Developmental care: protection approach for early development of preterm infants

OBJETIVO: Revisar ensaios clínicos randomizados, publicados entre 2002 e 2009, sobre a eficácia de intervenções em Cuidado ao Desenvolvimento em recém-nascidos pré-termo em Unidade de Terapia Intensiva Neonatal. FONTES DE DADOS: Foram selecionados estudos randomizados dos bancos de dados Medline, PsycINFO, ISI Web of Science, LILACS e SciELO, usando-se as palavras-chave "developmental care" e "neonate". Realizou-se uma análise metodológica dos estudos, com base nos critérios: randomização, estimativa do tamanho amostral, perda amostral, critérios de inclusão e exclusão, controle de variáveis de confusão, validade dos instrumentos, condição "cega" do pesquisador, realização de seguimento, validades externa e ecológica e cuidados éticos. SÍNTESE DOS DADOS: As intervenções em Cuidado ao Desenvolvimento promoveram melhora em curto prazo nos resultados fisiológicos, comportamentais, neurológicos e clínicos dos recém-nascidos. Observou-se diminuição da reatividade à dor nos recém-nascidos durante procedimentos de pesagem e troca de fraldas. Os pais que receberam intervenções em Cuidado ao Desenvolvimento passaram a apresentar maior senso de competência para cuidar do recém-nascido. Os profissionais treinados em Cuidado ao Desenvolvimento demonstraram melhor desempenho na assistência ao recém-nascido e valorizaram mais os estímulos ambientais, físicos e sociais. CONCLUSÕES: Intervenções em Cuidado ao Desenvolvimento na Unidade de Terapia Intensiva Neonatal promoveram benefícios ao desenvolvimento e saúde dos recém-nascidos pré-termo no período neonatal e no primeiro ano de vida. Em estudos futuros, recomenda-se maior rigor metodológico no que se refere à condição de pesquisador "cego" em relação às intervenções e controle das variáveis de confusão. Estudos prospectivo-longitudinais são necessários para avaliar a eficácia das intervenções em médio e longo prazo no desenvolvimentoABSTRACT OBJECTIVE: To review randomized clinical trials published from 2002 to 2009 focusing on the efficacy of Developmental Care interventions in preterm infants in a Neonatal Intensive Care Unit. DATA SOURCE: Randomized trials were selected from Medline, PsycINFO, ISI Web of Science, LILACS, and SciELO databases using the keywords "developmental care" and "neonate". A critical methodological analysis of the studies was performed based on the following criteria: random allocation, estimate of sample size, drop-out sample, inclusion and exclusion criteria, control of confounding variables, validity of instruments, researcher "blind" condition for intervention group, presence of follow-up, external and ecological validities, and ethical approval. DATA SYNTHESIS: The Developmental Care interventions improved short-term outcomes as physiological, behavioral, neurological and clinical status of newborns. Decreased infants' pain reactivity was noted during weighing and diaper change procedures. Parents exposed to Developmental Care interventions showed higher sense of competence to take care of the newborns. The staff trained in Developmental Care interventions showed better performance when looking after infants and paid more attention to the environmental, physical and social stimuli. CONCLUSIONS: The Developmental Care interventions in a Neonatal Intensive Care Unit promoted beneficial effects on development and health of preterm infants in the neonatal period and the first year of life. In future studies, a higher methodological control of blindness of intervention and confusion variables is recommended. Prospective-longitudinal studies should address the evaluation of this intervention on medium- and long-term developmental outcome

Water immersion vs. air insufflation in canine duodenal endoscopy: is the future underwater?

Endoscopy represents a commonly employed technique for canine enteropathies. Different trials in human intestinal endoscopy have suggested that the introduction of water for luminal distension, in place of air, improves the visualization of the mucosal texture and decreases pain. The aim of the study was to compare water immersion (WI) vs. air insufflation (AI) during duodenoscopy in anesthetized dogs in terms of mucosal visualization and nociception. Twenty-five dogs undergoing duodenoscopy were included. The same image of the descending duodenum was recorded applying WI and AI. Each pair of images was analyzed using morphological skeletonization, an image entropy evaluation, and a subjective blind evaluation by three experienced endoscopists. To evaluate differences in nociception related to the procedure applied, heart rate and arterial blood pressure were measured before, during and after WI/AI. To compare the two methods, a t-test for paired data was applied for the image analysis, Fleiss\u2019 Kappa evaluation for the subjective evaluation and a Friedman test for anesthetic parameters. No differences were found between WI and AI using morphological skeletonization and entropy. The subjective evaluation identified the WI images as qualitatively better than the AI images, indicating substantial agreement between the operators. No differences in nociception were found. The results of the study pointed out the absence of changes in pain response between WI and AI, likely due to the sufficient control of nociception by the anesthesia. Based on subjective evaluation, but not confirmed by the image analysis, WI provided better image quality than AI

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening