RESUMEN
Orotracheal intubation and mechanical ventilation (MV) have become routine practices in intensive care units. Unplanned extubation (UE) is one of the most important complications, particularly in premature infants and critically ill newborns. The objective of this study was to determine the prevalence of UE in a tertiary care neonatal intensive care unit (NICU). In this analytical cross-sectional retrospective study, all data, including perinatal data, indications for ventilatory support, days of MV at the time of UE, work shift, month of the event, reintubation, and postextubation complications, were obtained from the manual review of clinical charts. In total, 151 neonates, who received invasive MV, were included in this study. The prevalence of UE was 2.0/100 days of ventilation. The most affected were premature infants, with a gestational age of ≤ 32 weeks (54.7%) and a birth weight of ≤ 1500 g. The main cause for UE was deficient fixation of the endotracheal tube (ETT) (27.7%). Most UE events occurred during night shifts (48.1%). Reintubation was required in 83.3% of newborns. Immediate complications developed in 96.3% of the UE events, including desaturation (57.7%) and bradycardia (36.5%). The prevalence of UE was high, particularly in premature infants, with a high rate of reintubation and immediate complications. Standardized protocols for ETT care must be implemented to reduce these events.
Asunto(s)
Extubación Traqueal , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Intubación Intratraqueal , Respiración Artificial , Humanos , Recién Nacido , Estudios Transversales , Estudios Retrospectivos , Extubación Traqueal/efectos adversos , Extubación Traqueal/estadística & datos numéricos , Prevalencia , Femenino , Intubación Intratraqueal/estadística & datos numéricos , Masculino , Respiración Artificial/estadística & datos numéricos , Edad Gestacional , Centros de Atención Terciaria , Atención Terciaria de SaludRESUMEN
OBJECTIVES: this study aims to explore neonatal nurses' experiences of facilitating early bonding between mothers and premature babies. METHOD: a descriptive qualitative approach was adopted, using focus group discussions with 13 participants from four referral hospitals in a major city in a developing country. This was followed by in-depth interviews with three participants. RESULTS: three main themes emerged, highlighting the barriers and facilitators to early bonding between mothers and preterm infants. The study also explored care practices aimed at facilitating early bonding within the social environment of preterm infants, involving mothers, families, nurses and hospitals. CONCLUSIONS: the barriers and facilitators identified inform the development of intervention strategies for neonatal nurses to promote early bonding. Optimal early bonding requires enhanced nurse management skills, adequate hospital infrastructure and involvement of the patient's family. These findings contribute to the advancement of health and nursing knowledge.
Asunto(s)
Recien Nacido Prematuro , Relaciones Madre-Hijo , Apego a Objetos , Investigación Cualitativa , Humanos , Femenino , Recién Nacido , Adulto , Enfermería Neonatal , MasculinoRESUMEN
Aim: Promoter methylation of LINE-1 may be affected by prematurity, but there is little evidence in the literature.Materials & methods: Blood from premature and full-term neonates on days 0, 5, 30 and 90 was analyzed for DNA methylation percentage in a promoter region of the LINE-1, after bisulfite conversion and pyrosequencing.Results: Premature infants, as a whole, showed significantly lower methylation percentage at birth, but this difference diminished over time. However, the subgroup of extremely premature (<28 weeks gestational age) had higher methylation percentages, similar to full-term newborns.Conclusion: This research underscores the critical role of prematurity on the methylation pattern of LINE-1. These findings underline the complexity of epigenetic regulation in prematurity and emphasize the need for further studies.
Premature birth can have significant effects on a baby's development and long-term health. This study investigates how being born prematurely affects a process called DNA methylation, which can influence how genes are turned on or off. Specifically, we examined the LINE-1 promoter, a frequently occurring region of DNA known for its role in regulating gene activity.We collected blood samples from both premature and full-term newborns at birth and at several points in the early months of life. Our findings showed that premature babies have lower levels of LINE-1 promoter methylation at birth compared with full-term babies. These differences in methylation could possibly affect the babies' development and health as they grow.Our research highlights the need for continued study in this area to explore how these epigenetic changes impact long-term health and to develop strategies to mitigate these effects.
