Abstract Objective: To evaluate cardiac function and structural changes in children of diabetic mothers in the fetal and neonatal period using Doppler-echocardiographic data. Method: A prospective, descriptive observational study conducted in a private and tertiary care service for high-risk pregnant women. It included 48 children of mothers with gestational diabetes mellitus (GDM) considered clinically compensated during pregnancy, with a single fetus and absence of malformations. Myocardial thickness, shortening fraction, left ventricular (LVMPI) and right ventricular (RVMPI) myocardial performance index, and mitral and tricuspid valve E/A ratio were evaluated in 96 echocardiographic exams with Doppler. Results: The hypertrophic cardiomyopathy was 29% vs 6% p = 0.006 in the prenatal and postnatal periods respectively. The shortening fraction was 0% vs 6% p = 0.242 in the fetuses and newborns respectively. The myocardial performance index of the right ventricle was 12% vs 54% p ≤ 0.001, and on the left ventricle 27% vs 60% p = 0.001 in the prenatal and postnatal periods respectively. The ratio of mitral valve E/A waves was 6% vs 50% p ≤ 0.001 and the ratio of tricuspid valve E/A waves was 0% vs 27% p 0.001 in the fetuses and newborns respectively. Conclusion: A decrease in the rate of myocardial hypertrophy and changes in cardiac function parameters were observed in the fetal and neonatal periods.

RESUMO Introdução: A análise de óbitos ocorridos no período neonatal e a associação desses dados aos de necrópsias são fundamentais no auxílio à redução da taxa de mortalidade infantil no mundo. Objetivos: Observar as causas evitáveis de morte e os fatores associados ao maior risco de óbito neonatal precoce. Métodos: Foi realizado estudo transversal e descritivo de recémnascidos que foram a óbito em um hospital da Universidade Federal do Paraná (UFPR). Foram selecionados 314 casos de necrópsias e analisadas as causas evitáveis de morte, tempo de sobrevida, gênero, peso, idade gestacional, índice de Apgar do primeiro e do quinto minuto, cianose, acidose, aspiração meconial, necessidade de reanimação com oxigênio, causa de morte e doença básica. Resultados: Quando se analisa apenas a causa de morte, 300 casos (95,54%) seriam de causas evitáveis, porém, quando se analisa a doença básica, o número de casos diminui para 209 (66,56%). A causa de morte mais frequente foi hipóxia (85%), e a doença básica principal foi dano alveolar difuso (52,9%). Houve associação positiva das seguintes variáveis com o tempo de sobrevida: cianose (p = 0,02), idade gestacional (p = 0,012), causa do óbito (p < 0,001), valor de Apgar < 6 (p < 0,001) e valor do pH (p < 0,001). Conclusão: A incidência de causa evitável de morte é provavelmente menor quando analisada concomitantemente com a doença básica. A cianose, a idade gestacional, a causa do óbito, o Apgar < 6 e o valor do pH do sangue arterial estão associados ao tempo de sobrevida de recém-nascidos.

ABSTRACT Introduction: The analysis of deaths occurred in the neonatal period and the association of these data to necropsy data are crucial to reduce infant mortality rate worldwide. Objective: To analyze the preventable causes of death and the factors associated with a higher risk of early newborn death. Methods: A cross-sectional and descriptive study was performed with data about newborns that died during the neonatal period at a university hospital located in Curitiba; 314 cases of pediatric necropsies were selected, and preventable causes of death, survival time, sex, weight, gestational age, first- and fifth-minute Apgar score, cyanosis, acidosis, meconium aspiration, the need for oxygen resuscitation, cause of death and baseline disease were analyzed. Results: When considering only the cause of death, 300 cases (95.54%) would have preventable causes, but when analyzing the underlying disease, the number of cases decreased to 209 (66.56%). The most frequent cause of death was hypoxia (85%), and the main baseline disease was diffuse alveolar damage (52.9%). There was a positive association between these variables with survival time: cyanosis (p = 0.02), gestational age (p = 0.012), cause of death (p < 0.001), Apgar score < 6 (p < 0.001) and pH value (p < 0.001). Conclusion: The incidence of preventable causes of death is probably lower when analyzed concurrently with the underlying disease. Cyanosis, gestational age, cause of death, Apgar < 6 and arterial blood pH are associated with survival time of newborns.