Pulmonary innate immune response and melatonin receptors in the perinatal stress.

OBJECTIVE: To analyze the cytokines of the innate immune pulmonary response and the capacity for local response to melatonin according to the perinatal stress. METHODS: 49 cases of pediatric autopsies were evaluated, divided according to cause of death, perinatal stress, gestational age, and birth weight. The percentages of IL-6, C-reactive protein (CRP), IL-1ß, TNF-α, and melatonin receptor were evaluated by immunohistochemistry. RESULTS: The IL-6 expression was higher in the children showing chronic stress, anoxia, and infection. The IL-6 expression showed a progressive increase according to the relation between weight and GA. There was no significant difference in the expression of IL-1ß and TNF-α. The CRP expression was higher in the cases showing chronic stress and premature cases. The expression of melatonin receptors was significantly higher in the cases showing chronic stress, being more evident in the cases showing infection. CONCLUSION: The cause of death and the type of stress influence the expression in situ of melatonin and cytokines of the innate immune pulmonary response. The evaluation of IL-6 and CRP may contribute to the understanding of the evolution of neonates with chronic stress. The greater sensitivity of the lung to melatonin in these cases may indicate an attempt at controlling the immunological response, in an attempt to diminish the harmful effects of stress.

Morphologic analysis of fetal stress organsin different causes of perinatal death.

Complications act as stress-inducers during pregnancy so the fetus can develop functional compensatory mechanisms or morphologic changes. The cases analyzed are with congenital malformations or acute stress; chronic included cases with ascending infection (AI) and perinatal hypoxia/anoxia (PHA). The hematoxylin-eosin (H&E) was done to analyze the vacuolization, and the immunohistochemistry to the phagocytosis. The discreet standard of vacuolization was observed in 52.6% of the cases, 22.1% moderate, and 25.3% severe. The number of macrophages was higher in PHA. Changes in these organs are closely related to the cause of death and to the period during which the harmful agent.

Avaliação dos recém-nascidos a termo com índice de apgar baixo de um Hospital Geral Terciário, público e de ensino no Ceará, em 2005 / Evaluation of newborn term infants with low Apgar score in a Hospital Geral Terciário, and public education in Ceará in 2005

INTRODUÇÃO: A asfixia intra-uterina e a intraparto, o baixo peso ao nascer, asinfecções e a prematuridade constituem as principais causas de óbitos neonatais do recémnascido. O índice de Apgar é um dos critérios usados para diagnosticar asfixia. OBJETIVO: Analisar o perfil dos recém-nascidos a termo com índice de Apgar baixo (...) e índice de Apgar maior ou igual a 7, que nasceram em um Hospital Público no município de Fortaleza-Ce, no ano de 2005. METODOLOGIA: Trata-se de um estudoanalítico, retrospectivo, do tipo caso-controle, de base hospitalar. A população do estudo foi constituída pela coorte da pesquisa Tendências e Diferenciais na Saúde Perinatal noMunicípio de Fortaleza, Ceará: Comparação entre 1995 e 2005. Foram selecionados recém-nascidos (RNs) com idade gestacional maior ou igual a 37 semanas. Os que apresentaram índice de Apgar (...) 6 foram definidos como casos enquanto aqueles com índice de Apgar maior ou igual a 7 constituíram o grupo controle, ficando a amostracomposta por 626 RNs, sendo 313 casos e 313 controles. Empregou-se um questionário estruturado, adaptado do instrumento de coleta de dados da pesquisa, com variáveissociodemográficas, obstétricas, clínicas. RESULTADOS: Na amostra 62,5 por cento eram filhos de mulheres na faixa etária de 20-34 anos. Na análise multivariada foi considerado comofator de risco para índice de Apgar baixo as variáveis: baixa escolaridade da mãe (OR=2,48 IC95 por cento: 1,22- 5,06), tempo de trabalho de parto (OR=1,79 IC95 por cento: 1,03-3,11), peso aonascer (OR=3,25 IC95 por cento:1,15 -3,25), tipo de parto (OR=1,83 IC95 por cento: 1,33-2,51) e SHG (OR = 2,07, IC95 por cento: 1,34 -3,16). As variáveis idade materna, situação conjugal, ocupação, consulta pré-natal, sexo do RN e dia do nascimento não apresentaram associação com avariável desfecho. CONCLUSÃO: as mães dos recém-nascidos eram na sua maioria jovens, pertencentes às classes sociais menos favorecidas. O índice de Apgar baixo pode ser decorrente de fatores clínicos, obstétricos, perinatais, de organização da atenção ao binômio parturiente-feto e do contexto socioeconômico.

Factores maternos que influyen en la mortalidad fetal tardía

Con la finalidad de identificar algunos factores maternos perinatales que se relacionan con la mortalidad fetal tardía (MFT), se realizó una investigación retrospectiva, transversal y analítica, en el Hospital Abel Santamaría Cuadrado, que comprendió el período desde mayo del 2001 hasta mayo del 2003. El universo estudiado estuvo constituido por todas las gestantes que tuvieron su parto en la etapa anteriormente mencionada. Como grupo estudio se tomaron a todas las pacientes que tuvieron una muerte fetal tardía, y para la comparación se escogió un grupo control integrado por gestantes cuyos recién nacidos fueron vivos. Las variables analizadas estuvieron relacionadas con la madre, el embarazo, el feto y el nacimiento, así como las causas directas de la muerte. El análisis estadístico se realizó a través del por ciento, la media, la desviación estándar, el test de diferencia de proporciones (Z), y se empleó también el Odds Ratio (OR). Se obtuvo una elevada significación estadística entre la muerte fetal tardía y la gestante añosa, multípara, multigesta con antecedentes de enfermedades tanto asociadas como propias del embarazo, y el bajo peso materno al inicio del embarazo. Se concluye que es necesario identificar las gestantes con factores de riesgo de muerte fetal tardía y profundizar en su atención obstétrica...(AU)

