Revisitando o perímetro craniano de recém nascidos brasileiros de maternidades públicas e privadas

Objetivo Revisitar o perímetro cefálico (PC) de recém nascidos (RN) correlacionando com a idade gestacional (IG), gênero, tipo de parto (TP), sistema de saúde e construir e validar gráficos e curvas.

Métodos Estudou-se prospectivamente RN sadios analisando-se as diferenças entre os PC segundo a IG, gênero, TP e sistema de saúde. As curvas suavizadas de percentis foram criadas pelo método LMS (least mean squares).

Resultados 692 nasceram em maternidades privadas, 2.150 em maternidade pública, 839 nasceram de parto vaginal e 1.311 parto cesáreo. O gênero masculino apresentou PC maior que o feminino nas IG de 37 a 42 semanas. Os RN de maternidades privadas tiveram PC maior que os de maternidade pública. Os nascidos de parto cesáreo tiveram PC maior que os de parto vaginal.

Conclusão Importante consequência deste estudo foi que os resultados permitiram a criação de curvas e gráficos validados estatisticamente de aplicabilidade na prática clínica neonatal.

perímetro craniano neonatal; idade gestacional; gênero; maternidades pública e privadas; recém nascido

GA (weeks)	Cesarean			Vaginal			p-value	Female			Male			p-value	Private			Public			p-value

	n	Mean	SD	n	Mean	SD		n	Mean	SD	n	Mean	SD		n	Mean	SD	n	Mean	SD
34	16	31.3	1.9	19	32.0	1.3	0.159	15	31.4	1.2	20	31.8	1.9	0.509	4	32.0	0.8	31	31.6	1.8	0.695
35	33	32.6	1.5	35	31.9	1.6	0.074	32	31.9	1.3	36	32.4	1.8	0.167	12	32.9	1.4	56	32.1	1.6	0.088
36	52	32.9	1.7	50	33.0	1.5	0.858	40	32.3	1.4	62	33.3	1.7	0.003	27	33.7	1.7	75	32.7	1.5	0.004*
37	161	34.4	3.0	93	33.7	1.2	0.040*	111	33.5	1.3	143	34.6	3.1	0.001*	76	34.5	1.2	178	33.9	2.9	0.145
38	323	34.7	1.3	145	33.9	1.3	0.001*	221	34.0	1.3	247	34.8	1.4	0.001*	172	34.7	1.2	296	34.3	1.4	0.001*
39	505	34.9	1.4	169	34.3	1.4	0.001*	329	34.4	1.3	345	35.0	1.4	0.001*	230	35.2	1.2	444	34.5	1.4	0.001*
40	422	35.1	1.3	202	34.5	1.3	0.001*	310	34.5	1.2	314	35.2	1.3	0.001*	115	35.3	1.2	509	34.8	1.4	0.001*
41	281	35.2	1.2	123	34.6	1.4	0.001*	194	34.6	1.2	210	35.3	1.2	0.001*	46	35.0	1.2	358	35.0	1.3	0.943
42	140	35.3	1.3	78	35.1	1.3	0.336	100	34.8	1.3	118	35.5	1.3	0.001*	15.0	35.5	1.3	203	35.2	1.3	0.385

GA (weeks)	n	Mean	SD	Percentiles

				10th	25th	50th	75th	90th	95th
General
34	35	31.7	1.7	29.9	30.7	31.7	32.6	33.5	34.0
35	68	32.2	1.6	30.7	31.5	32.5	33.4	34.3	34.8
36	102	32.9	1.6	31.4	32.3	33.3	34.3	35.2	35.7
37	254	34.1	2.5	32.1	33.0	34.0	35.0	35.9	36.4
38	468	34.5	1.4	32.5	33.4	34.5	35.5	36.4	36.9
39	674	34.7	1.4	32.8	33.7	34.7	35.8	36.7	37.2
40	624	34.9	1.3	32.9	33.9	34.9	35.9	36.9	37.4
41	404	35.0	1.3	33.1	34.0	35.0	36.1	37.0	37.6
42	218	35.2	1.3	33.2	34.1	35.2	36.2	37.2	37.7
Female
34	15	31.4	1.2	30.1	30.8	31.6	32.4	33.2	33.6
35	32	31.9	1.3	30.7	31.4	32.2	33.1	33.8	34.3
36	40	32.3	1.4	31.3	32.0	32.9	33.7	34.5	34.9
37	111	33.5	1.3	31.8	32.6	33.5	34.3	35.1	35.5
38	221	34.0	1.3	32.3	33.1	34.0	34.8	35.6	36.1
39	329	34.4	1.3	32.7	33.5	34.3	35.2	36.0	36.5
40	310	34.5	1.2	32.9	33.7	34.6	35.5	36.3	36.7
41	194	34.6	1.2	33.1	33.9	34.8	35.7	36.5	36.9
42	100	34.8	1.3	33.2	34.0	34.9	35.8	36.6	37.1
Male
34	20	31.8	1.9	30.5	31.4	32.4	33.4	34.3	34.9
35	36	32.4	1.8	31.1	32.0	33.1	34.1	35.0	35.6
36	62	33.3	1.7	31.7	32.7	33.7	34.8	35.7	36.3
37	143	34.6	3.1	32.2	33.2	34.3	35.4	36.3	36.9
38	247	34.8	1.4	32.6	33.6	34.7	35.8	36.8	37.4
39	345	35.0	1.4	32.9	33.9	35.0	36.1	37.1	37.7
40	314	35.2	1.3	33.1	34.1	35.2	36.3	37.3	37.9
41	210	35.3	1.2	33.3	34.3	35.4	36.5	37.5	38.1
42	118	35.5	1.3	33.4	34.4	35.6	36.7	37.7	38.3

