Impact of resuscitation training program on neonatal outcomes in a region of high socioeconomic vulnerability in Brazil: an interventional study.

OBJECTIVES: This pre/post-intervention study aimed to evaluate neonatal outcomes after the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. METHOD: This interventional study was conducted across five secondary healthcare regions that supported 62 cities in the southwestern mesoregion of Piauí. It included 431 healthcare professionals responsible for neonatal care in the study region. The participants were trained in neonatal resuscitation through the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Delivery room structuring, healthcare professionals' knowledge, and neonatal care outcomes were analyzed immediately before and after intervention and after 12 months between February 2018 and March 2019, and healthcare professionals were evaluated. RESULTS: Training was conducted for over 106 courses. As a participant could take multiple courses, 700 training sessions were conducted. Regarding delivery room structuring, the acquisition of materials required for resuscitation increased from 28.4 to 80.6% immediately after the intervention and to 83.3% after 12 months. Knowledge retention was significant in the post-training period, with a 95.5% approval rate, and knowledge acquisition was satisfactory after 12 months. The number of newborns transferred during the study period increased significantly. A 72.6% reduction in mortality at birth was recorded, and 479 newborns were resuscitated. CONCLUSION: Following the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, structural improvements in delivery rooms, adequate knowledge retention regarding neonatal resuscitation, and a consequent reduction in neonatal mortality were observed.

Factors associated with skin-to-skin contact less than 180 min/day in newborns weighing up to 1,800 g: multicenter study.

This article aims to evaluate the factors associated with a skin-to-skin contact time <180 min/day in newborns weighing up to 1,800 g during neonatal hospitalization. Prospective observational cohort study conducted in neonatal units of reference for the Kangaroo Method in Brazil. Data from 405 dyads (mother/child) were analyzed from May 2018 to March 2020. Maternal and neonatal explanatory variables were collected from medical records and interviews. Skin-to-skin contact was recorded in forms posted at the bedside, filled out by parents and staff. The outcome variable was the mean time of skin-to-skin contact < 180 min/day. Hierarchical modeling was performed by Poisson regression with robust variance. The variables associated with the outcome were "without easy access to the hospital", "without previous knowledge of the kangaroo method" and "having had morbidities during pregnancy". Mothers without easy access to the hospital and who are unaware of the kangaroo method should be priority targets for health policies to develop strategies that promote greater exposure to skin-to-skin contact during the hospitalization period of their children.

Factors associated with skin-to-skin contact less than 180 min/day in newborns weighing up to 1,800 g: multicenter study / Fatores associados ao contato pele a pele inferior a 180 min/dia em recém-nascidos com peso até 1.800 g: estudo multicêntrico

Abstract This article aims to evaluate the factors associated with a skin-to-skin contact time <180 min/day in newborns weighing up to 1,800 g during neonatal hospitalization. Prospective observational cohort study conducted in neonatal units of reference for the Kangaroo Method in Brazil. Data from 405 dyads (mother/child) were analyzed from May 2018 to March 2020. Maternal and neonatal explanatory variables were collected from medical records and interviews. Skin-to-skin contact was recorded in forms posted at the bedside, filled out by parents and staff. The outcome variable was the mean time of skin-to-skin contact < 180 min/day. Hierarchical modeling was performed by Poisson regression with robust variance. The variables associated with the outcome were "without easy access to the hospital", "without previous knowledge of the kangaroo method" and "having had morbidities during pregnancy". Mothers without easy access to the hospital and who are unaware of the kangaroo method should be priority targets for health policies to develop strategies that promote greater exposure to skin-to-skin contact during the hospitalization period of their children.

