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2.
Rev. enferm. Cent.-Oeste Min ; 10(1): 3657, out. 2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1140143

RESUMO

Objetivo: Descrever as experiências de puérperas quanto ao contato pele a pele com o recém-nascido, realizado na primeira hora de vida e o início do aleitamento materno. Método: Trata-se de um estudo exploratório-descritivo, realizado com abordagem qualitativa. A pesquisa foi desenvolvida com puérperas no Alojamento Conjunto de um hospital privado. Para a coleta dos dados foi utilizada a técnica de entrevista semiestruturada. As informações foram submetidas à técnica de análise de conteúdo do tipo temática. Resultados: Foram elaboradas duas categorias: Contato pele a pele, na primeira hora de vida e os sentimentos vivenciados e Vivenciando o início do aleitamento materno. Observou-se que o contato pele a pele não fora realizado, conforme preconizado, mas, apesar disso, as participantes consideraram esse momento como importante, para auxiliar no início do aleitamento materno, pois se sentiram mais confiantes. Conclusão: Identificou-se que a instituição ainda utiliza um modelo intervencionista. Dessa forma, esta pesquisa foi relevante, pois poderá contribuir para a reflexão dos profissionais em relação aos cuidados prestados ao binômio mãe-bebê, possibilitando a qualificação das práticas do contato pele a pele e do aleitamento materno na primeira hora de vida. (AU)


Objective: To describe the skin-to-skin contact experiences of puerperal mothers with their newborn in the first hour of life and the beginning of breastfeeding. Method: This is an exploratory-descriptive study, conducted with a qualitative approach. The research was developed with puerperal mothers in join accommodation of a private hospital. To collect the information, the semi-structured interview technique was used. The information was submitted to the thematic content analysis technique. Results: Two categories were elaborated: Skin-to-skin contact in the first hour of life and the feelings they had and The experiences in the beginning of breastfeeding. It was observed that the skin-to-skin contact was not performed as recommended, but despite this, the participants considered this moment as important to help in the beginning of breastfeeding, as they felt more confident. Conclusion: It was identified that the institution still uses an interventionist model. Thus, this research was relevant, as it may contribute to the professionals' reflection on the care provided to the mother-baby binomial, enabling the qualification of skin-to-skin contact practices and breastfeeding in the first hour of life.(AU)


Objetivo: describir las experiencias de las mujeres posparto con respecto al contacto piel con piel con el recién nacido en la primera hora de vida y el comienzo de la lactancia. Método: este es un estudio exploratorio descriptivo, realizado con un enfoque cualitativo. La investigación se desarrolló con madres en el alojamiento conjunto de un hospital privado. Para recopilar la información, se utilizó la técnica de entrevista semiestructurada. La información se envió a la técnica de análisis de contenido temático. Resultados: se elaboraron dos categorías: Contacto piel con piel en la primera hora de vida y los sentimientos experimentados y experimentando el comienzo de la lactancia materna. Se observó que el contacto piel con piel no se realizó según lo recomendado, pero a pesar de esto, los participantes consideraron que este momento era importante para ayudar al comienzo de la lactancia, ya que se sentían más seguros. Conclusión: se identificó que la institución aún utiliza un modelo intervencionista. Por lo tanto, esta investigación fue relevante porque puede contribuir a la reflexión de los profesionales con respecto a la atención brindada al binomio madre-bebé, permitiendo la calificación de las prácticas de contacto piel con piel y lactancia materna en la primera hora de vida.(AU)


Assuntos
Humanos , Feminino , Recém-Nascido , Aleitamento Materno , Recém-Nascido , Enfermagem Neonatal , Salas de Parto , Relações Mãe-Filho
3.
Nursing (Säo Paulo) ; 23(268): 4570-4579, set.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1145303

