Informe sobre transmisión vertical de la hepatitis B en el Hospital Materno Infantil Sardá de la Ciudad de Buenos Aires durante el período 2018-2020 / Report on vertical transmission of hepatitis B at Hospital Materno Infantil Sardá in the City of Buenos Aires for the period 2018-2020

La hepatitis B es una infección vírica que afecta al hígado, puede dar lugar tanto a un cuadro agudo como a una enfermedad crónica, y se transmite por la vía sexual, vertical y parenteral. En este informe, se describe la situación mundial y nacional de esta patología, y su transmisión vertical, así como la caracterización de niños expuestos al virus durante el embarazo, nacidos en el Hospital Materno Infantil Ramón Sardá entre 2018 y 2021.

Factors associated with hospitalization during neonatal period / Fatores associados a internação durante o período neonatal

Abstract Objective: Neonatal mortality rate remains high in Brazil. The aim of the study was to evaluate the factors associated with hospitalization during the neonatal period. Methods: Cross-sectional study conducted in ten randomly-selected Brazilian municipalities. Mothers of children under the age of 6 who were carrying the child's health booklet were interviewed in basic health units. Hierarchical modeling of sociodemographic factors (distal level), maternal variables (intermediate level), and features of the newborns (proximal level) was performed. The variables that presented a value of p ≤ 0.20 in the univariate analysis were included in the multivariate hierarchical modeling process, with block input according to their hierarchical level. The variables with a value of p ≤ 0.05 were considered statistically significant. Results: 2022 mothers were included, allowing 258 (12.8%) cases of hospitalization during the neonatal period to be identified, of which 49.7% were male, 8.9% were premature, and 8.4% had low birth weight (<2500 g). After analysis by hierarchical approach, factors associated with neonatal hospitalization (prevalence ratio [95% CI]) included: history of prematurity (2.03 [1.25-3.30], p = 0.004), gestational risk (2.02 [1.46-2.79], p < 0.001); intrapartum risk (3.73 [2.33-5.99], p < 0.001); gestational age (32-37 weeks: 13.83 [1.74-110.09], p = 0.01; and < 32 weeks: 25.03 [3.03-207.12], p = 0.003); low birth weight (3.95 [2.56-6.09], p < 0.001), and male gender (1.44 [1.09-1.98], p = 0.01). Conclusion: Factors associated with maternal and neonatal history are associated with neonatal hospitalization.

Resumo Objetivo: A taxa de mortalidade neonatal permanece alta no Brasil. O objetivo do estudo foi avaliar os fatores associados à internação durante o período neonatal. Métodos: Estudo transversal feito em dez municípios brasileiros aleatoriamente selecionados. As mães das crianças com menos de seis anos que estavam com a caderneta de informações de saúde da criança foram entrevistadas nas unidades básicas de saúde. Foi realizada a modelagem hierárquica dos fatores sociodemográficos (nível distal), das variáveis maternas (nível intermediário) e das características dos recém-nascidos (nível proximal). As variáveis que apresentaram um valor de p ≤ 0,20 na análise univariada foram incluídas no processo multivariado de modelagem hierárquica com entrada em blocos de acordo com seu nível hierárquico. As variáveis com valor de p ≤ 0,05 foram consideradas estatisticamente significativas. Resultados: 2022 mães foram incluídas, nos possibilitando identificar 258 (12,8%) casos de internação durante o período neonatal, dos quais 49,7% foram meninos, 8,9% foram prematuros e 8,4% apresentaram baixo peso ao nascer (< 2.500 g). Após a análise por abordagem hierárquica, os fatores associados à internação neonatal (IP [IC de 95%]) incluíram: histórico de prematuridade (2,03 [1,25-3,30], p = 0,004), risco gestacional (2,02 [1,46-2,79], p < 0,001); risco intraparto (3,73 [2,33-5,99], p < 0,001); idade gestacional (32-37 semanas: 13,83 [1,74-110,09], p = 0,01) e (< 32 semanas: 25,03 [3,03-207,12], p = 0,003); baixo peso ao nascer (3,95 [2,56-6,09], p < 0,001) e sexo masculino (1,44 [1,09-1,98], p = 0,01). Conclusão: Os fatores associados a histórico materno e neonatal foram associados à internação neonatal.

