José Ricardo Dias Bertagnon

Apgar score and neonatal mortality in a hospital located in the southern area of São Paulo City, Brazil.

OBJECTIVE To correlate the Apgar score, and neonatal mortality and its causes at a hospital located in the southern area of São Paulo City. METHODS A retrospective study performed by analysis of medical charts (n = 7,094) of all live newborns during the period of 2005 to 2009, with data up to 28 days of life in reference to weight, Apgar score, survival and cause of mortality. Cases were analyzed by the chi2 test (p < 0.05). RESULTS In 7,094 births, there were 139 deaths, 58.3% during the first week, and 3.6% of them with Apgar < 4 in the 1st minute. A positive association was found between mortality and this variable, with significantly declining values up to 2,000 g in weight. In the group with weight < 1,000 g, the association with Apgar < 4 in the 1st minute with mortality was three-fold greater than in the 1,000-1,500 g weight group, and 35-fold greater than in the > or = 3,000 g group. Among newborns with Apgar 8-10, the rate of mortality and low weight was two times greater than in those with weight > 2,499 g. Fetal distress and prematurity were associated with early neonatal death; malformations and fetal distress to late mortality. The predictive value of death with Apgar < 4 varied, according to weight, from 62.74% in the < 1,000 g group to 5.5%, in the > 3,000 g group. CONCLUSIONS The Apgar score proved linked to factors both epidemiological and related to attention given to the birth and neonatal mortality, and was associated with extremely low birth weight.

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.

Frequência de hemorragia peri-intraventricular e seus fatores associados em recém-nascidos prematuros

RESUMOObjetivo:Identificar a frequencia de hemorragia peri-intraventricular e levantar seus fatores associados em recem-nascidos prematuros.Metodos:Realizou-se um estudo transversal com levantamento de prontuarios de recem-nascidos prematuros que realizaram ultrassonografia transfontanelar no ano de 2007 em um hospital da periferia da zona sul da cidade de Sao Paulo.Resultados:Foram encontradas frequencia de 50% entre os recem-nascidos prematuros que realizaram ultrassonografia transfontanelar e frequencia de 15,35% dentre todos os recem-nascidos prematuros nesse hospital no ano de 2007. Observaram-se, como fatores associados a hemorragia intracraniana estatisticamente [...]

Frequency of peri-intraventricular hemorrhage and its associated factors in premature newborns

OBJECTIVE To identify the frequency of intracranial hemorrhage and its associated factors in premature newborns. METHODS A cross-sectional study based on a survey of medical records of premature neonates submitted to transfontanellar ultrasound at a hospital located in a southern neighborhood of the city of São Paulo, in 2007. RESULTS A 50% rate of intracranial hemorrhage was found among premature newborns submitted to transfontanellar ultrasound, and 15.35% among all premature babies born in this hospital in 2007. The statistically significant factors associated to intracranial hemorrhage were gestational age less than 32 weeks, absence of prenatal care, invasive mechanical ventilation, infection, blood transfusion, hyaline membrane disease, hyponatremia and hyperglycemia. CONCLUSIONS The frequency of peri-intraventricular hemorrhage was 50% in patients at risk and 15.35% among all premature babies; the associated factors were gestational age less than 32 weeks, absence of prenatal care, need of invasive mechanical ventilation, infection, blood transfusion, hyaline membrane disease, hyponatremia and hyperglycemia.

Birth weight distribution of Hospital Geral do Grajaú population compared to São Paulo city population.

OBJECTIVE To compare the growth curves from a population from a large city suburban hospital with those of the city of São Paulo, São Paulo State, Brazil. METHODS At Hospital Geral do Grajaú, that serves the high pregnancy risk population lacking health facilities, of low education level and smaller number of prenatal visits and great morbidity, a growth curve was built for the newborns, as the Hospital is provided with updated equipment and personnel. The curve was built from the database available containing information on live births during the 2003 to 2007 period and totaling 9,952 newborns, as their weight at birth and gestational age were taken as parameters. The distribution curves of 3%, 10%, 50% and 90% of the Grajaú were compared to those of the city of São Paulo curve. RESULTS The curves did not significantly differ from those of the São Paulo curve percentiles, as shown by the mean deviation (Z score) calculation, notwithstanding the higher rates for prematurity, low weight, teenager mothers and lack of prenatal visits among the Grajaú population as compared to those of São Paulo. CONCLUSIONS The São Paulo city curve showed to be appropriate for the suburban population despite the existing differences.

