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Kranen-Mastenbroek, Vivianne Henriëtte Johanna Maria van. "Spontaneous motor behaviour in full-term small for gestational age and appropriate for gestational age newborn infants." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 1993. http://arno.unimaas.nl/show.cgi?fid=5853.
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Horta, Bernardo Lessa. "Determinants of catch-up growth in small-for-gestational age infants." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=38067.
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Objective. To identify predictors of catch-up growth during the first year of life among small for gestational age (SGA) infants in a developing country setting.Design. Cohort study, with follow-up visits at 1, 3, 6 and 12 months.
Setting. Pelotas, a southern Brazilian city.
Population. SGA infants who were born in 1993 and whose families lived in the urban area of Pelotas.
Main outcomes. Weight and length gain from birth to 6 months and from 6 to 12 months.
Results. Two hundred twenty term SGA infants were targeted for follow-up, which was achieved for 205 (93.2%) infants at 12 months. At 6 months, the proportion of infants with weight-for-age and length-for-age z-scores <-1.28 SDS was 18.9% and 37.8%, respectively. At 12 months, the proportion of children with a weight-for-age z-score <-1.28 SDS increased to 35.2%, whereas for length-for-age this proportion remained about the same as it had been at 6 months. Severity of intrauterine growth retardation, body proportionality at birth, maternal remunerated work after delivery, maternal age, parity, maternal prepregnancy body mass index and maternal smoking during pregnancy had no significant effect on postnatal growth in the first year of life. Those infants who were weaned by 1 month had faster weight and length gain by 6 months. Socioeconomic status (SES) modified the effect of breast feeding duration on weight and length gain in the first 6 months of life. Among high-SES families, those children who were weaned by 1 month gained 578 g more than those still breast feeding at 6 months. Among low-SES families, however, those children who were weaned by 1 month gained 349 g less than those still breast feeding at 6 months. Those children who were weaned by 6 months had faster weight gain from 6 to 12 months, and this association was not modified by SES, while low SES was associated with slower weight and length gain in the same period. Children of short (<150 cm) mothers gained 1.31 cm less (95% confidence interval -2.52 to -0.1) by 6 months than those of mothers >160 cm. Children who were hospitalized showed a nonsignificantly slower length gain throughout the first year of life.
Conclusion. SGA infants experienced catch-up growth for weight and length but remained shorter and lighter than those in the NCHS reference population at both 6 and 12 months of age. Socioeconomic status and infant feeding were the main determinants of catch-up growth.
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Davenport, Sarah E. "Potential Causes of Extrauterine Growth Failure in Premature Infants Born Appropriate for Gestational Age." eScholarship@UMMS, 2021. https://escholarship.umassmed.edu/gsbs_diss/1137.
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Background: Extrauterine growth restriction (EUGR) is multifactorial in etiology and predisposes infants to multiple morbidities that can be significantly ameliorated by adequate nutrition and appropriate longitudinal growth. Current strategies to reduce the risk of EUGR include optimization of parental nutrition, varying schedules of feeding advances, and caloric supplementation. Very low birthweight (VLBW) preterm infants are particularly affected by EUGR, therefore ensuring adequate postnatal growth is an essential component in improving the long-term health outcomes for VLBW infants. The objectives of this observational study were to examine potential risk factors for growth failure among premature infants that did not respond to caloric and volume supplementation.
Methods: We conducted a retrospective chart review of all infants born at the University of Massachusetts level III NICU from January 2016 to June 2020. Growth was tracked using PediTools electronic gestational age and growth calculators. (17) We reviewed the EMRs of infants who met the criteria for EUGR at the time of hospital discharge for a variety of potential factors affecting growth.
Results: Overall, a total of 448 infants were screened with a final study cohort of 358 infants, of which 13% were discharge with EUGR. Analysis of demographic and clinical characteristics of infants with EUGR before and after nutritional intervention showed no statistically significant differences between the two cohorts. Pre-protocol, only weight percentiles and z-scores were statistically significant. Post-protocol, the change in z-score was also statistically significant. The only factor found to be statistically significantly different between was Necrotizing enterocolitis (NEC). Timing of EUGR in the pre-protocol groups occurred between 33-35 weeks, while in the post-protocol group EUGR occurred between 32 and 37 weeks (Figure 2).
Conclusions: Our findings confirmed the presence of several factors that have been previously shown to increase risk for EUGR, including male sex, lower gestational age, lower birth weight, and the occurrence of NEC. It also identified an additional risk factor, that of being born “constitutionally small”. In the post-protocol cohort, the change in z-score was statistically significant in addition to birth weight percentile and z-score and discharge weight percentile in z-score. The window in which EUGR occurred as well as the interquartile range was significantly widened post-protocol. These data suggest that the volume supplementation protocol successfully addressed the causes of EUGR in some infants, but other mechanisms may have occurred in infants who were still discharged with EUGR post-protocol.
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Read, Anne Winifred. "An epidemiological study of small-for-gestational age infants: A case-control study of mothers who repeated small-for-gestational age births and multiparous mothers who had only one such birth." Thesis, Read, Anne Winifred (1988) An epidemiological study of small-for-gestational age infants: A case-control study of mothers who repeated small-for-gestational age births and multiparous mothers who had only one such birth. PhD thesis, Murdoch University, 1988. https://researchrepository.murdoch.edu.au/id/eprint/52315/.
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This case-control study, based on the total population of Western Australian mothers, is a comparison of the births of two groups of case mothers and their matched controls. The case groups were called ’repeater’ and 'non-repeater* mothers. Repeater mothers were women who had given birth to more than one small-for-gestational age (SGA) term infant whereas non-repeater mothers were multiparous women who had had only one such infant. The two groups of matched control mothers had had no SGA infants. All mothers with preterm births were excluded from the study. The hypotheses were –
1) repeater mothers differed from non-repeater mothers in terms of the antecedents of their SGA births
2) repeater mothers differed from non-repeater mothers in terms of the outcomes for their infants.
Data for the study were collected from multiple sources including Western Australian Midwives' Notifications, hospital records and maternal questionnaires. The aim was to make the information collected for each birth to each mother as complete as possible.
Descriptive and analytical results are presented. Repeater mothers are described in four groups according to their attained sibship size and the sequence of their SGA births. Comparisons of these groups indicated that different patterns of SGA birth sequences contributed in various ways to the overall differences found between repeaters, non-repeaters and controls.
The major part of the descriptive results includes three comparisons for most of the variables which relate to the index infant and parents - non-repeaters compared with repeaters, non-repeaters compared with their matched controls and repeaters compared with their matched controls. It was found that whilst non-repeater and repeater mothers and their index (SGA) infants showed similarities for some variables, there were significant differences between the two groups for others. For example, neonatal outcome for the index infants of non-repeaters was significantly worse than for the index infants of repeaters.
A further section of the descriptive results investigates total obstetric history for case and control mothers up to the birth of the index infant. Mothers were separated into those with two and those with three infants and sibships described in a longitudinal It manner. was found that two infant sibships differed from three infant sibships with regard to many of the antecedent and outcome variables investigated.
Multivariate analysis was carried out by logistic regression to determine which of the factors found to be significant in the descriptive results contributed independently to differences between non-repeaters and repeaters. Significant risk factors for repeating SGA births compared with non-repeater status were having three infants (rather than two), weight loss or static weight in the third trimester of pregnancy, smoking by the infant's father, maternal birthweight of less than 3000g or height of less than 155cm, and not knowing the morbidity history of their own parents.
For repeater mothers, smoking by the infant’s father was significantly associated with the 'disadvantaged' categories of socioeconomic measures such as being unemployed and renting (rather than owning) accommodation. In contrast, there were no significant associations between this group of smoking fathers and variables of a biological nature such as sex and congenital malformations of the infant, paternal height and birthweight. Thus it appears that paternal smoking acted as a measure of socioeconomic status although there may also have been a direct association between paternal smoking and fetal growth.
Although the tendency to repeat SGA term birth appeared to be related to socioeconomic conditions, maternal birthweight and height were also important and these factors may have been mediated by genetic and/or environmental circumstances.
It should also be noted that, for a small percentage of parity-one mothers, weight loss in pregnancy was predictive of repeater status and, for some of those mothers, was associated with a malformation in the previous infant.
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Dube, Frederick. "The effect of birth weight and gestational age on BCG-induced immune responses in infants following BCG vaccination." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10377.
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Includes bibliographical references (leaves 102-114).Bacillus Calmette?Gu?rin (BCG), the only currently licensed tuberculosis (TB) vaccine, provides variable efficacy. Despite the use of BCG, TB remains a global health problem. BCG is administered at birth; however, more than 15% of infants are born preterm [PT (<37 weeks gestation)], or have low birth weights [LBW (<2,500g)], with >90% of these born in developing countries, where the majority of TB cases are found. It is not known how birth weight at the time of vaccination may affect the BCG-induced immune response and subsequent protection against TB. We hypothesised that BCG-vaccinated PT and LBW infants would have a qualitatively and quantitatevely less optimal immune response, compared to term or normal birth weight (NBW) infants.
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Maleki-Yazdi, Keon. "The genetic determinants of small-for-gestational-age infants in thrombophilia and folate metabolism pathways investigated through meta-analysis." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=121509.
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Background: Previous data have demonstrated associations for an increased risk of the small-for-gestational-age (SGA) outcome in offspring of pregnant women with thrombophilia and folate metabolism gene polymorphisms. However, these results have not been consistent.Methods: The objective of this thesis is to review genetic association studies in thrombophilia and folate metabolism pathways for the SGA outcome (defined as birth weight below the 10th percentile for gestational age and sex according to national standards). We performed a series of meta-analyses for commonly studied maternal and newborn gene variants within the two pathways: prothrombin G20210A and factor V G1691A (Leiden) in the thrombophilia pathway, as well as methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C in the folate metabolism pathway. Results: In the thrombophilia pathway, the meta-analysis indicated an increased odds of SGA births among mothers carrying prothrombin G20210A (odds ratio=1.39 [95% confidence interval, 1.10 to 1.76]). Non-significant findings were found for maternal carriage of factor V Leiden, as well as prothrombin G20210A and factor V Leiden among newborn carriers. With respect to the folate metabolism pathway, maternal carriers of MTHFR C677T (odds ratio=1.22 [95% confidence interval, 1.05 to 1.42]), maternal homozygous MTHFR C677T (odds ratio=1.18 [95% confidence interval, 1.03 to 1.35]), and maternal homozygous A1298C (odds ratio=0.70 [95% confidence interval, 0.50 to 0.98]) were the only genotypes that reached statistical significance.Conclusion: To our knowledge, this is the first meta-analysis to indicate significant associations between an increased risk of SGA and maternal prothrombin G20210A carriers, maternal MTHFR C677T carriers, and homozygous mothers for MTHFR C677T. We also reported that pregnant women homozygous for MTHFR A1298C were at a decreased risk of SGA births.Contexte: La variation d'un seul élément du code moléculaire dite polymorphisme du nucléotide simple ou SNP peut contribuer à l'incidence de maladies dites complexes. Certains SNPs sur des gènes de thrombophilie et du métabolisme de l'acide folique dans le génome de la mère ont été associés avec un risque accru pour leurs bébés de naître petits pour leur âge gestationnel (PAG). Cependant, ces résultats ne sont pas uniformes. Méthodes: Cette thèse recense les études portant sur les SNPs dans les voies métaboliques de thrombophilie et du cycle du folate et l'issue de grossesse PAG (définie par un poids à la naissance inférieur au 10e percentile pour le sexe et l'âge gestationnel selon les normes nationales). Nous avons effectué une série de méta-analyses sur les SNPs nommés prothrombine G20210A et facteur V Leiden G1691A dans la voie de thrombophilie, ainsi que sur deux SNPs du gène méthylènetétrahydrofolate réductase (MTHFR) soient C677T et A1298C impliqués dans le métabolisme du folate. Résultats: Notre méta-analyse sur les voies de la thrombophilie a montré un risque accru de naissances PAG quand les mères portent le SNP G20210A (odds ratio=1,39 [intervalle de confiance à 95%: 1,10 à 1,76]. Des résultats non significatifs ont été trouvés lorsque la mère porte le facteur V Leiden, ainsi que lorsque le nouveau-né est porteur des SNP G20210A et facteur V Leiden. En ce qui concerne la voie du métabolisme du folate, les seuls résultats qui ont atteint la signification statistique étaient les suivants : lorsque les mères portaient la variation en une copie de C677T (odds ratio=1,22 [intervalle de confiance à 95%: 1,05 à 1,42]), étaient homozygotes (2 copies) pour C677T (odds ratio=1,18 [intervalle de confiance à 95%: 1,03 à 1,35]) ou homozygotes pour A1298C (odds ratio=0,70 [intervalle de confiance à 95%: 0,50 à 0,98]). Conclusion: À notre connaissance, cette étude est la première à décrire dans une méta-analyse des associations significatives entre un risque accru de naissances PAG et le fait que les mères portent une copie des SNPs prothrombine G20210A et MTHFR C677T ou deux copies de MTHFR C677T. Aussi, nous avons trouvé qu'il y avait une diminution du risque de PAG chez les femmes porteuses du SNP MTHFR A1298C.
