Comparação dos marcadores de alteração na deglutição entre pacientes com e sem Covid-19 pós-intubação orotraqueal / Comparison of swallowing alteration markers between patients with and without Covid-19 post-orotracheal intubation

RESUMO Objetivo comparar os marcadores de alteração na deglutição de pacientes com e sem COVID-19 e estudar as variáveis preditivas de contraindicação da alimentação por via oral em pacientes com necessidade de intubação orotraqueal prolongada. Métodos estudo caso-controle, retrospectivo, com coleta de prontuário de variáveis clínicas e demográficas e da avaliação clínica da deglutição. As variáveis coletadas foram comparadas estatisticamente entre pacientes com COVID-19 (grupo estudo -GE) e sem COVID-19 (grupo-controle - GC). A análise de regressão de robusta de Poisson foi utilizada para avaliar o efeito da COVID-19 e das demais variáveis na contraindicação da alimentação por via oral. Resultados foram incluídos 351 pacientes, 269 no GE e 82 no GC. Pacientes do GE apresentaram menor idade, quando comparados ao GC (50,7 ± 12,8). O tempo total de intubação orotraqueal foi significativamente maior no GE. Os pacientes do GE apresentaram maior prevalência de tosse fraca, disfonia, piores graus de disfagia e maior ocorrência de contraindicação da alimentação por via oral. Na análise bivariada, verificou-se que os pacientes com COVID-19 apresentaram 65% maior probabilidade dessa contraindicação. Entretanto, quando a COVID-19 foi ajustada com outras variáveis clínicas e demográficas, verificou-se que as estas apresentaram maior influência sobre a contraindicação de alimentação por via oral do que a COVID-19. Conclusão a intubação orotraqueal prolongada teve pior efeito nos marcadores de alteração na deglutição e na reintrodução da via oral de pacientes com COVID-19. A idade maior que 60 anos, tempo de intubação orotraqueal maior que cinco dias, reintubação e delirium demonstraram ser preditivas de contraindicação da alimentação por via oral em pacientes intubados.

ABSTRACT Purpose To compare the swallowing alteration markers in patients with and without COVID-19 and to study the predictive variables of oral feeding contraindication in patients requiring prolonged orotracheal intubation. Methods Retrospective case-control study, with medical record data collection of clinical and demographic variables and the clinical evaluation of swallowing. The collected variables were statistically compared between patients with COVID-19 (SG) and without COVID-19 (CG). Robust Poisson regression analysis was used to evaluate the effect of COVID-19 and other variables on oral feeding contraindication. Results 351 patients were included, 269 in the SG and 82 in the CG. Patients in the SG were younger when compared to the CG (50.7 ± 12.8). The total time of orotracheal intubation was significantly longer in the SG. The patients in the SG had a higher prevalence of weak cough, dysphonia, worse degrees of dysphagia and higher occurrence of contraindication of oral feeding. In the bivariate analysis, it was found that patients with COVID-19 were 65% more likely to have oral feeding contraindication. However, when COVID-19 was adjusted with other clinical and demographic variables, it was found that these variables had a greater influence on the contraindication of the oral feeding than the COVID-19. Conclusion Prolonged orotracheal intubation had a worse effect on alteration markers in swallowing and reintroduction of the oral feeding in COVID-19 patients. Age over 60 years, orotracheal intubation time greater than 5 days, reintubation, and delirium were shown to be predictive of oral feeding contraindication in intubated patients.

Deglutição de pacientes críticos e sua associação com características epidemiológicas e clínicas / Swallowing of critical patients and its association with epidemiological and clinical characteristics / Deglución de pacientes críticos y su associación con características epidemiológicas y clínicas

Introdução: Disfagia é um distúrbio de deglutição com sinais e sintomas específicos, caracterizada por alterações em qualquer fase ou entre as fases da dinâmica de deglutição, de origem congênita ou adquirida, podendo gerar prejuízo pulmonar, nutricional e social. É um transtorno frequentemente encontrado no centro de tratamento intensivo (CTI). Sendo assim, a identificação precoce dos principais agentes etiológicos para transtornos de deglutição é essencial para promover uma assistência fonoaudiológica mais adequada. Objetivo: Verificar a associação entre características epidemiológicas e clínicas com o desfecho contraindicação fonoaudiológica de alimentação por via oral em pacientes internados em um CTI. Métodos: Estudo transversal que avaliou pacientes internados no CTI submetidos a avaliação clínica da deglutição no período entre outubro de 2018 e maio de 2019. O nível 1 da Escala funcional de ingestão por via oral (FOIS) foi considerado de maior risco para aspiração respiratória e comparado com os níveis FOIS 2-7. Variáveis epidemiológicas e clínicas foram obtidas a partir dos registros dos pacientes. Análises univariadas e multivariadas foram realizadas para identificar associações e efeitos entre as variáveis e o desfecho contraindicação da alimentação por via oral. O nível de significância adotado foi de 5% e as análises foram realizadas no programa SPSS v.21.0. Resultados: Foram incluídos 128 pacientes (64,9% submetidos a intubação orotraqueal ­ IOT; idade de 60 ± 15,3 anos). Pacientes com FOIS 1 permaneceram mais dias em IOT, tiveram a internação no CTI prolongada e a cada dia de internação apresentaram risco de 5% de contraindicação da alimentação por via oral na avaliação fonoaudiológica. Conclusão: Foi evidenciada associação entre maior tempo de intubação orotraqueal, além de maior tempo de internação prévio, com a contraindicação da alimentação por via oral.

Introduction: Dysphagia is a swallowing disorder with specific signs and symptoms, characterized by alterations in any phase or between phases of swallowing dynamics, of congenital or acquired origin, which can lead to pulmonary, nutritional and social damage. It is a disorder often found in the intensive care unit (ICU). Therefore, the early identification of the main etiological agents for swallowing disorders is essential to promote more adequate speech therapy assistance. Objective: To verify the association between epidemiological and clinical characteristics with the outcome speech-language pathology contraindication for oral feeding in patients admitted to an ICU. Methods: Cross-sectional study that evaluated patients admitted to the ICU who underwent clinical evaluation of swallowing between October 2018 and May 2019. Level 1 of the Functional oral intake scale (FOIS) was considered at higher risk for respiratory aspiration and compared with FOIS levels 2-7. Epidemiological and clinical variables were obtained from patient records. Univariate and multivariate analyses were performed to identify associations and effects between variables and the outcome contraindication of oral feeding. The significance level adopted was 5% and the analyses were performed using the SPSS v.21.0 program. Results: 128 patients were included (64.9% undergoing orotracheal intubation - OTI; age of 60 ± 15.3 years). Patients with FOIS 1 spent more days on OTI, had a prolonged stay in the ICU and each day of hospitalization had a 5% risk of contraindication of oral feeding in the speech-language pathology assessment. Conclusion: There was an association between longer times of orotracheal intubation, in addition to longer previous hospitalization time, with the contraindication of oral feeding.

