Manual therapy for childhood respiratory disease: a systematic review.

OBJECTIVE: This study reviewed the scientific evidence available on the effects of manipulative techniques on children with respiratory diseases. METHOD: Three databases (SciELO, PEDro, and MEDLINE) were searched for clinical trials on the effects of manual therapy techniques on children and adolescents with respiratory diseases. The relevant studies were chosen by 2 independent researchers who assessed their abstracts and selected the studies that met the criteria for a complete and structured review. RESULTS: Of the 1147 relevant titles, 103 titles were selected for abstract assessment, and of these, 24 were selected for a full-text review. After critical analysis, 8 studies were included in the review and 16 were excluded for the following reasons: 1 covered only conventional therapy, 7 were not about the studied theme, and 8 included adults. Of the 8 studies included in the present review, 5 consisted of asthmatic children and the others of children with the following conditions: cystic fibrosis, bronchiolitis, recurrent respiratory infections, among others. Only 2 studies did not identify positive results with the use of manual therapy. The other 6 studies found some benefit, specifically in spirometric parameters, immunologic tests, anxiety questionnaire, or level of salivary cortisol. CONCLUSION: The use of manual techniques on children with respiratory diseases seems to be beneficial. Chiropractic, osteopathic medicine, and massage are the most common interventions. The lack of standardized procedures and limited variety of methods used evidenced the need for more studies on the subject.

Expiratory flow increase technique and acid esophageal exposure in infants born preterm with bronchopulmonary dysplasia.

OBJECTIVE: To determine if an expiratory flow increase technique (EFIT) is associated with acid reflux episodes in infants born preterm with bronchopulmonary dysplasia (BPD). METHODS: A crossover study was carried out. Eighteen subjects divided into 2 groups were randomly assigned to receive 2 EFIT sessions at 2 postprandial time points. Group 1 started 2 hours after feeding and group 2 started 3 hours after feeding. Esophageal acid exposure was assessed by the reflux index (RI) during EFIT and 20 minutes before EFIT by esophageal pH monitoring. RESULTS: A significant reduction in the RI was observed in group 1 with EFIT performed 2 hours after feeding. Group 2 showed no significant differences in RI values before and during EFIT in both postprandial periods. CONCLUSION: When EFIT is performed 2 and 3 hours after feeding, it is not associated with an increase in acid reflux episodes in infants born preterm with BPD.

Risk factors for gastroesophageal reflux disease in very low birth weight infants with bronchopulmonary dysplasia.

OBJECTIVE: To assess risk factors for gastroesophageal reflux disease (GERD) in very low birth weight infants with bronchopulmonary dysplasia. METHODS: A case-control study was carried out in 23 cases and 23 control subjects with bronchopulmonary dysplasia submitted to 24-hour esophageal pH monitoring between January 2001 and October 2005. Cases and controls were compared for gestational age, birth weight, gender, use of antenatal steroids, duration of assisted ventilation, duration of oxygen therapy, length of gastric tube use, administration of xanthines, postconceptual age, and weight at esophageal pH monitoring. Multiple logistic regression analysis was used to establish the odds ratio (OR) with a 95% confidence interval (95%CI). RESULTS: None of the groups (with and without GERD) showed statistically significant differences in terms of demographic variables and postnatal outcome, use of antenatal and postnatal corticosteroids, or in terms of caffeine use and duration of mechanical ventilation and oxygen therapy. However, feeding intolerance (OR = 6.55; 95%CI 1.05-40.8) and length of gastric tube use (OR = 1.67; 95%CI 1.11-2.51) turned out to be risk factors for GERD. Postconceptual age at the time of pH monitoring (OR = 0.02; 95%CI < 0.001-0.38) was regarded as a protective factor against GERD. CONCLUSION: The data obtained allow inferring that prolonged gastric tube use and feeding intolerance increase the risk for GERD. On the other hand, older postconceptual age at the time of pH monitoring reduces the risk for GERD in preterm infants with bronchopulmonary dysplasia weighing less than 1,500 g.

Radiological findings associated with the death of newborns with necrotizing enterocolitis.

