Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.362
Filtrar
1.
Int J Gynaecol Obstet ; 148(1): 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31556455

RESUMO

OBJECTIVE: To clarify the association between postpartum depression (PPD) and anemia in each stage of pregnancy as well as in the postpartum period. METHODS: A prospective cohort study was conducted between May 2010 and November 2013 at a tertiary hospital in Japan. In total, 1128 women were assessed using the Edinburgh Postpartum Depression Scale (EPDS) at postpartum week 4 and a blood test was performed in the second trimester (24-28 weeks of gestation), third trimester (35-36 weeks of gestation), and postpartum week 1. The primary outcome was PPD, defined as an EPDS score of 9 or higher. Multivariate logistic regression analysis was used to elucidate the association between anemia and PPD for each period. Additionally, trend analysis was conducted to determine if there was a linear association between maternal hemoglobin concentration and PPD. RESULTS: Postpartum anemia was significantly associated with increased PPD risk (adjusted odds ratio 1.63, 95% confidence interval 1.17-2.26) whereas anemia in the second and third trimesters was not. Similarly, a significant inverse association was observed between the quintiles of maternal hemoglobin levels in the puerperium and the PPD risk (P value for trend 0.004). CONCLUSION: Postpartum anemia was associated with an increased risk of PPD.


Assuntos
Anemia/etiologia , Depressão Pós-Parto/complicações , Doenças do Recém-Nascido/etiologia , Adulto , Anemia/diagnóstico , Depressão Pós-Parto/diagnóstico , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Japão , Razão de Chances , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Adulto Jovem
2.
BMJ ; 367: l6131, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748223

RESUMO

OBJECTIVE: To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks. DESIGN: Multicentre, open label, randomised controlled superiority trial. SETTING: 14 hospitals in Sweden, 2016-18. PARTICIPANTS: 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group. INTERVENTIONS: Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks. MAIN OUTCOME MEASURES: The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat. RESULTS: The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups. CONCLUSIONS: This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths. TRIAL REGISTRATION: Current Controlled Trials ISRCTN26113652.


Assuntos
Idade Gestacional , Doenças do Recém-Nascido , Trabalho de Parto Induzido , Conduta Expectante/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Análise de Intenção de Tratamento , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Natimorto/epidemiologia , Suécia/epidemiologia , Nascimento a Termo
3.
Nature ; 574(7776): 117-121, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31534227

RESUMO

Immediately after birth, newborn babies experience rapid colonization by microorganisms from their mothers and the surrounding environment1. Diseases in childhood and later in life are potentially mediated by the perturbation of the colonization of the infant gut microbiota2. However, the effects of delivery via caesarean section on the earliest stages of the acquisition and development of the gut microbiota, during the neonatal period (≤1 month), remain controversial3,4. Here we report the disrupted transmission of maternal Bacteroides strains, and high-level colonization by opportunistic pathogens associated with the hospital environment (including Enterococcus, Enterobacter and Klebsiella species), in babies delivered by caesarean section. These effects were also seen, to a lesser extent, in vaginally delivered babies whose mothers underwent antibiotic prophylaxis and in babies who were not breastfed during the neonatal period. We applied longitudinal sampling and whole-genome shotgun metagenomic analysis to 1,679 gut microbiota samples (taken at several time points during the neonatal period, and in infancy) from 596 full-term babies born in UK hospitals; for a subset of these babies, we collected additional matched samples from mothers (175 mothers paired with 178 babies). This analysis demonstrates that the mode of delivery is a significant factor that affects the composition of the gut microbiota throughout the neonatal period, and into infancy. Matched large-scale culturing and whole-genome sequencing of over 800 bacterial strains from these babies identified virulence factors and clinically relevant antimicrobial resistance in opportunistic pathogens that may predispose individuals to opportunistic infections. Our findings highlight the critical role of the local environment in establishing the gut microbiota in very early life, and identify colonization with antimicrobial-resistance-containing opportunistic pathogens as a previously underappreciated risk factor in hospital births.


