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2.
J Perinat Med ; 49(4): 500-505, 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-33554582

RESUMO

OBJECTIVES: To find out if the expressed breast milk delivery rate to neonatal intensive care unit (NICU) for babies who were hospitalized for any reason other than COVID-19, and exclusive breastfeeding (EB) rates between discharge date and 30th day of life of those babies were affected by COVID-19 pandemic. METHODS: Babies who were hospitalized before the date first coronavirus case was detected in our country were included as control group (CG). The study group was divided into two groups; study group 1 (SG1): the mothers whose babies were hospitalized in the period when mother were asked not to bring breast milk to NICU, study group 2 (SG2): the mothers whose babies were hospitalized after the date we started to use the informed consent form for feeding options. The breast milk delivery rates to NICU during hospitalization and EB rates between discharge and 30th day of life were compared between groups. RESULTS: Among 154 mother-baby dyads (CG, n=50; SG1, n=46; SG2, n=58), the percentage of breast milk delivery to NICU was 100%, 79% for CG, SG2, respectively (p<0.001). The EB rate between discharge and 30th day of life did not change between groups (CG:90%, SG1:89%, SG2:75.9; p=0.075). CONCLUSIONS: If the mothers are informed about the importance of breast milk, the EB rates are not affected by the COVID-19 pandemic in short term, even if the mothers are obligatorily separated from their babies. The breast milk intake rate of the babies was lowest while our NICU protocol was uncertain, and after we prepared a protocol this rate increased.


Assuntos
Aleitamento Materno/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Terapia Intensiva Neonatal/tendências , Adulto , Aleitamento Materno/psicologia , /prevenção & controle , Protocolos Clínicos , Estudos Transversais , Feminino , Promoção da Saúde , Hospitalização , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/normas , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/normas , Masculino , Pandemias , Relações Profissional-Família , Estudos Retrospectivos , Turquia/epidemiologia
4.
Isr Med Assoc J ; 9(22): 476-480, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954692

RESUMO

BACKGROUND: Neonatal hypothermia (< 36°C) has been associated with both neonatal morbidity and mortality. OBJECTIVES: To develop a multifactorial approach to reduce the incidence of neonatal hypothermia at admission to the neonatal intensive care unit. METHODS: The approach involved a detailed quality improvement (QI) plan, which included the use of occlusive wrapping and exothermic mattresses as well as higher delivery and operating room environmental temperatures. The improvement plan was implemented over a 10-month period. Retrospective comparison to the same 10-month period during the previous year assessed the effectiveness of the approach in reducing the incidence of admission hypothermia. RESULTS: The QI project included 189 patients. These patients were compared to 180 patients during the control period. The characteristics of the patient groups were similar and included preterm infants, who were subsequently analyzed as a subgroup. We found a significant reduction in the incidence of hypothermia, which was most profound for the subgroup of premature infants born at < 32 weeks gestation. Neonatal hyperthermia was identified as an unintended consequence of the project, and subsequently improved after initiating simple preventive measures. CONCLUSIONS: Occlusive wrapping, exothermic mattresses, and higher delivery and operating room environmental temperature may be successful in reducing admission neonatal hypothermia.


Assuntos
Regulação da Temperatura Corporal/fisiologia , Hipotermia/prevenção & controle , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Roupas de Cama, Mesa e Banho , Humanos , Hipotermia/epidemiologia , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Israel , Curativos Oclusivos , Salas Cirúrgicas , Melhoria de Qualidade , Temperatura
5.
Enferm. glob ; 19(59): 36-46, jul. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198883

RESUMO

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


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


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


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Cateterismo Venoso Central/efeitos adversos , Terapia Intensiva Neonatal/métodos , Cateterismo Venoso Central/enfermagem , Doenças do Recém-Nascido/enfermagem , Enfermagem Neonatal/métodos , Fatores de Risco , Segurança do Paciente/normas , Estudos Transversais , Cesárea/estatística & dados numéricos
7.
An. pediatr. (2003. Ed. impr.) ; 92(6): 359-364, jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199670

