Non-nutritive sucking evaluation in preterm newborns and the start of oral feeding: a multicenter study

OBJECTIVES: The assessment of early sucking by preterm infants provides information on the ability of these infants to efficiently and safely receive nutrients via an oral route (oral feeding). To analyze the application and reliability of an instrument in assessing non-nutritive sucking that indicates a capacity for oral feeding in the routine care of different neonatal units. METHODS: A multicenter, prospective cohort study was conducted in seven neonatal units. A non-nutritive sucking assessment with a formulary validated by Neiva et al (2008) (variables evaluated: rooting reaction; easy initiation of sucking; labial sealing; tongue central groove; peristaltic tongue movements; jaw raising and lowering movements; labial, tongue and jaw coordination; sucking strength; sucking rhythm; bites; excessive jaw excursion; stress signals) was applied to 199 pre-term newborns, who had a chronological age ≥ 2 days and were clinically stable. These infants were divided into two groups based on their corrected gestational age at the first assessment, as follows: Group I-infants with a gestational age ≤ 33 weeks and Group II-infants with a gestational age between 34 and 36 6/7 weeks. RESULTS: The mean gestational age was 31.66±2 weeks, and the mean birth weight was 1494 ± 373 g. The mean scores on the non-nutritive sucking assessment were 46 ± 25 in Group I and 49 ± 24 in Group II. The beginning of oral feeding was successful in 43 (67.2%) infants in Group I and 64 (81%) infants in Group II (p = 0.089). CONCLUSION: The method identified preterm infants who were able to feed orally based on 33 points in the non-nutritive sucking assessment and a corrected gestational age of 32 weeks or more. The corrected gestational age was the most important factor in predicting the success of oral feeding. .

Percepção dos familiares de pacientes internados em Unidade de Terapia Intensiva em relação à atuação da Fisioterapia e à identificação de suas necessidades / Perception of relatives of patients admitted in Intensive Care Units with regard to the practice of Physical Therapy and identification of their needs

Trata-se de um estudo descritivo e de abordagem qualitativa, que teve como objetivo verificar o conhecimento dos familiares de pacientes internados na Unidade de Terapia Intensiva do Hospital de Clínicas da Universidade Estadual de Campinas com relação à atuação da Fisioterapia intensiva neste serviço, bem como identificar suas necessidades. Foram entrevistados 60 familiares, sendo estes questionados a respeito do serviço de Fisioterapia e submetidos ao Inventário de Necessidades e Estressores de Familiares em Terapia Intensiva. Foi observado que a maioria deles desconhecia a atuação da Fisioterapia em tal Unidade, porém os que conheciam atribuíram nota máxima ao serviço. Em relação às necessidades dos familiares, notou-se que 56,7% julgaram necessário saber fatos concretos a respeito do progresso de seu familiar; 60% gostariam de ter a certeza que seu familiar está recebendo o melhor tratamento e 71,7% gostariam de ter dias e horários de visitas mais flexíveis. Constatou-se a falta de informações dos entrevistados em relação à atuação da Fisioterapia na Unidade de Terapia Intensiva. Foram identificadas as necessidades dos familiares, sendo possível, com isto, executar ações de melhoria. Por meio do presente estudo, a Unidade de Terapia Intensiva do Hospital de Clínicas da Universidade Estadual de Campinas identificou as principais necessidades dos familiares, adequou o espaço físico, implementou salas de acolhimento familiar e o curso de especialização em Fisioterapia Respiratória em Unidade de Terapia Intensiva Adulto, e criou informativos visuais quanto à sua atuação para melhores acolhimento e compreensão dos familiares.

