Challenges in the care of children born to mothers diagnosed with COVID-19 during the pandemic.

OBJECTIVE: To understand the challenges in the care of children born to mothers with COVID-19 during the pandemic. METHOD: Qualitative research, conducted from November 2020 to May 2021, in two public maternity hospitals, with women who had children during the first wave of the pandemic, diagnosed with COVID-19 during pregnancy and/or childbirth. There were nineteen semi-structured interviews with thematic analysis. Symbolic Interactionism was used as a theoretical framework. RESULTS: Changes in the care for newborn children were identified. In the domestic environment, hygiene measures with the newborn children were intensified, social isolation restricted the support network and mothers felt alone and overwhelmed. In terms of health care, there was a setback in neonatal care and interruption of professional care, such as the suspension of appointments. CONCLUSION: The pandemic has restructured traditional models of family care, intensified difficulties in accessing healthcare, and exposed children to inherent risks due to a lack of proper follow-up.

Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities.

OBJECTIVE: To analyze the experiences of maternal health workers in three Brazilian cities, located in the Northeast (São Luís), Southeast (Niterói), and South (Pelotas) regions during the first year of the COVID-19 pandemic. METHODS: Qualitative research carried out between December 2020 and February 2021. Interviews were conducted, in person or remotely, with 30 health workers, doctors and nurses, working in maternity hospitals of different degrees of complexity. RESULTS: Sociodemographic characteristics, employment relationships and professional qualification of the interviewees were described. Two thematic axes were identified: 1) changes in hospital organization and dynamics in the pandemic; 2) Illness and suffering of health workers. The majority of respondents were women. Most physicians had work relationships in the public and private sectors. In Niterói, health workers had better professional qualifications and more precarious work relationships (as temporary hires), compared to São Luís and Pelotas. In the context of the uncertainties resulting from the pandemic, this situation generated even more insecurity for those workers. The statements at the beginning of the pandemic covered topics such as changes in the organizational dynamics of services, healthcare, telemedicine, and interaction between health workers and users. In the health workers' perception, the initial period of the health emergency, which resulted in intense changes in the provision of services, was marked by an increase in preterm births, perinatal mortality, and fetal losses. Work overload, fear of contamination, concern for family members and uncertainties regarding the new disease caused intense suffering in health workers who had little institutional support in the cities studied. The suffering experienced by health workers went beyond the work dimension, reaching their private life. CONCLUSION: Changes caused by the pandemic required immediate adjustments in professional practices, generating insecurities in healthcare regardless of the location studied. The method of hiring health workers remained the same as the previously practiced one in each city. Due to the risk of disease transmission, measures contrary to humanization practices, and more restrictive in São Luís, were reported as harmful to obstetric care. The Covid-19 pandemic was a huge challenge for the Brazilian health system, aggravating the working conditions experienced by health workers. In addition to the work environment, it was possible to briefly glimpse its effects on private life.

Temporal trends and projections of caesarean sections in Brazil, its administrative macro-regions, and federative units. / Tendências temporais e projeções de cesariana no Brasil, macrorregiões administrativas e unidades federativas.

Trend studies on the model of birth in Brazil show a scenario of successive linear increases in cesarean rates. However, they ignore possible changes in the temporal evolution of this delivery modality. Thus, this study aimed to evaluate possible inflection points in cesarean rates in Brazil, its macro-regions, and federated units, as well as to estimate projections for 2030. A time series with information on cesarean sections from 1994 to 2019 from the SUS Department of Informatics was used. Autoregressive integrated moving average and joinpoint regression models were used to obtain cesarean rate projections and trends, respectively. Caesarean rates showed a significant upward trend over the 26 study years at all levels of aggregation. On the other hand, when considering the formation of segments, a stabilization trend was observed both in the country and in the South and Midwest regions, starting in 2012. Rates tended to increase in North and Northeast and significantly decrease in Southeast. Projections show that in 2030, 57.4% of births in Brazil will be cesarean, with rates higher than 70% in Southeast and South regions.

Os estudos de tendência sobre a via de nascimento no Brasil têm revelado um cenário de sucessivos aumentos lineares nas proporções de cesariana. Entretanto, a possibilidade de mudanças na evolução temporal da via cirúrgica não tem sido considerada. Dessa forma, objetivou-se verificar possíveis pontos de inflexão na proporção de cesarianas no Brasil, macrorregiões e unidades federativas, bem como estimar suas projeções para o ano de 2030. Utilizou-se a série temporal com as cesarianas notificadas no Departamento de Informática do SUS no período de 1994 a 2019. Foram utilizados modelos autorregressivos integrados de médias móveis e de regressão joinpoint para obtenção de projeções e de tendências das proporções de cesariana, respectivamente. As proporções de cesarianas apresentaram tendência significativa de aumento ao longo dos 26 anos de estudo em todos os níveis de agregação. Por outro lado, quando se considera a formação de segmentos, observa-se tendência de estabilização no país e nas regiões Sul e Centro-Oeste, a partir de 2012. Norte e Nordeste apresentaram tendência de aumento e o Sudeste, de queda significativa. Projeções indicam que no ano de 2030, 57,4% dos nascimentos no país ocorrerão por via cirúrgica e que nas regiões Sudeste e Sul, serão observadas proporções superiores a 70%.

Tendências temporais e projeções de cesariana no Brasil, macrorregiões administrativas e unidades federativas / Temporal trends and projections of caesarean sections in Brazil, its administrative macro-regions, and federative units

Resumo Os estudos de tendência sobre a via de nascimento no Brasil têm revelado um cenário de sucessivos aumentos lineares nas proporções de cesariana. Entretanto, a possibilidade de mudanças na evolução temporal da via cirúrgica não tem sido considerada. Dessa forma, objetivou-se verificar possíveis pontos de inflexão na proporção de cesarianas no Brasil, macrorregiões e unidades federativas, bem como estimar suas projeções para o ano de 2030. Utilizou-se a série temporal com as cesarianas notificadas no Departamento de Informática do SUS no período de 1994 a 2019. Foram utilizados modelos autorregressivos integrados de médias móveis e de regressão joinpoint para obtenção de projeções e de tendências das proporções de cesariana, respectivamente. As proporções de cesarianas apresentaram tendência significativa de aumento ao longo dos 26 anos de estudo em todos os níveis de agregação. Por outro lado, quando se considera a formação de segmentos, observa-se tendência de estabilização no país e nas regiões Sul e Centro-Oeste, a partir de 2012. Norte e Nordeste apresentaram tendência de aumento e o Sudeste, de queda significativa. Projeções indicam que no ano de 2030, 57,4% dos nascimentos no país ocorrerão por via cirúrgica e que nas regiões Sudeste e Sul, serão observadas proporções superiores a 70%.

