Examining the side effects of sucrose for pain relief in preterm infants: a case-control study

Sucrose solution is recommended as relevant pain relief management in neonates during acute painful procedures; however, only a few studies have analyzed the potentially adverse effects of sucrose administration to preterm neonates. The goal of this study was to examine the potential side effects of sucrose for pain relief in preterm infants, assessing feeding and weight gain during hospitalization and their feeding patterns postdischarge. The study sample consisted of 43 preterm neonates divided into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which no sucrose was administered. The SG received 0.5 mL/kg 25% oral sucrose for 2 min prior to all acute painful procedures during three consecutive days. A prospective review of medical charts was performed for all samples. The study was done prior to implementation of the institutional sucrose guidelines as a routine service, and followed all ethical requirements. There were no statistically significant differences between groups in terms of weight gain, length of stay with orogastric tubes, and parenteral feeding. Postdischarge, infant nutritional intake included feeding human milk to 67% of the SG and 74% of the CG. There were no statistically significant differences between groups regarding human milk feeding patterns postdischarge. Neonate feeding patterns and weight gain were unaffected following the short-term use of sucrose for pain relief.

Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

Nasal CPAP in the delivery room for newborns with extremely low birth weight in a hospital in a developing country

The objective of this study was to determine the feasibility of the use of continuous positive airway pressure installed prophylactically in the delivery room (DR-CPAP), for infants with a birth weight between 500 and 1000 g in settings with limited resources. During 23 months, infants with a birth weight between 500 and 1000 g consecutively received DR-CPAP. A total of 33 infants with low birth weight were enrolled, 16 (48.5%) were females. Only 14 (42.4%) received antenatal corticosteroids and only 2 of those 14 (14.3%) infants weighing 500-750 g were not intubated in the delivery room, and apnea was given as the reason for intubation of these patients. Of the 19 infants in the 751-1000 g weight range, 9 (47.4%) were intubated in the delivery room, 6 due to apnea and 3 due to respiratory discomfort. For DR-CPAP to be successful, it is probably necessary for preterm babies to be more prepared at birth to withstand the respiratory effort without the need for intubation. Antenatal corticosteroids and better prenatal monitoring are fundamental for success of DR-CPAP.

Pediatric pain: prevalence, assessment, and management in a teaching hospital

The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child’s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.

Long-term melatonin treatment reduces ovarian mass and enhances tissue antioxidant defenses during ovulation in the rat

Melatonin regulates the reproductive cycle, energy metabolism and may also act as a potential antioxidant indoleamine. The present study was undertaken to investigate whether long-term melatonin treatment can induce reproductive alterations and if it can protect ovarian tissue against lipid peroxidation during ovulation. Twenty-four adult female Wistar rats, 60 days old (± 250-260 g), were randomly divided into two equal groups. The control group received 0.3 mL 0.9 percent NaCl + 0.04 mL 95 percent ethanol as vehicle, and the melatonin-treated group received vehicle + melatonin (100 µg·100 g body weight-1·day-1) both intraperitoneally daily for 60 days. All animals were killed by decapitation during the morning estrus at 4:00 am. Body weight gain and body mass index were reduced by melatonin after 10 days of treatment (P < 0.05). Also, a marked loss of appetite was observed with a fall in food intake, energy intake (melatonin 51.41 ± 1.28 vs control 57.35 ± 1.34 kcal/day) and glucose levels (melatonin 80.3 ± 4.49 vs control 103.5 ± 5.47 mg/dL) towards the end of treatment. Melatonin itself and changes in energy balance promoted reductions in ovarian mass (20.2 percent) and estrous cycle remained extensive (26.7 percent), arresting at diestrus. Regarding the oxidative profile, lipid hydroperoxide levels decreased after melatonin treatment (6.9 percent) and total antioxidant substances were enhanced within the ovaries (23.9 percent). Additionally, melatonin increased superoxide dismutase (21.3 percent), catalase (23.6 percent) and glutathione-reductase (14.8 percent) activities and the reducing power (10.2 percent GSH/GSSG ratio). We suggest that melatonin alters ovarian mass and estrous cyclicity and protects the ovaries by increasing superoxide dismutase, catalase and glutathione-reductase activities.