Assuntos
Cesárea/efeitos adversos , Microbioma Gastrointestinal , Doenças do Recém-Nascido/microbiologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Infecções Oportunistas/congênito , Infecções Oportunistas/microbiologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Infecções Oportunistas/etiologia , Gravidez
4.
Int J Gynaecol Obstet ; 147(3): 404-412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479156

RESUMO

OBJECTIVE: To characterize the demographics, comorbidities, management, and outcomes of pregnant women with pre-gestational and gestational diabetes (GDM), including overt and true GDM, taking into account HIV infection and the influence of exposure to oral hypoglycemic agents (OHAs). METHODS: A review of medical records of 1071 diabetic pregnancies (between 2012 and 2018) at a tertiary hospital in South Africa. RESULTS: Of the women, 43% had GDM, 19% had type 1 diabetes (T1DM), and 38% had type 2 diabetes (T2DM). Each group had a mean initial body mass index (BMI) >25 kg/m2 . Despite poor initial HbA1c for pre-gestational groups, over 90% of the cohort achieved glycemic control by the time of delivery. The rate of prematurity was 30.9%. Perinatal mortality (PNM) was 5.1% for the pre-gestational group and 1.8% for GDM. Of the cohort, 23.9% was HIV infected. PNM was higher in the HIV-infected pregnancies (9.4%) than non-HIV exposed pregnancies (1.8%, P<0.001). The macrosomia rate was higher in the glibenclamide-exposed group than the insulin-alone group (12.2% vs 0%, P=0.025). CONCLUSION: Obesity is a significant predictor for macrosomia and was high in all groups. In a low-/middle-income country setting with a high prevalence of HIV and high usage of OHAs as an alternative to insulin therapy, HIV might be associated with higher PNM and glibenclamide with increased rates of macrosomia, which warrants further exploration.


Assuntos
Diabetes Gestacional/epidemiologia , Infecções por HIV/epidemiologia , Gravidez em Diabéticas/epidemiologia , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Recém-Nascido Prematuro , Mortalidade Perinatal , Gravidez , Estudos Retrospectivos , África do Sul/epidemiologia , Adulto Jovem
5.
BMJ Case Rep ; 12(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420423

RESUMO

Neonatal hypoparathyroidism is one of the rare causes of hypocalcaemia. Several cases of neonatal hypoparathyroidism secondary to maternal hyperparathyroidism have been reported. In this case report, we have a term neonate with normal birth history who presented with late onset hypocalcemic seizures. After excluding polyendocrinopathies and related syndromes, hypocalcaemia seizures were secondary to maternal asymptomatic hypoparathyroidism. Since this is one variety of unusual case of maternal and fetal hypoparathyroidism, further testing was mandatory to confirm familial origin. This focuses on the need for every clinician to test maternal metabolic status in case of neonatal manifestations.


Assuntos
Hipocalcemia/etiologia , Hipoparatireoidismo/complicações , Doenças do Recém-Nascido/etiologia , Complicações na Gravidez/etiologia , Efeitos Tardios da Exposição Pré-Natal/etiologia , Convulsões/etiologia , Feminino , Humanos , Recém-Nascido , Gravidez
6.
Nat Commun ; 10(1): 3494, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375667

RESUMO

Necrotizing enterocolitis (NEC) is an idiopathic, inflammatory bowel necrosis of premature infants. Clinical studies have linked NEC with antecedent red blood cell (RBC) transfusions, but the underlying mechanisms are unclear. Here we report a neonatal murine model to investigate this association. C57BL/6 mouse pups rendered anemic by timed phlebotomy and then given RBC transfusions develop NEC-like intestinal injury with prominent necrosis, inflammation, and submucosal edema/separation of the lamina propria in the ileocecal region and colon within 12-24 h. The anemic intestine is infiltrated by inflammatory macrophages, which are activated in situ by RBC transfusions via a Toll-like receptor (TLR)-4-mediated mechanism and cause bowel injury. Chelation of RBC degradation products with haptoglobin, absence of TLR4, macrophage depletion, and inhibition of macrophage activation is protective. Intestinal injury worsens with increasing severity and the duration of anemia prior to transfusion, indicating a need for the re-evaluation of current transfusion guidelines for premature infants.


