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O presente estudo investigou as contribuições dos princípios e da técnica da clínica winnicottiana no atendimento a duas mães e seus bebês no contexto da prematuridade. No primeiro caso, a mãe tinha 20 anos e a filha nasceu com 27 semanas gestacionais, pesando 1.020 gramas, e permaneceu 81 dias no hospital; no segundo, a mãe tinha 21 anos e as filhas gêmeas nasceram com 27 semanas gestacionais, pesando 1.600 gramas, e permaneceram 49 dias no hospital. O atendimento foi realizado durante a internação dos bebês. O foco da análise dos resultados foi no processo do atendimento, considerando cinco eixos temáticos derivados dos atendimentos: tolerância e confiabilidade; setting constante e confiável; acompanhamento das mães nas primeiras aproximações das filhas; espaço para elaboração dos conflitos conjugais e familiares; e desafios e impasses da clínica winnicottiana para a prematuridade. Os resultados revelaram que os atendimentos auxiliaram as mães em suas dificuldades frente à maternidade, bem como para verbalizar e elaborar as culpas, as perdas, o luto e os medos que a experiência do nascimento prematuro agrega à maternidade.
The present study investigated the contributions of the principles and techniques of Winnicott's clinic in the care of two mothers and their babies in the context of prematurity. In the first case, the mother was 20 years old and the daughter was born at 27 weeks gestational age, weighing 1,020 grams, and stayed 81 days in the hospital. In the second, the mother was 21 years old and the twin daughters were born at 27 weeks gestational age, weighing 1,600 grams, and stayed 49 days in the hospital. Care was provided during the babies' hospitalization. The focus of the analysis of the results was on the process of care, considering five thematic axes derived from the sessions: tolerance and reliability; constant and reliable setting; support for the mothers in the first approaches to their daughters; room for the elaboration of conjugal and family conflicts; and challenges and impasses of the Winnicottian clinic for prematurity. The results revealed that the consultations helped the mothers in their difficulties facing maternity, as well as to verbalize and elaborate the guilt, losses, mourning and fears that the experience of premature birth adds to maternity.
El presente estudio investigó las contribuciones de los principios y técnicas de la clínica de Winnicott en el cuidado de dos madres y sus bebés en el contexto de la prematuridad. En el primer caso, la madre tenía 20 años y la hija nació a las 27 semanas de edad gestacional, con un peso de 1.020 gramos, y permaneció 81 días en el hospital. En el segundo, la madre tenía 21 años y las hijas gemelas nacieron a las 27 semanas de edad gestacional, pesaron 1.600 gramos, y permanecieron 49 días en el hospital. La atención se prestó durante la hospitalización de los bebés. El foco del análisis de los resultados fue el proceso de atención, considerando cinco ejes temáticos derivados de las consultas: tolerancia y confiabilidad; setting constante y confiable; acompañamiento de las madres en los primeros acercamientos a sus hijas; espacio para la elaboración de conflictos conyugales y familiares; y desafíos e impasses de la clínica winnicottiana para la prematuridad. Los resultados revelan que las consultas ayudaron a las madres en sus dificultades frente a la maternidad, así como a verbalizar y elaborar las culpas, las pérdidas, el duelo y los miedos que la experiencia del nacimiento prematuro añade a la maternidad.
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O presente artigo tem como objetivo investigar os modos de cuidados clínicos com bebês prematuros internados em uma Unidade de Terapia Intensiva Neonatal (UTIN), à luz do referencial teórico da psicanálise, considerando os processos de instauração do sujeito e apontando para possíveis contribuições à atenção em saúde mental de bebês. A escuta psicanaliticamente orientada e as observações norteadas pelo uso do instrumento Indicadores de Risco para o Desenvolvimento Infantil (IRDI) compuseram as notas do diário de campo e permitiram a apresentação de vinhetas que ilustram a construção de possíveis dispositivos de trabalho clínico. Destaca-se a importância da sustentação de um espaço de escuta no qual se sobressaia o discurso familiar sobre o bebê, possibilitando a produção de narrativas singulares.
