Development of a predictive model of body fat mass for newborns and infants.

OBJECTIVES: The aim of this study is to develop predictive body fat mass models, one for newborns and one for infants, using air displacement plethysmography as a reference method. METHODS: The study was carried out with 125 newborns (1-5 d of age) and 71 infants (≥3-6 mo). The stepwise method was used to estimate the final model from the predictors of sex, weight, length, triceps skinfold, waist circumference, mean arm circumference, and gestational age. The quality of the models was evaluated by the determination coefficient, variance inflation factor, and residual analysis. The paired t test and Bland-Altman plot were used to assess the agreement between observed and estimated values. RESULTS: The final model for newborns was - 0.76638 + 0.2512 * weight (kg) + 0.0620 * PCT (mm) + 0.0754 * gender (R² = 70%) and the final model for infants: -2.22748 + 0.4928 * weight (kg) + 0.0737 * TSF (mm) + 0.2647 * gender (R² = 84%). CONCLUSIONS: This work determined equations to estimate the BFM of term newborns and infants. The models can be used in clinical practice, especially in health units without access to technologies for measuring body composition, adding important information for nutritional monitoring.

Does pregabalin act in pain control after lateral pharyngoplasties and tonsillectomies? A pilot study.

OBJECTIVE: Some studies have pointed to gabapentinoids as promising medications in postoperative pain control. The objective of the present study was to evaluate the efficacy of pregabalin in reducing postoperative pain in tonsillectomy and lateral pharyngoplasties. STUDY DESIGN: Double-blind randomized controlled trial. SETTING: Tertiary care center. METHODS: A double-blind randomized controlled trial was conducted with patients undergoing tonsillectomies and lateral pharyngoplasties between Aug 29, 2017, and Oct 31, 2020. Data of interest such as opioid consumption, pain scores, and adverse outcomes such as dizziness, nausea, headache, and sedation within 7 days following surgeries were analyzed. RESULTS: No statistically significant difference was observed in pain scores and opioid consumption between the groups studied in the pilot project. The use of pregabalin was associated with lower incidence of dizziness compared to controls. CONCLUSION: Gabapentinoids, especially pregabalin, are drugs whose potential for controlling pain after pharyngeal surgery, such as tonsillectomy and sleep apnea surgery, still needs to be more fully evaluated. After the conclusion of the present study, we hope to answer this question about the role of pregabalin in oropharyngeal surgeries.

Body composition at 4 to 7 years of age in children born <32 weeks gestational age or 1500 g: A cohort study.

BACKGROUND: Small for gestational age preterm infants show differences in body composition when compared to those appropriate for gestational age at term, which have consequences on metabolism. AIM: To compare growth and body composition of children born small and appropriate for gestational age between 4 and 7 years. METHOD: A Cohort of small and appropriate for gestational age infants <32 weeks or 1500 g were followed at term and 3 months corrected ages and at 4 to 7 years. Body composition assessment by air displacement plethysmography and anthropometry were performed at all moments. Differences between the two groups were assessed using t-student and Chi-square tests. RESULTS: Ninety-four infants were included at term (26 small and 68 appropriate for gestational age); 88 at 3 months (24 small and 64 appropriate for gestational age) and 47 between 4 and 7 years (11 small and 36 appropriate for gestational age). At term, small for gestational age infants had lower fat-free mass, fat mass, weight and length compared with those appropriate for gestational age (p < 0.001). At 3 months, fat-free mass (grams) remained lower in small for gestational age group (p < 0.001). Between 4 and 7 years, body composition and anthropometry were similar between the groups. CONCLUSION: Between 4 and 7 years, children born small and appropriate for gestational age had similar body composition. New long-term longitudinal studies are necessary to understand the influence of fat-free mass and fat mass in the first months of age on body composition throughout life.

Dietary and nutritional interventions in children with cerebral palsy: A systematic literature review.

