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A simplified method for diagnosis of gestational age in newborn infant
Abstract
concept that conversion of T4 to T~ depends upon a 5'monodeiodinase enzyme system that is immature at birth? The 3,3'T2 is thought to be derived at least in part from the peripheral conversion of T~ and reverse T~? In this infant, the 3,3'T~ level was high at birth, and remained elevated until the twenty-sixth day; therefore, it seems likely that the enzyme or enzymes capable of forming 3,3'T~ in thyrotoxicosis are operative at birth. LATS-P was present in high concentrations-i n the serum of both mother and infant, whereas LATS was measurable in both at low levels which could be considered nonspecific? The high concentration of LATS-P in the infant's serum when he was hyperthyroid and its reduction to undetectable levels when he became euthy-. roid suggest a role for this thyroid-stimulating immunoglobulin in the development of neonatal thyrotoxic0sis? Although the routine measurement, in all pregnant thyr0toxic women, of the thyroid-stimulating immunoglob.ulins LATS and LATS-P may be helpful in detecting neofmtal thyrotoxicosis, a definitive diagnosis of this disorder requires the demonstration of elevated iodothyronines in the infant. Although T4 and rT3 levels in cord serum are normally higher than in serum of euthyroid adults, ~" ~ markedly elevated levels should suggest hyperthyroidism. An elevated cord serum T3 value may be diagnostic, since it is normally very low, ~. s and an elevated cord serum 3,3'T: level also indicates overproduction of iodothyronines. This patient illustrates that a variety of iodothyronines are abnormally elevated in neonatal thyrotoxicosis, and supports the concept that the disorder is produced by transplacental transmission of thyroid-stimulating immunoglobulins.
... Data extracted from the medical files were: gestational age in weeks assessed by Capurro (Capurro et al. 1978), weight and length at birth, presence of genital ambiguity, karyotype and diagnosis of DSD. ...
... Gestational age: in weeks by Capurro (Capurro et al. 1978) Gestational age: in weeks Weight (g) and length (cm) at birth Intrauterine production or action of androgens: assessed according to the presence of genital ambiguity: female genitalia independent of the karyotype = absence of androgens production and(or) action; ambiguous genitalia in any karyotype except 46,XX = decreased androgens; male genitalia with karyotype 46,XY or ambiguous with karyotype 46,XX = increased androgens A c c e p t e d M a n u s c r i p t in the AR gene), PAIS (partial AIS = 46,XY karyotype, ambiguous genitalia, two testicles, mutation in the AR gene), CAH (46,XX karyotype with genital ambiguity or inferred 46,XY karyotype with male genitalia with biallelic mutations in the CYP21A2 gene). Although 46,XY individuals with CAH due to the classical form of 21hydroxylase deficiency were not considered DSD, the inclusion of these cases was necessary in the study because there was no model of 46,XY DSD with excess intrauterine androgen production (Speiser, White 2003;Merke, Bornstein 2005). ...
Background:
Males have higher weight and length at birth than females. Aim: To verify the influence of the Y chromosome and action of intrauterine androgens on weight and length at birth of children with Disorders of Sex Development (DSD). Subjects and methods: A cross-sectional and retrospective study. Patients with Turner syndrome (TS), complete (XX and XY), mixed (45,X/46,XY) and partial (XY) gonadal dysgenesis (GD), complete (CAIS) and partial (PAIS) androgen insensitivity syndromes and XX and XY congenital adrenal hyperplasia (CAH) were included. Weight and length at birth were evaluated.
Results:
Weight and length at birth were lower in TS and mixed GD when compared to XY and XX DSD cases. In turn, patients with increased androgen action (117 cases) had higher weight and length at birth when compared to those with absent (108 cases) and decreased (68 cases) production/action. In birthweight, there was a negative influence of the 45,X/46,XY karyotype and a positive influence of increased androgen and gestational age. In birth length, there was a negative influence of the 45,X and 45,X/46,XY karyotypes and also a positive influence of increased androgen and gestational age.
Conclusions:
The sex dimorphism of weight and length at birth could possibly be influenced by intrauterine androgenic action.
... O IMC materno foi calculado dividindo-se o peso corporal (em quilogramas) pelo quadrado da altura corporal (em metros). A sua classificação compreendeu: baixo peso (IMC < 18,5), peso normal ( IMC= 18,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]9), obesidade classe I ou sobrepeso (IMC= 25,0 -29,9), obesidade classe II (IMC= 30,0 -39,9) e obesidade extrema ou classe III (IMC ≥ 40,0). 13 Anotaram-se os resultados neonatais de interesse dos recém-nascidos: gênero e vitalidade (variáveis de controle), 14 Os resultados obtidos da avaliação dos grupos de estudo (de baixo peso e/ou obesas), compararam-se aos de um grupo controle de puérperas com IMC dentro da faixa de normalidade (eutróficas) e de seus recém-nascidos, atendidas na maternidade do HSL durante o mesmo período da pesquisa. ...
... O O perímetro braquial foi avaliado com o mesmo tipo de fita, no membro superior esquerdo (E) do recém-nascido em decúbito dorsal, com o braço em posição lateral ao tronco, cuidando-se para não enrugar a pele. O ponto médio foi medido entre as distâncias das extremidades do acrômio e olécrano, com o cotovelo fletido em ângulo de 90°. 3 A idade gestacional dos recém-natos, calculou-se através do cálculo pós-natal de seusparâmetros físicos e neurológicos.19 ...
Objetivos: analisar nas puérperas de baixo peso e obesas em gestação de termo, o relacionamento entre o ganho ponderal materno durante a gestação, e as prováveis repercussões para os pesos e demais valores antropométricos dos recém-nascidos. Métodos: estudo prospectivo de puérperas (baixo peso, obesidade e peso normal como controle), e seus recém-nascidos no HSL de Sorocaba-SP. As variáveis maternas dependentes utilizadas foram os ganhos de peso na gravidez através do IMC pré-gestacional; nos recém-nascidos anotaram-se o peso, demais valores antropométricos e IMC em 143 puérperas e seus recém-nascidos (43 de baixo peso, 50 obesas e 50 do grupo controle). Resultados: as variáveis de interesse, para efeito da variável-controle ‘grupo’ revelaram-se proporcionais e estatisticamente significantes nos três grupos. Combinadas com a faixa de ganho de peso resultaram em efeitos conjuntos estatisticamente não significantes; exceto para a variável perímetro braquial (baixo peso) que teve relação direta e proporcional ao ganho de peso materno. Conclusão: o ganho ponderal gestacional materno não influenciou estatisticamente nos pesos e demais valores antropométricos dos recém-nascidos nos grupos controle e obesas. Nas de baixo peso, influiu direta e significativa em todas as medidas antropométricas, representando apenas uma tendência estatística (p>0,05), porém, não proporcional ao ganho de peso materno; teve relação direta e proporcional apenas com a variável perímetro braquial de seus recém-nascidos.
... 50 Gestational time was self-reported by the mother (by date of last menstrual period [LMP]) or determined by the neonate Capurro test. 51,52 Blood pressure and proteinuria measurements were not collected for fathers and newborns. A non-parametric Wilcoxon rank test was used to test for statistical differences in blood pressure levels between affected mothers with mild and severe preeclampsia diagnoses with the wilcox.test ...
... It is worth clarifying that gestational age (the time of the fetus in the womb) was measured in two different ways throughout the study. The fetal measurement was done by the ''Capurro'' test, 51,52 which combines five different measurements in the neonate, while the maternal measurement relies on the date of the mother's last menstrual period before pregnancy. ...
Preeclampsia is a multi-organ complication of pregnancy characterized by sudden hypertension and proteinuria that is among the leading causes of preterm delivery and maternal morbidity and mortality worldwide. The heterogeneity of preeclampsia poses a challenge for understanding its etiology and molecular basis. Intriguingly, risk for the condition increases in high-altitude regions such as the Peruvian Andes. To investigate the genetic basis of preeclampsia in a population living at high altitude, we characterized genome-wide variation in a cohort of preeclamptic and healthy Andean families (n = 883) from Puno, Peru, a city located above 3,800 meters of altitude. Our study collected genomic DNA and medical records from case-control trios and duos in local hospital settings. We generated genotype data for 439,314 SNPs, determined global ancestry patterns, and mapped associations between genetic variants and preeclampsia phenotypes. A transmission disequilibrium test (TDT) revealed variants near genes of biological importance for placental and blood vessel function. The top candidate region was found on chromosome 13 of the fetal genome and contains clotting factor genes PROZ, F7, and F10. These findings provide supporting evidence that common genetic variants within coagulation genes play an important role in preeclampsia. A selection scan revealed a potential adaptive signal around the ADAM12 locus on chromosome 10, implicated in pregnancy disorders. Our discovery of an association in a functional pathway relevant to pregnancy physiology in an understudied population of Native American origin demonstrates the increased power of family-based study design and underscores the importance of conducting genetic research in diverse populations.
... Because the situation may exist with or without these conditions in any newborn [4]. The identification of IUGR is commonly made during the antenatal period; however, it can be detected during the newborn period immediately after delivery [5,6] by using clinical examination [3,7,8], anthropometry index [9], and clinical assessment of nutritional status (CAN) score [4]. IUGR is a public health problem and noted to affect approximately 10-15% of pregnant women. ...
... Rapid assessment of gestational age at birth: gestational age derived from the total scores of skin texture (4 items), skin color (4 items), breast size (4items), and ear firmness (4 items) [6,24]. But for this study gestational age was estimated by LMP (if she knows her LMP), if she didn't know her LMP, we used ultrasound estimation during delivery, if two of them were impossible, we used a rapid assessment of gestational age estimation at birth. ...
Background: After prematurity, intrauterine growth restriction (IUGR) is the second leading cause of perinatal mortality. IUGR has significant consequences in fetal, neonatal, and adult life. Currently, Ethiopia lacks information on IUGR's prevalence and its determinants. This study aimed to assess the proportion of IUGR at birth and its associated factors.
... The following maternal variables were used in this study: age, self-reported ethnicity, educational attainment, clinical status of relevant infections (syphilis, HIV, and hepatitis C), and substance use during pregnancy. Regarding newborns, the following variables were used: weight, Apgar score at 5 min, gestational age (GA) at neonatal examination assessed through Capurro's method 49 , and assigned sex. www.nature.com/scientificreports/ ...
