021, com oito mães de recém-nascidos prematuros e de baixo peso. Resultados: Foram criados e utilizados os documentos orientadores "Visita domiciliar para famílias com RN Prematuro e de Baixo Peso ao Nascer" e "Estratégia de perguntas norteadoras para visita domiciliar" para promover narrativas abertas dos cuidadores parentais sobre o cuidado com o recém-nascido de risco, criando um espaço relacional direcionado à construção conjunta. Conclusão: Os documentos utilizados favoreceram a condução das visitas domiciliares, auxiliando o enfermeiro a estabelecer vínculo profissional e construir espaço relacional através do diálogo na condução de suas atividades em ambiente domiciliar.

Right ventricular myocardial performance index (Tei) in premature infants

SUMMARY OBJECTIVE: The objective of this study was to evaluate the right ventricular myocardial performance index) based on echocardiography in very low birth weight premature neonates, close to hospital discharge. METHODS: This was a prospective cross-sectional study that included premature neonates with birth weight <1,500 g and gestational age <37 weeks at the Intermediate Neonatal Unit of Bonsucesso Federal Hospital from July 2005 to July 2006. The infants underwent two-dimensional color Doppler echocardiography, being the right ventricular myocardial performance index evaluated close to hospital discharge. We compared the neonatal and echocardiographic variables in neonates with and without bronchopulmonary dysplasia. RESULTS: A total of 81 exams were analyzed. The mean birth (standard deviation) weight and gestational age were 1,140 (235) g and 30 (2.2) weeks, respectively. The incidence of bronchopulmonary dysplasia was 32%. The mean right ventricle myocardial performance index (standard deviation) of the sample was 0.13 (0.06). We found a significant difference in aortic diameter [non-bronchopulmonary dysplasia 0.79 (0.07) vs. bronchopulmonary dysplasia 0.87 (0.11) cm, p=0.003], left ventricle in diastole [non-bronchopulmonary dysplasia 1.4 (0.19) vs. bronchopulmonary dysplasia 1.59 (0.21) cm, p=0.0006], ventricular septal thickness [non-bronchopulmonary dysplasia 0.23 (0.03) vs. bronchopulmonary dysplasia 0.26 (0.05) cm, p=0.032], and "a" measurement [(= sum of the isovolumetric contraction time, ejection time, and isovolumetric relaxation time) when calculating the myocardial performance index (p=0.01)]. CONCLUSION: Higher "a" interval in neonates with bronchopulmonary dysplasia suggests right ventricle diastolic dysfunction. We conclude that the right ventricle myocardial performance index is an important indicator both of ventricular function and for serial follow-up testing of very low birth weight premature neonates, especially those with bronchopulmonary dysplasia.

Características do contato pele a pele em unidades neonatais brasileiras: estudo multicêntrico / Características del contacto piel con piel en unidades neonatales brasileñas: estudio multicéntrico / Characteristics of skin-to-skin contact in Brazilian neonatal units: a multicenter study

Resumo Objetivo Descrever o início, duração, local e quem realiza o contato pele a pele em unidades neonatais brasileiras. Métodos Estudo multicêntrico descritivo, longitudinal, realizado de maio de 2018 a março de 2020, em cinco unidades neonatais referência para o Método Canguru no Brasil, que incluiu recém-nascidos com peso até 1800g. As características maternas e dos recém-nascidos foram coletadas em prontuários e entrevistas. A prática do contato pele a pele era registrada em cartões anexados ao leito, preenchidos pela equipe e pelos pais. A análise ocorreu por meio de estatística descritiva. Resultados Foram incluídos 405 recém-nascidos, 51,4% do sexo masculino, mediana de idade gestacional de 31,4 semanas e de peso ao nascimento de 1.412g. Em relação ao tempo de realização do contato pele a pele, a mediana da frequência do contato diário foi de 1,5 vezes (IIQ: 1,2 - 2,4), o tempo/dia de 147 min/dia (IIQ: 106,7 - 263,0) e a realização do primeiro contato aos cinco dias de vida (IIQ:4,0-8,0). O maior tempo de contato/dia foi realizado pelas mães, com mediana de 137,8 min/dia (IIQ:95,6-232,1) e a segunda etapa do Método Canguru, Unidade de Cuidados Intermediários Canguru, foi o local onde se realizou por maior tempo o contato, com mediana de 184,4 min/dia (IIQ:124,7-455,4). Conclusão Nas unidades avaliadas, o contato pele a pele é praticado de forma intermitente, poucas vezes por dia, predominantemente pelas mães e com maior tempo de exposição na segunda etapa. É necessário buscar meios que possibilitem mais encontros entre mãe/pai-filho e que dê condições de maior permanência dos genitores no hospital.

