40 research outputs found
Associação entre abuso de álcool durante a gestação e o peso ao nascer
OBJECTIVE: To assess the association between alcohol abuse during gestation and low birth weight. METHODS: Cross-sectional, population-based nested study from a cohort of 957 pregnant women who received prenatal assistance through Sistema Ăšnico de SaĂşde (National Health System) in the city of Pelotas, Southern Brazil, and delivered their babies between September 2007 and September 2008. The mothers were interviewed at two distinct moments: prenatal and postpartum periods. In order to verify alcohol abuse, the CAGE (Cut down, Annoyed by criticism, Guilty and Eye-opener) scale was used. Bivariate analyses were carried out, as well as multiple logistic regression adjusted by the variables prematurity and alcohol abuse. The level of significance that was adopted was 95%. RESULTS: Of the women who participated in the study, 2.1% abused alcohol during pregnancy and, among these, 26.3% had low birth weight children. There was an association between alcohol abuse and low birth weight (pOBJETIVO: Verificar la asociaciĂłn entre abuso de alcohol durante la gestaciĂłn y bajo peso al nacer. MÉTODOS: Estudio transversal de base poblacional anidado a una cohorte de 957 gestantes que realizaron acompañamiento prenatal en el Sistema Ăšnico de Salud de la ciudad de Pelotas, Sur de Brasil, y dieron a luz entre septiembre de 2007 y septiembre de 2008. Las madres fueron entrevistadas en dos momentos distintos: en el perĂodo de preparto y posterior al parto. Para verificar el abuso de alcohol fue utilizada la escala Cut down, Annoyed by criticism, Guilty y Eye-opener. Se realizaron análisis bivariados y regresiĂłn logĂstica mĂşltiple, ajustado por las variables prematuridad y abuso de alcohol. El nivel de significancia adoptado fue de 95%. RESULTADOS: De las mujeres que participaron del estudio, 2,1% abusaron de alcohol en la gestaciĂłn y, entre ellas, 26,3% tuvieron bebĂ©s con bajo peso. Hubo asociaciĂłn entre el abuso de alcohol y bajo peso al nacer (pOBJETIVO: Analisar a associação entre abuso de álcool durante a gestação e baixo peso ao nascer. MÉTODOS: Estudo transversal de base populacional aninhado a uma coorte de 957 gestantes que realizaram acompanhamento prĂ©-natal no Sistema Ăšnico de SaĂşde da cidade de Pelotas, RS, e deram Ă luz entre setembro de 2007 e setembro de 2008. As mĂŁes foram entrevistadas em dois momentos distintos: no perĂodo de prĂ©-parto e apĂłs o parto. Para verificar o abuso do álcool foi utilizada a escala Cut down, Annoyed by criticism, Guilty and Eye-opener. Foram realizadas análises bivariadas e regressĂŁo logĂstica mĂşltipla, ajustada pelas variáveis prematuridade e abuso de álcool. O nĂvel de significância adotado foi de 95%. RESULTADOS: Das mulheres que participaram do estudo, 2,1% abusaram de álcool na gestação e, entre essas, 26,3% tiveram filhos com baixo peso. Houve associação entre o abuso de álcool e baixo peso ao nascer (p < 0,038). CONCLUSĂ•ES: Os achados indicam que o abuso de álcool durante a gestação está associado ao baixo peso ao nascer
Early motor development: risk factors for delay in a population study in Southern Brazil
OBJECTIVE: To assess risk factors associated with motor development delay at three months of age. METHODS: Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS: We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p < 0.001), and with low birth weight (p < 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION: Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20
[1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
Association between alcohol abuse during pregnancy and birth weight
OBJECTIVE: To assess the association between alcohol abuse during gestation
and low birth weight. METHODS: Cross-sectional, population-based nested study from a cohort of 957 pregnant women who received prenatal assistance through Sistema
Ăšnico de SaĂşde (National Health System) in the city of Pelotas, Southern
Brazil, and delivered their babies between September 2007 and September 2008. The mothers were interviewed at two distinct moments: prenatal and postpartum periods. In order to verify alcohol abuse, the CAGE (Cut down, Annoyed by criticism, Guilty and Eye-opener) scale was used. Bivariate
analyses were carried out, as well as multiple logistic regression adjusted by
the variables prematurity and alcohol abuse. The level of signifi cance that
was adopted was 95%. RESULTS: Of the women who participated in the study, 2.1% abused alcohol during pregnancy and, among these, 26.3% had low birth weight children.
There was an association between alcohol abuse and low birth weight
(p<0.038). CONCLUSIONS: The fi ndings indicate that alcohol abuse during pregnancy
is associated with low birth weight