Recomendaciones para la evaluación del tamaño al nacer y del crecimiento posnatal de los recién nacidos prematuros / Recommendations for the assessment of birth size and postnatal growth of preterm newborns

Es innegable la necesidad de contar con curvas estándar de tamaño al nacer y crecimiento para evaluar y contribuir a orientar las acciones en la atención del neonato. Durante muchos años, se utilizaron las referencias de Lejarraga y Fustiñana, que fueron progresivamente reemplazadas por las de Fenton y Kim.Recientemente, el proyecto INTERGROWTH-21st construyó estándares de crecimiento prescriptivo para evaluar el tamaño al nacer desde las 33 semanas de edad gestacional, referencias para evaluar el tamaño al nacer desde las 24 a las 32,6 semanas de edad gestacional y curvas para el seguimiento longitudinal del crecimiento de recién nacidos pretérmino desde las 27 semanas de edad gestacional. Los Comités de Crecimiento y Desarrollo y de Estudios Feto-neonatales de la Sociedad Argentina de Pediatría, en conjunto con la Secretaría de Gobierno de Salud de la Nación, acordaron recomendar el reemplazo de las curvas de Fenton y Kim por las de INTERGROWTH-21st

It is unquestionable the need to have standards of size at birth and growth to evaluate and contribute to guide the actions in the care of the newborn. For many years the references of Lejarraga and Fustiñana were used, progressively replaced by those of Fenton and Kim. However, recently, the INTERGROWTH-21st project has developed prescriptive growth standards to evaluate the size at birth from 33 weeks of gestational age, references from 24 to 32.6 weeks of gestational age, and curves for postnatal growth from 27 weeks of gestational age onward. The Growth and Development and Neonatal Fetal Studies Committees of the Argentine Society of Pediatrics in conjunction with the Secretary of National Government of Health agreed to recommend the replacement of the Fenton and Kim curves with those of INTERGROWTH-21st.

[Recommendations for the assessment of birth size and postnatal growth of preterm newborns]. / Recomendaciones para la evaluación del tamaño al nacer y del crecimiento posnatal de los recién nacidos prematuros.

It is unquestionable the need to have standards of size at birth and growth to evaluate and contribute to guide the actions in the care of the newborn. For many years the references of Lejarraga and Fustiñana were used, progressively replaced by those of Fenton and Kim. However, recently, the INTERGROWTH-21st project has developed prescriptive growth standards to evaluate the size at birth from 33 weeks of gestational age, references from 24 to 32.6 weeks of gestational age, and curves for postnatal growth from 27 weeks of gestational age onward. The Growth and Development and Neonatal Fetal Studies Committees of the Argentine Society of Pediatrics in conjunction with the Secretary of National Government of Health agreed to recommend the replacement of the Fenton and Kim curves with those of INTERGROWTH-21st.

Es innegable la necesidad de contar con curvas estándar de tamaño al nacer y crecimiento para evaluar y contribuir a orientar las acciones en la atención del neonato. Durante muchos años, se utilizaron las referencias de Lejarraga y Fustiñana, que fueron progresivamente reemplazadas por las de Fenton y Kim. Recientemente, el proyecto INTERGROWTH-21st construyó estándares de crecimiento prescriptivo para evaluar el tamaño al nacer desde las 33 semanas de edad gestacional, referencias para evaluar el tamaño al nacer desde las 24 a las 32,6 semanas de edad gestacional y curvas para el seguimiento longitudinal del crecimiento de recién nacidos pretérmino desde las 27 semanas de edad gestacional. Los Comités de Crecimiento y Desarrollo y de Estudios Feto-neonatales de la Sociedad Argentina de Pediatría, en conjunto con la Secretaría de Gobierno de Salud de la Nación, acordaron recomendar el reemplazo de las curvas de Fenton y Kim por las de INTERGROWTH-21st.

Fatigue during Chest Compression Using a Neonatal Patient Simulator.

OBJECTIVE: The objective of this study was to evaluate chest compression (CC) quality and operator fatigue during CC, with coordinated ventilation, on a neonatal simulator and to explore its association with provider aerobic activity and body mass index. METHODS: This was a prospective observational experimental study on pediatricians, neonatologists, and neonatal nurses who frequently deliver newborns and who have signed the informed consent. Subjects performed CC coordinated with ventilations at a ratio of 3:1 for 10 minutes on a neonatal mannequin. Proxy of fatigue was defined as four consecutive CC below target. RESULTS: Forty subjects participated; 62% were women. Twenty one (52%) evidenced weariness, as they performed. No gender-based differences were found in weariness. No subject abandoned the procedure due to fatigue. Subjects who participated in aerobic exercise had a significantly better performance than those who did not participate. Early fatigue was significantly associated with higher BMI. The reduction in effectiveness occurred at a mean time of 7.7 minutes (range 3.5-9 minutes). CONCLUSION: CC performance quality decreased and fatigue was frequent before 10 minutes had elapsed on a neonatal simulator. Provider fatigue was associated with both lack of aerobic activity and BMI ≥ 25. Our findings support the need for guidelines requiring frequent rotation of CC providers during prolonged neonatal resuscitation.

Evaluación de la mortalidad neonatal en la Ciudad Autónoma de Buenos Aires según la residencia de la población y la pertenencia al subsistema de salud / Evaluation of neonatal mortality in Buenos Aires City by place of residence and use of a health system subsector

La mortalidad neonatal es el componente más importante de la mortalidad infantil. Su análisis es complejo y no depende exclusivamente del sistema sanitario. En la Ciudad Autónoma de Buenos Aires (CABA), entre 2000 y 2012, la mortalidad neonatal fue inferior a la media nacional, pero no registró cambios. Además, la diferencia es cada vez menor: en el año 2000, era un 46% inferior; en 2012, se redujo a un 21%. Objetivo: Evaluar la asociación entre el lugar de residencia de la madre, el subsector de salud al cual pertenece y la tasa de mortalidad en los menores de 28 días de vida en la CABA. Métodos: Estudio poblacional, transversal, durante los años 2011 y 2012, sobre datos del Registro Civil y de la Dirección de Estadísticas y Censos de la CABA. Resultados: Se registraron 164 837 nacimientos. La proporción de nacimientos en establecimientos públicos y privados permanece estable; este último subsector presenta el 57% de los nacimientos. Los recién nacidos presentan similar proporción de género, peso y edad gestacional promedio en ambos subsistemas. Hubo mayor mortalidad neonatal para madres no residentes de la CABA (6,55%o vs. 5,42%o; OR 1,21; IC 95%: 1,07-1,37; p 0,0039). Para madres residentes en la CABA, hubo mayor mortalidad neonatal en el subsistema de salud público (7,8% vs. 4,4%; OR 1,77; IC 95%: 1,48-2,11; p < 0,001). Conclusión: La CABA, único caso en el país, tiene un componente de nacimientos y defunciones extrajurisdiccionales muy importante, fundamentalmente del conurbano bonaerense, que no se refleja en las estadísticas oficiales que solo toman en cuenta el lugar de residencia de los padres.

