Perfil de prescripción de levetiracetam en niños menores de cuatro años atendidos en un hospital de alta complejidad de Chile / Levetiracetam prescription profile in children younger than 4 years treated at a tertiary care hospital in Chile

Introducción. El levetiracetam (LEV) es un antiepiléptico aprobado por el Instituto de Salud Pública de Chile como terapia concomitante en crisis epilépticas en niños mayores de cuatro años. Sin embargo, es ampliamente indicado desde el periodo neonatal, lo que hace necesario evaluar su utilización fuera de ficha técnica. Objetivo. Determinar el perfil de prescripción-indicación de LEV en el tratamiento de las crisis epilépticas en menores de cuatro años en un hospital de alta complejidad del sur de Chile. Población y método. Estudio observacional, descriptivo y retrospectivo. Se revisaron las historias clínicas de quienes iniciaron tratamiento con LEV entre 2014 y 2019, y se recopilaron datos sobre variables sociodemográficas, farmacológicas y clínicas. El análisis se basó en la descripción del perfil de los pacientes, prescripción, seguimiento y seguridad. Resultados. Se incluyeron 68 pacientes: 40 (58,8 %) de sexo masculino, 49 (72,1 %) con edad gestacional ≥ 37 semanas. La etiología principal de la epilepsia fue de tipo estructural (35,3 %); el LEV se utilizó principalmente en niños diagnosticados con malformación del sistema nervioso central (17,6 %) y predominó la monoterapia (55,9 %). En el 50 % se usó LEV para crisis focales. Cinco niños (7,3 %) presentaron trastornos de tipo psiquiátrico clasificados como probables reacciones adversas al medicamento. Conclusión. El LEV se utilizó en niños con diferentes diagnósticos con baja frecuencia de eventos adversos. El perfil de utilización varió en los diferentes grupos etarios. Es necesario identificar en futuros estudios la efectividad especialmente en el recién nacido y en epilepsias refractarias.

Introduction. Levetiracetam (LEV) is an antiepileptic drug approved by the Chilean Institute of Public Health as concomitant therapy for epileptic seizures in children older than 4 years of age. However, it is widely prescribed from the neonatal period, which makes it necessary to evaluate its off-label use. Objective. To determine the prescription-indication profile of LEV in the treatment of epileptic seizures in children younger than 4 years in a tertiary care hospital in southern Chile. Population and method. Observational, descriptive, and retrospective study. The medical records of patients who started treatment with LEV between 2014 and 2019 were reviewed, and data on sociodemographic, pharmacological, and clinical variables were collected. The analysis was based on the description of the profile of patients, prescriptions, follow-up, and safety. Results. A total of 68 patients were included: 40 (58.8%) were males, 49 (72.1%) were born at a gestational age ≥ 37 weeks. The main etiology of epilepsy was structural (35.3%); LEV was mostly used in children diagnosed with central nervous system malformation (17.6%), and monotherapy was the prevailing dosage (55.9%). LEV was used for focal seizures in 50% of cases. Five children (7.3%) had psychiatric disorders, classified as probable adverse drug reactions. Conclusion. LEV was used in children with various diagnoses, with a low rate of adverse events. The profile of drug use varied in the different age groups. Future studies are needed to identify effectiveness, especially in newborn infants and patients with refractory epilepsy.

The newborn screening tests in Brazil: regional and socioeconomic prevalence and inequalities in 2013 and 2019

Abstract Objective: To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. Methods: This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saude (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. Results: In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. Conclusions: The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.

Development and validation of a diagnostic prediction model for severe periventricular-intraventricular hemorrhage in newborns: insights from a retrospective analysis utilizing the MIMIC-III database

Abstract Objective: Periventricular-intraventricular hemorrhage is the most common type of intracranial bleeding in newborns, especially in the first 3 days after birth. Severe periventricular-intraventricular hemorrhage is considered a progression from mild periventricular-intraventricular hemorrhage and is often closely associated with severe neurological sequelae. However, no specific indicators are available to predict the progression from mild to severe periventricular-intraventricular in early admission. This study aims to establish an early diagnostic prediction model for severe PIVH. Method: This study was a retrospective cohort study with data collected from the MIMIC-III (v1.4) database. Laboratory and clinical data collected within the first 24 h of NICU admission have been used as variables for both univariate and multivariate logistic regression analyses to construct a nomogram-based early prediction model for severe periventricular-intraventricular hemorrhage and subsequently validated. Results: A predictive model was established and represented by a nomogram, it comprised three variables: output, lowest platelet count and use of vasoactive drugs within 24 h of NICU admission. The model's predictive performance showed by the calculated area under the curve was 0.792, indicating good discriminatory power. The calibration plot demonstrated good calibration between observed and predicted outcomes, and the Hosmer-Lemeshow test showed high consistency (p = 0.990). Internal validation showed the calculated area under a curve of 0.788. Conclusions: This severe PIVH predictive model, established by three easily obtainable indicators within the NICU, demonstrated good predictive ability. It offered a more user-friendly and convenient option for neonatologists.

