Arthur Lopes Gonçalves

Prevalência do aleitamento materno em recém-nascidos de baixo peso

The present situation regarding the breast feeding of children born with a weight of 2,500 grammes or less (LWB) at the Hospital das Clinicas of the Medical School of the Universidade de S. Paulo in Ribeirao Preto (Brazil) was studied. The study was descriptive and the data were obtained through a longitudinal follow-up carried over the period from October 1985 to September 1986 inclusive. Of the 222 children included in the study, 30 (13.5%) infants were not breastfed. Thus the incidence of breast feeding among this population was of 86.5%. At 3 months 62.5% of these infants were still being breastfed. At 6 months this figure fell to 38.5% and only 25.0% were still being breast-fed at the end of 12 months. The average duration of breast feeding for the 192 children that had started it was of 4 months. An association was found between the level of literacy of the mothers and the duration of breast feeding. Birthweight was found to be associated with the incidence and duration of breast feeding in general, as well as with the incidence of exclusive breast feeding. These data are considerably lower than recent figures obtained from the populations of well-developed countries, especially than those of Finnish infants born with a weight of less than 1.500 g. Action programmes involving the community and/or the Institution must be implemented in order to improve these figures.

Serum and red blood cell folate levels in parturients, in the intervillous space of the placenta and in full-term newborns

Folates, essential nutrients for man, are especially important during gestation. Serum and red blood cell folate levels were measured in 51 parturients and in their respective placentas and concepts, with the objective to further elucidate the mechanisms of folate transfer from mother to fetus. The interrelationships between the three compartments with respect to folate levels were also studied (Tab. I). Serum and red blood cell folates were measured by radioimmunoassay in samples of venous blood from the mother, from the intervillous space of the placenta, and from the umbilical cord. Higher folate levels were detected in newborns than in their mothers both in serum (3.9 times) and red blood cells (2.3 times). Serum folate levels were higher in the intervillous space of the placenta than in newborns (1.3 times) or mothers (4.5 times) Fig. 1, 2). These data suggest that the placenta concentrates folates, thus offering high concentrations of this vitamin to the fetus. It is possible that folate-binding proteins existing in the placenta participate in the mechanism of folate concentration in this organ. However, despite the existence of a transfer mechanism that benefits the fetus, a significant positive correlation was observed between serum folate levels of mothers, newborns and placentas.

Effects of human milk homogenization on fat absorption in very low birth weight infants

Abstract We tested the effects of ultrasonic homogenization of human milk on fat absorption in very low birth weight (VLBW) infants. The study was conducted on 18 VLBW infants divided into two groups: 8 infants whose mothers were able to produce a milk volume sufficient to satisfy their requirements received this milk without pasteurization, and the remaining 10 received their own mothers milk complemented with bank milk. Each group was submitted to two consecutive fat balances in which they received at random homogenized or non-homogenized milk. Gestational age, birth weight and amount of fat ingested did not differ between groups. Fecal fat excretion was significantly lower in the group fed homogenized and non-pasteurized own mothers milk. The groups fed non-pasteurized milk absorbed fat at percentages close to those of the group that received pasteurized and homogenized human milk. The group that received pasteurized and non-homogenized human milk presented the lowest fat absorption. We conclude that the ultrasound homogenization process improved the absorption of human milk fat, suggesting that pasteurized human milk utilized as part of an infant feeding regime should be pre homogenized.

Early-onset Bacterial Infection in Brazilian Neonates with Respiratory Distress: A Hospital-based Study

We investigated infants with respiratory distress within 4 days of birth whose mothers had not received antibiotic prophylaxis to evaluate the frequency and etiology of bacterial infection and associated risk factors. The study was conducted on 261 infants suffering respiratory distress admitted to a Brazilian neonatal intensive care unit, 94 per cent of whom were born prematurely. Gestational and delivery history; bacteriological cultures of blood, cerebrospinal fluid, tracheal aspirates and urine; complete and differential blood counts; a urinary group B streptococcal latex antigen test; and a chest radiograph were analysed. Indications of infection were found in 38.7 per cent and confirmed in 11.9 per cent of the neonates. Gram-positive (70.9 per cent) and gram-negative bacteria (29.1 per cent) were found in 31 cases of confirmed early bacteremia. Group B Streptococcus was the predominant causative agent (19.4 per cent) in infants exhibiting confirmed infection. Culture-proven infection was more frequent among infants delivered vaginally (adjusted OR = 2.53, p = 0.05) or born to mothers with signs of intra-amniotic infection (adjusted OR = 2.83, p = 0.04). Preventive measures against early bacterial infection in preterm infants from this population are strongly warranted.

Total nitrogen and electrolyte levels in colostrum and transition human milk.

