Percepção da equipe de enfermagem no manejo da dor no recém-nascido / Perception of the nursing team in pain management newborn

Introdução: Recém-nascidos de qualquer idade gestacional são capazes de reconhecer, processar e responder a estímulos dolorosos. Garantir a segurança e alívio do tratamento da dor é uma responsabilidade ética do profissional da saúde, pois é reconhecido que a maior parte da dor testada em bebês pode ser precavida ou aliviada. Objetivo: Compreender a percepção dos profissionais de enfermagem no manejo da dor no recém-nascido. Método: Trata-se de um estudo descritivo com abordagem qualitativa, realizado na Unidade de Terapia Intensiva Neonatal de um hospital escola do interior do estado de São Paulo, Brasil. A amostragem empregada foi intencional, com a participação de 11 profissionais, enfermeiros e técnicos em enfermagem. A coleta de dados se deu através de entrevista audiogravada em mídia digital portátil, guiada por uma pergunta norteadora. A análise de dados foi realizada com base na Análise de Conteúdo Temática de Bardin. Resultados: Emergiram três categorias temáticas: Métodos no manejo da dor do recém-nascido, Práticas de humanização e Percepção da avaliação da dor do recém-nascido, demonstrando que a equipe de enfermagem apresenta conhecimento e técnicas abrangentes em relação à percepção no manejo da dor do recém-nascido. Conclusão: Compreender a percepção dos profissionais de enfermagem no manejo da dor no recém nascido é importante, entretanto faz-se necessário a implantação de atividades que amplifiquem o conhecimento da equipe de enfermagem para adequado tratamento e controle da dor no RN

Introduction: Newborns of any gestational age are able to recognize, process and respond to painful stimuli. Ensuring the safety and relief of pain treatment is an ethical responsibility of the health professional, as it is recognized that most pain tested in infants can be cautious or relieved. Objective: To understand the perception of nursing professionals in the management of pain in the newborn. Method: This is a descriptive study with a qualitative approach, conducted in the Neonatal Intensive Care Unit of a teaching hospital in the state of São Paulo, Brazil. The sample used was intentional, with the participation of 11 professionals, nurses and nursing technicians. Data collection took place through an audio interview recorded on portable digital media, guided by a guiding question. Data analysis was performed based on Bardin's Thematic Content Analysis. Results: Three thematic categories emerged: Methods in the management of newborn pain, Humanization practices and Perception of newborn pain assessment nursing team presents comprehensive knowledge and techniques in relation to the perception in the management of pain of the newborn. Conclusion: Understanding the perception of nursing professionals in the management of pain in newborns is important, however, it is necessary to implement activities that expand the knowledge of the nursing team for adequate treatment and control of pain in newborns

Introducción: Los recién nacidos de cualquier edad gestacional son capaces de reconocer, procesar y responder a estímulos dolorosos. Garantizar la seguridad y el alivio del manejo del dolor es una responsabilidad ética del profesional de la salud, ya que se reconoce que la mayoría de los dolores probados en los bebés se pueden prevenir o aliviar. Objetivo: Comprender la percepción de los profesionales de enfermería sobre el manejo del dolor en el recién nacido. Método: Se trata de un estudio descriptivo con abordaje cualitativo, realizado en la Unidad de Cuidados Intensivos Neonatales de un hospital escuela del interior del estado de São Paulo, Brasil. El muestreo utilizado fue intencional, con la participación de 11 profesionales, enfermeros y técnicos de enfermería. La recolección de datos se realizó a través de entrevistas grabadas en audio en medios digitales portátiles, guiadas por una pregunta orientadora. El análisis de datos se realizó con base en el Análisis de Contenido Temático de Bardin. Resultados: Surgieron tres categorías temáticas: Métodos para el manejo del dolor en el recién nacido, Prácticas de humanización y Evaluación de la percepción del dolor en el recién nacido, demostrando que el equipo de enfermería posee conocimientos y técnicas integrales en relación a la percepción en el manejo del dolor del recién nacido. Conclusión: Comprender la percepción de los profesionales de enfermería en el manejo del dolor en el recién nacido es importante, sin embargo, es necesario implementar actividades que amplíen el conocimiento del equipo de enfermería para el adecuado tratamiento y control del dolor en el recién nacido

Diagnósticos e intervenções de enfermagem para recém-nascidos submetidos à cuidados intensivos / Diagnoses and nursing interventions for newborns undergoing intensive care