Catheter-related thrombosis in a neonatal intensive care unit: a case-control study

Introduction: Catheter-related thrombosis (CRT) accounts for most thrombotic events in the neonate. Objective: Investigate CRT frequency, association with days of catheter use until diagnosis, and number of catheters used, in a single-center Neonatal Intensive Care Unit. Methods: A case-control study that included 14 cases and 42 controls. Data collection occurred between January 2017 and December 2020 in a public NICU. Crude odds ratios (COR) were calculated. The study complied with ethical standards from national guidelines. Results: Two hundred and ninety-four neonates used central venous catheters, of which 14 (4.7%) were diagnosed with CRT. Catheter in use when diagnosis was made was centrally inserted central catheters in 8 (57.1%). Before diagnosis, the cumulative duration of catheter use was 34.5 days and the median number of catheters used was three. A higher SNAPPE-II (COR 1.03; 95% CI 1.01-1.06; p=0.03), cumulative days of catheter use >30 (COR 19.11; 95% CI 2.28-160.10; p=0.007) and number of catheters used ≥3 (COR 7.66; 95% CI 1.51-38.70; p=0.01) were associated with CRT. Conclusion: CRT cases were associated with clinical severity; number of catheters and cumulative days of catheter use. We suggest that screening for thrombosis should be performed in neonates who need a long time of catheter use and more than three catheters. Reducing the duration and number of venous catheters used will help to reduce CRT.

O uso do Facebook com pais de recém-nascidos: uma revisão integrativa / The use of Facebook with parents of newborns: an integrative review / El uso de Facebook con padres de recién nacidos: una revisión integradora

Investigar e analisar as evidências disponíveis na literatura sobre o uso do Facebook com os pais de recém--nascidos. Trata-se de uma revisão integrativa, realizada no segundo semestre de 2020, nas bases de dados Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), SciELO (Scientific Electronic Li-brary Online) e Medline (Medical Literature Analysis and Retrieval System Online). Amostra composta por 11 artigos, divididos em duas categorias. Foi evidenciado o uso do Facebook como forma de recrutamento de participantes e como suporte de apoio e compartilhamento de informações entre os pais dos recém--nascidos. No recrutamento, a utilização do Facebook foi eficaz, podendo ser um método viável de contatar usuários. Como suporte de apoio e compartilhamento de informações, a rede social também foi efetiva, devido à troca de experiência, apoio mútuo entre os usuários, disseminação de informações, facilidade ao usar a plataforma e alto engajamento dos participantes.

To investigate and analyze the evidence available in the literature on the use of Facebook with parents of newborns. This is an integrative review, carried out in the second half of 2020, in the Lilacs databases (Literatura Latino-Americana e do Caribe em Health Sciences), SciELO (Scientific Electronic Library Online) and Medline (Medical Literature Analysis and Retrieval System Online). Sample composed of eleven articles, divided into two categories. The use of Facebook was evidenced as a way of recruiting participants and as support and information sharing between parents of newborns. In recruitment, the use of Facebook was effective and may be a viable method of contacting users. As support and information sharing, the social network was also effective, due to the exchange of experience, mutual support among users, dissemination of information, ease of use of the platform and the high engagement of participants.

Investigar y analizar la evidencia disponible en la literatura sobre el uso de Facebook con padres de recién nacidos, se trata de una revisión integradora, realizada en el segundo semestre de 2020, en las bases de datos Lilacs (Literatura Latino-Americana e do Caribe em Health Sciences ), SciELO (Biblioteca científica electrónica en línea) y Medline (Sistema de recuperación y análisis de literatura médica en línea). Muestra compuesta por once artículos, divididos en dos categorías. Se evidenció el uso de Facebook como forma de captación de participantes y como apoyo e intercambio de información entre padres de recién nacidos. En la contratación, el uso de Facebook fue efectivo y puede ser un método viable para contactar a los usuarios. Como apoyo e intercambio de información, la red social también resultó eficaz, debido al intercambio de experiencias, el apoyo mutuo entre los usuarios, la difusión de información, la facilidad de uso de la plata-forma y el alto compromiso de los participantes.

Factors associated with early initiation of breastfeeding

Introduction: Early initiation of breastfeeding (EIBF) is still little stimulated in several hospitals in Brazil. Objective: To estimate the prevalence and factors associated with Early initiation of breastfeeding (EIBF). Methods: Cross-sectional, quantitative study with retrospective secondary data collection in hospital records of 250 full-term newborns, regardless of the type of delivery, with no history of maternal gestational risk, seen in the last six months. Data collection period in a public maternity hospital in Greater São Paulo. Data collection was performed between November 2018 and January 2019, with approval from the hospital and the FMABC Research Ethics Committee under register n. 2,924,393. Results: The prevalence of EIBF was 66%. BFH is associated with anesthesia at childbirth (p<0,001), APGAR less than or equal to 8 in the 1st and 5th minutes (p<0,001), and with c-section (p<0,001), which represented 29.2% of deliveries in the sample. Respiratory distress (38.82%), hypotonia (24.70%), followed by unfavorable maternal conditions (18.82%), were shown to be impeding factors for EIBF, although 90% of newborns received Apgar 9 /10 in the 5th minute. Conclusion: The prevalence of early breastfeeding is lower than recommended, but compatible with the most recent national frequency proportions.