RESUMO

INTRODUCCIÓN: Estudio retrospectivo en la unidad de cuidados intensivos neonatales de un hospital de tercer nivel sobre la incidencia de hiponatremia precoz (primeras 48 horas de vida) en prematuros. Buscamos factores de riesgo y de protección para esa alteración, como punto de partida para un cambio en la actuación médica al prescribir fluidos intravenosos. MATERIAL Y MÉTODOS: Muestra de 256 prematuros (edad gestacional: 235-366) ingresados en la unidad de cuidados intensivos neonatales de nuestro hospital, entre enero de 2016 y junio de 2018. Se determinó qué pacientes recibieron aportes intravenosos de sodio en distintos intervalos de las primeras 48 horas de vida y cuántos padecieron hiponatremia de cualquier tipo (< 135 mmol/l) y moderada-grave (< 130 mmol/l). Se estudió la relación entre hiponatremia precoz y peso/edad gestacional, administración de corticoides prenatales, enfermedad respiratoria, sepsis precoz y asfixia perinatal. RESULTADOS: Padecieron hiponatremia 81 pacientes, 31,64% del total (hasta un 50% en < 30 semanas de edad gestacional), siendo moderada-grave (< 130 mmol/l) en un 17,3% de los casos. El periodo de tiempo con más casos de hiponatremia fue el de las primeras 12 horas de vida (22,64%). Demostraron ser factores de riesgo el peso (p = 0,034), la edad gestacional (p < 0,001) y el padecimiento de enfermedad respiratoria (p < 0,001) y, en el análisis multivariable, este último se mostró relacionado de forma independiente con la hiponatremia precoz (p < 0,01; OR = 5,24; IC 95%: 2,79-9,84). La administración de betametasona prenatal no demostró proteger. CONCLUSIÓN: Según nuestros resultados creemos conveniente aportar sodio en los fluidos intravenosos prescritos los primeros días de vida, particularmente en prematuros de menos edad gestacional y en afectos de enfermedad respiratoria


INTRODUCTION: A retrospective study was conducted in the Neonatal Intensive Care Unit of a tertiary hospital to determine the incidence of early hyponatraemia (first 48hours of life) in preterm infants. Risk and protection factors in this condition were also examined as a starting point for a change in the medical action when prescribing intravenous fluids. MATERIAL AND METHODS: The study included a sample of 256 premature babies (gestational age: 235-366) admitted to the Neonatal Intensive Care Unit of a tertiary hospital between January 2016 and June 2018. The number of patients receiving intravenous sodium in different intervals during the first 48hours of life was determined, as well as the number of those with hyponatraemia of any type (< 135 mmol/l), and moderate-severe (< 130 mmol / l). An analysis was made of the relationship between early hyponatraemia and weight / gestational age, antenatal steroids exposure, respiratory pathology, early sepsis, and perinatal asphyxia. RESULTS: Hyponatraemia occurred in 81 patients, 31.64% of the total (up to 50% in < 30 weeks of gestational age), and was moderate-severe (< 130 mmol / l) in 17.3% of the cases. The period of time with the most cases of hyponatraemia was in the first 12hours of life (22.64%). Weight (P=.034), gestational age (P < .001) and respiratory disease (P < .001) were found to be risk factors and, in a multivariate analysis, the latter was independently related to early hyponatremia (P < .01, OR = 5.24, 95% CI: 2.79-9.84). Antenatal betamethasone exposure did not show to be a protection factor. CONCLUSION: According to the results of this study, it is considered an advantage to provide sodium in the intravenous fluids prescribed during the first days of life, particularly in preterm infants of lower gestational age and with respiratory disease involvement