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Nagai, Shizuyo. "Gonadotropin Levels in Urine during Early Postnatal Period in Small-for-Gestational Age Preterm Male Infants with Fetal Growth Restriction." Kyoto University, 2017. http://hdl.handle.net/2433/226767.
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Nyirati, Christina. "Profiles of risk for low birth weight, small for gestational age, and premature infants among Appalachian Ohio teenagers : a birth certificate study /." The Ohio State University, 1993. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487844105973922.
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Lum, Sook-Yuen. "Influence of low birthweight for gestational age on airway function in early infancy." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.398863.
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Ahlsson, Fredrik. "Being Born Large for Gestational Age : Metabolic and Epidemiological Studies." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9135.
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St-Arnaud-Trempe, Emmanuelle. "Effect of low alcohol consumption during pregnancy on the risk of small-for-gestational-age (SGA) birth." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=116079.
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Although the association between high maternal alcohol consumption and adverse reproductive outcomes is well established, the effect of lower levels of consumption during pregnancy is unclear; few studies have investigated this exposure. A hospital-based case-control study of small-for-gestational age (SGA) newborns (birth weight below the 10th percentile, according national standards for gestational age and sex) was conducted in Montreal between 1998 and 2000. Controls were born at the same hospital and during the same period with birth weight at or above the 10th percentile. This analysis aims at investigating the effect of low alcohol consumption (0.25 to 3 alcoholic drinks weekly) during pregnancy on the risk of small-for-gestational-age (SGA) birth. Independent effects of wine, beer and spirits and of paternal alcohol consumption before conception were also assessed. The logistic regression analysis showed no significant effect of light maternal drinking during pregnancy on the risk of SGA birth. The association was also studied separately for consumption of wine, beer and spirits, and likewise for paternal alcohol consumption, with similarly negative results.
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Gelaye, Bizu, Amber Domingue, Fernanda Rebelo, Lauren E. Friedman, Chunfang Qiu, Sixto E. Sanchez, Gloria Larrabure-Torrealva, and Michelle A. Williams. "Association of antepartum suicidal ideation during the third trimester with infant birth weight and gestational age at delivery." Routledge, 2019. http://hdl.handle.net/10757/625044.
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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Antepartum suicidal behaviors are a leading cause of maternal injury and death. Previous research has not investigated associations between antepartum suicidal ideation and perinatal complications. Our study objective was to evaluate the relationship of antepartum suicidal ideation with low infant birthweight, small for gestational age, and preterm birth. A cohort study was conducted among 1,108 women receiving prenatal care in Peru. Suicidal ideation was measured using the Patient Health Questionnaire-9 during pregnancy. Birth outcomes were extracted from medical records. Linear regressions and multivariable logistic regressions were used to estimate were used to investigate associations between suicidal ideation and pregnancy outcomes. The prevalence of suicidal ideation was 8.7%, preterm delivery was 5.7%, low birthweight was 4.4%, and small for gestational age was 3.4%. In an adjusted model, infant birthweight was 94.2 grams lower for mothers with antepartum suicidal ideation (95% CI: −183.0, −5.5, p = 0.037) compared with those without suicidal ideation. After adjusting for confounders including depression, participants with suicidal ideation had a nearly four-fold increased odds of delivering a small for gestational age infant (OR: 3.73; 95% CI: 1.59–8.74). These findings suggest suicidal ideation during pregnancy is associated with adverse perinatal outcomes, especially low infant birthweight.
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Gelaye, Bizu, Amber Domingue, Fernanda Rebelo, Lauren E. Friedman, Chunfang Qiu, Sixto E. Sanchez, Gloria Larrabure-Torrealva, and Michelle A. Williams. "Association of antepartum suicidal ideation during the third trimester with infant birth weight and gestational age at delivery." Routledge, 2018. http://hdl.handle.net/10757/624715.
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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Antepartum suicidal behaviors are a leading cause of maternal injury and death. Previous research has not investigated associations between antepartum suicidal ideation and perinatal complications. Our study objective was to evaluate the relationship of antepartum suicidal ideation with low infant birthweight, small for gestational age, and preterm birth. A cohort study was conducted among 1,108 women receiving prenatal care in Peru. Suicidal ideation was measured using the Patient Health Questionnaire-9 during pregnancy. Birth outcomes were extracted from medical records. Linear regressions and multivariable logistic regressions were used to estimate were used to investigate associations between suicidal ideation and pregnancy outcomes. The prevalence of suicidal ideation was 8.7%, preterm delivery was 5.7%, low birthweight was 4.4%, and small for gestational age was 3.4%. In an adjusted model, infant birthweight was 94.2 grams lower for mothers with antepartum suicidal ideation (95% CI: −183.0, −5.5, p = 0.037) compared with those without suicidal ideation. After adjusting for confounders including depression, participants with suicidal ideation had a nearly four-fold increased odds of delivering a small for gestational age infant (OR: 3.73; 95% CI: 1.59–8.74). These findings suggest suicidal ideation during pregnancy is associated with adverse perinatal outcomes, especially low infant birthweight.
Revisión por pares
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Francis, Kim. "Development of a New Pain Assessment Instrument: Pain Assessment and Care for the Extremely Low Gestational Age Infant Focused Instrument (PACEFI)." Thesis, Boston College, 2012. http://hdl.handle.net/2345/3898.
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Thesis advisor: June HorowitzPain in extremely low gestational age (ELGA) infants remains under-assessed and poorly managed despite the fact that pain may have profound consequences with regard to infants' neuro-development (Als, 1982). Pain prevention is a critical goal of pain assessment, yet barriers exist. Most critical is the lack of valid, reliable, and clinically useful pain tools. This observational descriptive study focused on the development of a gestational age appropriate instrument for 24-29 6/7 week infants and evaluation of the new instrument, Pain Assessment and Care for the Extremely Low Gestational Age Infant Focused Instrument (PACEFI). Additionally, differences in behavioral cues and physiologic indicators were evaluated for ELGA infants and very low gestational age (VLGA) infants for non-invasive and invasive procedures. Nurse raters used the PACEFI to rate these infants during both procedures at baseline, during, and recovery to assess variation in expected pain. The PACEFI demonstrated a high internal consistency (.879) and appeared to be contributing to the measurement of pain. A RANOVA found a significant difference in rating scores ( p < .001) for both procedures. Baseline and recovery scores were lower than during scores. ELGA infants demonstrated a dampened response (p < .023) as compared to the VLGA infants during the invasive procedure. Alternatively, ELGA infants demonstrated a more vigorous response for non-invasive procedure and dropped below baseline scores at recovery. The whole care experience during the non-invasive procedure may have led to sensitization for the VLGA infant and overwhelming energy expenditure for the ELGA infant. Furthermore, physiologic indicators and behavioral cues were inconsistent arguing for independent assessment of these parameters. Knowledge gained from this study: 1) provides information regarding gestational age differences in pain behaviors; and (2) clarifies if the measurement of these behaviors addresses the immediate need for pain assessment for this vulnerable population
Thesis (PhD) — Boston College, 2012
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Frunza, A. V. "The role of urinary β2-microglobulin in predicting tubular damage in premature infants of different gestational ages." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19798.
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Griffin, Melanie Joanne. "Use of third trimester serum biomarkers and ultrasound paameters to predict the small for gestational age infant at delivery." Thesis, King's College London (University of London), 2015. https://kclpure.kcl.ac.uk/portal/en/theses/use-of-third-trimester-serum-biomarkers-and-ultrasound-paameters-to-predict-the-small-for-gestational-age-infant-at-delivery(1d747923-4eb0-4060-a31e-4d7a28dfa61f).html.
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Current techniques to identify growth-restricted fetuses, at risk of health complications, have limited accuracy. Placental insufficiency is a key pathological process in fetal growth restriction (FGR). I investigated the potential clinical benefit of placental biomarkers to identify pregnancies delivering small for gestational age (SGA) infants in pregnancies with suspected pre-eclampsia and in those with reduced symphysis-fundal height measurement using delivery of an SGA infant as a surrogate measure of FGR. Suspected pre-eclampsia (PELICAN-PE study) In a large multicentre prospective cohort study investigating diagnostic accuracy of placental growth factor (PlGF) in women with suspected pre-eclampsia, I assessed test performance of 47 biomarkers and ultrasound parameters to identify women delivering an SGA infant. PlGF measurement outperformed all other biomarkers and currently used tests in predicting delivery of an SGA infant. Combinations of biomarkers added minimal value. Reduced symphysis-fundal height measurement (PELICAN-FGR study) I assessed the ability of PlGF and ultrasound parameters to predict delivery of an SGA infant in women with reduced symphysis-fundal height (current UK standard to identify pregnancies at risk of SGA) in a second multinational prospective cohort study. Test performance statistics were calculated for all parameters in isolation and combination. Ultrasound parameters had modest test performance for predicting delivery of an SGA infant. PlGF performed no better. Incorporating PlGF with ultrasound parameters provided modest improvements. In women presenting with suspected pre-eclampsia, PlGF measurement is a potentially useful adjunct to current practice in identifying those at risk of SGA. The findings of the PELICAN-FGR study cannot support the use of PlGF to risk stratify women referred with reduced symphysis-fundal height. The prevalence of FGR in the two studies differed, with a high number of normal pregnancies in those presenting with reduced symphysis-fundal height. The pathological process in normotensive versus hypertensive SGA may differ, potentially explaining these findings.
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Kistner, Anna. "Born too small or too early : effects on blood pressure, renal function and retinal vascularization in adulthood : experimental and clinical studies /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-154-7/.
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Edner, Ann. "Apnea, small for date and autonomic imbalance - risk factors in relation to SIDS /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-503-4/.
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Gómez, Maria Del Pilar Vélez. "Estudo intergeracional do peso ao nascer e da idade gestacional na coorte de nascimentos de 1982, Pelotas, Brasil." Universidade Federal de Pelotas, 2006. http://repositorio.ufpel.edu.br/handle/ri/1967.
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Previous issue date: 2006-11-22794 women from the 1982 Pelotas Birth Cohort Study and their first singleton live-born birth were selected to explore the association between maternal and offspring birthweight and gestational age, as well as to discriminate between confounders and mediating factors of these associations. Exposures were maternal birthweight and gestational age, low birthweight (LBW; <2500g), preterm birth (<37 weeks) and small for gestational age status (SGA; <10 th percentile of Williams), to the respective outcomes in offspring. Information was gathered on potential confounding or mediating factors according to a hierarchical framework approach. A strong correlation coefficient was found between maternal and infant birthweight (r=0.18, p<0.001). An increase of 100g in mothers birthweight predicted a gain of 16g in their infants birthweight (95% CI 8.0, 24.0g; p<0.001). Maternal LBW was independently associated to offspring LBW, preterm and SGA status. SGA mothers had an increased risk of delivering a preterm newborn. Causal chain linking maternal LBW and SGA of the newborn was mediated by maternal pre-gestational weight (a proxy of malnutrition), a condition closely related to poverty. Thus, malnourished women are likely to give birth to LBW babies, perpetuating poverty in the subsequent generation. Addressing malnutrition helps break this vicious cycle and stop the intergenerational transmission of LBW, hence decreasing poverty and malnutrition in developing countries.
794 women from the 1982 Pelotas Birth Cohort Study and their first singleton live-born birth were selected to explore the association between maternal and offspring birthweight and gestational age, as well as to discriminate between confounders and mediating factors of these associations. Exposures were maternal birthweight and gestational age, low birthweight (LBW; <2500g), preterm birth (<37 weeks) and small for gestational age status (SGA; <10 th percentile of Williams), to the respective outcomes in offspring. Information was gathered on potential confounding or mediating factors according to a hierarchical framework approach. A strong correlation coefficient was found between maternal and infant birthweight (r=0.18, p<0.001). An increase of 100g in mothers birthweight predicted a gain of 16g in their infants birthweight (95% CI 8.0, 24.0g; p <0.001). Maternal LBW was independently associated to offspring LBW, preterm and SGA status. SGA mothers had an increased risk of delivering a preterm newborn. Causal chain linking maternal LBW and SGA of the newborn was mediated by maternal pre-gestational weight (a proxy of malnutrition), a condition closely related to poverty. Thus, malnourished women are likely to give birth to LBW babies, perpetuating poverty in the subsequent generation. Addressing malnutrition helps break this vicious cycle and stop the intergenerational transmission of LBW, hence decreasing poverty and malnutrition in developing countries.
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Neuwald, Marla Finkler. "Peso ao nascer e cuidado parental percebido pela mãe : interações pré e pós-natais sobre o comportamento infantil aos 18 meses de vida." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/67519.
