Umbilical cord separation time, predictors and healing complications in newborns with dry care.

OBJECTIVE: The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old. DESIGN: A quantitative longitudinal observational analytical study by stratified random sample was adopted. SETTING: Public health system hospitals in southern Spain and at newborns' homes. PARTICIPANTS: Between April 2016 and December 2017, the study included 106 neonates born after 35-42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy. METHODS: The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller. RESULTS: The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16-7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R2 = 0.439 F: 15.361, p <0.01). CONCLUSION: The findings support the World Health Organization recommendations: dry umbilical cord cares is a safe practice that soon detaches the umbilical cord, taking into account the factors studied that will vary the length of time until the umbilical cord is separated.

Dry care versus chlorhexidine cord care for prevention of omphalitis. Systematic review with meta-analysis / Cura a seco versus cura com clorexidina para prevenção da onfalite. Revisão sistemática com metanálise / Cura seca frente a cura con clorhexidina para prevención de onfalitis. Revisión sistemática con metaanálisis

ABSTRACT Objective: to compare the effect of dry care and the application of chlorhexidine to the umbilical cord of newborns at risk of developing omphalitis. Method: systematic review with meta-analysis. Clinical trials comparing dry care with the application of clorexidine to evaluate omphalitis were selected. Methodological quality was evaluated using the Consolidated Standards of Reporting Trials. Results: the joint analysis of the studies shows a significant decrease in the risk of omphalitis in the chlorhexidine group compared to the dry care group (RR=0.58, CI: 0.53-0.64). However, in the analysis by subgroups, chlorhexidine umbilical cord care did not reduce the risk of omphalitis in hospital births (RR=0.82, CI: 0.64-1.05), in countries with a low infant mortality rate (RR=0.8, CI: 0.5-1.28), or at chlorhexidine concentrations below 4% (RR=0.55, CI: 0.31-1). Chlorhexidine acted as a protective factor at a concentration of 4% (RR=0.58, CI: 0.53-0.64), when applied in cases of home births (RR=0.57, CI: 0.51-0.62), in countries with a high infant mortality rate (RR=0.57, CI: 0.52-0.63). Conclusion: dry cord care is effective in countries with low infant mortality rate and in hospital births. However, 4% chlorhexidine for umbilical cord care protects against omphalitis in home births, in countries with a high infant mortality rate.

RESUMO Objetivo: comparar o efeito da cura a seco e da aplicação de clorexidina no cordão umbilical de recém-nascidos em risco de desenvolver onfalite. Método: revisão sistemática com metanálise. Foram selecionados os ensaios clínicos que comparavam a cura a seco com a aplicação de clorexidina para avaliar a onfalite. A qualidade metodológica foi avaliada com Consolidated Standards of Reporting Trials. Resultados: a análise conjunta dos estudos mostra uma redução significativa do risco de onfalite no grupo da clorexidina em comparação com a cura a seco (RR=0,58; IC 0,53-0,64). Entretanto, na análise por subgrupos, a cura com clorexidina não reduziu o risco de onfalite em nascimentos hospitalares (RR=0,82; IC: 0,64-1,05), nos países com baixa taxa de mortalidade infantil (RR=0,8; IC: 0,5-1,28), ou com concentrações de clorexidina abaixo de 4% (RR=0,55; IC: 0,31-1). A clorexidina atuou como fator de proteção na concentração de 4% (RR=0,58; IC: 0,53-0,64), aplicada em nascimentos no domicílio (RR=0,57; IC: 0,51-0,62), em países com taxas de mortalidade infantil elevadas (RR=0,57; IC: 0,52-0,63). Conclusão: a cura a seco é eficaz em países com baixa taxa de mortalidade infantil e em nascimentos no contexto hospitalar. No entanto, a cura com clorexidina 4% protege contra a onfalite nos nascimentos domiciliares, em países com elevada mortalidade infantil.

