The objectives for the first part of this thesis were to describe changes in oxygen saturation (SpO2) and heart rate (HR) in newly born infants in the delivery room (DR) and to illustrate the changes using centile reference charts. The objective of the second part of the thesis was to investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV), immediately after birth with a T-piece have higher SpO2 measurements at five minutes than infants ventilated with a self inflating bag (SIB). / Study Design. A prospective observational study was used to achieve the first objectives. For the second part of the thesis I coordinated a randomised, controlled trial of two devices used for resuscitation of extremely preterm infants in the DR where the primary outcome measure was SpO2. / Patients and methods. In all studies a Masimo Radical pulse oximeter (PO) was placed on the infant’s right hand/wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). / Results. Observational studies: The dataset to develop the reference range charts included 61,650 data points from 468 infants. Infants had a mean (range) gestational age of 38 (25-42) weeks and birthweight 2970 (625-5135) g. For all 468 infants at one minute the 3rd, 10th, 50th, 90th and 97th centiles were 29%, 39%, 66%, 87% and 92%; at two minutes 34%, 46%, 73%, 91% and 95% and at five minutes 59%, 73%, 89%, 97% and 98%. It took a median of 7.9 (IQR 5.0 to 10) minutes to reach a SpO2 > 90%. SpO2 of preterm infants rose more slowly than that of term infants. At one min the median (IQR) HR was 82 (66 to 138) bpm rising at two min and five min to 151 (112 to 169) bpm and 166 (148 to 176) bpm respectively. In preterm infants, the SpO2 and HR rose more slowly than term infants. / Randomised trial: Forty nine infants were randomly allocated to the T-piece and 50 to the SIB. Ten infants did not receive PPV, 4 (8%) in the T-piece group and 6 (12%) in the SIB group and were not included in the analysis. Forty-one infants received PPV with a T-piece and 39 with a SIB. At 5 minutes after birth there was no significant difference between the mean (SD) SpO2 in the T-piece and SIB groups [50 (31)% vs. 53 (25)%, (p=0.73)]. More T-piece infants received oxygen during DR resuscitation (100% vs. 90%, p=0.04). There was no significant difference between the groups in the use of continuous positive airway pressure (CPAP); endotracheal intubation or administration of surfactant in the DR. Fewer of the T-piece group who left the DR on CPAP were intubated in the first 24 hrs after birth. (7% vs. 23%, p=0.05). / Conclusion. The centile charts developed in this thesis provide a reference range for SpO2 and HR in the first 10 minutes after birth for preterm and term infants. In the randomised trial there was no significant difference in SpO2 at five minutes after birth in extremely preterm infants given PPV with a T-piece or a SIB.

The objectives for the first part of this thesis were to describe changes in oxygen saturation (SpO2) and heart rate (HR) in newly born infants in the delivery room (DR) and to illustrate the changes using centile reference charts. The objective of the second part of the thesis was to investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV), immediately after birth with a T-piece have higher SpO2 measurements at five minutes than infants ventilated with a self inflating bag (SIB). / Study Design. A prospective observational study was used to achieve the first objectives. For the second part of the thesis I coordinated a randomised, controlled trial of two devices used for resuscitation of extremely preterm infants in the DR where the primary outcome measure was SpO2. / Patients and methods. In all studies a Masimo Radical pulse oximeter (PO) was placed on the infant’s right hand/wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). / Results. Observational studies: The dataset to develop the reference range charts included 61,650 data points from 468 infants. Infants had a mean (range) gestational age of 38 (25-42) weeks and birthweight 2970 (625-5135) g. For all 468 infants at one minute the 3rd, 10th, 50th, 90th and 97th centiles were 29%, 39%, 66%, 87% and 92%; at two minutes 34%, 46%, 73%, 91% and 95% and at five minutes 59%, 73%, 89%, 97% and 98%. It took a median of 7.9 (IQR 5.0 to 10) minutes to reach a SpO2 > 