RESUMO

Objetivo: Verificar na literatura científica a atuação dos profissionais de saúde acerca do processo de humanização no centro obstétrico. Método: Trata-se de um estudo bibliográfico, tipo revisão sistemática. Realizou-se a busca por artigos; publicados nos últimos cinco anos (2014 a 2019); nos idiomas português, inglês e espanhol; disponíveis na íntegra. Foram consultadas as seguintes plataformas de dados: BDENF, MEDLINE, LILACS e SciELO. Resultado: Inicialmente foram encontrados 174; contudo, após a leitura permaneceram apenas os que atendiam aos critérios para inclusão e exclusão descritos na metodologia, totalizando 10 estudos. Conclusão: Observou-se a imprescindibilidade de reformar as práticas diárias, consolidar a adoção de práticas firmadas em fundamentos científicos impulsionando os profissionais e a sociedade civil a assegurar as gestantes um atendimento de saúde com igualdade e remediabilidade; e livre de violência obstétrica.(AU)


Objective: To verify in the scientific literature the performance of health professionals regarding the humanization process in the obstetric center. Method: This is a bibliographic study, type systematic review. The search for articles was carried out; published in the last five years (2014 to 2019); in Portuguese, English and Spanish; available in full. The following data platforms were consulted: BDENF, MEDLINE, LILACS and SciELO. Result: Initially 174 were found; however, after reading, only those who met the inclusion and exclusion criteria described in the methodology remained, totaling 10 studies. Conclusion: It was observed that the indispensability of reforming daily practices, consolidating the adoption of practices based on scientific foundations, boosting professionals and civil society to ensure that pregnant women receive health care with equality and remediation; and free from obstetric violence.(AU)


Objetivo: Verificar en la literatura científica el desempeño de los profesionales de la salud con respecto al proceso de humanización en el centro obstétrico. Método: Este es un estudio bibliográfico, tipo revisión sistemática. Se realizó la búsqueda de artículos; publicado en los últimos cinco años (2014 a 2019); en portugués, inglés y español; Disponible en su totalidad. Se consultaron las siguientes plataformas de datos: BDENF, MEDLINE, LILACS y SciELO. Resultado: inicialmente se encontraron 174; sin embargo, después de leer, solo aquellos que cumplieron con los criterios de inclusión y exclusión descritos en la metodología permanecieron, totalizando 10 estudios. Conclusión: Se observó que la necesidad de reformar las prácticas diarias, consolidar la adopción de prácticas basadas en fundamentos científicos, impulsar a los profesionales y sociedad civil para asegurar que las mujeres embarazadas reciban atención médica con igualdad y remediación; y libre de violencia obstétrica.(AU)


Assuntos
Humanos , Feminino , Gravidez , Enfermagem Materno-Infantil , Parto Humanizado , Humanização da Assistência , Enfermeiras Obstétricas , Saúde Materno-Infantil , Salas de Parto
5.
Am J Obstet Gynecol ; 223(5): B12-B15, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32861688

RESUMO

When performing a maternal transport between two facilities, numerous pieces of information must be communicated between physicians, nurses, and transport personnel, including the health status of 2 patients (mother and fetus), availability of bed space and personnel in 2 units at the receiving facility (labor and delivery unit and neonatal intensive care unit), arrangements for transportation, and inpatient and outpatient records. The amount and complexity of information creates a risk of medical error due to communication lapses. A cognitive aid such as a standardized form can help the team prepare for a transfer and provide a consistent framework for a handoff briefing among healthcare professionals. SMFM presents a sample briefing form to ensure that key elements are communicated for every maternal transport. Practical suggestions are given to help facilities customize the form and implement it on their units.


