Restrictive guideline reduces platelet count thresholds for transfusions in very low birth weight preterm infants.

BACKGROUND AND OBJECTIVES: Platelet transfusions are performed almost entirely according to expert experience. This study assessed the effectiveness of a restrictive guideline to reduce platelet transfusions in preterm infants. METHODS: A retrospective cohort of preterm infants with a birth weight of <1500 g had been born in 2 periods. In Period 1, a transfusion was indicated for a platelet count of <50,000/ml in clinically stable neonates or <100,000/ml in bleeding or clinically unstable infants. In Period 2, the indications were restricted to <25,000/ml in clinically stable neonates, or <50,000/ml in newborns who were either on mechanical ventilation, subject to imminent invasive procedures, within 72 h following a seizure, or extremely premature and <7 days old. A count of <100,000/ml was indicated for bleeding or major surgery. RESULTS: Periods 1 and 2 comprised 121 and 134 neonates, respectively. The rates of ventricular haemorrhage and intrahospital death were similar in both periods. The percentage of transfused infants, the odds of receiving a platelet transfusion, the mean platelet count before transfusion and the percentage of transfusions with a platelet count >50,000/ml were greater in Period 1. Among thrombocytopenic neonates, the percentage of transfused neonates and the number of transfusions were similar in both groups. CONCLUSION: The restrictive guideline for platelet transfusions reduced the platelet count thresholds for neonatal transfusions without increasing the rate of ventricular haemorrhage.

A very strict guideline reduces the number of erythrocyte transfusions in preterm infants.

BACKGROUND AND OBJECTIVES: Benefits of adopting restrictive guidelines for erythrocyte transfusions are still controversial. The objective of this study was to verify if a very strict guideline could reduce erythrocyte transfusions in preterm infants without adverse outcomes. MATERIALS AND METHODS: Two prospective cohorts of neonates with gestational age < 37 weeks and birth weight < 1500 g were studied. Neonates born in Period 1 were submitted to a strict guideline for erythrocyte transfusions. In Period 2, a new stricter protocol was introduced. Infants of both periods were compared regarding number of transfusions and clinical outcome. RESULTS: The median number of transfusions decreased from 2 (1 to 14) in Period 1 to 1 (1-9), P = 0.001, in Period 2. The linear regression multivariate analysis showed that the implementation of the stricter guideline was associated with a reduction in the number of transfusions received by patients by 0.55 (95% confidence interval: -0.08; -1.02) units/patients. Number of apnea episodes, weight at 28 days of life and days of hospital stay were similar in both periods. Intra-hospital death was lower in Period 2. CONCLUSION: A very strict guideline reduced the number of erythrocyte transfusions in preterm infants, without threatening their clinical course.

Transfusions of CPDA-1 red blood cells stored for up to 28 days decrease donor exposures in very low-birth-weight premature infants.

The goal of this research was to study the safety and the efficacy of transfusing citrate-phosphate-adenine anticoagulant-preservative (CPDA-1) RBC stored for up to 28 days to reduce donor exposures in premature infants. A prospective randomized two-group study was conducted with very low-birth-weight premature infants that received at least one RBC transfusion during hospital stay. Neonates randomly assigned to Group 1 (26 infants) were transfused with CPDA-1 RBC stored for up to 28 days; those assigned to Group 2 (26 infants) received CPDA-1 RBC stored for up to 3 days. Demographic and transfusion-related data were collected. Neonates from both groups showed similar demographics and clinical characteristics. The number of transfusions per infant transfused was 4.4 +/- 4.0 in Group 1 and 4.2 +/- 3.1 in Group 2, and the number of donors per infant transfused was 1.5 +/- 0.8 (Group 1) and 4.3 +/- 3.4 (Group 2), P < 0.001. RBC transfusions containing 29.7 +/- 18.3 mmol L(-1) of potassium (RBC stored for up to 28 days) did not cause clinical or biochemical changes and reduced donor exposures by 70.2%, compared to transfusions containing 19.8 +/- 12.3 mmol L(-1) of potassium (RBC stored for up to 3 days), P < 0.001. In conclusion, RBC stored for up to 28 days safely reduced donor exposures in premature infants.

