Effects of the use of a cocoon on the autonomic, motor, and regulatory systems in preterm newborns: Randomized clinical trial.

INTRODUCTION: The wrapping of the newborn in an orthopedic tubular mesh, simulating a cocoon, can allow the infant to regain the feeling of security and stability experienced in the uterus given that the movement of one of the parts of the body exerts tactile and pressure variation in others. OBJECTIVE: We aimed to evaluate the influence of an orthopedic tubular mesh, simulating a cocoon, in therapeutic positioning, on the variables of the autonomous, motor, and regulatory systems of preterm newborns. METHODS: A controlled and randomized clinical trial was conducted with preterm newborns positioned in dorsal decubitus and divided into two groups: (a) cocoon - newborns covered with an orthopedic tubular mesh, and (b) control - newborns positioned according to the sector's routine and without the use of an orthopedic mesh. During the follow-up, each newborn was placed in the position for 30 min and was recorded for a total of 2 min, once at the beginning and again at the end of the observation period. Variables related to the autonomous system (heart rate, respiratory rate, and peripheral oxygen saturation), motor system (general movements), and regulatory system (Neonatal Infant Pain Scale) were evaluated before and after the intervention. The videos were evaluated by a researcher blind to the purpose of the study, and the resulting data were analyzed using SPSS. RESULTS: Of the 40 preterm newborns evaluated (32.5 ± 1.83 weeks), 21 were female, and 20 were allocated to the cocoon group. The variables related to the autonomous, motor, and regulatory systems remained unchanged following the positioning in the cocoon, as compared to the typical positioning employed in the neonatal unit. CONCLUSION: The simulation of a cocoon, utilizing an orthopedic tubular mesh, when applied to preterm newborns admitted to a neonatal intensive care unit can contribute to maintaining low levels of stress, without altering variables of the autonomous, motor, and regulatory systems.

Real-time changes in rib cage expansion and use of abdominal mechanical stimulation in newborns: a quasi-experimental study / Mudanças na expansibilidade torácica com o uso de estímulo mecânico na região abdominal em recém-nascidos: um estudo quase-experimental

ABSTRACT Objective: To assess the rib cage expansion and respiratory rate in newborns using an abdominal stabilization band. Methods: The study included 32 newborns of both genders, with gestational age between 35 and 41 weeks. The abdominal stabilization band was used for 15 minutes between the xiphoid process and the anterosuperior iliac crest, with an abdominal contention 0.5cm smaller than the abdominal circumference. The rib cage expansion was evaluated by a breathing transducer (Pneumotrace II™) three minutes before using the band, during the use (15 minutes), and ten minutes after removing the band. The Shapiro-Wilk test verified data normality, and the Wilcoxon test compared the variables considering rib cage expansion and respiratory rate. Significance was set to p<0.05. Results: There was an increase in respiratory rate when comparing before and ten minutes after removing (p=0.008) the abdominal stabilization band, as well as when comparing during its use and ten minutes after its removal (p=0.001). There was also an increase in rib cage expansion when comparing before and during the use of the abdominal stabilization band (p=0.005). Conclusions: The use of the abdominal stabilization band promoted an increase in the rib cage expansion and respiratory rate in the assessed newborns and may be a viable option to improve the respiratory kinematics of this population.

RESUMO Objetivo: Avaliar a expansibilidade torácica e a frequência respiratória em recém-nascidos que fizeram uso de uma faixa de estabilização abdominal. Métodos: O estudo incluiu 32 recém-nascidos de ambos os sexos, com idade gestacional entre 35 e 41 semanas. A faixa de estabilização abdominal foi mantida por 15 minutos entre o processo xifoide e a espinha ilíaca anterossuperior, com contenção abdominal 0,5 cm menor do que a circunferência abdominal. A expansibilidade torácica foi avaliada por um transdutor piezoelétrico (Pneumotrace II™) 3 minutos antes do uso da faixa, durante 15 minutos, e 10 minutos após sua retirada. A normalidade das variáveis foi testada pelo teste de Shapiro-Wilk e a análise comparativa da expansibilidade torácica e da frequência respiratória foi realizada por meio do teste t pareado, considerando-se p<0,05. Resultados: Houve aumento da frequência respiratória quando comparados os tempos antes do uso da faixa e 10 minutos após a retirada (p=0,008), bem como quando comparados os tempos durante o uso e 10 minutos após a retirada da faixa (p=0,001). Houve aumento da expansibilidade torácica quando comparados os tempos antes e durante o uso da faixa (p=0,005). Conclusões: O uso da faixa de estabilização abdominal conferiu aumento da expansibilidade torácica e da frequência respiratória nos recém-nascidos estudados, podendo ser uma opção viável para a melhora da cinemática respiratória dessa população.