Neonatal mortality is the most important component of infant mortality. Analyzing neonatal mortality is complex and does not depend exclusively on the health system. In Buenos Aires City (CABA), between 2000 and 2012, neonatal mortality rate was lower than the national mean rate but no changes were recorded. Besides, the difference is narrowing: in 2000, it was 46% lower but in 2012, it was 21% lower. Objective: To assess the relationship among the place of maternal residence, the use of a health system subsector, and mortality rate among newborn infants younger than 28 days old in CABA. Methods: Cross-sectional, population-based study conducted in 2011 and 2012 using data from the Office of Vital Records and the Department of Statistics and Surveys of CABA. Results: A total of 164 837 births were recorded. The ratio of births in public and private facilities has remained stable; the private subsector accounts for 57% ofbirths. The ratiobetweenbothsubsectors was also similar in terms of gender, birthweight, and average gestational age. Neonatal mortalitywas higher among mothers who lived outside CABA (6.55%o versus 5.42%, odds ratio: 1.21, 95% confidence interval: 1.07-1.37, p 0.0039). Among mothers living in CABA, neonatal mortality was higher in the public health subsector (7.8% versus 4.4%, odds ratio: 1.77, 95% confidence interval: 1.48-2.11, p < 0.001). Conclusion: Unlike any other district in Argentina, CABA has a very high rate of births and deaths from other jurisdictions, especially from Greater Buenos Aires, which is not reflected in official statistics that only consider the place of parental residence.

Evaluation of neonatal mortality in Buenos Aires City by place of residence and use of a health system subsector. / Evaluación de la mortalidad neonatal en la Ciudad Autónoma de Buenos Aires según la residencia de la población y la pertenencia al subsistema de salud.

INTRODUCTION: Neonatal mortality is the most important component of infant mortality. Analyzing neonatal mortality is complex and does not depend exclusively on the health system. In Buenos Aires City (CABA), between2000 and 2012, neonatal mortality rate was lower than the national mean rate but no changes were recorded. Besides, the difference is narrowing: in 2000, it was 46% lower but in 2012, it was 21% lower. OBJECTIVE: To assess the relationship among the place of maternal residence, the use of a health system subsector, and mortality rate among newborn infants younger than 28 days old in CABA. METHODS: Cross-sectional, population-based study conducted in 2011 and 2012 using data from the Office of Vital Records and the Department of Statistics and Surveys of CABA. RESULTS: A total of 164 837 births were recorded. The ratio of births in public and private facilities has remained stable; the private subsector accounts for 57% ofbirths. The ratiobetweenbothsubsectors was also similar in terms of gender, birthweight, and average gestational age. Neonatal mortalitywas higher among mothers who lived outside CABA (6.55%o versus 5.42%, odds ratio: 1.21, 95% confidence interval: 1.07-1.37, p 0.0039). Among mothers living in CABA, neonatal mortality was higher in the public health subsector (7.8% versus 4.4%, odds ratio: 1.77, 95% confidence interval: 1.48-2.11, p < 0.001). CONCLUSION: Unlike any other district in Argentina, CABA has a very high rate of births and deaths from other jurisdictions, especially from Greater Buenos Aires, which is not reflected in official statistics that only consider the place of parental residence.

INTRODUCCIÓN: La mortalidad neonatal es el componente más importante de la mortalidad infantil. Su análisis es complejo y no depende exclusivamente del sistema sanitario. En la Ciudad Autónoma de Buenos Aires (CABA), entre2000 y 2012, la mortalidad neonatal fue inferior a la media nacional, pero no registró cambios. Además, la diferencia es cada vez menor: en el año 2000, era un 46% inferior; en 2012, se redujo a un 21%. OBJETIVO: Evaluar la asociación entre el lugar de residencia de la madre, el subsector de salud al cual pertenece y la tasa de mortalidad en los menores de 28 días de vida en la CABA. MÉTDODOS: Estudio poblacional, transversal, durante los años 2011 y 2012, sobre datos del Registro Civil y de la Dirección de Estadísticas y Censos de la CABA. RESULTADOS: Se registraron 164 837 nacimientos. La proporción de nacimientos en establecimientos públicos y privados permanece estable; este último subsector presenta el 57% de los nacimientos. Los recién nacidos presentan similar proporción de género, peso y edad gestacional promedio en ambos subsistemas. Hubo mayor mortalidad neonatal para madres no residentes de la CABA (6,55%o vs. 5,42%o; OR 1,21; IC 95%: 1,07-1,37; p 0,0039). Para madres residentes en la CABA, hubo mayor mortalidad neonatal en el subsistema de salud público (7,8% vs. 4,4%; OR 1,77; IC 95%: 1,48-2,11; p <0,001). CONCLUSIÓN: La CABA, único caso en el país, tiene un componente de nacimientos y defunciones extrajurisdiccionales muy importante, fundamentalmente del conurbano bonaerense, que no se refleja en las estadísticas oficiales que solo toman en cuenta el lugar de residencia de los padres.

