Introdução: O parto prematuro espontâneo é doença multifatorial e sua etiologia permanece desconhecida em até 40% das vezes. Neste estudo, investigamos a existência de trombofilias maternas adquiridas e hereditárias em gestantes de risco para o parto prematuro espontâneo e as relacionamos com a incidência de prematuridade na gestação. Métodos: Neste estudo prospectivo, realizado entre julho de 2004 e setembro de 2006, foram pesquisadas 66 gestantes com antecedente de parto prematuro espontâneo e 66 gestantes sem antecedente de complicações, com pelo menos um parto a termo anterior. Até 25 semanas de gestação, foi realizada coleta única dos seguintes testes laboratoriais: anticardiolipina IgG, anticardiolipina IgM, anticoagulante lúpico, fator V Leiden, mutação da protrombina e homocisteína. Foram excluídas três gestantes por abortamento, duas por incompetência cervical, duas por malformação fetal, e uma por coleta inadequada. Dessa maneira, foram avaliadas 64 gestantes de risco e 60 sem complicações (grupo controle). Resultados: A incidência de prematuridade espontânea foi significantemente maior no grupo de risco (RR=7,97; IC95%=1,92-33,04, p<0,05). Não houve diferenças quanto ao tipo de parto nem quanto às médias dos pesos dos recém-nascidos entre os grupos. Entre as pacientes com antecedente de prematuridade, a presença de trombofilias adquiridas e hereditárias foi mais freqüente (OR=3,2; IC95%=1,4-7,5, p<0,05). As trombofilias adquiridas, quando analisadas em separado, foram mais freqüentes no grupo de risco (OR=3,0; IC95%=1,1-7,7, p<0,05), assim como, observou-se maior freqüência da anticardiolpina IgG em títulos baixos (OR=2,8; IC95%=1,0-7,5, p<0,05) e IgM em títulos intermediários ou altos (OR=3,9; IC95%=1,0-15,1, p<0,05). O anticoagulante lúpico e as trombofilias hereditárias, quando analisados em separado, não diferiram entre os grupos. Entre os casos com prematuridade espontânea na gestação atual, 79% apresentaram algum teste de trombofilia alterado. Na análise univariada, a presença de trombofilias aumentou o risco de prematuridade espontânea (OR=4,5; IC95%=1,4-14,4, p<0,05). Na análise multivariada, no entanto, o parto prematuro prévio esteve 11 vezes mais associado à prematuridade espontânea. Conclusões: Concluímos que as trombofilias adquiridas e hereditárias foram mais freqüentes no grupo de risco, sendo prevalentes as adquiridas, das quais a anticardiolpina IgG e IgM foram as mais freqüentemente encontradas. Houve aumento do risco de prematuridade espontânea nas portadoras de trombofilias adquiridas e hereditárias, mas o antecedente de parto prematuro permaneceu como o maior fator de risco associado à prematuridade espontânea. / Introduction: The spontaneous preterm birth is a multifactorial disease and its etiology remains unknown in 40% of the time. In this study, we investigated the acquired and inherited thrombophilias in high risk pregnant patients to the spontaneous preterm birth and related to the incidence of prematurity in the current pregnancy. Methods: In this prospective study realized from July of 2004 to September of 2006 was evaluated 66 pregnant women with previous spontaneous preterm birth and 66 pregnant women without complications, with at least one previous term birth. Until 25 weeks of pregnancy, was realized single collection of the following laboratorial tests: IgG/IgM anticardiolipin, lupus anticoagulant, factor V Leiden, prothrombin mutation and homocystein. It was excluded three pregnant women due to miscarriage, two for cervical incompetence, two for fetal malformation, and one for inadequated collection of exams. In this way, we evaluated 64 high risk pregnant women and 60 with no complications (control group). Results: The frequency of spontaneous preterm birth was significantly higher in the high risk group (RR=7,97; IC95%=1,92-33,04, p<0,05). There was neither differences in the birth type nor in the average weight in newborn infants between the groups. Among to the patients with risk of preterm birth in the current pregnancy, the acquired and inherited thrombophilias were more frequent (OR=3,2; IC95%=1,4-7,5, p<0,05). The acquired thrombophilias, when analysed in separately, were more frequents in the risk group (OR=3,0; IC95%=1,1-7,7, p<0,05), like it was observed more frequency of IgG anticardiolipin in low titles (OR=2,8; IC95%=1,0-7,5, p<0,05) and IgM anticardiolipin in intermediary or high titles (OR=3,9; IC95%=1,0-15,1, p<0,05). The lupus anticoagulant and the inherited thrombophilias when analysed separately were not different among groups. In spontaneous preterm birth cases in the current pregnancy, 79% had some altered thrombophilia test. In univariated analysis, the existence of thrombophilias increased the risk for spontaneous preterm birth (OR=4,5; IC95%=1,4-14,4, p<0,05). In multivariated analysis, however, the previous spontaneous preterm birth was 11 times more associated with current spontaneous preterm birth. Conclusions: We conclude that the acquired and inherited thrombophilias were more frequent in high risk group, being more prevalent the acquired ones, of which IgG anticardiolipin and IgM anticardiolipin were more frequently founded. There was increased risk for spontaneous preterm birth in women with acquired and inherited thrombophilias but the previous preterm birth remained the major risk factor related to the spontaneous preterm birth.

