ABSTRACT: This study determined the zootechnical, metabolic, and health performance of Girolando calves born with high or low birth weight, conceived through in vitro fertilization. The study was carried out on a commercial dairy farm located in Passos, Minas Gerais, Brazil. For this, a hundred Girolando calves were divided into two groups: The Control, which consisted of calves that were born weighing ≤ 35 kg; and high birth weight (HBW) calves, which were born weighing > 35 kg. The calves were monitored for zootechnical parameters; epidemiological indices, for diseases such diarrhea and pneumonia; as well as serum concentrations of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, cholesterol, triglycerides, paraoxonase1, albumin, urea, and globulin. Calves from the HBW group had a higher general mortality rate, but no effects on the zootechnical performance or metabolism were observed. The results obtained allow us to conclude that Girolando calves generated by IVF and heavier at birth have a greater chance to present diseases such as omphalophlebitis, tympany, and bovine parasitic sadness, and have a higher rate of general mortality. Conversely, birth weight of the calves does not influence diarrhea or pneumonia, the zootechnical performance, or the metabolism.

RESUMO: Este estudo determinou o desempenho zootécnico, metabólico e saúde de bezerras Girolando nascidas com alto ou baixo peso, concebidas por fertilização in vitro. O estudo foi realizado em uma fazenda leiteira comercial localizada em Passos, Minas Gerais, Brasil. Cem bezerras Girolando foram divididas em dois grupos: Controle, que consistiu em bezerras que nasceram com peso ≤ 35 kg; e HBW, bezerras que nasceram com peso > 35 kg. As bezerras foram monitoradas quanto aos parâmetros zootécnicos; índices epidemiológicos para doenças como diarreia e pneumonia; bem como as concentrações séricas de aspartato aminotransferase, alanina aminotransferase, fosfatase alcalina, gama-glutamil transferase, colesterol, triglicérides, paraoxonase1, albumina, uréia e globulina. As bezerras do grupo HBW apresentaram maior taxa de mortalidade, mas nenhum efeito no desempenho zootécnico ou metabolismo foram observados. Os resultados permitem concluir que bezerras Girolando provenientes de FIV que nascem mais pesadas têm maior chance de apresentar doenças, como onfaloflebite, timpanismo e tristeza parasitária bovina, tendo uma maior taxa de mortalidade geral. Porém, o peso ao nascimento das bezerras não influenciou a ocorrência de diarreia ou broncopneumonia, o desempenho zootécnico e o perfil metabólico.

Abstract Objective To analyze access to surgical care for congenital heart diseases in public specialized centers in the state of São Paulo before and during the COVID-19 pandemic and availability of surgical care in specialized hospitals, to identify bottlenecks in the care path for neonatal cardiac surgery. Methods This study included 1,437 children, under one year old, with congenital heart disease and formal referral to heart surgery between February 1, 2019, and February 28, 2021. Quantitative data analysis was performed using t-tests or the Mann-Whitney test. Results Approximately 30 % of children with urgent congenital heart disease could not access recommended care, mainly those needing complex surgeries (categories RACHS 4 to 6). The main diagnoses of neonates accessing care were patency of the ductus arteriosus (10.5 %) and coarctation of the aorta (10.1 %). Referral time for children in RACHS 1 to 3 was 4 days (median), while for those in categories 4 to 6, it was 7 days (p< 0.001). Longer referral time (20 days) was associated with court orders. During the pandemic, referral time decreased to 3 days, compared to 5 days (median) in the pre-pandemic period (p< 0.001). Conclusion The emergency surgical treatment supply for congenital heart diseases is insufficient compared to the current demand. Future research should evaluate if access to care in publicly funded hospitals could be improved by better access to prenatal care for pregnant women, increased diagnostic and therapeutic capacity in pediatric cardiology, and financial incentives for complex cardiac surgeries.

ABSTRACT Objective: To describe the incidence and to analyze risk factors associated with cholestasis in neonates with gastroschisis. Methods: This is a retrospective cohort study in a tertiary single center analyzing 181 newborns with gastroschisis between 2009 and 2020. The following risk factors associated with cholestasis were analyzed: gestational age, birth weight, type of gastroschisis, silo closure or immediate closure, days of parenteral nutrition, type of lipid emulsion, days of fasting, days to reach a full diet, days with central venous catheter, presence of infections, and outcomes. Results: Among the 176 patients evaluated, 41 (23.3%) evolved with cholestasis. In the univariate analysis, low birth weight (p=0.023), prematurity (p<0.001), lipid emulsion with medium-chain triglycerides and long-chain triglycerides (p=0.001) and death (p<0.001) were associated with cholestasis. In the multivariate analysis, patients who received lipid emulsion with fish oil instead of medium chain triglycerides/long chain triglycerides (MCT/LCT) emulsion had a lower risk of cholestasis. Conclusions: Our study shows that lipid emulsion with fish oil is associated with a lower risk of cholestasis in neonates with gastroschisis. However, this is a retrospective study and a prospective study should be performed to confirm the results.