Morbidade e mortalidade perinatal em gestações que cursaram com amniorrexe prematura em maternidade pública do Norte do Brasil / Perinatal morbidity and mortality in pregnancies that progressed with ruptured membranes at a public hospital in Northern Brazil

OBJETIVO: Identificar os fatores obstétricos e perinatais associados à morbimortalidade perinatal em gestações que cursaram com amniorrexe prematura. MÉTODOS: Estudo transversal de base hospitalar, com dados secundários de prontuários de pacientes (n=87) que evoluíram com quadro de amniorrexe prematura com idade gestacional entre 24 e 42 semanas, definida pela ultrassonografia, e internadas no período de janeiro a abril de 2013 em uma maternidade pública no estado do Acre, região Norte do Brasil. Os dados foram submetidos à análise bivariada para seleção de variáveis que compuseram o modelo múltiplo utilizando a técnica de regressão logística de Poisson. RESULTADOS: A prevalência de morbimortalidade perinatal foi de 51,4%. Nesse total estão computados 2,3% de óbitos fetais (2 casos) e 9,2% de óbitos neonatais (8 casos). As variáveis que apresentaram associação no modelo múltiplo final com morbimortalidade foram: número de consultas de pré-natal ≥6, com razão de prevalência (RP) 0,5 e intervalo de confiança de 95% (IC95%) 0,3-0,9, idade gestacional ≥30 semanas (RP=0,6; IC95% 0,4-0,8), baixo peso ao nascer (RP=2,9; IC95% 1,5-5,4) e necessidade de ventilação mecânica (RP=3,8; IC95% 2,0-7,2). CONCLUSÃO: Observou-se elevada morbimortalidade perinatal entre casos que cursaram com amniorrexe prematura. A morbimortalidade esteve associada a fatores como menor número de consultas de pré-natal, extrema prematuridade e o baixo peso. .

PURPOSE: To identify obstetric and perinatal factors associated with perinatal morbidity and mortality in pregnancies that progressed with ruptured membranes. METHODS: A cross-sectional hospital-based study with secondary data from records of patients (n=87) that evolved with the premature rupture of membranes between 24 and 42 weeks of gestation, admitted from January to April 2013 to a public hospital in Acre State, North of Brazil. Data were subjected to bivariate analysis for selection of variables to be used in a multiple regression model according to Poisson logistic regression with robust error. RESULTS: The prevalence of perinatal morbidity-mortality was 51.4%, including a 2.3% death rate (2 cases) and a 9.2% fetal neonatal death rate (8 cases). The variables associated with mortality in the final multiple model were: number of prenatal consultations ≥6, with a prevalence ratio (PR) of 0.5 and a 95% confidence interval (95%CI) of 0.3-0.9, gestational age ≥30 weeks (PR=0.6; 95%CI 0.4-0.8), low birth weight (PR=2.9; 95%CI 1.5-5.4), and mechanical ventilation (PR=3.8; 95%CI 2.0-7.2). CONCLUSION: Perinatal morbidity and mortality were high among cases of ruptured membranes. Morbidity and mortality were associated with factors such as fewer prenatal visits, extreme prematurity and low birth weight in this group. .

Facility-based care for delivery and management of complications related to pregnancy and childbirth in Mexico

OBJECTIVE: To describe the incidence and management of severe maternal and newborn complications in selected health facilities in Mexico. MATERIALS AND METHODS: As part of the WHO Multicountry Survey on Maternal and Newborn health, information was collected from medical records of women with deliveries and/or severe maternal complications during pregnancy or puerperium in 14 hospitals in Mexico City and the state of Guanajuato, Mexico. RESULTS: Of 13 311 women, 157 (12 per 1 000 live births) had severe maternal complications including 4 maternal deaths. The most frequent complications were preeclampsia, postpartum hemorrhage, and chronic hypertension. Adverse perinatal outcomes were more frequent among women with severe maternal complications. A high use of uterotonics and parenteral antibiotics was found. A small proportion of women with eclampsia received magnesium sulfate. CONCLUSION: This study provides indicators on the incidence and management of maternal and neonatal complications in Mexico, which may be useful in studying and evaluating the performance of obstetric services.