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Hidratação/métodos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Doenças do Prematuro/etiologia , Doenças do Prematuro/prevenção & controle , Terapia Intensiva Neonatal/métodos , Sódio/uso terapêutico , Hiponatremia/diagnóstico , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Infusões Intravenosas , Fatores de Proteção , Estudos Retrospectivos , Fatores de Risco
8.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32409481
9.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32471844

RESUMO

Parenting in the NICU is an intense journey. Parents struggle to build intimacy with their child amid complex emotions and medical uncertainties. They need to rapidly adapt their vision of parenthood to the realities of intensive care. The psychological impact of this journey can have important effects on their psychological health. For parents of sick older children, "good parent" beliefs have been shown to foster positive growth. This concept is also essential for parents of infants in the NICU, although their path is complex.We write as clinicians who were also families in the NICU. We suggest parents need to hear and internalize 3 important messages that overlap but are each important: you are a parent, you are not a bad parent, and you are a good parent. We offer practical suggestions to NICU clinicians that we believe will help NICU parents cope while their infant is in the NICU and afterward.


Assuntos
Adaptação Psicológica , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/psicologia , Pais/psicologia , Estresse Psicológico/psicologia , Adaptação Psicológica/fisiologia , Feminino , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/métodos , Masculino , Estresse Psicológico/prevenção & controle
11.
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
12.
Arch Dis Child Fetal Neonatal Ed ; 105(5): 563-568, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32253200

RESUMO

Recent decades have seen the rapid progress of neonatal intensive care, and the survival rates of the most preterm infants are improving. This improvement is associated with changing patterns of morbidity and new phenotypes of bronchopulmonary dysplasia and preterm brain injury are recognised. Inflammation and immaturity are known contributors to their pathogenesis. However, a new phenomenon, the exhaustion of progenitor cells is emerging as an important factor. Current therapeutic approaches do not adequately address these new mechanisms of injury. Cell therapy, that is the use of stem and stem-like cells, with its potential to both repair and prevent injury, offers a new approach to these challenging conditions. This review will examine the rationale for cell therapy in the extremely preterm infant, the preclinical and early clinical evidence to support its use in bronchopulmonary dysplasia and preterm brain injury. Finally, it will address the challenges in translating cell therapy from the laboratory to early clinical trials.


Assuntos
Lesões Encefálicas/terapia , Displasia Broncopulmonar/terapia , Transplante de Células/métodos , Lactente Extremamente Prematuro , Doenças do Prematuro/terapia , Animais , Transplante de Células/efeitos adversos , Protocolos Clínicos , Ensaios Clínicos como Assunto , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Transplante de Células-Tronco de Sangue do Cordão Umbilical/métodos , Sangue Fetal , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Terapia Intensiva Neonatal/métodos , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Transplante de Células-Tronco Mesenquimais/métodos , Fatores de Tempo
13.
Am J Perinatol ; 37(8): 813-824, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32268381

RESUMO

The first case of novel coronavirus disease of 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) was reported in November2019. The rapid progression to a global pandemic of COVID-19 has had profound medical, social, and economic consequences. Pregnant women and newborns represent a vulnerable population. However, the precise impact of this novel virus on the fetus and neonate remains uncertain. Appropriate protection of health care workers and newly born infants during and after delivery by a COVID-19 mother is essential. There is some disagreement among expert organizations on an optimal approach based on resource availability, surge volume, and potential risk of transmission. The manuscript outlines the precautions and steps to be taken before, during, and after resuscitation of a newborn born to a COVID-19 mother, including three optional variations of current standards involving shared-decision making with parents for perinatal management, resuscitation of the newborn, disposition, nutrition, and postdischarge care. The availability of resources may also drive the application of these guidelines. More evidence and research are needed to assess the risk of vertical and horizontal transmission of SARS-CoV-2 and its impact on fetal and neonatal outcomes. KEY POINTS: · The risk of vertical transmission is unclear; transmission from family members/providers to neonates is possible.. · Optimal personal-protective-equipment (airborne vs. droplet/contact precautions) for providers is crucial to prevent transmission.. · Parents should be engaged in shared decision-making with options for rooming in, skin-to-skin contact, and breastfeeding..