Resumo O objetivo deste artigo é avaliar os fatores associados ao tempo de contato pele a pele < 180 min/dia em recém-nascidos com peso até 1.800 g durante a internação neonatal. Estudo observacional tipo coorte prospectivo conduzido em unidades neonatais de referência no Brasil. Foram analisados dados de 405 díades (mãe/filho), no período de maio de 2018 a março de 2020. As características da mãe e do recém-nascido foram coletadas em prontuários e entrevistas, a realização do contato pele-a-pele era registrada em fichas anexadas ao leito, preenchidas pela equipe e pelos pais. A variável desfecho foi o tempo médio diário de contato pele-a-pele inferior a 180 minutos. Foi realizada modelagem hierarquizada utilizando a regressão de Poisson com variância robusta para cálculo das razões de prevalência. As variáveis que permaneceram independentemente associadas foram: "não ter fácil acesso ao hospital" (morar longe ou ter dificuldade de transporte), "não possuir conhecimento prévio sobre o método canguru" e "ter apresentado morbidades durante a gestação". Mães sem fácil acesso ao hospital e que desconhecem o método canguru devem ser alvos prioritários das políticas de saúde para desenvolver estratégias que promovam maior exposição ao contato pele a pele durante o período de internação de seus filhos.

Growth phenotypes of very low birth weight infants for prediction of neonatal outcomes from a Brazilian cohort: comparison with INTERGROWTH

Abstract Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Methods: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92-2.31)/1.60 (1.27-2.02) for SGA; 0.90 (0.55-1.47)/1.05 (0.55-1.99) for LGA; 1.65 (1.08-2.51)/1.58 (1.28-1.96) for stunting; and 1.48 (1.02-2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.

Growth phenotypes of very low birth weight infants for prediction of neonatal outcomes from a Brazilian cohort: comparison with INTERGROWTH.

OBJECTIVE: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). METHOD: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. OUTCOME: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. RESULTS: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92-2.31)/1.60 (1.27-2.02) for SGA; 0.90 (0.55-1.47)/1.05 (0.55-1.99) for LGA; 1.65 (1.08-2.51)/1.58 (1.28-1.96) for stunting; and 1.48 (1.02-2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. CONCLUSION: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.

Impact of resuscitation training program on neonatal outcomes in a region of high socioeconomic vulnerability in Brazil: an interventional study

Abstract Objectives: This pre/post-intervention study aimed to evaluate neonatal outcomes after the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Method: This interventional study was conducted across five secondary healthcare regions that supported 62 cities in the southwestern mesoregion of Piauí. It included 431 healthcare professionals responsible for neonatal care in the study region. The participants were trained in neonatal resuscitation through the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Delivery room structuring, healthcare professionals' knowledge, and neonatal care outcomes were analyzed immediately before and after intervention and after 12 months between February 2018 and March 2019, and healthcare professionals were evaluated. Results: Training was conducted for over 106 courses. As a participant could take multiple courses, 700 training sessions were conducted. Regarding delivery room structuring, the acquisition of materials required for resuscitation increased from 28.4 to 80.6% immediately after the intervention and to 83.3% after 12 months. Knowledge retention was significant in the post-training period, with a 95.5% approval rate, and knowledge acquisition was satisfactory after 12 months. The number of newborns transferred during the study period increased significantly. A 72.6% reduction in mortality at birth was recorded, and 479 newborns were resuscitated. Conclusion: Following the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, structural improvements in delivery rooms, adequate knowledge retention regarding neonatal resuscitation, and a consequent reduction in neonatal mortality were observed.

Características do contato pele a pele em unidades neonatais brasileiras: estudo multicêntrico / Características del contacto piel con piel en unidades neonatales brasileñas: estudio multicéntrico / Characteristics of skin-to-skin contact in Brazilian neonatal units: a multicenter study

