Breastfeeding prevalence in newborns of mothers with COVID-19: a systematic review / Prevalencia de lactancia materna en recién nacidos de madres con COVID-19: una revisión sistemática / Prevalência de aleitamento materno em recém-nascidos de mães com COVID-19: uma revisão sistemática

ABSTRACT Objectives: to compare exclusive breastfeeding prevalence versus artificial feeding in newborns of mothers with COVID-19. Methods: a systematic review of prevalence, according to JBI. Searches in PubMed®, Embase, CINAHL, LILACS and Web of Science™ databases in August 2021. Cross-sectional, longitudinal or cohort studies were selected, without language and time limitations that showed breastfeeding prevalence or that allowed calculation. Results: fifteen articles published in 2020 and 2021, cohort (60%) or cross-sectional (40%) were analyzed. The average of exclusive breastfeeding in mothers with COVID-19 was 56.76% (CI=39.90-72.88), and artificial breastfeeding, 43.23% (CI = 30.99 - 55.88), without statistically significant differences. Conclusions: despite the recommendations for maintaining breastfeeding, there was a reduction worldwide, when compared to periods prior to the pandemic. With advances in science, these rates have improved, showing the impact of evidence on practices. As limitations, study sources are cited. It is recommended to carry out new studies. PROSPERO registration CRD42021234486.

RESUMEN Objetivos: comparar la prevalencia de lactancia materna exclusiva versus alimentación artificial en recién nacidos de madres con COVID-19. Métodos: revisión sistemática de prevalencia, según JBI. Búsquedas en las bases de datos PubMed®, Embase, CINAHL, LILACS y Web of Science™ en agosto de 2021. Se seleccionaron estudios transversales, longitudinales o de cohortes, sin limitaciones de idioma y tiempo que mostraran prevalencia de lactancia materna o que permitieran calcular. Resultados: se analizaron 15 artículos publicados en 2020 y 2021, de cohorte (60%) o transversal (40%). El promedio de lactancia materna exclusiva en madres con COVID-19 fue 56,76% (IC=39,90-72,88), y lactancia artificial, 43,23% (IC = 30,99 - 55,88), sin diferencias estadísticamente significativas. Conclusiones: a pesar de las recomendaciones de mantener la lactancia materna, hubo una reducción a nivel mundial, en comparación con períodos previos a la pandemia. Con los avances de la ciencia, estas tasas han mejorado, mostrando el impacto de la evidencia en las prácticas. Como limitaciones se citan las fuentes del estudio. Se recomienda realizar nuevos estudios. Registro PROSPERO CRD42021234486.

RESUMO Objetivos: comparar as prevalências de aleitamento materno exclusivo versus aleitamento artificial em recém-nascidos de mães com COVID-19. Métodos: revisão sistemática de prevalência, segundo JBI. Buscas nas bases PubMed®, Embase, CINAHL, LILACS e Web of Science™ em agosto de 2021. Selecionados estudos transversais, longitudinais ou coortes, sem limitação de idioma e tempo que apresentavam prevalência de aleitamento materno ou que permitissem o cálculo. Resultados: 15 artigos publicados em 2020 e 2021, coortes (60%) ou transversais (40%) foram analisados. A média de aleitamento materno exclusivo em mães com COVID-19 foi 56,76% (IC=39,90-72,88), e artificial, de 43,23% (IC = 30,99 - 55,88), sem diferenças estatisticamente significantes. Conclusões: apesar das recomendações para a manutenção do aleitamento materno, houve redução mundialmente, quando comparados à períodos anteriores à pandemia. Com avanços da ciência, esses índices têm melhorado, mostrando o impacto das evidências nas práticas. Como limitações, citam-se fontes dos estudos. Recomenda-se realização de novos estudos. Registro PROSPERO CRD42021234486.

Orthopedic assessment of the hips in newborns after initial pediatric survey / Avaliação ortopédica dos quadris de recém-nascidos após exame pediátrico inicial alterado

ABSTRACT Objective: To analyze and follow-up patients previously selected by pediatricians at the time of birth who presented altered initial physical examination results to identify the pathological changes in their hips. Methods: A prospective cohort study was conducted involving 34 newborns (68 hips) out of a total of 1273 live births; these infants were assessed within the first days of life as altered findings were noted in the initial examination by the pediatrician. The results of clinical and ultrasonographic examination performed using the GRAF method and of specific treatments were analyzed. Results: Of the 68 hips in 34 patients, 2 hips in 2 patients required intervention using the Pavlik harness for 8 weeks; a satisfactory treatment outcome was obtained in both cases. Conclusions: Despite the low orthopedic workload in medical courses, it was possible to identify data consistent with the literature, both in the presentation of clinical findings and in those that required treatment, indicating that an initial evaluation of all newborns is mandatory, especially those with risk factors. Level of evidence IV, case series.

