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Abstract Introduction The study of the diaphragm muscle has aroused the interest of physiotherapists who work with kinesiological ultrasonography, but still little explored; however, its findings can contribute to the clinical practice of hospitalized patients in neonatal intensive care units. Objective To measure the excursion and thickening of the diaphragm and describe measurements among neonates, preterm, and full-term. Methods Diaphragmatic kinesiological ultrasonography was performed on hospitalized newborns, in Neonatal Unit Care Unit, placed in supine position in their own bed, on the sixth day of life. Three repeated measurements of the same respiratory cycle were made, both for excursion and for diaphragmatic thickening. Results 37 newborns participated in the study and 25 were premature. The mean weight at the time of collection was 2,307.0 ± 672.76 grams and the gestational age was 35.7 ± 3.3 weeks. Diaphragmatic excursion increased with increasing gestational age (p = 0.01, df = 0.21) in term infants (p = 0.17, df = 0.35). Conclusion There was a positive correlation between diaphragmatic excursion and gestational age. There was no statistically significant difference in the measurements of excursion and inspiratory diaphragm thickening between preterm and term newborns, although pointing to higher measurements in the latter group.
Resumo Introdução O estudo do músculo diafragma tem des-pertado o interesse dos fisioterapeutas que trabalham com ultrassonografia cinesiológica. Ainda pouco explo-rado, contudo, seus achados podem contribuir para a prática clínica dos pacientes internados em unidades de terapia intensiva neonatal (UTIN). Objetivo Mensurar a excursão e o espessamento diafragmático e descrever as medidas entre recém-nascidos prematuros e a termo. Métodos Realizou-se ultrassonografia cinesiológica diafragmática em recém-nascidos internados em UTIN, posicionados em supino em seu próprio leito, no sexto dia de vida. Foram realizadas três medidas repetidas do mesmo ciclo respiratório, tanto da excursão quanto do espessamento diafragmático. Resultados Participaram do estudo 37 recém-nascidos, dos quais 25 eram pre-maturos. O peso no momento da coleta foi de 2.307,0 ± 672,76 gramas e a idade gestacional foi de 35,7 ± 3,3 semanas. A excursão diafragmática aumentou de acordo com o aumento da idade gestacional (p = 0,01; df = 0,21). A espessura variou entre 0,10 e 0,16 cm durante a inspiração nos prematuros e entre 0,11 e 0,19 cm nos nascidos a termo (p = 0,17; df = 0,35). Conclusão Houve correlação positiva entre a excursão diafragmá-tica e a idade gestacional. Não observou-se diferença estatisticamente significativa das medidas de excursão e de espessamento diafragmático inspiratório entre recém-nascidos prematuros e recém-nascidos a termo, embora apontando para maiores medidas neste último grupo.
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Los recién nacidos tienen un alto riesgo de morbimortalidad asociada a infecciones durante su estancia en unidades de cuidado intensivo neonatal, a lo que se asocia un aumento progresivo de infecciones por microorganismos multi-resistentes que requiere el uso de nuevos antimicrobianos. Presentamos el caso de una recién nacida de pretérmino de 36 semanas que cursó con una infección del tracto urinario bacteriémica por Klebsiella pneumoniae productora de carbapenemasa tratada de forma efectiva con 14 días de cefazi- dima-avibactam, sin efectos adversos observados. Según nuestro conocimiento, este es el primer caso reportado en nuestro país del uso de este antimicrobiano en población neonatal. Se necesita más información sobre la eficacia y seguridad de ceftazidima-avibactam en este grupo de pacientes.
Neonates are high risk patients regarding morbimortality secondary to infections during their neonatal intensive care unit stay, which is associated to a progressive increase in the report of multidrug resistant organism infections, that require the use of new antimicrobial. We report the case of a 36-week preterm with an urinary tract infection with bacteriemia caused by carbapenemase- producing Klebsiella pneumoniae treated effectively with 14 day of ceftazidime-avibactam, without observed adverse effects. To our knowledge, this is the first case report in our country of the use of this antibiotic in neonatal population. More information is needed regarding efficacy and safety of ceftazidime-avibactam in this group of patients.
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ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) may be asymptomatic or symptomatic in pregnant women. Compared to non-pregnant reproductive-aged women, symptomatic individuals appear to have a higher risk of acquiring severe illness sequelae. OBJECTIVES: We assessed the clinical and laboratory characteristics and outcomes of pregnant COVID-19 patients unvaccinated for severe acute respiratory syndrome coronavirus 2 according to the trimester of pregnancy. DESIGN AND SETTING: This was a retrospective observational study conducted in a tertiary-level hospital in Turkey. METHODS: This retrospective study reviewed the clinical and laboratory characteristics and outcomes of 445 pregnant COVID-19 patients hospitalized during the first, second, and third trimesters of pregnancy and 149 other pregnant women as controls in a tertiary center from April 2020 to December 2021. All participants were unvaccinated. RESULTS: Overall, the study groups were comparable in terms of baseline clinical pregnancy characteristics. There was no clear difference among the study participants with COVID-19 in the first, second, and third trimesters of pregnancy. However, a considerably high number of clinical and laboratory findings revealed differences that were consistent with the inflammatory nature of the disease. CONCLUSIONS: The study results reveal the importance of careful follow-up of hospitalized cases as a necessary step by means of regular clinical and laboratory examinations in pregnant COVID-19 patients. With further studies, after implementing vaccination programs for COVID-19 in pregnant women, these data may help determine the impact of vaccination on the outcomes of pregnant COVID-19 patients.
