Javier Meritano

Riesgo de morbimortalidad neonatal de recién nacidos < 1500 g asociado al volumen de pacientes, personal médico y de enfermería: una investigación multicéntrica latinoamericana

INTRODUCTION Few studies have attempted to evaluate the relationship between medical and nursing staffing and neonatal outcomes providing inconclusive evidence. The purpose was to assess whether morbidity and mortality of VLBW infants are associated with levels of patient volume, provision and training of medical and nursing, and if exist differences between public and private centers. MATERIAL AND METHODS Neonatal outcomes of all VLBW inborn infants consecutively admitted to 15 South-American NICUs between 2005 and 2007 were retrospectively studied. Data of patient volume and provision of medical & nursing resources were obtained from questionnaires. OUTCOME MEASURES death before discharge, incidence of severe IVH, BPD, ROP and late onset sepsis, adjusted for initial risk (Neocosur score). Units were categorized using total annual number of newborns < 1500 g (low < 50, medium 50-100, and high >100) and in public and private centers. RESULTS 2019 preterms were admitted. Mean (SD) gestational age, birth weight and initial risk were 28.9 (0.7) weeks, 1088 (53) g and 0.24 (0.04) respectively. Mortality varied among units and ranged between 6 to 38% (mean 23.2%), as well as other outcomes (median, intercuartil range [ICR]): severe IVH 7.3% (6-14); BPD 20.8% (15-43); ROP ≥ III 5.6% (2.7-8.5); late sepsis 23% (15-29). Staff provision were: daily medical hours (median, ICR) 2.6 (1.4-4.0), full-time (> 40 h/week) equivalent physicians (mean, SD) 15(8), daily nurse hours 6.1 (4.3-7.9), full-time (> 40 h/week) equivalent nurses 32 (22-56) and nurses-to-infant ratio 0.78 (0.52-0.92). Median daily NICU census was 9.8 (8.9-12). A low medical hours provision was significantly associated with increased mortality (OR 1.30 [95% CI: 1.04-1.76], p= 0.020); on the other hand low nurse provision was significantly associated with increased risk of mortality, adjusted by mother age and initial risk (trained NIC 1.52 [1.16 -1.99], nurses-to-infant ratio 1.81 [1.40-2.33]). Although public centers showed higher risk of morbidity and mortality compared with private centers, differences were statistically not significant. CONCLUSIONS In this population neonatal outcomes were associated with levels of patient volume and training of medical and nursing staff. No differences were observed between public and private centers.

