Enhancing tube feeding method for neurosurgery: the application of improved PICC technique.

BACKGROUND AND PURPOSE: Peripherally inserted central catheter (PICC) used in neurosurgical patients requires changes in patients' head positions. However, such changes can worsen pressure on the brain tissue, lead to sudden acute brain herniation and respiratory arrest, resulting in a higher chance of patient death. This paper addresses the aforementioned problems by introducing a new PICC catheterization method. METHOD: In a retrospective study, the records of patients with PICC from April 2020 to April 2023 were reviewed, and they were divided into three groups based on the methods employed. The first group as the conventional group, involved changing patients' body positions during catheterization. The second group, as the intracavitary electrocardiographic (IECG) group, utilized intracavitary electrocardiographic monitoring and involved changing patients' body positions during catheterization. The third group as the intracavitary electrocardiographic with improved body positioning (IECG-IBP) group, catheterization was performed with guidance from intracavitary electrocardiographs and without changing the patients' body positions. The ECG changes among patients undergoing different catheter delivery methods were then compared, as well as the rate of catheter tip misplacement. RESULT: The study encompassed a total of 354 cases. Our findings reveal distinct P wave amplitude percentages among the groups: 0% in the conventional group, 88.46% in the IECG group, and 91.78% in the IECG-IBP group. Furthermore, the following catheter tip misplacement rates were recorded: 11.54% for the conventional group, 5.39% for the IECG group, and 5.47% for the IECG-IBP group. Significantly notable differences were observed in these two key indicators between the conventional group and the IECG-IBP group. Notably, the IECG-IBP group demonstrated a more favorable outcome compared to the IECG group. CONCLUSION: In patients with neurosurgical diseases, especially those with tracheostomy and nuchal stiffness, the IECG-IBP PICC catheter insertion method can effectively reduce the patient's neck resistance, does not increase the patient's headache and dizziness symptoms, and does not reduce the success of one-time catheterization. Rate and does not increase the incidence of jugular venous ectopia.

"Rectal Feeding"-Unethical Medical Officer Participation at CIA Secret Interrogation Facilities.

This Viewpoint discusses recently released information regarding the practice of "rectal feeding" among detainees at Guantanamo Bay and Central Intelligence Agency (CIA) secret prisons.

Use of a Supplemental Feeding Tube Device and Breastfeeding at 4 Weeks.

BACKGROUND: Mothers having difficulty breastfeeding their infants may use alternative supportive feeding methods. Although a supplemental feeding tube device is commonly used, efficacy for supporting sustained breastfeeding remains unknown. PURPOSE: To describe supplemental feeding tube device use by breastfeeding mothers as an alternative feeding method through exploration of associations between supplemental feeding tube device use and continued breastfeeding at 4 weeks of infant's age. METHOD: Forty mothers participated. They were interviewed during the birth hospitalization and at 4 weeks postpartum. Questions addressed use of supplemental feeding tube devices, breastfeeding issues, and continued breastfeeding relationships. We examined the relationship between LATCH scores at 2 to 3 days of life. RESULTS: Breastfeeding mothers who chose to supplement with bottle-feeding instead of use of a supplemental feeding tube device were 30% less likely to continue breastfeeding at a medium/high/exclusive level. CONCLUSION: Use of the supplemental feeding tube device may help avoid the potentially detrimental effect of bottle-feeding on continued breastfeeding.

The comparative effect of creep and conventional feeding methods on growth performance and oxidative stress markers in Akkaraman lambs.

