Myeloperoxidase as cardiovascular risk marker in pre-pubertal preterm children?

BACKGROUND AND AIMS: To evaluate the biomarkers related to cardiovascular risk in pre-pubertal preterm children with a birth weight of less than 1,500 g and relate them to current nutritional status, insulin resistance, and inflammation. METHODS & RESULTS: This is a cross-sectional, controlled study with pre-pubertal preterm children aged 5-9 years with a birth weight of less than 1500 g (Preterm group, n = 44) compared to full term children of adequate weight for gestational age (Control group, n = 30). Clinical evaluation: anthropometry and pubertal staging. Laboratory tests: total cholesterol and fractions, triglycerides, paraoxonase 1, apolipoproteins A-I and B, myeloperoxidase (MPO), high sensitivity C-reactive protein (hs-CRP), glycemia and insulin (to calculate HOMA-IR). In the preterm group, 19 (43.2%) were male, with mean birth weight and gestational age of 1157 ± 242 g and 30.0 ± 2.3 weeks, respectively. The preterm group showed lower concentrations of HDL-c (60.1 ± 10.1 vs. 69.0 ± 10.0 mg/dL; p < 0.001); higher concentrations of hs-CRP [0.55 mg/dL (0.30; 39.4) vs. 0.30 mg/dL (0.30; 10.80); p = 0.043], of MPO [21.1 ng/mL (5.7; 120.0) vs. 8.1 ng/mL (2.6; 29.6); p < 0.001] and of MPO/HDL-c ratio [0.39 (0.09; 2.07) ng/mg vs. 0.11 (0.05; 0.58)]. The MPO/HDL-c ratio was the variable that showed the best discriminatory power between the groups (AUC = 0.878; 95% CI; 0.795-0.961). MPO concentrations in the preterm group were correlated with those of hs-CRP (r = 0.390; p = 0.009), insulin (r = 0.448; p = 0.002) and HOMA-IR (r = 0.462; p = 0.002). CONCLUSION: Prepubertal preterm children show high MPO concentrations and MPO/HDL-c ratio that are associated with inflammation and oxidative stress, which, in turn, may be associated with atherosclerosis.

Renal function in prepubertal children born with very low birthweight.

OBJECTIVES: The objective of this study was to evaluate estimated glomerular filtration rates (eGFR) and markers of renal function in very low birthweight (VLBW) children and to relate these parameters to current nutritional status. METHODS: A cross-sectional and controlled study was performed with prepubertal children between ages 5 and 10, including 44 VLBW participants and 30 healthy participants born at full term with an adequate birthweight (control group). The following data were collected: perinatal history; current weight, height and waist circumference; blood pressure (three measures); blood creatinine, urea, uric acid, cystatin-C, and neutrophil gelatinase-associated lipocalin levels; and urine albumin, creatinine, and calcium levels. RESULTS: Blood pressure, eGFR, albuminuria, concentrations of cystatin-C, neutrophil gelatinase-associated lipocalin, uric acid, urea, creatinine, and fractional calcium excretion did not differ between VLBW and control groups. Regarding the VLBW group, there was no difference in eGFR, albuminuria, and other markers of renal injury in overweight or obese children compared with children with a normal body mass index. CONCLUSIONS: Prepubertal children born with VLBW did not have altered renal function, regardless of their current nutritional status.

Avaliação da assistência ao parto em gestantes infectadas pelo HIV / Evaluation of delivery assistance in HIV infected pregnant women

Introdução: A transmissão vertical é a principal via de infecção pelo HIV em crianças. A maior parte dos casos de transmissão vertical do HIV (cerca de 65%) ocorre durante o trabalho de parto e no parto, e os 35% restantes ocorrem intra-útero e através do aleitamento materno. Atualmente, a taxa de transmissão vertical do HIV, sem qualquer intervenção, é de aproximadamente 20%, porém, diversos estudos publicados na literatura demonstram uma redução para níveis entre zero e 2% com o uso de antiretrovirais durante a gestação e o parto, cesárea eletiva em casos selecionados, uso de AZT xarope para o recém-nascido e contra-indicação do aleitamento materno. Objetivo: Avaliar a assistência ao parto das gestantes do Hospital Municipal Universitário de São Bernardo do Campo (HMUSBC) infectadas pelo HIV. Método: Estudo retrospectivo de 54 gestantes HIV-positivo, admitidas no HMUSBC para assistência ao parto, no período de Janeiro de 1999 a Junho de 2005. Resultados: Dentre as parturientes, 59% tinham idade entre 25 e 34 anos; 72% apresentavam idade gestacional maior ou igual a 38 semanas; 94% fizeram acompanhamento pré-natal; 52% utilizaram Zidovudina (AZT) associado a outros antiretrovirais durante a gestação. Quanto ao parto, 41% foram cesáreas eletivas e 78% receberam AZT intraparto. Para os recém-nascidos, 91% pesavam mais que 2.500 g. De todas as parturientes que fizeram pré-natal (n = 51) 80% recebeu AZT intraparto (p = 0,05) e 95% das parturientes que foram submetidas à cesariana receberam AZT intraparto (p = 0,001). Conclusão: A cesárea eletiva contribui significativamente para a administração de AZT intraparto; a realização do pré-natal favoreceu ao uso de AZT intraparto; de modo geral, o HMUSBC segue as orientações do Ministério da Saúde.