Respiratory distress syndrome prediction at birth by optical skin maturity assessment and machine learning models for limited-resource settings: a development and validation study.

Background: A handheld optical device was developed to evaluate a newborn's skin maturity by assessing the photobiological properties of the tissue and processing it with other variables to predict early neonatal prognosis related to prematurity. This study assessed the device's ability to predict respiratory distress syndrome (RDS). Methods: To assess the device's utility we enrolled newborns at childbirth in six urban perinatal centers from two multicenter single-blinded clinical trials. All newborns had inpatient follow-up until 72 h of life. We trained supervised machine learning models with data from 780 newborns in a Brazilian trial and provided external validation with data from 305 low-birth-weight newborns from another trial that assessed Brazilian and Mozambican newborns. The index test measured skin optical reflection with an optical sensor and adjusted acquired values with clinical variables such as birth weight and prenatal corticoid exposition for lung maturity, maternal diabetes, and hypertensive disturbances. The performance of the models was evaluated using intrasample k-parts cross-validation and external validation in an independent sample. Results: Models adjusting three predictors (skin reflection, birth weight, and antenatal corticoid exposure) or five predictors had a similar performance, including or not maternal diabetes and hypertensive diseases. The best global accuracy was 89.7 (95% CI: 87.4 to 91.8, with a high sensitivity of 85.6% (80.2 to 90.0) and specificity of 91.3% (95% CI: 88.7 to 93.5). The test correctly discriminated RDS newborns in external validation, with 82.3% (95% CI: 77.5 to 86.4) accuracy. Our findings demonstrate a new way to assess a newborn's lung maturity, providing potential opportunities for earlier and more effective care. Trial registration: RBR-3f5bm5 (online access: http://www.ensaiosclinicos.gov.br/rg/RBR-3f5bm5/), and RBR-33mjf (online access: https://ensaiosclinicos.gov.br/rg/RBR-33rnjf/).

Protective measures feasibility for infants of low income SARS-CoV-2 positive breastfeeding mothers: a prospective multicenter cohort study.

AIM: The aim was to evaluate the feasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers. BACKGROUND: Breastfeeding mothers with SARS-CoV-2 positive should avoid exposing the infant through protective measures (PM), but it could be challenging in a low-income population. METHODS: A prospective, multicenter study was conducted between July and October 2020 (BRACOVID). The participants were recruited at birth and interviewed through a structured questionnaire at seven and 14 days in the home environment. The feasibility of PM during breastfeeding at home was defined by guidelines recommendations (mask using, handwashing, and distancing from newborn when not breastfeeding). Three groups according to the feasibility of guidelines: complete guidelines feasibility (CG): all PM; partial guidelines feasibility (PG): at least one PM feasible; no guidelines (NG): infeasibility to all of PM. Flu-like neonatal symptoms, mothers' breastfeeding practices. We evaluated the association between PM feasibility and socioeconomic factors. RESULTS: 117 infected mothers from 17 Brazilian hospitals were enrolled. 47 (40%) mothers followed all recommendations, 14 (11.9%) could not practice at least one recommendation, and 50 (42.7%) did not execute any of them. The breastfeeding rate was 98%. Factors associated with infeasibility were monthly family income < 92.7 dollars/person, high housing density (>1 inhabitant/room), teenage mothers, responsive feeding, and poor schooling. Regarding infants' flu-like symptoms, 5% presented symptoms at fourteen days (NG group). CONCLUSION: The guidelines were not applied to infants of SARs-CoV-positive mothers in 54.6% of the dyads since the recommendations were unviable in their environments. During pandemics, we should look for feasible and effective guidelines to protect neonates from low-income populations. IMPLICATIONS FOR NURSING MANAGEMENT: Poor socioeconomic conditions lead to the unfeasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers during the isolation period in the pandemics. The orientations and the support provided to dyad should consider the socioeconomic factors to guide feasible measures in the home environment and promote adequate protections; only an individual approach will allow a safe environment for low-income infants.

Newborn Skin Maturity Medical Device Validation for Gestational Age Prediction: Clinical Trial.

