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1.
Enferm. intensiva (Ed. impr.) ; 30(4): 170-180, oct.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184481

RESUMO

Introducción: Los catéteres centrales de inserción periférica se han convertido en una prioridad en los neonatos que necesitan terapia intravenosa de larga duración, pero su uso no está exento de riesgos. Objetivo: Describir la aparición de eventos adversos en neonatos portadores de catéteres venosos centrales de inserción periférica y determinar factores de riesgo asociados a ellos. Métodos: Se llevó a cabo un estudio descriptivo transversal en el que se incluyeron la totalidad de neonatos portadores de catéteres venosos centrales de inserción periférica desde el 1 de octubre de 2014 hasta el 30 de septiembre de 2015. Se registraron los eventos adversos y variables sociodemográficas y clínicas relacionadas con los neonatos y los catéteres analizados. Resultados: Se incluyeron en el estudio un total de 116 neonatos y 140 catéteres. Se registraron eventos adversos en el 16,4% de ellos: bacteriemia asociada al catéter (5,7%), obstrucción (5,7%), extravasación (2,1%) y flebitis (2,1%). Los factores asociados a bacteriemia con el odds de prevalencia corresponde a neonatos: < 27 semanas de gestación (OR = 1,2; p = 0,02), con peso < 1.000 g (OR = 6,7; p = 0,02), portadores de catéter > 1 semana (OR = 9,8; p = 0,02) y con perfusión de antibióticos por catéter (OR = 1,3; p < 0,01). La flebitis se asocia con la inserción del catéter en miembros inferiores y cabeza (OR = 1,1; p = 0,03). Los factores asociados a bacteriemia con odds de prevalencia ajustada corresponde a neonatos de peso extremo (OR = 6,38; p = 0,03) y portadores del catéter > 7 días (OR = 9,41; p = 0,04). Conclusiones: La evaluación periódica de eventos adversos relacionados con catéteres es de gran utilidad para elaborar planes de mejora. Esto permitirá extremar la seguridad en los RN más vulnerables, en especial los neonatos con extremo bajo peso que precisan tratamientos muy prolongados


Background: Peripherally inserted central catheters have become a priority in infants who require long-term intravenous therapy, but their use involves certain risks. Objective: The aim of the study was to describe the occurrence of adverse events in newborns with peripherally inserted central catheters and to determine the risk factors associated with them. Methods: A descriptive cross-sectional study was designed and performed. All neonates with peripherally inserted central catheters from October 1st, 2014 to September 30 th, 2015 were included. The adverse events and sociodemographic and clinical variables related to neonates and analyzed catheters were recorded. Results: A total of 140 catheters were placed in 116 infants. All of them were analyzed. Adverse events occurred in 16.4%: catheter-associated bacteraemia (5.7%), obstruction (5.7%), extravasation (2.1%) and phlebitis (2.1%), < 27 weeks of pregnancy (OR = 1.2, P = .02), birth weight < 1000 g (OR = 6.7, P = .02), with catheters in situ for longer than one week (OR = 9.8, P = .02) and with perfusion of antibiotics per catheter (OR = 1.3, P < .01). Phlebitis is associated with the insertion of the catheter in LL and head (OR = 1.1, P = .03). Factors associated with bacteraemia risk with adjusted prevalence odds ratio are extremely low birth weight neonates (OR = 6.38; P = .03) and with a catheter in situ for longer than one week (OR = 9.41; P = .04). Conclusions: The periodic evaluation of catheter-related adverse events is very useful to prepare improvement plans. This will maximize safety for the most vulnerable newborns, especially those of extremely low birth weight that require very long treatments


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Cateteres Venosos Centrais/efeitos adversos , Fatores de Risco , Unidades de Terapia Intensiva Neonatal/tendências , Cuidados Críticos/métodos , Epidemiologia Descritiva , Bacteriemia/complicações , Bacteriemia/prevenção & controle , Flebite/prevenção & controle , Intervalos de Confiança
2.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31405887

