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1.
Texto & contexto enferm ; 29: e20190033, Jan.-Dec. 2020.
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1094552

RESUMO

ABSTRACT Objective: to apprehend the paternal experiences related to the care provided to the preterm child at home by comparing the parents participating or not in the care protocol. Method: a qualitative research, conducted from July to October 2017, with 24 parents of preterm infants after discharge from a teaching hospital in the state of Paraná, Brazil, who participated or not in a care protocol during the period of hospitalization. The analysis was performed through the Collective Subject Discourse. Results: the parents who had the opportunity to participate in the protocol at the hospital reported that this care was important so that they could help their partners with their children at home. However, the parents participating or not in the protocol realize that the mother has a greater bond because of the possibility of greater time availability and because they are the nursing mothers and refer to work as a barrier to child care. Conclusion: the parents participating in the protocol report that it had a positive impact on their child care at home, in contrast, non-participating parents reported that having been included or not in the protocol did not interfere with their conduct at home. However, both groups agree that cultural factors and work are barriers to child care.


RESUMEN Objetivo: conocer acerca de la experiencia de los padres en los cuidados prestados a hijos prematuros en el domicilio, comparando a padres que participaron en el protocolo de cuidados con aquellos que no participaron del mismo. Método: investigación cualitativa, realizada entre julio y octubre de 2017, con 24 padres de bebés prematuros después del alta hospitalar, en un hospital escuela del Estado de Paraná, Brasil, con padres que hubiesen o no participado en el protocolo de cuidados durante el período de internación. El análisis se realizó por medio del Discurso del Sujeto Colectivo. Resultados: los padres que tuvieron la oportunidad del participar en el protocolo en el hospital, advirtieron que esos cuidados fueron importantes a los efectos de poder ayudar a sus compañeras en el domicilio. Sin embargo, tanto los padres que habían participado del protocolo como aquellos que no lo habían hecho, coinciden en que la madre posee um vínculo más intenso debido a la posibilidad de disponer de más tiempo y al hecho de ser ellas quienes alimentan a sus hijos, reconociendo que el trabajo opera como barrera en lo que respecta al cuidado de su hijo. Conclusión: los padres que participaron en el protocolo refieren que el mismo repercutió favorablemente en los cuidados con el hijo en el domicilio. En contrapartida, los padres que no participaron refirieron que el hecho de haber participado o no en el protocolo, no incidió en su conducta en el domicilio. Por otra parte, los dos grupos concuerdan en que los factores culturales y el trabajo operan como barreras en el cuidado a sus hijos.


RESUMO Objetivo: apreender as vivências paternas referente aos cuidados prestados ao filho pré-termo no domicílio comparando os pais participantes ou não do protocolo de cuidados. Método: pesquisa qualitativa, realizada no período de julho a outubro de 2017, com 24 pais de bebês pré-termos após a alta hospitalar de um hospital escola do estado Paraná, Brasil. Os quais participaram ou não de um protocolo de cuidados durante o período de internação. A análise foi realizada por meio do Discurso do Sujeito Coletivo. Resultados: os pais que tiveram oportunidade de participar do protocolo no hospital referiram que estes cuidados foram importantes para que pudessem ajudar suas companheiras com seus filhos no domicílio. Contudo, os pais participantes ou não do protocolo percebem que a mãe possui maior vinculo devido à possibilidade de maior disponibilidade de tempo e por serem as nutrizes dos filhos e referem o trabalho como uma barreira para o cuidado com o filho. Conclusão: os pais participantes do protocolo referem que o mesmo repercutiu positivamente nos cuidados com o filho no domicilio, em contrapartida os pais não participantes referem que terem ou não realizado o protocolo não interferiu em suas condutas no domicilio, No entanto, ambos concordam que fatores culturais e o trabalho são barreiras para o cuidado ao filho.


Assuntos
Humanos , Recém-Nascido , Pais , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Cuidado da Criança , Enfermagem Neonatal
2.
Rev. enferm. UERJ ; 28: e48578, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1116102

RESUMO

Objetivo: conhecer a experiência dos pais como estratégia de avaliação da qualidade da assistência de enfermagem. Método: pesquisa descritiva com abordagem qualitativa, desenvolvida na Unidade Neonatal de um Hospital do sul do Brasil. A coleta de dados foi realizada através de entrevistas, utilizando a técnica do incidente crítico (TIC), com 18 pais que estavam com seus filhos internados por 20 dias ou mais e que tinham previsão e plano de alta hospitalar. Após, os dados foram submetidos à análise de conteúdo. Resultados: a análise revelou fragilidades no cuidado prestado pela equipe de enfermagem em relação à administração de medicamentos, ao uso de equipamentos, à monitorização e ao posicionamento dos bebês, aos cuidados com a pele e à higiene de mãos. Conclusão: a experiência dos pais revelou elementos que integram a avaliação da assistência em enfermagem, destacando-os como pilares para a segurança do paciente.