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ABSTRACT Objective: To analyze the temperature curve of raw or pasteurized human milk exposed to different heating methods. Method: Experiments with volumes of 5 ml to 100 ml of human milk were carried out between 2016 and 2021 and analyzed according to the exposure time by different heating methods. Descriptive statistics included the calculation of means, medians, minimum and maximum values, measures of dispersion and standard deviation. Results: The thermal curve made it possible to identify the heating of human milk close to body temperature when subjected to a water bath and microwaves. Milk exposed to room temperature (21°C) was unable to reach this temperature. When heated in a water bath at 40°C, smaller volumes reached body temperature between 3 and 5 minutes, while in a microwave at 50% power, practically all volumes reached temperature. Conclusion: The temperature curves of raw or pasteurized human milk were constructed, and it was possible to verify its behavior using different heating methods for administering the food in a neonatal intensive care unit, considering the volume, type and time of heating and temperature.
RESUMEN Objetivo: Analizar la curva de temperatura de la leche humana cruda o pasteurizada expuesta a diferentes métodos de calentamiento. Método: Se realizaron experimentos con volúmenes de 5 ml a 100 ml de leche humana entre 2016 y 2021 y se analizaron en función del tiempo de exposición mediante diferentes métodos de calentamiento. La estadística descriptiva incluyó el cálculo de medias, medianas, valores mínimos y máximos, medidas de dispersión y desviación estándar. Resultados: La curva térmica permitió identificar el calentamiento de la leche humana próximo a la temperatura corporal cuando se sometió a baño maría y microondas. La leche expuesta a temperatura ambiente (21°C) fue incapaz de alcanzar esta temperatura. Cuando se calentó en un baño de agua a 40°C, los volúmenes más pequeños alcanzaron la temperatura corporal entre 3 y 5 minutos, mientras que en un microondas al 50% de potencia, prácticamente todos los volúmenes alcanzaron la temperatura. Conclusión: Se construyeron las curvas de temperatura de la leche humana cruda o pasteurizada y se pudo comprobar su comportamiento utilizando diferentes métodos de calentamiento para administrar el alimento en una unidad de cuidados intensivos neonatales, teniendo en cuenta el volumen, el tipo y el tiempo de calentamiento y la temperatura.
RESUMO Objetivo: Analisar a curva de temperatura do leite humano cru ou pasteurizado exposto a diferentes métodos de aquecimento. Método: Experimentos com volumes de 5 ml a 100 ml de leite humano foram realizados entre 2016 e 2021 e analisados segundo o tempo de exposição por diferentes métodos de aquecimento. A estatística descritiva incluiu o cálculo das médias, medianas, valores mínimos e máximos, medidas de dispersão e desvio padrão. Resultados: A curva térmica permitiu identificar o aquecimento do leite humano próximo da temperatura corporal quando submetidos a banho-maria e micro-ondas. O leite exposto à temperatura ambiente (21°C) não foi capaz de atingir tal temperatura. No aquecimento em banho-maria a 40°C, volumes menores alcançaram a temperatura corporal entre 3 e 5 minutos, enquanto em micro-ondas na potência de 50%, praticamente todos os volumes alcançaram essa temperatura. Conclusão: As curvas de temperatura do leite humano cru ou pasteurizado foram construídas, sendo possível verificar o seu comportamento mediante diferentes métodos de aquecimento para administração do alimento em unidade de terapia intensiva neonatal, considerando o volume, tipo e tempo de aquecimento e temperatura.
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Humans , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Milk Banks , Milk, HumanABSTRACT
Objective:To systematically evaluate the safety of family integrated care (FICare) model in neonatal intensive care unit (NICU).Methods:Multiple medical databases were searched for clinical studies on FICare in NICU published from January 1, 2010 to May 28, 2022. The quality of the literature was evaluated using Risk?of?Bias?2 tool?and cohort evaluation criteria from the Cochrane Systematic Evaluation Manual depending on the types of studies included. Meta-analysis was performed using Review Manager 5.3 software.Results:Six randomized controlled trials and four cohort studies were included for meta-analysis. The results of meta-analysis showed that compared with the traditional care model, FICare model did not increase the risk of nosocomial infection ( RR=0.75, 95% CI 0.46-1.24, P=0.27) and unstable medical conditions ( RR=0.86, 95% CI 0.61-1.22, P=0.40). No significant difference existed in the all-cause mortality between FICare and traditional care ( RR=2.74, 95% CI 0.88-8.57, P=0.08). Conclusions:FICare does not increase the risk of nosocomial infection, unstable medical conditions and adverse events compared with traditional care. It is safe and feasible to implement FICare in NICU.
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Objective:To study the outcomes and post-discharge follow-up of neonatal tracheotomy in neonatal intensive care unit(NICU).Methods:This study included patients who were admitted to NICU in Beijing Children′s Hospital from January, 2016 to August, 2021, and less than 28 days or 44 weeks(corrected age)on admission, and required tracheotomy.The patients were divided into tracheotomy group and the non-tracheotomy group (the parents signed to refuse the tracheotomy) according to whether perform tracheotomy.Demographic data, general hospitalization information, diagnosis, indications for tracheotomy, follow-up outcomes at 3/6/12 months of age after discharge of patients were collected and analyzed.Results:Totally 26 patients were included in this study, 14 cases in tracheotomy group and 12 cases in non-tracheotomy group.The average gestational age was(37.7±3.80)weeks and(38.99±1.83)weeks, and birth weight was(2 823.57±948.89)g and (3 320.83±378.76)g, respectively.There were no significant differences in sex, gestational age, birth weight, age on admission, weight on admission, age at diagnosis, ratio of endotracheal intubation for respiratory support on admission between two groups( P>0.05). The commonest indications of tracheotomy group were bilateral vocal cord paralysis(50.0%) and congenital anomaly/defect of throat/larynx(21.4%), and the commonest indications of non-tracheotomy group were bilateral vocal cord paralysis(50.0%) and vocal cord/subglottic mass(25.0%), and there was no significant difference between two groups( P>0.05). The rate of discharge-against-medical order of tracheotomy and non-tracheotomy group was 7.14% and 66.67%( P=0.003), respectively.The total follow-up rate of tracheotomy and non-tracheotomy group was 88.9% and 38.9%, while the follow-up rates at 3 months, 6 months, and 12 months were 100.0% vs. 50.0%, 83.3% vs. 41.7%, and 81.8% vs. 25.0%, respectively, whose differences were statistically significant(all P<0.05). In the 14 cases of tracheotomy group, 3 cases died, 4 cases successfully removed the tracheal cannula, 5 cases did not remove the tracheal cannula, and 2 cases were lost. Conclusion:Bilateral vocal cord paralysis is the commonest indication of neonatal tracheotomy.Parents′ compliance in the tracheotomy group is significantly higher than that in non-tracheotomy group.To give caring skill training for parents of neonates with tracheotomy before discharge is beneficial for improving the overall prognosis of children.
