Computational methodology to support functional vision assessment in premature infants: A viability study.

BACKGROUND: Premature newborns have a higher risk of abnormal visual development and visual impairment. OBJECTIVE: To develop a computational methodology to help assess functional vision in premature infants by tracking iris distances. METHODS: This experimental study was carried out with children up to two years old. A pattern of image capture with the visual stimulus was proposed to evaluate visual functions of vertical and horizontal visual tracking, visual field, vestibulo-ocular reflex, and fixation. The participants' visual responses were filmed to compose a dataset and develop a detection algorithm using the OpenCV library allied with FaceMesh for the detection and selection of the face, detection of specific facial points and tracking of the iris positions is done. A feasibility study was also conducted from the videos processed by the software. RESULTS: Forty-one children of different ages and diagnoses participated in the experimental study, forming a robust dataset. The software resulted in the tracking of iris positions during visual function evaluation stimuli. Furthermore, in the feasibility study, 8 children participated, divided into Pre-term and Term groups. There was no statistical difference in any visual variable analyzed in the comparison between groups. CONCLUSION: The computational methodology developed was able to track the distances traveled by the iris, and thus can be used to help assess visual function in children.

Visual stimulation in the neonatal intensive care unit: A systematic literature review.

We aimed to systematically categorize evidence on the types of early visual stimulation applied to preterm infants (PTIs) admitted to neonatal intensive care units (NICUs), aiming to improve visual function parameters. This study was conducted according to PRISMA and registered in PROSPERO with CRD42022333753. Last search was conducted on March 15, 2023, in four different databases. Articles written in English, Portuguese, Spanish, or Italian, and available in full text were included. Two independent authors performed study selection, data extraction, and bias risk assessment. If there was any disagreement, a third author was contacted. A total of eight studies were included. From these, 62.5% presented a low risk of bias. 100% used a multisensory intervention, which included visual stimulation. In 50%, visual intervention consisted of black and white stimulation cards placed inside the incubator for three minutes. The outcomes showed positive benefits in visual function parameters and other reported clinical benefits in breastfeeding and neuromuscular development. This review demonstrated there is still scarce literature on the effects of early visual stimulation on purely visual functional outcomes, although the existing findings are promising. Parental involvement has been generating unquestionable benefits for the binomial mother-infant and gaining greater acceptance by health professionals.

Trajectory of Systemic Blood Pressure in Early Life: A Cohort Study.

Objective. To track the BP (blood pressure) trajectory of healthy infants during the first year of life of healthy infants born in Northeast Brazil. Methods. In this cohort study, BP was assessed by oscillometry at the first 24 hours of life and 12 months of age. Results. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) increased with age (P < .001) and were not influenced by gender (SBP: P = .178 and DBP: P = .623) or type of delivery (SBP: P = .827 and DBP: P = .106), when compared between the first 24 hours of life and 12 months of age. Conclusion. The data from the present study increased knowledge about the trajectory of BP during the first year of life. The increase in BP between the first month and the first year of life was not influenced by gender or type of delivery.

Therapeutic options for hemarthrosis in severe hemophilic patients / Opções terapêuticas para as hemartroses em pacientes hemofílicos graves

Introduction: Hemophilia A and B are rare congenital X-linked recessive diseases caused by lack or deficiency of the coagulation factors VIII (FVIII) or IX (FIX), respectively. The primary therapeutic approach is to replace the deficient coagulation factor, which can be achieved with factors derived from human plasma or recombinants. However, despite having a therapeutic approach, most severe cases are symptomatic and may have complications, mainly in the muscles and joints. One example of such disorder is hemarthrosis. This manifestation tends to affect mainly the knee, ankle, or elbow joints in about 80% of cases. Objective: to describe the primary forms of treatment for joint bleeding in patients with severe hemophilia. Methods: This is a qualitative research of the integrative review type meant to identify productions on topics associated with hemarthrosis and severe hemophilia. The articles were searched through the databases PubMed, Scientific Electronic Library Online (Scielo) and Virtual Health Library (BVS) with the following search descriptors: "hemarthrosis and hemophilia"; "joint diseases and Hemophilia" and corresponding terms in Portuguese. The inclusion criteria were as follows: a) scientific articles b) available in full-text c) studies available in Portuguese, English, or Spanish d) randomized clinical trials e) articles published between 2016 and 2021 f) articles containing hemarthrosis caused by severe hemophilia. As exclusion criteria, texts that had no relation to the theme, did not answer the guiding question, other types of articles that did not include randomized clinical trials and/or presented duplicates were discarded. Results: In total, 42 articles were found in the selected databases; eight were duplicated, and 25 were excluded for not being randomized clinical trials or because they did not contemplate the theme. After careful reading, nine articles that met the inclusion and exclusion criteria were identified. Of the eligible studies, one reported factor replacement, and eight reported physiotherapeutic treatment. Conclusion:Factor replacement for hemophilic patients is essential and, based on the information obtained, early replacement is ben-eficial for the patient to avoid joint complications. Prophylaxis is indicated in severe hemophilia and its main objective is to prevent recurrent hemarthrosis, which can cause permanent functional deformities. Some physiotherapeutic interventions are indicated to prevent joint damage in severe hemophilic patients. The findings show diversity in the physical therapy modalities employed. The complete prevention of joint damage is still a challenge. A combination of treatments and a multi-disciplinary team follow-up is necessary to ensure health and quality of life of patients. (AU)