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Introdução: Evidências sugerem uma associação entre nascer pequeno para idade gestacional (PIG) e o risco aumentado de desenvolver problemas de comportamento. Além disso, indivíduos que relatam ter recebido menor cuidado materno apresentam mais sintomas de depressão e de ansiedade, e, de modo geral, cuidam com menos eficiência de seus filhos. Portanto, uma interação entre nascer PIG e a percepção da mãe de baixo cuidado materno recebido nos seus primeiros dezesseis anos de vida poderia estar associada a prejuízos na função cognitiva e risco aumentado para psicopatologias ao longo da vida. O objetivo deste trabalho foi avaliar a interação entre nascer PIG e o cuidado parental percebido pela mãe sobre o comportamento infantil aos 18 meses de vida. Métodos: Estudo transversal aninhado a uma coorte prospectiva canadense de nascimentos – MAVAN (Maternal Adversity, Vulnerability and Neurodevelopment) – realizada entre os anos de 2003 e 2010. Os dados analisados são provenientes de 3 questionários (Parental Bonding Instrument, PBI, Early Chidhood Behavior Questionnaire, ECBQ e Infant-Toddler Social and Emotional Assessment, ITSEA) respondidos pelas mães de 305 crianças. Para análise utilizamos Multivariate Analysis of Variance (MANOVA) com análise de interação para detecção das diferenças entre os grupos. Resultados: Observou-se uma interação entre o cuidado materno percebido pela mãe e o peso ao nascimento na habilidade atencional de crianças aos 18 meses de vida em ambos os instrumentos ECBQ e ITSEA. Crianças nascidas PIG e de mães que relataram ter recebido baixo cuidado materno alcançaram menores escores de atenção relatados nos dois questionários analisados - ECBQ (p=0,002) e ITSEA (p=0,05). Efeitos principais das variáveis preditoras peso ao nascimento sobre os domínios aconchego (p=0,011), assim como do cuidado materno sobre os domínios prazer de baixa intensidade (p=0,016) e transferência de atenção (p=0,004) do ECBQ também foram encontrados. Conclusão: Os achados reforçam a importância de uma visão sistêmica do desenvolvimento que contemple aspectos do ambiente precoce e de cuidados parentais nos primeiros anos de vida. Além disso, o comprometimento da atenção encontrado já aos 18 meses nessas crianças tem implicâncias clínicas, visto que pode servir como sinal de alerta, sugerindo a necessidade de um acompanhamento precoce para esses sujeitos.Introduction: Evidence suggests an association between being born small for gestational age (SGA) and the increased risk for behavioral problems. Besides that, individuals who report have received lower quality of maternal care show increased prevalence of depression and anxiety, as well as in general are poorer caregivers of their offspring. Therefore, an interaction between the birth weight status and the quality of maternal care perceived by the mother could affect the cognitive functioning later in life. This study aimed to evaluate the interaction between being born SGA and the parental bonding perceived by the mother on the children’s behavior at 18 months of age. Methodology: a nested cross-sectional evaluation of a prospective Canadian birth cohort (MAVAN, Maternal Adversity, Vulnerability and Neurodevelopment), developed between the years of 2003 and 2010. Data from 305 children evaluated at 18 months of age and that had all three questionnaires completed (Parental Bonding Intrument - PBI, Early Chidhood Behavior Questionnaire - ECBQ and Infant-Toddler Social and Emotional Assessment – ITSEA) were used. Multivariate ANOVA accounting for parental interactions was used for the analysis. Results: Children born SGA from mothers reporting low maternal care had lower scores in the attentional set shifting trait (ECBQ, p=0.002) and attention construct (ITSEA, p=0.05) at 18 months of age. We also found isolated effects of SGA decreasing cuddliness (p=0.011) and high maternal care per se increased ECBQ low intensity pleasure (p=0.016) and attentional shifting (p=0.004). Conclusion: The findings reinforce the importance of a systemic developmental vision that integrates early environmental aspects and parental care in the first years of life. Besides, the effects on attention found already at 18 months have clinical relevance as it may serve as a warning sign for this population.
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Ekholm, Selling Katarina. "Birth-characteristics, hospitalisations, and childbearing : Epidemiological studies based on Swedish register data." Doctoral thesis, Linköping : Faculty of Health Sciences, Linköping University, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-9660.
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Taylor, Marian. "Infant Mortality Among African American Women Compared to European American Women in New York City." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3841.
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The birth of low weight babies in the United States has not had a meaningful decline for the last 10 years.It continues to be a major predictor of fetal-infant mortality. In addition, the rate of low birth weight infants among African American women continues to be twice that of European American women. Low birth weight babies may experience breathing problems, vision problems, diabetes, hypertension, and cerebral palsy. The purpose of this study was to examine why the high infant mortality rate persist among the African American communities of Southeast Queens, New York City as compared to European American communities in the Borough of Queens, New York City.This was a quantitative retrospective study with a correlational design that utilized secondary data derived from vital records maintained by the New York City Department of Health and Mental Hygiene. The investigation was guided by the ecological model as the theoretical framework to collect, assess, and analyze the data. Logistic regression was used to predict the association of risk factors to infant mortality. Low birth weight, preterm birth, late or no prenatal care, and smoking during pregnancy were risk factors associated with a high mortality rate among African American women. Positive social change implications for this study include the development of a social intervention that will be culturally based for the diverse communities of Southeast Queens, New York City. There will be a collaborative effort in implementing the evidence-based interventions involving interested stakeholders.
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Bergvall, Niklas. "Fetal programming and subsequent risks in adulthood: are the associations confounded by genetic and/or environmental factors? /." Stockholm : Department of Medical Epidemiology and Biostatistics, Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-271-2/.
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Brock, Romy Schmidt. "Valores de referência do índice de massa corpórea para recém-nascidos de acordo com a idade gestacional." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-06022007-160826/.
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INTRODUÇÃO: A avaliação nutricional do recém-nascido é tarefa complexa e qualquer desvio da normalidade está associada a um aumento do risco de morbi-mortalidade. As medidas antropométricas têm representado o principal método de avaliação nutricional no período neonatal. Elas são importantes tanto para a classificação e diagnóstico do crescimento intra-uterino, quanto para posterior acompanhamento nutricional e de crescimento. Um único parâmetro antropométrico, como a medida simples de peso, não consegue avaliar adequadamente o estado nutricional do recém-nascido. O uso de medidas combinadas permite melhor determinação do estado nutricional e da proporcionalidade corpórea. O índice de massa corpórea (IMC) tem se tornado a medida de escolha na determinação do estado nutricional em crianças por ser uma relação entre peso e o comprimento, entretanto ainda sem padrões de referência para o período neonatal. OBJETIVOS: Proposição de valores normativos do índice de massa corpórea de recém-nascidos em diferentes idades gestacionais em ambos os sexos e elaboração de uma curva de percentis suavizados. METODOLOGIA: Estudo retrospectivo incluindo todos os recém- nascidos vivos admitidos no Berçário Anexo à Maternidade do Hospital das Clínicas da Universidade de São Paulo durante o período de janeiro de 1993 a dezembro de 2004, selecionando-se o peso e o comprimento dos recém-nascidos, adequados para a idade gestacional, classificados segundo a curva de Alexander et al (1996). Os casos excluídos corresponderam àqueles que apresentaram inadequação do crescimento intra-uterino, presença de malformações maiores, cromossomopatias, hidropisia fetal, infecções congênitas e gemelaridade. O cálculo do tamanho amostral foi desenvolvido em função da obtenção de dados suficientes para permitir a validação da amostra e o cálculo dos percentis nas idades gestacionais de 29 a 42 semanas, totalizando 2406 recém-nascidos. O cálculo do IMC foi realizado baseado na seguinte fórmula: [peso(kg)/comprimento(m)2 ] e os percentis 3, 5, 10, 25, 50, 75, 90, 95 e 97 foram determinados separadamente para cada idade gestacional. Para a construção da curva de percentis suavizados foi selecionado um modelo matemático denominado ?modelo de ajuste sinusoidal, correspondente a equação de menor erro residual e que ao mesmo tempo descreve uma tendência de crescimento compatível com o parâmetro biológico. RESULTADOS: Os resultados obtidos para cada idade gestacional nos diversos percentis demonstraram uma curva ascendente em ambos os sexos desde a 29ª. até a 40ª. semana, seguida de uma tendência a retificação até a 42ª. semana. O valor do percentil 50 do IMC para recém-nascido do sexo masculino foi de 8,53 kg/m 2 com 29 semanas e de 14,02 kg/m 2 com 42 semanas de idade gestacional. No sexo feminino, o resultado do percentil 50 do IMC foi de 8,36 kg/m 2 com 29 e 14,04 kg/m 2 com 42 semanas. Não houve diferença estatisticamente significante entre os valores de IMC em ambos os sexos, nas diferentes idades gestacionais. CONCLUSÕES: Os valores de IMC apresentam uma correlação direta com a idade gestacional em ambos os sexos nos 9 percentis estudados. As curvas de IMC são úteis para classificar os recém-nascidos de diferentes idades gestacionais proporcionando uma nova ferramenta de avaliação nutricional dos recém-nascidos com ênfase na proporcionalidade corpórea.INTRODUCTION: The nutritional assessment of the newborn has been a challenging essay and any deviation from the normal is associated with an increased risk of morbidity and mortality. Anthropometric parameters have been the most important method to evaluate newborn nutrition. They are important in reflecting intrauterine growth and in defining a baseline for the infants\' follow-up. A single standard anthropometric factor, as the measure of simple weight, cannot assess the nutritional status of the newborn properly. The use of a combination of two anthropometric factors has been more appropriate to assess body composition and proportions. The Body Mass Index (BMI) has become the measure of choice for the determination of nutritional status during pediatric years, as it assesses the relationship between weight and length, however there is a lack of reference values for the neonatal period. OBJECTIVES: This report presents references for body mass index of the newborn at different gestational ages for both sexes, and to construct a normal smoothed percentile curve. METHODS: Retrospective study including all admitted infants, born between January 1993 and January 2004, at the Newborn Nursery of Clinics Hospital, School of Medicine, University of São Paulo. The appropriate for gestational age newborns, following the Alexander et al curve (1996) were included. The excluded cases were represented by newborns with impaired fetal growth or abnormalities such as hydrops fetalis, congenital malformations or multiple births. The overall sample size was determined by the need to obtain sufficient data for valid calculation of percentile values from 29 to 42 weeks, totalling 2406 infants. The BMI was calculated based on the formula: [weight (kg)/ length (m)2 ], and selected percentiles (3, 5, 10, 25, 50, 75, 90, 95, 97) were determined for all target gestational ages. For the construction of a normal smoothed percentile curve, a statistical procedure based on the mathematical model of \"sinusoidal fit\" was applied to establish a curve that estimates the biological growth parameters. RESULTS: The BMI for gestational age and gender increased sharply from 29 to 40 weeks in all percentiles, followed by a slight increase up to 42 weeks. The values of the 50 th percentile for boys were 8,53 kg/m 2 in the 29 th week and 14,02 kg/m 2 in the 42 nd week. The girls values of the 50 th percentile were 8,36 kg/m 2 and 14,04 kg/m 2 in the 29 th and 42 nd week, respectively. There was no statistical difference between the BMI values for both sexes in the 9 percentiles evaluated. CONCLUSION: The results present a direct correlation between gestational age and BMI for both genders in the 9 studied percentiles. The BMI growth charts are useful to characterize the newborn BMI in different gestational ages, and can provide a useful reference to assess intra-uterine proportional growth.
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Alburquerque, Duglio Miguel Adrian, Mallqui Orion Pizango, and Mariaca José Eduardo Tejeda. "Ganancia de peso gestacional y su asociación con el pequeño para la edad gestacional: cohorte retrospectiva en un hospital 2000-2010." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2015. http://hdl.handle.net/10757/621620.
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Objetivos: identificar los principales factores de riesgo para recién nacidos a término pequeños para edad gestacional (PEG).Materiales y métodos: cohorte retrospectiva que utilizó los datos del Sistema Informático Materno Perinatal del Hospital María Auxiliadora de Lima, Perú, durante el período 2000-2010. Se evaluó la edad materna, la paridad, el nivel educativo, el estado civil, el índice de masa corporal pregestacional, el número de controles prenatales (CPN), la presencia de patologías como preeclampsia, eclampsia, infección urinaria y diabetes gestacional como factores de riesgo para PEG. El peso para la edad gestacional fue calculado en base a percentiles peruanos. Se calculó los riesgos relativos crudos (RR) y ajustados (RRa) con sus respectivos intervalos de confianza al 95% para cada variable con respecto a la condición de PEG usando modelos lineales generalizados log binomial. Resultados: se incluyó a un total de 64 670 gestantes. La incidencia de PEG fue de 7,2%. La preeclampsia (RRa 2,0; IC 95% 1,86-2,15), la eclampsia (RRa 3,22; IC 95% 2,38-4,35),
el bajo peso materno (RRa 1,38; IC 95%: 1,23- 1,54), la nuliparidad (RRa 1,32; IC 95%:
1,23-1,42) y la edad ≥35 años (RRa 1,16; IC 95% 1,04- 1,29) se encontraron asociados con un riesgo mayor de recién nacido PEG. Asimismo, un número de 0-2 CPN (RRa 1,43; IC95%: 1,32-1,55), y 3-5 CPN (RRa 1,22; IC 95%: 1,14-1,32) también se
encontraron asociados con un riesgo mayor de recién nacido PEG, comparado con 6-8 CPN. Un número de ≥9 CPN (RRa 0,74; IC 95%: 0,69-0,80) fue factor protector. Conclusiones: es necesario identificar a las gestantes con factores de riesgo como los encontrados en este estudio, para disminuir la condición de PEG. Se debe actuar rigurosamente, poniendo especial énfasis en factores modificables, tales como la frecuencia de sus controles prenatales.Objective: to identify the main risk factors for term infants small for gestational age (SGA). Materials and methods: we conducted a retrospective cohort study using the database of Hospital María Auxiliadora, Lima, Peru, with information of all pregnant women during the period 2000-2010. We analyzed maternal age, parity, educational level, marital status, pre-pregnancy body mass index, number of prenatal visits (PNV), the presence of diseases such as preeclampsia, eclampsia, urinary tract infection and gestational diabetes as risk factors for SGA. The weight for gestational age was calculated on Peruvian percentiles. Crude relative risks (RR) and adjusted relative risk (aRR) with their respective confidence intervals at 95% for each variable was calculated using log binomial generalized linear models. Results: A total of 64 670 pregnant were included. The incidence of SGA was 7.2%. Preeclampsia (aRR 2.0, 95% CI: 1.86 to 2.15), eclampsia (aRR 3.22, 95% CI: 2.38 to 4.35), low maternal weight (aRR 1.38; 95% CI: 1.23 to 1.54), nulliparity (aRR 1.32; 95% CI: 1.23 to 1.42) and age ≥35 years (aRR 1.16, 95% CI: 1.04 to 1.29) were associated with an increased risk for newborn SGA. Also, a number of 0-2 PNV (aRR 1.43, 95% CI: 1.32 to 1.55), and 3-5 PNV (aRR 1.22; 95% CI: 1.14 to 1.32) were also found associated with an increased risk of newborn SGA, compared with 6-8 PNV. A number of ≥9 PNV (aRR 0.74; 95% CI: 0.69 to 0.80) was a protector factor. Conclusions: it is necessary to identify pregnant women with risk factors such as those found in this study, in order to reduce SGA. Particular emphasis on modifiable factors, such as the frequency of antenatal care visits, must be taken.
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Torchin, Héloïse. "Déterminants précoces de la dysplasie broncho-pulmonaire chez les grands prématurés Placental complications and bronchopulmonary dysplasia: EPIPAGE-2 cohort study Histologic chorioamnionitis and bronchopulmonary dysplasia in preterm infants: the epidemiologic study on low gestational ages 2 cohort." Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCB213.
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La dysplasie broncho-pulmonaire (DBP), conséquence d’un arrêt du développement du poumon immature, est la principale complication respiratoire de la grande prématurité. L’objectif était d’étudier certains déterminants anténataux et postnataux de la DBP, pour lesquels les études épidémiologiques ne sont pas consensuelles. Les données proviennent de la cohorte en population EPIPAGE 2. Nous avons d’abord étudié le lien entre les pathologies vasculaires gravidiques et la DBP, et montré que le risque de DBP modérée ou sévère à 36 SA était augmenté en cas de pathologie vasculaire compliquée d’un retard de croissance intra-utérin (RCIU), mais pas en cas de symptomatologie hypertensive maternelle sans RCIU associé. Nous avons ensuite analysé le rôle de l’inflammation anténatale, identifiée par une chorioamniotite histologique. Celle-ci n’était pas associée à une augmentation du risque de DBP modérée ou sévère chez les enfants nés prématurément dans un contexte de début de travail spontané à membranes intactes ou de rupture prématurée des membranes. Enfin, nous avons montré une hétérogénéité majeure dans les soins prodigués dès les premiers jours aux grands prématurés dans les unités de néonatologie, sans pouvoir conclure quant à l’impact de cette variabilité sur l’évolution vers une DBP. Les résultats explorant le lien entre deux pathologies fréquentes de la grossesse et la DBP sont en contradiction partielle avec les hypothèses physiopathologiques actuelles. L’exploration des déterminants précoces de la DBP peut contribuer à mieux cibler les sujets à inclure dans les études interventionnelles visant à diminuer l’incidence ou la sévérité de la DBP, et à améliorer les connaissances des praticiens et des familles sur les facteurs de risque de morbidité respiratoire néonataleBronchopulmonary dysplasia (BPD), due to disrupted development of the immature lungs, remains a common respiratory morbidity of very preterm birth. Our aim was to study antenatal and postnatal factors possibly associated with BPD at 36 weeks postmenstrual age, about which epidemiological results have been inconsistent. Data from the EPIPAGE-2 cohort study were used. We first studied the associations between placenta-mediated pregnancy complications and BPD. Pregnancies complicated by fetal growth restriction (FGR) were at higher odds of moderate to severe BPD, whereas hypertensive disorders of pregnancy without FGR were not. We then analyzed the impact of antenatal inflammation, defined using histological chorioamnionitis diagnosis. Among very preterm infants born after spontaneous preterm labor with intact membranes or after preterm premature rupture of the membranes, histological chorioamnionitis was not associated with moderate or severe BPD. Lastly, we found wide inter-center variability in care delivered to preterm infants from their very first days. However, we were not able to explain variations of BPD frequency between centers by these differences of care. Our results concerning the associations between two frequent pregnancy complications and BPD are in part contrary to current pathophysiological models. Understanding early BPD risk factors may help to better define patients for inclusion in clinical trials aiming to decrease BPD rates or severity and to improve clinicians and families knowledge about respiratory morbidity of preterm birth
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Aragão, Luciana Felipe Férrer. "Preditores do ganho estatural em crianças nascidas pequenas para a idade gestacional tratadas com hormônio do crescimento humano recombinante." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-06012017-094255/.
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INTRODUÇÃO: Crianças nascidas pequenas para a idade gestacional (PIG) possuem risco aumentado de apresentar baixa estatura na vida adulta. O benefício do tratamento com rhGH (recombinant human growth hormone) está bem estabelecido nas crianças nascidas PIG e com inadequação do catch up de crescimento, sendo importante estudar as variáveis preditoras de ganho estatural nesses indivíduos. OBJETIVO: Avaliar resposta terapêutica e variáveis clínicas associadas à recuperação do crescimento em dois anos de tratamento com rhGH em um grupo de crianças nascidas PIG. MÉTODOS: Foram selecionadas 35 crianças nascidas PIG em uso de rhGH há pelo menos dois anos e avaliadas as seguintes variáveis: sexo, idade gestacional, SDS de peso ao nascimento, SDS de comprimento ao nascimento, índice ponderal ao nascimento, idade cronológica no início do tratamento, SDS de estatura-alvo, dose de rhGH, relação entre idade óssea e idade cronológica, delta SDS de IGF-I. RESULTADOS: A média do SDS de estatura teve um incremento significante de 0,55 SDS (p < 0,01) e 0,86 SDS (p < 0,01), no primeiro e segundo anos de tratamento com rhGH, respectivamente. A dose de rhGH foi identificada como preditora de ganho estatural após um ano de tratamento, enquanto o SDS de comprimento ao nascimento e a idade gestacional se mostraram preditoras de crescimento após dois anos de rhGH. CONCLUSÃO: Foi confirmada uma resposta de crescimento positiva ao tratamento com rhGH nas crianças nascidas PIG sem catch up de crescimento nos primeiros dois anos de vida. A avaliação de características individuais ao nascimento e ao início do rhGH, assim como a identificação das variáveis preditoras do crescimento, são importantes na decisão e otimização do tratamentoINTRODUCTION: Children born small for gestational age (SGA) are at increased risk for short stature in adulthood. Treatment benefits with rhGH (recombinant human growth hormone) is well established in children born SGA and inadequate growth catch up, therefore it is very importante to study height gain predictors in these individuals. OBJECTIVE: To evaluate therapeutic response and clinical variables associated with growth recovery in two years of rhGH treatment in a group of children born SGA. METHODS: Thirty-five children born SGA in use of rhGH for at least two years were selected and the following variables were evaluated: gender, gestational age, birth weight SDS, birth length SDS, birth weight index, chronological age at the beginning of treatment, target-height SDS, rhGH dose, chronological age and bone age relation, and delta IGF-I SDS. RESULTS: The mean height SDS had a significant increase of 0.55 SDS (p < 0.01) and 0.86 SDS (p < 0.01) in the first and second year of treatment with rhGH, respectively. The rhGH dose was identified as a height gain predictor after one year of treatment, while birth length SDS and gestational age were predictors of growth gain after two years of rhGH. CONCLUSION: A positive growth response to rhGH treatment was confirmed in children born SGA with no growth catch up in their first two years of life. Evaluation of individual characteristics at birth and in the beginning of rhGH treatment, as well as the identification growth predictors, are important for the decision and treatment optimization
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Tejeda, Mariaca J. Eduardo, Mallqui Orion Pizango, Duglio Miguel Alburquerque, and Percy Mayta-Tristan. "Factores de riesgo para el neonato pequeño para la edad gestacional en un hospital de Lima." Instituto Nacional de Salud (INS), 2015. http://hdl.handle.net/10757/582632.
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Objectives. Identify risk factors for at-term small for gestational age newborns. Materials and methods. Retrospective cohort study using data from the Maternal Perinatal Information System of the Maria Auxiliadora Hospital of Lima, from the period 2000-2010. Maternal age, parity, education level, marital status, pregestational body mass index, number of prenatal care visits, presence of conditions such as preeclampsia, eclampsia, urinary tract infection and gestational diabetes as risk factors in small for gestational age newborns were evaluated. The weight for gestational age was calculated based on Peruvian percentiles. Crude relative risk (RR) and adjusted (ARR) were calculated with confidence intervals of 95% using log-binomial generalized linear models. Results. 64,670 pregnant women were included. The incidence for small for gestational age was 7.2%. Preeclampsia (ARR 2.0, 95% CI: 1.86 to 2.15), eclampsia (ARR 3.22, 95% CI: 2.38 to 4.35), low maternal weight (ARR 1.38; 95% CI: 1.23 to 1.54), nulliparity (ARR 1.32, 95% CI: 1.23 to 1.42), age ≥35 years (ARR 1.16, 95% CI: 1.04 -1.29), having prenatal care visits from 0 to 2 (ARR 1.43, 95% CI: 1.32 to 1.55) and 3 to 5 (ARR 1.22, 95% CI: 1.14 to 1.32) were risk factors for small for gestational age. Conclusions. It is necessary to identify pregnant women with risk factors such as those found to decrease the condition of small for gestational age. Actions should emphasize modifiable factors, such as the frequency of prenatal care visits.Objetivos. Identificar factores de riesgo para neonatos a término pequeños para la edad gestacional. Materiales y métodos. Cohorte retrospectiva que utilizó datos del Sistema Informático Materno Perinatal del Hospital María Auxiliadora de Lima, del período 2000 a 2010. Se evaluó la edad materna, paridad, nivel educativo, estado civil, índice de masa corporal pregestacional, número de controles prenatales, presencia de patologías como preeclampsia, eclampsia, infección urinaria y diabetes gestacional como factores de riesgo en pequeños para edad gestacional. El peso para la edad gestacional fue calculado sobre la base de percentiles peruanos. Se calcularon los riesgos relativos crudos (RR) y ajustados (RRa) con sus intervalos de confianza al 95% usando modelos lineales generalizados log binomial. Resultados. Se incluyeron 64 670 gestantes. La incidencia de pequeños para la edad gestacional fue 7,2%. La preeclampsia (RRa 2,0; IC 95%: 1,86-2,15), eclampsia (RRa 3,22; IC 95%: 2,38-4,35), bajo peso materno (RRa 1,38; IC 95%: 1,23-1,54), nuliparidad (RRa 1,32; IC 95%: 1,23-1,42), edad ≥35 años (RRa 1,16; IC 95%: 1,04-1,29), tener controles prenatales de 0 a 2 (RRa 1,43; IC 95%: 1,32-1,55) y 3 a 5 (RRa 1,22; IC 95%: 1,14-1,32) fueron factores de riesgo para ser pequeños para la edad gestacional. Conclusiones. Es necesario identificar a las gestantes con factores de riesgo como los encontrados para disminuir la condición de pequeños para la edad gestacional. Se debe actuar poniendo énfasis en factores modificables, tales como la frecuencia de sus controles prenatales
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Härkin, P. (Pia). "Closure of patent ductus arteriosus in very preterm infants:potential role of paracetamol and consequences of current treatments." Doctoral thesis, Oulun yliopisto, 2018. http://urn.fi/urn:isbn:9789526220253.