OBJECTIVE: The aim of this study was to identify radiological and clinical risk factors for death in newborns with necrotizing enterocolitis. MATERIALS AND METHODS: This was a retrospective cohort study, based on radiological examinations and medical charts of 66 infants with necrotizing enterocolitis, as confirmed by a finding of intestinal pneumatosis (stage IIA, according to modified Bell's staging criteria). Radiological and clinical variables were evaluated. RESULTS: Of the 66 infants evaluated, 14 (21.2%) presented pneumatosis in the large and small bowel; 7 (10.6%) presented air in the portal system; and 12 (18.2%) died. Bivariate analysis revealed that the following variables were associated with death: bowel perforation; pneumatosis in the large and small bowel; air in the portal system; earlier gestational age; longer time on mechanical ventilation before the identification of pneumatosis; and longer time on mechanical ventilation before discharge or death. In the multivariate regression, the following variables remained as predictors of death: pneumatosis in the large and small intestines (odds ratio [OR] = 12.4; 95% confidence interval [95% CI] = 1.2-127.4; p = 0.035), perforation (OR = 23.2; 95% CI = 2.2-246.7; p = 0.009), and air in the portal system (OR = 69.7; 95% CI = 4.3-[not calculated]; p = 0.003). CONCLUSION: The set of factors most strongly associated with death in infants with necrotizing enterocolitis comprised extensive pneumatosis, pneumoperitoneum, and air in the portal system. Our findings confirm the importance of radiological imaging in the diagnosis and monitoring of necrotizing enterocolitis.

Follow-up of neonatal jaundice in term and late premature newborns.

OBJECTIVES: To report on the results of a project following term and near term newborn infants who were jaundiced during the neonatal period. METHODS: Neonates were referred to the follow-up clinic with weight >/= 2,000 g and/or gestational age >/= 35 weeks, and jaundice at discharge was initially assessed with an Ingram icterometer or Bilicheck and, if indicated, with a Unistat bilirubinometer (Leica). These newborn infants had bilirubinemia at or above the 40th percentile on the nomogram developed by Bhutani. All infants treated with phototherapy while in hospital were reassessed by laboratory methods 24 hours after withdrawal of treatment. Patients were rehospitalized for intensive phototherapy if their level was greater than or equal to 20 mg/dL. RESULTS: From a total sample of 11,259 neonates, 2,452 (21.8%) were referred to the follow-up clinic, 87.2% (2,140) of whom did return. Eighty returned neonates were readmitted. Return appointments were set for 2,452 patients, 180 (7.3%) of whom had bilirubinemia >/= 15 mg/dL at discharge. Of these 180, 151 returned for follow-up. Twenty (13.2%) were readmitted for treatment. Of the total number of readmitted patients, two newborn infants had levels >/= 25 mg/dL and none >/= 30 mg/dL. All responded rapidly to intensive phototherapy, and there was no need for exchange transfusions. CONCLUSIONS: Our results suggest that the regime adopted is effective for detecting and preventing hyperbilirubinemia at risk of causing bilirubin-induced encephalopathy in term and near term newborn infants.

Excessive weight loss in exclusively breastfed full-term newborns in a Baby-Friendly Hospital. / Perda de peso excessiva em recém-nascidos a termo amamentados exclusivamente ao seio materno em um Hospital Amigo da Criança.

OBJECTIVE: To determine the risk factors for weight loss over 8% in full-term newborns at postpartum discharge from a Baby Friendly Hospital. METHODS: The cases were selected from a cohort of infants belonging to a previous study. Healthy full-term newborns with birth weight ≥2.000g, who were exclusively breastfed, and excluding twins and those undergoing phototherapy as well as those discharged after 96 hours of life, were included. The analyzed maternal variables were maternal age, parity, ethnicity, type of delivery, maternal diabetes, gender, gestational age and appropriate weight for age. Adjusted multiple and univariate Cox regression analyses were used, considering as significant p<0.05. RESULTS: We studied 414 newborns, of whom 107 (25.8%) had excessive weight loss. Through the univariate regression, risk factors associated with weight loss >8% were caesarean delivery and older maternal age. At the adjusted multiple regression analysis, the model to explain the weight loss was cesarean delivery (relative risk: 2.27 and 95% of confidence interval: 1.54 to 3.35). CONCLUSIONS: The independent predictor for weight loss >8% in exclusively breastfed full-term newborns in a Baby-Friendly Hospital was the cesarean delivery. It is possible to reduce the number of cesarean sections to minimize neonatal excessive weight loss and the resulting use of infant formula during the first week of life.