Assuntos
Anemia/complicações , Enterocolite Necrosante/etiologia , Transfusão de Eritrócitos/efeitos adversos , Doenças do Recém-Nascido/etiologia , Anemia/terapia , Animais , Animais Recém-Nascidos , Ceco/patologia , Colo/patologia , Modelos Animais de Doenças , Enterocolite Necrosante/patologia , Humanos , Íleo/patologia , Recém-Nascido , Doenças do Recém-Nascido/patologia , Recém-Nascido Prematuro , Mucosa Intestinal/patologia , Macrófagos/imunologia , Macrófagos/metabolismo , Camundongos , Receptor 4 Toll-Like/imunologia , Receptor 4 Toll-Like/metabolismo
7.
Int J Gynaecol Obstet ; 146(3): 326-332, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31242319

RESUMO

OBJECTIVE: To investigate whether glycated albumin, fructosamine, and hemoglobin A1c (HbA1c) are associated with neonatal complications in newborns of pregnant women with gestational diabetes mellitus (GDM). METHODS: Between November 2016 and September 2017, women with a singleton pregnancy and GDM were enrolled in a prospective study in an obstetric Portuguese referral center. Glycemic markers were compared between mothers of newborns with and without complications. Multivariable logistic regression models and corresponding areas under the receiver operating characteristic curve (AUC) were used. RESULTS: A total of 85 women participated in the study. Raised levels of glycated albumin and fructosamine were associated with at least one neonatal complication (OR- [odds ratio] estimate: 1.33, P=0.015; OR: 1.24, P=0.027, respectively) and with respiratory disorders at birth (OR 1.41, P=0.004; OR 1.26, P=0.014, respectively). HbA1c was not associated with these outcomes. All biomarkers were associated with large-for-gestational age (LGA) status (OR 1.61, P<0.001; OR 1.45, P<0.001; OR 3.62, P=0.032 for glycated albumin, fructosamine, and HbA1c, respectively). All had similar AUC for at least one neonatal complication (0.82; 0.81; 0.79, respectively). For newborn respiratory disorders, AUCs were 0.83, 0.81, and 0.76, respectively, and for LGA status were 0.81, 0.79, and 0.71, respectively. CONCLUSION: Raised values of glycated albumin and fructosamine were associated with particular perinatal complications in newborns of mothers with GDM, better discriminating mothers of newborns with and without complications than HbA1c.


Assuntos
Diabetes Gestacional/fisiopatologia , Frutosamina/metabolismo , Hemoglobina A Glicada/metabolismo , Doenças do Recém-Nascido/etiologia , Albumina Sérica/metabolismo , Adulto , Biomarcadores/metabolismo , Glicemia/metabolismo , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Macrossomia Fetal/etiologia , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Estudos Prospectivos , Curva ROC
8.
J Pediatr Endocrinol Metab ; 32(7): 767-774, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31211689

RESUMO

Background Persistent hypoglycemia (PH) beyond 3 days of life warrants investigation which includes a critical sample. We report our case series of five neonates who presented with PH as the first sign of congenital hypopituitarism. Design This is a case series. Methods/Results This is a case series of five neonates evaluated at our academic institution in a 3-year period (2013-2016), who presented with persistent severe hypoglycemia and were subsequently diagnosed with congenital hypopituitarism. All neonates were full term (mean gestational age 39.8 ± 1.4 weeks) born by caesarian section with a mean weight of 3.5 ± 0.16 kg and a mean length of 51.2 ± 1.2 cm at birth. All five neonates had PH beyond 3 days with an average blood glucose (BG) <35 mg/dL at presentation, requiring a mean glucose infusion rate (GIR) of 7.22 ± 1.98 mg/kg/min. The average BG during the critical sample was 42 ± 0.16 mg/dL (three patients). The mean duration of requirement of the glucose infusion was 6.2 ± 3 days during the immediate neonatal period. Diagnosis of the hypopituitarism took 2-52 days from the initial presentation of hypoglycemia. Besides growth hormone (GH) deficiency, cortisol deficiency was diagnosed in all the five neonates. Neuroimaging findings in all the neonates were consistent with pituitary stalk interruption syndrome (hypoplastic anterior pituitary, ectopic posterior pituitary [EPP] and interrupted pituitary stalk). Conclusions Hypoglycemia is a common metabolic complication affecting an infant in the immediate neonatal period. Delay in the diagnosis of hypopituitarism presenting as hypoglycemia is the result of the lack of awareness among neonatologists and/or pediatricians. We propose that providers be cognizant that PH can be the only presentation of hypopituitarism in the neonatal period. Therefore, having a high index of suspicion about this condition can avoid a delay in the evaluation, diagnosis and treatment of hypopituitarism.


