Orientador: Sergio Tadeu Martins Marba / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T19:06:43Z (GMT). No. of bitstreams: 1 Pavan_TychaBiancaSabaini_M.pdf: 1135745 bytes, checksum: 87193a679a977d0df4230db53eab4297 (MD5) Previous issue date: 2013 / Resumo: O objetivo do trabalho foi descrever e avaliar a capacidade da "RFLP-PCR" para detectar patógenos bacterianos em recém-nascidos (RN) e determinar seu uso diagnóstico na sepse neonatal precoce (SNP). Foram avaliados RNs assintomáticos, filhos de gestantes com fatores de risco para infecção ovular e RNs com apresentação de sintomas clínicos sugestivos para SNP, nas primeiras 48 horas de vida, atendidos na unidade neonatal do CAISM/UNICAMP/SP. Realizou-se extração genética das amostras de 200?L de sangue total através do kit QIAamp DNA Mini kit column (Qiagen), seguida da detecção do gene universal bacteriano 16 S rRNA e identificação microbiana pelas sucessivas digestões com enzimas de restrições - HaeIII, AluI, DdeI, MnlI. Foram avaliados 65 RN assintomáticos e 178 RN com apresentação de sinais clínicos sugestivo de SNP. Os patógenos detectados foram K. pneumoniae, S. pneumoniae, L. monocytogenes, P. aeruginosa, E.coli, S.pyognes, S. agalactiae, S. epidermidis e S. aureus. Resultados duvidosos ou bactérias não identificadas ocorram em 56 amostras. A positividade da "RFLP-PCR" foi de 55,3% no grupo assintomático e 51,6% no grupo sintomático, sem diferença estatística (p=0,583). Houve comprovação de sete RN com sepse por cultura e 24 com sepse clínica e foram encontrados valores de sensibilidade de 87,8%, especificidade de 46,6%, valores preditivo positivo de 23,3% e preditivo negativo de 95,4%. Em conclusão, o uso da técnica mostrou uma taxa de acurácia baixa para o diagnóstico para a SNP satisfatória / Abstract: Study objective was to describe and evaluate the ability of RFLP-PCR for detection of bacterial pathogens in newborn and to determine its diagnostic utility in early neonatal sepsis. There were evaluated asymptomatic newborns, children of mothers with risk factors for infection ovulate and newborns with presentation of clinical symptoms suggestive of early neonatal sepsis, occurring before 48 hours of life, evaluated at neonatal unit at CAISM-UNICAMP. Whole blood samples were taken from newborns - 200 ?L each. A genetic extraction were performed using QIAamp DNA Mini kit column (Qiagen) and also the detection of bacterial universal 16 S rRNA gene, subsequent microbial identification using restriction digestion enzymes - HaeIII, AluI, DdeI, MnlI. There were 65 asymptomatic infants and 178 symptomatic newborns. The identified bacteria were K. pneumoniae, S. pneumoniae, L. monocytogenes, P. aeruginosa, E.coli, S.pyognes, S. agalactiae, S. epidermidis and S. aureus. Uncertain or unidentified pathogens occurred in 56 samples. RFLP-PCR positivity was 55,3% in the asymptomatic group and 51,6% in the symptomatic group, with no statistical difference (p=0,583). There were culture comproved sepsis in 7 infants and in 24 newborns were made a diagnostic of clinical sepsis. Diagnostic indexes were: sensibility 87.8%, specificity 46.6%, positive predictive value 23.3% e negative predictive value 95.4%. In conclusion, RFLP-PCR had an unsatisfactory accuracy index early neonatal sepsis / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

A transverse study in term newborns was made to determine the occurrence of motor responses and possible asymmetries during the stimulation of the vestibular system through the head turning after release from the midline and passive rotation. From October to December of 2005, 320 neonates were admitted to the Adjacent Lodgings of the University Hospital of Santa Maria. From those, 89 were selected for assessment of the vestibular function since they have previously had fetal static control through ultrasound. Our results show that right-sided head lateralization was significantly greater than left-sided. The predominancy of the lateralization towards the right side also occurred in the male gender, cephalic presentations and left-sided back, however, not significant. On the passive rotation about the vertical axis, the great majority of the neonates presented eye deviation in the opposite direction of the body movement and about the horizontal axis, the great majority of them either remained with their