This study aimed to determine the effect of conventional and creep-feeding methods on growth performance and oxidative stress in Akkaraman (AKK) lambs. For this purpose, the AKK lambs (n = 60) used in this study were divided into four groups (15 n × 2 sex × 2 feeding methods), and all of them were fed the same ration. In the conventional feeding method, the lambs were taken to their dams for suckling twice a day and then kept in a separate compartment for further feeding. In contrast, in the creep-feeding method, the lambs always stayed with their mothers and had free access to supplementary feed by passing through the creep-feeding area. The data for body weights, body measurements, and saliva samples were collected five times, 14 days apart, to evaluate lambs' growth performance and oxidative stress markers. The results showed a higher (P < 0.05) body weight gain in the creep-fed group than in the conventional-fed group. The difference between creep and conventional feeding was significant (P = 0.033), but the difference between the groups in terms of gender was nonsignificant (P = 0.438). The males fed with the creep-feeding (CR-M) group had the largest body length (BL), pectoral chest width (PCW), chest depth (CD), chest circumference (CC), head length (HL), and head width (HW) measurements. The males fed with the conventional feeding (CO-M) group had the largest wither height (WH) measurement, and females fed with the conventional feeding (CO-F) group had the largest back length (BAL) body size. When the overall improvement in body measurements was considered, it was determined that the body sizes of many males in creep-feeding increased more than those of other feeding groups. The oxidative stress marker malondialdehyde (MDA) was higher (P < 0.001) in the conventional feeding group. Other oxidative stress markers, superoxide dismutase (SOD), catalase (CAT), and glutathione s-transferase (GSH-ST), were higher in the creep-feeding group (P < 0.001). Considering these findings, it is possible to conclude that creep-feeding is superior to conventional feeding to get a higher growth rate and reduce oxidative stress in AKK lambs.

Tempo de Transição da alimentação por sonda gástrica para alimentação por via oral em recém-nascidos pré-termo de uma unidade neonatal do Sistema Único de Saúde / Transition time from gastric tube feeding to oral feeding in preterm infants at a neonatal unit of the Unified Health System / Tiempo de transición de la alimentación por sonda gástrica a la alimentación oral en recién nacidos prematuros en una unidad neonatal del Sistema Único de Salud

Introdução: A retirada da sonda no recém-nascido pré-termo (RNPT) e o adequado estabelecimento da via oral são importantes para a saúde do bebê, já que favorecem aleitamento materno e alta hospitalar, entretanto, é um desafio nas unidades neonatais. Objetivos: Analisar os fatores associados ao tempo de transição da sonda para via oral em RNPT internados em Unidade Neonatal do Sistema Único de Saúde (SUS). Método: Foi realizado um estudo observacional analítico de coorte, com 45 RNPT que usaram sonda para alimentação no período de dezembro de 2021 a janeiro de 2022 e foram acompanhados pela equipe de Fonoaudiologia do serviço. Foram avaliados: a prontidão do prematuro para alimentação oral; a via oral com a técnica do finger feeding; a mamada e os níveis de habilidade oral. Resultados: Estiveram relacionadas ao maior tempo para transição da sonda para a via oral a idade gestacional ao nascimento inferior a 32 semanas, o peso ao nascimento inferior a 1500 gramas, a ausência de prontidão para via oral e a alta hospitalar em aleitamento artificial. Conclusão: Características do RNPT e da alimentação na avaliação e na alta hospitalar foram associados ao menor tempo de transição da sonda para a via oral. Assim, intervenções que estimulem o alcance da via oral no período de internação podem contribuir para a redução do tempo de transição e para o estímulo do aleitamento materno, favorecendo a saúde do RN, o vínculo mãe-bebê, a alta precoce, propiciando a rotatividade de leitos e, consequentemente, maior oferta aos usuários do SUS. (AU)

Introduction: The removal of the feeding tube in premature infants and the successful establishment of oral feeding are important for the baby's health, as they promote breastfeeding and hospital discharge. However, it is a challenge in neonatal units. Objectives: This article analyzes the factors associated with the time of transition from tube feeding to oral feeding in premature infants admitted to the Neonatal Unit of the Brazilian Unified Health System (SUS). Method: An analytical observational cohort study was conducted with 45 premature infants who used a feeding tube from December 2021 to January 2022 and were accompanied by the Speech Therapy team of the service. The following factors were evaluated: premature infant's readiness for oral feeding, oral feeding with finger feeding technique, breastfeeding, and levels of oral skill. Results: Factors associated with a longer transition time from tube feeding to oral feeding included gestational age at birth of fewer than 32 weeks, birth weight under 1500 grams, lack of readiness for oral feeding, and hospital discharge with artificial feeding. Conclusion: Characteristics of the premature infant and feeding at assessment and hospital discharge were associated with a shorter transition time from the tube to oral feeding. Therefore, interventions that stimulate oral feeding during hospitalization can help reduce the transition time and promote breastfeeding, benefiting the health of premature infants and the mother-baby bond. They can also contribute to early discharge, allowing for bed turnover and, consequently, increased availability for SUS users. (AU)

