Kátia Silveira da Silva

Valores de predição da avaliação neurológica e ultra-sonográfica cerebral neonatal em relação ao desenvolvimento de prematuros de muito baixo peso

OBJETIVO: Verificar os valores de predicao de dois exames (neurologico e ultra-sonografico) realizados no periodo neonatal, em relacao ao desenvolvimento neuromotor e cognitivo de prematuros. METODO: Foram estudados 70 prematuros com peso de nascimento inferior a 1.500g. A media do peso de nascimento e idade gestacional foram, respectivamente, 1.185g (DP:180) e 32,2 semanas (DP:1,4). Foi realizada avaliacao neurologica pelo metodo de Dubowitz e Dubowitz e ultra-sonografia cerebral por volta de 40 semanas de idade corrigida. Apos a alta do bercario estas criancas foram acompanhadas no ambulatorio de seguimento. RESULTADOS: Com idade media de 21 meses (DP: 4,9) corrigidos para a prematuridade, 25,7% das criancas apresentaram comprometimento neuromotor, e 20,3%, alteracao cognitiva. O exame neurologico neonatal foi mais sensivel que especifico em relacao a alteracao neuromotora (sensibilidade:77,7%, especificidade:57,6%), e cognitiva (sensibilidade: 78,5%, especificidade: 56,4%), e apresentou baixo valor de predicao tanto para alteracao neuromotora (38,9%) quanto cognitiva (31,4%). A ultra-sonografia apresentou elevada especificidade tanto para o desenvolvimento neuromotor (92,3%) quanto cognitivo (89,1%). O valor preditivo da ultra-sonografia foi satisfatorio para anormalidades neuromotoras (69,2%), porem baixo para as alteracoes cognitivas (50,0%). CONCLUSAO: A associacao dos dois exames com resultados anormais apresentou valores de predicao mais elevados para as anormalidades nas duas areas do desenvolvimento.

Resultado do teste rápido anti-HIV após o parto: uma ameaça à amamentação ao nascimento

OBJECTIVE To analyze factors associated with failure to breastfeed during the first hour of life, especially the influence of time of delivery of rapid HIV test results. METHODS Cohort study, beginning with the administration of the rapid test and ending the first time the baby is breastfed. The study population included 944 delivering mothers that received rapid HIV testing with a negative result in five Baby-Friendly hospitals of the High-Risk Pregnancy System in the city of Rio de Janeiro, Southeastern Brazil, in 2006. Trained interviewers obtained data from laboratory and patient charts and interviewed mothers shortly after delivery. The influence of sociodemographic variables and antenatal and delivery care characteristics on failure to breastfeed during the first hour of life was determined through a multilevel model. RESULTS Among participants, 15.6% received the result of rapid HIV testing before delivery, 30.8% after delivery, and 53.6% had not yet been informed of their results at the time of the interview. Prevalence of failure to breastfeed in the first hour of life was 52.5% (95% CI: 49.3;55.8). After adjustment, having received the result of rapid testing only after delivery doubled the risk of failing to breastfeed in the first hour (RR=2.06; 95% CI: 1.55;2.75). Other risk factors included nonwhite skin color, maternal income of up to one minimum wage, delivery by C-section, mothers lack of desire to breastfeed at birth, and mothers report that the hospital staff did not listen to her. Lack of knowledge of HIV testing from the mothers part was found to be a protective factor. CONCLUSIONS The major risk factor for not breastfeeding in the first hour of life was failure to receive the results of rapid HIV testing prior to delivery. HIV testing should be made widely available during antenatal care; rapid testing should be performed upon admission, only when indicated, and with active search and prompt delivery of results to expecting mothers.OBJETIVO: Analisar fatores associados a nao-amamentacao na primeira hora de vida, sobretudo a influencia do momento do resultado do teste rapido anti-HIV. METODOS: Estudo de coorte, sendo o ponto inicial a submissao ao teste rapido e o final a primeira mamada do bebe. A populacao estudada incluiu 944 parturientes submetidas ao teste rapido anti-HIV, com resultado negativo, em 2006, nos cinco hospitais amigos da crianca do Sistema de Gestacao de Alto Risco no municipio do Rio de Janeiro, RJ. Entrevistadoras treinadas obtiveram dados do laboratorio e do prontuario e no pos-parto aplicaram questionario para entrevista as maes. O modelo multinivel foi adotado para analisar a influencia de caracteristicas sociodemograficas, de assistencia pre-natal e ao parto sobre a nao-amamentacao na primeira hora de vida. RESULTADOS: Dentre as participantes, apenas 15,6% receberam seu resultado antes do parto, 30,8% depois do parto e 53,6% ainda desconheciam o resultado ao ser entrevistada. A prevalencia de nao-amamentacao na primeira hora de vida foi de 52,5% (IC 95%: 49,3;55,8). Apos ajuste, o recebimento do resultado do teste rapido apos o parto dobrou o risco da nao-amamentacao na primeira hora de vida (RR=2,06; IC 95%: 1,55;2,75). Outros fatores de risco foram: cor nao branca, renda materna de um salario minimo ou menos, parto cesareo, mae nao querer amamentar o bebe ao nascimento e mae referir que a equipe hospitalar nao a escutava. O desconhecimento da realizacao do teste rapido anti-HIV pela mae se mostrou como fator de protecao. CONCLUSOES: O principal fator de risco para a nao-amamentacao na primeira hora de vida foi o recebimento do resultado do teste rapido apos o parto. O teste anti-HIV deve ser amplamente disponibilizado no pre-natal e o teste rapido deve ser realizado sob indicacao, na admissao, com busca ativa e pronta comunicacao do resultado a mulher.