Maternal periodontal disease and preterm birth: a case-control study

OBJETIVOS: A doença periodontal pode ser uma fonte de infecção subclínica persistente que pode induzir respostas inflamatórias sistêmicas que aumentam o risco de parto pré-termo. O objetivo deste estudo foi determinar se a doença periodontal é um fator de risco para o parto pré-termo, bem como avaliar a associação deste risco com a idade gestacional. MÉTODOS: Este estudo de caso-controle abrangeu mulheres puérperas de gestações únicas; 53 mulheres que deram à luz antes da 37a semana de gestação (casos) foram comparadas a 79 que evoluíram com parto a termo (controles). Procedeu-se a uma avaliação clínica periodontal completa dentro das 72 h após o parto. RESULTADOS: A taxa de prevalência da doença periodontal foi de 41% (54/132). Os casos de parto pré-termo apresentaram uma proporção de sangramento muito maior em comparação com os controles (86,7% versus 68%; p = 0,026), bem como uma profundidade máxima da bolsa periodontal maior após medição por sonda (3,9 ± 1,6 mm versus 3,2 ± 1 mm; p = 0,043). Não foram detectadas diferenças relacionadas à doença periodontal prévia, à perda de adesão ou à porcentagem de doença periodontal entre os grupos estudados. A análise de regressão logística revelou que o parto prétermo foi associado ao índice de sangramento (odds ratio ajustada de 4,19; 95% CI: 1,28 – 13,69; p = 0,018) e à profundidade da bolsa periodontal (5,14; 95% CI: 1,50 – 17,6; p = 0,009). O risco de nascimento pré-termo associado à doença periodontal diminuiu com o aumento da idade gestacional. Além disso, o risco atribuído à população em geral é de 16%, risco este que aumentou com a diminuição da idade gestacional. CONCLUSÃO: Neste estudo com base na população, apenas o índice de sangramento e a profundidade da bolsa periodontal foram considerados fatores de risco para o parto prematuro; um risco maior foi associado à maior prematuridade.OBJECTIVES: Periodontal disease can be a source of subclinical and persistent infection that may induce systemic inflammatory responses that increase the risk of preterm birth. The goal of this study was to establish whether periodontal disease is a risk factor for preterm birth, and to evaluate the association of this risk with gestational age. METHODS: This th case-control study included postpartum women with singleton gestations; 53 women who gave birth before the 37 week (cases) were compared to 79 women with term deliveries (controls). Full-mouth clinical periodontal parameters were determined within 72 h after delivery. RESULTS: The prevalence of periodontal disease was 41% (54/132). The preterm birth cases showed a significantly higher proportion of bleeding than the term birth controls (86.7% versus 68%, p = 0.026) and a greater maximum periodontal pocket depth on probing (3.9 ± 1.6 mm versus 3.2 ± 1 mm, p = 0.043). No differences in previous periodontal disease, attachment loss, or the percentage of periodontal disease were detected between the study groups. Logistic regression revealed that preterm birth was associated with the bleeding index (adjusted odds ratio 4.19; 95% CI: 1.28 – 13.69, p = 0.018) and with periodontal pocket depth (5.14; 95% CI: 1.50 – 17.6, p = 0.009). The risk of preterm birth associated with periodontal disease decreased as gestational age increased. In addition, the population attributable risk was 16% overall; this risk increased as gestational age decreased. CONCLUSION: In this study population, only the bleeding index and periodontal pocket depth were risk factors for preterm birth; increased risk was associated with greater prematurity.

Size at birth and blood pressure in young adults: findings from a Brazilian birth cohort study

OBJETIVO: Descrever a prevalencia de pressao arterial limitrofe (PAL) e hipertensao (HT) entre adultos jovens e avaliar a associacao entre tamanho ao nascer e PAL/HT. METODOS: Dados foram coletados do primeiro estudo brasileiro de coorte de nascimentos em Ribeirao Preto (sudeste do Brasil), iniciado em 1978/79. De 6.827 recem-nascidos de parto unico hospitalar, 2.060 foram avaliados aos 23/25 anos. Foram realizadas coleta de sangue, avaliacao antropometrica e obtidas informacoes sobre ocupacao, escolaridade, habitos de vida e doencas cronicas. Pressao arterial (PA) foi classificada em: 1) PAL: PA sistolica (PAS) ≥ 130 e < 140 mm Hg e/ou PA diastolica (PAD) ≥ 85 e < 90 mmHg; 2) HT: PAS ≥ 140 e/ou PAD ≥ 90 mm Hg. Foi aplicado modelo de regressao logistica politomica. RESULTADOS: A prevalencia de PAL foi de 13,5% (homens 23,2%) e a de HT, 9,5% (homens 17,7%). PAL foi independentemente associada com sexo masculino (RR 8,84; IC95%: 6,09;12,82), comprimento ao nascer ≥ 50 cm (RR 1,97; 1,04; 3,73), indice de massa corporal (IMC) ≥ 30 kg/m2 (RR 3,23; 2,02; 5,15) e circunferencia de cintura alterada (RR 1,61; 1,13;2,29), enquanto HT associou-se com sexo masculino (RR 15,18; 8,92;25,81), IMC ≥ 30 kg/m2 (RR 3,68; 2,23;6,06), circunferencia de cintura alterada (RR 2,68; 1,77;4,05) e glicemia elevada (RR 2,55; 1,27;5,10), mas nao com comprimento ao nascer. CONCLUSOES: As prevalencias de PAL e HT entre os adultos jovens dessa coorte foram maiores em homens que em mulheres. Maior comprimento ao nascer foi associado com PAL, mas nao com HT, enquanto peso ao nascer nao foi associado com PAL ou HT. Fatores de risco do adulto explicaram a maioria dos aumentos de PAL ou HT.OBJECTIVE To describe the prevalence of borderline blood pressure (BBP)and hypertension (HT) among young adults and to assess the association between size at birth and BBP/HT. METHODS Data were collected from the fi rst Ribeirão Preto Birth Cohort Study conducted in the city of Ribeirão Preto, southeastern Brazil, that started in 1978-1979. Of the 6,827 singletons born in hospitals, 2,060 were assessed at23-25 years of age. Blood samples were collected, an anthropometric assessment was performed, and information was obtained regarding occupation, schooling,life habits and chronic diseases. Blood pressure (BP) was classified as: 1) BBP:systolic BP (SBP) ≥ 130 mm Hg and < 140 mm Hg and/or diastolic BP (DBP)≥ 85 mm Hg and < 90 mm Hg; and 2) HT: SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg. A polytomic logistic regression model was used. RESULTS BBP prevalence was 13.5% (males: 23.2%) and HT prevalence 9.5% (males: 17.7%). BBP was independently associated with male gender(relative risk [RR] 8.84; 95%CI 6.09;12.82); birth length ≥ 50 cm (RR 1.97;1.04;3.73); body mass index (BMI) ≥ 30 kg/m2 (RR 3.23; 2.02;5.15); and high waist circumference (RR 1.61; 1.13;2.29), while HT was associated with male gender (RR 15.18; 8.92;25.81); BMI ≥ 30 kg/m2 (RR 3.68; 2.23;6.06); high waist circumference (RR 2.68; 1.77;4.05); and elevated blood glucose (RR2.55; 1.27; 5.10), but not with birth length. CONCLUSIONS The prevalence of BBP and HT among young adults of this cohort was higher in males than females. Greater birth length was associated with BBP, but not with HT, whereas birth weight was not associated with either BBP or HT. Adult risk factors explained most of the increase in the levels of BBP and HT.