BACKGROUND: Early access to antenatal care and high-cost technologies for pregnancy dating challenge early neonatal risk assessment at birth in resource-constrained settings. To overcome the absence or inaccuracy of postnatal gestational age (GA), we developed a new medical device to assess GA based on the photobiological properties of newborns' skin and predictive models. OBJECTIVE: This study aims to validate a device that uses the photobiological model of skin maturity adjusted to the clinical data to detect GA and establish its accuracy in discriminating preterm newborns. METHODS: A multicenter, single-blinded, and single-arm intention-to-diagnosis clinical trial evaluated the accuracy of a novel device for the detection of GA and preterm newborns. The first-trimester ultrasound, a second comparator ultrasound, and data regarding the last menstrual period (LMP) from antenatal reports were used as references for GA at birth. The new test for validation was performed using a portable multiband reflectance photometer device that assessed the skin maturity of newborns and used machine learning models to predict GA, adjusted for birth weight and antenatal corticosteroid therapy exposure. RESULTS: The study group comprised 702 pregnant women who gave birth to 781 newborns, of which 366 (46.9%) were preterm newborns. As the primary outcome, the GA as predicted by the new test was in line with the reference GA that was calculated by using the intraclass correlation coefficient (0.969, 95% CI 0.964-0.973). The paired difference between predicted and reference GAs was -1.34 days, with Bland-Altman limits of -21.2 to 18.4 days. As a secondary outcome, the new test achieved 66.6% (95% CI 62.9%-70.1%) agreement with the reference GA within an error of 1 week. This agreement was similar to that of comparator-LMP-GAs (64.1%, 95% CI 60.7%-67.5%). The discrimination between preterm and term newborns via the device had a similar area under the receiver operating characteristic curve (0.970, 95% CI 0.959-0.981) compared with that for comparator-LMP-GAs (0.957, 95% CI 0.941-0.974). In newborns with absent or unreliable LMPs (n=451), the intent-to-discriminate analysis showed correct preterm versus term classifications with the new test, which achieved an accuracy of 89.6% (95% CI 86.4%-92.2%), while the accuracy for comparator-LMP-GA was 69.6% (95% CI 65.3%-73.7%). CONCLUSIONS: The assessment of newborn's skin maturity (adjusted by learning models) promises accurate pregnancy dating at birth, even without the antenatal ultrasound reference. Thus, the novel device could add value to the set of clinical parameters that direct the delivery of neonatal care in birth scenarios where GA is unknown or unreliable. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-027442.

Prematurity detection evaluating interaction between the skin of the newborn and light: protocol for the preemie-test multicentre clinical trial in Brazilian hospitals to validate a new medical device.

INTRODUCTION: Recognising prematurity is critical in order to attend to immediate needs in childbirth settings, guiding the extent of medical care provided for newborns. A new medical device has been developed to carry out the preemie-test, an innovative approach to estimate gestational age (GA), based on the photobiological properties of the newborn's skin. First, this study will validate the preemie-test for GA estimation at birth and its accuracy to detect prematurity. Second, the study intends to associate the infant's skin reflectance with lung maturity, as well as evaluate safety, precision and usability of a new medical device to offer a suitable product for health professionals during childbirth and in neonatal care settings. METHODS AND ANALYSIS: Research protocol for diagnosis, single-group, single-blinding and single-arm multicenter clinical trial with a reference standard. Alive newborns, with 24 weeks or more of pregnancy age, will be enrolled during the first 24 hours of life. Sample size is 787 subjects. The primary outcome is the difference between the GA calculated by the photobiological neonatal skin assessment methodology and the GA calculated by the comparator antenatal ultrasound or reliable last menstrual period (LMP). Immediate complications caused by pulmonary immaturity during the first 72 hours of life will be associated with skin reflectance in a nested case-control study. ETHICS AND DISSEMINATION: Each local independent ethics review board approved the trial protocol. The authors intend to share the minimal anonymised dataset necessary to replicate study findings. TRIAL REGISTRATION NUMBER: RBR-3f5bm5.

Induction of Expression of CD271 and CD34 in Mesenchymal Stromal Cells Cultured as Spheroids.