90%. SpO2 of preterm infants rose more slowly than that of term infants. At one min the median (IQR) HR was 82 (66 to 138) bpm rising at two min and five min to 151 (112 to 169) bpm and 166 (148 to 176) bpm respectively. In preterm infants, the SpO2 and HR rose more slowly than term infants. / Randomised trial: Forty nine infants were randomly allocated to the T-piece and 50 to the SIB. Ten infants did not receive PPV, 4 (8%) in the T-piece group and 6 (12%) in the SIB group and were not included in the analysis. Forty-one infants received PPV with a T-piece and 39 with a SIB. At 5 minutes after birth there was no significant difference between the mean (SD) SpO2 in the T-piece and SIB groups [50 (31)% vs. 53 (25)%, (p=0.73)]. More T-piece infants received oxygen during DR resuscitation (100% vs. 90%, p=0.04). There was no significant difference between the groups in the use of continuous positive airway pressure (CPAP); endotracheal intubation or administration of surfactant in the DR. Fewer of the T-piece group who left the DR on CPAP were intubated in the first 24 hrs after birth. (7% vs. 23%, p=0.05). / Conclusion. The centile charts developed in this thesis provide a reference range for SpO2 and HR in the first 10 minutes after birth for preterm and term infants. In the randomised trial there was no significant difference in SpO2 at five minutes after birth in extremely preterm infants given PPV with a T-piece or a SIB.

The objectives for the first part of this thesis were to describe changes in oxygen saturation (SpO2) and heart rate (HR) in newly born infants in the delivery room (DR) and to illustrate the changes using centile reference charts. The objective of the second part of the thesis was to investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV), immediately after birth with a T-piece have higher SpO2 measurements at five minutes than infants ventilated with a self inflating bag (SIB). / Study Design. A prospective observational study was used to achieve the first objectives. For the second part of the thesis I coordinated a randomised, controlled trial of two devices used for resuscitation of extremely preterm infants in the DR where the primary outcome measure was SpO2. / Patients and methods. In all studies a Masimo Radical pulse oximeter (PO) was placed on the infant’s right hand/wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). / Results. Observational studies: The dataset to develop the reference range charts included 61,650 data points from 468 infants. Infants had a mean (range) gestational age of 38 (25-42) weeks and birthweight 2970 (625-5135) g. For all 468 infants at one minute the 3rd, 10th, 50th, 90th and 97th centiles were 29%, 39%, 66%, 87% and 92%; at two minutes 34%, 46%, 73%, 91% and 95% and at five minutes 59%, 73%, 89%, 97% and 98%. It took a median of 7.9 (IQR 5.0 to 10) minutes to reach a SpO2 > 90%. SpO2 of preterm infants rose more slowly than that of term infants. At one min the median (IQR) HR was 82 (66 to 138) bpm rising at two min and five min to 151 (112 to 169) bpm and 166 (148 to 176) bpm respectively. In preterm infants, the SpO2 and HR rose more slowly than term infants. / Randomised trial: Forty nine infants were randomly allocated to the T-piece and 50 to the SIB. Ten infants did not receive PPV, 4 (8%) in the T-piece group and 6 (12%) in the SIB group and were not included in the analysis. Forty-one infants received PPV with a T-piece and 39 with a SIB. At 5 minutes after birth there was no significant difference between the mean (SD) SpO2 in the T-piece and SIB groups [50 (31)% vs. 53 (25)%, (p=0.73)]. More T-piece infants received oxygen during DR resuscitation (100% vs. 90%, p=0.04). There was no significant difference between the groups in the use of continuous positive airway pressure (CPAP); endotracheal intubation or administration of surfactant in the DR. Fewer of the T-piece group who left the DR on CPAP were intubated in the first 24 hrs after birth. (7% vs. 23%, p=0.05). / Conclusion. The centile charts developed in this thesis provide a reference range for SpO2 and HR in the first 10 minutes after birth for preterm and term infants. In the randomised trial there was no significant difference in SpO2 at five minutes after birth in extremely preterm infants given PPV with a T-piece or a SIB.