Depresión puerperal: impacto en la madre gestante y en el desarrollo físico, emocional y cognitivo posnatal de sus hijas/os. Una mirada ecológica / Postpartum depression: Impact on pregnant women and the postnatal physical, emotional, and cognitive development of their children. An ecological perspective

Los problemas de salud mental materna durante el embarazo, parto y puerperio son un desafío para la salud pública. Su falta de reconocimiento atenta contra el diagnóstico y tratamientos oportunos, e impacta en la madre y el establecimiento del vínculo fundamental del binomio. Debemos reconocer los factores de riesgo (edad, situación socioeconómica, antecedentes psicopatológicos, disfunción familiar, entorno desfavorable), las manifestaciones clínicas y las herramientas de detección. Existen evidencias de que el efecto del estrés, la ansiedad y la depresión durante el embarazo afectan negativamente el neurodesarrollo fetal y condicionan los resultados del desarrollo infantil. Describimos el impacto negativo de la depresión puerperal durante los primeros meses de vida, que afecta el vínculo madre-hija/o, el desarrollo posnatal (emocional, conductual, cognitivo, lenguaje) y el mantenimiento de la lactancia materna. También reconocemos factores protectores que atemperan sus efectos. Es fundamental establecer estrategias preventivas y abordajes diagnósticos y terapéuticos interdisciplinarios para minimizar los riesgos sobre la madre y sus hijas/os.

Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.

Fractura craneal deprimida congénita ("fractura ping-pong") en neonatos como diagnóstico diferencial de maltrato físico / Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse

Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.

Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.

Percepção de mães sobre a visitação aberta na unidade de terapia intensiva neonatal / Mothers' perception of open visitation in the neonatal intensive care unit / Percepción de las madres sobre las visitas abiertas en la unidad de cuidados intensivos neonatales

Objetivo: compreender a percepção de mães sobre a visitação aberta na unidade de terapia intensiva neonatal. Métodos: estudo descritivo, qualitativo, realizado por meio de entrevista semiestruturada e individualizada, em uma maternidade pública situada no interior de São Paulo, Brasil, em 2019. A amostra foi definida pelo método de saturação de dados e constou de 14 mães. Os dados foram submetidos a Análise de Conteúdo Temática. Resultados: elencaram-se duas categorias: evidenciando os benefícios da visitação aberta e desafios a serem superados. Os benefícios incluíram a satisfação em permanecer com o filho, participar dos cuidados, fortalecer o vínculo maternal, acompanhar a evolução do bebê, evidenciar a qualidade do cuidado e o envolvimento afetivo, redução de sentimentos negativos e visitação do pai no período noturno. Em contrapartida, os desafios incluíram a impossibilidade de permanecer com o filho, estar presente somente em horários pré-estabelecidos para receber informações de médicos, prioriza-las em relação as fornecidas pela enfermagem, receber informações parciais, ter receio em expressar as dúvidas e vivenciar sentimentos negativos. Conclusão: os achados deste estudo fornecem subsídios para que a equipe de saúde e os gestores promovam a adesão de mães à visitação aberta em unidades de terapia intensiva neonatais. (AU)

Objective: understand the perception of mothers about open visitation in the neonatal intensive care unit. Methods: descriptive, qualitative study, carried out through semi-structured and individualized interviews, in a public maternity hospital located in the interior of São Paulo, Brazil, in 2019. The sample was defined by the data saturation method and consisted of 14 mothers. Data were submitted to Thematic Content Analysis. Results: two categories were listed: showing the benefits of open visitation and challenges to be overcome. The benefits included the satisfaction of staying with the child, participating in care, strengthening the maternal bond, monitoring the baby's evolution, showing the quality of care and affective involvement, reducing negative feelings and visiting the father at night. On the other hand, the challenges included the impossibility of staying with the child, being present only at preestablished times to receive information from doctors, prioritizing it in relation to that provided by nurses, receiving partial information, being afraid to express doubts and experience negative feelings. Conclusion: the findings of this study provide support for the health team and managers to promote the adherence of mothers to open visitation in neonatal intensive care units. (AU)

Objetivo: comprender la percepción de las madres sobre la visita abierta en la unidad de cuidados intensivos neonatales. Métodos: estudio descriptivo, cualitativo, realizado a través de entrevistas semiestructuradas e individualizadas, en una maternidad pública ubicada en el interior de São Paulo, Brasil, en 2019. La muestra fue definida por el método de saturación de datos y estuvo conformada por 14 madres. Los datos se enviaron a Análisis de contenido temático. Resultados: se enumeraron dos categorías: mostrando los beneficios de la visita abierta y los desafíos a superar. Los beneficios incluyeron la satisfacción de quedarse con el niño, participar en los cuidados, fortalecer el vínculo materno, monitorear la evolución del bebé, mostrar la calidad del cuidado y el involucramiento afectivo, reducir los sentimientos negativos y visitar al padre por la noche. Por otro lado, los desafíos incluían la imposibilidad de quedarse con el niño, estar presente solo en horarios preestablecidos para recibir información de los médicos, priorizarla en relación a la brindada por enfermeras, recibir información parcial, tener miedo a expresar dudas y experimentar sentimientos negativos. Conclusión: los hallazgos de este estudio brindan apoyo al equipo de salud y gerentes para promover la adherencia de las madres a la visita abierta en las unidades de cuidados intensivos neonatales. básico sobre las conductas frente a los accidentes, a pesar de desconocieren el flujo de atención del servicio. (AU)