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Abstract The ductus arteriosus connects the pulmonary artery and the descending aorta in the foetus. In normal neonatal transition, the ductus closes soon after birth. If the duct remains significantly open after birth, it may complicate the recovery of a very preterm infant. Present treatments of patent ductus arteriosus (PDA) are either medical (ibuprofen or indomethacin) or surgical (ligation). However, these treatments can have serious side effects, especially in the most immature infants. This doctoral thesis studied the potential role of intravenous paracetamol for PDA treatment in very preterm infants born before 32 weeks of gestation. Consequences of the PDA treatments in an epidemiological birth cohort were also studied. In retrospective Study I stated that treatments of PDA decreased after the introduction of IV paracetamol for early pain management in preterm infants. Study II showed in a randomised clinical trial for the first time that paracetamol has a biological effect on the ductus arteriosus in preterm infants soon after birth. The ductus closed significantly earlier in the paracetamol group than in the placebo group. The epidemiological cohort Study III showed evidence that both medical and surgical treatment of PDA associated with severe bronchopulmonary dysplasia in infants born very preterm. Additionally, surgical PDA ligation was associated with increased risk of necrotising enterocolitis and intraventricular haemorrhage. Study IV showed that treatment of PDA was not associated with increased mortality, even in the most immature preterm infants born before 28 weeks of gestationTiivistelmä Valtimotiehyt on sikiöaikana avoimena oleva suoni, joka yhdistää keuhkovaltimon laskevaan aorttaan ja ohjaa vähähappisen veren istukkaan. Yhdessä soikean aukon kanssa suoni takaa sikiön verenkierron normaalin toiminnan ennen keuhkojen avautumista. Mikäli valtimotiehyt jää syntymän jälkeen pitkittyneesti auki, muuttaa se keskosen verenkiertoa siten, että osa aortan verenkiertoa ohjautuu keuhkoverenkiertoon vaikeuttaen pienen keskosen toipumista. Nykyhoitoina käytetään joko lääkkeellistä (ibuprofeeni tai indometasiini) tai kirurgista sulkua. Lääkkeellinen hoito ei ole kovin tehokas kaikista epäkypsimmillä keskosilla ja hoitoihin liittyy vakaviakin sivuvaikutuksia. Väitöskirjassa tutkittiin parasetamolilääkityksen vaikutusta hyvin pienen keskosen avoimen valtimotiehyen sulkeutumiseen. Epidemiologisessa osiossa tutkittiin nykyhoitojen sivuvaikutuksia hyvin pienillä keskosilla. Osatyössä I todettiin, että avoimen valtimotiehyen hoidon tarve väheni merkittävästi sen jälkeen kun parasetamoli oli otettu käyttöön kivun hoidossa vastasyntyneiden teholla. Osatyö II oli satunnaistettu ja sokkoutettu hoitotutkimus, jossa todettiin alkuperäishavaintona, että parasetamolilla on biologinen vaikutus keskosen avoimeen valtimotiehyeen. Parasetamolia saaneilla keskosilla valtimotiehyt sulkeutui aikaisemmin kuin verrokeilla. Hoidolla ei todettu merkittäviä sivuvaikutuksia. Osatöissä III ja IV tutkittiin kaikkien vuosina 2005−2013 Suomessa syntyneiden hyvin pienten keskosten avoimen valtimotiehyen hoitoja. Lääkehoidolla (ibuprofeeni ja indometasiini) ja kirurgisella hoidolla todettiin olevan yhteys keskosen kroonisen keuhkotaudin (BPD) vaikeimpaan muotoon. Kirurgisella hoidolla oli yhteys keskosen vaikeaan suolitulehdukseen ja vaikeaan aivoverenvuotoon. Kuolleisuuden riskin ei kuitenkaan todettu lisääntyneen valtimotiehyen hoitoihin liittyen
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Martinelli, Silvio. "Predição da restrição do crescimento fetal pela medida da altura uterina." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-23092014-160804/.
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O objetivo deste estudo foi verificar o poder de predição da medida da altura uterina para a restrição do crescimento fetal (RCF), por meio da curva de MARTINELLI et al. (2001), tendo como limite o percentil 5 e 10 para a idade gestacional e comparar com a curva de BELIZÁN et al. (1978). Entre julho de 2000 e fevereiro de 2003, 238 gestantes de alto risco foram submetidas a medidas de altura uterina, da 20a à 42a semana de gestação. Todas possuíam idade gestacional confirmada por ultra-sonografia precoce. A confirmação do diagnóstico de RCF foi dada após o nascimento pela curva de RAMOS (1983). Entre as gestantes, 50 (21,0%) tiveram recém-nascidos pequenos para a idade gestacional. O mesmo observador realizou 1617 medidas de altura uterina, com fita métrica, da borda superior da sínfise púbica ao fundo uterino. Para a ocorrência de RCF, considerando um exame positivo se uma medida de altura uterina encontrava-se abaixo do percentil 10 para a idade gestacional na curva de MARTINELLI et al. (2001), a sensibilidade (S) foi de 78%, especificidade (E) de 77,1%, valor preditivo positivo (VPP) de 47,6% e valor preditivo negativo (VPN) de 92,9%. Utilizando como limite o percentil 5, foram obtidos S= 64%, E= 89,9%, VPP= 62,7% e VPN= 90,4%, para o diagnóstico da RCF. Utilizando-se a curva de BELIZÁN et al. (1978) e considerando positivo exame com um valor abaixo do percentil 10 para a idade gestacional, os resultados encontrados foram S= 54%, E= 97,3%, VPP= 84,4% e VPN= 88,8% para a identificação da RCF. Comparada à curva de BELIZÁN et al. (1978), a curva de altura uterina de MARTINELLI et al. (2001) apresentou maior sensibilidade e valor preditivo negativo, consistindo em método de triagem mais adequado para a RCFThe aim of this study was to correlate uterine height measurements below the 5th and 10th percentiles using MARTINELLI et al. (2001) curve to fetal growth restriction (FGR) and to compare with the BELIZÁN et al. (1978) curve. During the period of July 2000 and February 2003, 238 pregnant women of high risk were submitted to uterine height measurements between the 20th and 42nd weeks of gestation. The whole group had well-known gestational age, confirmed by early ultrasound. The diagnosis of FGR was confirmed after birth according to RAMOS (1983). Among these women, 50 (21,0%) gave birth to light for gestational age infants. The same observer, using tape measure, performed 1617 uterine height measurements, from the upper border of the symphysis pubis to the fundus uteri. For the diagnosis of FGR, being considered as positive the exam with measurements below the 10th percentile according to MARTINELLI et al. (2001) curve, the sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were 78,0%, 77,1%, 47,6% and 92,9%, respectively. For the 5th percentile, this curve showed SE= 64,0%, SP= 89,9%, PPV= 62,7% and NPV= 90,4% for the detection of FGR. The BELIZÁN et al. (1978) curve, having the 10th percentile as the limit, yielded SE= 54,0%, SP= 97,3%, PPV= 84,4% and NPV= 88,8% for the identification of FGR. We conclude that, when used for screening FGR, the MARTINELLI et al. (2001) curve showed greater sensitivity and negative predictive value, and presents better results than that of Belizán et al. (1978)
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Hernandez, Wagner Rodrigues. "Progesterona natural na prevenção do parto prematuro em gestação gemelar: estudo randomizado, duplo-cego, placebo controlado." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-15032016-115638/.
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OBJETIVO: O objetivo deste estudo foi investigar o uso de progesterona natural vaginal para a prevenção de parto prematuro em gestações gemelares. Delineamento do estudo: foi realizado um estudo prospectivo, randomizado, duplo-cego, placebo controlado, que avaliou 390 gestações gemelares concebidas naturalmente entre mães sem história de prematuridade que estavam recebendo cuidados pré-natais em centro único. Mulheres com gestações entre 18 e 21 semanas e 6 dias foram aleatoriamente randomizadas para o grupo progesterona vaginal diária (200 mg) ou placebo até 34 semanas e 6 dias de gestação. O desfecho primário foi a diferença de idade gestacional média no parto; os resultados secundários foram a taxa de parto espontâneo < 34 semanas de gestação e a taxa de mortalidade e morbidade neonatal composta entre os grupos. RESULTADOS: As características gerais dos grupos foram semelhantes. A análise final incluiu 189 mulheres no grupo progesterona e 191 no grupo placebo. Nenhuma diferença (p=0,095) na idade gestacional média foi observada entre o grupo progesterona (35,08 ± 3,19 [DP]) e placebo (35,55 ± 2,85). A incidência de parto espontâneo com < 34 semanas de gestação foi de 18,5% no grupo de progesterona e 14,6% no grupo placebo (OR = 1,32; 95% intervalo de confiança, 0,24 - 2,37). Nenhuma diferença no resultado neonatal composto e mortalidade foi observada entre a progesterona (15,5%) e o grupo placebo (15,9%) (odds ratio, 1,01; 95% intervalo de confiança, 0,58 - 1,75). CONCLUSÃO: Em gestação gemelar, população não selecionada, o uso de progesterona natural micronizada 200mg/dia não reduz a incidência de parto prematuro espontâneoOBJECTIVE: The purpose of this study was to investigate the use of vaginal progesterone for the prevention of preterm delivery in twin pregnancies. STUDY DESIGN: We conducted a prospective, randomized, double-blind, placebo-controlled trial that involved 390 naturally conceived twin pregnancies among mothers with no history of preterm delivery who were receiving antenatal care at a single center. Women with twin pregnancies between 18 and 21 weeks and 6 days\' gestation were assigned randomly to daily vaginal progesterone (200 mg) or placebo ovules until 34 weeks and 6 days\' gestation. The primary outcome was the difference in mean gestational age at delivery; the secondary outcomes were the rate of spontaneous delivery at < 34 weeks\' gestation and the rate of neonatal composite morbidity and mortality in the treatment and no treatment groups. RESULTS: The baseline characteristics were similar in both groups. The final analysis included 189 women in the progesterone group and 191 in the placebo group. No difference (P .095) in the mean gestational age at delivery was observed between progesterone (35.08 ± 3.19 [SD]) and placebo groups (35.55 ± 2.85). The incidence of spontaneous delivery at < 34 weeks\' gestation was 18.5% in the progesterone group and 14.6% in the placebo group (odds ratio, 1.32; 95% confidence interval, 0.24 - 2.37). No difference in the composite neonatal morbidity and mortality was observed between the progesterone (15.5%) and placebo (15.9%) groups (odds ratio, 1.01; 95% confidence interval, 0.58 -1.75). CONCLUSION: In non-selected twin pregnancies, vaginal progesterone administration does not prevent preterm delivery
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Machado, Rita de Cassia Alam. "Gestações gemelares com pesos discordantes: estudo da predição ultra-sonográfica e dos resultados neonatais." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-30012007-094837/.