Salud perinatal de la población migrante / Migrant population and perinatal health

Introducción. La cantidad de migrantes extranjeros tiende a crecer. La situación de los residentes fuera de su propio país es compleja y genera un impacto en el sistema público de salud. El objetivo del trabajo fue analizar el riesgo perinatal de las madres migrantes y de sus recién nacidos en comparación con las madres argentinas nativas y sus recién nacidos. Métodos. Estudio de cohortes que incluyó a 2000 madres y sus recién nacidos (1000 migrantes y 1000 nativos) asistidos en una maternidad pública. Resultados. Los madres nativas presentaron mayor proporción de recién nacidos con bajo peso al nacer (9,9% contra 5,3; p < 0,01), primigestas (42% contra 37%; p= 0,012) y embarazo adolescente (6% contra 1,3%; p < 0,001). Las mujeres migrantes presentaron mayor proporción de embarazos mal controlados (21,7% contra 13,4%; p < 0,01), serología positiva para Chagas (3,2% contra 0,4%; p < 0,01) y recién nacidos que requirieron luminoterapia (20,5% contra 14,3%; p= 0,04). Conclusión. En este estudio, las madres argentinas presentaron mayor proporción de recién nacidos de bajo peso al nacer, primigestas y embarazo adolescente, mientras que las mujeres migrantes presentaron mayor proporción de serología positiva para Chagas, déficit en los controles del embarazo y luminoterapia en sus recién nacidos.

Introduction: The number of foreign migrants tends to grow. The situation of people living away from their own country is complex and has an impact on the public health system. The objective of this article was to analyze the perinatal risk of migrant mothers and their newborn infants in comparison to native Argentine mothers and their newborn infants. Methods. Cohort study that included 2000 mothers and their newborn infants (1000 migrants and 1000 natives) assisted at a public maternity hospital. Results. Native mothers had a higher rate of low birth weight newborn infants (9.9% versus 5.3%; p <0.01), primiparity (42% versus 37%; p= 0.012), and adolescent pregnancy (6% versus 1.3%; p <0.001). Migrant women had a higher rate of poorly controlled pregnancies (21.7% versus 13.4%; p <0.01), positive serology for Chagas disease (3.2% versus 0.4%; p <0.01), and newborn infants requiring phototherapy (20.5% versus 14.3%; p =0.04). Conclusion. In our study, Argentine mothers had a higher rate of low birth weight newborn infants, primiparity and adolescent pregnancies, while immigrant women had higher rate of positive serology for Chagas disease, poor antenatal controls and more newborn infants requiring phototherapy.

Migrant population and perinatal health.

INTRODUCTION: The number of foreign migrants tends to grow. The situation of people living away from their own country is complex and has an impact on the public health system. The objective of this article was to analyze the perinatal risk of migrant mothers and their newborn infants in comparison to native Argentine mothers and their newborn infants. METHODS: Cohort study that included 2000 mothers and their newborn infants (1000 migrants and 1000 natives) assisted at a public maternity hospital. RESULTS: Native mothers had a higher rate of low birth weight newborn infants (9.9% versus 5.3%; p <0.01), primiparity (42% versus 37%; p= 0.012), and adolescent pregnancy (6% versus 1.3%; p <0.001). Migrant women had a higher rate of poorly controlled pregnancies (21.7% versus 13.4%; p <0.01), positive serology for Chagas disease (3.2% versus 0.4%; p <0.01), and newborn infants requiring phototherapy (20.5% versus 14.3%; p =0.04). CONCLUSION: In our study, Argentine mothers had a higher rate of low birth weight newborn infants, primiparity and adolescent pregnancies, while immigrant women had higher rate of positive serology for Chagas disease, poor antenatal controls and more newborn infants requiring phototherapy.

Salud perinatal de la población migrante / Migrant population and perinatal health

Introducción. La cantidad de migrantes extranjeros tiende a crecer. La situación de los residentes fuera de su propio país es compleja y genera un impacto en el sistema público de salud. El objetivo del trabajo fue analizar el riesgo perinatal de las madres migrantes y de sus recién nacidos en comparación con las madres argentinas nativas y sus recién nacidos. Métodos. Estudio de cohortes que incluyó a 2000 madres y sus recién nacidos (1000 migrantes y 1000 nativos) asistidos en una maternidad pública. Resultados. Los madres nativas presentaron mayor proporción de recién nacidos con bajo peso al nacer (9,9% contra 5,3; p < 0,01), primigestas (42% contra 37%; p= 0,012) y embarazo adolescente (6% contra 1,3%; p< 0,001). Las mujeres migrantes presentaron mayor proporción de embarazos mal controlados (21,7% contra 13,4%; p < 0,01), serología positiva para Chagas (3,2% contra 0,4%; p < 0,01) y recién nacidos que requirieron luminoterapia (20,5% contra 14,3%; p= 0,04). Conclusión. En este estudio, las madres argentinas presentaron mayor proporción de recién nacidos de bajo peso al nacer, primigestas y embarazo adolescente, mientras que las mujeres migrantes presentaron mayor proporción de serología positiva para Chagas, déficit en los controles del embarazo y luminoterapia en sus recién nacidos.

Introduction. The number of foreign migrants tends to grow. The situation of people living away from their own country is complex and has an impact on the public health system. The objective of this article was to analyze the perinatal risk of migrant mothers and their newborn infants in comparison to native Argentine mothers and their newborn infants. Methods. Cohort study that included 2000 mothers and their newborn infants (1000 migrants and 1000 natives) assisted at a public maternity hospital. Results. Native mothers had a higher rate of low birth weight newborn infants (9.9% versus 5.3%; p <0.01), primiparity (42% versus 37%; p= 0.012), and adolescent pregnancy (6% versus 1.3%; p <0.001). Migrant women had a higher rate of poorly controlled pregnancies (21.7% versus 13.4%; p <0.01), positive serology for Chagas disease (3.2% versus 0.4%; p <0.01), and newborn infants requiring phototherapy (20.5% versus 14.3%; p =0.04). Conclusion. In our study, Argentine mothers had a higher rate of low birth weight newborn infants, primiparity and adolescent pregnancies, while immigrant women had higher rate of positive serology for Chagas disease, poor antenatal controls and more newborn infants requiring phototherapy.