Application of tactile/kinesthetic stimulation in preterm infants: a systematic review.

OBJECTIVE: To verify the methods used by the clinical trials that assessed the effect of tactile/kinesthetic stimulation on weight gain in preterm infants and highlight the similarities and differences among such studies. SOURCES: This review collected studies from two databases, PEDro and PubMed, in July of 2014, in addition to bibliographies. Two researchers assessed the relevant titles independently, and then chose which studies to read in full and include in this review by consensus. Clinical trials that studied tactile stimulation or massage therapy whether or not associated with kinesthetic stimulation of preterm infants; that assessed weight gain after the intervention; that had a control group and were composed in English, Portuguese, or Spanish were included. SUMMARY OF THE FINDINGS: A total of 520 titles were found and 108 were selected for manuscript reading. Repeated studies were excluded, resulting in 40 different studies. Of these, 31 met all the inclusion criteria. There were many differences in the application of tactile/kinesthetic stimulation techniques among studies, which hindered the accurate reproduction of the procedure. Also, many studies did not describe the adverse events that occurred during stimulation, the course of action taken when such events occurred, and their effect on the outcome. CONCLUSIONS: These studies made a relevant contribution towards indicating tactile/kinesthetic stimulation as a promising tool. Nevertheless, there was no standard for application among them. Future studies should raise the level of methodological rigor and describe the adverse events. This may permit other researchers to be more aware of expected outcomes, and a standard technique could be established.

[The influence of the supine and prone positions in the esophageal pH monitoring in very low birth weight infants]. / Influência dos decúbitos dorsal e ventral na monitorização do pH esofágico em recém-nascidos de muito baixo peso.

BACKGROUND: Scarce information is available on the effects of body's positioning in the number and the duration of gastroesophageal reflux episodes in very low birth weight infants. AIM: To evaluate the influence of prone compared to supine positions on the frequency and duration of acid gastroesophageal reflux episodes in very low birth weight infants and study the role of body position in the occurrence of exams with reflux index > or = 5% and > or = 10%. METHODS: Sixty one prolonged esophageal pH monitoring exams were retrospectively analyzed. The difference between the prone and supine position exam duration was not longer than 3 hours. The reflux index was evaluated for the total period of the exam (reflux index total) and for each period in the two positions. The total number of reflux episodes, the number of reflux episodes > 5 minutes and the longest reflux episode were evaluated for each period in the two positions. These parameters were compared in accordance with body positioning, for each one of the three reflux index total categories: reflux index total < 5%, > or = 5% and > or = 10%. The frequencies of exams with reflux index total > or = 5% and reflux index total > or = 10% were compared for both positions. RESULTS: The number of hours in prone (11.2 +/- 1.0) and in supine (11.2 +/- 1.1) position were not different. All the prone positions monitoring parameters were significantly lower than the supine ones, in the three reflux index total categories. In the supine position, 32.7% (20/61) and 27.8% (17/61) of the exams, which were normal in prone, became abnormal, taking into account reflux index > or = 5% and > or = 10%, respectively, obtained for each position. CONCLUSIONS: In prone position, there is a significant decrease in number and duration of acid reflux episodes in very low birth weight infants. Supine position promotes a significant increase in the number of esophageal pH monitoring exams with reflux index > or = 5% and > or = 10%, making easier the diagnose of the gastroesophageal reflux disease.

