Thesis (D.P.H.)--University of Alabama at Birmingham, 2007. / Title from PDF title page (viewed on Feb. 19, 2010). Includes bibliographical references.

No description available.

Background: Low birth weight (LBW) is a public health issue in the United States and around the globe. Although Low birth weight is an important predictor of subsequent health outcomes, the role of maternal age as a LBW risk factor is poorly understood. Determining whether or not maternal age is a risk factor for low birth weight can help reduce the incidence of LBW and maximize the health of offspring. Objective: This study examined the association between young mothers and LBW risk in a representative sample of Non-Hispanic Whites, Non-Hispanic Blacks and Hispanic American women. Factors such as mother’s age, smoking status, level of education, income, and marital status were evaluated to assess their associations with LBW outcome. Methodology: The selected study factors were analyzed using SPSS version 20. Data were obtained from the 2007-2008 National Health and Nutrition Examination Survey (NHANES). Young mothers were defined as females between the ages of 14 and19 years old that have a baby. A live born infant weighing less than 2,500 grams was considered to have LBW. Frequencies for the selected factors were created. Univariate and multivariate logistic regression analyses were also run to examine the association between young motherhood and LBW adjusting for maternal age, smoking, education, income and marital status. Results: There was no statistically significant association between young mothers and LBW in Non-Hispanic Whites (OR=.51; 95% CI=.12-2.13), Non-Hispanic Blacks (OR=.21; 95% CI=.03-1.59), and Hispanic Americans (OR=1.48; 95% CI=.74-2.97) women, after adjusting for maternal age, smoking, education, income and marital status. Conclusion: Although, the results of this study indicating the lack of association between young mothers and LBW is consistent with findings by some investigators (Reichman et al., 1997), there are several studies that have reported contrary results (Okosun et al., 2000). In light of these mixed findings, further research is necessary to examine the impact of young mothers on adverse birth outcomes, including, LBW.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb. 19, 2009). Includes bibliographical references.

Thesis (D.P.H.)--University of Oklahoma. / Bibliography: leaves 71-75.

Introdução: Há pouca informação a respeito do crescimento cerebelar em recém-nascidos de muito baixo peso (RNMBP). Tradicionalmente as funções cerebelares são relatadas como controle do tônus, postura e coordenação da atividade motora. Entretanto, há um incremento de evidências da implicação do cerebelo na cognição, linguagem, memória e aprendizagem motora. No pré-termo com seqüelas neurológicas, o cerebelo está relacionado com alterações cognitivas e distúrbios emocionais. Objetivo: Avaliar o crescimento cerebelar do nascimento até o termo em recém-nascidos de muito baixo peso (RNMBP). Comparar o diâmetro transverso cerebelar (DTC) de recémnascidos a termo com recém-nascidos de muito baixo peso na idade corrigida correspondente ao termo. Método: RNMBP foram incluídos seqüencialmente no estudo e seus DTCs foram medidos por ultrassonografia craniana nas primeiras 48 horas após o nascimento e no momento da alta hospitalar de todos. A fossa posterior foi examinada através da fontanela Mastóidea usando o aparelho de US GE LOGIC 5 e a medida do DTC realizada no plano coronal. O grupo controle foi formado por recém-nascidos a termo normais com idade gestacional pareada com a idade gestacional pós menstrual corrigida dos RNMBP,sendo seus DTCs medidos nas primeiras 48 horas após o nascimento. Idade gestacional, peso de nascimento, perímetro cefálico e idade da alta foram obtidos dos RNMBP; e idade gestacional, peso de nascimento e perímetro cefálico dos recém-nascidos controles. Teste T de Student’s e correlação de Pearson foram empregados.O estudo foi aprovado pelo Comitê de Ética da instituição. Resultados: Foram incluídos 24 RNMBP e 24 controles. Os RNMBP tiveram idade gestacional media de 30,5± 1,7 semanas, peso de nascimento de 1247± 190 gramas, perímetro cefálico de 27,3 ± 1,5 cm, DTC de 3,28 ± 0,28 cm e idade cronológica da alta de 45,9 ± 12,3 dias. Comparação entre os dois grupos: A idade gestacional corrigida dos RNMBP e a idade gestacional dos controles foram semelhantes (37,04 ± 1,73 semanas