Introdução: As hemofilias A e B são doenças congênitas raras, recessivas ligadas ao X, causadas por falta ou deficiência de fator de coagulação VIII (FVIII) ou IX (FIX), respectivamente. A terapêutica tem como conduta principal a reposição do fator de coagulação deficiente, podendo ser feita com fatores derivados de plasma humano ou recombinantes. Porém, apesar de possuir uma terapêutica, grande parte dos casos graves são sintomáticos e podem ter complicações, na sua maioria, nos músculos e nas articulações. Uma dessas desordens é a hemartrose. Essa manifestação tende a acometer principalmente articulações do joelho, tornozelo ou cotovelo em cerca de 80% dos casos. Objetivo: descrever as principais formas de tra-tamento para sangramento articular em pacientes com hemofilia grave. Método: Trata-se de uma pesquisa qualitativa do tipo revisão integrativa para identificação de produções sobre temas associados a hemartrose e hemofilia grave. A busca dos artigos foi através das bases de dados PubMed, Scientific Electronic Library Online (SciELO) e Biblioteca Virtual em Saúde (BVS) com os seguintes descritores de busca: "hemarthrosis and hemophilia"; "joint diseases and hemophilia" e termos correspondentes no português. Os critérios de inclusão foram os seguintes: a) artigos b) estar disponível em texto completo c) estudos disponíveis nos idiomas português, inglês ou espanhol d) ensaios clínicos randomizados e) artigos publicados entre 2016 e 2021 f) artigos que contemplem hemartrose por hemofilia grave. Resultados: No total, foram encontrados 42 artigos nas bases de dados selecionadas; oito estavam duplicados e 25 foram excluídos por não serem ensaios clínicos randomizados ou por não contemplarem a temática. Após leitura cuidadosa, foram identificados 9 artigos que atenderam aos critérios de inclusão e exclusão. Dos trabalhos elegíveis, um relatou sobre reposição de fator e oito artigos relataram sobre tratamento fisioterapêutico. Conclusão: A reposição de fatores para pacientes hemofílicos é essencial e, com base nas informações obtidas, a reposição precoce é benéfica para o paciente, evitando complicações articulares. A profilaxia está indicada na hemofilia grave e seu principal objetivo é prevenir a hemartrose recorrente, que pode causar deformidades funcionais permanentes. Algumas intervenções fisioterapêuticas são indicadas para prevenir danos articulares em pacientes hemofílicos graves. Os achados mostram diversidade nas modalidades de fisioterapia empregadas. A prevenção total dos danos articulares ainda é um desafio. É necessária uma combinação de tratamentos e acompanhamento por equipe multi-disciplinar de forma a garantir a saúde e qualidade de vida dos pacientes. (AU)

Effects of physical exercise for children and adolescents undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis

Hematopoietic stem cell transplantation (HSCT) is a treatment that requires long periods of hospitalization. The mobility restrictions result in physical, functional and psychological impairments. Physical exercise is a therapy that can restore physical and functional capacities; however, it is necessary to understand the effects of its practice in post-HSCT individuals. The purpose of this systematic review (SR) was to assess the impact of physical exercise in children and adolescents undergoing HSCT. The SR was conducted following the PRISMA guidelines through search in the electronic databases Embase, Lilacs, PEDro, PubMed and SCOPUS, without limitation of dates and languages. Randomized or non-randomized clinical trials with children and adolescents who underwent HSCT, aged between 3 to 19 years old, who participated in a regular physical activity program, were assessed. After removing duplicates and selecting studies according to the eligibility criteria, seven parallel studies incorporating hospitalized and discharged participants undertaking aerobic and strengthening exercises were included in this study. The main outcomes analyzed were exercise capacity, quality-of-life, body composition and freedom. Five studies comprised the meta-analysis regarding the effects of the distance walked in the 6-min walk test and quality-of-life. Physical exercise is considered to be safe, feasible and efficacious to prevent the decline of the quality-of-life in children and adolescents undergoing HCST, as well as a considerable improvement in physical capacity.