Real-time changes in rib cage expansion and use of abdominal mechanical stimulation in newborns: a quasi-experimental study.

OBJECTIVE: To assess the rib cage expansion and respiratory rate in newborns using an abdominal stabilization band. METHODS: The study included 32 newborns of both genders, with gestational age between 35 and 41 weeks. The abdominal stabilization band was used for 15 minutes between the xiphoid process and the anterosuperior iliac crest, with an abdominal contention 0.5cm smaller than the abdominal circumference. The rib cage expansion was evaluated by a breathing transducer (Pneumotrace II™) three minutes before using the band, during the use (15 minutes), and ten minutes after removing the band. The Shapiro-Wilk test verified data normality, and the Wilcoxon test compared the variables considering rib cage expansion and respiratory rate. Significance was set to p<0.05. RESULTS: There was an increase in respiratory rate when comparing before and ten minutes after removing (p=0.008) the abdominal stabilization band, as well as when comparing during its use and ten minutes after its removal (p=0.001). There was also an increase in rib cage expansion when comparing before and during the use of the abdominal stabilization band (p=0.005). CONCLUSIONS: The use of the abdominal stabilization band promoted an increase in the rib cage expansion and respiratory rate in the assessed newborns and may be a viable option to improve the respiratory kinematics of this population.

Trajectory of Systemic Blood Pressure in Early Life: A Cohort Study.

Objective. To track the BP (blood pressure) trajectory of healthy infants during the first year of life of healthy infants born in Northeast Brazil. Methods. In this cohort study, BP was assessed by oscillometry at the first 24 hours of life and 12 months of age. Results. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) increased with age (P < .001) and were not influenced by gender (SBP: P = .178 and DBP: P = .623) or type of delivery (SBP: P = .827 and DBP: P = .106), when compared between the first 24 hours of life and 12 months of age. Conclusion. The data from the present study increased knowledge about the trajectory of BP during the first year of life. The increase in BP between the first month and the first year of life was not influenced by gender or type of delivery.

Self-efficacy and breastfeeding outcomes in mothers of premature and term infants: a longitudinal study. / Autoeficácia e desfechos da amamentação em mães de bebês prematuros e a termo: um estudo longitudinal.

PURPOSE: To analyze the breastfeeding self-efficacy in mothers of premature and full-term newborns, in the period of 180 days, and to know the social and obstetric factors that influence the practice of maintaining the exclusive breastfeeding in the period of exclusive recommendation. METHODS: Cohort with 44 mothers admitted to a public maternity hospital between January and October 2018. The mothers were divided into two groups: Premature and Full-term Groups. The Breastfeeding Self-efficacy Scale was applied in the immediate postpartum period, in addition to a questionnaire elaborated by the authors to collect sociodemographic and obstetric variables. The follow-up was done on the 30th, 120th and 180th days of the newborn's life, by telephone. For the statistical analysis between the groups, the Statistical Package for the Social Sciences (SPSS) was used. RESULTS: There was no difference in the self-efficacy score, nor in the obstetric and socioeconomic characteristics between the groups, except for family income (lower in the Premature Group - p = 0.031). The diet type was different on the 30th day after delivery (p = 0.023), with greater adherence to the exclusive breastfeeding in the Premature Group. No association was found between breastfeeding self-efficacy and exclusive breastfeeding practice in the 180-day period. CONCLUSION: In this sample, the breastfeeding self-efficacy was not related to the exclusive breastfeeding practice in the period of 180 days, in both groups. The premature group showed lower family income and greater adherence to exclusive breastfeeding on the 30th day postpartum.

