Comparação de técnicas não invasivas para medir a pressão arterial em recém-nascidos / Comparison of noninvasive techniques to measure blood pressure in newborns

OBJETIVO: Comparar a pressão arterial pelos métodos do flush, da oximetria de pulso e da oscilometria utilizando o Doppler em neonatos. MÉTODOS: Foram realizadas medidas de pressão arterial não invasiva utilizando três métodos distintos (flush, oximetria de pulso e oscilometria automática) em três grupos de recém-nascidos selecionados por sorteio: 15 a termo e normais, 16 prematuros estáveis e 14 doentes. Todas as medidas foram filmadas, editadas separadamente, codificadas e analisadas independentemente por três neonatologistas. RESULTADOS: Realizaram-se 57 medidas por cada método. Os métodos do flush e da oximetria de pulso mostraram melhor correlação com o Doppler do que a oscilometria (coeficiente de correlação 0,89, 0,85 e 0,71, respectivamente, p < 0,01). A diferença entre as médias das medidas, seus respectivos desvios padrão e o intervalo de confiança de 95 por cento quando comparados com Doppler foram: -5,2±7,9 (-21,1:10,7) mmHg com o método do flush; 0,4±8,9 (-17,5:18,2) mmHg com a oximetria de pulso; e 6,4±16,1 (-25,8:8,6) mmHg com a oscilometria. O método do flush mostrou melhor concordância com o Doppler para diagnóstico de hipotensão do que os métodos da oximetria e da oscilometria. CONCLUSÕES: Os métodos do flush e da oximetria de pulso mostraram-se úteis para medir a pressão arterial sistólica de recém-nascidos, sendo que o método oscilométrico mostrou-se o menos concordante com o Doppler para detectar hipotensão.

OBJECTIVE: To compare blood pressure measurements in newborn infants using the flush method, pulse oximetry and oscillometry according to Doppler findings. METHODS: Noninvasive blood pressure measurements were made using three techniques (flush method, pulse oximetry and oscillometry) in three groups of newborns: 15 normal term infants, 16 stable preterm infants, and 14 critically ill infants. All measurements were video recorded, edited separately, coded and analyzed independently by three neonatologists. RESULTS: Fifty-seven measurements were made using each method. The flush method and pulse oximetry had a better correlation with Doppler findings than oscillometry (correlation coefficients: 0.89, 0.85, 0.71; p < 0.01). The difference between measurement means, their standard deviations and the 95 percent confidence intervals when compared with Doppler findings were: -5.2±7.9 (-21.1:10.7) mmHg for the flush method; 0.4±8.9 (-17.5:18.2) mmHg for pulse oximetry; and 6.4±16.1 (-25.8:8.6) mmHg for oscillometry. The flush method had a better agreement with Doppler findings for the diagnosis of hypotension than oximetry and oscillometry. CONCLUSIONS: The flush method and pulse oximetry seem to be useful techniques to measure systolic blood pressure in newborn infants; oscillometry had the poorest agreement with Doppler findings to detect hypotension.

Comparison of noninvasive techniques to measure blood pressure in newborns.

OBJECTIVE: To compare blood pressure measurements in newborn infants using the flush method, pulse oximetry and oscillometry according to Doppler findings. METHODS: Noninvasive blood pressure measurements were made using three techniques (flush method, pulse oximetry and oscillometry) in three groups of newborns: 15 normal term infants, 16 stable preterm infants, and 14 critically ill infants. All measurements were video recorded, edited separately, coded and analyzed independently by three neonatologists. RESULTS: Fifty-seven measurements were made using each method. The flush method and pulse oximetry had a better correlation with Doppler findings than oscillometry (correlation coefficients: 0.89, 0.85, 0.71; p < 0.01). The difference between measurement means, their standard deviations and the 95% confidence intervals when compared with Doppler findings were: -5.2 ± 7.9 (-21.1:10.7) mmHg for the flush method; 0.4 ± 8.9 (-17.5:18.2) mmHg for pulse oximetry; and 6.4 ± 16.1 (-25.8:8.6) mmHg for oscillometry. The flush method had a better agreement with Doppler findings for the diagnosis of hypotension than oximetry and oscillometry. CONCLUSIONS: The flush method and pulse oximetry seem to be useful techniques to measure systolic blood pressure in newborn infants; oscillometry had the poorest agreement with Doppler findings to detect hypotension.

[Breastfeeding and early childhood caries: a critical review]. / Aleitamento materno e cárie do lactente e do pré-escolar: uma revisão crítica.

OBJECTIVE: To find scientific evidence that can prove or refute the assumption that nocturnal and on demand breastfeeding are associated with caries in infants and preschool children. SOURCES OF DATA: MEDLINE, Lilacs, and SciELO articles were searched, as well as important internet sites, technical books and consensus publications of national and international organisms. The following keywords were used: "early childhood caries", "dental caries", "dental decay" and "breastfeeding". References cited in the articles selected were also included. SUMMARY OF THE FINDINGS: Studies associating caries with breastfeeding invariably observe factors associated with how this disease develops, letting aside those associated with breastfeeding. Many of these factors act as confusing variables because in the same way as they interfere in breastfeeding, they also influence the development of caries. Besides, current studies have already demonstrated the cariogenic potential of some types of aliments given to children against the non-cariogenic potential of the human milk. CONCLUSIONS: There is no scientific evidence proving that human milk can be associated with the development of caries. This is a complex relation to be established, as it is often blurred by too many variables.

Aleitamento materno e cárie do lactente e do pré-escolar: uma revisão crítica / Breastfeeding and early childhood caries: a critical review

Objetivo: Buscar evidências científicas que comprovem ou refutem a afirmação de que o aleitamento materno noturno e em livre demanda está associado com cárie do lactente e do pré-escolar. Fontes dos dados: Foi realizada busca de artigos científicos utilizando-se as bases de dados MEDLINE, Lilacs e SciELO, páginas de internet relevantes, livros técnicos e publicações de consenso de organismos nacionais e internacionais. As palavras-chave utilizadas foram: early childhood caries, dental caries, dental decay e breastfeeding. Percebida a relevância, também se buscou diretamente as referências indicadas nos artigos encontrados. Síntese dos dados: Os estudos que relacionam a cárie com o aleitamento materno invariavelmente só observam os fatores inter-relacionados com o surgimento dessa doença, deixando de lado aqueles associados à amamentação. Muitos desses fatores atuam como variáveis de confusão porque, do mesmo modo que interferem no aleitamento materno, também têm influência no surgimento da cárie. Além disso, estudos atuais têm demonstrado a cariogenicidade de vários alimentos dados às crianças e a não-cariogenicidade do leite materno. Conclusões: Não há evidências científicas que comprovem que o leite materno possa estar associado com o surgimento de cárie, sendo essa relação complexa e confundida por muitas variáveis.