Relationship between thoracoabdominal mobility and hours of life in infants: A cross-sectional study.

Assessing the relationship between thoracoabdominal mobility (TAM) in newborns (NBs) is relevant for a greater understanding of pulmonary kinematics. This study aimed to assess the association between TAM, hours of life and respiratory rate (RR) in term NBs. Healthy NBs were included in the sample. They were filmed for 2 min, with markers in the lateral region of the trunk, delimiting the thoracic and abdominal areas. TAM and RR were assessed using a MATLAB® routine. For kinematic analysis, an algorithm created graphs presenting thoracoabdominal mobility. A total of 26 NBs were evaluated. TAM was the only variable that exhibited a statistically significant intergroup difference, showing that the fewer the hours of life, the greater the mobility. Simple linear regression analysis showed that RR can explain 31% of the variation in abdominal mobility (p = 0.002). Thus, the fewer the hours of life, the greater the TAM of NBs, with a predominance of abdominal compartment mobility.

Effects of physical exercise for children and adolescents undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis.

Hematopoietic stem cell transplantation (HSCT) is a treatment that requires long periods of hospitalization. The mobility restrictions result in physical, functional and psychological impairments. Physical exercise is a therapy that can restore physical and functional capacities; however, it is necessary to understand the effects of its practice in post-HSCT individuals. The purpose of this systematic review (SR) was to assess the impact of physical exercise in children and adolescents undergoing HSCT. The SR was conducted following the PRISMA guidelines through search in the electronic databases Embase, Lilacs, PEDro, PubMed and SCOPUS, without limitation of dates and languages. Randomized or non-randomized clinical trials with children and adolescents who underwent HSCT, aged between 3 to 19 years old, who participated in a regular physical activity program, were assessed. After removing duplicates and selecting studies according to the eligibility criteria, seven parallel studies incorporating hospitalized and discharged participants undertaking aerobic and strengthening exercises were included in this study. The main outcomes analyzed were exercise capacity, quality-of-life, body composition and freedom. Five studies comprised the meta-analysis regarding the effects of the distance walked in the 6-min walk test and quality-of-life. Physical exercise is considered to be safe, feasible and efficacious to prevent the decline of the quality-of-life in children and adolescents undergoing HCST, as well as a considerable improvement in physical capacity.

Respiratory Therapeutic Strategies in Children and Adolescents with COVID-19: A Critical Review.

Evidence on the treatment strategies for the child population with critical conditions due to COVID-19 is scarce and lacks consensus. Thus, this study aimed to critically review non-pharmacological respiratory strategies for this population. Original studies were searched in six databases considering predefined inclusion criteria. Other studies and recommendations were also included after a manual search. Oxygen therapy, invasive (IMV) and non-invasive (NIV) ventilation were the most frequently addressed interventions. In general, the original studies have cited these strategies, but detailed information on the parameters used was not provided. The recommendations provided more detailed data, mainly based on experiences with other acute respiratory syndromes in childhood. In the context of oxygen therapy, the nasal catheter was the most recommended strategy for hypoxemia, followed by the high-flow nasal cannula (HFNC). However, the risks of contamination due to the dispersion of aerosols in the case of the HFNC were pointed out. Lung protective IMV with the use of bacteriological or viral filters was recommended in most documents, and there was great variation in PEEP titration. Alveolar recruitment maneuvers were mentioned in a few recommendations. NIV was not consensual among studies, and when selected, several precautions must be taken to avoid contamination. Airway suctioning with a closed-circuit was recommended to reduce aerosol spread. Information on prone positioning and physiotherapy was even more scarce. In conclusion, oxygen therapy seems to be essential in the treatment of hypoxemia. If necessary, IMV should not be delayed, and protective strategies are encouraged for adequate pulmonary ventilation. Information about techniques that are adjuvant to ventilatory support is superficial and requires further investigation.

Atuação e intervenção multiprofissional em recém-nascidos de baixo risco internados no alojamento conjunto: revisão integrativa da literatura / Multiprofessional performance and intervention in low risk newborns interned in maternity: integrative literature review