OBJETIVO: Analisar a autoeficácia da amamentação, no período de 180 dias, em mães de recém-nascidos prematuros e a termo, e conhecer os fatores que influenciam na prática do aleitamento materno exclusivo no período de recomendação exclusiva. MÉTODO: Coorte realizado com 44 puérperas de uma maternidade pública, entre janeiro e outubro de 2018. As puérperas foram divididas em dois grupos: Grupo Prematuro e Grupo Termo. A Breastfeeding Self-efficacy Scale foi aplicada no pós-parto imediato, além de um questionário elaborado pelos autores para coleta de variáveis sociodemográficas e obstétricas. O monitoramento da continuidade do aleitamento materno foi feito no 30º, 120º e 180º dia de vida do neonato, via telefone. Para a análise estatística entre os grupos foi utilizado o Statistical Package for the Social Sciences (SPSS). RESULTADOS: Não houve diferença na pontuação da autoeficácia, nas características obstétricas e socioeconômicas entre os grupos, exceto para a variável renda familiar, (menor no Grupo Prematuro - p=0,031). O tipo de dieta foi diferente no 30º dia pós parto (p=0,023), com maior adesão ao aleitamento materno exclusivo no Grupo Prematuro. Não foi encontrada associação entre a autoeficácia da amamentação e a prática do aleitamento materno exclusivo no período de 180 dias. CONCLUSÃO: Nesta amostra, a autoeficácia da amamentação não teve relação com a prática do aleitamento materno exclusivo no período de 180 dias em ambos os grupos. O grupo de prematuros apresentou menor renda familiar e maior adesão ao aleitamento materno exclusivo no 30º dia pós parto.

Embedding Play to Enrich Physical Therapy.

Play is an active process by which an individual is intrinsically motivated to explore the self, the environment, and/or interactions with another person. For infants and toddlers, engaging in play is essential to support development across multiple domains. Infants and toddlers with or at risk of motor delays may demonstrate differences in play or challenges with engaging in play activities compared to typically developing peers. Pediatric physical therapists often use play as a modality to engage children in therapeutic assessment and interventions. Careful consideration of the design and use of physical therapy that embeds play is needed. Following a 3-day consensus conference and review of the literature, we propose physical therapy that embeds play should consider three components; the child, the environment, and the family. First, engage the child by respecting the child's behavioral state and following the child's lead during play, respect the child's autonomous play initiatives and engagements, use activities across developmental domains, and adapt to the individual child's needs. Second, structure the environment including the toy selection to support using independent movements as a means to engage in play. Allow the child to initiate and sustain play activities. Third, engage families in play by respecting individual family cultures related to play, while also providing information on the value of play as a tool for learning. Partner with families to design an individualized physical therapy routine that scaffolds or advances play using newly emerging motor skills.

"I Am Afraid of Positioning my Baby in Prone": Beliefs and Knowledge about Tummy Time Practice.

Objective: To identify beliefs and knowledge about tummy time (TT) practice and its repercussions on motor development. Methods: Longitudinal study carried out with parents/caregivers of infants older than 30 days of life. Two assessments were performed. A structured interview was conducted, while the babies were between one and six months old to identify beliefs, knowledge about TT, and the motor milestone achievement expected for the age. At six to 12 months, the risk of motor development delay was tracked using the survey of well-being of young infant questionnaire (SWYC). Results: 41 families responded to the SWYC questionnaire (21 were allocated to the TT group). 31.70% reported that it was not important to put the infants in a prone position while awake, and 70.70% said they are afraid their babies would become breathless when positioned in a prone position. 85.70% of infants from the TT group showed typical development, while 55% of the control group showed atypical development for their age (p = 0.01). Only three infants from the control group were at risk of delayed motor development (p = 0.10). Conclusions: Most of the families feel insecure about proning their babies and fear breathlessness when positioned. Acquisition of motor milestones prevailed in the TT group, suggesting an association between TT practice and motor milestone achievement.

Risk of Global Developmental Delay in Infants Born from Mothers with COVID-19: A Cross-Sectional Study.

Purpose: To investigate the risk of global developmental delay in infants born from mothers with COVID-19. Patients and Methods: A cross-sectional study was conducted between March and November 2021, with 54 infants of both sexes aged between 1 and 12 months. Twenty-seven infants born from mothers diagnosed with COVID-19 during pregnancy composed the COVID-19 group, whereas infants born from mothers not exposed to COVID-19 composed the control group. Medical records and child health booklets provided neonatal and prenatal data. The Survey of Wellbeing of Young Children screened the risk of global developmental delay during a phone interview or home visit. Chi-squared, Mann-Whitney test, and binary logistic regression were applied. Results: The risk of motor developmental delay was identified in 15 infants (12 in the COVID-19 group), while 36 were at risk of behavioral alteration (22 in the COVID-19 group). The COVID-19 group presented a 6.3-fold risk of motor developmental delay. Motor developmental delay was also significantly associated with socioemotional alterations (odds ratio = 6.4, p = 0.01). Regarding families of infants in the COVID-19 group, 63% of the mothers presented risk of depression, 51.9% risk of substance abuse, 40.7% risk of food insecurity, and 7.4% risk of domestic violence. The inflexibility subscale of the survey was a statistically relevant variable for the socioemotional domain. Conclusion: Infants born from mothers with COVID-19 were at high risk of motor developmental delay and socioemotional alterations. Although, this study fills an important gap in the literature regarding the influence of maternal exposure to COVID-19 on infant development, new studies screening families with infants at risk of developmental delay may significantly impact maternal and child health-related indicators, such as physical health, emotional development and social behavior.

