César Coelho Xavier

Changes in placental morphology of small for gestational age newborns

OBJECTIVE To verify changes in placental morphology of small for gestational age newborns, considering that the occurrence of placental alterations is more frequent in small for gestational age (SGA) infants than in appropriate for gestational age (AGA) infants. METHODS Fifty SGA newborns were included in a cross-sectional study, which involved gross anatomy and light microscopy of placenta, membranes and umbilical cord. An equal size sample of randomized AGA newborns was used. All children were born at Maternidade Terezinha de Jesus, Juiz de Fora-MG, between February and November, 1996. After an informed consent was given by the mothers, the newborns were weighted at birth with assessment of length and head circumference. Every childs placenta, membranes and umbilical cord were sent to the laboratory of histology and embryology of the Department of Morphology of Universidade Federal de Juiz de Fora and Department of Pathology and Forensic Medicine of Universidade Federal de Minas Gerais. RESULTS Placentas of SGA newborns differed significantly with greater incidence of chorioamnionitis, placental infarction, extensive perivillous fibrin deposition and multiple foci of parabasal chronic villitis. They were also lighter and had smaller diameters. Placentary index (placental weight/newborńs weight ratio) was also significantly greater, indicating that although both placenta and small for gestational age newborn presented low weight, placentas impairment was smaller. CONCLUSIONS Placentas of small for gestational age newborns differed significantly if compared to those of adequate gestational age.

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.

Recommendations for breastfeeding during maternal infections

OBJETIVO: Revisao da literatura com o enfoque de amamentacao e doencas infecciosas maternas, no intuito de contribuir com conhecimentos para decisoes a serem tomadas pelo profissional de saude. FONTES DE DADOS: Informacoes foram obtidas em consultas que incluiram livros-texto, normas tecnicas, artigos selecionados por meio de busca na base de dados Lilacs e MEDLINE, alem de referencias especificas. SINTESE DOS DADOS: Nutrizes com doencas infecciosas podem transmitir agentes patogenicos pelo leite materno para a crianca. Embora a amamentacao confira protecao a crianca, ela pode tambem ser uma importante fonte de infeccao. Doencas maternas causadas por virus, fungos e agentes parasitarios podem, em alguns casos, ser transmitidas via leite humano. Para maes com infeccoes pelo virus da imunodeficiencia humana e virus T-linfotropicos humanos tipo I, a recomendacao e nao amamentar. Nas demais doencas, e necessaria uma avaliacao cuidadosa, mas, em geral, na maioria dos casos, o aleitamento materno e mantido. CONCLUSOES: Algumas doencas, principalmente as causadas por virus, podem ser transmitidas durante a amamentacao. O profissional de saude, ao identificar uma nutriz com infeccao viral ativa ou outra doenca infecciosa, necessita tomar a decisao de suspender ou nao a amamentacao, o que pode ser um fato angustiante pelo seu papel fundamental na promocao e estimulo ao aleitamento materno.

Assessing the Psychometric and Ecometric Properties of Neighborhood Scales in Developing Countries: Saúde em Beagá Study, Belo Horizonte, Brazil, 2008–2009

Although specific measurement instruments are necessary to better understand the relationship between features of neighborhoods and health, very few studies have developed instruments to measure neighborhood features in developing countries. The objective of the study was to develop valid and reliable measures of neighborhood context useful in a Latin American urban context, assess their psychometric and ecometric properties, and examine individual and neighborhood-level predictors of these measures. We analyzed data from a multistage household survey (2008–2009) conducted in Belo Horizonte City by the Observatory for Urban Health. One adult in each household was selected to answer a questionnaire that included scales to measure neighborhood domains. Census tracts were used to proxy neighborhoods. Internal consistency was evaluated by Cronbach’s alpha, and multilevel models were used to estimate ecometric properties and to estimate associations of neighborhood measures with socioeconomic indicators. The final sample comprised 4048 survey respondents representing 149 census tracts. We assessed ten neighborhood environment dimensions: public services, aesthetic quality, walking environment, safety, violence, social cohesion, neighborhood participation, neighborhood physical disorder, neighborhood social disorder, and neighborhood problems. Cronbach’s alpha coefficients ranged from 0.53 to 0.83; intraneighborhood correlations ranged from 0.02 to 0.53, and neighborhood reliability varied from 0.76 to 0.99. Most scales were associated with individual and neighborhood socioeconomic predictors. Questionnaires can be used to reliably measure neighborhood contexts in developing countries.

