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
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- When One Knows a Fetus Is Expected to Die: Palliative Care in the Context of Prenatal Diagnosis of Fetal Malformations(2017) CATANIA, Taisa Rocha; BERNARDES, Lisandra Stein; BENUTE, Glaucia Rosana Guerra; GIBELI, Maria Augusta Bento Cicaroni; NASCIMENTO, Nathalia Bertolassi do; BARBOSA, Tercilia Virginia Aparecida; KREBS, Vera Lucia Jornada; FRANCISCO, Rossana P. V.Background: Fetal malformations occur in 2% of gestations and are the fifth most common cause of neonatal death in the world. In many cases, fetal malformations result in neonatal death or long stay in intensive care facilities. Families that continue the pregnancy in such a situation need to make choices and cope with an overwhelming number of potential issues. Palliative care starting at the prenatal period is a growing field that allows the entire family to prepare for this difficult situation. Objective: To perform a systematic review of published data on palliative care in the prenatal period. Design: PubMed and the Cochrane Library were searched using the keywords (""perinatal"" OR ""prenatal"" OR ""fetal"") AND ""palliative care"" and also (""perinatal"" OR ""prenatal"" OR ""fetal"") AND ""hospice."" Setting/Subjects: Studies focusing on the long-term impact of prenatal palliative care published up to December 2015 were used. Measurements: Quantitative and qualitative studies. Results: In total, 541 studies were retrieved; 29 articles met the inclusion criteria. Studies were organized into different categories according to the design or main focus. The majority of studies retrieved were reflexives or presented a narrative proposal on palliative care started in the prenatal period (45%). Clinical studies comprised 17% of all articles found. No studies were found on the long-term impact of prenatal palliative care. Conclusions: Prenatal palliative care is a growing field and an important supportive care measure that can help grieving parents and families who do not want to or cannot interrupt their pregnancy. More studies should be carried out, specifically concerning long-term impact of prenatal palliative care. Guidelines and training of health professionals must be developed so that more families can benefit from this type of care.
- First-year profile of biomarkers for early detection of renal injury in infants with congenital urinary tract obstruction(2019) KOSTIC, Dusan; BEOZZO, Glenda Priscila Neves dos Santos; COUTO, Saulo Brasil do; KATO, Andre Henrique Teruaki; LIMA, Laila; PALMEIRA, Patricia; KREBS, Vera Lucia Jornada; BUNDUKI, Victor; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo; CARVALHO, Werther Brunow de; KOCH, Vera Hermina KalikaBackground Diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. Use of renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and prevention or minimization of definitive renal damage. Methods This longitudinal, prospective study analyzed the first-year profile of two serum renal biomarkers: creatinine (sCr) and cystatin C (sCyC); and six urinary renal biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-beta 1), retinol-binding protein (RBP), cystatin C (mu CyC), and microalbuminuria (ALB) in a cohort of 37 infants with UTO divided into three subgroups: 14/37 with unilateral hydro(uretero)nephrosis, 13/37 with bilateral hydro(uretero)nephrosis, and 10/37 patients with lower urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Results All urine biomarkers showed significantly higher values at the first month of life (p <= 0.009), while NGAL (p = 0.005), TGF-beta 1 (p<0.001), and mu ALB (p<0.001) were high since birth compared to controls. Best single biomarker performances were RBP in bilateral hydronephrosis and LUTO subgroups and KIM-1 in unilateral hydronephrosis subgroup. Best biomarker combination results for all subgroups were obtained by matching RBP with TGF-beta 1 or KIM-1 and NGAL with CyC ([AUC] <= 0.934; sensitivity <= 92.4%; specificity <= 92.8%). Conclusions RBP, NGAL, KIM-1, TGF-beta 1, and CyC, alone and especially in combination, are relatively efficient in identifying surgically amenable congenital UTO and could be of practical use in indicating on-time surgery.