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Introdução: Dentre as diversas áreas de sua competência, a Farmácia Hospitalar é responsável pela promoção e monitoramento do uso seguro de medicamentos. Objetivo: Investigar erros de prescrição, de dose, de preparo e desperdício de antimicrobianos distribuídos de forma individualizada para pacientes de UTI-Neonatal na Fundação Santa Casa de Misericórdia do Pará. Metodologia: Trata-se de uma pesquisa transversal, retrospectiva, fundamentada na pesquisa-ação, tendo como recorte temporal o período de novembro de 2021 a janeiro 2022. As variáveis relacionadas aos medicamentos foram comparadas ao protocolo de prescrição do NEOFAX®. Resultado: O estudo envolveu 76 pacientes e analisou 213 prescrições que envolveram 341 antimicrobianos, dos quais, 280 (82%) dos antimicrobianos prescritos não apresentavam clareza quanto às instruções de preparo e 98 (29%) apresentaram as doses em desacordo com o NEOFAX®. Os itens de maior dúvida foram quanto à estabilidade após o preparo: 341 (100%); quanto ao volume final após preparo 341 (100%) e quanto a técnica de preparo 266 (78%). Do total de pacientes, 32 (42%) eram de muito baixo peso, seguidos de 26 (34%) de extremo baixo peso, e 18 (24%) de baixo peso. Conclusão: Os dados obtidos no estudo subsidiaram a implantação de uma central de misturas intravenosas na instituição estudada.
Introduction: Among the various areas of its competence, the Hospital Pharmacy is responsible for promoting and monitoring the safe use of medicines. Objective: To investigate errors in prescribing, dosage, preparation and waste of antimicrobials distributed individually to neonatal ICU patients at Santa Casa de Misericórdia Foundation of Pará. Methodology: This is a retrospective cross-sectional study, based on action research, with a time frame of November 2021 to January 2022. The variables related to medications were compared to the NEOFAX® prescription protocol. Results: The study involved 76 patients and analyzed 213 prescriptions involving 341 antimicrobials. Of these, 280 (82%) of the prescribed antimicrobials were unclear regarding preparation instructions and 98 (29%) had doses in disagreement with NEOFAX®. The most doubtful items were about stability after preparation: 341 (100%); about the final volume after preparation 341 (100%) and about the preparation technique 266 (78%). Of the total number of patients, 32 (42%) were very low weight, followed by 26 (34%) extreme low weight, and 18 (24%) low weight. Conclusion: The data obtained in this study supported the implementation of an IV mixing center at the studied institution.
Introducción: Entre varias áreas de su competencia, la Farmacia Hospitalaria es responsable de promover y vigilar el uso seguro de los medicamentos. Objetivo: Investigar errores de prescripción, dosificación, preparación y desperdicio de antimicrobianos distribuidos de forma individualizada para pacientes de UCI neonatal en la Fundación Santa Casa de Misericórdia de Pará. Metodologia: Trata-se de uma pesquisa transversal, retrospectiva, fundamentada na pesquisa-ação, tendo como recorte temporal o período de novembro de 2021 a janeiro 2022. Las variables relacionadas con la medicación se compararon con el protocolo de prescripción NEOFAX®. Resultados: El estudio involucró 76 pacientes y analizó 213 prescripciones que involucraron 341 antimicrobianos, de los cuales, 280 (82%) de los antimicrobianos prescritos no eran claros en cuanto a las instrucciones de preparación y 98 (29%) presentaban las dosis en desacuerdo con el NEOFAX®. Los ítems de mayor duda fueron sobre la estabilidad tras la preparación: 341 (100%); sobre el volumen final tras la preparación 341 (100%) y sobre la técnica de preparación 266 (78%). Del total de pacientes, 32 (42%) eran de muy bajo peso, seguidos de 26 (34%) de bajo peso extremo y 18 (24%) de bajo peso. Conclusión: Los datos obtenidos en el estudio subsidian la implementación de un centro de mezclas intravenosas en la institución estudiada.
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Abstract Objectives: to assess the supply of human milk exclusively to prematures in a Neonatal Intensive Care Unit and the influence of external and organizational contexts on the degree of implementation of this intervention. Methods: this is an implementation evaluation with analysis of the external context (sociodemographic situation of mothers, support network and industry marketing) and organizational context (belonging to the hospital unit). To define the degree of implementation, the Analysis and Judgment Matrix was used, considering the compliance dimension, and the availability and technical-scientific quality sub-dimensions. The data used were obtained through interviews, semi-structured questionnaires and analysis of documents from the institution. Results: the degree of implementation of the intervention was 80.74%, proving to be satisfactory, with emphasis on the technical-scientific quality sub-dimension. Conclusions: the success in the supply of human milk is linked to public policies, the support and guidance offered to mothers in the hospital unit, presence of a support network, knowledge of mothers about the benefits of breastfeeding, adequate infrastructure and availability of supplies. The prematures being hospitalized in a child-friendly hospital contributed to the implementation of the intervention.