The investigation of the effects of prenatal cocaine exposure (PCE) on offspring has been inconsistent, with few studies investigating biological outcomes in humans. We profiled genome-wide DNA methylation (DNAm) of umbilical cord blood (UCB) from newborns with (n = 35) and without (n = 47) PCE. We used DNAm data to (1) assess pediatric epigenetic clocks at birth and (2) to estimate epigenetic scores (ES) for lifetime disorders. We generated gestational epigenetic age estimates (DNAmGA) based on Knight and Bohlin epigenetic clocks. We also investigated the association between DNAmGA and UCB serum brain-derived neurotrophic factor (BDNF) levels. Considering the large-scale DNAm data availability and existing evidence regarding PCE as a risk for health problems later in life, we generated ES for tobacco smoking, psychosis, autism, diabetes, and obesity. A gene ontology (GO) analysis on the CpGs included in the ES with group differences was performed. PCE was associated with lower DNAmGA in newborns, and this effect remained significant when controlling for potential confounders, such as blood cell type composition predicted by DNAm and obstetric data. DNAmGA was negatively correlated with BDNF levels in the serum of UCB. Higher tobacco smoking, psychosis, and diabetes ES were found in the PCE group. The GO analysis revealed GABAergic synapses as a potential pathway altered by PCE. Our findings of decelerated DNAmGA and ES for adverse phenotypes associated with PCE, suggest that the effects of gestational cocaine exposure on the epigenetic landscape of human newborns are detectable at birth.
... Ultrasounds were not routinely performed as standard of care; therefore, gestational age was based on the last menstrual period (LMP) and standardized physical examination to determine gestational age at birth. 23 If the physical examination assessment of gestational age differed by more than 3 weeks from the gestational age determined by LMP, the physical exam was used instead of the gestational age determined by LMP. ...
Introduction
Neurotoxicity resulting from air pollution is of increasing concern. Considering exposure timing effects on neurodevelopmental impairments may be as important as the exposure dose. We used distributed lag regression to determine the sensitive windows of prenatal exposure to fine particulate matter (PM 2.5 ) on children’s cognition in a birth cohort in Mexico.
Methods
Analysis included 553 full-term (≥37 weeks gestation) children. Prenatal daily PM 2.5 exposure was estimated using a validated satellite-based spatiotemporal model. McCarthy Scales of Children’s Abilities (MSCA) were used to assess children’s cognitive function at 4–5 years old (lower scores indicate poorer performance). To identify susceptibility windows, we used Bayesian distributed lag interaction models to examine associations between prenatal PM 2.5 levels and MSCA. This allowed us to estimate vulnerable windows while testing for effect modification.
Results
After adjusting for maternal age, socioeconomic status, child age, and sex, Bayesian distributed lag interaction models showed significant associations between increased PM 2.5 levels and decreased general cognitive index scores at 31–35 gestation weeks, decreased quantitative scale scores at 30–36 weeks, decreased motor scale scores at 30–36 weeks, and decreased verbal scale scores at 37–38 weeks. Estimated cumulative effects (CE) of PM 2.5 across pregnancy showed significant associations with general cognitive index ( = −0.35, 95% confidence interval [CI] = −0.68, −0.01), quantitative scale ( = −0.27, 95% CI = −0.74, −0.02), motor scale ( = −0.25, 95% CI = −0.44, −0.05), and verbal scale ( = −0.2, 95% CI = −0.43, −0.02). No significant sex interactions were observed.
Conclusions
Prenatal exposure to PM 2.5 , particularly late pregnancy, was inversely associated with subscales of MSCA. Using data-driven methods to identify sensitive window may provide insight into the mechanisms of neurodevelopmental impairment due to pollution.
... The mothers were interviewed about their socioeconomic conditions, and maternal and newborn characteristics in the maternity hospital using a pre-coded structured questionnaire with closed questions. The gestational age of the children was evaluated according to (Capurro et al., 1978). The children's anthropometric parameters in the first 24 h after birth were also assessed. ...
Background
Developmental models suggest that the phenotypes may arise from an immediate or mediated adaptive metabolic response of the perinatal growth. Evidence on the cumulative effects of growth and factors associated with risk of insulin resistance in adolescents is lacking.
Objective
To investigate the association between birthweight, weight gain during infancy, childhood and adolescence and the triglyceride-glucose index in adolescents.
Methods
This is a cohort of 217 children born at term, followed for the first six months, and reassessed at 8 and 18 years of age. The variables of interest were birthweight, postnatal growth defined as rapid postnatal growth when the weight gain from birth to six months of age was greater than 0.67 z-score, and the same criterion was used for high BMI gain from ages 6 months to 8 years, and from 8 to 18 years. Socioeconomic condition, nutritional status, practice of physical exercises and consumption of ultra-processed foods were verified. Multivariate linear regression analysis was used to verify the effect of the variables on the triglyceride-glucose index.
Results
Birthweight was not associated with triglyceride-glucose index in adolescence. Rapid postnatal growth during the first 6 months, higher BMI gain from 8 to 18 years and higher waist circumference contributed significantly to explain higher triglyceride-glucose index.
Conclusion for Practice
Our findings suggest that rapid postnatal growth may be one of the first signs of a higher triglyceride-glucose index in adolescence and that attention should be paid to the greater gain in body mass between childhood and adolescence for the risk of a higher triglyceride-glucose index.
... A clinical questionnaire, including the use of antibiotics over the last six months, was administered. A pediatrician examined all of the newborns after birth, clinically determined the newborns' health status, and calculated the gestational age using the Capurro method [22]. The mothers' and newborns' body compositions were assessed using the RJL Quantum IV System (RJL Systems Inc., Clinton Township, MI, USA) after birth. ...
Non-nutritive sweeteners (NNSs) provide a sweet taste to foods and beverages without significantly adding calories. Still, their consumption has been linked to modifications in adult’s and children’s gut microbiota and the disruption of blood glucose control. Human milk microbiota are paramount in establishing infants’ gut microbiota, but very little is known about whether the consumption of sweeteners can alter it. To address this question, we sequenced DNA extracted colostrum samples from a group of mothers, who had different levels of NNS consumption, using the Ion Torrent Platform. Our results show that the “core” of colostrum microbiota, composed of the genera Bifidobacterium, Blautia, Cutibacteium, Staphylococcus, and Streptococcus, remains practically unchanged with the consumption of NNS during pregnancy, but specific genera display significant alterations, such as Staphylococcus and Streptococcus. A significant increase in the unclassified archaea Methanobrevibacter spp. was observed as the consumption frequency of NNS increased. The increase in the abundance of this archaea has been previously linked to obesity in Mexican children. NNS consumption during pregnancy could be related to changes in colostrum microbiota and may affect infants’ gut microbiota seeding and their future health.
... 18 Estimou-se a idade gestacional dos recém-natos pelo cálculo pós-natal dos parâmetros físicos e neurológicos. 19 Os resultados obtidos por meio da avaliação do grupo de estudo, foram comparados aos de um grupo 3650 3655 3865 2490 4105 2635 4360 3200 3155 3480 2760 3330 2700 3235 2480 2600 2855 3900 3160 4030 3790 3280 2850 4235 3110 3080 3070 4030 3410 2660 2470 3375 3575 2475 2265 2490 3170 4180 3200 3670 2700 3005 2815 3360 3420 3370 3575 2930 2930 3245 3450 3910 3815 3035 3730 3815 2895 2345 3480 2905 2950 2905 3035 3570 2465 3250 3225 2700 3900 3125 3875 2760 3310 2780 3045 3530 3965 3820 2745 33 32 33 33 34 37 34 35 34 33 33 36 36 34 36 32 34 35 36 35 36 31 34 36 34 32 36,5 35 32 34 34,5 34 34 35 36,5 ...
Objetivos: analisar os valores antropométricos dos recém-nascidos de gestantes e parturientes de termo com PE leve. Métodos: análise prospectiva dos valores antropométricos de 30 recém-nascidos de puérperas de termo com PE leve, comparando-os às de 50 recém-nascidos de puérperas normais de termo atendidas no CHS. As variáveis de controle materno consideraram: idade, cor, estado cível e paridade, foram similares. As variáveis dependentes dos recém-nascidos compreenderam os valores antropométricos: peso, comprimento, perímetros cefálico, braquial e torácico. Resultados: estudando-se os recém-nascidos do grupo de estudo e do grupo de controle, observamos respectivamente para os valores antropométricos: peso: t = 0,17 e p = 0,4319 (Tabela 1), comprimento: t = 0,43 e p = 0,3357 (Tabela 2), perímetro cefálico: t = 1,6 e p = 0,0558 (Tabela 3), perímetro braquial: t = 0,41 e p = 0,3424 (Tabela 4) e perímetro torácico: t = 0,53 e p = 0,2976 (Tabela 5). Os resultados evidenciaram que as diferenças entre os parâmetros antropométricos dos grupos estudados, não representaram resultados estatisticamente significantes. Conclusões: nas gestações de termo os valores antropométricos dos recém-nascidos de gestações fisiológicas ou com PE leve, não foram diferenças estatisticamente significantes.
... 34 In PROGRESS, gestational age was based on LMP and updated by measurements from a standardized physical examination at birth to determine gestational age if discrepant by more than 3 weeks. 35 Birth weight data were extracted from labor and delivery records for all studies. We derived Fenton birth weight for gestational age z scores which facilitates harmonization across different cohorts, including those from different countries. ...
Unlabelled:
Data integration of epidemiologic studies across different geographic regions can provide enhanced exposure contrast and statistical power to examine adverse respiratory effects of early-life exposure to particulate matter <2.5 microns in diameter (PM2.5). Methodological tools improve our ability to combine data while more fully accounting for study heterogeneity.
Methods:
Analyses included children enrolled in two longitudinal birth cohorts in Boston, Massachusetts, and Mexico City. Propensity score matching using the 1:3 nearest neighbor with caliper method was used. Residential PM2.5 exposure was estimated from 2 months before birth to age 6 years using a validated satellite-based spatiotemporal model. Lung function was tested at ages 6-11 years and age, height, race, and sex adjusted z scores were estimated for FEV1, FVC, FEF25-75%, and FEV1/FVC. Using distributed lag nonlinear models, we examined associations between monthly averaged PM2.5 levels and lung function outcomes adjusted for covariates, in unmatched and matched pooled samples.
