Parity-Adjusted Term Neonatal Growth Chart Modifies Neonatal Morbidity and Mortality Risk Stratification

Objective: To investigate the impact of parity-customized versus population-based birth weight charts on the identification of neonatal risk for adverse outcomes in small (SGA) or large for gestational age (LGA) infants compared to appropriate for gestational age (AGA) infants. Study design: Observational, retrospective, cohort study based on electronic medical birth records at a single center between 2006 and 2017. Neonates were categorized by birth weight (BW) as SGA, LGA, or AGA, with the 10th and 90th centiles as boundaries for AGA in a standard population-based model adjusted for gestational age and gender only (POP) and a customized model adjusted for gestational age, gender, and parity (CUST). Neonates defined as SGA or LGA by one standard and not overlapping the other, are SGA/LGA CUST/POP ONLY. Analyses used a reference group of BW between the 25th and 75th centile for the population. Results: Overall 132,815 singleton, live, term neonates born to mothers with uncomplicated pregnancies were included. The customized model identified 53% more neonates as SGA-CUST ONLY who had significantly higher rates of morbidity and mortality compared to the reference group (OR = 1.33 95% CI [1.16–1.53]; p p = 0.007) or the LGA POP group. Neonatal mortality only occurred in the SGA and AGA groups. Conclusions: The application of a parity-customized only birth weight chart in a population of singleton, term neonates is a simple platform to better identify birth weight related neonatal risk for morbidity and mortality

Oxigenoterapia hiperbárica como tratamento adjuvante do pioderma gangrenoso Hyperbaric oxygen therapy as an adjuvant treatment for pyoderma gangrenosum

O pioderma gangrenoso é uma dermatose neutrofílica, rara da pele e do tecido subcutâneo, caracterizada por um processo necrosante progressivo e doloroso. A conduta no Pioderma gangrenoso requer, com frequência, o uso de drogas sistêmicas, tais como: corticoides, sulfonas e imunossupressoras, seja de maneira isolada, seja em combinação. Muitos relatos, na literatura, documentam o tratamento com êxito do Pioderma gangrenoso, com a oxigenoterapia hiperbárica. No nosso caso, uma jovem com lesões extensas e muito dolorosas, o tratamento com oxigenoterapia hiperbárica associado ao corticoide e imunossupressor promoveu cicatrização, com excelente resultado, com fechamento rápido da lesão e diminuição do desconforto.<br>Pyoderma Gangrenosum is a rare neutrophilic dermatosis of skin and subcutaneous tissue characterized by a painful and progressive necrotizing process. The management of pyoderma gangrenosum often requires systemic drug therapy, such as corticosteroids, sulfones or immunosuppressants, either alone or in combination. Several reports in the literature document the successful treatment of pyoderma gangrenosum with hyperbaric oxygen therapy. In our case, hyperbaric oxygen therapy associated with corticoids and immunosuppressants promoted healing of large and very painful lesions in an adolescent girl with an excellent outcome, including rapid wound closure and decreased discomfort