Resumo Objetivos: avaliar o fornecimento de leite humano de forma exclusiva aos prematuros em uma Unidade de Terapia Intensiva Neonatal e a influência dos contextos externo e organizacional no grau de implantação dessa intervenção. Métodos: trata-se de uma avaliação de implantação com análise dos contextos externo (situação sociodemográfico das mães, rede de apoio e marketing da indústria) e organizacional (pertencente à unidade hospitalar). Para definir o grau de implantação, foi utilizada a Matriz de Análise e Julgamento, considerando a dimensão conformidade, e as subdimensões disponibilidade e qualidade técnico-científica. Os dados utilizados foram obtidos por meio de entrevistas, questionários semiestruturados e análise de documentos da instituição. Resultados: o grau de implantação da intervenção foi de 80,74%, mostrando-se satisfatório, com destaque para a subdimensão qualidade técnico-científica. Conclusões: o sucesso no fornecimento de leite humano está atrelado às políticas públicas, ao apoio e orientações oferecidos às mães na unidade hospitalar, disponibilidade de rede de apoio, conhecimento das mães acerca dos benefícios do aleitamento materno, infraestrutura adequada e disponibilidade de insumos. Os prematuros estarem internados em hospital amigo da criança contribuiu para a implantação da intervenção.
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Humans , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Maternal-Child Health Services/organization & administration , Milk, Human , Health Evaluation , Breast FeedingABSTRACT
RESUMO A unidade de terapia intensiva neonatal (UTIN) é organizada para o atendimento ao recém-nascido que tenha dificuldade de adaptação e sobrevida no ambiente extrauterino, devido à patologia perturbadora, disfunção respiratória e prematuridade. O Rio Grande do Sul (RS) detém uma alta taxa de prematuridade, acima da média nacional. Assistindo ao neonato, o fisioterapeuta executa o papel primordial de estimular as funções respiratória e motora através de técnicas específicas. Este estudo observacional descritivo objetivou identificar as técnicas fisioterapêuticas utilizadas em UTINs no estado do RS. Assim, aplicou-se um questionário on-line aos fisioterapeutas atuantes em UTINs do RS, com 32 questões sobre formação e atuação profissional, jornada de trabalho, dados da unidade, relacionamento multiprofissional e técnicas fisioterapêuticas utilizadas. Ao final, 22 profissionais responderam ao questionário, havendo prevalência do sexo feminino (100%), idade média de 30,6 anos, tempo de formação médio de 6 anos, tempo de atuação em UTIN entre 6 e 15 anos (22,7%) e com pós-graduação na área de fisioterapia neonatal (73,3%). Prematuridade foi o principal motivo de internação (100%) e as condutas fisioterapêuticas mais citadas foram: posicionamento terapêutico e aspiração (95,5%); e incentivo à linha média (90,9%). Conclui-se que as condutas fisioterapêuticas identificadas no estudo são condizentes com a recomendação na literatura, sendo pertinentes e adequadas ao tratamento do paciente neonato.
RESUMEN La unidad de cuidados intensivos neonatales (UCIN) brinda cuidados a los recién nacidos que tienen dificultad para adaptarse y sobrevivir en el ambiente extrauterino, debido a una patología perturbadora, disfunción respiratoria y prematuridad. Rio Grande do Sul (Brasil) tiene una alta tasa de prematuridad por encima de la media nacional. En la asistencia al neonato, el fisioterapeuta juega un papel clave al estimular las funciones respiratorias y motoras a través de técnicas específicas. Este estudio observacional descriptivo tuvo por objetivo identificar las técnicas fisioterapéuticas que son utilizadas en las UCIN del estado de Rio Grande do Sul. Para ello, se aplicó un cuestionario en línea a los fisioterapeutas que actúan en las UCIN de este estado, que contenía 32 preguntas sobre formación y desempeño profesional, jornada laboral, datos de la unidad, relación multidisciplinar y técnicas fisioterapéuticas utilizadas. En total 22 entrevistados respondieron al cuestionario, con predominio del sexo femenino (100%), edad media de 30,6 años, tiempo de formación promedio de 6 años, tiempo de actuación en la UCIN entre 6 y 15 años (22,7%) y con posgrado en fisioterapia neonatal (73,3%). La prematuridad fue el principal motivo de hospitalización (100%), y los procedimientos fisioterapéuticos más citados fueron la conducta terapéutica y aspiración (95,5%); e incentivo a la línea media (90,9%). Se concluye que la actuación fisioterapéutica identificada es consistente con lo que recomienda la literatura, además de ser pertinente y adecuada para el tratamiento del paciente recién nacido.
ABSTRACT The neonatal intensive care unit (NICU) is organized to care for newborns who have difficulty in adapting and surviving in the extrauterine environment, due to disturbing pathology, respiratory dysfunction, and prematurity. Rio Grande do Sul (RS) has a high rate of prematurity, above the national average. To assist the newborn, the physical therapist stimulates the respiratory and motor functions with specific techniques. This descriptive observational study aimed to identify the physiotherapeutic techniques used in NICUs in the state of RS. An online questionnaire was applied to physical therapists working in NICUs in RS, with 32 questions related to training and professional performance, working hours, unit data, multiprofessional relationship, and physiotherapeutic technique used. In total, 22 professionals answered the questionnaire, all females (100%), mean age of 30.6 years, mean period since undergraduate education of 6 years, years of professional practice in the NICU ranging from 6 to 15 years (22.7%), and with a graduate degree in the field of Neonatal Physical Therapy (73.3%). Prematurity was the main reason for hospitalization (100%) and the physiotherapeutic conduct most study participants mentioned were therapeutic positioning and aspiration (95.5%) and encouraging crossing the midline (90.9%). We concluded that the physiotherapeutic conducts in this study are consistent with the literature, being relevant and appropriate for the treatment of newborns.
