The effect of obesity on the mortality of hospitalized adults with COVID-19 considering the human development index: A systematic review and meta-analysis.

The objective of this study is to verify the association between obesity and mortality in hospitalized patients with SARS-CoV-2 taking into account the Human Development Index (HDI). A search was performed in the PubMed, Virtual Health Library (Lilacs/Bireme/VHL Brazil), Embase, Web of Science, and Scopus databases from inception to May 2022. To be eligible, studies had to have cohort or case-control designs, be conducted with hospitalized adults (≥18 years old), and evaluate mortality rates between with obesity and without obesity individuals with SARS-CoV-2 confirmed by laboratory tests. The analyses were performed in Stata 12.0 using relative risk (RR) as a summary measure. Heterogeneity was explored by meta-regression and subgroup analyses considering the HDI, age, sex, and follow-up period. Out of 912 studies screened, 49 studies were eligible for qualitative synthesis, and 33 studies were eligible for quantitative analysis, representing 42,905 patients. The mortality risk from SARS-CoV-2 was higher in individuals with obesity compared with without obesity individuals only in the subgroups of patients <60 years old (RR = 1.31; 95% CI 1.18-1.45, I2  = 0.0%) and living in countries with a low HDI (RR = 1.28; 95% CI 1.10-1.48, I2  = 45.4%).

Mismatch Negativity is associated with affective social behavior in microcephaly.

Some children with severe microcephaly related to Zika virus infection show affective social-like behavior, such as smiling and rejection to a stranger's lap. Our objective was to check the association between this behavior and the occurrence of Mismatch Response (MMR) in event-related potentials. Twenty eight microcephalic children, aged 1-3 years, were divided in Affect(+) and Affect(-) groups, according to either the presence or absence of affective social-like behavior, respectively, and underwent the OddBall paradigm with vowels as auditory stimuli. MMR was statistically estimated comparing MMR sample means between both groups. The Affect(+) group significantly differed from the Affect(-) group and, as opposed to the latter, showed MMR as Mismatch Negativity (MMN) in the left occipital, left and right posterior temporal, and (especially) the right and median parietal leads. The relationship observed between MMN and affective social-like behavior suggests that these children may have cognitive mechanisms capable of providing some social interaction, despite their profound neurological dysfunction. MMN diagnostic techniques seem to be promising for the triage of microcephalic subjects regarding cognitive functions and for choosing a strategy for some social adaptation.

Stigmas of congenital Zika syndrome: family perspectives.

This article uses a socio-anthropological framework to explore the stigmas around interactions with children born with congenital Zika syndrome caused by the Zika virus epidemic in two Brazilian municipalities. Semi-structured interviews were conducted with parents and other relatives. We reflected on the search for meaning when having a baby with unexpected body marks, the moral suffering, the societal ableism, the burden of care, and the need for support networks. We concluded that public policies, especially social policies (health, education, and social assistance), are essential for compensatory mechanisms, recognition, and social inclusion of these children and their families.

Stigmas of congenital Zika syndrome: family perspectives / Estigmas da síndrome da Zika congênita: perspectivas das famílias / Estigmas del síndrome Zika congénito: perspectivas familiares

This article uses a socio-anthropological framework to explore the stigmas around interactions with children born with congenital Zika syndrome caused by the Zika virus epidemic in two Brazilian municipalities. Semi-structured interviews were conducted with parents and other relatives. We reflected on the search for meaning when having a baby with unexpected body marks, the moral suffering, the societal ableism, the burden of care, and the need for support networks. We concluded that public policies, especially social policies (health, education, and social assistance), are essential for compensatory mechanisms, recognition, and social inclusion of these children and their families.

O artigo adota um referencial socioantropológico para explorar os estigmas subjacentes às interações com crianças que nascem com a síndrome congênita do vírus Zika provocada pela epidemia de Zika em duas cidades brasileiras. Foram realizadas entrevistas semiestruturadas com os pais e outros familiares. Os autores refletem sobre a busca de sentido ao ter um filho com marcas corporais inesperadas, sofrimento moral, capacitismo, o fardo pesado dos cuidados e a necessidade de redes de apoio. Concluem que políticas públicas, principalmente sociais (saúde, educação e assistência social) são essenciais para produzir mecanismos compensatórios, reconhecimento e inclusão social dessas crianças e de suas famílias.