RESUMEN Objetivo: comparar el efecto de la cura seca y de la aplicación de clorhexidina en el cordón umbilical de los recién nacidos en el riesgo de desarrollo de onfalitis. Método: revisión sistemática con metaanálisis. Se seleccionaron ensayos clínicos que compararan la cura seca con la aplicación de clorhexidina evaluando la onfalitis. Calidad metodológica evaluada con Consolidated Standards of Reporting Trials. Resultados: el análisis conjunto de los estudios muestra una reducción significativa del riesgo de onfalitis en el grupo de clorhexidina en comparación con cura seca (RR=0,58; IC: 0,53-0,64). Sin embargo, en el análisis por subgrupos, la cura con clorhexidina no aportó reducción del riesgo de onfalitis en nacimientos hospitalarios (RR=0,82; IC: 0,64-1,05) en países con baja tasa de mortalidad infantil (RR=0,8; IC: 0,5-1,28), ni a concentraciones de clorhexidina inferiores al 4% (RR=0,55; IC: 0,31-1). La clorhexidina actuó como factor protector a concentraciones del 4% (RR=0,58; IC: 0,53-0,64), aplicada en nacimientos en el hogar (RR=0,57; IC: 0,51-0,62), en países con elevada mortalidad infantil (RR=0,57; IC: 0,52-0,63). Conclusión: la cura seca es eficaz en países con baja tasa de mortalidad infantil y nacimientos en ámbito hospitalario. Sin embargo, la cura con clorhexidina al 4% protege de onfalitis en nacimientos en el hogar, en países con elevada mortalidad infantil.

Enfermedad de von Willebrand y proceso de trabajo de parto / Von Willebrand disease and the labor process

El reconocimiento y tratamiento de los trastornos hematológicos que se producen durante el embarazo es difícil debido a la escasez de pruebas disponibles para guiar a los especialistas. La enfermedad de von Willebrand es el problema de coagulación más frecuente, causado por una deficiencia del factor de von Willebrand. Se expone el caso de una gestante de 33 años que comenzó su proceso de trabajo de parto pendiente de confirmar si sufría esta enfermedad, por lo que se le prestaron los cuidados pertinentes tanto en el intraparto como en el postparto inmediato en la unidad. El manejo exitoso de situaciones como estas implica el reconocimiento rápido de la hemorragia postparto para evitar posibles complicaciones que pueden alterar tanto el bienestar fetal como materno

It is difficult to identify and treat those haematological disorders developed during pregnancy, because there are not many tests available to guide specialists. Von Willbrand Disease is the most frequent coagulation problem, caused by a deficit in Von Willebrand Factor. We present the case of a 33-year-oldpregnant woman who started her labor process pending confirmation of whether she suffered this disease, and therefore she was provided with the relevant care both during labor and in the immediate post-labor stage at the Labor &Delivery Unit. The successful management of this type of situations involves a fast identification of post-labor bleeding in order to prevent any potential complications which might alter the wellbeing of both foetus and mother

Ortorexia: de sana inquietuda patología / Orthorexia: from a healthy concern to a pathology

La tendencia de culto al cuerpo y trastornos alimentarios sonhechos evidentes en la sociedad occidental actual, en la que seha interiorizado que un buen aspecto físico y salud son sinónimosde felicidad y por extensión, las personas se sientenatraídas por todas las actividades y productos saludables. Dela mano viene un emergente trastorno alimentario: la ortorexia,donde se manifiesta una preocupación patológica por ladieta sana. En España, actualmente, se desconoce la prevalenciade este trastorno ya que es un fenómeno muy novedoso,aunque algunos especialistas apuntan que entre sus visitashan tenido entre un 0,5 y 1% de pacientes ortoréxicos. El trastornose da fundamentalmente por factores socioculturales, yaque la hipótesis de conseguir alimentos totalmente naturalesen las “sociedades modernas” son casi nulas, incidiendo en laemergente proyección de los problemas mentales en trastornosendocrinos. El presente artículo analiza el problema desdesus orígenes, así como la prevalencia y grupos de riesgo, parapasar a ver las características y efectos de esta adicción (AU)