Porfirinas são produtos formados como intermediários na biossíntese do heme, variando de 8 a 4 grupos carboxilas: uro, hepta, hexa, penta e coproporfirinas. Alterações no perfil de porfirinas urinárias podem ser originados por uma causa hereditária ou por exposição ambiental/ocupacional. Este trabalho teve como objetivo estabelecer um método de cromatografia líquida de alta eficiência (CLAE) com detecção por fluorescência, sensível o suficiente para estimar valores de referência das frações de porfirinas urinárias, denominadas de perfil, para uma população da cidade de São Paulo, Brasil. A urina, amostra isolada, foi coletada de 126 indivíduos (18-65 anos) de ambos os sexos e não expostos ocupacionalmente a agentes porfirinogênicos tais como organoclorados, As, Hg e Pb. Os resultados obtidos apresentaram distribuição não-paramétrica e os valores de referência em &#181;g/g of creatinina, média ± dp e percentil 2,5 - 97,5 % foram: para a fração uro: 5,3 ± 6,0 e 0 - 20,8; para copro: 42,8 ± 26,4 e 7,4-133,6 e para porfirinas totais: 48,1 ± 27,7 e 7,4-159,4 respectivamente. As frações hepta, hexa e penta não foram quantificadas. Não foram encontradas diferenças estatisticamente significantes para os grupos de sexo e idade. O grupo de fumantes apresentou níveis mais baixos de copro e porfirinas totais (mediana 37,19 e 43,48) comparado com o grupo de nãofumantes (mediana 22,49 e 27,18). O método proposto, permite detectar discretas alterações na excreção de porfirinas e os limites de referência estimados têm potencial a serem utilizados como biomarcadores na exposição a agentes porfirinogênicos. / Porphyrins which are formed as intermediates in heme biosynthesis, vary from eight to four carboxyl groups: uro, hepta, hexa, penta and coproporphyrins. Alterations in the urinary porphyrin excretion profile may be caused by a hereditary disease or by environmental/occupational exposure. The purpose of this study was to establish a sensitive and accurate highperformance liquid chromatography (HPLC) method with fluorescence detection to estimate reference ranges of urinary porphyrin fractions in a population of São Paulo city, Brazil. Random urine samples were collected from 126 subjects (18 - to 65-year-old) of both sexes not occupationally exposed to porphyrinogenic agents such as chlorinated hydrocarbons, As, Hg and Pb. Distribution were nonparametric and reference ranges obtained in &#181;g/g of creatinine, mean ± SD and 2,5 -97,5 th percentile were: for 8- carboxyl (uro): 5,3 ± 6,0 and 0 - 20,8; for 4-carboxyl (copro): 42,8 ± 26,4 and 7,4-133,6 and for total porphyrins: 48,1 ± 27,7 and 7,4 -159,4 respectively. Hepta, hexa and pentaporphyrins were not quantified. No statistically significant correlation was found for sex and age. Smokers had lower levels of copro and total porphyrins statistically significant (median 37,19 and 43,48) than nonsmokers (median 22,49 and 27,18). The proposed method, which allows for the detection of minor alterations in porphyrin excretion and the reference ranges estimated are potentially applicable as biological markers in exposure to porphyrinogenic agents.

A significant growth of rhea breeding has been happening in the last years, but there is still a lack of information about this specie. Thus, this study had the objectives of determining rheas reference range of electrophoresis, to verify differences due to age. Some parameters were evaluated in 45 rheas, grouped into four categories: G1 (n=10), animals with 15 days of age; G2 (n=10), animals with 30 days of age; G3 (n=10), animals with 45 days of age and G4 (n=15), animals with 1 year of age. Were verified homogeneity in the electrophoresis parameters analyzed in the birds inside of each age group. Differences were verified among groups of age in PPT, albumin, globulins and relationship albumin/globulin values. Also difference among groups for the α1, α2, β and γ fractions. Comparison among studied parameters with other avian species observed in the literature demonstrated that most values are not similar and they may not be used as pattern to this specie. / A criação de emas vem crescendo em todo Brasil nos últimos anos, porém ainda há uma escassez de informações sobre esta espécie. O presente trabalho teve como objetivos determinar os valores de referência da eletroforese em emas e verificar as diferenças existentes entre as faixas etárias. Tais parâmetros foram analizados em 45 emas, divididos em quatro grupos: grupo 1 (n=10), animais com 15 dias de idade; grupo 2 (n=10), animais com 30 dias de idade; grupo 3 (n=10), animais com 45 dias de idade e grupo 4 (n=15), animais com 1 ano de idade. Verificaram-se homogeneidade nos parâmetros de eletroforese analisados nas aves dentro de cada faixa etária. Houve diferença entre grupos etários em valores de PPT, albumina, globulinas e relação albumina/globulinas. Também houve diferença entre grupos para as frações α1, α2, β e γ. A comparação dos parâmetros estudados com os de outras espécies aviárias, compilados na literatura, indicou que a maioria dos parâmetros são distintos, não devendo ser utilizados, os valores da literatura, como padrões para emas.