Effects of Prone Positioning on Head Control in Preterm Infants: Randomized and Controlled Clinical Trial Protocol.

PURPOSE: The primary aim will be to assess the effects of prone positioning (tummy time) on cervical extension (angular kinematics and time) in preterm infants. The secondary aim will be to assess the effects of tummy time on gross motor function. METHODS: This randomized, controlled clinical trial will include 40 preterm infants weighing less than 2500 g, randomly allocated into control or experimental group (n = 20) and followed up from birth to six months of corrected age by the team of the neonatal follow-up clinic. Caregivers will be routinely guided on bonding, developmental milestones, and how to perform the tummy time for 30 min throughout the day (experimental group). An illustrative booklet will be provided as support material. The hypothesis will be tested using inferential analysis, considering an alpha of 5%. DISCUSSION: We expect tummy time to strengthen cervical muscles needed to overcome gravity, master motor skills, and stimulate the integration between family activity and environmental experiences, considerable challenges to which preterm infants are exposed. TRIAL REGISTRATION: Registered in the Brazilian Registry of Clinical Trials (identifier RBR-2nwkr47) on 17 February 2022.

Impact of guidance and telemonitoring on foot flexibility due to postural congenital clubfoot in the first month of life: a longitudinal descriptive study / Impacto da orientação e do telemonitoramento na flexibilidade dos pés devido ao pé torto congênito postural no primeiro mês de vida: um estudo descritivo longitudinal

INTRODUCTION: Early intervention is essential for proper foot growth in postural congenital clubfoot (PCC), but little is known about its contribution to this deformity when subjects are evaluated through telemonitoring. OBJECTIVE: This study aimed to monitor the foot's flexibility of newborns diagnosed with PCC by telemonitoring them during the first months of life. METHODS: A longitudinal descriptive study was carried out with a full-term newborns group diagnosed with PCC in at least one limb, presenting a grade ≥ 0,5 on the Pirani score. Newborns with other malformations were excluded. They were assessed twice: before and 30 days after hospital discharge, and the foot flexibility classification by the Pirani score was provided. The telemonitoring occurred weekly between the assessments, and the parents were encouraged to mobilize their feet and maintain foot position using orthosis or taping. RESULTS: Thirteen newborns (eighteen feet) presenting PCC were included in this study; seven neonates discontinued the study due to absences from pre-scheduled evaluations, and six were telemonitored for 30 days. They were born at 39 weeks (± 1.18) and 3346.54 g (± 306.51). The majority of the newborns were female (69%), one was born vaginally, and eight (61%) had a family history of PCC. Pirani's score ranged from 1 to 3 in the initial assessment. After one month of telemonitoring, three feet progressed to 0, and four feet scored between 0.5 and 1. CONCLUSION: This study shows an important improvement in the foot's flexibility of newborns diagnosed with PCC evaluated through telemonitoring. Telemonitoring may be an additional resource for assisting newborns with PCC.

INTRODUÇÃO: A intervenção precoce é essencial para o correto crescimento do pé torto congênito postural (PTC), mas pouco se sabe sobre sua contribuição para essa deformidade quando os pacientes são avaliados por meio de telemonitoramento. OBJETIVO: Este estudo teve como objetivo acompanhar, por telemonitoramento, a flexibilidade do pé de recém-nascidos com diagnóstico de PTC durante os primeiros meses de vida. MÉTODOS: Foi realizado um estudo descritivo longitudinal com recém-nascidos a termo, diagnosticados com PTC em pelo menos um pé, apresentando escore de Pirani ≥ 0,5. Foram excluídos recém-nascidos com outras malformações. Os recém-nascidos foram avaliados nas primeiras horas de vida e 30 dias após a alta hospitalar. Durante este período os pais foram incentivados a mobilizar os pés diariamente e manter a posição por meio de órtese ou bandagem. O telemonitoramento ocorreu semanalmente, e a flexibilidade dos pés foi classificada pelo escore de Pirani. RESULTADOS: Foram incluídos neste estudo treze recém-nascidos (dezoito pés), sete descontinuaram o estudo por faltas nas tentativas de contato e seis foram telemonitorados por 30 dias. A maioria dos RN era do sexo feminino (69%), nasceram com 39 semanas (± 1,18) e 3.346,54g (± 306,51). Um nasceu de parto normal e oito (61%) tinham histórico familiar de PTC. Inicialmente, a pontuação de Pirani variou de 1 a 3. Após 30 dias de telemonitoramento, três pés evoluíram para 0 e quatro pontuaram entre 0,5 e 1. CONCLUSÃO: Este estudo mostra uma melhora importante na flexibilidade do pé de recém-nascidos com diagnóstico de PTC, avaliados por telemonitoramento. O telemonitoramento pode ser um recurso adicional para assistência ao recém-nascido com PTC.