RESUMO Objetivo: Analisar a incidência e os fatores de risco associados à colestase em recém-nascidos com gastrosquise. Métodos: Estudo de coorte retrospectivo em um único centro terciário, que analisou 181 recém-nascidos com gastrosquise entre 2009 e 2020. Foram examinados os seguintes fatores de risco associados à colestase: idade gestacional, peso ao nascer, tipo de gastrosquise, fechamento com silo ou fechamento imediato, dias de uso nutrição parenteral, tipo de emulsão lipídica, dias de jejum, dias para atingir a dieta completa, dias com cateter venoso central, presença de infecções e desfechos. Resultados: Dos 176 pacientes avaliados, 41 (23,3%) evoluíram com colestase. Baixo peso ao nascer (p=0,023), prematuridade (p<0,001), emulsão lipídica com triglicerídeos de cadeia média e triglicerídeos de cadeia longa (p=0,001) e óbito (p<0,001) foram associados à colestase. Na análise multivariada, os pacientes que receberam emulsão lipídica com óleo de peixe em vez da emulsão diária de triglicérides de cadeia média/triglicérides de cadeia longa (MCT/LCT) apresentaram menor risco de colestase. Conclusões: Nosso estudo mostra que a emulsão lipídica com óleo de peixe está associada a menor risco de colestase em neonatos com gastrosquise, porém este é um estudo retrospectivo, e um estudo prospectivo deve ser realizado para confirmar os resultados.

ABSTRACT Objective: To analyze the prevalence of off-label and unlicensed prescriptions for a population of neonates admitted to the Neonatal Intensive Care Unit in a hospital in southern Santa Catarina. Methods: Observational study with a cross-sectional design. All neonates admitted to the Intensive Care Unit during the period from March 2020 to March 2021 were included. Data collection was performed through a questionnaire made by the authors and the classification of drugs based on the Electronic Drug Description (Bulário Eletrônico) of the Brazilian Health Regulatory Agency and Drug Dex-Micromedex. Results: Data from 296 neonates were evaluated. The prevalence was 50,7% for prescribing off-label medications and 37,2% for unlicensed medications. The use of drugs was higher in preterm neonates, with low birth weight, 1st minute Apgar between 6–8, 5th minute Apgar between 7–8, and in need of invasive procedures. The most used off-label drugs were ampicillin, gentamicin and fentanyl (92.6, 92.0 and 26.6%, respectively), whereas the most used unlicensed drugs were caffeine, phenobarbital and bromopride (78.1, 16.3 and 10.9%, respectively). Conclusions: This study showed a large percentage of prescriptions made in the off-label (50.7%) and unlicensed (37.2%) form in the Neonatal Intensive Care Unit, corroborating the worrying world scenario. The most exposed neonates were precisely the most vulnerable ones and, among the most commonly prescribed medications, ampicillin and gentamicin stood out in off-label form and caffeine in unlicensed form.

RESUMO Objetivo: Analisar a prevalência de prescrições off-label e não licenciadas uma população de neonatos internados na Unidade de Terapia Intensiva Neonatal em um hospital ao sul de Santa Catarina. Métodos: Estudo observacional com delineamento transversal. Foram incluídos todos os neonatos admitidos na Unidade de Terapia Intensiva durante o período de março de 2020 a março de 2021. A coleta de dados foi realizada a partir de questionário elaborado pelos autores, e a classificação dos medicamentos, com base no Bulário Eletrônico da Agência Nacional de Vigilância Sanitária e no Drug Dex-Micromedex. Resultados: Foram avaliados dados de 296 neonatos. A prevalência foi de 50,7% para prescrição de medicações off-label e 37,2% para medicações não licenciadas. O uso dos fármacos foi maior em neonatos pré-termo, com baixo peso ao nascer, Apgar de 1o minuto entre 6–8, Apgar de 5o minuto entre 7–8, e com necessidade de procedimentos invasivos. Os fármacos off-label mais utilizados foram a ampicilina, gentamicina e fentanil (92,6, 92 e 26,6%, respectivamente), já os fármacos não licenciados mais utilizados foram a cafeína, fenobarbital e bromoprida (78,1, 16,3 e 10,9%, respectivamente). Conclusões: O estudo demonstrou grande porcentagem de prescrições realizadas de forma off-label (50,7%) e não licenciada (37,2%) na Unidade de Terapia Intensiva Neonatal de análise, corroborando o preocupante cenário mundial. Os neonatos mais expostos foram justamente aqueles mais vulneráveis e, entre as medicações mais utilizadas, destacam-se a ampicilina e a gentamicina de modo off-label e a cafeína de modo não licenciado.

