Desinfecção de incubadoras usadas em Unidades de Cuidados Intensivos Neonatais: revisão integrativa / Desinfección de incubadoras usadas en Unidades de Cuidados Intensivos Neonatales: revisión integradora / Disinfection of incubators used in Neonatal Intensive Care Units: an integrative review

Resumo Objetivo Analisar as evidências científicas de práticas de desinfecção de incubadoras usadas em Unidades de Cuidados Intensivos Neonatais. Métodos Revisão integrativa de literatura, realizada de junho a julho de 2020, nas bases de dados: LILACS, SciELO, CINAHL, SCOPUS, Web of Science e MEDLINE. Os achados foram organizados conforme o fluxograma PRISMA e discutidos de acordo com a literatura pertinente. Resultados Dos 780 artigos encontrados, apenas cinco contemplaram os critérios de inclusão. Os saneantes utilizados foram: cloreto de didecildimetilamônio, polihexametilenobiguanida e Peróxido de Hidrogênio (VHP); cloreto de didecildimetilamônio; N-(3-aminopropyl)-N-dodécylpropane-1,3-diamine; cloreto de didecildimetilamônio e limpeza a vapor; água com detergente para limpeza no balde e água sanitária (200mg/L) e desinfectante Umonium38® a 2,5%. Há diversidade de opções para desinfecção das incubadoras, com variação de métodos e frequência de limpeza. Os saneantes utilizados foram eficazes, apontando para redução da carga microbiana. Conclusão Observou-se uma variedade de procedimentos e produtos que podem ser utilizados para limpeza e desinfecção das incubadoras. Os procedimentos de desinfecção favoreceram a redução da contaminação da superfície. No entanto, a presença de micro-organismos, mesmo que reduzida, alerta sobre o risco à segurança do paciente.

Resumen Objetivo Analizar las evidencias científicas de prácticas de desinfección de incubadoras usadas en Unidades de Cuidados Intensivos Neonatales. Métodos Revisión integradora de literatura, realizada de junio a julio de 2020, en las bases de datos: LILACS, SciELO, CINAHL, SCOPUS, Web of Science y MEDLINE. Los resultados fueron organizados de acuerdo con el diagrama de flujo PRISMA y discutidos de acuerdo con la literatura pertinente. Resultados De los 780 artículos encontrados, solamente cinco contemplaron los criterios de inclusión. Los desinfectantes utilizados fueron: cloruro de didecildimetilamonio, polihexametilen biguanida y peróxido de hidrógeno (VHP); cloruro de didecildimetilamonio; N-(3-aminopropil)-N-dodecilpropano-1,3-diamina; cloruro de didecildimetilamonio y limpieza a vapor; agua con detergente para limpieza en el balde y cloro (200mg/L) y desinfectante Umonium38® al 2,5 %. Existe una diversidad de opciones para la desinfección de las incubadoras, con variación de métodos y frecuencia de limpieza. Los desinfectantes utilizados fueron eficaces, lo que indica una reducción de la carga microbiana. Conclusión Se observó una variedad de procedimientos y de productos que se pueden utilizar para la limpieza y la desinfección de las incubadoras. Los procedimientos de desinfección favorecieron la reducción de la contaminación de la superficie. Sin embargo, la presencia de microorganismos, aunque reducida, alerta respecto al riesgo a la seguridad del paciente.

Abstract Objective To analyze the scientific evidence of incubator disinfection practices used in Neonatal Intensive Care Units. Methods This is an integrative literature review, conducted from June to July 2020, in the LILACS, SciELO, CINAHL, Scopus, Web of Science and MEDLINE databases. The findings were organized according to the PRISMA flowchart and discussed according to pertinent literature. Results Of the 780 articles found, only five met the inclusion criteria. The sanitizers used were: didecyldimethylammonium chloride, PHMB and vaporized hydrogen peroxide (VHP); didecyldimethylammonium chloride; N-(3-aminopropyl)-N-dodecylpropane-1,3-diamine; didecyldimethylammonium chloride and steam cleaning; water with detergent for cleaning in the bucket and bleach (200 mg/L) and 2.5% Umonium38® disinfectant. There is a diversity of options for disinfection of incubators, with variation of methods and frequency of cleaning. The sanitants used were effective, pointing to reduction of microbial load. Conclusion A variety of procedures and products were observed that can be used for cleaning and disinfection of incubators. Disinfection procedures favored the reduction of surface contamination. However, the presence of microorganisms, even if reduced, alerts about the risk to patient safety.

Environmental magnetic field in a Neonatal Intensive Care Unit. A relevant verification. / Campo magnético ambiental en una Unidad de Terapia Intensiva Neonatal. Importancia de su verificación.

Preterm infants are born with immature organs, thus affecting the immune system. Electromagnetic fields influence melatonin production with low exposure levels. These infants require medical equipment 24/7 to recover, so they are constantly exposed to magnetic fields during their stay in the Intensive Care Unit. Our objective was to measure magnetic field levels generated around each incubator using a gauss meter and compare our results to the 2010 recommendations by the International Commission on Non-Ionizing Radiation Protection and the IEC 60601-1-2:2004 standard by the International Electrotechnical Commission (IEC). Among 11 hospitalized newborn infants, radiation was found within the recommended limits, but there was electromagnetic interference resulting from medical equipment layout problems in the unit.