Este artículo adopta un marco socioantropológico para investigar los estigmas subyacentes a las interacciones con niños, nacidos con el síndrome congénito del virus Zika, causado por la epidemia de Zika en dos ciudades brasileñas. Se realizaron entrevistas semiestructuradas con padres y otros parientes. Reflejamos en la investigación el significado de tener un bebé con marcas corporales inesperadas, sufrimiento moral, razón de la discapacidad social y carga de cuidado, así como la necesidad de redes de apoyo. Concluimos que las políticas públicas, especialmente las políticas sociales (salud, educación, y asistencia social), son cruciales produciendo mecanismos compensatorios, reconocimiento e inclusión social de estos niños y sus familias.

Prevalence and factors associated with surfactant use in Brazilian Neonatal Intensive Care Units: A multilevel analysis.

The treatment with exogenous surfactant reduces mortality and the risk of complications in preterm newborns with Respiratory Distress Syndrome. Higher usage levels have been associated with individual and institutional factors. The study aimed to identify these factors associated with use of this technology in 16 public Brazilian Neonatal Units using logistic multilevel analysis. In a sample of 630 newborns the use at some time was 82.6%. Only 24.7% made use of this technology up to two hours after birth. An intraclass correlation of 0.30 showed that 30% of the variance in the use of exogenous surfactant could be assigned to the contextual level. In the final model, a greater severity score (SNAPPE-II) was associated with increased surfactant use (OR = 2.64), whereas being small for gestational age (SGA) (OR = 0.59) was associated with lower use of this technology. At the contextual level the number of beds in the unit >15 (OR = 5.86), units with higher complexity (OR = 1.73) or units with implemented Kangaroo Mother Care (OR = 2.91), especially units in Rio de Janeiro state (OR = 16.17) were associated with greater surfactant use. Although individual clinical features explained most of the variation in the use of this technology, factors linked to the institution were also of utmost importance.

Prevalence and factors associated with surfactant use in Brazilian Neonatal Intensive Care Units: A multilevel analysis / Prevalência e fatores associados ao uso de surfactante em unidades de Terapia Intensiva Neonatais brasileiras: análise multinível

Abstract The treatment with exogenous surfactant reduces mortality and the risk of complications in preterm newborns with Respiratory Distress Syndrome. Higher usage levels have been associated with individual and institutional factors. The study aimed to identify these factors associated with use of this technology in 16 public Brazilian Neonatal Units using logistic multilevel analysis. In a sample of 630 newborns the use at some time was 82.6%. Only 24.7% made use of this technology up to two hours after birth. An intraclass correlation of 0.30 showed that 30% of the variance in the use of exogenous surfactant could be assigned to the contextual level. In the final model, a greater severity score (SNAPPE-II) was associated with increased surfactant use (OR = 2.64), whereas being small for gestational age (SGA) (OR = 0.59) was associated with lower use of this technology. At the contextual level the number of beds in the unit >15 (OR = 5.86), units with higher complexity (OR = 1.73) or units with implemented Kangaroo Mother Care (OR = 2.91), especially units in Rio de Janeiro state (OR = 16.17) were associated with greater surfactant use. Although individual clinical features explained most of the variation in the use of this technology, factors linked to the institution were also of utmost importance.

Resumo O tratamento com surfactante exógeno reduz a mortalidade e o risco de complicações em recém-nascidos com Síndrome de Angústia Respiratória. Maiores níveis de utilização dessa tecnologia têm sido associados tanto a fatores individuais como institucionais. O estudo teve como objetivo identificar esses fatores em 16 unidades neonatais públicas brasileiras usando análise multinível. De 630 recém-nascidos, 82,6% usaram a tecnologia em algum momento. Apenas 24,7% fizeram uso até duas horas após o nascimento. Uma correlação intraclasse de 0,30 mostrou que 30% da variação no uso podem ser atribuídos ao nível contextual. No modelo final, um escore de gravidade maior (SNAPPE-II) foi associado com aumento do uso de surfactante (OR = 2,64), enquanto que ser pequeno para a idade gestacional (PIG) (OR = 0,59) foi associado a um menor uso dessa tecnologia. No nível contextual o número de leitos na unidade > 15 (OR = 5,86), as unidades com mais alta complexidade (OR = 1,73) ou unidades com Método Canguru implementado (OR = 2,91), especialmente unidades no estado do Rio de Janeiro (OR = 16,17), foram associados com uma maior utilização de surfactante. Embora características individuais tenham explicado a maior parte da variação no uso desta tecnologia, fatores ligados à instituição também foram de extrema importância.

