Expectativas y percepciones de la madre respecto a su recién-nacido: aplicación del inventario de percepción neonatal de broussard

OBJECTIVES: To evaluate Broussard's Neonatal Perception Inventory (BPNI), an instrument to measure the mother's perception and expectations regarding her newborn infant at immediate postpartum and one month afterwards in primiparous and multiparous women. METHODS: Prospective cohort of 27 multiparous and 29 primiparous mothers of healthy newborn infants. In the second day postpartum, mothers were asked about the difficulties they thought that babies would offer regarding specific behaviors: crying, spitting, feeding, elimination, sleeping and predictability. Answers were rated in a 5-point scale. Next, mothers were questioned about their own babies regarding the same items. After 30 days, the mothers were questioned again about her perception of most babies and their own baby regarding the same items. The results were analyzed by repeated measures ANOVA considering the following main effects: time, group (primiparous and mul-tiparous), and subjects (mother's baby and most babies). RESULTS: Following birth, mothers expected their babies to have fewer difficulties in the daily activities than the ma-jority of the babies. These expectations were confirmed one month later for all items. There were no differences between primiparous and multiparous mothers. CONCLUSIONS: The Broussard's Neonatal Perception In-ventory was well understood and accepted by mothers and showed consistent results in this study. It can be used as a screening psychological tool to assess bonding between mothers and infants.OBJETIVOS: Analizar el Inventario de Percepción Neonatal de Broussard (BNPI - un instrumento que detecta las percepciones y expectativas maternas respecto a los hijos) enseguida al parto (T1) y con un mes de vida (T2), en puér-peras multíparas y primíparas. MÉTODOS: Coorte prospectiva con 27 multíparas y 29 primíparas madres de neonatos a término sanos. Se preguntó a la madre en T1 la dificultad que ella esperaba que la mayoría de los bebés tuviera respecto a llorar, alimentarse, regurgitar o vomitar, evacuar, dormir y tener una rutina. Las respuestas fueron marcadas en una escala de 5 puntos. Enseguida, se repitieron las preguntas respecto a su hijo recién-nacido. En T2, se preguntaba a la madre la dificultad que ella creía que la mayoría de los bebés y su propio hijo presentaban respecto a los mismos requisitos. El análisis estadístico utilizó ANOVA para medidas repetidas, teniendo en cuenta los siguientes efectos principales: tiempo (T1 y T2), grupo (primíparas y multíparas) y categoría (su bebé y la mayoría de los bebés). RESULTADOS: Enseguida al parto, las madres esperaban que sus hijos tuvieran menos dificultad en las actividades evaluadas que la mayoría de los bebés. Esta expectativa se confirmó con 30 días de vida para todos los comportamientos. No hubo diferencias entre primíparas y multíparas. CONCLUSIONES: El BNPI fue bien atendido y aceptado por las madres, mostrando resultados consistentes en este estudio. El instrumento puede ser útil para seleccionar pares madre-bebé con dificultades en el establecimiento de vínculo.OBJETIVOS: Analisar o Inventário de Percepção Neonatal de Broussard, um instrumento que detecta as percepções e expectativas maternas com respeito aos filhos logo após o parto (Tempo 1) e com um mês de vida (Tempo 2), em puérperas multíparas e primíparas. MÉTODOS: Coorte prospectiva com 27 multíparas e 29 primíparas mães de neonatos a termo saudáveis. Inquiriu-se à mãe no segundo dia pós-parto quanta dificuldade ela esperava que a maioria dos bebês tivesse em relação a chorar, alimentar, regurgitar ou vomitar, evacuar, dormir e ter uma rotina. As respostas foram marcadas em uma escala de 5 pontos. A seguir, repetiam-se as perguntas em relação ao seu filho recém-nascido. Após 30 dias, perguntava-se à mãe quanta dificuldade ela achava que a maioria dos bebês e seu próprio filho apresentavam em relação aos mesmos quesitos. A análise estatística utilizou ANOVA para medidas repe-tidas, considerando os seguintes efeitos principais: tempo, grupo (primíparas e multíparas) e categoria (seu bebê e a maioria dos bebês). RESULTADOS: Logo após o parto, as mães esperavam que seus filhos tivessem menos dificuldade nas atividades avalia-das do que a maioria dos bebês. Essa expectativa se confirmou com 30 dias de vida para todos os comportamentos. Não houve diferenças entre primíparas e multíparas. CONCLUSÕES: O Inventário de Percepção Neonatal de Broussard foi bem entendido e aceito pelas mães, mostrando resultados consistentes neste estudo. O instrumento pode ser útil para triar pares mãe-bebê com dificuldades no estabelecimento de vínculo.Universidade Federal de São Paulo (UNIFESP)Sociedade Brasileira de Psicanálise de São PauloHospital Geral de Itapecerica da SerraUNIFESPSciEL

