Newborn skin reflection: Proof of concept for a new approach for predicting gestational age at birth. A cross-sectional study

Current methods to assess the gestational age during prenatal care or at birth are a global challenge. Disadvantages, such as low accessibility, high costs, and imprecision of clinical tests and ultrasonography measurements, may compromise health decisions at birth, based on the gestational age. Newborns organs and tissues can indirectly indicate their physical maturity, and we hypothesized that evolutionary changes in their skin, detected using an optoelectronic device meter, may aid in estimating the gestational age. This study analyzed the feasibility of using newborn skin reflectance to estimate the gestational age at birth noninvasively. A cross-sectional study evaluated the skin reflectance of selected infants, preferably premature, at birth. The first-trimester ultrasound was the reference for gestational age. A prototype of a new noninvasive optoelectronic device measured the backscattering of light from the skin, using a light emitting diode at wavelengths of 470 nm, 575 nm, and 630 nm. Univariate and multivariate regression analysis models were employed to predict gestational age, combining skin reflectance with clinical variables for gestational age estimation. The gestational age at birth of 115 newborns from 24.1 to 41.8 weeks of gestation correlated with the light at 630 nm wavelength reflectance 3.3 mm/6.5 mm ratio distant of the sensor, at the forearm and sole . The best-combined variables to predict the gold standard gestational age at birth was the skin reflectance at wavelengths of 630 nm and 470 nm in combination with birth weight, phototherapy, and adjusted to include incubator stay, and sex. The main limitation of the study is that it was very specific to the premature population we studied and needs to be studied in a broader spectrum of newborns

New Technologies to Dating Pregnancy at Birth

The chapter provides a vision of new methods of pregnancy dating at birth to overcome the high costs of existing approaches or lack of access to the existing technologies. The authors have presented a literature review on recent scientific reports exploring novel technologies, such as those based on the newborn’s skin maturity assessment as machine learning models based on clinical data. The effortlessness of new approaches based on simplified clinical systems contrasting with molecular genetics and newborns screening analytes is discussed, even in scientific validation. Without the intention of an exhaustive or systematic review, we searched databases for reports concerning postnatal gestational age, prediction or estimate, novel approach, low and medium-income countries since 2015. Therefore, the authors did not compromise to offer a comprehensive picture of all postnatal gestational age methods. On the other hand, prematurity identification at birth remains a challenge in many birth settings, mainly in a scenario with scarce resources. Although postnatal pregnancy dating methods have strengths and disadvantages, this information is critical to recognize the risk of the newborn during the first hours of life, justifying technological investments

Analysis of obstetrical deliveries under conduction anesthesia and immediate neonatal repercussion

Introduction: Anesthesia is an important resource for pain relief during labor. It is not a risk-free procedure and its use involves decision-making based on clinical and obstetric conditions, woman’s desire and availability of the procedure. This study aimed to analyze the association between this intervention and the occurrence of operative delivery and low Apgar score. Method: Retrospective study of a hospital database containing 5,282 parturients with single gestation of a fetus with cephalic presentation born alive and without malformation, among the 8,591 births that occurred from 2014 to 2017, in the Clinical Hospital’s Maternity of UFMG. Outcomes of interest were compared between deliveries conducted with or without anesthesia by association tests. Results: The occurrence of labor conduction anesthesia was 29.9%, being more frequent among adolescents (33.3% versus 29.1%; p = 0.008), nulliparous (39.7% versus 21.6%; p<0.001), those with induced delivery (40.6% versus 26.5%; p<0.001), patients with heart disease (53.5% versus 29.6%; p<0.001) and parturients whose babies weighed 2500 g or more at birth (31.3% versus 19.7%; p<0.001). There was an association between anesthesia and increased use of forceps (15.7% versus 1.8%; p<0.001) and vacuum extractor (2.0% versus 0.6%; p<0.001), however, there was a reduction in the occurrence of cesarean section (7.3% versus 12.9%; p<0.001). Anesthesia was associated with a higher occurrence of 1st minute Apgar <7 (p<0.001), but did not change the 5th Apgar score (p = 0.243). Nulliparity seems to influence the occurrence of cesarean delivery (8.6% versus 5.2%; p = 0.013) and forceps use (19.4% versus 9.8%; p<0.001). Conclusion: The use of labor conduction anesthesia was associated with operative vaginal delivery, the lowest cesarean section rate, with no impact on the 5th minute Apgar score.Introdução: A anestesia é um recurso importante no alívio da dor durante o trabalho de parto (TP). Não é um procedimento isento de riscos e sua utilização envolve decisão com base nas condições clínicas e obstétricas, desejo da mulher e disponibilidade do procedimento. O objetivo deste estudo foi analisar a associação entre essa intervenção com a ocorrência de parto operatório e baixo escore de Apgar. Método: Estudo retrospectivo de base de dados hospitalar contendo 5.282 parturientes com gestação única, de feto em apresentação cefálica nascido vivo e sem malformação, entre os 8.591 nascimentos ocorridos no período de 2014 a 2017, na maternidade do Hospital das Clínicas da UFMG. Desfechos de interesse foram comparados entre partos conduzidos com ou sem anestesia, através de testes de associação. Resultados: A ocorrência de anestesia de condução de TP foi de 29,9%, sendo mais frequente entre adolescentes (33,3% versus 29,1%; p = 0,008), nulíparas (39,7% versus 21,6%; p<0,001), naquelas com parto induzido (40,6% versus 26,5%; p<0,001), portadoras de cardiopatias (53,5% versus 29,6%; p<0,001) e parturientes cujos recém-nascidos pesaram 2500 g ou mais ao nascer (31,3% versus 19,7%; p<0,001). Houve associação entre anestesia e aumento do uso de fórceps (15,7% versus 1,8%; p<0,001) e de vacum extrator (2,0% versus 0,6%; p < 0,001), porém ocorreu redução das taxas de cesariana (7,3% versus 12,9%; p<0,001). O uso da anestesia associou-se à maior ocorrência de Apgar de 1o minuto < 7 (p<0,001), mas não alterou o de 5o (p=0,243). A nuliparidade parece ter influência sobre a ocorrência de parto cesariano (8,6% versus 5,2%; p = 0,013) e uso de fórceps (19,4% versus 9,8%; p<0.001). Conclusão: O uso de anestesia de condução no parto associou-se ao parto vaginal operatório, e à menor taxa de cesariana, sem impacto no Apgar de 5o minuto