Neurogenic bladder findings in patients with Congenital Zika Syndrome: A novel condition.

INTRODUCTION: Congenital Zika Syndrome (CZS) has been associated with microcephaly and other central nervous system abnormalities including areas that have been implicated in the control of the lower urinary tract. As such, this descriptive case series has aimed to investigate whether CZS is linked with neurogenic bladder. Identifying such an association is paramount in the effort to recognize CZS complications that have putative treatment options that could mitigate the impact of CZS in infected children. METHODS: Following IRB approval, urological assessment was performed in all patients referred to our clinic between June 2016 and May 2017 who presented with confirmed CZS-associated microcephaly. The research protocol consisted of obtaining clinical history, laboratory tests, lower and upper urinary tract ultrasounds, as well as a diagnostic urodynamic evaluation. ZIKA virus infection was previously confirmed by maternal history and positive PCR in babies and mothers. Microcephaly and other central nervous system abnormalities were established based on neurological assessment and associated imaging of the central nervous system (CT head and/or Brain MRI). RESULTS: Twenty-two consecutive CZS patients were tested and confirmed to have neurogenic bladder. Of the 22 patients assessed, 21 presented with an overactive bladder combined with reduced bladder capacity and elevated detrusor filling pressures. Clinically significant increases in postvoid residual (PVR) were confirmed in 40% of cases while a urinary tract infection (UTI) was identified in 23% of cases. CONCLUSION: Neurogenic bladder, a known treatable health condition, was confirmed in 100% of patients tested in this study, most presenting with high-risk urodynamic patterns known to lead to renal damage when left untreated. Follow up studies are necessary to provide further insight onto long-term disease progression and to investigate the response to standard therapies for neurogenic bladder. Nonetheless, we emphasize the importance of proactive management of neurogenic bladder and prompt referral so as to help mitigate CZS disease burden for patients and their families.

Cardiac troponin T and illness severity in the very-low-birth-weight infant.

Introduction. Respiratory distress are very common in Very-low-birth-weight (VLBW) infants and Myocardial injury may play a role in the disease outcome. Cardiac troponin T (cTnT) is the most useful marker of injury in adult population, but has not been extensively studied in this population. Aim. To study the role of cTnT in VLBW infants and its association with clinical outcomes. Methods. All VLBW infants admitted to our NICU were included in the study. Echocardiography and blood samples for cTnT determination were collected at 24 and 48 hours of life, and values >0.1 ng/mL were considered CTnT-positive values. Results. A total of 116 neonates had their blood samples collected. The median cTnT concentration within 24 hours was 0.191 (0.1-0.79) ng/mL and within 48 hours was 0.293 (0.1-1.0) ng/mL. A logistic regression analysis showed that PDA, low GA, and use of dopamine were independently associated with positive cTnT and abnormal Dopplerfluxometry and diuretics use had protective effects and was independently associated with troponin values. Conclusion. We observed a high prevalence of positivecTnT values in VLBW infants associated with illness severity. Our findings suggest that cTnT may be a useful and early marker of myocardial injury in VLBW infants.

[Home environment and alterations in the development of children in a community of the outskirts of São Luís - MA]. / Ambiente domiciliar e alterações do desenvolvimento em crianças de comunidade da periferia de São Luís - MA.

The main bonds of infants in early childhood are established in the home environment. The home is fundamental for providing stimuli that can influence the development of the child. A cross-sectional study was conducted in a low income community in the outskirts of the city of São Luís to analyze the provision of stimuli in the home environment of 2-year-old children and the potential association with retardation in child development. A random sample of 176 2-year-old children registered in community outpatient healthcare departments was assessed. Two validated instruments were used, namely the Home Observation for Measurement of the Environment (HOME) Inventory and the Gesell Measurement of Development Scale. Data were gathered in the homes. Logistic regressions were carried out taking the Home Inventory (low or average/high) and the Gesell Scale (suspicion of delay/normal) as outcome variables. Low family income, low maternal and paternal schooling, number of residents, number of children < 5 years old and small number of rooms in the house were considered risk factors for low Home scores, which were associated with the suspicion of development delay. The quality and quantity of environmental stimuli in the family context proved to be essential for the development of the children evaluated.

