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Abstract Objective: To evaluate the association between dose of skin-to-skin contact (SSC) per day and initiation time with the occurrence of deaths in newborns with weight up to 1800g. Method: Multicentric cohort in five Brazilian neonatal units, including newborns with a birth weight of ≤1800g. The time of SSC was registered in individual file, by the team or family during the hospitalization. Maternal and newborn data were obtained through questionnaires applied to mothers and in medical records. Classification Tree was used for data analysis. Results: The performance of the first SSC after 206h was significantly associated with death (p = 0.02). Although there was no association between SSC/day and death (p = 0.09), the number of deaths among those who performed more than 146.9 minutes/day was lower (3;1.5%) than among those who performed this practice for a shorter time (13;6.4%), a fact considered of great clinical importance. Early and late infections present statistically significant associations with the outcome. The chance of death was equal to zero when there was no early infection in the group with the longest duration of SSC. This probability was also equal to zero in the absence of late sepsis for the group with less than 146.9 minutes/day of SSC. Conclusions: The first SSC before 206 hours of life is recommended in order to observe a reduction in the risk of neonatal death. Staying in SSC for more than 146.9 min/day seems to be clinically beneficial for these neonates mostly when it was associated with the absence of infection.

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OBJECTIVE: To evaluate the association between dose of skin-to-skin contact (SSC) per day and initiation time with the occurrence of deaths in newborns with weight up to 1800g. METHOD: Multicentric cohort in five Brazilian neonatal units, including newborns with a birth weight of ≤1800g. The time of SSC was registered in individual file, by the team or family during the hospitalization. Maternal and newborn data were obtained through questionnaires applied to mothers and in medical records. Classification Tree was used for data analysis. RESULTS: The performance of the first SSC after 206h was significantly associated with death (p = 0.02). Although there was no association between SSC/day and death (p = 0.09), the number of deaths among those who performed more than 146.9 minutes/day was lower (3;1.5%) than among those who performed this practice for a shorter time (13;6.4%), a fact considered of great clinical importance. Early and late infections present statistically significant associations with the outcome. The chance of death was equal to zero when there was no early infection in the group with the longest duration of SSC. This probability was also equal to zero in the absence of late sepsis for the group with less than 146.9 minutes/day of SSC. CONCLUSIONS: The first SSC before 206 hours of life is recommended in order to observe a reduction in the risk of neonatal death. Staying in SSC for more than 146.9 min/day seems to be clinically beneficial for these neonates mostly when it was associated with the absence of infection.

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OBJECTIVES: To estimate the baseline prevalence and risk factors for microcephaly at birth before the Zika virus epidemic in 2 Brazilian cities. METHODS: We used population-based data from the Brazilian Ribeirão Preto (RP) and São Luís (SL) birth cohort studies of 2010 that included hospital deliveries by resident mothers. The final sample was 7376 live births in RP and 4220 in SL. Gestational age was based on the date of the mother's last normal menstrual period or obstetric ultrasonography, if available. Microcephaly at birth was classified according to the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century and the Brazilian Ministry of Health. Risk factors for microcephaly, proportionate and disproportionate microcephaly, and severe microcephaly were estimated in a hierarchized logistic regression model. RESULTS: According to the International Fetal and Newborn Growth Consortium for the 21st Century definition, the prevalence of microcephaly (>2 SDs below the mean for gestational age and sex) was higher in SL (3.5%) than in RP (2.5%). The prevalence of severe microcephaly (>3 SDs below the mean) was higher in SL (0.7%) than in RP (0.5%). Low maternal schooling, living in consensual union or without a companion, maternal smoking during pregnancy, primiparity, vaginal delivery, and intrauterine growth restriction were consistently associated with microcephaly. The number of cases of microcephaly is grossly underestimated, with an underreporting rate of ∼90%. CONCLUSIONS: The prevalence of severe microcephaly was much higher than expected in both cities. Our findings suggest that microcephaly was endemic in both municipalities before the circulation of the Zika virus.