Los neonatos pretérminos nacen con inmadurez en los órganos, lo que lleva al compromiso del sistema inmunológico. Los campos electromagnéticos afectan la producción de melatonina a niveles bajos de exposición. Estos niños necesitan equipamiento médico las 24 horas del día para su recuperación, por lo que están expuestos a los campos magnéticos durante todo el tiempo que se encuentren en la Unidad de Terapia Intensiva. El objetivo fue medir los niveles de campo magnético que se generan alrededor de cada una de las incubadoras utilizando un gaussímetro y comparar los resultados con las recomendaciones de la Comisión Internacional para la Protección contra las Radiaciones No Ionizantes de 2010 y la norma de la International Electrotechnical Commission (IEC) IEC 60601-1-2:2004. En 11 neonatos internados, los valores de radiación se encontraban dentro de los recomendados, pero existía interferencia electromagnética por problemas de disposición de los equipos en el área.

Optimising image quality and radiation dose for neonatal incubator imaging.

INTRODUCTION: Neonates often require imaging within incubators however limited evidence exists as to the optimal method and acquisition parameters to achieve these examinations. This study aims to standardise and optimise neonatal chest radiography within incubators. METHODS: A neonatal anthropomorphic phantom was imaged on two different incubators under controlled conditions using a DR system. Exposure factors, SID and placement of image receptor (direct v tray) were explored whilst keeping all other parameters consistent. Image quality was evaluated using absolute visual grading analysis (VGA) with contrast-to-noise ratio (CNR) also calculated for comparison. Effective dose was established using Monte Carlo simulation using entrance surface dose within its calculations. RESULTS: VGA and CNR reduced significantly (p < 0.05) whilst effective dose increased significantly (p < 0.05) for images acquired using the incubator tray. The optimal combinations of parameters for incubator imaging were: image receptor directly behind neonate, 0.5 mAs, 60 kV at 100 cm SID, however, if tray needs to be used then these need to be adapted to: 1 mAs at maximum achievable SID. Effective dose was highest for images acquired using both incubator tray and 100 cm SID owing to a decrease in focus to skin distance. There is significant increase (p < 0.01) in VGA between using 0.5 mAs and 1 mAs but an apparent lack of increase between 1 and 1.5 mAs. CONCLUSION: Using the incubator tray has an adverse effect on both image quality and radiation dose for incubator imaging. Direct exposure is optimal for this type of examination but if tray needs to be used, both mAs and SID need to be increased slightly to compensate. IMPLICATIONS FOR PRACTICE: This study can help inform practice in order to both standardise and optimise chest imaging for neonates in incubators.

Utilizing Video versus Direct Laryngoscopy to Intubate Simulated Newborns while Contained within the Incubator: A Randomized Crossover Study.

OBJECTIVE: The use of video laryngoscopy for intubating neonates in ergonomically challenging settings has not been studied well. We aimed to assess the usefulness of video laryngoscopy for experienced neonatologists to intubate neonatal manikins in incubators via side hand ports or head window. STUDY DESIGN: In this randomized crossover trial at three neonatal intensive care units in Japan, 27 neonatologists were randomized into two groups, namely, those intubating neonatal simulators using video laryngoscopy and then using direct laryngoscopy, or vice versa. The intubations were performed via hand ports or head window without opening top and side walls in incubators in two manikin positions (rotated 90° or unrotated). Glottis visualization (0-100%), success rate, intubation time, and ease of laryngoscopy (from 1 [very difficult] to 10 [very easy]) were compared between video laryngoscopy and direct laryngoscopy. Generalized linear models were used for the analyses. RESULTS: This study assessed 108 intubations performed by 27 neonatologists. The use of video laryngoscopy improved the glottis visualization by 14% (95% confidence interval, 7.4-20%; p < 0.01) and easiness scores of laryngoscopy by 0.8 (0.2-1.4; p < 0.01), but did not reduce the intubation time. CONCLUSION: Video laryngoscopy is useful for experienced neonatologists for intubating neonatal manikins in incubators without opening the top or side walls.

Electromagnetic fields in neonatal incubators: the reasons for an alert.

BACKGROUND: Neonatal incubators are important tools for sick newborns in the first few days of life. Nevertheless, their electric engine, often very close to the newborn's body, emits electromagnetic fields (EMF) to which newborns are exposed. Aim of this paper is to review the available literature on EMF exposure in incubators, and the effects of such exposures on newborns that have been investigated. METHODS: We carried out a systematic review of studies about EMF emissions produced by incubators, using Medline and Embase databases from 1993 to 2017. RESULTS: We retrieved 15 papers that described the EMF exposure in incubators and their biological effects on babies. EMF levels in incubators appear to be between 2 and 100 mG, depending on the distance of the mattress from the electric engine. In some cases, they exceed this range. These values interfere with melatonin production or with vagal tone. Even caregivers are exposed to high EMF, above 200 mG, when working at close contact with the incubators. CONCLUSION: EMF have been described as potentially hazardous for human health, and values reported in this review are an alert to prevent babies' and caregivers' exposure when close to the incubators. A precautionary approach should be adopted in future incubator design, to prevent high exposures of newborns in incubators and of caregivers as well.

