Background: Delayed onset of minimal enteral nutrition compromises the immune response of preterm infants, increasing the risk of colonization and clinical complications (e.g., late-onset sepsis). This study aimed to analyze associations between late-onset sepsis in very low birth weight infants (<1500 g) and days of parenteral nutrition, days to reach full enteral nutrition, and maternal and nutritional factors. Methods: A cross-sectional study was carried out with very low birth weight infants admitted to a neonatal intensive care unit (NICU) of a reference maternity hospital of high-risk deliveries. Data regarding days of parenteral nutrition, days to reach full enteral nutrition, fasting days, extrauterine growth restriction, and NICU length of stay were extracted from online medical records. Late-onset sepsis was diagnosed (clinical or laboratory) after 48 h of life. Chi-squared, Mann–Whitney tests, and binary logistic regression were applied. Results: A total of 97 preterm infants were included. Of those, 75 presented late-onset sepsis with clinical (n = 40) or laboratory (n = 35) diagnosis. Maternal urinary tract infection, prolonged parenteral nutrition (>14 days), and extrauterine growth restriction presented 4.24-fold, 4.86-fold, and 4.90-fold higher chance of late-onset sepsis, respectively. Conclusion: Very low birth weight infants with late-onset sepsis had prolonged parenteral nutrition and took longer to reach full enteral nutrition. They also presented a higher prevalence of extrauterine growth restriction than infants without late-onset sepsis.

OBJECTIVE: To determine the incidence of hypothermia, risk factors and outcomes associated with lower temperature on admission to the neonatal intensive care unit in very low birth weight infants. METHODS: Longitudinal, observational, prospective study. Very low birth weight infants admitted to the neonatal intensive care unit between October/2017 to September/2018 were included. The dependent variable was axillary temperature at admission. Hypothermia incidence was calculated and temperature averages were compared for the risk factors and outcomes evaluated. Statistical tests: measures of central tendency, relative/absolute frequencies, Kolmogorov-Smirnov test, Levene and Students t test, considering significant p<0.05. RESULTS: 128 very low birth weight newborns, with average weight and gestational age, respectively, 1,079.2 g and 29 weeks, were included. Of these, 110 (85.9%) had moderate hypothermia, 13 (10.2%) mild hypothermia and only 5 (3.9%) were normothermic on admission. The average temperature found was 34.7°C. The following risk factors maintained an association with lower temperature at admission: weight and gestational age, Apgar index and neonatal resuscitation. The associated outcomes were: respiratory distress syndrome, use of mechanical ventilation and vasoactive drugs, pulmonary hemorrhage, use of oxygen at 28 days of life, delayed sepsis, and death. CONCLUSION: The incidence of hypothermia found was high and the lower temperature at admission was associated with higher morbidity and mortality. Care in care practices is necessary to maintain the temperature of very low birth weight newborns, especially those of lower weight and gestational age and who require neonatal resuscitation.

OBJECTIVE: To determine the incidence of extrauterine growth restriction (RCEU) in very low birth weight (VLBW) newborn and associated factors. METHODS: Longitudinal, prospective study with very low birth weight premature newborns in a maternity school, carried out between October/2017 to September/2018. Demographic, clinical and nutritional variables were evaluated. The curves used at birth and to monitor growth were those of the INTERGROWTH Project. RCEU was defined as a Z score of birth weight < -2. In inferential statistical analysis, chi-square, Students t, Mann-Whitney and logistic regression tests were used. RESULTS: 97 children were analyzed, of which 41.2% developed RCEU. Weight, Z score at birth and caloric intake in the first week of life were higher in children without growth restriction. The use of mechanical ventilation, length of stay in intensive care unit, bronchopulmonary dysplasia and late sepsis were associated with RCEU in the bivariate analysis. In multivariate logistic regression, only the Z score of birth weight (p<0.001) and the use of mechanical ventilation (p=0.006) remained associated with the outcome. Regarding the nutritional status at birth, the higher the Z score of weight, the lower the incidence of RCEU. CONCLUSION: The incidence of RCEU found was high, with the nutritional status at birth and the use of mechanical ventilation as the main associated factors.

Objetivo: Determinar a incidência de hemorragia pulmonar (HP) e os fatores de risco associados em prematuros com idade gestacional (IG) ≤ 32 semanas e de muito baixo peso. Metodologia: Estudo longitudinal, observacional, prospectivo com recém-nascidos ≤ 32 semanas e de muito baixo peso, internados em Unidade de Terapia Intensiva Neonatal em Natal/RN, no período de outubro/2017 a setembro/2018.  A incidência de HP foi determinada e as variáveis obstétricas e do período neonatal foram avaliadas como fatores de risco. A análise estatística realizada foi descritiva e inferencial com a utilização dos Testes Qui-quadrado, t de Student e regressão logística multivariada. Resultados: Foram incluídos no estudo 123 prematuros, dos quais 37 (30,1%) apresentaram HP. As médias de IG e peso de nascimento dos bebês que apresentaram essa complicação foram 27,2 semanas, e 875,5g, respectivamente. As variáveis, menor IG e peso ao nascimento, o não uso de corticoide antenatal, necessidade de manobras de reanimação na sala de parto, Apgar no 5º minuto <7, temperatura à admissão, administração de surfactante, persistência do canal arterial e sepse precoce foram identificadas como fatores de risco para HP. Na regressão logística os fatores que permaneceram associados à HP foram o não uso de corticoide antenatal, peso ao nascimento e persistência do canal arterial. Conclusão: A hemorragia pulmonar é um evento clínico com importante incidência em recém-nascidos prematuros e de muito baixo peso, com fatores de risco associados à prematuridade e assistência inadequada a gestante e ao recém-nascido, sendo de extrema importância o cuidado perinatal para evitar este desfecho que confere maior morbimortalidade aos pacientes.