Strict red blood cell transfusion guideline reduces the need for transfusions in very-low-birthweight infants in the first 4 weeks of life: a multicentre trial.

BACKGROUND AND OBJECTIVES: Very-low-birthweight infants are among the most heavily transfused patients. The objective of this study was to verify if the introduction of a strict guideline would reduce the need for red blood cell transfusions in the first 4 weeks of life in these neonates. MATERIALS AND METHODS: This was a multicentre prospective study of two cohorts of very-low-birthweight infants transfused in accordance with the recommendations of a neonatologist (Phase 1) or according to previously published guidelines (Phase 2). RESULTS: In the first 28 days of life, 102 patients (68.5%) in Phase 1 and 117 (59.7%) in Phase 2 were transfused. The number of transfusions was 1.9 +/- 2.0 in Phase 1 and 1.4 +/- 1.6 in Phase 2 (P = 0.01). After adjusting for gestational age, blood loss and the presence of respiratory distress syndrome, the strict guideline reduced the number of transfusions in 17.6% (IC 95%-30.5% to -2.6%). CONCLUSIONS: The strict guideline was effective in reducing erythrocyte transfusions in very-low-birthweight infants.

Neonatal late-onset bloodstream infection: attributable mortality, excess of length of stay and risk factors.

BACKGROUND: Bloodstream infection represents a major threat among neonates under intensive care with considerable impact on morbidity and mortality. This study evaluated extra stay, attributable mortality and the risk factors associated with late-onset bloodstream infection (LO-BSI) among neonates admitted to a neonatal intensive care unit during a 4-year period. METHODS: A retrospective matched cohort study was conducted. For each case, there was one control patient without LO-BSI matched for sex, birth weight, gestational age, duration of hospitalization prior to the date of LO-BSI in the respective cases, underlying illness and birth date. A novel test, sequential plan, was employed for attributable mortality analysis in addition to standard tests. Multiple logistic regression was employed for risk factor analysis. RESULTS: Fifty pairs of cases and controls were compared. LO-BSI prolonged hospital stay of 25.1 days in pairs where both subjects survived. Overall attributable mortality was 24% (95% CI: 9-39% p < 0.01) and specific attributable mortality due to Staphylococcus epidermidis was 26.7% (95% CI: 23-30.4%; p = 0.01). Blood and/or blood components transfusion was independently associated with neonatal LO-BSI (OR: 21.2; 95% CI: 1.1-423). CONCLUSIONS: LO-BSI infection prolongs hospital stay and is associated with increased mortality among neonates. In the present series, blood transfusion was a significant risk factor for LO-BSI.

Dosagem do fator natriurético atrial em pacientes pediátricos submetidos à ventilaçäo pulmonar mecânica / Dosage of atrial natriuretic peptide in pediatric patients submitted to mechanical ventilation