Introdução: O alojamento conjunto é definido como um espaço onde mãe e o recém-nascido saudáveis permanecem juntos após o nascimento até a alta hospitalar. Durante a sua internação, os profissionais de saúde são de extrema importância para uma assistência adequada e humanizada. Objetivo: Identificar quais profissionais e intervenções multiprofissionais são realizadas em recém-nascidos de baixo risco internados no alojamento conjunto. Procedimentos Métodológicos: Revisão sistemática integrativa da literatura com protocolo registrado na PROSPERO (ID134707). A busca foi realizada entre maio de 2018 a outubro de 2019, nas bases de dados MEDLINE, Pubmed, LILACS, SCIELO, PEDro, Scopus, Cochrane, Embase e Cinahl. Foram utilizados os termos medical subject heading (MeSH) Infant, Newborn, "Mother-childrelations", Hospital, Maternity, "Health CareLevels", "Rooming-in Care", e "Physical Therapy Modalities", nos idiomas inglês, português e espanhol. Para avaliação da qualidade utilizou-se Newcastle ­ ottawa quality assessment scale case control studies. Texto da Pesquisa: Somente dois estudos atenderam aos critérios de elegibilidade, demonstrando que os profissionais enfermeiros, fonoaudiólogos e médicos atuam no alojamento conjunto. Uma intervenção foi relacionada ao aleitamento materno, com a avaliação do posicionamento, pega, sucção, aspecto da mama e interação mãe-bebê, e a outra sobre o contato pele a pele e berço aquecido no controle da temperatura corporal do recém-nascido logo após o nascimento. Conclusão: Em razão da escassez de estudos, tornam-se necessárias mais pesquisas com boa qualidade metodológica sobre a atuação de outros profissionais na população de recém-nascidos de baixo risco internados no alojamento conjunto.

Introduction: Maternity is defined as a space where a healthy mother and newborn remain together after birth until hospital discharge. During hospitalization, health professionals are extremely important for adequate and humanized care. Aims: To identify which professionals and multiprofessional interventions are carried out on low-risk newborns admitted to the maternity. Methodological Procedures: Systematic integrative literature review with a protocol registered with PROSPERO (ID134707). The search was conducted between May 2018 - October 2019, in the databases MEDLINE, Pubmed, LILACS, SCIELO, PEDro, Scopus, Cochrane, Embase and Cinahl. The terms medical subject heading (MeSH) Infant, Newborn, "Mother-childrelations", Hospital, Maternity, "Health Care Levels", "Rooming-in Care", and "Physical Therapy Modalities" were used in English, Portuguese and Spanish. The Newcastle - ottawa quality assessment scale case control studies was used to assess quality. Research Text: Only two studies met the eligibility criteria, demonstrating that professional nurses, speech therapists and doctors work in the maternity. One intervention was related to breastfeeding, with the assessment of positioning, holding, sucking, breast aspect and mother-baby interaction, and the other on skin-to-skin contact and a heated cradle to control the newborn's body temperature soon after the birth. Conclusion: Due to the scarcity of studies, more research with good methodological quality on the performance of other professionals in the population of low-risk newborns admitted to the maternity is necessary.

Impact of type of delivery on thoracoabdominal mobility of newborns / Impacto do tipo de parto sobre a mobilidade Toracoabdominal de recém-nascidos

INTRODUCTION: In newborns delivered by cesarean section, there is less chest compression and little amount of fluid is drained by gravity, which temporarily reduces thoracoabdominal mobility OBJETIVE: The objective of this study is to evaluate the impact of the type of delivery on newborns Thoracoabdominal Mobility METHODS: This is a cross-sectional study with newborns of gestational age between 37 and 41 weeks, of both sexes, with up to 72 hours of life, breathing in ambient air and born by normal delivery or cesarean section. The Thoracoabdominal Mobility was evaluated by videogrammetry using MATLAB Software and considered, in metric units (cm2), as the difference between the highest and lowest thoracoabdominal expansibility for each respiratory cycle RESULTS: Twenty-six infants were included, 11 were male and 50% were born by cesarean section. The mean gestational age was 39 ± 0,9 and 28 ± 18 hours of life. The mobility, difference between greater and lesser expansion, of the thoracic area in vaginal and cesarean delivery was 6 ± 3 cm2 and 7 ± 5 cm2 and the abdominal area was 29 ± 22 cm2 and 21 ± 14 cm2, respectively. This difference was not statistically significant between the two types of delivery for the thoracic area, but was statistically different for the abdominal area (p= 0.01). And the higher the respiratory rate, the lower the abdominal mobility (r= -0.57, p= 0.02 CONCLUSION: The data indicate that the type of delivery seems to influence abdominal mobility and respiratory rate. In the studied sample, newborns with cesarean section presented lower abdominal mobility