GA (weeks)	General				Male				Female

	n	L	M	S	n	L	M	S	n	L	M	S
34	35	1	31.728	0.062	20	1	32.396	0.467	15	1	31.615	0.0379
35	68	1	32.513	0.058	36	1	33.067	0.467	32	1	32.247	0.0379
36	102	1	33.281	0.055	62	1	33.716	0.467	40	1	32.872	0.0379
37	254	1	33.960	0.051	143	1	34.289	0.467	111	1	33.461	0.0379
38	468	1	34.436	0.047	247	1	34.722	0.467	221	1	33.962	0.0379
39	674	1	34.730	0.044	345	1	35.024	0.467	329	1	34.335	0.0379
40	624	1	34.913	0.040	314	1	35.239	0.467	310	1	34.586	0.0379
41	404	1	35.061	0.036	210	1	35.408	0.467	194	1	34.768	0.0379
42	218	1	35.216	0.033	118	1	35.562	0.467	100	1	34.931	0.0379

GA (weeks)	n	Mean	SD	Percentiles

				10th	25th	50th	75th	90th	95th
General
34	4	32.0	0.8	30.8	31.5	32.3	33.1	33.8	34.2
35	12	32.9	1.4	31.5	32.3	33.1	33.9	34.6	35.0
36	27	33.7	1.7	32.2	33.0	33.8	34.6	35.3	35.8
37	76	34.5	1.2	32.8	33.5	34.4	35.2	35.9	36.4
38	172	34.7	1.2	33.2	34.0	34.8	35.6	36.4	36.9
39	230	35.2	1.2	33.5	34.3	35.1	36.0	36.7	37.2
40	115	35.3	1.2	33.7	34.4	35.3	36.1	36.9	37.4
41	46	35.0	1.2	33.7	34.4	35.3	36.2	36.9	37.4
42	15	35.5	1.3	33.7	34.5	35.3	36.2	37.0	37.4
Female
34	2	32.0	1.4	31.0	31.7	32.4	33.2	33.8	34.2
35	6	33.5	0.6	31.5	32.2	32.9	33.6	34.3	34.7
36	14	33.0	1.3	31.9	32.6	33.3	34.1	34.8	35.2
37	31	33.9	1.0	32.4	33.1	33.8	34.6	35.3	35.7
38	81	34.3	1.2	32.9	33.6	34.3	35.1	35.8	36.2
39	119	34.8	1.2	33.3	34.0	34.8	35.5	36.2	36.7
40	67	35.1	1.2	33.5	34.2	35.0	35.8	36.5	36.9
41	25	34.8	1.1	33.5	34.2	35.0	35.8	36.5	36.9
42	8	34.9	1.1	33.4	34.2	35.0	35.7	36.5	36.9
Male
34	2	32.0	0.0	31.3	32.0	32.8	33.5	34.2	34.6
35	6	32.3	1.8	32.0	32.7	33.5	34.3	35.0	35.4
36	13	34.5	1.9	32.7	33.4	34.2	35.0	35.7	36.1
37	45	34.9	1.2	33.2	33.9	34.7	35.6	36.3	36.7
38	91	35.1	1.2	33.6	34.4	35.2	36.0	36.7	37.2
39	111	35.6	1.2	33.9	34.7	35.5	36.3	37.1	37.5
40	48	35.7	1.1	34.1	34.9	35.7	36.5	37.3	37.7
41	21	35.4	1.3	34.2	35.0	35.8	36.7	37.4	37.9
42	7	36.2	1.2	34.4	35.1	35.9	36.8	37.5	38.0

