Feeding Practices of Preterm Low Birthweight Infants Up to 6 Months: A Comparison Between Kangaroo and Conventional Care.

OBJECTIVE: The objective of this study is to compare feeding practices of low birthweight (LBW) infants, according to type of care received during and after hospital discharge: Kangaroo Care (KC) and Conventional Care (CC). METHODS: Prospective cohort study was conducted at a university hospital (Brazil) between 2019 and 2021. The sample consisted of 65 LBW infants (weight ≤ 1800 g)-46 in KC and 19 in CC. KC includes breastfeeding (BF) guidance and support to parents at hospital and after discharge. Data collection was performed at hospital discharge, and at the 4th and 6th month of corrected gestational age (CGA). Consumption of 27 foods was analyzed in the last 2 periods of the follow-up and expressed in relative frequency. Three indicators were analyzed: exclusive breastfeeding (EBF), mixed BF, and introduction of liquid and solid foods. RESULTS: Groups had similar health characteristics, except for the weight at hospital discharge and the Score for Neonatal Acute Physiology - Perinatal (SNAPPE II) score that were lower in KC group. We found higher frequency of EBF among KC at hospital discharge (CC = 5.3% vs KC = 47.8%; P = 0.001). The higher frequency of mixed BF was observed in KC at 4 months of CGA (CC = 5.6% vs KC = 35.0%; P = 0.023), and at 6 months of CGA (CC = 0.0% vs KC = 24.4%; P = 0.048). Consumption of solid foods (4th month of CGA = 25.9%, 6th month of CGA = 91.2%) and liquids (4th month of CGA = 77.6%, 6th month of CGA = 89.5%) were similar between groups. CONCLUSIONS: In KC, SNAPPE II scores were lower and frequency of EBF was higher at hospital discharge and frequency of mixed BF was higher over 6 months. Early supply of infant formula, liquid and solid foods were similar in both groups.

Effects of intrauterine exposure to SARS-CoV-2 on infants' development: a rapid review and meta-analysis.

Potential medium- and long-term neurodevelopmental sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy have not been ruled out. We aimed to systematically review and summarize the evidence regarding the effects of intrauterine exposure to SARS-CoV-2 on infant development and behavior. Scopus, PubMed, Web of Science, CINAHL, and PsycNet databases were searched for studies published up to February 6, 2023, investigating the effects of gestational SARS-CoV-2 on infant development and behavior. We performed narrative synthesis according to updated protocols. Studies using comparison groups and with the Ages and Stages Questionnaires-Third Edition (ASQ-3) scores available were included in a meta-analysis performed according to Cochrane protocols. We used the Newcastle-Ottawa Quality Assessment Scale to analyze the risk of bias. Heterogeneity was calculated using the I2 statistic. The search identified 2,782 studies. After removing duplicates and applying the eligibility criteria, we performed a narrative synthesis of 10 included studies and a meta-analysis of three. There was no evidence of higher developmental delay rates in infants exposed to SARS-CoV-2 during pregnancy compared to non-exposed infants. However, the exposed infants scored lower than either the non-exposed children or pre-pandemic cohorts in some domains. Pooled results from the random-effects model indicated that SARS-CoV-2-exposed infants had lower scores on fine motor (mean difference [MD] = -4.70, 95% confidence interval [CI]: -8.76; -0.63), and problem-solving (MD = -3.05, 95% CI: -5.88; -0.22) domains than non-exposed infants (heterogeneity: I2 = 69% and 88%, respectively). There was no difference between the exposed and non-exposed infants in the communication, gross motor, and personal-social ASQ-3 domains.  Conclusion: We did not find evidence confirming the association between SARS-CoV-2 gestational exposure and neurodevelopmental delays. However, the meta-analysis indicated that gestational exposure negatively affected fine motor and problem-solving skills. Robust evidence on this topic is still incipient, and the available studies present methodological inconsistencies that limit the drawing of clear-cut conclusions.   PROSPERO registration: #CRD42022308002; March 14, 2022. What is Known: • COVID-19 is associated with adverse pregnancy outcomes potentially linked to neurodevelopmental delays. • SARS-CoV-2 vertical transmission is rare; however, infections during pregnancy can be deleterious to the fetus, possibly mediated by maternal immune activation and other inflammatory mechanisms. What is New: • No evidence of increased developmental delay rates among SARS-CoV-2 gestational-exposed infants was found. However, a meta-analysis of three studies showed lower scores in fine motor and personal social ASQ-3 domains among exposed infants. • SARS-CoV-2 gestational exposure and the pandemic can affect child development via many mechanisms. Potential neurodevelopmental sequelae of SARS-CoV-2 exposure during gestation have not been ruled out.