Cultured mesenchymal stromal cells (MSCs) are cells that can be used for tissue engineering or cell therapies owing to their multipotency and ability to secrete immunomodulatory and trophic molecules. Several studies suggest that MSCs can become pericytes when cocultured with endothelial cells (ECs) but failed to use pericyte markers not already expressed by MSCs. We hypothesized ECs could instruct MSCs to express the molecules CD271 or CD34, which are expressed by pericytes in situ but not by MSCs. CD271 is a marker of especial interest because it is associated with multipotency, a characteristic that wanes in MSCs as they are culture expanded. Consequently, surface expression of CD271 and CD34 was detected in roughly half of the MSCs cocultured with ECs as spheroids in the presence of insulin-like growth factor 1 (IGF-1). Conversely, expression of CD271 and CD34 was detected in a similar proportion of MSCs cultured under these conditions without ECs, and expression of these markers was low or absent when no IGF-1 was added. These findings indicate that specific culture conditions including IGF-1 can endow cultured MSCs with expression of CD271 and CD34, which may enhance the multipotency of these cells when they are used for therapeutic purposes.

A doença da membrana hialina em prematuros de baixo peso / Hyaline membrane disease in low birth weight preterm infants

Introdução: O objetivo do estudo foi determinar a prevalência da Doença da Membrana Hialina (DMH) em prematuros de baixo peso e suas principais complicações. Métodos: Foi realizado um estudo descritivo do tipo série de casos. A população em estudo foram 34 prematuros com peso inferior a 1500 gramas e/ou idade gestacional inferior a 32 semanas nascidos no período de julho de 2010 a julho de 2011 no Hospital Universitário de Canoas/RS. Resultados: Pré-eclâmpsia e trabalho de parto prematuro foram as causas mais frequentes de parto pré-termo. DMH ocorreu em todos os recém-nascidos com peso inferior a 1000 gramas. Em prematuros com peso ao nascer entre 1001 e 1250 gramas e 1251 e 1499 gramas, a prevalência da DMH foi de 71,4% e 44,4%, respectivamente. A complicação da DMH mais frequente foi a persistência do canal arterial. Conclusões: A prevalência da DMH encontrada foi de 100% nos prematuros com peso até 1000 gramas e de 71,4% nos RNs com peso entre 1001g e 1250g. Nos prematuros com peso de 1251g a 1499g, a prevalência foi de 44,4% (AU)

Introduction: The aim of the study was to determine the prevalence of hyaline membrane disease (HMD) in preterm, low birth weight infants and its major complications. Methods: A descriptive study of the case series was conducted. The study population were 34 preterm infants weighing less than 1500 grams and/or gestational age less than 32 weeks born from July 2010 to July 2011 at the University Hospital of Canoas, RS. Results: Pre-eclampsia and preterm labor were the most frequent causes of preterm birth. HMD occurred in all newborns weighing less than 1000 grams. In premature infants with birth weights between 1001 and 1250 grams and 1251 grams and 1499, the prevalence of DMH was 71.4% and 44.4%, respectively. The most frequent complication of DMH was the persistent ductus arteriosus. Conclusions: The prevalence of DMH was 100% in preterm infants weighing up to 1000 grams and 71.4% in newborns weighing between 1001g to 1250g. In premature infants weighing 1251g to 1499g, the prevalence was 44.4% (AU)

Aspectos relacionados à preferência pela via de parto em um hospital universitário / Aspects regarding childbirth delivery preferences at a university hospital

O índice de cesarianas vem aumentando progressivamente nos últimos anos. O presente estudo trata sobre preferência de puérperas em relação à via de parto. Objetiva identificar a via de parto de preferência das mulheres que tiveram filho na maternidade do HU/ULBRA; verificar fatores que influenciam a escolha; e comparar a indicação médica da cesariana com o entendimento sobre a justificativa da intervenção. Métodos: Estudo descritivo de amostra consecutiva no período de 01/05/2010 a 30/06/10. Foi aplicado um questionário em 400 puérperas internadas no Alojamento Conjunto do Hospital Universitário da ULBRA. Resultados: O parto vaginal foi a via de preferência em 72,8% das mulheres. Recuperação mais rápida, menor dor e sofrimento, procedimento mais rápido e menor risco de morte materna foram as principais justificativas dadas pelas puérperas para suas preferências pela via de parto. Interferiu significativamente na decisão ter companheiro, grau de instrução, renda familiar e tempo de ruptura de membranas. A principal indicação médica de cesárea foi a desproporção cefalopélvica (22,6%). E 35% das mulheres acreditam ter sido a falha na indução a razão da indicação por via abdominal. Conclusão: O parto vaginal é o preferido da maioria das mulheres entrevistadas (n=291). O perfil das pacientes que tem preferência por parto vaginal foi: mulheres mais jovens, com maior grau de instrução, menor renda familiar, com companheiro fixo e menor tempo de ruptura de membranas. Percebemos discordância entre as causas alegadas pelas puérperas e a indicação médica da cesárea.