Neonatal sepsis as a risk factor for neurodevelopmental changes in preterm infants with very low birth weight

OBJECTIVE to evaluate neonatal sepsis as a risk factor for abnormal neuromotor and cognitive development in very low birth weight preterm infants at 12 months of corrected age. METHODS this was a prospective cohort study that followed the neuromotor and cognitive development of 194 very low birth weight preterm infants discharged from a public neonatal intensive care unit. The Bayley Scale of Infant Development (second edition) at 12 months of corrected age was used. The outcomes were the results of the clinical/neurological evaluation and the scores of the psychomotor development index (PDI) and mental development index (MDI) of the Bayley Scale of Infant Development II. The association between neonatal sepsis and neuromotor development and between neonatal sepsis and cognitive development was verified by logistic regression analysis. RESULTS mean birth weight was 1,119g (SD: 247) and mean gestational age was 29 weeks and 6 days (SD: 2). Approximately 44.3%(n=86) of the infants had neonatal sepsis and 40.7% (n=79) had abnormal neuromotor development and/or abnormal psychomotor development index (PDI < 85) at 12 months of corrected age. On the mental scale, 76 (39.1%) children presented abnormal cognitive development (MDI<85). Children with neonatal sepsis were 2.5 times more likely to develop changes in neuromotor development (OR: 2.50; CI: 1.23-5.10). There was no association between neonatal sepsis and cognitive development impairment. CONCLUSION neonatal sepsis was an independent risk factor for neuromotor development impairment at 12 months of corrected age, but not for mental development impairment.

Gravidez recorrente na adolescência e vulnerabilidade social no Rio de Janeiro (RJ, Brasil): uma análise de dados do Sistema de Nascidos Vivos

Repeated pregnancy (RP) among adolescents is seldom researched in Brazil, even tough the debate on the reproductive rights is important for this extract of population. A transversal study was developed with data from the Declaration of Live Births of adolescent mothers, living in Rio de Janeiro (RJ, Brazil), in 2005. The aim was to estimate the magnitude and features associated with RP. Prevalence ratios (PR) of RP, with 95% confidence interval (CI) for selected variables, were estimated through log-binomial multivariate regression. Among 12,168 adolescents, a RP prevalence of 29.1% was identified and the principal factors associated were: age 15-19 anos (PR=5.42; RI 95% 3.72-7.81); not doing prenatal consultation (RP=2.36; CI 95% 2.16-2.58); educational status<4anos (PR=1.48; CI 95% 1.25-1.76); housewife job (PR=1.8; CI 95% 1.57-2.15) or other (PR=1.9; CI 95%; 1.73-2.10). Giving birth by cesarean section and low birth weight were negatively associated to repeated pregnancy with RP equal to 0,94 (CI 95%; 0,86-0,99) and 0.69 (CI 95%; 0.62-0.77). The adolescents with RP had worst socioeconomic and assistance indicators than those on their first pregnancy. Specific social policies for adolescent mothers, in vulnerable situation, will enable them to have better conditions to exercise their reproductive rights.

Pre-invasive cervical disease and uterine cervical cancer in Brazilian adolescents: prevalence and related factors

The objective was to describe the prevalence and factors associated with uterine cervical cancer (CA) and high-grade squamous intraepithelial lesions (HSIL) in adolescents. A cross-sectional study was carried out with 702 sexually active adolescents treated at a general hospital in Rio de Janeiro, Brazil, from 1993 to 2002. Screening was performed by cytopathology and colposcopy and confirmation by biopsy. Exposure variables were socio-demographic characteristics and those related to reproductive health, habits, and sexual behavior. Adjusted odds ratios were estimated using multivariate logistic regression analysis. Based on histopathology, the prevalence of HSIL/CA was 3% (95%CI: 1.8-4.6). There was one case of invasive cancer. With each additional pregnancy, the odds of HSIL/CA increased by 2.2 (95%CI: 1.1-4.4). Age was also associated with this outcome, doubling the odds of acquiring this degree of disease with each year of age (OR = 2.0; 95%CI: 1.2-3.4). The prevalence of lesions suggests the importance of including sexually active adolescent females in cervical cancer screening programs aimed at early detection and treatment of these lesions.

