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Los nacimientos prematuros son considerados una emergencia de salud global. A pesar de que se ha producido un aumento en las tasas de supervivencia de estos bebés, existen múltiples consecuencias derivadas de la prematuridad que pueden impactar en su desarrollo biopsicosocial. Una de ellas es la interferencia del ambiente de las Unidades de Cuidados Intensivos Neonatales (UCIN) en el desarrollo del vínculo maternofilial. Es por ello por lo que el objetivo del presente trabajo es explorar la influencia que tiene la prematuridad en el desarrollo del bebé y especialmente en el establecimiento de un vínculo maternofilial de calidad en el contexto de la Unidad de Cuidados Intensivos Neonatales (UCIN).

Resumen: Introducción: En Chile los casos reportados de COVID-19 a nivel nacional al tercer año de pandemia (3 de noviembre del 2022) son de 4.769.638 y 61.725 fallecidos (1,3%), con el 93% de la población con esquema completo de vacunación (17.686.528). Objetivo: El objetivo de este estudio es una comunicación breve sobre el impacto de la pandemia de SARS-CoV-2 en la mortalidad materna, perinatal y prematuridad en Chile. Método: Se utilizó la base de datos nacional del Departamento de Informática del Ministerio de Salud de Chile (DEIS), y la información reportada desde sitio web oficial de OMS. Se incluyeron todos los nacidos, muertes generales y fetales desde enero 1990 a septiembre del 2022. Se realiza una comparación entre los indicadores básicos maternos y perinatales de los últimos 30 años y los de los años de la pandemia. Resultados: Desde marzo 2020 a septiembre 2022, fallecieron más de 61.000 personas en Chile con diagnóstico asociado al COVID-19, el 17% de la mortalidad general para el período (364.000 fallecidos). Se observó una aceleración en la tendencia histórica hacia la disminución de la razón nacimientos/defunciones generales de 1,9 pre-pandemia a 1,4 al tercer año de pandemia. La razón de mortalidad materna en el año 2020 fue de 28,1 × 100.000 nacidos vivos y aumentó en comparación al año 2019 pre-pandemia (19,1) o a la línea simple de tendencia histórica proyectada para el 2020 (18) en un 56%. La prematuridad bajo 37 semanas de gestación, se incrementó de 8,5% (2019) a 9,5% para los años 2021 y 2022. La mortalidad neonatal de los primeros 28 días se mantuvo estable en 9 × 1.000 nacidos vivos durante los 3 años de pandemia y la mortalidad fetal (>21 semanas) tuvo un leve incremento a 4,7 × 1.000 nacidos vivos (año 2020) en relación a 3,4 del año 2019. Conclusiones: En Chile ocurrió un aumento de aproximadamente un 56% de la mortalidad materna el primer año de pandemia de SARS-CoV-2, el segundo año se observa un aumento significativo de la prematuridad tardía y un leve incremento de la mortalidad fetal. Estos hallazgos han sido reportados en las revisiones y últimas actualizaciones del año 2022. Abstract: Introduction: At the third year of the pandemic in Chile, the reported cases of COVID-19 reached 4,769,638 and 61,725 deaths (1.4%), with 93% of the population with a complete vaccination schedule (17,686,528). Aim: The purpose of this study is a brief communication on the impact of the SARS-CoV-2 pandemic on maternal, perinatal and prematurity mortality in Chile. Method: The national database of the Informatics Department of the Ministry of Health of Chile (DEIS), and the information reported from the official WHO website were used. All births, general and fetal deaths from January 1990 to September 2022 were included. A comparison is made between the basic maternal and perinatal indicators of the last 30 years and those of the years of the pandemic. Results: From March 2020 to September 2022, approximately 61,000 people died in Chile with a diagnosis associated with COVID-19, 17% of the general mortality for the period (approx. 364.000 deaths). An acceleration in the historical trend towards a decrease in the overall birth/death ratio was observed from 1.9 pre-pandemic to 1.4 during the third year of the pandemic. Maternal Mortality Ratio in 2020 (28.1 × 100,000) increased compared to 2019 pre-pandemic (19.1) or the simple historical trend line projected for 2020 (18.0) by 56%. Prematurity under 37 weeks of gestation increased from 8.5% (2019) to 9.5% for the years 2021 and 2022. Neonatal mortality in the first 28 days remained stable at 9 per thousand births during the 3 years of the pandemic and fetal mortality (>21 weeks) had a slight increase to 4.7 per thousand (year 2020) in relation to 3.4 in 2019. Conclusions: In Chile, an increase of approximately 56% in maternal mortality occurred in the first year of the SARS-CoV-2 pandemic. In the second year, a significant increase in late prematurity and a slight increase in fetal mortality were observed. These findings have been reported in the reviews and latest updates of the year 2022.

Resumen: Introducción: La relación entre sulfato de magnesio (MgSO4) y el retraso en la evacuación de meconio presenta resultados controvertidos en la literatura. Objetivos: Determinar si existe relación entre la administración de MgSO4 a la madre y la eliminación tardía de meconio (ETM) en el neonato y conocer los niveles de magnesio en sangre en estos, con respecto a la dosis acumulada de MgSO4 administrada a la madre. Población y métodos: Estudio descriptivo-analítico, en pacientes ≤ 32 semanas de edad gestacional, con diseño retrospectivo-prospectivo, llevado a cabo en dos hospitales de tercer nivel asistencial.Se definió la ETM como retraso en la evacuación meconial ≥ 48 horas y/o necesidad de estimulación rectal en ≥ 2 ocasiones para realizar deposición y/o retraso ≥ 48 horas entre la primera y segunda deposición. Resultados: Se reclutaron 283 pacientes (204 retrospectiva y 79 prospectivamente), de los cuales 152 (53,7%) presentó ETM.No se encontró relación entre la administración de MgSO4 a la madre, ni la dosis acumulada de MgSO4 en esta, ni los niveles de magnesio en sangre del neonato con la presencia de ETM.La mayor edad gestacional (OR 0,8, IC 0,69-0,93, p = 0,003) resultó factor protector independiente de la ETM y la necesidad de reanimación avanzada (OR 2,24, IC 1,04-4,86, p = 0,04) factor de riesgo. Conclusiones: Los niveles alcanzados de magnesio en sangre del neonato con las dosis de MgSO4 administradas a las madres, no se relacionan con la ETM. La menor edad gestacional y la necesidad de reanimación avanzada predicen mayor riesgo de ETM. Abstract: Introduction: The published evidence on the association between magnesium sulphate (MgSO4) and delayed passage of meconium (DPM) is contradictory. Objectives: To determine whether there is an association between the administration of MgSO4 to the mother and DPM in the neonate, and to analyse serum magnesium levels in neonates in relation to the cumulative dose of MgSO4 administered to the mother. Population and methods: Retrospective and prospective descriptive and analytical study conducted in patients delivered at or before 32 weeks of gestation in 2 tertiary care hospitals.Delayed passage of meconium was defined as failure to pass meconium within 48 hours of birth and/or need for rectal stimulation on 2 or more occasions to pass stool and/or interval of at least 48 hours between the first and second bowel movements. Results: The study included 283 patients (204 retrospectively and 79 prospectively), of who 152 (53.7%) experienced DPM.Delayed passage of meconium was not associated with antenatal MgSO4 administration, the cumulative maternal MgSO4 dose or neonatal serum magnesium levels.Older gestational age (OR, 0.8; confidence interval [CI], 0.69–0.93; P = .003) was an independent protective factor against DPM, while the need for advanced resuscitation (OR, 2.24; CI 1.04–4.86; P = .04) was a risk factor for DPM. Conclusion: The neonatal serum levels of magnesium reached with the doses of MgSO4 administered to mothers were not associated with DPM. Lower gestational age and the need for advanced resuscitation were predictors associated with an increased risk of DPM.

