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...
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...
Objective: On 23rd March 2020, Australia went into a nationwide lockdown that led to school closures. As a result, children spent more time at home, increasing their vulnerability to injuries sustained at home. This study aims to analyse the patterns of emergency paediatric plastic surgery admissions into a tertiary paediatric hospital in Sydney during the COVID-19 lockdown period, and to raise awareness on the impacts of lockdown measures on the vulnerable pediatric population. Methods: A retrospective analysis was conducted at a tertiary paediatric hospital in Sydney. Admissions into the Plastic and Reconstructive Surgery department during the lockdown period of 23rd March to 15th May 2020, and the same period in 2019 were included in the analysis. Ethics approval for the study was obtained from the Sydney Children’s Hospitals Network Human Research Ethics Committee [HREC Reference 2021/ETH00451] Results: There were 37 and 91 admissions in 2020 and 2019 respectively. The proportion of injuries sustained at home increased by 24% in 2020, consistent with increased time spent at home. The percentage of injuries due to animal bites and sharp objects increased while number of sports-related injuries and falls decreased during the lockdown. Motor vehicle accidents increased in 2020. More patients also opted for conservative management in 2020. Conclusion: This study has shown that during a pandemic lockdown, home injuries are more common, children are less likely to present to hospital and more likely to opt for conservative management. With a greater understanding of patterns of paediatric injuries during lockdowns, the relevant authorities can develop targeted advisories for dissemination to the public on how to create a safe home environment for children.
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