Plasma amino acids in pregnancy, placental intervillous space and preterm newborn infants

Plasma amino acid levels have never been studied in the placental intervillous space of preterm gestations. Our objective was to determine the possible relationship between plasma amino acids of maternal venous blood (M), of the placental intervillous space (PIVS) and of the umbilical vein (UV) of preterm newborn infants. Plasma amino acid levels were analyzed by ion-exchange chromatography in M from 14 parturients and in the PIVS and UV of their preterm newborn infants. Mean gestational age was 34 ± 2 weeks, weight = 1827 ± 510 g, and all newborns were considered adequate for gestational age. The mean Apgar score was 8 and 9 at the first and fifth minutes. Plasma amino acid values were significantly lower in M than in PIVS (166 percent), except for aminobutyric acid. On average, plasma amino acid levels were significantly higher in UV than in M (107 percent) and were closer to PIVS than to M values, except for cystine and aminobutyric acid (P < 0.05). Comparison of the mean plasma amino acid concentrations in the UV of preterm to those of term newborn infants previously studied by our group showed no significant difference, except for proline (P < 0.05), preterm > term. These data suggest that the mechanisms of active amino acid transport are centralized in the syncytiotrophoblast, with their passage to the fetus being an active bidirectional process with asymmetric efflux. PIVS could be a reserve amino acid space for the protection of the fetal compartment from inadequate maternal amino acid variations.

Amino acid composition of parturient plasma, the intervillous space of the placenta and the umbilical vein of term newborn infants

The objective of the present study was to determine the levels of amino acids in maternal plasma, placental intervillous space and fetal umbilical vein in order to identify the similarities and differences in amino acid levels in these compartments of 15 term newborns from normal pregnancies and deliveries. All amino acids, except tryptophan, were present in at least 186 percent higher concentrations in the intervillous space than in maternal venous blood, with the difference being statistically significant. This result contradicted the initial hypothesis of the study that the plasma amino acid levels in the placental intervillous space should be similar to those of maternal plasma. When the maternal venous compartment was compared with the umbilical vein, we observed values 103 percent higher on the fetal side which is compatible with currently accepted mechanisms of active amino acid transport. Amino acid levels of the placental intervillous space were similar to the values of the umbilical vein except for proline, glycine and aspartic acid, whose levels were significantly higher than fetal umbilical vein levels (average 107 percent higher). The elevated levels of the intervillous space are compatible with syncytiotrophoblast activity, which maintain high concentrations of free amino acids inside syncytiotrophoblast cells, permitting asymmetric efflux or active transport from the trophoblast cells to the blood in the intervillous space. The plasma amino acid levels in the umbilical vein of term newborns probably may be used as a standard of local normality for clinical studies of amino acid profiles.

Ultrastructural observations of the dorsal lobe of the prostate of rats (rattus norvegicus) submitted to experimental chronic alcohol ingestion

Los problemas relacionados al consumo abusivo de bebidas alcohólicas, son una de las preocupaciones de salud pública más discutidas. Se han estudiado las alteraciones morfológicas y funcionales causadas por ingestión crónica de alcohol en los testículos y órganos sexuales accesorios de los hombres y de los animales de laboratorio. El objetivo de este trabajo fue examinar los eventuales cambios morfológicos en el epitelio secretorio del lóbulo dorsal de la próstata, en ratas sometidas a la ingestión crónica de alcohol. Las ratas adultas en el grupo experimental fueron divididas según los períodos del tratamiento de 60, 120, 180, 240 y 300 días, recibiendo para beber sólo alcohol de caña de azúcar de 30º (30 por ciento v/v) y fueron alimentadas con ración de Purina a voluntad. Al final de cada período de tratamiento, cuatro ratas de cada grupo fueron anestesiadas por inhalación de éter y perfundida con 2,5 por ciento glutaraldeido y fragmentos del lóbulo dorsal fueron removidos y procesados para la microscopía electrónica. Los resultados demostraron a nivel celular reducción general del citoplasma y del retículo endoplasmático granular, así como también formación circular que consiste en membranas concéntricas en la región apical de las células epiteliales secretorias del lóbulo dorsal. La ingestión crónica del alcohol tuvo efectos deletéreos en las células epiteliasles secretoras del lóbulo dorsal de la próstata, después de los diferentes períodos del tratamiento

Ultrastructural changes of the choroid plexus of the lateral ventricles of rats, rattus norvegicus, submitted to experimental chronic alcoholism, followed by alcohol withdrawal

Cuarenta ratas machos adultas se dividieron en dos grupos de 20 animales cada uno (grupos control y experimentales). El grupo experimental recibió alcohol de caña de azúcar comercial, marca "51 Pirassununga", diluida a 30º g/L como dieta líquida por un período de 240 días y agua potable por los siguientes 60 días. Los animales se sacrificaron después de 60, 120, 180, 240 y 300 días de tratamiento. Se observaron varios cambios morfológicos en el grupo experimental de animales de hasta 240 días de tratamiento, encontrándose dilatación de las cisternas del retículo endoplasmático rugoso, espacios intercelulares aumentados, espacios entre las interdigitaciones basolaterales de las células, inflamación del tejido conjuntivo y presencia de una gran cantidad de células pinocíticas, de vacuolas digestivas y de vesículas con contenido electrolúcido a lo largo del citoplasma. Después de 300 días de tratamiento, el grupo experimental de animales presentó una regresión importante de los cambios descritos. No se observó cambios en el grupo de animales control