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RESUMO: A prematuridade e a internação em Unidade de Tratamento Intensivo Neonatal (UTIN) têm efeitos sobre pais e filhos, podendo obstaculizar essa relação e a constituição psíquica da criança. Esse estudo qualitativo objetivou compreender as vivências parentais na prematuridade, da internação do bebê até os 12 meses de vida. Realizaram-se entrevistas semiestruturadas com pais de quatro bebês prematuros durante sua internação na UTIN, após a alta e aos 12 meses de vida utilizando-se a análise temática, que gerou cinco grandes temas. Evidenciaram-se obstáculos vivenciados pelos pais, contudo, fortaleceram-se e retomaram a capacidade de cuidar, investir e sentirem-se investidos pelos filhos
Abstract: Prematurity and admission to the Neonatal Intensive Care Unit (NICU) have effects on parents and children, which can hinder their relationship and the child's psychic constitution. This qualitative study aimed to understand parental experiences with prematurity from the baby's hospitalization up until 12 months old. Semi-structured interviews were conducted with parents of four premature babies during their NICU stay, after discharge and at 12 months of life, using thematic analysis, which generated five major themes. Although obstacles experienced by the parents were evidenced, they strengthened and resumed the ability to care, invest and feel invested by their children.
Subject(s)
Infant, Premature , Intensive Care Units, Neonatal , ParentingABSTRACT
ABSTRACT Objective: Thyroid functions in the sick newborns may be altered in the first week of life. Transient hypothyroxinemia has been reported in these babies, which could be due to the immaturity of the hypothalamic-pituitary-thyroid axis or to acute illness. We conducted this study to estimate the incidence of hypothyroxinemia and determine its risk factors in sick term newborns. Materials and methods: We analyzed free T4 (FT4) and thyroid-stimulating hormone (TSH) levels in sick term neonates (≤7 days of life) admitted to the neonatal intensive care unit. FT4 and TSH levels were estimated in the first week of life in all the enrolled neonates (N = 98) and then repeated at 14-21 days of life in 46 babies. Risk analysis was conducted using univariate and multivariate logistic regression, and numerical data was compared using the Mann-Whitney U test and t-test. Results: Hypothyroxinemia was seen in 10 (10.2%) of the admitted term babies. Male gender, vaginal delivery, presence of hypoxic ischemic encephalopathy, and need for mechanical ventilation (>24 hours) were identified as risk factors. There was a significant negative linear correlation between FT4 level in the first week of life and duration of hospital stay. Conclusion: Hypothyroxinemia is common in sick term neonates.
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Abstract Background: Kangaroo mother care (KMC) offers several benefits for neonates and mothers. Although many studies have evaluated the effectiveness of KMC on infants, only few studies have examined the effects on mothers. This study aimed to evaluate the effectiveness of KMC on maternal resilience and breastfeeding self-efficacy via the role-play method in a neonatal intensive care unit. Methods: We conducted a randomized controlled trial. Mothers were randomized into two groups. Mothers in the intervention group were trained using the role-play method. Questionnaires were administered before and after the intervention. Data were analyzed with SPSS version 22. Results: The training demonstrated a statistically significant difference in resilience score and breastfeeding self-efficacy in each group after the intervention. In addition, a statistically significant difference was revealed between both groups in resilience scores and breastfeeding self-efficacy after the intervention. Conclusions: KMC training with the role-play method was most effective. Role-play and routine methods are recommended as methods of therapeutic care in clinical settings to improve maternal resilience and breastfeeding self-efficacy.
Resumen Introducción: El cuidado madre canguro ofrece una gran cantidad de beneficios para el neonato y la madre. Aunque muchos estudios han evaluado la eficacia del cuidado madre canguro en los bebés, solo pocos estudios han examinado los efectos en las madres. El propósito del presente estudio fue evaluar la efectividad del cuidado madre canguro sobre la resiliencia de la madre y la autoeficacia de la lactancia mediante el método de juego de roles en la unidad de cuidados intensivos neonatales. Métodos: Se llevó a cabo un ensayo controlado aleatorio. Las madres se asignaron en dos grupos al azar. Las madres del grupo de intervención fueron capacitadas mediante el método de juego de roles. Se aplicaron cuestionarios antes y después de la intervención. Los datos se analizaron utilizando SPSS versión 22. Resultados: El entrenamiento demostró una diferencia estadísticamente significativa en la puntuación de la resiliencia y la autoeficacia de la lactancia en cada grupo después de la intervención. Además, se reveló una diferencia estadísticamente significativa entre ambos grupos en la puntuación de resiliencia y la autoeficacia de la lactancia después de la intervención. Conclusiones: La capacitación del cuidado madre canguro mediante el método de juego de roles fue más efectiva. Se recomienda el juego de roles y los métodos de rutina como métodos de atención terapéutica en entornos clínicos para mejorar la resiliencia de la madre y la autoeficacia de la lactancia.