Assuntos
Lista de Checagem , Formulários como Assunto , Transferência da Responsabilidade pelo Paciente , Transferência de Pacientes/métodos , Transporte de Pacientes/métodos , Salas de Parto , Feminino , Ruptura Prematura de Membranas Fetais , Humanos , Unidades de Terapia Intensiva Neonatal , Erros Médicos/prevenção & controle , Trabalho de Parto Prematuro , Gravidez
6.
Isr Med Assoc J ; 8(22): 417-422, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32812715

RESUMO

BACKGROUND: Channeling medical resources for coronavirus disease-2019 (COVID-19) management can potentially endanger routine healthcare practices. As a preventive measure, a department of obstetrics and gynecology in Israel constructed a separate, designated complex for its COVID-19-exposed patients. OBJECTIVES: To evaluate the effect of the COVID-19 pandemic infection control measures on obstetric care in the obstetrical emergency department and delivery unit. METHODS: The authors collected data retrospectively from February 2020 to March 2020 and compared it to data of a parallel period in 2019. RESULTS: From 1 February 2020 to 28 March 2020, 3897 women were referred to the emergency department (ED), compared to 4067 the previous year. Mean duration of treatment until decision and referral indications did not differ between 2020 and 2019 (207 vs. 220 minutes, P = 0.26; urgent referrals 58.8% vs. 59.2%, P = 0.83). A per-week comparison showed a significant reduction in ED referrals only in the last week of the period (337 [2020] vs. 515 [2019], P < 0.001). The proportion of women admitted to the delivery unit in active labor was significantly higher in the last three weeks (39.1% vs. 28.2%, P = 0.005). During February and March 2020, 1666 women delivered, compared to 1654 during February and March 2019. The proportion of types and modes of delivery did not differ. In a per-week comparison, the number of deliveries did not differ (mean 208 vs. 206, P = 0.88). CONCLUSIONS: With timely preparation and proper management, negative impact of COVID-19 can be reduced in obstetrical emergency departments.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Salas de Parto/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Controle de Infecções/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Pneumonia Viral/terapia , Complicações Infecciosas na Gravidez/terapia , Adulto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Parto Obstétrico/métodos , Surtos de Doenças , Feminino , Humanos , Recém-Nascido , Controle de Infecções/métodos , Israel , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Estudos Retrospectivos
7.
Eur J Obstet Gynecol Reprod Biol ; 252: 444-446, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32731057

RESUMO

OBJECTIVE: To explore the prevalence of asymptomatic SARS-CoV-2 in the maternity population. STUDY DESIGN: Newham University Hospital based in East London serving a population with the highest death rate secondary to SARS-CoV-2 in the UK, commenced universal screening of all admissions to the Maternity Unit from 22nd April to 5th May, 2020. A proforma was created to capture key patient demographics, indication for admission and presence of SARS-CoV-2 related symptoms at the point of presentation. RESULTS: A total of 180 women with a mean age of 29.9 (SD 7.4) years, at a median gestation of 39 (IQR 37 + 1-40 + 3) weeks underwent universal screening with nasopharyngeal PCR swabs during the two-week period of the study. BAME identity or parity was not associated with the likelihood of a positive result. Seven women (3.9 %, 1.6-7.8) were tested positive for SARS-CoV-2, of whom 6 (3.3 %, 1.2-7.1) were asymptomatic; 85.7 % (42.1-99.6) of the SARS-CoV-2 positive women were asymptomatic. The sensitivity of symptom-driven testing was 14.3 % (0.36-57.87) and specificity was 91.86 % (86.72-95.48) with a positive predictive value of 6.67 % (1.08-31.95) and a negative predictive value of 96.34 % (95.10-97.28). CONCLUSION: The prevalence of SARS-CoV-2 in the maternity population served by Newham University Hospital was 3.9 %, four weeks after lockdown. Of the women who were found to be SARS-CoV-2 positive, a high proportion (87.9 %) were asymptomatic. These findings support the need for universal testing to enable targeted isolation and robust infectious control measures to mitigate outbreaks of SARS-CoV-2 in maternity units.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal/métodos , Adulto , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Salas de Parto , Feminino , Humanos , Londres/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Prevalência , Adulto Jovem
11.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32409481
12.
Artigo em Inglês | MEDLINE | ID: mdl-32410913

