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Master's Dissertation
DOI
10.11606/D.5.2008.tde-12012009-113034
Document
Author
Full name
Cristiane Ortigosa
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2008
Supervisor
Committee
Bittar, Roberto Eduardo (President)
Amed, Abes Mahamed
Francisco, Rossana Pulcineli Vieira
Title in Portuguese
Prematuridade tardia com e sem restrição do crescimento fetal: resultados neonatais
Keywords in Portuguese
Perinatologia
Prematuro
Retardo do crescimento fetal
Abstract in Portuguese
O objetivo deste estudo foi comparar a morbidade e a mortalidade entre prematuros tardios (34 a 36 semanas e 6 dias de idade gestacional ao nascimento) com e sem restrição do crescimento fetal (RCF). O estudo foi desenvolvido longitudinalmente, envolvendo gestantes que apresentaram parto prematuro, sendo 50 com RCF (Grupo I) e 36, sem RCF (Grupo II), no período de outubro de 2004 a outubro de 2006. Foram avaliados os seguintes resultados pós-natais: peso e idade gestacional (IG) ao nascimento, cesárea, Apgar de quinto minuto, pH do sangue da artéria umbilical ao nascimento, necessidade e tempo de intubação orotraqueal (IOT) e de internação na unidade de terapia intensiva neonatal (UTI). Foram também avaliados: síndrome do desconforto respiratório (SDR), sepse, plaquetopenia, hipoglicemia, hemorragia intracraniana (HIC), icterícia e necessidade de fototerapia, tempo de internação e ocorrência de óbito. Para análise estatística foram utilizados os testes de Qui-Quadrado, exato de Fisher e teste não paramétrico de Kruskal Wallis, adotado nível de significância de 5%. As idades gestacionais avaliadas foram semelhantes nos dois grupos, com média de 35,5 semanas. Observou-se, no grupo I, maior freqüência dos seguintes resultados pós-natais adversos: menor peso ao nascimento (p<0,001), maior incidência de cesárea (92% versus 25% do grupo II; p<0,0001), maior necessidade de internação em UTI (58% versus 33%; p=0,041), maior tempo de internação (p<0,001) e de internação em UTI neonatal (p<0,001), maior ocorrência de HIC (12% versus 0; p=0,037), maior ocorrência de hipoglicemia (p= 24% versus 6%; 0,047) e maior tempo de fototerapia (p=0,005). Os grupos não apresentaram diferenças nos índices de Apgar, pH de cordão, IOT, SDR, plaquetopenia, sepse e icterícia. Não houve casos de doença de membrana hialina, displasia broncopulmonar, hemorragia pulmonar ou óbito neonatal. Pode-se concluir que o grupo de prematuros tardios com RCF apresentou mais complicações neonatais do que o grupo sem RCF
Title in English
Late-preterm birth with and without fetal growth restriction: neonatal outcomes
Keywords in English
Fetal growth retardation
Infant premature
Perinatology
Abstract in English
The objective of this study was to compare neonatal morbidity and mortality between late-preterm infants (gestational age at birth: 34 to 36 weeks and 6 days) with and without fetal growth restriction (FGR). A longitudinal study was conducted between October 2004 and October 2006 involving 50 pregnant women with pre-term delivery associated with FGR (group I) and 36 women with spontaneous preterm delivery not associated with FGR (group II). The following postnatal outcomes were evaluated: weight and gestational age at birth, cesarean section rate, 5-minute Apgar score, umbilical artery pH at birth, and need for and duration of orotracheal intubation and hospitalization in the neonatal intensive care unit (NICU), as well as the presence of respiratory distress syndrome (RDS), sepsis, thrombocytopenia, hypoglycemia, intracranial hemorrhage (ICH) and jaundice, need for phototherapy, length of hospital stay, and occurrence of death. The chi-square test, Fishers exact test and nonparametric Kruskal-Wallis test were used for statistical analysis, adopting a level of significance of 5%. Gestational age was similar in groups I and II, with a mean of 35.5 weeks in both groups. A higher frequency of the following adverse postnatal outcomes was observed in group I: lower birth weight (p<0.001), higher incidence of cesarean section (92% versus 25% in group II; p<0.0001), greater need for NICU treatment (58% versus 33%; p=0.041), longer hospital (p<0.001) and NICU stay (p<0.001), higher frequency of ICH (12% versus 0; p=0.037) and hypoglycemia (24% versus 6%; p=0.047), and longer duration of phototherapy (p=0.005). No differences in Apgar scores, cord pH, orotracheal intubation, RDS, thrombocytopenia, sepsis, or jaundice were observed between groups. There were no cases of hyaline membrane disease, bronchopulmonary dysplasia, pulmonary hemorrhage, or neonatal death. In conclusion, the group of late-preterm infants with FGR presented more neonatal complications than the group without FGR
 
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Publishing Date
2009-01-20
 
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