INTRODUÇÃO: Nos recém-nascidos de parto cesáreo, ocorre menor compressão torácica e pouca quantidade de líquido é drenada por ação da gravidade, o que diminui, transitoriamente, a mobilidade toracoabdominal OBJETIVO: O objetivo do estudo é avaliar o impacto do tipo de parto na mobilidade torácica e abdominal em recém-nascidos MÉTODO: Trata-se de um estudo transversal com recém-nascidos de idade gestacional entre 37 a 41 semanas, de ambos os sexos, com até 72 horas de vida, respirando em ar ambiente e nascidos de parto normal ou parto cesáreo. A mobilidade torácica e abdominal foram avaliadas pela videogrametria por meio do Software MATLAB e considerada, em unidades métricas (cm2), como a diferença da maior e menor expansibilidade toracoabdominal para cada ciclo respiratório RESULTADOS: Foram inclusos 26 recém-nascidos 11 do sexo masculino e 50% nascidos de parto cesáreo. A idade gestacional média foi de 39 ± 0,9 sem e tinham 28 ± 18 horas de vida. A mobilidade, diferença entre a maior e menor expansibilidade, da área torácica no parto vaginal e cesáreo foi 6 ± 3 cm2 e 7 ± 5 cm2 e da área abdominal foi de 29±22 cm2 e 21± 14 cm2, respectivamente. Esta diferença não foi estatisticamente significante entre os dois tipos de parto para a área torácica, mas mostrou-se diferente estatisticamente para a área abdominal (p = 0,01). E para os recém-nascidos de parto cesáreo, quanto maior a frequência respiratória, menor a mobilidade abdominal (r= -0,57; p = 0,02 CONCLUSÃO: Os dados indicam que o tipo de parto parece influenciar a mobilidade abdominal e a frequência respiratória. Na amostra estudada os recém-nascidos de parto cesáreo apresentaram menor mobilidade abdominal

Avaliação biofotogramétrica da mobilidade toracoabdominal de recém-nascido após fisioterapia respiratória / Evaluation of thoracoabdominal mobility by biophotogrammetry in newborns after respiratory physical therapy

Introdução: Considerando a alta complacência da caixa torácica em recém-nascidos, as manobras de fisioterapia, quando aplicadas sobre o tórax, devem ser corretamente indicadas e avaliadas, por meio de instrumentos fidedignos e não invasivos, a fim de assegurar a sua eficácia e segurança. Objetivo: Avaliar a mobilidade toracoabdominal pela biofotogrametria (MT) em recém-nascidos após as manobras de vibrocompressão (VC) e Reequilíbrio Toracoabdominal (RTA). Métodos: A análise foi realizada em 40 recém-nascidos, com idade > 37 semanas, em posição supina, membros superiores em flexão, abdução e rotação externa e quadril flexionado. Cada recém-nascido realizou um tipo de manobra (VC ou RTA) e foi filmado por 60 segundos antes e após a terapia, por uma câmera digital perpendicular ao plano de movimento. A análise biofotogramétrica foi realizada pelo Software AutoCAD® e os resultados foram convertidos para unidades métricas (cm2 ). Resultados: A manobra de RTA aumentou a amplitude do movimento toracoabdominal e a VC diminuiu. A diferença média da mobilidade toracoabdominal, entre o antes e depois, para estas duas manobras, foi de +0,20 cm2 no RTA e ­1,72 cm2 na VC, entretanto não apresentaram diferença estatisticamente significativa. Conclusão: As manobras de RTA e VC apresentaram resultados antônimos sobre a mobilidade toracoabdominal, entretanto esta diferença não foi estatisticamente significativa. (AU)

Introduction: Considering the high complacency of the chest wall in newborns, physical therapy maneuvers, when applied to the chest, must be correctly indicated and evaluated through reliable and non-invasive tools, in order to ensure their efficacy and safety. Objective: To evaluate the thoracoabdominal mobility by biophotogrammetry (MT) in newborns after vibrocompression maneuvers (VC) and thoracoabdominal rebalancing (RTA). Methods: The analysis was performed in 40 infants, aged > 37 weeks, supine, upper limbs in flexion, abduction and external rotation and flexed hip. Each newborn performed a type of maneuver (VC or RTA) and was filmed for 60 seconds before and after therapy, by a digital camera perpendicular to the plane of movement. The biophotogrammetric analysis was performed by AutoCAD® Software and the results were converted to metric units (cm2). Results: The RTA increased the amplitude of the thoracoabdominal mobility and the VC decreased this amplitude. The mean difference in the range of the thoracoabdominal mobility before and after, for these two maneuvers was + 0.20 cm2 in the RTA and -1.72 cm2 in the VC, but did not present a statistically significant difference. Conclusion: The RTA and VC maneuvers presented antonym results on the thoracoabdominal mobility, however this difference was not statistically significant. (AU)

Thoracoabdominal mobility evaluation by photogrammetry in newborns after expiratory flow increase technique / Avaliação da mobilidade toracoabdominal por fotogrametria em recém-nascidos após a técnica de aumento do fluxo expiratório