Objective: to learn the parents' experience as a strategy for assessing the quality of nursing care. Method: in this qualitative, descriptive study at the Neonatal Unit of a hospital in southern Brazil, data were collected by critical incident (CI) interviews of 18 parents whose children had been hospitalized for 20 days or more, and whose discharge was scheduled and planned for. The data subsequently underwent content analysis. Results: data analysis revealed weaknesses in the care provided by the nursing staff as regards administration of medication, use of equipment, monitoring and positioning of babies, skin care and hand hygiene. Conclusion: The parents' experience revealed elements that enter into evaluation of nursing care, revealing parents to be mainstays of patient safety.


Objetivo: conocer la experiencia de los padres como estrategia para evaluar la calidad de la atención de enfermería. Método: en este estudio cualitativo y descriptivo en la Unidad Neonatal de un hospital en el sur de Brasil, los datos fueron recolectados por entrevistas de incidentes críticos (IC) de 18 padres cuyos hijos habían estado hospitalizados durante 20 días o más, y cuyo alta fue programada y planificada para. Los datos posteriormente se sometieron a análisis de contenido. Resultados: el análisis de datos reveló debilidades en la atención brindada por el personal de enfermería en lo que respecta a la administración de medicamentos, uso de equipos, monitoreo y posicionamiento de bebés, cuidado de la piel e higiene de manos. Conclusión: la experiencia de los padres reveló elementos que entran en la evaluación de la atención de enfermería, revelando que los padres son pilares de la seguridad del paciente.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Adulto , Pais , Qualidade da Assistência à Saúde , Unidades de Terapia Intensiva Neonatal/normas , Segurança do Paciente , Equipe de Enfermagem/normas , Análise e Desempenho de Tarefas , Brasil , Terapia Intensiva Neonatal , Pesquisa Qualitativa , Dano ao Paciente/prevenção & controle
3.
Mymensingh Med J ; 29(4): 784-792, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116078

RESUMO

This cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to determine antimicrobial sensitivity pattern in neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and then septic screening along with blood culture and antimicrobial sensitivity was done. All data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 68(72.3%) were preterm and 26(23.4%) were term. There was male predominance and male female ratio was 1.9:1. Most of the patient admitted within 72 hours of birth. Most (84%) had low birth weight (<2500gm). Pre-mature onset of labour, pre-mature rupture of membrane >18 hours, vaginal route of delivery, instrumental resuscitation, pre-lacteal feeding, bottle feeding were the major perinatal risk factors in this study. Early onset sepsis (76.6%) was most prevalent in this study. Blood culture yielded positive growth in 20(21.3%) cases. Among them, Klebsiella was found in 7(35%). E. coli in 6(30%), Acinetobacter was in 3(15%), Staphylococcus aureus in 2(10%) cases. Pseudomonas and Enterobacter were found in rest 2(10%) of the cases. Gram negative bacteria were found in 18(90%) cases. Klebsiella was sensitive to Imipenem (85.7%), Colistin (85.7%) and Ciprofloxacin (77.5%). Sensitivity of E. coli was Imipenem (100%), Colistin (100%), Amikacin (66.7%), Ciprofloxacin (66.7%), Netilmicin (66.7%) and Gentamicin (50%). Acinatobecter had sensitivity to Netilmicin, Colistin, Imipenem (100%). Staphylococcus was 100% sensitive to Imipenem, Netilmicin and Vancomycin. Pseudomonas was found sensitive to Imipenem (100%), Amikacin (100%), Netilmicin (100%) and Colistin (100%). Enterobacter was found highly sensitive to Ciprofloxacin, Colistin and Imipenem. Almost all organisms were resistant to Ampicillin, Gentamicin, Cefotaxime and Ceftazidime. Based on result it is concluded that Klebsiella pneumoniae and Escherichia coli are the leading cause of neonatal sepsis in this study and most of them resistant to multiple antibiotics. Organisms found more sensitive to Imipenem, Colistin, Ciprofloxacin and Netilmicin.


