Дисертації з теми "Premature morbidity"
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Berry, Margaret. "Effect of high incubator humidity on hydration associated morbidity for very premature infants." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0007/MQ44126.pdf.
Повний текст джерелаBerry, Margaret 1951. "Effect of high incubator humidity on hydration associated morbidity for very premature infants." Thesis, McGill University, 1997. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=20803.
Повний текст джерелаThirty-one incubator humidification and 60 non-humidification period infants were compared. Mean gestational age was 25.83 weeks for both groups. Mean highest serum sodium values were 143.5 (SD 9.4) and 152.9 (SD 4.9) mEq/l respectively (p < 0.001). Differences persisted after adjustment for confounding by age of placement in incubators, and in spite of fluid reduction in the D humidification period. Of infants with umbilical lines 2/16 and 33155 respectively attained serum potassium measurements over 6.9 mEq/l (p = .04). Overhydration outcomes did not differ, but power was limited and confounding was problematic for these analyses.
In summary, incubator humidification is associated with decreased hypernatremia and hyperkalemia in very premature infants.
Samms-Vaughan, Maureen Elaine. "Factors associated with low birthweight growth retardation and preterm birth in Jamaica : an epidemiological analysis." Thesis, University of Bristol, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.294549.
Повний текст джерелаMiller, Robin June. "Stability, structure, and effects of perinatal morbidity on temperament from infancy to adolescence /." View online ; access limited to URI, 2007. http://0-digitalcommons.uri.edu.helin.uri.edu/dissertations/AAI3292102.
Повний текст джерелаSouza, Renato Teixeira 1985. "Uma análise do parto prematuro terapêutico no contexto da prematuridade no Brasil : An analysis of provider-initiated preterm birth in the context of Brazilian prematurity." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312755.
Повний текст джерелаDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-26T18:48:20Z (GMT). No. of bitstreams: 1 Souza_RenatoTeixeira_M.pdf: 10640708 bytes, checksum: 93bc984ddc636a415fed23ea6ca3a333 (MD5) Previous issue date: 2015
Resumo: Introdução: Mais de 15 milhões de bebês nascem prematuros anualmente no mundo, sendo a prematuridade a maior causa de óbitos no período neonatal. A prematuridade terapêutica tem papel importante nesse contexto, pois se estima que 20 a 40% dos partos prematuros ocorrem por indicação dos provedores de assistência obstétrica. Dessa forma, a redução dos partos prematuros terapêuticos adquire cada vez mais importância para o controle da taxa de prematuridade e da morbimortalidade neonatais. O conhecimento dos fatores relacionados ao parto prematuro terapêutico é ponto fundamental para atingir essa redução. Objetivos: Avaliar a ocorrência do parto prematuro terapêutico e seus fatores associados na população do Estudo Multicêntrico de Investigação em Prematuridade (EMIP). Métodos: Análise secundária do EMIP, um estudo brasileiro de caso-controle aninhado a um corte transversal multicêntrico. O estudo ocorreu em 20 hospitais de referência em 3 regiões do Brasil de abril de 2011 a julho de 2012 e realizou a vigilância de 33.740 partos nesse período. O principal desfecho a ser avaliado é a ocorrência de parto prematuro terapêutico, definido como o parto que ocorreu antes de 37 semanas e que foi indicado pela equipe de assistência devido uma condição materna ou fetal. O grupo controle foi composto pelas mulheres com parto a termo. Os partos prematuros foram categorizados, conforme recomendações da Organização Mundial da Saúde, em prematuro extremo, muito prematuros e pretermo moderado Uma quarta categoria de idade gestacional, contemplando apenas os prematuros tardios, também foi analisada. Variáveis relacionadas a características sociodemográficas, pôndero-estaturais e de estilo de vida maternos, características da assistência ao pré-natal e ao parto e sobre a presença de morbidade ou complicação durante a gravidez, parto ou puerpério foram avaliadas na análise de risco para parto prematuro terapêutico. Foi realizada uma análise bivariada para estimar o risco de parto prematuro terapêutico para cada e uma análise multivariada com regressão logística não condicional para obter os fatores independentemente associados ao desfecho. Resultados: O parto prematuro terapêutico foi responsável por 35,4% dos partos prematuros na amostra estudada. As síndromes hipertensivas, o descolamento prematuro de placenta e a diabetes foram as condições que mais frequentemente motivaram a resolução prematura da gravidez. A idade materna avançada, a hipertensão crônica, a obesidade e a gravidez múltipla foram as principais condições maternas relacionadas à ocorrência de parto prematuro terapêutico. Houve uma tentativa de tratamento da condição materna que motivou a resolução em mais de 50% dos casos e 74,5% das mulheres com parto entre 28 e 31 semanas receberam corticoterapia. A cesariana foi a via de parto mais frequente. A proporção de mortalidade neonatal, do Apgar do quinto minuto menor que sete e da admissão em unidade intensiva neonatal foi muito maior nos prematuros terapêuticos do que no termo, mesmo considerando os prematuros tardios. Conclusões: Os resultados do estudo corroboram com a crescente importância do parto prematuro terapêutico, devido sua prevalência e impacto nos resultados perinatais. A gravidez múltipla, idade materna avançada, a obesidade e a presença de morbidades pré-gestacionais são os fatores que requerem especial atenção nas estratégias de prevenção da prematuridade terapêutica
Abstract: Background: More than 15 million babies are born prematurely each year worldwide and its the leading cause of deaths in the neonatal period. Provider-initiated preterm birth (piPTB) plays an important role in this context because it is estimated that 20-40% of preterm births occur by indication of obstetric care providers. Thus, the reduction in piPTB rate acquires more importance to decrease the rate of prematurity and neonatal morbidity and mortality. Knowledge of the factors related to piPTB is a key factor to achieve this reduction. Objectives: To evaluate the occurrence of provider-initiated preterm birth and the associated factors in the Multicenter Study on Preterm Birth in Brazil (EMIP) population. Methods: Secondary analysis of EMIP, a Brazilian multicenter cross-sectional study plus a nested case-control. The study took place in 20 referral hospitals in 3 regions of Brazil from April 2011 to March 2012 and conducted surveillance of 33,740 deliveries in this period. The primary outcome to be evaluated is the occurrence of provider-initiated preterm birth, defined as birth that occurred before 37 weeks and was medically indicated due to maternal or foetal condition. The control group was composed of women with term delivery. Preterm birth was categorized into extremely premature, very premature and moderate preterm, according to the World Health Organization. Another category that includes only the late preterm was also evaluated. Maternal, socio-demographic, obstetrical, prenatal care, delivery and postnatal characteristics were assessed as factors associated with piPTB. A bivariate analysis to estimate the risk for piPTB and a multivariate analysis using unconditional logistic regression for the factors independently associated with piPTB was performed. Results: The therapeutic preterm labor accounted for 35.4% of premature births in the sample. Hypertensive disorders, placental abruption and diabetes were the main conditions related to pi-PTB indications. Advanced maternal age, chronic hypertension, obesity and multiple pregnancy were the main maternal conditions related to pi-PTB. There was an attempt to treat maternal condition that led to the resolution in over 50% of cases and 74.5% of women with birth between 28 and 31 weeks received corticosteroid therapy. Cesarean section was the most frequent mode of delivery. The proportion of neonatal mortality, Apgar score<7 at 5 minutes and NICU admission were much higher in provider-initiated preterm newborns than in term newborns, even considering the late preterms. Conclusions: The results of our study corroborate the increasing notability of provider-initiated preterm birth, due to its prevalence and impact on perinatal outcomes. Multiple pregnancies, advanced maternal age, obesity and the presence of pre-gestational morbidities are the main factors that require special attention in prematurity prevention strategies
Mestrado
Saúde Materna e Perinatal
Mestre em Ciências da Saúde
Costa, Patrícia Teixeira. "Avaliação do impacto da implantação da assistência de fisioterapia respiratória sobre a morbidade de recém-nascidos prematuros de baixo peso." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-20092010-212701/.
