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1.
Cochrane Database Syst Rev ; 6: CD003959, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32573771

RESUMO

BACKGROUND: The ideal quantity of dietary protein for formula-fed low birth weight infants is still a matter of debate. Protein intake must be sufficient to achieve normal growth without leading to negative effects such as acidosis, uremia, and elevated levels of circulating amino acids. OBJECTIVES: To determine whether higher (≥ 3.0 g/kg/d) versus lower (< 3.0 g/kg/d) protein intake during the initial hospital stay of formula-fed preterm infants or low birth weight infants (< 2.5 kilograms) results in improved growth and neurodevelopmental outcomes without evidence of short- or long-term morbidity. Specific objectives were to examine the following comparisons of interventions and to conduct subgroup analyses if possible. 1. Low protein intake if the amount was less than 3.0 g/kg/d. 2. High protein intake if the amount was equal to or greater than 3.0 g/kg/d but less than 4.0 g/kg/d. 3. Very high protein intake if the amount was equal to or greater than 4.0 g/kg/d. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 8), in the Cochrane Library (August 2, 2019); OVID MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R) (to August 2, 2019); MEDLINE via PubMed (to August 2, 2019) for the previous year; and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (to August 2, 2019). We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-randomized trials. SELECTION CRITERIA: We included RCTs contrasting levels of formula protein intake as low (< 3.0 g/kg/d), high (≥ 3.0 g/kg/d but < 4.0 g/kg/d), or very high (≥ 4.0 g/kg/d) in formula-fed hospitalized neonates weighing less than 2.5 kilograms. We excluded studies if infants received partial parenteral nutrition during the study period, or if infants were fed formula as a supplement to human milk. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We identified six eligible trials that enrolled 218 infants through searches updated to August 2, 2019. Five studies compared low (< 3 g/kg/d) versus high (3.0 to 4.0 g/kg/d) protein intake using formulas that kept other nutrients constant. The trials were small (n = 139), and almost all had methodological limitations; the most frequent uncertainty was about attrition. Low-certainty evidence suggests improved weight gain (mean difference [MD] 2.36 g/kg/d, 95% confidence interval [CI] 1.31 to 3.40) and higher nitrogen accretion in infants receiving formula with higher protein content (3.0 to 4.0 g/kg/d) versus lower protein content (< 3 g/kg/d), while other nutrients were kept constant. No significant differences were seen in rates of necrotizing enterocolitis, sepsis, or diarrhea. We are uncertain whether high versus low protein intake affects head growth (MD 0.37 cm/week, 95% CI 0.16 to 0.58; n = 18) and length gain (MD 0.16 cm/week, 95% CI -0.02 to 0.34; n = 48), but sample sizes were small for these comparisons. One study compared high (3.0 to 4.0 g/kg/d) versus very high (≥ 4 g/kg/d) protein intake (average intakes were 3.6 and 4.1 g/kg/d) during and after an initial hospital stay (n = 77). Moderate-certainty evidence shows no significant differences in weight gain or length gain to discharge, term, and 12 weeks corrected age from very high protein intake (4.1 versus 3.6 g/kg/d). Three of the 24 infants receiving very high protein intake developed uremia. AUTHORS' CONCLUSIONS: Higher protein intake (≥ 3.0 g/kg/d but < 4.0 g/kg/d) from formula accelerates weight gain. However, limited information is available regarding the impact of higher formula protein intake on long-term outcomes such as neurodevelopment. Research is needed to investigate the safety and effectiveness of protein intake ≥ 4.0 g/kg/d.


Assuntos
Desenvolvimento Infantil/fisiologia , Proteínas na Dieta/administração & dosagem , Fórmulas Infantis/química , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Proteínas na Dieta/efeitos adversos , Cabeça/crescimento & desenvolvimento , Humanos , Recém-Nascido , Criança Pós-Termo , Nitrogênio/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Ganho de Peso
2.
PLoS One ; 15(4): e0231648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32330149

RESUMO

OBJECTIVE: This study assesses whether low birthweight/preterm (LBW/PT) adolescents with persistent inattention (PIA) have neuropsychological deficits that distinguish them from adolescents with school age limited inattention (SAL) and those largely unaffected (UA). METHOD: Three latent classes (PIA, SAL, UA), derived from an earlier analysis of a LBW/PT birth cohort were compared on non-executive and executive functioning measures assessed at age 16. RESULTS: The PIA class displayed the poorest performance on executive functioning, which was exaggerated in the context of lower IQ. The PIA and the SAL classes had poorer performance on non-executive functioning relative to the UA class. Both types of functioning mediated the relationship of class to school service use and grade retention. CONCLUSION: Neuropsychological impairment characterizes children and adolescents with inattention problems. Problems in executive functioning characterize the subset whose inattention persists through adolescence. Subsequent research can examine the potential for remediating these deficits to address academic and social problems.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Atenção , Função Executiva , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Feminino , Humanos , Recém-Nascido , Masculino
3.
BMJ Case Rep ; 12(12)2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31822528

RESUMO

Each year approximately 20 million low birthweight babies are born globally. Prematurity is a leading cause of neonatal mortality in developing countries and results in 60%-80% of neonatal deaths. Neonatal mortality is the major contributor to under-5 mortality. According to Pakistan Demographic and Health Survey 2017-2018, neonatal mortality in Pakistan is 42 per 1000 live births and under-5 mortality is 74 per 1000 live births. One out of every 22 newborns dies in Pakistan, which is an alarming figure. Majority of these deaths are preventable. They can be prevented by well-trained midwives, safe delivery, early initiation of breast feeding within an hour after birth and skin-to-skin contact. Pakistan is among the top 10 countries with the highest number of preterm births and with limited resources to manage the burden. Kangaroo mother care (KMC) is a safe and economical alternative to provide preterm care in developing countries. In babies at gestational age less than 37 weeks or with neonatal weight less than 2.5 kg, skin-to-skin contact prevents hypothermia and infection. Neonatal mortality and morbidity can be reduced by providing preterm care through KMC. This case report is of a preterm baby who was delivered at 33 weeks of gestation with a weight of 1.3 kg and was saved by KMC in the paediatric department of Services Hospital in Lahore.


Assuntos
Aleitamento Materno/métodos , Recém-Nascido de Baixo Peso/fisiologia , Método Canguru , Gravidez de Trigêmeos , Sobreviventes , Ganho de Peso/fisiologia , Aconselhamento Diretivo , Feminino , Humanos , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Terapia Intensiva Neonatal , Gravidez , Resultado do Tratamento
4.
Lancet ; 394(10210): 1724-1736, 2019 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-31590989

RESUMO

BACKGROUND: Coverage of kangaroo mother care remains very low despite WHO recommendations for its use for babies with low birthweight in health facilities for over a decade. Initiating kangaroo mother care at the community level is a promising strategy to increase coverage. However, knowledge of the efficacy of community-initiated kangaroo mother care is still lacking. We aimed to assess the effect of community-initiated kangaroo mother care provided to babies weighing 1500-2250 g on neonatal and infant survival. METHODS: In this randomised controlled, superiority trial, undertaken in Haryana, India, we enrolled babies weighing 1500-2250 g at home within 72 h of birth, if not already initiated in kangaroo mother care, irrespective of place of birth (ie, home or health facility) and who were stable and feeding. The first eligible infants in households were randomly assigned (1:1) to the intervention (community-initiated kangaroo mother care) or control group by block randomisation using permuted blocks of variable size. Twins were allocated to the same group. For second eligible infants in the same household as an enrolled infant, if the first infant was assigned to the intervention group the second infant was also assigned to this group, whereas if the first infant was assigned to the control group the second infant was randomly assigned (1:1) to the intervention or control group. Mothers and infants in the intervention group were visited at home (days 1-3, 5, 7, 10, 14, 21, and 28) to support kangaroo mother care (ie, skin-to-skin contact and exclusive breastfeeding). The control group received routine care. The two primary outcomes were mortality between enrolment and 28 days and between enrolment and 180 days. Analysis was by intention to treat and adjusted for clustering within households. The effect of the intervention on mortality was assessed with person-time in the denominator using Cox proportional hazards model. This study is registered with ClinicalTrials.gov, NCT02653534 and NCT02631343, and is now closed to new participants. FINDINGS: Between July 30, 2015, and Oct 31, 2018, 8402 babies were enrolled, of whom 4480 were assigned to the intervention group and 3922 to the control group. Most births (6837 [81·4%]) occurred at a health facility, 36·2% (n=3045) had initiated breastfeeding within 1 h of birth, and infants were enrolled at an average of about 30 h (SD 17) of age. Vital status was known for 4470 infants in the intervention group and 3914 in the control group at age 28 days, and for 3653 in the intervention group and 3331 in the control group at age 180 days. Between enrolment and 28 days, 73 infants died in 4423 periods of 28 days in the intervention group and 90 deaths in 3859 periods of 28 days in the control group (hazard ratio [HR] 0·70, 95% CI 0·51-0·96; p=0·027). Between enrolment and 180 days, 158 infants died in 3965 periods of 180 days in the intervention group and 184 infants died in 3514 periods of 180 days in the control group (HR 0·75, 0·60-0·93; p=0·010). The risk ratios for death were almost the same as the HRs (28-day mortality 0·71, 95% CI 0·52- 0·97; p=0·032; 180-day mortality 0·76, 0·60-0·95; p=0·017). INTERPRETATION: Community-initiated kangaroo mother care substantially improves newborn baby and infant survival. In low-income and middle-income countries, incorporation of kangaroo mother care for all infants with low birthweight, irrespective of place of birth, could substantially reduce neonatal and infant mortality. FUNDING: Research Council of Norway and University of Bergen.


Assuntos
Mortalidade Infantil , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Método Canguru/métodos , Mortalidade Perinatal , Desenvolvimento Infantil , Serviços de Saúde Comunitária , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Método Canguru/estatística & dados numéricos , Masculino , Projetos de Pesquisa , Fatores Socioeconômicos , Resultado do Tratamento
5.
Cochrane Database Syst Rev ; 8: CD002972, 2019 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-31452191

RESUMO

BACKGROUND: Artificial formula can be manipulated to contain higher amounts of macro-nutrients than maternal breast milk but breast milk confers important immuno-nutritional advantages for preterm or low birth weight (LBW) infants. OBJECTIVES: To determine the effect of feeding preterm or LBW infants with formula compared with maternal breast milk on growth and developmental outcomes. SEARCH METHODS: We used the standard strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 9), and Ovid MEDLINE, Ovid Embase, Ovid Maternity & Infant Care Database, and CINAHL to October 2018. We searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that compared feeding preterm or low birth weight infants with formula versus maternal breast milk. DATA COLLECTION AND ANALYSIS: Two review authors planned independently to assess trial eligibility and risk of bias, and extract data. We planned to analyse treatment effects as described in the individual trials and report risk ratios and risk differences for dichotomous data, and mean differences for continuous data, with 95% confidence intervals. We planned to use a fixed-effect model in meta-analyses and to explore potential causes of heterogeneity in subgroup analyses. We planned to use the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We did not identify any eligible trials. AUTHORS' CONCLUSIONS: There are no trials of formula versus maternal breast milk for feeding preterm or low birth weight infants. Such trials are unlikely to be conducted because of the difficulty of allocating an alternative form of nutrition to an infant whose mother wishes to feed with her own breast milk. Maternal breast milk remains the default choice of enteral nutrition because observational studies, and meta-analyses of trials comparing feeding with formula versus donor breast milk, suggest that feeding with breast milk has major immuno-nutritional advantages for preterm or low birth weight infants.