Abstract Trend studies on the model of birth in Brazil show a scenario of successive linear increases in cesarean rates. However, they ignore possible changes in the temporal evolution of this delivery modality. Thus, this study aimed to evaluate possible inflection points in cesarean rates in Brazil, its macro-regions, and federated units, as well as to estimate projections for 2030. A time series with information on cesarean sections from 1994 to 2019 from the SUS Department of Informatics was used. Autoregressive integrated moving average and joinpoint regression models were used to obtain cesarean rate projections and trends, respectively. Caesarean rates showed a significant upward trend over the 26 study years at all levels of aggregation. On the other hand, when considering the formation of segments, a stabilization trend was observed both in the country and in the South and Midwest regions, starting in 2012. Rates tended to increase in North and Northeast and significantly decrease in Southeast. Projections show that in 2030, 57.4% of births in Brazil will be cesarean, with rates higher than 70% in Southeast and South regions.

Experiences of women in prenatal, childbirth, and postpartum care during the COVID-19 pandemic in selected cities in Brazil: The resignification of the experience of pregnancy and giving birth.

The COVID-19 pandemic has impacted public and private health systems around the world, impairing good practices in women's health care. However, little is known about the experiences, knowledge, and feelings of Brazilian women in this period. The objective was to analyze the experiences of women, seen at maternity hospitals accredited by the Brazilian Unified Health System (SUS, acronym in Portuguese), regarding health care during pregnancy, childbirth, and postpartum periods, their interpersonal relationships, and perceptions and feelings about the pandemic. This was a qualitative, exploratory research, carried out in three Brazilian municipalities with women hospitalized in 2020, during pregnancy, childbirth, or postpartum period, with COVID-19 or not. For data collection, semi-structured individual interviews (in person, by telephone, or by digital platform) were conducted, recorded and transcribed. The content analysis of thematic modalities was displayed as per the following axes: i) Knowledge about the disease; ii) Search for health care in prenatal, childbirth, and postpartum periods; iii) Experience of suffering from COVID-19; iv) Income and work; and v) Family dynamics and social support network. A total of 46 women were interviewed in São Luís-MA, Pelotas-RS, and Niterói-RJ. Use of media was important to convey information and fight fake news. The pandemic negatively impacted access to health care in the prenatal, childbirth, and postpartum periods, contributing to worsening of the population's social and economic vulnerabilities. Women experienced diverse manifestations of the disease, and psychic disorders were very frequent. Social isolation during the pandemic disrupted the support network of these women, who found social support strategies in communication technologies. Women-centered care-including qualified listening and mental health support-can reduce the severity of COVID-19 cases in pregnant, parturient, and postpartum women. Sustainable employment and income maintenance policies are essential to mitigate social vulnerabilities and reduce risks for these women.

Factors associated with skin-to-skin contact less than 180 min/day in newborns weighing up to 1,800 g: multicenter study.

This article aims to evaluate the factors associated with a skin-to-skin contact time <180 min/day in newborns weighing up to 1,800 g during neonatal hospitalization. Prospective observational cohort study conducted in neonatal units of reference for the Kangaroo Method in Brazil. Data from 405 dyads (mother/child) were analyzed from May 2018 to March 2020. Maternal and neonatal explanatory variables were collected from medical records and interviews. Skin-to-skin contact was recorded in forms posted at the bedside, filled out by parents and staff. The outcome variable was the mean time of skin-to-skin contact < 180 min/day. Hierarchical modeling was performed by Poisson regression with robust variance. The variables associated with the outcome were "without easy access to the hospital", "without previous knowledge of the kangaroo method" and "having had morbidities during pregnancy". Mothers without easy access to the hospital and who are unaware of the kangaroo method should be priority targets for health policies to develop strategies that promote greater exposure to skin-to-skin contact during the hospitalization period of their children.

Factors associated with skin-to-skin contact less than 180 min/day in newborns weighing up to 1,800 g: multicenter study / Fatores associados ao contato pele a pele inferior a 180 min/dia em recém-nascidos com peso até 1.800 g: estudo multicêntrico

Abstract This article aims to evaluate the factors associated with a skin-to-skin contact time <180 min/day in newborns weighing up to 1,800 g during neonatal hospitalization. Prospective observational cohort study conducted in neonatal units of reference for the Kangaroo Method in Brazil. Data from 405 dyads (mother/child) were analyzed from May 2018 to March 2020. Maternal and neonatal explanatory variables were collected from medical records and interviews. Skin-to-skin contact was recorded in forms posted at the bedside, filled out by parents and staff. The outcome variable was the mean time of skin-to-skin contact < 180 min/day. Hierarchical modeling was performed by Poisson regression with robust variance. The variables associated with the outcome were "without easy access to the hospital", "without previous knowledge of the kangaroo method" and "having had morbidities during pregnancy". Mothers without easy access to the hospital and who are unaware of the kangaroo method should be priority targets for health policies to develop strategies that promote greater exposure to skin-to-skin contact during the hospitalization period of their children.

Resumo O objetivo deste artigo é avaliar os fatores associados ao tempo de contato pele a pele < 180 min/dia em recém-nascidos com peso até 1.800 g durante a internação neonatal. Estudo observacional tipo coorte prospectivo conduzido em unidades neonatais de referência no Brasil. Foram analisados dados de 405 díades (mãe/filho), no período de maio de 2018 a março de 2020. As características da mãe e do recém-nascido foram coletadas em prontuários e entrevistas, a realização do contato pele-a-pele era registrada em fichas anexadas ao leito, preenchidas pela equipe e pelos pais. A variável desfecho foi o tempo médio diário de contato pele-a-pele inferior a 180 minutos. Foi realizada modelagem hierarquizada utilizando a regressão de Poisson com variância robusta para cálculo das razões de prevalência. As variáveis que permaneceram independentemente associadas foram: "não ter fácil acesso ao hospital" (morar longe ou ter dificuldade de transporte), "não possuir conhecimento prévio sobre o método canguru" e "ter apresentado morbidades durante a gestação". Mães sem fácil acesso ao hospital e que desconhecem o método canguru devem ser alvos prioritários das políticas de saúde para desenvolver estratégias que promovam maior exposição ao contato pele a pele durante o período de internação de seus filhos.

Prenatal care and human rights: Addressing the gap between medical and legal frameworks and the experience of women in Brazil.

Access to quality and affordable healthcare is central to the fulfilment of women's reproductive and sexual health needs and rights. For this reason, the World Health Organization declared access to appropriate healthcare services during pregnancy and childbirth a fundamental women's right. Prenatal care is a recognized human right to women's health in Brazil, as declared by the 1988 Constitution and many Brazilian policies. However, implementing the rights to health in Brazil presents a fundamental performance gap between legal rights and their delivery concerning reproductive health. Through extensive fieldwork including focus groups, interviews with women and participate observation in two municipalities in northeastern Brazil, this article addresses these issues and explores women's lived experience of access to and their fulfilment of the right to health regarding prenatal healthcare. We offer and account of the experience of women regarding what they identified as barriers that trample their right to health, that is: a) limited personnel and medical equipment as a perception of neglect; b) timely delivery of services: time matters for perception and experience of rights; c) misinformation as a barrier to the exercise of health rights; and d) socioeconomic barriers. These barriers particularly affect the right of women in rural communities, with lower socioeconomic levels and education, as well as brown and black women, from an intersectionality perspective, who are already at greater health risk and inadequate prenatal care. As such, we argue there is a performance gap between what the normative and legal frameworks encourage the health system to do and what the system actually provides in terms of access, equality, respect and continuity of treatment amongst certain groups in society whose right to health are denied while their health risks increase.

Características do contato pele a pele em unidades neonatais brasileiras: estudo multicêntrico / Características del contacto piel con piel en unidades neonatales brasileñas: estudio multicéntrico / Characteristics of skin-to-skin contact in Brazilian neonatal units: a multicenter study

Resumo Objetivo Descrever o início, duração, local e quem realiza o contato pele a pele em unidades neonatais brasileiras. Métodos Estudo multicêntrico descritivo, longitudinal, realizado de maio de 2018 a março de 2020, em cinco unidades neonatais referência para o Método Canguru no Brasil, que incluiu recém-nascidos com peso até 1800g. As características maternas e dos recém-nascidos foram coletadas em prontuários e entrevistas. A prática do contato pele a pele era registrada em cartões anexados ao leito, preenchidos pela equipe e pelos pais. A análise ocorreu por meio de estatística descritiva. Resultados Foram incluídos 405 recém-nascidos, 51,4% do sexo masculino, mediana de idade gestacional de 31,4 semanas e de peso ao nascimento de 1.412g. Em relação ao tempo de realização do contato pele a pele, a mediana da frequência do contato diário foi de 1,5 vezes (IIQ: 1,2 - 2,4), o tempo/dia de 147 min/dia (IIQ: 106,7 - 263,0) e a realização do primeiro contato aos cinco dias de vida (IIQ:4,0-8,0). O maior tempo de contato/dia foi realizado pelas mães, com mediana de 137,8 min/dia (IIQ:95,6-232,1) e a segunda etapa do Método Canguru, Unidade de Cuidados Intermediários Canguru, foi o local onde se realizou por maior tempo o contato, com mediana de 184,4 min/dia (IIQ:124,7-455,4). Conclusão Nas unidades avaliadas, o contato pele a pele é praticado de forma intermitente, poucas vezes por dia, predominantemente pelas mães e com maior tempo de exposição na segunda etapa. É necessário buscar meios que possibilitem mais encontros entre mãe/pai-filho e que dê condições de maior permanência dos genitores no hospital.

Resumen Objetivo Describir el inicio, duración, lugar y quién realiza el contacto piel con piel en unidades neonatales brasileñas. Métodos Estudio multicéntrico descriptivo, longitudinal, realizado de mayo de 2018 a marzo de 2020, en cinco unidades neonatales de referencia del Método Canguro en Brasil, que incluyó recién nacidos de hasta 1800 g de peso. Las características maternas y de los recién nacidos fueron recopiladas en historias clínicas y entrevistas. La práctica del contacto piel con piel fue registrada en tarjetas anexadas a la cama, completadas por el equipo y por los padres. El análisis se realizó mediante estadística descriptiva. Resultados Se incluyeron 405 recién nacidos, 51,4 % de sexo masculino, mediana de 31,4 semanas de edad gestacional y de 1412 g de peso al nacer. Con relación al tiempo de realización del contacto piel con piel, la mediana de la frecuencia del contacto diario fue 1,5 veces (IIQ: 1,2 - 2,4), el tiempo/día fue de 147 min/día (IIQ: 106,7 - 263,0) y la realización del primer contacto a los cinco días de vida (IIQ:4,0-8,0). El mayor tiempo de contacto/día fue realizado por las madres, con una mediana de 137,8 min/día (IIQ:95,6-232,1) y la segunda etapa del Método Canguro, la Unidad de Cuidados Intermedios Canguro, fue el lugar donde se realizó el contacto por mayor tiempo, con una mediana de 184,4 min/día (IIQ:124,7-455,4). Conclusión En las unidades analizadas, el contacto piel con piel se practica de forma intermitente, pocas veces por día, predominantemente por las madres y con mayor tiempo de exposición en la segunda etapa. Es necesario buscar medios que permitan más encuentros entre madre/padre-hijo y que ofrezcan condiciones de mayor permanencia de los progenitores en el hospital.

