MÉTODOS NÃO FARMACOLÓGICOS PARA MANEJO DA DOR NA UTI NEONATAL

The intention of this study was to analyze the effectiveness of comfortable carrying and swaddling in reducing pain in premature babies. A quantitative approach was carried out, according to the hypotheses of an experimental study of the randomized and crossover clinical trial type. considering the analyzes based on the duration of the painful intervention, changes in heart rate, respiratory rate, and oxygen saturation, as well as the organization according to the subsystems of autonomic, motor and behavioral development of the newborn, it was evident that there were no statistically significant differences between the facilitated restraint and diaper interventions. However, faster physiological and behavioral stability was noted during the application of facilitating restraint compared to bandaging, promoting reorganization and reducing agitation and hemodynamic changes. Facilitated support is achieved by positioning the hands simulating the fetal position. Although swaddling the newborn involves keeping the newborn's limbs flexed and the hands close to the face, an adequate thoracic excursion must be ensured, a position that must be maintained by wrapping the premature baby's body in padding or diapers, which have the function of offering greater safety during the painful procedure. This study demonstrated the effectiveness of non-pharmacological interventions, restraint and swaddling in pain management during procedures that cause distress in neonates.A intenção deste estudo foi analisar a eficácia do transporte confortável e do enfaixamento na redução da dor em bebês prematuros. Foi realizada uma abordagem quantitativa, segundo as hipóteses de um estudo experimental do tipo ensaio clínico randomizado e cruzado. levando em consideração as análises baseadas na duração da intervenção dolorosa, nas alterações da frequencia cardíaca, na frequencia respiratória e na saturação de oxigênio, bem como na organização de acordo com os subsistemas de desenvolvimento autonômico, motor e comportamental do recém-nascido ficou evidente que houve não houve diferenças estatisticamente significativos entre as intervenções de contenção facilitada e fralda. Porém, foi notada estabilidade fisiológica e comportamental mais rápida durante a aplicação da contenção facilitadora em comparação ao enfaixamento, promovendo reorganização e reduzindo a agitação e as alterações hemodinâmicas. A sustentação facilitada é obtida pelo posicionamento das mãos simulando a posição fetal. Embora envolver o recém-nascido envolva manter os membros do recém-nascido flexionados e as mãos próximos ao rosto deve-se garantir uma adequada excursão torácica, posição que deve ser mantida envolvendo o corpo do prematuro em estofos, fossas ou fraldas, que têm a função de oferecer maior segurança durante o procedimento dolorido. Este estudo demonstrou a eficácia de intervenções não farmacológicas, contenção e enfaixamento no manejo da dor durante procedimentos que causam sofrimento em neonatos. &nbsp

Metabolically Healthy Obesity and High Carotid Intima-Media Thickness in Children and Adolescents: International Childhood Vascular Structure Evaluation Consortium

OBJECTIVE It has been argued that metabolically healthy obesity (MHO) does not increase cardiovascular disease (CVD) risk. This study examines the association of MHO with carotid intima-media thickness (cIMT), a proxy of CVD risk, in children and adolescents. RESEARCH DESIGN AND METHODS Data were available for 3,497 children and adolescents aged 6–17 years from five population-based cross-sectional studies in Brazil, China, Greece, Italy, and Spain. Weight status categories (normal, overweight, and obese) were defined using BMI cutoffs from the International Obesity Task Force. Metabolic status (defined as "healthy" [no risk factors] or "unhealthy" [one or more risk factors]) was based on four CVD risk factors: elevated blood pressure, elevated triglyceride levels, reduced HDL cholesterol, and elevated fasting glucose. High cIMT was defined as cIMT ≥90th percentile for sex, age, and study population. Logistic regression model was used to examine the association of weight and metabolic status with high cIMT, with adjustment for sex, age, race/ethnicity, and study center. RESULTS In comparison with metabolically healthy normal weight, odds ratios (ORs) for high cIMT were 2.29 (95% CI 1.58–3.32) for metabolically healthy overweight and 3.91 (2.46–6.21) for MHO. ORs for high cIMT were 1.44 (1.03–2.02) for unhealthy normal weight, 3.49 (2.51–4.85) for unhealthy overweight, and 6.96 (5.05–9.61) for unhealthy obesity. CONCLUSIONS Among children and adolescents, cIMT was higher for both MHO and metabolically healthy overweight compared with metabolically healthy normal weight. Our findings reinforce the need for weight control in children and adolescents irrespective of their metabolic status