The cesarean section rate has been increasing steadily in recent years. This study focuses on mothers’ preferences concerning mode of delivery. It was designed to identify the preferred route of delivery among women who gave birth at the maternity ward of HU/ULBRA; to identify factors that influence their choice, and to compare medical indications for cesarean section with mothers’ perception of the reasons for the intervention. Methods: A descriptive study of a consecutive sample from May 1 2010 to June 30 2010. A questionnaire was responded by 400 postpartum women admitted to the Quarters of ULBRA University Hospital . Results: The vaginal route was preferred by 72.8% of mothers. Faster recovery, less pain and suffering, quicker procedure, and lower risk of death were the main reasons reported by pregnant women for their preference for delivery route. Having a partner, level of education, family income, and time of rupture of membranes were reported as significantly influential in the decision. The main medical indications for cesarean section was cephalopelvic disproportion (22.6%). And 35% of women believed that failure in induction was the reason for the abdominal route. Conclusion: Vaginal delivery is preferred for most of the women interviewed (n = 291). Patients who prefer vaginal delivery had the following profile: younger women with higher levels of education, lower family income, with a steady partner and shorter duration of membrane rupture. We noticed a discrepancy between the causes reported by pregnant women and the medical indications for cesarean section.

Juventude e AIDS: conhecimento entre os adolescentes de uma escola pública em Canoas, RS / Youth and AIDS: knowledge among adolescents of a public school in Canoas, RS

Introdução: A Síndrome da Imunodeficiência Adquirida (AIDS) é uma pandemia com alto nível de letalidade, sendo que os adolescentes constituem-se num preocupante grupo de risco. O objetivo deste estudo foi avaliar o conhecimento da AIDS em adolescentes de uma escola pública, no município de Canoas, Rio Grande do Sul, comparando as diferenças e semelhanças entre gêneros. Metodologia: Estudo descritivo, transversal, de caráter quantitativo, do tipo inquérito. Na análise foram utilizados os testes t-Student, qui-quadrado de Pearson ou Exato de Fisher. As análises foram realizadas no programa SPSS (Statistical Package for the Social Sciences) versão 10.0. Resultados: Foram estudados 221 alunos de 7a e 8a séries. Não houve predomínio de gênero. A média de idade foi de 14,4 ± 1,39 anos. Quanto ao conhecimento dos adolescentes sobre AIDS, 91% respondeu afirmativamente. Em relação à transmissão vertical do HIV, as adolescentes negaram conhecer esse modo de transmissão, muito mais que os meninos (p=0,028). Por outro lado, julgaram necessário o teste anti-HIV para usuários de drogas injetáveis e para quem fez transfusão de sangue. Conclusão: A maioria dos adolescentes dessa escola possui um conhecimento adequado, porém conceitos errôneos ainda existem e precisam ser trabalhados.

Introduction: The Acquired Immunodeficiency Syndrome (AIDS) is a pandemic with a high level of lethality, and the adolescents are a worrying risk group. The aim of this study was to evaluate knowledge of AIDS among adolescents in a public school in the municipality of Canoas, Rio Grande do Sul, comparing gender differences and similarities. Methods: A descriptive, transversal study of the quantitative, inquiry type. The statistical analysis was done with the Student’s t-test, Persons’s Chi-square test or Fisher’s Exact Test. Data were processed with software SPSS (Statistical Package for the Social Sciences, version 10.0). Results: 221 7th and 8th grade students were investigated. There was no gender predominance. The mean age was 14.4 ± 1.39 years. Concerning adolescent’s awareness about AIDS, 91% answered in the affirmative. As for mother-to-child HIV transmission, the girls said they were unaware of this mode of transmission, much more than the boys did (=0.028). On the other hand, they recognized the need to test intravenous drug users and individuals submitted to blood transfusions for HIV. Conclusion: Most adolescents of this school have an appropriate knowledge about AIDS, but misconceptions still exist and should be worked at.