Asunto(s)
Metilación de ADN , Recien Nacido Prematuro , Elementos de Nucleótido Esparcido Largo , Regiones Promotoras Genéticas , Humanos , Recién Nacido , Femenino , Masculino , Epigénesis Genética , Edad GestacionalRESUMEN
One in ten babies are born preterm, as defined as being less than 37 weeks of gestational age. Premature births are associated with a high risk of poor neurodevelopmental outcomes, including hearing, visual, motor, and cognitive impairments. Currently, there is no specific standardization for neurological follow-up infants born premature. Most formal neonatal intensive care units, follow-up programs monitor children until early childhood. However, some deficits, such as mild cognitive impairment, may only become apparent in school years. This review outlines a neurological follow-up timeline, as well as the different standardized measures that can be used to monitor development to ensure that children born preterm receive timely and appropriate therapies and services.
Uno de cada diez bebés nacidos es prematuro, el cual se define como el nacido antes de las 37 semanas de edad gestacional. La prematuridad está asociada con un alto riesgo de trastornos del neurodesarrollo con limitaciones en la audición, visión, área cognitiva y motora. Actualmente, no existen programas estandarizados específicos para el seguimiento neurológico de los prematuros. La mayoría son desarrollados por las unidades de cuidados intensivos neonatales y dan seguimiento hasta la edad pre-escolar. Sin embargo, algunas deficiencias, como el deterioro cognitivo leve, son reconocidos tardíamente. Esta revisión describe un cronograma para el seguimiento neurológico y las herramientas estandarizadas que pueden utilizarse para vigilar el desarrollo y asegurar que los niños nacidos prematuros reciban terapias y otros servicios adecuados y oportunos.
Asunto(s)
Recien Nacido Prematuro , Humanos , Recién Nacido , Estudios de Seguimiento , Unidades de Cuidado Intensivo Neonatal , Trastornos del Neurodesarrollo , Examen Neurológico/métodos , Examen Neurológico/normas , Guías de Práctica Clínica como AsuntoRESUMEN
Intracranial hemorrhage continues to be a prevalent pathology in preterm newborns, especially in those with lower gestational age and birth weight. It occurs more frequently in the first days of life, and the severity of bleeding is directly related to the degree of immaturity and other conditions of the patient. Intracranial hemorrhage is associated with a significant increased risk of mortality and, in those who survive, it is associated with an increased risk of neurodevelopmental disorders and long-term disability. Establishing an accurate prognosis is essential but frequently it is difficult to assay, dealing with uncertainty that healthcare team and the family must consider when they have to decide about the goals of care to provide to the newborn, including withholding or withdrawing life support treatments. Reflections regarding the best interest of the newborn, the complexity of quality-of-life, end-of-life shared decision-making process, uncovered biases, parental values, emotions, preferences and hopes, should be included in these challenging bioethical considerations and communications with the family.
La hemorragia intracraneana sigue siendo una enfermedad prevalente en los recién nacidos prematuros, especialmente en aquellos con menor edad gestacional y peso al nacer. Ocurre más frecuentemente en los primeros días de vida y la gravedad del sangrado se relaciona directamente con el grado de inmadurez y otras condiciones que afectan al paciente. La hemorragia intracraneana se asocia a un riesgo significativamente mayor de mortalidad y, en los que sobreviven, con un mayor riesgo de trastornos del neurodesarrollo y discapacidad a largo plazo. Establecer un pronóstico certero es esencial, pero frecuentemente es difícil de determinar, y el equipo de salud y la familia deben enfrentarse con la incertidumbre al momento de decidir acerca de los objetivos de los cuidados para el recién nacido, incluyendo la posible abstención o suspensión de tratamientos de soporte vital. Reflexiones relacionadas con el mejor interés del recién nacido, la complejidad de pronosticar su calidad de vida, el proceso de toma de decisiones sobre el final de la vida, los sesgos subyacentes, los valores, emociones, preferencias y expectativas de los padres, deben ser incluidos en este escenario difícil desde el punto de vista bioético y en las comunicaciones con la familia.
