Comparison of mortality and survival without major morbidities of very preterm infants with very low birth weight from Japan and Brazil / Comparação entre mortalidade e sobrevida sem morbidades importantes dos recém-nascidos prematuros de muito baixo peso entre o Japão e o Brasil

Abstract Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30-11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32-0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26-15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38-7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25-10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.

RESUMO Objetivo: Este estudo foi realizado para compreender as disparidades na mortalidade e sobrevivência sem as principais morbidades entre recém-nascidos muito prematuros e de muito baixo peso entre Unidades de Terapia Intensiva Neonatal (UTINs) participantes da Rede Brasileira de Pesquisas Neonatais (RBPN) e Rede de Pesquisa Neonatal do Japão (NRNJ). Métodos: Foi realizada uma análise dos dados secundários dos bancos de dados da RBPN e da NRNJ. As pesquisas foram realizadas em 2014 e 2015 e incluíram 187 UTINs. O desfecho primário foi mortalidade ou sobrevida sem qualquer morbidade importante. Utilizou-se a análise de regressão logística com ajuste para os fatores de confusão. Resultados: A população do estudo foi composta por 6.406 recém-nascidos do NRNJ e 2.319 do RBPN. Ajustando para diversos fatores de confusão, os prematuros da RBPN tiveram 9,06 vezes maiores chances de mortalidade (IC95% 7,30-11,29) e menores chances de sobrevivência sem morbidades importantes (AOR 0,36; IC95% 0,32-0,41) em comparação com os da NRNJ. Fatores associados a maiores chances de mortalidade entre as UTINs brasileiras incluíram: síndrome de escape de ar (AOR 4,73; IC95% 1,26-15,27), enterocolite necrosante (AOR 3,25; IC95% 1,38-7,26) e sepse de início tardio (AOR 4,86; IC95% 2,25-10,97). Conclusões: Os recém-nascidos muito prematuros e de muito baixo peso do Brasil apresentaram chances significativamente maiores de mortalidade e menores chances de sobrevivência sem as principais morbidades em comparação aos do Japão. Além disso, identificamos os fatores que aumentam as chances da morte neonatal no Brasil, sendo a maioria relacionada à sepse tardia.

Comparative analysis of pulmonary function in children born preterm and full-term at 6-9 years of age / Análise comparativa da função pulmonar em crianças de 6 a 9 anos de idade nascidas pré-termo e a termo

Abstract Objective: To compare pulmonary function parameters and the prevalence of altered pulmonary function in children born preterm and full-term, using the Global Lung Initiative reference values. Methods: This is a cross-sectional study with 6-9-year-old children submitted to measurement of airway resistance (Rint) and spirometry according to the American Thoracic Society and European Respiratory Society Technical Statement. The inclusion criteria were, among the preterm group: gestational age <37 weeks and birth weight <2000g; among the full-term group: schoolchildren born full-term with birth weight >2500g, recruited at two public schools in São Paulo, Brazil, matched by sex and age with the preterm group. As exclusion criteria, congenital malformations, cognitive deficit, and respiratory problems in the past 15 days were considered. Results: A total of 112 children were included in each group. Preterm children had gestational age of 30.8±2.8 weeks and birth weight of 1349±334g. Among them, 46.6% were boys, 46.4% presented respiratory distress syndrome, 19.6% bronchopulmonary dysplasia, and 65.2% were submitted to mechanical ventilation in the neonatal unit. At study entry, both groups were similar in age and anthropometric parameters. Parameters of pulmonary function (Z scores) in preterm and full-term groups were: Rint (0.13±2.24 vs. -1.02±1.29; p<0.001); forced vital capacity (FVC) (-0.39±1.27 vs. -0.15±1.03; p=0.106), forced expiratory volume in one second (FEV1)/FVC (-0.23±1.22 vs. 0.14±1.11; p=0.003), FEV1 (-0.48±1.29 vs. -0.04±1.08; p=0.071), and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) (1.16±1.37 vs. 2.08±1.26; p=0.005), respectively. The prevalence values of altered airway resistance (16.1 vs. 1.8%; p<0.001) and spirometry (26.8 vs. 13.4%, p=0.012) were higher in preterm infants than in full-term ones. Conclusions: Preterm children had higher prevalence of altered pulmonary function, higher Z scores of airway resistance, and lower Z scores of FEV1/FVC and FEF25-75 compared with those born full-term.