Introducción: La disfagia es un trastorno de la deglución con signos y síntomas específicos, caracterizado por alteraciones en cualquier fase o entre fases de la dinámica de la deglución, de origen congénito o adquirido, que pueden conducir a daño pulmonar, nutricional y social. Es un trastorno que se encuentra a menudo en la unidad de cuidados intensivos (UCI). Por lo tanto, la identificación temprana de los principales agentes etiológicos de los trastornos de la deglución es fundamental para promover una asistencia logopédica más adecuada. Objetivo: Verificar la asociación entre las características epidemiológicas y clínicas con el desenlace fonoaudiológico contraindicación para alimentación oral en pacientes internados en una UTI. Métodos: Estudio transversal que evaluó a pacientes ingresados en UCI a quienes se les realizó evaluación clínica de la deglución entre octubre de 2018 y mayo de 2019. Nivel 1 de la Escala de ingesta oral funcional (FOIS) fue considerado de mayor riesgo para aspiración respiratoria y comparado con los niveles de FOIS 2-7. Las variables epidemiológicas y clínicas se obtuvieron de las historias clínicas de los pacientes. Se realizaron análisis univariados y multivariados para identificar asociaciones y efectos entre las variables y el resultado contraindicación de la alimentación oral. El nivel de significación adoptado fue del 5% y los análisis se realizaron con el programa SPSS v.21.0. Resultados: se incluyeron 128 pacientes (64,9% sometidos a intubación orotraqueal - IOT; edad de 60 ± 15,3 años). Los pacientes con FOIS 1 pasaron más días en OTI, tuvieron una estancia prolongada en la UCI y cada día de hospitalización tenían un 5% de riesgo de contraindicación de alimentación oral en la evaluación de patología del habla y lenguaje. Conclusión: Hubo asociación entre mayor tiempo de intubación orotraqueal, además de mayor tiempo de hospitalización previa, con la contraindicación de alimentación oral.

Agreement among instruments of quantitative evaluation of the hard palate in children / Concordância entre instrumentos de avaliação quantitativa do palato duro em crianças

ABSTRACT Purpose To evaluate the agreement among instruments of the quantitative evaluation of hard palate. Methods This cross-sectional study was performed with a sample of 30 children aged 6 to 11 from Santa Maria, Southern Brazil. The instruments for palate measurements evaluated were: digital caliper, used directly in the oral cavity and in plaster casts, Korkhaus tridimensional bow, used directly in the oral cavity and in plaster casts, and Dolphin Imaging Software used for measurements in cone-beam computed tomography (CBCT). The agreement among different instruments was evaluated using the Intraclass Correlation Coefficient (ICC). Results The means of all transversal dimensions obtained by cone-beam computed tomography were lower than those of the other instruments - the agreement values in the width between the canines and in the width between the first molars were lower when comparing the cone-beam computed tomography and the other instruments. In the width between the first and second premolars, all comparisons showed acceptable agreement values. Good concordance values were obtained when comparing the palate depth at the second premolar region when using a bow divider inside the oral cavity and in the cast. Conclusion Most instruments presented satisfactory agreement in the measurements related to the transverse plane of the hard palate. However, when the vertical plane was evaluated, only the bow divider applied to both cast and oral cavity presented ideal agreement.

RESUMO Objetivo Avaliar a concordância entre instrumentos de avaliação quantitativa do palato duro. Método Este estudo transversal foi realizado com uma amostra de 30 crianças de 6 a 11 anos de Santa Maria, sul do Brasil. Os instrumentos de medidas do palato avaliados foram: paquímetro digital, utilizado diretamente na cavidade oral e em modelos de gesso, arco tridimensional Korkhaus, usado diretamente na cavidade oral e em modelos de gesso, e Dolphin Imaging Software utilizado para medições em tomografia computadorizada de feixe cônico (CBCT). A concordância entre os diferentes instrumentos foi avaliada por meio do Coeficiente de Correlação Intraclasse (ICC). Resultados As médias de todas as dimensões transversais obtidas pela tomografia computadorizada de feixe cônico foram menores do que as dos outros instrumentos - os valores de concordância na largura entre os caninos e na largura entre os primeiros molares foram baixos na comparação entre a tomografia computadorizada de feixe cônico e os demais instrumentos. Na largura entre o primeiro e o segundo pré-molar, todas as comparações apresentaram valores de concordância aceitáveis. Valores de concordância aceitáveis também foram obtidos ao comparar a profundidade do palato na região do segundo pré-molar com o uso de um divisor de arco dentro da cavidade oral e no gesso. Conclusão A maioria dos instrumentos apresentou concordância satisfatória nas medidas relacionadas ao plano transverso do palato duro. Porém, quando avaliado o plano vertical, apenas o divisor de arco aplicado tanto no gesso quanto na cavidade oral apresentou concordância ideal.

Reference parameters for normality and associated factors to hard palate during mixed dentition phase / Parâmetros de referência para normalidade e fatores associados ao palato duro durante a fase de dentição mista

ABSTRACT Purpose To evaluate the association among dimensions of the hard palate according to the sexes, skin color, and periods of the mixed dentition and present reference parameters of normality for this stage of development. Methods This cross-sectional study evaluated a representative sample of children between the ages of 7 and 13 years in Santa Maria, southern Brazil. The outcomes of the study were the dimensions of the palate: width measurements and depth. Sociodemographic characteristics and related oral measures were also assessed. Adjusted linear regression model were used to evaluate the effect of the predictor's variables on the dimensions of the hard palate in millimeters. The reference standards for the hard palate normality were presented in mean, standard deviation, and 95% confidence interval. Results A total of 569 children were evaluated. The hard palate dimensions were larger in the male sex and smaller in the first transitional period of mixed dentition. Skin color had an influence on the hard palate width at the level of the premolars, and the width measurements were smaller in white individuals. Posterior cross bite, Angle Class II and III malocclusions and non-nutritional sucking habits caused reduction in the hard palate width measurements. Conclusion Different dimensions of the hard palate are influenced by demographic variables such as sex, skin color, and mixed dentition period. Children of the female sex, white-skinned and in the first transition period of mixed dentition had smaller dimensions of the hard palate. Establishing normality reference standards in measurements of the palates guides the clinical practice.