Assuntos
Hipoglicemia/etiologia , Hipopituitarismo/congênito , Hipopituitarismo/complicações , Doenças do Recém-Nascido/etiologia , Índice de Gravidade de Doença , Biomarcadores/análise , Feminino , Humanos , Hipoglicemia/diagnóstico , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Masculino , Gravidez , Prognóstico
9.
J Pediatr Endocrinol Metab ; 32(6): 607-613, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31141482

RESUMO

Background Wolcott-Rallison syndrome is a rare autosomal recessive disorder characterized by neonatal/early-onset non-autoimmune insulin-dependent diabetes, multiple epiphyseal dysphasia and growth retardation. It is caused by mutations in the gene encoding eukaryotic translation initiation factor 2α kinase 3 (EIF2AK3). We aimed to study the clinical characteristics and frequency of the disease in the Iranian population. Methods We recruited 42 patients who referred to the endocrine and metabolism clinic at Mashhad Imam Reza Hospital with neonatal diabetes. Molecular screening of KCNJ11, INS, ABCC8 and EIF2AK3 was performed at the Exeter Molecular Genetics Laboratory, UK. We calculated the frequency of the disease in 124 patients referred from Iran to the Exeter Molecular Genetics Laboratory for genetic screening and compared it to other countries worldwide. Results We identified seven patients as having Wolcott-Rallison syndrome. Genetic testing confirmed the clinical diagnosis and indicated five novel mutations. Only two patients developed clinical features of the syndrome by 6 months of age. Of all 124 cases of Iranian neonatal diabetes referred to the Exeter Molecular Genetics Laboratory for genetic screening, 28 patients (22.58%) had a recessive mutation in EIF2AK3. Conclusions The results of this study raises awareness of the condition and provides further accurate data on the genetic and clinical presentation of Wolcott-Rallison syndrome in the Iranian population. Our study highlights the importance of genetic testing in patients from consanguineous families with diabetes diagnosed within the first 6 months of life.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus/etiologia , Epífises/anormalidades , Doenças do Recém-Nascido/etiologia , Osteocondrodisplasias/complicações , eIF-2 Quinase/genética , Criança , Pré-Escolar , Consanguinidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Irã (Geográfico)/epidemiologia , Masculino , Mutação , Prognóstico
10.
Malawi Med J ; 31(1): 77-81, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31143401

RESUMO

Background: Delayed presentation might affect the ultimate management of children with congenital bowel obstructive bowel anomalies (CBA). We evaluated the profile, challenges of treatment and outcome of CBA presenting after neonatal age. Methods: We did a retrospective analysis of data of children with CBA presenting after neonatal age from January 2013 to November 2017. We used the Statistical Package for Social Sciences (SPSS) for data entry and analysis. Results: There were 57 cases in total comprising of Hirschsprung's disease (HD; 37 cases), anorectal malformation (ARM; 15 cases), and duodeno-jejunal web (5 cases), with median age of 9 months (IQR 4 months - 2 years) on presentation. Overall, 52 (91.2%) patients had one or more complications on presentation. Definitive procedure did not differ from established operations, but only 9 (15.8%) had primary procedures and 48 (84.2%) cases required multi-stage treatment. After an average follow up period of 19.5 months (range: 1-45 months), 18 (31.6%) cases developed procedure-related complications and 3 (5.3%) had residual bowel dysfunction, but there was no mortality. The morbidity was limited to cases with HD and ARM. Conclusion: In our setting, HD is the commonest bowel anomaly that presents after the neonatal age. The delayed presentation may predispose to complications and preclude single-stage treatment in some cases. Training of healthcare providers to improve recognition and early referral of these anomalies may lead to early diagnosis and minimize morbidity.