Autoeficácia e desfechos da amamentação em mães de bebês prematuros e a termo: um estudo longitudinal / Self-efficacy and breastfeeding outcomes in mothers of premature and term infants: a longitudinal study

RESUMO Objetivo Analisar a autoeficácia da amamentação, no período de 180 dias, em mães de recém-nascidos prematuros e a termo, e conhecer os fatores que influenciam na prática do aleitamento materno exclusivo no período de recomendação exclusiva. Método Coorte realizado com 44 puérperas de uma maternidade pública, entre janeiro e outubro de 2018. As puérperas foram divididas em dois grupos: Grupo Prematuro e Grupo Termo. A Breastfeeding Self-efficacy Scale foi aplicada no pós-parto imediato, além de um questionário elaborado pelos autores para coleta de variáveis sociodemográficas e obstétricas. O monitoramento da continuidade do aleitamento materno foi feito no 30º, 120º e 180º dia de vida do neonato, via telefone. Para a análise estatística entre os grupos foi utilizado o Statistical Package for the Social Sciences (SPSS). Resultados Não houve diferença na pontuação da autoeficácia, nas características obstétricas e socioeconômicas entre os grupos, exceto para a variável renda familiar, (menor no Grupo Prematuro - p=0,031). O tipo de dieta foi diferente no 30º dia pós parto (p=0,023), com maior adesão ao aleitamento materno exclusivo no Grupo Prematuro. Não foi encontrada associação entre a autoeficácia da amamentação e a prática do aleitamento materno exclusivo no período de 180 dias. Conclusão Nesta amostra, a autoeficácia da amamentação não teve relação com a prática do aleitamento materno exclusivo no período de 180 dias em ambos os grupos. O grupo de prematuros apresentou menor renda familiar e maior adesão ao aleitamento materno exclusivo no 30º dia pós parto.

ABSTRACT Purpose To analyze the breastfeeding self-efficacy in mothers of premature and full-term newborns, in the period of 180 days, and to know the social and obstetric factors that influence the practice of maintaining the exclusive breastfeeding in the period of exclusive recommendation. Methods Cohort with 44 mothers admitted to a public maternity hospital between January and October 2018. The mothers were divided into two groups: Premature and Full-term Groups. The Breastfeeding Self-efficacy Scale was applied in the immediate postpartum period, in addition to a questionnaire elaborated by the authors to collect sociodemographic and obstetric variables. The follow-up was done on the 30th, 120th and 180th days of the newborn's life, by telephone. For the statistical analysis between the groups, the Statistical Package for the Social Sciences (SPSS) was used. Results There was no difference in the self-efficacy score, nor in the obstetric and socioeconomic characteristics between the groups, except for family income (lower in the Premature Group - p = 0.031). The diet type was different on the 30th day after delivery (p = 0.023), with greater adherence to the exclusive breastfeeding in the Premature Group. No association was found between breastfeeding self-efficacy and exclusive breastfeeding practice in the 180-day period. Conclusion In this sample, the breastfeeding self-efficacy was not related to the exclusive breastfeeding practice in the period of 180 days, in both groups. The premature group showed lower family income and greater adherence to exclusive breastfeeding on the 30th day postpartum.

Factors Associated with Behavioral Disorders in Children with Congenital Zika Syndrome and Their Families-A Cross-Sectional Study.