Assuntos
Anti-Infecciosos , Sepse Neonatal , Sepse , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bangladesh/epidemiologia , Estudos Transversais , Escherichia coli , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Testes de Sensibilidade Microbiana , Sepse Neonatal/diagnóstico , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Gravidez , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/epidemiologia
4.
Harefuah ; 159(10): 754-758, 2020 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-33103396

RESUMO

INTRODUCTION: Apnea of prematurity affects the majority of infants born before 34 weeks of complete gestation. Significant recurrent apnea of prematurity is associated with both short and long term complications and is a risk factor for increased mortality and neurodevelopmental disability. The current review discusses the recent advances in the understanding of the pathophysiology of apnea of prematurity, as well as the clinical questions relevant to physicians and staff treating infants with apnea of prematurity. Finally, we discuss monitoring and discharge decisions, and present recommendations following discharge from the neonatal intensive care unit.


Assuntos
Apneia , Doenças do Prematuro , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Prognóstico
5.
Invest. educ. enferm ; 38(3): [e13], Octubre 20 2020. Table 1, Table 2, Table 3, Figure 1
Artigo em Inglês | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1129006

RESUMO

Objective. Determine the level of environmental and periauricular noise in preterm babies and identify the sources generating noise in the Neonatal Intensive Care Unit -NICU- of a reference hospital in San Luis Potosí, Mexico. Methods. Cross-sectional and analytic study of the measurement of the level of environmental noise in five critical areas of the NICU, according with the method of measurement of noise from fixed sources by the Mexican Official Norm and periauricular at 20 cm from the preterm patient's pinna. The measurements were carried out during three representative days of a week, morning, evening and nocturnal shifts. A STEREN 400 sound level meter was used with 30 to 130 dB range of measurement and a rate of 0.5 s. Results. The average level of periauricular noise (64.5±1.91dB) was higher than the environmental noise (63.3±1.74 dB) during the days and shifts evaluated. The principal noise sources were activities carried out by the staff, like the nursing change of shift and conversations by the staff, which raised the level continuously or intermittently, operation of vital support equipment (alarms) and incidences (clashing of baby bottles and moving furnishings) produced sudden rises of noise. Conclusions. Environmental and periauricular noise in NICU exceeds by two and almost three times the 45 dB during the day and 35 dB at night from the norm in hospitals. It is necessary to implement permanent noise reduction programs to prevent sequelae in the preterm infant and professional burnout in the nursing staff


Objetivo. Determinar el nivel de ruido ambiental y periauricular en prematuros e identificar las fuentes generadoras de ruido en la Unidad de Cuidados Intensivos Neonatales -UCIN- de un hospital de referencia de San Luis Potosí, México. Métodos. Estudio transversal y analítico de la medición del nivel de ruido ambiental en cinco áreas críticas de la UCIN de acuerdo al método de medición de ruido de fuentes fijas de la Norma Oficial Mexicana y periauricular a 20 cm del pabellón auricular del prematuro. Las mensuraciones se realizaron en tres días representativos de una semana, turnos matutino, vespertino y nocturno. Se utilizó un sonómetro STEREN 400 con rango de medición de 30 a 130 dB y una frecuencia de 0.5 s. Resultados. El promedio del nivel de ruido periauricular (64.5±1.91dB) fue mayor que el ambiental (63.3±1.74 dB) en los días y turnos evaluados. Las principales fuentes de ruido fueron las actividades realizadas por el personal como entrega de turno de enfermería y conversación del personal que elevó el nivel de manera continua o intermitente, el funcionamiento del equipo de soporte vital (alarmas) e incidencias (choque de biberones y mover mobiliario) produjeron elevaciones súbitas de ruido. Conclusiones. El ruido ambiental y periauricular en UCIN sobrepasa al doble y casi al triple los 45 dB en el día y 35 dB por la noche de la normativa en hospitales. Es necesario implementar programas permanentes de reducción de ruido para prevenir secuelas en el prematuro y desgaste profesional en el personal de enfermería.