RESUMO

In January 2020, China reported a cluster of cases of pneumonia associated with a novel pathogenic coronavirus provisionally named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). Since then, Coronavirus Disease 2019 (COVID-19) has been reported in more than 180 countries with approximately 6.5 million known infections and more than 380,000 deaths attributed to this disease as of June 3rd , 2020 (Johns Hopkins University COVID map; https://coronavirus.jhu.edu/map.html) The majority of confirmed COVID-19 cases have been reported in adults, especially older individuals with co-morbidities. Children have had a relatively lower rate and a less serious course of infection as reported in the literature to date. One of the most vulnerable pediatric patient populations is cared for in the neonatal intensive care unit. There is limited data on the effect of COVID-19 in fetal life, and among neonates after birth. Therefore there is an urgent need for proactive preparation, and planning to combat COVID-19, as well as to safeguard patients, their families, and healthcare personnel. This review article is based on the Centers for Disease Control and Prevention's (CDC) current recommendations for COVID-19 and its adaptation to our local resources. The aim of this article is to provide basic consolidated guidance and checklists to clinicians in the neonatal intensive care units in key aspects of preparation needed to counter exposure or infection with COVID-19. We anticipate that CDC will continue to update their guidelines regarding COVID-19 as the situation evolves, and we recommend monitoring CDC's updates for the most current information.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Fidelidade a Diretrizes , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva Neonatal/organização & administração , Serviços de Saúde Materno-Infantil , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Complicações Infecciosas na Gravidez/virologia , Adulto , Aleitamento Materno , Extração de Leite , Defesa Civil , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Salas de Parto , Feminino , Higiene das Mãos/normas , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Urbanos , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Comunicação Interdisciplinar , Serviços de Saúde Materno-Infantil/organização & administração , Cidade de Nova Iorque/epidemiologia , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Visitas a Pacientes
15.
J Neonatal Perinatal Med ; 13(3): 307-311, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32444569

RESUMO

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six "COVID-19 maternity centres" were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards.


Assuntos
Infecções por Coronavirus , Controle de Infecções , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias , Assistência Perinatal , Pneumonia Viral , Padrões de Prática Médica/tendências , Complicações Infecciosas na Gravidez , Betacoronavirus/isolamento & purificação , Aleitamento Materno/métodos , Defesa Civil/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Salas de Parto/normas , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Feminino , Humanos , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Inovação Organizacional , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle
16.
J Pediatr ; 222: 106-111.e2, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32418815

RESUMO

OBJECTIVE: To assess delivery room management of infants born preterm at 4 Level III perinatal centers in 3 European countries. STUDY DESIGN: This was a prospective, multicenter observational study. Management at birth was video-recorded and evaluated (Interact version 9.6.1; Mangold-International, Arnstorf, Germany). Data were analyzed and compared within and between centers. RESULTS: The infants (n = 138) differed significantly with respect to the median (25%, 75%) birth weight (grams) (Center A: 1200 [700, 1550]; Center B: 990 [719, 1240]; Center C: 1174 [835, 1435]; Center D: 1323 [971, 1515] [B vs A, C, D: P < .05]), gestational week (Center A: 28.4 [26.3, 30.0]; Center B: 27.9 [26.7, 29.6]; Center C: 29.3 [26.4, 31.0]; Center D: 30.3 [28.0, 31.9]), Apgar scores, rates of cesarean delivery, and time spent in the delivery room. Management differed significantly for frequency and drying time, rates of electrocardiographic monitoring, suctioning or stimulation, and for fundamental interventions such as time for achieving a reliable peripheral oxygen saturation signal (seconds) (Center A: 97.6 ± 79.3; Center B: 65.1 ± 116.2; Center C: 97.1 ± 67.0; Center D: 114.4 ± 140.5; B vs A, C, D: P < .001) and time for intubation (seconds) (Center A: 48.7 ± 4.2; Center B: 49.0 ± 30.7; Center C: 69.1 ±37.9; Center D: 65.1 ± 23.8; B vs D, P < .025). Mean procedural times did not meet guideline recommendations. The sequence of interventions was similar at all centers. CONCLUSIONS: The Video Apgar Study showed great variability in and between 4 neonatal centers in Europe. The study also showed it is difficult to adhere to published guidelines for recommended times for important, basic measures such as peripheral oxygen saturation measurements and intubation.