Tamanho ao nascer e pressão arterial em adultos jovens: achados de uma coorte de nascimentos brasileira

OBJETIVO: Descrever a prevalencia de pressao arterial limitrofe (PAL) e hipertensao (HT) entre adultos jovens e avaliar a associacao entre tamanho ao nascer e PAL/HT. METODOS: Dados foram coletados do primeiro estudo brasileiro de coorte de nascimentos em Ribeirao Preto (sudeste do Brasil), iniciado em 1978/79. De 6.827 recem-nascidos de parto unico hospitalar, 2.060 foram avaliados aos 23/25 anos. Foram realizadas coleta de sangue, avaliacao antropometrica e obtidas informacoes sobre ocupacao, escolaridade, habitos de vida e doencas cronicas. Pressao arterial (PA) foi classificada em: 1) PAL: PA sistolica (PAS) ≥ 130 e < 140 mm Hg e/ou PA diastolica (PAD) ≥ 85 e < 90 mmHg; 2) HT: PAS ≥ 140 e/ou PAD ≥ 90 mm Hg. Foi aplicado modelo de regressao logistica politomica. RESULTADOS: A prevalencia de PAL foi de 13,5% (homens 23,2%) e a de HT, 9,5% (homens 17,7%). PAL foi independentemente associada com sexo masculino (RR 8,84; IC95%: 6,09;12,82), comprimento ao nascer ≥ 50 cm (RR 1,97; 1,04; 3,73), indice de massa corporal (IMC) ≥ 30 kg/m2 (RR 3,23; 2,02; 5,15) e circunferencia de cintura alterada (RR 1,61; 1,13;2,29), enquanto HT associou-se com sexo masculino (RR 15,18; 8,92;25,81), IMC ≥ 30 kg/m2 (RR 3,68; 2,23;6,06), circunferencia de cintura alterada (RR 2,68; 1,77;4,05) e glicemia elevada (RR 2,55; 1,27;5,10), mas nao com comprimento ao nascer. CONCLUSOES: As prevalencias de PAL e HT entre os adultos jovens dessa coorte foram maiores em homens que em mulheres. Maior comprimento ao nascer foi associado com PAL, mas nao com HT, enquanto peso ao nascer nao foi associado com PAL ou HT. Fatores de risco do adulto explicaram a maioria dos aumentos de PAL ou HT.OBJECTIVE To describe the prevalence of borderline blood pressure (BBP)and hypertension (HT) among young adults and to assess the association between size at birth and BBP/HT. METHODS Data were collected from the fi rst Ribeirão Preto Birth Cohort Study conducted in the city of Ribeirão Preto, southeastern Brazil, that started in 1978-1979. Of the 6,827 singletons born in hospitals, 2,060 were assessed at23-25 years of age. Blood samples were collected, an anthropometric assessment was performed, and information was obtained regarding occupation, schooling,life habits and chronic diseases. Blood pressure (BP) was classified as: 1) BBP:systolic BP (SBP) ≥ 130 mm Hg and < 140 mm Hg and/or diastolic BP (DBP)≥ 85 mm Hg and < 90 mm Hg; and 2) HT: SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg. A polytomic logistic regression model was used. RESULTS BBP prevalence was 13.5% (males: 23.2%) and HT prevalence 9.5% (males: 17.7%). BBP was independently associated with male gender(relative risk [RR] 8.84; 95%CI 6.09;12.82); birth length ≥ 50 cm (RR 1.97;1.04;3.73); body mass index (BMI) ≥ 30 kg/m2 (RR 3.23; 2.02;5.15); and high waist circumference (RR 1.61; 1.13;2.29), while HT was associated with male gender (RR 15.18; 8.92;25.81); BMI ≥ 30 kg/m2 (RR 3.68; 2.23;6.06); high waist circumference (RR 2.68; 1.77;4.05); and elevated blood glucose (RR2.55; 1.27; 5.10), but not with birth length. CONCLUSIONS The prevalence of BBP and HT among young adults of this cohort was higher in males than females. Greater birth length was associated with BBP, but not with HT, whereas birth weight was not associated with either BBP or HT. Adult risk factors explained most of the increase in the levels of BBP and HT.