RESUMO Objetivo Avaliar a associação entre as dimensões do palato duro de acordo com os sexos, cor da pele e períodos da dentição mista e apresentar parâmetros de normalidade de referência para esta fase de desenvolvimento. Método Este estudo transversal avaliou uma amostra representativa de crianças com idade entre 7 e 13 anos em Santa Maria, sul do Brasil. Os desfechos do estudo foram as dimensões do palato: medidas de largura e profundidade. Características sociodemográficas e medidas orais relacionadas também foram avaliadas. Modelos de regressão linear ajustados foram utilizados para avaliar o efeito das variáveis preditoras sobre as dimensões do palato duro em milímetros. Os padrões de referência para a normalidade do palato duro foram apresentados em média, desvio padrão e intervalo de confiança de 95%. Resultados Foram avaliadas 569 crianças. As dimensões do palato duro foram maiores no sexo masculino e menores no primeiro período de transição da dentição mista. A cor da pele influenciou a largura do palato duro ao nível dos pré-molares, sendo as medidas de largura menores nos brancos. Mordida cruzada posterior, más oclusões de Classe II e III de Angle e hábitos de sucção não nutricionais causaram redução nas medidas da largura do palato duro. Conclusão As diferentes dimensões do palato duro são influenciadas por variáveis demográficas como o sexo, cor da pele e período de dentição mista. Crianças do sexo feminino, de cor de pele branca e no primeiro período de transição de dentição mista apresentaram menores dimensões do palato duro. O estabelecimento de padrões de referência de normalidade nas medidas do palato orienta a prática clínica.

Reference parameters for normality and associated factors to hard palate during mixed dentition phase.

PURPOSE: To evaluate the association among dimensions of the hard palate according to the sexes, skin color, and periods of the mixed dentition and present reference parameters of normality for this stage of development. METHODS: This cross-sectional study evaluated a representative sample of children between the ages of 7 and 13 years in Santa Maria, southern Brazil. The outcomes of the study were the dimensions of the palate: width measurements and depth. Sociodemographic characteristics and related oral measures were also assessed. Adjusted linear regression model were used to evaluate the effect of the predictor's variables on the dimensions of the hard palate in millimeters. The reference standards for the hard palate normality were presented in mean, standard deviation, and 95% confidence interval. RESULTS: A total of 569 children were evaluated. The hard palate dimensions were larger in the male sex and smaller in the first transitional period of mixed dentition. Skin color had an influence on the hard palate width at the level of the premolars, and the width measurements were smaller in white individuals. Posterior cross bite, Angle Class II and III malocclusions and non-nutritional sucking habits caused reduction in the hard palate width measurements. CONCLUSION: Different dimensions of the hard palate are influenced by demographic variables such as sex, skin color, and mixed dentition period. Children of the female sex, white-skinned and in the first transition period of mixed dentition had smaller dimensions of the hard palate. Establishing normality reference standards in measurements of the palates guides the clinical practice.

Agreement among instruments of quantitative evaluation of the hard palate in children.

PURPOSE: To evaluate the agreement among instruments of the quantitative evaluation of hard palate. METHODS: This cross-sectional study was performed with a sample of 30 children aged 6 to 11 from Santa Maria, Southern Brazil. The instruments for palate measurements evaluated were: digital caliper, used directly in the oral cavity and in plaster casts, Korkhaus tridimensional bow, used directly in the oral cavity and in plaster casts, and Dolphin Imaging Software used for measurements in cone-beam computed tomography (CBCT). The agreement among different instruments was evaluated using the Intraclass Correlation Coefficient (ICC). RESULTS: The means of all transversal dimensions obtained by cone-beam computed tomography were lower than those of the other instruments - the agreement values in the width between the canines and in the width between the first molars were lower when comparing the cone-beam computed tomography and the other instruments. In the width between the first and second premolars, all comparisons showed acceptable agreement values. Good concordance values were obtained when comparing the palate depth at the second premolar region when using a bow divider inside the oral cavity and in the cast. CONCLUSION: Most instruments presented satisfactory agreement in the measurements related to the transverse plane of the hard palate. However, when the vertical plane was evaluated, only the bow divider applied to both cast and oral cavity presented ideal agreement.

Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: an epidemiological study.

BACKGROUND: Malocclusions are highly prevalent in childhood and adolescence, being considered a public health problem worldwide, in addition to be considered an important predictor in the tongue position and speech disorders. OBJECTIVE: Evaluate the association of malocclusions with tongue position and speech distortion in mixed-dentition schoolchildren from the south of Brazil. METHODOLOGY: This cross-sectional study was performed using a database of an epidemiological survey realized in the southern of Brazil, in 2015, for evaluating the dental and myofunctional condition of the mixed-dentition from 7-13 years' schoolchildren. The outcome variables were tongue position and speech distortion, evaluated by a trained and calibrated examiner. Characteristics regarding sociodemographic and oral health measures (Angle's classification of the malocclusion, overjet, overbite, posterior crossbite and respiratory mode) were also assessed. Poisson regression models with adjusted robust variance were used to evaluate the association among predictors variables in the outcomes. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI). RESULTS: A total of 547 children were evaluated. Schoolchildren who presented anterior open bite (PR 2.36 95%CI 1.59-3.49) and having oral/oral-nasal breathing (RP 2.51 95%CI 1.70-3.71) are more likely to have altered position of the tongue. Both deep bite and being male represent protection factors for the abnormal tongue position. Regarding speech distortion, deep overbite presents a protective relationship to speech distortion (PR 0.41; 95%CI 0.24-0.71), whereas schoolchildren with posterior crossbite were more likely to present this problem (PR 1.77; 95%CI 1.09-2.88). CONCLUSION: Anterior open bite and posterior crossbite were the malocclusions related to speech distortion and/or altered tongue position. Oral/oral-nasal breathing was also related to myofunctional changes. Deep bite malocclusion was a protective factor for both speech problems and altered tongue position when compared to a normal overbite.

Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: an epidemiological study

Abstract Background Malocclusions are highly prevalent in childhood and adolescence, being considered a public health problem worldwide, in addition to be considered an important predictor in the tongue position and speech disorders. Objective Evaluate the association of malocclusions with tongue position and speech distortion in mixed-dentition schoolchildren from the south of Brazil. Methodology This cross-sectional study was performed using a database of an epidemiological survey realized in the southern of Brazil, in 2015, for evaluating the dental and myofunctional condition of the mixed-dentition from 7-13 years' schoolchildren. The outcome variables were tongue position and speech distortion, evaluated by a trained and calibrated examiner. Characteristics regarding sociodemographic and oral health measures (Angle's classification of the malocclusion, overjet, overbite, posterior crossbite and respiratory mode) were also assessed. Poisson regression models with adjusted robust variance were used to evaluate the association among predictors variables in the outcomes. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI). Results A total of 547 children were evaluated. Schoolchildren who presented anterior open bite (PR 2.36 95%CI 1.59-3.49) and having oral/oral-nasal breathing (RP 2.51 95%CI 1.70-3.71) are more likely to have altered position of the tongue. Both deep bite and being male represent protection factors for the abnormal tongue position. Regarding speech distortion, deep overbite presents a protective relationship to speech distortion (PR 0.41; 95%CI 0.24-0.71), whereas schoolchildren with posterior crossbite were more likely to present this problem (PR 1.77; 95%CI 1.09-2.88). Conclusion Anterior open bite and posterior crossbite were the malocclusions related to speech distortion and/or altered tongue position. Oral/oral-nasal breathing was also related to myofunctional changes. Deep bite malocclusion was a protective factor for both speech problems and altered tongue position when compared to a normal overbite.

Nasal patency and otorhinolaryngologic-orofacial features in children / Patência nasal e características otorrinolaringológicas e orofaciais em crianças

Abstract Introduction: Nasal obstruction is a common symptom in childhood, related to rhinitis and pharyngeal tonsil hypertrophy. In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing. Orofacial and otorhinolaryngologic changes are related to this breathing mode. Objective evaluation of upper airways may be obtained through nasal patency measurement. Objective: To compare nasal patency and otorhinolaryngologic-orofacial features in children. Methods: One hundred and twenty three children, 6-12 year-old, and of both sexes underwent speech therapy evaluation, according to Orofacial Myofunctional Evaluation protocol, clinical and endoscopic otorhinolaryngologic examination and nasal patency measurement, using the absolute and predicted (%) peak nasal inspiratory flow values. Results: Lower values of absolute and estimated peak nasal inspiratory flow values were found in children with restless sleep (p = 0.006 and p = 0.002), nasal obstruction report (p = 0.027 and p = 0.023), runny nose (p = 0.004 and p = 0.012), unsystematic lip closure during mastication (p = 0.040 and p = 0.026), masticatory speed reduced (p = 0.006 and p = 0.008) and altered solid food swallowing (p = 0.006 and p = 0.001). Absolute peak nasal inspiratory flow was lower in children with pale inferior turbinate (p = 0.040), reduced hard palate width (p = 0.037) and altered speech (p = 0.004). Higher absolute values were found in children with increased tongue width (p = 0.027) and, higher absolute and predicted (%) in children with mild everted lip (p = 0.008 and p = 0.000). Conclusions: Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. It is also emphasized that most of the children presented signs and symptom of allergic rhinitis.

Resumo Introdução: A obstrução nasal é um sintoma comum na infância relacionado a rinite e hipertrofia das tonsilas faríngeas. Na presença de obstrução nasal, a patência nasal pode estar reduzida e a respiração nasal ser substituída por respiração oral. Alterações orofaciais e otorrinolaringológicas estão relacionadas a esse modo de respiração. A avaliação objetiva das vias aéreas superiores pode ser obtida através da medida da patência nasal. Objetivo: Comparar a patência nasal e características otorrinolaringológicas e orofaciais em crianças. Método: Foram submetidas 123 crianças de seis a 12 anos, de ambos os sexos, a avaliação fonoaudiológica, de acordo com o protocolo de avaliação Miofuncional Orofacial, exame clínico e endoscópico otorrinolaringológico e medição da patência nasal, com o uso do pico de fluxo inspiratório nasal em valores absolutos e valores estimados (% pico de fluxo inspiratório nasal). Resultados: Valores mais baixos de pico de fluxo inspiratório nasal e % pico de fluxo inspiratório nasal foram encontrados em crianças com sono agitado (p = 0,006 e p = 0,002), relato de obstrução nasal (p = 0,027 e p = 0,023), rinorreia (p = 0,004 e p = 0,012), fechamento não sistemático dos lábios durante a mastigação (p = 0,040 e p = 0,026), velocidade mastigatória reduzida (p = 0,006 e p = 0,008) e alteração da ingestão de alimentos sólidos (p = 0,006 e p = 0,001). O pico de fluxo inspiratório nasal foi menor em crianças com conchas inferiores pálidas (p = 0,040), redução da largura do palato duro (p = 0,037) e alterações da fala (p = 0,004). Valores maiores foram encontrados em crianças com largura da língua aumentada (p = 0,027). Valores maiores de pico de fluxo inspiratório nasal e % de pico de fluxo inspiratório nasal foram observados em crianças com lábio levemente evertido (p = 0,008 e p = 0,000). Conclusões: A patência nasal foi menor em crianças com sono agitado, sinais e sintomas de rinite, redução da largura do palato duro e alterações nas funções de mastigação, deglutição e fala. Enfatiza-se também que a maioria das crianças apresentava sinais e sintomas de rinite alérgica.

Nasal patency and otorhinolaryngologic-orofacial features in children.

INTRODUCTION: Nasal obstruction is a common symptom in childhood, related to rhinitis and pharyngeal tonsil hypertrophy. In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing. Orofacial and otorhinolaryngologic changes are related to this breathing mode. Objective evaluation of upper airways may be obtained through nasal patency measurement. OBJECTIVE: To compare nasal patency and otorhinolaryngologic-orofacial features in children. METHODS: One hundred and twenty three children, 6-12 year-old, and of both sexes underwent speech therapy evaluation, according to Orofacial Myofunctional Evaluation protocol, clinical and endoscopic otorhinolaryngologic examination and nasal patency measurement, using the absolute and predicted (%) peak nasal inspiratory flow values. RESULTS: Lower values of absolute and estimated peak nasal inspiratory flow values were found in children with restless sleep (p=0.006 and p=0.002), nasal obstruction report (p=0.027 and p=0.023), runny nose (p=0.004 and p=0.012), unsystematic lip closure during mastication (p=0.040 and p=0.026), masticatory speed reduced (p=0.006 and p=0.008) and altered solid food swallowing (p=0.006 and p=0.001). Absolute peak nasal inspiratory flow was lower in children with pale inferior turbinate (p=0.040), reduced hard palate width (p=0.037) and altered speech (p=0.004). Higher absolute values were found in children with increased tongue width (p=0.027) and, higher absolute and predicted (%) in children with mild everted lip (p=0.008 and p=0.000). CONCLUSIONS: Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. It is also emphasized that most of the children presented signs and symptom of allergic rhinitis.