Assuntos
Malformações Anorretais/epidemiologia , Diagnóstico Tardio , Doença de Hirschsprung/epidemiologia , Doenças do Recém-Nascido/etiologia , Obstrução Intestinal/congênito , Obstrução Intestinal/epidemiologia , Intestino Delgado/anormalidades , Malformações Anorretais/diagnóstico , Pré-Escolar , Feminino , Doença de Hirschsprung/diagnóstico , Hospitais de Ensino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Obstrução Intestinal/etiologia , Malaui/epidemiologia , Masculino , Estudos Retrospectivos
11.
Brain Dev ; 41(7): 595-599, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30954359

RESUMO

BACKGROUND: A targeted treatment approach is increasingly promoted in epilepsy management. AIM: To investigate if etiology (both established or initially presumed) influences antiepileptic drug choice of experts in neonatal seizures. METHODS: An invitation to participate to a web-based questionnaire was sent to Italian pediatric neurologists affiliated to the Italian Society of Pediatric Neurology (SINP). RESULTS: 19 pediatric neurologists from different centers, all consultants of third level Neonatal Intensive Care Units (NICUs) answered. As first-line drug phenobarbital was the most common choice, it was used in 79% of cases of acute symptomatic seizures, in 63% of structural epilepsy, in 42% of genetic epilepsies. As second-line drug phenytoin was used by 58% in acute symptomatic seizures, 37% in structural epilepsy, 5% in genetic epilepsy. Pyridoxine/pyridoxalphosphate was much more used in genetic epilepsy (as first-line in 26%, as second-line in 37%) than in the other two conditions. Long-term conventional EEG monitoring was suggested as important to verify efficacy of drugs in controlling seizures by 84% of interviewed neurologists, but EEG was available around the clock in only 53% of their centers. 1 to 3-channel aEEG/EEG (commonly named CFM) was often used instead of conventional EEG monitoring. CONCLUSION: This is the first survey looking at a targeted approach in treatment of neonatal seizures by pediatric neurologists consulted by NICUs. The treatment approach is similar to previous surveys in case of acute symptomatic seizures, but in case of other etiologies the choices are different, especially for the second-line option. Larger studies should address this topic.


Assuntos
Epilepsia/etiologia , Epilepsia/terapia , Convulsões/terapia , Anticonvulsivantes/uso terapêutico , Pré-Escolar , Eletroencefalografia/métodos , Epilepsia/tratamento farmacológico , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Itália , Masculino , Neurologistas , Pediatras , Fenobarbital/uso terapêutico , Fenitoína/uso terapêutico , Convulsões/tratamento farmacológico , Convulsões/etiologia , Inquéritos e Questionários
12.
Eur J Paediatr Neurol ; 23(3): 368-383, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30879961

RESUMO

With a birth-prevalence of 37-67/100,000 (mostly term-born), perinatal stroke encompasses distinct disease-states with diverse causality, mechanism, time of onset, mode of presentation and outcome. Neonatal primary haemorrhagic stroke and ischemic events (also divided into neonatal arterial ischemic stroke and neonatal cerebral sinus venous thrombosis) that manifest soon after birth are distinguished from presumed perinatal - ischemic or haemorrhagic - stroke. Signs of the latter become apparent only beyond the neonatal period, most often with motor asymmetry or milestones delay, and occasionally with seizures. Acute or remote MRI defines the type of stroke and is useful for prognosis. Acute care relies on homeostatic maintenance. Seizures are often self-limited and anticonvulsant agents might be discontinued before discharge. Prolonged anticoagulation for a few weeks is an option in some cases of sinovenous thrombosis. Although the risk of severe impairment is low, many children develop mild to moderate multimodal developmental issues that require a multidisciplinary approach.


