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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2022.tde-26042022-150712
Document
Author
Full name
Débora Alencar de Menezes Athayde
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Damiani, Durval (President)
Castro, Angela Maria Spinola e
Diniz, Edna Maria de Albuquerque
Jorge, Alexander Augusto de Lima
Title in Portuguese
Alterações metabólicas e de distúrbios de crescimento em crianças nascidas com muito baixo peso e prematuros pequenos para idade gestacional aos 36 meses de idade gestacional corrigida
Keywords in Portuguese
Crescimento
Insuficiência de crescimento
Recém-nascido de muito baixo peso
Recém-nascido de baixo peso
Recém-nascido pequeno para a idade gestacional
Recém-nascido prematuro
Abstract in Portuguese
INTRODUÇÃO: Os avanços da medicina têm permitido a sobrevivência de recém-nascidos (RN) com idade gestacional (IG) e peso de nascimento cada vez menores. Entretanto, essas crianças podem apresentar dificuldade de ganho de peso e de estatura bem como alterações precoces em parâmetros metabólicos. OBJETIVOS: Avaliar as características clínicas e metabólicas de recémnascidos prematuros de muito baixo peso (RNPTMBP), aos primeiros trinta e seis meses de vida, comparando os grupos Adequado para Idade Gestacional (AIG) e Pequeno para Idade Gestacional (PIG). MÉTODOS: Estudo retrospectivo, de coorte, com levantamento de dados através de revisão de prontuários dos RNPTMBP, internados no centro de terapia intensiva neonatal, no período de 2008 a 2014, que receberam alta e foram acompanhados no ambulatório de seguimento de RN de risco no Instituto da Criança do HCFMUSP. Foram analisados os dados antropométricos ao nascimento, na alta hospitalar e aos 36 meses de idade gestacional corrigida para a prematuridade (ICP). Os escores-Z de peso, comprimento/estatura aos 36 meses foram calculados usando a referência da OMS/2006-2007. Foram dosados exames laboratoriais (colesterol total e frações, glicemia) com aproximadamente 36 meses (30-52 meses) de ICP. RESULTADOS: A amostra abrangeu 185 pacientes, sendo 94 (50,8%) PIG e 91 (49,2%) AIG. Dos 185 pacientes, 99 (53,5%) crianças eram do sexo feminino. A idade gestacional média foi de 30,6 (±2,6) semanas sendo significativamente menor no grupo AIG (p<0,0001). Os pacientes ficaram em média 63,1±30,2 dias internados. Ao nascimento, o peso médio foi de 1,096 (±0,252) e o comprimento foi 35,9cm (±2,9). Os Z-escores para o peso e para o comprimento foram menores no grupo PIG. (p<0,0001). Durante a internação hospitalar, houve uma perda de peso em ambos os grupos, com mudança de zescore de -1,7(+- 0,9) para o grupo AIG e de - 1,39 (+-0,9) para o grupo PIG. Ambos os grupos (AIG e PIG) apresentaram essa redução significativa do Zescore do peso e comprimento entre o nascimento e a alta, seguida de aumento entre a alta e o seguimento de 36 meses. Dentre os PIG, 70,2% (n=66) fizeram catchup para peso e 71,2% (n=67) fizeram o catchup para comprimento, ficando acima do z-escore -2 aos 36 meses de ICP. Os valores dos exames do perfil lipídico (colesterol total e frações), assim como a concentrações de glicemia foram semelhantes entre os grupos, aos 36 meses de ICP, sem diferenças estatísticas. Os recém-nascidos que evoluíram com RCEU (restrição de crescimento extrauterino definido como
Title in English
Metabolic alterations and growth disorders in children born with very low birth weight and preterm infants small for gestational age at 36 months of corrected gestational age
Keywords in English
Failure to thrive
Growth
Infant
Infant low birth weight
Infant very low birth weight
Premature small for gestational age
Abstract in English
INTRODUCTION Medical advances have allowed the survival of newborns (NB) with increasingly lower gestational age (GA) and birth weight. However, these children may have difficulty in gaining weight and height, as well as early changes in metabolic parameters. Objectives: To evaluate the clinical and metabolic characteristics of very low birth weight preterm newborns (RNPTMB) at the first thirty-six months of life, comparing the Appropriate for Gestational Age (AGA) and Small for Gestational Age (SGA) groups. METHODS This is a retrospective cohort study, with data collection through a review of the medical records of the RNPTMBP, hospitalized in the neonatal intensive care center, from 2008 to 2014, who were discharged and followed up at the follow-up outpatient clinic to NB at risk at the Instituto da Criança of HCFMUSP. Anthropometric data at birth, at hospital discharge and at 36 months of gestational age corrected for prematurity were analyzed. Z-scores for weight, length/height at 36 months were calculated using the WHO 2006-2007 reference. Laboratory tests were measured (total cholesterol and fractions, blood glucose) with approximately 36 months (30-52 months) of PCI. RESULTS The sample comprised 185 patients, 94 (50.8%) SGA and 91 (49.2%) AGA. Of the 185 patients, 99 (53.5%) children were female. Mean gestational age was 30.6 (±2.6) weeks, being significantly lower in the AGA group (p<0.0001). Patients were hospitalized for an average of 63.1±30.2 days. At birth, the mean weight was 1.096 (±0.252) and the length was 35.9 cm (±2.9). Z-scores for weight and length were lower in the SGA group. (p<0.0001). During hospitalization, there was a weight loss in both groups, with a z-score change of -1.7 (+- 0.9) for the AIG group and of - 1.39 (+-0.9) for the PIG group. Both groups (AIG and SGA) showed this significant reduction in the weight and length Z-score between birth and discharge, followed by an increase between discharge and the 36-month follow-up. Among the SGA, 70.2% (n=66) had catch-up for weight and 71.2% (n=67) had catch-up for length, remaining above the z-score -2 at 36 months of gestational age corrected for prematurity. The values of the lipid profile tests (total cholesterol and fractions), as well as the blood glucose concentrations, were similar between the groups, at 36 months of PCI, with no statistical differences. Newborns who developed EUGR (extrauterine growth restriction defined as
 
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Publishing Date
2022-04-28
 
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