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1.
Am J Hum Biol ; 37(1): e70002, 2025 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-39866093

RESUMO

OBJECTIVE: The objective is to analyze secular trends in birth weight (BW) for Chile from 1990 to 2021, focusing on the mean BW and low birth weight (LBW) prevalence, and to assess differences across Chilean regions. METHODS: Our sample, obtained from the Chilean National Statistics Office, contains information on 7 822 975 births, including the total births that took place in Chile from 1990 to 2021. We calculated mean BW and LBW prevalence at a national and a regional level. We also gathered national aggregates from 1974 to 1989 from secondary sources. RESULTS: At a national level, mean BW increased sharply in Chile from 1983 to 1994 (6%), remained stagnant thereafter, and fell slightly during the last decade and a half. LBW prevalence declined substantially from the mid-1970s to the mid-1990s, from 12% to 5%. It stagnated during the early 1990s, after which there was a small but continuous increase to over 6.5%. Antofagasta is the only outlier: its mean BW and the percentage of LBW are permanently lower and higher, respectively. CONCLUSIONS: A sharp increase in mean BW from the mid-1980s to the mid-1990s, together with the declining percentage of LBW from the mid-1970s to the mid-1990s, should be due to the better nutritional status of mothers. The decline in mean BW from the early 2000s (as well as the increasing percentage of LBW) may be due to an increasing proportion of preterm births and the increase in the age of women giving birth. The relatively poor performance of Antofagasta is explained by the region's high altitude, which affected large numbers of the population.


Assuntos
Peso ao Nascer , Recém-Nascido de Baixo Peso , Chile/epidemiologia , Humanos , Recém-Nascido , Prevalência , Feminino , Masculino
2.
J. pediatr. (Rio J.) ; J. pediatr. (Rio J.);100(6): 596-603, Nov.-Dec. 2024. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1582586

RESUMO

Abstract Objectives To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. Methods The authors studied 4062 surviving very preterm infants born < 32 weeks' gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. Results Infants' mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: −2.0, −1.8, and −1.5; head z: −1.3, −1.2 and −1.1 for exclusive human milk, mixed and exclusive formula respectively). Conclusion Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time.

3.
Horm Res Paediatr ; : 1-11, 2024 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-39536728

RESUMO

INTRODUCTION: Although the clinical benefits of long-term recombinant human growth hormone (rhGH) therapy have been well demonstrated in children born small for gestational age (SGA), little is known about the outcomes of this therapy in children born with very low birth weight (VLBW). This study aimed to report the short- and long-term response to rhGH therapy in a cohort of VLBW patients, comparing subgroups according to size, gestational age (GA), and causal factors associated with VLBW. METHODS: We describe 33 patients born at VLBW treated with rhGH; 16 also received GnRHa. Medical records were analyzed at baseline and after 1 year of rhGH treatment. Data on the adult height SDS from 23 patients were also collected. Growth velocities and height SDS changes were calculated, along with the differences between the observed and predicted growth velocities. RESULTS: The first-year growth velocity (7.5 ± 2.1 cm/year) was aligned with prediction models for SGA children. After 1 year of rhGH treatment, height SDS improved from -3.0 ± 1.1 to -2.6 ± 1.3, with no differences among subgroups. Among patients reaching adult height, 73.9% remained short (-2.5 ± 1.3) after long-term therapy (6.7 ± 3.3 years). The initial height SDS, height SDS change in the first year of treatment, and target height SDS were key independent predictors of height gain. CONCLUSION: The response to rhGH treatment was suboptimal in the VLBW group, independent of the size, GA, or etiological diagnosis. However, adult height may be improved in patients receiving rhGH treatment. This underscores the need for tailored protocols and further investigations to optimize outcomes in this population.

4.
Lancet Reg Health Am ; 39: 100921, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39559430

RESUMO

Background: Advances in neonatal care have increased survival rates for premature or low birth weight (LBW) infants but raised concerns about long-term neurosensory and psychomotor challenges. Objective: to investigate perinatal factors linked to visual and auditory problems in ex-preterm or LBW young adults, assessing their long-term quality of life. Methods: Participants from a 20-year-old randomised controlled trial comparing Kangaroo-Mother Care (KMC) to conventional care were re-enrolled. A group of 50 at term individuals without risk factors was assessed as a reference group. Findings: 5.9% of participants had functional visual issues and 8.1% experienced hearing problems. Those with hearing or visual impairments had longer hospital stays and more neonatal complications. Correlations were found between Griffiths auditory sub-scale results at 6 months and long-term auditory outcomes. Only 27.5% of those with deafness had access to cochlear implants or hearing aids, resulting in lower IQ scores, learning difficulties, and increased risk of depression and self-harm. Participants with visual impairments exhibited lower IQ scores, self-esteem, and HOME test acceptance. However, they did not differ from the group with normal vision in terms of quality of life, depression, or attachment scores. All participants, whether they had issues or not, rated their quality of life higher than their parents did. Interpretation: Preterm or LBW infants with visual and hearing deficits are more likely to face cognitive and emotional challenges in adulthood. This study underscores the importance of a multidisciplinary approach to promptly address these vulnerabilities, reducing the risk of long-term neurodevelopmental and functional issues. Funding: The Grand Challenge Canada, Fulbright Colciencias and Colombia Cientifica - Alianza, The World Bank, managed by the Colombian Administrative Department of Science, Technology and Innovation (COLCIENCIAS).