Tamaño al nacer y presión arterial en adultos jóvenes: resultados de una cohorte de nacimientos brasileña

OBJETIVO: Descrever a prevalencia de pressao arterial limitrofe (PAL) e hipertensao (HT) entre adultos jovens e avaliar a associacao entre tamanho ao nascer e PAL/HT. METODOS: Dados foram coletados do primeiro estudo brasileiro de coorte de nascimentos em Ribeirao Preto (sudeste do Brasil), iniciado em 1978/79. De 6.827 recem-nascidos de parto unico hospitalar, 2.060 foram avaliados aos 23/25 anos. Foram realizadas coleta de sangue, avaliacao antropometrica e obtidas informacoes sobre ocupacao, escolaridade, habitos de vida e doencas cronicas. Pressao arterial (PA) foi classificada em: 1) PAL: PA sistolica (PAS) ≥ 130 e < 140 mm Hg e/ou PA diastolica (PAD) ≥ 85 e < 90 mmHg; 2) HT: PAS ≥ 140 e/ou PAD ≥ 90 mm Hg. Foi aplicado modelo de regressao logistica politomica. RESULTADOS: A prevalencia de PAL foi de 13,5% (homens 23,2%) e a de HT, 9,5% (homens 17,7%). PAL foi independentemente associada com sexo masculino (RR 8,84; IC95%: 6,09;12,82), comprimento ao nascer ≥ 50 cm (RR 1,97; 1,04; 3,73), indice de massa corporal (IMC) ≥ 30 kg/m2 (RR 3,23; 2,02; 5,15) e circunferencia de cintura alterada (RR 1,61; 1,13;2,29), enquanto HT associou-se com sexo masculino (RR 15,18; 8,92;25,81), IMC ≥ 30 kg/m2 (RR 3,68; 2,23;6,06), circunferencia de cintura alterada (RR 2,68; 1,77;4,05) e glicemia elevada (RR 2,55; 1,27;5,10), mas nao com comprimento ao nascer. CONCLUSOES: As prevalencias de PAL e HT entre os adultos jovens dessa coorte foram maiores em homens que em mulheres. Maior comprimento ao nascer foi associado com PAL, mas nao com HT, enquanto peso ao nascer nao foi associado com PAL ou HT. Fatores de risco do adulto explicaram a maioria dos aumentos de PAL ou HT.OBJECTIVE To describe the prevalence of borderline blood pressure (BBP)and hypertension (HT) among young adults and to assess the association between size at birth and BBP/HT. METHODS Data were collected from the fi rst Ribeirão Preto Birth Cohort Study conducted in the city of Ribeirão Preto, southeastern Brazil, that started in 1978-1979. Of the 6,827 singletons born in hospitals, 2,060 were assessed at23-25 years of age. Blood samples were collected, an anthropometric assessment was performed, and information was obtained regarding occupation, schooling,life habits and chronic diseases. Blood pressure (BP) was classified as: 1) BBP:systolic BP (SBP) ≥ 130 mm Hg and < 140 mm Hg and/or diastolic BP (DBP)≥ 85 mm Hg and < 90 mm Hg; and 2) HT: SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg. A polytomic logistic regression model was used. RESULTS BBP prevalence was 13.5% (males: 23.2%) and HT prevalence 9.5% (males: 17.7%). BBP was independently associated with male gender(relative risk [RR] 8.84; 95%CI 6.09;12.82); birth length ≥ 50 cm (RR 1.97;1.04;3.73); body mass index (BMI) ≥ 30 kg/m2 (RR 3.23; 2.02;5.15); and high waist circumference (RR 1.61; 1.13;2.29), while HT was associated with male gender (RR 15.18; 8.92;25.81); BMI ≥ 30 kg/m2 (RR 3.68; 2.23;6.06); high waist circumference (RR 2.68; 1.77;4.05); and elevated blood glucose (RR2.55; 1.27; 5.10), but not with birth length. CONCLUSIONS The prevalence of BBP and HT among young adults of this cohort was higher in males than females. Greater birth length was associated with BBP, but not with HT, whereas birth weight was not associated with either BBP or HT. Adult risk factors explained most of the increase in the levels of BBP and HT.