Resumen: El control clínico y la monitorización de la bilirrubina en la etapa neonatal son fundamentales para evitar la toxicidad sobre el sistema nervioso central. Objetivo: determinar la correlación entre las cifras de bilirrubina transcutánea (BTC) y bilirrubina sérica total (BST) en recién nacidos ≥ 35 semanas. Pacientes y Método: estudio observacional, transversal, analítico y retrospectivo que incluyó a 90 neonatos de edad gestacional ≥ 35 semanas e ictericia mucocutánea a los que se les realizó BTC y simultáneamente BST, entre el 1 de junio de 2022 y el 31 de enero de 2023. Se compararon ambas variables y se determinó su correlación. Resultados: se analizaron los indicadores de validez obteniendo una sensibilidad y valor predictivo negativo de 100%. La media de las determinaciones de BTC fueron de 14,84 mg/dl ± 2,27 y la de BST de 13,1 mg/dl ± 2,39. La correlación obtenida indica que ambas variables están relacionadas siendo ésta una correlación directa y en función de la ecuación de predicción se manifiesta una apropiada correlación entre ambas. Se determinó que la BTC sobreestima en el 95,56% de las determinaciones la BST, e infraestima en el resto (4,44%). Las mediciones simultáneas de BTC y BST fueron distintas en todas las determinaciones con una media de las diferencias de 1,72 ± 1,48. Conclusiones: el método no invasivo BTC puede utilizarse como herramienta de cribado inicial para la población neonatal ≥ 35 semanas, dada la adecuada sensibilidad y valor predictivo negativo.

Abstract: Clinical control and monitoring of bilirubin in the neonatal stage are essential to avoid toxicity in the central nervous system. Objective: to determine the correlation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) levels in newborns ≥ 35 weeks. Patients and Method: observational, cross-sectional, analytical, retrospective study that included 90 neonates of gestational age ≥ 35 weeks with mucocutaneous jaundice who underwent TcB and TSB measurement simultaneously between June 1, 2022, and January 31, 2023. Both variables were compared, determining their correlation. Results: the validity indicators were analyzed, obtaining 100% sensitivity and negative predictive value. The mean of TcB determinations was 14.84 mg/dl ± 2.27 and that of TSB was 13.1 mg/dl ± 2.39. The correlation obtained indicates that both variables are related, which is a direct correlation and, according to the prediction equation, there is an appropriate correlation between them. It was determined that TcB overestimated TSB in 95.56% of the determinations, and underestimated TSB in the rest (4.44%). Simultaneous measurements of TcB and TSB were different in all determinations with a mean difference of 1.72 ± 1.48. Conclusions: the non-invasive TcB method can be used as an initial screening tool for the neonatal population ≥ 35 weeks, given its adequate sensitivity and negative predictive value.

ABSTRACT Introduction: Congenital cytomegalovirus infection in neonates weighing less than 1500 grams can be a cause of morbidity, mortality, and disability. Objective: To describe the behavior of congenital cytomegalovirus infection in a neonatal service. Methods: A descriptive and cross-sectional study was conducted with 61 neonates. Cytomegalovirus was detected in the first week of life in serum and urine, by polymerase chain reaction, to determine congenital infection. Perinatal variables were evaluated in all neonates, as well as clinical elements and results of complementary examinations in infected infants. Results: The incidence of congenital infection was 10% (6/61). 5% of the studies were positive (6/122). No urine samples were positive (0/61) and the virus genome was detected in 10% of serum samples (6/61). An association was found between nutritional assessment at birth and cytomegalovirus infection (p < 0.05). A total of 83% of infected neonates had some clinical sign, with respiratory distress syndrome being the most common (67%). In all neonates with congenital infection, brain ultrasound was normal, and retinopathy of prematurity was detected in 33% of patients with fundus retinopathy. Conclusions: The incidence of congenital cytomegalovirus infection is high in this risk group. The clinical signs found and the results of the fundus in neonates with congenital infection were related to prematurity and the nutritional assessment of hypotrophic was associated with this infection.

