Perinatal Factors Associated With Early Deaths Of Preterm Infants Born In Brazilian Network On Neonatal Research Centers [fatores Perinatais Associados Ao óbito Precoce Em Prematuros Nascidos Nos Centros Da Rede Brasileira De Pesquisas Neonatais]

Objective: To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g. Methods: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression. Results: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR=3.1;95%CI 1.4-6.6), and network center of birth. Conclusion: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country. Copyright © 2008 by Sociedade Brasileira de Pediatria.844300307Joseph, K.S., Liston, R.M., Dodds, L., Dahlgren, L., Allen, A.C., Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services (2007) CMAJ, 177, pp. 583-590Mathews, T.J., MacDorman, M.F., Infant mortality statistics from the 2004 period linked birth/infant death data set (2007) Natl Vital Stat Rep, 55, pp. 1-32Kramer, M.S., Demissie, K., Yang, H., Platt, R.W., Sauve, R., Liston, R., The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System (2000) JAMA, 284, pp. 843-849Ananth, C.V., Vintzileos, A.M., Epidemiology of preterm birth and its clinical subtypes (2006) J Matern Fetal Neonatal Med, 19, pp. 773-782Brasil. Ministério da Saúde. DATASUS. Informaç ões de Saúde-Estatísticas Vitais- Mortalidade e Nascidos Vivos: nascidos vivos desde 1994. http://tabnet.datasus.gov.br/cgi/deftohtm.exe? sinasc/cnv/nvuf.def. Acesso: 29.10.2007Brasil. Ministério da Saúde. DATASUS. Informaç ões de Saúde-Estatísticas Vitais- Mortalidade e Nascidos Vivos: óbitos infantis - desde 1979. http://tabnet.datasus.gov.br/cgi/ deftohtm.exe?sim/cnv/infuf.def. Acesso: 29.10.2007Barros, F.C., Diaz-Rossello, J.L., The quality of care of very low birth weight babies in Brazil (2007) J Pediatr (Rio J), 83, pp. 5-6Horbar, J.D., Badger, G.J., Carpenter, J.H., Fanaroff, A.A., Kilpatrick, S., LaCorte, M., Trends in mortality and morbidity for very low birth weight infants, 1991-1999 (2002) Pediatrics, 110, pp. 143-151Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al. Trends in neonatal morbidity and mortality for very low birth weight infants. Am J Obstet Gynecol. 2007;196:147.e1-8(2004) Infra-estrutura para atendimento integral ao recém-nascido, , http://www.sbp.com.br/show_item2.cfm?id_categoria=21&id_detalhe=1636&tipo_detalhe=s.Access:02.11.2007, Departamento de Neonatologia da Sociedade Brasileira de PediatriaBallard, J.L., Khoury, J.C., Wedig, K., Wang, L., Eilers-Walsman, B.L., Lipp, R., New Ballard Score, expanded to include extremely premature infants (1991) J Pediatr, 119, pp. 417-423Alexander, G.R., Himes, J.H., Kaufman, R.B., Mor, J., Kogan, M., A United States national reference for fetal growth (1996) Obstet Gynecol, 87, pp. 163-168Kattwinkel, J., (2000) Textbook of Neonatal Resuscitation, , 4th ed. Chicago, IL: American Academy of Pediatrics/American Heart Association;Richardson, D.K., Corcoran, J.D., Escobar, G.J., Lee, S.K., SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores (2001) J Pediatr, 138, pp. 92-100El-Metwally D, Vohr B, Tucker R. Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks. J Pediatr. 2000;137:616-22Costeloe, K., Hennessy, E., Gibson, A.T., Marlow, N., Wilkinson, A.R., The EPICure study: Outcomes to discharge from hospital for infants born at the threshold of viability (2000) Pediatrics, 106, pp. 659-671MacDonald, H., American Academy of Pediatrics. Committee on Fetus and Newborn. Perinatal care at the threshold of viability (2002) Pediatrics, 110, pp. 1024-1027Jain, L., Raju, T.N., editors. Late preterm pregnancy and the newborn (2006) Clin Perinatol, 33, pp. 751-972de Kleine, M.J., den Ouden, A.L., Kollee, L.A., Ilsen, A., van Wassenaer, A.G., Brand, R., Lower mortality but higher neonatal morbidity over a decade in very preterm infants (2007) Paediatr