Radiological findings associated with the death of newborns with necrotizing enterocolitis / Achados radiológicos associados ao óbito de recém-nascidos com enterocolite necrosante

Abstract Objective: The aim of this study was to identify radiological and clinical risk factors for death in newborns with necrotizing enterocolitis. Materials and Methods: This was a retrospective cohort study, based on radiological examinations and medical charts of 66 infants with necrotizing enterocolitis, as confirmed by a finding of intestinal pneumatosis (stage IIA, according to modified Bell's staging criteria). Radiological and clinical variables were evaluated. Results: Of the 66 infants evaluated, 14 (21.2%) presented pneumatosis in the large and small bowel; 7 (10.6%) presented air in the portal system; and 12 (18.2%) died. Bivariate analysis revealed that the following variables were associated with death: bowel perforation; pneumatosis in the large and small bowel; air in the portal system; earlier gestational age; longer time on mechanical ventilation before the identification of pneumatosis; and longer time on mechanical ventilation before discharge or death. In the multivariate regression, the following variables remained as predictors of death: pneumatosis in the large and small intestines (odds ratio [OR] = 12.4; 95% confidence interval [95% CI] = 1.2-127.4; p = 0.035), perforation (OR = 23.2; 95% CI = 2.2-246.7; p = 0.009), and air in the portal system (OR = 69.7; 95% CI = 4.3-[not calculated]; p = 0.003). Conclusion: The set of factors most strongly associated with death in infants with necrotizing enterocolitis comprised extensive pneumatosis, pneumoperitoneum, and air in the portal system. Our findings confirm the importance of radiological imaging in the diagnosis and monitoring of necrotizing enterocolitis.

Resumo Objetivo: Determinar fatores de risco radiológicos e clínicos para o desfecho de óbito em recém-nascidos com enterocolite necrosante. Materiais e Métodos: Estudo de coorte retrospectivo de exames radiológicos e prontuários de 66 recém-nascidos com enterocolite necrosante confirmada pela presença de pneumatose intestinal (estágio IIA, segundo os critérios modificados de Bell). Foram estudados achados radiológicos e variáveis clínicas. Resultados: Catorze casos (21,2%) apresentaram pneumatose nos intestinos grosso e delgado, 7 (10,6%) apresentaram ar no sistema porta e 12 (18,2%) faleceram. As análises bivariadas indicaram que as variáveis significativas para o óbito foram: perfuração intestinal, pneumatose localizada nos intestinos grosso e delgado, ar no sistema porta, menor idade gestacional, longos períodos de ventilação mecânica até a identificação da pneumatose e longos períodos de ventilação mecânica até a data de alta/óbito. Na regressão multivariada, mantiveram-se como preditores do óbito: pneumatose localizada nos intestinos grosso e delgado (odds ratio [OR] = 12,4; intervalo de confiança de 95% [IC 95%] = 1,2-127,4; p = 0,035), perfuração (OR = 23,2; IC 95% = 2,2-246,7; p = 0,009) e ar no sistema porta (OR = 69,7; IC 95% = 4,3-não calculado; p = 0,003). Conclusão: Pneumatose extensa, pneumoperitônio e ar no sistema porta compuseram o melhor conjunto de fatores associados ao óbito. Esses achados corroboram a importância da radiografia simples de abdome no diagnóstico e acompanhamento da enterocolite necrosante.

Excessive weight loss in exclusively breastfed full-term newborns in a Baby-Friendly Hospital / Perda de peso excessiva em recém-nascidos a termo amamentados exclusivamente ao seio materno em um Hospital Amigo da Criança

OBJECTIVE: To determine the risk factors for weight loss over 8% in full-term newborns at postpartum discharge from a Baby Friendly Hospital. METHODS: The cases were selected from a cohort of infants belonging to a previous study. Healthy full-term newborns with birth weight 2.000g, who were exclusively breastfed were included and excluded twins and those undergoing phototherapy as well as those discharged after 96h of life. The analyzed maternal and neonatal variables were maternal age, parity, ethnicity, type of delivery, maternal diabetes, gender, gestational age and appropriate weight for age. Adjusted multiple and univariate Cox regression analyses were used, considering as significant p<0.05. RESULTS: We studied 414 newborns, of whom 107 (25.8%) had excessive weight loss. Through the univariate regression, risk factors associated with weight loss>8% were cesarean delivery and older maternal age. At the adjusted multiple regression analysis, the model to explain the weight loss was cesarean delivery (Relative risk 2.27, 95% of Confidence Interval 1.54-3.35). CONCLUSIONS: The independent predictor for weight loss in exclusively breastfed full-term newborns in a Baby-Friendly Hospital was the cesarean delivery. It is possible to reduce the number of cesarean sections to minimize neonatal excessive weight loss and the resulting use of infant formula during the first week of life.