Reliability of two behavioral tools to assess pain in preterm neonates

CONTEXT: One of the main difficulties in adequately treating the pain of neonatal patients is the scarcity of validated pain evaluation methods for this population. OBJECTIVE: To analyze the reliability of two behavioral pain scales in neonates. TYPE OF STUDY: Cross-sectional. SETTING: University hospital neonatal intensive care unit. PARTICIPANTS: 22 preterm neonates were studied, with gestational age of 34 ± 2 weeks, birth weight of 1804 ± 584 g, 68% female, 30 ± 12 hours of life, and 30% intubated. PROCEDURES: Two neonatologists (A and B) observed the patients at the bedside and on video films for 10 minutes. The Neonatal Facial Coding System and the Clinical Scoring System were scored at 1, 5, and 10 minutes. The final score was the median of the three values for each observer and scale. A and B were blinded to each other. Video assessments were made three months after bedside evaluations. MAIN MEASUREMENTS: End scores were compared between the observers using the intraclass correlation coefficient and bias analysis (paired t test and signal test). RESULTS: For the Neonatal Facial Coding System, at the bedside and on video, A and B showed a significant correlation of scores (intraclass correlation score: 0.62), without bias between them (t test and signal test: p > 0.05). For the Clinical Scoring System bedside assessment, A and B showed correlation of scores (intraclass correlation score: 0.55), but bias was also detected between them: A scored on average two points higher than B (paired t test and signal test: p 0,05). Para a Escala de Conforto Clínico à beira do leito, os escores obtidos por A e B mostraram uma correlação significante (0,55), foi detectado: o escore obtido por A foi, em média, dois pontos superior ao de B (teste t e do sinal: p < 0,05). Para a mesma escala aplicada em vídeo, os escores obtidos por A e B não mostraram correlação (0,25) e detectou-se viés (teste t e do sinal: p < 0,05). CONCLUSÃO: Os resultados reforçam a confiabilidade do Sistema de Codificação da Atividade Facial Neonatal aplicado à beira do leito para a avaliação da dor no recém-nascido pré-termo.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Neonatal DivisionUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of EpidemiologyUNIFESP, EPM, Neonatal DivisionUNIFESP, EPM, Department of EpidemiologySciEL

Application Of Continuous Positive Airway Pressure In The Delivery Room: A Multicenter Randomized Clinical Trial.

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.47259-6

Seasonal variations in mortality and clinical indicators in international hemodialysis populations from the MONDO registry

BACKGROUND: Seasonal mortality differences have been reported in US hemodialysis (HD) patients. Here we examine the effect of seasons on mortality, clinical and laboratory parameters on a global scale. METHODS: Databases from the international Monitoring Dialysis Outcomes (MONDO) consortium were queried to identify patients who received in-center HD for at least 1 year. Clinics were stratified by hemisphere and climate zone (tropical or temperate). We recorded mortality and computed averages of pre-dialysis systolic blood pressure (pre-SBP), interdialytic weight gain (IDWG), serum albumin, and log C-reactive protein (CRP). We explored seasonal effects using cosinor analysis and adjusted linear mixed models globally, and after stratification. RESULTS: Data from 87,399 patients were included (northern temperate: 63,671; northern tropical: 7,159; southern temperate: 13,917; southern tropical: 2,652 patients). Globally, mortality was highest in winter. Following stratification, mortality was significantly lower in spring and summer compared to winter in temperate, but not in tropical zones. Globally, pre-SBP and IDWG were lower in summer and spring as compared to winter, although less pronounced in tropical zones. Except for southern temperate zone, serum albumin levels were higher in winter. CRP levels were highest in winter. CONCLUSION: Significant global seasonal variations in mortality, pre-SBP, IDWG, albumin and CRP were observed. Seasonal variations in mortality were most pronounced in temperate climate zones

2019 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations : summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research

Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network.

OBJECTIVE: To gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR). DESIGN: A web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns. SETTING: 39 NNUs from 12 countries. PATIENTS: Any neonate admitted to one of the participating NNUs. INTERVENTIONS: This was an observational cohort study. RESULTS: The number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions <32 weeks ranged from 0% to 19%, and the majority of units (26/39, 66%) use Essential Medicines List 'Access' antimicrobials as their first-line treatment in neonatal sepsis. Cephalosporin resistance rates in Gram-negative isolates ranged from 26% to 84%, and carbapenem resistance rates ranged from 0% to 81%. Glycopeptide resistance rates among Gram-positive isolates ranged from 0% to 45%. CONCLUSION: AMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally