[Neonatal Doppler velocimetry in full term small-for-gestational age newborns]. / Velocimetria Doppler no período neonatal em recém-nascidos a termo pequenos para idade gestacional.

This study aimed to evaluate the cerebral blood flow of full term small-for-gestational age newborns, using cranial ultrasound Doppler at birth. This study was performed at CAISM/UNICAMP (Tertiary Health Center for Women). Sixty term newborns were selected and divided in two groups: appropriate-for-gestational age (AGA) (36 neonates) and small-for-gestational age (SGA) (24 neonates). Cranial ultrasound Doppler evaluation was performed on both groups, between 24 and 48 hours after birth. Cerebral blood flow velocity (CBFV) was lower in the small-for-gestational age group, in the anterior cerebral artery (ACA). Doppler measurements were different statistically between the groups only for values related to peak systolic flow velocity (PSFV) and mean flow velocity (MFV) in the ACA. There was no significant difference for any evaluated parameters of flow velocity in the middle cerebral artery (MCA). It was concluded that SGA newborns showed PSFV and MFV significantly reduced only in the ACA. Weight/gestational age, neonatal polycythemia and mean arterial blood pressure values were statistically related to MFV in the ACA. In presence of fetal suffering, mean arterial blood pressure values and smoking in the pregnancy were statistically related to MFV in the MCA.

Vitamins C and E improve endothelial dysfunction in intrauterine-undernourished rats by decreasing vascular superoxide anion concentration.

Epidemiological studies suggest that intrauterine undernutrition plays an important role in the development of arterial hypertension in adulthood. Ascorbic acid (vitamin C) and alpha-tocopherol (vitamin E) have antioxidant properties that could improve redox-sensitive vascular changes associated with hypertension. The authors determined whether vitamins C and E treatments ameliorate the hypertension and vascular function in male rats submitted to intrauterine undernutrition. Pregnant Wistar rats were fed either normal or 50% of the normal intake diets during the whole gestational period. At 14 weeks of age, male offspring of nutritionally restricted dams were divided into 3 subgroups: vehicle-treated (vehicle for 15 days, by gastric gavage, n = 9), vitamin C-treated (ascorbic acid, 150 mg/Kg/d for 15 days, by gastric gavage, n = 15) and vitamin E-treated (alpha-tocopherol, 350 mg/kg per day for 15 days, by gastric gavage, n = 15). Systolic blood pressure was determined before and after antioxidant treatments by the tail-cuff method. At 16 weeks of age, the rats were used for the study of microvascular reactivity and intravital fluorescence microscopy. Intrauterine undernutrition induced hypertension, and vitamins C or E treatments reduced the blood pressure levels. The decreased acetylcholine and bradykinin-induced vasodilation was restored in the vitamin-treated rats. These effects were associated with decreased vascular superoxide anion concentration. The results show that vitamins C and E reduce oxidative stress and high blood pressure levels, and improve vascular function in intrauterine-undernourished rats.

Effects of perinatal undernourishment on neuronal development of the facial motor nucleus in the rat.

The facial nucleus (FN) of the rat is composed of multipolar neurons generated between gestational days G12 and G15. This nucleus is involved in the mechanisms underlying muscle contraction during the sucking reflex. After birth, the neuronal substrate of this reflex is gradually organized to allow the performance of other functions such as gnawing, chewing, swallowing and drinking. Undernourishment is known to produce different degrees of delayed brain development, the greatest of which are similar to the characteristics of the premature syndrome. Neuronal morphological alterations are associated with sucking-reflex deficiencies, which interfere with feeding by the newborn. The current study shows that perinatal undernourishment leads to dendritic arbor hypoplasia and small alterations of soma size in Golgi--Cox impregnated FN neurons of rats. The data suggest that these morphological alterations of FN neurons, may be associated with shifts in the input and integration of signals, and may finally modify the elaboration of motoneuron discharges partly modulating bucolabial muscle contraction during sucking movements and facial expression. Additionally, neonatal nutritional rehabilitation modifies the effects on FN neuronal development, ameliorating the influence of early adverse nutritional conditions.