Abstract Introduction: Expiratory flow increase is a maneuver of respiratory physical therapy that promotes flow direction to the upper airways however, when applied in newborns, it may result in changes of thoracoabdominal mobility. Objective: To evaluate the thoracoabdominal mobility by photogrammetry in newborns after expiratory flow increase technique. Methods: Experimental blind study performed with newborns in supine position on a support table with upper limbs flexed, abducted and externally rotated and hip flexed at 110°. Adhesive markers were allocated for geometric delimitation of the thoracoabdominal compartment and expiratory flow increase technique was performed for 5 minutes with the therapist's hands on the thorax and abdomen. Newborns were filmed before and after the maneuver and the frames were analyzed in AutoCAD® software by a blinded investigator at the time of the procedure. The largest and the smallest thoracoabdominal area were expressed in cm2 and the mean values were compared between two moments (pre and post maneuver) by paired t test. Results: Twenty newborns with a mean age of 39 weeks were included. Before the maneuver, thoracoabdominal area was 56.1 cm2 during expiration and 59.7 cm2 during inspiration, and after the maneuver the value was 56.2 cm2 during expiration and 59.8 cm2 during inspiration, with no statistical difference between before and after (p = 0.97, p = 0.92, respectively). Conclusion: Results demonstrate that expiratory flow increase technique does not seem to change thoracoabdominal mobility of healthy newborns.

Resumo Introdução: O aumento do fluxo expiratório é uma manobra da fisioterapia respiratória que promove um direcionamento do fluxo para as vias aéreas superiores, entretanto, quando aplicada em recém-nascidos, pode resultar em uma variação da mobilidade toracoabdominal. Objetivo: Avaliar a mobilidade toracoabdominal pela fotogrametria em recém-nascidos após a manobra de aumento do fluxo expiratório. Métodos: Estudo experimental, cego, realizado com os recém-nascidos posicionados em supino sobre uma bancada de apoio com o membro superior em flexão, abdução e rotação externa e quadril flexionado a 110°. Foram alocados marcadores adesivos para a delimitação geométrica do compartimento toracoabdominal e o aumento do fluxo expiratório foi realizado por 5 minutos com as mãos do terapeuta sobre o tórax e abdome. Os recém-nascidos foram filmados pré e pós-manobra e os fotogramas foram analisados no software AutoCAD por um pesquisador cego ao momento do experimento. A maior e a menor área toracoabdominal foram expressas em cm 2 e os valores médios foram comparados entre os dois momentos (pré e pós manobra) pelo Teste t pareado. Resultados: Foram incluídos 20 recém-nascidos com idade média de 39 semanas. Antes da manobra a área toracoabdominal foi 56,1 cm2 durante a expiração e 59,7 cm 2 na inspiração e após a manobra o valor foi 56,2 cm 2 durante a expiração e 59,8 cm 2 durante a inspiração, sem diferença estatística entre o antes e o depois (p = 0,97, p = 0,92, respectivamente). Conclusão: Os resultados deste estudo demonstram que a técnica de aumento do fluxo expiratório parece não alterar a mobilidade toracoabdominal de recém-nascidos saudáveis.

Neonatal peripheral facial paralysis' evaluation with photogrammetry: A case report.

Facial paralysis in newborns can leave functional sequelae. Determining the evolution and amount of functional losses requires consistent evaluation methods that measure, quantitatively, the evolution of clinical functionality. This paper reports an innovative method of facial assessment for the case of a child 28 days of age with unilateral facial paralysis. The child had difficulty breast feeding, and quickly responded to the physical therapy treatment.

Estimulação vestibular na unidade de terapia intensiva neonatal / Vestibular stimulation in the neonatal intensive care unit

OBJETIVO: avaliar os efeitos da estimulação vestibular no ganho de peso e comportamento em recém-nascidos pré-termos (RNPT) internados na Unidade de Terapia Intensiva Neonatal. MÉTODO: ensaio clínico randomizado e controlado, realizado com 26 RNPT com peso atual acima 1.100 kg, divididos e alocados em dois grupos, sendo 13 no grupo estudo (GE) e 13 no grupo controle (GC). A técnica de estimulação vestibular foi aplicada por meio do balanço do recém-nascido (RN) na rede, com um lençol, durante 5 minutos. Os recém-nascidos foram avaliados sob o aspecto comportamental de acordo com os sinais autonômicos, viscerais e comportamentais e o peso corporal foi acompanhado diariamente pelo prontuário médico. RESULTADOS: o índice de perda de peso do GE foi menor comparado ao GC. Com relação às características comportamentais o estado de sono difuso, presença de náuseas e salivações, hiperextensão de braços, pernas e tronco, irritabilidade, mostraram-se associados ao GC. Os RNs do GE apresentaram melhor coloração da pele. CONCLUSÃO: a estimulação vestibular pode diminuir a ocorrência de perda de peso e estresse no RNPT internado na Unidade de Terapia Intensiva Neonatal

Thoracic block technique associated with positive end-expiratory pressure in reversing atelectasis.