Aplicações da saúde digital no cuidado obstétrico: impactos e perspectivas que extrapolam a pandemia de COVID-19

Introduction: The women's welfare is viewed as a whole in women's health perspective, which may be exemplified as obstetrics and prenatal care, only by the means of access to health services and quality of information offered during pregnancy. Those factors enlarge women's empowerment, decrease pregnancy complications and mortality among this population. Along with COVID-19 pandemic, many informatized systems have been used in women's health and during pregnancy in order to improve quality of care, telehealth and mobile applications are important base constitutives of e-Health facilitating in doctor-patient communication. Objective: To evaluate in the scientific literature about the impacts of digital health system implementation on health promotion and pregnancy health care during prenatal and validation of pregnant information. Methods: Data search among PubMed, Scielo, Google Scholar and BVS between the period of 2019 and 2021, using Portuguese and English descriptions, including on this review meta-analysis, prospective and retrospective cohorts and case reports. Results and Discussion: The analysis comprehends in 13 selected articles that were included in three main areas involved in e-Health and obstetrics care, pregnancy information validity constitutes a building up public policy tool and empowers epidemiologic research, besides the fact that this information being as part of an active pregnancy's participation and maternal and infant health promotion. Educational health promotion mobile application is a popular way that telemedicine found to intervene in doctor-patient relationship. Thereby, even during pandemic times, prenatal care is an obstetrics health tool that was made approachable and diversified by e-Health. Lastly, the birth plan presents itself as an effective tool in prenatal, since it facilitates pregnancy communication among the medical team, family and friends about its birth preferences, which stimulates women to be part and protagonist of their own birth, humanizing it in this way. Conclusion: Through the analysis of the articles it was found that the obstetrics health information technology allows an integral care using mobile applications as electronic media improving health care and shortening health access barriers. Allied to an informatized birth plan, it's possible to share educational content and potencialize women's decision-making process.Introdução: O bem-estar da mulher em uma visão integral do cuidado à saúde feminina, exemplificado pelo cuidado obstétrico e atenção pré-natal, se respalda no acesso aos serviços de saúdes e à informação de qualidade, o que aumenta o empoderamento feminino, reduz complicações e os índices de mortalidade materno-fetais. Impulsionados pelo período de pandemia COVID-19, diversos sistemas informatizados têm se tornado aliados no cuidado à saúde da mulher e ao desenvolvimento da gestação, sendo a telemedicina e os aplicativos em saúde pilares importantes da e-Saúde que facilitam a interface médico-gestante. Objetivo: Levantar evidências científicas na literatura sobre os impactos da implementação de sistemas de saúde digital na promoção de saúde e atenção à gestante durante o cuidado pré-natal e a validação da informação gerada pela gestante. Método: Foram utilizadas as bases de dados PubMed, Scielo, Google Scholar e BVS no período de 2016 a 2021, com descritores em português e inglês, incluindo artigos de revisão, meta-análises, coortes prospectivas e retrospectivas, assim como os relatos de caso. Resultado e Discussão: Foram selecionados 13 artigos e analisados sob a perspectiva de três grandes áreas envolvidas na aplicação da saúde digital ao cuidado obstétrico, dentre as quais a validação da informação da gestante constitui uma ferramenta de fomento às políticas públicas e  pesquisas epidemiológicas, sendo a qualidade dessa informação e a participação ativa da gestante pilares importantes para a promoção de saúde materna-infantil; ademais, aplicativos educativos em saúde tem sido uma das formas informatizadas pela qual a telemedicina se populariza dentre os pacientes, inclusive como meio intervencionista nas relações médico-paciente. Assim, ferramentas de saúde obstétrica como o pré-natal se tornaram mais acessíveis e diversificadas, mesmo em um período de pandemia, por meio da e-Saúde. Por fim,o plano de parto mostra-se uma ferramenta eficaz no pré-natal, facilitando a comunicação da gestante com a equipe médica, familiares e amigos acerca das suas preferências quanto ao processo de parto, estimulando a mulher a ser protagonista de seu parto, humanizando-o. Conclusão: A análise das publicações avaliadas apontam que as tecnologias de informação na área de saúde obstétrica permitem um cuidado integral e próximo por meios eletrônicos como aplicativos digitais, melhorando a atenção e diminuindo barreiras de acesso aos serviços de saúde. Aliadas a um plano de parto consolidado e informatizado, além de partilharem conteúdos educativos, ainda potencializam o poder de decisão feminino