Objetivo. Determinar o nível de ruído ambiental e periatrial em bebês prematuros e identificar as fontes geradoras de ruído na Unidade de Terapia Intensiva Neonatal -UTIN- de um hospital de referência em San Luis Potosí, México. Métodos. Estudo transversal e analítico da medição do nível de ruído ambiental em cinco áreas críticas da UTIN de acordo com o método de medição de ruído de fontes fixas do Padrão Oficial Mexicano e periauricular a 20 cm da orelha do prematuro. As medições foram realizadas em três dias representativos da semana, turnos matutinos, vespertino e noturno. Foi utilizado um medidor de nível de som STEREN 400 com faixa de medição de 30 a 130 dB e frequência de 0.5 s. Resultados. O nível médio de ruído periatrial (64.5±1.91 dB) foi superior ao ruído ambiente (63.3±1.74 dB) nos dias e turnos avaliados. As principais fontes de ruído foram as atividades realizadas pela equipe, como entrega do plantão de enfermagem e conversas com a equipe que aumentavam o nível de forma contínua ou intermitente, o funcionamento do equipamento de suporte de vida (alarmes) e incidentes (choque de mamadeira e movimentação de móveis) produziu picos repentinos de ruído. Conclusões. O ruído ambiental e periatrial na UTIN é mais do que o dobro e quase o triplo dos 45 dB diurnos e 35 dB noturnos dos regulamentos dos hospitais. Faz-se necessária a implantação de programas permanentes de redução de ruído para prevenir sequelas em prematuros e esgotamento profissional na equipe de enfermagem.


Assuntos
Humanos , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Medição de Ruído , Decoração de Interiores e Mobiliário
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5822-5825, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019298

RESUMO

Heart rate (HR) measurement is crucial for newborn infant monitoring in the neonatal intensive care unit (NICU). The widely used contact HR measurement methods based on electrocardiography (ECG) and photoplethysmography (PPG) signals can lead to discomfort and possible skin irritation on neonates, which limit its application in NICU scenarios. In this work, we propose a non-contact HR monitoring method simply using a RGB camera. Eulerian video magnification (EVM) is employed to detect the subtle changes of neonatal faces results from blood circulation. The magnified signal is then transformed to the spectral domain to extract HR information. Compared with the widely investigated independent component analysis (ICA)-based HR measurement method using video recordings, the proposed method can achieve the real time HR measurement, which is a significant superiority in NICU neonatal monitoring. To the best of our knowledge, this is the first study to employ EVM algorithm in real time neonatal HR monitoring.


Assuntos
Unidades de Terapia Intensiva Neonatal , Fotopletismografia , Eletrocardiografia , Frequência Cardíaca , Humanos , Recém-Nascido , Monitorização Fisiológica
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 6135-6138, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019371

RESUMO

Newborns admitted to the neonatal intensive care unit (NICU) require a high level of care due to their precarious condition. Nurses typically monitor their vital signs continuously using wearable sensors such as electrocardiogram (ECG) electrodes placed on their chest and a pulse oximeter on a limb. When the patient moves, this can cause motion artifacts on one or more physiologic signals, potentially resulting in a false alarm on the patient monitor. We therefore propose a motion detection algorithm to mitigate these alarms by providing context. Using a camera positioned above the crib or overhead warming bed, we recorded videos from six patients and annotated all patient movements. These data were used to train and evaluate two different approaches for non-contact motion detection. Results were stronger for the optical flow technique than for the long short-term memory network approach. This represents a challenging problem due to variable lighting, patient clothing and bed coverings, and the complex clinical environment in the NICU.


Assuntos
Unidades de Terapia Intensiva Neonatal , Oximetria , Eletrocardiografia , Humanos , Recém-Nascido , Monitorização Fisiológica , Movimento (Física)
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5154-5157, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019146

RESUMO

Oxygen therapy is provided in neonatal intensive care units to prevent and treat neonatal hypoxia. This treatment is essential for the physiological development and survival of neonates with respiratory dysfunctions. One method of providing oxygen therapy involves the use of a simple face mask to deliver oxygen-enriched medical air. In these systems, a flow meter is used to adjust the volumetric flow rate of the gas between 5 to 15 L/min. If the flow rate falls below 5 L/min, there is a risk for exhaled carbon dioxide to accumulate in the mask and cause hypercapnia. Several potential hazards have been identified in the configuration of these oxygen therapy systems in neonatal intensive care units that can result in a decrease of flow rate measurement accuracy: the use of an oxygen flow meter to deliver a mixed gas, the orientation of how the flow meter is installed, and a decrease in pressure due to the use of junctions and medical gas hoses. With reduced measurement accuracy at low flow rate settings, clinical users may not be aware that flow rate may drop below 5 L/min. Furthermore, inconsistencies in physical set-up and labelling may result in the wrong gas being delivered to a neonatal patient. To ensure that patient safety is maintained in neonatal intensive care units, a best practice recommendation is provided to address these potential hazards.


