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BACKGROUND: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS: This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS: A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.
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Enfermedades Cardiovasculares , Humanos , Masculino , Anciano , Femenino , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Brasil , Estudios Transversales , Dieta , Dieta SaludableRESUMEN
As newborns are highly vulnerable, they require essential care for adequate child development. This study aimed to assess the care provided to newborns during the first 28 days of life and identify factors associated with adequate care. This was a longitudinal study conducted with 415 mothers and full-term newborns from 4 public maternity hospitals in Natal, Brazil, in 2019. Assistance, socioeconomic, and demographic data were collected 3 times: 48 hours, 7 days, and 28 days after birth. Pearson's chi-square and Poisson regression tests were used with a confidence interval of 95%. Most mothers were between 20 and 29 years old (46.5%), had a high school or higher education (65.3%), a partner (79%), an income ofâ ≤â 1 minimum wage (64, 6%), and were multiparous (62.9%). A total of 29 actions performed in maternity hospitals and 11 in primary healthcare were evaluated. Among the first, 8 (27.6%) were satisfactory; 11 (37.9%), partially satisfactory; and 10 (34.5%), unsatisfactory. In primary care, 2 actions (18.2%) were considered satisfactory; 3 (27.3%) partially satisfactory; and 6 (54.5%) unsatisfactory. In the multivariate analysis of the composite indicators related to adequacy of care, women undergoing vaginal delivery, those who are multiparous, and maternity hospitals at usual risk were associated with better adequacy of care indicators (Pâ ≤â .05). Maternity hospitals accredited to the Baby-Friendly Hospital Initiative had lower chances of the adequacy of promotion to exclusive breastfeeding. The sample loss rate was 13.7% in the first week and 16.6% at the end of the study period. There was inadequacy in the performance of care actions for newborns regarding access and comprehensiveness of care. These weaknesses highlight the need for reassessing skills and coordinating actions in the child's healthcare network.
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Cuidados Posteriores , Promoción de la Salud , Niño , Recién Nacido , Femenino , Embarazo , Humanos , Adulto Joven , Adulto , Estudios Longitudinales , Lactancia Materna , MaternidadesRESUMEN
INTRODUCTION: The Multiprofessional Health Residency Programs (PRMS) were set up as a strategy for training workforce for the Brazilian Unified Health System (SUS). OBJECTIVE: To investigate the proportion of alumni from Primary Health Care Multiprofessional Residency Programs admitted into the SUS and associated factors. METHODS: This is a sectional study developed with alumni from Primary Health Care Multiprofessional Residency Programs from all over Brazil, encompassing the period from 2015 to 2019. Participants answered an online questionnaire with general personal information, admission into stricto sensu graduate school, the labor market and, specifically, the SUS. We applied Pearson's chi-square test for bivariate analyses and Poisson's regression for multiple analysis. RESULTS: A total of 365 alumni from Programs from all Brazilian regions participated in the study. Of those, 80.2% reported entry into the labor market and 47.9% reported being employed in the SUS. Admission into the SUS has been associated with the professions that make up the Reference Team for Primary Health Care (PHC) (PR = 1.87; 95% CI 1.54-2.28) and non-admission into stricto sensu graduate programs (PR = 0.77; 95% CI 0.61-0.97). Regarding admission characteristics, the PHC scenario (47.4%) and work focused on health care (84.9%) were prevalent. Almost 40% of alumni who entered the SUS are working with unstable contracts. Besides, being a residency alumnus is often undervalued in recruitment (56.9%). Among those admitted into the SUS, 8.7% reported being selected to work in the Covid-19 pandemic effort. CONCLUSIONS: The results of this study reinforce the need for a policy to encourage the maintenance, creation and valorization of the PRMS. They also warn about the possibility that admission into the SUS for workers is increasingly difficult due to the current underfunding of the health system.
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COVID-19 , Internado y Residencia , Brasil , Humanos , Pandemias , SARS-CoV-2RESUMEN
OBJECTIVE: To describe feeding practices and the risk factors for the mixed breastfeeding and early weaning in the neonatal period. METHODS: Cohort study, which we collected socioeconomic, demographic, health care and feeding data from 415 mother/child binomials born in four public maternity hospitals in Natal/Brazil. They were followed-up at 48 hours, 7 and 28 days after birth. The association was established using Pearson's Chi-square test and Poisson's regression, after adjusting it to other variables. RESULTS: The prevalence of mixed breastfeeding in the first 2 days was 47,2% and early weaning in 7 and 28 days was 8,4% and 16,2% in that order. The main reasons for mixed breastfeeding and early weaning were: colostrum deficiency (33.8%), difficulty in latching/sucking (23.5%) and "little milk" (70.0%). The use of formula/milk/porridge remained associated with maternal age ≤ 20 years (RR = 0.64; 95%CI: 0.47-0.86), age 20-29 years (RR = 0,70; 95%CI: 0,57-0,87), primiparity (RR = 1.37; 95%CI: 1.11-1.60) and cesarean delivery (RR = 1.20; 95%CI: 1.00-1.45) at 2 days; absence of paternal support (RR = 4.98; 95%CI: 2.54-9.79) and pacifier use (RR = 3.21; 95%CI: 1.63-6.32) at 7 days; and only pacifier use (RR = 2.48; 95%CI: 1.53-4.02) at 28 days. CONCLUSIONS: Early weaning was associated with maternal and health care factors, thus suggesting the need to readjust good practices and educational actions to achieve the exclusive offer to the maternal breast in the neonatal period.
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Lactancia Materna , Adulto , Brasil/epidemiología , Niño , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Edad Materna , Embarazo , Destete , Adulto JovenRESUMEN
Neonatal screening is essential for child health and has the following purposes: (1) pulse oximetry screening to evaluate congenital heart diseases; (2) red reflex examination to investigate eye diseases; (3) newborn hearing screening test to evaluate congenital hearing diseases; (4) tongue test to evaluate the lingual frenulum and identify communication and feeding problems; (5) the Guthrie test to screen for metabolic diseases. This study investigated the prevalence of the five neonatal screening tests and its associated institutional and socio-cultural factors using a cross-sectional study with 415 mother and baby binomials from public maternity hospitals in Natal, RN, Brazil in 2019. Pearson's chi-squared, Mann-Whitney and Poisson regression tests were used, with a significance of p ≤ 0.05 and a 95% confidence interval. The sample loss was 71 mothers (17%). The prevalence in the first week and at the end of 28 days was 93% and 99.5% (pulse oximetry screening), 60% and 97.6% (red reflex examination), 71.9% and 93.6% (Guthrie test), 35.5% and 68.2% (hearing screening test), and 19% and 48.9% (tongue test). Only 152 newborns (36.6%) underwent all five tests. The performance of the tests was associated in the final model (p ≤ 0.05) with the residence of the mothers in the state capital (PR = 1.36; 95% CI = 1.18-1.56) and the provision of guidance for mothers about the five tests in maternity hospitals (PR = 1.30; 95% CI = 1.08-1.67). None of the tests met full coverage, and regional inequities were identified indicating the need to restructure the institutions, training and qualification procedures to improve of the work processes and longitudinal care.
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Tamizaje Neonatal/métodos , Brasil , Estudios Transversales , Femenino , Pruebas Auditivas/estadística & datos numéricos , Maternidades/estadística & datos numéricos , Hospitales Privados/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Humanos , Recién Nacido , EmbarazoRESUMEN
Background: Diabetes mellitus (DM) is associated with a higher prevalence of metabolic syndrome (MS) and cardiovascular mortality. However, few Brazilian studies evaluated MS in diabetic individuals with cardiovascular disease (CVD). Nevertheless, the objective of this study was to compare the prevalence of MS in cardiac patients with and without DM. Methods: Cross-sectional study of BALANCE Program Trial with patients with CVD, ≥45 years old, who had been attending specialized ambulatories on cardiovascular health, in eight states in the Northeast of Brazil. The components of MS were evaluated by following the criteria of National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP III) and Joint Interim Statement (JIS). In addition, there were investigated different indexes of abdominal obesity, variables related to lifestyle, and food intake. The statistical analysis included descriptive statistics and the Student's t-test, Mann-Whitney, and chi-squared tests for the comparison of groups. There were significant values of P < 0.05. Results: Six hundred forty-seven individuals were evaluated with average (standard deviation) age of 63.1 (9.3) years, being 50.5% females and 40.3% diabetic patients. When the groups of patients who were diabetic and the nondiabetic ones, the first showed higher percentage of obesity (38.5% vs. 23.2%, P < 0.001), of high waist circumference (84.8% vs. 71.9%; P < 0.001), higher waist-height ratio [0.6 (0.6-0.7) vs. 0.6 (0.5-0.6); P < 0.001], conicity index [1.35 (1.29-1.39) vs. 1.32 (1.27-1.38); P = 0.004], and prevalence of MS, because of the criteria of NCEP ATP III (98.8% vs. 80.4%; P < 0.001), as well as the criteria of JIS (99.2% vs. 89.3%; P < 0.001). The component of higher frequency was high blood pressure and/or hypertension (95.0%), followed by hypertriglyceridemia (93.0%). There were no differences regarding age, lifestyle, and food intake. Conclusions: Diabetic individuals with CVD showed more prevalence of MS and more abdominal obesity than nondiabetic individuals. ClinicalTrials.gov ID: NCT01620398.
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Enfermedades Cardiovasculares , Diabetes Mellitus , Síndrome Metabólico , Anciano , Brasil/epidemiología , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Síndrome Metabólico/epidemiología , Persona de Mediana EdadRESUMEN
The United Nations approved the Millennium Development Goals (MDGs) in 2000, including Target 4.A, or a two-thirds reduction in under-five mortality by 2015. Brazil reached this target in 2010. The current study aimed to analyze the trend in under-five mortality and the correlation with healthcare, socioeconomic, and sanitation indicators in Brazil's major geographic regions that helped the country meet the MDGs. This was an ecological study using secondary data for Brazil according to Intermediate Urban Linkage Regions (RIAU in Portuguese) from 2001 to 2017. Analyses of tendencies were performed with joinpoint and multiple linear regression models. The study showed a downward trend in the under-five mortality rate during the periods studied, with the largest statistically significant change from 2001 to 2010 (AAPC = -3.95; 95%CI: -4.3; -3.6), the lowest changes from 2011 to 2015 (AAPC = -2.35; 95%CI: -3.7; -1.0), and stabilized rates in 2016 and 2017 (AAPC = -0.07; ICC = -4.2; +4.3). Low income (extreme poverty) in the children's families and absence of maternal schooling were the variables most closely correlated with under-five mortality rate (r = 0.649, p < 0.001 and r = 0.640, p < 0.001, respectively). The fact that Brazil met the fourth target in the MDGs reflected the country's progress in reducing the under-five mortality rate, but the data suggest the rate's possible stabilization in recent years. Meanwhile, social and healthcare indicators revealed the importance of this reduction, challenging the country to maintain and further improve its public policies in this area.
No ano 2000, foram estabelecidos os Objetivos de Desenvolvimento do Milênio (ODM), que tiveram como quarta meta a redução da mortalidade na infância (em menores de 5 anos). Desde 2010, o Brasil alcançou a meta proposta. O objetivo deste estudo foi analisar o comportamento da mortalidade na infância e a correlação com os indicadores assistenciais, socioeconômicos e sanitários das regiões brasileiras que contribuíram para o país atingir os ODM. Trata-se de um estudo ecológico, com o uso de dados secundários do Brasil, por Regiões Intermediárias de Articulação Urbana (RIAU), no período de 2001 a 2017. Foram realizadas análises de tendência por meio do joinpoint e modelos de regressão linear múltipla. Constatou-se uma tendência de redução da taxa de mortalidade em menores de 5 anos nos períodos estudados, com maior inflexão estatisticamente significativa entre os anos de 2001 a 2010 (AAPC = -3,95; IC95%: -4,3; -3,6), com menores valores de 2011 a 2015 (AAPC = -2,35; IC95%: -3,7; -1,0) e estabilização em 2016 e 2017 (AAPC = -0,07; ICC = -4,2; +4,3). A baixa renda (extrema pobreza) das famílias das crianças e a ausência de escolaridade feminina foram as variáveis que mais se correlacionaram com a taxa da mortalidade na infância (r = 0,649, p < 0,001 e r = 0,640, p < 0,001, respectivamente). O cumprimento da quarta meta dos ODM pelo Brasil fez com que o país alcançasse um evidente progresso na redução da taxa de mortalidade na infância, porém percebe-se uma possibilidade de estabilização nesta taxa nos últimos anos. Por outro lado, indicadores sociais e ações assistenciais de saúde foram de grande importância nessa redução, constituindo um desafio ao país a manutenção e evolução das políticas públicas.
