Prevalence of abdominal obesity in adolescents: a systematic review.

The objectives of this study were to (i) review extant literature on the prevalence of abdominal obesity (AO) in adolescents of both sex (10-19 years old); (ii) analyse the cut-off points used for the diagnosis of AO and (iii) compare its prevalence between developed and developing countries. The search was carried out using online databases (MEDLINE, Web of Science, EMBASE, SPORTDiscus, SCIELO and BioMed Central), references cited by retrieved articles and by contact with the authors, considering articles published from the establishment of the databanks until 19 October 2009. Only original articles and those using waist circumference in the diagnosis were considered. Twenty-nine studies met the inclusion criteria. Fourteen of these studies were performed in developed countries. The prevalence of AO varied from 3.8% to 51.7% in adolescents from developing countries. The range of results was smaller among developed countries; with values from 8.7% to 33.2%. Eighteen different cut-off points were used. It was concluded the AO prevalence is high among adolescents, but is not clear what sex has a higher proportion and it is greater in adolescents from developing countries; however, there is no consensus in the literature about the criteria to be used.

Body mass index values for newborns according to gestational age / Valores de Índice de Masa Corporal en recién nacidos de acuerdo con la edad gestacional

Objective: The combination of twho anthropometric parameters has been more appropriate to assess body composition and proportions in children, with special attention to the Body Mass Index (BMI), as it relates weight and length. However the BMI values for the neonatal period have not been determined yet. This study shows the BMI for newborns at different gestational ages represented in a normal smoothed percentile curve. Methods: Retrospective study including 2,406 appropriate for gestational age newborns following the Alexander et al curve (1996) from 29 to 42 weeks of gestational age. Weight and lenght were measured following standard procedures. For the construction aof a normal smoothed percentile curve, the 3rd, 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were determined and a statistical procedure based on the mathematical model "sinosuoidal fit" was applied to establish a curve that estimates biological growth parameters. Results: The Body Mass Index values for gestational age in all percentiles shows a steady increase up to 38 weeks, levels off up to the 40th week, followed by a slight decrease to the 42nd week in both genders. Conclusion: The results show a direct correlation between gestational age and Body Mass Index for both genders in the nine percentiles, and can provide a useful reference to assess intra-uterine proportional growth (AU)

Objetivo: La combinación de dos parámetros antropométricos ha sido descrita como una manera más apropiada para determinar la composición y proporciones del cuerpo en niños, con especial atención para el índice de masa corporal (IMC), pues relaciona el peso y la estatura. Sin embargo, los valores del IMC para el periodo neonatal no han sido determinados todavía. Este estudio muestra el IMC para recién nacidos de diversas edades gestacionales presentados en una curva de percentiles suavizados. Métodos: En un estudio retrospectivo incluyendo 2.406 recién nacidos apropiados para la edad gestacional según la curva de Alexander y cols. (1996), entre 29 y 42 semanas de edad gestacional. El peso y la estatura fueron medidos según los procedimientos estándares. Para la construcción de la referida curva fueron determinados los siguientes percentiles: 3, 5, 10, 25, 50, 75, 90 y 95. El modelo matemático de ajuste sinusoidal fue aplicado para establecer una curva que estimase los parámetros biológicos del crecimiento. Resultados: Los valores del IMC para las edades gestacionales en todos los percentiles demostraron aumento constante hasta 38 semanas, estabilización hasta 40 semanas, seguida por una leve disminución hasta 42 semanas en ambos los sexos. Conclusión: Los resultados demuestran una correlación directa entre la edad gestacional y el IMC para ambos sexos en todos los percentiles estudiados, y pueden proporcionar una herramienta útil para determinar un crecimiento intrauterino proporcional (AU)

Body mass index values for newborns according to gestational age.

OBJECTIVE: The combination of twho anthropometric parameters has been more appropriate to assess body composition and proportions in children, with special attention to the Body Mass Index (BMI), as it relates weight and length. However the BMI values for the neonatal period have not been determined yet. This study shows the BMI for newborns at different gestational ages represented in a normal smoothed percentile curve. METHODS: Retrospective study including 2,406 appropriate for gestational age newborns following the Alexander et al curve (1996) from 29 to 42 weeks of gestational age. Weight and lenght were measured following standard procedures. For the construction a of a normal smoothed percentile curve, the 3rd, 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were determined and a statistical procedure based on the mathematical model "sinosuoidal fit" was applied to establish a curve that estimates biological growth parameters. RESULTS: The Body Mass Index values for gestational age in all percentiles shows a steady increase up to 38 weeks, levels off up to the 40th week, followed by a slight decrease to the 42nd week in both genders. CONCLUSION: The results show a direct correlation between gestational age and Body Mass Index for both genders in the nine percentiles, and can provide a useful reference to assess intra-uterine proportional growth.