RESUMO Objetivo: Comparar parâmetros de função pulmonar e a prevalência de função pulmonar alterada em crianças nascidas pré-termo e a termo, utilizando a referência Global Lung Function Initiative. Métodos: Estudo transversal com crianças de 6-9 anos submetidas à medida de resistência de vias aéreas (Rint) segundo o American Thoracic Society and the European Respiratory Society Technical Statement. Como critérios de inclusão, entre o grupo pré-termo, estavam os nascidos com idade gestacional <37 semanas e peso <2000g; e entre o grupo termo, escolares de duas escolas públicas do município de São Paulo, nascidos a termo com peso >2500g, pareados por sexo e idade com o grupo pré-termo. Excluíram-se malformações congênitas, déficit cognitivo e problemas respiratórios havia menos de 15 dias. Resultados: Incluíram-se 112 crianças em cada grupo. Os prematuros (46,4% masculinos) apresentaram idade gestacional de 30,8±2,8 semanas e peso de 1349±334g. Entre eles, 46,4% tiveram síndrome de desconforto respiratório, 19,6% displasia broncopulmonar, e 65,2% receberam ventilação mecânica na unidade neonatal. À inclusão no estudo, os dois grupos apresentaram idade e dados antropométricos semelhantes. Os valores (escores Z) em nascidos pré-termo e a termo foram, respectivamente: Rint (0,13±2,24 vs. -1,02±1,29; p<0,001), capacidade vital forçada (CVF) (-0,39±1,27 vs. -0,15±1,03; p=0,106), volume expiratório forçado no primeiro segundo (VEF1)/CVF (-0,23±1,22 vs. 0,14±1,11; p=0,003), VEF1 (-0,48±1,29 vs. -0,04±1,08; p=0,071) e fluxo expiratório forçado em 25-75% da capacidade vital (FEF25-75) (1,16±1,37 vs. 2,08±1,26; p=0,005). A prevalência de alterações na resistência de vias aéreas (16,1 vs. 1,8%, p<0,001) e na espirometria (26,8 vs. 13,4%, p=0,012) foi maior nos prematuros. Conclusões: As crianças nascidas pré-termo apresentaram maior prevalência de alteração pulmonar, maiores escores Z de resistência de vias aéreas e menores escores Z de VEF1/CVF e FEF25-75 quando comparadas às nascidas a termo.

Comparative analysis of pulmonary function in children born preterm and full-term at 6-9 years of age.

OBJECTIVE: To compare pulmonary function parameters and the prevalence of altered pulmonary function in children born preterm and full-term, using the Global Lung Initiative reference values. METHODS: This is a cross-sectional study with 6-9-year-old children submitted to measurement of airway resistance (Rint) and spirometry according to the American Thoracic Society and European Respiratory Society Technical Statement. The inclusion criteria were, among the preterm group: gestational age <37 weeks and birth weight <2000g; among the full-term group: schoolchildren born full-term with birth weight >2500g, recruited at two public schools in São Paulo, Brazil, matched by sex and age with the preterm group. As exclusion criteria, congenital malformations, cognitive deficit, and respiratory problems in the past 15 days were considered. RESULTS: A total of 112 children were included in each group. Preterm children had gestational age of 30.8±2.8 weeks and birth weight of 1349±334g. Among them, 46.6% were boys, 46.4% presented respiratory distress syndrome, 19.6% bronchopulmonary dysplasia, and 65.2% were submitted to mechanical ventilation in the neonatal unit. At study entry, both groups were similar in age and anthropometric parameters. Parameters of pulmonary function (Z scores) in preterm and full-term groups were: Rint (0.13±2.24 vs. -1.02±1.29; p<0.001); forced vital capacity (FVC) (-0.39±1.27 vs. -0.15±1.03; p=0.106), forced expiratory volume in one second (FEV1)/FVC (-0.23±1.22 vs. 0.14±1.11; p=0.003), FEV1 (-0.48±1.29 vs. -0.04±1.08; p=0.071), and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) (1.16±1.37 vs. 2.08±1.26; p=0.005), respectively. The prevalence values of altered airway resistance (16.1 vs. 1.8%; p<0.001) and spirometry (26.8 vs. 13.4%, p=0.012) were higher in preterm infants than in full-term ones. CONCLUSIONS: Preterm children had higher prevalence of altered pulmonary function, higher Z scores of airway resistance, and lower Z scores of FEV1/FVC and FEF25-75 compared with those born full-term.

Comparison of mortality and survival without major morbidities of very preterm infants with very low birth weight from Japan and Brazil.

OBJECTIVE: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). METHODS: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. RESULTS: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30-11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32-0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26-15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38-7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25-10.97). CONCLUSIONS: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.

Pattern of respiratory muscle activity during exercise tests in children born prematurely.

INTRODUCTION: Preterm children display only slightly lower exercise capacity than term children do during their development, despite their previous cardiopulmonary impairments. This raises doubts about the role of the respiratory muscles' influence on exercise capacity. This study aimed to compare respiratory muscle activity in preterm and term children using an exercise test. METHODS: This cross-sectional study involved comparison of 35 term children and 39 matched preterm children aged 6-9 years, who were born prematurely with a birth weight <1500 g. An adapted treadmill incremental test was utilized and surface electromyography of the sternocleidomastoid (SCM), upper trapezius (UT), and rectus abdominis (RA) muscles was performed. The root mean square was calculated every minute and compared between and within groups. A Monte Carlo simulation was also applied, and the area under the curve was calculated to evaluate the differences between groups. RESULTS: During the entire exercise, the SCM muscle activity was higher in preterm children with a larger area under the curve than in the term children. There was no difference in the RA and UT muscle activity between groups throughout the test. CONCLUSION: The results suggest a greater contribution of the SCM muscle sin preterm children's performance than in term children's performance during high-intensity exercises. TRIAL REGISTRATION: Brazilian Clinical Trial Registry (ReBec) - RBR-89hr2h.