- The role of renal biomarkers to predict the need of surgery in congenital urinary tract obstruction in infants(2019) KOSTIC, D.; BEOZZO, G. P. N. S.; COUTO, S. B. do; KATO, A. H. T.; LIMA, L.; PALMEIRA, P.; KREBS, V. L. J.; BUNDUKI, V; V, R. P. Francisco; ZUGAIB, M.; DENES, F. T.; CARVALHO, W. B. de; KOCH, V. H. K.Introduction The diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. The use of new renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and the prevention or minimization of definitive renal damage. Objective The aim of the study was to investigate a selection of promising biomarkers of renal injury with the intention of evaluating and comparing their profile with clinically based decisions for surgical intervention of infants with congenital obstructive uropathies. Study design The first-year profile of renal biomarkers, serum creatinine (sCr), serum and urine cystatin C (CyC), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-beta 1), retinolbinding protein (RBP), and microalbuminuria (mu ALB), was analyzed in a cohort of 37 infants with congenital UTO, divided into three subgroups, 14 cases with grade III unilateral hydro (uretero)nephrosis, 13 cases with grade III bilateral hydro (uretero)nephrosis, and 10 cases with low urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Serum and urine samples were stored at -70 degrees C and thereafter analyzed by quantitative enzymatic immunoassay. Results Compared with the control group (Figure), all renal biomarker values were significantly increased in patients (P <= 0.02). In the unilateral hydronephrosis and LUTO group, RBP (P <= 0.043), NGAL (P <= 0.043), KIM-1 (P <= 0.03), and TGF-beta 1 (P <= 0.034) values dropped significantly after surgery. Neutrophil gelatinase-associated lipocalin alone and in combination with urine and serum CyC demonstrated the best performance in determining the need for surgery (area under the curve, 0.801 and 0.881, respectively). Biomarker profile analysis was suggestive of surgical intervention in 55.4% (7/13) of non-operated cases, and most of the biomarker values were above the cutoff levels within at least 3 months before the clinically based surgical decision in 58% (14/24) of all operated patients. Discussion To the best of the authors' knowledge, this is the first study to present the clinical use of selected group of serum and urinary biomarkers in the setting of UTO to distinguish between patients who would benefit from surgery intervention. The most promising results were obtained using NGAL, RBP, TGF-beta 1, and KIM-1, especially in the unilateral hydro(uretero)nephrosis and LUTO subgroups when compared with the control group. Conclusions Urine biomarkers, alone and in combination, demonstrated high potential as a non-invasive diagnostic tool for identifying infants who may benefit from earlier surgical intervention. [GRAPHICS] .
- Type II and III Selective Fetal Growth Restriction: Perinatal Outcomes of Expectant Management and Laser Ablation of Placental Vessels(2018) MIYADAHIRA, Mariana Yumi; BRIZOT, Maria de Lourdes; CARVALHO, Mario Henrique Burlacchini de; BIANCOLIN, Sckarlet Ernandes; MACHADO, Rita de Cassia Alam; KREBS, Vera Lucia Jornada; FRANCISCO, Rossana Pulcineli Vieira; PERALTA, Cleisson Fabio AndrioliOBJECTIVES: To describe the perinatal outcomes of type II and III selective fetal growth restriction (sFGR) in monochorionic-diamniotic (MCDA) twin pregnancies treated with expectant management or laser ablation of placental vessels (LAPV). METHODS: Retrospective analysis of cases of sFGR that received expectant management (type II, n=6; type III, n=22) or LAPV (type II, n=30; type III, n=9). The main outcomes were gestational age at delivery and survival rate. RESULTS: The smaller fetus presented an absent/reversed ""a'' wave in the ductus venosus (arAWDV) in all LAPV cases, while none of the expectant management cases presented arAWDV. The median gestational age at delivery was within the 32nd week for expectant management (type II and III) and for type II LAPV, and the 30th week for type III LAPV. The rate of at least one twin alive at hospital discharge was 83.3% and 90.9% for expectant management type II and III, respectively, and 90% and 77.8% for LAPV type II and III, respectively. CONCLUSION: LAPV in type II and III sFGR twins with arAWDV in the smaller fetus seems to yield outcomes similar to those of less severe cases that received expectant management.
- Oral colonization: A possible source for candidemia in low-weight neonates(2014) BATISTA, G. C. M.; KREBS, V. L. J.; RUIZ, L. S.; AULER, M. E.; HAHN, R. C.; PAULA, C. R.Objective. - To check the oral colonization in neonates at high-risk and to associate these cases with candidemia. Subjects and methods. - This study was conducted in the NICU. For six months, 125 high-risk neonates were investigated for oral colonization and septicemia by yeasts. From this total, 19 neonates had yeasts on the oral mucosae and 12 neonates developed fungemia. All of the 12 neonates with fungemia were included in the amount of 19 who have presented oral colonization by yeasts. Results. - There was a species concordance between the yeasts of the oral mucosae and the blood in 6 neonates (50%) among the 12 neonates with oral colonization and septicemia at the same time. The yeasts isolated in these 6 cases regarding the species concordance were Candida albicans (5 cases, 83.4%) and Candida parapsilosis (1 case, 16.6%). All of the cases involving an association were confirmed by PFGE. All of the strains of yeasts involved in oral colonization and also blood presented the same karyotype. A total of 66.6% of the patients with strains in agreement progressed to death. Conclusion. - The results indicate the relevance of monitoring the oral microbiota, as a possible source of fungal infection, and assisting to develop appropriate therapeutic strategy.