eyes closed or did not present any deviation at all. Results corroborate with the existing literature and suggest an association between fetal static and vestibular function. It was shown through vestibular stimulation trials that term newborns already possess a functional asymmetry as well as motor responses to this system stimulation / Com o objetivo determinar a ocorrência de respostas motoras e possíveis assimetrias durante a estimulação do sistema vestibular pelas provas de queda da cabeça e rotação passiva, foi realizado um estudo transversal no recém-nascido de termo. No período de outubro a dezembro de 2005, 320 recém-nascidos foram admitidos no Alojamento Conjunto do Hospital Universitário de Santa Maria, e destes 89 foram selecionados para avaliação da função vestibular, por terem feito controle da estática fetal através do ultra-som. Nossos resultados mostram que a lateralização da cabeça para a direita foi significativamente maior do que para esquerda. Este predomínio da lateralização para a direita também ocorreu no gênero masculino, nas apresentações cefálicas e com o dorso para esquerda, no entanto estes não foram significativos. Nas provas de rotação passiva na vertical a grande maioria dos RN apresentou o desvio dos olhos sempre no sentido oposto ao movimento do corpo e no plano horizontal, a grande maioria dos RN permaneceu com os olhos fechados, ou não apresentou desvio algum. Nossos resultados corroboram com a literatura existente, e sugerem uma associação entre a estática fetal e a função vestibular. Através das provas de estimulação vestibular, ficou demonstrado que o RN de termo já possui respostas motoras a estimulação deste sistema, bem como uma assimetria funcional

The widely accepted view nowadays is that experiencing odours as rather pleasant or unpleasant is, to a certain degree, shaped on a daily basis through individual experience within one's culture via evaluative conditioning or, rather marginally so, via mere exposure to that certain odour. In other words, humans are not born with any fixed set of olfactory likes or dislikes but rather, they acquire them throughout their lifetime. However, olfactory sensation is not a "pure" percept, as odorant stimuli generally elicit a qualitative percept of an odorant - generated mainly by the olfactory nerve - as well as some degree of chemesthesis - a tactile confound of the odour generated mainly by the trigeminal nerve. The olfactory and trigeminal system exhibit complex interactions at both the peripheral and central level of chemosensory processing, which is also reflected in perceptual characteristics of the final percept, including perceived pleasantness (hedonics). If the olfactory contribution alone does not easily predict neonatal odour hedonics, due to newborns' limited previous exposure to chemosensory inputs, one may hypothesize that together with the strength of the trigeminal contribution they may form a significant factor affecting neonatal appetitive/aversive responses to odours. In the present...

Various surgical techniques for the repair of injured vas deferens in rat experiment Introduction: The herniotomy for inguinal hernia is one of the most frequent surgical procedures in paediatric surgery. The incidence of complication following primary inguinal herniotomy in neonates is not rare and repair of the injured vas deferens (VD) is not standardized. The aim of this experimental study was to assess the contusion of VD during the surgery with a surgical instrument and to perform and consequently analyze some possibilities of a simple repair method under the control of operating loupe. Methods: Seventy male rats were divided into seven subgroups according to the type of the vas deferens injury and its repair consequently: 1. Contusion, 2. cut-off and a simple one layer vasovasostomy sewn by absorbable sewing material, 3. cut-off and joining by an intraluminally lead fibre of absorbable sewing material knotted externally, 4. = 3. using non- absorbable sewing material, 5. = 2. combine with intraluminally situated absorbable sewing fibre fixed externally,6. = 5. combine with intraluminally situated non-absorbable sewing fibre fixed externally, 7. = 5. without external fixation. Fibres of non-absorbable sewing material were removed 3 weeks after the first operation. Operated or injured parts of...