Effects of experimental chronic alcoholism on the seminal vesicle and testis weigh of adult rats (rattus norvegicus)

Fueron estudiados los efectos del alcoholismo crónico experimental en el peso de las glándulas sexuales accesorias y en el peso del testículo. Ratas albinas adultas recibieron solamente aguardiente de caña de 30º Gay Lussac (v/v), mientras los controles recibieron agua del grifo. Después de 60, 120, 180 y 240 días de tratamiento las ratas de cada grupo fueron anestesiadas, pesadas y sacrificadas. Fueron registrados: alteraciones en el consumo de ración diario y consumo líquido, aumento de peso medio diario, peso medio de la próstata, de la vesícula seminal, de las glándulas de coagulación y peso del testículo. El alcoholismo crónico experimental afecto al peso tanto de las vesículas seminales, como de los testículos, ocasionando una reducción de ellos, recuperándose éstos órganos 240 días posterior a la suspensión de la administración del alcohol

Ultrastructural study of the palatine mucosa of the opossum (Didelphis albiventris)

As características das células epiteliais da mucosa palatina do gambá foram descritas utilizando o microscópio eletrônico de transmissäo. O epitélio é do tipo estratificado escamoso queratinizado formado por camadas basal, espinhosa, granulosa e córnea. As células epiteliais basais säo colunares com núcleos basais e contêm mitocôndrias, ribosomos e retículos endoplasmáticos granulares. As células espinhosas säo de forma poligonal e possuem filamentos de 10nm, enquanto as células da camada granulosa apresentam numerosos grânulos de keratohialina. As células córneas säo achatadas, com conteúdo amorfo e contêm distintas micropregas na superfície. Observa-se desmosomos entre as células epiteliais das diferentes camadas

Effects of experimental chronic alcoholism on the reproductive system of the male rat (Rattus norvegicus)

Amostras de vários órgäos que compöem o sistema reprodutor masculino, tais como: próstata, glândulas de coagulaçäo, vesículas seminais, uretra, bexiga urinária, parte dos ureteres e ductos deferentes, foram coletados e pesados com o objetivo de avaliar os efeitos do alcoolismo crônico experimental. Foi comprovada estatisticamente uma reduçäo do peso corporal e atrofia generalizada dos órgäos em estudo, em especial da próstata e vesícula seminal

Recem-nascido e suporte ventilatorio: demanda, indicacao, duracao e evolucao / Newborn infant and support ventilatory: demand, indications, duration and evolution

Com o objetivo de avaliacao da demanda de suporte ventilatorio de recem-nascidos do HCFMRP-USP, de suas caracteristicas e da evolucao neonatal de criancas submetida a esta forma de terapeutica, estudaram-se 913 criancas que apresentavam fatores sujeitos a utilizacao do mesmo, entre as 10014 criancas nascidas de 1985 a 1987. A proporcao de 3,0% das criancas nascidas no periodo utilizou assistencia ventilatoria, sendo 48,9% atraves de ventilacao mecanica.O retardo do crescimento intra-utero nas criancas de peso entre 1000 e 2000g correlacionou-se negativamente (p < 0,05) com a demanda. As principais complicacoes foram a infeccao hospitalar (19,6%) e os sequestros de ar (13,5%) e 67,2% das criancas ventiladas sobreviveram

Recem-nascidos com menos de 1.500 g.I - Aspectos epidemiologicos em tres epocas distintas nos ultimos 15 anos. / Newborn infants with birth weight with less than 1500 g. I - Epidemiological aspects in 3 different periods in the last 15 years

Alguns aspectos epidemiologicos de criancas nascidas com menos de 1.500 g em 1967/ 68, 1977/78 e 1981, no Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto sao descritos e analisados.As caracteristicas de peso, estatura, sexo e condicoes de nascimento das criancas (Apgar de 1o. minuto),assim como a idade e a frequencia das maes a clinica de pre-natal nao se modificaram nos periodos estudados.Em nenhum dos periodos a porcentagem destas criancas excedeu 2% dos nascimentos; a mortalidade destas criancas diminuiu de 88,6% em 1967/68 para 44,0% em 1981, porem estes obitos representaram cerca da metade da mortalidade geral do bercario. Em media 56,0% destes obitos ocorreram nas primeiras 24 horas de vida e 86,0% na primeira semana.Apos a alta do bercario 52% das sobreviventes foram reinternadas no primeiro ano de vida. Pelo alto risco apresentado por estas criancas, todos os esforcos devem ser feitos no sentido da prevencao do parto prematuro e, quando este for inevitavel, que se realize em centros capacitados para atende-lo adequadamente