Assuntos
Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Leite Humano , Humanos , Lactente , Fórmulas Infantis , Recém-Nascido , Ensaios Clínicos Controlados Aleatórios como Assunto , Ganho de Peso
6.
Cochrane Database Syst Rev ; 7: CD002971, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31322731

RESUMO

BACKGROUND: When sufficient maternal breast milk is not available, alternative forms of enteral nutrition for preterm or low birth weight (LBW) infants are donor breast milk or artificial formula. Donor breast milk may retain some of the non-nutritive benefits of maternal breast milk for preterm or LBW infants. However, feeding with artificial formula may ensure more consistent delivery of greater amounts of nutrients. Uncertainty exists about the balance of risks and benefits of feeding formula versus donor breast milk for preterm or LBW infants. OBJECTIVES: To determine the effect of feeding with formula compared with donor breast milk on growth and development in preterm or low birth weight (LBW) infants. SEARCH METHODS: We used the Cochrane Neonatal search strategy, including electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5), Ovid MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (3 May 2019), as well as conference proceedings, previous reviews, and clinical trials. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs) comparing feeding with formula versus donor breast milk in preterm or LBW infants. DATA COLLECTION AND ANALYSIS: Two review authors assessed trial eligibility and risk of bias and extracted data independently. We analysed treatment effects as described in the individual trials and reported risk ratios (RRs) and risk differences (RDs) for dichotomous data, and mean differences (MDs) for continuous data, with respective 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses and explored potential causes of heterogeneity in subgroup analyses. We assessed the certainty of evidence for the main comparison at the outcome level using GRADE methods. MAIN RESULTS: Twelve trials with a total of 1879 infants fulfilled the inclusion criteria. Four trials compared standard term formula versus donor breast milk and eight compared nutrient-enriched preterm formula versus donor breast milk. Only the five most recent trials used nutrient-fortified donor breast milk. The trials contain various weaknesses in methodological quality, specifically concerns about allocation concealment in four trials and lack of blinding in most of the trials. Most of the included trials were funded by companies that made the study formula.Formula-fed infants had higher in-hospital rates of weight gain (mean difference (MD) 2.51, 95% confidence interval (CI) 1.93 to 3.08 g/kg/day), linear growth (MD 1.21, 95% CI 0.77 to 1.65 mm/week) and head growth (MD 0.85, 95% CI 0.47 to 1.23 mm/week). These meta-analyses contained high levels of heterogeneity. We did not find evidence of an effect on long-term growth or neurodevelopment. Formula feeding increased the risk of necrotising enterocolitis (typical risk ratio (RR) 1.87, 95% CI 1.23 to 2.85; risk difference (RD) 0.03, 95% CI 0.01 to 0.05; number needed to treat for an additional harmful outcome (NNTH) 33, 95% CI 20 to 100; 9 studies, 1675 infants).The GRADE certainty of evidence was moderate for rates of weight gain, linear growth, and head growth (downgraded for high levels of heterogeneity) and was moderate for neurodevelopmental disability, all-cause mortality, and necrotising enterocolitis (downgraded for imprecision). AUTHORS' CONCLUSIONS: In preterm and LBW infants, moderate-certainty evidence indicates that feeding with formula compared with donor breast milk, either as a supplement to maternal expressed breast milk or as a sole diet, results in higher rates of weight gain, linear growth, and head growth and a higher risk of developing necrotising enterocolitis. The trial data do not show an effect on all-cause mortality, or on long-term growth or neurodevelopment.


Assuntos
Fórmulas Infantis , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Leite Humano , Humanos , Lactente , Recém-Nascido , Ensaios Clínicos Controlados Aleatórios como Assunto , Ganho de Peso
7.
Cochrane Database Syst Rev ; 7: CD004204, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-31314903

RESUMO

BACKGROUND: Preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with nutrient-enriched rather than standard formula might increase nutrient accretion and growth rates and might improve neurodevelopmental outcomes. OBJECTIVES: To compare the effects of feeding with nutrient-enriched formula versus standard formula on growth and development of preterm infants. SEARCH METHODS: We used the Cochrane Neonatal standard search strategy. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11), MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (until November 2018), as well as conference proceedings, previous reviews, and clinical trials databases. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials that compared feeding preterm infants with nutrient-enriched formula (protein and energy plus minerals, vitamins, or other nutrients) versus standard formula. DATA COLLECTION AND ANALYSIS: We extracted data using the Cochrane Neonatal standard methods. Two review authors separately evaluated trial quality and extracted and synthesised data using risk ratios (RRs), risk differences, and mean differences (MDs). We assessed certainty of evidence at the outcome level using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS: We identified seven trials in which a total of 590 preterm infants participated. Most participants were clinically stable preterm infants of birth weight less than 1850 g. Few participants were extremely preterm, extremely low birth weight, or growth restricted at birth. Trials were conducted more than 30 years ago, were formula industry funded, and were small with methodological weaknesses (including lack of masking) that might bias effect estimates. Meta-analyses of in-hospital growth parameters were limited by statistical heterogeneity. There is no evidence of an effect on time to regain birth weight (MD -1.48 days, 95% confidence interval (CI) -4.73 to 1.77) and low-certainty evidence suggests that feeding with nutrient-enriched formula increases in-hospital rates of weight gain (MD 2.43 g/kg/d, 95% CI 1.60 to 3.26) and head circumference growth (MD 1.04 mm/week, 95% CI 0.18 to 1.89). Meta-analysis did not show an effect on the average rate of length gain (MD 0.22 mm/week, 95% CI -0.70 to 1.13). Fewer data are available for growth and developmental outcomes assessed beyond infancy, and these do not show consistent effects of nutrient-enriched formula feeding. Data from two trials did not show an effect on Bayley Mental Development Index scores at 18 months post term (MD 2.87, 95% CI -1.38 to 7.12; moderate-certainty evidence). Infants who received nutrient-enriched formula had higher Bayley Psychomotor Development Index scores at 18 months post term (MD 6.56. 95% CI 2.87 to 10.26; low-certainty evidence), but no evidence suggested an effect on cerebral palsy (typical RR 0.79, 95% CI 0.30 to 2.07; 2 studies, 377 infants). Available data did not indicate any other benefits or harms and provided low-certainty evidence about the effect of nutrient-enriched formula feeding on the risk of necrotising enterocolitis in preterm infants (typical RR 0.72, 95% CI 0.41 to 1.25; 3 studies, 489 infants). AUTHORS' CONCLUSIONS: Available trial data show that feeding preterm infants nutrient-enriched (compared with standard) formulas has only modest effects on growth rates during their initial hospital admission. No evidence suggests effects on long-term growth or development. The GRADE assessment indicates that the certainty of this evidence is low, and that these findings should be interpreted and applied with caution. Further randomised trials would be needed to resolve this uncertainty.


Assuntos
Alimentos Formulados , Fórmulas Infantis , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Ingestão de Energia/fisiologia , Humanos , Fórmulas Infantis/normas , Recém-Nascido , Ensaios Clínicos Controlados Aleatórios como Assunto , Ganho de Peso
8.
Matern Child Health J ; 23(9): 1251-1259, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31214947

RESUMO

OBJECTIVES: To examine the association between gun violence and birth outcomes among women in Chicago. METHODS: Using a 5-year set of birth files (2011-2015) merged with census and police data, birth outcomes including low birth weight (LBW, BW < 2500 g), preterm birth (PTB, < 37 weeks gestation), and small-for-gestational-age (SGA, BW < 10th percentile) were examined among non-Hispanic (NH) white, NH black, and Hispanic women in Chicago. Gun violence rates were categorized into tertiles. Multilevel, multiple logistic regression examined the effects of gun violence and race/ethnicity on birth outcomes. RESULTS: Of 175,065 births, 10.6% of LBW, 10.6% of PTB, and 9.1% of SGA occurred in high violence tertile. Using white women in low violence tertile as reference, the OR for LBW among black women ranged 1.9-2.1 across all tertiles, and 0.8-1.2 among Hispanic women. OR for PTB for black women were 1.6-1.7 and 1.0-1.2 for Hispanic women, and OR for SGA for black women were 1.6-1.7 and for Hispanic women 0.9-1.0. CONCLUSIONS FOR PRACTICE: In Chicago, race/ethnicity was associated with birth outcomes, regardless of the level of exposure to gun violence, in 2011-2015. The differences in racial/ethnic composition across the violence exposure levels suggest that, rather than gun violence alone, residential segregation and the geographic inequities likely contribute to disparate birth outcomes.


Assuntos
Violência com Arma de Fogo/psicologia , Resultado da Gravidez/epidemiologia , Características de Residência/estatística & dados numéricos , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Chicago/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Violência com Arma de Fogo/estatística & dados numéricos , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de Baixo Peso/fisiologia , New Hampshire/epidemiologia , Saúde da População/estatística & dados numéricos , Gravidez , Análise de Regressão
9.
Compr Child Adolesc Nurs ; 42(sup1): 252-260, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192719

RESUMO

Weight gain in low birth weight infants can be improved by Kangaroo Mother Care (KMC). The sustainability of KMC implementation can be improved by increasing maternal confidence. Therefore, an appropriate method is needed in KMC education so that maternal confidence, KMC implementation, and weight gain in low birth weight infants can be increased. This study aimed to determine the effect of peer support on maternal self-confidence, KMC implementation, and infant's weight gain in four hospitals: one hospital in Jakarta, Bogor, Tangerang, and Bekasi. The study design was a randomized controlled trial with pre-post test equivalent group which involved 24 participants in both intervention and control group, respectively, based on selected criteria. The intervention provided was three sessions of education on KMC based on individual approach provided by peers. The KMC implementation and infant's weight gain were observed for five days. This study employed a maternal self-confidence questionnaire and KMC observation and weight gain form. The result showed significant differences in mother's confidence, KMC implementation, and infant's weight gain between the control group and intervention group (p = 0.001; 0.001; 0.032; 0.030). There was a significant correlation between infant's birth weight, maternal self-confidence and infant's weight gain, as well as between comorbidities and weight gain in infants. So, peer support effectively improved maternal self-confidence, KMC implementation, and weight gain in infants in hospital. Therefore, the implementation may be extended throughout home visits.