This is a project-based thesis focusing on the investigation of topics related to human newborns and the factors found in their surrounding environment that need to be assessed so as to provide them with a feeling comfort. The objective is to boost their emotional development by the means of light in a close relation to sound so as to provide them with a type of intelligence allowing them to normally interact within a society during their adult life, reassuring social equality and eliminating potential social exclusion due to unexpected behaviours. After researching topics to have a better understanding of the newborn baby and its enclosing environment, a luminaire design solution -functioning with a reactive scheme performed with integrated sound sensors- provided further results to the main topic investigation. The conceptual scheme for the product development was inspired by the connection between the newborn and their life-giver, closely linked to the cross-modality of sensory development before and after birth. Additional results were obtained with light measurement assessments and a parent survey targeting both the intended light quality subjective evaluations and the marketing strength of the designed product. This survey was used -along with other means- as a design evaluation tool at the final stage of the design process. Potential further improvements as well as considerations for a distinct spatial application are discussed in the final part of the thesis. The sustainability aspect covered within this degree project is closely linked to good physical and mental health aspects, clean energy use and efficiency achieved by the integration of input sound sensors and controls, and conscious production and consumption by the proposal of low global footprint materials for the luminaire design. In the conclusions, an overall summary of the thesis outcomes is presented and further research is proposed regarding both the main topic investigation as well as a greater user category that can be related to the light metric assessments that were carried out for this research.

This review will focus on a systems medicine approach to neonatal abstinence syndrome (NAS). Systems medicine utilizes information gained from the application of “omics” technology and bioinformatics (1). The omic approaches we will emphasize include genomics, epigenomics, proteomics, and metabolomics. The goals of systems medicine are to provide clinically relevant and objective insights into disease diagnosis, prognosis, and stratification as well as pharmacological strategies and evidence-based individualized clinical guidance. Despite the increasing incidence of NAS and its societal and economic costs, there has been only a very modest emphasis on utilizing a systems medicine approach, and this has been primarily in the areas of genomics and epigenomics. As detailed below, proteomics and metabolomics hold great promise in advancing our knowledge of NAS and its treatment. Metabolomics, in particular, can provide a quantitative assessment of the exposome, which is a comprehensive picture of both internal and external environmental factors affecting health.

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome exhibited by infants born to mothers with opioid use disorder (OUD). The American College of Obstetricians and Gynecologists and other professional societies endorse opioid agonist pharmacotherapy (MATs) as the optimal treatment for OUD during pregnancy. This study focuses on impact of weaning of MAT drugs on the incidence of NAS and neonatal birth outcomes among babies born to women with opioid exposure. The study population included eighty-six pregnant women with OUD, divided in to weaning and non-weaning groups based on their choice to wean the MATs during pregnancy. Univariate analysis was performed between the clinical and demographic variables of both groups. Multivariate analysis was performed to find the association between outcome variables and predictor variables. All analyses were conducted using SAS version 9.4. The study identified a significant negative correlation (p-value: 0.0099) between weaning from MATs and NAS incidence. The study showed significant correlations of weaning with shorter LOS (p-value: 0.0036) and higher birth weights (p-value: 0.0408). Weaning emerged as a significant predictor for decreasing the incidence of NAS and improving the neonatal outcomes. Logistic regression confirmed weaning as a protective factor (odds ratio: 4.881 CI: 1.3, 18.1). The intricacies of weaning of MATs in the context of OUD during pregnancy present profound health and ethical considerations for both mothers and infants. The investigation into NAS incidence among infants born to women with OUD revealed a significant association with weaning from MATs during pregnancy. The study highlights the potential benefits of weaning, offering insights into optimized neonatal care and efficient healthcare resource utilization.

