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Abstract(s)
Introdução: O recém-nascido grande para a idade gestacional representa um recém-nascido com peso ao nascimento superior ao percentil 90 para a idade gestacional. O aumento da prevalência destes recém-nascidos fundamenta-se, essencialmente, no elevado Índice de Massa Corporal pré-gestacional, no excessivo ganho ponderal durante a gravidez e no aumento da carga da diabetes gestacional que caracterizam a população materna atual. A associação destas gestações com múltiplas complicações materno-fetais é notável.
Objetivo: Este trabalho pretende determinar os principais fatores de risco e as complicações neonatais inerentes aos recém-nascidos grandes para a idade gestacional, utilizando como grupo comparativo um conjunto de recém-nascidos com peso adequado para a idade gestacional.
Métodos: Estudo observacional, analítico e retrospetivo, com recolha de dados constantes em livro de partos e processo clínico de grávidas e recém-nascidos respetivos, cujo parto ocorreu entre 1 de janeiro de 2013 e 31 de dezembro de 2016, no Centro Hospitalar Universitário Cova da Beira. A análise estatística foi efetuada com recurso ao software SPSS® versão 25.0.
Resultados: A amostra é constituída por 42 recém-nascidos grandes para a idade gestacional e 100 recém-nascidos com peso adequado para a idade gestacional. No que concerne aos fatores de risco, verificaram-se diferenças significativas entre os dois grupos. O grupo dos recém-nascidos com peso superior ao percentil 90 apresentou associação significativa com o sexo masculino, peso prévio e aumento ponderal maternos elevados, maior incidência de diabetes gestacional e de colonização por Streptococcus do Grupo B. Este grupo manifestou pior prognóstico neonatal, incluindo maior taxa de: hipoglicémia neonatal (31,0%), desconforto respiratório neonatal (45,2%), tocotraumatismo (34,1%) e admissão em Unidade de Cuidados Neonatais (57,1%). Constataram-se, ainda, percentis global e de perímetro abdominal na ecografia de 3º trimestre significativamente superiores no grupo dos recém-nascidos grandes para a idade gestacional.
Conclusão: O estudo revelou que os recém-nascidos grandes para a idade gestacional são, na sua maioria, indivíduos do sexo masculino (81,0%). Além disso, denotou-se a influência do status e comorbilidades maternos na génese de recém-nascidos grandes para a idade gestacional. Na generalidade, estes possuem mães com peso prévio e aumento ponderal na gravidez excessivos, com maior tendência à desregulação glicémica e colonização por Streptococcus do Grupo B. Estes recém-nascidos apresentam mais complicações peri e pós-parto, nomeadamente traumáticas, metabólicas e respiratórias, que motivam um maior número de admissões em Unidade de Cuidados Neonatais. A ecografia do 3º trimestre demonstra ter uma forte capacidade de previsão das alterações do peso ao nascimento.
Introduction: A large for gestational age neonate represents a newborn with birth weight above the 90th percentile for gestational age. The increase in the prevalence of these newborns is essentially based on the high pre gestational Body Mass Index, the excessive weight gain during pregnancy and the increase in the burden of gestational diabetes that characterize the current maternal population. The association of these pregnancies with multiple maternal-fetal complications is meaningful. Objectives: This study aims to determine the main risk factors and neonatal complications inherent in large for gestational age infants, using as a comparative group a set of neonates with adequate weight for gestational age. Methods: An observational, analytical and retrospective study was carried out, whose data was obtained from the birth book and clinical files of pregnant women and respective newborns whose delivery occurred between January 1st, 2013 and December 31st, 2016, at Centro Hospitalar Universitário Cova da Beira. Statistical analysis was performed using SPSS® software version 25.0. Results: The sample consisted of 42 large for gestational age neonates and 100 adequate weight for gestational age newborns. Regarding risk factors, there were significant differences between the two groups. The group of newborns weighing above the 90th percentile had a significant association with males, high previous maternal weight and large weight gain, a broader incidence of gestational diabetes and Group B Streptococcus colonization. This group had a worse neonatal prognosis, including higher rate of: neonatal hypoglycaemia (31,0%), neonatal respiratory distress (45,2%), delivery trauma (34,1%) and admission to the Neonatal Care Unit (57,1%). It was also verified that global and abdominal perimeter percentiles on the ultrasound of the third trimester were significantly higher in the group of large for gestational age neonates. Conclusion: The study revealed that large for gestational age newborns are mostly males (81,0%). Furthermore, it shows the influence of maternal status and comorbidities in the birth of large for gestational age neonates. In general, these mothers have excessive previous weight and higher weight gain during pregnancy, with a greater tendency for glycemic dysregulation and Group B Streptococcus colonization. These newborns present more peri and postpartum adverse outcomes, namely traumatic, metabolic and respiratory complications, which motivate a greater number of admissions in the Neonatal Care Unit. The ultrasound of the third trimester shows a strong ability to predict changes in birth weight.
Introduction: A large for gestational age neonate represents a newborn with birth weight above the 90th percentile for gestational age. The increase in the prevalence of these newborns is essentially based on the high pre gestational Body Mass Index, the excessive weight gain during pregnancy and the increase in the burden of gestational diabetes that characterize the current maternal population. The association of these pregnancies with multiple maternal-fetal complications is meaningful. Objectives: This study aims to determine the main risk factors and neonatal complications inherent in large for gestational age infants, using as a comparative group a set of neonates with adequate weight for gestational age. Methods: An observational, analytical and retrospective study was carried out, whose data was obtained from the birth book and clinical files of pregnant women and respective newborns whose delivery occurred between January 1st, 2013 and December 31st, 2016, at Centro Hospitalar Universitário Cova da Beira. Statistical analysis was performed using SPSS® software version 25.0. Results: The sample consisted of 42 large for gestational age neonates and 100 adequate weight for gestational age newborns. Regarding risk factors, there were significant differences between the two groups. The group of newborns weighing above the 90th percentile had a significant association with males, high previous maternal weight and large weight gain, a broader incidence of gestational diabetes and Group B Streptococcus colonization. This group had a worse neonatal prognosis, including higher rate of: neonatal hypoglycaemia (31,0%), neonatal respiratory distress (45,2%), delivery trauma (34,1%) and admission to the Neonatal Care Unit (57,1%). It was also verified that global and abdominal perimeter percentiles on the ultrasound of the third trimester were significantly higher in the group of large for gestational age neonates. Conclusion: The study revealed that large for gestational age newborns are mostly males (81,0%). Furthermore, it shows the influence of maternal status and comorbidities in the birth of large for gestational age neonates. In general, these mothers have excessive previous weight and higher weight gain during pregnancy, with a greater tendency for glycemic dysregulation and Group B Streptococcus colonization. These newborns present more peri and postpartum adverse outcomes, namely traumatic, metabolic and respiratory complications, which motivate a greater number of admissions in the Neonatal Care Unit. The ultrasound of the third trimester shows a strong ability to predict changes in birth weight.
Description
Keywords
Complicações Neonatais Diabetes Gestacional Fatores de Risco Gig Macrossomia