Methylene Blue to Neonatal Septic Shock treatment in neonate pigs,

Objective: The authors design an animal model of neonatal sepsis to analyze the treatment of neonatal septic shock with Methylene Blue (MB) in a swine model. Methods: The study design included twenty male newborn pigs divided into four groups: 1) The control group; 2) The sepsis group (induced with lipopolysaccharide); 3) The MB group, and 4) The MB-treated sepsis group. Septic shock was defined as Blood Pressure (BP) dropping 20% below the baseline value. Continuous Blood Pressure (BP), Nitric Oxide (NO) levels, cyclic Guanosine Monophosphate (cGMP), malondialdehyde acid, base excess, lactate, arterial blood gases, hematocrit, and echocardiography were analyzed. Results: The BP of the sepsis group treated with MB showed a slight improvement in the first hour after treatment; however, a significant difference was not observed compared to the untreated sepsis group. Besides hemodynamic stability, the current study did not show symptomatic pulmonary hypertension, suggesting that MB was safe in neonates and children. An improvement in Base Excel (BE) levels after MB administration in septic animals may indicate a possible improvement in microcirculation. Conclusion: The MB improved biomarkers related to septic shock prognosis, although an improvement in the blood levels could not be detected. MB might be a beneficial drug for hemodynamic instability in infants

Factors Associated With Red Blood Cell Transfusions In Very-low-birth-weight Preterm Infants In Brazilian Neonatal Units

Background: Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants. Methods: A prospective cohort of 4283 preterm infants (gestational age: 29.9 +/- 2.9 weeks; birth weight: 1084 +/- 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis. Results: A total of 2208 (51.6 %) infants received RBC transfusions (variation per neonatal unit: 34.1 % to 66.4 %). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95% CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), > 60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born. Conclusions: The frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants.1

Frequência de retinopatia da prematuridade em recém-nascidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo Frequency of retinopathy of prematurity at newborns at the Clinical Hospital, Ribeirão Preto Medical School, University of São Paulo

OBJETIVOS: Determinar a frequência de retinopatia da prematuridade no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP) e verificar a associação da retinopatia da prematuridade com fatores de risco conhecidos. MÉTODOS: Foi realizada análise prospectiva de 70 pacientes, nascidos no HCFMRP-USP, com peso inferior a 1.500 gramas, no período de um ano. Os pacientes foram divididos em dois grupos (Retinopatia da prematuridade e Normal) para realização de análise estatística com relação a fatores de risco conhecidos. Adotou-se nível de significância de 5%. RESULTADOS: A frequência de retinopatia da prematuridade foi de 35,71% entre os pré-termos estudados. Os fatores pesquisados que apresentaram relação de risco para o desenvolvimento da doença foram: peso (p=0,001), idade gestacional (p=0,001), escore SNAPPE II (p=0,008), uso de oxigenoterapia por intubação (p=0,019) e por pressão positiva de vias aéreas (p=0,0017), múltiplas transfusões sanguíneas (p=0,01) e uso de diuréticos (p=0,01). CONCLUSÃO: A frequência de retinopatia da prematuridade foi de 35,71% entre os prétermos nascidos com menos de 1.500 g. Vários fatores de risco foram identificados nos recém-nascidos do HCFMRP-USP, sendo constatado que crianças mais pré-termos apresentam formas mais graves de retinopatia da prematuridade.<br>PURPOSE: To determine the frequency of retinopathy of prematurity at the Clinical Hospital of Ribeirão Preto Medical School (HCFMRP-USP) and verify the association of retinopathy of prematurity with known risk factors. METHODS: Prospective analysis of 70 patients born in the HCFMRP-USP, weighing less than 1,500 grams, in a period of 1 year. The patients were divided into 2 groups (Retinopathy of prematurity and Normal) to verify the association of retinopathy of prematurity and known risk factors. Significance level of 5% was used. RESULTS: The frequency of retinopathy of prematurity was 35.71% among the study population. The studied risk factors significantly related to the development of the disease were: weight (p=0.001), gestational age (p=0.001), score SNAPPE II (p=0.008), use of oxygen by intubation (p=0.019) and continuous positive airway pressure (p=0.0017), multiple blood transfusions (p=0.01), and the use of diuretics (p=0.01). CONCLUSION: The frequency of retinopathy of prematurity was 35.71% and several risk factors have been identified in newborns in the HCFMRP-USP, being evidenced that the more preterm, the more severe retinopathy of prematurity is likely to be

Death Or Survival With Major Morbidity In Vlbw Infants Born At Brazilian Neonatal Research Network Centers