OBJETIVOS: Os objetivos deste trabalho foram verificar se existe alteraçäo na secreçäo do fator natriurético atrial (FNA) em crianças submetidas à ventilaçäo pulmonar mecânica e se essas possíveis alterações levariam à modificações no débito urinário e na excreçäo urinária de sódio. METODOLOGIA: Estudo prospectivo, realizado em uma Unidade de Cuidados Intensivos Pediátricos Terciária, em nove crianças submetidas à ventilaçäo pulmonar mecânica para recuperaçäo anestésica, exceto em uma que sofreu traumatismo cranioencefálico näo-cirúrgico. O período de estudo foi de Setembro de 1995 a Março de 1996. Aguardava-se pelo menos três horas do início da ventilaçäo pulmonar mecânica e entäo colhia-se amostra de sangue para dosagem de fator natriurético atrial, gasometria arterial, glicemia, creatinina e eletrólitos. Coletava-se ainda urina durante 6 horas para a verificaçäo do débito urinário e da concentraçäo de sódio. Depois da extubaçäo, aguardava-se por um período de 15 a 30 minutos e colhia-se sangue e urina para as mesmas dosagens realizadas anteriormente. A comparaçäo estatística foi feita pelo teste näo-paramétrico de Wilcoxon Signed Rank, sendo o nível de significância de 0,05. RESULTADOS: O fator natriurético atrial mostrou uma tendência ao aumento quando a ventilaçäo pulmonar mecânica foi retirada (p= 0,0547). O débito urinário e a natriurese näo se alteraram com a ventilaçäo pulmonar mecânica. CONCLUSÕES: A tendência ao aumento do fator natriuretico atrial ocorreu provavelmente por diminuiçäo da pressäo intratorácica. A reposiçäo volêmica no trans-operatório pode ter influenciado no débito urinário e na natriurese. Em pacientes submetidos à ventilaçäo pulmonar mecânica por períodos prolongados, com altos parâmetros de pressäo inspiratória e pressäo expiratória final positiva, seria interessante a dosagem do fator natriurético atrial e se esse se encontrasse diminuído, seria uma indicaçäo para o seu uso

[Airway pressure release in postoperative cardiac surgery in pediatric patients]. / Liberação de pressão de vias aéreas em pacientes pediátricos submetidos à cirurgia cardíaca.

OBJECTIVE: Comparison of three modes of MV: intermittent mandatory ventilation with positive end expiratory pressure (IMV + PEEP), APRV and continuous positive airway pressure (CPAP) in children during cardiac surgery post operative with pulmonary hypertension and mild or moderate pulmonary lesion. METHODS: Ten patients were studied with respiratory monitoring (Bear Neonatal Volume Monitor-1) in MV with a continuous flow, time cycled and pressure limited ventilator. The cardiocirculatory variables analyzed were central venous pressure (CVP), oxygen extraction ratio, cardiac rate, systolic arterial pressure, and arterial-mixed venous CO2 difference. Friedman's test (nonparametric) was used to compare the variables in three modalities of ventilation and the Wilcoxon test was used for the variables obtained in two of the modalities. RESULTS: The mean airway pressure (MAP) showed a significant increasing during APRV compared to IMV + PEEP (p = 0.012). The positive inspiratory pressure (PIP), the minute volume and the ratio of oxygen arterial pressure to oxygen inspired fraction (PaO2/FiO2) didn't show statistical difference. During APRV there was a significant decrease in respiratory rate (p = 0.004) and an increase in tidal volume (p = 0.045) when compared to CPAP and IMV + PEEP. In the cardiocirculatory system only CVP showed a significant increased (p = 0.019) during APRV. CONCLUSION: Due to the methodology utilized MAP was higher with APRV resulting in an increased tidal volume without respiratory or cardiocirculatory adverse effects when the three modes were compared. Our results suggest that APRV is a simple and safe method of ventilation.

The recognition of facial expression of pain in full-term newborns by parents and health professionals.

OBJECTIVE: To determine whether adults can recognize neonatal facial expression of pain. DESIGN: A cross-sectional study. SETTING: Neonatal intensive care unit, nursery, and outpatient clinic of one university hospital and one private hospital in São Paulo, Brazil. PATIENTS: Four hundred five adults divided into 2 groups: health and nonhealth professionals. INTERVENTION: The faces of 3 healthy full-term newborns who needed glucose screening were photographed at rest and during light exposure, heel rubbing, and heel puncture. A series of adults answered a questionnaire on personal and professional data and then they analyzed for 1 minute each of the 3 sets of pictures to answer the following question: "In which picture of this set do you think that the baby is feeling pain?" MAIN OUTCOME MEASURE: Number of correct answers for the 3 sets of photographs shown to the adults. RESULTS: Seventy-four percent of the health professionals and 86% of the nonhealth professionals indicated correctly the picture with facial expressions of pain in at least 2 of the 3 sets. Regarding which picture was picked out by the interviewee, 94% of the health professionals and 92% of the nonhealth professionals indicated the picture taken during the heel puncture in set 1. The same observation was made by 53% and 54% of the health professional and by 68% and 66% of the nonhealth professional interviewees for sets 2 and 3, respectively. CONCLUSIONS: Facial expression of pain represents an effective neonatal communication tool. However, the health professional group achieved a lower level of recognition of neonatal facial expressions of pain. Factors related to the personal and professional characteristics of the adults interviewed probably contributed to this result.