OBJETIVO: Determinar os fatores de risco para perda de peso acima de 8% em recém-nascido a termo por ocasião da alta pós-parto de um Hospital Amigo da Criança. MÉTODOS: Os casos foram selecionados de uma coorte de recém-nascido, pertencentes a um estudo prévio. Foram incluídos recém-nascidos a termo com peso ao nascer ≥2.000g, saudáveis e amamentados exclusivamente, excluídos os gemelares, os recém-nascidos que usaram fototerapia e aqueles com alta hospitalar após 96 horas de vida. As variáveis maternas e neonatais estudadas foram idade materna, paridade, raça, tipo de parto, diabete materna, sexo, idade gestacional e adequação do peso para idade. Foram usadas as análises de regressão de Cox univariada e múltipla ajustadas e foi considerado significativo p<0,05. RESULTADOS: Foram estudados 414 recém-nascidos dos quais 107 (25,8%) tiveram perda excessiva de peso. Pela regressão univariada, os fatores de risco associados à perda de peso >8% foram parto cesárea e maior idade materna. Pela análise de regressão múltipla ajustada, o modelo para explicar a perda de peso foi o parto cesárea (Risco Relativo: 2,27 e Intervalo de Confiança 95%: 1,54-3,35). CONCLUSÕES: O preditor independente para perda de peso maior do que 8% em recém-nascidos a termo amamentados exclusivamente em um Hospital Amigo da Criança foi a cesárea. É possível que a redução do número de cesáreas possa minimizar a perda de peso neonatal excessiva e o consequente uso de fórmula láctea na primeira semana de vida.

Systematic follow-up of hyperbilirubinemia in neonates with a gestational age of 35 to 37 weeks.

OBJECTIVES: To determine the outcomes of an intervention for follow-up of bilirubinemia in the first week of life in a cohort of newborn infants with gestational ages between 35 0/7 and 37 6/7 weeks and to determine risk factors for readmission for phototherapy (total bilirubin > 18 mg/dL). METHODS: Retrospective cohort study carried out at a public teaching hospital. Neonates underwent periodic monitoring of total bilirubin levels (measured in plasma or by transcutaneous device) before and after discharge to assess the need for phototherapy. A systematic approach, based on risk percentiles of a bilirubin reference curve, was employed. RESULTS: The study sample comprised 392 neonates. Only one outpatient visit was required in 61.7% of newborns. Peak total bilirubin was ≥ 20 mg/dL in 34 neonates (8.7%), and reached 25-30 mg/dL in three (0.8%). Phototherapy was indicated after discharge in 74 neonates (18.9%). Weight loss between birth and first follow-up visit and total bilirubin above the 40th percentile at discharge were risk factors for requiring phototherapy. Total bilirubin above the 95th percentile at discharge was associated with greater risk of readmission (RR = 49.5 [6.6-370.3]). Weight loss between discharge and first follow-up visit was the sole independent clinical predictor (RR = 1.16 [1.04-1.17]). CONCLUSION: Systematic follow-up during the first week of life was effective in preventing dangerous hyperbilirubinemia. Encouraging breastfeeding and discharging neonates only after weight loss has been stabilized may prevent readmission due to hyperbilirubinemia.