ABSTRACT Objective: To describe the impact of the Koala project (Actively Controlling Target Oxygen) on clinical outcomes in patients born with less than 36 weeks of gestation, in two maternity hospitals, comparing before and after the strategy implementation. Methods: This is an intervention study with 100 preterm infants with gestational age ≤36 weeks, who used oxygen in two maternity hospitals between January 2020 and August 2021. One of the hospitals was a private institution and the other was philanthropic. The goal for the target oxygen saturation with this project was 91–95%. Comparisons between the two stages (before and after the implementation of the project) were made evaluating the outcomes of retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and deaths. The continuous variables were described using mean, median, standard deviation and interquartile interval. The significance level adopted was 5% and the software used was R Core Team 2021 (version 4.1.0). Results: After oxygen control use according to the Koala protocol, there was a significant reduction in the cases of retinopathy of prematurity (p

Resumen: Objetivos: Describir los factores de riesgo de displasia broncopulmonar en las primeras semanas de vida en grandes prematuros. Material y métodos: Estudio observacional de cohortes, retrospectivo, en recién nacidos ≤ 32 semanas y ≤ 1.500 g. Se realizó un análisis multivariante de regresión logística para identificar factores de riesgo independientes en las primeras semanas de vida. Resultados: Se incluyeron 202 recién nacidos con una edad gestacional media de 29,5 ± 2,1 semanas. El 61,4% de los pacientes no recibió ventilación mecánica invasiva. El 28,7% fue diagnosticado de displasia broncopulmonar y el 10,4% de displasia broncopulmonar moderada-grave.La edad gestacional (p < 0,001; OR = 0,44 [IC 95% = 0,30-0,65]), la ventilación mecánica en el día 1 (p = 0,001; OR = 8,13 [IC 95% = 2,41-27,42]), la sepsis nosocomial (p < 0,001; OR = 9,51 [IC 95% = 2,99-30,28]) y la FiO2 en el día 14 (p < 0,001; OR = 1,39 [IC 95% = 1,16-1,66]) fueron los factores de riesgo independientes de displasia broncopulmonar. La ventilación mecánica el día 1 (p = 0,008; OR = 5,39 [IC 95% = 1,54-18,89]) y 3 de vida (p = 0,001; OR = 9,99 [IC 95% = 2,47-40,44]) y la sepsis nosocomial (p = 0,001; OR = 9,87 [IC 95% = 2,58-37,80]) se asociaron al desarrollo de displasia broncopulmonar moderada-grave. Conclusiones: La edad gestacional, la ventilación mecánica en los primeros días de vida y la sepsis nosocomial son factores de riesgo precoces de displasia broncopulmonar. El análisis de datos clínicos sencillos y objetivos nos permite seleccionar a un grupo de pacientes con alto riesgo de desarrollar displasia broncopulmonar, en el que podría estar justificado actuar de forma más agresiva y nos muestra áreas de mejora para prevenir su desarrollo o disminuir su gravedad. Abstract: Objectives: To describe risk factors of bronchopulmonary dysplasia in very preterm infants in the first weeks of life. Material and methods: Retrospective cohort study of preterm infants ≤ 32 weeks of gestational age and birth weight ≤ 1500 g. A multivariate logistic regression analysis was performed to identify independent risk factors for bronchopulmonary dysplasia in the first weeks of life. Results: A total of 202 newborns were included in the study (mean gestational age 29.5 ± 2.1 weeks), 61.4% never received invasive mechanical ventilation. The incidence of bronchopulmonary dysplasia was 28.7%, and 10.4% of the patients were diagnosed with moderate–severe bronchopulmonary dysplasia.Bronchopulmonary dysplasia was independently associated with gestational age at birth (p < 0.001; OR = 0.44 [95% CI = 0.30–0.65]), the need for mechanical ventilation on the first day of life (p = 0.001; OR = 8.13 [95% CI = 2.41–27.42]), nosocomial sepsis (p < 0.001; OR = 9.51 [95% CI = 2.99–30.28]) and FiO2 on day 14 (p < 0.001; OR = 1.39 [95% CI = 1.16–1.66]). Receiving mechanical ventilation at the first day of life (p = 0.008; OR = 5.39 [95% CI = 1.54–18.89]) and at the third day of life (p = 0.001; OR = 9.99 [95% CI = 2.47–40.44]) and nosocomial sepsis (p = 0.001; OR = 9.87 [95% CI = 2.58–37.80]) were independent risk factors for moderate–severe bronchopulmonary dysplasia. Conclusions: Gestational age at birth, mechanical ventilation in the first days of life and nosocomial sepsis are early risk factors for bronchopulmonary dysplasia. The analysis of simple and objective clinical data, allows us to select a group of patients at high risk of bronchopulmonary dysplasia in whom it could be justified to act more aggressively, and shows areas for improvement to prevent its development or reduce its severity.

Objective: The postpartum period represents a vulnerable time for women's mental health, especially for those with complications and prematurity. This study aims to explore the evolution of depression and anxiety levels during the 12 weeks postpartum in mothers of premature babies., Design: Prospective study of two parallel cohorts., Setting: Hospital Clínic of Barcelona., Participants: Women with obstetric complications [premature rupture of membranes or preeclampsia] requiring hospitalization and preterm delivery (< 37 weeks of gestation); 2) Women without complications with term delivery., Main Measures: Validated questionnaires were administered to measure anxiety (State-Trait Anxiety Inventory, STAI) and depression (Edinburgh Postnatal Depression Scale, EPDS) during the first week, and at 6 and 12 weeks postpartum., Results: 182 women were analyzed: 90 with uncomplicated pregnancies and term deliveries, and 92 with complications requiring preterm delivery. During the follow-up, women with premature newborns showed a significantly unfavorable progression in depression (p <0.001) and anxiety (p <0.001) scores, as well as a higher proportion of abnormal scores on both scales (p <0.001 and p=0.004, respectively) CONCLUSIONS: Women with preterm delivery show higher anxiety and depression levels than those with term delivery during the 12 weeks postpartum. It is essential to ensure a seamless transition between care levels to effectively address postpartum mental health., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)

Resumen: A pesar de las mejoras en el cuidado neonatal en las últimas décadas, los recién nacidos extremadamente prematuros continúan en alto riesgo de mortalidad y morbilidad, incluyendo discapacidad en el neurodesarrollo. El objetivo de este artículo es revisar la literatura en búsqueda de datos y recomendaciones respecto a este tema de tanta importancia en nuestra práctica clínica neonatal habitual. El establecimiento de un límite de la viabilidad sigue siendo un tema complejo y controvertido, que se debe basar en múltiples factores, no solo en la edad gestacional, y que varía ampliamente en función del entorno y las circunstancias concretas de nacimiento del bebé. La incertidumbre sobre el curso de los bebés extremadamente prematuros hace difícil establecer un pronóstico preciso. En el difícil proceso de toma de decisiones de este contexto, existe acuerdo a nivel internacional acerca de la elaboración de recomendaciones y guías para la asistencia perinatal de estos pacientes, así como la elaboración de registros nacionales de datos y la formación del personal a su cargo. Es una obligación del sistema sanitario poner a disposición de estos recién nacidos el mayor nivel asistencial posible. La participación de las familias, junto con una información bien fundamentada y honesta por parte del personal sanitario, es actualmente el modelo preferido en la toma de decisiones Summary: Despite improvements in neonatal care in recent decades, extremely preterm infants continue to be at high risk for mortality and morbidity, including neurodevelopmental disability. The aim of this article is to review the literature in search of data and recommendations regarding this issue of such importance in our routine neonatal clinical practice. The establishment of a limit of viability remains a complex and controversial issue, which must be based on multiple factors, besides gestational age, and which varies widely depending on the environment and the specific circumstances of the baby's birth. The uncertainty about the course of extremely premature babies makes it difficult to establish an accurate prognosis. In this difficult decision-making context, there is international agreement on the creation of recommendations and guidelines for the perinatal care of these patients, as well as the preparation of national data registries and the training of the health care providers. It is an obligation of the health care system to provide these newborns with the highest available level of care. Family participation, along with well-founded and honest information from healthcare personnel, is currently the preferred model for decision-making.

Resumen: La respuesta inflamatoria, frecuentemente asociada al parto prematuro extremo, tiene un rol relevante en el pronóstico, ya que la inmadurez propia del sistema inmune en estas condiciones impide la apropiada modulación de estos procesos, promoviendo una inflamación persistente en el tiempo con los consiguientes daños en el corto, mediano y largo plazo. Objetivo: revisar los mecanismos inmunológicos en el prematuro extremo, los efectos en los sistemas de mayor relevancia y nuevas perspectivas terapéuticas. Summary: Inflammatory response, frequently associated with extreme preterm birth, has a relevant role in outcome, since immaturity of immune system, in such conditions, does not allow an appropriate modulation of these processes leading to sustained inflammation, to secondary damage and thus promoting short-medium- and long-term sequelae. Objective: to review immunological mechanisms involved in extreme prematurity, their effects on the most relevant systems and new therapeutical approaches.