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RESUMO O objetivo deste estudo foi analisar a razão pela qual devemos nos preocuparmos com os bebês a termo internados em uma unidade de terapia intensiva neonatal. Trata-se de estudo documental, descritivo e retrospectivo de 262 recém-nascidos (RNs) a termo. As variáveis utilizadas foram: características dos RN; diagnóstico principal, tempo de permanência e acompanhamento pela equipe multiprofissional; e encaminhamento pós-alta. Houve prevalência do sexo masculino (52%), de Apgar 9 no 5º minuto e da raça/cor branca do RN e da mãe (61,1% e 48,9%, respectivamente). O diagnóstico principal foi a disfunção respiratória (28,8%), e o tempo de permanência foi de oito dias. Houve diferença significativa entre os tempos de permanência (p=0,013), em que as doenças cardiorrespiratórias e outras doenças levaram a um menor tempo de internação em relação à má formação ou às doenças maternas. O serviço social foi o mais procurado para o acompanhamento (81,2%) e a fisioterapia, o menos buscado (18%). RNs com maior peso ficaram menos tempo internados, e os acompanhados por fisioterapia apresentaram tempo de permanência mais elevados (p<0,001). O principal desfecho foi a alta hospitalar (68,7%) e encaminhamentos para a Unidade Básica de Saúde (57%). Os achados deste estudo apontam a presença de bebês menos graves, baixo número de estudos específicos para a população a termo e outros diagnósticos que nos remetem a cuidados não intensivos.
RESUMEN El objetivo de este estudio fue analizar el motivo de preocupación por los recién nacidos a término ingresados en una unidad de cuidados intensivos neonatal. Se trata de un estudio documental, descriptivo y retrospectivo, realizado con 262 recién nacidos (RN) a término. Las variables utilizadas fueron: características de los RN; diagnóstico principal, tiempo de estancia y seguimiento por el equipo multidisciplinar; y derivación posterior al alta. Hubo predominio del sexo masculino (52%), Apgar 9 al 5º minuto y raza/color blanca del RN y de la madre (61,1% y 48,9%, respectivamente). El principal diagnóstico fue disfunción respiratoria (28,8%), y la estancia hospitalaria fue de ocho días. Hubo una diferencia significativa entre el tiempo de estancia (p=0,013), en que las enfermedades cardiorrespiratorias y otras enfermedades resultaron en una menor estancia hospitalaria con relación a malformaciones o enfermedades maternas. El trabajo social fue el más buscado para el seguimiento (81,2%), y la fisioterapia, el menos buscado (18%). Los RN con mayor peso tuvieron una menor estancia hospitalaria, y aquellos que recibían seguimiento de fisioterapia tuvieron mayor tiempo de estancia (p<0,001). El principal desenlace fue el alta hospitalaria (68,7%) y las derivaciones a la Unidad Básica de Salud (57%). Los hallazgos de este estudio apuntan a la presencia de recién nacidos menos graves, un bajo número de estudios específicos para la población a término y otros diagnósticos que nos remiten a cuidados no intensivos.
ABSTRACT This study aims to analyze why we should care about full-term newborns admitted to a neonatal intensive care unit. This is a documented, descriptive, and retrospective study of 262 full-term newborns. Variables used: newborns' characteristics; main diagnosis, length of stay, follow-up by a multidisciplinary team; post-discharge referral. Most newborns were boys (52%), had a 5-minute Apgar score of nine, and most newborns and their mothers were white (61.1% and 48.9% respectively). Respiratory dysfunction was the main diagnosis (28.8%). Length of stay was eight days. There was a significant difference regarding length of stay (p=0.013), in which those with cardiorespiratory and other diseases stayed less time compared to those with malformation or maternal diseases. The social service was the most sought (81.2%) service, whereas physical therapy the least sought (18%). Newborns with higher weight were hospitalized for less time. Those that underwent physical therapy had longer stay (p<0.001). Main outcome was hospital discharge (68.7%) and referrals to the Basic Health Unit (57%). This study outcomes indicated newborns with less severe conditions, low number of specific studies for the full-term population, other diagnoses that refer to non-intensive care.
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Background: A Dutch committee for National Guidelines in Neonatology developed nineteen evidence- and consensusbased guidelines to be used in all Dutch neonatal intensive care units (NICUs). The primary goal was to make clinical practices more uniform and consistent. Objective: This study investigated to what extent the guidelines were implemented and which factors played a role in implementation. Study design: A mixed method study design was used to investigate both the level and the process of implementation. A nationwide, multicenter, cross-sectional survey was performed using a validated instrument for measuring the level of implementation (Normalization MeAsure Development questionnaire, NoMAD). The number of implemented guidelines per NICU and the frequency and content of the amendments that NICUs made to the original consensus guidelines were analyzed. Through semistructured interviews, perceived barriers and facilitators for implementation were explored. Participants: Fellows and neonatologists working at all ten Dutch level 3-4 NICUs were eligible. Results: On an average, NICUs implemented 12.6 (of 19) guidelines (range 6-17). The Normalization Process Scale was 54 (of 65). Main influencing factors impeding implementation were guideline-related (e.g., unpractical, lengthy guidelines) and personal (e.g., an active representative responsible for local implementation). Conclusion: The implementation of our guidelines appears to be successful. Ways for improvement can be distinguished in personal, guideline-related and external factors. Empowerment of local representatives was considered most essential.
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Abstract Objective: The present study aimed to evaluate the effects of hydrotherapy and tactile-kinesthetic stimulation on the birth weight of preterm infants admitted in the Neonatal Intensive Care Unit. Method: It was a randomized controlled trial, without blinding, in which 44 preterm infants of both sexes with gestational age between 32 and 34 weeks were included into two groups: hydrotherapy group (n = = 22) and tactile-kinesthetic stimulation group (n = 22). Weight gain was the parameter assessed daily. Results: In the tactile-kinesthetic stimulation group there was a variation in weight gain, but without significant difference (p = 0,43). However, in the hydrotherapy group, it was observed that increased weight gain started from the 2nd day (p < 0,001). Conclusions: Hydrotherapy group presented significantly increased weight after the interventions, indicating that this technique can interfere with weight gain in preterm infants.