Objective: To analyze unfavorable outcomes at hospital discharge of preterm infants born at Brazilian public university centers.Methods: Prospective cohort of 2646 inborn infants with gestational age 23-33 weeks and birth weight 400-1499g, without malformations, born at 20 centers in 2012-2013. Unfavorable outcome was defined as in-hospital death or survival at hospital discharge with 1 major morbidities: bronchopulmonary dysplasia (BPD) at 36 corrected weeks, intraventricular hemorrhage (IVH) grades 3-4, periventricular leukomalacia (PVL) or surgically treated retinopathy of prematurity (ROP).Results: Among 2646 infants, 1390 (53%) either died or survived with major morbidities: 793 (30%) died; 497 (19%) had BPD; 358 (13%) had IVH 3-4 or PVL; and 84 (3%) had ROP. Logistic regression adjusted by center showed association of unfavorable outcome with: antenatal steroids (OR 0.70; 95%CI 0.55-0.88), C-section (0.72; 0.58-0.90), gestational age <30 (4.00; 3.16-5.07), being male (1.44; 1.19-1.75), small for gestational age (2.19; 1.72-2.78), 5th-min Apgar <7 (3.89; 2.88-5.26), temperature at NICU admission <36.0 degrees C (1.42; 1.15-1.76), respiratory distress syndrome (3.87; 2.99-5.01), proven late sepsis (1.33; 1.05-1.69), necrotizing enterocolitis (3.10; 2.09-4.60) and patent ductus arteriosus (1.69; 1.37-2.09).Conclusions: More than half of the VLBW infants born at public university level 3 Brazilian hospitals either die or survive with major morbidities.2961005100

Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units

Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants. A prospective cohort of 4283 preterm infants (gestational age: 29.9 ± 2.9 weeks; birth weight: 1084 ± 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis. A total of 2208 (51.6%) infants received RBC transfusions (variation per neonatal unit: 34.1% to 66.4%). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95%CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), >60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born. The frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants

T-piece versus self-inflating bag ventilation in preterm neonates at birth

Objective To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. Design Pragmatic prospective cohort study. Setting 20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded. Interventions Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalada. Logistic regression adjusted for confounding variables was applied for main outcome. Results 1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 +/- 277 vs 941 +/- 279 g, gestational age 28.2 +/- 2.5 vs 27.8 +/- 2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%, Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% Cl 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695). Conclusion This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.Univ Fed Sao Paulo, Div Neonatal Med, Sao Paulo, BrazilUniv Sao Paulo, Dept Pediat, Fac Med Ribeirao Preto, Ribeirao Preto, BrazilUniv Fed Maranhao, Dept Pediat, Sao Luis, BrazilUniv Estadual Campinas, Dept Pediat, Fac Ciencias Med, Campinas, SP, BrazilUniv Sao Paulo, Dept Pediat, Fac Med, Sao Paulo, BrazilUniv Estadual Paulista, Div Neonatol, Fac Med Botucatu, Botucatu, SP, BrazilFundacao Oswaldo Cruz, Div Neonatol, Rio De Janeiro, BrazilPontificia Univ Catolica Rio Grande do Sul, Dept Pediat, Hosp Sao Lucas, Fac Med, Porto Alegre, RS, BrazilUniv Fed Rio Grande do Sul, Div Neonatol, Hosp Clin Porto Alegre, Porto Alegre, RS, BrazilUniv Estado Rio de Janeiro, Dept Pediat, Hosp Univ Pedro Ernesto, Rio De Janeiro, BrazilUniv Fed Minas Gerais, Div Neonatol, Belo Horizonte, MG, BrazilUniv Fed Uberlandia, Pediat, Uberlandia, MG, BrazilMaternidade Hilda Brandao, Dept Pediat, Fac Ciencias Med Minas Gerais, Belo Horizonte, MG, BrazilUniv Sao Paulo, Sch Med, Dept Pediat, Sao Paulo, SP, BrazilHosp Estadual Sumare, Neonatal Div, Sumare, BrazilHosp Geral Pirajussara, Neonatal Unit, Taboao Da Serra, BrazilHosp Estadual Diadema, Neonatal Unit, Diadema, BrazilUniv Estadual Londrina, Dept Pediat, Hosp Univ, Curitiba, Parana, BrazilUniv Fed Parana, Dept Pediat, Hosp Clin, Curitiba, Parana, BrazilInst Med Integral Prof Fernando Figueira, Dept Pediat, Recife, PE, BrazilInst Fernandes Figueira FIOCRUZ, Dept Pediat, Rio De Janeiro, BrazilUniv Fed Sao Paulo, Div Neonatal Med, Sao Paulo, BrazilWeb of Scienc

EVALUATION OF USABILITY OF A NEONATAL HEALTH INFORMATION SYSTEM ACCORDING TO THE USER’S PERCEPTION

ABSTRACT Objective: To 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. Methods: 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. Results: 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. Conclusion: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users