Resumen: Objetivos: Valorar si el peso ≤ 2,5 kg supone un incremento en la morbimortalidad de la cirugía cardiaca neonatal bajo circulación extracorpórea (CEC) y caracterizar este grupo de pacientes. Métodos: Estudio retrospectivo de todos los neonatos sometidos a una primera cirugía cardiaca con CEC entre 2007 y 2019, analizando los factores independientes de morbimortalidad. Resultados: Cuarenta y nueve pacientes ≤ 2,5 kg vs. 246 > 2,5 kg, sin diferencias significativas con relación a la edad en el momento de la reparación, aunque sí en la prematuridad y el sexo femenino, mayores en ≤ 2,5 kg. Los diagnósticos más frecuentes fueron hipoplasia del arco y truncus en ≤ 2,5 kg, y transposición de grandes arterias e hipoplasia de arco en > 2,5 kg. El tiempo de CEC y el uso de parada circulatoria fueron significativamente mayores en ≤ 2,5 kg. A pesar de que el grupo ≤ 2,5 kg tuvo una mortalidad mayor (22,4 vs. 8,1%; p 2,5 kg. El análisis de la prematuridad no mostró incremento significativo de morbimortalidad. Conclusiones: A pesar de los avances en el manejo peri-extracorpórea en ≤ 2,5 kg, disminuyendo la mortalidad en algunas enfermedades, el bajo peso sigue asociándose a aumento de mortalidad. El momento de cuándo intervenir deberá individualizarse por paciente, diagnóstico y resultados del propio centro. Abstract: Objectives: Evaluate whether a weight ≤2.5 kg carries an increase in morbi-mortality in neonatal cardiac surgery under cardiopulmonary bypass (CPB) and stablish the profile of these patients. Methods: Retrospective study of the neonates who underwent the first cardiac surgery under CPB between 2007-2019, analyzing independent risk factors for morbi-mortality. Results: Group of patients ≤2.5 kg: n = 49. Group of patients >2.5 kg: n = 246. No statistical differences found in age, although there were in prematurity and female sex, which were more frequent in ≤2.5 kg. Most frequent diagnosis in ≤2.5 kg was arch hypoplasia and truncus versus transposition of the great arteries (TGA) and arch hypoplasia in >2.5 kg. Cardiopulmonary bypass time and the use of circulatory arrest were significantly higher in ≤2.5 kg. Although ≤2.5 kg group presented a greater mortality (22.4 vs 8.1% p

Abstract Introduction Deficits in executive functioning, especially in inhibitory control, are present in children born very premature and/or with very low birth weight (VP/VLBW) and in children with attention-deficit/hyperactivity disorder (ADHD). Objective To evaluate whether ADHD imposes additional inhibitory control (IC) deficits in preschoolers born VP/VLBW. Methods 79 VP/VLBW (4 to 7 years) children were assessed for ADHD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children – Present and Lifetime Version (K-SADS-PL). IC was measured with Conners’ Kiddie Continuous Performance Test (K-CPT 2) and the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P).Results: No significant differences were found between ADHD (n = 24) and non-ADHD children (n = 55) for any of the measures (p = 0.062 to p = 0.903). Both groups had deficits in most K-CPT 2 scores compared to normative samples, indicating poor IC and inconsistent reaction times. Conclusions ADHD does not aggravate IC deficits in VP/VLBW children. Either neuropsychological tasks and parent reports of executive functions (EFs) may not be sensitive enough to differentiate VP/VLBW preschoolers with and without ADHD, or these children’s EFs are already so impaired that there is not much room for additional impairments imposed by ADHD.

Resumen: Introducción: En las últimas décadas, el nacimiento de niños prematuros se ha incrementado notablemente, siendo importante conocer sus efectos. El objetivo del estudio es determinar el perfil de desarrollo psicomotor de niños con antecedentes de prematuridad, a los 4, 5 y 6 años, y compararlos con un grupo de niños nacidos a término para detectar posibles desajustes. Pacientes y métodos: La muestra estaba constituida por 98 participantes, distribuidos uniformemente en 2 grupos, prematuros y a término. Se realizó un estudio de cohorte prospectivo longitudinal analítico observacional con un diseño de casos y controles. Se ha considerado la división del grupo prematuro en muy prematuros y prematuros moderados y tardíos. Las evaluaciones se realizaron con las Escalas McCarthy de Aptitudes y Psicomotricidad para niños. Resultados: Los datos muestran logros dentro de los intervalos medios. No obstante, se evidencian más dificultades en el desarrollo a los 4 años en el grupo de prematuros. Atendiendo a la edad gestacional, los muy prematuros (edad gestacional menor de 32 semanas) muestran puntuaciones significativamente más bajas con respecto a los prematuros moderados y tardíos, fundamentalmente a los 6 años, y con los nacidos a término, a los 4 y 6 años. Conclusiones: A menor edad gestacional, son mayores las dificultades, pudiendo afectar en la etapa de Educación Primaria. Se considera la necesidad de efectuar un seguimiento a todos los prematuros en la etapa preescolar, así como evaluar habilidades más específicas y continuar con la atención desde equipos especializados. Abstract: Introduction: The rate of premature births has significantly increased, and it is important to determine its effects. The objective of this study is to determine the psychomotor development profile of a group of children born prematurely, at the age of 4, 5 and 6, and to compare them with a group of full-term birth children, in order to detect any differences. Patients and methods: The sample consisted of 98 participants, evenly distributed into two groups, premature and full-term born children. A prospective longitudinal observational analytical study, with a design of cases and controls, was carried out. For some analyses, the separation into early pre-term, moderate pre-term, and late pre-term was considered. The evaluations were performed using the McCarthy Scale of Aptitudes and Psychomotor skills for children. Results: The data shows achievements within the middle intervals. However, there are more difficulties in development at 4 years in the group of premature children, according to gestational age. Early pre-term (gestational age less than 32 weeks) showed significantly lower scores compared to moderate and late pre-term, mainly at 6 years, and with those born at term, at 4 and 6 years. Conclusions: Development difficulties are greater at a lower gestational age, and may affect the Primary Education stage. The need to monitor all premature children in the preschool stage is suggested, as well as to evaluate more specific skills and continue with the care from specialist teams.

Resumen: Introducción: Estudio retrospectivo en la unidad de cuidados intensivos neonatales de un hospital de tercer nivel sobre la incidencia de hiponatremia precoz (primeras 48 horas de vida) en prematuros. Buscamos factores de riesgo y de protección para esa alteración, como punto de partida para un cambio en la actuación médica al prescribir fluidos intravenosos. Material y métodos: Muestra de 256 prematuros (edad gestacional: 235-366) ingresados en la unidad de cuidados intensivos neonatales de nuestro hospital, entre enero de 2016 y junio de 2018. Se determinó qué pacientes recibieron aportes intravenosos de sodio en distintos intervalos de las primeras 48 horas de vida y cuántos padecieron hiponatremia de cualquier tipo (

Recent years show a gradual increase in births of children with cerebral palsy. All children affected by this disease entity should be supported neurodevelopmental. The aim of the work is to assess the long-term development of children with cerebral palsy. It is intended, allowed to increase opportunities and leveling development differences neurological rehabilitation of children covered by unifying therapeutic support and education of parents. An important aspect is the assessment of the effects of neurodevelopmental therapy in the context of the intensity and complexity of the treatment and analysis of the development of motor skills of children covered by development assistance.

Resumen: Objetivo: Conocer la frecuencia y la magnitud de la hipofosforemia neonatal ( 32 semanas con peso 32 weeks with weight

Objective: The abandonment of the Kangaroo Mother Program is a public health problem that affects the health of premature infants. The objective of this study was to determine the factors associated with the abandonment of mothers or caregivers of premature infants in the first stage of the Kangaroo Mother Program of a Health Promoting Company (EPS) in the department of Antioquia (Colombia), between 2019 and 2021., Methods: An observational, cross-sectional, and analytical study was carried out, where information was collected on admissions to the program (N=1,344) between 2019 and 2021. The Chi-Square likelihood ratio test was performed with crude prevalence ratio, a generalized linear model of robust variance was applied with the adjusted prevalence ratio., Results: When adjusting for dropout with the independent variables, a higher probability of dropout was evidenced: with respect to the year 2020 (PR 2.44, 95% CI: 1.94-3.08, p-value=0.0001), marital status alone with support (PR 1.60, 95% CI: 0.84-3.04, p-value=0. 147), primary school completed or incomplete (PR 1.48, 95% CI 1.11-1.97, p-value=0.006), monthly income less than the current legal monthly minimum wage (CLMMW) (PR 1.26, 95% CI: 1.00-1.59, p-value=0.004) and area of residence living outside Medellin (PR 1.25, 95% CI: 1.06-1.46, p-value=0.006)., Conclusions: The findings of this study can be very useful to carry out interventions in families belonging to Kangaroo Programs, with the aim of intervening risk factors associated with program dropout.

