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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- 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.
- Severe Hyperbilirubinemia in Exchange Transfusion: Less Indication and Lower Mortality(2016) DURANTE, Patricia Prado; KREBS, Vera Lucia Jornada; CARVALHO, Werther Brunow de
- Pregnancy outcomes in severe polyhydramnios: no increase in risk in patients needing amnioreduction for maternal pain or respiratory distress(2016) KLEINE, Rodolpho Truffa; BERNARDES, Lisandra Stein; CARVALHO, Mariana Azevedo; CARVALHO, Mario Henrique Burlachini de; KREBS, Vera Lucia; FRANCISCO, Rossana Pulcineli VieiraIntroduction: Polyhydramnios is a common complication of fetal malformations and has been described to have high risk of pregnancy complications such as prematurity and placental abruption. In a subgroup of women severe polyhydramnios may lead to maternal dyspnea or untreatable pain, and amnioreduction is the procedure indicated to relieve those symptoms. There is a lack of information concerning the increase in the risk for the pregnancy when the procedure is indicated. Therefore, this study sought to evaluate the risk of complications in pregnancies with severe polyhydramnios that needed amnioreduction in relation to the basal risk for the pregnancy of having polyhydramnios without the need for the procedure.Materials and methods: Patients with singleton pregnancies and severe polyhydramnios followed in our fetal medicine center were evaluated retrospectively. Pregnancy complications (prematurity rate, fetal death, premature rupture of membranes, placental abruption and chorioamnionitis) were studied in the group of patients needing the procedure and their risk was compared to the risk of having a pregnancy with severe polyhydramnios but with no need for the procedure.Results: One hundred and thirty-five patients were evaluated. Forty-four patients (32.6%) needed amnioreduction. There was no increase in the risk of having complications when the procedure was needed OR=1.4 (CI 0.46-1.26).Conclusion: Amnioreduction performed to relieve maternal symptoms did not statistically increase the risk of pregnancy complications with severe polyhydramnios in single pregnancies.
- 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.
- Repercussões da hiperinsuflação manual em recém-nascidos pré-termo sob ventilação mecânica(2016) VIANA, Camila Chaves; NICOLAU, Carla Marques; JULIANI, Regina Celia Turola Passos; CARVALHO, Werther Brunow de; KREBS, Vera Lucia JornadaABSTRACT Objective: To assess the effects of manual hyperinflation, performed with a manual resuscitator with and without the positive end-expiratory pressure valve, on the respiratory function of preterm newborns under mechanical ventilation. Methods: Cross-sectional study of hemodynamically stable preterm newborns with gestational age of less than 32 weeks, under mechanical ventilation and dependent on it at 28 days of life. Manual hyperinflation was applied randomly, alternating the use or not of the positive end-expiratory pressure valve, followed by tracheal aspiration for ending the maneuver. For nominal data, the two-tailed Wilcoxon test was applied at the 5% significance level and 80% power. Results: Twenty-eight preterm newborns, with an average birth weight of 1,005.71 ± 372.16g, an average gestational age of 28.90 ± 1.79 weeks, an average corrected age of 33.26 ± 1.78 weeks, and an average mechanical ventilation time of 29.5 (15 - 53) days, were studied. Increases in inspiratory and expiratory volumes occurred between time-points A5 (before the maneuver) and C1 (immediately after tracheal aspiration) in both the maneuver with the valve (p = 0.001 and p = 0.009) and without the valve (p = 0.026 and p = 0.001), respectively. There was also an increase in expiratory resistance between time-points A5 and C1 (p = 0.044). Conclusion: Lung volumes increased when performing the maneuver with and without the valve, with a significant difference in the first minute after aspiration. There was a significant difference in expiratory resistance between the time-points A5 (before the maneuver) and C1 (immediately after tracheal aspiration) in the first minute after aspiration within each maneuver.
