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OBJETIVO: Estudar a relação entre a qualidade, tipos e trajetória dos movimentos generalizados espontâneos em recém-nascidos pré-termo com os achados da ultra-sonografia de crânio neonatal e com a evolução neurológica. MÉTODO: 40 recém-nascidos pré-termo, com idade gestacional < 35 semanas, tiveram seus movimentos generalizados registrados através de videoteipe durante os períodos pré-termo, a termo (37ª - 42ª semana de idade pós-concepcional) e pós-termo (49ª - 56ª semana de idade pós-concepcional), e foram seguidos prospectivamente até um ano de idade pós-concepcional. RESULTADOS: Nossos resultados mostraram que a qualidade dos movimentos generalizados, particularmente no período pós-termo (p = 0,009), foram relacionados com a presença de lesões cerebrais detectadas à ultra-sonografia e com a evolução neurológica. Enquanto a presença de lesões ultra-sonográficas graves foi associada à evolução neurológica desfavorável (p = 0,01), o achado de padrões de movimentos generalizados espontâneos normais foi associado à normalidade neurológica no seguimento, com valores preditivos negativos de 100%, para o período pré-termo, e 80% para ambos os períodos a termo e pós-termo. CONCLUSÕES: Quando usados conjuntamente, esses métodos podem aumentar a especificidade e a sensibilidade na detecção de um grupo de recém-nascidos pré-termo de alto risco para seqüelas neurológicas, no seguimento a longo prazo. OBJECTIVE: To study the relationship among the quality, type, and trajectory of general movements in preterm infants and neonatal cranial ultrasonography findings and neurological outcome. METHOD: Forty preterm newborn infants, with gestational ages under 35 weeks, had their general movements recorded through video-tape during the preterm, term (37th - 42nd postconceptional weeks of age) and post-term (49th - 56th postconceptional weeks of age) periods, and were prospectively followed up to one-year conceptional age. RESULTS: Our results showed that the quality of general movements, particularly in the post-term period (p = 0.009), were related with the presence of severe cerebral lesions in the neonatal cranial ultrasonography and the neurological outcome. While the presence of severe ultrasonography lesions was associated with an adverse neurological outcome (p = 0.01), the finding of normal general movements patterns was associated with a normal neurological outcome, with negative predictive values of 100%, for the preterm, and 80%, for both term and post-term periods. CONCLUSIONS: When concurrently used, these evaluation methods may increase the specificity and sensitivity in detecting the group of preterm infants at high-risk for neurological disturbances in long-term follow-up.

CONTEXT: Protein energy malnutrition constitutes a public health problem, especially in less affluent countries. The identification of amenable predictive risk factors is of major importance for policy makers to plan interventions to reduce infant malnutrition. OBJECTIVE: To identify risk factors for protein energy malnutrition among hospitalized low-income children aged 6 to 24 months. TYPE OF STUDY: Case-control study. SETTING: Two public hospitals in Recife, Brazil. PARTICIPANTS: The cases were 124 infants with length-for-age below the 10th percentile of the National Center for Health Statistics curve and the controls were 241 infants with length-for-age equal to or above the 10th percentile who were recruited in the same infirmary. METHODS: Cases and controls were compared in relation to a variety of sociodemographic, environmental and reproductive factors, and their healthcare, previous feeding practice and morbidity. Logistic regression analysis was used to investigate the net effect of risk factors on infant malnutrition, after adjusting for potential confounding variables. RESULTS: The mother's age, possession of a TV set, type of water supply, family size and location of the home were significantly associated with child malnutrition in the bivariate analysis. However, these associations lost their significance after adjusting for other explanatory variables in the hierarchical logistic regression analysis. This analysis showed that low birth weight contributed the largest risk for impaired growth. Increased risks of infant malnutrition were also significantly associated with households that had no toilet facilities or refrigerator, high parity for the mother, no breastfeeding of the infant, inadequate vaccination coverage and previous hospitalization for diarrhea and pneumonia. DISCUSSION: The literature shows that chronic malnutrition, as assessed by low length-for-age indexes, is often related to low income. However, this was not the case in this study, in which other variables had greater impact on child growth. CONCLUSIONS: In view of the multiple causes of malnutrition, the interrelationship among its determinants should be taken into account when adopting strategies for its reduction and prevention. CONTEXTO: Desnutrição energético-protéica constitui um problema de saúde pública especialmente em países em desenvolvimento. A identificação de fatores de risco passíveis de controle é de grande importância para os sanitaristas planejarem intervenções a fim de reduzirem a desnutrição na infância. OBJETIVOS: Identificar fatores de risco para desnutrição energético-protéica em crianças hospitalizadas e de baixa renda com 6 a 24 meses de idade. TIPO DE ESTUDO: Estudo do tipo caso-controle. LOCAL DO ESTUDO: Instituto Materno Infantil de Pernambuco e Hospital Barão de Lucena, dois hospitais públicos do Recife, nordeste do Brasil. PARTICIPANTES: Casos foram 124 crianças com comprimento para a idade abaixo do 10º percentil para a curva do National Center for Health Statistics e controles foram 241 crianças com comprimento para a idade igual ou acima do 10º percentil e recrutadas na mesma enfermaria. MÉTODOS: Casos e controles foram comparados em relação a uma série de fatores sociodemográficos, ambientais, reprodutivos, assistência à saúde, prática alimentar e morbidades prévias. Análise de regressão logística foi utilizada a fim de investigar o efeito independente dos fatores de risco para desnutrição infantil, após ajuste para potenciais fatores de confusão. A estratégia analítica usada foi o modelo hierárquico que consiste na entrada das variáveis explanatórias no modelo em uma ordem previamente estabelecida pelo pesquisador, baseada em um modelo conceitual que descreve as relações lógicas e teóricas entre os fatores de risco. RESULTADOS: A idade materna, posse de aparelho de TV, tipo de abastecimento de água, tamanho da família e local de moradia apresentaram associação significante com a desnutrição; no entanto, essas associações perderam a significância depois de serem controladas por outras variáveis explanatórias na análise de regressão logística hierarquizada. Esta análise mostrou que o baixo peso ao nascer contribuiu com o maior risco para desnutrição na população estudada (odds ratio = 6,04; p = 0,005). Maiores riscos para desnutrição também foram significantemente associados com habitações sem sanitário e sem geladeira, multiparidade, nunca ter sido amamentado, vacinação desatualizada e hospitalização prévia por diarréia e pneumonia. DISCUSSÃO: A literatura mostra que a desnutrição crônica, apontada por índices de altura-para-idade baixos, está freqüentemente associada a baixa renda. Isto não foi verificado neste estudo, em que outras variáveis, tais como peso baixo ao nascer e acesso a sanitários e refrigeradores, além da paridade da mãe, amamentação, vacinação e história de diarréia e pneumonia, tiveram maior impacto sobre o crescimento das crianças. CONCLUSÕES: Em vista da multicausalidade da desnutrição, as interrelações entre seus determinantes devem ser levadas em consideração ao se adotar estratégias para a sua redução e prevenção.

CONTEXT: Protein energy malnutrition constitutes a public health problem, especially in less affluent countries. The identification of amenable predictive risk factors is of major importance for policy makers to plan interventions to reduce infant malnutrition. OBJECTIVE: To identify risk factors for protein energy malnutrition among hospitalized low-income children aged 6 to 24 months. TYPE OF STUDY: Case-control study. SETTING: Two public hospitals in Recife, Brazil. PARTICIPANTS: The cases were 124 infants with length-for-age below the 10th percentile of the National Center for Health Statistics curve and the controls were 241 infants with length-for-age equal to or above the 10th percentile who were recruited in the same infirmary. METHODS: Cases and controls were compared in relation to a variety of sociodemographic, environmental and reproductive factors, and their healthcare, previous feeding practice and morbidity. Logistic regression analysis was used to investigate the net effect of risk factors on infant malnutrition, after adjusting for potential confounding variables. RESULTS: The mother's age, possession of a TV set, type of water supply, family size and location of the home were significantly associated with child malnutrition in the bivariate analysis. However, these associations lost their significance after adjusting for other explanatory variables in the hierarchical logistic regression analysis. This analysis showed that low birth weight contributed the largest risk for impaired growth. Increased risks of infant malnutrition were also significantly associated with households that had no toilet facilities or refrigerator, high parity for the mother, no breastfeeding of the infant, inadequate vaccination coverage and previous hospitalization for diarrhea and pneumonia. DISCUSSION: The literature shows that chronic malnutrition, as assessed by low length-for-age indexes, is often related to low income. However, this was not the case in this study, in which other variables had greater impact on child growth. CONCLUSIONS: In view of the multiple causes of malnutrition, the interrelationship among its determinants should be taken into account when adopting strategies for its reduction and prevention.

当院NICUでは家庭での事故や緊急時に対応できる教育が必要であると考え,入院した子どもの家族を対象に救急蘇生教室を実施している.本研究の目的は,教室参加者の特徴を知ること,教室前の子どもの心肺蘇生法に関する理解の実態を知ること,教室後のアンケート調査における参加者の反応から,救急蘇生教室の今後の課題を見出すことである.救急蘇生教室では研究グループの医師と看護師が小児に起こりやすい事故と対策,心肺蘇生法の手技の知識を提供し,人形を用いた実技講習を行っている.研究対象は2001年9月～2002年4月に入院した子どもを持つ144家族とした.その中で参加希望のあった42家族(29%)に同意を得,アンケート(回収率100%)を行った.診療録をもとに家族背景について検討し,またアンケート結果から項目毎に集計を行い,またχ2検定及び同等性の検定を用い,以下の結果が得られた.1)低出生体重児で入院日数が28日以上の子どもを持つ家族の参加が多かった.2)参加した母親の年齢,母児同室の有無,育児協力者の有無に有意差は無かった.3)参加前の心肺蘇生に関する知識は少なかった.4)参加者の多くが心肺蘇生法の必要性を重視していた.5)教室後再参加を希望する家族が多かった.小児の心肺蘇生手技習得の場は少なく我々小児医療に携わるものが,教育の場を提供していく必要がある.今後,教室の受講対象を広げた上で充実した教室運営と退院後も繰り返し受訴できるようなシステムづくりが今後の課題である., Our hospital periodically hold the meetings with staff and parents of the patients hospitalized in NICU. Parents learned the risk of domestic accidents in infants including SIDS and practiced pediatric CPR simulations. The Questionnaire revealed that they had little knowledge about pediatric CPR and wanted another opportunity of the meeting.

Desigualdades sócio-econômicas na mortalidade infantil precoce têm sido evidenciadas no Brasil, indicando que o maior risco de morte se relaciona com o nível sócio-econômico das mães. Apontam-se, neste trabalho, as desigualdades do baixo peso ao nascer e da mortalidade perinatal no Município do Rio de Janeiro, discutindo-se a adequação das principais medidas de desigualdades em saúde propostas na literatura. Como fonte de informações, utilizam-se os dados coletados em inquérito realizado em cerca de dez mil parturientes nas primeiras 48 horas após o parto, em maternidades públicas e privadas da cidade. Considerando o grau de instrução da mãe e a renda do chefe da família como indicadores do nível sócio-econômico, bem como o risco atribuível populacional relativo e o coeficiente angular de desigualdade como medidas de desigualdade em saúde, constata-se grande gradiente sócio-econômico da proporção de baixo peso ao nascer e, especialmente, da taxa de mortalidade perinatal. A associação persistente entre os fatores sócio-econômicos e os resultados adversos da gravidez reflete, pelo menos em parte, a ineficácia do sistema de saúde em minorar as desigualdades da saúde perinatal no Rio de Janeiro. Socioeconomic inequalities in early infant mortality have been evidenced in Brazil, with a greater mortality risk associated with the mother's socioeconomic status (SES). The aim of this paper is to identify socioeconomic inequalities in relation to low birth weight and perinatal mortality in the City of Rio de Janeiro, Brazil, discussing the appropriateness of the main health inequality indexes proposed in the international literature. As the information source, we use data collected in a survey of approximately 10,000 mothers selected for interview within 48 hours after delivery in public and private hospitals in the city. Using educational level and head of household's income as indicators of SES, as well as population attributable risk and slope index of inequality as health inequality measures, the results show a steep socioeconomic gradient in the proportion of low birth weight, and especially in the perinatal mortality rate. The persistent association between socioeconomic indicators and adverse results in pregnancy indicates (at least partially) the health system's inefficacy in diminishing perinatal health inequalities in Rio de Janeiro.

The prevalence of anemia and the serum ferritin levels were investigated in low birth weight infants at late infancy. The subjects were examined by different feeding methods. The results showed that the prevalence of anemia was higher in low birth weight infants group than those of control group. However, the levels of serum ferritin were low in both groups. The nutritional counseling might be important to prevent iron deficiency anemia at late infancy., 論文

Este trabalho tem como objetivo comparar as características sócio-econômicas, a assistência pré-natal e o estilo de vida de três grupos de puérperas, um composto por adolescentes (< 20 anos) e os demais por mulheres de 20-34 anos, categorizadas segundo experiência (ou não) de gravidez na adolescência. Foram entrevistadas 3.508 puérperas no pós-parto em maternidades municipais e federais do Município do Rio de Janeiro. A análise estatística consistiu em utilizar testes qui-quadrado (chi2) para testar hipóteses de homogeneidade de proporções. Ao comparar os três grupos, observou-se uma situação mais desfavorável entre as mães de 20-34 anos com história de gravidez na adolescência. Estas têm pior nível de instrução, mostram com maior freqüência hábitos de fumo e uso de drogas ilícitas durante a gestação e apresentam menor número de consultas de atendimento pré-natal. A assistência pré-natal se apresentou neste estudo como uma política compensatória eficiente para a prevenção da prematuridade e do baixo peso ao nascer, sobretudo entre as puérperas adolescentes. This paper compares socioeconomic characteristics, prenatal care, and life styles of three groups of post-partum women, one consisting of adolescents (< 20 years) and the other two of women 20-34 years old, classified according to their history of pregnancy during adolescence. A sample of 3,508 post-partum women was selected from public hospitals in the city of Rio de Janeiro, Brazil, and interviewed just after childbirth. To verify the hypothesis of homogeneity of proportions, chi-square tests (chi2) were used. Comparing the three groups, the most adverse conditions were found among the 20-34-year-old mothers with a history of pregnancy during adolescence. These women have the least schooling, the highest rates of smoking and use of illegal drugs during pregnancy, and the fewest prenatal appointments. According to this study, prenatal care proved to be an effective compensatory policy for the prevention of prematurity and low birth weight, especially among adolescent mothers.

Purpose Low birth weight (LBW) is one of the major public health problems in India. Hence, there is a need to identify risk factors that, when modified, will reduce the burden of unhealthy children on the healthcare system. The objective of this study was to determine whether periodontitis among mothers in the rural population of India is a risk factor for LBW babies. Methods A hospital-based case control study was conducted among 340 postpartum mothers. The cases consisted of 170 women who had given birth to babies weighing

本研究の目的は,HOTを終了した幼児期後期から学童期の子どもの母親が,子どもの病状・成長発達をどのように捉えているのかを明らかにすること,幼稚園・保育園や小学校での社会生活を送らせる上でどのようなことを考慮しているのかを明らかにすることであった.対象は,NICU退院後,慢性肺疾患のためにHOTを実施した,幼児期後期から学童期の子どもの母親7名であった.母親に対し,子どもの病状や成長発達,日常生活についての半構成インタビューを実施し,内容を分析した.得られた結論は以下のとおりであった.1.HOTを終了した幼児期後期から学童期の子どもの母親は,幼稚園・保育園や小学校での社会生活の中で,病状は以前よりも好転していると捉えていた.2.幼稚園・保育園に入園した全ケースの母親が,体力面・行動面で他児との違いを感じた経験があった.調査時には,遅れのあるケースも含めて,全員の母親が子どもは成長発達してきていると捉えていた.3.HOTを終了した子どもの母親が,幼稚園・保育園や小学校での社会生活を送らせる上で考慮していることは,体調によっては水泳を控えること程度で,他には特に考慮していることはなかった., The purposes of this study were to clarify mothers' perceptions about conditions and development of their toddlers and school children who finished home oxygen therapy, and to clarify mothers' considerations in social life at kindergartens or elementary schools. Subjects were seven mothers of toddlers and school children who were discharged from a NICU, and were on home oxygen therapy upon discharge for neonatal chronic lung disease. Semi-structured interviews were done, and mothers' perceptions were analyzed. The results were as follows : 1. The mothers perceived their children's conditions had became better than before, through children's social life at kindergartens or elementary schools. 2. The mothers perceived that their children delayed developmentally after entrance into kindergartens, but the mothers perceived that their children had became developed at the time of interviews. 3. The mothers didn't take into consideration especially in social life at kindergartens or elementary schools, except for withdrawal swimming according to conditions.

本研究の目的は,HOTを実施する子どもの,日常の生活場面における呼吸機能の状態を明らかにすること,および看護援助における酸素飽和度測定の有用性を明らかにすることであった.対象は,極低出生体重児として出生し,出生後NICUに入院し,慢性肺疾患のためにNICU退院時にHOTを開始した3名の子どもと母親であった.データ収集は家庭訪問にて退院後約1年まで縦断的に実施し,睡眠中・食事中・哺乳中の場面についての,パルスオキシメーターを用いての酸素飽和度および脈拍数の測定,睡眠中の呼吸数の測定,呼吸窮迫症状の観察を行った.また,同時に実施した子どもの病状についての母親へのインタビューや,訪問時の観察から,SpO2の測定に対する母親の反応を捉えた.得られた結論は次のとおりであった.1)HOTを実施する子どもの日常の生活場面における呼吸機能の状態は,HOTの実施処方が減り,処方薬が少なくなってゆく経過の中でも,安定し,好転する傾向にあった.2)HOTを実施する子どもの看護援助において,呼吸機能の状態を説明し,母親の病状の捉え方および対応を促進するのに,酸素飽和度測定を用いることは有用であると考えられた., The purposes of this study were to clarify respiratory conditions in children undergoing home oxygen therapy in daily life settings, and to clarify usefulness of measuring oxygen saturation (SpO2) for nursing care. Subjects were three child/mother pairs in which the children were below fifteen hundred grams at birth and entered a NICU after birth, and were on home oxygen therapy upon discharge for neonatal chronic lung disease. The data was collected longitudinally by home visits until one year after discharge. Data collection included SpO2 and pulse rate, using a pulse oximeter during sleep and feeding, the child's respiratory rate during sleep, and observed respiratory conditions. The mothers' perceptions of measuring SpO2 were examined from interview data about their children's respiratory conditions and mothers' sayings and doings. The results were as follows : 1. The children's respiratory conditions improved even when oxygen flow and medication were decreased. 2. It was considered that using a pulse oximeter was useful to promote mothers' perceptions of their children's respiratory conditions, and to promote mothers' skill to care for children.

Background Previous reviews (2005 to 2009) on preterm infants given probiotics or prebiotics with breast milk or mixed feeds focused on prevention of Necrotizing Enterocolitis, sepsis and diarrhea. This review assessed if probiotics, prebiotics led to improved growth and clinical outcomes in formula fed preterm infants. Methods Cochrane methodology was followed using randomized controlled trials (RCTs) which compared preterm formula containing probiotic(s) or prebiotic(s) to conventional preterm formula in preterm infants. The mean difference (MD) and corresponding 95% confidence intervals (CI) were reported for continuous outcomes, risk ratio (RR) and corresponding 95% CI for dichotomous outcomes. Heterogeneity was assessed by visual inspection of forest plots and a chi2 test. An I2 test assessed inconsistencies across studies. I2> 50% represented substantial heterogeneity. Results Four probiotics studies (N=212), 4 prebiotics studies (N=126) were included. Probiotics: There were no significant differences in weight gain (MD 1.96, 95% CI: -2.64 to 6.56, 2 studies, n=34) or in maximal enteral feed (MD 35.20, 95% CI: -7.61 to 78.02, 2 studies, n=34), number of stools per day increased significantly in probiotic group (MD 1.60, 95% CI: 1.20 to 2.00, 1 study, n=20). Prebiotics: Galacto-oligosaccharide / Fructo-oligosaccharide (GOS/FOS) yielded no significant difference in weight gain (MD 0.04, 95% CI: -2.65 to 2.73, 2 studies, n=50), GOS/FOS yielded no significant differences in length gain (MD 0.01, 95% CI: -0.03 to 0.04, 2 studies, n=50). There were no significant differences in head growth (MD −0.01, 95% CI: -0.02 to 0.00, 2 studies, n=76) or age at full enteral feed (MD −0.79, 95% CI: -2.20 to 0.61, 2 studies, n=86). Stool frequency increased significantly in prebiotic group (MD 0.80, 95% CI: 0.48 to 1.1, 2 studies, n=86). GOS/FOS and FOS yielded higher bifidobacteria counts in prebiotics group (MD 2.10, 95% CI: 0.96 to 3.24, n=27) and (MD 0.48, 95% CI: 0.28 to 0.68, n=56). Conclusions There is not enough evidence to state that supplementation with probiotics or prebiotics results in improved growth and clinical outcomes in exclusively formula fed preterm infants.

Background In Indonesia, the infant mortality rate in 2001 was 50 per 1000 live births, with 34.7% due to perinatal death. This perinatal death was associated with low birth weight (LBW) newborn, which was caused by prematurity, infection, birth asphyxia, hypothermia, and inadequate breast feeding. In developing countries, lack of facilities of LBW infant care leads to the utilization of kangaroo method as care to prevent hypothermia in LBW newborn. Objective To evaluate the differences of hypothermia event and duration of birth weight regain in LBW newborns between early kangaroo care (EKC) and conventional care (CC). Methods This was an open label randomized controlled trial. The 1500-2250 g LBW newborns who were born in Sanglah Hospital were randomized to EKC and CC groups. Results Hypothermia events were found more often in CC group than EKC group (RR=0.645, 90% CI 0.45 to 0.92, P=0.05). This difference was influenced by breast feeding frequency. Duration of birth weight regain in EKC group (median 5 days (SE=0.31, 90% CI 4.49 to 5.51) was shorter than CC group (median 6 days (SE=0.52, 90% CI 5.15 to 6.85), but this difference wasn't statistically significant (P=0.40). Percentage of birth weight decrease, breastfeeding frequency, and hyperbilirubinemia events that needed phototheraphy were associated with the duration of birth weight increase. Conclusion EKC helps to decrease the incidence of hypothermia events, but fails to shorten duration of birth weight increase. Percentage of birth weight decrease, breast-feeding frequency, and hyperbilirunemia events that need phototheraphy are associated with the duration of birth weight increase in LBW newborn.

The children of related parents show increased risk of early mortality. The Native American genome typically exhibits long stretches of homozygosity, and Latin Americans are highly heterogeneous regarding the individual burden of homozygosity, the proportion and the type of Native American ancestry. We analysed nationwide mortality and genome-wide genotype data from admixed Chileans to investigate the relationship between common causes of child mortality, homozygosity and Native American ancestry. Results from two-stage linear-Poisson regression revealed a strong association between the sum length of runs of homozygosity (SROH) above 1.5 Megabases (Mb) in each genome and mortality due to intracranial non-traumatic haemorrhage of foetus and newborn (5% increased risk of death per Mb in SROH, P = 1 × 10−3) and disorders related to short gestation and low birth weight (P = 3 × 10−4). The major indigenous populations in Chile are Aymara–Quechua in the north of the country and the Mapuche–Huilliche in the south. The individual proportion of Aymara–Quechua ancestry was associated with an increased risk of death due to anencephaly and similar malformations (P = 4 × 10−5), and the risk of death due to Edwards and Patau trisomy syndromes decreased 4% per 1% Aymara–Quechua ancestry proportion (P = 4 × 10−4) and 5% per 1% Mapuche–Huilliche ancestry proportion (P = 2 × 10−3). The present results suggest that short gestation, low birth weight and intracranial non-traumatic haemorrhage mediate the negative effect of inbreeding on human selection. Independent validation of the identified associations between common causes of child death, homozygosity and fine-scale ancestry proportions may inform paediatric medicine. Fil: Koenigstein, Fabienne. Ruprecht Karls Universitat Heidelberg; Alemania Fil: Boekstegers, Felix. Ruprecht Karls Universitat Heidelberg; Alemania Fil: Wilson, James F.. University of Edinburgh; Reino Unido Fil: Fuentes Guajardo, Macarena. Universidad de Tarapacá; Chile Fil: Gonzalez-Jose, Rolando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico de Ciencias Sociales y Humanas; Argentina Fil: Bedoya Berrío, Gabriel. Universidad de Antioquia; Colombia Fil: Bortolini, Maria Cátira. Universidade Federal do Rio Grande do Sul; Brasil Fil: Acuña Alonzo, Victor. Instituto Nacional de Antropología e Historia. Escuela Nacional de Antropología e Historia; México Fil: Gallo, Carla. Universidad Peruana Cayetano Heredia; Perú Fil: Ruiz-Linares, Andres. Fudan University; China. Aix-Marseille Université; Francia. Centre National de la Recherche Scientifique; Francia. University College London; Reino Unido Fil: Rothhammer, Francisco. Universidad de Tarapaca. Instituto de Alta Investigación; Chile Fil: Lorenzo Bermejo, Justo. Ruprecht Karls Universitat Heidelberg; Alemania

Estudos populacionais sobre mortalidade neonatal de nascimentos de muito baixo peso ao nascer contribuem para identificar sua complexa rede de fatores de risco. Foi estudada uma coorte de 213 recém-nascidos com peso inferior a 1.500g (112 óbitos neonatais e 101 sobreviventes) na Região Sul do Município de São Paulo, Brasil, em 2000/2001. Foram realizadas entrevistas domiciliares e obtidos dados de prontuários hospitalares. Foi realizada análise de sobrevida e empregada regressão múltipla de Cox. A elevada mortalidade na sala de parto, no primeiro dia de vida e ausência de sobreviventes < 700g dos nascimentos < 1.000g e com menos de 28 semanas sugere que condutas mais ativas destinam-se a nascituros de maior viabilidade. Mães residentes em favela, com história anterior de cesárea e aborto provocado, adolescentes, com sangramento vaginal e ausência de pré-natal aumentaram o risco de óbito neonatal. Partos cesarianos e internação em berçários mostraram efeito protetor. O peso ao nascer abaixo de 1.000g e Apgar menor que 7 foram risco. A elevada mortalidade está associada às condições de vida, características maternas e dos nascimentos e condições assistenciais. A melhoria da atenção pré-natal e ao recém-nascido pode atuar na redução da mortalidade.

CONTEXT: During the first year of life, the growth process is highly vulnerable to several impairing factors that need to be understood. OBJECTIVE: To perform follow-up evaluation on newborns weighing less than or equal to 2,000 g in a population of low socioeconomic level. TYPE OF STUDY: Retrospective. SETTING: Hospital Maternidade Escola de Vila Nova Cachoeirinha, São Paulo, Brazil. METHODS: The study included 60 children born between March 1996 and January 1998, weighing less than or equal to 2,000 g. They were divided into three subgroups, according to birth weight and adequacy for gestational age. The factors studied were maternal variables, illnesses among the newborns, hospital admissions subsequent to discharge from the nursery, and the evolution of weight from birth until 12 months of life. Statistical analyses were performed through application of the Statistical Package for Social Sciences (SPSS) V.9.0 and Curve Expert 1.3 programs. RESULTS: Previous maternal diseases occurred in 38.6% of the pregnant women and intercurrent events occurred in 100%. The prevailing neonatal diseases were sepsis (30%) and hyaline membrane disease (25%). There were 404 visits on an outpatient basis: the most frequently diagnosed complaints related to respiratory diseases (26%). Among visits to specialists, 81.7% were to the neuropediatrician. A diagnosis of normality was made for 80% of all visits, for all specialties. For each of these groups, a growth curve was established. These were shown to be below the reference curve standards, with such differences least evident with regard to the children's corrected age. DISCUSSION: The severity of the newborns'conditions may be related to the high incidence of maternal diseases prior to pregnancy as well as intercurrent events during pregnancy. The differences in growth in relation to NCHS charts show that corrected age should be used as a parameter. CONCLUSIONS: Socioeconomic conditions, clinical/obstetric events and newborn diseases during the hospital stay had repercussions on these children's progress during their first year of life. Their growth profile was found to be very far from the reference standard, thus indicating a need for constant, differentiated assessment. CONTEXTO: O processo de crescimento durante o primeiro ano de vida é altamente vulnerável a múltiplos fatores que podem prejudicá-lo, o que torna necessário seu conhecimento e controle rigoroso. OBJETIVO: Avaliar o acompanhamento de recém-nascidos com peso de nascimento < 2.000 g, de uma população de periferia de grande cidade, durante o primeiro ano de vida. TIPO DE ESTUDO: Retrospectivo, a partir de dados secundários. LOCAL: Hospital Maternidade Escola de Vila Nova Cachoeirinha, São Paulo, Brasil. MÉTODOS: 60 recém-nascidos com peso < 2.000 g, divididos em três subgrupos conforme peso e adequação à idade gestacional, foram estudados de março de 1996 a janeiro de 1998. Variáveis maternas, variáveis relativas ao seguimento das crianças no primeiro ano de vida, às admissões após a alta hospitalar e relativas ao peso durante o primeiro ano de vida foram estudadas. As análises estatísticas utilizaram o programa SPSS (Statistical Package for Social Sciences, SPSS) V.9,0 e o Curve Expert 1.3. RESULTADOS: Doenças maternas prévias ocorreram em 38,6% e em 100% dos casos houve intercorrências durante a gravidez. Das doenças neonatais, as de maior prevalência foram sepse (30%) e doença de membranas hialinas (25%). No ambulatório realizaram-se 404 consultas e as doenças respiratórias corresponderam ao diagnóstico de maior freqüência (26%). Das consultas com especialistas, aquelas com o neuropediatra corresponderam a 81,7%. Em 80% das consultas em todas as especialidades fez-se o diagnóstico de normalidade. Foi construída uma curva de crescimento para cada grupo e feitas comparações com as curvas de referência do National Center for Health Statistics que se mostraram abaixo dos padrões das curvas de referência, diferença menos evidente para a idade corrigida das crianças. DISCUSSÃO: O serviço onde foi realizado este estudo é referência para gestantes de alto risco de baixo nível socioeconômico. A gravidade das condições dos recém-nascidos pode estar relacionada com a alta incidência de doenças maternas antes da gravidez e intercorrências durante a gestação. As diferenças no crescimento em relação aos padrões do NCHS mostram que a idade corrigida deveria ser usada como parâmetro de crescimento para recém-nascidos de baixo peso. CONCLUSÕES: Condições socioeconômicas, eventos clínico-obstétricos e afecções apresentadas pelos recém-nascidos durante a internação repercutiram sobre sua evolução no primeiro ano de vida e seu perfil de crescimento distanciou-se do padrão referencial indicando necessitarem de avaliação constante e diferenciada.

BACKGROUND AND OBJECTIVE: Low birth weight infants 40 times greater than infants weighing more than 2500 g are at risk. These infants are usually separated from the mother immediately and are transferred to the neonatal intensive care unit. This separation can affect infant’s respiratory, heart rate and body temperature. It also caused severe stress to the mother and reduced mother’s self-esteem. The purpose of this study was to determine the effect of kangaroo mother care (KMC) on self-esteem in the mothers of low birth weight infants in Amirkola children hospital, Babol, Iran.METHODS: In a quasi-experimental study 60 mothers of low birth weight infants were selected by convenience sampling method and assigned randomly to two study groups, (experimental n=20 and control n=40). Data collection tools were questionnaire (demographic information of parents and neonates and Rosenberg self-esteem scale). The intervention group take care of in KMC method (mothers in the intervention group put their infants to the vertical position in the middle of her chest in order to skin-to skin contact), while the control group had taken only ordinary care of personnel and mother. The Rosenberg self-esteem scale is completed two times, at the first time, when mothers came to visit the neonates and then at discharge time. FINDINGS: From 60 mothers participated in this study, 29 (48.3%) were high school graduates, 53 (88.3%) were housewife and 39 (65%) had cesarean delivery method. Mean self-esteem score of mothers in the intervention group at admission and discharge were 22.1±2.7 and 23.4±1.9, respectively and in the control group when the infants were admitted and discharged it was 22.2±2.2 and 22.6±1.3, respectively. The significant difference in self-esteem of mothers before and after the intervention was not observed. In association with birth weight infants and maternal self-esteem levels, the Pearson correlation coefficient showed a significant relationship (p=0.01 and r=0.3).CONCLUSION: Results showed that KMC directly correlates with the level of self esteem and causes more peace, merit and ability in mothers.

BackgroundProgress in neonatal medicine has dramatically improved the survival rate of preterm births, but the evidence suggests that these low-birth weight infants (LBWIs) go on to develop pervasive development disorders and attention deficit hyperactivity disorder (ADHD) at greater rates than the general population. Children with neurodevelopmental disorders are known to suffer from deficits in visual cognition, such as in face perception and attentional functions, the characteristics of which already manifest in early infancy., PurposeThis study aimed to investigate visual cognition in LBWIs during infancy., Subjects20 LBWIs and 20 normal-birth-weight infants (NBWIs: control) of age 9–10 months (corrected age was used for LBWIs)., MethodChildren were held seated in front of an eye tracking system by a parent, and presented with facial photos as visual stimuli. During the familiarization phase, the child was presented with two images of the same human face (familiarization stimulus) on the left and right side of a display screen (5 × 10 s trials). Next, during the test phase, the child was presented with the same image on one side of the screen, and a photo of a different person’s face (novel stimulus) on the other (2 × 5 s trials). Gaze behavior was assessed in terms of the total time spent looking at either facial stimulus, and specifically at the eyes of the stimuli, as well as the number of attentional shifts between stimuli, and novelty preference., Results/DiscussionLBWIs spent significant less time looking at facial stimuli overall, and less time at the eye region, than NBWIs. These findings seem to evidence developmental differences in functions related to visual cognition., © 2020 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Background: Kangaroo Mother Care (KMC) is dened as skin-to-skin contact between a mother and her newborn baby derived from practical similarities to marsupial care giving, proximately exclusive breastfeeding and early discharge from hospital. This concept was proposed as an alternative to conventional methods of care for low birth weight (LBW) infants, and in replication to quandaries of earnest overcrowding in Neonatal Intensive Care Units (NICUs). KMC essentially utilizes the mother as a natural incubator Aim and Objectives: The aim was to assess the feasibility, acceptability and the effectiveness of KMC in LBW infants. It avoids agitation routinely experienced in busy ward. Material and Methods: A pilot open-labeled quasi-randomised clinical trial was conducted in Level III NICU of a teaching institution. 60 newborn infants