The Zika virus was responsible for an outbreak between 2015 and 2016 in Brazil: an alarming public health problem of international relevance. The Congenital Zika Syndrome (CZS) is often associated with manifestations that are responsible for cognitive and motor development delays and behavioral disorders. Thus, we aimed to characterize the clinical-epidemiological and familial context of those children and to identify factors associated with the risk of behavioral disorders using the Survey of Well-Being of Young Children questionnaire (SWYC). In total, 52 children diagnosed with CZS were evaluated. Logistic regressions were employed to assess predictive variables for behavioral alteration. Eighteen (35%) of the children presented a risk of behavioral alteration. Children born normocephalic were 36-fold more likely to present behavioral alteration (95% CI: 3.82 to 337.92, p = 0.002). Children with hearing and visual impairments showed reduced risks. In total, 35% percent of families reported food insecurity and 21% were at risk for maternal depression. Our findings suggest better social interactions and conditions to externalize reactions for children with CZS born normocephalic. The continuous assessment of these children and families may identify conditions associated with behavioral alteration and psychosocial vulnerabilities that help in decision-making, therefore optimizing patient-family interactions.

Effects of respiratory physiotherapy interventions on pulmonary mechanics of newborns: a protocol for a systematic review.

INTRODUCTION: Although respiratory physiotherapy techniques may reduce respiratory load in newborns, manual contact with the ribcage may interfere with pulmonary mechanics. Therefore, this systematic review aims to evaluate the effects of conventional and non-conventional respiratory physiotherapies on pulmonary mechanics of newborns. METHODS AND ANALYSIS: We will search PubMed, LILACS, SciELO, ScienceDirect, Cochrane Central and Web of Science databases. Searches will be conducted from September 2022. We will include randomised clinical trials reporting thoracoabdominal synchrony, lung volumes and capacities, respiratory discomfort and pain in newborns aged between 1 hour and 28 days and admitted to neonatal intensive care units. We will exclude studies not fully available or incomplete and studies conducted with newborns presenting structural alterations. Two independent researchers will perform the study selection, data extraction and quality assessment. After consensus, one reviewer will proceed with the process. We will include studies published in English or Portuguese, without publication date restriction. An overview of the included studies and extracted information will be reported and the quality of studies will be assessed. A meta-analysis will be conducted if data regarding between-group comparisons are available. ETHICS AND DISSEMINATION: Ethics approval is not required for this systematic review. Results will be presented in journals and national and international conferences, and findings will be shared on social media using accessible language. PROSPERO REGISTRATION NUMBER: CRD42021266729.

Reliability of a computational model for evaluating thoracoabdominal mobility in newborns: a cross-sectional study.

The present study aimed to verify the inter and intra-examiner reliability of an interactive custom-made MATLAB® App for bio-photogrammetric analysis of thoracoabdominal mobility in newborns and compare the respiratory rate (RR) results between the automatic MATLAB® App and its manual counterpart. This is a cross-sectional study conducted in 27 healthy newborns of both sexes (gestational age between 37 and 41 weeks and up to 72 h of life) who did not cry during data acquisition. Chest and abdominal areas of the subjects in the supine position were analyzed through 60 s videos, totaling 30,714 photograms. All photograms were analyzed by three examiners on three different occasions. Analysis of variance (ANOVA) and intraclass correlation coefficient (ICC) were applied, adopting a 95% confidence interval and significance level of α = 0.05. Reliability was excellent for intra (ICC 0.81-0.96) and inter-examiner correlations (ICC 0.84-0.99) between the chest and abdominal areas, in both inspiration and expiration, with no differences between them. Evaluation of newborns' thoracoabdominal mobility using the custom-made MATLAB® App for bio-photogrammetric analysis exhibited good to excellent intra- and inter-examiner reliability and an excellent correlation between manual and automatic models for measuring RR. Thus, it proved to be an objective and practical tool for bedside thoracoabdominal mobility assessment in different clinical situations involving neonatal care.

Distribuição espacial de leitos de Unidades de Terapia Intensiva Neonatal no Brasil e sua associação com a taxa de mortalidade infantil / Spatial distribution of number of Neonatal Intensive Care Units beds in Brazil and its association with child mortality rate

Esta pesquisa teve o objetivo de analisar a distribuição espacial de leitos de Unidades de Terapia Intensiva Neonatal (UTIN) e correlacioná-la com a taxa de nascidos vivos e a Taxa de Mortalidade Infantil (TMI) das unidades federativas brasileiras. Trata-se de um estudo ecológico, envolvendo as 27 unidades federativas, com dados obtidos de sistemas de informação em saúde e analisados por meio do SPSS 20.0 e GeoDa 1.12. Observou-se heterogeneidade na distribuição espacial da TMI e UTIN, com uma concentração maior de leitos de UTIN não ligados ao Sistema Único de Saúde (SUS) na Região Sudeste e leitos SUS na Região Nordeste. A TMI apresentou correlação espacial negativa com o número de leitos (Moran's I = - 0,323) nos estados de Amazonas e Pará. Concluiu-se que a relação inversa entre número de UTIN disponíveis e taxa de mortalidade limitou-se a dois estados, o que reforça a importância de mais estudos que possam investigar outras causalidades para a mortalidade infantil nas outras unidades federativas.