Perinat Epidemiol, 21, pp. 15-25Moro, M., Figueras-Aloy, J., Fernández, C., Doménech, E., Jiménez, R., Pérez-Rodríguez, J., Mortality for newborns of birthweight less than 1,500 g in Spanish neonatal units (2002-2005) (2007) Am J Perinatol, 24, pp. 593-601Drumond Ede, F., Machado, C.J., Franca, E., Early neonatal mortality: An analysis of multiple causes of death by the Grade of Membership method (2007) Cad Saude Publica, 23, pp. 157-166Richardson, D.K., Shah, B.L., Frantz 3rd, I.D., Bednarek, F., Rubin, L.P., McCormick, M.C., Perinatal risk and severity of illness in newborns at 6 neonatal intensive care units (1999) Am J Public Health, 89, pp. 511-516Horbar, J.D., Rogowski, J., Plsek, P.E., Delmore, P., Edwards, W.H., Hocker, J., Collaborative quality improvement for neonatal intensive care. NIC/Q Project Investigators of the Vermont Oxford Network (2001) Pediatrics, 107, pp. 14-22Vohr, B.R., Wright, L.L., Dusick, A.M., Perritt, R., Poole, W.K., Tyson, J.E., Center differences and outcomes of extremely low birth weight infants (2004) Pediatrics, 113, pp. 781-789Horbar JD, Plsek PE, Leahy KNIC/Q 2000. NIC/Q 2000: establishing habits for improvement in neonatal intensive care units. Pediatrics. 2003;111:e397-410Evans, N., Hutchinson, J., Simpson, J.M., Donoghue, D., Darlow, B., Henderson-Smart, D., Prenatal predictors of mortality in very preterm infants cared for in the Australian and New Zealand Neonatal Network (2007) Arch Dis Child Fetal Neonatal Ed, 92, pp. F34-F40Walther, F.J., Withholding treatment, withdrawing treatment, and palliative care in the neonatal intensive care unit (2005) EarlyHumDev, 81, pp. 965-972von Dadelszen, P., Magee, L.A., Taylor, E.L., Muir, J.C., Stewart, S.D., Sherman, P., Maternal hypertension and neonatal outcome among small for gestational age infants (2005) Obstet Gynecol, 106, pp. 335-339Casey, B.M., McIntire, D.D., Leveno, K.J., The continuing value of the Apgar score for the assessment of newborn infants (2001) N Engl J Med, 344, pp. 467-471,308-31

UPLC-MS-ESI-QTOF analysis and antifungal activity of the spondias tuberosa arruda leaf and root hydroalcoholic extracts

The aim of this study was to identify and evaluate the chemical compositions and effects of the S. tuberosa leaf and root hydroalcoholic extracts (HELST and HERST) against different strains of Candida. Chemical analysis was performed by Ultra-Performance Liquid Chromatography Coupled to Quadrupole/Time of Flight System (UPLC-MS-ESI-QTOF). The Inhibitory Concentration of 50% of the growth (IC50) as well as the intrinsic and combined action of the extracts with the antifungal fluconazole (FCZ) were determined by the microdilution method while the minimum fungicidal concentrations (MFCs) and the effect on fungal morphological transitions were analyzed by subculture and in humid chambers, respectively. From the preliminary phytochemical analysis, the phenols and flavonoids were the most abundant. The intrinsic IC50 values for HELST ranged from 5716.3 to 7805.8 \ub5g/mL and from 6175.4 to 51070.9 \ub5g/mL for the HERST, whereas the combination of the extracts with fluconazole presented IC50 values from 2.65 to 278.41 \ub5g/mL. The MFC of the extracts, individually, for all the tested strains was 6516384 \ub5g/mL. When fluconazole was combined with each extract, the MFC against CA URM 5974 was reduced (HELST: 2048 and HERST: 4096 \ub5g/mL). Synergism was observed against standard C. albicans (CA) and C. tropicalis (CT) strains and with the root extract against the CT isolate. The leaf extract inhibited the morphological transition of all strains while the root extract inhibited only CT strains