Introducción: La retirada de la sonda en los prematuros y el establecimiento adecuado de la vía bucal son importantes para la salud del bebé, ya que favorecen la lactancia y el alta hospitalaria, sin embargo, es un desafío en las unidades neonatales. Objetivos: Este artículo analiza los factores asociados al tiempo de transición de la sonda a la vía oral en prematuros internados en la Unidad Neonatal del Sistema Único de Salud (SUS). Método: Se realizó un estudio observacional analítico de cohortes, con 45 prematuros que utilizaron sonda de alimentación desde diciembre de 2021 hasta enero de 2022 y fueron seguidos por el equipo de logopedia del servicio. Se evaluaron: la disposición del prematuro para la alimentación oral; la vía oral con la técnica de alimentación con los dedos; lactancia materna y niveles de habilidad oral. Resultados: La edad gestacional ao nacer de menos de 32 semanas, el peso de nacimiento de menos de 1500 gramos, la falta de preparación para la administración oral y el alta hospitalaria con alimentación artificial se relacionaron con el mayor tiempo de transición de la vía por sonda a la vía oral. Conclusión: Las características del recién nacido prematuro y la alimentación en el momento de la evaluación y el alta hospitalaria se asociaron con un menor tiempo de transición de la sonda a la vía oral. Así, las intervenciones que fomenten la vía oral durante el período de hospitalización pueden contribuir a reducir el tiempo de transición y fomentar la lactancia materna, favoreciendo la salud del prematuro y el vínculo madre-bebé, además de contribuir al alta precoz, promoviendo la rotación de enfermeras, camas y, en consecuencia, mayor oferta a los usuarios del SUS. (AU)

Risk factors independently associated with the maintenance of severe restriction of oral intake and alternative feeding method indication at hospital outcome in patients after acute ischemic stroke.

BACKGROUND AND AIMS: From a clinical point of view, post-stroke patients present difficulties in swallowing management. The purpose of this research was to identify risk factors that were independently related to the maintenance of a severe restriction of oral intake in patients affected by acute ischemic stroke. METHODS: The authors conducted a prospective observational cohort study of patients with dysphagia post-acute ischemic stroke who were admitted to an Emergency Room (ER). Demographic and clinical data were collected at ER admission. Swallowing data was based on The Functional Oral Intake Scale (FOIS) and was collected at two distinct moments: initial swallowing assessment and at the patient outcome. Patients were divided into two groups according to their FOIS level assigned on the last swallowing assessment (at hospital outcome): G1 with severe restriction of oral intake and indication of feeding tube - patients with FOIS levels 1 to 4; G2 without restriction of food consistencies in oral intake - patients with FOIS levels 5 to 7. RESULTS: One hundred and six patients were included in our study. Results of the multivariate logistic regression model for the prediction of maintenance of a severe restriction of oral intake at hospital outcome in patients post-acute ischemic stroke indicated that increasing age (p = 0.006), and dysarthria (p = 0.003) were associated with higher chances of presenting severe restriction of oral intake at hospital outcome. CONCLUSIONS: Patients with acute ischemic stroke in an Emergency Room may experience non-resolved severe dysphagia, indicating the need to prepare for the care/rehabilitation of these patients.

Does the feeding method affect the quality of infant and maternal sleep? A systematic review.

Breastfeeding brings many benefits to both mother and infant. Although, many women stop breastfeeding their infants too soon. The perceived association between breastfeeding and sleep may influence their decision to terminate breastfeeding. In our systematic review, we focused on mapping the relationship between infant feeding method and total sleep time (TST), number of nocturnal awakenings, awakenings after sleep onset (WASO) of mothers and infants and sleep quality of mothers. We searched four databases according to selected keywords and inclusion criteria - articles published in peer-reviewed journals between 2012 and 2022; English language; a sample consisting of mothers, infants, or both (without psychiatric and health problems); a comparison of the sleep quality of breastfed and formula-fed children or breastfeeding and formula-fed mothers. We read 260 full texts of selected articles. A total of 35 articles were included in this review. Due to significant heterogeneity, meta-analysis was not possible to accomplish. The results are processed according to narrative synthesis. Most studies agree that breastfed infants wake up more often at night. Total sleep time and time spent awake during the night (WASO) did not differ between breastfed and non-breastfed infants. We observed identical results in sleep variables among mothers. Additionally, there was no difference in maternal sleep quality. The synthesis revealed that the results may have differed due to using subjective, objective methods or the infant's age. It is important to remember that night waking is a more complex concept. Infants wake for many reasons, not just due to breastfeeding. The narrative synthesis indicated that the chosen study design, measurement method, the variables, and the infant's age could influence outcomes. In addition, other variables appeared that may affect the entire process. Therefore, we recommend that attention be paid to this in future studies.