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OBJETIVO: Investigar uma possível associação entre a carga de trabalho de profissionais da saúde e eventos adversos intermediários, tais como extubação acidental, obstrução do tubo endotraqueal e desconexão acidental do circuito do ventilador, durante ventilação mecânica neonatal em unidades neonatais de alto risco. MÉTODO: Este estudo de coorte prospectiva analisou os dados referentes a 543 recém-nascidos de unidades de terapia intensiva neonatal (UTINs) de São Luís (MA) por 6 meses, durante os quais 136 recém-nascidos foram submetidos a ventilação mecânica em 1.108 turnos e foram observados 4.554 vezes. RESULTADOS: Ocorreram eventos adversos 117 vezes durante esse período. As associações entre carga de trabalho e eventos adversos foram analisadas por meio de equações de estimação generalizada. As variáveis de ajuste foram: peso de nascimento, gênero, maternidade estudada, pontuação no índice de risco clínico para bebês (clinical risk index for babies) e demanda de cuidados, determinada pela escala desenvolvida pela Northern Neonatal Network. Quanto maior o número de recém-nascidos classificados de acordo com a demanda de cuidados (RCDCs) por enfermeiro e técnico em enfermagem, maior a probabilidade da ocorrência de eventos adversos intermediários relacionados à ventilação mecânica. Um número de RCDCs > 22 por enfermeiro [risco relativo (RR) = 2,86] e > 4,8 por enfermeiro auxiliar (RR = 3,41) esteve associado a uma maior prevalência de eventos adversos intermediários. CONCLUSÕES: A carga de trabalho dos profissionais de UTINs parece interferir nos resultados intermediários do cuidado neonatal e, portanto, deve ser levada em conta na avaliação dos desfechos na UTIN.

OBJECTIVE: To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. METHOD: This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of São Luís, state of Maranhão, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. RESULTS: Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. CONCLUSIONS: The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomes.

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OBJECTIVE: To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. METHOD: This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of São Luís, state of Maranhão, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. RESULTS: Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. CONCLUSIONS: The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomes.

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Objetivo: Analisar a percepçäo dos pais sobre a internaçäo de seus filhos em Unidade de Tratamento Intensivo Neonatal visando a suvsidiar a promoçäo de uma abordagem mais humana, mais individualizada, na assistência a recém-nascidos de risco. Métodos: Foi utilizadaa metodologia qualitativa através das técnicas de observaçäo participante, história de vida e entrevista semi-estruturada com 20 casais jovens, de classe sócio-econômica baixa, cujos filhos estavam internados em Unidade de Tratamento Intensivo Neonatal de um hospital público. Resultados: A análise das entrevistas com os pais revela situaçöes de medo, angústia e estresse. O ambiente da Unidade de Tratamento Intensivo é novo e assustador, e as preocupaçöes dos casais säo muitas vezes bastante diferentes das dos profissionais de saúde ...

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O tratamento da hiperbilirrubinemia neonatal através da fototerapia é um dos procedimentos mais freqüentes em berçários. Estudos recentes têm sugerido que em recém-nascidos (RN) a termo, com icterícia näo hemolítica, a fototerapia deva ser iniciada com níveis séricos de bilirrubina total (BT) bem mais elevados do que os recomendados na literatura. Neste estudo retrospectivo, analisamos o uso da fototerapia em 117 RNs com icterícia näo emolítica. A populaçäo estudada foi dividida em 2 grupos de acordo com o nível sérico de bilirrubina no início da fototerapia. O grupo I compreendia 83 RNs cuja BT inicial era inferior a 15 mg porcento e o grupo II, 34 RN com BT inicial > a 15mg porcento. Nossos resultados demonstram que durante as primeiras horas de tratamento, a queda dos níveis séricos de BT foi significativamente maior nos RN cuja fototerapia foi iniciada com níveis de BT > 15 mg pocento. Apesar do nível nicial da fototerapia ter sido diferente entre os grupos, a duraçäo média da fototerapia e a concentraçäo sérica de BT ao final de 72 h de tratamento foi semelhante nos dois grupos. Estes dados sugerem que em recém-nascidos a termo com icterícia näö hemolítica o início da fototerapia deve ser protelado até que a concentraçäo sérica de bilirrubina atinja níveis iguais ou superiores a 15 mg porcento. Abaixo destes níveis, a fototerapia precoce deve ser substituída por uma observaçäo clínica e laboratorial cuidadosa do paciente

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