RESUMO

OBJECTIVES: To examine changes in care practices over time by race and ethnicity and whether the decrease in hospital mortality and severe morbidities has benefited infants of minority over infants of white mothers. METHODS: Infants 22 to 29 weeks' gestation born between January 2006 and December 2017 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals for African American and Hispanic versus white infants by birth year. We tested temporal differences in mortality and morbidity rates between white and African American or Hispanic infants using a likelihood ratio test on nested binomial regression models. RESULTS: Disparities for certain care practices such as antenatal corticosteroids and for some in-hospital outcomes have narrowed over time for minority infants. Compared with white infants, African American infants had a faster decline for mortality, hypothermia, necrotizing enterocolitis, and late-onset sepsis, whereas Hispanic infants had a faster decline for mortality, respiratory distress syndrome, and pneumothorax. Other morbidities showed a constant rate difference between African American and Hispanic versus white infants over time. Despite the improvements, outcomes including hypothermia, mortality, necrotizing enterocolitis, late-onset sepsis, and severe intraventricular hemorrhage remained elevated by the end of the study period, especially among African American infants. CONCLUSIONS: Racial and ethnic disparities in vital care practices and certain outcomes have decreased. That the quality deficit among minority infants occurred for several care practice measures and potentially modifiable outcomes suggests a critical role for quality improvement initiatives tailored for minority-serving hospitals.


Assuntos
Afro-Americanos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Morbidade , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu/etnologia , Feminino , Disparidades em Assistência à Saúde/tendências , Humanos , Lactente , Mortalidade Infantil/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Gravidez , Complicações na Gravidez/epidemiologia , Porto Rico/epidemiologia , Fatores Raciais , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
3.
PLoS Med ; 16(7): e1002860, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31335869

RESUMO

BACKGROUND: The Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh-2 Indian states with a respective population of 35 and 50 million. METHODS AND FINDINGS: We conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%-62%, p-value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%-8%), 15% (9%-24%), 4% (2%-8%) and 2% (1%-5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%-18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities. CONCLUSIONS: Our findings suggest differences in quality of neonatal intensive care and 28-day survival between the different types of hospitals, although comparison of outcomes is complicated by differences in the case mix and referral practices between hospitals. Uniform reporting of outcomes and risk factors across the private and public sectors is required to assess the benefits for the population of mixed-care provision.


Assuntos
Prestação Integrada de Cuidados de Saúde/tendências , Mortalidade Hospitalar/tendências , Hospitais Privados/tendências , Hospitais Públicos/tendências , Mortalidade Infantil/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Terapia Intensiva Neonatal/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , Estudos Transversais , Fidelidade a Diretrizes/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Índia , Lactente , Admissão do Paciente/tendências , Admissão e Escalonamento de Pessoal/tendências , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31036673

RESUMO

BACKGROUND AND OBJECTIVES: Evaluate effects of immigrant status on perceptions of discharge readiness in mothers of preterm infants <37 weeks' gestation and identify the impact of primary language and years in the United States. METHODS: Immigrant (n = 176) and native (n = 556) mothers of preterm infants cared for in the NICU for >5 days between 2012 and 2015 completed the Fragile Infant Parental Readiness Evaluation (FIPRE), a NICU-discharge readiness questionnaire. Group comparisons were made on the basis of immigrant status. Regression models examined effects of immigrant status, primary language, and years in the United States on discharge readiness. RESULTS: Immigrant mothers were more likely to be older, gravida >1, multiracial or people of color, and non-English speaking; have less than a high school education; and receive Medicaid but less likely to have child protective services involvement, substance abuse, and mental health disorder (MHD). Whereas rates of non-English primary language, low education, and Medicaid decreased, rates of MHDs increased with years in the United States. At NICU discharge, immigrant mothers had poorer perceptions of infant well-being, maternal well-being, maternal comfort, and time impact. In adjusted analyses, immigrant status, non-English primary language, and MHD predicted unfavorable scores. Among immigrant mothers, increased years in the United States and MHD predicted unfavorable scores. CONCLUSIONS: Although findings suggest acculturation with increased years in the United States, immigrant mothers perceived less discharge readiness in multiple domains, highlighting the need for culturally competent care and discharge services specifically tailored to help this vulnerable population.


Assuntos
Emigrantes e Imigrantes/psicologia , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/tendências , Mães/psicologia , Alta do Paciente/tendências , Cuidado Transicional/tendências , Adulto , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Estados Unidos/etnologia
5.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31028159