e 37,3 ± 1,8 semanas, respectivamente; p= 0,612).O peso dos RNMBP na alta foi significativamente inferior aos controles pareados (2,019 ± 209 g e 2631 ± 423 g; p‹0,0001). Perímetro cefálico dos RNMBP na alta e dos controles, foram respectivamente, 32,23 ± 1,39 centímetros e 33,0 ± 1,6 centímetros (p= 0,098) O DTC aumentou significativamente do nascimento até a alta nos RNMBP; sendo ainda significativamente inferior aos seus pares ao termo ( 4,19 ± 0,41cm e para os controles foi 4,5 ± 0,41 cm; p=0,008). Houve uma correlação positiva entre o perímetro cefálico e o crescimento cerebelar nos RNMBP. Dois RNMBP apresentaram leucomalácia cística e quatro leucomalácia peri-ventricular difusa na ressonância magnética do primeiro ano de vida. Avaliando-se apenas os RNMBP sem leucomalácia peri-ventricular, o crescimento cerebelar foi similar aos recém-nascidos controles (p= 0.135), mas foi menor nos recém-nascidos de muito baixo peso com leucomalácia peri-ventricular quando comparados com os controles (p= 0,005). Conclusões: O crescimento cerebelar foi similar nos recém-nascidos de muito baixo peso sem leucomalácia peri-ventricular e nos controles, e menor naqueles com leucomalácia periventricular em comparação aos controles. Nossos dados sugerem que o crescimento cerebelar é normal na ausência de dano supratentorial. / Introduction: There is little information on cerebellar growth in very low birth weight infants (VLBWI). The cerebellar functions are traditionally reported as tonus, posture and coordination of motricity activity. However, there is an evidence growth of the relation of the cerebellum in cognition, language, memory and motor learning. In VLBWI with neurologic injuries the cerebellum is related to cognitive alterations and emotional disturbance. Objective: Evaluate cerebellar growth from birth up to term in VLBWI. Compare transverse cerebellar diameter (TCD) of term infants and VLBWI at term corrected age. Design/Methods: VLBWI were sequentially included in the study. TCD was measured by cranial ultrasound in the first 48 hours after birth and at hospital discharge in all of them. The posterior fossa was examined through the Mastoid fontanelle using a General Eletric LOGIQ 5 scanner and TCD measurement was taken in the coronal plane. Control group was formed by normal term infants with gestational age that matched VLBWI corrected pos menstrual age. TCD was measured in the first 48 hours after birth. Data on gestational age, birth weight, head circumference, and age at discharge were collected from VLBWI; and gestational age, birth weight, and head circumference from controls newborns. Student’s T test and Pearson correlation were employed. Study was approved by institutional Ethic Committee. Results: We enrolled 24 VLBWI and 24 controls. VLBWI had mean gestational age 30.5±1.7 weeks, birth weight 1247±190 grams, head circumference 27.3 ±1.5cm,TCD 3.28± 0.28 cm, and chronological age at hospital discharge 45.9±12.3 days. Comparison between both groups: VLBWI corrected age at discharge and controls gestational age were similar: 37.4±1.73 weeks and 37.3±1,8 (p=0.612),VLBWI weight at discharge and controls birth weight was significantly inferior to controls: 2019±and 2631±423 grams (p‹ 0.0001),VLBWI head circumference at discharge and controls head circumference: 32.23±1.39 and 33.0 ±1.6 cm (p=0.098),VBWI TCD at discharge and controls TCD: 4.19±0.41 and 4.5±0.41 cm (p=0.008).TCD increased significantly form birth up to hospital discharge in VLBWI (p< 0.001); being still significantly inferior to its term infants matched. There was a significant positive correlation between head circumference and cerebellar growth in VLBWI. Two very low birth weight infants presented cystic and four diffuse peri-ventricular leukomalacia at magnetic resonance image in the first year. Evaluating only the VLBWI without periventricular leukomalacia the cerebellar growth was similar to controls (p=0.135), but it was smaller in VLBWI with peri-ventricular leukomalacia when compared with controls (p=0.005). Hence we divided the case group in with or without peri-ventricular leukomalacia. We compared the two groups with the control group. Conclusions: Cerebellar growth was similar in very low birth Wright infants without periventricular leukomalacia and controls, and smaller in cases with peri-ventricular leukomalacia than in controls. We suggest that cerebelar growth is normal in the absence of supratentorial injury.

