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You searched for:"Lígia Maria Suppo Souza Rugolo"
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Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):235-242
DOI 10.1590/S0100-72032012000500008
PURPOSE: To evaluate the survival and complications associated with prematurity of infants with less than 32 weeks of gestation. METHODS: It was done a prospective cohort study. All preterm infants with a gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies and admitted to the NICU between August 1st, 2009 and October 31st, 2010 were included. Newborns were stratified into three groups: G25, 25 to 27 weeks and 6 days; G28, 28 to 29 weeks and 6 days; G30, 30 to 31 weeks and 6 days, and they were followed up to 28 days. Survival at 28 days and complications associated with prematurity were evaluated. Data were analyzed statistically by c² test, analysis of variance, Kruskal-Wallis test, odds ratio with confidence interval (CI) and multiple logistic regression, with significance set at 5%. RESULTS: The cohort comprised 198 preterm infants (G25=59, G28=43 and G30=96). The risk of death was significantly higher in G25 and G28 compared to G30 (RR=4.14, 95%CI 2.23-7.68 and RR=2.84, 95%CI: 1.41-5.74). Survival was 52.5%, 67.4% and 88.5%, respectively. Survival was greater than 50% in preterm >26 weeks and birth weight >700 g. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia, which did not differ among groups. Logistic regression showed that pulmonary hemorrhage (OR=3.3, 95%CI 1.4-7.9) and respiratory distress syndrome (OR=2.5, 95%CI 1.1-6.1) were independent risk factors for death. There was a predominance of severe hemorrhagic brain lesions in G25. CONCLUSION: Survival above 50% occurred in infants with a gestational age of more than 26 weeks and >700 g birth weight. Pulmonary hemorrhage and respiratory distress syndrome were independent predictors of neonatal death. It is necessary to identify the best practices to improve the survival of extreme preterm infants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):235-242
DOI 10.1590/S0100-72032012000500008
PURPOSE: To evaluate the survival and complications associated with prematurity of infants with less than 32 weeks of gestation. METHODS: It was done a prospective cohort study. All preterm infants with a gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies and admitted to the NICU between August 1st, 2009 and October 31st, 2010 were included. Newborns were stratified into three groups: G25, 25 to 27 weeks and 6 days; G28, 28 to 29 weeks and 6 days; G30, 30 to 31 weeks and 6 days, and they were followed up to 28 days. Survival at 28 days and complications associated with prematurity were evaluated. Data were analyzed statistically by c² test, analysis of variance, Kruskal-Wallis test, odds ratio with confidence interval (CI) and multiple logistic regression, with significance set at 5%. RESULTS: The cohort comprised 198 preterm infants (G25=59, G28=43 and G30=96). The risk of death was significantly higher in G25 and G28 compared to G30 (RR=4.14, 95%CI 2.23-7.68 and RR=2.84, 95%CI: 1.41-5.74). Survival was 52.5%, 67.4% and 88.5%, respectively. Survival was greater than 50% in preterm >26 weeks and birth weight >700 g. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia, which did not differ among groups. Logistic regression showed that pulmonary hemorrhage (OR=3.3, 95%CI 1.4-7.9) and respiratory distress syndrome (OR=2.5, 95%CI 1.1-6.1) were independent risk factors for death. There was a predominance of severe hemorrhagic brain lesions in G25. CONCLUSION: Survival above 50% occurred in infants with a gestational age of more than 26 weeks and >700 g birth weight. Pulmonary hemorrhage and respiratory distress syndrome were independent predictors of neonatal death. It is necessary to identify the best practices to improve the survival of extreme preterm infants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):691-697
DOI 10.1590/S0100-72032005001100010
This is both a synthesis and a review of the major research findings, with the aim of validating Rudge's group IB. In this group of pregnants, screening for gestational diabetes was positive while the diagnosis was negative (normal 100 g-oral glucose tolerance test 100 g-OGTT). Nonetheless, the variations in glucose levels observed throughout the day, and confirmed by the glycemic profile (GP), characterized diurnal hyperglycemia, which accounts for maternal risk and adverse perinatal outcome. The description of this group is unique for both the establishment of the diagnosis during gestation and the follow-up of both the mother and the infant. These pregnancies have been erroneously classified as "low risk" and have not been diagnosed or treated. The IB group corresponds to 13.8% of the pregnant women screened in our service. This rate, added to the 7% of pregnancies complicated by diabetes, increase the occurrence of hyperglycemic disorders during gestation to up to 20.0%. In Rudge's group IB: a) perinatal mortality rate is 41‰, which is similar to that observed among diabetic pregnant women and 10 times higher than that found among non-diabetics; b) the observed placental abnormalities (both morphological and functional) differed from those seen in non-diabetic and diabetic pregnant women, indicating an adjustment to maintain functional activities that facilitated the passage of glucose to the fetus and explained fetal macrosomia (53.8% in non-treated pregnancies); c) maternal risk for hypertension, obesity and hyperglycemia was high and seemed to reproduce a model of metabolic syndrome, favoring the potential risk for future diabetes; d) 10 years after the index-pregnancy, type 2 diabetes was confirmed in 16.7% of the women in group IB. The authors suggest the development of multicentric studies in order to identify biomarkers specific for Rudge's group IB and establish protocols for the diagnosis of gestational hyperglycemic disorders using the combination GP + 100g-GTT as a standard. This procedure may cause an impact on the morbidity/mortality rate among pregnancies complicated by diurnal hyperglycemia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):691-697
DOI 10.1590/S0100-72032005001100010
This is both a synthesis and a review of the major research findings, with the aim of validating Rudge's group IB. In this group of pregnants, screening for gestational diabetes was positive while the diagnosis was negative (normal 100 g-oral glucose tolerance test 100 g-OGTT). Nonetheless, the variations in glucose levels observed throughout the day, and confirmed by the glycemic profile (GP), characterized diurnal hyperglycemia, which accounts for maternal risk and adverse perinatal outcome. The description of this group is unique for both the establishment of the diagnosis during gestation and the follow-up of both the mother and the infant. These pregnancies have been erroneously classified as "low risk" and have not been diagnosed or treated. The IB group corresponds to 13.8% of the pregnant women screened in our service. This rate, added to the 7% of pregnancies complicated by diabetes, increase the occurrence of hyperglycemic disorders during gestation to up to 20.0%. In Rudge's group IB: a) perinatal mortality rate is 41‰, which is similar to that observed among diabetic pregnant women and 10 times higher than that found among non-diabetics; b) the observed placental abnormalities (both morphological and functional) differed from those seen in non-diabetic and diabetic pregnant women, indicating an adjustment to maintain functional activities that facilitated the passage of glucose to the fetus and explained fetal macrosomia (53.8% in non-treated pregnancies); c) maternal risk for hypertension, obesity and hyperglycemia was high and seemed to reproduce a model of metabolic syndrome, favoring the potential risk for future diabetes; d) 10 years after the index-pregnancy, type 2 diabetes was confirmed in 16.7% of the women in group IB. The authors suggest the development of multicentric studies in order to identify biomarkers specific for Rudge's group IB and establish protocols for the diagnosis of gestational hyperglycemic disorders using the combination GP + 100g-GTT as a standard. This procedure may cause an impact on the morbidity/mortality rate among pregnancies complicated by diurnal hyperglycemia.