Assuntos
Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Mães/psicologia , Infuência dos Pares , Autoeficácia , Ganho de Peso/fisiologia , Peso ao Nascer/fisiologia , Humanos , Lactente , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Método Canguru/normas , Método Canguru/tendências , Isolamento Social/psicologia , Apoio Social
10.
PLoS One ; 14(6): e0218278, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31194812

RESUMO

Children born small for gestational age (SGA) generally have a catch-up growth and rapid weight gain in the first years of life, which is a high risk of insulin resistance and cardiovascular diseases later in life. It was reported that the level of imprinted genes IGF-2, CDKN1C and PHLDA2 regulates placental growth. We assessed these imprinted genes expression levels in placental tissue and their influences on catch-up growth of full-term SGA infants. The protein and mRNA levels of placental CDKN1C, PHLDA2 and IGF-2 were analyzed in 29 full-term SGA and 29 full-term infants born appropriate for gestational age (AGA) using quantitative RT-PCR and Western blot assay, respectively. Catch-up growth was indicated by increased standard deviation score (ΔSDS) of weight at 1, 3 and 6 months relative to birth weight (BW). Correlations between indicated variables were evaluated using Pearson correlation coefficient analysis. Compared to AGA infants, CDKN1C and PHLDA2 levels were significantly increased, whereas IGF-2 was significantly reduced in SGA infants. The value of ΔSDS was significantly higher in SGA than that in AGA infants. For SGA status, Pearson analysis shows i) a negative correlation of CDKN1C and PHLDA2 abundances with BW, and a positive correlation of IGF-2 with BW, ii) no correlation between the three imprinted gene abundances and placental weight (PW), and between PW and BW, iii) a positive correlation of PHLDA2 abundance with CDKN1C, and iv) a positive correlation of CDKN1C and PHLDA2 abundances with ΔSDS, and a negative correlation of IGF-2 with ΔSDS at 1, 3 and 6 months. Taken together, increased CDKN1C and PHLDA2 and reduced IGF-2 abundances in placental tissue were related to BW and early period catch-up growth in full-term SGA infants. Placental CDKN1C, PHLDA2 and IGF-2 level monitoring may be useful for predicting and preventing the development of SGA.


Assuntos
Peso ao Nascer/genética , Inibidor de Quinase Dependente de Ciclina p57/genética , Recém-Nascido de Baixo Peso/metabolismo , Recém-Nascido Pequeno para a Idade Gestacional/metabolismo , Fator de Crescimento Insulin-Like II/genética , Proteínas Nucleares/genética , Adulto , Estatura/fisiologia , Desenvolvimento Infantil , Inibidor de Quinase Dependente de Ciclina p57/metabolismo , Feminino , Impressão Genômica , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido , Doenças do Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Resistência à Insulina , Fator de Crescimento Insulin-Like II/metabolismo , Masculino , Proteínas Nucleares/metabolismo , Parto , Placenta/metabolismo , Gravidez
12.
Rev. cuba. pediatr ; 91(1): e600, ene.-mar. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-985591

RESUMO

Introducción: La displasia broncopulmonar es la secuela más común relacionada con los recién nacidos prematuros de muy bajo peso al nacer, derivada de la inmadurez pulmonar y en algunos casos del tratamiento. Objetivo: Identificar los factores de riesgo maternos y neonatales asociados a displasia broncopulmonar en recién nacidos prematuros de muy bajo peso al nacer. Métodos: La muestra estuvo conformada por 205 recién nacidos prematuros de muy bajo peso al nacer en el Hospital Belén de Trujillo, durante el período 2008-2015. El grupo de casos y el de controles fueron 41 pacientes con diagnóstico de displasia broncopulmonar y 164 pacientes sin diagnóstico de este trastorno respiratorio y que se ajustaran a los criterios de exclusión. Resultados: Los factores de riesgo asociados a displasia broncopulmonar fueron dos o más episodios de sepsis tardía (OR= 5,12; IC95 por ciento: 1,87-14,06), la prematuridad extrema (OR= 4,86; IC95 por ciento: 1,71-13,80), el peso extremadamente bajo al nacer (OR= 2,72; IC95 por ciento: 0,93- 7,94) y la reanimación neonatal (OR= 2,28; IC95 por ciento: 0,89-5,87). Conclusiones: La prematuridad extrema y dos episodios o más de sepsis tardía fueron los factores de riesgo que más se relacionan con la aparición de displasia broncopulmonar en recién nacidos prematuros de muy bajo peso al nacer(AU)


Introduction: Bronchopulmonary dysplasia is the most common sequelae related to very low birth weight premature infants, and it is derived from pulmonary immaturity and in some cases from treatment. Objective: To identify maternal and neonatal risk factors associated with bronchopulmonary dysplasia in very low birth weight premature infants. Methods: The sample was composed of 205 very low birth weight premature infants at Belén of Trujillo Hospital during the period 2008-2015. The group of cases and controls were 41 patients with diagnosis of bronchopulmonary dysplasia and 164 patients with no diagnosis of this respiratory disorder, respectively, and that both groups adjusted with exclusion criteria. Results: Risk factors associated with bronchopulmonary dysplasia were 2 or more episodes of late onset sepsis (OR=5.12; IC95 percent: 1,87-14,06), extreme prematurity (OR= 4.86; IC95 percent: 1.7-13.80), extremely low birth weight (OR= 2.72; IC95 percent: 0.9-7.94) and neonatal resuscitation (OR= 2.28; IC95 percent: 0.89-5.87). Conclusions: Extreme prematurity and 2 or more episodes of late onset sepsis were the most associated risk factors to the onset of bronchopulmonary dysplasia in very low birth weight premature infants(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Displasia Broncopulmonar/complicações , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro , Estudos de Casos e Controles , Estudos Retrospectivos , Fatores de Risco , Estudos Observacionais como Assunto
13.
Rev. cuba. pediatr ; 91(1)ene.-mar. 2019. tab
Artigo em Espanhol | CUMED | ID: cum-73696