Results:
In the matched pooled sample, PM2.5 exposure between postnatal months 35-44 and 35-52 was associated with lower FEV1 and FVC z scores, respectively. A 5 µg/m3 increase in PM2.5 was associated with a reduction in FEV1 z score of 0.13 (95% CI = -0.26, -0.01) and a reduction in FVC z score of 0.13 (95% CI = -0.25, -0.01). Additionally PM2.5 during postnatal months 23-39 was associated with a reduction in FEF25-75% z score of 0.31 (95% CI = -0.57, -0.05).
Conclusions:
Methodological tools enhanced our ability to combine multisite data while accounting for study heterogeneity. Ambient PM2.5 exposure in early childhood was associated with lung function reductions in middle childhood.
... Gestational age was defined by the date of the last reliable menstruation or obstetric ultrasound before 12 weeks of gestation or, in the absence of these data, by neonatal clinical examination using the New Ballard or Capurro methods. 16,17 Adequacy of weight for gestational age according to Alexander's classification (adequate, small, or large for gestational age), as well as neonatal complications associated with prematurity such as necrotizing enterocolitis and culture-proven sepsis, were recorded. 18 Data regarding PN therapy (age at initiation, whether supplemental or exclusive, duration, indication) and iodine or levothyroxine supplementation (if indicated) were also reviewed. ...
Objective
The use of parenteral nutrition (PN) formulations that do not contain iodine can contribute to the deficiency of this mineral, potentially leading to hypothyroidism and, ultimately, neurocognitive impairments. This study aimed to evaluate TSH alterations in newborns receiving PN.
Methods
Retrospective study of neonatal intensive care unit patients receiving PN for > 15 days. Nutritional, anthropometric, and biochemical variables (TSH, T4, CRP) were analyzed. Hypothyroidism was defined by TSH > 10 mU/L.
Results
Two hundred newborns were evaluated [156 (78%) preterm, 31±5 weeks of gestational age, 112 (56%) with very or extremely low birth weight]. The median (IQR) hospital stay was 68 (42-110) days, PN duration was 31 (21-47) days, and 188 (94%) patients also received enteral nutrition. Overall, 143 (71.5%) newborns underwent at least one TSH measurement. The prevalence of hypothyroidism was 10.5%. The Median PN duration in this group was 51 (34-109) days. Among those with hypothyroidism, 10 received Lugol's solution and six levothyroxine. Thirteen patients received prophylactic Lugol's solution with a median PN duration of 63 (48-197) days. TSH levels correlated positively with PN duration (r = 0.19, p = .02).
Conclusions
The present data suggest that changes in TSH and T4 levels are present in neonates receiving PN for > 15 days, suggesting this population may be at risk for developing hypothyroidism. Therefore, the authors suggest that TSH and T4 measurements should be included as routine in neonatal patients receiving PN for > 15 days if PN formulations are not supplemented with iodine, and that iodine supplementation be provided as necessary.
... As variáveis estudadas aos 12 e 24 meses foram: idade gestacional (12,13) e desempenho dos lactentes observado durante a aplicação da Escala de Aquisições Iniciais de Linguagem -Escala ELM (14) . Esta Escala investiga o desenvolvimento da linguagem, a fim de detectar precocemente suas alterações, sendo um instrumento de triagem, que analisa dados provenientes do relato da mãe ou do adulto responsável e de alguns itens aplicados diretamente com a criança. ...
... We excluded women with Diabetes Mellitus, gestational diabetes, hypertension, thyroid disorders or autoimmune diseases. After birth, the newborn was examined by a pediatrician, who determined gestational age by the Capurro method [29] and the newborn's health status. ...
Background. Human milk is essential for establishing the newborn’s gut microbiota, which can have an impact on future health. Several studies indicate that Non-nutritive Sweeteners (NNS) can modify the intestinal microbiota, promoting metabolic dysfunction in humans and rodents; however, the influence of NNS on human milk microbiota is unknown. This study aimed to assess changes in the relative abundance of several of bacterial groups in colostrum of women who consumed NNS during pregnancy.
Methods. This cross-sectional, pilot study included 39 women that gave birth to a live, healthy newborn in the General Hospital of Mexico. We assessed mothers’ diet and NNS consumption by validated questionnaires and the relative abundance of Bifidobacteriaceae, Lactobacillaceae, Lachnospiraceae, Roseburia, Eubacteriales, and Bacteroidales in colostrum samples by real-time PCR.
Results. Twenty-six women (66%) showed a low NNS consumption (<350 mg/week), whereas 13 (33%) showed a high NNS consumption (≥350 mg/week). The Lactobacillaceae relative abundance significantly decreased in the high NNS consumption group compared to the low NNS group (12.36±11.29 vs. 4.41±2.84, respectively; P<.001). NNS consumption associated with lower gestational age determined by the Capurro method or Ultrasound/Last Menstrual Period (r=-0.320, P= .025; and r=-0.355, P= .018, respectively).
Conclusion. NNS consumption during pregnancy is associated with decreased Lactobacillaceae abundance in colostrum and lower gestational age. The effects of NNS consumption during pregnancy on breast milk microbiota and gestational age should be further investigated.
Study registration: This study was registered in ClinicalTrials, number NCT03912038.
... The skin characteristics have been used in several clinical scores for decades. Visible modifications during clinical ectoscopy of newborns have demonstrated that the skin of extremely premature has little or no visible pigmentation, being markedly erythematous, putting these and other characteristics of the skin as potential markers of the chronology of pregnancy, as provided by maturity scores [16,17]. External characteristics of the newborn involving edema and skin opacity, lanugo, ear form, and firmness are antecedents in assessing gestational age at birth [18]. ...
The chapter provides a vision of new methods of pregnancy dating at birth to overcome the high costs of existing approaches or lack of access to the existing technologies. The authors have presented a literature review on recent scientific reports exploring novel technologies, such as those based on the newborn's skin maturity assessment as machine learning models based on clinical data. The effortlessness of new approaches based on simplified clinical systems contrasting with molecular genetics and newborns screening analytes is discussed, even in scientific validation. Without the intention of an exhaustive or systematic review, we searched databases for reports concerning postnatal gestational age, prediction or estimate, novel approach, low and medium-income countries since 2015. Therefore, the authors did not compromise to offer a comprehensive picture of all postnatal gestational age methods. On the other hand, prematurity identification at birth remains a challenge in many birth settings, mainly in a scenario with scarce resources. Although postnatal pregnancy dating methods have strengths and disadvantages, this information is critical to recognize the risk of the newborn during the first hours of life, justifying technological investments.
... We also included seasonality of urine collection (November-February, March-April, May-October) as a covariate to represent long-term and seasonal trends. Gestational age was calculated based on two methods: subtraction of the self-reported date of last menstrual period from delivery date and the Capurro method (Capurro et al., 1978;Rodosthenous et al., 2017). If the gestational age estimated by the two methods differed by more than three weeks (n = 40), we used the gestational age from the Capurro method. ...
Background
Phthalates are endocrine disrupting chemicals that may influence weight status; however, few studies have considered weight gain during pregnancy and subsequent long-term weight changes in women.
Objective
To determine associations of prenatal phthalate exposure with maternal weight during pregnancy and through up to seven years post-delivery.
Methods
We analyzed 15 urinary phthalate biomarker concentrations during the 2nd and 3rd trimesters among 874 pregnant women enrolled in the Programming Research in Obesity, Growth Environment and Social Stress Study in Mexico City. We examined three time-specific maternal weight outcomes: gestational weight gain (between 2nd and 3rd trimesters), short-term weight (between 3rd trimester and 12 months post-delivery), and long-term weight (between 18 months and 6–7 years post-delivery). We used Bayesian Kernel Machine Regression (BKMR) to estimate associations for the total phthalate mixture, as well as multivariable linear mixed models for individual phthalate biomarkers.
Results
As a mixture, 2nd trimester urinary phthalate biomarker concentrations were associated with somewhat lower gestational weight gain between the 2nd and 3rd trimesters (interquartile range, IQR, difference: −0.07 standard deviations, SD; 95% credible interval, CrI: −0.20, 0.06); multivariable regression and BKMR models indicated that this inverse association was primarily driven by mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP). Prenatal (2nd and 3rd trimesters) urinary phthalate mixture concentrations were positively associated with maternal weight change through 12 months postpartum (IQR difference: 0.11 SD; 95% CrI: 0.00, 0.23); these associations persisted from 18 months to 6–7 years follow-up (IQR difference: 0.07 SD; 95% CrI: 0.04, 0.10). Postpartum weight changes were associated with mono-3-carboxypropyl phthalate (MCPP) and MECPTP.
Conclusions
Prenatal phthalate exposure was inversely associated with gestational weight gain and positively associated with long-term changes in maternal weight. Further investigation is required to understand how phthalates may influence body composition and whether they contribute to the development of obesity and other cardiometabolic diseases in women.
... Neonatal characteristics included if the newborn was the first, and sex categorized as male or female. Gestational age was registered a numerical discrete variable, expressed in weeks, and estimated after birth with Capurro test (Capurro et al., 1978;Lee et al., 2017) (see supplemental information). Length and weight were obtained within 2 h after birth using standardized scale (digital, Seca 354© to the nearest 10 grams) and measuring tape, to the nearest centimeter; both registered as a discrete, numerical variables. ...
Objectives:
To provide an insight of the incidence of congenital developmental dysplasia of the hip in newborns from Yucatan born between 2015 and 2019 and analyze its association with maternal sociodemographic characteristics and neonatal, pregnancy and delivery related aspects.
Methods:
Retrospective, population-based study from Birth Registries database in Yucatan, Mexico between 2015 and 2019. Presence of hip dysplasia was described and analyzed considering three aspects (I) Maternal information (II) Pregnancy and birth (III) Neonatal examination. We obtained incidence rates from each year and the complete studied period. Association between hip dysplasia and maternal, neonatal and pregnancy/delivery variables was analyzed using logistic regression, unadjusted odds ratio and an adjusted model.
Results:
Hip dysplasia occurred in 13 per 10 000 live births. Significant associations were found between hip dysplasia and maternal place of residence in a city <50 000 inhabitants, without a local clinic. Propensity to give birth to a neonate with hip dysplasia increased with maternal age and ethnicity, in female newborns and when total number of pregnancy consultations summed <5. Newborns with hip dysplasia were heavier and less susceptible to be delivered vaginally. Congenital developmental hip dysplasia was comparatively more frequent among offspring of Mayan women and suboptimal access to medical care during pregnancy. Female neonates were affected the most, those first-borns. Neonates with hip dysplasia were heavier and more susceptible to be born by cesarean section.