Повний текст джерелаIntroduction: Physiotherapy is a relatively new specialty in Intensive Care Units of Neonates. Considering the success of prevention and treatment of respiratory complications, as result of physiotherapy assistance, the physiotherapist is recognized as an indispensable member of multiprofessional team. Neonatal physiotherapy can cause positive impact on treatment of premature neonates of low birth weight, contributing to minimize the complications, especially of the respiratory type. Moreover it can reduce hospital stay and ameliorate the neonate morbidity. The need for research in this area leads to this study with the aim to assess the impact of the implantation of physiotherapy care on morbidity of premature newborn of low birth weight. Methods: Newborn in Intensive Care Unit of Neonates at Sao Francisco University Hospital in the city of Braganca Paulista (SP) were included in the study, with gestational age less than 37 weeks, birth weight lower than 2500 g, diagnosis of respiratory distress syndrome under replacement therapy of exogenous surfactant and permanence in mechanical ventilation ( 7 days). Subjects of the study included 101 neonates, 41 were admitted between 2002 and 2004 (group 1, G1), time that there was not a structured physiotherapy care in Intensive Care Units of Neonates and 60 neonates from 2005 to 2007 (G2), at this time there was the structured assistance with an exclusive physiotherapist at the Unit. Both groups were compared in relation to neonates maternal characteristics and xiii evolution during the hospital stay. Statistical analyses were applied for groups comparison, Mann-Whitney, chi square and Fisher exact test. Statistical significance was established at 5%. Results: The groups demonstrated homogeneity in relation to maternal characteristics. Neonate aspects had showed more severity for G2, this group had more immature neonates. In relation to evolution, G2 remained longer in oxygen therapy (median = 11 days), in non-invasive ventilation (median = 2 days) and also in invasive mechanical ventilation (median = 13 days), however, using lower inspiratory peak pressure and lower inspired oxygen fraction. In G2, 16 (26.6%) neonates evolved into atelectasis whereas 12 (29.3%) in G1. Seventeen (28.3%) neonates in G2 developed pneumonia and 15 (36.5%) in G1. In G2, 14 (23.3%) neonates evolved into bronchopulmonary dysplasia against 11 (26.8%) of G1. 17 (28.3%) neonates in G2 presented early sepsis and 48 (80.0%) late sepsis, while G1 presented 8 (19.5%) and 27 (65.8%), respectively. G2 had longer hospital stay with median of 38 days whereas G1 had median of 30 days. Mortality of G1 was of 3 (7.3%) neonates and 8 (13.3%) of G2. Conclusion: Respiratory Physiotherapy can help favorably the evolution of premature newborn of low birth weight, diminishing respiratory complications, impacting therefore positively to reducing neonate respiratory morbidity
Pinto, Juliana Rodrigues. "Morbidade de crianças com baixo peso ao nascer durante o primeiro ano de vida na cidade de Sobral, Ceará." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-04112010-153526/.
Повний текст джерелаBACKGROUND: Low birth weight represents an important risk factor for neonatal and infant morbidity and mortality, accompanied by prematurity, intrauterine growth restriction, or both. OBJECTIVE: To study maternal, perinatal, environmental, economic characteristics, growth and feeding of children with low birth weight and their interaction in the increased morbidity during the first year of life. METHODS: A retrospective cohort study conducted in the city of Sobral, Ceará, in the period of three years (2005-2007) which included 261 children with low birth weight (LBW) and followed by the Family Health Program. We used the database of the Sistema de Informação de Nascidos Vivos (SINASC) and review data collection of hospital and ambulatory records of these children, quantification and causes of emergency room visits and hospitalizations. For analysis of the variables, were used frequency distributions, odds ratio (OR), confidence intervals (95%) and statistical significance of associations. The final analysis of association used logistic regression analysis to assess the risk factors associated with increased morbidity. RESULTS: Among 261 children studied, the average maternal age was 24 years, and 29.12% of mothers were teenagers. Approximately 41.76% were single mothers and 31.42% were married or with a stable union, and 24.14% were uneducated. Regarding perinatal characteristics, 52.11% were born vaginally, 52.49% were preterm, 55.56% were female and 98.08% of the children had Apgar 5 minutes greater than 6. The average birth weight was 2140 g, and 72.03% of children born weighing between 2000 and 2500 g. There was catch up in weight to four months of chronological age for children born at term and corrected gestational age for preterm at around 87% and 45% in height. The rate of exclusive breastfeeding was 26.05% and 8.43% to 4 and 6 months of age respectively. It was observed that 13.97% of children lived in wattle and daub house, 36.49% of households used wood stoves, and 36.11% lived with less than one minimum wage. As for morbidity, the 261 children born with low birth weight were 1103 visits due to illness in the Family Health Program, with the main cause was acute respiratory infections. There were 469 emergency visits and 156 pediatric emergency hospital admissions, especially in the neonatal period. Were identified as risk factors for increased morbidity: a) interruption of exclusive breastfeeding before 4 months which was associated with the presence of emergency consultation (OR 3.07, p <0.001), b) low gestational age and birth weight, with a greater likelihood of hospitalization in the neonatal period (OR 6.26, p <0.001), c) Prematurity and the no catch up in weight at to 4 months of age were associated with hospitalization for pneumonia, diarrhea and other reasons (OR 5, 15 and 0.65, p = 0.036 and 0.013, respectively). The other variables were not associated with morbidity study. CONCLUSION: Prematurity, interruption of exclusive breastfeeding before four months and no catch up growth were associated with greater morbidity in children with low birthweight. In the population served by the PSF, maternal characteristics, environmental and economic were not associated with increased morbidity
Vesna, Pavlović. "Morbiditet, telesni i rani psihomotorni razvoj prevremeno rođene dece začete vantelesnom oplodnjom." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2018. https://www.cris.uns.ac.rs/record.jsf?recordId=106200&source=NDLTD&language=en.