Perception of mothers when visiting their child in the neonatal unit for the first time / Percepción de las madres en visita a su hijo en la unidad neonatal por la primera vez / Percepção das mães ao visitar seu filho na unidade neonatal pela primeira vez

Abstract Objective: to identify feelings, experiences and expectations of the mothers during the first visit to the child hospitalized in a Neonatal Intermediate Care Unit of a teaching hospital in the interior of the state of Minas Gerais. Method: qualitative research conducted between November 2016 and April 2017, with 24 mothers during a first visit to their children in the intermediate care unit. Data were collected through semi-structured interviews, transcribed and submitted to Content Analysis. Results: from the analysis emerged three thematic categories: feelings that precede the first visit, the experience of the first visit, feelings experienced during the first visit. Conclusion and implications for practice: the participants demonstrated that the first visit to their children can bring positive feelings and negative experiences. Strategies to minimize fears and clarify doubts favor the realization of motherhood.

Resumen Objetivo: identificar sentimientos, experiencias y expectativas de las madres durante la primera visita al niño hospitalizado en una Unidad de Cuidados Intermedios Neonatales de un hospital universitario en el interior del estado de Minas Gerais. Método: investigación cualitativa realizada entre noviembre de 2016 y abril de 2017, con 24 madres que hacían la primera visita a sus hijos en la unidad de cuidados intermedios. Los datos fueron recolectaron a través de entrevistas semiestructuradas, transcritas y sometidas al Análisis de Contenido. Resultados: del análisis, emergieron tres categorías temáticas: sentimientos que anteceden a la primera visita; la experiencia de la primera visita; sentimientos maternos vividos durante la primera visita. Conclusión e implicaciones para la práctica: las participantes demostraron que la primera visita a sus hijos puede tener sentimientos positivos y experiencias negativas. Estrategias para minimizar los miedos y las dudas aclaradas favorecen la materialización de la maternidad.

Resumo Objetivo: identificar sentimentos, experiências e expectativas das mães durante sua primeira visita ao filho internado em uma Unidade de Cuidados Intermediários Neonatais de um hospital de ensino do interior do estado de Minas Gerais. Método: pesquisa qualitativa, realizada entre novembro de 2016 a abril de 2017, com 24 mães durante a primeira visita aos seus filhos na unidade de cuidados intermediários. Os dados foram coletados por meio de entrevistas semiestruturadas, posteriormente, transcritas e submetidas à Análise de Conteúdo. Resultados: da análise, emergiram três categorias temáticas: sentimentos que antecedem a primeira visita, a experiência da primeira visita e sentimentos maternos vivenciados durante a primeira visita. Conclusão e implicações para a prática: as participantes demostraram que a primeira visita aos seus filhos pode ter sentimentos positivos e experiências negativas. Estratégias para que sejam minimizados os medos e as dúvidas esclarecidas favorecem a concretização da maternidade.

Exposição e reatividade do prematuro ao ruído em incubadora / Exposure and reactivity of the preterm infant to noise in the incubator

RESUMO Objetivo Avaliar a exposição e a reatividade do prematuro ao ruído intenso durante o cuidado em incubadora. Método Estudo observacional prospectivo na unidade de cuidados intermediários de um hospital de Ribeirão Preto (SP). Na primeira etapa do estudo (dimensionamento do ruído) participaram 35 prematuros e na segunda (análise da reatividade diante de um ruído intenso), 20. O ruído foi mensurado durante duas horas por um dosímetro e a reatividade filmada por três câmeras conectadas no computador. Diante de Lmáx superior a 65 decibéis analisou-se a reatividade dos prematuros. Resultados Todos os prematuros apresentaram Leq acima do limite recomendado por organizações internacionais e mais da metade dos bebês esteve com Leq médios superiores ao limite permitido em incubadora pela norma brasileira. Diante do ruído intenso, grande parte dos bebês desencadeou reflexo cócleo-palpebral, sobressalto, mímica facial, modificou as atividades corporais ou apresentou padrão de sono e vigília, com diferenças estatisticamente significativas. Conclusão Os níveis sonoros mensurados foram intensos. O ruído a que os prematuros estão expostos nas incubadoras durante os cuidados recebidos constitui um evento estressante, modifica o estado comportamental e desencadeia respostas reflexas, corporais, manifestações faciais e mudança no estado de sono e vigília diante dos ruídos intensos e súbitos.