Do gender and age influence hard palate dimensions? A systematic review. / O gênero e a idade influenciam as dimensões do palato duro? Revisão sistemática da literatura.

PURPOSE: Analyze the influence of gender and age on hard palate dimensions and verify the reference parameters available in the literature. RESEARCH STRATEGIES: Two reviewers independently performed a search at the Cochrane Library, PubMed-Medline and Web of Knowledge databases using descriptors according to the syntax rules of each database. SELECTION CRITERIA: Observational or experimental human studies evaluating the dimensions of the hard palate or maxillary dental arch, with at least one transverse, vertical or sagittal plane measurement, in normal occlusions or class I malocclusions, and comparisons of the dimensions between genders and/or ages. DATA ANALYSIS: Descriptive analysis with the following subdivisions: design, sample, evaluation instruments, measurements in millimeters, and statistical analysis. Quality of the included studies was verified by the Newcastle - Ottawa Quality scale. RESULTS: Eighteen studies were selected and 11 presented results for hard palate or maxillary dental arch dimensions according to gender, six in age and gender and one in age only. CONCLUSION: The dimensions were larger in males and progressive increase in the measurements was observed from birth to the permanent dentition period.

OBJETIVO: Analisar a influência do gênero e da idade nas dimensões do palato duro, bem como verificar os parâmetros de referência disponíveis na literatura. ESTRATÉGIA DE PESQUISA: Dois examinadores realizaram a pesquisa de forma independente nas bases de dados Cochrane Library, PubMed-Medline e Web of Knowledge utilizando os descritores de acordo com as regras de sintaxe de cada banco de dados. CRITÉRIOS DE SELEÇÃO: Estudos em humanos observacionais ou experimentais, que avaliaram as dimensões do palato duro ou do arco dentário maxilar com pelo menos uma mensuração no plano transversal, vertical ou sagital em oclusões normais ou más oclusões classe I e que realizaram comparações das dimensões entre os gêneros e/ou idades. ANÁLISE DE DADOS: Análise descritiva, seguindo subdivisões: delineamento, amostra, instrumentos de avaliação, medidas em milímetros e análise estatística. A qualidade dos estudos incluídos foi verificada através da escala "Newcastle - Ottawa Quality". RESULTADOS: Foram selecionados 18 estudos. Destes, 11 apresentaram resultados das dimensões do palato duro ou do arco dentário maxilar conforme o gênero, seis em idade e gênero e um somente em idade. CONCLUSÃO: As medidas foram maiores no gênero masculino e houve um aumento progressivo nas dimensões do nascimento até o período de dentição permanente.

Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment.

PURPOSE: : This study was conducted to identify variables associated with mouth breathing diagnosis in children, based on multidisciplinary domains. METHODS: 119 children, six to 12 years old, underwent anamnesis, speech therapy (orofacial structures and stomatognathic functions), otorhinolaryngologic (OTRL) with clinical and endoscopic examinations, dental (occlusion) and physiotherapy (body posture and nasal patency) assessments. Nasal patency was evaluated using Peak Nasal Inspiratory Flow (PNIF) and the Nasal Obstruction Symptom Evaluation (NOSE) scale. A multiple logistic regression was performed considering breathing mode as the dependent variable and the co-variables from each multidisciplinary assessment as associated variables. RESULTS: Association with MB diagnosis was found in each professional domain with: nasal obstruction report (Odds ratio - OR=5.55), time of pacifier use (OR=1.25), convex facial type (OR=3.78), obtuse nasal angle (OR=4.30), half-open or open lip posture (OR=4.13), tongue position on the mouth floor (OR=5.88), reduced hard palate width (OR=2.99), unexpected contraction during mastication (OR=2.97), obstructive pharyngeal tonsils (OR=8.37), Angle Class II malocclusion (OR=10.85) and regular gingival maintenance (OR=2.89). CONCLUSION: We concluded that a multidisciplinary diagnosis is important, given that each evaluation domain, including OTRL, dental and speech therapy, presented variables associated with MB diagnosis. Body posture and nasal patency variables were not associated with MB.

Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment / Variáveis associadas ao diagnóstico de respiração oral baseado em uma avaliação multidisciplinar

ABSTRACT Purpose : This study was conducted to identify variables associated with mouth breathing diagnosis in children, based on multidisciplinary domains. Methods 119 children, six to 12 years old, underwent anamnesis, speech therapy (orofacial structures and stomatognathic functions), otorhinolaryngologic (OTRL) with clinical and endoscopic examinations, dental (occlusion) and physiotherapy (body posture and nasal patency) assessments. Nasal patency was evaluated using Peak Nasal Inspiratory Flow (PNIF) and the Nasal Obstruction Symptom Evaluation (NOSE) scale. A multiple logistic regression was performed considering breathing mode as the dependent variable and the co-variables from each multidisciplinary assessment as associated variables. Results Association with MB diagnosis was found in each professional domain with: nasal obstruction report (Odds ratio - OR=5.55), time of pacifier use (OR=1.25), convex facial type (OR=3.78), obtuse nasal angle (OR=4.30), half-open or open lip posture (OR=4.13), tongue position on the mouth floor (OR=5.88), reduced hard palate width (OR=2.99), unexpected contraction during mastication (OR=2.97), obstructive pharyngeal tonsils (OR=8.37), Angle Class II malocclusion (OR=10.85) and regular gingival maintenance (OR=2.89). Conclusion We concluded that a multidisciplinary diagnosis is important, given that each evaluation domain, including OTRL, dental and speech therapy, presented variables associated with MB diagnosis. Body posture and nasal patency variables were not associated with MB.