En el año 2000 se establecieron los Objetivos de Desarrollo del Milenio (ODM), cuya cuarta meta era la reducción de 2/3 de la mortalidad en la infancia (en menores de 5 años). Desde 2010, Brasil alcanzó la meta propuesta. El objetivo de este estudio fue analizar el comportamiento de la mortalidad en la infancia y la correlación con los indicadores asistenciales, socioeconómicos y sanitarios de las regiones brasileñas que contribuyeron a que país alcanzara los ODM. Se trata de un estudio ecológico, con la utilización de datos secundarios de Brasil, por Regiones Intermediarias de Coordinación Urbana (RIAU en Portugués), durante el período de 2001 a 2017. Se efectuaron análisis de tendencia a través de joinpoint y modelos de regresión lineal múltiple. Se constató una tendencia de reducción de la tasa de mortalidad en menores de 5 años durante los períodos estudiados, con mayor inflexión estadísticamente significativa durante el periodo de 2001 a 2010 (AAPC = -3,95; IC95%: -4,3; -3,6), con menores valores en 2011 a 2015 (AAPC = -2,35; IC95%: -3,7; -1,0) y estabilización en 2016 y 2017 (AAPC = -0,07; ICC = -4,2; +4,3). La renda baja (extrema pobreza) de las familias de los niños y la ausencia de escolaridad femenina fueron las variables que más se correlacionaron con la tasa de la mortalidad en la infancia (r = 0,649, p < 0,001 y r = 0,640, p < 0,001, respectivamente). El cumplimiento de la cuarta meta de los ODM, por parte de Brasil, consiguió que el país alcanzase un evidente progreso en la reducción de la tasa de mortalidad en la infancia, pese a que se percibe una posibilidad de estabilización en esta tasa en los últimos años. Por otro lado, indicadores sociales y acciones asistenciales de salud se revelaron de gran importancia en esa reducción, al constituirse en un desafío para el país en cuanto al mantenimiento y evolución de las políticas públicas.
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Mortalidad del Niño , Saneamiento , Brasil/epidemiología , Niño , Atención a la Salud , Humanos , Factores SocioeconómicosRESUMEN
Introdução:O novo coronavírus, denominado SARS-CoV-2, multiplica-se ainda de forma acelerada em alguns países, causando impactos na qualidade de vida da população. A transmissibilidade vertical ou pelo leite materno ainda é uma questão controversa que, dada as incertezas, pode comprometer a interação equipe/família/mãe/recém-nascido e a oferta do aleitamento materno nas primeiras horas de vida, com sua permanência no período neonatal. Objetivo:Discutiros desafios da saúde maternoinfantil e do aleitamento materno no contexto da pandemia causada pela COVID-19. Metodologia:Estudo do tipo descritivo, no qual foram verificados boletins, portarias e manuscritos relacionados ao aleitamento materno e aos cuidados maternos e neonatais para prevenção e transmissão do SARS-CoV-2. Resultados:Osdesafios perpassam pelo pré-natal, parto e puerpério devido às dificuldades assistenciais, medidas de proteção para o binômio, vulnerabilidade social e não cumprimento das recomendações. Conclusões:As dificuldades encontradas na pandemia podem refletir na saúde materna, na promoção do aleitamento materno, e na qualidade da alimentação e nutrição do recém-nascido (AU).
Introduction:The new coronavirus, called SARS-CoV-2, is still multiplying at an accelerated rate in some countries, thereby causing impacts on the quality of life of the population. Vertical or breast milk transmissibility is still a controversial issue, which, given the uncertainties, can undermine the team/family/mother/ newborn interaction, and the provision of breastfeeding in the first hours of life and its continuity in the neonatal period.Objective:To discuss the challenges of maternal and child health and breastfeeding in the contextof the pandemic caused by COVID-19.Methodology:Descriptive study, in which newsletters, ordinances and manuscripts related to breastfeeding and maternal and neonatal care for the prevention and transmission of SARS-CoV-2 were checked.Results:The challenges run through prenatal care, childbirth and the puerperium due to assistance difficulties, protection measures for the binomial, social vulnerability and non-compliance with the recommendations.Conclusions:The difficulties found in the pandemic may reflect on maternal health, on the promotion of breastfeeding, and on the quality of food and nutrition of the newborn (AU).
Introducción: El nuevo coronavirus, llamado SARS-CoV-2, todavía se está multiplicando a un ritmo rápido en algunos países, provocando impactos en la calidad de vida de la población. La transmisibilidad vertical o de la leche materna sigue siendo un tema controvertido, que,dadas las incertidumbres, puede comprometer la interacción equipo/familia/madre/recién nacido, y la oferta de lactancia materna en las primeras horas de vida y su permanencia en el período neonatal. Objetivo: Discutir los desafíos de la salud maternoinfantil y la lactancia materna en el período neonatal en el contexto de la pandemia causada por COVID-19.Metodología: Estudio descriptivo, en el que se verificaron boletines, ordenanzas y manuscritos relacionados con la lactancia materna y la atención maternay neonatal para la prevención y transmisión del SARS-CoV-2. Resultados: Los desafíos pasan por la atención prenatal, el parto y el puerperio por dificultades asistenciales, medidas de protección al binomio, vulnerabilidad social e incumplimiento de las recomendaciones. Conclusiones: Las dificultades encontradas en la pandemia pueden reflejarse en la salud materna, en la promoción de la lactancia materna, en la calidad de la alimentación y nutrición del recién nacido (AU).
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Lactancia Materna , Salud Materno-Infantil , Periodo de Transmisión , COVID-19 , Brasil/epidemiología , Epidemiología DescriptivaRESUMEN
The objective was to evaluate the childcare actions in the neonatal period from the strategies recommended by the Ministry of Health. Cross-sectional study carried out from the database of the national population-based survey entitled "Chamada Neonatal" (Neonatal Call--in English): assessment of attention to prenatal care and to children under one year in the North and Northeast, which happened in the nine priority municipalities for the Pact of reducing child mortality and Neonatal in Rio Grande do Norte, Brazil with 837 mother/child pairs. The variables were composed by issues/actions regarding the neonatal period, followed by a descriptive and inferential analysis. The whole database sample was used, composed of 57.6% in the capital and 42.4% in all the interiors. The frequency of hospital environment actions ranges from 35% to 96% and those carried out in primary care from 57% to 91.2%. Most are associated with the nature of public hospitals and the state capital, and the actions of care for continuity of care and better economic conditions (p <0.05). Not all actions met the totality of what is advocated in the programs and childcare policies, and reveals regional inequalities in healthcare.
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Mortalidad Infantil , Atención Prenatal , Brasil/epidemiología , Estudios Transversales , Atención a la Salud , Femenino , Disparidades en Atención de Salud , Humanos , Lactante , EmbarazoRESUMEN
ABSTRACT INTRODUCTION: The Multiprofessional Health Residency Programs (PRMS) were set up as a strategy for training workforce for the Brazilian Unified Health System (SUS). OBJECTIVE: To investigate the proportion of alumni from Primary Health Care Multiprofessional Residency Programs admitted into the SUS and associated factors. METHODS: This is a sectional study developed with alumni from Primary Health Care Multiprofessional Residency Programs from all over Brazil, encompassing the period from 2015 to 2019. Participants answered an online questionnaire with general personal information, admission into stricto sensu graduate school, the labor market and, specifically, the SUS. We applied Pearson's chi-square test for bivariate analyses and Poisson's regression for multiple analysis. RESULTS: A total of 365 alumni from Programs from all Brazilian regions participated in the study. Of those, 80.2% reported entry into the labor market and 47.9% reported being employed in the SUS. Admission into the SUS has been associated with the professions that make up the Reference Team for Primary Health Care (PHC) (PR = 1.87; 95% CI 1.54-2.28) and non-admission into stricto sensu graduate programs (PR = 0.77; 95% CI 0.61-0.97). Regarding admission characteristics, the PHC scenario (47.4%) and work focused on health care (84.9%) were prevalent. Almost 40% of alumni who entered the SUS are working with unstable contracts. Besides, being a residency alumnus is often undervalued in recruitment (56.9%). Among those admitted into the SUS, 8.7% reported being selected to work in the Covid-19 pandemic effort. CONCLUSIONS: The results of this study reinforce the need for a policy to encourage the maintenance, creation and valorization of the PRMS. They also warn about the possibility that admission into the SUS for workers is increasingly difficult due to the current underfunding of the health system.
RESUMO INTRODUÇÃO: Os Programas de Residência Multiprofissional em Saúde (PRMS) configuram-se como estratégia para a formação de força de trabalho para o Sistema Único de Saúde (SUS). OBJETIVO: Investigar a proporção de egressos de PRMS voltados à Atenção Primária à Saúde (APS) inseridos no SUS e fatores associados. MÉTODOS: Trata-se de um estudo seccional desenvolvido com egressos de PRMS voltados à APS de todo o Brasil, referente ao período de 2015 a 2019. Os participantes responderam a um questionário on-line com informações pessoais gerais, inserção na pós-graduação stricto sensu, no mercado de trabalho e especificamente no SUS. Foram aplicados o teste qui-quadrado de Pearson, para análises bivariadas, e Regressão de Poisson, para a análise múltipla. RESULTADOS: Participaram do estudo 365 egressos de Programas de todas as regiões brasileiras. Destes, 80,2% relataram inserção no mercado de trabalho e 47,9% informaram estar trabalhando no SUS. A inserção no SUS esteve associada às profissões que compõem a Equipe de Referência para a APS (RP = 1,87; IC95% 1,54-2,28) e à não inserção em programas de pós-graduação stricto sensu (RP = 0,77; IC95% 0,61-0,97). Quanto às características de inserção, prevaleceram o cenário da APS (47,4%) e o trabalho voltado à atenção à saúde (84,9%). Quase 40% dos egressos inseridos no SUS estão trabalhando por intermédio de vínculos instáveis, além de frequente não valorização do título da residência no recrutamento (56,9%). Entre os inseridos no SUS, 8,7% relataram terem sido selecionados para o enfrentamento da pandemia de covid-19. CONCLUSÕES: Os resultados deste estudo reforçaram a necessidade de política de incentivo à manutenção, criação e valorização dos PRMS e alertaram para possível aumento da dificuldade de inserção das categorias profissionais, frente ao cenário de desfinanciamento da saúde.
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Humanos , COVID-19 , Internado y Residencia , Brasil , Pandemias , SARS-CoV-2RESUMEN
Abstract Objectives: to identify the prevalence and determining factors of the complements in offering food to newborns. Methods: across-sectional study nested to a cohort study that assessed newborn care in four public maternity hospitals in Natal/Brazil. Sample was composed by 415 mothers and full-term newborns, with appropriate weight for gestational age and Apgar scores in 1st and 5th minutes ≥ 7. In order to analyze the determining factors, we used Poisson's regression. Results: from 415 newborns, 51.3% received feeding complements (57.6% in the first hour of life), of which 92% was infant formula. Only 50.7% of those complement in offering food were prescribed by physicians. Colostrum deficiency was the main reason to be indicated (33.8%). Maternal age ≤ 20 years old (PR=0.64; CI95%=0.47-0.86) and between 2030 years old (PR=0.70; CI95%=0.57-0.87)comparing to women older than 30 were shown as protective factors, while being primiparous (PR=1.37; CI95%=1.11-1.60) and had cesarean section (PR=1.2; CI95%=1.00-1.45) as risk factors. Conclusion: maternal characteristics are associated with the complement in offering food to the newborn in the first hours of life. The high prevalence shows the need for interventions that minimize the inadequate offer of infant formula and promote exclusive breastfeeding before hospital discharge.