The intestinal microbiota predicts COVID-19 severity and fatality regardless of hospital feeding method.

SARS-CoV-2-positive patients exhibit gut and oral microbiome dysbiosis, which is associated with various aspects of COVID-19 disease (1-4). Here, we aim to identify gut and oral microbiome markers that predict COVID-19 severity in hospitalized patients, specifically severely ill patients compared to moderately ill ones. Moreover, we investigate whether hospital feeding (solid versus enteral), an important cofounder, influences the microbial composition of hospitalized COVID-19 patients. We used random forest classification machine learning models with interpretable secondary analyses. The gut, but not the oral microbiota, was a robust predictor of both COVID-19-related fatality and severity of hospitalized patients, with a higher predictive value than most clinical variables. In addition, perturbations of the gut microbiota due to enteral feeding did not associate with species that were predictive of COVID-19 severity. IMPORTANCE SARS-CoV-2 infection leads to wide-ranging, systemic symptoms with sometimes unpredictable morbidity and mortality. It is increasingly clear that the human microbiome plays an important role in how individuals respond to viral infections. Our study adds to important literature about the associations of gut microbiota and severe COVID-19 illness during the early phase of the pandemic before the availability of vaccines. Increased understanding of the interplay between microbiota and SARS-CoV-2 may lead to innovations in diagnostics, therapies, and clinical predictions.

Choking, gagging and complementary feeding methods in the first year of life: a randomized clinical trial.

OBJECTIVE: Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. METHODS: Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) - group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05). RESULTS: 130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). CONCLUSION: Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.

The "FEEDS (FEeding Eating Deglutition Skills)" over Time Study in Cardiofaciocutaneous Syndrome.

Feeding, eating and deglutition difficulties are key concerns in patients with cardiofaciocutaneous syndrome (CFCS). This study intends to quantify the development of feeding skills from birth to adulthood in patients with CFCS. Twenty-seven patients (eight males; mean age: 16.7 ± 8.3 years; median age: 15 years, age range: 1.5-38 years) with molecularly confirmed clinical diagnosis of CFCS were prospectively recruited from the Rare Disease Unit, Paediatrics Department, Fondazione Policlinico Agostino Gemelli-IRCCS, Rome, Italy, over a one-year period. Pathogenic variants along with key information regarding oro-motor features were collected. Sialorrhea was quantified using the Drooling Quotient 5. Feeding abilities were screened using the Italian version of the Montreal Children's Hospital Feeding Scale (I-MCH-FS). The oral sensory processing section of the Sensory Profile completed the assessment. Mild-to-profuse drooling was experienced by 25% of patients, and food taste selectivity was a constant during infancy (65%), with persistence even beyond adolescence. Nineteen percent of participants with long-term enteral feeding dependency had BRAF, KRAS and MAP2K1 mutations. These findings document that mealtime challenges in CFCS do not remain restricted only to the paediatric age, and that supportive care until adulthood plays a key role.

Phenotypic plasticity and behavioral responses of dairy cattle on rotational grazing.

Heat stress is one of the most important environmental challenges faced by dairy cattle, with a deleterious effect on animal production and welfare. This research was conducted to evaluate the effects of the thermal environment on the physiological and behavioral responses of dairy cattle in a rotational picket. The research was conducted on an experimental farm, located in the Agreste region of the state of Pernambuco, Brazil. The animals were managed in a rotational picket system of signal grass, with an occupation and a rest period of 7 and 28 days, respectively, for a stocking rate of 3.2 AU ha-1. The determination of the effect of stressors on the animals was performed by recording the dry bulb temperature (°C), and the relative humidity, which allowed the characterization of the thermal environment by the temperature and humidity index and by the specific enthalpy (kJ kg-1). The physiological variables monitored were respiratory rate (mov. min-1), rectal temperature (°C), and skin temperature (°C). The behavioral responses quantified were activities, walking, ruminating, idling and ingestive behaviors, eating, and drinking, with the percentage of time spent on each activity being recorded. According to the canonical multivariate analysis, the chi-square test, and the variation of physiological patterns, the animals, even in a situation of greater thermal challenge, presented physiological responses within conditions considered normal; however, they reduced grazing activity (eating) during the hottest hours and increased the activities of rumination and idling.

