Una revisión acerca del cuidado de la salud mental en las familias de la Unidad de Cuidados Intensivos Neonatales / A Review of the Mental Health Care of Families in the Neonatal Intensive Care Unit

Introducción: el presente trabajo es una revisión de las prácticas que abordan la salud mental perinatal de las familias que atraviesan una internación en Unidades de Cuidados Intensivos Neonatales (UCIN). Los logros en la mayor sobrevida de recién nacidos de alto riesgo implican internaciones prolongadas y el cuidado emocional de sus familias. Estado del arte: el marco conceptual se refiere al cuidado centrado en las personas y su expresión perinatal en el modelo de Maternidades Seguras y Centradas en la Familia (MSCF). Se incluyen experiencias de referentes locales e internacionales que orientan las intervenciones en el campo. Conclusiones: se destaca la importancia del cuidado emocional en escenarios altamente estresantes, dado su impacto en el cuidado y la construcción de los vínculos tempranos entre los recién nacidos (RN) internados y sus referentes primarios. Se mencionan factores psicológicos de riesgo y posibles modos de abordaje. Se plantean acciones de promoción, prevención y asistencia en este contexto. (AU)

Introduction: This paper reviews practices addressing the perinatal mental health of families hospitalized in Neonatal Intensive Care Units (NICU). Achievements in increased survival of high-risk newborns involve prolonged hospitalization and emotional care of their families. State of the art:the conceptual framework refers to person-centered care and its perinatal expression in the Safe and Family-Centered Maternity Model (SFCMM). It includes experiences of local and international referents that guide interventions in the field. Conclusions:the importance of emotional care in highly stressful scenarios is highlighted, given its impact on the care and construction of early bonds between hospitalized newborns (NB) and their primary referents. It mentions psychological risk factors and possible approaches. We propose actions for promotion, prevention, and assistance in this context. (AU)

Albúmina sérica predictor de resultados intrahospitalarios en pacientes admitidos a la UCIN del Hospital de la Mujer / Serum albumin predicator of intrahospital outcomes in patients admitted to the NICU of the women's hospital

INTRODUCCIÓN: En el estrés metabólico existe una sobreproducción proteica de reactantes positivos de la fase aguda y en el hígado, se frena la síntesis de otras proteínas, incluyendo la albúmina, denominadas Reactantes Negativos de la Fase Aguda. Los rangos de referencia precisos para la hipoalbuminemia patológica han resultado difíciles de determinar en los recién nacidos. MATERIAL Y MÉTODOS: Descriptivo de corte transversal en 494 recién nacidos. Se realizó un análisis exploratorio de los datos con estadística descriptiva mediante el paquete estadístico SPSS v.20. RESULTADOS: 494 neonatos fueron seleccionados, 39% fueron prematuros tardíos, 27% reportó hipoalbuminemia en sus diferentes grados que se correlacionaron con los días de internación en UCIN (p=0,0001), necesidad y tiempo en ventilador mecánico (p=0,001), con la mortalidad (p=0,001) y patología infecciosa (p=0,001). DISCUSIÓN: La incidencia acumulada de sepsis no confirmada por hemocultivo fue de 54%, La hipoalbuminemia tiene asociaciones importantes con la evolución y pronóstico en pacientes pediátricos. La PCR no tiene correlación en el estudio (p=0,232) y solo fue reactiva en 4 pacientes (0,8%). CONCLUSIONES: El nivel de albúmina sérica reportada en las primeras 24 horas de ingreso a la UCIN es un predictor para los resultados intrahospitalarios (tiempo y requerimiento de ventilación mecánica), mortalidad neonatal, sepsis neonatal y enfermedad de membrana hialina. Su determinación sérica debe ser incluida en la lista de exámenes de laboratorio solicitados a su admisión y la PCR al ingreso debe ser excluida por su pobre sensibilidad como sugiere la SIBEN.

INTRODUCTION: In metabolic stress, there is a protein overproduction of positive acute phase reactants and in the liver, the synthesis of other proteins, including albumin, called negative acute phase reactants is slowed down. Precise reference ranges for pathologic hypoalbuminemia have proven difficult to determine in neonates. MATERIAL AND METHODS: Descriptive cross section in 494 newborns. An exploratory analysis of the data with descriptive statistics was carried out using the statistical package SPSS v.20. RESULTS: 494 neonates were selected, 39% were late preterm, 27% reported hypoalbuminemia in its different degrees that correlated with the days of hospitalization in the NICU (p=0.0001), need and time on a mechanical ventilator (p=0.001), with mortality (p=0.001) and infectious pathology (p=0.001). DISCUSSION: The cumulative incidence of sepsis not confirmed by blood culture was 54%. Hypoalbuminemia has important associations with outcome and prognosis in pediatric patients. CRP does not correlate the study (p=0.232) and was only reactive in 4 patients (0.8%). CONCLUSIONS: Serum albumin level reported in the first 24 hours of NICU admission is a predictor for in-hospital outcomes (time and requirement of mechanical ventilation), neonatal mortality, neonatal sepsis, and hyaline membrane disease. Its serum determination should be included in the list of laboratory tests requested upon admission and the PCR upon admission should be excluded due to its poor sensitivity, as suggested by SIBEN.