Повний текст джерелаIntroduction: Infertility is defined as an unsuccessful conception after one year of sexual intercourse without the use of contraception in the fertilizing phase of the menstrual cycle. Assisted reproduction methods represent an effective way of treating infertility. Examination and identification of short-term and long-term effects of artificial reproductive technologies is a very challenging task. The primary reason for this is the great heterogeneity in the way of collecting, processing, classifying and interpreting, now, the abundance of information that has been gathered in various studies. Individual approach to the treatment of infertility, rapid progress and constant changes in the methodology of the artificial reproductive technologies, in addition to the aforementioned difficulties associated with the collection and analysis of data, significantly hamper accurate assessment of all possible risks and consequences artificial conception. Despite numerous studies, scientific publications and the accumulated evidence, many doubts about the question whether artificially conceived pregnancies are accompanied by the higher risks or inadequate fetal development, poor perinatal and long-term outcomes still remained.The Aim: The objectives of this work were to determine the structure of morbidity in prematurely born children conceived by artificial reproductive technologies (from single and multiple pregnancies) in the first two years of life, and to identify perinatal factors that are associated with the occurrence of acute and chronic complications and diseases in prematurely born children from this pregnancies. In addition, the aim of the study was to determine the characteristics of psychomotor development in prematurely born children conceived by artificial reproductive technologies at the end of the twelfth, eighteenth and twenty-fourth month of life, as well as to identify specific risk factors for the unfavorable physical, neurological and psychological outcome of those children.Materials and Methods: The study included premature born newborns who were hospitalized in the Department for neonatology and intensive and semi-intensive care unit, and are thereafter, during the first two years of life. The retrospective part of the study included children who were hospitalized at the Institute, and who were born from January 1st 2011. to December 31st 2012. and were followed up to 2 years of life. Data on patients included in the retrospective part of the survey were collected through a review of medical records. The prospective part of the study included children who were treated and followed up at the Institute, and who were born between January 1st 2013 and December 31st 2014. and then followed up to 2 years of life. From this cohort two groups were formed: The tested group (Group 1) included all preterm infants who were conceived by ART. The control group (Group 2) included naturally conceived prematurely born children. The children in the control group were selected from the cohort so that their number was equal to the number of children in the study group. The gestational age of the examinees from the control group does not differ for more than ± 4 days from the children from the study group. The date of birth of subjects included in the control group does not differ for more than ± 3 months from the children in the study group.At the moment of inclusion in the study, the following individual data were taken:Maternal data, pregnancy and childbirth: the age of the mother at the moment of conception, the number of previous attempts at assisted conception, professional care, place of residence, chronic diseases diagnosed before pregnancy, acute and chronic diseases diagnosed during pregnancy (hypertension, pre-eclampsia, eclampsia, liver damage), premature rupture of the fetuses, the use of medication during pregnancy, single or multiple pregnancy. Data on placental disorders and abnormalities: ablation, placenta overdose, horioamnionitis. Child-related data: intrauterine infection, intrauterine growth restriction, delivery method, Apgar score. Anthropometric parameters (body weight, body length, head circumference) at birth and during the period of outpatient monitoring of the child. Length of initial hospitalization of the child. Length of invasive and / or non-invasive respiratory support and oxygen therapy. Diagnosis on discharge from the hospital: the presence of severe consequences of prematurity, which implies intracranial hemorrhage of 3rd and 4th degree (defined in International Classification of Disease - Tenth Revision (MKB10) under code P52.2), cystic periventricular leukomalacia, retinopathy of prematurity, bronchopulmonary dysplasia , necrotizing enterocolitis, sepsis and / or meningitis (microbiologically or clinically diagnosed). Presence of congenital anomalies or genetic syndromes and diseases (defined in MKB10 under codes Q00 to Q99), as well as the presence of congenital metabolic diseases (defined in MKB10 under codes E00 to E90).In the retrospective part of the study, specialist reports from a neonatological clinic were examined for child visits at the age of 12, 18 and 24 months, and the following data were ecorded: all pre-diagnosis reported on specialist reports from a neonatological clinic, anthropometric arms at the moment examination (body length, body weight and head circumference), neurological findings (tone, trophic, skin and tendon reflexes, presence of lateralization in neurological findings), ophthalmologist findings (neat / patial findings), assessment of fine and coarse motoring, speech, cognitive functions and social contact and a collective assessment of psychomotor development. In the prospective part of the study, during control examinations in a neonatological clinic, at the age of 12, 18 and 24 months, the following were determined and recorded: previously set out in the current medical documentation, anthropometric parameters at the moment of examination (body length, body weight and the volume of the head), neurological findings (tone, trophic, skin and tendon reflexes, presence of lateralization in neurological findings), ophthalmologist findings, assessment of fine and grose motor functions, speech, cognitive functions, social contact and psychomotor development.Results: The average BW of subjects in Group 1 at the age of 12 months, was statistically significantly lower in relation to respondents from Group 2 (Student's T test). The average length of subjects from both groups at the age of 12 months did not statistically differ (Student's T test). The average head circumference between children from both groups, at the age of 12 months, did not statistically differ (Student's T test). The proportion of subjects with pathological ophthalmological findings did not statistically significantly differ between Group 1 and Group 2 (Fischer's exact probability test). The proportion of subjects with pathological neurological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The average values of the global development coefficient (RQ), as well as the average score values for individual elements of development evaluation test - Brunet-Lézine scale (motor function, coordination, speech and sociability) did not differ significantly between groups (Student t test). In Group 1 there were 92 (59.740%) of children whose uncorrected RQ was under 90, while in Group 2 there were 61 (39.610%) children whose uncorrected RQ was below 90. This difference in the number of children with RQ below the average for calendar age is statistically significant (Hi square test, p = 0.0004). The relative risk of under-achievement in the psychomotor evaluation test (RQ <90) for children from Group 1 was higher than in children from Group 2 (RR = 1.495; 95% CI 1.181 - 1.922). In Group 1, there were 87 (56.494%) children who achieved sub-optimal corrected score values for the assessment of psychomotor development (corrected RQ <90). In Group 2, there were 69 (44.805%) children who achieved sub-optimal corrected score values for the assessment of psychomotor development (corrected RQ <90). This difference is statistically significant (Hi square test, p = 0.040). The relative risk for the suboptimal achievement in the psychomotor evaluation test (corrected RQ <90) for children from Group 1 was higher than in Group 2 (RR = 1.261; 95% CI 1.008 - 1.577). In Group 1, as many as 81/87 (93.310%) of children had a corrected RQ value of ≥ 85, while in Group 2 this value of the corrected RQ there were 60/69 (86.956%) children.At the age of 18 months, the average BW of subjects from both groups did not differ significantly (Student's T test). The average length of subjects from both groups, at the age of 18 months, did not statistically differ (Student's T test). The average head circumference of children from both groups, at the age of 18 months, did not statistically differ (Student's T test). The proportion of subjects with pathological ophthalmological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The proportion of subjects with pathological neurological findings did not statistically differ between Group 1 and Group 2 (Hi square test). The average RQ values, as well as the average scores for individual elements of psychomotor development (motor function, coordination, speech and sociability) according to the Brunet-Lézine scale, have been statistically significantly different between groups, at the age of 18 months (Student's T test). In Group 1 there were 57 (37.013%) children whose uncorrected RQ was below 90, while in Group 2 there were 31 (20,130%) children whose uncorrected RQ was below 90. The share of children with RQ below the average value for the calendar age is statistically significantly different between groups (Hi square test, p = 0.010). The relative risk