PURPOSE: Extremely low gestation age newborns (ELGANs) are at high risk for developmental brain abnormalities. This study is to determine deep and superficial gray matter volumetric abnormalities of ELGAN children and full term children at 9 to 11 years of age. METHODS: High-resolution magnetic resonance imaging (MRI) scans were obtained from 160 ELGAN children (70 males and 90 females) and 30 full term children (15 males and 15 females) using a dual-echo turbo spin-echo (DE-TSE) pulse sequence at 3.0T (or 1.5T at only one site). The DICOM MR images were processed with quantitative MRI algorithms programmed in Mathcad. The brain deep gray matter (dGM) was manually segmented; dGM and cortical gray matter (cGM) volumes were quantified using semi-automated clustering segmentation algorithms. RESULTS: ELGAN children had smaller deep gray matter volume (41.86 ± 7.42 ml) than full term children (49.24 ± 10.91 ml). Deep gray matter volumes of ELGAN children showed similar distribution range (SD = 7.42 ml) with the full term children (SD = 10.91 ml). About 83% of the ELGAN children had smaller deep gray matter volumes compared to the average volume of full term children at the same ages. Male children had smaller deep gray matter volumes in ELGAN (42.77 ± 7.09 ml) than in full term (51.74 ± 9.76 ml), but female children had similar deep gray matter volumes in ELGAN (41.14 ± 7.62 ml) with full term (44.27 ± 7.56 ml). Additionally, smaller deep gray matter volumes were observed more often in males (90%) than in females (65%). Cortical gray matter volumes of ELGAN children distributed from 345.60 to 1177.50ml. Moreover, female ELGAN children had smaller cortical gray matter volumes (828.14 ± 147.61 ml) than males (883.13 ± 151.34 ml). Correlation analysis revealed a positive correlation between cerebral deep gray matter volumes and total gray matter volumes (total: r = 0.57, p<0.0001; male: r = 0.542, p < 0.0001; female: r = 0.587, p < 0.0001). CONCLUSION: Male ELGAN children had smaller brain deep gray matter volumes than full term children at ages of 9 to 11 years, but not females. Cortical gray matter volumes of female ELGAN were smaller than male ELGAN. Smaller deep gray matter volumes were associated with smaller total gray matter volumes in ELGAN children.

