published_or_final_version / abstract / toc / Paediatrics and Adolescent Medicine / Doctoral / Doctor of Philosophy

In der prospektiven multizentrischen Studie wurde die Validität des kombinierten Apgar-Scores bei Neugeborenen mit postnataler Unterstützung untersucht. Die Studie wurde analog zur Studie 'TEST-Apgar' durchgeführt, die den kombinierten Apgar-Score an Frühgeborenen getestet hat.:Danksagung i Inhaltsverzeichnis ii Abkürzungsverzeichnis iv Abbildungs- und Tabellenverzeichnis v I. Einleitung 1 1. Perinatalmedizin 1 2. Der konventionelle Apgar-Score 1 2.1. Stärken des Apgar-Scores 2 2.1.1. Unterscheidung zwischen gutem und schlechtem postnatalem Zustand 2 2.1.2. Evaluation der Veränderung des Neugeborenen über die Zeit 4 2.1.3. Prädiktive Aussagekraft 4 2.2. Kritik am konventionellen Apgar-Score 6 2.2.1. Gewichtung der Parameter 6 2.2.2. Interindividuelle Variabilität bei der Bewertung 7 2.2.3. Bewertung von Frühgeborenen 9 2.2.4. Bewertung von beatmeten Neugeborenen 9 3. Neue Apgar-Scores zur Bewertung des postnatalen Zustands des Neugeborenen 10 3.1. Der spezifizierte Apgar-Score 11 3.2. Der erweiterte Apgar-Score 12 3.3. Der kombinierte Apgar 13 4. Fragestellung 14 II. Methoden 16 1. Studiendesign 16 2. Zustimmung durch die Ethikkommission 16 3. Auswahlkriterien des Studienkollektivs 16 3.1. Einschlusskriterien 16 3.2. Ausschlusskriterien 17 4. Verwendete Parameter 17 4.1. Daten zu Schwangerschaftsverlauf und Geburt 17 4.2. Neonatale Daten 17 4.3. Neonatale Entlassdaten 18 5. Verwendete Punktsysteme 18 6. Datenmanagement 20 7. Digitalisierung 20 8. Statistische Analyse 20 III. Ergebnisse 22 1. Deskription der Studienpopulation 22 1.1. Perinatale Charakteristika 22 1.2. Outcome Daten 23 1.3. Durchgeführte Interventionen 23 1.4. Zustandsbeschreibung 24 2. Überprüfung der Hypothese 26 2.1. Beschreibung des neonatalen Zustandes (spezifizierter Apgar-Score) 26 2.2. Beschreibung der erfolgten Intervention (erweiterter Apgar-Score) 26 2.3. Kombinierter Apgar 26 2.4. Prädiktion eines adverse outcomes 28 3. Sekundäre Fragestellungen 31 3.1. Aussagen zum Nabelschnur-pH-Wert 31 3.1.1. Zusammenhang zwischen NapH und klinischem Zustand 31 3.1.2. Zusammenhang zwischen NapH und Interventionen 31 3.1.3. Kombinierter Apgar-Score 31 4. Wechselseitige Beeinflussung von klinischem Zustand und durchgeführten Interventionen 33 IV. Diskussion 37 1. Kurzzusammenfassung der Ergebnisse 37 2. Diskussion 38 3. Ausblick 43 V. Fazit 46 VI. Zusammenfassung 47 VII. Summary 48 Literaturverzeichnis vi Anlage 1 x Anlage 2 xi

Thesis (M.S.)--University of Michigan, 1980.

Thesis (M.S.)--University of Michigan, 1980.

No description available.