Abstract Objective To describe the beginning, duration, location and who makes skin-to-skin contact in Brazilian neonatal units. Methods This is a descriptive, longitudinal multicenter study, carried out from May 2018 to March 2020, in five reference neonatal units for Kangaroo Mother Care in Brazil, which included newborns weighing up to 1,800 grams. Maternal and newborn characteristics were collected from medical records and interviews. Skin-to-skin contact was recorded on cards attached to the bed, filled in by the team and fathers. Analysis occurred through descriptive statistics. Results We included 405 newborns, 51.4% male, median gestational age of 31.4 weeks and birth weight of 1,412 grams. Regarding skin-to-skin contact time, the median daily contact frequency was 1.5 times (IQR: 1.2 - 2.4), the time/day was 147 min/day (IQR: 106.7 - 263.0) and the first contact at five days of life (IQR:4.0-8.0). The longest contact time/day was performed by mothers, with a median of 137.8 minutes per day (IQR:95.6-232.1), and the second stage of kangaroo Mother Care, kangaroo Intermediate Care Unit, was the place where contact was performed for the longest time, with a median of 184.4 minutes per day (IQR:124.7-455.4). Conclusion In the units assessed, skin-to-skin contact is practiced intermittently, a few times a day, predominantly by mothers and with longer exposure time in the second stage. It is necessary to seek ways that allow more encounters between mother/father-child and that gives conditions of greater permanence of fathers in the hospital.

Challenges in the care of children born to mothers diagnosed with COVID-19 during the pandemic / Desafíos en la atención de niños nacidos de madres diagnosticadas con COVID-19 durante la pandemia / Desafios no cuidado de crianças nascidas de mães com diagnóstico de COVID-19 durante a pandemia

ABSTRACT Objective: To understand the challenges in the care of children born to mothers with COVID-19 during the pandemic. Method: Qualitative research, conducted from November 2020 to May 2021, in two public maternity hospitals, with women who had children during the first wave of the pandemic, diagnosed with COVID-19 during pregnancy and/or childbirth. There were nineteen semi-structured interviews with thematic analysis. Symbolic Interactionism was used as a theoretical framework. Results: Changes in the care for newborn children were identified. In the domestic environment, hygiene measures with the newborn children were intensified, social isolation restricted the support network and mothers felt alone and overwhelmed. In terms of health care, there was a setback in neonatal care and interruption of professional care, such as the suspension of appointments. Conclusion: The pandemic has restructured traditional models of family care, intensified difficulties in accessing healthcare, and exposed children to inherent risks due to a lack of proper follow-up.

RESUMEN Objetivo: Comprender los desafíos en el cuidado de niños nacidos de madres con COVID-19 durante una pandemia. Método: Investigación cualitativa, realizada de noviembre de 2020 a mayo de 2021, en dos maternidades públicas, con mujeres que tuvieron hijos durante la primera ola de la pandemia, diagnosticadas con COVID-19 durante el embarazo y/o parto. Se realizaron diecinueve entrevistas semiestructuradas con análisis temático. Se utilizó como marco teórico el Interaccionismo Simbólico. Resultados: Se identificaron cambios en el cuidado del recién nacido. En el ámbito doméstico, se redoblaron las medidas de higiene con el recién nacido, el aislamiento social restringió la red de apoyo y las madres se sintieron solas y abrumadas. En cuanto a la atención, hubo retroceso en la atención neonatal e interrupción de la atención profesional, como la suspensión de citas. Conclusión: La pandemia ha reestructurado los modelos tradicionales de cuidado familiar, intensificado las dificultades de acceso a la salud y expuesto a los niños a los riesgos inherentes a la falta de seguimiento.

RESUMO Objetivo: Compreender os desafios no cuidado de crianças nascidas de mães com COVID-19 durante a pandemia. Método: Pesquisa qualitativa, realizada de novembro de 2020 a maio de 2021, em duas maternidades públicas, com mulheres que tiveram filhos na primeira onda da pandemia, diagnosticadas com COVID-19, durante a gestação e/ou parto. Realizaram-se 19 entrevistas semiestruturadas com análise temática. Utilizou-se do Interacionismo Simbólico como referencial teórico. Resultados: Identificaram-se mudanças nos cuidados a crianças recém-nascidas. No ambiente doméstico, as medidas de higiene com o recém-nascido foram redobradas, o isolamento social restringiu a rede de apoio e as mães se sentiram sozinhas e sobrecarregadas. No âmbito assistencial, houve retrocesso no cuidado neonatal e interrupção de cuidados profissionais, como suspensão de consultas. Conclusão: A pandemia reestruturou os modelos tradicionais de cuidados familiares, intensificou as dificuldades de acesso à saúde e expôs as crianças a riscos inerentes à falta de acompanhamento.

Sentimentos, reações e expectativas de mães de crianças nascidas com microcefalia pelo vírus zika / Feelings, reactions and expectations of mothers of children born with microcephaly by zika virus

Resumo Introdução: Em 2015, o Brasil foi afetado pela epidemia de microcefalia. As famílias atingidas vivenciaram uma doença desconhecida. Objetivo: Analisar sentimentos, reações e expectativas de mães de crianças nascidas com microcefalia pelo vírus Zika. Método: Abordagem qualitativa. Realizadas entrevistas estruturadas e semiestruturadas com 19 mães e uma bisavó. Análise de conteúdo na modalidade temática. Resultados: Os sentimentos descritos foram tristeza, medo, ansiedade e, algumas vezes, culpa. As reações relatadas foram choque, desespero, busca por informações, negação e, além disso, cada entrevistada vivenciou diferentes formas de aceitação. O luto do filho desejado foi um processo lento e doloroso. A maioria teve gestação não planejada, o que pareceu não ter influenciado nos sentimentos e reações provocados pelo diagnóstico dos filhos. As expectativas em relação ao futuro da criança envolveram medo da morte prematura e preocupações com o desenvolvimento motor, especialmente a incapacidade de andar e comer sozinho, levando à dependência. Conclusões: Diante do nascimento de um filho com microcefalia, as mães precisaram refazer seus planos à luz de uma nova realidade, que impactou na qualidade de vida. Os profissionais precisam estar preparados para lidar com tais questões, garantindo também atenção às mães.

