RESUMO
Objective: Given the high rate of premature birth in French Guiana (13.5%), and its stability in time, the aim of the present study was to define a predictive score for preterm birth in women with a unique pregnancy in order to help prioritize health resources in the local context.Methods: A retrospective study was conducted on all deliveries of unique pregnancies in French Guiana collected between 1 January 2013 and 31 December 2014 in the Registre d'Issue de Grossesse Informatisé (RIGI), a registry that collects data on live births over 22 weeks of amenorrhea on the territory. Statistically significant predictors (p < .05) of preterm delivery were included in a logistic regression model. The selected variables were chosen to be available during the first trimester. Coefficients were used to establish a score which was categorized and prospectively validated using data from 2015.Results: Seven explanatory variables, all measurable during the first trimester of pregnancy, were significantly associated with preterm birth. The predictive score divided in deciles allowed to establish sensitivity and specificity thresholds. Overall, depending on the chosen threshold the score sensitivity was low and the specificity was high. Lowering the threshold identified half of women as "at risk" for preterm birth.Conclusion: This first trimester score was insufficiently sensitive to identify individual women at risk for preterm delivery.
Assuntos
Nascimento Prematuro/diagnóstico , Adolescente , Adulto , Feminino , Guiana Francesa/epidemiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Curva ROC , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: To determine whether dengue epidemics are associated with an increase in adverse obstetrical outcomes. METHODS: Semi-ecological study combining individual data on obstetrical events from the perinatal registry and aggregated exposure data from the epidemiologic surveillance of dengue in Cayenne, French Guiana between 2004 and 2007. RESULTS: After adjustment for individual risk factors, analysis showed that an epidemic level of dengue transmission during the first trimester was associated with an increased risk of post-partum haemorrhage and preterm birth. The associated risks seemed to depend on the epidemic level. CONCLUSIONS: Despite its limitations, this study suggests that dengue in the first trimester may be related to preterm birth and to post-partum bleeding, thus leading to specific hypotheses that should be tested in prospective studies.
Assuntos
Dengue/complicações , Epidemias , Hemorragia Pós-Parto/etiologia , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Nascimento Prematuro/etiologia , Dengue/epidemiologia , Vírus da Dengue , Feminino , Guiana Francesa/epidemiologia , Humanos , Hemorragia Pós-Parto/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , PrevalênciaRESUMO
BACKGROUND: Preterm birth is a global problem in Perinatal and infant Health. Currently is gaining a growing attention. Rates of preterm birth have increased in most countries, producing a dramatic impact on public health. Factors of diverse nature have been associated to these trends. In Chile, preterm birth has increased since 90. Simultaneously, the advanced demographic transition has modified the characteristics of woman population related to maternity. The principal objective of this study is to analyze some sociodemographic characteristics of the maternal population over time, and their possible association to rates of preterm birth. The second aim is to identify groups of mothers at high risk of having a preterm child. METHODS: This population-based study examined all liveborn singletons in Chile from 1991 to 2008; divided in three periods. Preterm birth rates were measured as % births <37 weeks of gestation. Logistic regression assessed the risk of preterm birth associated with mother's age, parity, and marital status, expressed as crude and adjusted odds ratios. RESULTS: Over time, rates of preterm birth increased in overall population, especially during the third period (2001-2008). In the same time, characteristics of maternal population changed: significant increase of extreme reproductive ages, significant decrease in parity and increase in mothers living without a partner. Risk of preterm birth remained higher in groups of mothers: <18 and >38 years of age; without a partner; primiparas and grandmultiparas. However, global increase in preterm birth was not explained by the modification of socio demographics characteristics of maternal population. CONCLUSIONS: Some socio demographic characteristics remained associated with preterm birth over time. These associations allowed identifying five groups of mothers at higher risk to have a preterm child in the population. Increase in overall preterm birth affected all women, even those considered at "low sociodemographic risk" and the contribution of more recent period (2001-2008) to this increase is greater. Then, studied factors couldn't explain the increase in preterm birth. Further research will have to consider other factors affecting maternal population that could explain the observed trend of preterm birth.