Assuntos
Fluxômetros , Oxigênio , Dióxido de Carbono , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Oxigenoterapia
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 320-323, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017993

RESUMO

This paper presents a simple yet novel method to estimate the heart frequency (HF) of neonates directly from the ECG signal, instead of using the RR-interval signals as generally done in clinical practices. From this, the heart rate (HR) can be derived. Thus, we avoid the use of peak detectors and the inherent errors that come with them.Our method leverages the highest Power Spectral Densities (PSD) of the ECG, for the bins around the frequencies related to heart rates for neonates, as they change in time (spectrograms).We tested our approach with the monitoring data of 6 days for 52 patients in a Neonate Intensive Care Unit (NICU) and compared against the HR from a commercial monitor, which produced a sample every second. The comparison showed that 92.4% of the samples have a difference lower than 5bpm. Moreover, we obtained a median MAE (Mean Absolute Error) between subjects equal to 2.28 bpm and a median RMSE (Root Mean Square Error) equal to 5.82 bpm. Although tested for neonates, we hypothesize that this method can also be customized for other populations.Finally, we analyze the failure cases of our method and found a direct co-allocation of errors due to moments with higher PSD in the lower frequencies with the presence of critical alarms related to other physiological systems (e.g. desaturation).


Assuntos
Eletrocardiografia , Unidades de Terapia Intensiva Neonatal , Algoritmos , Frequência Cardíaca , Humanos , Recém-Nascido , Processamento de Sinais Assistido por Computador
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 600-603, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018060

RESUMO

Nearly 10% of all births in the United States are preterm. Preterm birth is a major risk for developmental neuromotor disorders. Early characterization of a future developmental outcome is necessary to design early interventions. However, such evaluations are currently subjective and typically happen only several months after birth. The aim of this study was to quantify movement bouts after birth and to determine if features of maturation might be characterized. Four preterm infants were continuously monitored for several months, from a few days after birth until discharge, in the Neonatal Intensive Care Unit. Movement was quantified from the photoplethysmogram using a wavelet-based algorithm. In all 4 infants, maturation was associated with a decrease (p < 0.001) in the occurrence of movement bouts ≤ 30s and an increase (p < 0.001) in longer movement bouts (> 30s). The distribution of movement durations followed a power law function with its exponent defining the characteristic of the distribution. The exponent significantly increased with post-menstrual age. Future research will test whether these maturational changes can predict developmental outcomes.Clinical Relevance- Early identification of changes in features of preterm infant movement may be useful in predicting neuromotor development and potential disorders.


Assuntos
Recém-Nascido Prematuro , Movimento , Algoritmos , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Parto , Gravidez , Estados Unidos
11.
Rev Assoc Med Bras (1992) ; 66(9): 1252-1257, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027454

RESUMO

OBJECTIVE: To describe the characteristics of patients treated at a level III surgical Neonatal Intensive Care Unit outside of a maternity service and analyze possible risk factors for mortality in this population. METHODS: A retrospective cohort study evaluating patients admitted to a level III surgical Neonatal Intensive Care Unit from June/2015 to November/2017. Univariate analysis was performed by the Chi-square test and T-student test or Mann-Whitney test. Multivariate analysis by logistic regression was performed including in the model the variables with a P-value <0.2 in univariate analysis. Kaplan-Meier curve and Log-Rank test were performed using the variables that were statistically associated with death in the multivariate analysis. A significance level of a=5% and an error B=80% were adopted. RESULTS: During this period, 246 patients were admitted to this service. 58 (23.8%) patients died, with a mean time until death of 18 days. Half of the patients had a clinical diagnosis of sepsis (50.6%), blood culture was positive in 25.2%, and gram-positive bacteria (48.4%) were the main pathogens isolated. The variables that remained in the final model after multivariate analysis were diagnosis of congenital heart disease (OR = 4.5; p = 0.016), clinical diagnosis of sepsis (OR = 8.1; p = 0.000), and isolation of gram-positive bacteria in blood culture (OR = 3.9; p = 0.006). CONCLUSION: The level III surgical Neonatal Intensive Care Unit outside of a maternity service has a different profile of morbidity and mortality, and death was associated with the diagnosis of congenital heart disease, the clinical diagnosis of sepsis, and the isolation of gram-positive bacteria in the blood culture.


Assuntos
Unidades de Terapia Intensiva Neonatal , Feminino , Humanos , Recém-Nascido , Morbidade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Sepse
12.
Am J Perinatol ; 37(12): 1283-1288, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32911555

RESUMO

The novel coronavirus disease 2019 (COVID-19) pandemic is affecting care for high-risk newborns in ways that will likely be sustained beyond the initial pandemic response. These novel challenges present an urgent imperative to understand how COVID-19 impacts parent, family, and infant outcomes. We highlight three areas that warrant targeted attention: (1) inpatient care: visitation policies, developmental care, and communication practices; (2) outpatient care: high-risk infant follow-up and early intervention programs; and (3) parent psychosocial distress: mental health, social support, and financial toxicity. Changes to care delivery in these areas provide an opportunity to identify and implement novel strategies to provide family-centered care during COVID-19 and beyond. KEY POINTS: · The COVID-19 pandemic is influencing care delivery for high-risk newborns and their families.. · Rapid changes to care delivery are likely to be sustained beyond the initial pandemic response.. · We have an urgent imperative to understand how COVID-19 impacts infant, parent, and family outcomes..