Ambiente domiciliar e alterações do desenvolvimento em crianças de comunidade da periferia de São Luís - MA / Home environment and alterations in the development of children in a community of the outskirts of São Luís - MA

Na primeira infância, os principais vínculos da criança são estabelecidos no ambiente doméstico. Este é fundamental quanto à oferta de estímulos que podem influenciar seu desenvolvimento. Com o objetivo de analisar o ambiente domiciliar de crianças de 2 anos de idade, quanto à oferta de estímulos e à sua relação com suspeitas de atrasos de desenvolvimento, realizou-se estudo transversal, em comunidade de baixa renda na periferia de São Luis. Calculou-se amostra aleatória de 176 crianças de 2 anos de idade cadastradas em unidades de saúde da comunidade. Utilizaram-se dois instrumentos validados: o Inventory Home (medida de estímulos domiciliares) e a Gesell Scale (medida de desenvolvimento). Os dados foram coletados nas próprias casas. Foram realizadas regressões logísticas tendo como variáveis resposta o HOME (baixo ou médio/alto) e Gesell (com suspeita de atraso ou s/atraso). Renda familiar baixa, baixa escolaridade materna e paterna, nº de residentes, nº de filhos < 5 anos e baixo nº de cômodos foram fatores de risco para HOME baixo. Este, por sua vez, associou-se com a suspeita de atraso no desenvolvimento (Gesell baixo). A qualidade e a quantidade de estímulos ambientais presentes no contexto familiar mostraram-se fundamentais para o desenvolvimento global das crianças avaliadas.

The main bonds of infants in early childhood are established in the home environment. The home is fundamental for providing stimuli that can influence the development of the child. A cross-sectional study was conducted in a low income community in the outskirts of the city of São Luís to analyze the provision of stimuli in the home environment of 2-year-old children and the potential association with retardation in child development. A random sample of 176 2-year-old children registered in community outpatient healthcare departments was assessed. Two validated instruments were used, namely the Home Observation for Measurement of the Environment (HOME) Inventory and the Gesell Measurement of Development Scale. Data were gathered in the homes. Logistic regressions were carried out taking the Home Inventory (low or average/high) and the Gesell Scale (suspicion of delay/normal) as outcome variables. Low family income, low maternal and paternal schooling, number of residents, number of children < 5 years old and small number of rooms in the house were considered risk factors for low Home scores, which were associated with the suspicion of development delay. The quality and quantity of environmental stimuli in the family context proved to be essential for the development of the children evaluated.

SNAPPE-II application in newborns with very low birth weight: evaluation of adverse outcomes in severe placental dysfunction.

AIM: The aim of this study was to evaluate the ability of the admission Score for Neonatal Acute Physiology - Perinatal Extension-II (SNAPPE-II) to predict adverse outcome among premature very low birth weight (BW) infants with abnormal Doppler blood flow in the uterus secondary to severe placental insufficiency of early onset. METHODS: A total of 86 neonates, weighing between 360 and 1498 g, were studied. Descriptive statistics of the population were reported. The areas under the receiver operating characteristics curves for the SNAPPE-II were calculated. The calibration of the model was assessed using the technique of Hosmer-Lemeshow. Adverse outcome was defined as mortality or the development of the following diagnoses: (1) periventricular-intraventricular hemorrhage (PIH); (2) retinopathy of prematurity stage 3 or 4; (3) periventricular leukomalacia; (4) bronchopulmonary dysplasia; (5) necrotizing enterocolitis (NEC). RESULTS: The SNAPPE-II area under curve was 0.86 (95% CI: 0.78-0.94) for mortality and 0.76 (95% CI: 0.65-0.86) for the prediction of adverse outcomes. Analyzing each morbidity variable, the SNAPPE-II AUC varied between 0.51 for NEC and 0.72 for PIH. CONCLUSION: SNAPPE-II shows accuracy in the prediction of adverse outcome for this highly selective group of very low BW infants compromised by severe placental insufficiency.