"É um bombardeio de sentimentos": experiências maternas no contexto do nascimento prematuro / "It's an explosion of feelings": maternal experiences in the context of preterm birth / "Es un bombardeo de sentimientos": experiencias maternas en el contexto del parto prematuro

O presente estudo investigou a experiência da maternidade de mães de bebês nascidos extremamente prematuros durante suas hospitalizações na UTI Neo. Em particular, buscou-se conhecer os sentimentos maternos relacionados a esse contexto. Participaram 18 mães cujos bebês tinham entre 25 e 28 semanas gestacionais e pesavam entre 625g e 1000g. As mães foram entrevistas 15 dias após o parto e as respostas foram examinadas por meio de análise de conteúdo qualitativa. Foram desenvolvidos três eixos, derivados das entrevistas: sentimentos sobre a UTI Neo; sentimentos sobre as manifestações do bebê; e sentimentos sobre a maternidade. Os achados revelaram uma complexidade de sentimentos maternos no contexto da UTI Neo. Porém, destacaram-se nas verbalizações maternas o investimento narcísico das mães nos seus bebês, que as levavam a se comunicar com eles a partir de pequenos gestos e expressões sensoriais, o que oportunizava, simultaneamente, a construção de um lugar simbólico para o bebê. (AU)

The present study investigated the motherhood experience of mothers of extremely preterm infants during their hospitalizations in the NICU. In particular, we sought to investigate the maternal feelings related to this context. Participants included 18 mothers whose babies were between 25 and 28 gestational weeks and weighed between 625g and 1000g. Mothers were interviewed 15 days after delivery and the responses were examined using qualitative content analysis. Three axes were developed, derived from the interviews: feelings about the NICU; feelings about the baby's manifestations; and feelings about motherhood. The findings revealed the complexity of maternal feelings in the context of the NICU. However, the mothers' narcissistic investment in their babies, which led them to communicate with them using small gestures and sensory expressions, stood out in the maternal verbalizations, which simultaneously made it possible to build a symbolic place for the infant. (AU)

El presente estudio investigó la experiencia de maternidad de madres de bebés nacidos extremadamente prematuros durante sus hospitalizaciones en la UCI Neonatal. En particular, se buscó conocer los sentimientos maternos relacionados con este contexto. Participaron 18 madres cuyos bebés tenían entre 25 y 28 semanas de gestación y pesaban entre 625 g y 1000 g. Las madres fueron entrevistadas 15 días después del parto y las respuestas se examinaron mediante análisis de contenido cualitativo. Se desarrollaron tres ejes, derivados de las entrevistas: sentimientos sobre la UCI Neonatal; sentimientos sobre las manifestaciones del bebé; y sentimientos sobre la maternidad. Los hallazgos revelaron una complejidad de los sentimientos maternos en el contexto de la UCI Neonatal. Sin embargo, la inversión narcisista de las madres en sus bebés se evidenció en sus verbalizaciones, que las llevaba a comunicarse con ellos a través de pequeños gestos y expresiones sensoriales que, simultáneamente, permitían la construcción de un lugar simbólico para el bebé. (AU)

Cord blood and serial lactate levels in predicting short-term outcome in term new-born babies with perinatal asphyxia

Introduction: Birth asphyxia is a leading cause of neonatal deaths across the globe. Clinical examination, Apgar score, pH, EEG/aEEG, Lactate are being used as markers for prediction of outcome. Serum Lactate is a better reflector of metabolic mechanism. We intend to study cord blood lactate and serial lactate levels in term birth asphyxia babies. Aim: To determine correlation between cord blood lactate, serial lactate levels and short term outcome in term new-born babies with perinatal asphyxia. Materials and Methods: It was a prospective, observational study. Thirty term babies with birth asphyxia were selected. Their Cord blood lactate, serum lactate at 6, 12, 24 hours of life were correlated to short term outcomes (NICU stay, shock, Acute kidney injury, mortality). Results: Eighteen babies with moderate asphyxia and 12 with severe asphyxia had mean cord blood lactate of 10.4mmol/L and 13.47mmol/L respectively. There was difference in mean lactate levels at 6, 12, 24 hours of life between the babies who survived and expired; also survivors had significant reduction in mean lactate levels at various time points. Babies with moderate asphyxia had no shock and AKI. Babies with severe asphyxia and shock had mean lactate levels of 12mmol/L in survivors and 13.8mmol/L in who expired. Babies with severe asphyxia and AKI had mean lactate of 14mmol/L in survivors and 14.6mmol/L in who expired. Babies with moderate asphyxia had no mortality. In babies with severe asphyxia, survivors had mean lactate of 12.74mmol/L and 14mmol/L in babies who expired. There was no correlation between the lactate levels and the length of the NICU stay. Conclusion: Serial lactate levels can be used to predictor the short term prognosis in term babies with perinatal asphyxia. There was significant difference in mean lactate levels between the babies who survived and expired. Serial lactate levels showed significant reduction in babies who survived.