RESUMEN Introducción: La infección congénita por el citomegalovirus en neonatos menores de 1500 gramos puede ser causa de morbilidad, mortalidad y discapacidad. Objetivo: Describir el comportamiento de la infección congénita por citomegalovirus en un servicio de neonatología. Métodos: Se realizó un estudio descriptivo y transversal con 61 neonatos. Se les realizó detección de citomegalovirus en la primera semana de vida en suero y orina, mediante reacción en cadena de la polimerasa, para determinar infección congénita. Se evaluaron variables perinatales en todos los neonatos, así como elementos clínicos y resultados de exámenes complementarios en los infectados. Resultados: La incidencia de infección congénita fue de un 10 % (6/61). El 5 % de los estudios fueron positivos (6/122). Ninguna muestra de orina resultó positiva (0/61) y en el 10 % de las muestras de suero (6/61) se detectó el genoma del virus. Se encontró asociación entre valoración nutricional al nacer e infección por citomegalovirus (p< 0,05). El 83 % de los neonatos infectados presentaron algún signo clínico y el síndrome de dificultad respiratoria fue el más frecuente (67 %). En todos los neonatos con infección congénita el ultrasonido cerebral fue normal y en el 33 % se detectó retinopatía de la prematuridad en el fondo de ojo. Conclusiones: La incidencia de infección congénita por citomegalovirus es alta en este grupo de riesgo. Los signos clínicos encontrados y los resultados del fondo de ojo en neonatos con infección congénita se relacionaron con la prematuridad y la valoración nutricional de hipotrófico se asoció con esta infección.

Abstract: Some systemic inflammatory indices have been reported to be associated with intracerebral hemorrhage in adults. However, the relationship between systemic inflammatory indices and intraventricular hemorrhage (IVH) in premature neonates is still not completely understood. Objective: To evaluate the relationship between systemic inflammatory indices obtained on the first day of life in premature infants and the development of severe IVH. Patients and Method: Premature newborns < 32 weeks of gestational age were included. Eligible patients were divided into 2 groups: Group 1: without IVH or grade I and II hemorrhage, and Group 2: grade III and IV HIV. Demographic characteristics, clinical outcomes, monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), pan-immune inflammation value (PIV), and Systemic inflammation response index (SIRI) were compared between groups. Results: A total of 1176 newborns were included in the study, 1074 in Group 1 and 102 premature babies in Group 2. There was no difference between the groups in terms of the count of leukocytes, neutrophils, monocytes, lymphocytes and platelets (p > 0.05). The values of NLR, MLR, PLR, PIV, SII and SIRI were similar in both groups (p > 0.05). Conclusion: While the relationship between inflammation, hemodynamics and IVH is still under discussion, our results show that systemic inflammatory indices have no predictive value for IVH.

ABSTRACT Neonatal sepsis is one of the main causes of neonatal deaths in developing countries, with data estimating more than one million deaths around the world every year. The aim is to present case a case, given the infrequency of late neonatal sepsis by Klebsiella oxytoca. This is the case of a pre-term female patient, with low weight at birth, who at 17 days of birth began with deterioration of her clinical status due to hypo-activity, skin paleness, morose suction and increase in abdominal circumference, accompanied by severe hematological dysfunction given by anemia, thrombocytopenia and neutropenia, which required several transfusions with blood products and combined antimicrobial therapeutic (first with meronem and amikacin, then with ciprofloxacin and vancomycin). She was also treated antifungals, diuretics, vasoactive drugs, mechanical ventilation and erythropoietin. She was consulted with Pediatric Cardiology and Infectious diseases. Finally she had a satisfactory evolution, with effective maternal breastfeeding. Sepsis increase in hospitalized neonates and bacterial resistance are public health problems. It is important to recognize the risk factors for sepsis in this group of patients, for their timely treatment.

