Third stage of the kangaroo method: exclusive breastfeeding and growth of preterm and/or low birth weight newborns.

OBJECTIVE: To evaluate the rates of exclusive breastfeeding (EBF) and growth of preterm and/or low birth weight newborns during the third stage of the Kangaroo Method (TSKM), at discharge. METHODS: Retrospective study in a reference public maternity hospital between Jan/2014 and Dec/2017, including the preterm (less than 37 weeks) and/or low birth weight (less than 2500 g) newborn infants. Information was collected from medical records. Statistics analysis was done in SPSS software. RESULTS: 482 infants were included and followed up at the TSKM ambulatory. The average gestational age was 33 weeks (variation: 24-39 weeks) and birth weight, 1715g (variation: 455-2830 g). EBF occurred in 336 (70.1%) infants at hospital discharge, and in 291 (60.4%) at TSKM discharge. Each additional day of hospital stay increased the chance of infant formula (IF) use by 9.3% at hospital discharge and by 10.3% at TSKM discharge. Staying in the Kangaroo Neonatal Intermediate Care Unit (KNICU) favored EBF at hospital discharge and TSKM discharge (p<0.001). Not performing the kangaroo position increased the chance formula administration to the newborn infant at hospital discharge by 11%. Weight gain and head circumference growth were higher in infants using formula (p<0.001). CONCLUSIONS: The length of hospital stay and not performing the kangaroo position favored the use of infant formula at hospital and TSKM discharge. Staying in the KNICU favored exclusive breastfeeding at hospital and TSKM discharge. Weight gain and HC growth were higher in newborns receiving infant formula.

Association between early onset of skin-to-skin contact and mother-infant interaction at hospital discharge and six months of corrected age among preterm infants.

OBJECTIVE: To compare mother-infant interaction between hospital discharge and at six months of corrected age of infants born ≤32 weeks and investigate the association between the onset of skin-to-skin contact and the difference in mother-infant interaction between discharge and six months of corrected age (CA) among preterm infants. MATERIAL AND METHODS: Prospective observational study, in which 72 mother-infant dyads were evaluated. Preterm newborns (born with gestational age ≤ 32 weeks of gestational age) from two public maternity hospitals were assessed by means of video macro analysis of the mother-infant interaction according to the parameters adopted by the Mother-Baby Observation Protocol 0-6 (POIMB), at hospital discharge and at six months of corrected gestational age. Such variables as socioeconomic conditions, depression and maternal anxiety were controlled. Multivariate model was built. RESULTS: Onset skin-to-skin contact within three days of life increased by 1.30 points for the best interactive infant behavior at discharge for the six months of CA. In addition, in relation to the tuning of the mother-infant dyad, the initiation of skin-to-skin contact at 20 days of life reduced 1.0 point significantly. Multiparous mothers or those exposed to cigarette smoke performed worse in the development of the dyad. CONCLUSION: The preterm newborn should initiate skin-to-skin contact early and, whenever possible, by the third day of life to favor mother-infant interaction.

Neuropsychomotor development in children born preterm at 6 and 12 months of corrected gestational age.

OBJECTIVE: To assess the incidence of neuropsychomotor developmental delay at 6 and 12 months of corrected gestational age in children born at 32 gestational weeks or less. METHODS: A descriptive and prospective study was carried out at two public maternity hospitals. Between April 2017 and January 2019, we assessed 133 children without any known risk factors for neuropsychomotor developmental delay. The Bayley III scale was used to evaluate cognitive and motor development. The p value of the numerical variables was calculated using the Mann-Whitney test, whereas proportions of categorical variables were compared using the Z-test. RESULTS: The mean maternal age was 26±6.9 years,78.8% were from middle and lower economic classes, and 57.1% of the analyzed children were female. Children presented with a higher incidence of delay at 12 months than at 6 months (10.3 and 2.3% at 12 and 6 months, respectively, for the cognitive score; 22.7 and 12% at 12 and 6 months, respectively, for the composite motor score; and 24.7 and 8.4% at 12 and 6 months, respectively, for the fine motor score). CONCLUSIONS: Cognitive and motor developmental delays were significant, with the highest incidence at 12 months. The results of this study encourage further research on this topic, since the exclusion criteria were comprehensive and the delays in neuropsychomotor development were significant.