This study aimed at analyzing the spatial distribution of beds in the Neonatal Intensive Care Units (NICU) and correlating it with Live Birth Rate and Child Mortality Rate (CMR) in the Brazilian states. This is an ecological study involving the 27 Brazilian states, with data obtained from health information systems and analyzed using SPSS 20.0 and GeoDa 1.12. There was heterogeneity in the spatial distribution of CMR and NICU, with a higher concentration of NICU beds not belonging to the Unified Health System (SUS) in the Southeast Region and SUS beds in the Northeast Region. CMR showed a negative spatial correlation with the number of beds (Moran's I = - 0.323) in the states of Amazonas and Pará. An inverse relationship between the number of NICUs available and the mortality rate was observed only in two states, which reinforces the importance of further investigating other causes for infant mortality in other states in future studies.

Relationship between thoracoabdominal mobility and hours of life in infants: A cross-sectional study.

Assessing the relationship between thoracoabdominal mobility (TAM) in newborns (NBs) is relevant for a greater understanding of pulmonary kinematics. This study aimed to assess the association between TAM, hours of life and respiratory rate (RR) in term NBs. Healthy NBs were included in the sample. They were filmed for 2 min, with markers in the lateral region of the trunk, delimiting the thoracic and abdominal areas. TAM and RR were assessed using a MATLAB® routine. For kinematic analysis, an algorithm created graphs presenting thoracoabdominal mobility. A total of 26 NBs were evaluated. TAM was the only variable that exhibited a statistically significant intergroup difference, showing that the fewer the hours of life, the greater the mobility. Simple linear regression analysis showed that RR can explain 31% of the variation in abdominal mobility (p = 0.002). Thus, the fewer the hours of life, the greater the TAM of NBs, with a predominance of abdominal compartment mobility.

First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit. / Primeira recomendação brasileira de fisioterapia para estimulação sensório-motora de recém-nascidos e lactentes em unidade de terapia intensiva.

OBJECTIVE: To present guidelines on sensory motor stimulation for newborns and infants in the intensive care unit. METHODS: We employed a mixed methods design with a systematic review of the literature and recommendations based on scientific evidence and the opinions of physiotherapists with neonatal expertise. The research included studies published between 2010 and 2018 in the MEDLINE® and Cochrane databases that included newborns (preterm and term) and infants (between 28 days and 6 months of age) hospitalized in the intensive care unit and submitted to sensory motor stimulation methods. The studies found were classified according to the GRADE score by five physiotherapists in different regions of Brazil and presented at eight Scientific Congresses held to discuss the clinical practice guidelines. RESULTS: We included 89 articles to construct the clinical practice guidelines. Auditory, gustatory and skin-to-skin stimulation stand out for enhancing vital signs, and tactile-kinesthetic massage and multisensory stimulation stand out for improving weight or sucking. CONCLUSION: Although all modalities have good ratings for pain or stress control, it is recommended that sensory motor stimulation procedures be tailored to the infant's specific needs and that interventions and be carried out by expert professionals.

OBJETIVO: Apresentar as diretrizes de estimulação sensório-motora para recém-nascidos e lactentes em unidade de terapia intensiva. MÉTODOS: Trata-se de um método de delineamento misto com revisão sistemática da literatura e recomendações com base na evidência científica e opiniões de fisioterapeutas especialistas em fisioterapia neonatal de estudos publicados entre 2010 e 2018 nas bases de dados MEDLINE® e Cochrane, que incluiu recém-nascidos (pré-termo e a termo) e lactentes (entre 28 dias e 6 meses de idade) admitidos à unidade de terapia intensiva e submetidos a métodos de estimulação sensório-motora. Os estudos encontrados foram classificados segundo o escore GRADE por cinco fisioterapeutas em diferentes regiões do país e apresentados em oito congressos científicos para discussão das diretrizes de práticas clínicas. RESULTADOS: Foram incluídos 89 artigos para construir as diretrizes de práticas clínicas. Estimulação auditiva, gustatória e contato pele a pele se destacaram por melhorar os sinais vitais, e a massagem terapêutica, assim como a estimulação multimodal tátil-cinestésica por melhorar o peso ou a sucção. CONCLUSÃO: Embora todas a modalidades tenham boas avaliações para controle da dor ou do estresse, é recomendado que os procedimentos de estimulação sensório-motora sejam adaptados às necessidades específicas da criança, e as intervenções sejam realizadas por profissionais experientes.