Much native data, little longitudinal information: a model of information for the continuity of care, from prenatal assistance to the emergency in maternities / Muitos dados nativos, pouca informação longitudinal: um modelo de informação para a continuidade do atendimento, desde a assistência pré-natal até a emergência em maternidades

Background: Information systems allow for the availability of clinical records in computer databases. Obstetric caring demands a continuous process of information sharing between health professionals. However, the lack of communication between points of assistance has allowed for an accumulation of local data without the benefits of data interoperability. Objective: The study’s objective is to develop an information model with essential obstetric data to reuse information from primary sources through to tertiary level of care, and to foster the continuity of information. Methods: An exploratory research involved focus group discussions with obstetricians as domain specialists and computer scientists. Fictitious cases of obstetric emergencies were discussed to select meaningful information from prenatal care for the specialists’ decision making. Ninety electronic medical records (EMR) from a university obstetric emergency unit were used to validate the information model. A second-round evaluation with the obstetrician met the specialists' requirements, the information model was also finalized after adjustments to semantic standards and the structure of the clinical data. Results: The study found a recurring set of clinical information that was common in both the domain specialist requests and the EMR retrospective analysis. However, the lack of informational standards, use of acronyms and abbreviations characterized real histories in the obstetric EMR. The minimum antenatal dataset entries was structured into nine sections, and fifty-six data entries. Conclusion: The development of an information model for the continuity of care records, based on the standard of interoperability and usefulness for clinicians, has the potential to overcome the informality of EMR

Antenatal Ultrasonographic Anteroposterior Renal Pelvis Diameter Measurement: Is It a Reliable Way of Defining Fetal Hydronephrosis?

Purpose. It was to quantify the intraobserver and interobserver variability of the sonographic measurements of renal pelvis and classify hydronephrosis severity. Methods. Two ultrasonographers evaluated 17 fetuses from 23 to 39 weeks of gestation. Renal pelvis APD were taken in 50 renal units. For intraobserver error, one of them performed three sequential measurements. The mean and standard deviation from the absolute and percentage differences between measurements were calculated. Bland-Altman plots were used to visually assess the relationship between the precision of repeated measurements. Hydronephrosis was classified as mild (5.0 to 9.9 mm), moderate (10.0 to 14.9 mm), or severe (≥15.0 mm). Interrater agreement were obtained using the Kappa index. Results. Absolute intraobserver variation in APD measurements was 5.2 ± 3.5%. Interobserver variation of ultrasonographers was 9.3 ± 9.7%. Neither intraobserver or interobserver error increased with increasing APD size. The overall percentage of agreement with the antenatal hydronephrosis diagnosis was 64%. Cohen's Kappa to hydronephrosis severity was 0.51 (95% CI, 0.33 to 0.69). Conclusion. Inter and intraobserver APD measurement errors were low in these group, but the agreement to hydronephrosis diagnosis and classification was fair. We suggest that standard and serial APD measurement can better define and evaluate fetal hydronephrosis

