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1.
Hippocampus ; 24(4): 415-23, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24339278

RESUMO

Neonatal noxious stimulation has been proposed to model pain triggered by diagnostic/therapeutic invasive procedures in premature infants. Previous studies have shown that hippocampal neurogenesis rate and the behavioral repertoire of adult rats may be altered by neonatal noxious stimuli. The purpose of this study was to evaluate whether noxious stimulation during neonatal period alters the nociceptive response and dentate gyrus neurogenesis when compared to rats subjected to a single noxious stimulus in late infancy. Plasma corticosterone and hippocampal brain-derived neurotrophic factor (BDNF) levels were measured. Neurogenesis in the dentate gyrus was evaluated in adolescent rats (postnatal day 40; P40) exposed twice to intra-plantar injections of Complete Freund's adjuvant (CFA) on P1 and P21 (group P1P21) or P8 and P21 (P8P21) or exposed once on P21 (pubertal). On P21, one subset of animals received 5-bromo-2'-deoxyuridine (BrdU) and was euthanized on P40 for identification of proliferating cells in the dentate gyrus. Another subset was sampled for thermal response or plasma corticosterone measurement and hippocampal BDNF levels. Proliferative cell rate in dentate gyrus was the highest in all re-exposed groups (P < 0.001), except for P8 females (P8P21F), revealing also a sex difference, where P8P21 males showed higher rate than females (P < 0.001). Stimulated groups took longer than CTL animals to lick the paws (P < 0.001), regardless of the age when the noxious stimulus was applied. Re-exposed groups had lower corticosterone plasma level (P1P21 M and F, P8P21M) than controls. On the contrary, hippocampal BDNF was increased in males from both re-exposed groups. These results show that infant noxious stimulation in neonatally previously stimulated rats is related to high proliferation in the DG and this association seems to be modified by the animal's sex. The new generated dentate granule cells in the hippocampus may have a role in the long-term behavioral responses to neonatal nociceptive stimulation. Noxious stimulation in the neonatal period results in sex-dependent neurogenic response.


Assuntos
Fator Neurotrófico Derivado do Encéfalo/metabolismo , Giro Denteado/fisiologia , Hipocampo/fisiologia , Neurogênese/fisiologia , Neurônios/fisiologia , Nociceptividade/fisiologia , Animais , Animais Recém-Nascidos , Corticosterona/sangue , Giro Denteado/crescimento & desenvolvimento , Feminino , Adjuvante de Freund , Hipocampo/crescimento & desenvolvimento , Masculino , Distribuição Aleatória , Ratos , Ratos Wistar , Fatores Sexuais
2.
Vox Sang ; 104(3): 207-13, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23046429

RESUMO

BACKGROUND AND OBJECTIVES: Platelet transfusions are performed almost entirely according to expert experience. This study assessed the effectiveness of a restrictive guideline to reduce platelet transfusions in preterm infants. METHODS: A retrospective cohort of preterm infants with a birth weight of <1500 g had been born in 2 periods. In Period 1, a transfusion was indicated for a platelet count of <50,000/ml in clinically stable neonates or <100,000/ml in bleeding or clinically unstable infants. In Period 2, the indications were restricted to <25,000/ml in clinically stable neonates, or <50,000/ml in newborns who were either on mechanical ventilation, subject to imminent invasive procedures, within 72 h following a seizure, or extremely premature and <7 days old. A count of <100,000/ml was indicated for bleeding or major surgery. RESULTS: Periods 1 and 2 comprised 121 and 134 neonates, respectively. The rates of ventricular haemorrhage and intrahospital death were similar in both periods. The percentage of transfused infants, the odds of receiving a platelet transfusion, the mean platelet count before transfusion and the percentage of transfusions with a platelet count >50,000/ml were greater in Period 1. Among thrombocytopenic neonates, the percentage of transfused neonates and the number of transfusions were similar in both groups. CONCLUSION: The restrictive guideline for platelet transfusions reduced the platelet count thresholds for neonatal transfusions without increasing the rate of ventricular haemorrhage.