Abstract Background: In 2015, Brazil was affected by the microcephaly epidemic, when affected families experienced an unknown disease. Objective: To analyze the feelings, reactions, and expectations of mothers of children born with microcephaly due to the Zika virus. Method: Qualitative approach. Structured and semi-structured interviews were conducted with 19 mothers and a great-grandmother. Content analysis in thematic modality. Results: The feelings described were sadness, fear, anxiety and, sometimes, guilt. The reactions reported were shock, despair, search for information, denial, and each interviewee experienced different forms of acceptance. Grieving the desired child was a slow and painful process. Most had unplanned pregnancies, which did not seem to have influenced the feelings and reactions caused by the children's diagnosis. Expectations regarding the child's future involved fear of premature death, concerns about motor development, especially the inability to walk and eat alone, leading to dependence. Conclusion: Given the birth of a child with microcephaly, mothers needed to redo their plans in the light of a new reality, which impacted on their quality of life. Professionals need to be prepared to deal with such issues while also ensuring attention to mothers.

Efeitos de uma epidemia no trabalho em saúde: cuidando de crianças com síndrome congênita pelo vírus Zika / Effects of an epidemic on health work: caring for children with Zika Virus congenital syndrome

Resumo Objetivou-se analisar relatos de profissionais, que atenderam crianças com síndrome congênita pelo vírus Zika (SCVZ), acerca de mudanças no processo de trabalho provocadas pela epidemia. Pesquisa qualitativa realizada em Centro de Referência em Neurodesenvolvimento, em uma capital do Nordeste brasileiro, no período de abril de 2018 a janeiro de 2019. Os participantes foram 12 profissionais de nível superior que trabalhavam na instituição na época da epidemia de Zika. Foram realizadas entrevistas semiestruturadas e observação participante, buscando-se a triangulação dos dados. Foi realizada análise de conteúdo na modalidade temática. Os resultados foram categorizados em: Uma epidemia desconhecida e A (des)organização do cuidado. Tal emergência em saúde pública provocou desde incertezas e inseguranças na população, em geral, e em profissionais de saúde, até mudanças em processos de trabalho e na reorganização de serviço de saúde. A epidemia da Zika também promoveu visibilidade à precariedade da atenção e dos recursos às crianças com necessidade de reabilitação.

Abstract The article aimed to analyze the reports of professionals who care for children with congenital syndrome caused by the Zika virus (SCVZ), on the changes in the work process caused by the epidemic. Qualitative research with data triangulation carried out at a Reference Center for Neurodevelopment, in a capital of Northeastern Brazil, from April 2018 to January 2019. The participants were 12 higher education professionals who worked at the institution at the time of the epidemic of Zika. They were adapted, semi-structured and participant observation, seeking data triangulation. A content analysis was carried out in the thematic modality. The results were categorized into: An unknown epidemic and the reorganization of care. The emergence of a new epidemic caused uncertainty in professionals, given their ignorance of the recent syndrome. It produced a feeling of insecurity and disorganization in the work process. It was concluded that an epidemic brought to light existing weaknesses and made it urgent to reorganize practices and expand the infrastructure of services.

Power relations and knowledge of neonatal teams in the Kangaroo Mother Care implementation and dissemination.

OBJECTIVE: to analyze the power relations and knowledge among health teams that permeate the Kangaroo Mother Care implementation and dissemination in the state of Santa Catarina. METHOD: socio-historical qualitative research, carried out in the state of Santa Catarina, from January to November 2019, based on interviews with 12 health professionals. Data were analyzed in the light of Foucault's genealogical proposal, with the help of Atlas.ti Cloud®. RESULTS: the relationships of neonatal team members strengthened Kangaroo Mother Care actions in the state, articulating services and favoring health professionals' autonomy. However, Kangaroo nurses stand out in this process, and the hegemonic medical discourse often still represses the other professional categories. CONCLUSION: professionals develop strategies to negotiate changes in the practice of care, moving between the plots of power and knowledge, sometimes exercising it, sometimes being passive to it.

The role of skin-to-skin contact in exclusive breastfeeding: a cohort study.

OBJETIVE: To understand the role of exposure to skin-to-skin contact and its minimum duration in determining exclusive breastfeeding at hospital discharge in infants weighing up to 1,800g at birth. METHODS: A multicenter cohort study was carried out in five Brazilian neonatal units. Infants weighing ≤ 1,800g at birth were eligible. Skin-to-skin contact time was recorded by the health care team and parents on an individual chart. Maternal and infant data was obtained from maternal questionnaires and medical records. The Classification Tree, a machine learning method, was used for data analysis; the tree growth algorithm, using statistical tests, partitions the dataset into mutually exclusive subsets that best describe the response variable and calculates appropriate cut-off points for continuous variables, thus generating an efficient explanatory model for the outcome under study. RESULTS: A total of 388 infants participated in the study, with a median of 31.6 (IQR = 29-31.8) weeks of gestation age and birth weight of 1,429g (IQR = 1,202-1,610). The exclusive breastfeeding rate at discharge was 61.6%. For infant's weighting between 1,125g and 1,655g, exposed to skin-to-skin contact was strongly associated with exclusive breastfeeding. Moreover, infants who made an average > 149.6 min/day of skin-to-skin contact had higher chances in this outcome (74% versus 46%). In this group, those who received a severity score (SNAPPE-II) equal to zero increased their chances of breastfeeding (83% versus 63%). CONCLUSION: Skin-to-skin contact proved to be of great relevance in maintaining exclusive breastfeeding at hospital discharge for preterm infants weighing 1,125g-1,655g at birth, especially in those with lower severity scores.

Presence of a full-time companion in Brazilian maternities linked to the Rede Cegonha. / Presença do acompanhante em tempo integral em maternidades brasileiras vinculadas à Rede Cegonha.

The objective was to estimate the proportion of women with a full-time companion in Brazilian maternities linked to the Rede Cegonha (RC) and to compare them between the macro-regions in Brazil. A nationwide study, carried out from December/2016 to October/2017. 10,665 puerperal women from all regions of Brazil participated in the study, who gave birth at one of 606 maternity hospitals with a regional action plan approved by RC. Proportions and respective 95% confidence intervals were estimated, adjusted for the cluster effect, by comparing the macro-regions using Wald's chi-square test. The presence of a full-time companion occurred in 71.2% of maternities, being higher among women aged 20-35 years, brown-skinned, with higher education, married, and assisted in vaginal delivery. Almost 30% of puerperal women did not have a full-time companion. In the Southeast and Midwest regions, self-declared black women, with less schooling and unmarried women were less accompanied. The moment of delivery had less presence of the companion (29.2%). Despite the advances, this right is still not fully fulfilled, pointing to the occurrence of social inequities among Brazilian macro-regions.

Objetivou-se estimar a proporção de mulheres com acompanhante em tempo integral em maternidades brasileiras vinculadas à Rede Cegonha (RC) e compará-las entre as macrorregiões no Brasil. Estudo de abrangência nacional, realizado no período de dezembro de 2016 a outubro de 2017. Participaram do estudo 10.665 puérperas de todas as regiões do Brasil, que pariram em uma das 606 maternidades com plano de ação regional aprovado na RC. Foram estimadas proporções e respectivos intervalos de confiança a 95%, ajustados para o efeito do cluster, comparando-se as macrorregiões pelo teste Qui-quadrado de Wald. A presença do acompanhante em tempo integral ocorreu em 71,2% das maternidades, sendo maior entre puérperas com idade de 20-35 anos, de cor parda, com maior escolaridade, casadas e assistidas em parto vaginal. Quase 30% das puérperas não tiveram acompanhante em tempo integral. Nas regiões Sudeste e Centro-Oeste, mulheres pretas autodeclaradas, de menor escolaridade e solteiras foram menos acompanhadas. O momento do parto teve menor presença do acompanhante (29,2%). Apesar dos avanços, este direito ainda não é cumprido integralmente, apontando para a ocorrência de iniquidades sociais entre as macrorregiões brasileiras.

Presença do acompanhante em tempo integral em maternidades brasileiras vinculadas à Rede Cegonha / Presence of a full-time companion in Brazilian maternities linked to the Rede Cegonha

Resumo Objetivou-se estimar a proporção de mulheres com acompanhante em tempo integral em maternidades brasileiras vinculadas à Rede Cegonha (RC) e compará-las entre as macrorregiões no Brasil. Estudo de abrangência nacional, realizado no período de dezembro de 2016 a outubro de 2017. Participaram do estudo 10.665 puérperas de todas as regiões do Brasil, que pariram em uma das 606 maternidades com plano de ação regional aprovado na RC. Foram estimadas proporções e respectivos intervalos de confiança a 95%, ajustados para o efeito do cluster, comparando-se as macrorregiões pelo teste Qui-quadrado de Wald. A presença do acompanhante em tempo integral ocorreu em 71,2% das maternidades, sendo maior entre puérperas com idade de 20-35 anos, de cor parda, com maior escolaridade, casadas e assistidas em parto vaginal. Quase 30% das puérperas não tiveram acompanhante em tempo integral. Nas regiões Sudeste e Centro-Oeste, mulheres pretas autodeclaradas, de menor escolaridade e solteiras foram menos acompanhadas. O momento do parto teve menor presença do acompanhante (29,2%). Apesar dos avanços, este direito ainda não é cumprido integralmente, apontando para a ocorrência de iniquidades sociais entre as macrorregiões brasileiras.

Abstract The objective was to estimate the proportion of women with a full-time companion in Brazilian maternities linked to the Rede Cegonha (RC) and to compare them between the macro-regions in Brazil. A nationwide study, carried out from December/2016 to October/2017. 10,665 puerperal women from all regions of Brazil participated in the study, who gave birth at one of 606 maternity hospitals with a regional action plan approved by RC. Proportions and respective 95% confidence intervals were estimated, adjusted for the cluster effect, by comparing the macro-regions using Wald's chi-square test. The presence of a full-time companion occurred in 71.2% of maternities, being higher among women aged 20-35 years, brown-skinned, with higher education, married, and assisted in vaginal delivery. Almost 30% of puerperal women did not have a full-time companion. In the Southeast and Midwest regions, self-declared black women, with less schooling and unmarried women were less accompanied. The moment of delivery had less presence of the companion (29.2%). Despite the advances, this right is still not fully fulfilled, pointing to the occurrence of social inequities among Brazilian macro-regions.

Utilização do cuidado popular por egressos de unidade de terapia intensiva neonatal / Utilización del cuidado popular en niños salidos de unidades de cuidados intensivos neonatales / Use of popular care by discharged patients of a neonatal intensive care unit

Resumo Objetivo Avaliar a relação entre a busca por cuidados populares e condições socioeconômicas e de saúde relacionadas às crianças egressas de unidade de terapia intensiva neonatal. Métodos Coorte retrospectiva com 165 crianças menores de 48 meses, egressas de unidade de terapia intensiva neonatal de duas das maiores maternidades públicas de uma capital do nordeste brasileiro, nos anos de 2014 e 2015. Dados perinatais foram obtidos de prontuários e sobre cuidados de saúde por meio de questionários. Criou-se um modelo teórico, estabelecendo relações entre condições socioeconômicas, presença de morbidade na alta e o impacto direto ou indireto no uso do setor popular. Para análise, utilizou-se Modelagem de Equações Estruturais (α=5%). Resultados A utilização do setor popular foi a menos prevalente entre os três setores de cuidado. A presença de morbidade na alta registrou efeito total significante (coeficiente padronizado de 0,302; valor de p=0,030), porém, sem efeito direto para a busca por esse setor. Dentre as práticas do setor popular, a procura por benzedeira/curandeiro (55,3%) foi a mais prevalente. Conclusão Apresentar morbidade na alta da unidade de terapia intensiva neonatal, associada a outras variáveis não identificadas, é fator que pode influenciar na busca por cuidados de saúde no setor popular, sem excluir a busca por cuidados com profissionais da saúde.