Reduced neonatal liver iron concentrations after uteroplacental insufficiency.

Neonatal liver (storage) but not heart (nonstorage) tissue iron concentrations were reduced by 60% at autopsy in 15 newborn infants who had gestations complicated by uteroplacental insufficiency because of maternal hypertension or Potter syndrome. The hepatic iron reductions in term and preterm infants, and with either antecedent condition, were similar.

Muerte perinatal / Perinatal death

Se revisaron 86 casos de mortalidad perinatal en el HOspital de Gineco Obstetricia de Garza García, N.L. de la Subsecretaría Estatal de Salud de enero de 1992 a diciembre de 1993. Período de 2 años. La tasa de mortalidad perinatal fue de 12.0 por mil nacimientos, menor que otros reportes. La mayor incidencia en pacientes jóvenes de 20 a 29 años con 47.7 por ciento y con paridad de 1 a 3 un 80.2 por ciento, la mayor frecuencia en embarazos a término de 37 a 42 semanas con 39.6 por ciento, 35 por ciento de los productos con peso mayor de 2,500 gramos y 65 por ciento menor. La muerte fetal se presentó con mayor frecuencia en el preparto 55.8 por ciento y menor en el intraparto 19.8 por ciento, las causas más frecuentes de muerte perinatal fueron insuficiencia placentaria 27.9 por ciento e inmadurez fetal con 24.4 por ciento. Se concluye que un control prenatal adecuado y una vigilancia del trabajo de parto traen como consecuencia una disminución de la mortalidad fetal

Function and morphometric evaluation of intrauterine undernutrition on kidney development of the progeny

Renal function and renal morphometry of the progeny of rats submitted to 50% dietary restriction (pairfed with control group) throughout pregnancy (Rtgroup), during the first half of pregnancy (R1 group) or during the second half of pregnancy (R2 group) were studied 3 months after birth. Glomerular filtration rate (GFR) and renal plasma flow (RPF) decrease significantly in all groups when compared to control (C) (GFR, 4.44 ñ 0.12, 4.04 ñ 0.18, and 4.00 ñ 0.16 vs 6.87 ñ 0.17, and RPF, 19.06 ñ0.57, 17.00 ñ 1.14, and 13.31 ñ0.50 vs 22.57 ñ 0.67, respectively). Urinary osmolality tended to be lower in the R2 and Rt groups (887.1 ñ 42.36 and 868.0 ñ 42.36 vs 975.1 ñ 38.31 in C), and the net acid excretion calculated per ml of GFR was either maintained or stimulated (R1 group). A significant decline in the number of glomeruli occurred in R1, R2 and Rt rats (79.84 ñ 2.08, 62.30 ñ 2.07, and 58.16 ñ 2.32 vs 99.77 ñ 2.28 in C repectively). The results show that intrauterine undernutrition actually caused a deleterious effect on the number of functional nephrons

Function and morphometric evaluation of intrauterine undernutrition on kidney development of the progeny.

Renal function and renal morphometry of the progeny of rats submitted to 50% dietary restriction (pair-fed with control group) throughout pregnancy (RT group), during the first half of pregnancy (R1 group) or during the second half of pregnancy (R2 group) were studied 3 months after birth. Glomerular filtration rate (GFR) and renal plasma flow (RPF) decreased significantly in all groups when compared to control (C) (GFR, 4.44 +/- 0.12, 4.04 +/- 0.18, and 4.00 +/- 0.16 vs 6.87 +/- 0.17, and RPF, 19.06 +/- 0.57, 17.00 +/- 1.14, and 13.31 +/- 0.50 vs 22.57 +/- 0.67, respectively). Urinary osmolality tended to be lower in the R2 and RT groups (877.1 +/- 42.36 and 868.0 +/- 42.36 vs 975.1 +/- 38.31 in C), and the net acid excretion calculated per ml of GFR was either maintained or stimulated (R1 group). A significant decline in the number of glomeruli occurred in R1, R2 and RT rats (79.84 +/- 2.08, 62.30 +/- 2.07, and 58.16 +/- 2.31 vs 99.77 +/- 2.28 in C respectively). The results show that intrauterine undernutrition actually caused a deleterious effect on the number of functional nephrons.

