Fatores de risco para óbito neonatal obtidos pelo modelo de regressão multivariado de Cox / Risk factors for neonatal death obtained by Cox multivariate regression analysis

OBJETIVO: Identificar os fatores associados ao óbito neonatal em São José dos Campos (SP). MÉTODOS: Estudo epidemiológico do tipo longitudinal para o qual foi construído um banco de dados com informações do recém-nascido e da mãe obtidas a partir das Declarações de Nascido Vivo e de Óbito de neonatos de mães residentes em São José dos Campos, nos anos de 2003 e 2004. Definiu-se como variável dependente o óbito até o 28º dia após o nascimento. A análise multivariada, utilizando o modelo de Cox, foi aplicada para verificar a associação entre o óbito neonatal e as seguintes variáveis independentes: sexo, peso ao nascer, duração da gestação, Apgar no 1º e 5º minuto, idade materna, nível de instrução da mãe, número de óbitos fetais e de filhos vivos prévio, tipo de parto e gestação única ou múltipla. O nível de significância adotado foi p<0,05. RESULTADOS: No período analisado, foram identificados 131 óbitos neonatais. Os resultados foram expressos por risco relativo (RR) e intervalo de confiança de 95 por cento (IC95 por cento). Idade gestacional <37 semanas (RR 6,92; IC95 por cento 3,64-13,17), Apgar no 5º minuto <7 (RR 3,14; IC95 por cento 1,95-5,04), Apgar no 1º minuto <7 (RR 3,48; IC95 por cento 2,17-5,60) e baixo peso ao nascimento (RR 4,49; IC95 por cento 3,36-8,53) foram as variáveis associadas significativamente com a morte, no modelo final. CONCLUSÕES: As variáveis associadas ao óbito neonatal em São José dos Campos estão relacionadas à qualidade da assistência pré-natal e perinatal.

OBJECTIVE: To identify the risk factors for neonatal death in São José dos Campos (SP) Brazil. METHODS: This longitudinal study retrieved data obtained from the Brazilian Birth and Death Certificates of neonates born to mothers living in São José dos Campos, Brazil, from 2003 up to 2004. Variables associated to neonatal death were analyzed by multivariate analysis using the Cox model. Independent variables were: maternal age, maternal educational level, number of previous stillbirths, number of children alive in the family, single or multiple pregnancy, gestation length, type of delivery, sex, birth weight, 1st and 5th minute Apgar scores. Significance was set at p<0.05 RESULTS: There were 131 deaths up to the 28th day after birth during the study period. Results were expressed in relative risk (RR) and 95 percent confidence intervals (CI). Gestational age <37 weeks (RR 6.92; 95 percentCI 3.64-13.17), 5th minute Apgar score <7 (RR 3.14; 95 percentCI 1.95-5.04), 1st minute Apgar score <7 (RR 3.48; CI 2.17-5.60) and low birth weight (RR 4.49; 95 percentCI 3.36-8.53) were associated with neonatal death in the final model. CONCLUSIONS: Variables associated with neonatal death in São José dos Campos, Brazil, are related to quality of health care during prenatal and perinatal periods.

OBJETIVO: Identificar los factores asociados al óbito neonatal en São José dos Campos. MÉTODOS: Se trata de estudio epistemológico de tipo longi-tudinal para el que se construyó una base de datos con informa-ciones del recién-nacido y de la madre, obtenidos a partir de las Declaraciones de Nacido Vivo y de óbito de neonatos y de madres residentes en São José dos Campos (São Paulo, Brasil), en los años de 2003 y 2004. Se definió como variable dependiente el óbito hasta el 28º día después del nacimiento. El análisis multivaria-do, utilizando el modelo de Cox, fue aplicado para verificar la asociación entre el óbito neonatal y las siguientes variables inde-pendientes: sexo, peso al nacer, duración de la gestación, Apgar en el 1er y 3er minuto, edad materna, nivel de instrucción de la madre, número de óbitos fetales y de hijos vivos previo, tipo de parto y gestación única o múltiple. El nivel de significancia adoptado fue p<0,05. RESULTADOS: En el periodo analizado se identificaron 131 óbitos neonatales. Edad gestacional menor que 37 semanas (RR 6,92; IC 95 por ciento 3,64-13,17), Apgar en el 5º minuto <7 (RR 3,14; IC 95 por ciento 1,95-5,04), Apgar en el 1er minuto <7 (RR 3,48; IC9 por ciento: 2,17-5,60) y bajo peso al nacimiento (RR 4,49; IC 95 por ciento: 3,36-8,53) fueron las variables asociadas significativamente con la muerte, en el modelo final. CONCLUSIONES: Las variables asociadas al óbito neonatal en São José dos Campos (São Paulo, Brasil), están relacionadas a la calidad de la asistencia pre-natal y perinatal.

