VERA LUCIA JORNADA KREBS
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
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- Neonatal infection and passive acquisition of serum total IgG and reactive with ""Streptococcus"" B, anti-LPS of ""Klebsiella spp"" and ""Pseudomonas spp"" antibodies in twins(2020) YOSHIDA, Renato de Arauio Monteiro; PALMEIRA, Patricia; CARNEIRO-SAMPAIO, Magda; BRIZOT, Maria de Lourdes; CARVALHO, Erther Brunow de; KREBS, Vera Lucia JornadaOBJECTIVE: To describe the concentration of total and specific IgG antibodies anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella spp, and anti-lipopolysaccharide of Pseudomonas spp in the umbilical cord of newborn(NB) twins and to analyze the association between neonatal infection and antibody concentration in the umbilical cord blood. METHODS: A prospective cross-sectional study of a cohort of NB twins admitted during the period of 20 months. Patients with malformations and mothers with infection were excluded. Variables analyzed: gestational age(GA); birth weight(BW); antibody concentrations in umbilical cord blood; infection episodes. We used the paired Student t-test, Spearman correlation, and generalized estimation equation. RESULTS: 57 pairs of twins were included, 4 excluded, making the sample of 110 newborns. GA=36 +/- 1.65weeks and BW=2304.8 +/- 460g(mean +/- SD). Antibody concentrations in twins(mean +/- SD): total IgG=835.77 +/- 190.73mg/dL, anti-StreptococcusB IgG=250.66 +/- 295.1 AU/mL, anti-lipopolysaccharide of Pseudomonas spp IgG=280.04 +/- 498.66 AU/mL and anti-lipopolysaccharide of Klebsiella spp IgG=504.75 +/- 933.93 AU/mL. There was a positive correlation between maternal antibody levels and those observed in newborns(p <0.005). The transplacental transfer of maternal total IgG and anti-LPS Pseudomonas IgG antibodies was significantly lower at NB GA <34 weeks(p <0.05). Five newborns were diagnosed with an infection. Infants with infection had significantly lower total IgG concentration(p <0.05). CONCLUSION: This study showed a positive correlation between maternal and newborn antibodies levels. In infants younger than 34 weeks there is less transfer of total IgG and anti-LPS Pseudomonas IgG. The highest incidence of infection in the newborn group who had significantly lower total IgG serum antibodies reinforces the importance of anti-infectious protection afforded by passive immunity transferred from the mother.
- Role of a Neonatal Intensive Care unit during the COVID-19 Pandemia: recommendations from the neonatology discipline(2020) CARVALHO, Werther Brunow de; GIBELLI, Maria Augusta Bento Cicaroni; KREBS, Vera Lucia Tornado; TRAGANTE, Carla Regina; PERONDI, Maria Beatriz MoliternoOn 11th March 2020, the World Health Organization (WHO) declared the COVID-19 a pandemic. The Obstetrics and Neonatology disciplines needed to be revised to suit the institutional need to expand intensive care beds to care for confirmed or suspected patients with COVID-19 in the state of Sao Paulo, following the recommendations of the Institutional Crisis Committee. Three different actions were needed: the structuring of teams and advanced medical post to attend COVID-19-free patients and those with suspect or confirmed COVID-19; elaborating the protocols from the delivery room throughout hospitalization. Some special considerations about breastfeeding and rooming-in were needed. The third action was the drafting of a protocol to admit infants from other hospitals with confirmed COVID-19 as the unit never admitted outpatients before.