Assuntos
Assistência Ambulatorial , Comunicação , Infecções por Coronavirus , Efeitos Psicossociais da Doença , Assistência à Saúde/métodos , Hospitalização , Pandemias , Pais/psicologia , Assistência Perinatal , Pneumonia Viral , Betacoronavirus , Intervenção Educacional Precoce , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Saúde Mental , Política Organizacional , Pediatria , Relações Profissional-Família , Risco , Apoio Social , Telemedicina , Telefone , Comunicação por Videoconferência , Visitas a Pacientes
13.
BMC Infect Dis ; 20(1): 682, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32942989

RESUMO

BACKGROUND: Enterobacter cloacae species is responsible for nosocomial outbreaks in vulnerable patients in neonatal intensive care units (NICU). The environment can constitute the reservoir and source of infection in NICUs. Herein we report the impact of preventive measures implemented after an Enterobacter cloacae outbreak inside a NICU. METHODS: This retrospective study was conducted in one level 3 NICU in Lyon, France, over a 6 year-period (2012-2018). After an outbreak of Enterobacter cloacae infections in hospitalized neonates in 2013, several measures were implemented including intensive biocleaning and education of medical staff. Clinical and microbiological characteristics of infected patients and evolution of colonization/infection with Enterobacter spp. in this NICU were retrieved. Moreover, whole genome sequencing was performed on 6 outbreak strains. RESULTS: Enterobacter spp. was isolated in 469 patients and 30 patients developed an infection including 2 meningitis and 12 fatal cases. Preventive measures and education of medical staff were not associated with a significant decrease in patient colonisation but led to a persistent decreased use of cephalosporin in the NICU. Infection strains were genetically diverse, supporting the hypothesis of multiple hygiene defects rather than the diffusion of a single clone. CONCLUSIONS: Grouped cases of infections inside one setting are not necessarily related to a single-clone outbreak and could reveal other environmental and organisational problematics. The fight against implementation and transmission of Enterobacter spp. in NICUs remains a major challenge.


Assuntos
Enterobacter cloacae/patogenicidade , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/prevenção & controle , Controle de Infecções/métodos , Surtos de Doenças/prevenção & controle , Enterobacter cloacae/genética , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/microbiologia , Fezes/microbiologia , Feminino , França , Humanos , Higiene , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Estudos Retrospectivos , Sequenciamento Completo do Genoma
14.
S Afr Med J ; 110(6): 497-501, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880561

RESUMO

BACKGROUND: The burden of neonatal surgical conditions is not well documented in low- to middle-income countries (LMICs). These conditions are thought to be relatively common, with a considerable proportion of neonates admitted to the neonatal intensive care unit (NICU) requiring surgical intervention. OBJECTIVES: To review neonates with surgical conditions admitted to the NICU in our hospital setting. METHODS: This was a retrospective, descriptive study of neonates with surgical conditions admitted to the NICU at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa, between 1 January 2013 and 31 December 2015. The characteristics and survival of these neonates were described using univariate analysis. The NICU at CMJAH is combined with a paediatric intensive care unit, to a total of 15 beds, and serves as a referral unit. RESULTS: Of 923 neonates admitted to the NICU, 319 (34.6%) had primarily surgical conditions. Of these 319 neonates, 205 survived (64.3%). There were 125/319 neonates (39.2%) with necrotising enterocolitis (NEC), 55 of whom survived (55/125; 44.0%), making the presence of NEC significantly associated with poor outcome (p<0.001). Other significant predictors of poor outcome were the patient being outborn (p=0.029); the presence of late-onset sepsis (p<0.001), with Gram-negative organisms (p=0.005); and lesser gestational age (p=0.001) and lower birth weight (p<0.001). Major birth defects were present in 166/319 neonates (52.0%). The abdomen was the most prevalent site of surgery, with 216/258 procedures (83.7%) being abdominal, resulting in a mortality rate of 76/216 (35.2%). CONCLUSIONS: Neonates with major surgical conditions accounted for one-third of NICU admissions in the present study. The study highlights the considerable burden placed on paediatric surgical services at a large referral hospital in SA. Paediatric surgical services, with early referral and improvement of neonatal transport systems, must be a priority in planned healthcare interventions to reduce neonatal mortality in LMICs.