Comparison of the effectiveness of different high-flow devices in neonatal care

Abstract Objective: To evaluate the success rate of high-flow nasal cannula (HFNC) therapy using an adapted obsolete mechanical ventilator (MV), Optiflow™ and Vapotherm™ in newborns (NBs). Method: This was a retrospective observational study conducted in the neonatal intensive care unit (NICU). The sample comprised NBs who underwent HFNC therapy due to ventilatory dysfunction, for weaning from non-invasive ventilation (NIV), or post-extubation. The three groups, stratified according to gestational age (GA) and birth weight, and corrected GA and weight at the beginning of HFNC use, were as follows: Optiflow ™, Vapotherm ™, and obsolete Mechanical Ventilator (MV) adapted for high flow therapy. Subsequently, the NBs were divided into a success group (SG) and a failure group (FG). HFNC success was defined as a therapy duration exceeding 72 h. Results: A total of 209 NBs were evaluated, with 31.1 % using HFNC due to ventilatory dysfunction, 2.4 % after extubation, and 66.5 % after NIV weaning. HFNC success rate was observed in 90.9 % of the NBs, with no difference between equipment types (Vapotherm ™, Optiflow ™, and adapted VM). Conclusion: Different types of HFNC equipment are equally effective when used in neonatology for respiratory dysfunction, as a method of weaning from NIV and post-extubation. Adapted obsolete MV can be an alternative for HFCN therapy in resource-constrained settings.

Correlation between nasal anatomical characteristics in newborns and short binasal prong dimensions

Abstract Objective: To correlate the nasal anatomical characteristics of newborns with the dimensions of short binasal prongs. Method: Observational, cross-sectional study carried out in two hospitals in southern Brazil. The authors evaluated 1620 newborns with neonatal data and nasal dimensions. To measure the dimensions of the nasal region, the authors considered the width of the medial columella, the right nostril diameter, and the left nostril diameter. These data were correlated with the dimensions of two models of short binasal prongs. Results: Of the total newborns evaluated, 807 were female (49.8%), and 813 were male (50.2%). The majority were white (96.2%). The mean gestational age was 37.4 ± 2.9 weeks, ranging from 22 to 42 weeks. The birth weight was 2946.8 ± 699.3 g, ranging from 490.0 to 4740.0 g. Most of the nasal measures were significantly larger than both prong model measurements. Conclusion: The sizes of short binasal prongs available on the Brazilian market do not match the nasal anatomical characteristics of newborns.

Satisfacción de madres neonatales frente a los cuidados de enfermería en hospital de los Andes peruanos / Satisfaction of neonatal mothers with nursing care in a hospital in the Peruvian Andes / Satisfação das mães neonatais com os cuidados de enfermagem em um hospital nos Andes peruanos

La satisfacción de las madres de recién nacidos con los cuidados de enfermería es crucial, dado el impacto emocional que supone la llegada de un nuevo bebé. Durante los primeros días tras el parto, es fundamental establecer un fuerte vínculo madre-recién nacido, así como garantizar un cuidado efectivo del bebé para que las madres se sientan seguras y confiadas en la atención hospitalaria. Además, las enfermeras desempeñan un papel esencial en el apoyo a la lactancia materna, con beneficios significativos para la salud del bebé. Objetivo. Determinar el nivel de satisfacción de las madres de recién nacidos con los cuidados de enfermería en el servicio de atención inmediata del recién nacido - alojamiento conjunto del Hospital de Pampas de Huancavelica. Materiales y métodos. La metodología empleada fue no experimental, de tipo descriptivo, transversal y prospectivo. Se encuestó a 262 madres de recién nacidos durante los meses de marzo a julio de 2023, utilizando un cuestionario estructurado con 24 ítems como instrumento de medición. Resultados. Se indica que el 65.3% de las madres encuestadas expresaron un nivel de satisfacción completa, el 25.2% mostró un nivel de satisfacción intermedia, y el 9.5% manifestó insatisfacción. Conclusiones. Aunque la mayoría de las madres encuestadas están satisfechas o muy satisfechas con los cuidados de enfermería recibidos, aún existe un porcentaje considerable de insatisfacción. Esto sugiere la necesidad de mejorar ciertos aspectos para garantizar una atención óptima a los recién nacidos y sus madres.

New mothers' satisfaction with nursing care is crucial, given the emotional impact of the arrival of a new baby. During the first days after delivery, establishing a strong mother-newborn bond is critical, as is ensuring effective infant care so that mothers feel secure and confident in hospital care. In addition, nurses play an essential role in supporting breastfeeding, with significant benefits for the baby's health. Objective. To determine the level of satisfaction of mothers of newborns with nursing care in the immediate newborn care service - joint accommodation of the Hospital de Pampas de Huancavelica. Materials and methods. The methodology used was non-experimental, descriptive, cross-sectional and prospective. A total of 262 mothers of newborns were surveyed during the months of March to July 2023, using a structured questionnaire with 24 items as a measurement instrument. Results. It is indicated that 65.3% of the mothers surveyed expressed a level of complete satisfaction, 25.2% showed an intermediate level of satisfaction, and 9.5% expressed dissatisfaction. Conclusions. Although most of the mothers surveyed are satisfied or very satisfied with the nursing care received, there is still a considerable percentage of dissatisfaction. This suggests the need to improve certain aspects to guarantee optimal care for newborns and their mothers.