Introdução: Recém-nascidos vivenciam eventos de adaptabilidade, e esta pode tornar-se um desafio quando há necessidade de cuidados intensivos, exigindo intervenções e cuidados especiais. Assim, a equipe de enfermagem deve predispor um ambiente que minimize o sofrimento do neonato por meio de cuidados de enfermagem embasados em instrumentos científicos padronizados. Objetivo: Apresentar diagnósticos e intervenções de enfermagem para recém nascidos submetidos a cuidados intensivos, segundo as taxonomias NANDA Internacional (NANDA-I) e a Classificação de Intervenções de Enfermagem (NIC). Método: Estudo quantitativo, descritivo, desenvolvido sob a forma de pesquisa documental e estudo de caso. A coleta de dados foi realizada em um hospital-escola, após a aprovação do Comitê de Ética, investigando achados de enfermagem de recém-nascidos internados no mês de Agosto de 2022, através de prontuários físicos e eletrônicos. Resultados: Prevaleceram recém-nascidos por cesariana e do sexo masculino, prematuros e de baixo peso, os quais foram expostos a procedimentos invasivos, evidenciando diagnósticos de enfermagem de risco. Amamentação interrompida, risco de hiperbilirrubinemia neonatal, risco de desequilíbrio eletrolítico, dinâmica de alimentação ineficaz do lactente, risco de volume de líquidos desequilibrado, risco de motilidade gastrintestinal disfuncional, risco de vínculo prejudicado, risco de infecção, risco de trombose, distúrbio no padrão de sono, risco de aspiração, integridade da pele prejudicada, risco de lesão por pressão neonatal, risco de trauma vascular, risco de desenvolvimento motor atrasado do lactente, risco de hipotermia neonatal, risco de termorregulação ineficaz e conforto prejudicado foram os diagnósticos de enfermagem levantados. Os domínios mais evidenciados foram: 2 - Nutrição (38%), 3 - Eliminação e Troca (7%), 4 - Atividade e Repouso (14%), 7 - Papéis e Relacionamento (3%), 11 - Segurança e Proteção (31%), 12 - Conforto (3%) e 13 - Crescimento e Desenvolvimento (3%). Prevaleceu o risco de hiperbilirrubinemia neonatal (100%) e risco de desequilíbrio eletrolítico (100%), sendo relacionados às terapias utilizadas e ao tempo de internação. Conclusão: Considerando os estressores decorrentes do período de internação, os diagnósticos e intervenções de enfermagem para neonatos em ambientes de terapia intensiva pontuam a necessidade de o enfermeiro embasar-se em estudos científicos, alinhado às taxonomias NANDA-I e NIC, para nortear cuidados mais eficazes.

Introduction: Newborns experience adaptability events, and this can become a challenge when there is a need for intensive care, requiring special interventions and care. Thus, the nursing team should provide an environment that minimizes the suffering of the neonate through nursing care based on standardized scientific instruments. Objective: To present diagnoses and nursing interventions for newborns undergoing intensive care, according to the NANDA International (NANDA-I) taxonomies and the Classification of Nursing Interventions (NIC). Method: Quantitative, descriptive study, developed in the form of documentary research and case study. Data collection was performed in a hospital-school, after the approval of the Ethics Committee, investigating nursing findings of newborns hospitalized in August 2022, through physical and electronic medical records. Results: Newborns by cesarean section and male, premature and underweight, who were exposed to invasive procedures, showing risk nursing diagnoses, prevailed. Interrupted breastfeeding, risk of neonatal hyperbilirubinemia, risk of electrolyte imbalance, ineffective feeding dynamics of the infant, risk of unbalanced fluid volume, risk of dysfunctional gastrointestinal motility, risk of impaired attachment, risk of infection, risk of thrombosis, sleep pattern disorder, risk of aspiration, impaired skin integrity, risk of neonatal pressure injury, risk of vascular trauma, risk of delayed motor development of the infant, risk of neonatal hypothermia, risk of ineffective thermoregulation and impaired comfort were the nursing diagnoses raised. The most evident domains were: 2 - Nutrition (38%), 3 - Elimination and Exchange (7%), 4 - Activity and Rest (14%), 7 - Roles and Relationship (3%), 11 - Safety and Protection (31%), 12 - Comfort (3%) and 13 - Growth and Development (3%). The risk of neonatal hyperbilirubinemia (100%) and risk of electrolyte imbalance (100%) prevailed, being related to the therapies used and the length of hospitalization. Conclusion: Considering the stressors arising from the period of hospitalization, the diagnoses and nursing interventions for neonates in intensive care environments point out the need for the nurse to be based on scientific studies, aligned with the NANDA-I and NIC taxonomies, to guide more effective care