Factors associated with the socioemotional development of preterm infants.

Preterm birth is a risk factor for problems in interactions with others. We compared the difference in socioemotional development between hospital discharge and at six months of corrected age of infants born ≤32 weeks and assessed the impact of maternal and infantile factors on socioemotional development rate within a 6 month's period. Mother-child dyads (n = 144) were assessed by the Mother-Baby Observation Protocol 0-6 months through a video microanalysis. Multivariate model was built. Neonatal, maternal and child factors were associated with interactive gaze, initiate contact, responsiveness, infantile vocalization, and thus contributed to the socioemocional development of preterm infants with their mothers.

Does ankyloglossia interfere with breastfeeding in newborns? A cross-sectional study.

BACKGROUND AND AIM: Ankyloglossia is a congenital anomaly that can affect breastfeeding. The aim was to evaluate the prevalence of ankyloglossia in newborns and breastfeeding difficulties reported by mothers; assess possible factors that may interfere with breastfeeding. METHODS: A cross-sectional study was conducted with 391 pairs of mothers/newborns at a university hospital. A pediatric dentist examined the oral cavity of the newborns for the occurrence of ankyloglossia. We analyzed medical records and the mothers answered a self-administered questionnaire to assess birth variables, breastfeeding difficulties, and sociodemographic factors. We calculated prevalence ratios (PRs) of breastfeeding difficulties according to the independent variables. RESULTS: The mean age of the newborns was 2.5±2.9 days and 52% were male. The prevalence of ankyloglossia was 15% and 91.4% of mothers reported not having breastfeeding difficulties. Ankyloglossia was not associated with breastfeeding difficulties (PR: 0.5; 95% CI: 0.2-1.4). Mothers with a low income (PR: 0.5; 95% CI: 0.3-0.8), those who received instructions on breastfeeding (PR: 0.4; 95% CI: 0.2-0.9), and those who breastfed exclusively (PR: 0.3; 95% CI: 0.1-0.8) had fewer breastfeeding difficulties. CONCLUSION: Successful breastfeeding was more dependent on being born at full term, the family income, receiving guidance with regard to breastfeeding, and exclusive breastfeeding. Although ankyloglossia was not associated with breastfeeding, future prospective studies should evaluate the long-term factors that may interfere with breastfeeding. RELEVANCE FOR PATIENTS: This study brings a new perspective on the importance of assessing ankyloglossia and breastfeeding difficulties, reinforces the benefits of exclusive breastfeeding and the need for breastfeeding instructions, as well as the need to evaluate breastfeeding before making a decision regarding frenectomy.

Perinatal risk factors and Apgar score ≤ 3 in first minute of life in a referral tertiary obstetric and neonatal hospital.

This study aimed to identify the maternal, labour and newborn risk factors associated with an Apgar score of ≤3 in the first minute of life. This was a cross-sectional evaluation from an internal database information system in a tertiary referral obstetric and neonatal centre. Newborns with gestational age ≥24 weeks and birth weight ≥500 g with a registered Apgar score in the first minute of life were included. A total of 4475 newborns had an Apgar score >3 and 154 newborns had an Apgar score ≤3 in the first minute of life. A multivariate analysis revealed that eclampsia (OR = 31.53), twin pregnancy (OR = 7.06), analgesia (OR = 1.97), prematurity (OR = 2.00) and caesarean section (OR = 2.06) were risk factors for an Apgar score ≤3 in the first minute of life. Identification of these risk factors indicates prompt assistance during prenatal and labour care to prevent neonatal hypoxia and low Apgar scores, identifying newborns that may need resuscitation procedures.Impact StatementWhat is already known on this subject? Adequate prenatal care and proper labour management are the main factors that reduce the risk of complications at birth. The Apgar score at the first minute of life reflects conditions during labour but it is not a parameter that indicates resuscitation procedures. Previous studies have reported the association Apgar score at five minutes of life with the neonatal outcome.What the results of this study add? This study identifies risk factors associated with an Apgar score ≤3 in the first minute of life in a tertiary referral hospital. Eclampsia was the greatest independent risk factor, increasing by 31 times the risk of having an Apgar score ≤3 in the first minute of life.What the implications are of these findings for clinical practice and/or further research? Identification of these risk factors, especially prompt treatment antenataly and during labour for hypertensive pregnant women, can prevent neonatal hypoxia and reduce the number of newborns that may need resuscitation procedures.

