Relação do peso de recém-nascidos e placentas. Estudo em recém-nascidos de termo, pré-termo e pós-termo, de pesos adequado, baixo e grande para a idade gestacional

Birth weight and placental weight of 566 newborns were determined. The newborns were classified by birth weight and gestational age in seven groups: term, preterm and postterm newborns with weight appropriate for gestational age; term and postterm newborns small for gestational age; term and preterm newborns large for gestational age. The differences in the mean placental weight in the preterm, term and postterm newborns with weight appropriate for gestational age were not significant. After 34 weeks of gestation there was little increase in placental weight. The mean placental weight of newborns large for gestational age was significantly different from that of term newborns appropriate for gestational age. In the term and postterm newborns small for gestational age the mean placental weight was significantly different from term and postterm newborns appropriate for gestational age. These findings suggest that newborns with an appropriate intrauterine growth have little increase in placental weight in the gestational period. Gestational age is not an important factor in determining placental weight in this period. Nutrition is important for placental growth-retarded infants have small placentas and large-for-date infants have large placental weight.

Estudo do peso e da idade gestacional de recem-nascidos e dos fatores que interferem no desenvolvimento fetal: nivel socio-economico, fatores maternos, fetais e placentarios

The present study was undertaken to determine the importance of socioeconomic factors (family income), urban or rural family location, parity, maternal age, the presence of maternal and fetal pathologies as well as placental abnormalities on the weight and gestational age of 566 newborns. The highest incidence of newborns with low birth weight for gestational age was significantly more frequent in urban populations when the mothers were from low socio-economic levels. In mothers from low socioeconomic levels infants with low birth weight for gestational age were seen in greater proportion among primaparas and had a tendency to be higher in mothers aged less than 20 years; prematurity was highest in mothers ≥ 30 years old and significantly higher from the 8th gestation on. Maternal and fetal pathologies emphasized these characteristics and placental pathologies were not correlated with the distribution of weight and length of gestation. In mothers of high socioeconomic levels age and parity were not correlated with weight and gestational age of the newborns.

Alterações anatomopatológicas placentárias. Relação com o peso e idade gestacional de recém-nascido

The authors studied gross and histological abnormalities of placentae from 566 newborns, grouped according to birth and gestational age. The relation of hemorragic abnormalities, infections of membranes and placental tissue, chronic infections, calcifications, hydropic degeneration of villi, chorangioma, cysts, vascular lesions (endarteritis) with newborn weight, length of gestation and intrauterine growth retardation were determined. We concluded that lesions due to disturbances of placental blood flow were significantly more frequent in placentae from term newborns small for gestational age; villi hydropic degenerations were more frequent in placentae of pre-term newborns appropriate for gestational age. Chronic infections had a tendency to be greater in placentae from infants with diminished intrauterine growth. Term newborns small for gestational age had greater proportions of placental abnormalities than the other groups.

Morphological aspects of the mid-palatal suture in the human foetus: A light and scanning electron microscopy study

Morphological features of the mid-palatal suture were studied in human foetuses from 4 to 9 months of intra-uterine life. The foetuses were divided into three age groups, GI (16-23 weeks), GII (24-31 weeks) and GIII (32-39 weeks). The mid-palatal suture in GI foetuses is rectilineal in form with a wide space between the palatal processes of the maxilla. The suture has a sinuous nature in GII and GIII foetuses due to growth of the bone processes crossing the mid-line. A wide zone of cellular proliferation observed in GI narrows in GII and GIII foetuses. The imbricating nature of the suture in GII and GIII is caused by bone growth adjacent to the mid-palatal suture. Sharpey's fibres, emerging from the bone processes, run to the median region of the mid-palatal suture and are observed from GI foetuses onwards. The collagen fibres of the mid-palatal suture are orientated transversely under the oral epithelium and exhibit a regular meshwork with a predominance of sagittal fibres in the median region of the suture. These fibres are orientated transversely and obliquely at the junction with the nasal septum.

Evaluation of lacrimal system outflow in the newborn by dye tests

PURPOSE: The aim of this study was to evaluate the outflow from the lacrimal excretory system (LES) at birth. METHOD: Two-hundred LES were evaluated by the Milder Test (DDT) and the modified Jones I Test (JIT) in 100 newborns (NBs) from 31 (T 1) until 42 (T 3) weeks of gestational age. The occurrence of obstruction was related to sex, weight at birth, presence of ocular discharge and the degree of maturity. RESULTS: Both tests were in agreement and showed LES obstruction in 61.5% (DDT) and 78.5% (JIT), respectively, while the LES outflow increased with increasing maturity. CONCLUSION: Evaluation of LES outflow at birth reveals obstruction rates that are much higher than those clinically observed in children with complaints of epiphora.