Resumen Objetivo Describir el inicio, duración, lugar y quién realiza el contacto piel con piel en unidades neonatales brasileñas. Métodos Estudio multicéntrico descriptivo, longitudinal, realizado de mayo de 2018 a marzo de 2020, en cinco unidades neonatales de referencia del Método Canguro en Brasil, que incluyó recién nacidos de hasta 1800 g de peso. Las características maternas y de los recién nacidos fueron recopiladas en historias clínicas y entrevistas. La práctica del contacto piel con piel fue registrada en tarjetas anexadas a la cama, completadas por el equipo y por los padres. El análisis se realizó mediante estadística descriptiva. Resultados Se incluyeron 405 recién nacidos, 51,4 % de sexo masculino, mediana de 31,4 semanas de edad gestacional y de 1412 g de peso al nacer. Con relación al tiempo de realización del contacto piel con piel, la mediana de la frecuencia del contacto diario fue 1,5 veces (IIQ: 1,2 - 2,4), el tiempo/día fue de 147 min/día (IIQ: 106,7 - 263,0) y la realización del primer contacto a los cinco días de vida (IIQ:4,0-8,0). El mayor tiempo de contacto/día fue realizado por las madres, con una mediana de 137,8 min/día (IIQ:95,6-232,1) y la segunda etapa del Método Canguro, la Unidad de Cuidados Intermedios Canguro, fue el lugar donde se realizó el contacto por mayor tiempo, con una mediana de 184,4 min/día (IIQ:124,7-455,4). Conclusión En las unidades analizadas, el contacto piel con piel se practica de forma intermitente, pocas veces por día, predominantemente por las madres y con mayor tiempo de exposición en la segunda etapa. Es necesario buscar medios que permitan más encuentros entre madre/padre-hijo y que ofrezcan condiciones de mayor permanencia de los progenitores en el hospital.

Abstract Objective To describe the beginning, duration, location and who makes skin-to-skin contact in Brazilian neonatal units. Methods This is a descriptive, longitudinal multicenter study, carried out from May 2018 to March 2020, in five reference neonatal units for Kangaroo Mother Care in Brazil, which included newborns weighing up to 1,800 grams. Maternal and newborn characteristics were collected from medical records and interviews. Skin-to-skin contact was recorded on cards attached to the bed, filled in by the team and fathers. Analysis occurred through descriptive statistics. Results We included 405 newborns, 51.4% male, median gestational age of 31.4 weeks and birth weight of 1,412 grams. Regarding skin-to-skin contact time, the median daily contact frequency was 1.5 times (IQR: 1.2 - 2.4), the time/day was 147 min/day (IQR: 106.7 - 263.0) and the first contact at five days of life (IQR:4.0-8.0). The longest contact time/day was performed by mothers, with a median of 137.8 minutes per day (IQR:95.6-232.1), and the second stage of kangaroo Mother Care, kangaroo Intermediate Care Unit, was the place where contact was performed for the longest time, with a median of 184.4 minutes per day (IQR:124.7-455.4). Conclusion In the units assessed, skin-to-skin contact is practiced intermittently, a few times a day, predominantly by mothers and with longer exposure time in the second stage. It is necessary to seek ways that allow more encounters between mother/father-child and that gives conditions of greater permanence of fathers in the hospital.

Management of congenital diaphragmatic hernia in preterm and low birth weight infants / 中华围产医学杂志