Assuntos
Contagem de Plaquetas/normas , Transfusão de Plaquetas/normas , Guias de Prática Clínica como Assunto , Plaquetas , Peso Corporal , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Terapia Intensiva Neonatal/organização & administração , Masculino , Projetos Piloto , Transfusão de Plaquetas/métodos , Respiração Artificial , Estudos Retrospectivos , Convulsões/terapia , Fatores de Tempo
3.
Vox Sang ; 95(2): 106-11, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18544122

RESUMO

BACKGROUND AND OBJECTIVES: Benefits of adopting restrictive guidelines for erythrocyte transfusions are still controversial. The objective of this study was to verify if a very strict guideline could reduce erythrocyte transfusions in preterm infants without adverse outcomes. MATERIALS AND METHODS: Two prospective cohorts of neonates with gestational age < 37 weeks and birth weight < 1500 g were studied. Neonates born in Period 1 were submitted to a strict guideline for erythrocyte transfusions. In Period 2, a new stricter protocol was introduced. Infants of both periods were compared regarding number of transfusions and clinical outcome. RESULTS: The median number of transfusions decreased from 2 (1 to 14) in Period 1 to 1 (1-9), P = 0.001, in Period 2. The linear regression multivariate analysis showed that the implementation of the stricter guideline was associated with a reduction in the number of transfusions received by patients by 0.55 (95% confidence interval: -0.08; -1.02) units/patients. Number of apnea episodes, weight at 28 days of life and days of hospital stay were similar in both periods. Intra-hospital death was lower in Period 2. CONCLUSION: A very strict guideline reduced the number of erythrocyte transfusions in preterm infants, without threatening their clinical course.


Assuntos
Transfusão de Eritrócitos/estatística & dados numéricos , Fidelidade a Diretrizes , Doenças do Prematuro/terapia , Guias de Prática Clínica como Assunto , Apneia/epidemiologia , Hemorragia Cerebral/epidemiologia , Estudos de Coortes , Transfusão de Eritrócitos/normas , Feminino , Idade Gestacional , Hematócrito , Mortalidade Hospitalar , Humanos , Hipóxia/epidemiologia , Hipóxia/prevenção & controle , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/prevenção & controle , Recém-Nascido Pequeno para a Idade Gestacional , Recém-Nascido de muito Baixo Peso , Tempo de Internação/estatística & dados numéricos , Masculino , Flebotomia/efeitos adversos , Respiração com Pressão Positiva/estatística & dados numéricos , Estudos Prospectivos
4.
J Perinatol ; 27(12): 761-5, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18034164

RESUMO

OBJECTIVE: Evaluate the need for resuscitative procedures at birth, in late prematures. STUDY DESIGN: This prospective cohort study enrolled all liveborn infants from 1 to 30 September 2003, with 34 to 41 weeks of gestation without congenital anomalies, born in 35 public hospitals of 20 Brazilian state capitals. Logistic regression analyzed variables associated with the need for bag and mask ventilation. RESULT: Of the 10 774 infants studied, 1054 were late preterms and 485 required resuscitative measures. Of the 1054, 338 (32%) received only free-flow oxygen, 143 (14%) were bag and mask ventilated, 27 (3%) were intubated and 10/27 received chest compressions and/or medications. Bag and mask ventilation in late preterms was associated with twin gestation, maternal hypertension, nonvertex presentation, cesarean delivery and lower gestational age. CONCLUSION: Improving control of maternal hypertension, prolonging gestation for 1 to 2 weeks and restricting operative deliveries could decrease the need of resuscitation of late preterms at birth.