Ruptura prematura das membranas amnióticas no pré-termo: fatores associados à displasia broncopulmonar / Preterm premature rupture of the fetal membranes: factors associated with bronchopulmonary dysplasia

OBJETIVO: identificar os fatores obstétricos e neonatais associados ao desfecho de displasia broncopulmonar em pacientes com amniorrexe prematura no pré-termo. MÉTODOS: foram analisados 213 prontuários do Instituto Fernandes Figueira, entre 1998 e 2002, cujas pacientes evoluíram com quadro de amniorrexe prematura <34 semanas de gestação. Foram excluídas gestações múltiplas. As variáveis de natureza clínico-obstétricas e neonatais foram cotejadas com o desfecho de displasia broncopulmonar. Os dados foram submetidos à análise bivariada, sendo os valores que exibiam significância estatística (p<0,05) submetidos à regressão logística. RESULTADOS: a prevalência de displasia broncopulmonar foi de 6.10 por cento. A análise univariada dos fatores associados ao desfecho de displasia broncopulmonar exibiu os seguintes resultados: tempo de ventilação mecânica neonatal >10 dias (OR: 54,00 [11,55-278,25] p=0,000); idade gestacional <30 semanas (OR: 6,33 [1,26-43,06] p=0,017) peso <1.000 g (OR: 4,82 [1,34-17,53] p=0,010); peso <1.500 g (OR: 14,09 [1,82-300,50] p=0,003; persistência do canal arterial (OR: 12,33 [3,07-50,10], p=0,000); doença da membrana hialina (OR: 8,46 [2,21-35,00] p=0,000); pneumonia congênita (OR: 7,48 [2,03-27,93] p=0,000); uso de surfactante neonatal (OR: 19,66 [4,54-97,76] p=0,000) e infecção neonatal (OR: 7,67 [0,99-163,79] p=0,049). No modelo multivariado final, somente as variáveis "ventilação mecânica">10 dias (p=0,001) e "uso de surfactante" (p=0,040) permaneceram independentemente associadas ao desfecho. CONCLUSÕES: observou-se que os fatores associados à displasia broncopulmonar são de natureza neonatal, sendo que a ventilação mecânica duradoura e o uso de surfactante neonatal influenciaram no desenvolvimento dessa doença.

PURPOSE: to analyze obstetric and neonatal factors associated with bronchopulmonary dysplasia outcome in patients with preterm premature amniorrhexis. METHODS: we analyzed 213 medical records of patients of Fernandes Figueira Institute who suffered premature amniorrhexis (<34 weeks of gestation) in the period from 1998 to 2002. Multiple gestations were excluded. Clinical-obstetric and neonatal variables were considered in relation to the bronchopulmonary dysplasia outcome. Data were subjected to bivariate analysis, and the values showing statistical significance (p<0.05) were subjected to logistic regression analysis. RESULTS: the prevalence of bronchopulmonary dysplasia was 6.10 percent. Univariate analysis of the factors associated with the pulmonary dysplasia outcome were: neonatal mechanical ventilation for more than ten days(OR: 54.00 [11.55-278.25] p=0.000); birth gestational age of less than 30 weeks (OR: 6.33 [1.26- 43.06] p=0.017); birth weight <1,000 g (OR: 4.82 [1.34-17.53] p=0.010); birth weight <1.500 g (OR: 14.09 [1.82-300.50] p=0.003; patent ductus arteriosus (OR: 12.33 [3.07-50.10], p=0.000); hyaline membrane disease (OR: 8.46 [2.21-35.00] p=0.000); congenital pneumonia (OR: 7.48 [2.03-27.93] p=0.000); use of neonatal surfactant (OR: 19.66 [4.54-97.76] p=0.000), and neonatal infection (OR: 7.67 [0.99-163.79] p=0.049). In the final multivariate model, only the variables "neonatal mechanical ventilation">10 days (p=0.001) and "use of a surfactant" (p=0.040) remained independently associated with bronchopulmonary dysplasia. CONCLUSIONS: the factors associated with bronchopulmonary dysplasia are related to neonatal features, asprolonged mechanical ventilation and the use of a surfactant influencethe development of thedisease.