A satisfação das novas mães com os cuidados de enfermagem é crucial, dado o impacto emocional da chegada de um novo bebê. Durante os primeiros dias após o nascimento, estabelecer um forte vínculo entre a mãe e o recém-nascido e garantir o cuidado eficaz do bebê é essencial para que as mães se sintam seguras e confiantes no atendimento hospitalar. Além disso, os enfermeiros desempenham um papel essencial no apoio ao aleitamento materno, com benefícios significativos para a saúde do bebê. Objetivo. Determinar o nível de satisfação das mães de recém-nascidos com o atendimento de enfermagem no serviço de atendimento imediato ao recém-nascido - alojamento conjunto do Hospital Pampas de Huancavelica. Materiais e métodos. A metodologia utilizada foi não experimental, descritiva, transversal e prospectiva. Um total de 262 mães de recém-nascidos foi pesquisado durante os meses de março a julho de 2023, usando um questionário estruturado com 24 itens como instrumento de medição. Resultados. Indicou-se que 65,3% das mães pesquisadas expressaram um nível de satisfação completa, 25,2% mostraram um nível intermediário de satisfação e 9,5% expressaram insatisfação. Conclusões. Embora a maioria das mães pesquisadas esteja satisfeita ou muito satisfeita com a assistência de enfermagem recebida, ainda há uma porcentagem considerável de insatisfação. Isso sugere a necessidade de melhorar certos aspectos para garantir o cuidado ideal para os recém-nascidos e suas mães.

Tecnologia educacional em vídeo para o ensino dos cuidados pós-reanimação neonatal / Video educational technology for teaching neonatal post-resuscitation care

Resumo: Esta pesquisa de desenvolvimento tecnológico apresenta a produção de uma série vídeos que abordam os Cuidados Pós-Reanimação Neonatal em Unidades de Terapia Intensiva, registrado como obra audiovisual brasileira na Agência Nacional do Cinema, com número de Certificado de Produto Brasileiro Nº B24-001351-00000. Teve como objetivo produzir e validar uma tecnologia educacional, no formato de vídeo, para a capacitação dos profissionais de enfermagem em Cuidados Pós-Reanimação Neonatal. Trata-se de uma pesquisa metodológica dividida em três fases: fase I - pré-produção, fase II - produção e fase III - pós-produção, realizada no período de maio de 2023 a janeiro de 2024. O estudo foi desenvolvido no Hospital de Base Dr. Ary Pinheiro, integrante da Rede de Atenção à Saúde do Estado de Rondônia ­ Brasil e no Programa de Pós-Graduação Prática do Cuidado em Saúde da Universidade Federal do Paraná. A validação do conteúdo do roteiro se deu à partir da avaliação de sete enfermeiros e quatro médicos especialistas com experiência na temática, obtendo-se Índice de Validade de Conteúdo- Geral de 89,8% e coeficiente alfa de Cronbach igual a 0,87, representando uma consistência quase perfeita. A validação da aparência dos vídeos contou com a participação dos mesmos especialistas que validaram o conteúdo, além do público-alvo, sendo estes últimos, seis enfermeiros e quatro técnicos em enfermagem. Na validação dos especialistas obteve-se Índice de Validade de Aparência-Individual de 100% e consequentemente Índice de Validade de Aparência-Geral de 100%. O coeficiente alfa de Cronbach foi igual a 0,95, representando uma consistência quase perfeita. Na validação realizada pelo público-alvo, dos 12 itens avaliados, cinco apresentaram Índice de Validade de Aparência-Individual de 90%, os demais obtiveram 100%. O Índice de Validade de Aparência-Geral foi de 96%, e o coeficiente alfa de Cronbach foi igual a 0,96, representando uma consistência quase perfeita. Como resultados foram produzidos quatro vídeos, fundamentados no Manual de Cuidados Pós-Reanimação Neonatal da Sociedade Brasileira de Pediatria e com contribuições dos especialistas e públicoalvo. Os vídeos foram produzidos em formato audiovisual 2D, com tempo individual inferior a 5 minutos e total de 17 minutos e 47 segundos, sendo disponibilizados gratuitamente em plataformas digitais como: CofenPlay®, Youtube® e Instagram®. Devido ao rigor metodológico utilizado neste estudo, é possível a replicação da produção dos vídeos com diversas temáticas e objetivos educacionais. Mediante o objetivo proposto, conclui-se que os vídeos produzidos são válidos para serem utilizados como um recurso tecnológico educacional facilitador do processo ensino-aprendizagem para a capacitação de profissionais de enfermagem em Cuidados Pós-Reanimação Neonatal.

Abstract: This technology development study presents the production of a series of videos addressing Neonatal Post-Resuscitation Care in Intensive Care Units. It was registered as a Brazilian audiovisual work at the National Cinema Agency under Brazilian Product Certificate number B24-001351-00000. The objective was to produce and validate an educational technology in video format to train nursing professionals in Neonatal Post-Resuscitation Care. This methodological study was divided into three phases: phase I - pre-production, phase II - production and phase III - post-production. It was developed between May 2023 and January 2024 at the Hospital de Base Dr. Ary Pinheiro, member of the Health Care Network of the state of Rondônia, Brazil, and in the Practical Postgraduate Program in Health Care at the Universidade Federal do Paraná. The content validation of the script was based on the evaluation performed by seven nurses and four specialist physicians with experience in the theme. The Overall Content Validity Index was 89.8% and the Cronbach's alpha coefficient was 0.87, representing an almost perfect consistency. The same experts who validated the content participated in the face validation of the videos, in addition to the target audience composed of six nurses and four nursing technicians. In the experts' validation, an Individual Face Validity Index of 100% was obtained and consequently, an Overall Face Validity Index of 100%. The Cronbach's alpha coefficient was 0.95, representing almost perfect consistency. In the validation by the target audience, five out of the 12 items evaluated presented an Individual Face Validity Index of 90%, while the others obtained 100%. The Overall Face Validity Index was 96%, and the Cronbach's alpha coefficient was 0.96, representing almost perfect consistency. As a result, four videos based on the Neonatal Post-Resuscitation Care Manual of the Brazilian Society of Pediatrics were produced, with contributions from specialists and the target audience. The videos were produced in 2D audiovisual format, with a duration of less than 5 minutes each and a total of 17 minutes and 47 seconds. They were made available free of charge on digital platforms such as: CofenPlay®, Youtube® and Instagram®. The methodological rigor used in this study allows the replication of the production of videos with different themes and educational objectives. Based on the proposed objective, the conclusion is that the videos produced are valid to be used as an educational technological resource to facilitate the teaching-learning process for the training of nursing professionals in Neonatal Post-Resuscitation Care.

