Conceição Aparecida de Mattos Segre

Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia?

CONTEXT With early discharge, many newborns have to be readmitted to hospital for hyperbilirubinemia to be treated, and this has been held responsible for the reappearance of kernicterus. OBJECTIVE To evaluate whether bilirubin levels in cord blood could predict neonatal hyperbilirubinemia that would require treatment, in full-term newborns up to their third day of life. TYPE OF STUDY Prospective study. SETTING Neonatal Unit of Hospital Israelita Albert Einstein, São Paulo, Brazil. PARTICIPANTS 380 full-term newborns considered normal: with or without ABO/Rh blood group incompatibility and without other complications. PROCEDURES Blood was taken from the umbilical cord for analysis of conjugated, unconjugated and total bilirubin serum levels. The newborns were followed up until discharge, and unconjugated bilirubin that required phototherapy was compared to the cord bilirubin assay. Discriminant analysis was used to classify newborns: with or without risk of needing phototherapy by the third day of life. MAIN MEASUREMENTS Bilirubin assay in cord blood; mothers and newborns blood groups; phototherapy indication. RESULTS The mean value for unconjugated bilirubin in cord blood was significantly higher in newborns whose unconjugated bilirubin required phototherapy. The presence of ABO blood group incompatibility was a significant variable in relation to unconjugated bilirubin that required phototherapy. The most useful cutoff point for unconjugated bilirubin in cord blood was 2.0 mg/100 ml. DISCUSSION Cord blood could be collected, stored and used for further analysis of unconjugated bilirubin levels as a means for considering whether or not to discharge a moderately jaundiced child from hospital, in association with other resources. CONCLUSIONS Blood incompatibility between mother and child was a predictor for the appearance of hyperbilirubinemia that required treatment. Considering a cutoff point of 2.0 mg/100 ml, it could be concluded that 53% of the newborns who had greater unconjugated bilirubin levels in cord blood would reach levels requiring phototherapy by the third day of life.

Twinning rate in a sample from a Brazilian hospital with a high standard of reproductive care

CONTEXT Epidemiological studies on twin births have been motivated mostly by the positive correlation between twinning rate and human fertility, prematurity, low birth weight, increased risk of infant death and long term risk for morbidity. OBJECTIVE This paper intends to estimate the incidence of multiple births in a private hospital in Brazil with a high standard of reproductive care, and to evaluate the effects of maternal age, gestation order and assisted fertilization on twinning rate. DESIGN Retrospective analysis. SETTING First-class tertiary private hospital, São Paulo, Brazil. PARTICIPANTS The multiple birth rate was investigated among 7,997 deliveries from 1995 to 1998, including 7,786 singletons, 193 twins, 17 triplets and one quadruplet. RESULTS The rates per 1,000 dizygotic and monozygotic pairs and for triplets were estimated as 19.51, 4.50 and 2.13, respectively. The dizygotic and triplet rates were the highest observed in Brazil up to the present day. The twinning rate among primigravidae older than 30 years was very high (45.02 per 1,000) and was due to a disproportionately high frequency of dizygotic pairs. The triplet rate was also very high among the mothers of this age group (5.71 per 1,000). These facts are strong indicators that these women were the ones most frequently submitted to assisted reproductive techniques. The mean maternal age of the studied population was about six years higher than that estimated for mothers in the general population of southeastern Brazil. Primigravidae aged under 30 years as well as multigravidae showed similar twinning rates, which were almost 20 per 1,000. Among the deliveries of multigravidae older than 30 years, an unusually high frequency of monozygotic twins was observed (7.04 per 1,000), probably as a consequence of the residual effect of long-term use of oral contraceptives. CONCLUSIONS The dizygotic twinning rate increased from 13.51 to 28.98 per 1,000 over the four years studied, with the twinning rate for primigravidae over 30 years old in 1998 being twice that observed in 1995. The mean maternal age was also high during this period, but the extremely high increase in twinning rate observed cannot be attributed solely to this variable. Assisted fertilization seems to be the most probable cause of this unusually high twinning rate.