for the suboptimal achievement in the Psychomotor Development Assessment (uncorrected RQ <90) for Group 1 children was higher than in Group 2 (RR = 1.288; 95% CI 1.181 - 2.730). A statistically significant difference between Group 1 and Group 2 existed when the number of children with corrected RQ below 90 was compared (36 naspram 19 respectively, Hi quadrate test, p = 0.011). The relative risk for the suboptimal achievement on the Psychomotor Evaluation Test (corrected RQ <90) for the children from Group 1 was higher when compared to children in Group 2 (RR = 1.895; 95% CI 1.139 – 3.152).At the age of 24 months the average BW, body length and head circumference of subjects in both groups were not significantly different (Student's T test). The proportion of subjects with pathological ophthalmological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The proportion of subjects with pathological neurological findings did not statistically significantly differ between Group 1 and Group 2 (Hi square test). The average RQ values, as well as the average score values for individual elements for development evaluation (motor function, coordination, speech and sociability) according Brunet-Lézine scale, did not significantly differ between groups at the age of 24 months (Student's T test). In Group 1, there were 21 children (13.636%) whose uncorrected RQ was under 90, while in Group 2 there were 17 (11.049%) of children whose uncorrected RQ was below 90. The difference in the number of children with RQ below the average for the calendar age was not statistically significant (Hi square test, p = 0.488). A statistically significant difference did not exist even when the number of children with values of the corrected RQ below 90 in Group 1 and Group 2 (12 naspram 9 respectively, Hi quadrate test, p = 0.497) was compared.Logistic regression analysis has shown that artificial conception, multiple pregnancy and IUGR are independent risk factors for lesser BW in a calendar age of 12 months. By logistic regression analysis, a statistically significant correlation between RQ values at 18 months of age and the following independent variables was obtained: artificially started pregnancy and multiple pregnancy. Group 1 and Group 2 patients did not significantly differ by any of the indicators of physical and psychomotor development at the age of 24 months.The structure of morbidity in children, during the two-year follow-up period, did not differ significantly between groups. The only difference between the groups was found in the rates of acute respiratory infections at the age of 12 and 18 months (rate of infections was higher in Group 1), whose occurrence, however, was directly related to multiple pregnancies, or the number of sibling in the household.Conclusion: The average age of mothers of children conceived by the IVF is higher than the average age of mothers of children who were conceived spontaneously. The structure of the morbidity of mothers of children who were artificially conceived and mothers of children born after spontaneous conception is the same, but the morbidity rate is higher in the mothers of children who were conceived by IVF. Pregnancies concieved by IVF almost exclusively ended by cesarean section. Premature rupture of the membranes is a common complication of IVF pregnancies. The rate of morbidity of prematurely born children conceived by ART is not higher than that of prematurely born children conceived naturally. The structure of morbidity in children from ART pregnancies was the same as in naturally conceived prematurely born children. The incidence of specific illnesses is the same, with the exception of bronchopulmonary dysplasia that occurs more frequently in children born from ART pregnancies, and retinopathy of prematurity that occurs more frequently in spontaneously conceived children. Maternal birth weight, intrauterine growth restriction, mother's age, maternal care, previous mother's chronic illness, mother's disease diagnosed during pregnancy, single and multiple pregnancies and PROM are potential risk factors for worse postnatal outcome in children from artificially initiated pregnancies. Risk factors for lower body weight in premature babies, at the age of 12 months, are: artificial conception, multiple pregnancy and intrauterine growth restriction. At the age of 12 months, prematurely born children from IVF pregnancies, have slightly worse (but not significantly lower) psychomotor achievements. At the age of 18 months, there is no difference in the indicators of physical development between prematurely born children who are artificially conceived and children born from spontaneous pregnancies. At the age of 18 months, prematurely born children from ART pregnancies have lower achievement on tests for assessing psychomotor development compared to prematurely born children from spontaneously initiated pregnancies. Risk factors associated with a poor performance on the psychomotor development assessment tests, in preterm infants, are an artificial conception of pregnancy and a multi fertile pregnancy. At the age of 24 months, there is no difference in the physical parameters between prematurely born children from ART and naturally conceived pregnancies. At the age of 24 months, there is no difference in the achievement on the test for the assessment of psychomotor development between children from ART and spontaneous pregnancies. At the age of 24 months, on the psychomotor development assessment, prematurely born children achieve the results consistent with their calendar age.
Moura, Katharina Vidal de Negreiros [UNIFESP]. "Displasia broncopulmonar: incidência e fatores de risco neonatais para recém-nascidos prematuros de muito baixo peso nascidos em hospital universitários de Maceió-2009." Universidade Federal de São Paulo (UNIFESP), 2010. http://repositorio.unifesp.br/handle/11600/9336.
Повний текст джерелаObjetivos: determinar a incidência de displasia broncopulmonar durante o período de um ano (março de 2009 a fevereiro de 2010) e analisar os fatores de risco neonatais associados ao desenvolvimento da doença em serviços públicos de referência para alto risco neonatal em Maceió, o Hospital Universitário Prof. Alberto Antunes e a Maternidade Escola Santa Mônica. Métodos: foram registrados dados de todos os prematuros de muito baixo peso admitidos nas duas instituições durante um ano. O diagnóstico de displasia broncopulmonar foi estabelecido naqueles prematuros com necessidade de oxigênio aos 28 dias de vida. A incidência foi calculada dividindo-se o número de casos pelo total de prematuros de muito baixo peso das duas maternidades, durante o período do estudo. Foram feitas análises das variáveis associadas com o teste do Quiquadrado, para as categóricas, e o teste T de Student ou Mann-Whitney para as numéricas. Para prever o valor dessas variáveis foi realizada a análise de regressão logística. Resultados: foram admitidos nas duas instituições 244 prematuros de muito baixo peso. A incidência observada foi 22,1%. Destes, 54 evoluíram com a doença e 94 não a apresentaram. Houve diferenças quanto às médias de peso dos grupos (1050g com displasia e 1275g sem displasia) e quanto às médias de idades gestacionais (30 semanas com displasia e 32 semanas sem a doença). Fizeram uso de ventilação mecânica 94% dos prematuros com displasia e 45,8% sem displasia, com p<0,01. Também houve associação com uso de surfactante no grupo com displasia (98% com e 71,7% sem displasia, com p<0,01). O modelo de regressão logística foi preditivo em 70% para ventilação mecânica ao nascer (RR=2,04; IC 95%: 1,62-2,55) e peso ao nascer inferior a 1000g (RR=1,89; IC: 1,19-3,00). Conclusões: a incidência de DBP foi similar à encontrada na literatura. Houve associação com, baixa idade gestacional, uso de surfactante, baixo peso ao nascer e ventilação mecânica, sendo esses dois últimos preditivos para a doença.
Objectives: To determine the incidence of bronchopulmonary dysplasia in the period of one year (from March 2009 to February 2010) and analyze the associated neonatal risk factors to the development of the disease in Public Services in two references of high risk newborn in Maceió, the “Hospital Universitário Alberto Antunes” and the “Maternidade Escola Santa Mônica”. Methods: All very low birth weight preterm infants who were admitted in the both institutions were recorded during one year. The diagnosis was established in those preterm infants who needed oxygen at 28 days of life. The incidence was calculated by dividing the number of cases by the total number of preterm births in both hospitals during the study period. The associated variables were analysed with the “Chi-square” test and the T test of Student or Mann-Whitney. Logistic regression analysis was performed to predict the value of those variables. Results: 244 RNMBP were admitted in both institutions. The incidence was 22.1%. 54 evolved with bronchopulmonary dysplasia and 94 without. There were differences regarding the average weight of the groups (1050g with and 1275g without dysplasia)) and also as to the gestational age (30 weeks with BPD and 32 weeks without the disease). 94% of the prematures with and 45,8% without the disease made use of mechanical ventilation, with p<0,01. There were association with surfactant in the group with bronchopulmonay dysplasia (98% with and 71,7% without displasia, com p<0,01). The logistic regression model was predictive in 70% of mechanical ventilation at birth (RR=2,04 IC 95% 1,62-2,55) and weight lower than 1000g (RR=1,89 IC 95% 1,19-3,00).Conclusions: The incidence of DBP was similar to the literature. There were association with low weight in born, with low gestational age, use of surfactant and mechanical ventilation. Mechanical ventilation and weight lower than 1000g were predictive for the disease.