Resumo Objetivo Descrever o início, duração, local e quem realiza o contato pele a pele em unidades neonatais brasileiras. Métodos Estudo multicêntrico descritivo, longitudinal, realizado de maio de 2018 a março de 2020, em cinco unidades neonatais referência para o Método Canguru no Brasil, que incluiu recém-nascidos com peso até 1800g. As características maternas e dos recém-nascidos foram coletadas em prontuários e entrevistas. A prática do contato pele a pele era registrada em cartões anexados ao leito, preenchidos pela equipe e pelos pais. A análise ocorreu por meio de estatística descritiva. Resultados Foram incluídos 405 recém-nascidos, 51,4% do sexo masculino, mediana de idade gestacional de 31,4 semanas e de peso ao nascimento de 1.412g. Em relação ao tempo de realização do contato pele a pele, a mediana da frequência do contato diário foi de 1,5 vezes (IIQ: 1,2 - 2,4), o tempo/dia de 147 min/dia (IIQ: 106,7 - 263,0) e a realização do primeiro contato aos cinco dias de vida (IIQ:4,0-8,0). O maior tempo de contato/dia foi realizado pelas mães, com mediana de 137,8 min/dia (IIQ:95,6-232,1) e a segunda etapa do Método Canguru, Unidade de Cuidados Intermediários Canguru, foi o local onde se realizou por maior tempo o contato, com mediana de 184,4 min/dia (IIQ:124,7-455,4). Conclusão Nas unidades avaliadas, o contato pele a pele é praticado de forma intermitente, poucas vezes por dia, predominantemente pelas mães e com maior tempo de exposição na segunda etapa. É necessário buscar meios que possibilitem mais encontros entre mãe/pai-filho e que dê condições de maior permanência dos genitores no hospital.

Resumen Objetivo Describir el inicio, duración, lugar y quién realiza el contacto piel con piel en unidades neonatales brasileñas. Métodos Estudio multicéntrico descriptivo, longitudinal, realizado de mayo de 2018 a marzo de 2020, en cinco unidades neonatales de referencia del Método Canguro en Brasil, que incluyó recién nacidos de hasta 1800 g de peso. Las características maternas y de los recién nacidos fueron recopiladas en historias clínicas y entrevistas. La práctica del contacto piel con piel fue registrada en tarjetas anexadas a la cama, completadas por el equipo y por los padres. El análisis se realizó mediante estadística descriptiva. Resultados Se incluyeron 405 recién nacidos, 51,4 % de sexo masculino, mediana de 31,4 semanas de edad gestacional y de 1412 g de peso al nacer. Con relación al tiempo de realización del contacto piel con piel, la mediana de la frecuencia del contacto diario fue 1,5 veces (IIQ: 1,2 - 2,4), el tiempo/día fue de 147 min/día (IIQ: 106,7 - 263,0) y la realización del primer contacto a los cinco días de vida (IIQ:4,0-8,0). El mayor tiempo de contacto/día fue realizado por las madres, con una mediana de 137,8 min/día (IIQ:95,6-232,1) y la segunda etapa del Método Canguro, la Unidad de Cuidados Intermedios Canguro, fue el lugar donde se realizó el contacto por mayor tiempo, con una mediana de 184,4 min/día (IIQ:124,7-455,4). Conclusión En las unidades analizadas, el contacto piel con piel se practica de forma intermitente, pocas veces por día, predominantemente por las madres y con mayor tiempo de exposición en la segunda etapa. Es necesario buscar medios que permitan más encuentros entre madre/padre-hijo y que ofrezcan condiciones de mayor permanencia de los progenitores en el hospital.

Abstract Objective To describe the beginning, duration, location and who makes skin-to-skin contact in Brazilian neonatal units. Methods This is a descriptive, longitudinal multicenter study, carried out from May 2018 to March 2020, in five reference neonatal units for Kangaroo Mother Care in Brazil, which included newborns weighing up to 1,800 grams. Maternal and newborn characteristics were collected from medical records and interviews. Skin-to-skin contact was recorded on cards attached to the bed, filled in by the team and fathers. Analysis occurred through descriptive statistics. Results We included 405 newborns, 51.4% male, median gestational age of 31.4 weeks and birth weight of 1,412 grams. Regarding skin-to-skin contact time, the median daily contact frequency was 1.5 times (IQR: 1.2 - 2.4), the time/day was 147 min/day (IQR: 106.7 - 263.0) and the first contact at five days of life (IQR:4.0-8.0). The longest contact time/day was performed by mothers, with a median of 137.8 minutes per day (IQR:95.6-232.1), and the second stage of kangaroo Mother Care, kangaroo Intermediate Care Unit, was the place where contact was performed for the longest time, with a median of 184.4 minutes per day (IQR:124.7-455.4). Conclusion In the units assessed, skin-to-skin contact is practiced intermittently, a few times a day, predominantly by mothers and with longer exposure time in the second stage. It is necessary to seek ways that allow more encounters between mother/father-child and that gives conditions of greater permanence of fathers in the hospital.