Assuntos
Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Chile/epidemiologia , Feminino , Humanos , Modelos Logísticos , Estado Civil , Razão de Chances , Gravidez , Fatores de Risco , Fatores SocioeconômicosRESUMO
BACKGROUND: Gestational age and birth weight are the principal determinants of newborn's health status. Chile, a middle income country traditionally has public policies that promote maternal and child health. The availability of an exhaustive database of live births has allows us to monitor over time indicators of newborns health. METHODS: This descriptive epidemiological study included all live births in Chile, both singleton and multiple, from 1991 through 2008. Trends in gestational age affected the rate of prevalence (%) of preterm births (<37 weeks, including the categories < 32 and 32-36 weeks), term births (37-41) and postterm births (42 weeks or more). Trends in birth weight affected the prevalence of births < 1500 g, 1500-2499 g, 2500-3999 g, and 4000 g or more. RESULTS: Data from an exhaustive register of live births showed that the number of term and postterm births decreased and the number of multiple births increased significantly. Birth weights exceeding 4000 g did not vary.Total preterm births rose from 5.0% to 6.6%, with increases of 28% for the singletons and 31% for multiple births (p for trend < 0.0001). Some categories increased even more: specifically preterm birth < 32 weeks increased 32.3% for singletons and 50.6% for multiple births (p for trend 0.0001).The overall rate of low birth weight infants (<2500 g) increased from 4.6% to 5.3%. This variation was not statistically significant for singletons (p for trend = 0.06), but specific analyses exhibited an important increase in the category weighing <1500 g (42%) similar to that observed in multiple births (43%). CONCLUSIONS: The gestational age and birth weight of live born child have significantly changed over the past two decades in Chile. Monitoring only overall rates of preterm births and low-birth-weight could provide restricted information of this important problem to public health. Monitoring them by specific categories provides a solid basis for planning interventions to reduce adverse perinatal outcomes.This epidemiological information also showed the need to assess several factors that could contribute to explain these trends, as the demographics changes, medical interventions and the increasing probability of survival of extremely and very preterm child.
Assuntos
Peso ao Nascer , Idade Gestacional , Gravidez Múltipla/estatística & dados numéricos , Gravidez Prolongada/epidemiologia , Nascimento Prematuro/epidemiologia , Chile/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Nascido Vivo/epidemiologia , Gravidez , Estudos Retrospectivos , Nascimento a TermoRESUMO
OBJECTIVE: To validate sensitivity of the bacterial meningitis score (BMS) in a large population of children with bacterial meningitis (BM). STUDY DESIGN: Secondary analysis of prospective data for children presenting with BM to a hospital emergency department between January 2001 and February 2005. The BMS was applied to all children with acute BM using the same inclusion criteria proposed by the authors of the rule. The sensitivity of the rule was calculated. RESULTS: Of the 900 children aged 29 days to 18 years with acute BM who met all inclusion criteria, 889 had enough data for assigning the BMS. Use of the BMS correctly identified 884 children with BM, for 99.6% sensitivity (95% confidence interval: 98.9% to 99.8%). CONCLUSIONS: The sensitivity of the BMS to detect disease was very high, but a few cases of BM were missed. Further refinements of the BMS may be warranted to lower the false-negative rate.
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Bacteriemia/diagnóstico , Proteínas do Líquido Cefalorraquidiano/análise , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/mortalidade , Índice de Gravidade de Doença , Adolescente , Bacteriemia/epidemiologia , Líquido Cefalorraquidiano/microbiologia , Criança , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Lactente , Recém-Nascido , Contagem de Linfócitos , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Probabilidade , Prognóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Sensibilidade e Especificidade , Análise de Sobrevida , Estudos de Validação como AssuntoRESUMO
OBJECTIVE: To validate high serum procalcitonin (PCT) as a predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI). STUDY DESIGN: This secondary analysis of prospective hospital-based cohort studies included children ages 1 month to 4 years with a first febrile UTI. RESULTS: Of the 398 patients included in 8 centers in 7 European countries, 25% had VUR. The median PCT concentration was significantly higher in children with VUR than in those without: 1.6 versus 0.7 ng/mL (P = 10(-4)). High PCT (> or =0.5 ng/mL) was associated with VUR (OR: 2.3; 95% CI, 1.3 to 3.9; P = 10(-3)). After adjustment for all cofactors, the association remained significant (OR: 2.5; 95% CI, 1.4 to 4.4; P = 10(-3)). The strength of the relation increased with the grade of reflux (P = 10(-5)). The sensitivity of procalcitonin was 75% (95% CI, 66 to 83) for all-grade VUR and 100% (95% CI, 81 to 100) for grade > or =4 VUR, both with 43% specificity (95% CI, 37 to 48). CONCLUSIONS: High PCT is a strong, independent and now validated predictor of VUR that can be used to identify low-risk patients and thus avoid one third of the unnecessary cystourethrographies in children with a first febrile UTI.