O parto pré-termo, definido como nascimento antes de 37 semanas de gestação, é causa importante de morbidade e mortalidade neonatais, além de possíveis sequelas a longo prazo. Este trabalho trata-se de uma coorte prospectiva cujo objetivo foi analisar quatro possíveis fatores etiológicos do parto pré-termo: estresse, depressão, violência e baixo suporte social, baseado nos dados do projeto temático original: \"Fatores etiológicos do nascimento pré-termo e consequências dos fatores perinatais na saúde da criança: coortes de nascimentos em duas cidades brasileiras\". Um total de 1400 gestantes da cidade de Ribeirão Preto foram entrevistadas durante o pré- natal e logo após o parto, obtendo-se informações sobre história obstétrica e sócioeconômica, grau de estresse, depressão, apoio social e violência doméstica; dados do parto e do recém nascido. Foram identificados 133 (9,7%) partos prematuros, dentre estes 95 (6,9%) partos prematuros espontâneos, excluindo-se partos induzidos e cesarianas eletivas. Foram realizadas análises simples entre os possíveis fatores e também análises ajustadas a diversos itens da história social e obstétrica de cada gestante. O estresse e a depressão foram os dois únicos itens que mostraram associação com o desfecho prematuridade. O estresse foi o único fator que manteve a associação nos modelos ajustados de análise. Verificou-se um risco relativo bruto de 1,82 (IC 1,2 - 2,7) e de 1,60 a 1,75, nos modelos ajustados. O apoio social e histórico de violência física, sexual ou psicológica não mostraram interferência estatisticamente significativa no desfecho. Os resultados são consistentes com dados da literatura atual e apontam a importância de se observar certos sinais e sintomas durante o pré-natal, assim como discutir novas estratégias de acolhimento e tratamento, consequentemente prevenindo o parto pré-termo. / Preterm birth, defined as birth before 37 weeks of gestation, is an important cause of neonatal morbidity and mortality, as well as possible long-term sequelae. This work is a prospective cohort whose objective was to analyze four possible etiological factors of preterm birth: stress, depression, violence and low social support, based on data from the original thematic project: \"Etiologic factors of preterm birth and consequences of perinatal factors on child health: birth cohorts in two Brazilian cities \". A total of 1400 pregnant women from the city of Ribeirão Preto were interviewed during prenatal care and after delivery, obtaining information on obstetric and social history, stress level, depression, social support, domestic violence, birth data and type of delivery. A total of 133 (9.7%) preterm births were identified, of which 95 (6.9%) were spontaneous preterm births, excluding induced births and elective cesareans. Straight analyzes were performed with the possible etiological factors and also adjusted analyzes with several items of the social and obstetric history of each woman. Stress and depression were the only two items that demonstrated association with prematurity. Stress was the only factor that maintained the association in the adjusted models of analysis. There was a crude relative risk of 1.82 (CI 1.2-2.7) and 1.60-1.75 in the fitted models. The social support and history of physical, sexual or psychological violence did not show statistically significant interference in the outcome.The results are consistent with data from the current literature and point out the importance of observing certain signs and symptoms during prenatal care, as well as discussing new strategies for the diagnosis and treatment, consequently preventing preterm delivery

Preterm infants have multiple health complications due to their underdeveloped neurological systems. Bottle-feeding difficulties are one complication that leads to pulmonary illness secondary to aspiration. Preterm infants exhibit clinical markers when experiencing distress during bottle-feeding. Training caregivers to identify clinical markers reduces the risk for aspiration. Simulation training provides a safe learning environment without harming patients. Twenty-two speech-language pathology and pre-requisite students divided into two simulation groups, video-simulation (N=12) and in-vivo simulation (N=10), were trained to document clinical markers of distress exhibited by preterm infants and make clinical judgments about bottle-feeding. Students rated their levels of anxiety during simulation training. Results revealed that students trained using video-simulation performed with higher clinical judgment scores and lower anxiety levels than students who received in-vivo training. Students’ knowledge of and ability to identify distress markers in preterm infants during bottle-feeding significantly improved after training in both groups without group differences.

Thesis (MPH.) -- University of Limpopo, 2018 / Children born preterm and low birth weight may have long-term negative consequences for visual function, compared with children born at full term. Visual memory (sensory), perceptual skills and learning are of fundamental importance for a range of functions and everyday activities, such as normal classroom learning, school performance and social interactions and may contribute to academic difficulties.The purpose of this study was to investigate the effect of gestational age and birth weight on visual perceptual skills.The study was approved by the University of Limpopo, Turfloop Research Ethics Committee. The Department of Education, Limpopo Province granted permission to conduct the study. Written informed consent was obtained from parents of the children and the study adhered to the tenets of the Helsinki Declaration.

Living in counties where manufacturers release environmental toxins, such as those tracked by the Environmental Protection Agency's (EPA) toxic release inventory (TRI), may elevate infants' health risks. Because infant mortality (IM) is a strong indicator of a population's health status, it is an important topic in public health research. The purpose of this research was to examine the potential relationships between IM, community size, and factors related to mothers' SES in counties where more than 25,000 pounds of annual toxic air releases occur. The dependent variable was IM per 1,000 live births in a given community for each of the 3 years included in this analysis (1987, 1995, and 2004). The independent variables included county size and factors related to mother's SES (education, age, ethnicity, and marital status). The theoretical framework consisted of Mosley and Chen's framework for exploring child survival. Archival, publicly available data were pulled from (a) the EPAs TRI data, and (b) linked birth and infant death files from the National Center for Health Statistics. The researcher followed a quantitative, retrospective cross-sectional design and conducted 3 linear regression models to test the research questions. Results indicated that an increase in community size was significantly associated with an increase in IM. Regarding the relationships between IM and the 4 different maternal characteristics (education, age, ethnicity, and marital status) included in the analysis, findings were mixed for the 3 years examined. Despite these unexpected findings, the overall results from this investigation, when considered alongside findings from previous research on IM, indicate that policy changes and interventions are needed to reduce socioeconomic disparities in IM, and to save the lives of more infants.