5.
Distúrbios Comun. (Online) ; 36(3): e67668, 2024-11-05.
Artigo em Inglês, Português | LILACS | ID: biblio-1586834

RESUMO

Introdução: O peso ao nascer e a idade gestacional influenciam a qualidade de vida das crianças e devem ser levados em consideração na avaliação de aspectos do desenvolvimento. Objetivo: verificar o desempenho em avaliação do vocabulário expressivo de crianças nascidas a termo e pequenas para a idade gestacional e compará-lo com crianças nascidas a termo e com peso adequado para a idade gestacional. Método: estudo transversal, do tipo analítico, com amostras por conveniência, não-pareada, aninhada a uma coorte. Avaliaram-se 36 crianças, entre quatro e sete anos, sendo 24 (66,7%) classificadas como pequenas para a idade gestacional e 12 (33%) adequadas para a idade gestacional. O vocabulário expressivo foi avaliado pelo teste de linguagem infantil ABFW. Os resultados foram avaliados por análise descritiva e analítica, utilizando o teste t não pareado, o teste qui-quadrado de Pearson e o teste exato de Fisher, com nível de significância p<0,05. Resultados: a média de designação do vocábulo usual foi inferior em todos os campos semânticos, exceto no campo conceitual vestuário. Identificaram-se, ainda, diferenças para meio de transporte (p=0,002) e formas/cores (p=0,011). A média de não designação foi acima ou igual em todos os campos conceituais, observando-se diferença significativa para alimentos (p= 0,019), móveis/ utensílios (p=0,020) e locais (p= 0,049). As médias do processo de substituição foram mais elevadas, na maioria dos campos semânticos, com diferença apenas para meio de transporte (p= 0,002).Conclusão: crianças pequenas para a idade gestacional nascidas a termo apresentaram desempenho abaixo do esperado nas provas de vocabulário expressivo quando comparadas com as crianças adequadas para a idade gestacional a termo. (AU)


Introduction: Birth weight and gestational age influence children's quality of life and must be taken into account when evaluating aspects of development. Purpose: verify the performance in evaluating the expressive vocabulary in children, born full-term and small for gestational age (SGA) and compare it with children born at term and with appropriate weight for gestational age(AGA). Method: cross-sectional study, typified as analytical, with convenience sampling, unpaired and nested to a cohort. A total of 36 children were evaluated, between four and seven years, 24 (66.7%) of whom were classified as SGA; and 12 (33%) as AGA. Expressive vocabulary was evaluated using the ABFW children's language test. The results were evaluated by means of descriptive and analytical analysis, using unpaired t test, Pearson's chi-square test and Fisher's exact test, with a significance level set at p<0.05. Results: the average of designation of the usual word was lower in all semantic fields, except in the conceptual field of clothing. Differences were also observed for transport facilities (p=0.002) and shapes and colors (p=0.011). The average of non-designation was above or equal in all conceptual fields, with a significant difference for food (p=0.019), furniture and utensils (p=0.020) and places (p=0.049). The averages of the substitution process were higher in most semantic fields, with a difference only for transport facilities (p=0.002). Conclusion: SGA children born full-term performed less than expected in expressive vocabulary tests when compared to AGA children. (AU)


Introducción: El peso al nacer y la edad gestacional influyen en la calidad de vida de los niños y deben tenerse en cuenta a la hora de evaluar aspectos del desarrollo. Objetivo: verificar el desempeño em la evaluación del vocabulario expresivo de niños nacidos a término y pequeños para la edad gestacional y compararlo con niños nacidos a término y con peso adecuado para la edad gestacional. Método: estudio transversal, analítico, por conveniencia, muestras no apareadas, anidadas dentro de una cohorte. Se evaluaron 36 niños, entre cuatro y siete años, 24 (66,7%) clasificados como pequeños para la edad gestacional y 12 (33%) apropiados para la edad gestacional. El vocabulario expresivo se evaluó mediante la prueba de lenguaje infantil ABFW. Los resultados fueron evaluados mediante análisis descriptivo y analítico. Resultados: la designación media de la palabra habitual fue inferior en todos los campos semánticos, excepto en el campo conceptual ropa. También se identificaron diferencias para el medio de transporte (p=0,002) y formas/colores (p=0,011). El promedio de no designaciones fue superior o igual en todos los campos conceptuales, observándose una diferencia significativa para alimentos (p= 0,019), muebles/utensilios (p=0,020) y lugares (p= 0,049). Las medias del proceso de sustitución fueron mayores en la mayoría de los campos semánticos, con diferencia sólo para los medios de transporte (p= 0,002). Conclusión: los niños nacidos a término que eran pequeños para la edad gestacional obtuvieron resultados inferiores a las expectativas en las pruebas de vocabulario expresivo en comparación con los niños aptos para la edad gestacional a término. (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Vocabulário , Recém-Nascido Pequeno para a Idade Gestacional , Testes de Linguagem , Estudos Transversais , Desenvolvimento da Linguagem
6.
Front Microbiol ; 15: 1456087, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39473842