Recem-nascidos com menos de 1.500g.II Modificacoes de conduta e avaliacao de desempenho em tres epocas distintas nos ultimos 15 anos. / Newborn infants with less than 1.500g. II.Changes of the management and evaluation of performance in 3 different periods in the last 15 years

O presente trabalho descreve o tratamento de criancas nascidas com menos de 1.500g no Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto, nos periodos de 1967/68, 1977/78 e 1981 e analisa as repercussoes das principais mudancas ocorridas. As alteracoes de conduta ente 1977/ 78 foram responsaveis por drastica reducao da taxa de mortalidade destas criancas que passou de 88,6% para 51,3% porem foi alta a frequencia de criancas com sequelas graves entre os sobreviventes de ambos periodos (75% e 45% respectivamente). Entre 1977/78 e 1981, constatou-se nova diminuicao na taxa de mortalidade, que passou de 51,3% para 44,0%, mas houve principalmente acentuada melhora no indice de sequelas graves, que chegou a 0% no ultimo periodo.Estes resultados reforcam a necessidade de unidades preparadas para o atendimento destas criancas de altissimo risco e enfatizam que a politica de prevencao da prematuridade e do baixo peso ao nascer deva ser a meta a ser perseguida

Recem-nascidos com menos de 1.500g III.Achados de necropsia em tres epocas distintas nos ultimos 15 anos. / Newborn infants with weight less than 1,500g. III. Findings in necropsy in 3 different times in the last 15 years

Os principais achados de necropsia de todas as 100 criancas nascidas com menos de 1.500 g no Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto nos periodos de 1967/78 e 1977/78 e 1981 e falecidas antes de terem tido alta de bercario sao descritos e analisados. Os achados de necropsia nao variaram de maneira importante nos 3 periodos estudados. Os problemas pulmonares foram relatados em 87% do total de necropsias, hemorragia cerebral em 11%, malformacoes multiplas em 8%, hemorragia subcapsular do figado em 4% e de incompatibilidade materno-fetal pelo fator Rh em 4%. Os autores sugerem que politica visando a prevencao da prematuridade, do baixo peso ao nascer e da anoxia neonatal deve ser enfatizada e que concomitantemente torna-se necessario o aprimoramento das tecnicas de assistencia respiratoria ao recem-nascido

O uso da lampada fluorescente branca em fototerapia. Aspectos fisicos. / The use of white fluorescent lights in phototherapy. Physical aspects

Os autores relatam um estudo experimental sobre parametros fisicos que poderiam influenciar no desempenho de lampadas fluorescentes brancas na fototerapia. Foram medidas radiancia e temperatura em incubadora e berco, tendo como fonte de luz conjuntos de seis lampadas fluorescentes brancas de 20W, dos tipos "Luz do Dia", "Branca Luxo" e "Branca Fria", a distancias variadas, com ou sem lencol envolvendo o sistema. A lampada "Luz do Dia" mostrou maior radiancia na faixa desejavel de 425 a 475 nm, e manteve condicoes aceitaveis de utilizacao por ate 600 horas de uso. Maior proximidade da fonte resultou em maior radiancia desejavel, porem com temperaturas elevadas, o que foi acentuado pelo uso de lencol. Em incubadora a radiancia util obtida foi menor que em berco, para a mesma distancia. Baseados nestes achados sao feitas algumas sugestoes para fototerapia

Assistencia respiratoria em criancas.Apresentacao de uma adaptacao para ventilacao artificial. / Ventilatory support in children. Presentation of an adaptation for artificial ventilation

Apresenta-se uma adaptacao para a assistencia ventilatoria em criancas. Consta do acoplamento de um respirador mecanico a um sistema semelhante ao descrito por Gregory e col

Surto de metemoglobinemia na enfermaria de pediatria do HCRP. Relato de 26 casos. / An outbreak of methemoglobinemia in the pediatric unit of the \"Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto\". Report of 26 cases

Os autores relatam um surto de metemoglobinemia na Enfermaria de Pediatria e Bercario Externo do HCRP, causado por tinta de marcar fraldas contendo nitrobenzol (anilina). Foram acometidas 26 criancas, sendo mais afetadas as que pesavam menos de 6 kg. Apos remocao das fraldas, retirada das criancas das incubadoras, administracao de acido ascorbico e azul de metileno, houve boa evolucao clinica com recuperacao de todos os casos. Ressaltam os autores a importancia da profilaxia evitando-se o uso de tintas com anilina ou, entao, a fervura ou autoclavagem das roupas marcadas com tais tintas devendo ser entregues ao uso somente 12 horas apos aquele procedimento