[Preterm premature rupture of the fetal membranes: factors associated with bronchopulmonary dysplasia]. / Ruptura prematura das membranas amnióticas no pré-termo: fatores associados à displasia broncopulmonar.

PURPOSE: to analyze obstetric and neonatal factors associated with bronchopulmonary dysplasia outcome in patients with preterm premature amniorrhexis. METHODS: we analyzed 213 medical records of patients of Fernandes Figueira Institute who suffered premature amniorrhexis (<34 weeks of gestation) in the period from 1998 to 2002. Multiple gestations were excluded. Clinical-obstetric and neonatal variables were considered in relation to the bronchopulmonary dysplasia outcome. Data were subjected to bivariate analysis, and the values showing statistical significance (p<0.05) were subjected to logistic regression analysis. RESULTS: the prevalence of bronchopulmonary dysplasia was 6.10%. Univariate analysis of the factors associated with the pulmonary dysplasia outcome were: neonatal mechanical ventilation for more than ten days(OR: 54.00 [11.55-278.25] p=0.000); birth gestational age of less than 30 weeks (OR: 6.33 [1.26- 43.06] p=0.017); birth weight <1,000 g (OR: 4.82 [1.34-17.53] p=0.010); birth weight <1.500 g (OR: 14.09 [1.82-300.50] p=0.003; patent ductus arteriosus (OR: 12.33 [3.07-50.10], p=0.000); hyaline membrane disease (OR: 8.46 [2.21-35.00] p=0.000); congenital pneumonia (OR: 7.48 [2.03-27.93] p=0.000); use of neonatal surfactant (OR: 19.66 [4.54-97.76] p=0.000), and neonatal infection (OR: 7.67 [0.99-163.79] p=0.049). In the final multivariate model, only the variables "neonatal mechanical ventilation">10 days (p=0.001) and "use of a surfactant" (p=0.040) remained independently associated with bronchopulmonary dysplasia. CONCLUSIONS: the factors associated with bronchopulmonary dysplasia are related to neonatal features, as prolonged mechanical ventilation and the use of a surfactant influence the development of the disease.

[Repercussions of premature rupture of fetal membranes on neonatal morbidity and mortality]. / Repercussões da amniorrexe prematura no pré-termo sobre a morbimortalidade neonatal.

The objective of this study was to analyze factors associated with death and survival with sequelae in neonates after premature rupture of fetal membranes (PROM). An observational historical cohort study analyzed charts of patients with PROM at < or = 34 weeks gestation. The variables were compared with neonatal death and survival with sequelae as the outcomes. In both groups, the data were submitted to bivariate analysis, and the variables showing significance were submitted to logistic regression. The final multivariate model for fetal death showed statistical significance for the following: chorioamnionitis; 5-minute Apgar score < or = 5; birth weight < or = 1,000g; and cardiopulmonary resuscitation. Survival with sequela was associated with: cervical colonization; patent ductus arteriosus; 5-minute Apgar score < or = 5; and birth weight < or = 1,000g. Infections, very low birth weight, and peripartum asphyxia were the principal variables associated with the target outcomes among newborns from gestations involving PROM.

Repercussões da amniorrexe prematura no pré-termo sobre a morbimortalidade neonatal / Repercussions of premature rupture of fetal membranes on neonatal morbidity and mortality

O objetivo foi analisar os fatores associados ao óbito e sobrevida com seqüela em neonatos egressos de gestações que cursaram com amniorrexe prematura. Estudo observacional do tipo coorte histórica analisou prontuários de pacientes que evoluíram com quadro de amniorrexe prematura < 34 semanas de gestação. As variáveis foram cotejadas com os desfechos óbito neonatal e sobrevida com seqüela. Em ambos os grupos os dados foram submetidos à análise bivariada, sendo os valores que exibem significância estatística submetidos à regressão logística. No modelo multivariado final em relação ao óbito fetal tiveram significância estatística: corioamnionite; índice de Apgar < 5 no 5º minuto; peso ao nascimento < 1.000g; e reanimação cardiopulmonar. Quanto à presença de seqüela entre os sobreviventes destacam se: a colonização cervical; persistência do canal arterial; índice de Apgar < 5 no 5º minuto; e peso ao nascimento < 1.000g. Processos infecciosos, extremo baixo peso ao nascer e asfixia periparto são as principais variáveis ligadas aos desfechos estudados entre neonatos egressos de gestações que cursaram com amniorrexe prematura.