RESUMO Objetivo: Analisar e acompanhar os pacientes previamente selecionados por pediatras desde o nascimento, em busca de alterações patológicas nos quadris, naqueles considerados com exame físico inicial alterado. Métodos: Estudo de coorte prospectivo, iniciado nos primeiros dias de vida, em 68 quadris de 34 recém-nascidos, de um total de 1.273 nascidos vivos no ano da pesquisa, devido a alguma alteração no exame inicial do pediatra. Primeiramente, foram utilizados exame clínico e ultrassonográfico, com o método de Graf, tendo sido instituído tratamento específico naqueles que se fizeram necessários. Resultados: Dos 68 quadris em 34 pacientes, dois quadris em dois pacientes distintos necessitaram de intervenção com uso do suspensório de Pavlik por 8 semanas, obtendo resultado satisfatório em ambos após o término do tratamento. Conclusão: Apesar da baixa carga horária da Ortopedia nos cursos de medicina, podem-se observar dados condizentes com a literatura, tanto na apresentação de achados clínicos, quanto nos que se fez necessário o tratamento, de forma que se mostra necessária a realização de avaliação inicial adequada de todos os recém-nascidos, em especial naqueles que possuem fatores de risco. Nível de evidência IV, Série de casos.

Maternal bedside care on early development of newborn and maternal depression and anxiety,lactation / 中国基层医药

Objective To investigate the influence of maternal and child care bedside on early development of newborns and maternal depression and anxiety,lactation.Methods From January 2013 to June 2015,120 cases of healthy full -term newborns and maternal admitted in our hospital were randomly divided into control group and observation group,60 cases in each group.The two groups of newborns and mothers were given routine care,including care and neonatal umbilical buttocks care,maternity care,including genital or abdominal incision dressing,newborns were routinely vaccinated.In the control group,the newborns were taken to a public bath chamber concentrated bath. The observation group was implemented maternal and child care bedside manner Based on this,at the bedside of the newborn bathing and massage,swimming daily with newborns.Anxiety score (SAS)and depression scale score (SDS)for depression and anxiety were evaluated before and after the two groups of mothers nursing,and maternal milk yield variation were observed at different time,measured neonatal neurological assessment score (NBNA)and height,body mass index,head circumference growth.Results After treatment,the SAS and SDS scores of mothers of the two groups were decreased compared with before treatment,which in the observation group decreased more significantly, the differences were statistically significant (t =3.46,4.21,all P <0.05).After care,the maternal milk productions of the two groups started to grow,which of the observation group were always increased better than the control group, the differences were statistically significant (χ2 =9.34,4.53,6.79,all P <0.05).The newborn NBNA scores,head circumference,height,improvement in the quality index of growth in the observer group were better than the control group,the differences were statistically significant (t =1.98,1.65,2.73,3.63,all P <0.05).Conclusion Maternal and child bedside care can significantly improve maternal depression and anxiety scores,increase maternal lactation, and has a certain role in promoting early neonatal development,it is worth clinical application.

Efeito do posicionamento prono e supino na função respiratória de recém-nascidos pré-termo: uma revisão bibliográfica / Effect of prone and supine positioning on pre-term newborn respiratory function - a bibliographic review / Efecto de los posicionamientos prono y supino en la función respiratoria de recién nacidos prematuros - una revisión bibliográfica

Revisão bibliográfica sistematizada nas bases de dados Medline e Scielo sobre os efeitos dos posicionamentos prono e supino na função respiratória de recém-nascidos prematuros. Após leitura dos títulos e resumos, foram selecionados apenas aqueles que avaliaram os efeitos desses posicionamentos na função respiratória. Não houve diferenças significativas quanto à saturação periférica de oxigênio, correlação positiva entre prono e sincronismo toracoabdominal, bem como entre supino e as pressões: inspiratória máxima e de oclusão em um milissegundo, ambas de baixa magnitude. Os estudos analisados foram inconclusivos quanto ao melhor posicionamento para recém-nascidos no tocante à função respiratória.

Review of the literature in Medline and Scielo bases about the effects of prone and supine positions in premature respiratory function in the newborn. After reading study titles and abstracts, only those that evaluated the effects of position in respiratory function were selected. There were no significant differences with regard to oximetry. There was a positive correlation between the prone position and thoracic-abdominal synchronism, between the supine position and maximal inhalation pressure as well as with one millisecond occlusion pressure, both of low magnitude. Studies analyzed were inconclusive about the best position for newborn respiratory function.

Revisión bibliográfica en las bases de datos Medline y Scielo acerca de los efectos de las posiciones decúbito prono y decúbito supino en la función respiratoria de recién nacidos prematuros. Después de leer los títulos y los resúmenes se seleccionaron solamente los trabajos que estudiaron los efectos de la posición en la función respiratoria. No hubo diferencias en la oximetría de pulso. Hubo correlación positiva entre la posición decúbito prono y el sincronismo torácico - abdominal, decúbito supino y la presión máxima inspiratoria y de oclusión en un milisegundo, de baja magnitud. Los trabajos analizados no son conclusivos con relación a cuál es la mejor posición para la función respiratoria de los recién-nacidos.