Salud perinatal de la población migrante / Migrant population and perinatal health

Introducción. La cantidad de migrantes extranjeros tiende a crecer. La situación de los residentes fuera de su propio país es compleja y genera un impacto en el sistema público de salud. El objetivo del trabajo fue analizar el riesgo perinatal de las madres migrantes y de sus recién nacidos en comparación con las madres argentinas nativas y sus recién nacidos. Métodos. Estudio de cohortes que incluyó a 2000 madres y sus recién nacidos (1000 migrantes y 1000 nativos) asistidos en una maternidad pública. Resultados. Los madres nativas presentaron mayor proporción de recién nacidos con bajo peso al nacer (9,9% contra 5,3; p < 0,01), primigestas (42% contra 37%; p= 0,012) y embarazo adolescente (6% contra 1,3%; p< 0,001). Las mujeres migrantes presentaron mayor proporción de embarazos mal controlados (21,7% contra 13,4%; p < 0,01), serología positiva para Chagas (3,2% contra 0,4%; p < 0,01) y recién nacidos que requirieron luminoterapia (20,5% contra 14,3%; p= 0,04). Conclusión. En este estudio, las madres argentinas presentaron mayor proporción de recién nacidos de bajo peso al nacer, primigestas y embarazo adolescente, mientras que las mujeres migrantes presentaron mayor proporción de serología positiva para Chagas, déficit en los controles del embarazo y luminoterapia en sus recién nacidos.(AU)

Introduction. The number of foreign migrants tends to grow. The situation of people living away from their own country is complex and has an impact on the public health system. The objective of this article was to analyze the perinatal risk of migrant mothers and their newborn infants in comparison to native Argentine mothers and their newborn infants. Methods. Cohort study that included 2000 mothers and their newborn infants (1000 migrants and 1000 natives) assisted at a public maternity hospital. Results. Native mothers had a higher rate of low birth weight newborn infants (9.9% versus 5.3%; p <0.01), primiparity (42% versus 37%; p= 0.012), and adolescent pregnancy (6% versus 1.3%; p <0.001). Migrant women had a higher rate of poorly controlled pregnancies (21.7% versus 13.4%; p <0.01), positive serology for Chagas disease (3.2% versus 0.4%; p <0.01), and newborn infants requiring phototherapy (20.5% versus 14.3%; p =0.04). Conclusion. In our study, Argentine mothers had a higher rate of low birth weight newborn infants, primiparity and adolescent pregnancies, while immigrant women had higher rate of positive serology for Chagas disease, poor antenatal controls and more newborn infants requiring phototherapy.(AU)

Migrant population and perinatal health. / Migrant population and perinatal health.

INTRODUCTION: The number of foreign migrants tends to grow. The situation of people living away from their own country is complex and has an impact on the public health system. The objective of this article was to analyze the perinatal risk of migrant mothers and their newborn infants in comparison to native Argentine mothers and their newborn infants. METHODS: Cohort study that included 2000 mothers and their newborn infants (1000 migrants and 1000 natives) assisted at a public maternity hospital. RESULTS: Native mothers had a higher rate of low birth weight newborn infants (9.9

versus 5.3

; p <0.01), primiparity (42

versus 37

; p= 0.012), and adolescent pregnancy (6

versus 1.3

; p <0.001). Migrant women had a higher rate of poorly controlled pregnancies (21.7

versus 13.4

; p <0.01), positive serology for Chagas disease (3.2

versus 0.4

; p <0.01), and newborn infants requiring phototherapy (20.5

versus 14.3

; p =0.04). CONCLUSION: In our study, Argentine mothers had a higher rate of low birth weight newborn infants, primiparity and adolescent pregnancies, while immigrant women had higher rate of positive serology for Chagas disease, poor antenatal controls and more newborn infants requiring phototherapy.

Size at birth and blood pressure in young adults: findings from a Brazilian birth cohort study / Tamanho ao nascer e pressão arterial em adultos jovens: achados de uma coorte de nascimentos brasileira

OBJECTIVE: To describe the prevalence of borderline blood pressure (BBP) and hypertension (HT) among young adults and to assess the association between size at birth and BBP/HT. METHODS: Data were collected from the fi rst Ribeirão Preto Birth Cohort Study conducted in the city of Ribeirão Preto, southeastern Brazil, that started in 1978-1979. Of the 6,827 singletons born in hospitals, 2,060 were assessed at 23-25 years of age. Blood samples were collected, an anthropometric assessment was performed, and information was obtained regarding occupation, schooling, life habits and chronic diseases. Blood pressure (BP) was classifi ed as: 1) BBP: systolic BP (SBP) ≥ 130 mm Hg and < 140 mm Hg and/or diastolic BP (DBP) ≥ 85 mm Hg and < 90 mm Hg; and 2) HT: SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg. A polytomic logistic regression model was used. RESULTS: BBP prevalence was 13.5% (males: 23.2%) and HT prevalence 9.5% (males: 17.7%). BBP was independently associated with male gender (relative risk [RR] 8.84; 95%CI 6.09;12.82); birth length ≥ 50 cm (RR 1.97; 1.04;3.73); body mass index (BMI) ≥ 30 kg/m2 (RR 3.23; 2.02;5.15); and high waist circumference (RR 1.61; 1.13;2.29), while HT was associated with male gender (RR 15.18; 8.92;25.81); BMI ≥ 30 kg/m2 (RR 3.68; 2.23;6.06); high waist circumference (RR 2.68; 1.77;4.05); and elevated blood glucose (RR 2.55; 1.27; 5.10), but not with birth length. CONCLUSIONS: The prevalence of BBP and HT among young adults of this cohort was higher in males than females. Greater birth length was associated with BBP, but not with HT, whereas birth weight was not associated with either BBP or HT. Adult risk factors explained most of the increase in the levels of BBP and HT.