RESUMEN La sepsis neonatal constituye una de las principales causas de muertes neonatales en los países en desarrollo, con datos que estiman más de un millón de muertes en todo el mundo cada año. Se persigue presentar un caso, dada la infrecuencia de la sepsis neonatal tardía por Klebsiella oxytoca. Se trata de una paciente femenina, pretérmino y de bajo peso al nacer, que a los 17 días de vida comenzó con deterioro de su estado clínico dado por hipoactividad, palidez cutánea, succión morosa e incremento de la circunferencia abdominal, acompañados de disfunción hematológica severa dada por anemia, trombocitopenia y neutropenia, que requirió varias transfusiones con hemoderivados y terapéutica antimicrobiana combinada (primero con meronem y amikacina, luego con ciprofloxacina y vancomicina). Se trató también con antifúngicos, diuréticos, drogas vasoactivas, ventilación mecánica y eritropoyetina. Se interconsultó con Cardiología e Infectología pediátricas. Tuvo finalmente una evolución satisfactoria, con lactancia materna efectiva. El incremento de la sepsis en neonatos hospitalizados y la resistencia bacteriana son problemas de salud pública. Es importante reconocer los factores de riesgo para la sepsis en este grupo de pacientes, para su tratamiento oportuno.

ABSTRACT Purpose: To assess the anterior and posterior segments of full-term neonates over a 1.5-year period. Methods: The findings of full-term neonates who underwent ophthalmological examinations between June 2019 and December 2020 were analyzed, and the results were retrospectively recorded. Results: The study comprised 2972 neonates with a mean birth week of 38.7 ± 1.2 weeks and a mean birth weight of 3235 ± 464 g. The neonates were examined on an average of 49.3 ± 18.9 postnatal days. Of the examined neonates, 185 (6.2%) showed abnormal ophthalmological findings, the most prevalent of which were retinal hemorrhage in 2.3% (n=68) and white changes in the peripheral retina in 1.9% (n=55) of the neonates. Cases of optic disc pathologies (n=20), choroidal nevus (n=10), iris-choroidal coloboma (n=5), subconjunctival hemorrhage (n=6), non-specific retinal pigmentary change (n=4), congenital cataract (n=3), posterior synechia (n=3), iris nevus (n=3), corneal opacity (n=1), choroidal coloboma (n=1), iris coloboma (n=1), buphthalmos (n=1), anophthalmos (n=1), microphthalmia (n=1), lid hemangioma (n=1), and vitreous hemorrhage (n=1) collectively accounted for approximately 2% of all neonates. Pathologies that could potentially impair vision, which were detected by ophthalmological examination, accounted for 1.2% of all neonates (n=37). Conclusion: The most prevalent finding of the ophthalmological examinations of neonates in the present study was retinal hemorrhage. Ophthalmological examinations of neonates can help in identifying diseases that may affect their vision and are curable or may lead to amblyopia in the long term.

RESUMO Objetivo: Avaliar os segmentos anterior e posterior em recém-nascidos a termo durante um período de 1,5 anos. Métodos: Foram analisados recém-nascidos a termo que tiveram os olhos examinados entre junho de 2019 e dezembro de 2020, e os resultados foram registrados retrospectivamente. Resultados: O estudo foi composto por 2.972 recém-nascidos com média de uma semana de nascimento de 38,7 ± 1,2 semanas e um peso médio ao nascer de 3235 ± 464 g. Os recém-nascidos foram examinados em média pós-natal de 49,3 ± 18,9 dias. Dos recém-nascidos, 185 (6,2%) apresentaram resultados oculares anormais. Os achados oculares anormais mais prevalentes foram hemorragia da retina em 2,3% (n=68) e alterações brancas na retina periférica em 1,9% (n=55) dos recém-nascidos. Casos de patologias de disco óptico (n=20), nevo de coroide (n=10), coloboma iris-coroide (n=5), hemorragia subconjuntival (n=6), alteração pigmentar da retina não específica (n=4), catarata congênita (n=3), Sinequia posterior (n=3), nevo da íris (n=3), opacidade da córnea (n=1), coloboma de coroide (n=1), coloboma de íris (n=1), buftalmos (n=1), anoftalmia (n=1), microftalmia (n=1), hemangioma de pálpebra (n=1) e hemorragia vítrea (n=1) contabilizaram coletivamente cerca de 2% dos recém-nascidos. As patologias que potencialmente prejudicam a visão, detectadas por exame ocular, representaram 1,2% dos recém-nascidos (n=37). Conclusão: O achado mais prevalente de exames oculares de recém-nascidos neste estudo foi hemorragia da retina. Exames oftalmológicos em recém-nascidos podem ser úteis na identificação de doenças que podem impactar a visão deles, podendo ser curáveis ou levar à ambliopia no longo prazo.

RESUMEN: Introducción: La valoración ultrasonográfica del peso fetal permite valorar el crecimiento y bienestar fetal pudiendo estimar el peso al nacimiento, factor determinante para el pronóstico vital. Objetivos: Determinar el margen de error ecográfico del peso fetal estimado (PFE) en relación con el peso al nacer de los neonatos de la Maternidad del Hospital de Clínicas entre los años 2020 y 2022 Materiales y Métodos: Se realizó un estudio observacional, descriptivo y transversal en mujeres que tuvieron un parto en el lugar y el período mencionado, y que contaban con ecografía obstétrica de crecimiento realizada con menos de 7 días respecto al nacimiento. Se calculó el error del PFE mediante la fórmula: (Peso al Nacer - Peso Fetal Estimado) / Peso al Nacer) x 100. Se contrastó el error del peso fetal estimado con el índice de masa corporal, diabetes y estados hipertensivos del embarazo, utilizando t de Student y con la edad gestacional y edad materna mediante el índice de Pearson tomando valores estadísticamente significativos menores a 0,05. Resultados: Se incluyeron 258 pacientes. El margen de error ecográfico del PFE fue de 8,3% DE ± 7. Se obtuvo un valor p para el IMC de 0,228, diabetes p 0,915, estados hipertensivos p 0,967, días en que se realizaba la ecografía p 0,5 y edad gestacional el p 0,001. Conclusiones: El margen de error ecográfico del PFE se encuentra por debajo de los parámetros internacionales. Se encontró asociación estadísticamente significativa con la edad gestacional, no así con las otras variables.

ABSTRACT: Introduction: Ultrasonographic assessment of fetal weight allows assessment of fetal growth and well-being and can estimate birth weight, a determining factor for vital prognosis. Objectives: Determine the ultrasound margin of error of the estimated fetal weight (EFP) in relation to the birth weight of neonates at the Maternity Hospital of the Hospital de Clínicas between the years 2020 and 2022. Materials and Methods: An observational, descriptive and cross-sectional study was carried out on women who had their birth in the aforementioned place and period and who had an obstetric growth ultrasound performed less than 7 days after birth. The error of the EPF was calculated using the formula: (Birth Weight - Estimated Fetal Weight) / Birth Weight) x 100. The error of the estimated fetal weight was contrasted with the body mass index, diabetes and hypertensive state of pregnancy, using Student's t and with gestational age and maternal age using the Pearson index taking statistically significant values less than 0.05. Results: 258 patients were included. The ultrasound margin of error of the EPF was 8.3% SD ± 7. A p value was obtained for BMI of 0.228, diabetes p 0.915, hypertensive states p 0.967, days in which the ultrasound was performed p 0.5 and age gestational p 0.001. Conclusions: The ultrasound margin of error of the EPF is below the international parameters. Statistically significant associations were found with gestational age, but not with the other variables.

RESUMO Introdução: A avaliação ultrassonográfica do peso fetal permite avaliar o crescimento e bem-estar fetal e pode estimar o peso ao nascer, fator determinante para o prognóstico vital. Objetivos: Determinar a margem de erro ultrassonográfica do peso fetal estimado (PFE) em relação ao peso ao nascer dos neonatos atendidos na Maternidade do Hospital de Clínicas entre os anos de 2020 e 2022. Materiais e Métodos: Foi realizado um estudo observacional, descritivo e transversal com mulheres que tiveram o parto no local e período mencionados e que realizaram ultrassonografia obstétrica de crescimento menos de 7 dias após o nascimento. O erro do PFE foi calculado pela fórmula: (Peso ao Nascer - Peso Fetal Estimado) / Peso ao Nascer) x 100. O erro do peso fetal estimado foi contrastado com o índice de massa corporal, diabetes e estado hipertensivo da gestação, utilizando-se o teste de Student. t e com idade gestacional e idade materna utilizando o índice de Pearson assumindo valores estatisticamente significativos menores que 0,05. Resultados: foram incluídos 258 pacientes. A margem de erro ultrassonográfica do PFE foi de 8,3% DP ± 7. Obteve-se valor de p para IMC de 0,228, diabetes p 0,915, estados hipertensivos p 0,967, dias em que foi realizada a ultrassonografia p 0,5 e idade gestacional p 0,001. Conclusões: A margem de erro ultrassonográfica do PFE está abaixo dos parâmetros internacionais. Foram encontradas associações estatisticamente significativas com a idade gestacional, mas não com as demais variáveis.