La voix est un stimulus auditif omniprésent dans notre environnement sonore. Elle permet non seulement la parole, mais serait aussi l’équivalent d’un visage auditif transmettant notamment des informations identitaires et affectives importantes. Notre capacité à discriminer et reconnaître des voix est socialement et biologiquement importante et elle figure parmi les fonctions les plus importantes du système auditif humain. La présente thèse s’intéressait à l’ontogénèse et à la spécificité de la réponse corticale à la voix humaine et avait pour but trois objectifs : (1) mettre sur pied un protocole électrophysiologique permettant de mesurer objectivement le traitement de la familiarité de la voix chez le sujet adulte; (2) déterminer si ce même protocole pouvait aussi objectiver chez le nouveau-né de 24 heures un traitement préférentiel d’une voix familière, notamment la voix de la mère; et (3) mettre à l’épreuve la robustesse d’une mesure électrophysiologique, notamment la Fronto-Temporal Positivity to Voices, s’intéressant à la discrimination pré-attentionnelle entre des stimuli vocaux et non-vocaux. Les résultats découlant des trois études expérimentales qui composent cette thèse ont permis (1) d’identifier des composantes électrophysiologiques (Mismatch Negativity et P3a) sensibles au traitement de la familiarité d’une voix; (2) de mettre en lumière un patron d’activation corticale singulier à la voix de la mère chez le nouveau-né, fournissant le premier indice neurophysiologique de l’acquisition du langage, processus particulièrement lié à l’interaction mère-enfant; et (3) de confirmer l’aspect pré-attentionnel de la distinction entre une voix et un stimulus non-vocal tout en accentuant la sélectivité et la sensibilité de la réponse corticale réservée au traitement de la voix. / Voice is a very prominent auditory stimulus in our acoustic environment. It is not only the carrier of speech, but would also be an auditory face that conveys important affective and identity information. Our ability to discriminate and recognize voices is socially and biologically important as it is amongst the most important functions of the human auditory system. This thesis was interested in the ontogenesis and specificity of the cortical response to human voice and had three objectives: (1) to develop an electrophysiological protocol to objectively measure the processing of voice familiarity in adult subjects; (2) to assess whether the same electrophysiological protocol could also objectify preferential processing of a familiar voice in 24-hour-old newborns, in particular the mother’s voice; and (3) to test the robustness of an electrophysiological measure, more specifically the Fronto-Temporal Positivity to Voices, interested in pre-attentional discrimination between vocal and non-vocal stimuli. Results from these three experimental designs have enabled (1) to identify electrophysiological components (Mismatch Negativity and P3a) sensitive to the processing of voice familiarity; (2) to highlight a singular pattern of cortical activation to the mother’s voice in newborns, providing the first neurophysiological evidence of language acquisition, a process especially related to the mother-child interaction; and (3) to confirm that vocal/non-vocal discrimination is a pre-attentional process, while enhancing the selectivity and the specificity of voice processing cortical response.

La dysplasie broncho-pulmonaire (DBP), caractérisée par un défaut de l’alvéolarisation, est une complication pathologique associée à un stress oxydant chez le nouveau-né prématuré. La DBP est présente chez près de 50 % des nouveau-nés de moins de 29 semaines de gestation. La nutrition parentérale (NP) que ces nouveau-nés reçoivent pour cause d’immaturité gastro-intestinale est une source importante de stress oxydant. En effet, leur NP est contaminée par des peroxydes, dont l’ascorbylperoxyde qui est une forme peroxydée du déshydroascorbate. La génération des peroxydes est catalysée par la lumière ambiante. La photoprotection de la NP, quoique difficile d’application en clinique, est associée à une diminution de l’incidence de la DBP chez les enfants prématurés. Chez l’animal nouveau-né, la photoprotection de la NP est associée à un meilleur développement alvéolaire. Ainsi, nous émettons l’hypothèse que l’ascorbylperoxide infusé avec la NP cause la perte d’alvéoles suite à une apoptose exagérée induite par l’oxydation du potentiel redox du glutathion. Cette oxydation du potentiel redox serait occasionnée par l’inhibition de la transformation hépatique de la méthionine en cystéine, menant à une