Impacto da fisioterapia aquática em UTIN sobre a mobilidade diafragmática avaliada por ultrassonografia cinesiológica: ensaio clínico / Impact of Aquatic Therapy in the NICU on diaphragmatic mobility assessed by ultrasound: clinical trial

INTRODUÇÃO: A fisioterapia aquática é uma modalidade de hidroterapia realizada em recém-nascidos (RN) nas Unidades de Terapia Intensiva Neonatal (UTIN). Os efeitos sobre nível de dor, estado comportamental e função respiratória já são conhecidos, porém pouco se refere aos efeitos sobre a função diafragmática na população recém-nascida a termo prematura. OBJETIVO: Avaliar o efeito da fisioterapia aquática sobre a amplitude diafragmática por meio da ultrassonografia cinesiológica diafragmática (USCD) em RNs internados em UTIN, bem como a segurança de sua realização quanto a estabilidade clínica dos RNs, estado comportamental, dor e desconforto respiratório. MÉTODOS: Ensaio clínico tipo antes e depois, de caráter transversal. Os RNs participantes do estudo receberam uma única intervenção com fisioterapia aquática durante 10 minutos. Foi realizada a avaliação utilizando a USCD antes e depois da sessão, e anotado as frequências cardíaca e respiratória, estado comportamental, dor e desconforto respiratório. RESULTADOS: Participaram 26 RNs. Observou-se aumento significativo da amplitude diafragmática (p= 0,02) e da saturação periférica de oxigênio (p= 0,05); os parâmetros fisiológicos permaneceram nos limites da normalidade e a intervenção não provocou desorganização comportamental, dor ou desconforto respiratório aos RNs. CONCLUSÃO: A fisioterapia aquática promoveu aumento da amplitude diafragmática, sugerindo que esta técnica pode ser utilizada como forma de estimular a contração da musculatura respiratória em RN, além de se mostrar uma técnica segura, pois não gerou instabilidade clínica, desorganização comportamental, dor ou desconforto respiratório aos participantes.

INTRODUCTION: Aquatic physiotherapy is a modality of hydrotherapy performed on newborn babies (NB) in the Neonatal Intensive Care Unit (NICU). The effects on pain levels, behavior, and respiratory function are already known; however, little has been said about the effects on diaphragmatic function in the preterm newborn population. OBJECTIVE: To evaluate the effect of aquatic physiotherapy on diaphragmatic amplitude using diaphragmatic kinesiologic ultrasound (DKUS) in NBs admitted to a NICU, as well as the safety regarding the clinical stability of the NBs, behavioral state, pain, and respiratory distress. METHODS: Crosssectional before-and-after clinical trial. The NBs participating in the study received a single intervention with aquatic physiotherapy for 10 minutes. An assessment was performed using the USCD before and after the session, and heart and respiratory rates, behavioral state, pain, and respiratory discomfort were recorded. RESULTS: Twenty-six NBs participated. There was a significant increase in diaphragmatic amplitude (p= 0.02) and peripheral oxygen saturation (p= 0.05); physiological parameters remained within normal limits, and the intervention did not cause behavioral disorganization, pain, or respiratory discomfort in NBs. CONCLUSION: Aquatic physiotherapy promoted an increase in diaphragmatic amplitude, suggesting that this technique can be used as a way to stimulate the contraction of the respiratory muscles in NB, in addition to being a safe technique, as it did not generate clinical instability, behavioral disorganization, pain, or respiratory discomfort to the participants.

Analysis of the changes in the management of preterm newborns born in a Spanish third-level hospital in the past 10 years / Análisis de los cambios en el manejo de recién nacidos prematuros nacidos en un hospital español de tercer nivel en los últimos 10 años

Abstract Background: Preterm newborns require the use of the best and most current strategies to treat and prevent both acute pathology and associated sequelae. This study aimed to compare the differences in the management of preterm newborns over 10 years in a tertiary hospital in Spain and its impact on height, weight, and neurological development in the medium term. Methods: We conducted a retrospective, observational, and analytical study examining the management and clinical variables in preterm newborns under 32 weeks of gestational age who were born in our hospital in 2011 and 2021. Results: Twenty-six newborns were included in the study. Significant differences in magnesium sulfate use, continuous positive airway pressure immediately after birth, and non-invasive mechanical ventilation during hospitalization were observed. Differences were found in the use of parenteral nutrition and the timing of initiation of enteral feeding. We did not observe differences in the neurological or weight evolution in the medium term. Conclusions: Significant differences in managing preterm newborns in these 10 years were observed. Lower mortality and alterations in central nervous system ultrasound and, significantly, less growth retardation during admission in 2021 have been observed; however, it does not manifest with improvement in long-term somatometrics or neurological prognosis.