The infant feeding methods promoted by South African Instagram influencers in relation to crying and sleeping, 2018-2020: a retrospective digital ethnography.

BACKGROUND: Globally, there has been a decline in breastfeeding rates. This has resulted in increased infant mortality due to infectious diseases and inappropriate feeding practices. The aggressive marketing of breastmilk substitutes (BMS) by manufacturers has contributed, in part, to these declines. With the progressive use of social media, marketing has shifted from traditional methods to the use of influencers, who command a huge following on their social media accounts and influence the daily decisions of their followers. This study investigates the infant feeding methods and associated products promoted by South African influencers in relation to crying and sleeping and their followers' responses. METHODS: This was a retrospective study, which used a mixed methods digital ethnographic approach to analyse posts related to infant feeding methods that were made by seven South African Instagram influencers between the period of January 2018 to December 2020. Framing analysis was used to analyse qualitative data and quantitative data were analysed descriptively. RESULTS: From the 62 posts that were analysed, 27 were sponsored advertisements (some violating local regulations) and 35 posts promoted breastfeeding. The 18,333 follower comments and 918,299 likes in response to the posts were also analysed. We found that influencers presented BMS products as a solution for a child who cries a lot and has trouble sleeping. BMS were framed as helpful for children who are seemingly always hungry and dissatisfied with breastmilk alone. The study also found that some influencers promoted breastfeeding on their Instagram pages. Unlike BMS posts, breastfeeding posts were not sponsored. With a few exceptions, followers tended to support and reinforce the framing of influencers. CONCLUSION: Stiffer regulations should be enforced against companies using influencers to promote infant formula and other BMS products, with proactive monitoring of social media. Professionals giving advice contrary to the guidelines from the WHO should be reported according to Regulation 991 and made accountable. Proactive engagement with Instagram influencers to promote breastfeeding should be considered.

Comparison of mothers' perceptions of hunger cues in 3-month-old infant under different feeding methods.

BACKGROUND: Mothers' perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods. METHODS: A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers' perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators. RESULTS: We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant's "hand sucking" (67.6% vs. 53.6%) and "moving head frantically from side to side" (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01-2.85), "hand sucking" (OR = 1.72, 95% CI: 1.04-2.87), "moving head frantically from side to side" (OR = 2.07, 95% CI: 1.19-3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure. CONCLUSION: EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.

Nifty Cup Versus Katori-Spoon Feeding in Preterm Infants: A Randomized Controlled Trial.

Background: Many preterm infants cannot breastfeed directly and depend on other feeding methods. Multiple studies have compared feeding methods for such infants; however, the best method remains unknown. We compared Nifty cup with Katori-spoon feeding in preterm neonates deemed fit for oral feeding. Methods: This open-label randomized controlled trial was performed in a level III neonatal unit. Preterm (<34 weeks) neonates deemed fit to initiate oral feeding were randomly allocated to the Nifty cup and Katori-spoon groups. Patients were followed up until 40 (±2) weeks of postmenstrual age or until death, whichever occurred earlier. The primary outcome was time to achieve full oral feeding. The secondary outcomes included the time spent per feeding session, time to full direct breastfeeding, anthropometry at discharge, duration of hospitalization, and mortality. The opinions of mothers and nurses were recorded using a structured questionnaire. Results: A total of 106 participants (53 in each group) were randomized and analyzed for the primary outcome. The median (1st, 3rd quartile) time to achieve complete oral feeds was 5 (2, 11) versus 6 (4, 11) days in the Nifty cup versus Katori-spoon groups, respectively (p = 0.2). Infants in the Nifty cup group reached full breastfeeds earlier (mean difference = 12.6 days; 95% confidence interval: 4.3 to 20.8, p = 0.003) and had less vomiting (9.4% versus 26.4%, p = 0.023). Mothers and nurses felt that breast milk expression and feeding with a Nifty cup was easier. Conclusions: Compared to the Katori-spoon, feeding with a Nifty cup did not shorten the time to full oral feeds. However, it helps in attaining full breastfeeds earlier than the Katori-spoon. Trial Registration: Clinical Trials Registry-India (CTRI/2021/06/034252).