Introduction: The past decade has seen a significant shift in the demographics of childbearing in the United States. The average age of women at first birth has steadily increased over the last four decades, with the birth rate for women aged 40-44 more than doubling from 1990 to 2012. The aim of this study was to evaluate the risk of adverse pregnancy outcomes with increasing maternal age and paternal age using national health statistics data. Methods: The study population included 3 495 710 live births among women 15-54+ years of age from the 2012 Natality dataset. Outcomes were modeled for both maternal and paternal 5-year age groups using logistic regression analysis to calculate adjusted and unadjusted odds ratios (AORs, ORs) with 95% confidence intervals. Analysis was performed to examine the association between maternal and paternal age across seven different adverse outcomes, including low birthweight, low Apgar score, early term pregnancies, abnormal newborn conditions and presence of congenital anomalies. Results: The risks for most outcomes paralleled with advanced maternal age and paternal age. Logistic regression models demonstrated that maternal age groups 40-44, 45-49 and 50-54+ were at highest risk for an adverse pregnancy outcome compared to the 30-34 year old reference group. Abnormal newborn conditions including assisted ventilation, NICU admission and use of antibiotics were significant for all age groups 40 and older. Low Apgar score, low birthweight and early term pregnancies were significantly higher among mothers as well as fathers with advanced age. Conclusions: These findings suggest that advanced maternal age is a risk factor for a variety of adverse pregnancy outcomes. Women aged 35-39 have a similar risk of an adverse outcome as their younger counterparts. This suggests that perhaps we should begin assessing high-risk pregnancies as starting at an older age versus the de facto standard of 35.

Orientador: Jair Cortez Montovani / Banca: Saskia Maria Wiegerinck Fekete / Banca: Fábio Augusto Winckler Rabelo / Resumo: Introdução: A integridade do sistema auditivo periférico e central é fundamental para o desenvolvimento intelectual e cognitivo. Assim, a audição é um pré-requisito para a aquisição e desenvolvimento da linguagem. Existe uma série de indicadores de risco para perda auditiva, dentre eles, o índice de "apgar baixo" e a asfixia perinatal, que é definida como uma injúria sofrida pelo recém-nascido, quando há hipoperfusão tecidual significativa e diminuição da oferta de oxigênio, resultante de diversas etiologias, no período periparto. A triagem auditiva neonatal universal (TANU) tem por finalidade, detectar mais precocemente possível, recém-nascidos com perda auditiva, principalmente os que apresentam indicadores de risco, por meio de procedimentos eletroacústicos e eletrofisiológicos, sendo os mais utilizados as emissões otoacústicas evocadas por estímulo transiente (EOE-t) e o potencial evocado auditivo de tronco encefálico (PEATE). Objetivo: Verificar o efeito do "apgar baixo" e da asfixia perinatal nas respostas das EOE-t e nas latências do PEATE. Método: Participaram do estudo 181 lactentes nascidos a termo, que foram atendidos no programa de TANU, do Hospital das Clínicas da Faculdade de Medicina de Botucatu, por meio do exame de EOE-t, com resultado "passa", em ambas as orelhas, e PEATE, com os valores de latência absoluta e interpicos. Estes foram divididos em 3 grupos sendo: G1 composto por 20 lactentes que tiveram asfixia perinatal, G2 com 111 lactentes que apresentaram apenas "apgar baixo" ao nascimento e G3 composto por 50 lactentes que tiveram índice de Apgar 1º e 5° minuto≥7. Resultados: As amplitudes das EOE-t nos registros de G3 apresentaram valores mais elevados, quando comparados aos valores de G1 e G2, especialmente na frequência de 4 kHz, para o sexo masculino. Não foram encontradas diferenças nos lactentes do sexo feminino. Também nos lactentes do sexo masculino foi... / Abstract: Introduction: The integrity of the peripheral and central auditory system is essential to the intellectual and cognitive development. Therefore, hearing is a prerequisite for language acquisition and development. There is a number of risk factors for hearing loss, such as the index of "low Apgar score" and perinatal asphyxia, which is defined as an injury suffered by the newborn when there is significant tissue hypoperfusion and decreased oxygen supply resulting from various etiologies in the peripartum period. The universal neonatal hearing screening (UNHS) is intended to detect newborns with hearing loss as early as possible, especially those who present risk factors, through electroacoustic and electrophysiological procedures. From these, the most used ones are the transient-evoked otoacoustic emissions (TEOEs) and the evoked auditory brainstem response (EABR). Objective: Check the effect of "low apgar score" and of perinatal asphyxia in the responses of TEOEs and in the latencies of EABR. Method: 181 infants born at term who were seen in the UNHS program at the hospital of Botucatu Medical School participated in the study. They had the TEOEs exam with the result "pass" in both ears and EABR with absolute and interpeak latency values. They were divided into 3 groups: G1 with 20 infants who had perinatal asphyxia, G2 with 111 infants who presented only "low Apgar score" at birth, and G3 with 50 infants who had Apgar index at 1 e 5 minutes≥7. Results: The amplitudes of the TEOEs in the records of G3 had higher values when compared to those of G1 and G2 mainly at the frequency 4 kHz in male infants. No differences were found in the female infants. In the male infants, increased latency of waves I and III bilaterally was observed in group G1. Conclusion: The amplitude response was reduced in the newborns who had asphyxia or low Apgar score at birth, which shows the importance of intrinsic analysis of the TEOEs exam. The ... / Mestre