Resumo Objetivos: identificar a prevalência e os fatores determinantes da oferta do complemento alimentar para o recém-nascido. Métodos: estudo transversal, aninhado a um estudo de coorte que avaliou a assistência ao neonato em quatro maternidades públicas de Natal/Brasil. Amostra composta de 415 mães, e recém-nascidos à termo, com peso adequado para idade gestacional e Apgar no 1º e 5º minuto ≥ 7. Para analisar os fatores determinantes, foi utilizado a regressão de Poisson. Resultados: dos 415 recém-nascidos, 51,3% receberam complemento (57,6% na primeira hora de vida), dos quais 92% com fórmula infantil. Destes, apenas 50,7% foi prescrito pelo médico. A deficiência de colostro foi o principal motivo de indicação (33,8%). A idade materna ≤ 20 anos (RP=0,64; IC95%=0,47-0,86) e entre 20-30 anos (RP=0,70; IC95%=0,57-0,87, em comparação com mulheres acima de 30 anos, mostrou-se como fator de proteção, enquanto ser primípara (RP=1,37; IC95%=1,11-1,60) e o parto cesárea (RP=1,2; IC95%=1,00-1,45) como fatores de risco. Conclusão: as características maternas e assistenciais estão associadas à oferta de complemento alimentar ao recém-nascido nas primeiras horas de vida. A alta prevalência mostra a necessidade de intervenções que minimizem a oferta inadequada de fórmula infantil, e promovam o aleitamento materno exclusivo antes da alta hospitalar.
Asunto(s)
Humanos , Recién Nacido , Lactante , Destete , Lactancia Materna/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Fórmulas Infantiles/estadística & datos numéricos , Nutrición del Lactante , Brasil , Estudios Transversales , Estudios de Cohortes , Bancos de Leche Humana , Nacimiento a Término , Fenómenos Fisiológicos Nutricionales del Lactante , Leche HumanaRESUMEN
ABSTRACT OBJECTIVE To describe feeding practices and the risk factors for the mixed breastfeeding and early weaning in the neonatal period. METHODS Cohort study, which we collected socioeconomic, demographic, health care and feeding data from 415 mother/child binomials born in four public maternity hospitals in Natal/Brazil. They were followed-up at 48 hours, 7 and 28 days after birth. The association was established using Pearson's Chi-square test and Poisson's regression, after adjusting it to other variables. RESULTS The prevalence of mixed breastfeeding in the first 2 days was 47,2% and early weaning in 7 and 28 days was 8,4% and 16,2% in that order. The main reasons for mixed breastfeeding and early weaning were: colostrum deficiency (33.8%), difficulty in latching/sucking (23.5%) and "little milk" (70.0%). The use of formula/milk/porridge remained associated with maternal age ≤ 20 years (RR = 0.64; 95%CI: 0.47-0.86), age 20-29 years (RR = 0,70; 95%CI: 0,57-0,87), primiparity (RR = 1.37; 95%CI: 1.11-1.60) and cesarean delivery (RR = 1.20; 95%CI: 1.00-1.45) at 2 days; absence of paternal support (RR = 4.98; 95%CI: 2.54-9.79) and pacifier use (RR = 3.21; 95%CI: 1.63-6.32) at 7 days; and only pacifier use (RR = 2.48; 95%CI: 1.53-4.02) at 28 days. CONCLUSIONS Early weaning was associated with maternal and health care factors, thus suggesting the need to readjust good practices and educational actions to achieve the exclusive offer to the maternal breast in the neonatal period.
Asunto(s)
Humanos , Femenino , Recién Nacido , Lactante , Niño , Adulto , Adulto Joven , Lactancia Materna , Destete , Brasil/epidemiología , Estudios de Cohortes , Edad MaternaRESUMEN
No ano 2000, foram estabelecidos os Objetivos de Desenvolvimento do Milênio (ODM), que tiveram como quarta meta a redução da mortalidade na infância (em menores de 5 anos). Desde 2010, o Brasil alcançou a meta proposta. O objetivo deste estudo foi analisar o comportamento da mortalidade na infância e a correlação com os indicadores assistenciais, socioeconômicos e sanitários das regiões brasileiras que contribuíram para o país atingir os ODM. Trata-se de um estudo ecológico, com o uso de dados secundários do Brasil, por Regiões Intermediárias de Articulação Urbana (RIAU), no período de 2001 a 2017. Foram realizadas análises de tendência por meio do joinpoint e modelos de regressão linear múltipla. Constatou-se uma tendência de redução da taxa de mortalidade em menores de 5 anos nos períodos estudados, com maior inflexão estatisticamente significativa entre os anos de 2001 a 2010 (AAPC = -3,95; IC95%: -4,3; -3,6), com menores valores de 2011 a 2015 (AAPC = -2,35; IC95%: -3,7; -1,0) e estabilização em 2016 e 2017 (AAPC = -0,07; ICC = -4,2; +4,3). A baixa renda (extrema pobreza) das famílias das crianças e a ausência de escolaridade feminina foram as variáveis que mais se correlacionaram com a taxa da mortalidade na infância (r = 0,649, p < 0,001 e r = 0,640, p < 0,001, respectivamente). O cumprimento da quarta meta dos ODM pelo Brasil fez com que o país alcançasse um evidente progresso na redução da taxa de mortalidade na infância, porém percebe-se uma possibilidade de estabilização nesta taxa nos últimos anos. Por outro lado, indicadores sociais e ações assistenciais de saúde foram de grande importância nessa redução, constituindo um desafio ao país a manutenção e evolução das políticas públicas.