Assuntos
Doenças do Recém-Nascido/etiologia , Doenças do Recém-Nascido/patologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Criança , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/etiologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/terapia , Masculino , Gravidez , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/terapia , Síndrome
13.
BMC Pregnancy Childbirth ; 19(1): 104, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30922264

RESUMO

BACKGROUND: This study was to evaluate the impact of different preoperative fasting conditions on women and neonates through a retrospective analysis. METHODS: A total of 1599 women were divided into 5 groups according to different preoperative fasting times: group A: solid food ≥8 h; clear fluids ≥6 h; B: solid food ≥8 h; clear fluids ≥2 h < 6 h; C: solid food ≥6 h < 8 h; clear fluids < 2 h; D: solid food ≥2 h < 6 h; clear fluids < 2 h; E: solid food < 2 h; clear fluids < 2 h. RESULTS: Incidence rate of vomiting of women was lower in group C (solid food ≥6 h < 8 h and clear fluids < 2 h) than other groups (P <  0.05). Compared with the fasting for a long time (groups A and B: solid food > 8 h and clear fluids > 2 h at least), the incidence rate of hypoglycemia and acidosis of neonates in group C displayed a certain decrease (P <  0.05). Although shorter fasting times (solid food < 6 h at least) reduced the incidence of hypoglycemia and acidosis in neonates, it increased the risk of vomiting of women. CONCLUSION: The preoperative fasting of solid food ≥6 h < 8 h and clear fluids < 2 h reduces the incidence of vomiting in women's anesthesia and the risk of hypoglycemia and acidosis in neonates.


Assuntos
Cesárea/efeitos adversos , Jejum/efeitos adversos , Doenças do Recém-Nascido/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/métodos , Vômito/epidemiologia , Acidose/epidemiologia , Acidose/etiologia , Adulto , Feminino , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Incidência , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Cuidados Pré-Operatórios/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Vômito/etiologia
14.
Nutrients ; 11(3)2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845641

RESUMO

Vegetarian and vegan diets have increased worldwide in the last decades, according to the knowledge that they might prevent coronary heart disease, cancer, and type 2 diabetes. Althought plant-based diets are at risk of nutritional deficiencies such as proteins, iron, vitamin D, calcium, iodine, omega-3, and vitamin B12, the available evidence shows that well planned vegetarian and vegan diets may be considered safe during pregnancy and lactation, but they require a strong awareness for a balanced intake of key nutrients. A review of the scientific literature in this field was performed, focusing specifically on observational studies in humans, in order to investigate protective effects elicited by maternal diets enriched in plant-derived foods and possible unfavorable outcomes related to micronutrients deficiencies and their impact on fetal development. A design of pregestational nutrition intervention is required in order to avoid maternal undernutrition and consequent impaired fetal growth.


Assuntos
Dieta Vegana/efeitos adversos , Dieta Vegetariana/efeitos adversos , Doenças do Recém-Nascido/etiologia , Desnutrição/etiologia , Complicações na Gravidez/etiologia , Feminino , Retardo do Crescimento Fetal/etiologia , Humanos , Recém-Nascido , Lactação , Fenômenos Fisiológicos da Nutrição Materna , Micronutrientes/deficiência , Necessidades Nutricionais , Gravidez
15.
Pediatr Clin North Am ; 66(2): 403-423, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30819345

RESUMO

Intrauterine growth restriction (IUGR) is an important cause of fetal, perinatal and neonatal morbidity and mortality. IUGR occurs because of multiple reasons. Neonates with IUGR experience acute problems in the perinatal and early neonatal period that can be life-threatening. The unfavorable uterine environment causing growth restriction results in programming that predisposes IUGR infants to long-term health issues such as poor physical growth, metabolic syndrome, cardiovascular disease, neurodevelopmental impairment and endocrine abnormalities, warranting careful monitoring. It is imperative to strike the balance between achieving optimal catch-up to promote normal development, while preventing the onset of cardiovascular and metabolic disorders in the long-term.