Effects of feeding methods on growth and slaughter performance, blood biochemical indices, and intestinal morphology in Minxinan black rabbits (Oryctolagus cuniculus).

Feed restriction after weaning is a common strategy used in commercial rabbit farms to improve feed efficiency, promote health, and reduce mortality. However, few studies have investigated the feed restrictions of Minxinan black rabbits (Oryctolagus cuniculus). Thus, the effects of feed restriction on growth and slaughter performance, intestinal morphology, and blood biochemical indices of Minxinan black rabbits were evaluated in this study. Rabbits in group A (control group) had ad libitum intake, while those in feed restriction groups (groups B, C, and D) were restricted to 80% of the average daily feed intake (ADFI) of group A the day before. The rabbits in group B were fed once per day at 8:00 am. Rabbits in groups C and D were fed twice per day at 8:00 am (50%) and 4:00 pm (50%) and 8:00 am (30%) and 4:00 pm (70%), respectively. The experimental period lasted for 8 weeks. Compared to that in group A, the diarrhea rate of group C was significantly decreased (P < 0.05), and the ADFI, feed conversion ratio, abdominal fat weight, abdominal fat rate, total protein, albumin, globulin, alanine aminotransferase (ALT), low-density lipoprotein, and intestinal crypt depth of all feed restriction groups were significantly reduced (P < 0.01). Feed conversion ratio in group D was significantly better than that in groups B and C (P < 0.05). The efficiency index (EI) of groups C and D was higher than that of groups A and B (P < 0.01). Triglyceride levels in groups C and D were significantly lower than those in group A. The villus length to crypt depth of the duodenum and jejunum in group D was significantly higher than that in group A (P < 0.01). In conclusion, the following parameters can be improved by feed restriction: feed conversion ratio, diarrhea rate, abdominal fat rate, serum ALT, lipid indices and intestinal health of Minxinan black rabbits, and the EI of the farm. Feeding twice per day, 30% at 8:00 am and 70% at 4:00 pm, had the best comprehensive effects.

Atuação da psicologia em unidade neonatal no contexto da pandemia da covid-19 / The work of psychology in a neonatal unit in the covid-19 pandemic / Actuación de la psicología en una unidad neonatal en el contexto de la pandemia de la covid-19

A pandemia de covid-19 provocou intensas mudanças no contexto do cuidado neonatal, exigindo dos profissionais de saúde a reformulação de práticas e o desenvolvimento de novas estratégias para a manutenção da atenção integral e humanizada ao recém-nascido. O objetivo deste artigo é relatar a atuação da Psicologia nas Unidades Neonatais de um hospital público de Fortaleza (CE), Brasil, durante o período de distanciamento físico da pandemia de covid-19. Trata-se de estudo descritivo, do tipo relato de experiência, que ocorreu no período de março a agosto de 2020. No contexto pandêmico, o serviço de Psicologia desenvolveu novas condutas assistenciais para atender às demandas emergentes do momento, como: atendimento remoto; registro e envio on-line de imagens do recém-nascido a seus familiares; visitas virtuais; e reprodução de mensagens de áudio da família para o neonato. Apesar dos desafios encontrados, as ações contribuíram para a manutenção do cuidado centrado no recém-nascido e sua família, o que demonstra a potencialidade do fazer psicológico.(AU)

The COVID-19 pandemic brought intense changes to neonatal care and required health professionals to reformulate practices and develop new strategies to ensure comprehensive and humanized care for newborn. This study aims to report the experience of the Psychology Service in the Neonatal Units of a public hospital in Fortaleza, in the state of Ceará, Brazil, during the social distancing period of the COVID-19 pandemic. This descriptive experience report study was conducted from March to August 2020. During the pandemic, the Psychology Service developed new care practices to meet the emerging demands of that moment, such as remote care, recordings and online submission of newborns' pictures and video images for their family, virtual tours, and reproduction of family audio messages for the newborns. Despite the challenges, the actions contributed to the maintenance of a care that is centered on the newborns and their families, which shows the potential of psychological practices.(AU)