Porfirinas são produtos formados como intermediários na biossíntese do heme, variando de 8 a 4 grupos carboxilas: uro, hepta, hexa, penta e coproporfirinas. Alterações no perfil de porfirinas urinárias podem ser originados por uma causa hereditária ou por exposição ambiental/ocupacional. Este trabalho teve como objetivo estabelecer um método de cromatografia líquida de alta eficiência (CLAE) com detecção por fluorescência, sensível o suficiente para estimar valores de referência das frações de porfirinas urinárias, denominadas de perfil, para uma população da cidade de São Paulo, Brasil. A urina, amostra isolada, foi coletada de 126 indivíduos (18-65 anos) de ambos os sexos e não expostos ocupacionalmente a agentes porfirinogênicos tais como organoclorados, As, Hg e Pb. Os resultados obtidos apresentaram distribuição não-paramétrica e os valores de referência em &#181;g/g of creatinina, média ± dp e percentil 2,5 - 97,5 % foram: para a fração uro: 5,3 ± 6,0 e 0 - 20,8; para copro: 42,8 ± 26,4 e 7,4-133,6 e para porfirinas totais: 48,1 ± 27,7 e 7,4-159,4 respectivamente. As frações hepta, hexa e penta não foram quantificadas. Não foram encontradas diferenças estatisticamente significantes para os grupos de sexo e idade. O grupo de fumantes apresentou níveis mais baixos de copro e porfirinas totais (mediana 37,19 e 43,48) comparado com o grupo de nãofumantes (mediana 22,49 e 27,18). O método proposto, permite detectar discretas alterações na excreção de porfirinas e os limites de referência estimados têm potencial a serem utilizados como biomarcadores na exposição a agentes porfirinogênicos. / Porphyrins which are formed as intermediates in heme biosynthesis, vary from eight to four carboxyl groups: uro, hepta, hexa, penta and coproporphyrins. Alterations in the urinary porphyrin excretion profile may be caused by a hereditary disease or by environmental/occupational exposure. The purpose of this study was to establish a sensitive and accurate highperformance liquid chromatography (HPLC) method with fluorescence detection to estimate reference ranges of urinary porphyrin fractions in a population of São Paulo city, Brazil. Random urine samples were collected from 126 subjects (18 - to 65-year-old) of both sexes not occupationally exposed to porphyrinogenic agents such as chlorinated hydrocarbons, As, Hg and Pb. Distribution were nonparametric and reference ranges obtained in &#181;g/g of creatinine, mean ± SD and 2,5 -97,5 th percentile were: for 8- carboxyl (uro): 5,3 ± 6,0 and 0 - 20,8; for 4-carboxyl (copro): 42,8 ± 26,4 and 7,4-133,6 and for total porphyrins: 48,1 ± 27,7 and 7,4 -159,4 respectively. Hepta, hexa and pentaporphyrins were not quantified. No statistically significant correlation was found for sex and age. Smokers had lower levels of copro and total porphyrins statistically significant (median 37,19 and 43,48) than nonsmokers (median 22,49 and 27,18). The proposed method, which allows for the detection of minor alterations in porphyrin excretion and the reference ranges estimated are potentially applicable as biological markers in exposure to porphyrinogenic agents.