Assuntos
Desenvolvimento Infantil , Retardo do Crescimento Fetal/diagnóstico , Doenças do Recém-Nascido/etiologia , Monitorização Fisiológica/métodos , Feminino , Retardo do Crescimento Fetal/terapia , Humanos , Lactente , Recém-Nascido , Gravidez
17.
BMC Pregnancy Childbirth ; 19(1): 87, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30871491

RESUMO

BACKGROUND: Transient donor hydrops (TDH) is defined as donor hydrops developed within days after laser therapy for twin-twin transfusion syndrome (TTTS) followed by resolution later. The purpose of this study was to evaluate the incidence, neonatal outcomes and predisposing factors of post laser therapy TDH in severe TTTS. METHODS: A total of 142 patients with severe TTTS who received laser therapy were included into this study. The pre-operative characteristics and neonatal outcomes were compared between TTTS with and without post laser therapy TDH. All live neonates received cranial ultrasound examination after delivery, mild cerebral injury was defined as exhibiting at least one of the following: intraventricular hemorrhage (IVH) grade I and II, lenticulostriate vasculopathy and subependymal pseudocysts; severe cerebral injury comprised at least one among the following: IVH grade III or grade IV, cystic periventriculoleukomalacia (PVL) grade II or more, porencephalic cysts, and ventricular dilatation. Fetal survival was defined as living more than 30 days after delivery.


Assuntos
Transfusão Feto-Fetal/cirurgia , Fetoscopia/efeitos adversos , Hidropisia Fetal/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Fotocoagulação a Laser/efeitos adversos , Adulto , Doença Cerebrovascular dos Gânglios da Base/epidemiologia , Doença Cerebrovascular dos Gânglios da Base/etiologia , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/etiologia , Estudos de Casos e Controles , Hemorragia Cerebral Intraventricular/epidemiologia , Hemorragia Cerebral Intraventricular/etiologia , Feminino , Transfusão Feto-Fetal/complicações , Transfusão Feto-Fetal/embriologia , Fetoscopia/métodos , Glioma Subependimal/epidemiologia , Glioma Subependimal/etiologia , Humanos , Hidropisia Fetal/etiologia , Incidência , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Fotocoagulação a Laser/métodos , Gravidez , Resultado da Gravidez , Gravidez de Gêmeos
18.
BJOG ; 126(8): 1008-1013, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30739400

RESUMO

BACKGROUND: As more women are presenting with three previous caesarean deliveries (CD), providers may suggest early term delivery as a means to avoid the risk of spontaneous labour and associated maternal morbidity. OBJECTIVE: To determine whether early term delivery is associated with lower maternal and neonatal morbidity for women with three previous CD. STUDY DESIGN: Secondary analysis of a prospective registry of CD at 19 US academic centres from 1999 to 2002. POPULATION: Women with three previous CD undergoing scheduled or emergent delivery with live, singleton gestations 37-41+ weeks of gestation were included. Women with non-low transverse incisions, antepartum stillbirth, previous myomectomy, fetal anomalies, more or fewer than three previous CD or attempting trial of labour after caesarean section were excluded. METHODS: Gestational age was categorised by week. We fitted logistic regression models to adjust for clinically relevant or statistically significant confounders. MAIN OUTCOME MEASURES: The primary and secondary outcomes were composites, respectively, of maternal and neonatal morbidity. RESULTS: In all, 821 women met the inclusion criteria; maternal morbidity composite occurred in 9.86% and neonatal morbidity occurred in 10.5%. After adjusting for confounding variables, maternal and neonatal morbidity occurred least frequently at 39 weeks. CONCLUSIONS: In women with three previous CDs, adverse maternal outcomes do not increase with increasing gestational age beyond 37 weeks but early term elective repeat CDs are associated with higher neonatal morbidity. Elective delivery of women with three previous CD at 39 weeks of gestation is safe in the absence of maternal or fetal indications for early term delivery. TWEETABLE ABSTRACT: Delivery of women with three previous caesarean deliveries at 39 weeks, in the absence of maternal or fetal indications for early term delivery, is associated with decreased maternal morbidity.