Objective: The availability in the literature of data related to perinatal variables in the Spanish population is very scarce. The aim of this study was to know the evolution of perinatal health indicators according to the risk groups of prematurity and birth weight, the proportion of multiple births, caesarean section and stillbirths., Methods: We conducted a population-based cross-sectional study of births in eleven hospitals in Castilla y León (January 2015 to June 2020). There were 70,024 newborns from 68,769 deliveries. Jointpoint regression analysis was used to identify changes in trend over the years, and binomial logistic regression was used to adjust for the potential interaction of hospital type, sex, type of delivery and multiple births on the frequencies of prematurity and death., Results: There was a 19.9% decrease in deliveries and a 42% decrease in multiple births, with no change in preterm (7.7%) and stillbirths (0.44%). The percentage of caesarean sections was 21.5% with a slight downward trend over time. Death (stillbirth) was associated with preterm multiple birth; especially with the male-male combination (p<0.05). Late preterm and early term newborns showed higher risk of death compared to term newborns: OR 7.7 (95%CI 5.6-10.7) and 2.4 (95%CI 1.6-3.6), respectively; as well as the low birth weight group (OR 17.6; 95%CI 13.9-22.2) and small for gestational age (OR 3.4; 95%CI 1.9-5.8), compared to those of adequate weight., Conclusions: Prior to the development of the COVID-19 pandemic there is a decline in births, including multiple births, with no change in stillbirths or prematurity. Late preterm and early term newborns are at increased risk of intrauterine death.

Premature births are an important health indicator for a country. These children have a higher risk of mortality and morbidity. The main brain injuries in preterm infants include white matter injuries, intracranial hemorrhages, and cerebellar injuries. These injuries can be detected through brain ultrasound and magnetic resonance imaging (MRI), with MRI being the most sensitive technique. Perinatal brain injuries may have long-term consequences on the neurodevelopment of preterm infants, with an increased risk of cerebral palsy, cognitive, behavioral, sensory, and learning disorders, among others. It is key to implement prevention strategies and early intervention to reduce the negative consequences of brain injuries associated with prematurity. Key words: prematurity, periventricular leukomalacia, intracranial hemorrhage, neurodevelopmental disorders, cerebral palsy.

Aryaev N. L., Marichereda V. G., Shevchenko I. M., Moskalenko T. Ya., El Mezevgi H. M., Shevchenko N. V. Оценка взаимосвязи факторов риска преждевременных родов в различные сроки беременности = Assess of preterm birth risk factors relationship at various pregnancy stages. Journal of Education, Health and Sport. 2016;6(9):422-432. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.153862 http://ojs.ukw.edu.pl/index.php/johs/article/view/3850 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.08.2016. Revised 25.08.2016. Accepted: 06.09.2016. УДК 618.396 /616-021.1 ОЦЕНКА ВЗАИМОСВЯЗИ ФАКТОРОВ РИСКА ПРЕЖДЕВРЕМЕННЫХ РОДОВ В РАЗЛИЧНЫЕ СРОКИ БЕРЕМЕННОСТИ Н. Л. Аряев1, В. Г. Маричереда1, И. М. Шевченко1, Т. Я. Москаленко1,2, Х. М. Эль-Мезевги1, Н. В. Шевченко2 1Одесский национальный медицинский университет, г. Одесса, Украина 2Родильный дом №7, г. Одесса, Украина Реферат В результате проведения ретроспективного анализа медицинской документации отмечено, что наиболее частыми и статистически значимыми факторами, сопровождающими и обусловливающими преждевременные роды, являются маточные кровотечения, ИЦН, инфекции различной этиологии и локализации, дисфункция плаценты, наличие выкидышей и преждевременных родов в анамнезе, низкий индекс массы тела, гинекологические операции в анамнезе и возраст матери старше 35 лет. В иерархии рисков ПР в сроке до 33 недель первое место занимают маточные кровотечения, затем следуют инфекции различной этиологии и локализации и ИЦН. При ПР в сроке 33-37 недель чаще фиксируется ИЦН, затем следуют маточные кровотечения и дисфункция плаценты. Наличие инфекционного процесса у беременной может привести к ПР в сроке до 33 недель, маточные кровотечения свидетельствуют о возможности наступления ПР до 33 недель. При наличии ИЦН у беременной наступление ПР в 33-37 недель возможно с вероятностью и достоверностью в 71,58%, при дисфункции плаценты вероятность и достоверность равна 62,76%. Маточные кровотечения свидетельствуют о возможности ПР с вероятностью и достоверностью в 57,13%, инфекционный процесс может провоцировать наступление ПР с вероятностью и достоверностью в 52,25%. Ключевые слова: преждевременные роды, факторы риска. ASSESS OF PRETERM BIRTH RISK FACTORS RELATIONSHIP AT VARIOUS PREGNANCY STAGES N. L. Aryaev1, V. G. Marichereda1, I. M. Shevchenko1, T. Ya. Moskalenko1,2, H. M. El Mezevgi1, N. V. Shevchenko2 1Odessa National Medical University, Odessa, Ukraine 2Maternity Hospital №7, Odessa, Ukraine Summary The result of the retrospective analysis of medical records indicated that the most frequent and statistically significant factors that accompany and cause premature labor are uterine bleeding, cervical incompetence, infections of different etiology and localization, dysfunction of placenta, presence of miscarriages and premature births in history, low body mass index, gynecological surgery and history of maternal age older than 35 years. Uterine bleedings rank first in the risk hierarchy of premature births (PB) at the terms up to 33 weeks, and they followed by infection of various etiology and localization and cervical incompetence. When the PR are in 33-37 weeks, cervical incompetence, followed by uterine bleeding and dysfunction of placenta are usually fixed. Infection in a pregnant woman can lead to PR in the period up to 33 weeks, as well as uterine bleeding suggests the possibility of occurrence of PR at the same term. Presence of cervical incompetence in pregnant may result in PB at the terms of 33-37 weeks, with probability and accuracy to 71.58%, while placental dysfunction’s accuracy is 62.76%. Uterine bleeding suggests the possibility of PB with probability and accuracy to 57.13%, infectious can provoke the onset of PB with probability and accuracy to 52.25%. Key words: prematurity, risk factors.

Fundamento: el bajo peso al nacer es un indicador de maduración biológica, del cual depende la salud del recién nacido y su evolución.Objetivo: describir características del comportamiento del bajo peso al nacer en la provincia Artemisa, durante el año 2014.Métodos: se realizó un estudio descriptivo retrospectivo. Se estudiaron 330 nacidos vivos bajo peso. Se utilizó una encuesta epidemiológica como instrumento validado para ello. Los datos se procesaron siguiendo una estadística descriptiva, se calcularon las distribuciones de frecuencias absolutas y porcentuales.Resultados: según la edad gestacional, predominó el bajo peso pretérmino; en la valoración nutricional el crecimiento intrauterino retardado; la tercera parte presentó alguna enfermedad grave, e igual proporción tuvo menos de 2000 gramos de peso. La supervivencia fue directamente proporcional al peso. La infección cervicovaginal, la anemia, la malnutrición al inicio del embarazo, la escasa ganancia de peso, el parto gemelar, la adolescencia y la enfermedad hipertensiva gravídica fueron los factores más asociados a la incidencia del bajo peso al nacer. La baja identificación del riesgo y el diagnóstico tardío del crecimiento intrauterino retardado fueron las principales brechas reducibles en la conducta médica preventiva.Conclusiones: la incidencia de bajo peso al nacer obedeció a múltiples factores asociados a la prematuridad y al crecimiento intrauterino retardado; así como a brechas reducibles en la conducta y/o atención preventiva preconcepcional y prenatal.

Prematurity is one of the most relevant health problems among children in the developed countries. Around 8 to 10% of children birth before the 37 week and/or with a very low birth weight (VLBW) (1500 g). This causes 75% of the prenatal mortality and the 50% of the children disability. The aim of this study was to assess neuropsychological and emotional impairments in 7 year old children who were born VLBW. A clinical interview, the Children Neuropsychological Assessment Battery, and the Behavioral Assessment System for Children (BASC) were administrated. VLBW children showed memory and executive function deficits, as well as, behavioral and attention problems. These results highlight the importance of long term follow up of the VLBW children and point out the necessity of developing adequate neuropsychological and emotional treatment program for these children.