RESUMO

Introducción: La displasia broncopulmonar es la secuela más común relacionada con los recién nacidos prematuros de muy bajo peso al nacer, derivada de la inmadurez pulmonar y en algunos casos del tratamiento. Objetivo: Identificar los factores de riesgo maternos y neonatales asociados a displasia broncopulmonar en recién nacidos prematuros de muy bajo peso al nacer. Métodos: La muestra estuvo conformada por 205 recién nacidos prematuros de muy bajo peso al nacer en el Hospital Belén de Trujillo, durante el período 2008-2015. El grupo de casos y el de controles fueron 41 pacientes con diagnóstico de displasia broncopulmonar y 164 pacientes sin diagnóstico de este trastorno respiratorio y que se ajustaran a los criterios de exclusión. Resultados: Los factores de riesgo asociados a displasia broncopulmonar fueron dos o más episodios de sepsis tardía (OR= 5,12; IC95 por ciento: 1,87-14,06), la prematuridad extrema (OR= 4,86; IC95 por ciento: 1,71-13,80), el peso extremadamente bajo al nacer (OR= 2,72; IC95 por ciento: 0,93- 7,94) y la reanimación neonatal (OR= 2,28; IC95 por ciento: 0,89-5,87). Conclusiones: La prematuridad extrema y dos episodios o más de sepsis tardía fueron los factores de riesgo que más se relacionan con la aparición de displasia broncopulmonar en recién nacidos prematuros de muy bajo peso al nacer(AU)


Introduction: Bronchopulmonary dysplasia is the most common sequelae related to very low birth weight premature infants, and it is derived from pulmonary immaturity and in some cases from treatment. Objective: To identify maternal and neonatal risk factors associated with bronchopulmonary dysplasia in very low birth weight premature infants. Methods: The sample was composed of 205 very low birth weight premature infants at Belén of Trujillo Hospital during the period 2008-2015. The group of cases and controls were 41 patients with diagnosis of bronchopulmonary dysplasia and 164 patients with no diagnosis of this respiratory disorder, respectively, and that both groups adjusted with exclusion criteria. Results: Risk factors associated with bronchopulmonary dysplasia were 2 or more episodes of late onset sepsis (OR=5.12; IC95 percent: 1,87-14,06), extreme prematurity (OR= 4.86; IC95 percent: 1.7-13.80), extremely low birth weight (OR= 2.72; IC95 percent: 0.9-7.94) and neonatal resuscitation (OR= 2.28; IC95 percent: 0.89-5.87). Conclusions: Extreme prematurity and 2 or more episodes of late onset sepsis were the most associated risk factors to the onset of bronchopulmonary dysplasia in very low birth weight premature infants(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Displasia Broncopulmonar/complicações , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Estudos de Casos e Controles , Estudos Retrospectivos , Estudos Observacionais como Assunto , Fatores de Risco
14.
Rev. logop. foniatr. audiol. (Ed. impr.) ; 39(1): 4-10, ene.-mar. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-176634

RESUMO

Introduction: Preterm and low-birth-weight newborns may present immaturity in the functions of sucking, swallowing and breathing, speech therapists inserted in the hospital focus on the development of newborns' oral sensorimotor system, promoting a safe transition from tube feeding to breastfeeding and contributing to improving the quality of life of the child population. The present study aimed to analyze the development of oral functions, oral feeding transition time and breastfeeding of preterm and low-birth-weight newborns under Speech-Language Pathology care. Methods: A prognostic study carried out at a maternity hospital, based on the data collected from 121 filed medical records of newborns attended between September 2015 to July 2017. The Kaplan-Meier method, the Log Rank test and the Pearson correlation test were used for data analysis, considering a significance level of 0.05 (95%). Results: It was observed that the lower the gestational age and the birth weight of newborns, the more speech therapy services were required until the establishment of exclusive OF; also, the transition time and the average time of using the orogastric tube were inversely proportional to the gestational age at birth. The non-nutritive sucking technique was the most used for stimulation, and 78.5% of the NBs were discharged from the hospital on exclusive breastfeeding. Conclusion: Moderate to late preterm and low-birth-weight newborns are able to more quickly acquire the oral sensorimotor system functional pattern, and there are indications that Speech-Language Pathology care reduces the transition time to oral feeding, thus increasing the success rate of exclusive breastfeeding