TEDE
BV UNIFESP: Teses e dissertações
Cortada, i. Esteve Marcel. "Seqüeles, morbiditat i comorbiditat en el desenvolupament d’un grup d’infants prematurs." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/461708.
Повний текст джерелаhis thesis focuses on analyse the causes that can affect cognitive development in premature and full term new-borns who have been admitted to a Neonatal Intensive Care Unit (NICU). Also, in the study are included children born between the 1st January 2001 and the 31st December 2008, altogether it consists of a sample of 440 new-born babies from the following gestational age: extremely premature (n = 30), very premature (n = 125), moderate premature (n = 124), late premature (n = 130) and full term (n = 31). Evaluates children between the age of 34 and 46 post-menstrual weeks using the Brazelton Scale (NBAS). It then follows them up at 3, 6, 9, 12, 18, 24 and 30 months using the Bayley scales, and then when they are 3, 4, 5, 6 and 7 years old using the Terman-Merrill tests and the WPPSI-III. The main objectives to achieve were: (a) To describe morbidity, comorbidity and side effects associated with a child and then compare them based on clinical and socio-demographic variables; (b) to describe the development from birth up to 4 or 7 years of age based on clinical and socio-demographic variables; (c) to identify the risk factors that influence the development and comorbidity and; (d) to identify the protective factors that influence the development and the comorbidity. The results display that children who have suffered stress in a Neonatal Intensive Care Unit (NICU) have lower IQ scores (z) in the period of this study; the neurobiological toxicity caused by the stress affects all children admitted to the NICU, and it could be neutralised with healing based on physiological development and care, and assisting the family. For instance, reducing overstimulation of light has shown to reduce retinopathy; the children who suffered some elements of the stress risk factor in the NICU, if they did not have the Family-Focused Developmental Care (FFDC), were found to have had lower scores in the NBAS in the clusters motor system, regulation of states and stability of the autonomous nervous system and higher scores in the organization of states. It is also found that babies who did not receive the FFDC had a moderate risk of suffering from regulated disorders in comparison than those who received it. The course of cognitive development is more affected by the weeks of gestation than the weight and pathology. In cognitive tests, girls scored higher but boys increased their IQ(z) to a greater extent than girls. It was found that children in families with low economic and educational levels, had a decrease in the IQ(z) from the exploration to the period of 10 to 18 months. The locals had IQ scores slightly higher on the development index than foreigners, and the difference is significant between the periods of 19 to 30 months and 31 to 59 months. Concerning the comorbidity factor, local groups have significant associations with psycho-functional disorders while foreigners suffer more from parental relationship disorders. There are more chances for a baby to be breast-fed after being born if the baby has more weeks of gestation, for it gains more weight and consequently it has more protective factors. With less weeks of pregnancy, the risk factors are higher and the probability of artificial feeding increase. The effect of the negative impact on cognitive development is due to social factors, such as relationships and low socioeconomic status, that appear in the period of 10 to 18 months. Also, the impact of whether the one of the parents or both are foreigners appears between 19 to 30 months. There is a relationship between being admitted to the NICU and children and families that have disrupted parental relationship. The administration of the NBAS by a professional with the parents present, has resulted with less parental relationship disorder. Keeping in mind, disorders associated with parental relationships are fundamentally psycho-functional and emotional disorders. Thus, this study has shown the more visits to the Tracking Development Program the more detection of psycho- functional and emotional disorders.
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.
Повний текст джерелаChatot, Didier. "Evolution de la mortalite et de la morbidite des prematures de 32 semaines et moins d'age gestationnel admis dans le service de neonatalogie du chru de fort-de-france." Rennes 1, 1992. http://www.theses.fr/1992REN1M068.
Повний текст джерелаDrysdale, Simon Bruce. "Diminished lung function, viral infections and chronic respiratory morbidity in prematurely born infants." Thesis, King's College London (University of London), 2014. http://kclpure.kcl.ac.uk/portal/en/theses/diminished-lung-function-viral-infections-and-chronic-respiratory-morbidity-in-prematurely-born-infants(eac3c59e-4db9-4531-823c-237d0cab1e94).html.
Повний текст джерелаRAYNAUD, RAVNI CATHERINE. "Devenir a moyen terme des nouveau-nes de poids de naissance inferieur a 1500 grammes : etude prospective a propos des enfants admis dans l'unite de reanimation neonatale du chru de saint-etienne." Saint-Etienne, 1991. http://www.theses.fr/1991STET6419.
Повний текст джерелаLECLERCQ, BAUDET ODILE. "Le role des facteurs obstetricaux dans la mortalite perinatale et dans la morbidite neonatale chez les enfants de moins de 32 semaines d'amenorrhee revolues." Lyon 1, 1989. http://www.theses.fr/1989LYO1M074.
Повний текст джерелаRonkainen, E. (Eveliina). "Early risk factors influencing lung function in schoolchildren born preterm in the era of new bronchopulmonary dysplasia." Doctoral thesis, Oulun yliopisto, 2016. http://urn.fi/urn:isbn:9789526213477.