RESUMO

OBJECTIVES: Unintended extubations (UEs) lead to significant morbidity in neonates. A quality improvement project was initiated in response to high rates in our level IV NICU. We targeted creating and sustaining UE rates below the published standard of 1 per 100 ventilator days. METHODS: This project spanned 4 time periods: baseline, epoch 1 (December 2010-May 2012), sustain, and epoch 2 (May 2015-December 2017) by using standard quality improvement methodology. Epoch 1 interventions included real-time analysis of UE events, standardization of taping, patient positioning and movement, accurate event reporting, and change in nomenclature. Epoch 2 interventions included reduction in daily chest radiographs (CXRs) and development of a high-risk tool. Patient and event characteristics were statistically compared across time points. RESULTS: Of the 612 UE events recorded over 10 years, 249 UEs occurred from May 2011 to 2017 involving 184 unique patients. UE rates decreased by 43% (from 1.75 to 0.99 per 100 ventilator days; epoch 1) and were sustained until a notable spike. Epoch 2 interventions led to a further 31% rate reduction. Single CXR use decreased by half. Median corrected gestational age at the time of an event was 35 weeks (interquartile range: 29-41). Seventy percent of infants experiencing an UE required reintubation, 29% had a previous event, and 9% had a code event. CONCLUSIONS: A decrease in UE below benchmarks can be achieved and sustained by standardization and mitigation interventions. This decline was also accompanied by a reduction in use of CXRs without increasing UE events.


Assuntos
Centros Médicos Acadêmicos/tendências , Extubação/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Intubação Intratraqueal/tendências , Melhoria de Qualidade/tendências , Centros Médicos Acadêmicos/normas , Extubação/normas , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/normas , Intubação Intratraqueal/normas , Masculino , Melhoria de Qualidade/normas
6.
Rev. pesqui. cuid. fundam. (Online) ; 11(1): 147-153, jan.-mar. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-968585

RESUMO

Objetivo: Compreender a percepção familiar sobre o acolhimento no contexto da assistência em enfermagem neonatal, antes e após a implementação de um protocolo de acolhimento. Método:Estudo de intervenção, caráter descritivo, realizado numa Unidade de Terapia Intensiva Neonatal, de abril a setembro de 2014, antes e após a implementação de uma rotina de acolhimento da unidade, junto a 24 pais. Os dados foram coletados com instrumento semiestruturado e foram analisados conforme referencial metodológico da Análise de Conteúdo, da qual emergiram cinco categorias temáticas. Resultados: Transversalidade do cuidado de enfermagem; contato inicial ao contexto de cuidado neonatal; compartilhamento de informações e saberes profissional; corresponsabilização do cuidado a partir do papel parental; protagonismo familiar para alta hospitalar. Conclusão: A compreensão das potencialidades e fragilidades no processo de acolhimento, a partir da perspectiva familiar possibilita a transformação da realidade, propiciando uma assistência pautada nas reais necessidades da família e, portanto, mais humanizada e qualificada


Objective: To understand the familiar perception about the host in the context of the assistance in neonatal nursing, before and after the implementation of a host protocol. Method: Interventional study, descriptive, performed in a Neonatal Intensive Care Unit, from April to September 2014, before and after the implementation of a routine of receiving the unit, together with 24 parents. The data were collected with a semi-structured instrument and were analyzed according to the methodological framework of Content Analysis, and five thematic categories emerged. Results: Transversality of nursing care; Initial contact with the context of neonatal care; Sharing of information and professional knowledge; Responsible care copying from parental paper; Family role for hospital discharge. Conclusion: The understanding of the potentialities and fragilities in the reception process, from the family perspective allows the transformation of reality, providing assistance based on the real needs of the family and therefore more humanized and qualified


Objetivo: Comprender la percepción familiar sobre La acogida em el contexto de La asistencia em enfermería neonatal, antes y después de la implementación de un protocolo de acogida. Método: Estudio de intervención, carácter descriptivo, realizado en una Unidad de Terapia Intensiva Neonatal, de abril a septiembre de 2014, antes y después de la implementación de una rutina de acogida de la unidad, junto a 24 padres. Los datos fueron recolectados com un instrumento semiestructurado y se analizaron como referencia metodológica Del Análisis de Contenido, y surgieron cinco categorías temáticas. Resultados: Transversalidad del cuidado de enfermería; Contacto inicial al contexto de cuidado neonatal; Compartir información y conocimientos profesionales; Corresponsabilidad del cuidado a partir del papel parental; Protagonismo familiar para el alta hospitalaria. Conclusión: La comprensión de las potencialidades y fragilidades em el proceso de acogida, a partir de la perspectiva familiar, posibilita la transformación de la realidad, propiciando una asistencia pautada en las reales necesidades de la familia y por lo tanto, más humanizada y calificada


