Aspectos genéticos do hipotireoidismo congênito

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Métodos de alimentação alternativos para recém-nascidos prematuros

OBJETIVO: Apresentar revisão de literatura sobre o uso do copo/xícara como método alternativo de alimentação para recém-nascidos prematuros e verificar se há consenso sobre sua indicação para essa população. FONTES DE DADOS: Revisão de literatura narrativa, tendo sido selecionados artigos nas bases de dados Medline, Lilacs, SciELO e Cochrane, independentemente do ano, usando descritores específicos: alimentação artificial, recém-nascido prematuro, aleitamento materno, métodos de alimentação. SÍNTESE DOS DADOS: Apesar de alguns estudos afirmarem que o método do copo/xícara é eficaz e seguro para alimentar recém-nascidos pré-termo e a termo, tais estudos não avaliam de forma objetiva o efeito do método sobre a deglutição desses pacientes. CONCLUSÕES: Verificou-se não haver consenso na literatura quanto à complementação da alimentação de recém-nascidos prematuros por meio do copo/xícara. Estudos controlados devem ser realizados com a finalidade de rever riscos e benefícios do uso de métodos alternativos na alimentação do recém-nascido prematuro.

Idade materna como fator de risco: estudo com primigestas na faixa etária igual ou superior a 28 anos

Trata-se de estudo transversal, cujo objetivo foi analisar a idade materna como fator de risco ou não, através da verificação de intercorrências na gestação, parto e puerpério de primigestas com idade igual ou superior a 28 anos e das condições de nascimento e alta de seus recém-nascidos, comparando-as com o grupo de primigestas na faixa etária de 20 a 27 anos. Foi realizado em Botucatu/S.P., no período de janeiro de 1990 a junho de 1995. A análise estatística, discutida ao nível de 5% de significância, foi realizada através da prova de Mann-Whitney, teste de Goodman e avaliação do risco relativo e risco relativo corrigido, através da técnica de Mantel-Haenszel. Concluiu-se que a idade materna igual ou superior a 28 anos não constituiu fator de risco gestacional, puerperal e intra-parto mas, por outro lado, foi fator de risco, mesmo após controlado o tipo de parto, para as seguintes intercorrências perinatais: taquipnéia transitória do recém-nascido, cianose generalizada ao nascer e infecção neonatal.

Adesão a um Programa de Triagem Auditiva Neonatal

A Triagem Auditiva Neonatal tem se efetivado mundialmente como meio para detecção precoce da surdez. Na Unicamp, desde 2002, os recém-nascidos na maternidade do Centro de Atenção Integral à Saúde da Mulher são agendados para a triagem auditiva no Centro de Estudos e Pesquisas em Reabilitação Prof. Dr. Gabriel Porto. No entanto, nem todos vêm para a triagem e alguns abandonam o processo de avaliação antes do diagnóstico. O objetivo desta pesquisa foi caracterizar as taxas de adesão de lactentes ao Programa de Triagem Auditiva Neonatal. Tratou-se de pesquisa que utilizou dados contidos nos prontuários dos lactentes que efetuaram a triagem no período de fevereiro a novembro de 2007. Permaneceram no alojamento conjunto do CAISM 2107 lactentes e vieram para a triagem 1310. Dentre aqueles que não passaram na triagem (92 lactentes), realizaram o exame de PEATE-A 73 lactentes. A adesão na primeira etapa da triagem foi de 62,17%, e na segunda, 79,34%. As taxas de adesão são inferiores às preconizadas pelo Joint Comittee on Infant Hearing e encontradas em alguns países desenvolvidos. No entanto, aproximam-se de outras experiências brasileiras de programas de triagem auditiva neonatal. O acompanhamento sistemático às famílias dos lactentes que não passaram na primeira avaliação e a conscientização destas sobre a detecção precoce da perda auditiva e suas consequências podem ter contribuído para o aumento da taxa de adesão na segunda etapa da triagem.

Prevalência de fissuras orais de 1975 a 1994

OBJETIVO: Estimar a prevalência de fissuras orais no Brasil, segundo etiologia e região geográfica. MÉTODOS: Foram levantados os registros de casos de fissura oral entre recém-nascidos no período de 1975 a 1994. As fontes de dados foram o Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo, o Ministério da Saúde -- Departamento de Informática do Sistema Único de Saúde (Datasus) e a Fundação Instituto Brasileiro de Geografia e Estatística. RESULTADOS/CONCLUSÕES: Foram encontrados 16.853 casos novos de fissura oral, estimando-se a prevalência de 0,19 por mil nascidos vivos, com tendência ascendente para os qüinqüênios do período. As regiões Centro-Oeste, Sudeste e Sul apresentaram as maiores taxas. A fissura labial ou lábio-palatina foi mais freqüente (74%) do que a fissura palatina isolada (26%).