OBJETIVO: Describir la incidencia y manejo de complicaciones maternas y neonatales severas en hospitales seleccionados de México. MATERIAL Y MÉTODOS: En el marco de la Encuesta Multipaís de la OMS sobre Salud Materna y Neonatal, se recolectó información de los expedientes médicos de las mujeres que tuvieron su parto o experimentaron complicaciones maternas severas durante el embarazo o puerperio en 14 hospitales de la Ciudad de México y el estado de Guanajuato, México. RESULTADOS: De 13 311 mujeres, 157 (12/1 000 nacidos vivos) tuvieron complicaciones maternas severas, incluyendo 4 muertes maternas. Las complicaciones más frecuentes fueron preeclampsia, hemorragia postparto e hipertensión crónica. Los resultados perinatales adversos fueron más frecuentes en las mujeres con complicaciones severas. Hubo un uso amplio de uterotónicos y antibióticos parenterales. Una baja proporción de mujeres con eclampsia recibió sulfato de magnesio. CONCLUSIONES: Esta encuesta proporciona indicadores sobre la incidencia y manejo de las complicaciones maternas y neonatales en México, los cuales pueden ser de utilidad para estudiar y evaluar el desempeño de los servicios obstétricos.

Hijo de madre adolescente: riesgos, morbilidad y mortalidad neonatal / Risks in adolescent mothers and their children's: morbidity and mortality

Antecedentes: El embarazo en adolescentes es un problema de salud pública por las consecuencias para el binomio madre-hijo. Objetivo: Determinar las características y riesgos en madres adolescentes y sus hijos (antropometría, condición de nacimiento y morbi-mortalidad), en comparación con un grupo de madres adultas control de 20-34 años. Métodos: Estudio de cohorte prospectiva con 379 hijos de mujeres adolescentes y 928 adultas. Los datos fueron analizados empleando mediana, promedio y medidas de dispersión, pruebas t-test no pareado o Wilcoxon rank-sum (Prueba de Mann-Whitney), ANOVA o Kruskall-Wallis, Chi2 o Exacta de Fisher, riesgo relativo y riesgo atribuible a la exposición porcentual con sus intervalos de confianza de 95 por ciento. Resultados: Entre adolescentes hubo mayor número de madres solteras (25,6 por ciento), menor escolaridad y seguridad social en salud (25,9 por ciento) (p<0,05). En adolescentes tempranas hubo más casos de preeclampsia (26,3 por ciento) y trabajo de parto prematuro (10,5 por ciento). Entre madres adolescentes el 30,9 por ciento de los hijos fueron prematuros, y presentaron más patología cardiaca, infecciones bacterianas, sífilis congénita, labio y paladar hendido, y mayor mortalidad, cuando se compararon con hijos de madres adultas (p<0,05). Conclusiones: La maternidad en adolescentes conlleva mayores riesgos de salud para ellas y sus hijos, aumentando la morbilidad, mortalidad, con una perspectiva de exclusión social a lo largo de la vida, pues la mayoría son pobres, con poca educación y madres solteras y sin pareja.

Background: Adolescent pregnancy is a public health problem because of the consequences for mother and child. Objective: To determine the characteristics and risks in adolescent mothers and their children's (anthropometry, birth status, morbidity and mortality) compared with a group of older mothers 20-34 years and control their children. Methods: Prospective cohort study with 379 children and 928 adult female adolescents. Data were analyzed using median, mean and dispersion measures, tests unpaired t-test or Wil-coxon rank-sum (Mann-Whitney test), ANOVA or Kruskal-Wallis, Chi2 or Fisher's exact, relative risk and attributable risk percentage exposure with confidence intervals of 95 percent. Results: Among adolescents there were more single mothers (25.6 percent), lower education and social health insurance (25.9 percent) (p<0.05). In early adolescents were more cases of preeclampsia (26.3 percent) and preterm labor (10.5 percent). Among teenage mothers, 30.9 percent of the children were premature, and had more heart disease, bacterial infections, syphilis, and congenital cleft lip and palate and higher mortality when compared with children of older mothers (p<0.05). Conclusions: Teenage motherhood carries greater health risks to themselves and their children, increasing morbidity, mortality, with a perspective of social exclusion throughout life, as most are poor, poorly educated and single mothers without partner.