This article aims to investigate the clinical care modalities with premature newborn infants admitted to a Neonatal Intensive Care Unit (NICU), in the light of the theoretical framework of psychoanalysis, considering the processes of instituting the subject and pointing to possible contributions to care in mental health of babies. The psychoanalytically oriented listening and the observations guided by the use of the Risk Indicators for Child Development (IRDI) instrument compose the notes of the field diary and allowed the presentation of vignettes that illustrate the construction of possible clinical work devices. It stands out the importance of supporting the space of listening in which the familiar discourse on the baby, making possible the production of singular narratives.
El presente artículo tiene como objetivo investigar los modos de atención clínica con bebés prematuros internados en una Unidad de Terapia Intensiva Neonatal (UTIN), a la luz del referencial teórico del psicoanálisis, considerando los procesos de instauración del sujeto y apuntando para posibles contribuciones a la atención en salud mental de los bebés. La escucha psicoanalítica orientada y las observaciones orientadas por el uso del instrumento Indicadores de Riesgo para el Desarrollo Infantil (IRDI) compusieron las notas del diario de campo y permitieron la presentación de viñetas que ilustran la construcción de posibles dispositivos de trabajo clínico. Se destaca la importancia de la sustentación de un espacio de escucha en el que se sobresalía el discurso familiar sobre el bebé, posibilitando la producción de narrativas singulares.
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Objective To explore the epidemiological analysis of complications in premature infants.Methods From January 2017 to March 2018,1800 premature babies in Ningbo Women and Children Hospital were selected in the study.The clinical data of pregnant women,premature infants and premature complications,and so on were investigated,and summarized epidemiology of premature infant complications.Results The probability of premature birth was 9.09％.The differences between different gestational age(x2 =2 481.34) and different body weight (x2 =3 088.21) were statistically significant (all P ＜ 0.05).Premature rupture of membranes occurred as the main one of the common factors lead to premature birth,the fetal distress was also more common factors,so in different gestational age,the difference was not statistically significant (P ＞ 0.05).However,compared with other factors,the difference of premature infants at different gestational weeks was statistically significant (P ＜ 0.05).Conclusion Epidemiological study of preterm infants,can promote their perinatal management level and quality,and then pointed to strengthen perinatal health education and health care,for the effective prevention and treatment of common diseases of perinatal,key management and monitoring work earnestly strengthen the high-risk pregnancy,attaches great importance to the establishment of collaborative relationship between made in pediatric claims intrauterine transhipment,making pregnant women can be produced in the hospital for treatment for premature babies,and reduce the mortality and morbidity rates of premature and low birth weight,can reduce the risk of intellectual disability,eventually making the birth population overall quality improved.
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OBJECTIVE:To explore short-term efficacy and safety of early use of high-dose,medium-dose and low-dose ami-no acid in premature babies. METHODS:99 premature babies were selected and randomly divided into high-dose group,medi-um-dose group and low-dose group,with 33 cases in each group. 3 groups were given Amino acid injection,ivgtt,within 24 h af-ter birth,high-dose group was given 3 g/(kg·d),medium-dose group 2 g/(kg·d)and low-dose group 1 g/(kg·d);those dose in-creased by 0.5 g/(kg·d)day by day;predicted peak values of them were 3.5,3.5 and 3 g/(kg·d),respectively. Treatment courses of 3 groups lasted for 28 d. Health indexes,renal function indexes and blood indexes were observed in 3 groups. The occurrence of complications and ADR were recorded in 3 groups. RESULTS:2 cases withdrew from high-dose and low-dose groups. Hospital-ization stay,the time of body weight increasing to 2 500 g and the rate of body weight decreasing in high-dose group were signifi-cantly lower or shorter than in medium-dose and low-dose groups;the medium-dose group was significantly lower or shorter than the low-dose group,with statistical significance (P<0.05);the levels of creatinine,residual alkali,serum total bilirubin in high-dose group were significantly higher than medium-dose and low-dose groups,and the medium-dose group was significantly higher than the low-dose group,with statistical significance(P<0.05). The number of complications cases in high-dose group(11 cases)were significantly lower than in medium-dose group(20 cases)and low-dose group(26 cases),with statistical significance (P<0.05). No obvious ADR was found in 3 groups. CONCLUSIONS:High-dose of amino acid intravenous nutrition support in early stage can promote the recovery of nutrition state and healthy constitution in premature babies with good tolerance and safety.