Made available in DSpace on 2015-12-10T14:22:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-27. Added 1 bitstream(s) on 2015-12-10T14:28:21Z : No. of bitstreams: 1 000849397.pdf: 984155 bytes, checksum: 1d6762d74b07b55b7a8a520ae48a08ad (MD5) / Introdução: A integridade do sistema auditivo periférico e central é fundamental para o desenvolvimento intelectual e cognitivo. Assim, a audição é um pré-requisito para a aquisição e desenvolvimento da linguagem. Existe uma série de indicadores de risco para perda auditiva, dentre eles, o índice de apgar baixo e a asfixia perinatal, que é definida como uma injúria sofrida pelo recém-nascido, quando há hipoperfusão tecidual significativa e diminuição da oferta de oxigênio, resultante de diversas etiologias, no período periparto. A triagem auditiva neonatal universal (TANU) tem por finalidade, detectar mais precocemente possível, recém-nascidos com perda auditiva, principalmente os que apresentam indicadores de risco, por meio de procedimentos eletroacústicos e eletrofisiológicos, sendo os mais utilizados as emissões otoacústicas evocadas por estímulo transiente (EOE-t) e o potencial evocado auditivo de tronco encefálico (PEATE). Objetivo: Verificar o efeito do apgar baixo e da asfixia perinatal nas respostas das EOE-t e nas latências do PEATE. Método: Participaram do estudo 181 lactentes nascidos a termo, que foram atendidos no programa de TANU, do Hospital das Clínicas da Faculdade de Medicina de Botucatu, por meio do exame de EOE-t, com resultado passa, em ambas as orelhas, e PEATE, com os valores de latência absoluta e interpicos. Estes foram divididos em 3 grupos sendo: G1 composto por 20 lactentes que tiveram asfixia perinatal, G2 com 111 lactentes que apresentaram apenas apgar baixo ao nascimento e G3 composto por 50 lactentes que tiveram índice de Apgar 1º e 5° minuto≥7. Resultados: As amplitudes das EOE-t nos registros de G3 apresentaram valores mais elevados, quando comparados aos valores de G1 e G2, especialmente na frequência de 4 kHz, para o sexo masculino. Não foram encontradas diferenças nos lactentes do sexo feminino. Também nos lactentes do sexo masculino foi... / Introduction: The integrity of the peripheral and central auditory system is essential to the intellectual and cognitive development. Therefore, hearing is a prerequisite for language acquisition and development. There is a number of risk factors for hearing loss, such as the index of low Apgar score and perinatal asphyxia, which is defined as an injury suffered by the newborn when there is significant tissue hypoperfusion and decreased oxygen supply resulting from various etiologies in the peripartum period. The universal neonatal hearing screening (UNHS) is intended to detect newborns with hearing loss as early as possible, especially those who present risk factors, through electroacoustic and electrophysiological procedures. From these, the most used ones are the transient-evoked otoacoustic emissions (TEOEs) and the evoked auditory brainstem response (EABR). Objective: Check the effect of low apgar score and of perinatal asphyxia in the responses of TEOEs and in the latencies of EABR. Method: 181 infants born at term who were seen in the UNHS program at the hospital of Botucatu Medical School participated in the study. They had the TEOEs exam with the result pass in both ears and EABR with absolute and interpeak latency values. They were divided into 3 groups: G1 with 20 infants who had perinatal asphyxia, G2 with 111 infants who presented only low Apgar score at birth, and G3 with 50 infants who had Apgar index at 1 e 5 minutes≥7. Results: The amplitudes of the TEOEs in the records of G3 had higher values when compared to those of G1 and G2 mainly at the frequency 4 kHz in male infants. No differences were found in the female infants. In the male infants, increased latency of waves I and III bilaterally was observed in group G1. Conclusion: The amplitude response was reduced in the newborns who had asphyxia or low Apgar score at birth, which shows the importance of intrinsic analysis of the TEOEs exam. The ...