Introducción: Los recién nacidos experimentan eventos de adaptabilidad, y esto puede convertirse en un desafío cuando existe la necesidad de cuidados intensivos, requiriendo intervenciones y cuidados especiales. Así, el equipo de enfermería debe propiciar un ambiente que minimice el sufrimiento del recién nacido a través de cuidados de enfermería basados en instrumentos científicos estandarizados. Objetivo: Presentar diagnósticos e intervenciones de enfermería para recién nacidos en cuidados intensivos, de acuerdo con las taxonomías de la NANDA Internacional (NANDA-I) y la Clasificación de Intervenciones de Enfermería (NIC). Método: Estudio cuantitativo, descriptivo, desarrollado en forma de investigación documental y estudio de caso. La recolección de datos se realizó en un hospital de enseñanza, previa aprobación del Comité de Ética, investigando los hallazgos de enfermería de los recién nacidos hospitalizados en agosto de 2022, a través de registros físicos y electrónicos. Resultados: Predominó los recién nacidos por cesárea y de sexo masculino, prematuros y de bajo peso al nacer, que fueron expuestos a procedimientos invasivos, evidenciando diagnósticos de enfermería de riesgo. Interrupción de la lactancia materna, riesgo de hiperbilirrubinemia neonatal, riesgo de desequilibrio electrolítico, dinámica de alimentación infantil ineficaz, riesgo de volumen de líquido desequilibrado, riesgo de motilidad gastrointestinal disfuncional, riesgo de deterioro del apego, riesgo de infección, riesgo de trombosis, patrón de sueño alterado, riesgo de aspiración, deterioro de la integridad de la piel, riesgo de lesión por presión neonatal, riesgo de trauma vascular, riesgo de retraso en el desarrollo motor infantil, riesgo de hipotermia neonatal, riesgo de ineficacia de la termorregulación y deterioro del confort fueron los diagnósticos de enfermería planteados. Los dominios más evidentes fueron: 2 - Nutrición (38%), 3 - Eliminación e Intercambio (7%), 4 - Actividad y Descanso (14%), 7 - Roles y Relación (3%), 11 - Seguridad y Protección (31%), 12 - Comodidad (3%) y 13 - Crecimiento y Desarrollo (3%). Predominó el riesgo de hiperbilirrubinemia neonatal (100%) y el riesgo de desequilibrio hidroelectrolítico (100%), relacionándose con las terapias utilizadas y el tiempo de estancia hospitalaria. Conclusión: Considerando los estresores resultantes del período de hospitalización, los diagnósticos e intervenciones de enfermería para neonatos en cuidados intensivos apuntan la necesidad de que los enfermeros se basen en estudios científicos, alineados con las taxonomías NANDA-I y NIC, para orientar cuidados más efectivos

Factors associated with high care burden of primary caregivers of children with medical complexity after completing a discharge-support program in a recovery center.

INTRODUCTION: Recently, many seriously ill children requiring medical equipment are being recommended to transition from hospital to home care in Japan. Since 2011, our recovery center has provided a support program for the transfer process from hospital to home for ill children and their families. The purpose of this study was to evaluate the factors related to high care burden after completing the discharge-support program. METHODS: A questionnaire-based cross-sectional study was conducted on all primary caregivers whose children received the program in our center and moved from hospital to home (30 children and 29 families) from May 2011 to May 2018. Fifteen children came from the neonatal intensive care unit. The questionnaire consisted of three parts: characteristics of children and families and life after the program; the Zarit Burden Interview (ZBI); and the Positive and Negative Affect Schedule (PANAS). RESULTS: Twenty-three primary caregivers responded (79% response rate). All children received tracheostomy and 71% received home mechanical ventilation. Primary caregivers were all mothers. High ZBI score was not related to the severity and type of medical equipment. There were relationships between high ZBI score and following factors: 'unimproved relationship between patients and family members without primary caregivers' and 'additional medical equipment after discharge'. The result of PANAS showed that positive attitude was not different between those with high and low ZBI scores. CONCLUSION: It is crucial to reach out to family members without a primary caregiver. Additional medical care/equipment after the program is related to the care burden of primary caregivers.

WebPalestra: amamentação em situações especiais, como oferecer complementos?

Não é recomendado oferecer o leite em mamadeira, pois o bebê se acostuma ao bico que lhe é oferecido por maior número de vezes. Ele se habitua com a forma, consistência, textura e elasticidade do bico de borracha e também com a maneira de como mamar nele. O leite materno oferecido exclusivamente para os prematuros diminui significativamente a incidência e a gravidade de algumas doenças específicas, que só ocorrem nessa fase da vida do bebê, como também existe menor índice de reinternação.

Neonatal Enterovirus: A Case Report in a Term Infant Requiring Air Evacuation.