Objective:To investigate the treatment of preterm and low birth weight infants with congenital diaphragmatic hernia (CDH) and to share the experience.Methods:This retrospective study enrolled 117 newborns with CDH who underwent major surgery at Children's Hospital, Capital Institute of Pediatrics from May 1, 2011, to March 31, 2022. Based on gestational age and birth weight, the infants were divided into the preterm and/or low birth weight group (gestational age < 37 weeks and/or birth weight less than 2 500 g, n=41) and the control group (gestational age ≥ 37 weeks and birth weight ≥ 2 500 g, n=76). Furthermore, the preterm and/or low birth weight infants were divided into the thoracoscopic surgery subgroup ( n=31) and the open surgery subgroup ( n=10) according to the surgical approach. Statistical analysis of the data was performed using two independent sample t-tests, rank sum tests, Chi-square test, or Fisher's exact probability test. Results:Preoperative data showed that the Apgar scores at 1 min [7.0 (6.0-8.0) vs 9.0 (8.0-9.8), Z=－4.03] and 5 min [9.0 (8.0-10.0) vs 9.0 (9.0-10.0), Z=－2.13] of the preterm and/or low birth weight infants were both lower than those in the control group (both P<0.05), while the proportion of infants with moderate to severe pulmonary hypertension was higher [68.3% (28/41) vs 38.2% (29/76), χ 2=9.68, P<0.05]. There were no statistically significant differences between the two groups in terms of the proportion of thoracoscopic surgery, operation time, right diaphragmatic hernia, presence of hernia sac, grading of the defect, presence of liver herniation, and application of mesh (all P>0.05). Regarding the postoperative outcomes, the death rate in the preterm and/or low birth weiht group was higher compared to the control group [36.6% (15/41) vs 13.2% (10/76), χ 2=8.70, P<0.05]. Additionally, the time required to resume full enteral nutrition after surgery was longer in the preterm and/or low birth weight group than that in the control group [25 d (18-29 d) vs 16 d (10-25 d), Z=2.31, P<0.05]. The thoracoscopic subgroup had a lower mortality compared to the open surgery subgroup [25.8% (8/31) vs 7/10, P<0.05]. The thoracoscopic surgery subgroup had a higher Apgar score at 1 min after birth [(7.4±1.6) vs (6.0±2.2), t=2.20, P<0.05], later age at operation (hours after birth) [31.0 h (23.0-48.0 h) vs 17.0 h (4.7-24.5 h), Z=2.57, P<0.05], a lower proportion of infants operated within 24 hours after birth [32.3% (10/31) vs 8/10, P<0.05], and longer duration of operation [170.0 min (122.0-200.0 min) vs 110.0 min (87.3-120.0 min), Z=3.65, P<0.05]. Conclusions:In this study, a higher mortality in the preterm and/or low birth weight group compared to the control group was observed, which may be attributed to the higher proportion of neonates with moderate-severe pulmonary hypertension. The thoracoscopic diaphragmatic repair can be attempted for preterm and low birth weight infants who have relatively stable respiratory and circulatory functions.

Clinical practice guideline for kangaroo mother care in preterm and low birth weight infants.

Kangaroo mother care has reduced mortality and morbidity in preterm and low birth weight infants and has many benefits, such as promoting breastfeeding. Based on the current evidence in China and international, we developed a clinical practice guideline for kangaroo mother care in preterm and low birth weight infants using the Grading of Recommendations, Assessment, Development and Evaluation and proposed 34 recommendations for 20 key questions. Our goal is to promote the appropriate implementation of kangaroo mother care in clinical practice.

Variables maternas relacionadas con la condición trófica al nacer / Maternal variables related to the trophic condition at birth

RESUMEN Introducción: El crecimiento y desarrollo prenatal tiene su expresión en el peso al nacer, que adquiere gran importancia por su relación con la morbilidad y mortalidad en cualquier etapa de la vida. Objetivo: Identificar las asociaciones de variables maternas con la condición trófica del recién nacido. Métodos: Se realizó un estudio descriptivo, en tres áreas de salud del municipio Santa Clara, en el periodo comprendido de enero 2013 a diciembre 2020. De una población de 6035 recién nacidos se seleccionó una muestra aleatoria de 2454. De los libros de genética se obtuvo la información de variables maternas y del neonato. Se aplicaron las pruebas no paramétricas de independencia basada en la distribución chi cuadrado y Kruskal Wallis en el análisis estadístico. Resultados: A excepción de la edad, las variables estudiadas mostraron relación con la condición trófica al nacer. El estado nutricional deficiente fue más frecuente en nacimientos pequeños y el obeso en los grandes. En nacimientos grandes se observó mayores porcentajes de gestantes con riesgo de diabetes gestacional. Los trastornos hipertensivos, la anemia, la infección del tracto urinario, la sepsis vaginal y el hábito de fumar se presentaron en mayores porcentajes en gestantes cuyos recién nacidos fueron pequeños. Conclusiones: De las variables estudiadas el riesgo de diabetes gestacional y los trastornos hipertensivos mostraron la mayor fuerza de asociación con la condición trófica al nacer.