Trabalho precoce e riscos à saúde / Early work and health risks

O trabalho de crianças e adolescentes é um grave problema social que atinge toda a humanidade, e está estreitamente vinculado à condiçäo econômica, näo sendo, porém, restrito aos países pobres. Este trabalho tem como objetivo fazer uma revisäo bibliográfica sobre aspectos epidemiológicos, culturais, legais e socioeconômicos do trabalho precoce, bem como estabelecer os principais riscos e suas eventuais conseqüências à saúde do menor trabalhador. Para tanto, levamos em consideraçäo os tipos de trabalho mais prevalentemente exercidos por menores no Brasil e no Estado do Rio Grande do Sul

Trabalho precoce e riscos O saúde / Early work and health risks

O trabalho de crianþas e adolescentes é um grave problema social que atinge toda a humanidade, e está estreitamente vinculado O condiþõo econ¶mica, nõo sendo, porém, restrito aos países pobres. Este trabalho tem como objetivo fazer uma revisõo bibliográfica sobre aspectos epidemiológicos, culturais, legais e socioecon¶micos do trabalho precoce, bem como estabelecer os principais riscos e suas eventuais conseq³Ûncias O saúde do menor trabalhador. Para tanto, levamos em consideraþõo os tipos de trabalho mais prevalentemente exercidos por menores no Brasil e no Estado do Rio Grande do Sul (AU)

Trabalho precoce e riscos à saúde / Precocious work and risks to the health

O trabalho de crianças e adolescentes é um grave problema social que atinge toda a humanidade, e está estreitamente vinculado à condição econômica, não sendo, porém, restrito aos países pobres. Este trabalho tem como objetivo fazer uma revisão bibliográfica sobre aspectos epidemiológicos, culturais, legais e socioeconômicos do trabalho precoce, bem como estabelecer os principais riscos e suas eventuais conseqüências à saúde do menor trabalhador. Para tanto, levamos em consideração os tipos de trabalho mais provavelmente exercidos por menores no Brasil e no Estado do Rio Grande do Sul(AU)

Hipercalemia em recém-nascido de muito baixo peso: incidência e fatores associados / Hyperkalemia in very low birthweight infants: incidence and associated factors

O presente estudo avaliou a incidência de hipercalemia (potássio ò 6mEq/l) em RNPs com peso ó 1250 gramas e idade gestacional ó 32 semanas nas primeiras 72 horas de vida, nascidos no Hospital de Clínicas de Porto Alegre, no período de 1 ano. A incidência de hipercalemia foi de 38,5 por cento (potássio ò 6mEq/l) e de 15,4 por cento com níveis de potássio passíveis de arritmias cardíacas (KP > 6,7 mEq/l). A populaçäo foi dividida em 2 grupos: grupo KN com potássio < 6mEq/l (16 casos) e grupo KE com potássio ò 6mEq/l (10 casos). A conduta no controle hidroeletrolítico e na manutençäo do ambiente térmico neutro foi a mesma nos 2 grupos. Nenhum dos grupos recebeu potássio nas primeiras 36 horas de vida. O grupo KE apresentou níveis de potássio mais elevados durante todo o estudo. As médias dos pesos de nascimento dos grupos näo diferiram significativamente (KN = 963 gr; KE = 987 gr). O grupo KN apresentou idade gestacional (29,3 semanas X 30,8 semanas) e índice de Apgar no primeiro minuto (3,18 X 5,7) significativamente menores (p=0,004 e p=0,015 respectivamente). Näo houve diferença significativa entre os dois grupos em relaçäo a hemorragia intraventricular, acidose, doença da membrana hialina, níveis de insulina, glicemia, índice glicemia/insulina, taxa de filtraçäo glomerular, diurese, potássio urinário, excreçäo fracionada de potássio e índice tubular de aldosterona. O nível de aldosterona foi significativamente maior no grupo KE com 24 horas de vida (212,8 ng/dl X 110,2 ng/dl, p=0,029). Sugere-se que menhum dos fatores estudados é responsável pela hipercalemia näo oligúrica do recém-nascido de muito baixo peso, salientando-se, entretanto, a importância de controlar os níveis de potássio sérico nesses recém-nascidos.

Doença da membrana hialina / Hyaline membrane disease

Os autores fazem uma abordagem sobre a doença da membrana hialina, cujo conhecimento da fisiopatologia aumentou nas recentes décadas, possibilitando, ao lado de novas técnicas ventilatórias e preparaçöes artificiais do surfactante, uma reduçäo da mortalidade e morbidade dos recém-nascidos