Made available in DSpace on 2016-09-27T13:40:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-01-21. Added 1 bitstream(s) on 2016-09-27T13:45:11Z : No. of bitstreams: 1 000870498.pdf: 1363365 bytes, checksum: 2f8ec1d14651feb899a0ae62638612d7 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo do trabalho foi avaliar a eficácia de protocolos terapêuticos na abordagem clínica e laboratorial de cordeiros prematuros para estimular a atividade respiratória. Constituíram-se quatro grupos: grupo I (n=6): cordeiros sem tratamento; grupo II (n=9): cordeiros cujas mães receberam dexametasona pré-parto; grupo III (n=6): cordeiros tratados com surfactante; e grupo IV (n=6): cordeiros cujas mães receberam dexametasona pré-parto e tratados com surfactante. Foi realizada avaliação física, termográfica, radiográfica e espirométrica dos animais após o nascimento (M0), aos 15 minutos (M1/4), à uma (M1), às seis (M6), às 12 (M12), às 24 (M24) e às 48 horas de vida (M48). Amostras sanguíneas foram colhidas para realização de hemogasometria, hemograma, perfil funcional hepático e renal, glicemia, lactatemia e determinação sérica de cortisol e insulina. Após o nascimento até o M48, os cordeiros apresentaram pH baixos, associados à alta pCO2 e elevação de HCO3. Houve diminuição na contagem de He, VG, VCM e Hb nas primeiras 48 horas. A concentração sérica de creatinina diminuíu até o M48. Ocorreu aumento do lactato até o M1, seguido por diminuição até o M48. Os cordeiros prematuros apresentaram baixa vitalidade e comprometimento na função pulmonar. A utilização do surfactante deve ser realizada em conjunto com a administração de dexametasona materna pré-parto. As variações no hemograma e no perfil bioquímico são fisiológicas. A termografia pode ser utilizada para análise e monitoramento da temperatura corporal. / The objective was to evaluate the efficacy of different therapeutic protocols in clinical and laboratory approach of premature lambs to stimulate respiratory activity. Four groups were formed: group I (n=6) included lambs without treatment; group II (n=9) included lambs born to mothers that were treated with dexamethasone antepartum; group III (n=6) included lambs treated with surfactant; and group IV (n=6) included lambs treated with surfactant and born to mothers that were treated with dexamethasone antepartum. Physical, thermal, radiographic and spirometric evaluation were performed after birth (T0), 15 minutes later (T15), one hour (T1), six hours (T6), 12 hours (T12), 24 hours (T24) and 48 hours after birth (T48). Blood samples were taken at the same time to perform blood gas analysis, liver and renal profile, blood glucose, blood lactate and serum concentration of insulin and cortisol. After birth to T48, all the lambs showed low pH values, which were associated with high pCO2 values and HCO3 . There was a decrease in RBC, HCT, MCV and HGB in the first 48 hours. Creatinine serum concentrations was decreased to the T48 . There was an increase of lactate to the T1, with a reduction to the T48. Premature lambs showed low vitality and impaired pulmonary function. The use of surfactant should be performed in combination with maternal antepartum dexamethasone administration. Changes in blood count and biochemical profile are physiological variations. Thermal imaging can be used for analysis and monitoring of temperatures. / FAPESP: 2011/188103