Resumen Introducción: La inmadurez de los recién nacidos pretérmino (RNP) requiere el empleo de las mejores y más actuales estrategias para tratar la patología aguda y prevenir sus eventuales secuelas asociadas. El objetivo planteado es comparar las diferencias en el manejo de RNP a lo largo de diez años en un hospital de tercer nivel en España y su impacto en el desarrollo neurológico y póndero-estatural a medio plazo. Métodos: Estudio retrospectivo, observacional y analítico examinando variables del manejo y clínicas de todos los RNP menores de 32 semanas de edad gestacional nacidos en nuestro hospital (nivel III-A) en 2011 y en 2021. Resultados: Se incluyeron 26 infantes (2011: 10 niños, 2021: 16 niños). Observamos diferencias significativas en el uso prenatal de sulfato de magnesio, mayor uso de presión positiva continua en la vía aérea (CPAP) al ingreso y ventilación mecánica no invasiva durante el ingreso, retraso en el uso de surfactante, empleo de alimentación intravenosa e inicio precoz de la alimentación enteral. Existe una menor tasa de mortalidad y desnutrición postnatal en 2021. No observamos diferencias en la evolución neurológica o ponderal a medio plazo. Conclusiones: Existen diferencias en el manejo de los prematuros en estos 10 años con mayor ajuste a las guías nacionales e internacionales vigentes. Esto se relaciona con menor mortalidad y alteraciones en la ecografía del sistema nervioso central y, significativamente, con un menor retraso en el crecimiento durante el ingreso en 2021; no se demostró mejoría del pronóstico somatométrico o neurológico a largo plazo.

Changes in Neonatal Intensive Care Unit statistics during the COVID-19 pandemic / Cambios en las estadísticas de una Terapia Intensiva Neonatal durante la pandemia COVID-19

Abstract Background: With the identification of COVID-19 disease in China, a pandemic began that affected health-care systems. The Neonatal Intensive Care Unit (NICU) of the Hospital de Ginecobstetricia del Centro Médico Nacional de Occidente experienced an increase in patient flow as part of the COVID-19 strategy of the Instituto Mexicano del Seguro Social (IMSS). This study aimed to analyze the impact of the COVID-19 pandemic on neonatal care and mortality indicators in our unit. Methods: We conducted a retrospective study to compare the number of hospital births, pre-term newborns (PTNB), NICU admissions, and deaths. Changes in frequencies between 2019 and 2021 were analyzed using Poisson distribution. Changes in PTNB births, proportion of admissions, and deaths/NICU discharges were analyzed by z-test for two proportions. Results: Between 2019 and 2021, the number of births increased by more than 2-fold. NICU admissions increased from 770 in 2019 to 1045 in 2021 (p < 0.01). The ratio of deaths/discharge from the service was 16.9% in 2019 and 13.1% in 2021 (p = 0.02). Conclusions: Mortality indicators in the NICU decreased from 2019 to 2021, even with the increase in the number of patients admitted during the COVID-19 pandemic.

Resumen Introducción: Con la identificación de la enfermedad por COVID-19 en China, inició una pandemia que afectó a los sistemas de salud. La Unidad de Cuidados Intensivos Neonatales (UCIN) del Hospital de Ginecobstetricia del Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social (IMSS) vio incrementado su flujo de pacientes como parte de la Estrategia COVID-19 del IMSS. El objetivo fue analizar el impacto de la pandemia COVID-19 en los indicadores de atención y mortalidad neonatal en nuestra unidad. Métodos: Se realizó un estudio retrospectivo para comparar el número de nacimientos en el hospital, nacimientos de recién nacidos prematuros (RNPT), ingresos a UCIN y defunciones. Se analizaron los cambios en frecuencias entre los años 2019 a 2021 mediante la distribución de Poisson. Los cambios en nacimientos de RNPT, proporción de ingresos y defunciones/egreso en UCIN se analizaron mediante prueba Z para dos proporciones. Resultados: Entre los años 2019 a 2021, el número de nacimientos incrementó más de 2 veces. Los ingresos a UCIN aumentaron de 770 en 2019, a 1045 en 2021 (p < 0.01). La proporción de defunciones/egreso del servicio fue de 16.9% en 2019, y 13.1% en 2021 (p = 0.02). Conclusiones: Los indicadores de mortalidad en la UCIN disminuyeron de 2019 a 2021, aun con el incremento en el número de pacientes atendidos durante la pandemia COVID-19.

Prevalencia de osteopenia del prematuro antes y después de la implementación de una estrategia temprana de manejo fosfocálcico / Prevalence of osteopenia of prematurity before and after implementing an early strategy with the use of calcium and phosphate