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A gemelaridade apresenta algumas intercorrências específicas, como a discordância de peso entre fetos e recém-nascidos (RNs). O objetivo do presente estudo foi predizer a discordância de peso do exame ultra-sonográfico comparada à do parto e avaliar a morbidade e a mortalidade neonatais nas gestações gemelares discordantes quanto ao peso. Este foi um estudo retrospectivo, com levantamento dos casos do período de 1998 a 2004, no Setor de Gestações Múltiplas da Clínica Obstétrica do HCFMUSP. Na avaliação da predição ultra-sonográfica, foram inseridas 221 gestações gemelares e, na avaliação da morbidade e da mortalidade, 151 gestações com partos nessa instituição. A discordância de peso foi definida como >= 20%, sendo excluídos os casos de malformações fetais (n=43) e da Síndrome da transfusão feto-fetal (n=24). Para análise da adequação do peso ao nascimento, utilizou-se a curva de Alexander et al., 1998, para gêmeos. No estudo da predição, foram utilizados quatro intervalos de tempo em relação ao parto (0 a 7 dias - n = 96; 8 a 14 dias - n = 66; 15 a 21 dias - n = 58; 22 a 28 dias - n = 59 gestações), somando 279 avaliações. No grupo de 0 a 7 dias, a estimativa da sensibilidade foi de 93,6%, especificidade de 79,4%, valor preditivo positivo de 89,2%, valor preditivo negativo de 87,1% e acurácia de 88,6%. Nos demais grupos, a sensibilidade e a acurácia foram de 95,8% e 84,9%, 95,6% e 84,5%, 90,9% e 84,8%, respectivamente. Em relação à morbidade, 111 gestações eram concordantes (73,5%) e 40 discordantes quanto ao peso. No grupo discordante, 75% das gestações gemelares apresentaram pelo menos um recém-nascido com Restrição de Crescimento Fetal (RCF). Nesta análise, as gestações gemelares concordantes monocoriônicas obtiveram menor média de idade gestacional no parto (34,3 versus 36,2 semanas, p=0,004), menor peso médio (2067 versus 2334 gramas, p=0,0016) e maior tempo de internação (10,6 versus 7,3 dias, p=0,0023) que as gestações concordantes dicoriônicas. Nas gestações discordantes, não houve diferença significativa em relação à corionicidade. As gestações discordantes, com pelo menos um RN abaixo do percentil 10, apresentaram menor média de idade gestacional (35,2 versus 36,8 semanas, p=0,009) e maior tempo de internação (17,5 versus 8,2 dias, p=0,026). Não foi observada diferença significativa de morbidade e mortalidade entre RNs concordantes e discordantes, com pesos entre os percentis 10 e 90. Os fetos menores das gestações discordantes demonstraram maior freqüência de índice de Apgar inferior a 7 (27,5% versus 7,5%, p=0,01). A avaliação da mortalidade não demonstrou diferença significativa em relação aos grupos concordantes (3,7%) e discordantes (4,5%; p = 1,00). No presente estudo, conclui-se que os quatro grupos apresentaram adequada correlação entre a discordância de peso à ultra-sonografia e no nascimento, porém com melhor predição até sete dias antes do parto. A morbidade neonatal esteve relacionada à RCF do menor feto. A discordância de peso e a corionicidade não interferiram na mortalidade neonatal.The aim of this study was to evaluate the ability of prenatal ultrasound scans to predict fetal growth discordance in twin pregnancies and perinatal morbidity/mortality associated with these cases. This was a retrospective study (1998-2004) involving twin pregnancies that were scanned and had their delivery at our Institution (HCFMUSP). Cases with fetal malformations (n=43) or twin to twin transfusion syndrome (n=24) were excluded. The study of ultrasound scans consisted of 221 twin pregnancies. The final morbidity/mortality study group consisted of 151 twin pregnancies. Birth weight was evaluated based on twin growth charts published by Alexander et al (1998) and weight discordance as a difference >= 20%. Small for gestacional age (SGA) was defined as birth weight below the 10th centile. The study of ultrasonographic prediction of interwin discordance was made using four different intervals between ultrasound examination and delivery (0 to 7 days, n = 96; 8 to 14 days, n = 66; 15 to 21 days, n = 58; 22 to 28 days, n = 59 pregnancies), with a total of 279 ultrasound examinations. In group 0 to 7 days, the sensitivity was 93,6%, specificity was 79,4%, positive predicted values was 89,2%, negative predicted values was 87,1% and accuracy was 88,6%. In the groups 8 to 14 days, 15 to 21 days and 22 to 28 days the sensitivity and accuracy were 95,8% and 84,9%, 95,6% and 84,5%, 90,9% and 84,8%, respectively. Birthweight discordance was observed in 40 sets of twins (26.5%) and 12 cases were monochorionic MC (30%). Twenty five cases (22.5%) in the non discordant group were MC. In the non discordant group, monochorionic pregnancies showed lower gestational age at delivery (34.3 versus 36.2 wks, p=0.004), lower mean birth weight (2067g versus 2334g, p=0.0016) and longer length of stay in hospital (10.6 versus 7.3 days, p=0.0023) compared to dichorionic twins. In the group with twin birthweight discordance, there were no significant differences between MC and DC pregnancies and 75% of the cases had at least one newborn with SGA. These cases were showed lower gestational age at delivery (35.2 versus 36.8wks, p=0.009) and longer length of stay in hospital (17.5 versus 8.2 days, p=0.026). In the discordant group, the smaller twin had a higher frequency of first minute Apgar score < 7 (27.5% versus 7.5%, p=0.01). Perinatal mortality rate was similar in both groups (discordant 4.5% and concordant 3.7%, p=1.0). There were no significant differences in morbidity and mortality between concordant and discordant twins when birth weight was between the 10 th and 90 th centile. In conclusion, there was a good correlation between fetal growth discordance predicted by prenatal scan and actual birth weight discordance. Neonatal morbidity was related to SGA. Excluding fetal malformation and TTTS cases, birth weight discordance in twin pregnancies is not a significantly associated with neonatal mortality.
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Nunes, Maria de Fátima Fernandes Pussick. "Fatores associados ao retardo de crescimento intra-uterino em recém nascidos em maternidades públicas da cidade de Salvador-Bahia." Programa de pós-graduação em Saúde Coletiva, 2007. http://www.repositorio.ufba.br/ri/handle/ri/10404.
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Fatores associados ao retardo no crescimento intra-uterino ainda não foram totalmente esclarecidos. Recém-nascidos (RN) pequenos para a idade gestacional (PIG) apresentam alterações nos valores hematológicos comparados aos RN adequados para a idade gestacional (AIG) e pré-termos. Persistem também limitações metodológicas inerentes a acurácia dos métodos de determinação da idade gestacional. Objetivos: Determinar os fatores associados ao RCIU, as características hematológicas dos recém nascidos portadores do RCIU e avaliar a acurácia dos métodos da avaliação da idade gestacional utilizados no diagnóstico antropométrico desses recém-nascidos. Metodologia: Estudo envolvendo puérperas e 564 RN em 2 maternidades públicas da cidade de Salvador. Foram classificados de AIG, RN com o peso ≥10th e <90th, de PIG aqueles com peso <10th, avaliados pela curva de Williams; e pré-termo, aqueles com <37 semanas de gestação. Os dados foram coletados utilizando-se de questionário padronizado. Foram tomadas as medidas antropométricas da criança e da puérpera e coletou-se o sangue do cordão umbilical. A idade gestacional foi calculada pelos métodos da data da última menstruação, ultrassonografia e físico de Capurro. Estudo 1 de desenho caso-controle. Estudos 2 e 3 de desenhos de corte transversal. Análise estatística: No estudo 1, utilizou-se a regressão logística não condicional para testar a associação entre a variável dependente e as preditoras e Odds Ratio foi adotado como medida de associação. No estudo 2, a média e seu respectivo DP, valor máximo e mínimo foram usados para descrever os valores hematológicos do cordão umbilical. Para o estudo 3, realizou-se a diferença entre as medianas da idade gestacional segundo os métodos, utilizando-se do teste não paramétrico “Wilcoxon Signed Rank Test”. A correlação entre as idades gestacional estimadas pelo DUM, USG e Capurro e entre estes métodos e o peso ao nascer foi realizada utilizando-se do coeficiente de correlação de Pearson. Utilizou-se o Coeficiente Kappa para avaliar a concordância entre os métodos na estimação do estado antropométrico do recém-nascido. A validade dos métodos na estimação da idade gestacional foi avaliada por meio do cálculo da sensibilidade, especificidade, VPP, VPN e pela curva ROC. Foram utilizados os pacotes estatístico SPSS.11 e o Stata 8, aceitando-se a significância de 5% nas estimativas de interesse. Resultados: Com o estudo 1, identificou-se que a primeira gestação (OR:2,85; 1,73-4,71), o hábito de fumar (OR: 2,65; 1,35-5,19) e a gestação anterior desfavorável (OR:2.10; 1,21-3,64) se comportaram como fatores de risco para retardo no crescimento intra-uterino. Os resultados do estudo 2 indicaram que valores mais altos de hemácias (4,21×1012/l±0,48), hemoglobina (14,50 g/dl ±1,42), hematócrito (43,50%±4,36), ferritina (162,61 µg/l ±100,10); RDW (13,34±0,85%) e leucócitos (12,82 109/l ±3,39) foram identificados nos RN PIG, quando comparados com aqueles dos AIG a termo e pré-termos. Os RN AIG pré-termos apresentaram valores mais altos de VGM e HGM. Os valores médios das plaquetas foram mais altos nos RN AIG a termo. A partir dos resultados do estudo 3, observou-se que o método de Capurro incrementou a idade gestacional em intervalos menores de 39 semanas e a USG a aumentou a partir deste patamar, em relação ao método DUM. Os métodos DUM e USG apresentaram maior correlação entre a estimativa da idade gestacional e o estado antropométrico para o conjunto dos RN (r=0,668) e para a identificação do RN AIG (r=0,685). Considerando a idade gestacional estimada pelo DUM e a relação com o peso ao nascer, o coeficiente de correlação foi mais elevado (r=0,609) na identificação dos RN PIG’s. Na predição de RN PIG’s, maior sensibilidade foi observada para a USG (96,6%) e maior especificidade para o Capurro (75,5%). Acurácia mais elevada na estimativa da idade gestacional foi observada para a USG na 41ª, tomando como referencia o DUM (ROC=77%). Conclusão: O RCIU associou-se à primeira gestação, à gestação anterior desfavorável e ao hábito de fumar. RN portadores de RCIU apresentaram valores ematológicos mais elevados em relação os RN AIG e pré-termos e o método físico de Capurro apresentou pior desempenho na identificação de RCIU.
Salvador
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Lopes, Margareth Corrêa Lima. "Crescimento de recém-nascidos pré-termos tardios nos primeiros seis meses de idade corrigida em Cuiabá-MT." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-24102014-125210/.
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Introdução: O nascimento de recém-nascidos pré-termo tardios (RNPT-T), geralmente tratados como \"quase termo\", vem aumentando nas últimas décadas. Vários fatores são atríbuídos à sua etiologia e contribuem para aumentar as taxas de morbimortalidade perinatal e infantil. Atualmente se dispõe de poucos estudos sobre esses recém-nascidos, especialmente sobre o seu crescimento. Objetivos: Analisar o crescimento de RNPT-T nos seis primeiros meses de idade corrigida. Métodos: Estudo observacional, analítico de uma coorte de 64 RNPT-T, coletados nos quatro maiores hospitais de Cuiabá, entre janeiro e setembro de 2013 e acompanhados até 6 meses de idade corrigida. Os dados foram coletados ao nascer, às 40 semanas, 3 e 6 meses de idade corrigida. Foram realizadas análises de correlação entre os parâmetros antropométricos perímetro braquial (PB) e prega cutânea tricipital (PCT) em função dos índices antropométricos PB/PC (perímetro cefálico), peso/comprimento (P/C) e Índice de Massa Corpórea (IMC) e realizada regressão linear múltipla. Resultados: Ao nascimento, 81,3% foram classificados como adequados para a idade gestacional, com a média de peso de 2343,80g ± 430,50. Todos os recém-nascidos apresentaram crescimento contínuo nos seis meses de idade corrigida para os valores de peso, comprimento e perímetro cefálico (PC). Já os valores médios de PCT, de PB/PC e de IMC não mostraram diferença aos 6 meses de idade corrigida. Todos os coeficientes de correlação (r) dos parâmetros PCT e PB em relação aos índices antropométricos apresentaram significância estatística, sendo os valores mais altos para PB versus PB/PC e P/C e menores para PB versus IMC. No modelo final da regressão linear múltipla da PCT, o PB/PC contribuiu significantemente para predizer o depósito de gordura ao nascimento, às 40 semanas e aos 3 meses de idade corrigida (33,8%%, 46,07% e 18,08% respectivamente); aos 6 meses o melhor preditor foi a razão P/C (10,45%). O melhor preditor para o PB foi o PB/PC, que permaneceu no modelo com valores de 73,71%% em todos os tempos avaliados. Conclusão: Os parâmetros peso, comprimento, perímetro cefálico e perímetro braquial e a relação P/C aumentaram nos quatro tempos de aferição, enquanto o PCT e as relações PB/PC e IMC não se modificaram do primeiro para o segundo trimestre e o PB/PC foi o melhor preditor do depósito de gordura subcutânea tricipital (PCT) e de massa gorda e muscular (PB)Introduction: The birth of newborns late preterm (RNPT -T), usually treated as \"near term\", has been increasing in recent decades. Several factors are attributed to its etiology and contribute to increased rates of perinatal and infant morbidity and mortality. Currently there are few studies of these newborns, especially about their growth. Objectives: To analyze the growth pattern of late preterm infants from birth to six months of corrected age. Methods: This cohort study included 64 RNPT-T, in four major hospitals in Cuiabá, between January and September 2013 and followed until 6 months corrected age. Data were collected at birth, at 40 weeks, 3 and 6 months corrected age. Correlation analyzes between anthropometric parameters mid- arm circumference (MAC) and triceps skinfold (TS) on the basis of anthropometric indices MAC / HC (head circumference), weight / length (W / L) and body mass index (BMI) were performed multiple linear regression. Results: At birth, 81.3 % were classified as appropriate for gestational age, with the average weight of 2343.80 ± 430.50 g. All newborns had a continuous growth in the six months corrected age for the values of weight, length and head circumference (HC). The average value of TS values of MAC / HC and BMI showed no difference at 6 months of corrected age. All correlation coefficients (r) of the TS and MAC parameters in relation to anthropometric indices showed statistically significant, with the highest values for MAC versus MAC / HC and W / L and lower for MAC versus BMI. At the end of the TS model of multiple linear regression, the MAC / HC contributed significantly to predict the deposition of fat at birth, at 40 weeks and at 3 months\' corrected age (33.8 %, 46.07 % and 18.08 % respectively); at 6 months was the best predictor of the ratio W/ L (10.45%). The best predictor for the MAC was the MAC / HC, which remained in the model with values of 73.71 % at all evaluated times. Conclusion: The parameters weight, length, head circumference and arm - circumference and the ratio W / L increased in the four times of measurement, while the TS and MUAC / HC relations and BMI did not change from the first to the second quarter and MAC / HC was the best predictor of subcutaneous fat deposit triceps (TS) and fat and muscle (MAC) mass
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Ivana, Vorgučin. "Praćenje vrednosti insulinu sličnog faktora rasta tip 1 u serumu i brzine rasta tokom terapije hormonom rasta kod dece." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. http://www.cris.uns.ac.rs/record.jsf?recordId=95556&source=NDLTD&language=en.
