Lilian dos Santos Rodrigues Sadeck

Prediction of Length of Hospital Stay in Neonatal Units for Very Low Birth Weight Infants

OBJECTIVE:To develop models for estimating the length of hospital stay (LOS) of very low birth weight infants (VLBW), based on perinatal risk factors present during the first week of life and during the entire hospitalization period.STUDY DESIGN:The files of 155 VLBW were analyzed, and the influence of individual risk factors were initially evaluated by univariate analysis, using multiple-regression. Two mathematical models were built to estimate the LOS.RESULTS:The first model, using risk factors present during the first 3 days of life, is as follows: LOS = −0.074A + 22.06B + 22.85C − 16.78D − 2.07E + 10.51F + 203.12 (R2 = 0.63). (The letters are added to show what each number represents: A: birth weight; B: occurrence of respiratory distress syndrome; C: endotracheal intubation during resuscitation; D: 1-minute Apgar score; E: gestational age; F: presence of complications during delivery.) The second model, using factors present during the entire hospitalization period, is: LOS = 0.61G + 29.19H + 24.68I + 14.21J + 23.56K + 9.54L + 7.41M + 20.43 (R2 = 0.82). (G: age receiving nutritional support of ≥120 kcal/kg per day; H: occurrence of systemic candidiasis; I: birth weight < 1000 gm; J: presence of delivery complication; K: occurrence of bronchopulmonary dysplasia; L: birth weight ≥ 1000 gm and ≤ 1249 gm; M: occurrence of anemia).CONCLUSION: Both models are applicable for estimating the hospitalization period, and the addition of variables present during the entire hospitalization period improved the accuracy of the model.

Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units

BACKGROUND: Guidelines for red blood cell (RBC) transfusions exist; however, transfusion practices vary among centers. This study aimed to analyze transfusion practices and the impact of patients and institutional characteristics on the indications of RBC transfusions in preterm infants.

Immune response of preterm infants to hepatitis B vaccine administered within 24 hours after birth

OBJECTIVE To investigate the immune response of preterm infants to hepatitis B vaccination. METHODS Three doses of recombinant hepatitis B vaccine (5 micro g dose) were administered to 35 preterm and 21 full-term infants within 24 hours after birth and at one and six months of postnatal age. RESULTS A protective antibody response (anti-HB > 10 mUI/mL) was observed three months after the last dose in 92.6% and 100% of preterm and full-term infants (p > 0.05), respectively. Newborns with gestational age below 34 weeks presented lower antibody responses in all three periods. However, gestational age was not important to determine the antibody response in the three periods analyzed. When antibody response was analyzed in terms of birth weight, it was observed that a protective response was present in 75 and 100% of newborns with birth weight < or = 1,500 g and > 1,500 g, respectively. Birth weight was shown to be a relevant factor in determining a protective antibody response at six months of postnatal age. Nonresponders received a fourth vaccine dose and an adequate antibody response was obtained in 100%. CONCLUSION The antibody response of preterm infants was similar to that of term newborns. Hepatitis B vaccination can be initiated on the first day of life in preterm newborns, following the same scheme recommended for term newborns. However, in preterm infants with birth weight less than or equal to 1,500 g, whose antibody response is lower, anti-HB titers should be monitored at nine months of age, or a four-dose vaccination scheme should be provided, with doses on the first day of postnatal life and one, six and nine months later.

Longitudinal study of Cystatin C in healthy term newborns.