Liberaçäo de pressäo de vias aéreas em pacientes pediátricos submetidos à cirurgia cardíaca / Airway pressure release in postoperative cardiac surgery in pediatric patients

OBJETIVO: Comparar três modos de VPM, a ventilação mandatória intermitente com pressão expiratória positiva (VMI+PEEP), a VLPVA e a utilização de pressão positiva contínua em vias aéreas (CPAP) em crianças no pós-operatório de cirurgia cardíaca com hipertensão pulmonar e lesão pulmonar leve ou moderada. MÉTODOS: Estudados 10 pacientes com monitorização respiratória (Bear Neonatal Volume Monitor-1Ò), em VPM com aparelho de fluxo contínuo, ciclado a tempo e limitado a pressão. As variáveis cardiocirculatórias analisadas foram a pressão venosa central (PVC), extração de oxigênio (ExtO2), freqüência cardíaca (FC), pressão arterial sistólica (PAS), pressão arterial média (PAM) e a diferença artério-venosa de CO2 (D(A-V)CO2). Utilizou-se o teste não-paramétrico de Friedman para comparar as variáveis aferidas nas três modalidades de ventilação e o teste de Wilcoxon para a comparação das variáveis obtidas em duas das modalidades. RESULTADOS: A pressão média de vias aéreas (PMVA) apresentou um aumento significante durante a VLPVA em relação à VMI+PEEP (p=0,012). A pressão inspiratória positiva (PIP), o volume minuto e a relação da pressão arterial de O2 com a fração inspirada de O2 (PaO2/FiO2) não mostraram diferença estatística. Houve uma diminuição da freqüência respiratória (FR) na VLPVA (p=0,004) e um aumento do volume corrente (VC) (p=0,045) comparativamente aos outros dois modos de ventilação. A PVC foi a única variável cardiocirculatória que apresentou alteração mostrando ser maior (p=0,019) na VLPVA. CONCLUSÕES: Devido à metodologia empregada, houve um aumento significativo da PMVA na VLPVA, com conseqüente aumento do VC e manutenção das outras variáveis respiratórias e cardiocirculatórias quando comparados os três modos de VPM, indicando ser a VLPVA um método seguro e de fácil aplicação.

Differences in pain expression between male and female newborn infants.

The study of neonatal gender differences in pain expression is important since neonatal pain behavior occurs prior to any learned reaction pattern. The objective of this study was to verify the presence of gender differences in pain expression in preterm and term newborn infants. Sixty-five consecutive neonates (37 female and 28 male infants) with gestational age between 28 and 42 weeks and with 25-120 h of life were studied. Healthy term neonates required a capillary puncture for PKU screening and clinically stable premature infants needed a capillary puncture for glucose dosage. The Neonatal Facial Coding System (NFCS) and the Neonatal Infant Pain Scale (NIPS) were evaluated at bedside prior to the puncture, when patients were at rest, during foot heating; during capillary puncture; and at 1, 3, and 5 min after heel lancing. Results were analyzed by repeated-measures ANOVA followed by the Multiple Comparison Method of Bonferroni. A significant difference among the mean NFCS scores during the six study periods was noted for the whole group of neonates (P<0.000001). Also, a significant interaction between the NFCS score profile in female and male neonates at the different study periods was observed (P=0.025). Regarding NIPS, ANOVA showed only a significant difference among the mean NIPS scores during the six study periods for the whole group of neonates (P<0.000001). No significant interactions between gestational age and time, nor between gestational age and gender were noted, for both NFCS and NIPS. In conclusion, recently born female neonates of all gestational ages expressed more facial features of pain than male infants, during the capillary puncture and 1 min afterwards. Maybe differences in pain processing and/or pain expression among genders may explain this finding.