Relationship between maternal weight gain and birthweight

OBJECTIVE: To investigate the influence of gestational weight gain on birthweight of the newborn, in order to clarify if this weight increment results in heavier newborn. METHODS: Retrospective cohort in a tertiary level private institution that attends a high income population of São Paulo - Brazil; inclusion of all the mother-newborn pairs with complete data (2275) in the Cadastro de Informações Perinatais (CIP) in the software EPI 6; from February/95 till June/96.RESULTS: Gestational weight gain between 12 and 20 kg resulted in a greater number of newborn with birthweights between 3000 and 3499g. Pregnancies with a weight gain below or equal 10 kg correlated with newborn of low birthweight (Odds ratio= 1.81; CI= 1.20-2.73; 95% of significance). Gestational gain beneath or equal to 12 kg had a greater risk of a newborn with insufficient weight - 2499< birthweight < 3000g - (Odds ratio= 1.47; CI= 1.19-1.81; 95% of significance). Gestational gain above 16 kg did not correlate with increase in birthweight.CONCLUSIONS: The gestational weight gain of 12 kg is the minimum increase of weight in order that the newborn is over 3000g. The gestational weight gain above 16 kg did not increase birthweight. The high social economic level was not sufficient to avoid low birthweight or insufficient weight at birth.

Prevalence of hearing loss in very low birthweight newborns

* Livre docente em Pediatria Neonatal pela Escola Paulista de Medicina-UNIFESP. Coordenadora do Curso de Especializacao em Perinatologiado Instituto de Ensino e Pesquisa Albert Einstein. Coordenadora daForca-Tarefa sobre Prevencao da Deficiencia Auditiva na Infância daSociedade Brasileira de Pediatria.

Curvas de crescimento intra-uterino de uma população de alto nível socioeconômico

OBJECTIVE: growth curves can be used to assess intrauterine growth, to predict diseases in newborns, and to characterize different populations. The objective of this study was to obtain intrauterine growth curves of newborns from the maternity ward of the Hospital Albert Einstein (MAE) and compare them with intrauterine growth curves of a population from California, USA. METHODS: We plotted the growth curves according to weight at birth and gestational age, which was obtained according to information from the mother, after the 32nd week of gestation, between February 1995 and February 1999. We calculated the birth weights for the 10th, 50th, and 90th percentiles of weight at birth for each gestational age and compared them with those of the growth curves from California. RESULTS: The growth curves for the 10th and the 50th percentiles did not differ from the California growth curves. For the 90th percentile, however, the MAE growth curves were lower than those of California. The MAE population presented fewer small-for-gestational age (SGA) and big-for-gestational age (BGA) newborns when assessed according to the California curves. The categories of SGA, normal, and BGA for both male and female newborns indicated a statistically significant relation with the weight gain of mothers. CONCLUSIONS: The two populations assessed in this study were different according to intrauterine growth curves. Further studies should be carried out in order to identify specific factors that may be acting on the MAE population.

Análise comparativa das gestações e da frequência de prematuridade e baixo peso ao nascer entre filhos de mães adolescentes e adultas

OBJECTIVE To perform a comparative analysis between the frequency of prematurity and low birth weight among newborns of adolescent and adult mothers, and to evaluate selected maternal data. METHODS A comparative cohort study involving 703 pregnant women and their newborns at a public hospital in the city of São Paulo (270 mothers aged 10-19 years, and 433 aged 20-35 years), during the period from March to August 2003. RESULTS The birth of premature or low birth weight children was not prominent in any of the age groups; the small differences found were not statistically significant. However, significant differences were found between the two age groups in the items: number of gestations, with a predominance of first pregnancies among adolescents (70.3%), and a greater number of second or third pregnancies among adults (26.9 and 53.3%, respectively); in the prenatal period, fewer clinic visits among adolescents and more visits among adults (45.1% and 63.3%, respectively). CONCLUSION The group of pregnant adolescents in the population studied did not differ from the group of adults as to frequency of prematurity and low birth weight. Among adolescents, there was a significantly higher number of primiparous patients compared to adults, and a lower number of prenatal visits.