A preschool four-year-old male patient had been admitted to the Mandaqui Hospital with a diagnosis of lobar pneumonia, pleural effusion, and right lung atelectasis. Treatment consisted of antibiotics and physiotherapy sessions, using a technique described in the literature as Insufflation Technique to Reverse Atelectasis (ITRA), which consists of a thoracic block of healthy lung tissue, leaving only the atelectasis area free, associated with the use of invasive or noninvasive mechanical ventilation with positive airway pressure for reversal of atelectasis. Two physiotherapy sessions were conducted daily. The sessions lasted 20 minutes and were fractionated into four series of five minutes each. Each series bilateral thoracic block was performed for 20 seconds with a pause lasting for the same time. Associated with the thoracic block, a continuous positive airways pressure was used using a facial mask and 7 cm H2O PEEP provided via CPAP. Conclusion. ITRA technique was effective in reversing atelectasis in this patient.

Use of music during physical therapy intervention in a neonatal intensive care unit: a randomized controlled trial

INTRODUCTION: Previous studies have shown music therapy as a way to improve the clinical status of premature infants, improving vital signs and decreasing crying episodes OBJECTIVE: Compare the effects of music on vital signs of premature infants undergoing respiratory physiotherapy METHODS: We performed a randomized clinical trial consisting of 26 premature infants, divided into control group (N=12) and study group (N=14), carried out in a Neonatal Intensive Care Unit. All newborn infants undergone standard practice physiotherapy for 15 minutes: vibration and aspiration. On the study group they were exposed to classical music three minutes before the standard physiotherapy, and finished three minutes after the end of these procedures. A recorder was placed inside the incubator with an intensity of 25 decibels. Measurements of heart and respiratory rate and oxygen saturation were measured before, during and after each sessions of respiratory physiotherapy for two groups RESULTS: When comparing control and study groups regarding heart rate frequency and oxygen saturation, there was no statistically significant difference, but the inclusion of music determined clinically the variability of these data and 30% of the variation in respiratory rate was due to the inclusion of music during and after the physiotherapy, and the neonatal noninvasive ventilation showed less variation in their respiratory rate when compared to the neonatal on oxygen therapy CONCLUSION: The results have showed a beneficial effect of music, showing lower respiratory rate in newborn infants during and after respiratory physiotherapy procedure.(AU)

Use of music during physical therapy intervention in a neonatal intensive care unit: a randomized controlled trial

Previous studies have shown music therapy as a way to improve the clinical status of premature infants, improving vital signs and decreasing crying episodes OBJECTIVE: Compare the effects of music on vital signs of premature infants undergoing respiratory physiotherapy METHODS: We performed a randomized clinical trial consisting of 26 premature infants, divided into control group (N=12) and study group (N=14), carried out in a Neonatal Intensive Care Unit. All newborn infants undergone standard practice physiotherapy for 15 minutes: vibration and aspiration. On the study group they were exposed to classical music three minutes before the standard physiotherapy, and finished three minutes after the end of these procedures. A recorder was placed inside the incubator with an intensity of 25 decibels. Measurements of heart and respiratory rate and oxygen saturation were measured before, during and after each sessions of respiratory physiotherapy for two groups RESULTS: When comparing control and study groups regarding heart rate frequency and oxygen saturation, there was no statistically significant difference, but the inclusion of music determined clinically the variability of these data and 30% of the variation in respiratory rate was due to the inclusion of music during and after the physiotherapy, and the neonatal noninvasive ventilation showed less variation in their respiratory rate when compared to the neonatal on oxygen therapy CONCLUSION: The results have showed a beneficial effect of music, showing lower respiratory rate in newborn infants during and after respiratory physiotherapy procedure.