Baby friendly hospital initiative: 25 years of experience in brazil / Iniciativa hospital amigo da criança: 25 anos de experiência no brasil

ABSTRACT Objective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children's Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" and "breastfeeding". The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.

RESUMO Objetivo: Descrever a experiência de 25 anos da Iniciativa Hospital Amigo da Criança (IHAC) no Brasil, cuja primeira unidade foi implementada em 1992. Métodos: Informações e dados foram obtidos em publicações nos sites da Organização Mundial da Saúde (OMS), do Fundo Internacional de Emergência para a Infância das Nações Unidas (UNICEF) e do Ministério da Saúde e em periódicos nacionais e internacionais, abrangendo o período de 1990 a 2017. Utilizaram-se os descritores: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" e "breastfeeding". Foram avaliados o número de hospitais nos 25 anos, a trajetória da IHAC e suas repercussões sobre o aleitamento materno no Brasil. Resultados: A IHAC é uma estratégia de intervenção na assistência hospitalar ao nascimento com foco na implementação de práticas que promovem o aleitamento materno exclusivo desde as primeiras horas de vida e com o apoio, entre outras medidas de impacto positivo na amamentação, do Código Internacional de Comercialização de Substitutos do Leite Materno. Atualmente, a iniciativa foi revisada, atualizada e expandida para integrar o cuidado aos recém-nascidos nas unidades neonatais e na atenção à mulher desde o pré-natal. Pôde-se concluir que, ao longo desses 25 anos, a quantidade de hospitais variou muito, com números ainda aquém da capacidade de leitos hospitalares. Hospitais credenciados como o Hospital Amigo da Criança mostram índices de amamentação superiores ao de hospitais não credenciados, entretanto o número de hospitais credenciados no Brasil ainda é pouco se comparado com outros países. Conclusões: A IHAC contribuiu para o aleitamento materno no Brasil nessas últimas décadas. Mais apoio pelas políticas públicas é necessário para ampliar o número de instituições credenciadas no país.

Is sensory processing associated with prematurity, motor and cognitive development at 12 months of age?

BACKGROUND: Prematurity may be a risk factor for sensory processing difficulties. Limited research has investigated sensory processing in preterm infants in their first year of life, when sensory processing dysfunctions are more subtle and difficult to detect. AIMS: The aims of this study were to investigate the association between prematurity and sensory processing and the associations between sensory processing and motor and cognitive development in infants at 12 months of age. STUDY DESIGN: Cross-sectional study. SUBJECTS: 45 infants allocated in two groups: control (37-41 weeks' gestation) and preterm (<34 weeks' gestation). OUTCOME MEASURES: Sensory processing was assessed with the Test of Sensory Functions in Infants (TSFI). Motor and cognitive development was assessed with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). RESULTS: Preterm group was associated with significant decrease in TSFI's total (p < 0.01), reactivity to deep tactile pressure (p = 0.02) and vestibular stimulation reactivity (p = 0.03) scores. Bayley-III motor score was positive associated with TFSI score on ocular-motor control domain (p = 0.03). Bayley-III cognitive score and TSFI scores were not significantly associated. CONCLUSIONS: Prematurity negatively interferes with sensory processing, especially in tactile and vestibular domains, and better sensory processing in ocular-motor control contributes to better motor performance at 12 months of age. It is important to consider sensory processing in early developmental evaluation and interventions to promote better developmental outcomes in preterm infants.

BABY FRIENDLY HOSPITAL INITIATIVE: 25 YEARS OF EXPERIENCE IN BRAZIL.

OBJECTIVE: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. METHODS: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children's Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" and "breastfeeding". The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. RESULTS: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. CONCLUSIONS: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.

Association between hemodynamic activity and motor performance in six-month-old full-term and preterm infants: a functional near-infrared spectroscopy study.

This study aimed to assess task-induced activation in motor cortex and its association with motor performance in full-term and preterm born infants at six months old. A cross-sectional study of 73 six-month-old infants was conducted (35 full-term and 38 preterm infants). Motor performance was assessed using the Bayley Scales of Infant Development third edition-Bayley-III. Brain hemodynamic activity during motor task was measured by functional near-infrared spectroscopy (fNIRS). Motor performance was similar in full-term and preterm infants. However, differences in hemodynamic response were identified. Full terms showed a more homogeneous unilateral and contralateral activated area, whereas in preterm-born the activation response was predominantly bilateral. The full-term group also exhibited a shorter latency for the hemodynamic response than the preterm group. Hemodynamic activity in the left sensorimotor region was positively associated with motor performance measured by Bayley-III. The results highlight the adequacy of fNIRS to assess differences in task-induced activation in sensorimotor cortex between groups. The association between motor performance and the hemodynamic activity require further investigation and suggest that fNIRS can become a suitable auxiliary tool to investigate aspects of neural basis on early development of motor abilities.

SENSORY PROCESSING DURING CHILDHOOD IN PRETERM INFANTS: A SYSTEMATIC REVIEW. / PROCESSAMENTO SENSORIAL NO PERÍODO DA INFÂNCIA EM CRIANÇAS NASCIDAS PRÉ-TERMO: REVISÃO SISTEMÁTICA.

OBJECTIVE: To conduct a systematic search for grounded and quality evidence of sensory processing in preterm infants during childhood. DATA SOURCE: The search of the available literature on the theme was held in the following electronic databases: Medical Literature Analysis and Retrieval System Online (Medline)/PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs)/Virtual Library in Health (BVS), Índice Bibliográfico Español de Ciencias de la Salud (IBECS)/BVS, Scopus, and Web of Science. We included only original indexed studies with a quantitative approach, which were available in full text on digital media, published in Portuguese, English, or Spanish between 2005 and 2015, involving children aged 0-9years. DATA SYNTHESIS: 581 articles were identified and eight were included. Six studies (75%) found high frequency of dysfunction in sensory processing in preterm infants. The association of sensory processing with developmental outcomes was observed in three studies (37.5%). The association of sensory processing with neonatal characteristics was observed in five studies (62.5%), and the sensory processing results are often associated with gestational age, male gender, and white matter lesions. CONCLUSIONS: The current literature suggests that preterm birth affects the sensory processing, negatively. Gestational age, male gender, and white matter lesions appear as risk factors for sensoryprocessing disorders in preterm infants. The impairment in the ability to receivesensory inputs, to integrateand to adapt to them seems to have a negative effect on motor, cognitive, and language development of these children. We highlight the feasibility of identifying sensory processing disorders early in life, favoring early clinical interventions.

OBJETIVO: Buscar sistematicamente evidências fundamentadas e de qualidade sobre o processamento sensorial em crianças nascidas pré-termo no período da infância. FONTES DE DADOS: A busca da literatura disponível sobre o tema foi realizada nas bases de dados eletrônicas Sistema Online de Busca e Análise de Literatura Médica (Medline)/PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs)/Biblioteca Virtual em Saúde (BVS), Índice Bibliográfico Español de Ciencias de la Salud (IBECS)/BVS, Scopus e Web of Science. Foram incluídos estudos indexados, originais, quantitativos e disponíveis na íntegra em meio digital, publicados em português, inglês ou espanhol, entre 2005 e 2015, envolvendo crianças entre zero e 9 anos de idade. SÍNTESE DOS DADOS: A busca identificou 581 artigos, e oito foram incluídos conforme critérios de elegibilidade. Destes, seis estudos (75%) encontraram alta frequência de processamento sensorial alterado em crianças pré-termo. A associação entre processamento sensorial e desfechos de desenvolvimento foi observada em três estudos (37,5%). Verificou-se associação entre processamento sensorial e características neonatais em cinco estudos (62,5%). Os resultados de processamento sensorial frequentemente se associam a idade gestacional, sexo masculino e lesões da substância branca. CONCLUSÕES: Análise da literatura atual sugere que prematuridade tem impacto negativo no processamento sensorial. Idade gestacional, sexo masculino e lesões de substância branca aparecem como fatores de risco para alterações de processamento sensorial em crianças nascidas pré-termo. O prejuízo na capacidade de receber informações sensoriais, de integrar e de adaptar-se a elas parece interferir negativamente no desenvolvimento motor, cognitivo e de linguagem dessas crianças. Destaca-se a viabilidade da identificação das alterações de processamento sensorial nos primeiros anos de vida, favorecendo o encaminhamento precoce para intervenções clínicas.