Introdução: Anemia é uma patologia sistêmica e um problema de saúde pública em todo o mundo, inclusive entre prematuros que são considerados grupo de risco. Objetivo: Determinar a prevalência de anemia ferropriva e deficiência de ferro com um ano de idade corrigida em pré-termos de muito baixo peso e verificar os possíveis fatores de risco associados. Metodologia: estudo transversal aninhado a uma coorte de pré-termos em uso profilático de ferro, nascidos com peso inferior a 1500 gramas e idade gestacional menor de 34 semanas, já existente, composta de crianças em acompanhamento regular no ambulatório de seguimento de prematuros de hospital terciário aos doze meses de idade corrigida. O diagnóstico de anemia foi feito pela presença de hemoglobina menor que 11g/dL, e a deficiência de ferro foi determinada por níveis de ferritina inferiores a 10mcg/L, saturação de transferrina menor que 10% e o VCM (volume corpuscular médio) menor que 80fL. Métodos estatísticos: ANOVA One-Way, Qui-quadrado, t de Student, Mann-Whitney, exato de Fisher e Regressão de Poisson. Resultados: Foram incluídas 310 crianças, com prevalência de 26,5% de anemia (n=82), já a prevalência de deficiência de ferro foi de 48%. O maior consumo de leite de vaca aos seis meses de idade corrigida, a menor idade da mãe, o maior número de gestações e ter nascido pequeno para a idade gestacional foram independentemente associadas à anemia após ajustes. Conclusões: A prevalência de anemia é alarmante, e os fatores que mais influenciaram este alto índice foram: menor idade materna, maior número de gestações, menor peso de nascimento para a idade gestacional e maior consumo de leite de vaca aos seis meses de idade corrigida. Estratégias educacionais, alimentares e ambientais poderão impactar em menor prevalência de anemia no seguimento após a alta. / Introduction: Anemia is a systemic condition and a public health issue worldwide, premature infants that are considered a high-group risk. Objective: To ascertain the prevalence of iron deficiency and iron-deficiency anemia at 1 year corrected age in very low birth weight preterm infants and potential risk factors therefor. Methods: An existing cohort of very low birth weight preterm infants (weight <1500 g and gestational age <34 weeks at birth) receiving prophylactic iron supplementation and regular follow-up at the outpatient prematurity clinic of a tertiary referral hospital was assessed at 12 months corrected age. Anemia was diagnosed by a hemoglobin level <11 g/dL, and iron deficiency, by ferritin levels <10 mcg/L, transferrin saturation <10%, and MCV (mean corpuscular volume) <80 fL. Statistical methods included one-way ANOVA, Poisson regression, and chi-square, Student’s t, Mann-Whitney U, and Fisher’s exact tests. This study was approved by the local Research Ethics Committee. Results: The sample comprised 310 infants. The overall prevalence of anemia was 26.5% (n=82), and that of iron deficiency, 48%. Four factors were independently associated with anemia after adjustment: greater cow’s milk intake at 6 months corrected age, younger maternal age, greater number of pregnancies and small for gestational age status. Conclusions: The prevalence of anemia in this sample was concerning. The most influential determinants of anemia were: younger maternal age, greater number of pregnancies, small for gestational age status and cow’s milk intake at 6 months corrected age. Educational strategies geared to proper feeding and environmental factors may help decrease the prevalence of anemia after discharge in very low birth weight preterm infants.