Asunto(s)
Recien Nacido Prematuro , Humanos , Recién Nacido , Privación de Tratamiento/ética , Calidad de Vida , Índice de Severidad de la Enfermedad , Hemorragia Cerebral/terapia , Pronóstico , Edad GestacionalRESUMEN
To stratify groups of infants by gestational age and identify the lower limit of normal (LLN) of the cross-sectional area of peripheral muscles as well as diaphragmatic excursion and thickness and parasternal activation during spontaneous respiration in full-term and preterm newborns. A cross-sectional study was conducted at a neonatal unit. Preterm newborns (PTNBs) with gestational age of 28 to 366/7 weeks and full-term newborns (NBs) with gestational age of 37 to 416/7 weeks, clinically and hemodynamically stable, breathing ambient air with no signs of respiratory distress were included. NBs on oxygen therapy, those with known genetic syndromes, malformations of the nervous system and those having undergone surgery were excluded. Ultrasound was performed over the rectus femoris, tibialis anterior, and biceps brachii muscles (cross-sectional area) and diaphragm (thickness and excursion). One hundred twenty NBs were stratified based on gestational age (< 30 weeks [n = 25]; 31 to 35 weeks [n = 51]; 37 to 41 6/7 weeks [n = 44]). Significant differences were found in the cross-sectional area of the rectus femoris muscles and thigh circumference of NBs > 37 weeks compared to the other 2 groups (p < 0.05). Differences were found in diaphragm thickness and excursion between the groups with gestational age > 37 weeks and < 30 weeks. Greater activation of the parasternal muscles was found in the PTNBs. With regard to LLN, significant differences were found between the groups with gestational age > 37 weeks and < 30 weeks for all variables analyzed and between the group with gestational age > 37 weeks and other 2 groups for the cross-sectional area of the rectus femoris, diaphragmatic excursion, and diaphragm contraction velocity. Differences were found among the groups in the size of peripheral muscles as well as diaphragm thickness and excursion. Moreover, greater activation of the parasternal muscle was found in NBs with gestational age < 30 weeks. This study establishes normal values of ultrasound measures for full-term and preterm newborns.
Asunto(s)
Diafragma , Edad Gestacional , Recien Nacido Prematuro , Ultrasonografía , Humanos , Estudios Transversales , Diafragma/diagnóstico por imagen , Diafragma/anatomía & histología , Recién Nacido , Masculino , Ultrasonografía/métodos , Femenino , Valores de Referencia , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/anatomía & histologíaRESUMEN
Aim: To evaluate the urinary biomarkers related to sepsis in preterm newborns (NBs) and to investigate the predictive capacity of these biomarkers for a longer hospital stay.Methods: Serum and urine were collected from 27 healthy NBs, 24 NBs with neonatal infection without sepsis and 11 NBs with sepsis for the measurement of sindecan-1, lipocalin associated with urinary neutrophil gelatinase (uNGAL), urinary cystatin-C (uCysC) and urinary kidney injury molecule-1.Results: Levels of uNGAL and urinary cystatin-C were elevated in NBs with sepsis and neonatal infection, and uNGAL was significant predictor of hospital stay longer than 30 days (odds ratio: 1.052; 95% CI: 1.012-1.093; p = 0.01).Conclusion: uNGAL was associated with sepsis in preterm NBs and was useful to predict extended hospital stay.
[Box: see text].