Urinary tract infection in full-term newborn infants: risk factor analysis.

OBJECTIVE: To analyze the correlation of risk factors to the occurrence of urinary tract infection in full-term newborn infants. PATIENTS AND METHODS: Retrospective study (1997) including full-term infants having a positive urine culture by bag specimen. Urine collection was based on: fever, weight loss > 10% of birth weight, nonspecific symptoms (feeding intolerance, failure to thrive, hypoactivity, debilitate suction, irritability), or renal and urinary tract malformations. In these cases, another urine culture by suprapubic bladder aspiration was collected to confirm the diagnosis. To compare and validate the risk factors in each group, the selected cases were divided into two groups: Group I - positive urine culture by bag specimen collection and negative urine culture by suprapubic aspiration, and Group II - positive urine culture by bag specimen collection and positive urine culture by suprapubic aspiration. RESULTS: Sixty one infants were studied, Group I, n = 42 (68.9%) and Group II, n = 19 (31.1%). The selected risk factors (associated infectious diseases, use of broad-spectrum antibiotics, renal and urinary tract malformations, mechanical ventilation, parenteral nutrition and intravascular catheter) were more frequent in Group II (p<0.05). Through relative risk analysis, risk factors were, in decreasing importance: parenteral nutrition, intravascular catheter, associated infectious diseases, use of broad-spectrum antibiotics, mechanical ventilation, and renal and urinary tract malformations. CONCLUSION: The results showed that parenteral nutrition, intravascular catheter, and associated infectious diseases contributed to increase the frequency of neonatal urinary tract infection, and in the presence of more than one risk factor, the occurrence of urinary tract infection rose up to 11 times.

[Basis of nutritional support in pediatrics] / Princípios do suporte nutricional em pediatria.

OBJECTIVE: To present an update and systematic review of the basis of nutritional support in pediatrics, emphasizing the importance of nutrition in critically ill patient. METHODS: Relevant studies were selected from databases (Medline, Scielo, Lilacs, etc.). Textbooks and theses were analyzed, and the authors personal experience was also considered. RESULTS: Nutritional therapy is part of the treatment. In order to reach the objective, it is important to determine specific nutritional requirements of water, calories, proteins, macro and micronutrients. So, nutritional evaluation should consist of clinical, anthropometric, and laboratory assessment, so that the best nutritional therapy (parenteral and/or enteral) is chosen. Patient monitoring is also indicated in order to prevent complications. CONCLUSION: Nutritional therapy is essential for the treatment. When well indicated and well monitored, it helps in the patient s recovery, and in the decrease of morbidity and mortality.

Prediction of hyperglycemia in preterm newborn infants.

Many conditions are associated with hyperglycemia in preterm neonates because they are very susceptible to changes in carbohydrate homeostasis. The purpose of this study was to evaluate the occurrence of hyperglycemia in preterm infants undergoing glucose infusion during the first week of life, and to enumerate the main variables predictive of hyperglycemia. This prospective study (during 1994) included 40 preterm neonates (gestational age < 37 weeks); 511 determinations of glycemic status were made in these infants (average 12.8/infant), classified by gestational age, birth weight, glucose infusion rate and clinical status at the time of determination (based on clinical and laboratory parameters). The clinical status was classified as stable or unstable, as an indication of the stability or instability of the mechanisms governing glucose homeostasis at the time of determination of blood glucose; 59 episodes of hyperglycemia (11.5%) were identified. A case-control study was used (case = hyperglycemia; control = normoglycemia) to derive a model for predicting glycemia. The risk factors considered were gestational age (< or = 31 vs. > 31 weeks), birth weight (< or = 1500 vs. > 1500 g), glucose infusion rate (< or = 6 vs. > 6 mg/kg/min) and clinical status (stable vs. unstable). Multivariate analysis by logistic regression gave the following mathematical model for predicting the probability of hyperglycemia: 1/exp{-3.1437 + 0.5819(GA) + 0.9234(GIR) + 1.0978 (Clinical status)}The main predictive variables in our study, in increasing order of importance, were gestational age, glucose infusion rate and, the clinical status (stable or unstable) of the preterm newborn infant. The probability of hyperglycemia ranged from 4.1% to 36.9%.

