No abstract

CONTEXT: With early discharge, many newborns have to be readmitted to hospital for hyperbilirubinemia to be treated, and this has been held responsible for the reappearance of kernicterus. OBJECTIVE:To evaluate whether bilirubin levels in cord blood could predict neonatal hyperbilirubinemia that would require treatment, in full-term newborns up to their third day of life.

Mesquita MA, Segre CAM. Freqüência dos efeitos do álcool no feto e padrão de consumo de bebidas alcoólicas pelas gestantes de maternidade pública da cidade de São Paulo. Rev Bras Crescimento Desenvolvimento Hum. 2009; 19(1): 63-77 Resumo:Objetivo: avaliar a frequência dos efeitos do álcool no feto e o padrão de consumo de bebidas alcoólicas pelas gestantes de maternidade pública da cidade de São Paulo. Método: foram examinados 1964 recém-nascidos vivos, e entrevistadas as suas mães por meio de perguntas diretas e pelo questionário T-ACE. Quantificou-se o consumo semanal de álcool pelas puérperas, três meses antes e durante a gestação e compararam-se as características físicas dos recém-nascidos com esse padrão de consumo. Foram utilizados os testes de Mann-Whitney, teste qui-quadrado e o coeficiente de correlação de Spearman. Adotou-se o nível de significância de 5%. Resultados: Em 76 crianças (38,69/1000 nascidos vivos) identificou-se o espectro de desordens fetais alcoólicas. Três delas (1,52/1000 nascidos vivos) tinham síndrome alcoólica fetal. Três meses antes da gravidez, 43,90% das mulheres consumiram álcool semanalmente. Na gravidez esse número caiu para 21,20% no primeiro trimestre, 17,50% no segundo e 17,10% no terceiro e 33,29% das puérperas consumiram álcool em algum momento da gestação. O questionário T-ACE foi positivo em 31,11% puérperas e negativo em 68,84%. Quanto maior a quantidade de álcool consumido, durante os primeiros seis meses gestacionais, menor o peso de nascimento, perímetro cefálico e comprimento dos recém-nascidos. Essas medidas não apresentaram diferenças significativas entre as puérperas T-ACE positivas e negativas. Conclusões: Foram encontrados 76 recém-nascidos com o espectro de desordens fetais alcoólicas. O uso de álcool pelas gestantes foi alto, sugerindo a realização de rastreamento rotineiro desse consumo. Palavras-chave:Recém-nascidos; gestantes; álcool; síndrome alcoólica fetal; transtornos relacionados ao uso de álcool. Rev Bras Crescimento Desenvolvimento Hum. 2009; 19(1): 63-77 PESQUISA ORIGINAL ORIGINAL RESEARCH

Weight-for-length adequacy and weight/length index alone, without the knowledge of gestational age, were able to identify newborns at risk for some selected neonatal diseases.

OBJECTIVE: To verify if medium intensity exercise performed during pregnancy can influence in the type of delivery, and to observe compliance to an exercise program among primiparous women with different levels of schooling. METHODS: A study carried out at the Centro de Incentivo ao Aleitamento Materno, in São Sebastiao (SP), between April 7, 2008, and April 14, 2009. A prospective study involving 66 primiparous women who were divided into two groups: an Exercise Group, engaged in regular physical activity during pregnancy, and the Control Group, that did not participate in regular physical activity during the same period. Significance level in this project was 5% (p=0.05). RESULTS: The group that did engage in regular exercise had a higher rate of vaginal deliveries, with a statistically significance difference evaluated by the χ² test (p=0.031). The pregnant women with the highest level of schooling showed greater compliance with the exercise program, with a statistically significant difference (p=0.01736). CONCLUSION: Physical exercise in primiparous women increased the chances of vaginal deliveries, and there was greater compliance with the exercise program among those with a higher level of schooling when compared to those with a basic education.