Conclusion:
Maternal, neonatal, and perinatal factors are associated with DDH in Yucatecan infants born during 2015-2019. Factors that describe living conditions seems to have a more important effect on the presence of this condition.
... Cases without a report of gestational age and those with incomplete data were excluded. The case group was delimited on the basis of the estimated gestational age determined in the neonatologist report according to the methods described by Capurro et al 38 and Ballard et al. 39 A set of instruments with adequate sensitivity and specificity was selected to measure the variables of interest. ...
Objectives
This study aimed to identify the risk factors associated with preterm birth, and to determine the prevalence of preterm births in the Dominican Republic.
Design
Case-control study.
Settings
Seven National Reference Hospitals from different regions of the Dominican Republic.
Participants
A probabilistic sampling of both cases and controls was performed with a ratio of 2.92:1, and a power analysis was performed with α=0.05, P 1 =0.5, P 2 =0.6, and β=0.08, to yield a distribution of 394 cases and 1150 controls. Estimation of gestational age was based on neonatologist reports.
Primary outcome measures
A protocol was created to obtain maternal and obstetric information.
Results
The main risk factors were a family history of premature births (p<0.001, OR: 14.95, 95% CI 8.50 to 26.29), previous preterm birth (p=0.005, OR: 20.00; 95% CI 12.13 to 32.96), advanced maternal age (over 35 years; p<0.001, OR: 2.21; 95% CI 1.57 to 3.09), smoking (p<0.001, OR: 6.65, 95% CI 3.13 to 13.46), drug consumption (p=0.004, OR: 2.43, 95% CI 1.37 to 4.30), premature rupture of membranes (p< 0 .001, OR: 2.5) and reduced attendance at prenatal consultations (95% CI 6 to 7, Z=−10.294, p<0.001).
Conclusion
Maternal age greater than 35 years, previous preterm birth, family history of preterm births and prelabour rupture of membranes were independent risk factors for preterm birth. Adolescence, pregnancy weight gain and prenatal consultations, on the other hand, were protective factors for preterm birth. Although the prevalence of premature births in this study was 25%, this could have been biased.
... According to Capurro's methodology, the values missing (n = 105) in the SIP database were replaced by the gestational age determined by physical examination. 32 Mother's age was defined as age at delivery (categorized as <20, 20-34, and ≥35 years). Parity was categorized as childless, 1-2, or and, >2 births). ...
Background:
We have previously documented an inverse relationship between PM2.5 in Lima, Peru, and reproductive outcomes. Here, we investigate the effect of temperature on birth weight, birth weight-Z-score adjusted for gestational age, low birth weight, and preterm birth. We also explore interactions between PM2.5 and temperature.
Methods:
We studied 123,034 singleton births in three public hospitals of Lima with temperature and PM2.5 during gestation between 2012 and 2016. We used linear, logistic, and Cox regression to estimate associations between temperature during gestation and birth outcomes and explored possible modification of the temperature effect by PM2.5.
Results:
Exposure to maximum temperature in the last trimester was inversely associated with both birth weight [β: -23.7; 95% confidence interval [CI]: -28.0, -19.5] and z-score weight-for-gestational-age (β: -0.024; 95% CI: -0.029, -0.020) with an interquartile range of 5.32 °C. There was also an increased risk of preterm birth with higher temperature (interquartile range) in the first trimester (hazard ratio: 1.04; 95% CI: 1.001, 1.070). The effect of temperature on birthweight was primarily seen at higher PM2.5 levels. There were no statistically significant associations between temperature exposure with low birth weight.
Conclusions:
Exposition to maximum temperature was associated with lower birth weight and z-score weight-for-gestational-age and higher risk of preterm birth, in accordance with much of the literature. The effects on birth weight were seen only in the third trimester.
... Neonate gestational age was calculated based on Capurro score. 13 Serology tests for anti-L. monocytogenes All samples were processed at the Laborat orio de Zoonoses Bacterianas (LABZOO) from Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), within 24h after collection. ...
Objective
To describe the prevalence and factors associated with serologic response to Listeria monocytogenes in HIV infected and uninfected pregnant women in Brazil.
Methods
Cross-sectional study, pregnant women after 14 weeks of gestational age were enrolled. Positive serologic test for L. monocytogenes was defined as titers >1:80 (agglutination test). Comparisons were performed using logistic regression.
Results
A total of 213 women were enrolled, 73 (34%) were HIV infected. 55 women were seroreactive for L. monocytogenes, 27 (37%) HIV-infected and 28 (20%) HIV-uninfected (p < 0.01). Considering the diet record, white cheese consumption was associated with seroreactivity (p < 0.01). In the group of pregnant women living with HIV, the variables associated with L. monocytogenes positive serology were: lower CD4+ cells count at study entry OR=4.8 (95%CI=1.1–19.8) and having neonates admitted to the intensive care unit OR=5.9 (95%CI=1.01–34.9).
Conclusion
Positive serology for Listeria monocytogenes was associated with HIV infection. Brazilian women should avoid white cheese during pregnancy.
... Other authors have identified the complexity of the Dubowitz examination as the impetus for creating simplified postnatal assessments, such as the New Ballard. [19][20][21][22] These simplified methods of gestational age calculation are typically shortened at the cost of examination validity. 15 Only 25% of trainees in our study were concerned that the examination would take too long for health workers to perform in a clinical setting. ...
# Background
Accurate assignment of the gestational age of newborns is important for the identification of prematurity. The Dubowitz assessment is the gold standard among postnatal examinations used to assign gestational age, but implementation has been limited because of examination complexity and training requirements. The objective of this study was to explore factors related to teaching and implementing the Dubowitz examination that may influence its uptake in India and Malawi.
# Methods
This cross-sectional study was conducted in India and Malawi during the preparation for a low-birthweight infant feeding exploratory study. Twenty trainees participated in a Dubowitz examination training workshop that occurred over two half-day sessions. Trainees completed pretraining and posttraining surveys related to their perceptions of the Dubowitz training, the examination, and factors affecting the administration of the examination in their setting.
# Results
All survey respondents expressed confidence in their ability to perform the Dubowitz examination after the training. Less than a third expressed concerns about the time required to learn (30%) or perform the examination (25%). Eighty-five percent of trainees identified concerns related to parental perception of the examination that may inhibit implementation. Trainees averaged 14 minutes (standard deviation: 4.5 minutes) to complete the examination. More than 80% of trainee answers were within one point of the trainer for 16 of the 22 Dubowitz signs. Trainee composite scores were within ±3 weeks of the trainer for 95% of assessments based on Bland-Altman analysis.
# Conclusions
The Dubowitz examination at birth is a method to improve identification of premature infants in the absence of prenatal dating. We found widespread acceptance for the Dubowitz assessment among participants in training workshops in India and Malawi, despite the complexity and length of the examination. The high level of trainee-trainer concordance on individual examination signs suggests that an acceptable level of competence is feasible after a short, concentrated workshop. Further investigation into barriers that hinder implementation such as negative parental perceptions is warranted.
# Registration details
Clinical Trials Registration: NCT04002908 (www.clinicaltrials.gov) and CTRI/2019/02/017475 (Clinical Trial Registry of India - http://ctri.nic.in).
... La evaluación pediátrica al nacimiento es aceptada como el método estándar de oro de determinación de la edad gestacional en nuestro medio. El método para la valoración pediátrica está basado en el estudio de Capurro, del año 1973, que estudió una población mucho menor a la nuestra (117 neonatos) y estableció mediante regresión un puntaje, teniendo en cuenta los parámetros de textura de piel, forma de oreja, glándula mamaria, pliegues plantares, el signo de la bufanda y el sostén cefálico (8) . Este modelo y muchos otros descritos en la literatura, como la prueba de Dubowitz y Ballard, fueron realizados en los tiempos que el ultrasonido no era de uso clínico rutinario, como lo es hoy (9,10) . ...
Objetivos: Comparar la edad gestacional determinada por la evaluación pediátrica al nacimiento (test de Capurro) y la prueba de oro, la ecografía del primer trimestre (10 +0 a 14+2 semanas) en gestantes con FUR confiable. Diseño: Estudio retrospectivo de correlación. Institución: Instituto Nacional Materno Perinatal, Lima, Perú. Participantes: Fetos y los mismos recién nacidos. Métodos: A 167 gestantes se les realizó ecografía a las 10+0 a 14+2 semanas en el período de 2005 al 2009; la edad gestacional al nacer de estos fetos se comparó con la edad gestacional al nacer por la prueba de Capurro. Principales medidas de resultados: Comparación de medianas con la prueba de Wilcoxon, coeficiente de correlación interclase, coeficiente de concordancia de correlación, repetibilidad o acuerdo según gráfico de Bland & Altman. Resultados: La mediana de edad gestacional calculada por Capurro fue 39 semanas versus la longitud corono nalga de 38 semanas ((Wilcoxon test z=-3,88, P<0,01). El coeficiente de correlación intraclase fue 0,67 (IC95%: 0,58 a 0,75), el coeficiente de correlación de concordancia de Lin (0,65 (IC95%: 0,55 a 0,72) y los límites de acuerdo de Bland & Altman -0,41 (LOA95% -2,9 a 2,1). Conclusiones: La edad gestacional determinada por el examen de Capurro tiende a sobreestimar la edad gestacional A pesar de que hay una relación directa entre estos dos métodos, la correlación no es perfecta y ambos métodos no son repetibles, como lo demuestran los diversos coeficientes calculados.
... Neonatal gestational age at birth, in completed weeks, was determined with obstetric estimation or with pediatric newborn examination (8,9). Birth weight and head circumference z scores were classified according to the International Fetal and Newborn Growth Consortium for the 21st Century criterion (10). ...
Background
Studies addressing neuroimaging findings as primary outcomes of congenital Zika virus infection are variable regarding inclusion criteria and confirmatory laboratory testing.
Purpose
To investigate cranial US signs of prenatal Zika virus exposure and to describe frequencies of cranial US findings in infants exposed to Zika virus compared to those in control infants.