- Nonimmune fetal ascites: identification of ultrasound findings predictive of perinatal death(2016) BACCEGA, Felipe; BRIZOT, Maria de Lourdes; KREBS, Vera Lucia Jornada; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloAim: To determine the ultrasonographic findings that predict death in fetal ascites. Methods: This was a retrospective cohort study involving pregnancies with ultrasonographic findings related to fetal ascites. The inclusion criteria were as follows: single pregnancy with a live fetus; ultrasound findings of ascites; ascites unrelated to maternal fetal alloimmunization; and pregnancy follow-up at our institution. The chi(2)-test was used to evaluate the association of ultrasound findings and death. Multiple logistic regression analysis was performed to determine the ultrasound findings that are predictive of death prior to hospital discharge. Results: A total of 154 pregnancies were included in the study. In 8 (5.19%) cases, ascites was an isolated finding, and in 146 cases, other alterations were observed during the ultrasound evaluation. Death before hospital discharge occurred in 117 cases (76.00%). The following ultrasonographic findings were significantly associated with death: gestational age at diagnosis <24 weeks (P < 0.0001); stable/progressive ascites evolution (P = 0.004); the presence of hydrops (P < 0.0001); and the presence of cystic hygroma (P < 0.0001). The presence of hydrops, the presence of respiratory tract malformations, and stable/progressive ascites evolution were significantly associated with the prediction of death. Conclusions: Based on ultrasound examination, the presence of hydrops, malformation of the respiratory tract, and stable/progressive evolution of ascites increase the chances of death in cases of fetal ascites.
- Early fluid overload is associated with mortality and prolonged mechanical ventilation in extremely low birth weight infants(2020) MATSUSHITA, Felipe Yu; KREBS, Vera Lucia Jornada; FERRARO, Alexandre Archanjo; CARVALHO, Werther Brunow deRecent studies revealed that fluid overload is associated with higher mortality in critically ill children and adults. This study aimed to evaluate the association between fluid overload in the first 3 days of life and mortality in extremely low birth weight infants. This single-center retrospective cohort study included two hundred nineteen newborns with birth weight less than 1000 g who were admitted to the neonatal intensive care between January 2012 and December 2017. Overall mortality was 32.4%, the median gestational age was 27.3 (26.1-29.4) weeks, and birth weight was 770 (610-900) grams. In the group with severe fluid overload, we found a higher rate of deaths (72.2%); mean airway pressure was significantly higher and with longer invasive mechanical ventilation necessity. Conclusion: Early fluid overload in extremely low birth weight infants is associated with higher mortality rate, higher mean airway pressure in invasive mechanically ventilated patients, and longer mechanical ventilation duration in the first 7 days of life.What is Known:center dot Fluid overload is associated with a higher mortality rate and prolonged mechanical ventilation in children and adults.What is New:center dot Fluid overload in the first 72 h of life in an extremely premature infant is associated with higher mortality rate, higher mean airway pressure in invasive mechanically ventilated patients, and longer mechanical ventilation duration the first 7 days of life.
bookPart Ruy Jornada Krebs - ""um dos pilares da educação física brasileira""(2018) VIEIRA, José Luiz Lopes; COPETTI, Fernando; KRUG, Arno; KREBS, Vera LuciabookPart Ventilação mecânica neonatal(2022) ZACHARIAS, Romy Schmidt Brock; KREBS, Vera Lúcia JornadaconferenceObject Detection of 22q11.2 Deletion in Infants with Congenital Heart Disease (Preliminary Data)(2013) CARNEIRO-SAMPAIO, M.; GRASSI, M. Sierro; KULIKOWSKI, L. Domenici; JACOB, C. Miuki Abe; DUTRA, R. Lelis; MIURA, N.; CECCON, M. E. Jurfest Rivero; KREBS, V. L. Jornada; CARVALHO, W. Brunow; JATENE, M.