[Dosage of atrial natriuretic peptide in pediatric patients submitted to mechanical ventilation]. / Dosagem do fator natriurético atrial em pacientes pediátricos submetidos à ventilação pulmonar mecânica.

OBJECTIVE: The aims of this article are to verify if there is any alteration in the secretion of natriuretic atrial factor (NAF) in children submitted to mechanical pulmonary ventilation and if these possible alterations would lead to modification in the urinary volume and in the urinary sodium excretion. METHODOLOGY: A prospective study in a tertiary pediatric intensive care unit, nine children submitted to mechanical pulmonary ventilation for recuperation from anesthetics, except one who suffered a not surgical cranioencephalic trauma. The period of the study was from September 1995 to March 1996. Patients with renal pathology, pulmonary pathology, in use of diuretics until 24 hours before the collection of laboratory dosages, hemodynamic instability in need of vasoactive and inothropic agents, and patients with alterations of sodium blood levels were excluded from this work. In order to have an adequate alveolar recruitment at least 3 hours were taken. After this period a blood sample was collected for dosage of natriuretic atrial factor, arterial gas analysis, glucose analysis, creatinine and electrolytes dosage. Urine was collected in a 6 hours interval during the patient's period under mechanical pulmonary ventilation in order to verify the urinary volume and urinary sodium excretion. Fifteen to thirty minutes after extubation, blood an urine were collected for the same dosages done before. Urine was collected in a 6 hour period. A statistical comparison was done by the non parametric test of Wilcoxon signed rank, with a significance level of 0,05. RESULTS: The natriuretic atrial factor showed tendency to increase when mechanical pulmonary ventilation was taken away (p=0,0547). The urinary volume and natriuresis were not altered by mechanical pulmonary ventilation.

Validity of behavioral and physiologic parameters for acute pain assessment of term newborn infants.

CONTEXT: The subjectivity of pain causes enormous difficulties in evaluating neonatal pain with a single, practical and easy-to-apply tool. Pain evaluation in the neonatal period should be performed by valid, safe, useful and feasible methods. OBJECTIVE: To evaluate the validity of the Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS), heart rate (HR) and O2 saturation (O2 sat) for neonatal pain assessment. DESIGN: Prospective, double-blind randomized trial. SETTING: A secondary level maternity hospital. PARTICIPANTS: 70 healthy neonates requiring bilirubin dosage were randomly assigned to receive a venous puncture (P: n = 33, BW 3.2 kg, SD 0.6; GA 39 wk, SD 1; 59 h of life, SD 25) or an alcohol swab friction (F: n = 37; BW 3.1 kg, SD 0.5; GA 39 wk, SD 1; 52 h of life, SD 17). INTERVENTION: All measurements were taken prior to (PRE), during (TO), and 1 (T1), 3(T3), 5(T5) and 10(T10) minutes after the procedure. MEASUREMENTS: A neonatologist evaluated NFCS, NIPS, HR and O2 sat by pulse oxymetry. RESULTS: Median NFCS and NIPS results at T0, T1 and T3 were higher in P group, compared to F. More P neonates presented NFCS > 2 and/or NIPS > 3 at T0, T1 and T3. HR was lower in P group at T1. Average O2 sat was above 90% during the whole study period in both groups. CONCLUSION: NFCS and NIPS are suitable instruments for neonatal pain evaluation. Heart rate and O2 saturation can be used only as auxiliary methods.