Enterovirus infections in neonates have the potential to cause a cascade of devastating clinical complications that can lead to death. Because of vague maternal symptom presentations, the diagnosis may not be obvious to antepartum adult providers. Clinicians evaluating infants in the newborn nursery and following initial hospital discharge must be alert for this potential infection. Common newborn issues, such as hyperbilirubinemia and weight loss, may be early signs of a more life-threatening diagnosis. Enterovirus infections may be responsible for a continuum of critical diagnoses in the neonate. Utilization of viral panels during the initial rule-out sepsis evaluation may provide rapid diagnosis and, ultimately, earlier response times to devastating clinical symptoms. Antepartum history and presenting features of enteroviral infections warrant rapid diagnosis with viral polymerase chain reaction detection panels to potentially reduce antibiotic usage and inpatient length of stay. The purpose of this case report is to review risk factors, presentation, and management of neonatal enterovirus infections. As this infant was born in a remote setting and required air evacuation, the logistics of this transport are also discussed.

System Specific Effects of Therapeutic Hypothermia with Neonatal Encephalopathy: Pearls for Clinicians.

Neonatal encephalopathy (NE) is defined as a condition of impaired neurological function often caused by a peripartum event that impairs gas exchange resulting in hypoxia, hypercapnia, cerebral ischemia, and metabolic acidosis. NE is a significant cause of neonatal morbidity and mortality. Therapeutic hypothermia (TH) is the standard of care for the treatment of moderate and severe NE and has significantly improved long-term outcomes for affected infants. There are extensive systemic physiologic effects associated with TH that clinicians need to be aware of to optimize care for these infants. There is a paucity of literature that comprehensively identifies causal relationships between the physiologic and biochemical effects of TH. This can leave neonatal clinicians devoid of a comprehensive understanding of the medical management of NE. Therefore, this article seeks to help fill this gap, improve clinician knowledge base, and ultimately improve the care of infants undergoing TH.

Provision of Sedation and Treatment of Seizures During Neonatal Therapeutic Hypothermia.

Hypoxic-ischemic encephalopathy (HIE) produces a high rate of long-term neurodevelopmental disability in survivors. Therapeutic hypothermia dramatically improves the incidence of intact survival, but does not eliminate adverse outcomes. The ideal provision of sedation and treatment of seizures during therapeutic hypothermia represent therapeutic targets requiring optimization in practice. Physiologic stress from therapeutic hypothermia may obviate some of the benefits of this therapy. Morphine is commonly utilized to provide comfort, despite limited empiric evidence supporting safety and efficacy. Dexmedetomidine represents an interesting alternative, with preclinical data suggesting direct efficacy against shivering during induced hypothermia and neuroprotection in the setting of HIE. Pharmacokinetic properties must be considered when utilizing either agent, with safety dependent on conservative dosing and careful monitoring. HIE is the leading cause of neonatal seizures. Traditional therapies, including phenobarbital, fosphenytoin, and benzodiazepines, control seizures in the vast majority of neonates. Concerns about the acute and long-term effects of these agents have led to the exploration of alternative anticonvulsants, including levetiracetam. Unfortunately, levetiracetam is inferior to phenobarbital as first-line therapy for neonatal seizures. Considering both the benefits and risks of traditional anticonvulsant agents, treatment should be limited to the shortest duration indicated, with maintenance therapy reserved for neonates at high risk for recurrent seizures.

Variables asociadas a eventos adversos en neonatos con catéter venoso central de inserción periférica / Variables associated with adverse events in neonates with peripherally inserted central catheters / Variáveis associadas a eventos adversos em neonatos com cateter central de inserção periférica

OBJETIVO: Identificar los factores asociados con la aparición de eventos adversos en el catéter de inserción central periférica en recién nacidos. MÉTODOS: Un estudio transversal con un enfoque cuantitativo realizado en una Unidad de Cuidados Intensivos Neonatales de un hospital de maternidad de referencia en atención materna e infantil de alto riesgo en el noreste de Brasil. Muestra de 108 neonatos recolectados de febrero a noviembre de 2016. RESULTADOS: La prevalencia de eventos adversos en los recién nacidos fue del 53,70%, asociada a las siguientes variables: sexo masculino (p = 0,033), peso inferior a 2500 gramos (p = 0,003), inserción después de 48 horas (p = 0,027), más de tres intentos de punción (p = 0,024), dificultad de progresión del catéter (p = 0,040), presencia de intercurrencias durante la inserción del catéter (p = 0,027), sobre dos cambios de apósito = 0.009) y ubicación no central del dispositivo (p = 0.042). CONCLUSIÓN: Los resultados indican la necesidad de estrategias para la prevención de eventos adversos, con énfasis en la educación continua y el mejoramiento de habilidades en la gestión de este dispositivo