La pandemia de la COVID-19 ha traído cambios intensos en el contexto de la atención neonatal, que requieren de los profesionales de la salud una reformulación de sus prácticas y el desarrollo de nuevas estrategias para asegurar una atención integral y humanizada al recién nacido. El objetivo de este artículo es reportar la experiencia del Servicio de Psicología en las Unidades Neonatales de un hospital público de Fortaleza, en Ceará, Brasil, durante el periodo de distanciamiento físico en la pandemia de la COVID-19. Se trata de un estudio descriptivo, un reporte de experiencia, que se llevó a cabo de marzo a agosto de 2020. En el contexto pandémico, el servicio de Psicología desarrolló nuevas conductas asistenciales para atender a las demandas emergentes del momento, tales como: atención remota; grabación y envío em línea de imágenes del recién nacido; visitas virtuales; y reproducción de mensajes de audio de la familia para el recién nacido. A pesar de los desafíos encontrados, las acciones contribuyeron al mantenimiento de la atención centrada en el recién nacido y su familia, lo que demuestra el potencial de la práctica psicológica.(AU)

Tempo de transição alimentar e método de alimentação na alta hospitalar de prematuros com displasia broncopulmonar / Feeding transition time and feeding method at hospital discharge of preterm infants with bronchopulmonary dysplasia

RESUMO Objetivo Comparar o tempo de transição alimentar e a forma de alimentação por via oral na alta hospitalar, entre recém-nascidos prematuros com diagnóstico de displasia broncopulmonar e prematuros sem o diagnóstico. Métodos Estudo transversal, retrospectivo com base na coleta de dados nos prontuários. Foram coletados dados de 78 recém-nascidos, em uma maternidade de referência. A amostra foi estratificada em dois grupos, de acordo com a presença do diagnóstico de displasia broncopulmonar, sendo um grupo de prematuros com displasia broncopulmonar e outro sem. Foram analisados o tempo de transição alimentar e o método de alimentação na alta hospitalar de ambos os grupos. Resultados Houve diferença significativa no tempo de transição alimentar e no método de alimentação na alta hospitalar entre os grupos. Os recém-nascidos pré-termo com displasia broncopulmonar apresentaram média de 18,03 (± 5,5) dias de transição e saíram em uso de mamadeira. Conclusão O grupo com displasia broncopulmonar necessitou de maior tempo de transição alimentar e teve menor frequência de aleitamento materno exclusivo, em relação ao grupo sem o diagnóstico.

ABSTRACT Purpose To compare the time of food transition and the form of oral feeding at hospital discharge, between premature newborns diagnosed with bronchopulmonary dysplasia and premature newborns without the diagnosis. Methods Cross-sectional, retrospective study based on data collection from medical records. Data were collected from 78 newborns, in a reference maternity hospital, in which the sample was stratified into two groups according to the presence or absence of the diagnosis of bronchopulmonary dysplasia. The time of food transition and the feeding method at hospital discharge were analyzed for both groups. Results There was a significant difference in the time of food transition and in the feeding method at hospital discharge between the groups. Preterm newborns with bronchopulmonary dysplasia had an average of 18.03 (± 5.5) transition days and left using a bottle. Conclusion The group with bronchopulmonary dysplasia required a longer time of food transition and fewer ( of its ) infants had exclusive breastfeeding compared to the group without the diagnosis.

Deglutição de pacientes críticos e sua associação com características epidemiológicas e clínicas / Swallowing of critical patients and its association with epidemiological and clinical characteristics / Deglución de pacientes críticos y su associación con características epidemiológicas y clínicas

Introdução: Disfagia é um distúrbio de deglutição com sinais e sintomas específicos, caracterizada por alterações em qualquer fase ou entre as fases da dinâmica de deglutição, de origem congênita ou adquirida, podendo gerar prejuízo pulmonar, nutricional e social. É um transtorno frequentemente encontrado no centro de tratamento intensivo (CTI). Sendo assim, a identificação precoce dos principais agentes etiológicos para transtornos de deglutição é essencial para promover uma assistência fonoaudiológica mais adequada. Objetivo: Verificar a associação entre características epidemiológicas e clínicas com o desfecho contraindicação fonoaudiológica de alimentação por via oral em pacientes internados em um CTI. Métodos: Estudo transversal que avaliou pacientes internados no CTI submetidos a avaliação clínica da deglutição no período entre outubro de 2018 e maio de 2019. O nível 1 da Escala funcional de ingestão por via oral (FOIS) foi considerado de maior risco para aspiração respiratória e comparado com os níveis FOIS 2-7. Variáveis epidemiológicas e clínicas foram obtidas a partir dos registros dos pacientes. Análises univariadas e multivariadas foram realizadas para identificar associações e efeitos entre as variáveis e o desfecho contraindicação da alimentação por via oral. O nível de significância adotado foi de 5% e as análises foram realizadas no programa SPSS v.21.0. Resultados: Foram incluídos 128 pacientes (64,9% submetidos a intubação orotraqueal ­ IOT; idade de 60 ± 15,3 anos). Pacientes com FOIS 1 permaneceram mais dias em IOT, tiveram a internação no CTI prolongada e a cada dia de internação apresentaram risco de 5% de contraindicação da alimentação por via oral na avaliação fonoaudiológica. Conclusão: Foi evidenciada associação entre maior tempo de intubação orotraqueal, além de maior tempo de internação prévio, com a contraindicação da alimentação por via oral.