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Adulto , Unidades de Terapia Intensiva Neonatal/tendências , Enfermagem Neonatal , Humanização da Assistência , Acolhimento , Família , Relações Pai-Filho , Relações Mãe-Filho
7.
Arch Dis Child Fetal Neonatal Ed ; 104(3): F324-F325, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30355782

RESUMO

BACKGROUND: Previous surveys have demonstrated that neonatal resuscitation practices on the delivery suite vary between UK units, particularly according to the hospital's neonatal unit's level. Our aim was to determine if recent changes to the Resuscitation Council guidelines had influenced clinical practice. METHODS: Surveys of resuscitation practices at UK delivery units carried out in 2012 and 2017 were compared. RESULTS: Comparing 2017 with 2012, initial resuscitation using air was more commonly used in both term (98% vs 75%, p<0.001) and preterm (84% vs 34%, p<0.001) born infants. Exhaled carbon dioxide monitoring was more frequently employed in 2017 (84% vs 19%, p<0.001). There were no statistically significant differences in practices according to the level of neonatal care provided by the hospital. CONCLUSION: There have been significant changes in neonatal resuscitation practices in the delivery suite since 2012 regardless of the different levels of neonatal care offered.


Assuntos
Salas de Parto/tendências , Assistência Perinatal/tendências , Ressuscitação/tendências , Salas de Parto/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/normas , Unidades de Terapia Intensiva Neonatal/tendências , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Monitorização Fisiológica/tendências , Assistência Perinatal/métodos , Assistência Perinatal/normas , Guias de Prática Clínica como Assunto , Prática Profissional/normas , Prática Profissional/tendências , Ressuscitação/métodos , Ressuscitação/normas , Medicina Estatal/normas , Medicina Estatal/tendências , Reino Unido
8.
Neonatology ; 115(2): 108-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30384374

RESUMO

BACKGROUND: Prescription drug shortages have increased significantly during the past two decades and also impact drugs used in critical care and pediatrics. OBJECTIVES: To analyze drug shortages affecting medications used in neonatal intensive care units (NICUs). METHODS: Drug shortage data for the top 100 NICU drugs were retrieved from the University of Utah Drug Information Service from 2001 to 2016. Data were analyzed focusing on drug class, formulation, reason for shortage, and shortage duration. RESULTS: Seventy-four of the top 100 NICU drugs were impacted by 227 shortages (10.3% of total shortages). Twenty-eight (12.3%) shortages were unresolved as of December 2016. Resolved shortages had a median duration of 8.8 months (interquartile range 3.6-21.3), and generic drugs were involved in 175 (87.9%). An alternative agent was available for 171 (85.8%) drugs but 120 (70.2%) of alternatives were also affected by shortages. Parenteral drugs were involved in 172 (86.4%) shortages, with longer durations than nonparenteral drugs (9.9 vs. 6.4 months, p = 0.022). The most common shortage reason was manufacturing problems (32.2%). CONCLUSIONS: Drug shortages affected many agents used in NICUs, which can have quality and safety implications for patient care, especially in extremely low birth weight infants. Neonatologists must be aware of current shortages and implement mitigation strategies to optimize patient care.


Assuntos
Medicamentos Genéricos/provisão & distribução , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/normas , Medicamentos sob Prescrição/provisão & distribução , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/tendências , Terapia Intensiva Neonatal/organização & administração , Neonatologistas , Estados Unidos
9.
Rev Bras Enferm ; 71(suppl 6): 2758-2766, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30540054

RESUMO

OBJECTIVE: to analyze the Developmental Care in nursing care for Newborns in critical Neonatal Intensive Care Units. METHOD: a qualitative study with 11 nurses from Neonatal Intensive Care Units of a city in the State of São Paulo countryside, based on the Developmental Care. Data collection was based on non-participant observation, documentary research in medical records and semi-structured interviews. The Symbolic Interactionism was adopted as theoretical framework, and the Bardin Content Analysis, as method of analysis. RESULTS: nurses have knowledge about Developmental Care; however, there are dissonances with doing them. The analysis is presented from two thematic categories: "Nurses' performance in the Developmental Care" and "Nurse, Family and Developmental Care". FINAL CONSIDERATIONS: it is necessary to encourage reflections on the care of nurses regarding Developmental Care, and to foster sensitivity and perception in relation to the executed and registered.