ABSTRACT Introduction: prenatal growth and development have their expression in birth weight, which acquires great importance due to its relationship with morbidity and mortality at any stage of life. Objective: to identify the associations of maternal variables with the trophic condition of the newborn. Methods: a descriptive study was carried out in three health areas from Santa Clara municipality between January 2013 and December 2020. A random sample of 2,454 was selected from a population of 6,035 newborns. Information on maternal and newborn variables was obtained. Non-parametric tests of independence based on the Chi-square distribution and Kruskal Wallis were applied in the statistical analysis. Results: the variables studied showed a relationship with the trophic condition at birth, except for age. Poor nutritional status was more frequent in small births and obesity in large ones. In large births, higher percentages of pregnant women at risk of gestational diabetes were observed. Hypertensive disorders, anemia, urinary tract infection, vaginal sepsis and smoking were present in higher percentages in pregnant women whose newborns were small. Conclusions: from the studied variables, the risk of gestational diabetes and hypertensive disorders showed the strongest association with the trophic status at birth.

Adverse pregnancy and perinatal outcomes in Latin America and the Caribbean: systematic review and meta-analysis.

Objective: To estimate the point prevalence and likely ranges of pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, low birth weight and preterm delivery in Latin America and the Caribbean, and evaluate the heterogeneity of the estimates. Methods: We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of maternal and perinatal adverse outcomes in populations in Latin American and the Caribbean published between 2000 and 2019 in English, Spanish, or Portuguese. We searched PubMed, Embase, and LILACS. We estimated the point prevalence and evaluated overall heterogeneity and, in sub-group analyses, heterogeneity by study design and level of bias. Results: Of 1087 records retrieved, 50 articles were included in the review: two on hypertensive disorders of pregnancy, 14 on pre-eclampsia, six on gestational diabetes, nine on low birth weight and 19 on preterm birth. No meta-analysis for hypertensive disorders of pregnancy could be done because of the small number of studies. Point prevalence estimates and 95% confidence intervals (CIs) for pre-eclampsia, gestational diabetes, low birth weight, and preterm birth were: 6.6% (95% CI: 4.9%, 8.6%), 8.5% (95% CI: 3.9%, 14.7%), 8.5% (95% CI: 7.2%, 9.8%), and 10.0% (95% CI: 8.0%, 12.0%), respectively. We observed substantial heterogeneity overall and by study design. No major differences in estimates were observed by level of bias. Conclusions: The results of this study provide updated estimates of some of the most prevalent adverse pregnancy and perinatal outcomes in Latin America and the Caribbean. They highlight that important heterogeneity exists in prevalence estimates, which may reflect the diversity of populations in the region.

Fast-track referral for health interventions during pregnancy: study protocol of a randomised pragmatic experimental study to reduce low birth weight in Portugal (STOP LBW).

INTRODUCTION: Low birth weight (LBW) is associated with a wide range of short-term and long-term consequences and is related to maternal psychosocial and behavioural determinants. The objective of this study is to estimate the effect of implementing fast-track referral for early intervention on psychosocial and behavioural risk factors-smoking, alcohol consumption, depression and physical violence-in reducing the incidence of LBW. METHODS AND ANALYSIS: Parallel superiority pragmatic clinical trial randomised by clusters. Primary healthcare units (PHCU) located in Portugal will be randomised (1:1) to intervention or control groups. Pregnant women over 18 years of age attending these PHCU will be eligible to the study. Risk factors will be assessed through face-to-face interviews. In the intervention group, women who report at least one risk factor will have immediate access to referral services. The comparison group will be the local standard of care for these risk factors. We will use intention-to-treat analyses to compare intervention and control groups. We estimated a sample size of 2832 pregnant women to detect a 30% reduction in the incidence rate of LBW between the control and intervention groups. Secondary outcomes are the reduction of preterm births, reduction of the four risk factors and acceptance of the intervention. ETHICS AND DISSEMINATION: The study was approved by the Ethics Committee of the Public Health Institute of the University of Porto (no CE20140). The findings will be disseminated to the public, the funders, health professionals, health managers and other researchers. TRIAL REGISTRATION NUMBER: NCT04866277.