Assuntos
Mortalidade Infantil , Doenças do Recém-Nascido/mortalidade , Doenças do Recém-Nascido/cirurgia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , África do Sul/epidemiologia , Taxa de Sobrevida
15.
Ann Agric Environ Med ; 27(3): 348-355, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32955213

RESUMO

INTRODUCTION AND OBJECTIVE: Newborn babies staying on hospital wards are likely to be colonized by microorganisms, including potentially pathogenic fungi. The aim of the study was to assess the mycological purity of hospital wards and medical equipment utilized in the treatment and nursing of newborns. MATERIAL AND METHODS: The study was conducted in Neonatal High Dependency Units (NHDU) and Neonatal Intensive Care Units (NICU). 539 samples were collected from 24 different sources, 130 from ward furnishings and 289 from medical equipment. The study was carried out following the microbiology research methods for sample collection. Subsequently, the samples (swabs, water from incubators, washings from respirator tubes and nasal cannulas (nCPAP)) were cultivated on Sabouraud agar plates. The stamps were collected with the application of Count-Tact method. The samples were incubated at the temperature of 25+/-2 o C and the number of fungi assessed (cfu/cm -2 of the surface area). The species were identified based on their morphological and biochemical features. RESULTS: Fungal growth was observed on 60% of samples collected from ward furnishings and 7% of samples collected from medical equipment. The average number of cfu/cm -2 ranged between 0-8.84 in the case of ward furnishings and between 0-1.22 cfu/cm -2 in the case of medical equipment. In 180 samples collected from the material which had direct contact with newborns no fungal growth was observed. CONCLUSIONS: The furnishings of the wards on which newborns were treated and nursed were contaminated with fungi to an extent which did not pose a threat to the life and health of the newborns. Medical equipment (respirators, incubators, nCPAP cannulas and masks) which came into direct contact with newborns was free from fungi.


Assuntos
Contaminação de Equipamentos/estatística & dados numéricos , Fungos/isolamento & purificação , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Decoração de Interiores e Mobiliário/estatística & dados numéricos , Humanos , Recém-Nascido
16.
Am J Perinatol ; 37(13): 1317-1323, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32892325

RESUMO

OBJECTIVE: The perinatal consequences of neonates born to severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) infected mothers are uncertain. This study aimed to compare the differences in clinical manifestation, laboratory results, and outcomes of neonates born to mothers with or without coronavirus disease 2019 (COVID-19). STUDY DESIGN: A total of 48 neonates were admitted to Tongji Hospital and HuangShi Maternal and Child Healthcare Hospital from January 17 to March 4, 2020. The neonates were divided into three groups according to the mothers' conditions: neonates born to mothers with confirmed COVID-19, neonates born to mothers with clinically diagnosed COVID-19, and neonates born to mothers without COVID-19. The clinical data of mothers and infants in the three groups were collected, compared, and analyzed. RESULTS: The deliveries occurred in a negative pressure isolation room, and the neonates were separated from their mothers immediately after birth for further observation and treatment. None of the neonates showed any signs of fever, cough, dyspnea, or diarrhea. SARS-CoV-2 reverse transcriptase-polymerase chain reaction of the throat swab and feces samples from the neonates in all three groups was negative. No differences were detected in the whole blood cell, lymphocytes, platelet, and liver and renal function among the three groups. All mothers and their infants showed satisfactory outcomes, including a 28-week preterm infant. CONCLUSION: The clinical manifestations, radiological, and biochemical results did not show any difference between the three groups. No evidence of vertical transmission was found in this study whether the pregnant women developed coronavirus infection in the third (14 cases) or second trimester (1 case). KEY POINTS: · Characteristics of neonates born to mothers with and without COVID-19 have been compared.. · All the 48 cases presented in the study had good outcomes.. · A 28-week preterm born to COVID-19 mother presented to be clear of SARS-COV-2 infection..