RESUMO

Background: Low birth weight (LBW; <2,500 g) affects approximately 15 to 20 percent of global births annually and is associated with suboptimal child development. Recent studies suggest a link between the maternal gut microbiome and poor obstetric and perinatal outcomes. The goal of this study was to examine relationships between maternal microbial taxa, fecal metabolites, and maternal anthropometry on incidence of LBW in resource-limited settings. Methods: This was a secondary analysis of the Women First trial conducted in a semi-rural region of Guatemala. Maternal weight was measured at 12 and 34 weeks (wk) of gestation. Infant anthropometry measures were collected within 48 h of delivery. Maternal fecal samples at 12 and 34 weeks were used for microbiome (16S rRNA gene amplicon sequencing) and metabolomics analysis (34 wk). Linear mixed models using the MaAslin2 package were utilized to assess changes in microbiome associated with LBW. Predictive models using gradient boosted machines (XGBoost) were developed using the H2o.ai engine. Results: No differences in ß-diversity were observed at either time point between mothers with LBW infants relative to normal weight (NW) infants. Simpson diversity at 12 and 34 weeks was lower in mothers with LBW infants. Notable differences in genus-level abundance between LBW and NW mothers (p < 0.05) were observed at 12 weeks with increasing abundances of Barnesiella, Faecalibacterium, Sutterella, and Bacterioides. At 34 weeks, there were lower abundances of Magasphaera, Phascolarctobacterium, and Turicibacter and higher abundances of Bacteriodes, and Fusobacterium in mothers with LBW infants. Fecal metabolites related to bile acids, tryptophan metabolism and fatty acid related metabolites changed in mothers with LBW infants. Classification models to predict LBW based on maternal anthropometry and predicted microbial functions showed moderate performance. Conclusion: Collectively, the findings indicate that alterations in the maternal microbiome and metabolome were associated with LBW. Future research should target functional and predictive roles of the maternal gut microbiome in infant birth outcomes including birthweight.

7.
Chemosphere ; 366: 143469, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39384135

RESUMO

Low birth weight (LBW) is a global health concern. While it is commonly associated with maternal health and behavior, exposure to ambient air pollution, can also play a role in contributing to LBW. In Brazil, where diverse environmental conditions and regional disparities exist, assessing the impact of ambient air pollution on LBW becomes particularly pertinent. To our knowledge, there is a gap in the existing literature, as no previous study has specifically investigated the relationship between ambient air pollution and LBW nationwide in Brazil. This study aims to fill this gap by examining the association between ambient air pollution and LBW in each trimester of pregnancy across the Brazilian states. In this work, birth data from January 1, 2001, to December 31, 2018 has been used. We utilized logistic regression models to estimate the odds ratio (OR) for low birth weight (LBW) associated with ambient air pollution (PM2.5, NO2, and O3) during each trimester of pregnancy (1st to 3rd trimester) across all 27 Brazilian states in our nationwide case-control study. We adjusted our model for several variables, including ambient temperature, relative humidity, and socioeconomic status (SES) variables at the individual level. We also conducted effect modification analyses by infant sex, mother's age, and the number of prenatal visits. Our study comprises over 10,213,144 birth records nationwide. Of these, 479,204 (4.92%) infants were included as cases of LBW. Our results indicate positive associations between PM2.5 and LBW, mainly in the Southern region. For example, in the state of Santa Catarina (South region), ORs were 1.003 (95% CI: 1.002, 1.004), 1.003 (95% CI: 1.002, 1.004), and 1.005 (95% CI: 1.003, 1.007) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. NO2 had a robust association with LBW in the Northern and Northeastern states, including the state of Amapá (North region, where the Amazon Forest is located) with ORs of 1.377 (95% CI: 1.010, 1.878), 1.390 (95% CI: 1.020, 1.894), and 1.747 (95% CI: 1.297, 2.352) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. Similarly, O3 had a robust association in the North and Midwest states, as observed in the state of Amapá with ORs of 1.033 (95% CI: 1.012, 1.054), and 1.033 (95% CI: 1.013, 1.053) for the 2nd, and 3rd trimesters, respectively. In the stratified analysis, boys were more vulnerable than girls, and the lower number of prenatal visits was associated with higher OR. Our findings are essential to the development of guidelines to prevent maternal exposure and protection of newborns in Brazil. This study provides valuable insights for region-specific strategies to improve maternal and neonatal health.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Recém-Nascido de Baixo Peso , Exposição Materna , Material Particulado , Humanos , Brasil , Poluição do Ar/estatística & dados numéricos , Feminino , Gravidez , Recém-Nascido , Poluentes Atmosféricos/análise , Material Particulado/análise , Adulto , Exposição Materna/estatística & dados numéricos , Masculino , Estudos de Casos e Controles , Ozônio/análise , Adulto Jovem , Razão de Chances , Dióxido de Nitrogênio/análise , Modelos Logísticos
8.
Front Pediatr ; 12: 1344291, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39228440