En el año 2000 se establecieron los Objetivos de Desarrollo del Milenio (ODM), cuya cuarta meta era la reducción de 2/3 de la mortalidad en la infancia (en menores de 5 años). Desde 2010, Brasil alcanzó la meta propuesta. El objetivo de este estudio fue analizar el comportamiento de la mortalidad en la infancia y la correlación con los indicadores asistenciales, socioeconómicos y sanitarios de las regiones brasileñas que contribuyeron a que país alcanzara los ODM. Se trata de un estudio ecológico, con la utilización de datos secundarios de Brasil, por Regiones Intermediarias de Coordinación Urbana (RIAU en Portugués), durante el período de 2001 a 2017. Se efectuaron análisis de tendencia a través de joinpoint y modelos de regresión lineal múltiple. Se constató una tendencia de reducción de la tasa de mortalidad en menores de 5 años durante los períodos estudiados, con mayor inflexión estadísticamente significativa durante el periodo de 2001 a 2010 (AAPC = -3,95; IC95%: -4,3; -3,6), con menores valores en 2011 a 2015 (AAPC = -2,35; IC95%: -3,7; -1,0) y estabilización en 2016 y 2017 (AAPC = -0,07; ICC = -4,2; +4,3). La renda baja (extrema pobreza) de las familias de los niños y la ausencia de escolaridad femenina fueron las variables que más se correlacionaron con la tasa de la mortalidad en la infancia (r = 0,649, p < 0,001 y r = 0,640, p < 0,001, respectivamente). El cumplimiento de la cuarta meta de los ODM, por parte de Brasil, consiguió que el país alcanzase un evidente progreso en la reducción de la tasa de mortalidad en la infancia, pese a que se percibe una posibilidad de estabilización en esta tasa en los últimos años. Por otro lado, indicadores sociales y acciones asistenciales de salud se revelaron de gran importancia en esa reducción, al constituirse en un desafío para el país en cuanto al mantenimiento y evolución de las políticas públicas.
The United Nations approved the Millennium Development Goals (MDGs) in 2000, including Target 4.A, or a two-thirds reduction in under-five mortality by 2015. Brazil reached this target in 2010. The current study aimed to analyze the trend in under-five mortality and the correlation with healthcare, socioeconomic, and sanitation indicators in Brazil's major geographic regions that helped the country meet the MDGs. This was an ecological study using secondary data for Brazil according to Intermediate Urban Linkage Regions (RIAU in Portuguese) from 2001 to 2017. Analyses of tendencies were performed with joinpoint and multiple linear regression models. The study showed a downward trend in the under-five mortality rate during the periods studied, with the largest statistically significant change from 2001 to 2010 (AAPC = -3.95; 95%CI: -4.3; -3.6), the lowest changes from 2011 to 2015 (AAPC = -2.35; 95%CI: -3.7; -1.0), and stabilized rates in 2016 and 2017 (AAPC = -0.07; ICC = -4.2; +4.3). Low income (extreme poverty) in the children's families and absence of maternal schooling were the variables most closely correlated with under-five mortality rate (r = 0.649, p < 0.001 and r = 0.640, p < 0.001, respectively). The fact that Brazil met the fourth target in the MDGs reflected the country's progress in reducing the under-five mortality rate, but the data suggest the rate's possible stabilization in recent years. Meanwhile, social and healthcare indicators revealed the importance of this reduction, challenging the country to maintain and further improve its public policies in this area.
Asunto(s)
Humanos , Niño , Saneamiento , Mortalidad del Niño , Factores Socioeconómicos , Brasil/epidemiología , Atención a la SaludRESUMEN
Introdução:Vivencia-se na atualidade uma pandemia causada pelo novo Coronavírus,o qual é transmitido por meio de gotículas de saliva, espirro e tosse, fazendo-se necessário mudanças na assistência ao paciente. Objetivo:Descrever a experiência com a construção de um Procedimento Operacional Padrão para assistência nutricional em pacientes acometidos pelo Coronavírus. Metodologia:Trata-se de um estudo descritivo, do tipo relato de experiência,vivenciado pela equipe de residentes multiprofissionais em nutrição do Hospital Universitário Onofre Lopes,da Universidade Federal do Rio Grande do Norte. Resultados:Baseado nas recomendações da Organização Mundial de Saúde e do Conselho Federal de Nutrição e, com a participação dos profissionais do serviço, foi construído o referido procedimento que descreve as boas práticas na triagem, avaliação e conduta nutricional. Conclusão:A implantação e implementação do POP oportunizou a interação de conhecimentos e novas condutas assistenciais, mesmo diante das limitações estruturais, de equipamentos de proteção individual e de medidas de contingenciamento implementadas no serviço (AU).
Introduction:We are currently experiencing a pandemic caused by the new Coronavirus, which is transmitted through droplets of saliva, sneezing and coughing, making changes in patient care necessary. Objective:To describe the experience with the construction of a Standard Operating Procedure for nutritional assistance in patients affected by the Coronavirus. Methodology:This is a descriptive study, an experience report, experienced by the team of multiprofessional residents in nutrition at the Hospital Universitário Onofre Lopes, at the Federal University of Rio Grande do Norte. Results:Based on the recommendations of the World Health Organization and the Federal Nutrition Council and, with the participation of service professionals, the referred procedure was developed, which describes good practices in screening, assessment and nutritional conduct. Conclusion: The implementation and implementation of SOP provided an opportunity for the interaction of knowledge and new care behaviors, even in the face of structural limitations, personal protective equipment and contingency measures implemented in the service (AU).
Introducción:Actualmenteestamos experimentando una pandemia causada por el nuevo Coronavirus, que se transmite a través de gotas de saliva, estornudos y tos, lo que hace que sea necesario realizar cambios en la atención del paciente. Objetivo:Describir la experiencia con la construcción de un Procedimiento Operativo Estándar para asistencia nutricional en pacientes afectados por el Coronavirus. Metodología:Este es un estudio descriptivo, un informe de experiencia, experimentado por el equipo de residentes multiprofesionales en nutrición del Hospital Universitário Onofre Lopes, de la Universidad Federal de Río Grande del Norte. Resultados:Basado en las recomendaciones de la Organización Mundial de la Salud y el Consejo Federal de Nutrición y, con la participación de profesionales de servicio, se desarrolló el procedimiento referido, que describe buenas prácticas en la detección, evaluación y conducta nutricional. Conclusión:La implementación e implementación de SOP brindó una oportunidad para la interacción del conocimiento y los nuevos comportamientos de atención, incluso frente a limitaciones estructurales, equipos de protección individual y medidas de contingencia implementadas en el servicio (AU).