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.

Hypermagnesemia and feeding intolerance in preterm infants: A cohort study.

BACKGROUND: Feeding intolerance (FI) is a common clinical problem in preterm infants often caused by some neonatal disorders and drugs, including antenatal exposure to magnesium sulfate (MgSO4 ). OBJECTIVE: To evaluate the association between hypermagnesemia at birth and FI in preterm infants during the first 72 h of life. METHOD: This was a cohort study conducted with preterm infants aged <34 weeks' gestation. Infants presenting at least two of the following signs were considered as having FI: vomiting, abdominal distension, the need for continuous intermittent feeding, and delayed meconium passage. Hypermagnesemia was characterized by umbilical serum Mg levels > 2.5 mEq/L. RESULTS: A total 251 infants were evaluated. The median birth weight and gestational age were 1390 g (IQR, 1020-1070) and 31 weeks (IQR, 28-32). The FI rate was 17.5%. The exposure rate to MgSO4 was similar in the tolerant and intolerant groups (53.1% × 63.6%; P = 0.204), but hypermagnesemia was more frequent in the FI group (40.9% × 24.2%; P = 0.024). The univariate analysis showed that infants with hypermagnesemia were twofold more likely to present FI (odds ratio [OR], 2.16; 95% CI, 1.09-4.26). In the multiple logistic regression analysis, we found that hypermagnesemia was independently associated with FI (OR, 2.51; 95% CI, 1.06-5.91), as well as maternal diabetes mellitus (OR, 2.56; 95% CI, 1.07-6.14), Score for Neonatal Acute Physiology-Perinatal Extension II (OR, 1.051; 95% CI, 1.025-1.078), and brain hemorrhage (OR, 3.61; 95% CI, 1.31-9.91). CONCLUSION: In addition to other factors, hypermagnesemia at birth was independently associated with early FI in preterm infants.

Risk Perception and Decision Making about Early-Onset Sepsis among Neonatologists: A National Survey.

OBJECTIVE: Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions. STUDY DESIGN: Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients. RESULTS: In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions. CONCLUSION: Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS. KEY POINTS: · Neonatologists overestimate the risk of EOS.. · There is wide variation in diagnostic/treatment thresholds for EOS.. · Clinical decision on EOS is not consistent with risk thresholds.. · Knowledge of risk may increase investigation and treatment of EOS..

Evaluation of the effectiveness of antenatal corticoid in preterm twin and single pregnancies: a multicenter cohort study.