Estimula��o visual precoce para rec�m-nascidos prematuros internados na unidade neonatal / Visual stimulation for early preterm newborns in the neonatal unit

Objetivo: Avaliar um programa de estimula��o visual elaborado para rec�m-nascidos prematuros internados na unidade neonatal. M�todos: Prematuros entre 30 e 36 semanas foram divididos em dois grupos: grupo I, estimulado por 14 dias consecutivos, uma vez por dia, e grupo II, n�o estimulado. Para o programa de estimula��o foi apresentado frente ao rec�m-nascido, por at� 5 minutos, um �nico cart�o a uma dist�ncia de 30 cm do campo visual. Foram utilizados tr�s cart�es em forma de c�rculo, com 12 cm de di�metro, um com desenho conc�ntrico alternando as cores preta e branca, um segundo com cara de cachorro e um terceiro cart�o com quatro tri�ngulos intercalados entre preto e branco. Os dois grupos foram avaliados no primeiro e no 15� dia, com a mesma metodologia utilizada no grupo I. Utilizou-se o teste X2 para compara��o entre os grupos, considerando significante p<0,05. Resultados: O estudo demonstrou diferen�a estat�stica significativa entre as respostas obtidas no 1� e no 15� dia para o grupo I, cujos participantes receberam estimula��o visual todos os dias (p=0,015) e n�o foi encontrada diferen�a estat�stica significativa entre as respostas obtidas no 1� e no 15� dia para o grupo II, cuja estimula��o ocorreu no 1� dia (p=0,248). Conclus�o: A estimula��o visual realizada por 14 dias consecutivos levou a uma melhora significativa das respostas na avalia��o do 15� dia e os artefatos utilizados para estimula��o n�o influenciaram a resposta. O n�mero de participantes testados deve ser ampliado, para garantir os resultados obtidos at� o momento.

Vínculo materno e objeto transicional no sono de crianças com deficiência visual / Maternal bond and transitional object in sleep of children with visual impairments

Introdução: Os problemas do sono resultam de uma interaçãocomplexa entre fatores fisiológicos e relacionamento com os pais.Os objetivos do estudo foram identificar o vínculo materno e o usode objetos transicionais no sono de crianças com deficiência visual.Métodos: Estudo transversal realizado na Fundação Dorina Nowill.Os pais e responsáveis pela criança preencherem dois questionáriossobre o comportamento, hábitos e problemas no sono da criança.Para análise dos dados, os resultados foram descritos em frequênciarelativa e teste exato de Fisher. Resultados: Estudo com 14 criançascom idade de 4 ± 1,64 anos. As crianças que precisam de um objetotransicional, também precisam dos pais durante o sono (p < 0,05) e64,3% dos pais não realizam rotinas na hora de dormir. Conclusão: Ascrianças com deficiência visual apresentam um vínculo materno ouusam um objeto transicional durante o sono e os pais não realizamrotinas na hora de dormir.

Introduction: Sleep problems in children result from a complexinteraction between physiological factors and relationship withparents. The purpose of this study was to identify the maternalbond and the use of transitional objects in children with visualimpairments with sleep disorders. Methods: Cross-sectional studyperformed at Fundation Dorina Nowill. The parents or the responsiblefor the child fill out two questionnaires about behavior andhabits during the child sleep. The results were reported in relativefrequency and Fisher’s exact test. Results: The study included 14children 4 ± 1.64 years old. Children who need a transitional objectalso need parents during sleep (p < 0.05) and 64.3% of parents donot realize routines at bedtime. Conclusion: Most children withvisual impairment have a maternal bond or a transitional objectduring sleep and their parents do not establish bedtime routinesfor the children.

Fisioterapia respiratória em recém-nascidos pré-termo: ensaio clínico randomizado / Respiratory physiotherapy in pre-term newborns: a randomic clinical trial

Introdução: A especialidade da fisioterapia respiratória tem como objetivo minimizar os efeitos das complicações pulmonares e melhorar as funções respiratórias, aumentando o transporte mucociliar com técnicas que consistem em manobras manuais para higiene brônquica, como vibração e aumento do fluxo expiratório. Objetivo: Comparar os efeitos da técnica convencional (vibração) com a técnica atual (aumento do fluxo expiratório lento), em presença de sinais de desconforto respiratório em recém-nascidos pré-termo. Método: Ensaio clínico randomizado realizado com 43 recém-nascidos pré-termo divididos em dois grupos: grupo aumento do fluxo expiratório lento e grupo vibração. Os parâmetros foram coletados com o Boletim de Silverman Andersen: frequência cardíaca, frequência respiratória e saturação de oxigênio para avaliação dos sinais de desconforto respiratório e clínica dos recém-nascidos pré-termo, registrados em dois momentos: antes e após o término do procedimento. Para a análise estatística foi utilizado o teste t Student não pareado, com p < 0,05. Resultado: As técnicas de aumento do fluxo expiratório e vibração não diferiram entre os grupos. Observamos que os parâmetros frequência cardíaca, frequência respiratória e saturação de oxigênio não apresentaram alteração após a intervenção fisioterapêutica. Conclusão: As técnicas fisioterapêuticas aumento do fluxo expiratório lento e vibração não apresentam diferença entre os grupos e os parâmetros fisiológicos se mantiveram dentro do limite de normalidade, não causando instabilidade aos recém-nascidos pré-termo...