Relação entre comprimento craniocaudal e diãmetro da vesícula embrionária/fetal com idade de gestação por meio de avaliação ultra-sonográfica em ovino da raça Bergamácia

This study aimed to relate embryonic/fetal vesicle diameter (EVD) and crown-rump length (CRL) to gestational age in ewes from the 15 th to the 45 th day of pregnancy. Nineteen adult Bergamácia ewes with synchronized estrus were mated by the same male. Ultrasonographic evaluations were performed every 24 hours from the 15 th to the 30 th day after mating and every five days from the 30 th to the 45 th day using 5.0 and 7.5MHZ linear transducers. Average daily growth of EVD and CRL were 1.40mm and 1.33mm, respectively. The inverse calibration obtained for EVD was: Days = -11 + 50(0.1 + 0.04log EVD) 1/2 with R 2 = 0.85, and for CRL was: Days = 13.63 + 12.5(- 0.71 + 0.16CRL) 1/2 with R 2 = 0.93. Both EVD and CRL obtained by ultrasonography are useful measurements that allow the prediction of gestational age in Bergamácia ewes.

Efeito da posição do prematuro no desmame da ventilação mecânica

Objective: the purpose of this study was to determine the effects of prone positioning on cardiorespiratory stability and weaning outcome of preterm infants during weaning from mechanical ventilation. Methods: from January to December 1999, a sample of 42 preterm infants, with birthweight < 2,000 g, mechanically ventilated in the first week of life, were randomly divided, in the beginning of the weaning process, in two groups according to the position: supine position (n = 21) or prone position (n = 21). Heart rate, respiratory rate, transcutaneous oxygen saturation and ventilatory parameters were recorded every one hour. Length of the weaning process and complications were also assessed. Results: in both groups the mean gestational age was 29 weeks, most of the patients presented very low birthweight and respiratory distress syndrome. The mean length of the weaning process was 2 days. There were no differences between the groups regarding respiratory rate, heart rate and transcutaneous oxygen saturation, however, oxygen desaturation episodes were more frequent in supine position (p = 0.009). Ventilatory parameters decreased faster and reintubation was less frequent in the prone group (4% versus 33%). No adverse effects of prone positioning were observed. Conclusion: these results suggest that prone position is a safe and beneficial procedure during the weaning from mechanical ventilation and may contribute to weaning success in preterm infants.

Antenatal corticosteroid use and clinical evolution of preterm newborn infants

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment 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 better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection. Copyright © 2004 by Sociedade Brasileira de Pediatria.

Growth and developmental outcomes of the extremely preterm infant

Objetive: To provide information for pediatricians and neonatologists to create realistic outcome expectations and thus help plan their actions. Sources of data: Searches were made of the Cochrane Library, MEDLINE, and Lilacs databases. Summary of the findings: The assessment of growth and development over the first 2-3 years must adjust chronological age with respect of the degree of prematurity. There is special concern regarding the prognoses of small for gestational age preterm infants, and for those with bronchopulmonary dysplasia. Attention must be directed towards improving the nutrition of extremely low birth weight infants during their first years of life; these infants have high prevalence levels of failure to catch-up on growth, diseases and rehospitalizations during their first 2 years. They are frequently underweight and shorter than expected during early childhood, but delayed catch-up growth may occur between 8 and 14 years. Extremely low birth weight infants are at increased risk of neurological abnormalities and developmental delays during their first years of life. Educational, psychological, and behavioral problems are frequent during school years. Teenage and adult outcomes show that although some performance differences persist, social integration is not impaired. Conclusions: The growth and neurodevelopment of all ELBW infants must be carefully monitored after discharge, to ensure that children and their families receive adequate support and intervention to optimize prognoses. Copyright © 2005 by Sociedade Brasileira de Pediatria.

The influence of sardine consumption on the omega-3 fatty acid content of mature human milk

Objectives: The purpose of this study was to investigate what effect the ingestion of sardines, rich in omega-3 series polyunsaturated fatty acids, has on the composition of breastmilk. Methods: This was a prospective study of 31 nursing mothers under observation at the Hospital Guilherme Álvaro. Each was given 2 kg of fresh sardines twice with a 15-day interval. Milk was sampled and a 24-hour dietary recall questionnaire was applied on days 0, 15 and 30. Milk was assayed for fatty acid content by gas chromatography. Statistical analysis of the results was performed using nonparametric tests with significance set at p < 0.05. Results: The results demonstrate that the nutritional intake of the nursing mothers was adequate at all three sample points. With regard to the omega-3 series fatty acid content of the breastmilk, it was observed that regular consumption and shorter intervals between ingestion and milk collection resulted in higher concentrations of docosapentaenoic acid and docosahexaenoic acid at 15 and 30 days into the study. Fatty acids from the omega-3 and omega-6 series exhibited a significant correlation, r 2 was 0.58 and 0.59 at 15 and 30 days, respectively. Conclusion: These results suggest that incorporating fish into the diets of nursing mother during lactation, in the form of 100 g of sardines two or three times a week, contributes to an increase in omega-3 series fatty acids. Copyright © 2006 by Sociedade Brasileira de Pediatria.