BACKGROUND: The effects of antenatal corticosteroids (ANSs) on twins are not well established. OBJECTIVE: To determine the impact of ANS use according to the number of fetuses. METHODS: Retrospective cohort study of newborns between 23 and 33 weeks of gestational age, birth weight from 400 to 1499 g, without malformations, delivered at 20 public university hospitals from 2010 to 2014.Exposed group: Received ANS (any time, any dose) and no exposed group: no received ANS. Analysis of birth conditions and clinical outcomes. Association of variables, relative risks, and 95% confidence intervals estimated from the adjustment of log-binomial regression models. RESULTS: About 7165 premature infants were analyzed: 5167 singleton, 937 twins, and 104 triplets. Characteristics of gestations with one, two, or three fetuses not receiving ANS were similar. Reduced hemodynamic instability in single and twins gestations in the first 72 h were observed (Adj R2 Twins = 0.78; 95% CI = 0.69-0.86) (Adj R2 Singles = 0.79; 95% CI = 0.62-0.99). Reduced peri-intraventricular hemorrhage (Adj R2 Twins = 0.54; 95% CI = 0.36-0.78) (Adj R2 singles = 0.54; 95% CI = 0.36-0.78); and early sepsis reduction on single and triplex gestations (Adj R2 triplex = 0.51; 95% CI = 0.27-0.94) (Adj single R2 = 0.51; 95% CI = 0.27-0.94) were observed. CONCLUSIONS: This study demonstrates ANS produces an important protective factor for severe intraventricular hemorrhage and hemodynamic instability in single and multiple pregnancies. ANS had a protective effect on death and birth conditions improvement just in single gestations. Regarding respiratory aspects was not observed the protective effect in the single or multiple gestations.

Early neonatal sepsis: prevalence, complications and outcomes in newborns with 35 weeks of gestational age or more / Sepse neonatal precoce: prevalência, complicações e desfechos em recém-nascidos com 35 semanas ou mais de idade gestacional

ABSTRACT Objective: To analyze the incidence, complications, and hospital discharge status in newborns with ≥35 weeks of gestational age with early neonatal sepsis. Methods: This is a cross-sectional, retrospective study. Cases of early-onset sepsis registered from January 2016 to December 2019 in neonates with gestational age of 35 weeks or more were reviewed in a level III neonatal unit. The diagnoses were performed based on the criteria by the Brazilian Health Regulatory Agency (Anvisa), and the episodes were classified according to microbiological classification and site of infection. The following complications were evaluated: shock, coagulation disorders, and sequelae of the central nervous system. The conditions at hospital discharge were also assessed. The collected data were analyzed with the descriptive analysis. Results: In the period, early neonatal sepsis occurred in 46 newborns, corresponding to 1.8% of all newborns admitted to the neonatal unit, with a prevalence of 4/1,000 live births. Culture confirmed sepsis ocurred in three patients (0.3/1,000 live births), with the following agents: S. pneumoniae, S. epidermidis and S. agalactiae. As to site of infection, there were 35 cases of primary bloodstream infection, seven cases of pneumonia and four cases of meningitis. Most patients (78.3%) had at least one risk factor for sepsis, and all were symptomatic at admission. There were no deaths. Complications occurred in 28.2% of the cases, especially shock (10 cases - 21.7%). Conclusions: The prevalence of proven early neonatal sepsis was low. Despite the common occurrence of complications, there were no deaths.

RESUMO Objetivo: Analisar a prevalência, as complicações e as condições de alta dos recém-nascidos ≥35 semanas com diagnóstico de sepse neonatal precoce. Métodos: Estudo transversal, com coleta retrospectiva de dados. Incluíram-se todos recém-nascidos com 35 semanas ou mais de idade gestacional, com diagnóstico de sepse precoce em um período de quatro anos (janeiro/2016 a dezembro/2019) em uma unidade neonatal nível III. Os diagnósticos realizaram-se segundo os critérios da Agência Nacional de Vigilância Sanitária e os episódios classificados segundo a confirmação microbiológica e o sítio de infecção. As complicações avaliadas foram: choque, distúrbio de coagulação e sequelas do sistema nervoso central. Também se avaliaram as condições de alta. Os dados coletados foram analisados utilizando estatística descritiva. Resultados: No período, 46 recém-nascidos apresentaram sepse precoce, correspondendo a 1,8% das internações e a uma prevalência de 4/1.000 nascidos vivos. Em três pacientes a sepse foi confirmada por culturas (0,3/1.000 nascidos vivos), respectivamente por S. pneumoniae, S. epidermidis e S. agalactiae. Quanto ao sítio de infecção, foram 35 casos de infecção primária da corrente sanguínea, 7 casos de pneumonia e 4 de meningite. A maior parte dos pacientes (78,3%) possuía pelo menos um fator de risco para sepse, e todos apresentaram-se sintomáticos. Não houve óbito. Complicações ocorreram em 28,2% dos casos, especialmente choque (10 casos - 21,7%). Conclusões: A prevalência de sepse neonatal precoce comprovada foi baixa. Apesar da ocorrência comum de complicações, não houve óbitos.