Objetivo: determinar a associação de crises epilépticas neonatais por diagnóstico clínico em pré-termos de muito baixo peso ao nascer com o desfecho neurológico no segundo ano de vida. Métodos: estudo de coorte, com análise retrospectiva de dados coletados prospectivamente. Incluídos recém nascidos pré-termos de muito baixo peso ao nascer (menor que 1500g) que tenham sobrevivido ao período neonatal e acompanhados no ambulatório de follow up da instituição. As crises epilépticas neonatais foram determinadas por critério clínico. O desfecho foi avaliado através da escala de Bayley II, medidas de perímetro cefálico, presença de deficiências sensoriais e óbito. O grupo com crises foi comparado ao grupo sem crises de acordo com o desfecho neurológico. Testes empregados na análise estatística: Qui-quadrado ou exato de Fisher (variáveis qualitativas), teste t de Student (variáveis quantitativas), risco relativo como medida de associação, Regressão de Poisson. Resultados: Trezentos e dois pacientes foram incluídos no estudo, com idade gestacional média de 30,4 ± 2,28 semanas e peso de nascimento médio 1182 ± 228,6 gramas. Sessenta pacientes (20%) tiveram crise epiléptica neonatal por diagnóstico clínico. O grupo com crises tinha médias de idade gestacional e peso significativamente menores, além de uma maior incidência de morbidades neonatais. Em relação ao desfecho neurológico, a diferença entre os grupos foi significativa, com um risco relativo estimado de 1,34 , com IC 95% 1,09-1,66 (p=0,006). Corrigindo-se com a regressão passo a passo, este efeito diminuiu, especialmente quando incluídas as variáveis de morbidade neurológica. Conclusão: Pacientes pré-termos com crises epilépticas neonatais apresentam um risco aumentado de desfecho neurológico adverso no segundo ano de vida. sobreposição entre as crises neonatais e as patologias que o pré-termo está exposto dificultam a determinação do seu impacto no desenvolvimento desses pacientes. / Purpose: to establish the association between clinical neonatal seizures in very low birth weight preterm infants and the neurological outcome in the second year of corrected age. Methods: cohort study, with retrospective analyses of prospective collected data. We included very low birth weight newborns (less than 1500g), which survived to the neonatal period, in regular follow-up, who were born between November/2003 and June/2010. Neonatal seizures were determined by clinical criteria. The outcome was assessed by the results of Bayley II scales, head circumference measurements, presence of sensorial deficits and death. The group with seizures was compared to the group without seizures. Statistical methods included Chi-square, Student’s t, Fisher’s exact tests and Poisson regression. Results: we included 302 patients, with mean gestational age and birth weight of respectively 30.4 ± 2.28 weeks and 1182 ± 228.6 grams. Sixty patients (20%) had clinical neonatal seizures. The group with seizures had lower gestational age and birth weight, and a greater incidence of neonatal morbidities. The relative risk of a worse neurological outcome was 1.34, with a CI 95% of 1.09 – 1.66 (p=0.006). After the Poisson regression this effect was reduced, especially when the neurological variables were included. Conclusion: preterm newborns with neonatal seizures are at increased risk for worse neurological outcome in the second year of life. The overlap among the neonatal seizures and the morbidities that these infants are exposed to increases the difficulty to define its impact in the patient neurological outcome.