Cambios en la distribución etaria de las madres en Chile y en el Hospital Clínico de la Universidad de Chile y su influencia en la morbimortalidad neonatal / Change in the age distribution of mothers in Chile and its influence on neonatal morbidity

Antecedentes: En las últimas décadas en Chile y otros países Sudamericanos se ha producido un cambio en la distribución etaria de las madres. Objetivos: Obtener la distribución de los nacimientos por grupos de edades maternas en el Hospital Clínico de la Universidad de Chile (HCUCH) y compararlos con iguales grupos en todo Chile. Comprobar que los grupos de edades extremas están aumentando. Estudiar la relación entre estos cambios con algunas patologías del recién nacido, como prematuridad, recién nacidos pequeños para su edad gestacional (PEG) y malformaciones congénitas. Método: Datos de la maternidad del HCUCH (1982-2010) y del Ministerio de Salud (1990-2008). Se distribuye a las madres en 3 grupos: <20, >35 y 20-34 años. Las comparaciones se hicieron con prueba de Chi Cuadrado. Resultados: En Chile el grupo de madres >35 años aumentó en más del 50 por ciento al comparar los años 1990 (10,2 por ciento del total) y 2008 por ciento(15,8 por ciento) (p<10-8). Las madres adolescentes en Chile aumentaron de 13,8 por ciento en 1990 a 16,6 por ciento en 1998 (p<10-8). En el HCUCH las adolescentes disminuyeron de 16,08 por ciento en 1982 a 9,09 por ciento en 2010 (p<10-8). Las >35 años aumentaron significativamente, al igual que en Chile, de 9,8 por ciento en 1982 a 22,17 por ciento en el año 2010 (p<10-8). Esta distribución etaria en el HCUCH (1996-2010) se asoció con otros cambios significativos: disminuyeron los RN PEG (p=0,02) y los prematuros (<37 semanas) aumentaron significativamente (p<0,00001). El grupo de mujeres >35 años se asocia con mayor cantidad de RN femeninos, malformaciones congénitas, síndrome de Down y partos por cesárea.

Introduction: In recent decades, both in Chile and other South American countries there has been a change in the age distribution of mothers. Objectives: To obtain the distribution of births by maternal age groups in the Hospital Clinic of the University of Chile (HCUCH) and compare them with similar groups throughout Chile. Check that the extreme age groups are increasing. To study the relationship between these changes and some diseases of the newborn, such as prematurity, infants small for gestational age (SGA) and birth defects. Methods: We reviewed the database of the Maternity HCUCH (1982-2010) and of the Ministry of Health (19902008). The mothers are distributed in 3 groups: <20, >35 and between 20-34 years. Comparisons were made with chi square test. Results: In Chile, the group of mothers >35 years old has increased by over 50 percent when comparing the 1990 (10.2 percent of total) and 2008 15.8 percent (p<10-8). Teenager mothers in Chile increased from 13.8 percent in 1990 to 16.6 percent in 1998 (p<10-8). In the HCUCH variations were different, adolescents decreased 16.08 percent in 1982 to 9.09 percent in 2010 (p<10-8). The >35 years increased significantly, as in all of Chile, 9.8 percent in 1982 to 22.17 percent in 2010 (p<10-8). The live birth age distribution in the HCUCH (1996-2010) led to significant changes: reducing SGA (p=0.02), the premature (<37 weeks) increased significantly (p<0.00001). The group of women >35 years is associated with increased number of children women, congenital malformations, Down syndrome and cesarean deliveries.

Morbilidad y mortalidad neonatal asociada a la diabetes gestacional / Neonatal morbidity and mortality asociated with gestational diabetes

Objetivo: Determinar la asociación de la morbilidad y mortalidad neonatal con la diabetes gestacional. Método: Estudio tipo cohortes. Se realizó un estudio en embarazadas desde diciembre de 2007 a noviembre de 2008 en el servicio de tococirugía del Hospital General Regional No. 1 de Querétaro, México, se formaron dos grupos de 71 pacientes, uno con diabetes gestacional y otro sin ella. El muestreo fue por cuota pareado por edad. En ambos grupos se midieron variables sociodemográficas, antecedentes obstétricos, vía de interrupción del embarazo, morbilidad y mortalidad neonatal. Los resultados se analizaron con Chi cuadrado y riesgo relativo con un poder alfa de 0,05. Resultados: La tasa de morbilidad en el grupo expuesto fue de 60 por ciento. Las variables que tuvieron significancia estadística fueron: la obesidad pregestacional (RR: 2,7), cesßrea (RR: 3,3), complicaciones metabólicas (RR: 10), morbilidad respiratoria (RR: 6,7), macrosomía (RR: 4,1), hipoglucemia (RR: 14,2) y taquipnea transitoria del recién nacido (RR: 7,7). La edad materna, sobrepeso gestacional, nivel socioeconómico, escolaridad, antecedentes de macrosómicos, de cesáreas y de malformaciones congénitas; malformaciones congénitas, bajo peso neonatal, prematurez, enfermedad de membrana hialina, hiperbilirru-binemia, hipocalcemia, mortalidad neonatal y la asfixia no tuvieron asociación significativa. La complicación metabólica más frecuente fue: hipoglucemia (17,2 por ciento). No hubo muertes perinatales. Conclusiones: El grupo expuesto estudiado mostró mayor morbilidad asociada a la diabetes gestacional que el grupo no expuesto, es necesario el diagnóstico temprano en mujeres con factores de riesgo para esta entidad y establecer un programa de tratamiento con vigilancia estrecha.