RESUMO

Background: Theophylline was an orally administered xanthine used for treatment of apnea of prematurity and Bronchopulmonary Dysplasia in ambulatory follow-up of Low-Birth-Weight infants (LBWI) with oxygen-dependency in the outpatient Kangaroo Mother Care Program (KMCP). Theophylline's main metabolic product is caffeine; therefore, it was an alternative due to the frequent lack of ambulatory oral caffeine in low and middle-income countries. Objective: To assess the effectiveness of oral theophylline in decreasing days with oxygen and to describe frequency of adverse related events. Methods: Quasi-experiment before and after withdrawal of theophylline given systematically to LBWI with ambulatory oxygen in two KMCPs. Results: 729 patients were recruited; period 1: 319 infants when theophylline was given routinely and period 2: 410 infants when theophylline was no longer used. The theophylline cohort had less gestational age, less weight at birth, more days in Neonatal Intensive Care Unit, more days of oxygen-dependency at KMCP admission, and more frequencies of Intrauterine Growth Restriction and apneas. After adjusting with propensity score matching, multiple linear regression showed that nutrition was associated with days of oxygen-dependency, but theophylline treatment not. No differences were found in frequencies of readmissions up to 40 weeks, intraventricular hemorrhage or neurodevelopmental problems. Participants in period 2 had more tachycardia episodes. Conclusions: We did not find association between oral theophylline treatment and the reduction of days with ambulatory oxygen. For the current management of oxygen-dependency in LBW infants, the importance of nutrition based on exclusive breast feeding whenever possible, is the challenge.

9.
J Pediatr ; 275: 114253, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39181317

RESUMO

OBJECTIVE: To evaluate whether a higher proportion of enteral vs parenteral protein ratio (E:P ratio) in the first 28 days after birth is associated with increased brain volume and somatic growth in very low birth weight (VLBW; birth weight <1500 g) infants. STUDY DESIGN: This was a retrospective analysis of a subcohort of VLBW infants (n = 256, gestational age mean 28.07 [SD 2.17] weeks, birth weight 1038.80 [SD 262.95] grams) from the Cincinnati Infant Neurodevelopment Early Prediction Study, a regional prospective study of infants born at ≤32 weeks' gestation. Brain magnetic resonance imaging was obtained at term-equivalent age. Macronutrient intake and growth metrics for the first 28 days were collected retrospectively. The primary outcome was total brain tissue volume. The relationships between E:P ratio, total and regional brain tissue volumes, and somatic growth were analyzed by multivariable linear regression models; composite variables were used to adjust for potential confounders including pregnancy risk factors and initial severity of illness. RESULTS: Higher E:P ratio was associated with increased total brain tissue volume but was not associated with change in head circumference z score. In secondary analyses, higher E:P ratio was associated with increased weight velocity. There were no significant associations between E:P ratio and change in weight or length z scores or regional brain volumes. CONCLUSIONS: Higher E:P ratio in the first 28 days was positively associated with total brain volume and weight gain. Promoting the provision of enteral over parenteral protein may improve brain and somatic growth in VLBW infants.


Assuntos
Encéfalo , Nutrição Enteral , Recém-Nascido de muito Baixo Peso , Imageamento por Ressonância Magnética , Nutrição Parenteral , Humanos , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Recém-Nascido , Feminino , Encéfalo/crescimento & desenvolvimento , Encéfalo/diagnóstico por imagem , Estudos Retrospectivos , Nutrição Enteral/métodos , Masculino , Nutrição Parenteral/métodos , Tamanho do Órgão , Proteínas Alimentares/administração & dosagem , Recém-Nascido Prematuro/crescimento & desenvolvimento , Estudos Prospectivos , Idade Gestacional
10.
Lancet Reg Health Am ; 37: 100833, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39070074

RESUMO

Background: Ethno-racial inequalities are critical determinants of health outcomes. We quantified ethnic-racial inequalities on adverse birth outcomes and early neonatal mortality in Brazil. Methods: We conducted a cohort study in Brazil using administrative linked data between 2012 and 2019. Estimated the attributable fractions for the entire population (PAF) and specific groups (AF), as the proportion of each adverse outcome that would have been avoided if all women had the same baseline conditions as White women, both unadjusted and adjusted for socioeconomics and maternal risk factors. AF was also calculated by comparing women from each maternal race/skin colour group in different groups of mothers' schooling, with White women with 8 or more years of education as the reference group and by year. Findings: 21,261,936 newborns were studied. If all women experienced the same rate as White women, 1.7% of preterm births, 7.2% of low birth weight (LBW), 10.8% of small for gestational age (SGA) and 11.8% of early neonatal deaths would have been prevented. Percentages preventable were higher among Indigenous (22.2% of preterm births, 17.9% of LBW, 20.5% of SGA and 19.6% of early neonatal deaths) and Black women (6% of preterm births, 21.4% of LBW, 22.8% of SGA births and 20.1% of early neonatal deaths). AF was higher in groups with fewer years of education among Indigenous, Black and Parda for all outcomes. AF increased over time, especially among Indigenous populations. Interpretation: A considerable portion of adverse birth outcomes and neonatal deaths could be avoided if ethnic-racial inequalities were non-existent in Brazil. Acting on the causes of these inequalities must be central in maternal and child health policies. Funding: Bill & Melinda Gates Foundation and Wellcome Trust.

11.
Pediatr Pulmonol ; 59(12): 3260-3267, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39023342

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) remains a significant challenge in neonatal care. Prenatal inflammation and neonatal sepsis contribute to the multifactorial nature of BPD. A potential association between empirical antibiotic therapy and BPD risk has been proposed due to microbiota dysbiosis in very low birth weight premature infants. METHODS: A single centered retrospective cohort study of preterm infants (24-32 weeks gestation) from 2014 to 2021. The study compared groups that received empirical antibiotics in the first days of life and those that did not receive any antibiotic in the first days of life. The primary outcomes studied were BPD, death, and the combined outcome of BPD/death. Statistical analysis employed t-tests, Mann-Whitney U, Chi-square, and logistic regression. RESULTS: Of 454 preterm infants, 61.5% received antibiotics. This group had lower gestational age, birth weight, and Apgar scores. Antibiotic use was associated with higher incidence of BPD (35.5% vs. 10.3%), death (21.5% vs. 8.6%), and combined outcomes (54.5% vs. 18.3%). In multivariate analysis, antibiotic use independently associated with BPD (OR 2.58, p < 0.001) and combined outcome BPD/death (OR 2.06, p < 0.02). Antenatal corticosteroids provided protection against BPD, but not mortality. CONCLUSION: This study suggests an association between early empirical antibiotic use and BPD in preterm infants, emphasizing the need for judicious antibiotic practices in neonatal care.


Assuntos
Antibacterianos , Displasia Broncopulmonar , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Humanos , Displasia Broncopulmonar/epidemiologia , Recém-Nascido , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Feminino , Masculino , Idade Gestacional , Incidência , Lactente Extremamente Prematuro
12.
J Pediatr (Rio J) ; 100(6): 596-603, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39025129

RESUMO

OBJECTIVES: To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. METHODS: The authors studied 4062 surviving very preterm infants born < 32 weeks' gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. RESULTS: Infants' mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: -2.0, -1.8, and -1.5; head z: -1.3, -1.2 and -1.1 for exclusive human milk, mixed and exclusive formula respectively). CONCLUSION: Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time.


Assuntos
Leite Humano , Estado Nutricional , Alta do Paciente , Humanos , Recém-Nascido , Alta do Paciente/estatística & dados numéricos , Brasil , Estado Nutricional/fisiologia , Feminino , Masculino , Fórmulas Infantis , Idade Gestacional , Unidades de Terapia Intensiva Neonatal , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Peso ao Nascer/fisiologia , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Lactente Extremamente Prematuro/crescimento & desenvolvimento
13.
An. Fac. Med. (Perú) ; 85(3): 268-276, jul.-set. 2024. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1581612

RESUMO

RESUMEN Introducción. En Perú, poco estudios han evaluado adecuadamente si las atenciones prenatales en los establecimientos de salud protegen del bajo peso al nacer de los niños. Objetivo. Determinar la asociación entre la calidad de la atención prenatal y el bajo peso al nacer (BPN) en el Perú. Métodos. Estudio trasversal analítico de fuentes secundarias con datos de la Encuesta Demográfica y de Salud Familiar de Perú del 2021. La exposición fue la calidad de la atención prenatal determinada por tres dimensiones: número de controles, momento del primer control y cumplimiento de las intervenciones programadas. La calidad de la atención prenatal fue «adecuada¼ cuando los tres componentes fueron correctamente cumplidos. El BNP correspondió a menos de 2500 gramos. Resultados. Analizamos datos de 18 484 mujeres y sus respectivos hijos. Entre los nacidos a término el 2,9% tuvo BPN. El 85,9% tuvo de 6 a más controles prenatales. El 79,8% tuvo su primer control en el primer trimestre de la gestación. El 47,4% cumplió los nueve componentes de la atención prenatal. No hubo asociación entre la inadecuada calidad de atención prenatal y el BPN (OR = 1,14; IC95%: 0,86 a 1,52; p = 0,360). Mujeres con menos de 6 controles tuvieron 57% mayor odds de BPN comparados con recién nacidos cuyas madres tuvieron 6 o más controles (IC95%: 1,11 a 2,23; p = 0,012). Conclusiones. En las gestaciones a término, no encontramos asociación entre la calidad de atención prenatal y BPN. Gestantes con menos de 6 atenciones prenatales tuvieron mayor riesgo de un recién nacido con BPN.


