Adaptation and Initial Validation of the Premature Infant Pain Profile-Revised (PIPP-R) in Brazil.

BACKGROUND: The use of reliable pain assessment measures is essential for scoring and managing pain in infants. The Premature Infant Pain Profile (PIPP) is reliable and valid and has been recently revised. To adapt and validate the PIPP-R into Portuguese and to evaluate its psychometric properties are required to ensure maintenance of meaning and content. AIMS: The aim of this study was to culturally adapt to Brazilian Portuguese and explore content validity and construct validity of the Premature Infant Pain Profile-Revised. DESIGN: This is a methodological study. PARTICIPANTS/SETTINGS: Two existing data sets of randomized clinical trials previously conducted were used to examine initial construct validity of the prefinal version of the Premature Infant Pain Profile-Revised. METHODS: Cross-cultural adaptation and validation occurred in four steps. Independent versions of the Premature Infant Pain Profile-Revised were produced, followed by the preparation of a synthetic version. Two back-translated versions were realized by professional translators. An expert committee evaluated idiomatic and semantic equivalence and clarity and relevance of the items. A content validity index was calculated. Finally, a consolidated prefinal version in Portuguese was then produced. RESULTS: No difficulties in producing the material were reported. Semantic and idiomatic aspects were considered adequate, and content validity index was 1.0. Premature Infant Pain Profile and Premature Infant Pain Profile-Revised scores were highly correlated for pain after heel lancing and venipuncture (R2 = 0.986, p < .001) and for pain associated with analgesic strategies (R2 = 0.966-1.00, p < .001). CONCLUSIONS: The Premature Infant Pain Profile-Revised was culturally adapted into Brazilian Portuguese. Appropriate content validity index was determined. Evidence of construct validity was also found. Future studies are warranted to explore the feasibility and other psychometric properties of using the Premature Infant Pain Profile-Revised translated and adapted into Brazilian Portuguese in the clinical setting.

Biobehavioral Responses of Preterm Infants to Conventional and Swaddled Tub Baths: A Randomized Crossover Trial.

Bathing is a routine care procedure that exposes preterm infants to prolonged handling, which could cause stress and potentially disrupt infants' biobehavioral responses. The aim of this double-blind randomized crossover trial was to compare the preterm infant's body temperature, heart rate (HR), peripheral capillary oxygen saturation (SpO2), salivary cortisol levels, and sleep-wake states during and after swaddled and conventional tub baths. Forty-three infants born at 32 to 36 weeks postmenstrual age, weighing 2225 g or less, were enrolled in the study. Infants were videotaped before and after each type of baths. The time interval between baths ranged from 24 to 72 hours to allow a washout period. Physiological, hormonal, and behavioral responses were collected at baseline and during recovery from baths. No significant differences in the mean body temperature, HR, SpO2, salivary cortisol levels, and sleep-wake states between the bath types were observed in the baseline or recovery responses during the first 20 minutes after bath. Regardless of bath type, salivary cortisol levels showed a nonstatistical significant increase.

Changes in physiological and behavioral parameters of preterm infants undergoing body hygiene: a systematic review.

Objective To verify the effect of bathing on the body temperature of preterm infants (PTI). Method Systematic review conducted in the following bibliographic electronic sources: Biblioteca Virtual em Saúde/Lilacs (BVS), Cumulated Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, Google Scholar, PubMed, SCOPUS and Web of Science, using a combination of search terms, keywords and free terms. The review question was adjusted to the PICO acronym (Patient/population, Intervention, Control/comparative intervention, Outcome). The selected publications were evaluated according to levels of evidence and grades of recommendation for efficacy/effectiveness studies, as established by the Joanna Briggs Institute. Results Eight hundred and twenty four (824) publications were identified and four studies met the inclusion criteria, of which three analyzed the effect of sponge baths and the effect of immersion baths. Conclusion Sponge baths showed a statistically significant drop in body temperature, while in immersion baths the body temperature remained stable, although they studied late preterm infants.

[Reasons for non-elective removal of epicutaneous catheters in neonates]. / Causas de remoção não eletiva do cateter epicutâneo em neonatos.

This study aimed to describe the incidence and reasons for nonelective removal of epicutaneous catheters in neonates, identifying its association with the catheter insertion site. This was a prospective cohort study, conducted in a neonatal intensive care unit of a private tertiary hospital in the city of São Paulo, Brazil. We analyzed 266 epicutaneous catheter insertions. The incidence of non-elective removal was 39.1%. The most frequent post-insertion complications were suspicion of catheter-related bloodstream infection (25%) and rupture (23.1%). Most catheters were inserted through the right side of the body (65%), in upper limbs (77.1%), and using the axillary veins (31.2%). The findings did not suggest association between the incidence of non-elective removal and the insertion site of the epicutaneous catheter in neonates. Nurses should implement strategies to improve care and decrease incidence of non-elective epicutaneous catheter removals among neonates.