Introducción. Con el uso de la nutrición parenteral agresiva en recién nacidos de muy bajo peso, se detectaron alteraciones del metabolismo fosfocálcico. En 2016 se implementó una estrategia de prevención a través del monitoreo fosfocálcico y su suplementación temprana. El objetivo fue estudiar si esta estrategia disminuye la prevalencia de osteopenia e identificar factores de riesgo asociados. Población y métodos. Estudio cuasiexperimental que comparó la prevalencia de osteopenia entre dos grupos: uno después de implementar la estrategia de monitoreo y suplementación fosfocálcica (01/01/2017-31/12/2019), y otro previo a dicha intervención (01/01/2013-31/12/2015). Resultados. Se incluyeron 226 pacientes: 133 pertenecen al período preintervención y 93 al posintervención. La prevalencia de osteopenia global fue del 26,1 % (IC95% 20,5-32,3) y disminuyó del 29,3 % (IC95% 21,7-37,8) en el período preintervención al 21,5 % (IC95% 13,6-31,2) en el posintervención, sin significancia estadística (p = 0,19). En el análisis multivariado, el puntaje NEOCOSUR de riesgo de muerte al nacer, recibir corticoides posnatales y el período de intervención se asociaron de manera independiente a osteopenia. Haber nacido luego de la intervención disminuyó un 71 % la probabilidad de presentar fosfatasa alcalina >500 UI/L independientemente de las restantes variables incluidas en el modelo. Conclusión. La monitorización y suplementación fosfocálcica precoz constituye un factor protector para el desarrollo de osteopenia en recién nacidos con muy bajo peso al nacer.

Introduction. With the use of aggressive parenteral nutrition in very low birth weight infants, alterations in calcium and phosphate metabolism were detected. In 2016, a prevention strategy was implemented through calcium phosphate monitoring and early supplementation. Our objective was to study whether this strategy reduces the prevalence of osteopenia and to identify associated risk factors. Population and methods. Quasi-experiment comparing the prevalence of osteopenia between two groups: one after implementing the calcium phosphate monitoring and supplementation strategy (01/01/2017­12/31/2019) and another prior to such intervention (01/01/2013­12/31/2015). Results. A total of 226 patients were included: 133 in the pre-intervention period and 93 in the post-intervention period. The overall prevalence of osteopenia was 26.1% (95% CI: 20.5­32.3) and it was reduced from 29.3% (95% CI: 21.7­37.8) in the pre-intervention period to 21.5% (95% CI: 13.6­31.2) in the post-intervention period, with no statistical significance (p = 0.19). In the multivariate analysis, the NEOCOSUR score for risk of death at birth, use of postnatal corticosteroids, and the intervention period were independently associated with osteopenia. Being born after the intervention reduced the probability of alkaline phosphatase > 500 IU/L by 71%, regardless of the other variables included in the model. Conclusion. Calcium phosphate monitoring and early supplementation is a protective factor against the development of osteopenia in very low birth weight infants.

Manutenção do cateter central de inserção periférica neonatal: protocolo de revisão de escopo / Maintenance of the neonatal peripherally inserted central catheter: a scoping review protocol

OBJETIVO: Mapear e sintetizar as evidências sobre os cuidados realizados por enfermeiros para a manutenção do cateter central de inserção periférica neonatal. MÉTODO: O protocolo foi construído seguindo as recomendações do Instituto Joanna Briggs (JBI), atendendo às diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A revisão de escopo descreverá e mapeará as evidências científicas relativas à manutenção do cateter central de inserção periférica neonatal presentes nas literaturas nacionais e internacionais.

OBJECTIVE: To map and synthesize the evidence regarding the care provided by nurses for the maintenance of neonatal peripherally inserted central catheters. METHOD: The protocol was developed following the Joanna Briggs Institute (JBI) recommendations, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The scoping review will describe and map the scientific evidence of maintaining neonatal peripherally inserted central catheters from the national and international literature.

Generation of an induced pluripotent stem cell line from a patient with surfactant metabolism dysfunction carrying ABCA3 mutations / 中华实用儿科临床杂志

Objective:Induced pluripotent stem cells (iPSCs) cell lines were established using peripheral blood mononuclear cells (PBMCs) from a patient suffering from neonatal respiratory distress syndrome (NRDS) who carried Adenosine triphosphate-binding cassette transporter A3 ( ABCA3) compound heterozygous mutations. Methods:Cell experimental research.Peripheral venous blood was collected and PBMCs were isolated and cultured in vitro. PBMCs were transfected with non-integrated Sendai vector carrying reprogramming factors.The chromosome karyotypes of the established iPSCs were analyzed.Immunofluorescence and flow cytometry were used to detect pluripotency markers of stem cells and verify their differentiation potential.Sanger sequencing was performed to analyze gene mutations.In addition, short tandem repeat (STR) analysis was performed, polymerase chain reaction(PCR) and agarose gel electrophoresis were used to detect virus residual. Results:Karyotype analysis of established iPSCs cell lines showed normal diploid 46, XY karyotype.Immunofluorescence showed positive staining of stem cell pluripotency markers OCT4, SSEA4, Nanog and Sox2.Flow cytometry was used to detected stem cell pluripotency markers and showed expression of TRA-1-60, SSEA-4 and OCT4.After differentiation into all three germ layers, immunofluorescence was performed to detect ectoderm (Pax-6), mesoderm (Brachyury) and endoderm alpha-fetoprotein markers, and the results showed positive staining, which confirmed that the iPSCs had the potential to differentiate.Sanger sequencing showed c. 3997_3998del and c. 3137C>T compound heterozygous mutations.STR analysis showed they originate from PBMCs, and no Sendai virus residual was detected by PCR and agarose gel electrophoresis.Conclusions:In this study, PBMCs from patient carrying ABCA3 compound heterozygous mutations was used to establish iPSCs cell lines.The research lays a foundation for the study of pathogenesis, therapeutic drug screening and cell therapy of NRDS caused by ABCA3 gene mutations.