Objectives: To determine the association of neonatal morbidity and mortality with gestational diabetes. Methods: Study cohort. A study of pregnant women from December 2007 to November 2008 in the service of ginecology and obstetrics HGR No. 1 Querétaro, were divided into two groups of 71 patients, one gestational diabetic and one without it. The quota sampling was matched by age. In both groups were measured sociodemographic, obstetric history, via interruption of birth, neonatal morbidity and mortality. The results were analyzed with Chi square and relative risk with a power alpha of 0.05. Results: The morbidity rate in the exposed group was 60 percent. Variables that were statistically significant were: pregestational obesity (RR: 2.7), cesarean (RR 3.3), metabolic complications (RR 10), respiratory illness (RR: 6.7), macrosomia (RR: 4.1), hypoglycemia (RR: 14.2) and transient tachypnea of the newborn (RR: 7.7). Maternal age, gestational overweight, socioeconomic status, education, history of macrosomic, and cesarean birth defects, congenital malformations, low birth weight, prematurity, hyaline membrane disease, hyperbilirubinemia, hypocalcemia, and neonatal asphyxia had no significant association. The most common metabolic complication was hypoglycemia (17.2 percent). There were no perinatal deaths. Conclusions: The exposed group showed higher morbidity associated with gestational diabetes that the unexposed group, early screening is necessary in women with risk factors for this disease and establish a treatment program with close monitoring.

Síndrome HELLP ¿evidencias de una posible respuesta inflamatoria sistémica en la preeclampsia? / The HELPP syndrome: evidence of a possible systemic inflammatory response in pre-eclampsia?

INTRODUCTION: The principal causes of morbidity and mortality during pregnancy in Mexico, are preeclampsia/eclampsia, obstetric hemorrhage and puerperium complications; this is, 62 of maternal deaths in last years. HELLP syndrome was observed between 5 to 25 of the mortality in pregnancies of 36 weeks or less. OBJECTIVE: To analyze patients with HELLP syndrome in ICU's (Intensive Care Unit) of a Gynecology and Obstetric Hospital, related to the abnormal hematological, hepatic and renal results with the obstetric case history and the clinical complications. MATERIALS AND METHODS: A transversal study in patients with HELLP syndrome during 1998 and 1999 were carry out. CASE DEFINITION: Peripheral blood with Microangiopathic hemolysis, elevated liver enzymes: AST, ALT over 40 UI/L, even when were LDH lower than 600 UI/L. It was evaluated the hepatic and renal function, platelets count, microangiopathic hemolysis, arterial pressure, seizures, icteric skin color, blindness, visual disturbances, nausea, vomiting and upper quadrant right abdominal pain. In newborn we analyzed gestational age, sex, weight and APGAR. We studied for an association between maternal and biochemical variables with Correlation Pearson Test, and dependence between variables with lineal regression model. RESULTS: 2878 patients with hypertensives disorders in pregnancy (11.64). The 1.15 (n = 33) had HELLP syndrome with specific maternal mortality of 0.4 per 10,000 live birth, perinatal mortality of 1.62 per 10,000 live birth; and renal damage in 84.5. Coefficient beta was higher between number of pregnancies to platelets count (-0.33) and creatinine clearance (-0.401). CONCLUSION: We found an important renal damage, low platelets, elevated liver enzymes in women with two or more pregnancies. Then we propose there are similarities between HELLP syndrome and Systemic Inflammatory Response Syndrome (SIRS) because they could have the same pathophysiology.