Aerobic Capacity of Preterm Children with Very Low Birth Weight at School Age and its Associated Factors / Capacidad aeróbica de niños prematuros de muy bajo peso al nacer y edad escolar y sus factores asociados

INTRODUCTION: Respiratory morbidities of preterm infants can cause significant ventilatory impairment thus compromising the aerobic capacity in childhood and adolescence. Therefore, the present study was conducted to evaluate the aerobic capacity in school age preterm children with VLBW and its associated factors. METHODS: A cross-sectional study was conducted among preterm born with VLBW and term children, both aged 6-9 years. An individualized symptom-limited treadmill testing protocol performed aerobic capacity. Measured variables: oxygen pulse (PuO2), percentage of maximum heart rate for age (%HR max), tidal volume/inspiratory capacity ratio (TV/IC), oxygen consumption (VO2) peak, and the ratio of the anaerobic threshold of gas exchange to the predicted percentage of maximum VO2 (VO2@LA/%VO2 max.pred.) were compared between groups. Univariate and multiple linear regression analyses were used to determine the factors associated with aerobic capacity. RESULTS: Thirty-four preterm and 32 term children were included. Similar VO2 peak and the other variables were observed. The development of bronchopulmonary dysplasia (BPD) and being obese/overweight was positively associated with %HR max. The Z-score for height/age and birth weight < 1000 g was positively associated with PuO2 and peak VO2, and negatively associated with overweight/obesity and female sex. CONCLUSIONS: Aerobic capacity was similar in both groups. Sex, development of BPD, birth weight < 1000 g and factors related to body growth, such as Z-score for height/age and overweight/obesity, were associated with aerobic capacity in preterm children with VLBW

INTRODUCCIÓN: Las enfermedades respiratorias de los niños prematuros pueden causar importantes impedimentos ventilatorios que comprometen la capacidad aeróbica en la infancia y en la adolescencia. El presente estudio se llevó a cabo para evaluar la capacidad aeróbica de niños prematuros en edad escolar de muy bajo peso al nacer (BPN) y los factores asociados. MÉTODOS: Se llevó a cabo un estudio transversal con niños prematuros de muy BPN y con niños a término, ambos grupos con edades comprendidas entre los 6 y 9 años. Las siguientes variables se compararon entre los 2 grupos: el pulso de oxígeno (PuO2), el porcentaje de frecuencia cardíaca máxima (%FC máx.), la relación entre el volumen corriente y la capacidad inspiratoria (TV/IC), el consumo pico de oxígeno (VO2) y la relación entre el umbral anaeróbico de intercambio de gas y el porcentaje estimado de VO2 máximo (VO2@LA/%VO2 máx. pred.). Se llevaron a cabo análisis de regresión lineal univariante y multivariante para determinar los factores asociados con la capacidad aeróbica. RESULTADOS: Se incluyeron 34 niños prematuros y 32 niños a término. Se registraron valores similares de VO2 pico y de otras variables. El desarrollo de displasia broncopulmonar (BPD) y de obesidad/sobrepeso mostró una asociación positiva con el %FC máx. El Z-score para la altura/edad y el peso al nacer < 1.000 g se asoció positivamente con la SaO2 y el VO2 y negativamente con el sobrepeso/obesidad y el sexo femenino. CONCLUSIONES: La capacidad aeróbica fue similar entre los 2 grupos. El sexo, el desarrollo de BPD, peso al nacer < 1.000 g y factores relacionados con el crecimiento corporal, tales como el Z-score para la altura/edad y para el sobrepeso/obesidad se asociaron con la capacidad aeróbica en niños prematuros de muy BPN

Aerobic Capacity of Preterm Children with Very Low Birth Weight at School Age and its Associated Factors.

INTRODUCTION: Respiratory morbidities of preterm infants can cause significant ventilatory impairment thus compromising the aerobic capacity in childhood and adolescence. Therefore, the present study was conducted to evaluate the aerobic capacity in school age preterm children with VLBW and its associated factors. METHODS: A cross-sectional study was conducted among preterm born with VLBW and term children, both aged 6-9 years. An individualized symptom-limited treadmill testing protocol performed aerobic capacity. Measured variables: oxygen pulse (PuO2), percentage of maximum heart rate for age (%HR max), tidal volume/inspiratory capacity ratio (TV/IC), oxygen consumption (VO2) peak, and the ratio of the anaerobic threshold of gas exchange to the predicted percentage of maximum VO2 (VO2@LA/%VO2 max.pred.) were compared between groups. Univariate and multiple linear regression analyses were used to determine the factors associated with aerobic capacity. RESULTS: Thirty-four preterm and 32 term children were included. Similar VO2 peak and the other variables were observed. The development of bronchopulmonary dysplasia (BPD) and being obese/overweight was positively associated with %HR max. The Z-score for height/age and birth weight <1000g was positively associated with PuO2 and peak VO2, and negatively associated with overweight/obesity and female sex. CONCLUSIONS: Aerobic capacity was similar in both groups. Sex, development of BPD, birth weight <1000g and factors related to body growth, such as Z-score for height/age and overweight/obesity, were associated with aerobic capacity in preterm children with VLBW.

Bundle to reduce unplanned extubation in a neonatal intensive care unit.