Early Empiric Antibiotic Use Is Associated With Delayed Feeding Tolerance in Preterm Infants: A Retrospective Analysis.

The causative factors of neonatal feeding intolerance are poorly understood, but potentially related to clinical practices such as empiric antibiotic usage. The objective of this study was to evaluate whether early empiric antibiotic exposure negatively affects preterm infants' enteral feeding tolerance. Data from infants without risk factors for sepsis, 500 to 1499 g birth weight and 24 to 34 weeks gestational age were analyzed. The primary outcomes were the empiric antibiotic exposure effects on the infants' total parenteral nutrition usage duration and prevalence of necrotizing enterocolitis (NEC). Among the 901 infants included, 67 were exposed to early empiric antibiotic. A 50% increase in parenteral nutrition usage duration and a 4-fold greater prevalence of NEC was seen in the early empiric antibiotic-exposed neonates, when compared with control infants (P < 0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.

PROCESSAMENTO SENSORIAL NO PERÍODO DA INFÂNCIA EM CRIANÇAS NASCIDAS PRÉ-TERMO: REVISÃO SISTEMÁTICA / SENSORY PROCESSING DURING CHILDHOOD IN PRETERM INFANTS: A SYSTEMATIC REVIEW

RESUMO Objetivo: Buscar sistematicamente evidências fundamentadas e de qualidade sobre o processamento sensorial em crianças nascidas pré-termo no período da infância. Fontes de dados: A busca da literatura disponível sobre o tema foi realizada nas bases de dados eletrônicas Sistema Online de Busca e Análise de Literatura Médica (Medline)/PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs)/Biblioteca Virtual em Saúde (BVS), Índice Bibliográfico Español de Ciencias de la Salud (IBECS)/BVS, Scopus e Web of Science. Foram incluídos estudos indexados, originais, quantitativos e disponíveis na íntegra em meio digital, publicados em português, inglês ou espanhol, entre 2005 e 2015, envolvendo crianças entre zero e 9 anos de idade. Síntese dos dados: A busca identificou 581 artigos, e oito foram incluídos conforme critérios de elegibilidade. Destes, seis estudos (75%) encontraram alta frequência de processamento sensorial alterado em crianças pré-termo. A associação entre processamento sensorial e desfechos de desenvolvimento foi observada em três estudos (37,5%). Verificou-se associação entre processamento sensorial e características neonatais em cinco estudos (62,5%). Os resultados de processamento sensorial frequentemente se associam a idade gestacional, sexo masculino e lesões da substância branca. Conclusões: Análise da literatura atual sugere que prematuridade tem impacto negativo no processamento sensorial. Idade gestacional, sexo masculino e lesões de substância branca aparecem como fatores de risco para alterações de processamento sensorial em crianças nascidas pré-termo. O prejuízo na capacidade de receber informações sensoriais, de integrar e de adaptar-se a elas parece interferir negativamente no desenvolvimento motor, cognitivo e de linguagem dessas crianças. Destaca-se a viabilidade da identificação das alterações de processamento sensorial nos primeiros anos de vida, favorecendo o encaminhamento precoce para intervenções clínicas.

ABSTRACT Objective: To conduct a systematic search for grounded and quality evidence of sensory processing in preterm infants during childhood. Data source: The search of the available literature on the theme was held in the following electronic databases: Medical Literature Analysis and Retrieval System Online (Medline)/PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs)/Virtual Library in Health (BVS), Índice Bibliográfico Español de Ciencias de la Salud (IBECS)/BVS, Scopus, and Web of Science. We included only original indexed studies with a quantitative approach, which were available in full text on digital media, published in Portuguese, English, or Spanish between 2005 and 2015, involving children aged 0-9years. Data synthesis: 581 articles were identified and eight were included. Six studies (75%) found high frequency of dysfunction in sensory processing in preterm infants. The association of sensory processing with developmental outcomes was observed in three studies (37.5%). The association of sensory processing with neonatal characteristics was observed in five studies (62.5%), and the sensory processing results are often associated with gestational age, male gender, and white matter lesions. Conclusions: The current literature suggests that preterm birth affects the sensory processing, negatively. Gestational age, male gender, and white matter lesions appear as risk factors for sensoryprocessing disorders in preterm infants. The impairment in the ability to receivesensory inputs, to integrateand to adapt to them seems to have a negative effect on motor, cognitive, and language development of these children. We highlight the feasibility of identifying sensory processing disorders early in life, favoring early clinical interventions.