Introdução: Há pouca informação a respeito do crescimento cerebelar em recém-nascidos de muito baixo peso (RNMBP). Tradicionalmente as funções cerebelares são relatadas como controle do tônus, postura e coordenação da atividade motora. Entretanto, há um incremento de evidências da implicação do cerebelo na cognição, linguagem, memória e aprendizagem motora. No pré-termo com seqüelas neurológicas, o cerebelo está relacionado com alterações cognitivas e distúrbios emocionais. Objetivo: Avaliar o crescimento cerebelar do nascimento até o termo em recém-nascidos de muito baixo peso (RNMBP). Comparar o diâmetro transverso cerebelar (DTC) de recémnascidos a termo com recém-nascidos de muito baixo peso na idade corrigida correspondente ao termo. Método: RNMBP foram incluídos seqüencialmente no estudo e seus DTCs foram medidos por ultrassonografia craniana nas primeiras 48 horas após o nascimento e no momento da alta hospitalar de todos. A fossa posterior foi examinada através da fontanela Mastóidea usando o aparelho de US GE LOGIC 5 e a medida do DTC realizada no plano coronal. O grupo controle foi formado por recém-nascidos a termo normais com idade gestacional pareada com a idade gestacional pós menstrual corrigida dos RNMBP,sendo seus DTCs medidos nas primeiras 48 horas após o nascimento. Idade gestacional, peso de nascimento, perímetro cefálico e idade da alta foram obtidos dos RNMBP; e idade gestacional, peso de nascimento e perímetro cefálico dos recém-nascidos controles. Teste T de Student’s e correlação de Pearson foram empregados.O estudo foi aprovado pelo Comitê de Ética da instituição. Resultados: Foram incluídos 24 RNMBP e 24 controles. Os RNMBP tiveram idade gestacional media de 30,5± 1,7 semanas, peso de nascimento de 1247± 190 gramas, perímetro cefálico de 27,3 ± 1,5 cm, DTC de 3,28 ± 0,28 cm e idade cronológica da alta de 45,9 ± 12,3 dias. Comparação entre os dois grupos: A idade gestacional corrigida dos RNMBP e a idade gestacional dos controles foram semelhantes (37,04 ± 1,73 semanas e 37,3 ± 1,8 semanas, respectivamente; p= 0,612).O peso dos RNMBP na alta foi significativamente inferior aos controles pareados (2,019 ± 209 g e 2631 ± 423 g; p‹0,0001). Perímetro cefálico dos RNMBP na alta e dos controles, foram respectivamente, 32,23 ± 1,39 centímetros e 33,0 ± 1,6 centímetros (p= 0,098) O DTC aumentou significativamente do nascimento até a alta nos RNMBP; sendo ainda significativamente inferior aos seus pares ao termo ( 4,19 ± 0,41cm e para os controles foi 4,5 ± 0,41 cm; p=0,008). Houve uma correlação positiva entre o perímetro cefálico e o crescimento cerebelar nos RNMBP. Dois RNMBP apresentaram leucomalácia cística e quatro leucomalácia peri-ventricular difusa na ressonância magnética do primeiro ano de vida. Avaliando-se apenas os RNMBP sem leucomalácia peri-ventricular, o crescimento cerebelar foi similar aos recém-nascidos controles (p= 0.135), mas foi menor nos recém-nascidos de muito baixo peso com leucomalácia peri-ventricular quando comparados com os controles (p= 0,005). Conclusões: O crescimento cerebelar foi similar nos recém-nascidos de muito baixo peso sem leucomalácia peri-ventricular e nos controles, e menor naqueles com leucomalácia periventricular em comparação aos controles. Nossos dados sugerem que o crescimento cerebelar é normal na ausência de dano supratentorial. / Introduction: There is little information on cerebellar growth in very low birth weight infants (VLBWI). The cerebellar functions are traditionally reported as tonus, posture and coordination of motricity activity. However, there is an evidence growth of the relation of the cerebellum in cognition, language, memory and motor learning. In VLBWI with neurologic injuries the cerebellum is related to cognitive alterations and emotional disturbance. Objective: Evaluate cerebellar growth from birth up to term in VLBWI. Compare transverse cerebellar diameter (TCD) of term infants and VLBWI at term corrected age. Design/Methods: VLBWI were sequentially included in the study. TCD was measured by cranial ultrasound in the first 48 hours after birth and at hospital discharge in all of them. The posterior fossa was examined through the Mastoid fontanelle using a General Eletric LOGIQ 5 scanner and TCD measurement was taken in the coronal plane. Control group was formed by normal term infants with gestational