Повний текст джерелаTiivistelmä Keskosten tehohoito on kehittynyt viime vuosikymmeninä merkittävästi, ja yhä epäkypsempänä syntyvät keskoset selviävät hengissä syntymän jälkeen. Keskosten pitkäaikainen keuhkosairaus, bronkopulmonaalinen dysplasia (BPD), on perinteisesti johtunut hengityskonehoidon ja happikaasun aiheuttamasta keuhkovauriosta ja johtanut keuhkokudoksen arpeutumiseen. Aiempaa ennenaikaisemmilla keskosilla esiintyy kuitenkin nykyään niin sanottua uutta BPD:tä, jonka ajatellaan johtuvan enemmän keuhkorakkuloiden kehityshäiriöstä kuin hoitojen aiheuttamasta keuhkovauriosta. Selvitimme, miten nykyaikaisilla menetelmillä hoidettujen keskosten keuhkojen rakenne ja toiminta kehittyvät kouluikään mennessä. Seurantatutkimukseemme osallistui 88 ennenaikaisena syntynyttä, kouluikään ehtinyttä lasta ja 88 täysiaikaisena syntynyttä, kaltaistettua verrokkia. Keskosena syntyneiden lasten keuhkofunktio oli kouluiässä huonompi kuin täysiaikaisena syntyneiden verrokkien. Alhaisin keuhkofunktio oli niillä keskosena syntyneillä lapsilla, jotka olivat sairastaneet vastasyntyneenä BPD:n. Myös kohdunsisäiseen kasvuhäiriöön (intrauterine growth restriction, IUGR) liittyi alentunut keuhkofunktio. BPD ja IUGR ennustivat alentunutta keuhkofunktiota toisistaan riippumatta. Tutkimuksessa tehtiin myös keuhkojen ohutleiketietokonekuvaus 21 keskoselle, jotka olivat sairastaneet BPD:n. Lähes kaikilla havaittiin poikkeavia löydöksiä – eniten niillä, joilla oli ollut vastasyntyneenä BPD:n vaikea tautimuoto. Keskosina syntyneet joutuivat kahden ensimmäisen vuoden aikana verrokkeja useammin sairaalahoitoon. Yleisimpiä syitä olivat hengityksen vinkumista aiheuttavat taudit kuten ilmatiehyttulehdus, ahtauttava keuhkoputkitulehdus tai akuutti astmakohtaus. Vastasyntyneenä sairastettu BPD ei kuitenkaan lisännyt todennäköisyyttä joutua sairaalahoitoon. Tutkimuksessa tehtiin myös meta-analyysi nykyaikaisilla menetelmillä hoidettujen keskosten keuhkofunktiosta: lievää BPD:tä sairastavien tulokset näyttävät parantuneen, kun taas keskivaikeaa tai vaikeaa tautimuotoa sairastavien ja ilman BPD:tä selvinneiden keuhkofunktio ei ole muuttunut uusien hoitojen myötä. Yhteenvetona voidaan todeta, että keskosten keuhkojen toimintakyky on jonkin verran alentunut täysiaikaisiin verrattuna. Lievästi alentunut keuhkofunktio ei kuitenkaan yleensä aiheuttanut koululaisille oireita. Keskosena syntyneiden lasten hengityselinten toimintaa on syytä seurata, sillä niin sanotun uuden BPD:n pitkäaikaisesta ennusteesta ei ole vielä tietoa
Leneuve, Dorilas Malika. "Les facteurs de risque de la naissance prématurée en Guyane Française Rosk factors for premature birth in French Guiana: the importance of reducing health inegalities Predictive factors of preterms delivery in French Guiana for singleton pregnancies: definition and validation of a predictive score Risk Factors for Very Preterm Births in French Guiana : The Burden of Induced Preterm Birth African ancestry and the threshold defining preterm delivery: in French Guiana black babies born at 36 weeks are as vulnerable as white babies." Thesis, Guyane, 2019. http://www.theses.fr/2019YANE0003.
Повний текст джерелаContext and objective: French Guiana, an overseas department and region, has nearly 8,000 births per year.Since 1992, the proportion of premature births, although stable, has remained high at around 13.5%, almost double that of France (7%) (data from the Pregnancy Outcome Register and national perinatal survey). While in most countries we see an increase in prematurity, we could, wrongly, be satisfied with a non-increase in the prematurity rate that would reflect progress. However, deaths from perinatal causes remain one of the main causes of premature mortality in French Guiana and partly explain the gap with France in terms of life expectancy at birth.Given this lack of improvement in the prematurity rate, it seems important to better understand the factors that make prematurity so frequent and so difficult to control in French Guiana. The thesis focused on identifying the predictive factors of prematurity with the ultimate aim of contributing to improving the care of pregnant women and curbing the curve of the prematurity rate. Methodology: This research work is divided into 4 areas of investigation:- A descriptive retrospective study, based on data from the RIGI (Register of Computerized Pregnancy Outcomes) 2013-2014 of 12,983 viable births in the department,- The development of a predictive prematurity score from the 2013-2014 RIGI, compared to the 2015 RIGI data of 6,914 viable births,- A case-control etiological study of extreme prematurity, monocentric, from February 2016 to January 2017 in the only type III health-care institution in the French Guiana Region,- Analysis of the average term at birth and morbidity and mortality from the RIG (Register of Pregnancy Outcomes) 2002-2007 of 35,648 viable births and the RIGI 2013-2014.Results:Over the study period, the proportion of preterm births was 13.5% (1,755/12,983). The proportion of spontaneous prematurity was 51.3% , compared to 48.7% of induced prematurity. More than half (57.2% or 7 421/12 983) of the study population had social security, but 9.3% had no social security coverage. The lack of social security coverage was a risk factor for prematurity with an adjusted OR of 1.9 CI at 95% [1.6-2.3] p=0.0001. Similarly, with regard to pregnancy management, the absence of prenatal care as well as that of birth preparation would double the risk of premature birth. For pathologies associated with pregnancy, pre-eclampsia syndrome was the main dysgravidia associated with the risk of prematurity (OR adjusted by 6.7[95% CI =5.6-8.1] p=0.0001). Finally, the fairly common hypothesis that part of the high prematurity rate is related to the fact that black babies are more mature and black mothers give birth physiologically a little earlier did not emerge in our analyses. Indeed, there was no statistically significant difference in morbidity and mortality for infants born to Afro-Caribbean mothers and Caucasian women. Conclusion: The work carried out has identified many factors associated with prematurity, factors already described elsewhere. Although at the individual level it was impossible to predict who would give birth prematurely, the weight of social factors and poor follow-up suggested that a population-based approach might be appropriate. Thus, the most vulnerable women often reside in well-identified areas that could be the subject of targeted actions to improve follow-up and identify complications. This problem of social inequalities in health goes well beyond prematurity and is found for almost all pathologies, suggesting that there are synergies to be sought and that the population scale is undoubtedly strategic. The weight of preeclampsia as a risk factor for induced prematurity in French Guiana raises questions: indeed, it seems much more important than elsewhere for reasons that remain to be clarified
Argondizzo, Luciana Corrêa. "Estudo de prevalência e morbimortalidade de prematuros tardios internados em uma unidade de tratamento intensivo neonatal de Pelotas, RS." Universidade Catolica de Pelotas, 2013. http://tede.ucpel.edu.br:8080/jspui/handle/tede/332.