Application of tactile/kinesthetic stimulation in preterm infants: a systematic review / Aplicação da estimulação tátil-cinestésica em neonatos prematuros: análise sistemática

OBJECTIVE: To verify the methods used by the clinical trials that assessed the effect of tactile/kinesthetic stimulation on weight gain in preterm infants and highlight the similarities and differences among such studies. SOURCES: This review collected studies from two databases, PEDro and PubMed, in July of 2014, in addition to bibliographies. Two researchers assessed the relevant titles independently, and then chose which studies to read in full and include in this review by consensus. Clinical trials that studied tactile stimulation or massage therapy whether or not associated with kinesthetic stimulation of preterm infants; that assessed weight gain after the intervention; that had a control group and were composed in English, Portuguese, or Spanish were included. SUMMARY OF THE FINDINGS: A total of 520 titles were found and 108 were selected for manuscript reading. Repeated studies were excluded, resulting in 40 different studies. Of these, 31 met all the inclusion criteria. There were many differences in the application of tactile/kinesthetic stimulation techniques among studies, which hindered the accurate reproduction of the procedure. Also, many studies did not describe the adverse events that occurred during stimulation, the course of action taken when such events occurred, and their effect on the outcome. CONCLUSIONS: These studies made a relevant contribution towards indicating tactile/kinesthetic stimulation as a promising tool. Nevertheless, there was no standard for application among them. Future studies should raise the level of methodological rigor and describe the adverse events. This may permit other researchers to be more aware of expected outcomes, and a standard technique could be established. .

OBJETIVO: Verificar quais metodologias foram usadas por ensaios clínicos que avaliaram o efeito da estimulação tátil-cinestésica sobre o ganho de peso de neonatos prematuros e destacar as diferenças e semelhanças entre esses estudos. FONTES DOS DADOS: Esta análise coletou estudos de duas bases de dados, Pedro e PubMed, em julho de 2014, além de bibliografias. Dois pesquisadores avaliaram os títulos relevantes independentemente e, então, escolheram consensualmente quais estudos seriam lidos completamente e incluídos nesta análise. Foram incluídos os ensaios clínicos que estudaram a estimulação tátil ou a massagem terapêutica associada ou não à estimulação cinestésica em neonatos prematuros e avaliaram o ganho de peso após a intervenção, tiveram um grupo de controle e foram escritos em inglês, português ou espanhol. SÍNTESE DOS DADOS: Foram encontrados 520 títulos e foram selecionados 108 para leitura. Os estudos repetidos foram excluídos, o que resultou em 40. Desses, 31 atenderam a todos os critérios de inclusão. Há muitas diferenças na aplicação das técnicas de estimulação tátil-cinestésica entre os estudos, o que prejudica a reprodução precisa do procedimento. Além disso, muitos estudos não descreviam os eventos adversos ocorridos durante a estimulação, o procedimento feito quando esses eventos ocorriam e seu efeito sobre o resultado. CONCLUSÕES: Esses estudos fizeram uma contribuição relevante ao incluir a estimulação tátil-cinestésica como uma ferramenta promissora. Contudo, não houve padrão de aplicação entre eles. Estudos futuros podem aumentar o nível do rigor metodológico e descrever os eventos adversos. Isso pode permitir que outros pesquisadores tenham mais ciência do que esperar e assim estabelecer uma técnica padrão. .

Incidence and risk factors of accidental extubation in a neonatal intensive care unit.

OBJECTIVE: To determine the incidence and risk factors of accidental extubation (AE) in a tertiary neonatal intensive care unit. METHODS: A prospective cohort study was conducted to determine AE incidence density per 100 patient-days, during a 23-month period, in 222 newborns receiving assisted ventilation (AV). Logistic regression analysis was used to determine risk factors for AE. The presence of a cyclical pattern in extubation rates, according to the variables of interest, was investigated by Cosinor analysis. RESULTS: The mean AE rate was 5.34/100 patient-days ventilated. AE-associated predictive variables were: subsequent use of the oral and nasal routes during AV [relative risk (RR) = 4.73; 95% confidence interval (95%CI) 1.92-11.60], AV duration (per day, RR = 1.03; 95%CI 1.02-1.04), and number of patient-days ventilated (RR = 1.01; 95%CI 1.01-1.02). According to the adjusted multiple regression analysis, total AV time was the only independent predictor of AE in this sample (RR = 1.02; 95%CI 1.01-1.03). AV time of 10.5 days showed an accuracy of 0.79 (95%CI 0.71-0.87) for the occurrence of AE. Cosinor analysis showed significant periodicity in overall AE rate and in the number of patient-days ventilated. There was a significant correlation between the number of patient-days ventilated and AE frequency. CONCLUSION: Mean AE density was 5.34/100 patient-days ventilated. AV duration was the only independent predictor of AE. The best accuracy for AE occurrence was achieved at 10.5 days of AV duration.