Rede de doação de leite humano: integração de unidades básicas de saúde, atenção secundária e banco de leite humano / Network of Human Milk Donation: An integration of health primary care, health secondary care and Human Milk Bank

Objetivo: Estudo inovador onde são relatadas as estratégias e resultados da formação de uma rede integrada de um Serviço de Apoio ao Aleitamento Materno e Posto de Coleta de Leite Humano ambulatorial, alocados em uma Unidade de Referência Secundária de Especialidade Pediátrica, em parceria com Unidades Básicas de Saúde. Métodos: Estudo restrospectivo com análise dos dados de doadoras e da qualidade do leite recebido pelo Banco de Leite Humano de referência. Antecedendo à coleta de leite humano doado, oficinas de quatro horas de duração, com referencial teórico da educação crítico-reflexiva foram utilizadas para capacitação dos profissionais. Abordou-se o acolhimento da gestante e puérpera na orientação sobre a amamentação e doação de leite humano. O processo de coleta, armazenamento e transporte seguiu as normas préestabelecidas do Banco de Leite Humano de Referência. Resultados: O volume de LH doado foi de 5,27% do volume total captado pelo Banco de Leite de Referência entre Janeiro de 2009 e Dezembro de 2015. A perda total foi de 19,18% sendo a acidez da amostra a maior causa. Conclusão: Até o momento, não há registro de Posto de Coleta de Leite Humano em unidades secundárias de acordo com a Rede Brasileira de Bancos de Leite do Brasil. Esta estratégia mostrou-se promissora na captação do leite humano doado e pode reduzir a necessidade de criar uma infraestrutura de postos de coleta em Unidades Básicas de Saúde. (AU)

Objective: Innovative study in which the strategies and results of the formation of an integrated network of a Breastfeeding Support Service and an ambulatory Human Milk Collection Center, allocated in a Pediatric Specialty Secondary Reference Unit in partnership with Basic Health Units, are reported. Methods: Retrospective study with analysis of donor data and the quality of the milk received by the Reference Human Milk Bank. Preceding the donated human milk collection, four-hour-long workshops with a theoretical outline of critical-reflexive education were presented to capacitate professionals. The reception of pregnant and puerperal women in the guidance on breastfeeding and donation of human milk was approached. The collection, storage and transportation process followed the pre-established norms of the Reference Human Milk Bank. Results: The quantity of donated human milk was 5.27% of the total amount collected by the Reference Human Milk Bank between January 2009 and December 2015. Total loss was 19.18%, the major cause being the acidity of the sample. Conclusion: To date, there is no record of a Human Milk Collection Center in secondary units, according to the Brazilian Network of Milk Banks of Brazil. This strategy has shown promise in collecting donated human milk. It may also reduce the need to build an infrastructure of collection centers in Basic Health Units. (AU)

Use of unlicensed and off-label drugs in neonates in a Brazilian university hospital

ABSTRACT This study was designed to investigate the use of off-label and unlicensed drugs in a Neonatal Care Unit (NCU) and to compare the frequency of use of off-label drugs according to the drug regulatory agencies in Brazil (Agência Nacional de Vigilância Sanitária-ANVISA) and the United States Food and Drug Administration (FDA). A prospective observational study was carried out in the NCU. Prescriptions were classified as off-label and unlicensed using both ANVISA and FDA criteria. A total of 157 newborns and 1187 prescriptions were analyzed. The most prescribed drug was fentanyl (9.3%), followed by multivitamin (8.4%) and gentamicin (7.9%). According to ANVISA criteria, there were 665 (56.0%) off-label prescriptions and 86 (7.2%) unlicensed prescriptions and 95.5% of newborns received at least one drug off-label. By contrast, according to FDA criteria, there were 592 (49.9%) off-label prescriptions and 84 (7.1%) unlicensed prescriptions, and 72.0% of newborns received at least one drug off-label. The off-label use of drugs registered by ANVISA differed significantly from that of drugs registered by the FDA. There was a high frequency of off-label and unlicensed drug use in the investigated NCU, and there was an inverse relationship between off-label and unlicensed usage and the gestational age of the newborns.