OBJECTIVE: To identify the factors associated with the occurrence of adverse events by a peripherally inserted central catheter in newborns. METHODS: A quantitative, cross-sectional study carried out in the Neonatal Intensive Care Unit of a reference maternity hospital in high-risk maternal and child care in Northeast Brazil. The sample of 108 neonates was collected from February to November 2016. RESULTS: The prevalence of adverse events in newborns was 53.70%, associated with the following variables: male gender (p = 0.033), weight below 2500 grams (p = 0.003), insertion performed after 48 hours of life (p = 0.027), more than three puncture attempts (p = 0.024), difficulty in inserting the catheter (p = 0.040), intercurrence during catheter insertion (p = 0.027), over two dressing changes (p = 0.009), and non-central position of the device (p = 0.042). CONCLUSION: The results indicate the need for strategies to prevent adverse events, with emphasis on continuing education and on the improvement of skills regarding the use of this device

OBJETIVO: Identificar os fatores associados à ocorrência de eventos adversos por cateter central de inserção periférica em recém-nascidos. MÉTODOS: Estudo transversal, com abordagem quantitativa, realizado em Unidade de Terapia Intensiva Neonatal de uma maternidade referência no atendimento materno-infantil de alto risco no Nordeste do Brasil. Amostra de 108 neonatos coletada no período de fevereiro a novembro de 2016. RESULTADOS: A prevalência de eventos adversos em recém-nascidos foi de 53,70%, associados às seguintes variáveis: sexo masculino (p = 0,033), peso menor que 2500 gramas (p = 0,003), inserção realizada após 48 horas de vida (p = 0,027), mais de três tentativas de punção (p = 0,024), dificuldade de progressão do cateter (p = 0,040), presença de intercorrência durante a inserção do cateter (p = 0,027), acima de duas trocas de curativos (p = 0,009) e localização não central do dispositivo (p = 0,042). CONCLUSÃO: Os resultados indicam a necessidade de estratégias de prevenção de eventos adversos, destacando-se a educação continuada e aprimoramento de habilidades quanto ao manejo desse dispositivo

Nurses' experiences in the care of high-risk newborns: a phenomenological study.

OBJECTIVE: To describe nurses' experience in the care of high-risk newborns. METHOD: This is a descriptive study with a qualitative approach, based on Merleau-Ponty's phenomenology and performed at the Fernando Magalhães Maternity Hospital in the state of Rio de Janeiro, through interviews with 30 nurses who work in neonatal care, according to the phenomenological thinking of Maurice Merleau- Ponty. RESULTS: Three categories emerged: "experienced body of the nurse practitioner on the high-risk newborn"; "experienced world of the nurse practitioner on the high-risk newborn"; and "time spent by the nurse practitioner with the high-risk newborn". FINAL CONSIDERATIONS: The study allowed us to describe, through the participants' speeches, that the care of the high-risk newborn is broad, that is, objective, subjective and carried out with advanced technologies, their experiences and scientific improvement are composed of shared practice and theory with the family, professionals and beginners in the neonatal universe, favoring a differentiated and humanized care.

Profile of at-risk newborns attended by nurses in outpatient follow-up clinic: a retrospective cohort study.

OBJECTIVE: to analyze the cohort profile of at-risk newborns attended by nurses in a multidisciplinary follow-up clinic, with emphasis on the type of feeding and weight gain, after hospital discharge. METHOD: retrospective cohort, whose population is composed of at-risk newborns attended in a 4-year period. Data came from medical records and attendance report, later exported to R Program. The outcome variables were number of the nursing consultation, type of feeding, daily weight gain and main guidelines. We used descriptive statistics, frequency distribution and applied Mann-Whitney, Chi-Square, Spearman correlation, Variance and Tukey analysis, with p <0.05 being significant. RESULTS: a total of 882 consultations with 629 infants and families were analyzed. The frequencies of exclusive breastfeeding and weight gain increased as the consultations progressed. The infants who needed more consultations and with lower weight gain were those with lower gestational age (p = 0.001) and birth weight (p = 0.000), longer length of hospital stay (p <0.005), and diagnoses related to extreme prematurity (p <0.05), among others. CONCLUSION: nurses verified the importance of outpatient follow-up of at-risk newborns, especially in promoting breastfeeding and healthy growth.

Nursing knowledge of essential maternal and newborn care in a high-mortality urban African setting: A cross-sectional study.