The objective of this study was to analyze factors associated with death and survival with sequelae in neonates after premature rupture of fetal membranes (PROM). An observational historical cohort study analyzed charts of patients with PROM at < 34 weeks gestation. The variables were compared with neonatal death and survival with sequelae as the outcomes. In both groups, the data were submitted to bivariate analysis, and the variables showing significance were submitted to logistic regression. The final multivariate model for fetal death showed statistical significance for the following: chorioamnionitis; 5-minute Apgar score < 5; birth weight < 1,000g; and cardiopulmonary resuscitation. Survival with sequela was associated with: cervical colonization; patent ductus arteriosus; 5-minute Apgar score < 5; and birth weight < 1,000g. Infections, very low birth weight, and peripartum asphyxia were the principal variables associated with the target outcomes among newborns from gestations involving PROM.

Evaluation of the neonatal outcomes of the kangaroo mother method in Brazil.

OBJECTIVE: To evaluate the results of the kangaroo mother method in Brazil. METHODS: A prospective cohort study comparing 16 units that have or do not have the second phase of the kangaroo mother method: eight were national centers of excellence for the kangaroo mother method (study group) and eight were part of the Brazilian Neonatal Research Network (control group). A total of 985 newborn infants with birth weights of 500 to 1,749 g were enrolled. Multivariate analyses employed multiple linear regression and Poisson regression with robust adjustment. RESULTS: The adjusted analysis (controlled for birth weight, gestational age, Score for Neonatal Acute Physiology Perinatal Extension II, Neonatal Therapeutic Intervention Scoring System, and maternal age and educational level) demonstrated that mean length of hospital stay (p = 0.14) and intercurrent clinical conditions in the intermediate or kangaroo unit were equal for both groups. Weight (p = 0.012), length (p = 0.039) and head circumference (p = 0.006) at 36 weeks' corrected gestational age were all lower at the kangaroo units. The kangaroo units exhibited superior performance in relation to exclusive breastfeeding at discharge (69.2 vs. 23.8%, p = 0.022). CONCLUSIONS: The evidence suggests that the humanization strategy adopted by the Brazilian Ministry of Health is a safe alternative to conventional treatment and a good strategy for promoting breastfeeding.

Assistência e mortalidade neonatal no setor público do Município do Rio de Janeiro, Brasil: uma análise do período 1994/2000 / Neonatal care and mortality in public hospitals in Rio de Janeiro, Brazil, 1994/2000

Este artigo apresenta uma avaliação da intervenção realizada pela Secretaria Municipal de Saúde do Rio de Janeiro(SMS-RJ) (estratégias de organização e qualificação da assistência neonatal na rede municipal, incluindo a ampliação dos leitos neonatais de risco), com o objetivo de reduzir a mortalidade neonatal. Analisamos as mudanças ocorridas no atendimento dos diferentes prestadores do setor público (período 1994/2000), na taxa de mortalidade neonatal dos nascimentos ocorridos nas instituições do Sistema Unico de Saúde (1995/2000) e o perfil das internações em quatro Unidades de Terapia Intensiva Neonatal (UTIN) da SMS-RJ (2000). Encontramos a concentração do atendimento neonatal de risco nas unidades municipais (de 28,0 por cento do atendimento de nascidos vivos prematuros, em 1994, para 67,0 por cento em 2000), redução na mortalidade neonatal dos nascimentos ocorridos no SUS (de 19,9 óbitos por mil nascidos vivos em 1996 para 15,5 em 2000). Não houve redução nas taxas de prematuridade e baixo peso ao nascer entre as mães residentes no Município do Rio de Janeiro. Na análise das internações nas UTIN encontramos elevada proporção de neonatos de mães moradoras de outros municípios, 14,0 por cento de mães que não realizaram pré-natal e 32,0 por cento de mortalidade entre neonatos com peso ao nascer < 1.500g.

[Neonatal care and mortality in public hospitals in Rio de Janeiro, Brazil, 1994/2000]. / Assistência e mortalidade neonatal no setor público do Município do Rio de Janeiro, Brasil: uma análise do período 1994/2000.