OBJECTIVE: The purpose of this study was to determine the levels of Cystatin C in healthy term newborns in the first month of life. INTRODUCTION: Cystatin C may be a suitable marker for determining the glomerular filtration rate because it is not affected by maternal renal function. METHODS: Cohort study. Inclusion: term newborns with appropriate weight; mother without renal failure or drugs that could affect fetal glomerular filtration rate. Exclusion: malformations; hypertension or any condition that could affect glomerular filtration rate. Cystatin C (mg/L) and creatinine (mg/dl) were determined in the mother (Mo) and in the newborn at birth (Day‐0), 3rd (Day‐3), 7th(Day‐7) and 28th(Day‐28) days. Statistics: one way ANOVA and Pearsons correlation tests. Sample size of 20 subjects for α  =  5% and a power test  =  80% (p<0.05). RESULTS: Data from 21 newborns were obtained (mean ± standard deviation): MoCystatin C = 1.00±0.20; Day‐0 Cystatin C 1.70±0.26; Day‐3 Cystatin C = 1.51±0.20; Day‐7 Cystatin C = 1.54±0.10; Day‐28 Cystatin C = 1.51±0.10. MoCystatin C was smaller than Day‐0 Cystatin C (p<0.001), while MoCreatinine was not different from Day‐0 Creatinine. Cystatin C only decreased from Day‐0 to Day‐3 (p = 0.004) but newborns Creatinine decreased along the time. Correlations were obtained between MoCystatin C and MoCreatinine (p = 0.012), as well as Day‐3 (p = 0.047) and Day‐28 (p = 0.022) Cystatin C and Creatinine values. CONCLUSION: Neonatal Cystatin C values were not affected by MoCystatin C and became stable from the 3rd day of life.

Predictive value of the "Clinical Risk Index for Babies" for the risk of neonatal death

OBJECTIVE Several indicators, mainly birthweight and gestational age, have been used to predict the mortality risk in neonatal intensive care units. In order to assess the potential value of CRIB in predicting neonatal mortality, the score was used over the first 12 hours of life of the newborns admitted to this unit, during the year of 1996. METHOD The inclusion criteria consisted of all infants without inevitably lethal congenital malformations, birthweight below 1,500 g and/or gestational age less than 31 weeks. Newborn children who died within 12 hours after delivery were excluded. The CRIB score covers birth weight, gestational age, the presence of congenital malformations (not inevitably lethal) and three indexes of physiological status during first 12 hours after birth-maximum and minimum appropriate fraction of inspired oxygen and maximum (most acidotic) base excess. RESULTS In a prospective cohort, seventy one newborn children were studied. The birthweight (average) was 1,119 +/- 275.6 g, gestational age 30 weeks 4/7 +/- 2 weeks 3/7; male (57%); Apgar 1(0) min. score < or = 3 (36.2%) and Apgar 5 degrees min. score < 5 (5.8%). The mortality rate was 29.6% (gold standard). But mortality rate by birthweight less than 1,000 gr. or gestational age lower than 29 weeks was 60.0% and for the CRIB score above 10 was 100%. DISCUSSION The specificity and predictive positive values for CRIB score above 10 were greater than any other two parameters. The area under the receiver operating characteristic (ROC) curve for predicting death was significantly greater for CRIB than for birthweight alone. It was concluded that the CRIB score is a better predictive indicator for mortality than are birthweight and gestational age.

Fatores de risco associados ao desmame em crianças até seis meses de idade no município de São Paulo

Objective: To evaluate risk factors associated to interruption of exclusive breastfeeding among children ≤6 months of age in Sao Paulo city in 2008. Methods: A special questionnaire (Breastfeeding and Cities Project-1998) was applied to the parents/guardians of children ≤6 months of age during the National Poliomyelitis Campaign. Sample calculation used a two stage cluster sampling procedure. The following groups were compared: I (children exclusively breastfed); II (children without exclusive breastfeeding). Factors analyzed: mother’s age and schooling, infant birth weight, gender, type of delivery, being born in a Baby-Friendly Hospital, presence of early breastfeeding, use of pacifier in the last 24 hours, and mother working outside home. Statistical analysis included binary logistic regression by SPSS 15.0, being significant p<0.05. Results: 724 interviews were performed with 275 (39.1%) children in Group I and 429 (60.9%) in Group II. Differences between groups were found on: use of pacifier

Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus

OBJECTIVE To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD. METHODS This was a multicentric, cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment), G2 - pharmacologic (indomethacin or ibuprofen), G3 - surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. OUTCOMES death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. STATISTICS Students t-test, chi-squared test, or Fishers exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significant. RESULTS 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) and ROPsur were observed in G3 (23.5%). The lowest occurrence of death/BPD36wks occurred in G2 (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments were protective for the outcome death/BPD36wks. CONCLUSION The conservative approach of PDA was associated to high mortality, the surgical approach to the occurrence of BPD36wks and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks.

