Does staged closure have a worse prognosis in gastroschisis?

INTRODUCTION: Correction of gastroschisis can be accomplished by primary or staged closure. There is, however, no consensus regarding the best approach or criteria to favor one method over the other has been established. OBJECTIVE: To compare the outcome of primary and staged closure in newborns with gastroschisis using intravesical pressure (IVP) as the decision criterion. PATIENTS & METHODS: We prospectively analyzed 45 newborns with gastroschisis. An IVP with a threshold of 20 cm H2O was used to indicate primary or staged closure, and the outcomes between the two methods were compared. RESULTS AND DISCUSSION: Newborns in whom primary closure was feasible were born at a lower gestational age. There was no significant difference in the frequency of complications, time to begin oral feeding, length of parenteral nutrition or length of hospital stay. Compared with previous reports, our data showed higher rates of prenatal diagnosis and cesarean delivery, a lower average birth weight, a higher rate of small gestational age babies and a more frequent association with intestinal atresia. Conversely, our data showed a lower rate of postoperative necrotizing enterocolitis and a lower average length of hospital stay. CONCLUSION: No significant difference was observed in the outcome of newborns who underwent primary closure or staged closure of gastroschisis when using an IVP below 20 cm H2O as the criterion for primary closure

The frequency of pharmacological pain relief in university neonatal intensive care units

OBJECTIVE: To evaluate the use of drugs to relieve the pain of invasive procedures newborn infants cared for at a university hospital NICU. METHODS: A prospective cohort study of all newborn infants hospitalized in four NICU during October 2001. The following data were collected: demographic data of the hospitalized newborn infants; clinical morbidity; number of potentially painful procedures and frequency of analgesic administration. Factors associated with the use of analgesia in this cohort of patients were studied by multiple linear regression using SPSS 8.0. RESULTS: Ninety-one newborn infants were admitted to the NICU during the study period (1,025 patient-days). Only 25% of the 1,025 patient-days received systemic analgesia. No specific drugs were administered to relieve acute pain during any of the following painful events: arterial punctures, venous, capillary and lumbar punctures or intubations. For chest tube insertion, 100% of newborn infants received specific analgesia. For the insertion of central catheters 8% of the newborn infants received painkillers. Only nine of the 17 newborn infants that underwent surgical procedures received any analgesic dosage during the postoperative period. For 93% of patients under analgesia the drug of choice was fentanyl. The presence of mechanical ventilation increased the chance of newborn infants receiving painkillers by 6.9 times and the presence of chest tube increased this chance by five times. CONCLUSION: It is necessary to train health professionals in order to bridge the gap between scientific knowledge regarding newborn infant pain and clinical practice.OBJETIVO: Verificar a freqüência com que são empregados analgésicos para o alívio da dor desencadeada por procedimentos invasivos em recém-nascidos internados em UTI universitárias e verificar o perfil de uso de medicamentos para o alívio da dor. MÉTODOS: Coorte prospectiva, avaliada entre 1° e 31 de outubro de 2001, de todos os recém-nascidos internados em quatro UTI. Dados coletados: características gerais das unidades; dados demográficos dos recém-nascidos; morbidade clínica e freqüência do emprego de analgésicos. Realizaram-se a análise estatística descritiva e a regressão linear múltipla por meio do SPSS 8.0, para analisar os fatores associados ao uso de analgésicos nesta coorte. RESULTADOS: No período, foram internados 91 recém-nascidos (1.025 pacientes-dia). Apenas 25% dos 1.025 pacientes-dia receberam alguma dose de analgésico por via sistêmica. Não foi administrada nenhuma medicação específica para o alívio da dor aguda durante os seguintes eventos dolorosos: intubações traqueais, punções arteriais, venosas, capilares e lombares. Na inserção de dreno de tórax, 100% dos recém-nascidos receberam analgesia específica e, para a passagem de cateteres centrais, apenas 8%. De 17 recém-nascidos submetidos a procedimentos cirúrgicos, somente nove receberam analgésicos no pós-operatório. O medicamento mais utilizado foi o fentanil (93%). A presença de ventilação mecânica elevou em 6,9 vezes, e a de dreno de tórax em cinco vezes a chance do recém-nascido receber alguma dose de analgésico. CONCLUSÃO: Há necessidade de melhorar a formação dos profissionais de saúde para diminuir a distância entre os conhecimentos científicos existentes a respeito da dor no recém-nascido e a prática clínica.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina Pediatria NeonatalUniversidade Estadual de Campinas Faculdade de Ciências Médicas Departamento de PediatriaUNICAMP Centro de Atenção Integral à Saúde da MulherUniversidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina Departamento de PediatriaSanta Casa de São Paulo Faculdade de Ciências Médicas Departamento de PediatriaUNIFESP, EPM, Disciplina Pediatria NeonatalSciEL