The tendency to worship the body and eating disorders are evidentfacts in today’s Western countries in which people have putinto their minds that having a good physical appearance and enjoyinga good health are the formula to reach happiness andas a result people feel attracted towards all healthy activities andproducts. Hand in hand with that comes an eating disorderknown as orthorexia. This disease is characterised by an excessivefocus on eating healthy foods. The prevalence of thisdisorder is currently unknown in Spain as it a rather rare andnew phenomena. Some specialist estimate that from 0.5 to 1%of their total number of visits have been with orthorexic patients.The disorder is based on sociocultural factors as the hypothesisto get completely natural products in today’s modernsocieties is practically nil.This fixation has a direct impact on the emerging association betweenmental problems and endocrine disorders. This paperdepicts the problem from its origin and establishes its prevalenceand the groups at risk. It also describes the characteristicsand effects of this “addiction” to the consumption of healthyfoods (AU)

Cuidar con risa y humor / Caring with laughs and good humour

Risa y salud son dos conceptos sobre los que históricamente se intuye relación.La ciencia está demostrando que el humor y la risa pueden ser elementos muy positivos:reír es saludable para la salud física, psicológica, social y espiritual.El presente artículo tiene como propósito hacer una recorrido sobre el origen y laevolución de la risoterapia, así como sobre la evidencia científica en torno a losefectos de la risa, para pasar a exponer sus indicaciones y por último cómo la risay el humor podrían formar parte de los cuidados enfermeros.En nuestro ámbito, la aplicación de la risa y el humor se debe hacer de forma inteligentey en el momento adecuado, creando un marco beneficioso para la relaciónterapéutica y siendo a su vez una poderosa modalidad terapéutica que ayudaa otras formas de terapia. Por nuestra cercanía con el paciente, es la enfermerala pieza clave para su uso

Laughing and health are two concepts historically thought to be interrelated. Scienceis demonstrating that good humour and laughing can be very positive elements:laughing is healthy for our physical, psychological social and spiritual health.The aim of this article is to present a retrospective examination on the origin andevolution of “laughter therapy” and to present the available scientific evidence onthe effects of laughing, with a description its indications. A second aim is to describehow laughing and good humour could become a part of nursing care.In our setting, the application of laughing and good hum or must be carried out in anintelligent manner and at the right time, creating a beneficial framework for the therapeuticrelationship and constituting a powerful therapeutic tool that reinforces otherforms of therapy. Given the closeness established between patient and nurse, it is thenurse who holds the key for the implementation of this therapeutic modality

Cuidar con risa y humor. Cuidar con risa y humor / Caring with laughs and good humour

Risa y salud son dos conceptos sobre los que históricamente se intuye relación. La ciencia está demostrando que el humor y la risa pueden ser elementos muy positivos: reír es saludable para la salud física, psicológica, social y espiritual. El presente artículo tiene como propósito hacer una recorrido sobre el origen y la evolución de la risoterapia, así como sobre la evidencia científica en torno a los efectos de la risa, para pasar a exponer sus indicaciones y por último cómo la risa y el humor podrían formar parte de los cuidados enfermeros. En nuestro ámbito, la aplicación de la risa y el humor se debe hacer de forma inteligente y en el momento adecuado, creando un marco beneficioso para la relación terapéutica y siendo a su vez una poderosa modalidad terapéutica que ayuda a otras formas de terapia. Por nuestra cercanía con el paciente, es la enfermera la pieza clave para su uso

Laughing and health are two concepts historically thought to be interrelated. Science is demonstrating that good humour and laughing can be very positive elements: laughing is healthy for our physical, psychological social and spiritual health. The aim of this article is to present a retrospective examination on the origin and evolution of “laughter therapy” and to present the available scientific evidence on the effects of laughing, with a description its indications. A second aim is to describe how laughing and good humour could become a part of nursing care. In our setting, the application of laughing and good hum or must be carried out in an intelligent manner and at the right time, creating a beneficial framework for the therapeutic relationship and constituting a powerful therapeutic tool that reinforces other forms of therapy. Given the closeness established between patient and nurse, it is the nurse who holds the key for the implementation of this therapeutic modality