[Introduction of complementary feeding and associated factors in preterm and low birthweight newborns: a prospective cohort study]. / Introdução da alimentação complementar e fatores associados em recém-nascidos pré-termo e com baixo peso: estudo de coorte prospectivo.

This study aimed to analyze the association between sociodemographic factors, maternal and neonatal characteristics and the time taken to introduce complementary feeding in low birthweight and preterm newborns. This is a prospective cohort study of 79 preterm newborns weighing less than or equal to 1,800g. Data were collected at the time of hospital discharge and at the 6th, 9th ,and 12th months of corrected gestational age (CGA), using a structured questionnaire to analyze the time taken to introduce complementary feeding and the texture of the foods introduced. Furthermore, the Survey of Well-being of Young Children (SWYC-BR) was used to assess the risk of developmental delay. Cox proportional hazards regression was used to analyze the variables. The introduction of complementary feeding was assessed in preterm newborns based on the median age of introduction of liquid foods (3.50; IQR: 2.50-5.00), followed by solid (4.70; IQR: 3.20-5.20) and soft foods (5.00; IQR: 4.50-5.50). There was also an association with gestational age (RR = 1.25; 95%CI: 1.02-1.52) throughout the process of food introduction. For solid and soft foods, those with the longest length of stay (RR = 1.03; 95%CI: 1.10-1.05) and on mixed breastfeeding (RR = 2.97; 95%CI: 1.24-7.09) delayed the introduction of complementary feeding the longest. For liquid foods, less severe preterm newborns (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0.96; 95%CI: 0.94-0.98]) and mothers who were breastfeeding at hospital discharge (RR = 11.49; 95%CI: 1.57-84.10) delayed the introduction of complementary feeding. Guidelines are needed to better advise professionals and parents and/or guardians on the ideal time to introduce feeding.

O objetivo deste artigo foi analisar a associação entre os fatores sociodemográficos, as características maternas e neonatais e o tempo de introdução da alimentação complementar em recém-nascidos pré-termo e com baixo peso. Trata-se de um estudo de coorte prospectivo feito com 79 recém-nascidos pré-termo com peso menor ou igual a 1.800g. Os dados foram coletados no momento da alta hospitalar e ao 6º, 9º e 12º mês de idade gestacional corrigida (IGC), com auxílio de um questionário estruturado para analisar o tempo de introdução da alimentação complementar e texturas dos alimentos introduzidos. Além disso, para avaliar o risco de atraso de desenvolvimento, utilizou-se o Survey of Well-being of Young Children (SWYC-BR). Para análise das variáveis, aplicou-se regressão de riscos proporcionais de Cox. A introdução da alimentação complementar foi observada nos recém-nascidos pré-termo, com a mediana de idade de introdução de alimentos líquidos (3,50; IQ: 2,50-5,00), seguido por sólidos (4,70; IQ: 3,20-5,20) e pastosos (5,00; IQ: 4,50-5.50). Ainda, verificou-se associação da idade gestacional (RR = 1.25; IC95%: 1,02-1,52) em todo o processo da introdução alimentar. Para os alimentos sólidos e pastosos, aqueles com o maior tempo de internação (RR = 1,03; IC95%: 1,10- 1,05) e em amamentação mista (RR = 2,97; IC95%: 1,24-7,09) adiaram mais o tempo para introduzir a alimentação complementar. Para alimentos líquidos, recém-nascidos pré-termo menos graves (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0,96; IC95%: 0,94-0,98]) e mães que estavam amamentando na alta hospitalar (RR = 11,49; IC95%: 1,57-84,10) postergaram a introdução alimentar. Diretrizes para melhor orientação de profissionais e pais e/ou responsáveis sobre o momento ideal de introdução alimentar se faz necessário.