ABSTRACT Introduction. In Peru, few studies have adequately evaluated whether prenatal care in health facilities protects against low birth weight in children. Objective. To determine the association between the quality of prenatal care and low birth weight (LBW) in Peru. Methods. Cross-sectional study of secondary data source from the 2021 Peruvian Demographic and Family Health Survey. The exposure was the quality of prenatal care determined by three dimensions: number of controls, timing of the first control and compliance with scheduled interventions. The quality of prenatal care was "adequate" when all three components were correctly met. The BNP corresponded to less than 2500 grams. Results. We analyzed data from 18,484 women and their respective children. Among those born at term, 2.9% had LBW. The 85.9% had 6 or more prenatal controls. The 79.8% had their first check-up in the first trimester of gestation. 47.4% complied with the nine components of prenatal care. There was no association between inadequate quality of prenatal care and LBW (OR = 1.14; 95%CI: 0.86 to 1.52; p = 0.360). Women with fewer than 6 controls had 57% higher odds of LBW compared to infants whose mothers had 6 or more controls (95%CI: 1.11 to 2.23; p = 0.012). Conclusions. In term gestations, we found no association between quality of prenatal care and LBW. Pregnant women with less than 6 prenatal care visits had a higher risk of a LBW newborn.

14.
Medicina (Kaunas) ; 60(6)2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38929560

RESUMO

Background: The aim of this review was to evaluate the effects of periodontal disease (PD) treatment in pregnant women to reduce the risk of preterm birth (PB) and low birth weight (LBW) by conducting an umbrella review. Methods: A comprehensive search for the literature up to April 2024 was conducted across multiple databases including PubMed, Cochrane Library, Scopus, EMBASE, Scielo, Web of Science, Google Scholar, Proquest Dissertations and Theses, and OpenGrey. We specifically targeted systematic reviews (SRs) with or without meta-analyses, irrespective of language or time constraints, focusing on primary studies examining the effect of PD treatment in pregnant women to reduce the risk of PB and LBW. Various types of non-systematic reviews, intervention studies, observational studies, preclinical and basic research, summaries, comments, case reports, protocols, personal opinions, letters, and posters were excluded from consideration. The quality and overall confidence of the included studies were assessed using the AMSTAR-2 tool. Results: After the initial search, 232 articles were identified, of which only 24 met the selection criteria after exclusion. The majority of these studies indicated that periodontal treatment reduces the risk of PB and LBW. Conclusions: According to the findings and conclusions drawn from the SRs with a high overall confidence level, PD treatment in pregnant women reduces the risk of PB and LBW.


Assuntos
Recém-Nascido de Baixo Peso , Doenças Periodontais , Nascimento Prematuro , Humanos , Gravidez , Feminino , Doenças Periodontais/prevenção & controle , Doenças Periodontais/terapia , Doenças Periodontais/complicações , Nascimento Prematuro/prevenção & controle , Recém-Nascido , Complicações na Gravidez/prevenção & controle
15.
Acta Paediatr ; 113(10): 2180-2188, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38895876

RESUMO

AIM: To ascertain whether maternal food insecurity was associated with low birth weight of their babies. METHODS: Systematic review conducted following the items of the Preferred Reporting Items for Systematic Reviews-PRISMA, and recorded in PROSPERO. The descriptors food security, low birth weight and infant low birth weight were combined in the electronic databases: Scopus, PubMed, Cochrane Library, Latin American and Caribbean Health Sciences Literature and Google Scholar, independently by two researchers, between October 2022 and September 2023. The meta-analysis of the association between food insecurity and low birth weight was conducted. The included studies underwent quality and risk of bias assessment. RESULTS: The initial search resulted in 631 records, 12 of which met the inclusion criteria and were selected for this study. Mothers experiencing food insecurity presented 3.09 more risk of having low birth weight babies when compared to those in food security situations. CONCLUSION: Evaluating and monitoring the food and nutritional situation of pregnant women is necessary, with emphasis on the importance of prenatal care, to direct public policies that ensure food security and strengthen adequate nutritional conditions for pregnant women and their babies.