Introducción: Los recién nacidos (RN) prematuros y con bajo peso pueden presentar inmadurez en las funciones de succión, deglución y respiración. Los logopedas en los hospitales trabajan el desarrollo del sistema sensoriomotor oral de los RN, promoviendo una transición segura de la sonda a la lactancia materna, lo que contribuye a mejorar la calidad de vida de la población infantil. El objetivo del presente estudio era analizar el desarrollo de las funciones orales, el tiempo de transición a la alimentación por vía oral (VO) y la lactancia materna de los RN prematuros, y con bajo peso al nacer bajo el cuidado fonoaudiológico. Métodos: Este estudio de pronóstico se llevó a cabo en una maternidad, con base en la recopilación de datos en prontuarios archivados de 121 RN atendidos entre septiembre de 2015 y julio de 2017. En el análisis de los datos se aplicó el método de Kaplan-Meier, el test log-rank y la prueba de correlación de Pearson. Se consideró un nivel de significancia de 0,05 (95%). Resultados: Se observó que cuanto menores eran la edad gestacional y el peso de nacimiento del RN, más necesidad de servicios fonoaudiológicos había hasta el establecimiento de la VO exclusiva, y el tiempo de transición y el tiempo promedio de utilización de la sonda orogástrica eran inversamente proporcionales a la edad gestacional al nacimiento. La técnica de succión no nutritiva fue la más utilizada para la estimulación, y el 78,5% de los RN recibieron el alta hospitalaria con lactancia exclusiva. Conclusión: Los RN prematuros de moderados a tardíos y de bajo peso son capaces de adquirir el patrón funcional del sistema sensoriomotor oral con mayor rapidez, y hay indicios de que la atención fonoaudiológica reduce el tiempo de transición alimentaria a la VO, y aumenta la tasa de éxito de lactancia materna exclusiva


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Destreza Motora/fisiologia , Sensação/fisiologia , Fonação/fisiologia , Comportamento de Sucção/fisiologia , Deglutição/fisiologia , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Fonoaudiologia/estatística & dados numéricos , Intervenção Médica Precoce/organização & administração , Testes de Função Respiratória/estatística & dados numéricos , Lactação/fisiologia
15.
Crit Rev Microbiol ; 45(1): 118-129, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30773108

RESUMO

For decades, supporting the optimal growth of low birth weight (LBW) infants has been considered one of the most important paediatric challenges, despite advances in neonatal intensive care technology and nutrition interventions. Since gut microbiota affects such diverse phenotypes in adults, the difference in gut microbiota composition between normal infants and LBW infants raises the possibility of gut microbiota playing an important role in different growth rates of neonates. Based on the concept that probiotics are generally beneficial to the health, numerous studies have been made on probiotics as a supplement to the diet of the LBW infants. However, clinical results on the effects of probiotics on LBW infant growth are either inconsistent or contradictory with each other, and thus the contribution of gut microbiota in neonatal growth has remained inconclusive. In this review, recent researches on neonatal gut microbiota are discussed to develop a new strategy for targeting gut microbiota as a solution to growth retardation in LBW infants. We also discuss how to establish the ideal gut microbiota to support optimal growth of LBW infants.


Assuntos
Desenvolvimento Infantil , Microbioma Gastrointestinal , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Microbiota , Probióticos/administração & dosagem , Humanos , Recém-Nascido
16.
Asia Pac J Clin Nutr ; 28(Suppl 1): S32-S42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30729773

RESUMO

BACKGROUND AND OBJECTIVES: Low birth weight leads to growth faltering, attributable inter alia to malnutrition and maternal health and literacy. Risk for growth faltering in rural children under five is studied. STUDY DESIGN: The Risk Approach Strategy in Tanjungsari, West Java has been analysed for all pregnancies during 1988-1989 and 4,698 singleton infants born between 1 January 1988 and 31 April 1990. Weight and body length/height measurements were repeated over 60 months, and plotted against WHO standards. Weight-for-age and height-forage z-scores were calculated using 2006 WHO growth as reference. The correlation between shortness (so-called stunting) and its presumptive risk factors was determined. A subset underwent DNA analysis for insulin-like growth factor-1 (IGF-1), and insulin receptor substrate-1 (IRS-1) polymorphism. RESULTS: Weight and body length/height follow-ups were followed-up for 3795 infants; 14.2% of the cohort had low birth weight (<2500 g) (LBW) and 85.8% normal birth weight (NBW). LBW infants showed a similar velocity but tended to catch up more slowly (GEE; p<0.001). Relative to WHO references, the differential for stature increased with age, largely offset by reduced weight-for-age so that weight-for-height tracked close to the WHO reference; this contrasts with more divergence internationally. Birth length and weight, along with potable water access were correlated with stunting for children under 2 years. Neither the observed IGF-1, IRS-1 or combined gene polymorphisms were associated with LBW. Conclusions: The prediction by factors operative during pregnancy for early life stature, with some adaptation for LBW infants, endures to 60 months.


Assuntos
Transtornos do Crescimento/diagnóstico , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Adolescente , Adulto , Peso ao Nascer , Estatura , Peso Corporal , Pré-Escolar , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/fisiopatologia , Humanos , Indonésia/epidemiologia , Lactente , Recém-Nascido , Fator de Crescimento Insulin-Like I/genética , Estudos Longitudinais , Masculino , Polimorfismo Genético , Gravidez , Prevalência , Análise de Regressão , Fatores de Risco , Adulto Jovem
17.
Early Hum Dev ; 130: 33-37, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30660016