Assuntos
Recém-Nascido Prematuro , Nascimento Prematuro , Ressuscitação/métodos , Adolescente , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos
5.
J Perinatol ; 35(11): 954-7, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26378913

RESUMO

OBJECTIVE: The objective of this study was to assess the frequency of early deaths associated with birth asphyxia of very low birth weight infants between 2005 and 2010, in Brazil. STUDY DESIGN: This population study enrolled all live births with birth weight from 400 to 1499 g, gestational age ⩾ 22 weeks, without malformations that died up to 6 days after birth with perinatal asphyxia. Asphyxia was defined if intrauterine hypoxia, asphyxia at birth or meconium aspiration syndrome were written in any line of the death certificate. Active search was carried out in 27 Brazilian federative units. RESULT: For every 1000 live births of very low birth weight infants without congenital malformations, 40.25 and 32.38 died with birth asphyxia in the first week after birth, respectively, in 2005 and 2010 (P<0.001). The contribution of birth asphyxia to early neonatal death of these infants was approximately 10 to 12% all study years. CONCLUSION: Reduction of birth asphyxia in very low birth weight infants is essential to reducing neonatal mortality in Brazil.


Assuntos
Asfixia Neonatal/mortalidade , Causas de Morte , Recém-Nascido de muito Baixo Peso , Mortalidade Perinatal/tendências , Brasil/epidemiologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Medição de Risco
6.
Pain ; 85(1-2): 127-33, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10692611

RESUMO

The study of neonatal gender differences in pain expression is important since neonatal pain behavior occurs prior to any learned reaction pattern. The objective of this study was to verify the presence of gender differences in pain expression in preterm and term newborn infants. Sixty-five consecutive neonates (37 female and 28 male infants) with gestational age between 28 and 42 weeks and with 25-120 h of life were studied. Healthy term neonates required a capillary puncture for PKU screening and clinically stable premature infants needed a capillary puncture for glucose dosage. The Neonatal Facial Coding System (NFCS) and the Neonatal Infant Pain Scale (NIPS) were evaluated at bedside prior to the puncture, when patients were at rest, during foot heating; during capillary puncture; and at 1, 3, and 5 min after heel lancing. Results were analyzed by repeated-measures ANOVA followed by the Multiple Comparison Method of Bonferroni. A significant difference among the mean NFCS scores during the six study periods was noted for the whole group of neonates (P<0.000001). Also, a significant interaction between the NFCS score profile in female and male neonates at the different study periods was observed (P=0.025). Regarding NIPS, ANOVA showed only a significant difference among the mean NIPS scores during the six study periods for the whole group of neonates (P<0.000001). No significant interactions between gestational age and time, nor between gestational age and gender were noted, for both NFCS and NIPS. In conclusion, recently born female neonates of all gestational ages expressed more facial features of pain than male infants, during the capillary puncture and 1 min afterwards. Maybe differences in pain processing and/or pain expression among genders may explain this finding.


Assuntos
Comportamento do Lactente/psicologia , Recém-Nascido/psicologia , Dor/psicologia , Expressão Facial , Feminino , Humanos , Recém-Nascido Prematuro/psicologia , Masculino , Medição da Dor , Caracteres Sexuais
7.
Arch Pediatr Adolesc Med ; 154(10): 1009-16, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11030853

RESUMO

OBJECTIVE: To determine whether adults can recognize neonatal facial expression of pain. DESIGN: A cross-sectional study. SETTING: Neonatal intensive care unit, nursery, and outpatient clinic of one university hospital and one private hospital in São Paulo, Brazil. PATIENTS: Four hundred five adults divided into 2 groups: health and nonhealth professionals. INTERVENTION: The faces of 3 healthy full-term newborns who needed glucose screening were photographed at rest and during light exposure, heel rubbing, and heel puncture. A series of adults answered a questionnaire on personal and professional data and then they analyzed for 1 minute each of the 3 sets of pictures to answer the following question: "In which picture of this set do you think that the baby is feeling pain?" MAIN OUTCOME MEASURE: Number of correct answers for the 3 sets of photographs shown to the adults. RESULTS: Seventy-four percent of the health professionals and 86% of the nonhealth professionals indicated correctly the picture with facial expressions of pain in at least 2 of the 3 sets. Regarding which picture was picked out by the interviewee, 94% of the health professionals and 92% of the nonhealth professionals indicated the picture taken during the heel puncture in set 1. The same observation was made by 53% and 54% of the health professional and by 68% and 66% of the nonhealth professional interviewees for sets 2 and 3, respectively. CONCLUSIONS: Facial expression of pain represents an effective neonatal communication tool. However, the health professional group achieved a lower level of recognition of neonatal facial expressions of pain. Factors related to the personal and professional characteristics of the adults interviewed probably contributed to this result.