Objective: To evaluate the effectiveness of a bundle to reduce unplanned extubations (UE) in ventilated newborn infants (NB) and to verify the factors associated to UE.Method: Intervention study with a historical control group in a university hospital neonatal intensive care unit (NICU) between June 2014-May 2015 (Period I) and September 2015-August 2016 (Period II). All ventilated NB were included except those with facial malformations. The bundle (new tracheal tube fixation model, team training, identification of NB at risk of UE, and debriefing after UE episodes) was implemented between Periods I and II. Rates of UE/100 NB ventilated-day were compared between periods for the entire sample and according to the cause: accidental or by medical indication. Factors associated to the first UE episode of each NB were studied by logistic regression.Results: A total of 231 intubations were performed in 120 infants in Period I (gestational age 33.6 ± 4.7 W; birth weight: 2020 ± 929 g) and 212 intubations in 131 infants in Period II (34.2 ± 4.7 W; 2080 ± 997 g). UE occurred in 19.9% and 14.6% of the NB, in Periods I and II, respectively. Accidental extubation and change of the tube by medical indication were observed in 58.7% and 41.3% of UE in Period I and in 51.6% and 48.4% in Period II. Higher birth weight, lower SNAPPE-II score, and daytime period were associated with a lower chance of UE in all newborns.Conclusion: The bundle did not reduce the UE in NB ventilated in NICU but continued control of UE rates is crucial for improved care, especially for immature and critically neonates.What is new about the paper? The study presented a strategy for assessing the causes of unplanned extubations in a Neonatal Intensive Care Unit, considering not only the accidental extubations, but aldo the medical ordered extubations, which contributes to the definition of actions for the reduction of unplanned extubations in the NICU setting.

Association between thoracic musculoskeletal abnormalities and lung function in preterm infants.

INTRODUCTION: In view of the difficulties and risks of performing lung function tests in infants and the hypothesis that children with abnormal pulmonary test may exhibit thoracic musculoskeletal alterations. OBJECTIVES: This study aimed to determine the frequency of abnormal lung function and their relationship. MATERIALS AND METHODS: This was a cross-sectional study with children from 6 to 12 months of corrected age, born at a gestational age of <37 weeks and with a birthweight ≤1500 g, who were subjected to a lung function test and photogrammetry--an objective and non-invasive procedure. To verify the association between the thoracic musculoskeletal abnormalities and measure changes in lung function, univariate linear regression was used. The level of statistical significance was setted at P < 0.05. RESULTS: Of the 38 infants, 12 (31.6%) exhibited abnormal lung function, including 9 (23.7%) with obstructive function and 3 (7.9%) with restrictive function. A significant association was noted between forced expiratory volume at 0.5 second <-2 z score and the acromion/xiphoid process/acromion angle (ß = 4.935); forced vital capacity <-2 z score and the angle of the manubrium/left acromion/trapezium (ß = 0.033) and forced expiratory volume at 0.5 second and forced vital capacity ratio <-2 z score and the inframammillary point/xiphoid process/inframammillary point angle (ß = 0.043). CONCLUSION: Preterm infants with very low birthweight presented a high frequency of abnormal lung function, particularly obstructive type and thoracic musculoskeletal abnormalities were associated with changes in lung function.

Comparative analysis of gross motor coordination between overweight/obese and eutrophic children / Análise comparativa da coordenação motora grossa em crianças com sobrepeso/obesidade e eutróficas / Análisis comparativo de la coordinación motora gruesa en niños con sobrepeso / obesidad y eutróficas

Abstract Introduction: Overweight and obese children may have lower motor coordination score than normal-weight children. Objective: To compare gross motor coordination between overweight/obese and normal-weight children and investigate the associated factors with the motor coordination scores. Method: This cross-sectional study involved 169 children of both genders, aged 6-9 years. Children with malformations, bone, muscle, and joint or neurological disorders, and BMI z < -2 were excluded. Gross motor coordination was assessed by the "Körperkoordinationstest für Kinder" (KTK). The associated factors with the motor coordination scores were analyzed by linear regression. Results: The mean scores for balancing backwards (84.2 ± 13.2 vs. 91.0 ± 15.0), hopping over on one foot (127.9 ± 10.1 vs. 132.3 ± 12.1), shifting platforms sidewise (123.5 ± 23.4 vs. 129.8 ± 14.9), as well as the overall motor scores (112.5 ± 14.8 vs. 118.8 ± 11.6) were significantly lower (p < 0.05) in overweight/obese children when compared to normal-weight children. The percentage of poor motor scores (< 85) in balancing backwards was higher in overweight/obese children (60.4% vs. 36.4%, p = 0.004) and was similar for jumping sideways (18.8% vs. 9.9%, p = 0.116), as well as for shifting platforms sidewise (6.3% vs. 0.8%, p = 0.070). By multiple linear regression analysis, the variables overweight/obesity and sports practice for less than 2 times/week decreased significantly (p < 0.05) the motor coordination score by -18.7 and -15.6 points, respectively. Conclusion: The overweight/obese children scored lower in the motor coordination tests compared to the normal-weight children. Overweight/obesity and low frequency of physical activity were associated with lower scores of gross motor coordination.