Determinação precoce do sexo fetal pela análise do DNA no plasma materno

Purpose: to verify the viability of early diagnosis of fetal gender in maternal plasma by the real-time polymerase chain reaction (real-time PCR) starting at the 5th week of pregnancy. Methods: peripheral blood was collected from pregnant women with single fetus starting at the 5th week of gestation. After centrifugation, 0.4 mL plasma was separated for fetal DNA extraction. The DNA was analyzed in duplicate by real-time PCR for two genomic regions, one of the Y chromosome and the other common to both sexes, through the TaqMan® method, which uses a pair of primers and a fluorescent probe. Patients who aborted were excluded. Results: a total of 79 determinations of fetal DNA in maternal plasma were performed in 52 pregnant women. The results of the determinations were compared to fetal gender after delivery. Accuracy according to gestational age was 92.6% (25 of 27 cases) at 5 weeks with 87% sensitivity, and 95.6% (22 of 23 cases) at 6 weeks with 92% sensitivity. Starting at the 7th week of pregnancy, accuracy was 100% (29 of 29 cases). Specificity was 100% regardless of gestational age. Conclusion: real-time PCR for the detection of fetal gender in maternal plasma starting at the 5th week of gestation has good sensitivity and excellent specificity. There was agreement of the results in 100% of the cases in which male gender was diagnosed, regardless of gestational age, and from the 7th week of gestation for female gender diagnosis.

Implantation sites after embryo transfer into the central area of the uterine cavity

A total of 63 pregnancies (47 singleton, 15 twin, 1 triplet) from intracytoplasmic sperm injection cycles were analysed. In all embryo transfers, the catheter was introduced into the endometrial cavity guided by abdominal ultrasound, with the catheter tip placed at the middle point of the endometrial cavity. Gestational sacs (GS) were located 21-24 days after transfer (gestational age = 5 weeks) by two-dimensional and three-dimensional transvaginal ultrasound. The uterine cavity was divided into three parts: upper, middle and lower. Furthermore, the upper region was subdivided into right, middle and left areas, and the middle region was subdivided into right and left areas. The frequency of gestational sacs in each area was evaluated. In singleton pregnancies 66.0% (31/47) of the GS were detected in the upper region, 29.8% (14/47) in the middle region and 4.2% (2/47) in the lower region. In multiple pregnancies (twins and triplet) 45.5% (15/33) of the GS were detected in the upper region, 51.5% (17/33) in the middle region and 3.0% (1/33) in the lower region. In conclusion, the results demonstrate that when embryos are transferred to the central area of the uterine cavity there is an increase in implantation rate in the middle region compared with the rate expected in naturally conceived pregnancies (9-15%).

Fração de excreção de sódio, osmolaridade e densidade urinária em recém-nascidos prematuros alimentados com leite humano de banco adicionado de suplemento

Objective: This research was performed with the objective of investigating the renal effects on premature newborn infants of fortifying banked donor human milk. Methods: Clinical intervention trial, of the before-and-after type, involving 28 premature newborn infants split into two groups by postconceptional age at the start of the study: GI < 34 weeks (n = 14) and GII ≥ 34 weeks (n = 14), and assessed at three sample points: S1, on unfortified donor human milk, S2, after 3 days, and S3, after 10-13 days on fortified donor human milk. Nutrient intake, weight gain, fractional sodium excretion, urinary osmolality and specific density were compared with two-way ANOVA for repeated measures. Results: Fluids, energy and sodium intakes were similar for both groups, and weight gain was satisfactory. Among the preterms with < 34 weeks postconceptional age, serum sodium was lower at the end of the study and the fractional sodium excretion was elevated at the start and at the end of the study (S1 = 2.11±1.05; S2 = 1.25±0.64; S3 = 1.62±0.88), with a significant difference in relation to GII (S1 = 1.34±0.94; S2 = 0.90±0.54; S3 = 0.91±0.82). Osmolality and urinary specific density were normal, with no differences between groups or collection dates. Conclusions: No adverse effects on the renal function of these preterms were detected as a result of being fed fortified donor human milk. Copyright © 2006 by Sociedade Brasileira de Pediatria.