['Sandwich PhD': considerations for a successful experience abroad]. / Doutorado sanduíche: considerações para uma experiência de sucesso no exterior.

International PhD internship, named "Sandwich PhD" in Brazil is an opportunity to improve research abilities, to become known in academic area and to establish and/or increase work opportunities in an international context. In this article, we describe key factors regarding the planning and development of the "Sandwich PhD" as experienced by professors and students involved in the collaboration between the School of Nursing, University of São Paulo and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. We also present the participation of PhD students' network as an alternative to the "Sandwich PhD". An international experience, when well-planned and developed correctly, promotes students' personal and professional development and favors the internationalization of Brazilian graduate programs and research groups.

[Analgesia and sedation during placement of peripherally inserted central catheters in neonates]. / Analgesia e sedação durante a instalação do cateter central de inserção periférica em neonatos.

This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of São Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.

[Prevalence and reasons for non-elective removal of peripherally inserted central catheter in neonates]. / Prevalência e motivos de remoção não eletiva do cateter central de inserção periférica em neonatos.

This is a cross sectional study conducted with 67 newborns admitted at the neonatal intensive care unit of a private hospital in São Paulo, between July and December 2010, who underwent 84 Peripherally Inserted Central Catheter (PICC line) placement procedures. The aim was to describe the prevalence and reasons of non-elective removal of the catheter. Data was collected from medical records and institutional forms related to PICC placement. The mean of corrected gestational age of the neonates was 32.8 weeks, weight 1671.6 g and postnatal age 9.4 days. The non-elective removal was observed in 33 (39.3%) catheters, 18.1% due to occlusion, 9.5% rupture, 7.1% extremity edema, 6.0% suspected infection, 1.2% accidental dislodgement 1.2% poor extremity perfusion and 1.2% due to extravasation. The prevalence and the reasons of non-elective removal indicated that strategies to prevent avoidable complications related to PICC are necessary.

[Profile of mothers of newborns with blood glucose control in the first hours of life]. / Perfil das mães de neonatos com controle glicêmico nas primeiras horas de vida.

Some maternal factors associated with neonatal hypoglycemia justify monitoring blood glucose levels in the first 24 hours of life. The objective of this study was to describe the socio-demographic and obstetric characteristics of mothers to newborns undergoing capillary blood glucose control in the first 24 hours of life, hospitalized in a rooming-in maternity ward of a Baby Friendly Hospital. This is a descriptive exploratory study which involved the analysis of data from 380 medical records of mothers hospitalized from July to December, 2006 at the maternity ward of the University of São Paulo Teaching Hospital. It was found that 18 (5.6%) mothers developed gestational diabetes, none of them were treated with oral hypoglycemic agents, 53 (16.2%) had hypertension during pregnancy and 17 (32.1%) used anti-hypertensive medication, 215 (56.6%) received glucose 5% continuous infusion during labor and delivery. Correlation studies linking maternal variables and neonatal hypoglycemia are needed to identify the predicting factors of this neonatal morbidity.

[Assessment of the newborn respiratory function in the immediate neonatal period]. / Avaliação da função respiratória do recém-nascido no período neonatal imediato.

The aim of the study was to identify the predictive factors and the signals of transient tachypnea of the newborn valued by the nurses who work at neonatal ward and rooming-in when they assess the newborn respiratory function during the immediate neonatal period in the first six hours after birth. A cross sectional study carried out at two public hospitals of São Paulo city. The sample consisted of 28 nurses who replied a structured questionnaire about the newborn respiratory function assessment practices. Data showed they valuated to know the evaluation of labor, delivery and Apgar score when they evaluate the newborn respiratory function. About the signals of respiratory distress they valued to evaluate the respiratory rate and auscultation, evaluation of the respiratory distress using the Silverman-Andersen Index besides, the neonatal nurses valued to evaluate de oxygen saturation.

Pharmacological analgesia in neonates undergoing cardiac surgery.