ABSTRACT Purpose To evaluate preterm infants' exposure and reactions to intense noise during incubator care. Methods An observational and prospective study was performed in the intermediary care unit of a hospital in Ribeirão Preto (SP). Thirty-five preterm infants participated in the first stage of the study (measuring noise) and 20 in the second (analysis of responses to intense noise). Noise was measured for two hours using a dosimeter, and the responses were video recorded by three cameras connected to a computer. The preterm infants' responses to an Lmax higher than 65 decibels were analyzed. Results Every preterm infant presented Leq above the limit recommended by international organizations, and more than half of the babies had a mean Leq above the limit permitted by the Brazilian standard. Regarding the babies' responses to the intense noise, the majority of them showed blink reflex, startle reflex, facial mimics, changed bodily activities or changed sleep and wake state, all with statistically significant differences. Conclusion The sound levels measured were intense. The noises that preterm infants are exposed to while being cared for in incubators constitute a stressor event. Sudden, intense noises change their behavioral state and causes reflexive and bodily responses, facial manifestations and changes in their sleep and wake state.

Conhecimentos e práticas de manuseio de incubadoras neonatais por profissionais de enfermagem / Knowledge and practices regarding the handling of neonatal incubators among nursing professionals

Resumo Objetivo Comparar conhecimentos e práticas de manuseio de incubadoras neonatais por enfermeiras e técnicas/auxiliares de enfermagem. Métodos Estudo transversal, realizado em unidade neonatal de hospital de referência, com dados obtidos por questionário sobre conhecimentos e observação direta, estruturada e não participante, das práticas da equipe de enfermagem no manuseio de incubadoras. Criou-se escore de adequação de práticas realizadas. Resultados Não houve diferença entre os dois grupos estudados, quanto aos conhecimentos sobre manuseio de incubadoras, exceto para o benefício de umidificação, mais citado entre enfermeiras (p=0,040). Comparando-se escores de práticas obtidos isoladamente e considerando o escore total, também não se constatou diferença (p=0,723). Técnicas/auxiliares de enfermagem e enfermeiras realizaram 70% de práticas adequadas ao manusearem a incubadora, proporção baixa, visto tratar-se de hospital de alta complexidade. Conclusão Em geral, não houve diferença entre os componentes da equipe de enfermagem com relação aos conhecimentos e práticas estudadas.

Abstract Objectives To compare knowledge and practices regarding the handling of neonatal incubators among nurses and nursing technicians/aides. Methods This was a cross-sectional study conducted at the neonatal unit of a reference hospital, with data obtained via a questionnaire about the professionals' knowledge and direct, structured and nonparticipant observation of nursing team practices when handling incubators. The researchers developed a score to represent the adequateness of the practices observed. Results No difference was observed between the two studied groups in terms of knowledge in handling incubators, except for knowledge about the benefit of humidification, cited mostly by nurses (p=0.040). No differences were observed when comparing practice scores obtained individually and the overall score (p=0.723). The incubator practices of nursing technicians/aides and nurses were 70% adequate, which is a low percentage considering the hospital's high complexity. Conclusion In general, there was no difference between the nursing team members with regards to the studied knowledge and practices.

[Infection Prevention in Premature Infants and Newborns in Thuringia: Implementation of Recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO)]. / Infektionsprävention bei Früh- und Neugeborenen in Thüringen: Umsetzung der Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO).

Systematic recording of practical implementation of current recommendations of KRINKO for the prevention of nosocomial infections in premature and newborn infants in children's hospitals in Thuringia. All neonatal treatment centers in Thuringia (n=18) were included in this survey. Answer were received from 83% (15/18). Degree of compliance was 100% in level-1 (3/3) and level-2 centers (5/5), and 70% in level-3 centers (7/10). The aim of the questionnaire was to evaluate infection prevention measures as well as structural/organizational parameters in neonatal centers in Thuringia. Preventive measures as well as weekly screening for colonization was fully performed in patients with a birth weight <1 500 g (n=205) at all centers. Additionally, prolonged screening and colonization surveillance measures were performed in 60% of all units until discharge from the hospital. Results related to structural/organizational parameters and especially structural conditions in neonatal centers in Thuringia pointed up challenges (2 m minimum distance between incubators in 27% (n=4/15), isolation in single room in 53% (n=8/15)). Insufficient number of staff also hamper the complete implementation of KRINKO recommendations (intensive care unit: patient/staff ratio (MW±SD) 2.5±1.1; newborn area 4.3±0.9). Analysis shows actual rate of implementation of KRINKO recommendations as well as structural/organizational parameters in neonatal treatment centers in Thuringia. It provides important points for discussion regarding necessary staff numbers and structural conditions. Analysis could also be used for future surveys in other regions in Germany.

Effect of comfort pads and incubator design on neonatal radiography.