OBJETIVO: Descrever a prevalência de pressão arterial limítrofe (PAL) e hipertensão (HT) entre adultos jovens e avaliar a associação entre tamanho ao nascer e PAL/HT. MÉTODOS: Dados foram coletados do primeiro estudo brasileiro de coorte de nascimentos em Ribeirão Preto (sudeste do Brasil), iniciado em 1978/79. De 6.827 recém-nascidos de parto único hospitalar, 2.060 foram avaliados aos 23/25 anos. Foram realizadas coleta de sangue, avaliação antropométrica e obtidas informações sobre ocupação, escolaridade, hábitos de vida e doenças crônicas. Pressão arterial (PA) foi classificada em: 1) PAL: PA sistólica (PAS) ≥ 130 e < 140 mm Hg e/ou PA diastólica (PAD) ≥ 85 e < 90 mmHg; 2) HT: PAS ≥ 140 e/ou PAD ≥ 90 mm Hg. Foi aplicado modelo de regressão logística politômica. RESULTADOS: A prevalência de PAL foi de 13,5% (homens 23,2%) e a de HT, 9,5% (homens 17,7%). PAL foi independentemente associada com sexo masculino (RR 8,84; IC95%: 6,09;12,82), comprimento ao nascer ≥ 50 cm (RR 1,97; 1,04; 3,73), índice de massa corporal (IMC) ≥ 30 kg/m² (RR 3,23; 2,02; 5,15) e circunferência de cintura alterada (RR 1,61; 1,13;2,29), enquanto HT associou-se com sexo masculino (RR 15,18; 8,92;25,81), IMC ≥ 30 kg/m² (RR 3,68; 2,23;6,06), circunferência de cintura alterada (RR 2,68; 1,77;4,05) e glicemia elevada (RR 2,55; 1,27;5,10), mas não com comprimento ao nascer. CONCLUSÕES: As prevalências de PAL e HT entre os adultos jovens dessa coorte foram maiores em homens que em mulheres. Maior comprimento ao nascer foi associado com PAL, mas não com HT, enquanto peso ao nascer não foi associado com PAL ou HT. Fatores de risco do adulto explicaram a maioria dos aumentos de PAL ou HT.

Randomized trial of early bubble continuous positive airway pressure for very low birth weight infants.

OBJECTIVE: To determine whether very low birth weight infants (VLBWIs), initially supported with continuous positive airway pressure (CPAP) and then selectively treated with the INSURE (intubation, surfactant, and extubation to CPAP; CPAP/INSURE) protocol, need less mechanical ventilation than those supported with supplemental oxygen, surfactant, and mechanical ventilation if required (Oxygen/mechanical ventilation [MV]). STUDY DESIGN: In a multicenter randomized controlled trial, spontaneously breathing VLBWIs weighing 800-1500 g were allocated to receive either therapy. In the CPAP/INSURE group, if respiratory distress syndrome (RDS) did not occur, CPAP was discontinued after 3-6 hours. If RDS developed and the fraction of inspired oxygen (FiO(2)) was >0.35, the INSURE protocol was indicated. Failure criteria included FiO(2) >0.60, severe apnea or respiratory acidosis, and receipt of more than 2 doses of surfactant. In the Oxygen/MV group, in the presence of RDS, supplemental oxygen without CPAP was given, and if FiO(2) was >0.35, surfactant and mechanical ventilation were provided. RESULTS: A total of 256 patients were randomized to either the CPAP/INSURE group (n = 131) or the Oxygen/MV group (n = 125). The need for mechanical ventilation was lower in the CPAP/INSURE group (29.8% vs 50.4%; P = .001), as was the use of surfactant (27.5% vs 46.4%; P = .002). There were no differences in death, pneumothorax, bronchopulmonary dysplasia, and other complications of prematurity between the 2 groups. CONCLUSION: CPAP and early selective INSURE reduced the need for mechanical ventilation and surfactant in VLBWIs without increasing morbidity and death. These results may be particularly relevant for resource-limited regions.

Size at birth and blood pressure in young adults: findings from a Brazilian birth cohort study.

OBJECTIVE: To describe the prevalence of borderline blood pressure (BBP)and hypertension (HT) among young adults and to assess the association between size at birth and BBP/HT. METHODS: Data were collected from the fi rst Ribeirão Preto Birth Cohort Study conducted in the city of Ribeirão Preto, southeastern Brazil, that started in 1978-1979. Of the 6,827 singletons born in hospitals, 2,060 were assessed at23-25 years of age. Blood samples were collected, an anthropometric assessment was performed, and information was obtained regarding occupation, schooling,life habits and chronic diseases. Blood pressure (BP) was classified as: 1) BBP:systolic BP (SBP) ≥ 130 mm Hg and < 140 mm Hg and/or diastolic BP (DBP)≥ 85 mm Hg and < 90 mm Hg; and 2) HT: SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg. A polytomic logistic regression model was used. RESULTS: BBP prevalence was 13.5% (males: 23.2%) and HT prevalence 9.5% (males: 17.7%). BBP was independently associated with male gender(relative risk [RR] 8.84; 95%CI 6.09;12.82); birth length ≥ 50 cm (RR 1.97;1.04;3.73); body mass index (BMI) ≥ 30 kg/m2 (RR 3.23; 2.02;5.15); and high waist circumference (RR 1.61; 1.13;2.29), while HT was associated with male gender (RR 15.18; 8.92;25.81); BMI ≥ 30 kg/m2 (RR 3.68; 2.23;6.06); high waist circumference (RR 2.68; 1.77;4.05); and elevated blood glucose (RR2.55; 1.27; 5.10), but not with birth length. CONCLUSIONS: The prevalence of BBP and HT among young adults of this cohort was higher in males than females. Greater birth length was associated with BBP, but not with HT, whereas birth weight was not associated with either BBP or HT. Adult risk factors explained most of the increase in the levels of BBP and HT.

Morbimortalidad asociada a recién nacidos pretérminos tardíos / Morbidity and mortality associated with late preterm infants newborn

Introducción: Los recién nacidos pretérminos tardíos (RNPT-T) son los neonatos nacidos entre las 34 y 36 semanas de edad gestacional. Debido a su incremento es importante conocer el comportamiento de los mismos, a fin de adecuar el manejo y seguimiento posteriores al alta. Este estudio describe la morbimortalidad, mortalidad, síndrome de dificultad respiratoria (SDR), ictericia, dificultad en la alimentación e hipoglucemia asociada a los RNPT-T en comparación con los RNT. Población y métodos: Estudio de cohortes retrospectivo. Se incluyeron 500 RN entre 34 a 36,6 semanas (RNPT-T) y 500 entre 37-41,6 semanas (RNT) de edad gestacional nacidos en el HMI "Ramón Sardá" de Buenos Aires entre 2007 y 2008. Resultados: Los RNPT-T presentaron significativamente mayor mortalidad que los RNT (2,9‰ vs. 0,49‰ respectivamente (RR 4,1 IC 95% 3,2-15,7) y morbilidad, representada por mayor SDR, ictericia, dificultad en la alimentación, internación prolongada e hipoglucemias. Conclusión: Los recién nacidos pretérminos tardíos presentan mayor mortalidad y morbilidades que los recién nacidos de termino.