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Amongst all the traumatic experiences in a human life, death of child is considered the most painful, and has profound and lasting impact on the life of parents. The experience is even more complex when the death occurs within a neonatal intensive care unit, particularly in situations where there have been conflicts associated with decisions regarding the redirection of life-sustaining treatments. In the absence of national guidelines and legal backing, clinicians are faced with a dilemma of whether to prolong lifesustaining therapy even in the most brain-injured infants or allow a discharge against medical advice. Societal customs, vagaries, and lack of bereavement support further complicate the experience for parents belonging to lower socio-economic classes. The present review explores the ethical dilemmas around neonatal death faced by professionals in India, and suggests some ways forward.
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OBJETIVO: Conhecer as percepções das mães de recém-nascidos prematuros internados na Unidade Neonatal diante da pandemia do COVID-19. MÉTODO: Pesquisa qualitativa realizada entre junho e julho de 2020, envolvendo 12 mães de recém-nascidos prematuros internados nas unidades neonatais de uma maternidade no estado do Ceará durante a pandemia do Coronavírus. As mães foram contactadas via aplicativo WhatsApp. Para a análise textual foi utilizada a classificação hierárquica descendente realizada pelo software IRAMUTEQ. RESULTADOS: A percepção das mães estava centrada nas dificuldades enfrentadas neste período de pandemia. A palavra "não" foi fortemente apresentada no corpus do texto, evidenciando o impacto do impedimento da visita, da permanência das mães nas unidades e o fato de não poder amamentar. CONCLUSÃO: A prestação de uma assistência humanizada nas unidades neonatais não deve se limitar ao recém-nascido, sendo fundamental o apoio emocional às mães por parte da equipe de saúde.
OBJECTIVE: To know the perceptions of mothers of premature newborns hospitalized in the Neonatal Unit in the face of the COVID-19 pandemic. METHOD: Qualitative research carried out in June and July 2020, involving 12 mothers of premature newborns hospitalized in the neonatal units of a maternity hospital in the state of Ceará during the Coronavirus pandemic. Mothers were contacted via WhatsApp application. For the textual analysis, the descending hierarchical classification performed by the IRAMUTEQ software was used. RESULTS: The mothers' perception was centered on the difficulties faced in this pandemic period. The word "no" was strongly presented in the corpus of the text, evidencing the impact of the impediment of the visit, of the mothers' permanence in the units and the fact of not being able to breastfeed. CONCLUSION: The provision of humanized care in neonatal units should not be limited to the newborn, and emotional support for mothers by the health team is essential.
OBJETIVO: Conocer las percepciones de las madres de recién nacidos prematuros internados en unidades neonatales ante la pandemia del COVID-19. MÉTODO: Investigación cualitativa realizada en junio y julio de 2020 con la participación de 12 madres de recién nacidos prematuros internados en las unidades neonatales de una maternidad del estado de Ceará durante la pandemia del Coronavirus. Se contactó a las madres por medio de la aplicación WhatsApp. Para el análisis textual se utilizó la Clasificación Jerárquica Descendente realizada en el programa de software IRAMUTEQ. RESULTADOS: La percepción de las madres se enfocó en las dificultadas que debieron enfrentar en este período de la pandemia. La palabra "no" se hizo presente en gran medida en el corpus del texto, evidenciando así el efecto de la imposibilidad de las visitas y de la permanencia de las madres en las unidades, además del hecho de no poder amamantar. CONCLUSIÓN: La prestación de atención humanizada en las unidades neonatales no debe limitarse al recién nacido, siendo fundamental el apoyo emocional a las madres por parte del equipo de salud.
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Humans , Infant, Newborn , Infant, Premature , COVID-19 , Mothers , Intensive Care Units, Neonatal , Child, Hospitalized , Qualitative ResearchABSTRACT
INTRODUÇÃO: A terapia com oxigênio suplementar reduz quadros de hipóxia, diminuindo a mortalidade entre recémnascidos prematuros (RNPT), porém a excessiva exposição ao oxigênio tem o potencial de atingir e danificar múltiplos órgãos do neonato. OBJETIVO: Determinar os fatores associados ao uso de suporte ventilatório/oxigenoterapia nos RNPT. MATERIAIS E MÉTODOS: Estudo observacional, longitudinal, prospectivo de caráter quantitativo, realizado no período de julho de 2019 a março de 2020, em unidade de terapia intensiva neonatal (UTIN) de um hospital público universitário. Foram observados RNPT em uso de oxigenoterapia, desde o período de admissão até a alta, sendo coletados dados gestacionais, de nascimento e parâmetros da oxigenoterapia. RESULTADOS: 62 RNPT foram acompanhados com média de idade gestacional (IG) de 30,5 semanas (±3,43) e mediana de peso ao nascimento (PN) de 1.390 gramas (555 g - 3.115 g). O tempo médio de internação de 35 dias (3-176) e de oxigenoterapia foi de 7,5 dias (1-176). Ao relacionar o total de dias em oxigenoterapia com o valor do Apgar no 5º minuto, não houve relação significativa (rho= -0,158; p=0,219), porém, houve relação com a IG ao nascimento (rho= -0,725; p<0,001), uso de corticoide antenal (p=0,006) e surfactante exógeno (<0,001). Houve relação também com displasia broncopulmonar (DBP) e retinopatia da prematuridade (ROP) (p<0,001). CONCLUSÃO: Os fatores associados ao tempo e uso de oxigenoterapia foram a IG, PN, uso de corticoide antenal e surfactante exógeno, sendo observado também associação com DBP e ROP.