Influencia de los factores socioculturales en la morbilidad y/o mortalidad materna y perinatal de adolescentes atendidas en tres estados de la República Mexicana / Effect of sociocultural factors on maternal and perinatal morbidity with or without mortality among adolescents seen in 3 states of the Mexican Republic

This study was aimed on comparing the degree of association between social-cultural factors and maternal or perinatal morbidity and/or mortality of the adolescent. A paired case-control study was designed with adolescent in puerperal immediate stage affiliated to the Mexican Institute of Social Security from Tabasco, Tlaxcala and Northern Veracruz, that were adjusted to the selection criteria of the sample, between June of 1998 and February of 1999. Two groups were integrated, cases, with adolescent in puerperal immediate stage affected (with maternal or perinatal morbidity and/or mortality) and controls, with adolescent not affected in puerperal immediate stage. Information concerned to biological and social-cultural risk factors from each subject was obtained applying a validated survey (EFRASEMA 1) and checking their clinical file, whose information was poured in a database (EFRASEMA 2). Interviewers did not know the outcome of the study, which in turn assured the blindness of the information. Once data was obtained, subjects were assigned to each group of study. Matching factors were age, nutritional status, intergenesic interval and previous pregnancy systemic pathology. Proportion of subjects, cases and controls; with or without social-cultural risk factors was determined. The risk of maternal or perinatal morbidity and/or mortality in the exposed subjects was estimated by odds ratio (OR) and the differences inferred through Mantel and Haenszel chi 2 and Fisher's exact tests (confidence intervals alpha = 0.05 and beta = 0.2). There was a sample of 486 subject, 44 were eliminated due to insufficient data. Studied population was integrated finally with 221 cases and 221 paired controls 1: 1. 71.950 of participants were married, 22.62 in free union, 4.98 single and 0.45 separate, average global age was 17.98 +/- 1.39 years. The inferential analysis showed an OR 0.64 (Cornfield 95 confidence limits: 0.40 < OR < 1.03, p = 0.0510600) concerning desired pregnancy in favor to controls. Appropriate reproductive information had an OR = 0.34 (Cornfield 95 confidence limits: 0.21 < OR < 0.54 p = 0.0000014). Ideal cumulated fertility offered an OR 0.62 (Cornfield 95 confidence limits: 0.39 < OR < 0.98, p = 0.0298500). These results show an association between the social-cultural factors and the presence of maternal or perinatal morbidity and/or mortality in the studied adolescents. Desired pregnancy, appropriate reproductive information and ideal cumu

Efecto de riesgo en el hijo de madre con edad avanzada (estudio de casos y controles) / Effect of risk on the child of an older mother (case-control study)

INTRODUCTION: During the last decades the number of births in women with 35 or more years of age has increased approximately 35-50. OBJECTIVE: To establish the neonatal morbidity associated with advanced maternal age, compared with mothers in the optimal reproductive stage. MATERIALS AND METHODS: This is a retrospective case-control survey. In 1999 we revised 210 records from neonates and mothers with 35 or more years of age (cases) and 210 records of neonates and mothers with age between 18 and 34 years (controls). The variability significance was established with t-student, X2 and risk with the probabilistic risk ratio. RESULTS: There was a significant difference in the socioeconomic and educational level. Advanced maternal age predisposed 2.43 times indication for cesarean section, increased the risk for gestational diabetes (11.35), toxemia (4.11) and in its severe form (2 times). Miscarriage menace (5.65 times). Lower birth weight (p < 0.007) and wet lung syndrome were more frequent in the advanced age group (p < 0.02). Risk for hypoglycemia was 1.62. There was also an increase in the risk for Trisomy 21 (p < 0.05) with an OR of 4 in cases. Genetic service evaluated 35 patients in the maternal advanced age group with an OR of 35. CONCLUSIONS: Advance maternal age increases maternal morbidity and the risk for preterm delivery, low birth weight, asymptomatic hypoglycemia, wet lung syndrome and risk for chromosomopathies.

Enfermedad por membranas hialinas: epidemiología en el Instituto Nacional de Pediatría / Hyaline membrane disease: epidemiology at the national Institute of Pediatrics

Se estudiaron 134 recién nacidos con enfermedad por membranas hialinas en la unidad de Cuidados intensivos Neonatales del Instituto Nacional de Pediatría (INP) de 1989 a 1991; 59.70 por ciento correspondieron a varones y 40.30 por ciento a mujeres; la edad gestacional promedio fue 32.4 semanas y el peso al nacer de 1,715 g. Las complicaciones más frecuentes fueron icteriacia, trastornos metabólicos, anemia, sepsis, persistentcia de conducto arterioso y hemorragia intracraneana. La mortalidad fue de 54.47 por ciento; las secuelas de los sobrevivientes, de 72 por ciento, principalemente neurológicas. Se concluye que el principal factor es la prematurez y que podría ayudarse a disminuir su frecuencia con un buen control médico prenatal

