Energy expenditure in very low birth weight newborns: a comparison between small and appropriate-for-gestational-age.

AIMS: To compare resting energy expenditure (REE) in small- and appropriate-for-gestational-age very low birth weight newborns after reaching corrected at-term age. METHODS: Observational study that included all clinically stable very low birth weight newborns admitted to a neonatal intensive care unit. The newborns were classified as small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA). Resting energy expenditure was measured using indirect calorimetry when the newborns reached at-term age. RESULTS: A total of 51 newborns, of which 23 were SGA and 28 AGA, were included. There was no statistically significant difference in REE between the two groups, although the observed levels were higher than the reference values. CONCLUSION: There is no statistical difference in resting expenditure energy between SGA and AGA infants when they reached term. The higher energy expenditure found in both groups may be explained by other factors related to prematurity and its complications and requires further investigation.

Multicenter, double-blind, comparative clinical study on the efficacy and acceptability of a monthly injectable contraceptive combination of 150 mg dihydroxyprogesterone acetophenide and 10 mg estradiol enanthate compared to a monthly injectable contraceptive combination of 90 mg dihydroxyprogesterone acetophenide and 6 mg estradiol enanthate.

Healthy, regularly menstruating women, aged 14-38 years, were enrolled in a comparative, double-blind, phase III, clinical trial to evaluate the contraceptive efficacy and acceptability of a combination of 90 mg dihydroxyprogesterone acetophenide with 6 mg estradiol enanthate compared to the commercially available contraceptive combination of 150 mg dihydroxyprogesterone acetophenide with 10 mg estradiol enanthate. Subjects received the contraceptive combination intramuscularly, between the 7th and 10th day of each menstrual cycle, during 12 consecutive menstrual cycles. Approximately 60% of the subjects in both groups completed the study. Principal reasons for discontinuation were personal, nonmedical reasons. Principal medical reasons for discontinuation were menstrual-related, irregular bleeding being the most frequent. Differences in menstrual patterns between the two groups did not lead to differences in discontinuation rates. Three contraceptive failures occurred during the trial, one in Group A (90/6 mg) and two in Group B (150/10 mg), indicating that the lower dose formulation is at least as efficient as the higher dose.

[A difficult and delicate task: prescribing contraception for adolescents]. / Uma tarefa ardua e delicada: prescrever a contracepcao para adolescentes.

PIP: The choice of the most appropriate contraceptive method, when its use is begun, and the motivation of adolescents to use it, are significant factors in adolescent contraceptive continuation. The contraceptive method must suit the personality of the adolescents, who are insecure in most cases, less stable emotionally, rebellious, and uninformed. This pattern can induce constant changes of partners, and accidental and unpredictable sexual activity. Since adolescence is a period of biological and psychological transformation, the contraceptive must be highly effective, safe, and well-tolerated, so that its side effects should not prejudice the continuation of its use. The behavioral contraceptive methods, coitus interruptus, ovulation, and sympto-thermal methods, are contraindicated for adolescents because of their low effectiveness and the requirement of a great deal of discipline. The condom, diaphragm, and spermicides can prevent sexually transmitted diseases, thus they are optimal for adolescents. Their effectiveness is higher than that of behavioral methods but could be better, and they require a certain discipline, which limits sexual spontaneity. The IUD is contraindicated in adolescents and in women who have never given birth, because of the possibilities of pelvic inflammation resulting in pain and bleeding and expulsion of the IUD. The use of hormonal contraception is recommended only two years after the first menstruation, for fear of interference in the biological development of the adolescent. Recent studies have shown that modern low-dose oral contraceptives (OCs) do not exert harmful effects on the adolescent organism. While paying heed to contraindications, OCs can be indicated for this age group. Hormonal contraceptives are effective, safe, and well-tolerated by the majority of patients. They regulate menstruation, and provide beneficial effects such as the reduction of dysmenorrhea and the protection against pelvic inflammatory diseases, benign diseases of the breast, and even uterine and ovarian cancer.^ieng