Assuntos
Crescimento e Desenvolvimento/fisiologia , Enfermeiras e Enfermeiros/normas , Cuidados de Enfermagem/métodos , Adulto , Brasil , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/tendências , Masculino , Enfermagem Neonatal/métodos , Pesquisa Qualitativa
10.
Rev Bras Enferm ; 71(suppl 6): 2783-2791, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30540057

RESUMO

OBJECTIVE: To understand the conditions that influence the adherence and application of best practices by nurses in the context of the Nursing care management in the Kangaroo Mother Care in the Neonatal ICU. METHOD: Study of qualitative approach, whose theoretical and methodological frameworks were Symbolic Interactionism and Grounded Theory, respectively. We used the in-depth interview with 8 nurses from the Neonatal ICU of a public maternity hospital in the city of Rio de Janeiro. RESULTS: The conditions involved in adhering to the best practices of humanization in the Neonatal ICU are related mainly to human resources, interaction among professionals, work processes and leadership strategies; and care management. CONCLUSION: Professional and institutional challenges have been identified that need to be addressed to improve adherence and implementation of the Kangaroo Mother Care best practices.


Assuntos
Método Canguru/métodos , Cuidados de Enfermagem/tendências , Guias de Prática Clínica como Assunto , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/tendências , Entrevistas como Assunto/métodos , Método Canguru/normas , Pessoa de Meia-Idade , Enfermagem Neonatal/métodos , Cuidados de Enfermagem/métodos , Pesquisa Qualitativa
11.
Pediatrics ; 142(Suppl 1): S545-S551, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30171140

RESUMO

In Norway, a national consensus-based guideline used to address thresholds for offering life support at extreme preterm birth was issued in 1998. Since then, therapeutic advances may have changed attitudes and expectations to treatment, both within the medical community and the public, and there are concerns that systematic variations in treatment practices may exist. With this article, we describe current practices and relate them to other ethical and legal comparable areas in health care. We conclude that a revision of the 1998 guideline is warranted to obtain a common understanding of prognoses and appropriate decision processes at the limit of viability.


Assuntos
Atitude do Pessoal de Saúde , Viabilidade Fetal/fisiologia , Lactente Extremamente Prematuro/fisiologia , Unidades de Terapia Intensiva Neonatal/normas , Guias de Prática Clínica como Assunto/normas , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/tendências , Noruega/epidemiologia , Taxa de Sobrevida/tendências
12.
Pediatrics ; 142(Suppl 1): S590-S592, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30171146

RESUMO

In this article, I identify 3 ways of justifying neonatal policies of when to provide life-saving treatment to infants who were born extremely premature: by appealing to universal principles or rights, to considerations of the best interests of the children, or to considerations of the best interests of the families. I go on to show how each of these justifications can be used to characterize the discourse on neonatal policies in 1 of the Scandinavian countries.


Assuntos
Política de Saúde , Cuidado do Lactente/ética , Unidades de Terapia Intensiva Neonatal/ética , Dinamarca/epidemiologia , Política de Saúde/tendências , Humanos , Cuidado do Lactente/tendências , Lactente Extremamente Prematuro/fisiologia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/tendências , Noruega/epidemiologia , Suécia/epidemiologia
13.
Pediatrics ; 142(3)2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30143568

RESUMO

BACKGROUND: Longitudinal growth curves, based on repeated measurements from the same group of infants, exist for preterm infant weight and length but not for BMI. Our existing BMI (weight divided by length squared) curves are based on cross-sectional birth data obtained from a different group of infants at each gestational age (GA). METHODS: We calculated BMI over time for 68 693 preterm infants between 24 and 36 weeks GA. Stratifying infants by sex, GA at birth, and quintiles based on birth BMI, we created longitudinal median curves using R and validated the resulting curves for empirical fit, proper classification, and normality of z scores. RESULTS: We created 2 sets of BMI growth charts. The first set displays fitted median curves for all 5 percentile groups in each GA group by sex. The second set displays fitted median curves with their corresponding third and 97th percentiles by percentile group, GA, and sex. In the validation analysis, percentage of daily observations below the median curve approximated the expected 50th percentile after the initial 3 days. Unlike the cross-sectional curves, the longitudinal curves reveal the pattern of change corresponding to nadir; postnadir, these curves remained consistently below the cross-sectional curves and varied by GA and sex as expected. The percentage of observations falling below the 50th percentile for cross-sectional curves (revealing optimal growth) was generally much higher than for longitudinal curves (revealing actual growth). CONCLUSIONS: These new longitudinal curves provide clinicians data on how premature infants' body proportionality changes over time.