Asunto(s)
Biomarcadores , Cistatina C , Recien Nacido Prematuro , Tiempo de Internación , Lipocalina 2 , Sepsis , Humanos , Recién Nacido , Cistatina C/sangre , Cistatina C/orina , Lipocalina 2/orina , Lipocalina 2/sangre , Biomarcadores/orina , Biomarcadores/sangre , Sepsis/orina , Sepsis/diagnóstico , Sepsis/sangre , Masculino , Femenino , Recien Nacido Prematuro/orina , Proteínas de Fase Aguda/orina , Proteínas Proto-Oncogénicas/orina , Proteínas Proto-Oncogénicas/sangreRESUMEN
This study aimed to analyze the association between sociodemographic factors, maternal and neonatal characteristics and the time taken to introduce complementary feeding in low birthweight and preterm newborns. This is a prospective cohort study of 79 preterm newborns weighing less than or equal to 1,800g. Data were collected at the time of hospital discharge and at the 6th, 9th ,and 12th months of corrected gestational age (CGA), using a structured questionnaire to analyze the time taken to introduce complementary feeding and the texture of the foods introduced. Furthermore, the Survey of Well-being of Young Children (SWYC-BR) was used to assess the risk of developmental delay. Cox proportional hazards regression was used to analyze the variables. The introduction of complementary feeding was assessed in preterm newborns based on the median age of introduction of liquid foods (3.50; IQR: 2.50-5.00), followed by solid (4.70; IQR: 3.20-5.20) and soft foods (5.00; IQR: 4.50-5.50). There was also an association with gestational age (RR = 1.25; 95%CI: 1.02-1.52) throughout the process of food introduction. For solid and soft foods, those with the longest length of stay (RR = 1.03; 95%CI: 1.10-1.05) and on mixed breastfeeding (RR = 2.97; 95%CI: 1.24-7.09) delayed the introduction of complementary feeding the longest. For liquid foods, less severe preterm newborns (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0.96; 95%CI: 0.94-0.98]) and mothers who were breastfeeding at hospital discharge (RR = 11.49; 95%CI: 1.57-84.10) delayed the introduction of complementary feeding. Guidelines are needed to better advise professionals and parents and/or guardians on the ideal time to introduce feeding.
O objetivo deste artigo foi analisar a associação entre os fatores sociodemográficos, as características maternas e neonatais e o tempo de introdução da alimentação complementar em recém-nascidos pré-termo e com baixo peso. Trata-se de um estudo de coorte prospectivo feito com 79 recém-nascidos pré-termo com peso menor ou igual a 1.800g. Os dados foram coletados no momento da alta hospitalar e ao 6º, 9º e 12º mês de idade gestacional corrigida (IGC), com auxílio de um questionário estruturado para analisar o tempo de introdução da alimentação complementar e texturas dos alimentos introduzidos. Além disso, para avaliar o risco de atraso de desenvolvimento, utilizou-se o Survey of Well-being of Young Children (SWYC-BR). Para análise das variáveis, aplicou-se regressão de riscos proporcionais de Cox. A introdução da alimentação complementar foi observada nos recém-nascidos pré-termo, com a mediana de idade de introdução de alimentos líquidos (3,50; IQ: 2,50-5,00), seguido por sólidos (4,70; IQ: 3,20-5,20) e pastosos (5,00; IQ: 4,50-5.50). Ainda, verificou-se associação da idade gestacional (RR = 1.25; IC95%: 1,02-1,52) em todo o processo da introdução alimentar. Para os alimentos sólidos e pastosos, aqueles com o maior tempo de internação (RR = 1,03; IC95%: 1,10- 1,05) e em amamentação mista (RR = 2,97; IC95%: 1,24-7,09) adiaram mais o tempo para introduzir a alimentação complementar. Para alimentos líquidos, recém-nascidos pré-termo menos graves (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0,96; IC95%: 0,94-0,98]) e mães que estavam amamentando na alta hospitalar (RR = 11,49; IC95%: 1,57-84,10) postergaram a introdução alimentar. Diretrizes para melhor orientação de profissionais e pais e/ou responsáveis sobre o momento ideal de introdução alimentar se faz necessário.