UNLABELLED: The objectives of this study were to verify the frequency of pharmacological analgesia and the occurrence of postoperative pain in neonates undergoing cardiac surgery. METHODS: This is a cross-sectional study and data were collected from 30 medical charts of neonates who underwent cardiac surgery in a private hospital in the city of São Paulo. RESULTS: The majority (96.6%) of neonates received analgesia: 18 (60.0%) received continuous analgesics, five (16.7%) received intermittent drugs, and six (20.0%) received a combination of continuous and intermittent analgesics. Fentanyl citrate was continuously administered to 24 (80.0%) neonates. Intermittent dipyrone and morphine was administered to ten (33.3%) and one (3.3%) neonates, respectively. Pain registers were observed in 17 (56.7%) medical charts and the occurrence of pain among neonates who received analgesics was 53.4%. CONCLUSION: There was no efficacy in pharmacological postoperative pain control in the neonates included in this study.

[Profile of newborns who underwent cardiac surgery in a private hospital in the city of São Paulo]. / Perfll de recém-nascidos submetidos à cirurgia cardíaca em hospital privado do Município de São Paulo.

The aim of this cross-sectional study was to characterize newborns that underwent cardiac surgery in a private hospital, a reference center in neonatal cardiac surgery, in the city of Sõ Paulo. Data were collected from medical reports from July, 2001 to December, 2005. Newborns with gestational age of more than 35 weeks were included in the study. Newborns that died on the first 48 postoperative hours and with other malformations were excluded. Most of the neonates were term, weighted 2500 grams or more, and underwent surgery in the first week of life. There were 24 different diagnoses identified and 14 different types of surgery performed. In the first post-operative day, all newborns had invasive devices for vital signs monitoring or for treatment and life support, which shows not only the complexity of the treatment but the need for planning and organizing health services in order to provide adequate care for these patients.

[Initial placement of the peripherally inserted central catheter's tip in neonates]. / Localização inicial da ponta de cateter central de inserção periférica (PICC) em recém-nascidos.

This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC) and to verify the prevalence of success in inserting such catheters in neonates. The study was carried out in the neonatal care unit of Hospital das Clinicas, Universidade de São Paulo. Data were collected prospectively from March to September 2006. 37 neonates underwent PICC insertion were included in the study. The rate of success for this procedure was 72.3% (27 neonates). Of them, four (14.8%) had the catheter tips placed in the axilary or inominate veins. Three others (11.1%) had them placed in a jugular vein. When these catheters were removed, 13 (48.2%) catheter tip were placed in the right atrium, and they were relocated to the superior vena cava.

Assessment and management of pain in newborns hospitalized in a Neonatal Intensive Care Unit: a cross-sectional study.

OBJECTIVE:: to determine the frequency of pain, to verify the measures adopted for pain relief during the first seven days of hospitalization in the Neonatal Intensive Care Unit and to identify the type and frequency of invasive procedures to which newborns are submitted. METHOD:: cross-sectional retrospective study. Out of the 188 hospitalizations occurred during the 12-month period, 171 were included in the study. The data were collected from the charts and the presence of pain was analyzed based on the Neonatal Infant Pain Scale and on nursing notes suggestions of pain. For statistical analysis, the Statistical Package for the Social Sciences was used, and the significance level was set at 5%. RESULTS:: there was at least one record of pain in 50.3% of the hospitalizations, according to the pain scale adopted or nursing note. The newborns underwent a mean of 6.6 invasive procedures per day. Only 32.5% of the pain records resulted in the adoption of pharmacological or non-pharmacological intervention for pain relief. CONCLUSION:: newborns are frequently exposed to pain and the low frequency of pharmacological or non-pharmacological interventions reinforces the undertreatment of this condition. OBJETIVO:: determinar a frequência de dor e verificar as medidas realizadas para seu alívio durante os sete primeiros dias de internação na Unidade de Terapia Intensiva Neonatal, bem como identificar o tipo e frequência de procedimentos invasivos aos quais os recém-nascidos foram submetidos. MÉTODO:: estudo retrospectivo transversal. Das 188 internações ocorridas no período estipulado de 12 meses, 171 foram incluídas na pesquisa. Os dados foram coletados a partir dos prontuários e a presença de dor foi analisada tanto com base na escala de dor Neonatal Infant Pain Scale quanto mediante anotação de enfermagem sugestiva de dor. Para análise estatística, utilizou-se o programa Statistical Package for the Social Sciences, adotando-se nível de significância de 5%. RESULTADOS:: em 50,3% das internações houve ao menos um registro de dor, conforme escala de dor adotada ou anotação de enfermagem. Os recém-nascidos foram submetidos à média de 6,6 procedimentos invasivos por dia. Apenas 32,5% dos registros de dor resultaram na adoção de condutas farmacológicas ou não farmacológicas para seu alívio. CONCLUSÃO:: observa-se que os recém-nascidos são frequentemente expostos à dor e a baixa frequência de intervenções farmacológicas ou não farmacológicas reforça o subtratamento dessa condição. OBJETIVO:: determinar la frecuencia del dolor, comprobar las medidas tomadas para su alivio durante los siete primeros días de internación en una Unidad de Terapia Intensiva Neonatal e identificar el tipo de procedimientos invasivos y la frecuencia a que se sometieron los recién nacidos. MÉTODO:: estudio retrospectivo transversal. De las 188 internaciones realizadas en el período estipulado de 12 meses, se incluyeron 171 en la investigación. Los datos se recolectaron a partir de los prontuarios; la presencia de dolor se analizó según la Escala de Valorización del Dolor en el Neonato (Neonatal Infant Pain Scale) y las notas de enfermería sobre el dolor. Para el análisis estadístico, se utilizó el programa 'Paquete estadístico para las ciencias sociales' (Statistical Package for the Social Sciences), adoptándose el nivel de significación del 5%. RESULTADOS:: en el 50,3% de las internaciones hubo al menos un registro de dolor, según la escala de dolor adoptada o las notas de la enfermería. Se sometió a los recién nacidos a un promedio de 6,6 procedimientos invasivos por día. Sólo el 32,5% de los registros de dolor resultaron en la adopción de conductas farmacológicas o no farmacológicas para su alivio. CONCLUSIÓN:: se observa que los recién nacidos a menudo están expuestos al dolor, y la frecuencia baja de intervenciones farmacológicas o de las no farmacológicas refuerza el subtratamiento de dicha condición.