Assuntos
Peso ao Nascer/fisiologia , Índice de Massa Corporal , Gráficos de Crescimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal/tendências , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Estados Unidos/epidemiologia
14.
Trans R Soc Trop Med Hyg ; 112(7): 335-341, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30010994

RESUMO

Background: The authors assessed the risk of admission and mortality at the main neonatal intensive care unit (NICU) at the National Hospital Simão Mendes (NHSM) in Guinea-Bissau. Methods: The Bandim Health Project (BHP) maintains a health and demographic surveillance system (HDSS) in the capital Bissau, including at the NHSM. Data from January 2008 to August 2013 was used to assess NICU incubator admissions and mortality. Results: The overall NICU admission rate was 4.8% (1575/33,005); the lowest rate in 2012 (4.0% (214/5293)) and the highest rate in 2009 (6.0% (369/6134)). The overall mortality among admitted children was 19.6% (289/1476), declining from 26.7% (68/255) in 2008 to 13.0% (16/123) in 2013. Birth weight <1500 g (OR=353, (95% CI: 244-510) compared with normal birth weight 2500 g-4000 g), Apgar score≤3 (OR=13.2 (9.72-18.0) compared with Apgar score 7-10) and single motherhood (OR=1.44 (1.20-1.74)) were associated with NICU admission. Low Apgar score was a risk factor for NICU mortality (OR=6.21 (2.05-18.81)) and females (OR=0.55 (0.38-0.79) had a lower mortality than males. Conclusion: Approximately 5% of the hospital-born children were admitted to an incubator and among those almost 20% died, although mortality did decline. Male sex, very low birth weight and low Apgar score were strongly associated with NICU admissions and mortality.


Assuntos
Índice de Apgar , Peso ao Nascer , Hospitalização , Hospitais Públicos , Recém-Nascido de Baixo Peso , Unidades de Terapia Intensiva Neonatal , Mortalidade Perinatal , Feminino , Guiné-Bissau/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Hospitais Públicos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/tendências , Masculino , Mães , Razão de Chances , Mortalidade Perinatal/tendências , Vigilância da População , Fatores de Risco , Fatores Sexuais , Pais Solteiros
15.
Rev Bras Enferm ; 71(suppl 3): 1281-1289, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29972525

RESUMO

OBJECTIVE: To describe and discuss the process of developing a flowchart collectively constructed by the health team of a Neonatal Intensive Care Unit for the management of neonatal pain. METHOD: This is a descriptive and an exploratory study with a qualitative approach that used Problem-Based Learning as a theoretical-methodological framework in the process of developing the assistance flowchart for the management of neonatal pain. RESULTS: Based on this methodology, there was training in service and the discussion of key points of pain management by the health team, which served as input for the construction of the flowchart. FINAL CONSIDERATIONS: The assistance flowchart for pain management, based on scientific evidence, provided means to facilitate the decision-making of the health team regarding the pain of the newborn. It is suggested to use the flowchart frequently to promote the permanent education of the team and identify possible points to be adjusted.


Assuntos
Guias como Assunto/normas , Manejo da Dor/métodos , Medição da Dor/instrumentação , Humanos , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/tendências , Dor/enfermagem , Medição da Dor/métodos , Aprendizagem Baseada em Problemas/métodos , Pesquisa Qualitativa , Desenho de Programas de Computador
16.
Br J Clin Pharmacol ; 84(6): 1313-1323, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29624207

RESUMO

AIMS: Evidence for drug use in newborns is sparse, which may cause large differences in drug prescriptions. We aimed to investigate the differences between neonatal intensive care units (NICUs) in the Netherlands in currently prescribed drugs. METHODS: This multicentre study included neonates admitted during 12 months to four different NICUs. Drugs were classified in accordance with the Anatomical Therapeutic Chemical (ATC) classification system and assessed for on/off-label status in relation to neonatal age. The treatment protocols for four common indications for drug use were compared: pain, intubation, convulsions and hypotension. RESULTS: A total of 1491 neonates (GA range 23+6 -42+2 weeks) were included with a total of 32 182 patient days, 181 different drugs and 10 895 prescriptions of which 23% was off-label in relation to neonatal age. Overall, anti-infective drugs were most frequently used with a total of 3161 prescriptions, of which 4% was off-label in relation to neonatal age. Nervous system drugs included 2500 prescriptions of which 31% was off-label in relation to neonatal age. Nervous system drugs, blood and blood forming organs, and cardiovascular drugs showed the largest differences between NICUs with ranges of 919-2278, 554-1465, and 238-952 total prescriptions per 1000 patients per ATC class, respectively. CONCLUSIONS: We showed that drug use varies widely in neonatal clinical practice. The drug classes with the highest proportion of off-label drugs in relation to neonatal age showed the largest differences between NICUs, i.e. cardiovascular and nervous system drugs. Drug research in neonates should receive high priority to guarantee safe and appropriate medicines and optimal treatment.


Assuntos
Disparidades em Assistência à Saúde/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Terapia Intensiva Neonatal/tendências , Padrões de Prática Médica/tendências , Medicamentos sob Prescrição/uso terapêutico , Consenso , Tratamento Farmacológico/tendências , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Países Baixos , Uso Off-Label , Medicamentos sob Prescrição/efeitos adversos , Estudos Retrospectivos
17.
Rev. pesqui. cuid. fundam. (Online) ; 10(1): 106-112, jan.-mar. 2018. tab
Artigo em Inglês, Português | LILACS | ID: biblio-908438

RESUMO

Objective: to analyze the arguments contained in electronic reports on the network about the use of the hammock with premature infants in NICU environment. Method: A qualitative, exploratory document study. Six electronic news were analyzed searching for information that it could describe the technique and the results about using the hammock. Results: The main benefits highlighted were weight gain, better motor and sensory development and stress reduction. The more frequently arguments based on concrete evidence were linguistic competence and authority. Conclusion: The reports reveal a favorable view of hammock usage, and pointed benefits in accordance to previous studies, however there is a need to develop studies to evidence this practice.


Objetivo: analisar os argumentos contidos nas notícias veiculadas na mídia eletrônica sobre o uso da rede em prematuros no ambiente da UTI Neonatal. Método: Estudo qualitativo, exploratório, do tipo documental. Foram analisadas seis notícias eletrônicas, buscando informações que descrevessem a técnica e os resultados do uso da rede e o tipo de argumentação utilizado. Resultados: Ganho de peso, melhor desenvolvimento motor e sensorial, redução do estresse foram os principais benefícios apontados. Argumentos mais frequentes foram de competência linguística, de autoridade, baseado em provas concretas. Conclusão: As notícias mostram uma visão favorável sobre o uso da rede, e os benefícios apontados encontram ressonância nos estudos já realizados, entretanto há necessidade de realizar estudos que gerem evidências para esta prática.


Objetivo: analizar los argumentos en los informes en los medios electrónicos a respecto del uso de la red en los bebés prematuros en el ambiente de la UCIN. Método: Estudio cualitativo, exploratorio documental. Seis notas electrónicas fueran analizadas en busca de informaciones para describir la técnica y los resultados del uso de la red y el tipo de argumento que fue utilizado. Resultados: Aumento de peso, un mejor desarrollo motor y sensorial, reducción del estrés son los principales beneficios evidenciados. Los argumentos eran con frecuencia la competencia lingüística, la autoridad, basado en pruebas concretas. Conclusión: Los informes muestran una opinión favorable del uso de la red, y los beneficios apuntados resuenan en estudios previos, sin embargo hay una necesidad de estudios para generar evidencia de esta práctica.


Assuntos
Humanos , Recém-Nascido , Comunicação em Saúde , Recém-Nascido Prematuro , Disseminação de Informação , Unidades de Terapia Intensiva Neonatal/tendências , Enfermagem Neonatal , Imprensa , Posicionamento do Paciente/métodos , Mídias Sociais , Brasil
18.
Transfusion ; 58(5): 1206-1209, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29479718

RESUMO

BACKGROUND: The objective of this study was to determine if a change in cryoprecipitate transfusion policy impacts donor exposure and fibrinogen level in a neonatal intensive care unit (NICU) population. STUDY DESIGN AND METHODS: The cryoprecipitate policy was changed from transfusing 10ml/kg to a maximum of 1 unit per transfusion in January 2013. Data were obtained via retrospective chart review of all infants receiving cryoprecipitate transfusions from January 2008 to February 2015 in the NICU at Christiana Hospital. RESULTS: A total of 103 neonates received a total of 144 cryoprecipitate transfusions. Before the policy change, term babies were more likely to be exposed to more than one donor compared to preterm babies (75% vs. 6%, p < 0.01). After the policy change, no babies were exposed to greater than one donor per transfusion and there were similar increases in posttransfusion fibrinogen level as before the policy change. CONCLUSION: Limiting cryoprecipitate transfusions to 1 unit per transfusion decreased donor exposure in infants without negatively impacting posttransfusion fibrinogen levels. This is especially evident in term neonates.