Introduction: Late preterm infants are the infants born between 34 and 36 weeks of gestational age. Because of the increase is important to know their behavior in order to adapt the management and follow-up after discharge. We described in this study the morbidity associated with late preterm infants compared to term infants, determine the incidence of complications often presented such as respiratory distress syndrome (RDS), jaundice, feeding difficulty, hypoglycemia, and death in comparison with infants of =37 weeks gestation age. Population and methods: Retrospective cohort study of infants from 34 to 36.6 weeks gestational age (M=500) born in the "Ramón Sardá" Maternity Hospital during 2007 and 2008. Results: We found that PNB-T had significantly higher mortality compared with the term infants (2.9‰ vs.0.49 ‰, RR 4.1 95% CI 3.2 - 15.7). RDS, jaundice, feeding difficulty, prolonged and major hypoglycemia were higher in the study group. Conclusion: Late preterm infants have higher mortality and morbidity than term infants.

Pre-hipertensión e hipertensión arterial en adultos jóvenes y su relación con la antropometría al nacimiento: estudio de cohorte / Relationship between size at birth and borderline blood pressure or hypertension in young adults: cohort study

INTRODUCCION: Varios estudios han informado que los trastornos del crecimiento fetal están asociados con las enfermedades crónicas no transmisibles en la edad adulta, entre ellos la hipertensión arterial (HT), de acuerdo con la hipótesis del origen fetal de las enfermedades de adultos.OBJETIVO: Describir la prevalencia de la presión arterial límite o pre-hipertensión (BBP) e HT entre los adultos jóvenes nacidos en la cohorte 1978-1979 de RiberÊo Preto (Brasil), y evaluar el riesgo de BBP e HT en los adultos jóvenes asociados con el tamaño al nacer, ajustado para el parto y las características de la vida adulta.METODOS: De 6.827 hijos únicos nacidos en los hospitales, 2.060 fueron evaluados a los 23/25 años. Se realizaron análisis bioquímicos y una evaluación antropométrica, y se obtuvo información sobre ocupación, educación, hábitos de vida y enfermedades crónicas. La presión arterial (PA) se clasificó en: 1) BBP: PA sistólica (PAS) ≥ 130 mmHg y/o PA diastólica (PAD) ≥ 85 mmHg, 2) HT: PAS > 140 y/o PAD > 90 mmHg. Las características sociodemográficas y clínicas en el nacimiento y en la edad adulta fueron evaluadas mediante la aplicación de un modelo de regresión logística politómica.RESULTADOS: La prevalencia de BBP fue de 13,5% (hombres 82,8%) y la prevalencia de HT fue de 9,5% (hombres 89,8%). La BBP se asoció con el sexo masculino (RAR 9,11; IC 95% 6,23 a 13,32), el Indice de Masa Corporal (IMC) > 30 kg/m2 (RAR 3,01; IC 95% 1,87-4,85) y la alteración de la circunferencia de la cintura (RAR 1,68, IC 95% 1,17-2,40); la HT se asoció con las mismas variables más alta glucemia en ayunas (RAR 2,86; IC 95% 1,42-5,76).CONCLUSIONES: La prevalencia de BBP e HT entre los adultos jóvenes fue elevada. No guardó relación con el tamaño al nacer, pero estuvo asociada con la adiposidad corporal alterada y la glucemia.

INTRODUCTION: Several studies have reported that disorders of fetal growth are associated with non-communicable chronic diseases in adulthood, among them hypertension (HT), according to the hypothesis of the fetal origin of adult diseases.OBJECTIVE: To describe the prevalence of borderline blood pressure (BBP) and HT among young adults born in the 1978-79 RiberÊo Preto cohort, and to assess the risk of BBP and HT in young adults associated with size at birth, adjusted for birth and adult life characteristics.METHODS: Of the 6.827 singletons born in hospitals, 2.060 were assessed at 23/25 years of age. Blood was collected, anthropometric assessment was performed and information was obtained regarding occupation, schooling, life habits and chronic diseases. Blood pressure (BP) was classified as: 1) BBP: systolic BP (SBP) ≥ 130 mmHg and/or diastolic BP (DBP) ≥ 85 mmHg; 2) HT: SBP > 140 and/or DBP > 90 mmHg. Socio-demographic and clinical characteristic at birth and in adulthood were evaluated applying a polytomic logistic regression model.RESULTS: BBP prevalence was 13.5% (men 82.8%) and HT prevalence was 9.5% (men 89.8%). BBP was associated with male gender (aRR 9.11; 95% CI 6.23-13.32), Body Mass Index (BMI) > 30 kg/m2 (aRR 3.01; 95% CI 1.87-4.85) and altered waist circumference (aRR 1.68; 95% CI 1.17-2.40), whilst HT was associated with the same variables plus high fasting glycemia (aRR 2.86; 95% CI 1,42-5.76)CONCLUSIONS: The prevalence of BBP and Ht among young adults was high, with no relation with size at birth but associated to altered body adiposity and glycemia.