Resumo Introdução: Crianças com sobrepeso/obesidade podem ter menores escores de coordenação motora, comparadas às eutróficas. Objetivo: Comparar a coordenação motora grossa entre escolares com sobrepeso/obesidade e eutróficos e analisar os fatores associados aos escores de coordenação motora. Método: Este estudo transversal incluiu crianças de 6-9 anos, de ambos os sexos. Foram excluídas crianças com malformações congênitas, deformidades osteomioarticulares, distúrbios neurológicos ou IMC < -2 escore-z. Avaliou-se a coordenação motora grossa pelos testes Körperkoordinations test für Kinder (KTK). Fatores associados aos escores de coordenação motora foram analisados por regressão linear. Resultado: As médias dos escores na marcha para trás (84,2 ± 13,2 vs. 91,0 ± 15,0), saltos monopedais (127,9 ± 10,1 vs. 132,3 ± 12,1), transferência em plataformas (123,5 ± 23,4 vs. 129,8 ± 14,9) e o escore global dos testes (112,5 ± 14,8 vs. 118,8 ± 11,6) foram significantemente menores (p < 0,05) em crianças com sobrepeso/obesidade, comparadas às eutróficas. A porcentagem de alunos com escore motor deficiente (< 85) foi maior no sobrepeso/obesidade na marcha para trás (60,4% vs. 36,4%, p = 0,004) e semelhantes nos saltos laterais (18,8% vs. 9,9%, p = 0,116) e transferência lateral (6,3% vs. 0,8%, p = 0,070). Na análise de regressão linear múltipla, as variáveis sobrepeso/obesidade e prática de esporte < 2 vezes/semana reduziram significantemente (p < 0,05) o escore motor global em 18,7 e 15,6 pontos, respectivamente. Conclusões: Crianças com sobrepeso/obesidade apresentaram menores escores de coordenação motora que as eutróficas. Sobrepeso/obesidade e baixa frequência de atividade física se associaram a menores escores de coordenação motora grossa.

Resumen Introducción: Niños con sobrepeso/obesidad pueden tener menores escores de coordinación motora, comparados a las eutróficas. Objetivo: Comparar la coordinación motora gruesa entre escolares con sobrepeso/obesidad y eutróficos, y analizar factores asociados a coordinación motora. Método: Este estudio transversal incluyó niños de 6-9 años, de ambos géneros. Se excluyeron: niños con malformaciones congénitas, deformidades osteomioarticulares, trastornos neurológicos o IMC < -2 escore-z. Se evaluó la coordinación motora gruesa por las pruebas Körperkoordinations test für Kinder (KTK). Factores asociados a los escores de coordinación motora fueron analizados por regresión lineal. Resultado: Las medias de los escores en la marcha hacia atrás (84,2 ± 13,2 vs. 91,0 ± 15,0), saltos monopedales (127,9 ± 10,1 vs. 132,3 ± 12,1, transferencia en plataformas (123,5 ± 23,4 vs. 129,8 ± 14,9) y escore global (112,5 ± 14,8 vs. 118,8 ± 11,6) fueron significativamente menores (p < 0,05) en niños con sobrepeso/obesidad, comparados a las eutróficas. El porcentaje de alumnos con escore motor deficiente (< 85) fue mayor en sobrepeso/obesidad en la marcha hacia atrás (60,4% vs. 36,4%, p = 0,004) y similares en los saltos laterales (18,8% vs. 9,9%, p = 0,116) y transferencia lateral (6,3% vs. 0,8%, p = 0,070). En el análisis de regresión lineal múltiple, las variables sobrepeso/obesidad y práctica de deporte < 2 veces/semana redujeron significantemente (p < 0,05) el puntaje motor global en 18,7 y 15,6 puntos, respectivamente. Conclusiones: Niños con sobrepeso/obesidad presentaron menores escores de coordinación motora que las eutróficas. Sobrepeso/obesidad y baja frecuencia de actividad física se asociaron a menores escores de coordinación motora gruesa.

PHOTOGRAMMETRY: A PROPOSAL OF OBJECTIVE ASSESSMENT OF CHEST WALL IN ADOLESCENT IDIOPATHIC SCOLIOSIS.

OBJECTIVE: To evaluate the chest wall shape in patients with adolescent idiopathic scoliosis (AIS) in comparison to healthy subjects and the association between the chest wall shape with the spine deformity and lung function in patients with AIS. METHODS: This cross-sectional study enrolled 30 AIS patients and 20 healthy subjects aged 11-18 years old. The Cobb angle evaluation was performed in AIS patients. The chest wall shape was assessed by the photogrammetry method, using the Postural Assessment Software (PAS). We created thoracic markers shaped as angles (A) and distances (D), as follows: A2 (right acromion/xiphoid/left acromion), A4L (angle formed between the outer point of the smallest waist circumference and its upper and lower edges on the left side), A7 (angle formed by the intersection of the tangent segments of the upper and lower scapulae angles), D1R/D1L [distance between the xiphoid process and the last false rib on the right (R) and left (L) sides], and D3 (distance between xiphoid process and anterior superior iliac spine). RESULTS: The thoracic markers A2 and A7 were significantly higher, while the A4L and D1R/D1L were significantly reduced in the AIS group compared to the control. Moderate correlations were found between: A2 and the main and proximal thoracic Cobb angles (r=0.50, r=0.47, respectively); D1R/D1L and the main thoracic Cobb angle (r=- 0.40); and the forced expiratory volume in the first second (FEV1) and D3R (r=0.47). CONCLUSIONS: The photogrammetry method was able to detect chest wall changes in AIS patients, besides presenting correlation between Cobb angles and lung function.