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.

Early neonatal sepsis: prevalence, complications and outcomes in newborns with 35 weeks of gestational age or more.

OBJECTIVE: To analyze the incidence, complications, and hospital discharge status in newborns with ≥35 weeks of gestational age with early neonatal sepsis. METHODS: This is a cross-sectional, retrospective study. Cases of early-onset sepsis registered from January 2016 to December 2019 in neonates with gestational age of 35 weeks or more were reviewed in a level III neonatal unit. The diagnoses were performed based on the criteria by the Brazilian Health Regulatory Agency (Anvisa), and the episodes were classified according to microbiological classification and site of infection. The following complications were evaluated: shock, coagulation disorders, and sequelae of the central nervous system. The conditions at hospital discharge were also assessed. The collected data were analyzed with the descriptive analysis. RESULTS: In the period, early neonatal sepsis occurred in 46 newborns, corresponding to 1.8% of all newborns admitted to the neonatal unit, with a prevalence of 4/1,000 live births. Culture confirmed sepsis ocurred in three patients (0.3/1,000 live births), with the following agents: S. pneumoniae, S. epidermidis and S. agalactiae. As to site of infection, there were 35 cases of primary bloodstream infection, seven cases of pneumonia and four cases of meningitis. Most patients (78.3%) had at least one risk factor for sepsis, and all were symptomatic at admission. There were no deaths. Complications occurred in 28.2% of the cases, especially shock (10 cases - 21.7%). CONCLUSIONS: The prevalence of proven early neonatal sepsis was low. Despite the common occurrence of complications, there were no deaths.

Temporal trend in early sepsis in a very low birth weight infants' cohort: an opportunity for a rational antimicrobial use.

OBJECTIVE: This study aimed to evaluate annual trends of early neonatal sepsis and antimicrobial use in very low birth weight infants for 12 years, as well as to identify microbiological agents, antimicrobial sensitivity profiles, and association with early neonatal death. METHOD: This was a retrospective cohort study including 1254 very low birth weight infants admitted from 2006 to 2017. Four groups were evaluated: culture-confirmed sepsis; presumed neonatal sepsis; ruled out neonatal sepsis group; and infants not exposed to antibiotics. RESULTS: The medians of gestational age and birth weight were 29 weeks (27-31) and 1090g (850-1310), respectively. The rates of culture-confirmed sepsis, presumed neonatal sepsis, ruled out neonatal sepsis, and not exposed to antibiotics were 1.3, 9.0, 15.4, and 74.3%, respectively. From the initial group of newborns whose antimicrobial treatment was administered for sepsis' suspicion, it was possible to discontinue antibiotic in 44%. The culture-confirmed sepsis rates remained stable (p=0.906). Significant tendencies of decreasing presumed sepsis rates (p<0.001) and increased ruled out neonatal sepsis/not exposed to antibiotics rates (p<0.001) were observed. Streptococcus agalactiae and enteric Gram-negative rods were the predominant agents and most of them were sensitive to crystalline penicillin/ampicillin (88.2%) and to ampicillin and/or amikacin. Early death occurred in 10.8%, specifically in the culture-confirmed sepsis and presumed neonatal sepsis groups. CONCLUSION: The confirmed sepsis rate was low and remained stable. There was a significant downward trend in the presumed neonatal sepsis rate and a significant upward trend in the ruled out neonatal sepsis group. The rate of not exposed to antibiotics infants was high, also presenting a significant downward trend. The identified bacteria were those commonly found and showed usual antimicrobial susceptibility patterns. Death predominantly occurred in groups that received antibiotic treatment.