Cateteres umbilicais em recém-nascidos: indicações, complicações e diagnóstico por imagem / Umbilical catheters in newborns: indications, complications and imaging diagnosis

Objetivos: Revisar os últimos dados de literatura acerca do cateterismo umbilical quanto a indicações, complicações e diagnóstico de sua localização através de exames de imagem.Métodos: Foram pesquisados artigos nas bases de dados PubMed, SciELO e LILACS, através dos seguintes descritores, assim como dos termos correspondentes em inglês: cateteres umbilicais; exame radiológico; ultrassonografia; recém-nascido; e cuidados intensivos neonatais. Foram incluídos também livros texto clássicos em literatura neonatal.Resultados: Foram selecionados 51 artigos, quatro livros texto e um manual versando sobre cateteres umbilicais venosos e arteriais em recém-nascidos. Revisamos indicações, novas técnicas de inserção, complicações associadas, fatores de risco e diagnóstico por imagem, com ênfase nas referências anatômicas utilizadas para o diagnóstico da posição da extremidade do cateter.Conclusões: O cateterismo umbilical representa um importante acesso à corrente sanguínea do recém-nascido e o diagnóstico por imagem desempenha um papel fundamental na avaliação correta do seu posicionamento, possibilitando, em caso de mau posicionamento, a conduta imediata para prevenção de complicações.

Aims: To review the latest literature on umbilical catheterization including its indications, complications, and diagnostic imaging for verification of catheter position.Methods: The PubMed, SciELO, and LILACS databases were searched using the following keywords and the corresponding terms in Portuguese: umbilical catheters; radiological examination; ultrasonography; newborn; and neonatal intensive care. Classic textbooks on neonatology were also reviewed.Results: A total of 51 articles, four classic textbooks, and one manual dealing with venous and arterial umbilical catheterization in neonates were selected. We reviewed the indications, new insertion techniques, complications, risk factors and, diagnostic imaging, with emphasis on the anatomic landmarks used for determination of catheter tip position.Conclusions: Umbilical catheterization is an important access to the bloodstream of the newborn, and diagnostic imaging plays a key role in the assessment of catheter tip position, thus enabling immediate management and preventing complications in cases of misplacement.

Presence of air in the hepatic portal system in association with umbilical venous catheter malposition / Presença de ar no sistema porta hepático associada a cateter umbilical venoso mal posicionado

The authors report a case of umbilical venous catheter malposition with air in the portal venous system in a preterm neonate. Initially, the hypothesis of necrotizing enterocolitis was considered, but the newborn progressed with no finding of disease and the air disappeared at follow-up radiography. The differential diagnosis of such a finding can avoid unnecessary clinical treatments.

Apresentamos um caso relacionado a cateter umbilical venoso mal posicionado, associado à presença de ar no sistema portal, em um recém-nascido prematuro. A hipótese de enterocolite necrosante foi considerada inicialmente, porém o recém-nascido evoluiu sem achados da doença, tendo o ar desaparecido em radiografia de controle. O diagnóstico diferencial deste achado evita condutas clínicas desnecessárias.

Clinical predictors of abnormal esophageal pH monitoring in preterm infants.

BACKGROUND: Risk factors for gastroesophageal reflux disease in preterm neonates have not been yet clearly defined. AIM: To identify factors associated with increased esophageal acid exposition in preterm infants during the stay in the neonatal unit. METHODS: A case-control study in preterm infants who had undergone prolonged monitoring of distal esophageal pH, following clinical indication. Eighty-seven preterms with reflux index (percentage of total time of esophageal pHmetry) > or = 10% (cases) and 87 unpaired preterms were selected with reflux index <10% (controls). Demographic variables, signs and symptoms, main diagnoses and some aspects of treatment were studied. Simple and multiple logistic regression analysis adjusted for birthweight and postconceptional age at the pH study were used. RESULTS: The factors associated with a greater chance of reflux index > or = 10% in preterms were: vomiting, regurgitation, Apnea, female gender. The variables that were associated with a lower frequency of increased reflux index were: volume of enteral intake at the onset of symptoms > or = 147 mL/kg/day, and postnatal corticoid use. CONCLUSIONS: Vomiting, regurgitation, apnea, female gender and acute respiratory distress during the first week of life were variables predictive of increased esophageal acid exposition in preterm infants with birthweight <2000 g. Bronchopulmonary dysplasia and use of caffeine were not associated with reflux index > or = 10%.