Assuntos
Infecções por Coronavirus , Controle de Infecções , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Ressuscitação , Gestão de Riscos/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Ressuscitação/métodos , Ressuscitação/tendências
14.
Rev. Rol enferm ; 43(4): 264-279, abr. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193744

RESUMO

INTRODUCCIÓN: Los recién nacidos ingresados en las Unidades de Cuidados Intensivos Neonatales (UCIN) están expuestos a numerosos procedimientos diagnósticos y terapéuticos. Estos procesos causan dolor y estrés, que a su vez pueden provocar consecuencias futuras para el neonato. Las escalas de valoración del dolor se crearon para poder evaluarlo y tratarlo adecuadamente. Actualmente la inexistencia de consenso y protocolos de ámbito internacional provoca una evaluación y consecuentemente un tratamiento irregular. El objetivo de este trabajo es dar a conocer los procedimientos invasivos más frecuentes, las escalas que se utilizan en las UCIN para valorar el dolor producido durante estos procedimientos y las estrategias que se utilizan para disminuir el dolor y estrés de los neonatos. METODOLOGÍA: Estudio documental mediante revisión por publicaciones en bases de datos de ciencias de la salud (PubMed/Medline), siguiendo las recomendaciones PRISMA. Se utilizaron los descriptores MeSH: pain assessment tools. El intervalo de publicación revisado fue de 1999 a 2017. Un total de 72 artículos cumplieron los criterios de inclusión. RESULTADOS: El procedimiento invasivo más frecuente en las UCIN es la punción con lanceta (32,8%). La escala de valoración más utilizada es la PIPP (51,8%). El tratamiento no farmacológico más común para la disminución del dolor y estrés fue la administración de soluciones glucosadas orales (59%). CONCLUSIONES: Existen más de 16 herramientas de evaluación del dolor en los neonatos. Cada UCIN utiliza las escalas de valoración del dolor en torno a la naturaleza propia de la unidad. La falta de homogeneidad y consenso provoca que no se obtenga una valoración regular y uniforme


INTRODUCTION: New-borns that are hospitalized in Neonatal Intensive Care Units (NICU) are subjected to numerous diagnostics and therapeutic procedures. These procedures cause pain and distress that they can produce futures consequences. Pain assessment tools were created to assess and to treat appropriately. Currently there are not an international consensus and protocols to assess the pain in new-borns, for this reason there is an irregular value and treatment. The aim of this review is to let know the invasive procedures most frequently applicate in NICU, the pain assessment tools most utilized and the different strategies to reduce pain and distress of new-borns. METHODS: Documental study through published reviews in Health Sciences databases (PubMed/Medline). PRISMA recommendations were followed. Mesh terms «pain assessment tools» were utilised. The interval of years reviewed was from 1999 to 2017.72 articles were met the inclusion criteria. RESULTS: The most invasive procedure in NICU was the heel lancet (32.8%). The pain assessment tool most utilised was PIPP (51.8%). The pharmacological treatment most applicate to reduce pain and distress of new-born was the oral glucose solutions (59%). CONCLUSIONS: There are more than 16 pain assessment tools to assess newborns' pain. Each NICU use the most tool concerned by the specific nature of the unit. There are not consensus and homogeneity to assess pain in new-borns. In fact, this makes an irregular a uniformity value


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Terapia Intensiva Neonatal/métodos , Unidades de Terapia Intensiva Neonatal , Enfermagem Neonatal , Dor/enfermagem
15.
J Music Ther ; 57(2): 219-242, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32112555