El objetivo de este estudio fue analizar la asociación entre los factores sociodemográficos, características maternas y neonatales y el momento de introducción de la alimentación complementaria en recién nacidos pretérmino (recém-nascidos pré-termo) y de bajo peso. Se trata de un estudio de cohorte prospectivo realizado con 79 recém-nascidos pré-termo con un peso menor o igual a 1.800g. Los datos se recopilaron en el momento del alta hospitalaria y al 6º, 9º y 12º mes de edad gestacional corregida (EGC), con la ayuda de un cuestionario estructurado para analizar el momento de introducción de la alimentación complementaria y las texturas de los alimentos introducidos. Además, para evaluar el riesgo de retraso en el desarrollo, se utilizó la Survey of Well-being of Young Children (SWYC-BR). Para analizar las variables, se aplicó la regresión de riesgos proporcionales de Cox. La introducción de la alimentación complementaria se observó en los recém-nascidos pré-termo, con la mediana de edad de introducción de alimentos líquidos (3,50; IIC: 2,50-5,00), seguido de los sólidos (4,70; IIC: 3,20-5,20) y pastosos (5,00; IIC: 4,50-5,50). Además, se constató la asociación de la edad gestacional (RR = 1,25; IC95%: 1,02-1,52) durante todo el proceso de introducción alimentaria. En el caso de alimentos sólidos y pastosos, aquellos con mayor tiempo de hospitalización (RR = 1,03; IC95%: 1,10-1,05) y en lactancia mixta (RR = 2,97; IC95%: 1,24-7,09) retrasaron más la introducción de alimentación complementaria. En el caso de alimentos líquidos, los recém-nascidos pré-termo menos graves (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0,96; IC95%: 0,94-0,98]) y las madres que estaban amamantando al alta hospitalaria (RR = 11,49; IC95%: 1,57-84,10) pospusieron la introducción de alimentos. Se hacen necesarias pautas para una mejor orientación a profesionales y padres o tutores sobre el momento ideal para la introducción alimentaria.
Asunto(s)
Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Factores Socioeconómicos , Humanos , Estudios Prospectivos , Recién Nacido , Femenino , Masculino , Edad Gestacional , Lactante , Lactancia Materna/estadística & datos numéricos , Adulto , Alimentos Infantiles , Factores de TiempoRESUMEN
Introducción. La hernia de Amyand es una condición en la que el apéndice cecal está contenido dentro del saco herniario inguinal. Su diagnóstico y su manejo continúan siendo un reto al tratarse de una patología poco frecuente. Caso clínico. Lactante varón de 10 meses con antecedente de prematuridad extrema, quien presentó hernia de Amyand derecha con apéndice normal. Se retornó el apéndice a la cavidad y se procedió a la reparación de la hernia. Resultado. Después de un año de seguimiento, el paciente no presentó complicaciones. Conclusiones. Se ha reportado que el riesgo de incarceración en niños nacidos a término es del 12 % y en prematuros del 39 %, por tanto, la reparación quirúrgica de una hernia inguinal siempre es necesaria. No existe un tratamiento estándar para la hernia de Amyand en niños, por tanto, la clasificación CiX podría considerarse para el manejo. Se presenta una propuesta de tratamiento en la población pediátrica, donde se incluyeron 3 tipos, considerando el estadio evolutivo del apéndice cecal y que casi la totalidad de hernias inguinales en niños son debidas a persistencia del proceso vaginal, por tanto, el tratamiento quirúrgico solo incluye herniotomía. Al no utilizar material protésico, se facilita el manejo y se reduce el riesgo de infección.
Introduction. Amyand's hernia is a condition in which the cecal appendix is contained within the inguinal hernia sac, its diagnosis and management continue to be a challenge as it is a rare pathology. Case report. A 10-month-old male infant with a history of extreme prematurity presented a right Amyand's hernia and a normal appendix. The appendix was returned to the cavity and the hernia was repaired. Result. After one year of follow-up, the patient had no complications. Conclusions. Has been reported that the risk of incarceration in full-term children is 12% and in premature babies it is 39%, therefore, surgical repair of an inguinal hernia is always necessary. There is no standard treatment for Amyand hernia in children, therefore the CiX classification could be considered for management. A treatment proposal is presented in the pediatric population, where three types were included, considering the evolutionary stage of the cecal appendix and that almost all inguinal hernias in children are due to persistence of the vaginal process; therefore, surgical treatment only includes herniotomy. By not using prosthetic material, handling is facilitated and the risk of infection is reduced.
Asunto(s)
Humanos , Apendicitis , Recien Nacido Prematuro , Hernia Inguinal , Apéndice , Hernia , LactanteRESUMEN
The eHealth technologies promote parental care practices for preterm infants. Nonetheless, we should underscore the abundant information and available apps and disparities in these resources' quality, usability, and reliability. This article examines eHealth technologies directed at parents to care for preterm infants. An integrative review was conducted across the principal health databases (Capes, EBSCO, BVS, PubMed, Scholar, and SciELO), selecting works published from 2011 to 2022 in Portuguese and English, focusing on the use of eHealth technologies for the care of preterm infants. We identified 13 articles related to information and communication technologies in strategies for educating and promoting the health of preterm infants and their parents and the importance of evaluating and validating eHealth technologies in maternal and child health promotion. Properly validated eHealth technologies can be crucial in supporting parents in promoting health and providing care for preterm infants after hospital discharge, which, in turn, can drive the evolution of healthcare systems and improve clinical practices.
