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ABSTRACT Objective: To analyze the prevalence of off-label and unlicensed prescriptions for a population of neonates admitted to the Neonatal Intensive Care Unit in a hospital in southern Santa Catarina. Methods: Observational study with a cross-sectional design. All neonates admitted to the Intensive Care Unit during the period from March 2020 to March 2021 were included. Data collection was performed through a questionnaire made by the authors and the classification of drugs based on the Electronic Drug Description (Bulário Eletrônico) of the Brazilian Health Regulatory Agency and Drug Dex-Micromedex. Results: Data from 296 neonates were evaluated. The prevalence was 50,7% for prescribing off-label medications and 37,2% for unlicensed medications. The use of drugs was higher in preterm neonates, with low birth weight, 1st minute Apgar between 6-8, 5th minute Apgar between 7-8, and in need of invasive procedures. The most used off-label drugs were ampicillin, gentamicin and fentanyl (92.6, 92.0 and 26.6%, respectively), whereas the most used unlicensed drugs were caffeine, phenobarbital and bromopride (78.1, 16.3 and 10.9%, respectively). Conclusions: This study showed a large percentage of prescriptions made in the off-label (50.7%) and unlicensed (37.2%) form in the Neonatal Intensive Care Unit, corroborating the worrying world scenario. The most exposed neonates were precisely the most vulnerable ones and, among the most commonly prescribed medications, ampicillin and gentamicin stood out in off-label form and caffeine in unlicensed form.
RESUMO Objetivo: Analisar a prevalência de prescrições off-label e não licenciadas uma população de neonatos internados na Unidade de Terapia Intensiva Neonatal em um hospital ao sul de Santa Catarina. Métodos: Estudo observacional com delineamento transversal. Foram incluídos todos os neonatos admitidos na Unidade de Terapia Intensiva durante o período de março de 2020 a março de 2021. A coleta de dados foi realizada a partir de questionário elaborado pelos autores, e a classificação dos medicamentos, com base no Bulário Eletrônico da Agência Nacional de Vigilância Sanitária e no Drug Dex-Micromedex. Resultados: Foram avaliados dados de 296 neonatos. A prevalência foi de 50,7% para prescrição de medicações off-label e 37,2% para medicações não licenciadas. O uso dos fármacos foi maior em neonatos pré-termo, com baixo peso ao nascer, Apgar de 1o minuto entre 6-8, Apgar de 5o minuto entre 7-8, e com necessidade de procedimentos invasivos. Os fármacos off-label mais utilizados foram a ampicilina, gentamicina e fentanil (92,6, 92 e 26,6%, respectivamente), já os fármacos não licenciados mais utilizados foram a cafeína, fenobarbital e bromoprida (78,1, 16,3 e 10,9%, respectivamente). Conclusões: O estudo demonstrou grande porcentagem de prescrições realizadas de forma off-label (50,7%) e não licenciada (37,2%) na Unidade de Terapia Intensiva Neonatal de análise, corroborando o preocupante cenário mundial. Os neonatos mais expostos foram justamente aqueles mais vulneráveis e, entre as medicações mais utilizadas, destacam-se a ampicilina e a gentamicina de modo off-label e a cafeína de modo não licenciado.
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Objetivo: analisar o conhecimento produzido em relação à comunicação entre familiares e profissionais de saúde, na assistência aos recém-nascidos e lactentes internados em Unidades de Terapia Intensiva Neonatal e de Cuidados Intermediários Neonatais, na percepção de familiares. Método: revisão integrativa, realizada no período de janeiro de 2009 a fevereiro de 2021, em bases virtuais de dados. Foram selecionados sete artigos. Resultados: predominaram estudos qualitativos desenvolvidos por enfermeiros, com maior proporção no ano de 2010. Emergiram duas categorias temáticas: "Experiência com a internação dos filhos em Unidade de média e alta densidade tecnológica" e "Inconsistência na comunicação". Conclusão: a percepção familiar diante da comunicação sobre a saúde do filho internado recebe reações positivas e negativas. Para os pais, quando os profissionais transmitem adequadamente as notícias sobre seus filhos hospitalizados, isto conduz a sentimentos de esperança, gerando na família a perspectiva de sobrevida e recuperação dos seus filhos.
Objective: to analyze the knowledge produced regarding the communication between family members and health professionals in the care of newborns and infants admitted to Neonatal Intensive Care Units and Neonatal Intermediate Care Units, in the perception of family members. Methodology: integrative review, carried out from January 2009 to February 2021, in virtual databases. Seven articles were selected. Results: There was a predominance of qualitative studies developed by nurses, with a higher proportion in 2010. Two thematic categories emerged: "Experience with the hospitalization of children in medium and high technology units" and "Inconsistency in communication". Conclusion: The family perception regarding communication about the health of their hospitalized child suffers positive and negative reactions. For parents, when professionals adequately transmit the news about their hospitalized children, this leads to feelings of hope generating in the family the perspective of survival and recovery of their children.
Objetivo: analizar el conocimiento producido en relación a la comunicación entre familiares y profesionales de la salud, en la atención de recién nacidos y lactantes hospitalizados en Unidades de Cuidados Intensivos Neonatales y Cuidados Intermedios Neonatales, en la percepción de los familiares. Metodología: revisión integradora, realizada de enero de 2009 a febrero de 2021, en bases de datos virtuales. Se seleccionaron siete artículos. Resultados: Predominó los estudios cualitativos desarrollados por enfermeras, con mayor proporción en 2010. Surgieron dos categorías temáticas: "Experiencia con la hospitalización de niños en una unidad de densidad tecnológica media y alta" e "Inconsistencia en la comunicación". Conclusión: La percepción familiar sobre la comunicación sobre la salud de su hijo hospitalizado sufre reacciones positivas y negativas. Para los padres, cuando los profesionales transmiten adecuadamente las noticias sobre sus hijos hospitalizados, esto genera sentimientos de esperanza, generando en la familia la perspectiva de supervivencia y recuperación de sus hijos.