[Effect of malnutrition and chronic use of nicotine during pregnancy on lung phospholipid concentration in neonate rats] / Efeito da desnutrição e do uso crônico de nicotina durante a gestação sobre a concentração de fosfolipídios pulmonares em ratos recém-nascidos.

OBJECTIVE: The aim of the present study was to determine whether lung phospholipid concentration is affected in neonate rats "Wistar EPM-1" following a continuous 21-day gestational exposure to nicotine. METHODS: Eighty rats "Wistar EPM-1" were randomly divided in four control (diet free and water "ad libitum") groups (10 rats each): 1 - Control, 2 - Physiologic Solution (infused with 0.15ml of NaCl 0.9%), 3 - Nicotine 1 (infused with 900 micro g/kg/day of nicotine bitartrate 95%), and 4 - Nicotine 2 (infused with 2.700 micro g/kg/day of nicotine bitartrate 95%), and four undernourished (diet 13g/day and water ad libitum) groups (10 rats each), that received the same kind of treatment as the control groups. The infusion of nicotine was subcutaneous. The offspring were divided in eight groups according to their origin. RESULTS: A significant high lung phospholipid concentration was observed in the non-undernourished nicotized group which was injected with a high dose of nicotine. In the other groups, there was no alteration in that concentration. CONCLUSION: We conclude that gestational exposure to nicotine increases lung phospholipid concentration in neonate rats, and that the nutritional state also influences this lung phospholipid concentration.

Physiological, hormonal, and behavioral responses to a single fentanyl dose in intubated and ventilated preterm neonates.

OBJECTIVE: To study the responses of ventilated preterm neonates to a single dose of opioid. STUDY DESIGN: In a randomized, double-blind, controlled trial, 22 mechanically ventilated preterm infants (< or = 32 weeks) were observed before medication and at 30 and 60 minutes after administration of fentanyl (3 micrograms/kg) or placebo. Heart rate, blood pressure, arterial blood gases, ventilator settings, and behavioral measures (Neonatal Facial Coding System and Modified Postoperative Comfort Score) were recorded during each period. Blood cortisol, growth hormone, glucose, and lactate were measured before and at 60 minutes after analgesia. Behavioral measures were assessed at the bedside and from video films recorded during each observation period. RESULTS: Patients presented high basal levels of cortisol, growth hormone, and lactate. Behavioral scales indicated the presence of pain before any medication. In the fentanyl group, the maximum and minimum heart rate decreased and growth hormone level increased after analgesia. At the video analysis of behavioral measures, postoperative comfort score increased and neonatal facial coding system score decreased in the fentanyl group. CONCLUSION: Single doses of fentanyl analgesia can reduce the physiologic/behavioral measures of pain and stress associated with mechanical ventilation in preterm infants.

[Preterm neonates treated in intensive care units: development of interaction behavior in the first year of life] / Recém-nascidos pré-termo internados em unidade de terapia intensiva: desenvolvimento da conduta interativa no primeiro ano de vida.

OBJECTIVE: The aim of this research was to characterize the interaction during the first year of preterm infants whose weight was lower than 2000g and who had been in neonatal intensive care units for at least 10 days. METHOD: Fifty-three infants were observed during a year, twenty-one being boys and thirty-two girls. These infants were assessed regarding seventeen kinds of behavior which we considered important in person to person relationship, i.e., behavior which led to interaction or maintained it. In our analysis we considered the age at which the child was seen, sex, weight at birth, new born classification, time of hospitalization and neurological diagnosis.RESULTS: An analysis of the results showed that there was an evolution in the way preterm infants interacted although the progress was smaller than the one of their pair terms. The occurrence of communicative behavior was not affected by sex, weight at birth or newborn classification (adequate or small for gestational age). The postnatal time of hospitalization affected the occurrence of the behavior smiles to the reflected image in mirror. The infants diagnosed as being neurologically impaired showed a statistically significant smaller occurrence of behaviors: respond to smiles and speech by smiling, play peek-a-boo, protest at mothers departure, point to desired objects and carry out given orders. CONCLUSIONS: The infants diagnosed as having neurological disabilities showed a delay in more complex forms of interaction. The infants with more than 35 days of hospitalization showed alteration in the self-body construction, related to personality build up.

