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Aims: To verify the feasibility and preliminary effects of the STEP protocol, an intervention based on specific motor skills, environmental factors and participation, in infants at biological risk.Methods: Twenty-eight at-risk infants (STEP Protocol = 14; Standard Intervention = 14), aged 3-9 months and at risk for developmental delay. The following outcomes were assessed: motor skills (Alberta Infant Motor Scale-AIMS); frequency and involvement of participation (Young Children's Participation and Environment Measure-YC-PEM), and home environment opportunities (Affordances in the Home Environment for Motor Development-AHEMD-IS). For both groups, interventions were provided by parents. The intervention for group was based on the following principles: (1) standard intervention: stimulation of motor skills; (2) STEP: stimulation of motor skills, participation, mother-infant interaction, environmental enrichment. A mean comparison test was applied to verify difference between groups after the intervention.Results: The protocol showed good retention and recruitment rates. The STEP group had significantly higher outcomes after intervention on the AIMS (p = 0.014); frequency (p = 0.02) and engagement (p = 0.03) in participation, when compared to standard intervention.Conclusions: The results showed that the STEP protocol is feasible, and presents better results compared to the standard intervention, which reinforces the importance of promoting participation, specific motor skills and family involvement.

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BACKGROUND: With the implementation of social distancing due to the Covid-19 pandemic, many at-risk infants are without therapy. An alternative mode of therapy in this situation is tele-care, a therapy in which assessments and interventions are carried out online, in the home environment. We describe a tele-care protocol involving parent delivered task and context specific movement training, participation and environmental adaptation for infants at risk for developmental delay. METHODS: Randomized controlled trial. Infants at risk, with 3 to 9 months corrected age, will be included, and randomized into two groups: control group (conventional guidelines) and experimental group (task, environment and participation in context-specific home program). Infants will be assessed for motor capacity (Infant Motor Profile and Alberta Infant Motor Scale); participation (Young Children's Participation and Environment Measure) and environment factors (Parent-Child Early Relational Assessment; Affordances in the Home Environment for Motor Development). The intervention period will be 10 weeks, and evaluations will be carried out before and after that period. All the assessment and intervention procedures will be carried out online, with instructions to parents for home therapy. The statistical analysis will be guided according to the distribution of the data, and a significance level of 5% will be adopted. All ethical approvals were obtained by the Ethics Committee of the University of São Carlos (Case number 31256620.5.0000.5504). The protocol will follow the SPIRIT statement. Findings will be disseminated in peer-reviewed publications and presented at national and international conferences. DISCUSSION: The results of this study will describe the effectiveness of a home intervention, focusing on specific activities, participation and environmental changes. These results will support the implementation of a remote protocol, with lower financial costs and focused on the particularities of the family. This type of care model can possibly help public policies to ensure equal access to evidence-based quality healthcare. TRIAL REGISTRATION: Brazilian Clinical Trials Registry: RBR8xrzjs , registered September 1, 2020.

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OBJECTIVE: To measure the real-world effectiveness of palivizumab immunoprophylaxis against respiratory syncytial virus (RSV)-confirmed infection before age 2 years in a population-cohort of high-risk infants. STUDY DESIGN: Palivizumab is funded for high-risk infants in Western Australia. We used probabilistically linked administrative data encompassing RSV laboratory-confirmed infections, hospital admissions, and palivizumab dispensing records for a cohort of 24 329 high-risk infants admitted to neonatal intensive care units, born 2002-2013 with follow-up to 2015. We used a traditional cohort method with Cox proportional hazards regression and a self-controlled case series analysis to assess effectiveness of palivizumab in reducing RSV-confirmed infection by number of doses. RESULTS: From the cohort of 24 329 infants, 271 (1.1%) received at least 1 dose of palivizumab and 1506 (6.2%) had at least 1 RSV-confirmed infection before age 2 years. Using the traditional cohort approach, we found no protective association of palivizumab receipt with RSV detection (adjusted hazard ratio = 0.99 [95% CI 0.5, 1.9] for 1 dose). However, using a self-controlled case series to eliminate confounding by indication, a protective association was seen with a 74% lower RSV incidence (relative incidence = 0.26; 95% CI 0.11, 0.67) following any dose of palivizumab compared with control (nonexposed) periods. CONCLUSIONS: After accounting for confounding by indication through a self-controlled analysis, palivizumab appeared effective for reducing virologically confirmed RSV in this high-risk cohort.

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Esta pesquisa tem como objeto de estudo as representações sociais e as práticas de seguimento do recém-nascido de alto risco. Trata-se de um estudo descritivo, com abordagem qualitativa, que objetivou analisar as representações sociais e as práticas de seguimento de recém-nascidos de alto risco, em programas de follow-up no município do Rio de Janeiro. Definiram-se como objetivos específicos: descrever as representações sociais dos profissionais sobre o recém-nascido de alto risco; descrever as atividades e os procedimentos adotados pelos programas de seguimento do recém-nascido de alto risco; caracterizar as ações desenvolvidas pela equipe multidisciplinar que atua no seguimento do recém-nascido de alto risco; discutir a atuação das enfermeiras no seguimento do recém-nascido de alto risco, no contexto da equipe multidisciplinar. A orientação teórico-metodológica adotada foi a da Teoria das Representações Sociais, concebida por Moscovici, que considera as representações como teorias do senso comum, construídas para explicar aspectos da vida cotidiana. Esta pesquisa contou com a participação de 23 profissionais de três equipes multidisciplinares, que realizam o acompanhamento ambulatorial das crianças egressas da Unidade de Terapia Intensiva Neonatal, com os quais foram realizadas entrevistas estruturadas. A análise das entrevistas foi realizada através da técnica de análise de conteúdo. O resultado da análise revelou 8 categorias que são as seguintes: a percepção da criança de risco; objetivos e significado do follow-up; a percepção do funcionamento do follow-up; a atividade educativa no follow-up; atitudes e sentimentos maternos e familiares diante do follow-up; perfil da clientela e a possibilidade do acompanhamento; o trabalho interdisciplinar no follow-up e a participação da enfermeira no follow-up...

The objective of this research has is to study the social representations and follow-up practices on high-risk newborns. It is a descriptive essay, with qualitative approach, which aimed at the analysis of social representations and follow-up practices on high-risk infants on follow-up programs in Rio de Janeiro, RJ, Brazil. Specific objectives are defined as follows: to describe the social representations of the high-risk newborn by the nursing professionals; to describe the activities and procedures adopted on the follow-up programs on the high-risk new-born; to point out the specific qualities of the actions developed by the multidisciplinary team involved in the follow-up of the high-risk newborn; to discuss the nurses' performance on the follow-up of the high-risk newborn in the context of a multidisciplinary team. The theoretical framework was built upon the theory of Social Representations conceived by Moscovici, who considers the representations as common sense theories conceived to explain aspects of our daily life. This research counted on 23 professionals on three multidisciplinary teams who carry out the follow-ups on ambulatory infant egresses from the Neonatal Intensive Therapy Unit. Structured interviews with those professionals were analyzed under the light of content-analysis techniques. Results of the analysis revealed 8 categories as follows: perception of the high-risk infant; objectives and significance of the follow-up; perception of the follow-up work; pedagogical activity on the follow-up; maternal attitudes and feelings in the face of the follow-up; client profile and the possibility of the follow-up; interdisciplinary work on the follow-up and nurses' participation on the follow-up...

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