Introduction: Dysphagia is a swallowing disorder with specific signs and symptoms, characterized by alterations in any phase or between phases of swallowing dynamics, of congenital or acquired origin, which can lead to pulmonary, nutritional and social damage. It is a disorder often found in the intensive care unit (ICU). Therefore, the early identification of the main etiological agents for swallowing disorders is essential to promote more adequate speech therapy assistance. Objective: To verify the association between epidemiological and clinical characteristics with the outcome speech-language pathology contraindication for oral feeding in patients admitted to an ICU. Methods: Cross-sectional study that evaluated patients admitted to the ICU who underwent clinical evaluation of swallowing between October 2018 and May 2019. Level 1 of the Functional oral intake scale (FOIS) was considered at higher risk for respiratory aspiration and compared with FOIS levels 2-7. Epidemiological and clinical variables were obtained from patient records. Univariate and multivariate analyses were performed to identify associations and effects between variables and the outcome contraindication of oral feeding. The significance level adopted was 5% and the analyses were performed using the SPSS v.21.0 program. Results: 128 patients were included (64.9% undergoing orotracheal intubation - OTI; age of 60 ± 15.3 years). Patients with FOIS 1 spent more days on OTI, had a prolonged stay in the ICU and each day of hospitalization had a 5% risk of contraindication of oral feeding in the speech-language pathology assessment. Conclusion: There was an association between longer times of orotracheal intubation, in addition to longer previous hospitalization time, with the contraindication of oral feeding.

Introducción: La disfagia es un trastorno de la deglución con signos y síntomas específicos, caracterizado por alteraciones en cualquier fase o entre fases de la dinámica de la deglución, de origen congénito o adquirido, que pueden conducir a daño pulmonar, nutricional y social. Es un trastorno que se encuentra a menudo en la unidad de cuidados intensivos (UCI). Por lo tanto, la identificación temprana de los principales agentes etiológicos de los trastornos de la deglución es fundamental para promover una asistencia logopédica más adecuada. Objetivo: Verificar la asociación entre las características epidemiológicas y clínicas con el desenlace fonoaudiológico contraindicación para alimentación oral en pacientes internados en una UTI. Métodos: Estudio transversal que evaluó a pacientes ingresados en UCI a quienes se les realizó evaluación clínica de la deglución entre octubre de 2018 y mayo de 2019. Nivel 1 de la Escala de ingesta oral funcional (FOIS) fue considerado de mayor riesgo para aspiración respiratoria y comparado con los niveles de FOIS 2-7. Las variables epidemiológicas y clínicas se obtuvieron de las historias clínicas de los pacientes. Se realizaron análisis univariados y multivariados para identificar asociaciones y efectos entre las variables y el resultado contraindicación de la alimentación oral. El nivel de significación adoptado fue del 5% y los análisis se realizaron con el programa SPSS v.21.0. Resultados: se incluyeron 128 pacientes (64,9% sometidos a intubación orotraqueal - IOT; edad de 60 ± 15,3 años). Los pacientes con FOIS 1 pasaron más días en OTI, tuvieron una estancia prolongada en la UCI y cada día de hospitalización tenían un 5% de riesgo de contraindicación de alimentación oral en la evaluación de patología del habla y lenguaje. Conclusión: Hubo asociación entre mayor tiempo de intubación orotraqueal, además de mayor tiempo de hospitalización previa, con la contraindicación de alimentación oral.