Materials and Methods
In this single-center prospective cohort study, participants were enrolled during the December 2015–July 2016 outbreak of Zika virus infection in southeast Brazil (Natural History of Zika Virus Infection in Gestation cohort). Eligibility criteria were available cranial US and laboratory findings of maternal Zika virus infection during pregnancy confirmed with RNA polymerase chain reaction testing (ie, Zika virus–exposed infants). The control group was derived from the Zika in Infants and Pregnancy cohort and consisted of infants born to asymptomatic pregnant women who tested negative for Zika virus infection during pregnancy. Two radiologists who were blinded to the maternal Zika virus infection status independently reviewed cranial US scans from both groups and categorized them as normal findings, Zika virus–like pattern, or mild findings. Associations between cranial US findings and prenatal Zika virus exposure were assessed with univariable analysis.
Results
Two hundred twenty Zika virus–exposed infants (mean age, 53.3 days ± 71.1 [standard deviation]; 113 boys) and born to 219 mothers infected with Zika virus were included in this study and compared with 170 control infants (mean age, 45.6 days ± 45.8; 102 boys). Eleven of the 220 Zika virus–exposed infants (5%), but no control infants, had a Zika virus–like pattern at cranial US. No difference in frequency of mild findings was observed between the groups (50 of 220 infants [23%] vs 44 of 170 infants [26%], respectively; P = .35). The mild finding of lenticulostriate vasculopathy, however, was nine times more frequent in Zika virus–exposed infants (12 of 220 infants, 6%) than in control infants (one of 170 infants, 1%) (P = .01).
Conclusion
Lenticulostriate vasculopathy was more common after prenatal exposure to Zika virus, even in infants with normal head size, despite otherwise overall similar frequency of mild cranial US findings in Zika virus–exposed infants and in control infants.
... Mothers with previous intrauterine growth restriction diagnosis by Doppler ultrasound, preeclampsia, diabetes, antiphospholipid syndrome, connective tissue diseases, chronic infection, alcoholism, or smoking during the current pregnancy were not included. Birth anthropometry was performed by a pediatrician, and gestational age was determined using the Capurro method [39], following standardized procedures from the health centers. Birth weight data was corrected for gestational age and sex and Endocrine expressed as z-score using validated tables for the Mexican population [40,41]. ...
Background and purposeNeonates at the highest and lowest percentiles of birth weight present an increased risk of developing metabolic diseases in adult life. While environmental events in utero may play an important role in this association, some genetic variants are associated both with birth weight and type 2 diabetes mellitus (T2DM), suggesting a genetic link between intrauterine growth and metabolism in adult life. Variants rs11708067 in ADCY5 and rs7754840 in CDKAL1 are associated with low birth weight, risk of T2DM, and lower insulin secretion in adults. We aimed to investigate whether, besides birth weight, these polymorphisms were related to insulin secretion at birth.MethodsA cohort of 218 healthy term newborns from uncomplicated pregnancies were evaluated for anthropometric and biochemical variables. Cord blood insulin and C-peptide were analyzed by ELISA. Genotyping of rs11708067 in ADCY5 and rs7754840 in CDKAL1 was performed.ResultsNewborns carrying the A allele of ADCY5 rs11708067 had lower cord blood insulin and C-peptide, even after adjusting by maternal glycemia, HbA1c, and pregestational BMI. Lower birth weight was found for AA-AG genotypes compared to GG, but no differences were seen in adjusted birth weight or z-score. Variant rs7754840 in CDKAL1 was not associated with birth weight, neonatal insulin, or C-peptide for any genotype or genetic model.Conclusions
The variant rs11708067 in ADCY5 is associated with lower neonatal insulin and C-peptide concentrations. Our results suggest that the genetic influence on insulin secretion may be evident from birth, even in healthy newborns, independently of maternal glycemia and BMI.
... Baseline information on demographics, anthropometric characteristics, and health status was collected from all participants at the first and every subsequent visit. We calculated gestational age at enrollment using the date of last menstrual period and at birth using a standardized physical examination assessment 24 . Children with missing data regarding prenatal exposure (n= 262), behavioral problems (n= 271), and covariates (n=1), children with maternal smoking exposure during pregnancy (n=4), and outliers for behavioral problems (> 3 SD above the mean) (n=2) were excluded, resulting in a total of 514 children (259 girls) aged 4-6 years (mean age = 4.8 years; SD = 0.6 years) included in the main analyses (see Figure 1). ...
Background
Phthalate exposure has been associated with increased childhood behavioral problems. Existing studies failed to include phthalate replacements and did not account for high correlations among phthalates. Phthalates’ exposure is higher in Mexico than in U.S. locations, making it an ideal target population for this study.
Aim
To examine associations between 15 maternal prenatal phthalate metabolite concentrations and children’s behavioral problems.
Methods
We quantified phthalate metabolites in maternal urine samples from maternal-child dyads (n = 514) enrolled in the Programming Research in Obesity, Growth Environment and Social Stress (PROGRESS) birth cohort in Mexico City. We performed least absolute shrinkage and selection operator (LASSO) regressions to identify associations between specific-gravity adjusted log2-transformed phthalate metabolites and parent-reported 4-6 year old behavior on the Behavior Assessment System for Children (BASC-2), accounting for metabolite correlations. We adjusted for socio-demographic and birth-related factors, and examined associations stratified by sex.
Results
Higher prenatal mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) urinary concentrations were associated with increased hyperactivity scores in the overall sample (ß = 0.57, 95% CI = 0.17, 1.13) and in girls (ß = 0.54, 95% CI = 0.16, 1.08), overall behavioral problems in boys (ß =0.58, 95% CI = 0.20, 1.15), and depression scores in boys (ß = 0.44, 95% CI = 0.06, 0.88). Higher prenatal monobenzyl phthalate (MBzP) concentrations were associated with reduced hyperactivity scores in girls (ß = -0.54, 95% CI = -1.08, -0.21).
Discussion
Our findings suggested that prenatal concentrations of phthalates and their replacements altered child neurodevelopment and those associations may be influenced sex.
... During the 3-year study period, 300 preterm infants were admitted to the neonatal area, of which 216 met the inclusion criteria: gestational age <37 weeks (obtained by the Capurro method), 11 birth weight <2500 g, indirect ophthalmoscopy by the ophthalmology specialist, and 84 were excluded due to death before the first month of life, failure to complete screening for ROP, multiple pregnancies, congenital malformation, or incomplete data in their medical history. ...
Purpose
The purpose of this research is to determine retinopathy of prematurity (ROP) prevalence and possible risk factors associated with ROP development in newborns admitted to a neonatal unit of a Peruvian National Reference Hospital.
Patients and Methods
This retrospective study included 216 preterm infants. The data were collected between January 2016 and December 2018. All infants were examined according to Peruvian guidelines for screening and treatment of ROP. The association of clinical risk factors and the development of ROP was analyzed and predictive factors were determined.
Results
The study subjects were 216 preterm infants of which 72 had some stage of ROP (32 stage 1; 23 stage 2 and 17 stage 3) and 144 preterm infants without ROP. The incidence of ROP in preterm infants less than 32 weeks was 60.9%, while for those weighing less than 1500 g it was 71.6%. The factors associated with ROP were gestational age below 32 weeks, birth weight below 1500 grams, neonatal sepsis, oxygen therapy, mechanical ventilation, hyaline membrane disease, bronchopulmonary dysplasia, persistence of ductus arteriosus and intraventricular hemorrhage. Exclusive breastfeeding was found to play a protective role against ROP. Binary logistic regression analysis found that only gestational age below 32 weeks (OR, 2.637; 95% CI, 1.04–6.69), weight below 1500 grams (OR, 4.377; 95% CI, 1.75–10.92), neonatal sepsis (OR, 6.517; 95% CI, 2.81–15.14), vaginal delivery (OR, 3.748; 95% CI: 1.54–9.14), and the presence of hyaline membrane disease (OR, 3.58; 95% CI, 1.47–8.74) are predictors of ROP.
Conclusion
The incidence of ROP among very low birth weight infants was 71.6%. Infants with weight below 1500 grams, neonatal sepsis, presence of hyaline membrane disease whose mother had vaginal delivery are at risk for the development of ROP. Thus, preventing premature births and encouraging exclusive breastfeeding are two main ways to prevent ROP.
... Gestational age: in weeks by Capurro [21] Gestational age: preterm (< 37 weeks), term (between 37 weeks and 41 weeks and 6 days, and postterm if > 42 weeks) [22] Weight (g) and length (cm) at birth: they were transformed into a z score using the Intergrowth 21st [23] for gestational age and male or female sex according to the presence or absence of Y chromosome in the karyotype, respectively. ...
The aim of this study was to verify the influence of Y chromosome and intrauterine androgens production/action on birth weight and length of children with Disorders/Differences of Sex Development (DSD). This was a cross-sectional and retrospective study. Cases of Turner syndrome (TS), complete (XX and XY), mixed (45,X/46,XY) and partial (XY) gonadal dysgenesis (GD), complete (CAIS) and partial (PAIS) androgen insensitivity syndromes and XX and XY congenital adrenal hyperplasia (CAH) were included. Such conditions were grouped according to karyotype and to intrauterine production/action of androgens. The sample consisted of 293 cases, 50 with TS, 28 mixed GD, 117 CAH (49 XY and 68 XX), 18 CAIS, 10 PAIS, 30 partial GD, 10 XY and 30 XX complete GD. Birth weight and length were lower in TS and mixed GD when compared to XY and XX. In turn, patients with increased androgen production/action (117 cases) had higher birth weight and length when compared to those with absent (108 cases) and decreased (68 cases) production/action. It was observed a negative influence of the 45,X/46,XY karyotype in birth weight and a positive influence of increased androgen production/action. Regarding birth length, there was a negative influence of the TS karyotype and of decreased androgen production/action. In conclusion, in DSD, both karyotype, especially with a 45,X cell line, and intrauterine androgenic production/action influence sex dimorphism of birth weight and length. It can be inferred that in children with normal karyotype and without a DSD, this dimorphism is mainly due to intrauterine androgenic production or action.
... Gestational age was calculated according to obstetric ultrasound up to the 20th week of pregnancy and when this was not available, the last menstrual period (LMP) was used. Gestational age by the Capurro method [16] was used only in cases where the others parameters were not adequate. Microcephaly was considered when the newborn HC was equal or less than 2 standard deviations (SD) under the mean measurement expected for sex and gestational age considering the standard curve INTERGROWTH-21st for both term and preterm babies [17]. ...
Congenital Zika virus (ZIKV) infection may present with a broad spectrum of clinical manifestations. Some sequelae, particularly neurodevelopmental problems, may have a later onset. We conducted a prospective cohort study of 799 high-risk pregnant women who were followed up until delivery. Eighty-three women and/or newborns were considered ZIKV exposed and/or infected. Laboratory diagnosis was made by polymerase chain reaction in the pregnant mothers and their respective newborns, as well as Dengue virus, Chikungunya virus, and ZIKV serology. Serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis infections were also performed in microcephalic newborns. The newborns included in the study were followed up until their third birthday. Developmental delay was observed in nine patients (13.2%): mild cognitive delay in three patients, speech delay in three patients, autism spectrum disorder in two patients, and severe neurological abnormalities in one microcephalic patient; sensorineural hearing loss, three patients and dysphagia, six patients. Microcephaly due to ZIKV occurred in three patients (3.6%). Clinical manifestations can appear after the first year of life in children infected/exposed to ZIKV, emphasizing the need for long-term follow-up.
... Data on birth outcomes including gestational length were directly extracted from the University Hospital's electronic records. The gestational age of all children was assessed by the delivering health worker using the Capurro method (Capurro, Konichezky, Fonseca, & Caldeyro-Barcia, 1978). The Capurro allows for an accurate assessment of gestational age when data on the last menstrual period or and early ultrasound results are not available (Pereira, Dias, Bastos, da Gama, & Leal Mdo, 2013). ...
Globally, an estimated 15 million children are born prematurely each year, resulting in a high burden of under-five mortality and neurodevelopmental disability. Kangaroo Mother Care (KMC) is a key intervention to support the development of preterm infants. However, evidence on the impact of KMC in routine care settings remains limited. This paper examines the associations between maternal KMC efforts and child development among preterm infants using data from a prospective cohort study conducted in São Paulo, Brazil. Study outcomes were height-for-age z-scores (HAZ) and cognitive development at age 3 years. Practicing KMC was positively associated with HAZ (+0.91 SD, 95% CI [0.126, 1.695]), and cognition (+0.37 SD, [0.034, 0.806]) of preterm children. The results suggest that KMC can improve children’s cognitive and physical development. New programmes to increase KMC uptake in the setting studied may be beneficial for both mothers and their preterm children.
... Confidence intervals for proportions were calculated using standard errors based on a binomial distribution. GA was estimated most commonly by last menstrual period (516/626, 82%); otherwise by ultrasound (90/626, 14%), clinical examination, or Capurro scores [24]. R and SAS 9.4 were used for data analysis. ...
Worldwide recognition of the Zika virus outbreak in the Americas was triggered by an unexplained increase in the frequency of microcephaly. While severe microcephaly is readily identifiable at birth, diagnosing less severe cases requires comparison of head circumference (HC) measurement to a growth chart. We examine measured values of HC and digit preference in those values, and, by extension, the prevalence of microcephaly at birth in two data sources: a research study in Honduras and routine surveillance data in Uruguay. The Zika in Pregnancy in Honduras study enrolled pregnant women prenatally and followed them until delivery. Head circumference was measured with insertion tapes (SECA 212), and instructions including consistent placement of the tape and a request to record HC to the millimeter were posted where newborns were examined. Three indicators of microcephaly were calculated: (1) HC more than 2 standard deviations (SD) below the mean, (2) HC more than 3 SD below the mean (referred to as “severe microcephaly”) and (3) HC less than the 3rd percentile for sex and gestational age, using the INTERGROWTH-21st growth standards. We compared these results from those from a previous analysis of surveillance HC data from the Uruguay Perinatal Information System (Sistema Informático Perinatal (SIP). Valid data on HC were available on 579 infants, 578 with gestational age data. Nine babies (1.56%, 95% CI 0.71–2.93) had HC < 2SD, including two (0.35%, 95% CI 0.04–1.24) with HC < 3SD, and 11 (1.9%, 95% CI, 0.79–3.02) were below the 3rd percentile. The distribution of HC showed strong digit preference: 72% of measures were to the whole centimeter (cm) and 19% to the half-cm. Training and use of insertion tapes had little effect on digit preference, nor were overall HC curves sufficient to detect an increase in microcephaly during the Zika epidemic in Honduras. When microcephaly prevalence needs to be carefully analyzed, such as during the Zika epidemic, researchers may need to interpret HC data with caution.
... Covariates were selected a priori and included child sex, birth weight for gestational age z-score, maternal asthma (ever yes/no), age (continuous in years) and educational attainment at enrollment (<high school, some high school or high school graduate, >high school) and seasonality. Ultrasounds are not routinely performed as standard of care in Mexico, therefore gestational age was based on last menstrual period (LMP) and by a standardized physical examination to determine gestational age at birth via delivery sheet (Capurro et al., 1978). Physical exam gestational age was used instead of the gestational age determined by LMP if the physical examination assessment differed by more than 3 weeks from the LMP gestational age. ...
Background
Exposure to particulate matter <2.5 μm in diameter (PM2.5) and environmental tobacco smoke (ETS) are associated with respiratory morbidity starting in utero. However, their potential synergistic effects have not been completely elucidated. Here, we examined the joint effects of prenatal and early life PM2.5 and prenatal ETS exposure on respiratory outcomes in children.
Material and methods
We studied 536 mother-child dyads in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) study in Mexico City. Exposure to PM2.5 was estimated using residence in pregnancy and child's first year of life with a satellite-based spatio-temporal model. ETS exposure was assessed by caregiver's report of any smoker in the household during the second or third trimester. Outcomes included report of ever wheeze and wheeze in the past 12 months (current wheeze) assessed when children were 6–8 years old considered in separate models. Associations were modeled using distributed lag models (DLM) with daily PM2.5 averages for pregnancy and the first year of life, adjusting for child's sex, birth weight z-score, mother's age and education at enrollment, maternal asthma, season of conception and stratified by prenatal ETS exposure (yes/no).
Results
We identified a sensitive window from gestational week 14 through postnatal week 18 during which PM2.5 was associated with higher risk of ever wheeze at age 6–8 years. We also observed a critical window of PM2.5 exposure between postnatal weeks 6–39 and higher risk of current wheeze. We found significant associations between higher prenatal and early life PM2.5 exposure and higher cumulative risk ratios of ever wheeze (RR:3.76, 95%CI [1.41, 10.0] per 5 μg/m³) and current wheeze in the past year (RR:7.91, 95%CI [1.5, 41.6] per 5 μg/m³) only among children born to mothers exposed to ETS in pregnancy when compared to mothers who were not exposed.
Conclusions
Exposure to prenatal ETS modified the association between prenatal and early life PM2.5 exposure and respiratory outcomes at age 6–8 years. It is important to consider concurrent chemical exposures to more comprehensively characterize children's environmental risk. Interventions aimed at decreasing passive smoking might mitigate the effects of ambient air pollution.
... Differences between the right and left ears and sex were analyzed. Preterm infants, born at less than 37 weeks, had their ages corrected using the Capurro method (17). ...
OBJECTIVES:
Assessing infants’ hearing is of utmost importance, as hearing at this phase is required for the development of oral language. Through hearing, human beings are capable of developing communication. The Brainstem Auditory Evoked Potentials are an indispensable test to diagnose deafness in infants. This study aimed to analyze the results of the Brainstem Auditory Evoked Potentials in children with risk factors for hearing loss.
METHODS:
This cross-sectional study analyzed the Brainstem Auditory Evoked Potentials in 123 infants aged 1 to 24 months at a hearing health care service. The Vivosonic Integrity V500 equipment, which enabled the child to be awake while the testing was carried out, was used in this study. The data were compared by gestational age and sex, according to the standards suggested in the equipment handbook.
RESULTS:
A significant difference was verified for age ranges 4 to 6 months, 13 to 15 months (waves I and V), and 7 to 9 months (wave V). The lower values in absolute wave latencies were comparable to data from the equipment handbook, justifying the need for standardization of the screening process.
CONCLUSION:
There are some differences between the standards in the equipment handbook and those observed in our study. These results will serve as a reference for the standardization of the equipment used in the hearing health care service.
Objective This study aimed to investigate the association between variations in cytokine levels in the first 72 hours of life and prematurity.
Study Design In this prospective study, we examined the cytokine levels of 110 newborns in the first 72 hours of life. The participants were divided into two groups based on gestational age (66 very preterm and 44 term newborns), and cytokine levels (interleukin [IL]-6, IL-8, and IL-10, tumor necrosis factor-α [TNF-α], and transforming growth factor-β [TGF-β]) were evaluated.
Results Premature newborns exhibited higher levels of IL-6, IL-8, and IL-10, while TNF-α and TGF-β levels were lower comparing to term newborns. Even after adjusting for maternal and peripartum factors, the significant differences persisted.
Conclusion Our study underscores significant cytokine profile differences between full-term and very preterm newborns in early life. Elevated IL-6 and IL-8 levels in preterm infants suggest potential perinatal inflammation links to prematurity.
Key Points
Introducción.- Si bien los parámetros antropométricos (peso, talla y perímetro cefálico) usados en la evaluación nutricional del recién nacido (RN) pueden ser normales, algunos RN a término (RNT) adecuados para su edad gestacional (AEG) sufren de desnutrición fetal cuando se valoran los compartimientos graso y proteico a través del test de Metcoff. El objetivo del presente trabajo es conocer la incidencia de desnutrición fetal en los RNT AEG, mediante la evaluación clínica del estado nutricional (ECEN) y su calificación según Metcoff, además de conocer las características de sus madres, en el periodo de marzo del 2000 a noviembre del 2001 en el Instituto Materno Perinatal (IMP) de Lima. Métodos: Se realizó un estudio descriptivo, transversal y prospectivo en el IMP. Se evaluó el estado nutricional de una muestra de 56 RNT AEG, vivos, de parto eutócico y único, sin la presencia de factores de riesgo que afecten la salud de la madre, el RN o de ambos. La selección fue de una muestra probabilística de tipo accidental. Los resultados se muestran en tablas y gráficos. Resultados: Se evaluaron 56 RNT AEG. Predominó el sexo femenino (55.4%) con respecto al masculino (44.6%). El promedio y desviación estándar del peso, talla y perímetro cefálico para los considerados como bien nutridos fue 3347 ± 290 g, 50.22 ± 1.17 cm y 34.29 ± 1.09 cm, respectivamente, mientras que para los desnutridos fue 3068 ± 139 g, 49.6 ± 0.55 cm y 33.4 ± 1.51 cm, respectivamente. El test de Metcoff mostró desnutrición clínica en 5 RNT AEG, lo que representa una incidencia del 8.9%.