Is glycosuria a reliable indicator of adequacy of glucose infusion rate in preterm infants?

CONTEXT: Adequacy of glucose infusion may be monitored via the glycosuria levels, as there is a relationship between glycemia and glycosuria regulated by the renal glucose threshold. In the neonatal period, however, this relationship is not so clear. OBJECTIVE: To evaluate the occurrence of glycosuria in preferm infants submitted to glucose infusion and to verify the relationship between glycosuria and blood glucose level. DESIGN: Accuracy study. SETTING: Neonatal intensive care unit of General Maternity Hospital. PATIENTS: 40 Preterm newborns receiving glucose infusion. PROCEDURES: 511 concomitant determinations of glycemia and glycosuria were performed. These 511 pairs were divided into stable and unstable, according to the clinical status of the newborn at the time of data collection, and they were studied in relation to the gestational age, birth weight and glucose infusion rate. RESULTS: The results revealed a greater frequency of glycosuria in gestational age < or = 30 weeks, birth weight < 1500 g and glucose infusion rate > 6 mg/kg/min. Eight (25.8%) episodes of positive glycosuria occurred in the absence of hyperglycemia, indicating only a moderate concordance between them. CONCLUSION: Glycosuria alone is an unreliable marker of blood glucose concentration and adequacy of glucose infusion rate. It is therefore necessary to monitor blood glucose levels in infants submitted to continuous glucose infusion.

Relationship between plasma creatinine concentration and glomerular filtration in preterm newborn infants.

Fluid management and dosage regimens of drugs in preterm infants should be based on the glomerular filtration rate. The current methods to determine glomerular filtration rate are invasive, time-consuming, and expensive. In contrast, creatinine clearance can be easy obtained and quickly determined. The purpose of this study was to compare plasma creatinine on the third and seventh day of life in preterm newborn infants, to evaluate the influence of maternal creatinine, and to demonstrate creatinine clearance can be used as a reliable indicator of glomerular filtration rate. We developed a prospective study (1994) including 40 preterm newborns (gestational age < 37 weeks), average = 34 weeks; birth weight (average) = 1840 g, in the first week of life. Inclusion criteria consisted of: absence of renal and urinary tract anomalies; O2 saturation >/= 92%; adequate urine output (>1ml/kg/hr); normal blood pressure; absence of infections and no sympathomimetic amines in use. A blood sample was collected to determine plasma creatinine (enzymatic method) on the third and seventh day of life and creatinine clearance (CrCl) was obtained using the following equation: [formula: see text], k = 0.33 in preterm infant All plasma creatinine determinations showed normal values [third day: 0.78 mg/dl +/- 0.24 (mean +/- SD)and seventh day: 0.67 mg/dl +/- 0.31 - (p>0.05)]. Also all creatinine clearance at third and seventh day of life were normal [third day: 19.5 ml/min +/- 5.2 (mean +/- SD) and seventh day: 23.8 ml/min +/- 7.3 - (p>0,05)]. All preterm infants developed adequate renal function for their respective gestational age. In summary, our results indicate that, for clinical practice, the creatinine clearance, using newborn length, can be used to estimate glomerular filtration rate in preterm newborn infants.

Urinary tract infection in full-term newborn infants: value of urine culture by bag specimen collection.

OBJECTIVE: To evaluate the efficacy of urine culture by bag specimen for the detection of neonatal urinary tract infection in full-term newborn infants. Retrospective study (1997) including full-term newborn infants having a positive urine culture (> 100,000 CFU/ml) by bag specimen collection. The urinary tract infection diagnosis was confirmed by positive urine culture (suprapubic bladder aspiration method). The select cases were divided into three groups, according to newborn infant age at the bag specimen collection: GI (< 48 h, n = 17), GII (48 h to 7 d, n = 35) and GIII (> 7 d, n = 9). Sixty one full-term newborn infants were studied (5.1% of total infants). The diagnosis was confirmed on 19/61 (31.1%) of full-term infants born alive. Distribution among the groups was: GI = 2/17 (11.8%), GII = 10/35 (28.6%), and GIII = 7/9 (77.7%). The most relevant clinical symptoms were: fever (GI--100%, GII--91.4%) and weight loss (GI--35.3%, GII--45.7%). Urine culture results for specimens collected by suprapubic aspiration were: E. coli GI (100%), GII (40%) and GIII (28.6%), E. faecalis GI (30%), Staphylococcus coagulase-negative GII (20%) and GIII (42.8%), and Staphylococcus aureus GII (10%). Correlation between positive urine culture collection (bag specimen method) and urinary tract infection diagnosis, using relative risk analysis, produced the following results: GI = 0.30 (CI 95% 0.08-1.15), GII = 0.51 (CI 95% 0.25-1.06) and GIII = 3.31 (CI 95% 1.8-6.06). The most frequent urinary tract infection clinical signs in the first week were fever and weight loss, while non-specific symptomatology occurred later. E. coli was most frequent infectious agent, although from the 7th day of life, staphylococcus was noted. The urine culture (bag specimen method) was effective in detecting urinary tract infection only after the 7th day of life.