RESUMO Objetivo Este estudo foi conduzido para identificar as variáveis associadas ao diagnóstico de respiração oral em crianças, baseado nos domínios multidisciplinares. Método Cento e dezenove crianças, de seis a 12 anos, realizaram uma avaliação abrangente composta por uma anamnese e exames fonoaudiológico (estruturas orofaciais e funções estomatognáticas), otorrinolaringológico (avaliação clínica e endoscópica), odontológico (conservação oral e oclusão) e fisioterapêutico (postura corporal e permeabilidade nasal). A permeabilidade nasal foi aferida utilizando-se o Pico de Fluxo Inspiratório Nasal (PFIN) e a escala NOSE (Nasal Obstruction Symptom Evaluation). Foi realizada uma regressão logística múltipla, considerando o modo respiratório como variável dependente e as covariáveis de cada avaliação multidisciplinar como variáveis associadas. Resultados Foi encontrada uma associação do diagnóstico de respiração oral com variáveis de cada domínio profissional: relato de obstrução nasal (Odds ratio - OR=5,55), tempo de uso de chupeta (OR=1,25), tipo facial convexo (OR=3,78), ângulo nasolabial obtuso (OR=4,30), postura de lábios entreabertos e abertos (OR=4,13), postura de língua no assoalho oral (OR=5,88), largura do palato duro reduzida (OR=2,99), contrações inesperadas durante a mastigação (OR=2,97), tonsilas faríngeas obstrutivas (OR=8,37), má oclusão classe II de Angle (OR=10,85) e estado gengival regular (OR=2,89). Conclusão Concluiu-se que o diagnóstico multidisciplinar é importante, uma vez que as avaliações dos domínios fonoaudiológico, otorrinolaringológico e odontológico obtiveram variáveis associadas ao diagnóstico de respiração oral. As variáveis relacionadas à postura corporal e permeabilidade nasal não foram associadas ao diagnóstico de respiração oral.

O gênero e a idade influenciam as dimensões do palato duro? Revisão sistemática da literatura / Do gender and age influence hard palate dimensions? A systematic review

RESUMO Objetivo Analisar a influência do gênero e da idade nas dimensões do palato duro, bem como verificar os parâmetros de referência disponíveis na literatura. Estratégia de pesquisa Dois examinadores realizaram a pesquisa de forma independente nas bases de dados Cochrane Library, PubMed-Medline e Web of Knowledge utilizando os descritores de acordo com as regras de sintaxe de cada banco de dados. Critérios de seleção Estudos em humanos observacionais ou experimentais, que avaliaram as dimensões do palato duro ou do arco dentário maxilar com pelo menos uma mensuração no plano transversal, vertical ou sagital em oclusões normais ou más oclusões classe I e que realizaram comparações das dimensões entre os gêneros e/ou idades. Análise de dados Análise descritiva, seguindo subdivisões: delineamento, amostra, instrumentos de avaliação, medidas em milímetros e análise estatística. A qualidade dos estudos incluídos foi verificada através da escala "Newcastle - Ottawa Quality". Resultados Foram selecionados 18 estudos. Destes, 11 apresentaram resultados das dimensões do palato duro ou do arco dentário maxilar conforme o gênero, seis em idade e gênero e um somente em idade. Conclusão As medidas foram maiores no gênero masculino e houve um aumento progressivo nas dimensões do nascimento até o período de dentição permanente.

ABSTRACT Purpose Analyze the influence of gender and age on hard palate dimensions and verify the reference parameters available in the literature. Research strategies Two reviewers independently performed a search at the Cochrane Library, PubMed-Medline and Web of Knowledge databases using descriptors according to the syntax rules of each database. Selection criteria Observational or experimental human studies evaluating the dimensions of the hard palate or maxillary dental arch, with at least one transverse, vertical or sagittal plane measurement, in normal occlusions or class I malocclusions, and comparisons of the dimensions between genders and/or ages. Data analysis Descriptive analysis with the following subdivisions: design, sample, evaluation instruments, measurements in millimeters, and statistical analysis. Quality of the included studies was verified by the Newcastle - Ottawa Quality scale. Results Eighteen studies were selected and 11 presented results for hard palate or maxillary dental arch dimensions according to gender, six in age and gender and one in age only. Conclusion The dimensions were larger in males and progressive increase in the measurements was observed from birth to the permanent dentition period.

CONSTRUÇÃO DE UMA LINHA DE CUIDADO NEONATAL: PERCEPÇÃO DOS PROFISSIONAIS DA ATENÇÃO BÁSICA À SAÚDE / THE BUILD OF A NEONATAL LINE OF CARE: PRIMARY HEALTH CARE PROFESSIONALS PERSPPECTIVE / CONSTRUCCIÓN DE UNA LÍNEA DE ATENCIÓN NEONATAL: PERCEPCIÓN DE LOS PROFESIONALES DE LA ATENCIÓN PRIMARIA DE SALUD

A linha de cuidado é uma estratégia que visa aos fluxos assistenciais seguros e garantidos ao usuário no Sistema Único de Saúde. O objetivo deste artigo foi analisar a percepção de profissionais da Atenção Básica à Saúde sobre a linha de cuidado neonatal. Realizou-se pesquisa qualitativa. Foram aplicadas entrevistas semiestruturadas a sete enfermeiros e cinco médicos pediatras de Unidades Básicas de Saúde do município de origem. Por meio da análise de conteúdo, emergiram duas categorias: percepção de profissionais sobre a linha de cuidado neonatal e construção da linha de cuidado neonatal. Os resultados mostraram que a Nota de Alta, instrumento utilizado na Unidade de Tratamento Intensivo Neonatal, que visava à continuidade do cuidado, não era efetiva para o que se propunha, uma vez que transferia aos pais a tarefa de buscar o acesso à rede. Também foi possível observar que existia um movimento de busca da comunicação entre os níveis primário e terciário de atenção à saúde. Concluiu- -se que, apesar da fragilidade observada nas redes de atenção no município, os profissionais da Atenção Básica possuíam a compreensão do que era uma linha de cuidado e já adotavam algumas práticas que procuravam o estabelecimento desta junto a um hospital do município.

The line of care is a strategy targeting safe and ensured assistance flow to the Unified Health System user. The objective of this article was to analyze the perception of Primary Health Care professionals on neonatal line of care. Semi-structured interviews with seven nurses and five physicians pediatricians of Basic Health Units from the city of origin were applied. By means of content analysis two categories emerged: perception of neonatal care line professionals and construction of neonatal care line. The results showed that the Discharge Note, an instrument used in the Neonatal Intensive Care Unit, aimed at the continuity of care, wasn't effective for its propose, since it transferred to the parents the task of seeking access to the network. It was also possible to observe that there was a movement to search for communication between the primary and tertiary levels of health care. In conclusion, despite the fragility observed in the care networks in the city, the Basic Care professionals had an understanding of what was a care line and already adopted some practices that sought to establish it alongside a hospital in the municipality.