AIMS: To assess the knowledge of nurses of national guidelines for emergency maternity, routine newborn and small and sick newborn care in Nairobi County, Kenya. BACKGROUND: The vast majority of women deliver in a health facility in Nairobi. Yet, maternal and neonatal mortality remain high. Ensuring competency of health workers, in providing essential maternal and newborn interventions in health facilities will be key if further progress is to be made in reducing maternal and neonatal mortality in low-resource settings. DESIGN: Cross-sectional survey. METHODS: Questionnaires comprised of clinical vignettes and direct questions and were administered in 2015-2016 to nurses (n = 125 in 31 facilities) on duty in maternity and newborn units in public and private facilities providing 24/7 inpatient neonatal services. Composite knowledge scores were calculated and presented as weighted means. Associations were explored using regression. STROBE guidelines were followed. RESULTS: Nurses scored best for knowledge on active management of the mother after birth and immediate routine newborn care. Performance was worst for questions on infant resuscitation, checking signs and symptoms of sick newborns, and managing hypertension in pregnancy. Overall knowledge of care for sick newborns was particularly low (score 0.62 of 1). Across all areas assessed, nurses who had received training since qualifying performed better than those who had not. Poorly resourced and low case-load facilities had lower average knowledge scores compared with better-resourced and busier facilities. CONCLUSION: Overall, we estimate that 31% of maternity patients, 3% of newborns and 39% of small and sick newborns are being cared for in an environment where nursing knowledge is very low (score <0.6). RELEVANCE TO CLINICAL PRACTICE: Focus on periodic training, ensuring retention of knowledge and skills among health workers in low-case load setting, and bridging the know-do gap may help to improve the quality of care delivered to mothers and newborns in Kenya.

Accuracy of the Defining Characteristics of the Nursing Diagnosis Hypothermia in Newborns.

PURPOSE: To analyze the accuracy of the defining characteristics of hypothermia in newborns and to verify associations between defining characteristics and clinical variables. METHODS: A cross-sectional accuracy study with statistical analysis. FINDINGS: Slow capillary refill, decrease in ventilation, peripheral vasoconstriction, and insufficient weight gain were the defining characteristics with the highest specificity values, while slow gastric emptying, skin cool to touch, irritability, and bradycardia were the defining characteristics with the highest values for both sensitivity and specificity. CONCLUSION: Slow gastric emptying, skin cool to touch, irritability, and bradycardia are good clinical indicators to infer initial stages of hypothermia and to confirm its presence. IMPLICATIONS FOR NURSING PRACTICE: Accuracy measures may contribute to the improvement of the diagnostic inferential process. OBJETIVO: Analisar acurácia das características definidoras de Hipotermia em recém-nascidos e identificar a associação delas com variáveis clínicas. MÉTODO: Estudo de acurácia transversal com análise estatística. RESULTADOS: Preenchimento capilar lento, diminuição da ventilação, vasoconstrição periférica e ganho de peso insuficiente apresentaram valores altos de especificidade enquanto esvaziamento gástrico lento, pele fria, irritabilidade e bradicardia apresentaram valores elevados de sensibilidade e especificidade. CONCLUSÃO: Esvaziamento gástrico lento, pele fria, irritabilidade e bradicardia são úteis para inferir estágios iniciais de hipotermia e para confirmação diagnóstica. IMPLICAÇÕES PARA PRÁTICA DE ENFERMAGEM: Medidas de acurácia podem contribuir para o processo de inferência do diagnóstico hipotermia.

Nurses' experiences in the care of high-risk newborns: a phenomenological study / Experiencias del enfermero en el cuidado del recién nacido de alto riesgo: un estudio fenomenológico / Vivências do enfermeiro no cuidado ao recém-nascido de alto risco: estudo fenomenológico

ABSTRACT Objective: To describe nurses' experience in the care of high-risk newborns. Method: This is a descriptive study with a qualitative approach, based on Merleau-Ponty's phenomenology and performed at the Fernando Magalhães Maternity Hospital in the state of Rio de Janeiro, through interviews with 30 nurses who work in neonatal care, according to the phenomenological thinking of Maurice Merleau- Ponty. Results: Three categories emerged: "experienced body of the nurse practitioner on the high-risk newborn"; "experienced world of the nurse practitioner on the high-risk newborn"; and "time spent by the nurse practitioner with the high-risk newborn". Final considerations: The study allowed us to describe, through the participants' speeches, that the care of the high-risk newborn is broad, that is, objective, subjective and carried out with advanced technologies, their experiences and scientific improvement are composed of shared practice and theory with the family, professionals and beginners in the neonatal universe, favoring a differentiated and humanized care.

RESUMEN Objetivo: Describir las experiencias del enfermero en el cuidado del recién nacido de alto riesgo. Método: Estudio descriptivo de tipo cualitativo, con base en la fenomenología de Merleau-Ponty, siendo realizado en el Hospital Maternidad Fernando Magalhães del estado de Río de Janeiro, en el que se entrevistaron 30 enfermeros que actúan en el cuidado neonatal. Resultados: Se encontraron tres categorías: "el cuerpo vivido del profesional enfermero sobre el recién nacido de alto riesgo"; "el mundo vivido del profesional enfermero sobre el recién nacido de alto riesgo"; y "el tiempo vivido del profesional enfermero sobre el recién nacido de alto riesgo". Consideraciones finales: A partir de los relatos de los participantes, este estudio nos permitió describir que es amplio el cuidado del recién nacido de alto riesgo, es decir, objetivo, subjetivo y realizado con tecnologías avanzadas, que presenta vivencias y perfeccionamiento científico según la teoría y la práctica compartidas con la familia, los profesionales y los iniciantes en el universo neonatal, lo que promueve un cuidado diferenciado y humanizado.