Factors Associated with Nipple Lesions in Puerperae.

This retrospective cross-sectional study aimed to evaluate the factors associated with nipple lesion development in puerperae. Analyses were performed using the Poisson regression with robust variance. The level of significance was set at 5% (p < 0.05). We evaluated 1270 puerperae, among whom 193 (15.4%) presented with nipple lesions. The condition was more prevalent among the mothers who did not receive information about breastfeeding [PR, 1.69; 95% confidence interval (CI), 1.19-2.42], those who underwent cesarean delivery (PR, 1.48; 95% CI, 1.02-2.16), those who used a pacifier (prevalence ratios (PR), 2.04; 95% CI, 1.05-3.95), those who used baby formula only (PR, 1.61; 95% CI, 4.82-5.36) and those who used baby formula combined with breastfeeding (PR, 1.61; 95% CI, 1.06-2.45). A lower incidence of nipple lesions was observed among those who did not receive information on hand expression of breast milk (PR, 0.65; 95% CI, 0.46-0.93) and those who did not breastfeed in the first hour of life (PR, 0.61; 95% CI, 0.38-0.97).

Near-infrared spectroscopy as an auxiliary tool in the study of child development / Espectroscopia de luz próxima ao infravermelho como ferramenta auxiliar no estudo do desenvolvimento infantil

OBJECTIVE: To investigate the applicability of Near-Infrared Spectroscopy (NIRS) for cortical hemodynamic assessment tool as an aid in the study of child development. DATA SOURCE: Search was conducted in the PubMed and Lilacs databases using the following keywords: ''psychomotor performance/child development/growth and development/neurodevelopment/spectroscopy/near-infrared'' and their equivalents in Portuguese and Spanish. The review was performed according to criteria established by Cochrane and search was limited to 2003 to 2013. English, Portuguese and Spanish were included in the search. DATA SYNTHESIS: Of the 484 articles, 19 were selected: 17 cross-sectional and two longitudinal studies, published in non-Brazilian journals. The analyzed articles were grouped in functional and non-functional studies of child development. Functional studies addressed the object processing, social skills development, language and cognitive development. Non-functional studies discussed the relationship between cerebral oxygen saturation and neurological outcomes, and the comparison between the cortical hemodynamic response of preterm and term newborns. CONCLUSIONS: NIRS has become an increasingly feasible alternative and a potentially useful technique for studying functional activity of the infant brain.

OBJETIVO: Investigar a aplicabilidade da espectroscopia de luz próxima ao infravermelho (NIRS) para avaliação da hemodinâmica cortical como ferramenta auxiliar no estudo do desenvolvimento infantil. FONTES DE DADOS: Revisão integrativa de literatura feita nas bases de dados PubMed e Lilacs, a partir da combinação das palavras-chave: "psychomotor performance/child development/growth and development/neurodevelopment/NIRS/spectroscopy/near-infrared" e seus correspondentes em português e espanhol. A pesquisa seguiu protocolo adaptado dos critérios estabelecidos pela Cochrane e teve como limite temporal de 2003 a 2013. Foram incluídas publicações nos idiomas inglês, português e espanhol. SÍNTESE DOS DADOS: Foram localizados 484 artigos, dos quais 19 foram selecionados, 17 transversais e dois longitudinais, todos publicados em periódicos estrangeiros. A análise dos artigos permitiu agrupá-los, quanto à sua abordagem, em estudos funcionais e estudos não funcionais do desenvolvimento infantil. Os estudos funcionais abordaram o processamento de objetos e o desenvolvimento de habilidades sociais, da linguagem e cognitivo. Os estudos não funcionais discutiram a relação entre a saturação de oxigênio cerebral e o desfecho neurológico e a comparação entre a resposta hemodinâmica cortical de recém-nascidos prematuros e a termo. CONCLUSÕES: A NIRS se torna, cada vez mais, uma opção viável e uma técnica potencialmente útil para estudos de atividade funcional do cérebro infantil.

Drug utilisation profile in the neonatal unit of a university hospital: a prospective observational study in Brazil.