Doença periodontal materna e parto pré-termo: um estudo de caso-controle

OBJETIVOS: A doença periodontal pode ser uma fonte de infecção subclínica persistente que pode induzir respostas inflamatórias sistêmicas que aumentam o risco de parto pré-termo. O objetivo deste estudo foi determinar se a doença periodontal é um fator de risco para o parto pré-termo, bem como avaliar a associação deste risco com a idade gestacional. MÉTODOS: Este estudo de caso-controle abrangeu mulheres puérperas de gestações únicas; 53 mulheres que deram à luz antes da 37a semana de gestação (casos) foram comparadas a 79 que evoluíram com parto a termo (controles). Procedeu-se a uma avaliação clínica periodontal completa dentro das 72 h após o parto. RESULTADOS: A taxa de prevalência da doença periodontal foi de 41% (54/132). Os casos de parto pré-termo apresentaram uma proporção de sangramento muito maior em comparação com os controles (86,7% versus 68%; p = 0,026), bem como uma profundidade máxima da bolsa periodontal maior após medição por sonda (3,9 ± 1,6 mm versus 3,2 ± 1 mm; p = 0,043). Não foram detectadas diferenças relacionadas à doença periodontal prévia, à perda de adesão ou à porcentagem de doença periodontal entre os grupos estudados. A análise de regressão logística revelou que o parto prétermo foi associado ao índice de sangramento (odds ratio ajustada de 4,19; 95% CI: 1,28 – 13,69; p = 0,018) e à profundidade da bolsa periodontal (5,14; 95% CI: 1,50 – 17,6; p = 0,009). O risco de nascimento pré-termo associado à doença periodontal diminuiu com o aumento da idade gestacional. Além disso, o risco atribuído à população em geral é de 16%, risco este que aumentou com a diminuição da idade gestacional. CONCLUSÃO: Neste estudo com base na população, apenas o índice de sangramento e a profundidade da bolsa periodontal foram considerados fatores de risco para o parto prematuro; um risco maior foi associado à maior prematuridade.OBJECTIVES: Periodontal disease can be a source of subclinical and persistent infection that may induce systemic inflammatory responses that increase the risk of preterm birth. The goal of this study was to establish whether periodontal disease is a risk factor for preterm birth, and to evaluate the association of this risk with gestational age. METHODS: This th case-control study included postpartum women with singleton gestations; 53 women who gave birth before the 37 week (cases) were compared to 79 women with term deliveries (controls). Full-mouth clinical periodontal parameters were determined within 72 h after delivery. RESULTS: The prevalence of periodontal disease was 41% (54/132). The preterm birth cases showed a significantly higher proportion of bleeding than the term birth controls (86.7% versus 68%, p = 0.026) and a greater maximum periodontal pocket depth on probing (3.9 ± 1.6 mm versus 3.2 ± 1 mm, p = 0.043). No differences in previous periodontal disease, attachment loss, or the percentage of periodontal disease were detected between the study groups. Logistic regression revealed that preterm birth was associated with the bleeding index (adjusted odds ratio 4.19; 95% CI: 1.28 – 13.69, p = 0.018) and with periodontal pocket depth (5.14; 95% CI: 1.50 – 17.6, p = 0.009). The risk of preterm birth associated with periodontal disease decreased as gestational age increased. In addition, the population attributable risk was 16% overall; this risk increased as gestational age decreased. CONCLUSION: In this study population, only the bleeding index and periodontal pocket depth were risk factors for preterm birth; increased risk was associated with greater prematurity.