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Cada año nacen a nivel mundial alrededor de 15 millones de niños anticipadamente y dicha tasa de nacimientos prematuros sigue en aumento. De estos infantes, un millón muere a causa de secuelas relacionadas con su temprana llegada al mundo. A partir de la experiencia en Psicología Perinatal en tres hospitales de la Ciudad Autónoma de Buenos Aires y el Gran Buenos Aires, se observaron ciertos cuestionamientos de los padres de niños que se encuentran internados debido a su prematuridad en servicios de Unidad de Cuidados Intensivos Neonatales (UCIN). Por este motivo el objetivo del trabajo realizado fue elaborar una Guía para padres de bebés nacidos prematuros que permita una correcta y rápida comprensión del ámbito de internación además de las situaciones por las que podría atravesar un niño nacido prematuro. Se utilizaron para este fin textos y cuadros. A su vez se trabajó acerca de los equipos empleados, el personal de salud que lo atenderá, el contacto con el niño, la lactancia, las experiencias de otros padres, páginas y redes sociales relacionadas con la temática y los derechos del niño prematuro según UNICEF. Se incluyen también, algunas sugerencias y fuentes bibliográficas. Esta guía pretende colaborar en el empoderamiento de los padres con niños internados en UCIN. En futuros estudios se podría evaluar el impacto de la misma en los padres y en los servicios de salud.
Each year are born prematurely 15 million babies worldwide and premature birth rates continue to rise. One million children die from complications from his prematurity and many survivors face a life with sequels. Prematurity is the leading cause of neonatal death and the second cause of deaths in children under five. In a report by March of Dimes is a need to addres surgent measures to deal with the millions of children born premature each year and ensure that all professionals can have an important role to make these measures. So working in the written information provided to relatives of patients admitted in NICU can be one of many possible ways to work on this goal. It is understood by premature baby, every infant born before 37 weeks gestational age. There are classifications of children born prematurely, Unicef puts based on gestational age: Between 36 and 31 weeks referred to Moderate Prematurity, between 30 and 28 weeks, Prematurity Extreme and when the birth occurs before 28 weeks, It is considered very extreme. Through experience in Perinatal Psychology in different institutions with hospitalization in Neonatal Intensive Care Unit (NICU) of the Ciudad Autónoma de Buenos Aires and Gran Buenos Aires, we have noted certain issues and characteristics particular to the parents of children hospitalized in NICU due to their premature birth. The aim of this work was to create a guide for parents experiencing the hospitalization of their children in NICU that permits rapid and comprehensive consultation for those un familiar with psychological-medical terminology. Comprehension is enriched by the addition of images and tables allowing cross-reference. This guide is intended to assist in empowering parents with children in NICU. This paper tries to give an idea that allows to remove the stigma of prematurity and take the child as a person who exceeds its prematurity. The issues dealt with in the guide are generally expressed through questions and corresponding answers: What does it mean that my baby has been born prematurely? What situations can my child experience during his/her hospitalization for premature birth and how is he/she assisted? What role do I play as mother or father in the neonatal unit? What care can I give as mother or father to my baby during his / her hospitalization? What signs does my baby present when they feel un comfortable or in pain? How can I comfort my baby? What is the experience of breastfeeding for a baby born prematurely? Can other family members visit my baby while he / she is hospitalized in the NICU? Is there a parents' group? What examinations will my child need after being discharged? Other informative items are added to help parents realize they are not the only ones, such as UNICEF's Rights of the Premature Child, experiences and feelings of mothers and fathers of babies born pre maturely, the sense of personal experience, recommendations, sites of interest on the internet (web and social networks) and bibliographical references. We stress the use of the phrase child / baby born prematurely and not just premature, to highlight that this child is a person who goes beyond the circumstance of having been born prematurely. This helps the parents to think of the situation as related to an experience in the life of their child and in their lives, rather than a constant in time, thus aiming to avoid future stigmatization, anxiety and over -protection. In future studies could evaluate the impact of this guide on parents and health services.