Resumen Objetivo Evaluar la relación entre la búsqueda de cuidados populares y las condiciones socioeconómicas y de salud relacionadas con niños salidos de unidades de cuidados intensivos neonatales. Métodos Cohorte retrospectiva con 165 niños menores de 48 meses, salidos de unidades de cuidados intensivos neonatales de dos de las mayores maternidades públicas de una capital del nordeste brasileño, durante los años 2014 y 2015. Los datos perinatales se obtuvieron de las historias clínicas y los datos sobre cuidados de salud por medio de cuestionarios. Se creó un modelo teórico, que estableció relaciones entre condiciones socioeconómicas, presencia de morbilidad en el alta e impacto directo o indirecto en el uso del sector popular. Para el análisis, se utilizó el Modelo de Ecuaciones Estructurales (α=5 %). Resultados La utilización del sector popular fue la menos prevalente entre los tres sectores de cuidado. La presencia de morbilidad en el alta registró un efecto total significante (coeficiente estandardizado de 0,302; valor de p=0,030), pero sin efecto directo en la búsqueda de ese sector. Entre las prácticas del sector popular, la búsqueda de acceder a un curandero (55,3 %) fue la más prevalente. Conclusión Presentar morbilidad en el alta de la unidad de cuidados intensivos neonatales, junto con otras variables no identificadas, es un factor que puede influenciar en la búsqueda de cuidados de salud en el sector popular, sin excluir la búsqueda de cuidados con profesionales de salud.

Abstract Objective To evaluate the relationship between the search for popular care and socioeconomic and health conditions related to children discharged from a neonatal intensive care unit. Methods Retrospective cohort with a total of 165 children under 48 months old, discharged from the neonatal intensive care unit of two of the largest public maternity hospitals in a capital city in northeastern Brazil, in 2014 and 2015. Perinatal data were obtained from medical records and on health care through questionnaires. A theoretical model was created, establishing relationships between socioeconomic conditions, the presence of morbidity at discharge and the direct or indirect impact on the use of the popular sector. For analysis, Structural Equation Modeling was used (α=5%). Results The use of the popular sector was the least prevalent among the three care sectors. The presence of morbidity at discharge had a significant total effect (standardized coefficient of 0.302; p-value = 0.030), however, with no direct effect on the search for this sector. Among the practices of the popular sector, the search for a healer (55.3%) was the most prevalent. Conclusion Having morbidity at discharge from the neonatal intensive care unit, associated with other unidentified variables, is a factor that can influence the search for health care in the popular sector, without excluding the search for care with health professionals.

Skin-to-skin contact and breastfeeding at childbirth: women's desires, expectations, and experiences / Contato pele a pele e amamentação no momento do parto: desejos, expectativas e experiências de mulheres

ABSTRACT Objective: To analyze women's desires, expectations and experiences regarding skin-to-skin contact and breastfeeding in the first hour of life of their newborns. Methods: Qualitative research carried out in a teaching hospital in the Northeast Region of Brazil. The patients were followed longitudinally during prenatal care, at birth and during the puerperium. The participants were pregnant women during normal risk prenatal care, aged over 18 years old. Structured and semi-structured interviews were carried out in the prenatal period, participant observation at the time of delivery and new interviews in the puerperium. Content analysis was applied in the thematic modality. Results: 18 women between 21 and 38 years old were enrolled in the research. Women expressed the desire for skin-to-skin contact and breastfeeding as immediate practices right after delivery and birth. However, many women did not believe it was possible, and the performance of routine procedures was considered the main obstacle. These expectations that skin-to-skin contact and early breastfeeding would not be carried out were confirmed in the experiences immediately after birth. Conclusions: The expectations and experiences brought by these women suggest a flaw that starts in prenatal care and implies difficulties in implementing the studied practices. Thus, the empowerment and participation of women can become an important tool in the humanization of birth.

RESUMO Objetivo: Analisar os desejos, as expectativas e as experiências de mulheres no que diz respeito ao contato pele a pele e à amamentação na primeira hora de vida. Métodos: Pesquisa qualitativa realizada em um hospital de ensino de uma capital da Região Nordeste. As mulheres foram acompanhadas longitudinalmente, durante o pré-natal, o parto e o puerpério. As participantes eram gestantes em pré-natal de risco habitual, com idade maior de 18 anos. Foram realizadas entrevistas estruturadas e semiestruturadas no pré-natal, observação participante no momento do parto e novas entrevistas no puerpério. Fez-se a análise de conteúdo na modalidade temática. Resultados: Participaram da pesquisa 18 mulheres, entre 21 e 38 anos. Elas expressaram o desejo do contato pele a pele e da amamentação como práticas imediatas após o parto e o nascimento, contudo muitas não acreditavam que fosse possível, sendo o principal entrave a realização de procedimentos de rotina. As expectativas de impossibilidade do contato pele a pele e amamentação precoce foram confirmadas no momento do parto. Conclusões: As expectativas e experiências trazidas pelas mulheres apontam para uma falha que se inicia no pré-natal e implica dificuldades na implementação das práticas estudadas. Desse modo, o fortalecimento da participação das mulheres pode se mostrar uma ferramenta importante na humanização do nascimento.

The role of skin-to-skin contact in exclusive breastfeeding: a cohort study

ABSTRACT OBJETIVE To understand the role of exposure to skin-to-skin contact and its minimum duration in determining exclusive breastfeeding at hospital discharge in infants weighing up to 1,800g at birth. METHODS A multicenter cohort study was carried out in five Brazilian neonatal units. Infants weighing ≤ 1,800g at birth were eligible. Skin-to-skin contact time was recorded by the health care team and parents on an individual chart. Maternal and infant data was obtained from maternal questionnaires and medical records. The Classification Tree, a machine learning method, was used for data analysis; the tree growth algorithm, using statistical tests, partitions the dataset into mutually exclusive subsets that best describe the response variable and calculates appropriate cut-off points for continuous variables, thus generating an efficient explanatory model for the outcome under study. RESULTS A total of 388 infants participated in the study, with a median of 31.6 (IQR = 29-31.8) weeks of gestation age and birth weight of 1,429g (IQR = 1,202-1,610). The exclusive breastfeeding rate at discharge was 61.6%. For infant's weighting between 1,125g and 1,655g, exposed to skin-to-skin contact was strongly associated with exclusive breastfeeding. Moreover, infants who made an average > 149.6 min/day of skin-to-skin contact had higher chances in this outcome (74% versus 46%). In this group, those who received a severity score (SNAPPE-II) equal to zero increased their chances of breastfeeding (83% versus 63%). CONCLUSION Skin-to-skin contact proved to be of great relevance in maintaining exclusive breastfeeding at hospital discharge for preterm infants weighing 1,125g-1,655g at birth, especially in those with lower severity scores.