Evaluation of clinical profile and screening guidelines of retinopathy of prematurity in an urban level III neonatal intensive care unit

Purpose: To evaluate the clinical profile and screening guidelines of retinopathy of prematurity (ROP) in an urban level III neonatal intensive care unit (NICU). Methods: Infants with ?2000?gm birth weight or <34 weeks gestational age were prospectively screened for ROP in an urban level III NICU between January 2018 and December 2020, based on national screening guidelines. Standard guidelines were used for ROP classification and treatment. Results: In total, 211 infants completed screening; 46 (21.8%) infants developed ROP and 13 (6.2%) had type 1 (laser treatable) ROP. Of the 46 infants with ROP, 44 (95.65%) had zone 2 and two (4.34%) had zone 1 disease. In the 102 infants with ?1500?gm birth weight, the incidence of ROP and type 1 ROP were 41.18% and 11.76%, respectively. Out of the 109 infants with >1500?gm birth weight, four (3.67%) developed ROP and one (0.91%) infant (an outborn) required treatment. Conclusion: The majority of infants developing ROP in a level III urban NICU had ?1500?gm birth weight. Zone 1 ROP was uncommon. Incidence of ROP in heavier infants (>1500?gm birth weight) was low, and treatment was required in a rare instance. In an urban NICU, the burden of ROP screening and treatments shifts to small and low?birth?weight infants

A RETROSPECTIVE STUDY TO ASSESS FETO-MATERNAL OUTCOME IN SEVERELY ILL COVID-19 POSITIVE PREGNANT FEMALES ADMITTED AT DEDICATED COVID CARE CENTER

Background - Covid 19 infection caused by corona virus SARS- COV -2To study the fetomaternal outcome in severely ill covid positive pregnant females. Methods- An Observational study was conducted at dedicated COVID care center, jhalawar from Jan 2021 to May 2021 among pregnant females. In this study we included all Severely ill symptomatic COVID positive females which could not maintain oxygen saturation, were included in this study. Results-A total of 54 pregnant women, 24women delivered with 2 twin pregnancy . Out of this 30% underwent cesarean section and 15% were delivered by vaginal route. Postpartum hemorrhage seen in 29% of patients.24% of baby were < 2.5 kg, 12% babies were admitted in NICU. Blood products transfused in 9 patients. Remdesivir were given in 26 (48%) patients. Conclusion-We found that severe COVID-19 infection in pregnancy was associated with risks of preeclampsia, stillbirth, preterm birth and NICU admission. Future studies are needed to collect more robust data to further validate or substantiate these findings, better understand the pathophysiologic pathways that explain these associations and identify effective strategies to prevent adverse outcomes in pregnant people with COVID-19

Ethical Issues around Death and Withdrawal of Life Support in Neonatal Intensive Care

Amongst all the traumatic experiences in a human life, death of child is considered the most painful, and has profound and lasting impact on the life of parents. The experience is even more complex when the death occurs within a neonatal intensive care unit, particularly in situations where there have been conflicts associated with decisions regarding the redirection of life-sustaining treatments. In the absence of national guidelines and legal backing, clinicians are faced with a dilemma of whether to prolong lifesustaining therapy even in the most brain-injured infants or allow a discharge against medical advice. Societal customs, vagaries, and lack of bereavement support further complicate the experience for parents belonging to lower socio-economic classes. The present review explores the ethical dilemmas around neonatal death faced by professionals in India, and suggests some ways forward.

Drug utilization study in neonatal intensive care unit at tertiary care hospital

SUMMARY OBJECTIVE: Neonates are more susceptible to drug interactions and adverse effects, and special care should be taken when prescribing medication to them. This study aimed to investigate drug usage in the neonatal intensive care unit of a tertiary care hospital. METHODS: This prospective observational study was conducted on 98 patients at the Apollo tertiary care hospital (Bannerghatta, Bangalore, India) in a period of 6 months. The most common indications for neonatal intensive care unit admission, average number of drugs per patient, the most frequently used medication, distribution of patients based on the birth procedure, and possible drug interactions were collected from patient profiles. RESULTS: Among the patients, 52% were males and 48% were females. Notably, 38% of patients were preterm, 60% were term, and only 2% were post-term. Also, 80.6% were born by cesarean section and 19.4% were born by normal vaginal delivery. The highest mean of drug use was in the patient of 1,000-1,500 g (8.06 per patient). Preterm was the most frequent indication for admission in neonatal intensive care unit, followed by hyperbilirubinemia and then respiratory distress syndrome. The most frequently used medication was vitamin K (99%) and antibiotics followed by dextrose. In different types of antibiotics, amikacin (41%), cefoperazone+sulbactam (35%), cephalosporin (1%), ceftriaxone (0.7%), and amoxicillin (0.3%) were commonly administered. There were some possible interactions, such as aminoglycoside with furosemide and calcium gluconate. CONCLUSION: Premature birth and resulting low birth weight were the main reasons for drug prescription. High administration of antibiotics is probably an area of concern and should be seriously considered.

Comparison Of Maternal And Fetal Outcome Following Caesarean Section In Pre- Eclamptic Patients Under General And Spinal Anesthesia

Background:Pre-eclampsia is a multi-system disorder in pregnancy associated with significant maternal morbidity and mortality and also affects neonatal outcome. Choice of anesthesiatechnique and skillful management is equally important for maternal and fetal well-being. So, this study was designed to compare the maternal and fetal outcome following cesarean section in pre-eclamptic patients under general and spinal anesthesia. Material And Methods:This prospective, randomized observational study was carried out in 60 parturients age between 18 to 40 years divided in two groups 30 parturients in each. ASA Physical Status II and III who delivered after 34 weeks of gestation with criteria of mild pre-eclampsia by means of Elective/emergency C-section were included. After giving pre medication Group G received thiopentone, succinylcholine intravenously before intubation followed by oxygen, sevoflurane and atracurium (after delivery of baby). Group S received spinal anesthesia by using 2 ml of 0.5% heavy bupivacaine. Heart rate, blood pressure, SpO2 of mother and neonate were recorded at specific time points. Also post of ICU shifting of mother for maternal outcome and APGAR score at 1,5,7minutes, ABGA, resuscitation requirement and NICU admission data were recorded for fetal outcome.Result:After induction maternal heart rate and blood pressure were higher side (still within 30% from baseline) in group G as compared to group S. APGAR score, ABGA and NICU shifting requirements had favorable outcome in group S. Conclusion:Spinal anesthesia is first choice as it is more safe, simple and with better maternal and fetal outcome.

Incidence of Neonatal Seizures and it's ClinicoEtiological Profile in A Tertiary Care Hospital in Western India

Introduction: Neonatal seizure is defined as paroxysmal electrical discharge from the brain. The immature brain seems more prone to seizures. The incidence was found to increase with decreasing gestation and birth weight- preterm neonates (20.8 vs. 8.4 per 1000 live-births) while very low birth weight neonates had more than 4-fold higher incidence (36.1 per 1000 live-births). Objective: The study was conducted to estimate the incidence, etiological factor, time of onset, clinical types, and biochemical abnormalities among the different types of neonatal seizures. Methods: This is a hospital based prospective observational study conducted in NICU, Department of Pediatrics, SMIMER during the period of January 2020 to March 2021. Results: Total patients with neonatal seizures were 90 in our study. Incidence of neonatal seizures in our study was 1.1%. Incidence was higher in pre-term neonates (4.8%) and more in males (56.67%). Incidence of neonatal seizures was higher in LBW babies (4.3%) and more common in SGA babies (51.11%). Incidence among vaginal delivered babies was 0.9%, LSCS was 1.7% and forceps was 1.1%. Birth asphyxia (41.1%) was the most common cause of all neonatal seizures followed by hypoglycemia (17.8%), neonatal meningitis/septicemia (14.5%), hypocalcemia (12.2%), ICH (7.8%). Subtle seizures (44.4%) were the most common type of seizure followed by tonic (38.9%), focal clonic (11.1%), multifocal clonic (5.6%). 33.3% of neonatal seizures occurred in < 24hrs & 40% in 24-72 hrs. The most common biochemical abnormality was hypoglycemia (17.8%) followed by hypocalcemia (12.2%). Conclusion: Incidence of neonatal seizures was 11.1/1000 live births (1.1%) & more common in preterm, LBW & LSCS deliveries. Birth asphyxia was the most common cause and subtle seizures were the most common type of seizure. Subtle seizures were more common in 24-72 hours of life. Most common biochemical abnormality was hypoglycemia followed by hypocalcemia

The Department of Pediatrics, Safdarjang Hospital, New Delhi, 1950-2020

The paper attempts to capture the development of the Department of Pediatrics, Safdarjang Hospital, New Delhi, from a historical perspective in its founding years in late 1950s, showing the progress from its nascent state as a part of adult medicine to a full-fledged independent department with state-of-the-art advances in the 2020s. From an ordinary Pediatrics Department, it was reorganized radically to expand clinical facilities as well as education and research by innovative methods, developing subspecialties including an upgradation of the neonatology division, simultaneously establishing linkages with community level centres. The pioneering workshops for training obstetricians and pediatricians paved the way for initiation of multiple such national workshops across the country, by the Government of India, for establishment of neonatal care units countrywide. It was instrumental in the formulation of ‘Essential Newborn Care’ as the first national newborn care program and later a new concept of ‘Mother and Neonatal Care Unit (M-NICU)’ for perinatal care, apart from many other contributions for shaping national policies.