Asunto(s)
Protocolos Clínicos/normas , Infecciones por Coronavirus/prevención & control , Atención Integral de Salud , Nutricionistas , Brasil , Aprendizaje Basado en Problemas/métodos , Promoción de la SaludRESUMEN
O período neonatal requer uma atenção qualificada, dada a susceptibilidade do recém-nascido às adversidades. Este estudo objetivou avaliar o acesso e a implementação das ações assistenciais preconizadas pelo Ministério da Saúde para o período neonatal e suas associações com as características institucionais e sócios demográficas. Realizou-se um estudo de coorte em quatro maternidades públicas da cidade de Natal/RN, Brasil. Constituiu a amostra 415 binômios mãe/filho, sendo recém-nascidos a termo, peso ≥ 2,5kg e Apgar ≥ 7,0. A coleta de dados foi realizada 48h após o nascimento (presencial), com sete dias e 28 dias de vida (por ligação telefônica). A partir dos dados obtidos foram desenvolvidos cinco estudos, sendo três transversais, um longitudinal, e face ao contexto atual da Covid-19, uma revisão narrativa. Os estudos abordaram questões referentes às ações assistenciais ao recém-nascido e a continuidade do cuidado no período neonatal, à prevalência da realização dos cinco testes de triagem neonatal, aos determinantes da oferta de complemento ao leite materno nas primeiras 48 horas de vida, às práticas alimentares no período neonatal, e aos desafios para manter o aleitamento materno exclusivo diante da pandemia da Covid-19. A análise estatística incluiu frequências absolutas e relativas, e a regressão múltipla de Poisson, com Intervalo de Confiança (IC) de 95%. Dos 415 binômios inicialmente avaliados, houve uma perda de 13,7% no segundo período e de 16,6% no terceiro período. As mães, majoritariamente, encontravam-se na faixa etária de 20 a 29 anos (46,5%), eram casadas ou viviam em união estável (79,0%) e possuíam ensino médio ou superior (65,3%). Quanto ao recém-nascido, a maioria (52,5%) era do sexo masculino, com média da idade gestacional de 39,2 ± 1,3 semanas e peso ao nascer de 3.310 ± 478,6g. Destacam-se como principais resultados: Das 40 ações realizadas na maternidade e na Atenção Primária em Saúde, 20% foram classificadas em satisfatórias, 50% parcial e 30% insatisfatórias. A adequação de indicadores compostos da assistência esteve associada às mulheres submetidas ao parto vaginal, multípara, e às maternidades de risco habitual. Dentre essas ações, a prevalência da realização dos cinco testes foi de 36,6%, estando associada às mães residentes na capital do estado (RP=1,36; IC95%=1,18-1,56) e àquelas que receberam orientações antes da alta (RP=1,30; IC95%=1,08-1,67). A oferta de complemento ao leite materno aconteceu para 51,3% dos recém-nascidos, sendo 57,6% na primeira hora de vida e 92% com fórmula artificial, estando associado a idade materna ≤ 20 anos (RP=0,64; IC95%=0,47-0,86), primiparidade (RP=1,37; IC95%=1,11-1,60) e cesárea (RP=1,2; IC95%=1,00-1,45). O desmame precoce ocorreu em 8,4% dos recém-nascidos na primeira semana e em 16,2% ao final dos 28 dias, estando associado à ausência de apoio paterno (RR:4,98; IC:2,54-9,79) e ao uso de chupeta (RR= 3,2, IC:1,63-6,32) aos sete dias, e somente ao uso de chupeta (RR=2,48, IC:1,53-4,02) aos 28 dias. A pandemia do novo coronavírus ainda é uma questão controversa que, dadas as incertezas, pode comprometer a interação equipe/família/mãe/recém-nascido, e o aleitamento materno nas primeiras horas de vida. Os resultados apontam fragilidades e a necessidade de reestruturação da assistência e readequação de boas práticas que favoreçam o cuidado integral e longitudinal ao neonato (AU).
The neonatal period requires qualified attention, given the newborn's susceptibility to adversities. This study was intended to evaluate the access the implementation of the care actions recommended by the Brazilian Ministry of Health for the neonatal period and its associations with institutional characteristics and demographic partners. A cohort study was held in four public maternity hospitals in the city of Natal/RN, Brazil. The sample consisted of 415 mother/child binomials, being full-term newborns, weight ≥ 2.5 kg and Apgar ≥ 7.0. Data collection took place 48 hours after birth (in person), with seven days and 28 days of life (by telephone call). From the obtained data, five studies were developed, three cross-sectional, one longitudinal; and, in view of the current context of Covid-19, a revisão narrativa. The studies addressed the following issues related to the care actions for the newborn and the continuity of care in the neonatal period; the prevalence of the five neonatal screening tests; the determinants of the supply of complement to breast milk in the first 48 hours of life; the feeding practices in the neonatal period and the challenges to maintain exclusive breastfeeding in the face of the Covid-19. The statistical analysis included applications of Pearson's chi-square and multiple Poisson regression, with a 95% confidence interval (95% CI). Of the 415 binomials initially assessed, there was a loss of 13.7% in the second period and 16.6% in the third period. The mothers, mostly, were in the age group of 20 to 29 years (46.5%), were married or lived in a stable relationship (79.0%) and had high school or higher education (65.3%). As for the newborn, most (52.5%) were male, with an average gestational age of 39.2 ±1,3 weeks and birth weight of 3.310 ± 478,6g. The main results of the studies should be highlighted: (1) Of the 29 actions performed in the maternity ward and 11 in Primary Health Care, 20% were classified as satisfactory, 50% partial and 30% unsatisfactory. The adequacy of composite care indicators was associated with multiparous women undergoing vaginal delivery, usual risk maternity hospitals. Among these actions, the prevalence of the five tests was 36.6%, associated with mothers living in the state capital (PR = 1.36; 95% CI = 1.18-1.56) and with those who received guidance at the maternity hospitals (PR = 1.30; 95% CI = 1.08-1.67). Half of the newborns received complementary breast milk, being 57.6% in the first hour of life and 92% with artificial formula, which was associated with maternal age ≤ 20 years (PR = 0.64; 95% CI = 0.47-0.86), primiparity (PR=1.37; 95% CI=1.11-1.60) and cesarean (PR = 1.2; 95% CI = 1.00-1.45). Early weaning occurred in 8.4% of newborns in the first week and in 16.2% at the end of the 28 days, being associated with the absence of paternal support (RR: 4.98; CI: 2.54- 9.79) and the use of a pacifier (RR = 3.2, CI: 1.63-6.32) seven days, and only using a pacifier (RR = 2.48, CI: 1.53-4.02) at 28 days. (5) The new coronavirus pandemic is still a controversial issue that, given the uncertainties, may compromise team/family/mother/newborn interaction, as well as breastfeeding, in the first hours of life. The results underline the need to restructure care and readjust good practices that favor comprehensive and longitudinal care of the newborn (AU).