BACKGROUND: Advances in neonatology have contributed to changes in the drug utilisation profile in neonates, both in the number of drugs and the pharmacotherapeutic groups. OBJECTIVE: To analyse drug use in the neonatal care unit of a teaching hospital in Brazil and to evaluate the associations among perinatal, clinical care and drug use data. SETTING: The neonatal care unit of a teaching hospital in Brazil. METHODS: A prospective observational study was conducted. Perinatal, clinical care and pharmacotherapy data were collected from the patients' medical records. Labelling information regarding neonatal use was analysed for prescribed drugs. The data were analysed using univariate descriptive statistics and quasi-Poisson regression. MAIN OUTCOME MEASURE: Frequency of drug use by gestational age. RESULTS: The study included 187 patients; 157 (84.0 %) received drugs. The mean gestational age was 35.8 weeks. The mean number of drugs prescribed per patient was 6.4. The number of drugs used was inversely correlated to gestational age and birth weight. The most commonly prescribed drugs belonged to the following anatomical therapeutic chemical groups: nervous system drugs, anti-infectives for systemic use, and alimentary tract and metabolism drugs. Information regarding neonatal use was given in the labelling of only 20.5 % of the prescribed drugs. Of these, only 9.5 % had information specific for preterm infants. CONCLUSIONS: Drug administration to neonates is frequently and inversely correlated to gestational age and birth weight. Neonates are exposed to different therapeutic classes, reflecting scientific advances in neonatology. In Brazil, the percentage of drugs with neonate-specific labelling information is low. Consequently, there is an evident need for efforts to guarantee effective and safe pharmacotherapy for neonates.

Preterm newborn readiness for oral feeding: systematic review and meta-analysis.

PURPOSE: To identify and systematize the main studies on the transition from enteral to oral feeding in preterm infants. RESEARCH STRATEGY: Articles that describe the transition from oral to enteral feeding in preterm infants were located in MEDLINE, LILACS, and SciELO databases. SELECTION CRITERIA: Original studies, with available abstract, published in the last 10 years were included. DATA ANALYSIS: Analysis of the methodology and the main results of the studies, and meta-analysis of the effects of sensory-motor-oral stimulation at the time of transition to full oral feeding and duration of hospitalization were conducted. RESULTS: Twenty-nine national and international publications were considered. Most studies were clinical trials (44.8%) and did not use rating scales to start the transition process (82.7%). In the meta-analysis, positive effect of stimulation of the sensory-motor-oral system was observed with respect to the transition time to oral diet (p=0.0000), but not in relation to the length of hospital stay (p=0.09). However, heterogeneity between studies was found both in the analysis of the transition time to full oral feeding (I2=93.98) and in the length of hospital stay (I2=82.30). CONCLUSION: The transition to oral feeding is an important moment, and various physical and clinical characteristics of preterm infants have been used to describe this process. Despite the impossibility of generalizing the results due to the heterogeneity of the studies, we have noted the importance of strategies for stimulation of sensory-motor-oral system to decrease the period of transition to full oral feeding system.

[Near-infrared spectroscopy as an auxiliary tool in the study of child development]. / Espectroscopia de luz próxima ao infravermelho como ferramenta auxiliar no estudo do desenvolvimento infantil.

OBJECTIVE: To investigate the applicability of Near-Infrared Spectroscopy (NIRS) for cortical hemodynamic assessment tool as an aid in the study of child development. DATA SOURCE: Search was conducted in the PubMed and Lilacs databases using the following keywords: "psychomotor performance/child development/growth and development/neurodevelopment/spectroscopy/near-infrared" and their equivalents in Portuguese and Spanish. The review was performed according to criteria established by Cochrane and search was limited to 2003 to 2013. English, Portuguese and Spanish were included in the search. DATA SYNTHESIS: Of the 484 articles, 19 were selected: 17 cross-sectional and two longitudinal studies, published in non-Brazilian journals. The analyzed articles were grouped in functional and non-functional studies of child development. Functional studies addressed the object processing, social skills development, language and cognitive development. Non-functional studies discussed the relationship between cerebral oxygen saturation and neurological outcomes, and the comparison between the cortical hemodynamic response of preterm and term newborns. CONCLUSIONS: NIRS has become an increasingly feasible alternative and a potentially useful technique for studying functional activity of the infant brain.