diminution de la synthèse de glutathion au foie et dans les tissus tels que les poumons. La confirmation de cette hypothèse suggérera qu’un ajout de glutathion dans la NP permettra une meilleure détoxification de l’ascorbylperoxide par l’action de la glutathion peroxydase, et préviendra l’oxydation du potentiel redox et ainsi, la perte d'alvéoles par apoptose. Objectifs : Le but de mon projet de recherche est de comprendre les mécanismes biochimiques liant la NP et le développement de la DBP chez le nouveau-né prématuré et de proposer une alternative nutritionnelle prévenant le développement de cette complication fréquemment observée dans cette population. Les objectifs spécifiques sont : 1) d’évaluer l’impact, au poumon, de l’infusion de l’ascorbylperoxyde sur l’axe métabolique potentiel redox du glutathion - apoptose - le développement alvéolaire; 2) d’étudier l’impact de l’ascorbylperoxyde et du potentiel redox sur l’activité hépatique de la méthionine adénosyltransférase (MAT), première enzyme de la cascade métabolique transformant la méthionine en cystéine; et 3) de tenter de prévenir l’impact négatif de la NP ou de l’infusion d’ascorbylperoxyde sur le poumon en améliorant le statut en glutathion. Méthodes: Par un cathéter fixé dans la jugulaire, des cochons d’Inde de trois jours de vie (n = 8 par groupe) ont reçu en continu durant 4 jours une NP ou une solution de base (dextrose + NaCl) enrichie des différentes molécules à l’essai. Le premier objectif a été atteint en enrichissant la solution de base en ascorbylperoxyde à 0, 20, 60 et 180 μM. Ces solutions contenaient ou non 350 μM H2O2 pour se rapprocher des conditions cliniques. Le second objectif a été atteint en investiguant les mécanismes d’inhibition de la MAT dans des animaux infusés ou non avec des solutions contenant la solution de base, des peroxydes, du glutathion et la NP (dextrose + acides aminés + multivitamines + lipides). Le troisième objectif a été atteint en ajoutant ou non à une solution d’ascorbylperoxide ou à la NP 10 μM de glutathion (GSSG), afin d’obtenir une concentration plasmatique normale de glutathion. Après 4 jours, les poumons étaient prélevés et traités pour la détermination de GSH et GSSG par électrophorèse capillaire, le potentiel redox était calculé selon l'équation de Nernst et le niveau de caspase-3 actif (marqueur d’apoptose) par Western blot et l’index d’alvéolarisation quantifié par le nombre d’interceptes entre des structures histologiques et une droite calibrée. Les données étaient comparées par ANOVA, les effets étaient considérés comme significatifs si le p était inférieur à 0,05. Résultats: L’infusion de l’ascorbylperoxyde, indépendamment du H2O2, a induit une hypoalvéolarisation, une activation de la caspase-3 et une oxydation du potentiel redox de manière dose-dépendante. Ces effets ont été empêchés par l’ajout de GSSG à la NP ou à la solution d’ascorbylperoxyde (180 M). L’ascorbylperoxyde et le H2O2 ont inhibé l’activité de MAT tandis qu’elle était linéairement modulée par la valeur du potentiel redox hépatique. Conclusion : Nos résultats suggèrent que l’ascorbylperoxyde est l’agent actif de la NP conduisant au développement de la DBP. Ainsi la correction des bas niveaux de glutathion induits par les peroxydes de la NP favorise la détoxification des peroxydes et la correction du potentiel redox pulmonaire ; ce qui a protégé les poumons des effets délétères de la NP en outrepassant l’inhibition de la MAT hépatique. Nos résultats sont d'une grande importance car ils donnent de l'espoir pour une prévention possible de la DBP. / Bronchopulmonary dysplasia (BPD) is a major complication of preterm newborns, affecting nearly 50% of infants born before 29 weeks of gestation. BPD is characterized by an arrest in alveolar development. The onset of BPD is related to oxidative stress. Research has shown that parenteral nutrition (PN), which is given to preterm newborns to bypass an immature gastrointestinal system, is a major source of oxidative stress. Indeed, PN is contaminated with peroxides, including ascorbylperoxide, an oxidized form of dehydroascorbic acid. Ambient light is a catalyst for the generation of peroxides. Photo-protection of PN, although difficult to apply in the clinical situation, is associated with a lower incidence of BPD in premature infants and with better alveolar outcomes in animal models of neonatal PN. We hypothesized that the ascorbylperoxide in PN disrupts alveolar development. The main mechanism of action is an inhibition of the transformation of methionine into cysteine in the liver, leading to a lower glutathione synthesis in the liver