Objectives: to determine causes and variables related to newborn deaths of a neonate intensive care unite (ICU) in the Southern

Objective: To compare mortality and the principal intercurrent clinical conditions suffered by late-preterm newborn infants born with gestational ages of 34 full weeks to 36 weeks and 6 days, and full term newborns.Methods: This was a cross-sectional study of all preterm newborn infants born at a public hospital from August 2010 to August 2011. The study sample comprised late-preterm infants (cases) and a group of full term newborns (controls). Three controls were enrolled for each case. Maternal, gestational and neonatal variables were analyzed. Means and standard deviations were used to compare numerical variables between case and control groups using Student's t test and the Mann-Whitney test; Pearson's chi-square was used for categorical variables. Odds ratios and 95% confidence intervals were calculated to estimate risk. Results:The study sample comprised 239 late-preterm infants and 698 full term newborns. Mothers aged over 35 years and/or with a history of previous premature deliveries had a higher proportion of late-preterm children. The following gestational variables were associated with late-preterm delivery: hypertension, infectious diseases, rupture of membranes more than 18 hours previously and multiple pregnancies. When compared with full term newborns, late-preterms were statistically more likely to be subject to hypothermia/hyperthermia, hypoglycemia, respiratory pathologies, resuscitation in the delivery room, phototherapy, supplementary feeding, mechanical ventilation, venous infusions, antibiotics and admission to the neonatal intensive care unit, resulting in a nine times greater neonatal mortality rate. Intercurrent conditions were inversely related to gestational age. Conclusions:Late-preterm newborn infants had a mortality rate nine times that of full term infants and were exposed to a greater risk of intercurrent conditions during the neonatal period. These intercurrent conditions were inversely related to gestational age.J Pediatr (Rio J). 2012;88(3):259-66: Newborn, infant, premature, preterm, complications. ResumoObjetivo: Comparar as taxas de óbito e as principais intercorrências clínicas entre recém-nascidos pré-termo tardios nascidos com idade gestacional entre 34 semanas completas e 36 semanas e 6 dias e recém-nascidos a termo. Métodos:Estudo transversal envolvendo todos os recém-nascidos pré-termo tardios nascidos entre agosto de 2010 e agosto de 2011. A população do estudo foi constituída pelos recém-nascidos pré-termo tardios (casos) e um grupo de recém-nascidos a termo (controles), sendo selecionados três controles para cada caso. Foram analisadas variáveis maternas, da gestação e neonatais. Na análise estatística, utilizaram-se médias, desvios padrão e testes t de Student e de MannWhitney para variáveis numéricas, o qui-quadrado de Pearson para variáveis categóricas e estimativa de risco pela odds ratio com intervalo de confiança de 95%. Resultados:A população do estudo foi constituída por 239 recém-nascidos pré-termo tardios e 698 recém-nascidos a termo. As gest...