BACKGROUND: There has been increasing interest in patient dose reduction in neonatal intensive care units. Removing comfort pads for radiography has been identified as a potential means to decrease patient dose. OBJECTIVE: To assess the effect of comfort pads and support trays on detector entrance exposure (DEE) and image quality for neonatal radiography, and its implication for patient dose. MATERIALS AND METHODS: Comfort pads and support trays from three incubator and warmer systems were examined. The attenuation of the primary beam by these structures was measured using a narrow beam geometry. Their effect on DEE and image quality was then assessed using typical neonatal chest radiography techniques with three configurations: 1) both the comfort pad and support included in the beam, 2) only the support tray included and 3) both the comfort pad and support tray removed. RESULTS: Comfort pads and support trays were found to attenuate the primary beam by 6-15%. Eliminating these structures from the X-ray beam's path was found to increase the detector entrance exposure by 28-36% and increase contrast-to-noise ratio by more than 21%, suggesting room for patient dose reduction when the same image quality is maintained. CONCLUSION: Comfort pads and tray support devices can have a considerable effect on DEE and image quality, with large variations among different incubator designs. Positioning the image detector directly underneath neonatal patients for radiography is a potential means for patient dose reduction. However, such benefit should be weighed against the risks of moving the patient.

Repercussões do uso de incubadoras umidificadas na regulação térmica do prematuro: uma revisão integrativa / Repercussions of using humidified incubators in thermoregulation of premature: an integrative review / Repercusiones del uso de incubadoras humidificadas en la regulación térmica del prematuro: una revisión integradora

Objetivo: analisar, em publicações científicas, as repercussões do uso de incubadoras umidificadas na regulaçãotérmica do recém-nascido prematuro. Método: procedeu-se metodologicamente a uma revisão integrativa, nas basesde dados no período de 2005-2015, selecionando 10 artigos mediante os critérios de inclusão. Resultados: a análisedos artigos ressalta variação das práticas de regulação da umidade em incubadoras neonatais. A manutenção datemperatura corporal foi semelhante nos prematuros que permaneceram em incubadora umidificada comparadosaos mantidos em incubadora convencional, porém houve redução da perda transepidérmica, da taxa de infusão defluidos, desequilíbrios eletrolíticos e menor perda de peso e taxas de infecção não elevadas. Conclusão: evidenciou--se ausência de publicações nacionais sobre o tema e repercussões satisfatórias sobre a utilização da umidade emaltas concentrações comparada à baixa umidade, contudo mais pesquisas são necessárias para definição de umpadrão para a prática segura da umidificação em ambiente de incubadora.

Objective: to analyze, in scientific literature, the repercussions of the use of humidified incubators in the thermalregulation of the preterm newborn. Method: a methodological procedure for an integrative review, in databases forthe period 2005-2015, selecting 10 articles using the inclusion criteria. Results: the analysis of articles highlights thewide variation of moisture regulation practices in neonatal incubators. Maintaining body temperature was similarin preterm infants who remained in humidified incubators when compared to those in conventional incubators;however, there was a reduction of transepidermal loss, fluid infusion rate, electrolyte imbalances and lower weightloss, and no high infection rates. Conclusion: the lack of national literature on the matter was evidenced andsatisfactory repercussions on the use of high concentration humidity compared to low humidity, nevertheless, moreresearch is required to define a standard for safe practice of humidification in the environment of incubators.

Objetivo: analizar, en la literatura científica, las repercusiones del uso de incubadoras humidificadas en laregulación térmica del recién nacido prematuro. Método: se procedió metodológicamente a una revisión integradora,en las bases de datos en el período de 2005-2015, seleccionando 10 artículos por medio de criterios de inclusión.Resultados: el análisis de los artículos destaca la amplia variación de las prácticas de regulación de la humedaden las incubadoras neonatales. El mantenimiento de la temperatura corporal fue similar en los recién nacidosprematuros que permanecieron en incubadora humidificada en comparación a los mantenidos en incubadorasconvencionales; sin embargo, hubo una reducción de la pérdida transepidérmica, la tasa de infusión de fluido, losdesequilibrios de electrolitos y menos pérdida de peso, y no hay altas tasas de infección. Conclusión: se evidenció laausencia de publicaciones nacionales sobre el tema y repercusiones satisfactorias sobre la utilización de la humedaden altas concentraciones comparadas a la baja humedad, sin embargo se necesita más investigación para ladefinición de un estándar para la práctica segura de la humidificación en ambiente de incubadora.

Maturação auditiva periférica: análise das amplitudes das emissões otoacústicas produto de distorção em neonatos pré-termo e a termo / Peripheral auditory maturation: analysis of the amplitudes of the distortion product otoacoustic emissions in preterm and term neonates