The objective of this research was to study the composition of human milk in terms of protein levels and levels of the electrolytes sodium, potassium, calcium, magnesium, phosphorus and chloride in colostrum 48-72 hours post-partum, and in the transition milk (96 +/- 9 hours, 120 +/- 9 hours and 144 +/- 9 hours post-partum) of mothers who had fullterm and pre-term deliveries. The mothers were kept in the hospital with the objective to control a few important lactation parameters such as exercising or resting conditions, sleep, nutrition and suckling stimulation. Only low socioeconomic level mothers took part in the study. The initial period of lactation was studied because this is the time when secretion suffers rapid changes, going from colostrum to transition milk, and then to mature milk. The results observed for the different times and for the two groups were compared both within and between groups. No significant differences were obtained for any of the comparisons, except for transitory oscillations in potassium, calcium, chloride and phosphorus levels observed within groups. In general, it can be said that there was no variation between colostrum and transition milk for the mothers who delivered at full term or pre-term. No differences were found either when the groups were compared at the different times post-partum. This means that, under the conditions used in this study, milk did not vary as its type naturally changed (from colostrum to transition milk) for the two groups and that the levels of the constituents studied also remained unchanged when studied as a function of full-term or pre-term delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma amino acids in pregnancy, placental intervillous space and preterm newborn infants

Plasma amino acid levels have never been studied in the placental intervillous space of preterm gestations. Our objective was to determine the possible relationship between plasma amino acids of maternal venous blood (M), of the placental intervillous space (PIVS) and of the umbilical vein (UV) of preterm newborn infants. Plasma amino acid levels were analyzed by ion-exchange chromatography in M from 14 parturients and in the PIVS and UV of their preterm newborn infants. Mean gestational age was 34 +/- 2 weeks, weight = 1827 +/- 510 g, and all newborns were considered adequate for gestational age. The mean Apgar score was 8 and 9 at the first and fifth minutes. Plasma amino acid values were significantly lower in M than in PIVS (166%), except for aminobutyric acid. On average, plasma amino acid levels were significantly higher in UV than in M (107%) and were closer to PIVS than to M values, except for cystine and aminobutyric acid (P < 0.05). Comparison of the mean plasma amino acid concentrations in the UV of preterm to those of term newborn infants previously studied by our group showed no significant difference, except for proline (P < 0.05), preterm > term. These data suggest that the mechanisms of active amino acid transport are centralized in the syncytiotrophoblast, with their passage to the fetus being an active bidirectional process with asymmetric efflux. PIVS could be a reserve amino acid space for the protection of the fetal compartment from inadequate maternal amino acid variations.

Growth and nitrogen balance in preterm infants fed formula with long chain polyunsaturated fatty acids

A decrease in nitrogen retention and growth rate has been observed in some formulas supplemented with LCP. In the present study we report on the growth and nitrogen balance of preterm infants fed formula supplemented with or without a blend of LCP containing both ω-3 and ω-6 fatty acids. A prospective study was conducted on 58 VLBW-infants with a mean ± SEM weight of 1245±21g. The infants were divided into 3 groups. If the mother had milk, the infant received human milk fortified (18 infants). If the mother had no milk, the infant received one of two identical formulas except for the fat component in a double-blind manner (20 infants each group). Infants were followed up for 30 days on their diets. Initial and final anthropometric parameters, BUN, total protein, and albumin were normal and similar in the three groups. Both, protein intake and protein excretion through urine and feces, were similar for the three groups. Mean percent protein absorption was 71%. Plasma amino acid levels were similar at the beginning of the study and after 30 days were similar for the infants fed the two formulas. The infants that received fortified human milk presented significantly higher proline levels and significantly lower lysine, aspartic acid, threonine, glutamic acid, and methionine levels compared to the infants fed the two formulas. We conclude that the addition of LCP to preterm infant formula did not affect protein absorption or plasma amino acid profile. The formulas did not mimic fully the amino acid profile of preterm infants fed enriched human milk.

Estudo longitudinal da evolução ponderal de crianças pré-termo do nascimento até o sexto mês pós-termo

Estudou-se a dinâmica do crescimento em peso de 95 recem-nascidos pre-termo adequados para a idade gestacional, do nascimento ate o sexto mes pos-termo. As criancas estudadas foram divididas em 4 grupos, segundo a idade em semanas com que nasceram - 33, 34, 35 e 36 semanas de gestacao, respectivamente, tendo sido pesadas ao nascer e depois a cada 2 ou 4 semanas. Para cotejo dos resultados foram estudados os incrementos do peso para cada grupo nas mesmas idades corrigidas, tendo o seguimento sido efetuado ate 64 semanas de idade pos-menstrual, equivalente ao sexto mes pos-termo. Os resultados evidenciaram que nas duas primeiras semanas de vida pos-natal o ganho ponderal foi pequeno, aumentando consideravelmente nas semanas subsequentes, mantendo incremento periodico (VCI) quase constante nos 4 grupos nos primeiros meses de vida, porem a velocidade de crescimento por unidade (VCU) apresentou valores maximos no primeiro mes pos-natal e queda semelhante nos 4 grupos nos meses seguintes, com valores proximos aos de criancas de paises desenvolvidos.

Pesquisa de anticorpos para sífilis e toxoplasmose em recém-nascidos em hospital de Ribeirão Preto, SP, Brasil

Foram aplicados testes para pesquisa dos niveis de IgM (por imunodifusao radial simples) e de anticorpos para sifilis (FTA- ABS-IgG e IgM, VDRL e Wassermann (W) e toxoplasmose (imunofluorescencia IgG (IFI-IgG) e IgM (IFI-IgM) em 408 casos de recem-nascidos (RN) do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (Brasil), escolhidos casualmente no periodo de 01/07 a 09/10/198 1. O fator reumatoide (FR) foi pesquisado para excluir resultados falso-positivos para anticorpos classe IgM. Os soros IFI-IgG positivos, e eventualmente falso-negativos a IFI-IgM para toxoplasmose, foram tratados por cromatografia em gel. Um soro positivo para FR foi tratado com gamaglobulina humana agregada pelo calor antes da pesquisa de anticorpos IgM. Confrontou-se os soros reagentes para sifilis com dados de prontuarios dos respectivos RN e maes. Foram reagentes a pelo menos um dos testes para sifilis 7,0% dos RN; o FTA-ABS-IgG foi positivo em 89,3%, o VDRL em 67,8% e o W em 60,7%. Um soro foi FTA-ABS-IgM reagente. A co-positividade entre FTA-ABS-IgG e VDRL foi 60,7%; entre FTA-ABS-IgG e W 53,6% e entre VDRL e W 60%. A confrontacao mostrou que em 53,5% dos RN a sorologia foi positiva ao nascimento, em 3,6% negativa e em 42,9% nao havia dados. O seguimento clinico-sorologico revelou que 2 RN evoluiram com sinais de lues congenita e outros 2 a suspeita clinica foi descartada pela sorologia de controle; em 21 nao havia dados. Foram reagentes a IFI-IgG para toxoplasmose 71,3% dos RN e 100% nao reagentes a IFI-IgM antes e apos a cromatografia. No periodo estudado nao houve diagnostico clinico de toxoplasmose congenita. Tres RN apresentaram valores de IgM aumentados, mas nao houve diagnostico clinico ou laboratorial de lues ou toxoplasmose congenitas nos mesmos. Sugere-se a nivel local introducao do FTA-ABS-IgG para triagem mais abrangente da sifilis congenita.Tests were performed for the determination of IgM levels (by simple radial immunodiffusion) and antibodies for syphilis (FTA-ABS-IgG and IgM, VDRL and Wassermann (W)) and toxoplasmosis (indirect immunofluorescence IgG (IFI-IgG) and IgM (IFI-IgM)) in 408 new-borns (NB) sera at the University Hospital of the Faculty of Medicine of Ribeirao Preto, USP, selected at random from July 1 to October 9, 1981. Only 3 NB showed greater than normal values of IgM levels in serum, but no clinical or laboratory diagnosis of congenital syphilis or toxoplasmosis was made for them. Two hundred and 91 infants (71.3%) were IFI-IgG positive for toxoplasmosis and none IFI-IgM, before or after chromatography. No clinical diagnosis of congenital toxoplasmosis was made during the period studied. The rheumatoid factor (RF) was determined in order to exclude false-positive results for antibodies of the IgM class. All possible false-negative sera to IFI-IgM and IFI-IgG positive for toxoplasmosis were treated by gel chromatography. Only one positive serum for RF was treated with heat-aggregated gamma-globulin before being tested for the presence of IgM antibodies. Sevem percent of the NB (28) were positive to at least one of the tests for syphilis. FTA-ABS-IgG was positive in 89.3% of them, VDRL in 67.8% and W in 60.7%. Only one serum sample was positive for FTA-ABS-IgM. The concordance of positivity between FTA-ABS-IgG and VDRL was 60.7%; 53.6% between FTA-ABS-IgG and W and 60% between VDRL and W. The syphilis-positive sera were compared with the data in the medical records of the respective NB and their mothers. It was shown that among the 28 NB with positive tests for syphilis only 5 3.5 % of them were detected at birth, 3.6% had negative serology and no data were available for 42.9%. Clinical and/or serological follow-up disclosed that 2 NB evolved with signs of congenital syphilis, 2 were suspected to have syphilis, and were treated but control serology ruled out this possibility, and no data were available for 24. A new screening strategy for this disease and the introduction of the FTA-ABS-IgG test for a more extensive selection of congenital syphilis is suggested.

Clinical aspects of children presenting specific IgM antibodies to cytomegalovirus by immunofluorescent test

Clinical data observed in 25 children presenting IgM specific antibodies to cytomegalovirus (CMV) by immunofluorescent test are reported. The children were grouped by the presented clinical picture in: neonatal hepatitis, mononucleosis syndrome,pneumonitis, neurologic disease, ocular abnormalities, and thrombocytopenic purpure. Clinical aspects of CMV infection were analyzed and compared with data reported in the literature. CMV infections can involve multiple organs and this viral disease must to be considered on differential diagnosis of many infectious diseases.