BACKGROUND: Cerebral palsy is an extremely severe brain injury associated with multiple nutritional and clinical issues, such as underweight, gastroesophageal reflux, constipation, and nutrient deficiency. Evidence-based dietary and nutritional interventions may improve the quality of life of children with cerebral palsy. AIM: Systematically review randomized clinical trials evaluating nutritional and dietary interventions in the clinical, nutritional, and neurodevelopmental aspects of children with cerebral palsy. METHODS: A search was performed in electronic databases (LILACS, Medline, Web of Science, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, Brazilian Digital Library of Theses and Dissertations, ProQuest Dissertations and Theses Database, OpenGrey) using keywords. The search was firstly performed in May 2020 and updated on June 18th, 2021. Eligible studies were randomized clinical trials, that included children between 2 and 12 years old, and evaluated the effect of nutritional or dietetic interventions on clinical, nutritional or neurodevelopmental outcomes. Risk of bias was investigated using the RoB-2 tool. The study was registered on PROSPERO (CRD42020181284). RESULTS: Fifteen studies were selected. Positive results included the use of whey-based or pectin-enriched enteral formulas for gastroesophageal reflux (n = 6); 25-hydroxy-vitamin D supplementation for hypovitaminosis D (n = 2); supplementation with lipid mixture or diet with high-density energy for improvements in anthropometric measures (n = 2); supplementation with probiotics, prebiotics, symbiotics or magnesium for constipation (n = 2); nutritional support system for gross motor function (n = 1); lactoferrin and iron hydroxide polymaltose for iron deficiency anemia (n = 1); and educational intervention to improve feeding skills (n = 1). The overall risk of bias was high for 60% of the studies, and some concerns were raised for the remaining 40%. CONCLUSION: Some promising dietary and nutritional interventions may promote important clinical improvements for patients with cerebral palsy. However, evidence is weak, as few clinical trials have been published with many methodological errors, leading to a high risk of bias.

Toxoplasmosis in pregnancy: a clinical, diagnostic, and epidemiological study in a referral hospital in Rio de Janeiro, Brazil.

Toxoplasmosis in pregnant women can cause significant morbidity and mortality in the fetus, which may be mitigated by early diagnosis and treatment. Social factors have also been related to the risk of developing the congenital form of toxoplasmosis, since some of these factors interfere directly in the quality of prenatal care. This study aimed to describe the clinical, laboratory, and epidemiological data of pregnant women diagnosed with toxoplasmosis and their newborns followed up at a referral hospital in Rio de Janeiro, Brazil. This was descriptive cohort study of 334 pregnant women with toxoplasmosis followed from May 2014 to December 2017. We conducted interviews to assess knowledge about the disease and its preventive measures, analyzed clinical and laboratory data during antenatal visits, and collected data from the newborns' medical charts. RESULTS: This was a predominantly low-income women cohort study, with little schooling, mainly referred from public health services late in pregnancy (178; 53.3%), in the second and third trimesters (286; 85.6%). Diagnosis of acute toxoplasmosis had not been confirmed in 171 cases (51.2%). Out of 183 (54.9%) women who had initiated treatment at the original health services, 45 (24.6%) received an incorrect prescription. Seventy-two amniocenteses were performed, with positive real-time polymerase chain reaction (qPCR) in the amniotic fluid in two cases (2.8%). Congenital toxoplasmosis at birth was identified in eight newborns (5.4%). CONCLUSION: Late referral to specialized medical services, inadequate toxoplasmosis management at the original prenatal care services, and social vulnerabilities are contributing factors to the persistent occurrence of congenital toxoplasmosis cases.

Predictors of perinatal outcome in early-onset fetal growth restriction: A study from an emerging economy country.

OBJECTIVE: To identify antenatal predictors of adverse perinatal outcomes in a population of preterm fetuses with early placental insufficiency diagnosed by Doppler abnormalities. METHOD: In this cross-sectional study of a cohort of singleton pregnant women diagnosed with early placental insufficiency, relationships between perinatal variables (arterial and venous Doppler, gestational age, birth weight, oligohydramnios, estimated fetal weight, and fetal weight z-scores) and major neonatal complications were analyzed by logistic regression. RESULTS: Two hundred sixty-five women were delivered, between 24 and 33 weeks gestation. The overall frequency of intact survival was 57.9% (n = 154). Gestational age thresholds for best prediction of survival was 27 + 6 weeks and for intact survival was 29 + 0 weeks gestation. Fetal weight and absent/reversed ductus venosus a-wave were the main predictors of survival in the regression model. When fetal weight was substituted for fetal weight z-score, ductus venosus abnormal Doppler predicted mortality and absent or reversed umbilical artery diastolic velocities predicted intact survival. CONCLUSIONS: This study illustrates the impact of gestational age and fetal weight on perinatal outcomes in early placental insufficiency, with well-defined thresholds. Gestational age and fetal weight, or a combination of fetal weight z-scores and fetal Doppler parameters, were the best predictors of intact survival in our sample.

Analysis of the Performance of 11 Formulae for Fetal Weight Estimation in Preterm Fetuses with Abnormal Doppler Velocimetry - A Retrospective Multicenter Study.