As tecnologias eHealth contribuem na promoção das práticas parentais de cuidado para bebês pré-termo. Não obstante, é notável a abundância de informações e aplicativos disponíveis, a disparidade na qualidade, facilidade de uso e confiabilidade desses recursos. Este artigo objetiva examinar as tecnologias eHealth direcionadas aos pais para o cuidado de bebês pré-termo. Realizou-se uma revisão integrativa nas principais bases de dados da área da saúde (Capes, EBSCO, BVS, PubMed, Scholar e SciELO), com a seleção de publicações de 2011 a 2022, em português e inglês, sobre a utilização de tecnologias eHealth voltadas aos cuidados de bebês pré-termo. Identificaram-se 13 artigos com temáticas sobre: as tecnologias da informação e comunicação nas estratégias de educação e a promoção da saúde de bebês pré-termo e seus pais; e importância da avaliação e validação das tecnologias eHealth na promoção da saúde materno-infantil. Tecnologias eHealth validadas adequadamente podem desempenhar um papel fundamental em apoiar os pais na promoção da saúde e na prestação de cuidados ao bebê pré-termo após a alta hospitalar. Isso, por sua vez, tem o potencial de impulsionar a evolução dos sistemas de saúde e a melhoria das práticas clínicas.
Asunto(s)
Recien Nacido Prematuro , Padres , Telemedicina , Humanos , Recién Nacido , Promoción de la Salud/métodos , Reproducibilidad de los Resultados , Aplicaciones MóvilesRESUMEN
Some systemic inflammatory indices have been reported to be associated with intracerebral hemorrhage in adults. However, the relationship between systemic inflammatory indices and intraventricular hemorrhage (IVH) in premature neonates is still not completely understood. OBJECTIVE: To evaluate the relationship between systemic inflammatory indices obtained on the first day of life in premature infants and the development of severe IVH. PATIENTS AND METHOD: Premature newborns < 32 weeks of gestational age were included. Eligible patients were divided into 2 groups: Group 1: without IVH or grade I and II hemorrhage, and Group 2: grade III and IV HIV. Demographic characteristics, clinical outcomes, monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), pan-immune inflammation value (PIV), and Systemic inflammation response index (SIRI) were compared between groups. RESULTS: A total of 1176 newborns were included in the study, 1074 in Group 1 and 102 premature babies in Group 2. There was no difference between the groups in terms of the count of leukocytes, neutrophils, monocytes, lymphocytes and platelets (p > 0.05). The values of NLR, MLR, PLR, PIV, SII and SIRI were similar in both groups (p > 0.05). CONCLUSION: While the relationship between inflammation, hemodynamics and IVH is still under discussion, our results show that systemic inflammatory indices have no predictive value for IVH.
Asunto(s)
Recien Nacido Prematuro , Inflamación , Humanos , Recién Nacido , Femenino , Masculino , Inflamación/sangre , Enfermedades del Prematuro/sangre , Enfermedades del Prematuro/diagnóstico , Hemorragia Cerebral/sangre , Hemorragia Cerebral/diagnóstico , Neutrófilos , Hemorragia Cerebral Intraventricular/sangre , Recuento de Plaquetas , Índice de Severidad de la Enfermedad , Monocitos/inmunología , Valor Predictivo de las Pruebas , Edad Gestacional , Biomarcadores/sangreRESUMEN
Preterm infants, especially those of lower gestational age (GA), are at high risk of hospital readmission in the early years. OBJECTIVE: To describe the frequency and characteristics of readmissions in preterm infants younger than 32 weeks of GA or weighing less than 1500 g (< 32w/< 1500 g) at 2 years post-discharge from neonatology. PATIENTS AND METHOD: Retrospective observational study of a cohort of newborns < 32w/< 1500 g discharged from a public health care center (2009-2017). The frequency, time of occurrence, risk factors, causes, and severity of hospital readmissions were analyzed. The respective perinatal characteristics and subsequent readmissions were described. The Ethics Committee approved the data collection protocol. RESULTS: 989 newborns < 32w/< 1500 g were included; 410 (41.5%) were readmitted at least once before the age of 2 years, equivalent to 686 episodes (1.7/child); 129 children (31.4%) were admitted to the Pediatric Intensive Care Unit (PICU), with a mean length of stay of 7.7 days. The greatest risk for hospital readmission was during the first 6 months post-discharge. The main cause was respiratory (70%) and respiratory syncytial virus was the most frequent germ. The risk factors associated with readmission due to respiratory causes were bronchopulmonary dysplasia (BPD) (OR: 1.73; 95%CI: 1.26-2.37) and number of siblings (OR: 1.18; 95%CI: 1.04-1.33). CONCLUSIONS: Newborns < 32s/< 1500 g are at high risk of hospital readmission due to respiratory causes and PICU admission in the first months post-discharge; BPD and number of siblings were the main risk factors.