RESUMO

Music therapy (MT) interventions and skin-to-skin care (SSC) both aim to address the varied needs of preterm infants, including sensory regulation and stress reduction, inclusion of parents in their infant's care, support of parents' emotional state, and enhancing the parent-infant attachment process. Few studies have investigated the combination of both modalities through randomized controlled trials. Evidence of longer-term effects is missing. This article presents a study protocol that will investigate the effects of combined family-centered MT intervention and SSC on preterm-infants' autonomic nervous system (ANS) stability, parental anxiety levels, and parent-infant attachment quality. 12 clusters with a total of 72 preterm infants, with their parents, will be randomized to one of two conditions: MT combined with SSC or SSC alone. Each parent-infant dyad will participate in 3 sessions (2 in the hospital and a 3-month follow-up). The primary outcome of preterm infants' ANS stability will be measured by the high frequency power of their heart rate variability. Secondary outcomes will be physiological measures and behavioral states in infants and anxiety and attachment levels of parents. This trial will provide important, evidence-based knowledge on the use of the "First Sounds: Rhythm, Breath, and Lullaby" model of MT in neonatal care, through an intervention that is in line with the Newborn Individualized Developmental Care and Assessment Program model for supportive developmental care of preterm infants and their parents. Ethical approval (no. 0283-15) was granted from the local Institutional Review Board in April 2017. This trial is registered in ClinicalTrials.gov, NCT03023267.


Assuntos
Sistema Nervoso Autônomo , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Musicoterapia/métodos , Pais/psicologia , Afeto , Ansiedade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Apego ao Objeto , Relações Pais-Filho
16.
Crit Care ; 24(1): 65, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32093763

RESUMO

BACKGROUND: Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. METHODS: Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. RESULTS: Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). CONCLUSIONS: Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.


Assuntos
Terapia Intensiva Neonatal , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Cuidados Críticos/métodos , Estado Terminal , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/normas , Sistemas Automatizados de Assistência Junto ao Leito/normas , Revisões Sistemáticas como Assunto , Ultrassonografia/métodos , Ultrassonografia/normas
17.
Infant Ment Health J ; 41(3): 340-355, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32057129

RESUMO

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants' medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider-patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.


Assuntos
Adaptação Psicológica , Efeitos Psicossociais da Doença , Educação não Profissionalizante/métodos , Saúde do Lactente , Doenças do Recém-Nascido , Poder Familiar/psicologia , Adulto , Desenvolvimento Infantil , Saúde da Família/educação , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/psicologia , Doenças do Recém-Nascido/terapia , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/psicologia , Masculino , Índice de Gravidade de Doença
19.
Lancet Child Adolesc Health ; 4(4): 331-340, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32014122

RESUMO

Surfactant is a cornerstone of neonatal critical care, and the presumed less (or minimally) invasive techniques for its administration have been proposed to reduce invasiveness of neonatal critical care interventions. These techniques are generally known as less invasive surfactant administration (LISA) and have quickly gained popularity in some neonatal intensive care units. Despite the increase in the use of LISA, we believe that the pathobiological background supporting its possible clinical benefits is unclear. Similarly, it is unclear whether there are any ignored drawbacks, as LISA has been tested in only a few trials and some physiopathological issues seem to have gone unnoticed. Active research is warranted to fill these knowledge gaps before LISA can be firmly recommended. In this Viewpoint, we provide an in-depth analysis of LISA techniques, based on physiological and pathobiological factors, followed by a critical appraisal of available clinical data, and highlight some possible future research directions.


Assuntos
Terapia Intensiva Neonatal/métodos , Doenças Pulmonares Intersticiais/complicações , Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Resistência das Vias Respiratórias , Humanos , Recém-Nascido , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Laringoscopia/efeitos adversos , Metanálise como Assunto , Surfactantes Pulmonares/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
20.
CMAJ ; 192(4): E81-E91, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31988152

RESUMO

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.


Assuntos
Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Melhoria de Qualidade , Canadá , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Avaliação de Programas e Projetos de Saúde , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Análise de Sobrevida
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