Efectos de la edad materna en el estado de salud del neonato: evidencia chilena / Effects of maternal age in newborn health status: chilean reality

El propósito de este estudio fue de comparar los resultados del embarazo, el crecimiento y el desarrollo de los infantes de madres adolescentes y de madres mayores en un medio en América Latina en el cual las madres jóvenes recibieron un cuidado prenatal intensivo y en el cual se registró y se estimuló fuertemente la lactancia en todas las madres. Nuestra hipótesis fue que las tasas generalmente más altas de bajo peso al nacer y de las complicaciones neonatales entre los infantes de madres chilenas adolescentes se podría eliminar por medio de un protocolo agresivo de cuidado prenatal. Los datos sobre el cuidad prenatal, la gestación, el nacimiento, el crecimiento y el desarrollo de los infantes fueron extraídos retrospectivemente de los registros médicos de 200 pacientes de un nivel socioeconómico bajo paridad I, habiendo todas ellas recibido el cuidado por medio del mismo equipo médico del hospital. La muestra incluyó a 50 mujeres de entre los 14 y los 16 años de edad, 50 mujeres de entre 17 y 19 años de edad y 100 mujeres de entre 20 y 24 años de edad. Aunque las madres adolescentes ganaron menos peso durante su embarazo e hicieron menos visitas prenatales que las mujeres mayores, éstad dieron a luz bebés que pesaron, en promedio, 100 gramos más que los infantes de las madres mayores. Este estudio sugiere que, entre las mujeres de similar nivel socioeconómico, con igual acceso a una atención médica adecuada, las diferencias frecuentemente observadas en el estado de salud del neonato entre las madres adolescentes y las madres mayores, desaparecen

O lugar do biológico e do social na morbimortalidade perinatal: estudo de caso em amostra de parturientes e recém-nascidos atendidos em hospitais de Säo Luis do Maranhäo / The biological and social corelations in the perinatal morbidity and mortality: a case study in a example of parturient women and newborn in hospitals in Säo Luis, Maranhäo

Partindo de hipóteses básicas onde o processo saúde-doença no período perinatal apresenta-se por um lado, como expressäo de condiçöes particulares as quais famílias estäo submetidas, de maneira diferencial, na funçäo de sua descriçäo de classe e, por outro, como expressäo da articulaçäo de um conjunto de condiçöes biológicas e sociais em permanente relaçäo, o presente trabalho procura, em uma amostra de parturientes e recém-nascidos de hospitais de Säo Luis do Maranhäo, refletir sobre o assunto. Conclui pela pertinência do emprego do conceito sociológico de classe social ao estudo de eventos perinatais que, articulado e esquemas teóricos mais elaborados do campo da Perinatologia, permite ampliar o nível de explicaçäo do fenômeno.

Perfil da mortalidade neonatal em Porto Alegre: revisäo de 715 casos de necrópsias / Profile of the neonatal mortality in Porto Alegre: review of 715 cases of necropsy

Para a programaçäo da assistência e educaçäo médica é fundamental o conhecimento dos tipos e freqüências de patologias que acometem a populaçäo neonatal da nossa regiäo. Com essa finalidade, os autores, revisaram 715 casos de necrópsias realizadas no HCPA, num período de dez anos, 75,2% dos casos eram provenientes de outros hospitais de Porto Alegre e o restante do próprio HCPA. Os resultados obtidos em relaçäo à mortalidade neonatal correspondem aos descritos na literatura, sendo que nos casos provenientes de outros hospitais de Porto Alegre predominaram: prematuridade (48,3%), doenças hematológicas (46,6%), membrana hialina (33,0%), doenças infecciosas (21,9%), sofrimento fetal (21,2%), mal formaçöes (16,2%), outras (9,4%); e no HCPA: prematuridade (62,7%), membrana hialina (38,4%), doenças hematológicas (36,2%), malformaçöes (24,3%), sofrimento fetal (15,9%),doenças infecciosas (13,6%), e outras (11,9%). Tais dados salietam as características terciárias do HCPA. Esses dados podem contribuir para o conhecimento das condiçöes de saúde de recém-nascidos em nosso meio