Asunto(s)
Edad Gestacional , Recien Nacido Prematuro , Readmisión del Paciente , Humanos , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Recién Nacido , Femenino , Masculino , Factores de Riesgo , Lactante , Tiempo de Internación/estadística & datos numéricos , Alta del Paciente , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/terapia , PreescolarRESUMEN
PURPOSE: to verify the association between the perception of mothers of premature infants regarding the features that may interfere with breastfeeding and the mother's socioeconomic data, pregnancy and the baby's clinical data. METHODS: observational, descriptive and analytical quali-quantitative cross-sectional study. One hundred and fourteen mothers of premature infants were included and data were collected through questionnaires, applied at hospital discharge, and analysis of medical records. Maternal responses about the interference observed in the breastfeeding process were categorized by content analysis and associated with socioeconomic, pregnancy and baby data. RESULTS: the mothers' perceptions regarding the factors that interfere with the baby's feeding at the mother's breast were divided into four semantic categories: clinical and/or physical conditions of the baby; clinical, physical and/or psycho-emotional conditions of the mother; support network; and strategies for initiating and/or maintaining breastfeeding. Education, paternal presence, having other children and having breastfed them were associated with the maternal perception that their clinical, physical and/or psycho-emotional conditions interfere with breastfeeding. In addition, the support network was associated with exclusive breastfeeding at discharge. CONCLUSION: education, paternal presence, multiparity and having breastfed previous children influenced the maternal perception that their clinical, physical and/or psycho-emotional conditions interfere with breastfeeding. In addition, mention of the support network was associated with exclusive breastfeeding at discharge.
OBJETIVO: verificar a associação entre a percepção das mães de prematuros a respeito dos fatores que podem interferir no aleitamento e as características socioeconômicas da mãe, da gestação e clínicas do recém-nascido. MÉTODO: estudo qualiquantitativo observacional, descritivo e analítico do tipo transversal. Foram incluídas 114 mães de prematuros. Os dados foram coletados por meio de questionários, aplicados à alta hospitalar e análise dos prontuários. As respostas maternas sobre as interferências observadas no processo do aleitamento foram categorizadas por análise de conteúdo e associadas aos dados socioeconômicos, da gestação e do recém-nascido (RN). RESULTADOS: as percepções das mães quanto aos fatores que interferem na alimentação do RN ao seio materno foram divididas em quatro categorias semânticas: condições clínicas e/ou físicas do RN; condições clínicas, físicas e/ou psicoemocionais da mãe; rede de apoio; e estratégias para iniciar e/ou manter o aleitamento materno. Escolaridade, presença paterna, possuir outros filhos e tê-los amamentado apresentaram associação com a percepção materna de que suas condições clínicas, físicas e ou psicoemocionais interferem no aleitamento. Além disso, a rede de apoio esteve associada ao aleitamento materno exclusivo à alta. CONCLUSÃO: escolaridade, presença paterna, multiparidade e ter amamentado filhos anteriores influenciaram a percepção materna de que suas condições clínicas, físicas e ou psicoemocionais apresentam interferência no aleitamento. Além disso, a menção à rede de apoio esteve associada com o aleitamento materno exclusivo à alta.