El objetivo de este estudio fue analizar la asociación entre los factores sociodemográficos, características maternas y neonatales y el momento de introducción de la alimentación complementaria en recién nacidos pretérmino (recém-nascidos pré-termo) y de bajo peso. Se trata de un estudio de cohorte prospectivo realizado con 79 recém-nascidos pré-termo con un peso menor o igual a 1.800g. Los datos se recopilaron en el momento del alta hospitalaria y al 6º, 9º y 12º mes de edad gestacional corregida (EGC), con la ayuda de un cuestionario estructurado para analizar el momento de introducción de la alimentación complementaria y las texturas de los alimentos introducidos. Además, para evaluar el riesgo de retraso en el desarrollo, se utilizó la Survey of Well-being of Young Children (SWYC-BR). Para analizar las variables, se aplicó la regresión de riesgos proporcionales de Cox. La introducción de la alimentación complementaria se observó en los recém-nascidos pré-termo, con la mediana de edad de introducción de alimentos líquidos (3,50; IIC: 2,50-5,00), seguido de los sólidos (4,70; IIC: 3,20-5,20) y pastosos (5,00; IIC: 4,50-5,50). Además, se constató la asociación de la edad gestacional (RR = 1,25; IC95%: 1,02-1,52) durante todo el proceso de introducción alimentaria. En el caso de alimentos sólidos y pastosos, aquellos con mayor tiempo de hospitalización (RR = 1,03; IC95%: 1,10-1,05) y en lactancia mixta (RR = 2,97; IC95%: 1,24-7,09) retrasaron más la introducción de alimentación complementaria. En el caso de alimentos líquidos, los recém-nascidos pré-termo menos graves (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0,96; IC95%: 0,94-0,98]) y las madres que estaban amamantando al alta hospitalaria (RR = 11,49; IC95%: 1,57-84,10) pospusieron la introducción de alimentos. Se hacen necesarias pautas para una mejor orientación a profesionales y padres o tutores sobre el momento ideal para la introducción alimentaria.

Salivary detection of Chikungunya virus infection using a portable and sustainable biophotonic platform coupled with artificial intelligence algorithms.

The current detection method for Chikungunya Virus (CHIKV) involves an invasive and costly molecular biology procedure as the gold standard diagnostic method. Consequently, the search for a non-invasive, more cost-effective, reagent-free, and sustainable method for the detection of CHIKV infection is imperative for public health. The portable Fourier-transform infrared coupled with Attenuated Total Reflection (ATR-FTIR) platform was applied to discriminate systemic diseases using saliva, however, the salivary diagnostic application in viral diseases is less explored. The study aimed to identify unique vibrational modes of salivary infrared profiles to detect CHIKV infection using chemometrics and artificial intelligence algorithms. Thus, we intradermally challenged interferon-gamma gene knockout C57/BL6 mice with CHIKV (20 µl, 1 X 105 PFU/ml, n = 6) or vehicle (20 µl, n = 7). Saliva and serum samples were collected on day 3 (due to the peak of viremia). CHIKV infection was confirmed by Real-time PCR in the serum of CHIKV-infected mice. The best pattern classification showed a sensitivity of 83%, specificity of 86%, and accuracy of 85% using support vector machine (SVM) algorithms. Our results suggest that the salivary ATR-FTIR platform can discriminate CHIKV infection with the potential to be applied as a non-invasive, sustainable, and cost-effective detection tool for this emerging disease.

The possible mediating relationship promoted by the self-efficacy of breastfeeding associated with the Kangaroo Method on indicators of exclusive breastfeeding.

OBJECTIVE: Assess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding. METHOD: Cross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%. RESULTS: The kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p = 0.000). There was a positive association between having remained in the kangaroo (p = 0.003) and the breastfeeding self-efficacy score (p = 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator. CONCLUSION: The self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association.

The possible mediating relationship promoted by the self-efficacy of breastfeeding associated with the Kangaroo Method on indicators of exclusive breastfeeding

Abstract Objective Assess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding. Method Cross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%. Results The kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p= 0.000). There was a positive association between having remained in the kangaroo (p= 0.003) and the breastfeeding self-efficacy score (p= 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator. Conclusion The self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association.

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil: III - training indicator / Indicadores de qualidade aplicados a um programa de educação continuada de um hospital universitário brasileiro de alta complexidade: III ­ indicador de treinamento

The level of knowledge and training of nursing staff has been related to indicators of quality of care in health, although the application of indicators is still rare related to continuing education programs. The aim of this study was to use the training indicator to evaluate the efficiency of a Continuing Education Program focused on nursing staff in a Brazilian university hospital. In addition, it also checked if different nursing staff characteristics interfere in the training indicator. The number of hours that each nursing professional spent in the program was measured, and this indicator was related to professional features like professional category, unit of work, employment link and department. We note that inpatient sectors and high-complexity care feature a greater average number of hours when compared to units of lower complexity or support or administrative sectors. Another relevant point was the lower number of hours of training of nurses compared to other nursing categories, highlighting the need to consider different strategies for each nursing category. Despite this, nurses that perform assistance compared to those who perform only administrative activities showed no differences in participation. We observe that the profile of professionals was a relevant factor in participating in the program, and that this must be taken into consideration in the planning of continuing education programs. The program in this institution, which has compulsory participation during working hours, was also effective compared to the few studies that have measured the number of hours of training in hospitals of high complexity.