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Recién Nacido , Servicios de Salud del Niño , Mortalidad , Servicios de Salud Materno-Infantil , Accesibilidad a los Servicios de Salud , Registros Médicos , Salud Infantil , Estudios Transversales/métodos , Interpretación Estadística de Datos , Estudios LongitudinalesRESUMEN
Resumo O objetivo foi avaliar as ações de atenção à criança no período neonatal a partir das estratégias preconizadas pelo Ministério da Saúde. Estudo transversal realizado a partir do banco de dados da pesquisa nacional de base populacional intitulada “Chamada Neonatal: avaliação da atenção ao pré-natal e aos menores de um ano nas regiões Norte e Nordeste”, que aconteceu nos nove municípios prioritários para o Pacto de Redução da Mortalidade Infantil e Neonatal no Rio Grande do Norte, com 837 pares mãe/filho. As variáveis foram compostas pelas questões/ações referentes ao período neonatal, seguidas de uma análise descritiva e inferencial. Foi utilizada toda a amostra do banco de dados composta por 57,6% na capital e 42,4% no conjunto dos interiores. A frequência das ações de âmbito hospitalar variou de 35% a 96% e as realizadas na atenção básica de 57% a 91,2%. A maioria teve associação com os hospitais de natureza pública e com a capital do estado, e as ações de atenção à continuidade do cuidado com melhores condições econômicas (p < 0,05). Todas as ações não atenderam a totalidade do que é preconizado nos programas e políticas de atenção à criança, e revelam as iniquidades regionais em saúde.
Abstract The objective was to evaluate the childcare actions in the neonatal period from the strategies recommended by the Ministry of Health. Cross-sectional study carried out from the database of the national population-based survey entitled “Chamada Neonatal” (Neonatal Call - in English): assessment of attention to prenatal care and to children under one year in the North and Northeast, which happened in the nine priority municipalities for the Pact of reducing child mortality and Neonatal in Rio Grande do Norte, Brazil with 837 mother/child pairs. The variables were composed by issues/actions regarding the neonatal period, followed by a descriptive and inferential analysis. The whole database sample was used, composed of 57.6% in the capital and 42.4% in all the interiors. The frequency of hospital environment actions ranges from 35% to 96% and those carried out in primary care from 57% to 91.2%. Most are associated with the nature of public hospitals and the state capital, and the actions of care for continuity of care and better economic conditions (p <0.05). Not all actions met the totality of what is advocated in the programs and childcare policies, and reveals regional inequalities in healthcare.
Asunto(s)
Humanos , Femenino , Embarazo , Lactante , Atención Prenatal , Mortalidad Infantil , Brasil/epidemiología , Estudios Transversales , Atención a la Salud , Disparidades en Atención de SaludRESUMEN
RESUMO Objetivo Identificar a prevalência da utilização de suplemento alimentar em recém-nascidos e avaliar as características, os solicitantes e os motivos justificados para sua utilização em um "Hospital Amigo da Criança". Métodos Trata-se de estudo do tipo transversal, realizado com 113 díades mãe e filho de um hospital universitário com o título de "Amigo da Criança", no período de agosto de 2012 a fevereiro de 2013. A partir de um questionário estruturado, foram coletadas informações sociodemográficas, antecedentes obstétricos, condições de nascimento da criança, características do suplemento e prescritores. Foi realizada análise descritiva e inferencial (teste Qui-quadrado de Pearson), aceitando um nível de significância p?0,05, com intervalo de confiança de 95%. Resultados A prevalência de indicação de suplemento alimentar foi de 16,0%, com menor aderência para os nascidos nas primeiras horas do dia (p=0,006). O profissional de enfermagem foi o que mais solicitou o suplemento (54,0%), e no menor tempo (1 a 6 horas) após o nascimento da criança (p=0,05). Quanto aos motivos de indicação, apenas 6,2% atenderam às recomendações da Iniciativa Hospital Amigo da Criança, destacando-se a hipogalactia como principal motivo (71,7%), com maior probabilidade de indicação para os recém-nascidos de parto cesáreo (p<0,02). Conclusão Apesar do título de "Hospital Amigo da Criança", foram identificadas inúmeras indicações de suplemento ali-mentar desnecessárias e precipitadas, o que pode dificultar o aleitamento materno e favorecer o desmame precoce, sugerindo a necessidade de uma avaliação mais criteriosa na indicação pela equipe assistencial.
ABSTRACT Objective To identify the prevalence of infant formula use and assess the characteristics, requesters, and reasons that justify its use in a Baby-Friendly Hospital. Methods This cross-sectional study included 113 mother/child dyads from a university hospital with the title "Baby-Friendly Hospital" from August 2012 to February 2013. A structured questionnaire collected sociodemographic data, obstetric history, newborn birth conditions, infant formula characteristics, and prescribers. Descriptive and inferential analyses (Pearson's Chi-square test) were conducted using a significance level of p?0.05 and a 95% confidence interval. Results The prevalence of infant formula prescription was of 16.0%, with smaller adherence in infants born in the first hours of the day (p=0.006). Nurses made the most requests (54.0%) and in the shortest period of time (1 to 6 hours) after delivery (p=0.05). Only 6.2% of the requests complied with the recommendations made by Baby-Friendly Hospitals, and the main reason for the request was hypogalactia (71.7%). Infant formula was more likely to be indicated to infants born by cesarean section (p<0.02). Conclusion Despite the title "Baby-Friendly Hospital", numerous unnecessary and hasty infant formula indications were identified, which may hinder breastfeeding and favor early weaning, suggesting that the care team needs to assess infant formula indication more thoroughly.