Resumo: O objetivo do trabalho foi avaliar a eficácia de protocolos terapêuticos na abordagem clínica e laboratorial de cordeiros prematuros para estimular a atividade respiratória. Constituíram-se quatro grupos: grupo I (n=6): cordeiros sem tratamento; grupo II (n=9): cordeiros cujas mães receberam dexametasona pré-parto; grupo III (n=6): cordeiros tratados com surfactante; e grupo IV (n=6): cordeiros cujas mães receberam dexametasona pré-parto e tratados com surfactante. Foi realizada avaliação física, termográfica, radiográfica e espirométrica dos animais após o nascimento (M0), aos 15 minutos (M1/4), à uma (M1), às seis (M6), às 12 (M12), às 24 (M24) e às 48 horas de vida (M48). Amostras sanguíneas foram colhidas para realização de hemogasometria, hemograma, perfil funcional hepático e renal, glicemia, lactatemia e determinação sérica de cortisol e insulina. Após o nascimento até o M48, os cordeiros apresentaram pH baixos, associados à alta pCO2 e elevação de HCO3. Houve diminuição na contagem de He, VG, VCM e Hb nas primeiras 48 horas. A concentração sérica de creatinina diminuíu até o M48. Ocorreu aumento do lactato até o M1, seguido por diminuição até o M48. Os cordeiros prematuros apresentaram baixa vitalidade e comprometimento na função pulmonar. A utilização do surfactante deve ser realizada em conjunto com a administração de dexametasona materna pré-parto. As variações no hemograma e no perfil bioquímico são fisiológicas. A termografia pode ser utilizada para análise e monitoramento da temperatura corporal. / Abstract:The objective was to evaluate the efficacy of different therapeutic protocols in clinical and laboratory approach of premature lambs to stimulate respiratory activity. Four groups were formed: group I (n=6) included lambs without treatment; group II (n=9) included lambs born to mothers that were treated with dexamethasone antepartum; group III (n=6) included lambs treated with surfactant; and group IV (n=6) included lambs treated with surfactant and born to mothers that were treated with dexamethasone antepartum. Physical, thermal, radiographic and spirometric evaluation were performed after birth (T0), 15 minutes later (T15), one hour (T1), six hours (T6), 12 hours (T12), 24 hours (T24) and 48 hours after birth (T48). Blood samples were taken at the same time to perform blood gas analysis, liver and renal profile, blood glucose, blood lactate and serum concentration of insulin and cortisol. After birth to T48, all the lambs showed low pH values, which were associated with high pCO2 values and HCO3 . There was a decrease in RBC, HCT, MCV and HGB in the first 48 hours. Creatinine serum concentrations was decreased to the T48 . There was an increase of lactate to the T1, with a reduction to the T48. Premature lambs showed low vitality and impaired pulmonary function. The use of surfactant should be performed in combination with maternal antepartum dexamethasone administration. Changes in blood count and biochemical profile are physiological variations. Thermal imaging can be used for analysis and monitoring of temperatures. / Orientador:Luiz Cláudio Nogueira Mendes / Banca:Flávia de Almeida Lucas / Banca:Alexandre Secorun Borges / Banca:Guilherme de Paula Nogueira / Banca: Fernando José Benesi / Doutor