BACKGROUND: Certain determinants can be associated with avoidable perinatal deaths, and audits are needed to establish what these determinants are, and what can be done to prevent such deaths. OBJECTIVES: The study aimed at identifying and describing determinants associated with avoidable perinatal deaths at a district hospital in Lesotho and strategies to curb their occurrence. METHOD: A retrospective descriptive study was conducted using 142 anonymised obstetric records from January 2018 to December 2020. A data collection tool was adopted from the Perinatal Problem Identification Programme. In this tool, avoidable determinants are referred to as 'factors' or 'problems'. RESULTS: A concerning number of perinatal deaths were secondary to avoidable patient factors, namely a delay in seeking medical care, inappropriate responses to antepartum haemorrhage, and inadequate responses to poor foetal movements. Medical personnel factors are also worth observing, namely incorrect use of partograph, insufficient notes to comment on avoidable factors and 'other' medical personnel problems. Ranking highest among administrative problems were the unavailability of intensive care unit beds and ventilators and inadequate resuscitation equipment. Administrative problems accounted for more perinatal deaths than the patient-related factors and medical personnel factors. CONCLUSION: There is an urgent need for periodic audits, health education for patients, staff competency and the necessary equipment to resuscitate neonates. CONTRIBUTION: Avoidable determinants associated with perinatal deaths in a district hospital in Lesotho could be identified. This information provides an understanding of what can be done to limit avoidable perinatal deaths.

BACKGROUND: Early postnatal discharge is perceived as a factor that contributes to the possibilities of the maternal, neonatal complications and deaths. The implementation of the community-based postnatal care model is crucial to mitigate the morbidity and mortality of postnatal women and neonates during the first weeks of delivery. A community-based postnatal care model was developed for the management of neonates during the postnatal care period in the community. OBJECTIVES: The study aims to share the developed community-based postnatal care model that could assist postnatal women in the management of neonates. METHOD: Empirical findings from the main study formed the basis for model development. The model development in this study was informed by the work of Walker and Avant; Chinn and Kramer Dickoff, James and Wiedenbach; and Chinn and Jacobs. RESULTS: The results indicated that there was no community-based postnatal care model developed to manage neonates. The model is described using the practice theory of Dickoff, James and Wiedenbach elements of agents, recipients, context, process, dynamics and outcomes within the community context of the postnatal care period. The model was further described by Chinn and Krammer following the assumptions of the model, concept definition, relation statement and nature of structure. CONCLUSION: The utilisation of the model is critical and facilitates the provision of an enabling and supportive community-based context by primary caregivers for the effective management of neonates. CONTRIBUTION: This study provides a reference guide in the provision of community-based postnatal care by postnatal women after discharge from healthcare facilities.

Patterns of neonatal hypoxic-ischaemic brain injury (HIBI) are fairly well known. There are, however, other diagnoses with imaging patterns that may mimic HIBI. A review of MRI studies was conducted for children with suspected cerebral palsy, correlated with prior imaging, clinical details and laboratory tests where available. In the 63 identified cases, imaging features were, in many cases, very similar to the known patterns of HIBI. The alternative diagnoses can be classified as developmental, vascular, chromosomal, infections, metabolic disorders, and congenital syndromes. These findings are described in this pictorial essay. The potential mimickers of HIBI described in this essay can demonstrate similar imaging appearances to HIBI. CONTRIBUTION: There are multiple possible causes of neonatal encephalopathy other than hypoxic-ischaemic encephalopathy. Many conditions may mimic HIBI, each of which can be associated with significant morbidity. It is prudent for the reporting radiologist to be aware of these alternate clinico-radiological diagnoses.

Resumo: A diarréia neonatal em bezerros (DNB) é uma doença infecciosa grave em todo o mundo. No Uruguai, a taxa de mortalidade de bezerros associada a doenças infecciosas é alta. O colostro representa a principal fonte de anticorpos e está correlacionado com bons indicadores de saúde e sobrevivência durante a lactação. A vacinação contra a DNB melhora a composição de imunoglobulinas do colostro em vacas prenhes e o seu correto consumo garante a transmissão de anticorpos ao neonato. As vacinas contra DNB geralmente contêm bacterina ou fímbrias purificadas de E. coli, como a bacterina de E. coli CS31A+, bem como antígenos virais. A prevalência de clpG é uma das mais altas entre os genes de virulência de E. coli em fezes de bezerros no Uruguai. ClpG é a proteína estrutural da adesina CS31A. O objetivo do trabalho foi determinar o nível de anticorpos anti-ClpG no colostro de vacas Holandesas não vacinadas e vacinadas contra DNB no Uruguai. O estado funcional da glândula mamária foi analisado. Não foram encontradas diferenças significativas na composição de proteína ou lactose. As diferenças em termos de gordura foram consideradas dentro da média do colostro. Para as análises de anticorpos, uma proteína ClpG recombinante foi purificada usando um sistema de expressão de E. coli. As análises de ELISA mostraram anticorpos anti-ClpG em ambos os grupos, refletindo a exposição natural das vacas às cepas de E. coli CS31A+. Com o modelo misto utilizado, não foi detectada homogeneidade de variância, mas foram encontradas diferenças significativas nas medianas dos valores de IgG entre vacas vacinadas e não vacinadas. Em vacas vacinadas, foi observada uma tendência de aumento de IgG anti-ClpG no colostro, o que poderia resultar em um melhor resultado para os bezerros se a transferência passiva ocorresse de forma efetiva.