Introducción: los costos económicos y psicosociales asociados con los resultados falsos positivos de la pesquisa neonatal de hiperplasia adrenal congénita son altos. Objetivos: identificar los factores perinatales que intervienen en la elevación y en el tiempo de normalización de los valores de 17 hidroxiprogesterona (17OHP), en pacientes no afectados por hiperplasia adrenal congénita. Métodos: se realizó un estudio descriptivo longitudinal retrospectivo en 1 114 pacientes procedentes de Ciudad de La Habana y La Habana, con resultados falsos positivos en la pesquisa, desde enero/2007 hasta junio/2010. Se identificaron las diferencias en la frecuencia de los factores perinatales reconocidos en este grupo con una muestra de población general, y otra integrada por enfermos de hiperplasia adrenal congénita. Resultados: de los pacientes falsos positivos, el 50,7 % pertenecía al sexo masculino y 49,3 % al femenino. El 54,7 % nació por cesárea, y el 82 % no presentó sufrimiento fetal agudo, aquellos con menor edad gestacional y peso al nacer más bajo presentaron niveles medios de 17OHP más elevados. El 68,1 % normalizó la 17OHP al cumplir un mes de vida, independientemente del tipo de parto y de la presencia de sufrimiento fetal agudo; pero la edad gestacional y el peso al nacer tuvieron correlación inversa con la persistencia de su elevación. Predominó el parto eutócico en los neonatos enfermos y normales, y la cesárea en los falsos positivos. La media de la edad gestacional y del peso al nacer fue significativamente menor en los casos en el primer grupo, comparada con la de los grupos restantes. Conclusiones: la prematuridad y el bajo peso al nacer tuvieron una influencia significativa sobre la elevación y la persistencia de los valores de 17OHP, no así el tipo de parto y el sufrimiento fetal agudo.Introduction: the psychosocial and economic costs associated with the false-positive results of the neonatal screening of congenital adrenal hyperplasia are high. Objectives: to identify the perinatal factors to get involved in the rise and in the normalization time of values of 17 hydroprogesterone (17OHP) in patients not involved by a congenital adrenal hyperplasia. Methods: a retrospective, longitudinal and descriptive study was conducted in 1 114 patients from Ciudad de La Habana and La Habana with false-positive results according to screening from January, 2007 to June, 2010. Authors identified the differences in frequency of perinatal factors recognized in this group with a sample of general population, and other including congenital adrenal hyperplasia patients. Results: from the false-positive patients, the 50.7 % was of male sex and the 49.3 % to the female one. The 54.7 % was born by cesarean section and the 82 % has not acute fetal suffering, those small for the gestational age and lower birth weight had mean levels of 17OHP higher. The 68.1 % normalized the OHP at one month of life, independently the type of labor and of the presence of acute fetal suffering but the gestational age and the birth weight had an inverse correlation with the persistence of its rise. There was predominance of eutocia labor in the sick and normal neonates and the cesarean section in the false-positive ones. The mean of gestational age and of the birth weight was significantly minor in the cases of the first group, compared with the remaining groups. Conclusions: the prematurity and the low birth weight had a significant influence on the rise and the persistence of values of 17OHP, but not the type of labor and the acute fetal suffering.

Uno de los problemas actuales de mayor importancia en medicina perinatal lo constituye el parto pretérmino, pues además de elevar la morbilidad y mortalidad perinatales, causa daño neurológico y afecta el desarrollo en los recién nacidos. En este artículo no solo se destaca el valor de la cervicometría como método de pesquisaje en población con alto riesgo de parir antes del término, sino su importancia para pronosticar la amenaza de ocurrencia de esto último cuando existen contracciones uterinas, por lo cual se describen la técnica adecuada, las vías, las indicaciones y las ventajas de este procedimiento, así como también se determina el nivel de corte para la longitud cervical en sus diferentes modalidades. Como resultado se introdujo un protocolo de atención para embarazadas con riesgo de prematuridad, basado en el empleo de la cervicometría, considerada esta última como un valioso instrumento de pesquisaje en la población seleccionada.One of the current problems of greater importance in perinatal medicine is the preterm labor, because besides elevating the perinatal morbidity and mortality, it causes neurological damage and affects growing in the newborns. In this paper not only the value of cervicometry is highlighted as a screening method in population with high risk of preterm newborns, but also its importance to predict the occurrence threat of the last condition when uterine contractions exist, reason why the appropriate technique, approaches, indications and the advantages of this procedure are described, as well as the cut level for the cervical length is determined in its different modalities. As a result, a care protocol for pregnants with prematurity risk based on the use of cervicometry was introduced, which is considered a valuable screening tool in the selected population.

Antecedentes: En las últimas décadas en Chile y otros países Sudamericanos se ha producido un cambio en la distribución etaria de las madres. Objetivos: Obtener la distribución de los nacimientos por grupos de edades maternas en el Hospital Clínico de la Universidad de Chile (HCUCH) y compararlos con iguales grupos en todo Chile. Comprobar que los grupos de edades extremas están aumentando. Estudiar la relación entre estos cambios con algunas patologías del recién nacido, como prematuridad, recién nacidos pequeños para su edad gestacional (PEG) y malformaciones congénitas. Método: Datos de la maternidad del HCUCH (1982-2010) y del Ministerio de Salud (1990-2008). Se distribuye a las madres en 3 grupos: 35 y 20-34 años. Las comparaciones se hicieron con prueba de Chi Cuadrado. Resultados: En Chile el grupo de madres >35 años aumentó en más del 50% al comparar los años 1990 (10,2% del total) y 2008 (15,8%) (p35 años aumentaron significativamente, al igual que en Chile, de 9,8% en 1982 a 22,17% en el año 2010 (p35 años se asocia con mayor cantidad de RN femeninos, malformaciones congénitas, síndrome de Down y partos por cesárea.Introduction: In recent decades, both in Chile and other South American countries there has been a change in the age distribution of mothers. Objectives: To obtain the distribution of births by maternal age groups in the Hospital Clinic of the University of Chile (HCUCH) and compare them with similar groups throughout Chile. Check that the extreme age groups are increasing. To study the relationship between these changes and some diseases of the newborn, such as prematurity, infants small for gestational age (SGA) and birth defects. Methods: We reviewed the database of the Maternity HCUCH (1982-2010) and of the Ministry of Health (19902008). The mothers are distributed in 3 groups: 35 and between 20-34 years. Comparisons were made with chisquare test. Results: In Chile, the group of mothers >35 years old has increased by over 50% when comparing the 1990 (10.2% of total) and 2008 15.8% (p35 years increased significantly, as in all of Chile, 9.8% in 1982 to 22.17% in 2010 (p35 years is associated with increased number of children women, congenital malformations, Down syndrome and cesarean deliveries.

Although diet composition has been implicated as a major factor in the etiology of various gastrointestinal diseases, conclusive evidence remains elusive. This is particularly true in diseases such as necrotizing enterocolitis where breast milk as opposed to commercial formula appears to confer a "protective effect" to the "immature gut." Yet the mechanism by which this occurs continues to remain speculative. In the present study we hypothesize that the basic chemical composition of diet fundamentally selects for specific intestinal microbiota which may help explain disparate disease outcome and therapeutic direction. Complimentary animal and human studies were conducted on young piglets (21 d.)(n = 8) (IACUC protocols 08070 and 08015) and premature infants (adjusted gestational age 34-36 weeks) (n = 11) (IRB Protocol 15895A). In each study, cecal or stool contents from two groups (Breast milk-fed (BF) vs. Formulafed (FF)) were analyzed by gas chromatography/mass spectrometry (GC/MS) and comprehensive metabolic profiles generated and compared. Concurrently, bacterial community structure was assayed and respective representative microbiota of the groups determined by 16S rRNA gene amplicon pyrosequencing. Statistical modeling and analysis was done using SIMCA-P+ and R software. GC/MS metabolomics identified clear differences between BF and FF groups in the intestinal environment of piglets and humans. Sugars, amino-sugars, fatty acids, especially unsaturated fatty acids, and sterols were identified as being among the most important metabolites for distinguishing between BF and FF groups. Joint analysis of microbiota and metabolomics pinpointed specific sets of metabolites (p < 0.05) associated with the dominant bacterial taxa. The chemical composition of diet appears to have a significant role in defining the microbiota of the immature gut. Tandem analysis of intestinal microbial and metabolic profiles is potentially a powerful tool leading to better understanding of the role of diet in disease perhaps even leading to specific strategies to alter microbial behavior to improve clinical outcome.Aunque se ha implicado a la composición de la dieta como un factor principal en la etiología de varias enfermedades gastrointestinales, la evidencia concluyente sigue siendo esquiva. Esto es particularmente cierto en enfermedades como la enterocolitis necrosante en la que la leche materna, en contraposición de las fórmulas comerciales, parece conferir un "efecto protector" para el "intestino inmaduro" o el ecosistema intestinal juvenil del "intestino inmaduro", si bien el mecanismo por el que esto ocurre sigue siendo una especulación. La hipótesis de nuestro estudio es que la composición química básica de la dieta selecciona fundamentalmente microbióticos intestinales específicos que pueden explicar los resultados dispares de la enfermedad y tener implicaciones terapéuticas. Se realizaron estudios adicionales en animales y humanos en lechones (21 d.) (n = 8) (protocolos IACUC 08070 y 08015) y lactantes prematuros (edad gestacional ajustada de 34-36 semanas) (n = 11) (Protocolo IRB 15895A). En cada estudio, se analizaron los contenidos cecales y fecales de ambos grupos (alimentación materna (AM) y alimentación con fórmula (AF)) mediante cromatografía de gases/espectrometría de masas (CG/EM) y se generaron y compararon perfiles metabólicos completos. De forma concurrente, se probó la estructura de la comunidad bacteriana y se determinaron los representantes micriobióticos respectivos de los grupos mediante la pirosecuenciación del ARNr 16S del amplicón. Se realizó un modelo y análisis estadístico utilizando los programas informáticos SIMCA-P+ y R. La metabolómica de CG/EM identificó diferencias claras entre los grupos AM y AF en el ambiente intestinal de los lechones y los humanos. Se encontró que los azúcares, los amino-azúcares, los ácidos grasos, especialmente los insaturados, y los esteroles estaban entre los metabolitos más importantes para distinguir entre los grupos AM y AF. El análisis conjunto de la microbiótica y de la metabolómica resaltó conjuntos específicos de metabolitos (p < 0,05) asociados con los taxones bacterianos dominantes. La composición química de la dieta parece tener un papel significativo en la definición de los microbióticos del intestino inmaduro. El análisis en tándem de los perfiles microbianos y metabólicos es, potencialmente, una herramienta poderosa que permitirá mejorar el conocimiento del papel de la dieta en la enfermedad y quizás conduzca a estrategias específicas para alterar el comportamiento microbiano mejorando el pronóstico clínico.