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O agravamento da gengivite, durante a gravidez, é atribuído principalmente ao aumento dos níveis de progesterona, a qual produz dilatação e tortuosidade na microvascularização gengival, estase circulatória e susceptibilidade aumentada à irritação mecânica, todas as quais favorecem um extravasamento de fluido para os tecidos perivasculares. A gravidez afeta a severidade de áreas previamente inflamadas, mas não altera a gengiva saudável. Assim o objetivo do estudo foi avaliar a influência do tratamento periodontal de suporte sobre o nascimento de bebês prematuros ou de baixo peso em gestantes com doença periodontal. Foram selecionadas 20 pacientes com doença periodontal diagnosticada, periodontite crônica moderada ou severa. Aleatoriamente as pacientes foram separados em 2 grupos, com 10 gestantes cada, onde todas receberam tratamento periodontal básico, sendo um grupo recebendo também a terapia periodontal de suporte e outro recebendo instrução de higiene oral durante todo o acompanhamento da gestação. Os resultados demonstraram uma redução estatisticamente significativa em todos os parâmetros, com destaque maior para o grupo 2, onde ocorreram as maiores reduções nas variações das médias dentro dos parâmetros de Profundidade de Sondagem e Nível de Inserção Clínica (p<0.05). Assim, podemos sugerir que a terapia periodontal de suporte influenciou positivamente na prevenção do nascimento de bebês prematuros ou de baixo peso em gestantes com doença periodontal.
The aggravation of gingivitis during pregnancy is mainly attributed to the increased levels of progesterone , which produces dilation and tortuosity in gingival microvasculature , circulatory stasis and increased susceptibility to mechanical irritation , all of which favor a leakage of fluid into the perivascular tissue . Pregnancy affects the severity of previously inflamed areas , but does not change the gums healthy. Thus the aim of the study was to evaluate the influence of supportive periodontal treatment on preterm birth or low birth weight in women with periodontal disease. We selected 20 patients diagnosed with periodontal disease , moderate to severe chronic periodontitis . Patients were randomly divided into 2 groups , each with 10 pregnant women , where all received basic periodontal treatment , one group also receiving supportive periodontal therapy and the other receiving oral hygiene instruction throughout the monitoring of pregnancy . The results showed a statistically significant reduction in all parameters , especially higher for group 2 , which showed the largest reductions in variations of the medium within the parameters of Probing Depth and Clinical Attachment Level (p<0.05) . Thus, we suggest that periodontal therapy support positively influenced in the prevention of preterm birth or low birth weight in women with periodontal disease.