Resumen: La diarrea neonatal de terneros (DNT) es una enfermedad infecciosa grave a nivel mundial. En Uruguay, la tasa de mortalidad de terneros asociada a enfermedades infecciosas es alta. El calostro constituye la principal fuente de anticuerpos y se correlaciona con buenas trazas de salud y supervivencia durante la lactancia. La vacunación contra la DNT mejora la composición de inmunoglobulinas del calostro en vacas preñadas y su correcto consumo asegura la transmisión de anticuerpos al neonato. Las vacunas contra la DNT frecuentemente contienen bacterina o fimbrias purificadas de E. coli, como bacterina de E. coli CS31A+, así como antígenos virales. La prevalencia de clpG es una de las más altas entre los genes de virulencia de E. coli en heces de terneros en Uruguay. ClpG es la proteína estructural de la adhesina CS31A. El objetivo del trabajo fue determinar el nivel de anticuerpos anti-ClpG en calostro de vacas holstein-friesian sin vacunar y vacunadas contra la DNT en Uruguay. Se analizó el estado funcional de la glándula mamaria. No se encontraron diferencias significativas en la composición de proteína o lactosa. Las diferencias en términos de la grasa se asumieron dentro del promedio para el calostro. Para los análisis de anticuerpos se purificó una proteína ClpG recombinante usando un sistema de expresión en E. coli. Los análisis de ELISA mostraron anticuerpos anti-ClpG en ambos grupos, lo que refleja la exposición natural de las vacas a cepas E. coli CS31A+. Con el modelo mixto utilizado no se detectó homogeneidad de varianza, pero sí diferencias significativas en las medianas de los valores de IgG entre vacas vacunadas y no vacunadas. En vacas vacunadas se observó una tendencia de aumento de IgG anti-ClpG en el calostro, lo que podría resultar en un mejor resultado para los terneros si la transferencia pasiva ocurre efectivamente.

Abstract: Neonatal calf diarrhea (NCD) is a severe infectious disease, distributed worldwide. In Uruguay, the calf mortality rate in dairy farms associated with infectious diseases is high. Colostrum intake constitutes the primary source of antibodies of neonates and correlates with good tracers of health and survival during the suckling stage. Vaccination against NCD improves the colostrum’s immunoglobulin composition in pregnant cows. Its correct consumption ensures the transmission of antibodies to the calf and should prevent or reduce the occurrence and outcome of diseases. Several vaccines against NCD are on the market, containing E. coli bacterin, purified E. coli fimbriae together with toxoids, and viral antigens. E. coli CS31A+ bacterin have been included in some vaccines against NCD. The prevalence of clpG is one of the highest among E. coli virulence genes in calves feces in Uruguay. ClpG is the structural protein of CS31A adhesin. This work aimed to determine the level of anti-ClpG antibodies in the colostrum of Holstein-Friesian cows without vaccination and vaccinated against NCD in Uruguay. The colostrum composition was analyzed to determine the functional state of the mammary gland. Non-significant differences were determined in the colostrum-protein or -lactose composition. The differences in terms of fat were assumed on the average for colostrum. A recombinant ClpG protein was purified using a prokaryotic expression system from E. coli. ELISA analyses showed anti-ClpG antibodies in both groups of bovines, reflecting the natural exposure of cows to E. coli CS31A+ strains. Mixed model analysis showed no variance homogeneity between groups but significant differences in medians of the IgG values between groups of cows. A tendency to increase the amount of IgG against ClpG in the colostrum of vaccinated cows was observed, which can result in a better outcome for the calves if the passive transfer of IgG effectively occurs.