Assuntos
Insegurança Alimentar , Recém-Nascido de Baixo Peso , Humanos , Recém-Nascido , Feminino , Gravidez , Fatores de Risco
16.
Lancet Reg Health Am ; 35: 100774, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38828284

RESUMO

Background: Few studies have evaluated the effects of the Coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, on maternal and perinatal health at a populational level. We investigated maternal and perinatal health indicators in Brazil, focusing on the effects of the COVID-19 pandemic, and SARS-CoV-2 vaccination campaign for pregnant women. Methods: Utilizing interrupted time series analysis (January 2013-December 2022), we examined Maternal Mortality Ratio, Perinatal Mortality Rate, Preterm Birth Rate, Cesarean Section Rate, and other five indicators. Interruptions occurred at the pandemic's onset (March 2020) and pregnant women's vaccination (July 2021). Results were expressed as percent changes on time series' level and slope. Findings: The COVID-19 onset led to immediate spikes in Maternal Mortality Ratio (33.37%) and Perinatal Mortality Rate (3.20%) (p < 0.05). From March 2020 to December 2022, Cesarean Section and Preterm Birth Rates exhibited upward trends, growing monthly at 0.13% and 0.23%, respectively (p < 0.05). Post start of SARS-CoV-2 vaccination (July 2021), Maternal Mortality Ratio (-34.10%) and Cesarean Section Rate (-1.87%) promptly declined (p < 0.05). Subsequently, we observed a monthly decrease of Maternal Mortality Ratio (-9.43%) and increase of Cesarean Section Rate (0.25%) (p < 0.05), while Perinatal Mortality Rate and Preterm Birth Rate showed a stationary pattern. Interpretation: The pandemic worsened all analyzed health indicators. Despite improvements in Maternal Mortality Ratio, following the SARS-CoV-2 vaccination campaign for pregnant women, the other indicators continued to sustain altered patterns from the pre-pandemic period. Funding: No funding.

17.
Arch. latinoam. nutr ; Arch. latinoam. nutr;74(2): 74-82, jun. 2024. tab
Artigo em Inglês | LILACS, LIVECS | ID: biblio-1561530

RESUMO

Introduction: Child health is conditioned by the circumstances of pregnancy, childbirth, and early life. Objective: To describe the maternal and neonatal characteristics of live births (LBs) in the Information System on Live Births of Santa Catarina (SC), Brazil. Materials and methods: A cross-sectional study describedthe maternal and neonatal characteristics of 940,059 LBs, from 2010 to 2019. Pearson's chi-square test and Fisher's exact test were conducted, with a statistical significance level of p < 0.05. Results: The mean values of maternal age, number of live children, and number of fetal deaths as well as abortions were 27.1 years, 0.9, and 0.2, respectively. The averages of the number of gestation weeks, number of prenatal consultations, the start date of the prenatal care, and birth weight were 38.5 weeks, 8.1 months, 2.5 monthsand 3,217.1 grams, respectively. Low birth weight (LBW) was prevalent among mothers without education (p < 0.001), including those without prenatal visits (p < 0.001). A higher prevalence of being underweight was observed among female neonates (p < 0.001) and with a maternal age of ≥ 40 years (10.8%; p < 0.001) compared to newborns with good vitality. Newborns with good vitality had a low prevalence of underweight (p < 0.001). The frequency of the variables studied increased, comparing the beginning and end of the period and whether the differences are statistically significant. Conclusions: The study draws attention to the need for interventions to improve the indicators that determine LBW(AU)


Introducción: La salud infantil está condicionada por las circunstancias del embarazo, parto y primeras etapas de la vida. Objetivo: Describir las características maternas y neonatales de los nacidos vivos en el Sistema de Información de Nacidos Vivos de Santa Catarina, Brasil. Materiales y métodos: Estudio transversal describiendo las características maternas y neonatales de 940.059 nacidos vivos entre 2010 y 2019. Se realizó la prueba de chi cuadrado de Pearson y exacta de Fisher y se estableció p < 0,05. Resultados: Los valores medios para la edad materna, el número de nacidos vivos y el número de mortinatos y abortos espontáneos fueron 27,1, 0,9 y 0,2, respectivamente. Las medias del número de semanas de gestación, el número de visitas prenatales, la fecha de inicio de la atención prenatal y el peso al nacer fueron 38,5 semanas (DE 2,2), 8,1 meses, 2,5 meses y 3 217,1 gramos, respectivamente. El bajo peso al nacer (BPN) fue prevalente entre las madres sin estudios (p < 0,001), incluidas las que no acudieron a una cita prenatal (p < 0,001). Hubo una mayor prevalencia de BPN en neonatos de sexo femenino (p < 0,001) con madres de edad ≥ 40 años (10,8%; p < 0,001). Los neonatos con buena vitalidad tuvieron una baja prevalencia de BPN (p < 0,001). La frecuencia de las variables estudiadas aumentó al comparar el inicio y el final del período y si las diferencias son estadísticamente significativas. Conclusiones: El estudio llama la atención sobre la necesidad de intervenciones para mejorar los indicadores que determinan el BPN(AU)


Assuntos
Recém-Nascido , Recém-Nascido , Gravidez , Saúde da Criança , Idade Materna , Nascido Vivo , Serviços de Saúde da Criança
18.
Eur J Pediatr ; 183(8): 3243-3251, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38700694