Predictors of Nonelective Removal of Peripherally Inserted Central Catheters in Infants.

BACKGROUND: Nonelective removal of peripherally inserted central catheters (PICCs) due to complications continues to be a major concern in neonatal intensive care units (NICUs) around the world. Nonelective removal results in interruption of intravenous therapy, added costs, stress, and negative impacts on infant's health. Identification of predictors of complications that lead to nonelective removal of PICCs would allow for the initiation of preventive strategies to improve the quality of care. AIM: To identify predictors of nonelective removal of PICCs in neonates. METHODS: A prospective cohort study with a sample of 524 PICC lines inserted in 436 neonates admitted to a tertiary-level NICU of a Brazilian hospital. Data were collected on all neonates between August 31, 2010, and August 30, 2012. Neonates were monitored daily from insertion of the catheter until its removal. Bivariate analysis and a logistic regression were conducted in order to identify predictors of nonelective removal. RESULTS: A diagnosis of a transitory metabolic disorder (hypoglycemia; disorders of calcium, magnesium, sodium, or potassium; or dehydration), previous PICC line insertion, insertion of dual-lumen polyurethane PICC, noncentral tip position, and multiple intravenous solutions in a single-lumen silicone PICC were predictors of nonelective removal of PICC lines. CONCLUSION: The avoidance of repeated PICC insertions, noncentral tip position, and placement of single-lumen silicone PICCs for administration of four or more intravenous solutions is suggested. Interventions should be explored that facilitate PICC insertion success and correct tip placement.

[Care practices on the resuscitation of newborns in the context of a delivery center]. / Práticas assistenciais em reanimação do recém-nascido no contexto de um centro de parto normal.

Approximately 10 to 15% of the neonates present difficulties in adapting to extra uterine life, which requires ability and readiness from the professional to intervene properly. This is an observational, cross-sectional study aimed at describing the care practices on the resuscitation of the newborn in the Delivery Center of a public hospital in the city of São Paulo. Data were obtained from the observation of 100 assistances given by health care professional staff and were recorded on a check-list instrument. Meconium-amniotic fluid was found in 24 (24.0%) births and 47 (47.0%) newborns were submitted to respiratory airways aspiration. Of these, 6.4% (3) had their trachea aspirated. 26 (26.0%) newborns were ventilated, 5 (19.2%) of which by mask plus positive pressure; 1 (1.0%) newborn was submitted to a chest compression. After the initial resuscitation procedures, 6 (6.0%) newborns were referred to the neonatal intensive care unit.

The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns.

OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns. METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve. RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points), moderate (4 to 8 points), and high (≥ 9 points). Accuracy was 0.76. CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.

[Colic in newborns and infants: a literature review]. / Cólica em recém-nascido e lactente: revisão da literatura.