Uso antenatal de corticosteróide e condições de nascimento de pré-termos nos hospitais da Rede Brasileira de Pesquisas Neonatais

PURPOSE: to assess the use of antenatal corticosteroid (AC) by mothers and its repercussion on the birth conditions of preterm babies at the eight university neonatal units belonging to the Brazilian Network of Neonatal Research. METHODS: an observational prospective cohort study. All 463 pregnant women with a gestational age (GA) of 23 to 34 weeks and their 514 newborn babies were evaluated during the period from August 1 to December 31, 2001. The data were obtained by maternal interview, by the analysis of the medical records and by the follow-up of the newborn infants, and analyzed statistically using c2, Mann-Whitney and ANOVA tests and multiple logistic regression, with the level of significance set at 0.05. RESULTS: 60.1% (282/463) of the pregnant women (a variation from 12.5 to 87.3% among units) received at least one AC dose. The AC use was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented higher birth weight (1,379±421 vs 1,244±543 g), longer gestational age (30.9±2.0 vs 29.5±3.5 weeks), better Apgar scores at the 1st and 5th minute, and a reduced need for intervention in the delivery room. The use of AC, the GA and a baby small for GA independently improved the birth conditions. CONCLUSIONS: at most centers, AC was administered at frequencies below the desired ones, and in 50% of cases in an inadequate manner. Treatment was applied more to mothers who received appropriate prenatal care and was associated with better birth conditions.

Indicações clínico-epidemiológicas para investigação ecocardiográfica no período neonatal. Valor dos grupos de risco

PURPOSE: An echocardiographic study was performed in newborns from risk groups, with the aim of to determining prevalence and to evaluate the indications for this test in the neonatal period. METHODS: One hundred fifty six newborns were studied . They were admitted to the Newborn ward of the Department of Obstetric of the HC-FMUSP, in the period of November 91 to April 93, from mothers with congenital heart disease or diabetes, low birth weight newborns, with extracardiac malformations, cardiac signs and/or congenital infections. RESULTS: The observed prevalence was 21.8%, greater than that of the general population (0.8-1.2%). The group composed by 27 children with extracardiac abnormalities presented the largest prevalence when compared with the other groups (40.7%). These data justify the use of echocardiography in high risk newborns for the detection of congenital heart disease.

Infant breastfeeding prevalence in the city of São Paulo, Brazil, 2008

This cross-sectional epidemiological study based on AMAMUNIC aimed to evaluate infant breastfeeding (BF) prevalence and duration in São Paulo, Brazil. Sample size was based on a cluster calculation, selecting 35 primary care units and 35 infants (< 1 year of age) per unit. A total of 1,424 interviews with mothers were performed (56 items on feeding in the previous 24 hours) in August 2008, subsequently analyzed according to residential areas: Central West, East, North, Southeast, and South. Prevalence of exclusive breastfeeding (EBF) was 52% up to three months and 39% up to six months, as follows: 44% (Central West), 57% (East), 62% (North), 43% (Southeast), and 48% (South) up to three months and 36% (Central West), 46% (East), 39% (North), 36% (Southeast), and 33% (South) up to six months. Prevalence of EBF according to infant age was 58% in the first month, 50% in the second and third, and 13% in the sixth. In conclusion, EBF prevalence up to six months is still heterogeneous in the city, suggesting the need for programs to encourage BF that are differentiated according to region.