as well as in peripheral tissues such as lung. Lower glutathione (GSH) concentrations favour a shift of redox potential to a more oxidized state and consequently, to exaggerated apoptosis. If our hypothesis is correct, the addition of glutathione to PN would help detoxify ascorbylperoxide through the action of glutathione peroxidase and prevent the deleterious impact of PN. Objectives: The aims of my research project were to investigate the biochemical mechanisms linking PN to the development of BPD in premature newborns and to propose a nutritional alternative that would prevent the occurrence of this frequently observed complication. Specific objectives were: 1) to assess the effect of intravenously infused ascorbylperoxide on the metabolic axis redox potential of glutathione in the lung; specifically, apoptosis and the alveolarization index; 2) to study the impact of ascorbylperoxide and the redox potential on the activity of methionine adenosyltransferase (MAT) in the liver; methionine adenosyltransferase is the first enzyme in the metabolic cascade from methionine to cysteine; and 3) to try to prevent the deleterious impact of PN or ascorbylperoxide infusions on the lung by improving glutathione status. Methods: Through a catheter in the jugular vein, 3-day-old guinea pigs (n = 8 per group) received continuous infusions of PN or a simple solution (dextrose + NaCl) enriched with different molecules for testing. The first objective was achieved by enriching the basic solution with ascorbylperoxide at concentrations of 0, 20, 60 and 180 M. To mimic clinical conditions, these solutions contained, or not, 350 M H2O2. The second objective was achieved by investigating the mechanisms of MAT inhibition in animals infused, or not, with solutions consisting of the basic solution, peroxides, glutathione, and PN (dextrose + amino acids + multivitamins + lipids). The third objective was achieved by adding, or not, 10 M of glutathione (GSSG) to the ascorbylperoxide or PN solution until a normal plasma concentration of glutathione was obtained. After 4 days, the lungs were removed. GSH and GSSG levels in the lungs were determined by capillary electrophoresis. The redox potential was calculated using the Nernst equation. The activation and the concentration of active caspase-3 (marker of apoptosis) were determined by Western blot, and the alveolarization index quantified by the number of intercepts between histological structures and a calibrated straight line. Data were compared by ANOVA; effects were considered significant if p was less than 0.05. Results: The infusion of ascorbylperoxide, independently of H2O2, induced hypoalveolarization, activation of caspase-3, and oxidation of the redox potential, in a dose-dependent manner. These effects were prevented by the addition of GSSG to the ascorbylperoxide (180 M) or PN solutions. Ascorbylperoxide and H2O2 inhibited MAT activity in the liver. Hepatic MAT activity was linearly modulated by the value of the redox potential. Conclusion: Our results suggest that ascorbylperoxide is the active ingredient in PN that leads to the development of BPD. Correcting the low glutathione levels induced by peroxides in PN solutions would promote the detoxification of peroxides and re-establish proper pulmonary redox potentials. Glutathione correction further protects the lungs from the deleterious effects of PN by bypassing hepatic MAT inhibition. This result is of great importance because it gives hope for the possible prevention of BPD.

Introdução: A prevalência de perda auditiva em recém-nascidos (RN) normais e lactentes é estimada em 1,5 a 6/1.000 nascidos vivos, sendo que naqueles considerados de alto risco varia de 1,5 a 17%. Objetivos: Verificar a prevalência de deficiência auditiva adquirida em RN e lactentes que ficaram internados em unidade de cuidados intensivos (UTI) e intermediários; relacionar a deficiência auditiva com a existência de fatores de risco para este evento e determinar o nível anatômico da lesão nos RN que apresentarem esta deficiência. Métodos: Estudo de coorte prospectivo no período de setembro de 2003 a março de 2004, com 71 recém-nascidos de três Hospitais da cidade de São Paulo, com populações de características semelhantes. Em relação ao sexo, 26 (36,62%) eram do sexo feminino e 45 (63,38%) do masculino; a média de peso e idade gestacional ao nascimento foi 2.480,63g (825g-4215g) e 36,14 semanas (25,57 - 41,57 semanas), respectivamente. Os 71 RN realizaram a primeira avaliação auditiva utilizando o método de emissão otoacústica evocada transiente (EOAET) aplicado durante a internação hospitalar. A