Effects of intrauterine undernutrition on the renal function of the progeny

The progency of rats submitted to 50% food restriction during a) the first 11 days of pregnancy (R1 group) and b) the entire period of pregnancy (RT group) was studied for renal function. After birth, the litter was left with the mother for 28 days and allowed free access to food and water until the experimental time, which occurred 3 months after birth. Glomerular filtration rate (GFR), renal plasma flow (RPF) and urinary flow (V) decreased significantly in both the Rl and RT groups when compared to control rats (C) (GFR = 4.44 + or 0 0.12 and 4.26 + or - 0.17 vs 6.95 + or - 0.25, and RPF = 19.06 + or - 0.57 and 12.59 + or - 0.60 vs 24.64 + or - 1.18). However, net acid excretion calculated per ml GFR was maintained or even stimulated (AB = 12.63 + or - 0.44 and 8.31 + or - 0.29 vs 7.97 + or - 0.85). The results show that a definite impairment of glomerular hemodynamics is demonstrable 3 months after birth in the progeny of mothers submitted to severe food restriction during pregnancy, even when the progeny have been on a normal diet for 2 months after suckling

Síndrome HELLP: a propósito de un caso / HELLP syndrome: apropos of a case

Se presenta un caso clínico de síndrome HELLP y se realiza una revisión de la literatura. El síndrome es una variedad de la peeclampsia consistente en hemólisis microangiopática, trombocitopenia y falla hepatocelular: se debería a un desequilibrio en la sínteses de prostaglandinas, con aumento de tromboxano y disminución de prostaciclina. El pronóstico es malo, con mortalidad perinatal de 8-36% y materna de l,8-3,5%. Como conclusión, el síndrome HELLP es un índice de severidad de la pre-eclampsia, y su manejo debe ser agresivo, con interrupción inmediata del embarazo

Monitoreo fetal: control electrónico de la frecuencia cardiaca fetal durante el embarazo y el parto

Condensa el conocimiento que actualmente se posee sobre el monitoreo fetal, sirve de punto de partida para los profesionales que tienen interés en profundizar sus conocimientos sobre el tema o desean iniciar investigaciones científicas

Monitoreo fetal: control electrónico de la frecuencia cardiaca fetal durante el embarazo y el parto

Condensa el conocimiento que actualmente se posee sobre el monitoreo fetal, sirve de punto de partida para los profesionales que tienen interés en profundizar sus conocimientos sobre el tema o desean iniciar investigaciones científicas

[Placental pathology of the small-for-gestational-age newborn infant]. / Patología placentaria en el recién nacido pequeño para la edad gestacional.

The problem of the newborn that is small for its gestational age is emphasized. Fetal growth is dependent upon the growth potential of the fetus and the availability of intrauterine nutrition. Proper nourishment for optimal fetal growth will require adequate maternal and placental circulations, sufficient quantities of circulating nutrients in the maternal blood, and a proper area of placental membrane, which is capable of achieving satisfactory maternal-fetal transfer. Many factors appear to produce this syndrome including genetic anomalies, intrauterine infection and deficiencies of placenta and cord, but in most small-for-dates infantes the common underlying situation appears to be a state of intrauterine malnutrition, mediated by a maternal-fetal vascular insufficiency. Placental factor probably accounts for only a small proportion of deprived fetuses. However, the present knowledge on the histopathology of the placenta from cases of small-for-date babies is relatively poor to reach a final conclusion. More research in the direction of the maternal side of the placenta and in particular to the placental bed, including more complete study of the lesions in the uteroplacental vessels will probably clarify the problem of fetal growth retardation.