Enfermedad periodontal materna y parto pretérmino: un estúdio de caso-control

OBJETIVOS: A doença periodontal pode ser uma fonte de infecção subclínica persistente que pode induzir respostas inflamatórias sistêmicas que aumentam o risco de parto pré-termo. O objetivo deste estudo foi determinar se a doença periodontal é um fator de risco para o parto pré-termo, bem como avaliar a associação deste risco com a idade gestacional. MÉTODOS: Este estudo de caso-controle abrangeu mulheres puérperas de gestações únicas; 53 mulheres que deram à luz antes da 37a semana de gestação (casos) foram comparadas a 79 que evoluíram com parto a termo (controles). Procedeu-se a uma avaliação clínica periodontal completa dentro das 72 h após o parto. RESULTADOS: A taxa de prevalência da doença periodontal foi de 41% (54/132). Os casos de parto pré-termo apresentaram uma proporção de sangramento muito maior em comparação com os controles (86,7% versus 68%; p = 0,026), bem como uma profundidade máxima da bolsa periodontal maior após medição por sonda (3,9 ± 1,6 mm versus 3,2 ± 1 mm; p = 0,043). Não foram detectadas diferenças relacionadas à doença periodontal prévia, à perda de adesão ou à porcentagem de doença periodontal entre os grupos estudados. A análise de regressão logística revelou que o parto prétermo foi associado ao índice de sangramento (odds ratio ajustada de 4,19; 95% CI: 1,28 – 13,69; p = 0,018) e à profundidade da bolsa periodontal (5,14; 95% CI: 1,50 – 17,6; p = 0,009). O risco de nascimento pré-termo associado à doença periodontal diminuiu com o aumento da idade gestacional. Além disso, o risco atribuído à população em geral é de 16%, risco este que aumentou com a diminuição da idade gestacional. CONCLUSÃO: Neste estudo com base na população, apenas o índice de sangramento e a profundidade da bolsa periodontal foram considerados fatores de risco para o parto prematuro; um risco maior foi associado à maior prematuridade.OBJECTIVES: Periodontal disease can be a source of subclinical and persistent infection that may induce systemic inflammatory responses that increase the risk of preterm birth. The goal of this study was to establish whether periodontal disease is a risk factor for preterm birth, and to evaluate the association of this risk with gestational age. METHODS: This th case-control study included postpartum women with singleton gestations; 53 women who gave birth before the 37 week (cases) were compared to 79 women with term deliveries (controls). Full-mouth clinical periodontal parameters were determined within 72 h after delivery. RESULTS: The prevalence of periodontal disease was 41% (54/132). The preterm birth cases showed a significantly higher proportion of bleeding than the term birth controls (86.7% versus 68%, p = 0.026) and a greater maximum periodontal pocket depth on probing (3.9 ± 1.6 mm versus 3.2 ± 1 mm, p = 0.043). No differences in previous periodontal disease, attachment loss, or the percentage of periodontal disease were detected between the study groups. Logistic regression revealed that preterm birth was associated with the bleeding index (adjusted odds ratio 4.19; 95% CI: 1.28 – 13.69, p = 0.018) and with periodontal pocket depth (5.14; 95% CI: 1.50 – 17.6, p = 0.009). The risk of preterm birth associated with periodontal disease decreased as gestational age increased. In addition, the population attributable risk was 16% overall; this risk increased as gestational age decreased. CONCLUSION: In this study population, only the bleeding index and periodontal pocket depth were risk factors for preterm birth; increased risk was associated with greater prematurity.