Study on the motivation and path of the formation of breastfeeding education behavior of nurses in NICU based on grounded theory / 中国实用护理杂志

Objective:To explore the motivation of the formation of the breastfeeding mission and education behavior of nurses in NICU, analyze the deep reasons, and construct the motivation and path theoretical model of the formation of the breastfeeding mission and education behavior of nurses in NICU.Methods:Through semi-structured interviews, the qualitative research method of grounded theory was used to study 20 nurses in the Second Affiliated Hospital, University of South China from July to September 2020, to construct the motivation and path theoretical model of the formation of the breastfeeding mission and education behavior of nurses in NICU.Results:The research identified five main categories: attitude factor, ability factor, behavior factor, internalization and externalization. Under the influence of three dimensions of attitude level, ability level and behavior level and their cross-layer interaction effects, the NICU nurses were driven to form stable breastfeeding mission and education behaviors through internalization and externalization.Conclusions:Based on the evolutionary context of "multi-dimensional factors and their interaction drivers-internalization-externalization", the relationship between attitude factors, ability factors, behavioral factors, internalization, and externalization are clarified. It provides a theoretical reference basis for managers in managing the breastfeeding propaganda and education of nurses in the NICU, and enriches the theoretical framework of breastfeeding behavior in the NICU.

Mães de bebês em UTIN: rede de apoio e estratégias de enfrentamento / Mothers of babies in NICU: support network and coping

A Unidade de Terapia Intensiva Neonatal (UTIN), embora seja um ambiente de cuidados especiais para garantir a sobrevivência de recém-nascidos, tende a suscitar, nas mães e familiares, percepções e sentimentos ambíguos sobre os eventos relacionados a internação e, ainda, alterar a saúde emocional dos envolvidos. O presente estudo teve como objetivo verificar a associação entre apoio social, estratégias de enfrentamento e tempo de internação, de mães de bebês em UTIN. Os dados foram obtidos de uma amostra de 50 mães de bebês, na maioria até 10 dias internados, que responderam a Escala Modos de Enfrentamento de Problemas e a Escala de Apoio Social. Observou-se que as mães perceberam maior apoio de familiares, principalmente nas dimensões material e afetivo. As estratégias de enfrentamento de maior recorrência foram as focalizadas no problema e na busca de prática religiosa e/ou pensamento fantasioso. Os resultados demonstraram a importância do apoio de diferentes dimensões e as dificuldades de enfrentamento das situações estressoras com o passar dos dias de internação. Os resultados apontaram para a necessidade de atenção e cuidado a essa população.(AU)

The Neonatal Intensive Care Unit (NICU), although it is an environment of special care to ensure the survival of newborns, tends to raise, in mothers and family members, ambiguous perceptions and feelings about events related to hospitalization and also change the emotional health of those involved. This study aimed to verify the association between social support, coping strategies and length of stay of mothers of babies in the NICU. Data were obtained from a sample of 50 mothers of babies, most of them within 10 days of hospitalization, who answered the Modes of Coping with Problems Scale and the Social Support Scale. It was observed that mothers perceived greater support from family members, especially in the material and affective dimensions. The coping strategies of greatest recurrence were those focused on the problem and the search for religious practice and / or fanciful thinking. The results demonstrate the importance of the support of different dimensions and the difficulties of coping with stressful situations with the passage of the days of hospitalization. The results highlight the need for attention and care to this population.(AU)

La Unidad de Cuidados Intensivos Neonatales (UCIN), si bien es un ambiente de cuidados especiales para asegurar la supervivencia de los recién nacidos, tiende a suscitar, en las madres y familiares, percepciones y sentimientos ambiguos sobre eventos relacionados con la hospitalización y también cambiar la salud emocional de los recién nacidos. los implicados. Este estudio tuvo como objetivo verificar la asociación entre apoyo social, estrategias de enfrentamiento y tiempo de estadía de madres de bebés en la UCIN. Los datos se obtuvieron de una muestra de 50 madres de bebés, la mayoría dentro de los 10 días de la hospitalización, que respondieron la Escala de Modos de Enfrentamiento de Problemas y la Escala de Apoyo Social. Se observó que las madres percibieron un mayor apoyo por parte de los familiares, especialmente en las dimensiones material y afectiva. Las estrategias de enfrentamiento más recurrentes fueron las centradas en el problema y la búsqueda de prácticas y / o fantasías religiosas. Los resultados demostraran la importancia de los apoyos de diferentes dimensiones y las dificultades para enfrentar situaciones estresantes durante los días de hospitalización. Los resultados destacaran la necesidad de atención y cuidado de esta población.(AU)