Vascular Flora Of The Legado Das Águas, Reserva Votorantim, Municipalities Of Tapiraí, Miracatú And Juquiá, São Paulo, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)We present a list of vascular plants found in Legado das Águas, Reserva Votorantim, a private reserve having an area of approximately 35,000 ha that spans the municipalities of Tapiraí, Miracatú, and Juquiá, in the state of São Paulo, Brazil. The reserve is part of a complex of state-protected areas including Alto Ribeira Touristic State Park, Intervales State Park, Carlos Botelho State Park, Jurupará State Park, and Serra do Mar State Park. Together, these form an important and large area of continuous and well-preserved forest. Our study, which involved two main floristic surveys in March/April 2013 and April 2014, recorded 768 species, representing 131 families and 432 genera. The majority of species were angiosperms (619) representing 106 families and 370 genera. There were also two species of gymnosperms belonging to two genera in separate families; 147 species of ferns and lycophytes belonging to 23 families and 60 genera. In demonstrating the presence of almost 800 species of plants, of which 16 are threatened, our study highlights the importance of floristic surveys and the critical role of private protected areas in managing and preserving native flora. © 2016 Check List and Authors.1262011/22923-8, FAPESP, Fundação de Amparo à Pesquisa do Estado de São Paulo2015/9444-4, FAPESP, Fundação de Amparo à Pesquisa do Estado de São PauloFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Evaluation Of The Neonatal Outcomes Of The Kangaroo Mother Method In Brazil [avaliação Dos Resultados Neonatais Do Método Canguru No Brasil]

Objective: To evaluate the results of the kangaroo mother method in Brazil. Methods: A prospective cohort study comparing 16 units that have or do not have the second phase of the kangaroo mother method: eight were national centers of excellence for the kangaroo mother method (study group) and eight were part of the Brazilian Neonatal Research Network (control group). A total of 985 newborn infants with birth weights of 500 to 1,749 g were enrolled. Multivariate analyses employedmultiple linear regression and Poisson regression with robust adjustment. Results: The adjusted analysis (controlled for birth weight, gestational age, Score for Neonatal Acute Physiology Perinatal Extension II, Neonatal Therapeutic Intervention Scoring System, and maternal age and educational level) demonstrated that mean length of hospital stay (p = 0.14) and intercurrent clinical conditions in the intermediate or kangaroo unit were equal for both groups. Weight (p = 0.012), length (p = 0.039) and head circumference (p = 0.006) at 36 weeks' corrected gestational age were all lower at the kangaroo units. The kangaroo units exhibited superior performance in relation to exclusive breastfeeding at discharge (69.2 vs. 23.8%, p=0.022). Conclusions: The evidence suggests that the humanization strategy adopted by the Brazilian Ministry of Health is a safe alternative to conventional treatment and a good strategy for promoting breastfeeding. Copyright © 2008 by Sociedade Brasileira de Pediatria.845428435Mathelin, C., (1999) Osorriso da Gioconda: Clínica psicanalí ticacombebês prematuros, , Rio de Janeiro: Companhia de Freud;Lamy, Z.C., (2000) Unidade neonatal: Um espaço de conflitos e negociações [Tese], , Rio de Janeiro, RJ: Fundação Oswaldo Cruz;Walsh-Sukys M, Reitenbach A, Hudson-Barr D, DePompei P. Reducing light and sound in the neonatal intensive care unit: an evaluation of patient safety, staff satisfaction, and costs. J Perinatol. 2001;21:230-5. Erratum in: J Perinatol. 