Objetivo : Comparar neonatos prematuros e a termo quanto à presença e amplitude das Emissões Otoacústicas Produto de Distorção (EOAPD), bem como caracterizá-los em relação aos indicadores de risco para perda auditiva. Métodos : Estudo realizado por análise das EOAPD (frequências de 2000, 3000, 4000, 6000 e 8000 Hz) e dos indicadores de risco para perda auditiva. Os neonatos foram agrupados segundo a idade gestacional. Os resultados foram analisados empregando-se testes ANOVA, Kruskal-Wallis e Qui-quadrado (5%). Resultados : A amostra constituiu-se de 109 neonatos (218 orelhas), com distribuição homogênea quanto ao gênero e a classificação a termo/pré-termo. Foi observado alto risco para perda auditiva em 40,4% dos lactentes. Dos indicadores de risco para deficiência auditiva, os mais frequentes foram a permanência em incubadora e internação em UTI superiores a cinco dias. As EOAPD mostraram-se presentes em 209 orelhas (95,9%). A ausência de respostas às EOAPD foi significativamente mais recorrente nos grupos com menor idade gestacional. Verificou-se aumento das amplitudes das EOAPD de acordo com o aumento da idade gestacional, exceto para a frequência de 8000 Hz na orelha esquerda. Não foi observada diferença entre orelhas e gêneros quanto à presença e amplitude das EOAPD. Conclusão : Há diferença entre os grupos pré-termo e a termo, quanto à presença e amplitude das EOAPD: maior probabilidade de falha nos grupos com menor idade gestacional e aumento (não linear) das amplitudes, conforme a idade gestacional torna-se maior. Os achados sugerem o fenômeno de maturação do sistema auditivo periférico. .

Purpose : To compare preterm and term neonates in relation to the presence and amplitude of Distortion Product Otoacoustic Emissions (DPOAEs), as well as to characterize them regarding risk indicators for hearing loss. Methods : Study realized by the analysis of the DPOAEs (frequencies of 2000, 3000, 4000, 6000 and 8000 Hz) and risk indicators for hearing loss. The neonates were grouped according to the gestational age. The results were analyzed by ANOVA, Kruskal-Wallis and Chi-square tests (5%). Results : The sample consisted of 109 neonates (218 ears) in homogenous distribution related to gender and preterm/term classification. A high risk for hearing loss was observed in 40.4% of the infants. From the risk indicators for hearing loss, the most common were the duration of the stay in incubators and intensive care units (ICU) longer than five days. The DPOAEs were present in 209 ears (95.9%). The absence of responses to DPOEAs was significantly more frequent in groups with lower gestational age. It was observed an increase of the amplitudes of the DPOEAs with the increase of the gestational age, except for the frequency of 8000 Hz in the left ear. There were no differences between ears and genders regarding the presence and amplitude of the DPOAEs. Conclusion : There are differences between preterm and term groups in relation to the presence and amplitude of the DPOAEs: higher probability of failure in the groups with lower gestational age and (nonlinear) increase of the amplitudes with the increase of the gestational age. The findings suggest the phenomenon of maturation of the peripheral auditory system. .

The cost-savings of implementing kangaroo mother care in Nicaragua / Reducción de costos mediante la implantación del método madre canguro en Nicaragua

OBJECTIVE: To examine the costs of implementing kangaroo mother care (KMC) in a referral hospital in Nicaragua, including training, implementation, and ongoing operating costs, and to estimate the economic impact on the Nicaraguan health system if KMC were implemented in other maternity hospitals in the country. METHODS: After receiving clinical training in KMC, the implementation team trained their colleagues, wrote guidelines for clinicians and education material for parents, and ensured adherence to the new guidelines. The intervention began September 2010 The study compared data on infant weight, medication use, formula consumption, incubator use, and hospitalization for six months before and after implementation. Cost data were collected from accounting records of the implementers and health ministry formularies. RESULTS: A total of 46 randomly selected infants before implementation were compared to 52 after implementation. Controlling for confounders, neonates after implementation had lower lengths of hospitalization by 4.64 days (P = 0.017) and 71% were exclusively breastfed (P < 0.001). The intervention cost US$ 23 113 but the money saved with shorter hospitalization, elimination of incubator use, and lower antibiotic and infant formula costs made up for this expense in 1 - 2 months. Extending KMC to 12 other facilities in Nicaragua is projected to save approximately US$ 166 000 (based on the referral hospital incubator use estimate) or US$ 233 000 after one year (based on the more conservative incubator use estimate). CONCLUSIONS: Treating premature and low-birth-weight infants in Nicaragua with KMC implemented as a quality improvement program saves money within a short period even without considering the beneficial health effects of KMC. Implementation in more facilities is strongly recommended.