Las curvas de referencia de crecimiento intrauterino según edad gestacional en el Perú son escasas y no actualizadas. Objetivos: 1) Determinar nuevos valores normales de peso al nacimiento (PN), talla, perímetro cefálico y relación peso/talla. 2) Diseñar una curva de crecimiento intrauterino entre las 24 y 43 semanas de edad gestacional. 3) Comparar con un estudio anterior. Método: Se incluyeron los recién nacidos vivos de raza mestiza durante el período de julio de 1988 a febrero de 2004 (n = 20.388) a nivel del mar. Se excluyeron aquellos con PN menor de 500 g, edad gestacional (EG) menor de 24 semanas, con errores en la apreciación de la edad y patologías obstétricas reconocidas universalmente que pudieran influir en el peso al nacimiento y anomalías congénitas. Fuente de datos: Sistema Informático Perinatal (SIP) y Registro Estadístico Neonatal Propio (REN). Programas Utilizados para los Cálculos: Microsoft Visual FoxPro 6,0, Microsoft Excel y Word, Epi Info 6,0 y SPSS 10,0. Se calculó el peso al nacimiento medio, DS, ES, coeficiente de variación, percentilados real y polinómico. Resultados: Se halló una media de 3.270,03 g, DS: 442,5, ES: 3,1 y mediana: 3.280 g. Comparado con un estudio anterior, se observó una disminución del PN en el percentil 90 para todas las edades gestacionales, excepto en las semanas 41 a 43, e incremento en el percentil 10. Es indispensable contar con curvas de crecimiento intrauterino actualizadas en cada país para una mejor clasificación de los recién nacidos.
Background:
Few birth cohorts in South America evaluate the joint effect of minerals and toxic metals on neonatal health. In Madre de Dios, Peru, mercury exposure is prevalent owing to artisanal gold mining, yet its effect on neonatal health is unknown.
Objectives:
We aimed to determine whether toxic metals are associated with lower birth weight and shorter gestational age independently of antenatal care and other maternal well-being factors.
Methods:
Data are from the COhorte de NAcimiento de MAdre de Dios (CONAMAD) birth cohort, which enrolled pregnant women in Madre de Dios prior to their third trimester and obtained maternal and cord blood samples at birth. We use structural equation models (SEMs) to construct latent variables for the maternal metals environment (ME) and the fetal environment (FE) using concentrations of calcium, iron, selenium, zinc, magnesium, mercury, lead, and arsenic measured in maternal and cord blood, respectively. We then assessed the relationship between the latent variables ME and FE, toxic metals, prenatal visits, hypertension, and their effect on gestational age and birth weight.
Results:
Among 198 mothers successfully enrolled and followed at birth, 29% had blood mercury levels that exceeded the U.S. Centers for Disease Control and Prevention threshold of 5.8μg/L and 2 mothers surpassed the former 5-μg/dL threshold for blood lead. The current threshold value is 3.5μg/dL. Minerals and toxic metals loaded onto ME and FE latent variables. ME was associated with FE (β=0.24; 95% CI: 0.05, 0.45). FE was associated with longer gestational age (β=2.31; 95% CI: -0.3, 4.51) and heavier birth weight. Mercury exposure was not directly associated with health outcomes. A 1% increase in maternal blood lead shortened gestational age by 0.05 d (β=-0.75; 95% CI: -1.51, -0.13), which at the 5-μg/dL threshold resulted in a loss of 3.6 gestational days and 76.5g in birth weight for newborns. Prenatal care visits were associated with improved birth outcomes, with a doubling of visits from 6 to 12 associated with 5.5 more gestational days (95% CI: 1.6, 9.4) and 319g of birth weight (95% CI: 287.6, 350.7).
Discussion:
Maternal lead, even at low exposures, was associated with shorter gestation and lower birth weight. Studies that focus only on harmful exposures or nutrition may mischaracterize the dynamic maternal ME and FE. SEMs provide a framework to evaluate these complex relationships during pregnancy and reduce overcontrolling that can occur with linear regression. https://doi.org/10.1289/EHP10557.
Objective
Glycaemia in newborns changes significantly after birth; however, little is known about these changes. The objective was to describe continuous interstitial glucose values in term newborns who were exclusively breast fed on the first day of life.
Design
We studied 159 newborns with appropriate weights for gestational age, who were exclusively breast fed on the first day of life, using a continuous glucose monitoring device that calculates interstitial glucose every 5 min. The device was removed after 24 hours, and the results were analysed using the R program, which provides the minimum, maximum, median and a standard curve with centiles.
Results
At the second hour of life, the moment in which the sensor started to identify the newborn’s glycaemia, interstitial glucose levels were 2.59–4.43 mmol/L (46.7–79.9 mg/dL). The median interstitial glucose level of the newborns during the first day of life was 3.33±0.48 mmol/L (60±8.6 mg/dL). Interstitial glucose levels dropped until the sixth hour of life, reaching 2.19–3.95 mmol/L (39.5–71.1 mg/dL), and then increased again. The maximum values were found at the 20th and 21st hours of life, which were 2.81–4.64 mmol/L (50.6–83.6 mg/dL).
Conclusion
The interstitial glucose during the first 24 hours of life declined until the sixth hour of life, then increased around the 20th hour and remained stable until the end of the first day of life.
This study aims to estimate the gestational age in neonates admitted to NICU and postnatal wards within the first 24 hours of life using Parkin score. All newborns had their ENBS and PS Scores calculated, and the appropriate GA listed in the chart was assigned. After gathering the aforementioned data, comparisons were done between other sets of data, including the correlation between LMP/USG and ENBS, LMP/USG and Parkin score, ENBS and Parkin score, and the time required for ENBS and PS. The gestational age ranged from 27 to 42 weeks, while the Parkin's score ranged from 1 to 12. The condition, birth weight, and maturity of the infants were evaluated. Parkin score with GA determined by LMP/USG has a Pearson correlation of zero for healthy and ill newborns. The Pearson connection between PS and gestational age as determined by LMP/USG is zero for newborns with AGA, LGA, and SGA. For term and preterm neonates, the LMP/USG-estimated Pearson correlation for PS with GA is 0. The average deviation from LMP, as measured by Parkin Score, was 9 or 10. 5 days, 11 days for babies with AGA, LGA, and SGA. The average deviation from LMP for Preterm, Full Term, and Post Terms, respectively, was 12 days, 8 days, and 9 days while taking PS's definition of maturity into account. Parkin's Score is therefore simple to administer, especially in neonates who are ill, requires little time, and is simple to teach other paramedical workers.
Assessing fetal development is essential to the provision of healthcare for both mothers and fetuses. In low- and middle-income countries, conditions that increase the risk of fetal growth restriction (FGR) are often more prevalent. In these regions, barriers to accessing healthcare and social services exacerbate fetal maternal health problems. One of these barriers is the lack of affordable diagnostic technologies. To address this issue, this work introduces an end-to-end algorithm applied to a lowcost, hand-held Doppler ultrasound device for estimating gestational age (GA), and by inference, FGR. The Doppler ultrasound signals used in this study were collected from 226 pregnancies (45 low birth weight at delivery) between 5 and 9 months GA by lay midwives in highland Guatemala. We designed a hierarchical deep sequence learning model with an attention mechanism to learn the normative dynamics of fetal cardiac activity in different stages of development. This resulted in a state-of-the-art GA estimation performance, with an average error of 0.79 months. This is close to the theoretical minimum for the given quantization level of one month. The model was then tested on Doppler recordings of the fetuses with low birth weight and the estimated GA was shown to be lower than the GA calculated from last menstruation. Thus, this could be interpreted as a potential sign of developmental retardation (or FGR) associated with low birth weight, and referral and intervention may be necessary.
Background:
South Asia, accounts for 60% of preterm births worldwide. To provide vital care and prevent complications that arise with preterm births, accurate determination of gestational age is important.
Methods:
We conducted a cross-sectional study at Maternity Hospital in Sudan, to evaluate the use of anthropometric measurements (head-circumference and crown-heel-length) for Gestational age assessment. Our sample included preterm babies over a period of six months. Neonatal anthropometry measurements, and Gestational age assessment was done within 48 hours of birth. Variables were summarized using descriptive statistics and the strength of association was determined through correlation analysis. Linear regression equations were derived to estimate gestational age using head circumference and crown heel length.
This study aimed to compare the anthropometric measurements and body proportionalities of neonates born before the Zika virus epidemic with those born during this period. We compared 958 neonates born during the pre-Zika epidemic with 264 neonates born during the epidemic period. The newborns had their head circumference, weight, and length classified according to the Fenton & Kim growth chart. We considered disproportionate those individuals that presented microcephaly and adequate weight or length for sex and gestational age, and those whose head circumferences were lower than the ratio ((length / 2) + 9.5) - 2.5cm. We estimated the frequencies of Zika positivity and brain imaging findings among neonates with microcephaly born during the epidemic period, concerning the anthropometric and body proportionality parameters. Low weight and proportionate microcephaly were similar among newborns from both periods. However, the frequencies of newborns with microcephaly with a very low length and disproportionate microcephaly were higher among the neonates of the epidemic period with brain abnormalities and positive for Zika virus. We conclude that, at birth, the disproportion between head circumference and length can be an indicator of the severity of microcephaly caused by congenital Zika.
Aims
To evaluate the influence of weight and body proportionality at birth as well as weight gain in the first six months of life on waist size at eight and 18 years of age.
Methods
It is a prospective cohort involving 163 full-term low birth weight infants (LBW) and 212 appropriate birth weight infants (ABW) born in 1993 and 1994 from five municipalities in the northeast region of Brazil with a poor socioeconomic status. The sample consisted of 214 adolescents recruited at birth and reassessed at eight and 18 years of age.
Results
The multiple linear regression analysis showed that rapid weight gain between birth and six months of age most contributed to the variation in waist circumference (WC) at eight years (10.9%) and 18 years (2.8%). ABW explained 2.1% and 2.9% of the variation in WC at eight and 18 years of age, respectively. Male sex contributed more to the difference in the WC at eight years of age (3.9%) than 18 years of age (1.5%).
Conclusions
ABW and rapid weight gain in the first six months of life had positive influence on waist size and may be related to the accumulation of abdominal adiposity in childhood and adolescence.
Análise dos motivos de afastamento dos trabalhadores de serviço de nutrição e dietética de hospital universitário.
Background:
Epicardial fat thickness (EFT) in adults and children has been related to the metabolic syndrome and other cardiovascular risk factors; however, scarce studies have evaluated it in infants of diabetic mothers (IDM) in whom, alterations in the thickness of the interventricular septum have been reported. This study compares the EFT in IDM versus infants of non-diabetic mothers (INDM) and its association with others echocardiographic parameters.
Methods:
We performed a cross sectional study in 93 infants (64 IDM and 29 INDM). To evaluate EFT dimensions, an echocardiogram was performed within the first 24h of extrauterine life in both groups. In diabetic mothers, HbA1c was also determined.
Results:
There was no significant difference in birth weight between the groups although gestational age was lower in IDM. The EFT (3.6 vs. 2.5 mm, p < 0.0001), the interventricular septum thickness (IVST) (6.2 vs. 5.2 mm, p < 0.0001) and the IVST / left ventricle posterior wall (1.3 vs. 1.1, p = 0.001) were higher in the IDM; while the left ventricular expulsion fraction [LVFE] (71.1 vs. 77.8; p < 0.0001) was lower than in the INDM, respectively. We found a positive correlation between EFT with IVST (r = 0.577; p = 0.0001), LVPW (r = 0.262; p = 0.011), IVST/LVPW index (r = 0.353; p = 0.001), and mitral integral early velocity (r = 0.313; p = 0.002), while a negative correlation with LVFE was observed (r = -0.376; p = 0.0001).
Conclusions:
The EFT is higher in IDM than in INDM. It was positively related with echocardiographic parameters of left ventricular thickness and negatively with left ventricular ejection function.
Objective: To evaluate low birthweight and rapid postnatal weight gain as predictors of elevated blood pressure in adolescence in a population of low socioeconomic status.
Methods: A cohort study was carried out with 208 adolescents, 78 born with low weight and 130 born with appropriate weight. The infants were followed up during the first six postnatal months and reassessed at 8 and 18 years of age. The main exposure variables were birth weight and weight gain in the first six postnatal months. Rapid weight gain was defined when above 0.67 z score. The investigated co-variables were: sex, maternal height and family income at birth, breastfeeding duration from birth to six months, nutritional status at eight years old, socioeconomic conditions, nutritional status, fat mass index and physical activity level at 18 years. The outcome variable was the occurrence of elevated blood pressure at 18 years old.
Results: The proportion of adolescents with elevated blood pressure was 37.5%. The multivariable logistic regression analysis showed the variables independently associated with a higher chance of elevated blood pressure in adolescence were rapid postnatal weight gain (OR=2.74; 95% CI 1.22-6.14; p=0.014), male sex (OR=4.15; 95% CI 1.66-40 10.38; p=0.002) and being physically active (OR=2.70; 95% CI 1.08-6.74; p=0.034).
Conclusions: The occurrence of rapid weight gain in the first six postnatal months was a predictor for elevated blood pressure in adolescence. This result highlights the influence of factors related to development in early childhood on health problems in the future.
OBJECTIVES: Although child mortality has declined significantly in recent decades, the reduction of neonatal mortality remains a major challenge as neonatal mortality represents 2/3 of the mortality rate in this population. The objective of this study was to evaluate the utility of the Score for Neonatal Acute Physiology Perinatal Extension II (SNAP-PE II) score for evaluating the survival prognosis of newborns admitted to a neonatal intensive care unit (NICU). METHODS: The study design involved an observational cross-sectional retrospective collection, as well as a prospective component. The sample included all newborns admitted to the NICU validated by the SNAP-PE II tool from January 1 to December 31, 2014. RESULTS: A predominance of young mothers (25.4 years), underwent prenatal care (86.2%), however a considerable percentage (49.4%) of mothers received insufficient medical consultation (less than six consults during their pregnancy). A prevalence of male admissions (62.4%) were noted in the NICU. Premature (61.7%) and underweight (weight o2,500 grams) newborns were also prevalent. The SNAP-PE II score showed an association between the infants who were discharged from the neonatal unit and the non-survivors. An increased prevalence of low birth weight and hypothermia was noted in the group of non-survivors. The mean arterial pressure appears to be a significant risk factor in the newborn group that progressed to death. Hypothermia, mean arterial pressure, and birth weight were the most significant variables associated with death. CONCLUSION: The SNAP-PE II was a beneficial indicator of neonatal mortality. The prevention of prematurity and hypothermia by improving maternity care and newborn care can decisively influence neonatal mortality.
KEYWORDS: Hypothermia; Low Weight; Neonatal Intensive Care Units; Newborn; Risk Assessment; SNAP-PE II.
Pregnancy is characterized by high bone remodeling and might be a window of susceptibility to the toxic effects of metals on bone tissue. The aim of this study was to assess associations between metals in blood [lead (Pb), cadmium (Cd)and arsenic (As)] and bone remodeling during pregnancy. We studied pregnant woman from the PROGRESS Cohort (Programming Research in Obesity, Growth, and Environment and Social Stress). We measured concentrations of metals in blood and obtained measures of bone remodeling by quantitative ultrasound (QUS) at the radius in the second and third trimester of pregnancy. To account for chronic lead exposure, we measured lead in tibia and patella one-month postpartum with K-shell X-ray fluorescence. We assessed cross-sectional and longitudinal associations between multiple-metal concentrations and QUS z-scores using linear regression models and linear mixed models adjusted for potential confounders. Third trimester blood Cd concentrations were marginal associated with lower QUS z-scores [-0.16 (95% CI: -0.33, 0.007); P-Value= 0.06]. Mixed models showed that blood Cd was longitudinally and marginally associated with an average of -0.10 z-score (95% CI: -0.21, 0.002; P-Value=0.06) over the course of pregnancy. Associations for Pb and As were all inverse however none reached significance. Additionally, bone Pb concentrations in patella, an index of cumulative exposure, were significantly associated with -0.06 z-score at radius (95% CI: -0.10, -0.01; P-Value=0.03) during pregnancy. Pb and Cd blood levels are associated with lower QUS distal radius z-scores in pregnant women. Bone Pb concentrations in patella were negatively associated with z-score at radius showing the long-term effects of Pb on bone tissue. However, we cannot exclude the possibility of reverse causality for patella Pb and radius z-score associations. Our results support the importance of reducing women’s metal exposure during pregnancy, as metals exposure during pregnancy may have consequences for bone strength later in life.
The main finding of our study is the association between Cd blood levels and radius z-score during pregnancy. Bone lead in patella was also negatively associated with radius z-scores.
The impact of Zika virus (ZIKV) infection on pregnancies shows regional variation emphasizing the importance of studies in different geographical areas. We conducted a prospective study in Tegucigalpa, Honduras, recruiting 668 pregnant women between July 20, 2016, and December 31, 2016. We performed Trioplex real-time reverse transcriptase–PCR (rRT-PCR) in 357 serum samples taken at the first prenatal visit. The presence of ZIKV was confirmed in seven pregnancies (7/357, 2.0%). Nine babies (1.6%) had microcephaly (head circumference more than two SDs below the mean), including two (0.3%) with severe microcephaly (head circumference [HC] more than three SDs below the mean). The mothers of both babies with severe microcephaly had evidence of ZIKV infection. A positive ZIKV Trioplex rRT-PCR was associated with a 33.3% (95% CI: 4.3–77.7%) risk of HC more than three SDs below the mean.
Background
The goals of nutrition therapy include providing adequate growth and development, avoiding a negative energy and nitrogen balance, and preventing complications.
Objective
To evaluate the nutrition therapy received by newborns at the neonatal intensive care unit (NICU) of a public maternity hospital in Rio de Janeiro, Brazil.
Methods
Retrospective longitudinal observational study in which data were collected on newborns admitted to NICU, in Rio de Janeiro, in 2016. The time that elapsed before commencement of parenteral and trophic enteral nutritional, time to reach full enteral nutrition, type of diet at the beginning of trophic enteral nutrition and at discharge from the NICU, and the relationship between birth weight and nutritional therapy were evaluated.
Results
Trophic enteral nutrition began after 24.42 (SD +20.23) hours, on average, and the mean time to reach full enteral nutrition was 10.0 (SD +5.51) days. Newborns with a birth weight below 1500 g had a longer hospital stay (p = .002), longer oxygen therapy (p = .009), a longer time before commencement of enteral feeding (p = .005), and took longer to reach full enteral feeding (p = .010).
Conclusions
The institutional nutritional therapy practices were consistent with those proposed in the literature, but more support is needed for breastfeeding in this group.
A simple scoring system based on skin colour, skin texture, breast development, and ear firmness that can be performed even in an ill baby without manipulation or movement enables gestational age to be estimated to within +/- 15 days (95% confidence limits) at any time in the first 2 days of life. More complex techniques only marginally improve this estimate.
A scoring system for gestational age, based on 10 neurologic and 11 “external” criteria, has been applied to 167 newborn infants. The “external” score gave a better correlation with gestation than did the neurologic score, but the combined total score was better than either alone. The correlation coefficient for the total score against gestation was 0.93. The error of prediction of a single score was 1.02 weeks and of the average of two independent assessments was 0.7 weeks. The method gives consistent results within the first 5 days and is equally reliable in the first 24 hours of life. This scoring system is more objective and reproducible than trying to guess gestational age on the presence or absence of individual signs.
Neurological examination of the newborn infant is described, based on the evaluation of passive tone, active tone, and primary reflexes. Gestational age may thereby be assessed at birth, enabling short gestation infants to be distinguished from those that are small-for-dates.
Comparison was made between birth weight and maturity scoring (obtained by grading 11 physical characteristics) as a means of estimating gestational age in infants premature by weight. Thirty-nine babies were examined, and there was a better correlation between the maturity score and gestational age than between birth weight and gestational age. It appears that in those cases where the length of pregnancy is in doubt maturity scoring is of value in differentiating "small for dates" babies from those who are truly premature.
Rapid assessment of gestational age at birth
- Parkin