Challenges in the Diagnosis & Management of Neonatal Sepsis

Neonatal sepsis is the main cause of neonatal mortality and a major public health problem, especially in underdeveloped countries. Although recent medical services have improved neonatal care, but still challenges remain in the diagnosis and management of neonatal infections. The diagnosis of neonatal sepsis is complicated by the frequent presence of non-infectious conditions that resemble sepsis, especially in preterm infants, and by the absence of optimal diagnostic tests. Since neonatal sepsis is a high-risk disease, especially in preterm infants, clinicians are compelled to empirically start antibiotics to infants with risk factors with and without signs of suspected sepsis. Unfortunately, both broad-spectrum antibiotics and prolonged treatment with empirical antibiotics are associated with adverse outcomes and increase antimicrobial resistance rates. Given the high incidence and mortality of sepsis in preterm infants and its long-term consequences on growth and development, efforts to reduce the rates of infection in this vulnerable population are one of the most important interventions in neonatal care. In this review, we discuss the most common questions and challenges in the diagnosis and management of neonatal sepsis, with a focus on developing countries

Os impactos da hospitalização neonatal para mães de recém-nascidos / The impacts of hospitalization for mothers of newborns / Los impactos de la hospitalización neonatal para las madres de recién nacidos

Objetivo: Analisar os impactos da hospitalização neonatal em UTI para as mães de recémnascidos. Método: Trata-se de um estudo de abordagem quanti-qualitativa. Para a coleta de dados utilizou-se perguntas feitas de maneira virtual através de um questionário com 13 perguntas, aplicado por meio da plataforma digital Google Forms. As participantes foram mães de recém-nascidos que estiveram ou que estão hospitalizados em UTIN. Para análise de dados utilizou-se a compilação dos dados que posteriormente foram agrupados por afinidade e apresentados no relatório final em gráficos e dados discursivos. Resultados: A discussão foi construída com 10 categorias, sendo algumas delas: o tratamento humanizado dos profissionais na UTIN, a visão que as mães têm da UTIN antes e depois da hospitalização, os impactos que a hospitalização geram na vida das mães, os sentimentos das mães ao vivenciarem essa experiência, compartilhamento de informações da UTIN para as mães. Conclusão: O presente estudo deixa evidências de que a hospitalização é um período doloroso para as mães, onde há um grande número de transtornos psicológicos como consequência, há também uma necessidade de humanização de forma integral, além do estímulo, compartilhamento de informações e principalmente empatia dos profissionais que atuam nessa área.

Objective: To analyze the impacts of neonatal hospitalization in ICU for newborn mothers. Method: This is a quantitative-qualitative study. For data collection, questions were asked in a virtual way through a questionnaire with 10 questions, applied through the digital platform Google Forms. The participants were mothers of newborns who were or who are hospitalized in the NICU. For data analysis, we used the compilation of data that were later grouped by affinity and presented in the final report in graphs and discursive data. Results: The discussion was built with 10 categories, some of them being: the humanized treatment of professionals in the NICU, the view that mothers have of the NICU before and after hospitalization, the impacts that hospitalization generates on the lives of mothers, the feelings of mothers in experiencing this experience, sharing information from the NICU to mothers. Conclusion: This study leaves evidence that hospitalization is a painful period for mothers, where there is a large number of psychological disorders as a consequence, there is also a need for full humanization, in addition to the stimulus, information sharing and especially empathy of the professionals who work in this area.

Objetivo: Analizar los impactos de la hospitalización neonatal en UTI para las madres de recién nacidos. Método: Se trata de un estudio de abordaje cuantitativo-cualitativo. Para la recolección de datos se utilizaron preguntas hechas de manera virtual a través de un cuestionario con 10 preguntas, aplicado por medio de la plataforma digital Google Forms. Las participantes fueron madres de recién nacidos que estuvieron o que están hospitalizados en UTIN. Para análisis de datos se utilizó la compilación de los datos que posteriormente fueron agrupados por afinidad y presentados en el informe final en gráficos y datos discursivos. Resultados: La discusión fue construida con 10 categorías, siendo algunas de ellas: el tratamiento humanizado de los profesionales en la UTIN, la visión que las madres tienen de la UTIN antes y después de la hospitalización, los impactos que la hospitalización generan en la vida de las madres, los sentimientos de las madres al experimentar esta experiencia, compartir información de la UTIN para las madres. Conclusión: El presente estudio deja evidencias de que la hospitalización es un período doloroso para las madres, donde hay un gran número de trastornos psicológicos como consecuencia, también hay una necesidad de humanización de forma integral, además del estímulo, intercambio de información y principalmente empatía de los profesionales que actúan en esa área.