RESUMO Objetivo: Descrever a vivência do enfermeiro no cuidado ao recém-nascido de alto risco. Método: Estudo descritivo com abordagem qualitativa, pautado na fenomenologia de Merleau-Ponty e realizado no Hospital Maternidade Fernando Magalhães do estado do Rio de Janeiro, por meio de entrevistas com 30 enfermeiros que atuam no cuidado neonatal, segundo o pensamento fenomenológico de Maurice Merleau-Ponty. Resultados: Emergiram três categorias: "corpo vivido do profissional enfermeiro sobre o recém-nascido de alto risco"; "mundo vivido do profissional enfermeiro sobre o recém-nascido de alto risco"; e "tempo vivido do profissional enfermeiro sobre o recém-nascido de alto risco". Considerações finais: O estudo nos permitiu descrever, através das falas dos participantes, que o cuidado ao recém-nascido de alto risco é amplo, ou seja, objetivo, subjetivo e realizado com tecnologias avançadas, suas vivências e aprimoramento científico composto do teórico prático compartilhado com a família, profissionais e iniciantes no universo neonatal favorecendo um cuidado diferenciado e humanizado.

Meconium Peritonitis: A Case Study.

Meconium peritonitis is a sterile chemical peritonitis preceded by bowel perforation, resulting in meconium leakage and subsequent inflammatory cascade within the peritoneal cavity. The presentation can range from simple failure of the neonate to pass meconium to complications such as persistent pulmonary hypertension, lung hypoplasia, and systemic inflammatory syndrome. The purpose of this article is to review a case of meconium peritonitis while considering its etiology, diagnosis, management, and multidisciplinary team care.

Atención en la Unidad de Observación del Recién Nacido en un hospital universitario / Care at the Neonatal Observation Unit of a University Hospital

OBJETIVO: conocer la atención prestada en una Unidad de Observación del Recién Nacido (UORN) de un hospital universitario de referencia en Asturias. MÉTODO: se ha llevado a cabo un estudio descriptivo retrospectivo de todos los recién nacidos en el Hospital Universitario Central de Asturias que precisaron control postnatal sin la necesidad de ser ingresados, permaneciendo en la UORN. Se revisaron las historias clínicas recuperando información de los recién nacidos atendidos, se identificó la atención brindada por las enfermeras de la UORN en la sala de partos (reanimación conjunta con el neonatólogo) y en la UORN (motivo y tiempo de permanencia de los neonatos en dicha unidad). El periodo de estudio fue de seis meses (de julio a diciembre de 2016). Se realizó análisis descriptivo. RESULTADOS: se registraron 1.125 neonatos vivos. La enfermera de la UORN fue requerida en 524 nacimientos (46,5%) y 177 (15,7%) bebés pasaron a la UORN, siendo el nacimiento por cesárea la primera causa de estancia en la unidad (72,3%) mientras la madre permanecía en la Unidad de Reanimación Postquirúrgica. El tiempo medio de permanencia de los neonatos en la UORN fue de seis horas. De los 524 nacimientos atendidos por la enfermera de la UORN fue necesaria la asistencia y/o ayuda a la reanimación junto a pediatra o neonatólogo en 371 casos (70,8%). CONCLUSIONES: la atención prestada en la UORN o por enfermeras de dicha unidad aporta calidad y humanización en la asistencia neonatal, evitando ingresos innecesarios en los servicios de neonatología

OBJECTIVE: to understand the care offered at a Neonatal Observation Unit (NOU) of a University Hospital of Reference in Asturias. METHOD: a descriptive retrospective study was conducted on all newborns from the Central University Hospital in Asturias who required postnatal monitoring without hospitalization, and stayed at the NOU. Clinical records were reviewed, information was collected about the newborns managed, and the care offered by NOU nurses at the delivery room (joint resuscitation with the Neonatologist) and the NOU (reason for stay and time during which newborns stayed at said unit). The period of study was six months (July to December, 2016), and descriptive analysis was conducted. RESULTS: in total, 1,125 live newborns were registered. The NOU nurse was required in 524 births (46.5%), and 177 (15.7%) babies were transferred to the NOU; the first cause of stay at said unit was Caesarean birth (72.3%), while the mother stayed at the Post-surgical Resuscitation Unit. The mean time of stay of newborns at the NOU was of six hours. Of the 524 births attended by the NOU nurse, assistance and/or help for resuscitation was required, with the Pediatrician or Neonatologist, in 371 cases (70.8%). CONCLUSIONS: care offered at the NOU or by nurses from said unit provides quality and humanization for neonatal care, preventing unnecessary hospitalizations at the Neonatal Unit