OBJETIVO: Analizar los costos de la implantación del método madre canguro en un hospital de referencia de Nicaragua, incluidos los costos de capacitación, implantación y funcionamiento, y calcular la repercusión económica en el sistema de salud nicaragüense si se aplicara el método en otras maternidades del país. MÉTODOS: Tras recibir capacitación clínica en el método, los miembros del equipo encargado de su implantación capacitaron a sus colegas, elaboraron directrices para los médicos y material educativo para los padres, y garantizaron la adhesión a las nuevas directrices. La intervención empezó en septiembre del 2010. El estudio comparó los siguientes datos: peso de los lactantes, empleo de medicamentos, consumo de leches maternizadas, uso de incubadoras, y hospitalizaciones durante los seis meses previos y posteriores a la implantación. Los datos relativos a los costos se recopilaron a partir de los registros contables de los ejecutores y los formularios del Ministerio de Salud. RESULTADOS: Los datos de 46 lactantes seleccionados aleatoriamente antes de la implantación se compararon con los de 52 lactantes del período posterior a la intervención. Mediante el control de los factores de confusión, después de la intervención, el tiempo medio de hospitalización de los recién nacidos fue inferior en 4,64 días (P = 0,017), y el 71% (P < 0,001) de los lactantes recibieron lactancia materna exclusiva. La intervención tuvo un costo de US$ 23 113 pero el dinero ahorrado gracias a la menor duración de las hospitalizaciones, la eliminación del uso de incubadoras, y la reducción de los costos en antibióticos y leches maternizadas compensó estos gastos en uno a dos meses. Se proyecta extender el método a otros 12 establecimientos sanitarios de Nicaragua para ahorrar aproximadamente US$ 233 000 (con base en el cálculo del uso de incubadoras en el hospital de referencia) o US$ 166 000 (con base en un cálculo más conservador del uso de incubadoras) al cabo de un año. CONCLUSIONES: El tratamiento de los neonatos prematuros y con bajo peso al nacer mediante el método madre canguro, implantado como un programa de mejora de la calidad en Nicaragua, ahorra dinero en un período corto, incluso sin tener en cuenta los efectos beneficiosos del método sobre la salud. Se recomienda su implantación en otros establecimientos sanitarios.

Enfermeria y neurodesarrollo: proyectando calidad de vida desde la Ucin, segunda parte / Nursing and neurodevelopment: projecting quality of life from the unit neonatal intensive care

El presente trabajo tiene el objetivo de sistematizar el cuidado de enfermeria en el servicio de Neonatologia del Sanatorio Allende con el motivo principal de acordar la atención segun evidencia cientifica, abogando por la seguridad a los recien nacidos y sus familiares, con un claro intento de iniciar un proceso de control de calidad en la atención de enfermeria que promuevan el correcto y adecuado desarrollo de su sistema nervioso y las conductas que de el dependan, incrementando asi la sobrevida y futura calidad de vida. En este numero se publica la segunda parte donde se desarrolla especificamente el cuidado del microambiente.

Enfermeria y neurodesarrollo: proyectando la calidad de vida desde la Unidad de Cuidados intensivos neonatales 1era parte / Nursing and neurodevelopment: proyecting quality of life from de Unit neonatal intensive care 1 part

El presente trabajo tiene el objetivo de sistematizar el cuidado de enfermeria en el Servicio de Neonatologia del Sanatorio Allende con el motivo principal de acordar la atencion según evidencia cientifica, abogando por la seguridad a los recien nacidos y sus familias, con un claro intento de iniciar un proceso de control de calidad en la atención de enfermeria que promuevan el correcto y adecuado desarrollo de su sistema nervioso y las conductas que de el dependan, incrementando asi la sobrevida y futura calidad de vida.

Noise at the Neonatal Intensive Care Unit and inside the incubator / Ruído na Unidade de Terapia Intensiva Neonatal e no interior da incubadora / Ruido en la Unidad de Terapia Intensiva Neonatal y en el interior de la incubadora

The goal was to identify sound pressure level (SPL) at the neonatal intensive care unit (NICU) and inside the incubator of a teaching hospital of a public university from São Paulo - SP, Brazil. SPL inside the NICU and the incubator were measured using four dosimeters in January/2010. SPL at the NICU varied from 52.6 dBA to 80.4 dBA and inside the incubator, from 45.4 dBA to 79.1 dBA. SPL both at the NICU and inside the incubator are above the recommended values, but levels were higher at the NICU than inside the incubator. Although there are some specific factors related to SPL inside the incubator, the NICU and incubator acoustic features present a system: an increase/decrease in SPL at the NICU usually tends to increase/decrease SPL inside the incubator. The study points to the need for simultaneous monitoring of SPL at the NICU and inside the incubator.

Este trabalho teve por objetivo identificar o nível de pressão sonora (NPS) da Unidade de Terapia Intensiva Neonatal (UTIN) e do interior da incubadora de um hospital escola de uma universidade pública de São Paulo, SP, Brasil. Como método para essa identificação, tanto do NPS da UTIN como do NPS da incubadora, foram utilizados quatro dosímetros, em janeiro de 2010. Os resultados obtidos apontam que o NPS da UTIN variou entre 52,6 dBA e 80,4 dBA, e que o NPS do interior da incubadora foi de 45,4dBA a 79,1dBA. Evidenciou-se que tanto o NPS da UTIN como o do interior da incubadora estão acima dos recomendados, sendo mais altos na UTIN do que na incubadora. Embora haja alguns fatores específicos relacionados ao NPS no interior da incubadora, perfis acústicos da UTIN e da incubadora são como sistema: elevação/redução do NPS da UTIN, geralmente, tende a elevar/reduzir o NPS no interior da incubadora. Portanto, pode-se concluir que o presente estudo aponta para a importância do monitoramento simultâneo dos NPS da UTIN e do interior da incubadora.