Social support represents a network that provides for family, relatives, and friends and is an important predictor of future health and well-being. A knowledge gap exists in the literature regarding a need for social support for Black mothers of preterm babies. This qualitative study explored the perception of social support for Black mothers of preterm babies in Southwest Ohio. The phenomenological method of inquiry was used to gain an in-depth understanding of social support Black mothers receive after preterm birth. The social ecological theory provided a framework for understanding how individual, interpersonal, community, organizations, and policy affect a Black mother's perception of social support after preterm birth. NVivo was used to organize each data category for thematic analysis. The themes included (a) father of the baby, (b) help in times of need, (c) financial assistance, (d) government assistance, (e) lack of support, (f) mom and baby, (g) transition challenges, (h) depression, (i) acknowledging hospital support, (j) uncomfortable support, (k) unrelated support, and (l) increase in assistance. The findings indicate the lack of understanding of preterm birth and its long-term implications for a child, the need for additional interventions prior to discharge, and additional culturally appropriate training of healthcare staff. The study contributed to social change by increasing the understanding of researchers and health care professional regarding social support and improving transitions after preterm birth from hospital to home for Black mothers.

According to the CDC, each year approximately 0.06 % of the world's population dies in infancy. The March of Dimes indicated that the leading causes of infant mortality include birth defects, preterm birth, low birth weight, sudden infant death syndrome, maternal complications of pregnancy, and respiratory distress syndrome, most of which are considered preventable with access to adequate prenatal care by mothers. The goal of this study was to examine the association between maternal health literacy levels and preterm birth. This research was based on the theoretical framework of the Interaction Model of Client Health Behavior. The hypothesis for this study was that reproductive-age women with low levels of maternal health literacy would be more likely to experience a preterm birth. In this case control study, cases were defined as women delivering before 37 weeks gestation. The REALM health literacy assessment tool was used in a sample of 169 women meeting the criteria; 56 fit the case criteria and 113 fit the control criteria. The data were analyzed in SPSS using logistic regression, with preterm birth as the dependent variable, and health literacy levels as the independent variable. When comparing mothers who delivered preterm to mothers that delivered term, there was no significance difference (p = 0.112) with respect to maternal health literacy. There was no association between low maternal health literacy levels, as assessed by the REALM instrument, and preterm birth for English-speaking women between the ages of 18 and 35 within the metropolitan Atlanta area. This study reinforces the need to reengage health practitioners to achieve a modest understanding of the principals of health literacy and the health literacy levels of their patients to assist in maternal health improvements. A focus on the development and implementation of educational competencies for clinicians on maternal health literacy would attribute to a positive social change.

Abstract Delivering a preterm baby who is admitted to a neonatal intensive care unit can be an enormous hardship for parents and families, and especially for mothers. The consequences of prematurity alter the parental role, affect their confidence in caring for the baby, and subsequently may impact infant outcomes. Adequately educating mothers of premature babies using an evidence-based practice approach may help them gain the confidence and skills needed to care for their infants. The purpose of this project was to create a tool kit to educate mothers of premature babies about the essential components of caring for their babies, establish content validity of the tool kit among clinical experts, and make recommendations about the use of the tool kit in the neonatal intensive care unit. Polit, Beck, and Owen’s framework was used to establish content validity. Neonatal intensive care nurses who were considered “experts” using Benner’s novice-to-expert theory (n = 7 reviewed the tools which were quantitatively computed and yielded an Item Content Validity Index value range of 0.86 to 1.00, and a Scale Content Validity Index of 0.97, reflecting that the content met the objectives of the toolbox. Positive social change can be realized through use of the tool kit in the neonatal intensive care unit to educate mothers in the care of their preterm babies, thus improving both maternal and infant outcomes.

acase@tulane.edu