Assuntos
Expressão Facial , Recém-Nascido/fisiologia , Medição da Dor/métodos , Dor/diagnóstico , Dor/fisiopatologia , Pais/psicologia , Recursos Humanos em Hospital/psicologia , Adulto , Estudos Transversais , Sinais (Psicologia) , Feminino , Humanos , Recém-Nascido/psicologia , Modelos Lineares , Masculino , Variações Dependentes do Observador , Dor/psicologia , Fotografação , Inquéritos e Questionários
8.
Sao Paulo Med J ; 117(2): 72-80, 1999 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-10488604

RESUMO

CONTEXT: The subjectivity of pain causes enormous difficulties in evaluating neonatal pain with a single, practical and easy-to-apply tool. Pain evaluation in the neonatal period should be performed by valid, safe, useful and feasible methods. OBJECTIVE: To evaluate the validity of the Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS), heart rate (HR) and O2 saturation (O2 sat) for neonatal pain assessment. DESIGN: Prospective, double-blind randomized trial. SETTING: A secondary level maternity hospital. PARTICIPANTS: 70 healthy neonates requiring bilirubin dosage were randomly assigned to receive a venous puncture (P: n = 33, BW 3.2 kg, SD 0.6; GA 39 wk, SD 1; 59 h of life, SD 25) or an alcohol swab friction (F: n = 37; BW 3.1 kg, SD 0.5; GA 39 wk, SD 1; 52 h of life, SD 17). INTERVENTION: All measurements were taken prior to (PRE), during (TO), and 1 (T1), 3(T3), 5(T5) and 10(T10) minutes after the procedure. MEASUREMENTS: A neonatologist evaluated NFCS, NIPS, HR and O2 sat by pulse oxymetry. RESULTS: Median NFCS and NIPS results at T0, T1 and T3 were higher in P group, compared to F. More P neonates presented NFCS > 2 and/or NIPS > 3 at T0, T1 and T3. HR was lower in P group at T1. Average O2 sat was above 90% during the whole study period in both groups. CONCLUSION: NFCS and NIPS are suitable instruments for neonatal pain evaluation. Heart rate and O2 saturation can be used only as auxiliary methods.


Assuntos
Medição da Dor/métodos , Dor/diagnóstico , Doença Aguda , Método Duplo-Cego , Expressão Facial , Frequência Cardíaca , Humanos , Recém-Nascido , Estudos Prospectivos , Reprodutibilidade dos Testes
9.
J Pediatr (Rio J) ; 70(2): 82-90, 1994.
Artigo em Português | MEDLINE | ID: mdl-14688879

