Colostrum immunotherapy and length of hospital stay in preterm infants: an intervention study / Imunoterapia de colostro e tempo de internamento de prematuros: estudo de intervenção

Abstract Objectives: to evaluate the effect of oropharyngeal colostrum immunotherapy on the length of hospital stay in preterm newborns with very low birth weight. Methods: interventional ambispective study, which consisted of eight daily administrations of 0.2 ml (four drops) of colostrum, totaling up to 56 syringes (for up to seven days). The control was historic. The main independent variable: length of hospital stay (days). Survival analysis was performed using the Kaplan-Meier Method and the survival effect was estimated - Log Rank Test (Mantel-Cox) and Breslow Test (Generalized Wilcoxon). A significance level of 5% was adopted. Results: of the 109 mother/child pairs, 56 were part of the treatment and 53 were part of the control group. There was no association between oropharyngeal colostrum immunotherapy and length of stay for preterm newborns with very low birth weight in the general sample. However, after stratification, a shorter hospital stay (42 versus 51 days, HR= 1.78, CI95%=1.02-3.09, p=0.04) was demonstrated among premature infants with ≥28 gestational weeks undergoing oropharyngeal colostrum immunotherapy. Conclusions: we found an association between oropharyngeal colostrum immunotherapy and shorter median length of hospital stay in the subgroup of premature infants ≥ 28 weeks of gestational age, but we did not find significant differences in those <28 weeks.

Resumo Objetivos: avaliar o efeito da imunoterapia orofaríngea de colostro no tempo de internamento hospitalar de recém-nascidos pré-termos de muito baixo peso. Métodos: estudo de intervenção, ambispectivo, que consistiu em oito administrações diárias de 0,2 ml (quatro gotas) de colostro, totalizando até 56 seringas (por até sete dias). O controle foi histórico. A variável independente principal: tempo de permanência hospitalar (dias). Realizada análise de sobrevivência pelo Método de Kaplan-Meier e estimado o efeito da sobrevida - Teste de Log Rank (Mantel-Cox) e Teste de Breslow (Wilcoxon Generalizado). Adotou-se o nível de significância de 5%. Resultados: das 109 duplas mães/filho, 56 fizeram parte da análise do grupo tratamento e 53 do controle. Não houve associação entre imunoterapia orofaríngea de colostro e tempo de internamento de recém-nascidos pré-termos de muito baixo peso na amostra geral. Após estratificação demonstrou-se menor tempo de permanência hospitalar (43 versus 51 dias, HR=1,78, IC95%= 1,02-3,09, p=0,04) entre os prematuros com ≥28 semanas gestacionais submetidos a imunoterapia orofaríngea de colostro. Conclusões: encontrou-se associação entre imunoterapia orofaríngea de colostro e menor mediana de tempo de internamento hospitalar no subgrupo de prematuros ≥ 28 semanas de idade gestacional, porém não foram encontradas diferenças significativas naqueles < 28 semanas.

COVID-19 epidemic curve in Brazil: a sum of multiple epidemics, whose inequality and population density in the states are correlated with growth rate and daily acceleration. An ecological study

ABSTRACT Background: The epidemic curve has been obtained based on the 7-day moving average of the events. Although it facilitates the visualization of discrete variables, it does not allow the calculation of the absolute variation rate. Recently, we demonstrated that the polynomial interpolation method can be used to accurately calculate the daily acceleration of cases and deaths due to COVID-19. This study aimed to measure the diversity of epidemic curves and understand the importance of socioeconomic variables in the acceleration, peak cases, and deaths due to COVID-19 in Brazilian states. Methods: Epidemiological data for COVID-19 from federative units in Brazil were obtained from the Ministry of Health's website from February 25 to July 11, 2020. Socioeconomic data were obtained from the Instituto Brasileiro de Geografia e Estatística (https://www.ibge.gov.br/). Using the polynomial interpolation methods, daily cases, deaths and acceleration were calculated. Moreover, the correlation coefficient between the epidemic curve data and socioeconomic data was determined. Results: The combination of daily data and case acceleration determined that Brazilian states were in different stages of the epidemic. Maximum case acceleration, peak of cases, maximum death acceleration, and peak of deaths were associated with the Gini index of the gross domestic product of Brazilian states and population density but did not correlate with the per capita gross domestic product of Brazilian states. Conclusions: Brazilian states showed heterogeneous data curves. Population density and socioeconomic inequality were correlated with a more rapid exponential growth in new cases and deaths.

Covid-19 growth rate analysis: application of a low-complexity tool for understanding and comparing epidemic curves

Abstract INTRODUCTION: The acceleration of new cases is important for the characterization and comparison of epidemic curves. The objective of this study was to quantify the acceleration of daily confirmed cases and death curves using the polynomial interpolation method. METHODS: Covid-19 epidemic curves from Brazil, Germany, the United States, and Russia were obtained. We calculated the instantaneous acceleration of the curve using the first derivative of the representative polynomial. RESULTS: The acceleration for all curves was obtained. CONCLUSIONS: Incorporating acceleration into an analysis of the Covid-19 time series may enable a better understanding of the epidemiological situation.