Fatores de risco para óbito em unidade de terapia intensiva neonatal, utilizando a técnica de análise de sobrevida / Risk factors for neonatal death in neonatal intensive care unit according to survival analysis

OBJETIVO: Identificar fatores de risco associados ao óbito de recém-nascidos internados na unidade de terapia intensiva neonatal do Hospital Universitário de Taubaté, SP. MÉTODOS: É um estudo longitudinal com informações obtidas dos prontuários dos recém-nascidos internados na unidade de terapia intensiva neonatal, do Hospital Universitário da Universidade de Taubaté. A variável dependente foi o tipo de desfecho: alta ou óbito. As variáveis independentes foram variáveis maternas e gestacionais: idade materna, hipertensão, diabetes, terapia com corticóide e parto; variáveis do recém-nascido: peso ao nascer, duração da gestação, escore de Apgar no primeiro e quinto minutos de vida, nascimento múltiplo, malformações congênitas e sexo; variáveis relativas à internação: relato de ventilação mecânica, ventilação pressão positiva, relato de nutrição parenteral prolongada, sepse, entubação, massagem cardíaca, fototerapia, doença da membrana hialina, oxigênioterapia, tempo de internação e fração inspirada de oxigênio. Foi construído um modelo de forma hierarquizada em três níveis para análise de sobrevida, através do modelo de Cox; o programa computacional utilizado foi o Stata v9 e permaneceram no modelo final as variáveis com p<0,05. Os riscos foram estimados pela medida de efeito denominada hazard ratio (HR) com os respectivos intervalos de confiança de 95 por cento. Foram excluídos do estudo os recém-nascidos transferidos durante a internação para outro serviço. RESULTADOS: Foram internados no período de estudo 495 recém-nascidos, com 129 óbitos (26,1 por cento). No modelo final, permaneceram as variáveis uso de corticoterapia (HR 1,64; IC 95 por cento 1,02-2,70), mal formação congênita (HR 1,93; IC 95 por cento 1,05-2,88), muito baixo peso ao nascer (HR 4,28; IC 95 por cento 2,79-6,57) e escores de Apgar menores que sete no1º min (HR 1,87; IC 95 por cento 1,19-2,93) e no 5º min (HR 1,74; IC 95 por cento 1,05-2,88) e as variáveis fototerapia...

OBJECTIVE: To identify risk factors associated with death of infants admitted to neonatal intensive care unit of Taubaté University Hospital. METHODS: It is a longitudinal study with information obtained from medical records of newborns admitted to the neonatal intensive care unit of Taubaté University Hospital. Type of outcome, discharge or death, was dependent variable. The independent variables were maternal and gestational variables: maternal age, hypertension, diabetes, corticosteroid therapy and delivery; variables of the newborn: birth weight, gestation length, Apgar score in the first and fifth minutes of life, multiple birth, congenital malformations and sex; hospitalar variables: report of mechanical ventilation, positive pressure ventilation, reports of prolonged parenteral nutrition, sepsis, intubation, cardiac massage, phototherapy, hyaline membrane disease, oxygen and fraction of inspired oxygen. It was built a model in three hierarchical levels for the survival analysis by the Cox model; it was used the software Stata v9 and the final model contained variables with p <0.05. The risks were estimated by measure effect known as hazard ratio (HR) with confidence intervals of 95 percent. The newborns transferred during hospitalization to another service were excluded from the study. RESULTS: There were admitted during the study period 495 newborns, with 129 deaths (26.1 percent). In the final model, only the variables of steroid use (HR 1.64, 95 percent CI 1.02-2.70), malformation (HR 1.93, CI 95 percent 1,05-2,88), very low birth weight (HR 4.28, 95 percent CI 2,79-6,57) and Apgar scores lower than seven of no1 min (HR 1.87, 95 percent CI 1,19-2,93) and 5 min (HR 1.74, 95 percent CI 1,05-2,88) and the variables phototherapy (HR 0.34; 95 percent CI 0,22-0,53) and endotracheal intubation (HR 2.28, 95 percent CI 1 .41-3, 70). CONCLUSION: Factors related primarily to the newborn and the hospitalar internment (except therapy with corticosteroids)...

Risk factors for neonatal death in neonatal intensive care unit according to survival analysis. / Fatores de risco para óbito em unidade de terapia intensiva neonatal, utilizando a técnica de análise de sobrevida.

OBJECTIVE: To identify risk factors associated with death of infants admitted to neonatal intensive care unit of Taubaté University Hospital. METHODS: It is a longitudinal study with information obtained from medical records of newborns admitted to the neonatal intensive care unit of Taubaté University Hospital. Type of outcome, discharge or death, was dependent variable. The independent variables were maternal and gestational variables: maternal age, hypertension, diabetes, corticosteroid therapy and delivery; variables of the newborn: birth weight, gestation length, Apgar score in the first and fifth minutes of life, multiple birth, congenital malformations and sex; hospitalar variables: report of mechanical ventilation, positive pressure ventilation, reports of prolonged parenteral nutrition, sepsis, intubation, cardiac massage, phototherapy, hyaline membrane disease, oxygen and fraction of inspired oxygen. It was built a model in three hierarchical levels for the survival analysis by the Cox model; it was used the software Stata v9 and the final model contained variables with p <0.05. The risks were estimated by measure effect known as hazard ratio (HR) with confidence intervals of 95%. The newborns transferred during hospitalization to another service were excluded from the study. RESULTS: There were admitted during the study period 495 newborns, with 129 deaths (26.1%). In the final model, only the variables of steroid use (HR 1.64, 95% CI 1.02-2.70), malformation (HR 1.93, CI 95% 1,05-2,88), very low birth weight (HR 4.28, 95% CI 2,79-6,57) and Apgar scores lower than seven of no1 min (HR 1.87, 95% CI 1,19-2,93) and 5 min (HR 1.74, 95% CI 1,05-2,88) and the variables phototherapy (HR 0.34; 95% CI 0,22-0,53) and endotracheal intubation (HR 2.28, 95% CI 1 .41-3, 70). CONCLUSION: Factors related primarily to the newborn and the hospitalar internment (except therapy with corticosteroids) were identified as associated to mortality highlighting a possible protective factor of phototherapy and the risk of infants with very low birth weight.

Solvent effects on the spectroscopic properties of 4-hexylresorcinol.

A study was made on the spectroscopic properties of 4-hexylresorcinol (4HR) in several solvents at room temperature. Absorption and emission spectra were slightly affected by solvent polarity. Stokes' shifts were small (approximately 3000 cm(-1)) and the fluorescence quantum yields varied between 0.05 and 0.68, depending on the solvent. The spectral shifts were correlated with different solvent scales. Multiple regression analysis indicates that both non-specific solute-solvent interactions as well as specific solute-solvent interactions (such as hydrogen bonding) play an important role in the position of the Stokes' shift and on the fluorescence quantum yield in the solvents under study.

Caracterización de poblaciones microbianas presentes en la macroalga comestible monostroma undulatum, wittrock / Characterization of microbial population present in the edible seaweed monostroma undulatum, wittrock

Se evaluó la calidad microbiológica del alga Monostroma undulatum, Wittrock que se desarrolla en la costa patagónica, para el consumo humano y se analizó la diversidad y el rol de la población bacteriana que la coloniza naturalmente. Las muestras de algas fueron recolectadas en las costas de Puerto Deseado Provincia de Santa Cruz, Patagonia Argentina (47°45'L.O.). Se investigaron bacterias heterótrofas psicrótrofas (BBRN), bacterias de bajo requerimiento nutricional marinas (BBRN marinas), Vibrios sp, Coliformes totales, Coliformes termotolerantes, bacterias anaerobias sulfito reductoras de esporas, hongos y levaduras. Se seleccionaron cepas que fueron caracterizadas de acuerdo a su morfología, tinción de Gram, fisiología y metabolismo. Las mismas se identificaron presuntivamente como: Vibrio (20 por ciento), E. coli inactiva (18 por ciento) Flavobacterium (11 por ciento), Flexibacter (9 por ciento), Moraxella (9 por ciento), grupo Alcaligenes/Pseudomonas (9 por ciento), Aeromonas (2 por ciento), Acinetobacter (2 por ciento). Cotophaga (2 por ciento), Photobacterium (2 por ciento), grupo ps/Caulobacter/Alteromonas/Spirillum (2 por ciento). Entre los microorganismo Gram positivos se destacó el género Staphylococcus. Entre las cepas estudiadas, no se detectaron especies patógenas para el hombre. En algas frescas como así también en el agua del mar, no se detectó la presencia de microorganismos indicadores de contaminación fecal. Estos resultados indicarían una calidad microbiológica del alga aceptable para la alimentación humana. La población bacteriana asociada a Monostroma undulatum estuvo compuesta principalmente por microorganismos Gram negativos, psicrótrofos, marinos y comprendió una gran variedad de géneros, predominando los vibrios y las enterobacterias. Asimismo las bacterias identificadas presentaron una gran capacidad de hidrolizar diferentes sustratos y así podrían contribuir en la cadena trófica marina de este ecosistema marino al que pertenecen las algas

[Characterization of microbial population present in the edible seaweed, Monostroma undulatum, Wittrock]. / Caracterización de poblaciones microbianas presentes en la macroalga comestible Monostroma undulatum, Wittrock.

The microbiological quality of Monostroma undulatum, Wittrock from the Southern Argentinean coast, was studied for its application for human food. Also the diversity and function of the native bacterial population to this green seaweed was analyzed. Samples were collected in Puerto Deseado, province of Santa Cruz, Southern Argentina (47 degrees 45'L.S., 65 degrees 55'L.W). The samples were analyzed for the presence of psycotrophic heterotrophic bacteria, marine heterotrophic bacteria, low nutritional request bacteria (LNRB), marine low nutritional request bacteria (LNRB marine), Vibrio spp, total and thermotolerant colifom bacteria, anaerobic sulfite reducing bacteria, yeasts and moulds. The isolates were identified using standard techniques based on morphologic, physiologic and metabolic characteristics. Among the gram-negative bacteria isolated, the predominant genera belonged to Vibrio (20%), E. coli inactiva (18%), Flavobacterium (11%), Flexibacter (9%), Moraxella (9%), Alcaligenes/Pseudomonas group (9%), Aeromonas (2%), Acinetobacter (2%). Cotophaga (2%), Photobacterium (2%), Ps/Caulobacter/Alteromonas/Spirillum group (2), The main genus of gram-positive bacteria was Staphylococcus. Human pathogenic bacteria were not detected. Fecal contamination indicator bacteria were not isolated from fresh seaweed and seawater. These results showed an adequate microbiological quality of seaweed acceptable for human food. The bacterial population associated to Monostroma undulatum, consisted of gram-negative, marine and psycotrophic microorganisms, including vibrios and enterobacteria as their main components. Also the identified bacteria showed a great capacity to hydrolyze different substrates and so they might contribute to the balance of this marine ecosystem.

[Chemical composition and seasonal fluctuations of the edible green seaweed, Monostroma undulatum, Wittrock, from the Southern Argentina coast]. / Contenido en algunos nutrientes del alga marina comestible Monostroma undulatum Wittrock de la costa patagónica argentina.

The chemical composition of green seaweed, Monostroma undulatum, Wittrock, growing in the Southern Argentina coast, was studied. Samples were collected in Puerto Deseado, province of Santa Cruz (47 degrees 45'L.S., 65 degrees 55'L.W.), from October to December 1999 and 2000. It has been analyzed six sample during this period. Algae were washed with sea water and dried at room temperature for 24 hs. Moisture, nitrogen, lipids and ashes were determined according to AOAC; fiber (total, soluble and insoluble), according to Lahaye. After mineralization with nitric acid, sodium and potassium were determined by flame photometry, calcium by complexometric method, and phosphorus by Gomori's method. The ranges expressed per 100 g dry algae were: protein (Nx6.25): 12.89-21.85; ashes (g): 33.92-40.05; lipid (g): 0.32-1.47; total fiber (g): 14.36-19.6; digestible carbohydrates (calculated by difference) (g): 20.86-32.48; sodium (g): 7.39-13.11; potassium (g): 1.38-3.18; calcium (mg): 149-226; phosphorus (mg): 190-447; Vitamin C (mg): 159-455. These results show that this green seaweed is an important source for protein, fiber, macronutrients minerals and vitamin C, during the macroscopic period. There was an important fluctuation that must be taken into account to consider the commercial collection to use it in human nutrition.