- Artificial intelligence and machine learning in pediatrics and neonatology healthcare(2022) MATSUSHITA, Felipe Yu; KREBS, Vera Lucia Jornada; CARVALHO, Werther Brunow de
- Characterization of the motor performance of newborns in a neonatal unit of tertiary level(2016) GIACHETTA, Luciana; NICOLAU, Carla Marques; JULIANI, Regina Celia Turola Passos; CARVALHO, Werther Brunow De; KREBS, Vera Lucia JornadaObjective: To characterize the motor performance of newborns in a neonatal unit of tertiary level and compare the results to the values recommended by the Test of Infant Motor Performance (TIMP). Method: Newborns between 34 and 416/7 weeks of corrected gestational age, breathing spontaneously and presenting state of consciousness 4 or 5, according to Brazelton, were included. TIMP was used to evaluate the motor performance. Results: The age groups of 34-35 and 36-37 weeks showed on average TIMP scores similar to the reference values (p> 0.05), while in the age groups of 38-39 weeks and 40-41 weeks TIMP scores were statistically lower than the reference values (p< 0.001 and p= 0.018, respectively). The 34-35 and 36-37 week groups were rated as average, while the 38-39 and 40-41 week groups were defined as low average. Classifications below average and very below average were not observed. Conclusion: The newborns showed average scores compared to the TIMP reference values; however, there were two groups whose performances were within the low average. There was no significant difference in motor performance of newborns in the age groups of 38-39 and 40-41 weeks. This behavior suggests that the sample studied has special features that possibly negatively influenced their motor performance. The results showed that the TIMP is a very useful tool and can be used safely in tertiary neonatal units.
- Guidance on breastfeeding during the Covid-19 pandemic(2020) CALILL, Valdenise Martins Laurindo Tuma; KREBS, Vera Lucia Tornado; CARVALHO, Werther Brunow deOBJECTIVE: These recommendations aim to provide guidance on breastfeeding for mothers with suspected or confirmed Covid-19. METHODS: We performed a review of the recent medical literature on breastfeeding mothers with suspected or confirmed Covid-19, focusing on the neonatal period. RESULTS: We analyzed 20 recent publications on breastfeeding, Covid-19, and its transmission through breastmilk. We presented possible options for breastfeeding and their consequences for the mother and the child. CONCLUSION: All maternal decisions in relation to breastfeeding are justifiable since the infection by Covid-19 is still poorly known. However, puerperal women and their families must be very well informed to make a conscious choice based on the information available in the literature so far.
- Gray zone: mortality profile of newborns at the limit of viability(2019) CARVALHO, Werther Brunow de; MATSUSHITA, Felipe Yu; KREBS, Vera Lucia Jornada
- Intrauterine growth restriction in monochorionic-diamniotic twins(2014) MACHADO, Rita de Cassia Alam; BRIZOT, Maria de Lourdes; MIYADAHIRA, Seizo; FRANCISCO, Rossana Pulcineli Vieira; KREBS, Vera Lucia Jornada; ZUGAIB, MarceloObjective: to evaluate neonatal morbidity and mortality in monochorionic-diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). Methods: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10th percentile on twins' growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16). Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. Results: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). Conclusion: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR.
- Menkes disease: importance of diagnosis with molecular analysis in the neonatal period(2015) COSTA, Larissa Sampaio de Athayde; PEGLER, Stephanie Pucci; LELLIS, Rute Facchini; KREBS, Vera Lucia Jornada; ROBERTSON, Stephen; MORGAN, Tim; HONJO, Rachel Sayuri; BERTOLA, Debora Romeo; KIM, Chong AeMenkes disease is a congenital disorder caused by changes in copper metabolism derived from mutations in the ATP7A gene. It is characterized by physical and neurological alterations. In the neonatal period, these alterations can be nonspecific, which makes early diagnosis a challenge. Diagnosis can be suspected when there are low levels of ceruloplasmin and serum copper. Molecular analysis confirms the diagnosis. Treatment is parenteral administration of copper histidine. We report a familial case with molecular confirmation. The proband had clinical and biochemical suspicious. Treatment with copper histidine was indicated, but initiated at the age of 2 months and 27 days only. He did not present improvements and died at 6 months. The mother became pregnant again, a male fetus was identified and copper histidine was manufactured during pregnancy. He was born healthy, biochemical markers were reduced and treatment was indicated. Molecular analysis was performed confirming mutation in both the mother and the proband, while the other son did not have mutation, so treatment was discontinued. We support the clinical relevance of molecular confirmation for the correct diagnosis and genetic counseling, once clinical findings in the neonatal period are nonspecific and early treatment with parenteral copper histidine must be indicated.