Objectives: To establish the profile of neonates in Caxias do Sul city, and to study early neonatal mortality, its causes and related variables.Methods: This cohort study enrolled 5,545 newborns, which were followed up to 7 days after birth. The probability of early neonatal mortality was calculated and multiple logistic regression was performed to relate all studied variables to the outcome of early neonatal death.Results: The observed probability of early neonatal mortality was 7.44 per thousand live births. The incidence of premature births and low birth weight was 9.4% and 8.1%, respectively. Fifty five percent of the neonates were born through cesarean section, which were related to socioeconomic and educational level. Previous history of neonatal mortality, maternal age > 35 years, gestational age, Apgar score < 7, male sex and low birth weight were related to early neonatal death. The main cause of death was hyaline membrane disease, followed by congenital cardiopaties, extreme preterm and abruptio placentae.Conclusion: Even though the observed probability of early neonatal mortality was low, some deaths may have been avoided if better prenatal and delivery care, as well as newborn assistance had been offered. J. pediatr. (Rio J.). 2000; 76(3): ResumoObjetivo: Estabelecer o perfil dos neonatos de Caxias do Sul e estudar a mortalidade neonatal precoce, suas causas e as variáveis a esta relacionadas.Métodos: Estudo de coorte envolvendo 5.545 recém-nascidos acompanhados por até 7 dias de vida. Calculou-se a probabilidade de morte neonatal precoce (PMNP), utilizando-se a regressão logística múltipla para relacionar as variáveis estudadas com a mortalidade neonatal precoce.Resultados: A PMNP observada foi de 7,44 por mil nascidos vivos. A incidência de partos prematuros e de baixo peso ao nascer foi de 9,4% e 8,1%, respectivamente. O índice de cesarianas foi de 55%, apresentando relação com o nível socioeconômico e educacional. As variáveis relacionadas ao óbito foram a história de natimortalidade, a idade materna >35 anos, idade gestacional, Apgar < 7, sexo masculino e baixo peso. A principal causa de óbito foi a doença da membrana hialina, seguida pelas cardiopatias congêni-tas, prematuridade extrema e descolamento prematuro de placenta.Conclusão: Apesar da PMNP ter sido baixa, ocorreram mortes que poderiam ter sido evitadas com um melhor atendimento no pré-natal, no parto e na assistência ao RN. J. pediatr. (Rio J. IntroduçãoA mortalidade infantil (MI) é vista hoje como um evento evitável e traçador da qualidade de vida e dos serviços de saúde. Para Leal 1 , ela é um indicador do nível de saúde de uma população, sintetizando as condições de bem-estar social, político e ético de uma dada conformação social.Nas últimas décadas, tem havido um decréscimo acentuado da MI em todo o mundo, como demonstra o relatório da Unicef, 1997. No Brasil, o coeficiente de mortalidade infantil (CMI) passou de 118 por mil nascidos vivos (NV) em 1960 para 48 por mil NV no período de 1987 a 1996, mas ainda apresenta var...

This study aimed to identify risk factors associated with very low birth weight in a general

RESUMOObjetivo: identificar fatores maternos e perinatais relacionados a fetos com peso igual ou maior do que 4.000 g no nascimento. Métodos: estudo de corte transversal, de 411 casos consecutivos de macrossomia fetal, ocorridos no período de março de 1998 a março de 2005. Compararam-se os dados obtidos aos de 7.349 casos de fetos com peso entre 2.500 e 3.999 g ao nascimento, ocorridos no mesmo período. Foram analisadas variáveis maternas (idade, paridade, diabete melito, ocorrência de parto cesáreo, mecônio, desproporção feto-pélvica, principais indicações das cesáreas) e perinatais (ocorrência de tocotraumatismo, índice de Apgar inferior a sete no 1º e 5º minuto, natimortalidade, neomortalidade precoce, necessidade de internação na Unidade de Tratamento Intensivo Neonatal). As avaliações estatísticas foram realizadas com o teste não paramétrico do χ 2 com a correção de Yates e com o teste t de Student. Adotou-se o nível de significância de p<0,05. Resultados: as diferenças entre os grupos foram consideradas estatisticamente significantes ao se analisarem a idade materna (p<0,05), paridade (p<0,05) e índice de Apgar menor que 7 no 1º minuto (p<0,05; OR=1,8; IC 95%: 1,4-2,5) e 5º minuto (p<0,05; OR=2,3; IC 95%: 1,3-4,1), diabete melito materno (p<0,05; OR=4,2; IC 95%: 2,7-6,4), ocorrência de mecônio (p<0,05; OR=1,3; IC 95%: 1,0-1,7), necessidade de cuidados intensivos neonatais (p<0,05; OR=2,0; IC 95%: 1,5-2,7), neomortalidade precoce (p<0,05; OR=2,7; IC 95%: 1,0-6,7), parto cesáreo (p<0,05; OR=2,03; IC 95%: 1,6-2,5) e desproporção fetopélvica (p<0,05; OR=2,8; IC 95%: 1,6-4,8), mas não quanto ao tocotraumatismo e à natimortalidade. No grupo de fetos macrossômicos, as principais indicações de operação cesariana foram a iteratividade (11,9%) e a desproporção fetopélvica (8,6%). No grupo controle as principais indicações foram a iteratividade (8,3%) e o sofrimento fetal agudo (3,9%). Conclusão: a despeito das limitações características de uma avaliação retrospectiva, o estudo demonstra quais complicações tendem a se associar ao excessivo tamanho fetal, podendo ser de utilidade no manejo obstétrico de pacientes com suspeita de crescimento fetal excessivo. A macrossomia fetal permanece sendo problema obstétrico de difícil solução, associado a importantes conseqüências maternas e perinatais, haja vista as significantes taxas de morbiletalidade observadas em países desenvolvidos e em desenvolvimento. PALAVRAS-CHAVE: Macrossomia fetal; Morbidade materna; Morbidade fetal; Peso fetalABSTRACT Purpose: to identify maternal and perinatal factors related to neonates with birthweight ≥4,000 g. Methods: cross-section cohort study with 411 consecutive cases of fetal macrosomia (FM) which occurred from March 1998 to March 2005. Data were compared to 7,349 cases of fetal birthweight ≥2,500 and <3,999 g which occurred in the same period. Maternal variables (maternal age, parity, diabetes, previous cesarean section, meconium-stained amniotic fluid, cephalopelvic disproportion, main cesarean section indications) and perinatal variabl...