Relação entre a posição Canguru e a estabilidade fisiológica e equilíbrio sono-vigília de recém-nascidos prematuros na UTIN e percepção materna / Relationship between the kangaroo position and physiological stability and sleep-wake balance of premature newborns in the NICU and maternal perception

A posição canguru é uma estratégia do Método Canguru que aproxima as mães de seus filhos, promovendo estabilidade fisiológica. OBJETIVO: Analisar a estabilidade fisiológica e equilíbrio sono-vigília dos RNPTs de uma Unidade de Terapia Intensiva Neonatal (UTIN) em um hospital público universitário, bem como a percepção materna quanto a posição canguru. MÉTODO: Estudo observacional com análise de resultados qualitativos e quantitativos. Desenvolveu-se entre julho a dezembro de 2017 na UTIN. Os dados foram coletados dos prontuários dos RNs. Os parâmetros fisiológicos e estado comportamental de escala sono vigília, antes e após 50 minutos na posição canguru. E as mães responderam à 10 perguntas abertas quanto a seus sentimentos no contato pele a pele. RESULTADOS: Foram incluídos 18 recém-nascidos e 10 mães responderam a entrevista. Os RNs mantiveram a frequência cardíaca (p=0,28) e saturação periférica de oxigênio (p=0,77) nos limites da normalidade, a temperatura corporal apresentou diferença estatisticamente significante (p=0,01) variando entre 36,5 e 36,7o. Os RNs mudaram o estado comportamental e as mães perceberam estas mudanças durante a realização da posição canguru e se sentiram mais próximas dele por meio do contato pele a pele. CONCLUSÃO: Os recém-nascidos posicionados em canguru no tórax de suas mães mantiveram seus dados fisiológicos estáveis e a temperatura corporal dos mesmos apresentou pequeno acréscimo dentro da normalidade, mostrando ser seguro estar na posição canguru. As mães perceberam que tal ato as aproximou de seus filhos despertando sentimentos positivos de alegria, emoção e amor, indo ao encontro do que é preconizado pelo Método Canguru.

The kangaroo position is a strategy of the Kangaroo Method that brings mothers closer to their children, promoting physiological stability. OBJECTIVE: To analyze the physiological stability and sleep-wake balance of premature newborn from a Neonatal Intensive Care Unit (NICU) in a public university hospital, as well as the maternal perception of the kangaroo position. METHOD: Observational study with analysis of qualitative and quantitative results. It developed between July and December 2017 at the NICU. Data were collected from the newborns' medical records. The physiological parameters and behavioral state of sleep wake scale, before and after 50 minutes in the kangaroo position. And the mothers answered 10 open questions about their feelings about skinto-skin contact. RESULTS: 18 newborns were included and 10 mothers answered the interview. Prelatures maintained their heart rate (p =0.28) and peripheral oxygen saturation (p = 0.77) within normal limits, body temperature showed a statistically significant difference (p = 0.01) ranging between 36.5 and 36.7o. Newborns changed their behavioral state and mothers noticed these changes during the performance of the kangaroo position and felt closer to them through skin-to-skin contact. CONCLUSION: Newborns positioned in a kangaroo on their mothers' thorax kept their physiological data stable and their body temperature showed a small increase within normal limits, showing that it is safe to be in the kangaroo position. The mothers realized that such an act brought them closer to their children, arousing positive feelings of joy, emotion and love, in line with what is recommended by the Kangaroo Method.

To study the feto-maternal outcome in cases with previous surgical intervention for first trimester abortion on subsequent pregnancy and to compare with cases without history of previous abortion

Background: To study the Feto-maternal outcome in cases with previous surgical intervention for first trimester abortion on subsequent pregnancy and to compare with cases without history of previous abortion.Methods: A cross sectional observational study was conducted over a period of two years. Study included 80 consenting females at 28 weeks POG. Females with history of prior surgical abortion just before the present pregnancy were included as cases (n=40) and rest as controls (n=40). Detailed obstetric history was taken, subjects were then followed till delivery and feto-maternal outcomes such as period of gestation, mode of delivery birth weight, Apgar score, increased NICU stay at the time of delivery were recorded and analyzed.Results: We observed that the women with history of induced surgical abortion were at increased risk of Pre term birth (52.5%, p value0.006), Cesarean section (40%, p value 0.012), Low birth weight (47.5%, p value <0.001), increased NICU stay (32.5%, p value 0.027) compared to primi-gravida controls.Conclusions: We concluded that women with previous history of induced surgical abortions were at increased risk of preterm birth, very preterm birth and low birth weight babies, NICU stay in the subsequent pregnancies. The risk of caesarean was found to be increased in women with previous induced abortions exposing the women to the morbidity associated with the C-section. Hence patient with prior history of surgical first trimester abortion needs more vigilant monitoring during antenatal period in subsequent pregnancy.