RESUMO

The purpose of this study was to verify if multidimensional pain assessment, performed through physiologic and behavioral measures, together with this assessment modifications in response to opioid analgesia, could determine the presence of pain in preterm neonates (PT) under mechanical ventilation through endotracheal tube (ETT). The population consisted of 22 PT with gest. age < or = 32 weeks, between 12-48 h of life. All of them had an ETT and an umbilical arterial line in place and were on mechanical ventilation. The infants were admitted at São Paulo Hospital NICU from 11/91 to 11/92. Neonates' observation was performed in three 10 minute periods: prior medication (Pre-Analgesia), 30 min (Analgesia 1) and 60 min (Analgesia 2) after the injection of either fentanyl (3 mcg/kg) or sterile water (0.2 ml). In each period an arterial blood gas was drawn and the following parameters were recorded: ventilator settings, heart rate, non-invasive blood pressure and 02 saturation. Behavioral measures were also observed: ATTIA scale, MCGRATH scale and GRUNAU & CRAIG pain facial features. In Pre-Analgesia and Analgesia 2 periods, blood samples were obtained and serum cortisol, serum GH, plasmatic glucose and lactate were measured. Patients were filmed through the study and behavioral measures applied for each patient film. The research author was blind to the medication until final results. High levels of serum cortisol, serum GH and plasmatic lactate were present in the whole study population prior to medication. They also presented low ATTIA scale scores and pain facial mimic, as per MCGRATH and GRUNAU & CRAIG evaluations. Patients that received fentanyl exhibited decrease in the maximum heart rate, decrease in serum cortisol, increase in serum GH, stability in blood glucose levels, better ATTIA scale comfort scores and less pain facial movements. None of these occurred in neonates that received placebo. Critically ill intubated and ventilated PT do feel pain, as assessed by this multidimensional evaluation. Analgesia should be considered in order to treat these patients' pain.

10.
J Pediatr (Rio J) ; 73(6): 411-8, 1997.
Artigo em Português | MEDLINE | ID: mdl-14685376

RESUMO

OBJECTIVE: To establish the sensitivity and specificity of two behavioral pain scales in different gestational ages (GA). METHODS: 133 clinically stable neonates, <72 h of life, without diseases, analgesic/sedative use or Apgar<7 at 5' were randomly assigned to receive capillary puncture--P or alcohol swab friction--F. Patients were divided according to GA (28-33 wk=A; 34-37 wk=B; 38-41 wk=C ) and procedure: Group A-P (n=17, BW 1.5 +/- .4 kg); A-F (n=18, BW 1.5 +/- .4 kg); B-P (n=25, BW 2.5 +/- .5 kg); B-F (n=25, BW 2.4 +/- 0.6 kg); C-P (n=23, BW 3.3 kg +/- 0.5 kg); C-F (n=25; BW 3.3 +/- 0.4 kg). A neonatologist, blind to P or F, evaluated the Neonatal Facial Action Coding System (NFCS 0-8 pts, pain>3) and the Neonatal Infant Pain Scale (NIPS 0-7 pts, pain>3). All evaluations were performed prior to P or F, without (pr) and with foot heating (h), during (0), 1' and 3' after P or F. Reliability was assessed in 20% of the sample. Agreement rate was NFCS-97% and NIPS-95%. RESULTS: During the procedure, median NFCS and NIPS P score were greater than F (M. Whitney), p< or =0.0001) for A, B and C groups. At 1', NCFS and NIPS P scores were greater than F (MW, p< or =0.04) for A and C groups. For P patients, NFCS and NIPS scores were similar among the 3 GA groups at all study periods (K. Wallis). For F patients only at 0; NIPS scores were different (K. Wallis, p<0.03). During the procedure, NFCS>3 had sensitivity of 88-91% and specificity of 80-84%, NIPS>3 presented sensitivity of 77-87% and specificity of 68-83%. CONCLUSION: Both behavioral scales are sensitive tools for pain assessment in premature infants, although NFCS seems superior to NIPS.

11.
Acta Gastroenterol Latinoam ; 14(1): 27-35, 1984.
Artigo em Espanhol | MEDLINE | ID: mdl-6524269

RESUMO

Fifteen patients considered as "geronts" (average 70 years) have been performed Radiology, Endoscopy and Gastric Biopsies, with differents degrees of chronic gastritis as only gastric pathology, and 8 "healthy adults" (controls) were assessed on the T1/2 of gastric evacuation, with a solid meal marked with DPTA Tc 99 and measurement of isotopic activity in Gamma Camera before and after administration of a therapeutic dose of Clebopride. In the basal trial it was found that geronts gastric emptying is delayed more than controls (112 and 89 minutes). The activity of Clebopride revealed a significant decrease in both groups, being more important in geronts. This findings suggests the clinic usefulness in different pathological situations, where its useful to accelerate the time of gastric evacuation (gastric esofagic reflux, gastric ulcer) and in the geront with dispeptic symptoms and chronic gastritis related to age, as the only gastric pathology.