Mid-arm circumference and mid-arm/head circumference ratio in term newborns

CONTEXT Mid-arm circumference of the newborn is strongly associated with birth weight and is a very good indicator of low and insufficient birth weight. However, there are few Brazilian studies on the relationship between mid-arm and head circumferences and, thus, this does not form part of the routine evaluation for newborns. OBJECTIVES To establish the mid-arm circumference and mid-arm/head circumference ratio in a population of term newborns. TYPE OF STUDY Cross-sectional study carried out between June 1997 and August 1999. SETTING Hospital Maternidade Leonor Mendes de Barros, São Paulo. PARTICIPANTS Term newborns (66 males and 65 females) of appropriate growth for gestational age, whose mothers were healthy, were included in the study. MAIN MEASUREMENTS Arm circumference, arm circumference/head circumference ratio, birth weight and gestational age were measured within 48 hours of birth. Data were considered significant when p < 0.01. RESULTS The mean values for the mid-arm circumference were 10.76 cm (standard deviation, SD = 0.68) for females and 10.76 (SD = 0.81) for males. The mean value for the mid-arm/head circumference ratio was 0.31 (SD = 0.02) for both sexes. Mid-arm circumference values were significantly related to birth weight and gestational age, whereas mid-arm/head circumference ratio was related only to birth weight. CONCLUSIONS Mid-arm circumference and mid-arm/head circumference ratio values were established for the studied population. It was possible to obtain curves for both mid-arm circumference and mid-arm/head circumference ratio in relation to birth weight. However, for mid-arm circumference, it was only possible to obtain curves in relation to gestational age. The use of the regression curves did not seem powerful enough to predict the mid-arm circumference and mid-arm/head circumference ratio in this population of term newborns. There were no gender differences for either of the measurements studied.

Physical exercise during pregnancy and its influence in the type of birth

OBJECTIVE To verify if medium intensity exercise performed during pregnancy can influence in the type of delivery, and to observe compliance to an exercise program among primiparous women with different levels of schooling. METHODS A study carried out at the Centro de Incentivo ao Aleitamento Materno, in São Sebastiao (SP), between April 7, 2008, and April 14, 2009. A prospective study involving 66 primiparous women who were divided into two groups: an Exercise Group, engaged in regular physical activity during pregnancy, and the Control Group, that did not participate in regular physical activity during the same period. Significance level in this project was 5% (p = 0.05). RESULTS The group that did engage in regular exercise had a higher rate of vaginal deliveries, with a statistically significance difference evaluated by the χ² test (p = 0.031). The pregnant women with the highest level of schooling showed greater compliance with the exercise program, with a statistically significant difference (p = 0.01736). CONCLUSION Physical exercise in primiparous women increased the chances of vaginal deliveries, and there was greater compliance with the exercise program among those with a higher level of schooling when compared to those with a basic education.

Color Doppler evaluation of the influence of type of delivery, sex, postnatal age and time post feeding on full term healthy newborns cerebral blood flow.

OBJECTIVE The purpose of this study was to evaluate with Color Doppler the influence of type of delivery, sex, postnatal age and time post feeding on full term healthy newborns cerebral blood flow. METHOD 50 newborns were studied. The Doppler parameters, peak-systolic velocity, end-diastolic velocity, mean velocity, pulsatility index and resistance index, were measured in the anterior cerebral artery, middle cerebral artery, posterior cerebral artery, and basilar artery. The data were compared and analyzed by statistical tests. Informed consent was obtained from all parents, and the study was approved by institutional ethical committee and review board. RESULTS We observed not statistically significant differences on cerebral blood flow Doppler parameters in relation to type of delivery, sex, postnatal age and feeding in full term healthy newborns. CONCLUSION We believe that the knowledge of these cerebral hemodynamic profile of newborns in the first days of life can contribute in an accurate interpretation of cranial Doppler abnormal findings when pathologic flow velocities are analyzed.

Influence of socioeconomic levels on birthweight of twins and singletons.

This study aimed to compare birthweight distribution of twins and singletons from three different socioeconomic level hospitals and evaluate the possible contribution of assisted reproduction technologies (ART). Data for twins and singletons were collected in the 1990s from hospitals A (370 twins, 370 singletons), B (306 twins, 306 singletons), and C (562 twins, 562 singletons). Only hospitals B and C have ART procedures. Gestational age was significantly lower in hospital C for singletons and twins. Birthweight for singletons was lower at hospital A (p <.005 for hospital B and p =.000 for hospital C); however, birthweight for twins was lower for hospitals A and C compared to hospital B (p =.000 for both comparisons). There were no differences between the mean birthweight for singletons and twins either to primigravidae or multigravidae in hospital A; nevertheless, for B and C the mean birthweight of twins was significantly lower in primigravidae than in multigravidae (p =.029 and p =.006, respectively). Considering twins up to 37-weeks of gestational age, hospital C showed the highest percentage of twin births (73.3%). These data suggest that the use of ART accounts for a disproportionate number of low birthweight and/or premature infants in primigravidae of higher socioeconomic level.