This paper is a literature review on excessive crying and colic that affect babies during their first period of life. This text presents the clinical definition, etiology, colic associated factors and interventions to relief and treatment of infant colic. Articles published in medical and nursing journals indexed at MEDLINE and LILACS computerized database available in the libraries of BIREME, Universidade de São Paulo and CAPES homepage were analysed.

[Neonatal nursing: analysis of publications indexed in computerized databases]. / Enfermagem neonatal: análise das publicações indexadas nos índices de referências informatizados.

The aim of this study was to identify and analyze the production of scientific knowledge in the area of neonatal nursing by using table of contents of computerized databases. This quantitative, descriptive study took as its source of information the MEDLINE, CINAHL, and LILACS databases between 1990 and 2000. The titles entered were "neonatal nursing" when accessing the first two databases and "neonatal nursing and neonatal nurse" with LILACS. This process identified 3,576 publications, 2,336 (61.12%) indexed in the CINAHL, 3,062 (85.58%) included in North American and English periodicals. Of the total of publications, 1940 were analyzed and the caring process was the theme with the greatest number of publications--804 (41.45%).

Transmissão vertical da sífilis: vivência materna durante a hospitalização para diagnóstico e tratamento de seu filho recém-nascido / Congenital syphilis: maternal experience during the hospitalization for diagnosis and treatment of her infant newborn / Transmisión vertical de sífilis: vivencia materna durante la hospitalización para el diagnóstico y tratamiento de su hijo recién nacido

Introdução: O diagnóstico e tratamento da sífilis congênita requer internação mais prolongada do\r\nrecém-nascido na maternidade, trazendo preocupação e ansiedade materna. Objetivo: Compreender\r\na experiência materna de ter seu fi lho internado para tratamento da sífilis congênita. Método: Estudo\r\ncom desenho qualitativo que adotou a Teoria Fundamentada nos Dados como referencial metodológico.\r\nParticiparam do estudo 11 puérperas cujos fi lhos estavam internados na unidade neonatal de um hospital\r\nescola de São Paulo para tratamento de sífilis congênita. Os dados foram obtidos por meio de entrevista.\r\nResultados: Dois fenômenos emergiram dos dados analisados: "Vivenciando o impacto do diagnóstico\r\nda sífilis" e "Vivenciando a internação do fi lho". Priorizando o tratamento do fi lho acima da minha saúde\r\ne bem-estar é o lema que representa a categoria central da vivência materna. Conclusão: A experiência\r\nmaterna é melhor enfrentada quando a mãe recebe apoio familiar e a abordagem assistencial dos profissionais é isenta de preconceitos e julgamentos.

Introduction: The diagnosis and treatment of congenital syphilis requires more prolonged hospitalization\r\nof the newborn in the maternity ward, causing maternal concern and anxiety. Objective: To understand\r\nthe maternal experience of having her child hospitalized for the treatment of congenital syphilis. Method:\r\nQualitative research by Grounded Theory approach. The study included 11 postpartum women whose\r\nchildren were hospitalized to congenital syphilis treatment at a university hospital neonatal unit, in the\r\ncity of São Paulo, Brazil. Data were collected by interview. Results: Two phenomena emerged from analyzed data: "Living the impact of syphilis diagnosis" and "Experiencing the hospitalization of the child".\r\nPrioritizing the treatment of the child above my health and well-being is the motto that represents the central category of maternal experience. Conclusion: Maternal experience is best faced when the mother\r\nreceives family support and the professional approach is free of prejudices and judgments.

Introducción: El diagnóstico y tratamiento de la sífilis congénita requiere una internación más prolongada\r\ndel recién nacido en la maternidad, trayendo preocupación y ansiedad materna. Objetivo: Comprender\r\nla experiencia materna de tener su hijo internado para el tratamiento de la sífilis congénita. Método: El\r\nestudio adoptó la Teoría Fundamentada en los Datos como referencial metodológico. Participaron del\r\nestudio 11 puérperas cuyos hijos estaban internados en la unidad neonatal de un hospital escuela de\r\nSão Paulo para tratamiento de sífilis congénita. Los datos fueron obtenidos por medio de entrevistas.\r\nResultados: Dos fenómenos emergieron de los datos: "Vivenciando el impacto del diagnóstico de la\r\nsífilis" y "Vivenciando la hospitalización del hijo". Priorizando el tratamiento del hijo por encima de mi\r\nsalud y bienestar es el lema que representa la categoría central de la experiencia materna. La experiencia materna es mejor enfrentada cuando la madre recibe apoyo familiar y el abordaje asistencial de los\r\nprofesionales está exenta de prejuicios y juicios.