[Early-onset neonatal sepsis and late-appearing diaphragmatic hernia]. / Sepse neonatal precoce e reconhecimento tardio de hérnia diafragmática.

The interesting association between delayed presentation of right-sided diaphragmatic hernia and neonatal Group B streptococcal infections occurs rarely and its pathogenesis is still obscure. Two preterm newborn infants with early onset of neonatal sepsis (one due to Group B Streptococcus) followed by recognition of right-sided diaphragmatic hernia on the 9th and 25th day of life are reported. In both cases the course of neonatal sepsis and pneumonia was complicated due to the appearance of right-sided pleural effusion and atelectasis. On serial chest roentgenograms right-sided bowel gas was noticed and the liver shadow became gradually elevated. Diagnosis was confirmed by ultrasonography and computed tomography. Suspicion of associated diaphragmatic hernia should be raised in neonatal streptococcal infection whenever subsequent progressive respiratory deterioration ensues, requiring mechanical ventilation after initial clinical improvement or in the presence of right-sided pleural effusion.

[Hyperglycemia and glucosuria in preterm infants receiving parenteral glucose: influence of birth weight, gestational age and infusion rate] / Hiperglicemia e glicosúria em recém-nascidos pré-termo recebendo glicose parenteral: influência do peso, idade gestacional e velocidade de infusão.

OBJECTIVE: Morbidity and mortality of premature infants have decreased considerably over the last decades, therefore, adequate nutrition of the premature is a major concern. Enteral feeding is the route of choice, but when it is not possible the parenteral route, which contains glucose as one of its main components, is used. Glucose infusions are not devoid of risk as they facilitate the development of hyperglycemia leading to intracranial hemorrhage, glucosuria and dehydration. The aim of this paper is to relate hyperglycemia and glucosuria to birth weight, gestational age and glucose infusion rate.METHODS: The study was developed at the Nursery of Santa Catarina Hospital (São Paulo). The authors developed a prospective study; 511 concurrent determinations of glycemia and qualitative glucosuria were performed in 40 preterm newborn infants receiving parenteral glucose (mean of 12.8 dosages per newborn).RESULTS: Fifty-nine (11.5%) episodes of hyperglycemia were detected, and their frequency was higher at lower gestational ages (/= 6 mg/kg/min). Thirty-one (6.1%) episodes of glucosuria were detected, and were more frequent in lower gestational ages (/= 6 mg/kg/min).CONCLUSIONS: The frequency of hyperglycemia and glucosuria in preterm newborn infants receiving glucose infusion was higher in lower gestational ages, lower birth weights and higher glucose infusion rates. In preterm newborn infants it is necessary to observe the glucose infusion rate and its respective glycemia, in order to avoid the complications of hyperglycemia.

[Biochemical glucose test x glucose strip test: results of 464 determinations in pre-term infants]. / Glicemia capilar x fitas reagentes: resultado de 464 determinações em recém-nascidos pré-termo.

The preterm infant frequently requires glucose level monitorization. This paper compared determinations of blood glucose by two methods: glucose strip test and biochemistry. There was determined 464 pairs of glucose levels by both methods in 40 preterm infants receiving glucose infusion. The hypoglycemia interval showed that the precision of strips was lower than the biochemical method. The same was found in hyperglycemia interval, but the result was a few better. Concluding, the authors emphasize the use of glucose strip test only for screening and the biochemical test for treatment.

PCR in the first oropharynx aspirate of the newborn: a possible source for identification of congenital infection agents.

We present a case of prenatal diagnosis of congenital rubella. After birth, in addition to traditional serologic and clinical examinations to confirm the infection, we could identify the virus in the "first fluid aspirated from the oropharynx of the newborn", using polimerase chain reaction (PCR). We propose that this first oropharynx fluid (collected routinely immediately after birth) could be used as a source for identification of various congenital infection agents, which may not always be easily identified by current methods.