Assuntos
Terapia Intensiva Neonatal/métodos , Índice de Apgar , Áustria , Salas de Parto , Feminino , Alemanha , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Países Baixos , Estudos Prospectivos , Gravação em Vídeo
18.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32241824

RESUMO

Multiple births are increasing in frequency related to advanced maternal age and fertility treatments, and they have an increased risk for congenital anomalies compared to singleton births. However, twins have the same congenital anomalies <15% of the time. Thus, having multiple births with discordant anomalies is a growing challenge for neonatologists. Although external anomalies can often be spotted quickly at delivery or sex differences between multiples can rapidly identify those with internal anomalies described on prenatal ultrasound, we present a case of male multiples, who would optimally receive different initial resuscitation strategies on the basis of the presence or absence of an internal anomaly. The similar size of 4 extremely preterm quadruplets raises concern for whether accurate, immediate identification of 1 neonate with a congenital diaphragmatic hernia will be reliable in the delivery room. Clinicians discuss the ethical considerations of an "all for one" approach to this resuscitation.


Assuntos
Cesárea/ética , Salas de Parto/ética , Ruptura Prematura de Membranas Fetais/diagnóstico , Ruptura Prematura de Membranas Fetais/terapia , Lactente Extremamente Prematuro , Gravidez de Quadrigêmeos , Cesárea/métodos , Parto Obstétrico/ética , Parto Obstétrico/métodos , Feminino , Humanos , Lactente Extremamente Prematuro/fisiologia , Recém-Nascido , Intubação Intratraqueal/ética , Intubação Intratraqueal/métodos , Gravidez , Gravidez de Quadrigêmeos/fisiologia
19.
Rev. chil. obstet. ginecol. (En línea) ; 85(2): 132-138, abr. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115508

RESUMO

INTRODUCCIÓN: La gestión actual de camas hospitalarias sigue un modelo de indiferenciación en el que existen camas quirúrgicas, médicas y de pacientes críticos. Las maternidades si bien no siguen este modelo, tienen egresos indiferenciados con pacientes que pueden egresar post parto o aún embarazadas (con patologías perinatales). OBJETIVO: Evaluar diferencias entre egresos con parto normal y aquellos con patologías de alto riesgo obstétrico (ARO) respecto a estancia media (EM) y el consumo de recursos cuantificado con el peso medio de los grupos relacionados con el diagnóstico (PMGRD). MÉTODO: Estudio transversal con egresos maternales periodo 2017-2018. Se usó Categoría Diagnóstica Mayor (CIE - 10) para definir dos grupos de egreso: 1. Con parto normal a término o 2. Con patología ARO. Se compararon 1.658 y 1.669 egresos del grupo 1 y 2 respectivamente. Las variables de resultado son EM y PMGRD. Se compararon variables cuantitativas con t de student y Kruskal Wallis. Se usó Odds Ratio con respectivo intervalo de confianza para evaluar asociación entre variables y regresión logística multivariada para ajustar asociación. RESULTADOS: La edad, proporción de gestantes tardías, EM y PMGRD fue mayor en los egresos ARO (p<0,05). Existe fuerte asociación de EM prolongada (>4 días) y PMGRD elevado (>0.3109) con los egresos ARO (ORa=3.75; IC95%=3.21-4.39 y ORa=1.28; IC95%=1.1-1.49 respectivamente). CONCLUSIONES: Es necesario diferenciar los egresos del servicio de maternidad porque los egresos de ARO muestran mayor complejidad. La evaluación del riesgo usando EM y PMGRD permite analizar con especificidad los egresos maternales para una mejor gestión de camas y del recurso humano.