La línea de atención es una estrategia que busca medios asistenciales seguros y garantizados al usuario en el Sistema Único de Salud. El objetivo de este artículo fue analizar la percepción de los profesionales de la atención primaria de salud sobre la línea de cuidado neonatal. Se realizó una investigación cualitativa. Se aplicaron entrevistas semiestructuradas a siete enfermeras y cinco médicos pediatras de Unidades Básicas de Salud en la ciudad de origen. En el análisis de contenido emergieron dos categorías: la percepción de los profesionales sobre la línea de atención neonatal y la construcción de la línea de cuidado neonatal. Los resultados mostraron que la Nota de Alta, instrumento utilizado en la Unidad de Tratamiento Intensivo Neonatal, que apunta a la continuidad del cuidado, no era efectiva para lo que se proponía, ya que transfería a los padres la tarea de buscar el acceso a la red. También fue posible observar que existía un movimiento de búsqueda de la comunicación entre los niveles primario y terciario de atención a la salud. Se concluyó que, a pesar de la fragilidad observada en las redes de atención en el municipio, los profesionales de la Atención Básica poseían la comprensión de lo que era una línea de cuidado y ya adoptaban algunas prácticas que buscaban el establecimiento de esta junto a un hospital del municipio.

Body posture and pulmonary function in mouth and nose breathing children: cross-sectional study / Postura corporal e função pulmonar em crianças respiradoras orais e nasais: estudo transversal

Abstract Introduction: Mouth breathing can lead to changes in body posture and pulmonary function. However, the consequences are still inconclusive and a number of studies are controversial. Objective: Evaluate and correlate spirometric parameters and postural measures in mouth breathing children, and compare them to nose breathers. Methods: two groups of 6 to 12 year-old children were evaluated: mouth breathers (MB, n = 55) and nose breathers (NB, n = 45). Spirometry and body posture analysis using photogrammetry (SAPo 0.68® v) were carried out. The following spirometric measures were evaluated: peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio (%) and forced expiratory flow between 25% and 75% of FVC (FEF 25-75%). Biophotogrammetric measures analyzed were: horizontal alignment of acromions (HAA) and anterior superior iliac spine (HAASIS), Charpy angle, horizontal alignment of the head (HAH), cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), cervical distance (CD) and lumbar distance (LD). Results: There were no intergroup differences in spirometric and postural variables. Positive and moderate correlations were found between CL and CD measures with PEF, FEV1, FVC and FEF 25-75%, while weak correlations were observed between lumbar lordosis and PEF, FEV1 and FVC. Conclusion: The breathing mode had no influence on postural and respiratory measures. However, greater forward head posture, with smaller cervical lordosis, was related to higher lung volumes and flows in both groups.

Resumo Introdução: A respiração oral pode levar a alterações na postura corporal e na função pulmonar. Entretanto, tais implicações ainda são inconclusivas e alguns estudos são controversos. Objetivo: avaliar e correlacionar parâmetros espirométricos e medidas posturais em crianças respiradoras orais, comparando-as com respiradores nasais. Métodos: foram avaliadas crianças de 6 a 12 anos que compuseram os grupos: respiradores orais (RO, n = 55) e nasais (RN, n = 45). Foram realizadas espirometria e análise da postura corporal, por meio de biofotogrametria (SAPo v 0.68®). As medidas de espirometria utilizadas foram: pico de fluxo expiratório (PFE), volume expiratório forçado no primeiro segundo (VEF1), capacidade vital forçada (CVF), relação VEF1/CVF (%) e fluxo expiratório forçado entre 25% e 75% da CVF (FEF25-75%). As medidas biofotogramétricas analisadas foram: alinhamento horizontal dos acrômios (AHA) e das espinhas ilíacas ântero-superiores (AHEIAS), ângulo de Charpy, alinhamento horizontal da cabeça (AHC), lordose cervical (LC), cifose torácica (CT), lordose lombar (LL), distância cervical (DC) e distância lombar (DL). Resultados: Não houve diferença entre os grupos nas variáveis espirométricas e posturais. Foram encontradas correlações positivas e moderadas entre as medidas posturais LC e DC e as medidas de PFE, VEF1, CVF e FEF25-75%. Ainda, correlações fracas entre DL e PFE, VEF1 e CVF foram encontradas. Conclusão: Na amostra estudada, o modo respiratório não gerou influência nas medidas posturais e respiratórias. Porém, a maior projeção anterior da cabeça com menor lordose cervical se relacionou com maiores volumes e fluxos pulmonares, em ambos os grupos.

Medidas antropométricas orofaciais de crianças segundo o tipo facial / Anthropometric orofacial measurements of children according to facial type

RESUMO Objetivo: avaliar as medidas antropométricas orofaciais segundo o tipo facial de crianças do sexo masculino e feminino. Métodos: participaram do estudo 126 crianças, 64 do sexo feminino e 62 do sexo masculino, com idade entre sete anos e 11 anos. As medidas antropométricas orofaciais foram comparadas entre os tipos faciais obtidos por meio da análise cefalométrica. Inicialmente foi realizada análise descritiva dos tipos faciais de acordo com os sexos. Por meio da Análise de Variância, foi realizada a comparação das medidas antropométricas no sexo masculino e feminino isoladamente e, posteriormente, foi realizada a análise independe do sexo. Os dados foram analisados considerando nível de significância de 5%. Resultados: encontrou-se um número maior de braquifaciais, seguidos de mesofaciais e dolicofaciais na totalidade da amostra. Na comparação das medidas antropométricas entre os três tipos faciais, evidenciou-se no sexo masculino diferença significante na medida de terço facial inferior e no sexo feminino, nas medidas da altura facial, terço inferior e lábio inferior. Quando comparadas as medidas antropométricas de forma independente do sexo, evidenciou-se diferença significante no terço inferior, lados direito e esquerdo da face, lábios superior e inferior. Conclusão: como esperado, nas análises de todos os resultados, considerando ou não os sexos, as medidas antropométricas orofaciais foram menores nos braquifaciais, com maior evidência encontrada nas medidas relacionadas ao plano vertical inferior.

