Biomedical subjects

Heloísa Bettiol

Publications and source records attributed to Heloísa Bettiol.

5 recordsLinked to original sources

PubMed2006

Feeding-facilitating techniques for the nursing infant with Robin sequence.

OBJECTIVE: To determine the effectiveness of feeding-facilitating techniques in children with Robin sequence. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, São Paulo, Brazil. PATIENTS: Twenty-six children less than 2 months of age with Robin sequence, whose only cause of respiratory obstruction was glossoptosis. Thirteen infants were treated by being placed in the prone position (Group 1), and 13 were treated by nasopharyngeal intubation (Group 2). INTERVENTIONS: During hospitalization, the following feeding-facilitating techniques were applied daily to all children: pacifier, massage to relax and anteriorize the tongue, long and soft bottle nipple with original or enlarged hole, global symmetric position, rhythmic movement of the nipple during suction, and insertion of the nipple on the tongue. RESULTS: During the first evaluation, Group 1 patients accepted 36.15 +/- 33.05 mL milk orally within a period of 44.62 +/- 42.94 minutes, whereas Group 2 ingested 20.00 +/- 20.51 mL milk within 30.38 +/- 25.77 minutes. A significant increase (p < .01) in the volume of ingested milk was observed for the two groups at hospital discharge after a mean treatment period of 10.7 days (Group 1: 63.46 +/- 22.58 mL and Group 2: 55.00 +/- 13.07 mL). The mean duration of feeding decreased in the two groups, with a value of 21.54 +/- 7.18 minutes for Group 1 and of 20.28 +/- 8.53 minutes for Group 2. CONCLUSION: The results showed that feeding-facilitating techniques can foster oral feeding in infants with Robin sequence.

Airway Obstruction↗

PubMed2005

Risk factors for intrauterine growth restriction: a comparison between two Brazilian cities.

In Brazil, similar intrauterine growth restriction (IUGR) rates were observed between cities with distinct levels of socioeconomic development, challenging the current knowledge that higher rates of IUGR would necessarily be observed in poorer areas than in wealthier ones. Ribeirão Preto, a city located in the most developed area in Brazil, showed an IUGR rate of 18% in 1994, whereas this rate was 18.5% in 1997/1998 in São Luis, located in one of the poorest areas in the country. The objective of this study was to compare risk factors for IUGR in these two cities and to identify factors that are responsible for this unexpected lack of difference between the rates. Using data from two birth cohorts, including 2839 neonates who were from Ribeirão Preto and born in 1994 and 2439 neonates who were from São Luis and born in 1997/1998, a multivariable analysis was conducted to assess changes in the risk for IUGR in the poorer city compared with the wealthier one in a combined model, adjusting for some risk factors for IUGR. The wealthier city showed higher rates of maternal smoking, attendance in the private sector, and obstetric interventions than the less developed one. Differences in maternal smoking and obstetric interventions were possibly responsible for the similarity of the rates between cities. It seems that early detection of IUGR followed by cesarean section in the wealthier city is associated with increased low birth weight and IUGR rates but reduced stillbirth and infant mortality rates.

Adolescent↗

PubMed2005

Why are the low birthweight rates in Brazil higher in richer than in poorer municipalities? Exploring the epidemiological paradox of low birthweight.

Socio-economic disadvantage is usually associated with low birthweight (LBW). However, it has been shown that Mexican Americans, despite being economically less advantaged, present LBW rates that are similar to or lower than those found among white women in the US. This fact has been called 'the epidemiological paradox of low birthweight'. Natality data from Brazil revealed the existence of a similar paradox: LBW rates are higher in more developed than in less developed regions within the country. In this study, data from two population-based cohort studies carried out in the nineties, including 2439 births in Sao Luis, a poor city in north-eastern Brazil, and 2839 births in Ribeirao Preto, a socio-economically well-off city in south-eastern Brazil, were used to explore this paradox. The method proposed by Wilcox and Russell and a graphic analysis of the frequency distribution of birthweight according to gestational age were used to provide indirect information about possible gestational age misclassification. Contrary to expectations, the LBW rate was higher in Ribeirao Preto than in Sao Luis (10.7 vs. 7.6%, P <0.001), while preterm birth (PTB) rate (12.7 vs. 12.1%, P=0.520) and percentage of small-for-gestational-age (SGA) infants (12.5 vs. 13.5%, P=0.290) were similar for the two cities. However, SGA rate among preterm infants was higher in Ribeirao Preto (16.4 vs. 9.8%, P=0.014). A bimodal distribution of birthweight was observed for children with less than 32 weeks in Sao Luis. As estimated by the Wilcox and Russell method, the residual distribution was greater in Ribeirao Preto than in Sao Luis (3.4 vs. 2.4%). Part of the LBW paradox observed for the two cities was due to the higher PTB rate and higher number of preterm SGA infants in Ribeirao Preto. Factors such as greater medical intervention in preterm newborns close to the end of pregnancy in more developed municipalities, artefacts in the determination of gestational age, and the under-registration of livebirths and registration of livebirths as stillbirths in less developed municipalities may explain why LBW rates in Brazil are higher in richer than in poorer municipalities.

Birth Weight↗

PubMed2004

Risk factors for preterm births in São Luís, Maranhão, Brazil.

Preterm birth continues to be one of the main causes of neonatal morbidity and mortality. The objective of the present study was to identify risk factors for preterm birth in São Luís, Maranhão, Brazil. The sample consisted of hospital births at 10 public and private hospitals from March 1, 1997 to February 28, 1998. A total of 2,443 live births were randomly selected, excluding multiple deliveries and stillbirths. Preterm birth rate in São Luís was 12.7%. Risk factors for preterm delivery were maternal age below 18 years, family income equal to or less than one minimum wage/ month, primiparity, vaginal delivery at a public hospital, single mothers (or living without a partner), and absence of prenatal care. The following factors remained associated with preterm birth after multivariate analysis to control for confounding: maternal age below 18 years (OR=1.9), primiparity (OR=1.5), and failure to appear for scheduled prenatal care visits (OR=1.5).

Adolescent↗

PubMed2003

Infant mortality and low birth weight in cities of Northeastern and Southeastern Brazil.

OBJECTIVE: To compare estimates of low birth weight (LBW), preterm birth, small for gestational age (SGA), and infant mortality in two birth cohorts in Brazil. METHODS: The two cohorts were performed during the 1990s, in S o Lu s, located in a less developed area in Northeastern Brazil, and Ribeir o Preto, situated in a more developed region in Southeastern Brazil. Data from one-third of all live births in Ribeir o Preto in 1994 were collected (2,839 single deliveries). In S o Lu s, systematic sampling of deliveries stratified by maternity hospital was performed from 1997 to 1998 (2,439 single deliveries). The chi-squared (for categories and trends) and Student t tests were used in the statistical analyses. RESULTS: The LBW rate was lower in S o Lu s, thus presenting an epidemiological paradox. The preterm birth rates were similar, although expected to be higher in Ribeir o Preto because of the direct relationship between preterm birth and LBW. Dissociation between LBW and infant mortality was observed, since S o Lu s showed a lower LBW rate and higher infant mortality, while the opposite occurred in Ribeir o Preto. CONCLUSIONS: Higher prevalence of maternal smoking and better access to and quality of perinatal care, thereby leading to earlier medical interventions (cesarean section and induced preterm births) that resulted in more low weight live births than stillbirths in Ribeir o Preto, may explain these paradoxes. The ecological dissociation observed between LBW and infant mortality indicates that the LBW rate should no longer be systematically considered as an indicator of social development.

Brazil↗