Se tuvo por objetivo identificar el nivel de presión sonora (NPS) de la Unidad de Terapia Intensiva Neonatal (UTIN) y del interior de la incubadora de un hospital escuela de una universidad pública de Sao Paulo-SP, Brasil. El NPS de la UTIN y de la incubadora fueron obtenidos por cuatro dosímetros en enero de 2010. El NPS de la UTIN varió entre 52,6 dBA y 80,4 dBA y el del interior de la incubadora fue de 45,4dBA a 79,1dBA. Tanto el NPS de la UTIN como el del interior de la incubadora son mayores que lo que recomendado, siendo más altos en la UTIN que en la incubadora. A pesar de que existen algunos factores específicos relacionados al NPS en el interior de la incubadora, los perfiles acústicos de la UTIN y de la incubadora son como un sistema, es decir: la elevación/reducción del NPS de la UTIN generalmente tiende a elevar/reducir el NPS en el interior de la incubadora. Se concluye que muy importante la monitorización simultánea del NPS de la UTIN y del interior de la incubadora.

Thermoregulation and thermography in neonatal physiology and disease.

INTRODUCTION: Infrared thermal imaging, or thermography, is a technique used to measure body surface temperature in the study of thermoregulation. Researchers are beginning to use this novel methodology to study cancer, peripheral vascular disease, and wound management. METHODS: The authors tested the feasibility of using an FLIR SC640 uncooled, infrared camera to measure body temperature in neonates housed in heated, humid incubators. The authors examined thermograms to analyze distributions between central and peripheral body temperature in extremely low birth weight infants. The authors have also used this technology to examine the relationship between body temperature and development of necrotizing enterocolitis in premature infants. RESULTS: Handheld, uncooled, infrared cameras are easy to use and produce high-quality thermograms that can be visualized in grayscale or color palettes to enhance qualitative and quantitative analyses. CONCLUSION: Future research will benefit from the use of this noninvasive, inexpensive measurement tool. Nurse researchers can use this methodology in adult and infant populations to study temperature differentials present in pathological conditions.

Noise measurement in NICUs and incubators with newborns: a systematic literature review / Mensuração de ruído sonoro em unidades neonatais e incubadoras com recém-nascidos: revisão sistemática de literatura / Mensuración de ruido en unidades neonatales e incubadoras con recién nacidos: revisión sistemática de literatura

This systematic literature review evaluated the methodological quality of studies measuring noise in neonatal intensive care units. A manual and also electronic search in the Medline, Scielo, Lilacs, BDENF, WHOLIS, BDTD, Science Direct, NCBI and Scirus databases resulted in 40 studies that met the criterion "measuring noise in neonatal units and/or incubators". Experts in neonatology and acoustics validated the critical analysis instrument, which obtained a mean = 7.9 (SD=1.3). The inter-observer reliability in 18 articles resulted in an Intra-class correlation coefficient (ICC) of 0.89 (CI 0.75-0.95). The quality indicators were 50 percent better in those studies that measured noise only in the unit's environment and associated measuring strategies to the physical area. The results showed great methodological variability, which hindered comparability and raised the probability of bias. The conditions required to ensure internal and external validity were observed in few studies.

Trata-se de revisão sistemática de literatura para avaliar a qualidade metodológica dos estudos que mediram ruído nas unidades neonatais. Após busca nas bases eletrônicas MEDLINE, SciELO, LILACS, BDENF, WHOLIS, BDTD, ScienceDirect, NCBI e Scirus, e busca manual, foram incluídos 40 estudos que atenderam o critério "mensurar ruído em unidades neonatais e/ou incubadoras". O instrumento de análise crítica foi validado por especialistas em neonatologia e acústica - nota média 7,9 (dp=1,3) - e a confiabilidade interobservador, em 18 artigos, resultou num coeficiente de correlação intraclasse (ICC) de 0,89 (IC95 por cento 0,75-0,95). Os indicadores de qualidade foram 50 por cento melhores para os estudos que mediram somente no ambiente da unidade ao associar as estratégias de mensuração à área física. Os resultados revelaram grande variabilidade metodológica, o que dificulta a comparabilidade e, algumas vezes, representa alta probabilidade de viés. O rigor necessário para garantir a validade interna e externa foi observado em poucos estudos.

Se trata de una revisión sistemática de la literatura para evaluar la calidad metodológica de los estudios que midieron el ruido en las unidades neonatales. Después de buscar en las bases electrónicas Medline, Scielo, Lilacs, BDENF, WHOLIS, BDTD, Science Direct, NCBI y Scirus, y de busca manual, fueron incluidos 40 estudios que atendieron el criterio "mensurar ruido en unidades neonatales y/o incubadoras". El instrumento de análisis crítico fue validezo por especialistas en neonatología y acústica - nota media 7,9 (DE=1,3) - y la confiabilidad inter-observador en 18 artículos resultó en un ICC de 0,89 (IC95 por ciento 0,75-0,95). Los indicadores de calidad fueron 50 por ciento mejores para los estudios que midieron solamente en el ambiente de la unidad, asociando las estrategias de mensuración al área física. Los resultados revelaron gran variabilidad metodológica, lo que dificulta la comparación y algunas veces representa alta probabilidad de sesgo. El rigor necesario para garantizar la validez interna y externa fue observado en pocos estudios.