Prevención de la encefalopatía hipóxico-isqúemica mediante Fenobarbital en forma temprana y a dosis alta

Objetivo: evaluar la utilidad del Fenobarbital (Fb), administrado en forma temprana y a dosis alta, en la prevención de la encefa-lopatía hipóxico-isquémica (EHI), secundaria a asfixia perinatal (APN). Material y métodos: mediante un ensayo clínico al azar, se asignaron a recién nacidos (RN) de término o postérmino con APN, a un grupo experimental (A) o al control (B); a los del primero se le administró Fb a 40 mg/Kg iniciado en la primera hora de edad, y a los del grupo B sólo en caso de crisis convul-sivas, a dosis habitual; el resto del tratamiento fue similar. Se evaluó la frecuencia de EHI, según la clasificación de Sarnat, así como otras complicaciones de la APN. Se midieron los signos vitales en uno y otro grupos y los niveles séricos de Fb en el grupo A. Se utilizaron las pruebas estadísticas de t o de U Mann-Whitney, X ² cuadrada o probabilidad exacta de Fisher. Se obtuvo consentimiento informado de los padres. Resultados: fueron 37 RN en el grupo A y 36 en el B, similares en proporción de sexos, edad gestacional y gasometría inicial, el peso fue mayor en el grupo A (p < 0.05). El diagnóstico de APN se hizo por pH < 7.00 y uno o dos de los criterios usados de asfixia, en la mayoría de los neonatos. Hubo diferencia respecto al momento de inicio y la cantidad total del Fb, entre los grupos. La EHI se presentó en 5/37 (13.5%) niños del grupo A y en 8/36 (22.2%) del B; las crisis convulsivas, o estadio II de EHI, se observaron en 4/37 (10.8%) y 4/36 (11.1%), respectivamente, sin diferencia en estas proporciones, ni en la frecuencia de otras complicaciones. La aplicación del Fb no originó efectos adversos en los signos vitales y todos los RN que lo recibieron tuvieron niveles séricos adecuados y sólo uno mostró niveles tóxicos. Discusión: no hubo diferencia significativa en la frecuencia global de EHI ni en la de convulsiones, o estadio II de EHI, entre los neonatos que recibieron Fb y a los que se no se les aplicó; por lo anterior, y aunque no hubo efectos colaterales, no se recomienda su empleo con este fin. Se plantea la necesidad del seguimiento de estos recién nacidos para valorar los efectos del Fb a largo plazo, ya que pudiera tener efecto favorable sobre el desarrollo psicomotor.

Objective: to assess usefulness of high-dose early phenobarbital therapy for prevention of hypoxic-ischemic encephalopathy (HIE) secondary to perinatal asphyxia (PNA). Material and Methods: by means of a randomized clinical trial, asphyxiated full-term or post-term newborn infants were divided in two groups: Group A was the experimental group, while group B was the control group. Infants in group A received phenobarbital, 40 mg/kg, during the first 60 min after birth. Infants on group B received phenobarbital at conventional doses, only if there was clinical evidence of seizures; otherwise, treatment was similar in both groups. We estimated frequency of HIE according to Sarnat classification and also rate of post-asphyxial complications in other organs. Phenobarbital levels were measured in Group A. Statistical tests used were Student t, Mann-Whitney U, X ² , or Fisher. Informed consent was obtained from parents of each infant. Results: 37 infants belonged to Group A, while Group B was composed of 36 infants. Both groups were similar in sex, gestational age and cord gases. Birth weight was higher in Group A (p<0.05). Diagnostic criteria for PNA a cord pH <7.00 plus one or two criteria of commonly used parameters for asphyxia. There was a difference in total dose of phenobarbital and time of initial dose in both groups. HIE was present in 13.5% (5/37) of group A, and 22.2% (8/36) of group B. Seizures (Stage II of HIE) occurred in 10.8% (4/37) and 11.1% (4/36), respectively, without significant statistical difference. There was also no difference in rate of post-asphyxial, non-brain complications in both groups. There were no side effects or changes in vital signs associated with use of phenobarbital. Only one infant had toxic phenobarbital serum levels. Discussion: there was no significant difference in the overall frequency of HIE, nor in the incidence of seizures or stage II of HIE in both groups. According to these results and even though there were no side effects, we think Phenobarbital is not useful for these purposes. Long-term follow-up of the treated infants is justified, since Phenobarbital might have a beneficial effect on neuro-behavioral development.

Study on hypocarbia in newborns during mechanical ventilation / 中华围产医学杂志

Objective To explore the causes and adverse effects of hypocarbia in newborns during mechanical ventilation. Methods Two hundred and forty-six newborns received assisted ventilation from Jan. 1994 to Dec. 2003 were retrospectively reviewed. Results The morbidity of hypocarbia was 14. 2%. It is common in preterm infants and the onset time of which were (31. 6?26. 9) hours after mechanical ventilation. The common primary disease was respiratory distress syndrome (RDS) (22. 6%). The mortality (32. 9%) and incidence of intracranial hemorrhage (20%) in hypocarbia cases were higher than those of the control group (7. 1 % and 5. 7%) (P