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Objective To explore the risk factors and seek effective intervention of intracranial hemorrhage in the premature in-fants .Methods Clinical data of the premature infants in our hospital from January 2009 to December 2013 was retrospectively ana-lysed and single factor analysis of 20 relevant factors was done for cases with intracerebral haemorrhage and without intracerebral haemorrhage .Logistic regression analysis were done for some influence factors of intracranial hemorrhage .Results 1 726 cases of premature babies were included in the study ,including 264 cases of intracranial hemorrhage .Logistic regression analysis results shown that the neonatal transport network and integrated active transport models are protective factors of intracranial hemorrhage in the premature infant .We found that basic-level hospital transport was an independent risk factor .Between January 2009 and De-cember 2011 ,142 of 714 premature infants were intracranial hemorrhage ,including 88 cases from 348 patients transported from bas-ic-level hospital ,the incidence of intracranial hemorrhage was 25 .29% ,and compared with the incidence of intracranial hemorrhage (14 .75% ) of our hospital ,the difference was statistically significant (P<0 .05) .From January 2012 ,we established perfect neonatal transport network and implementation of comprehensive active transport model .122 of 1 012 premature infants were intracranial hemorrhage ,including 75 cases of 490 patients from basic-level hospitals .The incidence was statistically significant different com-pared with the incidence of intracranial hemorrhage(9 .00% ) transported from our hospital(P<0 .05) .The incidence of intracranial hemorrhage in the premature infants transported from basic-level hospitals were statistically different before and after neonatal transport network and comprehensive active transport model was established (P<0 .01) .Conclusion It will effectively reduce the incidence of intracranial hemorrhage in the premature infant by establishing the perfect regional neonatal three-level network trans-port system and comprehensive active transport models .
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Objective To investigate the changes and clinical significance of myocardial enzyme spectrum in the premature in-fants with hyperbilirubinemia .Methods The myocardial enzymes spectrum (AST ,CK ,CK-MB) in 90 premature infants with hy-perbilirubinemia were tested and the detection results were analyzed .Then their comparison with the control group consisting of 27 premature infants was performed .Results The detection results of myocardial enzymes spectrum in the hyperbilirubinemia prema-ture infants were higher than those in the control group ,but only the increase of CK-MB had statistical significance (P<0 .05);the positive incidence rate of the myocardial enzymes in the hyperbilirubinemia premature infants was 55 .56% (50/90) ,which was ob-viously higher than 7 .41% (2/27) in the control group ,the difference had statistical significance (P<0 .01) .Conclusion Hyperbil-irubinemia in premature infants can cause the myocardial damage and has the high incidence rate .The myocardial enzyme spectrum should be routinely detected for guiding the clinical treatment in the premature infants with hyperbilirubinemia .
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Objective@#(1) To determine if preterm babies with ROP are missed with the existing Philippine Pediatric SocietyPhilippine Academy of Ophthalmology 2005 screening criteria of ≤32 weeks gestational age (GA) and ≤1,500 grams birth weight (BW), (2) to determine the incidence (missed-out rate) of these babies with ROP (>32 weeks GA, >1,500 grams BW), (3) to describe their profile, and (4) to determine the appropriate upper limit for GA and BW that can provide safe and efficient screening for severe ROP.@*Methods@#This is a multicenter, retrospective cohort, observational study using data on ROP screening from the medical records of preterm babies from 4 institutions. All babies born ≤36 weeks GA, regardless of BW, who previously underwent ROP screening in 2011-2013, were included. Outcome measures were: (1) missed-out rate, (2) profile of missed babies with ROP (GA, BW, and risk factors), and (3) the proposed new criteria.@*Results@#Of the 762 babies screened, 105 (13.8%) had ROP. Of these, 13 (12%) had severe ROP, 28 (27%) was born at 33-36 weeks GA, and 32 (30%) with >1,500 grams BW. The oldest and heaviest of these missed babies with type 1 ROP was almost consistently reported at <35 weeks GA and <2,000 grams BW. Associated significant risk factors seen among missed babies were sepsis, respiratory distress syndrome (RDS), oxygen supplementation, and blood transfusion. There were 45 babies (43%) with ROP but with no risk factors. Among these were babies with GA >32 weeks and BW >1500 grams with ROP. The incidences of ROP, with and without risk factors, in the 4 institutions were not statistically significant. Seventeen (16.2%) preterm babies were missed with the existing criteria. Two of these had no risk factors but had type 1 and type 2 ROP. When <35 weeks GA and <2,000 grams BW as the new criteria were applied, the missed-out rate was reduced to 2% and was further reduced to zero with the inclusion of risk factors.