ABSTRACT Purpose: assess anthropometric orofacial measurements of boys and girls according to facial type. Methods: participants were 126 children, 64 girls and 62 boys, aged between seven and 11 years. Anthropometric orofacial measurements were compared between the facial types obtained by cephalometric analysis. Initially, a descriptive analysis of facial types was conducted based on sex. Anthropometric measurements in boys and girls were compared separately by analysis of variance, followed by sex-independent analysis. Data were analyzed considering a significance level of 5%. Results: a larger number of brachyfacial individuals were found in the sample, followed by mesofacial and dolichofacial subjects. Comparison of facial measurements for the three types showed a significant difference in the lower third of the face among boys, and in face height, lower third and lower lip among girls. When anthropometric measurements were compared independently of sex, a significant difference was observed in the lower third, right and left sides of the face, as well as the upper and lower lips. Conclusion: as expected, analyses of all the results, considering sex or not, found lower anthropometric orofacial measurements in brachyfacial individuals, which was most evident in measurements related to the lower vertical plane.

Cardiorespiratory parameters and their relation with gestational age and level of oral feeding skills in preterm infants. / Parâmetros cardiorrespiratórios e sua relação com a idade gestacional e nível de habilidade de alimentação oral de recém-nascido pré-termo.

PURPOSE: To correlate cardiorespiratory parameters with gestational age and level of oral feeding skills in the first oral feeding in preterm infants. METHODS: Study participants were 37 clinically stable preterm infants. Cardiorespiratory rate was assessed before and after introduction of oral feeding. The newborns were divided into three strata according to gestational age at birth. Oral skill was classified into four levels: I - low oral skill and low resistance to feeding; II - low oral skill and high resistance to feeding; III - high oral skill and low resistance to feeding; IV - high oral skill and high resistance to feeding. RESULTS: No difference was observed in heart and respiratory rate between the strata of gestational age at birth and between the levels of oral skill. Comparison between pre- and post-cardiorespiratory rates within each level of oral skill and stratum of gestational age showed difference between heart rate in the strata of gestational ages of 30 to 33 weeks and of 34 to 36 weeks, as well as between oral skill of levels I, II, and IV. With regard to the comparison between pre- and post- respiratory rates, difference was found in the oral skill of level I. CONCLUSION: Differences were observed between pre- and post-prandial cardiorespiratory rates regarding the first oral feeding, as well as between strata of gestational age at birth and levels of oral feeding skills.

Parâmetros cardiorrespiratórios e sua relação com a idade gestacional e nível de habilidade de alimentação oral de recém-nascido pré-termo / Cardiorespiratory parameters and their relation with gestational age and level of oral feeding skills in preterm infants

RESUMO Objetivo Correlacionar os parâmetros cardiorrespiratórios com a idade gestacional e com o nível de habilidade de alimentação oral na introdução da alimentação oral de recém-nascidos pré-termo. Método Participaram desta pesquisa 37 recém-nascidos pré-termo, clinicamente estáveis. A verificação das frequências cardíaca e respiratória foi realizada antes e após a introdução da primeira alimentação por via oral. Os recém-nascidos foram distribuídos em três estratos conforme a idade gestacional do nascimento. A habilidade oral foi classificada em quatro níveis: I - baixa habilidade oral e baixa resistência para alimentação; II - baixa habilidade oral e alta resistência para alimentação; III - alta habilidade oral e baixa resistência para alimentação; IV - alta habilidade oral e alta resistência para alimentação. Resultados Não houve diferença na frequência cardíaca e respiratória entre os estratos da idade gestacional e entre os níveis de habilidade oral. Ao comparar a frequência cardíaca e respiratória inicial e final dentro de cada nível de habilidade oral e estrato da idade gestacional, observou-se diferença entre a frequência cardíaca nos estratos das idades gestacionais entre 30 e 33 semanas e entre 34 e 36 semanas, bem como nos níveis de habilidade oral I, II e IV; com relação à comparação entre a frequência respiratória inicial e final, foi encontrada diferença no nível I de habilidade de alimentação oral. Conclusão As frequências cardíaca e respiratória sofreram alterações quando comparadas com dados pré e pós-prandial na primeira alimentação por via oral, assim como quando comparadas sobre aspectos da idade gestacional e nível de habilidade oral.

ABSTRACT Purpose To correlate cardiorespiratory parameters with gestational age and level of oral feeding skills in the first oral feeding in preterm infants. Methods Study participants were 37 clinically stable preterm infants. Cardiorespiratory rate was assessed before and after introduction of oral feeding. The newborns were divided into three strata according to gestational age at birth. Oral skill was classified into four levels: I - low oral skill and low resistance to feeding; II - low oral skill and high resistance to feeding; III - high oral skill and low resistance to feeding; IV - high oral skill and high resistance to feeding. Results No difference was observed in heart and respiratory rate between the strata of gestational age at birth and between the levels of oral skill. Comparison between pre- and post-cardiorespiratory rates within each level of oral skill and stratum of gestational age showed difference between heart rate in the strata of gestational ages of 30 to 33 weeks and of 34 to 36 weeks, as well as between oral skill of levels I, II, and IV. With regard to the comparison between pre- and post- respiratory rates, difference was found in the oral skill of level I. Conclusion Differences were observed between pre- and post-prandial cardiorespiratory rates regarding the first oral feeding, as well as between strata of gestational age at birth and levels of oral feeding skills.

Assessment for oral feeding in preterm infants. / Avaliação para o início da alimentação oral de recém-nascidos pré-termo.

PURPOSE: To assess the accuracy of the Preterm Oral Feeding Readiness Scale (POFRAS) on the beginning of oral feeding in preterm infants and to verify the concordance between this tool and the Oral Feeding Skill Level. METHODS: 82 preterm infants were assessed by POFRAS regarding their readiness to initiate oral feeding and by the oral feeding skill level evaluation during the first oral feeding. POFRAS's accuracy was estimated regarding proficiency by a Receiver Operating Characteristics (ROC) curve. The concordance between the tools was obtained by analysis of the Kappa coefficient. RESULTS: POFRAS's global accuracy was of 71.29%. The cut-off value of 29 was the one that presented most optimization of the sensitivity based on specificity. The Kappa coefficient has shown a weak concordance between the instruments to identify infants able and unable to oral feeding (k=0.281). CONCLUSION: POFRAS's accuracy to initiate oral feeding considering the proficiency was similar to that obtained with the technique of translactation. We observed a weak concordance between the instruments. We suggest that, in clinical practice, both instruments should be used in a complementary manner, since both present important aspects of the preterm feeding behavior that together will better guide the necessary conduct to provide an effective and quick transition to full oral feeding in this population.