PREDICTIVE VALUE OF THE GENERAL MOVEMENTS ASSESSMENT IN PRETERM INFANTS: A META-ANALYSIS.

OBJECTIVE: To discuss the predictive value of the General Movements Assessment for the diagnosis of neurodevelopment disorders in preterm newborns. DATA SOURCE: We conducted a systematic literature review using the following databases: Scientific Electronic Library Online (SciELO), National Library of Medicine, National Institutes of Health (PubMed), and Excerpta Medica Database (EMBASE). The articles were filtered by language, year of publication, population of interest, use of Prechtl's Method on the Qualitative Assessment of General Movements, and presence of variables related to the predictive value. The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the methodology of the included studies. Sensitivity, specificity, Diagnostic Odds Ratio, positive and negative likelihood ratio, and parameter of accuracy were calculated. DATA SYNTHESIS: Six of 342 articles were included. The evaluation of Writhing Movements is a good indicator for recognizing cerebral palsy, as it has high values for the sensitivity and accuracy parameters. The evaluation of Fidgety Movements has the strongest predictive validity for cerebral palsy, as it has high values in all measures of diagnostic accuracy. The quality assessment shows high risk of bias for patient selection and flow and timing of the evaluation. Therefore, the scale has potential to detect individuals with neurodevelopment disorders. However, the studies presented limitations regarding the selection of subjects and the assessment of neurological outcomes. CONCLUSIONS: Despite the high predictive values of the tool to identify neurological disorders, research on the subject is required due to the heterogeneity of the current studies.

Predictive value of the general movements assessment in preterm infants: a meta-analysis / Valor preditivo da general movements assessment na avaliação neurológica de recém-nascidos pré-termo: uma metanálise

ABSTRACT Objective: To discuss the predictive value of the General Movements Assessment for the diagnosis of neurodevelopment disorders in preterm newborns. Data source: We conducted a systematic literature review using the following databases: Scientific Electronic Library Online (SciELO), National Library of Medicine, National Institutes of Health (PubMed), and Excerpta Medica Database (EMBASE). The articles were filtered by language, year of publication, population of interest, use of Prechtl's Method on the Qualitative Assessment of General Movements, and presence of variables related to the predictive value. The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the methodology of the included studies. Sensitivity, specificity, Diagnostic Odds Ratio, positive and negative likelihood ratio, and parameter of accuracy were calculated. Data synthesis: Six of 342 articles were included. The evaluation of Writhing Movements is a good indicator for recognizing cerebral palsy, as it has high values for the sensitivity and accuracy parameters. The evaluation of Fidgety Movements has the strongest predictive validity for cerebral palsy, as it has high values in all measures of diagnostic accuracy. The quality assessment shows high risk of bias for patient selection and flow and timing of the evaluation. Therefore, the scale has potential to detect individuals with neurodevelopment disorders. However, the studies presented limitations regarding the selection of subjects and the assessment of neurological outcomes. Conclusions: Despite the high predictive values of the tool to identify neurological disorders, research on the subject is required due to the heterogeneity of the current studies.