Objectives: to determine the seroprevalence rate of toxoplasmosis, HIV, syphilis and rubella in a population of puerperal women. Methods: a prospective, cross-sectional study was performed from February 2007 to April 2008 at Hospital Geral, Universidade de Caxias do Sul in a population of 1,510 puerperal women. Women that gave birth to live born or stillborn infants were included in the study; maternal and perinatal variables were analyzed. Descriptive statistics and Pearson's chi-square with occasional Fisher's correction were used for comparisons. Alpha was set in 5%. Results: a total of 148 cases of congenital infection (9.8%) were identified: 66 cases of syphilis (4.4%), 40 cases of HIV (2.7%), 27 cases of toxoplasmosis (1.8%) and 15 cases of rubella (1.0%). In ten cases there was co-infection (four cases of HIV and syphilis, two cases of HIV and rubella, one case of HIV and toxoplasmosis, two cases of rubella and syphilis, and one case of toxoplasmosis and rubella). In a comparison between puerperal women with and without infection there was no statistical significance in relation to incidence of abortions, small for gestational age, prematurity, live births and stillbirths, and prenatal care. Need of neonatal intensive care unit (NICU), maternal schooling, maternal age higher than 35 years and drug use (alcohol, cocaine and crack) had statistical significance. Conclusion: the prevalence rate of infections was 9.8%. Need of NICU, maternal schooling lower than eight years, maternal age higher than 35 years and drug use were significantly associated with occurrence of congenital infection.