Повний текст джерелаObjective: Assess the characteristics of late pre term newborns admitted in a neonatal intensive care unit. Methods: Descriptive, cross-sectional, retrospective study with all the patients in the neonatal intensive care unit of a university hospital in a mid-size city, between January 2011 and December 2012. Perinatal and neonatal variables were avalued throughout hospitalization. Results: The study population consisted of 330 patients. Newborns under 33 weeks of gestational age accounted for 50% of hospitalizations, late preterm infants, for 27,3% and full-term newborns, for 20%. The majority of the population had adequate weight for gestational age, with a rate of 67.8% among late preterm. Over seventy percent of the general population and those born cesarean; whose primary indication was fetal distress. The main cause of hospitalization for all groups was infant respiratory distress syndrome, accounting for 70% of admissions of late preterm. Sepsis reached 66.7% of this group requiring several therapeutic measures during hospitalization. The mortality rate of late preterm infants was 5.6%, the lowest among groups of gestational age. Conclusion: The need for emergency neonatal care and increased occupancy rate in intensive care units show us the importance of this premature group and warns us that are not functionally "near term" and that their particularities physiological and metabolic put them on a different level to be disregarded at the time of his birth
Objetivo: Determinar a prevalência e as características dos recém-nascidos prematuros tardios admitidos em uma unidade de tratamento intensivo neonatal. Métodos: Estudo descritivo, transversal, retrospectivo com todos os pacientes internados na unidade de tratamento intensivo neonatal de um hospital universitário, entre Janeiro de 2011 e Dezembro 2012. Variáveis perinatais e neonatais foram avaliadas durante todo período de internação. Resultados: A população do estudo foi constituída de 330 pacientes. Recém-nascidos com idade gestacional menor ou igual a 33 semanas foram responsáveis por 53,3% das internações, prematuros tardios por 27,3% e nascidos a termo por 20%. A maioria da população tinha peso adequado para a idade gestacional, com uma taxa de 67,8% entre os pré-termos tardios. Mais de setenta por cento destes e da população geral nasceram de cesareana; cuja principal indicação foi sofrimento fetal agudo. A principal causa de internação para todos os grupos foi síndrome do desconforto respiratório, responsável por 70% das admissões dos prematuros tardios. Sepse atingiu 66,7% deste grupo que necessitou de várias medidas terapêuticas durante a internação. A taxa de mortalidade dos pré-termos tardios foi de 5,6%, a mais baixa dentre os grupos de idade gestacional. Conclusão: A necessidade de atendimento emergencial neonatal e a crescente taxa de ocupação de leitos de intensivismo nos demonstra a importância deste grupo de prematuros e nos alerta que funcionalmente não são quase a termo 60 e que suas particularidades fisiometabólicas os colocam num patamar diferenciado que devem ser respeitados no momento do seu nascimento
Machado, Junior Luis Carlos 1957. "Nascimento a partir de 34 semanas : prevalência e associação com mortalidade e morbidade neonatais = Birth after 34 weeks gestation : prevalence and association with neonatal morbidity and mortality." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311727.
Повний текст джерелаTese (Doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: INTRODUÇÃO: A idade gestacional ao nascimento é um dos principais fatores associados com complicações e mortes neonatais. Crianças nascidas entre 34 semanas e 36 semanas e seis dias de idade gestacional, denominadas prematuros tardios, são, tradicionalmente, considerados como de risco e prognóstico muito semelhantes aos dos recém-nascidos a termo. Estudos mais recentes, porém, têm mostrado que tanto prematuros tardios, quanto aqueles nascidos entre 37 e 38 semanas, apresentam resultados neonatais e no primeiro ano de vida, significativamente piores que os dos recém-nascidos a partir de 39 semanas. OBJETIVOS: revisar a literatura sobre o tema, analisar a prevalência de nascimento de prematuros tardios no tempo e comparar a frequência de mortes e complicações neonatais nos prematuros tardios e nos nascidos entre 37 e 38 semanas, com as mortes e complicações neonatais dos recém-nascidos a partir de 39 semanas. MÉTODO: revisão de literatura englobando os bancos de dados Medline, Lilacs e Biblioteca Cochrane. Realizado estudo de coorte retrospectiva com os dados de recém-nascidos vivos atendidos no Centro de Atenção Integral à Saúde da Mulher (CAISM) da Universidade Estadual de Campinas (UNICAMP), de janeiro de 2004 a dezembro de 2010. Os dados foram extraídos a partir do arquivo eletrônico da instituição. Foram excluídos os casos sem informação sobre a idade gestacional, as malformações e doenças congênitas fetais e as gestações múltiplas. Além das mortes neonatais, foram estudadas as seguintes complicações: hemorragia do sistema nervoso central, convulsões, índice de Apgar menor que sete no primeiro e quinto minutos, pneumonia, atelectasia, displasia broncopulmonar, pneumotórax, laringite pós entubação, síndrome de aspiração de mecônio, hipotermia, hipocalcemia e icterícia. As variáveis de controle foram: idade materna, estado civil, tabagismo, realização de pré-natal, hipertensão arterial (pré eclampsia ou crônica), diabetes, infecção urinária, outras morbidades maternas, primiparidade, cinco ou mais partos anteriores, tipo de parto, crescimento fetal restrito e sexo do recém-nascido. Para análise estatística foi aplicado o teste de qui-quadrado e o teste exato de Fisher, quando indicado. Assumiu-se o valor de p menor que 0,05 como significâncias estatísticas. Foi utilizado odds ratio (OR) como medida de efeito e a regressão logística múltipla para a análise multivariada. RESULTADOS: Foram estudados 18.032 nascimentos únicos, sendo 1.653 prematuros tardios e 16.379 recém nascidos de termo. Houve mais mortes neonatais (OR ajustado = 5.30; IC 95%: 2,61?10,74) nos prematuros tardios em comparação com os recém-nascidos a termo (nascidos entre 37 e 42 semanas). Também houve mais mortes neonatais (OR ajustado = 2,44; IC 95% 1,05-5,63) nos recém-nascidos de termo precoce comparados aos de termo tardio. Houve associação significativa para todas as complicações estudadas com a prematuridade tardia, exceto para síndrome de aspiração de mecônio. Encontrou-se tendência significativa de aumento na proporção de prematuros tardios em relação ao total dos partos ao longo do período estudado. CONCLUSÃO: Conclui-se que tanto os prematuros tardios quanto os nascidos entre 37 e 38 semanas são uma população de maior risco se comparados aos recém-nascidos a partir de 39 semanas
Abstract: INTRODUCTION: Gestational age at birth is a major determinant of neonatal mortality and complications. The risk of death and complications in infants born at 34 to 36 weeks of pregnancy (named late preterm infants) has been traditionally considered to be very similar to that of term infants. Some recent studies, however, have shown that late preterm infants, as well as those born at 37 and 38 weeks, have significantly worse outcomes in the neonatal period and in the first year of life than those born at 39 weeks or later. OBJECTIVE: to conduct a literature review on this issue; assess the prevalence and any temporal trend in late preterm births in the period that was studied; to compare neonatal deaths and complications in late preterm infants versus term infants, and compare neonatal deaths in infants born at 37 and 38 weeks (early term) versus those born at 39 to 42 weeks (late term). METHODS: A retrospective cohort study of live births was carried out in the Women's Integrated Healthcare Center (CAISM), State University of Campinas (UNICAMP), from January 2004 to December 2010. Data were extracted from an electronic database containing all medical records of the institution. Excluded from the study were congenital diseases and malformations, multiple pregnancies and cases without data on gestational age. Outcomes studied were neonatal deaths, length of hospital stay and the following complications: central nervous system hemorrhage, convulsions, Apgar score lower than seven at the first and fifth minute, pneumonia, atelectasis, pneumothorax, bronchopulmonary dysplasia, pulmonary hypertension, postintubation laryngitis, meconium aspiration syndrome, hypothermia, hypocalcemia and jaundice. Control variables were: maternal age, marital status, smoking habit, and absence of prenatal care, maternal hypertensive disease, maternal diabetes, urinary tract infection, other maternal morbid condition, primiparity, five or more previous births, fetal growth restriction, fetal gender, labor induction and pre labor cesarean section. It was used the chi square test and Fischer's exact test when indicated. The odds ratio (OR) was used as a measure of effect and multiple logistic regression was used for multivariate analysis. A significant level of 5% was adopted. RESULTS: After exclusions, there were 18,032 single births (1,653 late preterm births and 16,379 term births). An adjusted OR of 5.30; 95% confidence interval of 2.61--- 10.74 was found for neonatal death in late preterm births compared to term births (at 37 to 42 weeks), and an adjusted OR of 2.44; 95 confidence interval of 1.05-5.63 for neonatal death in early term births compared to late term births. A significantly higher risk was found in late preterm infants compared to term infants for all complications studied, except for meconium aspiration syndrome. There was a significantly growing trend in the proportion of late preterm births at the institution in the period studied. CONCLUSION: It was concluded that late preterm infants are at higher risk of undesirable outcomes than term infants. Furthermore, early term infants have a higher risk of death compared to late term infants and these differences are clinically relevant
Doutorado
Saúde Materna e Perinatal
Doutor em Ciências da Saúde
Richards, Stephen John. "The development of a theory of life-environment disruption to account for the phenomenon of premature morbidities and mortalities associated with a radical change in a person’s living environment." Thesis, 2018. http://hdl.handle.net/2440/114268.