Avaliação das internações de crianças de 0 a 5 anos por infecções respiratórias em um hospital de grande porte

RESUMOObjetivo:Avaliar internacoes de criancas de 0 a 5 anos por infeccoes respiratorias em um hospital de grande porte da zona sul de Sao Paulo.Metodos:Foram utilizados 4.240 prontuarios de criancas internadas com os diagnosticos de pneumonia, broncopneumonia, bronquiolite e bronquite, no ano de 2008 a 2009, utilizando-se como base idade, genero e estacoes do ano.Resultados:Desse total de criancas entre 0 a 60 meses de idade, 139 (3,2%) tiveram pneumonia, com discreto predominio do sexo feminino, e 73,4% ocorreram entre 12 a [...]

Distribuição do peso ao nascer da população do Hospital Geral do Grajaú comparada à da população da cidade de São Paulo

RESUMOObjetivo:Comparar a curva de crescimento intrauterino de uma populacao que se serve de um hospital da regiao periferica com a curva de crescimento intrauterino da cidade de Sao Paulo, Brasil.Metodos:O Hospital Estadual do Grajau serve a uma populacao com gestacao de alto risco, com falta de recursos de saude, baixo nivel de escolaridade, poucas consultas de pre-natal e grande morbidade. O hospital que atende a essa populacao tem recursos e pessoal especializado, o hospital escola de medicina. A curva foi [...]

Bilirubin encephalopathy due to Rh incompatibility

The authors present the case of a newborn of an Rh-factorsensitized mother, who received early hospital discharge while icteric only to be readmitted at an Emergency Service at five days of age with signs of kernicterus. Despite treatment given, the neonate progressed with a clinical picture of bilirubin encephalopathy. The lack of interaction between the obstetric and neonatal teams, premature hospital discharge, and lack of concern of neonatologists with jaundice in a full-term infant are highlighted as causes of a condition that should have disappeared if there had been adequate prevention.

Associação de afecções neonatais com a relação peso/ comprimento e a adequação de peso para idade gestacional

RESUMOObjetivo:Verificar qual a frequencia de afeccoes em cada extrato de recem-nascidos classificados segundo relacao peso/comprimento e comparar com essas frequencias nos extratos da classificacao segundo a adequacao do peso para a idade gestacional.Metodos:Estudo retrospectivo transversal por avaliacao de prontuario de todos os recem-nascidos vivos no Hospital Geral do Grajau, de Setembro a Dezembro de 2009 (n =577),classificados segundo a relacao peso/ comprimento e tambem pela adequacao peso para idade gestacional. Foram calculados os percentis 10 e 90 da distribuicao da [...]

Evaluation of hospitalization of children aged 0 to 5 years admitted for respiratory infections at a large hospital

OBJECTIVE To evaluate the admission of children aged 0 to 5 years due to respiratory infections at a major hospital in the Southern region of the city of São Paulo. METHODS A total of 4,240 clinical records of children hospitalized and diagnosed with pneumonia, bronchopneumonia, bronchiolitis and bronchitis were evaluated for the 2008-2009 period, based on age, gender and year season. RESULTS Out of this total of children aged 0 to 60-months, 139 (3.2%) presented with pneumonia, with a slight predominance in female babies, and 73.4% occurred between 12 and 60 months (102 cases), particularly during the winter. No significant difference was found as to gender in bronchopneumonia. Age range and year seasons showed to be significant. As regards to bronchiolitis, there was a slight increase in male babies (253 cases) aged less than 12 months and in the autumn season. A total of 182 (4.3%) presented with bronchitis, mainly boys (101 cases) in children aged 12 to 60 months, predominantly during autumn/summer seasons. CONCLUSION The assessment of admissions of children aged 0 to 5 years due to respiratory infections at a major hospital at the Southern region of the city of São Paulo, in the 2008-2009 period, showed that respiratory diseases affect age groups, and gender in a different way occurring in specific periods of the year.