INTRODUCTION: The current management of hospital beds in Chile follows an undifferentiation model in which there are surgical, medical and critical patient bed. Maternity hospitals although they do not follow this model, have undifferentiated discharges with patients who may leave poatpartum or still pregnant (with perinatal pathologies) OBJECTIVE: To assess differences between discharges with normal delivery and those with high obstetric risk pathologies (HOR) with respect to mean stay (MS) and the resource spending quantified with the average weight of the diagnosis related group (AWDRG). METHOD: Cross-sectional study with maternal discharges between 2017-2018 period. Major Diagnostic Category (ICD - 10) was used to define two discharge groups: 1. With normal term birth or 2. With HOR pathology. 1,658 and 1,669 egress from group 1 and 2 were compared respectively. The outcome variables are EM and AWDRG. Quantitative variables were compared with student t and Kruskal Wallis. Odds Ratio and respective confidence interval were used to evaluate association between variables and multivariate logistic regression to adjust association. RESULTS: Age, proportion of late pregnant women, MS and AWDRG was higher in HOR discharges (p <0.05). There is a strong association of prolonged MS (> 4 days) and elevated AWDRG (> 0.3109) with HOR discharges (ORa = 3.75; 95% CI 3.21-4.39 and ORa = 1.28; 95% CI 1.1-1.49 respectively). CONCLUSIONS: It is necessary to differentiate medical discharge of the maternity service because the HOR egress show greater complexity. The risk assessment using MS and AWDRG allows to analyze with specificity the maternal discharge for a better management of beds and human resources.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Alta do Paciente/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Gravidez de Alto Risco , Salas de Parto/economia , Alta do Paciente/economia , Ocupação de Leitos , Intervalos de Confiança , Modelos Logísticos , Estudos Transversais , Análise Multivariada , Idade Materna , Tempo de Internação , Parto Normal
20.
Arch Dis Child Fetal Neonatal Ed ; 105(6): 605-608, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32152191

RESUMO

OBJECTIVE: The clinical impact of ventilation corrective steps for delivery room positive pressure ventilation (PPV) is not well studied. We aimed to characterise the performance and effect of ventilation corrective steps (MRSOPA (Mask adjustment, Reposition airway, Suction mouth and nose, Open mouth, Pressure increase and Alternative airway)) during delivery room resuscitation of preterm infants. DESIGN: Prospective observational study of delivery room PPV using video and respiratory function monitor recordings. SETTING: Tertiary academic delivery hospital. PATIENTS: Preterm infants <32 weeks gestation. MAIN OUTCOME MEASURE: Mean exhaled tidal volume (Vte) of PPV inflations before and after MRSOPA interventions, categorised as inadequate (<4 mL/kg); appropriate (4-8 mL/kg), or excessive (>8 mL/kg). Secondary outcomes were leak (>30%) and obstruction (Vte <1 mL/kg), and infant heart rate. RESULTS: There were 41 corrective interventions in 30 infants, with a median duration of 15 (IQR 7-29) s. The most frequent intervention was a combination of Mask/Reposition and Suction/Open. Mean Vte was inadequate before 16/41 interventions and became adequate following 6/16. Mean Vte became excessive after 6/41 interventions. Mask leak, present before 13/41 interventions, was unchanged after 4 and resolved after 9. Obstruction was present before five interventions and was subsequently resolved only once. MRSOPA interventions introduced leak in two cases and led to obstruction in one case. The heart rate was <100 beats per minute before 31 interventions and rose to >100 beats per minute after 14/31 of these. CONCLUSIONS: Ventilation correction interventions improve tidal volume delivery in some cases, but lead to ineffective or excessive tidal volumes in others. Mask leak and obstruction can be induced by MRSOPA manoeuvres.


Assuntos
Salas de Parto , Doenças do Prematuro/terapia , Respiração com Pressão Positiva/métodos , Insuficiência Respiratória/terapia , Falha de Equipamento , Feminino , Idade Gestacional , Frequência Cardíaca , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/fisiopatologia , Masculino , Máscaras , Monitorização Fisiológica , Respiração com Pressão Positiva/instrumentação , Estudos Prospectivos , Insuficiência Respiratória/fisiopatologia , Volume de Ventilação Pulmonar
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