Processo de trabalho na Unidade de Terapia Intensiva Neonatal: construção de uma atenção orientada pela integralidade

Se trata de un estudio cualitativo que tuvo como objetivo analizar la accion de los profesionales y su contribucion en la construccion del cuidado integral al recien nacido internado en la Unidad de Terapia Intensiva Neonatal (UTIN). El estudio fue realizado en el Hospital Sofia Feldman, en Belo Horizonte (Minas Gerais) y tuvo como sujetos 10 profesionales que asisten al recien nacido en la UTIN y 7 padres de recien nacidos, alli internados. Para recolectar los datos se utilizo el Taller de Trabajo y la Observacion Participante. El tratamiento y el analisis de los datos recolectados fueron hechos por medio del Analisis del Discurso. A partir de los datos se evidencio el potencial de la practica de los profesionales orientada por el sentido del cuidado integral, por los actos de salud que materializan el cuidado integral, las diferentes percepciones de los participantes acerca del trabajo realizado por el equipo y de que forma la logica de la organizacion del proceso de trabajo inscribe el quehacer del colectivo de los trabajadores.

Imputação múltipla e análise de casos completos em modelos de regressão logística: uma avaliação prática do impacto das perdas em covariáveis

Researchers in the health field often deal with the problem of incomplete databases. Complete Case Analysis (CCA), which restricts the analysis to subjects with complete data, reduces the sample size and may result in biased estimates. Based on statistical grounds, Multiple Imputation (MI) uses all collected data and is recommended as an alternative to CCA. Data from the study Saúde em Beagá, attended by 4,048 adults from two of nine health districts in the city of Belo Horizonte, Minas Gerais State, Brazil, in 2008-2009, were used to evaluate CCA and different MI approaches in the context of logistic models with incomplete covariate data. Peculiarities in some variables in this study allowed analyzing a situation in which the missing covariate data are recovered and thus the results before and after recovery are compared. Based on the analysis, even the more simplistic MI approach performed better than CCA, since it was closer to the post-recovery results.

Growth of preterm newborns during the first 12 weeks of life

OBJECTIVE To assess the somatic growth of preterm newborns through growth curves during the first 12 weeks of life. METHOD A longitudinal and prospective study was carried out at two state operated maternity hospitals in the city of Belo Horizonte. Three hundred and forty preterm infants with birth weight less than 2,500 g were weekly evaluated in terms of body weight, head circumference, and height. Growth curves were constructed and adjusted to Counts model. RESULTS Counts model clearly showed that the dynamics of loss, stabilization and gain of weight of all curves are graphically similar. The growth curve was characterized by weight loss during the 1st week (4-6 days) ranging from 5.9 to 9.7% (the greater the percentage, the lower the birth weight). For all curves, recovery of birth weight ranged from 16 to 19 days, showing that these newborns took longer to recover their birth weight. After the 3rd week, the newborns maintained increasingly rates of weight gain. Head circumference and height curves are little affected by weight loss. However, newborns with low birth weight presented loss of head circumference and height, probably due to their lower gestational ages. CONCLUSION The dynamics of the preterm infants evaluated was similar to that of previous studies. The infants also presented growth deficit. However, it was also noted that the infants present a high potential to recover their growth.

Safety of Kangaroo Mother Care in Intubated Neonates Under 1500 g

Kangaroo Mother Care (KMC) has been used as a technique to promote mother-child bonding. It has been discussed of its use for preterm under mechanical ventilation. The objective of this study is to assess the vital signs of preterm infants with a birth weight lower than 1500 g who are under intubation and hemodynamically stable in KMC. Forty-three preterm infants with a mean gestational age at birth of 29.1 ± 1.6 weeks and a mean birth weight of 1.1334 ± 2318 g. The preterm infants were longitudinally assessed for 90 min (15 min before, 60 min in KMC and 15 min after). These periods were compared, and the dependent variables heart rate, oxygen saturation (SpO(2)), axilary temperature and mean arterial blood pressure were statistically significant (p < 0.05). Clinically, however, the results were not significantly different. The results show that KMC is a safe method under the study conditions presented here.