segunda avaliação foi ambulatorial e além de o método de EOAET foi aplicado também o de audiometria de tronco cerebral (ABR). A média de idade cronológica e idade gestacional corrigida na primeira avaliação auditiva foi 19,36 dias e 38,86 semanas, enquanto na segunda avaliação foi 73,50 dias e 46,61 semanas, respectivamente. Os fatores de risco escolhidos para testar uma possível relação com deficiência auditiva foram: perinatais, respiratórios, infecciosos, metabólicos, uso de equipamentos e outros, como: tempo de ventilação mecânica, utilização de oxigenioterapia não invasiva, tempo de incubadora e tempo de internação na UTI, fármacos ototóxicos, neurológicos, insuficiência renal e retinopatia da prematuridade. Os dados foram avaliados descritivamente pelo cálculo de médias e proporções, análise inferencial e teste de concordância entre a primeira e segunda avaliação audiológica. Resultados: Dos 71 RN avaliados, 23 (32,39%) apresentaram alteração auditiva, sendo 8 (30,77%) do sexo feminino e 15 (33,33%) do masculino. Em relação à lateralidade, 11 (47,83%) RN apresentaram alterações unilaterais e 12 (52,17%) bilaterais e em relação ao local da lesão, 14 (60,87%) apresentaram alterações cocleares, 1 (4,35%) retrococlear e 8 (34,78%) mista. A alteração auditiva esteve estatisticamente associada com: RN pequeno para a idade gestacional, apnéia, hipocalcemia, uso de dois ou mais fármacos ototóxicos, amicacina e furosemida Houve fraca concordância entre as duas avaliações realizadas com EOAET (k=0,138, intervalo de confiança (95%)=[0; 0,364]). Conclusões: a prevalência de perda auditiva nos RN e lactentes internados nas unidades de cuidados intensivos e intermediários foi mais elevada do que a da citada na literatura. Houve associação estatística com seis fatores de risco estudados e não houve diferença entre o comprometimento unilateral e bilateral, com predomínio da freqüência de alterações cocleares, seguidas de alterações mistas e retrococleares / Introdution: The prevalence of newborn and infant hearing loss is estimated to range 1.5 to 6 per 1.000 live births and newborn with risk factors for hearing loss range 1.5 to 17%. Objective: To verify the prevalence of newborns and infants hearing loss admitted in the intensive and intermediary care unit; to relate the hearing loss with the presence of risk factors for such event and to determine the wound anatomic level. Methods: It is a prospective cohort study with 71 newborns (NB), in three Hospitals in São Paulo (September 2003 and March 2004). Twenty six (36.62%) NB females and 45 (63.38%) males. The average of the weight and of the gestational age at the birth were 2,480.63 g (825 g-4,215 g) and 36.14 weeks (25.57-41.57 weeks), respectively. The first evaluation using the transient evoked otoacoustic emission during the hospitalization. The second was performed in the ambulatory of the hospital with transient evoked otoacoustic emission and auditory brainstem response. The average of the chronologic age and of the gestacional age at the first evaluation were 19.36 days and 38.86 weeks and at the second evaluation were 73.50 days and 46.61 weeks, respectively. The risk factors for hearing loss evaluated: perinatal, respiratory, infection, metabolic, use of equipment and others (mechanical ventilation duration, use of non-invasive oxygen-therapy, time in the incubator and neonatal in the intensive unit care), ototoxic medications, neurological, renal ins ufficiency and retinopathy of prematurity. The data were evaluated calculating averages and proportions, inferential analysis and concordance test between the first and the second audiologic evaluation. Results: Twenty three (32.39%) NB of the 71 presented a hearing loss, eight (30.77%) females and 15 (33.33%) males. Eleven (47.83%) newborns presented unilateral alteration and 12 (52.17%) bilateral. Fourteen NB (60.87%) presented cochlear alteration, 1 (4.35%) retrocochlear and 8 (34.78%) mixed. The hearing loss was significantly associated with small for gestational age newborns; apnea, hypocalcaemia, administration ototoxic medications, administration of amicacine and furosemida. The concordance test between the first and the second transient evoked otoacoustic emission was weak (k=0.138, 95%confidence interval 0;0.364). Conclusions: The prevalence of hearing loss in this study was high that in the literature. The hearing loss was significantly associated with six risks factors studied. The difference between unilateral and bilateral alteration wasn\'t observed, the cochlear alteration was more frequent, following the mixed and retrocochlear alteration