Introducción: El avance en los cuidados intensivos neonatales y de la medicina perinatal ha conllevado el desarrollo de programas de seguimiento de sus recién nacidos de alto riesgo. En Cuba existen experiencias en el seguimiento del neurodesarrollo de estos recién nacidos en varios centros, pero los métodos de trabajo difieren. Objetivo: Proponer la implementación de un programa de seguimiento de recién nacidos de alto riesgo que sea estándar para todo país. Desarrollo: Se propuso un programa de seguimiento de niños de riesgo neurológico, en el que se parte de la evaluación del riesgo neurológico del niño al egreso del hospital donde nace. Este programa se basa en la creación, para este propósito, de consultas de carácter territorial en cada provincia. Se definieron los criterios de ingreso en el programa, los métodos e instrumentos a emplear, la periodicidad de los controles, y los profesionales de las especialidades que deben participar en el mismo. Se describieron los principales problemas de estos niños durante el seguimiento, y se ofreció una guía de cómo afrontarlos. Conclusión: El establecimiento de un programa de seguimiento que sea uniforme en todo el país, además de cumplir con el principio ético de justeza, permitirá el establecimiento de comparaciones de la calidad de los servicios entre centros de atención perinatal, así como la realización de estudios colaborativos multicéntricos, todo lo cual contribuirá al mejoramiento de la calidad de vida de los niños cubanos con riesgo neurológico al nacer.Introduction: The advances of the perinatal medicine and in the neonatal intensive care have lead to the development of programs to follow-up the high-risk new born children. There are experiences In Cuba in the follow-up of the neurodevelopment of these new born children in several institutions, but the working methods differ. Objective: proposing the implementation of a follow-up program of the high-risk new born children standardized for all the country. Development: We proposed a follow-up program of neurological risk children, beginning with the evaluation of the neurological risk of the child at the discharge form the hospital where he/she was born. This program is based in the creation, for this purpose, of territorial consultations in each province. We defined the criteria for entering the program, the methods and instruments to use, the periodicity of the controls, and the professionals of the specialties who could participate in it. We described the main problems of these children during the follow-up, and offered a guideline of how to affront them. Conclusion: The implementation of a follow-up program unified in all the country, besides fulfilling the ethic principle of justice, will allow the implementation of comparisons of the service quality among institutions of perinatal care. It also will allow carrying out multiinstitutional collaborative researches. All of these will contribute to the improvement of the life quality of the Cuban children with neurological risk at birth.

Objetivo: describir las características clínicas y demográficas y los factores de riesgo de neonatos con retinopatía de la prematuridad (ROP), detectados en el programa de tamización de la Clínica Universitaria Bolivariana, en la ciudad de Medellín, Colombia, durante los años 2003 a 2008.Metodología: se revisaron los registros de 1.080 neonatos. Los criterios para tamización fueron: 32 o menos semanas de edad gestacional (EG) y 1.600 gramos o menos de peso al nacer (PN). Se creó una base de datos en la que se registraron las variables demográficas, algunos factores de riesgo maternos y neonatales, la clasificación de la ROP y el tratamiento requerido. Se analizaron y compararon los resultados con la epidemiología regional e internacional.Resultados: la prevalencia global de ROP fue del 18,2% (197 neonatos), con EG media de 29,53 semanas y PN medio de 1.230 gramos. En menores de 1.250 gramos dicha prevalencia fue del 40%. Los factores de riesgo más frecuentes fueron la enfermedad de membrana hialina, la sepsis (p = 0,00) y la preeclampsia; 125 de los 197 niños (63,5%) recibieron terapia con oxígeno (p = 0,00). El 10,2 % de los neonatos con ROP requirieron tratamiento quirúrgico.Conclusión: con el presente estudio, se aportan datos estadísticos actualizados referentes a la prevalencia de ROP y a los factores de riesgo en nuestra población.

Objetivo. Describir la tendencia en los nacimientos y los principales indicadores materno-infantiles en Chile desde el año 2000 al 2009. Método. Se realiza un análisis descriptivo de la información obtenida desde el Ministerio de Salud de Chile para el período estudiado. Resultados. Durante el período estudiado nacen aproximadamente 2.400.000 personas, se observa un significativo aumento en su número a partir del año 2004 al 2009 (+9,7%). Las tasas de mortalidad neonatal precoz, tardía, post neonatal e infantil fueron de 3,86; 1,18; 2,54 y 7,58 por 1000 nacidos vivos durante el año 2009, presentado un porcentaje de disminución de un 13,5; 8,4; 16,2; 13,7% respectivamente en comparación al año 2000. La mortalidad materna disminuyó en un 13,2% desde 19,7 a 17,1 por cien mil nacimientos en el mismo período. La prematurez (Objective. To describe the trend in annual live birth in Chile between 2000 and 2009, as well as the main descriptive statistics and health indicators associated. Methods. We performed a descriptive analysis form the database provided by the Department of Statistics and Information of the Chilean Ministry of Health. Data of 2.400.000 deliveries were analyzed from 2000 and 2009. We analyzed live births, maternal, fetal, infant mortality, as well as main descriptive characteristics by year. Results. The total of live births in Chile has progressively increased after the year 2005 until 2009 (+ 9.7%). The early neonatal, late neonatal, post neonatal mortality and mortality infant were 3.86, 1.18, 2.54 and 7.58 per 1000 live births in 2009, showing a decrease of 13.5; 8.4; 16.2; 13.7% respectively compared to 2000. Maternal mortality declined a 13.2% from 19.7 to 17.1 x 100.000 births in the same period. Prematurity (