Assuntos
Transfusão de Sangue/normas , Unidades de Terapia Intensiva Neonatal/tendências , Doadores de Tecidos , Fibrinogênio/análise , Humanos , Lactente , Recém-Nascido , Políticas , Estudos Retrospectivos
19.
Rev. pesqui. cuid. fundam. (Online) ; 10(1): 106-112, jan.-mar. 2018. tab
Artigo em Inglês, Português | BDENF - Enfermagem | ID: bde-32267

RESUMO

Objective: To analyze the arguments contained in electronic reports on the network about the use of the hammock with premature infants in NICU environment. Method: A qualitative, exploratory document study. Six electronic news were analyzed searching for information that it could describe the technique and the results about using the hammock. Results: The main benefits highlighted were weight gain, better motor and sensory development and stress reduction. The more frequently arguments based on concrete evidence were linguistic competence and authority. Conclusion: The reports reveal a favorable view of hammock usage, and pointed benefits in accordance to previous studies, however there is a need to develop studies to evidence this practice.(AU)


Objetivo: Analisar os argumentos contidos nas notícias veiculadas na mídia eletrônica sobre o uso da rede em prematuros no ambiente da UTI Neonatal. Método: Estudo qualitativo, exploratório, do tipo documental. Foram analisadas seis notícias eletrônicas, buscando informações que descrevessem a técnica e os resultados do uso da rede e o tipo de argumentação utilizado. Resultados: Ganho de peso, melhor desenvolvimento motor e sensorial, redução do estresse foram os principais benefícios apontados. Argumentos mais frequentes foram de competência linguística, de autoridade, baseado em provas concretas. Conclusão: As notícias mostram uma visão favorável sobre o uso da rede, e os benefícios apontados encontram ressonância nos estudos já realizados, entretanto há necessidade de realizar estudos que gerem evidências para esta prática.(AU)


Objetivo: Analizar los argumentos en los informes en los medios electrónicos a respecto del uso de la red en los bebés prematuros en el ambiente de la UCIN. Método: Estudio cualitativo, exploratorio documental. Seis notas electrónicas fueran analizadas en busca de informaciones para describir la técnica y los resultados del uso de la red y el tipo de argumento que fue utilizado. Resultados: Aumento de peso, un mejor desarrollo motor y sensorial, reducción del estrés son los principales beneficios evidenciados. Los argumentos eran con frecuencia la competencia lingüística, la autoridad, basado en pruebas concretas. Conclusión: Los informes muestran una opinión favorable del uso de la red, y los beneficios apuntados resuenan en estudios previos, sin embargo hay una necesidad de estudios para generar evidencia de esta práctica.(AU)


Assuntos
Humanos , Recém-Nascido , Enfermagem Neonatal , Recém-Nascido Prematuro , Imprensa , Unidades de Terapia Intensiva Neonatal/tendências , Posicionamento do Paciente/métodos , Disseminação de Informação , Comunicação em Saúde , Mídias Sociais , Brasil
20.
Infant Behav Dev ; 50: 22-27, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29126078

RESUMO

OBJECTIVE: The aim of this study was to evaluate the efficacy of five-day course of sunflower oil massage with moderate pressure on the weight gain and length of NICU stay in preterm infants. METHODS: Forty-four healthy preterm infants with a corrected gestational age of 30-36 weeks at the time of the study, were randomly assigned to the study group receiving body massage with sunflower oil and the control group receiving only routine NICU care. The massage was performed three times per day, each session including three consecutive five-minute stages, for five days. The primary outcome was to evaluate the efficacy of a short course of moderate pressure sunflower oil massage on the weight gain velocity. The secondary outcome was to compare the length of NICU stay between the two groups. RESULTS: During the study period, the increase in the average daily and fifth-day weight gain was significant in the intervention group. The length of NICU stay was shorter in the intervention group significantly. CONCLUSION: Our findings suggest that even a short course of body massage with sunflower oil for only five days increases preterm infants' weight gain and decreases their duration of NICU stay significantly.


Assuntos
Recém-Nascido Prematuro/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal/tendências , Tempo de Internação/tendências , Massagem/tendências , Óleo de Girassol/administração & dosagem , Ganho de Peso/fisiologia , Método Duplo-Cego , Feminino , Humanos , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido , Masculino , Massagem/métodos , Resultado do Tratamento
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