O crime organizado e as novas tecnologias : uma faca de dois gumes

O benefício que determinados Estados retiram das novas tecnologias é incalculável. Contudo, não são os únicos a tirar partido dessas vantagens. O crime organizado, e em especial o cibercrime, aproveita as vulnerabilidades dos sistemas de informação, em que as nossas sociedades estão baseadas, para lucro próprio. Apesar dos conhecimentos que já possuímos sobre este tipo de criminalidade, os nossos esforços não têm conseguido travar o número crescente de ataques cibernautas, nem evitar o aumento das perdas das empresas e dos particulares. Não devemos, no entanto, cair no erro pessimista de pensar que não existe nenhuma forma eficiente de combater o cibercrime. Existe todavia, muito trabalho por desenvolver. Desde a consciencialização da população, para os perigos inerentes à Internet, até à formação de recursos humanos mais qualificados, passando pela investigação e a cooperação entre sectores, há sem dúvida muito ainda por fazer. Adoptámos as novas tecnologias, resta-nos agora aceitar por completo as responsabilidades que elas acarretam

Transmission of signals using white LEDs for VLC applications

In this paper an integrated wavelength optical filter and photodetector for Visible Light Communication (VLC) is used. The proposed application uses indoor warm light lamps lighting using ultra-bright white LEDs pulsed at frequencies higher than the ones perceived by the human eye. The system was analyzed using two different types the white LEDs, namely, phosphor and trichromatic based LEDs. The signals were transmitted into free space and the generated photocurrent was measured by the pin-pin photodetector based on a-SiC:H/a-Si:H. This device operates in the visible spectrum, allowing thus the detection of the pulsed white light emitted by the LEDs. However, as it also works as a visible optical filter with controlled wavelength sensitivity through the use of adequate optical biasing light, it is able to detect different wavelengths. This feature allows the detection of the individual components of the tri-chromatic white LED, which enlarges the amount of information transmitted by this type of white LED, when compared to the phosphor based LED. A capacitive optoelectronic model supports the experimental results and the physical operation of the device. A numerical simulation is presented.info:eu-repo/semantics/publishedVersio

The frequency of pharmacological pain relief in university neonatal intensive care units

OBJECTIVE: To evaluate the use of drugs to relieve the pain of invasive procedures newborn infants cared for at a university hospital NICU. METHODS: A prospective cohort study of all newborn infants hospitalized in four NICU during October 2001. The following data were collected: demographic data of the hospitalized newborn infants; clinical morbidity; number of potentially painful procedures and frequency of analgesic administration. Factors associated with the use of analgesia in this cohort of patients were studied by multiple linear regression using SPSS 8.0. RESULTS: Ninety-one newborn infants were admitted to the NICU during the study period (1,025 patient-days). Only 25% of the 1,025 patient-days received systemic analgesia. No specific drugs were administered to relieve acute pain during any of the following painful events: arterial punctures, venous, capillary and lumbar punctures or intubations. For chest tube insertion, 100% of newborn infants received specific analgesia. For the insertion of central catheters 8% of the newborn infants received painkillers. Only nine of the 17 newborn infants that underwent surgical procedures received any analgesic dosage during the postoperative period. For 93% of patients under analgesia the drug of choice was fentanyl. The presence of mechanical ventilation increased the chance of newborn infants receiving painkillers by 6.9 times and the presence of chest tube increased this chance by five times. CONCLUSION: It is necessary to train health professionals in order to bridge the gap between scientific knowledge regarding newborn infant pain and clinical practice.OBJETIVO: Verificar a freqüência com que são empregados analgésicos para o alívio da dor desencadeada por procedimentos invasivos em recém-nascidos internados em UTI universitárias e verificar o perfil de uso de medicamentos para o alívio da dor. MÉTODOS: Coorte prospectiva, avaliada entre 1° e 31 de outubro de 2001, de todos os recém-nascidos internados em quatro UTI. Dados coletados: características gerais das unidades; dados demográficos dos recém-nascidos; morbidade clínica e freqüência do emprego de analgésicos. Realizaram-se a análise estatística descritiva e a regressão linear múltipla por meio do SPSS 8.0, para analisar os fatores associados ao uso de analgésicos nesta coorte. RESULTADOS: No período, foram internados 91 recém-nascidos (1.025 pacientes-dia). Apenas 25% dos 1.025 pacientes-dia receberam alguma dose de analgésico por via sistêmica. Não foi administrada nenhuma medicação específica para o alívio da dor aguda durante os seguintes eventos dolorosos: intubações traqueais, punções arteriais, venosas, capilares e lombares. Na inserção de dreno de tórax, 100% dos recém-nascidos receberam analgesia específica e, para a passagem de cateteres centrais, apenas 8%. De 17 recém-nascidos submetidos a procedimentos cirúrgicos, somente nove receberam analgésicos no pós-operatório. O medicamento mais utilizado foi o fentanil (93%). A presença de ventilação mecânica elevou em 6,9 vezes, e a de dreno de tórax em cinco vezes a chance do recém-nascido receber alguma dose de analgésico. CONCLUSÃO: Há necessidade de melhorar a formação dos profissionais de saúde para diminuir a distância entre os conhecimentos científicos existentes a respeito da dor no recém-nascido e a prática clínica.40541