A vitamina A é particularmente importante durante os períodos críticos de crescimento, proliferação e desenvolvimento dos tecidos como gestação, período neonatal e infância. Este trabalho tem o objetivo de avaliar a influência das variáveis maternas, como idade gestacional e paridade, sobre os níveis de retinol no colostro e verificar se a concentração de vitamina A no colostro dessas mães fornece a quantidade recomendada deste micronutriente para os recém-nascidos. Foram recrutadas 84 parturientes saudáveis atendidas em uma maternidade pública brasileira. As concentrações de retinol no colostro foram analisadas por cromatografia líquida de alta eficiência. O retinol no colostro de mães a termo (n=49) e pré-termo (n=35) apresentaram valores de 111,3 ± 12,4 µg/dL e 79,2 ± 10,6 µg/dL (p< 0,0001), respectivamente e a concentração de retinol no colostro de primíparas (n= 40) (82,5 ± 8,8 µg/dL) e de multíparas (n= 44) (116,9 ± 10,3 µg/dL) também foi estatisticamente diferente (p< 0,0001). Os níveis de retinol no colostro de mães a termo, bem como os de mães que tiveram um ou mais de um filho neste estudo atendem as necessidades da criança (400 µg de retinol/dia). Entretanto, os níveis de retinol no colostro de mães pré-termo não condizem com as recomendações da DRI para prematuros, que é de 420 µg de retinol/dia. Esses resultados demonstram a necessidade de suplementar com vitamina A as mães pré-termo a fim de garantir um fornecimento adequado dessa vitamina ao recém-nascido.Vitamin A is particularly important during the critical periods of growth, proliferation and development of tissues such as pregnancy, neonatal period and childhood. This study aims to evaluate the influence of maternal variables such as gestational age and parity, on the levels of retinol in colostrum and verify that the concentration of vitamin A in the colostrum of those mothers provides the recommended amount of this micronutrient for newborns. We recruited 84 healthy pregnant women attended at a Brazilian public hospital. Retinol concentrations in colostrum were analyzed by high performance liquid chromatography. The retinol in colostrum from mothers at term (n = 49) and preterm (n = 35) showed values of 111.3 ± 12.4 µg/dL and 79.2 ± 10.6 µg/dL ( p

O objetivo deste artigo é desenvolver uma reflexão acerca dos modelos de maternidade e família implícitos no documento oficial do Ministério da Saúde sobre o Programa Canguru. Também explora a forma como o Programa é aplicado numa maternidade do Nordeste, apresentado como assistência humanizada para o atendimento ao bebê prematuro e/ou de baixo peso. A perspectiva adotada para este estudo documental é a análise foucaultiana do discurso, que focaliza o papel da linguagem na conformação da vida social e psicológica dos atores sociais envolvidos. A análise mostra que existe um discurso prescritivo, universalista, de caráter impositivo, que posiciona as mulheres como objetos passivos de intervenção, através da idealização da maternidade saudável e da família nuclear típica da classe média.The article aims to develop a reflection about the models of motherhood and family implicit in the official document edited by the Ministry of Health about the Kangaroo Program. It also explores the way the Program is developed at a Maternity Hospital in the North-Eastern part of the country, as it is presented as humanized health care for premature and/or underweight babies. The methodological perspective adopted is the foucauldian discourse analysis which focuses on the role of language in the configuration of the social and psychological life of the social actors involved. The analysis shows that there exists a comprehensive, prescriptive, and authoritarian discourse, positioning women as passive objects of intervention, through the idealization of a healthy motherhood and a typical nuclear middle class family.

Revisão bibliográfica, realizada junto aos bancos de dados MEDLINE, SciELO, ScienceDirect e LILACS, com o objetivo de identificar a produção científica na área de saúde sobre os principais fatores envolvidos na etiopatogênese do processo de Restrição de Crescimento Intra-Uterino (RCIU), entre os anos de 1990 e 2008. A RCIU constitui a segunda causa de mortalidade perinatal. O recém-nascido com RCIU possui um aumento de duas a dez vezes nas porcentagens habituais de mortalidade perinatal e apresenta complicações associadas à prematuridade. A morbidade está diretamente relacionada às alterações metabólicas e imunológicas, desacelerações cardíacas, acidose fetal, baixo Índice de Apgar, hipóxia, hipoglicemia, hipotermia, asfixia, coagulação intravascular disseminada, hemorragia intracraniana e aspiração meconial. A identificação das principais alterações maternas, fetais e neonatais envolvidas no processo de RCIU é de fundamental importância para o planejamento de ações de prevenção e melhora da qualidade da assistência de enfermagem prestada às gestantes no pré-natal, pré-parto, parto e puerpério, bem como ao recém-nascido com RCIU durante o período neonatal.

Realizou-se revisão sistemática sobre o consumo de cafeína em gestantes na ocorrência de baixo peso ao nascer e prematuridade, enfocando métodos para quantificação deste consumo e confundimentos controlados na análise. A revisão consistiu na busca de artigos publicados de 1996 a 2006 nas bases MEDLINE, LILACS e PubMed, utilizando-se as palavras-chave: "caffeine", "coffee", "low birth weight", "birth weight", "preterm", "premature" e "prematurity". Dez artigos foram selecionados. Os métodos utilizados para quantificar o consumo de cafeína foram: questionário de freqüência alimentar semiquantitativo - da dieta ou apenas de produtos cafeinados, sendo um do tipo auto-aplicado; recordatório alimentar; perguntas sobre tipo e modo de preparo; análise de amostras; e dosagens urinária e plasmática. Em três estudos revisados, o consumo elevado de cafeína associou-se com baixo peso ao nascer e/ou prematuridade. Contradições nos achados devem-se a dificuldades na mensuração do consumo de cafeína; às fontes abordadas; a variações no preparo e na quantidade consumida; e ao tamanho amostral. Não foi demonstrada associação entre ingestão moderada de cafeína e crescimento fetal, sendo necessária uma avaliação mais precisa do consumo dessa substância.This article reports on a systematic review of studies on caffeine intake during pregnancy and prevalence of low birth weight and prematurity, focusing on methods to quantify intake and control for confounding. The review consisted of an article search from 1996 to 2006 in MEDLINE, LILACS, and PubMed, using the key words: "caffeine", "coffee", "low birth weight", "birth weight", "preterm", "premature", and "prematurity". Ten articles were selected. Methods used to quantify caffeine consumption were: semi-quantitative food frequency questionnaires for diet or only caffeinated products, including one self-applied questionnaire; food recall; questions on type and method of preparation; analysis of samples; and urine and plasma caffeine levels. In three studies, high caffeine consumption was associated with low birth weight and/or prematurity. Contradictions between studies may be due to difficulties in measuring caffeine consumption; assessment of different caffeine sources; variations in the mode of preparation and amount consumed; and sample size. Association between moderate caffeine consumption and fetal growth was not demonstrated, so a more precise measurement of caffeine intake is necessary.

El embarazo en adolescentes es motivo de preocupación importante por las implicaciones personales y sociales que tiene. Objetivo: describir los resultados obstétricos y perinatales de las pacientes atendidas entre junio del 2000 y octubre de 2001, en el Hospital Universitario San Vicente de Paúl, en Medellín, Colombia. Materiales y métodos: se trata de un estudio descriptivo, con datos obtenidos de la base de datos del Departamento de Obstetricia y Ginecología de la Universidad de Antioquia. Resultados: el 28,6% de las pacientes eran adolescentes, una cuarta parte de ellas tenía embarazos repetidos. Un porcentaje importante de pacientes que no había hecho control prenatal. El 53,6% de las adolescentes y el 50,4% de las adultas presentaron parto pretérmino. En las adolescentes hubo menos preeclampsia severa, pero más casos de eclampsia en general que en las adultas. La ruptura prematura de membranas ovulares se presentó más frecuentemente en las adolescentes. Las hemorragias del tercer trimestre se observaron con más frecuencia en mujeres mayores, al igual que la diabetes gestacional. El porcentaje de cesáreas fue menor en las adolescentes. El bajo peso al nacer y la prematuridad fueron más frecuentes en las adolescentes. Las complicaciones maternas en el posparto inmediato se presentaron en el 5,4% de las adolescentes y en el 3,6% de las adultas. Conclusiones: las adolescentes presentaron con mayor frecuencia eclampsia, partos pretérmino, ruptura prematura de membranas, bajo peso al nacer, prematuridad, complicaciones posparto e infecciones de herida quirúrgica; mientras que las adultas, hemorragias de tercer trimestre, diabetes gestacional y cesáreas.Adolescent pregnancy is motive of important worrying not only for personal but also for the social implications that it has. Objective: to describe the obstetrics and perinatal results of the patients attended from June 2000 to October 2001 at the H.U.S.V.P in Medellin, Colombia. Material and methods: It’s a descriptive study with data obtained from the data system of Obstetrician and Gynecology Department of Universidad de Antioquia. Results: 28,6% of patients were teenagers, a quarter of them had repetitive pregnancies; an important percent of patients didn’t have prenatal control. 53,6% of teenagers had less severe pre eclampsia, but more eclampsia than adults did. Premature rupture of membranes was more usual in teenagers. Third trimester bleeding and gestational diabetes were more frequent in adult women. The percent of ceasarean section was less in adolescents. Low weight babies and prematurity were more frequent in teenagers. 5,4% of adolescents and 3,6% of adults had postpartum maternal complications. Conclusions: teenagers presented: eclampsia, preterm delivery, premature rupture of the membranes, low weight birth, prematurity, postnatal complications, and surgical wound with more frequency, while adults showed up with third trimester bleeding, gestational diabetes and caesarean section.