RESUMO

This study aims to analyze the main risk factors for acute kidney injury in the subgroup of very-low birth weight newborns, using the diagnosing criteria of the Kidney Disease Improving Global Outcomes (KDIGO) or the Acute Kidney Injury Network (AKIN). A systematic review of the literature was performed on the EMBASE® and PubMed® platforms. Studies that evaluated the risk factors for developing AKI in VLBW newborns were included. For the meta-analysis, we only included the risk factors that were associated with AKI in the univariate analysis of at least two studies. After an initial screening, abstract readings, and full-text readings, 10 articles were included in the systematic review and 9 in the meta-analysis. The incidence of AKI varied from 11.6 to 55.8%. All the studies have performed multivariate analysis, and the risk factors that appeared most were PDA and hemodynamic instability (use of inotropes or hypotension), sepsis, and invasive mechanical ventilation. After the meta-analysis, only cesarian delivery did not show an increased risk of AKI, all the other variables remained as important risk factors. Moreover, in our meta-analysis, we found a pooled increased risk of death in newborns with AKI almost 7 times.  Conclusion: AKI in VLBW has several risk factors and must be seen as a multifactorial disease. The most common risk factors were PDA, hemodynamic instability, sepsis, and invasive mechanical ventilation. What is known: • Acute kidney injury is associated with worst outcomes in all ages. It´s prevention can help diminish mortality. What is new: • A synthesis of the main risk factors associated with AKI in very low birth weight newborns.


Assuntos
Injúria Renal Aguda , Recém-Nascido de muito Baixo Peso , Humanos , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/diagnóstico , Recém-Nascido , Fatores de Risco , Incidência , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Doenças do Prematuro/diagnóstico
19.
World J Clin Pediatr ; 13(1): 89086, 2024 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-38596446

RESUMO

BACKGROUND: A progressive decrease in exclusive breastfeeding (BF) is observed in Latin America and the Caribbean compared with global results. The possibility of being breastfed and continuing BF for > 6 months is lower in low birth weight than in healthy-weight infants. AIM: To identify factors associated with BF maintenance and promotion, with particular attention to low- and middle-income countries, by studying geographic, socioeconomic, and individual or neonatal health factors. METHODS: A scoping review was conducted in 2018 using the conceptual model of social determinants of health published by the Commission on Equity and Health Inequalities in the United States. The extracted data with common characteristics were synthesized and categorized into two main themes: (1) Sociodemographic factors and proximal determinants involved in the initiation and maintenance of BF in low-birth-weight term infants in Latin America; and (2) individual characteristics related to the self-efficacy capacity for BF maintenance and adherence in low-birth-weight term infants. RESULTS: This study identified maternal age, educational level, maternal economic capacity, social stratum, exposure to BF substitutes, access to BF information, and quality of health services as mediators for maintaining BF. CONCLUSION: Individual self-efficacy factors that enable BF adherence in at-risk populations should be analyzed for better health outcomes.

20.
Sci Total Environ ; 927: 172369, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38604361

RESUMO

Particulate matter is a type of air pollution that consists of fine particles with a diameter <2.5 µm (PM2.5), which can easily penetrate the respiratory system and enter the bloodstream, increasing health risks for pregnant women and their unborn babies. Recent reports have suggested that there is a positive association between PM2.5 exposure and adverse pregnancy outcomes. However, most evidence of this relationship comes from Western countries. Thus, the objective of this study was to evaluate the association between PM2.5 exposure during pregnancy and birth outcomes among pregnant women in Colombia. This study included 542,800 singletons born in 2019 to Colombian women, aged 15+ years, residing in 981 municipalities. Data on parental, child and birth characteristics were extracted from anonymized live birth records. Satellite-based estimates of monthly PM2.5 concentrations at the surface level were extracted for each municipality from the Atmospheric Composition Analysis Group (ACAG). PM2.5 exposure during pregnancy was indicated by the monthly average of PM2.5 concentrations across the pregnancy duration for the municipality where the child was born. The associations of municipality-level PM2.5 concentration during pregnancy with pre-term birth (PTB) and low birth weight (LBW) were tested in separate two-level logistic regression models, with babies nested within municipalities. The prevalence of PTB and LBW were 8.6 % and 8.3 %, respectively. The mean PM2.5 concentration across the 981 municipalities was 18.26 ± 3.30 µg/m3, ranging from 9.11 to 31.44 µg/m3. Greater PM2.5 concentration at municipality level was associated with greater odds of PTB (1.05; 95%CI: 1.04-1.06) and LBW (1.04; 95%CI: 1.03-1.05), after adjustment for confounders. Our findings provide new evidence on the association between PM2.5 on adverse pregnancy outcomes from a middle-income country.


Assuntos
Poluentes Atmosféricos , Recém-Nascido de Baixo Peso , Exposição Materna , Material Particulado , Resultado da Gravidez , Material Particulado/análise , Feminino , Gravidez , Colômbia/epidemiologia , Humanos , Exposição Materna/estatística & dados numéricos , Poluentes Atmosféricos/análise , Resultado da Gravidez/epidemiologia , Adulto , Adulto Jovem , Adolescente , Poluição do Ar/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Recém-Nascido
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