Subject(s)
Retinopathy of Prematurity , Mass ScreeningABSTRACT
Este trabalho traz uma reflexão a partir de minha trajetória profissional, desde 1994, no Hospital Regional de Assis/SP sobre a clínica com bebês nascidos prematuramente. No início, as ações fonoaudiológicas com bebês estiveram inspiradas pela legitimidade do discurso do risco, em que se apoia a área. Entretanto, o comprometimento com a clínica ocasionou o meu afastamento desse discurso e, consequentemente, engendrou a aposta na força determinante da linguagem na estruturação subjetiva, isto é, na força do ôdiscursoõ como fonte de possibilidade de um vir-a-ser-sujeito da cria humana, atuando como posição de antecipação introduzida pelo laço com a parentalidade.
This paper presents a reflection based on my professional career since 1994 at the Hospital Regional of Assis/SP concerning the clinic with babies born prematurely. Initially, the speech-therapy aplication in babies were inspired by the legitimacy of the risk discourse, which supports the area. However, the commitment to the clinic caused my remoteness to this speech and, consequently, engendered the wager on determining the strength of language in subjective structuring, i.e., the strength of the "speech" as a source of opportunity for a come to be subject of human creation, acting as the anticipated position introduced by the link with parenthood.
Este trabajo presenta una reflexión de mi carrera profesional, desde 1994, en el Hospital Regional de Assis/SP, sobre la clínica con bebés que nacen prematuramente. Inicialmente, las acciones de foniatría con bebés fueron inspiradas por la legitimidad del discurso de riesgo, que soporta el area. Sin embargo, el comprometimiento con la clínica ocasionómi alejamiento de este discurso y, en consecuencia, ha surgido la apuesta en la fuerza determinante del lenguaje en la estructuración subjetiva, es decir, en la fuerza del "discurso" como fuente de posibilidadde un venir-a-ser-sujeto de cría humana, actuando como posición de anticipación introducida por el lazo con la parentalidad.
Subject(s)
Early Intervention, Educational , Infant, Premature , Speech, Language and Hearing SciencesABSTRACT
The effect of mothers age and the participation in the Kangaroo Mother Care (KMC) on attachment relationships, was studied in a group of mothers and their infants from low socioeconomic status sample. The motherinfant interaction was observed in daily situations, finding out that the KMC increases the mothers sensitivity and decreases the negative effects of poverty, prematurity, hospitalisation and teenage maternity on infant security. The KMC does not increase the possibility that the infants establish insecure attachment relationships. These findings provide necessary evidence for the development of prevention-intervention programs for high risk populations.
Este estudio investigó el efecto de la edad materna y la participación en el Programa Madre Canguro (PMC) sobre el la relación de apego establecida en un grupo de madres y bebés de estrato socioeconómico bajo. Las díadas se agruparon dependiendo de, a) la edad de las madres al momento del parto (madres adolescentes y madres adultas); y b) la participación de los bebés en el PMC (bebés canguro y bebés no-canguro). La evaluación de las interacciones madre-bebé se llevó a cabo a través de observaciones naturalistas en las casas de las familias. Los resultados indicaron que el programa de atención alternativo para los bebés de bajo peso al nacer, el PMC, incrementa la sensibilidad materna y disminuye el efecto negativo de variables como la pobreza, la prematurez, la hospitalización y separación temprana, y la maternidad adolescente sobre la primera relación de apego. Se encontró además que el PMC no incrementa la posibilidad de establecer relaciones de apego inseguras entre los bebés y sus madres; al contrario, la participación en el PMC se constituyó como un factor de protección para éstas díadas. Los resultados proveen insumos útiles para el desarrollo de programas de prevención-intervención dirigidos a poblaciones de alto riesgo, a la vez que contribuyen al fortalecimiento de conceptos, áreas de análisis y metodologías propias de la teoría del apego en el contexto colombiano.