Monitoring the temperature of the newborn through a wireless device with an alert system: development and proof of concept / Monitoramento da temperatura do recém-nascido através de um dispositivo sem fio com sistema de alertas: desenvolvimento e prova de conceito

Introduction: The maintenance of the newborn temperature is one of the most relevant factors for his survival. Maintaining thermal control prevents several complications related to hypothermia and hyperthermia and reduces the chance of dying from different causes. Temperature monitoring systems are common in neonatal intensive care units. However, outside of this environment, the detection of hypothermia is still a challenge.Objective: The objective of the study is to develop a prototype neonatal temperature monitoring system to alert thermal uncontrolled.Method: In an observational cohort study, the temperature of 21 newborns was monitored in a conventional manner and by a new monitoring system under test. All were born with a gestational age above 35 weeks, healthy and were accommodated in a joint accommodation ward, in a public university maternity hospital. To this end, a prototype system consisting of a temperature sensor, a Wi-Fi emitter and a data collection and processing center was developed. The value measured by the prototype was hidden, as well as the warnings of thermal uncontrolled. The reliability of the temperature sensor was evaluated in an experiment that compared measurements made by the sensor with that of a conventional thermometer. In a real scenario, the temperature sensor was affixed to the skin of the newborn's infra-axillary region, the temperature being automatically measured every 10 minutes. The performance of the prototype was evaluated by comparing the episodes of thermal uncontrolled detected by the two measurement techniques, in relation to the closest pair of measures. The total set of measurements of the prototype was also analyzed. Hypothermia was characterized by temperature <36.5ºC and hyperthermia> 37.5ºC. The Kappa concordance analysis compared the results of the two measurement modes.Results: The temperature measured by the prototype sensor and the conventional digital thermometer had an intraclass correlation coefficient = 1. In the care scenario, the average time to monitor the temperature of the newborns was 22:36 hours. The difference between the 115 pairs of measures performed by nursing in relation to those recorded by the prototype averaged 0.014 ºC (SD = 0.14). Comparing the measurement pairs, hypothermia was detected by nursing in 14 (66.7%) newborns and by the prototype in 15 (71.5%) newborns, Kappa index = 0.889. When all measurements performed by the real-time monitoring system were considered, hypothermia was recorded in 520/2809 (28.8%) measurements, while by the intermittent mode, hypothermia was recorded in 30/115 (26.8%). There were three episodes of hypothermia or hyperthermia detected by the new device, at times not monitored by nursing.Conclusions: Temperature monitoring by a computerized system detected more thermal abnormalities than the conventional method. The developed prototype demonstrated its potential to offer continuous and simultaneous monitoring to a group of newborns hospitalized in a maternity unit.  

Modelo de Objetos do openEHR: uma Revisão Sistemática da Literatura e sua relação com métricas de software

Dos principais padrões em sistemas de Registro Eletrônico de Saúde (RES), destaca-se a abordagem da Fundação openEHR. Este trabalho apresenta uma Revisão Sistemática da Literatura dos estudos que utilizam esta abordagem com ênfase na utilização do seu Modelo de Objetos. A pesquisa foi realizada nas bases de dados internacionais com base em quatro questões de pesquisa e critérios de inclusão e exclusão definidos. Entre os resultados obtidos, foi possível observar que o continente europeu é o maior centro dos estudos relacionados com a abordagem openEHR, com exceção da Austrália na Oceania. Pode-se concluir que uma versão estável da especificação openEHR contribuiu para o aumento de estudos a partir de 2008. Em relação às métricas de software aplicadas ao modelo do openEHR, até a realização deste trabalho, não se observaram estudos dessa natureza. Além disso, esta revisão possibilitou relacionar as ferramentas para coleta de métricas disponíveis na literatura

Estudo piloto de validação de um chatbot de rastreamento, implementado para direcionar a teleassistência em COVID-19 / Pilot validation of a frontline chatbot to face COVID-19 using telehealth assistance

A pandemia do novo coronavírus  tem sobrecarregado os sistemas de saúde ao limite da capacidade de atendimento. Nosso objetivo foi avaliar a eficácia de um chatbot desenvolvido para triagem de pacientes, antes de teleconsulta, para identificar sintomas de COVID-19. Sintomas informados no diálogo foram comparados com os relatados aos médicos, em um serviço de urgência. Em 96 pacientes, dispneia foi o sintoma mais frequente (16,6%) e o único que mostrou concordância moderada com a história registrada em prontuário eletrônico (Kappa=0,605). Concluindo, a tecnologia mostrou-se útil para detectar um dos sintomas graves da COVID-19, mas não foi possível evidenciar sua eficácia em relação aos sintomas menore