Síndrome de aspiración meconial: Avances científicos de los últimos veinticinco años / Meconium aspiration syndrome: twenty-five years of scientific developments

El síndrome de aspiración meconial (SAM) se refiere a los problemas respiratorios que sufre un recién nacido cuando inhala meconio, su primera excreción intestinal, durante o después del parto, y este llega hasta los pulmones. La presencia de meconio en el líquido amniótico es un signo de sufrimiento fetal que precisa una cuidadosa supervisión tanto del parto como de la salud fetal. Con el objetivo de resaltar la importancia de una minuciosa supervisión durante el parto y de una adecuada evaluación de la salud del bebé, se prevé realizar una revisión bibliográfica que permita resumir los principales avances médicos de los últimos veinticinco años, partiendo de una conceptualización teórica, con el fin de subrayar que aquellos recién nacidos que lo padecen presentan una serie de signos y síntomas sobre los cuales será necesario incidir en caso de producirse

Meconium aspiration syndrome (MAS) refers to respiratory problems experienced by newborns after inhaling meconium, their first intestinal excretion, reaching the lungs during or after childbirth. The presence of meconium in the amniotic fluid is a sign of fetal distress that requires close monitoring of labor and fetal health. In order to emphasize the importance of careful supervision during childbirth, together with an adequate evaluation of the newborn's health, a bibliographic review has been carried out to present the main medical advances achieved over the last twenty-five years on the matter. The aim is to establish a theoretical framework based on a series of signs and symptoms, which must be monitored in order to identify and tackle the syndrome in its early stages

Lesiones de la piel en neonatos en cuidados intensivos neonatales / Lesões de pele em neonatos em cuidados intensivos neonatais / Skin injuries in newborns in neonatal intensive care

Objetivo: Describir la ocurrencia de lesiones de la piel en recién nacidos internados en una Unidad de Cuidados Intensivos Neonatal de un hospital público de Brasilia, Distrito Federal, Brasil. Método: Estudio cuantitativo, descriptivo y de abordaje prospectivo, realizado con 104 neonatos desde septiembre hasta diciembre de 2014. El análisis estadístico descriptivo incluyó frecuencia absoluta y relativa, mediana y desvío estándar. Resultados: 42 neonatos desarrollaron lesiones de la piel, resultando 77 lesiones, siendo las más incidentes las dermatitis del pañal (15,4%), edema (15,4%), eritema (13,5%) e infiltración (12,5%), seguidas de equimosis (4,8%) y descamación (3,8%). Conclusión: Es necesaria la creación de protocolos y/o la utilización de instrumentos que miren al mantenimiento de la integridad de la piel del recién nacido, que puedan ser herramientas útiles para identificar cualquier alteración en el sistema tegumentario del neonato y, de este modo, prevenir o disminuir su incidencia y sus consecuencias (AU)

Objetivo: Descrever a ocorrência de lesões de pele em recém-nascidos internados na UTI Neonatal de um hospital público de Brasília, Distrito Federal, Brasil. Método: Estudo quantitativo, descritivo e de abordagem prospectiva, realizado com 104 neonatos de setembro a dezembro de 2014. A análise estatística descritiva incluiu frequência absoluta e relativa, média e desvio padrão. Resultados: 42 neonatos desenvolveram lesões de pele, totalizando 77 lesões, sendo as mais incidentes: dermatite de fralda (15,4%), edema (15,4%), eritema (13,5%) e infiltração (12,5%), seguidas de equimose (4,8%) e descamação (3,8%). Conclusão: É necessária a criação de protocolos e/ou utilização de instrumentos que visem a manutenção da integridade da pele do recém-nascido, podendo ser ferramentas úteis para identificar qualquer alteração no sistema tegumentar do neonato e assim prevenir ou diminuir sua incidência e suas consequências (AU)

Objective: To describe the occurrence of skin lesions in newborns admitted to the Neonatal Intensive Care Unit of a public hospital in Brasilia, Federal District, Brazil. Method: Quantitative, descriptive and prospective study, which was conducted between September and December 2014. The target group consisted of 104 newborns. The descriptive analysis included absolute and relative frequencies, median and standard deviation. Results: 42 newborns developed skin lesions, in 77 resulting injuries. The most incident was diaper rash (15.4%), erythema (13.5%) and infiltration (12.5%), Followed by ecchymosis (4.8%) and desquamation (3.8%). Conclusion: It is essential to create protocols and/or to use instruments that aim to maintain the integrity of the newborn's skin, which can be useful for identifying any alteration, preventing or minimizing its impact and consequences (AU)