Fatores associados à morbidade respiratória entre 12 e 36 meses de vida de crianças nascidas de muito baixo peso oriundas de uma UTI neonatal pública

The aim of this paper was to estimate respiratory morbidity and its determinants for premature infants aged 12 to 36 months. The population comprised 84 infants from a cohort of very low birth weight premature infants. The outcome was the respiratory morbidity incidence rate. The relationship between the independent variables and respiratory morbidity was estimated using a Poisson regression model. From 12 to 24 months of age, 56.3% of children had experienced at least one episode of respiratory disease. >From 24 to 36 months, 38.1% of children were affected. Variables significantly associated with respiratory morbidity were bronchopulmonary dysplasia (RR = 1.9; 95%CI: 1.2-2.9), abnormal lung compliance (RR = 1.6; 95%CI: 1.1-2.3), neonatal pneumonia (RR = 2.8; 95%CI: 1.9-4.0), patent ductus arteriosus (RR = 1.6; 95%CI: 1.1-2.5), and respiratory morbidity in the first year of life (RR = 1.7; 95%CI: 1.2-2.5). The incidence of respiratory morbidity remains high in this group of high-risk infants, which calls for regular follow-up and effective interventions to prevent respiratory disease and to improve the quality of life of these children and their families.

Risco reprodutivo e renda familiar: análise do perfil de gestantes

Faced with the challenge of tackling maternal and perinatal morbidity and mortality, the discussion of reproductive risk and its association with health vulnerability situations is relevant to public health. The research carried out at Instituto Fernandes Figueira/Fiocruz sought to describe the reproductive risk profile of women admitted to prenatal care between 2006 and 2008 and investigating its relation to family income and health vulnerability situations. This is a cross-sectional study which used the prenatal care database as its source. The economic profile of the group under scrutiny is a low income group. An association between low income and fetal malformations, pregnancy before 15 years of age, and HIV was detected. A higher family income was associated with the mothers age over 35 years, abnormal nuchal translucency, gynecopathies, and habitual abortion. The findings may reflect vulnerability situations of low income women, such as unfavorable health conditions and limited access to and use of health services. It is necessary to acquire in-depth knowledge of the reproductive risk profile in Brazil and its distribution according to socio-demographic characteristics, seeking to enhance health care practices provided.

Escala de apoio social aplicada a uma população de gestantes: confiabilidade teste-reteste e estrutura de concordância dos itens

There is a growing interest in research on the association between social support and health outcomes. The objective of this study was to evaluate the reliability and structure of agreement of a social support scale. Test-retest reliability was measured in a group of pregnant women (n = 65) in a public maternity ward. Intraclass correlation coefficient (ICC) and quadractically weighted kappa (kw2) were used as agreement measures. Log-linear statistical models were fitted to describe patterns of agreement. ICC for social support score was 0.90. The kw2 ranged from 0.23 to 0.70. Log-linear models that provided the best fit to the data were diagonal agreement plus linear-by-linear association and quasi-independence models. The scale was considered a reliable instrument to measure social support scale in low-income pregnant women.

Prognosis of Intraepithelial Cervical Lesion during Adolescence in Up to Two Years of Follow-Up

Our objective was to describe the evolution of cervical SIL within 24 months of the initial diagnosis, in a cohort study of 147 sexually active adolescents attending a public health service in Rio de Janeiro, between 1993 and 2006. The participants were divided in two groups, according to whether cervical biopsy was performed or not. The median of the interval between sexual debut and the atypical cytopathology was 12 months and in 8.2% of patients there was a diagnosis of HSIL at the first abnormal smear. After a two-year follow-up by cytology, the regression (ASCUS 91%, LSIL 63.6%, HSIL 50%) and progression (LSIL 6.1%) were verified. In the group undergoing biopsy, the final histological regression reached 59.4% for CIN1 and 71.4% for CIN2, while the progression from CIN1 to CIN 2/3 was 3.1%. Our results corroborate the recommendation for conservative management in compliant adolescents due to a high regression rate. However, there should be maintained a careful follow-up based on the possible evolution of the lesion.

Predictive factors for neuromotor abnormalities at the corrected age of 12 months in very low birth weight premature infants

BACKGROUND The increase in survival of premature newborns has sparked growing interest in the prediction of their long-term neurodevelopment. OBJECTIVE To estimate the incidence of neuromotor abnormalities at the corrected age of 12 months and to identify the predictive factors associated with altered neuromotor development in very low birth weight premature infants. METHOD Cohort study. The sample included 100 premature infants. The outcome was neuromotor development at 12 months classified by Bayley Scale (PDI) and neurological assessment (tonus, reflexes, posture). A multivariate logistic regression model was constructed. Neonatal variables and neuromotor abnormalities up to 6 months of corrected age were selected by bivariate analysis. RESULTS Mean birth weight was 1126g (SD: 240). Abnormal neuromotor development was presented in 60 children at 12 months corrected age. CONCLUSION According to the model, patients with a diagnosis including bronchopulmonary dysplasia, hypertonia of lower extremities, truncal hypotonia showed a 94.0% probability of neuromotor involvement at 12 months.