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Triagem Neonatal/métodos , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Avaliação de Sintomas , Adulto , China/epidemiologia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Resultado da Gravidez , Trimestres da Gravidez , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
17.
PLoS One ; 15(9): e0238629, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915835

RESUMO

BACKGROUND: Globally, every year greater than twenty million newborns are born weighing less than 2500grams, of which over 96% of them were in developing countries. It contributes to sixty to eighty percent of all neonatal deaths, annually. These infants weighing less than 2500gram will have a poor immune system and are at risk of morbidity and mortality. This study was aimed to investigate the survival status and predictors of mortality among neonates admitted with low birth weight at public hospitals in Ethiopia. METHOD: A prospective cohort study was conducted among selected 216 newborns admitted with low birth weight who were admitted in neonatal intensive care unit at Arba Minch General hospital, Sawla General Hospital and Chencha district hospital from 1st March 2018 to 28st February 2019. Data were entered into Epi data version 3.02 and exported to STATA V 14 for analysis. The Kaplan Meier survival curve together with log rank test was used to estimate the survival time of the newborns. Variables which had p-value <0.05 in multivariable analysis using the cox proportional hazard model were declared as statistically significant. RESULT: The cumulative proportion of surviving at the end of third days was 99.01% (95%CI: 96.11, 99.75). Similarly it was 97.81% (95%CI: 94.25, 99.18), 96.27% (95%CI: 91.76, 98.33) and 94.33% (95%CI: 88.72, 97.19) at the end of fourth, fifth and sixth day respectively. The overall mean survival time was 17.13 days (95%CI: 12.76, 21.49). The incidence of mortality among neonates admitted with low birth weight was 83 per 1000 live births. Mothers with DM (AHR:4.79; 95%CI:1.15, 19.8), maternal HIV infection(AHR:6.47;95%CI:1.43,29.3), not keeping the newborn under KMC(AHR:13.0;95%CI:3.42, 49.5) and initiating exclusive breast feeding within one hour(AHR:0.19;95%CI:0.04, 0.95) were statistically significant in multivariable cox regression analysis. CONCLUSION: The risk of mortality among neonates admitted with low birth weight was high at the early admission period and the incidence of mortality was high. Maternal history of diabetes mellitus, HIV/AIDS infection, keeping the newborn under kangaroo mother care and exclusive breast feeding initiation were statistically significant predictors of mortality. Special emphasis should be given for neonates with low birth weight at the early follow up periods and Kangaroo mother care practice should be a usual practice.


Assuntos
Infecções por HIV/epidemiologia , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Morte Perinatal , Criança , Etiópia/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/virologia , Hospitalização , Hospitais Públicos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Método Canguru , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais
18.
Am J Perinatol ; 37(S 02): S5-S9, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898875

RESUMO

Despite continued advances and developments in neonatal medicine, neonatal sepsis is the third leading cause of neonatal mortality and a major public health problem, especially in developing countries. Sepsis accounts for mortality for almost 50% of global children under 5 years of age.Over the past 50 years, there have been many advances in the diagnosis, prevention, and treatment of neonatal infections. The diagnostic advances include better culture techniques that permit more rapid confirmation of the diagnosis, advent of polymerase chain reaction (PCR) to rapidly diagnose viral infections, use of biologic markers indicating evidence of infection, and a better understanding of immunoglobulin markers of infection. From a therapeutic stand point, there have been a variety of antibiotics, antifungals, and antiviral agents, better approaches to prevent sepsis, specific immunotherapy, for example, respiratory syncytial virus (RSV); bundled approach to prevention of deep-line infection and better antibiotic stewardship, leading to earlier discontinuation of antibiotic therapy.Hand hygiene remains the benchmark and gold standard for late-onset sepsis prevention. The challenge has been that each decade, newer resistant bacteria dominate as the cause of sepsis and newer viruses emerge, for example, human immunodeficiency virus, zika virus, and novel coronavirus disease 2019.Future treatment options might include stem cell therapy, other antimicrobial protein and peptides, and targeting of pattern recognition receptors in an effort to prevent and/or treat sepsis in this vulnerable population. Also, the microbiome of premature infants has a smaller proportion of beneficial bacteria and higher numbers of pathogenic bacteria compared with term infants, likely owing to higher frequencies of cesarean sections, antibiotic use, exposure to the hospital environment, and feeding nonhuman milk products. Modifying the microbiome with more mother's milk and shorter duration of antibiotics in noninfected babies should be a goal. KEY POINTS: · Neonatal sepsis remains a leading cause of mortality.. · Challenges include bacterial resistance and newer viruses.. · Future treatments may include newer antibiotics/antivirals and stem cell therapy..


Assuntos
Antibacterianos/uso terapêutico , Unidades de Terapia Intensiva Neonatal , Sepse Neonatal/mortalidade , Sepse Neonatal/prevenção & controle , Antivirais/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Doenças do Prematuro/prevenção & controle , Sepse Neonatal/tratamento farmacológico
19.
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
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