Acompanhamento sistematizado da hiperbilirrubinemia em recém-nascidos com 35 a 37 semanas de idade gestacional / Systematic follow-up of hyperbilirubinemia in neonates with a gestational age of 35 to 37 weeks

Objetivos: Identificar os resultados do acompanhamento da bilirrubinemia na primeira semana de vida em uma coorte de recém-nascidos (RNs) de 350/7 a 376/7 semanas de idade gestacional e estabelecer fatores de risco para reinternação para fototerapia pós-alta hospitalar (bilirrubinemia total > 18 mg/dL). Métodos: Estudo de coorte retrospectivo em hospital público universitário. Os recém-nascidos tiveram acompanhamento da bilirrubina total plasmática ou transcutânea pré- e pós-alta da enfermaria de alojamento conjunto para avaliação da necessidade de fototerapia. Foi empregada uma abordagem sistematizada, utilizando-se os percentis de risco de uma curva de referência. Resultados: Foram estudados 392 RNs. Uma consulta ambulatorial foi necessáriaem 61,7% dos RNs. Tiveram valores máximos de bilirrubinemia total ≥ 20 mg/dL 34 RNs (8,7%), e três RNs (0,8%) apresentaram bilirrubinemia total entre 25-30 mg/dL. Fototerapia foi indicada após alta em 74 RNs (18,9%). Os fatores de risco foram a perda de peso do nascimento até o primeiro retorno e os percentis à alta acima do P40. A bilirrubinemia total à alta acima do P95 foi associada ao maior risco de reinternação [RR = 49,5 (6,6-370,3)]. A perda de peso até o primeiro retorno foi o único preditor clínico independente [RR = 1,16 (1,04-1,17)]. Conclusão: A abordagem sistematizada da bilirrubinemia na 1ª semana foi efetiva na prevenção de hiperbilirrubinemias perigosas. O suporte à amamentação e a alta hospitalar após a estabilização da perda de peso podem ser medidas preventivas da reinternação por hiperbilirrubinemia.

Objectives: To determine the outcomes of an intervention for follow-up of bilirubinemia in the first week of life in a cohort of newborn infants with gestational ages between 350/7 and 376/7 weeks and to determine risk factors for re-admission for phototherapy (total bilirubin > 18 mg/dL). Methods: Retrospective cohort study carried out at a public teaching hospital. Neonates underwent periodic monitoring of total bilirubin levels (measured in plasma or by transcutaneous device) before and after discharge to assess the need for phototherapy. A systematic approach, based on risk percentiles of a bilirubin reference curve, was employed. Results: The study sample comprised 392 neonates. Only one outpatient visit was required in 61.7% of newborns. Peak total bilirubin was ≥ 20 mg/dL in 34 neonates (8.7%), andreached 25-30 mg/dL in three (0.8%). Phototherapy was indicated after discharge in 74 neonates (18.9%). Weight loss between birth and first follow-up visit and total bilirubin above the 40th percentile at discharge were risk factors for requiring phototherapy. Total bilirubin above the 95th percentile at discharge was associated with greater risk of readmission (RR = 49.5 [6.6-370.3]). Weight loss between discharge and first follow-up visit was the sole independent clinical predictor (RR =1.16 [1.04-1.17]). Conclusion: Systematic follow-up during the first week of life was effective in preventing dangerous hyperbilirubinemia. Encouraging breast feeding and discharging neonates only after weight loss has been stabilized may prevent readmission due to hyperbilirubinemia.