2001;21:572Martín Ancel, A., Iriondo Sanz, M., Fina Martí, A., Roqués Serradilla, V., García Del Río, M., López Sastre, J.B., On recommendations, protocols, and clinical guidelines (2001) An Esp Pediatr, 55, pp. 99-100Brasil. Ministério da Saúde. Norma da atenção humanizada ao recém-nascido de baixo peso - Método Canguru. Brasília, DF: MS1999Brasil. Ministério da Saúde. Norma da atenção humanizada ao recém-nascido de baixo peso - Método Canguru. Brasília, DF: MS2000Rey, E., Martínez, H., Manejo racional del niño prematuro (1983) Bogotá, (Colombia): Universidad NacionalCurso de Medicina FetalAnderson GC, Marks EA, Wahlberg V. Kangaroo care for premature infants. AmJ Nurs. 1986;86:807-9. Erratum in: Am J Nurs. 1986;86:1000Anderson, G.C., Current knowledge about skin-to-skin (kangaroo) care for preterm infants (1991) J Perinatol, 11, pp. 216-226Conde-Agudelo A, Diaz-Rossello JL, Belizan JM. Mãe canguru para reduzir morbidade e mortalidade em recém-nascidos com baixo peso ao nascer (Cochrane Review). In: Resumos de Revisões Sistemáticas em Português, Issue 2, 2007. Oxford: Update SoftwareFeldman, R., Weller, A., Sirota, L., Eidelman, A.I., Skin-to-Skin contact (Kangaroo care) promotes self-regulation in premature infants: Sleep-wake cyclicity, arousal modulation, and sustained exploration (2002) Dev Psychol, 38, pp. 194-207Kirsten, G.F., Bergman, N.J., Hann, K.M., Kangaroo mother care in the nursery (2001) Pediatr Clin North Am, 48, pp. 443-452Ramanathan, K., Paul, V.K., Deorari, A., Taneja, U., George, G., Kangaroo Mother Care in very low birth weight infants (2001) Indian J Pediatr, 68, pp. 1019-1023Ludington-Hoe, S.M., Johnson, M.W., Morgan, K., Lewis, T., Gutman, J., Wilson, P.D., Neurophysiologic assessment of neonatal sleep organization: Preliminary results of a randomized, controlled trial of skin contact with preterm infants (2006) Pediatrics, 117, pp. e909-e923Gray, L., Watt, L., Blass, E.M., Skin-to-skin contact is analgesic in healthy newborns (2000) Pediatrics, 105, pp. e14Charpak, N., Ruiz-Pelaez, J.G., Figueroa de, C.Z., Charpak, Y., A randomized, controlled trial of kangaroo mother care: Results of follow-up at 1 year of corrected age (2001) Pediatrics, 108, pp. 1072-1079Penalva, O., Schwartzman, J.S., Descriptive study of the clinical and nutritional profile and follow-up of premature babies in a Kangaroo Mother Care Program (2006) J Pediatr (Rio J), 82, pp. 33-39Charpak, N., Ruiz-Pelaez, J.G., Figueroa de, C.Z., Charpak, Y., Kangaroo mother versus traditional care for newborn infants >/= 2,000 grams: A randomized, controlled trial (1997) Pediatrics, 100, pp. 682-688Ruiz-Peláez, J.G., Charpak, N., Cuervo, L.G., Kangaroo Mother Care, an example to follow from developing countries (2004) BMJ, 329, pp. 1179-1181Venancio, S.I., Almeida, H., Método Mãe Canguru: Aplicação no Brasil, evidências científicas e impacto sobre o aleitamento materno. (2004) J Pediatr (Rio J), 80, pp. S173-S180Richardson, D.K., Corcoran, J.D., Escobar, G.J., Lee, S.K., SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores (2001) J Pediatr, 138, pp. 92-100Gray, J.E., Richardson, D.K., McCormick, M.C., Workman-Daniels, K., Goldmann, D.A., Neonatal therapeutic intervention scoring system: A therapy-based severity-of-illness index (1992) Pediatrics, 90, pp. 561-567Barros, A.J., Hirakata, V.N., Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio (2003) BMC Med Res Methodol, 3, p. 21Roberts, K.L., Paynter, C., McEwan, B., A comparison of kangaroo mother care and conventional cuddling care (2000) Neonatal Netw, 19, pp. 31-35Cattaneo, A., Davanzo, R., Worku, B., Surjono, A., Echeverria, M., Bedri, A., Kangaroo mother care for low birth weight infants: A randomised controlled trial in different settings (1998) Acta Paediatr, 87, pp. 976-985Kadam, S., Binoy, S., Kanbur, W., Mondkar, J.A., Fernandez, A., Feasibility of kangaroo mother care in Mumbai (2005) Indian J Pediatr, 72, pp. 35-38Sloan, N.L., LeonCamacho, L.W., PintoRojas, E., Stern, C., Maternidad IsidroAyora Study Team. Kangaroo mother method: Randomised controlled trial of an alternative method of care for stabilised low-birthweight infants. Maternidad Isidro Ayora Study Team (1994) Lancet, 344, pp. 782-78