Full textAbstract:
Hormon rasta ima ključnu ulogu u mnogim fiziološkim procesima, anabolički efekti, stimulisanje rasta dugih kostiju, regulacija transkripcije gena u ciljnim ćelijama su uglavnom posredovani preko mitogenog polipeptida, insulinu sličan faktor rasta tip 1 (insulin like growth factor 1-IGF-1). Hormon rasta indukuje proizvodnju IGF-1 u jetri, koji reaguje sa receptorima ciljnih organa indukujući rast, odnosno IGF-1 posreduje svim stimulativnim dejstvima hormona rasta na kost, hrskavicu, rast mišić a i na metabolizam masti i ugljenih hidrata. U proceni redovnosti, bezbednosti i efikasnosti terapije hormonom rasta koristi se merenje koncentracije IGF-1 u serumu. Istraživanje je urađeno kao retrospektivno-prospektivna studija, a obuhvatilo je 80 pacijenata na terapiji hormonom rasta koja se kontrolišu i leče na Odeljenju za endokrinologiju, dijabetes i bolesti metabolizma Instituta za zdravstvenu zaštitu dece i omladine Vojvodine u Novom Sadu. Istraživani uzorak je obuhvatio 80 pacijenata, od kojih 35 dece sa nedostatkom hormona rasta, 24 dece rođene male za gestacionu dob i 21 devojčicu sa Tarnerovim sindromom. Svi ispitanici su praćeni od početka primene hormona rasta i tokom prve dve godine terapije hormonom rasta. U ovom istraživanju su praćeni auksološki i laboratorijski parametri u cilju ispitivanja odgovora na terapiju hormonom rasta. Praćene su bazalne vrednosti IGF-1 i promene nivoa IGF-1 u serumu tokom terapije hormonom rasta i korišćene da bi se ispitao odgovor na terapiju hormonom rasta, praćenjem brzine rasta, promena skora standardnih devijacija - SSD za telesnu visinu i koštanog sazrevanja. Ciljevi istraživanja su bili da se utvrdi povezanost vrednosti insulinu sličnog faktora rasta tip 1, brzine rasta i koštanog sazrevanja tokom terapije hormonom rasta. Takođe je poređena brzina rasta dece sa deficitom hormona rasta, devojčica sa T arnerovim sindromom i dece rođene male za gestaciono doba na terapiji hormonom rasta. U istraživanom uzorku, dvogodišnjim praćenjem terapije hormonom rasta je postignut dobar odgovor na terapiju, među decom sa nedostatkom hormona rasta je 71,5% postiglo normalnu telesnu visinu (±2 SSDTV) posle dve godine terapije hormonom rasta, 79,2% dece rođene male za gestacionu dob i 42,9% devojčica sa Tarnerovim sindromom. Značajna zastupljenost dece prepubertetskog uzrasta na početku terapije hormonom rasta, među decom sa nedostatkom hormona rasta 77,2%, među decom rođenom malom za gestacionu dob 79,1% i među devojčicama sa Tarnerovim sindromom 90,5% što je značajno uticalo na uspešnost terapije. Tokom terapije hormonom rasta je utvrđeno povećanje brzine rasta i SSD TV kod sve tri grupe ispitanika. U sve tri grupe ispitanika je tokom terapije hormonom rasta utvrđen porast nivoa IGF-1 seruma i SSDIGF-1 i ubrzanje koštanog sazrevanja tokom terapije hormonom rasta. Za prvih šest meseci terapije nema statistički značajnih razlika među grupama u brzini rasta (p>0,05), dok je za period prve i druge godine terapije hormonom rasta utvrđeno da postoji statistički značajna razlika među grupama (p<0,05), da je brzina rasta kod devojčica za Tarnerovim sindromom statistički značajno manja i od brzine rasta kod dece sa nedostatkom hormona rasta (p <0,05), i od brzine rasta kod dece rođene male za gestacionu dob (p<0,05). Među decom sa nedostatkom hormona rasta i dece rođene male za gestacionu dob nema statistički značajne razlike u brzini rasta (p>0,5). U ovom istraživanju je praćenjem auskoloških i laboratrijskih parametara tokom dvogodišnje primene hormona rasta, konstruisano više matematičkih modela za predviđanje odgovora na terapiju hormona rasta koji su statistički veoma značajani sa visokim koeficijentom višestruke linearne korelacije. U ovom istraživanju nije dobijena statistički značajna korelacija izmedju nivoa promene IGF-1 i brzine rasta za ceo uzorak, kao ni za decu sa nedostatkom hormona rasta, decu rođenu malu za gestacionu dob i devojčice za Tarnerovim sindromom. Nije dobijena statistički značajna korelacija izmedju nivoa promene IGF-1 i ubrzanja koštanog sazrevanja za ceo uzorak i za tri grupe pacijenata.Growth hormone plays a key role in many physiological processes. The anabolic effects, the stimulation of growth of the long bones and the regulation of gene transcription in the target cells are mediated mainly via mitogenic polypeptide and insulin-like growth factor type 1 (insulin like growth factor 1-IGF-1). Growth hormone induces the production of IGF-1 in the liver, which interacts with receptors of the target organs inducing growth, that is, IGF-1 mediates all the stimulating effects of growth hormone on bone, cartilage, muscle growth and the metabolism of fats and carbohydrates. In assessing the regularity, safety and efficacy of growth hormone therapy, measuring the concentration of IGF-1 in serum is used. The survey was conducted as a retrospective-prospective study and involved 80 patients treated with growth hormone, monitored and treated at the Department of Endocrinology, Diabetes and Metabolic Diseases, at the Institute for Health Protection of Children and Youth of Vojvodina in Novi Sad. Investigated sample included 80 patients, of whom 35 children have growth hormone deficiency, 24 children were born small for gestational age and 21 girls with Turner syndrome. All the patients were monitored from the beginning of the administration of growth hormone and during the first two years of growth hormone therapy. In this study, auxological and laboratory parameters were monitored for the purpose of examining the response to treatment of growth hormone. The basal values of IGF-1 and changes in IGF-1 levels in serum, along with monitoring the rate of growth velocity and recent changes in standard deviation - SSD for body height and bone maturation, were monitored during growth hormone therapy and used for the evaluation of the response to growth hormone therapy. The objectives of the study were to determine the correlation of insulin-like growth factor type 1 values, the growth velocity and maturation of bone during growth hormone therapy. Also, the growth velocity in children with growth hormone deficiency was compared with the growth velocity in girls with Turner syndrome and in children born small for gestational age while treated with growth hormone. Two-year monitoring of growth hormone therapy in the study sample has show n good response to therapy. 71.5% of children with growth hormone deficiency, 79.2% of children born small for gestational age, and 42.9% of girls with Turner syndrome achieved normal body height (± 2 SSDTV) after two years of growth hormone therapy. There was a significant share of children at prepubertal age at the beginning of growth hormone therapy: 77.2% of children with growth hormone deficiency, 79.1% of children born small for gestational age and 90.5% of girls with Turner syndrome, which significantly influenced the success of the therapy. During the growth hormone therapy there was an increase of growth velocity and SSD TV in all three groups of children. An increase in levels of IGF-1 serum and SSDIGF-1 and acceleration of bone maturation were determined in all three groups of patients during growth hormone therapy. For the first six months of therapy there was no statistically significant difference between groups in growth velocity (p> 0.05), while the period of the first and second year of growth hormone therapy showed a statistically significant difference between groups (p <0.05). The growth velocity in girls with Turner syndrome was significantly lower than the growth velocity in children with growth hormone deficiency (p <0.05) and in children born small for gestational age (p <0.05). Between children with growth hormone deficiency and children born small for gestational age there was no statistically significant difference in growth velocity (p> 0.5). By monitoring auxological and laboratory parameters during the two years of application of growth hormone, several highly statistically significant mathematical models for predicting the response to treatment of growth hormone were constructed in this study with a high coefficient of multiple linear correlation. In this study, there was no statistically significant correlation between the level of change in IGF-1 and growth velocity for the entire sample, as well as for children with growth hormone deficiency, children born small for gestational age and girls for Turner syndrome. There was no statistically significant correlation between the level of change in IGF-1 and acceleration of bone maturation for the entire sample and for the three groups of patients.
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Angrisani, Rosanna Mariangela Giaffredo. "Estudo eletrofisiológico longitudinal da via auditiva em lactentes nascidos pequenos para a idade gestacional." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-12022014-162325/.
Full textAbstract:
A adequação do peso ao nascimento é um fator de risco para atrasos de desenvolvimento. Dentre outras causas de morbidade e mortalidade, encontra-se a prematuridade e a Restrição de Crescimento Intrauterino (RCIU). O termo \"Pequeno para a Idade Gestacional\" (PIG) é utilizado muitas vezes, como indicador de RCIU, cujo feto pode ter sido submetido a agravos em diferentes momentos da gestação. A literatura aponta o PIG como risco para atraso no desenvolvimento neuropsicomotor, incluindo a linguagem. Objetivo: Acompanhar a maturação da via auditiva em lactentes nascidos PIG, comparando-os aos lactentes nascidos Adequados para Idade Gestacional (AIG) a termo e pré-termo, por meio do estudo das respostas do PEATE por estímulo click e tone burst (TB) nos seis primeiros meses de vida. Método: Estudo longitudinal, observacional de caráter multicêntrico. Foram avaliados 172 lactentes nascidos PIG e AIG, a termo e pré-termo, nos períodos neonatal, aos três e aos seis meses, por meio do PEATE com estímulo tipo click e tone burst em 0,5 kHz e 1 kHz, a 80dBnNA. Resultados: no período neonatal, os RN T/PIG não se diferenciaram dos RN T/AIG quanto às respostas do PEATE, o mesmo ocorrendo entre PT/PIG e PT/AIG. Ao se comparar o grupo T e PT/PIG, observou-se diferença entre as latências das ondas III, V e intervalos interpicos (Itpc) I-III e I-V, com latências maiores nos PT/PIG; não foram evidenciadas diferenças com TB nas frequências avaliadas. Na comparação do grupo T e PT/AIG, observou-se diferença entre as latências das ondas III, V e nos Itpc III-V e I-V e latências maiores nos PT/AIG. Não houve diferenças no TB nas frequências avaliadas. Aos três meses, não houve diferenças entre os T/PIG e T/AIG; na comparação PT/PIG e PT/AIG, houve diferenças no Itpc III-V, com latência menor no grupo PT/PIG. Não houve diferenças entre T/PIG e PT/PIG; o grupo AIG mostrou diferença entre T e PT nas latências da onda V e Itpc I-V. Na terceira coleta, aos seis meses, os T/PIG e T/AIG evidenciaram diferenças significativas entre as latências da onda III e Itpc I-III, o mesmo não ocorrendo quando se comparou PT/PIG e PT/AIG, os quais se diferenciaram somente no Itpc III-V. Ao se comparar T/PIG e PT/PIG, verificou-se diferenças relevantes somente no TB 0,5 kHz. Conclusão: Os achados do presente estudo permitiram concluir que o processo maturacional da via auditiva em lactentes nascidos PIG ocorre em diferente velocidade quando comparado ao de lactentes AIG; os PIG têm maturação acelerada, principalmente nos três primeiros meses, caracterizando desta forma um período de recuperação do ponto de vista da audição; a prematuridade influencia mais a maturação do sistema nervoso auditivo central que o fator peso ao nascer no período neonatal; a maturação ocorreu no sentido caudo-rostral nos dois grupos. O PEATE com TB em 0,5 kHz e em 1 kHz evidenciou o processo maturacional, porém não de modo tão detalhado quanto o fez com o estímulo tipo click. As crianças PIG devem ser monitoradas até pelo menos os três anos de idadeThe appropriateness of weight at birth is a risk factor for developmental delays. Prematurity and intrauterine growth restriction (IUGR) are among other causes of morbidity and mortality. The term \"small for gestational age\" (SGA) is often used as an indicator of IUGR, when the fetus may have been subjected to restrictions at different periods of pregnancy. The literature points SGA as a risk for neuropsychological developmental delay, including language. Objective: to monitor the maturation of the auditory pathway in SGA infants, comparing to term and preterm appropriate for gestational age (AGA) infants, through the analysis of the ABR responses to click and tone burst stimulus in the first six months of life. Method: A longitudinal, observational and multicenter study was conducted. A total of 172 SGA and AGA infants, term and preterm, were evaluated in the neonatal period and at three and six months of age through the ABR with click and tone burst stimulus with 0.5 kHz and 1 kHz at 80dBHL. Results: in the neonatal period, the term SGA infants did not differ from term AGA infants for ABR responses. The same was observed between preterm SGA and preterm AGA infants. When comparing the term and preterm SGA groups, there was a difference between the latencies of waves III, V and interpeak intervals (lTPI) I-III and I-V, with longer latencies in preterm SGA; there were no differences with the tone burst stimuli in the analyzed frequencies. When comparing the AGA term and preterm groups, differences were observed on latencies of waves III, V and ITPI III-V and I-V, with longer latencies for preterm infants. There were no differences in the frequencies evaluated with the tone burst stimuli. At three months of age, there were no differences between the term SGA and AGA; when comparing preterm SGA and AGA, differences were found for ITPI III-V, with shorter latencies in preterm SGA. SGA term and preterm infants did not differ; there were differences between term and preterm AGA in latencies of wave V and ITPI I-V. In the third data collection, at six months of age, term SGA and AGA infants significantly differed on latencies of wave III and ITPI I-III, which did not occur when comparing preterm SGA and AGA infants, who differed only regarding ITPI III-V. Significant differences were only observed when comparing term and preterm SGA infants regarding the tone burst stimuli at 0.5 kHz. Conclusion: The findings of this study showed that the maturational process of the auditory pathway in SGA infants occurs at different speed when compared to AGA infants; SGA infants have accelerated maturation, especially in the first three months of age, thus characterizing a recovery period from the hearing standpoint; in the neonatal period, the maturation of the central auditory nervous system is more influenced by prematurity than birth weight; maturation occurred in caudo-rostral direction in the two groups. The ABR with tone burst at 0.5 kHz and 1 kHz evidenced maturational process, but not in such detail as with the click stimuli. The SGA infants should be monitored until at least three years of age
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Coletta, Rocio Riatto Della. "Análise das repetições CA do gene IGF1, VNTR do gene da insulina e região promotora P4 do gene IGF2 em indivíduos nascidos pequenos para idade gestacional." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5135/tde-29042008-144128/.