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OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case-control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes.
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Humans , Female , Pregnancy , Infant, Newborn , Premature Birth/epidemiology , Infections/epidemiology , Urinary Tract Infections/epidemiology , Brazil/epidemiology , Population Surveillance , Cross-Sectional Studies , Risk Factors , Chorioamnionitis/epidemiology , Vaginosis, Bacterial/epidemiologyABSTRACT
Objective To investigate the relationship between neonatal health and TCM constitution types of early to mid-pregnancy expectant parents;To provide basis for the targeted interventions for couples of childbearing age before pregnancy-periconceptional TCM constitution. Methods Compiling scales for pregnant couple’ TCM constitution type assessment and postpartum visits to newborns, the research team got access to the information of neonatal physical problems, constitutions and changes of 675 babies’ father and mother who had established maternal manual from April, 2012 to March, 2013 at the Sanlin Community Health Center of Pudong District of Shanghai. Results Early to mid-pregnancy expectant parents mainly had peace constitution type. In detail, 55% of pregnant women had gentle constitution type, while others mainly had qi deficiency, yang deficiency and damp-heat constitution types;76% expectant fathers got peace constitution, while others mainly got damp-heat, yin deficiency and qi deficiency constitution types. Marital pregnancy physique did not change significantly. Compared with the peace constitution type, newborns, whose fathers got damp-heat constitution type, had higher risk of jaundice, and whose mothers got yin deficiency, the babies had higher risk of spits (P<0.05). The constitution types of expectant parents did not have obvious combined action on neonatal health. Conclusion There is a certain relationship between neonatal health and TCM constitution types of early to mid-pregnancy expectant parents. It is necessary to distinguish constitution types of prospective parents, and thus to take targeted health interventions.
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India has made impressive gains in its child survival indices during the past half a century with infant mortality rates declining from 159.3 in 1960 to 44 in 2011 and neonatal mortality rate declining from 47 (1990) to 32 (2010). Neonatal health is now an integral part of the country’s flagship program – National Rural Health Mission. Facility based newborn care is not only available in large public and private sectors hospitals, but also in about 300 of India’s district hospitals. Complementing these efforts is home based newborn care being delivered by community health volunteers. The last two decades has also witnessed an increase in newborn research and its incorporation into medical and paramedical education as a major course component. Neonatology now is an independent superspecialty in India. The National Neonatology Forum has had a major role in spearheading reforms in neonatal care in India.
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A large proportion of four million neonatal deaths occur each year during the first 24 hours of life. Research is particularly needed to determine the efficacy of interventions during the first 24 hours. Large cadres of community-based workers are required in newborn-care research both to deliver these interventions in a standardized manner in the home and to measure the outcomes of the study. In a large-scale community-based efficacy trial of chlorhexidine for cleansing the cord in north-eastern rural Bangladesh, a two-tiered system of community-based workers was established to deliver a package of essential maternal and newborn-care interventions and one of three umbilical cord-care regimens. At any given time, the trial employed approximately 133 community health workers—each responsible for 4-5 village health workers and a population of approximately 4,000. Over the entire trial period, 29,760 neonates were enrolled, and 87% of them received the intervention (their assigned cord-care regimen) within 24 hours of birth. Approaches to recruitment, training, and supervision in the study are described. Key lessons included the importance of supportive processes for community-based workers, including a strong training and field supervisory system, community acceptance of the study, consideration of the setting, study objectives, and human resources available.
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This article reviews the importance of regional initiatives in the context of global efforts to achieve the Millennium Development Goal 4 and 5 and describes the action-oriented multi-country healthcare professional association (HCPA) workshops organized by the Partnership for Maternal, Newborn and Child Health. The South Asian HCPA workshop served as a catalyst for strengthening the ability of HCPAs in South Asian countries to organize and coordinate their activities effectively, play a larger role in national planning, and collaborate with other key stakeholders in maternal, newborn and child health.
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The validity of three methods (last menstrual period [LPM], Ballard and Dubowitz scores) for assessment of gestational age for premature infants in a low-resource setting was assessed, using antenatal ultrasound as the gold standard. It was hypothesized that LMP and other methods would perform similarly in determining postnatal gestational age. Concordance analysis was applied to data on 355 neonates of <33 weeks gestational age enrolled in a topical skin-therapy trial in a tertiary-care children’s hospital in Bangladesh. The concordance coefficient for LMP, Ballard, and Dubowitz was 0.878, 0.914, and 0.886 respectively. LMP and Ballard underestimated gestational age by one day (±11) and 2.9 days (±7.8) respectively while Dubowitz overestimated gestational age by 3.9 days (±7.1) compared to ultrasound finding. LMP in a low-resource setting was a more reliable measure of gestational age than previously thought for estimation of postnatal gestational age of preterm infants. Ballard and Dubowitz scores are slightly more reliable but require more technical skills to perform. Additional prospective trials are warranted to examine LMP against antenatal ultrasound for primary assessment of neonatal gestational age in other low-resource settings.