Assuntos
Recesariana/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Doenças do Recém-Nascido/etiologia , Complicações na Gravidez/etiologia , Fatores de Tempo , Adulto , Parto Obstétrico/efeitos adversos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Estudos Prospectivos , Sistema de Registros , Estados Unidos
19.
Indian J Pediatr ; 86(4): 340-346, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30809767

RESUMO

OBJECTIVE: To identify independent risk factors to develop a central line- associated bloodstream infection (CLABSI) in critically ill neonates with major underlying diseases. METHODS: A nested case-control study was conducted in a neonatal intensive care unit (NICU). Patients with a central venous catheter (CVC) were included. Cases were neonates who developed a CLABSI and controls were patients without CLABSI. Variables included: perinatal history, characteristics of the catheter, installation and catheter use, surgical interventions, and hospital stay. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. X2, Fisher exact, and Mann-Whitney U tests were used when appropriate. Variables with a p value ≤0.10 in the univariate analysis were introduced in a non-conditional logistic regression model. RESULTS: Seventy four cases and 105 controls were analyzed. Univariate risk factors were: any surgery, abdominal surgery, length of hospitalization (≥14 d), double-lumen CVC, surgical cut-down technique, complications, CVC placement in internal jugular vein, dressing type, blood transfusions, parenteral nutrition, and number of CVC manipulations (>200). In the logistic regression analysis, independent risk factors with a p value <0.05 were: double-lumen catheter (OR 5.8, 95% CI 1.2-30), length of hospitalization ≥14 d (OR 4.6, 95% CI 1.8-11.4), abdominal surgery (OR 2.7, 95% CI 1.2-6.2) and blood transfusions (OR 2.5, 95% CI 1.2-5.3). CONCLUSIONS: One risk factor was related to the catheter itself. Management of underlying diseases in specialized NICU contributes to a greater extent to the development of a central line-associated bloodstream infection.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Doenças do Recém-Nascido/etiologia , Peso ao Nascer , Estudos de Casos e Controles , Infecções Relacionadas a Cateter/microbiologia , Anormalidades Congênitas/epidemiologia , Estado Terminal/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/microbiologia , Unidades de Terapia Intensiva Neonatal , Masculino , Fatores de Risco , Fatores Sexuais
20.
Pediatr Dev Pathol ; 22(4): 356-364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30722724

RESUMO

Autopsy reports of 78 stillbirths and early infant deaths (up to age 8 weeks) were reviewed to investigate the prevalence of extrahepatic nonreticuloendothelial siderosis (EHNRS) in the context of neonatal liver failure. Of these, 10 liveborns (12.8%), M:F 3:2, with mean gestational age 37.6 weeks (range: 35-39) and mean age at the time of demise 19.1 days (range: 7-42), showed significant liver injury: infection (n = 7, viral > fungal), congenital malformations (n = 2), and ischemia (n = 1). None had maternal history of gestational alloimmune liver disease (GALD) or previous fetal/neonatal death due to liver failure. Seven of 10 cases (70%) showed EHNRS: pancreas (n = 6), kidneys (n = 4), thyroid and adrenal glands (n = 3), and bronchial glands and heart (n = 2). Iron deposition was most frequent in the pancreas (60%), most diffuse in the kidneys, and seen in at least 2 organs, with pancreas and kidney being the most frequent combination. Hepatic C5b-9 expression was variable (1+ to 4+) except 1 case (100% necrosis). The duration of illness and the mean age at the time of demise tended to be higher in those with EHNRS. In summary, hepatic and EHNRS, with or without C5b-9 expression, are not specific for GALD. Other causes of liver failure should be investigated as clinically and pathologically appropriate.


Assuntos
Complexo de Ataque à Membrana do Sistema Complemento/metabolismo , Morte Fetal/etiologia , Doenças do Recém-Nascido/etiologia , Ferro/metabolismo , Falência Hepática/etiologia , Siderose/etiologia , Feminino , Humanos , Imuno-Histoquímica , Recém-Nascido , Doenças do Recém-Nascido/patologia , Fígado/metabolismo , Fígado/patologia , Falência Hepática/complicações , Falência Hepática/patologia , Assistência Perinatal , Gravidez , Estudos Retrospectivos , Siderose/patologia , Natimorto
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA