Ana Lucia Goulart

Neurodevelopmental assessment of very low birth weight preterm infants at corrected age of 18-24 months by Bayley III scales

OBJECTIVE To evaluate the prevalence of delay and factors associated with neurodevelopmental scores in premature infants. METHODS Cross-sectional study to assess the development by Bayley Scales III, including very low birth weight preterm infants aged 18 to 24 months who were under follow-up at the outpatient clinic for preterm infants. Congenital malformation, genetic syndrome, symptomatic congenital infection at birth, deafness, and blindness were excluded. Numerical variables were compared by Mann-Whitney or Student t test and categorical variables by chi-square or Fishers exact test. Factors associated with developmental scores were analyzed by linear regression, and statistical significance level was established at p < 0.05. RESULTS Out of the 58 children included, four (6.9%) presented cognitive delay, four (6.9%) motor, 17 (29.3%) language, 16 (27.6%) social-emotional and 22 (37.0%) adaptive-behavior delay. By multiple linear regression, the variables: social classes CDE (-13.27; 95%CI: -21.23 to -5.31), oxygen dependency at 36 weeks of corrected age (-8.75; 95%CI: -17.10 to -0.39) decreased the cognitive developmental score. Periventricular leukomalacia decreased the cognitive (-15.21; 95%CI: -27.61 to -2.81), motor (-10.67; 95%CI:-19.74 to -1.59) and adaptive-behavior scores (-21.52; 95%CI: -35.60 to -7.44). The female sex was associated with higher motor (10.67; 95%CI: 2.77 to 12.97), language (15.74; 95%CI: 7.39 to 24.09) and social-emotional developmental scores (10.27; 95%CI: 1.08 to 19.46). CONCLUSIONS Very low birth weight preterm infants aged from 18 to 24 months of corrected age presented more frequently language, social-emotional and adaptive-behavior delays. The variables: social classes CDE, periventricular leukomalacia, bronchopulmonary dysplasia and male sex reduced the neurodevelopmental scores.

Is breast milk collected at home suitable for raw consumption by neonates in Brazilian public neonatal intensive care units

This study was designed to verify if breast milk collected at home is appropriate for raw consumption by neonates in a Brazilian public neonatal intensive care unit (NICU). From May 1998 to February 2000, microbiological characteristics of breast milk samples collected at home were analyzed. The milk samples were considered appropriate for raw consumption if mesophilic bacteria count was < 2500 CFU/mL and potential pathogens were not detected. Of 90 milk samples collected from 32 mothers of hospitalized neonates, 36 (40%) were rejected because of potentially pathogenic bacteria (72.2%), mesophilic bacteria count ≥ 2500 CFU/mL (13.9%), and both conditions (13.9%). The most frequent nonpathogenic and potentially pathogenic bacteria isolated were Staphylococcus coagulase negative and Klebsiella pneumoniae, respectively. Using univariate analysis, demographic, socioeconomic, educational, and house characteristics were not found to be associated with milk contamination. Breast milk collected at home may not be appropriate for raw consumption in Brazilian NICUs. Pasteurization could improve its microbiological quality. Further studies are needed.

Premature infants with birth weights of 1500–1999 g exhibit considerable delays in several developmental areas

To establish the prevalence and factors associated with developmental scores and delays in premature infants.

Neonatal screening for severe combined immunodeficiency in Brazil

OBJECTIVE To apply, in Brazil, the T-cell receptor excision circles (TRECs) quantification technique using real-time polymerase chain reaction in newborn screening for severe combined immunodeficiency and assess the feasibility of implementing it on a large scale in Brazil. METHODS 8715 newborn blood samples were collected on filter paper and, after DNA elution, TRECs were quantified by real-time polymerase chain reaction. The cutoff value to determine whether a sample was abnormal was determined by ROC curve analysis, using SSPS. RESULTS The concentration of TRECs in 8,682 samples ranged from 2 to 2,181TRECs/μL of blood, with mean and median of 324 and 259TRECs/μL, respectively. Forty-nine (0.56%) samples were below the cutoff (30TRECs/μL) and were reanalyzed. Four (0.05%) samples had abnormal results (between 16 and 29TRECs/μL). Samples from patients previously identified as having severe combined immunodeficiency or DiGeorge syndrome were used to validate the assay and all of them showed TRECs below the cutoff. Preterm infants had lower levels of TRECs than full-term neonates. The ROC curve showed a cutoff of 26TRECs/μL, with 100% sensitivity for detecting severe combined immunodeficiency. Using this value, retest and referral rates were 0.43% (37 samples) and 0.03% (3 samples), respectively. CONCLUSION The technique is reliable and can be applied on a large scale after the training of technical teams throughout Brazil.

Immunophenotypic Profile and Increased Risk of Hospital Admission for Infection in Infants Born to Female Kidney Transplant Recipients

Children born to female kidney recipients are exposed to immunosuppressive drugs during gestation. Little is known about their immune system at birth or in the long term. Twenty‐eight children born to female kidney recipients and 40 full‐term children born to healthy mothers were evaluated. T, B, NK, NKT, γδT cells were assessed by flow cytometry and functional evaluation of T and dendritic cells after in vitro activation was performed at birth and at 8 months of age. At birth, infants born to female kidney recipients showed lower numbers of CD4+ T, NKT and intense reduction of B cells (median cells/mm3, transplant: 153.7 X control: 512.4; p < 0.001). There was also a reduced percentage of activated CD8+ T and of CD4+ regulatory T cells. Activated memory and exhausted memory B cells showed higher percentages among children exposed to immunosuppressors when compared to control group. At 8 months, most immune alterations were no longer observed, but four children still had low numbers of some lymphocyte subsets at this age. Children born to female kidney recipients had 4.351 (95% CI: 1.026–15.225; p = 0.046) higher risk of hospital admission in the first months of life—some, with severe clinical manifestations—than those born to healthy women.

Functional capacity during exercise in very‐low‐birth‐weight premature children

The functional capacity of children born prematurely with very‐low‐birth weight was compared with that of children born at full‐term using the six‐minute walk test (6MWT) and the ten‐minutes shuttle walk test (10MSWT). The factors affecting walking distance were analyzed.

Photogrammetry: an accurate and reliable tool to detect thoracic musculoskeletal abnormalities in preterm infants

OBJECTIVE To analyse the accuracy and reproducibility of photogrammetry in detecting thoracic abnormalities in infants born prematurely. DESIGN Cross-sectional study. SETTING The Premature Clinic at the Federal University of São Paolo. PARTICIPANTS Fifty-eight infants born prematurely in their first year of life. OUTCOME MEASURES Measurement of the manubrium/acromion/trapezius angle (degrees) and the deepest thoracic retraction (cm). Digitised photographs were analysed by two blinded physiotherapists using a computer program (SAPO; http://SAPO.incubadora.fapesp.br) to detect shoulder elevation and thoracic retraction. Physical examinations performed independently by two physiotherapists were used to assess the accuracy of the new tool. RESULTS Thoracic alterations were detected in 39 (67%) and in 40 (69%) infants by Physiotherapists 1 and 2, respectively (kappa coefficient=0.80). Using a receiver operating characteristic curve, measurement of the manubrium/acromion/trapezius angle and the deepest thoracic retraction indicated accuracy of 0.79 and 0.91, respectively. For measurement of the manubrium/acromion/trapezius angle, the Bland and Altman limits of agreement were -6.22 to 7.22° [mean difference (d)=0.5] for repeated measures by one physiotherapist, and -5.29 to 5.79° (d=0.75) between two physiotherapists. For thoracic retraction, the intra-rater limits of agreement were -0.14 to 0.18cm (d=0.02) and the inter-rater limits of agreement were -0.20 to -0.17cm (d=0.02). CONCLUSION SAPO provided an accurate and reliable tool for the detection of thoracic abnormalities in preterm infants.

Growth and energy and protein intake of preterm newborns in the first year of gestation-corrected age

CONTEXT There are few longitudinal studies that analyze the growth and nutritional status parameters of children born prematurely. OBJECTIVE To evaluate the growth and dietary intake of preterm newborns in the first year of gestation-corrected age. DESIGN Prospective clinical study. SETTING Tertiary care hospital. PATIENTS 19 children (7 male) who were born prematurely, with birth weight between 1000 g and 2000 g, which was adequate for the gestational age. PROCEDURES At 3, 6, 9 and 12 months of gestation-corrected age, children were evaluated in relation to weight, height and cephalic perimeter, using the National Center for Health Statistics as the standard reference, and the Rozalez-Lopez and Frisancho standards for brachial perimeter and triceps and subscapular skinfolds. The calculated dietary intake was compared to the Recommended Dietary Allowances. MAIN MEASUREMENTS The Z score was calculated for the weight/age, height/age and weight/height relationships, and the percentiles of the perimeters and skinfolds were considered. Dietary intake records were made using the 24-hour Dietary Recall and the Food Frequency Intake Questionnaire methods. The Virtual Nutri software was used to calculate energy and protein intake. RESULTS The weight/age, height/age and weight/height relationships and the brachial perimeter and triceps skinfold were statistically greater in the first semester in relation to the second. The cephalic perimeter remained above the 50th percentile for the ages studied and there was no difference in the subscapular skinfold between the first and second semesters, remaining below the 50th percentile. The calorie and protein intake, although statistically lower in the first than in the second semester, always remained above the recommended. CONCLUSIONS The pace of growth is greater in the first semester than in the second, not reaching the standard expected for full-term newborns, with the exception of the cephalic perimeter, which remains adequate. Calorie/protein intake shows an inverse relationship with growth speed, remaining above the recommended for full-term newborns, although with difficulty in depositing subcutaneous fat, in spite of the high caloric intake.

Assessment of swallowing in preterm newborns fed by bottle and cup

Objetivo: Comparar o desempenho da degluticao com uso de copo e mamadeira em prematuros, na primeira oferta do alimento por via oral. Metodos: Estudo em prematuros de muito baixo peso ao nascer, sem comprometimento neurologico, sindromes geneticas ou malformacoes congenitas. Os recem-nascidos foram avaliados por meio da videofluoroscopia, com uso de copo e mamadeira, quando atingiram idade corrigida ≥34 semanas, peso ≥1.500 g e apresentavam indicacao de iniciar alimentacao por via oral. Todos receberam alimentacao exclusivamente por gavagem no periodo previo ao estudo. Resultados: Foram avaliados 20 prematuros, com peso medio de 1.356 g e idade gestacional ao nascimento de 31,3 semanas. Grande parte dos recem-nascidos alimentados por mamadeira (68%) apresentou succao forte e com ritmo e 63% mostraram boa coordenacao das funcoes succao/degluticao/respiracao. A mesma porcentagem de recem-nascidos alimentados pelo copo (68%) nao realizou o movimento de sorver e apenas 32% sorveram quantidades minimas de contraste liquido. Nao foram observados sinais de penetracao laringea e aspiracao traqueal em ambos os procedimentos. Conclusao: Na primeira oferta de alimento por via oral, recem-nascidos prematuros apresentaram melhor desempenho na degluticao com o uso da mamadeira em relacao ao copo.PURPOSE To compare the swallowing performance of premature infants using a cup and a bottle during the first offer of food by mouth. METHODS This study was carried out with preterm newborns who presented low weight at birth and no neurological illnesses, genetic syndromes or congenital malformations. The newborns were assessed by videofluoroscopy while using a cup and a bottle, when they reached a post-conceptual age of ≥34 weeks, weight ≥ 1,500 g and showed signs of readiness for oral feeding. All children were fed exclusively by gavage during the period prior to the study. RESULTS This study included 20 preterm newborns, with average birth weight of 1,356 g and gestational age of 31.3 weeks. The majority of the bottle-fed newborns (68%) presented strong and rhythmic suction and 63% showed good sucking/swallowing/breathing coordination. The same percentage of newborns fed by cup (68%) could not perform the sipping movement and only 32% could suck a minimal amount of liquid contrast. There were no signs of laryngeal penetration and tracheal aspiration in both procedures. CONCLUSION At the first oral feeding, preterm newborns showed better swallowing performance with a bottle in comparison to using a cup.

Repercussions of preterm birth on symptoms of asthma, allergic diseases and pulmonary function, 6–14 years later

BACKGROUND Prevalence of allergic diseases and impaired pulmonary function may be high in children born prematurely. This study aimed to assess pulmonary function and prevalence of asthma, atopic diseases and allergic sensitisation in these patients. METHODS A cross-sectional study was conducted with children aged 6-14 years who were born prematurely with birth weight <2000g from January 2008 to May 2011. Exclusion criteria were: major malformations, or acute respiratory disorders. The International Study of Asthma and Allergies in Childhood questionnaire was applied followed by allergic skin prick test and spirometry. RESULTS The study included 84 children aged 9.3±2.3 years born at mean gestational age of 31.8±2.4 weeks. The prevalence of current asthma was 25%, more severe asthma was 15.5%; rhinitis was 38.1%; flexural eczema was 8.3%; and a positive skin-prick test was 69.6%. Frequencies of children with values <80% of predicted were: FVC (8.3%), FEV1 (22.6%), and FEV1/FVC ratio (16.7%). Prevalence of children with FEF25-75% <70% of the predicted value was 32.4%, positive bronchodilator response was observed in 20.5% of cases, and altered pulmonary function in 42.9%. Factors associated with altered pulmonary function were oxygen dependency at 28 days of life (OR: 4.213, p=0.021), the presence of wheezing in childhood (OR: 5.979, p=0.014) and infants height (OR: 0.945, p=0.005). CONCLUSIONS There was a high prevalence of severe asthma, allergic sensitisation, and altered pulmonary function among children and adolescents born prematurely. Bronchopulmonary dysplasia and a history of wheezing were risk factors for altered pulmonary function.