Experimental paracoccidioidomycosis in hamsters (Mesocricetus auratus): Gestational interactions

Paracoccidioides brasiliensis is a dimorphic fungus presenting specific steroid hormone receptors, both in the yeast and mycelial forms and estrogen inhibits the transition from mycelium to yeast. In the acute phase, the disease occurs with equal frequency in both sexes but in adults, females are spared. Placental fungal infection has been reported, but references to fetal infection have not been confirmed. We used 78 Syrian female hamsters divided into 3 groups: GI consisted of 30 infected mated females, GII of 20 infected unmated females and GIII of 28 uninfected mated females. Animals of group I were mated 4 weeks after infection and half of them were submitted to cesarean section on day 15 after successful mating; the other half was maintained and submitted to cesarean section and sacrificed 14 weeks after infection. Half of the animals of group II were sacrificed seven weeks and the other half 14 weeks after infection. Uninfected animals of group III were treated the same as the animals of group I. The animals were infected with strain 18 of P. brasiliensis by the intracardiac route. We evaluated the disease by the volume of granulomas in different organs, number of fungi in liver and spleen and the immunologic responses [ELISA, Double Immunodifusion (DID), Delayed Hypersensitivity Skin Test (DHT) and Macrophage Migration Inhibition (MMI)]. We studied the infection through the gestation by evaluation of the abortions, morphologic and clinic examinations of the fetuses. Our results showed that the infection did not transfer to the fetus through the placenta, but the number of abortions was larger among infected females. The newborns of GI females were smaller, weighed less and showed little vitality. The disease was more severe and disseminated in infected mated females, especially in the second sacrifice 14 weeks after inoculation, when the total volume of granulomas in them (56.3 mm) was much greater than in the infected unmated females (12 mm).

The newborn pain cry: Descriptive acoustic spectrographic analysis

Introduction: Study the characteristics of pain vocal emission of newborns during venepuncture through acoustic analysis and relate it to NIPS pain scale and some variables of the newborns.Methods: Emissions of 111 healthy term newborns were recorded, whose lifetime varied from 24 to 72 h. The acoustic analysis was realized with GRAM 5.7 software verifying the occurrence of tense strangled voice quality, sounds, concentration of acoustic energy, breaks, double harmonic breaks and frequency instability, type of phonation, vocal attack and cough. The NIPS scale was realized during venepuncture and descriptive statistical analysis and correlation through Spearman test.Results: Hundred percent of the emissions had guttural sounds, vowels, hard vocal attack, frequency, breaks, double harmonic breaks and tense strangled voice quality; 34.2% higher fundamental frequency; 62.2% periods of emission absence and 100% occurrence of tracing instability, concentration of acoustic energy, inspiratory and expiratory phonation. The cough occurred in 14.4%. The signs of vocal tract constriction associated with all. The parameters. There was a negative correlation between the higher fundamental frequencies and the weight of newborns and positive correlation between cough and NIPS score.Conclusions: the newborn pain emission is tense and strident, the modifications of frequency and spectrographic tracing and the presence of sounds show laryngeal and vocal tract participation. The smaller the newborn weight, the bigger the presence of higher fundamental frequency with tense strangled voice quality and the bigger the NIPS score, the more frequent the cough. Such characteristics make pain crying peculiar, helping in the evaluation of pain during a procedure. (c) 2006 Elsevier B.V.. All rights reserved.

Detection of immunoglobulin G antibodies to Neospora caninum in humans: High seropositivity rates in patients who are infected by human immunodeficiency virus or have neurological disorders

