Incidência e fatores associados ao nascimento de recém-nascidos pequenos para a idade gestacional, segundo curva de crescimento intrauterino de fenton e intergrowth 21st

• Ano de defesa: 2018
• Autor(a) principal: Barreto, Claudia Malisano [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Newborn; Small for gestational age; Associated; Intrauterine growth curves; Recém-nascido; Pequeno para a idade gestacional; Associação; Curva de crescimento intrauterino
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6641967; https://repositorio.unifesp.br/handle/11600/52462

Objectives: The primary objective of this study was to compare the incidence of smallforgestationalage (SGA) among late preterm and term newborn infants, using as reference Fenton and Intergrowth21 intrauterine growth curves. The secondary objective was to analyze factors associated with percentile of birth weight and the risk of SGA births in this sample of newborns. Methods: This was a retrospective study with data of infants born alive in a level II public maternity. This study was approved by the Research Ethics Committee of the Institution. Inclusion criteria were: consecutive live births neonates in the study period with a gestational age of 34 to 416/7 weeks, whose parents had signed the informed consent form for the primary study. Newborns with unknown gestational age, birth weight or sex were excluded. Weight for gestational age adequacy was assessed by the Fenton and Intergrowth21 curves, considering SGA those born with birth weight below the 10th percentile. Birth weight, length and head circumference were analyzed according to the percentile distribution. The incidence of PIG was calculated for both curves and the degree of agreement between them by kappa coefficient. Numerical variables were expressed as mean and standard deviation or median (minimummaximum) and compared by Student's t test or MannWhitney test, according to data distribution. Categorical variables were described in number and percentage and compared by Χ2 or Fisher's exact test. Factors associated with the birth weight percentile were analyzed by linear regression and the relative risk for SGA birth by BreslowCox regression. Statistical analyzes were performed with the SPSS17® program (IBM SPSS Statistics, Somers, NY, USA), considering significant, p <0.05.Results: A total of 2849 (95%) newborns with known gestational age, birth weight and gender data were included. The birth weight was 3210±483 g and the gestational age was 38.8±1.4 weeks, being 51.1% males, 7.8% were born late preterm and 92.2% at term. Delivery route was caesarean section in 31.5% and forceps in 3.4% of the cases. The incidence of PIG NB was significantly higher for the Fenton curve, compared to Intergrowth21 (13.0% vs. 8.7%, p <0.001, kappa = 0.677). Maternal and neonatal characteristics of the neonates classified as SGA by the Fenton and Intergrowth21 curves were similar, except for the greater proportion of males and higher birth weight, length and head circumference among SGA classified by the Fenton curve. By the final multiple linear regression model, primigravida and multiple gestation were negatively associated with the birth weight percentile in the two curves. In addition, by the Fenton curve, male gender and gestational age were also negatively associated with the birth weight percentile. The risk factors for PIG were multiple gestation (RR: 3.6) and primigravida (RR: 1.7) in the Fenton curve; and multiple gestation (RR: 5.8) and positive serology (IgM) for cytomegalovirus (RR: 7.8) on Intergrowth21. Conclusions: The incidence of SGA was significantly higher in the Fenton curve, with substantial agreement between curves. The variables primigravida, multiple gestation, gestational age and male gender reduced the birth weight perentile in one or the other curve. The adjusted relative risk for SGA birth was significantly higher in multiple gestation, primigravida and positive maternal serology (IgM) for cytomegalovirus.