Avaliação da implantação do cuidado humanizado aos recém-nascidos com baixo peso: método canguru

OBJECTIVE: To evaluate the implementation of the kangaroo mother method in hospitals trained by the Brazilian Ministry of Health. METHOD: Cross-sectional study, evaluating 176 (60.1%) out of 293 hospitals that were trained by the Brazilian Ministry of Health from 2000 to 2003 in Brazil. This study was conducted in two phases. The first phase consisted of sending a questionnaire to 293 hospitals; in the second phase an in loco visit was made in a sample of 29 among those hospitals. The instrument for data collection was sent to all hospitals by mail, fax or e-mail through the Ministry of Health and they addressed the three dimensions of the normative assessment: structure, processes, and results. The second phase consisted of an evaluation of the process, using a structured guide of non-participant observation. To estimate the reliability of the variable “deployment of the steps of the method” between questionnaire and site visit, we used the kappa test. RESULTS: The first stage of the kangaroo mother method was implemented in 84.9% of the hospitals, but only 47.3% of them implemented the three stages according to the Brazilian norm. The kappa test results indicated a moderate agreement for the first stage, and substantial for the second and third stages of the method. CONCLUSION: Hospital training was important for triggering the implementation process of the kangaroo mother method. However, they were not enough to promote the implementation of the three phases of the method.

Growth velocity of preterm appropriate for gestational age newborns

OBJECTIVE: To assess the growth velocity of preterm appropriate-for-gestational-age newborns through growth curves. METHOD: A longitudinal and prospective study was carried out at two state-operated maternity hospitals in Belo Horizonte. Two hundred and sixty appropriate for gestational age preterm infants with birth weight < 2,500 g were evaluated weekly for body weight, head circumference and length. Growth velocity curves were constructed based on the derivative of the mathematical equation of the Counts model applied to somatic growth. Two analyses were made in the present study: absolute velocity, i.e., weight gain (g/day), and head circumference and length gains (cm/week); and relative velocity, i.e., weight gain(g/kg/day), and head circumference and length gains (cm/m/week). RESULTS: The curves of weight gain (g/day) were proportional to birth weight (the lowest and the highest birth weight neonates gained 15.9 and 30.1 g/day, respectively). The curves of weight gain (g/kg/day) were inversely proportional to birth weight with increasingly higher rates of weight gain between the first and fourth weeks (during the third week, the lowest and the highest weight newborns gained 18 and 11.5 g/kg/day, respectively). Later there was a drop, and by the 12th week the rates were similar for all groups (7.5 to 10.2 g/kg/day). The curves of relative velocity (cm/m/week) for head circumference and length were inversely proportional to birth weight; the lower weight preterm newborns had, the higher head circumference and length growing rates were, compared with those with more weight. CONCLUSION: The relative velocity is the best parameter to describe the growth dynamics of preterm infants, especially of those with lower birth weight. Lower birth weight infants gained more weight, head circumference and length.OBJECTIVE To assess the growth velocity of preterm appropriate for gestational age newborns through growth curves. METHOD A longitudinal and prospective study was carried out at two state-operated maternity hospitals in Belo Horizonte. Two hundred and sixty appropriate for gestational age preterm infants with birth weight < 2,500 g were evaluated weekly for body weight, head circumference and length. Growth velocity curves were constructed based on the derivative of the mathematical equation of the Counts model applied to somatic growth. Two analyses were made in the present study: absolute velocity, i.e., weight gain (g/day), and head circumference and length gains (cm/week); and relative velocity, i.e., weight gain(g/kg/day), and head circumference and length gains (cm/m/week). RESULTS The curves of weight gain (g/day) were proportional to birth weight (the lowest and the highest birth weight neonates gained 15.9 and 30.1 g/day, respectively). The curves of weight gain (g/kg/day) were inversely proportional to birth weight with increasingly higher rates of weight gain between the first and fourth weeks (during the third week, the lowest and the highest weight newborns gained 18 and 11.5 g/kg/day, respectively). Later there was a drop, and by the 12th week the rates were similar for all groups (7.5 to 10.2 g/kg/day). The curves of relative velocity (cm/m/week) for head circumference and length were inversely proportional to birth weight; the lower weight preterm newborns had, the higher head circumference and length growing rates were, compared with those with more weight. CONCLUSION The relative velocity is the best parameter to describe the growth dynamics of preterm infants, especially of those with lower birth weight. Lower birth weight infants gained more weight, head circumference and length.