Morbimortalidad asociada a recién nacidos pretérminos tardíos / Morbidity and mortality associated with late preterm infants newborn

Introducción: Los recién nacidos pretérminos tardíos (RNPT-T) son los neonatos nacidos entre las 34 y 36 semanas de edad gestacional. Debido a su incremento es importante conocer el comportamiento de los mismos, a fin de adecuar el manejo y seguimiento posteriores al alta. Este estudio describe la morbimortalidad, mortalidad, síndrome de dificultad respiratoria (SDR), ictericia, dificultad en la alimentación e hipoglucemia asociada a los RNPT-T en comparación con los RNT. Población y métodos: Estudio de cohortes retrospectivo. Se incluyeron 500 RN entre 34 a 36,6 semanas (RNPT-T) y 500 entre 37-41,6 semanas (RNT) de edad gestacional nacidos en el HMI "Ramón Sardá" de Buenos Aires entre 2007 y 2008. Resultados: Los RNPT-T presentaron significativamente mayor mortalidad que los RNT (2,9ë vs. 0,49ë respectivamente (RR 4,1 IC 95% 3,2-15,7) y morbilidad, representada por mayor SDR, ictericia, dificultad en la alimentación, internación prolongada e hipoglucemias. Conclusión: Los recién nacidos pretérminos tardíos presentan mayor mortalidad y morbilidades que los recién nacidos de termino. (AU)

Introduction: Late preterm infants are the infants born between 34 and 36 weeks of gestational age. Because of the increase is important to know their behavior in order to adapt the management and follow-up after discharge. We described in this study the morbidity associated with late preterm infants compared to term infants, determine the incidence of complications often presented such as respiratory distress syndrome (RDS), jaundice, feeding difficulty, hypoglycemia, and death in comparison with infants of =37 weeks gestation age. Population and methods: Retrospective cohort study of infants from 34 to 36.6 weeks gestational age (M=500) born in the "Ramón Sardá" Maternity Hospital during 2007 and 2008. Results: We found that PNB-T had significantly higher mortality compared with the term infants (2.9ë vs.0.49 ë, RR 4.1 95% CI 3.2 - 15.7). RDS, jaundice, feeding difficulty, prolonged and major hypoglycemia were higher in the study group. Conclusion: Late preterm infants have higher mortality and morbidity than term infants. (AU)

Pre-hipertensión e hipertensión arterial en adultos jóvenes y su relación con la antropometría al nacimiento: estudio de cohorte / Relationship between size at birth and borderline blood pressure or hypertension in young adults: cohort study

INTRODUCCION: Varios estudios han informado que los trastornos del crecimiento fetal están asociados con las enfermedades crónicas no transmisibles en la edad adulta, entre ellos la hipertensión arterial (HT), de acuerdo con la hipótesis del origen fetal de las enfermedades de adultos.OBJETIVO: Describir la prevalencia de la presión arterial límite o pre-hipertensión (BBP) e HT entre los adultos jóvenes nacidos en la cohorte 1978-1979 de RiberÒo Preto (Brasil), y evaluar el riesgo de BBP e HT en los adultos jóvenes asociados con el tamaño al nacer, ajustado para el parto y las características de la vida adulta.METODOS: De 6.827 hijos únicos nacidos en los hospitales, 2.060 fueron evaluados a los 23/25 años. Se realizaron análisis bioquímicos y una evaluación antropométrica, y se obtuvo información sobre ocupación, educación, hábitos de vida y enfermedades crónicas. La presión arterial (PA) se clasificó en: 1) BBP: PA sistólica (PAS) ≥ 130 mmHg y/o PA diastólica (PAD) ≥ 85 mmHg, 2) HT: PAS > 140 y/o PAD > 90 mmHg. Las características sociodemográficas y clínicas en el nacimiento y en la edad adulta fueron evaluadas mediante la aplicación de un modelo de regresión logística politómica.RESULTADOS: La prevalencia de BBP fue de 13,5% (hombres 82,8%) y la prevalencia de HT fue de 9,5% (hombres 89,8%). La BBP se asoció con el sexo masculino (RAR 9,11; IC 95% 6,23 a 13,32), el Indice de Masa Corporal (IMC) > 30 kg/m2 (RAR 3,01; IC 95% 1,87-4,85) y la alteración de la circunferencia de la cintura (RAR 1,68, IC 95% 1,17-2,40); la HT se asoció con las mismas variables más alta glucemia en ayunas (RAR 2,86; IC 95% 1,42-5,76).CONCLUSIONES: La prevalencia de BBP e HT entre los adultos jóvenes fue elevada. No guardó relación con el tamaño al nacer, pero estuvo asociada con la adiposidad corporal alterada y la glucemia.

INTRODUCTION: Several studies have reported that disorders of fetal growth are associated with non-communicable chronic diseases in adulthood, among them hypertension (HT), according to the hypothesis of the fetal origin of adult diseases.OBJECTIVE: To describe the prevalence of borderline blood pressure (BBP) and HT among young adults born in the 1978-79 RiberÒo Preto cohort, and to assess the risk of BBP and HT in young adults associated with size at birth, adjusted for birth and adult life characteristics.METHODS: Of the 6.827 singletons born in hospitals, 2.060 were assessed at 23/25 years of age. Blood was collected, anthropometric assessment was performed and information was obtained regarding occupation, schooling, life habits and chronic diseases. Blood pressure (BP) was classified as: 1) BBP: systolic BP (SBP) ≥ 130 mmHg and/or diastolic BP (DBP) ≥ 85 mmHg; 2) HT: SBP > 140 and/or DBP > 90 mmHg. Socio-demographic and clinical characteristic at birth and in adulthood were evaluated applying a polytomic logistic regression model.RESULTS: BBP prevalence was 13.5% (men 82.8%) and HT prevalence was 9.5% (men 89.8%). BBP was associated with male gender (aRR 9.11; 95% CI 6.23-13.32), Body Mass Index (BMI) > 30 kg/m2 (aRR 3.01; 95% CI 1.87-4.85) and altered waist circumference (aRR 1.68; 95% CI 1.17-2.40), whilst HT was associated with the same variables plus high fasting glycemia (aRR 2.86; 95% CI 1,42-5.76)CONCLUSIONS: The prevalence of BBP and Ht among young adults was high, with no relation with size at birth but associated to altered body adiposity and glycemia.

[Patient volume, medical and nursing staffing and its relationship with risk-adjusted outcomes of VLBW infants in 15 Neocosur neonatal network NICUs]. / Riesgo de morbimortalidad neonatal de recién nacidos < 1500 g asociado al volumen de pacientes, personal médico y de enfermería: una investigación multicéntrica latinoamericana.

