The role of skin-to-skin contact in exclusive breastfeeding: a cohort study.

OBJETIVE: To understand the role of exposure to skin-to-skin contact and its minimum duration in determining exclusive breastfeeding at hospital discharge in infants weighing up to 1,800g at birth. METHODS: A multicenter cohort study was carried out in five Brazilian neonatal units. Infants weighing ≤ 1,800g at birth were eligible. Skin-to-skin contact time was recorded by the health care team and parents on an individual chart. Maternal and infant data was obtained from maternal questionnaires and medical records. The Classification Tree, a machine learning method, was used for data analysis; the tree growth algorithm, using statistical tests, partitions the dataset into mutually exclusive subsets that best describe the response variable and calculates appropriate cut-off points for continuous variables, thus generating an efficient explanatory model for the outcome under study. RESULTS: A total of 388 infants participated in the study, with a median of 31.6 (IQR = 29-31.8) weeks of gestation age and birth weight of 1,429g (IQR = 1,202-1,610). The exclusive breastfeeding rate at discharge was 61.6%. For infant's weighting between 1,125g and 1,655g, exposed to skin-to-skin contact was strongly associated with exclusive breastfeeding. Moreover, infants who made an average > 149.6 min/day of skin-to-skin contact had higher chances in this outcome (74% versus 46%). In this group, those who received a severity score (SNAPPE-II) equal to zero increased their chances of breastfeeding (83% versus 63%). CONCLUSION: Skin-to-skin contact proved to be of great relevance in maintaining exclusive breastfeeding at hospital discharge for preterm infants weighing 1,125g-1,655g at birth, especially in those with lower severity scores.

The role of skin-to-skin contact in exclusive breastfeeding: a cohort study

ABSTRACT OBJETIVE To understand the role of exposure to skin-to-skin contact and its minimum duration in determining exclusive breastfeeding at hospital discharge in infants weighing up to 1,800g at birth. METHODS A multicenter cohort study was carried out in five Brazilian neonatal units. Infants weighing ≤ 1,800g at birth were eligible. Skin-to-skin contact time was recorded by the health care team and parents on an individual chart. Maternal and infant data was obtained from maternal questionnaires and medical records. The Classification Tree, a machine learning method, was used for data analysis; the tree growth algorithm, using statistical tests, partitions the dataset into mutually exclusive subsets that best describe the response variable and calculates appropriate cut-off points for continuous variables, thus generating an efficient explanatory model for the outcome under study. RESULTS A total of 388 infants participated in the study, with a median of 31.6 (IQR = 29-31.8) weeks of gestation age and birth weight of 1,429g (IQR = 1,202-1,610). The exclusive breastfeeding rate at discharge was 61.6%. For infant's weighting between 1,125g and 1,655g, exposed to skin-to-skin contact was strongly associated with exclusive breastfeeding. Moreover, infants who made an average > 149.6 min/day of skin-to-skin contact had higher chances in this outcome (74% versus 46%). In this group, those who received a severity score (SNAPPE-II) equal to zero increased their chances of breastfeeding (83% versus 63%). CONCLUSION Skin-to-skin contact proved to be of great relevance in maintaining exclusive breastfeeding at hospital discharge for preterm infants weighing 1,125g-1,655g at birth, especially in those with lower severity scores.

The effect of kangaroo care on modulate chronic stress response in preterm infants and mothers.

To assess stress experienced during Neonatal Intensive Care Unit (NICU) stay, we analyzed fingernail Cortisol (CORT) and Dehydroepiandrosterone (DHEA) levels and ratios in mothers and preterm infants (PI); compared hormones levels/ratio (CORT and DHEA) in kangaroo care (KC) versus standard care (SC) groups and examined relationships between PI hormone levels total days spent in the NICU. Mothers and their infants were recruited in the NICU, included levels I-IV and kangaroo care unit, within one week of infant birth in hospitals in Brazil. At 3 months after birth, mothers provided 3-month growth clippings from all ten digits of their own and their infants' fingernails. CORT and DHEA were measured using enzyme immunoassays (mothers) and high-performance-liquid-chromatography-with-mass-spectrometry (infants). Sample: n = 59 mothers (KC = 30/SC = 29) and 63 infants (KC = 32/SC = 31). Data were analyzed using non-parametric/parametric comparative statistics. NICU stay ranged from 3-103 days. For mothers in Kangaroo and Standard Care the CORT, DHEA levels and DHEA:CORT ratio (DC) ratio did not differ. Infants in KC had higher DHEA (p = 0.003) and a higher DC ratio (p = 0.011) than SC infants. Even though KC infants stayed in the NICU for a greater number of days than infants in SC, they had higher mean level of DHEA, and DC ratio, suggesting that KC played a role in promoting their stress regulatory capacities and may mitigate toxic effects of chronic hypercortisolemia. However, for mothers, KC did not reduce chronic stress compared to that in women in the SC condition. Further research warranted.

Deficiência de glicose-6-fosfato desidrogenase: frequência, aspectos clínicos e laboratoriais / Deficiency of glucose-6-dehydrogenases phosphate: frequecy, laboratorial and clinic aspects

Foram estudados 181 neonatos a termo, nascidos no serviço de neonatologia do Instituto Materno Infantil de Pernambuco (IMIP), no período de 0l.03.90 à 31.12.90. Determinaçäo da atividade de G.6.PD foi efetuada no sangue do cordäo, utilizando a técnica de reduçäo de metemoglobina. Constatamos 8 casos de enzimopenia (4,42%). Análise dos aspectos clínicos e laboratoriais foi realizada em apenas 7 casos. Todas as mäes dos neonatos com a deficiência foram de cor näo branca e a doença predominou nos recém-nascidos do sexo masculino (71,4%). Em todos os casos o comportamento clínico foi benigno. Icterícia foi observada em 5 casos (71,4%) e ausência da mesma em 2(28,6%). A icterícia foi precoce em apenas 1 caso (20% dos neonatos com icterícia). Anemia e dados laboratoriais de hemólise benigna foram observados em 1 caso (14,28%). Houve indicaçäo de tratamento com fototerapia em somente 1 caso (20%) dos neonatos com enzimopenia e que apresentaram icterícia

Avaliacào do perímetro braquial em recém-nascidos, como método de verificaçao de baixo peso ao nascer / Assessment of newborn ARM circumference as a method of predicting low bithrweight

Os autores estudaram 1 024 recém-nascidos na cidade do Recife com a finalidade de observar a associaçao entre o peso ao nascer e o perímetro braquial. Observaram uma forte correlaçao entre peso e perímetro braquial (R= +0,78). A sensibilidade e especificidade deste paràmetro para detectar baixo peso também foi elevada. Concluem que o perímetro braquial possa ser utilizado como medida antropométrica alternativa para seleccionar pacientes em risco nos lugares onde nào se possa medir corretamente o peso no nascimiento

Avaliacão do perímetro braquial em recém-nascidos, como método de verificaçao de baixo peso ao nascer / Assessment of newborn ARM circumference as a method of predicting low bithrweight

Os autores estudaram 1 024 recém-nascidos na cidade do Recife com a finalidade de observar a associaçao entre o peso ao nascer e o perímetro braquial. Observaram uma forte correlaçao entre peso e perímetro braquial (R= +0,78). A sensibilidade e especificidade deste parãmetro para detectar baixo peso também foi elevada. Concluem que o perímetro braquial possa ser utilizado como medida antropométrica alternativa para seleccionar pacientes em risco nos lugares onde não se possa medir corretamente o peso no nascimiento