Assuntos
Idoso , Antieméticos/farmacologia , Benzamidas/farmacologia , Esvaziamento Gástrico/efeitos dos fármacos , Adulto , Feminino , Gastrite Atrófica/fisiopatologia , Humanos , Masculino , Ácido Pentético , Cintilografia , Estômago/diagnóstico por imagem
12.
Acta Gastroenterol Latinoam ; 17(2): 73-84, 1987.
Artigo em Espanhol | MEDLINE | ID: mdl-3442189

RESUMO

We intended to estimate D.G.R. in patients suffering from GU, and CG, comparing them with healthy controls. 70 patients, divided in 3 groups, were studied; Group A (Control): 14 cases, Group B (GU) type I Johnson: 11 cases, type III Johnson: 20 cases; Group C (CG): 25 cases (11 antral and 14 antral and fundic). The following studies were performed in all of them upper digestive tract X-ray and fibro-endoscopy with multiple antral and fundic biopsies. Tc 99 HIDA 2 ml. Cu. I.V. was used as radioactive compound, and in the first hour 0.3 ml Cu. in 100 cc of water was administered orally, so as to confirm gastric topography. All patients were studied for 2 hour. Quantitative assessment of D.G.R. was expressed in % related to the hepatobiliary area. D.G.R. was detected in 7.1% of patients in Group A: 54.5% of GU type I and 70% in GU type III. In antral CG a 72.7% of D.G.R. was observed and in antral and fundic CG a 87.6% was found. The differences were significant in all the cases. D.G.R. MAGNITUDE, expressed as geometric mean, was: for Group A: 0.73%; for Group B: Ulcer type I: 6.26% and type III: 6.26%, for Group C: 6.78% in antral gastritis and 11.41% in antral and fundic gastritis.


Assuntos
Refluxo Duodenogástrico/diagnóstico por imagem , Gastrite/fisiopatologia , Úlcera Gástrica/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Refluxo Duodenogástrico/complicações , Feminino , Gastrite/complicações , Humanos , Iminoácidos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos , Cintilografia , Úlcera Gástrica/complicações , Lidofenina Tecnécio Tc 99m
13.
Rev Assoc Med Bras (1992) ; 39(2): 100-4, 1993.
Artigo em Português | MEDLINE | ID: mdl-8242098

RESUMO

To study neonatal Syphilis seropositivity incidence, its association with HIV-1 seropositivity and the impact of Congenital Syphilis CDC case definition, cord blood VDRL and Indirect Hemagglutination (IHA) for Syphilis were performed in 3,664 newborns from Dec/91-July/92. A positive group was formed by those with positive VDRL and IHA or just positive IHA. The control group consisted of 200 VDRL and IHA negative neonates. Among the 3,664 neonates 5.6% were seropositive for Syphilis. A significant association was noted (p < or = 0.05) between neonatal seropositivity for Syphilis and mothers older than 20 years, single, with sexual promiscuity, drug use, no pre-natal care, multiparity and previous still-births. All positive neonates fitted in the Presumptive Congenital Syphilis CDC definition. In 50 seropositive for Syphilis neonates ELISA for HIV-1 was performed and 6/50 were positive. Congenital Syphilis is of concern, specially in neonates of mothers with risk factors for Syphilis acquisition. HIV-1 should be considered in seropositive for Syphilis neonates. Adoption of Congenital Syphilis new CDC case definition is advised, particularly in countries where prenatal care is deficient.


Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Sífilis Congênita/epidemiologia , Sorodiagnóstico da AIDS , Síndrome da Imunodeficiência Adquirida/complicações , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Sífilis/complicações , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis , Sífilis Congênita/complicações
14.
Braz J Med Biol Res ; 47(3): 259-64, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24554040

RESUMO

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Salas de Parto , Recém-Nascido de muito Baixo Peso/fisiologia , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Extubação , Brasil , Feminino , Mortalidade Hospitalar , Humanos , Hipertensão/diagnóstico , Recém-Nascido , Intubação Intratraqueal , Tempo de Internação , Masculino , Bem-Estar Materno , Gravidez , Diagnóstico Pré-Natal , Respiração Artificial/estatística & dados numéricos
15.
J Perinatol ; 32(12): 913-9, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22460546

RESUMO

OBJECTIVE: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death. STUDY DESIGN: Prospective cohort of 484 infants with 23(0/7) to 26(6/7) weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life. RESULT: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions. CONCLUSION: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day.


Assuntos
Mortalidade Infantil/tendências , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Neonatologia/normas , Obstetrícia/normas , Corticosteroides/uso terapêutico , Análise de Variância , Brasil , Reanimação Cardiopulmonar/normas , Reanimação Cardiopulmonar/tendências , Cesárea , Estudos de Coortes , Intervalos de Confiança , Parto Obstétrico/métodos , Feminino , Viabilidade Fetal , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Relações Interprofissionais , Cuidados para Prolongar a Vida/métodos , Modelos Logísticos , Masculino , Neonatologia/tendências , Obstetrícia/tendências , Razão de Chances , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Gravidez , Prognóstico , Estudos Prospectivos , Resultado do Tratamento
16.
Braz. j. med. biol. res ; 47(3): 259-264, 03/2014. tab
Artigo em Inglês | LILACS | ID: lil-704627

RESUMO

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.


Assuntos
Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Pressão Positiva Contínua nas Vias Aéreas , Salas de Parto , Recém-Nascido de muito Baixo Peso/fisiologia , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Extubação , Brasil , Mortalidade Hospitalar , Hipertensão/diagnóstico , Intubação Intratraqueal , Tempo de Internação , Bem-Estar Materno , Diagnóstico Pré-Natal , Respiração Artificial
17.
Addictive Behaviors ; 35(3): 266-269, abr. 2010.
Artigo em Inglês | Sec. Munic. Saúde SP, Hospital Municipal Maternidade Escola V. N. Cachoeirinha-Produção, Sec. Munic. Saúde SP, Sec. Munic. Saúde SP | ID: sms-9610

RESUMO

Objetive: The aim of this study is to check the validity of the self-report of drug use by pregnant adolescents, by comparing their responses to a structured interview about their use of cocaine and marijuana during the pregnancy with an analysis of their hair. Results: Hair analysis detected the use of cocaine and/or marijuana, 17 (1,7%) used only cocaine, and 3 (0,3%) used both drugs. None of the patients had reported the use of these substances in their interview with healthcare profissionals. Conclusion: Althougth the prevalence of the use of drugs during pregnancy is significant despite consistent evidence about the compromise of the neurobehavioral development of the newborns that are exposed to drugs during the prenatal period, drugs use is frequently not reported. Therefore, more sensitive methods of detection should be used so that appropriate medical and psychosocial interventions com be implemented for the mothers as well as for their children. (AU)


Assuntos
Adolescente , Gravidez na Adolescência , Cocaína/efeitos adversos , Cocaína/toxicidade , Abuso de Maconha
18.
Rev. bras. psiquiatr ; 32(1): 66-69, mar. 2010.
Artigo em Inglês | Sec. Munic. Saúde SP, Hospital Municipal Maternidade Escola V. N. Cachoeirinha-Acervo | ID: sms-9611