Objective: To evaluate the effect of place of birth and transport on morbidity and mortality of preterm newborns in the southern region of Brazil. Methods:This cohort study included preterm newborns transported to a reference intensive care unit (transport group = 61) and followed up until discharge. Data about care in hospital of origin and transport were obtained at admission. This group was compared with infants born in the maternity ward of the reference hospital paired according to gestational age (control group = 123). Primary outcome was death, and secondary outcomes were changes in blood glucose, temperature and oxygen saturation at admission and the incidence of necrotizing enterocolitis, bronchopulmonary dysplasia and sepsis. Relative risk (RR) was used to evaluate the association between variables and outcome. The level of significance was set at α = 5% and β = 90%.Results: Mean travel distance was 91 km. Mean gestational age was 34 weeks. Of the neonates in the transport group, 23% (n = 14) did not receive pediatric care in the delivery room. During transportation, 33% of newborns were accompanied by a pediatrician, and the equipment available was: incubator (57%), infusion pump (13%), oximeter (49%) and device for blood glucose test (21%). The transport group had a greater incidence of hyperglycemia (RR = 3.2; 2.3-4.4), hypoglycemia (RR = 2.4; 1.4-4.0), hyperthermia (RR = 2.5; 1.6-3.9), and hypoxemia (RR = 2.2; 1.6-3.0). The percentage of deaths was 18% in the transport group and 8.9% in the control group (RR = 2.0; 1.0-2.6). Conclusions:This study revealed deficiencies in neonatal care and transport. Perinatal care and transport should be better organized in the northeastern region of Rio Grande do Sul, Brazil.J Pediatr (Rio J). 2011;87(3):257-262: Neonates, patient transport, intensive care unit. ResumoObjetivo: Verificar a influência do local de nascimento e do transporte sobre a morbimortalidade de recém-nascidos prematuros na Região Sul do Brasil. Métodos:Estudo de coorte com recém-nascidos prematuros transferidos para a unidade de tratamento intensivo de referência (grupo transporte = 61), tendo sido acompanhados até a alta. Os dados sobre o atendimento no hospital de origem e transporte foram obtidos no momento da internação. Esse grupo foi comparado com neonatos da maternidade de referência, pareados por idade gestacional (grupo controle = 123), tendo como desfecho primário o óbito e desfechos secundários as alterações da glicemia, temperatura e saturação de oxigênio no momento da internação e a incidência de enterocolite necrosante, displasia broncopulmonar e sepses. Na associação entre as variáveis e o desfecho, foi utilizado o risco relativo. Foi adotado um nível de significância de α = 5% e β = 90%. Resultados:A distância média percorrida foi de 91 km. A idade gestacional média foi de 34 semanas. Entre os recém-nascidos transferidos, 23% (n = 14) não tiveram atendimento pediátrico na sala de parto. No transporte, 33% dos recém-nascidos foram acompanhados por pediatra, e os equipa...

Keywords► obesity ► body mass index ► pregnancy outcomes ► neonatal outcomes AbstractPurpose To assess the impact of pre-pregnancy obesity (body mass index [BMI] ! 30 kg/m 2 ) on the gestational and perinatal outcomes. Methods Retrospective cohort study of 731 pregnant women with a BMI ! 30 kg/m 2 at the first prenatal care visit, comparing them with 3,161 women with a BMI between 18.5 kg/m 2 and 24.9 kg/m 2 . Maternal and neonatal variables were assessed. Statistical analyses reporting the demographic features of the pregnant women (obese and normal) were performed with descriptive statistics followed by two-sided independent Student's t tests for the continuous variables, and the chi-squared (χ 2 ) test, or Fisher's exact test, for the categorical variables. We performed a multiple linear regression analysis of newborn body weight based on the mother's BMI, adjusted by maternal age, hyperglycemic disorders, hypertensive disorders, and cesarean deliveries to analyze the relationships among these variables. All analyses were performed with the R (R Foundation for Statistical Computing, Vienna, Austria) for Windows software, version 3.1.0. A value of p < 0.05 was considered statistically significant. Results Obesity was associated with older age .2); p < 0.01], hyperglycemic disorders [OR 6.5 (4.8-8.9); p < 0.01], hypertensive disorders [OR 7.6 (6.1-9.5); p < 0.01], caesarean deliveries [OR 2.5 (2.1-3.0); p < 0.01], fetal macrosomia [OR 2.9 (2.3-3.6); p < 0.01] and umbilical cord pH [OR 2.1 (1.4-2.9); p < 0.01). Conversely, no association was observed with the duration of labor, bleeding during labor, Apgar scores at 1 and 5 minutes after birth, gestational age, stillbirth and early neonatal mortality, congenital malformations, and maternal and fetal injury.