Effects Of Therapeutic Approach On The Neonatal Evolution Of Very Low Birth Weight Infants With Patent Ductus Arteriosus

Objective To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD.Methods This was a multicentric, cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment), G2 - pharmacologic (indomethacin or ibuprofen), G3 - surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. Outcomes: death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significantResults 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) and ROPsur were observed in G3 (23.5%). The lowest occurrence of death/BPD36wks occurred in G2 (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments were protective for the outcome death/BPD36wks. Conclusion The conservative approach of PDA was associated to high mortality, the surgical approach to the occurrence of BPD36wks and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks.906616623Clyman, R.I., Mechanisms regulating the ductus arteriosus (2006) Biol Neonate., 89, pp. 330-335Benitz, W.E., Treatment of persistent patent ductus arteriosus in preterm infants: Time to accept the null hypothesis? (2010) J Perinatol., 30, pp. 241-252Redline, R.W., Wilson-Costello, D., Hack, M., Placental and other perinatal risk factors for chronic lung disease in very low birth weight infants (2002) Pediatr Res., 52, pp. 713-719Evans, N., Kluckow, M., Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants (1996) Arch Dis Child Fetal Neonatal Ed., 75, pp. 183-F186Noerr, B., Current controversies in the understanding of necrotizing enterocolitis Part 1 (2003) Adv Neonatal Care., 3, pp. 107-120Koch, J., Hensley, G., Roy, L., Brown, S., Ramaciotti, C., Rosenfeld, C.R., Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less (2006) Pediatrics., 117, pp. 1113-1121Afiune, J.Y., Singer, J.M., Leone, C.R., Evolução ecocardiográfica de recém-nascidos com persistência do canal arterial (2005) J Pediatr (Rio J)., 81, pp. 454-460Sosenko, I.R., Fajardo, M.F., Claure, N., Bancalari, E., Timing of patent ductus arteriosus treatment and respiratory outcome in premature infants: A double-blind randomized controlled trial (2012) J Pediatr., 160, pp. 929-935. , e1Laughon, M.M., Simmons, M.A., Bose, C.L., Patency of the ductus arteriosus in the premature infant: Is it pathologic? Should it be treated? (2004) Curr Opin Pediatr., 16, pp. 146-151Clyman, R.I., Chorne, N., Patent ductus arteriosus: Evidence for and against treatment (2007) J Pediatr., 150, pp. 216-219Bose, C.L., Laughon, M., Treatment to prevent patency of the ductus arteriosus: Beneficial or harmful? (2006) J Pediatr., 148, pp. 713-714Clyman, R.I., Couto, J., Murphy, G.M., Patent ductus arteriosus: Are current neonatal treatment options better or worse than no treatment at all? (2012) Semin Perinatol., 36, pp. 123-129Alexander, G.R., Himes, J.H., Kaufman, R.B., Mor, J., Kogan, M., A United States national reference for fetal growth (1996) Obstet Gynecol., 87, pp. 163-168Jhaveri, N., Moon-Grady, A., Clyman, R.I., Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fails to close after indomethacin treatment (2010) J Pediatr., 157. , 381-7, 387.e1Clyman, R., Cassady, G., Kirklin, J.K., Collins, M., Philips, J.B., III, The role of patent ductus arteriosus ligation in bronchopulmonary dysplasia: Reexamining a randomized controlled trial (2009) J Pediatr., 154, pp. 873-876Mirea, L., Sankaran, K., Seshia, M., Ohlsson, A., Allen, A.C., Aziz, K., Treatment of patent ductus arteriosus and neonatal mortality/morbidities: Adjustment for treatment selection bias (2012) J Pediatr., 161, pp. 689-694. , e1Youn, Y., Lee, J.Y., Lee, J.H., Kim, S.Y., Sung, I.K., Lee, J.Y., Impact of patient selection on outcomes of PDA in very low birth weight infants (2013) Early Hum Dev., 89, pp. 175-17

Evaluation of usability of a neonatal health information system according to the user’s perception

Mensurar o grau de satisfação de profissionais de saúde quanto à usabilidade de um sistema de informação em saúde neonatal e identificar os fatores que podem influenciar na satisfação do usuário frente à usabilidade. Estudo transversal e exploratório realizado com 50 profissionais de saúde integrantes dos centros da Rede Brasileira de Pesquisas Neonatais. Para avaliação da usabilidade foi utilizado o instrumento System Usability Scale entre fevereiro e março de 2017. Realizou-se a análise estatística descritiva e inferencial das variáveis coletadas, com a finalidade de descrever a amostra, quantificar o grau de satisfação dos usuários e identificar as variáveis associadas ao grau de satisfação do usuário em relação à usabilidade. Da população avaliada, 75% era do sexo feminino, com idade média 52,8 anos, 58% com pós-graduação (doutorado); tempo médio da última formação de 17 anos; área de atuação em medicina (neonatologia), grau intermediário de conhecimento em informática e tempo de utilização média do sistema de 52 meses. Quanto à usabilidade, 94% avaliaram o sistema como “bom”, “excelente” ou “melhor impossível”. A usabilidade do sistema não foi associada a idade, sexo, escolaridade, profissão, área de atuação, nível de conhecimento em informática e tempo de uso do sistema. O grau de satisfação do usuário do sistema informatizado de saúde foi considerado bom. Não foram identificados fatores demográficos que influenciassem sua avaliação3719096To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as “good”, “excellent” or “better than imaginable”. The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the user