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Calcitonina/sangue , Precursores de Proteínas/sangue , Infecções Urinárias/sangue , Infecções Urinárias/diagnóstico por imagem , Urografia/estatística & dados numéricos , Peptídeo Relacionado com Gene de Calcitonina , Intervalos de Confiança , Europa (Continente) , Feminino , Seguimentos , Glicoproteínas , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
OBJECTIVE: To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department (ED). STUDY DESIGN: All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein, procalcitonin [PCT], white blood cell [WBC] count, neutrophil count) and cerebrospinal fluid (CSF) findings (protein, glucose, WBC count, neutrophil count) available in the ED were determined. Tests with the best predictive value were identified by using univariate and multivariate analyses and ROC curves comparison. RESULTS: Among the 167 patients included, 21 had bacterial meningitis. The CSF gram-stain and bacterial antigen test had 86% and 60% sensitivity rates, respectively. PCT (>/=0.5 ng/mL) and CSF protein (>/=0.5 g/L) were the best biologic tests, with 89% and 86% sensitivity rates, 89% and 78% specificity rates, adjusted odds ratios of 108 (95% CI, 15-772) and 34 (95% CI, 5-217), and areas under the ROC curves of 0.95 and 0.93, respectively. CONCLUSION: PCT and CSF protein had the best predictive value to distinguish between bacterial and aseptic meningitis in children.
Assuntos
Calcitonina/sangue , Meningite Asséptica/diagnóstico , Meningites Bacterianas/diagnóstico , Precursores de Proteínas/sangue , Adolescente , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Proteína C-Reativa/análise , Peptídeo Relacionado com Gene de Calcitonina , Proteínas do Líquido Cefalorraquidiano/análise , Criança , Pré-Escolar , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Glucose/líquido cefalorraquidiano , Humanos , Lactente , Contagem de Leucócitos , Masculino , Meningite Asséptica/sangue , Meningite Asséptica/líquido cefalorraquidiano , Meningites Bacterianas/sangue , Meningites Bacterianas/líquido cefalorraquidiano , Neutrófilos/metabolismo , Curva ROC , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: To test the sensitivities of recently published American recommendations predicting occult intracranial lesion (OICL) in girls with central precocious puberty (CPP), and to validate a previously derived diagnosis rule predicting OICL based on age at puberty onset and estradiol (E2) level. STUDY DESIGN: A retrospective, multicenter, hospital-based, cohort study was performed, including all girls with CPP seen in 7 centers in 6 European countries during given periods. American recommendations and the previously derived diagnosis rule were tested. RESULTS: Girls with CPP (n=443), including 35 with OICL, were recruited. American recommendations did not identify all OICL. Previously identified independent risk factors for OICL were confirmed: age <6 years (adjusted odds ratio 20.5; 95% CI, 8.1-52.1) and E2 >45th percentile (3.0; 95% CI, 1.3-7.1). The previously derived diagnosis rule had 100% sensitivity (95% CI, 90-100): all girls with OICL had either an age <6 years or an E2 level >45th percentile. The specificity was 39% (95% CI, 34-44). CONCLUSIONS: American recommendations do not seem safe to select European girls with CPP who require brain imaging. In settings where systematic brain imaging is not possible, the proposed diagnosis rule could safely help to avoid more than one third of unnecessary brain imaging.
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Encefalopatias/epidemiologia , Árvores de Decisões , Puberdade Precoce/epidemiologia , Encefalopatias/complicações , Encefalopatias/diagnóstico , Criança , Europa (Continente) , Medicina Baseada em Evidências , Feminino , Humanos , Imageamento por Ressonância Magnética , Seleção de Pacientes , Puberdade Precoce/etiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate the prevalence of cranial ultrasound abnormalities in very preterm infants as a function of gestational age, plurality, intrauterine growth restriction, and death before discharge. STUDY DESIGN: A prospective, population-based cohort of 2667 infants born between 22 and 32 weeks of gestation in 1997 in nine regions of France, transferred to a neonatal intensive care unit, for whom at least one cranial ultrasound scan was available. RESULTS: The frequencies of white matter damage (WMD), major WMD, cystic periventricular leukomalacia (PVL), periventricular parenchymal hemorrhagic involvement, and intraventricular hemorrhage with ventricular dilatation were 21%, 8%, 5%, 3%, and 3%, respectively. The risk of WMD increased with decreasing gestational age. Mean age at diagnosis of cystic PVL was older for the most premature infants. Intraventricular hemorrhage with ventricular dilatation was associated with a higher risk of cystic PVL. Intrauterine growth restriction was not associated with a lower prevalence of cystic PVL. CONCLUSION: The frequency of WMD is high in very preterm babies and is strongly related to gestational age. The incidence of cystic PVL did not differ between babies with intrauterine growth restriction and babies who were appropriate for gestational age.