GA (weeks)	n	Mean	SD	Percentiles

				10th	25th	50th	75th	90th	95th
General
34	31	31.6	1.8	30.0	30.9	31.9	32.9	33.8	34.3
35	56	32.1	1.6	30.6	31.5	32.5	33.5	34.4	35.0
36	75	32.7	1.5	31.2	32.1	33.2	34.2	35.1	35.7
37	178	33.9	2.9	31.7	32.7	33.7	34.8	35.7	36.3
38	296	34.3	1.4	32.2	33.1	34.2	35.2	36.2	36.8
39	444	34.5	1.4	32.5	33.5	34.5	35.6	36.6	37.1
40	509	34.8	1.4	32.8	33.7	34.8	35.9	36.8	37.4
41	358	35.0	1.3	33.0	33.9	35.0	36.1	37.1	37.7
42	203	35.2	1.3	33.2	34.2	35.2	36.3	37.3	37.9
Female
34	13	31.4	1.3	29.8	30.5	31.4	32.2	32.9	33.3
35	26	31.6	1.2	30.4	31.2	32.0	32.8	33.6	34.0
36	26	32.0	1.4	31.0	31.8	32.6	33.5	34.3	34.7
37	80	33.4	1.4	31.6	32.4	33.3	34.1	34.9	35.4
38	140	34.0	1.3	32.1	32.9	33.8	34.7	35.4	35.9
39	210	34.3	1.4	32.5	33.3	34.2	35.1	35.9	36.3
40	243	34.4	1.2	32.8	33.6	34.5	35.4	36.2	36.6
41	169	346	1.3	33.0	33.8	34.7	35.6	36.4	36.9
42	92	34.8	1.26	33.2	34.0	34.9	35.8	36.6	37.1
Male
34	18	31.8	2.0	30.2	31.2	32.3	33.3	34.3	34.9
35	30	32.5	1.8	30.8	31.8	32.9	34.0	35.0	35.6
36	49	33.0	1.5	31.4	32.4	33.5	34.6	35.7	36.2
37	98	34.5	3.6	31.9	33.0	34.1	35.2	36.2	36.9
38	156	34.6	1.4	32.3	33.4	34.5	35.7	36.7	37.3
39	234	34.8	1.4	32.6	33.7	34.8	36.0	37.0	37.7
40	266	35.2	1.4	32.9	33.9	35.1	36.3	37.3	38.0
41	189	35.4	1.2	33.1	34.2	35.3	36.5	37.6	38.2
42	111	35.5	1.3	33.3	34.4	35.5	36.7	37.8	38.4

GA (weeks)	n	Mean	SD	Percentiles

				10th	25th	50th	75th	90th	95th
Cesarean
34	16	31.3	1.9	30.4	31.3	32.3	33.2	34.1	34.6
35	33	32.6	1.5	31.0	31.9	32.9	33.9	34.8	35.4
36	52	32.9	1.7	31.7	32.6	33.6	34.6	35.5	36.1
37	161	34.4	3.0	32.2	33.1	34.2	35.2	36.1	36.7
38	323	34.7	1.3	32.6	33.6	34.6	35.6	36.6	37.1
39	505	34.9	1.4	32.9	33.8	34.9	35.9	36.9	37.5
40	422	35.1	1.3	33.1	34.0	35.1	36.2	37.1	37.7
41	281	35.2	1.2	33.2	34.2	35.2	36.3	37.3	37.8
42	140	35.3	1.3	33.3	34.3	35.4	36.4	37.4	38.0
Vaginal
34	19	32.0	1.3	30.3	31.1	31.9	32.8	33.6	34.1
35	35	31.9	1.6	30.8	31.6	32.5	33.4	34.1	34.6
36	50	33.0	1.5	31.3	32.1	33.0	33.9	34.7	35.2
37	93	33.7	1.2	31.8	32.6	33.5	34.4	35.2	35.7
38	145	33.9	1.3	32.1	33.0	33.9	34.8	35.6	36.1
39	169	34.3	1.4	32.5	33.3	34.2	35.2	36.0	36.5
40	202	34.5	1.3	32.7	33.6	34.5	35.4	36.3	36.8
41	123	34.6	1.4	33.0	33.8	34.8	35.7	36.6	37.1
42	78	35.1	1.3	33.2	34.1	35.0	36.0	36.8	37.4

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[TFN1] *The differences are statistically significant considering α = 0.05; SD: standard deviation; GA: gestational age.