RESUMO

INTRODUCTION: Children born from pregnancies that were complicated by hypertensive disorders of pregnancy (HDP, i.e. pre-eclampsia or HELLP syndrome) are at risk for elevated systolic and diastolic blood pressure (SBP/DBP) in childhood. AIM: To examine which neonatal, life style, and family characteristics are associated with SBP/DBP. METHODS: Study design: Prospective cohort. SUBJECTS: 12-years-old preterm and growth restricted children born to women with severe early-onset HDP. OUTCOME MEASURES: SBP/DBP standard deviation scores (SDS), corrected for age, gender and height. RESULTS: Ninety-two of the 174 mother-child pairs participated at age 12 years (mean gestational age 32 weeks, range 27 to 38 weeks, mean birth weight ratio (BWR) 0.68, range 0.33 to 0.99). Mean SBP SDS was 0.70 ±â€¯0.81 and mean DBP SDS was 0.14 ±â€¯0.78. SBP SDS was positively associated with very preterm birth (beta 0.53, p = .002), with child BMI SDS (beta 0.25, p = .035), and maternal BMI ≥ 25 kg/m2 at 12 years (beta 0.49, p = .003), and not with pre-pregnancy maternal BMI ≥ 25 kg/m2. DBP SDS was positively associated with maternal BMI ≥ 25 kg/m2 (beta 0.35, p 0.002). BWR was not associated with blood pressure. CONCLUSIONS: In 12-years old children born to women with HDP, higher systolic blood pressure values were associated with very preterm birth and child BMI. Higher blood pressure values were also associated with current maternal BMI ≥ 25 kg/m2. Life style adaptations may benefit long-term cardio vascular health in mother and child.


Assuntos
Pressão Sanguínea , Retardo do Crescimento Fetal/fisiopatologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Criança , Características da Família , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Estilo de Vida , Masculino , Gravidez
18.
Neonatal Netw ; 38(1): 27-33, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30679253

RESUMO

Extrauterine growth restriction (EUGR) affects a significant number of very low birth weight (VLBW) infants and has the potential to impact neurodevelopmental outcome as well as other aspects of long-term health. More aggressive nutritional approaches have reduced the incidence of postnatal growth failure but many questions remain about the expected rate of growth for very preterm infants, the best ways to measure growth velocity, and the optimal approaches to supporting growth. This article examines some of the outstanding issues regarding postnatal growth failure and summarizes current practice recommendations.


Assuntos
Transtornos do Crescimento , Recém-Nascido de Baixo Peso , Doenças do Prematuro , Terapia Nutricional , Peso ao Nascer , Desenvolvimento Infantil , Idade Gestacional , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/fisiopatologia , Transtornos do Crescimento/terapia , Humanos , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/terapia , Enfermagem Neonatal/educação , Terapia Nutricional/efeitos adversos , Terapia Nutricional/métodos
19.
Neonatal Netw ; 38(1): 34-38, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30679254

RESUMO

PURPOSE: To assess the effect of a quality improvement (QI) bundle on improving breast milk output among very low birth weight (VLBW) mothers. DESIGN: Before and after nonrandomized QI project. SAMPLE: Mothers who delivered a VLBW infant in October and November 2015 were the prospective cohort. Those who delivered a VLBW infant in August and September 2015 were the retrospective cohort. The QI bundle consisted of early expression of milk, use of breast pumps, frequent expressions, videos, and regular counseling. This bundle was done for the prospective cohort. OUTCOMES MEASURES: Quantity of expressed breast milk on day 7. RESULTS: There were 13 mothers in the retrospective cohort and 18 mothers in the prospective one. The mean birth weight (1297.80 and 1207.70 g, p = .19) and gestation (32.5 and 31.5 wk, p = .27) were similar. There was a significant increase in the milk output on day 7 in the prospective group 113.6 ± 45 vs 182 ± 63 mL (p = .001).


Assuntos
Aleitamento Materno/métodos , Extração de Leite/métodos , Aconselhamento , Recém-Nascido de Baixo Peso , Leite Humano , Adulto , Aconselhamento/métodos , Aconselhamento/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Índia , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Masculino , Comportamento Materno , Leite Humano/química , Leite Humano/metabolismo , Avaliação de Processos e Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Melhoria de Qualidade
20.
Neonatal Netw ; 38(1): 39-45, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30679255

RESUMO

Parenteral nutrition (PN) is frequently required by extremely preterm infants due to gastrointestinal immaturity and complications of prematurity. Parenteral nutrition-associated cholestasis (PNAC) and intestinal failure-associated liver disease (IFALD) are common complications of prolonged PN. Plant-based intravenous lipid emulsions, containing proinflammatory omega-6 fatty acids and phytosterols, may contribute to these conditions as well as other comorbidities such as bronchopulmonary dysplasia and retinopathy of prematurity. Intravenous lipid emulsions containing animal-based fats, such as fish oil, contain fewer proinflammatory omega-6 fatty acids and more anti-inflammatory omega-3 fatty acids and antioxidants. SMOFlipid, recently Food and Drug Administration (FDA)-approved for adult use, is a blend of plant- and animal-based lipid emulsions with a favorable omega-6:omega-3 ratio that may prevent the development and progression of PNAC/IFALD in infants. Careful review of data supporting this alternative intravenous lipid emulsion is required prior to widespread use in neonatal intensive care.


Assuntos
Colestase , Emulsões Gordurosas Intravenosas , Doenças do Prematuro/terapia , Nutrição Parenteral , Colestase/diagnóstico , Colestase/etiologia , Colestase/prevenção & controle , Emulsões Gordurosas Intravenosas/administração & dosagem , Emulsões Gordurosas Intravenosas/efeitos adversos , Emulsões Gordurosas Intravenosas/farmacologia , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Enfermagem Neonatal/educação , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/métodos , Planejamento de Assistência ao Paciente/normas
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