- Desempenho linguístico de prematuros de 2 anos, considerando idade cronológica e idade corrigida(2016) MONTEIRO-LUPERI, Telma Iacovino; BEFI-LOPES, Debora Maria; DINIZ, Edna Maria Albuquerque; KREBS, Vera Lucia; CARVALHO, Werther Brunow deABSTRACT Introduction Preterm birth causes problems that are not restricted to perinatal mortality. Some premature, even in the absence of brain damage, have negative effects on various aspects of development, such as language difficulties. Objective This study aimed to verify the linguistic performance of preterm children at 2 years old, considering the chronological age and corrected age. Methods The study included 23 preterm children and applied the Test of Early Language Development- TELD-3 to assess the language skills. Results The premature children showed the linguistic performance alterations in Teld-3 in 39.13% of cases. They were also analyzed considering the delay to the chronological and corrected ages and there was no difference in performance for both receptive subtests (p = 0.250) and significant (p = 1.000). Conclusion The group of premature children at 2 years is a population at risk for language disorders that cannot be compensated with age correction.
- Fetal ductus arteriosus constriction and closure: analysis of the causes and perinatal outcome related to 45 consecutive cases(2016) LOPES, Lilian Maria; CARRILHO, Milene Carvalho; FRANCISCO, Rossana Pulcineli Vieira; LOPES, Marco Antonio Borges; KREBS, Vera Lucia Jornada; ZUGAIB, MarceloObjective: The aim of this study was to analyze the causes and perinatal outcome related to fetal ductus arteriosus constriction or closure at a single center over a 26-year period.Methods: This was a retrospective analysis of 45 consecutive cases of constriction (n=41) and closure (n=4) from 1987 through 2013. Patients were divided into Group A (maternal use of non-steroidal anti-inflammatory drugs (NSAID), n=29), Group B (idiopathic, n=8), and Group C (other drugs not previously described, n=8).Results: The median gestational age at diagnosis was 34 weeks (range, 27-38), mean systolic and diastolic velocity in the ductus arteriosus was 2.010.66m/s and 0.71 +/- 0.46m/s, respectively. Among the 29 cases of NSAIDs, 27.5% (8/29) have taken a single day use and 75% multiple days/doses. Right ventricular dilatation was present in 82.2% of the fetuses, tricuspid insufficiency in 86.6%, and heart failure in 22.2%. Neonatal persistent pulmonary hypertension occurred in 17.7% of the patients. Late follow-up showed all 43 survivors alive and healthy with only two deaths from unrelated causes.Conclusions: The results of this study indicate that clinically significant ductal constriction may follow maternal exposure to single doses of NSAIDs. Unknown causes or other new substances were also described, such as naphazoline, fluoxetine, isoxsuprine, caffeine and pesticides. Echocardiographic diagnosis of ductal constriction led to an active medical approach that resulted in low morbidity of this group of patients.
- Short-term prognostic factors in myelomeningocele patients(2016) RODRIGUES, Andre Broggin Dutra; KREBS, Vera Lucia Jornada; MATUSHITA, Hamilton; CARVALHO, Werther Brunow dePatients with myelomeningocele have a high mortality and neurological disabilities that are correlated with the anatomical characteristics of the defect and with the development of acquired complications. The challenge in the postnatal management of myelomeningocele (MMC) is the early recognition of cases at risk for complications in order to establish individualized treatment strategies. This study aims to identify short-term prognostic markers for newborns with MMC. Anatomical characteristics of the spinal defect and technical aspects of the neurosurgical correction were analyzed for this purpose. A retrospective cohort study was conducted in 70 patients with MMC born between January 2007 and December 2013. Features of MMC anatomy and neurosurgical treatment were analyzed for the following outcomes: neonatal resuscitation, length of hospital stay, need for ventricular shunt, wound dehiscence, wound infection, central nervous system infection, and sepsis. Large MMC was associated with central nervous system (CNS) infection, wound complications, and longer hospital stay. Patients with thoracic MMC required longer hospital stay. Surgical repair performed after 48 h of life increased in 5.72 times the risk of CNS infection. Absence of antenatal hydrocephalus was a favorable prognostic marker. Extent of the spinal cord defect and the time of surgical correction influenced the short-term outcomes of patients with myelomeningocele. Extensive lesions were associated with higher rates of CNS infections, surgical wound complications, and prolonged hospital stay. Interventions performed within 48 h after birth significantly reduced occurrence of CNS infections. Absence of antenatal hydrocephalus was associated with fewer complications in the first days of life.