Asunto(s)
Lactancia Materna , Recien Nacido Prematuro , Madres , Factores Socioeconómicos , Humanos , Lactancia Materna/psicología , Femenino , Estudios Transversales , Recién Nacido , Madres/psicología , Adulto , Encuestas y Cuestionarios , Percepción , Adulto Joven , Embarazo , MasculinoRESUMEN
Objetivo: Determinar la frecuencia de complicaciones materno-perinatales y factores clínicos asociados a estos resultados en estantes con lupus. Métodos: Se realizó un estudio de casos y controles a partir de historias clínicas de pacientes con diagnóstico Lupus Eritematoso Sistémico en embarazo, entre 2010-2022 en una institución de salud en Medellín-Colombia. Éstas se clasificaron como casos (pacientes con resultados adversos materno-perinatales) y controles (pacientes sin resultados adversos). Resultados: Se incluyó un total de 67 pacientes (35 casos y 32 controles). Las complicaciones maternas más frecuentes fueron los trastornos hipertensivos asociados al embarazo (71,4 %), incluyendo preeclampsia y una presentación importante de partos pretérmino (68,6 %). La nefritis lúpica previa y durante el embarazo, fue más frecuente en los casos que en los controles (31,4 % versus 9,4 %). Los compromisos cardiovasculares, de mucosas y musculo-esquelético, fueron más frecuentes durante el embarazo (31,4 %, 40 % y 34,3 %, respectivamente), coincidiendo con mayor actividad del lupus, principalmente durante el embarazo. El compromiso cardiovascular y de mucosas durante el embarazo, así como tener síndrome antifosfolípido se relacionaron con desenlace materno-perinatal adverso. Conclusión: Componentes clínicos propios de la enfermedad como la nefritis lúpica, el síndrome antifosfolípido, el compromiso cardiovascular, y de mucosas podrían predisponer a desenlaces maternos y/o perinatales adversos como trastornos hipertensivos asociados al embarazo, pretérmino, restricción de crecimiento fetal, entre otros(AU)
Objective: To determine the frequency of maternal-perinatal complications and the clinical factors associated with these outcomes in pregnant women with lupus. Methods: A case-control study was conducted using the medical records of patients diagnosed with pregnancy and lupus in a healthcare institution in Medellin, Colombia, between 2010 and 2022. The patients were classified as cases (patients with adverse maternal-perinatal outcomes) and controls (patients without adverse outcomes). Results: A total of 67 patients (35 cases and 32 controls) were included. The most frequent maternal complications were pregnancyassociated hypertensive disorders (71.4%), including preeclampsia and a significant presentation of preterm deliveries (68.6%). Lupus nephritis prior to and during pregnancy was more frequent in cases than in controls (31.4% versus 9.4%). Cardiovascular, mucosal and musculoskeletal compromises were more frequent during pregnancy (31.4%, 40% and 34.3%, respectively), coinciding with greater lupus activity, mainly during pregnancy. Cardiovascular and mucosal involvement during pregnancy, as well as having antiphospholipid syndrome, were related to adverse maternal-perinatal outcome. Conclusion: Clinical components of the disease such as lupus nephritis, antiphospholipid syndrome, cardiovascular and mucosal involvement, are factors that may predispose these patients to adverse maternal and/or perinatal outcomes, such as hypertensive disorders associated with pregnancy, low birth weight, preterm, fetal growth restriction, among others(AU)
Asunto(s)
Humanos , Femenino , Embarazo , Adolescente , Adulto , Complicaciones del Embarazo , Artritis/etiología , Enfermedades Autoinmunes , Hipertensión Inducida en el Embarazo , Lupus Eritematoso Sistémico/complicaciones , Trastornos por Fotosensibilidad/etiología , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Mujeres EmbarazadasRESUMEN
OBJECTIVES: To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. METHODS: The authors studied 4062 surviving very preterm infants born < 32 weeks' gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. RESULTS: Infants' mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: -2.0, -1.8, and -1.5; head z: -1.3, -1.2 and -1.1 for exclusive human milk, mixed and exclusive formula respectively). CONCLUSION: Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time.