This is a descriptive study, with a qualitative approach, that aimed at verifying the knowledge of relatives of patients hospitalized at the Intensive Care Unit of Hospital de Clínicas at Campinas State University about the performance of the intensive physical therapy, as well as at identifying their needs. We interviewed 60 relatives, questioning them about the Physical Therapy service. The Critical Family Need Inventory was also applied. We observed that most relatives were unaware of the physical therapy team performance at the Intensive Care Unit; however, those who knew about it attributed the highest score to the service. Regarding the relatives' needs, we observed that 56.7% judged necessary to know the facts about the patients' progress; 60% would like to be sure that the patient is receiving the best treatment, and 71.7% would like more flexibility in days and time of visits. It was possible to observe lack of information regarding the action of physical therapy at the Intensive Care Unit and to identify the relatives' needs, allowing improvement actions. The Intensive Care Unit of Hospital de Clínicas at Campinas State University has adapted the physical space and implemented rooms for family reception, with the help of family support and humanization groups. Along with these actions, it was implemented a specialization course in Respiratory Physical Therapy at the Adults Intensive Care Unit and visual aids regarding its importance and actions to a better reception and understanding of the family were distributed.

Transição alimentar em recém-nascidos com displasia broncopulmonar / Transition time for full oral feeding in newborns with bronchopulmonary dysplasia

OBJETIVO: verificar o tempo de transição da sonda para a via oral plena nos lactentes com Displasia Broncopulmonar (DBP) e descrever as intercorrências observadas durante os períodos de alimentação. MÉTODOS: revisão de prontuários do setor de Fonoaudiologia de 32 lactentes nascidos no Hospital Universitário Pedro Ernesto (HUPE/UERJ) divididos em 2 grupos. Grupo 1: 18 lactentes com diagnóstico de DBP; grupo 2: 18 lactentes com idade gestacional entre 29 e 32 semanas sem complicações clínicas relevantes que foram utilizados como grupo controle. Foram registrados o tempo de transição alimentar, as intercorrências durante a alimentação e via oral na alta hospitalar de ambos os grupos. RESULTADOS: média e desvio padrão do tempo de transição alimentar dos grupos 1 e 2 respectivamente: 18,22 dias e 14,79; 6,50 dias e 3,68, com p=0,002. Nos broncodisplásicos foram comuns intercorrências respiratórias, dificuldade de coordenação sucçãoXrespiraçãoXdeglutição, dificuldades no padrão oral, além de sinais de retraimento e rebaixamento do estado de consciência durante a alimentação. Apesar disso, 10 lactentes (52,63 por cento) tiveram alta em aleitamento materno exclusivo e 3 (15,78 por cento) em aleitamento misto. CONCLUSÃO: pacientes com DBP precisaram de um período maior de treino de VO (18 dias), além de serem passíveis de intercorrências durante a alimentação. No entanto, constata-se que foi possível o aleitamento materno exclusivo.

PURPOSE: to check the time of transition from the feeding tube to oral feeding in newborns with Bronchopulmonar Dysplasia (BPD); observe the difficulties occurred during the oral feeding./ METHODS: the speech pathology department reviewed thirty-two past cases of newborns born in the Pedro Ernesto Hospital of Rio de Janeiro State University. The first group was composed of eighteen newborns with BPD, while a second group was composed of eighteen healthy newborns born between 29 and 32 weeks used as a control group. We observed in both groups the following items: time it took for the newborns to transition from the feeding tube to the oral one, the difficulties presented during feeding periods, and finally the type of oral alimentation used by the discharge time. RESULTS: the mean and standard deviation of the sample were 18.22 days and 14.79, respectively; for the control group it was 6.50 and 3.68, respectively (p=0.002). The group with BPD showed respiratory stress, lack of coordination between suctions, breathing and swallowing, and suction dysfunction. They also fell asleep during alimentation, showing extreme physical strain and defensive behaviors. Despite these results, 10 newborns (52.63 percent) were discharged on exclusive breastfeeding and 3 (15,78 percent) on mixed feeding (cupfeeding with breastfeeding). CONCLUSION: patients with BPD need extended time (18 days) to learn oral feeding, and moreover, they are susceptible to intercurrence during feeding. Nevertheless, it was possible to testify an exclusive breastfeeding.