Brazilian multicenter study on prevalence of preterm birth and associated factors

<p>Abstract</p> <p>Background</p> <p>The occurrence of preterm birth remains a complex public health condition. It is considered the main cause of neonatal morbidity and mortality, resulting in a high likelihood of sequelae in surviving children. With variable incidence in several countries, it has grown markedly in the last decades. In Brazil, however, there are still difficulties to estimate its real occurrence. Therefore, it is essential to establish the prevalence and causes of this condition in order to propose prevention actions. This study intend to collect information from hospitals nationwide on the prevalence of preterm births, their associated socioeconomic and environmental factors, diagnostic and treatment methods resulting from causes such as spontaneous preterm labor, prelabor rupture of membranes, and therapeutic preterm birth, as well as neonatal results.</p> <p>Methods/Design</p> <p>This proposal is a multicenter cross-sectional study plus a nested case-control study, to be implemented in 27 reference obstetric centers in several regions of Brazil (North: 1; Northeast: 10; Central-west: 1; Southeast: 13; South: 2). For the cross sectional component, the participating centers should perform, during a period of six months, a prospective surveillance of all patients hospitalized to give birth, in order to identify preterm birth cases and their main causes. In the first three months of the study, an analysis of the factors associated with preterm birth will also be carried out, comparing women who have preterm birth with those who deliver at term. For the prevalence study, 37,000 births will be evaluated (at term and preterm), corresponding to approximately half the deliveries of all participating centers in 12 months. For the case-control study component, the estimated sample size is 1,055 women in each group (cases and controls). The total number of preterm births estimated to be followed in both components of the study is around 3,600. Data will be collected through a questionnaire all patients will answer after delivery. The data will then be encoded in an electronic form and sent online by internet to a central database. The data analysis will be carried out by subgroups according to gestational age at preterm birth, its probable causes, therapeutic management, and neonatal outcomes. Then, the respective rates, ratios and relative risks will be estimated for the possible predictors.</p> <p>Discussion</p> <p>These findings will provide information on preterm births in Brazil and their main social and biological risk factors, supporting health policies and the implementation of clinical trials on preterm birth prevention and treatment strategies, a condition with many physical and emotional consequences to children and their families.</p

Cord IgM levels in placentas with villitis of unknown etiology

Peer Reviewe

Programa de regionalização na Assistencia Neonatal: uma visao do serviço social na atenção a saude

O artigo contextualiza a trajetória de um programa de Neonatologia do Centro de Atenção Integral à Saúde da Mulher, norteado por políticas públicas visando a humanização e qualidade dos serviços prestados, como também a ação do assistente social como agente educador e executor deste processo. Esse programa é viabilizado entre Serviços de Saúde que através de um sistema de Regionalização do atendimento Neonatal pela referência e contra-referência atuam integrados para realizar a transferência de recém-nascidos internados conforme necessidades e competências. Esta discussão poderá enfatizar o trabalho multiprofissional e a necessidade de um planejamento regional entre cidades e Serviços de Saúde para execução dessa proposta.The article contextualize the trajectory of Neonatology care programs the Centro de Atenção Integral à Saúde da Mulher &#8722; CAISM in Campinas, Brazil and the treatment guided by public politics, aimed at humanizing and the quality of services provided, also the action the social worker as an educator and executor in this process. This program is viable between Health Services help with a system of regional division on attention to neonatal for reference and counter-reference working integrated to make possible transference of news born in a Hospital conform with necessities and competencies. This discussion should emphasize the multi-professional work and the necessity for regional planning between cities and Health Services for this proposal