Photogrammetry: a proposal of objective assessment of chest wall in adolescent idiopathic scoliosis / Fotogrametria: uma proposta de avaliação objetiva da caixa torácica na escoliose idiopática do adolescente

ABSTRACT Objective: To evaluate the chest wall shape in patients with adolescent idiopathic scoliosis (AIS) in comparison to healthy subjects and the association between the chest wall shape with the spine deformity and lung function in patients with AIS. Methods: This cross-sectional study enrolled 30 AIS patients and 20 healthy subjects aged 11-18 years old. The Cobb angle evaluation was performed in AIS patients. The chest wall shape was assessed by the photogrammetry method, using the Postural Assessment Software (PAS). We created thoracic markers shaped as angles (A) and distances (D), as follows: A2 (right acromion/xiphoid/left acromion), A4L (angle formed between the outer point of the smallest waist circumference and its upper and lower edges on the left side), A7 (angle formed by the intersection of the tangent segments of the upper and lower scapulae angles), D1R/D1L [distance between the xiphoid process and the last false rib on the right (R) and left (L) sides], and D3 (distance between xiphoid process and anterior superior iliac spine). Results: The thoracic markers A2 and A7 were significantly higher, while the A4L and D1R/D1L were significantly reduced in the AIS group compared to the control. Moderate correlations were found between: A2 and the main and proximal thoracic Cobb angles (r=0.50, r=0.47, respectively); D1R/D1L and the main thoracic Cobb angle (r=- 0.40); and the forced expiratory volume in the first second (FEV1) and D3R (r=0.47). Conclusions: The photogrammetry method was able to detect chest wall changes in AIS patients, besides presenting correlation between Cobb angles and lung function.

RESUMO Objetivo: Avaliar o formato da caixa torácica em pacientes com escoliose idiopática do adolescente (EIA), comparando-os com indivíduos saudáveis e analisar a associação do formato da caixa torácica com a deformidade da coluna vertebral e função pulmonar em pacientes com EIA. Métodos: Estudo transversal que avaliou 30 pacientes com EIA e 20 indivíduos saudáveis com idade entre 11 e 18 anos. O ângulo de Cobb foi avaliado em pacientes com EIA. O formato da caixa torácica foi analisado pelo método da fotogrametria, utilizando o Software para Avaliação Postural (SAPO). Foram criados marcadores torácicos descritos como ângulos (A)e distâncias (D): A2 (acrômio direito/processo xifoide/acrômio esquerdo), A4E (ângulo formado entre o ponto externo da menor circunferência da cintura e suas bordas superior e inferior do lado esquerdo), A7 (ângulo formado pela interseção das retas tangentes aos ângulos superior e inferior das escápulas), D1D/D1E [distância entre o processo xifoide e a última costela falsa nos lados direito (D) e esquerdo (E)] e D3 (distância entre o processo xifoide e a espinha ilíaca anterossuperior). Resultados: Os marcadores torácicos A2 e A7 foram significativamente maiores, enquanto o A4E e o D1D/D1E foram significativamente menores no grupo EIA em relação ao controle. Foram encontradas correlações moderadas entre: A2 e os ângulos de Cobb torácico principal e proximal (r=0,50 e r=0,47, respectivamente); D1D/D1E e o ângulo de Cobb torácico principal (r=-0,40); e o volume expiratório forçado no primeiro segundo (VEF1) e D3D (r=0,47). Conclusões: O método da fotogrametria detectou alterações na caixa torácica de pacientes com EIA, além de apresentar correlações significativas entre os ângulos de Cobb e a função pulmonar.

Association between preterm birth and thoracic musculoskeletal static alterations in adolescents.

OBJECTIVE: To compare thoracic musculoskeletal static alterations in adolescents born prematurely with those born at term and investigate neonatal and post-neonatal variables associated with thoracic alterations. METHOD: This is a cross-sectional study with 57 adolescents aged 10-15 years born prematurely and 57 adolescents born at term paired by gender and age. Photographs of the head and thorax in the front, back, and right side views were studied using a computer program. The two groups were compared in regards to: elevation of clavicles, elevation of shoulders, protrusion of the head, and anteroposterior and mediolateral thoracic length. Factor associated with thoracic disorders were evaluated by linear regression analysis. RESULTS: The Preterm group had mean gestational age of 32.0±2.8 weeks and the birth weight was 1462±338 and 3342±430 g for the Preterm and Term adolescents, respectively. Preterm adolescents had higher elevation of the left shoulder (22.7±5.4° vs. 20.6±5.3°;sim, p=0.038) and the right shoulder (22.2±4.4° vs. 18.5±5.7°; p<0.001). Smaller protrusion of the head (27.8±6.1° vs. 32.4±7.9°; p=0.008), mediolateral thoracic length (22.9±2.3 cm vs. 25.1±3.1 cm; p<0.001) and anteroposterior thoracic length (19.7±2.2 cm vs. 21.1±3.4 cm; p<0.001) were found in preterm adolescents. By multiple regression analysis, factors associated with higher shoulder elevation were birth weight <1500 g (p<0.001) and mechanical ventilation during neonatal period >5 days (p=0.009). CONCLUSION: Adolescents born prematurely presented greater thoracic musculoskeletal static alterations compared to those born at term. Factors associated with these alterations were: very low birth weight and longer duration of mechanical ventilation in the neonatal unit.

Association between preterm birth and thoracic musculoskeletal static alterations in adolescents

OBJECTIVE: To compare thoracic musculoskeletal static alterations in adolescents born prematurely with those born at term and investigate neonatal and post-neonatal variables associated with thoracic alterations. METHOD: This is a cross-sectional study with 57 adolescents aged 10-15 years born prematurely and 57 adolescents born at term paired by gender and age. Photographs of the head and thorax in the front, back, and right side views were studied using a computer program. The two groups were compared in regards to: elevation of clavicles, elevation of shoulders, protrusion of the head, and anteroposterior and mediolateral thoracic length. Factor associated with thoracic disorders were evaluated by linear regression analysis. RESULTS: The Preterm group had mean gestational age of 32.0±2.8 weeks and the birth weight was 1462±338 and 3342±430 g for the Preterm and Term adolescents, respectively. Preterm adolescents had higher elevation of the left shoulder (22.7±5.4o vs. 20.6±5.3o;sim, p=0.038) and the right shoulder (22.2±4.4o vs. 18.5±5.7o; p<0.001). Smaller protrusion of the head (27.8±6.1o vs. 32.4±7.9o; p=0.008), mediolateral thoracic length (22.9±2.3 cm vs. 25.1±3.1 cm; p<0.001) and anteroposterior thoracic length (19.7±2.2 cm vs. 21.1±3.4 cm; p<0.001) were found in preterm adolescents. By multiple regression analysis, factors associated with higher shoulder elevation were birth weight <1500 g (p<0.001) and mechanical ventilation during neonatal period >5 days (p=0.009). CONCLUSION: Adolescents born prematurely presented greater thoracic musculoskeletal static alterations compared to those born at term. Factors associated with these alterations were: very low birth weight and longer duration of mechanical ventilation in the neonatal unit. .

Tubing length for long-term oxygen therapy.

BACKGROUND: Most patients on long-term oxygen therapy use stationary oxygen delivery systems. It is not uncommon for guidelines to instruct patients to use tubing lengths no longer than 19.68 ft (6 m) when using an oxygen concentrator and 49.21 ft (15 m) when using cylinders. However, these concepts are not based on sufficient evidence. Thus, our objective was to evaluate whether a 98.42-ft (30-m) tubing length affects oxygen flow and FIO2 delivery from 1 cylinder and 2 oxygen concentrators. METHODS: The 3 oxygen delivery systems were randomly selected, and 1, 3, and 5 L/min flows and FIO2 were measured 5 times at each flow at the proximal and distal outlets of the tubing by a gas-flow analyzer. Paired Student t test was used to analyze the difference between flows and FIO2 at proximal and distal outlets of tubing length. RESULTS: A total of 45 flows were measured between proximal and distal outlets of the 98.42-ft (30-m) tubing. Flows were similar for 1 and 3 L/min, but distal flow was higher than proximal flow at 5 L/min (5.57×5.14 L/min, P<.001). FIO2 was lower at distal than proximal outlet tubing at flows 1, 3, and 5 L/min, but the mean difference between measurements was less than 1%. CONCLUSIONS: Tubing length of 98.42 ft (30 m) may be used by patients for home delivery oxygen with flows up to 5 L/min, as there were no important changes in flows or FIO2.

[Availability of physical therapy assistance in neonatal intensive care units in the city of São Paulo, Brazil]. / Disponibilidade de assistência fisioterapêutica em unidades de terapia intensiva neonatal na cidade de São Paulo.

OBJECTIVE: To describe the characteristics of physical therapy assistance to newborns and to provide a profile of physical therapists working in intensive care units in the city of São Paulo, Brazil. METHODS: This cross-sectional study was conducted in every hospital in São Paulo city that had at least one intensive care unit bed for newborns registered at the National Registry of Health Establishments in 2010. In each unit, three types of physical therapists were included: an executive who was responsible for the physical therapy service in that hospital (chief-physical therapists), a physical therapist who was responsible for the physical therapy assistance in the neonatal unit (reference-physical therapists), and a randomly selected physical therapist who was directly involved in the neonatal care (care-physical therapists). RESULTS: Among the 67 hospitals eligible for the study, 63 (94.0%) had a physical therapy service. Of those hospitals, three (4.8%) refused to participate. Thus, 60 chief-PTs, 52 reference-physical therapists, and 44 care-physical therapists were interviewed. During day shifts, night shifts, and weekends/holidays, there were no physical therapists in 1.7%, 45.0%, and 13.3% of the intensive care units, respectively. Physical therapy assistance was available for 17.8±7.2 hours/day, and each physical therapist cared for 9.4±2.6 newborns during six working hours. Most professionals had completed at least one specialization course. CONCLUSION: Most neonatal intensive care units in the city of São Paulo had physical therapists working on the day shift. However, other shifts had incomplete staff with less than 18 hours of available physical therapy assistance per day.

Disponibilidade de assistência fisioterapêutica em unidades de terapia intensiva neonatal na cidade de São Paulo / Availability of physical therapy assistance in neonatal intensive care units in the city of São Paulo, Brazil

Objetivo: Descrever as características da assistência fisioterapêutica prestada a neonatos e delinear o perfil dos fisioterapeutas que trabalham em unidades de terapia intensiva na cidade de São Paulo. Métodos: Estudo transversal realizado em todos os hospitais da cidade de São Paulo que tinham registro de pelo menos um leito de terapia intensiva para neonatos, segundo o Cadastro Nacional de Estabelecimentos de Saúde em 2010. Em cada unidade, foram incluídos três categorias de fisioterapeutas: um executivo, responsável pelo serviço de fisioterapia do hospital (chefe da fisioterapia); um fisioterapeuta responsável pela assistência fisioterapêutica na unidade neonatal (fisioterapeuta de referência); e um selecionado ao acaso e diretamente envolvido no cuidado ao recém-nascido (fisioterapeuta assistencial). Resultados: Dentre os 67 hospitais elegíveis para o estudo, 63 (94,0%) dispunham de um serviço de fisioterapia. Três (4,8%) desses hospitais recusaram-se a participar. Assim, foram entrevistados 60 chefes da fisioterapia, 53 fisioterapeutas de referência e 44 fisioterapeutas assistenciais. Durante os turnos diurnos, noturnos e de finais de semana/feriados, respectivamente, não havia fisioterapeutas disponíveis em 1,7%, 45,0% e 13,3% das unidades de terapia intensiva. A assistência fisioterapêutica estava disponível por 17,8±7,2 horas/dia, e cada fisioterapeuta cuidava de 9,4±2,6 neonatos durante um turno de 6 horas. A maioria dos profissionais havia concluído pelo menos um curso de especialização. Conclusão: A maioria as unidades de terapia intensiva neonatal da cidade de São Paulo tinha fisioterapeutas atuando durante o turno diurno. Entretanto, os demais turnos tinham equipes incompletas e menos de 18 horas de assistência fisioterapêutica disponível ao dia. .

Objective: To describe the characteristics of physical therapy assistance to newborns and to provide a profile of physical therapists working in intensive care units in the city of São Paulo, Brazil. Methods: This cross-sectional study was conducted in every hospital in São Paulo city that had at least one intensive care unit bed for newborns registered at the National Registry of Health Establishments in 2010. In each unit, three types of physical therapists were included: an executive who was responsible for the physical therapy service in that hospital (chief-physical therapists), a physical therapist who was responsible for the physical therapy assistance in the neonatal unit (reference-physical therapists), and a randomly selected physical therapist who was directly involved in the neonatal care (care-physical therapists). Results: Among the 67 hospitals eligible for the study, 63 (94.0%) had a physical therapy service. Of those hospitals, three (4.8%) refused to participate. Thus, 60 chief-PTs, 52 reference-physical therapists, and 44 care-physical therapists were interviewed. During day shifts, night shifts, and weekends/holidays, there were no physical therapists in 1.7%, 45.0%, and 13.3% of the intensive care units, respectively. Physical therapy assistance was available for 17.8±7.2 hours/day, and each physical therapist cared for 9.4±2.6 newborns during six working hours. Most professionals had completed at least one specialization course. Conclusion: Most neonatal intensive care units in the city of São Paulo had physical therapists working on the day shift. However, other shifts had incomplete staff with less than 18 hours of available physical therapy assistance per day. .

Functional capacity during exercise in very-low-birth-weight premature children.

OBJECTIVES: The functional capacity of children born prematurely with very-low-birth weight was compared with that of children born at full-term using the six-minute walk test (6MWT) and the ten-minutes shuttle walk test (10MSWT). The factors affecting walking distance were analyzed. METHODS: A cross-sectional study was conducted with two groups of children aged 6-9 years, matched by sex and age. One group included children born before 37 weeks of gestation weighing <1,500 g and the second group included children born at term. Both groups were submitted to the 6MWT and 10MWST, performed on the same day with an interval of 20 min between tests and the sequence of the tests was randomized, by sealed-envelope technique. Physiological parameters were measured at the beginning and end of each test. The walking distance and factors affecting the walking distance were analyzed. RESULTS: Thirty-seven children born prematurely and 37 born at term were studied. The premature children walked shorter distances in the 6MWT (480.9 ± 80.5 m vs. 518.3 ± 51.8 m, P = 0.010) than term children, and both groups walked similar distances in the 10MSWT (391.5 ± 99.0 m vs. 406.1 ± 79.2 m, P = 0.487). By multiple linear regression analysis, adjusted for confounders, walking distance was associated with height (OR: 3.6) and oxygen dependency at 28 days (OR: -67.7) in the 6MWT (P < 0.001) and with height (OR: 4.9) and oxygen dependency at 28 days (OR: -91.0) in the 10MSWT (P < 0.001). CONCLUSION: In conclusion, this study suggests that children born prematurely with very low birth weight, especially those who had bronchopulmonary dysplasia present limited functional capacity during exercise.

Early nasal injury resulting from the use of nasal prongs in preterm infants with very low birth weight: a pilot study.

OBJECTIVE: To analyze the incidence of early-onset nasal injury in infants with very low birth weight and indication for noninvasive ventilation via nasal prongs. METHODS: A prospective case series of infants with gestational age <37 weeks, weight <1.500 g and postnatal age <29 days. The patients were evaluated three times daily from the installation of nasal prongs to the 3rd day of use. The patients' clinical conditions and the device's characteristics and its application were analyzed. The initial analysis was descriptive, indicating the prevalence of nasal injury and factors associated with it. Categorical data were analyzed using the chi-squared test or Fisher's exact test, and numerical data were analyzed using the t-test or the Mann-Whitney test. RESULTS: Eighteen infants were included; 12 (with a gestational age of 29.8 ± 3.1 weeks, birth weight of 1.070 ± 194 g and a Score for Neonatal Acute Physiology - Perinatal Extension (SNAPPE) of 15.4 ± 17.5) developed nasal injuries (injury group), and 6 (with a gestational age of 28.0 ± 1.9 weeks, weight of 1.003 ± 317 g and SNAPPE of 26.2 ± 7.5) showed no nasal injury (uninjured group). The injury group subjects were more often male (75% versus 17%), and their injuries appeared after an average of 18 hours, predominantly during the night (75%). CONCLUSION: The incidence of nasal injury in preterm infants who experienced noninvasive ventilation via nasal prongs was high, and a study of associated factors may be planned based on this pilot.