This article analyzes an intervention by the Rio de Janeiro Municipal Health Department (SMS-RJ), Brazil, to reduce the neonatal mortality rate (strategies for organizing and upgrading neonatal care in the municipal system, including an increase in the number of neonatal high-risk beds). We studied the trends in neonatal mortality rate (1995/2000), neonatal care provided in different public hospitals (1994/2000), and admissions profile and mortality in four neonatal intensive care units (NICUs) under the SMS-RJ (2000). There was a concentration of high-risk neonatal care in the municipal hospitals (an increase from 28.0% of the care provided for live premature neonates in 1994 to 67.0% in 2000) and a reduction in the neonatal mortality rate in units under the Unified National Health System (from 19.9 deaths per thousand live births in 1996 to 15.5 in 2000). There was no reduction in the prematurity and low birth weight rates among mothers residing in the municipality of Rio de Janeiro. Analysis of admissions to the NICUs showed a high proportion of neonates born to mothers from municipalities outside Rio de Janeiro, while 14.0% of the mothers had not received prenatal care, and the mortality rate among newborns with birth weight < 1.500g was 32.0%.

Análise situacional do atendimento ambulatorial prestado a recém-nascidos egressos das unidades de terapia intensiva neonatais no Estado do Rio de Janeiro / Situational analysis of outpatient care for newborns discharged from neonatal intensive care units in the State of Rio de Janeiro

A diminuição da mortalidade neonatal contribui para o aumento de crianças que necessitam de maior atenção em relação a morbidades clínicas e à evolução do desenvolvimento neuropsicomotor. O objetivo deste estudo foi discutir a situação da assistência às crianças egressas das Unidades de Terapia Intensiva Neonatais (UTIN) em cinco unidades em diferentes regiões do Estado do Rio de Janeiro; em nenhuma havia informações sobre o perfil dos egressos da UTIN. Evidenciou-se restrição ao acesso e baixa estruturação da rede em relação à assistência prestada a esses bebês. Não há uniformidade no atendimento prestado, e ambulatórios específicos para essa população concentram-se na cidade do Rio de Janeiro. Constatou-se deficiência de profissionais nas áreas de reabilitação - fisioterapia motora, terapia ocupacional, fonoaudiologia e psicologia -, e de especialistas para atendimento oftalmológico adequado e para a criança portadora de deficiência auditiva. Os autores discutem possíveis explicações para essa situação, propondo a organização de um sistema de atendimento em graus de complexidade para poder viabilizar o acesso das crianças de risco a um atendimento diferenciado, importante para detecção precoce de anormalidades do desenvolvimento.

[Evaluation of the nutritional status at 40 weeks corrected gestational age in a cohort of very low birth weight infants]. / Avaliação dos fatores associados ao estado nutricional na idade corrigida de termo em recém-nascidos de muito baixo peso.

OBJECTIVE: To evaluate the nutritional status at term of a cohort of newborn babies with birth weights of less than 1,500 g and to correlate this with nutritional practices and clinical variables. METHODS: Very low birth weight infants admitted to eight neonatal intensive care units from November 1999 to April 2000 were studied prospectively. The units were defined as Type I if they employed aggressive nutritional support techniques and Type II if other nutritional practices were used. Babies were defined as malnourished if their z-score for weight was less than or equal to -2 on the Canadian Perinatal Surveillance System growth curves. Data were analyzed using multivariate linear regression and logistic regression. The study was approved by the Committee for Ethics in Research. RESULTS: Sixty-three percent (126/200) of the study population were classified as being malnourished at term. Weight at term (corrected gestational age) showed a direct correlation with birth weight, but an indirect correlation with the length of stay, gestational age at birth, time to regain birth weight and CRIB score (p < 0.05). Small for gestational age infants had a 12.19 times greater chance of being malnourished at term. Being born at a Type I unit reduced the risk of malnutrition at term by 2.17 times, male sex reduced this risk by 0.4 times and achieving total enteral nutrition by the 10th day of life reduced it by 1.97 times (p < 0.03). CONCLUSIONS: The most effective means of preventing babies being malnourished at term is by encouraging perinatal practices aimed at preventing restricted intrauterine growth, in addition to giving priority to aggressive nutritional management.