RESUMO Objetivo: Analisar o valor preditivo da General Movements Assessment para o diagnóstico de alterações do neurodesenvolvimento em recém-nascidos pré-termo. Fonte de dados: Foi realizada uma revisão sistemática da literatura utilizando as bases de dados: Scientific Electronic Library Online (SciELO), National Library of Medicine, National Institutes of Health (PubMed) e Excerpta Medica Database (EMBASE). Os artigos foram filtrados por idioma, ano de publicação, população de interesse, utilização do Método Prechtl de avaliação e presença das variáveis relacionadas ao valor preditivo da escala. O Quality Assessment of Diagnostic Accuracy Studies 2 foi utilizado para avaliar a metodologia dos artigos. Foi realizado o cálculo de sensibilidade, especificidade, Diagnostic Odds Ratio, razão de verossimilhanças positiva e negativa e parâmetro de acurácia. Síntese dos dados: Foram incluídos seis artigos dentre os 342 encontrados. A escala, quando realizada no período Writhing Movements, possui bom poder discriminativo para o desfecho paralisia cerebral, com valores elevados de sensibilidade e acurácia. Quando realizada no período Fidgety Movements, possui maior valor preditivo para paralisia cerebral, com valores elevados em todas as medidas de acurácia diagnóstica. O risco de viés foi considerado elevado na seleção de pacientes e no fluxo e momento da avaliação. Desse modo, a escala tem potencial para detectar indivíduos que evoluíram com alterações do neurodesenvolvimento, porém, os artigos apresentaram limitações quanto à seleção dos sujeitos e à forma de avaliação do desfecho neurológico. Conclusões: Apesar dos altos valores preditivos descritos para identificação de alterações neurológicas, novas pesquisas são necessárias, devido à heterogeneidade dos estudos e ao método de avaliação a longo prazo do neurodesenvolvimento.

Ultrasound diagnosis of microcephaly: a comparison of three reference curves and postnatal diagnosis.

PURPOSE: To evaluate which reference curve (RC)-Snijders, Intergrowth 21st (IG21) and World Health Organization (WHO)-is more accurate for microcephaly diagnosis. METHODS: Retrospective cohort study with more than 30,000 exams in more than 11,000 women. Microcephaly was confirmed by a neonatologist at birth and positive predictive values (PPVs) and misdiagnosis were assessed. RESULTS: A total of 71 cases were confirmed as microcephaly at birth. IG21 and Snijders PPVs showed to be more significant over WHO's (p < 0.001), without difference between them (p = 0.39). All RC were superimposed and did not show significant difference. When evaluated in different fragments, three trends were observed (until 30 weeks, between 30 and 36 and after 36 weeks of gestational age), with the latter interval showing a significant difference between IG21 and WHO (p = 0.0079). Conversely, WHO exhibited only one misdiagnosis, a much lower rate than Snijders, who missed eight cases and IG21, nine. CONCLUSION: WHO's RC appears to misdiagnose fewer cases, which could be useful for a population screening, while IG21's RC presented a more significant PPV, being more useful for a more precise final diagnosis in reference centers.

Evaluation of usability of a neonatal health information system according to the user's perception / Avaliação da usabilidade de um sistema de informação em saúde neonatal segundo a percepção do usuário

ABSTRACT Objective: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. Methods: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. Results: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as "good", "excellent" or "better than imaginable". The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. Conclusion: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.

RESUMO Objetivo: Mensurar o grau de satisfação de profissionais de saúde quanto à usabilidade de um sistema de informação em saúde neonatal e identificar os fatores que podem influenciar na satisfação do usuário frente à usabilidade. Métodos: Estudo transversal e exploratório realizado com 50 profissionais de saúde integrantes dos centros da Rede Brasileira de Pesquisas Neonatais. Para avaliação da usabilidade foi utilizado o instrumento System Usability Scale entre fevereiro e março de 2017. Realizou-se a análise estatística descritiva e inferencial das variáveis coletadas, com a finalidade de descrever a amostra, quantificar o grau de satisfação dos usuários e identificar as variáveis associadas ao grau de satisfação do usuário em relação à usabilidade. Resultados: Da população avaliada, 75% era do sexo feminino, com idade média 52,8 anos, 58% com pós-graduação (doutorado); tempo médio da última formação de 17 anos; área de atuação em medicina (neonatologia), grau intermediário de conhecimento em informática e tempo de utilização média do sistema de 52 meses. Quanto à usabilidade, 94% avaliaram o sistema como "bom", "excelente" ou "melhor impossível". A usabilidade do sistema não foi associada a idade, sexo, escolaridade, profissão, área de atuação, nível de conhecimento em informática e tempo de uso do sistema. Conclusões: O grau de satisfação do usuário do sistema informatizado de saúde foi considerado bom. Não foram identificados fatores demográficos que influenciassem sua avaliação.