Estudios realizados en neonatos con diagnóstico-clínico de hipoxia neonatal: en el Hospital Samuel Dario Maldonado de San Antonio del Táchira en el período de enero-diciembre 2001 / Studies in neonates with clinical diagnose of neonatal hypoxia in Hospital Samuel Dario Maldonado of San Antonio del Tachira in the period january-december 2001

A partir de las ultimas décadas la hipoxia neonatal representa un gran problema; por la morbilidad tan elevada; y con el propósito de conocer que sucedía con los niños que durante su nacimiento presentaron hipoxia neonatal se realizó un estudio analítico retrospectivo de 100 niños que presentaron diagnóstico clínico de hipoxia neonatal moderada severa durante el período enero-diciembre 2001 en el Hospital Samuel Dario Maldonado San Antonio del Táchira fueron seleccionados 30 casos, presentándose el mayor porcentaje por cesárea segmentaria (23,33 por ciento) seguida de parto eutocico (20 por ciento) y período expulsivo prolongado (16,66 por ciento), parto prematuro (13,33 por ciento). También observamos el test de apgar donde el mayor porcentaje encontrado fue de 6 puntos en 7 casos con (23,33 por ciento) tiempo durante 24-28 horas (16.66 por ciento) siendo el sexo masculino el más predominante (56,66 por ciento) acorde a la edad.

Perinatal mortality in Jamaica 1986-1987.

A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54,400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51% of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70% to the rest of the time period when the post-mortem rate was only 40%. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40% of deaths overall and 59% of deaths in infants of more than 2500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20% of deaths. Sixty percent of the infants in this group weighed less than 2500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focuses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.

PIP: A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica over a 12-month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54,400 infants born giving a perinatal death rate of 38.0/1000 births. The death rate was 5 time higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51% of the infants who died perinatally had such an examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death, and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70% to the rest of the time when the rate was only 40%. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40% of deaths overall and 59% of deaths in infants of more than 2500 g birthweight. Antepartum fetal deaths were the 2nd largest group. comprising 20% of deaths. 60% of the infants in this group weighed less than 2500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important since it puts attention on details of labor and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care.

Perinatal mortality in Jamaica 1986-1987

A large population-based study of all stillbirths and neonatal deaths occurring on the island of Jamaica during a 12 month period is described. During this time, 2069 perinatal deaths were identified in an estimated total of 54,400 infants born giving a perinatal death rate of 38.0 per 1000 births. The death rate was 5 times higher among twins than singletons. An attempt was made to obtain detailed postmortem examination of as many cases as possible. In the event, 51 percent of the infants who died perinatally had such postmortem examination. Postmortem rate was affected by sex, multiplicity of the infant, time of death, month of death and area of delivery. Deaths were classified using the Wigglesworth scheme. The distribution of categories was similar in the months when the postmortem rate was 70 percent to the rest of the time period when the post-mortem rate was only 40 percent. The Wigglesworth classification of deaths identified those associated with intrapartum asphyxia as the most important group, accounting for over 40 percent of deaths overall and 59 percent of deaths of infants of more than 2500 g birthweight. Antepartum fetal deaths were the second largest group, comprising 20 percent of deaths. Sixty percent of the infants in this group weighted less than 2500 g at birth. Major malformations were responsible for few perinatal deaths in Jamaica. This simple classification is important as it focuses attention on details of labour and delivery that may require change and is useful in planning future delivery of obstetric and neonatal care. (AU)

morbimortalidad por hipoxia en el período 1982-1987 / Morbiortality due to hypoxia during 1982-1986 period

Se estudiaron entre 1982 y 1987 en el Hospital Docente Ginecoobstétrico de Guanabacoa 20 580 recién nacidos vivos, de los cuales 626 presentaron hipoxia en el perìodo neonatal. Se encontró que la morbilidad por hipoxia en los 626 recién nacidos representó el 3,0

. El 51,1

de los niños deprimidos coincidieron con partos eutócicos. La frecuencia de hipoxia fue mayor en los grupos de 2 500 g de peso o más. Se señala un reducción del 1

en el trienio 1985-1987 de mortalidad por hipoxia, aunque todavía la mortalidad por anoxia en estos neonatos es elevada (AU)

morbimortalidad por hipoxia en el período 1982-1987 / Morbimortality due to hypoxia during 1982-1986 period

Se estudiaron entre 1982 y 1987 en el Hospital Docente Ginecoobstétrico de Guanabacoa 20 580 recién nacidos vivos, de los cuales 626 presentaron hipoxia en el perìodo neonatal. Se encontró que la morbilidad por hipoxia en los 626 recién nacidos representó el 3,0 %. El 51,1 % de los niños deprimidos coincidieron con partos eutócicos. La frecuencia de hipoxia fue mayor en los grupos de 2 500 g de peso o más. Se señala un reducción del 1 % en el trienio 1985-1987 de mortalidad por hipoxia, aunque todavía la mortalidad por anoxia en estos neonatos es elevada