[Auto-PEEP effects on respiratory mechanics and blood gases in mechanically ventilated patients] / Importância da auto-PEEP sobre a mecânica respiratória e gases arteriais em pacientes submetidos a ventilação pulmonar mecânica.

OBJECTIVE: The purpose of this study was to examine the auto-PEEP incidence and magnitude and the relationship between its reductions and changes in respiratory mechanics and gas exchanges in mechanically ventilated patients addmited in an Intensive Care Unit.METHODS: A prospective study was conducted in seventeen infants undergoing mechanical ventilation due to respiratory or neuromuscular diseases. We have measured blood gases, mean airway pressure, tidal volume, compliance, resistance and time constants of the respiratory system and monitored pressure, flow and volume waveforms and pressure-volume and flow-volume loops.RESULTS: Thirteen patients or 76% developed auto-PEEP and the reduction of its magnitude (from 5.4 -/+ 3.2 to 4.1 -/+ 2.6 cmH2O, p<0.01) showed association to mean airway pressure decrease (from 10.2 -/+ 3.1 to 9.3 -/+ 2.3 cmH2O, p<0.01), tidal volume (from 45.3 -/+ 19.1 to 51.3 -/+ 22.9 ml, p<0.01) and corrected compliance increase (1.02 -/+ 1.20 to 1.13 -/+ 1.41 ml/cmH2O/kg, p=0.05). Expiratory resistance remained unchanged (from 15.0 -/+ 8.6 to 15.7 -/+ 9.4 cmH2O/l/sec/kg, p=0.06). Arterial blood gases showed pH increase (from 7.37 -/+ 0.12 to 7.42 -/+ 0.05, p<0.05) and PCO2 and PO2 decrease (from 40.1 -/+ 11.1 mmHg to 33.1 -/+ 7.4 mmHg, p<0.01 and 65.0 -/+ 13.9 to 58.0 -/+ 12.6 mmHg, p<0.01 respectively).CONCLUSIONS: Auto-PEEP reduction was associated with pulmonary mechanics and blood gases improvement. Knowledge of auto-PEEP presence and magnitude allowed to respiratory system compliance and time constants correction, providing accurate index of the pulmonary mechanics.

[Behavioral pain scales assessment in neonates]. / Aplicação das escalas comportamentais para a avaliação da dor em recém-nascidos.

OBJECTIVE: To establish the sensitivity and specificity of two behavioral pain scales in different gestational ages (GA). METHODS: 133 clinically stable neonates, <72 h of life, without diseases, analgesic/sedative use or Apgar<7 at 5' were randomly assigned to receive capillary puncture--P or alcohol swab friction--F. Patients were divided according to GA (28-33 wk=A; 34-37 wk=B; 38-41 wk=C ) and procedure: Group A-P (n=17, BW 1.5 +/- .4 kg); A-F (n=18, BW 1.5 +/- .4 kg); B-P (n=25, BW 2.5 +/- .5 kg); B-F (n=25, BW 2.4 +/- 0.6 kg); C-P (n=23, BW 3.3 kg +/- 0.5 kg); C-F (n=25; BW 3.3 +/- 0.4 kg). A neonatologist, blind to P or F, evaluated the Neonatal Facial Action Coding System (NFCS 0-8 pts, pain>3) and the Neonatal Infant Pain Scale (NIPS 0-7 pts, pain>3). All evaluations were performed prior to P or F, without (pr) and with foot heating (h), during (0), 1' and 3' after P or F. Reliability was assessed in 20% of the sample. Agreement rate was NFCS-97% and NIPS-95%. RESULTS: During the procedure, median NFCS and NIPS P score were greater than F (M. Whitney), p< or =0.0001) for A, B and C groups. At 1', NCFS and NIPS P scores were greater than F (MW, p< or =0.04) for A and C groups. For P patients, NFCS and NIPS scores were similar among the 3 GA groups at all study periods (K. Wallis). For F patients only at 0; NIPS scores were different (K. Wallis, p<0.03). During the procedure, NFCS>3 had sensitivity of 88-91% and specificity of 80-84%, NIPS>3 presented sensitivity of 77-87% and specificity of 68-83%. CONCLUSION: Both behavioral scales are sensitive tools for pain assessment in premature infants, although NFCS seems superior to NIPS.

[Growth of premature infants fed own mother's milk supplied with two milk formulas]. / Crescimento de prematuros alimentados com leite materno suplementado com duas fórmulas lácteas.

The purpose of the authors in this article was to evaluate the effects of supplementing maternal milk with two different caloric formulas on the growth of premature newborns until they reached 40 weeks of post-conceptional age. Seventy premature infants weighing < 1750g at birth were randomized: 35 adequate for gestational age (AGA) and 35 small for gestational age received maternal milk and either a special preterm formula or a modified formula. Anthropometric measurements and clinical evaluations were used to determine the nutritional status and the postnatal growth of these infants, who were analyzed in six different moments: at maximum weight loss, at return to birth weight, at definite weight gain, when exclusively fed with formula, at 2000g, and when they reached 40 weeks of post-conceptional age. The AGA premature newborns on preterm formula had greater daily weight gain, cephalic circumference increase and growth. The SGA premature newborns on preterm formula had greater daily weight gain and cephalic circumference increase observed from the third week of life onward. The AGA premature newborns on modified formula had less weight gain and smaller increments in the cephalic circumference. The SGA premature on modified formula had the worst anthropometric results. The preterm formula was more efficient than the modified formula in promoting postnatal growth of AGA and SGA premature infants. We believe that, due to their special characteristics, SGA premature should receive individualized nutritional caloric planning

Morphological and biochemical action of dipyrone on rat placenta.

1. The morphological and biochemical action of dipyrone (N-[2,3-dimethyl-5-oxo-1-phenyl-3-pyrazolin-4-yl]-methylamino methanesulfonate, sodium monohydrate) on the placenta of albino rats was studied by means of karyometry of trophoblastic giant cells and by determinations of DNA, RNA and total protein contents. 2. The animals were treated with a single daily dose of 50 mg/kg body weight during 5 different periods: from the 9th to the 12th, 11th to the 14th, 13th to the 16th, 15th to the 18th or 17th to the 20th day of pregnancy. 3. Karyometric results showed that the nuclear volumes of placental cells in rats treated with dipyrone during the first 3 periods were significantly greater than in control animals and that, closer to term, no differences were observed in this regard. Only the animals treated from the 9th to the 12th day of pregnancy had higher placental contents of DNA, RNA and protein than the corresponding controls. 4. Our results showed that dipyrone had a blocking effect on placental cell division which occurs mainly in the initial steps of placental development.

[Tissue weight and histologic alterations in pregnant rats submitted to malnutrition and chronic nicotine distress, and in their neonates]. / Alterações de peso tecidual e histológicas em ratas gestantes submetidas à desnutrição e ao estresse crônico de nicotina, e em seus recém-nascidos.

The effects of a gestational exposure of 80 rats Wistar EPM-1 to nicotine and undernutrition was examined. The weight and histological alterations on the liver and lungs was evaluated on the rats and their offspring. A significantly lower weight gain, including liver and lung weight, was observed in nicotine exposed groups. There was no alteration of the placental weight. Decidual necrosis and hepatic congestion was frequent in the rats. Lung emphysema was found in the neonates.