OBJECTIVE: To assess 11 formulae commonly used to estimate fetal weight in a population of premature fetuses who had abnormal Doppler velocimetry due to early-onset placental insufficiency. The performance of each formula was evaluated in subgroups of fetuses with expected growth and intrauterine growth restriction. METHODS: Data were collected from fetuses and mothers who delivered at three Brazilian hospitals between November 2002 and December 2013. We used the following formulae: Campbell; Hadlock I, II, III, IV and V; Shepard; Warsof; Weiner I and II; and Woo III. RESULTS: We analyzed 194 fetuses. Of these, 116 (59.8%) were considered appropriate for gestational age (AGA), and 103 (53.1%) were male. The amniotic fluid volume was reduced in 87 (44.8%) fetuses, and the umbilical artery Doppler revealed absence or inversion of diastolic flow in 122 (62.9%) cases, and the analysis of the ductus venosus revealed abnormal flow in 60 (34.8%) fetuses. The Hadlock formulae using three or four fetal biometric parameters had low absolute percentage error in the estimated fetal weight among preterm fetuses with abnormal Doppler studies who were born within 5 days of the ultrasound evaluation. The results were not influenced by the clinical and ultrasound parameters often found in early-onset placental insufficiency. CONCLUSION: In this study, the formulae with the best performance for fetal weight estimation in the analyzed population were Hadlock I and IV, which use four and three fetal biometric parameters respectively to estimate the weight of preterm fetuses with abnormal Doppler studies.

OBJETIVO: Avaliar o desempenho de 11 fórmulas comumente utilizadas para estimativa de peso fetal em uma população de fetos prematuros com dopplervelocimetria alterada devido a insuficiência placentária de início precoce. O desempenho de cada fórmula foi avaliado em subgrupos de fetos com crescimento adequado e com crescimento intrauterino restrito. MéTODOS: Foram coletados os dados de mães e fetos cujos partos foram acompanhados em 3 instituições brasileiras entre novembro de 2002 e dezembro de 2013. As fórmulas selecionadas para análise foram: Campbell; Hadlock I, II, III, IV e V; Shepard; Warsof; Weiner I e II; e Woo III. RESULTADOS: Foram analisados os pesos de 194 fetos, dos quais 116 (59,8%) foram considerados adequados para a idade gestacional, 103 (53,1%) eram do sexo masculino, em 87 (44,8%) havia redução do volume de líquido amniótico, em 122 (62,9%) o Doppler de artéria umbilical demonstrou ausência ou inversão do fluxo na diástole, e em 60 (34,8%) a análise do duto venoso indicou fluxo anormal. A média do erro percentual absoluto (EPA) demonstrou que as fórmulas de Hadlock que utilizam 3 ou 4 parâmetros biométricos fetais apresentaram o melhor desempenho. Os resultados obtidos para essas fórmulas não sofreram influência dos parâmetros clínicos e ultrassonográficos frequentemente encontrados na insuficiência placentária de início precoce. CONCLUSãO: O presente estudo demonstrou o melhor desempenho das fórmulas de Hadlock que contêm 3 ou 4 parâmetros da biometria para estimativa de peso de fetos prematuros com anormalidades ao mapeamento Doppler.

Growth and body composition of preterm infants less than or equal to 32 weeks: Cohort study.

BACKGROUND: Extremely preterm infants with weights less than the 10th percentile at discharge have a fat-free mass deficit. AIM: To analyze the relationship of weight Z-scores less than -2SD at term age with fat-free mass and fat mass at term age and at 1 and 3 months of corrected age in very preterm infants. STUDY DESIGN: COHORT STUDY: Subjects: Sixty-six preterm infants born before or at 32 weeks gestation with birth weight equal or greater than the 10th percentile for age were included at term age. They were classified according to weight Z-score as either: "term (-)" (n = 18) if weight Z-scores were less -2SD or "term (+)" (n = 48) if the weight Z-scores were equal or greater than -2SD at term age. OUTCOME MEASURES: Growth and body composition by an air displacement plethysmography system and bioimpedance were assessed at term age and 1 and 3 months of corrected age. RESULTS: Lower fat-free mass persisted up to 3 months in the "term (-)" group [4137 g (645) vs 4592 g (707), p < .01]. Fat mass was lower in the "term (-)" group at term and at 1 month but was similar at 3 months of corrected age [1295 g (774) vs 1477 g (782), p = .109]. Weight, length and head circumference Z-scores were lower in the "term (-)" group compared to those in the "term (+)" group. CONCLUSIONS: The lean tissue deficits were maintained in the "term (-)" group while the differences in body fat percentage were not.