Challenges at the front: experiences of professionals in admitting patients to the intensive care unit during the covid-19 pandemic / Desafíos delanteros: experiencias de profesionales en el ingreso de pacientes en la unidad de cuidados intensivos en la pandemia del covid-19 / Desafios do front: experiências de profissionais na admissão de pacientes em unidade de terapia intensiva na pandemia da covid-19

ABSTRACT Objective: to know the perspectives, practices and challenges in decision-making for admitting patients into the Intensive Care Unit during the Covid-19 pandemic. Methods: a qualitative study developed in two public hospitals in Maranhão, Brazil, from November/2020 to January/2021. Data collection took place through individual interviews guided by a script. A total of 22 professionals participated in the study: nurses and doctors who worked in the Intensive Care Unit and Bed Regulation in the first wave of the pandemic. Content Analysis was used in the thematic mode, with support from the Qualitative Data Analysis software program for data categorization. The theory of Responsibility for Reasonableness guided the study. Results: two main categories emerged: "The context of the decision-making process - the paradox of celestial discharges" and "Decision-making for admission". In the scenario of high demand, a lack of beds, and the uncertainties of the "new disease", deciding who would occupy the bed was arduous and conflicting. Clinical and non-clinical criteria such as severity, chance of survival, distance to be covered and transport conditions were considered. It was found that the ambivalence of feelings attributed to death and care at that moment of the pandemic marked the social and technical environment of intensive care. Conclusions: the complexity of the decision-making process for admission to an intensive care unit was evidenced, demonstrating the importance of analyzing the allocation of critical resources in pandemic scenarios. Knowing the perspectives of professionals and their reflections on the experiences in that period can help in planning the allocation of health resources in future emergency scenarios.

RESUMEN Objetivo: conocer perspectivas, prácticas y desafíos en la toma de decisiones para el ingreso de pacientes a camas en Unidades de Cuidados Intensivos en la pandemia de COVID-19. Métodos: un estudio cualitativo, desarrollado en dos hospitales públicos de Maranhão, Brasil, de noviembre/2020 a enero/2021. La recolección de datos se realizó a través de entrevistas individuales guiadas por un guión. Un total de 22 profesionales participaron en el estudio: enfermeros y médicos que actuaban en la Unidad de Cuidados Intensivos y Regulación de Camas en la primera ola de la pandemia. Se utilizó el Análisis de Contenido en la modalidad temática, con apoyo del Software de Análisis Cualitativo de Datos para la categorización de los datos. La teoría de la Responsabilidad por la Razonabilidad guió el estudio. Resultados: surgieron dos categorías principales: "El contexto del proceso de toma de decisiones - la paradoja de los altos celestes" y "Toma de decisiones para la admisión". En el escenario de alta demanda, escasez de camas e incertidumbres de la "nueva enfermedad", decidir quién ocuparía la cama fue arduo y conflictivo. Se consideraron criterios clínicos y no clínicos, como gravedad, probabilidad de supervivencia, distancia a recorrer y condiciones de transporte. Se constató que la ambivalencia de los sentimientos atribuidos a la muerte y al cuidado, en ese momento de la pandemia, marcaron el ambiente social y técnico de la terapia intensiva. Conclusiones: se evidenció la complejidad del proceso de toma de decisiones para el ingreso a una unidad de cuidados intensivos, demostrando la importancia de analizar la asignación de recursos críticos en escenarios de pandemia. Conocer las perspectivas de los profesionales y sus reflexiones sobre las experiencias en ese período puede ayudar en la planificación de la asignación de recursos de salud en futuros escenarios de emergencia.

RESUMO Objetivo: conhecer perspectivas, práticas e desafios na tomada de decisão para admissão de pacientes em leitos de Unidades de Terapia Intensiva na pandemia da Covid-19. Métodos: estudo qualitativo, desenvolvido em dois hospitais públicos do Maranhão, Brasil, de novembro/2020 a janeiro/2021. A coleta de dados ocorreu por meio de entrevistas individuais guiadas por roteiro. Participaram do estudo 22 profissionais: enfermeiros e médicos que atuaram em Unidade de Terapia Intensiva e Regulação de Leitos na primeira onda da pandemia. Empregou-se a Análise de Conteúdo na modalidade temática, com apoio do Qualitative Data Analysis Software para categorização dos dados. A teoria da Responsabilidade pela Razoabilidade norteou o estudo. Resultados: emergiram duas categorias principais: "Contexto do processo decisório - o paradoxo das altas celestiais" e "Tomada de decisão para admissão". No cenário de alta demanda, insuficiência de leitos e de incertezas da "nova doença", decidir quem ocuparia o leito era árduo e conflitante. Critérios clínicos e não clínicos, como gravidade, chance de sobrevivência, distância a ser percorrida e condições do transporte foram considerados. Constatou-se que a ambivalência de sentimentos atribuídos à morte e ao cuidado, naquele momento da pandemia, marcaram o ambiente social e técnico da terapia intensiva. Conclusões: evidenciou-se a complexidade do processo decisório para admissão em unidade de terapia intensiva, demonstrando a importância de analisar a alocação de recursos críticos em cenários pandêmicos. Conhecer as perspectivas dos profissionais e as reflexões deles sobre as experiências naquele período podem auxiliar no planejamento de alocação de recursos de saúde em cenários emergenciais futuros.