INTRODUCTION: Few studies have attempted to evaluate the relationship between medical and nursing staffing and neonatal outcomes providing inconclusive evidence. The purpose was to assess whether morbidity and mortality of VLBW infants are associated with levels of patient volume, provision and training of medical and nursing, and if exist differences between public and private centers. MATERIAL AND METHODS: Neonatal outcomes of all VLBW inborn infants consecutively admitted to 15 South-American NICUs between 2005 and 2007 were retrospectively studied. Data of patient volume and provision of medical & nursing resources were obtained from questionnaires. OUTCOME MEASURES: death before discharge, incidence of severe IVH, BPD, ROP and late onset sepsis, adjusted for initial risk (Neocosur score). Units were categorized using total annual number of newborns < 1500 g (low < 50, medium 50-100, and high >100) and in public and private centers. RESULTS: 2019 preterms were admitted. Mean (SD) gestational age, birth weight and initial risk were 28.9 (0.7) weeks, 1088 (53) g and 0.24 (0.04) respectively. Mortality varied among units and ranged between 6 to 38% (mean 23.2%), as well as other outcomes (median, intercuartil range [ICR]): severe IVH 7.3% (6-14); BPD 20.8% (15-43); ROP ≥ III 5.6% (2.7-8.5); late sepsis 23% (15-29). Staff provision were: daily medical hours (median, ICR) 2.6 (1.4-4.0), full-time (> 40 h/week) equivalent physicians (mean, SD) 15(8), daily nurse hours 6.1 (4.3-7.9), full-time (> 40 h/week) equivalent nurses 32 (22-56) and nurses-to-infant ratio 0.78 (0.52-0.92). Median daily NICU census was 9.8 (8.9-12). A low medical hours provision was significantly associated with increased mortality (OR 1.30 [95% CI: 1.04-1.76], p= 0.020); on the other hand low nurse provision was significantly associated with increased risk of mortality, adjusted by mother age and initial risk (trained NIC 1.52 [1.16 -1.99], nurses-to-infant ratio 1.81 [1.40-2.33]). Although public centers showed higher risk of morbidity and mortality compared with private centers, differences were statistically not significant. CONCLUSIONS: In this population neonatal outcomes were associated with levels of patient volume and training of medical and nursing staff. No differences were observed between public and private centers.

Riesgo de morbimortalidad neonatal de recién nacidos < 1500 g asociado al volumen de pacientes, personal médico y de enfermería: una investigación multicéntrica latinoamericana / Patient volume, medical and nursing staffing and its relationship with risk-adjusted outcomes of vlbw infants in 15 Neocosur neonatal network Nicus

Objetivo. Evaluar si la morbilidad y mortalidad de los neonatos <1500 g se relacionan con el volumen de pacientes atendidos y el número y capacitación del personal médico y de enfermería,y si existen diferencias entre centros públicos y privados. Población, material y métodos. Los quince centros del Grupo Colaborativo Neocosur se clasificaron según el número de nacimientos anualesde <1500 g en: <50 (bajo), 50-100 (medio) y >100 (alto), y su condición de públicos o privados. Se analizaron la base de datos y se realizó una encuesta sobre indicadores de actividad, número, carga laboral y capacitación del personal médico y de enfermería.Las medidas de resultados fueron muerte antes del egreso y morbilidades: hemorragia intracraneana (HIC), retinopatía del prematuro (ROP),displasia broncopulmonar (DBP) y sepsis tardía. Resultados. Entre enero 2005 y diciembre 2007 hubo 2019 neonatos <1500 g. La media (DE) de mortalidad fue 23,24 por ciento (8,48); las medianas (intervalo intercuartílico) fueron: DBP 20,8 por ciento(15-43), ROP mayor o igual III 5, 6 por ciento (2,7-8,5), HIC, mayor o igual III 7,3 por ciento(6-14) y sepsis tardía 23 por ciento (15,4-29). Los centros con menos RN < 1500 g tuvieron la tasa de sepsis tardía más elevada (p: 0,004). Los centros con mayor número de nacimientos presentaron mayo rriesgo de HIC y ROP y contaban con más pediatras neonatólogos. Los centros medios tuvieron mayor número de jornadas completas de enfermería. Siete centros tuvieron una relación enfermera-cuna <0,77.Conclusiones. Los resultados neonatales están relacionados con el volumen de actividad y el nivel de los profesionales, especialmente enfermeras y auxiliares. No hubo diferencias significativas entre centros públicos y privado.

Introduction. Few studies have attempted to evaluate the relationship between medical and nursing staffing and neonatal outcomes providinginconclusive evidence. The purpose wasto assess whether morbidity and mortality of VLBW infants are associated with levels of patientvolume, provision and training of medical and nursing, and if exist differences between public and private centers. Material and methods. Neonatal outcomes of all VLBW inborn infants consecutively admitted to 15 South-American NICUs between 2005and 2007 were retrospectively studied. Data of patient volume and provision of medical & nursing resources were obtained from questionnaires.Outcome measures: death before discharge, incidence of severe IVH, BPD, ROP and late onset sepsis, adjusted for initial risk (Neocosurscore). Units were categorized using total annual number of newborns <1500 g (low <50, medium 50-100, and high >100) and in publicand private centers. Results. 2019 preterms were admitted. Mean(SD) gestational age, birth weight and initial risk were 28.9 (0.7) weeks, 1088 (53) g and 0.24 (0.04) respectively. Mortality varied among units and ranged between 6 to 38% (mean 23.2%), as well as other outcomes (median, intercuartil range[ICR]): severe IVH 7.3% (6-14); BPD 20.8% (15-43); ROP ≥ III 5.6% (2.7-8.5); late sepsis 23% (15-29).Staff provision were: daily medical hours (median, ICR) 2.6 (1.4-4.0), full-time (>40 h/week) equivalent physicians (mean, SD) 15(8), dailynurse hours 6.1 (4.3-7.9), full-time (>40 h/week) equivalent nurses 32 (22-56) and nurses-to-infant ratio 0.78 (0.52-0.92). Median daily NICU censuswas 9.8 (8.9-12). A low medical hours provision was significantly associated with increased mortality (OR 1.30 [95%CI: 1.04-1.76], p= 0.020); on the other hand low nurse provision was significantly associated with increased risk of mortality, adjusted by motherage and initial risk (trained NIC 1.52 [1.16 -1.99], nurses-to-infant ratio 1.81 [1.40-2.33])...