RESUMO

Objetive: To investigate the association of cocaina and marijuana use during adolescent pregnancy in são paulo-sp, brazil with psychiatric disorders, social status and sexual history. method: one thousand pregnancy adolescents were assessed by using the composite international diagnostic interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in são paulo. Hair samples were collected for analysis. Results: the following data were associated with cocaine and/or marijuana use during the third trimester of the pregnancy: being younger than 14 year of agge, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disordes, post-traumatic stress disorder, and somatoform disorder. Conclusion: in earlt adolescence pregnancy, having 3 or more sexual partners in the life for this population os significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women.(au) - en


Assuntos
Adolescente , Gravidez na Adolescência , Comorbidade , Cocaína , Cannabis
19.
Transfus Med ; 15(6): 467-73, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16359417

RESUMO

The goal of this research was to study the safety and the efficacy of transfusing citrate-phosphate-adenine anticoagulant-preservative (CPDA-1) RBC stored for up to 28 days to reduce donor exposures in premature infants. A prospective randomized two-group study was conducted with very low-birth-weight premature infants that received at least one RBC transfusion during hospital stay. Neonates randomly assigned to Group 1 (26 infants) were transfused with CPDA-1 RBC stored for up to 28 days; those assigned to Group 2 (26 infants) received CPDA-1 RBC stored for up to 3 days. Demographic and transfusion-related data were collected. Neonates from both groups showed similar demographics and clinical characteristics. The number of transfusions per infant transfused was 4.4 +/- 4.0 in Group 1 and 4.2 +/- 3.1 in Group 2, and the number of donors per infant transfused was 1.5 +/- 0.8 (Group 1) and 4.3 +/- 3.4 (Group 2), P < 0.001. RBC transfusions containing 29.7 +/- 18.3 mmol L(-1) of potassium (RBC stored for up to 28 days) did not cause clinical or biochemical changes and reduced donor exposures by 70.2%, compared to transfusions containing 19.8 +/- 12.3 mmol L(-1) of potassium (RBC stored for up to 3 days), P < 0.001. In conclusion, RBC stored for up to 28 days safely reduced donor exposures in premature infants.


Assuntos
Adenina , Preservação de Sangue/métodos , Citratos , Transfusão de Eritrócitos/métodos , Glucose , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Fosfatos , Análise Química do Sangue , Doadores de Sangue , Qualidade de Produtos para o Consumidor , Transfusão de Eritrócitos/normas , Humanos , Recém-Nascido , Fatores de Tempo
20.
Vox Sang ; 88(2): 107-13, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15720608

RESUMO

BACKGROUND AND OBJECTIVES: Very-low-birthweight infants are among the most heavily transfused patients. The objective of this study was to verify if the introduction of a strict guideline would reduce the need for red blood cell transfusions in the first 4 weeks of life in these neonates. MATERIALS AND METHODS: This was a multicentre prospective study of two cohorts of very-low-birthweight infants transfused in accordance with the recommendations of a neonatologist (Phase 1) or according to previously published guidelines (Phase 2). RESULTS: In the first 28 days of life, 102 patients (68.5%) in Phase 1 and 117 (59.7%) in Phase 2 were transfused. The number of transfusions was 1.9 +/- 2.0 in Phase 1 and 1.4 +/- 1.6 in Phase 2 (P = 0.01). After adjusting for gestational age, blood loss and the presence of respiratory distress syndrome, the strict guideline reduced the number of transfusions in 17.6% (IC 95%-30.5% to -2.6%). CONCLUSIONS: The strict guideline was effective in reducing erythrocyte transfusions in very-low-birthweight infants.


Assuntos
Transfusão de Eritrócitos/estatística & dados numéricos , Recém-Nascido de muito Baixo Peso/sangue , Guias de Prática Clínica como Assunto , Volume Sanguíneo , Estudos de Coortes , Idade Gestacional , Hematócrito , Hemoglobinas/análise , Hospitalização , Humanos , Recém-Nascido , Nascimento Prematuro/sangue
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