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Introdução: A sepse neonatal é uma das principais causas de morbimortalidade em Unidades de Terapia Intensiva Neonatal, e a dificuldade no seu diagnóstico precoce tem levado ao uso excessivo de antibióticos e ao surgimento de microrganismos resistentes. A busca de novos marcadores bioquímicos, que sejam capazes de predizer precocemente o risco de desenvolver sepse, tem sido alvo de muitos estudos, em especial os biomarcadores urinários, cuja coleta é realizada de forma segura e não invasiva. O objetivo deste estudo foi avaliar o desenvolvimento de sepse neonatal, em recém-nascidos pré-termo de muito baixo peso ao nascer, por meio dos biomarcadores urinários. Método: Estudo realizado com recém-nascidos menores que 34 semanas de idade gestacional e peso de nascimento menor que 1500 gramas. A coleta de urina foi realizada entre 48-72h de vida e foram dosados 27 biomarcadores. Os recém-nascidos incluídos foram divididos em dois grupos de acordo com a evolução de cada um: GC – grupo controle (não desenvolveu sepse) e GS – grupo de estudo (desenvolveu sepse tardia). Resultados: 35 recém-nascidos foram avaliados, 12 do GC e 23 do GS. Os resultados evidenciaram elevação precoce estatisticamente significativa em 11 biomarcadores no GS em relação ao GC (IL-4 (p= 0,042), IL-5 (p=0,039), IL-7 (p=0,022), IL-9 (0,009), IL-15 (p=0,015), IL-17A (p=0,009), TNF-α (p=0,015), MiP-1α (p=0,011), MiP-1 (p=0,002), RANTES (p=0,021) e G-CSF (p= 0,009)). A ventilação mecânica foi a única variável clínica que apresentou associação estatisticamente significante com 6 destes 11 biomarcadores (IL-5 p=0,04; IL-7 p=0,02; IL-15 p=0,03; IL-17A p=0,03; MiP-1β p= 0,02 e G-CSF p= 0,04). Conclusão: A urina se apresenta como um fluido promissor na dosagem de biomarcadores e com grande potencial para avaliação do risco de sepse neonatal. A elevação precoce na urina destas citocinas, sugere que estas podem ser utilizadas como preditores da sepse tardia neonatal. Introduction: Neonatal sepsis is one of the main causes of morbimortality in the Neonatal Intensive Care Units, and the difficulty in its early diagnosis has led to the excessive use of antibiotics and the emergence of resistant microorganisms. The search for new biochemical markers, that are capable to early predict the risk of developing sepsis, has been the subject of many studies, especially urinary biomarkers, which are collected safely and non-invasively. The objective of this study was to evaluate developing neonatal sepsis in very low birth weight preterm infants, using urinary biomarkers. Method: The study was performedincluded newborns with gestational age less than 34 weeks and birth weight less than 1500 grams. Urine collection was performed between 48-72h of life and 27 biomarkers were dosed. The study included newborns younger than 34 weeks gestational age and birth weight less than 1500 grams. The included newborns were divided into two groups according to the evolution of each: GC - control group (did not develop sepsis) and GS - a study group (developed late sepsis). Results: 35 newborns were evaluated, 12 of the CG and 23 of the GS. The results showed a statistically significant early elevation in 11 GS biomarkers in relation to the CG (IL-4 (p = 0.042), IL-5 (p = 0.039), IL-7 (P = 0.015), IL-15 (p = 0.015), IL-17A (p = 0.009), TNF-α (p = 0.015), MiP- 0.021) and G-CSF (p = 0.009)). Mechanical ventilation was the only clinical variable that presented a statistically significant association with 6 of these 11 biomarkers (IL-5 p = 0.04, IL-7 p = 0.02, IL-15 p = 0.03, IL-17A p = 0.03, MiP-1 p = 0.02 and G-CSF p = 0.04)Conclusion: Urine is a promising fluid in the dosage of biomarkers and with great potential for the evaluation of the risk of neonatal sepsis. The early increase in the urine of these cytokines suggests that these can be used as predictors of late neonatal sepsis. Dissertação (Mestrado)

Purpose: To evaluate the structural ocular sequelae of retinopathy of prematurity in children at risk for the disease in Manaus, Amazonas, Brazil. Methods: A prospective, cohort-type, observational study was conducted. Fifty-seven children at risk for this retinopathy, who were born in the public health system facilities, were referred for ophthalmic evaluation at a secondary eye hospital. Inclusion criteria were gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g. Results: Eighteen (31.6%) children were diagnosed with any stage of retinopathy of prematurity during the study period, and four (7.0%) of them needed treatment. Structural ocular sequelae were identified in 3 of 56 children (5.3%), consisting of peripheral retinal detachment with macular dragging in 3 eyes of 3 children and macular involving retinal detachment in 2 eyes of 2 children. Associations between occurrence of retinopathy of prematurity and birth weight, gestational age at birth and days in oxygen were observed (p