age that matched VLBWI corrected pos menstrual age. TCD was measured in the first 48 hours after birth. Data on gestational age, birth weight, head circumference, and age at discharge were collected from VLBWI; and gestational age, birth weight, and head circumference from controls newborns. Student’s T test and Pearson correlation were employed. Study was approved by institutional Ethic Committee. Results: We enrolled 24 VLBWI and 24 controls. VLBWI had mean gestational age 30.5±1.7 weeks, birth weight 1247±190 grams, head circumference 27.3 ±1.5cm,TCD 3.28± 0.28 cm, and chronological age at hospital discharge 45.9±12.3 days. Comparison between both groups: VLBWI corrected age at discharge and controls gestational age were similar: 37.4±1.73 weeks and 37.3±1,8 (p=0.612),VLBWI weight at discharge and controls birth weight was significantly inferior to controls: 2019±and 2631±423 grams (p‹ 0.0001),VLBWI head circumference at discharge and controls head circumference: 32.23±1.39 and 33.0 ±1.6 cm (p=0.098),VBWI TCD at discharge and controls TCD: 4.19±0.41 and 4.5±0.41 cm (p=0.008).TCD increased significantly form birth up to hospital discharge in VLBWI (p< 0.001); being still significantly inferior to its term infants matched. There was a significant positive correlation between head circumference and cerebellar growth in VLBWI. Two very low birth weight infants presented cystic and four diffuse peri-ventricular leukomalacia at magnetic resonance image in the first year. Evaluating only the VLBWI without periventricular leukomalacia the cerebellar growth was similar to controls (p=0.135), but it was smaller in VLBWI with peri-ventricular leukomalacia when compared with controls (p=0.005). Hence we divided the case group in with or without peri-ventricular leukomalacia. We compared the two groups with the control group. Conclusions: Cerebellar growth was similar in very low birth Wright infants without periventricular leukomalacia and controls, and smaller in cases with peri-ventricular leukomalacia than in controls. We suggest that cerebelar growth is normal in the absence of supratentorial injury.

Objectives – To measure the effect of non – asthmatic atopy (NAA) on the risk of adverse pregnancy outcomes; low birth weight (LBW), small for gestational age (SGA) and preterm birth (PTB), among primiparous women 19 – 25 years of age. Methods – Vital Statistics records from births occurring between 2004 and 2014, from approximately 60,000 primiparous women in South Carolina, aged 19 to 25 years, were linked to their Medicaid records. Maternal records were examined to determine if they had a previous diagnosis of NAA. Women with a diagnosis of NAA were frequency matched with a ratio of 1:4 to non – atopic controls by age, sex of infant, and asthma diagnosis. Next, the frequencies of LBW, SGA and PTB were compared across the two groups of women. Tests for linear trend across birth weight categories and gestational age at birth categories were then conducted after which separate Poisson regression models were estimated to measure the risk of each outcome. Results – Linear tests for increasing trend were statistically significant (p < 0.001); indicating that higher percentages of NAA are associated with higher infant birth weight. Similarly, higher percentages of NAA were associated with greater gestational age at birth. After controlling for maternal race/ethnicity, smoking during pregnancy, gestational diabetes and pre – pregnancy hypertension; mothers with a diagnosis of NAA had reduced risk for each outcome (RR = 0.96, 0.94 and 0.95 for LBW, SGA and PTB respectively). These results were not statistically significant (p > 0.05). Similar results were seen when data was further explored by maternal race/ethnicity. Conclusions – NAA could promote a healthy pregnancy and reduce the risk of adverse outcomes and should therefore be taken into account when assessing a woman’s risk of same. Until now this protection has gone unnoticed due to the increase in the risk of study outcomes that are associated with a diagnosis of asthma, and the fact that in many instances asthma is present with NAA. Additional analyses are needed to evaluate unknown factors associated with its diagnosis and treatment. Keywords: rhinitis, dermatitis, asthma, low birth weight, small for gestation age, preterm birth, race/ethnicity