Respiratory synchrony comparison between preterm and full-term neonates using inertial sensors.

INTRODUCTION: Due to inefficient respiratory control, newborns become prone to asynchronous thoracoabdominal (TA) movements. The present study quantitatively estimated the synchrony of TA in preterm and full-term newborns through an inertial and magnetic measurement units (IMMUs) system. METHODS: This cross-sectional study was conducted with 20 newborns divided into Preterm Group (PTG, n = 10) and Full-Term Group (FTG, n = 10). Each neonate had IMMUs placed on the sternum and near the umbilicus, thus the TA motion was estimated through the resultant inclination angles calculated using a sensor fusion filter. The respiratory incursions were also manually counted and video-recorded for two minutes, then used to validate a Matlab custom-written routine for their automatic identification. The respiratory cycles were used to calculate the phase change angle (φ) between the thoracic and abdominal compartments. Association between the manual and automatic methods were verified by Pearson's correlation and root mean squared errors (RMSE), and the comparison between the groups was performed through the Student's t test with α = .05. RESULTS: The values of respiratory incursions measured by both methods showed a high association and low measurement error (r = .96, RMSE = 9.8, p < .001). The FTG presented a higher occurrence of TA synchrony (p = .049) while the PTG group presented a higher occurrence of TA asynchrony (p = .036). No difference was found between the groups regarding the paradoxical classification (p = .071). CONCLUSION: The proposed method was valid to quantitatively assess the TA synchrony of hospitalized neonates. Preterm infants had a higher occurrence of the asynchronous respiratory pattern in comparison to full-term infants.

Primeira recomendação brasileira de fisioterapia para estimulação sensório-motora de recém-nascidos e lactentes em unidade de terapia intensiva / First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit

RESUMO Objetivo: Apresentar as diretrizes de estimulação sensório-motora para recém-nascidos e lactentes em unidade de terapia intensiva., Métodos: Trata-se de um método de delineamento misto com revisão sistemática da literatura e recomendações com base na evidência científica e opiniões de fisioterapeutas especialistas em fisioterapia neonatal de estudos publicados entre 2010 e 2018 nas bases de dados MEDLINE® e Cochrane, que incluiu recém-nascidos (pré-termo e a termo) e lactentes (entre 28 dias e 6 meses de idade) admitidos à unidade de terapia intensiva e submetidos a métodos de estimulação sensório-motora. Os estudos encontrados foram classificados segundo o escore GRADE por cinco fisioterapeutas em diferentes regiões do país e apresentados em oito congressos científicos para discussão das diretrizes de práticas clínicas., Resultados: Foram incluídos 89 artigos para construir as diretrizes de práticas clínicas. Estimulação auditiva, gustatória e contato pele a pele se destacaram por melhorar os sinais vitais, e a massagem terapêutica, assim como a estimulação multimodal tátil-cinestésica por melhorar o peso ou a sucção., Conclusão: Embora todas a modalidades tenham boas avaliações para controle da dor ou do estresse, é recomendado que os procedimentos de estimulação sensório-motora sejam adaptados às necessidades específicas da criança, e as intervenções sejam realizadas por profissionais experientes.

Abstract Objective: To present guidelines on sensory motor stimulation for newborns and infants in the intensive care unit. Methods: We employed a mixed methods design with a systematic review of the literature and recommendations based on scientific evidence and the opinions of physiotherapists with neonatal expertise. The research included studies published between 2010 and 2018 in the MEDLINE® and Cochrane databases that included newborns (preterm and term) and infants (between 28 days and 6 months of age) hospitalized in the intensive care unit and submitted to sensory motor stimulation methods. The studies found were classified according to the GRADE score by five physiotherapists in different regions of Brazil and presented at eight Scientific Congresses held to discuss the clinical practice guidelines. Results: We included 89 articles to construct the clinical practice guidelines. Auditory, gustatory and skin-to-skin stimulation stand out for enhancing vital signs, and tactile-kinesthetic massage and multisensory stimulation stand out for improving weight or sucking. Conclusion: Although all modalities have good ratings for pain or stress control, it is recommended that sensory motor stimulation procedures be tailored to the infant's specific needs and that interventions and be carried out by expert professionals.