SUMMARY. There are few data regarding folate deficiency and its impact on outcome pregnancy. The purpose of this study was to determine the association and its magnitude between prematurity and folate deficiency in women in their third trimester of pregnancy, and at labor. An incident case - control study was conducted using 2 controls per case. Data was obtained in a tertiary hospital in Valencia, Venezuela. A total of 543 women who delivered between May and December 1996 entered into the study. Women having a preterm delivery (RESUMEN: El objeto fue determinar la asociación y su magnitud entre prematuridad y deficiencia de folato. Se utilizó un diseño de casos y control (2 controles por caso), realizado en la Maternidad "Dr. J.L. Facchín de Boni", principal hospital obstétrico y ginecológico de Valencia, Venezuela. Entre mayo y diciembre de 1996 fueron estudiadas 543 embarazadas al final del tercer trimestre gestacional y en trabajo de parto. Los casos (

RESUMEN. Para estudiar la relación entre la antropometría materna y la ganancia neta de peso gestacional con el peso de nacimiento, y su asociación con los riesgos de Peso Bajo al Nacer (PBN) , Pequeño para la Edad Gestacional (PEG) y Recién Nacido (RN) Prematuro se evaluaron restrospectivamente 9613 registros del Sistema Informático Perinatal (OPS/OMS) del Hospital Sardá entre 1994 y 1995. Criterios de exclusión : muerte fetal, gemelar, malformaciones congénitas, ausencia del control prenatal y falta del registro de peso y talla. Se observó un 9,6 % del total de madres y 15% de adolescentes con bajo IMC preconcepcional (media 24,8 + 4,3 Kg/ m2), mientras que el sobrepeso-obesidad alcanzó al 28%. La ganancia neta de peso (media 9,25 + 4,9 Kg) representó el 16% del peso previo y fue mayor a menor IMC (p < 0,001). El peso al nacer (media 3375 + 467 g) fue menor a menor IMC (p < 0,001) y el riesgo de BPN (pSUMMARY. Relationship between maternal anthropometry and weight gain with birth weight, low birth weight, small for date and prematurity at an urban population of Argentina. To asses the relationship between body mass index and net weight gain during pregnancy with birth weight and the risks of low birth weight, small for date and prematurity 9613 records from Sardá ´s Perinatal Database between 1994-1995 were reviewed. Exclusion criteria were fetal death, twin pregnancy, congenital malformations, lack of prenatal visits and lack of preconceptional weight and height. 9.6% of mothers and 15% of adolescents presented with low preconceptional BMI (median: 24.8 + 4.3 Kg/m²); in contrast, 28% were overweight and obese. Net weight gain (median 9.25+ 4.9 Kg) accounted for 16% of previous weight and was higher with lower BMI (p=0.001). Birth weight (median 3375 + 467 g) decreased with lower BMI (p= 0.001) and the risks of low birth weight (p < 0.05), small for date (p < 0.05), and prematurity (p= 0.05) was independently associated with BMI, and increased (p < 0.001) when lower the net weight gain was. The best predictors for low birth weight, small for date and prematurity risks were low preconceptional weight (40-51 kg) (adjusted OR 1.72; [ 95%CI 1.48-1.95], 2.12 [1.82-2.41] and 1.46 [1.12-1.79] respectively). Net weight gain and several predictive variables did not explain more than 10.8% of the variability of birth weight. Preconceptional weight should have important implications for the design of future nutritional strategies at a poblational level, especially for adolescents

To determine the association and its magnitude between prematurity and anemia in women in their third trimester of pregnancy and at labor. An incident case - control study was conducted using 2 controls per case. Data was obtained in a tertiary hospital in Valencia, Venezuela. A total of 543 women who delivered between May and December 1996 entered into the study. Women having a preterm delivery, less than 37 weeks of gestation at delivery, were defined as cases (n=181). Anemia was defined according to WHO as Hb less than 11g/dL. Logistic regression was used to analyze the data and likelihood ratio test was done for model comparison. Maternal anemia was found to be significantly associated with prematurity (Odds Ratio: 1.70; 95%CI = 1.18 to 2.57 P = .001), after adjusting for Placental Abruption, PROM, Previous Premature Labor, Prenatal Care Visits, and Uterine Bleeding during more than one trimester. Maternal anemia at the end of the third trimester of pregnancy, at labor, was associated with an increased risk of prematurityAsociación entre prematuridad y anemia materna al final del tercer trimestre en embarazadas venezolanas. El objetivo de este estudio fue determinar la asociación y su magnitud entre prematuridad y anemia materna al final del tercer trimestre del embarazo ( en el momento del trabajo de parto). Estudio de Casos y Controles (2 controles por caso). Entre mayo y diciembre de 1996 fueron estudiadas 543 embarazadas al final del tercer trimestre gestacional y en trabajo de parto. Los casos fueron 181. La anemia fue definida como la presencia de Hb < de 11g/dL (OMS). Los datos fueron analizados mediante regresión logística. Para evaluar la significancia de los modelos reducidos se utilizó la prueba de razón verosimilitud.Se determinó que la prematuridad está asociada significativamente con anemia materna (OR: 1.70 IC95% = 1.18 a 2.57, P = .001), después de ajustar por desprendimiento placentario, ruptura prematura de membranas _ RPM - partos prematuros previos, menos de 5 visitas prenatales y sangramiento uterino en más de un trimestre. La anemia materna al final del tercer trimestre está asociada con un mayor riesgo de prematuridad

O objetivo do estudo foi avaliar a qualidade da assistência ao trabalho de parto prematuro, utilizando referentes, indicadores e padrões derivados de evidências científicas - ensaios clínicos controlados e meta-análises -, tomando como caso a corticoterapia anteparto. Foram analisados dados de sumários de alta relativos a sete maternidades públicas do Rio de Janeiro. O padrão utilizado para a análise de processo foi de 100%. Não foi possível estimar padrões de resultado - incidência esperada de síndrome de angústia respiratória e mortalidade neonatal - para os referentes previstos, em razão da impossibilidade de ajustar os resultados para idade gestacional, poderoso fator interveniente. A utilização da corticoterapia antenatal pelos serviços analisados foi irrisória, cerca de 4% e 2%, para os referentes relativos a pacientes com menos de 34 semanas e com até 36 semanas de idade gestacional, respectivamente. A falha no uso da corticoterapia antenatal quando indicada merece a atenção de planejadores e gestores do setor, tendo em vista a fácil incorporação de tal tecnologia, bem como os benefícios e os custos desta, em comparação com aqueles associados à assistência neonatal a bebês prematuros.This study aimed to assess quality of obstetric care for preterm labor patients, using referents, indicators, and standards derived from scientific evidence, focusing on antenatal corticotherapy. Available metanalyses and randomized controlled trials were examined to establish referents, defining indicators and estimating process and outcome standards for the present study. Data from hospital discharge summaries of seven public maternity hospitals in Rio de Janeiro were analyzed. The standard of process used was 100%. It was not possible to estimate outcome standards, since the necessary adjustment for gestational age was not feasible. Utilization of antenatal corticotherapy in the present study was very low, about 4% and 2%, considering patients up to 33 weeks and 6 days and 36 weeks and 6 days, respectively. Failure to use antenatal corticotherapy when formally indicated deserves attention by health planners and managers, considering: a) the ease in incorporating such a technology, in contrast to the adequate incorporation of special/intensive neonatal care; b) benefits and costs associated with this technology compared to those of delivering neonatal care to premature babies.

Este trabalho analisa pesquisas recentes que estudam a associação entre depressão na gravidez e prematuridade. A difusão de informações científicas faz dessa categoria nosográfica (depressão) uma presença constante e, muito freqüentemente, imprecisa, nos discursos do senso comum. No campo da saúde mental, são várias as áreas que a abordam e de modos bastante diversos. Por outro lado, apesar de haver indicações sugerindo a influência de estados emocionais em desfechos orgânicos, permanecem dificuldades em demonstrá-la através dos métodos convencionais de pesquisa científica. Parece que um dos problemas em associar depressão à prematuridade deve-se a aspectos epistemológicos relacionados à demarcação teórica da depressão.This paper examines recent research on the association between depression during pregnancy and preterm delivery. Dissemination of scientific information on this disease entity (depression) means that it is often present in common-sense discourse, although frequently used rather imprecisely. While various areas from the mental health field approach depression in very different ways, they suggest the influence of emotional states on organic outcomes. Still, this relationship remains difficult to prove by conventional scientific research methods. One problem in establishing associations between depression and preterm delivery appears to be due to epistemological aspects related to the theoretical demarcation of depression.