Full textAbstract:
Introdução: Polimorfismos na região promotora dos genes da insulina, IGF2 e IGF1 podem estar relacionados a uma diminuição da expressão desses genes na vida fetal que, por sua vez, pode causar restrição do crescimento intra-uterino e maior risco de hipospádia. Na vida pós-natal, perda completa ou parcial da expressão desses genes pode resultar em ausência de recuperação estatural e menores concentrações séricas de IGF1 na criança, além de um maior risco de diabetes melito tipo 2 e síndrome de resistência à insulina no adulto. Objetivos: Analisar em crianças nascidas pequenas para idade gestacional (PIG) com ou sem recuperação estatural (RE): 1) a freqüência alélica e genotípica dos polimorfismos VNTR-INS e das repetições CA do gene IGF1; 2) a região promotora P4 do gene IGF2; 3) a influência do VNTR INS e das repetições CA do gene IGF1 na sensibilidade à insulina e nas concentrações séricas de IGF1, respectivamente. Pacientes: Foram estudados 142 indivíduos nascidos PIG com (n= 66) e sem recuperação (n= 76) estatural selecionados de três diferentes centros (HC-FMUSP, Santa Casa de São Paulo e HC-UFPR) e um grupo controle constituído de 297 indivíduos nascidos adequados para idade gestacional (AIG). Métodos: Extração de DNA genômico; amplificação por PCR das regiões contendo os polimorfismos VNTR INS e repetições CA do IGF1 e da região promotora P4; digestão por enzima de restrição; software Genescan; seqüenciamento automático; avaliação bioquímica e hormonal da glicemia, insulina e IGF1, extração de RNA, PCR em tempo real e análise estatística com SPSS 13.0 (Statistical Package fo Social Sciences). Resultados: A média do Z-altura, Z-IMC (índice de massa corpórea), Z-altura paterno e ZEA (estatura alvo) foram maiores nas crianças PIG que tiveram recuperação estatural, com o Z-PC (perímetro cefálico) maior nas crianças sem recuperação estatural. O Z-IGF1 sérico foi significantemente mais elevado em crianças que apresentaram RE (p<0,05). A distribuição e genotipica das repetições CA do gene IGF1 e do VNTR INS foi semelhante estatisticamente entre os grupos AIG e PIG, e entre os PIG com e sem RE; não foi observada associação entre esse polimorfismo e as variáveis clínicas e laboratoriais do estudo. O estudo da região promotora P4 do gene IGF2 identificou um novo polimorfismo de 9-12 repetições C na posição -1982, antes do sítio de início de transcrição do exon 2, e este apresentou distribuição semelhante entre os grupos PIG e AIG. Foi identificada também uma troca C/T em heterozigose no nono nucleotídeo do alelo 11C em quatro crianças nascidas PIG. Contudo, a quantificação da expressão do gene IGF2 em duas dessas crianças não demonstrou perda da expressão desse gene. Conclusões: Não observamos influência dos polimorfismos acima descritos no crescimento pré e pós-natal, na presença de resistência à insulina, nem em concentrações séricas de IGF1 dos indivíduos nascidos PIG. Identificamos uma nova variante na região promotora P4 do gene IGF2, contudo estudos preliminares não demonstraram influência desse polimorfismo sobre o crescimento intra-uterino.Introduction: Polymorphisms in the promoter region of insulin (INS), IGF2 and IGF1 genes may decrease their expression during fetal life and afterward could be related to intra-uterine fetal growth retardation and greater risk of hypospadia development. In post-natal life, decreased expression of these genes can result in lack of stature recovery and in lower IGF1 serum levels in children, as well as in higher risk for type 2 diabetes mellitus and metabolic syndrome in adults. Objectives: The aims of the present study were: (1) to analyze the allelic and the genotypic frequency of the insulin (INS) gene variable number of tandem repeats (VNTR) and the IGF1 gene CA repeats; (2) to analyze the P4 promoter region of IGF2 gene (3) to test the contribution of INS VNTR, IGF1 gene CA repeats on insulin sensitivity and IGF1 serum levels in children born SGA with and without catch up, respectively. Patients: We studied 142 individuals born SGA with catch up (n = 66) and without catch up (n = 76) selected from three different centers (HCFMUSP, Santa Casa de Sao Paulo and HC-UFPR). The control group consisted of 297 children born appropriate for gestational age (AGA). Methods: Extraction of genomic DNA, PCR-amplification of the VNTR of insulin gene, CA repeats of IGF1 and IGF2 gene P4 promoter region; restriction analysis; Genescan software; automatic sequencing. Blood measurements of serum level of glucose, insulin and IGF1. Statistical analysis (Statistical Package for Social Sciences software). Results: Regarding birth parameters, the average of Z-height, Z-BMI (body mass index) and Z-height paternal and Z- EA (target height) were higher in children born SGA who had catch up. Interestingly, we observed that the Z-PC was higher in children born SGA without catch up. In addition, the Z-IGF1 serum levels were significantly higher in children who had catch up (p <0.05). The molecular analysis of IGF1 gene CA repeats and of INS gene VNTR locus did not show a statistically significant difference in the allelic and genotypic distribution of these polymorphisms between adequate for gestational age (AGA) and SGA groups nor between SGA with and without catch up. Similarly, we have not found an association of these polymorphisms with clinical or laboratory variables of this study. A novel polymorphism in the P4 promoter region of the IGF2 gene was identified. It was characterized by cytosine repeats (9-12) at position -1982 before transcription initiation site of exon 2 of IGF2 gene. Yet, we have identified a heterozygous substitution of cytosine for thymine at the nucleotide position 9 in the allele 11C in four children born SGA. This change was also absent in the control population. Quantization of IGF2 gene expression in two of these children did show loss of expression of this gene in patients carrying the variant 9C/T. Conclusions: We have not observed an association of the above described polymorphisms with pre and post natal growth, or with the occurrence of insulin resistance in individuals born SGA. IGF-1 levels did not seem to be associated with the polymorphisms either. A new variant in the P4 promoter region of IGF2 gene was identified, however preliminary studies showed no influence on intra-uterine growth.
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Vieira, Valérie Gonçalves. "The golden hour in infants <29 weeks of gestational age." Master's thesis, 2019. https://hdl.handle.net/10216/120817.
Full textAbstract:
Objective. There is still few evidence and research about the best intervention for the extreme low gestational age newborn (ELGAN) in the delivery room and neonatal intensive care unit (NICU). The main goal of this investigation was to evaluate the impact of the golden hour variables in early outcomes and mortality rate, specifically in infants less than 29 weeks of gestational age (GA).
Methods. Data from 101 newborns with <29 weeks of GA admitted to our level III NICU between June 2011 and June 2018 were analyzed retrospectively. Information about demographics, prenatal, delivery room, interventions after birth, NICU stay and outcomes were recorded. A regression model was used to predict the factors that affect early neonatal outcomes.
Results. Our study showed an association between oxygen and bronchopulmonary dysplasia (BPD) (odds ratio (OR) 1.50; 95% confidence interval (95%CI) 1.01-2.24; p=0.045 ); systolic pressure to intraventricular hemorrhage (IVH) ≥ grade 3 (OR 1.37; 95%CI 2.035-4.014; p=0.019); glucose was protective to patent ductus arteriosus (PDA) (OR 0.97; 95%CI 0.955-0.994; p=0.010 ); and continuous positive airway pressure (CPAP) in the NICU was protective to death (OR 0.011; 95%CI 0.101-0.401; p=0.014). We did not find any statistically significant independent associations between temperature, post-natal steroids and infection, with short term outcomes. The overall mortality rate for newborns in our center of care was 33.7% with a median (min-max) length of hospital stay of 60 days (1-191).
Conclusions. The first minutes after birth have a big impact in neonatal outcomes.
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Ferreira, Joana Maria Soares. "The golden hour in Infants <32 weeks of gestational age." Master's thesis, 2015. https://hdl.handle.net/10216/78867.
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Ferreira, Joana Maria Soares. "The golden hour in Infants <32 weeks of gestational age." Dissertação, 2015. https://hdl.handle.net/10216/78867.
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Vieira, Valérie Gonçalves. "The golden hour in infants <29 weeks of gestational age." Dissertação, 2019. https://hdl.handle.net/10216/120817.
Full textAbstract:
Objective. There is still few evidence and research about the best intervention for the extreme low gestational age newborn (ELGAN) in the delivery room and neonatal intensive care unit (NICU). The main goal of this investigation was to evaluate the impact of the golden hour variables in early outcomes and mortality rate, specifically in infants less than 29 weeks of gestational age (GA).
Methods. Data from 101 newborns with <29 weeks of GA admitted to our level III NICU between June 2011 and June 2018 were analyzed retrospectively. Information about demographics, prenatal, delivery room, interventions after birth, NICU stay and outcomes were recorded. A regression model was used to predict the factors that affect early neonatal outcomes.
Results. Our study showed an association between oxygen and bronchopulmonary dysplasia (BPD) (odds ratio (OR) 1.50; 95% confidence interval (95%CI) 1.01-2.24; p=0.045 ); systolic pressure to intraventricular hemorrhage (IVH) ≥ grade 3 (OR 1.37; 95%CI 2.035-4.014; p=0.019); glucose was protective to patent ductus arteriosus (PDA) (OR 0.97; 95%CI 0.955-0.994; p=0.010 ); and continuous positive airway pressure (CPAP) in the NICU was protective to death (OR 0.011; 95%CI 0.101-0.401; p=0.014). We did not find any statistically significant independent associations between temperature, post-natal steroids and infection, with short term outcomes. The overall mortality rate for newborns in our center of care was 33.7% with a median (min-max) length of hospital stay of 60 days (1-191).
Conclusions. The first minutes after birth have a big impact in neonatal outcomes.
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Durães, Maria Inês da Cunha. "Morbidity and mortality of preterm infants less than 26 weeks of gestational age." Master's thesis, 2016. https://repositorio-aberto.up.pt/handle/10216/89361.
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Marques, Beatriz Lousa Alves Riquito. "Morbidity and mortality in preterm infants less than 29 weeks of gestational age." Master's thesis, 2018. https://hdl.handle.net/10216/112050.
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Durães, Maria Inês da Cunha. "Morbidity and mortality of preterm infants less than 26 weeks of gestational age." Dissertação, 2016. https://repositorio-aberto.up.pt/handle/10216/89361.
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Marques, Beatriz Lousa Alves Riquito. "Morbidity and mortality in preterm infants less than 29 weeks of gestational age." Dissertação, 2018. https://hdl.handle.net/10216/112050.
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Campos, Patrícia Isabel Azevedo. "Prenatal Corticosteroids and Respiratory Distress Syndrome Prevention in Infants less than 35 Weeks of Gestational Age." Master's thesis, 2015. https://repositorio-aberto.up.pt/handle/10216/78938.
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Parente, Carina Sofia Beleza. "Factors associated with long-term mechanical ventilation in preterm infants <29 weeks of gestational age." Master's thesis, 2019. https://hdl.handle.net/10216/119926.
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Campos, Patrícia Isabel Azevedo. "Prenatal Corticosteroids and Respiratory Distress Syndrome Prevention in Infants less than 35 Weeks of Gestational Age." Dissertação, 2015. https://repositorio-aberto.up.pt/handle/10216/78938.
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Parente, Carina Sofia Beleza. "Factors associated with long-term mechanical ventilation in preterm infants <29 weeks of gestational age." Dissertação, 2019. https://hdl.handle.net/10216/119926.
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Dossal, Sanam [Verfasser]. "Long-term follow-up of preterm infants with gestational age below 33 weeks of gestation born in the year 1999 / vorgelegt von Sanam Dossal." 2009. http://d-nb.info/1002066808/34.
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