Study of fetomaternal outcome in eclampsia

Background: Eclampsia is a life-threatening emergency that continues to be a major cause of maternal and perinatal mortality. The purpose of our study was to analyse the trend of eclampsia in a tertiary care teaching institute and to find out the fetomaternal outcomes of eclampsia.Methods: A retrospective epidemiological study was undertaken in the department of Obstetrics and Gynaecology, Jhalawar medical college, Jhalawar during the period ‘September 2018 to August 2019’. Women who presented as eclampsia or developed eclampsia during hospital stay were included in the study. Data analysed included various maternal parameters, fetal parameters, and the outcome of the pregnancy.Results: The incidence of antepartum eclampsia was (0.92%). High risk associated factors were primigravida (65.90%), low maternal age (21-30 years), illiteracy, and inadequate antenatal care. Caesarean section was the mode of delivery in 48 cases (54.54%) most common indication was unfavourable cervix, 80.6% women had antepartum eclampsia and 68.18% women had severe preeclampsia. There was 6.8% maternal mortality, attributed to pulmonary edema and acute renal failure. Perinatal mortality was 14.77% with 8 still births and 5 neonatal deaths. Prematurity complicated 46.66% pregnancies. Thirty neonates were admitted to NICU.Conclusions: Eclampsia is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper antenatal care, low socio-economic status, and lack of education. It can be concluded that better antenatal care, early recognition of disease, timely referral, early initiation of treatment and termination of eclamptic patients improves outcome. Management of eclamptic patients should be performed at tertiary care centres, where ICU facilities, NICU facilities, and multidisciplinary units are available.

O ato de nomear o bebê internado em uma Unidade de Terapia Intensiva Neonatal: uma aposta no advento do sujeito? / The act of naming the baby admitted to a Neonatal Intensive Care Unit: a bet on the subjects advent?

Resumo: O artigo trata das possíveis consequências da passagem de bebês por uma Unidade de Terapia Intensiva Neonatal (UTIN), tomando o conceito de nome próprio como ponto norteador. Consiste em escrita de relato de experiência profissional orientado a partir da Psicanálise, com recortes de trabalho realizado em UTIN com os bebês e suas famílias. A prática suscitou a consideração de que a aposta, advinda do desejo dos que cercam o bebê de que nele há um sujeito, é a via de possibilitar-lhe uma vida, o que comparece na convocação que lhe é feita a partir do nome que lhe é atribuído.

Abstract: The article deals with the possible consequences of babies passages through a Neonatal Intensive Care Unit (NICU), taking the concept of proper name as the guiding point. It consists of written reports of professional experience based on Psychoanalysis's reference, with clippings of work done in NICU with infants and their families. The practice has given rise to the consideration that the bet, coming from the desire of those who surround the baby that there is a subject in him, is the way to give him a life, which appears in the summons that is made from the name that he is assigned.

Prevalence of thyroid dysfunction in neonatal population

Background: The objectives of this study was to study the prevalence of thyroid disorders in high risk neonatal populations and to study association of maternal thyroid dysfunction with neonatal thyroid problems and outcome.Methods: This was an observational study, conducted in NICU at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. The study included neonates born to mothers with thyroid disorder or with clinical features suggestive of thyroid dysfunction. Neonates with history of maternal thyroid dysfunction were screened at 72 to 96 hrs of postnatal age. Those with TSH >10 mIU/L or free T4 <1.1 ng /ml were followed up after two weeks. The neonates with clinical features suggestive of thyroid dysfunction were screened at presentation and those with abnormal thyroid profile were followed up after two weeks. Results obtained were statistically analyzed using SPSS 17.0 software.Results: Out of 260 neonates screened, 208 neonates were born to mothers with hypothyroidism, 6 neonates had increased levels of TSH during first week which normalised on follow up during third week. One neonate born to hyperthyroid mother, showed increased TSH levels during first week and 2nd week which declined to normal level on follow up at 3rd week. Out of 51 neonates with clinical features suggestive of thyroid dysfunction, born to euthyroid mothers, 3 neonates had increased levels of TSH on presentation which normalised on further follow up. Thus, majority of high risk neonates at birth show transient hypothyroidism.Conclusions: None of the neonate was labelled as hypothyroid, all the 10 neonates showed transient hyperthyrotropinemia.