Considering that little is known about the epidemiology of Neospora caninum infection in humans, particularly in populations with high Toxoplasma gondii infection rates, the present study aimed to investigate the presence of antibodies to N. caninum in T. gondii-seropositive and -seronegative individuals. A total of 256 serum samples divided into four groups (61 samples from human immunodeficiency virus [HIV]-positive patients, 50 samples from patients with neurological disorders, 91 samples from newborns, and 54 samples from healthy subjects) were assessed for N. caninum and T. gondii serologies by indirect fluorescent-antibody test, enzyme-linked immunosorbent assay, and immunoblotting (IB). Immunoglobulin G antibodies to N. caninum were predominantly detected in HIV-infected patients (38%) and patients with neurological disorders (18%), while newborns and healthy subjects showed lower seropositivity rates (5% and 6%, respectively). Seropositivity to N. caninum was significantly associated with seropositivity to T. gondii in both HIV-infected patients and patients with neurological disorders. Seroreactivity to N. caninum was confirmed by IB, with positive sera predominantly recognizing the 29-kDa antigen of N. caninum. The results of this study indicate the presence of N. caninum infection or exposure in humans, particularly in HIV-infected patients or patients with neurological disorders, who could have opportunistic and concurrent infections with T. gondii. These findings may bring a new concern for the unstable clinical health of HIV-infected patients and the actual role of N. caninum infection in immunocompromised patients.

Sepsis and Neutropenia in Very Low Birth Weight Infants Delivered of Mothers with Preeclampsia

Objective To study the association between maternal preeclampsia and neonatal sepsis in very low birth weight newborns.Study design We studied all infants with birth weights between 500 g and 1500 g who were admitted to 6 neonatal intensive care units of the Brazilian Network on Neonatal Research for 2 years. Exclusion criteria were major malformations, death in the delivery room, and maternal chronic hypertension. Absolute neutrophil count was performed in the first 72 hours of life.Results A total of 911 very low birth weight infants (preeclampsia, 308; non-preeclampsia, 603) were included. The preeclampsia group had significantly higher gestational age, more cesarean deliveries, antenatal steroid, central catheters, total parenteral nutrition, and neutropenia, and less rupture of membranes >18 hours and mechanical ventilation. Both groups had similar incidences of early sepsis (4.6% and 4.2% in preeclampsia and non-preeclampsia groups, respectively) and late sepsis (24% and 22.1% in preeclampsia and non-preeclampsia groups, respectively). Vaginal delivery and neutropenia were associated with multiple logistic regressions with early sepsis, and mechanical ventilation, central catheter, and total parenteral nutrition were associated with late sepsis. Death was associated with neutropenia in very preterm infants.Conclusions Preeclampsia did not increase neonatal sepsis in very low birth weight infants, and death was associated with neutropenia in very preterm infants. (J Pediatr 2010; 157: 434-8).

Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center

The aim of this study was to evaluate the incidence of and mortality due to meningitis and compare data according to microbiological diagnosis. This was a ten-year retrospective study conducted at a neonatal intensive care unit (NICU). Newborns with meningitis confirmed by positive CSF culture were included; those with congenital infection or malformations that made lumbar puncture impossible were excluded. The variables investigated were birth weight, gestational and postnatal age, procedures, hematological and CSF parameters, and complications. Parametric and non-parametric tests were used (statistical value p<0.05). The incidence of meningitis was 0.6% and mortality was 27%. of the 22 cases, 59% involved Gram-negative bacteria; 36% Gram-positive and 5% fungi. The groups did not differ in relation to birth weight, gestational and postnatal age, procedures or hematological and CSF parameters. Sepsis, convulsions and deaths were frequent in both groups, without statistical difference. Gram-negative cases showed abscesses and higher frequency of ventriculitis and hydrocephaly. Meningitis was infrequent, but presented high mortality and frequent complications.

Metabolismo (lipídios e proteínas) e histopatologia do cérebro de ratos recém nascidos, jovens e adultos, submetidos a desnutrição proteico calórica, tipo marasmo

Brains of Wistar male rats (newborns, youngs and adults) submitted to protein-calorie deprivation for different periods (27, 33 and 60 days) were studied histologically and biochemically (protein and lipids contents). Lower levels of lipid, particularly among young rats, were observed in all groups. The protein levels were also significantly lower in the newborns, only slightly diminished in the youngs and not altered in the adults. On the other hand the histological study made in all groups did not show any qualitative modifications. The authors concluded that the protein-calorie deprivation affects the brain composition markedly in the earlier periods of life when the developing rate is greater. This could result in irreversible brain damage.

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.

Contribuição para o estudo da proção cervical da veia facial de fetos, recém-nascidos e crianças.

In the study of cervical posterior of the facial vein of the foetus, newborns and children we injected in the veins of the head and neck of 15 corpses, rubber material (Xantopren and or Neoprene Latex). The results showed than the retromandibular and or the facial vein form a venous trunk in 83.3%, what finish always in the intern jugular vein or join the retromandibular vein and casually also with a posterior auricular vein originating the extern jugular vein (16.7%).