Повний текст джерелаThesis (Ph.D.) -- University of Adelaide, The Joanna Briggs Institute, 2018
Constante, Andreia Alexandra Duarte. "Eficácia do NIDCAP na morbilidade neonatal e no neurodesenvolvimento – Scoping Review." Master's thesis, 2017. http://hdl.handle.net/10316/82618.
Повний текст джерелаIntrodução: Os recém-nascidos (RN) pré-termo (RNPT) possuem um risco de morbilidade neonatal e de sequelas no neurodesenvolvimento, que está associado à imaturidade dos seus sistemas orgânicos, e é tanto maior quanto menor for a idade gestacional. O Programa Individualizado de Avaliação e Cuidados Centrados no Desenvolvimento do Recém-Nascido (NIDCAP) é um programa de intervenção que visa otimizar e adaptar os cuidados neonatais para RNPT reduzindo os riscos que lhe estão associados. Contudo, a investigação sobre os resultados deste programa NIDCAP não tem obtido dados consistentes.Objetivos: O objetivo deste trabalho é compreender e esclarecer se continua a ser esta a realidade em investigação recente e assim contribuir para melhor esclarecimento do papel do NIDCAP na morbilidade neonatal e no neurodesenvolvimento desta população.Material e métodos: Foi realizada uma Scoping review, seguindo as recomendações metodológicas do Joanna Briggs Institute. Para isso foi conduzida uma pesquisa da literatura em três bases de dados eletrónicas (MEDLINE, CINAHL e The Cochrane Library), usando conetores boleanos, para pesquisar os dois principais termos presentes no título e/ou resumo dos artigos: “NIDCAP”, “Newborn Individualized Developmental Care and Assessment Program”.Resultados: Foram incluídos onze estudos, dez abordaram o neurodesenvolvimento, cinco analisaram a morbilidade neonatal e quatro focaram ambos os temas. Na morbilidade neonatal verificou-se uma redução da taxa de incidência de displasia broncopulmonar, da sua gravidade e do número de dias de internamento no grupo submetido ao NIDCAP. Em relação à hemorragia peri/intraventricular de grau superior ou igual a 3; à sépsis com hemocultura positiva; à retinopatia da prematuridade de grau superior ou igual a 3 e número de dias de ventilação invasiva os resultados foram contraditórios, na sua maioria não foram detetadas diferenças estatisticamente significativas. Relativamente ao neurodesenvolvimento, no que diz respeito à avaliação neurocomportamental, neuroestrutural, neurofisiológica e neuropsicológica, as evidências de inconsistências foram superiores, porém, os RNPT submetidos ao NIDCAP mostraram melhor regulação dos sistemas neurovegetativo, motor e de autorregulação avaliados pelo Assessment of Preterm Infant’s Behavioral (APIB). Apresentaram um cérebro estruturalmente mais maduro, no estudo por RM cerebral e uma melhoria neurofisiológica com redução da conectividade entre múltiplas regiões cerebrais no estudo por EEG. Os índices do desenvolvimento mental e motor avaliados pela escala de Bayley II aos 24 meses, foram também significativamente superiores no grupo de RNPT abordado pelo NIDCAP. Os dois estudos de seguimento em ex-RNPT aos oito e nove anos de idade mostraram um melhor desempenho de controlo mental, atenção, processamento integrativo no domínio visuoespacial e superioridade na função executiva no grupo submetido ao NIDCAP. Conclusão: Apesar dos enormes avanços nos cuidados neonatais no apoio ao desenvolvimento do RN de alto risco, a inconsistência na definição e na operacionalização dos cuidados de desenvolvimento, incluindo o próprio método NIDCAP, continua a ser uma preocupação que limita a realização de comparações sistemáticas.
Introduction: Preterm newborns (PTNBs) have a risk of neonatal morbidity and sequelae in neurodevelopment that is associated with the immaturity of their organic systems, and is greater the risk the lower the gestational age. The Newborn Individualized Development Care and Assessment Program (NIDCAP) is an intervention program that aims to optimize and adapt neonatal care for PTNBs and thereby minimize the risks associated with the weaknesses of this particular group of newborns. Research on NIDCAP has presented inconsistent results. Purpose: The objective of this work is to understand and clarify if this is still the reality in recent research and thus contribute to further clarification of the role of NIDCAP in neonatal morbidity and neurodevelopment in this population.Material and Methods: A Scoping review was carried out following the methodological recommendations of the Joanna Briggs Institute. For that a research of the literature in three electronic databases (MEDLINE, CINAHL and The Cochrane Library) was conducted, using Boolean connectors, to search for two main terms present in the title and / or summary of the articles: "NIDCAP", "Newborn Individualized Developmental Care and Assessment Program".Results: Eleven studies were included, ten addressed neurodevelopment, five analyzed neonatal morbidity and four focused on both themes. Within the neonatal morbidity, there was a reduction in the rate of incidence of bronchopulmonary dysplasia, its severity and the number of days of hospitalization in the group submitted to NIDCAP. In relation to peri / intraventricular hemorrhage grade higher or equal to 3; sepsis with positive blood culture; preterm retinopathy grade three or more and number of days of invasive ventilation, the results were contradictory, for the most part no statistically significant differences were detected. Regarding neurodevelopment in relation to neurobehavioral, neurostructural, neurophysiological and neuropsychological evaluation, the evidence of inconsistencies was superior, however NIDCAP newborn infants showed better regulation of the neurovegetative, motor and self-regulation systems evaluated by the Assessment of Preterm Infant's Behavioral (APIB). They presented a structurally more mature brain in the brain MRI study and a neurophysiological improvement with reduced connectivity between multiple brain regions in the EEG study. Mental and motor development indexes assessed by the Bayley II scale at 24 months were also significantly higher in the NIDCAP group. The two follow-up studies of ex-PTNB at eight and nine years of age obtained better performance of mental control, attention, integrative processing in the visuospatial domain and superiority in the executive function In the group submitted to NIDCAP. Conclusion: Despite the enormous advances in neonatal care in supporting the development of high-risk newborns, inconsistency in the definition and operationalization of developmental care, including the NIDCAP method itself, remains a current concern that limits systematic comparisons.
"Accounting for the Distribution of Adverse Birth Outcomes in Ontario: A Hierarchical Analysis of Provincial and Local Outcomes." Thesis, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24083.
Повний текст джерелаWilliams, David Neil. "Accounting for the Distribution of Adverse Birth Outcomes in Ontario: A Hierarchical Analysis of Provincial and Local Outcomes." Thèse, 2013. http://hdl.handle.net/10393/24083.
Повний текст джерела