O nível de conhecimento e treinamento das equipes de enfermagem tem sido relacionado a indicadores de qualidade da assistência em saúde, embora ainda são raros a aplicação de indicadores relacionados a programas de educação continuada. O objetivo deste estudo foi usar um indicador de treinamento para medir a eficiência de um programa de educação continuada focado na equipe de enfermagem em um hospital universitário brasileiro de alta complexidade. Além disso, verificar se diferentes características do perfil do pessoal de enfermagem são capazes de interferir nos indicadores de treinamento. Foi mensurado o número de horas que cada profissional de enfermagem obteve no programa e este indicador foi relacionado a características do profissional como categoria profissional, unidade de trabalho, vínculo empregatício e departamento. Observamos que setores de internação e de alta complexidade apresentam um número médio de horas maior quando comparados a unidades de menor complexidade e setores de apoio e administrativos. Outro ponto relevante foi o menor número de horas de treinamento dos enfermeiros comparados a outras categorias, evidenciado a necessidade de se considerar diferentes estratégias para cada categoria. Apesar disto enfermeiros assistenciais comparados a aqueles que efetuam somente atividades administrativas não mostraram diferenças na participação. Observamos que o perfil dos profissionais foi fator relevante na participação no programa, e que estes devem ser levados em consideração no planejamento de programas de educação permanente. O programa, que nessa instituição tem participação obrigatória durante as horas de trabalho, também foi efetivo comparado a poucos estudos que tem mensurado o número de horas de capacitação em hospitais de grande complexidade.

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil: I ­ attendance indicators / Indicadores de qualidade aplicados a um programa de educação continuada de um hospital universitário brasileiro de alta complexidade: I ­ indicadores de comparecimento

Studies with nursing continuing education are common in the literature with a predominance of qualitative approaches. Quantitative assessments are punctual and focused on a single quality indicator, and few studies relate these indicators to the profile of nursing staff. The objective of the study was to describe the Training Cycles of the Clinical Hospital of Uberlândia as a strategy of a Nursing Continuing Education Program and evaluate the attendance indicators and their association with the nursing staff profile. The Training Cycles of the Clinical Hospital of Uberlândia are cyclic courses that are offered continually, in a mandatory participation regime, during work hours, outside of the hospital, focused on Nursing staff. The study was conducted in 2013/2014 and has a documentary character. It was held in a public high complexity university hospital in Brazil. The Relative Frequency Attendance was calculated in relation to the nursing professional category and shift. Attendance indicators were affected by professional category. Participation increased over time for the technical level (assistants and nursing technicians) and decreased for nurses. We found an attendance rate of 54.49% in nursing hospital staff. The attendance indicators were also different for the period/shift of the course (gradual decrease of attendance from morning to afternoon to night). We also observed a decrease in attendance indicators over time. Attendance indicators were effective in describing the results of the Continuing Education Program and allowed the service administrators to associate the indicator results to the nursing profile. These results served as a basis for adjustments in the continuing education program of the institution.

Estudos com educação continuada em enfermagem são comuns na literatura, embora com predominância de abordagem qualitativa. Avaliações quantitativas são pontuais e concentradas em um único indicador de qualidade, e em raros casos relacionam estes indicadores com o perfil da enfermagem. O objetivo deste estudo foi descrever o Ciclo de Capacitação do Hospital de Clínicas de Uberlândia como uma estratégia de um Programa de Educação Continuada em Enfermagem e avaliar os indicadores de comparecimento desse programa e sua associação com o perfil dos profissionais de enfermagem. O Ciclo de Capacitação do Hospital de Clínicas de Uberlândia é um curso cíclico que é oferecido continuamente, em um regime de participação obrigatória, durante as horas de trabalho, fora do hospital, e dedicado à equipe de enfermagem. O estudo foi realizado em 2013/2014, tem caráter documental, foi realizado num hospital público, de alta complexidade e universitário no Brasil. Foi calculado a Frequência Relativa de Comparecimento em função da categoria profissional e do plantão. Observamos uma taxa de comparecimento de 54.49% para os profissionais de enfermagem do hospital. Os indicadores de comparecimento foram afetados pela categoria profissional (aumento da participação ao longo do tempo para os profissionais de nível técnico (auxiliares e técnicos de enfermagem) e diminuição da participação dos enfermeiros. Houve diferenças entre os turnos de oferecimento do curso (diminuição gradativa da participação da manhã para a tarde e desta para a noite). Observou-se também a redução nos indicadores de comparecimento ao longo dos cursos em função do tempo de oferecimento. Os indicadores de comparecimento propostos foram eficazes em descrever os resultados e o comportamento do programa de educação continuada e permitiram associar seus resultados ao perfil dos profissionais de enfermagem e serviram de embasamento para ajustes no programa de educação permanente da instituição.