INTRODUCTION: Supplemental oxygen therapy reduces hypoxia by reducing mortality among preterm newborns (PTNBs), but excessive exposure to oxygen has the potential to affect and damage multiple organs of the newborn. OBJECTIVE: To determine the factors associated with the use of ventilatory support/oxygen therapy in PTNBs. MATERIALS AND METHODS: This is an observational, longitudinal, prospective quantitative study, conducted from July 2019 to March 2020, in a neonatal intensive care unit (NICU) of a public university hospital. PTNBs on oxygen therapy were observed from the time of admission to discharge, and gestational data, birth data and oxygen therapy parameters were collected. RESULTS: 62 PTNs were followed with a mean gestational age (GA) of 30.5 weeks (±3.43) and median birth weight (BW) of 1,390 grams (555 g - 3,115 g). The mean hospital stay of 35 days (3-176) and oxygen therapy was 7.5 days (1-176). When relating the total days in oxygen therapy with the value of Apgar at the 5th minute, there was no significant relationship (rho= -0.158; p=0.219), however, there was a relationship with GA at birth (rho= -0.725; p<0.001), use of antenal corticosteroids (p=0.006) and exogenous surfactante (<0.001). There was also a relationship with bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) (p<0.001). CONCLUSION: The factors associated with time and use of oxygen therapy were GA, BW, use of antenal corticosteroids and exogenous surfactant, and association with BPD and ROP was also observed.
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Oxygen Inhalation Therapy , Infant, Premature , Interactive Ventilatory SupportABSTRACT
INTRODUÇÃO: A terapia com oxigênio suplementar reduz quadros de hipóxia, diminuindo a mortalidade entre recémnascidos prematuros (RNPT), porém a excessiva exposição ao oxigênio tem o potencial de atingir e danificar múltiplos órgãos do neonato. OBJETIVO: Determinar os fatores associados ao uso de suporte ventilatório/oxigenoterapia nos RNPT. MATERIAIS E MÉTODOS: Estudo observacional, longitudinal, prospectivo de caráter quantitativo, realizado no período de julho de 2019 a março de 2020, em unidade de terapia intensiva neonatal (UTIN) de um hospital público universitário. Foram observados RNPT em uso de oxigenoterapia, desde o período de admissão até a alta, sendo coletados dados gestacionais, de nascimento e parâmetros da oxigenoterapia. RESULTADOS: 62 RNPT foram acompanhados com média de idade gestacional (IG) de 30,5 semanas (±3,43) e mediana de peso ao nascimento (PN) de 1.390 gramas (555 g - 3.115 g). O tempo médio de internação de 35 dias (3-176) e de oxigenoterapia foi de 7,5 dias (1-176). Ao relacionar o total de dias em oxigenoterapia com o valor do Apgar no 5º minuto, não houve relação significativa (rho= -0,158; p=0,219), porém, houve relação com a IG ao nascimento (rho= -0,725; p<0,001), uso de corticoide antenal (p=0,006) e surfactante exógeno (<0,001). Houve relação também com displasia broncopulmonar (DBP) e retinopatia da prematuridade (ROP) (p<0,001). CONCLUSÃO: Os fatores associados ao tempo e uso de oxigenoterapia foram a IG, PN, uso de corticoide antenal e surfactante exógeno, sendo observado também associação com DBP e ROP.
INTRODUCTION: Supplemental oxygen therapy reduces hypoxia by reducing mortality among preterm newborns (PTNBs), but excessive exposure to oxygen has the potential to affect and damage multiple organs of the newborn. OBJECTIVE: To determine the factors associated with the use of ventilatory support/oxygen therapy in PTNBs. MATERIALS AND METHODS: This is an observational, longitudinal, prospective quantitative study, conducted from July 2019 to March 2020, in a neonatal intensive care unit (NICU) of a public university hospital. PTNBs on oxygen therapy were observed from the time of admission to discharge, and gestational data, birth data and oxygen therapy parameters were collected. RESULTS: 62 PTNs were followed with a mean gestational age (GA) of 30.5 weeks (±3.43) and median birth weight (BW) of 1,390 grams (555 g - 3,115 g). The mean hospital stay of 35 days (3-176) and oxygen therapy was 7.5 days (1-176). When relating the total days in oxygen therapy with the value of Apgar at the 5th minute, there was no significant relationship (rho= -0.158; p=0.219), however, there was a relationship with GA at birth (rho= -0.725; p<0.001), use of antenal corticosteroids (p=0.006) and exogenous surfactant (<0.001). There was also a relationship with bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) (p<0.001). CONCLUSION: The factors associated with time and use of oxygen therapy were GA, BW, use of antenal corticosteroids and exogenous surfactant, and association with BPD and ROP was also observed.
Subject(s)
Oxygen Inhalation Therapy , Infant, Premature , Intensive Care Units, NeonatalABSTRACT
Wolf-Hirschhorn syndrome is a chromosomal aberration caused by a deletion of the distal short arm of chromosome 4, characterized by distinct craniofacial features, failure to thrive, psychomotor developmental retardation, epilepsy, and feeding disorders. We report a case of patient with Wolf-Hirschhorn syndrome who underwent interventional rehabilitation commencing from the neonatal period in the neonatal intensive care unit. The patient was born at gestational age of 38 weeks 0 days, weighing 1583 g, with an Apgar score of 4/9, and was diagnosed with partial monosomy of the short arm of chromosome 4. Postnatal inspiratory stridor exacerbation was noted for which high-flow nasal cannula therapy was initiated. Rehabilitation commenced on the 18th day after the infant's birth, to promote sensorimotor development. Initially, the trunk was in a low muscle tension and unstable state. Therefore, we first prescribed rest followed by sensorimotor rehabilitation. When the infant's clinical condition stabilized, we performed prone and anti-gravity hugging exercises to improve the low trunk tension. Breastfeeding evaluation began 56 days after birth, when the respiratory condition improved. We practiced feeding the infant orally, in collaboration with doctors and nurses, to reduce bending and stabilize the posture when raising the mandible. The infant was gradually able to feed orally and gained weight. Thereafter, he was discharged 141 days after birth. This report concluded that rehabilitation intervention from the neonatal period, in collaboration with the multidisciplinary team and patient's family, contributed to initiation of oral feeding, improvement of sensorimotor development, and smooth transition to home care.