OBJETIVO: verificar os principais fatores que influenciam o desmame em prematuros nascidos em maternidade pública da cidade de São Paulo. MÉTODO: estudaram-se 89 prematuros de baixo peso acompanhados em ambulatório, no período de agosto de 2006 a maio de 2007. Esses prematuros foram divididos em dois grupos conforme a presença de desmame parcial (introdução de complemento lácteo por mamadeira) ou desmame total (interrupção do aleitamento materno). Foram estudadas variáveis maternas e das crianças, obtidas por meio de entrevista com a mãe e consulta a prontuários. Na análise estatística, utilizaram-se os testes t (Student) e de correlação (Spearman). Adotou-se o nível de significância de 5%. RESULTADOS: a média de idade para o desmame parcial foi de 1,41 meses. Mães que realizaram ordenha durante a internação, ou que iniciaram ou retornaram ao trabalho, introduziram mamadeira mais tardiamente. Quanto menor o peso ao nascer e a idade gestacional, mais tardia a introdução da mamadeira. Quanto menor a idade de introdução da chupeta, mais precoce o desmame parcial. A média de idade para o desmame total foi de 2,93 meses. Mães que internaram na enfermaria canguru, ou que iniciaram ou voltaram ao trabalho, interromperam o aleitamento materno mais tardiamente. CONSIDERAÇÕES FINAIS: os achados do presente trabalho apontam para a importância de fatores controláveis pela equipe de saúde na prevenção do desmame precoce em prematuros, como ordenha, metodologia canguru e orientação para o não uso de chupetas. Fatores não controláveis como peso ao nascer e trabalho materno, mostraram-se indicativos de maior permanência do aleitamento materno.

This population based study compares the rates of multiple births in the 1990s in four hospitals of different socioeconomic levels. It is well known that women from higher socioeconomic groups have easiest access to infertility therapies because of greater financial resources. The hospital of lower socioeconomic level presented multiple birth rates of approximately 8 per thousand during the decade, which may be considered as the natural one. The other three hospitals presented increased rates that were positively correlated to socioeconomic level. This increase occurred mainly due to dizygotic twins and to triplets and was as high as 4.8 per thousand in 1999. Maternal age was also positively correlated to socioeconomic level for singletons as well as for twins. However, during the decade the mean maternal age increased only in the two hospitals with better socioeconomic levels. Gestational order decreased as socioeconomic levels increased, mainly for twins and triplets. The percentage of singletons with low birthweight and very low birthweight decreased as socioeconomic level increased. However, twins presented with an equal distribution in the four hospitals, indicating that better socioeconomic level did not affect the incidence of low birthweight and very low birthweight among twins. Fetal death rate decreased as socioeconomic level increased but twin/singleton fetal death ratio is three times greater in the hospital of higher socioeconomic level suggesting that even in ideal conditions of medical and hospital facilities, the mortality of twins continues to be much higher than that of singletons.

PARTICIPANTS:Term newborns (66 males and 65 females) of appropriate growth for gestational age, whose mothers were healthy, were included in the study. MAIN MEASUREMENTS:Arm circumference, arm circumference/head circumference ratio, birth weight and gestational age were measured within 48 hours of birth. Data were considered significant when p < 0.01. RESULTS:The mean values for the mid-arm circumference were 10.76 cm (standard deviation, SD = 0.68) for females and 10.76 (SD = 0.81) for males. The mean value for the mid-arm/head circumference ratio was 0.31 (SD = 0.02) for both sexes. Mid-arm circumference values were significantly related to birth weight and gestational age, whereas mid-arm/head circumference ratio was related only to birth weight. CONCLUSIONS:Mid-arm circumference and midarm/head circumference ratio values were established for the studied population. It was possible to obtain curves for both mid-arm circumference and mid-arm/head circumference ratio in relation to birth weight. However, for mid-arm circumference, it was only possible to obtain curves in relation to gestational age. The use of the regression curves did not seem powerful enough to predict the mid-arm circumference and mid-arm/head circumference ratio in this population of term newborns. There were no gender differences for either of the measurements studied.